J NEW SURGICAL OPTION MINIMIZES NECK SCAR

osh Rahn wasn’t feeling right but his symptoms were vague. His body ached. He had trouble focusing at work and concentrating.

Fortunately, the 30-year-old West Fargo resident was already seeing Essentia Health endocrinologist Dr. Alberto Cabo Chan for diabetes care, and his physician knew the significance of his symptoms and the higher levels of calcium in Rahn’s blood. The trouble turned out to be an overactive parathyroid gland – a gland Josh had never even heard of.

Parathyroid glands are the size of a grain of rice, but they can cause big problems in the body if they’re not working properly. Symptoms like fatigue, depression, fractures, chronic constipation, bone pain and high blood pressure can all be associated with a parathyroid gland that produces too much hormone.

This condition, called hyperparathyroidism, most often occurs when a growth or tumor forms on one of the four tiny glands located in the neck. Essentia Health-Fargo is the only healthcare provider in the region to offer a new minimallyinvasive procedure to remove the overactive gland and tumor.

Parathyroid glands play an important role in regulating calcium in the body, explains Dr. Cabo Chan. If left untreated, the condition can cause recurrent kidney stones, osteoporosis and broken bones, because the gland leaches calcium from the bones.

Dr. Cabo Chan used to send patients who were candidates for this minimally-invasive procedure to the Mayo Clinic in

Rochester, Minn. Now, he can refer them to his colleague, Dr. David Tsen, an Essentia Health Ear/Nose/Throat specialist who’s had extensive training and has been providing the delicate endoscopic surgery for about a year.

“It’s a lot more convenient for the patient,” Dr. Cabo Chan says. “They don’t have to travel and the procedure can be done as soon as possible. If you can do everything within the same institution, it’s much better for the patient.”

“That was a plus,” Rahn says. “It was one-day surgery – in and out.”

During the surgery, Dr. Tsen makes a 2-centimeter incision in the neck and uses a tiny camera to locate the tumor. “It’s quite an improvement over traditional procedure,” he says. “I’ve seen neck surgeries with a 6- to 8-centimeter incision.”

Patients often go home the same day. “In general, the smaller cut you can make, the happier people will be,” Dr. Tsen says. “The patient is in less pain and will need less pain medication.”

The minimally invasive technique can also be used for some tumors on the thyroid gland.

Dr. Cabo Chan enjoys telling patients that they can stay close to home for their surgery. “They are surprised,” he says. “They have already done their research and they think this procedure is only available in certain states.”

Rahn says he was pleased to have his condition diagnosed and taken care of close to home. “I read this often goes untreated for many, many years,” he says. “I’m glad this was caught.”

SISTERS BATTLE RARE, DIFFICULT DISEASE

Sanford Heart Center offers crucial expertise

For sisters Lana Eichhorn and Carmen Froseth of Fargo, the symptoms were eerily familiar. Their mother experienced them years ago.

“Mom started having trouble walking hills. Next she couldn’t catch her breath going up a flight of stairs,” recalled Lana. “She was diagnosed in April 1991 and passed away seven months later.”

Last summer, after similar symptoms, Lana and Carmen learned they had pulmonary arterial hypertension (PAH) -- the same disease that took their mother at age 33.

“The diagnosis was terrifying,” said 28-year-old Carmen.

“And it was happening to both of us at the same time,” said 36-year-old Lana.

What’s PAH?

• In PAH, the arteries of the lungs constrict abnormally, forcing the heart to work harder to pump blood. This can lead to heart damage and ultimately heart failure.

• Often PAH is secondary to other diseases. Inherited and isolated PAH such as Carmen’s and Lana’s is rare.

• PAH symptoms can include chest pain, dizziness, shortness of breath and fatigue. These relatively common symptoms make PAH difficult to diagnose. An echocardiogram is key.

• PAH has no cure, but today’s treatments can reduce symptoms, improve quality of life and slow the disease. The medicines are powerful, but expensive.

Then came hope, thanks to 20 years’ medical progress that continues today.

Essential expertise

The sisters connected with Dr. Heeraimangalore Manjunath, Sanford cardiologist who is board certified in advanced heart failure, including PAH; it’s a rare specialty. He and specially trained nurse Cindy Jurva provide precise, comprehensive care at the Pulmonary Hypertension Clinic in the cardiology department at Sanford Heart Center in Fargo.

“PAH is a very difficult disease, both for the patient and the medical team,” said Dr. Manjunath. “Key steps include identifying patients at risk, diagnosing the exact type of PAH, and carefully initiating patients on the correct group of medications.”

Carmen takes a combination of medications daily. Lana’s more advanced disease required a chest catheter to enable a continuous flow of lung medicine. Both sisters have experienced improvement.

A different life

So far Lana and Carmen have been able to continue their full-time jobs, but other aspects of life have changed:

• Married five years, Carmen cannot have children because of the physical stress of childbearing and the harmful fetal effects of the medicines.

• Lana and her husband have two young children. Steps will be taken to ensure that if they have PAH, it will be diagnosed as early as possible.

• Limitations in activities. “You learn to live with them,” said Carmen. “I’ve noticed we’re both so much more grateful for everything we’ve been blessed with.”

So what keeps these sisters fighting this harsh disease? “You fight for your family and for everyone you care about,” said Lana. “No, you can’t do everything you used to do, but you’re alive and that’s what matters most.”

They fight for each other, too. Carmen and Lana text, call or see each other almost daily.

With hope, humor and hugs, they bring new meaning to an old saying: “A sister is a forever friend.” [AWM]