Archive for July, 2018

Enhancing Sexual Health After Cancer

Christopher Deibert, MD, urological surgeon

Receiving a cancer diagnosis can be difficult for anyone to endure. But even after treatment is over, some people may still have to deal with the lingering health effects that cancer treatments may cause.

Cancer can dramatically change a person’s life. It can affect your self-image. It can physically change your body’s appearance. It can suppress your sexual desire, and for men, it can reduce testosterone production. All of these can lead to erectile dysfunction (ED).

Cancers in the pelvic area such as the prostate, bladder, rectum or colon, typically have the greatest impact on a man’s sexual health. That’s because surgery or radiation therapy for these cancers are more likely to affect the nerves and blood vessels that are responsible for an erection. Some chemotherapies can also cause some degree of ED. These issues can be short or long term. If nerves are damaged during surgery, sometimes they may heal with time and your ED issue will be resolved.

The good news is in many cases, we can improve the situation with one of several treatments.

When I evaluate a man for ED after they’ve completed cancer treatment, I like to discuss the types of changes they are experiencing and try to quantify these. The type of cancer treatment you received, as well as any history of diabetes or high blood pressure are also discussed. This includes physical changes, sexual desire and erectile issues. I may recommend testosterone testing to determine if it’s a hormonal problem.

At the Nebraska Medicine Men’s Health Program, we can offer many options to help you. Sometimes putting men on testosterone replacement therapy is all that is needed. However, if ED is not due to decreased testosterone production, there are other possible treatments. Oral medications that fall into a class of drugs called phosphodiesterase inhibitors (Viagra and Cialis), can relax muscles and increase blood flow to the penis, making it easier to get an erection and maintain it. Another procedure involves a vacuum erectile device that slides over the penis. The device pulls air out of the cylinder, which helps pull blood into the penis. A suppository can be placed inside the penis to stimulate an erection or medication can be injected with a tiny needle into the penis. If none of these medical options are effective or they have stopped working, surgery may be an option. Surgery involves the placement of a prosthetic implant inside the penis that includes an activation pump that will produce an erection when activated.

As part of the treatment and recovery process, men need to recognize that they may experience significant sexual changes and these need to be discussed with their doctors. I also encourage men to have frank, sexual-intimacy conversations with their partners. They should discuss how their body image has changed, what their desires and expectations are and how they feel mentally and physically. Sometimes intimacy in the relationship may change but it can still be meaningful even if it doesn’t look the same. When this is discussed with their partners, and both understand these issues, many couples can continue to have a deep and rich intimate relationship.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

About the Author

Christopher Deibert, MD, urological surgeon
Urological surgeon, co-director, Men’s Health Program

Pancreas Disease Program Expands beyond Omaha Metro

Luciano Vargas, MD

The Pancreas Disease Program continues to grow and is now expanding outside of the greater Omaha metro. Patients in Hastings, Nebraska, and the surrounding area, can receive expert and specialized care for complex hepatobiliary diseases at the Nebraska Medicine Liver and Pancreas Diseases Clinic at Mary Lanning Healthcare.

Surgical director, Luciano Vargas, MD, and Shaheed Merani, MD, are spearheading the clinic, which specializes in the clinical evaluation and surgical management of liver, pancreatic and biliary disorders. The goal of the clinic is to limit undesired travel for patients and to offer diagnostic, evaluative and follow-up appointments close to home.

“Aside from being in much closer proximity to patients living in the Hastings area, our outreach clinic allows patients to meet their physicians prior to coming to Omaha in the event that their treatment plan requires a surgical procedure that cannot be performed at Mary Lanning,” says Dr. Vargas. “This helps decrease anxiety when patients do need to travel to Omaha for follow-up care.”

Shaheed Merani, MD

Drs. Vargas and Merani are the only specialty-trained liver and pancreas surgeons in the tri-city region (Hastings, Grand Island and Kearney). Physicians with patients in the area who need liver, biliary and pancreatic surgical evaluation or for those who have patients seeking a second opinion can refer their patients to the clinic.

The Liver and Pancreas Diseases Clinic is an expansion of the Pancreas Disease Program, the only program in the region that is recognized and designated as a National Pancreas Foundation Center. Drs. Vargas and Merani are currently at the outreach clinic on the second and fourth Thursdays of the month.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Epilepsy Program Expands to Meet Growing Patient Needs

Deepak Madhavan, MD, epilepsy specialist

The Nebraska Medicine Epilepsy Program is expanding. The program will be adding three new neurologists who are fellowship-trained in epilepsy care in July, and will soon be opening a new clinic in the Bellevue community.

It is estimated that more than 20,000 people in Nebraska have epilepsy and approximately 6,000 of these people have intractable epilepsy, which means they need specialized care beyond medications to control their seizures.

We don’t have enough epilepsy specialists in the state to handle the volume of patients in Nebraska and the surrounding area. This expansion will allow us to see more patients in a more timely fashion.

Timelier Appointments Now Available
The recent expansion of our staff is allowing us to make timelier appointments for you. To schedule an appointment with one of our epilepsy specialists, please call us at 800.922.0000.

The Nebraska Medicine Epilepsy Program is the largest and most comprehensive epilepsy program in the state and region, and follows more than 3,000 patients. Nebraska Medical Center was designated as a Level 4 Epilepsy Center by the National Association of Epilepsy Centers, providing the highest level of care to patients with seizures and epilepsy. Level 4 centers use a multidisciplinary approach and offer intense neurodiagnostic monitoring and treatment methods including medications and surgical options.

Patients who come here have access to specialty medications, social work, nurse case management, neuropsychology, neurosurgery, registered dietitian-provided diet options and community resources.

We have always been at the forefront of offering the newest and most advanced technology as well as clinical trials with the goal of helping our patients become seizure-free and improve their quality of life.

Approximately 55 percent of patients can become seizure-free with the proper medications.  Approximately 35 percent will need surgery combined with medications, and the remaining 10 percent will see significant improvement but may still experience some seizures. In addition to expanding its staff, the program will also be adding additional services and technology to help the most difficult-to-treat cases.

The epilepsy monitoring unit at Nebraska Medical Center, which uses EEG monitoring to diagnose epilepsy patients, will be expanding the number of available beds from six to eight and will be offering more high-level diagnostic procedures.

The epilepsy program currently offers an implantable responsive neurostimulator for people with intractable epilepsy that works similar to a heart pacemaker. The stimulator monitors brain waves at the focal point of where the seizure begins. When it senses unusual electrical activity that can lead to a seizure, it emits small pulses of stimulation that help interrupt the activity before it becomes a seizure.

Responsive neurostimulation has been shown to reduce the incidence of seizures by 50 percent in the first year and by as much as 75 percent in the fourth and fifth years.

The technologies and treatment methods we offer provide much promise for people with the most severe cases of epilepsy. Our goal is to achieve freedom of seizures for everyone.

About the Author

Deepak Madhavan, MD, epileptologist
Epileptologist, medical director of the Epilepsy Program

The Global Game-changer Ready for Next Chapter

Nizar Mamdani, executive director, International Healthcare Services, has truly seen the world. Born in Tanzania, Africa, educated in Tokyo, Japan, and fluent in seven languages, Mamdani has spent nearly the past two decades building the medical center’s international presence.

Nizar Mamdani, executive director, International Healthcare Services

It started in 1999 when Mamdani’s wife, Nancy, was battling non-Hodgkin lymphoma when they were living in Atlanta, Georgia.

Her cancer was advanced. She received two rounds of chemotherapy at Emory University Hospital in Atlanta, but the cancer had returned. Her only hope was a peripheral stem cell transplant.

A successful international businessman, Mamdani checked out three of the leading cancer centers in the country – Johns Hopkins, MD Anderson and Memorial Sloan Kettering – to find the best place for his wife.

A physician at Memorial Sloan Kettering said there was only one physician who could possibly help her. His name was James Armitage, MD, and he was located at UNMC and Nebraska Medicine.

The Mamdanis came to Omaha, Nebraska, but unfortunately, Nancy’s cancer was too far along to allow for a transplant. She was in and out of the hospital over a 16-month period before passing away.

Despite the sad ending, Mamdani was impressed. He knew the medical center had a world-class cancer program. The world just didn’t know it.

Using his international connections, Mamdani offered to spread the word around the globe. He was named executive director for International Healthcare Services for Nebraska Medicine and made a five-year commitment to get the job done.

Traveling tirelessly, he established partnerships with 133 institutions in 45 countries. He brought in hundreds of patients from 57 countries for treatment. He generated tens of millions of dollars of business for the medical center.

“It’s very competitive internationally,” Mamdani says. “It’s all about relationships.”

The five-year commitment came and went. He loved the job. He wanted to keep going. He also found an amazing woman, Marsha Davidson, PhD, and they tied the knot 13 years ago.

With his 73rd birthday approaching in two months, Mamdani has decided it’s time for the next chapter. He will retire at the end of this week.

“I have been blessed to work with the most fantastic and caring physicians, nurses, health care professionals, colleagues and in particular, my dedicated and compassionate co-workers, Mohammed Al Kadhim and Ana Chavez,” says Mamdani. “They went out of their way to help me and our international patients. You develop such a bond – they become a part of your family. Many of these patients have become my lifelong friends. I will truly miss them and working at this great institution.”

“He’s done an amazing job,” says Dr. Armitage. “He’s done things that others couldn’t do. He placed articles on UNMC in international publications. He brought in a large number of foreign referrals that pay at a higher rate than most U.S. patients. But, more than that, he’s an exceptionally good person. He’s been a great friend.”

One Busy Man

Active on numerous charitable organizations, Mamdani is CEO of First Sight, a nonprofit that provides visual screening and prescription eyeglasses at no cost to needy individuals around the world. In the past few years, First Sight distributed 80,000 eyeglasses. Since 2005, Mamdani also has served as president of eTransMed, a medical documentation company. Among his numerous accomplishments at Nebraska Medicine and UNMC, Mamdani has:

  • Travelled to 57 countries to market Nebraska Medicine and UNMC internationally
  • Put Nebraska Medicine and UNMC’s name on the world map as an exceptional international patient referral center
  • Provided no-cost training and observational/educational programs for more than 100 health care specialists from 26 countries
  • Facilitated a lucrative paid training program for health care professionals from partner institutions
  • Provided personalized patient care services to international patients visiting Nebraska Medical Center
  • Hosted hundreds of professionals, dignitaries, diplomats and country leaders
  • Arranged and accompanied more than 20 visits for medical center health care teams to participate in conferences in nine countries
  • Participated in more than two dozen international conferences and exhibitions showcasing Nebraska Medicine and UNMC
  • Established an electronic second opinion program