Volume 27
Number 4
February 19, 2016
Hospital of the University of Pennsylvania
WHEN MINUTES COUNT
The fight to save a patient with a rare, deadly disease Kim Pimley returned home on January 5th from a wonderful vacation to Hawaii with her son. Within a few days, though, she was feeling “not quite right... but I figured it would pass,” she said. When her shortness of breath had not improved by that Monday, she decided to see her doctor, who said she looked fine but ordered a chest x-ray. Two days later — January 13th — after her x-ray showed pleural effusion (water in the lungs), she was admitted to the University Medical Center of Princeton at Plainsboro. The following day, after “a million tests,” her cardiologist identified that she had severe cardiac dysfunction and arranged a transfer to HUP. What she initially thought was a minor complaint turned out to be something much more serious. In fact, it almost took her life.
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T H U R S D AY 14
INSIDE Mind Your Brain: Helping TBI Survivors...............3 What’s New at the Center for Nursing Renewal? ..............3 Keep Patient Information Safe...3 Caring for a “Growing” Population..................................4 Join Penn’s Love Run Team!....4 Raising Colon Cancer Awareness..................................4 Heartfelt Thanks........................4
Pimley arrived at HUP by ambulance late Thursday afternoon and was immediately brought up to the Cardiac Care Unit on the service of Anjali Vaidya, MD, of the Heart Failure and Cardiac Transplant Program. Based on the appearance of her echocardiogram, the irregular heartbeat on telemetry, and how quickly Pimley’s condition seemed to be deteriorating, one diagnosis came to Vaidya’s mind: giant cell myocarditis. Giant cell myocarditis, an inflammation of the heart, is a very rare cardiovascular disorder that destroys the heart’s ability to beat normally. There is no known cause. A mere 300 cases — and very few studies — have been reported in the literature.
“Our program sees a lot of sick patients with heart failure,” Vaidya said. “But we not only know the exact number of cases of giant cell we’ve treated over the years but can also recite the names of the patients.” Vaidya had Pimley brought to the cardiac catheterization lab where Daniel Kolansky, MD, associate chief for Clinical Affairs in Cardiovascular Medicine, performed a diagnostic heart biopsy and a right heart catheterization to measure the pressures and flows of her heart. “When I first met Kim, it was evident she was in severe heart failure,” Vaidya said. Kolansky also placed an intra-aortic balloon pump to help increase blood flow. (Continued on page 2)
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WHEN MINUTES COUNT While Pimley was in the cath lab, Vaidya got consent for and arranged for her to undergo evaluation for a possible heart transplant. “I was worried,” she said. When Vaidya returned to the CCU, she advised Pimley to have her loved ones come back to HUP — in her room — the following morning as early as possible so they would be present to meet the other key members of the heart transplant team. “When she told me to call my son [who had just returned to Tokyo after the trip] to come back, I knew it was bad,” Pimley said. JAN
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F R I D AY
Pimley’s condition continued to worsen, despite having the pump and medication to help her heart beat stronger. In the early morning she began having persistent ventricular tachycardia, a life-threatening irregular heart rhythm, and was stabilized on ECMO (extracorporeal membrane oxygenation), which provided both cardiac and respiratory support. But “she was at high risk of having a cardiac arrest,” Vaidya said. By mid-morning the confirmed diagnosis came back. Vaidya’s hunch had been correct. Pimley had giant cell myocarditis. That afternoon, at an emergency meeting of the entire heart transplant team, a decision was made. She was listed for heart transplant as a status 1A, the most urgent category. She had been at HUP less than 24 hours. JAN
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S U N D AY
Kim was at very high risk and I don’t
know if she would have survived. I will remember this patient for a long time. JAN
18 M O N D AY The transplant team got the call they were hoping for in the early morning: the heart was a go! Pimley said a small prayer before being put under but also noted that even the date of the transplant — the 18th — was hopeful. “18 in the Jewish religion is chai, which means life,” she said. After successful cardiac transplant surgery by Pavan Atluri, MD, a new heart was beating in Pimley’s chest. Over the next eight days, she recovered and regained her strength. FEB
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T U E S D AY
The day after a second routine post-transplant biopsy showed no rejection, Pimley was discharged from HUP. Her experience was “an education about how wonderful the caregivers are and how challenging their jobs are,” she said, adding that her team showed “clinical brilliance and strategic decision-making prowess that was only surpassed by their compassion and kindness.” Pimley thinks a lot about her donor and prays for their family at this difficult time. She vows not to waste “a tick of this beautiful new heart.” And she wonders what might have happened if she had continued to ignore the signals her body was sending. “Kim was at very high risk and I don’t know if she would have survived,” Vaidya said. “I will remember this patient for a long time.” Read about the behind-the-scenes efforts to save Kim Pimley’s life at http://bit.ly/1VkfCti.
In spite of the serious circumstances, Pimley actually had many things in her favor heading into a transplant. She was, ironically, in very good shape physically. In fact, on her trip to Hawaii, she had completed a rigorous course in Krav Maga, Israeli self-defense. “I was healthy as a horse,” she said. And she was always on the go. In addition to running a financial training company, she serves as chair of the Board of Trustees of the Princeton Healthcare System and sits on the Executive Council of the American Jewish Committee. Her blood type, small stature, and elevated status on the transplant list (due to her dire condition) improved her chances of getting a heart quickly. “We hoped something might happen by the end of the weekend,” Vaidya said. “All the stars seemed to align.” The call came in that night. Based on initial testing, there was a potential match but they wouldn’t know for sure until the organ was procured. `` In a biopsy of Kim Pimley’s heart, normal heart cells (pink/red) are being completely invaded by abnormal giant cells (purple).
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WHAT’S NEW
AT THE CENTER FOR NURSING RENEWAL? With the closing of Penn Tower, the Center for Nursing Renewal found a new home on 2 Donner, offering a variety of services, such as:
• Classes (including yoga, Pilates and interval training)
`` Robin Armstrong (l) with Candace Gantt
Mind Your Brain HELPING TBI
SURVIVORS
Each year an estimated two million Americans suffer a traumatic brain injury (TBI). Many are concussions — the most common form — but even the mildest TBI can leave a person with symptoms (such as forgetfulness, confusion, or not being able to stay on point) that linger long after the injury itself. “There’s a lot of frustration and confusion over where to go for symptoms that continue past discharge,” said Robin Armstrong, administrative lab manager in Neurosurgery. Armstrong and other members of Penn’s Center for Brain Injury and Repair (CBIR) have done community outreach to raise awareness about TBIs and how to prevent them — for example, wearing a helmet during risky sports. But last year, in response to the many calls she and others received from survivors about where to find help after discharge, they pulled together the Mind Your Brain @ Penn Medicine conference to share research, insights and therapies that address the personal and medical issues of those impacted by brain injury. “This was the first time our department has offered this type of program to the public,” she said. “Dr. Grady [chair of Neurosurgery] has been so supportive.” Armstrong worked with former Penn patient Candace Gantt — who spearheaded the idea — to pull the conference together. Gantt suffered a TBI after being hit by a truck while biking and spent several weeks in a coma at Penn. But one year after the injury, she returned to competing in half-Ironman races and also began raising funds through her races for the CBIR. Funds are awarded as pilot grants to young investigators focused on brain injury research, diagnostics and treatment. A recent Penn Medicine CAREs grant will help the CBIR sponsor a second conference in March. The program will feature presentations, interactive discussions and resource sharing by a variety of authorities, including Penn Medicine’s experts on neuroscience and brain injury, physical, occupational, and speech therapists, and brain injury survivors. “We want to provide the necessary resources to help TBI survivors on their journey to recovery,” Armstrong said. The conference, which is for brain injury survivors, families, caregivers and others who are interested, will be held on Friday, March 4, in the Smilow Research Center. To learn more, go to pennmedicine.org/myb. Departments that provide care to TBI patients and are interested in participating in next year’s event should contact Armstrong at robin@upenn.edu. To learn more about Penn’s Center for Brain Injury and Repair, go to med.upenn.edu/cbir.
• Fitness room • Library with computer • Lactation Lounge (three stations) • Relaxation room (three massage chairs) • Refreshment room • Touchdown stations with computers The Center (accessible via the Silverstein elevators to second floor and following signs to cafeteria) is open Monday through Friday from 7:30 a.m. to 9:00 p.m., but, as part of a pilot program, the Center will be open on Saturdays in February as well, from 9:30 a.m. to 3:30 p.m. If you have any questions, call the Center at 215.662.2471.
Keep Patient Information Safe February is Data Privacy Month, a reminder that protecting the privacy of our patients’ information is a priority. For example:
• Never store patient information on unencrypted devices.
• Only access patient records as needed for your job.
• Always lock records with protected information in filing cabinets and dispose of them by shredding.
To learn more ways to keep protected health information safe, go to http://bit.ly/1KUr523. If you have any questions, contact privacy@uphs.upenn.edu.
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Join Penn’s
CARING FOR A “GROWING” POPULATION Over 78 million adults and nearly 13 million adolescents in this country are obese. Philadelphia has the second highest rate of obesity among the 10 counties with the nation’s largest cities. Indeed, according to a U.S. Centers for Disease Control and Prevention report, in North Philadelphia, 70 percent of kids are overweight or obese and are more likely to stay that way into adulthood. And adult obesity rates in the surrounding counties are high as well. With these individuals making up nearly one-third of the country’s population, the need for effective, durable, and safe obesity treatment — like bariatric surgery and other weight management programs — is greater than ever. One way to help alleviate the rates is to improve access to care. “By making information sessions and clinical visits available to patients in the areas surrounding Philadelphia, we’re able to help more of those who are battling obesity,” said Noel Williams, MD, FRCSI, director of the Penn Metabolic and Bariatric Surgery Program. Bariatric surgery is not for cosmetic weight loss or to lose a few pounds. Qualified patients are more than 100 pounds over their ideal body weight or have a Body Mass Index greater than 40. Learn more at http://bit.ly/20XVy6N.
Heartfelt Thanks A LET TER FROM THE WIFE OF A TRANSPLANT PATIENT
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I feel like shouting from the rooftops that Penn Medicine to a person is the finest, most professional, caring institution I have ever been to. From the valet parker to the transporter to the operating prep room to the nurses, doctors, transplant team, the people who clean. Everyone we came in contact with was outstanding! I will just note 4 very special people who pop in my head first:
Ralph Ogden, the transporter… AMAZING compassion when we needed it most. We came two times only to be sent home because the [organ] was not a fit. Both times Ralph took us back and forth to the room. So when we came the third time he made sure he took us and was thrilled for us….
Jennifer Naji, on Rhoads 5 ICU, was a top notch professional and a warm and caring woman.
Latoya Jones, of Rhoads 4 [surgical unit] … laughter, good spirits giving us confidence and making relationships with us.
Tasha Washington on Rhoads 4 who cared for [my husband] with care and the greatest sense of humor in the world.
I hope this recognizes some of our heroes and thanks them and Penn for a lifesaving week so I get to spend another 20 years with my loving husband.
LOVE RUN TEAM! Join Team Penn for the 2016 Philadelphia Love Run, a half marathon race on Sunday, April 10. From the Art Museum to Independence Hall, this race includes many of the city’s most historic sites. As a team member, you qualify for a discount on the registration fee, some great giveaways, and access to the Penn Medicine team tent on race day. To register for Team Penn, go to PennMedicine.org/LoveRunTeam.
Raising Colon Cancer
AWARENESS
Colon cancer is the most commonly diagnosed cancer in the United States. If caught early, there is a 90 percent chance that your cancer can be cured. A simple colonoscopy can make a world of difference. To show your support for Colon Cancer Awareness, wear blue on Friday, March 4. Take a picture and share on Facebook using the #GetScreened and @PennCancer tags.
HUPdate HUPdate EDITORIAL STAFF EDITORIAL Sally SapegaSTAFF Sally Sapega Editor and Photographer Editor and Photographer Lauren Hochenberger Lauren Hochenberger Graphic Designer Designer
ADMINISTRATION Susan E. Phillips ADMINISTRATION
SeniorE.Vice President, Public Affairs Susan Phillips Senior Vice President, Public Affairs Holly Auer Director of Communications
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