SUMMER 2020
comes to Health, Science & Wellness COVER STORY
Inside UChicago Medicine’s new outpatient center ALSO IN THIS ISSUE PAGE 1
Unraveling a medical mystery PAGE 2
COVID-19: Thank you to healthcare workers PAGE 8
THINGS YOU’RE TOO EMBARRASSED TO ASK A DOCTOR
River East
Summer 2020
The Forefront
IN THIS ISSUE
7
ON THE COVER
4
Cover photo by Tom Harris
UChicago Medicine River East brings the forefront of medicine to a downtown neighborhood. The new outpatient center offers primary and specialty care in a warm and welcoming environment.
VOCAL HEALTH Our new Voice Center takes a holistic approach to voice care.
Brian Bates and Angela Willis, APN, CNP
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HEALTHY JOINTS
Keep moving to prevent arthritis and improve symptoms.
READ ONLINE A WHOLE NEW LIFE
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Brian Bates lost 130 pounds after undergoing the duodenal switch weight loss procedure.
Amanda Adeleye, MD
ASK THE EXPERT Signs and symptoms of infertility and when to seek help.
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
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ALTERNATIVES TO A COLONOSCOPY Choosing the right colorectal cancer screening test for you.
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This publication does not provide medical advice or
Contributing photographers
treatment suggestions. If you have medical problems
Ben Bitton, Andrew Collings, Jimmy Fishbein, Tom Harris, Wendy Heise, Jean Lachat, Jordan Porter-Woodruff, Nancy Wong and John Zich
or concerns, contact a physician, who will determine your treatment. Do not delay seeking medical advice because of something you read here. For urgent needs, call 911 right away.
PUTTING THE PUZZLE TOGETHER
When Carson Herzog was just 3 months old, his mom, Jessica, noticed his eyes darting around the room erratically. Rob, the baby’s dad and a paramedic, recognized it as a focal seizure. Also known as a partial seizure, a focal seizure begins in one side of the brain. The Herzogs took Carson to their local hospital, but an electroencephalogram didn’t show any signs of a seizure. The worried parents were sent home with instructions to follow up with their pediatrician. Carson’s eyes darted about all night.
Jessica asked Phitsanuwong about something she’d read online: Opsoclonusmyoclonus syndrome (OMS), an extremely rare neurological disorder with symptoms that include rapid, multi-directional eye movement, neurological deterioration, involuntary muscle jerks and uncoordinated movement. In young children, OMS is linked to the presence of cancer.
Carson had not been diagnosed with cancer, but Phitsanuwong thought it was worth investigating. He brought in his colleague, Susan Cohn, MD, a nationally recognized expert in childhood cancer.
“While the seizures and episodic nature of the abnormal eye movements was not classic OMS, his history for worsening symptoms with viral illnesses and vaccines did support That night was the start of a medical mystery it,” Cohn said. that would take almost three years to solve and lead to a one-in-a-million diagnosis. Cohn ordered a full-body CT scan.
“I was terrified that he had a brain tumor or brain cancer,” Jessica said.
The pediatrician thought Carson had epilepsy triggered by an ear infection. The Herzogs made sure to take the baby to the doctor at the earliest sign of an ear infection, but the seizures continued. When Carson was 11 months old, he started showing a lack of muscle control, or ataxia. At age 2, he had a generalized tonicclonic seizure, commonly called a grand mal seizure. There were no signs of infection or fluid in his ears.
Everyone in the room was shocked when they saw a tumor in Carson’s lungs.
“At almost three years old, we finally found a diagnosis,” Jessica said.
MEDICAL MYSTERY
Cohn found that Carson had an inflammatory myofibroblastic tumor, an uncommon, usually benign (noncancerous) tumor made up of cells called myofibroblastic spindle cells.
Carson had surgery at Comer Children’s to remove the tumor. He then received steroids and intravenous gamma globulin, a regimen that is commonly used to treat children with neuroblastoma and OMS. Within a week of starting the therapy, Carson’s abnormal eye movements and ataxia virtually disappeared. After one month of treatment, his vocabulary dramatically improved from speaking less than 10 words to full sentences. Carson’s treatment is currently being weaned, and today, he is a happy 3-year-old who loves running and building with blocks. “We were looking into making our house wheelchair-accessible, preparing for him to die by age 16,” Jessica said. “But then we got Carson back, solely because the team at Comer listened to us and truly cared about him.”
Rob and Jessica Herzog with their son, Carson, during his November hospitalization at the University of Chicago Medicine Comer Children’s Hospital.
“I knew that something more had to be done,” Jessica said. She made an appointment with pediatric neurologist Chalongchai Phitsanuwong, MD, an epilepsy expert at the University of Chicago Medicine Comer Children’s Hospital. “Connecting with Dr. Phitsanuwong was like the piece of the puzzle that was missing the entire time,” Jessica said. “I was so relieved that I cried when I left the appointment.”
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THANK YOU TO OUR
Healthcare workers are putting themselves in harm’s way in the fight against COVID-19. Here are thoughts of gratitude shared from across the country:
“You are sacrificing so much to save people’s lives and to maintain normalcy. Because of your efforts, I can trust that my family, friends and neighbors will stay safe during this unprecedented crisis. That’s why you are the heroes of this generation.’’
“The bravery you exhibit every single day, the hard work you do, and the way you act selflessly is beyond amazing, and you deserve the absolute world. Thank you from the bottom of my heart.”
“Thank you all for helping Chicago and the world in these difficult times. As I am about to start college with a major in nursing, I am now more than ever sure what I want to do with my life and career.”
View more at UChicagoMedicine.org/ThousandsofDifferences
ACCESS WORLD-CLASS HEALTHCARE FROM HOME Your family’s health doesn’t stop being a priority when leaving the house is a challenge. For your convenience and safety, UChicago Medicine offers secure and easy-to-conduct virtual visits by video or phone for most of your healthcare needs — including primary care, pediatrics, women’s health, oncology, cardiology and surgery consultations. Additionally, video visits are now covered by most insurance plans.
UChicagoMedicine.org/Video-Visits Call 1-888-824-0200 to make an appointment.
Step inside
UChicago Medicine
River East Mobile check-in. Easy parking. Access to world-renowned medical specialists in an expansive, light-filled space.
It’s all part of the University of Chicago Medicine’s new River East outpatient care center, at 355 E. Grand Avenue. The new $20 million, 40,000-square-foot multispecialty clinic opened in February. “We wanted River East to incorporate everything patients today want, and to enhance their overall experience,” said Shari Snow, MD, Executive Medical Director of UChicago Medicine River East. The Illinois Health Facilities and Services Review Board approved the UChicago Medicine project in November 2018, allowing the Hyde Parkbased academic medical center to put down roots in a downtown Chicago neighborhood where many of its patients
work, shop and live. UChicago Medicine River East provides access to a broad scope of services. Besides primary care, there are nearly two dozen medical specialties offered, from cardiology to plastic surgery. Services include mammography and psychotherapy, and procedures such as cardiac stress tests, advanced
laser treatments and minimally invasive gynecologic surgery can be performed in the center. The center also features a comprehensive weight management program, leading care for patients suffering from inflammatory bowel disease, and a Voice Center with specialty care for people with voice and airway disorders.
A NEW POWER DUO TO HELP WITH EARLY BREAST CANCER DETECTION. In a first-of-its-kind partnership, the University of Chicago Medicine teamed up with Solis Mammography to improve the comfort and accuracy of mammograms. Solis provides the SmartCurve System — curved compression panels for mammograms that are shaped like a women’s breast rather than a flat panel. They feature a breast stabilization system with 3D imaging to reduce false positives and help find cancer in women with dense breast tissue. The test results then get reviewed by UChicago Medicine’s nationally renowned radiologists and diagnostic experts. Mammograms with SmartCurve technology are offered at UChicago Medicine’s River East, Hyde Park and Orland Park locations, with more locations to be added. | A B O V E | Lead mammography technologist Giselle Anderson operates the SmartCurve
System. The technology is used at UChicago Medicine River East and other locations.
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UChicago Medicine River East incorporates the latest technology to make visiting the doctor easier and more efficient. Appointment checkin and payments are done on kiosks. Mobile check-in is offered on the MyChart app. Push notifications can be sent to patients if earlier appointments open up. Appointments can be booked online, and there may be extended hours or same-day physician visits or tests available.
Patients driving to UChicago Medicine River East will find an easy-to-navigate indoor parking garage with an elevator that opens onto the care center lobby. Patients receive discounted parking rates. UChicago Medicine River East is a bright, welcoming space. Floor-to-ceiling windows fill the waiting areas with natural light and city views. Modern touches include sliding wooden doors on the exam rooms and desktop phone chargers on the waiting-area tables.
“This new site is part of our healthcare mission to expand access to our worldleading care and clinicians. It will provide greater healthcare options and, most importantly, increase convenience for more patients.”
PRIMARY AND SPECIALTY CARE SERVICES AT RIVER EAST » Behavioral health
The construction incorporated many environmentally friendly features, including the use of recycled raw materials and lights that automatically adjust based on natural lighting in the space.
» Cardiology and electrophysiology
The interior design and branding for the clinic were led by global architecture and design firm Perkins and Will. Guiding principles included improved access to waiting areas filled with natural light, a visual tone inspired by nature, and an overall calming sense of well-being within the clinic.
» I nflammatory bowel disease (IBD) care
As part of a partnership UChicago Medicine has with Solis Mammography, a state-of-the-art mammography center is scheduled to open in the River East location later this year. “We’re bringing the forefront of medicine to more patients in this community,” said Sharon O’Keefe, President of the University of Chicago Medical Center.
Several contemporary botanic images by local photographer Laurel Feldman are displayed in the hallways of River East.
» C olon and rectal surgery “Take Care of You,” a laser-cut wood wall piece by Chicago artist Matthew Hoffman, created in his You Are Beautiful studio.
» Dermatology » Endocrinology » Gastroenterology
» Infectious diseases » Laryngology (voice care) » 3D Mammography » Nephrology » O bstetrics and gynecology (including urogynecology and gynecologic oncology) » Plastic surgery » Primary care » Rheumatology » Sleep medicine » Urology » Weight management
“Chicago, IL,” a hand-drawn abstract map “to help remember the important places in your life” by Jennifer Carland.
Art and design support wellness A calming and beautiful environment, expressed through art, is integral to the design and architectural vision for UChicago Medicine at River East. “The center is a place of care and caring,” said Monica Hork, Healing Arts Coordinator for UChicago Medicine. “Providing an environment where patients feel comfortable before, during and after their appointments is our shared objective.” Art in a variety of styles was chosen to be
warm and welcoming, and to reduce anxiety related to illness. Suspended over the staircase leading to the second-floor clinic is a nature-inspired sculpture. Patients can take in the subtle beauty of the piece in the light-filled waiting room. Consistent with all elements in this contemporary space, art also supports wellness in the patient care areas. As an added reminder, a wall sculpture at the entrance of the center encourages all patients and visitors to “take care of you.”
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E. Grand Avenue
KEY FEATURES OF THE NEW CARE CENTER UChicago Medicine River East is the academic health system’s newest ambulatory facility with state-of-the-art equipment, spacious examination rooms and a contemporary waiting area with floor-to-ceiling windows. N. McClurg Court
N. MICHIGAN AVE.
E. GRAND AVE. N. LAKE SHORE DR.
N. COLU MBUS DR .
N. McCLURG CT.
E. ILLINOIS ST.
Chicago River
E. WACKER DR .
E. Illinois Street
About 40,000 square feet and 41 exam rooms Economic benefit of over $7.9 million » 36 construction firms worked on the project, 26 of which were minority- or womenowned businesses » 228 construction jobs created, 100 of which went to minority and/or women workers
53 doctors covering about two dozen primary and specialty care services Two entrances » 300 block of East Illinois Street and 300 block of East Grand Avenue
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Technological features » User-friendly check-in and payment kiosks » Charging outlets on work desks in waiting area » Mobile check-in through MyChart app » Push notifications if earlier appointments open up
Team-centric stations for efficient, effective collaboration Designated parking spaces in attached garage » 25 UChicago Medicine signs to guide patients » Direct access from your car to front door of care center
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Unique services » A voice center, with advanced treatment for voice and airway disorders » State-of-the-art mammography center, featuring curved paddles for greater comfort » Enhanced treatment for inflammatory bowel disease (IBD) » Cardiac electrophysiology
Environmentally friendly features » Use of recycled raw materials during construction » Lights that adjust based on natural lighting in the space
Warm, welcoming art » Unique art and architecture designed with comfort in mind
Laryngeal surgeon and voice specialist Brandon Jackson Baird, MD, sees patients at UChicago Medicine’s River East and Hyde Park locations.
Specialized care for voice problems Has your voice quality changed? Are you experiencing discomfort or strain while speaking or singing? The University of Chicago Medicine Voice Center welcomes vocal professionals — including singers, actors, speakers and broadcasters — and anyone experiencing a voice problem. Laryngeal (voice box) surgeon Brandon Jackson Baird, MD, director of the new Voice Center, specializes in treating a wide range of laryngeal diseases, including voice and swallowing disorders. He discusses common symptoms, advanced diagnostics, treatment options and how he got interested in laryngeal surgery and vocal rehabilitation. WHEN SHOULD SOMEONE SEE A VOICE SPECIALIST?
If you are experiencing a weak, breathy or raspy voice, difficulty raising your voice, and/or changes in voice quality when speaking or singing, our Voice Center team can help. We also care for patients who
have pain when speaking or singing or difficulty swallowing and those who have voice concerns related to cancer or cancer treatment.
The decision to have surgery is made by the patient after all available options and alternatives are thoroughly reviewed. WHAT LED TO YOU BECOMING
HOW ARE VOICE PROBLEMS
A LARYNGEAL SURGEON?
DIAGNOSED?
I became interested in science and music at a very early age. And I’ve always wanted to help people. After completing medical school and an ear, nose and throat surgical residency, I did a fellowship in voice surgery at Massachusetts General Hospital-Harvard Medical School, one of the leading voice centers in the U.S.
A member of our team will conduct a thorough exam, listening to your voice and using sophisticated equipment to record, measure and analyze airflow, acoustic levels and other aspects of the voice. Additionally, we will inspect your vocal cords (also called vocal folds) using a laryngoscope — a small camera that goes through your nose or your mouth. WHAT IS YOUR APPROACH TO CARE?
We consider each patient’s personal goals and explain all treatment options. We offer customized voice therapy by speechlanguage pathologists; in-office injections for paralysis and spasmodic dysphonia; laser treatments for cancer dysplasia and papilloma; medications; and microsurgery to remove cancers, cysts, nodules, polyps and other lesions affecting the vocal folds.
As a trained singer, I understand what professional vocalists are going through when they face problems with their voice. It’s very rewarding to see my patients get better and get back to their passion.
LEARN MORE
UChicagoMedicine.org/voice MAKE AN APPOINTMENT
1-888-824-0200
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In January, UChicago Medicine launched its first official podcast, an audio show series, titled:
THINGS YOU’RE TOO EMBARRASSEDTO ASK A DOCTOR
searched online for the
Why do women lose hair after giving birth?
answer to a medical
Dr. Maryam Siddiqui:
Our show is designed for anyone who has ever
question rather than turning to a physician. Each episode features a different physician specialist and topic. Here are a few questions pulled from transcripts of the podcast episodes.
What we see is that normally your hair growth is in two phases. There’s a resting phase, and then there’s a growth phase. In pregnancy, that shedding phase is shut down. So, you actually do have thicker, more luxurious hair during pregnancy. And then what happens is, after you deliver, all of the hair that was supposed to be in the resting phase now starts to shed. So, over the course of the next couple of months, you’ll lose a lot of hair. And it does take up to a year for that hair growth to fully come back. Supplements that are rich in biotin and the B vitamins can be helpful, like hair and nail formulas. Making sure that your iron reserve and your anemia are corrected is also important.
Maryam Siddiqui, MD Obstetrics and gynecology
8 » THE UNIVERSITY OF CHICAGO MEDICINE
Sometimes people have excessive hair loss that is outside of what we would expect for postpartum. And those women probably need to get their thyroid function checked. Those are some of the things that we see. I think a lot of people worry about huge clumps of hair coming out. But it does eventually correct itself.
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Vijaya Rao, MD Gastroenterology
What does it mean if my poop is green? Dr. Vijaya Rao: That’s
a common question we get in clinic. People are always very concerned about the color of their poop. And the thing that I generally tell patients is, oftentimes, the color of your poop is reflective of what you ate. So, when poop is green, it doesn’t really mean anything dangerous. It may have been that you ate more green things that day. I always tell patients that the two colors that we’re actually most worried about, or I guess three, are black like tar, red like bright red or maroon stools, or very occasionally, a pale or a white stool. But every other color of the rainbow in between is not concerning.
What is pel vic organ prolapse? So, whenever I talk to my patients about pelvic organ prolapse, I tell them to think of the vagina like a house with four walls and a roof. Pelvic organ prolapse is kind of a relaxation of the support of the vagina. And it causes a caving in of some of those walls.
Dr. Dianne Glass:
The uterus sits in the roof of the vagina. If the support of the uterus relaxes, the uterus can kind of descend into the vagina a little. Similarly, that wall between the bladder and the vagina can relax into the vagina a little bit, causing a bulge in the vaginal area or even coming out of the opening of the vagina. The organs themselves don’t come out. They’re always covered by the skin of the vagina, but the vagina can descend and even kind of turn inside out a bit like a sock. The bladder that sits just behind the vagina or the uterus can come down through the opening of the vagina.
Dianne Glass, MD, PhD Urogynecology
Can my uterus fall out? Dr. Glass: Sort
of. The uterus sits inside the body. The cervix, which is the very bottom part of the uterus, pokes into the vagina. As prolapse gets worse, the uterus can descend lower in the pelvis, kind of into the vagina. And eventually, the vagina can actually flip sort of inside out. And so, the uterus is inside the vagina but outside of the body, if that makes sense.
Sarah Stein, MD Pediatric dermatology
How does someone remove a wart? Warts don’t have to be removed. They’re not harmful. If they’re not causing a problem or the individual is not concerned by how they look, they can be left alone. But when people don’t like having them, they don’t like the look of them or they are causing pain on the bottom of the foot, for example, then it’s reasonable to try to treat them. There are a lot of treatments for warts because none of them work very well. And that’s a pretty good rule of thumb — the more treatments there are for something, the less well any one of those treatments probably works.
Dr. Sarah Stein:
In the dermatology office, our usual first approach to wart treatment is to freeze them. That’s called cryotherapy. There are a lot of different agents that can freeze. In fact, there are some products that are sold over the counter in the drugstore that are also used to freeze warts. The different chemicals will get the skin different degrees of cold. And so that probably impacts how effective any one of those treatments is. Even with the freezing treatment in the doctor’s office, it usually takes more than one time of freezing the wart before it’ll go away. So, you’ll come into the office. You’ll have your wart frozen. It’ll get maybe red, maybe swollen, maybe blistered, peel some layers. That’ll happen over a couple of weeks. And then three or four weeks later, you’ll need to come back and treat the spot again because there’s probably still some of that wart left at the base.
People are going to start cringing in their cars or while they’re exercising right now, but testicles can twist on themselves. Basically, that cord that attaches can twist and the blood supply can cut off. And it gets extremely painful really quickly — shout-out-loud kind of pain.
Dr. Scott Eggener:
And if that occurs to you, get into an Scott Eggener, MD emergency room. Urology It’s most common in teenagers and people in their 20s and 30s. If it’s caught in time, we can untwist them and save the testicle. If people wait too long, the blood supply gets compromised. And oftentimes the testicle is dead and needs to be removed. Earlier is better. Each hour matters. We can usually save the testicle if people show up within six or eight hours, but our success rate is lower the longer they wait. This isn’t subtle. You know that something is going on. The mind is amazing and sometimes explains things away. But if you do experience that pain, get in to see somebody.
To listen to full episodes of our show and to submit your own questions, visit UChicagoMedicine.org/podcast
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‘I love the new me’ In 2017, Brian Bates knew he needed to find a “healthier place in life.” Although he had worked with a personal trainer and nutritionist for several years, Bates was unable to reach his weight loss goal. The London-based international capital markets lawyer was up to 283 pounds, with a body mass index (BMI) of 39 (30 and higher is considered obese). “I developed sleep apnea, pre-hypertension and pain in my legs, hips and feet,” Bates said. “I couldn’t enjoy the type of lifestyle that I had as a younger person. And traveling internationally, which was necessary for my job, had become increasingly difficult.” CHOOSING THE BEST OPTION
One of Bates’ colleagues, who had undergone obesity surgery 15 years earlier, recommended a duodenal switch — a type of obesity surgery — due to her experience with long-term success. She advised him to choose a gastric surgery practice that was highly experienced in the complex procedure. After researching surgical weight loss programs in the U.S. and London, Bates decided to fly across the Atlantic to meet with the bariatric team at the University of Chicago Medicine.
match between the choice of procedure and the patient. “Each patient has a different amount of weight to lose and different health issues related to obesity,” said bariatric surgeon Vivek Prachand, MD. “In addition, the surgeries have different levels of effectiveness and side effects.” UChicago Medicine offers all four types of bariatric surgery — sleeve gastrectomy, gastric bypass, gastric band and duodenal switch. “In just one stop, I met with the surgeon, nurses, a dietitian and a psychologist,” said Bates, a Midwest native with homes in London and in Northwest Indiana. “The conversation was professional, constructive and informative. Because I could speak to them directly and candidly — and due to their vast experience with the duodenal switch — I knew the UChicago Medicine team was for me.” The duodenal switch — also called the biliopancreatic diversion with duodenal switch and commonly referred to as DS — combines a sleeve gastrectomy with an intestinal bypass. Because it reduces how much food a person feels like eating and results in improvement of metabolism, it helps patients lose weight and maintain weight loss.
Every patient considering obesity surgery at UChicago Medicine first meets with the entire weight loss care team. The visits take a half day, with the goal of finding the right
“Brian’s BMI was less than the typical DS patient,” said Prachand, noting that the procedure is usually performed when the BMI is over 50, or over 40 if the patient has other health issues, such as severe diabetes. “He didn’t need DS from the standpoint of the magnitude of his weight.”
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Brian Bates lost 130 pounds after he had obesity surgery and learned a new way of eating.
The weight loss surgeons at the University of Chicago Medicine, leaders in the bariatrics field for more than 20 years, have performed hundreds of duodenal switch procedures.
Prachand recommended the sleeve gastrectomy. But when Bates pushed back, Prachand listened. Bates wanted the DS not only for its effectiveness at weight loss, but, more importantly, for its durability. “If I was going to have weight loss surgery, I wanted the procedure with the greatest chance of long-term success,” he said. “The conversation we had with Brian about having the more complex procedure was a challenge, not a confrontation,” Prachand said. “There are different risks and benefits with the duodenal switch compared to sleeve gastrectomy. We needed to be sure we went into this together, in a clear-eyed way.
“Based on our discussion, I felt very confident that Brian had an excellent understanding of these differences and realistic expectations about surgery. He committed to diligently using DS as a tool to achieve his health goals and understood that surgery was neither a shortcut, nor an easy way out to weight loss and health improvement.” SURPASSING HIS GOAL
Bates underwent the DS procedure in December 2017. After recovery, with the help of a nutritionist and a support group, he learned a new way of eating. Because about two-thirds of his small intestine was now bypassed, there were changes in the way his body absorbed certain nutrients, such as fats and protein, as well as vitamins and minerals. As his body adapted to these changes, Bates adjusted his diet. He regularly takes supplements to meet his nutritional needs.
“I’m still exploring what works, but absolutely none of this has been problematic for me,” said Bates. “I eat several small meals each day, focusing on protein from foods such as beans and porridge. And I take several vitamins and nutritional supplements daily. It’s become a part of my routine.” Bates has surpassed his goal of losing 100 lbs. “It’s been a miracle. I love the new me and the life I now lead, with new interests — particularly having fun in the London fashion scene. I’ve also developed far greater self-confidence and now speak on issues concerning diversity, inclusion and mental health. I am determined to assist others in finding their path to a better self.” Prachand said Bates is an example of the individualized care offered to every patient who comes to the bariatric surgery program at UChicago Medicine. “Our team worked together closely with Brian to use the right tool to achieve the best outcome possible.”
Which weight loss approach is right for you? Vivek Prachand, MD
MEDICAL MANAGEMENT
ENDOBARIATRIC PROCEDURES
BARIATRIC PROCEDURES
Which weight loss approach is right for you? UChicago Medicine offers a full spectrum of services for weight management and obesity treatment, including medication, behavioral therapy, nonsurgical procedures and bariatric surgery. LEARN MORE
UChicagoMedicine.org/weight-management
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A NEW TOOL TO TACKLE CELIAC DISEASE
A research breakthrough has delivered a vital tool for efforts to treat and prevent celiac disease. After more than 20 years of work, University of Chicago scientists have produced the first accurate laboratory model of celiac disease, which causes gastrointestinal symptoms and damage to the small intestine when someone eats gluten — a protein found in grains such as wheat, barley and rye. Treatments that could reverse or prevent the disease can now be tested in a model that faithfully represents the condition in humans. There currently is no cure for celiac disease, and the only effective treatment is a gluten-free diet. Even on a strict diet, 40% of affected patients suffer inflammation and damage to the small intestine. The exact cause is unknown, but researchers have identified genetic,
immune system and environmental components that work together to trigger the disease. The laboratory models have the same genetic and immune system characteristics as humans who develop celiac disease after eating gluten. “It’s the first model where the mouse develops damage to the small intestine just by eating gluten and then later reverses the disease’s damage on a gluten-free diet,” said Bana Jabri, MD, PhD, Director of Research at the University of Chicago Medicine Celiac Disease Center and senior author of the study, published in February in Nature. The model will be used to help design new therapeutic strategies and test new treatments in collaboration with national and international academic centers and pharmaceutical companies.
LINKING CHEMICAL RHYTHMS TO EATING BEHAVIORS, OBESITY
Obesity affects over 90 million adults in the U.S., but how different chemical signals in the body are involved remains unclear. A new study shows that chemicals in the endocannabinoid system — a part of the nervous system that helps regulate appetite — are altered during obesity. Erin C. Hanlon, PhD, a research assistant professor at the University of Chicago, and colleagues found that in obese individuals, the rhythmic cycle of a chemical signal linked to eating for pleasure peaks later in the day when compared to non-obese individuals. This shift may be what causes obese individuals to eat when they aren’t hungry and to snack before bedtime — another factor linked to weight gain — or the change in rhythm may occur after weight gain and further perpetuate the cycle. The study, which was published in the Journal of Clinical Endocrinology and Metabolism, presents new avenues for understanding how the endocannabinoid system is involved in eating behaviors linked to obesity.
STUDY FINDS GAPS IN NURSING HOME SAFETY DATA
Nursing home patient falls are significantly underreported on a federal website called Nursing Home Compare, often used by families researching options for loved ones. Reviewing nearly 88.7 million Medicare claims from 2011 to 2015, Prachi Sanghavi, PhD, a University of Chicago researcher, identified 150,828 major injury falls in claims filed by hospitals for reimbursement. The data used by Nursing Home Compare accounted for only 57.5% of these falls, with far fewer falls being reported for black, Asian and Hispanic patients relative to whites. Though often preventable, falls are a leading cause of death among the over-65 population. Sanghavi suggests that the website use an objective source, like claims data, rather than numbers selfreported by nursing homes. The findings were published in December in Health Services Research. READ MORE AT
UChicagoMedicine.org/forefront 12 » THE UNIVERSITY OF CHICAGO MEDICINE
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CLOSING MACULAR HOLES WITHOUT SURGERY
The macula of the eye provides us with the sharp vision we need to read, drive and see fine details. A new method for treating macular holes — a common vision problem in people over 60 that causes distorted and blurry vision — may allow some patients to avoid invasive surgery. Traditional treatment for a macular hole involves the surgical removal of transparent gel from the middle of the eye. University of Chicago Medicine ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, has been researching whether medicated drops can help close these holes. The three-drug regimen dehydrates the retina and decreases swelling, allowing the edges of the macular hole to creep back together. The treatment was most effective in patients who already had retinal surgery and whose macular hole was under 200 micrometers. Skondra hopes to begin a multi-center randomized trial to further study the treatment’s effectiveness.
Keep moving to preserve joint health For millions of Americans with osteoarthritis (OA) — the most common type of arthritis — joint pain, swelling and stiffness can become chronic conditions. Arthritis is most often felt in the knees, but also can affect the hips, lower back, neck and larger joints in the feet and hands. The good news? There are effective ways to both minimize your risk of OA and manage the pain and stiffness. Exercise and strength work are at the top of the list. “The more active you are, the better,” said University of Chicago Medicine orthopaedic surgeon Sara Wallace, MD, MPH, who specializes in joint care. WHAT CAUSES ARTHRITIS?
“There are components of wear and tear, but that’s not the driving force,” Wallace said. “We think there’s largely a genetic predisposition for osteoarthritis; it’s more about the way your cartilage was designed.” Obesity and major injuries at or around the joint also increase the risk of developing arthritis. Less common causes include inflammatory conditions and osteonecrosis, which is the loss of blood supply to the bone.
MINIMIZING THE RISK
You can lessen your risk and control symptoms — to some degree — by maintaining a healthy weight and remaining active. “Weight-bearing force helps maintain joint health,” Wallace said. “Strengthening muscles around the joints is also key to reducing pain and taking stress off joints.” Options for pain relief include acetaminophen or an anti-inflammatory pain reliever such as ibuprofen. The next step would be corticosteroid injections to reduce inflammation and pain. “Beyond that, you are looking at joint replacement,” Wallace said.
MANAGING ARTHRITIS
“Exercise is medicine,” Wallace said. “And the more balanced and stronger the muscles are around the joint, the better the joint health will be overall and the less pain you will experience.” Wallace recommends people stay active, exercise and do physical therapy to strengthen the muscles around the joints. “Maintain a healthy weight,” she said. “Even a 5- to 10-pound weight loss can have a tremendous impact on reducing joint pain.” Gentle stretching, yoga and tai chi may also improve flexibility and reduce stiffness and pain.
Increasing joint mobility with exercise and injection therapies
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Brendon Ross, DO, MS, a UChicago Medicine specialist in nonoperative orthopaedics and sports medicine, focuses on exercise, physical therapy and orthobiologics to increase joint mobility. “Strengthening the muscles around the joint — whether it’s the hip, knee or shoulder — offloads the burden of force that’s being transmitted to the joint,” he said. “Muscles are a very important component of stability and structure and can often slow the degenerative changes of arthritis.” Ross also offers injection therapies in his clinic. In addition to corticosteroids, these therapies include viscosupplementation with hyaluronic acid — a naturally occurring substance in joint fluid — and platelet-rich plasma to increase joint mobility, reduce pain and promote faster healing.
Sara Wallace, MD, MPH
RIVER FOREST 290
SOUTH LOOP Comer Children’s Hospital Duchossois Center for Advanced Medicine
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ASK T HE E XPE R T
Helping couples overcome infertility Infertility affects one in eight heterosexual couples who are trying to get pregnant. Reproductive endocrinologist, Amanda Adeleye, MD, sees firsthand the impact infertility has on people who desire to have a baby. At the University of Chicago Medicine Center for Reproductive Medicine and Fertility, Adeleye and her colleagues start by identifying the causes of infertility in each person or couple, then exploring every option to help patients build their families. She answers commonly asked questions about infertility. HOW DO I KNOW IF MY PARTNER OR I MAY BE INFERTILE?
Infertility is defined as the inability to conceive after one year of trying. If you or your partner are over the age of 35, you should see a fertility specialist after six months. After age 40, we recommend seeking help right away because we know fertility declines as age increases. WHAT ARE THE MOST COMMON CAUSES OF INFERTILITY?
Infertility can be a result of many different factors — even in one person or couple. The most common causes include problems with ovulation, structural issues in the uterus or fallopian tubes, or abnormalities in sperm. In females, medical conditions such as uterine fibroids, endometriosis, polycystic ovary syndrome (PCOS), uterine polyps or a history of pelvic infections are often associated with infertility. CAN YOU STILL BE INFERTILE IF YOU HAVE A PERIOD?
Yes. Having regular predictable periods is a good indicator that you ovulate regularly. In other words, it means an egg is being
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| A B O V E | Reproductive endocrinologist Amanda Adeleye, MD, helps patients explore their
family building options.
released from your ovaries on a regular basis. But, ovulation alone does not guarantee that you can get pregnant. Sometimes there can be an issue with egg quality, how the egg is fertilized, its ability to be transported to the uterus, or how it becomes implanted in the uterus. There may also be a problem with the sperm. If you’re having a period and regular intercourse for six months to a year or longer, talk with your doctor about other factors that may be keeping you from getting pregnant. HOW IS INFERTILITY A UNIQUE HEALTH CHALLENGE FOR WOMEN OF COLOR?
Outcomes indicate that black, Asian and Hispanic or Latina women may have less success with fertility treatments compared to white women. Overall, we don’t know exactly why this happens. However, we do know certain medical conditions that can impact fertility occur more frequently in some races than in others. For example, women of color have a higher likelihood of having uterine fibroids than white women. Additionally, studies show that women of color are more likely to be affected by
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socioeconomic factors that can make it more difficult to get treatment. At UChicago Medicine, we take a personalized approach to educating each patient about their reproductive health and familybuilding options. Our team is committed to providing excellent care for everyone. WHAT SHOULD I DO IF I THINK I’M INFERTILE?
If you believe that you or your partner may be experiencing infertility, it’s important to seek an evaluation with a reproductive endocrinology and infertility specialist as soon as you can. Typically, the first steps will involve a visit to the doctor, blood tests, a pelvic ultrasound and a semen analysis. CAN INFERTILITY BE CURED?
Infertility isn’t cured but it can be treated. In many cases, factors that lead to infertility can be overcome with treatments like intrauterine insemination or in vitro fertilization. Your doctor can help you understand which family building options may work best for you.
NEWS NEW PHYSICIANS
SPOTLIGHT
HONORS Cardiothoracic surgeon DAVID ONSAGER, MD, and transplant coordinator JAMIE BUCIO, CPTC, EMT-P, received the 2020 Courage and Innovation Service Award at the UChicago Medicine Heart Failure and Transplant Gala.
THOMAS FISHER, JR., MD, MPH
Immunology researcher MARISA ALEGRE, MD, PHD, pulmonologist GOKHAN MUTLU, MD, and oncologist THOMAS GAJEWSKI, MD, PHD, were elected to the Association of American Physicians (AAP). The AAP recognizes physician-scientists who exemplify the pinnacle of pioneering and enduring, impactful contributions to improve health.
Maria Lucia Madariaga, Thoracic surgery
MD MARIA LUCIA MADARIAGA, MD
Microbiome and food allergy researcher CATHRYN NAGLER, PHD, was selected as a distinguished fellow of the American Association of Immunologists (AAI). The distinction recognizes AAI’s active, long-term members for exceptional careers and scientific contributions. VINAY KUMAR, MD, received the 2020 Distinguished Service Award from the Association of Pathology Chairs, the group’s highest award, in recognition of his profound influence in the field of pathology.
Rheumatology PANKTI REID, MD
Surgical oncologist OLIVER ENG, MD, is a recipient of an Appendix Cancer Pseudomyxoma Peritonei (ACPMP) Research Foundation grant.
Section Chief of Gynecology and Minimally Invasive Surgery, has been named the Executive Medical Director of UChicago Medicine River East.
KATHLEEN GOSS, PHD,
LINA KHAMIS, MD, an internal medicine specialist with interests in preventive and wellness medicine, along with the management of chronic diseases, is the new Medical Director for Consultative and Primary Care Services at UChicago Medicine River East.
TIHA M. LONG, PHD, joined the cancer center as Director for Strategic Research Partnerships.
AYTEKIN OTO, MD, MBA, was named chair of the Department of Radiology.
is now Associate Director for Administration at the University of Chicago Medicine Comprehensive Cancer Center.
LIBBY PEART is Vice
President, Network Development for the UChicago Medicine Care Network.
RYAN E. LONGMAN, MD, is the new Director of Ultrasound and Medical Genetics at UChicago Medicine.
THOMAS FISHER, JR., MD, MPH,
and JOEL received Diversity Leadership Awards from the University of Chicago for their work to build a more equitable society. Pankti Reid, MD Fisher is an emergency medicine physician at the University of Chicago Medicine. Jackson is Assistant Director of Inclusion and Training for the Diversity, Inclusion and Equity Department at UChicago Medicine.
D. JACKSON
SPOTLIGHT LEADERSHIP SPOTLIGHT
LEADERSHIP SHARI SNOW, MD,
JOEL D. JACKSON
EMILY CHASE, PHD, RN, has been named Senior Vice President, Patient Care Services and Chief Nursing Officer at UChicago Medicine. Chase previously served as Vice President, Comer Children’s Hospital and Advanced Practice Nursing Services since 2016. SUSAN MURPHY, BSN, MS, RN,
Chief Experience and Innovation Officer at UChicago Medicine, was named one of 25 hospital and health system CXOs to know for 2020 by Becker’s Hospital Review.
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No pulse for six minutes. Ingalls’ teamwork saved him. A father-to-be who suffered a cardiac arrest will be able to meet his newborn daughter, thanks to the collaborative effort between departments at UChicago Medicine Ingalls Memorial Hospital in Harvey. Kenyon Givens, 44, started to feel discomfort in his chest one night in December 2019. “I took some aspirin and went to bed,” the Blue Island resident said. But when he woke up with chest pain, his wife, LaToya Givens, brought him to the Ingalls Emergency Department (ED). “The medical staff immediately took me to get an EKG,” Givens said. As he was filling out paperwork, Givens collapsed. He was in cardiac arrest. The ED staff started cardiopulmonary resuscitation (CPR), applying a defibrillator several times and administering medications. “It’s my understanding that I didn’t have a pulse for about six minutes,” Givens said.
A prolonged loss of blood flow in cardiac arrest can leave patients at risk for brain injury. But Givens started to move his hands and respond to commands soon after he was moved to the Intensive Care Unit (ICU). “It was really amazing. He started making facial expressions to eventually breathing on his own, making jokes and laughing,” said ICU nurse Nneka Onyejiaka. Once Givens’ heart rhythm was restored, interventional cardiologist Francis Q. Almeda, MD,* performed a cardiac catheterization to ensure there were no blockages in the heart. A few days later, cardiac electrophysiologist Andy C. Lin, MD,* placed an implantable cardioverter defibrillator (ICD) near Givens’ heart. If Givens experiences symptoms of cardiac arrest in the future, the ICD will deliver a controlled electric pulse, or shock, to restore the heart’s beating.
Ingalls staff who cared for Givens included nurses, physicians, techs, therapists, administrators, lab and pharmacy staff, and others. “Everyone worked as a team to provide excellent care for a patient with positive results,” said Michealene Redemske, RN, a nurse in the ICU. *Dr. Almeda and Dr. Lin are independent medical
practitioners and are not employees or agents of Ingalls Memorial Hospital or University of Chicago Medical Center (“UChicago Medicine”).
Givens learned that an abnormal heart rhythm, called ventricular fibrillation, contributed to his cardiac arrest. After a week in the hospital, he went home. He recently started cardiac rehabilitation at Ingalls. “My wife was five months pregnant at the time, and I can’t imagine not seeing the birth of my child,” Givens said. “I’m feeling grateful to still be around.” Givens spent his recovery time at home getting the nursery ready for the couple’s daughter, who was born April 20.
| A B O V E | Kenyon and LaToya Givens
Investing in the health of families and communities The University of Chicago Medicine serves 23 percent of Chicago’s population on the South Side, where residents are disproportionately affected by high rates of chronic conditions such as asthma, diabetes and high blood pressure, as well as by community violence and trauma. Through research, partnerships and health-related programs and events, UChicago Medicine’s Urban Health Initiative leads the medical system’s efforts to improve community health and promote health equity — equal opportunity to live one’s healthiest life.
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In fiscal 2019, UChicago Medicine provided $519.5 million in benefits and services to the community — a 9% increase over the previous year. This investment included supporting patients who rely on Medicare or Medicaid, or who were unable to pay for care. It also included teaching and training tomorrow’s health care professionals, funding medical research and donating to community groups for health and wellness initiatives. Learn more in the 2019 Community Benefit Report: UChicagoMedicine.org/community
David Jonas
BUILDING
ON A BREAKTHROUGH
Michael Bishop, MD
Gift accelerates research to improve cancer therapies and extend benefits to more patients Researchers at the University of Chicago Medicine will come together to develop personalized therapies for hard-to-treat cancers, thanks to a $10 million gift from the Jonas family. The gift establishes the David and Etta Jonas Center for Cellular Therapy at UChicago Medicine, named for David Jonas and his late wife, Etta. The Jonas Center unites a team of experts dedicated to improving cellular therapy, especially T-cell treatments like CAR (chimeric antigen receptor) T-cell therapy, an emerging form of cancer treatment that has shown great promise in harnessing a patient’s own immune system to find and destroy cancer cells. “I was impressed by UChicago Medicine’s multidisciplinary research program and commitment to attaining tangible outcomes that will really serve cancer patients,” Jonas said. “They have all the key elements for a successful research program: experience in clinical trials, access to the most leading-edge technology, a tremendous track record in attracting scientific talent, and a strong team to lead the program.” Through the Jonas Center, researchers at UChicago Medicine will work to realize the therapy’s full potential, including efforts to overcome two key challenges: The therapy is currently limited to treating certain blood cancers, and only a subset of patients have a successful response.
To extend the therapy’s benefits to more patients, researchers at UChicago Medicine developed a new, highly personalized approach to T-cell therapy, which can safely target cancer cells, without damaging healthy tissue. The Jonas Center will accelerate this work and develop this therapy for clinical trials for patients with metastatic solid tumors, like pancreatic and ovarian cancers. “This gift will allow us to translate these groundbreaking discoveries made in the laboratory into novel cancer therapies, which have the potential to treat not just blood cancers, but also solid tumors,” said Kenneth S. Polonsky, MD, Dean and Executive Vice President for Medical Affairs at the University of Chicago. “If we can accomplish even part of that, it will be a major transformation in cancer therapy that will change the lives of many patients here in the United States and around the world.” To improve CAR T-cell therapy’s effectiveness, Michael Bishop, MD, Director of the Cellular Therapy Program, is leading an effort to develop methods to predict if, and how well, patients will respond to the therapy, along with interventions to improve response rates. In addition to providing essential funding to advance these research initiatives, the Jonas family’s gift will put in place the necessary infrastructure to sustain a successful research enterprise in the years to come. “This is the most exciting time in my entire career,” Bishop said. “We finally have hope for patients who previously didn’t have hope. And now we are working to improve upon these results. Within the next 10 years, I think these treatments are going to become more effective, less toxic, and most importantly, will give new options to a broader scope of patients.”
We feel extremely proud and appreciative to have the opportunity to partner with the University of Chicago in this effort. We see our contribution as the seed for building a robust program that will lead to the next breakthrough in cancer therapy.” DAVID J O NAS
NONPROFIT ORGANIZATION U.S. POSTAGE PAID CAROL STREAM, IL PERMIT NO. 2003
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Proud to remain a national leader in patient safety. We thank our physicians, nurses and caregivers for helping the University of Chicago Medicine achieve its 17th consecutive A grade in patient safety from prestigious industry watchdog the Leapfrog Group. Even during the most challenging and uncertain of times, their relentless commitment to providing patients with the highest level of care keeps us at the forefront of safety. UChicago Medicine remains the only hospital in Chicago to achieve this perfect record since the survey began in 2012. We are proud to be one of the safest hospitals in the country. Ultimately, this recognition means our patients can feel confident about entrusting their care with us, today and in the days ahead.
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