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Archive for August, 2015

The Special Meaning of April 17th

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Dave Eggers

April 17, 2015 marks the 17th Anniversary for Dave Eggers’ liver transplant at Nebraska Medicine.

It was in January of 1988, right in the middle of a rewarding Air Force flying career, when I was told that I had a serious bile duct disease in my liver. I would need a liver transplant to save my life. Being a person who enjoyed perfect health my entire life (up to then), I knew nothing about transplantation and what my family and I would be going through.

The Air Force wisely sent me to the Nebraska Medicine transplant team for a complete liver transplant evaluation. They took a great amount of time to help me understand that because of the tremendous shortage of donors, coupled with the slow progression of my disease, I would need to be a lot sicker to get placed on the liver transplant list. Obviously, this wasn’t very positive information for me or my family. In short, we were scared.

It turned out that the liver experts were right. I was placed on the transplant list nine years later, in June of 1997, and the difficult experience of waiting began.

Dave currently works at the Lied Transplant Center, helping patients and their families through their own transplant journeys.

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Dave currently works at the Lied Transplant Center, helping patients and families through their own transplant journeys.

In 1998, the month of April became very special for me and my family. In the early morning of April 17th, I was awakened in my hospital room at Nebraska Medicine to be told that the liver I had been praying and waiting ten years for had finally arrived! My family and I, while elated at the news, knew that the donor’s family was grieving the loss of their loved one. Even though my operation was difficult and lasted 12 hours, I recovered quickly and was home six days later! I was blessed with a tremendous donation from a man I never met.

My Air Force career was over, but as luck would have it, I ended up joining the Nebraska Medicine staff in March of 1999 when the Lied Transplant Center opened. For the past 16 years I have had the honor of helping many organ transplant patients and their families get through their own transplant journeys.

I am living proof that transplants work. Lots of life experiences have happened to me during the past 17 years. A total stranger gave me and others the “gift of life” on that early morning of April 17th. My family and I will be forever grateful to this person for what he and his family did for me. Please, get the facts about organ donation and then tell your family about your decision about being an organ, tissue, or eye donor.

A Rising Star in the Wild West – Neurology @ Nebraska Medicine

U.S. News and World Reports recently ranked Nebraska Medicine as one of the best hospitals in the country for its expertise in six adult specialties: cancer care, gastroenterology and GI surgery, nephrology, neurology and neurosurgery, pulmonology and urology. This is the best performance for the hospital in terms of national recognition in these rankings.

In a series of blog posts, the experts from each nationally-ranked department will highlight what makes Nebraska Medicine a leader in providing care to its patients.

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We’re delighted with the news – that US News & World Report has given our division a #31 ranking among the best hospitals in America. It means our neurology and neurosurgery division is in very good company.

Some people might be surprised. They don’t expect to find excellent neurological care here in Nebraska. They think of institutions on the east coast—the famous hospitals with long histories.

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Matthew Rizzo, MD Chief of Neurology and Neurosurgery

Well, it’s no surprise to those of us who chose Nebraska Medical Center for our medical practice. We recognize the top-notch individuals in this group. I like Nebraska and the Wild West mentality. The people here have a can-do attitude. We know that Nebraska Medicine is a rising star. The Department of Neurological Sciences and our partners in neurosciences make up an equally premier service on the rise—a very broad, comprehensive program involving mind, body and health.

Let me tell you about our neuroscience specialists – trained in neurology, neurosurgery, psychiatry, psychology, anesthesia and pain/palliative treatment. They treat the full range of neurological conditions—tumors of the brain or spine, epilepsy, Alzheimer’s or dementia, stroke, psychiatric disorders, multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), spinal disorders, traumatic brain injury, degenerated or herniated disks, pain syndromes, vascular malformations and aneurysms.

In collaboration with our pediatrics colleagues at the Monroe Meyer Institute, we also treat children with autism and attention deficit disorders. And, we treat both adults and children with neurological problems related to diabetes and cancer.

Many, many people are affected by neurologic conditions for decades. These chronic conditions can be very debilitating. That’s why Nebraska Medicine stays on top of the latest treatments—and why we conduct ongoing research to uncover the best treatments. We aspire to be the best neurological service in Omaha, in the Heartland and in the world.

These specialty clinics are crown jewels in our neurology division:

Movement disorders clinic

Midwesterners don’t brag much, but maybe we should. In Neurology, we’ve brought on board many top experts, including Diego Torres-Russotto, MD, a specialist in movement disorders. Dyskinesia, for example, is characterized by a slight tremor or involuntary muscle movements. This is a symptom for several medical conditions, and requires a specialist to determine the cause. Dr. Torres-Russotto is an expert at this type of complex diagnosis and outlining the best treatment.

He is also a specialist in diagnosing orthostatic tremor, a neurological condition that involves the legs and trunk. Very few doctors recognize the symptoms or know how to treat this condition. With Dr. Torres, you’re in very good hands.

If you’ve got a tremor that is affecting your everyday life, it’s important to see a specialist who can recognize the subtlest clues – and who can make a correct diagnosis. That’s the only way to assure you’ll get the best treatment.

For example, we’ve found that Botulinum toxin is a very successful treatment for severe intractable tremors and a variety of neurological conditions – blepharospasm, cervical dystonia, writer’s cramp, spasticity, hemi-facial spasm and cerebral palsy. Many of these conditions are otherwise incapacitating.

While people didn’t know what to think about Botox a few years ago, we’ve found it to be an excellent treatment with very minor side effects. Botox is just one treatment we can offer our patients—to give them relief from debilitating problems.

Epilepsy clinic

We also have great expertise in treating epilepsy—including the really complex, difficult cases that require surgery. Deepak Madhavan, MD, is our epilepsy specialist, and he gives hope every day to patients whose lives are paralyzed by this disorder. He knows the difficulties that epilepsy causes—and he presents patients with medical and surgical treatments that can bring real relief.

In just a few years, the science and treatment of epilepsy has advanced tremendously—and patients can actually live seizure-free. That’s right, your hope is now more than a dream. We now have sophisticated diagnostic tools such as magnetoencephalography (MEG) under the expert guidance of Dr. Tony Wilson, PhD., to localize epilepsy in the brain. That allows us to determine the best treatment.

In Dr. Madhavan’s very capable hands, you can get on with your life, your work, your education with the security knowing that your seizures are under control.

Memory disorders clinic

Certainly, Alzheimer’s is a memory disorder we see every single day. Researchers say that if we live long enough, most of us are likely to develop dementia and Alzheimer’s, Parkinson’s disease or a related condition.

Many people come to us when they’re concerned about a family member. They see signs of a faltering memory, and they’re not quite sure whether to be concerned or not. We invite them to come in, and we provide the appropriate evaluation tests.

We can rule out treatable conditions that look like Alzheimer’s but really aren’t. Even hearing loss can make someone seem as if his or her thinking is impaired.

There may be a thyroid or sleep problem, or depression, which also affect memory and decision-making. Older people are often taking one or three or five medications – all prescribed by a well-intentioned doctor — but when taken together, memory can be affected.

In fact, prescription medicine for sleep problems or heart disease may cause slower thinking—making it look as if something is wrong. It may just be a too-high dosage, or it may be the patient needs a different pill.

After they are diagnosed, our patients receive the medications that help control symptoms. They also can enter a rehabilitation program for stroke or traumatic brain injury. Very often, we link patients with community resources and support groups. Also, our patients can participate in clinical trials and have access to new drugs long before they are widely available.

Our psychology and neuropsychology experts, under David Cates, PhD, are top-notch in diagnosing disease—which helps us begin early treatment, then gauge disease activity and improvement over time. Our goal is to help people age successfully at home, with healthy minds and brains, as long as possible.

Telemedicine and telehealth

This corner of the world — Nebraska and our nearest neighbors in the northern Great Plains — is a wide-open space. Many patients live in remote areas interspersed with small pockets of urban development. It’s a burden for them to drive to our clinic; they have to spend a lot of windshield time just to get to the doctor’s waiting room.

That’s why we’ve started a telemedicine program for stroke, Parkinson’s disease and multiple sclerosis (MS) patients. With high-speed internet and excellent technology, these patients can work with their local doctors—with the aid of consultations from our experts here in Omaha.

In fact, we have some specialists driving to these remote clinics—or even making house calls. Our patients love this personalized service. The specialists really enjoy doing this; it feels like you’re doing the right thing for your patients.

Many of these people wouldn’t get the medical treatment they need if we didn’t offer these telemedicine services.

The future for neurology services

We’ve very excited about the strength of our Neurology program and all our Neurosciences services—and about the opportunities that lie ahead. We continue to bring in specialists from the top institutions as well as the best technology, and foresee strong opportunities to improve.

We want to serve Omaha—as well as our neighbors throughout Nebraska, Kansas, the Dakotas, western Iowa and northern Missouri. We want to reach out across the country and around the world to connect with patients. We can offer them the best-quality neurology care available, while conducting premier research—and while training the next generation of healthcare experts to carry on.

Thanks, US News & World Report, for the great ranking—which we plan on surpassing in short order.

World-Class Digestive and Liver Care – Close to Home

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U.S. News and World Reports recently ranked Nebraska Medicine as one of the best hospitals in the country for its expertise in six adult specialties: cancer care, gastroenterology and GI surgery, nephrology, neurology and neurosurgery, pulmonology and urology. This is the best performance for the hospital in terms of national recognition in these rankings.

In a series of blog posts, the experts from each nationally-ranked department will highlight what makes Nebraska Medicine a leader in providing care to its patients.

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Mark Mailliard, MD | Chief of Gastroenterology and GI Surgery
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Alan Langnas, MD |  Chief of Transplant Surgery
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Jon Thompson, MD |  Colon and Rectal Surgery

We’re ranked as the 29th best hospital in the country for Gastroenterology (GI) and GI Surgery, according to this year’s U.S. News & World Report’s Best Hospitals in America report.

That’s excellent news!

If you’ve been diagnosed with a digestive or liver disorder, it’s important to know you’re seeing the “best of the best” when you come to our clinic. Our specialists diagnose and treat all GI problems—including inflammatory bowel disease, pancreatic disease, cancer of the GI tract and motility disorders.

We have special expertise with the most complex disorders—intestinal failure, pancreatic disorders, chronic liver disease, cirrhosis complications, liver tumors and viral hepatitis, especially hepatitis C.

When we added specialized endoscopy to our liver service, we brought a level of care unique to this region. Endoscopy of liver bile ducts and liver transplant are mainstays in our referrals.

Our colleagues around the world tell us they would send family members to Omaha if they needed a liver transplant. We heartily agree!

A revolutionary new therapy

We have another gem in our practice—an innovative therapy drawing international attention. Perhaps you’ve heard about it in the news. It may sound “different”—but it’s been tremendously successful in helping very sick patients.

Fecal microbiota transplantation therapy is proving to be an excellent treatment for patients who are fighting a bad intestinal bug–Clostridium difficile, or C. diff. Alex Hewlett, DO, is leading the  team to provide this novel therapy.

Here’s how the problem develops—and how fecal therapy works:

When patients are prescribed antibiotics too often, the drugs can wipe out the beneficial bacteria in the gut. That leaves the intestine vulnerable to attack by C. diff bacteria, which invade the intestine. Patients get very sick, with bloody diarrhea and dehydration. The colon can be damaged; some patients have died.

In many cases, C. diff can be controlled with antibiotics, but at times that fails. Fecal therapy is the only treatment that has been shown to work for 88 percent of patients treated.

What exactly is fecal therapy? It involves taking a watered-down stool from a healthy person (often a relative) and transferring it into the patient’s digestive tract via a tube down the mouth or nose, or into the colon. This “new” healthy bacteria helps to repopulate the digestive tract to combat the C. diff overgrowth.

With fecal therapy, these very sick patients have a chance to get well. The results can be very dramatic—even life-saving. In medicine, we view it as another way for the body to naturally heal itself.

Our international reputation

These complex digestive and liver problems require a robust, comprehensive team with the best medical, nursing, diagnostic, surgical and therapeutic resources—which many hospitals simply don’t have.

For patients who need this level of diagnostics and treatment, we serve as a referral and second-opinion hospital. Physicians need a destination for their sickest patients—and that’s where we excel.

Nebraska Medicine is known nationally and internationally for our work. Patients come here from all over the U.S. –North Carolina, New York City, California—even as far away as the Middle East. We offer a language translation service for those patients, to help them feel comfortable in their interactions here.

Patients like coming to Omaha because of our world-class medical care—and because Omaha isn’t such a big city. They’ve heard it’s easy to get around. They’re right!

Caring for the sickest patients

Referring physicians need a clinic like ours to treat their sickest patients. We’re equipped to do that. But we know that medicine is far more than medical services and technology. We understand the stress our patients are feeling.

Every patient comes to us after receiving bad news from their local physician. They know it’s a potentially life-threatening medical problem. We do our best to allay their fears, address their concerns and provide reassurance and hope.

We want our patients to feel like we’ve wrapped a warm blanket around them. We want them to feel safe, warm and looked after during this very critical time in their lives.

We have a comprehensive team—a nurse coordinator, nurse practitioner, surgeon, physician, social workers, physical therapists, pharmacists – all focused on their care.

This team approach provides great continuity of care. From clinic to hospital to outpatient care to home—we make sure the patient’s care is seamlessly connected. We make sure each patient feels secure, and in expert hands, while facing critical health problems.

With world-class surgeons and physicians—and the best care possible—we give patients the best outcome possible. This is the mission we embrace every single day.

UNMC/Nebraska Medicine named national Ebola training, education center

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UNMC/Nebraska Medicine, in collaboration with Emory University in Atlanta and Bellevue Hospital Center in New York City, have been awarded a $12 million grant by the U.S. Department of Health and Human Services (HHS) to establish and co-lead the nation’s National Ebola Training and Education Center (NETEC).

The three institutions will partner with the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) to support the training of health care providers and facilities on strategies to manage Ebola and other emerging infectious diseases.

UNMC and its primary clinical partner, Nebraska Medicine, will receive $5.1 million of the $12 million federal grant – the largest share of the three collaborating institutions.

Regional Ebola treatment center 

UNMC/Nebraska Medicine is one of nine regional Ebola treatment centers recently named by HHS as part of a national network of 55 Ebola treatment centers with enhanced capabilities to treat patients with confirmed Ebola or other highly infectious diseases.

Ebola treatment centers are staffed, equipped and have been assessed to have current capabilities, training and resources to provide the complex treatment necessary to care for a person with Ebola while minimizing risk to health care workers.

“We are pleased to receive this designation as a national leader in the world’s fight against Ebola and other infectious diseases,” said Jeffrey P. Gold, M.D., UNMC chancellor and board chairman for UNMC’s clinical partner, Nebraska Medicine. “Our campus is in this position because we have selfless, talented individuals who prepared for a decade to care for the sickest of patients in our biocontainment unit. They did so valiantly over several months in 2014, and they also have shared their expertise to train countless others from around the world in preparation for the next highly infectious disease outbreak.

“I also want to thank our state’s congressional delegation for their support and work in helping us receive this significant designation.”

During the Ebola outbreak of 2014, UNMC/Nebraska Medicine was recognized as a national asset and referred to as the “gold standard” for treatment and development of safety protocols to handle Ebola and highly infectious diseases.

UNMC/Nebraska Medicine has the largest operational biocontainment unit in the nation.

UNMC/Nebraska Medicine and Emory University have worked with the CDC since December to train more than 460 health care workers from 87 health care systems, including 37 designated Ebola treatment centers, on all aspects of infection control and patient care for individuals with Ebola.

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Philip Smith, M.D., medical director of the Nebraska Biocontainment Unit at Nebraska Medicine and professor, UNMC College of Public Health, is principal investigator of the UNMC/Nebraska Medicine grant from HHS.

UNMC and Emory are offering additional training opportunities this summer for up to 400 staff from Ebola assessment hospitals.
The new National Ebola Training and Education Center will expand on the success of this initial work and offer state health departments and health care facilities additional access to the clinical expertise and training capabilities offered by these institutions.

“The national center contributes to our nation’s health security by developing and teaching evidence-based practices of experienced providers and health care institutions in caring for patients with Ebola and other serious infectious diseases,” said Nicole Lurie, M.D., assistant secretary for preparedness and response for HHS. “While this training starts with Ebola, it also will help the health care community deal with other serious infectious diseases in the future.”

CDC Director Tom Frieden, M.D., said the ongoing Ebola epidemic in West Africa is proof “that a threat anywhere can be a threat everywhere; the United States must continue to prepare.

“Hospitals are often the first place where a new disease threat is recognized. This new center will help our hospitals and health care workers prepare to handle new threats and safely care for patients.”

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