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Archive for June, 2016

Nebraska Medicine Offers Cure for Hepatitis C that is 95 Percent Effective

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Mark Mailliard

Mark Mailliard, MD, chief of Gastroenterology and Hepatology at Nebraska Medicine and director of the Hepatitis C Clinic, discusses exciting new treatments for Hepatitis C.

Is there an actual cure for hepatitis C? How effective is this drug cocktail?

Instead of “cure,” I like to use the word “eradicate.” With the drugs we have now, we can eradicate the hepatitis C virus without risk of recurrence or reactivation. You would have to be infected again to acquire the virus.

With hepatitis C, your body does not build immunity – unlike with other viruses. So our goal is to kill the virus in your system. That might be considered a cure, but because you can acquire the infection again, it’s a little different than mumps, for example. Once you’ve had mumps, you are immune – in essence, “cured.”

But, the good news is – with these new medications, we estimate that up to 95 percent of hepatitis C patients can get rid of the virus. Not everyone, because of certain factors. But just about everyone. That’s amazing news!

What drugs are part of this new treatment?

The new drugs are Sovaldi, Harvoni, Olysio, Viekira, Daklinza, Technivie. Sovaldi (sofosbuvir) is the big wonder drug – and it is quite an advancement. This drug has a unique mechanism that prevents the hepatitis C virus from replicating. That’s medical-speak for “stops the virus in its tracks.” If the virus can’t produce new strands of virus, it’s dead in the water. Production halted. The virus goes away. This drug is incredibly effective and amazingly safe. People have little to no side effects. It’s a walk in the park compared to previous hepatitis C drugs. My patients love it!

How it works is interesting, as this drug blocks a “gate” we haven’t used before, similar to a gate to your backyard. These gates are composed of molecules called nucleotides. This drug blocks a “gate” called the NS5B nucleotide – which prevents the virus from multiplying in the body.

This time, the drug developers nailed it. The patients who have taken this new drug — Sovaldi – can’t believe the difference. They are absolutely delighted! Further good news, this drug works for most people.

For patients with the genotype 1 strain of hepatitis C, we prescribe Harvoni (ledipasvir/sofosbuvir) which is a combination drug that includes Sovaldi, and is the preferred option with practically no side effects.

Another option – the Viekira Pak – is four medicines combined which patients take twice daily. Some patients will add a Ribavirin pill with this Pak, which adds up to 9 to 10 total pills per day.

That may sound like a lot of pills, but it’s still far fewer than in the past. And with virtually no side effects — this really is a critical improvement.

How long have these drugs been available?

Sovaldi became available in December 2013; Harvoni in November 2014; Daklinza in July 2015 (yes, very recently); the Viekira Pak since January 2015. As you can see, these are indeed very new medications. We’re intent on getting them to our patients ASAP.

Do I have to make several trips to Nebraska Medicine for treatment?

Actually, there are only two or three times when you need to come to the clinic.

If you’re just getting tested for hepatitis C infection, you will come for an initial blood test. Some patients have had this initial testing elsewhere and come to us for confirmation and treatment.

If there is evidence of infection, you’ll come in for a second test to confirm the diagnosis – and to determine the virus count in your blood. That tells us how aggressive your infection is. You will also get an ultrasound of your liver at that appointment.

After those initial two visits for testing, you’ll come back to talk about treatment. You’ll get your prescription at that third visit.

Once you’ve got your prescription, you’re on your own! There’s no need to return for check-ups, or anything like that. We’ll stay in touch with you via phone calls, to make sure everything is going smoothly. And, of course, you can always call us with questions. Our goal is to help you get rid of this virus, and to make your treatment as smooth as possible. Whatever we can do to help with that, we are happy to do.

Who should get tested for hepatitis C virus? Why is it necessary to get treated?

People born between 1945 and 1965 are encouraged to get tested since many don’t recognize they are at risk for the disease. A simple blood test can diagnose the disease.

Not only will treatment reduce the chance for liver failure and liver cancer, the diagnosis reminds patients of the danger of alcohol use and obesity, which increase the risk of getting cirrhosis and cancer.

New Solutions for Congestive Heart Failure

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As one of the largest heart failure centers in the U.S., Nebraska Medicine is participating in a nationwide clinical research trial of an investigational LVAD called HeartMate 3.

For patients with advanced congestive heart failure, the heart is weak and unable to keep adequate blood circulating in the body, resulting in symptoms such as fatigue, shortness of breath and weight gain.

If that describes you, or someone in your family, you know that medications can help. A heart transplant is another possibility. Also, a Left Ventricular Assist Device (LVAD) can assist the heart, either long-term, or until a heart is available for transplantation.

As one of the largest heart failure centers in the U.S., Nebraska Medicine, is participating in a nationwide clinical research trial of an investigational LVAD called HeartMate 3, IRB#344-15-FB.

Nebraska Medicine began enrolling patients in July 2015, and is still enrolling patients. Nationwide, 59 hospitals are participating in this trial – and will enroll 1,028 patients total, who will be followed for up to two years.

Details about the device

The first LVAD device was developed originally in the 1980s. The device circulates blood throughout the body when the heart is too weak to pump blood on its own. It is sometimes called a “heart pump” or “VAD.”

HeartMate II® is the second version of this device — a smaller version of the LVAD that is implanted in the chest, and has been a real breakthrough in medical technology. This device has rapidly become the most widely used device of its kind in the world.

The HeartMate 3 is the newest generation of LVAD – designed to work at slower speeds and hopefully prevent blood cell breakage. The MOMENTUM 3 trial is designed to evaluate the safety and effectiveness of the HeartMate 3 by determining whether the HeartMate 3 has similar outcomes to what we have seen with the HeartMate II. While the HeartMate 3 was designed in an attempt to negate some of the side effects that are seen with the HeartMate II, this is not the primary intent of the trial; however, it is something that will be evaluated.

The design of the Heartmate 3 pump will theoretically allow the pump to “wash itself out,” potentially reducing the risk of clot formation within the pump. Also, because the pump is designed to prevent blood cell breakage, it is theorized that the patient may have a lower risk of complications of blood cell breakage.

Nebraska Medicine is very excited about participating in the MOMENTUM 3 trial and expects that all patients will be enrolled nationwide by this summer.

Who participates in the trial?

Patients with severe congestive heart failure, who are either candidates for heart transplantation or need the device for long-term therapy, may be eligible for the research study.

In this research study, eligible patients will receive either a HeartMate 3 or HeartMate II pump. The research study team will monitor participants’ quality of life, heart function, device function, need for hospitalization or another surgery – as well as survival and other factors. Collecting outcomes data such as this will help assess the device’s safety and effectiveness.

Results of this research study are not expected to be released until enrollment is complete and all the data is collected and submitted to the U.S. Food and Drug Administration (FDA). Certainly, the HeartMate II has been a great success – so we are excited to see what the data from the MOMENTUM 3 trial will show.

Is it time to speak with a cardiologist about your heart disease risks? To make an appointment with one of our advanced heart failure specialists, please call 1-800-922-0000.

New service for sickle cell disease patients

by Vicky Cerino, UNMC public relations

Martin0531Jacinta Mwita and her son, Martin.

A patient’s story

Eleven-year-old Martin Mwita, of Omaha, has made more than 300 visits to health care facilities since he was a baby. Because of sickle cell disease, he’s suffered three strokes and countless other health episodes.

Jacinta Mwita, Martin’s mother, said the therapy improves the quality of the family’s life.

“The difference in his health since changing from transfusion to red blood exchange is incredible,” said Jacinta Mwita, a single mom who works full time. “The best they could get his sickled red cells down to before was to 50 percent. Now it’s 5 percent.

“The longer intervals in between treatment will be one of the biggest benefits of finding more life balance, so we don’t have to take much time away from everything else, especially school. It’s not just him, it’s everyone,” Jacinta said.

She is thankful to the blood donors who have improved not only Martin’s quality of life, but his family’s too. Though the family doesn’t know the identity of the donors who live in various states, the Red Cross contacts 20 who donate blood specifically to Martin because their blood matches Martin’s at a more complex level than just blood type.

“Isn’t that amazing? It’s incredible that someone we don’t even know would do this. I would love to meet them and say ‘thank you,'” she said. “I thank the staff and particularly those in the Lied Transplant Center. The nurses are incredible and the doctors care. Martin has practically grown up at the unit and they all know him by name.”

A therapy now available through Nebraska Medicine and UNMC will significantly reduce the risk of stroke for children with severe sickle cell disease.

The medical center recently began offering the state’s first pediatric chronic red cell blood exchange in conjunction with the American Red Cross.

Sickle cell disease can lead to many complications including stroke, chronic leg ulcers, frequent pain crises and blood clots. It can result in an increased susceptibility to infection. About 1 in 600 African-Americans has sickle cell disease.

Those who could benefit from the therapy are children and adults with a history of stroke or those whose imaging tests show a high risk of stroke. Newborns are screened for sickle cell disease and those found with the disease are screened yearly for potential strokes beginning at two years of age.

Physicians involved in the new service are Sara Shunkwiler, M.D., Scott Koepsell, M.D., Ph.D., and James Harper, M.D.

“Red cell exchange is not only an iron neutral procedure, it also can more quickly and more efficiently decrease the percentage of a patient’s red blood cells that are sickled,” said Dr. Shunkwiler, assistant professor, UNMC Department of Pathology and Microbiology and medical director of Blood Bank and Tissue Services at Nebraska Medicine. “This is the first time that chronic red cell exchanges for pediatric patients have been performed in this area.”

For sickle cell patients who have already had a stroke, frequent blood transfusions (chronic transfusion therapy) can decrease their risk of having a second stroke by as much as 90 percent. However, frequent transfusions can lead to a buildup of iron in the body which can lead to organ damage and eventually organ failure.

Shunk0531Sara Shunkwiler, M.D. 

Red blood cell exchange offers the risk lowering benefit of frequent blood transfusions without increasing the iron stored in the body. Patients are connected to an apheresis machine which removes sickled red cells and replaces them with normal red cells from donors.

Patients typically have red blood exchanges every three to four weeks that usually takes two to three hours.

This is in contrast to chronic transfusion therapy which is required as frequently as every other week, takes most of a day to complete and can cause scar tissue, making it difficult to get and maintain good vein access.

Dr. Shunkwiler collaborates with Dr. Harper to identify children who need the service. Dr. Harper is a UNMC associate professor and pediatric hematologist/oncologist at Nebraska Medicine and Children’s Hospital & Medical Center.

Three Heart Transplants in 34 Hours

When transplant surgeon John Um, MD, walked into Nebraska Medicine – Nebraska Medical Center the morning of April 11, little did he know, it was the start of two very long days. By the evening of April 12, Dr. Um had performed three heart transplants in 34 hours – a personal best for himself and the transplant team at Nebraska Medicine.

“The surgeries were pretty long. About six to eight hours each,” describes Dr. Um.
three heart transplant recipients in 34 hours and their doctor

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From left to right: Harvey Brandy, Lucas Kollars, Curt Spethman and Dr. John Um

It all started with 24-year-old Lucas Kollars of Arlington, Neb., who was found unresponsive at home by his mother. After receiving a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD), Kollars was on the heart transplant waiting list for 58 hours.

“Dr. Um said I had about two more days to live,” says Kollars.

Twelve hours after finishing Kollars’ heart transplant, Dr. Um started on the second one. The patient was 57-year-old Harvey Brandy of Omaha. Brandy’s heart problems began several years ago with a heart attack. After receiving a stent and pacemaker, Brandy’s name was placed on the transplant waiting list. It took three days to find a match.

“At the time, I was feeling really, really bad,” says Brandy. “My heart was only functioning at ten percent.”
heart transplant

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While Dr. Um finished Brandy’s procedure, 60-year-old Curt Spethman of Omaha was being prepped for surgery. Spethman’s heart issues were fairly recent, but progressing quickly. His name was only on the transplant waiting list for five days.

“I was amazed at how fast it happened,” says Spethman. “You’re scared, but then you go – ‘I’m getting a heart. A second chance.'”

At 10:40 a.m. on April 12, Dr. Um began Spethman’s transplant. Even though it was his third in two days, Dr. Um was prepared and ready to go. He couldn’t let Spethman miss out on his second chance at life.

“I have a couch in my office where I can put my feet up, get some sleep and grab a coffee,” explains Dr. Um. “We also have multiple teams that are able to come in. They’re refreshed as well. This allowed everyone to be working at the best possible level. It’s a testament to the med center to invest in those resources and have the personnel to do those things.”

On May 11, all three patients met each other for the first time. They also thanked Dr. Um for his incredible work.

“I feel great. I’m walking around – about a mile or more a day,” says Kollars. “I want to thank Dr. Um and Dr. Aleem Siddique. They saved my life about nine different times.” “If it weren’t for the team at Nebraska Medicine, I wouldn’t be here. . It’s amazing what they do,” adds Spethman. “I’m now walking down the sidewalk and planting flowers again. It’s incredible.”

“One day, I’m going to come back and buy them a box of donuts,” laughs Brandy. “To show my appreciation.”

To learn more about the three heart transplants in 34 hours, watch this video:

 

Nebraska Medicine Again Named To 100 Great Hospitals List

List features biggest names in American health care

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Becker’s Hospital Review has published the 2016 edition of “100 Great Hospitals in America,” a compilation of some of the most prominent, forward-thinking and focused healthcare facilities in the nation. For the third straight year, Becker’s named Nebraska Medicine to the prestigious list.

Hospitals included on the list are home to many medical and scientific breakthroughs, provide best-in-class patient care and are stalwarts of their communities, serving as research hubs or local anchors of wellness. A version of this list has been published each year since 2011.

“It is an incredible honor to once again be included on this list,” said Rosanna Morris, interim CEO at Nebraska Medicine. “Our health care professionals strive every day to provide serious medicine and extraordinary care to each of our patients. It’s gratifying to see that the work we’re doing here is being recognized and is paying off.”

To develop the list, Becker’s Hospital Review‘s editorial team conducted research and evaluated reputable hospital ranking sources, such as U.S. News & World Report, Truven Health Analytics, Healthgrades, the American Nurses Credentialing Center, The Leapfrog Group and several other resources. The final result is a group of 100 hospitals that are leaders in their region, their state and the nation in terms of high-quality patient care.

“This is a testament to the extraordinary patient care we provide at Nebraska Medicine,” said Brad Britigan, MD, interim president at Nebraska Medicine. “It’s also evidence that the cutting-edge treatment we provide is on par with what is being delivered at the most high-profile medical facilities in the country.”

The hospitals included in the 2016 edition of the list are:
•Abbott Northwestern Hospital, part of Allina Health (Minneapolis)
•Ann & Robert H. Lurie Children’s Hospital of Chicago
•Aspen (Colo.) Valley Hospital
•Aspirus Wausau (Wis.) Hospital
•Aurora St. Luke’s Medical Center (Milwaukee)
•Banner – University Medical Center Phoenix
•Baptist Health Lexington (Ky.)
•Barnes-Jewish Hospital (St. Louis)
•Baylor St. Luke’s Medical Center (Houston)
•Beaumont Hospital – Royal Oak (Mich.) Campus
•Billings (Mont.) Clinic
•Bon Secours St. Francis Hospital (Charleston, S.C.)
•Boston Children’s Hospital
•Brigham and Women’s Hospital (Boston)
•Carolinas Medical Center (Charlotte, N.C.)
•Cedars-Sinai Medical Center (Los Angeles)
•CHI St. Vincent Infirmary (Little Rock, Ark.)
•Children’s Hospital Los Angeles
•Children’s Hospital of Philadelphia
•Children’s Hospital of Pittsburgh of UPMC
•Children’s National Medical Center (Washington, D.C.)
•The Christ Hospital (Cincinnati)
•Christiana Hospital (Newark, Del.)
•Cincinnati Children’s Hospital Medical Center
•Cleveland Clinic
•Dana-Farber Cancer Institute (Boston)
•Dartmouth-Hitchcock Medical Center (Lebanon, N.H.)
•Duke University Hospital (Durham, N.C.)
•Emory University Hospital (Atlanta)
•Florida Hospital Orlando
•Froedtert & the Medical College of Wisconsin Froedtert Hospital (Milwaukee)
•Geisinger Medical Center (Danville, Pa.)
•Good Samaritan Hospital (Cincinnati)
•Hackensack (N.J.) University Medical Center
•Hoag Memorial Hospital Presbyterian (Newport Beach, Calif.)
•Hospital for Special Surgery (New York City)
•Hospitals of the University of Pennsylvania-Penn Presbyterian (Philadelphia)
•Houston Methodist Hospital
•Indiana University Health University Hospital (Indianapolis)
•Inova Fairfax Hospital (Falls Church, Va.)
•Intermountain Medical Center (Murray, Utah)
•John Muir Medical Center, Walnut Creek (Calif.)
•Johns Hopkins Hospital (Baltimore)
•Lehigh Valley Hospital–Cedar Crest (Allentown, Pa.)
•Loyola University Medical Center (Maywood, Ill.)
•Massachusetts General Hospital (Boston)
•Mayo Clinic (Rochester, Minn.)
•Medical University of South Carolina (Charleston)
•Memorial Sloan Kettering Cancer Center (New York City)
•Mount Sinai Hospital (New York City)
•National Institutes of Health Clinical Center (Bethesda, Md.)
•Nebraska Medicine – Nebraska Medical Center (Omaha, Neb.)
•NewYork-Presbyterian Hospital (New York City)
•NorthShore University HealthSystem Evanston Hospital (Ill.)
•Northwestern Memorial Hospital (Chicago)
•NYU Langone Medical Center (New York City)
•Ochsner Medical Center (New Orleans)
•The Ohio State University Wexner Medical Center (Columbus)
•Oregon Health and Science University Hospital (Portland)
•Porter Adventist Hospital (Denver)
•Poudre Valley Hospital (Fort Collins, Colo.)
•Rush University Medical Center (Chicago)
•Ronald Reagan UCLA Medical Center (Los Angeles)
•Sanford USD Medical Center (Sioux Falls, S.D.)
•Scripps Memorial Hospital La Jolla (Calif.)
•Sentara Norfolk (Va.) General Hospital
•Spectrum Health Medical Center–Butterworth Hospital (Grand Rapids, Mich.)
•Stanford (Calif.) Health Care-Stanford Hospital
•St. Cloud (Minn.) Hospital
•St. Joseph’s Hospital and Medical Center (Phoenix, Ariz.)
•St. Jude Children’s Research Hospital (Memphis, Tenn.)
•St. Luke’s Boise (Idaho) Medical Center
•Tampa (Fla.) General Hospital
•Texas Children’s Hospital (Houston)
•Thomas Jefferson University Hospitals (Philadelphia)
•UAB Hospital (Birmingham, Ala)
•UC San Diego Medical Center
•UCSF Medical Center (San Francisco)
•UF Health Shands (Gainesville, Fla.)
•University Hospitals Case Medical Center (Cleveland)
•University of California Davis Medical Center (Sacramento)
•University of Chicago Medicine
•University of Colorado Hospital (Aurora)
•University of Iowa Hospitals and Clinics (Iowa City)
•University of Kansas Hospital (Kansas City)
•University of Maryland Medical Center (Baltimore)
•University of Michigan University Hospital (Ann Arbor)
•University of Minnesota Medical Center (Minneapolis)
•University of North Carolina Medical Center (Chapel Hill)
•University of Tennessee Medical Center (Knoxville)
•University of Texas MD Anderson Cancer Center (Houston)
•University of Utah Hospitals and Clinics (Salt Lake City)
•University of Washington Medical Center (Seattle)
•UPMC Presbyterian (Pittsburgh)
•UR Medicine Strong Memorial Hospital (Rochester, N.Y.)
•UW Health–University Hospital (Madison)
•Vanderbilt University Medical Center (Nashville, Tenn.)
•Virginia Commonwealth University Medical Center (Richmond, Va.)
•Wake Forest Baptist Medical Center (Winston-Salem, N.C.)
•Yale-New Haven (Conn.) Hospital

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