The Forefront - Fall 2020 - University of Chicago Medicine

FALL 2020

Health, Science & Wellness COVER STORY

From very sick to ‘the old Josh’ PAGE 10

A 10-year-old survives a rare and frightening complication of COVID-19 ALSO IN THIS ISSUE PAGE 4

Game-changing immunotherapies for lymphoma PAGE 17

Is texting giving you a pain in the neck?

Fall 2020

The Forefront

IN THIS ISSUE ON THE COVER

10 Cover photo

by Jean Lachat

How Comer Children’s Hospital specialists helped Joshua Smith recover from a rare inflammatory syndrome linked to COVID-19 in kids.

4

FROM WHEELCHAIR TO HIKING TRAIL An immunotherapy clinical trial brought Linda Winkler’s relapsed lymphoma into remission.

Making breast cancer genetic screening accessible to more women.

7

Lagwena Smith with her sons, Joshua, left, and Jeremiah

Diaz with the “lungs” pillow signed by his UChicago Medicine transplant team.

READ ONLINE COVID-19 UPDATES Get the latest advice on how to stay safe. Learn about treatments and research.

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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 Thomas E. Jackiewicz President of the University of Chicago Medical Center

A SECOND BREATH

A year after his successful lung transplant, patient Edgardo Diaz survived COVID-19.

BEYOND MAMMOGRAPHY

16

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VISIT OUR WEBSITE FOR MORE INFORMATION: Adult and children’s care UChicagoMedicine.org Science, health and wellness news

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Read The Forefront online at UChicagoMedicine.org/TheForefront Email us at imagine.editor@uchospitals.edu Facebook.com/UChicagoMed Instagram.com/UChicagoMed Twitter.com/UChicagoMed This publication does not provide medical advice or treatment

Contributing photographers

suggestions. If you have medical problems or concerns, contact

Jimmy Fishbein, Rob Hart, Jean Lachat, Jordan

a physician, who will determine your treatment. Do not delay

Porter-Woodruff, Mike Roos, Scott Shigley and

seeking medical advice because of something you read here.

Nancy Wong

For urgent needs, call 911 right away.

SICKNESS DOESN’ T FIGHT FAIR. NEITHER DO WE. See how UChicago Medicine challenges the status quo to make a real difference in your life at UChicagoMedicine.org/NotFair

Brian Williams, MD Trauma Surgeon

| A B O V E | Thoracic surgeon and lung cancer specialist Jessica Donington, MD.

Newly diagnosed with cancer?

SC H E D U LE A F R E E V I D E O S E SS I O N W I TH A L E A D I NG O N CO LO G I ST A cancer diagnosis is a life-changing event.

Suddenly there are many decisions to make, and you may not know what questions to ask. At the University of Chicago Medicine, we understand your urgency and the need for answers about your care options.

Our new Express Expert Cancer Opinion (EECO) program offers newly diagnosed patients a 10- to 15-minute introductory video session with one of our leading cancer experts — at no cost to you.

EECO is a convenient way to meet with an oncologist from the comfort and privacy of your home.

What to expect » A video session within one to two business days of your request »A n expert oncologist who specializes in your tumor type or diagnosis »T echnical assistance setting up the video session to ensure a troublefree meeting »P hysician-recommended next steps at the conclusion of the video session

WHAT TYPES OF CANCER ARE

WHAT IF I DON’T HAVE A WAY TO FAX

ELIGIBLE?

OR SEND MY MEDICAL RECORDS?

All types of cancer, with the exception of blood cancers (leukemia, lymphoma, myeloma).

Medical records are preferred, not required.

If, after the EECO session, you’d like to receive your care at UChicago Medicine, we will need your permission to collect the necessary records.

WHAT WILL I LEARN DURING THE SESSION?

WILL THE EECO ONCOLOGIST BECOME

The EECO session is meant to be an initial brief introduction with one of our expert oncologists, who will answer questions and discuss treatment options offered at UChicago Medicine that may be right for you.

Not necessarily. The oncologist you speak to during the express session may continue your care or may refer you to another UChicago Medicine specialist.

CAN I SCHEDULE A NEW PATIENT

WHAT IF THE ONCOLOGIST I WANT TO

APPOINTMENT WITH AN ONCOLOGIST

SEE DOES NOT OFFER EECO SESSIONS?

AT THE SAME TIME?

MY TREATING PHYSICIAN?

In a single phone call, you can schedule an EECO session and a comprehensive new patient session.

You may schedule a new patient session with the oncologist of your choice.

However, that appointment may not take place within 48 hours of contacting us.

CAN I HAVE AN EECO SESSION BY

WHAT HAPPENS AFTER MY EECO VISIT?

PHONE?

You can choose to have your EECO session by phone or video. You can also elect to have an in-person session, but this may take more time to schedule.

You will be contacted by a member of our healthcare team to coordinate and schedule your next session, collect necessary medical records and arrange for any additional testing.

Call 1-855-702-8222 to schedule your Express Expert Cancer Opinion 2 » THE UNIVERSITY OF CHICAGO MEDICINE

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CANCER DOESN’ T FIGHT FAIR. NEITHER DO WE. See how UChicago Medicine challenges the status quo of cancer treatment to make a real difference in your life at UChicagoMedicine.org/NotFair

Jessica Donington, MD Chief, Section of Thoracic Surgery

Linda Winkler, 61, on a trail in Medicine Bow National Forest in Wyoming. She was one of the first patients in the U.S.

to go into remission during a clinical trial testing a combination immunotherapy for lymphoma.

Scott McIntyre, 57, with his wife, Cindy, in South Bend, Indiana. He was the first

patient to be treated with CAR T-cell therapy in Illinois.

Scaling new heights TWO LYMPHOMA PATIENTS, TWO TRAILBLAZING TREATMENTS Relapsed non-Hodgkin lymphoma was once a fatal disease. But now, new immunotherapies are changing the path for patients if the cancer comes back after standard treatments.

“It’s a pretty amazing time for lymphoma treatment,” said oncologist Sonali Smith, MD, Director of the Adult Lymphoma Program at the University of Chicago Medicine and an internationally recognized expert on therapies for the blood cancer. “These immunotherapies are improving the cure rate for non-Hodgkin lymphoma and helping patients live better and longer.”

The most common type of non-Hodgkin lymphoma is called diffuse large B-cell lymphoma (DLBCL). Standard treatment for DLBCL begins with a combination of five chemotherapy medications.

“Our goal is to achieve cure the first time around,” Smith said. “But if the cancer recurs, we have several other treatments — including more chemotherapy followed by stem cell transplant — to offer to our patients.”

But for patients Linda Winkler and Scott McIntyre, the lymphoma was particularly aggressive and returned after multiple therapies, including an autologous (using the patient’s own cells) stem cell transplant. Smith offered them the opportunity to participate in clinical trials testing new immunotherapies for DLBCL. Considered revolutionary in the treatment of blood cancers, immunotherapy harnesses the power of the immune system to fight cancer. “There are several types of immunotherapy, which work in different ways,” Smith said. “Our team works with each patient to offer the most appropriate therapy for their disease.”

FROM A WHEELCHAIR TO A HIKING TRAIL

Linda Winkler was first diagnosed with a slowgrowing lymphoma in 2005. She underwent several rounds of chemotherapy over the next decade. But in the fall of 2016, the dietitian and Colorado resident learned the cancer had come back, and had transformed into DLBCL. When a stem cell transplant failed to bring the cancer into remission, her doctors gave her just a few months to live. The only hope would be to participate in a clinical trial of a new treatment.

“My sister, who lives in Illinois, found Dr. Smith and a trial testing immunotherapy for DLBCL,” Winkler said. With the help of her family, she arrived at UChicago Medicine a week later.

“Linda was so weak from her illness that she had to be brought to our clinic in a wheelchair,” Smith said. “We began treatment on the trial immediately.”

The multi-center phase 1 trial, which was led by Smith, tested the combination of the established drug rituximab with an immune checkpoint inhibitor now called magrolimab. Together, the two anti-cancer medications block a “don’t eat me” signal that protects cancer cells and activate an “eat me” signal, allowing disease-fighting immune cells (called macrophages) to engulf and kill them.

“We were able to manipulate the immune system of patients with non-Hodgkin lymphoma that had relapsed and progressed after various prior therapies,” Smith said. “And we could do it with limited side effects.”

Within a week of starting therapy, Winkler was feeling better. A month later, the cancer was in complete remission. By the end of treatment, she was well enough to undergo a second stem cell transplant, this time with cells donated by a family member. At the time, patients whose cancer went into remission were referred for

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an allogeneic (using donor cells) stem cell transplant. This was considered to be the most aggressive and best treatment despite significant short- and long-term toxicity.

in South Bend, Indiana, was losing his battle with DLBCL. Chemotherapy, a stem cell transplant and targeted therapy each brought only a temporary remission.

Winkler returned to her home in Colorado.

She continues to receive treatment for graft-versus-host disease, a common side effect when a patient receives stem cells from a donor. But today, Winkler, a lover of the wilderness, spends as much time as possible in the mountains with friends and her dog, Willow, a Siberian Husky/Akita mix.

Just when he thought he had run out of options, Smith called him about a new trial for a promising immunotherapy called CAR T-cell being offered at UChicago Medicine and a few other select centers around the country.

“My treatments can get in the way of my hiking and camping,” she said. “But surviving lymphoma is wonderful. It feels like a miracle.”

‘THE DOCTORS DIDN’T GIVE UP’

In 2015, Scott McIntyre, a truck dealer

CAR T-cell therapy involves extracting a cancer patient’s white blood cells and reprogramming the T cells — the roving warriors of the immune system — with an antibody-like protein called chimeric antigen receptor, or CAR. The modified cells are returned to the patient’s body, a process that takes less than 10 minutes.

These re-engineered T cells bypass healthy cells and latch on to and kill the diseased

cells — enabling a patient’s own immune system to fight cancer.

Soon after having the procedure, McIntyre’s health improved. A few weeks later, Smith called him at home with the results of a new bone marrow biopsy. There was no cancer.

That was four years ago and the cancer has not come back. “CAR T was our ‘Hail Mary pass’,” said McIntyre, a diehard Notre Dame fan. “We threw the ball up in the air and it ended up being a touchdown.

The doctors didn’t give up.”

Having patients like McIntyre and Winkler return to a life “where they can cheer at a football game or hike in the mountains is the whole reason we are in this field,” Smith said.

Immunotherapy has been a game-changer for lymphoma patients.

I believe it will break us through to the next layer of defeating cancer.”

SONALI SMITH, MD Director, Adult Lymphoma Program

Did you know?

The University of Chicago Medicine Comprehensive Cancer Center is a cancer research and treatment center and one of only two National Cancer Institute-designated Comprehensive Cancer Centers in Illinois. Over 200 physician-scientists perform groundbreaking research and translate their discoveries into personalized medicine to prevent and treat cancer. The center offers more than 350 cancer therapeutic clinical trials, and holds more than $41 million in annual peer-reviewed research funding.

LIVE AT T H E F O R E F R O N T

Oncologists Sonali Smith, MD, and Michael Bishop, MD, talk about how immunotherapy is revolutionizing the treatment of some blood cancers.

UChicagoMedicine.org/ immunotherapy-live

Learn more about immunotherapy and our clinical trials at UChicagoMedicine.org/immunotherapy 6 » THE UNIVERSITY OF CHICAGO MEDICINE

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More than mammography MODERN BREAST CANCER SCREENING now includes GENETIC RISK ASSESSMENT

Breast cancer care in the U.S. has transformed over the past few years into a holistic, multidisciplinary approach that focuses on preventive oncology, which boils down to knowing an individual’s risk before they get cancer.

The U.S. Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN) now recommend familial risk assessment for women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or who have an ancestry associated with BRCA1/BRCA2 gene mutations. Women with positive results should receive genetic counseling and, if indicated after counseling, genetic testing.

Although genetic testing has become inexpensive and accessible, testing rates are surprisingly low.

They are far lower for Black women than for white women, and for uninsured patients.

These racial and socioeconomic disparities underscore the importance of programs that offer all patients who meet the USPSTF and NCCN criteria for genetic counseling and testing.

Even during COVID-19 — a pandemic — we’re making breast cancer trials and screening accessible to women across socioeconomic and racial groups. We want to transform the way we care for breast cancer patients.”

University of Chicago Medicine researchers are addressing these disparities through several initiatives:

DEEPA SHETH, MD Interventional breast radiologist

WISDOM

SCORE

CAPS

In partnership with the prevention oncology and genetics group, researchers are using technology to streamline the process of risk assessment. When patients schedule mammograms through UChicago Medicine, MyChart automatically sends a message asking them to answer questions about family history. If a high-risk individual is identified, she can have virtual genetic counseling and receive a testing kit through the mail. This contactless approach safely connects high-risk women with personalized cancer prevention strategies.

The Women Informed to Screen Depending On Measures of risk (WISDOM) study invites healthy women ages 40 to 74 to select one of two screening methods: a personalized, risk-based approach informed by genetic testing or the standard annual mammogram.

The national study is recruiting 100,000 women to better understand the safest and most effective guidelines for breast cancer screening.

In the Chicago Alternate Prevention Study (CAPS), women at ultra-high risk for breast cancer — either as a result of genetics or dense breasts — are offered two screening scans per year using a new, ultra-fast MRI method developed by UChicago Medicine researchers paired with abbreviated MRI. The study aims to show that the six-minute MRI scans are a safe alternative to prophylactic bilateral mastectomy.

With funding from the American Hospital Association Institute for Diversity and Health Equity and Blue Cross Blue Shield of Illinois, the Screening OutReach and Engagement (SCORE) initiative offers free genetic testing for uninsured women who have never been screened.

Community organizations Equal Hope, Sisters Working It Out and Chicago Family Health are helping to recruit community members.

Prevention Project

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Celebrating her 3-year ‘liver-versary’ Jessica Maher had a rare form of cancer. UChicago Medicine specialists performed a rare — and complex — transplant surgery.

Jessica Maher strikes a joyous pose at a 2018 wedding she attended.

Jessica Maher’s ultrasound was supposed to show why the healthy 31-year-old was having chest pains. What her doctors found was alarming, though it had nothing to do with her pain.

“The whole left side of my liver was riddled with tumors — more than they could count,” Maher said. “It was an accident that the ultrasound caught this, and that they saw it.”

Maher was diagnosed with intrahepatic cholangiocarcinoma (iCCA), a rare form of cancer of the bile ducts inside the liver.

The next few years were filled with chemotherapy treatments, surgeries and illness. Her skin and the whites of her eyes turned yellow (jaundice), and her condition steadily declined.

Maher’s only hope was a liver transplant.

But transplant surgery isn’t an accepted option for iCCA patients because of historically poor outcomes and increased risk of recurrence. Only a few hospitals in the country will even consider doing it. Additionally, donor livers aren’t readily available, and many insurance companies won’t approve the surgery because it’s considered experimental.

8 » THE UNIVERSITY OF CHICAGO MEDICINE

One night, Maher was chatting in a Facebook group for people with cholangiocarcinoma when someone mentioned the University of Chicago Medicine’s transplant program. She learned UChicago Medicine was expanding its liver tumor and adult living-donor transplant programs to focus on cancers previously deemed “untransplantable,” including iCCA and colorectal cancer with liver metastasis. And even if she couldn’t have surgery, the medical center had several clinical trials with unique chemotherapies that might help her.

Maher, told she only had months to live, reached out to UChicago Medicine liver transplant specialist and surgeon John Fung, MD, PhD, Co-Director of the Transplant Institute. She flew in to see him from her home outside Philadelphia, and shared her story.

Fung consulted with his multidisciplinary team and determined Maher was a good candidate for the liver transplant surgery.

Her tumors were stable, and the cancer hadn’t spread outside her liver.

In light of a protocol that incorporates new advances in staging, chemotherapy to shrink the tumor before surgery and management of immunosuppression, Maher’s insurance company approved the transplant. She also

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would be given priority for a donor due to the degree of liver damage.

Some in the medical field question whether transplants like these should be done, given that the cancer is likely to come back. Fung disagrees. Of the six iCCA patients whose livers he’s transplanted, five are still disease-free and one has had just mild recurrence.

“Recurrence is not necessarily the end,” Fung said. “You can manage the cancer afterwards.”

Transplant oncology is still fairly new and involves liver transplants for patients who were previously not considered for transplantation. UChicago Medicine’s Liver Tumor Program, directed by Anjana Pillai, MD (transplant hepatology) and Talia Baker, MD (transplant surgery), uses a multidisciplinary team approach to identify patients who may benefit from liver transplantation.

Maher underwent the nearly 17-hour surgery at UChicago Medicine in 2017.

She spent the next month in the hospital, and her long recovery was complicated by a bile leak, a blood clot and bowel surgery.

She lost 25 pounds and needed physical therapy to restore her atrophied muscles.

Recovering from her liver tranplant.

It was all worth it, Maher said, while celebrating her 3-year “liver-versary” this summer. Today, the 39-year-old is back to work in a medical device company’s marketing department, plays tennis, does yoga, and enjoys time with her husband, family and friends.

Two months after the surgery.

“Jessica’s case is really what made me look at these cancers from a different lens. She was so sick, but now she is this beautiful woman living her life,” Pillai said. “We know recurrence occurs, but she got three more years than she would have without the transplant, and hopefully many more.”

Maher and her husband, Jim, in Italy.

Fung and Pillai want to continue developing the transplant oncology program so it keeps UChicago Medicine at the forefront in this field. “We’re cautiously optimistic that we’re making some headway in this area,” Fung said. “If we’re very thoughtful about it, and choose the right patients, we can make a big difference.”

Not ‘too young’ for colorectal cancer More people under age 50 are being diagnosed with — and dying from — colorectal cancer. While colorectal cancer rates have decreased for people over 50 years old, they have climbed 51% since 1994 for those under age 50, according to the American Cancer Society. Death rates in this younger group are also rising.

“What’s alarming about this upward trend is that we don’t know what’s causing it,” said gastroenterologist Sonia Kupfer, MD, Director of the University of Chicago Medicine’s Gastrointestinal Cancer Risk and Prevention Clinic.

Kupfer notes that this trend parallels the rise in obesity in America, but that factors such as poor diet or a sedentary lifestyle aren’t solely to blame. That’s what puzzles

Kupfer and her colleagues: They’re seeing more colorectal cancer patients who skew younger and are generally healthy. They don’t have risk factors like being over 50, a family history or a genetic syndrome.

And they’re not obese, sedentary, heavy drinkers, smokers or poor eaters (consuming excessive processed food and red meat).

In response to the growing number of cases among younger adults, the American Cancer Society recently lowered its recommended age for a colonoscopy from 50 to 45. People with a family history of a close relative with colorectal cancer should start having colonoscopies at age 40. And people of all ages should be aware of colon cancer symptoms.

“It’s not impossible for people in their 30s to get colon cancer,” Kupfer said. “The best advice we can give is to not ignore any type of symptom. Let your doctor know if you have blood in your stool.

Don’t just say, ‘Oh, it’s probably just a hemorrhoid.’”

A colonoscopy is the best and most accurate way to check for and remove precancerous polyps. Scientists are working on ways to make colorectal cancer screenings easier, including a blood-based test. UChicago Medicine also is part of a current study that uses artificial intelligence (AI) to improve colonoscopies using algorithms to detect polyps and improve visual detection.

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SAVING JOSHUA Since the start of the COVID-19 pandemic, doctors have found some things about the new coronavirus baffling. University of Chicago Medicine Comer Children’s Hospital physician Julia Rosebush, DO, recalls that was the case when treating the 10-year-old boy whose life she helped save in May. “I remember him saying, ‘I’m hungry, I want to eat’,” said Rosebush, an expert in pediatric infectious diseases.

“Initially, he didn’t appear as sick as his test results indicated.”

Joshua Smith was very sick, however.

Prior to his hospitalization, he’d had a fever for three days that didn’t respond to acetaminophen.

“I had that feeling that something wasn’t right,” said Lagwena Smith. Her son was transferred to UChicago Medicine from another hospital with a fever and low blood pressure, a dangerous sign that his heart was not working well and that he could slip into shock.

Doctors quickly learned that Lagwena had recovered from COVID-19 roughly a month earlier. Joshua tested negative for an acute COVID-19 infection, but it would take several days to receive the results of a test to determine whether he’d previously been infected and recovered.

Equally puzzling to Rosebush was that Joshua’s condition improved after receiving intravenous immunoglobins meant to combat inflammation — but then deteriorated again.

“We really struggled to understand what could be fueling his illness,” Rosebush recalled.

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| A B O V E | Joshua, left, and Jeremiah are fraternal twins. Joshua was the first child treated at

Comer Children’s Hospital for a rare complication linked to COVID-19.

At this point, Joshua’s care team realized they might be witnessing their first known case of a new inflammatory condition they’d learned about from colleagues in New York and Europe, places hard-hit

by COVID: multisystem inflammatory syndrome in children (MIS-C).

MIS-C is a rare, potentially severe complication linked to COVID-19 that some children develop. Symptoms of MIS-C include a rash, fever, abdominal pain, vomiting, diarrhea and fatigue.

Untreated, MIS-C can be life-threatening because it causes inflammation in the heart and other organs, as well as swelling of blood vessels.

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“The issue is not the COVID-19 making the child sick, but rather the patient’s immune system overreacting,” said Melissa Tesher, MD, a pediatric rheumatologist who also treated Joshua.

Test results eventually showed that Joshua had antibodies for the virus — meaning he had once been infected.

Joshua’s Comer Children’s care team included physicians in rheumatology, infectious diseases, cardiology, hematology, intensive care and hospital medicine. It proved critical that some of them had been participating in international, national and local Zoom meetings with other physicians treating COVID-19.

“It’s been such an incredible learning experience,” said Rosebush. “No one specialty can do this alone, and for that we’ve become stronger.”

The team decided to treat Joshua with corticosteroids, medications that help reduce inflammation. He was given anakinra, a medication that can help decrease an overactive immune system, as well as a blood thinner to counter the increased risk of blood clots faced by patients with COVID-19.

“As we’re learning more, we’ve been giving steroids right at the beginning for MIS-C patients,” said Tesher, who along with Rosebush was involved in creating state guidelines on how hospitals should diagnose and treat MIS-C. As of August, UChicago Medicine had treated seven children with MIS-C. Like most patients with MIS-C, all are fully recovered. Although the syndrome is exceedingly rare, Rosebush expects to see more cases if COVID-19 continues to spread and a definitive link with the virus is established.

“It remains to be seen what, if any, long-term effects there are from MIS-C,” said Rosebush. “But children have an innate ability to rebound. They’re resilient.”

As for Joshua, he is back at home in the south suburbs and doing well. His recovery is being monitored by his physicians, who have asked him to take a break from sports as they ensure his heart has fully recuperated.

“His appetite is good, his attitude is good,” said Lagwena. “To me, he’s the old Josh.”

JOSHUA’S COMER CHILDREN’S PHYSICIAN TEAM

JULIA ROSEBUSH, DO Infectious disease

RACHEL WOLFSON, MD Intensive care

UTKARSH KOHLI, MD Cardiology

MELISSA TESHER, MD Rheumatology

NICOLA ORLOV, MD Hospital medicine

A place to play The University of Chicago Medicine Comer Children’s Hospital Play Garden received a 2019 Honor Award for Design from the Illinois Chapter of the American Society of Landscape Architects. The play garden, which opened in 2018, is designed to be accessible to children of all physical abilities, including those in hospital beds, wheelchairs and IV carts. “Elements of music, nature and art are found within an eccentric garden that was inspired by Dr. Seuss’ creative stories and imagery,” the award announcement said. “The garden provides unique and creative play experiences, including those that focus on building cognition, social and environmental development, gross motor skills, speech and language, and fine motor skills. Various shapes, sizes, textures, and out-of-theordinary plants and flowers help make this a colorful, vibrant, and altogether unique space for patients and their families.”

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RANKED NATIONALLY FOR ADULT AND PEDIATRIC CARE

Nine UChicago Medicine specialties are ranked among the top 50 in the nation in the latest U.S. News & World Report survey of the country’s best adult hospitals, with three in the top 20: gynecology (12), gastroenterology/GI surgery (13) and diabetes/ endocrinology (19).

Comer Children’s Hospital ranked among the best children’s hospitals in the country in two pediatric specialties, gastroenterology/GI surgery (35) and diabetes/endocrinology (47).

Other UChicago Medicine top-50 specialties in the 2020-21 adult hospital rankings are urology (22), nephrology (23), cancer (24), orthopaedics (32), ear, nose and throat (35), and pulmonology (49). Two other specialties — neurology and neurosurgery, and

geriatrics — are considered “high performing,” which means their scores were in the top 10%, but were outside of the top 50.

“In just two years, we have tripled the number of specialties recognized in the top 50 rankings,” said Kenneth S. Polonsky, Dean and Executive Vice President for Medical Affairs at the University of Chicago and President of the UChicago Medicine health system. “These achievements affirm the work of our faculty, nurses and staff, who continually strive for excellence in patient care and safety.”

For a full list of hospital rankings, visit usnews.com.

PARASITE PUT-DOWN

SHOULD I SOCIALIZE? NEW COVID-19 APP HELPS USERS

The first cure for a common parasitic infection may be on the horizon, thanks to ongoing research led by the University of Chicago. People contract Toxoplasma toxoplasmosis by eating infected undercooked meat, drinking contaminated water or exposure to parasites in soil, usually from cat feces. The lifelong and presently incurable infection can permanently damage patients’ eyes and brains, and may cause severe illness or death. Malaria, caused by a related parasite, kills about 500,000 children each year and threatens visitors to endemic areas.

Researchers have discovered that the compound tetrahydroquinolone can eliminate the parasites that cause both diseases. Rima McLeod, MD, a UChicago Medicine professor of ophthalmology and visual science and pediatrics and world-renowned expert on toxoplasmosis, is lead author of the study on this remarkable development, published in Frontiers in Cellular and Infection Microbiology.

COMMUNICATE HEALTH RISKS WITH EACH OTHER

An easy-to-use new app, MyCovid Passport, helps users create and share a visual history of their self-monitored health, whether they are well, under the weather or recovering. This helps with social interactions and honors users’ level of comfortability for socializing. The app tracks symptoms — everything from temperature and breathing difficulty to mental health — to help users assess their risk level. “We approached it as if we were taking a phone call from a patient, answering their questions and guiding them through the disease,” said Stephen Schrantz, MD, a UChicago Medicine internist who specializes in infectious diseases, who partnered with the app’s developers, UChicago neonatologist Bree Andrews, MD, MPH, medical anthropologist Yaya Ren, PhD, JD, and health tech startup PreeMe+You. The app also serves as a symptom journal that users can share with family or friends to show they are healthy, or to indicate that they should sit out group events. The user’s data is kept private and not used for profit. MyCovid Passport is available in the App Store and Google Play Store.

12 » THE UNIVERSITY OF CHICAGO MEDICINE

HEART ‘REWIRE’ STOPS FAINTING

Plagued by fainting spells, a patient found relief through a procedure performed for the first time in the U.S. at the University of Chicago Medicine. For most of her life, the 52-year-old woman suffered from vasovagal syncope, which causes fainting when triggers, such as the sight of blood, prompt heart rate and blood pressure to drop suddenly, reducing blood flow to the brain. Other therapies, including medications and a pacemaker, had not helped. Roderick Tung, MD, essentially rewired the patient’s heart through a procedure called cardioneural ablation. The woman has not fainted since. “We are quite encouraged with this result,” Tung said. He hopes to perform a controlled study on the procedure, which was described in JACC: Case Reports. Tung cautions that the procedure is not for everyone and that much more research is needed before it is considered for standard clinical practice.

READ MORE AT

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HEART DISEASE DOESN’ T FIGHT FAIR. NEITHER DO WE. See how UChicago Medicine challenges the status quo of heart and vascular treatment to make a real difference in your life at UChicagoMedicine.org/NotFair

Bryan Smith, MD Cardiologist

‘NOTHING’S GOING TO STOP ME’ Edgardo Diaz

One year after his successful lung transplant, Edgardo Diaz, 30, was back in the hospital — this time in critical condition with COVID-19.

Running out of time and options, Diaz’s doctors at the University of Chicago Medicine invited him to participate in a clinical trial of convalescent plasma — plasma rich in virus-fighting antibodies, taken from the blood of COVID-19 survivors.

Diaz is believed to be the first lung transplant patient in the world to receive convalescent plasma for COVID-19. He may even be the first person with any type of transplant to receive the COVID-19-fighting plasma, said Remzi Bag, MD, Medical Director of UChicago Medicine’s Lung Transplant Program, and one of Diaz’s doctors.

Within hours after receiving the convalescent plasma on April 25, Diaz’s 104-degree fever started going down. Days later, his breathing and kidney function improved. He was released from the hospital May 1.

Back home in Oak Forest, Diaz said he feels “even better than I did before I had COVID-19.” He’s been able to resume his workouts, and will be returning to work as an EMT.

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During his illness, Diaz stayed in close contact with the UChicage Medicine team that performed his double-lung transplant for cystic fibrosis. Though his lung transplant made him ineligible for most UChicago Medicine COVID-19 clinical trials, Diaz met the FDA criteria for the plasma trial because his condition was life-threatening, said Maria Lucia Madariaga, MD, who leads the trial and was one of Diaz’s lung transplant surgeons.

“It’s a pretty safe therapy,” Madariaga said, adding that early reports she’s seen nationwide about giving convalescent plasma to COVID-19 patients showed few side effects. “We have given it to high-risk, immunocompromised patients, and it still seems safe.”

Unlike most hospitals in the U.S., which buy blood from a private company, UChicago Medicine has its own blood bank with plasma donations from recovered COVID-19 patients.

“For a disease like COVID-19, with so many unknowns, it’s great that we’re able to offer this and other clinical trials,” Bag said.

Bag doesn’t believe convalescent plasma treatment will work for everyone, although it seems like a promising treatment. “You get great results in some patients and not in others,” Bag said. “Edgardo did remarkably well.”

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When someone is infected with COVID-19, the body’s immune system produces proteins called antibodies that, in most cases, will seek out and neutralize the virus.

They provide the immune system extra resources to fight off the infection. Those antibodies then stay in the blood and provide immunity. That’s why the plasma from COVID-19 survivors is valuable to those who are very ill.

As a result of his lung transplant, Diaz already was familiar with mask wearing, handwashing and other measures to prevent infection, and he continues to take precautions to avoid germs.

“I beat coronavirus! At this point, nothing’s going to stop me,” Diaz said.

PLASMA DONATION: Anyone over the age of 18, who had a documented case of COVID-19 and has been symptom-free and healthy for more than 14 days, may donate plasma. Learn more at

is.gd/giveplasma

Find expert information about COVID-19 UChicagoMedicine.org/covid-19

CROHN’S DISEASE DOESN’ T FIGHT FAIR. NEITHER DO WE. See how UChicago Medicine challenges the status quo of inflammatory bowel disease treatment to make a real difference in your life at UChicagoMedicine.org/NotFair

David T. Rubin, MD Chief, Section of Gastroenterology, Hepatology and Nutrition

Move over, soda. Carbonated water drinks — including sparkling, seltzer, fizzy and mineral waters — are all the rage.

But are these bubbly beverages good for you?

sodium can add up. Some people express concern about the carbonic acid in these waters. Even if carbonated water is a little bit acidic, it shouldn’t have a detrimental effect on dental enamel.”

HOW MANY BUBBLES?

“They are a healthier alternative to soda, juice or sports drinks,” said University of Chicago Medicine dietitian Lori Welstead, RD, LDN. “Still, it’s important to choose the right type of carbonated water, because they are not all created equal.”

Carbonated water is a good substitute for those trying to kick the soda habit. And club soda and sparkling water hydrate better than regular soda. There have been studies that show carbonated water can help improve digestion and reduce constipation.

Carbonated water provides true hydration, and is a much better option than drinking regular soda or even diet soda, especially for those who are watching their weight.

But some contain added sugars or artificial sweeteners, which can increase calories, harm teeth and trigger some health conditions. Club soda and sparkling water have no added sugar. Tonic water has about 15 grams of sugar in a serving — a third as much as a regular soda.

But, Welstead cautions, excessive intake can induce gas and bloating, making you uncomfortable. Using straws to drink carbonated water also can increase gas and bloating. Patients with acid reflux, gas or gastroesophageal reflux disease (GERD) who are drinking mostly carbonated water should switch to non-carbonated beverages, like plain water.

CHECK THE LABEL

Welstead recommends consumers look closely at the labels on carbonated water products. “Make sure it’s zero calories and zero sugar,” she said. “And avoid drinks with high fructose corn syrup and regular sugar. Artificial flavoring is OK, but my recommendation is to limit excessive artificial sweeteners.

“Another ingredient to be mindful of is sodium. One hundred to 200 milligrams of

Some studies suggest that carbonated water helps people clear their throat and swallow better, which is beneficial to the millions of Americans who have dysphagia, or trouble swallowing. Sparkling mineral water contains calcium, which can improve bone health. And carbonated mineral waters with magnesium and calcium also have may have bone-boosting benefits.

For those who wonder about using a machine at home to make carbonated water, Welstead has this advice: “It’s fine.

Just don’t add sugar.”

Get the facts on choosing fizzy drinks UChicagoMedicine.org/sparkling-water

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Lori Welstead, RD, LDN

Texting is a pain in the neck... and thumb!

A long wait for a meal at a restaurant or killing time before an appointment is often filled by texting, tweeting and scrolling on our smartphones. As much fun — and utility — as these mobile time sinks add to our lives, they’re also increasingly giving us constant thumb and neck pain.

University of Chicago Medicine orthopaedic surgeon Jason Strelzow, MD, and orthopedist Christopher Hicks, MD, explain how to keep texting pain-free.

Text thumb WHAT CAUSES TEXT THUMB? DR. STRELZOW: The medical term for “text thumb” is de Quervain’s tenosynovitis.

Tendons that run up our thumb allow us to move it, and they come through a tunnel at the side of our wrist. If the thumb is overused, the tendon starts to swell. That, in turn causes the tunnel to swell, which causes the discomfort.

WHAT CAN I DO ABOUT TEXT THUMB?

The best thing you can do is use your thumb in moderation. First, try an ergonomic change. If you’re using a two-handed grasp and typing with your thumbs, swap to a single hand. You can “pick and peck,” which is where you type with a straight finger instead of a flexed thumb. It is more difficult and not as fast, but it causes less pain.

take anti-inflammatories (such as ibuprofen or other over-the-counter medication) and give their thumb some rest. If the symptoms are especially severe, I’ve recommended using a hand brace that’s designed to prevent them from further irritating the tendon.

breaks down the moves correctly, you want to stretch your upper trapezius area, your scalenes and your paraspinals, the muscles at the back of your neck. These areas are the most likely to spasm when you’re stressing your neck.

HOW LONG SHOULD I REST MY HAND?

WHAT HAPPENS IF NECK PAIN GOES

A good “rule of thumb” is give your hand a rest for as long as you’ve had the symptoms.

WHAT ADVICE DO YOU HAVE FOR PEOPLE WHO CHRONICALLY GET TEXT THUMB?

Don’t push through it! Ignoring the pain in your hand can make it worse. If it’s bad enough that you have to take medications for it, you need to give your hand a long rest.

UNTREATED?

Bad posture can lead to shoulder pain and predispose you to a condition called subacromial impingement, which is inflammation in your shoulder. It can also lead to disc protrusions in the back of your neck. Another possibility is stenosis, the narrowing of your spinal canal, which can cause a lot of pain and numbness. Suffering through it won’t do you any favors down the road.

Text neck WHAT DO YOU RECOMMEND TO PEOPLE WHO HAVE NECK PAIN FROM PHONE USE? DR. HICKS: The most important change people can make is correcting their posture.

People have neck pain from reading and texting on their smartphones because they hold their phones in their laps or lower than eye level and it promotes terrible posture.

Rounded shoulders or a forward-flexed neck puts stress on the musculature on the back of your neck. I tell people to put and hold their phones at eye level and their symptoms usually will improve.

Christopher Hicks, MD

WHAT CAN SOMEONE WITH NECK PAIN DO?

ARE THERE TREATMENTS?

My first recommendation to patients is to

With the help of a physical therapist or assistance from a website or video that

Jason Strelzow, MD

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NEWS New leader takes the helm at UChicago Medicine

Sharon O’Keefe leaves ‘rich and meaningful legacy’

Thomas E. Jackiewicz is the new President of the University of Chicago Medical Center and Chief Operating Officer of the UChicago Medicine health system.

Sharon O’Keefe retired in July as President of the University of Chicago Medical Center, after a distinguished 46-year career in academic medicine. O’Keefe also served as Chief Operating Officer of the University of Chicago Medicine health system.

Jackiewicz joined UChicago Medicine in August after serving as Chief Executive Officer for Keck Medicine of the University of Southern California and a senior vice president for USC. He succeeds Sharon O’Keefe, who retired in July.

During her 9½-year tenure at UChicago Medicine, O’Keefe’s focus on improving the quality, safety and experience of clinical services resulted in 17 consecutive “A” grades for hospital safety from the industry watchdog Leapfrog Group. And in 2018, the medical center received the prestigious Magnet Recognition from the American Nurses Credentialing Center for excellence in nursing and patient care.

His career has focused on executing ambitious and broad transformations in academic medicine and engaging physician leaders in organizational change. During his almost nine-year tenure at Keck Medicine, he grew USC’s medical enterprise from two for-profit hospitals to a $2.1 billion regional academic health system with internationally renowned physicians, care quality in the top quartile in the country and strong scientific research capabilities.

I’ve admired UChicago Medicine and its pioneering approach to advancing clinical care through scientific research, and for educating the next generation of physicians and scientists. I look forward to building upon this historic tradition to advance innovation and continue to extend access to UChicago Medicine’s outstanding medical care across Chicago, the south suburbs and Northwest Indiana.”

Jackiewicz previously served in leadership roles in both medical schools and academic health systems at the University of California, San Diego, the University of Pennsylvania, Stanford University School of Medicine and Columbia University Medical Center.

“Tom is the right leader to succeed Sharon and help us continue the University of Chicago’s legacy of advancing the forefront of medicine through outstanding patient-centered clinical care, scientific discovery and innovation, and continued growth as an academic health system,” said Kenneth S. Polonsky, MD, Dean and Executive Vice President for Medical Affairs at the University of Chicago and President of the UChicago Medicine health system.

THOMAS E. JACKIEWICZ President of the University of Chicago Medical Center and Chief Operating Officer of the UChicago Medicine health system

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The Forefront | FA L L 2 0 2 0

Under her leadership, UChicago Medicine opened the 1.2 million-square-foot Center for Care and Discovery; acquired and integrated the Ingalls Memorial community health system; expanded outside of Hyde Park with the opening of ambulatory centers in Orland Park, the South Loop and River East; and opened a larger adult emergency department with a Level 1 adult trauma center.

“Sharon has had a profound impact on UChicago Medicine and is leaving a rich and meaningful legacy,” said Kenneth S. Polonsky, MD, Dean and Executive Vice President for Medical Affairs. “She has been a superb clinical and organizational leader, driven by a passion to provide superior patient care and an ability to work effectively with physicians, nurses, other healthcare professionals and other members of our staff.”

LEADERSHIP NEW PHYSICIANS Cardiac surgery

MICHAEL G. EARING, MD, has been named Section Chief of Pediatric Cardiology at the University of Chicago Medicine Comer Children’s Hospital. He also directs UChicago Medicine’s Adult Congenital Heart Disease Program.

Anesthesiology ELIZABETH STARKER, MD Ophthalmology BIRVA SHAH, OD

SEAN PINNEY, MD, is the new Co-Director of the UChicago Medicine Heart and Vascular Center and Director of the Advanced Heart Failure, Transplant and Mechanical Circulatory Support Program.

Orthopaedic surgery ALLISON MAYFIELD, MD BRADLEY ZARLING, MD MAHMOUD OKASH, MD Cardiology

Urology LUKE REYNOLDS, MD

ZENITH JAMERIA, MD ARUN KANNAN, MD ANDREW OEHLER, MD

Physical medicine and rehabilitation DAVID WEISS, MD

Hematology/oncology BENJAMIN DERMAN, MD BRIAN HEISS, MD

Psychiatry MALCOLM VANDREVALA, MD

VINOD KONDRAGUNTA, MD

Radiation oncologist STEVEN CHMURA, MD, PHD, was named Scientific Director for the UChicago Medicine Comprehensive Cancer Center Cancer Clinical Trials Office.

DEBRA STULBERG, MD, was

named Chair of the Department of Family Medicine.

PADMA RAJAGOPAL, MD JONATHAN TRUJILLO, MD

HONORS

Infectious diseases MAGGIE COLLISON, MD GREGORY OLSON, MD Internal medicine RAJEEV ANCHAN, MD Neurology ELISHEVA COLEMAN, MD Pediatric neurology RYAN COATES, MD Pulmonary medicine SIVASUBRAMANIUM BHAVANI, MD LUCAS KIMMIG, MD JULIE LIN, MD Nephrology SAMANTHA GUNNING, MD Obstetrics and gynecology

KATRINA LEE, MD

MICHELLE M. LE BEAU, PHD,

Director of the University of Chicago Medicine Comprehensive Cancer Center, received the 2020 AACR-Margaret Foti Award for Leadership and Extraordinary Achievements in Cancer Research from the American Association for Cancer Research. She is also the recipient of the 2020 Henry M. Stratton Medal from the American Society of Hematology (ASH) for her contributions to basic hematology research.

Pediatric hematologist/oncologist JENNIFER was named 2020 Researcher of the Year by the Leukemia & Lymphoma Society.

MCNEER, MD,

Oncologist WENDY STOCK, MD, was selected for a 2020 American Society of Hematology Mentor Award for her contributions to the professional development of numerous hematology trainees at various stages in their careers.

Radiation oncologist STANLEY LIAUW, MD, was named a Fellow of the American Society for Radiation Oncology (ASTRO).

Gastroenterologist RUSSELL COHEN, MD, and advanced practice nurse MICHELE RUBIN, MSN, APRN, were recognized by the Crohn’s & Colitis Foundation as recipients of the 2020 Uniting to Care & Cure Award. The award recognizes members of the IBD professional community who go above and beyond to support the foundation’s mission to improve patient quality of life and find cures for inflammatory bowel disease.

Oncologist RITA NANDA, MD, was invited by the Society of Immunotherapy of Cancer (SITC) to serve as a member of the SITC Cancer Immunotherapy Guidelines Breast Cancer Expert Panel, reflecting her expertise and national visibility.

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When stress hits you in the gut Do you ever feel like there’s a knot in your stomach when you’re worried or stressed?

Do nerves make you feel butterflies in your gut? Stomach problems are among the most common symptoms of stress and anxiety.

UChicago Medicine Ingalls Memorial gastroenterologist Kevin Dolehide, DO, explains that stress-related stomach pain can sometimes develop into more serious conditions.

If you have stomach or gastrointestinal discomfort, you should be seeing your primary care doctor at least once a year, Dolehide said. If the pain is not severe and doesn’t require immediate medical attention, your primary care physician may refer you to a gastroenterologist — a specialist in the treatment of diseases of the GI tract and liver.

“A gastroenterologist can help rule out if your stomach pain is coming from something organic versus a stressful situation,” Dolehide said.

When a person is stressed, the adrenal glands make and release the hormone cortisol into the bloodstream. This causes the fight-or-flight response, and can also trigger abdominal discomfort, stomach cramps, constipation, diarrhea, nausea and other symptoms.

Chronic stress can lead to more serious conditions like inflammatory bowel disease, gastritis, ulcers and bleeding in the stomach.

These conditions also can become a source of stress, exacerbating the problem.

People experiencing chronic stress may also eat more or eat unhealthy foods, smoke or drink more alcohol or coffee than normal, Dolehide said. These new habits can also cause stomach or GI discomfort.

How can you decipher when the symptoms above are associated with a temporarily stressful situation, or when a more serious condition is developing? Dolehide said warning signs like weight loss, bloody or black stools, or abnormal lab results that indicate anemia or other abnormalities

20 » THE UNIVERSITY OF CHICAGO MEDICINE

may show that something more serious is occurring.

“Primary care physicians often refer patients who are acutely ill for a colon cancer screening,” Dolehide said. The American Cancer Society recommends that regular screenings for colon cancer begin at age 45 for those at average risk. People of any age experiencing certain symptoms should talk with their doctor about testing.

Though gastroenterologists can screen for and treat a wide variety of symptoms, conditions and illnesses caused by stress, it’s important for patients to have a conversation with their primary care doctors about how to better manage stress to prevent ongoing stomach and GI issues.

Dolehide said his father, who was a longtime physician, always said “the stressed fall into the lap of a physician.” The two worked together at their practice in the Beverly neighborhood of Chicago for 25 years, until his father retired from medicine at age 88. Dolehide’s uncle also practiced medicine and inspired him to become a physician.

Kevin Dolehide, DO, sees patients at the UChicago Medicine Medical Group in Beverly and Ingalls Memorial Hospital in Harvey.

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I enjoy working in the same building where my dad worked. It’s really a community-based office setting that’s safe and welcoming for patients.

My wonderful staff helps to keep my stress levels down!”

KEVIN DOLEHIDE, DO

To make an appointment with a primary care physician or gastroenterologist at UChicago Medicine Ingalls Memorial, call 855-826-3878 or request an appointment online at UChicagoMedicine.org/Ingalls

COMMUNITY RALLIES TO SUPPORT COVID-19 RESPONSE We have all been affected by the coronavirus pandemic.

Whether or not we have personally contracted the virus, our lives have changed — from social distancing and donning masks for everyday tasks to economic hardship and great, personal loss. Yet, so many in the Chicago community and beyond have come forward to support essential healthcare workers and patients and families through UChicago Medicine’s COVID-19 Response Funds.

To date, nearly 1,350 individuals, half of whom had never made a gift to the University of Chicago, have donated $2.2 million.

For our essential workers — the “healthcare heroes” who work as nurses, technicians, schedulers, patient transporters, public safety officers, and more — these funds have helped to alleviate personal burdens so they can continue to serve and provide care to patients. For some, this has meant extra help to afford unanticipated child care costs; food and services for fragile, elderly parents; and temporary housing and added transportation costs to reduce infection risk.

“The generosity of so many people who donated to the COVID-19 Response Funds has been heartwarming,” said Leif Elsmo, UChicago Medicine’s Executive Director for Community and External Affairs. “This support has made a significant difference in the lives of our frontline workers and patients during these challenging times.”

For patients and families, donations to the COVID-19 Response Funds have helped to address what arose as a great need: safe access to high-quality food. For some of our sickest

patients, the risks of grocery shopping in a pandemic combined with economic hardship are doubly lifethreatening. These funds have been used to purchase restaurant gift cards, allowing these fragile patients to receive hot meals delivered to their homes, with the added benefit of supporting local restaurants.

COVID-19 Response Funds have also been applied to a new initiative to help Chicago’s South Side communities — which have been disproportionately affected by the pandemic — reduce spread of the virus. UChicago Medicine is partnering with the South Side Healthcare Collaborative, a network of more than 30 federally qualified health centers and community hospitals, to implement contact tracing. Contact tracing is a public health practice for reducing the spread of disease by interviewing those infected and tracking down people who could have been exposed through contact with an infected person.

Beyond monetary support, community members have donated thousands of masks and gloves as hospital supplies ran short, and individual meals for frontline healthcare workers as gestures of gratitude for their work. Still others have gone online to share words of encouragement and support.

“There are so many people who have donated masks and meals, or who have shared notes of affirmation,” said Ashley Suah, MD, chief surgery resident. “All of that goes a really long way.”

There is no bright side of a pandemic, but there is an opportunity for the best of humanity to shine.

Thank you. Your support is making a difference in the lives of so many.

For more information on supporting the UChicago Medicine COVID-19 Response Funds or to learn about other ways you can help, please visit givetomedicine.uchicago.edu.

| B E L OW | From left: Nurses at UChicago Medicine Ingalls Memorial with meals donated to thank them for their work on the frontline.

Many community members made and donated masks. UChicago Medicine shared PPE and other supplies with community organizations, such as iGrow, which made weekly care packages for clients in the Englewood neighborhood.

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