Archive for September, 2015

Best Hospital for Urology Care – Right Here

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.

It’s gratifying to see U.S. News & World Reports lists Nebraska Medicine among the best hospitals in the nation for urology. The report ranks us 25th among the 1,570 programs evaluated in our specialty.

Chad-LaGrange-Urology-300x199Chad LaGrange, MD

We’ve taken several steps to reach this high level of patient care. It’s critical for patients living in this region to have the best urological care close to home—so they don’t have to travel long distances.

Their lives are disrupted enough when they deal with urologic conditions, including cancer. We take pride in offering the best in minimally invasive urologic surgery—both standard laparoscopic and robot-assisted laparoscopic prostatectomy.

In the past year, we’ve expanded our service significantly. Several urologists have joined our team, which allows us to treat a wider array of urological problems. Our surgeons are now performing procedures we could not offer in the past—like robotic cystectomy for bladder cancer, urethral reconstructive surgery and penile prosthetics.

You may have noticed that I mentioned “robotics” a few times here. Our patients have various misconceptions about robotic surgery.

What exactly is robotic surgery?

I’m sure our patients know there’s no robot in the surgical suite. But they may not realize that the “robotic” part involves the tools the surgeon uses.

Robotic tools are built to function like a surgeon’s hands. They allow us to perform very delicate surgery with far more precision. The surgeon’s skill and experience is still very important, and that’s a critical factor in this type of surgery. It’s our hands doing the surgery, aided by these very precise instruments.

I can explain it more when I see you, but you should know that robotic surgery helps ensure a very positive result—with far less blood loss, pain and recuperation time.

Lots of robotics experience

Of course, we perform the typical robotic prostatectomy to remove cancer from the prostate. But not many centers offer the more complex procedures—like radical cystectomy, which involves removing all or part of the bladder.

The average urologist performs only one cystectomy (maybe none) in a year’s time. At Nebraska Medicine, we do five of these complex procedures every month–a very high-volume center for bladder cancer and cystectomy. Only the top urology centers in the country are doing that. We’re proud to provide that level of expertise.

“Patient-friendly” is still a priority

With all this technology, we still pride ourselves on being friendly.

When a patient first calls our department, a “real person” will answer the phone. We don’t want people to navigate their way through lengthy phone menus. Our patients have enough stress in their lives after getting their diagnosis. We want to help relieve that stress.

We also make every effort to get a patient in to see us right away. Our patients shouldn’t have to wait long for appointments and surgery.

Our department has the exceptional nursing. Our nurses are great, very dedicated. Patients quickly form strong relationships with our nursing staff, and rely on them for support during difficult times. Our nurses take a very personal approach to patient care; they always put the patient first.

Our multidisciplinary oncology clinic is another step in that direction. Our patients can have all their appointments in one visit—radiation oncologist, medical oncologist, urologist. This makes it much easier for patients; they don’t have to travel around to get their questions answered.

With this approach, we coordinate the patient’s care more easily. We get all their physicians in the same room, which greatly improves the communication. We doctors learn a lot from each other—and as a result, our patients get better care.

We’ve also opened up new clinical trials to provide vaccine therapy for metastatic kidney cancer. The drug is in a Phase 3 trial, and results thus far are very optimistic.

These are all advantages when you are treated in an academic environment like Nebraska Medicine. And it’s all right here, close to home.

My Transplant Team is Part of My Family

Harry Danner recounts his long journey to wellness and the team who helped him get there.

I retired from the US Air Force in 1982 where I was an Electronics Warfare Specialist. Upon retirement, at age 37, I started my own electrical business. In August of 1983 I suffered a massive heart attack that left me with a heart that was barely functioning with a 10% ejection fraction.

Harry-Danner-and-FamilyHarry with his mother and sister in 1986

Needless to say, this caused many financial hardships to the tune of hundreds of thousands of dollars. Much of this was covered by my veterans’ benefits but I was still left with a huge debt. Nothing but uncertainty was ahead for me and my wife, Judy. She was my rock through everything!

Doctors were able to keep me alive with my damaged heart for two and a half years. But in 1986 they were unable to do anything else as my heart had become too weakened to keep me going much longer. In April of that year, I learned about an experimental heart transplant program at the Veterans Affairs Medical Center in Richmond, Va. Our oldest daughter flew to Plattsmouth, Neb., where we lived at the time, to help take care of the home and our youngest daughter. I was placed on the transplant list and waited for three weeks before an organ became available.

This experience sent me and my wife on the biggest adventure of our lives together. On May 11, 1986 (Mother’s Day) a heart became available. During this waiting period my wife and I went through every imaginable scenario of consequences.

The transplant turned out to be a great success. Of course, due to the inexperience of medical personnel in the field of heart transplants, I went through many episodes of major and minor rejection. The normal hospital stay after the transplant was about 90 days at that time. After I had been there for 89 days I was released and we returned to Plattsmouth, Neb. Until 1998 I returned to Richmond, Va. on a regular basis for follow up care. This was the year that the transplanted heart began to fail. For the next five years I went through just about every procedure that can be done to a heart to keep it functioning. I had developed, in laymen’s terms, what is called small vessel disease. I ended up with approximately 10 stents in my heart along with having a bypass performed on my heart.

It was by pure luck that I met Dr. Ioana Dumitru in December, 2003, at the Veterans Affairs Medical Center in Omaha, Neb. Through a very frank discussion, she explained to me that my only viable option was another heart transplant. After all the pain and procedures that I had endured over the last five years, I had pretty much come to the same conclusion. I had a bi-ventricular defibrillator implanted and Dr. Dumitru, along with her transplant coordinators, made arrangements with the University of Utah Medical Center to be evaluated for another transplant. I was accepted into the heart transplant program and it was the beginning of another trek for Judy and me.

This time things took a little more time. Although the wait time was only two and a half months, it seemed like forever to us. We kept ourselves busy by volunteering at the transplant house where we were living. Since both of us are very skilled people we were able to accomplish quite a lot in our short stay.

Harry-Judy-DannerJudy and Harry Danner

On September 3, 2004 (Labor Day) we got the call that a heart had become available. This time, we were just too nervous to drive ourselves to the hospital. The owner of the transplant house offered to drive us. We gladly accepted.

Between the time we got the notification and the time we were told to come in, Judy and I notified our family back in Nebraska and Iowa. Through some sort of miracle all three of our daughters were able to get on a plane and make it to Salt Lake City, Utah before the surgery. I was able to spend about 15 minutes with my girls before having to be taken to the operating room.

Exactly six hours later the transplant surgeon notified my family that the transplant was completely successful. After this, I was transported to the Intensive Care Unit (ICU.) Although I still had all the tubes in my neck and arms, I was still able to be brought to a completely upright position the first day after the surgery. With the bed in an upright position I was able to walk in place. I felt amazing!

By the fourth day after my transplant, I was walking up and down two flights of stairs and being transferred to a regular post transplant room. I would spend the next three days in that room. I was discharged after only seven days in the hospital back to our temporary residence.

I was supposed to spend the next six months in Utah for follow-up. But since I had a transplant team eagerly awaiting my transfer back to Omaha, I was cleared to go home after just three months. Judy and I returned home in December of 2004 and began a long and successful relationship with Dr. Dumitru, Margie Chartrand and the rest of the transplant team at The Nebraska Medical Center.

After my massive heart attack in 1983, I’ve seen many dramatic changes in the heart transplant field. Through all the changes, I believe I have the best transplant care team in the business at The Nebraska Medical Center. They are more than just a team, they are a part of my family.

New Endovascular Device Improves Outcomes for Severe PAD Patients

Cardio-PictureA new minimally-invasive procedure to treat peripheral artery disease (PAD) now available at Nebraska Medicine is allowing doctors to treat severely-hardened or completely-blocked arteries with improved outcomes.

The only one of its kind in the area, the Avinger Ocelot system combines the use of a minimally-invasive catheter combined with visual guidance to wisk through blockages that typically might require bypass surgery.

“This has expanded the number of patients we can treat without the need to perform bypass surgery or amputation,” says David Vogel, MD, vascular surgeon at Nebraska Medicine, who has received specialized training to perform the procedure. “Many patients are not candidates for bypass surgery because they have too many other medical comorbidities. Amputation then becomes their only option.”

Getting treatment is critical as untreated PAD result in limb loss.

The Ocelot catheter acts like a corkscrew to cut through a blockage. A guide wire is then passed through the area followed by the insertion of a balloon, stent, or removal of the plaque through arthrectomy, restoring blood flow to the legs. The catheter also includes lighting which allows physicians to see real-time images from inside the artery using optical coherence tomography.

“Before this procedure, we could only get across and treat around 70 percent of complete blockages,” says Dr. Vogel. “Now with the Ocelot catheter we are able to get across over 90 percent of these complete blockages and treat them. Getting through heavily calcified plaque still remains one of our biggest challenges.”

Many patients can go home the same day and return to normal activities within a couple of days, notes Dr. Vogel.

PAD affects about 1 in 20 Americans over the age of 60 and the risk continues to rise as you get older, according to the National Institutes of Health. Primary risk factors include smoking, older age and having certain diseases or conditions. It is also most common among African-Americans. Smoking increases a person’s risk for PAD by fourfold. Smokers also typically develop symptoms 10 years earlier than the general population. Conditions that increase your risk for PAD include diabetes, high blood pressure, high blood cholesterol, coronary heart disease, stroke and metabolic syndrome.

Common symptoms include calf or buttock pain when walking. As the condition progresses, patients may also experience pain in the feet at night. If a patient has gangrene or non-healing lesions, treatment is more urgent as the longer a patient waits, the more difficult to achieve healing for these patients.

To determine if your patient is a candidate for this procedure, a treadmill test should be performed by someone experienced in performing these tests. “These tests are often inaccurate when performed in unexperienced hands,” says Dr. Vogel.

It is estimated that more than 200,000 amputations are performed each year as a result of PAD and other complications such as diabetes. “With this new endovascular device, we will be able to avoid amputations in many patients,” says Dr. Vogel.

Nebraska Medicine Surgeon Appointed to National Thyroid Guidelines Panel

William Lydiatt, MD, an otolaryngologist and head and neck surgeon, has been appointed vice chair of the National Comprehensive Cancer Network (NCCN) Thyroid Guidelines Panel.

William Lydiatt, MD

A member of the head and neck committee since the 1990s, Dr. Lydiatt is looking forward to serving in a leadership position. “This role provides an opportunity to make a real difference in the standards of care for treating thyroid cancers,” says Dr. Lydiatt. “The chair and vice chair have an important role in guiding the committee, using best evidence to enhance and improve care nationally.”

NCCN, a non-for-profit alliance of 25 of the world’s leading cancer centers devoted to patient care, research and education, is dedicated to improving the quality, effectiveness and efficiency of cancer care so that patients can live better lives. As one of the 13 original NCCN member institutions, Nebraska Medicine remains committed to the organization’s vision by serving as a leader in defining and advancing high-quality, high-value cancer care.

Through a joint partnership with Methodist Hospital, Dr. Lydiatt is part of a team of seven head and neck surgeons, one of the largest in the country. Collectively, the group treats more than 80 percent of all Nebraskans with head and neck cancer and more than 50 percent of all Iowans.

Dr. Lydiatt also serves as the vice chair of the American Joint Committee on Cancer (AJCC). Clinicians and the surveillance community count on the AJCC for the most comprehensive anatomic staging data available, the Cancer Staging manual and Cancer Staging Atlas.

Nebraska Medicine a National Pancreas Foundation Center

by Jenny Nowatzke, Nebraska Medicine

Nebraska Medicine has been nationally recognized as a National Pancreas Foundation Center (NPF) by the National Pancreas Foundation, a nonprofit organization that provides support, research and education for those suffering from pancreatitis and pancreatic cancer. Nebraska Medicine is the only hospital in Nebraska to receive this prominent designation, joining 29 other institutions across the United States.

“Our team is thrilled to be named the only NPF Center in the state of Nebraska,” said Nebraska Medicine pancreatic surgeon Luciano Vargas, M.D., an assistant professor in the UNMC Department of Surgery. “Our pancreas program provides multidisciplinary, patient-centered care for patients with different pancreatic disorders. The program has been made possible by a strong commitment and support from Alan Langnas, D.O., and the leadership at Nebraska Medicine.”

NPF Centers are awarded after a rigorous audit review to determine that an institution’s focus is on multidisciplinary treatment of pancreatitis, treating the “whole patient” with a focus on the best possible outcomes and an improved quality of life.

“We are very humbled and proud of this achievement,” said Rosanna Morris, interim CEO at Nebraska Medicine. “Having the NPF Center designation will help distinguish us as an institution whose focus is on providing the best and most innovative care possible for those suffering from pancreatitis.”

“Once an institution receives this designation, our foundation can recommend with confidence that patients will receive quality care at these designated centers,” said Matthew Alsante, executive director of the National Pancreas Foundation.

An approved NPF Center has to meet the criteria that were developed by a task force made up of invited subject matter experts and patient advocates. The criteria includes having the required expert physician specialties such as gastroenterologists, pancreas surgeons, and interventional radiologists, along with more patient-focused programs such as a pain management service, psychosocial support and more.

“It’s an honor for me to work with such a wonderful team of physicians,” said Sarah Ferguson, nurse coordinator for the Pancreas and Biliary Disorders Clinic at Nebraska Medicine. “Their dedication, expertise and compassion towards helping patients with pancreatitis is truly deserving of this national recognition.”

For a full listing of the criteria, click here.

Medical Advances Improve Pediatric Kidney Transplant Survival Rates

Medical advances over the last 15 years have greatly improved patient and graft survival among children with kidney transplants. This can be attributed to multiple factors including refinements in pre-transplantation preparation, enhanced surgical techniques, better choice of donors, more potent immunosuppressive medications, greater understanding of pediatric-specific pharmacokinetics and use of evidence-based medication protocols, says Teri Mauch, MD, pediatric nephrologist at Nebraska Medicine.


Teri Mauch, MD

“It has also become the treatment of choice for children with end-stage renal disease because it provides longer survival rates than dialysis and provides better quality of life because it gives the child full kidney function where dialysis only replaces about 10 percent of kidney function,” says Dr. Mauch.

Nebraska Medicine is known for its Kidney Transplant Program, performing the first kidney transplant in the state in 1970. Now more than 40 years old, the program has become widely recognized as one of the most active and innovative kidney and pancreas transplantation centers worldwide. The program is a leader in adult, pediatric, living-donor transplants and laparoscopic kidney procedures and consistently achieves graft and patient survival rates higher than national averages.

“We have a dedicated team of multi-disciplinary health care professionals who ensure appropriate care before, during and after the transplant,” says Dr. Mauch. “Pre-transplant evaluation and preparation are critical components to ensuring a transplant has the best outcome, followed by comprehensive follow-up care.”

In addition, the same team does the pre-transplant evaluation and surgery for both the pediatric and adult programs. “This provides excellent continuity of care as a patient transitions from the pediatric to the adult program,” adds Dr. Mauch.

The most common cause of pediatric end-stage renal disease (ESRD) in children who undergo transplantation is congenital malformations of the kidney and urinary tract (40 percent), followed by glomerular disorders (25 percent) and hereditary/genetic renal diseases (15 percent). Focal segmental glomerulosclerosis is a common cause of ESRD in African-American patients.

Other common causes include acute kidney injuries, hemolytic uremic syndrome, acute renal failure due to sepsis or shock, reflux nephropathy and diabetic nephropathy. “We are also finding that obesity can damage the organs in young children and may cause the pathologic lesion FSGS with proteinuria,” notes Dr. Mauch.

Indications that a child may need to be evaluated for a kidney transplant include poor growth, generalized swelling (edema), brown or red urine, persistent protein in the urine or high blood pressure.

Dr. Mauch says that all children ages three and older should have their blood pressures checked with every medical encounter. Children under age three with the following risk factors also should have their blood pressures checked: history in the neonatal intensive care unit, low birth weight, kidney problems, family history of blood pressure, heart or kidney disease.

Ambulatory blood pressure monitoring is becoming the preferred method to measure blood pressure, says Dr. Mauch. This involves wearing a cuff for 24 hours which provides a reading every 20 to 30 minutes. Nocturnal blood pressure is the most serious form and has the highest correlation to organ damage, says Dr. Mauch.

The average transplant lasts 12 to 15 years, says Dr. Mauch, after which a child can be retransplanted. However, if a child has lost a kidney due to rejection, circulating antibodies can make finding a suitable match for another transplant more difficult.

Graft survival is greater for children who use a living donor versus a deceased donor allograft, notes Dr. Mauch. For patients who must use a deceased donor, waiting time depends on blood type. The waiting list for a pediatric kidney transplant typically ranges from one week to a year.

Most patients can go home within one week following transplantation, says Dr. Mauch. After the transplant, labs will need to be checked twice weekly for the first month and less frequently thereafter, but never less frequently than once a month.

Nebraska Medicine is also a leader in multi-organ transplants and one of the few medical centers in the country that performs small bowel transplants.

“Some children need multiple organs,” says Dr. Mauch, “and our team is very experienced at caring for these children. We have a comprehensive program that uses a team approach to care. We all work together in a coordinated effort to ensure all of the patient’s needs are met.”