Advances | Tampa General Hospital | Spring 2022 (East Coast)

ADVANCES THE ACADEMIC DIFFERENCE

EMBRACING THE FUTURE LEADING IN INNOVATION AND PLANNING FOR TOMORROW’S TGH

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I N N O VAT I V E S E R V I C E L I N E S

MEET OUR LEADERSHIP To learn more about our institutes, visit TGH.org

TGH Children’s Hospital Patricia J. Emmanuel, MD Medical Director, TGH Children’s Hospital

Professor and Chair, Department of Pediatrics, USF Health Morsani College of Medicine

TGH Neuroscience Institute Clifton L. Gooch, MD

Medical Director, Neurology, TGH Neuroscience Institute

TGH Urology Institute Raviender Bukkapatnam, MD Medical Director, TGH Urology Institute President, Florida Urology Partners

Rafael Carrion, MD

Medical Director, TGH Urology Institute Professor and Chair, Department of Urology, USF Health Morsani College of Medicine

Vice President, Clinical & Translational Research, TGH-USF Health Joint Office of Clinical Research Professor & Chair, Department of Neurology, USF Health Morsani College of Medicine

TGH Ear, Nose & Throat Institute

Harry van Loveren, MD

Tapan A. Padhya, MD

Professor & Chair, Department of Neurosurgery and Brain Repair,

Professor & Chair, Division of Head & Neck Oncology,

USF Health Morsani College of Medicine

USF Health Morsani College of Medicine

Medical Director, Neurosurgery, TGH Neuroscience Institute

TGH Cancer Institute Abraham Schwarzberg, MD Senior Vice President, Network Development Chief of Oncology, TGH Cancer Institute Vice President, Clinical Trials & Translational Research, TGH-USF Health Joint Office of Clinical Research

Eduardo Sotomayor, MD Director, TGH Cancer Institute

Medical Director, TGH Ear, Nose & Throat Institute

TGH Women’s Institute Judette Louis, MD, MPH Medical Director, TGH Women’s Institute

Professor and Chair, Department of Obstetrics and Gynecology, USF Health Morsani College of Medicine

TGH Orthopaedic Institute Roy Sanders, MD

Medical Director, TGH Orthopaedic Institute President, Florida Orthopaedic Institute

TGH Transplant Institute Kiran Dhanireddy, MD, FACS

Executive Director and Liver Transplantation Surgical Director, TGH Transplant Institute

Professor & Chair, USF Health Department of Orthopaedic Surgery

TGH Global Emerging Diseases Institute Seetha Lakshmi, MD

Medical Director, TGH Global Emerging Diseases Institute Assistant Professor, Division of Infectious Disease and

TGH Heart & Vascular Institute Guilherme Oliveira, MD, MBA Executive Director, TGH Heart & Vascular Institute

Professor and Chief, Division of Cardiovascular Sciences, USF Health Morsani College of Medicine

International Medicine, USF Health Morsani College of Medicine

Radiology & Imaging Krishna Nallamshetty, MD Chief of Staff, Tampa General Hospital

Associate Professor of Radiology & Cardiology,

Community & Corporate Wellness Daron Diecidue, MD

USF Health Morsani College of Medicine President, Radiology Associates of Florida

Bruce Zwiebel, MD

Member, TGH Board of Directors

Medical Director, Community & Corporate Wellness

Professor and Vice Chair of Clinical Affairs,

CEO, TGH Urgent Care Powered by Fast Track

USF Health Morsani College of Medicine Director, Radiology Associates of Florida

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SUMMER 2022

CONTENTS Departments FORWARD 10 LEADING THE WAY Q&A with John Couris, president and CEO of Tampa General Hospital 14 FIT TO PRINT How 3D printing technology is changing the way physicians diagnose and treat patients 16 HEALING ALL WOUNDS TGH’s Regional Burn Center is home to a multifaceted team of specialists who bring compassion and expertise to burn care

WELL-BEING 58 FLORIDA’S BOUNTY Chef Justin Timineri shares fresh, healthy recipes using locally and regionally grown ingredients 64 SUNSHINE STATE SUPPLIES Wellness products to support better workouts, glowing skin, strong hair, and more

Features 18 TGH: FLORIDA’S HOSPITAL TGH’s half-billion-dollar expansion will allow it to reach more patients and improve quality of care for all 24 THE ROOM OF THE FUTURE Inside the state-of-the-art ICU rooms currently in use at TGH 26 LIFE ON THE LINE Physicians, surgeons, and nurses choreograph a highly difficult delivery and intubation procedure to help a newborn baby breathe

30 IN NEED OF ZS How the TGH Sleep Disorders Center is helping patients get more rest, plus a look at the new Inspire device to treat obstructive sleep apnea 34 TIMING IS EVERYTHING Heart rhythm disorders are quite common, and TGH is offering innovative surgical techniques to treat them 38 BETTER TREATMENTS, BETTER OUTCOMES Advances in stroke care are giving physicians and surgeons more tools to help patients recover 42 A FIGHTING CHANCE When a young cancer patient found himself in a life-or-death situation, surgeons and oncologists at TGH and USF Health acted swiftly to save him 46 BREATHING EASY Meet the recipient of TGH’s 700th lung transplant and learn more about the Transplant Institute’s commitment to excellence 50 HOPE FOR A HEALTHIER LIFE The TGH + USF Health Bariatric Center is providing patients with the tools and support to lose weight and regain control of their health 54 DISCOVERING A DONOR CLOSE TO HOME When Mike Haggard needed a new kidney, his brother-in-law stepped up to donate—and TGH took care of the rest

ON THE COVER: Dr. Lucian Lozonschi, director of cardiothoracic surgery, photographed by Daniel Wallace at Tampa General Hospital

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CONVENIENT ACCESS TO

WORLD-CLASS CANCER CARE TAMPA GENERAL HOSPITAL’S PARTNERSHIP WITH CANCER CENTER OF SOUTH FLORIDA BRINGS NATIONALLY RECOGNIZED CANCER CARE TO THE PALM BEACHES AND TREASURE COAST. Tampa General Hospital’s Cancer Institute is in the nation’s top 10% for cancer care. The experienced doctors and nurses of CCSF collaborate with TGH’s world-renowned surgical oncologists to provide complex services and personalized medicine — all coordinated by compassionate Care Navigators, who guide patients through their journey. The partnership provides access to groundbreaking clinical trials and specialized care, fueled by academic medicine from one of the nation’s best hospitals.

For a consultation call (561) 644-0125.

CancerCenterOfSouthFlorida.com

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1 Tampa General Circle Tampa, FL 33606 813.844.7000 • TGH.org

John Couris, President and CEO, Tampa General Hospital

SHARED PURPOSE We heal. We teach. We innovate.

Care for everyone. Every day.

VISION We will become the safest and most innovative academic health system in America.

VALUES Accountability. Compassion. Courage. Excellence. Integrity.

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BEST-IN-CLASS PHYSICIANS.

BEST IN FLORIDA CARE. TAMPA GENERAL HOSPITAL GASTRO GROUP OF THE PALM BEACHES DELIVERS FLORIDA’S BEST GASTROENTEROLOGY CARE IN A PATIENT-CENTRIC, CONVENIENT SETTING. Tampa General Hospital is the highest ranked in Florida, #26 in the nation for Gastroenterology & GI Surgery and is one of Florida’s leading academic medical centers. Surgeons and specialists from TGH work collaboratively with TGH Gastro Group physicians to bring comprehensive treatment options and a seamless patient experience, including, pre- and post-surgical care conveniently performed in Palm Beach County and the Treasure Coast.

For a consultation, please call (561) 644-0125.

Steven Krumholz, MD

Jeffrey H. Garelick, MD

Robert S. Raymond, MD

Glenn H. Englander, MD

Maria Cristina Hatara, MD

Olga Fernandez, APRN

Meriah Pacheco, APRN

Asher Borradaile, APRN

GastroGroupPB.com

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THE ACADEMIC DIFFERENCE Publisher Terry Duffy Associate Publisher Dina Turner Editorial Director Daphne Nikolopoulos Editor Mary Murray Creative Director Olga M. Gustine Art Director Ashley Meyer CONTRIBUTING EDITORS Stacey Brandt, Lisa Greene, Jennifer McVan, Laurie Slater CONTRIBUTING WRITERS Eric Barton, Karen Feldman, Sandra Gurvis, K.S. Meyer, Dave Scheiber, Liza Grant Smith, Seth Soffian CONTRIBUTING PHOTOGRAPHERS Cara DeHart Lewis, Emily Panakos, Jerry Rabinowitz, Daniel Wallace ADVERTISING Publisher, Naples Meegan Wyatt Director of Sales Deidre Wade Account Managers Kathleen Beuttel, Kathy Breen, Tanya Lorigan, Melissa Zolin Schwartz Advertising Services Coordinators Rebecca Desir, Elizabeth Hackney PRODUCTION Production Director Selene M. Ceballo Production Manager Kayla Earle Digital Pre-Press Specialist George Davis Advertising Design Coordinators Anaely J. Perez Vargas, Jeffrey Rey Production Coordinator Ileana Caban Digital Production Coordinator Brendan Everson OPERATIONS Chief Operating Officer Todd Schmidt Office Manager Robin Pribramsky IT Manager Keith Gonzalez Marketing Manager Christopher Link Distribution Manager Judy Heflin Circulation Manager Marjorie Leiva Circulation Promotions Manager Marcos Alviar Logistics Manager Omar Morales Circulation Assistant Elizabeth Gillespie Accounting Specialist Mary Beth Cook Accounts Receivable Specialist Ana Coronel

In Memoriam Ronald J. Woods (1935-2013) HOUR MEDIA, LLC CEO Stefan Wanczyk President John Balardo PUBLISHERS OF: Palm Beach Illustrated • Naples Illustrated • Fort Lauderdale Illustrated • Orlando Illustrated Palm Beach Charity Register • Naples Charity Register • Florida Design • Florida Design Naples • Florida Design Miami • Florida Design Sourcebook Palm Beach Relocation Guide • Southwest Florida Relocation Guide • Fifth Avenue South • The Jewel of Palm Beach: The Mar-a-Lago Club Traditions: The Breakers • Palm Beach 100 • Naples 100 • Art & Culture: Cultural Council for Palm Beach County • Pinnacle: Jupiter Medical Center Foundation Waypoints: Naples Yacht Club • Naples on the Gulf: Greater Naples Chamber • Jupiter • Stuart • Aventura • Vero Beach Magazine • Community Report: Collier County Foundation • Advances: Tampa General Hospital • Fisher Island Magazine • Naples Realtor: Naples Area Board of REALTORS Published by Palm Beach Media Group North P.O. Box 3344, Palm Beach, FL 33480 Telephone: 561.659.0210 • Fax: 561.659.1736 www.palmbeachmedia.com Copyright 2022 Palm Beach Media Group North Inc. All rights reserved.

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MORE ACCESS TO

MORE EXPERTISE TAMPA GENERAL HOSPITAL GENERAL SURGEONS OF THE PALM BEACHES DELIVERS POWERFUL ACCESS TO ACADEMIC MEDICINE AND COMPLEX CARE. Patients in the Palm Beaches and Treasure Coast know renowned West Palm Beach surgeons Dr. Daniel R. Higgins, Dr. Itzhak Shasha and recently welcomed Dr. Jason Hechtman. And as part of TGH General Surgeons of the Palm Beaches, they’re able to harness the power of academic medicine to provide their patients a wider variety of clinical trials and easy access to Tampa General

Dr. Daniel R. Higgins

Dr. Itzhak Shasha

Dr. Jason Hechtman

for highly complex care, when needed.

For a consultation, please call:

(561) 644-0125

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FORWARD

LEADING THE WAY Tampa General Hospital is building a tech-centric health care system centered around the patient experience

BY MARY MURRAY

When John Couris, president and CEO of Tampa General Hospital, described the culture of innovation at TGH, he made an apt comparison to Apple.

“Our goal is to create an ecosystem akin to what Apple has done with its business model,” Couris said. “Most of us enjoy Apple phones, iPads, and computers because of the ecosystem that they’ve created. They’ve created intuitive, reliable, secure systems. We’re doing the same thing, but in health care. That’s the journey we’re on.”

Fueling this journey is the goal of designing a health care experience so tapped into the needs of patients that caregivers can devote their time to not just healing patients, but connecting with them on a personal level. From CareComm, the hospital’s patient care coordination command center powered by artificial intelligence and backed by GE Healthcare, to InnoVentures, a progressive program that invests in and supports medical start-ups and other health care companies as well as drives innovative programs within TGH, Tampa General is solving the problems of today while transforming the future of health care.

These efforts have not gone unnoticed. TGH has earned Chime Digital Health’s Most Wired Award nine years in a row and was named one of Healthcare Global’s Top 10 Best Smart Hospitals, one of only three hospitals in the U.S. to receive such an accolade in 2021. Advances recently sat down with Couris to discuss the technological innovations and programs that set TGH apart.

Q. What does it mean to be a smart hospital?

A. Healthcare Global defines smart hospitals as hospitals striving for innovation and research within the health care industry. It’s demonstrated by providing specialized services and facilities and the ability to redesign clinical processes that lead to higher patient satisfaction. What it means for us is that we’re an organization that is completely wired around the team member experience and the patient experience. It means that we have a responsibility and an obligation to provide the best technology, innovations, and systems to drive real value for the health care consumer.

I’ll give you a consumer-oriented example.

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We’ve implemented something called a geo fence. If a patient comes to one of our outpatient clinics and they’ve registered online, as they drive up and get into the parking lot, the minute they cross that geo fence, we send a notification saying, “Welcome to Tampa General. You’re going to be seen soon. Would you like to finish your registration online on your phone?” They can go online, answer a few questions, pay their co-pay—before they even walk in the door, they’re already registered. Not a lot of hospitals do that. That’s an example of a smart hospital and of having a direct impact on the consumer experience.

Q. TGH partnered with GE Healthcare to create CareComm. How has this system benefited patient care?

A. CareComm allows us to use artificial intelligence and predictive analytics to manage the efficiency, throughput, and quality of our institution. CareComm allows us to anticipate the needs of our patients, physicians, and nurses before they become needs. An example of that would be nurses, doctors, pharmacists, and a whole team who are on multidisciplinary rounds, they notice that there’s an issue or there will be an issue with a patient unless they attend to it. The nurse or the doctor can push a button on their tablet that alerts the CareComm team; they can then articulate the problem, and the CareComm team goes into action before it becomes a problem, such as a delay in care. This technology enables us to get out ahead of it.

CareComm runs 24 hours a day, seven days a week, and that’s powerful. It’s kind of like the ad for IBM Watson that shows a repair guy coming into an office building to fix an elevator, and the security guards says, “Why are you here?” And the repair guy says, “Well, your elevator’s about to break down and I need to fix it before it does.” CareComm anticipates and solves the problems that can cause decreased efficiency, and that matters.

Q. How does being a teaching hospital aligned with the University of South Florida support this culture of innovation?

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A. Our relationship with the University of South Florida is very strong. We’re completely integrated. We have one of the largest academic medical groups in the state—more than 800 physicians and advanced practice providers. The whole idea is to mutually align our interests around quality, clinical outcomes, safety, and value for the consumer.

We believe that academic medicine is critically important in defining how medicine is practiced.

This relationship enhances our ability to do that for the community.

For example, we have one of the busiest transplant institutes in the country. Well, that’s a collaboration between the medical center and the medical school. We have one of the largest neurosciences programs in the country, with outstanding quality and results. That’s another example of the power of academic medicine. The collaboration drives research, education, and innovative care.

Q. Can you point to a research initiative that exemplifies TGH’s leadership in innovation?

A. COVID. At one point through COVID, we had over 70 COVID-related research trials. When Regeneron was made famous by then-President Donald Trump, we had already been working with it and administering the monoclonal antibodies. We were giving them to people in this community who met the protocol for research. Then our program became the poster child for how it was implemented across the state of Florida. That was driven by Tampa General Hospital research and the academic alliance we have with USF. Q. How has prioritizing advanced technology enabled TGH to evolve along with the needs of its patients?

A. All this technology is designed to give us more opportunity to be with our patients and create real value for them. When you take everything we’re talking about—CareComm, research, the smart hospital—these advances have allowed us to continue to grow. We’ve gone from having 17 locations to over 85 locations. We are investing $550 million into our community through the expansion of our footprint. All these things have allowed us to do what we’re doing today. There isn’t one thing that makes it happen. And we look at technology as a strategic differentiator that allows us to engage in a much more personal way with the patient.

ALL THIS TECHNOLOGY IS DESIGNED TO GIVE US MORE OPPORTUNITY TO BE WITH OUR PATIENTS AND CREATE REAL VALUE FOR THEM.”

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Abraham Schwarzberg, MD TGH Cancer Center of South Florida

Talya Schwarzberg, MD TGH Cancer Center of South Florida

Vijay Narendran, MD, MBA TGH Cancer Center of South Florida

Sujal Shah, MD TGH Cancer Center of South Florida

Raymond Tsao, MD TGH Cancer Center of South Florida

Kelly Foster, MD TGH Cancer Center of South Florida

Andrew Whitis, PA TGH Cancer Center of South Florida

Valerie Fiordilino-Maslow, PA TGH Cancer Center of South Florida

Sydnie Swartz, APRN TGH Cancer Center of South Florida

Darcy Garland, APRN TGH Cancer Center of South Florida

Katherine Arreaza, APRN TGH Cancer Center of South Florida

Emily Mattingly, APRN TGH Cancer Center of South Florida

Anna Manasherov, APRN TGH Cancer Center of South Florida

Ofelia R. Betancourt, APRN TGH Cancer Center of South Florida

Christina Gustavson, APRN TGH Cancer Center of South Florida

Cheryl Casella-Rymer, APRN TGH Cancer Center of South Florida

Steven Krumholz, MD TGH Gastro Group of the Palm Beaches

Jeffrey H. Garelick, MD TGH Gastro Group of the Palm Beaches

Robert S. Raymond, MD TGH Gastro Group of the Palm Beaches

Glenn H. Englander, MD TGH Gastro Group of the Palm Beaches

Maria Cristina Hatara, MD TGH Gastro Group of the Palm Beaches

Olga Fernandez, APRN TGH Gastro Group of the Palm Beaches

Meriah Pacheco, APRN TGH Gastro Group of the Palm Beaches

Asher Borradaile, APRN TGH Gastro Group of the Palm Beaches

Jason M. Hechtman, MD, FACS TGH General Surgeons of the Palm Beaches

Daniel R. Higgins, MD, FACS TGH General Surgeons of the Palm Beaches

Itzhak Shasha, MD, FACS TGH General Surgeons of the Palm Beaches

WE THINK THE WORLD OF

OUR WORLD-CLASS TEAM

Tampa General Hospital proudly calls some of the East Coast’s finest physicians and advanced practice providers part of our team. Together, we’re harnessing the power of academic medicine to elevate care for rare and complex conditions throughout Florida. For a consultation, please call (561) 644-0125.

TGH.org

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FORWARD

Fit to Print

FROM DIAGNOSIS TO TREATMENT, TAMPA GENERAL HOSPITAL AND USF HEALTH ARE LEADERS IN 3D PRINTING TECHNOLOGY

BY SETH SOFFIAN

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ummer Decker, PhD, was describing the look and feel of a human liver—tough and dense, with complex vasculature and distinct segments—when she darted away for something better than words. She returned to her office in the radiology department holding an exact replica, created on a 3D printer, of a cancer patient’s actual liver.

Immediately clear on the multicolored, multi-textured object was the precise location of the mass that needed to be removed and the intricate blood vessels that surgeons would need to navigate in order to do so.

“We’ve been able to give [surgeons] a clear version, so they know exactly where that tumor is and exactly where the vessels are,” said Decker, a key figure leading the internationally renowned 3D printing efforts at Tampa General Hospital and director of 3D clinical applications, vice chair for research and innovation in radiology, and

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associate professor at the USF Health Morsani College of Medicine at the University of South Florida.

Sophisticated models like the one Decker displayed provide doctors in cardiology, oncology, trauma, and other disciplines with more than just an all-angles look at complex problems. They also allow physicians to test different devices and techniques for optimum fit and suitability before performing surgical procedures. Printing capabilities are so good— down to the micron level, equal to one thousandth of a millimeter—that they surpass what X-rays, MRIs, CT scans, and other images can provide.

“Even the finest scan cannot be as good as what the printers can print,” Decker said.

Having seven of the most state-of-the-art 3D printers available enables the TGH and USF Health team to create models in rapid fashion, revolutionizing how physicians envision and execute treatment plans.

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Advances in 3D printing currently in use at TGH include creating models in a biomimetric material that mimics human tissue (right) and using reconstructions to guide surgeries (below). Opposite page: Summer Decker, PhD, and Dr. Fadi Matar examine a 3D-printed heart.

One of the foremost benefits is the ability to forecast possible ramifications of a procedure.

Dr. Krishna Nallamshetty “It’s been helping tremendously,” said Dr. Fadi Matar, an interventional cardiologist at TGH and associate professor of internal medicine at the USF Health Morsani College of Medicine, who now won’t touch a complex case without a patient’s 3D model. “A new heart valve can compromise other structures. We look at the impact of the device on the model. A lot of times our fears are not substantiated, and then we can proceed.”

Another improved outcome from such advancements are shorter surgeries, which can mean less time under anesthesia for patients. One case at TGH saw the shattered half of a patient’s face—damaged by a gunshot—reconstructed using a mirrored 3D print of the undamaged side. This model helped to cut surgical time for the procedure from 11 hours to three.

The use of 3D printing in medical research dates back well beyond a decade. But TGH and USF—early adopters of their own research program that fed clinical breakthroughs as well—continue to benefit from and contribute to groundbreaking work in the field.

“We get referrals from all over the country for high-complexity patients,” said Dr. Krishna Nallamshetty, chief of staff and comedical director of radiology at TGH and an associate professor of radiology and cardiology in the USF Health Morsani College of Medicine. “The people who have used the technology are amazed by how useful it can be and what the impact is on patient care.”

In fact, firms in aerospace, automotive, filmmaking, and other industries turn to TGH when adapting new technology to their medical divisions. “We actually advise industry,” said Decker, who trains radiologists, residents, medical students, technologists, and other medical professionals in 3D printing at facilities around the world. “We sit on the committees to say, ‘This material works. This doesn’t. This one works for hearts. This one doesn’t.’ We can really guide the industry to give us what we need medically.”

The 3D-printed liver Decker displayed, for example, uses what is known as biomimetic material, which mimics human tissue. It is superior to anything available even a couple of years ago, she explained.

Matar is such a proponent of 3D printing that he has begun researching heart replica models that can actually pump, unlike existing static models. It’s the kind of continued collaborative work the USF Health and TGH team hopes to see more of as the imaging team moves from the USF Health South Tampa Center for Advanced Healthcare to the main hospital.

“Every doctor who comes into radiology will be able to see what we can offer,” Nallamshetty said. “Then we can suggest to them how to best apply some of these really innovative techniques to help take care of our patients better.”

Such achievements need not be limited to life-like tissues or the most complex cases. In 2020, for instance, USF Health earned international acclaim for their rapid development of a widely deployed 3D-printed nasal swab that helped alleviate global supply shortages at the outset of the COVID-19 pandemic. The USF-patented design, which was tested at TGH and other health care facilities, has now produced more than 80 million swabs in more than 57 countries around the world.

From materials to surgical prep and application, the promise of 3D printing knows no bounds. “I think we’re still just at the tip of the iceberg,” Nallamshetty concluded. “The best is yet to come.”

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FORWARD

HEALING

ALL WOUNDS

The Regional Burn Center offers compassionate, advanced care to those who need it most

BY SETH SOFFIAN

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Sunny Sandhu never learned what caused the explosion that nearly took his life.

Sandhu was a medical student living on the small Caribbean island of Saba at the time of the 2019 accident, when flames engulfed his apartment. He was burned on more than 95 percent of his body.

What Sandhu did discover during six months of treatment at Tampa General Hospital’s Regional Burn Center—and later after moving home to his native Southern California to continue his recovery—was a level of care and concern for which he’ll forever be indebted.

“I just feel an immense sense of gratitude,” said Sandhu, who was then 25. “It does get me a bit emotional.”

Now 28, Sandhu remains in touch with most of the medical staff who treated him at TGH, where he was

flown via aeromedical helicopter from St. Martin after he was originally transDr. Jake Laun ferred there from Saba.

As the only Level I trauma center in West Central Florida, TGH regularly receives burn patients from 23 counties across Florida. TGH’s Wallace Trauma Center was the first verified American College of Surgeons (ACS) Level I adult and pediatric trauma center in the State of Florida.

TGH is one of only five burn centers in Florida to earn verification from the American Burn Association (ABA). The verified status—which the hospital also holds as one of only two pediatric burn centers in the state—means TGH has met the stringent guidelines for patient care, procedures, and staffing.

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WE’RE ALWAYS ADAPTING, ALWAYS CHANGING, IF THERE IS SOMETHING NEW THAT COULD POTENTIALLY HELP. TAMPA GENERAL [HAS] EVERY LAYER OF POSSIBLE TREATMENT.” — Dr. Jake Laun

“Our whole goal is to try to get them back into society in the most meaningful, functional way we possibly can after a potentially devastating injury,” said Dr. Jake Laun, who practices at TGH as a sixth-year resident in plastic surgery at the USF Health Morsani College of Medicine at the University of South Florida.

Laun, as with others at the burn center, speaks of deeply impactful, long-standing relationships with many of the patients they treat, often those most severely injured. “I think that’s why a lot of us have gone into burn care and burn surgery,” he continued. “It [can be] such a debilitating injury. You definitely have that emotional connection to the patients.”

TGH’s 18-bed burn center includes six beds for intensive care and 12 for wound care, as well as treatment rooms and a burn operating room located within the unit itself. It offers the latest in immediate medical care and shortand long-term surgical treatments, including burn-specific reconstructive efforts for adults and children.

“We’re constantly looking at how to better care for patients,” said Laun, noting the many research contributions TGH and the USF Health Morsani College of Medicine have made in the areas of fluid management, nutrition, and infection monitoring, as well as medical and surgical treatment of burns. “We’re always adapting, always changing, if there is something new that could potentially help. Tampa General [has] every layer of possible treatment.”

While TGH is not alone in employing an array of medical and other professionals to treat burn patients—including doctors, nurses, mental health professionals, dietitians, and physical and occupational therapists—it stands apart in its degree of commitment to the integrated team approach, one cultivated by Dr. David J. Smith, chair of the Department of Plastic Surgery in the USF Health Morsani College of Medicine. Every Monday, for example, a team of 15-20 health care professionals discusses every patient in the burn center and analyzes their treatment plans for everything from minor cases of road rash to severe traumas.

“I think that sets the tone of making sure everyone is involved and knowing that every single person is critical to getting our patients back to their way of life,” Laun said.

Given the emotional toll that often accompanies severe burns, TGH also provides mental health evaluations and long-term patient support in its treatment. That begins with an initial visit from a mental health professional for all new patients, but it also includes monthly support group meetings for burn survivors and their families. In addition, children who have suffered burn injuries are invited to Camp Hopetáke, a weeklong summer camp where kids can share their experiences and feelings.

The camp is free to attend, thanks to efforts by TGH, the Tampa General Hospital Foundation, and Tampa Firefighters Local 75.

“It’s extremely valuable,” Laun said of the camp and other support services, which include burn center visits from past patients. “It’s a tough battle. These patients go through a lot.

Having that support is really inspirational. It’s really inspirational for us, too, to see how resilient these patients are.”

For Sandhu, the two-fold approach of heartfelt care and innovative treatments has proven to be crucial to his recovery. When finding effective donor sites for skin grafts turned out to be difficult due to the extensive nature of his burns, the team at TGH employed new technology that used his own tissue to help cover his injuries.

“I’m doing okay, all things considered,” Sandhu said. “I’ve been able to get back to a basic level of functionality. I’m able to do most tasks independently. There’s still a journey to go.”

In California, Sandhu continues to focus on his recovery, working with burn specialists, exercising, and exploring meditation and spirituality to help him move beyond his trauma.

Once he builds his endurance more, he hopes to be able to work again. He would like to pursue a job that enables him to “be of service,” perhaps teaching or social work.

“I’ve been told numerous times by numerous people that I’m fortunate to have lived,” Sandhu said. “So I think the meaning of my newfound

life has to be to live in a way that satisfies that claim, that living was a fortune. That’s my goal…

You can make something good of suffering and even possibly triumph over it.”

And while it’s been nearly two years since Sandhu returned home, he has “built a bond that lasts for life” and remains in touch with many of his TGH caregivers.

“They’re very gracious to refer to me as their friend,” Sandhu said. “It’s quite humbling actually. I just feel eternally indebted to the care and compassion I received at their hands.”

Tampa General ’s Wallace Trauma Center: Expertise Ready to Save Lives

• More than 3,000 trauma patients treated each year

• Only Level I trauma center in West

Central Florida and the first verified American College of Surgeons (ACS) Level I adult and pediatric trauma center in the State of Florida

• One of five burn centers in Florida to earn verification from the American Burn Association (ABA)

• One of two pediatric burn centers in Florida to earn verification from the ABA

• Designated Florida Department of

Health Brain and Spinal Cord Injury Program (BSCIP)

• Specialty surgeons are available for the following trauma cases: cardiac, hand, microsurgery, obstetric/gynecologic, ophthalmic, oral/maxillofacial, orthopedic, otorhinolaryngologic, plastic, thoracic, and urologic

• TGH operates five aeromedical helicopters to transport trauma patients from 23 surrounding counties (air transport services provided by Metro Aviation, Inc.)

• Treats patients of all ages • Dedicated trauma team and operating rooms are always ready 24/7

• Participates in an inclusive system of

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TGH: Florida’s Hospital

Improving patient care and expanding facilities to reach more Floridians are the focus of the hospital’s half-billion-dollar master expansion plan

BY DAVE SCHEIBER

From left: Expanded cancer care offerings at the Brandon Healthplex will include a new clinic space; the Bayshore Pavilion will offer 100 more beds and 12 new operating rooms.

Above: Dr. Lucian Lozonschi, director of cardiothoracic surgery

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hen John Couris, Tampa General Hospital’s president and CEO, looks to the future, he sees a road map for an extraordinary journey. It is one that will lead TGH to a destination of heightened prominence in the delivery of cutting-edge care—not only in the region and state but the nation.

Paving the path forward is an ambitious master facility plan, the largest in the hospital’s history. And as the plan rolls out in three phases over the next five years, it will allow TGH to meet the needs of patients in Tampa Bay and far beyond with unparalleled effectiveness and agility.

“Our vision is very straightforward,” Couris said. “It’s to be the safest,

most innovative academic health system in the country. And part of that vision is to modernize facilities and improve capacity, to bring in new technology, to build new services and buildings, and to invest in our people. That’s really what the master facility plan does: allows us to invest in innovation and support the creation of tomorrow’s TGH.” The master facility plan is the physical manifestation of the hospital’s strategic plan, and it began taking shape in late 2017 and early 2018. Ultimately, TGH will invest $550 million in upgrades that will benefit patients throughout Florida, have an estimated economic impact of more than $976 million for the Tampa Bay area, and create nearly 6,000 new jobs.

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In the process, it will expand TGH’s geographic footprint, while fueling the “vertical” growth of new buildings and improvements to existing infrastructure on its 30-acre grounds, comprising some 3.6 million square feet and including more than 85 locations off the main TGH campus.

Kelly Cullen, TGH’s executive vice president and chief operating officer, is leading the development of the master facility plan. A former emergency room nurse whose career

experience was shaped by bedside care, Cullen sees her work on the plan through the lens of what’s best for patients.

“Everything we do is with the patient’s best interest at heart, so if we make decisions with the patient at the center, we’re going to do a great job,” she said. “Tampa General is not just the leader in the local market, but we also serve patients statewide and beyond. And as we grow, we have to make sure that we have the right capacity, the right pathways of care,

Inset: Expanded and renovated burn ICU Below: TGH will create 12 new operating rooms and renovate others.

and the right talent in place to take care of these patients.”

One of the Phase 1 enhancements—a new intensive care unit—opened in June 2021. The $17.5 million project added 34 rooms with advanced care technologies encompassing some 27,500 square feet. Other planned upgrades include: ● Bayshore Pavilion vertical expansion: The project will add four floors to TGH’s Bayshore Pavilion, resulting in 12 new operating rooms and 100 new beds. ● Regional Burn Center renovation and expansion: With an anticipated completion in late 2022, this project will provide larger rooms, more efficient layouts, and a new design. ● Renovated main operating room suite: To include modernized operating rooms with upgraded equipment. ● Main campus renovations: To include renovating the main lobby and adding meeting space. ● Freestanding emergency department: Located on one of Tampa’s main thoroughfares, Kennedy Boulevard, a mile from the hospital’s main campus, the 15,000-squarefoot facility will provide additional emergency capacity to serve community needs. ● TGH Brandon Healthplex Cancer Institute: The Brandon Healthplex is located

John Couris

Kelly Cullen

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Above: TGH continues to invest in the most innovative surgical technology available. Right: TGH leaders celebrate the opening of the Central Energy Plant, which will help ensure the hospital’s safe operation during extreme weather.

10 miles from the main campus and serves suburban communities. This new clinic space will be added to provide multidisciplinary integrated oncology services, to include diagnostic testing, new and expanded treatments, and support services. Additional new treatments, such as bone marrow transplants and other cellular therapies, also will be offered at the TGH Cancer Institute. ● Purchase of Hillsborough Community College Davis Islands building: Adjacent to the main hospital campus, this building will be outfitted for administrative, education, and training purposes to free up additional clinical space. ● Central Energy Plant expansion: The $53 million project will expand power generation capabilities to provide 100 percent redundant protected power in the event there is a hurricane or other event that causes widespread power outages. ● Off-site sterile processing facility: This will move sterile processing of surgical instruments off the hospital campus to streamline operational efficiencies and make more space available on the main campus.

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EVERYTHING WE DO IS WITH THE PATIENT’S BEST INTEREST AT HEART, SO IF WE MAKE DECISIONS WITH THE PATIENT AT THE CENTER, WE’RE GOING TO DO A GREAT JOB.” —Kelly Cullen home to millions of residents, and it ranks as one of the 20 largest freestanding hospitals in the country. Now it is poised to expand into a new generation of care and impact.

“We’ll have close to 1,200 beds when this phase of the master facility plan is complete,” Couris explained. “Adding capacity to care for more patients in the hospital gives us important flexibility. It allows us to be proactive, not reactive, and to change with the demands of the community, state, and country.”

Couris points to the hospital’s successful handling of the COVID-19 crisis during its height in 2020 as an apt example of how TGH dealt with a community demand—this one of crisis proportions—on the fly.

“Because of our size, because of our team, we were able to morph and adapt as the virus morphed and adapted,” he said. “And other than a mandated stop on elective surgeries across many states early on, we never slowed down or stopped our care for non-COVID patients.”

TGH will be even more capable of dealing with the unforeseen—whether that be a natural disaster or the next pandemic—as it grows with the master facility plan.

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Inset: Rendering of a new freestanding emergency department planned for Kennedy Boulevard Below: Sterile processing services will be moved off site.

“As a Level 1 trauma center, we are always in a state of readiness, but COVID brought that to a whole new level,” Cullen added. “It honestly taught us how fast we can move and, most significantly, how important every single team member in this institution is, from the person who cleans the floor to the trauma surgeon.

With the master facility plan, we’re not just making a commitment to the area and state— we’re making a commitment to our team members that says, ‘This is how much we love Tampa General and the work we do.’ We’re willing to invest this much money, time, energy, and expertise into making it even better.”

With population growth of 1.4 percent a year in Hillsborough County alone, TGH projects an increase in patient admissions to 2.3 percent

by the end of the decade, underscoring the need for additional expansion and innovation.

Phases 2 and 3 will be a continuation of efforts to modernize TGH’s facilities, allowing the hospital to keep growing and investing in such regions as Palm Beach, Fort Myers, and Naples.

“As we grow in Palm Beach, for instance, we are not interested in interrupting referral patterns or existing relationships with physicians and hospitals,” Couris added. “What we are interested in doing is providing care and access, doing rare and complex work. We want people to realize that. And we’re actually partnering with many local physicians because they understand and appreciate that.”

Dr. Nishit Patel, TGH’s chief medical informatics officer, views the master facility plan as

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an opportunity to think differently about hospital designs and health care delivery.

“This is an incredibly unique opportunity for us to rethink the basic elements of clinical spaces and instead envision what is needed to truly support our physicians, nurses, and clinical team members to deliver world-class care to our patients,” he said. “In the ‘room of the future,’ we have created an environment that helps our clinicians more efficiently care for our patients and can even help save precious minutes through room automation during critical events like a code blue, which is called when a cardiac arrest occurs. When you combine this framework with the tremendous power of telehealth technology to connect patients to both their care teams and their families, we see a space that effortlessly supports both the current and future models of care delivery.”

Rachel Feinman, TGH’s vice president of innovation, sees modernization as a key element to the master facility plan. “In addition to just adding capacity and space, the ability to think innovatively is vital,” she said. “And part of the master facility plan means hardwiring the institution in new ways that will bring about new technological solutions.”

The two specially equipped “rooms of the future” in the newly built ICU are such an ex-

The new ICU on the sixth floor of the East Pavilion measures 27,500 square feet and features 34 state-of-the-art rooms, two of which are “rooms of the future” that include responsive tech that automatically reacts when code blues occur.

ample. They are currently being tested with patients and accomplish several important tasks: increasing efficiency for physicians and nurses to provide information that leads to better patient care; allowing for virtual care, in which patients can connect wirelessly with family and loved ones, as well as physicians; and supporting emergency events that use technology in the rooms by automating code blue identification. (Turn the page to learn more about these innovative spaces.)

At the heart of everything contained in the master facility plan is a TGH credo: the right care, at the right time, in the right place.

“That says we are serious about our work, serious about our community, and serious about caring for people in the state of Florida,” Couris said. “I want people to know that we are the state of Florida’s hospital. We are one of the go-to places for patients when they are really sick, and we will provide them with world-class care.”

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THE ROOM OF

THE FUTURE TWO INNOVATIVE ICU ROOMS SIGNAL A NEW ERA FOR CARE AND CONNECTION

BY DAVE SCHEIBER

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It is a bold, boundary-pushing symbol of Tampa General Hospital’s master facility plan: a unique intensive care unit room with a window onto the next generation of care.

This room is far more than four walls to house seriously ailing patients. In fact, it is an innovation that holds a new vision—created to behave more like a team member than anything else. Equipped for a wide range of key, nonclinical tasks, it allows nurses and other clinicians to fully focus on the essence of their craft: helping patients.

And the name perfectly conveys its boundless potential: the room of the future.

The new entity—currently in use in two modernized, high-tech rooms—exists within TGH’s revamped intensive care unit (ICU) launched in June 2021. The $17.5 million project includes 34 state-of-the-art ICU rooms encompassing some 27,500 square feet. With 100 more ICU beds on the horizon, TGH has plans to incorporate more rooms of the future going forward.

The cutting-edge concept arose from the crosscurrents of competing health care headwinds, explained Jason Swoboda, TGH’s director of innovation.

“One headwind is a shift in patient satisfaction and in coming to view patients as consumers,” he said. “You can easily look up clinician and hospital scores today, so there’s a constant focus on improving outcomes. This headwind is in the form of shaping the health care environment.”

Another is connected to team member satisfaction and the nationwide shortage of nurses and clinicians. During the conceptual process, there was an opportunity, Swoboda explained, to support them in their passion—caring for patients—rather than being bogged down in extraneous tasks that could be handled by technology.

A third headwind is the rising cost of health care in general.

“We wanted to do something to improve quality outcomes, improve patient satisfaction, and help our team members, all while lowering the

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The ICU rooms of the future feature multipurpose smart boards that help caregivers track patient information, in addition to exterior smart displays that inform the care team and visitors of what precautions are necessary before entering a room.

cost of care,” Swoboda added. “So, we took those headwinds against us and thought, ‘What if we could make the room a team member? And if it were a team member, how would we want it to behave?’”

That question guided the development of the room of the future. Hospital team members and a patient advisory committee provided input on the room’s ideal attributes, asking how such a room could advance TGH’s quest to be America’s safest and most innovative academic health system.

One scenario quickly emerged: code blue. In the event of a cardiac arrest, every second counts. When a code blue is activated, the room of the future automatically moves into action: muting the TV volume, turning up the room lights, lowering the shades, and more—all steps that can shave off valuable seconds when time is of the essence.

“We wondered, ‘How could these four walls, instead of simply being bland and inanimate, become an active participant with the care team of the nurse, physician, or technician?’” said Dr. Nishit Patel, TGH’s chief informatics officer.

Another solution came in the form of a digital, multipurpose board as the centerpiece of the room, replacing the traditional erasable white board. The electronic board updates the patient’s vital signs and keeps track of special instructions. The information is instantly displayed for medical staff and patients to see.

“A lot of what we ask our bedside nurses to do is take information and add it to the marker board,” Patel said. “A great deal of time is spent with people literally just writing on a board, updating dietary orders and various data. Oftentimes, that’s not really value added—the value is in the conversations happening, for example, between the nurse and patient around the goals for the day, for what the diet change means, their pain scores, or any number of situations.

“Not only does the new board take away some of the operational inefficiency and factors that contribute to

burnout, but it frees up the clinicians to do the actual clinical care of the patients. When you add these things up, there’s a lot of value returned in terms of efficiency and providing quality care.”

Of equal importance is the potential of the board to help avoid delays. Notes, instructions, and guidelines are also simultaneously displayed on a digital board outside of the room, so key updates about a patient’s condition or labs can be clearly and quickly communicated to the entire care team.

“Imagine that as soon as a physician puts in a dietary order—stopping food for a patient so a procedure can be done, for example—that instruction is instantly updated on the digital board in the room and outside of it for all to see,” Patel said.

Another scenario: A swab to check for a virus has come back positive, meaning a new type of precaution must be implemented immediately. The information appears within moments on the digital board, eliminating any potential delays.

“The thing about innovation is that it’s always changing,” said Rachel Feinman, TGH’s vice president of innovation.

“We need to continue to innovate, identify new solutions, and find new ways to improve on the quality of care. That way it will always be the room of the future, not the present.”

That means more enhancements are in the works.

These include ways to digitally display X-rays to share with patients, allow for virtual check-ins from medical staff, and let patients communicate easily with family and friends via video connections.

“We’ve taken these different scenarios and created a room that will help provide high satisfaction for our patients and families,” Swoboda said. “And above all, it will allow our clinicians to focus on what they love to do most: take care of patients.”

Jason Swoboda

Dr. Nishit Patel

Rachel Feinman

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LIFE on the Line To save a baby, a medical team of 40 choreographs a complex procedure

BY DAVE SCHEIBER

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hen Diana McDowell was wheeled toward the Tampa General Hospital operating room to deliver her baby boy on November 23, 2020, she looked up from her gurney to see a sight she never expected: doctors and nurses in scrubs lining the hallway applauding as she came into view.

McDowell felt a rush of emotion and gratitude. In that moment, the fear and uncertainty weighing heavily on her mind faded—as she prepared for a complex, highly specialized surgery to deliver her baby, whose airway was completely displaced by the development of an abnormal fluid-filled sac-like structure in his neck. Called a cystic hygroma, the growth would impair the baby’s ability to breathe as soon as he was born.

She knew there were no guarantees that she would see her infant son alive

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Inset: Because Diana McDowell’s baby had a cystic hygroma in his neck, TGH and USF Health medical team members had to perform a highly difficult procedure immediately upon belivery. Below: Nurse Julie Johnson prays with McDowell’s mother.

when the procedure—known as EXIT, short for ex utero intrapartum treatment—was complete. Yet there was one thing McDowell believed in her heart.

“No matter what the outcome was,” she recalled, “I knew that every single person there was going to do their best to take care of my baby and take care of me.”

Many of the 40 or so USF Health and TGH medical team members were already inside one of two adjacent operating rooms reserved that day. They were each poised to handle their specific roles for the rare procedure, planned when McDowell was referred to TGH after her baby’s condition was discovered on a scan when she was seven months pregnant.

As a leading academic medical center, TGH is one of the few hospitals in Florida with the expertise to perform this complex operation.

A team of USF Health and TGH physicians performed the hospital’s first EXIT procedure in 2009, and the procedure has been done at TGH at least three times since 2019.

It is so complicated that by the time McDowell’s surgery began, doctors, nurses, and medical technicians from multiple units across the hospital had already conducted a choreographed run-through two weeks earlier. They had held numerous videoconferences to review plans and backup strategies and remained on call 24/7 in the four weeks leading up to the surgery in case McDowell went into labor in the middle of the night.

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YOU ALWAYS GO THROUGH DIFFERENT SCENARIOS IN YOUR HEAD OF WHAT MIGHT HAPPEN. BUT IT’S VERY REWARDING WHEN YOU GET THE TUBE IN PLACE AND KNOW THE BABY IS DOING WELL.” —Dr. Jaime Flores-Torres compression of their airways in the womb due to an obstruction. During the procedure, the mother is anesthetized, while only the head and shoulders of the baby are delivered through a Cesarean incision.

If all goes as planned, the baby will quickly be intubated while still connected to the placenta to receive life-sustaining cardiopulmonary support—and then the rest of the delivery can be completed.

Dr. Sarah Običan The process requires battlefield-like coordination between teams from maternal fetal medicine, neonatology, pediatric anesthesia, pediatric surgery, and more.

The procedure affords precious little margin for error, with every second counting in an atmosphere of high stress that demands unflappable nerves from every team member in the room.

“The amount of organization required Dr. Jaime Flores-Torres to have all these different teams of people in the operating room at once is enormous,” said Dr. Sarah Obican, division director of maternal fetal medicine and co-director of the TGH + USF Health Fetal Care Center and associate professor of obstetrics and gynecology at the USF Health Morsani College of Medicine at the University of South Florida.

“It takes incredible coordination and effort,” she continued. “We held multiple Dr. Alejandro Rodriguez meetings and every person who would be part of the surgery had to commit to being at a practice session or they wouldn’t be allowed to participate.

We ran through various scenarios to determine, ‘If this happens, then what are we going to do?’ We had to be prepared for every possible situation.”

Opposite page: Obican, who worked on the EXIT procedure Baby Quentin (pictured with his with fellow TGH obstetrician and gynecologist Dr. mother, Diana, his Alejandro Rodriguez, an assistant professor in the father, Troy, and his two older sisUSF Health Morsani College of Medicine and coters) is now thrivdirector of the TGH + USF Health Fetal Care Cening, reaching all of ter, underscored the dual nature of the challenge. the normal baby milestones by his “It’s difficult in that you have to do two things: first birthday. take care of both the mother and the baby,”

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Obican said. “This requires relaxing the uterus so much that it doesn’t contract. You need it to be very flaccid so that when the baby is halfway out—ready to be intubated—it is still on essentially a cardio-pulmonary bypass provided by the placenta. You can’t allow the uterus to contract, because that will cause the placenta to deliver and then you’ve lost the opportunity to be on that bypass.”

In that event, the baby would have to be immediately delivered without being intubated. Odds of a positive outcome would be severely reduced. There are other variables as well. If an intubation could not be successfully performed, a tracheotomy would be required. The plan for McDowell called for one doctor to get two attempts at intubating the baby. If neither worked, another doctor would step forward and try twice in hopes of getting the breathing tube in place—with the baby’s survival on the line and the clock ticking.

“We know going in, and Mom knows, that we are going to do everything we can, but if the baby doesn’t get an airway, it’s not going to make it,” Obican said.

Meanwhile, Obican had her own formidable challenge. She would use a uterine stapling device that makes a large incision in the uterus while simultaneously stitching up the sides of the cut to reduce bleeding, which could otherwise cause a drop in the mother’s blood pressure or blood pooling internally—and the potential of losing her. The manufacturer only makes a very limited number of tools every year, Obican said, and TGH always orders several just in case.

“I have to use two of them and have two on back up [so] if one doesn’t deploy, I have an extra one on hand,” she said. “And I practiced multiple times before the procedure with my co-surgeon, Dr. Rodriguez.”

While Obican was busy preparing, TGH’s fetal care center nurse coordinator, Julie Johnson, RN, BSN, RNC, played the role of master scheduler among the different units. She also served as McDowell’s personal point of contact.

“I’m that constant face,” she said. “I was the person Diana knew she would travel the road with. She had my cell number and could call me anytime day or night.”

Before anesthesia was given, Johnson asked for a moment so she could pray with McDowell. The procedure then began and unfolded with planned precision, with Obican and Rodriguez delivering the head and shoulders of the baby through the incision. But then came the

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For more information about the TGH + USF Health Fetal Care Center, please call (813) 259-8513

critical moment: the attempt at intubating. TGH Children’s Hospital neonatologist Dr. Jaime Flores-Torres, who had brought a team from neonatology and had another one standing by in the NICU, was first to try.

It worked perfectly. There was still much to be done, but nearby Johnson did a silent golf clap with that key hurdle surmounted.

“It’s a stressful moment,” said Flores-Torres, an assistant professor of pediatrics in the USF Health Morsani College of Medicine. “You always go through different scenarios in your head of what might happen. But it’s very rewarding when you get the tube in place and know the baby is doing well.”

When McDowell came to shortly afterward, Johnson was by her side to deliver the good news. The two women hugged and cried together. McDowell’s husband, Troy, who had been waiting anxiously in a nearby lounge, was brought in minutes later to share in the joyous moment.

Quentin spent his first four months in the NICU, then came home and was doing well, reaching all of the normal baby milestones by his first birthday. The growth on his neck is being treated

with injections of medication to shrink it. Eventually, when he’s older, it will be evaluated for surgical removal.

In the meantime, he still has a tracheostomy tube to make sure he can breathe safely. McDowell counts her blessings to have been referred by her OB-GYN and a maternal fetal medicine group to TGH. “Julie was amazing—she was there for every text, every call, and would call me at 9 o’clock at night just to check on me and answer any questions,” McDowell said. “But truthfully, everyone was amazing.

“I was just overwhelmed by Dr. Obican [and] the way she would explain things to me. She made me feel so assured that I was definitely in good hands, no matter what the outcome would be. She gave her heart 100 percent to the situation. And Dr. Flores-Torres, I can’t say enough about him. All of them—and everyone else at TGH—made me feel like they were in this with me all the way, before, during, and after.”

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In Need of Zs The TGH Sleep Disorders Center helps patients get more rest and improves well-being

By Dave Scheiber

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In 2015, Dr. Tapan Padhya (left) became the first surgeon in Florida to perform an Inspire nerve transplant, a device that helps those with moderate to severe obstructive sleep apnea.

Our days are longer, and we have less time to sleep. And even if we feel like we’re closing our eyes, we’re not getting a quality night’s sleep.”

—DR. TAPAN PADHYA

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etween busy jobs, family responsibilities, and the stress of daily life, it’s no surprise that Americans are suffering from a lack of sleep.

Adults require seven or more hours of sleep each night, according to the federal Centers for Disease Control and Prevention (CDC). But more than one-third of U.S. adults report sleeping less than that on average.

It’s a problem one could easily lose sleep over. Getting less than the seven-hour guideline can potentially lead to serious health issues. In fact, reduced sleep has been linked to seven of the leading causes of death in the United States, from accidents to heart disease and cancer.

At Tampa General Hospital’s Sleep Disorders Center, Dr. Tapan Padhya, medical director of the TGH Ear, Nose & Throat Institute, is finding solutions to the causes of sleep deprivation. Padhya, who also is professor and chair of the Department of Otolaryngology – Head and Neck Surgery at the USF Health Morsani College of Medicine at the University of South Florida, is a pioneer in the use of a cutting-edge device called Inspire to help patients suffering from one of these causes: sleep apnea.

“There are two parts of sleep,” Padhya explained. “One part is duration of sleep through the night. The average sleep cycle is about 90 minutes, and you need four to five of those cycles to get a restful sleep. The other part is the quality of sleep. This is where conditions disrupt sleep, including obstructive sleep apnea, insomnia, and narcolepsy.”

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The Inspire device is implanted under the collarbone and activated via remote control. When the patient takes a breath while sleeping, the device delivers an electrical stimulus to gently push the tongue out and create an open airway.

Adults require seven or more hours of sleep each night, according to the federal Centers for Disease Control and Prevention. But more than one-third of U.S. adults report sleeping less than that on average. contrast, those with insomnia find it difficult to fall asleep or to get back to sleep if awakened.

With obstructive sleep apnea, the muscles that support the tongue and palate temporarily relax, narrowing one’s airway and momentarily restricting breathing.

“Narcolepsy and insomnia have more of a psychological component to them, whereas obstructive sleep apnea is a structural/collapse issue,” Padhya said. “The risk goes up significantly for most everyone over 30 years of age.”

Obesity also increases the risk of developing the condition, which afflicts some 18 million Americans. In the United States, BMI and obesity increase as people age, contributing to the increased prevalence of sleep apnea.

Padhya knows of what he speaks. As an obstructive sleep apnea sufferer himself, he wears a CPAP (continuous positive airway pressure) machine at night to prevent his airway from collapsing. “I’m very empathetic to the sleep disorder population because I live it every day,” he said. “I connect with them because I know what they’re experiencing, and I know what their sleep partner is saying.”

Sleep disorders aside, the general lack of adequate sleep remains a concern, made

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worse by people’s habits of using their cellphones or watching TV at bedtime.

“Our days are longer, and we have less time to sleep,” Padhya noted.

“And even if we feel like we’re closing our eyes, we’re not getting a quality night’s sleep.”

Patients at the TGH Sleep Disorders Center answer a questionnaire to help determine what kind of problem they may have. They also complete an extensive “sleep-wake” cycle history that delves into habits. Some are asked to keep a sleep diary, noting when they go to bed, get up in the middle of the night, and awaken over a two-week period. One common issue is that people are quick to push back their bedtime.

“The thing that gives us the most problem is going to bed,” Padhya said. “People have to wake up at the same time in their lives, so going to bed early enough is the challenge.

It is frequently pushed back due to family care or job commitments. Our fallback is to catch a power nap during the day or catch up on sleep over the weekend. But getting a nap isn’t possible for everyone. And it’s been shown that sleeping in on the weekend does not catch you up.”

The result is America’s sleep shortage.

“Many people’s quality of life is being affected in some way,” Padhya said. “Sleep deprivation goes hand-in-hand with sleep disorders.”

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Just Like a Dream For those who suffer from sleep apnea, the Inspire device can be a game changer

David Borden was running out of options and hope. The 43-year-old Ocala resident had been using a CPAP machine for his obstructive sleep apnea for more than 20 years, and it was making his life worse.

“It was constantly leaking, there was always air blowing, and it was even hard on my partner—she couldn’t get a good night’s sleep,” Borden said.

Further complicating his problem was that Borden has suffered from another health condition since early childhood, and the CPAP machine seemed to be aggravating that as well.

But then he heard a radio ad about a surgically implanted product for sleep apnea called Inspire.

He went online and learned that the procedure was available at Tampa General Hospital, a two-hour drive south on I-75. He made an appointment at TGH’s Sleep Disorders Center and was soon conferring with Dr. Tapan Padhya about a surgery that would ultimately change Borden’s life dramatically.

Little did he know at the time that Padhya was instrumental in the pivotal clinical trial that helped with FDA approval for Inspire in 2014. He became the first in Florida to perform the Inspire nerve implant in 2015, and the first in the federal Veterans Administration system nationally. Today, Padhya has performed more than 250 implant surgeries.

Created by Medtronic, Inspire addresses the

David Borden’s severe sleep apnea was impacting not only his health and sleep quality, but the sleep quality of his partner, Diana Sawyer, too. That all changed when he received the Inspire transplant.

root cause of sleep apnea. It is half the size of a cell phone, placed under the collarbone during an outpatient procedure, and activated by remote control. Electric leads beneath the skin deliver a small stimulus to the base of the tongue when a patient takes a breath.

“It will gently push the tongue out to help the airflow,” Padhya explained. “You have an open airway.

You don’t have that struggle to breathe.”

To qualify for the Inspire treatment, patients must have a body mass index under 32, their sleep apnea must be moderate to severe, and they must previously have tried using a CPAP and believe that it no longer works for them.

A month after Borden’s implantation, the device was turned on and calibrated—and Borden enjoyed

a restful night’s sleep for the first time since he could remember. In fact, he was so quiet that his partner wondered momentarily if he was still breathing.

“She thought about holding a mirror under my nose to make sure that I was,” he said with a laugh.

With help from TGH, Borden’s turnaround has been nothing short of inspiring. “I don’t wake up tired anymore, and I finally feel rested,” he said. “I can’t say enough about Dr. Padhya—he’s awesome.

And the whole thing is like a dream.”

Something he can finally enjoy doing again.

For more information about the TGH Sleep Disorders Center, please call (813) 844-4292

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TIMING

IS EVERYTHING

WHEN IT COMES TO CORRECTING HEART RHYTHM DISORDERS, SPECIALISTS AT TAMPA GENERAL HOSPITAL ARE AT THE FOREFRONT OF NEW SURGICAL TECHNIQUES

BY K.S. MEYER Everyone has heard the stories: The promising young Navy recruit who can’t join up because of some less-than-optimal EKG readings.

The healthy grandmother who collapses while pouring her morning coffee. The experienced marathoner who falls dead 10 miles into a race.

Heart rhythm disorders, or arrhythmias, are far more common than many people realize, affecting more than 14 million Americans. They

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can either be present at birth or occur for no apparent reason. Unlike most other heart disease, they often are unrelated to a patient’s lifestyle, although age, smoking, and other factors, such as use of caffeine or other stimulants, can increase the risk of harm from an arrhythmia.

While most arrhythmias are as easy for a skilled physician with a stethoscope to diagnose as a speech impediment is to the common ear,

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Opposite page: Dr. Bengt Herweg reviews an image of a patient’s heart. TGH is implementing cutting-edge treatments to correct arrhythmias, including cardiac resynchronization and cardiac or catheter ablation.

Dr. Bengt Herweg

Dr. David Wilson

the underlying conditions giving rise to the symptom are notoriously difficult to flag and treat. Fortunately, the team at Tampa General Hospital is a leader in more modern approaches to treating arrhythmias that are more effective and carry fewer risks.

“The electrical activation of the heart is a major determinant of cardiac function,” said Dr. Bengt Herweg, medical director of the Electrophysiology Center of Excellence in the TGH Heart & Vascular Institute and professor of medicine at the USF Health Morsani College of Medicine at the University of South Florida. “A heart rate either too slow or too fast can result in fainting spells, and diseases of the electrical conduction system can result in heart failure, manifesting itself by lack of energy, volume overload, and premature death. Fixing electrical problems in the heart is, therefore, ‘low-hanging fruit’ when it comes to making a quick and lasting difference for patients.”

In decades past, treatment meant either flooding the heart muscle with medication or performing open-heart surgery.

“That’s a hallmark of what we were doing,” Dr. David Wilson, medical director of the electrophysiology laboratory in the TGH Heart & Vascular Institute and assistant professor of medicine at the USF Health Morsani College of Medicine, said of using medication to treat arrhythmias. “You’re manipulating the chemistry of the heart cells to make arrhythmias less likely. And that manipulation can, unfortunately, actually trigger arrhythmias under a certain set of circumstances, so those patients require closer follow-up and monitoring.”

The most frequent treatment for correcting symptomatic or dangerous arrhythmias in recent years has been catheter ablation, or insertion of devices including pacemakers and defibrillators with leads inserted into the heart muscle to force it to work properly.

“The preferred management may entail pacemakers, depending on the type of rhythm,” Wilson said. “It may entail ways to mitigate sudden cardiac death, like implantable defibrillators. It may involve the use of catheter ablation, which is an endovascular technique where we go in and try to find the specific foci or triggers for cardiac arrhythmias and seek to modify the heart’s natural electrical system or destroy tissue that may be causing arrhythmias in order to prevent them from happening.”

While the insertion of electric leads does eliminate most symptomatic arrhythmias, it also may create problems down the road, with most leads

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becoming worn out after a certain amount of time and requiring extraction. Electrophysiologists have developed new ways to solve this issue as well.

“Five, 10 years ago, patients who had dysfunctional leads may have only been offered the option to have those leads abandoned, and then forced to have redundant, old hardware left in place while adding new hardware, which carries its own risks for vascular occlusion and infection or compromise of heart valves,” explained Wilson. “Whereas nowadays, we’re able to offer them transvenous lead extraction, where we go in and remove malfunctioning leads and replace them with brand new, serviceable leads.”

Herweg described another procedure to help regulate the heart’s rhythm.

“Another novel treatment option is cardiac resynchronization by stimulation of the specialized conduction system of the heart,” Herweg said. “We gain access to the venous system of the heart, usually through the left shoulder area; we come down through a small vein and that leads down to the heart. Under fluoroscopic guidance and electrical recordings from inside the heart we then place leads in millimeter-thin fibers of the conduction system and institute pacing, once we’re in the right spot.”

Once the pacing leads are in place, the electrophysiologist can adjust their output until the heart muscle is “firing” in total synchronicity and producing maximal cardiac output.

Now that more sophisticated interventions are available, electrophysiologists can use the heart’s own natural electrical system to create a more immediate, less sluggish firing of the muscle. The results have been promising, and TGH physicians have participated in clinical trials and published research to share their successes in this area.

“We now know, according to observational preliminary data, that pacing the conduction system of the heart not only does not have any ill side effects but can, even in selected patients, improve cardiac function and treat congestive heart failure,” Herweg said. “It’s a formative sort of cardiac resynchronization therapy. We have been involved in this from the beginning here at TGH.” Some situations might require more intensive measures to correct a faulty heart rhythm. One of these treatments is cardiac or catheter ablation, which blocks the misfiring electrical signals in the heart and restores a normal rhythm. Once considered a riskier procedure, various measures have been implemented to ensure such procedures are

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For more information about the TGH Heart & Vascular Institute, please call (813) 844-3900 or email heart-vascular@tgh.org

quickly executed and less invasive.

“If we’re doing catheter ablation, we do have equipment that [enables us to] use multiple modalities to correct for things like cardiac motion and the complexities of working on a beating heart,” said Wilson. “Those include ultrasound, advanced computer 3D-mapping techniques, and fluoroscopy. All those systems can, in some form, talk to each other and allow us to integrate all modalities in order to correct for things like respiratory motion in order to give us the most stable appearance of cardiac structures as possible.”

When a more aggressive intervention is needed to correct a more severe arrhythmia, such as atrial fibrillation—which dramatically increases the risk of both heart attacks and strokes—catheter ablation has shown significant promise with less risk and a shorter hospital stay than conventional open-heart surgery.

“Catheter ablation for atrial fibrillation is still a relatively new procedure,” Wilson said. “The very first one was performed around 1997, and it’s really become ubiquitous over the last 10 to 15 years. When I started performing these, about 10 years ago, it wouldn’t be unusual for a patient to be sent to an ICU afterwards—they’d be in the hospital for one to three days after that, and maybe require IV medications like diuretics in order to remove excess fluid, or in order to monitor for signs and symptoms of heart failure. The procedure itself could sometimes take up to six to eight hours to perform. Nowadays, with modern techniques and improved technology, just physician time can be two hours or less, and patients can go home the same day.”

The same day. Even five years ago, this would have been unheard of for patients, let alone coupled with the news that their arrhythmia had been treated in full, with almost no chance of relapse. This is now reality.

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BETTER TREATMENTS,

BETTER OUTCOMES

Advancements at Tampa General Hospital give doctors new options for helping stroke patients

BY ERIC BARTON 38

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The fact that strokes have fallen from the No. 3 to the No. 5 leading cause of death is good news, but it’s not take-your-eye-off-theball kind of news. We’ve gone from having one tool in the toolbox to treat patients to a large number of tools in the toolbox.”

—DR. W. SCOTT BURGIN

D

Right: Dr. W. Scott Burgin is the director of the Comprehensive Stroke Center at TGH, where a dedicated neuro ICU staff is trained in treating strokes. TGH radiologists are also using new AI systems to analyze brain scans and improve response time.

r. W. Scott Burgin, director of the Comprehensive Stroke Center at Tampa General Hospital, has a personal reason for ensuring his patients receive the best care possible: His father suffered from a stroke.

Since Burgin first began specializing in the field, the number of strokes in the United States has grown exponentially. Yet, Burgin said, there’s an encouraging statistic: Strokes have now dropped from the No. 3 to the No. 5 cause of death, with 150,005 individuals succumbing to cerebrovascular diseases in 2019, according to the federal Centers for Disease Control and Prevention (CDC).

“It’s both a testament to progress and a stimulus to move forward,” said Burgin, who is also professor and director of vascular neurology at the USF Health Morsani College of Medicine at the University of South Florida. “We get into this kind of work to try to help people, and it’s good to know

that with hard work we’ve seen something from all this.”

The reason for that drop can be attributed to a slew of new procedures and equipment available to doctors and hospital staff to help victims of strokes. That’s especially true at TGH, the first hospital on the West Coast of Florida to obtain national comprehensive stroke accreditation status from the Accreditation Commission of Health Care.

TGH first received this certification in 2011, following a complex evaluation of standardized performance measures; a recertification takes place every two years.

Burgin helps oversee the certification program and said it’s a benefit to residents of the region, who can rest assured that if they have a stroke, they have the best care available, including a commitment to the rapid treatment that is vitally important for stroke care. TGH’s comprehensive neuroscience care team is ready to treat strokes 24/7 and measures how long it takes from the ADVANCES

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This is sort of like Star Trek. This is as close as we’ve come to Dr. McCoy holding the scanner up and showing, yes, you’re having a stroke.

—DR. W. SCOTT BURGIN

the hospital’s radiology department employs state-of-the-art imaging technology, which represents a vast improvement over what existed just a few years ago. An artificial intelligence (AI) system can analyze scans and make initial assessments. If this technology sees signs that a patient may have had a stroke, it will alert the staff involved in their care, allowing them to react quickly. The system may spot a blocked artery or read the blood flow characteristics that can help Burgin and others create a plan for treatment far quicker than what was previously possible.

“This is sort of like Star Trek,” Burgin said.

“This is as close as we’ve come to Dr. McCoy holding the scanner up and showing, yes, you’re having a stroke.”

Advances in stents and catheter treatments also allow TGH doctors to treat stroke victims in ways that weren’t previously possible.

Among the new equipment is a Zoom 88 large

distal platform catheter, an advanced device manufactured by Imperative Care that provides hospital staff with the means necessary to clear potentially deadly and debilitating blood clots. In November 2021, TGH and the USF Health Morsani College of Medicine became the first institution in the U.S. to employ the new catheter, which is FDA cleared for neurovascular access, to treat stroke patients as part of a national multi-site clinical trial.

At TGH, partners from USF Health have been studying how stem cells administered early in the course of a stroke can aid in patient recovery. Early indications show that the injections can help these patients recover more completely, although the procedure needs FDA approval before becoming more widely used. While preliminary, the initial results are “very exciting” that stem cells could become the next significant development in stroke treatments, Burgin said.

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moment a patient arrives until the instant they start treatment.

The hospital’s comprehensive status means patients have access to cutting-edge procedures and new clinical research trials often available only at an academic medical center such as TGH. Tampa General is recognized as “high performing,” or ranked among the top 10 percent of U.S. hospitals for stroke care and neurology and neurosurgery by U.S. News & World Report for 2021-2022. TGH has also received the “Get with the Guidelines” Stroke Gold Plus Award and “Target: Stroke” Honor Roll-Elite recognition from the American Heart Association/American Stroke Association.

Among the advanced care features that stroke sufferers can find at TGH is a dedicated neuro ICU staff trained in treating people with strokes, bleeding in and around the brain, and other neurological conditions. In addition,

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A STROKE

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A stroke is a brain emergency. When a person has a stroke, speedy treatment can mean the difference between complete recovery and disability or death. Remember that “time is brain”—anyone seeing or experiencing stroke symptoms should call 911 immediately.

Even with all these improvements, Burgin noted that strokes remain the No. 1 cause of disability in the country, a number that’s a constant reminder to him to keep looking for new ways to treat patients.

“The fact that strokes have fallen from the No. 3 to the No. 5 leading cause of death is good news, but it’s not take-your-eye-off-the-ball kind of news,” Burgin said. “We’ve gone from having one tool in the toolbox to treat patients to a large number of tools in the toolbox.”

Even now, Burgin said, he’s on the hunt for one more innovation with a simple end goal: turning a stroke from something potentially life-threatening or debilitating into something that’s unfortunate but won’t slow you down. “We want to ameliorate the downside of what happens when you have a stroke,” Burgin said, “but it requires a comprehensive approach, something that we’re working on every day.”

What is a stroke?

The American Stroke Association (ASA) states that a “stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot [ischemic] or bursts [hemorrhagic].” When this occurs, regions of the brain are deprived of blood flow and oxygen, causing brain cells to die, sometimes within a matter of minutes.

What are the risk factors?

While numerous factors can cause a stroke, common risks include smoking, obesity, high blood pressure, diabetes, atrial fibrillation, and heart disease. Age is also a factor, with more than 70 percent of all strokes occurring in those older than 65. In addition, women face a higher risk of stroke, according to the ASA, with about 55,000 more women than men experiencing strokes every year.

What are the symptoms? The ASA uses the F.A.S.T. acrostic to help individuals spot strokes and react quickly. If you are experiencing Face drooping, Arm weakness, or Speech difficulty, then it is Time to call 911. Additional symptoms include numbness in the face, extremities, or on one side of the body; confusion, including trouble speaking or understanding speech; trouble seeing; trouble walking, including dizziness or loss of balance or coordination; or a severe headache without a known cause.

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FACE DROOPING,

Arm weakness, or Speech difficulty

3

CALL 911 IMMEDIATELY

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A FIGHTING

CHANCE

WHEN A TUMOR APPEARED FROM NOWHERE AND NEARLY KILLED A YOUNG PATIENT, A TEAM OF TAMPA GENERAL HOSPITAL AND USF HEALTH PHYSICIANS FOUGHT BACK

By Dave Scheiber It began with a nagging cough. The sound was a bronchial hack that Noah Schwartz attributed to springtime allergies. After all, he was in excellent health at age 24—a strapping young man from Jupiter, Florida, with upcoming plans to move to Los Angeles with a pal from his alma mater, the University of Miami, and grow their budding music company.

But then came the shortness of breath and difficulty sleeping on his back at night, forcing him to sit upright in bed. Since this was April 2021, with serious COVID-19 cases on the rise, Noah wondered if he might have contracted the virus. He tested negative. His primary doctor in Miami suspected bronchitis and prescribed a regimen of antibiotics, but they did no good.

Not long after, while walking to the garage at his house, he ran his hand across his chest and felt an unusual bump under the surface of his skin.

“It felt more internal than external, and it really concerned me,” Noah recalled.

It was the start of a nightmare. Within days, Noah was on the verge of death. He was diagnosed with a large tumor, caused by non-Hodgkin’s lymphoma, that was pressing dangerously against his heart, lungs, and windpipe. Yet it also set in motion a dramatic chain of events that brought Noah to Tampa General Hospital—rushed across the state by ambulance—and a series of critical decisions by a world-class team of TGH physicians that ultimately saved his life.

“When an airplane crashes, it happens after a sequence of mistakes,” said Dr. Eduardo Sotomayor, director of TGH’s newly established Cancer Institute and one of the physicians who played a vital role in the unfolding life-and-death situation. “But in Noah’s case, it was the opposite of an airplane crash. All of the right decisions were

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made at the right time for this kid. And the sequence of events that took place—at each step of the way—is why he is alive today.”

Here is how that sequence in 2021 played out—with every hour, every move, counting in a race against the clock to keep the tumorous mass from stopping his heart.

Monday, April 12: Sotomayor, a world-renowned oncologist and leading expert in lymphomas, arrived at TGH to direct the new Cancer Institute after leading cancer care and research at George Washington University Cancer Center in Washington, D.C., for five years. The first critical step in the sequence—unbeknownst to anyone—was in place.

Friday, April 16: The next step involved the local hospital that Noah went to so the mysterious bump could be examined. A CT scan revealed the ominous mass. Fortunately, the physician on the case—Dr. Abraham Schwarzberg, now senior vice president of network development and chief of oncology at TGH—recognized immediately that Noah needed to be treated at an academic medical center offering the best possible advanced care.

“Dr. Schwarzberg told me, ‘We can do the biopsy here, but this kid needs to be in a place that has one of the best intensive care units in the state,’” Sotomayor recalled. “This situation cannot be, ‘Handle it here.’ Luckily Noah was immediately transferred to TGH.” Noah was admitted at TGH that Friday night and seemed to be doing fine. But all that was about to drastically change.

Saturday, April 17: Noah was taken to the operating room the next morning for a biopsy and the physician on call happened to be Dr. Eric Sommers, medical director of

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Time was of the essence after doctors discovered a large tumor in Noah Schwartz’s chest.

Opposite page: Noah with his mother and sister, who had Hodgkin’s lymphoma while in college.

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Left: These 3D models of Noah’s chest (created in collaboration with the Division of 3D Clinical Applications, USF/TGH Radiology) depict the tumor (in pink) that was pressing against Noah’s heart, lungs, and windpipe. Right: Noah began IV chemotherapy two days after the mass was detected. Opposite page: Noah has made a full recovery and has been celebrating his health with family.

TGH thoracic oncology and a highly experienced cardiothoracic surgeon. Sommers’ presence proved vital. What began as a routine biopsy changed in a flash as the anesthesia increased the tumor’s pressure on Noah’s heart and lungs, causing him to go into cardiac arrest.

With no time to spare, Sommers assessed the situation and knew his only chance to pull Noah through was to place him on an extracorporeal membrane oxygenation (ECMO) machine. ECMO machines are used in heart and lung transplants, and TGH had about 10 of them available. Sommers was well versed with their use.

Noah appeared to be dying, so Sommers made an urgent call to the oncology physician on call—the man who had started at TGH only six days before, Sotomayor. Looking back, Sotomayor thought it was unusual that he was on call his first week, but he wanted to get a feel for the hospital. And that put him in a position to field the urgent call from Sommers. “It was meant to be,” said Sotomayor.

“He said to me, ‘Welcome, and I have a patient with an aggressive lymphoma in his chest. By the way, he is on an ECMO machine and needs to be treated immediately,’” Sotomayor recounted.

Yet another unexpected twist was about to take place.

“I went to the waiting area to talk to Mom and tell her what had happened,” Dr. Sommers related. “She looked at me stunned and said,

Dr. Eduardo Sotomayor

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Dr. Abraham Schwarzberg

‘This is exactly what happened with his sister.’”

Indeed, Noah’s sister had been stricken with Hodgkin’s lymphoma when she was in college, but she made a full recovery through chemotherapy without complications. Noah’s case, however, was proving far different and more critical, with his life hanging in the balance of every decision.

In short order, he was stabilizing on ECMO, while Sotomayor alerted TGH pathologist Dr. Julie Vitko to request an urgent pathology diagnosis. She obliged, diagnosing Noah within 12 hours of seeing him with primary mediastinal large B-cell lymphoma, which often impacts younger individuals with large masses.

“Without the ECMO,” said Sotomayor, “Noah would be dead. Period.”

Sunday, April 18: With the diagnosis in hand, Sotomayor made a call to an old friend, Dr. Kieron Dunleavy of Georgetown University’s Lombardy Cancer Center. “After 25 years, I think I know a little about lymphomas, but Dr. Dunleavy is the leading expert in the world in primary mediastinal lymphomas,” he said. “He told me, ‘You need to start chemotherapy treatment today, right now.’”

Sotomayor was visiting the Dali Museum in St. Petersburg when the call took place but he raced back to TGH and spoke to Noah’s mother,

Dr. Guilherme Oliveira

Dr. Eric Sommers

Dr. Gaetane Michaud

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ALL OF THE RIGHT DECISIONS WERE MADE AT THE RIGHT TIME FOR THIS KID. AND THE SEQUENCE OF EVENTS THAT TOOK PLACE—AT EACH STEP OF THE WAY—IS WHY HE IS ALIVE TODAY.” —Dr. Eduardo Sotomayor Lesli Schwartz, about starting chemotherapy. “I said, ‘Look, we can cure Noah—what he has is 95 percent curable, so we need to fight. If he is able to survive the next two to three weeks, we are going to cure him.”

By Sunday night, chemotherapy was under way—with Sotomayor personally invested, thinking of his own son, who was Noah’s age. It was now an all-out race between the chemo and the tumor. In the early going, Noah suffered every possible side effect. But an experienced multidisciplinary team that ultimately included oncology, pulmonology, and cardiology—one of the advantages of an academic medical center like TGH and USF Health—helped Noah weather the storm.

Among the physicians was Dr. Gaetane Michaud, a TGH pulmonologist and faculty member in the Division of For more information about cancer Pulmonary, Critical Care, care at the TGH Cancer Institute, please call (813) 844-7585 and Sleep Medicine at the USF Health Morsani College of Medicine, and Dr. Guilherme Oliveira, executive director of the TGH Heart and Vascular Institute and professor and chief of cardiovascular sciences in the Morsani College of Medicine. Luckily for Noah, he was an experienced cardio-oncologist.

Michaud had arrived in Tampa Bay only several months earlier from New York University Langone Health. Oliveira came from Case Western Reserve University School of Medicine in 2019. “An A team was in place from experts that came to TGH from very prestigious academic centers,” said Sotomayor. As Sotomayor and his nurse, Tracy Stegeman, began visiting Noah on twice-daily rounds, Michaud and Oliveira took over his care when he developed lung and heart complications.

At one point, it appeared Noah might need a lung transplant due to the severe damage caused by the mass, but the threat passed. Then there was the scare when the lymphoma began closing off his windpipe.

“One Sunday night, I’d been at the beach the entire day with my kids, and his airway collapsed,” said Michaud. “I was about 40 minutes away without beach traffic, so we frantically got here [to TGH] and took him to the operating room, and we were able to open up his airways again.”

Michaud would play a huge part in Noah’s gradual recovery over the next seven weeks as he remained in an induced coma. When he

awakened, terrified and disoriented, he had lost 100 pounds from his 6-foot-3-inch frame. “I was in shock, and emotional for sure,” he said.

“I couldn’t move at all, and it was beyond scary.”

But with Michaud’s team helping his lungs heal, Oliveira and his team taking care of the heart, and Sotomayor’s work to cure his lymphoma, Noah was gradually on the road to recovery. After six cycles of intense chemotherapy under the supervision of Sotomayor’s team at the TGH Cancer Institute and Schwarzberg’s team in Jupiter, imaging studies showed no sign of the lymphoma that nearly killed him. Today, he has gained back his weight, regained his life, and is once again immersed in his music media and artist management company, Sheeshmedia.com, which had been sidetracked by the pandemic and then his ordeal.

Noah and his mother are deeply grateful to the team of experts at the TGH Cancer Institute. “If I ever get married, which I plan to one day, Dr. Sotomayor will be in attendance,” Noah said. “He’s a lifelong friend.”

“Doctors also believe in miracles, and many people were praying for Noah,” said Sotomayor. “This was not his time. I’ve told him: ‘Noah, you have a mission in life. I don’t know what it is—you have to find out.

But you were given a second chance.’”

Thanks to a perfect sequence of events—the right decisions, the right doctors, and the right place, every step of the way.

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Since receiving a lung transplant at TGH’s Transplant Institute, Derick Cabral has been able to once again enjoy some of his favorite hobbies.

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REACHING A MILESTONE 700 LUNG TRANSPLANTS IS JUST ONE MARKER

BREATHING

OF SUCCESS FOR TAMPA GENERAL HOSPITAL AND ITS RENOWNED

EASY TRANSPLANT INSTITUTE

BY SANDRA GURVIS

In July 2021, St. Petersburg mechanic Derick Cabral contracted COVID-19 and was soon hospitalized and flown to Tampa General Hospital due to his worsening condition.

“I was intubated after having a panic attack because I couldn’t breathe,” recalled the 32-year-old Cabral, who also has borderline diabetes.

Waking up in TGH’s intensive care unit (ICU) two days later, “I was more disappointed over being unconscious during the helicopter ride and missing that than I was worried about being in the ICU,” he half-joked.

Doctors had treated Cabral with everything from a noninvasive ventilator to ease his breathing, to the far more intense extracorporeal membrane oxygenation (ECMO)—which pumps blood outside of the body into a heart-lung machine—to save his life. But after the immediate crisis, Cabral faced lung damage that was likely permanent and might get worse. He suffered from shortness of breath, constant fatigue, aches, and other symptoms.

Still, youth and good fortune were in Cabral’s favor. After being fully evaluated, his case was put before TGH’s medical review board, which determined that a lung transplant was his best option.

Miraculously, after only nine days on the transplant list, Cabral received a new set of lungs on October 2, making him TGH’s 700th lung transplant since its program began in 2002.

“This is notable, especially in a time when the pandemic has provided obstacles for us all,” said ADVANCES

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TGH IS DEEPLY COMMITTED TO TRANSPLANTATION AND TO PROVIDING LIFESAVING THERAPY TO THE SICKEST MEMBERS OF THE COMMUNITY.” —DR. KIRAN DHANIREDDY Dr. Kapil Patel, medical director of TGH’s Center for Advanced Lung Disease and an assistant professor at the USF Health Morsani College of Medicine at the University of South Florida. In collaboration with USF Health, the Transplant Institute at TGH is one of only 20 programs out of 53 transplant centers in the nation to reach this milestone number of lung transplants.

Patel credited the Transplant Institute’s dedicated health care team for making this achievement possible. Dr. Kiran Dhanireddy, the institute’s executive director, also recognized the importance of LifeLink of Florida, a local organ procurement organization, as well as “the selfless organ donors and gracious donor families who chose to save lives.”

Along with being a transplant innovator for more than 50 years and one of the busiest transplant institutes in the United States, TGH is one of only a few dozen hospitals in the country to have performed more than 11,000 transplant surgeries. It is the only hospital in West Central Florida to offer all five organ transplants for adult patients: heart, lung, liver, kidney (from living and deceased donors), and pancreas.

Pediatric kidney transplants are also available.

“TGH is deeply committed to transplantation and to providing lifesaving therapy to the sickest members of the community,” Dhanireddy said.

Along with shorter wait times, TGH patients typically experience survival rates that are equal to or greater than those at other programs across the country, according to Scientific Registry of Transplant Recipients (SRTR) data.

Named by U.S. News & World Report as a “high performing” hospital for pulmonology and lung surgery for 2021-2022, TGH operates one of only four active lung transplant programs in Florida. The lung transplant program now is noted for its cutting-edge methods of preserving lungs prior to transplantation and for developing advanced techniques for detecting and treating rejection.

As TGH transplant physicians evolve with the times and lead in innovation they are also responding to the coronavirus pandemic and its implications on lung health. Lung transplant patient Cabral is not alone—TGH is seeing other patients affected by COVID-19.

“As a result of COVID-19, we have seen an increase in the scarring of lungs and the development of interstitial lung disease,” noted Dhanireddy.

Interstitial lung disease (ILD) is another term for pulmonary fibrosis, which means scarring or inflammation of the lungs. This scarring makes it hard for the lungs to get enough oxygen and, therefore, inhibits a person’s ability to breathe. This is a chronic lung disease that can be permanent and worsen Dr. Kapil Patel over time. The TGH lung transplant program specializes in ILD as well as cystic fibrosis, pulmonary hypertension, and other complex conditions.

Each organ program that comprises the TGH Transplant Institute boasts its own unique success stories, and its health care professionals are constantly working toward future innovations. Areas of research include ways to keep the immune system from rejecting donated organs and the implementations of advanced therapies to manage and treat mitigating diseases to reduce the need for transplantation in the first place. Furthermore, a minimally invasive robotic kidney transplant system is in the works, and Dhanireddy said that the institute is also in the process of establishing a live liver donor transplant program.

Meanwhile, each day provides Cabral with more endurance and strength.

“I look forward to returning to a normal life and am tremendously grateful to Dr. Patel and the entire transplant team,” he said.

Dr. Kiran Dhanireddy

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HOPE FOR A HEALTHIER LIFE Tampa General Hospital’s cutting-edge approach to bariatric surgery improves outcomes for high-risk patients

BY KAREN FELDMAN 50

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ore than 228,000 Americans undergo bariatric surgery each year to help them lose weight. That may sound like a lot, but it turns out that fewer than 1 percent of eligible Americans are evaluated for bariatric surgery.

Studies show there’s a gap between Americans’ perceptions of bariatric surgery and the

reality. Weight-loss surgery is actually more effective than nonsurgical methods for weight loss, according to systematic reviews of multiple studies conducted by the Cochrane Library. It’s also less risky than many people believe, said Dr. Christopher DuCoin, medical director of bariatric surgery at Tampa General Hospital and chief of gastrointestinal surgery at the

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We have the infrastructure to take care of everybody; there is no patient we turn away, whether they need surgery, medical management, or one of the alternate procedures we offer. We can take care of anybody.”

—Dr. Christopher DuCoin

Right: Dr. Christopher DuCoin is the medical director of bariatric surgery at Tampa General Hospital and chief of gastrointestinal surgery at the USF Health Morsani College of Medicine.

Opposite page: DuCoin leads a team during a bariatric surgical precedure at the TGH + USF Health Bariatric Center.

USF Health Morsani College of Medicine at the University of South Florida.

“Some people might think that it’s a highrisk procedure, but it’s probably the safest elective surgery being done in the United States, with a risk profile safer than a gall bladder surgery, a hysterectomy, or an elective knee procedure,” DuCoin said.

At the TGH + USF Health Bariatric Center, surgeons also perform these surgeries robotically, which translates into smaller incisions and faster recoveries. Most patients need to be hospitalized for less than 24 hours. Physicians generally perform the procedure on people for whom their excessive weight has become a serious health problem—and for whom diet

and exercise have not worked—usually those who are considered severely obese, or have a body mass index (BMI) of 40 or higher.

More than 42 percent of Americans now qualify as obese, meaning they have a BMI of 30 or higher, and more than 9 percent are severely obese—numbers that have continued to rise over the past 25 years.

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Bariatric surgery is typically performed on patients with a BMI of 40 or higher. Common procedures offered at the TGH + USF Health Bariatric Center include Roux-en-Y gastric bypass and sleeve gastrectomy, both of which are performed laparoscopically.

The TGH + USF Health Bariatric Center is equipped to care for a wide variety of patients seeking weight-loss solutions, DuCoin said.

“We have the infrastructure to take care of everybody; there is no patient we turn away, whether they need surgery, medical management, or one of the alternate procedures we offer,” he said. “We can take care of anybody.”

Gastric bypass, a procedure that involves changing the structure of the digestive system, enables patients to lose weight and can help reduce the risk of other health conditions correlated with obesity. The goal is to help the patient lose weight while also eliminating medical conditions such as diabetes, hypertension, and sleep apnea.

An extreme example of this is a patient who was experiencing heart failure and in need of a lifesaving heart transplant. He had received a left ventricular assist device (LVAD) in 2015 that helped his heart function. While that bought him time, he was obese and, in the subsequent four years, was unable to lose weight.

Due to his heart condition and the LVAD, several bariatric surgeons at other locations were reluctant to operate on him, making his situation ever more dangerous and frightening. But, as a leading academic medical center with multidisciplinary expertise, the TGH + USF Health Bariatric Center performs an array of complex procedures that many hospitals decline to offer.

DuCoin took on the case and performed the patient’s bariatric surgery in July 2020. Within three months, the man lost 75 pounds, which made him eligible for the transplant list. At the

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end of 2021, he was still awaiting a donor with the right blood type, but he has continued to lose weight, which increases his chances of living a healthy life.

“It’s amazing that he has lived five years with an LVAD, but he will get his heart now,” DuCoin said. “It’s just a matter of finding the right donor.”

The patient will be able to have the transplant at the TGH Transplant Institute, providing continuity of care as well as a highly skilled medical team with a wide range of specialties that will likely improve his outcome.

“You have to have the bariatric team, the cardiologists, the cardiothoracic surgeons, and the cardiac anesthesiologists. It takes a full team and a high level of coordination to care for a patient this complex,” DuCoin said. “But more than that, it’s difficult to find all of this in a single institute. The stars have aligned here just right.”

U.S. News & World Report has ranked TGH No. 26 in the nation and No. 1 in the state of Florida for gastroenterology and GI surgery

for 2021-2022. TGH is where the state’s first successful heart transplant was performed, in 1985. TGH also has one of the oldest accredited bariatric centers in Florida, which treats roughly 2,000 patients a month.

“We have one of the strongest transplant programs and strongest bariatric programs,” DuCoin said. “This is where patients should come to get optimized for transplant.”

Bariatric surgery either restricts the amount of food a patient can eat, by reducing the size of his or her stomach, or it diverts food from the stomach and limits the length of the intestine that comes in contact with the food. Some surgeries combine the two approaches. One procedure commonly used at TGH is Roux-en-Y gastric bypass, which limits intake, digestion, and absorption of food and can result in a 55 to 70 percent reduction in excess body weight over time. Another is sleeve gastrectomy, in which a stapling device is used to divide the stomach vertically, creating a banana-like tube that restricts food

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intake. These procedures are performed laparoscopically so they are minimally invasive, which means recovery time is relatively short compared to standard operations.

DuCoin credits the multifaceted team at TGH for ensuring such procedures are possible for high-risk patients. “The success is the sheer volume of people we have—four nurse practitioners, three dietitians, two psychologists, and my surgical partners of the highest caliber, while we also have obesity medicine physicians and physicians dedicated to the care of adolescents,” he said. “We have an army of people working to get patients through the process in a safe manner with the highest quality outcomes. And the level of support at Tampa General Hospital is what makes all of this possible.”

He is also upbeat about other innovative procedures the gastrointestinal team is doing.

These include employing minimally invasive robotics to treat conditions such as gastroesophageal reflux disease (GERD) and achalasia, a condition in which the lower part of the esophagus fails to relax so food is unable to pass to the stomach.

After training in Germany, DuCoin now performs a procedure called peroral endoscopic myotomy (POEM) as well. This incisionless surgery involves extending a flexible endoscope through the mouth and down the esophagus into the stomach to remove masses and obstructions. A procedure such as this would previously have been done through conventional surgery that requires abdominal incisions and much longer recovery times.

Beyond these innovative offerings, TGH is always exploring how it can help individuals with complex and unusual cases as well as minimize risks in whatever ways possible.

And that’s what gives physicians the confidence to tackle the tough cases.

“If no one takes them on, we know what the alternative is,” DuCoin said. “We give hope to people. If you are interested, or think you can live a better life, we would like to help you get there.”

For more information about the TGH + USF Health Bariatric Center, please email bariatriccenter@tgh.org or call (813) 844-7473

Above: Dr. Christopher DuCoin and Dr. Ashley Mooney, a bariatric surgeon at the TGH + USF Health Bariatric Center, appeared on Tampa Bay’s Morning Blend show with host Natalie Taylor to discuss the different bariatric procedures available at TGH and the hospital’s comprehensive approach to helping patients reach their weightloss and health goals.

We give hope to people. If you are interested, or think you can live a better life, we would like to help you get there.”

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DISCOVERING A DONOR

CLOSE TO HOME A LAWYER WITH AN INCURABLE KIDNEY DISEASE FINDS A DONOR AND A TRANSPLANT INSTITUTE

By Eric Barton Photography by Jerry Rabinowitz

Mike and Bekki Haggard

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Mike Haggard has a whiteboard in the office of his Coral Gables law firm that he uses to game plan upcoming trials. He bought a second one for a very different purpose: to list out the people who might be willing to risk their lives for him.

At the time, Haggard knew his best chance for staying alive. He needed to find someone to donate a kidney to him, and he needed to do so quickly.

A lot has happened to Haggard since. He found the donor he needed, had the transplant surgery at Tampa General Hospital that would prolong his life, and, in the process, learned just how important it is to find the right hospital to handle such procedures.

All of this began with something simple—a bit of back pain Haggard said he felt one day in 2002. He got an MRI, and the original diagnosis was a herniated disc. Finally, the doctor asked if he had any history of kidney disease in his family.

“Right there I was like, ‘Oh my gosh,’” Haggard recalled. “All that family history came back to mind.”

While Haggard was growing up, several people in his family were impacted by polycystic kidney disease (PKD). He hadn’t thought about it for years, but after he mentioned it to his doctor, tests confirmed he had it too.

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AS MUCH AS WE WANT TO HELP IMPROVE THE HEALTH AND LIFE OF THE RECIPIENT, WE HAVE TO PROTECT THE LIVING DONORS FROM IMMEDIATE AND FUTURE HARM. WE ARE NOT SUCCESSFUL UNLESS BOTH DONOR AND RECIPIENT DO WELL.” —DR. JAMES HUANG

An incurable and inherited disorder, PKD gradually caused cysts to develop in Haggard’s kidneys, which slowly lost function over the course of years. Haggard had the disease for 13 years before his doctor told him he would need to get a new kidney soon. If he couldn’t find one, he’d spend years on dialysis, and the disease could progress to a point where it could cost him his life.

On his whiteboard, Haggard listed out the people closest to him. His wife, Bekki, volunteered first, but she wasn’t a compatible match. They put out a call to friends and family, and 13 people came forward.

After problems at a Miami area hospital, Haggard reached out to someone who suffered from PKD. “He said, ‘Stop. You’ve got to get up to TGH right now. They are taking good care of me.’”

The TGH Transplant Institute is one of the busiest transplant institutes in the country and has the largest live donor kidney transplant program in Florida. As the only West Central Florida hospital to offer transplants for five organs, TGH surgeons perform everything from heart to liver transplants. With half a century of transplant surgeries under its belt, TGH is among only a handful of hospitals in the country to have performed more than 11,000 transplants—more than 6,500 of them kidney transplants.

Once Haggard went to TGH, things “began happening like clockwork,” he said. His brother-in-law, Allen Buckhalt, stepped up and offered to be a donor. At first, Haggard and his wife were both reluctant. Bekki Haggard recalled thinking that it could jeopardize her little brother’s career as an Army helicopter pilot. “I said to him, ‘Look, you need to think about this. We’ve got other people, and we don’t want this to affect your flying abilities.’”

But Buckhalt had a feeling that he was a match. He went to TGH and, sure enough, he was an ideal candidate.

On October 6, 2016, the Haggards drove up I-75 toward Tampa with Hurricane Matthew on their heels. Buckhalt went in for surgery first, and Dr. James Huang, surgical director of living donor renal transplantation at TGH, came out to tell the Haggards that the first step had gone well. Haggard went in next.

“As a sister and a wife, it was a nerve-racking situation,” Bekki Haggard said. “I’m concerned for my husband but, of course, for my little brother too.”

But the surgery went off without a hitch, and soon both men were recovering, with Bekki Haggard going from one room to the other to check on them.

It was exactly what Huang planned—a positive outcome for both patients.

“As much as we want to help improve the health and life of the recipient, we have to protect the living donors from immediate and future harm,” Huang said. “We are not successful unless both donor and recipient do well.”

The health and support systems of potential donors are evaluated carefully before each transplant is scheduled. The surgery is minimally invasive, so many donors are out of the hospital the next day and may return to work in two to three weeks.

And the surgery hasn’t kept donors like Buckhalt from returning to demanding jobs, such as firefighting or flying helicopters.

Buckhalt, who had joined the military in college just after 9/11, was redeployed to Afghanistan for his fourth combat tour not long after the procedure. It’s a fact that Buckhalt often mentions to potential donors who call him to ask for advice before a similar surgery. Said Bekki Haggard: “Allen tells people, ‘Six months later I was flying combat missions in the Middle East.’”

The Haggards also receive calls from those suffering from PKD or who are in need of an organ transplant, sometimes three or four times a week. They’re happy to discuss the particulars of how it went, and they also never end those calls without mentioning TGH. “Without a doubt, they were amazing,” Bekki Haggard said. “It wasn’t just the doctors and the nurses who were so helpful. It was also the coordinators on the front lines who helped us with all the red tape and scheduling.”

After Mike’s transplant, the Haggards wanted to give back to TGH in a meaningful way. They established a fund to help hire a full-time team member to support the Transplant Institute with its outreach and education regarding living donations.

Aside from realizing the importance of finding the right hospital, the Haggards also learned the bond that occurs during an organ donation. Buckhalt was already family, but Haggard said he now shares a bond with his brother-in-law that’s hard to define for anyone who hasn’t gone through it. In October, they celebrated their fifth anniversary since the operation, knowing that it couldn’t have happened without Buckhalt.

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WELL-BEING

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FLORIDA’S

WHEN IT COMES TO HEALTHY EATING, Florida’s year-round grow season means home chefs have access to amazing raw ingredients. As executive chef of the Florida Department of Agriculture’s Fresh From Florida Program, Justin Timineri crafts flavorful recipes that showcase the state’s locally or regionally grown or harvested crops. The native Floridian understands the importance of making healthy food appealing, especially for children. Here, he shares easy recipes that celebrate Florida’s agricultural treasures and ocean gems.

PHOTOGRAPHY COURTESY OF FRESH FROM FLORIDA

Florida Shrimp Boil with Sweet Corn and New Potatoes

CHEF JUSTIN TIMINERI, C.E.C., Certified Executive Chef, Florida Department of Agriculture

Preheat a large pot over medium-high heat. Add oil and turkey sausage and cook until lightly browned, about 2 minutes. Fill pot with water until pot is two-thirds full. Add most of the seafood seasoning, reserving one tbsp. for later. Bring the contents of the pot to a boil. Add the potatoes and cook for 10 minutes. Add corn and cook for 4 minutes. Add shrimp and cook until they are cooked through, about 2 to 3 minutes.

Drain all ingredients and place the shrimp boil ingredients on a platter. Lightly season with the remaining seafood boil seasoning mix and salt and pepper to taste. Garnish the shrimp boil platter with the diced tomato and parsley. Serve the shrimp boil with lemon wedges and hot sauce.

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INGREDIENTS (Serves 10-12) 1 lb. cooked low-sodium/low-fat turkey sausage (cut into 1-inch pieces) 1/2 cup seafood boil seasoning mix 1 lb. small new potatoes (peeled, if desired) 5 ears Florida sweet corn (husked and cut in half) 1 1/2 lb. large Florida pink shrimp (heads off, peeled, and deveined, if desired) 1 large Florida tomato (finely diced) 1/4 cup fresh parsley (finely chopped) Sea salt and fresh ground pepper to taste

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Grilled Florida Shrimp with Mango and Sweet Chili Sauce INGREDIENTS (Serves 4-6) 1 cup sweet chili sauce 1/2 lime (juiced) 1 tbsp. fresh ginger (grated) 1 tbsp. fresh mint (finely chopped) 4 Florida mangos (peeled and cut into 1/2-inch cubes) 20 large Florida shrimp (peeled and deveined) 2 tbsp. Florida sugar 1/4 cup scallions (finely sliced) Sea salt and fresh ground pepper to taste 20 small bamboo skewers (soaked in water for at least 1 hour) Cooking oil spray for grilling

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Combine the sweet chili sauce, lime juice, ginger, and mint in a small bowl. On a clean surface, place a mango cube in between the tail and top of a shrimp. Insert the bamboo skewer through the shrimp and mango.

Repeat the skewering process until all shrimp are skewered and store in the refrigerator until ready to grill.

Preheat a charcoal grill (or indoor grill pan) and cook the shrimp and mango skewers. When the shrimp is close to being cooked through, glaze with the sweet chili sauce. Sprinkle with sliced scallions, season, and serve.

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Roasted Florida Corn and Tomato Salad INGREDIENTS (Serves 4) 2 ears Florida sweet corn 1/4 cup skim or low-fat milk 1 cup plain Greek yogurt 2 tbsp. fresh herbs (such as thyme, rosemary, parsley, and/or dill) 1 garlic clove 1 lemon (juiced) 1 tsp. all-purpose seasoning (your favorite) Sea salt and fresh ground pepper to taste 2 heads Florida romaine lettuce (leaves left whole) 2 Florida tomatoes (finely diced)

Preheat a large cast-iron skillet to medium heat. Place corn in dry pan and roast for 8 to 10 minutes, turning several times to char all sides. Remove from heat, cool, then remove from cob.

Prepare dressing by adding milk, yogurt, fresh herbs, garlic, lemon juice, all-purpose seasoning, and salt and pepper to a blender. Blend thoroughly and set aside (or store in refrigerator) until ready to use.

Assemble salad by placing 2 to 3 romaine leaves on a plate, followed by 1/4 cup roasted corn, and 2 to 3 tbsp. diced tomatoes. Drizzle with dressing and serve immediately. Feel free to replace the romaine leaves with Florida spinach or arugula.

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Florida Escarole, Tomato, and White Bean Soup

Florida Watermelon Popsicles

INGREDIENTS (Serves 6) 1 tbsp. olive oil 2 cups onion (diced small) 2 cups Florida celery (diced small) 2 cups Florida carrots (peeled and diced small) 2 tbsp. fresh garlic (minced) 2 tbsp. fresh herbs (such as rosemary, thyme, and oregano; finely chopped) 8 cups low-sodium vegetable or chicken broth 1 tbsp. all-purpose seasoning blend (such as Everglades) 1 can white beans (drained) 4 large Florida tomatoes (diced) 1 large or 2 small heads Florida escarole (chopped large) Sea salt and fresh ground pepper to taste Florida-made hot sauce (your favorite) Fresh grated Parmesan cheese to taste Preheat a large soup pot or Dutch oven over medium-high heat. Add the olive oil to the preheated pot. Carefully add the onions, celery, and carrots to the pot. Cook ingredients for 5 to 7 minutes, while stirring occasionally. Add the garlic and fresh chopped herbs and cook for another 2 minutes. Add the broth and seasoning blend to the cooking ingredients in the pot.

Bring ingredients to a light boil and turn the heat down to a simmer. Add the beans, diced tomatoes, and escarole. Cook ingredients for at least another 7 to 10 minutes until the escarole is tender.

Taste soup and adjust seasoning with sea salt, fresh ground pepper, and a dash or two of hot sauce. Serve soup warm with fresh grated Parmesan cheese and extra hot sauce for garnish.

INGREDIENTS (Serves 4-6) 4-6 cups Florida seedless watermelon (cubed) 4 tbsp. Florida key lime juice 1/4 cup Florida sugar 1 lime (zest only) Add all ingredients to a blender and puree until smooth. Pour into popsicle molds (use wooden popsicles sticks or molds that have sticks provided) and freeze for at least 3 hours to set. Remove from molds and serve immediately.

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WELL-BEING

Sunshine State Supplies Florida-based companies are creating products intended to benefit PERSONAL AND ECOLOGICAL WELLNESS

BY LIZA GRANT SMITH

Blaze a Trail Add a fun and competitive element to your workouts with BlazePod, a smart reflex training system made in Miami. The standard kit ($300) includes four rechargeable LED light pods that, in conjunction with an app, can guide users through numerous workouts designed to improve reaction time, speed, and agility. (blazepod.com)

Clothes for a Cause Started by graduate students at the University of Miami, the purpose-driven Waterlust brand designs fitness clothing (deemed “advocate apparel”) to tell science stories. Each pattern speaks to a different ecological concern, and 10 percent of profits from every collection are donated to an associated organization. Sport an athleisure look from the whale shark collection (priced by piece) to support the Marine Megafauna Foundation. (waterlust.com)

Get a Grip Not only is grip strength an indicator of overall strength, but it is also associated with better mobility and athletic endurance. Improve yours with the digital grip strengthener ($69) from Plantation, Florida–based Squegg.

This smart squeeze ball is ergonomically designed, portable, and pairs with an app that evaluates your grip strength, measures grip count, and tracks progress. (mysquegg.com)

Hair Heroes Headquartered in Delray Beach, Florida, the team at Under the Sun has designed a more natural prescription for sunparched locks. The company’s trio of shampoo, leave-in styling conditioner, and conditioning treatment ($70) swaps parabens, sulfates, and sodium chloride in favor of botanical extracts that deflect the sun, salt, heat, and humidity. They claim the result is supremely nourished hair that is protected from Florida’s harsh elements. (alwaysunderthesun.com)

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To a Tea Founded by Amy Suzanne, a St. Augustine, Florida, mother of five who struggled with health issues until embracing natural products, Pink Stork offers wellness drinks, gummies, vitamins, and more to support the different stages of motherhood (including pregnancy, postpartum, and fertility), as well as general health concerns. Made with organic rosehips, dandelion, and lemon balm, the Calm tea ($16) promotes stress relief and relaxation. (pinkstork.com)

Face Value As a leader in the natural, plant-based skin care movement, Tammy Fender and her luxe products have earned a devoted following, including among celebrity fans. Those who can’t make it to her South Florida spas in West Palm Beach or Delray Beach can purchase her Restorative at-home facial treatment kit ($185), which claims to nourish dry, mature, or depleted skin. (tammyfender.com)

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