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Health, Science & Wellness
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TOGETHER WE ANSWER CANCER Young patient, tough decisions PAGE 8
Lexi Fiedler confronts the challenges of a breast cancer diagnosis
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Microsurgery eases pain, swelling from lymphedema PAGE 12
Are you at risk for prostate cancer?
ALSO IN THIS ISSUE PAGE 3
The ups and downs of using a standing desk PAGE 7
Why adults still need to get their shots
Fall 2019
The Forefront
IN THIS ISSUE ON THE COVER
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NO MORE SEIZURES Treatment stopped Riley Crump’s frequent seizures caused by childhood absence epilepsy.
STABILIZING CENTRAL SLEEP APNEA
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A new implantable device stimulates breathing in patients with a serious sleep disorder.
SLOWING CIRRHOSIS
Lexi Fiedler and her husband, Jeff Penzenik
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Keeping your liver healthy may preserve function.
Cover photo by Robert Kozloff
Lexi Fiedler was newly married with two stepsons when she learned she had breast cancer.
UChicagoMedicine.org/ forefront
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TOGETHER WE ANSWER CANCER UChicagoMedicine.org/AnswerCancer
READ ONLINE
ADULT IMMUNIZATIONS
7
Boosters and new vaccines protect you and others.
MORE NEWS FROM THE FOREFRONT Sign up for our Health & Science e-newsletter.
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#AnswerCancer
The Forefront magazine features stories about life-changing care and breakthroughs in medical research at the University of Chicago Medicine and Biological Sciences. Kenneth S. Polonsky, MD Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine and Executive Vice President for Medical Affairs Sharon O’Keefe President of the University of Chicago Medical Center
VISIT OUR WEBSITE FOR MORE INFORMATION: Adult and children’s care UChicagoMedicine.org Science, health and wellness news
Senior Vice President, Chief Communications and Marketing Officer: William “Skip” Hidlay Editor: Anna Madrzyk Associate Editor: Gretchen Rubin Design: SBDWorks, Inc. Contributing writers
UChicagoMedicine.org/forefront
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This publication does not provide medical advice or treatment suggestions. If you have medical problems
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or concerns, contact a physician, who will determine
Robert Kozloff, Jean Lachat, Eddie Quinones,
your treatment. Do not delay seeking medical advice
Nancy Wong
because of something you read here. For urgent needs, call 911 right away.
James Mastrianni, MD, PhD (left) and James Tao, MD, PhD
WELCOME TO THE FOREFRONT OF NEUROLOGICAL CARE With so many vital functions controlled by the brain and nervous system, it’s crucial to seek the finest care when problems arise. At the University of Chicago Medicine, our team of neuroscience experts are highly skilled in evaluating and treating even the most complex and challenging conditions, including epilepsy, stroke, Alzheimer’s disease and more. And our scientists are leading the way in research discoveries that will bring more effective treatments and — ultimately — cures.
UChicagoMedicine.org/neuro Call 1-888-824-0200 for more information.
MAKING THE GRADE FOR PATIENTS AND FAMILIES
The University of Chicago Medicine recently received its 15th consecutive “A” grade in hospital safety from the industry watchdog The Leapfrog Group. We are the only institution in Chicago with this distinction.
ENCOURAGING NEWS FOR HARD-TO-TREAT CANCER
A new drug has been found to significantly prolong disease control for some patients with advanced pancreatic cancer. The pill, olaparib, targets cancer cells that have a defect in DNA damage repair. Patients with inherited BRCA mutations took olaparib after chemotherapy. “About a quarter of these patients responded to olaparib for a median of two years, which is truly remarkable in a disease where most patients survive for less than a year,” said oncologist Hedy Kindler, MD, of the University of Chicago Medicine. “Chemotherapy followed by maintenance olaparib treatment should become a new standard of care for patients with metastatic pancreatic cancer who have this mutation.” Kindler was lead author of the study published in the New England Journal of Medicine.
BABY BELLY BUGS
Healthy babies’ intestines contain bacteria that prevent food allergies, a University of Chicago Medicine researcher found. The investigators used mice raised in a sterile environment, meaning they had no bacteria of their own. When the nonallergic infants’ bacteria were introduced into these mice, they were protected from cow’s milk allergy, the most common childhood food allergy. Mice given bacteria from infants allergic to milk suffered an allergic reaction to cow’s milk, as did a control group of mice that did not receive any infant bacteria. “These findings are already helping us create new kinds of treatments to prevent or reverse food allergies,” said Cathryn Nagler, PhD, food allergy researcher at UChicago and senior author of the study, published in Nature Medicine. Researchers from Argonne National Laboratory and the University of Naples Federico II in Italy participated in the study.
SLEEP TIGHT, STAY SHARP
Older people who have trouble staying asleep are more likely to experience a decline in mental abilities. For several nights, 759 adults ages 62 to 90 wore a motion-detecting wrist sensor. They were tested for mild cognitive impairment at that same time and again five years later. The differences in the tests revealed which participants declined in reasoning, memory, attention and language skills. “We found that more disrupted sleep is related to worse cognitive function,” said Diane Lauderdale, PhD, an epidemiologist and chair of the Department of Public Health Sciences at the University of Chicago. Participants’ total amount of sleep was not related to cognitive function. “The problem seems to be an inability to sleep in a consolidated way, spending significant time awake during the night,” said Lauderdale, author of the study published online in the American Journal of Epidemiology.
TWIN EPIDEMICS
Opioid use by a parent doubles the risk for suicidal behavior in children, according to a recent study. Suicide among young people in the U.S. rose dramatically over the last 15 years, as did opioid use and abuse in adults. Examining the cases of more than 240,000 parents and their 330,000 children, ages 10 to 19, University of Chicago and University of Pittsburgh researchers confirmed suspicions that the two epidemics were linked. “Improved diagnosis and treatment of parents who use opioids, as well as mental health screening and referral to care for their children, could help reverse the upward trend in deaths due to these twin epidemics,” said Robert Gibbons, PhD, director of the Center for Health Statistics at UChicago. Gibbons is senior author of the study, published in JAMA Psychiatry.
READ MORE AT
UChicagoMedicine.org/forefront
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TAKING A STAND IN THE WORKPLACE The ups and downs of height-adjustable desks
Prolonged sitting has been linked with muscle and joint discomfort, and can increase your risk for disease — including certain cancers. Even if you are otherwise active, sitting for long periods of time may cancel out some of the health benefits gained from exercise. So, what happens if your job requires that you spend the majority of your day at your desk? Some workers have started using height-adjustable desks, which allow them to quickly raise or lower workstations so they can stand or sit as needed. University of Chicago Medicine orthopaedic surgeon Sara Wallace, MD, MPH, specializes in treating patients with hip and knee arthritis. She says that while height-adjustable desks can be beneficial overall, they should be customized for each user’s comfort and physical and health needs. HEALTH BENEFITS
A standing desk encourages movement throughout the workday. When in a standing position, we naturally shift and move our bodies as we work. Standing and movement help to maintain healthy bones and joints. Particularly for individuals with arthritis, movement will help to reduce stiffness. Also, standing encourages the use of core muscles to maintain an upright posture. It may also increase alertness while on the job. NOT FOR EVERYONE
For individuals with arthritis, constant weight bearing may worsen joint pain. Standing for long periods of time can also worsen leg swelling, particularly if someone is pregnant or has a condition that causes the veins to stay filled with blood, especially when standing. For these individuals, it is important to alternate between sitting and standing throughout the day. DON’T JUST STAND THERE
While switching between standing and sitting at the workstation can be beneficial, nothing beats a good walk to improve health, Wallace said. “Walking helps with good bone and joint health, even for someone with arthritis,” she said. “Instead of emailing or calling your coworker around the corner, walk over to talk in person; this type of movement and face-to-face interaction can improve both our physical and psychological well-being.”
Lorna Wong, executive director of communications at UChicago Medicine, often spends several hours at her computer and has used a standing desk for more than a year.
I like the flexibility an adjustable desk provides, allowing me to stretch and move around, even as I am typing on the keyboard.”
Tips for using a height-adjustable desk DO » P osition the desk at an appropriate working height so that your wrists, elbows, shoulders and back are neutrally aligned. » Remember to move throughout the day. » T ake breaks from standing if you start to become fatigued.
DON’T » L ean forward onto your desk, crouch or stoop from the lower back. » W ork in a standing position unless your computer or working material is accessible and visible to you at a comfortable height. » M ake drastic changes: If you aren’t used to standing for long periods of time, transition to the standing position gradually, and as tolerated.
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Room to grow Leia Annerino with her parents, Anthony and Susan
Leia Annerino wasn’t even a day old when her mother, Susan, noticed something while gazing at her daughter: The little girl’s face wasn’t quite symmetrical, and her right eye did not fully shut. Soon, Susan and her husband, Anthony, had their own term of endearment for it: Leia’s Popeye eye. “When she’d fall asleep, you could see her right eye open a little,” recalled Susan. “We’d always gently tap her eyelid closed because we didn’t want her eye to dry out.” At her daughter’s two-month checkup, Susan mentioned it to the pediatrician. A CT scan eventually revealed that Leia’s skull wasn’t shaped correctly. Most babies are born with seven bone plates that form the skull. These plates are linked together by connective tissues that act like flexible seams, making it easier for babies to pass through the birth canal and for their brains to grow. The sutures normally fuse together anywhere between 9 months old to well into adulthood. Doctors found that parts of Leia’s skull had prematurely fused together, a birth defect called craniosynostosis. It’s estimated that craniosynostosis affects one
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out of every 2,000 to 3,000 births. The condition gave Leia an uneven appearance around her right eye and forehead. Even more importantly, however, it meant her brain might not have room to grow normally on one side. My question was, ‘Where can I take her? Who operates on this?’” Susan said. Susan’s research led her to the University of Chicago Medicine Comer Children’s Hospital Craniofacial Anomalies Multidisciplinary Program (CAMP), one of the most active craniofacial programs in the region. CAMP offers multiple specialists, including neurosurgeons, plastic surgeons, audiologists and otolaryngologists, to diagnose and treat children with abnormalities of the skull and face. The Mount Greenwood family met with pediatric plastic and reconstructive surgeon Russell Reid, MD, PhD, and neurosurgeon
David Frim, MD, PhD, who recommended corrective surgery to remove, reshape and replace the bones in Leia’s skull. During the six-hour surgery, Reid exposed the skull bones. Frim removed them, while keeping the brain safe. Reid then reshaped the bones and put them back together to give Leia’s brain space for future growth. Susan remembers the first moment she saw her daughter after the operation. “She looked perfect,” said Susan, a speechlanguage pathologist at UChicago Medicine Ingalls Memorial. “I could tell right away that she looked more symmetrical.” At Leia’s most recent checkup, the family celebrated the news that Leia no longer needs follow-up appointments, which she had been receiving since her operation at 4 months old. “She’s a typical 5-year-old, academically ready for kindergarten,” Susan said. “This is how she’s supposed to be.”
With craniosynostosis, a child can have developmental, vision, neurologic and airway issues, so there’s a real need to provide holistic comprehensive care.” RUSSELL REID, MD, PHD Pediatric plastic and reconstructive surgeon
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Riley Crump
From the time Riley was 18 months old, Helaina and James Crump knew there was something different about their youngest daughter. On family walks around the neighborhood, the toddler would suddenly stop in her tracks. After a few seconds, she’d snap out of it as if nothing had happened. “Her brain is just big, she’s going to be a genius,” James would say. The family’s pediatrician in Mississippi told them Riley was just learning about the world around her. But as she grew older, her “daydreams” became more worrisome. Riley would not respond to someone calling her name or shaking her. “If it was just daydreaming, it shouldn’t have gotten worse,” Helaina said. When Riley was 7, her parents, now living in the south suburbs, made an appointment with Denice Cook, MD, an independent community pediatrician practicing at University of Chicago Medicine Ingalls Memorial in Harvey. “Dr. Cook immediately referred us for an EEG (electroencephalogram), gave us a referral to a neurologist and more,” Helaina said. “She was on it.” Riley’s parents took her to the University of Chicago Medicine Comer Children’s Hospital for the hour-long test, which records the electrical activity of the brain. An hour later, the Crumps learned that Riley’s “daydreams” were seizures, and that she was having 20 to 30 an hour. While the Crumps were still at the hospital, Riley’s test results were discussed by a team of epilepsy experts in the New Onset Seizure Clinic. “The clinic’s goal is that early on every
SIGNS that a child may be experiencing
absence seizures include: » Sudden stop of motion without falling » Staring off blankly, as if in a daydream
» Cannot be roused from a seemingly frozen state » Blinking over and over or eyelids fluttering » No recollection of what happened » Teacher notices child’s inability to pay attention
child who has an unprovoked seizure will quickly see a team with special expertise in epilepsy,” said Douglas Nordli Jr., MD, chief of pediatric neurology at Comer Children’s. “We call it a ‘reverse referral’ because the specialist sees the child at the onset of the problem, and often accurately determines if the patient can safely follow up with their primary care team or might benefit from specialized care. Many times, families can receive a definitive diagnosis before they leave.” Childhood absence epilepsy typically affects children ages 4 to 14, said Audrey Oetomo, MSN, a pediatric nurse practitioner. Most children outgrow absence seizures. But until then, they are prescribed medication to help control the frequency.
Within a week after starting the medication, Riley’s seizures stopped. “She has not had an episode since,” Helaina said. Riley finished the school year with straight A’s, and received a certificate for perfect attendance and a tablet for being a star pupil. And, when Riley started second grade this year, Helaina was relieved she no longer had to alert teachers to Riley’s daydreams. “I’ll just tell them that they have a genius on their hands,” she said. Learn more about the New Onset Seizure Clinic at Comer Children’s Pediatric Epilepsy Center: UChicagoMedicine.org/child-epilepsy
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Sleep easier
Men are more likely to develop central sleep apnea than women, and patients over age 65 are at an increased risk.
Central sleep apnea (CSA) is a serious disorder in which
a person continually stops and starts breathing while sleeping. It happens when the brain fails to send the correct signals to the muscles that control breathing.
It’s different from — and much less common than — obstructive sleep apnea (OSA), which is caused by a partial obstruction in the upper airway. University of Chicago Medicine pulmonologist Babak Mokhlesi, MD, an expert in sleep disorders, and cardiologist Hemal Nayak, MD, an expert in heart rhythm disorders and arrhythmias, explain more about CSA and an exciting new treatment now offered at the University of Chicago Medicine. WHAT ARE THE SIGNS AND SYMPTOMS OF CENTRAL SLEEP APNEA?
Common signs of CSA include difficulty staying asleep, shortness of breath, chronic fatigue, snoring and morning headaches. CSA can cause sudden drops in blood oxygen levels and lead to significant fluctuations in blood pressure during sleep. This can put a significant strain on a person’s cardiovascular system. WHO IS MOST AT RISK FOR CSA?
Patients who have other diseases, such as chronic heart failure, atrial fibrillation, kidney failure, diabetes and stroke are at an increased risk for developing CSA.
Babak Mokhlesi, MD
Exposure to very high altitudes and opioid use also raises the risk for CSA. The condition is more common in men and in people over 65. HOW IS IT DIAGNOSED?
The best way to diagnose CSA is through an overnight study, which may take place at home or in a sleep laboratory. A test called a polysomnogram will determine whether sleep disturbances are the result of incorrect signals from the brain (CSA) or from a blockage in the airway (OSA).
Hemal Nayak, MD
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The remedē System for central sleep apnea is placed under the skin just under the right collarbone during a minimally invasive, outpatient procedure. The battery-powered device uses two thin wires, or leads — one to deliver the signal and the other to sense breathing. At first, patients feel a slight sensation when the system is actively stimulating the diaphragm. Eventually, most patients are not aware of the device.
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WHAT IS THE NEW TREATMENT FOR CSA?
UChicago Medicine was the first hospital in the Chicago/Northwest Indiana region to offer a breakthrough treatment for CSA after it was approved by the FDA. The implantable device, called the remedē System, stimulates a nerve in the chest responsible for sending signals to the diaphragm. These signals stimulate, monitor and stabilize breathing patterns, enabling patients to breathe and sleep during the night.
Keeping up with your shots Immunizations aren’t just for children and teens. Adults need booster shots, too. Gloria Okereke, DO, a family
practitioner at University of Chicago Medicine Ingalls Memorial, recommends checking with your physician to stay up-todate on your immunizations.
Tetanus, diphtheria, pertussis
Measles, mumps, rubella
Adults should receive a tetanus, diphtheria and acellular pertussis (Tdap) booster once every 10 years, especially those who may be at risk of puncture wounds, such as the kind that occur if you step on a nail.
Children receive two doses of the measles, mumps, rubella (MMR) vaccine, once at 12 to 15 months and again between 4 and 6 years. Some children may get a similar vaccine (MMRV) that also prevents varicella (chickenpox). Adults can receive the MMR or MMRV vaccine if they did not get it as a child.
Okereke said pregnant patients should get a Tdap booster in the third trimester of every pregnancy, preferably in the early part of gestational weeks 27–36. That’s because antibodies from the vaccine are passed on to protect the developing baby from whooping cough (pertussis), which can be life-threatening in infants.
“It’s part of our role as primary care physicians to make sure there are no gaps in your care,” Okereke said. “We’re trying to protect the general population from contracting potentially life-threatening illnesses, especially illnesses we can prevent.” Here is a list of boosters and vaccines to receive as an adult:
Flu (Influenza) Adults are encouraged to get a flu shot every year — typically in the fall or winter. Since the flu virus changes each year, annual vaccinations are needed. “Flu can be very serious in patients who have poor immune systems, or patients who are very young or old,” Okereke said, although influenza can be serious for healthy adults, too.
Shingles (Zoster) The Centers for Disease Control and Prevention recommends adults age 50 and older receive the zoster vaccine to prevent shingles, a viral infection that causes a painful rash. Shingles is caused by the same virus that causes chickenpox. While anyone who has had chickenpox can develop shingles, adults over age 60 are at the highest risk.
✓ A vaccine card can be helpful to track what
shots you’ve already received and what is due next, especially if you change physicians.
HPV The CDC recommends receiving a series of vaccines to prevent human papillomavirus (HPV), the common sexually transmitted infection linked to cervical and head and neck cancer. Both men and women through age 45 can get this immunization. For patients older than 15, three doses are required to be fully vaccinated.
Pneumonia At-risk adults between the ages of 19 and 64 should receive an immunization for pneumonia. You may be more susceptible to pneumonia if you smoke, have respiratory diseases such as COPD or asthma, suffer from renal failure, or have an immune suppression disorder, alcoholism or HIV. Doctors also recommend all patients older than 65 receive two pneumonia boosters.
LO C AT I O N S
UChicago Medicine at Ingalls
Gloria Okereke, DO
Calumet City
South Holland
Crestwood
Tinley Park
UChicago Medicine at Ingalls Memorial Harvey
Flossmoor
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A young woman faces breast cancer
SPECIAL SECTION
TOGETHER WE ANSWER CANCER
At 32, Lexi Fiedler was fit and healthy, a runner with five marathons under her belt and no family history of breast cancer. So, when she noticed a hard spot on her breast in summer 2018, she didn’t think much of it. At her checkup a few weeks later, Fiedler’s primary care physician didn’t seem concerned either, but suggested an ultrasound just to be safe. Fiedler didn’t even think about the possibility of cancer until she was referred for a biopsy. But she reminded herself that only 20 percent of biopsies end up being cancer. Less than 5 percent of breast cancer diagnoses are in women under 40.
It’s a big responsibility, in the face of a cancer diagnosis, to very quickly contemplate, ‘What are my hopes and dreams for having a family? And to what lengths am I willing to go?’” STACY TE SSLE R LIN DAU, M D Director, Program in Integrative Sexual Medicine (PRISM)
“This couldn’t happen to me,” she thought. “This couldn’t happen to me,” she thought. But when her doctor called with the results, the news was But when her doctor the results, the news was devastating: stage 2,called triplewith positive breast cancer (ER-positive, devastating: Stage 2, triple positive breast cancer (ER-positive, PR-positive, HER2-positive), an aggressive form requiring PR-positive, an aggressive form requiring immediate HER2-positive), chemotherapy followed by surgery. immediate chemotherapy followed by surgery.
Lexi Fiedler with her husband, Jeff Penzenik, stepsons, Nathan and Lucas, and the family dog, Fred
Lexi Fiedler’s UChicago Medicine Physician Team
OLWEN HAHN, MD
Oncologist
Diagnoses and treats breast cancer, and serves as the primary investigator on multiple studies that examine the effectiveness of new drugs.
JEAN BAO, MD
Breast cancer surgeon
Specializes in the surgical treatment of breast cancer, benign breast disease and patients with a genetic disposition or strong family history of breast cancer.
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DAVID W. CHANG, MD
STACY TESSLER LINDAU, MD
Performs complex microsurgical reconstructive surgery in cancer patients, and has an international reputation as a pioneer and an innovator in the field of breast reconstruction.
Directs the Program in Integrative Sexual Medicine (PRISM), which provides care for many women with sexual health concerns caused by cancer or its treatment.
Plastic and reconstructive surgeon
Gynecologist
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To learn more about Lexi’s treatment, visit UChicagoMedicine.org/Lexi
Join Lexi at the 2019 RBC Race for the Kids
Fiedler turned to physicians at the University of Chicago Medicine, whom she describes as “some of the brightest minds in the cancer world.” Trusting them fully helped her quickly make some big, difficult decisions.
For the last three years, Lexi Fiedler has thrown her time and talent into organizing the annual RBC Race for the Kids at Comer Children’s.
“I definitely agonized over every one of them,” she said. “I felt like my doctors were always in my corner and didn’t want me to regret my decisions, so they shared all the options with me, and that really helped.” Within a matter of weeks, Fiedler would have to decide whether to have both breasts removed or just the affected one, whether to have her breast surgically reconstructed, and whether she wanted an implant or a procedure to reconstruct the breast using her own tissue. But she also had to make life-altering decisions most older breast cancer patients don’t face: Did she want her eggs harvested and frozen before beginning treatment? Should those eggs be made into embryos with her husband’s sperm? Did she want to breastfeed someday? Fiedler, a newlywed with two young stepsons, had figured she still had several years to decide about having biological children. It was “on the table,” she said, but definitely not on the schedule. “As soon as the doctors told me I might not be able to have children, I realized I still wanted the option,” she said. “I ultimately decided if I didn’t do it, I might regret it later.”
Lexi Fiedler missed running the Chicago Marathon last year during her breast cancer treatment, but she is training for a half marathon this fall.
blood vessels from the abdomen to the breast. UChicago Medicine is one of the few places in Chicago to offer this option. The difficult decisions, chemotherapy and surgery are behind her, but Fiedler’s cancer treatment is not over. She’s taking part in a clinical study about breast cancer patients who don’t have radiation therapy. She is finishing up a year’s worth of Herceptin and Perjeta infusions, two targeted therapies for HER2-positive breast cancer. She will continue taking several drugs for the next five to 10 years, including the estrogen-reducing medication anastrozole.
Her mastectomy in March 2019 was performed at the same time as her DIEP flap reconstruction surgery — a complex microsurgery that transplants tissue and
Now in remission, the 33-year-old is back to work as a fundraiser for the University of Chicago Medicine and Biological Sciences Development office. She is busy planning the 2019 RBC Race for the Kids at the University of Chicago Medicine Comer Children’s Hospital. She is training for the Chicago Half Marathon in late September. And she is enjoying spending time with her friends and family.
Young women with breast cancer face unique challenges. A peer support group called The Breasties (thebreasties.org) helped Lexi Fiedler connect with women under 40 affected by cancer.
“Physically, I look like I’m on the other side of it, but I’m still struggling with things,” Fiedler said. “I have good days and bad days. I’m just always wondering if it’s going to come back. Every day I think about that. If I drink alcohol is it going to come back? If I eat fried foods is it going to come back? If I don’t eat enough greens, is it going to come back? This has been the hardest year, but I’ve also never felt more loved and supported in my entire life.”
Within a week of her diagnosis, Fiedler began an intensive, daily fertility preservation process to freeze her eggs. That was followed by 20 rounds of pre-surgery chemotherapy.
Last year, even while coping with treatment for breast cancer, Lexi was able to lead the race into its best fundraising performance ever — a benchmark she plans to top with this year’s race.
Join Lexi for a family-fun day at the 2019 RBC Race for the Kids on Sunday, Oct. 6, to support lifesaving research at the University of Chicago Medicine Comer Children’s Hospital. Run, walk or fundraise to help save kids’ lives in Chicago and throughout the world. Events include a 5K Run/Walk, Kids’ Mile and Kids’ Dash.
Register today at
giving.uchicago.edu/race
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TOGETHER WE ANSWER CANCER
Compassionate, leading-edge breast cancer care The University of Chicago Medicine breast cancer team has expertise across the full spectrum of breast cancer care: breast imaging, breast surgery, medical and radiation oncology, reconstructive surgery, clinical genetics, pathology and nursing.
Expanded breast cancer screening closer to home
EXPERT DIAGNOSIS
The University of Chicago Medicine will open a $5.7 million dedicated breast imaging center next year in its Orland Park outpatient facility. The center will provide screening and diagnostic mammography as part of a joint venture with Solis Mammography. It will feature a 3D mammography machine that uses SmartCurve comfort technology paddles that follow the shape of a woman’s breast. It will also have breast ultrasound services for diagnostic scans and biopsy targeting, as well as a bone density scanner. “By combining Solis Mammography’s model with our outstanding cancer program and oncology team, who will interpret imaging results and manage quality, we will be able to provide patients with integrated mammography care,” said Kenneth S. Polonsky, MD, executive vice president for medical affairs at the University of Chicago. UChicago Medicine will also partner with Solis Mammography to provide mammography services at the health system’s Hyde Park campus and its new River East location, which will open in 2020.
290
Duchossois Center for Advanced Medicine
HYDE PARK
Hyde Park Main Campus - Chicago 55
Flossmoor
294 355
New Lenox
90 94
ORLAND PARK
Orland Park
TINLEY PARK
Tinley Park
Board-certified pathologists who focus their practice on benign and malignant breast diseases provide crucial insight and expertise in the multidisciplinary treatment of breast cancer patients. CLINICAL TRIALS
UChicago Medicine is the only institution in Chicago offering phase I, phase II and phase III clinical trials for women with early-stage and metastatic breast cancer. SURGICAL EXPERTISE
Our surgeons are highly skilled, nationally recognized experts in the surgical treatment of breast cancer and advanced breast reconstruction options. DEDICATED BREAST CANCER NURSING
Our breast cancer care locations Harvey
Our board-certified radiologists provide the full range of image interpretation and image-guided procedures to uncover signs of disease, including 2D digital mammography, 3D mammography and breast MRI (magnetic resonance imaging). Our main campus location in Hyde Park and Ingalls locations in Harvey and Tinley Park are designated as Breast Imaging Centers of Excellence by the American College of Radiology.
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Most of our nurses are certified through the Oncology Nursing Society, which brings a special cancer-focused expertise to our patients. Nurse navigators help patients transition smoothly from one department to the next. RISK AND PREVENTION
UChicago Medicine offers a comprehensive breast cancer risk reduction and prevention program for patients who may have inherited a gene mutation associated with breast cancer.
Surgery that
CHANGED EVERYTHING Ellen Szelina
“It changed everything for me and my family,” she said. Chang stressed that the surgery isn’t for everyone and won’t cure lymphedema. It is more effective for swelling in the arms than in the legs. But it can significantly improve a patient’s quality of life. UChicago Medicine is one of just a few centers in the country offering lymphovenous bypass and lymph node transfer. Patients have come from all over the world for these innovative surgical procedures. “The earlier the intervention, the better,” Chang said. “You will still have to live with the condition for the rest of your life. It’s just a lot easier to deal with.” For Szelina, it was a perfect solution.
The rosebushes in Ellen Szelina’s backyard needed to be pruned, a job the retired Willowbrook nurse always enjoyed doing herself. But after her 2011 treatment for breast cancer, she developed lymphedema in her left arm — severe, chronic swelling that sometimes occurs after lymph node removal or radiation treatment. The constant threat of infection from something as small as a cut or an accidental bump made her afraid to do many of the things she loves, like gardening, traveling or playing with her dog. No matter how careful she was, Szelina’s lymphedema regularly triggered infections that were accompanied by a high fever and painful swelling in her arm and hand. Each time, she’d have to spend a few days in the hospital getting IV antibiotics. “It was always in the front of my mind, because when I got sick, I got really sick really fast,” she said. Then she read about David W. Chang, MD, chief of plastic and reconstructive surgery at the University of Chicago Medicine and a world-renowned lymphedema microsurgeon.
“I kind of thought there weren’t any other options for me, until I found this,” said Szelina, 60, a mother of two. “I hope by sharing my story, I can help someone else find their happy ending.” To find out if you would be a good candidate for this surgery, email Dr. David Chang at s.sur.lymphedema@bsd.uchicago.edu.
Chang pioneered a unique, complex surgery for lymphedema patients that reroutes the lymphatic system around damaged lymph nodes. He performs the surgery under a special microscope and uses superfine instruments to reconnect tiny lymphatic and blood vessels almost invisible to the naked eye. The surgery allows the lymph fluid to drain again instead of accumulating, resulting in significantly less swelling and lower risk of infection. Szelina’s 2016 surgery was successful, and since then, she has been back to doing the things she loves. She no longer has infections or needs daily antibiotics to prevent them. In June, she and her family rode mules down into the Grand Canyon — something she’d never dared to do before the surgery.
| A B O V E | Ellen Szelina during a family vacation at the Grand Canyon.
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SPECIAL SECTION
TOGETHER WE ANSWER CANCER
CANCER IN CHECK
Ken Karr, captain of his hockey team, was back on the ice at a rink on Chicago’s West Side one month after prostate cancer surgery.
Ken Karr’s oldest brother passed away from prostate cancer in 2011. Joe Karr was only 55. Another brother, Paul, 59, is fighting the disease. A family history of one or more close relatives with prostate cancer at an early age is a risk factor for developing the same cancer. So, although Karr was just in his 40s when his first brother was diagnosed, his physician recommended yearly screening with the prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). PSA is a protein produced by both normal and cancerous cells of the prostate gland. The test measures the level of PSA in a man’s blood. If the level is considered high, the next step is often a biopsy of the patient’s prostate tissue to determine if cancer is present and if it is likely to spread. The DRE allows the physician to determine the size of the prostate and feel for bumps or other abnormalities.
While Karr’s PSA level was only slightly elevated, a biopsy of tissue from his prostate showed a small amount of cancer at a very early stage. An MRI was done to confirm the location, size and stage of the cancer. “In situations like this — when the cancer is slow growing and at an early stage — we usually take a conservative Scott Eggener, MD approach, following the patient’s PSA levels and repeating biopsies at regular intervals,” Eggener explained. “But because of his family history with the disease, Ken wanted to move forward with surgery to remove the prostate. I supported him in that decision.” Using robot-assisted techniques, Eggener performed Ken’s prostatectomy in early February 2019. Robotic surgery allows for
Karr’s PSA level remained in the normal range for more than a decade. But when his internal medicine physician felt a suspicious lesion during a DRE in 2018, he recommended Karr, 56, see a prostate cancer specialist. After researching his options in the Chicago area, Karr made an appointment with Scott Eggener, MD, a urologic oncologist at the University of Chicago Medicine.
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The American Cancer Society recommends that men at high risk for prostate cancer start regular screening between the ages of 40 and 45.
better precision, and gives the surgeon a three-dimensional view and better range of motion during the procedure. Benefits for the patient include smaller incisions, less pain and a faster return to normal activities.
Are you at risk for prostate cancer?
Fortunately, Karr didn’t experience urinary incontinence or sexual dysfunction — two side effects that are often associated with prostate cancer treatment.
All men, especially those 65 and older, are at risk for developing prostate cancer. These other factors raise the odds for developing the disease:
Eggener expected Karr, who is fit and athletic, to recover quickly. Still, he was surprised when he ran into Karr and his wife, Patti, at a ski resort in Colorado just two weeks after the surgery. “I told Dr. Eggener that he did a fantastic job and thanked him for his talent and steady hand,” Karr said. “We high-fived each other. And then as he skied away, I yelled, ‘I owe you a drink.’” | B E L OW | Ken Karr puts on a show of strength next to a bus shelter ad
featuring members of the UChicago Medicine prostate cancer team.
» A family history of prostate cancer (including brothers, father, grandfathers or uncles) » Multiple family members who have had prostate cancer » A single family member who had high-grade, advanced or metastatic prostate cancer » African ancestry » Ashkenazi Jewish ancestry » You or certain family members have specific genetic risk factors (e.g. BRCA1, BRCA2, ATM, CHEK2 gene) » A family history of breast, ovarian or pancreatic cancer
If you believe that you have a greater risk for prostate cancer, talk to your doctor about being screened.
Specialized care for men at risk for prostate cancer or with aggressive disease The University of Chicago Medicine High-Risk and Advanced Prostate Cancer Clinic (UCHAP) provides comprehensive screening and care for men at increased risk for prostate cancer and those who have aggressive disease. Funded by a generous gift by an anonymous
donor, the team-based program includes urologists, geneticists, medical oncologists, radiation oncologists, radiologists, pathologists and care navigators. These specialists work together to provide the most advanced clinical care for men with prostate cancer. Beyond treatment, the UCHAP physicians and scientists
are committed to advancing scientific knowledge to improve prostate cancer care for men everywhere. Learn more about high-risk and aggressive prostate cancer: UChicagoMedicine.org/uchap
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SPECIAL SECTION
TOGETHER WE ANSWER CANCER
Understanding early stage prostate cancer treatments
When prostate cancer is in an early stage (cancer cells are found only in the prostate), men have several treatment options. Many factors need to be considered when determining the most effective approach for each patient.
» Radiation therapy may be given after initial diagnosis or
after surgery to prevent, or treat, a recurrence of cancer. There are two common types of radiation therapy for prostate cancer:
› Intensity-modulated radiation therapy
At the University of Chicago Medicine, we explain the pros and cons of each therapy and recommend a care plan that is suited to the status of the cancer and to the patient’s personal situation and priorities.
(IMRT) — external beams of radiation are focused on the prostate cancer
›B rachytherapy — internal form of radiation
therapy in which radioactive “seeds” are implanted directly in the prostate
»A ctive surveillance involves following the patient’s
prostate-specific antigen (PSA) levels closely and performing repeat biopsies to ensure the cancer is not progressing or changing.
»F ocal therapies are minimally invasive procedures that
» Robotic surgery to remove the prostate gland
(prostatectomy) is a minimally invasive approach performed through tiny incisions. When possible, the surrounding nerves are preserved, optimizing the chances of maintaining urinary and sexual function.
At the forefront of treating prostate cancer The University of Chicago Medicine is the first hospital in the Midwest to offer an advanced robotic ultrasound technology for early-stage prostate cancer. Focal One high-intensity focused ultrasound (HIFU) delivers non-invasive, precision treatment to the prostate, reducing the likelihood of side effects and enabling patients to enjoy an improved quality of life. Visit UChicagoMedicine.org/HIFU
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target only the parts of the prostate where cancer is located. MRI-guided laser ablation uses highly targeted heat to eradicate cancerous tumors in the prostate while high-intensity focused ultrasound (HIFU) uses the energy of sound waves to create heat and destroy cancer cells.
NEWS LEADERSHIP
is the new president of Ingalls Memorial Hospital and UChicago Medicine’s Community Health and Hospital Division. Sinotte brings more than 10 years of senior-level experience in health care management and operational leadership.
BRIAN SINOTTE
NEW PHYSICIANS
PIYUSH AGARWAL, MD Urologic surgery Director, bladder cancer program CRAIG A. UMSCHEID, MD, MS Chief Quality and Innovation Officer Internal medicine DIEGO DI SABATO, MD Transplant surgery BRIAN WILLIAMS, MD Trauma surgery NARUTOSHI HIBINO, MD Cardiothoracic surgery
PHYSICIAN SPOTLIGHT TITUS DANIELS, MD,
(left) has been named chief medical officer for UChicago Medicine’s Community Health and Hospital Division. KENNETH NUNES, MD, (right) chief of general obstetrics and gynecology, succeeds Daniels as UChicago Medicine’s chief ambulatory medical officer. ERIC G. PAMER, MD, is the inaugural faculty director of the Duchossois Family Institute at UChicago Medicine. The institute carries out research on the human immune system, microbiome and genetics.
HONORS
BRENDA BATTLE, RN, BSN, MBA, was named a fellow of the Institute of Medicine of Chicago, an independent organization of distinguished leaders in the health field who collaborate to improve the health of the public. She is chief diversity, inclusion and equity officer at UChicago Medicine and vice president of the Urban Health Initiative.
Becker’s Hospital Review named UChicago Medicine one of the 150 TOP PLACES TO WORK IN HEALTHCARE
for 2019.
UChicago Medicine received the American Heart Association/American Stroke Association’s GET WITH THE
GUIDELINES® TARGET: STROKE HONOR ROLL GOLD PLUS QUALITY ACHIEVEMENT AWARD
consecutive year.
gave the presidential keynote address at the 2019 American Diabetes Association Scientific Sessions meeting.
for the second
LOUIS H. PHILIPSON, MD, PHD,
The University of Chicago Medical Center was designated a 2019 LGBTQ HEALTHCARE EQUALITY LEADER
by the Human Rights Campaign Foundation/HRC. UChicago Medicine earned the top score of 100 in the Healthcare Equality Index 2019 survey.
HALINA BRUKNER, MD, has been appointed dean for medical education at the University of Chicago Pritzker School of Medicine.
Cardiac surgeon VALLUVAN JEEVANANDAM, MD, (left) has been named director of the UChicago Medicine Clinical Heart and Vascular Center. Cardiologist JAMES LIAO, MD, (right) is the co-director of the new center.
RICHARD LARSON, MD, will receive the Henry M. Stratton Medal from the American Society of Hematology. The prize honors senior investigators for their contributions to basic and clinical/ translational hematology research.
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Creating safer South Side communities Chicago Eco House works to create safe spaces through beautification and economic development in Chicago’s Woodlawn and Englewood neighborhoods.
The group is one of 14 grassroots organizations that recently received violence prevention and recovery grants from the newly formed Southland RISE (Resilience Initiative to Strengthen and Empower) collaborative, which is powered by the University of Chicago Medicine and Advocate Christ Medical Center. Southland RISE awarded $100,000 to South Side community-based organizations for programs that keep young people | A B O V E | Chicago Eco House works in Englewood,
West Woodlawn and West Garfield Park to transform vacant lots into sustainable plots of land to farm fruits, vegetables, flowers and chicken eggs. Other programs engage participants using music, boxing, and digital storytelling, and by teaching leadership and conflict resolution skills.
engaged and safe during the summer — when students are out of school and need access to safe venues and activities. Two-time grant recipient Chicago Eco House used last year’s funding to transform vacant lots into vegetable gardens and flower farms in West Woodlawn. This year, the group installed beehives and trained its teen participants in beekeeping. “We’re teaching kids that it’s possible to turn something that looks like nothing into something that’s positive and is a viable asset,” said Quilen Blackwell, Chicago Eco House’s executive director. “This grant and partnership enable it to happen.”
Growing and sustaining the violence recovery and trauma care ecosystem in the Southland relies on engaged communities and collaboration, both at the institutional and grassroots levels.” BRENDA BATTLE, RN, BSN, MBA Vice President of UChicago Medicine’s Urban Health Initiative
New report outlines top health priorities for the South Side Residents on the South Side have identified chronic diseases, the need for violence prevention and trauma resiliency, and health inequities as key health concerns that they face, according to the University of Chicago Medicine’s 2019 Community Health Needs Assessment (CHNA). Published every three years, the CHNA is used to identify community health priorities and make decisions on where to commit resources that can most effectively improve community members’ health and wellness. New to the 2019 report: profiles detailing the health of 27 South Side communities. Read the full report: UChicagoMedicine.org/community-health
| A B O V E | Participants work out during a cycling
class at South Side Fit, a program that promotes fitness, wellness and nutrition and addresses chronic health conditions like diabetes.
UChicago Medicine to open new facility in River East Construction is underway on the University of Chicago Medicine’s newest outpatient facility, located at 355 E. Grand Ave. in the River East neighborhood. Expected to open in early 2020, the 42,000-squarefoot center will offer an array of services including primary care, women’s care, specialty care, and lab and X-ray services. Additionally, extended-hour
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urgent care services will be available to help those with non-life-threatening medical issues. The opening of the state-of-the-art clinic will consolidate our Huron and Streeterville locations, providing patients with a one-stop shop for their health needs in the heart of a bustling community filled with great amenities and Chicago attractions.
GIFT BRINGS
HOPE
Family supports research and care for patients with central nervous system disorders At 18 months, Margaret Hackett was diagnosed with craniometaphyseal dysplasia, a rare condition that causes thickening of the bones in the skull. When she entered junior high, the dysplasia led to more serious problems, including hydrocephalus and Chiari malformation — central nervous system (CNS) congenital anomalies that create pressure in the brain and cause the lower part of the brain to protrude into the spinal canal. To help others who face similar circumstances, Margaret’s parents, Raynelle and Bill, donated $2.5 million to establish the Margaret Hackett Family Center Program in CNS Congenital Anomalies at the University of Chicago Medicine. The Hacketts’ journey to care wasn’t easy. After several initial surgeries, physicians told the family that there was nothing more they could do. Left without guidance, Raynelle and Bill anxiously searched for other options. Eventually, they saw an online video featuring David Frim, MD, PhD, an internationally renowned neurosurgeon and neuroscience researcher at UChicago Medicine. Although Frim had never seen a case quite like Margaret’s, he was willing to help. “Dr. Frim likes a challenge,” Margaret said. “He doesn’t just make decisions based on what’s in medical textbooks. He takes into account the needs of the patient and family.” Soon after the family met Frim, bone growth at the base of Margaret’s skull became increasingly aggressive, cutting off the flow of oxygen and blood to her brain. To halt the excess bone growth, Frim and his team performed surgeries every three to six months. David Frim, MD, PhD
Frim also performed a radical procedure to provide additional
| A B O V E | Margaret Hackett with her parents, Bill and Raynelle,
and her service dog, Feivel
room for Margaret’s brain. This involved removing the back half of her skull, dividing it into pieces, reconnecting the pieces with mesh and wire, and repositioning it back in place. Around age 14, Margaret developed another condition, syringomyelia, where fluid collects within the spinal cord and creates cysts. To release the fluid, Frim placed drainage tubes in Margaret’s spinal cord. “Dr. Frim always listened to our concerns,” Bill said. “The connection he has with Margaret is incredible. His advocacy for her has built a deep sense of trust.” Now 33, Margaret has undergone 37 brain and spinal cord surgeries. Despite the challenges they’ve faced, the Hackett family is grateful. “Margaret has received the world’s best care,” Bill said. “UChicago Medicine has been like a second family to us. It’s an amazing, warm community.” The Margaret Hackett Family Center Program in CNS Congenital Anomalies at UChicago Medicine will provide resources for patients and families, advance research projects and establish a network of care providers with expertise in treating these anomalies. “The program will help propel our research efforts, including determining which treatment approaches work best,” Frim said. “Every step forward allows us to help more patients and families here in Chicago and beyond.” The program also aims to build a community for patients and families to connect with one another. “The whole reason behind this is to give people hope,” Bill said. “While there may not be answers today, we are confident that there will be tomorrow.” To learn more, visit mhfamilycenter.org.
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NATIONALLY RECOGNIZED FOR EXCEPTIONAL CARE Being recognized by U.S. News & World Report as one of the top hospitals in Illinois and the country is a tribute to the many physicians, nurses and staff who are committed to providing the very best patient care. This distinction comes on top of our prestigious Magnet designation for excellence in nursing and patient care, as well as our 15th consecutive “A� grade in hospital safety from industry watchdog The Leapfrog Group. While accolades like these are gratifying, the best recognition comes from you, our patients. Thank you for inspiring us to remain at the forefront of world-class health care, medical education and research.
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