Archive for December, 2018

U.S. Air Force, Nebraska Medicine, UNMC Collaborate on C-STARS Omaha

U.S. Air Force, Nebraska Medicine, UNMC Collaborate on C-STARS Omaha December 17, 2018 In The Community The University of Nebraska Medical Center, Nebraska Medicine and the Air Force Research Laboratory are partnering to form the Center for Sustainment of Trauma Readiness Skills (C-STARS) Omaha. C-STARS Omaha focuses on advancing the readiness skills and competency of U.S. Air Force (USAF) medical personnel who provide safe and effective care for patients who have contracted or may have been exposed to highly hazardous infectious diseases, such as the Ebola virus.

Maj. Elizabeth Schnaubelt, MD, medical director of the C-STARS Omaha unit.

“Through this collaboration, we will train USAF health care professionals by leveraging UNMC expertise and best practices on infection prevention and control procedures for biocontainment care,” says Maj. Elizabeth Schnaubelt, MD, medical director of the C-STARS Omaha unit. The training program includes didactic lectures, simulation experiences and hands-on skills training modeled after the well-respected Nebraska Medicine Biocontainment Unit team. The program also will incorporate a train–the-trainer model so that USAF teams who have completed the C-STARS Omaha training can instruct other military medical professionals on biocontainment care when they are deployed to provide care outside of the United States. “The focus is on infectious diseases, those highly hazardous and contagious illnesses that troops might encounter,” says Dr. Schnaubelt. The 2014–2016 West Africa Ebola outbreak highlighted the need for such training when the Department of Defense deployed service members to support the U.S. government’s response to the Ebola crisis. Since then, the development of a C-STARS unit focusing on infectious diseases became a priority. The Omaha C-STARS unit is one of five; others are located in Cincinnati, Ohio; Baltimore, Maryland.; St. Louis, Missouri and Las Vegas, Nevada. Each unit has a different specialty focus. “This collaboration is based upon a strong underlying partnership with the U.S. Air Force and a recognition of the potential synergy in working together to develop and deliver training,” says Chris Kratochvil, MD, vice president of Research for Nebraska Medicine and associate vice chancellor for Clinical Research at UNMC. The USAF has assigned four members to the C-STARS Omaha team. The team includes an active duty infectious diseases physician, a clinical nurse, a public health technician and an administrator. “This is an incredible opportunity for the U.S. Air Force to partner with UNMC and Nebraska Medicine, world-renowned for their expertise in biocontainment care, innovative research and exceptional commitment to advancing quality health care and education. I feel very fortunate to be a part of this important project to enhance the preparedness of U.S. Air Force medical personnel,” says Dr. Schnaubelt.

Hip Replacement Relieves Patient’s Physical, Mental Anguish

Beau Konigsberg, MD, goes over Cathy Sickler’s most recent x-rays during her one-year check-up appointment after having her right hip replaced.

You know that short walk you take to get your mail, or the steps you take from one end of the grocery store to the other? We complain about it being too cold outside or the crowds of people we have to maneuver past, but Cathy Sickler isn’t complaining – not anymore.

“Every day when I get up and walk and feel myself walking normally again, in my heart, I am so thankful for this moment,” Sickler says while at her one-year post-operation checkup. “I don’t feel like I have very many limitations at all.”

It has been one year since Sickler’s quality of life began to improve when she had her right hip replaced. Leading up to her procedure, she had been experiencing hip discomfort for years, due to a labrum cyst, arthritis and ligament strain.

“The pain was so bad that I couldn’t get groceries, had a hard time going up and down my stairs to let my dogs out … I started getting depressed and thought it would never stop hurting,” she says. “I was a train wreck.”

When there were no other options but to have her hip replaced, she put her trust in the hands of orthopaedic surgeon Beau Konigsberg, MD, and the rest of her health care team at Nebraska Medicine.

Beau Konigsberg, MD, checks Cathy Sickler’s range of motion in her right leg, during her one-year checkup after having her hip replaced.

Leading up to the procedure, Sickler was anxious about everything from potential anesthesiology side effects to making sure her legs were both the same length after the hip replacement. She was comforted by the expertise and reassurance she received from her care team.

“I can’t stress enough about how much it was a total team here of people working together to make sure everything leading up to the procedure and after was a success,” she says. “They really seemed to tailor everything to a personalized plan.”

Sickler adds that the time spent by Dr. Konigsberg with her leading up to the procedure was invaluable, and helped give her confidence that everything would go as planned.

“Dr. Konigsberg took the time to figure out who I was and what I was about and it helped him understand how to best communicate with me,” she says. “He realized that I have to really be sold on the best option and told me like it was, and I really appreciated that transparency and honesty.”

A year removed from having her hip replaced, Sickler has regained her independence back and is back to being able to do more physical activity.

“Before, I couldn’t walk to the mailbox. Now, I could walk five miles if I had to. When I walk into the gym, I walk like a boss,” she says with a laugh. “I don’t have a big enough word to describe what this entire experience has meant to me. I’m just so grateful to Dr. Konigsberg and everyone at Nebraska Medicine who helped me.”

With Right Treatment, Most Epilepsy Patients Can Live Normal Lives


Treatment and management of epilepsy continues to evolve and improve. With the right diagnosis and treatment, most patients can live a normal life.

We have made great advancements in epilepsy treatment over the last 20 years with more medications, advanced diagnostic tests and more precise surgical techniques.

While the treatment of epilepsy has made great strides, awareness of this unpredictable disease has not kept pace. It is still not uncommon for people with epilepsy to be misdiagnosed with something else.

Having Uncontrollable Seizures?
Get evaluated by the experts. To make an appointment with one of our epilepsy specialists at the Nebraska Medical Center campus or our new clinic in Bellevue, call 800.922.0000. Visit us online to learn more at NebraskaMed.com/Neuroloigcal-care/Epilepsy.

Epilepsy is estimated to occur in as many as 20,000 individuals in Nebraska. Depending on what part of the brain the seizure is originating from, it can trigger different types of symptoms. These include symptoms ranging from involuntarily screaming, laughing inappropriately, falling to the ground in convulsions, to less noticeable symptoms such as falling into an unconscious stare or state of confusion and not remembering what happened during the incident.

Arun Swaminathan, MD, epilepsy specialist

As a result, the more subtle seizures are sometimes misdiagnosed as a small stroke, depression, anxiety or hallucinations. That’s why it’s very important to come to an experienced epilepsy center like ours to ensure you receive the correct diagnosis. The type and combination of drugs prescribed for each individual depends on the specific type of epilepsy and its point of origin in the brain.

Early diagnosis and treatment is also important to prevent the disease from progressing and causing long-term side effects. Untreated, recurrent seizures can cause progressive changes to the epileptic networks in the brain and worsen seizures over time.

The Nebraska Epilepsy Center, the only comprehensive epilepsy center of its type in the region, diagnoses and treats epilepsy patients from children to adults, using some of the most advanced diagnostic and treatment tools available.

One of these tools is the MEG scanner, which uses magnetic fields generated by the brain’s neuronal activity to detect seizure activity with greater detail and accuracy than previous testing tools. By allowing doctors to identify exactly where the brain is malfunctioning, the MEG improves doctors’ ability to diagnose and treat the disorder with the appropriate medications and provides greater surgical precision when removing the lesion becomes necessary.

Using the appropriate medications can make a significant difference in managing seizures. Sixty to 70 percent of patients can become seizure-free on the proper medications. The remaining 30 to 35 percent will need surgery combined with medications.

I specialize in brain surgery to treat epilepsy for these more complex cases. This includes less invasive laser procedures to destroy the parts of the brain that are triggering the seizures; open surgery to remove the seizure trigger points; as well as surgery that involves implanting a computer chip into the brain or neck to detect and prevent seizures.

The future continues to look promising for epilepsy. Treatments continue to improve and there are many new medications and therapies on the horizon.



About the Author

Arun Swaminathan, MD
Epilepsy specialist

New BrainPath® Technology for Treating Hemorrhagic Stroke Now Available at Nebraska Medicine – Nebraska Medical Center

Andrew Gard, MD

There are two common types of strokes, ischemic and hemorrhagic (bleeding) stroke. Ischemic stroke is the most common type of stroke, accounting for the majority of stroke cases. Although hemorrhagic strokes account for only 15 percent of all stroke cases, it is the deadliest form of stroke. The location of the bleeding is an important factor in determining the cause of the stroke, as well as the treatment.

Bleeding within the fluid-filled space surrounding the brain is called a subarachnoid hemorrhage. A common cause of subarachnoid bleeding is a ruptured brain aneurysm. Please see our previous post regarding brain aneurysms.

When you come to Nebraska Medicine, you can be sure you will receive the best care available from a highly skilled and dedicated stroke team, providing you or your loved one the best chance for a full recovery. Nebraska Medicine – Nebraska Medical Center is the only certified Comprehensive Stroke Center in the state.

Bleeding within the brain substance itself is called an intracerebral hemorrhage (ICH). ICH can be due to a blood vessel bursting within the brain tissue. The bleeding causes injury directly to the brain by destroying brain cells along its path, but also indirectly by forming a thick clot which causes pressure injury to the brain tissue surrounding the blood clot. As the body tries to dissolve the blood clot, there may also be swelling around the clot, as well as an irritating chemical reaction with the breakdown of the clot. Both of these processes lead to poor outcomes in patients with hemorrhagic stroke.

The location of the bleeding is an important factor in determining the cause of the stroke, as well as the treatment.

For large, symptomatic ICH, surgery may be indicated to improve survival and progression. For many years, surgery for hemorrhagic stroke was limited because these bleeds are often deep within the brain. Surgically accessing these deep hemorrhages previously involved large openings with possible injury to the overlying brain tissue.

Now at Nebraska Medicine – Nebraska Medical Center, we have newer technology that allows for a minimally invasive approach to evacuating deep symptomatic ICH. This minimally invasive approach utilizes small tubular retractors (BrainPath) to gently spread the brain fibers apart as well as improved visualization. These tools allow us to evacuate the clot and reduce brain injury from the clot itself. After treating the patient for ICH, we continue to identify and correct risk factors for future stroke, including high blood pressure, bleeding disorders or other structural abnormalities.

To schedule an appointment with a Nebraska Medicine stroke specialist, call 800.922.0000.


About the Author

Andrew Gard, MD