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Soaring like an Eagle

Kyndal Rock's picture
Submitted by Kyndal Rock on October 29, 2020 - 09:53

“Mom, when can I be a Boy Scout?”

Inspired by her older brother’s commitment to his troop, Olivia Foli, 16, knew that she wanted to follow in his footsteps and join the Boy Scouts of America, or BSA.

However, Olivia did not want to be just any Boy Scout — She wanted to be an Eagle Scout, the highest rank attainable in the Scouts BSA program.Olivia Foli, 16, places a stone painted with the word “thrifty” in the UF Health Children’s Healing Garden. The rock is part of a scavenger hunt for pediatric patients.

Just two short years ago, this was an impossibility. It was not until 2018 that the BSA announced that girls would be allowed into the scouting program.

For the first time in history, Olivia and many other girls would have the opportunity to earn the honor of being an Eagle Scout.

Olivia is a part of Gainesville’s Scouts BSA Troop 21, an all-girls troop that she helped start in February of 2019.

In order to receive her Eagle Scout ranking, Olivia would need to plan and lead an extensive service project. She decided on one that would benefit patients at the UF Health Shands Children’s Hospital, as she was once a patient herself.

Olivia was born with brachial plexus, a nerve injury, which left her right arm paralyzed. After surgery at 7 years old, she attended occupational therapy at UF Health Shands until she was 14.

“I feel like the meaning behind my project is bringing joy to these patients in such a difficult time because I personally know what it is like to be in the hospital as a child,” Olivia said.

Olivia placed 12 large, painted rocks in the UF Health Children’s Healing Garden for patients to find on a scavenger hunt. Each 20-inch stone symbolizes the 12 points of the Scout Law: trustworthiness, loyalty, helpfulness, friendliness, courtesy, kindness, obedience, cheerfulness, thriftiness, bravery, cleanliness and reverence.

Upon completion of the scavenger hunt, patients will get to keep one smaller, painted rock that speaks to them. Olivia calls them “healing stones.” Each stone contains an encouraging message or trait that Olivia hopes will connect with young patients.

Olivia donated 676 healing stones that came from roughly 100 people spread over 11 troops, three organizations and seven states including Florida, Georgia, Texas, Oregon, California, Virginia and Pennsylvania.

The stones were hand-painted and sent directly to Olivia for her project.

Upon completion of the scavenger hunt, patients will be able to select one healing stone to keep.The idea came about when Olivia’s mother, Kim Foli, bumped into Amy Wegner, director of the Child Life Program, in the hallway at UF Health Shands Hospital.“Being able to take these small, natural rocks, paint them and help them to bring joy to the patients is really what my project is about,” Olivia said.

Kim expressed Olivia’s interest in volunteering at the hospital as a scout. At that time, UF Health had just started breaking ground on the UF Health Children’s Healing Garden.

According to Wegner, the Eagle Scouts have a similar mission of promoting being outdoors and in nature, just as the garden promotes relaxation and physical activity for patients and families.

“She has had such a good understanding of the purpose of the garden and she has an understanding of what children in the hospital may go through while they’re here,” Wegner said.

Wegner had the opportunity to attend a Troop 21 meeting to discuss future projects for the garden. She says Olivia’s extensive scouting background helps her better understand the therapeutic benefits of nature, especially for children.

Upon completion of her project, Olivia will receive her Eagle Scout ranking, making her part of the inaugural class of female Eagle Scouts.

“To me, Eagle Scout isn’t really the badge, but more of the skills that you learn to get to that point,” Olivia said.

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1,219 Days of Beating Cancer

Molly Brennan's picture
Submitted by Molly Brennan on October 26, 2020 - 15:36

Ann Collett used to dread 7:30 p.m.

At a time when many mothers across Gainesville were putting their young children to bed, Ann was preparing her son’s nightly chemo treatment.

William, an eighth-grader at Queen of Peace Catholic Academy, had been fighting acute lymphoblastic leukemia since he was just 10 years old. Forty months of treatment later, William officially beat pediatric cancer on Sept. 14. Tom, Ann, William and Magen Collett

In May of 2017, William was an “avid sports enthusiast,” playing basketball, running cross country and participating in track and field for his school. He was finishing fourth grade and was, by all accounts, a healthy kid.

“Everything just sort of came out of nowhere,” Ann recounts. “We went to our family pediatrician, Mary Grooms, M.D., FAAN, [Monday morning]. By late Monday afternoon, we were at Shands.”

William had been slowing down and getting headaches and bruises in recent weeks. The Colletts would come to find that these were signs associated with leukemia.

When William was diagnosed with acute lymphoblastic leukemia at UF Health Shands Children’s Hospital, Ann and husband Tom were shocked. Although they had known William was under the weather, cancer had been the last thing on their minds.

“He had been running a 5k just a couple of weeks before,” Ann said. “It was all kind of surprising.”

Ann and Tom are both active in the Gainesville community through various charities, such as Climb for Cancer and Stop Children’s Cancer. They had attended numerous local events supporting families battling pediatric cancer, with Tom even emceeing some of them as a Gator IMG Sports Network commentator.

Now, they were that family.

Following his diagnosis, William stayed at UF Health for almost two weeks. The first 30 days of his treatment — known as the “induction” phase — were focused on getting him into remission. With leukemia, remission can be achieved relatively quickly.

The next phases of William’s treatment focused on ridding the body of stray leukemia cells. Consolidation, interim maintenance and delayed intensification lasted 10-11 months and involved several hospitalizations.

While neutropenic fever is not uncommon with chemotherapy, every fever resulted in a trip to the UF Health Shands Pediatric E.R. for William. Because of his immunocompromised state, each fever was to be treated as if it were an infection.

Ann recalls that one of these fever-related E.R. trips turned into a 12-day hospital stay. For William, these stays were especially hard without his beloved Shih-Tzu-Yorkshire-terrier mix, Heartley. Upon returning home from his hospital trips, William would immediately find Heartley in his lap.

Being in one of the more intense phases of his treatment, William stayed out of school for most of his fifth-grade year, keeping up with classes and homework at home. This setback, however, did not stop William from maintaining his placement in advanced math classes.

“They would send his work home, teachers would record classes for him and offer one-on-one tutoring,” Ann said. “We would go to school so he could have lunch with his friends, or if there was a special event, we would go so he could participate.”

Around a year after his diagnosis, William entered the maintenance phase of his treatment, where he was able to “semi-resume” his life and return to school. By now, William was 11 and finishing elementary school.

For the next 28-29 months, William would receive monthly infusions, almost-monthly spinal taps and daily chemotherapy at home.

Ann recalls her son’s insistence that he resume playing on his school’s sports teams. One day, William was receiving a lumbar puncture, and a few days later he was running cross country, she said.

When COVID-19 hit the U.S. in March, the Colletts were already ahead of most Americans when it came to sanitizing protocols.

“COVID did not bring anything new into our world,” Ann said. “We’ve long been using antibacterial wipes and gel and just being very cautious about doors [and] being near people who are sick.”

William Collett runningIn fact, 2020 has been “joyful” for the Collett family, despite its faults.

Sept. 14, 2020, had been marked on Ann’s calendar for years. This would be the day that William would be done with his treatments and officially be cancer-free. Not even a pandemic could tarnish this milestone for the Colletts.

When that day was only 100 days away, Ann said the reality of it finally began to sink in. When that day came, the Colletts could not control their excitement.

On Sept. 14, in the UF Health Children’s Healing Garden, Ann, Tom, William, sister Magen, William’s grandparents, family friends and William’s care team all gathered for a socially distanced bell-ringing ceremony. William Slayton, M.D., professor and chief of the division of pediatric hematology/oncology, gave a short speech and led songs and chants with his colleagues.

“It’s for the parents and for the child,” Slayton said of the ceremony. “The bell-ringing signifies the end of the treatment, but also the beginning of the rest of the person’s life.

Ann remembers how excited she was as she stood with her family in the garden, smiling and clapping for William and his care team. One of her friends commented after the event that Ann’s legs “would not stop going” and that it looked like she was going to jump for joy.

“The nurses on Unit 41 — most all of them were there when we started,” Ann said. “The PAs and ARNPs who are up in that department, they have just been amazing to work with.”

William’s team of pediatric hematology/oncology specialists included Slayton; John Fort, M.D., clinical associate professor; Stephanie Bryan, PAConstance Stichweh, ARNP; and William Higgins, PA. This care team, plus Deborah Ringdahl, clinical case manager, made 40 months of treatment “as fun and as uplifting as possible,” according to Ann.

As William rang the bell signifying the end of his leukemia treatments, the garden erupted into cheers and applause. Ann, Tom, Magen and William embraced, holding each other tightly, before Slayton awarded William with a certificate, trophy and — to William’s delight — a brand new basketball.

“William faced his leukemia with a really great attitude,” Slayton said. “It never really seemed like the leukemia was holding him down.”

Slayton said he will remember William for the “really colorful and interesting” shoes and socks his patient would wear to appointments. “Swag” was a good word for it, Slayton remarked.

Following the ceremony, the Colletts were met at home with an elaborate drive-by parade. Cars were lined down the block, decorated with balloons and homemade signs, some shooting confetti out of their windows.

“More than one person said to me, ‘We needed this… not just for William, but in the midst of what we’re going through in 2020, we needed a celebration,’” Ann said.

William is building his immune system back up at home, the invisible burden of 7:30 p.m. chemo treatments now lifted. He is hoping to be back at school before March of 2021.

With most of the family at home now, the Colletts have been occupying their time with a furry new family member: 1-year-old mini goldendoodle Auggie.

Auggie entered the Colletts’ lives in early March, full of personality. He is now in training to be a therapy dog.

“We have felt that Heartley made such a difference in William and his treatment,” Ann said. “We didn’t have access to our dog when we would be getting treatment… Once we can return to visiting people in the hospital, Auggie and I will be ready to roll.”

Ann said that living through her son’s “life-changing” diagnosis forced her family to “sift and shift” their lives: Sift through tasks, hobbies and relationships that were unfulfilling or draining, and shift whatever was left and prioritize that.

William’s 40-month battle with leukemia reaffirmed what mattered most to the Colletts: family, friends and faith, Ann said. It also encouraged them to take things day by day.

“You cannot look at the end at the very beginning. You could know what the end will be, but for me to imagine what that was like — 1,219 days from diagnosis to ringing the bell — that’s too much for a person to comprehend,” Ann said. “Just know that you’ll get there and focus on today.”

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Music is Powerful Medicine

Submitted by Theresa Bradley on October 23, 2020 - 06:36

Jane playing piano and smiling
Jane Mason, an acclaimed pianist and composer, has filled the lives of people around the world with her music, performing in concert halls from Sidney, Australia to Venice, Italy and throughout the U.S. She is also an accomplished painter, having created more than 500 original works.

For a short while, the music stopped and the paintbrush lay dormant after Jane, 77, suffered her second stroke in April 2020.

The stroke occurred while Jane was relaxing in the yard after a productive afternoon of gardening. She phoned her daughter, Jill, to check in. Just minutes into the call, the telltale signs started, and Jane knew she was having another stroke.

Her daughter’s frantic cries went unanswered: “Mom! Mom! What’s happening? Are you OK?” Jane could not speak and could not move.

Jill called 911, staying on the phone with her mom while also guiding paramedics around Jane’s expansive, rural property near Palatka as they searched for her.

A helicopter arrived to fly Jane to the nearest hospital. But a developing thunderstorm altered their course and first responders redirected the chopper to UF Health Gainesville, heading toward clearer skies.

“That decision saved my wife’s life,” said Jane’s husband, Marty.

“We didn’t know it at the time, but UF Health Gainesville was the only place Jane needed to be.”

The hospital is home to the UF Health Comprehensive Stroke Center, which has been certified by The Joint Commission, the recognized leader in health care certification. This advanced level of certifications indicates that a hospital provides more extensive treatment options as well as essential therapies for recovering after a stroke.

By the time the helicopter arrived at UF Health, doctors and nurses were fully informed of Jane’s condition. Brian Hoh, a renowned neurosurgeon, and his stroke team were prepared to perform a life-saving thrombectomy, an innovative endovascular procedure used to remove blood clots from brain arteries.

Dr. Hoh said: “Seconds matter. From the moment a patient enters our emergency department, (s)he is on a well-orchestrated course to receive rapid and highly advanced treatment. Everyone in the ED is onboard. Nothing gets in our way. We must work fast to stop further damage to the brain. That can mean the difference between returning to a normal life and enjoying the things you love or being permanently disabled.”

Before Marty got to the hospital, Jane was out of the procedure and out of imminent danger.

But the stroke paralyzed Jane’s hands, which had so skillfully executed her music and art.

Jane transferred to UF Health Rehab Hospital for an intensive, personalized recovery plan, including physical, speech and swallowing therapy.

Today, six months after her stroke, the music has returned. Jane is back at the piano playing her favorite pieces — “He Touched Me” and “Amazing Grace.”

Each day brings improvement as Jane strives to match her pre-stroke performance. She has returned to near-normal in most aspects of her life.

Anna Khanna, medical director of the Comprehensive Stroke Center at UF Health, said: “Patients who suffer this type of stroke, a large artery occlusion, frequently have significant and permanent damage. Often, they cannot use one entire side of their body. Jane’s recovery is quite remarkable.”

The secret may be found, at least in part, in music and art.

Dr. Khanna said, “Some patients — artist, educators and others — who have trained their brains in a certain way recover more quickly and gain back more abilities, as long as they receive rapid and effective medical treatment following the stroke.”

Jane may have developed a high level of brain function through art and music that helped her not only regain these talents but other abilities as well.

Jane and Marty thank the Comprehensive Stroke Team at UF Health for giving Jane her life back.

“Everyone responded incredibly skillfully and quickly. They cared. They knew what we needed but they also listened to us. We found friends and confidants in our long-term therapists and nurses.”

Marty said, “They kept me going.”

Jane’s hope is to once again play piano well enough to return to the concert hall and to paint again. Marty believes she will achieve it through sheer will and tenacity.

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The dark side of social media: e-cigarettes targeting young adults

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Submitted by Kacey Finch on October 22, 2020 - 09:00

A curly-haried, dark-skinned young woman looks out a window while holding an e-cigarette to her lips.

These days, electronic cigarettes, or e-cigarettes, are everywhere — even in the hands of young adults.

But because e-cigarettes are such a new product, their long-term effects, including their cancer risk, are still unknown. The potential implications that vaping could have on younger people has also been the subject of much discussion, and several restrictions, such as flavor bans, have been helpful in curbing e-cigarette use. However, one area of the e-cigarette industry remains underregulated: social media.

“There really is no regulation about what can be done in the social media environment, and this group of 18- to 24-year-olds pretty much lives online,” said Jordan Alpert, Ph.D., an assistant professor in the UF College of Journalism and Communications’ department of advertising. “They’re being exposed to messages that are glamorizing and glorifying e-cigarettes every day.”

Alpert set out to discover what impact the social media marketing of e-cigarettes is having on young adults. He researched different brands and used documents from Phillip Morris International Inc., a cigarette and tobacco company, to study whether e-cigarette brands are using similar marketing strategies to target young adult consumers.

Alpert’s study found that e-cigarette brands often tried to target their younger audience by making their products look “cool” with flavors and pop culture references.

“The big finding was that this kind of exposure to e-cigarettes really normalized them. They just became a typical, everyday thing that young adults see,” Alpert said. “It didn’t seem taboo or like anything was wrong with that. This constant exposure really normalized the activity for this age group.”

Brands often focused on an appeal of an overall lifestyle without even mentioning their products. For example, Alpert said, one advertisement showed a person lounging by a luxurious swimming pool and holding an e-cigarette pen — never directly mentioning the product but instilling in consumers’ minds that this would be a “cool” lifestyle they could live.

“The goal of this study was to bring more attention to the kind of marketing tactics that are going on and to try to have some discussion about any kind of regulations that could occur in the social media environment,” Alpert said.

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A surprising ally in the fight against cancer: “mommy bloggers”

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Submitted by Kacey Finch on October 20, 2020 - 09:00

A young Black mother works on a laptop on her couch. Two children lay across her back, looking at their phones.

It can be hard to find trustworthy online sources, especially when it comes to health information. A UF Health Cancer Center researcher has found a way to relay scientifically based breast cancer information to mothers through sources that women reportedly trust and relate to — “mommy bloggers.”

Carla L. Fisher, Ph.D., a cancer behavior scientist, set out to find a way to disseminate evidence-informed breast cancer messages that would resonate with mothers and daughters, motivating them to talk about environmental breast cancer risk and lifestyle changes they could make together to reduce their risk.

Fisher and her colleague Kevin Wright, Ph.D., of George Mason University, are scientists in the National Institute of Environmental Health Sciences’ Breast Cancer and the Environment Research Program, or BCERP —a program of scientists and community partners created more than two decades ago to identify environmental breast cancer risk factors. Through a study funded by the National Institute of Environmental Health Sciences, Fisher and Wright teamed to develop a social media intervention to communicate environmental breast cancer risk information to mothers and daughters.

Fisher’s research shows that mothers and daughters are concerned about their risk but find talking about the topic challenging. Research demonstrates that online, third-party sources can help them navigate these conversations. Women who use the internet for health information and mothers often turn to “mommy bloggers,” women who make a living by blogging — online journaling — about motherhood and various aspects of life, as a trusted source.

“What we see in the research is that mothers often identify with mommy bloggers,” Fisher said. “They even, in a way, develop a sense of a relationship and a community within that social media group.”

The community of mommy bloggers presented Fisher and Wright an opportunity to distribute evidence-based information.

“With social media, you can cast a wide net, reaching more people,” Fisher said. “The dissemination can keep going on and on and on, because of the various connected platforms people use.”

Fisher and Wright developed collaborations with 75 mommy bloggers to spread evidence-based information from BCERP’s free online toolkit that was created for mothers. With their research team members, they created a shareable, uneditable infographic to incorporate into a blog post that provided mothers and daughters four action steps to take to reduce their risk. The researchers also provided the bloggers with an uneditable introduction paragraph to include to assure readers that the information was coming from a trusted source.

Keeping with the theme of their blogs, the mommy bloggers were encouraged to write the blog in a way that would resonate with their readers. With blogs being shareable, the message made it onto several platforms, such as Facebook, Pinterest and Instagram.

“We did see that there was an impact,” Fisher said. “It shows that this is an angle that we want to utilize more and a partnership that can bridge the social media community of mothers out there in society with the science community.”

The blog posts reached more than 400 mothers, and the impact didn’t stop at getting the message to a wider net of people. The researchers also found mothers exposed to the blogs were more satisfied with the breast cancer risk information, more motivated to engage in risk-reducing behavior, and more likely to share the breast cancer risk reduction tips with their daughters.

“Mothers said that when the information is presented on something like social media, it’s much easier to talk to their kids because it’s less personalized,” Fisher said. “The information on social media can facilitate a less emotionally charged conversation about cancer, particularly in a way where you’re not scaring and frightening your kids.”

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One step at a time: Kathy’s journey to wellness at UF Health Integrative Medicine

Submitted by Nina Wright on October 16, 2020 - 12:42

When Kathy Nobel started experiencing pain from an inherited neurological disorders, Charcot-Marie-Tooth disease, or CMT, she knew she did not want to be on strong opioids. While there is no cure for CMT, Kathy found relief through the practice of acupuncture at UF Health Integrative Medicine.

BE HOPE

Kyndal Rock's picture
Submitted by Kyndal Rock on September 28, 2020 - 12:06

A young girl wearing a pink and white dress stands next to a garden of red, pink and yellow flowers.

Cole Dooley, M.D., is no stranger to pediatric cancer. As both a pediatric anesthesiologist and the father of a child with incurable cancer, the realities of childhood cancer have forever changed his life.

On July 14, 2012, Cole and Sarah Dooley welcomed Phoebe Louise into the world.

They chose the name “Phoebe” for its meaning: “radiant light.” The name perfectly embodied every bit of hope, beauty and inspiration they wished for her.

Phoebe was born prematurely at 34 weeks. When she arrived, she was quickly diagnosed with Tetralogy of Fallot, a form of congenital heart disease.

Phoebe Louise Dooley was born July 14, 2012.Phoebe underwent heart surgery at the UF Health Congenital Heart Center when she was roughly 8 weeks old. The surgery was successful and, soon, Phoebe was on the road to recovery and healing.

For the next couple of years, Phoebe lived a normal, healthy life. She jumped, ran and played with other children, her previous health problems unrecognizable on the playground.

However, Phoebe’s parents became concerned when they noticed Phoebe’s eyes would cross while watching television. She was taken to an eye doctor who recommended Phoebe have an MRI.

This MRI would later reveal a tumor in Phoebe’s brainstem.

On March 22, 2016, at just three years old, Phoebe was diagnosed with diffuse intrinsic pontine glioma (DIPG), an aggressive, incurable tumor.

The tumor was located on the part of the brainstem that controlled all of Phoebe’s vital functions, including her heartbeat and breathing.

Phoebe’s doctors told her parents that the tumor was not treatable by surgery. The only available treatment was radiation therapy.

“[Surgery would be like] pouring pink sand into regular sand and then trying to pick out the pink sand,” Cole said. “You would never really get it all out.”

While many of the children who undergo radiation therapy have their tumors shrink and symptoms decrease, over time, these symptoms reappear and grow more severe.

Though the radiation came with its own side effects such as increased appetite, fatigue and changes in her emotional state, the majority of Phoebe’s brain tumor symptoms resolved and she began to get better.

Phoebe started treatment in April of 2016, and by the beginning of August of 2016, she was largely back to her bubbly self.

This time of reduced symptoms and progress, known as the “honeymoon period,” generally lasts a number of months before the tumor resumes its growth.

Cole still remembers the family trip he took with Phoebe to the Jacksonville Zoo the day before they found out her life-changing diagnosis.

“She was running around with the other kids and playing on the playground equipment,” Cole said. “The next day someone told me that she might die in six months.”

A smiling young girl pushes a toy plastic cart.

As a physician, Cole knew what the disease statistics meant. As a parent, Cole was grasping for hope that doctors could do something.

“I wanted so badly to believe she could have a different story than anyone else,” Cole said. “Unfortunately, it’s not the case with this disease.”

Phoebe’s condition did not start to decline until early March of 2018. By May, Phoebe had entered hospice care.

A young girl stands next to a painted wooden tiger.

On Sunday, Aug. 5, 2018, Phoebe passed away at home surrounded by loved ones.

Phoebe had fought and continued to shine her light for 29 months after being diagnosed with a cancer that usually only allots 6 to 9 more months of life post-diagnosis.

In 2017, the Phoebe Louise Dooley Foundation was created to help raise money for families fighting similar battles and to fund research for pediatric cancer, specifically DIPG.

Cole believes that the foundation will bring awareness to pediatric cancer and encourage support of pediatric cancer research, ultimately changing the face of the disease.

“My goal is for people to recognize the gold ribbon the same way that they do the pink ribbon,” Cole said.

In addition to the foundation, Cole serves as an advisor on the board of the Phoebe Louise Dooley Student Organization at UF (PLDSO).

PLDSO is a student-run organization that allows students interested in health care to get involved with the community through volunteer opportunities with children and their health care.

Throughout Phoebe’s DIPG journey, one thing that kept Cole optimistic was his daughter’s vibrant and lively spirit. Someone even pointed out to him that rearranging the letters of Phoebe’s name spelled “Be Hope.”

This powerful message embodied Phoebe’s illuminating spirit that continues to shine and radiate hope to all her friends and family.

“She served as the inspiration, and somebody showed me that in words when they rearranged the letters in her name,” Cole said.

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Staying Upbeat Through Every Diagnosis

Kyndal Rock's picture
Submitted by Kyndal Rock on September 2, 2020 - 10:16

Kendall Lewis stands next to a volleyball net on a sunny day. She is wearing a face mask and is carrying an orange and blue Florida Gators volleyball. How 9-year-old Kendall Lewis navigates life with VACTERL association.

If you ask 9-year-old Kendall “Miss K” Lewis how many surgeries she’s had in her life, she will laugh and say, “Too many!”

Within hours of her birth on June 2, 2011, Kendall was transported to UF Health Shands Children’s Hospital for multiple abnormalities. That day, Kendall was diagnosed with VACTERL association, a disorder that affects numerous body systems.

Upon learning of their newborn child’s diagnosis, the Lewis family was overwhelmed with emotion.

“We had never heard of it,” said Mindy Lewis, Kendall’s mother. “It seemed like every time we saw someone the first few days, we found out something else was wrong.”


VACTERL

VACTERL is an acronym that represents a multitude of birth abnormalities:

  • V stands for vertebral defects – Kendall’s L4 vertebrae is a hemivertebrae, or wedge-shaped. She has deformities of the sacrum and coccyx, a tethered spinal cord and scoliosis, which has progressed over the last year.
  • A stands for anal atresia – Kendall had a low imperforate anus, meaning she was born without the anal opening where it should have been.
  • C stands for cardiac defects – Kendall has Tetralogy of Fallot with pulmonary atresia (TOF/PA). The vein and valve responsible for bringing blood to the lungs from the heart was essentially non-existent. She has a number of other heart issues as well.
  • T/E stands for tracheoesophageal fistula – Kendall had a tracheoesophageal fistula with esophageal atresia – an abnormal connection between her trachea and her esophagus – and her esophagus was not attached to her stomach.
  • R stands for renal anomalies – Kendall has a duplicated collection system on her right kidney.
  • L stands for limb abnormalities – Some people diagnosed with VACTERL association have limb defects for abnormalities. This is the only component of the disorder that Kendall does not have.

Mindy says her daughter’s diagnosis has changed her family’s life.

“As the parent to a complex medical child – and one who also happens to be immunocompromised – we have had to adjust our world a little,” Mindy said.

At just five days old, Kendall underwent her first set of surgeries including her fist bowel reconstructive surgery and a procedure to repair and reconnect her esophagus to her stomach.

Kendall has endured a total of three open-heart surgeries: her first at 26 days old, her second at three years old and her third at five years old.

“It was nerve-wracking, knowing that you were essentially helpless and trusting a medical team and some equipment to keep your baby alive while they stop her heart to work on it,” Mindy said.

In the spring of 2015, Kendall underwent a cardiac catherization to help the narrowing in her conduit due to her immune system disagreeing with donor tissue. As her body struggled with rejecting her new heart conduit, Kendall had a second bowel reconstructive surgery.

In 2018, the Lewis family found out that Kendall had likely suffered from a small stroke after her second open-heart surgery in 2014. During an MRI scan, it was revealed that she also has hemiplegic cerebral palsy, in which one side of the body is affected.

For the Lewis family, it feels like every year brings a new battle for Kendall.

“Some things resolve over time or become a dormant issue,” Mindy said. “Every year since she was born, we have been given a new diagnosis to go with her other ones.”

Regardless of the medical curveballs she is thrown, Kendall continues to adapt to her ever-changing condition with a positive, upbeat attitude.

As a rising fourth grade student, Kendall participates in numerous activities in and out of the classroom – one of the most recent activities being volleyball.

According to Mindy, volleyball has given Kendall something she can strive for and helps strengthen her body, which was mildly affected by the stroke and hemiplegic cerebral palsy. When Kendall plays volleyball, she gets to be a “normal” kid.

“Her coordination is better, her spirits are better [and] she is actually pretty darn good,” Mindy said.

Kendall has significantly improved her pulmonary function test over the past year, and her enhanced lung capacity is believed to be the result of playing a sport.

UF Health Shands Children’s Hospital has been a home away from home for the Lewis family since the day Kendall was born nine years ago. Kendall has faith and trust in the facility, according to Mindy.

Kendall is followed by ten specialty teams at UF Health including cardiology; pulmonology; ear, nose and throat; immunology; pediatric surgery; neurology; orthopedic surgery; nephrology; gastroenterology and plastic surgery.

When Kendall visits UF Health Shands Children’s Hospital for her appointments, she is more excited than she is nervous.

Kendall has become friends with many student volunteers during her time on UF Health campus, and many of them will visit her during her stays, painting their nails and playing with makeup.

“UF Health is a family,” Mindy said. “That’s why they are a part of our family.”

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‘Another bump in the road:’ COVID-19 from the perspective of UF Health cancer patients

Kacey Finch's picture
Submitted by Kacey Finch on August 6, 2020 - 09:01

Harvey and Ilene BuddBefore COVID-19, cancer patients were united by their fight against the disease, no matter the difference in type, location or stage. Today, they’re united by another battle; one outside of their diagnosis — the fight to stay alive while immunosuppressed during a global pandemic.

Anita Barrow, 47, an ovarian cancer patient at UF Health, knows what it’s like to battle the two deadly diseases at once. In May, Barrow contracted the coronavirus.

“It felt like fire in my sinus cavity, and I lost all sense of smell and taste,” she said.

She immediately contacted her UF Health Cancer Center oncologist, Karen Daily, D.O., who instructed Barrow to stop taking her oral chemotherapy immediately. Her immune system was already weakened and needed to focus on fighting one disease at a time.

According to the American Cancer Society, patients who are currently fighting cancer and some cancer survivors are at higher risk for COVID-19 due to weakened immune systems caused by cancer and chemotherapy. Being higher risk means a greater chance of catching the infection and a higher chance of developing severe pneumonia or multi-organ system failure.

“I wish I could tell the person who exposed me that I had to stop taking my cancer medication, which prolongs my healing process and puts me at risk of my cancer coming back,” Barrow said.

For Barrow, the worst part of contracting COVID-19 hasn’t been the symptoms or the delay of her cancer treatment — it’s been the quarantine.

“I haven't seen my oldest daughter and my granddaughter since Mother's Day,” she said. “It’s just heartbreaking.”

Harvey Budd, 72, agreed that living with cancer during a pandemic has been depressing at times, but he and his wife, Ilene, are thankful for the care they have received.

“Life has been a series of ups and downs — this is just another bump in the road,” he said. “We’re so lucky as a community to have UF Health around the corner.”

When Budd, a former Gainesville city commissioner and president of Budd Broadcasting Co. Inc., first started his cancer treatment at University of Florida Health in January, his visits were accompanied by smiling faces, busy parking lots, hot coffee machines, free snacks and an unguarded door.

Two months later, all of that changed when COVID-19 hit the United States. Now, the friendly faces are covered by masks, the parking lot is barren, coffee and snacks have disappeared, and patients and visitors are met at the door by a staffer waiting with a thermometer.

“I was doing social distancing before it was cool,” said Budd, who was diagnosed with the blood cancer, diffused large B-cell lymphoma. “Cancer and COVID-19 together makes you much more aware of the precautions you need to take.”

COVID-19 didn’t stop Budd and his health care team, including oncologist Nam Dang, M.D., Ph.D., from continuing his treatment plan. Every 21 days for five months, Budd and Ilene made the short trip from their Gainesville home to UF Health for a day of chemotherapy and lumbar puncture therapy, a procedure that puts chemo into the spine to create a barrier between the cancer and the brain.

By the end of his chemotherapy, Budd was officially cancer free. His positive experience at UF Health made him want to stay within the institution for his next form of treatment — radiation. He’ll be traveling from Gainesville to the UF Health Proton Therapy Institute in Jacksonville.

“We cannot say enough about Dr. Dang,” Budd said. “If we could have hugged him at the end of six chemo treatments, we would have — if COVID-19 wasn’t in the way.”

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With You Every Step of the Way: Continuity of Care for Cleft and Craniofacial Patients

Submitted by Dorothy Hagmajer on July 29, 2020 - 15:15

Each year, one in 700 children is born with cleft and craniofacial differences. These can result from abnormal growth patterns of the face or skull, which involves soft tissue and bones, and can include malformations stemming from genetics, disease, or environmental factors.

At UF Health, each patient is backed by a team of interdisciplinary practitioners who lend a holistic perspective to the care that accompanies the patient and their families every step of the way.

“Many people think that care for craniofacial differences and cleft begins and ends with a surgery,” said Jessica Ching, M.D., assistant professor in the division of plastic and reconstructive surgery in the UF College of Medicine. “In reality, we’re with these patients every step of the way.”

While care often includes surgical procedures, Ching and her team provide a wide spectrum of treatments and support for their patients even into adulthood. These needs change over time. In the early stages, one of the most vital things Ching looks for is adequate nutrition.

“Ensuring the babies are able to get the nutrition they need helps ensure they can avoid missing major developmental milestones,” Ching said.

Ching’s team creates a unique treatment plan for each patient tailored to their needs--incorporating those of the parents and guardians, too.

“When we think about what the child needs, we think of the parents, too,” said Holly Shenk, R.N., coordinator of the UF Health Craniofacial Clinic. “This can be a learning process for both child and parent, and one that can be alienating without the right support.”

One means of support for patients and families is the annual Craniofacial Camp. Free to UF patients, the camp gives kids the opportunity to spend four days developing coping skills and building self-confidence. This year, the camp will stay closed due to the coronavirus pandemic.

But families still have other ways to connect.

Shenk links patients with Facebook support groups made for families, by families. Although a social worker helps run the social media group, the space is filled with families offering resources and shared experiences on how to overcome challenges like bullying or anxiety.

“Our online support groups are a significant source of encouragement and advocacy,” she said.

The UF Health Craniofacial Center is also heavily involved with the Florida Cleft and Craniofacial Network, or FCCN. The cooperative group is composed of members from the University of Florida, Children’s Medical Services of the Florida Department of Health, regional and local family networks, and Florida health care providers.

“Like our center, it helps educate and empower both families and professionals with current knowledge and understanding of this population’s needs,” Ching said.

July is National Cleft and Craniofacial Awareness and Prevention Month.

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Staying Hydrated and Fit This Summer: Plank, Drank and Thank Us Later

Kyndal Rock's picture
Submitted by Kyndal Rock on July 29, 2020 - 09:00

Staying hydrated is essential in Florida's summer months, when the heat index can often reach triple digits. Dehydration can cause heat illnesses, and chronic dehydration can lead to other complications such as kindey stones. Roughly 60% of our bodies are made up of water—no wonder we need to replenish it daily!

Each summer, UF and UF Health employees take part in the Plank and Drank challenge to promote proper hydration and physical health. This year's challenge wraps up on August 2.

Each day, employees are encouraged to hold a plank position for a certain amount of time and document their water intake. The goal is for employees to strengthen their core muscles, while at the same time developing healthy habits for proper water consumption. Supplying the body with enough water can increase an individual’s cognitive and physical functions, and improve their overall health conditions.

While our challenge is ending - yours has just begun! Invite your friends and family to take part in your own home version this August.

UF Health Shands CEO Ed Jimenez displays proper planking technique.

Above: UF Health Shands CEO Ed Jimenez displays proper planking technique. “Hydration is the core of overall wellness." he said. "Medical professionals all believe that properly hydrating the body is important whether you are an athlete or someone working up on their feet all day long."

Drinking enough water

The National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is: 3.7 liters for men, and 2.7 liters for women. The Centers for Disease Control (CDC) recommend drinking one 1 cup (8 ounces) of water every 15–20 minutes while working in extreme heat, which would equal 24–32 ounces per hour.

Keeping a proper hydration level has many beneficial effects:

  • It maintains one’s body’s fluid balance, which regulates normal functioning like digestion and body temperature
  • It fuels muscles, lubricates the joints and boosts energy
  • It improves focus and promotes clearer thinking
  • It can create a feeling of “fullness,” which can contribute to weight loss

Why Planking?

In addition to taking in enough water daily, it is important to incorporate static core exercises, like planking. Planking has many benefits on the body including building strength, stability and frame of mind.

  • Planking strengthens one’s core muscles, which leads to better stability and performance of daily activities
  • Planking helps alleviate back pain by strengthening back muscles
  • Planking can enhance a person's mood by releasing “feel good” endorphins
  • Planking improves posture and balance

When doing these type of static core exercises, it is important for one to make sure they are using the proper form:

  • Plank from your hands or forearms
  • Maintain hands or elbows directly underneath the shoulders
  • Never clasp your hands when performing a plank
  • Keep your spine straight and head neutral (eyes forward, not looking up or down)

Keep a Record

Keep a log of your water intake and record the time you plank each day. Keeping a record helps for you to develop a routine and to see how you improve over time. You can use GatorCare's July 2020 Plank & Drank calendars as a start for creating your own!

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A Look Into Our UF Health Youth Gender Program

Submitted by on June 25, 2020 - 11:04

The University of Florida Health Youth Gender Program provides social, medical and mental health support to gender-expansive youth and young adults and their families. Our mission is to provide a safe space for youth while educating families and community members on gender-expansive and transition-related issues. We help empower our patients to make informed decisions with accurate information and take an active role in their care. The UF Health Youth Gender Program collaborates with Equality Florida and shares anecdotes of negative school and community youth experiences with Equality Florida’s TRANSaction project to target injustices, bullying and harassment in school districts across the state. We also connect patients and their families to legal services as needed, from name change assistance to filing complaints against a school district.

The program began in 2016 and was established by UF Health pediatric endocrinologist Janet Silverstein, M.D., who was determined to bridge the gap in care for gender-expansive people. We see more than 200 patients in addition to their families each year. Many of our patients are from rural areas across Florida, where gender-expansive resources are limited.

As a patient advocate, it is my job to share my experiences as a trans person with patients and provide resources, research studies and articles to demonstrate how we use evidence-based practices in our program. I advocate for gender-expansive youths’ needs in the practice and with their families. Often, we see youth who are invalidated and alienated by their families and their communities. Our program is often the only place in which patients can be themselves. As the patient advocate, I am usually the first trans person they’ve met, as many are used to being the “token trans kid” in their communities.

During Pride Month in June, it is important to recognize our history. In 1969, Marsha P. Johnson, a Black trans woman, and Sylvia Rivera, a Latinx trans woman, started a riot to combat LGBTQ oppression, and they are the main reason we have a Pride Month to celebrate today.

Learn more about the UF Health Youth Gender Program.

- Lucas Cole DeMonte, M.Ed., Ed.S., UF Health Youth Gender Program Patient Advocate

Other resources for Parents and Families:

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When your headache could be something more

Peyton Thomas's picture
Submitted by Peyton Thomas on June 9, 2020 - 09:00

A woman holds her head in pain.

Nearly everyone has an occasional headache, but when it becomes a regular occurrence, you may be suffering from a headache disorder. Migraine headaches are one of the most common causes of headaches and disproportionately affect women, according to Harvey Chim, M.D., F.A.C.S., a UF Health plastic surgeon who specializes in migraine surgery.

“Migraine headaches have certain characteristics that distinguish them from an ordinary headache such as originating from a certain area of the head,” Chim said. “They can sometimes cause light flashes and can be worse with certain triggers such as temperature, noise or menstrual periods.”

Migraine headaches affect 12% of the population worldwide and women make up 85% of those sufferers. Common symptoms include throbbing pain, nausea, vomiting, dizziness and sensitivity to sound, light, touch and smell. Medical treatment is the first line of defense to help ease the symptoms of migraine headaches.

While women make up a large majority of sufferers, migraine is common in people between the ages of 18 and 44. While the causes aren’t completely understood, the disorder is often hereditary. Diagnosis is normally made through a neurologist.

Luckily, people with severe, chronic migraines have surgical options to reduce their symptoms or pain. The surgery aims to decompress the sensory nerves around the skull that contribute to pain from migraine headaches. Chim says the procedure can immensely improve a patient’s quality of life and ease the pain caused by the disorder. There is more than 20 years of published evidence supporting surgery for treatment of migraine headaches.

June is Migraine and Headache Awareness Month and aims to raise awareness and recognition of migraine and other headache disorders. In recognition of this month, learn more about how UF Health can help treat your migraine headache.

Best-Case Scenario

Devin Nori's picture
Submitted by Devin Nori on June 4, 2020 - 08:00

When a brainstem tumor almost took Mycah’s life, her UF Health pediatric neurosurgeon prepared a plan to save her.

Just weeks before her eighth birthday in late November 2018, Mycah Moody began feeling fatigued. When she started losing weight, could barely eat without choking and was coughing constantly, her parents took her to the nearest emergency room, where she was told she had a virus that would pass with time.

The symptoms persisted and, at her birthday party, her lips turned blue. She was rushed back to the local emergency room, only to be given the same diagnosis. She was instructed to stay hydrated and get more rest while the virus ran its course.

A week later, on the morning of Christmas Eve, the family received news that a relative had passed away. When Susie, Mycah’s mother, went to wake up her daughter, Mycah was lethargic and her eyes were shaking. Susie immediately rushed Mycah to UF Health.

Mycah MoodyWithin an hour and a half of being at UF Health Shands Children’s Hospital, Mycah was diagnosed with a large tumor in her brainstem. The brainstem is the most critical and sensitive region of the brain, which controls basic life functions such as breathing, heartbeat and swallowing.

Mycah was quickly admitted to the UF Health Pediatric Intensive Care Unit, where she was hooked up to IV fluids and given steroids. Teams of health care workers came into her room all throughout the night to run tests and confirm her diagnosis. After reviewing her MRI scan, UF Health pediatric neurosurgeon Jason Blatt, M.D., prepared a treatment plan.

“Mycah was in the process of dying from her tumor when we met her,” said Blatt, an assistant professor in the UF College of Medicine’s Lillian S. Wells Department of Neurosurgery. “She was listless, could hardly talk, and was eating poorly because the tumor was affecting the nerves that controlled her speech and swallowing.”

Blatt decided a craniotomy was needed to access the tumor. This procedure would involve removing the back lower portion of Mycah’s skull, then separating the two halves of the cerebellum to expose the delicate brainstem and the tumor within. Before the surgery, Blatt briefed Mycah and her family on the implications of the procedure — Mycah might rely on feeding and breathing tubes for the rest of her life and need extensive, lengthy treatment for the tumor.

“Parents often think that goal No. 1 of surgery is to get the tumor out. That’s actually goal No. 2,” Blatt said. “Goal No. 1 is to keep the patient, in this case Mycah, safe.”

Mycah Moody plays pianoDuring the seven-hour surgery, Blatt was able to remove 98% of the tumor, leaving the last tiny bit stuck to a critical blood vessel to prevent giving Mycah a devastating stroke. He determined that the tumor was a Grade 1 pilocytic astrocytoma, a benign tumor seen mostly in children, and Mycah would not need any chemotherapy, radiation or further procedures.  

“We were expecting the worst-case scenario and came out with the best-case scenario,” Susie said. “Dr. Blatt is amazing. I can’t stress that enough. He could not have been more incredible with my daughter and my family.”

Now, a little over a year later, Mycah is at the top of her class. She loves playing piano, reading and watching YouTube, and she only returns to UF Health for check-ups every six months. Her singing voice has returned, a pastime she loves, and she is back to normal activities. This one procedure changed the entire course of her life, and she has returned to her happy, healthy self.

Get the answers to cancer-related COVID-19 questions

Submitted by on May 26, 2020 - 09:02

Brenda Sheptock, RN, Beverly Fitzhugh, RN and Criscina Collins, LPN, at the UF Health Medical Oncology – Davis Cancer Pavilion

Stay-at-home restrictions are beginning to lift in several areas across the United States, but immunosuppressed cancer patients are still at high risk of falling seriously ill from the novel coronavirus COVID-19.

In a recent University of Florida Health Cancer Center webinar, “COVID-19: What People with Cancer Need to Know,” Merry-Jennifer Markham, M.D., FACP, FASCO, associate director for medical affairs for the UF Health Cancer Center, discussed how to navigate cancer during the COVID-19 pandemic.

Here, Dr. Markham answers some cancer-related COVID-19 questions:

Is it safe to delay my cancer screening test or risk-reducing surgery if I have a hereditary cancer syndrome? How long is it safe to delay?

For patients with an increased risk of cancer due to a hereditary syndrome, the safety of delaying a cancer screening or a risk-reducing surgery depends on the individual patient and their medical history. Patients and their doctors must weigh the risks associated with not delaying — the risk of becoming very ill with COVID-19 if exposed during a health care visit versus the risk of cancer being diagnosed through a screening test.

It is unknown how long it is safe to delay preventive cancer surgery. However, it is important to note that your doctor will only suggest delaying screening or surgery if it is safe for you to do so.

Does my cancer treatment cause immunosuppression?

According to the American Cancer Society, cancer patients fall in the high-risk category due to weakened immune systems caused by cancer and its treatments. Being high risk means cancer patients are more likely to become seriously ill from COVID-19, which could include requiring hospitalization, developing pneumonia or developing multi-organ system failure.

The type of treatment a patient receives factors into their immunosuppression.

So, what treatments cause immunosuppression?

  • Chemotherapy does. Immunosuppression can be measured by the white blood cell count. However, sometimes the immune system is weakened even if the white blood cell count isn’t lowered. There is no definite answer on how long immunosuppression from chemotherapy can last. It often depends on the type of chemotherapy and the type of cancer.
  • Immunotherapy doesn’t. In some cases, this treatment option can actually strengthen the immune system. However, doctors are not sure what impact it has on COVID-19 infections or symptoms.
  • Biologic agents may or may not. Many times, they don’t affect the immune system, but this may vary by medication. It is important to discuss your personal risk with your doctor.
  • Radiation does. Radiation is known to cause immunosuppression for some period of time.
  • Surgery does. Immunosuppression from surgery may last for about a month, but it also depends on the type of surgery. For example, a splenectomy (surgery to remove the spleen) may result in chronic immunosuppression to some degree since the spleen plays a large part in the body’s normal immune function.

Are some cancers associated with higher risk for COVID-19 infections or complications?

Since there are still many unknowns about COVID-19’s effect on cancer, the best answer available right now is probably. Cancers associated with the immune system, such as blood cancers, and cancer affecting the lungs likely put patients at higher risk of more severe COVID-19 infections and/or complications.

How do I find a cancer clinical trial during COVID-19?

It is recommended that you ask your cancer care team for help finding a clinical trial. You can also:

When stay-at-home restrictions lift, what should I do?

Coronavirus is still circulating in our communities — some more than others. Just because the stay-at-home restrictions will begin to lift soon does not mean that the risk of contracting COVID-19 has gone away. It is likely that we will see another wave of COVID-19 cases and deaths when nonessential businesses reopen.

Continue to stay at home and avoid public places as much as possible, especially if you are high risk and/or immunosuppressed.

To get the answers to other COVID-19-related questions about cancer, watch Dr. Markham’s webinar. For more information of UF Health's response to COVID-19, visit coronavirus.ufhealth.org.

Giving patients back the hope of having a family

Kacey Finch's picture
Submitted by Kacey Finch on May 21, 2020 - 09:00

A man and woman hold hands in the sunshine. Intertwined in their hands are tiny baby shoes.

Some cancer treatments can harm a patient’s fertility. The University of Florida Health’s Helping Oncofertility Patients become Educated, or HOPE, Network is on a mission to help preserve it.

“The goal of HOPE Network is to try to help young, reproductive age or prepuberty oncology patients understand what their options would be to preserve their fertility,” said Alice Rhoton-Vlasak, M.D., director of the HOPE Network.

The program works toward that goal by offering novel fertility preservation options to UF Health patients. Currently, the HOPE Network is the only fertility program in Florida that is trained in and offering ovarian tissue freezing, which became a standard procedure with published guidelines in January.

“Certain cancer treatments and surgeries can damage or destroy the ovaries and eggs, which leads to early menopause and infertility,” said Rhoton-Vlasak, a professor in the UF College of Medicine’s department of obstetrics and gynecology. “Ovarian tissue freezing is the newest option to preserve fertility.”

The treatment involves removing a piece of or the whole ovary, freezing the extracted ovary in tiny strips containing the follicles with eggs, and transplanting the strips back into the area of the ovary post-cancer. The ovarian tissue can be frozen indefinitely, allowing women to choose to implant the tissue when they want to start a family. When the tissue is transplanted, hormones and menstrual cycles can come back, restoring fertility and allowing natural pregnancy to occur.

“Those transplants don't usually work forever,” Rhoton-Vlasak said. “They have a lifespan of about three to six years. You could potentially transplant back another piece of the woman’s own tissue so that she gets longer benefit from the hormones. Even if they don't want more babies, those hormones are important for your bones and heart until the natural age of menopause.”

When fertility preservation treatments need to happen quickly as a result of a patient’s cancer treatment, the HOPE Network team is available, working around the clock to see patients in their times of need.

“It's important that we can see people rapidly so that we don't delay their cancer treatments,” she said.

One way the program is able to see patients in a timely manner is with the help of the HOPE Network’s inpatient oncology patient navigator, Lauren Staley.

“I would say the biggest difference between what we do at UF Health and what other fertility programs do is that we have an inpatient nurse navigator, so services are available in multiple settings,” Rhoton-Vlasak said.

Staley saves patients a trip out of their hospital rooms by traveling to them, offering consultations and specimen collections in patients’ hospital rooms.

Operated through the division of reproductive endocrinology and infertility in the UF College of Medicine’s department of obstetrics and gynecology, the HOPE Network consists of a diverse team of health care providers including physicians, nurse coordinators, nurse navigators, psychologists, financial counselors, radiologists, surgeons and embryologists.

Some fertility treatments are not covered by insurance, but patients have the opportunity to receive grant funding that is generously donated to the HOPE Network by the Climb for Cancer Foundation, Rhoton-Vlasak said. Over the past seven years, Diane and Ron Farb, founders of Climb for Cancer, have donated thousands of dollars in grants to help build the program, covering resources such as patient education brochures, provider meetings and patient consultations.

The HOPE Network offers a variety of fertility treatment options for men and women. Men have the option of sperm banking, while women may freeze eggs, freeze embryos or use a medicine that may protect the ovaries from chemotherapy.

“Almost 100% of postpubertal male patients will bank sperm; it's less expensive and causes no therapy delays,” Rhoton-Vlasak said. “For female patients, fertility preservation options are more complex and take more time, visits and money so less women do it, but probably an equal number of men and women get counseling at UF Health.”

The HOPE Network lives up to its name — giving patients back the hope of having a family.

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Like A Water Balloon in a River

Devin Nori's picture
Submitted by Devin Nori on May 14, 2020 - 09:00

Kayden LeeWhen Madeline Lee went to her 28-week prenatal checkup, she was not able to see her son’s head in the sonograms. Her doctor later determined that the fetus had abnormal fluid in his brain and referred Madeline to UF Health in Gainesville.

“Needless to say, the results tore me apart,” Madeline said. “They were not at all what I was hoping to hear.”

When she got to UF Health Shands Children’s Hospital, she and the baby’s father, Markieth, met a team of specialists who quickly provided a diagnosis. Their baby boy, Kayden, had an arachnoid cyst, the most common type of brain cyst. This fluid pocket is lined by the arachnoid mater of the brain, which resembles a spider web when analyzed under a microscope. Oftentimes, those with arachnoid cysts do not exhibit any symptoms and, if stable, the cysts do not require treatment.

David Burchfield, M.D., chief of neonatology, decided that when Kayden was born, he would be immediately sent for imaging, be seen by pediatric neurosurgery, and would be admitted to the neonatal ICU at UF Health Shands Children’s Hospital for monitoring. Sure enough, a few weeks later, Kayden was born and the plan went into effect.

Lance Governale, M.D., chief of pediatric neurosurgery, saw Kayden shortly after birth and did not find signs of increased pressure in the head. Kayden also had an MRI, which showed that the cyst was still there, but it had not expanded. Therefore, there was no reason to rush the baby into surgery, and Madeline and her son eventually went home. In order to keep a close watch on the cyst, another doctor’s visit and an MRI were scheduled for a month later. This time, Governale discovered that the cyst had enlarged and knew he needed to take action.

“I describe an arachnoid cyst like a water balloon in a river, with the river being the naturally flowing cerebrospinal fluid that bathes the brain and spinal cord,” Governale said. “To treat the cyst, you don’t need to remove it. Instead, you make holes in the cyst wall so that its fluid flows with the surrounding normal fluid.”

This procedure is called a minimally invasive endoscopic arachnoid cyst fenestration. Although placing a shunt tube is also an option, these can malfunction over a lifetime. Governale recommended the minimally invasive endoscopic option, and the family agreed. It was scheduled for the following week.

“We arrived to the appointment hoping and praying that the first surgery would go great so there wouldn’t have to be a second or third one,” Madeline said. “He (Governale) was able to perform a successful surgery so the fluid would drain on its own without needing a shunt.”

The procedure went very well, and the cyst significantly decreased in size. Since then, Kayden has experienced no health issues and the cyst has remained small. Now 20 months old, he returns for checkups with Governale every three months.

“When I say that Dr. Governale performed a miracle surgery on Kayden, he really did! The baby that was born with fluid in his brain is now a very healthy 1-year-old little boy,” Madeline said. “I will always be thankful for Dr. Governale.”

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Heather’s Lifelong Battle

Alisha Katz's picture
Submitted by Alisha Katz on May 5, 2020 - 09:00

Caption forthcoming

Heather Lowery’s parents were told that she would likely not live to be 3 months old. At 36, Heather has proved them wrong and has set an example for adults living with congenital heart disease.

At 8 months pregnant, Heather’s mother learned from physicians that Heather’s heart was not developing correctly. When she was born at UF Health Shands Hospital on July 9, 1983, her heart rate, which should have been between 150 and 160, measured at 60 beats per minute. Doctors discovered that the baby from Starke was born with congenitally corrected transposition of the great arteries, a complex defect where the heart’s two ventricles along with the two great arteries are reversed.

She was observed and recovered in the neonatal intensive care unit for her first two weeks of life and, at 3 months old, underwent her first of 20 pacemaker-related procedures.

At around age 4 or 5, Heather started to see Jay Fricker, M.D., pediatric cardiologist at the UF Health Congenital Heart Center.

“We’re like family, we’ve been part of each other’s lives for so long,” Heather recalled. “He’s like another dad to me.”

At 9 years old, Heather underwent her first open-heart surgery to try and establish a normal blood flow pattern through her heart.

But despite the number of doctor visits, multiple surgeries and inpatient stays, Heather fondly remembers having a relatively normal life growing up. And while she was looked out for by those around her, including a school bus driver who would always urge her to sit at the front of the bus, Heather was determined to not let her disease define or stop her. As a student at Bradford High School, she even served on her color guard team and on her cheer squad.

Just as Heather entered adulthood at 18, doctors recommended that she have a second open-heart surgery to replace a heart valve. Heather was given the option of a pig valve, which would allow her to get through her child bearing years with the possibility of conceiving, but would likely require replacement in 10 to 15 years, or to have a mechanical valve which would complicate her having children because of the need for blood thinning medication. But when surgeons went to operate, they noticed that Heather’s valve could potentially be repaired without the need for a valve replacement.

Over the next 15 years, Heather married her husband, Ryan, a firefighter, and together they adopted a daughter, Emma.

But in 2018, Heather noticed a decline in her health. Fricker discussed with her and Ryan the option of a heart transplant.

“It scared me to death,” Heather said. “It went from scary to really scary.”

Heather underwent a transplant evaluation over several months, and was also transitioned from pediatric to adult cardiology care during that time.

In early 2019, Heather experienced outward signs of heart failure with her body retaining too much fluid and her feeling constantly short of breath. She was admitted to UF Health Heart & Vascular Hospital on multiple occasions.

Heather was seen by Philip Chang, M.D., director of the pediatric and congenital heart electrophysiology program at the UF Health Congenital Heart Center. Chang monitored her heart’s electrical wiring, including her pacemaker.

On May 31, 2019, Heather underwent a complex procedure with Chang to change her existing pacemaker to a combined implantable cardioverter-defibrillator and cardiac resynchronization pacemaker device to protect her in the event of life-threatening arrhythmias, which heart failure patients can be at risk for, and to try to improve her heart failure.

During her hospital stay after the device was implanted, Diego Moguillansky, M.D., M.S., co-director for the adult congenital cardiology program at the UF Health Congenital Heart Center, cared for Heather and gained a deeper understanding of her medical history.

Despite the change in her cardiac device and very close attention to her medication doses, Heather continued to retain fluid. Gaining even three pounds over one night triggered discomfort, and resulted in swelling in her face, neck and chest. Moguillansky strongly recommended a third open-heart surgery to replace a leaky valve that was likely contributing significantly to her heart failure and could not be adequately addressed with medications alone.

“My husband and I talked about it, prayed about it, and, just before the holidays last year, decided to go through with the surgery,” Heather said.

On Feb. 6, 2020, Mark Bleiweis, M.D., director of the UF Health Congenital Heart Center and chief of congenital cardiothoracic surgery, performed a complex 12-hour valve replacement surgery and implanted an On-X™ mechanical valve.

“We love him. He’s one of the best, stand up guys I’ve ever seen,” Heather said. “He doesn’t make you feel rushed or make you feel like he’s not listening. He is a phenomenal guy.”

Heather stayed in the pediatric cardiac intensive care unit for nine days and was attended to by multiple nurses; intensive care unit physicians; Jana Reid, APRN, a member of the adult congenital cardiology team; Moguillansky and Bleiweis. Together, they monitored Heather’s vitals and encouraged her throughout recovery.

“My hope and prayer is that I won’t have any fluid buildup, and I’ll be able to not be short of breath,” Heather said.

Only time will tell if Heather will need a heart transplant, the next step that would need to be taken if she continues to experience symptoms of heart failure.

But in the meantime, Heather looks forward to doing a little more than before. She looks forward to not having daily weigh-in rituals and has always wanted to ride a bike.

As a volunteer at her daughter’s school, Heather enjoys watching her daughter attempt to ride a tricycle every Thursday. One day, she hopes to ride alongside her.

“I live each day like it’s my last and one day at a time,” Heather said.

Changing the Narrative of Cystic Fibrosis

Peyton Thomas's picture
Submitted by Peyton Thomas on May 4, 2020 - 08:00

There was once a time where cystic fibrosis, or CF, was considered a terminal disease. While this may have been the case years ago, patients diagnosed with CF now can work with their medical team to create a treatment plan tailored to the individual characteristics of their disease so that they can live a fulfilling and sustainable life.

“We are in an era of medications that are revolutionizing CF,” said Jorge Lascano, M.D., the director of UF Health’s adult cystic fibrosis program. “CF is no longer a death sentence, and the research we are doing will continue to help our patients live longer and better lives.”

CF, a genetic disease, affects a person’s organs, primarily the lungs, and creates a thick, sticky mucus in the body that can lead to blockages, damage or infections to the affected organs. Symptoms vary depending on the patient but often include persistent coughing and frequent lung infections — such as pneumonia or bronchitis — that can require aggressive treatment, as well as issues with bowel function.

The disease is most commonly diagnosed at birth thanks to CF gene screening. Physicians can now also diagnose people later in life who may have a mild form of the disease not detectable at birth. This is done by looking for specific genetic mutations.

“The disease does not occur more in male or female patients, but it is typically more common in Caucasian patients,” said Lascano, an associate professor of medicine in the UF College of Medicine. “As we take care of a very diverse population here at UF Health, we continue to help patients with CF from different races and backgrounds.”

Once diagnosed, patients can require three to four hours of treatment each day and must work with their provider to create a personalized treatment plan to improve their overall quality of life. Physicians must work to help support the patient’s goals and lifestyle to ensure consistency and effectiveness, according to Lascano. UF Health’s CF program prioritizes the importance of comprehensive care for its patients to develop their plan, supporting adults and children as they reach the critical transition from pediatric to adult practices. UF Health’s CF program has created transition practices both locally and remotely to assure patients are ready to move on with their lives once they transfer services.

“Our team is complete with a multidisciplinary staff so when patients visit our clinic, they can see every specialist in one trip, including our endocrinologist, gastroenterologist and ENT,” Lascano said. “This is important specifically for the large number of patients who travel from out of town to receive our care.”

This month, the UF Health’s CF program will host its second North Central Florida CF conference, bringing together professionals from multiple disciplines to learn and discuss the changes in CF care. UF Health joins the Cystic Fibrosis Foundation in celebrating CF Awareness Month to help others learn about how the disease impacts the lives of those affected.

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Al Benefits From UF Health Urology, Cardiology Tag Team

Leah Harms's picture
Submitted by Leah Harms on April 30, 2020 - 09:00

Al Johnson and his wife

Al Johnson has lived in Georgia for most of his life. After owning a successful auto repair shop in the area for 20 years, he had to retire his business right next door due to his unexpected health issues. This was crushing to him after building a business he truly loved.

“I’d probably still be working if it weren’t for all my medical issues,” Al said.

Al’s health changed significantly in 2010, when he got diagnosed with prostate cancer at 58. After months of misdiagnosis, discussions of having his prostate removed, cancer spreading into his lymph nodes and radiation, he didn’t know what his future looked like. As a man of faith, he trusted God to help him through and get him to the right physicians.

In 2014, he finally was able to come to UF Health and get the help he needed. Dr. Larry Yeung, in the UF Department of Urology, evaluated him and after some testing and maintenance, installed a suprapubic catheter for Al. Two years later, Dr. Yeung coordinated a colostomy operation with Dr. Sanda Tan.

After some initial success, his bladder was removed, and he was also given a urostomy bag. While it was a painful process, Al knew he found a hospital and physicians he could trust.

That discovery would soon pay off again.

In 2018, Al unexpectedly had a heart attack. Since he still lives in Georgia, he saw local doctors who performed angioplasty and placed a stent in the right coronary artery. They told him that he has a chronic total occlusion (CTO) of left anterior descending artery (LAD), and angioplasty or coronary artery bypass grafting (CABG) were not possible due to complexity of the lesion. He continued to experience angina and was eventually referred back to UF Health.

Al met Dr. Calvin Choi, an interventional cardiologist who leads the UF Health Chronic Total Occlusion clinic. After a lengthy discussion, Al remembers Dr. Choi guaranteeing that he would do his best.

Al said that reminded him of himself, so he trusted him. Al underwent a successful angioplasty of LAD CTO and is now doing well. He only has to return for once-a-year cardiac checkups.

“Dr. Choi called me and talked to me one night for 45 minutes,” Al said. “I’ve never had a doctor do that. It was like he was a family member.”

Al and his wife now come down here for his urologic and cardiac care. It’s a drive, but it’s worth it to them.

“That hospital has more caring people than any place I’ve been in my life.”

Testicular Cancer Awareness Month

Peyton Thomas's picture
Submitted by Peyton Thomas on April 28, 2020 - 09:00

A middle-aged dad plays basketball with his son.

This April, UF Health celebrates Testicular Cancer Awareness Month to inform and spread awareness about the importance of understanding this disease. Testicular cancer occurs when cancer cells form in one or both testicles and about 9,600 new cases are expected to be diagnosed this year in the U.S., primarily affecting young men in their late teens through early thirties.

The cancer usually presents itself as a mass, which may be accompanied by pain or swelling in the testicle(s). However, one of the biggest issues surrounding testicular cancer is patients waiting too long to be seen by a physician. According to Dr. Padraic O’Malley, MSc, MD, FRCSC, the time between when a patient identifies an unusual mass and when they seek medical attention is critical.

“The sooner we can identify the cancer, the more we can limit the amount of treatment the patient will need,” Dr. O’Malley said.

Since early detection is vital, monthly self-examinations are recommended to stay aware of any potential abnormalities. Once diagnosed, testicular tumors are removed in an outpatient surgical procedure, and the patient then goes through blood work and a CT scan. UF Health provides testicular cancer patients with a multidisciplinary group approach to evaluate these results and help the patient make any additional treatment decisions necessary based on the advancement of their disease. Survival outcomes are excellent for most men with testicular cancer and self-examination may not decrease this, but it may decrease the need for additional therapies, including chemotherapy, radiation or more invasive surgery.

“We work closely with the infertility group to encourage patients to bank their sperm,” Dr. O’Malley said. “Chemotherapy, surgery and radiation can affect fertility in some cases, but we work to encourage them to consider their future fertility desires.”

While these might not always be the easiest conversations, Dr. O’Malley walks patients through the process and common misconceptions through initial counseling. One of the most common concerns is the cancer’s effect on libido, masculinity and erectile function, which still remain healthy following surgery and treatment.

The best way to handle testicular cancer is being proactive. When a patient notices any unusual mass, Dr. O’Malley advises not waiting and expecting it to just go away. Early detection is crucial in tackling testicular cancer, and UF Health provides these guidelines for monthly self-examinations.

A Cancer Patient’s Guide to COVID-19

Submitted by on April 26, 2020 - 09:00

Two women health care providers talk while wearing masks.

Cancer doesn’t stop — not even for the novel coronavirus disease, COVID-19. The unknowns related to the virus are leaving people concerned, especially cancer patients who may have weakened immune systems as a result of cancer treatment and/or may be older.

The Florida Cancer Control and Research Advisory Council (CCRAB), North Central Florida Cancer Control Collaborative (NCFCCC) and the UF Health Cancer Center recently hosted the webinar “Cancer in the time of Coronavirus,” with Christopher Cogle, M.D., an oncologist and UF professor of medicine, and Amar Kelkar, M.D., a UF hematology and oncology fellow. They provided information for cancer patients, survivors, caregivers and providers on how to best navigate cancer treatment and survivorship during the coronavirus pandemic.

Here are their answers to some COVID-19-related questions that cancer patients may have:

What is COVID-19? How can I contract it? How can I prevent it?

Coronaviruses are a family of viruses that typically cause respiratory illness. COVID-19 is caused by a novel coronavirus originating from an outbreak in Wuhan, China.

COVID-19 causes respiratory illness and spreads from person to person through droplets released into the air by infected individuals. These droplets can also live on surfaces for several hours to days. Other people contract the disease by breathing in the droplets or touching surfaces they land on and then touching their eyes, nose or mouth. The most common symptoms of this coronavirus include cough, fever or shortness of breath.

Although there are no vaccines yet for COVID-19, prevention right now includes washing hands frequently, social distancing and wearing a mask to prevent touching your face.

To learn more about COVID-19, check out the Centers for Disease Control and Prevention’s fact sheet.

Am I at higher risk of becoming critically ill from COVID-19 because I have cancer?

According to the American Cancer Society, patients who are currently fighting cancer and some cancer survivors are at higher risk for COVID-19 due to weakened immune systems caused by cancer and chemotherapy. Another risk for many patients with cancer is older age. Being higher risk means a greater chance of catching the infection and a higher chance of developing severe pneumonia or multi-organ system failure.

When should I…?

Call my doctor?

You should call your oncologist as soon as you show symptoms, including fever, cough, shortness of breath, tiredness, diarrhea, dehydration, worsening cancer or cancer treatment symptoms, or if someone in your home tests positive for COVID-19.

Get tested?

Seek a COVID-19 test if you have a fever or cough. Call your primary care provider to discuss your symptoms. All community exposures will be referred to the Department of Health in your respective county; however, in order to streamline the process, please contact your doctor first. If you do not have a primary care physician, please contact the health department in your area. Residents of Alachua, Duval, Lake County, Marion and Sumter counties can find more information here.

Go to the hospital?

Try to avoid the hospital unless you have shortness of breath, low neutrophil count (also called neutropenia) and fever, or history of transplant and fever.

What precautions are my oncologists taking to protect me?

Your oncologist may reduce the dosage of your medication or radiation, delay surgery, delay the start of medication or radiation, use telehealth visits or home health care rather than clinic or hospital visits, or switch from medication injections to oral drugs. Your oncologist may also start using growth factors such as erythropoietin or G-CSF to boost your blood counts.

Doctors make these adjustments based on a balance between your risks for cancer progression or relapse and your risks for COVID-19.

Why isn’t my doctor delaying my cancer treatment during this time?

If your doctor is not delaying your treatment, it’s because of a high need to treat the cancer now. For example,

  • You have a disease with high-risk of progression or relapse.
  • Your surgery is time-sensitive.
  • There may be no alternative treatments available.
  • Without therapy, you may die in the next two to four weeks.
  • Your symptoms may not be controlled by oral medications.
  • You may have life-threatening complications from the disease.

Where can I look for accurate, up-to-date information about COVID-19?

Check out these resources for COVID-19 information and updates:

Provided by By Christopher Cogle, M.D. and Amar Kelkar, M.D..

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Putting Practice into Action

Alisha Katz's picture
Submitted by Alisha Katz on April 20, 2020 - 14:39

Dave poses with a fish he has caught.

For 18 years, Sandra “Sandy” Demasters-Reynolds, M.S.N, R.N., CCTC, has served as the living donor program manager at the UF Health Shands Transplant Center. But Sandy never really thought of becoming a living organ donor herself until organ failure affected a loved one of her own.

Sandy’s brother-in-law, Dave, was diagnosed with polycystic kidney disease, an inherited disorder that causes cysts to develop within the kidneys and disrupt kidney function. The 66-year-old knew his mother had kidney failure and was on dialysis, but he did not know what caused her kidneys to fail. Dave was diagnosed after his daughter was diagnosed with the disease in her early teens.

Dave, who lives on a farm in Tennessee, always kept himself busy. Whether it was tending to their horses or working multiple trades, he monitored himself routinely and continued to live an active lifestyle.

In the summer of 2018, Dave started to feel the effects of his disease. As his condition worsened, he had to initiate renal replacement therapy in the form of home kidney hemodialysis with the help of his wife, Billie, also a nurse.

Several days each week, Dave spent two to four hours on dialysis, with an additional hour and a half to set up and prime equipment.
“They were doing home dialysis and Billie sent a picture of him sitting on the dialysis machine smiling,” Sandy recalled. “I‘m like, ‘That’s not Dave, he’s much more active than that. He deserves a chance to get off of dialysis through transplant.’”

Sandy, who also previously interacted with many liver, kidney and kidney-pancreas transplant patients in the UF Health surgical intensive care unit, explained that patients who need dialysis often have to visit dialysis centers three days a week for hemodialysis. They cannot perform home hemodialysis for a variety of reasons, such as not having a support person to assist, having a difficult time performing dialysis at home and not living in an environment suitable for the dialysis to occur.

Dave was evaluated and placed on the kidney transplant list. He had four potential donors apply to donate a kidney but each living donor fell through, primarily because of preexisting conditions.

Sandy knew she couldn’t sit idle while Dave’s condition continued to deteriorate. She knew the average life of a patient on dialysis is five years. She wanted Dave and Billie to be able to enjoy the retirement they had worked so hard to prepare.

Sandra Demasters-Reynolds

So, Sandy started the process to become a living kidney donor. She completed an online application, submitted her medical history and physical labs and waited to be contacted. Since her brother-in-law lived out of state and was receiving care elsewhere, Sandy intended to travel to his home for care — if she was approved as a donor.

After passing the initial application and medical history component, Sandy traveled for a two-day evaluation that included ensuring her kidneys were functioning properly and that she could function without the need for both kidneys.

Doctors approved Sandy for the procedure, but there was a caveat: She was not the correct blood match for her brother and, therefore, could not donate her organ to him.

Instead of being Dave’s living donor, Sandy and Dave were registered on the paired kidney donation list. Part of the living kidney donor program, paired kidney donations are situations when a recipient and donor who do not match blood types find another recipient and donor in the same situation, and swap organs.

Sandy explained that there are many misconceptions surrounding living donor programs, one myth being that a person cannot be a living donor if they are not blood-related. Other misconceptions include believing that their religion won’t support organ donation when, in fact, all major religions in the U.S. support living and deceased organ donation — even those that are against blood transfusions. Other common misconceptions include that a person cannot live with one kidney and that they’ll need another later in life, as well as the belief that out-of-pocket costs for the donor will be too high.

In general, living donors need to be between the ages of 18 and 70. Donors must be willing to donate, have a blood type that is compatible with the recipients, or agree to paired donation, as well as not have diabetes, or high blood pressure that requires being on multiple blood pressure medications.

“I knew paired donation was our only option. I knew with the paired donation, we’re not only helping my brother-in-law and the other paired recipient get a kidney, but two others can receive a deceased donor kidney,” Sandy said. “Four people in need of a kidney transplant were helped. Two receiving a living donor kidney, which removed them from the deceased donor list and allowed two deceased donor kidneys to go to other candidates in need of a transplant.”

Dave and Sandy together in the hospital.

On Dec. 2, 2019, Sandy received a call that there was a potential pair and, if everything worked out, the surgery would take place on Jan. 2, 2020 — one day before her 60th birthday.

Prior to the procedure, Sandy reached out to longtime colleague Kenneth Andreoni, M.D., a transplant surgeon and the chief of transplantation surgery at the UF Health Shands Transplant Center, to connect with her surgeon.

The transplant program at UF Health has been part of three-way and two-way swaps. This involves staff at both transplant centers coordinating operating room times for donors, kidney travel from one center to the other and the recipient surgery to transplant the donated kidney.

After the surgery, Sandy spent two days in the hospital and four to five weeks recovering before returning to work. She will have routine six-month, one-year and two-year follow up appointments in Gainesville. Dave is recovering well and adjusting to life as a transplant recipient.

This experience has expanded Sandy’s role at the UF Health Shands Transplant Center far beyond a program manager. She’s not only a donor herself, she’s become an advocate for other living donors and a community speaker about living donation.

“I feel I have a new purpose in life, to share about living donation and paired donation. I want to share my story to encourage other potential living donors,” she said.

Sandy makes it her mission to visit all of the living donors from UF Health to answer any questions they might have about the recovery and to say thank you.

“I feel it is important to visit our UF Health living donors,” Sandy said. “I am another face to say thank you because I feel they cannot hear it enough. A living donor has agreed to have a surgery they do not need in order to help another person. What a selfless gift! And the donor may not realize they have helped more than one person.”

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Facts and Benefits of Organ Donation

Peyton Thomas's picture
Submitted by Peyton Thomas on April 16, 2020 - 10:30

Graphic that says April in National Donate Life Month

Today, there are over 110,000 people nationwide on the organ transplant waiting list hoping for a life-extending donation. Unfortunately, 8,000 people on this list die each year waiting for an organ. Despite 40,000 lifesaving transplants last year, there is still a significant shortage of donors. To help bridge this gap in supply and demand, Donate Life America has designated April as National Donate Life Month.

The month is devoted to raising awareness about organ donation and encouraging people to register.

Kenneth Andreoni, M.D., chief of the UF College of Medicine’s division of transplantation surgery, has witnessed an increase in the age and comorbidities of donors, as well as the complexity of comorbidities of the recipient patients the program treats.

Misconception plays a major role in people’s choice to register for organ donation, and National Donate Life Month helps to clear up these myths. Right now, despite 95% of adults in the United States supporting organ donation, only 58% are registered donors. There needs to be a drastic shift in perception of organ donation to fix this problem, and that starts with education.

“It’s important for people not to assume that they can’t be a donor for a variety of reasons,” Andreoni said. “Most people can donate something, whether it’s an organ or tissue, which can save dozens and dozens of lives down the road.”

Luckily, registering as an organ donor has never been easier. Many states allow people to register upon getting their driver’s license, making the information easily accessible moving forward. In addition to helping the lives of strangers in need, this decision can also aid loved ones in the event of an accident.

“It’s wonderful that with the current laws around the country, and especially in Florida, that you can simply show your willingness to donate on your driver’s license,” Andreoni said. “That’s an active step made by the person, which is extremely simple and kind to family members because you’re not burdening them with that decision. It’s a lot smoother for the family to know that their loved one wanted to donate.”

After this impactful decision is made, it goes a long way. One donor alone can save or drastically improve the lives of eight or more people, and donations don’t always have to occur postmortem. Living donation serves as a viable option, especially in cases of kidney and liver transplantation, and saves the life of both the recipient and the next person on the waiting list.

“A large number of transplant patients do extremely well, improving the quality and timespan of their life,” Andreoni said. “It also drastically increases the productivity of their life, meaning they can be employed again and be involved with their family’s lives again, which is of value hard to measure.”

National Donate Life Month helps tie all the facts and benefits of organ donation together, and serves as an important stepping stone to solving the issue of donor shortages. Learn more about how to register to be an organ donor and about the UF College of Medicine division of transplantation surgery.

Helping Kids Keep From Spreading COVID-19

Lauren Gajda's picture
Submitted by Lauren Gajda on April 6, 2020 - 09:00

During the COVID-19 crisis, it is important to create a sense of safety for children. These are uncertain times, and our kiddos might be feeling anxious — or maybe even sad or scared. There are a lot of unknowns, which can lead to a sense of losing control.

Our UF Health Shands Child Life specialists say it is important to give children specific examples of what they can do to stay safe. A list of who is helping them stay safe often provides comfort, too.

One of the most important things kids can do to help prevent the spread of COVID-19 is wash their hands in addition to practicing social distancing.

Here are some fun ideas and resources to help youngsters with hand-washing:

Kids should sing a song while washing their hands to make sure they wash for at least 20 seconds. They can sing the Happy Birthday song or the Alphabet song. Another idea is to have them sing the kid-favorite Baby Shark song. There is even a new hand-washing version.

Let your children know there are many people out there who are monitoring the COVID-19 situation and taking care of the details in order to prevent the spread of the virus, as well. Our helpers include:

  • Parents/caretakers
  • Teachers
  • Legislators
  • People working in health care
  • People working at stores to keep your kitchen stocked

There are many more helpers out there. Ask your kids if they can think of others. And remember — always wash your hands!

Protect the Skin You’re In

Peyton Thomas's picture
Submitted by Peyton Thomas on April 4, 2020 - 19:28

Woman running on a sunny day.

Soaking up the sun can feel harmless, especially when you’re lying by the beach or spending time with friends and family outdoors. But when they’re caught up in the fun, many people forget to consider the negative effects the sun can have on their skin. Unprotected exposure to the sun’s ultraviolet, or UV, rays is one of the leading causes of skin cancer, the most common cancer in the U.S.

The two main groups of skin cancer are nonmelanoma cancers, basal and squamous cell carcinoma; and melanoma cancers, which are less common but more aggressive. Each year, between 2 and 3 million people are affected by nonmelanoma cancers, and about 132,000 people are affected by melanoma cancers. According to Mark Leyngold, M.D., a plastic surgeon at UF Health Plastic Surgery and Aesthetics Center, each type of cancer can look very different.

“The most common signs of skin cancer are any abnormal bumps, moles or discolored spots that linger,” said Kathryn Hitchcock, M.D., Ph.D., a radiation oncologist at UF Health Radiation Oncology.

Other warning signs include rapid skin lesion growth, irregular borders, bleeding or pain, according to Leyngold. It’s important to stay alert of these warning signs because treating early detected skin cancers is much easier than the treatment process for cancers that have progressed over time.

Skin cancer is often identified by a primary care provider or dermatologist, where a sample is taken of the suspicious area and sent for lab testing. If the sample tests positive, surgical removal is used to initially treat the cancer.

“After surgery, a multidisciplinary team reviews the pathology to discuss the next steps for the patient,” Hitchcock said, “In some cases, we identify perineural invasion, which is when cancer cells use the nerves as a highway to attack other parts of the body.”

If the team sees perineural invasion or a similar spread of cancer cells, the patient will need more treatment, typically radiation therapy to attack the cancer. Even if the initial surgery removes all signs of the cancer cells, some patients will need additional reconstructive surgery using skin grafts or flaps to completely repair the affected area.

At UF Health, our specialists work together to ensure every patient is provided with the best method of care. While skin cancer can create a difficult journey for those affected, there are many steps you can take to reduce your risk.

“Everyone should be protecting their skin with at least SPF 30 or greater when spending time in the sun,” Leyngold said. “But sun exposure should be limited. It’s especially important to avoid tanning beds at all costs.”

In addition to limiting exposure to UV rays, visiting your dermatologist at least once a year is recommended to help detect any possible signs or symptoms of skin cancer. UF Health Dermatology identifies and treats a full spectrum of skin conditions for general adult and pediatric patients, and serves as one of the most comprehensive dermatology practices in North Florida.

The Ride of Her Life

Kacey Finch's picture
Submitted by Kacey Finch on March 17, 2020 - 10:00

During her monthlong stay at UF Health, Davis-Quinney had the support of her husband and sister.”

Sandra Davis-Quinney has met bumps, curves and stops on her cancer journey. Even with the rough roads she’s traveled, Sandra tries to remain hopeful, resiliently staying on the ride.

Her determination brought her to UF Health Cancer Center’s Jack Hsu, M.D. After multiple rounds of chemotherapy from 2017 to 2019 were unsuccessful against her non-Hodgkin’s lymphoma, Sandra’s next option was a stem cell transplant. However, when her physicians were unable to collect enough stem cells for a transplant, that option was taken off the table. Heading home to Jacksonville to get back on medication and let her body “get itself together,” Sandra met with her UF Health Jacksonville oncologist, Joseph Mignone, M.D., and began looking into other available options.

When she learned at UF Health about the novel chimeric antigen receptor (CAR) T-cell therapy, a genetic therapy that modifies the patient’s own cells to attack their cancer, she knew her ride was just finally gaining momentum. Sandra was a candidate for the treatment, but she wasn’t just any candidate — she was the first CAR T-cell patient at UF Health.

Hsu and his UF Health Bone Marrow Transplant Unit team spent two years preparing to become certified as a CAR T-cell therapy site — developing policies and procedures, building relationships with those in other subspecialties and earning an accreditation for a stem cell lab. In October 2018, UF Health became a designated site for administering the therapy.

“This is the first genetic therapy that was approved for the treatment of adult hematologic malignancies,” said Hsu, a clinical associate professor of medicine in the UF College of Medicine. “It provides another option for patients who have very-high-risk lymphoma.”

Dr. Jack Hsu was on-call 24/7 during Davis-Quinney’s treatment.

The reality of being the first CAR T-cell patient at UF Health didn’t sink in for Sandra until the process was set in motion, she said. She had heard about different clinical trials and new treatments, but now she was the star of the show in one of them.

“Being the first patient is a big deal,” she said. “If it affords other people the opportunity and the availability is here for them, then that’s great.”

The initial extraction of her cells wasn’t what she expected. She imagined it would be invasive and painful, but the procedure ended up being more like drawing blood.

“You feel different in your body because they extract the blood, extract what they need from the blood, and put it back into your body,” Sandra said. “I was freezing cold, but it wasn't painful.”

Going through the actual CAR T-cell therapy was a different story. Because she had been through multiple rounds of chemo, Sandra said the therapy itself was bearable.

“It was not pleasant at times, but it wasn't really bad until I went through the process of where I had to go to the intensive care unit,” she said.

There are two possible major side effects to the treatment — cytokine release syndrome, which causes patients to develop swelling and their blood pressures to drop; and neurotoxicity, which causes changes to patients’ mental status, Hsu said. Sandra developed both.

“Getting her through that, since we didn’t have practical experience before this, was very exciting because although we knew what to expect, actually seeing it was a different experience,” Hsu said.

Because she developed neurotoxicity, Sandra doesn’t remember the week she spent in the intensive care unit. For days, she was coherent and talking, but there’s a gap where the memories of those days should be.

Although her body is still adjusting to life after CAR T-cell therapy, an evaluation three months after her therapy revealed the news Hsu, Sandra and her family longed to hear — her lymphoma is in complete remission.

“No pain, no gain,” Sandra said. “I just do what I need to do and live life as a happy day every day.”

Hsu said treating the first CAR T-cell patient at UF Health was scary yet exciting. He was confident in the policies and procedures he and his team spent years perfecting.

“I'm happy to say that because we spent some time ironing out the details and trying to figure out potential points of failure, we didn't really have much of a problem,” he said.

The CAR T-cell therapy program at UF Health opens doors to new opportunities for patients, physicians and researchers. Now, UF Health can participate in CAR T-cell-specific trials and work with pharmaceutical companies to target other diseases.

“Developing this program gives us the ability to participate in trials of this class of therapy because not all facilities are going to be able to do this,” Hsu said.

CAR T-cell therapy is in active investigation, not only for other blood cancers like multiple myeloma but also solid tumors like colon cancer. These treatments will become an important therapeutic option for patients like Sandra, especially as similar therapies are further designed and explored.

The accessibility to novel treatments like CAR T-cell therapy is why Sandra says she chose UF Health. While her cancer journey hasn’t always been smooth, her determination to stay on the ride has led her to the finish line.

“There are challenges. There's days that I’m disappointed with what my counts are, but I don't let it discourage me,” she said. “I keep praying, driving, putting fuel in my tank and propelling forward.”

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5 Ways to Reduce Your Risk of Kidney Disease

Peyton Thomas's picture
Submitted by Peyton Thomas on March 12, 2020 - 11:03

graphic text reads world kidney day 12 march 2020
Today is World Kidney Day, a global campaign aimed at raising awareness about the importance of our kidney health. Kidney disease is a noncommunicable disease that damages your kidney function and affects more than 1 in 7 adults. This year’s theme is focused on how to prevent the onset and progression of the disease, so we’ve listed five ways to reduce your risks and protect your kidneys.

1. Get a screening from your doctor
Nine in 10 adults don’t know they have kidney disease. You can lose more than half your kidney function without realizing until it’s too late. Next time you’re getting an annual checkup, talk to your provider about getting screened. They’ll use a blood test and a urine test to identify if your kidneys are working as they should.

2. Manage your blood sugar
Diabetes is one of the most common causes of chronic kidney disease because it’s a condition where your blood sugar levels are too high. When your blood has too much sugar, the kidney filters that remove waste and fluid become damaged and are unable to perform their necessary functions. Improving your diet and exercise habits are key ways to maintain a healthy blood sugar.

3. Monitor your blood pressure
High blood pressure is the second-leading cause of kidney disease. This condition can damage blood vessels in the kidneys, which weakens their ability to work properly. Similar to kidney disease, people with blood pressure are often unaware because there are often no symptoms. In addition to getting checked at your annual physical, you can monitor your blood pressure for free at many pharmacies or by using an at-home, digital blood pressure monitor.

4. Eat a kidney-friendly diet
A healthy diet is beneficial for preventing diabetes and reducing the risk of high blood pressure, which lowers your chance of kidney disease. The National Kidney Foundation recommends cutting sodium, reducing red meat intake and limiting processed foods for a kidney-friendly diet.

5. Get active
Staying physically active also helps prevent the issues related to increasing the risk of kidney disease. Walking, biking, swimming and other aerobic exercises are all recommended to improve your overall health. Regular exercise helps maintain a healthy weight, control blood pressure and lower blood sugar, which helps make sure your kidneys are functioning properly.

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Some Things Can Wait. Colorectal Cancer Doesn’t.

Devin Nori's picture
Submitted by Devin Nori on March 6, 2020 - 09:56

Colorectal cancer is the third most common cancer in the U.S., and second-leading cause of death, taking 50,000 lives each year. However, thanks to years of raising awareness and education, there are currently over 1 million colorectal cancer survivors alive in the U.S. With the goal of keeping this number rising, March is National Colorectal Cancer Awareness Month.

Throughout the month, fundraisers and walks are held nationwide to bring survivors and advocates together for the cause. March 6 is Dress in Blue Day as a part of the ongoing social media campaign #TomorrowCantWait, urging individuals to get screenings and listen to their bodies when something is wrong.

Symptoms of colorectal cancer include changes in bowel habits, abdominal discomfort, rectal bleeding and fatigue. However, these symptoms are similar to those of other conditions, making people look past them initially. Oftentimes, by the time they go in for evaluation, the cancer has advanced. This is why colorectal cancer is often referred to as “the silent killer.”

This makes regular screenings an absolute necessity to anybody who is over 50 years old, or has a family history of colorectal cancer or lives with pre-existing conditions like genetic disorders, cancers or inflammatory bowel disease.

Luckily, when detected early, colorectal cancer is highly treatable. Most commonly, treatment includes some form of surgery. Early-stage colorectal cancer typically only requires a minimally invasive approach. But as the cancer advances, so does the complexity of the treatment. For serious cases, chemotherapy and radiation may be necessary.

Sanda Tan, M.D., Ph.D., a UF Health colorectal surgeon, has watched UF Health’s Gastrointestinal Oncology Center develop with a strong team of fellowship-trained specialists.

“We are a group of physicians who work together as a team,” said Tan, an associate professor of surgery in the UF College of Medicine. “We meet every Thursday at tumor board, where every rectal cancer gets presented, so each case has a whole team of physicians sitting in one room to come up with the optimum treatment plan.”

In addition to collaborative care, the program also has several clinical trials in progress to research new treatment techniques and methods. The team is currently evaluating how radiation time can be altered for certain cases and how surgery can be paired with chemotherapy to improve outcomes.

“The bottom line is that you have dedicated physicians working together and resources that are just a phone call away to help patients navigate each step of their care,” Tan said.

To learn more about how you can participate in National Colorectal Cancer Awareness Month, visit Colorectal Cancer Alliance for events near you and UF Health Gastrointestinal Oncology Center for consultation.

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From Bird Strike to Hope: The Story of Moe Ricks’s Optimism in the Face of Tragedy

Submitted by on February 21, 2020 - 11:24

In July 2019, staff wheeled Maurice (Moe) Ricks into surgery to prep him to receive a new heart and kidney, which were on a plane to Gainesville, Florida. The plane struck a flock of birds shortly after takeoff, rendering the left engine disabled. Pilots made an emergency landing at an airport near Atlanta. Despite everyone’s best efforts to quickly secure another flight to Gainesville, Moe’s new heart and kidney never made it to him. But that’s when a different kind of healing took place, one Moe describes as “healing for my soul.” Art sprang from tragedy, providing Moe a unique perspective on what it means to hope and persevere in the face of tragedy. Watch Moe’s story and see what care can mean at UF Health.

Download the song Waiting

Download the Song (MP3 file)

Contributors:

  • Ricky Kendall, Musician in Residence
  • Michael Claytor, Musician in Residence
  • Andrew Hix, Writer in Residence
  • Moe Ricks
  • Dr. Edward Staples
  • Diana Andersen-Davis, RN
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The Food that Fuels You

Devin Nori's picture
Submitted by Devin Nori on February 17, 2020 - 12:38

woman in athletic clothing standing at a kitchen counter cutting up fresh fruit for a smoothie
Many people use the start of the new year as a reminder to get back into their diet and exercise routine, but it’s important that we maintain these healthy habits throughout the entire year. In this spirit, the Academy of Nutrition and Dietetics deemed March as National Nutrition Month, devoted to the education and implementation of healthy living.

“I think it’s great to have a month dedicated to bringing awareness to the way we are eating, to what we are feeding our bodies and the kind of lifestyles we have that will contribute to our overall health. It’s good to take time to realize that food is fuel, nourishes our body and can greatly impact the way our body works if we feed it in a healthy way,” said Alba Osorio, M.S., R.D., L.D./N., a UF Health dietitian. “Unfortunately, we sometimes use food as comfort and for the wrong reasons.”

Food has many important roles in our bodies, such as being a modulator of inflammation and of gene expression, providing raw materials for structural support and membranes; it is also a controller of gut flora — good food and fiber feeds the good bacteria. Our gut bacteria has a huge influence on our health and studies have shown their role in vitamin synthesis, they are involved in bile acid metabolism and the production of neurotransmitters.

A key component to being healthy is listening to your body and understanding how much fuel it actually needs and what foods to eat. We can find ourselves turning to food when we’re stressed, bored or when we’re celebrating. This can create an association that has the potential to develop into an unhealthy dependency or emotional eating. One way to combat this is by monitoring what we eat through an app or a journal. This helps us visualize what we’re putting into our bodies each day and to find different and healthier ways to cope with those feelings, such as physical activity.

“Because of the type of busy lifestyles that we have there’s not a schedule for meals, so some people skip meals and choose to snack throughout the day instead,” Osorio said. “Of course, the kind of foods that they choose to snack on are fast foods and packaged foods rather than lean, nutrient-dense foods or fresh fruits and vegetables.”

By making small adjustments, like replacing cream and sugar from our morning coffee with fat free milk, we can make a long-term impact on our health. Another easy daily change is to read food labels before making purchases at the grocery store to further understand what makes up the meal.

As much as nutrition is viewed as an adult issue, our eating habits develop far earlier than we realize. As we grow up, so do our eating habits. However, it’s important to understand where these habits come from.

“Parents are the first models for kids to learn from, so they set an example by what they eat and also what they feed their kids,” Osorio said. “If they’re not being consistent by what they eat themselves and what they feed them, the kids are going to learn conflicting messages.”

Luckily, nobody is alone in their journey to a healthy lifestyle. UF Health provides a handful of programs and resources to help get patients on track and keep them there. Every third Thursday of the month, UF Health’s Metabolic and Bariatric Surgery team holds support groups for current and prospective bariatric surgery patients, promoting physical activity and healthy eating. To learn more about these resources, visit UF Health’s Bariatric Surgery Center.

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Keeping Your Kidneys in Tip-Top Condition

Peyton Thomas's picture
Submitted by Peyton Thomas on February 17, 2020 - 10:18

blue and purple image of kidneys
More than 30 million adults in the U.S. are diagnosed with kidney disease, and UF Health is committed to raising awareness about prevention. While only about the size of your fist, your kidneys perform vital functions for the body. Most people know they make urine, which extracts extra water and waste from your system. However, the kidneys also control your body’s chemical balance, blood pressure and red blood cell production. About 14% of the U.S. population experiences chronic kidney disease, which is a condition that impairs kidney function and affects around 850 million people worldwide.

Kidney disease is known as a “silent killer” because people often do not experience any signs or symptoms until the disease has advanced. According to Mark Segal, M.D., Ph.D., chief of UF Health’s division of nephrology, hypertension and renal transplantation, patients can lose 50% or more of their kidney function without even knowing it.

Diabetes, hypertension and family history relating to kidney failure are the most common risk factors of kidney disease. Racial disparities in the disease have shown Hispanics and Native Americans are at a higher risk for kidney disease due to increased frequency of diabetes and high blood pressure. African Americans are at higher risk due to increased frequency of diabetes, high blood pressure and genetic risk factors.

“Once you develop kidney insufficiency, you are much more susceptible to cardiovascular disease,” said Segal, an associate professor in the UF College of Medicine. “It’s important for everyone to take preventive measures and modifications to maintain health.”

At UF Health, our team offers access to subspecialty nephrology practices to ensure patients are treated by doctors with expertise in their specific condition. Physicians in these specialty areas diagnose the underlying cause of hypertension and provide specific treatment for acute kidney injury, which is the rapid loss of kidney function.

“Acute kidney injury can occur during hospitalization due to other conditions the patient may have experienced,” Segal said. “Having suffered from acute kidney injury, you are at higher risk of further kidney damage and cardiovascular disease. The physicians in this practice can stratify your risk and treat to minimize the possibility of further consequences.”

These practices help address all risk factors for the patient and determine treatment based on specific symptoms. UF Health is ranked by U.S. News & World Report as one of the nation’s top hospitals for nephrology. While kidney disease can be intimidating, there are many ways to help prevent it. Maintaining a balanced lifestyle through regular physical activity and healthy food choices is one of the best ways to keep your kidneys healthy. Foods that are high in antioxidants, vitamins or nutrients, such as apples, blueberries or salmon, are beneficial for kidney health.

Getting tested is essential to check on your kidney health. One of the easiest tests is measuring your blood pressure, which can be done quickly at your local drugstore. Other blood and urine tests can be handled by your primary care provider. This month, make it your priority to stay on top of your kidney health by getting tested and improving your lifestyle.

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A perfect match

Submitted by on February 14, 2020 - 13:38
If the best gift of all is life, then the second-best must be love.

Jessica Scoggins and Daniel Sullivan, both transplant recipients, met through their involvement in LifeQuest Organ Recovery Services support groups. They joined after their transplants and their hearts were shaped in a way they could have never expected.

In the spring of 2018, Daniel received a lung transplant at UF Health Shands. In the fall of 2018, Jessica received a liver transplant at UF Health Shands. Both found a sense of community in their support groups that motivated them to give back.

One day when Daniel and Jessica were volunteering at a LifeQuest event, people began to notice their compatible hearts for living life to the fullest and for promoting the importance of organ donation.

“The people we were volunteering with kept sending us on little adventures and errands together because they were trying to set us up,” Jessica said.

Support group members had a hand in getting Daniel and Jessica together.

Daniel, however, had a different take on their first meeting. “She was giving me the eye,” he said chuckling.

Jessica said she wasn’t expecting anything more than a friend, especially since Daniel would soon be moving to Spain. However, after growing closer, they realized it was worth it.

“With us both being transplant recipients, we know that whatever life we have in this second chance is precious, and we view life in the same way,” Daniel said. “Our time may be limited … you just never know. We try to enjoy the time we have together and make it the best possible.”

Understanding the importance of helping people through the transplant process, Daniel and Jessica use their time together to go to support groups or visit people who are beginning their transplant journey.

“As much as we care for each other, we really find joy in helping other people because what we’ve experienced is not the norm,” Jessica said.

LifeQuest provides an outlet for people to experiencing healing through joy-filled volunteering. Coral Denton, LifeQuest Organ Recovery Services public education coordinator, trains and matches volunteers to work events in groups that allow for relationship building beyond the event or organization. She seeks to build a community-like atmosphere with volunteers from all backgrounds, such as support groups, recipients, donor families and more.

Having trained both Jessica and Daniel, Coral has seen the way volunteering has allowed them to become more comfortable in sharing their stories, both publically and with each other.

“Since getting to know them both, I’ve seen them become more confident in telling their stories and caring for each other,” she said.

Daniel affirmed this truth about his relationship with Jessica.

“She’s felt the same things that I’ve felt,” Daniel said. “It’s so nice to be with someone who gets it.”

If you have a connection to organ donation and are interested in volunteering, please contact Coral Denton at dentcl@lifequest.ufl.edu or 352-733-0350.

This story was written by Emily Dunston, Strategic Communications Intern.
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The Gift That Keeps On Giving

Devin Nori's picture
Submitted by Devin Nori on February 12, 2020 - 08:37

A hand holding a red heart with the words proud to be an organ donor on it
Valentine’s Day is a time for loving, sharing and caring. We know what this means in the romantic sense, but what if there were a more meaningful way to celebrate the holiday?

Feb. 14, 2020 marks the 22nd annual National Donor Day, a day dedicated to spreading awareness about organ donation. National Donor Day focuses on more than traditional organ donation, highlighting the importance of tissue, marrow, platelets and blood donations.

Stephan Moore, UF Health Shands Transplant Center program director, has witnessed the impact of organ donation throughout his nearly seven years in the position. He has watched the program expand to new heights as the need for organ donors has continued to grow.

Right now, the demand outweighs the supply, leaving patients in dire need of organs without enough donors to contribute. As of July 2019, over 113,000 people are on the national transplant waiting list. With a list this massive and not enough organs to support it, an average of 20 people die each day waiting for a transplant.

While 85% of adults in the United States support organ donation, only 58% are registered as donors. Because many people are hesitant to become a registered organ donor based on misconceptions, the goal of National Donor Day is to close this gap through increased awareness and education. Some potential donors find the thought morbid, even though in 2018, over 6,830 transplants were from living donors who were able to contribute an organ, like a kidney, or portion of an organ, like a lobe of their liver. Others might think that one person registering can’t make much of a difference, but one donor can save eight lives or more by contributing organs such as the heart, pancreas, intestines, lungs, kidneys and liver (which in some cases can be dissected for two recipients), as well as eyes, skin, tissue and more. Organ donations aren’t just benefiting older sick people, either. Young individuals are also in need of organs for a chance to live life to the fullest.

“We’ve had patients experience strange reactions while giving birth that mess up their lungs. Lung transplants have been able to save lives of young ladies with young children, and allow people to take care of their families,” Moore said. “Transplants really allow people to get back to a normal life.”
Not only does organ donation save patients’ lives, it often helps grieving families to heal.

“Once the donor family gets past the trauma of losing their loved one, they come to the realization that someone was helped through their tragedy,” Moore said. “I get to read some of the letters that donor families receive from recipients, and many of them find comfort in knowing that somebody was helped through their loss.”

To learn more about how to register and advocate for organ donation, visit UF Health Shands Transplant Center for resources.

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Call Everyone: Bobby's Journey with CHD

Alisha Katz's picture
Submitted by Alisha Katz on February 7, 2020 - 07:38

Robert “Bobby” Murray, 34, was born in Hollywood, Florida on Jan. 23, 1985 – during a decade in which long-term survival into adulthood for a person with congenital heart disease was grim. He had two rare heart defects present at birth: tricuspid atresia, a heart valve defect that blocks blood flow; and transposition of the great arteries, meaning the two arteries leaving the heart are reversed.

Bobby underwent his first surgery just before turning 2 years old and another at 15 years old to palliate his complex heart condition with a Fontan operation, a complex procedure to bypass his missing right heart to provide pulmonary blood flow. But, thereafter, Bobby’s life felt seemingly normal for over a decade.

In 2007, Bobby’s left arm went numb. Bobby’s mother, a nurse practitioner, urged him to go the emergency room when doctors discovered blood clots had lodged in his left arm. Bobby underwent surgery to remove the clots, but two years later he had clots in his right arm. The clots, formed because of a dilated Fontan baffle, had Bobby and his mother traveling for care from South Florida to Orlando, from one opinion to the next. In 2010, Bobby had an additional operation to revise his Fontan to an extra-cardiac conduit.

But heart trouble found Bobby again, this time in 2012. He needed a pacemaker implant through open chest surgery to help control his heart rhythm. Bobby’s sternal precautions, which typically includes avoiding any significant weight lifting for eight weeks after surgery, were removed just in time for him to hold his first child, Skyler.
Over the next three years, Bobby experienced chest pains, constant fatigue and vomiting – he was in heart failure.

Frustrated and upset, Bobby’s mother sought another opinion. A colleague recommended Diego Moguillansky, M.D., director of the adult congenital cardiology program and an adult congenital cardiologist at University of Florida Health.

Bobby and a child in a selfie. Both are smiling at the camera.

Bobby and his mother traveled to Gainesville, Florida in December of 2015 for a series of tests, including a liver biopsy, a cardiac catheterization, bloodwork and a cardio-pulmonary stress test.

“After all the tests were done they said, ‘You need a heart transplant,’” Bobby recalled.

Overwhelmed and overcome with emotions, Bobby and his mother drove back home to celebrate Christmas, New Year’s and his birthday with his son, who was now 3 years old. On Feb. 24, 2016, Bobby was admitted to UF Health Shands Hospital to wait for his heart.

“It was a mental battle,” Bobby said.

He would spend the next 14 months at the hospital under the care of Moguillansky on two potent IV medications given to temporarily improve cardiac function while waiting for a heart. While in the hospital, he would see his family every other week and the cardiology unit nursing staff became his extended family.

Donor hearts came and went, but none were the perfect match for Bobby.

Until one night in March.

“It was 1:30 a.m., and I was asleep. Jonathan, my nurse, said ‘Diego is on the phone,’” Bobby said.

Bobby, who had become close friends with Jonathan, thought it was a prank. But Jonathan urged Bobby to take the call – this was it.

“Diego said, ‘I think we have a heart for you. We have to make sure we have everything you need so don’t tell anyone yet,” Bobby said.

About 10 minutes later, Moguillansky rang again.

“He said, ‘It’s yours. Call everyone,’” Bobby said.

Bobby, alone at the hospital, called his mother. His father. His brother. His son’s mother. Then, he made if Facebook official.

“My phone wouldn’t stop going off as I was getting ready for surgery,” Bobby said.

As vials of blood were drawn for testing and Bobby was prepped for surgery, his mother turned her four-hour commute to Gainesville into a two-and-a-half hour drive. Just in the nick of time, Bobby’s mother arrived, exiting the elevator as her son was wheeled off to surgery.

Mark Bleiweis, M.D., director of the UF Health Congenital Heart Center and chief of congenital cardiothoracic surgery, and his team performed the eight-hour surgery on March 16, 2017, now affectionately known as Bobby’s “heartiversary,” a celebration of his transplant anniversary date.

Bobby recovered in the UF Health Congenital Heart Center’s intensive care unit for nearly 10 days and was under the care of Moguillansky shortly after surgery.

“Dr. Moguillansky has great bedside manner,” Bobby said. “He’s honest, and I value honesty over everything else.”

Bobby spent nearly three weeks in Unit 54 where they observed him for rejection, a complication that can arise because of a transplant. Before being discharged to go home, Bobby would need to stay one month in temporary housing nearby for additional observation.

On April 7, 2017, Bobby packed his bags and left around 9 p.m. to surprise Skyler, who thought was coming home the following day.

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#MadisonStrong

Alisha Katz's picture
Submitted by Alisha Katz on February 7, 2020 - 07:37

One glance at Madison Rhodes, 14, and no one would ever imagine the struggles she has endured.

Madison was born in Central Florida on May 25, 2005 with a single ventricle heart defect, with only one functioning ventricle to pump blood. She also had transposition of the great arteries, when the two arteries leaving the heart are reversed, and multiple heart valve complications.

a teen girl posing in a hospital room wearing every day clothes

At 6 days old, Madison underwent her first heart procedure. As with most single ventricle patients, Madison underwent her first open-heart surgery, known as the Glenn procedure, at 6 months, and underwent a second corrective procedure, known as the Fontan, at 4 years old. One week later, she experienced complications, and one week later, she had a pacemaker implanted.

Madison’s childhood was filled with a pacemaker battery replacement, heart catheterizations, overnight hospital stays and regimented medication schedules.
But, through her journey, Madison led an active lifestyle. She enjoyed being a part of her school’s cheer team in addition to acting at her local playhouse and biking.
“She just seemed like a normal child, full of energy, she was nonstop all the time,” said Cynthia Rhodes, Madison’s mother. “You would completely forget she had these complications.”

In January 2018, Madison had a fainting spell. After an exam, some changes were made to her current medication and an additional medication was added. The doctors determined that everything appeared OK and she was released. In July of that same year, Madison started showing more unusual symptoms, like taking frequent naps and retaining fluids.

“She would say that she just didn’t feel good,” Cynthia said.

Madison was admitted to a children’s hospital in Orlando on July 27, 2018. Doctors there recommended that she continue her care with the team at UF Health Shands Children’s Hospital. Madison’s physicians believed she was retaining fluid because her heart wasn’t working properly.

“They said, ‘This is pretty serious. It doesn’t look good,’” Cynthia recalled.

Madison was taken by ambulance to Gainesville, where it became apparent that Madison would need to be placed on the heart transplant list.

Upon arriving at UF Health, Madison was administered IV medications to help her heart function, and for a short time she seemed to improve. Then one night in September, her heart rate spiked unexpectedly. Nurses hit the code alarm and started administrating medication. A couple nights later, her heart rate spiked again, eventually slowing back down on its own.

UF Health physicians knew Madison’s time was limited. Her care team recommended placing her on a Berlin Heart®, a mechanical device that takes over the work of the heart. Although they had initially recommended that the procedure take place later in the week, doctors, including Mark Bleiweis, M.D., director of the UF Health Congenital Heart Center and chief of congenital cardiothoracic surgery, and Jay Fricker, M.D., pediatric cardiologist, advised moving her surgery sooner.

“When Dr. Bleiweis went in (to operate), her heart stopped,” Cynthia said.

Madison’s body was running on fumes.

On Sept. 4, 2018, physicians implanted a Berlin Heart® that would serve as her bridge to transplant.

“She could only unplug her unit from the wall for 30 minutes in the morning and in the evening to walk the unit,” Cynthia said. “On a couple of emotional nights when Madison just wanted to go home I explained to her that this is the way it was going to be until she received her new heart. It took about eight weeks until she wanted friends or family to visit.”

Madison would be tethered to the device from September until January. While she waited for her new heart, her care team focused on strengthening her body for transplant. She befriended the nurses, earning nicknames such as Slime Queen for her obsession with slime and Mad Dog Maddie for her wild attitude. Madison also enjoyed talking with other transplant patients about their experience.

On the afternoon of Jan. 23, 2019, Madison and her family received word of a donor match.

“We were shocked. We never imagined a transplant would be as soon as it was,” Cynthia said. “That evening Madison danced down the hallways.”

Family and friends from back home were called as Madison prepared for her new heart.

On the morning of Jan. 24, Madison’s care team was ready to operate.

“She didn’t want to be wheeled to the OR she wanted to walk in,” Cynthia recalled. “She walked to the OR while smiling and waving to the staff, family and friends on her way.”

Family anxiously waited at the hospital all day until Madison’s surgery was complete.

“She recovered great,” Cynthia said. “She shocked her team of doctors and nurses.”

Ten days later, Madison and her family moved into transplant housing. On March 22, 2019, Madison was released to go home. Her hometown decorated the streets and proclaimed #MadisonStrong for her arrival.

madison in a burgundy cheerleading uniform

Madison continues her regular visits to UF Health and even meets with some of the nursing staff for lunch.

In August, Madison started school at a freshman. She’s a member of the high school’s bowling team.

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Keeping Thea All Smiles

Alisha Katz's picture
Submitted by Alisha Katz on February 7, 2020 - 07:37

two parents holding and looking at a smiling baby
Althea “Thea” Brown is all smiles. And her spunky personality along with her curiosity for the world around her will undoubtedly bring a grin to your face. But it’s hard to fathom that during her short 18 months of life, Thea has undergone more tests, surgeries and procedures than any child her age should have to endure.

Maggie and Chad Brown, of Lakeland, were expecting their second child, Thea, when their obstetrician noticed something unusual with Thea’s heart. Ultimately, their daughter was diagnosed with hypoplastic left heart syndrome, a birth defect in which the left side of the heart does not form properly, which affects normal blood flow through the heart.

As Maggie’s delivery date approached, her high-risk obstetrician recommended that they change their plans and instead of delivering in Tampa, deliver at UF Health Shands Children’s Hospital in Gainesville.

“We quickly had an appointment at UF Health to meet with Dr. (Jennifer) Co-Vu (fetal cardiologist) and with Connie (Nixon, clinical coordinator), and found out about the program,” Maggie said. “That same day we toured the hospital, and had the pleasure of meeting Dr. (Mark) Bleiweis (cardiothoracic surgeon). He assured us they would do everything to make sure that Althea was OK.”

On April 17, 2018, Althea was welcomed into the world at UF Health and admitted to the Neonatal Intensive Care Unit. Then, she was moved to the Pediatric Cardiac Intensive Care Unit.

At 9 days old, Thea had her first open-heart surgery known as a Norwood procedure. Just before her 1-month birthday, Thea was released to go home and celebrate. While waiting for Thea’s second open-heart surgery, the family was sent home with an electronic home monitoring device to track weight, medicines, feedings, diaper changes and vitals that are sent immediately to Thea’s physicians.

“Interstage (time between the first and second surgery) is a very delicate time, so it is extremely helpful in monitoring to know if there are any red flags or if anything is wrong,” Maggie explained.

At UF Health, the interstage mortality rate for single ventricle heart patients, like Thea, has been maintained at 0%.

In September 2018, Thea and her family returned her second open-heart surgery.

“The staff, doctors and nurses did a great job of preparing us for the surgery and what to expect,” Maggie said. “Everyone truly cares and loves their patients. Staff is always willing to do whatever it takes and to put the patient first.”

Thea’s third and final open-heart surgery will take place once she’s 3 and a half.

“She will never be fixed or healed, but this allows her to have a chance to thrive and have a normal life,” Maggie said.

For children with Thea’s condition, sometimes a heart transplant is a necessity, but Maggie is hopeful that will not be the case.

“We came to UF Health to give Althea the best care she could receive,” Maggie said. “The staff and doctors are wonderful here, and we will continue to come back for her care for the rest of her life.”
a dad holding a happy baby in his arms

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Ethan’s Race Against the Clock

Alisha Katz's picture
Submitted by Alisha Katz on February 7, 2020 - 07:37

After a devastating hurricane season in 2018, Michelle Byron and her family were looking forward to being back in their home in Panama City just in time for Thanksgiving. While shopping for last-minute preparations at Target, Michelle received an unexpected call from her husband, Chuck. Their 16-year-old son, Ethan, had an emergency during a simple outpatient procedure in Tallahassee. As Ethan was being prepped for surgery, his heart rate spiked and plummeted.

“My husband called and said, ‘He’s going to be OK, but something is wrong with his heart,’” Michelle said.
profile view of a teen boy in a hospital gown in a hospital bed
Ethan’s care team recommended he be seen by Philip Chang, M.D., director of the pediatric and congenital heart electrophysiology program at the UF Health Congenital Heart Center. As Michelle sprinted out of Target to the parking lot, Ethan was flown by helicopter to UF Health Shands Children’s Hospital in Gainesville. Chuck was already on his way to the hospital.

“He (Chuck) said, ‘Be careful and get there as soon as you can,’” Michelle recalled. “I cried and prayed, and got myself together to drive to (UF Health) Shands.”

Michelle drove the long journey from the Panhandle to Gainesville, where she had volunteered at UF Health Shands Hospital’s pediatric unit 25 years prior.

For the next 36 hours, the pediatric cardiac critical care team and Chang at the UF Health Congenital Heart Center worked to find the most suitable medications to regulate Ethan’s heart rate. Doctors determined that Ethan had an unusual combination of permanent junctional reciprocating tachycardia, a form of supraventricular tachycardia, in addition to Wolff-Parkinson-White syndrome, an extra electrical pathway in the heart. Ethan’s family was informed that he was born with these and may have unknowingly experienced arrhythmias in the past. Looking back, Ethan recalls signs that he never associated with a heart condition, such as feeling his heart rate speed up excessively fast while running down a basketball court and remaining fast when he stopped.

“When I saw him lying there, it was tough,” Michelle said. “It was surreal that my own child was now here. It felt like I came back home in a way.”

For 10 days, Ethan received medication directly through his arm and neck to better reach his heart.

Dr. Chang recommended that Ethan have a cardiac ablation, a procedure to definitively treat his condition.

“I wasn’t going to stay on medicine for life if there was any chance they can cure me,” Ethan said.

After being released from the hospital, Ethan and his family traveled to Gainesville three times for ablation procedures. While SVT is typically successfully treated with a single ablation procedure, Ethan’s case was particularly challenging. After three ablation procedures, in April of 2019, Ethan was medicine-free.

The arrhythmias were gone.

“The team was phenomenal,” Michelle said. “Dr. Chang didn’t give up on him. He put in many, many hours of studying his case.”

“Dr. Chang’s really nice and helpful,” Ethan said. “He genuinely cared for me as an individual patient.”

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Caring for Those with Congenital Heart Disease

Devin Nori's picture
Submitted by Devin Nori on February 7, 2020 - 07:36

two hands making a heart shape around two baby feet
Congenital heart defects, better known as abnormalities of the heart, remain the most prevalent type of birth defect, affecting one in every 133 people. This year, the American Heart Association will recognize Congenital Heart Defect Awareness Week from Feb. 7-14 to advocate nationwide about the impact of these conditions on newborns, children, adolescents and adults alike.

“I think that a lot of doctors don’t even realize how common it is,” said Giles Peek, M.D., FRCS, C.Th., FFICM, a professor and cardiothoracic surgeon at the UF Health Congenital Heart Center. “They often don’t think that the heart is the source of the problem because they don’t associate heart issues with a baby.”

Congenital heart defects, or CHDs, vary in severity and present with different symptoms, including shortness of breath, blue-tinted skin and swollen body tissues or organs. These conditions can arise from complications with the walls of the heart, the valves of the heart or the arteries and veins near the heart, disrupting normal blood flow. With proper treatment through medication and surgery, children born with CHDs often live well into adulthood. In the United States alone, an estimated 1.4 million adults currently live with a congenital heart defect.

The UF Health Shands Children’s Hospital’s pediatric cardiology and heart surgery program is ranked No. 11 among the Top 50 programs in the nation by U.S. News & World Report, and consistently exceeds the national operative survival rate average. In addition to treating newborns, children and adolescents, health care providers with the program also see an average annually of 1,900-plus adult congenital heart patients, making the program’s team well-versed in all levels of care.

“It is a completely integrated program,” Peek said. “Everybody works on the same team rather than the situation in many other hospitals where cardiology, surgery, anesthesia and everyone else are in separate teams.”

This multidisciplinary approach allows the team, led by Mark Bleiweis, M.D., to remain ahead of the curve as the first in Florida to perform a pediatric heart transplant, infant heart transplant and Berlin Heart® implant. The program also performed a heart-lung transplant on the youngest infant in 2013, and has successfully separated conjoined twins who were connected at the heart, liver and sternum.

Despite its accomplishments, the program is always looking to grow. Surgical suites have been renovated to remain on the leading edge of technology and patient care. Physicians continue their research through basic and clinical trials, even establishing the UF Health Congenital Heart Center Journal Club, which meets monthly to discuss relevant literature on congenital heart defects and treatment.

Learn more about how you can get involved with Congenital Heart Defect Awareness Week at American Heart Association or UF Health Congenital Heart Center.

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From Cancer Patient to Survivor: Judy’s Journey

Alisha Katz's picture
Submitted by Alisha Katz on February 4, 2020 - 07:42

A group of five people posing with a large Christmas ornament that says Christmas at Gaylord Palms
In the mid-1990s, Judith “Judy” Hogan felt a lump on the back of her neck. Judy’s dermatologist at the time diagnosed her with basal cell carcinoma, a common form of skin cancer that can be caused by numerous factors, including smoking and sun exposure, and had it removed. More than 20 years later, Judy’s cancer returned with a vengeance.

The Deltona woman visited her dermatologist in July 2018 when her physician noticed some abnormal skin spots. Ten biopsies were taken from across the front of her neck, left cheek and nose, and, as suspected, they were deemed cancerous. Her dermatologist recommended scheduling a full body evaluation and discussing treatment options at UF Health Dermatology – Springhill in Gainesville.

In September 2018, Judy and her husband, Mark, traveled to Gainesville for the first of many procedures. Judy had a skin growth removed on the right side of her neck, but because of her daughter’s wedding in October, Judy asked to delay more extensive surgeries until after the big day.

On Dec. 13, Judy and Mark met with Mark Leyngold, M.D., cosmetic and reconstructive surgeon at UF Health, to coordinate a number of Mohs surgeries. Unlike more widely known cancer treatments like chemotherapy and radiation, Mohs surgery is a type of outpatient surgery where surgeons carefully remove layers of skin to reach cancerous cells while also leaving healthy tissue intact. On Jan. 15, 2019, Judy had her first Mohs operation performed on her left cheek.

Leyngold, an assistant professor of surgery in the UF College of Medicine, also recommended reconstructive surgery, a type of plastic surgery that is performed to restore normalcy to people who have been affected by a change in the body’s shape or appearance. The day after Judy’s Mohs surgery, Leyngold performed a skin generation procedure using a product made from a cow, compressing it and stitching it into the face. For nearly one month, Judy recovered back at home in bandages until her initial skin graft procedure. On Feb. 15, Judy and Mark drove back to Gainesville for the second part of her reconstructive surgery, which involved taking skin from her hip and applying it to her face.

“Dr. Leyngold was very professional and, if you asked a question, he would always answer you. (He would) make sure you understood what was going to happen,” Judy said.

After her recovery, on March 7, Judy had a six-hour Mohs procedure on her nose. Judy then was sent the day after surgery to see another facial plastic and reconstructive surgeon at UF Health, Timothy Lian, M.D., M.B.A., FACS.

Lian, a professor in the otolaryngology department in the UF College of Medicine, mapped out a plan to perform a paramedian forehead flap, a two-step reconstructive procedure that pulls skin down from the forehead and wraps it around the nose. Unlike Judy’s skin graft for her cheek, this procedure involved connecting blood supply from the forehead to the nose to help with skin and tissue regeneration, serving as a type of umbilical cord. On March 12, Lian performed Judy’s forehead flap, and, on April 16, Lian performed the final part of Judy’s reconstructive surgery by dividing the flap. After a final checkup, Lian recommended that she return to Leyngold for her lower eyelid surgery.

On July 10, nearly seven months after her initial diagnosis, Judy and Mark headed to Gainesville for another follow-up appointment, as well as a preoperative appointment in preparation for left lower eyelid surgery to treat another suspicious growth.

Along with the care Leyngold provided, Judy’s medical journey also included the oversight of plastic surgery physician assistants Dawn Daigen, PA-C; Anne Marie Staples, PA-C; and Jaime Rafanan, PA-C. All three helped with Judy’s pre- and postoperative care and worked closely together to provide Judy with the answers and clarity she needed for her multiple procedures.

“If you had an appointment and saw a physician assistant, if they felt like they needed to consult with Dr. Leyngold, he would be asked during that same time,” Judy said.

Judy crouching down on the ground posing with a flamingo Christmas decoration wearing a santa hat
Judy’s lower eyelid cancer was removed followed by reconstructive surgery. Leyngold performed a Hughes flap, a procedure where part of the upper eyelid is used to rebuild the lower eyelid. Additionally a skin graft was taken from her neck to provide extra skin resurfacing for the eyelid. The surgery was a success and Judy was cancer free. She had to have her eye covered for six weeks for the graft to heal properly. Thereafter, she had her second surgery to uncover her eye and finalize her reconstruction. At last, Judy could see with a normal and functioning eyelid.

Since then, Judy has had the left side of her nose reshaped and has also had an eyebrow lift, both performed by Leyngold. Her doctors in Deltona as well as in Gainesville continue to be astounded by her minimal scarring.

“I have a lot of healing to go and it will take a couple years, but overall only a little bit of scarring,” Judy said.

Sept. 25, 2019 marked Judy’s final reconstructive procedure — a momentous step for a cancer survivor. After countless bandages, multiple hotel stays and many miles driven, Judy and Mark now take life one day at a time.

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International Integrative Health Day

Submitted by on January 23, 2020 - 10:12

Hawiian woman sitting on the couch holding a cup of coffee and looking into the distance
It’s often difficult to widen your lens and focus on the big picture. This can also prove true in health care. While specialized care is necessary to treat complex conditions, the wholeness of the patient should be a priority as well. The team at UF Health Integrative Medicine aims to treat the whole person – mind, body, and spirit.

January 23 is International Integrative Health Day and we encourage you to take a moment to consider how you can incorporate self-care and holistic healing into your daily routine.

Here are some ideas to celebrate integrative health:
Invite a friend out to a healthy lunch – Be conscious of the menu and customize your normal selection or order a healthier option such as a salad or grilled chicken with steamed vegetables.

Reconnect with nature – Spending time outdoors is a great way to improve your mood and give yourself a much needed break. Go for a walk outside, explore a new trail or plan to do some gardening on the weekend.

Practice mindfulness – Find a quiet area and practice deep breathing techniques as you clear your mind. Take the opportunity to focus on letting go of attachments, criticism and anxious thoughts as you narrow in on being in the moment.

Take time to de-stress – Constant stress can have a negative impact on your overall health. Find what helps you relax whether it’s exercise, meditation, or listening to music. Cultivate positivity by writing a gratitude list. Listing the things that you are thankful for is shown to be a useful tool for reflection and stress management.

Educate yourself – Build on your knowledge of integrative health by reading an article, tuning into a podcast or scheduling an appointment with a physician board-certified in integrative medicine.

To learn more about integrative medicine and incorporating it into your health care, visit the Integrative Medicine website.

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UF Health ahead of the curve in perinatal safety standards

Peyton Thomas's picture
Submitted by Peyton Thomas on January 14, 2020 - 08:13

pregnant woman on laying hospital bed

Beginning in July 2020, The Joint Commission will implement two new standards to improve the quality and safety of perinatal care. The new standards being implemented require processes and procedures to be established for the care of women with maternal hemorrhage, severe hypertension and preeclampsia. Even though these requirements go into effect next year for all Joint Commission-accredited hospitals, UF Health has already begun implementing these procedures to ensure safe, high-quality patient care.

Sharon Byun, M.D., an associate professor and residency program director in the UF College of Medicine’s department of obstetrics and gynecology, is committed to adhering to regulatory standards and patient safety. She has served as the physician director of quality for the department for 10 years.

“We’ve been working on improvements regarding these measures for several years through ongoing, continuous quality improvement aimed at reducing the likelihood of patient harm due to these conditions,” Byun said.

With the support of leadership and the statewide affiliation with the Florida Perinatal Quality Collaborative, UF Health has seen a decline in maternal complications due to hemorrhage and hypertensive conditions. These perinatal safety measures include early recognition and treatment of these conditions, and patient and provider educational awareness.

The UF Health obstetrics and gynecology team has implemented initiatives that directly relate to the new standards that go into effect in 2020. These practices include prioritizing patient safety and education by performing obstetric hemorrhage risk assessments on admission, and providing educational materials about preeclampsia when discharging from triage, antepartum and the postpartum units. Additionally, labor and delivery and the postpartum units are equipped with hemorrhage carts to ensure quick emergency response if necessary.

The department also prioritizes staff education and training to ensure patient safety and quality care. This training includes obstetric emergency simulation drills and educational programs on the team’s procedures for cases of hemorrhage, preeclampsia and severe hypertension.

“Implementation of any initiative requires a comprehensive multidisciplinary approach, but the overall goal is to reduce complications and make obstetric care safer for all women,” Byun said.

More public attention is being called to safe maternal care, specifically reducing racial and socioeconomic disparities in maternal outcomes. About 700 women die each year as a result of pregnancy-related deaths, and the risk of mortality is three to four times higher for black women.

Allyson Felix, the most decorated U.S. Olympic track and field athlete, recently testified before the House of Representatives to shed light on these issues and her personal experience with preeclampsia. Serena Williams, world-renowned professional tennis player, also serves as a strong advocate for pregnancy-related medical issues after experiencing them herself.

“The care of women can’t be improved if we don’t have people talking about these issues,” Byun said. “Raising public awareness, improving access to safe care and educating patients on these risks are all imperative to providing safe health care for every woman.”

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Rylan’s Recovery

Lauren Gajda's picture
Submitted by Lauren Gajda on January 9, 2020 - 09:13

UF Health pediatric neurosurgery team saves Rylan from traumatic brain injury.

It was about 8 a.m. on March 20, 2019, when Rylan Lord took his family’s ATV out for a drive. He was riding at a leisurely pace on the dirt road of their 7-acre property in Dixie County, only about 50 yards from his house, when he overcorrected a turn. The vehicle suddenly flipped and landed on top of Rylan’s head.

Still conscious, the 14-year-old knew he needed to seek help quickly. Even though he was badly injured, Rylan managed to get out from underneath the machine. He knew something was wrong with his left eye because he was seeing double, but he closed it and walked to his house.

Ryan laying in a hospital bed with a large stapled incision on his head“The door slammed open, and I just knew something was wrong,” said Rylan’s mother, Erin. “When I saw him, his head was bleeding profusely. I immediately got him to the couch and put a towel over his head to apply pressure and try to stop the bleeding. It looked like he had lost his eye.”

Erin called 911 and then continued to ask her son questions to keep him awake.

“The ambulance got there in a matter of minutes, but it felt like forever,” Erin said.

Dixie County paramedics Alison Stevens and Roy Maggard called for a helicopter to take Rylan to UF Health Shands Children’s Hospital. The family lived about an hour and a half from UF Health, and Stevens and Maggard knew that Rylan did not have much time. The paramedics put Rylan in an induced coma, and UF Health ShandsCair airlifted him from Old Town to Gainesville. Erin and Rylan’s father, Jon, drove to the hospital even though they did not want to leave their son.

“I remember Alison telling me, ‘Trust me. I’ll treat him like he’s mine. Just go,’ and so we did,” Erin said.

When Rylan arrived in Gainesville, doctors told his parents he did not have much time because of the trauma his brain had suffered. He was rushed to surgery, where pediatric neurosurgeon Jason Blatt, M.D., operated to eliminate the bleeding occurring between the tough outer membrane covering the brain and the skull. This injury is referred to as an epidural hematoma.

The surgery was successful at stopping the bleeding and alleviating the pressure on Rylan’s brain, but now it was a waiting game. Rylan’s injury had led to multiple skull and facial fractures, four other smaller bleeds and bruises all around his brain. Doctors did not know what condition he would be in when he woke up or how his brain would function.

Three days after the surgery, Rylan emerged from the coma.

“The best possible scenario happened,” Erin said. “While he suffered loss of vision in his left eye, he was going to be OK. Dr. Blatt told us that everyone from the EMS providers to the physicians to the nurses did everything perfectly to save Rylan’s life.”

Rylan spent the next week in the intensive care unit at UF Health Shands Children’s Hospital and then was transferred to a regular room for a little over a week. After three weeks in the hospital, Rylan was cleared to return home and go to a rehab center. By the time he left the hospital, he was already having conversations with his family and care team and walking short distances with his therapists. However, he had mild residual weakness on his right side from the epidural hematoma, which was cured in rehab.

Rylan is getting better and stronger every day, but he still has more surgeries to go. In March, pediatric plastic surgeon Jessica Ching, M.D., will put a plate in his eye socket to correct his double vision, and after that, physicians will assess what needs to be done next.

Rylan and his family could not be more thankful for all of the providers, nurses and support staff who they have met along the way. Whenever they visit Blatt and the pediatric neurosurgery team, they are usually toting a large cake or other homemade treat as a token of their ongoing appreciation.

“We call Dr. Blatt ‘Uncle Jason.’ He’s part of our family now,” Erin said. “During this process, he has always put things in my terms. He has been like talking to my best friend. He always made me feel comfortable and made things relatable. He was a big part in saving my son’s life, and as far as I’m concerned, if he wants my right arm, he can have it.”

Rylan, now 15, said he is getting back to normal. While there are still some complications from the injury, he believes he is going to be OK, and he can deal with what he has to do.

“I wish I could describe (to everyone involved in my care) how thankful I am,” Rylan said. “They are all awesome and amazing.”

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Traveling for Kidney Care: Baylor’s Journey

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Submitted by Brittany Purcell on December 17, 2019 - 14:12

Baylor Bennett was born with a blockage in his kidneys. His parents were told that he would grow out of it, and for six years, he had no symptoms. Then, one day in October 2018, Baylor doubled over in pain. He was taken to an emergency room in Mobile, Alabama, where an imaging scan showed his left kidney was inflamed from a blockage.

Baylor was treated by a general nephrologist at the hospital because there is no pediatric urologist in Mobile. After being discharged, his family took him to Pensacola, Florida to be seen by one.
Baylor and younger sibling posing for a photo

After imaging, it was determined Baylor would need surgery, which could be performed as an open procedure or robotically. Baylor’s parents wanted the surgery performed robotically so he would miss less time at school. Robotic surgery involves smaller incisions that lead to shorter hospital stays and quicker recovery times.

“Pediatric robotic urologic surgeons are not easy to find,” Baylor’s father, Todd Bennett, explained. “After doing our research, we knew we had three choices: New Orleans, Birmingham or Gainesville. Dr. Bayne at UF Health was the only one who offered to perform Baylor’s surgery robotically.”

Christopher Bayne, M.D., a pediatric robotic urologic surgeon and an assistant professor in the UF College of Medicine’s division of pediatric urology, explained that symptoms like Baylor’s can be difficult to correctly identify.

“Older children like Baylor tend to have an obstruction that comes and goes, and we do not know the cause of this,” he said. “Cyclical episodes of abdominal pain and vomiting can go a long time and not be worked up. Sometimes symptoms like these are chalked up to constipation. In Baylor’s case, the initial imaging showed the left kidney was enlarged/swollen.”

Bayne initially communicated with the family by telephone. Baylor and his family met Bayne for the first time the day before surgery, when he walked them through the surgical plan. He scheduled them for his last appointment of the day so they would have plenty of time to ask questions.

“One of my goals is to put them at ease and walk them through the surgery. I really wanted them to feel as comfortable and as relaxed as they could,’’ he said. “I get the anxiety of it. I wanted them to breathe a sigh of relief.”

On Dec. 21, Bayne performed a robot-assisted laparoscopic pyeloplasty, a surgical procedure that involves correcting the main drainage connection of the kidney.
During the surgery, Baylor’s parents received hourly updates from Bayne’s head nurse.

“I was incredibly impressed with the whole process,’’ said Todd. “The level of anxiety was very low. I felt comfortable with Dr. Bayne and his team from the get-go.”

When Baylor woke up from surgery, he asked for Gatorade and pizza.

baylor in a hospital gown tucked into a hospital bed while smiling and holding a thumbs up

“We were worried he was going to be in pain after surgery, but it was almost like he didn’t have surgery,” said Todd. “He never cried. He never took anything more than Tylenol. I can’t imagine it could have gone any better.”

Two days later, Baylor was on his way back to Mobile, just in time for Christmas. He was running around, playing on Christmas morning — and never missed a day of school.

“We will forever be grateful for your university and teaching center because he gets the chance to be a normal kid,” said Todd.

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Saving Lives in the Air

Devin Nori's picture
Submitted by Devin Nori on December 10, 2019 - 09:50
UF Health ShandsCair performs the program’s first in-flight prehospital blood transfusion.

UF Health ShandsCair helicopter in the air

After over a year of preparation, the UF Health ShandsCair team performed its first in-flight prehospital blood transfusion. Don Irving piloted the flight, where Staccie Allen D.N.P., APRN, EMT-P, CFRN, C.C.P., and Jesse Blaire, EMT-P, C.C.P., were able to give a patient one unit of blood to help stabilize the person’s blood pressure and heart rate before landing.

“You see the benefits of providing blood quickly in tons of military literature, and much of what we do is derived from that,” Allen said. “We realized how important access to blood is before getting to the hospital, and research shows how much of a difference it makes. It makes an incredible impact on patient outcome.”

In early 2018, chief flight nurse Todd Brooks, B.S.N., R.N., EMT-P, began advocating for carrying blood inflight. This practice had been discussed within the program before, but it required the involvement of and assistance from multiple teams within UF Health before implementation. This included obtaining a grant for a blood refrigerator through the UF Health Shands Hospital Auxiliary and establishing new protocols within the blood bank. Finally, everything fell into place.

“It was a strong step forward for UF Health to allow and support the initiative to carry blood in flight,” Brooks said.

UF Health is at the forefront of the movement locally, as the practice becomes more common on medical helicopters around the country. ShandsCair’s new service will benefit many types of patients, including those with low blood pressure and a high heart rate and/or suspicion of internal or external bleeding. Carrying blood gives the team a chance to provide a new level of care and buy patients more time before even arriving at the hospital.

ShandsCair team of four people standing in front of a ShandsCair helicopter

The ShandsCair 1 team now boards every flight with blood, plasma and medication to slow bleeding. The materials are stowed in a compact cooler kept in the blood refrigerator to monitor their temperatures and are easy to grab on the go.

“We want to have all five helicopters carrying blood and hope to treat medical patients in addition to trauma patients,” Brooks said.

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More than just an ordinary headache

Devin Nori's picture
Submitted by Devin Nori on December 5, 2019 - 08:14
How a Chiari malformation diagnosis was the key to ending Delvis’ pain.

Delvis posing for the photo with his hands up in the air

Delvis Mendez Jr., known to his family as Guizmo, was a typical active 6-year-old. He loved to play with friends, did well in school and even earned his yellow belt in taekwondo. But every now and then, his fun-loving spirit would come to a halt when a headache would arise. He would complain about being in excruciating pain, and then five minutes later would be running and jumping in the backyard. His mother, Doriley Fernandez, did not think much of these headaches because of how quickly they came and went. When Delvis lost his balance and fell during taekwondo and mentioned numbness in his fingers, however, she knew something was wrong.

She immediately rushed her son to a hospital emergency room near where the family lives in Dunnellon, Florida. Upon arrival, Delvis said his headache was gone, and he felt fine. She knew this time that it was not just any ordinary headache and begged the doctor to do a CT scan. Upon analyzing the results, they determined that Delvis had Type 1 Chiari malformation, a structural anomaly at the back of the brain and skull that can cause headaches. Typically, the headaches are at the back of the head or upper neck and are brought on or made worse by coughing or straining. Chiari can also cause swallowing problems, breathing pauses at night called central sleep apnea, numbness and tingling in the upper back and upper arms, spinal curvature or scoliosis, among other symptoms.

“For us, it was the beginning of a lot of reading and a lot of researching,” Doriley said. “We went to two other doctors first, but they didn’t convince us.”

Finally, the family was sent to UF Health Shands Children’s Hospital in Gainesville. Lance S. Governale, M.D., chief of pediatric neurosurgery at UF Health, met with the family and explained all their options. Governale discussed with the family every possibility for treatment that Delvis could undergo. Ultimately, they all agreed that the best chance to help Delvis was with Chiari decompression surgery.

“Dr. Governale treated him with such care,” Doriley said. “He should be the No. 1 surgeon for kids on the planet.”

The surgery was a complete success, and after only four days in the hospital, Delvis was able to go home free from pain.

Delvis returned to see Governale for follow-up appointments. He was Governale’s first patient at UF Health Pediatric Specialties – Oakhurst in Ocala, one of many remote locations that brings care to patients beyond Gainesville.

“We have been trying to offer more and more outreach services because it is ideal to be able to provide care for patients close to their homes,” Governale said. “In addition to Gainesville, UF Health pediatric neurosurgery sees patients in Ocala, Lake City, Tallahassee and Daytona.”

After the surgery, Delvis jumped back into his normal life, but this time he was headache-free. He caught right up with his classmates, returning to school less than a month after the surgery, and he graduated the third grade without any delays. Now, eight months after the surgery, Delvis is doing better than ever.

“Guizmo is free of headaches, free of pain,” Doriley said. “He’s growing into a young man now in less than a year.”

Doriley is thankful for the quick detection and care her son received at UF Health, and she wants to spread the word about Chiari malformation so other parents know that the condition exists. She does not want any other child to live in pain for as long as her son did.

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Living With Gastroparesis

Devin Nori's picture
Submitted by Devin Nori on December 3, 2019 - 09:11

When Melanie Dickens was 10 years old, she fell off a pair of stilts and injured her left leg. The injury triggered complex regional pain syndrome and led to complications by revealing underlying issues with her autonomic nervous system from her genetic mutations — which are still poorly understood.

When she was 11, Melanie started experiencing stomach pains and was having trouble keeping food and water down. Even pretzel sticks were out of the question.

A gastric emptying test revealed that Melanie had gastroparesis, a condition where the stomach’s ability to move and function is impaired, causing severe nausea, vomiting, bloating and intense pain. This condition is linked to her dysautonomia, in which the nerves that regulate her nonvoluntary body functions — such as heart rate, blood pressure and sweating — do not function properly. For six years, she relied on nasal feeding tubes.
Melanie’s condition is rare, and UF Health Shands Children’s Hospital is the only children’s hospital in Florida able to treat the combination of conditions that affect her.

At the hospital, chief of pediatric surgery Saleem Islam, M.D., M.P.H., implanted a gastric stimulator in her abdomen. With the help of nutritionist Daniel Stewart, R.D., and chief of pediatric gastroenterology Christopher Jolley, M.D., an associate professor in the UF College of Medicine’s division of pediatric gastroenterology, hepatology and nutrition, Islam decided that a permanent tube would be much more helpful for Melanie, especially when her condition flares.

Despite seeing more than 1,000 patients a year, Islam, a professor of surgery and pediatrics in the UF College of Medicine, develops bonds with all of his patients that go beyond just their diagnoses. He and Melanie now share inside jokes, and together they give her stuffed animals fake gastronomy tubes to match her own.

She continues to travel from Melbourne, Florida to see Islam for treatment about every five months, and, on a good day, consumes 500 calories by mouth.

“We have such a good relationship,” said Islam. “The fact that she still wants to travel this distance for care says a lot about her relationship with the institution, as well.”

Even though gastroparesis is currently incurable, Melanie has been able to live a more comfortable life with her condition. She credits much of this to her treatment at UF Health and the care of Islam.

“From the start, Dr. Islam was always joking around with me,” Melanie said. “One time I was just about to fade out before a procedure, and I had Winnie the Pooh stuff with me. He asked if I knew the theme song, and I apparently sang it through the entire procedure.”

Melanie routinely has to get her devices replaced, including her gastro-jejunal tube to help absorb nutrients and her tunneled central venous line to combat another condition she faces — postural orthostatic tachycardia syndrome — again related to the autonomic nervous system. 

Now 19 years old and in her second year at Eastern Florida State College, Melanie is managing her life around her situation. Despite undergoing many procedures, the longest she has had to spend in the hospital was a week and a half. Even during the hardest parts, she was still able to keep up with her classes online and even attend half-days in person.

She found music to be a great distraction and frequently attends concerts of her favorite bands — 5 Seconds of Summer, Night Ranger and Blue October. She also loves to draw and bake for her parents. She has even found a way to combine these two passions by painting onto sugar cookies using food dye and water.

“My experiences at UF Health have been amazing,” Melanie said. “Everyone I’ve encountered when I’ve had my procedures was so awesome and friendly.”

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UF Health Cancer Physician Talks Rare Form of Pancreatic Cancer

Brian Ramnaraign, M.D.'s picture
Submitted by Brian Ramnaraign, M.D. on November 21, 2019 - 09:05
3D illustration of a pancreasPancreatic neuroendocrine tumors accompany a rare form of pancreatic cancer that account for only 1-2% of all pancreatic tumors. I usually tell my patients that this is the type of pancreatic cancer that Steve Jobs had, unlike the more common pancreatic adenocarcinoma, which is the type of pancreatic cancer that actor Patrick Swayze had.

Some pancreatic neuroendocrine tumors can produce excess hormones that can lead to high or low blood sugar, acid reflux and indigestion or diarrhea. However most pancreatic neuroendocrine tumors do not, and are known as "non-functional". Almost half of these tumors are found "incidentally," meaning the patient had no symptoms, but was undergoing treatment for another condition or issue when it was found.

Patients diagnosed with these tumors require specialized and individualized care, because not all pancreatic neuroendocrine tumors need treatment. Some patients may require surgery, while others may require hormone treatment with specialized medications, and the rest can be closely monitored.

In rare cases, a pancreatic neuroendocrine tumor may require chemotherapy. Treatment depends on a variety of factors including the extent of the tumor, the aggressiveness and the burden on the patient’s quality of life.

At the University of Florida Health Cancer Center, we have a team of physicians, including myself, who specialize in the care of these patients. We offer Dotatate PET scans, which are specialized imaging tests for pancreatic neuroendocrine tumors, as well as treatment for all forms and stages of this disease. We are even able to offer the latest therapy in neuroendocrine tumors, known as Lutathera, which delivers short waves of radiation specifically to neuroendocrine tumor cells.

At UF Health, we take pride in providing our patients individualized, high quality and up-to-date cancer care.

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The impact of pancreatic cancer on minority groups

Peyton Thomas's picture
Submitted by Peyton Thomas on November 21, 2019 - 08:21

Latinx person looking down as if they have received bad news
Pancreatic cancer will affect more than 56,000 adults in the United States this year. Of these individuals diagnosed, incidence rates are 25% for higher for black patients compared to others. On the other end of the spectrum, according to the National Cancer Database, the Latino population tends to have better outcomes than both black and white patients in regards to this disease.

Research has been done that normalizes socioeconomic factors, and the outcomes indicate that biological differences likely affect minority groups’ susceptibility to pancreatic cancer. This remains a significant disparity in pancreatic cancer patients, and UF Health physicians are committed to research that can lead to development in treatment options to help bridge this gap.

In 2018, the National Cancer Institute awarded a five-year, $16 million grant to the University of Florida to establish a cancer health equity center committed to cancer research focused on minority patients.

Jose Trevino, M.D., is an assistant professor in the UF College of Medicine’s department of surgery and leads research within the center. Through his work, he looks at differences in outcomes, genetics, muscle physiology, tumor biology and other translatable factors that affect an individual’s pancreatic cancer treatment to reduce disparities in the efficacy.

With pancreatic cancer treatment, the personalization of care is critical. With continued commitment to research focused complexities and factors regarding racial disparities, UF Health is taking steps to develop new ways to best battle this disease.

“Hopefully one day, we will look at ancestry as a marker for possible therapeutics, and we can use this data to determine different therapies,” Trevino said.

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The Importance of Genetic Testing for Pancreatic Cancer Patients

Kacey Finch's picture
Submitted by Kacey Finch on November 21, 2019 - 08:10

person in a lab working with genetic materialCancer is a genetic disease, whether hereditary or not. However, a recent discovery led to a national change in genetic testing guidelines specifically for pancreatic cancer patients.

“In 2018, genetic testing guidelines were updated to recommend that all patients with pancreatic cancer be offered genetic counseling and testing,” said Lisa Brown, MS, a certified genetic counselor at UF Health. “These changes were created by the American Society of Clinical Oncology and the National Comprehensive Cancer Network in response to multiple recent studies linking diagnosed pancreatic cancer patients with an increased risk of hereditary cancer, regardless of their family history.”

headshot of Lisa BrownUF Health provides genetic counseling through the Hereditary Cancer Program to help patients determine if they are at a greater risk for cancer development. Brown is trained to detect high-risk families, help them to understand their risk and make them aware of prevention, early detection and treatment options.

“Hereditary cancer is caused by inherited changes, known as mutations, in genes that significantly increase the risk to develop various types of cancer,” Brown said. “Understanding a patient’s genetic predispositions can help doctors choose the most effective and personalized methods to treat their cancer.”
While the guidelines for pancreatic cancer patients were just recently updated, the UF Health genetic counseling team has been providing cancer genetic services, including cancer risk assessment, genetic testing and personalized recommendations for cancer screening and risk reduction, since 2001.

“Although not everyone with hereditary cancer will develop cancer, both men and woman can still pass the gene mutation to their children,” Brown said. “Fortunately, there are medical management options to reduce the risk of cancer, which is why knowing about a mutation can be helpful.”

Learn more about our hereditary cancer program at UF Health on our website.

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Surgical Hope for Pancreatic Cancer

Kacey Finch's picture
Submitted by Kacey Finch on November 20, 2019 - 11:25

Doctor Steven Hughes in the operating room

The diagnosis of cancer can be tough to process. But when diagnosed with pancreatic cancer, a disease commonly known to have low survival rates, patients find it hard to hold on to hope. 

Steven Hughes, M.D., chief of the division of surgical oncology at University of Florida Health, provides innovative care for patients with pancreatic diseases.

“Perhaps the greatest challenge pancreatic cancer patients face today is the misconception that there is no hope after diagnosis,” Hughes said. “National statistics show that as many as 40% of patients with early pancreatic cancer that are candidates for surgery never even see a surgeon. We must alter this perception.”

UF Health consultations can provide hope and options for patients diagnosed with pancreatic cancer. Hughes emphasized that this is an important resource to acknowledge.

Patients with early pancreatic cancer could qualify for minimally invasive surgery, including the Whipple procedure, an operation that involves removing the head of the pancreas, the beginning of the small intestine, the gallbladder and the bile duct and reattaching the remaining organs to allow for normal digestion after surgery.

“One important point of this is that, in the right hands, surgery for pancreatic cancer has become very safe,” Hughes said. “In fact, most patients can qualify as candidates for minimally invasive (laparoscopic or robotic) surgical approaches, often referred to as key-hole or Band-Aid surgery.”

Hughes and his UF Health colleagues are highly experienced in Whipple procedures, performing a high volume of about 100 a year. To have the best outcome from this operation, the American Cancer Society recommends that patients seek a hospital that does at least 15 Whipple procedures per year.

“Individual expectations may vary, but the vast majority of patients can expect to return to a normal life within a month or two after these procedures,” he said.

The National Pancreas Foundation (NPF) recently named UF Health an NPF Center for excellence in pancreatic cancer treatment. The designation acknowledges high-quality approaches toward pancreatic cancer treatment.

“UF Health has a select team of surgeons devoted to pancreatic surgery, and our rates of use of robotic and/or laparoscopic approaches, outcomes and complication rates are among the best in the country,” Hughes said.

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Have Hope: Discover Treatment Options for Pancreatic Cancer

Submitted by on November 20, 2019 - 08:26
By Kacey Finch and Peyton Thomas

Pancreatic cancer affects more than 42,000 Americans each year and is the fourth leading cause of cancer-related death in United States. By 2030, it is expected to be the second leading cause of cancer death. This Pancreatic Cancer Awareness Month, patients should know of the treatments available at UF Health.

With several different approaches available, treatment of pancreatic cancer is determined by the type and stage, which is the process used by physicians to describe location, size and spread of the cancer. Treatment of pancreatic cancer in the current era is personalized and based on the individual patient and disease characteristics.

Care provider standing next to a patient bed with their hand on the patient's hands“At UF Health, our pancreatic cancer team remains committed to delivering high quality, personalized patient care, while serving as a source of hope for patients and their families,” said Thomas George, M.D., FACP, a clinical investigator at the UF Health Cancer Center. “Pancreatic cancer is a challenging disease, but our team consists of leaders in the field who are dedicated to developing new treatment options through clinical research.”

For patients with earlier stage pancreatic cancer, surgery is often one of the first steps, with the intention of curing the cancer. Around the time of surgery (before or after), additional therapy is offered, including chemotherapy with or without radiation therapy.

Chemotherapy medicines are drugs that travel through the blood stream with the intent to damage and kill cancer cells by stopping them from growing and dividing. Several chemotherapy combinations have been approved by the Food and Drug Administration (FDA) in the last several years for the treatment of resected pancreatic cancer.

Advanced stages of pancreatic cancer, which cannot be removed with surgery or has spread to other sites of body, are described as “locally advanced” or stage 4. Treatment is often intended toward control of disease. Chemotherapy does not cure metastatic pancreatic cancer, but it can relieve symptoms, slow the spread of the cancer and prolong life. Treatment options may include targeted therapy or immunotherapy.

National guidelines strongly recommend molecular profiling of the tumor and the patient to determine best personalized treatment options. The molecular profile helps determine the tumor biology, helping enhance the success of the treatment approach.

“To best treat each individual situation, UF Health performs genetic testing and a molecular profile on every patient,” George said. “This approach, in conjunction with weekly team meetings of all physicians involved in the patient’s care, allows our physicians to best target the patient’s cancer and evaluate which treatment options could be taken.”

The FDA has approved one targeted therapy drug for pancreatic cancer and immunotherapy for a small group of pancreatic cancer patients based on molecular profile and tumor biology. Several other targeted therapies and immunotherapies for pancreatic cancer are still being studied in the clinical trials and further information can be obtained from the UF Health Cancer Center or ClinicalTrials.gov.

“The ultimate goal is to create specialized therapy that allows the patient’s own immune system to identify and attack the cancer, a method that is successfully working with other cancers,” George said. “The research being conducted allows UF Health to create innovate strategies to continue the fight against pancreatic cancer.”

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Targeting Pancreatic Cancer with Radiotherapy

Submitted by on November 12, 2019 - 09:56

By K.E. Hitchcock, MD PhD for the UF Hope and Healing Blog

doctor Katheryn Hitchcock of Radiation Oncology talking with a patient

Survival rates in cancer worldwide have been improving for the last 40 years, but some types, like pancreatic cancer, lag stubbornly behind. More than 56,000 people in the United States will be diagnosed with pancreatic cancer this year (footnote 1), and scientists and doctors are looking to the most up-to-date technologies available to try to change their statistics.

Scientific studies over many years have looked at improving rates of successful surgical removal of cancers of the pancreas. One approach is to use radiation and chemotherapy before the operation to shrink the tumor and “clean up” stray cancer cells that have moved into the normal tissue around the main tumor mass (footnote 2). This is called neoadjuvant therapy, and is especially important when the tumor can’t be removed at the time of discovery because it is too entwined with vital parts of the body (footnote 3). Sometimes surgery cannot be done at all, and in that case radiation and chemotherapy become the main treatments.

Recent developments in radiation oncology have made radiotherapy for pancreatic cancer more effective and easier on the body. An improved technique called image-guided radiotherapy uses a low-dose CT scan at the time of each daily treatment to verify that the computer model of the patient’s body is perfectly aligned to her position. This ensures that the radiation beams will be delivered accurately, protecting the normal tissues from unnecessary damage. It’s especially important in the case of internal organs like the pancreas that can move quite a bit from day to day.

Radiation oncologists are using a newer technique called stereotactic body radiotherapy (SBRT) to treat some pancreatic cancers in just a few days rather than over the 5-6 weeks that traditional treatment requires. Because it is new, this approach does not have as much data to support it as long-term treatment, and not all patients are eligible, but early results have been promising and your radiation oncologist should be willing to at least discuss it with you (footnote 4).

proton therapy treatment

Another newer technique in pancreatic cancer treatment is proton radiotherapy. Although proton treatment has been used since the 1960s to cure cancer, only in recent years has this option become widely available. Proton therapy produces the same cure rates as traditional photon radiotherapy, but can sometimes deliver less radiation dose to the surrounding normal organs (footnote 5). This may mean a lower risk of side effects. Because we are still investigating the use of proton therapy in pancreatic cancer, insurance companies handle this type of treatment differently and it’s important to be in close communication with your agent if you seek this type of care.

If you are faced with a pancreatic cancer diagnosis, keep in mind that every cancer in every patient is different. Please hear what your doctors have to say when recommending the best approach for your specific situation. Because pancreatic cancer is not a common disease like breast cancer or prostate cancer, you are encouraged to seek treatment at a large university hospital or other research-based practice where the most recent developments in cancer testing and therapy are incorporated into everyday treatment.

Good cancer care need not be an unbearable burden to your family. You should feel comfortable asking up front about treatment costs and choosing among capable facilities based on their affordability. You are not alone in your journey through cancer. The UF team is here and ready to help.

1. American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.
2. Paniccia A, Hosokawa P, Henderson W, et al. Characteristics of 10-year survivors of pancreatic ductal adenocarcinoma. JAMA Surgery 2015;150:701-710.
3. Versteijne E, Vogel JA, Besselink MG, Busch ORC, Wilmink JW, Daams JG, van Eijck CHJ, Groot Koerkamp B, Rasch CRN, Van Tienhoven G. Meta‐analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. British Journal of Surgery 2018, 105(8): 946-58.
4. Petrelli F, Comito T, Ghidini A, Torri V, Scorsetti M, Barni S. Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Cancer: A Systematic Review and Pooled Analysis of 19 Trials. IJROBP 2017 97(2): 313-22.
5. Verma V, Lin S, Simone CB, Mehta MP. Clinical outcomes ant toxicities of proton radiotherapy for gastrointestinal neoplasms: a systemic review. J Gastro Oncol 2016, 7(4): 644

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Keeping Your Health Information Private on Social Media

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Submitted by Erika Boltz on November 12, 2019 - 09:34

hand holding up an iphone with colorful light orbs across the photo
We strive to protect the privacy of our patients at UF Health. Your personal health information is for you to keep safe and we ask that you help guard others’ privacy when in the hospital. Members of our staff are trained on how to handle this sensitive information, but unfortunately, once it enters the world of social media, it’s no longer secure.

We have put together a list of tips to consider before sharing information on a social media site:

  • When taking photos while visiting our campuses, offices, and other facilities, be mindful of others who may be in the background
  • For your safety and privacy, avoid taking/posting photos on your own page, or UF Health pages, that contain medical information (ex., patient wrist band, computer monitors, whiteboards and/or financial information)
  • Please ask hospital team members for their permission before including them in photos
  • Remember the Internet is permanent – assume that once you post information it stays visible forever
  • Do not reveal your location within the hospital (ie., do not show room numbers or other identifying information)
  • Turn-off GPS capabilities on your smartphone before posting photos
  • Contact local authorities and/or the specific social media outlet if you feel you are being bullied or harassed on social media. Each social media platform has reporting mechanisms built-in for these situations.

Additional information regarding patient privacy at UF Health can be found in the Patient Guide.

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The Perfect Balance of Employment and Deployment

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Submitted by Devin Nori on November 8, 2019 - 08:38

This Veterans Day, we honor not only our veterans, but also those who allow their military and civilian careers to develop together. The Employer Support of the Guard and Reserve sponsors a series of awards to commemorate these allies, including the Patriot Award. This recognition honors supervisors of employees serving in the National Guard or Reserve for their ongoing support during activations and training.

Left to right: Tim Lambert, ESGR Florida vice chair, Mark Thomas, ShandsCair operations manager, and Michael Johnson, ShandsCair ground medic.

Michael Johnson, a ground medic on the UF Health ShandsCair team, serves as a flight medic in C Co (AA) 1-111th REGT GSAB out of Jacksonville, Florida. He began working at ShandsCair about a year and a half ago, and was met by strong support for his military duties. Johnson nominated his supervisor, Mark Thomas, B.S.N., R.N., EMT-P, the UF Health ShandsCair operations manager, for the Patriot Award. Johnson said it was in appreciation for Thomas’ encouragement and for his acceptance of Johnson’s commitment to both roles.

“Mark Thomas has been consistently supportive of me as I fulfill my military obligations in the Army National Guard,” Johnson said. “There’s been a couple things that have popped up over the past year unexpectedly, and he’s the first boss I’ve had who right off the bat told me to go ahead and take care of it without any pushback.”

Whether it’s taking Johnson off the schedule when he receives last-minute orders or remaining in contact with Army leadership to get documentation squared away, Thomas continues to have Johnson’s back. He had no idea he was being nominated, and was completely blindsided when he learned he had won the award.

“I was very honored,” Thomas said. “I want to stress that this should be a unit citation because it’s not just me helping out. It’s all his co-workers and the team supporting him.”

The Employer Support of the Guard Reserve sent a representative, Tim Lambert, to present the award to Thomas in the form of a certificate and accompanying lapel pin. The presentation was held on Nov. 5, just in time for Veterans Day.

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UF Health Psychiatry’s journey to Trauma-Informed Care

Submitted by on November 7, 2019 - 15:22

Official proclamation from Florida governor Ron DeSantis
Personal trauma such as violence, abuse, neglect, loss and other emotionally harmful experiences can leave lasting scars — visible and otherwise — long after the events occur. Health care providers recognize this pain and seek to assist their patients and their families through trauma-Informed care, of TIC, which promotes a culture of safety, empowerment and healing.

In recognition of the importance of TIC for our community, Gov. Ron DeSantis recently proclaimed Nov. 1 as Florida Trauma-Informed Care Day.

At UF Health, providers have been ramping up their training and awareness of TIC through a number of activities. Over the past 18 months, leaders at the UF Health Shands Psychiatric Hospital and the UF department of psychiatry had been researching available resources, especially those offered through the Substance Abuse and Mental Health Services Administration, or SAMHSA, a branch of the US. Department of Health and Human Services.

Part of this education has included identifying and visiting peer institutions that are leading the way in TIC awareness. A team from UF Health recently visited one of these sites, The Ohio State University, and returned with a greater appreciation of the potentially positive outcomes of TIC in regards to quality of care, patient and staff satisfaction, and safety. The team members said the visit strengthened their resolve to implement TIC throughout UF Health.

The UF Health site visit team included Regina Bussing, M.D., a professor and chair of the UF College of Medicine’s department of psychiatry; Richard Holbert, M.D., a UF associate professor and medical director of the UF Health Shands Psychiatric Hospital; Joseph Thornton, M.D., a UF associate professor and chief of psychiatry at UF Health Shands Hospital, and Laura Rodriguez-Roman, M.D., an assistant professor in the UF College of Medicine’s department of psychiatry. Also on the team were leaders from the UF Health Shands Psychiatric Hospital, including Mitchell Hall, the assistant administrator, Ashley McReynolds, the acting director of nursing, and Eaton Fletcher, of the Employee Assistance Program.

In October, nearly 300 UF Health physicians, nursing leaders and UF Health Shands Psychiatric Hospital staff gathered for TIC training sessions led by internationally recognized TIC experts Brian Sims, M.D., and Raul Almazar, R.N., M.A. Sims and Almazar also visited the UF Health Shands Psychiatric Hospital, where they remarked on the large number of participating physicians and staff committed to TIC.

Leading up to the training events, targeted educational messages were provided to resident physicians, teaching faculty and staff through the office of Jacqueline Hobbs, M.D., Ph.D., an associate professor and vice chair for education and residency training at the UF College of Medicine. Similar preparations were offered at the UF Health Shands Psychiatric Hospital.

As a result of the training and other steps, UF Health will continue to implement TIC training elsewhere in the system, including for emergency room and security staff.

Combatting COPD

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Submitted by Devin Nori on November 6, 2019 - 09:24

doctor holding up and looking at a chest x-ray
University of Florida Health researchers are on a mission to provide prevention education and effective treatment for chronic obstructive pulmonary disease, or COPD.

COPD is an umbrella term used to describe a group of lung diseases that often make breathing difficult. These diseases include emphysema and chronic bronchitis, characterized by lingering cough, chest tightness and wheezing.

Pichapong Tunsupon, M.D., an assistant professor within the UF College of Medicine’s division of pulmonary, critical care, and sleep medicine, has clinical and research interests in COPD and pulmonary rehabilitation. Through his education and fellowship training, he has become well-versed in the causes and treatments for COPD.

About 16 million Americans are diagnosed with COPD, and smoking has proved to be the most common cause of COPD that can be symptomatically treated to improve quality of life and exercise capacity. There is no curative therapy for COPD yet. This is why UF Health is working toward a cure through research and different treatment methods.

The team at UF Health treats patients from throughout Florida using a comprehensive program that employs innovative treatment methods to counteract the effects of COPD and to help patients regain their health. Patients undergo pulmonary function testing to screen for obstructive lung disease before proceeding with appropriate treatment. The team also checks for other comorbidities such as cardiac diseases, metabolic diseases and psychiatric problems to ensure that each patient’s conditions are addressed accordingly.

UF Health offers physical therapy programs, walking saturation tests to evaluate if a patient needs oxygen supplements, vaccinations and evaluations to determine if a patient will be a candidate for lung transplant. The team creates an effective treatment program for patients that goes beyond medication and takes lifestyle adjustments into consideration.

Patients who smoke can receive counseling to help them transition out of the habit. Since smoking is the leading cause of COPD, many patients struggle with this adjustment. This program works to help patients quit smoking for good and to move forward with their treatment in the best way possible.

In addition, UF Health also provides management plan resources and support groups for patients suffering from COPD. At these group meetings, patients and their families have the opportunity to learn more about their condition and how to maintain a healthy lifestyle to help lessen its effects.

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Bringing Halloween to the Hospital

Devin Nori's picture
Submitted by Devin Nori on October 31, 2019 - 14:41

Everybody knows about the people who treat kids’ illnesses, but what about those who keep their spirits up? Some of the patients at UF Health Shands Children’s Hospital can be admitted for weeks or months, sometimes even longer. That’s why UF Health’s Child Life Program is dedicated to making their stays as comfortable, fun and familiar as possible.

The Child Life Program not only helps children cope with hospitalization and procedures, but also helps provide activities and special events while they are hospitalized. One goal of the program is to normalize the hospital for patients, which can be done through organizing special events for the different seasons and holidays.
Child life staff member decorating a pumpkin with a pediatric patient

“The patients wake up and see their doctors and nurses, and the routine can get kind of boring surrounded by blank walls and their little televisions,” UF Health Child Life specialist Amanda McLeod said. “We have a calendar of activities to encourage kids to come to the group room. When we have special events to include in the mix, it’s pretty incredible!”

This Halloween season, the team planned events for nearly every day in October. One event, Pumpkins for Munchkins, has been held annually for more than five years. Dunkin’ Donuts sponsors the event, bringing doughnuts for the staff and families and plastic pumpkins for patients to decorate. On Halloween day, the team joins with UF Health Volunteer Services for a Pet Therapy Parade, in which pet therapists and their owners dress up in costumes to parade through the units.

To make sure everyone feels the holiday spirit, the pediatric units also have reverse trick-or-treating. For patients who might not be able to leave their rooms, Child Life specialists and volunteers bring goodies to them. Walmart, one of the Children’s Miracle Network’s major supporters, got involved by donating costumes so that all of the kids could dress up even if they couldn’t leave their room.

There are plenty of ways for the community to get involved, whether it is by planning special events with an organization, donating to the program or volunteering in the hospital. Special events typically run for about an hour, up to six people from the organization are invited to help facilitate. The Child Life Program accepts donations year-round and their wish list can be found on their website. Visit the Child Life Program website to learn more about ways to help.

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Grand Adventure: Tumor treatment ensures hike happens

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Submitted by Peyton Thomas on October 22, 2019 - 08:45

In September 2018, David Walther traveled from The Florida Panhandle to Arizona for another shot at adventure. The 62-year-old high school economics teacher from Jay, Florida was looking to complete a rim-to-rim hike at the Grand Canyon in just a single day.

David had conquered the 21-mile hike four times before, and he had logged numerous hours of training in preparation for this latest trek. But this time, something wasn’t right. The day before the hike, David felt severe head pain. He had been experiencing bad headaches for the past few weeks, but this time, the pain was almost unbearable. man wearing hiking clothes holding up a thumbs up and smiling

He knew he needed medical care, and with the help of three fellow teachers he traveled with, David went to an urgent care facility in Page, Arizona. An initial diagnosis suggested cancer, and David immediately booked a flight back to Florida.

At a hospital in Pensacola, David underwent an MRI that confirmed he had a glioblastoma, a type of tumor that can occur in the brain or spinal cord. Headaches are one of the most common symptoms of a glioblastoma because as the tumor grows, it increases pressure on the skull and the brain.
David was advised to seek care at UF Health, so he and his wife made the five-hour drive to Gainesville. On Sept. 11, 2018, David underwent surgery performed by UF Health neurosurgeon, Maryam Rahman, M.D., an assistant professor in the UF College of Medicine’s department of neurosurgery.

Following the surgery, David immediately began six weeks of radiation and chemotherapy treatment. He said the positivity and care from radiation oncologist Robert J. Amdur, M.D., a radiation therapy professor in the UF College of Medicine, and his medical oncologist Ashley Ghiaseddin, M.D., made a world difference.

“I had such positive experiences at UF Health,” David said. “There are always a great group of people around who look after me tremendously.”
David quickly returned to work and finished out the school year in December, just under three months following his surgery. This August, the beloved Pace High School teacher entered his 41st year of teaching.

Determined to make that fifth hike, David created his own workout routine. He did a mix of activities, including running the bleachers, bike riding and lifting weights. Periodically, he returns to Gainesville for a medical appointment and when he does, he typically heads to Ben Hill Griffin Stadium for some exercise.

“I know I’m not back at 100%,” David said, “but I’m pretty close. It’s been an emotional time for me to be surrounded by loved ones as I try to redeem myself and complete what I had hoped to do last year.” And this past September, David returned to Arizona for some unfinished business. Accompanied by his wife, two daughters, granddaughters, and former students – and with the assistance of UF Health helping his every step – David completed hike No. 5 through the Grand Canyon.

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Myths and Facts Surrounding Sepsis

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Submitted by Peyton Thomas on September 26, 2019 - 08:04

Sepsis, the body’s reaction to an infection, can lead to tissue damage, organ failure and even death. In light of September being Sepsis Awareness Month, we’ve broken down the basics and cleared up some misconceptions surrounding sepsis.

microscopic view of sepsis

1. Sepsis causes more deaths than prostate cancer, breast cancer and AIDS combined.
FACT. Sepsis is more common than most people realize. Over 1.5 million Americans are diagnosed with sepsis each year and nearly 250,000 die from it. Sepsis creates a chain reaction throughout the body and, without timely treatment, can have lasting effects on the individual.

2. Sepsis only affects patients in hospitals.
MYTH. Sepsis can develop in any person with an infection, meaning many people may already be in a hospital. However, sepsis is a common reason why people seek care in an emergency room, even if they didn’t realize they had an infection. Anybody with an infection can be a victim of sepsis, regardless of whether they’re being treated for the infection already.

3. The symptoms of sepsis are very similar to those of other conditions.
FACT. Symptoms of sepsis include fever, weakness, shortness of breath, disorientation and clammy skin. These symptoms tend to go hand-in-hand with numerous other conditions as well, making it very difficult to diagnose sepsis early. Many times, patients will assume the onset of these symptoms are completely unrelated to infection. However, patients with unexplained fevers, malaise and confusion, especially in the setting of a new suspected or diagnosed infection, should seek care immediately.

4. Sepsis is rare and only affects people who already have a preexisting condition.
MYTH. While infants, the elderly, and those with weakened immune systems are most susceptible to sepsis, it can affect anyone. Anyone with an infection, from an inflamed paper cut to pneumonia, is potentially at risk. This is why it is so important to understand sepsis for all that it is, and to recognize the signs early on.

5. If detected and treated early, those who overcome it can go on to live healthy lives.
FACT. Although sepsis is a serious illness, people are often able to lead happy and healthy lives after receiving proper and timely care. Treatment may include antibiotics, IV fluids to maintain blood pressure and prevent significant organ damage, and monitoring in the intensive care unit. Some patients may require an operation or procedure to control the infection. The body and mind need time to recover as they would after any sickness, but after the initial healing period, people can maintain a healthy life.

Sepsis is known as the “silent killer,” and for a good reason. With such low awareness surrounding sepsis, it’s no wonder people don’t recognize it in their own bodies. This Sepsis Awareness Month, start the conversation about sepsis and spread the word. Learn more about sepsis from UF Health.

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Veteran Advocates ‘Take Care of Yourself’

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Submitted by Brittany Purcell on September 24, 2019 - 15:59

After 20 years in the military and 18 years in the United Nations, including four peacekeeping missions, retired Army veteran Chris Maxfield faced yet another life-threatening battle, this one back home.

Upon retirement, Chris and his wife settled in Florida. As part of his annual exam with Carolyn Stalvey, M.D., associate professor of internal medicine in the UF College of Medicine, she administered a PSA test and blood workups. Due to a bad urinary tract infection years ago, the 65-year-old had compiled a 10-year history of stable PSA scores in his medical record.

patient and his wife in formal wear posing in front of a gold backdrop

Stalvey noticed his numbers were a little higher than past years. While still low, they were within range to warrant a referral to UF Health Urology. In his initial appointment, Chris was seen by Michael Dennis, M.D., a clinical assistant professor of urology in the UF College of Medicine.

“He said we could do another PSA test in three months, do a specialized urine test or a biopsy,” Chris said, “and I chose the urine test.”

When the results came back, they indicated a high probability of prostate cancer, which was confirmed by a subsequent biopsy.

“I was about to leave for a trip to New York, so I took my biopsy results with me to show my previous urologist for a second opinion,” Chris said. “He said I should look into robotic surgery and wrote to his New York colleagues to see who in Florida to recommend.”

His colleagues’ responses brought up Li-Ming Su, M.D., a UF Health Urology robotic surgeon. Upon returning to Florida, Chris met with Su, a professor in the UF College of Medicine, about having robotic surgery to remove the cancer. Su explained the options of surgery or radiation, as well as the risks and benefits.

“All cancers have to be viewed in a personalized matter and Chris’ was the type of cancer that has choices,” Su said. “It is important to treat the cancer but also give a realistic view of what life is like after treatment.”

“Everything clicked just right to get Dr. Su,” Chris said. “He knew we wanted to take care of this quickly and called me days later saying they had an opening the following week.”

Chris’ cancer was caught early on and contained within the prostate. Su performed a robotic-assisted laparoscopic prostatectomy to remove it.

“This whole experience was high-quality, highly professional and highly competent on all sides. It was like a well-oiled machine with an abundance of personal human touch,” Chris recounted. “At all times, I was informed and felt like I was part of the medical team instead of just the person who was being operated on.”

For the Army veteran, the experience taught a valuable lesson in being proactive when facing a more invisible enemy.

“My takeaway is not about me. It is about ‘taking care of yourself.’ If you feel like something is not right, follow it. Don’t leave it until it’s too late.”

The American Urological Association guidelines for prostate cancer screening suggest that patients between the ages of 55-69 undergo a PSA blood test and prostate examination every one to two years. Men with increased risk of prostate cancer, e.g., African American race and men with first-degree male relatives with a history of prostate cancer, should begin screening at an earlier age.

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Ahoy, Scurvy Awareness!

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Submitted by Devin Nori on September 20, 2019 - 09:31

Multicolored citrus slices laid invitingly on a wooden cutting board

Today is Talk like a Pirate Day, which is a great opportunity to shed some light on scurvy - a disease that is often associated with those who sail the seven seas.

There is a common misconception that scurvy disappeared around the time that plundering villages became socially unacceptable. In reality, scurvy remains a global health issue.

Scurvy is caused by a vitamin C deficiency. While most people have daily access to fresh foods and produce containing vitamin C, this is not the case for everyone. People in developing countries and those living in poverty in developed countries can have a hard time finding natural sources of vitamin C.

Those at higher risk for scurvy include those with eating disorders or mental illnesses, alcoholics and the elderly, when exposed to prolonged dietary deficiencies. Smokers can also fall into this category, as smoking affects the way the body absorbs vitamin C.

The severity of scurvy isn’t the issue, it’s the lack of education surrounding the disease. Most people don’t know the symptoms to look for in themselves or loved ones.

While scurvy is easily treatable, it can be difficult to diagnose. The symptoms of scurvy – including fatigue, loss of appetite and muscle pain – are vague and can be associated with many other conditions. Many times, a doctor will go through several other diagnostics before testing the patient’s vitamin C level.

Treatment of scurvy includes vitamin C supplementation and lifestyle changes to incorporate more vitamins into the patient’s daily consumption. Some symptoms, like fatigue, can go away within the first day or so, but others can last longer.

We’re going to need all hands on deck in spreading awareness, so grab some citrus or walk the plank!
You can learn more about scurvy and other conditions like it from the UF Division of Infectious Diseases & Global Medicine.

A Rockstar Recovery

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Submitted by Devin Nori on September 18, 2019 - 14:38

From a young age, Dylan Lambert felt different. He was originally from Montreal, Canada and grew up in a small town in rural Georgia. His opportunities seemed few and far between, and the future looked bleak. With little to do, he began to drink.

At first, he drank to ease his anxiety and help him sleep. After a while, though, Dylan decided that it was more fun to drink than to go to school. It got to the point that he found himself drinking during every part of his day. dylan lambert playing a guitar on a couch sitting next to a dog

“I was just so profoundly sad all the time. I felt like I had the life falling out of me slowly since the day I was born,” Dylan said. “There was no potential for love left in me, and I was doomed pretty much from the start.”

As his drinking continued, Dylan found himself slowly becoming a worse friend to the people he cared about most. Things became all about him, and he lost regard for anyone or anything else. He realized he had hit his breaking point when he got involved with his best friend’s girlfriend. He checked himself in for treatment a week later.

When Dylan first arrived at UF Health Florida Recovery Center, he was scared. He didn’t know what to expect and felt that he had lost most control over his life. He became confrontational, and it took a lot of adjustment. Upon leaving, he relapsed and was found with alcohol poisoning by a savior he refers to as K. This led to his second attempt at recovery at FRC.

“By the time I made it back, I didn’t care what happened to me,” Dylan said. “I didn’t care if I lived or died or ended up in jail or homeless.”

The start of Dylan’s second stay at FRC wasn’t easy, but he eventually gave into the routine that was presented to him and found a reason to live again. He was given a guitar, and the instrument helped shape much of his recovery process. He found comfort in the values of the treatment, which promoted vigorous honesty and gratitude. He felt he was receiving overwhelming love and support.

“I’m very cynical, but I think the recovery community goes beyond cynicism. Everyone wants you to get well and is willing to open their arms to you,” Dylan said. “I don’t think I’d be alive right now without FRC.”

Upon completing treatment, Dylan, now 24, started living his best life. He moved to Nashville, where he interns at Blackbird Studios, a recording company that has worked with performers including Carrie Underwood, Lynyrd Skynyrd and Queen. He has a girlfriend, and, inspired by his favorite bands – LCD Soundsystem and Sonic Youth – he plays rock ‘n’ roll regularly.

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Mikah’s Story

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Submitted by Lauren Gajda on September 4, 2019 - 09:26

Living a normal life with a rare form of glioblastoma

One day in January 2018, Mikah Phillips came home from school with a headache. After it persisted, his mom, Debbie, took the 9-year-old to a pediatrician. Eventually, they went to a pediatric emergency room in Panama City, Florida, where doctors thought Mikah may have a sinus headache, possibly the flu.

A computerized tomography, or CT scan, revealed a parent’s worst nightmare for Debbie and Justin Phillips. Mikah had a brain tumor that was 6 centimeters in diameter, about the size of an egg. He was rushed to a children’s hospital in Pensacola, where he had surgery to remove the mass. pediatric patient wearing glasses smiling standing on stairs

The mass was biopsied and on Feb. 8, Mikah’s physicians told his parents that he had glioblastoma multiforme, the most aggressive form of brain cancer in children and adults. The physicians referred the family to Sridharan Gururangan, FRCP (Edin.), the director of pediatric neuro-oncology at UF Health Shands Children’s Hospital in Gainesville. Debbie and Justin brought Mikah to meet Gururangan to talk through the diagnosis and decide on the next steps for treatment.

Scans from Mikah’s next follow-up appointment brought more bad news. Just four weeks after the surgery, there was a rapid recurrence of the original tumor — the mass had grown back in the same site, and it was its original size.

Gururangan had a plan. Mikah had a second surgery in March 2018, performed by UF Health pediatric neurosurgeon Jason Blatt, M.D., who successfully removed the entire tumor. Despite this aggressive surgery, Blatt made sure to keep Mikah from having any neurologic deficit by using a sophisticated surgical guidance computer to avoid damaging sensitive brain regions, thereby protecting his speech and motor functions.

Further examination confirmed that Mikah’s tumor was a rare form of glioblastoma that carried numerous mutations due to a condition called microsatellite instability, which causes the tumor to be genetically very unstable.

Research has shown this type of glioblastoma responds to a form of immunotherapy using an antibody (given through the vein) that inhibits “brakes” on the lymphocytes, which are preventing these immune cells from responding to his tumor. Once the antibody turns off the brakes, Mikah’s lymphocytes could rapidly multiply in his blood and mount an immune response in his tumor that could kill any remaining tumor cells after surgery.

This antibody, called Nivolumab, has shown dramatic responses and prolongation of life in adult patients with skin and lung cancers but is not approved by the Food and Drug Administration for use in children with brain tumors. However, Gururangan was able to obtain this commercially available but expensive antibody without cost for Mikah using a patient-specific compassionate use protocol under FDA guidelines. Since starting Nivolumab, Mikah’s tumor has shown no signs of regrowth for more than a year and has helped him avoid radiation, which is the usual treatment for this tumor. Although this treatment approach has had a positive effect on Mikah’s tumor, it is unclear how it will work in other children with his disease.

“Dr. G (Gururangan) is a wonderful man and has done so much for Mikah,” said Debbie. “He keeps our spirits lifted and is gentle when he needs to deliver bad results. He explains everything to Mikah in a way he can understand that doesn’t seem scary.”

Mikah with the game ball, his doctor and a referee in The Swamp

Every two weeks, Mikah receives infusions at the Pediatric Infusion Center & Specialties Clinic at UF Health Shands Children’s Hospital. In addition, he has an MRI done every three months to see if the tumor has grown back.

“We can’t say enough about the nurses in the infusion center,” said Debbie. “My son loves them and always give them big smiles.”

Traveling for Mikah and his family from Panama City to Gainesville became the norm for more than 16 months. They would leave at 6:30 a.m. and get to UF Health by noon, and then leave to drive home around 4 in the afternoon. The back-and-forth from Panama City to Gainesville would have continued as long as Mikah is able to tolerate this treatment. (The Pediatric Neuro-Oncology Family Support Fund helps families such as Mikah’s with financial assistance for travel and other needs, enabling them come to UF Health for treatment regularly).

“It had gotten difficult to travel so much, so our goal was to move to Gainesville, which we were excited to be able to do in July,” said Debbie. “No more long drives for us.”

Debbie explains that through all of the treatment, Mikah tries to be a normal kid. Now 10 years old, Mikah loves riding his bike and going to water parks.

“You wouldn’t know he’s sick,” said Debbie. “We try to keep his life normal, and Dr. G and UF Health have made that possible.”

After Mikah has taken the drug for two years, Gururangan will reevaluate his prognosis and, with the family involved, decide what course his treatment plan will take next.

“We take it day by day,” said Debbie.

Gururangan is cautiously optimistic about Mikah’s prognosis and is very gratified that he has been able to control the tumor growth with Nivolumab without having to use chemotherapy or radiation.

Gururangan credits the team approach at UF Health for being able to provide positive outcomes in children like Mikah with serious life-threatening illnesses.

UF Health is now extending its “team” approach far beyond Gainesville, leading a new, multi-institutional research collaborative called the ReMission Alliance Against Brain Tumors. In February, UF Health hosted the first ReMission Summit in Orlando, Florida, uniting more than 100 experts in neuro-oncology, tumor immunology, genetics, artificial intelligence, neuroimaging and bioinformatics to form an elite research community focused on achieving transformative outcomes for patients with brain tumors over the next decade.

“I am grateful to the scientists who work to discover potential treatments like this one as a form of immunotherapy,” Gururangan said. “I work closely with other immunotherapy experts at UF and beyond to devise novel approaches to treat children with brain tumors like Mikah’s using different forms of immunotherapy, including the one that has been so far successful in Mikah.”

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When Seconds Count: Identifying and treating sepsis

Submitted by on September 3, 2019 - 09:05

If you’ve heard the word sepsis and have ignored it — or don’t know what it is or why it matters — you are not alone. Nearly half of Americans have never heard of the condition and more than a third cannot identify all of the symptoms.

In a nutshell, sepsis is the body's faulty, drastic reaction to an infection. This often leads to tissue damage, organ failure, and even death. It is most dangerous in young children and the elderly as well as those with a weakened immune system or chronic illness.

“Sepsis is now the most expensive in-hospital condition in America. In fact, it is responsible for more deaths in America than AIDS, prostate cancer and breast cancer combined,” said Philip Efron, M.D., co-director of Laboratory of Inflammation Biology and Surgical Science and part of the UF Sepsis and Critical Illness Research Center.

Unfortunately, there are over one million cases of sepsis each year in the U.S. and it is the nation’s third leading killer with more than 258,000 deaths annually (more than AIDS, prostate cancer and breast cancer combined.)

The Centers for Disease Control and Prevention (CDC) considers sepsis a medical emergency, similar to a stroke or heart attack. Time is the enemy for patients with sepsis as their bodies are mounting a massive, life-threatening response to infection that can destroy tissue and damage organs in a matter of minutes. With sepsis, seconds count!

What can you to do help prevent sepsis?

“Get all recommended vaccines. Make sure to practice good hygiene practices with cuts and wounds to prevent infection. These can help reduce your risk of sepsis. Also, if there is an infection, stay alert to possible sepsis symptoms (such as chills, fever, rapid heart beat or breathing) and get immediate medical treatment. Catching sepsis early can reduce lifelong complications and be lifesaving,” Dr. Efron said.

Additionally, education of the signs and symptoms, which include fever, chills, rapid breathing and heart rate, rash, confusion and disorientation, can save a life. Ask, “Could it be sepsis?” and get immediate medical attention if you suspect sepsis is present.

Be aware that the elderly (≥65 years old), premature infants or children less than 1 year old, patients with weakened immune systems and chronic, serious illnesses are the most at risk for sepsis, including intensive care unit (ICU) patients after surgery or trauma.

Physicians, nurses and all staff at UF Health have new tools and procedures to identify sepsis and respond quickly with treatment. We have a review committee who analyzes sepsis cases to improve care and scientists at the UF Sepsis and Critical Illness Research Center are working to prevent sepsis, minimize its damage and improve long-term survival.

In fact, UF Health is at the forefront at implementing all the recommendations of the CDC, which include:

• Preventing infections
• Educating patients and families
• Acting fast, and
• Reassess patient management

With education, awareness and patient monitoring, we can stop sepsis in its tracks.

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When battling sarcoma, is proton therapy a secret weapon?

Casey Jackson's picture
Submitted by Casey Jackson on August 29, 2019 - 09:27

Sometimes called the “forgotten cancer,” sarcoma only makes up approximately 1% of cancer diagnoses in adults — but about 15% of cancers in those under the age of 20, according to the National Foundation for Cancer Research. It forms in the body’s connective tissues that support, protect and give structure to other tissues and organs in the body such as bone, cartilage, fat, blood and lymphatic tissue. While there are more than 70 kinds of sarcomas, they can generally be categorized into two main groups: bone and soft tissue.

Many sarcoma patients require high doses of radiation as part of their curative treatment, and sarcoma can be an ideal candidate for proton therapy. This is a special type of radiotherapy used for cancer treatment that can spare normal tissue in the body from receiving radiation, resulting in fewer and less severe short and long-term side effects than standard radiation therapy, according to the National Association for Proton Therapy

patient ringing chimes after completing proton therapy treatment

“The thing about radiation is that it is a nonspecific treatment, so it damages normal tissue just like it damages cancer cells,” said Nancy Mendenhall, M.D., FASTRO, medical director of the UF Health Proton Therapy Institute in Jacksonville. “Proton therapy has a better dose distribution so there is less opportunity for injury.”

Proton therapy uses high-energy protons rather than X-rays to destroy cancer cells. A machine is used to speed up the protons and painlessly deliver them through the skin and into the tumor.

Additionally, high doses of traditional radiation, or X-rays, in some cases can lead to the development of a different type of cancer in the treated area. Proton therapy can reduce that risk by directly targeting only the areas of the body that are affected by cancer. For example, when a sarcoma is located in the abdomen, proton therapy may be used to save kidneys from the effects of radiation.

Proton therapy also has other advantages for treating sarcoma, especially when the cancer is located on or close to bones. For example, radiation and surgery can increase the risk of a bone fracture, while proton therapy reduces the amount of radiation to bone and helps reduce the possibility of a fracture. According to the National Association for Proton Therapy, multiple studies have shown that patients receiving proton therapy also have better survival rates when compared to other radiation treatment.

The optimal management for complex sarcoma requires multimodality therapy, often including combinations of surgery, radiotherapy and chemotherapy, said Michael Rutenberg M.D., Ph.D., an assistant professor radiation oncology at the UF College of Medicine – Jacksonville and a UF Health Proton Therapy Institute physician.

“Proton radiation technology provides a very valuable tool to help deliver the best cancer outcomes possible, while reducing the risks of radiotherapy-related side effects,” said Rutenberg. “The UF Health Proton Therapy Institute has the broadest range of proton therapy delivery techniques of any other center in the U.S. or abroad.

“However, the value of the technology is also determined by the clinical experience and expertise in treating this rare malignancy,’’ he said. “UF has one of the most active proton programs for adult and pediatric bone and soft tissue sarcoma in the world.”

The UF Health Proton Therapy Institute was the fourth proton center in the United States. Since opening in 2006, the institute has treated more than 8,000 patients from 33 countries. Annually, the institute treats an average of 100 pediatric and adult sarcoma patients using proton therapy.

Much of the data describing the role of proton therapy in both children and adult sarcoma has come from the UF Health Proton Therapy Institute, said Rutenberg. Clinical research from the institute has contributed to the acceptance and growing demand in the United States and the world for proton radiotherapy.

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Back on the saddle

Alisha Katz's picture
Submitted by Alisha Katz on August 1, 2019 - 13:56

In the face of adversity, Lisa Alexander got back on the horse — literally.

woman smiling with four horses

Lisa has made horses an integral part of her life since her 30s. Once a competitor in upper-level dressage, a highly skilled form of horseback riding, Lisa lives on a property in northwest Ocala where she cares for 12 equines. But Lisa’s passion for riding and nurturing horses came to a sudden halt three years ago when she was diagnosed with breast cancer.

At first, Lisa said she was intimidated by the diagnosis and at the thought of losing the body she once knew and relied on to ride horses.

“It’s your whole body, your muscles, your center of gravity,” Lisa said.

Lisa selected a full mastectomy of her right breast because of the nature of her cancer. Fortunately, because of her surgery, Lisa did not require additional treatment, such as chemotherapy or radiation.

After a six-month healing process, Lisa was ready to look at her options for breast reconstruction.

“I thought, ‘What are my choices to reclaim my body, one I can live with and live my life with?’” Lisa said.

When searching for a hospital to have her reconstruction done, Lisa, who is originally from a metropolitan area with an academic medical center, had a bias for teaching hospitals.

“We have this amazing resource in North Central Florida where you have people who are so skilled that they teach medicine and the teaching experience itself is multiplied through practice,” Lisa said. “Instead of a doctor (practicing medicine) alone, it’s a doctor with an audience. Being open about that process is of such value. You can’t get that elsewhere.”

Lisa sought out the UF Health Plastic Surgery and Aesthetics Center, where she met Bruce Mast, M.D., chief of plastic and reconstructive surgery at UF Health and the Maurice J. Jurkiewicz Professor of Reconstructive Plastic Surgery at the UF College of Medicine. “It was a very thoughtful process and Dr. Mast was very understanding that I wanted my body back,” Lisa said. “I was very afraid of losing my physical abilities with reconstructive surgery. I wanted to lift a saddle onto my horse.”

Lisa elected to have a breast implant, the least impactful surgical option. “Life went on (after reconstruction), but I realized that the implant was not the best choice,” Lisa said.

At Lisa’s one-year reconstructive appointment, Mast examined her progress and began asking her questions. Mast noticed that the implant had become surrounded by thick scar tissue, which resulted in discomfort and limited Lisa’s movement due to tightness.

Mast offered Lisa a more invasive surgical option, known as a flap procedure that would release the scar tissue and add more tissue to better shape the breast. The procedure involved moving muscle, tissue and skin from a person’s back, while the tissue kept its own blood supply, to release the scar tissue, shape the breast and use a smaller implant. The flap procedures are more complicated because they work with live tissue and blood supply.
“It took bravery on my part,” Lisa said. “But I’ve thought about that moment a lot and how it could have played out anywhere else.”

Lisa believes that the value of a teaching hospital and academic medical center is the availability of many techniques and the open mindedness to apply the right treatment to each patient.

After Lisa’s flap reconstructive surgery, the six-week healing process included weekly follow-up visits and phone conversations with the physician assistants, or PAs, at the UF Health Plastic Surgery and Aesthetics Center. Since the flap procedure included incisions on the back and front of Lisa’s body, she was connected to drains that would be checked frequently, in addition to checking for how the muscle was holding the new implant in the correct place.

“The PAs are some of the most skilled women that I have ever met,” Lisa said. “They know what they’re doing, they know his (Dr. Mast’s) work, they know the procedure and they know the healing process.”

During her procedures, Lisa’s husband, Gordy, would bring the equines — donkeys, miniature ponies and horses alike — into their stalls for Lisa to meet and hug without risking injury. Now, Lisa is back to caretaking for them.

“There’s something about how you get accustomed to being in your own body and then something changes profoundly,” Lisa said. “I adjusted but you don’t understand all the compromises that go with that until someone removes it. I want my body to take me places and allow me experiences for as long as I possibly can. This has been a gift. I have a whole new threshold of wholeness now to work from.”

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Clearing Up Everything Cleft and Craniofacial

Devin Nori's picture
Submitted by Devin Nori on July 22, 2019 - 10:50

Craniofacial deformities include birth defects in the face or head. Many people know about cleft lips and cleft palates, but that tends to be where their knowledge on the topic ends. In light of July being Cleft and Craniofacial Awareness Month, it’s time to clear up some misconceptions and promote a greater understanding of the condition.

baby with cleft lip sleeping

Myth: Craniofacial abnormalities have cognitive impacts on the individual.

False!

These deformities purely affect the face and head, and have no effect on the brain. People with craniofacial deformities do not have any kind of mental disability as a result and do not have altered personalities or intellectual capabilities.

Myth: Craniofacial deformities are a result of the parent doing something wrong during the pregnancy.

False!

While the direct cause is unknown, research indicates that the condition comes from a combination of genetic and environmental factors. Parents often think they did something wrong and the deformity is their fault, but isolated cleft lip or palate is nobody’s fault. Cleft palate and/or lip occurs for a variety of reasons and is among the most common birth defects, according to Centers for Disease Control and Prevention.

Did you know?
Cleft lip is more common in boys than in girls, but isolated cleft palate is more common in girls.

Myth: Craniofacial deformities require emergency surgery.

False!

In some cases, surgeons will wait at least a year to operate on infants with craniofacial deformities to let the child grow and develop healthily. While there are certain cases that require quicker surgery, these instances are very care and occur with conditions like Pierre Robin sequence, where the child’s airways are obstructed.

Myth: Oral clefts are the only type of craniofacial deformity.

False!

While the most common, cleft palate and/or lip are not the only type of craniofacial deformity. Other common forms of craniofacial deformities include craniosynostosis, hemifacial macrosomia and Goldenhar syndrome. Some of these deformities stem from a specific genetic mutation unique to the patient, making their care more specialized.

To learn more about craniofacial deformities or seek treatment, visit the UF Health Craniofacial Center. Our team of specialists have been seeing patients for over 40 years and are equipped to handle a multitude of conditions and provide resources on education, financial assistance and support organizations for patients and their families.

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Seizing the Day: Brooklynn’s Escape From Epilepsy

Talal Elmasry's picture
Submitted by Talal Elmasry on July 1, 2019 - 12:41

Robyn Nelson called louder and louder for her 4-year-old daughter, who was somehow drifting away despite lying right by her mother’s side.

“Mommy, where are you? I don’t see you,” said Brooklynn Nelson, who repeated the same response after her mom assured her she was right in front of her face.

During this time, Brooklynn’s eyes deviated to the left. She was having a seizure, her first of many in what has become an arduous battle with epilepsy.

“She became unresponsive, foaming at the mouth,” Robyn said. “People have in their mind an idea of a seizure. She didn’t have those classic indicators, like the rigid body, shaking. She didn’t have those things that you imagine when you think of somebody having a seizure.”

On that Fourth of July night in 2006, EMS swiftly took Brooklynn, who was unresponsive the entire ride, to UF Health Shands Hospital. She was given sedatives to undergo a spinal tap, or lumbar puncture, eventually regaining consciousness to reunite with her shaken mom.

“That was one of the most terrifying experiences of my entire life,” Robyn said. “It was completely debilitating, and I was racked with fear after that.”

The long, hard road

New cases of epilepsy are common among young children. However, while some are triggered by a medical condition or injury that affects the brain, Brooklynn’s epilepsy was de novo, likely from a subtle focal brain malformation.

At UF Health Pediatric Neurology, she was investigated on the epilepsy monitoring unit and followed for several years while being treated with medication. Still, she was having breakthrough seizures, or those that suddenly occur despite consistent medical treatment.

The condition had Brooklynn watching life pass her by, stealing her happiness and freedom.

“Whenever I was having seizures, I had adults hovering over me watching my every move,” Brooklynn said. “Because they’re like, ‘Oh, you’re going to seize. You can’t do anything by yourself.’”
Brooklynn spent several years suffering from idiopathic epilepsy, a type that doesn’t have a known cause.

Although physicians at that time discussed Brooklynn’s case at a conference and indicated she might be a potential candidate for surgery, Robyn simply wasn’t ready to allow her daughter, who was 6 years old, to have brain surgery before exploring other options first.

There was a possibility of her incurring brain damage. There was even a risk to Brooklynn’s life.

“You just don’t know what can happen. It’s the brain. It’s super unpredictable,” Robyn said. “I mean, you take out a kidney, you still got one, things are functioning. You take out a gallbladder and things still function. Some people live with a lung. The brain? It’s different.”

When Brooklynn was around 13 years old, the family transferred her to another hospital within the state of Florida to get more answers. She had countless MRIs, CT scans, PET scans, EEGs. After trying different medications, they found a regimen that was helping.

However, there was a problem. It was causing significant weight gain.

“I mean we’re talking she went from probably 115 to 180 pounds over the course of a year with no real change in her diet or activity,” Robyn said. “She was an active cheerleader, so we knew it was medication-related. We decided to stop taking that medication.”

Brooklynn withdrew from that medication for about four months. In February of 2018, she had a seizure after being seizure-free for about 15 months.

It was like, ‘What do we do now?’ That was when we sought care with Dr. [Giridhar] Kalamangalam.”

Getting to the bottom of Brooklynn’s seizures

Dr. Kalamangalam, her neurologist, brought Brooklynn into the UF Health Neuromedicine Hospital’s epilepsy monitoring unit in March of 2018, taking her off all medications.

The hope was to invoke her seizures, the very thing that horrified Robyn when she first saw it happen 13 years ago after a peaceful family barbecue on Independence Day.

Brooklynn ended up having 16 seizures detected on her EEG in one 24-hour span while in the monitoring unit.

“You feel helpless. You feel helpless, and there’s nothing you can do to make it better,” Robyn said. “It’s kind of one of those feelings where my hands are tied behind my back and I see my child drowning, and there’s nothing I can do about it.”

However, unlike the very first seizure that made Robyn feel powerless, these episodes brought hope, and they were key to Brooklynn’s recovery.

From left to right: Elizabeth Nelson, sister; Robyn Nelson, mother; Brooklynn; Matthew Nelson, father; Matthew Nelson Jr., brother.

Parents in Robyn’s position dread the sight of their child having a seizure and normally take every measure to prevent them, but it’s quite the opposite when you’ve got experts in the room who need to see it happen.

“That was a lot for her to have, but it helped us to know, ‘OK, this is the region of the brain that this is coming from,” Robyn explained. “Externally, we can track that, but now we have to figure out where to go from here.”

To bring about these seizures in Brooklynn, physicians had to try multiple triggers, the main one being sleep deprivation. There were times when Brooklynn was awake for more than 24 hours, stimulating herself by watching movies, playing games or painting her nails.

“You pray for them to come,” Robyn said.

Based off the information they captured from that prolonged Video-EEG, study, Dr. Kalamangalam expressed his belief that Brooklynn would benefit greatly from surgery. Still, there were several steps they’d need to take first.

No matter how long the process, Brooklynn was never alone.

“My mom was so supportive,” Brooklynn said. “She was there for every hospital stay. We just have a really close relationship. She’s my best friend.”

Mapping it out

At one point last year, Brooklynn — having exhausted six or seven medications — was experiencing seizures that had become more frequent and more severe. They were coming in the form of grand mal seizures, the kind that cause loss of consciousness and violent muscle contractions. These led Brooklynn to fall and injure herself several times.

Those incidents clarified Brooklynn’s path to surgery. She had to be informed of her options, have neuropsychological testing, a PET scan, an MRI and blood work.

Robyn was overwhelmed when her daughter got past one final hurdle.

“I’ll never forget where I was the day that I got the call that she was cleared to move on to the next step, which was the SEEG (stereoelectroencephalography),” Robyn said. “I remember crying tears of fear and excitement that day.”

The SEEG, performed in August of last year, was the first of two invasive surgeries Brooklynn would have. The SEEG was done to further pinpoint where the seizures were originating from. Depth electrodes were inserted into different regions of her brain, including the temporal lobe, frontal lobe and insula.

Left: As part of her evaluation, depth electrodes were placed in various parts of Brooklynn’s brain. Right: The SEEG pinpointed the seizure focus that led to the temporal lobe being removed to cure her epilepsy.

Brooklynn, treated in the neurointensive care unit, had eight seizures. Her neurosurgeon, Dr. Steven Roper, and his team obtained a clear map of Brooklynn’s brain and discovered the seizures were originating from the right hippocampus. Meanwhile, they knew exactly what needed to be removed to give Brooklynn the best chance for fewer seizures and a better quality of life.

“After being in the hospital for nine days, Dr. Roper told us that they had all the information they needed,” Robyn said.

Brooklynn’s successful temporal lobe resection removed the part of the brain where her seizures originated from.

Even after 13 years of exhausting every other option, and Brooklynn’s temporal lobe resection already scheduled, Robyn struggled with the enormous risk the operation carried. She went to therapy and hoped a sign from a higher power would indicate she was doing what was best for her daughter.

Robyn got that sign the same day Brooklynn was slated to have her surgery last October.

“That morning she woke up and she had two seizures right back to back,” Robyn said. “It was just kind of that clarity came over me. This is why we made this decision. This is God’s way of saying, ‘You have to do this. This is the right thing.’”

Long journey leads to new travels

For nearly her entire life, Brooklynn wondered whether she’d ever enjoy full independence, like the freedom to not need someone in the pool with her at all times, or to have her friends on standby for emergency treatment during a sleepover.

“I felt like all of my friends or the people at my high school, they were just living their life normally,” Brooklynn said. “And I felt like I was being held back and put in this little box. I wasn’t able to grow up, because I had to be watched all the time, and that really hurt me. I feel like I didn’t have the same chances as them.”

Brooklynn is already far removed from that feeling. In fact, she says she can’t even remember what it feels like to have a seizure since her last episode was so long ago.

Brooklynn has been seizure-free since her temporal lobe resection in October. April 10 was a big day for her, marking exactly six months since that surgery, opening the doors (literally) to the ultimate symbol of freedom for any 17-year-old.

Brooklynn is seen with Dr. Giridhar Kalamangalam nearly five months after her temporal lobe resection. She has now been seizure-free for almost nine months.

Six months without a seizure meant Brooklynn was eligible to get a driver’s license in the state of Florida. Recently, Robyn was at the DMV, jumping at the opportunity to prepare everything for Brooklynn. She surprised her daughter with a car shortly after.

“Oh my gosh. I was so excited,” Brooklynn said. “I always thought that I was never going to drive, so it was the realization that it’s all happening. I got a car, and I’m about to get my learner’s permit. It’s just fantastic.”

This challenging experience has inspired Brooklynn, a hopeful PA or nurse practitioner, to make a difference in other people’s lives.

She was accepted into the UF Student Science Training Program, or SSTP, a seven-week program that runs from June 9 to July 27. It consists of laboratory research, a science lecture series and a UF Honors Program seminar class. The emphasis of the program is research participation with a UF faculty research scientist and his or her research team.

Brooklynn was thrilled to be accepted as she works toward her main goal of attending UF.

“Because I’ve had so many medical issues in my life, I can relate to the patients better than someone who didn’t go through all this stuff,” Brooklynn said.

Brooklynn was accepted into the UF Student Science Training Program, or SSTP, and is an aspiring PA or nurse practitioner.

Brooklynn is still overcoming medical issues related to her epilepsy. She underwent two surgeries in April, one to have a stent placed in her ureter due to kidney stones that developed from one of her anti-seizure medications. Not long after, she went in to have the stents changed and have the kidney stones blasted and broken apart.

And Brooklynn will stay on anti-seizure medication for at least two more years. After that, they can decide whether to take her off it.

For now, Robyn is appreciating the new route they’re on, which is far removed from the one she braved with Brooklynn.

“Right now, we’re just taking it day by day,” Robyn said. “She’s a great kid, and she’s super easy-going, and all the stuff she’s been through, you would never know it.”

Scoliosis: A Medical Spotlight

Michael Ward's picture
Submitted by Michael Ward on June 24, 2019 - 15:44

June is Scoliosis Awareness Month and we caught up with Laurel Blakemore, M.D., the Division Chief of Pediatric Orthopaedics at UF Health, who specializes in scoliosis surgery and spinal deformities. See what she has to say on the topic in the Q and A below:

photo of doctor blakemore

What is scoliosis?

Scoliosis is a sideways curvature of the spine that occurs most often in children and just before puberty.

What causes scoliosis and who can be affected?

The causes are mostly unknown, but the disorder is hereditary and runs in families. There are several different types, which can affect children of all ages as young as newborns. Some cause no problems while others, especially in young children, can become life-threatening.

Your focus is pediatric orthopaedics so what are some early signs and symptoms parents can be aware of in their children? Potential treatment options?

Signs of scoliosis may include uneven shoulders or waistline, a bump on the back or occasionally back discomfort.

Treatment of children is very different, especially in young children whose bodies need to keep getting taller. Braces or casts are used whenever possible to avoid surgery, and surgery is often geared towards preserving spine growth.

What are some of the unique benefits to choosing UF Health for treatment of scoliosis and related conditions?

Scoliosis in children is best treated by a doctor with special training in pediatric orthopaedic surgery. UF Health has fellowship-trained specialists in pediatric spine deformity. They use non-surgical and surgical strategies to offer individualized care for children with these conditions.

Do you have any additional resources for parents/individuals who may have further questions?

Blakemore, along with Stephanie Ihnow, M.D., are fellowship-trained and Board Certified Pediatric Orthopaedic surgeons, both showing clinical interests in scoliosis.

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Pilot training program aims to improve oncologists' LGBTQ+ literacy

Elena Moore's picture
Submitted by Elena Moore on June 19, 2019 - 14:07
We live in a time of expanding recognition and social acceptance of the spectrum of human sexuality and gender identities. However, even with all this societal change, why do members of the LGBTQ+ community still face significant health disparities when it comes to cancer treatment?

rainbow flag waving in the wind

According to the American Cancer Society, people in the LGBTQ+ community face certain health disparities, which are often rooted in barriers to care and lack of comfort in health care settings. Low rates of health insurance (as many health insurance policies do not cover unmarried partners), fear of discrimination and negative experiences with heath care providers deters some LGBTQ+ patients from seeking medical care and routine screenings.

When combined with an increased prevalence for certain risk factors, such as drug and alcohol use, LGBT+ populations also have potentially greater risks for several types of cancer. For example:

• Gay and bisexual men are at a greatly increased risk of human papillomavirus (HPV)-associated anal cancer.
• Gay and bisexual women have an increased risk of breast cancer linked to high rates of smoking, obesity, and alcohol use. Women who haven’t had children and haven’t breast-fed, and are older when they first give birth — all factors more likely to affect gay and bisexual women – are also at a slightly higher risk of breast cancer.
• Transgender women on hormone therapy have increased odds of breast cancer, but the overall risk is not as high as it is for the general female population.
• Gay and bisexual men are the population most affected by HIV. Some evidence suggests that men with HIV, especially those with AIDS, are at greater risk of testicular cancers.

A recent study that surveyed nearly 200 oncologists’ attitudes and practice behaviors regarding LGBTQ+ health found that while many oncologists said they were willing to treat and be listed as an LGBTQ+ -friendly provider, many of them weren’t necessarily proficient in inclusive treatment. For example, only 26 percent of oncologists surveyed said they ask for a patient’s sexual orientation and only 46 percent thought that knowing the sexual orientation of their patient was important.

So while most oncologists tend to have positive feelings toward those in the LGBTQ+ community, many of them aren’t necessarily educated on how to properly make LGBTQ+ people feel welcome and comfortable in a medical setting. This can deter members of the LGBTQ+ community from seeking proper help.

These treatment disparities and lack of knowledge within the oncology community inspired investigators from the UF Health Cancer Center, the Sylvester Comprehensive Cancer Center in Miami, and the H. Lee Moffitt Cancer Center & Research Institute in Tampa to create a pilot program to train oncologists on how to approach treatment for those who are LGBTQ+ . The course, called Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills, or COLORS, is an online LGBTQ+ cultural competency training for oncologists.

“Working with my collaborators from Sylvester and Moffitt on this educational module was a wonderful experience,” said Merry-Jennifer Markham, M.D., FACP, associate director for medical affairs at the UF Health Cancer Center. “The entire team was focused on creating a training program that underscored the importance of treating members of the LGBTQ+ community with sensitivity, respect and with understanding of their unique concerns. This was important to all of us because, ultimately, helping all of our patients to receive excellent care is the goal.”

The COLORS program is a web-based resource consisting of four 30-minute modules, making the program easy and quick for busy oncologists. The modules include:

1. LGBTQ+ Basics
2. Inclusive environments
3. Initiating oncology care with LGBTQ+ patients
4. Issues in cancer survivorship among LGBTQ+ patients

“We hope that the COLORS training module can eventually be provided to oncologists nationwide,” said Markham. “Providing additional training to oncologists or other cancer care providers on the unique needs of the LGBTQ+ population is an important step in helping to minimize health disparities in cancer care.”

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Kashton’s Story

Lauren Gajda's picture
Submitted by Lauren Gajda on June 11, 2019 - 11:33
Kashton in a wagon.When a fall left Kashton with severe burns, UF Health pediatric surgeons provided the specialized care he needed to get back on his feet.

It was a typical Saturday morning in August for the Hill family. They were in the backyard of their home, enjoying the outdoors and relaxing as they took in the peacefulness that helped them unwind from the workweek.

Josef and CeAnn Hill sat and watched Kashton, their 1-year-old fun-loving, rambunctious little boy, play and laugh as he bounced around the yard. The toddler found a stick and wandered near the family’s fire pit, where days earlier, Josef had burned some brush. They didn’t know it at the time, but somehow some simmering embers remained buried deep beneath the ashes.

When Kashton, known to his family as Kash, lost his balance, the laughter immediately turned to cries of pain as he slipped into the fire pit. CeAnn was less than a foot away from Kash and pulled him out within seconds, but the damage was done. The boy had burns running down his legs, ankles and feet.

Josef and CeAnn rushed him to the closest E.R. After tending to the wounds, the staff at the Williston facility told the Hills to take Kash to the UF Health Shands Children’s Hospital, which has a dedicated pediatric burn unit.

“When we got to UF Health, Kash and I were both screaming and crying for help,” said CeAnn. “The staff at the hospital jumped in quickly and wheeled us to the PICU (pediatric intensive care unit), so Kash could get the attention he needed.”

That was just the beginning of a more than six-week hospital stay for Kash. From the PICU, he was moved to a room on the fourth floor of the children’s hospital for continued monitoring and care. Every day, he had to be put under anesthesia so that his wounds could be evaluated and treated. In addition, he had three surgeries to debride the wounds, meaning damaged tissues were removed to promote healing. He also had skin grafts to transplant healthy skin.

UF Health pediatric surgeon Shawn Larson, M.D., who is the medical director for UF Health’s Pediatric Burn & Trauma Program, along with Lauren Indelicato, D.N.P, APRN, were involved in all of Kash’s surgical care.

“They are absolutely amazing,” CeAnn said. “Dr. Larson explained everything to us upfront and was super real. He made us feel confident that Kash would have a successful outcome. Lauren made us feel comfortable from Day 1.”

During his stay at UF Health, Kash hated to be in his room, so the Hills got to know the nursing staff on the floor pretty well.

“He loved riding around in the red wagons provided by the hospital, so we would take him around for walks all day long,” said CeAnn.

Despite his scars, Kash is doing amazingly well, his mother said. He is scheduled to have laser surgery at UF Health at the end of May to help loosen up the scars. In the next few years, Kash will likely need additional surgeries to loosen up the scars even more and to help his toes, which as a byproduct of the burns, do not touch the ground.

CeAnn said her son’s ordeal has not hindered him.

“Kashton is now 2 years old and loves to be active,” she said. “Running around and playing is actually really good physical therapy for him.’’

She said her family is very thankful for the care Kash has received at UF Health.

“We highly recommend UF Health and can’t say enough about the care we received,’’ CeAnn said. “We never had one bad experience. From the doctors to the nurses, physical therapists, financial advisers and receptionists, every single person made us feel at home. They became our family.”

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What is Migraine Surgery?

Alisha Katz's picture
Submitted by Alisha Katz on June 10, 2019 - 10:10
In the U.S. alone, 38 million people are affected by migraines and 1 billion people are affected worldwide. Many suffer from recurring migraines despite all of their efforts to make them stop. However, migraine surgery can be an option to stop symptoms or to reduce the pain.

Surgery may sound scary, but this procedure offers an opportunity for a better quality of life.

woman sitting at a computer holding her head as if she has a headache

Why surgery for migraines?

Migraines have been linked to the compression and irritation of major nerves in the face and head. Migraine surgery is a procedure that decompresses those sensory nerves around the skull, which are the most likely source of migraines. This procedure takes about one to five hours depending on the number of trigger sites one has. Harvey Chim, M.D., FACS, associate professor of surgery at the UF College of Medicine, says it helps patients with chronic intractable migraines by providing a permanent solution for pain after other medical options have been tried. According to the Migraine Relief Center, surgically relieving the pressure on those nerves can reduce the frequency, severity and duration of your headaches or even eliminate them altogether.

How does it work?

There are four main trigger sites where patients often experience pain when they have a migraine. This is how migraine surgery can provide pain relief to the following sites:

1. Forehead – You may feel pain around the eyebrows. The main muscles involved in frowning compress nerves. Surgery at this site includes removal of the muscles with an incision at the hairline or through the upper eyelid.

2. Temples – Sometimes the pain is located on either of the temples. Surgery removes the nerves that provide sensations to the temples.

3. Nasal – A deviated septum and enlarged turbinates, which are structures on the side wall of the inside of the nose, can cause pain behind the eyes, giving rise to a migraine. For relief, surgery straightens the septum and decreases the size of the turbinates.

4. Back of the head – Pain at the back of the neck is caused by the compression of the greater occipital nerve. A small incision in the midline of the neck and a nerve decompression provides relief.

What are the results?

According to a recent study published in Plastic and Reconstructive Surgery, 88 percent of patients who underwent surgical deactivation of targeted trigger sites reported at least a 50 percent reduction in the frequency, severity and duration of their migraine headaches five years later. Thirty-one percent of participants confirmed complete elimination of migraines.

“Patients are very happy after surgery because they have been living with pain for years,” says Chim, who specializes in migraine surgery. “Now, they do not have to deal with the uncertainty of when they will get a migraine headache that might ruin their day.”

Even though most procedures have favorable outcomes, every case and history of the patient is different. If you are considering migraine surgery, make sure to consult with a physician first to see if this procedure is right for you. For more information on migraine surgery at UF Health, visit www.plastics.ufhealth.org/migraine-surgery.

Call 352.265.8402 or contact us today to schedule a consultation.

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Living seizure-free – How epilepsy surgery changed Starr’s life.

Sofia DiMartino's picture
Submitted by Sofia DiMartino on May 24, 2019 - 10:09

couple posing in matching red formal outfits to attend senior prom
At just 19 years old, Starrlynn Gamble has dealt with more dangerous surgeries and life-threatening conditions than many older than her could claim, starting the day she was born.

Starrlynn, known as Starr by her family, was born with a congenital heart condition called transposition of the great arteries, which required corrective open heart surgery.

At nearly 3 months old, Starr underwent the procedure at a North Carolina hospital, but she suffered a massive stroke during the operation that left her with epilepsy, developmental delays and physical impairments, including partial paralysis of her right side.

The ensuing years were filled with physical and occupational therapy. Starr wore braces on both legs to help her walk, then was able to remove the left brace as she grew stronger. Although she had limited use of her right arm, Botox injections helped to increase her arm’s mobility.

Yet, while her physical abilities were improving, epilepsy continued to wreak havoc on Starr’s life as her seizures would occur without warning. Despite taking numerous anti-seizure drugs, Starr was having up to eight severe seizures every month.

“She had some really, really bad ones,” said Starr’s mom, Brenda. “We never knew when they were going to happen, and a few times she fell and cracked her head open.”

This continued until nine months ago, when Jason Blatt, M.D., a pediatric neurosurgeon who leads the UF Health pediatric epilepsy surgery program, and Parrish Winesett, M.D., a UF Health pediatric neurologist, suggested Starr receive surgical treatment.

“I was very wary of them cutting my daughter’s head open and going into her brain, but I talked to Starr about it and she told me, ‘If it would help my seizures, why can’t we try?’ and I finally agreed,” Brenda said.

“When Starr and her parents came to meet me, they expressed fear that she would be unable to care for herself and would continue having disabling seizures after her parents passed,” Blatt said. “We had a long talk about her future, and that if they wanted her to have a shot at independent living, I felt that surgery would give her the greatest chance of success.”

Blatt explained the whole surgery in detail before operating on Starr and impressed Brenda with his direct but confident delivery.

“I can’t say enough good things about him,” Brenda said. “He is just a miraculous doctor. That man has God working through him, there’s no doubt about that.”

The procedure took place over the course of nearly seven hours. Blatt opened Starr’s skull and disconnected the entire left half of her brain, which had been damaged by the stroke in infancy and was felt to be the source of her seizures. The dramatic surgery is known as a “hemispherotomy” and is reserved for epilepsy patients with the most severe, widespread brain damage. This newer procedure offers the benefits of the older hemispherectomy operation with a lower risk of some major complications.

Starr’s procedure was successful, and our UF Health staff had her up and walking the next day. After a 10-day stay in the hospital, she was finally able to go home. At first, Brenda was helping her walk, but after a day at home, Starr was walking independently.

It has been nine months since the procedure, and Starr has not had a single seizure. Brenda is amazed by her overall progress.

“Her cognitive ability has improved immensely and so has her retention level,” Brenda said. “It’s like she’s a different child.”

“This is why I love to do epilepsy surgery,” said Blatt. “Every time I see Starr, I remind her that we did this to give her an independent life, so I give her a ‘homework’ task at each visit. So far she has learned to cook, plans a family dinner each week, does her own laundry and packs her own lunches each day. She has really blossomed.”

Today, Starr enjoys doing her favorite things without the fear of falling and seizing without warning. She sings constantly and loves music. She’s a people-person who loves to play basketball and soccer.

“She’s just one of those kids who loves to help and loves to do things for people,” Brenda said.

Recently, Starr went to senior prom with her boyfriend, someone she’s kept in touch with from kindergarten. It never would have been possible without the surgery performed by Blatt.

“It was just so special,” Brenda said. “It was the first time she’s ever been to a dance with a boy.”

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What To Know About Mental Health: Everyone’s Doing The Best They Can

Brittany Purcell's picture
Submitted by Brittany Purcell on May 24, 2019 - 09:55

person comforting another person by holding their handsMichael Shapiro, M.D., an assistant professor in the UF College of Medicine’s department of psychiatry and medical director of UF Health Child Psychiatry and Psychology at UF Health Springhill, provides an expert’s perspective on mental health to increase awareness and decrease the stigma for those with a mental illness.

May is Mental Health Awareness Month.

Why is it important to take care of your mental health?

Physical and mental health are so tied together. Imagine what it is like to go a day without good sleep or a day without eating. That affects your whole experience. We should treat our brain like any other body part. For example, if your leg was injured it would be much more obvious to rest it. We do not do that with our brains. When it is a mental issue we tell people to push through, and we would never say that to someone with a broken leg.

What are some strategies people can take to improve their mental health?

Try as much as possible to live your typical life, whatever that may be. If typically you’re a person who goes to the movies – go to the movies. Know what you can do to feel worthwhile and purposeful. The more you keep aspects of your typical life, the more that helps you get by on a day-to-day basis.

I would also say, know who your go-to people are and know that it is OK to ask for support. Having social connections and emotionally supported relationships is a huge protective factor for people with mental illness. When you are having a bad day or a bad time, have a person you can go to, someone you can say, “Hey, I’m having a hard day today and I could use someone to vent to.”

What are signs that I should reach out to someone?

Changes in behavior that are different than what is expected for that person. This can include: they are more irritable than usual, more isolated, showing up late if they are usually on time, sleeping more or sleeping less, spending more time alone or the things that they used to care about do not seem to matter to them as much anymore.

There is nothing wrong with asking someone, “Are you OK?” The first step is being curious and trying to understand. Part of the package is not being judgmental or blaming. Focus on listening and understanding instead of trying to “fix their problem.”

What would you tell those with mental illness, their families and friends?

Sometimes we make people with a mental illness work harder than they have to. We may put pressure on the patient by saying, “What happened? Did you take your medicine? Are you eating right? Why are you having a bad day?” This is basically saying, “You shouldn’t feel bad if you are doing what you’re supposed to.” Everybody has bad days, including people with mental illness. There’s a lot of help in just having a nonjudgmental, listening attitude and that works for people with or without mental illness.

One thing that stops people from getting help is they blame themselves for their symptoms or they worry they are going to upset other people by telling them they have a mental illness. Mental illness is nobody’s fault. Nobody wants to have a mental illness. Nobody wants to have a family member with a mental illness. No one is trying to be sick. Everyone is doing the best they can. The difference with mental illness compared to physical illnesses is people with physical illnesses don’t feel blamed.

If you or a loved one are struggling, call any of the numbers below for help.

• UF Health Mental Health Evaluation Line: 352.265.5481
• National Suicide Prevention Lifeline: 1.800.273.8255
• Crisis Text Line: Text “HOME” to 741741
• Alachua County Crisis Center: 352.264.6789

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Bladder Cancer – Susan’s Road to Acceptance

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Submitted by Brittany Purcell on May 22, 2019 - 08:57

Susan Baglivio

It was late December when Susan Baglivio, a 68-year-old outpatient surgery nurse from St. Augustine, felt that she may have a urinary tract infection, or UTI. She had frequent urination and felt like she was sitting on a lump.

“I’d never had a UTI my whole life, and it just seemed like I had one,” she said.

Susan went to see her gynecologist and was given antibiotics. Her problems continued to get worse and the day after Christmas, she couldn’t tolerate the pain any longer. She went to the E.R., where an examination revealed a mass that was diagnosed as bladder cancer.

Paul Crispen, M.D., a urologic oncologist, treated Susan. “While most patients present with blood in the urine, her initial presentation was caused by pain and urinary frequency,” said Crispen, an associate professor in UF College of Medicine’s urology department.

Thankfully, Susan’s CT scans did not show evidence that the cancer had spread beyond her bladder and left ureter. Her options included surgery and chemotherapy, alone or in combination with one another.

“I didn’t want to have chemotherapy,” said Susan. “When I met with Dr. Crispen I realized I had no choice, my tumor was fast growing.”

Because of the location and stage of her cancer, she was told her best chance for cure was the surgical removal of her bladder and left kidney following chemotherapy.

“The urologist said everything’s going to have to come out,” she recounted. “I went into shock. I didn’t know I was going to lose my bladder.”

Post-treatment was a difficult road for Susan, who now has a urostomy bag that collects her urine. She’s tried to make the best of the tough situation.

“My last name is Baglivio and now I go by Susie Bags because I wear a bag,” she said. “I tried so many different brands of bags, and after surgery I was dealing with urinary tract infections. It took me months to accept what I was going through.”

Urinary tract infections can be common after bladder removal surgery, largely due to the new urinary drainage system required for urine to leave the body.

“The best advice for someone diagnosed with bladder cancer is to make sure you know all of your options,” said Crispen. “I encourage patients to ask open questions to their care providers and participate in bladder cancer advocacy groups locally and nationally. Shelly Doran, a genitourinary oncology nurse navigator, has set up a local support group for patients at UF Health. Additionally, the Bladder Cancer Advocacy Network is an excellent organization that provides a wealth of resources to patients. In terms of treatment, I encourage patients to consider clinical trials, which offer our patients the latest breakthroughs in the treatment of bladder cancer.”

Now, Susan connects with her patients who are going through the same treatment.

“I interview patients before they have surgery now in preadmission, and if I have someone who might be going through the same procedure, I’ll say, ‘If this should happen to you, call me, and I will offer all of my assistance’, because that will make it all worthwhile,” she said.

May is Bladder Cancer Awareness Month. In the U.S., bladder cancer is the fourth most common cancer for men and the 11th most common cancer for women. There are multiple known risk factors for bladder cancer including exposure to specific chemicals, medications and infections. However, the number one risk factor for developing bladder cancer is smoking. Some patients develop bladder cancer without any obvious risk factors, like Susan.

This month, we reflect on stories like Susan’s and aim to increase awareness of bladder cancer.

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Surviving Childhood Cancer: Lennox’s Story

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Submitted by Sofia DiMartino on May 20, 2019 - 08:00

June 26, 2017, was the worst day of Gary and Carly Allen’s lives. It was the day their child, 2 1/2-year-old Lennox Allen, was diagnosed with an aggressive brain tumor.

Before the nightmare began, the couple were living an idyllic life. Gary Allen, D.O., a family medicine resident at UF Health Shands Hospital, was working hard to serve patients while taking care of a growing family. Carly was a stay-at-home mom for their two little boys, Austin and Lennox, with another one on the way.
It didn’t come as a surprise to the young family when Lennox began experiencing morning vomiting episodes. Their oldest, Austin, had also vomited frequently when he was young. However, Carly noticed that there seemed to be a pattern with Lennox. He would get fussy, grab the back of his head and then suddenly vomit.

Concerned about her son, Carly took him in for a pediatric check-up. Tests showed no signs of gastrointestinal problems, yet Lennox’s symptoms persisted.

On June 24, 2017, Gary came home from work and noticed that Lennox was walking unsteadily. Having studied signs of brain abnormalities in medical school, Gary knew that Lennox’s symptoms — including vomiting, headaches and an unsteady gait — were common signs that something was very wrong neurologically.

After sharing his concern with Carly, Gary took Lennox to the UF Health Shands Pediatric Emergency Room. Within an hour, while Lennox watched his favorite TV show, Paw Patrol, the emergency physician called Gary out into the hallway and gently broke the news. Lennox had been diagnosed with a large posterior fossa brain tumor. The physician told Gary that neurosurgery would be inevitable in the coming days.

In shock, Gary called Carly, who was shopping for groceries with Austin, to tell her the news. She ran out of the store, pulling Austin by one hand, crying and devastated.

“I went through the whole stages of grief, like denial and anger,” Carly said. “I had hope, but at the same time, I had totally no hope that things were going to go right. I was angry that this had had happened to him. We were heartbroken.”

Prior to Lennox’s impending surgery, the Allens discovered they had yet another hurdle to cross. UF Health was waiting for a new pediatric neurosurgeon, Lance Governale, M.D., to move with his family to Gainesville. Who then, would perform Lennox’s surgery?

After Lennox’s physician called Governale and explained the situation, the Harvard-trained pediatric neurosurgeon immediately agreed to fly to Gainesville early to operate on Lennox’s brain tumor.

“Dr. Governale, I love that man,” Carly said. “He flew in when he was supposed to be trying to help his family move from Ohio, and he came for Lennox to do the surgery. Several months later, we realized how important it was that it was him who did the surgery.”

After Governale completed the tumor resection, an intraoperative biopsy diagnosed Lennox with an atypical teratoid rhabdoid tumor. This rare form of pediatric cancer, commonly known as AT/RT, is fast-growing and typically found in children younger than 3 years of age. Because the tumor type is so uncommon, many physicians have never heard of or dealt with it, but Governale had.

“Dr. Governale was up-to-date with what AT/RT was and how important it was that he got the whole tumor,” Carly said.

The eight-hour surgery was a success, and Lennox was cleared to undergo the next stage of cancer treatment, which included intensive chemotherapy, stem cell transplant and proton therapy, under the supervision of UF Health neuro-oncologist Sridharan Gururangan, M.D.

Lennox Allen at UF Health Neuromedicine Hospital

“Dr. Gururangan is one of those doctors who can present material to you with a tender spot,” Carly said. “He knows how to present the bad material, but then give you hope that there’s something that can be done about it. I’m grateful that there are people out there who dedicated their lives to studying such rare things like AT/RT, and that’s him.”

Lennox had to be hospitalized to receive his chemotherapy medications, meaning he would be in a hospital room for three weeks at a time. The drug also caused a variety of painful side effects.

“A lot of people ask me what he did while he was in the hospital,” Carly said, “But he was so incredibly sick, and he was only 2 1/2 during it. On his good days, he would get up and play with some of the volunteers or we’d take him on a wagon ride. But the majority of the time, all he wanted to do was watch YouTube Kids, and we didn’t really care because he was so miserable.”

Chemotherapy wreaked havoc on Lennox’s little body. His red blood cell counts fell, necessitating a blood transfusion, and then his white blood cells and neutrophils fell quickly after that. Lennox spiked a viral fever, which also caused terrible diarrhea. When his hair began to fall out from treatment, Gary shaved off the rest of it.

Through it all, Lennox’s soon-to-be little brother was growing quickly inside his mother’s womb and on Oct. 31, 2017, Darren Lee Allen was born at UF Health Shands Children’s Hospital. The Allens took the baby upstairs where Lennox was being treated, and the brothers met for the first time. That night, Gary went home to take Austin trick-or-treating.

On Dec. 12, 2017, the Allen family got their Christmas wish early, as Gururangan found no trace of AT/RT in Lennox’s body. While this was the news they were waiting for, Lennox had to continue treatment to decrease the chance for recurrence. He went to the UF Health Proton Therapy Institute where he received 28 rounds of radiation. On Feb. 5, he finally completed all treatments and was able to go home for good. Carly said their family owes it all to UF Health’s team care approach to cancer treatment.

“The team of them together, Dr. G (Gururangan) and Dr. Governale, it’s awesome that we have that at UF,” Carly said. “It gives pediatric patients with brain tumors a leg up.”

Today, Lennox is at home being a typical 4-year-old. He loves to play outside, draw and color. He loves his friends and teachers at the school he now attends, and he loves dinosaurs. Carly calls him “the happiest kid ever.”

Yet, life after cancer treatment isn’t always sunshine and rainbows. For a while, Lennox was tube-fed because the side effects from chemotherapy made him dislike eating. Today, however, he is eating on his own.

Lennox still has slight right-sided weakness and some speech delay after the tumor removal and receives therapy for both, but Carly could not be happier with his progress and achievements.

“So, what? Lennox has that right-sided weakness? So what?” Carly said. “He still has the same personality. He’s thriving. He’ll live a normal life despite all that he’s gone through. Lennox’s prognosis started with Dr. Governale, and he set him up for success.”

Now, looking back on her family’s experience with an aggressive childhood cancer, Carly is thankful for the care her family received and offers advice for other parents who may soon be facing the same painful experience.

“My biggest thing is you’re going to have to get help. No one ever wants to accept help, but at that moment I accepted everything because I couldn’t do it all by myself,” Carly said. “When it comes to the health care providers, trust that they know what they’re talking about and trust them. No one can prepare you for that awful day when someone tells you your child has cancer. No one can prepare you for that. It’s OK to cry. Ask questions and just let the doctors help you.”

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All of Us Research Program marks first anniversary at UF Health

Submitted by on May 17, 2019 - 10:42

The All of Us Journey bus was featured at UF Health last fall. The hands-on mobile recruitment unit helped us teach the benefits of precision medicine and the goals of the program. Pictured (L-R) are the UF Health All of Us Research Program co-principal investigators William Hogan, M.D., UF College of Medicine professor of Health Outcomes and Biomedical Informatics, and Elizabeth Shenkman, Ph.D., UF College of Medicine chair of Health Outcomes and Biomedical Informatics and director of the Institute for Child Health Policy, with David R. Nelson, M.D., UF interim senior vice president for Health Affairs and president of UF Health.

In May, we marked the one-year anniversary of UF’s involvement in the groundbreaking nationwide All of Us Research Program. The mission for All of Us complements ours: to support health research and improve health for all Americans.

The National Institutes of Health-funded program is designed to gather health data from at least 1 million people within 5 years and follow participants for a decade in order to advance precision medicine. Precision medicine is personalized health care based on factors including where an individual lives, what they do and their family health history. Researchers will study the impact of differences in lifestyle, environment and genetic makeup on individual health.

In May 2018, UF joined the SouthEast Enrollment Center (SEEC), which includes UF, the University of Miami, Emory University and Morehouse School of Medicine. More than 25 medical institutions are involved in All of Us. Data gathered by the All of Us Research Program will provide an avenue for use by researchers around the world.

“Our goal at UF is to recruit 15,000 participants from around the state over the next five years,” said Elizabeth Shenkman, Ph.D., the co-principal investigator for the All of Us Research Program at UF Health.

Shenkman is the UF College of Medicine chair of Health Outcomes and Biomedical Informatics and director for the Institute for Child Health Policy. She and William Hogan, M.D., UF College of Medicine professor of Health Outcomes and Biomedical Informatics, are the co-principal investigators for both the All of Us Research Program at UF Health as well as the OneFlorida Clinical Research Consortium. OneFlorida is collaborating closely with the SouthEast Enrollment Center and serves as the data coordinating center for the consortium.

The UF study team has been recruiting participants including our own faculty, residents, staff, students and volunteers as well as community members. The regional network aims to strengthen the program’s reach into diverse populations, including lower-income, Hispanic and Latino, African-American, and rural communities.

“This is the best way to contribute for anyone who wants to help improve health for future generations. The breadth of this project will be astounding,” Shenkman said. “All of Us has the potential to impact thousands of other studies covering a wide variety of health conditions.”

Participants are asked to complete surveys about their health, share their medical record information and contribute a blood and urine sample that will be used for genetic analysis. SEEC has already contributed nearly 4,000 medical records across the 4 institutions to the program. This information is stored for researchers to apply to use to study different diseases, populations or trends over time. Precision medicine has the potential to allow healthcare providers to inform people about the best ways to stay healthy. If someone becomes sick, precision medicine may help health care teams find the best treatment for that individual.

According to David R. Nelson, M.D., interim senior vice president for health affairs at UF and president of UF Health, “The program needs participants who care about improving the health of everyone, people who are willing to share information about themselves that could help cure diseases in our lifetime.

“This initiative represents a new era for precision health to enable more proactive and personalized health care that empowers people to lead healthy lives.”

Visit our All of Us Research Program page for information and http://bit.ly/AoU-HSC to enroll in the program.

Before I Die I want to _____

Amy Cook's picture
Submitted by Amy Cook on April 15, 2019 - 16:18

Before I Die chalk wall

Join the conversation this National Healthcare Decisions Day

Before I Die walls, a way for community members to reflect on their mortality and consider their wishes, returned to Gainesville in early April.

The walls were installed to promote National Health Care Decisions Day on April 16, a special day to empower the public and health care providers about the importance of advance care planning.

The walls began when Candy Chang, a woman from New Orleans, grieved the death of a loved one. She painted “Before I die I want to _____,” on an abandoned house to encourage people in the community to confront mortality and begin a conversation about their end-of-life care wishes.

In 2017, the walls made their way to Gainesville.

“We wanted to bring it to UF Health, and multiple departments collaborated to do this in Gainesville to start advance care planning conversations,” said Alyssa Milonas, a Neuromedicine Interdisciplinary Clinical and Academic Program, or NICAP, intern.

The NICAP interns installed 13 walls at locations across Gainesville. They include the 1329 Building, Facilities Administration Building, UF Health/HSC Sun Terrace, Arts in Medicine, HealthStreet, Reitz Union, Alachua County Senior Center, Haven, United Church of Gainesville, Possum Creek, Cone Park Library Branch and the 34th Street wall.

“The thing with mortality is it isn’t just for one audience. We reached out to libraries, UF Health, Santa Fe, churches, everywhere we could think of with a different demographic,” Milonas said. “There’s no requirements. We just wanted to encompass all of Gainesville.”

Jacqueline Baron-Lee, Ph.D., UF Health Shands director of quality improvement, said that each person who was part of the wall installation was able to write on it.

“It’s one of those mediums where you can share something that’s as jovial as jumping out of an airplane or as heartwarming as a mother wanting to make an impact in her daughter’s life,” she said.

Baron-Lee is thankful for student leaders Alyssa Milonas, Nyasia Jenkins, Hannah Mathews, Brittany Henry and Kelly Likos who are making an impact through the walls.

“What’s really encouraging is this group of students are the future of health care,” she said, “and they’re the ones helping us spray paint till 9 p.m. and making their mark each time we install a wall.”

Before I Die Wall description

The NICAP interns plan to increase the amount of walls each year to further the movement and get Gainesville even more engaged, Milonas said.

“We have the public posting the walls on social media and using the hashtag,” she said. “We have information at all of the walls that explains National Healthcare Decisions Month and all of the events going on in April.”

Visit our Advance Directives page for more information about advance care planning.

Surgeons Save Newborn Suffering From Spina Bifida

Sofia DiMartino's picture
Submitted by Sofia DiMartino on April 2, 2019 - 09:07

Lindsey Courson of Tallahassee was 26 and expecting her second child. Her first, a little boy named Camden, was a healthy, rambunctious 1 ½-year-old, and she and Clay, her husband of five years, were ecstatic about their new addition.

They weren’t yet aware that they would be embarking on their most difficult journey yet.

Their baby, a little boy they named Collin, arrived on March 10, 2011, through a planned C-section. Upon delivery, doctors immediately noticed that something was wrong.

Collin had a hole in his back, exposing his spine and threatening his survival. The dangerous condition, called spina bifida, required surgery within the first 24 to 48 hours of his life.

Collin Courson

Collin was quickly diagnosed with the most severe form of spina bifida, called myelomeningocele, in which his spinal cord failed to close during fetal development early on in his mother’s pregnancy. Due to this, many of his nerves were exposed throughout development, resulting in damage to the cord as the pregnancy continued.  

Collin was in danger, and the hospital he was born in did not have a neonatal intensive care unit, or NICU. He needed be transferred to another medical center quickly.

“The hardest thing was not being educated on his condition,” Lindsey said. “If we had known he had spina bifida before he was born, we would have delivered him at UF Health Shands Children’s Hospital. I didn’t know if he was going to be disabled or if he was going to be mentally handicapped for the rest of his life. It was terrifying.”

Under the loving watch of his father, Collin was transferred to another hospital in Tallahassee that had a NICU while Lindsey stayed behind, unable to travel after her C-section.

There, Collin’s family was given a choice.

He needed to be transferred again to a hospital more equipped to handle his crucial imminent surgery, and his family had to choose between another facility and UF Health.

“We pretty much immediately chose UF Health,” Lindsey said. “It was the closest to us, only two hours away, and we’d heard really great things about their children’s hospital.”

On the evening of his birth, Collin and his father traveled by ambulance from Tallahassee to UF Health Shands Children’s Hospital in Gainesville.

“It was so difficult not being able to go to Gainesville with him immediately,” Lindsey said. “It was all pretty difficult on our family.”

The day after Collin was born, doctors at UF Health closed his spine and attempted to place all of the previously exposed spinal nerves back into his body. They discovered that Collin had a second condition, which typically accompanies myelomeningocele, called hydrocephalus, meaning he had fluid backup within his brain. The condition is chronic, meaning Collin will be dealing with it for the rest of his life.

During this time of diagnosis and agonizing discovery, Collin’s family was assisted by a social worker who helped coordinate meetings with the pediatric neurosurgeon and Collin’s other doctors at UF Health. Lindsey credits the hospital, its staff and its nurses as the best elements of her experience due to their care and kindness during one of the most difficult times in her life.

To combat the hydrocephalus, pediatric neurosurgeons placed a shunt in Collin’s brain, which would drain the excess spinal fluid. Unfortunately, shunts can have issues over time, sometimes rarely, sometimes commonly. Over the next seven years, Collin’s shunt required 11 revisions, meaning he’s undergone 11 brain surgeries since birth at UF Health.

Procedures like these have become a part of Collin’s routine now, but Lindsey thinks back to those early days as a time of fear and emotion, overcome by the reassurance and understanding that UF Health was prepared to save her son.  

“I remember walking into UF Health Shands and just being in awe of the staff, the facilities and the hospital,” Lindsey said.

She experienced a similar emotion in 2017 when she was introduced to a new pediatric neurosurgeon for Collin for the first time since she’d arrived at UF Health in 2011. Initially, there was apprehension. Then, there was relief. When Lindsey met UF Health chief of pediatric neurosurgery Lance S. Governale, MD, she knew that her baby would continue to be treated with the highest level of care and expertise.

“The first time I met Dr. Governale, I remember thinking to myself, ‘He is so confident!’” Lindsey said. “At the time, my son needed spinal cord surgery that had been attempted the year before and was not successful, and I remember him saying he wouldn’t know until he went in there, but he was so confident that it was going to go well, and that made me feel so much better.”

Governale describes the surgery as long and rigorous, but crucial to the success of Collin’s growth.

“Many times in spina bifida the spinal cord becomes tethered, causing tension on the nerves as the child grows which must be relieved with surgery,” Governale said. “Collin’s previous doctor ran into thick, dense scar that he was unable to separate. But Collin was getting worse so I recommended that we try again.”  

The surgery was successful, and Dr. Governale was able to detether Collin’s spinal cord, relieving the tension on the spinal nerves and improving his symptoms.

Since then, Lindsey has been shown time and time again that Dr. Governale goes out of his way to help his patients get the best care possible, especially those like the Coursons who are traveling from out of town to UF Health.

“I truly feel that he cares for his patients,” Lindsey said. “He has gone over and above to accommodate out of town patients. He now comes to Tallahassee once a month to see local patients here.”

Dr. Governale has even helped with accommodating MRIs to work around the schedules of those coming to UF Health from out of town.

“If somebody is coming to us from outside of Gainesville, and they need multiple appointments, we try to make sure they are scheduled the same day,” Governale said.

Lindsey is thankful for it all, as it has allowed Collin to live a relatively normal life, despite the conditions he deals with every day. Since birth, now 7-year-old Collin has had leg weakness and numbness, but he pushes through and walks with the help of braces.

Despite these challenges, Collin remains an active kid with a big heart. He does well in school. He loves to visit the beach, go boogie boarding and swim in the family pool. He plays with his brother and rides the toy four-wheeler around outside (with a helmet, of course).

To the average person, Collin appears to be a regular child with a mild disability. This, Lindsey says, is a blessing she owes to the hard work of the physicians and staff at UF Health.

“All the doctors at UF Health have just said how great Collin looks and how great he’s doing,” Lindsey said. “But the inside of him does not look like the outside. He looks great and he looks healthy, but his MRIs show a completely different child.”

Lindsey remembers the advice she was first given at UF Health from a physician assistant on staff, and she offers it to other moms who might be discovering their babies have serious health conditions, like spina bifida or hydrocephalus.

“She said, ‘Collin is a baby and he’s going to have normal baby stuff. He’s going to get colds. He’s going to get sick. He’s going to have fevers. He’s going to teethe. He’s going to be a baby first. He’s just also going to have spina bifida. Sometimes, it’s hard to differentiate the two, but he’s going to be your baby first.’”

Before and After: Christina’s Complete Transformation at UF Health

Talal Elmasry's picture
Submitted by Talal Elmasry on April 1, 2019 - 13:48

Christina Mandeville before and after visiting the UF Health Weight Loss Surgery Center

At her biggest, Christina Mandeville — a mother of three — was 350 pounds and suffering from multiple ailments. UF Health dramatically turned her life around, both physically and emotionally.

As a nurse, Christina is naturally devoted to care for the well-being of others. However, the 34-year-old Branford, Fla., resident was slow to realize the lack of attention she was giving to her own health.

Christina eventually found herself anchored at an unbearable weight, which kept her stranded somewhere far away from her children, both physically and emotionally. She needed a lifeline.

“I have three kids [ages 15, 13 and 11], and it was just getting to the point where I couldn’t do anything with them,” Christina said. “I was miserable, my body hurt all the time, and I was always tired. I was very depressed. I needed a change.”

Luckily, Christina already had a place that earned her trust over the years by caring for her children.

“My youngest kid was born at UF Health Shands Hospital. My middle child, which is my oldest son, he actually spent a week over at [UF Health] Shands [Hospital] because of RSV [respiratory syncytial virus] when he was 8 months old, so we’ve been back and forth over there with respiratory issues with him,” Christina said. “But they’ve always treated us well.”

Christina was desperate to get down to a manageable weight. At 350 pounds, it would take three procedures and coordination between multiple departments at UF Health to get her where she wanted to be.

The original surgery was performed by Dr. Jeffrey Friedman three years ago at the UF Health Weight Loss Surgery Center. Initially, Christina had her heart set on doing a gastric sleeve procedure in which up to 80 percent of the stomach is removed to encourage weight loss.

However, Dr. Friedman convinced Christina that the gastric bypass surgery would be a better option in her case to lose the necessary weight and feel better. This technique helps patients lose weight by changing how their stomach and small intestine absorb and digest food.

At the time of the operation, Christina was at 309 pounds. Now, she’s down to 160.

“Christina had a BMI over 50 prior to her Roux-en-Y gastric bypass,” Dr. Friedman said. “She did great from this operation and lost over 150 lbs., achieved a normal BMI and had resolution of multiple comorbidities in the first year after her operation.”

Christina, who’s been nursing since 2009 and currently works through a Branford company to provide in-home care for disabled babies, enjoyed a swift recovery with no complications.

“I actually went back to work within a week,” Christina said. “I didn’t have any issues as far as that goes.”

Christina’s journey wasn’t over yet, though.

Her two follow-up procedures were performed by Dr. Bruce Mast at the UF Health Plastic Surgery and Aesthetics Center. The first of those two operations was done in June 2017, a lower body lift with abdominoplasty, or tummy tuck. The second was done a couple months later to address her upper body, with Dr. Mast doing work on her arms and performing breast augmentation.

Suddenly, after all that time as a castaway, Christina had navigated herself to the relationship she always wanted with her kids, and herself.

“I can get out and run around with my kids, and I sleep so much better,” Christina said. “My body doesn’t hurt, because I used to have a lot of hip pain and feet pain and back pain and everything else, but I don’t have that anymore. I feel a million times better.”

According to Dr. Mast, his patient’s attitude resembled that of an artist fiercely eager to paint their bare canvas with color.

“Christina was a wonderfully upbeat individual,” Dr. Mast said. “She seemed to be so grateful for her transformation and the improved quality of life it offered. She was always realistic, informed, reasonable and genuinely pleasant and likeable.”

Before the massive weight loss surgery and body contouring procedures at UF Health, Christina’s uncomfortable life contained other problematic areas. Now, the benefits of those operations are chipping away at each one.

Christina, who said she’s been on depression and anxiety medication “on and off for years,” has felt a major transformation.

“I’m very thankful for all the surgeons that I’ve come across, because they’ve made me feel better about myself, like my personal views on myself are better,” Christina said.

“I’m not depressed like I was. I mean, it’s a work in progress, but they’ve definitely made a huge difference for me.”

She was also pre-diabetic and no longer has that issue. Meanwhile, Christina made sure to point out the way her physicians handled another one of her conditions to illustrate how thorough her care was at UF Health.

Christina also has hemochromatosis, which means she gets overloaded with iron in her blood system. Dr. Mast worked one-one-one with her hematologist, also through UF Health Shands Hospital, to evaluate whether she was safe to have the second follow-up surgery because she was notably anemic after the previous one.

“I was very pleased with the continuity of care that everybody provided,” said Christina, who also made a point to mention her “very sweet” nurse practitioner Dawn Daigen.

“The fact that they were able to communicate amongst each other just to make sure everything was going to be OK. I’m very thankful.”

Through a Doctor's Eyes

Mohammad Ebraheem's picture
Submitted by Mohammad Ebraheem on March 30, 2019 - 08:00

Arriving early to the hospital to walk around the Pediatric Cardiac Intensive Care Unit before my night shift begins, I grab a cup of coffee from the coffee shop and head up the stairs to the 10th floor.

As I walk in, the day team lines the hallway awaiting the arrival of pediatric cardiology patients - infants, toddlers and adolescents alike - from the OR. The unit operates much like a beehive, each person on task, moving quickly and efficiently throughout the unit. I notice the smiles they wear on their faces as they move along busily to the next task.

Nurses move in and out of patient rooms, periodically pausing to ask doctors a question before continuing to take care of some of the most complex patients in the hospital.

Patients and their families wave to me as I walk past their rooms – some of them waiting to be taken to surgery while others are just waking up from an operation. Others are waiting patiently for the next step in their care.

As the post-op patients arrive, the anesthesia team pushes beds down the hallway where the ICU team waits to take over patient care. The surgeon is already at the bedside and families stands by, ready to see their loved one. After undergoing surgery, each patient’s body is weak and dependent upon machines to assist with their recovery. The ICU team operates with one common goal, to ensure a smooth, mistake-free transition while keeping each patient safe and comfortable. Though the team has completed hundreds of similar transitions, they treat each patient as their most-important case.

After confirming that each transition went smoothly and my assistance is not required, I turn and walk down another hallway toward more patients who are awaiting care. I put on a clean gown and gloves to meet with families and hope to catch a playful grin from my patients. Whitecoats aren’t always so scary after all.

My next stop is the call room. As I walk, I can’t help but wonder how these patients with congenital heart disease who are fighting for their lives every moment of each day be so strong? Their smiles truly inspire others to be courageous and to remain hopeful. These patients fill the lives of everyone around them with joy. I am proud to be a part of their care team.

Matthew Tavormina: A Medical Miracle

Sofia DiMartino's picture
Submitted by Sofia DiMartino on March 27, 2019 - 08:33

Rather than shopping for baby clothes and diapers, Alyssa and Brian Tavormina went shopping for a burial plot for their unborn child. They purchased the blankets — soft, warm and protective as his mother’s womb — that Matthew would be wrapped in on the day of his burial.

This grim scene was far from expected on the day the couple went in for a routine ultrasound in March 2017.

On that day, when they were meant to see their second child for the first time, they were instead met with concerned glances and the words every parent fears hearing:

“I need to show you something on your baby.”

What the doctor saw was devastating. A large pocket of fluid appeared to be coming off the back of baby Matthew’s head. Their doctor originally diagnosed Matthew with a cystic hygroma, a fluid-filled sac that results from a backup of lymphatic fluid and can be associated with several genetic disorders or be entirely coincidental. He sent Alyssa and Brian in for genetic testing after referring them to a high-risk OB-GYN. There was a chance, he said, that the cystic hygroma could resolve itself if the Tavorminas tested negatively for all associated genetic issues.

Matthew Tavornina

Yet, before Brian and Alyssa received their genetic testing results, the high-risk OB told them it wasn’t a cystic hygroma at all. Instead, Matthew had an encephalocele, which occurs when the neural tube that typically closes during the third and fourth week of pregnancy to form the brain and spinal cord does not close completely, causing the brain and the membranes that cover it to protrude through an opening in the skull. This meant that no matter what the genetic testing said, Matthew’s condition would not improve on its own. This doctor told the terrified couple that their baby had a 0 percent chance of survival and that, best case scenario, Matthew would only be able to breathe and blink. These words would haunt them for the rest of Alyssa’s pregnancy.

The Tavorminas later received their genetic testing results and discovered no abnormalities, but, to Alyssa, the time it took to receive those results was a blessing.

“It was honestly a good thing that she told us about the encephalocele before we got the results back from the genetic testing, because if we had gotten the genetic testing results before, it would have given us false hope,” Alyssa said

During this time, the Tavorminas leaned into their faith to overcome their fear and pain, creating a Facebook prayer page for their unborn child. Over 500 people followed and offered prayers as the Tavorminas posted updates about their progress. This, to Alyssa, was both a beautiful and difficult process.

“It took us nine weeks to tell really anyone other than close family and friends about Matthew,” Alyssa said. “We are very private people, but we kind of kept having the conversation that: A) we needed prayer and B) we had no idea what God was doing through all of this. We decided that if sharing our story could help one other person out there, then we were willing to stick our necks out and spread a very private and personal thing.”

When Alyssa was 16 weeks pregnant, she transferred her medical care to UF Health Shands Hospital, where physicians became concerned about something else. The physician noticed that besides the encephalocele, another pocket of fluid was present inside the back of Matthew’s head, and his cerebellum, the part of his brain that would coordinate and regulate muscular activity, wasn’t visible either. By the time Alyssa was 20 weeks, the doctor was even more concerned by the lack of visibility.

Finally at 22 weeks, Alyssa underwent a fetal MRI and her physician gave the worried parents a definitive explanation for Matthew’s developmental problems.

He explained that baby Matthew had a condition called Dandy-Walker, a rare congenital malformation involving both the cerebellum and the fourth ventricle. 

Typically, Matthew’s ventricles would be skinny, narrow pathways of cerebrospinal fluid located in the center of his brain. With a Dandy-Walker malformation, however, his fourth ventricle had ballooned up to be a fourth of his head size. Due to the malformation, Matthew’s cerebellum hadn’t developed properly and the pressure in his head caused by the oversized ventricle had created an opening in the back of his skull. 

The encephalocele pushing through that opening coupled with the Dandy-Walker malformation was an extremely rare occurrence. For that reason, physicians couldn’t give a positive prognosis for Matthew’s development, or any at all.

Instead, the Tavorminas were met with bad news after bad news, and they had no idea what to expect when their baby was born. The couple was repeatedly given the same prognosis: Matthew could pass in the womb, pass at birth, be severely disabled or live a somewhat normal life.

“We didn’t get a single piece of good news in every single ultrasound we had other than that he had a heartbeat, all four limbs, all other major organs and a precious face,” Alyssa said.

Then, suddenly, nine months was almost up, and Matthew was preparing to enter the world via C-section. Due to Matthew’s condition, and the couple’s understanding that he would likely require neurosurgery within 24 hours of his birth, the parents hunted for a pediatric neurosurgeon worthy of the job.

They found that physician in UF Health’s Lance Governale, M.D.

When Alyssa called to ask a question about UF Health’s pediatric neurosurgery program, expecting a receptionist, the Harvard-trained chief of pediatric neurosurgery, Dr. Governale, answered the phone instead.

“We talked to him, and we had a very personal, very information-filled conversation, like you’re talking to a friend,” Alyssa said. “While we were planning our C-section, he gave me the reassurance that we would be taken care of and that he would be there to operate on our son. That conversation was the peace and comfort I needed, and it was a game-changer.”

With that, Alyssa was able to move forward and schedule the C-section at UF Health.

Dr. Governale assured the Tavorminas that though they had heard many terrible prognoses for Matthew, it didn’t mean that any or all would come true.

“I told them that you really can’t accurately predict function. Kids are very resilient,” Governale said. “There may be some degree of developmental delay, but there might not be.”

Matthew entered the world against the odds on Sept. 18, 2017. He emerged pink and crying, before being whisked off to the Neonatal Intensive Care Unit, or NICU, for treatment. The Tavorminas found out later that Matthew had his umbilical cord wrapped three times around his neck at birth, so it was another little miracle that he had needed to be born by C-section.

Less than 24 hours after birth, baby Matthew was undergoing a more than two-hour brain surgery. Dr. Governale operated, removing the extra brain lining on the outside of the skull and tucking the rest of Matthew’s enlarged ventricle back inside. The hole in his skull would need to be monitored over time to ensure that it closed completely on its own, now that it was relieved of pressure.

The afternoon after the surgery, Matthew drank milk for the first time and the Tavorminas were finally able to hold their baby boy.

It was the culmination of a long and emotional journey for the couple, one that was eased by UF Health faculty and staff.

 “We had an amazing anesthesiologist and a great surgeon,” Alyssa said. “We had been praying for peace and comfort as the day of his arrival approached, and we didn’t expect we would get that from the wonderful UF Health faculty and staff on the day of his birth.”

Before being released from the NICU a week after he entered the world, Dr. Governale informed the Tavorminas that their little miracle had hydrocephalus due to his condition. Matthew had a ventriculoperitoneal (VP) shunt placed at 7 days old to drain the excess cerebrospinal fluid from his brain. At 3 months old, Matthew’s VP shunt failed, which is common, and Dr. Governale replaced the shunt.

            Alyssa said Dr. Governale’s care for her son means the world.

 “Dr. Governale has exceeded all of our expectations,” Alyssa said. “His bed side manners are incredible and beyond what we ever imagined; we feel as though he treats our son and us as a friend. Along our journey, he has patiently comforted us and answered any questions each step of the way. Honestly, Dr. Governale has been an answered prayer, and we call ourselves blessed to be in his care.”

Today, Matthew is an active 1-and-1/2-year-old who loves to play with his older brother and has made tremendous gains, defying all the odds. Though he struggles with balance and coordination issues due to his malformed cerebellum, Matthew crawls quickly to make his way around. When he can’t balance sitting directly on his bottom, Matthew compensates for his physical limitations by sitting in the W-position. Recently, he’s begun pulling up on furniture to slowly cruise around the room while holding on. Matthew’s physical therapists say he will walk one day.

“When he was born, everything was a question,” Alyssa said. “We didn’t know if he would be able to breath, swallow, or regulate his heartrate because of all the fluid pressure on his brainstem. He could have a cleft palate, a cleft lip, a bad heart. We didn’t know if he would ever walk, talk, crawl or eat properly. Now, from what we’ve seen and what he’s done with the help of therapy, he seems to be able to compensate for the malformations in his brain. His brain is slowly overcoming it.”

Although the Tavorminas have now moved to the Jacksonville area, they continue to come to Gainesville for their pediatric neurosurgical care.  And Dr. Governale is very happy with Matthew’s progress.

Recently, Matthew’s neurologist told the Tavorminas that the baby was progressing so well that there was no reason for him to come back for a check-up unless new problems started to develop, such as seizures which Matthew is at high risk for due to the brain malformation.

Dr. Governale is happy with his progress, too.

“He has some developmental delay, but it’s overall mild. He definitely does not have severe delay,” Governale said. “With therapies, we will continue to work to maximize his function.”

Alyssa and Brian Tavormina feel blessed to be able to share their story of a miracle, and hope they can offer inspiration for families embarking on a similarly painful journey.

“Our whole goal was to show others that there’s hope, even in the most daunting of times,” Alyssa said. “Throughout our journey we were hopeful and tried to encourage others even when we weren’t sure if our baby would be OK. It’s easier to have hope and joy when your baby’s doing well, but we pressed into our faith throughout the hardest chapter of our lives.”

Kidney Cancer – a Silent Disease

Brittany Purcell's picture
Submitted by Brittany Purcell on March 25, 2019 - 15:06

Jessica Van Leer was experiencing pain in her abdomen when she arrived at the UF Health Shands Hospital E.R. After a series of tests, the medical team had two findings: the source of her pain was an ovarian cyst, but Jessica also had an incidental finding of a tumor on her left kidney.

“I was 32 at the time and wasn’t experiencing any symptoms, no pain,” said Jessica, who is now 35.

Recent studies have found an uptick in findings of kidney cancer similar to the way Jessica’s was found – incidental small kidney masses found by CT scan and MRI imaging when the patient is coming in for a different chief complaint.

The E.R. team’s discoveries led Jessica to Li-Ming Su, M.D., urologic surgeon, professor and chair of the UF College of Medicine’s urology department.

“In Jessica’s case, we rarely see kidney cancer in people her age,” Su said. “Kidney cancer is often a silent disease, but when found early, it allows physicians to treat and cure more patients by performing surgeries to remove only the mass and not the entire kidney”

And that is exactly what he did.

Su performed a robotic partial nephrectomy using the daVinci™ Surgical Robotic System and only removed part of Jessica’s left kidney through key hole incisions. He was able to remove only the tumor, sparing over 90% of her healthy kidney. Historically done through open surgery, robotic surgery allows for the procedure to be less invasive. Robotic surgery also allows for a shorter hospital stay and significantly reduces blood loss and the need for transfusions.

“Dr. Su and his team made everything easy for me,” said Jessica. “Including performing a double surgery to remove the ovarian cyst while Dr. Su removed the tumor so I did not have to have two surgeries.”

Catching Jessica’s cancer early meant no chemotherapy or radiation treatments.

“I count myself incredibly lucky to have most of my kidney still left and not have to go through any other treatment. Just surgery and I was okay,” she said. “I only have four very small scars each about an inch long.”

Jessica is now two and a half years cancer free, and spends her days practicing yoga and teaching music at Santa Fe College.

March is Kidney Cancer Awareness Month. This month we reflect on stories like Jessica’s and aim to increase awareness of kidney cancer. 

Kidney cancer risk factors include: smoking, obesity, family history of kidney cancer, kidney failure on long-term dialysis and chemical exposures (cadmium and pesticides).

For patients who have any signs of blood in the urine associated with flank pain or weight loss, it is important to be seen by a urologist and be evaluated for potential causes of bleeding such as: kidney and bladder cancer amongst other urologic conditions.

Nathaniel Yeatman: One Family’s Journey with Craniosynostosis

Sofia DiMartino's picture
Submitted by Sofia DiMartino on March 19, 2019 - 09:39
Yeatman family standing next to a tree, smiling

Marissa and Jon Yeatman gave birth to a healthy baby boy named Nathaniel on Feb. 9, 2018, in Tallahassee, Florida. He was their second child and made their daughter a big sister, a position she was eager to take on.

Three days after his birth, Marissa and Jon took their baby to the pediatrician for his newborn checkup, and the doctor noticed an abnormality in the shape of Nathaniel’s skull.

“The pediatrician took pretty much one look at him and said, ‘Let’s take some X-rays,’” Marissa said.

Though Nathaniel’s head only had a mildly pinched appearance, his abnormal head shape foreshadowed a much more serious problem. Nathaniel was diagnosed with sagittal craniosynostosis, a birth defect in which one of the fibrous joints between the bones of Nathaniel’s skull closed prematurely before his brain was fully formed.

“Usually when you look at a newborn’s head on an X-ray, it looks like the skull is kind of shattered, but part of his looked like it was already formed and closed like an adult,” Marissa said.

Their pediatrician recommended Lance S. Governale, M.D., UF Health’s chief of pediatric neurosurgery who has a focus in craniosynostosis. The Yeatmans contacted him immediately, hoping to resolve the issue as quickly as possible.

Dr. Governale knew he needed to treat the problem early, so he scheduled the Yeatmans for an appointment close to their home at the UF Health Pediatric Specialties practice in Tallahassee.

“At that point, he was like new, new to the world,” Marissa said. “He was only about a month old. So, our options were kind of broadened, because we caught it so young.”

To gather more information, Dr. Governale obtained a special CT scan. CT scans involve some amount of radiation exposure, but at UF Health’s Gainesville and Tallahassee locations, Dr. Governale introduced ultra- low-dose CT scanning. These scans provide 3D views of the skull at a radiation dose similar to a few X-rays and much lower than standard CT scans.
After Nathaniel’s CT scan confirmed the condition, Dr. Governale laid out three different treatment options.

“The skull is made up of multiple different bones with sutures in between them,” Governale said. “Sutures allow the skull to grow. If they close early, it alters the head shape. In addition, suture closure can restrict skull growth while the brain is trying to grow leading to increased pressure.”

Craniosynostosis is typically treated surgically, due to the need to unlock the bones and reshape the skull. The traditional surgery, larger and more invasive, would probably require a blood transfusion and a longer hospital stay, but Dr. Governale was committed to offering minimally invasive options.

“One minimally invasive option consists of unlocking the bones through one or two small incisions with the assistance of an endoscope, and then using a helmet afterward to reshape the skull,” Governale said. “The downside is that the helmet has to be worn for 23 hours per day for upwards of nine months. It also requires regular visits to a helmet orthotist, who may not be located in the family’s region, like Tallahassee.”

Because of these issues, Dr. Governale and his pediatric craniofacial plastic surgery partner, Jessica A. Ching, M.D., introduced a second minimally invasive option to UF Health — cranial expander springs. With springs, a helmet is not required. UF Health Shands Children’s Hospital in Gainesville is the only site in Florida offering this newest treatment option.

Though she trusted the physician’s expertise, Marissa was relieved to feel as if she wasn’t forced into one specific treatment option for her baby boy. She felt that Dr. Governale let her have the final say.

“He was really good about not pushing one option over the others,” Marissa said. “He said if there was one option that was better than the other two, he wouldn’t offer the other two.”

That third, minimally invasive option for Nathaniel was the one that the nervous parents eventually chose.

In May of 2018, Nathaniel underwent craniosynostosis surgery with cranial expander spring implantation. Drs. Governale and Ching made one incision, used an endoscope to help open the sealed suture and then put in two cranial expander springs to reshape the skull. Three and a half months later, they went back in and took out the springs, completing the process — no helmet required.

A team approach is essential for treating craniosynostosis. The physicians work side-by-side to tailor the treatment to the patient and involve other specialists if needed, including ENT, oral surgery, dentistry, genetics, speech therapy, audiology, psychology and social work. Although Nathaniel did not need those additional specialists, he did have one more added benefit of Dr. Ching’s participation in the surgery — a beautiful closure with minimal scarring, something Marissa and Sean are very thankful for.

“She did an amazing job with all of his stitches and everything,” Marissa said. “The scar was actually, originally, a pretty odd U-shape. As his head is growing, it has started to stretch and look straighter. Already, you can’t see the incision that much.”

Today, Nathaniel is a healthy 1-year-old, and you can’t tell there was ever anything wrong with his skull.

“He had an excellent reshaping. His head looks normal now and is allowing his brain to grow,” Governale said. “We’ll be watching him, but hopefully, because he’s otherwise healthy, he won’t encounter additional issues.”

Nathaniel’s more focused on doing his favorite things, now that he doesn’t have to worry about surgeries or doctors’ visits. His big sister is his greatest source of entertainment.

“He loves his sister. Hands down, she’s the one that can make him smile the most,” Marissa said. “Any time she gives him attention and plays with him, he’s just so happy. They’re cute together.”

Nathaniel started walking recently and is very mobile. He loves eating and playing with a little lion rattle. The lion has been with him from the day he was born through every surgery after that.

Like that little rattle, Marissa and Jon have been there the whole way, too, and have learned a lot through their hardest moments with Nathaniel. Marissa offers advice to other parents who are about to undertake their own harrowing journey with craniosynostosis.

“I would say don’t panic,” Marissa said. “You’ll get through this. Honestly, the doctors know exactly what they’re doing. Trust them.”

She also encourages parents to trust their gut when it comes to health care decisions for their children.

“It’s very, very scary seeing your newborn baby go into surgery,” Marissa said. “It’s just very difficult. When Nate was waking up after his first surgery, he was very fussy. That whole day he was fussy: upset, disoriented, crying. I was second guessing our decision while trying to comfort him. Then, the next day, he woke up and smiled and was suddenly completely himself again. Don’t second guess yourself. You know what’s right for your family and your child. It’s crazy how resilient children are.”

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New guidelines for daily aspirin therapy

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Submitted by Doug Bennett on March 18, 2019 - 15:50

For some older adults, a low-dose aspirin has been a daily staple of life to prevent a heart attack or stroke. Now, the American College of Cardiology and the American Heart Association have issued new guidelines recommending against low-dose aspirin therapy for adults older than 70 or anyone who is at higher risk of bleeding. The new guidelines follow the results last year of a large clinical trial by the National Institutes of Health, which found that daily aspirin did not prolong healthy, independent living among older adults without prior cardiovascular events. Aspirin therapy has been studied by UF Health cardiologists Ahmed N. Mahmoud, M.D., left, and Anthony A. Bavry, M.D.

Aspirin therapy has also been studied by UF Health cardiologists Anthony A. Bavry, M.D. and Ahmed N. Mahmoud, M.D. In 2017 and 2018, their two published analyses of 11 aspirin therapy clinical trials concluded that daily aspirin therapy does not save lives, causes additional bleeding and provided no benefit for patients with peripheral vascular disease, which causes narrowed arteries and reduced blood flow to the limbs.

Here, Dr. Bavry addresses some questions related to the new guidance:

What is most important for patients to know about the new aspirin therapy guidelines?

Recent research has found that aspirin may not save lives when used for primary prevention but it does increase major bleeding. Accordingly, updated guideline recommendations from the American College of Cardiology/American Heart Association have downgraded the use of aspirin for primary prevention. In summary, aspirin can still be considered on a case-by-case basis for 40-to-70-year-old individuals who are considered to be at highest risk.

Can certain patients still benefit from aspirin therapy? If so, which ones?

The current guidelines reserve the possible use of aspirin for primary prevention for the "highest risk" patients. However, who is "highest risk" is not precisely defined. As always, patients who are uncertain if aspirin is appropriate for them should discuss this topic with their cardiologist or medical provider.

How do the new recommendations fit in with your prior research?

We published an analysis which explored the use of aspirin for primary prevention. We failed to find a convincing benefit for aspirin therapy for primary prevention. In addition, aspirin was associated with important bleeding risks. This and other research helped to update guideline recommendations.

What do the new guidelines suggest to you about an emerging medical consensus on aspirin therapy?

Through ongoing research, the cardiovascular community is coming to the realization that aspirin may not offer all the benefit we formerly thought it was capable of.

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Anthony A. Bavry, M.D., is an associate professor in the UF College of Medicine's department of medicine and a cardiologist at the Malcom Randall Veterans Affairs Medical Center in Gainesville. Ahmed N. Mahmoud, M.D., is a cardiology fellow in the UF College of Medicine’s department of medicine.

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Weight Loss with Canaglifozin Linked to Improvement in Nonalcoholic Fatty Liver Disease

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Submitted by UF Health on March 11, 2019 - 14:38

Clinicians frequently overlook nonalcoholic fatty liver disease in their patients who have Type 2 diabetes. Yet it is estimated that approximately 70% of obese adults with diabetes have fatty liver disease, and approximately 30% to 40% of those with steatosis have the more severe form, nonalcoholic steatohepatitis. Fatty liver disease is the second most common cause of liver transplantation and puts patients at higher risk for progressive liver disease, cirrhosis and hepatocellular carcinoma. It is associated with increased insulin resistance, atherogenic dyslipidemia and cardiovascular disease.

Canaglifozin is a member of a novel class of oral antidiabetic agents called sodium glucose co-transporter-2 inhibitors, which are known to promote weight loss and decrease the risk of cardiovascular events in patients with Type 2 diabetes. Recognizing that both of these characteristics are desirable for patients with fatty liver disease, Kenneth Cusi, M.D., FACP, FACE, chief of the University of Florida College of Medicine’s Division of Endocrinology, Diabetes and Metabolism, and his research team undertook a groundbreaking clinical study to determine whether patients with Type 2 diabetes and fatty liver disease who lose weight when treated with canaglifozin also experience a reduction in liver fat and improvement in insulin secretion and action. The results of this study were recently reported in the journal Diabetes, Obesity and Metabolism

Cusi notes, “This is the first randomized controlled trial suggesting that patients with Type 2 diabetes and fatty liver disease who lose weight when treated with canaglifozen may experience improvement in liver fat, insulin secretion and insulin action.” The study found that treatment with canaglifozen significantly improved insulin sensitivity and insulin clearance, and restored beta-cell glucose sensitivity. More patients with fatty liver disease who were treated with canaglifozin experienced weight loss of 5 percent or more compared with placebo, and the magnitude of weight loss was highly correlated with a reduction in intrahepatic triglycerides. 

Cusi underscores the innovative and important work UF Health is doing in this therapeutic area and points out, “This study is valuable for all clinicians who treat patients with Type 2 diabetes who are obese.”

Promising Potential New Treatment for Patients with Sepsis, Cancer or Genetic Conditions

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Submitted by UF Health on March 11, 2019 - 14:31

Cells need energy to live, which they get from adenosine triphosphate. Pyruvate dehydrogenase complex is needed to form adenosine triphosphate, so in turn this mitochondrial enzyme is essential to life. Numerous disease processes have the ability to deactivate pyruvate dehydrogenase complex, thus preventing cellular glucose oxidation. Researchers at UF Health, the Southeast’s most comprehensive academic medical center, have found a potential target for treating the problem that is showing great promise.

Peter Stacpoole, M.D., Ph.D., a professor of medicine, biochemistry and molecular biology at the University of Florida in the Division of Endocrinology, Diabetes and Metabolism, and his fellow researchers have been evaluating the potential utility of an investigational drug called dichloroacetate in the treatment of sepsis, cancer or genetic conditions. For more than three decades, dichloroacetate has been tested in a wide range of diseases and conditions, including Type 2 diabetes, myocardial ischemia and congenital lactic acidosis.

In their clinical trials, Stacpoole and colleagues have demonstrated that dichloroacetate is effective in promoting immunometabolic and organ homeostasis in sepsis, and in targeting the pyruvate dehydrogenase complex/pyruvate dehydrogenase kinase axis in cancer. They have also investigated development of a sensitive and rapid clinical genetic screening test for patients who may be treated with dichloroacetate.

Stacpoole and colleagues have shown that dichloroacetate reactivates pyruvate dehydrogenase complex and increases mitochondrial oxidative bioenergetics in isolated hepatocytes and splenocytes. They have also shown that dichloroacetate promotes vascular, immune and organ homeostasis, accelerates bacterial clearance and increases patient survival.

UF Health is currently working in collaboration with researchers at Wake Forest University and Washington University to determine the long-term implications and potential benefits for dichloroacetate in patients who are critically ill, patients with acquired diseases and pyruvate dehydrogenase complex inhibition, and children with enzyme mutations.

Integrative Medicine: A partnership of conventional and holistic medicine

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Submitted by UF Health on March 11, 2019 - 08:28

Integrative medicine may be an unfamiliar concept among patients and arguably an underutilized treatment option for an array of medical conditions. It is a holistic approach to medicine that focuses on treating the whole person – mind, body and spirit. Since the program’s inception at UF Health, more than five years ago, the integrative medicine team has supplemented the care of many patients who find traditional methods and pharmaceuticals are unable to provide optimal results. Mike Husted’s journey is an example of how integrative medicine can provide new alternatives and hope to treatment plans.A UF Health provider conducts acupuncture on a patient

Mike Husted grew up in Florida and graduated from Deland High School. Husted, who now lives in Port Orange, made a career serving in the U.S. Air Force and served in Texas, where he boasts that he married a Texas girl. After his career in the Air Force, Mike earned a master’s degree in social work. He continued to serve his country through his work with the Department of Veteran Affairs and assisting wounded soldiers seeking medical care at the VA Medical Center adjacent to Fort Hood, Texas. He loved his work and spending time with wife and family, but Mike was forced to retire early due to chronic pain of his jaw. He said he struggled to maintain an adequate quality of life. “I was miserable all the time,” he said.

In 2009 and 2012, while living in Texas, Mike underwent two surgeries to address dysfunction of the temporomandibular joint, or TMJ, which caused chronic pain of his jaw. The first surgery attempted to repair the joint and the second was a total joint replacement on the left side of his jaw. Although, the total joint replacement surgery was a success he suffered from residual effects including atypical trigeminal neuralgia, or ATN. Damage to the trigeminal nerve can result in constant burning, aching, hypersensitivity and ear pain.

When Mike decided it was time to come home to Florida, his surgeon referred him to the care team at UF Health where he would be able to receive specialized treatment for his condition. He committed to a two-hour drive from Port Orange to Gainesville to meet with members of the UF College of Dentistry – M. Frank Dolwick, D.M.D, Ph.D., a professor and chair of the department of oral and maxillofacial surgery, and Monica Fernandez, D.D.S, M.S. a clinical assistant professor in the department of restorative dental sciences. Mike praised the providers for their exceptional care, but he continued to struggle with the side effects of his previous surgeries.

The traditional course of treatment for ATN begins with pharmaceuticals, but Mike said although the medications were helpful, he had experienced too many side effects. He explored options including further surgeries and possibly a nerve block, but he was not a good candidate for those and he was reluctant to seek further traditional methods.

“After you’ve been hurt, you don’t want to take the chance of making it worse,” he said. “I would wake up in the morning not knowing what kind of day it was going to be and sometimes, I just stayed home.” The smallest incidents such as a cold breeze or the noise from a restroom hand dryer would trigger increased pain, headaches and frequent migraines.

To find relief for Mike, Fernandez referred him to Irene Estores, M.D., the director of integrative medicine program at UF Health. After an individual consultation, Estores recommended medical acupuncture to help relieve Mike’s facial pain and sensitivity.

One thing that distinguishes receiving medical acupuncture at UF Health is the personalized consultation by a fellowship trained integrative medicine physician to determine the best patient care. Mike found confidence in knowing that Estores is a physician and a medical acupuncturist. 

Acupuncture involves piercing the skin with very thin needles in specific patterns and points on the body. This method, originating in China, is now widely accepted and practiced as a component of integrative medicine.

Mike completed eight weeks of treatment with acupuncturist David McMahon, A.P., at UF Health Integrative Medicine – Spring Hill. Acupuncture provided immediate relief and subsequent sessions alleviated even more side effects.

“It has helped reduce the sensitivity,’’ he said. “I can do more things with my wife and get out more.”

Mike will need long-term care and he is continuing weekly acupuncture treatments with a provider in Deland. He anticipates less-frequent care will be required as he continues to experience positive effects. He credits the multidisciplinary care he received at UF Health for his improved quality of life.

“Not all of the pain is gone,’’ he said. “But my bad days are better and my good days are better.”

Do you have ADHD? Unleashing college potential masked by ADHD

Submitted by Lindsay Israel on March 2, 2019 - 20:42

Highlighting the word ADHD in a book.

I remember when I first arrived at the University of Florida for my freshman year, I was worried that the workload would be overwhelming as compared to high school. Luckily, I adapted to college work pace and performed well.

However, there were several fellow students who did not seem to adjust, falling behind in classes, eventually settling to simply stay afloat. Back then, I was not well-informed about disorders related to attention and, frankly, it never came to mind that they could be affected.

Now that I am a psychiatrist, I have a much deeper understand and perspective on the constant daily battles that people with Attention-Deficit Hyperactivity Disorder, or ADHD, have to endure in multiple spheres of their lives.

Our college years are often where we kick off the start of our adult lives, and imagine if you are at the starting line with a parachute tied to your back. Learning with ADHD feels very much like running with a parachute, watching everyone else running ahead of you. Discovering you have ADHD could cut the strings, opening new doors and possibilities for the future.

What is ADHD?

ADHD is a chronic condition resulting in difficulty with maintaining attention, organization and impulse control.

Given the fact that the majority of our childhood, adolescence and young adulthood is spent in a school setting, school life can become an uphill battle in the context of ADHD. Always feeling behind compared to fellow students, sub-par grades, behind in assignments, the self-confidence suffers.

College students with ADHD

Pinning down how many college students have ADHD is difficult because the current statistics are skewed. According to the National Center for Biotechnology Information, ‘’between 2 and 8 percent of college students in the United States have ADHD.”

The NCBI also states that “estimates are largely based on studies that obtained self-reported symptoms or diagnostic status from a convenience samples of students at individual campuses, and not on comprehensive evaluations conducted with nationally representative samples.”

With that said, ADHD affects millions of children and adolescents in the U.S. every year. Many thought it was over-diagnosed, being pushed by parents seeking extra accommodations for their child for test-taking purposes, or falling under the widely cast net of simple immaturity.

However, there are many cases where ADHD is overlooked.

I’ll see children and teenagers with above-average intelligence who do not require as much vigorous effort in high school to maintain good grades go undiagnosed. In many instances, there are students with ADHD who are underperforming to their intellectual level but assume that this is the best they can do.

Many times, this can lead to persistent frustration, low self-esteem and depression if the underlying diagnosis of ADHD is left untreated.

College can make it worse. The students no longer have their parents to push them along, remind them of tests or project due dates. They do not have the coddling high school teacher who offers them extra credit to help boost the grade of a hard-working yet struggling student.

What happens when these young adult college students are on their own?

Often, they receive no guidance and no diagnosis.

Could you have ADHD?

How would a college student know when it is time to get help?

Here are 10 questions college students can ask themselves to help determine if they should seek assistance. These struggles would likely be seen in multiple settings, such as school, work, or home and occur more days than not.

  1. Do I find myself constantly rereading to understand the text?
    This issue typically will cause you to take what feels like an excessive amount of time to read, do homework, etc. You are left feeling like you are seeing the words, but the information is not processing.
  2. Do I get easily distracted?
    This can manifest in two different ways. One is when you are either in a conversation or trying to work on a task and you are distracted by your own unrelated thoughts, missing pieces of the conversation or causing you to reread, as in #1. The second form is when you are distracted by external stimuli, sounds or movements around you, causing you to lose focus.
  3. Do I stop and start multiple tasks without completion?
    This can be related to fidgeting, difficulty sitting still, distraction by your own thoughts, or simply losing interest.
  4. Do I struggle with time management?
    You find yourself running out of time on tests or you run late for meetings, events and classes.
  5. Do I lose/misplace items often and tend to be forgetful?
    You are constantly losing your phone, keys, watch, wallet, etc. either due to not paying attention to where you placed the items or forgetting where. You also forget important dates or things on a to do list, like paying a bill.
  6. Do I procrastinate?
    This classic behavior is one of the most common issues, but you are not lazy. You simply dread the idea of the task that awaits you and avoid doing it at all cost, despite the potential negative consequences.
  7. Do I have trouble staying organized?
    If you have a mental list, you will not stop to make a written list. If you make a written list, you lose the list. Your papers are everywhere, and your to do list is somewhere in the mess.
  8. Do you find most school-related work “boring?”
    This might have been how you felt about school since your elementary years. It takes a lot to capture your interest, especially if it is a topic or task that requires your sustained attention.
  9. Do I miss details?
    This might be because you are rushing through a task or a reading passage or because you realized you have run out of time due to time management issues. This issue can also present itself because you are not paying attention in a conversation or during class when the professor is speaking, and you miss an important piece of information.
  10. Do I have trouble waiting my turn?
    This struggle typically accounts for the impulsive symptoms associated with ADHD, whereas questions one through nine are more reflective of the inattentive symptoms of ADHD. Impatience and low-frustration tolerance can persistent even into full adult maturity. You struggle with interrupting people during a conversation, intruding in someone’s personal space or getting a little agitated waiting in lines. You might touch things on people’s desk without permission, or simply take over what someone else is doing.

How did you do?

Did you answer YES to three or more of these questions? Couldn’t make it past reading the first paragraph of this article?

If so, save yourself a semester of trying to pull up your grades and digging yourself out of the academic hole and seek mental health services.

Where can you turn for help?

Most universities provide accommodations such as student mental health services on campus for free to enrolled students. You can also talk to your parents with honesty and ask them to arrange for an evaluation with a mental health professional.

The bottom line is you are more than capable of making it through college and doing very well. ADHD is not the result of a lack of intelligence or work ethic; it is an issue with executive functioning and it is treatable.

You deserve every chance possible to succeed in college and achieve any and all goals you set for yourself.

Lindsay Israel, M.D., is a board-certified psychiatrist. She is a graduate from the University of Florida College of Medicine’s Department of Psychiatry. Her goal is to help patients feel empowered, because their symptoms can leave them feeling powerless. She specializes in Transcranial Magnetic Stimulation, or TMS, therapy for the treatment of various psychiatric disorders. TMS is FDA-approved for depression and is a noninvasive, nonmedication alternative to traditional treatments. Israel’s specialized clinic, Success TMS, focuses on this advanced therapy, which allows patients to achieve remission from depression and return back to their best lives.

Living With a Great Hope

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Submitted by Sofia DiMartino on February 28, 2019 - 11:36

Jonah and Hannah Strickland

Dawn Strickland describes her four children as any doting parent would. Jonah, the oldest, is 16 and a wonderful helper. Joel, 14, is the sweetest boy. Nine-year-old Grace, the little athlete, is simply wonderful, and 2-year-old Hannah is a little ball of life.

“I have never in my life seen a child with more personality,” Dawn said of Hannah. “She has all that just stuck in that tiny, little body of hers.”

What Dawn doesn’t mention in describing her four children is that both Joel and Hannah have a rare, and life-threatening, genetic, metabolic disease called cystinosis.

The rare lysosomal storage disorder causes the amino acid cystine to accumulate in many organs of the body, including the kidneys, eyes and liver. Often diagnosed before the age of 2, children with the disease typically experience excessive thirst and frequent urination, as well as sensitivity to light caused by cystine crystals that develop behind their corneas.

This frequent urination is one of the greatest challenges for Dawn and her husband Travis. Hannah doesn’t sleep through the night because she wakes up every hour-and-a-half incredibly thirsty, meaning Dawn doesn’t sleep, either.

“She wakes up and gets anywhere from 12 to 14 diapers every day,” Dawn said. “I’m constantly changing her. She uses at least five diapers every night and gets up for five to six drinks of water. We don’t sleep longer than two hours at a time.”

This frequent urination results in loss of minerals, which are typically absorbed by the kidneys. In children with cystinosis, this lack of nutrients causes kidney failure to occur very early in life, meaning early intervention is imperative to patient success.

The couple did not have that early identification with Joel and searched for over two years for a diagnosis for him.

“Very early on, he was very sickly,” Dawn said. “When I tried to nurse him, he wouldn’t latch on.”

Dawn’s physicians in her hometown of Niceville, Florida, suspected tongue-tie as the reason Joel was struggling to breastfeed. But after a procedure to relieve it, nothing got better.

“As time went on, he was just getting sicker,” Dawn said. “We took him to several local doctors and that was his first admission to the hospital. I’d say he was around 18 months or so.”

Joel spent two weeks in the hospital. After receiving no diagnosis, Dawn took her son to another local facility where his symptoms were treated for seven months. Still, no one had any answers to the question of what could be causing them.

“They were treating him from a working diagnosis, which meant they had no clue,” Dawn said. “Looking back, I would have chosen UF Health from the get-go.”

When Joel was 2 years old, the Stricklands tried again to find a diagnosis, but the out-of-town hospital they went to had no appointments available in the timeframe the family needed.

“At this point, he was vomiting 10 to 12 times a day and not keeping any food down,” Dawn said. “He probably only weighed 17 or 18 pounds. To say it was a nightmare was really an understatement.”

Dawn took Joel to the emergency room, where he was denied admission as a non-emergent case. Overcome by concern for her son, Dawn refused to leave the ER until staff scheduled an appointment for Joel.

“Miraculously, they got me an appointment the next day,” she said. “I was so desperate at that point, I didn’t care if the police took me away.”

Finally, Dawn got the answer she’d been searching for, as the doctor asked, “Have you ever heard of cystinosis?”

Incredibly, Dawn had. She had mentioned cystinosis as a potential diagnosis with previous doctors.

“I had asked,’’ she said. “I had asked the so-called experts at the other hospitals. And everybody just laughed at me and said that’s so rare, and you don’t really know what you’re talking about. I felt like somebody had punched me in the gut.”

Soon after, an ophthalmologist identified crystals on the back of Joel’s corneas. Bloodwork came back confirming a diagnosis of cystinosis.

“As upsetting as it was, it was also a huge relief thinking that we finally had some answers,” Dawn said.

When Grace was born, she didn’t show any signs of the disease, and, seven years later, Hannah didn’t, either. Hannah was eating well and gaining weight. She wasn’t overly fussy, but Dawn’s motherly intuition kicked in and she felt something was different than it had been with Grace.

“I had to ask the nephrologist twice to have her tested, and he was shocked when it came back that she had it,” Dawn said.

Cystine levels typically should be below 0.2, but Hannah’s cystine level at 5 months old was nine, confirming the cystinosis diagnosis.

Hannah and Joel both have G-tubes for easier ingestion of the many medications that keep them alive, but both struggle with eating because of side effects. Hannah goes to occupational therapy to improve her eating as she’s not often hungry and, when she is, she often chews her food and then spits it out.

“Sometimes she says her tummy hurts a lot and I know it’s from the medicine and she’ll complain,” Dawn said. “You’ll just have to stop what you’re doing and hold her.”

In 2018, the Stricklands faced the inevitable as Joel’s creatinine levels began to drop, alerting to his doctors that he was entering end-stage kidney failure.

Joel would need a kidney transplant, and the parents decided he should have it at UF Health. There, Joel had a team of nephrologists and transplant surgeons, led by Kiran Upadhyay, M.D., working to ensure the surgery was successful.

Before Joel could receive a new kidney, the family had to consider the source of the donation: a family member or a deceased donor.

“Joel made the decision,” Dawn said. “My husband I were willing to donate to him, but he was really adamant that he didn’t want a kidney from a family member. I was super uncomfortable with his decision, and I’d even lost a bunch of weight so I could be donor. But with everything he’s been through, we wanted him to have some sense of control.”

In March of 2018, Joel was placed on the deceased donors list, and on June 7 his family received the call that a kidney was available.

After the successful surgery, his family stayed in the Pediatric Intensive Care Unit and then moved down to the transplant floor. The whole experience, Dawn said, was eased greatly by UF Health’s nursing staff.

“Every time we’re at UF Health, the nurses make everything just amazing,” Dawn said. “Of course I know the doctors are good. We wouldn’t have come here if they weren’t, but nurses really make or break the stay. We have not had a bad nurse, and some have kind of become our friends around this. They’ve become kind of like family.”

Today, Joel goes to check-ups just about every week to see doctors and get his blood drawn as his team keeps a very watchful eye on his levels and well-being. He makes sure to have his medications everywhere he goes, as to not forget an all-important dose.

Dawn spends time home-schooling and taking care of her children. In her few free hours, she advocates for funding of cystinosis research.

“The majority of the medications that have been made have been created because the community banded together and raised the money collectively,” she said. “We’re a very small community, but we’re very, very strong.”

This dedication has helped researchers make tremendous strides. The disease has recently been cured in mice, leading Dawn to hope that a cure in humans will be discovered in time to help her children.

“If I can prevent one family from having to experience that two-year stretch of not knowing that I went through with Joel, then it’s absolutely worth my time to tell our little story,” Dawn said.

She carries one word with her every day throughout her most difficult moments caring for Joel and Hannah: hope.

“We’ll have a new family that pops into our online support group every once and awhile,” Dawn said. “It makes me emotional to think about, but I just want to tell them that if I can do this, you can. Although we’re very aware of the medical challenges we face as a family, we are so much more than ok. We live with a great hope & a lot of that is due to all of the talented & dedicated professionals at UF Health.”

Artificial device mends a baby girl’s broken heart

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Submitted by Kelly Daly on February 28, 2019 - 00:46

Kennedy Curry

Ceara Curry and her husband, Kenton, were brand new to parenthood when their baby turned into a miracle.

At 6-months-old, Ceara and Kenton’s daughter, Kennedy, contracted what they believed was a common cold. Her pediatrician told Ceara that her baby had allergies, but Kennedy worsened overnight.

“I knew something was off,” Ceara said. Time would prove that her instincts were correct.

Ceara took her daughter back to the pediatrician, and the doctor suspected they heard a heart murmur. An X-ray revealed that Kennedy had an enlarged heart.

The Curry family was instructed to take Kennedy to UF Health Shands Children’s Hospital. Upon their arrival at the UF Health Congenital Heart Center, doctors discovered that Kennedy’s heart was failing.

“It was very, very terrifying,” Ceara said. “As a mom with a completely healthy baby, we went from being told it was allergies to it being heart failure a week later. We were crushed.”

Kennedy was diagnosed with dilated cardiomyopathy, a disease of the heart muscle that causes the ventricle to stretch to a point where it can’t healthily pump blood to the body. Her heart was pumping at only 8 percent.

Kennedy worsened overnight in the pediatric cardiac intensive care unit, and didn’t respond to medicine.

“I was heartbroken,” Ceara said. “We didn’t know if she was going to make it.”

But the team of clinicians didn’t give up hope. Desiree Machado, M.D., a pediatric critical care physician at UF Health Shands Children’s Hospital, and a team of specialists stood outside Kennedy’s room to monitor her during that critical first night. Machado and team kept a close eye on Kennedy to see if she would need to be placed on extracorporeal membrane oxygenation, or ECMO, a life support machine that puts oxygen in the blood and removes carbon dioxide. All the meanwhile, Kennedy remained heavily sedated as her heart function stabilized.

On March 21, 2018, Kennedy was placed on the Berlin Heart®, an artificial heart device made specifically for babies and children facing heart failure. The device supported Kennedy’s heart function as the Curry family awaited a new heart.

“I felt selfish praying for a new heart for her,” Ceara said. “I started praying for healing, and she got it.”

After 3-and-a-half months of waiting, Kennedy’s failing heart did the impossible – it got better.

“Her heart started competing with the machine,” Ceara said. It wasn’t before long that Kennedy’s doctors began a weening process and allowed her heart to pump on its own.

On June 25, 2018, Kennedy was disconnected from the Berlin Heart®, and no longer needed a heart transplant.

“The whole experience was amazing,” Ceara said. “It definitely led us to appreciate life and the little things more.”

During the four months Kennedy was in the hospital, Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and the chief of congenital cardiothoracic surgery; Dipankar Gupta, MBBS, D.C.H, M.D., a pediatric critical care physician; and Machado, kept Ceara and Kenton a part of the treatment plan for their daughter. As new parents, it was important for the Currys to know each step of the process, and the team allowed Ceara to continue to care for Kennedy as a mother.

Now, as a healthy 17-month-old, Ceara says Kennedy is a firecracker. She enjoys walking and exploring, and she has found a particular love for sweet potatoes.

“My daughter had not seen the sunlight in four months,” Ceara said of Kennedy’s time in the hospital. “This is a whole new world for her. She’s making up for lost time.”

Through it all, Ceara and Kenton held on to their faith and their trust in Kennedy’s doctors.

“I’m thankful for the PCICU,” Ceara said. “If I had to recommend a children’s hospital to anyone, it would be UF Health Shands Children’s Hospital.”

A Big Move for a Bigger Reason

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Submitted by Kelly Daly on February 7, 2019 - 14:32

Natalie MangumNatalie Mangum was married to her husband, Mike, for five years when he woke up one day and said, “I want to move to Florida.”

The idea of a cross-country move from their home in Utah did not excite Natalie, so the couple decided to stay closer to family and move to California. They were all set to relocate, but something didn’t feel right.

“There was this weight,” Natalie said. “We do things on a whim, but I was very anxiety-ridden.”

Knowing that a life-changing move was a one-time endeavor, Mike flew to Florida, found a home in Palm Coast and, in two weeks, the couple had moved across the country. Natalie’s weight felt like it had been lifted.

But the move to Florida meant having to find a new cardiologist for Natalie who was diagnosed at 6-months-old with VSD, a ventricular septal defect that is a hole in the wall separating the two lower chambers of the heart.

“I was told time and time again that I wouldn’t have to get my heart fixed,” said Natalie, now 28. She continued her routine EKGs and echocardiograms each year.

After the move, Natalie began feeling fatigued with odd chest pain and shortness of breath. Her cardiologist in Palm Coast believed she was going into heart failure, and Natalie was recommended to see Arwa Saidi, MB. BCh. FACC , the co-director of the adult congenital heart disease program at UF Health Shands Hospital, at one of UF Health’s congenital cardiology satellite clinics in Daytona Beach

“Going into it, it was scary for me because I had been told time and time again that my heart wouldn’t need to be fixed,” Natalie said. “So when Dr. Saidi told me it needed to, I was scared.”

Natalie traveled to UF Health Shands Hospital in Gainesville, Florida and underwent open-heart surgery with Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and the chief of congenital cardiothoracic surgery at UF Health, on Dec. 14, 2018. A second hole in the wall that separates the top two chambers of her heart was found, as well.

Natalie made an excellent post operative recovery and was released from UF Health Shands Hospital just four days after her surgery.

“I think that something that is very helpful in someone’s care and recovery is to have positive people around them,” Natalie said. “Having a good experience at UF Health Shands helped me be able to be released from the hospital so soon.”

Even Mike, who said he typically isn’t a fan of hospitals, admitted he was blown away by their experience with the doctors and nurses who ensured that the couple’s needs were met. Natalie said her care team took their time, comforted and encouraged her with positive attitudes.

Natalie Mangum's three dogs.

Natalie is now recovering at her home in Palm Coast with Mike and their three dogs, and she plans to return to her job as soon as she is healed.

Through her entire experience, Natalie is humbled by the way her and Mike’s choice to move to Florida played out.

“Things happen for a reason,” Natalie said. “I firmly believe that we were supposed to be here to have my experience at UF Health Shands.”

Exploring the Sinus Microbiome in Chronic Sinusitis

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Submitted by UF Health on February 6, 2019 - 12:51

Researchers at the University of Florida are among the first investigators to examine the clinical and microbiologic characteristics, risk factors and recalcitrance in patients with chronic rhinosinusitis who had Achromobacter or Serratia marcescens infection in the sinuses.

Jeb Justice, M.D., chief of the Division of Rhinology and Skull Base Surgery at the UF College of Medicine — part of UF Health, the Southeast’s most comprehensive academic health center — was an author of two groundbreaking studies that focused on these less commonly isolated, gram-negative organisms in chronic rhinosinusitis. The results of both studies were published in Otolaryngology Online in 2018. [ref]

“A great deal of research exists into more common bacteria in chronic rhinosinusitis, such as Staphylococcus aureus and Pseudomonas aeruginosa,” says Justice. “In our institution we saw patients with less common gram-negative organisms and sought to elucidate whether they were causing disease or were innocent bystanders.”

Serratia marcenens is a gram-negative facultative anaerobe classified as a member of enterobacteriacae that has been isolated in nosocomial infections. Achromobacter is an aerobic, motile, nonfermenting, gram-negative bacillus found around the world in water and soil, including swimming pools and well water, and in dialysis and chlorhexidine solutions.

According to Dr. Justice, until recently the microbiota underlying chronic rhinosinusitis have been poorly understood. UF is one of the few centers in the country using advanced gene sequencing and molecular diagnostic testing to identify less common bacteria. These newer techniques, which move beyond simple bacterial culture, have vastly improved our understanding of the diversity of the sinus microbiome.

“Chronic sinusitis is a disease that impacts over 30 million people in this country and there is no cure for it,” explains Justice. “Some of the best treatments of sinusitis can have significant long-term side effects for patients. As we work to better understand the microbiome and its alterations in each individual patient, our surgical techniques and comprehensive approach to the care of sinus patients allows us to provide culture-directed topical therapies that can improve patient quality of life while limiting the amount of systemic therapies they need. This can be a huge win for our patients."

UF is committed to furthering the base of knowledge about these pathogenic bacteria and their role in chronic rhinosinusitis.


http://www.jorl.net/otolaryngology/the-role-of-achromobacter-xylosoxidans-positive-sinus-cultures-in-patients-with-refractory-chronic-rhinosinusitis.pdf

http://www.alliedacademies.org/articles/the-role-of-serratia-marcescens-positive-nasal-cultures-in-patients-with-refractory-chronic-rhinosinusitis.pdf

Leading-Edge Surgical Techniques Allow Patients to Breathe Better

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Submitted by UF Health on February 5, 2019 - 12:37

Breathing is a basic life function. For individuals experiencing breathing difficulties due to congenital defects, external injury or medical procedures, such as prolonged intubation, airway reconstruction can be life-changing. University of Florida Health is one of the few centers in the southeastern United States with a team of specialists who have the expertise to rebuild airways in patients with complex breathing issues. These experts are highly skilled at open and endoscopic airway reconstruction.

According to Neil Chheda, M.D., chief of the division of laryngology in the department of otolaryngology, the approach at the University of Florida College of Medicine – part of UF Health, the Southeast’s most comprehensive academic health center – is multidisciplinary. “Our coordinated approach involves pulmonary, thoracic and anesthesiology specialists working together to ensure the best possible surgical outcomes for our patients.”

Patients benefit from the experienced surgical team at UF Health who perform hundreds of airway reconstructions each year. A large proportion of these procedures are completed endoscopically. “At our facility we’ve found that we can execute many procedures through the mouth, limiting the need for incisions in the neck,” explains Chheda.

The UF team is advancing new endoscopic procedures and techniques, providing nearly unlimited treatment options for patients with breathing issues. But care doesn’t end with surgery. Patients may need swallowing and voice rehabilitation after airway reconstruction. 

Concludes Chheda, “With our multidisciplinary team we can ensure that every patient receives the customized treatment he or she needs for as long as it’s needed.” Such individualized treatment is the cornerstone of care at UF Health.

Collaborating for Better Outcomes in Patients with Fatty Liver Disease

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Submitted by UF Health on February 5, 2019 - 07:47

Nonalcoholic fatty liver disease is a growing worldwide health problem and has been linked to common disorders such as Type 2 diabetes and cardiovascular disease. To improve outcomes for patients with fatty liver disease, Kenneth Cusi, M.D., FACP, FACE, chief of the University of Florida College of Medicine’s Division of Endocrinology, Diabetes and Metabolism, says, “We need a multidisciplinary approach with endocrinologists and hepatologists working together to get the upper hand in managing fatty liver disease.”

Cusi recently co-authored an article in the journal Lancet Diabetes & Endocrinology in which novel concepts related to the diagnosis, risk prediction and treatment of fatty liver disease are highlighted. The authors note that reliable noninvasive tools for diagnosing non-alcoholic fatty liver disease, or NAFLD, are needed, especially in patients with insulin resistance or diabetes, and that diagnosis is needed earlier because such comorbidities can strongly affect patients with advanced stages of the disease.

Still, Cusi and his colleagues point out that fatty liver disease can be identified when the patient is evaluated and can then be treated, calling for endocrinologists and hepatologists to work together to manage its deleterious hepatic and extrahepatic effects. Cusi explains, “Increased liver fat content is a stronger determinant of insulin resistance and cardiovascular disease than total body fat mass or even visceral fat mass.” Cusi notes that in NAFLD, the liver becomes an indicator of cardiometabolic health—a barometer that allows the identification of individuals, both with and without obesity, who are insulin-resistant and in a metabolic state of severe adipose-tissue dysfunction and lipotoxicity. Patients with Type 2 diabetes and NAFLD have the highest cardiometabolic disease risk.

In reviewing current treatments for fatty liver disease, the authors note most doctors are unaware that weight loss by lifestyle modification and bariatric surgery improve inflammation and liver fibrosis. In addition, certain pharmacological agents used to treat diabetes, particularly pioglitazone, offer significant benefit to patients reversing liver steatosis, inflammation and, on occasion, fibrosis.

At UF Health, endocrinologists and hepatologists are putting theory into practice by applying these emerging concepts in a collaborative environment focused on advancing management and improving outcomes for patients with fatty liver disease.

The Florida Sleeve: Procedure introduced by UF Health is shown to be durable and effective in Marfan syndrome patients with aortic root aneurysm

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Submitted by UF Health on February 4, 2019 - 07:59

A recent retrospective study published by a team at University of Florida Health has shown that the Florida Sleeve procedure — originally developed at UF approximately 15 years ago — is associated with encouraging results in Marfan syndrome patients with aortic root aneurysm. This valve-sparing technique involves protecting the aortic root with a Dacron sleeve while leaving native tissue in place.

Tomas Martin, M.D., a professor of surgery in the division of thoracic and cardiovascular surgery at the University of Florida College of Medicine and director of the UF Health Aortic Disease Center, is one of the pioneers of the Florida Sleeve procedure. He attributes the widespread national and international acceptance of this technique to the relative ease with which it can be conceptualized and performed compared with other valve-sparing techniques. “This study,” he notes, “shows that the Florida Sleeve is a viable option for patients with Marfan syndrome.” With a significant reduction in aortic insufficiency grade postoperatively, no in-hospital or 30-day death or stroke, 94% survival at 1 to 8 years, and 100% freedom from reoperation at 8 years, “our study shows that this technique is excellent for use in this group of patients, with good short- and mid-term results.”

Aortic root aneurysm is common in patients with Marfan syndrome and UF Health has been using the Florida Sleeve in these patients since the procedure was first developed . However, some surgeons have concerns about the long-term durability and dimensional stability of this repair, and about the potential need for reoperation in these patients. According to Martin, this analysis — which represents follow-up of the largest cohort of Marfan syndrome patients treated with the Florida Sleeve — shows that “none of the problems that people anticipated have happened.”

It is Martin’s hope that these encouraging results will lead to an increase in use of the Florida Sleeve in patients with Marfan syndrome and that, as a result, “more of these patients will have their native aortic valve saved.”

Reference

Aalaei-Andabili SH, Martin T, Hess P, Klodell C, Karimi A, Arnaoutakis G, Lee T, Beaver T. Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function in Marfan Syndrome Patients. Ann Thorac Surg. 2017 Sep;104(3):834-839. doi: 10.1016/j.athoracsur.2017.01.044. Epub 2017 Apr 12.

A multidisciplinary University of Florida Health team successfully performed transcarotid endovascular repair of an ascending aorta pseudoaneurysm in an elderly patient

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Submitted by UF Health on February 4, 2019 - 07:54

A multidisciplinary team led by George Arnaoutakis, M.D., an assistant professor in the Division of Thoracic and Cardiovascular Surgery at the University of Florida College of Medicine, in collaboration with Martin Back, M.D., a professor in the Division of Vascular Surgery and Endovascular Therapy, recently reported  the successful transcarotid endovascular repair of a large ascending aorta pseudoaneurysm in a 77-year-old female patient.

The case was particularly challenging because, in addition to three prior sternotomies, numerous medical comorbidities and severe thoracoabdominal aortic tortuosity, the patient had a mechanical aortic valve. The team achieved complete exclusion of the pseudoaneurysm while preserving full function of the valve. The patient experienced no complications from the procedure and was discharged from the hospital five days postoperatively. Damage to the prosthetic valve was avoided by using the right common carotid artery for the endovascular approach, positioning the wire just above the mechanical aortic valve and administering adenosine to induce temporary asystole.

Traditional repair of ascending aortic pseudoaneurysm involves replacement of the ascending aorta with the patient on cardiopulmonary bypass and under deep hypothermic circulatory arrest. Delivery of aortic cuff endografts via conventional femoral access — a less invasive approach — has also been described. However, both of these approaches were contraindicated due to the patient’s previous sternotomies, extreme frailty and unfavorable iliofemoral anatomy.

Arnaoutakis notes, “This case illustrates the inventive use of existing technology that is typical of the clinicians at UF Health. We have access to all the latest technology and this allows us to offer innovative solutions for management of complex patients such as this. Few cases present this degree of challenge, but this technique is something that we now have in our armamentarium.”

In summarizing the team’s management of this patient, Arnaoutakis says, “This case is an example of the multidisciplinary, collaborative approach to the management of difficult cases that typifies the work at UF Health.” 

Reference

Millar et al. Transcarotid endovascular repair of ascending aorta pseudoaneurysm. Accepted for publication by the Journal of Cardiac Surgery.

 

University of Florida Division of Thoracic and Cardiovascular Surgery demonstrates improved midterm survival with single-stage repair of aortic arch disease

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Submitted by UF Health on February 1, 2019 - 15:48

A study led by cardiothoracic surgeons at the University of Florida College of Medicine has shown that, when compared to two-stage repair of the aortic arch, the frozen elephant trunk procedure, or single-stage hybrid aortic arch replacement, was associated with comparable risks of 30-day mortality and postoperative adverse events, such as stroke or paraplegia. Moreover, at two years, the single-stage procedure was associated with a significantly lower risk of endoleaks and higher survival.

According to Thomas Beaver, M.D., a professor and chief in the Division of Thoracic and Cardiovascular Surgery, these results confirm that “patients with complex thoracic aortic disease of the ascending arch and descending aorta can now be managed with a single operation that is comparable to our historical two-stage approach.”

UF Health physicians provide expertise, which is a product of the elderly demographic of their referral population and therefore a relatively high incidence of aortic pathology. The strong team-based approach to management of cardiovascular disease is characterized in the work at UF Health Shands, and Dr. Beaver’s focus on making treatment safer and easier for patients.

His aim in this patient population is to complete as much of the repair as possible in one surgery. This focus on the single-stage procedure, when anatomically feasible, means that all eligible patients receive a complete repair; use of the two-stage procedure is typically associated with a proportion of patients who do not present for the second surgery and therefore undergo only partial repair. 

Dr. Beaver and his team recently published their experience in the Annals of Thoracic Surgery. The UF Health Aortic Disease Center sees patients from throughout Florida and the Southeast.

Reference

Alhussaini M, et al. Neurologic Outcomes in Aortic Arch Repair with Frozen Elephant Trunk versus Two-stage Hybrid Repair. Accepted by Annals of Thoracic Surgery.

Women's Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction study sheds light on a highly prevalent but poorly understood condition

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Submitted by UF Health on February 1, 2019 - 15:31

Several physicians from University of Florida Health have recently published findings that shed light on a poorly understood but highly prevalent condition. Drs. Petersen, Anderson, Handberg and Pepine are part of a research team aiming to understand the pathogenesis of heart failure in women that is characterized by signs and symptoms of ischemia, no obstructive coronary artery disease, no coronary microvascular dysfunction and preserved left ventricular ejection fraction.

This study, which forms part of the National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction, or WISE-CVD, program of research, has allowed the team to conclude that maladaptive remodeling of the left ventricle in the setting of prolonged hypertension underlies this condition.

According to John Petersen, M.D., an associate professor of medicine in the division of cardiovascular medicine at the University of Florida College of Medicine, these important mechanistic findings demonstrate what can be achieved when a dedicated group of researchers collaborates to explore unique questions. “By acquiring data on a large cohort of patients and then subclassifying them in different ways, we have been able to perform analyses that answer multiple questions,” he said, adding that the results of this analysis represent “one more piece of the puzzle” relating to heart failure in women.

Carl Pepine, M.D., a professor of medicine at University of Florida College of Medicine, has been involved with the NIH-funded WISE program since its inception. For him, this study is important because it provides deeper understanding of a well-recognized health disparity between men and women for which there is no known cause or treatment. “The No. 1 problem in women in the United States is high blood pressure,” he said, “and we speculate that a lifetime of increased blood pressure leads to this maladaptive remodeling.”

The current findings have led to the upcoming WARRIOR study, which is designed to determine whether intensive management of risk factors in this patient population will reduce the incidence of death and major adverse cardiovascular events. 

Reference

Elboudwarej O, et al. Maladaptive left ventricular remodeling in women: An analysis from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction study. Int J Cardiol. 2018;268:230-235.


Blog Featured Image: https://commons.wikimedia.org/wiki/File:Cardiac_mri_slice_bionerd.jpg used under GNU Free Documentation License

University of Florida Health cardiologists show that socioeconomic status does not influence clinical outcomes after ventricular assist device implantation

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Submitted by UF Health on February 1, 2019 - 15:21

A study  led by physicians at the University of Florida College of Medicine’s Division of Cardiovascular Medicine has shown that survival benefit after ventricular assist device, or VAD, implantation is not influenced by socioeconomic status, or SES. Survival, 30-day readmission, complications of device support and prolonged implant length of stay, or LOS, were among the outcomes unaffected by SES. 

“This study has shown that patients with low SES should not be denied evaluation for VAD simply on the basis of SES,” said Mustafa Ahmed, M.D., an assistant professor of medicine and the study’s lead author. One of the main advantages of this study compared with previous investigations involving the effect of SES on outcomes is that Dr. Ahmed’s team assessed SES using patient-level measures rather than census data.

This study is part of a broader program that aims to look beyond survival in VAD patients. As well as assessing quality metrics such as readmission and complication rates, cost-effectiveness and LOS, Dr. Ahmed plans to evaluate metrics related to patient-centered care, and carry out prospective studies to determine how to engage effectively with different types of patients, including those with low levels of health literacy. Dr. Ahmed’s team is also interested in developing robust models of psychosocial risk in order to improve preimplantation assessment of this important parameter.

These goals all feed into the overall aim of refining the identification of patients who are good candidates for VAD implantation and ensuring that all suitable patients are offered the opportunities afforded by referral to VAD teams, irrespective of SES.

“Patients with low SES often face barriers to referral for advanced treatments, such as VAD and transplantation,” said Dr. Ahmed. “Our study has shown that low SES does not increase risk and that these patients have the same benefits from VAD as other patients. Patients with low SES should be evaluated holistically in terms of their suitability for VAD.

Mission: Prevention. University of Florida Health Leads the Way in Encouraging Lifestyle Modification to Prevent and Treat Heart Failure

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Submitted by UF Health on February 1, 2019 - 15:17

Monica Aggarwal, M.D., FACC, an assistant professor of medicine in the University of Florida College of Medicine's Division of Cardiovascular Medicine and director of UF Health’s Integrative Cardiology and Prevention Program, is on a mission to teach physicians and surgeons about the importance of lifestyle factors in the prevention and management of heart failure.

In a recent publication in the Journal of the American College of Cardiology, Dr. Aggarwal reviewed the role of dietary composition and supplements, bodyweight, exercise and mindfulness in patients with heart failure and — most importantly — provided practical measures to make it easier for physicians to translate her recommendations into clinical practice.

Although preventive cardiology is a recognized specialty in the United States, Dr. Aggarwal believes there is an opportunity for greater focus on nutritional and lifestyle factors. “If you give patients the tools and the motivation to change, they will,” she says. But, both nationally and internationally, and among both specialists and nonspecialists, physicians’ level of education about nutrition and lifestyle is typically poor. As a result, their interaction with patients on these topics is suboptimal.                                                             

The preventive cardiology program Dr. Aggarwal is building at UF Health is already bringing her “great joy.” She has devised a new plant-based menu for patients admitted to the UF Health Heart & Vascular Hospital and regularly speaks to clinicians in other hospitals and the community about the importance of lifestyle in the prevention and management of cardiovascular disease. She is also creating information packages for hospitalized patients that will be distributed before discharge, educating patients about how to initiate beneficial lifestyle changes.

Dr. Aggarwal acknowledges the huge effort of the team at UF Health who are helping to make her preventive cardiology vision a reality. Her recent publication and the work that the team are doing at UF Health has generated considerable interest in the medical community and she is eager to see her ideas more widely adopted. “The more people we can get excited about this mission the better,” she said. 

Reference

Aggarwal M, et al. Lifestyle Modifications for Preventing and Treating Heart Failure. J Am Coll Cardiol. 2018 Nov 6;72(19):2391-2405. doi: 10.1016/j.jacc.2018.08.2160.

University of Florida Health is a Leader in Cardiovascular Care

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Submitted by UF Health on February 1, 2019 - 14:46

The University of Florida Health Divisions of Cardiovascular Medicine and Surgery are working together as leaders in the care of our patients in Florida and across the country. This team-based approach, in which cardiologists and cardiovascular surgeons work closely together to provide outstanding patient care, is facilitated by the outstanding new UF Health Heart & Vascular Hospital in Gainesville, Florida, a state-of-the-art facility designed around the needs of the patient. The new hospital has co-located clinics with cardiologists and surgeons, along with adjacent testing centers to facilitate “one-stop shopping.”

The UF Health Heart & Vascular Hospital is built with an “eye to the future” as five of the 15 new operating rooms are ‘hybrid’ and allow surgery and advanced imaging for minimally invasive and catheter-based therapy.

An example of this new approach to surgical care is described by Dr. George Arnaoutakis, a cardiac surgeon, and Dr. Martin Back, a vascular surgeon, in their case report [JD2] titled “Transcarotid endovascular repair of an ascending aorta pseudoaneurysm”. This successful percutaneous catheter-based aneurysm treatment avoided a major open heart procedure, allowing the patient a quicker recovery.  

For several years our team has been a leader in hybrid endovascular surgery for complex aortic arch procedures. Our team of cardiac surgeons, including Drs. Tomas Martin, Thomas Beaver and George Arnaoutakis, work closely with our vascular surgery colleagues, Drs. Huber, Upchurch, Back and Fatima. This month we published an updated series of single-stage hybrid total aortic arch replacement in Annals of Thoracic Surgery article. We have found a single-stage approach compares favorably with the historic two-stage open repair in suitable patients. For a further update and to learn more about thoracic stent grafts or TEVAR (Thoracic Endovascular Aortic Repair), please see our recently updated Medscape overview.

This type of surgical innovation has been a hallmark at UF Health. One example that continues to stand out is “The Florida Sleeve,” a surgical procedure to repair functional type I aortic insufficiency from aortic root aneurysms developed 15 years ago here at UF Health by a team by Tomas Martin, M.D., who is now Professor and Director of the UF Health Aortic Disease Center. The Florida Sleeve has broadened the availability of aortic valve repair for patients with aortic root aneurysms so more patients can avoid a replacement. For an update on The Florida Sleeve Repair see our most recent article on our extensive experience in Marfan syndrome patients study in The Annals of Thoracic Surgery.

Stay tuned for more updates from UF Health on our innovative clinical care and ongoing research. We welcome visitors to our new Heart and Vascular Hospital in Gainesville – and we look forward to hearing from you! 

 

Sincerely,

Jamie Conti, M.D., FACC
Professor and Chair
UF Department of Medicine

Gilbert Upchurch Jr., M.D.
Edward R. Woodward Professor and Chair
UF Department of Surgery

Juan Aranda Jr., M.D., FACC
Professor and Interim Chief
UF Division of Cardiovascular Medicine

Thomas Beaver, M.D., MPH
Professor and Chief
UF Division of Thoracic and Cardiovascular Surgery

Thomas Huber, M.D., Ph.D.
Professor and Chief
UF Division of Vascular Surgery

University of Florida Health Fights Obesity with Multidisciplinary Approach

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Submitted by UF Health on February 1, 2019 - 13:07

Researchers at University of Florida Health are using a multidisciplinary approach to fight obesity. Experts from surgery, cardiology, pulmonology, gastroenterology, nephrology, internal medicine, nutrition and psychiatry collaborate to offer comprehensive, minimally invasive bariatric surgeries at the UF Health Weight Loss Surgery Center. “Through our research and clinical practice, our bariatric surgery center is well on its way to becoming the best, not just in the state of Florida but also in the Southeast region,” said center director Jeffrey Friedman, MD, FACS. The center holds joint accreditation from the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery.

Physicians see a large volume of patients for consultation, including adolescents and children. The center at UF Health Shands Hospital offers gastric bypass and laparoscopic sleeve gastrectomy as well as revision and corrective surgeries to address complications from previous surgeries. Friedman notes, “Patients from all over the state who have had bariatric surgery complications are referred to us for corrective procedures.”

The center has an active research program that’s funded by the National Institutes of Health. Researchers at UF Health are working to increase options for these patient who are often disqualified from heart transplant surgery due to obesity. A study published in the journal Surgery for Obesity and Related Diseases in September 2018 demonstrated the safety of laparoscopic sleeve gastrectomy in patients who had morbid obesity and end-stage heart failure requiring left ventricular assist device, or LVAD, support. According to the author, to our knowledge, this is the largest reported series of bariatric surgery performed on heart failure patients with LVAD support for the purpose of increasing eligibility for cardiac transplantation. Laparoscopic sleeve gastrectomy lowered body mass index in the majority of these patients, making them eligible for a heart transplant. Friedman adds, “In some cases, patients no longer need a transplant because weight loss restores their cardiac function.”

Looking ahead, Friedman sees a place for bariatric surgery in the treatment of diabetes and points to the American Diabetes Association recommendations for the use of metabolic surgery to manage Type 2 diabetes. “With multidisciplinary clinical expertise and a strong focus on research, UF Health provides state-of-the-art care for obesity and continues to advance the field to improve patient health outcomes,” says Dr. Friedman.

 

References

RB Hawkins, K Go, SL Raymond, A Ayzengart, J Friedman, et al. Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant. Surg Obes Relat Dis. 2018;14:1274-1275

The Search Continues for a Noninvasive Test for Nonalcoholic Steatohepatitis that Works in the Real World

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Submitted by UF Health on February 1, 2019 - 12:58

Nonalcoholic steatohepatitis, or NASH, is a serious progression of nonalcoholic fatty liver disease. Percutaneous liver biopsy is currently the gold standard for diagnosing and staging nonalcoholic steatohepatitis, but it is frequently avoided due to the high cost, potential risk to the patient and lack of approved treatments once diagnosis is confirmed. According to Fernando Bril, M.D., an assistant professor in the University of Florida College of Medicine’s Division of Endocrinology, Diabetes and Metabolism, “This is a bidirectional problem. We need better diagnostic tools to identify nonalcoholic steatohepatitis, but we also need a better way to treat it once we find it. That’s why UF Health is committed to meeting both challenges.”

Bril works alongside a team of several researchers led by Kenneth Cusi, M.D., who are searching for an effective noninvasive diagnostic test for nonalcoholic steatohepatitis at UF Health. They have investigated several methods in the past, including the use of biomarkers such as plasma cytokeratin-18 and the One Way Liver Metabolomics test, and the use of ultrasound. Most recently, they investigated the use of a commercially available blood test that is a combination of four different noninvasive biomarker panels, including one for diagnosing steatosis, two for diagnosing necrosis and inflammation, and one for diagnosing fibrosis. All four panels were developed and validated originally in nondiabetic cohorts. Cusi’s team assessed them in combination to see how they would perform in a large cohort of patients with Type 2 diabetes, reflecting a more real-world setting for diagnosing nonalcoholic steatohepatitis.

The study, which was conducted in 220 patients, found that many of the panels may underperform in patients with Type 2 diabetes. The results suggest that patients with Type 2 diabetes may require different panels specifically developed for this patient population to diagnose nonalcoholic steatohepatitis.

Bril and his colleagues at UF Health will continue their search for an effective diagnostic test for nonalcoholic steatohepatitis while they also continue working on effective treatments.

 

References

Bril F, Ortiz-Lopez C, Lomonaco R, et al. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Internat. 2015;35:2139-2146.

Bril F, Millán L, Kalavalapali S, et al. Use of a metabolomics approach to non-invasively diagnose non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. Diab Obes Metab. 2018;20:1702-1709.

Bril F, McPhaul MJ, Caulfield MP, et al. Performance of the SteatoTest, ActiTest, NashTest, and FibroTest in a multiethnic cohort of patients with type 2 diabetes mellitus. J Invest Med. 2018;0:1-9: doi:10.1136/jim-2018-000864

Cusi K, Chang Z, Harrison S, et al. Limited value of plasma cytokeratin-18 as a biomarker for NASH and fibrosis in patients with non-alcoholic fatty liver disease. J Hepatol. 2014;60: 167-174.

Flipping the Metabolic Switch to Fight Obesity

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Submitted by UF Health on February 1, 2019 - 12:54

Calorie restriction without malnutrition has been shown to impart a number of health benefits in addition to weight loss in overweight adults. However, many adults have difficulty sustaining calorie restriction long-term. Intermittent fasting is an increasingly popular alternative to sustained calorie restriction, and has been shown to impart similar benefits of weight loss and improvement in cardiovascular health. Troy William Donahoo, M.D., FTOS, a clinical associate professor at the University of Florida College of Medicine’s Division of Endocrinology, Diabetes and Metabolism, and his colleagues recently published a widely cited article in which they propose the mechanism by which intermittent fasting works.

Donahoo states, “Humans in hunter-gatherer societies were intermittently subjected to times of little or no food. For energy, their metabolism learned to adapt by quickly switching from lipidogenesis or fat storage to fat mobilization. The history of fasting for medical purposes dates back to the ancient Chinese, Greek and Roman physicians.” From their extensive literature search, Donahoo and colleagues found that intermittent fasting regimens flip a metabolic switch in the body, promoting short-term ketogenesis to transform fat into energy while preserving muscle mass and function.

Donahoo puts these findings into perspective, “The obesity epidemic in America, which certainly affects us right here in Florida, is getting worse. Clinicians are treating patients who are obese and battling comorbidities, such as Type 2 diabetes, insulin resistance and dyslipidemia. Employing intermittent fasting regimens to flip the metabolic switch from fat storage to fat mobilization gives clinicians a valuable tool to help improve body composition in patients who are overweight or obese, with many inherent potential health benefits.”

UF Health is committed to furthering the base of knowledge into how intermittent fasting may help to optimize physiological function, enhance performance and slow aging and disease processes, including exploring biomarkers of the metabolic switch.

Tiny Fireball: Riley

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Submitted by Kelly Daly on February 1, 2019 - 09:00

Riley CampbellErin Campbell was only in her second trimester when she found out that the course of her entire pregnancy would be altered.

At 18 weeks, Erin’s baby girl, Riley, was diagnosed with hypoplastic left heart syndrome, or HLHS, a birth defect that affects normal blood flow through the heart, as the left side of the heart does not form correctly.

“My husband and I were really broken up about it,” Erin said. “You can’t change the situation, and we just made the best out of it. We’ll do whatever we can for our little girl.”

Erin and her husband, Rory, immediately delved into research and went to three different hospitals for a second and third opinion. They were in search for the greatest doctor and surgeon to give Riley the best chance. Their research led them to UF Health Shands Children’s Hospital in Gainesville, Florida.

“It was an easy decision,” Erin said. “There’s a family-feel, and it didn’t feel processed. It was more of a one-on-one experience, and we had a lot of attentiveness with the doctors and nurses.”

The Campbell family is from Fort Pierce, Florida, about three-and-a-half hours from Gainesville, but Erin said the time spent travelling was no problem if it meant receiving the best care for Riley. Seeing Jennifer Co-Vu, M.D., the director of the single ventricle and fetal cardiac programs at the UF Health Congenital Heart Center, and Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and the chief of congenital cardiothoracic surgery at UF Health, made every drive worth it.

“We clicked with Dr. Co-Vu almost instantly,” Erin said. “We’re cut from the same cloth. It’s so nice and refreshing to have that in more of a personal setting.”

Riley had her first surgery, known as a Norwood procedure, when she was just 6 days old. The operation reconstructs the heart to allow the right side to become the main pumping chamber instead of the left side. The Campbells were in the pediatric cardiac intensive care unit for less than a month when they got to bring Riley home.

“We knew that when she [Riley] was in my belly that she was a fighter,” Erin said. “She’s chill when she wants to be, but she’s a fireball at the same time.”

Riley is now 7-weeks-old, and Erin said she only has to visit the children’s hospital once every two weeks since her daughter is doing so well.

Riley is at home with her furry brother and sister, Brody and Stella. The Australian shepherds stay by her side as she grows stronger each day.

“They are just smitten with her,” Erin said.

Riley is at home with her furry brother and sister, Brody and Stella. The Australian shepherds stay by her side as she grows stronger each day.

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Timing of Adjuvant Mitomycin C Administration May Impact Bladder Cancer Recurrence Following Nephroureterectomy

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Submitted by UF Health on January 23, 2019 - 12:35

Researchers at University of Florida Health are among the first investigators to evaluate the impact of the timing of intravesical mitomycin C administration on the rate of bladder tumor recurrence following radical nephroureterectomy for upper tract urothelial cancer.

Paul Crispen, M.D., an associate professor in the department of urology at UF, was an author of this groundbreaking study, published in Bladder Cancer in October 2018. According to Crispen, “These results may have practice-changing implications.”

About 80,000 people are diagnosed with urothelial cancer in the United States each year, and a majority of cases occur in the bladder. Upper tract urothelial cancer is rare, accounting for less than 10 percent of malignancies in the genitourinary tract. Radical nephroureterectomy with bladder cuff excision remains the standard surgical approach for high-risk patients and for lower-risk tumors that cannot be managed endoscopically. Unfortunately, bladder tumor recurrence is common, with rates up to 47 percent.

Crispen and colleagues retrospectively reviewed data for 51 adult patients who underwent radical nephroureterectomy for upper tract urothelial cancer, received intravesical mitomycin C during their perioperative course and had cystoscopic surveillance follow-up. The primary endpoint was bladder tumor recurrence rate within the first year after surgery.

The investigators categorized patients into two groups based on timing of intravesical mitomycin C administration:

  • Patients who received mitomycin C intraoperatively or in the recovery room on the day of surgery
  • Patients who received mitomycin C on the first day after surgery or later

The investigators found that earlier instillation of mitomycin C was associated with a decreased bladder tumor recurrence rate. The estimated probability of one-year recurrence was 16 percent for patients who received mitomycin C on the day of surgery and 33 percent for those receiving the drug on postoperative day one or later (log rank test P value = 0.09).

Crispen concludes, “While these results suggest the timing of intravesical chemotherapy administration may have an impact on the rate of bladder tumor recurrence, we need more evidence from prospective trials before we change current practice.” 

Crispen and UF colleagues are currently enrolling patients in a Phase 2 trial at the University of Florida, the first prospective study of its kind to attempt to identify the importance of timing of mitomycin C administration relative to bladder tumor recurrence rate following radical nephroureterectomy. The ClinicalTrials.gov Identifier is NCT03658304. This study may provide answers to the question, “Does timing matter?”

University of Florida Researchers Add to the Knowledge Base About Quinolone Toxicity

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Submitted by UF Health on January 22, 2019 - 14:40

Investigators at the University of Florida are at the forefront of research into toxicities associated with commonly used ear medications, notably ototopical quinolones. Patrick Antonelli, M.D., FACS, chair of the UF College of Medicine Department of Otolaryngology, has been an author of several studies that have shown an association between quinolone use and delayed tympanic membrane healing and increased risk of perforations requiring tympanoplasty.

In one analysis published in Clinical Infectious Diseases in 2017, Antonelli and UF colleagues retrospectively analyzed insurance data for 96,595 children to compare the rates of eardrum A new UF Health study questions the safety of antibiotic ear drops prescribed to children after ear tube surgery.perforations after use of two commonly used ear drops, quinolones and neomycin, following tympanostomy tube placement. They found that children who received quinolone ear drops after tube placement were 60 percent more likely to develop eardrum perforations that required surgical repair compared with children receiving neomycin ear drops. The study also suggested that the concomitant use of steroids further increased the risk of tympanic membrane perforations.

“Quinolones have been considered to be safe largely because of a perceived absence of undesirable side effects, especially with regard to a lack of toxicity in the inner ear,” explains Antonelli. “Our research, however, suggests that we must be ever-vigilant in our use of quinolone ear drops until a safer alternative becomes available.”

Antonelli and his team at UF Health also have conducted several experimental animal studies to examine the effect of different antibiotic eardrops on the tympanic membrane. In a mouse model, ototopical quinolones reduced fibroblast viability and collagen and alpha-tubulin protein levels. In a rat model, ototopical quinolones delayed tympanic membrane healing in a drug-specific manner, with ciprofloxacin having a greater impact than ofloxacin. 

The research by the physician scientists in the UF Department of Otolaryngology will help advance our knowledge of quinolone toxicity.

University of Florida Health Advances Care for Patients with Hepatitis C

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Submitted by UF Health on January 16, 2019 - 13:44

Researchers at University of Florida Health have played a pivotal role in developing new treatments and improving health outcomes for patients with hepatitis C. David Nelson, M.D., interim senior vice president of health affairs at the University of Florida and president of UF Health, is a professor of medicine and a nationally recognized expert in liver diseases.

“UF Health is home to a large hepatitis C observational cohort study and is leading two large, multi-center randomized controlled trials on hepatitis C,” said Nelson. Clinical research at UF Health has not only advanced drug discovery  in the field, but is now uncovering real-world evidence  on the economic and clinical impacts of hepatitis C therapies. UF Health’s latest findings from a study that compares the top hepatitis C treatments in real-world populations, which is funded by the Patient-Centered Outcomes and Research Institute, will be presented in Vienna in April 2019.

Nelson’s leadership in hepatitis C research was recognized in 2013 with the Clinical Research Forum’s Top Ten Clinical Research Achievement Award. He also plays an active role in developing national and international guidelines for the management of hepatitis C. He is the U.S. representative on the World Health Organization’s hepatitis C virus guidelines committee and has co-authored the U.S. guidelines for hepatitis C treatment and the Clinical Pharmacogenetics Implementation Consortium guidelines on genomic-guided hepatitis C virus therapy. 

Nelson directs the UF Clinical and Translational Science Institute at UF Health, which is focused on accelerating the translation of scientific discoveries from the bench to the bedside to improve patient care across a wide range of diseases. The institute’s funding through two National Institutes of Health Clinical and Translational Science Awards totaling more than $42 million makes UF Health a nationally recognized hub for translational science.

“UF Health has played an important role in drug discovery for hepatitis C treatments and we’re now in a position to uncover the real-world impact of these treatments to improve patient health outcomes,” said Nelson.

University of Florida Health Leads the Way in Minimally Invasive Endoscopic Procedures

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Submitted by UF Health on January 16, 2019 - 13:41

University of Florida Health offers an individualized approach to care for patients suffering from gastrointestinal disorders. At UF Health, patients have access to novel interventions, such as minimally invasive endoscopic procedures, that avoid open surgery and reduce recovery times. “Not every procedure or intervention applies to every patient. The key is to identify who will benefit the most from a specific intervention — that’s the kind of care that we provide,” says Dennis Yang, MD, an assistant professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition.

Due to advances in technology, a great number of gastrointestinal lesions that once required open surgery for removal can now be resected endoscopically. Gastroenterologists at UF Health have the clinical expertise and skill to perform these procedures and have been moving away from open surgical interventions when a minimally invasive resection is better suited to the particular patient.

UF Health is helping to advance the endoscopic diagnosis of precancerous lesions in the gastrointestinal tract. The first prospective, open-label study to directly compare two endoscopic ultrasound methods for the diagnosis of neoplastic pancreatic cysts demonstrated that needle tissue biopsy had a higher diagnostic accuracy than fine needle aspiration. “Our research has uncovered a novel diagnostic approach for neoplastic pancreatic cysts,” says Yang. UF Health coordinated this multicenter study and Yang served as principal investigator. Findings from this study were published in Clinical Gastroenterology and Hepatology in November 2018.

University of Florida Researchers Complete a Preclinical Study Using Tumor Derived RNA Nanoparticle Vaccines for Head and Neck Cancer

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Submitted by UF Health on January 11, 2019 - 15:01

Researchers at the University of Florida College of Medicine Department of Otolaryngology examined the anti-tumor activity of tumor-derived RNA nanoparticles in an oral cavity squamous cell carcinoma murine model. The research was conducted in collaboration with Elias Sayour, M.D, Ph.D., in the UF Brain Tumor Immunotherapy Program. The results were presented at the American Association for Cancer Research meeting in November 2018.

According to Natalie Silver, M.D., M.S., an assistant professor in the division of head and neck oncologic surgery in the Department of Otolaryngology at the university and one of the investigators for this project, UF is one of the few institutions in the world that has developed clinically translatable nanoparticles that can be loaded with RNAs encoding for tumor neoantigens. This is the first step in generating personalized cancer vaccines.

In combination with immunotherapy, personalized cancer vaccines may help activate the immune system to overcome resistance to checkpoint inhibitors, the standard of care for patients with platinum refractory recurrent/metastatic head and neck cancer. “Nearly 85 percent of patients with recurrent disease become resistant to checkpoint inhibitors,” says Silver. “Reprogramming the immune system with personalized RNA nanoparticle vaccines may offer a solution.”

Silver and her colleagues administered mice weekly tumor-derived RNA nanoparticle vaccines derived from a murine oral cavity squamous cell carcinoma line. Tumor-infiltrating lymphocytes and immune cell populations in the spleen were analyzed with flow cytometry. Mice receiving the tumor-derived RNA nanoparticle vaccine had significantly decreased tumor growth compared with mice receiving nanoparticles alone. In addition, treatment with tumor-derived RNA nanoparticle vaccines significantly reduced regulatory T cells and significantly increased cytotoxic and memory T cells in spleen and tumor tissues.

Silver says, “Our findings have potential clinical and translational implications. We may be able to use this technology in humans to activate and manipulate the immune system, against head and neck cancer. Through RNA engineering we are able to further personalize vaccine formulations.”

University of Florida Researchers Investigate Chronic Opioid Use in Patients with Head and Neck Cancer

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Submitted by UF Health on January 11, 2019 - 09:00

At a time when overdose deaths from prescription and non-prescription opioids have reached epidemic proportions, researchers at the University of Florida College of Medicine’s Department of Otolaryngology — part of UF Health, the Southeast’s most comprehensive academic health center — have taken a closer look at chronic opioid use in patients with oropharyngeal squamous cell carcinoma. The retrospective analysis, which will be published in Laryngoscope in early 2019, found that an alarming number of patients were chronic opioid users three months after treatment.

Nearly 52,000 people are diagnosed with cancer of the oral cavity and pharynx each year in the United States. According to Natalie Silver, M.D., M.S., an assistant professor in the division of head and neck oncologic surgery at UF, “Up to 85 percent of patients with head and neck cancer report significant pain at the time of diagnosis. Opioids are the cornerstone of treatment for both acute and chronic pain management for these patients.” The current opioid crisis in the United States, where more than 100 people die every day from an opioid overdose, highlighted the need to look at long-term opioid use in this patient cohort.

Investigators retrospectively studied 198 patients who underwent curative radiotherapy for oropharynx cancer at UF Health from 2012-2017. They found that more than 50 percent of the patients treated with radiation in this cohort continued to use opioids three months after the conclusion of treatment. These data were presented at the American Head and Neck Society 2018 Annual Meeting.

Silver and her colleagues found significant predictors for chronic opioid use to be pre-treatment opioid use, history of depression, age ≤ 62 and presence of a pre-existing chronic pain condition. Human papillomavirus, or HPV, and p16, a surrogate marker for HPV, negative tumor status also was a predictor. 

This study serves as the foundation for additional research to better define at-risk patients and to identify strategies to manage patients’ pain without increasing the risk of chronic opioid use.

OR Team Top Among Peers

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Submitted by Amy Cook on January 4, 2019 - 11:17

UF Health Shands Perioperative Services department and the UF Health Shands Hospital OR

The UF Health Shands Perioperative Services department and the UF Health Shands Hospital OR recently received the CORE Award from the Association of perioperative Registered Nurses. Ours is only the third OR in the nation and the first in Florida to receive this recognition. The award stands for Committed to OR Excellence and is given to teams for exceptional care and improved outcomes.

“To achieve a high level of sustained excellence for an award like this, you have to have a very engaged and committed team,” said Ed Jimenez, UF Health Shands CEO. “Our perioperative staff have worked hard to improve patient care and their results have been exemplary.”

The team cares for pediatric and adult patients during surgery. They help manage surgical tools in the OR, assist faculty throughout surgery and serve as patient advocates.

The award criteria include demonstrated excellence in effective communication, knowledge, evidence-based practice and processes and patient outcomes. The award reflects a commitment to clinical quality and patient safety in the OR.

“Our nurses play an integral role in the patient experience, and we’re proud of their passion for providing high-quality care,” said Irene Alexaitis, D.N.P., R.N., NEA-BC, UF Health Shands Hospital chief nursing officer and Nursing and Patient Services vice president. “Their compassionate service, dedication to quality outcomes and interdisciplinary approach is what sets our organization apart, and this achievement is a testament to that.”

Michele Brunges, M.S.N., R.N., CNOR, UF Health Shands Perioperative Services director, led the application committee and was honored to work alongside such a talented team.

Brunges said, “I want the team to feel proud of themselves. This award is for them to take a step back and recognize their hard work and contributions.”

Thank you to our UF Health Shands AORN CORE committee members for all of their hard work.

— Michele Brunges, R.N., M.S.N., CNOR

— Sharon Batie, R.N., M.S.N., CNOR

— Theresa Hughes, R.N., M.S.N., CNOR

— Janice Rivera, R.N.

Weighty Choices: Selecting Optimal G-CSF Doses for Stem Cell Mobilization to Optimize Yield

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Submitted by UF Health on January 4, 2019 - 10:39

Nosha Farhadfar, MD, and colleagues at University of Florida Health Cancer Center led a study conducted by an international team of researchers using data reported to the Center for International Blood and Marrow Transplant Research. The study led to important, practice-changing discoveries about obese and morbidly obese stem cell donors, which she presented at the American Society of Hematology, or ASH, Annual Meeting in December 2018. Allogeneic stem cell transplant is the only curative option for many patients with leukemia or lymphoma. Obese and morbidly obese individuals make up about 40% of the U.S. population, and this percentage is expected to grow in the near term. Thus, understanding the impact that obesity has on stem cell donation is critical. 

In a landmark study that involved over 20,000 unrelated peripheral blood stem cell donors, Farhadfar and colleagues identified an important difference between obese/morbidly obese stem cell donors and donors with a lower body mass index: The stem cell yield is significantly higher among obese/morbidly obese donors. This may be due to the chronic low-grade inflammation present in obese/morbidly obese individuals, leading to an increase in the number of circulating progenitor cells.

Prior to stem cell collection, donors are injected with a medication known as granulocyte colony-stimulating factor to mobilize their stem cells from the bone marrow to the peripheral blood, to increase the yield of stem cell collection. Granulocyte colony-stimulating factor agents are dosed by body weight; thus, heavier donors receive higher doses. However, the researchers observed that increasing the daily granulocyte colony-stimulating factor dose above 780 g/day for obese donors and 900 g/day for morbidly obese donors did not increase stem cell yield. Furthermore, obese/morbidly obese donors were more likely to experience treatment–associated toxicity, including pain, fatigue and insomnia. Farhadfar observes, “There is a maximum effective G-CSF dose for peripheral blood stem cell mobilization in obese and morbidly obese donors where higher doses add no additional benefit and may result in more complications.”

These results suggest that weight-based doing of granulocyte colony-stimulating factor is unnecessary for obese/morbidly obese individuals, as higher doses do not improve stem cell yields and contribute to toxicity. Thus, to improve the quality of life of obese/morbidly obese unrelated stem cell donors, “Consideration to reduce granulocyte colony-stimulating factor doses in obese and morbidly obese donors should be evaluated to allow for improved donor safety without compromising apheresis efficiency,” says Farhadfar.

University of Florida Health Cancer Center is a Leader in Cancer Care

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Submitted by UF Health on January 4, 2019 - 10:34

Dear Colleagues,

The University of Florida Health Cancer Center is dedicated to providing Florida residents with leading-edge cancer care and original research for the prevention, early diagnosis, and treatment of cancer. Cancer is the leading cause of death for Floridians, and our state has the second highest cancer mortality rate in the nation. Furthermore, the age group at highest risk of developing cancer—65 years and older—is projected to grow by 25% over the next two decades. Therefore, our efforts to serve Florida have never been more critical. 

The UF Health Cancer Center, consisting of 230 researchers, clinicians, and educators, offers a comprehensive care model, with 12 multidisciplinary cancer programs featuring advanced treatment options, including chemotherapy, minimally invasive surgery, robotic surgery, radiotherapy, and participation in clinical trials. We are the Southeast’s most comprehensive academic health center—boasting six health colleges, nine research institutes/centers, two teaching hospitals, two specialty hospitals, and a host of medical practices and outpatient services across north central and northeast Florida. This multidisciplinary membership enables exciting collaborations and encourages translation of basic laboratory findings to novel curative and preventive therapies.

Currently, there is only one National Cancer Institute designated center in Florida; the UF Health Cancer Center aims to become the second, and over the last five years, has been progressing along the four major NCI research initiatives to do so:

  • Basic research: The UF Health Cancer Center has reaffirmed its commitment to basic science and understanding how (and why) cancer develops.
  • Clinical research: Through improvement in design and execution, the UF Health Cancer Center has doubled clinical trial accrual within two years, and has joined the Pancreatic Cancer Action Network (PANCAN) and the NCI Experimental Therapeutics Clinical Trials Network (ETCTN).
  • Population-based research: The UF Health Cancer Center addressed population science goals by evaluating and addressing cancer pain, weight loss, radiation toxicity, palliative care, and equity in outcomes.
  • Translational research: The UF Health Cancer Center is engaged in research across medical and scientific disciplines, from immunotherapy for brain tumors to developing new anti-cancer agents from sea creatures.

At this unique intersection of research, education, and treatment, the UF Health Cancer Center is striving to find tomorrow’s answers for today’s patients. Recent achievements include $28 million in cancer-related funding, doubling of peer-reviewed funding in the last five years, and developing the OneFlorida data trust, a database of 14 million anonymized patient records including many cancer patients that can illuminate trends in cancer incidence, risk factors, mortality and treatments.

Now that you’ve learned more about us, please consider voting for us for the U.S. News & World Report rankings for cancer.

Sincerely,

Jonathan Licht, M.D.,
Director of the UF Health Cancer Center

University of Florida Health Researcher Combines DNA Sequencing and Cloud Computing to Match Novel Treatments and Leukemia Patients

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Submitted by UF Health on January 4, 2019 - 10:30

The University of Florida Health Cancer Center collaborated with the Oregon Health and Sciences University and dozens of other academic medical centers across the country to   evaluated genomic abnormalities in acute myeloid leukemia at a depth that has illuminated new therapeutic strategies.

Christopher Cogle, MD, a physician-scientist in the Division of Hematology and Oncology of the University of Florida Department of Medicine, was an author of a groundbreaking study published in Nature in October 2018, in which researchers generated a large dataset that can be leveraged to address clinical, genomic, transcriptomic, and functional analysis of the biology of AML. According to Dr. Cogle, “This study started with a deep curiosity about leukemia and ended with major discoveries about the underpinnings of leukemia that led us to develop new treatment strategies for our patients.”

About 21,000 people are diagnosed with AML in the United States each year, and about 10,000 die from the disease. It is a heterogeneous disorder, with several genetic classes, multiple cellular subtypes, and nearly 2,000 somatically mutated genes discovered thus far. These complex mutational patterns within and across patients make the implementation of targeted therapies challenging. Despite extensive research efforts, few new therapies have been developed, and the standard of care has remained largely unchanged for the past 30-40 years.

The project described in the Nature publication evaluated a total of 672 specimens from 662 patients from the Beat AML initiative. By conducting exome sequencing, RNA sequencing, and ex vivo drug sensitivity, the group identified both mutations in genes not previously associated in AML patients and novel correlations between gene signatures and drug responses. Furthermore, the integration of these datasets has revealed new markers and mechanisms of drug sensitivity and resistance to explore.

The data have been released to the public, and can be accessed via Vizome, a new online viewer. Thus, the dataset combines two of the greatest advances in society in recent decades, DNA sequencing and cloud computing, Cogle describes. While each of these technologies have much to offer on their own, the combination is more powerful in the manner in which it illuminates novel pathway in which to pursue new treatment options for patients with leukemia.

Precision medicine, and more specifically precision oncology, aims to tailor cancer therapy to individual patients. However, oncology drug trials frequently fail because the “wrong” patients—i.e., those with unidentified, yet incorrectly matched, genetic and molecular disease characteristics—are enrolled. This new dataset allows smarter design of clinical trials by employing “precision recruiting” to better match patients and drugs.  These large data sets require the coordination of efforts of investigators across the country and enrolment of large number of patients.

Dr. Cogle concludes, “The results of this study flip precision oncology around; in addition to finding the right drug for the patient, these discoveries enable us to find the right patient for the drug.”

Reference

Tyner JW, Tognon CE, Bottomly D, et al. Functional genomic landscape of acute myeloid leukemia. Nature. 2018;562(7728):526-531.

University of Florida is the premiere center in the state with a comprehensive program focused on malignant and benign skull base tumors

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Submitted by UF Health on January 4, 2019 - 08:54

The University of Florida Department of Otolaryngology at the UF College of Medicine – part of UF Health, the Southeast’s most comprehensive academic health center – is one of the few centers in the Southeastern United States with a comprehensive, multidisciplinary program focused on children and adults with malignant and benign skull base tumors. Comprising neurosurgeons, otolaryngologists, radiologists, endocrinologists, radiation oncologists and medical oncologists, the UF team is recognized as experts at diagnosing and treating the broad range of anterior and lateral skull base tumors.

Treating skull base tumors is challenging due to their location deep within the head, near critical nerves and blood vessels. Through the integration of leading-edge technologies, such as virtual surgical planning and 3D modeling, the UF team aims to safely remove tumors in this delicate and complex region using the least-invasive methods possible. One technique widely used by the specialists at UF Health is the minimally-invasive endoscopic endonasal approach, by which the tumor is removed entirely through the nose, without external excisions. This method enables the UF skull base team to gain access to and successfully treat tumors that even now in centers without endoscopically trained surgeons are extremely morbid.

Traditionally, whether a neurosurgeon or otolaryngologist treated lesions of the skull base, they were limited by exposure, meaning the need to make large external excisions, or visualization using the naked eye or a microscope, explains Brian Lobo, M.D., an assistant professor in the Division of Rhinology and Skull Base Surgery at the University of Florida who is an expert in advanced rhinology and endoscopic skull base surgery. “Today, our patients benefit from the collaboration between Rhinologists, Neuro-Otologists, and Neurosurgeons, which has made endoscopic endonasal surgery the standard of care for many anterior skull base lesions and enables us to avoid weeks of rehabilitation, post-operative neurological deficits, and a protracted inpatient stay in most cases.”

With the comprehensive skull base program now available at UF Health, patients in Southern Georgia, and Central Florida no longer have to travel long distances to receive world-class care.  Dr. Lobo notes that the collaboration of otolaryngology and neurosurgery has increased the number of patients he is able to serve. “Before arriving and helping establish the program, we removed almost no pituitary tumors endoscopically. Today we are fortunate to serve about five patients a month.”

The skull base specialists at UF Health perform delicate procedures every day, with one aim: to enable patients to have the best outcomes possible. 

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Head-on Approach to a Growing Crisis

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Submitted by UF Health on January 3, 2019 - 11:37

Dear colleagues,

At University of Florida, the Division of Endocrinology, Diabetes and Metabolism is conducting leading-edge research to learn more about the link between obesity, diabetes and fatty liver disease, and innovating new approaches to diagnosis, management and treatment.

There is an epidemic of obesity and Type 2 diabetes in America, and it’s mounting to a crisis of associated and progressive disorders, including liver damage and cirrhosis. By 2030, it is estimated that 65 million more adults in the U.S. will be obese than in 2010. In Florida, the overall obesity rate among adult health care users between the ages of 20 and 79 years old is estimated to be 37%. It’s therefore no surprise that two often overlooked complications of obesity and diabetes are quickly becoming major health concerns here in Florida and across the country: nonalcoholic fatty liver disease, or NAFLD, which occurs in approximately two-thirds of patients who are obese, and nonalcoholic steatohepatitis, or NASH, which is the more severe form of fatty liver disease and predicted to be the leading cause of liver cirrhosis and transplantation by 2020.

Clinicians often miss the opportunity to diagnose fatty liver disease until it’s too late and has progressed into life-threatening cirrhosis. Early detection is the key and can lead to lifesaving early interventions, such as lifestyle changes, weight loss and pharmacologic treatment.

At UF Health Shands, we’re exploring new strategies to help primary care physicians and endocrinologists become more aware of and proactive in the diagnosis and treatment of obesity and diabetes, as well as exploring multidisciplinary treatment approaches in which endocrinologists and hepatologists work together collaboratively to manage fatty liver disease.

We found that pioglitazone is an effective long-term treatment for steatohepatitis in patients with prediabetes or diabetes. Our team has investigated whether the efficacy of pioglitazone varies depending on a patient’s glucose status — that is, whether they are insulin-resistant or diabetic, and found differences that may impact clinicians’ treatment decisions as well as patient outcomes.

We’re currently looking at a variety of different ways to address the impact of obesity, diabetes, fatty liver disease and steatohepatitis, so we can apply this knowledge to improving outcomes for all patients. This includes groundbreaking research into dietary approaches to weight loss in older adults who are obese, and how weight loss resulting from treatment with a sodium-glucose cotransporter-2, or SGLT-2, inhibitor may benefit patients by reducing liver fat and improving insulin secretion and action.

We are also evaluating the potential role of glucagon-like peptide-1 receptor agonists and insulin-sensitiers in the management of obesity and fatty liver disease.  These and other novel therapeutic options under investigation at UF Health hold promise, and may become a cornerstone in the management of both obesity and diabetes in the near future.

Our diabetes and obesity research programs are growing rapidly with new investigators and collaborations in multicenter studies to find new treatments.

For more information about our research, contact our team at 352.294.4896. In addition, please consider us when voting for the U.S. News and World Report rankings for Endocrinology. 

Sincerely,

Kenneth Cusi, M.D., FACP, FACE
Chief, Division of Endocrinology, Diabetes & Metabolism
Department of Medicine
University of Florida

University of Florida Health Head and Neck Surgeons Integrate 3D Technologies to Optimize Patient Outcomes

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Submitted by UF Health on January 3, 2019 - 09:47

Virtual surgical planning, or VSP, is an invaluable tool for complete head and neck reconstructive surgery that allows the team of surgeons at the University of Florida College of Medicine’s Department of Otolaryngology — part of UF Health, the Southeast’s most comprehensive academic health center — to develop a precise surgical plan on the computer before stepping into the operating room. Only a handful of institutions in the United States use this innovative technology on a regular basis.

With VSP, head and neck surgeons can design and print 3D patient-specific skull models, cutting guides and other instruments for use within the sterile field to facilitate an anatomically-based personalized surgical approach. Common head and neck applications of this technology are tumor excision and facial reconstructive procedures, such as mandibular, maxillary or full jaw reconstruction; craniofacial reconstruction; dental implants with free flap reconstruction; and trauma reduction surgery. 

“3D printing technology has changed the way we view oncologic head and neck reconstruction, as it simplifies and shortens a long and complicated procedure,” explains Peter T. Dziegielewski, M.D., FRCS(C), chief of the division of head and neck oncologic surgery at UF. “Virtual surgical planning and 3D modeling reveal complexities of a case before, rather than during a procedure,” he says. Consequently, presurgical planning removes some of the unpredictability associated with reconstructive surgery and enables surgeons to make more accurate incisions. For patients, improved surgical precision can mean less time in the operating room, as well as better cosmesis and functional outcomes. 

Since the team integrated this revolutionary technology a few years ago, VSP has become an indispensable tool in oncologic craniomaxillofacial reconstruction, especially with regard to patient education. When patients and their families can view and manipulate an actual replica that duplicates nearly every detail of the original, including the pathology, they are better able to visualize and understand the procedures they will undergo.

The oncologic reconstruction surgical team at UF Health performs technically challenging procedures every day. As leaders in implementing virtual surgical planning into daily practice, the team strives to achieve the best possible outcomes for all patients. 

University of Florida Department of Otolaryngology is a Leader in Complete Oral Reconstruction and Rehabilitation after Head and Neck Cancer Surgery

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Submitted by UF Health on January 3, 2019 - 09:40

Each year over 50,000 Americans are diagnosed with head and neck cancers, including those of the oral cavity and pharynx. As surgical and adjuvant treatments have advanced, an increasing number of patients are becoming long term survivors of head and neck cancer.  These individuals require multidisciplinary care from a team of surgeons, oncologists, dental specialists, physical therapists and speech-language pathologists to address the significant disability that often results from treatment, including facial deformity, impaired speech, swallowing dysfunction and loss of oral and dental structures. The University of Florida College of Medicine’s Department of Otolaryngology — part of UF Health, the Southeast’s most comprehensive academic health center — houses the largest comprehensive oral rehabilitation program in Florida. Through their research and clinical programs, the teams focus on restoring each patients’ ability to speak, swallow and chew. These seemingly basic functions also give patients the confidence to appear in public and participate in social activities they may have given up.

The team at UF aims to restore both form and function, which is not always possible with conventional reconstructive methods. “As patients survive oral cancer treatment, the last piece of their recovery is dental rehabilitation,” says Peter D. Dziegielewski, M.D., FRCS(C), chief of the division of head and neck oncologic surgery at UF. “With virtual surgical planning and 3D modeling we are finally able to maximize recovery and give patients back what they lost to cancer.”

As leaders in the use of virtual surgical planning in head and neck reconstruction, the team of surgeons and prosthodontists develops a digital anatomically based, personalized surgical plan for each patient. Using advanced technology, the team at UF Health is able to reconstruct complex defects using free flaps from the fibula, radius and scapula. Tumor removal, free flap transfer and dental implant placement occur during the same procedure. This reduces recovery time and increases time with full oral restoration. The goal is to maximize the quality of life following the survival of head and neck cancer treatment.

Thinking “Fast” May Improve Outcomes in Obese Adults with Type 2 Diabetes and Fatty Liver Disease

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Submitted by UF Health on January 2, 2019 - 14:26

Despite decades of research and thousands of articles on the subject, clinicians are no closer to finding the ideal diet for patients with diabetes than when their search began. Low-carb, low-fat, ketogenic, vegetarian, vegan, carb counting — it seems that a study is no sooner published supporting a particular diet than another is published suggesting the opposite diet is better.

In the opinion of Troy William Donahoo, M.D., FTOS, a clinical associate professor at the University of Florida in the Division of Endocrinology, Diabetes and Metabolism, “Clearly the ideal diet for patients with diabetes isn’t simply a question of composition versus calories. There must be something more.” Donahoo’s research on fasting is headed in that direction.

Upton Sinclair wrote about fasting more than 100 years ago. The effects of starvation on the human body were studied after World War II. In the 1950s and 1960s clinicians experimented with fasting in severely obese patients, at times with fatal consequences. Medical science has come a long way since then. Donahoo’s research team is tackling the problem by investigating the potential benefits of an increasingly popular dieting strategy called intermittent fasting.

When fasting, the body converts fat into fatty acids that can be absorbed by the blood. But as Donahoo explains, “The human body is designed to feed and fast, not for long-term ketosis or chronic dietary restriction.” Encouraged by the success of the team’s pilot study on intermittent fasting, which was recently published in Obesity, the official journal of the Obesity Society, Donahoo’s team is now evaluating the safety and efficacy of intermittent fasting in adults with Type 2 diabetes and nonalcoholic fatty liver disease.

UF Health is thinking “fast” and working hard to improve outcomes in obese adults with Type 2 diabetes and fatty liver disease.

University of Florida Health Tackles Perioperative Hypothermia

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Submitted by UF Health on January 2, 2019 - 14:13

While University of Florida Health physicians are committed to tackling difficult and complicated challenges to improve the health and outcomes of patients, they also are mindful of examining and improving standard care pathways, which can make a big difference for patients.

Researchers at UF Health led by Dr. Thomas Read, chief of the division of gastrointestinal surgery, are working to improve outcomes for patients who undergo colon and rectal surgical procedures by helping them avoid complications associated with hypothermia, which is thought to increase the risk of post-colectomy infections.

Hypothermia is thought to increase the risk of post-colectomy infections. Dr. Read’s group conducted a study to determine when patients get cold as they undergo elective colectomy. They found that most body temperature loss occurs in the preoperative period, rather than during the operation itself as was previously believed. Dr. Read was first author on a study published in Techniques in Coloproctology in May 2018 that explored this phenomenon. He points out, “approximately 15 years ago, efforts were made to actively re-warm patients during surgery to restore their body temperature, but not surprisingly, patients lose body heat before surgery begins.

“Surgeons know that patients do better when they’re kept warm. Ironically, operating rooms are kept cold because surgeons, nurses and other health care professionals are all working under hot lights with gowns over their clothes, but patients are almost completely undressed and are at risk of further losing body heat when intubated because of the loss of thermoregulation with anesthesia.” Dr. Read’s group has used forced air heater blankets to warm patients before surgery and as they go into the operating room to help reduce heat loss. “We’ve found that this simple technique reduces the need for expensive warming methods during surgery and leads to better outcomes for patients.”

University of Florida Health Leads the Way in Gastroenterology and Gastrointestinal Surgery

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Submitted by UF Health on January 2, 2019 - 13:37

Dear colleagues,

In the Division of Gastroenterology, Hepatology and Nutrition at University of Florida Health, we run a comprehensive program that covers the vast majority of gastrointestinal diseases, with faculty that provide specific expertise and services for tertiary and quaternary level consultations. In addition to care for pancreatitis and pancreatic cancer, the division specializes in advanced endoscopic procedures.

In the Division of Gastrointestinal Surgery, we specialize in both colorectal surgery and minimally invasive bariatric surgery.

We have broad-based expertise in pancreatitis that includes consultative care, a comprehensive program in pancreatic surgery for pancreatitis and a robust clinical research program that is uncovering better ways to treat pancreatitis. Patients who are referred to UF Health for second opinions on diagnoses of acute and chronic pancreatitis gain access to a team of experts who can determine the appropriateness of endoscopic therapy and additional diagnostic testing, and provide strategies for effective disease management. The strength of our program is built on a combination of multidisciplinary clinical expertise, particularly our collaborative work with pancreatic surgeons, and a solid research program.

Our leadership in pancreatic cancer care is exemplified by our Center of Excellence designation for pancreatitis and pancreatic cancer by the National Pancreas Foundation. We are one of 10 clinical centers in the Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer, funded by the National Cancer Institute and the National Institute of Diabetes and Digestive Diseases. The clinical centers are collaborating to understand the links between pancreatitis, diabetes and pancreatic cancer. This research brings together specialties across the spectrum of expertise at UF Health, including gastroenterology, surgery and endocrinology, to focus on these interrelated diseases.

We are also one of 10 institutions selected to be part of the Pancreatic Cancer Action Network’s Precision Promise program. Precision Promise seeks to predict the response of groups of patients to specific drug therapies based on genomic signatures found in their pancreatic cancer cells. This program has the potential to deliver precision medicine for pancreatic cancer patients, and we are well-poised as an institution to help lead this effort because of our basic science expertise, translational scientists and data-crunching abilities.

At UF Health, we are committed to improving outcomes for patients undergoing colorectal surgery. Our colorectal surgery group performs routine and complicated surgeries to treat colorectal cancers. We provide integrated multidisciplinary colorectal cancer care – our team holds weekly conferences to ensure that medical and radiation oncologists, surgeons, pathologists and radiologists work together for the benefit of patients.

Our coordination of surgical care with radiation oncologists, involvement of colorectal cancer specialists and constant work to improve surgical techniques all make UF Health a leader in colorectal surgery care. The colorectal surgery group also plays a role in training residents in surgery and is involved in the treatment of other gastrointestinal disorders, such as inflammatory bowel disease.

Our minimally invasive bariatric surgery program is an American College of Surgeons- and American Society for Metabolic and Bariatric Surgery-accredited bariatric surgery center. The group offers advanced minimally invasive surgery, which significantly reduces the stress that patients experience compared with major, open surgeries.

We collaborate across UF Health with experts in psychiatry, cardiology, pulmonology, medicine, nephrology and nutrition to offer a variety of procedures, including gastric bypass and laparoscopic sleeve gastrectomy. The group also performs corrective and revision surgeries to address complications and conversion surgeries, such as converting a laparoscopic band to a sleeve or Roux-en-Y. These options help make UF Health a leader in ensuring that patients experience better outcomes in bariatric surgery. 

The practice of gastrointestinal medicine is often compartmentalized with gastroenterologists and gastrointestinal surgeons working independently, but here at UF Health, we foster close collaborations between the medical and surgical sides to improve patient care and outcomes.

Now that you’ve learned more about us, please consider voting for us in the U.S. News & World Report rankings for Gastroenterology. 

Sincerely,

Chris Forsmark, M.D.
Chief, Division of Gastroenterology, Hepatology and Nutrition
Department of Medicine
University of Florida

Thomas Read, M.D.
Chief, Division of Gastrointestinal Surgery
Department of Medicine
University of Florida

University of Florida Health Leads U.S. in Third-Space Endoscopy

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Submitted by UF Health on January 2, 2019 - 13:30

University of Florida Health is a national leader in the use of third-space endoscopy, an approach that allows gastroenterologists to tunnel within the muscular walls of hollow organs and remove large areas of tissue, such as polyps and areas of premalignant degeneration.

Dr. Chris Forsmark, chief of the division of gastroenterology, hepatology and nutrition at the UF College of Medicine, part of UF Health, explains that the division offers complex and advanced endoscopic procedures that go beyond standard gastroenterology procedures like upper endoscopies and colonoscopies. As the field of endoscopic therapeutics grows, UF Health Shands receives more and more referrals for these complex endoscopic procedures. 

Gastroenterologists at UF Health perform third-space endoscopy procedures known as endoscopic submucosal dissection, which, according to Dr. Forsmark, can be used to “remove tissue that is up to 6 cm across, which is much larger than we could ever do before and would have required surgery.”

In an incisionless procedure, endoscopic submucosal dissection can be used to treat esophageal disorders, such as repairing a muscular sphincter that does not relax enough to allow passage of food.

Third-space endoscopy is expanding the field of endoscopic therapeutics, and the faculty at UF Health are world-renowned for performing these novel endoscopic procedures. “Our work in this space is leading to endoscopic bariatric procedures where we can begin to mimic what surgeons are doing in obesity surgery but without incisions,” says Dr. Forsmark. Faculty at UF Health continue to drive the field forward by developing the specialized skills required to perform complex endoscopic procedures, thereby offering patients better treatment options for gastrointestinal disorders.


Blog featured image credit: Huge liposarcoma of esophagus resected by endoscopic submucosal dissection: case report with video.

Give Hope. Spread Joy.

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Submitted by Lauren Irizarry on December 31, 2018 - 13:18

Now through midnight, Dec. 31, UF Health is holding its annual end-of-year giving campaign, “Give Hope. Spread Joy,” which asks donors to consider making a donation to the nonprofit academic health care center. Along with a gift, donors are encouraged to include a message that will be shared with the patients, faculty and staff members spending the holidays in the hospital.

Those notes touch many patients and staff members, lifting their spirits during the holiday season. Dana Viviano, R.N., nurse manager, UF Health Shands Cancer Hospital Unit 5E, writes:

“I wanted to extend a personal thank you for Giving Hope and Spreading Joy during the holidays.

I am the nurse manager for Unit 5E at the UF Health Shands Cancer Hospital. We are the gastrointestinal surgical oncology unit that provides care to patients before and after their surgical procedures. The staff on 5E often witness how an acute health care crisis impacts families over the holiday season.

Because of the severity of their illness, many of our patients will need to undergo lifesaving surgical interventions over the holiday season. These patients and their families experience a different holiday season without the traditional meals or family moments. Our unit is proud to provide empathetic care and bring hope to so many undergoing treatment for these serious and complex illnesses.

We want you to know that we do our best to capture the magic of the holidays at UF Health, and try to ensure that every patient has the opportunity to celebrate the holiday season with family and friends while they are with us, their 5E family.

I am proud to be their nurse manager. My sincere gratitude for each of you for the hope and joy you give to our patients, their families and our staff during this time of year.”

Gifts made during this year’s campaign will support the UF Health Heart & Vascular and Neuromedicine Hospitals, UF Health Cancer Center, UF Health Shands Children’s Hospital as well as the greatest needs of UF Health. This includes lifesaving medical equipment, groundbreaking studies and essential patient care programs that impact the future of patient care.

The “Give Hope. Spread Joy.” campaign is in its third year and marks the end of the holiday giving season. Last year’s campaign resulted in nearly 300 messages that expressed well wishes and holiday greetings.

“For over 50 years, [UF Health] Shands has been my hospital of choice,” wrote one donor. “I am alive and healthy because of you and my excellent primary doctor. Keep your tradition of excellence and concern for people and details.”

Another wrote, “Sorry to hear you are in the hospital! Sending you healing thoughts and warm wishes to brighten your day during your stay.”

Gifts may be made at giving.UFHealth.org/givehope.

University of Florida Department of Otolaryngology offers multidisciplinary rehabilitation for people with voice and swallowing disorders

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Submitted by UF Health on December 26, 2018 - 15:19

Cancer and stroke survivors who develop dysphagia receive coordinated and comprehensive care at University of Florida College of Medicine’s Department of Otolaryngology. The specialists are highly experienced in evaluating and treating even the most complex dysphagia cases using the latest imaging technology and innovative treatment approaches.

The UF team offers a unique voice and swallowing program that integrates surgical intervention when necessary to address anatomic limitations that arise as a consequence of cancer treatment or neurologic impairment. The program aims to restore quality of life in patients whose pathologies left them with the diminished ability to perform basic life functions such as swallowing and speaking.

According to Neil Chheda, M.D., chief of the Division of Laryngology in the Department of Otolaryngology, the approach at the University of Florida – part of UF Health, the Southeast’s most comprehensive academic health center – is multidisciplinary. “Historically, the care of the patient with a complex dysphagia was siloed with little communication between different departments. We have found that a more comprehensive approach delivers better outcomes.”

Dr. Chheda evaluates all aspects of swallow from mouth to stomach including in-office functional testing, and collaborates with all members of the patient’s care team to design a personalized treatment plan. “I work closely with the speech-language pathologist to look at form as well as function,” he says. Treatment may include exercises to strengthen oral musculature or improve coordination and, when appropriate, open or endoscopic surgery to address anatomic dysfunction, such as vocal fold paralysis, velar insufficiency, or upper esophageal sphincter compliance. “To my knowledge we offer more aggressive intervention than any other facility in Florida,” Chheda says.

Voice and swallowing disorders can make people feel depressed and socially isolated due to their condition. Thus, intervention begins as quickly as possible after the insult or, in head and neck cancers, once radiation concludes. Explains Dr. Chheda, “Our goal is to do what’s best for the patient to help them regain the ability to perform activities that you and I take for granted.”

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University of Florida’s Department of Otolaryngology Leads the Way in Care of Ear, Nose and Throat Conditions

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Submitted by UF Health on December 26, 2018 - 14:53

Dear Colleagues,

The team of board-certified physicians at the University of Florida’s Department of Otolaryngology is uniquely qualified to deliver the highest quality of care and the most advanced treatments to patients with a full spectrum of ear, nose and throat conditions, including head and neck cancer. Our department maintains two outpatient practices and conducts original otolaryngologic research at its laboratory facilities. In addition to its outstanding residency training program, the department also offers a superb clinical fellowship in advanced head and neck oncologic and reconstructive surgery.

The UF Department of Otolaryngology comprises 13 faculty in seven divisions:

  • Allergy and Sleep Surgery Center
  • Facial Plastic and Reconstructive Surgery
  • Head and Neck Surgical Oncology
  • Laryngology and Professional Voice Center
  • Otology/Neurotology
  • Pediatric ENT/Pediatric Airway Center
  • Rhinology and Skull Base Surgery

The Head and Neck Surgical Oncology division brings together our experts in several specialties to provide personalized treatment for cancers of the mouth, pharynx, larynx, salivary glands and thyroid. The department is one of the premier centers in the United States to offer a comprehensive multidisciplinary approach and minimally invasive surgery to address skull base tumors in both children and adults. The department utilizes advanced 3D modeling and incorporates virtual surgical planning to guide complex head and neck surgeries, and to improve patient outcomes. 

Survival is not our only goal. Our faculty also strives to improve quality of life for people who have survived neurologic insults or cancer. For individuals experiencing voice and swallowing disorders, the approach is also multidisciplinary, involving close collaboration between the otolaryngologist and the speech-language pathologist to determine the cause and to create a customized treatment plan that includes surgical intervention—often in the office—to address anatomic limitations as quickly as possible. Our department is one of the few centers in the nation to offer comprehensive oral rehabilitation and full dental restoration.

In addition to our commitment to patient care, our department’s dedication to research has enabled our investigators to focus on novel topics. Our team has been investigating toxicities associated with commonly used ear medications, notably quinolone ear drops. In a groundbreaking analysis published in Clinical Infectious Diseases in 2017 that included 96,595 children, our research team found that those who received quinolone ear drops after tympanostomy tubes had a higher risk of tympanic membrane perforations than those who received neomycin ear drops. We have been able to confirm the adverse impact of quinolones on tympanic membranes in animal models.  Soon to be published articles show that quinolone ear drops may lead to perforations of intact tympanic membranes. 

Investigators within our department are focused on other exciting topics, as well. For example, Natalie Silver, M.D., and her UF collaborators recently reported the results of the first known study demonstrating antitumor efficacy of tumor-derived RNA nanoparticle vaccines in an oral cavity squamous cell carcinoma syngeneic mouse model. These results will serve as the foundation for future clinical trials aimed at reprogramming the immune system with engineered personalized RNA nanoparticle vaccines.

Now that you’ve learned more about us, please consider voting for us for the U.S. News & World Report rankings for ear, nose and throat.

Warmest regards,
Patrick Antonelli, M.D., FACS,
Chair, Department of Otolaryngology
UF College of Medicine

Be Aware this Flu Season

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Submitted by Hannah Elliott on December 21, 2018 - 09:00

As the holiday time of the year comes to a close, another season – one that is much less fun – is looming. This is the time of year when cases of the flu peak, and Cristina Zeretzke-Bien, M.D., an emergency medicine physician at University of Florida Health, offers the signs and symptoms of the flu so you’re prepared this season:

  • Fever of 101.4 or higher
  • Chills
  • Cough
  • Sore throat
  • Body aches
  • Headache
  • Difficulty breathing/shortness of breath
  • Fatigue
  • Runny/stuffy nose

If you or your loved one are experiencing a combination of these symptoms, you should determine the next course of action for treatment. According to Zeretzke-Bien, the biggest thing to differentiate between when to turn to the emergency room and when to stay home is whether you or your child is a high-risk patient.

High-risk patients include:

  • Children less than 2 years old
  • Adults older than 65
  • Patients who have chronic pulmonary disease or a neurological disease
  • Patients who have cardiovascular, renal, hepatic, hematologic (including sickle cell anemia), or metabolic (including diabetes) disorders
  • Patients who are immunosuppressed (including those with HIV and women who are pregnant or postpartum)

Patients who are at high risk would require closer monitoring and checking in with subspecialists for flu-like symptoms, but this doesn’t necessarily need to be done at an emergency room. As long as the patient is staying hydrated, resting, controlling fever with over-the-counter medication and is alert, oriented and doesn’t appear toxic, Zeretzke-Bien says it’s recommended to visit a primary care provider or subspecialists for a quicker, more efficient evaluation process.

If symptoms are severe, though, the patient may need to seek a higher level of care in the emergency department. The more severe symptoms, which are the most important to monitor, include dehydration or a persistent cough concerning for pneumonia. Signs of severe dehydration include dry lips, sunken eyes and no urinary output.

For more information about the flu or to track the nationwide pattern of positive cases, please visit the Centers for Disease Control at www.cdc.gov/flu/index.htm.

Combatting Holiday Depression

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Submitted by Sofia DiMartino on November 26, 2018 - 08:00

Depression impacts nearly 6.7 million adults in the United States, and the stress of the holidays can make that depression worse.

Many factors play into the reality of depression magnifying around the holiday season, including increased loneliness, strain on finances and guilt caused by unhealthy choices. 

Uma Suryadevara, M.D., a UF Health psychiatrist, said that seasonal affective depression is often regular depression but exacerbated around the holidays and said she sees an increase in patients coming to her for help with depression during the holiday season. 

“If a person is a little bit prone to depression and then they have to do a whole lot during the holidays, this could lead to more stress, which could lead to more isolation, and they eventually could end up getting more depressed,” Suryadevara said.

UF Health can help those who know they struggle with holiday depression by addressing some of the common problems that cause stress during the holidays and by offering ways to stop these triggers before they occur.

THE DILEMMA: The holidays are traditionally accompanied by spending on gifts, food and travel, which can impact finances and put stress on anyone who can’t afford what they feel their family deserves.

THE SOLUTION: Encourage yourself to be realistic and recognize that holidays can’t be the same every year. Understand that despite what you spend on gifts, decorations or get-togethers, the holidays are a time of togetherness and love, and those around you will be appreciative of your thoughtfulness no matter what you spend on them. To prevent stress from financial hardship due to overspending, plan ahead for events and travel plans. Create a budget and stick to it.

THE DILEMMA: The holidays are typically spent surrounded by family and friends. Sometimes loved ones have recently passed away, families have broken up due to divorce or people are forced to spend a holiday far away from the people they care about. Special occasions like holidays can make this loss or loneliness even more apparent and deepen depressive episodes.

THE SOLUTION: Acknowledge the feelings you’re having, whether they be those of grief or loneliness, and reach out to those around you to express how you are feeling. Everyone has experienced these feelings in some form and has the capacity to be understanding. You’d be surprised at the lengths people would go to help you feel wanted and loved, especially during the holiday season while the spirit of giving is in the air.

THE DILEMMA: The holidays are a time of sharing love through baked goods and casseroles. Often, this food is very rich and is served in portion sizes that lead to overeating. Overeating can cause decreased self-confidence, stress and guilt, which can make a depressed person feel worse about themselves. 

THE SOLUTION: Don’t abandon your healthy habits during the holidays. Though everyone looks forward to the delicious foods served on Thanksgiving and Christmas, don’t eat more than you typically would. Spreading the food out over several days of well-portioned meals can lead to less guilt and more times you get to eat the annual foods you love. Are you worried about disappointing or embarrassing family members by not eating their dish? It is often empowering to say no or stick to what you need for your own health and well-being. Be open about what you’re going through, and your family will understand your choices.

THE DILEMMA: The holidays are coming quickly, and you haven’t had time to purchase gifts for anyone, let alone think about what they’d want. This added anxiety can add another layer to depression, making every day a greater struggle.

THE SOLUTION: First, plan ahead to avoid last-minute shopping. Shop months in advance and take advantage of sale events like Black Friday to get all of your shopping done ahead of time. Then, don’t allow perfectionism to get you down. If you feel you can’t find the perfect gift this year, that’s okay! You can always make up for it at their birthday or next holiday season. Odds are they will be grateful you purchased them anything.

At the end of the day, take time to de-stress. Warmth and doing things you enjoy both improve mood, so take a hot bath, wrap yourself in a blanket and relax while doing your favorite thing. As always, seek professional help if you feel you need it.

UF Health psychiatrists are faculty members at the University of Florida, expertly trained and certified by the American Board in Psychiatry to provide patients with consultations, evaluations and treatments, as well as a wide variety of services.

 
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Early Detection is the Difference-Maker with Lung Cancer

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Submitted by Talal Elmasry on November 16, 2018 - 09:00

Lung cancer doesn’t make its presence known until it’s too late. However, technology has made it easier to catch at an early stage, which is key with this cancer.

Lung cancer has a way of staying hidden and becoming increasingly fatal the longer it does so. However, there are enormous benefits to shining light on this particular cancer early on, and that’s more possible now than it used to be.

Early detection, which is crucial in all cases of cancer, gives patients options they otherwise wouldn’t have since the disease may be smaller in size and hasn’t metastasized to other regions of the body. However, identifying lung cancer in its beginning stages can have an even more distinguishable impact on survival when compared to other types.

Since lung cancer stands out due to its prevalence (second-most common type), mortality (deadliest type) and tendency to fly under the radar, early detection is vital with this disease.

Lung cancer stays out of sight

One of the reasons why lung cancer is the deadliest type of cancer for both men and women in the United States is the fact that symptoms don’t emerge until the disease has reached an advanced, non-curable stage.

Only then does the patient begin to experience a cough that is persistent, progressive or even bloody. Other symptoms come in the form of chest pain, difficulty breathing or infections such as bronchitis or pneumonia. Even when these things show up, they’re commonly confused with the side effects of smoking or another sickness.

The lack of warning signs makes it important for patients to be proactive in getting yearly screenings. Those at high risk — individuals who smoke, inhale secondhand smoke, get exposed to high radon levels or other substances, or those with a family history of lung cancer — should get their lungs checked on a regular basis.

Early screening and its impact on survival

Time is a critical factor when it comes to those with lung cancer, which has a five-year relative survival rate of 18.7 percent, according to the latest annual report to the nation on the status of cancer. That percentage is lower than any form of cancer listed in the report from 2006-12, with the exceptions being pancreatic cancer (8.5 percent) and liver cancer (18.1 percent).

These statistics can vary a great deal depending on the type and stage of the lung cancer. With that said, screening that leads to early detection while it’s still localized within the lungs can increase the five-year survival rate to about 56 percent.

In some cases, catching the disease in its earliest stages can have a striking effect. For example, detecting non-small cell lung cancer (by far the most common type) at stage IA1 has a five-year survival rate of 92 percent.

At the UF Health Lung Cancer Program, 9 out of 10 lung cancer referrals are seen within seven days. That accessibility is key to giving our patients the best possible chance in the battle.

When it comes to those checkups, there hasn’t been a widely accepted screening tool available for early-stage lung cancer until recently. Far too often, regular chest X-rays have missed lung tumors during the most beneficial time to be a reliable method for detection.

A better method for detection is here

When it comes to those checkups, there hasn’t been a widely accepted screening tool available for early-stage lung cancer until recently. Far too often, regular chest X-rays have missed lung tumors during the most beneficial time to be a reliable method for detection.

Supported by the National Lung Screening Trial (NLST) and the American Society of Clinical Oncologists, along with many studies, low-dose computed tomography (LDCT) has proven to be more effective at detection than chest X-rays for those at high risk. Unlike the single-picture chest X-ray, the multi-picture CT scan uses detailed cross-sectional images of the body. The CT scanner does this by rotating around you while you lie on a table and taking several X-rays.

The LDCT scan’s superior ability to uncover lung tumors, even small lesions that could potentially carry cancer, is a key reason the NLST and other research has shown that getting annual LDCT scans before symptoms appear can help reduce the risk of dying from lung cancer.

UF Health offers LDCT scans, which are now covered by Medicare once per year for beneficiaries who meet these criteria:

  • ages 55-77, and are either current smokers or have quit smoking within the last 15 years
  • tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years)
  • receive a written order from a physician or qualified non-physician practitioner who meets certain requirements

Please ask your primary physician for more info and to schedule an appointment if necessary.

Bonnie Versus Breast Cancer

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Submitted by Sofia DiMartino on November 13, 2018 - 12:40

As a lifelong Gainesville resident, Bonnie Green has lived a full life in a small town.

Born in a local hospital, which she laughingly says no longer exists, Bonnie was raised in the heart of The Gator Nation. She graduated from a local high school, went to college at Santa Fe and got married. She worked as a cardiovascular echo tech, then spent time raising her children as a stay-at-home mom of two. She spent her spare time focusing on creative endeavors: crocheting, painting, drawing and writing.

She had no idea that the little town that had afforded her so much light and happiness would soon become the backdrop for the darkest period in her life.

In the fall of 2016, Bonnie visited the doctor for a routine mammogram. She was faced, for the first time in her life, with an unusual result.

“They asked me if I had time to do a biopsy that day,” Bonnie said. “I have to tell you, it scared me to death.”

Bonnie knew what a biopsy order might mean. Several of her family members had been diagnosed with breast cancer in the past, and Bonnie had helped her sister through a breast cancer diagnosis and treatment just five years earlier.

“I started worrying. What if that happened to me, too, with all the family history,” Bonnie said.

Bonnie’s intuition proved to be correct when her biopsy results came back positive for pre-cancer in her right breast.

With a diagnosis of pre-cancer, Bonnie’s care transferred to Lisa Spiguel, M.D., a surgeon at UF Health specializing in oncology and surgical breast cancer treatment. Spiguel sent her for an MRI to get better cancer visualization.

“Bonnie came to see me initially because she had had an abnormal screening mammogram,” Spiguel said. “I wanted a full evaluation, so I ordered a breast MRI.”

Sitting in the MRI machine, Bonnie had a feeling something else was wrong, but results weren’t available immediately. She spent the next several days in a panic.

“I was anxious and calling, and when they got the results, they told me I had to come in, so I knew something was wrong,” Bonnie said. “So, I asked the nurse to tell me the truth over the phone, and that’s when I found out.”

The MRI had discovered Stage 1 breast cancer in her other breast, meaning both breasts contained cancerous tissue. To ensure successful treatment, and that the disease wouldn’t spread, Bonnie needed surgery as soon as possible.

Bonnie describes that moment of diagnosis as one of pure shock and sadness, pulling her into a darker place than she’d ever imagined. The woman who’d once loved to paint and crochet began to set all of that aside. She would start paintings but never finish them, and she began to give away the pieces of art she’d treasured the most.

Still, Bonnie refused to let her soul be crushed under the heavy weight of a cancer diagnosis. With the help of an anti-depressant, lots of prayer and ceaseless support from her family, Bonnie rallied and prepared herself for the first stage of her fight.

Bonnie opted for a double mastectomy, a dramatic surgery in which Spiguel would dissect the lymph nodes of the breast and remove all breast tissue and muscle near the cancer-affected area. After the procedure, with all the tissue removed, Bonnie’s breasts would no longer exist.

“After discussing all of the risks and what her future risk of breast cancer was, Bonnie elected to proceed with a bilateral mastectomy, not to treat her cancer better but to prevent future cancer,” Spiguel said. “When a woman has decided to proceed with mastectomy, we talk about the role of reconstruction.”

Hoping to return her breasts to their original appearance after the surgery, Bonnie was introduced to UF Health plastic and reconstructive surgeon Mark Leyngold, M.D. to discuss her options for breast reconstruction.

“Dr. Leyngold is the best,” Bonnie said. “He really just put me at ease, and the dedication the girls in the office put in to make sure every question was listened to was just amazing. He was adamant that he was going to give me exactly what I wanted breast reconstruction-wise within the parameters of what fit me.”

Bonnie decided that the best option for her body was to undergo a flap procedure, using tissue from her abdomen for the reconstruction.

Dr. Leyngold guided Bonnie to this decision but says that it really comes down to what the patients want, not his preference.

“We really have to take into consideration what they feel is appropriate or what they feel is a good outcome and what their goals are,” Leyngold said.

“I’ll kind of combine my expertise and their goals and give them a good result where they feel happy.”

On the day of the procedure, in January of 2017, both surgeons went in and performed their respective duties in remarkable collaboration.

Spiguel performed a double mastectomy, dissecting Bonnie’s lymph nodes and removing all of her breast tissue and nearby muscle. Afterward, Leyngold placed tissue expanders under the skin where Bonnie’s breasts used to be in order to make room for the future tissue transfer.

The procedure was successful and Bonnie went home to recover, but she soon felt that something was wrong. After feeling pain in her right breast several days post-procedure, she came down with a fever of 103.

“I let Dr. Leyngold know, and he immediately had me come in, no waiting, and had me come into the hospital,” Bonnie said.

Dr. Leyngold discovered that Bonnie had an infection in her right expander, a common complication for breast reconstruction surgeries. He immediately treated it with antibiotics.

“He [Dr. Leyngold] took such good care of me,” Bonnie said. “Even when I was in the hospital and safe, everyone was constantly checking in and making sure I had the right care.”

After healing, Bonnie underwent 18 rounds of chemotherapy beginning in May of 2017 and was able to undergo her breast reconstruction. Today, she is cancer-free.

Bonnie credits her success to the joint efforts of Drs. Spiguel and Leyngold and their teams, calling them experts in the field who made her feel like family.

“We try to create an atmosphere that makes the patient feel like they’re being cared for, like they’re in good hands,” Leyngold said. “We try to instill confidence in our skills and give the patient an understanding that we’re not just there to operate on them, but we’re there to treat them as a whole patient. We spend time with patients in the room, and let them ask all their questions and put them at ease.”

Just a few months ago, Bonnie began to get back into what she loves most, and today she is back to crocheting and painting again. Bonnie works for the University of Florida’s Health Science Center Library has joined their marketing team and says she feels lucky to be a small part of promoting what UF Health can do, especially because of all that they have done for her.

“They’re concerned and they’re professional, yet friendly and courteous,” Bonnie said. “I couldn’t have made it without Dr. Leyngold and Dr. Spiguel and their teams. I really just felt like they went above and beyond with everything, as far as I’m concerned, and I’m sure they do the same thing with their other patients, too.”

The Main Road to Lung Cancer and How to Steer Clear

Talal Elmasry's picture
Submitted by Talal Elmasry on November 9, 2018 - 14:10

During Lung Cancer Awareness Month, learn some technique on how to drop smoking.

It’s hard to imagine the deadliest cancer in the country is also the most preventable, but that’s the puzzling truth about lung cancer. That makes November, which is Lung Cancer Awareness Month, an especially important time to educate ourselves and our loved ones who might be in danger.

For a great number of people who stand in the crosshairs of this condition, all it takes is recognizing two things: their addiction to smoking and their options to drop it.

Lung cancer’s main culprit

This year, lung cancer is projected to take the lives of almost 155,000 Americans. While there may be a few causes and risk factors for this unsettling number — the highest among all forms of cancer in both men and women — nothing comes close to the threat posed by smoking.

In fact, according to the International Association for the Study of Lung Cancer, or IASLC, 80 to 90 percent of the casualties this disease claims could be prevented if people avoided smoking cigarettes.

Even if you’ve been smoking, however, there are still benefits to stopping. Once you are 10 years clear of smoking, your risk of dying from lung cancer is about half that of a person who is still smoking.

Still, some people will have an extremely difficult time veering off the path that frequently leads to lung cancer. The first step is to admit that you have an addiction.

Signs of addiction

The addictive power of nicotine, the substance in tobacco that creates this unhealthy gravitational pull toward smokers, can’t be underestimated.

The feelings of pleasure, as well as the reduction of stress and anxiety, produced by nicotine can lead to a dependence that is strong enough to keep users smoking even if they know the negative effects and want to quit.

However, identifying that you are addicted must be done to overcome the habit. Here are a few clues:

  • Smoking more than one pack a day
  • Smoking despite being sick or having a health issue
  • Smoking within minutes of waking up
  • Giving up social or recreational activities to smoke
  • Waking up at night to smoke
  • Smoking to ease symptoms of withdrawal
  • You can’t stop smoking despite serious attempts to do so

Even many people who categorize themselves as social or casual smokers may wrongfully believe that they’re dodging harmful effects by not smoking every day or only once a day. However, plenty of research has been done to debunk this train of thought over the last several years.

Nicotine PatchBest quit-smoking products

There are a few products that can help you kick the habit. Many of them are known as nicotine replacement therapy because they effectively address cravings and withdrawal symptoms by supplying a healthy dose of nicotine in various ways.

  • Nicotine patch
  • Nicotine gum
  • Nicotine lozenge
  • Nicotine inhaler
  • Nicotine nasal spray

Meanwhile, there are two approved quit-smoking medications that are nicotine-free, and both are prescription only.

  • Chantix
  • Zyban

E-cigarettes have not been approved as a stop-smoking alternative.

Progress has been made

It’s also worth pointing out the strides that have been made because of increasing awareness of lung cancer.

The most recent data from the American Cancer Society finds that the lung cancer death rate has dropped by 45 percent since 1990 in men and by 19 percent since 2002 in women due to less smoking, and that downward trend has become steeper over the past decade.

At the UF Health Lung Cancer Program, 90 percent of new lung cancer referrals are seen within seven days. Why is that important? According to the Cancer Treatment Centers of America, the patient survival rate for non-small cell lung cancer (by far the most common type of lung cancer) drops significantly the longer it goes undetected.

Patients diagnosed after six months survive 67 percent of the time, but that rate falls to 46 percent after 12 months, then to 32 percent after 18 months.*

*Based on data from 2000-13 (data related to deaths is usually 2-4 years behind the current year because of the time it takes to accurately research and disseminate the information).

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Putting a face to the name: Depression

Sofia DiMartino's picture
Submitted by Sofia DiMartino on November 1, 2018 - 00:00

Has a depression skeptic ever told you that it’s all in your head? Well, as a matter of fact, it is.

Depression is a brain disease that takes a colorful world and paints it in shades of gray. The persistent sadness and lack of interest that characterizes major depressive disorder can lead to a variety of symptoms and outward manifestations, including trouble sleeping, loss of interest in favorite activities, changes in appetite and touchiness.

On its own, each single symptom of depression could simply be caused by a bad day or a disappointment. Together, however, the amalgamation of symptoms is crippling, life-interrupting and potentially fatal. This misunderstanding between depressed and non-depressed persons has led to the adjective “depressed” being thrown around as a synonym for sadness, degrading public understanding of the severity of the condition.

Nonetheless, clinical depression shows up on a positron emission tomography, or PET scan, morphing the brain scan results from spots of bright yellow lighting up with brain activity to a quiet, blue sea, representing a brain with diminished activity.

According to Uma Suryadevara, MD, a UF Health psychiatrist, the difference between clinical depression and sadness comes down to its disruptive effect.

“The main difference between depression and sadness is the dysfunction that depression causes,” Suryadevara said. “If the sadness is interrupting the life, that’s the sign that it’s clinical depression. It’s not just sadness anymore.”

This small differentiation is the reason it’s so important to pay attention to your body and mental health, as well as that of those around you, to ensure you’re not ignoring the signs of a major mental illness with the potential to spiral quickly out of control.

Every person with major depressive disorder is different. Still, certain methods of coping with the illness are considered somewhat universal. For example, it is important for those with depression to stay involved with the lives of others. This allows them to have a support group of people who make them feel safe and cared for.

However, it also might be difficult for the average person with depression to reach out to those who could be there to support them, as they often feel that people may not be interested in spending time with them at all. This is a depressive symptom in which everyday situations turn into “impossible tasks.” For this reason, if you know someone with depression, it is equally important for you to reach out to them to demonstrate your support and interest in helping them, even if they decline your help.

“There are times when someone is depressed and they won’t feel like doing anything,” Suryadevara said. “The caregiver will not understand unless they know what the person feels like. Sometimes what happens when they’re depressed and someone reaches out to help them, the depressed person may be resistant to change, and the other person may feel pushed away or rejected.”

Other coping mechanisms, like doing enjoyable things, exercising or eating a healthy diet, may be additionally helpful in improving mood and outlook for depressed persons. Nonetheless, many times these at-home methods are simply not enough, and that’s where UF Health comes in.

UF Health psychiatrists can provide counseling services and evaluate patient need for prescription medication. They can also recommend patients for an innovative, noninvasive procedure that uses magnets to improve depression symptoms.

This procedure, called transcranial magnetic stimulation, or TMS, uses magnetic fields to stimulate nerve cells in the brain. It takes less than an hour and is conducted in a doctor’s office five days a week for approximately four to six weeks, depending on the patient’s condition. During the treatment, a patient has a device containing magnets placed on his or her head. While the patient relaxes comfortably in a chair, the device releases more than 3,000 magnetic pulses into his or her brain.

The patient is awake and alert throughout the procedure and may hear a clicking sound or feel a tapping sensation but will feel no pain.

TMS is just as effective as many drug therapy programs, is covered by some insurance plans and has none of the nasty side effects of prescription drugs. Patients can return to their normal activities immediately after the procedure.

This procedure, coupled with appropriate counseling or medicinal therapies, can help patients overcome a battle for control of their own minds. Still, Suryadevara said, many times the greatest fighter of depressive symptoms could simply be a helpful hand and a watchful eye.

“Reach out to your loved ones, and make sure they understand that you are always there for them,” Suryadevara said. “Watch behavioral changes. If the person is the kind of person who likes to watch movies or something and they’re not doing that, being a little forceful and changing the behavior itself can change the way the depression reacts to it.”

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Stay Safe this Halloween

Hannah Elliott's picture
Submitted by Hannah Elliott on October 25, 2018 - 11:31

Goblins and ghouls are not the only threats on Halloween. In 2017, 65 children with Halloween-related injuries were treated at the UF Health Pediatric Emergency Room, and five children were admitted into the UF Health Shands Trauma Center’s intensive care unit. Carolyn Holland, M.D., the pediatric emergency department’s assistant medical director, shares some common safety tips to make sure your child stays safe this Halloween.

“You want Halloween to be fun and exciting,” Holland said. “But you don’t want to have to visit us in the emergency department.”

Follow traffic laws, be aware of traffic
Statistics show that twice as many children die on Halloween from being hit by cars than on any other night of the year. Car accidents can be avoided with a number of precautions, including adult supervision, following the traffic laws, costume adjustments, and trick-or-treating in groups and traffic-controlled areas.

  • Adult supervision - Adult supervision is important to ensure children follow traffic laws. Adults should make sure children stay on the sidewalks and use crosswalks when crossing the street. They should also watch for any distracted drivers or vehicles moving out of driveways. Children over 12 years old should trick-or-treat in groups to facilitate a buddy system if there is no adult present.
  • Costume adjustments - When trick-or-treating at dusk, it’s important to make sure children’s costumes are visible and do not inhibit their abilities to see cars or other threats. Instead of wearing hats, masks and other accessories that may block peripheral vision, opt for makeup or face paint. Reflective tape, flashlights and glow sticks also help to ensure children can be seen by drivers. Swords, knives and smaller costume accessories should be short, soft and flexible.
  • Traffic-controlled trick-or-treating - Areas that are expecting trick-or-treaters are optimal for children’s safety. There are a few neighborhoods in Gainesville that are really popular for trick-or-treating, and those neighborhoods often provide controlled traffic on Halloween.

Read labels
Many children suffer allergic reactions from candies and costume materials. Allergic reactions can be avoided by reading the labels of candies, makeup products and face paints used to complete your child’s costume. Always test the makeup in a small area first, and remove it before bedtime to prevent irritation. Lower the risk of serious eye injury by not wearing decorative contact lenses. Only eat factory-wrapped treats, and examine all treats for choking hazards and tampering.

Take caution for avoidable injuries
Injuries from pumpkin carving and falls during trick-or-treating are also common around Halloween. Children should avoid running from house-to-house and be cautious of tripping on their costumes or other hindrances.

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Understanding Obsessive-Compulsive Disorder

Hannah Elliott's picture
Submitted by Hannah Elliott on October 11, 2018 - 14:50

Joseph McNamara, Ph.D., a psychologist at UF Health Psychiatry and co-director of the UF Center for OCD, Anxiety and Related Disorders, debunks several common misperceptions about obsessive-compulsive disorder, or OCD.

There are several key components to OCD

OCD is sparked by a recurring obsessive thought, which is distressing to the patient. The patient is prompted by his or her distress to do something to make the thought go away. This is the compulsion aspect of OCD. In fulfilling the compulsion, the thought is only temporarily erased. In fact, the patient has actually reinforced the thought.

McNamara explained, in the case of a child being afraid to touch a doorknob, parents often try to curb the child’s fears by opening doors for the child.

“Every time they [parents] do that, unfortunately, they are reinforcing for their child that doorknobs are something they need to be afraid of,” McNamara said. “And so the child’s fear of doorknobs is going to grow and grow and grow.”

OCD is maintained by fear

OCD is maintained by avoidance and accommodation, which both feed into the patients fear.

“What we really want to do is work with patients to go from, ‘How do I avoid or accommodate?” to ‘How do I approach?’” McNamara said.

McNamara continued with his example to demonstrate this concept:

  • Avoidance - refusal to touch a doorknob.
  • Accommodation - accommodating to touch a doorknob (wearing gloves, wrapping hand in towel).
  • Approach - touching the doorknob and embracing whatever may happen.

At UF Health Psychiatry, patients with OCD work in different techniques toward the “approach” method through exposure response prevention, a part of cognitive behavioral therapy. Patients are encouraged to recognize the fear and ask, “What’s something I can do to approach my fear and break it down to something that’s within the range of what I can do?”

With exposure response prevention, a patient will systematically work his or her way to the approach method. A patient who is afraid of touching a doorknob will not start off touching a doorknob. First steps for the patient could include being close to the doorknob or placing his or her hand near, but not touching, the doorknob.

“You start at the bottom of the fear ladder and you climb your way up,” McNamara said.

Most patients, especially children, don’t realize that exposure to their fears will actually help. But it’s crucial for patients to find somebody they can work with to help face these fears, which is why UF Health Psychiatry’s summer camp is called Fear Facers.

Every case is not the same

McNamara has been working in an OCD clinic for over 10 years, and has never seen two cases of OCD that are exactly the same.

Often, people will equate someone being a germaphobe, or preferring things neat, to having OCD. He said this isn’t the case and there’s a lot of variability in how OCD symptoms present themselves.

There is hope for OCD patients

McNamara said most people don’t understand how severe OCD can be. In fact, it’s ranked by the World Health Organization as one of the top 10 most-disabling disorders. Most patients are afraid to seek help. The average length of time before somebody gets into treatment is about seven to 10 years.

There’s hope at UF Health Psychiatry, though, where up to 85 percent of patients have a 50 percent reduction in symptoms by the time they complete their 15th session. McNamara’s goal is for his patients to feel like they are in control of their lives rather than OCD controlling their lives.

“I think one of the things OCD takes away from people is the hope that it can ever get any better,” he said. “We are determined to help our patients regain hope and improve their quality of life.”

OCD Awareness Week is Oct. 7 to 13.

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The New “S Talk”

Hannah Elliott's picture
Submitted by Hannah Elliott on October 7, 2018 - 16:05

As part of this year’s Mental Illness Awareness Week, UF Health Psychiatry hopes to make room for a new “S talk” in the classrooms of Alachua County Public Schools.

Leadership of UF Health Psychiatry’s Partners in Adolescent Lifestyle Support Talk, Heal, Reach Out, Include, Validate and Encourage, or PALS THRIVE, a teen support program, wants youth to know the warning signs of suicide and mental illness resources available within the community.

PALS THRIVE is a three-pronged program consisting of education, leadership and treatment. Its motto, “No One Sits Alone,” reflects its mission of preventing suicide and fostering an inclusive environment in schools.

In a partnership with the PALS THRIVE program and the Alachua County Crisis Center, the Alachua County School Board is piloting Hope Squad, a peer-to-peer program where students can learn to identify peers who may need help and suggest appropriate services for them.

According to Suicide Awareness Voices of Education, or SAVE, a national suicide awareness and prevention program, warning signs of suicide include:

  • Talking about wanting to die or to kill oneself
  • Talking about suicide methods
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Substance abuse
  • Anxiousness, agitation and recklessness
  • Irregular sleeping patterns
  • Withdrawing or isolating oneself
  • Rage or talking about seeking revenge
  • Displaying extreme mood swings

PALS THRIVE Administrative Coordinator Denise Thomas, creator of the term “S talk,” also suggested alternate resources and services for those in need, including UF Health Psychiatry’s outpatient locations, Meridian Behavioral Healthcare, the National Suicide Hotline, the Alachua County Crisis Center, the Village Counseling Center and numerous University of Florida mental wellness programs.

“We want to work as a community,” PALS THRIVE Clinical Coordinator Yanel Casanova, LMHC, said. “If PALS is not the perfect fit, we will help you find what you need. We are strongest when we work together.”

To kickstart seven days of education, awareness and suicide prevention measures, PALS THRIVE will be screening the 2016 documentary “Not Alone” at The Hippodrome Theatre at 5:30 p.m. on Monday, Oct. 8. “Not Alone” focuses on signs of suicide and how to appropriately discuss mental illness with peers.

PALS THRIVE plans to continue to play the documentary in schools as a tool to connect children, parents and the parent-teacher association to this very important message.

Mental Illness Awareness Week is Oct. 7 to 13.

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Coming Clean

Alisha Katz's picture
Submitted by Alisha Katz on October 2, 2018 - 12:50

Kimberly WilloughbyKimberly Willoughby never felt good enough. Too short. Too overweight. She believed that everyone else deserved a good life, but not her.

It’s taken her many years and countless tears, but today, at age 48, she’s living the life she’s always dreamed about. But first, she traveled a road filled with hardship, addiction and, at last, recovery.

Growing up in Mount Sterling, Kentucky, Kimberly graduated from college, became a nurse, married and had two children. But throughout much of her life, Kimberly struggled with her first addiction: food. At 300 pounds, Kimberly underwent gastric bypass surgery in 2004.

Adapting to a new lifestyle, she was optimistic that her old habits would disappear. But in 2007, her marriage began to suffer. Kimberly filed for divorce and moved out. For six months, she experienced insomnia and drank every night. Kimberly and her husband reunited in 2008, but their issues were not resolved.

“I went home for the kids,” she said. “My whole world revolved around being a mom.”

One day, Kimberly learned she would be a grandmother, but the good news came with a condition from her daughter: Kimberly would not be allowed to see her grandchild if she continued to drink. She started sneaking her drinking, hoping her daughter and husband wouldn’t find out.

In 2014, Kimberly and her daughter tossed around the idea of moving to Florida, but those plans changed when her daughter married a man in the military and they moved to a military base in Germany.

“I cried every day,’’ Kimberly said. “I missed my kids so bad.”

Kimberly — along with her husband, mother and stepfather — proceeded with the move from Kentucky to Inverness, Florida. She hoped that a change of scenery would mend her marriage and her outlook on life. For a few months, it worked. Kimberly did not touch a drink. But soon, she her marriage started to unravel again.

“We had nothing in common and he was very angry,” she said. “I kept thinking, ‘How am I going to leave now that we’ve all made this move?’”

By 2016, Kimberly was drinking all day, every day. Kimberly found ways to drink as much and as often as she could. Before work. At work. In a closet. In her water bottle.

Things went from bad to worse when she started abusing prescription medications. Kimberly had chronic back pain from a work-related injury she suffered at age 19, and a doctor prescribed her Tramadol, a pain reliever. Around the same time, she had a surgery and was prescribed Percocet, another pain medicine. From then on, Kimberly took any prescription she could get her hands on.

Kimberly decided to quit her job as a nurse at a local hospital, but on her last day, she was caught drinking and had to complete a urine screening. She was reported to the Florida Department of Health and was referred to Scott Teitelbaum, M.D., F.A.S.M., the medical director of the UF Health Florida Recovery Center, or FRC, for an evaluation. In July, she grudgingly met with Teitelbaum, who recommended a treatment plan and explained that she had seven days to choose a facility for care.

Upset and angry, Kimberly decided instead enrolled in a six-week treatment program in Georgia. There, she stopped drinking but lied her way through therapy. She didn’t fool anyone.

“They said, ‘If you’re not going to talk to us, then there’s nothing to work on,’ ” she said.

Kimberly attended Alcoholics Anonymous, but she didn’t embrace AA’s mission.

“I stayed dry for 11 months but still wanted to be dead. I didn’t want to wake up,” Kimberly said. “I’d drink more and more, thinking, ‘When I black out this time, I won’t wake up.’ Then, I’d wake up mad.”

After months of not drinking, Kimberly started relying on over-the-counter diet pills. Instead of the suggested daily intake of two pills, Kimberly was taking up to 12.

Meanwhile, a storm continued to brew at home.

“My husband didn’t believe I was going to AA,” she said. For a while, her husband would go with her to AA, watching her every move but not participating.

Kimberly started using Tramadol again. When she ran out, she started taking her dog’s medications.

She had to take a random urine drug screening on a Monday, but this time, she took a handful of pills the weekend prior, hoping to get caught. Kimberly reported for another evaluation with Teitelbaum at the end of July of 2017. She brought letters of recommendation from participants at AA, her manager, co-workers and her church to show how well she had been doing.

Teitelbaum called her personally to tell her that her levels were too high to have only taken a handful of pills over the weekend. Now was the time to come clean.

“He [Teitelbaum] got my drug test back and said my levels were through the roof,” Kimberly said. “He said, ‘You’re going to have to work on yourself or you’ll never stay clean.’ I will forever believe that he gave me the opportunity to save my life.”

Teitelbaum recommended inpatient treatment to the board of nursing where they contacted her with a list of three to four facilities to attend. This time, Kimberly was ready to participate in treatment. On Aug. 21, 2017, she was admitted to the UF Health Shands Psychiatric Hospital and checked into the FRC the next day. Kimberly enrolled in the partial hospitalization program where she lived at the addiction treatment facility and was treated by Jamie Smolen, M.D., a UF Health psychiatrist, and Jorelle Degen, L.M.H.C., a UF Health substance abuse therapist.

Kimberly said the turning point came when her husband attended a therapy session.

“He was asked on a scale from one to 10 how happy are you with your marriage, and he said a six or a seven,” Kimberly said. “I deserve a 10. I want to be blissfully happy.”

Her husband left that day — for good. Kimberly connected with a women’s advocacy group, and continued to work on her addiction and self-care.

On Oct. 3, 2017, Kimberly completed the recovery program and moved into a sober house. She continued to practice all of the recovery steps.

In January, 2018, Kimberly returned to work as a nurse. She continues to remain very active at the FRC and goes back one to two times a week to meet for after care. She’s also involved in an FRC reunion event and still sees Smolen. Kimberly stayed in Gainesville when the rest of her family moved back to Kentucky. Her divorce was finalized in February.

Today, Kimberly is employed, spends time with her Dalmatian “Katie,” continues therapy, maintains healthy relationships, practices yoga, sponsors other recovering addicts and teaches a nursery class at her church on Sundays.

“I love my life,’’ she said. “I’m proud of the woman I’ve become.”

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Six Things You Should Know About Prostate Cancer

Nicole Gonzalez's picture
Submitted by Nicole Gonzalez on September 19, 2018 - 09:00

Thomas F. Stringer, M.D., a board-certified urologist and associate chairman of UF Health Urology, provides an expert’s perspective on a disease that affects 11 percent of men: prostate cancer.

September is Prostate Cancer Awareness Month.

Prostate cancer is common and may present without signs or symptoms in early stages.

“Second to lung cancer, prostate cancer is the the next most common cause of cancer death in men in the United States,” Stringer said. However, according to the Surveillance, Epidemiology and End Results Program of the National Cancer Institute, the five-year survival rate of men diagnosed with prostate cancer in the U.S. is approximately 98 percent. Tumors within the prostate grow slowly and usually do not push against any major anatomical structures, so signs and symptoms may not be noticeable in early-stage prostate cancer.

Risk factors may render men more likely to develop prostate cancer.

Even though the cause of prostate cancer is unclear, certain risk factors may increase men’s risk of developing the condition.

  • The older you are, the higher your risk of developing prostate cancer.
  • African-American men are roughly 70 percent more likely to develop prostate cancer.
  • Men with a family history of prostate cancer are approximately twice as likely to develop the disease.

For men at high-risk, the PSA-screening discussion and decision should be initiated as young as age 40.

Prostate cancer screening can detect cancer.

Screening, or looking for cancer before it causes symptoms, can help find prostate cancer at its earliest stages to provide effective treatment. The goal of prostate cancer screening is to identify high-risk, localized prostate cancer that can be successfully treated and to prevent the mortality and morbidity associated with incurable advanced or metastatic disease. Although the U.S. Preventative Service Task Force concluded that men should begin screening at 55, the Prostate Cancer Advisory Council feels this recommendation falls short of addressing risk factors that could influence when men should be screened. Stringer said, “There are populations who are at risk earlier, so I would recommend African-Americans, especially those with a strong family history of prostate cancer, start screening in their early 40s.” He also recommends those exposed to Agent Orange, a powerful herbicide widely used during the Vietnam War, be screened earlier. Talking to a health care provider about risk factors is important in deciding whether or not to be tested earlier.

Prostate cancer is treatable if diagnosed early.

Treatment recommendations depend on several factors, including the symptoms, type of cancer and patient’s preferences. For example, if the cancer meets criteria for low-risk disease, the patient may be eligible for active surveillance. “The reality is that not everyone has to be treated for prostate cancer,” Stringer said. “Active surveillance means that you’re actively watching—drawing blood tests, checking the prostate, re-biopsy and re-imaging the prostate. It’s all a part of the process to make sure the disease isn’t progressing while we are paying attention to it.”

Medical research is working to make progress in prostate cancer prevention and treatment.

Physicians and scientists around the world are committed to learning more about the causes, treatments and possible preventions of prostate cancer. Researchers are working to detect prostate cancer earlier and more precisely, and looking for methods to treat prostate cancer more effectively. UF Health is using technology to take a 3-D image of the prostate by ultrasound and fuse the image with magnetic resonance imaging, or MRI, scans to do biopsies based on the target. “Certainly, it’s more accurate in detecting high-risk prostate cancer. We are working on a simulation of teaching residents how to do this perform the technique of image-guided prostate biopsy without having a patient there,” Stringer said.

If your life has been touched by prostate cancer, you are not alone.

Patients and their families can be heavily affected by the diagnosis of prostate cancer. Support and advocacy groups can offer a place to turn for help and empowerment. These groups gather a community of people who share a diagnosis to share information, encouragement and support. Stringer recommends those interested in patient advocacy explore the Florida Prostate Cancer Advisory Council website. “We have a website that discusses screening, management, up-to-date research around the state and clinical trials. Part of that interaction is that it has patient advocates.” Advocacy and support groups offer an outlet to talk about feelings, a place to receive suggestions, and a forum to learn coping skills to changing situations.

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Preventing Sepsis & Treating Deadly Infections: Adam Nickels’ Story

Sofia DiMartino's picture
Submitted by Sofia DiMartino on September 17, 2018 - 16:23

Adam Nickels felt fine, until he didn’t.

Nickels was working toward a doctorate in aerospace engineering at the University of Florida late last year. He enjoyed being active; lifting weights, hiking, biking and riding his motorcycle. Christmas was just around the corner, and Nickels was looking forward to the holiday break, blissfully unaware that he soon would be fighting for his life.

On a Monday morning, Nickels went to work feeling normal. Around midday, he began to feel like he had the flu. Shivering with fever, Nickels went home and decided not to go to into work the next day.

Nickels knew he was sick but didn’t have any inkling how bad he was until a coworker’s wife and UF medical student, Cindy Medina, stopped by.

“She came over and gave me some soup and noticed spots on my hands that I hadn’t seen,” Nickels said. “She told me that I needed to go to the hospital because illnesses that had spots were not good.”

Though Nickels had never wanted to be an interesting medical case, his mysterious sickness rapidly turned him into one. He went to the UF Health Shands Emergency Center – Springhill, where doctors quickly decided to transfer him to UF Health Shands Hospital.

Nickels began to realize that things were seriously wrong with his health.

“I went to use the restroom and by the time I got back to my room, things fell apart,” Nickels said. “I got viciously sick. I was throwing up and my head was in the most pain it’s ever been in.”

During the ride to the hospital, Nickels’ pain was so severe that friends had to answer medical questions for him. Once there, doctors performed a variety of tests that quickly confirmed their suspicions.

Nickels had meningococcemia, a blood infection caused by a bacterium called Neisseria meningitidis, which can also cause meningitis B. The rare infection can cause a person to feel sick in the morning and die by the afternoon. As this bacterium is known to thrive on college campuses, where students live and interact in close quarters, most university students are aware of the risk and are vaccinated for N. meningitidis before their first year on campus. This vaccine, however, does not cover all strains of the infectious agent. Nickels, who thinks he had the vaccine, doesn’t know how he could have contracted the illness.

“There was nothing out of the ordinary that I did the couple of days before that,” Nickels said. “I have no idea how I could have gotten it.”

After suspicion rose that Nickels could have the rare infection, but before his diagnosis, his emergency department doctor, Matthew Shannon, M.D., admitted him to the hospital and alerted hospital epidemiologist and infectious disease doctor, Nicole Iovine, M.D., Ph.D.

Iovine sees the flow of events in Nickels’ case as a prime example of excellent interventionist medicine.

“When Dr. Medina realized that Adam needed to go to the emergency department, that was a life-saving intervention. Dr. Shannon realizing that he couldn’t go home, but he needed to be admitted: that was the second life-saving intervention. That’s huge,” Iovine said. “Then, when he got here, it was realized that he had this potentially life-threatening infection, meningococcemia, and he was treated appropriately and rapidly.”

Iovine was called in to ensure that no significant exposures of the bacterium to UF Health staff had occurred. She works on a team treating patients like Nickels who develop an infection that, left untreated, can spiral into a condition called sepsis.

Sepsis is the body’s extreme response to severe infection. It’s common, deadly and happens fast, as blood becomes overwhelmed by bacteria and organs shut down due to low blood pressure. Sepsis is the final stage of infection and is the number one cause of mortality in hospitals.

“Sepsis is the final common pathway by which many common infections can kill you,” Iovine said. “If someone has terrible pneumonia, for example, we may know that the infection is in the lungs, but the overwhelming response to that infection, which is sepsis, that’s how people die.”

Iovine works with a team to implement a set of procedures created to ensure a standardized approach for preventing sepsis. Through this, when patients come into the hospital, nurses observe them for signs of sepsis risk. If signs are evident, special nurses, called STAT nurses, are called in to perform a sepsis evaluation. If sepsis is still a possibility after a final physician evaluation, steps for sepsis prevention are activated.

Due to these protocols, Nickels was immediately administered broad-spectrum antibiotics and sepsis was prevented. Today, he is alive to tell his story of beating the odds and overcoming meningococcemia.

“His case was a beautiful example of when things work right,” Iovine said. “It was a great example of how everything works with protocol. Timing is key. Acting early saves lives, and I can tell you, without any reservation that if this had not been caught early, he would be dead.”

After leaving the hospital, Nickels had a midline intravenous catheter for continued antibiotic infusion. He was constantly winded and was unable to do anything active for about a month. Residual headaches from the illness forced him to slow down his studies, but Nickels managed to make enough progress that, miraculously, he never fell behind.

Nickels went on to graduate from UF in May of 2018. He is now back to his normal routine and is as active, if not more so, than he was before his illness. Due to the quick and effective work of UF Health physicians, Nickels has no permanent damage.

“I definitely use a lot more hand sanitizer,” Nickels said. “I could’ve died, lost a foot or arm, been partially blind or lost my hearing, but I was given this gift of being okay again. You have to appreciate that. You walk away with a profound sense of gratitude for everybody.”

In Iovine’s mind, while Nickels case ended positively, it’s impossible to leave a sepsis-prevention case and feel like you’re finished, especially when death by sepsis is still so common. For this reason, Iovine, other physicians, nurses and pharmacists meet in a sepsis committee three times a week to review every case of sepsis that occurs at UF Health.

“As part of that review of each case, we look at if we did everything correctly, if there are ways we can improve, and provide feedback to the caretakers to see how we can make it better and improve the process,” Iovine said.

Due to the dedication of the sepsis-prevention team, there has been a 26 percent decline in sepsis mortality at UF Health Shands Hospital since 2015, but Iovine is not satisfied.

“We can always do better when it comes to sepsis prevention,” she said. “So, we’re not going to be content, and we’re never going to sit back.”

UF is leading the way in sepsis research with The University of Florida Sepsis and Critical Illness Research Center, which studies long-term effects and outcomes in patients treated for sepsis in the surgical and trauma intensive care units at UF Health Shands Hospital. The first of its kind in the nation, the research center is dedicated to developing clinical solutions for sepsis and for conditions that develop after the infection.

September is Sepsis Awareness Month, and UF Health encourages patients, employees and the public to educate themselves about the signs and symptoms of sepsis.

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All of Us

Submitted by on September 15, 2018 - 10:41

All of Us

David R. Nelson, M.D.
Interim senior vice president for health affairs, UF President, UF Health

Betsy Shenkman, Ph.D.
Chair, Health Outcomes and Biomedical Informatics, UF

UF Health is taking part in an ambitious nationwide research effort with the goal of trying to accelerate research and improve the health of all Americans. The All of Us Research Program hopes to gather health information from a cross-section of 1 million or more people in the United States over the next decade to help shape the future of health care.

Researchers around the world will use the data gathered by All of Us, a National Institutes of Health initiative, to study the impact of differences in lifestyle, environment and genetic makeup on individual health. To be successful, the program needs participants who care about improving the health of everyone, people who are willing to share information about themselves that could help cure diseases in our lifetime.

You can learn more about this initiative when the All of Us Journey arrives at the University of Florida’s academic health center, outside the George T. Harrell, M.D., Medical Education Building, from 10 a.m. to 4 p.m. Friday, and at Gainesville’s Depot Park from 10 a.m. to 4 p.m. on Saturday.

Those interested in being part of this nationwide effort can visit a specially equipped vehicle and check out interactive exhibits. They can ask questions of the staff and fill out a contact card so staff can reach out to them later. People can also choose to have the risks and benefits to this research study explained, and if you agree, you can enroll in the project at this time.

Those who agree to participate later will complete online health surveys and, in some cases, be asked to go to a partner center to have their physical measurements taken and to provide blood and urine samples.

This initiative represents a new chapter in precision health, which is a fundamental shift to more proactive and personalized health care that empowers people to lead healthy lives. It takes into account factors like where you live, what you do and your family health history. The goal is to be able to tell people the best ways to stay healthy. If someone does get sick, precision health may help health care teams find the treatment that will work best. Unlike a single research study focused on a specific disease or population, All of Us will serve as a resource for thousands of studies, covering a wide variety of health conditions.

UF is among more than 25 institutions chosen to implement the All of Us Research Program. UF is part of the SouthEast Enrollment Center network, led by the University of Miami Miller School of Medicine, and including Emory University and the Morehouse School of Medicine in Atlanta. The network will work with the OneFlorida Clinical Research Consortium, whose coordinating center is led by the UF Clinical and Translational Science Institute. This network aims to strengthens the program’s reach into underserved populations, including lower-income, Hispanic and Latino, African-American, Native American and rural communities. UF’s goal is to enroll 20,000 participants over the next five years.

In this era of ubiquitous avenues of online information, and the companion concerns about privacy and high-profile data breaches, All of Us has taken great steps to safeguard participant information. All data, including your genetic data, are encrypted on protected computers that are security-tested regularly. Participants’ names and other direct identifiers, such as your address, are removed and replaced with a code.

The data will be accessible to researchers in the U.S. and around the world to accelerate health research and medical breakthroughs. There are strict rules researchers must follow to access the data to keep participant information secure.

For precision health to succeed, researchers and clinicians need the best information about the populations they serve. Such medical databases already have led to new discoveries in areas ranging from cancer treatment to the reduction of medical treatment errors. Researchers have homed in on disparities in health care, shown how preventive services can reduce mortality, and influenced health policy decisions on a national level.

Advances in technology are transforming health research today at speeds unthinkable in the not-too-distant past, enabling instant collaboration among scientists around the world. These advances are leading to new ways to tailor prevention and care strategies to patients based on their genetic composition and health history.

People like you.

Visit the All of Us Journey

The All of Us Research Program is a nation-wide research program that seeks to enroll one million people and they are looking for your help. Through health surveys, electronic health records, physical measurements and more, researchers are able to take the information you provide in this study and use it to advance precision medicine.

Precision medicine is health care that is based on you as an individual. It takes into account factors like where you live, what you do, and your family health history. Precision medicine’s goal is to be able to tell people the best ways to stay healthy. If someone does get sick, precision medicine may help health care teams find the treatment that will work best.

The All of Us Journey is coming our way to see what makes Gainesville unique and you’re invited.
You have two chances to visit:

  • September 21, 2018
    10am-4pm

    In front of the Harrell Medical Education Building
    Behind UF Health Shands Children's Hospital
  • September 22, 2018
    10am-4pm
    Depot Park
    Also featuring the UF Mobile Outreach Clinic

Find Out More

You can join the All of Us program today by visiting: https://www.joinallofus.org/en

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A Gentle Paw

Rossana Passaniti's picture
Submitted by Rossana Passaniti on September 15, 2018 - 10:14

A wagging tail, a cold nose, a gentle paw. Our canine companions can be the best stress relievers at the end of a long day. For dog lovers, “man’s best friend” is exactly that, and for hospitalized patients with pets at home, it can be hard to be away from them.

Fortunately, pet therapy volunteers and their own dogs have been spreading cheer to patients, visitors and staff at UF Health hospitals since 1995. At the UF Health Neuromedicine Hospital, these teams brighten the days of patients admitted to the hospital as well as of those in the waiting room at the UF Health neurology and neurosurgery practices.

A dedicated team of graduate students affiliated with the Neuromedicine Interdisciplinary Clinical and Academic Program, or NICAP, in the UF College of Medicine is working to increase the number of pet therapy teams visiting the neuro hospital from the current 12 to 50.

NICAP Pet Program

How to Volunteer

To become a volunteer team in the pet therapy program, individuals with dogs must complete an application process that includes online orientation, proof of pet vaccinations, proof of an applicant’s immunizations and several onsite shadowing opportunities.

For additional application details, visit the Pet Therapy page on the NICAP website. For more information, contact the NICAP program at nicap@health.ufl.edu or 352-273-6961.

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Beyond the Field

Alisha Katz's picture
Submitted by Alisha Katz on September 10, 2018 - 14:25

Jacob JonesGrowing up in the South, Jacob Jones, 30, was raised on football. Jacob always committed himself physically and emotionally to the game that would lead to team victories and good times alongside his dad, also known as ‘’Coach.’’ But for nearly a third of his life, Jacob Jones had his own share of personal losses. Jacob suffered from an addiction to opioids.

In 2006, Jacob, a native Alabaman, was recruited by the University of Alabama Crimson Tide football program to play as a wide receiver. But during his freshman year, he struggled to acclimate himself to college life nearly four hours away from home. Jacob, who suffered from anxiety and panic disorder for much of his life, had difficulty sleeping and controlling his anxiety. He turned to drinking and smoking marijuana. During the same year, Jacob developed pneumonia, and was given a prescription for liquid hydrocodone, a narcotic commonly used to treat coughs that also acts as a pain reliever.

“I remember loving how it took away my anxiety,” Jacob said. At last, he slept well and felt great. But this new feeling came at a price.

Within a couple of days, his prescription that was intended to last for weeks had lasted only a couple days. The narcotic had piqued his interest and, slowly, he introduced himself to other painkillers.

During his second year on the team, Jacob tore his quadriceps for his second time during practice, and started to experience more frequent tears with internal bleeding. After consulting with his family, team physicians and his coach, Jacob was placed on medical leave from football.

In an excerpt from him upcoming book, Jacob writes,“I remember saying to a friend ‘now I can sleep in, go to parties, be a normal college student and not have to worry about being hungover for a 6 a.m. workout.’ I could do whatever I wanted without any repercussion or regulation. This, at least, was my thinking.”

To ease the pain, he was prescribed hydrocodone for a short time, and started buying Xanax and OxyContin off the street. In 2008, Jacob continued his schooling and moved in with roommates who were also using the drug.

“Instantly, all of my anxieties, fears and pains were gone [while on drugs],” he writes. “This is exactly what I needed at this point in my life. My dreams of playing football were gone. My whole identity was wrapped up in being an Alabama football player, and now that I was not that, my life was dull. After the initial prospect of freedom and partying, I quickly became depressed, anxious and less social. I felt like I let everyone down. My grades continued to slip, there were no goals in my life, and my network of friends kept evolving to meet my lifestyle.”

As Jacob started to feel the euphoria associated with the drug, he also continued to suffer from anxiety and poor sleep. After three years of abusing drugs and alcohol, Jacob reached out to his parents for help. Surprised and concerned, his parents urged him to come home. He packed his bags, turned in his team football jersey and unenrolled from the university.

In 2010, Jacob went to his first rehab facility for 30 days, but none of his treatments stuck. He reverted back to relying on alcohol and starting using opiates only one month later. This time, going even further than he had left off before rehab. Two years later, he was arrested for possession of a narcotic and was mandated to go through drug court. For the next year, he was required to complete random drug tests on a weekly basis and attend court every Friday to review his progress.

In December 2014, he hit rock bottom. Jacob decided to withdraw from drugs cold turkey and started to feel manic. His increased heart rate was reaching a dangerous level, and he was admitted to a critical care coronary unit. After being discharged from the unit, Jacob spent three weeks in a psychiatric ward.

Three months after leaving the hospital, Jacob started feeling better. He received a phone call from a family friend who owned a restaurant franchise and asked him if he wanted to manage a store. For two years, Jacob spent countless hours focusing all his energy on the restaurant. Then, old habits returned.

“I basically crashed and burned,” he said.

Jacob quit his job at the restaurant as his life crumbled around him. His relationship with his family became strained, and his focus returned to using drugs.

“I remember my aunt telling me, ‘Your family has almost had enough of you where they’re almost done with you.’ I never thought that was a reality. They [my parents] have been there for the good and bad. I never really thought they’d say you can’t come around anymore, until now,” Jacob said.

Jacob wanted to throw up the white flag – this time, for good.

Initially, Jacob enrolled in a detox facility outside of Tallahassee and was scheduled to start at a Christian work camp for men suffering from substance abuse. After the completion of his detox program and en route to the work camp, Jacob had second thoughts. He was concerned that the absence of certified psychiatrists and psychologists at the work camp would set him up for failure after completion of the program – prompting his dependence on drugs to creep back up. Jacob asked a family friend who was driving to stop and help him think through his options. Over a smoothie, Jacob and his friend had a conversation about what to do.

The family friend, whose close friend had also dealt with addiction, suggested the UF Health Florida Recovery Center in Gainesville. After learning more about the center’s comprehensive approach, the decision was made for Jacob’s parents to take him to Gainesville to give him the best opportunity for addiction recovery. Jacob felt good about the decision, knowing that not only would he be diagnosed for his addiction, but treatment would be geared specifically toward his anxiety and panic disorder.

On May 15, 2016, Jacob arrived to the Florida Recovery Center and began the intake process, which involves assessing the patient’s condition. While being asked by Anthony Russell, M.D., about how he felt about his recovery on this go-around, Jacob responded: optimistic.

“Most people at that point are irritated or upset. I was going to do whatever they told me to do, whatever it takes. Just do my best,” he said.

Jacob enrolled in the three-month partial hospitalization program where he lived at the addiction treatment facility, and participated in individual and group therapies.

“The process groups were great because they were a very close-knit group,” he said. “I was able to share things that I never was able to share previously. It was good and tough. There were things at that point that I was ashamed of. The men’s community group was also very inviting. They were all men striving for the same thing and it was very inspiring to be around men who were open and honest.”

After spending 90 days in all-day treatment, Jacob spent another month and a half living at the recovery center, and meeting with a counselor once a week.
Jacob compares the process to a releasing a goldfish into a bowl. When a goldfish is brought home in a bag, the bag is submerged in the same bowl of water it will swim in. All the meanwhile, the fish is getting acclimated to the water temperature and its surroundings. Once the fish has spent enough time in the bag underwater, it is released into the bowl and continues to adapt to the outside waters.

Nearly two years later, Jacob has moved to Gainesville to build a new life.

“[While at the Florida Recovery Center] I started to invest in the people here and built a strong network over five months’ time,” he said. “I found a good church and I’m very active.”

Jacob continues to chronicle about his journey with addiction and is writing his first book.

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A New Age for Colorectal Cancer Screening

Kacey Finch's picture
Submitted by Kacey Finch on August 20, 2018 - 12:23

New colorectal cancer screening guidelines no longer make colonoscopies a rite of passage for 50-year-olds. Instead, 45-year-olds will celebrate their mid-forties by making an appointment most people dread.

Colorectal cancer starts in the colon or the rectum; it can also be called colon cancer or rectal cancer, depending on where it begins. The two cancers are grouped together because of their similar features, such as affecting the large intestine.

Typically a cancer found in people older than 50, colorectal cancer is the third most common cancer among men and women and the third leading cause of cancer-related deaths.

The guidelines for colorectal cancer screenings were changed due, in part, to data showing an increase in the rate of the cancer among younger populations.

Younger rectal patients are unique

A study led by UF cancer researcher Dr. Atif Iqbal, M.D., found that younger patients with stage two or three rectal cancer did not see the same survival benefit from receiving the current recommended treatments, chemotherapy and radiation, as did older patients.
The findings suggest that early-onset colorectal cancer may differ biologically in its response to treatment.

“The standard of care was established using previous studies that are predominantly based on patients who are older than 50 years of age,” said Iqbal. “However, something is different about this younger group — perhaps biologically —leading to these results.”

Prior to the study, colorectal screening guidelines recommended people aged 50 or older seek screenings due to the cancer being historically considered a disease for the older adults. Now, with the number of younger patients with colorectal cancer on the rise, the age has decreased to 45.

The study is the largest study of rectal cancer to date to include specific survival data for the younger population.

“This is important because the data we are providing right now in our clinics is not accurate, as the data has not been individualized for the younger population,” Iqbal said. “However, our study provides practicing physicians with the ability to offer prognosis, which is personalized to the younger population.”

What’s next?

Iqbal’s research highlights the paths future studies for this population should take and could drastically change how colorectal cancer is treated in younger patients.

“There are previous studies that show that, overall, the mortality rate for colorectal cancer is improving, but the rates for younger patients have increased progressively over the last 50 years,” Iqbal said.

Future care for younger colorectal cancer patients should focus on the possibility of avoiding extra treatment toxicity, such as chemotherapy and radiation, he said.

“Because older individuals established the standard of care, we’re using it on everybody — but now we see that younger patients don’t really respond that well to it,” Iqbal said.

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Breastfeeding Across Cultures

Sofia DiMartino's picture
Submitted by Sofia DiMartino on August 17, 2018 - 15:50

Tathiane and OliviaTathiane Mallett moved to the United States from Brazil with her husband, leaving behind close friends and family. She went through a 30-hour labor without an epidural or anesthesia and gave birth to a beautiful girl named Olivia. She then moved from Michigan to Gainesville when her baby was only 2 weeks old.

After so much hardship, Tathi was convinced that breastfeeding, at least, would be easy. She found it to be quite the opposite.

While in the hospital after Olivia’s birth, Tathi experienced extreme discomfort during breastfeeding. Her mother, visiting from Brazil, assured her that soon she would get used to the feeling, and the pain would go away, just as it had for her sisters.

By the time Olivia was 6 weeks old, however, she was still fussy during breastfeeding and was barely gaining any weight. Tathi was very concerned.

“I was getting quite frustrated. I kept thinking, ‘What am I doing wrong?’ ” Tathi said.

Tathi went to see Mary Ryngaert, a lactation consultant at The Center for Breastfeeding & Newborns, within the department of pediatrics at UF Health, carrying a video of her breastfeeding technique. There, Olivia was diagnosed with tongue-tie, a congenital condition in which tissue connects the tongue to the floor of the mouth, making it difficult for a baby to latch during breastfeeding.

After a small procedure to fix the tongue-tie, Olivia began breastfeeding normally, something Tathi describes as nothing short of a miracle.

“She was not as fussy anymore,” said Tathi, “and she gained almost a pound in six days.”

Post-procedure, however, Tathi had to re-learn how to breastfeed, as she’d grown so accustomed to nursing a baby with tongue-tie. When latching was still difficult, Ryngaert recommended that Tathi join the UF Breastfeeding Support Group.

The UF Breastfeeding Support Group is made up of moms and moms-to-be, as well as a lactation specialist. There, women can voice their questions and concerns about breastfeeding in a tight-knit supportive environment. For Tathi, it meant a lot to have both breastfeeding moms and a specialist in the same room, giving her a perfect mix of personal support and professional advice.

“If you just come here, you know you will get out of your house at least once a week and you will see other adults,” said Tathi. “You’ll spend an hour and a half or two hours just talking and laughing.”

Continuing to breastfeed was important to the new mom for both personal and cultural reasons. According to Tathi, women in Brazil are judged much more harshly if they choose not to breastfeed as compared to in the United States. Tathi felt that pressure, even as far as she’d come from her home country.

However, the physical experience of breastfeeding in Brazil is also entirely different than in the U.S. In Brazil, breastfeeding publicly is deeply accepted, while in the United States, women are expected to cover up and breastfeed privately, a style of breastfeeding that Tathi describes as lonely.

The cultural deviation is evident even in the recommendations for time spent nursing. In Brazil, women are expected to breastfeed for an hour each session, but Tathi found that this meant that breastfeeding took up the vast majority of her day. After attending the UF Breastfeeding Support Group, Tathi discovered that American breastfeeding recommendations differed greatly from those in Brazil, with American guidelines recommending shorter feeding times, among other concepts that Tathi describes as more practical.

Tathi still struggled, however, to reconcile the differences between the culture she’d grown up with and the one she was becoming a part of.

“It was really confusing because it was like, should I follow my culture? Should I follow the one I’m in now?” said Tathi.

Tathi eventually chose to follow American recommendations and is successfully breastfeeding Olivia. She owes that success, she said, to both her lactation specialist and the UF Breastfeeding Support Group, which allowed her not only to overcome her breastfeeding difficulties but also to connect with other moms in the same circumstances.

“I don’t think I would’ve kept the whole breastfeeding thing up if it wasn’t for Mary Ryngaert and the breastfeeding support group, for sure,” said Tathi. “It was too painful and every two and a half to three hours, I was crying, saying I can’t do this.”

Now, even when having a difficult day or nursing session, Tathi knows that she can.

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UF Health Plastic Surgeon Saves Little Girl’s Leg

Sofia DiMartino's picture
Submitted by Sofia DiMartino on August 8, 2018 - 12:13

For young Jennyfer Carranza, an ordinary day playing in the yard quickly turned catastrophic when she got too close to her father’s lawn mower. Jennyfer’s shoelaces got caught in the mower’s blades, pulling her closer to the machine and slicing a deep cut into one of her heels.

“One doesn’t expect that type of thing to happen, and it’s even worse when it happens to your child,” said Jennyfer’s mother, Laura.

Jennyfer’s parents brought her to UF Health, where Harvey Chim, M.D., a plastic and reconstructive surgeon who specializes in lower extremity reconstruction and limb salvage, was called in to evaluate the leg wound and determine what options were available for the little girl.

It was an emotional experience for the UF Health team, Chim said, with some calling for a foot amputation. Chim, with hopes to help Jennyfer run and play freely again, decided to perform a free flap procedure, a surgery involving skin grafting to reconstruct Jennyfer’s ankle and cover her wound.

“These are complicated procedures, but in a center such as ours, where we do them often and we have the experience and expertise, patients can expect a very good outcome,” said Chim, an associate professor in the UF College of Medicine’s department of surgery.

The decision Chim made allowed Jennyfer to regain her mobility, keep her foot and go back to living the way she used to. Her parents couldn’t be more grateful.

“She has gone back to living her normal life. She can run,” said Jennyfer’s father, Isaac. “I don’t have enough to give for all that they have done for my daughter.”

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Get the Facts on Childhood Rhabdomyosarcoma

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Submitted by Kacey Finch on July 30, 2018 - 16:35

July brings awareness to the cancer that is responsible for 10 percent of all childhood cancer-related deaths: sarcoma. In recognition of Sarcoma Awareness Month, it’s crucial to discuss the soft tissue sarcoma making up three percent of all childhood cancers, rhabdomyosarcoma.

What is Rhabdomyosarcoma?

Rhabdomyosarcoma, or RMS, is a type of sarcoma, which is a cancer that can develop in the connective tissues. RMS is a specifically a cancer made up of cells that normally develop into skeletal muscles.

Seven weeks into the development of an embryo, rhabdomyoblasts, which are the cells that will eventually form the skeletal muscles, begin to form and can develop into RMS.

Because of how it occurs, RMS is most common in children, with more than half of the near 350 cases a year composed of children younger than 10 years old. In one to two percent of all cases, RMS is congenital, or a birth defect.

“Here at UF, we typically see eight to ten newly diagnosed rhabdomyosarcoma patients per year,” said Joanne Lagmay, M.D., director of the pediatric solid tumor program at UF Health.

Types of RMS

RMS has two main types:

1. Embryonal Rhabdomyosarcoma (ERMS):
• Usually occurs in children in their first five years of life but is the most common type for all ages.
• Cells look like the developing muscle cells of a six- to eight-week embryo.
• Tends to occur in head, neck, bladder, vagina, prostate or testicles.
• Makes up 60 to 70 percent of RMS cases.

2. Alveolar Rhabdomyosarcoma (ARMS):
• Typically affects all age groups.
• Is more common among adolescents.
• Tends to occur in large muscles, such as trunk, arms and legs.
• Cells look like normal muscle cells seen in a 10-week fetus.
• Grows faster than ERMS and requires more intense treatment.

To learn about less common types of RMS, visit the Cancer.org webpage.

Signs and Symptoms of RMS

Because skeletal muscles are found almost everywhere in the body, RMS is not constrained to one site, which means symptoms vary depending on the tumor’s location.

Possible symptoms:

• A tumor around the eye could cause the eye to bulge or appear cross-eyed.
• A tumor in the neck, chest, back, limbs or groin could appear as a lump or swelling.
• A tumor in the ear or nose can result in earaches and congestion.
• A tumor in the bladder or prostate can bring about bloody urine, vaginal bleeding or painful urination and bowel movements.
• A tumor in the abdomen can result in vomiting, stomach pain or constipation.
• More advanced cases of RMS may see symptoms such as bone pain, a lasting cough, weakness or weight loss.

Treatment

The treatment of RMS is contingent on how much of the tumor can be resected upfront. After surgery, treatment types used for RMS include chemotherapy and radiation therapy.

A team approach is highly recommended for children and teens affected by RMS. The medical team could include an orthopedic surgeon, pediatric surgeon, pediatric oncologist, radiation oncologist, pathologist and physiatrist. Other team members may include nurses, dietician, Child Life and social workers.

The UF Pediatric Sarcoma Program is dedicated to providing comprehensive, cutting edge and compassionate care for children and young adults who have been diagnosed with sarcoma,” Lagmay said. “To provide multidisciplinary care requires that each patient case is discussed with many experts available within UF Health.”

Dr. Lagmay with a patient

Clinical trials, or carefully controlled research studies, for RMS are another way to get leading-edge cancer treatment. While they are not for everyone, parents can learn more about clinical trials by asking their child’s doctor.

Advancements in treatment of RMS have improved prognosis of patients, but survivors need to be monitored throughout their life for lasting or late effects of chemotherapy and radiation.

While RMS is a rare form of cancer, it is one of the most common soft tissue sarcomas among young children. Be aware and know the signs this Sarcoma Awareness Month.

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From behind the camera to center stage

Submitted by Nacuya Rucker on July 5, 2018 - 16:10

You may not know her name or recognize her face, but you know her by reputation. Chances are, you’ve seen her work. Mindy Miller, UF Health Communications photographer on the Creative Services and Interactive Media team, works in what she dubs her positive bubble. She gets called in to document groundbreaking discoveries and innovative approaches to clinical care — things that save and transform lives.

“I’m really fortunate that creativity is my job,” Miller said. “Whether it’s a marketing event or a human interest shoot, I get to help people share their stories and celebrate their success.”

But her creativity doesn’t stop when she ends her work day. In fact, it flourishes in a different way.

Mindy Miller

On most evenings, you can find Mindy at the Gainesville Circus Center practicing her new craft — circus arts.

“We’re a family of misfits. I love it all, but I particularly love any apparatus that puts me up in the air,” Miller said.

The circus arts are a beautiful combination of theatre, music, dance and fitness. So Mindy isn’t just having fun, she’s challenging her body to achieve new heights and she’s also improving the health of her brain.

Lifelong learning, among other practices like exercise and meditation, is a protective factor for a healthy, aging brain. Research shows that older adults who receive more formal education or who actively challenge their brains by learning new hobbies and skills have more white matter, which is associated with greater cognitive functioning.

“Performing is way out of my comfort zone. It makes me nervous, but I am surprised by how much I’ve grown to love it,” Miller said.

Mindy has taken her kids on this journey. They play, have fun, get their exercise and watch their mother learn new tricks, which can lead to amusing scenes.

Mindy Miller

“They see me fail repeatedly when I’m learning a new acrobatic trick,” Miller said. “It’s both fun and hilarious for them to watch, but it is also beautiful for me knowing that they are watching me fail towards success. They get to see me fail at something new, sometimes even falling clumsily, but they also see me laugh it off and try again.”

352Creates celebrates people who incorporate creativity into their daily lives because research supports the health benefits of engaging in the creative process.

For more information about 352Creates, visit 352creates.com, connect on social media platforms, share your activities using #352Creates and stay tuned for updates on the UF Health.

Men’s Health Month: From Prostate Cancer Patient to Survivor and Advocate

Jordan Folkes's picture
Submitted by Jordan Folkes on June 1, 2018 - 14:43

Tony BraunTony Braun was at his urologist’s office one day in 2010 because of a kidney stone when the physician became alarmed. Bloodwork showed Tony’s prostate-specific antigen, or PSA, a blood test that screens for prostate abnormalities, had elevated from 1.9 to 2.7 over the course of nine years. The rise in Tony’s PSA led to his urologist recommending a prostate biopsy.

He had not experienced any symptoms of prostate cancer and he was stunned by the news. The disease is rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50, according to the American Cancer Society. Although most clinical laboratories report a normal PSA range of 0-4.0.

Tony was 58 years old, and the Ocala resident faced an internal struggle. He didn’t know if he was ready to face the results of a prostate biopsy because he lost his father to this illness in 1996. At that time, treatment options were fewer and riskier than they are today. Tony’s personal connection with the disease led to his decision to undergo the biopsy.

After finding that he did indeed have prostate cancer, Tony spoke to several urologists about next steps. The main takeaway from these meetings was the recommendation that Tony should have his prostate surgically removed.

A family friend suggested he contact Li-Ming Su, M.D., the David A. Cofrin professor of urologic oncology and chair of the UF College of Medicine's department of urology. His meeting with Su, which lasted an hour and a half, answered all of Tony’s questions. Tony trusted Su’s expertise, attention to detail and caring approach to patients.

“Without hesitation, I would say that Dr. Su is one of the finest human beings I have ever met,” Tony said.

With confidence in Dr. Su’s experience and ability, Tony underwent robotic prostatectomy surgery. Technological advancements in robotic procedures offered an alternative to the treatment his father had and one that was far less invasive. Robotic surgery, as an advanced form of laparoscopic or “key hole” surgery, is performed using a high definition camera with a three-dimensional image and tiny robotic, multi-jointed instrument tips that allow the surgeon to precisely dissect, divide, cauterize and suture tissues with the same ease as in traditional open surgery, but with far less pain, blood loss and hospitalization for the patient.

During pre-surgical testing one week before his procedure to remove the prostate, Tony ran into Su and confided his fears about his upcoming surgery. “Dr. Su said, ‘If you weren’t scared I’d think there was something wrong with you,’” Tony said. Su explained to Tony that it is normal to have some trepidation in undergoing such a surgery, but that his health and motivation were critical factors toward a successful recovery.

It comforted Tony for Su to address his concerns in a realistic and human way. Four weeks after surgery, Tony was able to start exercising again with his trainer and continue his everyday routine. Today, Tony, 66, is living cancer free with outstanding results from his prostate surgery.

Su remarked that Tony’s positive outlook allowed for him to recover quickly from his prostate surgery.

“Tony continues to inspire me in his quest to give back by informing other patients about treatment options and especially his journey in beating prostate cancer. He has made it a mission of his to advocate for prostate cancer awareness education and screening,” Su said.

According to the most recent American Urological Association guidelines on prostate cancer screening, U.S. men are advised to undergo screening including both a PSA test and a prostate examination between the ages of 55 and 69, after which further screening can be tailored based on the patient’s health and life expectancy. For those patients who are at increased risk, such as those with a positive family history like Tony’s case or African American race, screening should start a decade earlier and should be individualized.

Life After Melanoma

Kacey Finch's picture
Submitted by Kacey Finch on May 30, 2018 - 17:38

Elderly man under the shade at the beach

Summer is fast approaching, and with it comes sunburn season. For some people, however, avoiding a sunburn is more than just a passing thought on the way to the beach — it’s a matter of life and death. Why? Because of melanoma, the deadliest form of skin cancer.

Preventing skin cancer is discussed frequently, but during this Melanoma Awareness Month it’s time to discuss how to prevent it from coming back when you’ve already had it.

Melanoma survivors at higher risk

The rates of melanoma have been rising for the last 30 years. It is the fifth most-common cancer among men and the sixth most-common cancer in women.

While it only accounts for about 1 percent of skin cancers, melanoma causes the largest majority of skin cancer-related deaths. As with many cancers, however, the best chance for survival occurs when melanoma is detected early. In fact, the five-year survival rate for early-stage melanomas is as high as 97 percent.

Unfortunately, melanoma survivors have a higher risk of the cancer coming back. Therefore, the American Cancer Society suggests melanoma survivors talk with their doctor about developing with a care plan for post-melanoma life. This plan could include:

  • A schedule for follow-up exams and tests
  • A schedule for other tests they might need in the future
  • Information on possible latent side effects from treatment, as well as what to look out for and when to contact their doctor
  • Diet and exercise suggestions

For melanoma survivors, skin and lymph node exams should be performed regularly by a self-exam and by a doctor to watch for any new or recurrence of skin cancer. New lumps or a change in skin color should be seen by a doctor and new symptoms that do not go away should also be reported.

Typically, physical exams after early-stage melanomas occur every six to 12 months. For thicker melanomas, the time frame may shorten to every three to six months.

Common second cancers after melanoma

While survivors of melanoma have a 28 percent increased risk of a second cancer, another skin cancer is the most common. Survivors also have a higher risk of:

  • Female breast cancer
  • Non-Hodgkin lymphoma
  • Prostate cancer
  • Salivary gland cancer
  • Small intestine cancer
  • Kidney cancer
  • Thyroid cancer
  • Soft tissue cancer

For men, melanoma is most commonly found on their chest and back.
For women, it is most commonly found on their legs.


Reducing the risk of cancer recurrence

To maintain good health and lower the risk of cancer recurrence, it is important for melanoma survivors to attend all follow-up appointments and do the following:

Limit your exposure to ultraviolet, or UV, rays

To minimize risk of getting melanoma, the most important thing to do is avoid UV rays, both manmade (tanning beds and sun lamps) and natural (the sun).

Sailesh Konda, M.D., an assistant clinical professor of dermatology at the University of Florida, recommends staying out of the sun when UV rays are strongest, which is between 10 a.m. and 4 p.m. If you can’t avoid the sun during those hours, he encourages the use of sunscreen of at least 30 SPF.

“I recommend broad-spectrum sunscreens with titanium dioxide or zinc oxide, which offer protection against both UVA and UVB rays,” Konda said. “UVA and UVB rays can cause premature skin aging and an increased risk of developing skin cancer.”

He also suggests sun-protective clothing, a broad-brimmed hat, legally tinted car windows and UV-blocking sunglasses. That’s right — your eyes need protection from sunburn as well.

Adopt healthy habits

Put down that cigarette and pick up an apple. Not smoking, eating nutritious food, exercising and maintaining a healthy weight may help reduce the incidence of most cancers, according to the American Cancer Society.

Keep a strong immune system

A weak immune system could leave room for melanoma, or any cancer, to come back. Boosting your immunity isn’t easy, but steps can be taken to help an immune system fight back. Adopting those healthy habits, avoiding infections, washing hands, getting adequate sleep and minimizing stress will help an immune system stay healthy and fight off germs. Immune systems tend to weaken with age, so it is especially important for older people to take these precautions to help avoid cancer recurrence.

How to spot melanoma

Melanoma survivors should conduct regular self-exams. When looking for melanoma during a self-exam, keep the ABCDE rule in mind:

  • A stands for Asymmetry.
    Be on the lookout for a mole or birthmark where one half does not match the other.
  • B is for Border.
    If the edges of a mole are ragged, blurred, irregular or notched, it could be a sign of melanoma.
  • C has Color.
    Melanoma may show itself in the form of color inconsistency. Colors may include different shades of black and brown or patches of pink, red, white or blue.
  • D stands for Diameter.
    It is abnormal for a spot to be larger than six millimeters, so, if it is, talk to a doctor. While some forms of melanoma are smaller than this, larger spots are signs of melanoma.
  • E is for Evolving.
    A mole or mark that changes in size, shape or color is cause for concern.

Others signs and symptoms of melanoma are:

  • A sore that doesn’t heal
  • Spread of pigment from the border to surrounding skin
  • Redness beyond the border
  • Itchiness, tenderness or pain
  • Change in the surface of a mole

Have fun in the sun, but don’t forget to protect your skin while doing so!

Nayla’s New Lungs

Alisha Katz's picture
Submitted by Alisha Katz on May 24, 2018 - 10:26

For as long as she can remember, Nayla Rivera and her father, Chris, have trekked from one medical appointment to another, mostly in South Florida.

When she was 6 months old, Nayla vomited on a regular basis. Initially, doctors diagnosed her with acid reflux. To rule out anything more serious, Nayla was sent to have a sweat test, a procedure that confirms cystic fibrosis, or CF, a life-threatening lung disorder.

The results came back positive.

“I started reading about CF, and found there was no cure,” Chris said.

Growing up, Nayla never let her CF diagnosis interfere with her desires to play soccer or cheerlead.

“She’s loyal. She’s cool. She’s very strong,” Chris said.

At UF Health, doctors use a special technique to downsize lungs from an adult donor and transplant them into pediatric patients like Nayla. Just another example of the problem-solving care being used at UF Health.

Like clockwork, Nayla would be admitted to a hospital each December for a ‘’tune-up,’’ a procedure that cleans out the lungs for CF patients. Tune-ups often require a three- to six-week stay, sometimes interfering with holidays including Christmas and New Year’s Day.

When Nayla was 13, Chris began to notice she became winded much faster than before. He also noticed that his daughter caught colds frequently and remained sick for weeks.

Three years later, Nayla’s condition took a turn for the worse as her lung capacity dwindled. “The doctors weren’t sure if she would make it,” Chris said.

With few options left and the need for tune-ups becoming more frequent, Nayla’s physician recommended that she travel to UF Health Shands Children’s Hospital in Gainesville to discuss a lung transplant. The hospital is the only one in Florida that has a pediatric lung transplant program. It is also among a handful in the country to utilize a technique called cadaveric lobar transplantation, which allows the thoracic surgeon to downsize lungs from an adult donor and transplant them into smaller pediatric recipients. This capability leads results in significantly shorter wait times for pediatric lung transplant candidates and avoids deaths on the waitlist.

In July 2017, Chris and Nayla met Michael Tsifansky, M.D., a pediatric intensivist and pulmonologist and the medical director for the UF Health Pediatric Lung Transplant program. At the appointment, Nayla was so sick, that she had to be hospitalized for another tune-up while Tsifansky and his team assessed to see if she would be a candidate for transplantation.

The process and preparation for becoming a lung transplant recipient are rigorous. Steps to get on the list include showing adequate physical strength, good nutritional status and emotional determination. While patients need to be sick enough to need a transplant, they also need to be well enough to heal afterward.

In December, Nayla had her third tune-up of the year and, on the 29th, she was approved at UF Health to be added to the transplant list. Nayla was now sent home to wait for her lungs to arrive.

She didn’t have to wait long.

“On Jan. 4, I was coming home from work and I got the call,” Chris said. “We’ve got the lungs.”

Nayla and Chris rushed to a nearby hospital where they took an ambulance to the airport and flew to Gainesville. In the meantime, physicians in Gainesville were assessing the lungs to ensure they were the best match.

“Nayla was freaky calm,’’ Chris said.

When they got to Gainesville, Nayla was admitted to the hospital for the 10-hour surgery performed by Tiago Machucha, M.D., Ph.D., a thoracic surgeon and the surgical director of the UF Health Pediatric Lung Transplant Program. Machuca and his team utilized cadaveric lobar transplantion technique, which allowed Nayla to get a successful transplant only several days after listing.

“You see him in scrubs, but the way that he treated me wasn’t like (he was) a doctor,” Chris said. “It was like we knew each other. He made sure I understood what he was telling me.”

Nayla received her new lungs on Jan. 5 and started on the long road to recovery. Each day, Nayla had to relearn everyday actions like walking, washing her hair and brushing her teeth.

Chris remained by his daughter’s bedside and drew strength from the support provided by the hospital staff. “The whole team is awesome,” Chris said.

“Every one of them brings something different to the table.”

Chris offered advice to other parents going through a similar situation.

“It’s going to be lonely, and no one is going to really know what you’re going through. They can sympathize, but no one’s really going to be able to relate,” Chris said. “There are going to be times you get frustrated and want to give up. You’ve got to be mentally strong and never show that you’re afraid. We [parents] are like their superheroes.’’

In February, Nayla was discharged to live in transplant housing before going back to South Florida in March. Nayla and Chris left for home, knowing her physicians were only a phone call away.

“This is the first time I’ve had doctors’ and nurses’ cell numbers,’’ Chris said. “Not because I asked them for it. That’s amazing. There’s only so much acting a person can do. They don’t have to give these numbers out.”

One month after being home, doctors noticed subtle signs of possible rejection, a term used when the body does not want to completely accept the new organ. As a safety precaution, Nayla returned to Gainesville for a treatment that would rid the body of the antibodies against the new lungs and the cells that produced them. The procedure was a resounding success.

Now, with her new set of lungs, Nayla can focus on just being a 16-year-old. She’d like to become a doctor or researcher. To help others like herself.

Know the Signs of a Food Allergy

Sophia Ramos's picture
Submitted by Sophia Ramos on May 7, 2018 - 21:59

Jar of peanut butter and peanuts

May 13 starts Food and Allergy Awareness week, recognizing the 15 million Americans who are affected by food allergies. Such allergies happen when the body mistakes a food protein as a threat, triggering the immune system to have an allergic reaction, which can vary from mild discomfort to severe distress. In the most serious cases, the body can go into anaphylaxis, which can be life-threatening.

When experiencing anaphylaxis, symptoms often develop rapidly in various parts of the body. After exposure to an allergen, severity typically peaks between five to 30 minutes. The signs and symptoms of anaphylaxis can be one or a combination of the following:

  • Mouth
    Swelling of the lips, tongues, or roof of the mouth
  • Eyes/Nose
    Runny nose, stuffy nose or sneezing
  • Skin
    Hives or body rash, redness/flushing, itching or swelling
  • Gut
    Sharp abdominal pain, vomiting, diarrhea, nausea
  • Throat
    Hoarseness, tightening of throat, difficulty swallowing, hacking cough, stridor
  • Lungs
    Shortness of breath, wheezing, coughing, pain or tightness in chest
  • Mental
    Anxiety, panic, sense of doom
  • Circulation/Heart
    Chest pain, low blood pressure, weak pulse, shock, paleness in color, dizziness, fainting, lethargy

Managing a food allergy can be difficult without knowing the cause. For most people, they are unaware they have a food allergy until they have an allergic reaction. At UF Health Allergy, we can conduct diagnostic tests and review your health history to determine potential triggers for allergic reactions and anaphylaxis. For more information or to schedule an appointment, please call 352-265-0420.

Anaphylaxis can be life-threatening. If you or someone you know is experiencing symptoms of anaphylaxis, please seek medical attention immediately.

Acid Reflux Ties to Esophageal Cancer

Billie Arnett's picture
Submitted by Billie Arnett on May 1, 2018 - 15:52

Gastroesophageal reflux disease, or GERD, may have links to esophageal cancer. GERD is a condition in which stomach acid leaks into your esophagus, or food pipe. The fibrous muscle in your lower esophagus struggles to keep swallowed food down, causing heartburn and irritation of the esophagus.

GERD can occur at any age and more than half of babies will experience reflux in their first few months. At least once a week, about 40 percent of the American population experiences GERD symptoms. What many people do not realize about GERD is the threat of developing esophageal cancer.

Two illnesses that GERD conditions can lead to include Barrett’s esophagus and esophageal cancer. Men are three times more likely to develop these conditions, according to the National Institutes of Health. Barrett’s esophagus is a condition in which the lining of the esophagus is damaged by stomach acid over time.

If GERD symptoms persist, they could hint at traces of adenocarcinoma, a type of cancer that forms in glandular cells of the esophagus. Patients with severe symptoms should ask for a gastrointestinal tract evaluation from a gastroenterologist. If your symptoms are mild, you may not need require close examination.

Cancer symptoms to search for:

  • Chronic cough
  • Dysphagia: trouble swallowing and a sensation that food is stuck in your throat
  • Chest Pain
  • Weight loss without trying

Cancer prevention

  • Treating known symptoms of GERD with medications
  • Surveillance endoscopy (EGD)
  • Elimination of Barrett’s esophagus by endoscopic procedures

Being proactive about GERD is key to preventing esophageal cancer. Here is what you need to know to better maintain the symptoms.

Preventing GERD flare-ups with healthy food and habits:

  • Eat smaller portions; give your digestive system a break.
  • Eat naturally low-fat foods such as vegetables, lean meats and egg whites. Oatmeal can absorb acid in the stomach.
  • Avoid smoking, it worsens symptoms.
  • Limit alcohol consumption and do not drink alcohol on an empty stomach. Acidity will irritate your stomach.
  • Avoid citrus fruits, spicy foods and tomatoes.
  • Ginger is an anti-inflammatory and helps treat heartburn symptoms.
  • Choose acetaminophen over aspirin, ibuprofen or naproxen.

Some prescription medications can agitate GERD. If you are taking medications for blood pressure, depression or anxiety, motion sickness, or asthma, consult your physician as these could worsen GERD symptoms. Discuss GERD symptoms with your physician if you have concerns about your medications.

GERD treatment options

  • Anti-reflux surgery
  • Proton pump inhibitors (PPIs) – medication that reduces the production of acid by blocking the enzyme in the wall of the stomach that produces acid
  • H2 blockers – medication that lowers the amount of acid released in the stomach
  • Endoscopic therapies – a flexible tube passed through the mouth into the stomach

One of the most effective treatment methods available to GERD patients is the anti-reflux surgery. A magnetic implant, called the LINX®, is inserted around the outside of the lower esophageal sphincter. The implant helps prevent reflux by helping muscles close tightly. The minimally invasive procedure takes two to three hours. For more information about this option, visit https://ufhealth.org/anti-reflux-surgery.

Showing your mettle: Life with Limb Loss

Leah Harms's picture
Submitted by Leah Harms on April 27, 2018 - 11:09

Steff Woodworth is used to showing her mettle. 

A four-time cancer survivor, health care advocate and amputee, Steff has overcome some serious hurdles.

Steff’s first battle with cancer was when she was only 12 years old. Diagnosed with osteogenic sarcoma, a cancer of the bone, she lost her leg right before she became a teenager. This opened up her world to living a life with limb loss.

“You just have to get on and get back on your feet.”

Steff has now lived with the loss of a limb for almost 50 years. She is an active member in the limb loss community and Gator Amps, the support group for community members with limb loss at UF Health Shands Rehab Hospital. She knows the importance of community and of helping others through the transition of losing a limb.

April, Amputee Awareness Month, is a good reminder to her and everyone else in the limb loss community that it is not an easy process, but having a solid support group, like the rehab hospital’s, helps. 

Today, Saturday, April 28, is National Show your Mettle Day, celebrated by the Amputee Coalition. On this day and every day, Steff is proud to show both her mettle and metal, and encourages everyone else with limb loss to do the same.

Visit UF Health Shands Rehab Hospital’s support group page to learn more. You may also email Andrea at gilban@shands.ufl.edu.

Aneurysm strikes baseball pitcher, but why? A neurosurgeon explains the mysterious condition

Submitted by on April 24, 2018 - 17:21

Chicago White Sox relief pitcher Danny Farquhar, 31, suffered a brain hemorrhage in the White Sox dugout after throwing 15 pitches Friday night, April 20, devastating his family, teammates and fans. The cause was a ruptured brain aneurysm, according to reports. Farquhar is in critical condition at Rush University Medical Center.

I am a neurosurgeon who operates on patients who have suffered ruptured brain aneursysms, and I also study the causes and treatments for them. I see life changed in an instant for far too many people.

There is no evidence that brain aneurysm is related to traumatic brain injury. So how is it, many may wonder, that a young athlete in phenomenal shape could suddenly develop a deadly condition?

From out of the blue

An aneurysm is a weak spot on the wall of an artery.

An aneurysm occurs in a weak spot in the wall of an artery. Sometimes, that weak spot expands, almost like a water balloon.

The Brain Aneurysm Foundation estimates that 6 million people, or 1 in 50, have an unruptured brain aneurysm. Aneurysms can be detected by imaging, but screening imaging is not recommended unless there are symptoms or there is a strong family history of brain aneurysms. Over time, the weak spot expands almost like a water balloon. If it keeps expanding, it will eventually reach a breaking point and burst. The causes are largely unknown. Some may be hereditary.

Aneurysms can form anywhere in the body, but brain aneurysms occur in the blood vessels of the brain, usually at the base. Aneurysms tend to form at branching points where blood vessels diverge.

Brain aneurysms affect young and old, rich and poor, those with a family history of aneurysms and those without.

They typically strike without warning, and 50 percent of the time prove fatal, throwing families into shock and sudden grief. Four out of 5 people who suffer a brain aneurysm have no family history of it. There is some indication in the research that smoking puts you at higher risk, and that aneurysms disproportionately affect women.

But no one knows for sure what causes brain aneurysms, which affect up to 5 percent of Americans and result in 30,000 cases of ruptured aneurysms each year.

Symptoms of a brain aneurysm include headaches, double vision, vision changes, seizures or other neurological changes.

The real problem occurs when the aneurysm ruptures.

Patients with a ruptured aneurysm experience bleeding in the brain called sub-arachnoid hemorrhage, which is a type of stroke. Such patients may feel an overpowering “thunderclap” headache. They may die suddenly or be found comatose. When a patient has a ruptured aneurysm, we try to treat it so that it doesn’t rupture again. If it ruptures a second time, there is an 80 percent chance of death.

A devastating disorder

The statistics for this devastating disorder are grim: When a brain aneurysm ruptures, there is a 15 percent chance of death before even getting to a hospital. Of those who survive, there is a 30 to 50 percent chance of permanent disability, ranging from severe brain damage to more mild cognitive difficulties. Many are unable to return to work.

Current research in the field of cerebral aneurysm points to inflammation as a possible cause for aneurysms to arise.

Patients diagnosed with an unruptured aneurysm often learn of it incidentally. Maybe they came in for double vision or headaches. Maybe it was cranial nerve palsy, or, in rare cases, a seizure.

Patients with a diagnosed aneurysm may undergo surgery. This involves opening the skull and pinching off the aneurysm with a metal clip. Or they may receive endovascular treatment, in which I and other surgeons thread a small tube through an artery in the leg all the way up to the brain to fill the inside of the aneurysm with soft packing wires called coils. Or, we place a stent, a metal mesh tube.

My goal is to identify the cause – and to pursue preventative and therapeutic treatments.

Brings back memories of Konrad Reuland

Farquhar’s ruptured aneurysm is a painful reminder of the tragic death of another professional athlete, Konrad Reuland.

As I and others hope for the best for Farquhar, I am reminded of Reuland, whose life became forever linked with baseball Hall of Famer Rod Carew in December 2016. Carew, who needed a new heart, received Reuland’s. Reuland suffered a brain aneurysm on Nov. 26, 2016. He died Dec. 12, 2016.

Medical experts and sports historians believed the surgery that saved Carew’s life to be the first heart transplant operation between two major league athletes. The story of Reuland’s gift and Carew’s recovery touched the hearts of fans across the country.

Reuland’s decision just a few months earlier, as a 20-something who appeared to be the very picture of health, to check the organ-donor box on a driver’s license form changed not only the course of Carew’s life but also those of two other people who received Reuland’s liver and kidney.

Carew, who played for the Minnesota Twins and California Angels and ended his career with 3,053 hits, received the other kidney. Carew had suffered a major heart attack in 2015 and had been placed on a waiting list for a heart transplant.

Carew, whose jersey number was 29, did not know at the time of his Dec. 16, 2016 surgery that he was receiving Reuland’s heart. Reuland’s family did not know who the recipients of the 29-year-old’s organs would be.

But Mary Reuland, Konrad’s mother, figured out the connection between Carew and her son a few weeks later. She had read about the lifesaving heart transplant that Carew received four days after Konrad’s death, and several people had asked her if she thought Carew could have been the recipient. Curious, Mary Reuland called the organ donation network, which matched Konrad’s heart to Carew. She learned that her son’s heart was in fact the one that saved Carew’s life. The families met less than three months later, and Mary Reuland listened with a stethoscope to her son’s beating heart inside Carew’s chest.

Artificial heart gives a baby girl a second chance at life

Alisha Katz's picture
Submitted by Alisha Katz on April 23, 2018 - 16:36

Valeria Ocampo waited eight months for a heart transplant until something miraculous happened. Her heart was strengthening while being on a mechanical heart. On Friday, Valeria became the first patient at UF Health to be weaned off the device and was sent home without the need for a transplant.

This story is a follow-up to “How an artificial heart brought a bubbly baby’s smile back” that was published in January 2018.

For more than half of her life, 15-month-old-Valeria Ocampo lay in her hospital crib and peeked toward her window. On the 10th floor of the UF Health Shands Children’s Hospital, she waited for a new heart to arrive. And waited. For months, Valeria was connected to the Berlin Heart®, an artificial heart device made specifically for babies and children facing heart failure.

But in March, clinicians noticed that part of the device had not been working properly. After performing an echocardiogram, also known as a sonogram of the heart, Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and the chief of congenital cardiothoracic surgery at the UF Health Congenital Heart Center, noticed something unusual. Valeria’s heart was overriding the device. She was improving.

Valeria Ocampo became the first patient in the pediatric cardiac intensive care unit, or PCICU, at the UF Health Shands Children’s Hospital to be weaned off the Berlin Heart® without the need of a heart transplant.

Since August 2017, Victoria Escobar and Carlos Ocampo, Valeria’s parents, had tried to make life at the hospital as routine as possible. Victoria would set scheduled meals and family members would clean surfaces in Valeria’s hospital room as they would routinely at home.

As Valeria’s condition worsened, she was placed on the Berlin Heart® to serve as a bridge to transplantation. After months of waiting for a new heart, doctors were astounded at the progress Valeria was making toward recovery. In fact, Valeria had been meeting all the criteria to wean her off the device at bedside – a procedure that had never been done at UF Health. Bleiweis and his team contacted the Berlin Heart® manufacturer to discuss the planning process for completing such a task.

In early March, clinicians in the PCICU gradually lowered her dependency on the machine and performed an echocardiogram each day to evaluate her heart function. Valeria’s heart performance remained consistent and the process was carried out for two weeks. The team of physicians from the UF Health Congenital Heart Center met frequently to review Valeria’s case. Bleiweis, along with Joseph Philip, M.D., the medical director of the pediatric cardiac intensive care unit; Ahmed Asfari, M.D., a fellow in the unit; Desiree Machado, M.D., a pediatric cardiologist; and Himesh Vyas, M.D., a pediatric interventional cardiologist, were in Valeria’s room to witness the transition.

On March 21, the machine was turned off. Valeria’s heart continued to pump.

“Everyone had red eyes, watery eyes. Everyone was in shock,” Victoria said. “Everything that could’ve been very negative was very positive all the time.”

On April 2, Valeria had the device surgically removed by Bleiweis and his operating team. A surgery that was expected to last hours was completed in just 55 minutes.

“She was reborn. As Dr. Bleiweis said, ‘She’s going to be born again after surgery,’ and that’s exactly what happened,” Carlos said.

“There are no words to describe how Dr. Bleiweis is as a doctor and as a person. We love him forever and ever. He’s our hero,” Victoria said. “We are very lucky that we got to meet him and that he got to work with her.”

“Valeria and her family have touched the lives of our clinicians in many ways,” Bleiweis said. “It has been our privilege to care for Valeria over the past eight months, and to see her achieve milestones, like celebrating her first birthday in the unit. We feel that we’ve become a part of their family and they’ve become a part of ours.”

Valeria and her family were discharged from the hospital 11 days after surgery.

“Our team at the UF Health Congenital Heart Center is beyond thrilled with the progress that Valeria has made while in the care of our pediatric cardiac intensive care unit,” Bleiweis said. “Her and her family’s resilience and hope has resonated with so many congenital heart families. Valeria’s miraculous journey is an example of the exemplary care our team strives to provide on a day-to-day basis to give each child a fighting chance.”

“Our experience at UF Health was amazing,” Victoria said. “I feel like I was hospitalized with her.

“All the staff here is very skilled, very caring,’’ she said. “They treated her as if she was theirs. I really appreciated all of the nurses and the bonds we created with them. We had a great experience if you remove the pain for having her – everything was a great experience. If a parent asks for me advice, just try to live a normal life and try to be near to your baby. We brought home to the room. She never understood she was going through so much.”

UF alum tackles cancer in the heart of the Gator Nation

Alisha Katz's picture
Submitted by Alisha Katz on April 17, 2018 - 04:35

Travis and Gail Rockey

Travis Rockey, 67, and Gail, his wife of 43 years, spend their days in retirement serving others.

"We believe that service to others is a critical part of giving back," Travis said.

In January 2013, Travis decided to retire in June from his position as president and chief operating officer of a privately held media company headquartered in Charleston, South Carolina where he worked for 30 years. One morning, he discovered a swollen lymph node in his neck while shaving. He had it checked out and the diagnosis was sobering: squamous cell carcinoma, a head and neck cancer caused by the Human Papilloma virus, or HPV 16. He moved up his retirement to late April and began cancer treatment in May. Travis finished treatment on Sept. 1, 2013 after three rounds of chemo and 33 rounds of radiation.

Upon completion of his treatment, Travis and Gail took extra precautions to monitor their health by scheduling visits with their primary care physicians and specialists before moving from Charleston to a home they owned in Mount Dora, Florida. Travis and Gail were given the green light until Travis' final appointment with his urologist. Travis' physician noticed that while his prostate-specific antigen, or PSA, a blood test that screens for prostate abnormalities, including prostate cancer, was low and had not changed for years, the physical exam suggested there may be cause for concern. Since Travis and Gail were moving to Florida, Travis' urologist recommended follow-up care by Li-Ming Su, M.D., the David A. Cofrin professor of urologic oncology and chair of the UF College of Medicine's department of urology.

In early November, Travis traveled to Gainesville to meet with Su. During Travis' physical exam, Su identified a prostate nodule. This, in addition to the rise in his PSA test, led Su to perform a prostate biopsy.

On Nov. 22, 2013, Su shared the results of the biopsy.

Travis and Gail Rockey"Dr. Su said, 'The bad news is you have cancer. The good news is you have a Gleason 6,'" Travis said. The Gleason rating system ranks different grades of prostate cancer severity, with 6 being the lowest grade of aggressiveness and least likely to spread. Travis' immediate reaction was that the cancer was spreading. Su assured him that was not the case and that the two cancers were unrelated.

"There's no way to describe what happens to you when a doctor tells you that you have cancer, or as I call it, puts the 'C' behind your name," Travis said. "Your whole world changes in an instant. The things you are thinking and planning vanish. You move to the moment. Even after treatment, when there is no evidence of cancer, every time you have a sore throat or pain, or don't feel good, in the back of your mind you wonder if the cancer is back."

Since Travis was treated at an outside facility for the previous cancer and was making quarterly visits for checkups, he received a second opinion from a radiological oncologist during one of his scheduled visits. After weighing each option for treatment: doing nothing, surgery and radiation, the possible side effects of each and discussing them in depth with Su, Travis elected surgery at UF Health Shands Hospital.

"Mr. Rockey did precisely what all men who are diagnosed with prostate cancer should do. He did his research and even got a second opinion," Su said. "Having already survived cancer once before, Travis knew that gaining a complete and thorough understanding of his treatment options and potential side effects would mentally prepare himself for the journey ahead."

"I just wanted the tumor out so I opted for the surgery," Travis said.

On Feb. 24, 2014, Su performed a nerve-sparing robotic prostatectomy surgery to remove the cancerous prostate gland, while delicately preserving the nerves and surrounding muscles responsible for sexual and urinary function. Travis stayed one night at the hospital and, seven days later, returned to Su's office for a follow-up appointment.

"From a surgical standpoint, it was just what I expected," Travis said. "The margins had not been invaded by cancer. Dr. Su did a terrific job with the surgery. Follow up was excellent. Dr. Su said my prognosis was excellent."

As time moved on, Travis had a six-month and annual checkups for both cancers. He moved into the survivors program at the medical facility that treated his head and neck cancer, and expects to do the same at UF Health in February 2019.

"Travis has done especially well following his surgery, perhaps better than most as not only has he been cured of his cancer, but also his physiological functions have returned back to baseline," Su said.

Since his treatment and diagnoses, Travis has made it a priority to connect with other cancer patients and start a conversation, especially with those who are new to a cancer diagnosis.

"Never let cancer define you, it is just something you have," Travis said. "Look forward, don't look back. Every day is a gift, enjoy it."

Travis and Gail are snowbirds, splitting their time between Gainesville and Flat Rock, North Carolina. Travis shoots trap at Gator Skeet and Trap, volunteers with his Delta fraternity chapter at the University of Florida, is a part of the UF College of Journalism and Communications advisory board - his alma mater, and volunteers with Service Core of Retired Executives, or SCORE. Gail volunteers as a reading tutor and, in 2017, tutored a woman from Colombia to pass an American citizenship exam.

In August 2017, Travis and Gail moved from Mount Dora to Gainesville.

"We moved to Gainesville because of UF Health," Travis said. "It's great to be back in The Gator Nation for the second half of our lives."

"Travis' determination and conviction to overcome two separate cancers is extremely inspiring to me as a physician," Su said. "Moreover, I am moved by his commitment to serve others through sharing his storing and educating others about the importance of prostate cancer screening. He is truly a special patient and individual."

Chronic funny bone discomfort is no fun at all

Jordan Folkes's picture
Submitted by Jordan Folkes on March 30, 2018 - 15:55

The ''funny bone'' that packs a stinging punch after just a simple bump is actually a nerve and not a bone at all. Spanning from the upper arm alongside the inner part of your elbow, the ulnar nerve lets your brain know about feelings in your fourth and fifth fingers. Although "funny bone" sensations can be described as temporary discomfort, chronic pressure or stretching of the nerve can affect blood supply to the ulnar nerve, causing numbness or tingling in the fingers, forearm or hand. This is known as cubital tunnel syndrome.

Ulnar nerve at elbow joint

When symptoms are very severe or not getting better, surgery may be an option to help relieve the pressure. UF Health's own Dr. Harvey Chim, associate professor of plastic and reconstructive surgery in the UF College of Medicine, specializes in this area. He recently had a study on the subject published in the medical journal Plastic and Reconstructive Surgery as the editor's pick for the month.

The study conducted by five physicians from Gainesville to Miami, including Dr. Chim, compared two surgical procedures done to treat cubital tunnel syndrome - open release surgery and endoscopic, surgery - in 655 patients.

In open surgery, the ulnar nerve is released through an 8- to 10-centimeter incision. The study found that the size and shape of the incision may vary and that recovery time can take anywhere from a few weeks to a several months with this procedure. Alternatively, results indicated that endoscopic surgery uses a smaller incision, so it is less invasive. This type of procedure also showed a reduction in nerve handling as well as expedited recovery time for patients and decreased scar discomfort.

"The endoscopic approach is great for patient care because it allows for the decompression of the ulnar nerve through a 2-centimeter incision, which allows patients to recover faster after surgery," said Chim.

If faced with these symptoms, you should begin treatment as early as possible, under a doctor's direction. Cubital tunnel syndrome can be treated through a variety of methods ranging from non-surgical treatments like splinting, over-the-counter medications, or yoga, to surgical methods such as open release and endoscopic surgery. Dr. Chim is the only physician in North Florida who performs endoscopic cubital tunnel release. For more information, visit UFHealth.org/plastics or call 352.265.8402 to schedule a consultation.

UF Health Shands nurses spread beauty, joy, kindness, and positivity

John Kieslich's picture
Submitted by John Kieslich on March 27, 2018 - 12:35

If you look closely around town, you may find beautifully decorated rocks in unexpected places. It might be in a tree or by a potted plant. It might very well have been thoughtfully painted by one of our caring nurses.

As part of the ‘Create in Place’ event for 352Creates, 20 UF Health Shands nurses stations and other services painted more than 400 rocks with messages of positivity and hope as a way to de-stress, have fun and build camaraderie.

‘Create in Place’ happens the second Friday of every month and serves as a reminder that creativity can fit organically into our everyday lives. For ‘Create in Place,’ 352Creates encourages individuals and organizations to do something creative wherever they naturally are — at work, home, school or wherever! It doesn’t have to take much time or cost a lot of money, and research shows you’re healthier for it.

Jennifer Pruitt, R.N.,M.S.N., C.N.M.,ARNP, UF Health Shands Mother/Baby Unit clinical leader, like many other nurse managers, encouraged her staff to participate and put her full support behind them taking the opportunity to take a break and create in place.

“The Mother/Baby Unit absolutely loved being part of this project. The nurses and staff had an amazing time and it gave them a nice creative outlet and de-stressor during their downtime,” Pruitt said. “This was definitely the topic of conversation this week and it was neat to see the creative and artistic talents within our unit.”

Pruitt added that the act of creating art brought her staff closer together.

However, it wasn’t only nurses who participated in the activity. The pharmacy team in the UF Health Shands Cancer Hospital heard about the project and were excited to participate. Bonnie Garland, CPhT, RPhT, UF Health Pharmacy technician, wanted her coworkers to all have rocks to paint so that they could better practice self-care on the job.

“We tell ourselves and others that we’re just too busy to do things that nourish us, whether it’s something fun and creative like this, or going to a yoga class. We don’t take time to take care of ourselves,” Garland said. “But I loved this rock-painting activity because it doesn’t take long, you can do it by yourself and get real contemplative, or you can have fun with it with a group of friends. In the end, you have something beautiful that you can treasure or share with others.”

352Creates celebrates people who incorporate creativity into their daily lives because research supports the health benefits of engaging in the creative process.

For more information about 352Creates, visit 352creates.com, connect on social media platforms, share your activities using hashtag #352Creates and stay tuned for updates on the UF Health Bridge, Shands News and Doctor Gator.

Lungs for Lexi

Alisha Katz's picture
Submitted by Alisha Katz on March 17, 2018 - 09:30

Alexia McCue on her horseNot many teenagers can say they placed first in equestrians at the Special Olympics. Few teenagers can say they had a double-lung transplant, too. Alexia "Lexi" McCue, 13, accomplished both.

Lexi was born on Nov. 1, 2004 with cystic fibrosis, or CF, a life-threatening lung disorder. Her condition worsened as she aged and, at age 7, Lexi was hospitalized in South Florida.

Enter Mary McCue, 74, a medical foster parent of 16 years. After 11 years of working as a pediatric rehabilitation nurse, Mary, a mother of six, had decided she wanted to help medically fostered children. She and her late husband, Bill, had dreamed of starting a medical foster care program. Mary completed the Model Approach to Partnerships in Parentings in addition to a separate training program for working with medical foster children.

One day, Mary received a phone call from the hospital about a child who needed to be placed in a medical foster care home. "They [the hospital] said, 'You've got to come meet Lexi,' and the next day I went down and got her," Mary said.

When Mary first met Lexi, the girl weighed only 30 pounds, had a feeding tube and wore toddler-sized clothing. Mary and Bill took in Lexi without hesitation, and started her on oxygen the first night in their care.

Growing up with the couple in Coral Springs, Florida, Lexi went to school for first through third grade while carrying around her oxygen tank. In time, Lexi's body weakened and she was taken out of school and enrolled in hospital/homebound education.

Mary continued to transport Lexi to appointments close to home and would bring Lexi back-and-forth from South Florida to UF Health in Gainesville to see a lung transplant specialist. Initially, Pamela Schuler, MD, the former medical director for UF Health's cystic fibrosis program and pediatric lung transplant program, would see Lexi for many years. After Schuler's departure, Lexi would be under the close eye of Michael Tsifansky, M.D., a pediatric pulmonologist and medical director for the UF Health Pediatric Lung Transplant program. The family had no other option in Florida but UF Health to seek a transplant.

In 2015, Lexi's breathing had become so shallow that simple tasks like walking felt impossible. She had to be placed on the lung transplant waitlist. Mary and Lexi uprooted from Coral Springs and moved to transplant housing in Gainesville where they would wait for a call that her new lungs had arrived.

Five times, Mary and Lexi received a call, but none of the lungs were a perfect match.

"Each time, we'd be at the hospital for 12 or 13 hours, but they'd say, 'Not for Lexi.' They wanted to find the perfect match," Mary said. "Lexi was extremely positive. She knew what was going to happen."

The sixth time was a charm. On March 10, 2016 at midnight, Lexi was taken to surgery by Tiago Machuca, M.D., Ph.D., a thoracic surgeon and surgical director of the UF Health Pediatric Lung Transplant Program, and Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and chief of congenital cardiothoracic surgery at the UF Health Congenital Heart Center. The surgery was a success.

At 6 a.m., Mary was called to the pediatric cardiac intensive care unit, or PCICU, to see Lexi. Nearly 15 clinicians filled Lexi's room.

"They said, 'Now she needs you, go talk to her'," Mary said.

Five hours after her surgery, Lexi had the strength to be extubated, the process of removing a tube from the trachea, a procedure that typically takes two days. By the following day, Tsifansky had her walking on the treadmill. Lexi's recovery in the PCICU lasted less than two weeks.

Since her transplant, Lexi and Mary relocated to Williston, Florida where they live with their two cats, Cleopatra and Chloe, and their black-and-white dog, Lola. On July 26, 2016, Mary formally adopted Lexi as her daughter.

"The first time I saw her run, I was in tears," Mary said. "She was chugging along and grabbing her tank before. She was on oxygen 24/7."

Lexi has also developed a talent for horseback riding. In September 2017, a cashier at their local Winn-Dixie grocery store introduced Lexi to the idea. Since then, Lexi has been training at Tomorrow's Equestrian Center, a therapeutic riding program designed for children and adults with disabilities in North Central Florida.

"She goes up to the horses and talks to them," Mary said.

On Feb. 10, Lexi competed in her first regional equestrian Special Olympics. She received two blue ribbons and first place in equitation and trailing categories. Now, she trains for the Florida Special Olympics, which will take place at Lake Mary at the end of March.

When she's not riding, Lexi teaches herself guitar on her iPad and listens to some of her favorite music, including Green Day and My Chemical Romance.

The life of a transplant patient often includes another new organ during their lifetime. Until then, Lexi will continue to take daily rejection medicines, walk on the treadmill and see a pulmonologist to monitor her condition. All of this is in addition to mastering her next equestrian trick: jumping.

Four Tips for Saving Your Vision!

Jordan Folkes's picture
Submitted by Jordan Folkes on March 15, 2018 - 14:49

Close-up of a woman's eyes

March is “Save Your Vision” month, and now is a great time to learn how you can do more to protect your eyes. At UF Health, we want you to understand the importance of maintaining good eye health and how the impact of everyday activity affects our vision over time. With help from the American Optometric Association, The Vision Center, and physicians at the UF Health Eye Center, here are some tips that we can all use toward protecting and promoting our eyes for the future.

Get a Comprehensive Eye Exam

Comprehensive eye exams are key to knowing the health of your eyes. Professional eye care services offered by our physicians can let you know whether or not someone needs glasses, contact lenses, or corrective procedures to see better. Aside from general vision troubles and getting them corrected via eye examinations, dilated eye exams are the only way to detect common eye diseases such as glaucoma, diabetic eye disease and other age-related macular degeneration.

“Our vision is one of our most valuable senses,” said Matthew Gray, M.D., an ophthalmologist at the UF Health Eye Center who specializes in corneal and external ocular diseases, and refractive surgery. “A sizeable portion of the population, especially those over age 65, have some degree of visual impairment that can either be treated or could have been prevented. Early detection of eye disease by having a routine eye exam is the most reliable way to preserve your vision.”

Eat the right foods for eye health

The fabled tale about carrots helping our vision does not stray too far from the truth. Carrots are rich in beta-carotene and Vitamin A. Lack of Vitamin A leads to cataracts and even blindness in many cases. Eating a diet rich in fruits and vegetables has been heavily regarded through research as a good way to keep the eyes healthy.

Wear protective vision

We have learned through living in heat-intensive states in the South that the rays of the sun are no joke. Just as we use sunscreen to protect our skin from the powerful rays, sunglasses are not a fashion accessory but important tools for protecting our eyes from the sun’s ultraviolet rays. Be sure to purchase sunglasses that block out 99 to 100 percent of UVA and UVB radiation.

Other protective vision include safety glasses and eye guards when doing work that requires your eyes to be shield from chemicals or debris. Not only do you want to be sure to wear these things to protect your vision in the moment, you want to ensure that your eyesight will last as long as possible and not disappear in the blink of an eye.

Spend less time looking at screens

According to The Vision Council, “More than 83 percent of Americans report using digital devices for more than two hour per day and 53.1 percent report using two or more digital devices simultaneously, with 60.5 percent reporting experiencing symptoms of digital eye strain.” Modern cellphones and laptops are being updated to have features that aid our eye health over time such as “night mode” to reduce blue light. Digital eyestrain affects all ages and can be reduced through a variety of methods. For example, using preservative-free artificial tears available over the counter; following the 20-20-20 rule, which consists of taking a 20-second break from the screen every 20 minutes and looking at something 20 feet away; and increasing text size on devices to better define content on the screen.

Plastic Surgery Myths Vs. Facts

Jordan Folkes's picture
Submitted by Jordan Folkes on March 14, 2018 - 10:53

Plastic surgery is a field of medicine and surgery that includes treatments that restore, reconstruct or refine aspects of people’s appearance. The procedures are done to restore function or to affect appearance to improve people’s lives for personal reasons. Entertainment and the media portray plastic surgery as a surgery for the rich, who live glamourous lives and seek changes based on trends. Although this may be true in some cases, it is not true for many who seek the changes for medical or emotional reasons. The public perception of plastic surgery is clouded by a lot of myths. Here are five things you should know!

Myth: The term plastic surgery comes from the use of implants and other synthetics materials.

False!

The term plastic surgery derives from the Greek word “plastikos,” which means to shape or to mold. General plastic surgery procedures involve manipulating and moving around tissue to suit a specific purpose. The word plastic was first used to describe a specialty of surgery in 1837, but the practice dates back to around 3000 B.C., documented in ancient Egyptian medical texts.

Myth: All plastic surgery procedures are invasive.

False!

Many cosmetic procedures can be noninvasive, including botulinum toxin type a, or Botox; chemical peels, or CoolSculpting. Botox can be used to treat crow’s feet, forehead creases, frown lines, skin bands on the neck, while chemical peels can help improve acne or acne scarring, fine lines and wrinkles, pigmentation problems and rough or sun-damaged skin. CoolSculpting is the only FDA-cleared, nonsurgical procedure that safely targets and eliminates diet- and exercise-resistant fat.

Myth: Plastic surgery may be covered by insurance

True!

Reconstructive surgery is usually covered by insurance. This surgery is defined by the restoration, recreation and reforming of aspects of physical appearance and function that have been affected by development, growth, disease or trauma. Reconstructive surgeries include breast reduction and reconstruction related to breast cancer, skin cancer, and trauma, as well as nose surgery for obstructed breathing, hand and peripheral nerve surgery and more.

Myth: There is an age cut-off for having plastic surgery.

False!

Though age is a consideration and should be something that patients look into before undergoing any procedure, the overall health and fitness of an individual is most important. Plastic surgery has been used in a wide variety of ages for either cosmetic or medical reasons.

Myth: The Florida Board of Medicine does not have regulations or rules that specifically govern services that doctors offer.

True!

Any physician licensed in Florida is able to legally treat patients in the state. With that said, UF Health physicians advise patients to know the certifications of their potential doctors. The American Board of Plastic Surgery has been around since 1937 and has issued more than 9,920 certificates to plastic surgeons who “have met high standards in training requirements and successfully passed the examinations covering the breadth of plastic surgery.” Being safe and knowing your options are always key factors in determining the potential for success for your surgery.

All of our physicians are board-certified plastic surgeons with credentials provided by the American Board of Plastic Surgery. The UF Health Plastic Surgery and Aesthetics Center offers a multitude of services from aesthetic care to surgical procedures. Our center offers numerous nonsurgical cosmetic treatment such as Botox, CoolSculpting and laser hair removal to name a few. Our physicians also offer surgical procedures consisting of body contouring, facial surgery, breast procedures and more. For more information, visit UFHealth.org/plastics or call 352-265-8402 to schedule a consultation.

Prevent and Protect Yourself from HPV

Submitted by on March 2, 2018 - 15:28

2018 HPV Awareness Day is March 4

This year, the University of Florida Health Cancer Center is recognizing March 4, International HPV Awareness Day, by equipping you with the information you need to protect yourself from this infection, which causes 30,700 cases of cancer in the U.S. each year.

What is HPV?

Human papillomaviruses, or HPVs, are a group of more than 200 related viruses that are spread through sexual contact. Most types are not harmful. According to the Centers for Disease Control and Prevention, nearly every sexually active person will develop some form of HPV in their lifetime — but in nine out of 10 of those cases, the virus will not show any symptoms and will go away within two years. There are times, however, when certain types of the HPV virus can progress to cancer.

Infections caused by HPV:

  • Cervical cancer: Almost all cases of cervical cancer are caused by HPV.
  • Cancer of the anus: About 95 percent of anal cancers are caused by HPV.
  • Cancers of the mouth, tongue and throat: About 70 percent of oropharyngeal cancers are caused by HPV.
  • Vaginal and vulvar cancer: About 65 percent of vaginal cancers and 50 percent of vulvar cancer are caused by HPV.
  • Cancer of the penis: About 35 percent of penile cancers are caused by HPV.
  • Genital warts: About 90 percent of genital warts are caused by HPV.
  • Warts in the throat: Two types of HPV can cause benign tumors to grow in the air passages leading from the nose and mouth into the lungs.

HPV also causes the most common cancer, oropharyngeal squamous cell carcinoma. This head and neck cancer has increased by 300 percent in the past 20 years, according to a recent study by Ashish Deshmukh, Ph.D., MPH, an assistant professor in the department of health services research, management and policy at the University of Florida.

Fortunately, there is an effective vaccine against HPV; unfortunately, however, recent data shows that only 57 percent of girls and 35 percent of boys have received the vaccine, according to the CDC.

In the past, HPV was considered particularly threatening to women. However, one of the most high-risk strains of HPV, HPV 16, is seven times more common among men than women, Deshmukh said in a recent interview with CBS. Researchers also found that one in nine men in the U.S., or 12 percent, have an oral infection of the virus, compared to only 3 percent of women.

Researchers are unsure why the oral HPV rate is so much higher in men than in women, but there are ways to protect yourself and your loved ones from the virus and prevent its spread.

How do you protect yourself and your loved ones from HPV?

Vaccines

According to the CDC, vaccines are very effective and can prevent most of the cancers caused by HPV.

Experts say boys and girls between the ages of 11 and 12 should receive both doses of the vaccine six to 12 months apart. If they received their two shots less than five months apart, they will need a third dose of the vaccine. If your child is over 14 years old, he or she should receive three shots over six months.

If your teenager has not gotten the vaccine, you should consult a doctor or nurse about getting it as quickly as possible. In addition, if your teen did not finish the vaccine series, he or she should complete it now.

The HPV vaccine is recommended for men who are aged 21 years and younger. If they have sex with other men, it is recommended they receive the vaccine through age 26. This also applies to transgender young adults. Women should receive the vaccine through age 26.

These ages are recommended for maximum vaccine effectiveness. According to the CDC, clinical trials indicate that after these ages, the vaccine provided little to no protection to HPV-related diseases. If you are over these ages and want to receive the vaccine, it is possible, but it may not be covered by your insurance provider.

Screening

Another way to protect yourself from the harmful effects of HPV and cervical cancer is to screen regularly — which means to check for HPV or HPV-related diseases before there are any symptoms. Beginning at age 21, women should receive a Pap test every three years. This can help diagnose cervical cancer early. Women can also pair it with an HPV test, which can find any of the high-risk types of HPV that are commonly found in cervical cancer.

Currently, there is no approved test for HPV in men and screening is not recommended by the CDC for anal, penile or throat cancers. However, men who may be at increased risk for anal cancer, including men with HIV or men who receive anal sex, may be eligible for an anal Pap test and should ask their health care provider. Lastly, see a health care provider if you have any new or unusual growths, lumps or sores on your penis, scrotum, anus, mouth or throat.

For more information on how to protect yourself from HPV, talk to your health care provider or visit our HPV Vaccine health topic page.

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The inside scoop on flu vaccines: Addressing myths about the flu shot

Nicole Iovine's picture
Submitted by Nicole Iovine on February 26, 2018 - 11:55

Every autumn, we start to hear the buzz about getting a flu shot. As an infectious disease specialist and hospital epidemiologist at UF Health, that’s also when I hear a lot of questions about the flu shot. There is a lot of misinformation about flu vaccination, so I will try to demystify it by going through the two most common misconceptions that I hear.

Here they are:

“The last time I got the flu shot, it gave me the flu.”

This statement is a good example of what we call in medicine “true, true, unrelated.” It means that it may be true that you got the flu shot, and it may be true that you got the flu, but those two events are not related to each other. The simple fact is that the flu shot contains only killed virus. There is no live virus in it that could begin to multiply to cause the flu. So how could you develop flu soon after getting the flu shot? Let’s say you were vaccinated against flu on Dec. 10, and then on Dec. 12, you develop fever, cough, runny nose and body aches. You are tested for flu, and the test result is positive. The reason you got the flu is that you were already infected with the flu virus when you got the flu shot. You were going to get sick no matter what! It takes about 14 days to develop a full immune response to the shot, so you were not yet protected on day two after vaccination. Also, the “incubation period” for flu is five days. That means that you could have been infected with flu as early as Dec. 8. Here’s a really interesting fact: A person can transmit the flu to another person a full 24 hours before developing any of their own symptoms. So, you might have no idea from whom you contracted the flu because he or she may have appeared perfectly healthy.

“I heard that this season’s flu shot doesn’t work.”

This statement is a good example of over-extrapolation. It stems from “vaccine efficacy” or “VE” studies aimed at determining how many flu infections are prevented by vaccination. These studies do not provide information about the severity of illness in vaccinated people who do come down with the flu. Many studies have shown very important benefits of flu vaccination, such as reducing hospitalizations, reducing ICU stays, protecting babies from flu after birth when their moms are vaccinated in pregnancy and reducing cardiac events in people with heart conditions, to name a few. Returning to the VE studies, it is important to know that there is a separate VE for each flu strain, of which there are four in total. Each flu shot contains either three or four flu strains: So, even if the VE is lower for one of the strains, it is usually a lot higher for the other ones. This is the case for this year’s flu VE.

I hope I’ve convinced you that the flu shot is a very important tool you can use to maintain good health and protect against severe illness. The protections it offers include a decreased chance of getting the flu, a more mild course if you do get infected and a decreased chance of transmitting the virus to others. Finally, it is still not too late to get vaccinated, so GET VACCINATED!

At UF Health, we’re committed to helping keep our community healthy and safe. We appreciate everyone’s help in sharing information — and reducing misinformation — about flu this season. Please visit us on the web to learn more about flu prevention and our visitor guidelines this flu season.

Photo by Kelly Sikkema on Unsplash

Zika virus likely transmitted through breast milk, report finds

Evan Barton's picture
Submitted by Evan Barton on February 20, 2018 - 14:39

Baby with mother

Mothers infected with the Zika virus may be able to transmit the virus to newborn infants through breast milk, according to a recent report authored in part by a University of Florida researcher.

A team of scientists based in the United States and Venezuela identified infectious Zika virus in the plasma, urine and breast milk of a mother in Venezuela and in the plasma and urine of her child, who was exclusively being breastfed. Genetic sequence analyses revealed the same Zika virus strain was in both the mother and her child. The findings were published in December 2017 in the journal Clinical Infectious Diseases.

Although the mother showed symptoms of Zika fever, in her child the infection was asymptomatic. Both experienced the infection concurrently, however.
“Some viruses are infectious in breast milk,” said John Lednicky, Ph.D., a virology professor in the UF College of Public Health and Health Professions and a member of the UF Emerging Pathogens Institute. Lednicky is a senior author of the report.

“For those viruses, a breastfeeding child can acquire active infections upon ingestion of the milk,” he added.

While the investigators cannot prove that the mother passed Zika virus to her child, Lednicky believes this scenario to be very likely since the viral strains found in both the mother and the child’s fluids were nearly identical.

The mother hailed from Barquisimeto, Venezuela, a city in the northwestern region of the country, less than 300 miles from the Colombian border. The fluid samples analyzed by the scientists were taken just a few days after the mother’s initial doctor’s visit in March 2016. At the time, officials in Colombia were aware of the Zika epidemic within their borders but the prevalence of the virus in Venezuela was unclear. According to the report, the child spent most of its time indoors in a screened, air-conditioned home, thus reducing the probability of mosquito-borne transmission of the Zika virus.

In addition to providing evidence of Zika virus transmission through breast milk, the report offers further proof of the viability of the virus in breast milk.

“At the time the work was started, it was not known if Zika virus was infectious in breast milk.” Lednicky said. “Moreover, we wanted to see if Zika virus would be more prevalent in particular components of breast milk. It appears that the virus was more prevalent in the lipid component.”

To read the report, titled “Evidence for Mother-to-Child Transmission of Zika Virus Through Breast Milk,” visit the Clinical Infectious Disease website.

Successful spine surgery has patient living pain free

Nickie Doria's picture
Submitted by Nickie Doria on February 8, 2018 - 13:08

Sharon MeeksSharon Meeks has spent her life taking care of her family. She and her husband were married for 55 years. They raised three children and worked hard on their 107-acre cattle farm in central Florida. Hearing Sharon’s story, you might never guess that she was plagued with adult scoliosis for more than a decade.

Sharon had surgery many years ago to treat a routine spinal problem. The surgery was successful, but over time, her condition continued to worsen. Her posture curved. She was involuntarily leaning to one side and arching forward. This shift in stance was causing her terrible hip and back pain. She couldn’t walk. She could barely stand long enough to do normal activities like prepare a meal. The progressive deformation of her spine was debilitating. Her primary physician told her that if she didn’t do something to correct this problem, she would be confined to a wheelchair within 12 months.

So, Sharon, now 75 years old, did something.

Her son, Sanford, had studied at the University of Florida College of Medicine and worked with several faculty members in the department of neurosurgery. He knew his mom needed a level of care that might not be available in their local community. So, he encouraged his mother to see Daniel J. Hoh, M.D., a UF Health neurosurgeon and assistant professor in the department of neurosurgery, to determine if there was a potential cure for her complex spinal condition.

Dr. Hoh is experienced in complex spinal procedures, including scoliosis surgery, and has performed more than 1,000 spinal operations in his time at UF Health. He evaluated Sharon, identified that she had adult onset scoliosis and determined she was an ideal candidate for scoliosis correction surgery. After several in-person meetings with Dr. Hoh and with the support of her family, Sharon decided to proceed with an operation.

Sharon’s all-day surgery involved several intricate steps. Dr. Hoh had to remove the spinal instrumentation from her prior surgery. Then, he performed multiple osteotomies – procedures that involve carefully placed wedge cuts in the vertebra to increase the flexibility of the spine. Once the spine was correctable, he was able to directly manipulate the spinal column to restore it back to normal alignment, thereby reversing the underlying scoliosis. Finally, the operation involved inserting new spinal instrumentation across multiple levels to stabilize the newly re-aligned spine.

“I heard there were more than 25 people in the waiting room praying for me,” Sharon said. “I had so much support from friends, people from church and my family.”

Dr. Hoh said in the past, people like Sharon might not have been considered good candidates for this kind of surgery.

“Traditionally, surgeons may have considered cases like Sharon’s inoperable because either the spinal deformity was too complicated, or they considered the patient’s age to be too high of a risk for surgery,” Dr. Hoh said. “But now, with advances in current medicine, we have better surgical techniques, spinal implant technology, anesthesia, critical care, therapy and rehabilitation – all of which open the possibility of potentially life-improving surgery for people who previously were without hope.”

According to Dr. Hoh, many patients who were once told that they suffered from “failed back syndrome” and that no corrective options existed, may in fact have treatable underlying adult scoliosis. With better recognition of this increasing age-related problem, both conservative and surgical treatment options may be available for some of these individuals.

“I didn’t want to be in a wheelchair. I wanted to be up doing things with my children and my friends,” Sharon said.

Dr. Hoh said recent research has shown that in carefully selected patients, adult scoliosis correction surgery can significantly improve pain and quality of life. More importantly, surgeons are learning how to use advanced preoperative imaging to individually tailor the surgical technique and achieve the optimal spinal alignment and best, postoperative result for each patient.

After surgery, Sharon worked diligently through physical and occupational therapy. She is happily back to living an active life on her farm. She is busy with her church group, and she’s able to shop for hours with her daughter – all of the activities that she loved doing, and was unable to do before the surgery.

“It’s like a miracle,” she said. “I can walk. That’s the biggest result from the surgery. I can walk, and I have no pain.”

Dr. Hoh and his team believe in providing specialized, individualized spine care – which means matching the right surgery for the right patient, particularly when it comes to correcting adult scoliosis.

“Everyone is unique. It’s as if everyone has their own individualized spinal blueprint,” he said. “For every patient, our goal is to tailor the ideal operation to achieve the best possible outcome.”

Five innovative ways UF Health physicians approach congenital heart care

Billie Arnett's picture
Submitted by Billie Arnett on February 7, 2018 - 09:00

Baby with a felt heart

From Feb. 7 to 14, UF Health recognizes Congenital Heart Defect Awareness Week, to raise awareness of the most common type of birth defect found in newborns. At the UF Health Congenital Heart Center, specialists use innovative methods to improve the lives of pediatric and adult patients. Services range from bridges transplantation, advanced imaging and ventricular assist devices. Here is a guide to some of the latest advancements in congenital heart care being used at the center:

Single ventricle home monitoring program – iPad app

Congenital heart condition: single-ventricle defects, such as hypoplastic left-heart syndrome

The UF Health Congenital Heart Center began a program to improve patient-to-physician communication in 2017. Caregivers of patients with single-ventricle defects are instructed to use an app to report their health to nurses and doctors. This app allows caregivers to monitor and record their child’s condition in real time. Vital signs and other updates are then sent to a clinical portal through the app. As a result, the congenital cardiology team can see subtle, day-to-day changes in a patient’s state. Thanks to this system, caregivers spend less time waiting for returned phone calls or emergency doctor visits. By catching dramatic changes early and needing less co-payments, the app also saves families money.

3-D printing

Congenital heart conditions: many

3-D printing is becoming more and more common within the medical arena. UF Health surgeons have been implementing this trend in numerous fields including pediatric cardiology and heart surgery. By creating 3-D models of organs including the heart, medical teams can view the organ from all angles. This tool is used more commonly in patients with complex conditions that require the organs to be looked at from. One example of this was when surgeons needed to carefully plan the separation of a pair of conjoined twins’ heart.

Melody® transcatheter pulmonary valve

Congenital heart condition: aortic stenosis

Melody® transcatheter pulmonary valve replacement helps a patient’s damaged aortic valve, a valve between the left ventricle and the aorta. The minimally invasive procedure is seen as revolutionary in narrowing aortic valves in children and young adults, and is a way to void open-heart surgery. As a result of the procedure, the new valve prevents the aorta from overworking to push blood through a once-narrow valve.

Berlin Heart®

Congenital heart conditions: cardiomyopathy, end-stage heart failure

The Berlin Heart® ventricular assist devices, or VADs, was designed specifically for infants and children facing heart failure. The device helps the heart pump blood from one of the main pumping chambers to the rest of the body or to the other side of the heart. These pumps may be implanted in the body or connected to a pump outside of the body. UF Health Shands Children’s Hospital was the first hospital in Florida to implant a Berlin Heart® in 2007.

SynCardia Total Artificial Heart®

Congenital heart condition: end-stage heart failure,

When a patient’s condition is severe enough, doctors need to waitlist the patient for an organ donation. The SynCardia Total Artificial Heart® works like a human heart transplant. The device replaces both failing heart ventricles and the four heart valves. This eliminates the sources of end-stage biventricular heart failure. Unlike a human-donor heart, the Total Artificial Heart is immediately available and even portable. It is the only FDA-approved artificial heart.

How an artificial heart brought a bubbly baby’s smile back

Billie Arnett's picture
Submitted by Billie Arnett on January 29, 2018 - 13:48

Valerie Ocampo and family. Photos courtesy of Perfect-photos.com.

Valeria Ocampo giggles and babbles as most babies do. She likes to play with her toy giraffe and rattle. What separates her from other babies is she does these things now with the help of an artificial heart.

On Jan. 6, 2017, Valeria was born in Orlando without complications. Her mother, Victoria Escobar, explained that her pregnancy also was normal and she greatly anticipated the arrival of her second child. But at 7 months old, Valeria was diagnosed with cardiomyopathy, a heart muscle disease that enlarged her heart. Doctors at the UF Health Shands Children’s Hospital implanted a Berlin Heart®, an artificial heart device made specifically for babies and children facing heart failure.

Difficulties began when Valeria was 5 months old. Victoria and her husband, Carlos Ocampo, noticed Valeria’s irregular breathing and eating patterns. They suspected at first that her food aversion was related to a recent vaccination but, at an Orlando hospital, pediatricians wanted to rule out a muscular or neurological problem. After several inconclusive tests, a gastroenterologist referred Valeria’s parents to a cardiologist.

At 7 months old, Valeria’s echocardiograph revealed a heart defect and she was admitted to the Orlando hospital on the same day as she was diagnosed. Doctors discovered that her aorta had a coarctation, or narrowing, and was overworked while trying to regulate blood rushing back toward the heart.

Valeria’s symptoms worsened suddenly after she was admitted and the family needed a heart failure specialty team that would act quickly. Her heart condition left her pale, skinny and constantly sweaty. Her food aversion caused her to be fussy, Victoria said.

At the recommendation of her physicians, Valeria was transferred by ambulance to the UF Health Shands Children’s Hospital’s pediatric cardiac intensive care unit in Gainesville where F. Jay Fricker, M.D., the medical director of the UF Health Congenital Heart Center and a pediatric cardiologist, kept a close watch on her.

“When we came here [pediatric cardiac intensive care unit], it was so relaxed. They deal with this more often so they know what to do,” Victoria Escobar said.

After running multiple tests and observing Valeria’s condition, Fricker explained to the family that she would need a heart transplant.

“Dr. Fricker said, ‘I’m so sorry but we’re going to have to list her now’,” Victoria Escobar said. “We were in shock. It was very hard to digest.”

On Aug. 25, Valeria was listed for a heart transplant.

Later that same day, Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and the chief of congenital cardiothoracic surgery at the UF Health Congenital Heart Center, met with Victoria and Carlos to explain a procedure that would serve as a bridge to Valeria’s transplant. The device, known as a Berlin Heart®, was a mechanical heart that would sustain Valeria until her new heart arrived.

“In my mind, I was dreaming this isn’t true – maybe she will heal,” Victoria Escobar said.

Five days later, Valeria received the artificial heart and started the next stage of her journey. She responded well to the procedure and anesthesiologists told her mother that her color returned minutes after she received her Berlin Heart®. Shortly after Valeria’s surgery, Victoria met with a representative from the Berlin Heart® supplier who was visiting the hospital. As fate would have it, Hurricane Harvey had almost interfered with the delivery of parts to the hospital but it seemed like everything was timed perfectly, Victoria said.

Valeria’s battle did not end there, though. Nurses noticed Valeria was rejecting her pacifier and making grunting noises. A team of intensive care clinicians rushed in and detected and treated her for a collapsed lung.

Since then, Valeria’s health has steadily improved and strengthened. Her family has tried to normalize their stay in the hospital as much as possible by sticking with routines. For instance, Victoria is closely involved with scheduled meals for Valeria, which creates a comforting routine for the baby. Family members have even brought in their own cleaning supplies so they can clean toys and surfaces as they would routinely at home.

In addition to routine, the family also continues to celebrate joyous occasions. Valeria’s grandmother traveled from Madrid, Spain to the UF Health Shands Children’s Hospital to celebrate Valeria’s first birthday. Now hanging next to Valeria’s crib in the unit are tiny formal dresses she wore on her first birthday photoshoot. Maintaining “good vibes” around the baby and hospital room has helped the family cope with this roller coaster, Victoria said.

“I don’t want her to have memories as an ill and very sick child,” Victoria Escobar said. “I want her to remember that we always wanted her to be happy and healthy, and to try to have a life as normal as possible.”

A Tough Ride

Submitted by Katrina Ciccarelli McAfee on January 3, 2018 - 09:00

For cystic fibrosis patient and lifelong cyclist Peter Kavanagh, it’s all about adaptability. That’s why a month after receiving a lung transplant at UF Health Shands Hospital in January 2017, he was back on his bike.

At a young age, Peter was diagnosed with cystic fibrosis and since then, he’s been in the hospital 70 times. For him, living with the disease meant that he always had to work extra hard at everyday tasks.

“It’s an invisible disease sometimes,” Kavanagh said. “Many people don’t understand what it takes to live with cystic fibrosis. There’s a lot of stuff that I’ve missed out on and it put a toll on me.”

Peter was 19 years old when he had his first transplant evaluation and wasn’t sure if he was ready for the procedure. He held off as long as he could, but his health started to decline.

“He was getting sick really fast and that’s when the entire team got together and we started to anticipate scenarios,” UF Health Lung Transplant Surgical Director Tiago Machuca, MD, PhD, said. “We decided to perform the lung transplant. His operation was challenging in terms of dissecting the lungs from the chest wall and from all of the repeated infections and the inflammation.”

Although it wasn’t an easy recover, Peter was resilient.

“We could see that he was really committed to his recovery,” Machuca said. “He was extremely compliant and full of energy.”

After a month, Peter was back on his bike, even though people told him that it was too soon. Since he’s started cycling again, Peter has ridden several hundred miles.

Since his recovery, Peter has focused on giving back whether if it’s through donating masks to transplant patients, participating in “Walk for Wishes” for the Make-A-Wish Foundation or serving as support for patients who are going through lung transplants.

“If I’m in a position to give back, I will.”

Lung transplant patients like Peter will now benefit from our newest facility opening, the UF Health Heart & Vascular Hospital, where heart and lung transplants will be performed. These patients will also been seen for follow up surgical appointments at the new UF Health Surgical Specialists practice on the first floor of the new hospital.

Read more about this new facility and view a 360-degree tour of the building. or learn more about our lung transplant program.

Tips for a Healthier You in 2018

Submitted by on January 1, 2018 - 09:00

It’s a new year, and for many, that means new goals. Each year, millions of Americans make New Year’s resolutions that they forget or fail to keep up by February. At UF Health, we want you to be your healthiest and happiest while understanding what is best for your health. UF Health Family Medicine – Jonesville physician James Medley, M.D., offers six steps to help you keep up with your New Year’s goals and make sure you are your healthiest in 2018.

  1. Get quality sleep

Sleep is for more than just feeling well-rested throughout the day. Quality sleep for the recommended amount of time can improve your focus, self-control and your immune system. It is recommended that the average adult gets on average seven to nine hours of sleep a night and keeps a consistent sleep schedule throughout weekends and holidays as well.

  1. Make time for exercise

Not only does exercise keep the heart healthy it helps with fighting anxiety and depression, attention, self-control and can even help you feel more awake during the day. It’s recommended that you spend 150 minutes each week doing moderate-intensity exercises such as brisk walking, swimming and running. It’s important to remember to slowly increase exercise to avoid injury and to speak with a doctor about starting a new exercise program if you have diabetes or a heart condition.

  1. Mind the beverages 

If you’re looking to carry a drink with you throughout the day, it’s best to stick with a bottle of water. Electrolyte beverages, such as Powerade® or Gatorade®, are only necessary if you’re exercising strenuously for long periods of time and sweating profusely. These beverages and drinks such as fruit juice can be considered “healthy” but can really just be fruit-flavored sugar water. If you’re a coffee or tea drinker, try adding less milk, cream and sugar to these drinks and you may find that you’ll grow to like them even more.

  1. Put down the sugar 

We all love the occasional sweet treat, especially during the holidays, but avoiding sugar can really contribute to you living a healthier lifestyle in the new year. Sugar is addictive and the more you eat, the more your body with crave it. Learn to cook with more “sweet” spices, such as cinnamon, cloves, nutmeg and you may realize you’ve been missing out all along.

  1. Pay attention to what you’re cooking with

It’s no secret that there are hidden sugars, carbohydrates and saturated fats in foods. When cooking, keep in mind that what you put in your food can really make a difference in your health. When a recipe calls for butter, try a healthier substitute such as walnut oil or canola oil. Remember that not all oils are the same when it comes to cooking. Some, like olive oil, break down at lower temperatures and can create unhealthy compounds, but they can also be great for flavoring vegetables or in salad dressings.

  1. Watch out for fads

Don’t believe everything you see in ads and on TV. Soy everything, gluten-free and a dairy-free diet have been known to be promising for losing weight, but unless you have a medical reason to avoid these foods, it may be hurting your wallet and be unhealthy to you. Organic and “non-GMO” foods have not been shown to provide health benefits over their mainstream counterparts and some may be a trick to charge more for the same item. Instead, focus on buying fresh or frozen foods, which tend to have more nutrients than cooked or canned foods. 

Songs from the Heart

Tyler Francischine's picture
Submitted by Tyler Francischine on December 22, 2017 - 12:26

UF Health Shands Arts in Medicine artist-in-residence creates album with pediatric patients

Swaying underneath bright lights, Ricky Kendall holds the neck of his guitar with one hand and points into the crowd with the other.

“Anyone out there with a big imagination?” he asks.

A little girl in a big fluffy dress jumps into the air. “Me! Me!” Nearby, a toddler totes a plastic hoop that towers over her, and a young Spider-Man bounces her body to the beat, nearly missing her mouth with giant spoonfuls of ice cream.

The audience for this concert, held Nov. 17 at Heartwood Soundstage just south of downtown Gainesville, is younger than usual for Kendall. That’s because it’s a celebration of Kendall’s latest release, “Thankful for Love,” an album co-written between 2013 and 2014 with pediatric patients at UF Health Shands Children’s Hospital.


“Thankful for Love” is available on CD with a $20 donation to Brianna’s H.O.P.E. Fund. Donate here.


As an artist-in-residence with the UF Health Shands Arts in Medicine program, Kendall spends much of his time with patients of all ages performing tunes and creating music and visual art. This album, however, is so much more than a collection of songs. It’s an affirmation of the power of love in healing both body and soul.

“I tried to write in veins that would speak to several emotional stops during a hospital stay,’’ Kendall said. “These kids who are going through terminal illnesses or organ transplants are asking existential questions that most kids don’t have to consider.’’

Many of the album tracks retain the upbeat melodies and relaxed rhythms omnipresent in children’s music, he said, but the lyrics go deeper than that. He hopes families going through tough periods of illness will listen to the songs together.

“On this album, there’s silliness and there’s sadness,’’ Kendall said. “But in the sadness, there’s hope. I want this music to help alleviate the difficulty of processing this deep information for both children and their parents.”

Kendall hopes listeners gain a sense of the power of human connection that can occur within a health care setting.

“Kids get a lot of care here, but oftentimes that story doesn’t make its way out of the hospital,” he said. “This is a way to tell their story outside of those walls through music and art.”

A song unfolds

The day “Thankful for Love” was composed at UF Health Shands Children’s Hospital was a particularly tough one for Brianna Medina, Kendall recalled. The 8-year-old Orlando girl had a lot of questions – questions about the heart she was waiting for, questions about the artificial heart machine she was hooked up to, and questions of why. “Why me? Why now? Why isn’t this getting better?”

Kendall, who visited Brianna regularly in the pediatric ICU where she awaited a heart transplant, tried to steer the conversation toward something simpler.

“We started to think about the things we’re thankful for,” he said. “Brianna listed her dog, her family, God. I jotted these down and asked her, ‘Do you mind if we write a song about this?’ I went home, put chords and a melody to the lyrics and brought it back to her. She made a couple of changes, she sang it with me and she learned it.”

Kendall said this experience planted the seed that ultimately grew into the eight-song album “Thankful for Love,” and beyond. He began to work on songwriting more frequently with the young patients he visited, helping them translate their visual artwork into words and spending his evenings at home putting melodies to those words for the songs on the album.

Ricky Kendall performs Thankful for Love during a concert in Gainesville to mark the debut of the album he helped create with patients at the UF Health Shands Children’s Hospital. With him are the children of friends and colleagues: From top left, Nathalie Larson; top right, Taye Shitama; bottom row from right Harper Melosh, Valarie Larson, and Wren Melosh.

Ricky Kendall performs Thankful for Love during a concert in Gainesville to mark the debut of the album he helped create with patients at the UF Health Shands Children’s Hospital. With him are the children of friends and colleagues: From top left, Nathalie Larson; top right, Taye Shitama; bottom row from right Harper Melosh, Valarie Larson, and Wren Melosh.

“After that visit, I wanted to collaborate more with kids,” he said. “Their imaginations are boundless.”

The songs on the album cover topics including your best stuffed animal friend, the arrival of a new baby brother, make believe, fighting for your life and staying positive. On “Girog,” Kendall outlines the entire life of a half-dog, half-giraffe stuffed animal.

The co-writing was a give-and-take process. Sometimes Kendall would lift lyrics directly from the young peoples’ mouths. He’d often ask their opinion on the guitar tone to best match the mood of the lyrics.

Kendall and arts therapist Amy Bucciarelli worked with Brianna to create both music and visual art. The album cover for “Thankful for Love” is an adult artist’s interpretation of a painting the pair worked with Brianna to create. In the original work, a red heart marked with a capital ‘T’ for trust sprouts a pair of golden wings.

Brianna’s mother, Maria Medina, recalled her daughter’s inspiration.

“Brianna didn’t trust anyone in the hospital anymore. She would be told she’s going to get better, today is the day. But it didn’t happen,” she said. “Amy worked with her to paint a visual symbol of establishing trust, what it looks like to unlock that precious sort of relationship.”

Before the album could be completed, Brianna passed away from complications of restrictive cardiomyopathy in 2014. Medina, who established Brianna’s H.O.PE. Fund to support arts programming in medical settings, funded the creation of the album, which was produced with help from Tina Mullen, director of the UF Health Shands Arts in Medicine program, and Dave Melosh, who owns Heartwood Soundstage.

Medina said she hopes the album’s listeners hear the creative force within Kendall’s young collaborators.

“I want listeners to be touched and moved to support programs that ensure the arts remain in medical settings,” she said. “There has to be room for children to still be children within the medical model that exists today.”

Separate from sickness

Dealing with trauma at a tender age is not a foreign concept to Kendall, 36, who is from Stuart, Florida. He spent two and a half weeks in the hospital at age 6 after being injured in a car accident.

“I almost lost my life,” he said. “I still remember the taste of Jell-O mixed with oxygen tubes, the day they removed the staples from my chest and stomach, the nurse’s care and the friends who visited me.”

A veteran Gainesville performer of 16 years whose previous release was the 2015 album “Passing Chord,” Kendall was brought onto the Arts in Medicine team by former artist-in-residence and musician Danielle DeCosmo.

The program brings healing energy to patients in a unique, creative way that has nothing to do with beeping machines and scary procedures.

“Arts in Medicine gives kids the opportunity to remain kids,’’ said Mullen. “So often, we see kids become displaced through illness – separated from home, school, friends and pets, all the things they are familiar with. Allowing free creative expression brings forward their true spirit. It reminds them and their families about life outside of illness. They can just be themselves.”

Pediatric cardiologist Frederick Fricker, M.D., treated Brianna during her stay in UF Health Shands Children’s Hospital. He said he recommends all patients take advantage of the Arts in Medicine program offerings.

“If you’re in a hospital tethered to a room, tethered to an IV, the loneliness and boredom are incredible,” he said. “Brianna was always making something, constantly keeping herself involved. Creating through Arts in Medicine allows kids like Brianna to express themselves. You look at their art and you see their fear, anxiety and hope. It’s a therapeutic way they can communicate and reflect on their circumstances.”

Bucciarelli, who is now an instructor at UF’s Innovation Academy, built therapeutic relationships with patients, providing them with psychological support and introducing them to artists-in-residence such as Kendall when she believed they could benefit from some fun and lightness.

“Maybe it was to make their songwriting dreams come true or to help a song unfold about their hopes,’’ she said. “The magic of the arts therapist working with the artist-in-residence was that I could hold a safe, therapeutic space for the patient while the artist used their talents to inspire a deep level of creative expression. That’s why the songs on this album are so moving and powerful. Ricky has a gift for connecting with patients. He can really pull the creative juices out of them.”

Kendall said by performing songs or drawing with patients he is giving what he has to give in the best possible way. He recalled surprising Brianna on her birthday by performing her favorite songs from the “Frozen’’ soundtrack. It was a profoundly meaningful moment, he said.

“It’s hard to heal by yourself,’’ he said. “This album is a companion to make a hospital stay seem less strange and more familiar and comforting. Art can be a way for people to make peace with trauma or loss.”

Pure celebration

Bucciarelli said her practice has proven art’s ability to empower, giving patients like Brianna a sense of control and humanity.

“It was so valuable to give Brianna that sweet spot in her day to make art with me. It gave her strength and energy to move forward with the difficult things she had to go through,” she said. “For someone who’s sick, whose decisions and freedoms have been taken away from them because they need to stay in the hospital, art is something they can physically do.”

Art also creates a legacy for those who leave this world too soon, a collection of tangible memories that loved ones can return to, Kendall said.

“The Medina family is able to have this song and these paintings. This is Brianna’s legacy,” he said. “Even when you’re at your final time, you can still create some of the most brilliant colors you could’ve ever made. Brianna did just that. It’s a beautiful thing.”

Mullen recalled the Heartwood concert as a night of pure celebration.

“There were about 100 families there and kids running all over the place,’’ she said. “I was especially touched to see Brianna's family standing in front of the stage recording on their phone as Ricky played ‘Thankful for Love.’ It's not the first time they've heard it, but hearing it at such a joyous event was fulfilling for them.”

Standing with her family the night of the concert, Maria Medina said listening to Kendall sing Brianna’s lyrics makes her feel close to her daughter.

“We can’t stop children from getting sick, but we can give them time and space to work on their sense of inner healing and to process their own health journey,’’ she said. “When Brianna was making art through music or narrative, for that moment, she was able to separate from her sickness. She could be herself.’’

Maria Medina has a photo of her daughter pinned to her sweater. Every so often she adjusts the pin, as if to ensure Brianna’s smiling face is still near her own heart.

“Brianna’s voice is still being heard though this song,’’ she said.

The clock within — circadian rhythms and the cycle of life

Bill Levesque's picture
Submitted by Bill Levesque on December 10, 2017 - 08:30

As a new class of Nobel Prize laureates is honored Sunday at a ceremony in Stockholm, a University of Florida Health researcher nearly 5,000 miles away will reflect on just how far her research specialty has come.

Circadian rhythms are finally debutantes at the ball.

Three American scientists are receiving the 2017 Nobel Prize in physiology or medicine and sharing 9 million Swedish kroner, worth about $1.1 million. Jeffrey C. Hall and Michael Rosbash, both of Brandeis University, and Michael W. Young, of Rockefeller University, are being recognized for seminal work identifying the biological underpinnings of circadian rhythms.

“It’s a wonderful moment for everyone in the field,” said Michelle Gumz, Ph.D., an assistant professor of medicine in the UF College of Medicine who has studied circadian rhythms most of her career.

The moment is especially meaningful to Gumz, who works in the division of nephrology. In September she received a $1.47 million, five-year grant from the National Institutes of Health to study the role of circadian rhythms in the kidneys.

By studying that kidney clock, Gumz said, scientists may come to a better understanding of the underlying mechanisms causing high blood pressure. The research also may contribute to a better overall understanding of how circadian clock proteins regulate physiological function.

Michelle Gumz, Ph.D. (left), received a $1.47 million grant from the National Institutes of Health in September to study the circadian rhythms of kidneys. Here she works with Lauren Douma, Ph.D., a postdoctoral fellow in Gumz’ lab.

“What really excited me about this field is that there are so many areas that are just unexplored,” Gumz said. “And it’s applicable across all the kingdoms of life. It’s a truly ancient mechanism.”

Indeed, the Nobel laureates performed their research in the fruit fly, but their results are directly applicable to humans.

Circadian rhythms, the biological clock encoded in the DNA of all cells, had not been well understood until research on the topic blossomed in the 1970s and 1980s.

These molecular clocks keep life in tune with the rotation of the Earth and the cycle of night and day. In humans, our blood pressure and body temperature dip during the night.

Our highest testosterone secretion comes at 9 a.m., our highest alertness an hour later. By early afternoon, our best coordination and fastest reaction times are recorded. Around 5 p.m., our bodies are working at their greatest cardiovascular efficiency and muscle strength.

The Nobel laureates isolated a gene that triggers the biological rhythm, prize officials said when the awards were announced in October. The gene encodes a protein that accumulates in the cell during the night before degrading by day.

“With exquisite precision, our inner clock adapts our physiology to the dramatically different phases of the day,” the Nobel Assembly said in a news release. “The clock regulates critical functions such as behavior, hormone levels, sleep, body temperature and metabolism.

“Our well-being is affected when there is a temporary mismatch between our external environment and this internal biological clock.”

So, travel between time zones results in “jet lag,” or workers on the graveyard shift might have trouble sleeping during the day.

“The organisms that evolved this internal clock mechanism had a selective advantage if they were better adapted to the night/day environment,” Gumz said. “Then they would be able to better survive an injury, or escape a predator, or find food.”

Circadian rhythms have sometimes been ignored in biomedical research, as some scientists fail to fully recognize their importance in human biology, Gumz said.

As an example, she pointed out that many studies do not note the time of day when researchers collect data on mouse models. This could have ramifications for extending findings in rodents, which are nocturnal, to humans, who are mostly creatures of the day.

As with humans, the mouse model’s blood pressure varies, dipping at the nadir of their circadian day. For the mouse model, that dip comes during the day. For humans, it comes during the night.

The Nobel Prize for circadian rhythm research, Gumz said, lends considerable legitimacy to the field.

“That’s the main reason why we’re so excited by this,” she said. “There is this feeling that people will really begin to appreciate just how important this is, just how fundamental this is. That’s our hope.”

One of the things Gumz is studying in her grant research is the concept of non-dipping hypertension. Many humans have a misaligned circadian rhythm, and her lab has developed a mouse model to study this phenomenon.

Gumz said some among us may have blood pressure that does not dip at night. Extensive evidence from the medical literature shows that loss of the normal circadian rhythm for blood pressure is associated with increased risk for stroke, heart attack and overall adverse cardiovascular outcomes.

“So how do we intervene? How do we fix that?” she said. “The long-term goal of our research is to help improve patient care in terms of understanding the importance of time of day. Time of day for taking blood pressure measurements. Time of day for administering medication. And so, it’s always my hope that our mechanistic, basic science work will have an impact in terms of spreading the word to other researchers and physicians about the importance of circadian rhythms.”

To non-scientists, the concept of our organs and cells ticking to some internal timepiece may seem fanciful. In fact, it’s as real as a Rolex.

“Do your kidneys know what time it is?” Gumz asked in a 2015 paper.

The answer, of course, is ‘yes.’

Remembering loved ones

Submitted by on November 30, 2017 - 15:30

Bereavement program will host second annual Adult Fall Remembrance Ceremony Dec. 6

The UF Health Palliative Care team will host the second annual Adult Fall Remembrance Ceremony on Wednesday, Dec. 6 at 6 p.m. at the UF Baughman Center. This evening of remembrance will help provide support for those in the Gainesville community who have lost a loved one.

Cathy Silloway, LCSW, ACHP-SW, a UF Health Shands Patient and Family Resources palliative care social worker, has a special passion for helping people cope with their loss and honor loved ones.

“People can bring a picture of their loved one if they want,” Silloway said. “Sometimes that’s a way to start more conversation about their loved one if they don’t know how else to do it.”

The nondenominational ceremony will last around 45 minutes with refreshments and comments by several speakers. The event is free and open to the public.

“There will be a lot of reassurance and a lot of listening,” Silloway said. “People want to know if the grief that they are experiencing is normal and we can give them that support.”

Anne Meiring, LCSW, CPXP, a UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety Patient Experience quality improvement specialist, UF Health Language Access improvement specialist and UF Health Advance Directives co-facilitator, attended last year’s remembrance ceremony as a participant.

“I had recently lost a loved one, and I brought along a friend who had lost a loved one, too,” she said. “It was such a respectful, warm, genuine, caring and compassionate evening. I left thinking we have a great community.”

Another attendee last year was Donna Cottle, LifeQuest donor family services coordinator. She notes that families are encouraged by the unity and support they receive from each other.

“They are grieving and sometimes they feel alone, and we don’t want them to feel alone,” Cottle said. “You can see it on their faces — they are empowered.”

For more information about the event, please email Cathy Silloway at adultbereavement@shands.ufl.edu.

Something remarkable: A teen celebrates Thanksgiving with his new lungs

Alisha Katz's picture
Submitted by Alisha Katz on November 22, 2017 - 14:42

Dr. Tiago Machuca, Matias and  Dr. Mauricio PipkinAt any other time, Matias Cozzi, might have enjoyed Thanksgiving like any 17-year-old. Perhaps he’d overindulge in turkey and pie during an uneventful holiday in the happy company of family. Then he might sneak off to play a little soccer with friends.

But this is not an ordinary Thanksgiving for the teenager.  

It’s a time to enjoy the love of a family that never gave up and to give thanks to the supporters and friends and the medical professionals who helped ensure something remarkable.

Matias is alive.

“The whole family is going to come up to celebrate with us,” said Andrea Cozzi, Matias’ mother. “We are very happy and lucky for the blessing of our family. With their support and courage, they helped us keep fighting and keep hoping. We have lots to give thanks for.”

Matias Cozzi, remembers the moments as if they were sparks of light. The moment he was transported to University of Florida Health. The moment he was told he would need a double lung transplant. The moment his lungs arrived. Then, the moment he was saved by UF faculty physicians — four times over.

In August 2017, Matias started to cough up an unusual amount of blood. Matias, who has been living with cystic fibrosis, or CF, most of his life, had grown accustomed to coughing up blood on occasion. Overall, he managed his CF around the clock with a combination of pills, four nebulizer treatments each day, therapies and an active lifestyle through soccer. However, during the summer, Matias noticed unusual changes in his health.

“I got really sick once and didn’t go back to soccer,” Matias said. “That’s when it started getting worse and worse.”

On August 6, Matias’ father, Ed, and Andrea Cozzi, took their son from their home in Port St. Lucie, Fla., to St. Mary’s Medical Center in West Palm Beach about 50 miles to the south. Physicians suspected that Matias might be dealing with something more serious than ever before. They recommended that Matias be taken to specialists at UF Health Shands Children’s Hospital in Gainesville for further evaluation and to have a minimally invasive procedure to plug the bleeding arteries in the lung.

Matias was air-lifted to Gainesville for further assessment on the night of Aug. 6, and met Michael Tsifansky, M.D., a pediatric pulmonologist and medical director for the UF Health Pediatric Lung Transplant program. That same night, Tsifansky raised the idea of lung transplantation.

“I was down from day one,” Matias said. “I thought a transplant was going to happen and it was going to be easy after that.”

“Matias was so positive. He really wanted his lungs,” Andrea Cozzi said. “I was so scared. I had hoped that this wasn’t going to happen.”

Matias, one of the couple’s three children, was the only one born with CF, a condition that progressively worsens and attacks the respiratory system in addition to other organs. In severe cases, patients with CF often require a lung transplant.

Unfortunately, Matias was not yet a candidate for the lung transplant wait list. The process and preparation for becoming a lung transplant recipient are rigorous. Steps to get on the list include showing adequate physical strength, good nutritional status and emotional determination. And while patients need to be sick enough to need a transplant, they also need to be well enough to heal afterward.

Under the observation of Tsifansky and Mutasim Abu Hasan, M.D., a pediatric pulmonologist at UF Health, Matias was admitted to the pediatric intensive care unit. He underwent a second procedure to stop the bleeding in his lungs, but the arteries leading to his left lung became obstructed and collapsed. Doctors quickly removed the obstruction. An hour later, the other lung collapsed.

“In those moments, every day took so long. Now, looking back at it, it went by fast,” Andrea Cozzi said.

As Matias’ condition continued to deteriorate, time was of the essence to get him on the transplant wait list.

Matias has grit in spades, but was so weak and malnourished that even if put on the list, his chances of surviving until transplant — and through the procedure itself — would be extremely low. To make his situation worse, Matias developed respiratory failure and pneumonia. His lungs were failing and despite a ventilator, they were not capable of keeping him alive.

Biding for time, Tsifansky and the pediatric intensive care unit team reached out to Tiago Machuca, M.D., Ph.D., a thoracic surgeon and surgical director of the UF Health Pediatric Lung Transplant Program, to see whether Matias would be a candidate for a life-saving, temporary, device serving as an artificial lung machine. It’s called extracorporeal membrane oxygenation, or ECMO, life support that put oxygen in the blood and taking out carbon dioxide.

ECMO was now the only option to keep Matias alive until a transplant.

Machuca and his team connected him to the artificial lung. As a result, Matias was now awake and no longer dependent on a mechanical ventilator. There was only one caveat — the pneumonia would continue to worsen, so doctors had a limited window to get Matias stronger and listed for a lung transplant.

“They told Matias, you have to walk and sit to show that you are strong enough,” Andrea Cozzi said.

The team and the family elected to pursue ECMO in hopes that Matias’ strength and weight would improve enough to get him on the list. Slowly, Matias started sitting, walking and gaining weight.

But as the first two weeks passed by, his condition worsened, and he began to bleed from his airways and lungs. Tsifansky and Machuca continued to closely monitor Matias and realized that even on ECMO, time was running out faster than expected.

“By that point, Matias and the family had been through so much and showed such courage, determination and will to survive, that even though we knew his condition was worsening, we decided to place Matias on the transplant list,” Tsifansky said.

“What we were able to experience over those two weeks gave us the confidence that, if we were going to push medical and surgical limits, Matias was the perfect candidate,” Machuca said.

“I remember that day my dad telling me, ‘You’re on the list, you’re on the list,’” Matias said.

Now, a second battle began: the wait for new lungs. Fortunately, Matias was at a hospital that is determined to shorten wait times for lung transplantation in adults (an average wait time of three months instead of six) and children.

At that point, doctors estimated that the ECMO machine would not be able to support him for more than 48 hours. But even then, Matias, his family, and the team were committed on doing everything necessary to get to the transplant and do well afterwards.

“I remember the day prior to my transplant when I had to walk at least 10 steps to show Dr. Tsifansky I was strong enough for a transplant but that’s all I remember,” Matias said. “I had people around me trying to support me to walk a certain number of steps.”

They would try to challenge him to see if he was determined to have a pair of lungs,” Andrea Cozzi said. “They don’t want to give lungs to a patient who isn’t going to fight for those lungs.”

Then, two days after being placed on the wait list, doctors discovered that they had a donor.

“I remember Dr. Tsifansky saying, ‘Those are the lungs for Matias,’” Andrea said. “He said to Matias, ‘Give me two hours, they are going to get those lungs for you.’”

Time, however, was nearly exhausted. In less than 24 hours, ECMO would stop working. The moment had arrived for Matias to demonstrate his physical strength and show he could walk and sit on his own.

Matias pushed forward to achieve both physical goals with the help and encouragement of family and multiple team members.

"I had people around me trying to support me to walk a certain number of steps,” Matias said.

“They would try to challenge him to see if he was determined to have a pair of lungs,” Andrea Cozzi said. “They don’t want to give lungs to a patient who isn’t going to fight for those lungs.”

One by one by one the steps came. Which each, Matias displayed fight to spare. He did it.

Over the course of Sept. 20 and 21, Machuca and Mauricio Pipkin, M.D., thoracic surgeon at UF Health, performed a 12-hour lung transplant procedure. Matias condition was grave. His blood contained barely enough oxygen to sustain life.

The family, including siblings, grandparents and extended family, waited for Matias to receive his new set of lungs. Matias’ father would also celebrate his birthday on the same day as his son’s new start to life.

The surgeons arrived to the waiting area to give the family the news. The operation was a success and Matias was stable.

"Matias’ complex case is a testament to the outstanding care that our teams provide through UF Health’s pediatric heart and lung transplant program,” ,” said Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and chief of congenital cardiothoracic surgery at the UF Health Congenital Heart Center.

For the first three weeks post-transplant, Matias recovered in the pediatric cardiac intensive care unit.

"To me, post-transplant was the hardest because I had to learn everything. I couldn’t talk. I couldn’t eat. I couldn’t drink,” Matias said. “I went through a lot of rough times. But I had my family."

Matias regained his strength nearly a month and a half after the surgery.

"Now that I’m getting stronger, I can walk and move myself in bed. Before, I couldn’t move my hand,” Matias said. “I feel good. I don’t feel pain."

Matias’ next goal was to be discharged before Thanksgiving. With the same determination that helped him achieve those handful of steps, Matias achieved this goal, too.

He was discharged from post-transplant recovery on Nov. 20 and has begun the rehabilitation process also at UF Health Shands Hospital. That will take at least three months more.

"We thought when we came to Gainesville that we were going to start the process of transplant,” Andrea Cozzi said. “This hospital was excellent for us and for him. The way they treated us and him — unbelievable."

As a result of Matias’ transplant, his daily maintenance medications will soon be only a few pills. He hopes he will be able to play soccer again months down the road.

"Before all of this, I stopped playing soccer because I couldn’t physically do it,” Matias said. “Now that I have new lungs, I want to do the things I couldn’t like go on bike ride and go outside."

Family from throughout Florida will make the trip for a big Thanksgiving at the rehabilitation housing where Matias is staying with his parents. Matias will have his favorite holiday meal.

Melted marshmallows over mashed sweet potatoes. He’s an ordinary teen again.

Cristina Matos was given a second chance at life

Submitted by Jessica Barton on November 1, 2017 - 14:23

Christina MatosCristina Matos was referred to the UF Health Cancer Center by a nurse friend. Together, they were searching for possible solutions to Cristina’s debilitating diagnoses, a glioblastoma and spine metastasis. Cristina was in horrible pain, bed-ridden. She was on multiple medications, and had been told by her local doctors she had only weeks to live.

“She is alive today because of what her DNA could tell us. This is truly personalized medicine at its best.” — David Tran, MD

When she arrived at the Preston A. Wells Jr. Center for Brain Tumor Therapy at UF, Cristina met David Tran, MD, a UF Health Cancer Center neuro-oncologist. He was able to use a genomic therapy to determine targeted chemotherapy for Cristina.

Dr. Tran reduced Cristina’s medications, and put her on chemo medication only. Within days, she began to feel positive effects, and within weeks she was able to walk.

“My pain is minimal at this point. It’s been about a year since I met Dr. Tran, and life is good. I’m happy,” she said. Cristina is traveling the world with her family, exercising at the gym almost daily, going out with friends, driving and enjoying being a mom to her young son.

Dr. Tran said her response to this medication is unprecedented. And she agrees. “I had a death sentence. I was lying in my bedroom waiting to die,” Cristina said. “I am so glad I listened to my heart, chose to fight and found this option.”

College professor teaches tenacity in fighting breast cancer

Submitted by Jessica Barton on November 1, 2017 - 14:16

Debbie Paine teaching students in her classroom.After receiving an abnormal result on her annual mammogram, college professor Debbie Paine met with physicians in her hometown of Valdosta, Georgia. The diagnosis was breast cancer, but Debbie cancer, but Debbie felt that her physician was prescribing a one-size-fits-all treatment, so on the advice of her husband, she sought a second opinion at UF Health.

From the moment she met with UF Health surgical oncologist Dr. Lisa Spiguel, Debbie knew she was in good hands.

“Dr. Spiguel made a plan that felt right for me,” Debbie said. “She listened to me, and I felt confident that the surgery and followup treatment developed by the team at UF Health were the right solution for me.”

Debbie’s breast cancer team at UF Health consisted of surgical oncologist.Dr. Lisa Spiguel, radiation oncologist Dr. Judith Lightsey, medical oncologist Dr. Coy Heldermon and nurse navigator Pamela Clevenger.

Dr. Spiguel and her multidisciplinary team created a customized treatment plan for Debbie that consisted of surgery and radiation therapy, avoiding the side effects of chemotherapy.

Debbie drove to the UF Health Radiation Oncology — Davis Cancer Pavilion from Valdosta every day for 28 days, a 228-mile round trip, logging well over 6,000 miles in her treatment.

“It was a drive worth taking. Now I can continue doing things that I had to put on hold,” Debbie said.

Sweet relief, sweet dreams

Submitted by Katherine Gutierrez on October 30, 2017 - 11:10

Bob Cohen & his wife sitting on a swing.For 15 years, Bob Cohen kept tossing and turning in order to stay alive.

Cohen, a resident of Gainesville since 1988, has always been active, loves to read non-fiction, plays chess and enjoys biking. He is an environmental consultant for the state government, practices mediation and is on the Gainesville Police Advisory Council. But his sleep apnea, a disorder where breathing is paused during sleep because of an obstruction to the airway, was taking a toll on his home and work life. Cohen said he was tired all the time and could not sleep for fear of not waking up.

When Cohen would sleep on his side, he had moderate sleep apnea, an apnea-hyponea index, or AHI, of 15 of more. AHI is the average amount of times an individual ceases breathing within an hour. When he slept on his back, he would have an AHI of 60 or more (severe sleep apnea). The risks of untreated severe sleep apnea includes the desaturation of the  oxygen blood supply, tiredness and in extreme cases enlarged heart leading to other heart problems.

The standard treatment for sleep apnea is to use a continuous positive airway pressure, or CPAP, machine. But about 30 to 50 percent of people can’t tolerate the CPAP machine and Cohen was one of them.

Alternatives to the CPAP machine was a procedure Cohen referred to as a “nasty surgery” where doctors would have to rewire Cohen’s jaw, known as Maxillomandibular osteotomy and advancement. He did not want that procedure.

Another option is the use of a mandibular adjustment device, a dental device that looks like a mouthpiece which is molded to the patient’s mouth to gently pull the lower jaw forward to open the air passage while sleeping. Cohen had one made, but there was only one problem: he had all his teeth. There wasn’t enough room in his mouth and it became very uncomfortable. As a result, he would have to take it out every two or three hours.

“It served as an aid, but not as a solution,” Cohen said. “So then, I read about the Inspire Therapy® and made an appointment to see Dr. Harwick, who is the only one in Gainesville who does this treatment.”

Inspire Therapy® device is a FDA-approved upper airway stimulation device that help patients suffering from moderate to severe obstructive sleep apnea. John Harwick, M.D., an otolaryngologist at UF Health ENT and Allergy – Hampton Oaks, helped Cohen in his journey to counting sheep.

In order to qualify for the procedure, patients have to go through a bronchoscopy assessment, where an anesthesiologist gradually induces sleep while the doctor uses a scope to see how the patient’s windpipe collapses. It has to collapse in a certain pattern for the device to work.

Once approved for the therapy, Cohen was one of the first few patients at UF Health to ever receive this implant. In September 2016, Harwick implanted the three-part device in Cohen through three, two-inch-incisions, just under the skin. One was in the right upper-chest, one under the arm and another under the neck. It detects when a person is breathing and sends little electrical stimulations to their muscles to move the tongue slightly preventing the airway from collapsing. Cohen has a remote control that he can use to turn the device on and off. He turns it on when he goes to sleep and if he wakes up during the night he can push the button on the remote control and it will pause for 20 minutes, so that he can go back to sleep.

“It was a great relief to meet Dr. Harwick,” Cohen said. “He is brilliant and he knows what he is doing. I was impressed by his professional ability and his excellent bedside manner.”

Cohen has had diverse life experiences from writing a book while he was in the Peace Corps titled “Perfect Questions, Perfect Answers” that has been translated in over 40 different languages to helping design the newly renovated Plaza of the Americas on the University of Florida campus. Now that he is able to sleep, all he wants to do is retire and write another book.

“Life is never dull,” Cohen said. “I can’t complain about that.”

Teen birth hot spots identified despite overall decline in U.S. teen pregnancy

Bill Levesque's picture
Submitted by Bill Levesque on October 21, 2017 - 10:00

Fewer teens are having babies, a long-term trend that has accelerated in recent years. Since 1991, federal numbers show, the teen birth rate is down 67 percent.

But some U.S. counties continue to buck that trend.

A team that includes University of Florida Health researchers has identified clusters of teen births across the nation in a study providing “a literal road map” for local and state officials to target resources and interventions to help reverse this pattern.

“The big take-home is just showing that, despite the trend throughout the United States of decreasing teenage birth rates, we have these areas we’ve identified through this mapping that aren’t falling,” said study co-author Kay Roussos-Ross, M.D., an assistant professor in the department of obstetrics and gynecology in the UF College of Medicine.

Teen Births unadjusted vs poverty (adjusted clusters) map

One of the most striking findings, the researchers noted, was the high incidence of teen births on Native American reservations. Reservations held eight of the top 10 clusters in population areas with fewer than 100,000 people, according to the study, published recently in the journal Obstetrics & Gynecology.

Those areas under 100,000 people with the highest teen birth rates, from high to low, are:

  • Pine Ridge, South Dakota;*
  • Legend Lake, Wisconsin;*
  • Wolf Point, Montana;*
  • Eagle Butte, South Dakota;*
  • Rugby, North Dakota;*
  • Cut Bank, Montana;*
  • Petersburg, Virginia;
  • New Town, North Dakota;*
  • Junction City, Kansas; and
  • Wagner, South Dakota.* (An asterisk denotes an area with a reservation.)

“One of the big things we tried to show here was, if we have limited funds available in the United States, should we be targeting those funds in specific areas,” said Julie Zemaitis Decesare, M.D., an associate professor and the UF College of Medicine’s obstetrics and gynecology residency program director at Sacred Heart Health System in Pensacola. “One example is that this may show that maybe we should focus on reservations to see if we can further make an impact.”

The study’s lead author is Raid Amin, Ph.D., professor of mathematics and statistics at the University of West Florida in Pensacola. Co-authoring is Jennifer Hans, M.S., a student at UWF whose idea led to the study.

Researchers wanted to learn whether certain areas of the contiguous United States could be identified as teen birth “hot spots” despite the decline in pregnancy rate in this group. They decided to look at all live births to women 15 to 19 years old from 2006 to 2012, drawing data from the National Center for Health Statistics.

Teen Births unadjusted vs diploma (adjusted clusters) map

Researchers hypothesized that hot spots would remain even after adjusting the data for poverty and educational level, which are known predictors of high teen birth rates. The researchers also tabulated unadjusted rates. By taking poverty and educational attainment out of the mix, the study said, “This indicates that there are other factors contributing to the high teenage birth rates in these clusters.”

And those factors can be targeted once they are identified, researchers said.

In fact, hot spots did remain.

The cities greater than 100,000 population rated with the highest teen birth rates, adjusted for education level, from high to low, are:

  • Denver, Colorado
  • Washington, D.C.
  • Tulsa, Oklahoma
  • Charleston, West Virginia
  • Oklahoma City, Oklahoma
  • Baltimore, Maryland
  • Kansas City, Missouri
  • Fayetteville, North Carolina
  • St. Louis, Missouri
  • Columbus, Georgia

The cities greater than 100,000 population rated with the highest teen birth rates, adjusted for poverty, from high to low, are:

  • Fort Worth, Texas
  • Grand Junction, Colorado
  • Dallas, Texas
  • Salinas, California
  • San Antonio, Texas
  • Houston, Texas
  • Gainesville, Florida
  • Kansas City, Missouri
  • Jacksonville, Florida
  • Yakima, Washington

-30-

Mend a Failing Heart

Submitted by Katrina Ciccarelli McAfee on October 20, 2017 - 10:00

Heart failure occurs when the heart is unable to pump enough blood to meet the body’s needs. This condition affects nearly six million Americans annually and is often unrecognized or misdiagnosed. It’s important to know the causes and symptoms of this condition, as early diagnosis can help patients live an active life.

Every minute at least one person is diagnosed with heart failureKnow the symptoms:

  • Shortness of breath, which can happen even during mild activity
  • Difficulty breathing when lying down
  • Weight gain with swelling in the legs and ankles
  • General fatigue and weakness

Know the causes:

  • Previous heart attack
  • Heart defects
  • High blood pressure
  • Diabetes
  • Alcohol or drug abuse

Know the symptoms of heart failureTypes of heart failure:

  • Left-sided heart failure occurs when a heart can’t handle pumping the amount of blood it needs, making it work harder and prohibiting the body from getting the oxygen levels it requires to survive.
  • In right-sided heart failure, a heart loses pumping power, causing blood to back up in the blood vessels and swelling and blood retention in areas such as the ankles and legs.
  • Congestive heart failure is a heart weakness that leads to a buildup of fluid in the lungs and surrounding body tissues, causing congestion.

Treatment options

Heart failure treatment is not linear — many factors impact treatment options. Once evaluated, patients may receive medication to strengthen and manage their heart. In some cases, advanced therapies are needed, which include a heart pump or heart transplant.

UF Health cardiologists and cardiovascular surgeons work together to treat patients with heart failure and offer the latest in treatment options, including:

  • Medical management
  • Pacing and cardioverter-defibrillator device implantation and management
  • Access to investigational mechanical support devices and pharmacologic agents
  • Ventricular assist devices – a device that helps the heart pump blood from one of the main pumping chambers to the rest of your body or to the other side of the heart. These pumps may be implanted in your body or connected to a pump outside your body.
  • Heart transplant

The prevalence of heart failure in America and other growing complex cardiac cases has led UF Health to our most ambitious endeavor to date – a new facility built around the needs of patients with heart and vascular conditions. Every detail of the new UF Health Heart & Vascular Hospital, opening in December 2017, is built with patients and their loved ones in mind.

UF Health Cardiovascular Hospital

Key features include:

  • Streamlined access to highly specialized, comprehensive outpatient and inpatient services in one location
  • Aesthetic design that promotes patient safety, healing and recovery
  • Patient rooms feature natural light and a slightly recessed family space with convertible furniture, encouraging loved ones to stay for support
  • Third floor features an open terrace situated on a “green roof” for fresh air and natural light, and also includes free Wi-Fi and telemetry, a remote monitoring system for patients who need constant heart function monitoring
  • Outdoor entrance space features healing garden that includes a reflection pond, waterscapes and outdoor walkways
  • Specially designed “water-friendly” bathrooms are accessible for people with disabilities and accommodate a wheelchair or walker
  • Sanctuary of Wisdom available for prayer and contemplation for people of all religious and spiritual interests
  • Dedicated parking garage features 600 spaces for patients and visitors
  • Infotainment system with large flat-screen TV monitors and interactive bedside tablets for patients and family members to use for patient education, hospital information and entertainment

Learn more about the new heart hospital at UFHealth.org/BuiltAround or our UF Health Heart and Vascular Care program at UFHealth.org/heart.

In All Kinds of Weather

Submitted by on October 19, 2017 - 10:55

UF Medical Students Take Resources to Puerto Rico

Josh Pickering, a UF senior biochemistry major, and Brandon Burns, a fourth-year medical student in the UF College of Medicine, traveled to Puerto Rico the week of October 16 to help survivors of Hurricane Maria by taking along essential supplies, including water filters. So far, it’s been a harrowing experience.

“Driving at night is extremely dangerous,’’ Pickering said, adding that many roads are clear but traffic lights are out because of the nearly islandwide power outage. “We have to avoid potholes and debris and watch out for power lines hanging in the road. It is especially difficult in the more remote regions.’’

The duo collected 200 personal water filtration systems, medicine, and equipment for road and debris clearance and delivered them to various locations on the island.

“We were at an emergency hospital in Arecibo that was set up in a sports arena. The hospital is now without running water and has to wait for it to come back online,” Pickering said.

“The tourist areas seem to be pumping the most money into repair, and should be online soonest,’’ he said. “The people that will take the hardest hit will be the poorest individuals in the mountains where it is difficult to reach. We brought everything we could carry — and then some.”

Sending Relief to Stricken Island

Since Sept. 20, when Hurricane Maria roared across Puerto Rico as a Category 4 monster, Luis M. Colon-Perez, Ph.D., has been unable to communicate with his family on the devastated island. Colon-Perez, a member of the psychiatry department in the UF College of Medicine, comes from Utuado, in the central mountains of Puerto Rico and said he felt compelled to do something to help those struggling with Maria’s aftermath. With help from colleagues and his wife, Yarelis Soto Gonzales, a UF psychiatry resident, Colon-Perez has organized two large collections of donated items that he has taken to Orlando to be shipped to Puerto Rico.
The first collection, on Sept. 23, included items donated by colleagues in the psychiatry department as well as friends in the Evelyn F. and William L. McKnight Brain Institute of the University of Florida and at the Malcom Randall Veterans Affairs Medical Center. A second, larger collection included items from boxes set up at various locations.

“I felt this was a good way to keep me from thinking about all the bad stuff,’’ Colon-Perez said.

Diabetic supplies for Harvey and Irma victims gathered by UF Health researcher’s non-profit group

A Gainesville nonprofit group led by a University of Florida Health diabetes researcher and his wife shipped $1 million worth of insulin and diabetic supplies to Texas to aid those impacted by victims of Hurricane Harvey. After Hurricane Irma passed through, they quickly regrouped to again access, mobilize, ship and distribute additional supplies to those in need.

Mark Atkinson, Ph.D., director of the UF Diabetes Institute, a professor in the UF College of Medicine’s departments of pathology and pediatrics and president of Insulin for Life USA, founded the group with his wife in 2012. Insulin for Life USA typically gathers unused diabetic supplies and dispatches them to needy patients around the world. Hurricane Harvey and Irma created an instant need closer to home. Last year, the group, composed of UF College of Pharmacy students, distributed more than $3 million of diabetic supplies to people who need them.

Insulin for Life is accepting all types of diabetes-related donations – in-date, unneeded insulin vials, pens and cartridges; glucagon; A1C test kits; glucose meters and strips, syringes and other supplies. Cash donations, which help with shipping expenses and allow the supplies to be distributed free to needy people, are also welcomed. Volunteers who can help sort and package supplies may also be needed as more supplies get donated, Atkinson said. For more information or for information about donating, go to http://ifl-usa.org/ or call 352-327-8649 or email Carol@ifl-usa.org

Shelter from the Storm

Carlyn Ellison, a master’s in public health student in the UF College of Public Health and Health Professions, had just signed up as an American Red Cross volunteer when news hit that Hurricane Irma was making a beeline for Florida.

After some hurried emergency training, Ellison got her first volunteer assignment the night before the storm hit northern Florida: staffing a shelter in Gilchrist County, Alachua County’s neighbor to the west. Ellison set up the shelter’s registration station and registered more than 250 evacuees during a 12-hour shift.

One of the challenges Ellison faced was communicating with Spanish-speaking families at the shelter, but she found some bilingual teens to help translate all announcements.

“In those instances, we, as public health professionals, have to be ready to make the best out of the situation.”

UF played key role in Hurricane Irma relief

As Hurricane Irma approached Florida the first week in September, different groups within the UF College of Veterinary Medicine rallied to aid pet owners, veterinarians and animals of many species throughout the state.

The UF Veterinary Hospital provided continual 24/7 emergency services before, during and immediately after Hurricane Irma to pets, horses and wildlife, serving as a valuable patient care resource in light of closures of nearly every other veterinary specialty and emergency hospital in the state.

In addition, the UF Veterinary Emergency Treatment Service, the college’s disaster response and technical rescue team carried out several different missions relating to the storm. As Hurricane Irma approached on Sept. 9, the UF VETS team traveled to Bushnell and picked up 100 dog crates for delivery to Alachua County Animal Services’ operations to support pet-friendly shelters in the area. The team also investigated complaints of abandoned horses in Ocala. After the hurricane came through, the team coordinated an ambitious rescue of five horses stranded in floodwaters in High Springs.

UF’s Shelter Medicine group helped support the Alachua County Humane Society’s efforts to move animals out of shelters in harm’s way, and assisted in distributing donated vaccines and medications for 800 animals to the Humane Society, and delivered supplies to shelters in Taylor and Suwanee counties so they could care for animals arriving after the storm. The team contacted each of Florida’s 155 animal shelters to ensure they were getting the help they needed.

Members of the UF Aquatic Animal Health team were also vital to recovery as they assisted with three separate calls to rescue several displaced manatees found in different bodies of water.

A Quest for Answers: Cayden’s Story

Alisha Katz's picture
Submitted by Alisha Katz on October 12, 2017 - 14:00

Cayden Kauffman loves to explore the world in his baby walker. Once the 9-month-old gets scooting, there’s no stopping him from thrusting forward and sliding around. While Cayden today is much like a typical bouncing baby boy, his kick-start to life was anything but ordinary.  

Alexandrea Kauffman with Cayden.Alexandrea and Nicholas Kauffman of Panama City went for their 18-week sonogram to learn the gender of their second child, Cayden. During the appointment, doctors discovered that the fetus’ heart wasn’t developing properly and they referred the family to a maternal fetal medicine, or MFM, physician in the area.

“I cannot be blindsided,’’ said Alexandrea. “I said, ‘Give me the worst-case scenario.’”

The MFM physician was unable to pinpoint Cayden’s abnormality and referred the parents to Jennifer Co-Vu, M.D., director of the fetal cardiac program at the UF Health Congenital Heart Center and a part of the maternal fetal care program at UF Health in Gainesville.

The uncertainty was stressful for the couple. “No one having answers was the hardest part,” Alexandrea recalled.

The Kauffmans traveled to Gainesville hoping for answers. At UF Health, Co-Vu explained that she found multiple heart defects and a labor plan needed to be put in place. Cayden would be born with an isolated aortic atresia, a defect where the aortic valve is not open, and a ventricular septal defect, a condition win there is a whole between the lower chambers of the heart.

Since the fetus was at high risk, physicians recommended that Alexandrea give birth in Gainesville. The couple traveled to Gainesville for appointments every three to four weeks and then every two weeks as the delivery date approached. At 37 weeks, the Kauffmans stayed in Gainesville and, at 39 weeks, Alexandrea went into labor at UF Health Shands Children’s Hospital. She was wheeled to an operating room in case an emergency C-Section would be needed. Her nurse, Tara Summers, R.N., talked her through every step of the way to reassure Alexandrea that she and Cayden would be okay.

“She said, ‘You got this, push as hard as you can,’” Alexandrea said.

Once Cayden was born, he was taken to a warmer and wheeled to the neonatal intensive care unit, or NICU. Shortly thereafter, Alexandrea’s husband noticed she was hemorrhaging. Nicholas called in the nursing team and they went quickly into action to stop the bleeding.

“The nurses went above and beyond in how they handled the situation,” Alexandrea said. 

Cayden KauffmanAs a result of her hemorrhage, Alexandrea wasn’t able to walk until the next day. Meanwhile, Cayden spent two days in the NICU and was transferred to the pediatric cardiac intensive care unit, or PCICU, prior to surgery. One week after birth, Cayden underwent corrective heart surgery by Mark Bleiweis, M.D., the director of the UF Health Congenital Heart Center and chief of congenital cardiothoracic surgery at the UF Health Congenital Heart Center. Cayden recovered for three weeks in the PCICU and was sent home just before his first Christmas. In June, Cayden underwent another surgery and was in the PCICU for a week. As Cayden’s body grows, he will need additional procedures to heal his heart.

But those operations are in the future. For now, Cayden is focused on just being a little boy.

“He is just so sweet and is so happy,’’ Alexandrea said. “It’s amazing considering what he’s been through.”

 

Sending relief to stricken island

Gregory Hamilton's picture
Submitted by Gregory Hamilton on October 5, 2017 - 18:59

UF psychiatric researcher hopes to help hurricane survivors in his native Puerto Rico.

Since Sept. 20, when Hurricane Maria roared across Puerto Rico as a Category 4 monster, Luis M. Colon-Perez, Ph.D., has been unable to communicate with his family on the devastated island. Colon-Perez, a member of the psychiatry department in the UF College of Medicine, is from Utuado, in the central mountains of Puerto Rico and said he felt compelled to do something to help those struggling with Maria’s aftermath. With help from colleagues and his wife, Yarelis Soto Gonzales, a UF psychiatry resident, Colon-Perez has organized two large collections of donated items that he has taken to Orlando to be shipped to Puerto Rico.

The first collection, on Sept. 23, included items donated by colleagues in the psychiatry department as well as friends in the Evelyn F. and William L. McKnight Brain Institute of the University of Florida and at the Malcom Randall Veterans Affairs Medical Center.

The second trip took place on Saturday, Sept. 30 and was a much larger collection of items that had been donated all week at boxes set up at various locations.

“I felt this was a good way to keep me from thinking about all the bad stuff,’’ Colon-Perez said.

Shelter From the Storm

Jill Pease's picture
Submitted by Jill Pease on October 5, 2017 - 18:35

Carlyn EllisonCarlyn Ellison, a master’s in public health student in the College of Public Health and Health Professions, had just signed up as an American Red Cross volunteer in anticipation of conducting her internship with the group in the spring, when news hit that Hurricane Irma was making a beeline for Florida.

After some hurried emergency training, Ellison got her first volunteer assignment the night before the storm hit northern Florida: staffing a shelter in Gilchrist County, Alachua County’s neighbor to the west. Ellison set up the shelter’s registration station and registered more than 250 evacuees during a 12-hour shift.

“I talked to multiple families and let them express their situations to me. I learned that it is sometimes best not to offer your own advice, but simply be someone that they can tell their worries to,” she said. “I was happy that I could just be there for people who felt like they had zero control over their lives.”

One of Ellison’s challenges was finding a way to communicate to the eight Spanish-speaking families housed at the shelter. After asking around, she found some bilingual teens to help with translation so that all announcements were made in both English and Spanish.

“In those instances, we, as public health professionals, have to be ready to make the best out of the situation,” said Ellison, who plans to pursue a career in emergency management. “It is important not to get frustrated and take a moment to think critically and creatively. In the future, I will make plans, but also remember that no plan is perfect.”

Take the Pledge: Learn About Mental Illness

Submitted by on October 4, 2017 - 19:11

Mental Illness Awareness Week

This year, Oct. 1–7 is Mental Illness Awareness Week, a time to shine a light on mental illness and replace stigma with hope. Each year we fight stigma, provide support, educate the public and advocate for equal care. You can get involved at www.nami.org/miaw.

One in five adults experiences a mental illness in any given year. Those problems can contribute to onset of more serious long-term conditions such as major depression, bipolar disorder or schizophrenia. Approximately one-half of chronic mental illness begins by the age of 14. Unfortunately, long delays—sometimes decades—often occur between the time symptoms first appear and when people get help.

It is critical to learn to recognize early symptoms of mental illness and talk with a doctor about any concerns. Early identification and treatment can make a big difference for successful management of a condition.

For example, major depression is a mood disorder that is more serious than “feeling blue” or temporary sadness. Be alert to any combination of the following symptoms:

  • Depressed mood (sadness)
  • Poor concentration
  • Insomnia
  • Fatigue
  • Disturbance of appetite
  • Feelings of guilt
  • Thoughts of suicide

Bipolar disorder involves cycles of both depression and mania. It is different from normal “ups and downs” that many people experience. It involves dramatic shifts in mood, energy and ability to think clearly. Symptoms are not the same in everyone; some people may experience intense “highs,” while others primarily experience depression. Mania involves combinations of the following symptoms:

  • Euphoria
  • Surges of energy
  • Reduced need for sleep
  • Grandiosity
  • Talkativeness
  • Extreme irritability
  • Agitation
  • Pleasure-seeking
  • Increased risk-taking behavior

Schizophrenia is a different type of mental illness but can include features of mood disorders. It affects a person’s ability to think clearly, manage emotions, make decisions and relate to other people. Untreated, it also may include psychosis—a loss of contact with reality. Symptoms include:

  • Difficulty with memory
  • Difficulty in organizing thoughts
  • Lack of content in speech
  • Emotional flatness
  • Inability to start or follow through with activities
  • Inability to experience pleasure
  • Delusions
  • Hallucinations

Other types of mental illness include attention-deficit hyperactivity disorder, or ADHD, anxiety disorders (including posttraumatic stress disorder) and borderline personality disorder. Mental Illness Awareness Week is a time to learn about them all.

NAMI offers helpful information through its website (www.nami.org) and HelpLine (800-950-NAMI (6264)). With affiliates in hundreds of communities nationwide, NAMI also offers free education classes and support groups.

Anyone who experiences symptoms of mental illness should see a doctor to discuss and be checked for possibly related physical conditions. The next step might be referral to mental health specialist. Many treatment options exist. At UF Health, several levels of care are available, from crisis stabilization to inpatient and outpatient programs. People can call UF Health Psychiatry at 352.265.HELP(4357) 24 hours a day, seven days a week to get immediate help or to schedule an appointment.

During Mental Illness Awareness Week, take the #StigmaFree Pledge at www.nami.org/stigmafree. Help yourself, your family, your friends and your community. Help make a difference by saving lives and supporting recovery.

UF Researchers Awarded Grants for Brain Aneurysm Research

Submitted by Jeff Stevens on September 19, 2017 - 15:31

Brain Aneurysm FoundationThree UF Health researchers are receiving a total of $115,000 in grants from The Brain Aneurysm Foundation.

Brian Hoh, M.D., Koji Hosaka, Ph.D., and Sylvain Doré, Ph.D., have been awarded grants for their research on brain aneurysms, a condition that affects one in 20 people in the United States often resulting in death or lifelong disability.

The Brain Aneurysm Foundation is the largest private funder of brain aneurysm research in the United States and is a globally recognized leader in brain aneurysm awareness, education, support, advocacy and research funding.

"We are honored and grateful to The Brain Aneurysm Foundation and the donors to the BAF for supporting research in brain aneurysms,” said Hoh, the James and Brigitte Marino Family Professor in Cerebrovascular and Endovascular Neurosurgery and associate chair of the Lillian S. Wells department of neurosurgery.

“Brain aneurysms affect 5 percent of the population, and when they rupture result in 50 percent death or disability. Yet we do not know what causes brain aneurysms or what causes them to rupture,’’ he said. “With these grants from The BAF, we will be able to continue our work to better understand what causes brain aneurysms and to hopefully develop better treatment."

Hoh is being awarded $40,000 for his study, “IL-6 and IL-17 in the Cerebral Aneurysm Development of VCD mice,” work that he is performing with Siham Hourani, a doctoral graduate student in his laboratory. The two other recipients include Hosaka, also from the department of neurosurgery, who is receiving $40,000 for his research,

“Mechanism of Aneurysm Progression and Healing: Telomere and Telomerase Activity in Cerebral Aneurysm’’; and Doré, a professor in the Center for Translational Research in Neurodegenerative Disease, who is receiving $35,000 for his research, “Is CO-Releasing Molecule a Potent Tool for Attenuating Vasospasm and Providing Neuroprotection after Subarachnoid Hemorrhage?”

The grant awards will be presented on Sept. 28 at the Washington Duke Inn & Golf Club in Durham, North Carolina.

To purchase tickets for the program, or for more information about The Brain Aneurysm Foundation, visit bafound.org.

Heart Health

Bill Levesque's picture
Submitted by Bill Levesque on September 6, 2017 - 11:01

A recent survey by the Journal of the American College of Cardiology found that 45 percent of the women who participated did not realize heart disease was the leading cause of death among women.

University of Florida Health Shands Hospital is now taking on the challenge of providing more education and outreach to women with heart disease by joining the WomenHeart National Hospital Alliance.

WomenHeart: The National Coalition for Women with Heart Disease recently awarded UF Health Shands Hospital a two-year membership and promotes the alliance as an opportunity for hospitals to focus on and improve patient outcomes.

Through the Alliance, UF Health is positioning itself as a leader in women’s heart health.

The partnership works to ensure women have access to information, education and patient support services about heart disease. It also provides educational materials and programs for hospitals by some of the nation’s leading medical experts in women’s heart health.

Benefits include the opportunity for two women with heart disease to be selected by UF Health to attend the annual WomenHeart Science & Leadership Symposium at the Mayo Clinic in the fall. This is a four-day workshop during which they will be certified to return to UF Health as support network coordinators and community educators.

UFHealth’s representatives also will be able to attend a member meeting in Washington, D.C. to interact with national leaders in the heart health field and to collaborate with NHA colleagues across the nation on best practices, ideas and the challenges related to education and outreach to women with or at risk of heart disease.

Additionally, clinicians will be able to participate in educational webinars by experts in emerging research on heart disease in women.

“Participation in the WomenHeart National Hospital Alliance is an important step in providing education to our local community about the importance of heart health in women,” said Ki Park, M.D., an assistant professor in the division of cardiovascular medicine in UF’s College of Medicine. “It will also help our hospital in providing resources for women with heart disease as well as improve awareness of specific risk factors for heart disease in women.”

Fight the Flu This Fall

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Submitted by UF Health on September 6, 2017 - 10:00

Autumn leaves. Pumpkin carving. Cooler weather. And the sniffles.

It’s the time of the year to go outside and enjoy the cooler air, not stay in bed with a box of tissues and a cup of hot butternut-squash soup.

Because the influenza virus can spread so easily to others without any visible signs of symptoms, it’s important to make sure you get your flu shot early on in the season.

People who are at greater risk of serious flu-related symptoms include children younger than five; adults 65 and older; people who have asthma, chronic lung disease, heart disease, blood disorders, pregnant women; and people who have HIV or AIDS.

Family Medicine Physician Dr. Dickmann, M.D. suggest that vaccinations should be done once during each flu season, generally starting in September each year. However, there are preventative steps you can take daily to avoid catching the flu.

How can you keep from getting the flu?

  • Avoid close contact with anyone you know who is sick

According to Dr. Dickmann, the influenza virus in spread between people through droplets generally from coughing or sneezing. Typically it’s safe to stay five to six feet away from anyone sneezing or coughing.

  • Sanitize shared items

Door knobs, TV remotes, sheets and blankets, bathroom sinks and computer keyboards are all shared objects in a household that don’t always get cleaned as much as they should. If you’re sick, consider cleaning everything you touch inside or outside your home to prevent others from catching your cold.

  • Wash your hands

More than ever, make sure to wash both hands often with soap and water. If soap and water aren’t available, the Centers for Disease Control and Prevention recommends using an alcohol-based rub. This is important because people frequently touch their eyes, nose and mouth, where germs can easily enter into the body.

  • Drink enough water

Staying hydrated helps your body circulate blood more freely, allowing flu-fighting white-blood cells to fight off viruses. Water is a natural way to help your immune system fight germs and helps flush out any harmful toxins from your immune system. Upping your water intake also will replace lost fluids and will keep your nose and throat from feeling too dry.

  • Eat nutritious foods

Diets that are too low in calories or contain too many processed or fast foods will lack the nutrients necessary to maintain a healthy immune system.

“Eating a healthy diet with plenty of fresh fruits and vegetables helps the immune system stay strong, and along with getting vaccinated and taking precautionary measures,” Dickmann said. “A good immune system is the best defense against catching the flu.”

What should you do if you get sick?

  • Stay home

The CDC suggests that you stay home for at least 24 hours after your fever is gone, unless it’s to seek medical care. Staying home can help ensure that others don’t get sick as well as that you get the rest you need to feel better.

If you are looking for a primary care physician or to receive your flu vaccine, UF Health Family Medicine offers board-certified physicians with a full range of medical services for patients of all age groups. If you wish to make an appointment with UF Health Family Medicine, call us at 352-265-1234 or visit our website UFHealth.org/family-medicine.

Diabetic supplies for Hurricane Harvey victims gathered by UF Health researcher’s non-profit group

Doug Bennett's picture
Submitted by Doug Bennett on August 31, 2017 - 14:36

When Hurricane Harvey swamped Southeast Texas, many people lost access to crucial medical supplies. A Gainesville nonprofit group led by a University of Florida Health diabetes researcher and his wife has stepped up to help, getting thousands of pounds of insulin and diabetic supplies on the road to Texas — with more to come.

Insulin for Life USA typically gathers unused diabetic supplies and dispatches them to needy patients around the world. Hurricane Harvey created an instant need closer to home.

“There are a lot of people in Southeast Texas who have diabetes. Many of them lost the insulin and supplies they need to manage their disease,” said Mark Atkinson, Ph.D., director of the UF Diabetes Institute, a professor in the UF College of Medicine’s departments of pathology and pediatrics and president of Insulin for Life USA.

On Wednesday afternoon, five pallets of diabetic supplies – some 4,000 pounds in all – were boxed up and sent to Texas. For Atkinson, who is president of Insulin for Life, and his wife, Carol, it’s their first time handling domestic aid since they founded the group in 2012.

As Mark Atkinson spoke earlier this week about organizing donations, emails about the need for diabetic supplies in the Houston area kept pinging his phone. It’s a tall order for the Atkinsons and their small cadre of volunteers, which include UF College of Pharmacy students, but they get results: Last year, the group distributed more than $3 million of diabetic supplies to people who need them.

Insulin for Life is accepting all types of diabetes-related donations – in-date, unneeded insulin vials, pens and cartridges; glucagon; A1C test kits; glucose meters and strips, syringes and other supplies. Cash donations, which help with shipping expenses and allow the supplies to be distributed free to needy people, are also welcomed. Volunteers who can help sort and package supplies may also be needed as more supplies get donated, Atkinson said. For more information or for information about donating, go to http://ifl-usa.org/ or call 352-327-8649 or email Carol@ifl-usa.org.

Carpal Tunnel: What You Need to Know

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Submitted by UF Health on August 28, 2017 - 09:10

There are times you don’t realize how important a function of your body is until it gets injured. You may be doing something you do every day and then pain and numbness hits your wrist. This may be the first indication that you have carpal tunnel syndrome. According to the National Institute of Neurological Disorders and Stroke, women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common nerve condition where the median nerve in your wrist is being compressed. It is often confused with tendonitis— the inflammation, irritation, and swelling of a tendon— but carpal tunnel syndrome is a repetitive stress injury that affects the hands and fingers. Gestational carpal tunnel syndrome can also occur during pregnancy when there is swelling or fluid retention in the wrist. Whatever the case may be, it needs to be diagnosed and treated.

What are the symptoms?

Symptoms of carpal tunnel syndrome include:

• Tingling or “pins and needles” sensation in fingers and hand, most significantly in the thumb, index and middle fingers.
• Sensory loss and burning sensation, where pain may radiate up into the arm.
• Weakness and difficulty with fine motor movements.

Treatment

Carpal tunnel syndrome doesn’t always end in surgery. There are other ways to treat it. A conservative treatment involves wearing an extension wrist splint and taking anti-inflammatory pain relievers. You can also ice your wrist and take frequent rests from repetitive tasks, which can help to alleviate mild symptoms.

If the pain is too severe or conservative treatment doesn’t work, a surgical procedure can help. There are two types of carpal tunnel release surgeries: open and endoscopic surgery. Both surgeries use local anesthetic and do not require a hospital stay.
An open surgery is when the surgeon makes a cut in the palm of a hand. This surgical method allows the surgeon to have a better view of the nerve in order to release the pressure on the median nerve relieving the symptoms of carpal tunnel syndrome. After the surgery is complete, the skin is closed with stiches.

The endoscopic approach is a minimally invasive surgery where the surgeon makes a small incision in the wrist (a single portal technique) or at the wrist and palm (a two-portal technique), which requires the use of an endoscope (a thin tube with a camera) along with other surgical instruments. This method allows the surgeon to see the structures in the wrist such as the ligaments and helps relieve the pressure and symptoms of carpal tunnel syndrome.

Most patients who have had carpal tunnel surgery have less or no pain and numbness in their hand and better hand function after surgery.

If you are not sure if you have carpal tunnel syndrome, make sure to consult with a physician first for diagnosis and treatment. For more information on carpal tunnel release surgery at UF Health visit our website.

Call 352.265.8402 today to schedule a consultation.

Innovative surgical technique has one fortunate patient hitting the high notes

Nickie Doria's picture
Submitted by Nickie Doria on August 15, 2017 - 09:00

She waited. She wondered. She worried.
Then, she listened carefully as he said her name. “Therese.”
Four days after having a major stroke, Michael Markowitz spoke his wife’s name.
“I was afraid he might never say it again,” she said.

On Nov. 23, 2016, Michael had a stroke while at his dentist’s office. It was his 61st birthday and although Therese had teased him about spending his birthday having his teeth cleaned, Michael went anyway.

“It’s a good thing I didn’t listen to her,” he said with a chuckle. “The staff there had just been trained on how to recognize stroke symptoms, so they knew what was happening to me and called 911.”

When the ambulance arrived, the only word Michael could muster was “Shands.” The stroke had paralyzed his right arm and leg, and he was unable to speak.

“They have a reputation for being great,” he said. “I knew I would get the care I needed there.”

Michael, the lead singer of the rock and blues band Little Mike and the Tornadoes, had suffered a major stroke on the left side of his brain, and UF Health neurosurgeon Brian Hoh, M.D., performed an emergency blood clot removal surgery called mechanical thrombectomy. But, unlike the hundreds of surgeries before, this one was different.

A chronic complete blockage in Michael’s left internal carotid artery prevented Hoh from using a typical technique. Instead, he had to enter through the right side of Michael’s brain and cross over to the left side, a rare and novel approach.

“Michael’s case is remarkable,” Hoh said. “Some cerebrovascular/endovascular neurosurgeons can go their entire careers without ever encountering something like this.”

Hoh said the large, experienced team of doctors, nurses and clinicians and the specialized equipment at UF Health Shands Comprehensive Stroke Center are what makes difficult procedures like this one possible.

Five days after his surgery, Michael walked out of the hospital fully recovered. Within a month, he was back on stage belting out song lyrics. And, within three mont