Archive for February, 2019

U.S. Rep. Don Bacon Stops by for a Tour

From left, Michael Wadman, MD, chair of the UNMC Department of Emergency Medicine; U.S. Rep. Don Bacon; Jim Linder, MD, CEO of Nebraska Medicine; Wesley Zeger, DO, vice chair of Clinical Operations, Emergency Medicine; Robert Muelleman, MD, professor, Emergency Medicine; Suzanne Watson, nurse manager, and Bill Koile, director, Emergency Department Services.

How do you explain the work being done at the Fred & Pamela Buffett Cancer Center to a retired Air Force Brigadier General? Charles Enke, MD, chair of the UNMC Department of Radiation Oncology, explained it to Rep. Don Bacon this way: “From the military standpoint, this is the war on cancer.” Bacon spent time Dec.17 learning about cancer rates, screenings and treatment as Dr. Enke took him room to room in Radiation Oncology, showing him the latest cancer-fighting technology and explaining how the facility’s design caters to patient privacy and preferences. Bacon studied images of tumors from test cases and asked a lot of questions. “Hardest time of their lives,” he said of the patients who come to the Buffett Center. “And you’re healing them.” The congressman then toured the Emergency Department, listening as Michael Wadman, MD, chair of UNMC Department of Emergency Medicine, explained some of the challenges the ED staff faces, including patients with behavioral health issues or those who come in under the influence of meth or other drugs. The ED is on pace to see 65,000 patients this year, a number Bacon described as amazing. “Hopefully none of us have to go to the Buffett Cancer Center or the Emergency Room,” Bacon said at the end of his tour. “But if you do, you’re going to get first class, great care right here.”

Charles Enke, MD, shows Rep. Don Bacon our CT simulator in Radiation Oncology at the Fred & Pamela Buffett Cancer Center.

Cardiac Sonographer Treats Unique Patient

It was a day just like any other, and Walker Thomas, cardiac sonographer, UNMC Department of Anesthesiology, was about to perform an echocardiogram on a patient. Thomas packed up the Phillips CX50 portable ultrasound machine and drove to Omaha’s Henry Doorly Zoo and Aquarium. His next patient? A 24-year-old, 390-pound gorilla named Sampson. “Gorilla hearts look very similar to human hearts,” says Thomas. “They can develop heart disease just like humans. Once you know what you’re looking for, you can do a basic echocardiogram like you can on a human.” UNMC has supplied supplemental health care expertise since 2007 to certain zoo and aquarium animals in need of specialized care. Nearly all animal medical care at the zoo is provided by on-site veterinarians, but some preventative health care requires specialized equipment and expertise, such as the portable ultrasound machine Thomas uses. Heart images of the gorillas are submitted to the Great Ape Heart Project, which monitors the heart health of captive great apes around the nation. Great apes include gorillas, orangutans, chimpanzees and bonobos. Cardiac disease is the leading cause of morbidity and mortality in male gorillas housed in zoos and occurs in the wild with an unknown prevalence. Five of the six adult male gorillas currently housed at the zoo are being treated for cardiac abnormalities.

Walker Thomas performs an echocardiogram on one of the gorillas at Omaha’s Henry Doorly Zoo and Aquarium. UNMC has supplied supplemental health care expertise since 2007 to certain zoo and aquarium animals in need of specialized care.

“Anytime we put an animal under general anesthesia we do as many diagnostics as possible while we have hands-on access to avoid having to immobilize again in the near future,” says Julie Napier, senior veterinarian at the zoo and aquarium. This can include, but is not limited to, a physical exam including auscultation of the heart and lungs, and checks of the eyes, ears, teeth, skin, nails, haircoat, and temperature, an ultrasound to evaluate abdominal organs, obtaining urine by cystocentesis, a TB test, and phlebotomy for complete blood count and chemistry. These procedures also provide opportunity to gather data for research projects as requested. “Fortunately, due to excellent training by the supervisor of the gorillas and her staff, we immobilize our gorillas much less frequently, and when we do immobilize, we use a protocol that was developed by a veterinary anesthesiologist,” says Napier. “There are always risks with anesthesia, but the protocol we use is extremely safe. We’ve been immobilizing our gorillas for echocardiograms since 2007 and have not had a complication to date.” Not all heart images are captured under anesthesia. Most of the great apes are trained to stand and press their chest against an enclosure with their arms outstretched so that a sonographer can apply a probe to their chest for scanning. This reduces the instances in which an ape has to undergo anesthesia. Napier says each great ape gets an echocardiogram about every 18 months, but only goes under anesthesia once every three to five years depending on their health. Echocardiograms performed under anesthesia provide an opportunity for a better look at the heart because the sonographer can maneuver around their thick chest pad. Completed scans are read by cardiologists at the Great Ape Heart Project as well as Thomas Porter, MD, director of the echocardiography laboratory. “It’s an honor to have a part in maintaining the health of these animals,” says Thomas. “These two major institutions in our community are collaborating to make a better world for these great apes.”

Physicians Enjoy Big Ten Spotlight

Nebraska Medicine and UNMC physicians recently received nationwide publicity, after being featured in the Big Ten Cancer Research Consortium December newsletter. Pavankumar Tandra, MBBS, medical oncologist, was profiled in the newsletter’s Investigator Spotlight. Matthew Lunning, DO, hematologist/medical oncologist, and David Anderson, PhD, post-doctoral research associate in UNMC’s Mind & Brain Health Labs, shared an article regarding our chimeric antigen receptor (CAR) T-cell therapy, encouraging physicians to be mindful about the toxicities patients can experience. Drs. Lunning and Anderson discuss the work underway at Nebraska Medicine to explore ways to develop biological predictors of CAR T-related toxicities.

New Surgical Procedure Improves Outcomes for Most Advanced Atrial Fibrillation Cases

The convergent procedure combines cardiac surgery with radiofrequency ablation to terminate abnormal electrical pathways within the heart

Atrial fibrillation, an abnormal heart rhythm characterized by rapid and irregular beating, often starts gradually. At first, you may notice an occasional, brief feeling of a skipped or fluttering heartbeat. As it progresses, it may be accompanied by stronger heart palpitations, fainting, dizziness or shortness of breath. Many cases of arrhythmia are treatable with medications or ablation. Ablation uses radiofrequency energy to destroy the pathways to the heart that are causing the arrhythmia. However, in about 25 to 30 percent of cases, the atrial fibrillation does not respond to either medications or conventional ablation techniques. Are You a Candidate? Make an Appointment! Find out if you are a candidate for this innovative procedure. Call us to schedule an appointment with one of our cardiologists at 800.922.0000. Nebraska Medicine is the only hospital in the state to offer a new minimally invasive technique for patients with resistant atrial fibrillation called convergent. An alternative to open heart surgery, the procedure is providing up to an 85 percent success rate. Atrial fibrillation is one of the most difficult types of arrhythmia to diagnose and treat because the arrhythmia usually occurs from multiple sources in and around the heart. Nebraska Medicine’s advanced 3-D mapping provides doctors a visual map of the heart allowing them to pinpoint the exact origin of these abnormal electrical pathways. The convergent procedure combines cardiac surgery with radiofrequency ablation to terminate abnormal electrical pathways that are in hard-to-reach problem areas within the heart. Using the data gathered from 3-D mapping, the cardiac surgeon starts by making a small incision beneath the breast bone and performs an ablation on the surface of the heart. This is then followed by an internal ablation in which an electrophysiologist threads a catheter to the inside of the heart through a vessel in the groin to destroy any remaining abnormal electrical impulses. The prior alternative for the convergent procedure was a 6 to 8-hour open heart surgery.

HelenMari Merritt, DO, cardiothoracic surgeon

“This procedure is safer, has less down time and has great success rates,” says HelenMari Merritt, DO, cardiothoracic surgeon at Nebraska Medicine. Dr. Merritt has received special training to perform this surgery. “Improving outcomes for resistant atrial fibrillation cases is going to help many people,” says Dr. Merritt. “Atrial fibrillation becomes more common as we age and its prevalence is increasing. The incidence is expected to double by up to 12 million people by the year 2050.” Candidates for the procedure include those who are intolerant to medications; those whose atrial fibrillation that has not responded to medications or ablation; patients with an enlarged left atrium; and young people with atrial fibrillation. “Treatment of arrhythmias is usually required only if the arrhythmia is causing significant symptoms or if it’s putting you at risk for more serious cardiac complications,” says Dr. Delaney. “Our state-of-the-art 3-D mapping equipment combined with our experience and advanced surgical and interventional procedures allows us to diagnose and treat some of the most complex cases.”