Archive for the ‘Medical Professionals’ Category

First in Omaha to Perform New Heart Procedure

Interventional cardiologist Haysam Akkad, MD, is the first to use the absorbing stent in Omaha.

Interventional cardiologist Haysam Akkad, MD, is the first to use the absorbing stent in Omaha.

Jim Makey is competitive by nature. He loves winning and being first. However, being first in Omaha to receive a new absorbing stent, is not something he had in mind.

“I bragged to my friends and family that I was the first person in Omaha to have the new absorbing stent,” Makey says. “I like to be first in everything I do, so I’ll count this as a win.”

During the summer, Makey competed in a pair of half marathons and then the Mayor’s Triathlon in Papillion. The school principal then went on vacation, but once he returned he noticed reoccurring chest pains. Simple tasks like mowing the yard or jogging had required him to take breaks due to the pain.

“At first I thought, ‘man, I really got out of shape during those two weeks of vacation,’” he says.

After visits to doctor, he learned about the coronary artery blockage.

“I have a pretty active lifestyle, so that news really came as a surprise,” Makey says.

On Nov. 29, 2016, Haysam Akkad, MD, interventional cardiology, placed the absorbing stent in Makey, marking the first time this type of stent had been inserted in Omaha.

The absorbing stent received FDA approval in July 2016. Photo credit: Abbott Group

The absorbing stent received FDA approval in July 2016.
Photo credit: Abbott Group

The absorbing stent is the first of its kind and was approved by the Food and Drug Administration in July 2016. The new stent is another option for patients, other than the traditional metallic stent. The dissolving stent treats coronary artery disease like a metal stent. It props open the diseased vessel to restore blood flow, however, it then dissolves after the artery is healed, leaving no metal behind to restrict natural vessel motion. The new stent is made of a naturally dissolvable material called polylactide, similar to dissolving stitches. The stent disappears completely in approximately three years, once it has done its job of keeping a clogged artery open and promoting healing of the artery.

Dr. Akkad describes the absorbing stent as a breakthrough that will change how coronary artery disease is treated. “It takes interventional cardiology to different level, where the patient will have his or her coronaries fixed and have the added benefit of not having any stent material left in his or her body after a few years,” he says.

After almost two month since having the new stent placed, Makey is getting back to feeling like his normal, active self again.

“The recovery has gone really well,” he says. “I’ve even been doing more intervals of walking and jogging on the treadmill without any pain or stress. If someone else finds themselves situation, as I was in, I’d definitely recommend the absorbing stent. Everyone’s situation is different, but it’s been a good decision for me.”

 

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, Dr. Haysam Akkad is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better interventional cardiology treatment.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancer care and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Therapy Shows Promising Results for Lymphoma Patients

Julie Vose, MD, chief of hematology/oncology, is seen talking with lymphoma patient Amy Cheese, who has experienced tremendous results in Dr. Vose's clinical trial.

Julie Vose, MD, chief of Hematology/Oncology, is seen talking with WOWT reporter Brian Mastre and lymphoma patient Amy Cheese, who has experienced tremendous results in Dr. Vose’s clinical trial.

It’s the fifth most common type of cancer in U.S. adults. For years, traditional therapies to treat non-Hodgkin’s lymphoma (NHL) have included chemotherapy, radiation and a stem cell/bone marrow transplant. Currently, a new treatment option is showing great promise at Nebraska Medicine. Chimeric Antigen Receptor (CAR T-Cell Therapy) takes the patient’s own immune system and modifies it to attack the cancer.

“T cells are white blood cells that help our bodies fight infection and cancer,” explains Julie Vose, MD, chief of Hematology/Oncology. “In lymphoma patients, these cells have gone haywire. They don’t fight the cancer properly. This clinical trial allows us to take the patient’s own T cells outside the body and restimulate them to be able to fight their own lymphoma.”
Julie Vose, MD, talks to reporter Brian Mastre regarding her clinical trial recently featured on WOWT.

Julie Vose, MD, talks to reporter Brian Mastre regarding her clinical trial recently featured on WOWT.

Patients like third grade teacher Amy Cheese of Fort Collins, Colo., who was diagnosed with lymphoma 15 months ago. She endured three different types of chemotherapy, but nothing worked to shrink the grapefruit-sized tumor in her chest. Cheese’s oncologist recommended she travel to Nebraska Medicine for Dr. Vose’s clinical trial.

“One month after receiving my modified T cells, 75 percent of the tumor was gone,” explains Cheese. “The T cells will continue to fight the cancer for an additional two months.”

During her most recent visit on Jan. 23 with Dr. Vose, Cheese received the news she’s been waiting to hear.

“I am in remission,” smiles Cheese. “The tumor is gone! I can’t wait to get back to my classroom and start teaching again. I am so thankful for Dr. Vose and her incredible team.”

“It’s a great opportunity for non-Hodgkin’s lymphoma patients who have failed every other therapy,” adds Dr. Vose. “This treatment has the potential for fighting many different types of cancers.”

Nebraska Medicine is the only center in the region offering this therapy option. To learn more, watch this story from WOWT.

HPV-Associated Cancers Continue To Rise; Preventive Vaccine Underused

Omaha’s Fred & Pamela Buffett Cancer Center, 68 other national cancer centers urge action to increase national vaccination rates

Recognizing a critical need to improve national vaccination rates for the human papillomavirus (HPV), the Fred & Pamela Buffett Cancer Center in Omaha again unites with 68 other National Cancer Institute (NCI)-designated cancer centers in issuing a joint statement in support of recently revised recommendations from the Centers for Disease Control and Prevention (CDC).

Sonja Kinney, MD
Sonja Kinney, MD

The Fred & Pamela Buffett Cancer Center – an NCI-designated cancer center – is a collaboration of Nebraska Medicine and the University of Nebraska Medical Center in Omaha.

In October, new guidelines from the CDC recommended that children aged 11 to 12 should receive two doses of the HPV vaccine at least six months apart. Adolescents and young adults older than 15 should continue to complete the three-dose series.

According to the CDC, incidence rates of HPV-associated cancers have continued to rise, with approximately 39,000 new HPV-associated cancers now diagnosed each year in the United States. Although HPV vaccines can prevent the majority of cervical, anal, oropharyngeal (middle throat) and other genital cancers, vaccination rates remain low across the U.S., with just 41.9 percent of girls and 28.1 percent of boys completing the recommended vaccine series.

Sonja Kinney, M.D., director of the division of general obstetrics and gynecology at the University of Nebraska Medical Center, said the vaccine can protect against the two high-risk HPV strains that are responsible for causing 70 percent of all cervical cancers and the two low-risk HPV strains that cause 90 percent of genital warts.

“The incidence of these cancers is rapidly increasing, so we must take action now to prevent a future epidemic,” said Dr. Kinney, who sees patients at Nebraska Medicine. “HPV infections are incredibly common. Almost all sexually active people – 75 to 80 percent — will be infected. Most infections have no symptoms and are naturally cleared. However, in some cases, HPV infection can lead to several types of devastating cancers later in life, including cervical, oropharyngeal, anal and genital cancers.”

The vaccines are given as a series of injections that prompt the body’s immune system to make antibodies. The vaccine also provides protection against head and neck cancers and some anal cancer that may be linked to infection with the HPV virus.

Research shows barriers to overcome to improve vaccination rates, including a lack of strong recommendations from physicians and parents not understanding that this vaccine protects against several types of cancer.

In an effort to overcome these barriers, NCI-designated cancer centers have organized a continuing series of national summits to share new research, discuss best practices, and identify collective action toward improving vaccination rates.

The updated statement is the result of discussions from the most recent summit, hosted last summer by The Ohio State University. Nearly 150 experts from across the country gathered in Columbus to present research updates and plan future collaborative actions across NCI-designated cancer centers.

The Fred & Pamela Buffett Cancer Center – a National Cancer Institute-designated cancer center – is a collaboration of Nebraska Medicine and the University of Nebraska Medical Center in Omaha, Neb. The new cancer center will open in June 2017 with cancer research at the Suzanne and Walter Scott Cancer Research Tower and clinical treatments at the C.L. Werner Cancer Hospital.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, Dr. Sonja Kinney is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better obstetrics and gynecologic treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

One Year Later, Lung Transplant Patient Shares Journey

Phil Sauvageau Says God and Team at Nebraska Medicine Saved His Life

(From left to right:) Aleem Siddique, MD, lung transplant surgical director; Phil Sauvageau, lung transplant patient; and Heather Strah, MD, lung transplant medical director.

(From left to right:) Aleem Siddique, MD, lung transplant surgical director; Phil Sauvageau, lung transplant patient; and Heather Strah, MD, lung transplant medical director.

To find yourself on the brink of death is bound to be a life-changing experience. That’s how Phil Sauvageau described himself just weeks before he received a double lung transplant last January.

“To put things in perspective, on Jan. 24 of last year, I was only expected to live for a few more weeks,” Sauvageau writes. “I desperately needed a lung transplant. Without it, I would die.”

His prayers were answered. Sauvageau became the first patient at Nebraska Medicine to receive a lung transplant. Now that one year has passed, Sauvageau reflected on the experience in a blog he wrote for Nebraska Medicine. Take a moment to read. It’s worth it.


Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, Dr. Aleem Siddique, MD and Heather Strah, MD are an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better lung transplant treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

 

 

Partnerships That Foster The Exchange Of Healthcare Professionals

Mr. Nizar Mamdani, Executive Director, International Healthcare Services, Nebraska Medicine

 

The University of Nebraska Medical Center/ Nebraska Medicine’s International Healthcare Services (“UNMC”) is a renowned leader in patient care excellence in the United States and is internationally recognized for its innovative programs. It has world-class experts in patient-care, research, education, training and management to enhance patient-care delivery around the world. UNMC has established 124 collaborative partnerships in 44 countries. The diverse array of global partnerships touches patients around the world.

Nizar Mamdani, Executive Director of the International Healthcare Services, experienced first hand how extraordinary the healthcare delivery in cancer care and bone marrow transplantation is at UNMC. His wife, Nancy, was a Non-Hodgkin’s patient at UNMC. “I recognized the importance for international patients to be the ultimate beneficiaries from UNMC’s advanced treatment programs”, says Mamdani. He started UNMC’s International Healthcare department and the “No-Cost” healthcare training/observation programs for international healthcare professionals.

 

“No-Cost training programs work fairly simply. Healthcare professionals participate in a two-week, observership with UNMC’s experts. They receive free housing, meals, local transportation, and priceless training. The rewards of such training programs are returned many times over, because the patients, in their own countries, are the ultimate beneficiaries of our training programs”, says Mamdani. Hundreds of healthcare professionals have participated in UNMC’s No-Cost programs while 54 UNMC specialists visited 24 partner institutions for training.

Abdalla Bajawi, a trainee in Pathology from King Fahd Specialized Hospital, Dammam, Saudi Arabia said, “We are so impressed with advanced technology and the state-of-the-art medical advancement here. I’m training in HBLC and will transfer the knowledge to my colleagues when I go back”.

“The relationships Nizar describes are having a strong impact, according to Dr. James Armitage, a world-renowned hematologist at UNMC. “Anytime you can interact with colleagues around the world to the betterment of patients is excellent.”

For more information contact: nmamdani@nebraskamed.com; www.unmc.edu/international

 

Fostering Educational Collaboration in Neurology at UNMC

The Department of Neurological Sciences at University of Nebraska Medical Center/Nebraska Medicine (UNMC), offers highly specialized and individually customized Neurology Preceptorship programs in Parkinson’s, Huntington, Botulinum Toxin Chemo-denervation, Movement Disorders, Deep Brain Stimulation surgery and continuous Levodopa infusion pump therapy. Participation by international healthcare professionals in such program experiences help enhance their skills in specific sub-specialties.

UNMC has a proven track record in clinical services, medical education, biomedical research, and international outreach. Danish Bhatti MD, Director of UNMC says, “Our primary focus has always been to provide exceptional educational opportunities and extraordinary patient care at all levels. Our Neurology Preceptorship program is yet another example to fulfill a strong need of sub-specialty training exposure for practicing international Neurologists”.

UNMC’s one to three month’s Neurology Preceptorship programs are designed for fully-trained international neurologists in active practice, who are interested in advancing knowledge in cutting-edge technology and current guidelines/practices in their area(s) of interest.

“With rapid advancements in all Neurological sub-specialties, our Preceptorship programs enhance experiences in Movement Disorders, Stroke, Neuro-Critical Care, Epilepsy, Neuromuscular Medicine, Multiple Sclerosis, Neuro-Immunology, Inpatient Neurology (Neuro-Hospitalist) and other sub-specialties.” says Dr Bhatti. “Research is also a vital part of the department’s activities, including clinical and translational research for neurologic disorders such as Alzheimer’s, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis, Parkinson’s, Peripheral Neuropathy and Stroke”.

Nizar Mamdani, executive director and founder of the International Healthcare Services says, “Dr. Bhatti is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better Neurology treatment and educational opportunities. Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world,” says Mamdani. Contact: nmamdani@nebraskamed.com; www.unmc.edu/international; +1-402-559-3656.

Oxygen Under Pressure – a future adjunct option for refractory wounds

By Dr. Lon W. Keim

 

Imagine being at risk of losing one of your feet.

That’s what a mother of seven from Kuwait with advanced diabetes mellitus recently faced before coming to Nebraska Medicine and the University of Nebraska Medical Center, through the assistance of the Office of International Healthcare Services.

She presented with a problem wound involving her right foot, now threatened by potential amputation. Her management was further complicated by the need of dialysis three times per week for her end stage renal disease.

Years ago Dr. Jefferson Davis and Dr. Thomas Hunt coined the term “problem wounds,” which they defined as wounds which simply do not heal as they should.

Through their experience and research they determined that a common denominator of problem wounds is tissue hypoxia or oxygen deprivation. Tissue hypoxia is commonly a result of three factors: inadequate oxygen in the blood, insufficient regional blood flow, or most often – focal oxygen demand exceeds delivery. That is the metabolic demands of the wound exceed oxygen delivery from the available blood supply.

Accordingly, the body’s inherent defense mechanisms – the ability to fight infection, generate new blood vessels, build tissue, create strength, provide coverage – are forced to function in an oxygen deficient environment. Thus a problem wound, like the one the woman from Kuwait experienced, is created.

Re-establishment of local regional blood flow through vascular enhancement procedures such as arthrectomies, angioplasties, stent placement, and bypass procedures is the essential cornerstone of initial management.

Hyperbaric Oxygen Therapy (HBO) also has been found to be a useful adjunct in selected patients who tissue oxygenation is not improved to accepted levels by revascularization procedures The patient is entirely enclosed in a monoplace chamber  and breathes 100 percent oxygen at pressures greater than  1.0 atmospheric pressure absolute (ATA).

With increased pressure, the amount of oxygen physically dissolved in the blood is increased. This increased oxygen pressure in plasma enhances diffusion from existing vasculature and improves regional wound tissue oxygen tensions.

The increased oxygen tension will not make a normal wound heal faster, but allows an otherwise compromised wound to heal through improved white cell function, enhanced antibiotic effectiveness, promotion of micro-vessel growth and collagen formation. It should be emphasized that HBO is not a substitute for adequate debridement or appropriate antibiotics, adequate nutrition, or local wound care.

Prior to coming to Nebraska, the mother from Kuwait had been evaluated by clinicians in Europe who believed nothing further could be done with amputation being the next most likely course of action.  She was subsequently referred to Nebraska Medicine where vascular surgeons were able to improve her distal vascular circulation through angioplasties and stent placement.

Subsequent transcutaneous oxygen assessment confirmed marginal tissue oxygen tensions that reversed with Hyperbaric Oxygen Therapy, thereby justifying further treatment with HBO. While continuing her dialysis three times a week, through a series of HBO treatments at 2.4 ATA  for 90 minutes each, local wound care, and pressure off loading, her wound oxygen tensions improved, allowing her wound to heal to a degree it was believed she could be safely discharged and return to Kuwait with her limb intact.

It should be emphasized that her recovery was the result of a team effort that included: skilled surgeons, gifted interventional radiologists, talented infectious disease expertise, attentive nurses, ongoing dialysis support, pressure off loading, aggressive nutritional support, and hyperbaric oxygen therapy.

The Hyperbaric Unit at Nebraska Medicine is equipped with four monoplace chambers capable of treating patients at pressures up to 3.0 ATA. The unit is staffed by hyperbaric trained critical care nurses, and is located immediately adjacent to an ICU. As such, the Nebraska Medicine specialists are capable of both treating walk-in outpatients as well as those requiring intensive critical care support. Although available 24/7 for emergent conditions, the unit routinely runs four shifts a day, with the majority of patients treated once daily five days a week.

HBO is viewed as the primary treatment for only three conditions: (1) acute carbon monoxide intoxication, (2) decompression sickness (bends), and air emboli (air bubbles within the vascular system).

For all other conditions, HBO is viewed as adjunctive therapy to the traditionally accepted mandates of care: adequate debridement and wound care, pressure off loading, edema control, nutrition, wound care, appropriate antibiotics, etc.

The following conditions have been approved and are endorsed by the Undersea and Hyperbaric Medicine Society (UHMS) as appropriate for treatment with HBO: (1) Clostridial myonecrosis – gas gangrene, (2) Necrotizing Soft Tissue Infections, (3) Refractory Chronic Osteomyelitis, (4) Compromised Flaps & Grafts, (5) Diabetes Mellitus – with lower extremity problem wounds refractory to conventional management for > 30 days, Wagner III-IV, (6) Delayed Radiation Injury – to Soft Tissues and Bone including radiation cystitis, radiation caries, colorectal radiation enteritis, or any chronic non-resolving chronic wound within a prior area of radiation, (7) Crush Injury – Skeletal Muscle Compartment Syndromes, (8) Intracranial Abscess, (9) Idiopathic Sudden Sensorineural Hearing Loss, (10) Exceptional Blood Loss Anemia, and (11) Thermal Burns.

The risks and side effects associated with HBO therapy are few. They include: confinement anxiety; barotrauma to the ears sinuses and potentially the lungs; fire (controlled by rigid adherence to strict safety protocols), rare oxygen induced seizures; and occasional transient reversible changes in vision. All in all, it is extremely well tolerated with minimum risks.

Multiple Myeloma 2016: where do we stand?

Multiple myeloma (MM) is the second most common hematologic malignancy in the United States, with rising incidence and prevalence, and is fast becoming an expanding health care burden globally. At a median age of 69, it may manifest differently, however, detrimental effects of abnormal plasma cells invariably involve the bone marrow, skeleton, kidneys, electrolytes and may predispose patients to infections by impairing immunity.

Though considered incurable, the field of MM, the survival of patients has more than doubled over the past decade.

Muhamed Baljevic, M.D., a multiple myeloma specialist and his team at the University of Nebraska Medical Center/Nebraska Medicine (UNMC) have been providing the latest treatment option include the use of cornerstone agents such as proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs), and their combinations. Daratumumab and elotuzumab recently became the first monoclonal antibodies to join the therapeutic armamentarium against MM.

Unfortunately, despite tremendous advances and ever increasing degrees of response, disease usually relapses, with decreasing remission durations upon each additional treatment.

On the brighter side, small molecules and an array of antibodies against other surface antigens and immune checkpoints are already part of early phase development in humans. The present appears to suggest chemo-immuno approaches as the future standard in the front-line setting, for both transplant eligible and transplant unfit patients. Consolidation therapy with Bi-specific T-cell engagers (BiTE), vaccine and checkpoint immunologic approaches also promise to push the boundaries of short and long-term outcomes.

Nizar Mamdani, executive director of UNMC’s International Healthcare says, “Dr. Baljevic and his expert team are remarkable examples of the caliber of specialists and researchers working tirelessly to help provide better treatment options”.

“Through collaborative strategic partnerships with 124 institutions in 44 countries, we continue to provide innovative treatment options, as well as specialized tele-pathology and second opinion consultation services for cancer care, neurology and transplantation patients around the world.”

UNMC also provides no-cost, training and educational programs. “Through our customized training programs, we facilitate patients around the globe to be the ultimate beneficiaries of the most advanced treatment options and empower them to receive the latest treatments in their own home countries,” says Mamdani.

New Procedure a First for Nebraska

A neck injury sent Scott Winter to the ED, only to discover he suffered from atrial fibrillation. His cardiologist, Shane Tsai, MD, recommended a new procedure that would prevent his heart from beating irregularly. Winter would be the first patient in the state to undergo this procedure, performed by HelenMari Merritt, DO.

Watch more in this video below.

Less-invasive Option for Thyroid Surgery

Estelle Chang, MD.

Estelle Chang, MD.

It’s a new option for patients who require thyroid surgery, one that’s much less invasive. Minimally-invasive robotic surgery is now offered at Nebraska Medicine for patients who need thyroidectomy, meet specific criteria, and desire a procedure that won’t leave a visible neck scar.

Estelle Chang, MD, an Otolaryngology Head and Neck surgeon, recently returned from a six month Advanced Robotic Head and Neck Endocrine Surgery fellowship at Yonsei Severance Hospital in Seoul, South Korea.  During her fellowship training, Dr. Chang also studied the latest, minimally invasive, thyroid and parathyroid surgery techniques. She also offers minimally invasive robotic surgeries for patients who need to have their submandibular gland, thyroglossal duct cyst and other non-cancerous lesions from neck removed.

“Traditionally, thyroidectomy has been performed using a 4 to 8 cm incision in the front of the neck which leaves a very visible scar,” says Dr. Chang. “Robotic thyroidectomy is the latest, minimally invasive surgical technique that is used to remove all or part of a thyroid gland without leaving a visible scar.”

Robotic surgery for thyroid disorders in the United States is currently offered at a few leading academic medical centers. It is considered to be a very safe procedure in the hands of an experienced robotic surgeon, says Dr. Chang. Robotic surgery can also be used to remove other benign masses of the neck, such as lipomas and thyroglossal duct cysts.

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