A PUBLICATION OF KECK MEDICINE OF USC
VOL. 2017 ISSUE 1
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10 S pecialists at USC Verdugo Hospital team up to 18Hills 6 P provide ump Upcomplete the Volume A Bigcancer Win for Weight Loss care for breast patients
Sp ec i Ve al In r s Ho dug ert sp o H for ita ill U l s SC
HIGH-TECH PROSTHETIC IMPLANTS AND SURGICAL ADVANCES MEAN TOTAL HIP REPLACEMENTS ARE A VIABLE OPTION FOR YOUNGER PATIENTS.
A PUBLICATION OF KECK MEDICINE OF USC
Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. Encompassing academic, research and clinical entities, it consists of the Keck School of Medicine of USC, one of the top medical schools in Southern California; the renowned USC Norris Comprehensive Cancer Center, one of the first comprehensive cancer centers established in the United States; the USC Care faculty practice; the Keck Medical Center of USC, which includes two acute care hospitals: 401-bed Keck Hospital of USC and 60-bed USC Norris Cancer Hospital; and USC Verdugo Hills Hospital, a 158-bed community hospital. It also includes outpatient facilities in Beverly Hills, downtown Los Angeles, La Cañada Flintridge, Pasadena, and the USC University Park campus. USC faculty physicians and Keck School of Medicine departments also have practices throughout Southern California. Thomas Jackiewicz, MPH Senior Vice President and CEO for Keck Medicine of USC
Editor
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Contributing Writers
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Amanda Busick Jeana Rettig
Martin Booe, Hope Hamashige, Candace Pearson
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©2017 Keck Medicine of USC Permission to reprint articles is available upon request. No artwork may be reproduced without the artist’s consent. Our mailing list comes from several sources. If you receive duplicate copies of this magazine, please send us all the label information and we will strive to eliminate the duplication. Direct inquiries to Keck Medicine of USC Marketing and Communications, SST-2830, 2011 N. Soto St., Los Angeles, CA 90032.
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Keck Medicine of USC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Keck Medicine of USC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. ATTENTION: If you speak Spanish, Chinese, Vietnamese, Tagalog, Korean, Armenian, Persian-Farsi, Russian, Japanese, Arabic, Punjabi, Cambodian, Hmong, Hindi, or Thai— call the number below for free language assistance services. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800.872.2273. 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800.872.2273.
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ON THE COVER 2 Hip Hip Hooray!
A young man’s hip replacement makes him feel like the Bionic Man.
FEATURES 6 All in the Family A family takes charge of their health with genetic testing for gene mutations that cause cancer.
13 Vision Quest A partial corneal transplant restores a retired neurosurgeon’s sight.
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14 The Right Call
His vacation could have been deadly if not for some quick thinking and the USC Aortic Center’s rapid response program.
16 Staying on Course
A Keck Medicine patient doesn’t let an MS diagnosis slow her down.
18 Listening to the Signs
A USC graduate student bounces back after treatment for a rare brain tumor.
20 Healthoughts: Medical News You Can Use
Recent rankings for Keck Medicine of USC, facts about diabetes and atrial fibrillation.
NEWS FROM USC VERDUGO HILLS HOSPITAL 9 Coming Up Roses USC-VHH offers advanced spine surgery in a community setting. 10 All the Right Answers Not content with her original breast cancer care plan, a woman finds the answers she needs at USC-VHH.
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12 Q&A: Male Infertility Straight talk about male infertility.
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I AM THE BIONIC MAN 2 (800) USC-CARE
COVER STORY
by Hope Hamashige
THE EVENING AFTER HIS HIP REPLACEMENT SURGERY, ANDREW CROMWELL WALKED A FEW LAPS AROUND THE NURSE’S STATION ON HIS FLOOR OF KECK HOSPITAL OF USC. WHEN HE FINALLY SETTLED INTO BED, HE FIRED UP HIS LAPTOP COMPUTER AND SENT OUT A QUICK MISSIVE TO LET HIS FAMILY AND FRIENDS KNOW HOW HE WAS FEELING. “I am the Bionic Man,” he wrote before turning in. By the next day, Cromwell was walking up and down flights of stairs in the hospital, albeit slowly, and was sent home with a bag of pain pills that he never used. “I never needed them,” he says. When his hip and back began causing him pain about a year ago, Cromwell decided it was probably related to a spill he had taken at home a few months earlier. Assuming it would subside with time, he visited massage therapists and a chiropractor hoping they would help speed his recovery.
Instead, the pain became more consistent and more intense. Before long, the banking executive was having trouble performing two key functions of his job: sitting comfortably at his desk and on airplanes. Cromwell bought new chairs and adjusted the way he sat at his desk in a vain attempt to find a solution to the pain that was beginning to wear on his good nature. He eventually sought help of an orthopaedic surgeon in Orange County who told him he had osteonecrosis, or bone death preceded by loss of blood to the bone, in the head of
his femur. His doctor also said he did not have the expertise to treat him, but did know someone who did. “He said that I should see Jay Lieberman at Keck Medicine because he is someone who has significant experience treating osteonecrosis of the hip,” recalls Cromwell. Though there are less dramatic measures for treating early stage osteonecrosis, his condition was advanced. The team at Keck Medicine’s orthopaedic surgery program could attempt a core decompression, a procedure to try to restore blood
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flow to the bone, but if that didn’t work, he would eventually need a hip replacement.
I FEEL GREAT AND I WOULDN’T THINK TWICE ABOUT IT IF I HAD TO DO THIS AGAIN OR IF I HAVE TO DO THIS ON THE OTHER HIP.
At 41, Cromwell did not expect to be a candidate for total hip replacement, but he quickly learned that this procedure is no longer performed only on older people. Though surgery is never the first line of defense, particularly when dealing with young people, Lieberman, MD, professor and chair of the department of orthopaedic surgery at the Keck School of Medicine of USC and director of the Institute of Orthopaedics, notes that in cases where other potential treatments have failed and the patient’s quality of life is compromised by conditions including osteonecrosis or osteoarthritis, the team of orthopaedic surgeons at Keck Medicine have replaced hips on people under the age of 20.
While those represent unusual cases, research from the U.S. National Center for Health Statistics shows that the number of total hip replacements performed on people between the ages of 45 and 54 rose 205 percent between 2000 and 2010. One of the reasons for this is that the prostheses have improved dramatically in recent years. When hip replacements were first performed, the prosthetic hip often wore out after 10 years, so doctors avoided performing them on young people because it meant they would need many difficult surgeries in their lifetime. Today, however, new materials used to construct prosthetic hips last longer, work better and create fewer complications in patients. As a result, notes Daniel A. Oakes, MD, associate professor of clinical orthopaedic surgery at the Keck School and director of the USC Joint Replacement Program, some patients may now have the same prosthetic hip for upward of 25 years. Cromwell eventually decided that having a hip replacement was his best option to keep up with his responsibilities at work and at home, as a dad to young kids who are “always on the go.” He says he was also confident that he was in good hands. The multidisciplinary team of orthopaedic surgeons at Keck Medicine is highly experienced and often deals with complex cases, which is one of the reasons it is ranked 22 in the nation by U.S. News and World Report. Within a few weeks of his surgery, Cromwell made his first post-operative cross-country flight for work and, to his surprise, it was the first time he had flown in many months without pain. Because he’s in his early 40s, it is likely that Cromwell will need to have his prosthesis replaced at some point in the future. There’s also the possibility that the osteonecrosis will affect his other hip and he will face having to have a second hip replacement, but that idea doesn’t have him too concerned. “I took a week off work after surgery, but I didn’t need more than a couple of days,” he admits. “I feel great and I wouldn’t think twice about it if I had to do this again or if I have to do this on the other hip.”
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QUESTIONS 5EXPERT ANSWERS 5 FIVE EXPERT SURGEONS FROM THE DEPARTMENT OF ORTHOPAEDIC SURGERY AT KECK MEDICINE OF USC ANSWER SOME COMMON QUESTIONS ABOUT JOINT REPLACEMENT.
1. What is a joint replacement? Joint replacement is actually the replacement of the worn cartilage with a new metal or ceramic surface against plastic. In the knee, the operation puts a new surface on the knee. In the hip, the metal stem in the femur and the metal shell in the pelvis is where we attach the new surface to your bone. Think of it as a resurfacing with metal on the end of the femur (upper bone) and plastic on the tibia (lower bone). The longevity of these operations is now 30 years when done correctly, so for most patients the joint will last the rest of their lives.
THEDOC LAWRENCE DORR, MD professor of clinical orthopaedic surgery at the Keck School of Medicine of USC
2. What can a patient do now to avoid surgery later? Genetics, anatomy and some environmental issues are not under our control but the hallmark of joint preservation is low-impact, consistent and directed exercise to build muscle and cardiovascular fitness without causing undue wear and tear to the joints. Eating a good balanced diet, avoiding smoking and maintaining a healthy lifestyle also help. Finally, many patients don’t get enough rest, which allows the body to recover and heal.
3. How has joint replacement surgery advanced over the years? The two most important recent advances in total hip and knee replacement have been the development of advanced pain management regimens and the implementation of aggressive physical therapy protocols. Our patients start receiving pain medication three days prior to surgery to block pain receptors in the brain. Additionally, the affected joint is injected with pain medications at the end of the procedure. Total knee replacement patients also receive a regional block that relieves pain and allows them to walk the evening of surgery. The combination of these treatments results in excellent pain control. The new pain regimens also allow for patients’ rapid mobilization—at Keck Medicine of USC, most receive physical therapy and get out of bed the day of surgery. The physical therapists will also teach the patient joint exercises. These effective pain protocols and aggressive PT allow many patients to go home the day after the surgery. As a result, patients quickly gain confidence in their new joints, which further facilitates the recovery process.
THEDOC JAY LIEBERMAN, MD professor and chair, Department of Orthopaedic Surgery at the Keck School of Medicine of USC
Since joint replacement patients are of varying ages and health statuses, recovery is not the same in all patients. However, most patients are walking fairly well at two weeks and are well along the path to recovery by six weeks. Patients will be up for a walk the same day of the surgery with a walker or crutches, and most will be able to go home one to two days after surgery. There will likely be some discomfort, but probably not as bad as might be expected, and appropriate pain medication will be prescribed. Frequent elevation of the leg is recommended to ease swelling in the leg at and below the area of surgery. Compression stockings are useful to help prevent excessive swelling and blood clots.
THEDOC DONALD LONGJOHN, MD assistant professor of clinical orthopaedic surgery at the the Keck School of Medicine of USC
5. Is there an option for patients to undergo a less invasive surgery? The knee has three main compartments: the medial (inside of knee), the lateral (outside of knee), and the patellofemoral (under the knee cap). Between 10-20% of our patients with knee arthritis have damage to only one compartment and the rest of the knee is unaffected. In these cases, it is ideal to replace only the worn part of the knee and to preserve the remaining normal structures. At Keck Medicine, we utilize robotic assisted technology to precisely place the partial knee replacements through a less invasive surgical approach which facilitates recovery and optimizes long term outcome.
THEDOC DANIEL OAKES, MD associate professor of clinical orthopaedic surgery at the Keck School of Medicine of USC
THEDOC PAUL GILBERT, MD assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC
4. What can a patient expect during their recovery?
Learn more at: joint-replacement.keckmedicine.org KeckMedicine.org
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ALL
IN THE
AMILY F by HOPE HAMASHIGE
When Sherri Hollingsworth learned she had uterine cancer, it wasn’t a complete shock. Many people in her family had been diagnosed with cancer, including her mother, who also had been diagnosed with uterine cancer.
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“I would say that figuring out I had a genetic mutation was a gift.” Because of her family’s strong predisposition to cancer and because gynecological cancers are often hereditary, Hollingsworth’s doctor suggested she see one of the genetic counselors at the USC Norris Comprehensive Cancer Center. Working with the doctors and counselors in the Cancer Genetics Program at USC Norris, she pieced together a history of cancer in her family. A blood test confirmed what her doctor had suspected: She had Lynch syndrome, an inherited genetic condition that is associated with an elevated risk of several types of cancer. “I would say that figuring out I had a genetic mutation was a gift,” says Hollingsworth, because the information will help all of her family understand their risk and prepare for it.
behalf with insurance companies. The team will seek low-cost options when needed, and help their patients and their families stay on top of their screenings, including some they might not ordinarily get. “Once someone comes to Genetics we become super advocates for that patient and for their whole family,” explains Julie Culver, a genetics counselor at USC Norris.
“We know that in Lynch syndrome, screening leads to a 65 percent reduction in mortality,” says Stephen B. Gruber, MD, PhD, MPH, professor of medicine at the Keck School of Medicine of USC, who has studied Lynch syndrome for 30 years. “Screening saves lives.”
Kevin McDonnell, MD, PhD, instructor of clinical medicine at the Keck School, added that the genetic information is also shared with patients’ medical teams, including oncologist, and may inform the type of treatment they receive. “With some genetic mutations, identification of the mutation may allow treatment with specific medications that improve their responses to cancer therapy.”
Once a diagnosis is made, the team at USC Norris goes into high gear to develop a treatment strategy for the entire family. They will test other family members, work up their screening plans and intervene on their
After Hollingsworth tested positive for Lynch syndrome, her daughter Cory Kachigan also tested positive. Like her mother, Kachigan believes that knowing her genetic predisposition to cancer gives
THE BOTTOM LINE FOR PATIENTS WITH LYNCH SYNDROME Proactive, regular screening is essential to early detection and better outcomes. Patients with Lynch syndrome should begin screening for colon cancer earlier and more frequently than the general population. They should consider screening and preventive options for a broad variety of cancers.
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KEVIN MCDONNELL, MD, PHD instructor of clinical medicine at the Keck School of Medicine of USC
“In spite of being the most common inherited susceptibility to colon cancer, Lynch syndrome is both underdiagnosed and
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her an edge. At 25, she says she has time to work with the team at USC Norris to develop her screening plan. She also has many years to take charge of her overall health. “The cancer genetics program team helped me understand that by no means is this a 100 percent guarantee that these things will happen,” Kachigan says. But to give herself the best shot at living a long life, Kachigan has come to terms with the fact she will start screening younger than most people and that she will be tested for a wide variety of cancers. In the meantime, she and her mother help each other through the journey by encouraging each other to eat healthfully and regularly attending exercise classes together, including a barre class several mornings a week. And should it come to it, the USC Norris team is the most qualified to treat cancers that might arise. “USC Norris is the leading center in the nation for Lynch syndrome,” Gruber says. “We have all the expertise to manage patients with Lynch syndrome, from geneticists, surgeons, medical oncologists and clinical trials that help advance care for our patients.”
Learn more at: cancer.keckmedicine.org 8 (800) USC-CARE
STEPHEN B. GRUBER, MD, PHD, MPH professor of medicine at the Keck School of Medicine of USC
underrecognized. It is unfortunate because having this information definitely saves lives.”
LYNCH SYNDROME: SOME FACTS IN THE GENES Lynch syndrome is an inherited genetic condition, also known as hereditary nonpolyposis colorectal cancer. Lynch syndrome carries a significantly higher risk for developing colon cancer, often at an earlier age than the general population. 70% BY 70 Lynch syndrome patients have a 70 percent chance of developing colon cancer by age 70. It also increases the risk of several other cancers, including endometrial, ovarian, kidney, stomach, small bowel and hepatobiliary cancers. 30 YEARS OF RESEARCH Though a genetic link to colon cancer was suspected for about a century, the first gene associated with Lynch syndrome was identified about 30 years ago. Since then, research has pushed understanding of the disease and doctors have been able to adopt life-saving strategies that include screening, medication and sometimes risk-reducing surgery.
COMING UP Roses
by Candace Pearson
USC Verdugo Hills Hospital offers advanced spine surgery in a community setting.
Gary Dennis used to enjoy taking frequent lunchtime walks from his office to the Exposition Park Rose Garden and USC campus, about a two-mile round trip. However in 2016, that scenic stroll — and his daily commute from Eagle Rock — became impossible when the back pain that had plagued him sporadically since 2002 intensified.
THE DIAGNOSIS Driving 12 traffic-plagued miles into work, he often had to pull over, get out of the car and wait for the pain to subside. He was ready to take things to the next level: surgery. “I’d been hoping that day would come for a long time,” says Dennis, a 36-year USC employee in the information technology department. Dennis met with Raymond J. Hah, MD, assistant professor of orthopaedic surgery at the Keck School of Medicine of USC, who specializes in conditions of the neck and back at USC Verdugo Hills Hospital. The diagnosis: spinal stenosis of the lumbar spine. This narrowing of the spinal canal in the lower back is caused by the growth of bone, tissue or both, in openings in the spinal bones. These growths can pinch and inflame nerves near the spinal cord.
THE SURGERY Spinal stenosis is slowly progressive and does not always require surgery. But for many, the solution is a laminectomy, also known as decompression surgery. This diagnosis came at just the right time. The USC-VHH spine program — an extension of the respected USC Spine Center at Keck Medicine of USC — launched six months earlier with advanced surgical services that most community hospitals do not offer. “Our goal is to make this one of the best spine centers in the region,” says Hah, who also practices at Keck Hospital of USC.
Hah says a successful spinal procedure “goes beyond the surgeon’s role. It takes a multidisciplinary team.” That includes experienced operating room nurses, surgical technicians, physical and occupational therapists, pain management experts and other specialists in post-operative care. Dennis was walking the USC-VHH hallways the afternoon of his surgery without aid and went home the next day. Good recovery from back surgery depends in part on such “early mobilization,” Hah says. “Having the patient get up and moving soon after surgery helps with minimizing pain and easing recovery.”
THE OUTCOME Dennis tested his post-surgical progress in a series of careful outings. A trip to the Pantages Theater for a performance was uncomfortable, but he followed that with a USC football game that caused only a few twinges. Finally, he sailed through a Los Angeles Rams game with flying colors. Now eight months after surgery, Dennis is managing to walk up to a mile and a half at a time. He fully expects those Exposition Park roses to be blooming for him again very soon.
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RAYMOND J. HAH, MD assistant professor of orthopaedic surgery at the Keck School of Medicine of USC
Learn more at: uscvhh.org/spine USCVHH.org
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All the Right Answers by Hope Hamashige
SUSAN GARRAHAN DIDN’T FEEL SHE AND HER ONCOLOGIST WERE ON THE SAME PAGE WHEN IT CAME TO HIS PLAN FOR TREATING HER BREAST CANCER. THE ONCOLOGIST, TO WHOM SHE HAD BEEN REFERRED BY HER INSURANCE COMPANY, RECOMMENDED A LUMPECTOMY ON HER LEFT BREAST FOLLOWED BY CHEMOTHERAPY AND RADIATION. SHE WASN’T COMFORTABLE WHEN HE REBUFFED HER CONCERNS ABOUT RADIATION, BUT SHE WAS MOST ALARMED AFTER LEARNING THAT HE WOULD CONSIDER HER TREATMENT TO BE A “SUCCESS” IF SHE LIVED FOR ANOTHER FIVE YEARS. THEN 48, GARRAHAN WANTED TO BEAT THE CANCER, RETIRE FROM HER JOB AT JET PROPULSION LABORATORY IN 15 OR 20 YEARS AND ENJOY A LONG LIFE IN THE COMPANY OF HER HUSBAND AND FAMILY. 10 (818) 790-7100
THEDOCS So she went in search of a second opinion, even though her insurance company did not want to pay for one. Her hunt for a fresh point of view led her to Ketan Patel, MD, and Maria Nelson, MD, both assistant professors of clinical surgery at the Keck School of Medicine of USC. “I felt like they understood my questions and concerns about the risks and I felt like they answered my questions honestly,” Garrahan says. Nelson and Patel are part of a team of breast specialists at USC Verdugo Hills Hospital (USC-VHH) who offer patients a unique approach to treating breast cancer by coordinating care at every step and collaborating to develop a comprehensive, personalized treatment plan that begins with understanding their patients’ expectations for their treatment. “We spend time with them, learning what they expect and telling them about all of their options and the pros and cons of each,” Patel explains. Nelson and Patel believe that working together improves outcomes for their patients. They always know what the other is planning so there are no surprises for them or for their patients. They also perform the broadest possible range of surgical options including procedures not offered everywhere such as DIEP flap reconstructions, in which fat, skin, and blood vessels from the lower belly are used to rebuild the breast. Garrahan changed her insurance to a plan that would allow her to receive her treatment at USC-VHH. And while it was their willingness to work with her, rather than dictate to her, that made her take that step, she is glad for another reason. After reviewing Garrahan’s records, Nelson performed additional tests, which revealed precancerous tumors in her right breast and uncovered a rare genetic mutation that put Garrahan at high risk for developing soft tissue cancer.
MARIA NELSON, MD KETAN PATEL, MD assistant professors of clinical surgery at the Keck School of Medicine of USC
“We spend time with patients, learning what they expect and telling them about all of their options and the pros and cons of each.” “It’s not uncommon for a patient’s work-up to be inadequate,” Nelson notes. “I find that with our multi-disciplinary team approach, we are able to be more thorough and help ensure nothing is missed.” Armed with better information, Garrahan chose to have a nipple-sparing double mastectomy to minimize the chance of recurrence and spare her from radiation. Nelson and Patel operated on her in tandem, performing the double mastectomy and the first phase of her reconstruction in one day. But she’s grateful for more than just the care she received. “Dr. Patel and Dr. Nelson saved me from a terrible outcome,” Garrahan says. “I could have a large visible scar and radiation damage and I also know that I would have gotten cancer in my right breast and would have gone through everything all over again.” A little more than a year after her initial surgery, Garrahan has only one physical reminder of her breast cancer: a pencil thin scar on each now-healthy breast. And though she is also still taking Tamoxifen, she says that her best medicine is Skippy, a dog she rescued and who now accompanies her on daily walks, another measure she is taking to stay healthy for the long run.
“ Dr. Patel and Dr. Nelson saved me from a terrible outcome... I felt like they understood my questions and concerns about the risks and I felt like they answered my questions honestly.” Learn more at: uscvhh.org/ hospital-services/ breast-care-services USCVHH.org
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A & Q
Everything You Wanted to Know About Male Infertility but Were Afraid to Ask
MARY SAMPLASKI, MD, ASSISTANT PROFESSOR OF CLINICAL UROLOGY AT THE KECK SCHOOL OF MEDICINE OF USC, AND EXPERT FERTILITY SPECIALIST AT USC VERDUGO HILLS HOSPITAL, ANSWERS A FEW COMMON QUESTIONS ABOUT MALE INFERTILITY.
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H ow long should a couple try to conceive before seeking help from a specialist or being tested?
A C ouples should seek medical attention from a fertility specialist after a year of unprotected intercourse. If the female partner is older than 35 years, or there are concerns in either partner, it may be wise to be evaluated after 6 months of trying.
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W hat can I do to improve our chances of conception?
uit smoking. Men who smoke cigarettes A Q have lower sperm counts — which applies to both cigarettes and marijuana. It takes smokers longer to conceive and smoking (even secondhand smoke) may lead to genetic abnormalities.
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I s my cell phone a culprit? What about hot tubs?
A T he role of cell phones in male infertility is still being determined. Existing studies have demonstrated conflicting results, but some have found a decrease in sperm motility after exposure to cell phone radiation. However, these negative effects were negated by taking a multivitamin. A H ot tubs and saunas are well known to be harmful to sperm. The purpose of the testicles being outside of the body is for them to be slightly cooler, which promotes sperm production.
A L ose weight. Overweight and obese men have worse sperm quality compared with men of healthy weight. A D on’t use testosterone supplements. Testosterone supplementation will shut down sperm production.
Learn more at: uscvhh.org/ hospital-services/urology 12 (818) 790-7100
MARY SAMPLASKI, MD assistant professor of clinical urology at the Keck School of Medicine of USC
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BIBIANA J. REISER, MD, MS assistant professor of clinical ophthalmology at the Keck School of Medicine of USC
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VISION Quest by Martin Booe
Photo courtesy of USC Gayle and Edward Roski Eye Institute
Vision loss is unwelcome under any circumstance, but for GEORGE LOCKE, MD, retired professor of neurosurgery, good eyesight was crucial not just to his own well-being, but to that of the many patients he’d cared for throughout his career. Three years ago, Locke began to suffer from clouded vision in his right eye brought on by a combination of glaucoma and cataracts. A series of procedures to restore his vision had culminated in a corneal transplant with a troubling outcome: tissue rejection with a lot of scarring. Locke knew another surgery would be complex and delicate, so he drew on his own considerable medical knowledge and researched options for the most appropriate treatment with the best clinician. His inquiries led him to the USC Gayle and Edward Roski Eye Institute and Bibiana J. Reiser, MD, MS, assistant professor of clinical ophthalmology at the Keck School
of Medicine of USC, and an expert in corneal disease and tissue surgery. Rather than repeat the full corneal transplant, Reiser performed a procedure known as Descemet’s stripping automated endothelial keratoplasty (DSAEK), in which only the diseased portion of the corneal tissue is removed and then replaced with a graft from donor tissue. And because DSAEK does not require sutures, it promotes more rapid vision recovery, decreases the chance of surgically induced loss of visual acuity and reduces the risk of surgical complications. “Today there is quite an array of transplant techniques available to patients who have
corneal disease,” Reiser says. “They range from a full-thickness transplant to transplants that only replace the front part of the eye – or the back part of the eye like the transplant that Dr. Locke had. At Roski, we have a very deep bench of individual specialists, so patients can see a specialist who’s one of the best at a particular surgery, rather than someone who may do a wider range of surgeries but may not be the best.” Happily, Locke’s operation was a success and his eyesight has been completely restored. “My experience at Keck Medicine in care and surgery has been absolutely phenomenal,” Locke says. “This is as good as it gets. I love the people here, their professionalism and compassion. I would recommend USC Roski Eye Institute and particularly my doctors to anyone, especially if they’re facing a complicated eye surgery.”
Learn more at: eye.keckmedicine.org KeckMedicine.org
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The Right CALL
IT WAS LIKE A SCENE FROM A MOVIE. ROMNEY MAWHORTER REMEMBERS THE HELICOPTER LANDING ON THE ROOF OF KECK HOSPITAL OF USC. HE REMEMBERS THE TEAM OF DOCTORS AND NURSES RUNNING TO THE CHOPPER, YELLING IN ORDER TO BE HEARD OVER THE WHIPPING OF THE HELICOPTER BLADES.
by Hope Hamashige
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Only a few hours earlier, Mawhorter and his wife were on a ferry to Catalina Island to enjoy a romantic weekend without the kids. At lunch, the couple at the next table asked Mawhorter if he would snap their picture. He obliged, but when he turned to rejoin his wife he collapsed, feeling as if his entire torso was being squeezed so tightly that he could barely draw a breath. Mawhorter was suffering the effects of an aortic dissection, which occurs when the inner layer of the aorta, the large blood vessel branching off the heart, tears, allowing blood to flow through the tear and causing the inner and middle layers of the aorta to separate (dissect). The condition is life-threatening and the clock started ticking the second Mawhorter hit the ground. When Mawhorter arrived at the tiny hospital in Avalon, on what was arguably the worst day of his life, he felt like he had also gotten lucky, because while the doctor there could not save his life, she knew who could. She called the USC Comprehensive Aortic Center, which sent a helicopter equipped with staff trained to help Mawhorter make the trip to Keck Hospital of USC. “The biggest blessing is that the doctor in Catalina knew who to call,” he says. “The fact that they were able to get me out of Catalina and over to Keck Hospital saved my life. I’m grateful to all the doctors who worked on me that day.” One of the many jobs of Fernando Fleischman, MD, assistant professor of clinical surgery at the Keck School of Medicine of USC and co-director of the USC Comprehensive Aortic Center, is getting the word out to
“THE FACT THAT THEY WERE ABLE TO GET ME OUT OF CATALINA AND OVER TO KECK HOSPITAL SAVED MY LIFE. I’M GRATEFUL TO ALL THE DOCTORS WHO WORKED ON ME THAT DAY.”
AORTIC DISSECTION is an acute aortic syndrome that requires immediate medical attention by an experienced and well-equipped team because patients can die within hours. Most community hospitals are not equipped to handle these patients and need to send them to one of a handful of hospitals that can.
community hospitals around Southern California about the priority care that Keck Medicine of USC can provide patients with acute aortic syndromes. Because Keck Hospital does not have an emergency room, he explains, some are not aware that he and his team can take patients in crisis who need immediate care. “We provide more acute care than many people in Southern California realize,” Fleischman says. He and Sophia Lam, a nurse practitioner in the USC Comprehensive Aortic Center, have visited community hospitals across the high desert, out to the Inland Empire and up and down the Southern California coast, educating them about Keck Medicine’s immediate treatment capabilities when it comes to patients with acute aortic syndromes. A little less than five hours after he collapsed on Catalina, Mawhorter was being operated on by Fleischman. Repairing an aortic dissection is one of the riskiest surgeries doctors perform and the damage in this case was extensive, but Mawhorter survived. Two years later, he is active and living a full life again, focusing on the blessings that came his way that day and all of the days he’s had since.
Learn more at: cvti.keckmedicine.org
THEDOC FERNANDO FLEISCHMAN, MD assistant professor of clinical surgery at the Keck School of Medicine of USC and co-director of the USC Comprehensive Aortic Center
RAPID TRANSPORT For patients with acute aortic syndromes (AAS), time can be the difference between life and death. Keck Hospital of USC is one of the few hospitals in Southern California that treats patients with AAS. To make sure these patients get the proper treatment as quickly as possible, the Keck Rapid Transport System was created. Community hospitals can call the Aortic Center’s hotline, which is answered by a medical professional, not a service, 24 hours a day. Patients are evaluated by a vascular or cardiac surgeon. Whether they need to be transported by ambulance or helicopter is determined by proximity and the severity of their condition. A recent review of the Keck Rapid Transport System, published in the Journal of Vascular Surgery, showed hospitals as far away as Las Vegas have used the system.
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MINUTES median transport time
THEDOC FRED WEAVER, MD, MMM professor of surgery and chief of the division of vascular surgery at the Keck School of Medicine of USC and co-director of the USC Comprehensive Aortic Center
“ RAPID TRANSPORT IS A CRITICAL COMPONENT OF OUR AORTIC CENTER. THESE PATIENTS NEED HIGH-INTENSITY CARE IN RAPID FASHION WHICH WE PROVIDE, BUT MANY HOSPITALS DO NOT.” KeckMedicine.org
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STAYING on
COURSE
by Martin Booe
STACY KINSEL WAS IN A MEETING WITH CLIENTS ONE DAY IN 1999 WHEN SHE SUDDENLY EXPERIENCED EXTREME NUMBNESS IN HER LEGS AND FEET. A FORENSIC ACCOUNTANT WITH BACHELORS AND MASTERS DEGREES IN ACCOUNTING FROM THE UNIVERSITY OF SOUTHERN CALIFORNIA, KINSEL USED HER WELL-HONED RESEARCH SKILLS TO FIND THE BEST SOURCE FOR DIAGNOSIS AND TREATMENT AND SOON FOUND HER WAY TO THE USC MULTIPLE SCLEROSIS COMPREHENSIVE CARE CENTER AT KECK MEDICINE OF USC. AFTER A SERIES OF TESTS, SHE WAS CONFIRMED WITH A DIAGNOSIS OF MULTIPLE SCLEROSIS (MS), AN AUTOIMMUNE DISEASE THAT AFFECTS THE CENTRAL NERVOUS SYSTEM (CNS), WHICH IS MADE UP OF THE BRAIN, SPINAL CORD AND OPTIC NERVES. What did this mean for her future? As head of her own forensic accounting firm, Kinsel Forensics, Kinsel’s work calculating economic damages requires her to be on the witness stand for hours, in addition to spending hours conducting research and preparations. “It can be a little intense, to say the least, and it requires a lot of stamina,” Kinsel says. “And I wanted to have a family so I worried how it would affect my ability to carry a 16 (800) USC-CARE
pregnancy to term. Needless to say, I was pretty scared.” The fact that the progression of the natural course of MS is notoriously unpredictable did not make it any easier to take stock of the situation. The type and severity of MS symptoms vary widely. While the cause is unknown, MS is believed to result from the body’s immune system attacking its own nerve tissues.
The resulting nerve damage can manifest in symptoms as mild as tingling and numbness or as debilitating as major loss of muscle control. It also can bring on vision problems, memory failure, fatigue, loss of bladder or bowel control and severe mobility impairment. “MS is one of the diseases for which you can change the long-term outcome if treated methodically,” says Kinsel’s physician, Regina Berkovich, MD, PhD assistant professor of
clinical neurology at the Keck School of Medicine of USC. “As a neurologist, I’m really happy to be in a field where we can change the long-term destinies of our patients. That’s why we take a very active position in educating our patients.”
“A real sense of community” In the early 1970s, little could be done to treat MS; diagnosis often was delayed for observation of developing symptoms and analysis of spinal fluid. With the advent of the MRI, however, it became possible to detect specific MS lesions in the central nervous system and to diagnose it much earlier. The first long-term, disease-modifying therapy (DMT) became available in 1993 and since then, drugs to treat MS have become increasingly numerous and effective. Kinsel has the most common type of MS, known as “relapsing-remitting,” which tends to bring on disease attacks followed by periods of relative stability, called remissions. The goal of treatment is to minimize the chance of exacerbations, further growth of lesions and associated MS progression. Her current treatment involves a weekly infusion of the drug natalizumab at the USC MS Comprehensive Care Clinic. The drug, which works by blocking white blood cells from entering the brain and spinal cord, can cause some side effects and has potential risks, but Kinsel says she has not experienced a reaction. And although she has had four attacks since her initial diagnosis, she has recovered fully from each one and hasn’t had a new attack in years. “There’s a real sense of community at the center,” Kinsel says. “People reach out to each other. People like me who’ve been living with MS
“ MS is one of the diseases for which you can change the long-term outcome if treated methodically.”
for a long time are always happy to help newer people. I’ve always been comfortable with the care I’ve received, and I’d certainly recommend the center and Dr. Berkovich to anyone.”
Close Collaboration and Trust Kinsel counts herself as particularly fortunate, but Berkovich says her experience is not so uncommon; good prognosis in MS is achievable, and it requires a very close collaboration and trust between the patient and the MS specialist with the support of the entire MS center. Kinsel’s career has flourished without interruption and her wish to have a family was fulfilled with two successful and completely normal pregnancies. “What makes people successful like Stacy?” Berkovich asks rhetorically. “Number one is a proactive, positive attitude and determination to stay on top of the disease. That requires a trusting relationship with your physician; we really need to know if you’re not tolerating your treatment well so we can adjust it or change it to make sure you are comfortable, because staying on MS DMT is extremely important. I want my patients to tell me everything they experience because we’re in the same camp. And our mutual opponent is MS.”
MS: AT A GLANCE Early symptoms can include weakness, tingling, numbness, and blurred vision. Other possible signs: muscle stiffness, cognition problems and urinary problems.
350,000
IN THE U.S. estimated number of people diagnosed with MS
200
NEW CASES diagnosed every week (source: National Institutes of Health)
2X
WOMEN= MORE LIKELY than men to be affected by MS
|
>
Berkovich has the kind of passion that comes from being personally touched by MS. As a young girl in her native Russia, she watched her aunt slowly and painfully lose vitality to the disease. “If I have a patient reluctant to go on therapy, I think about my aunt,” she says.
AT RISK people of distant Northern European ancestry
THEDOC REGINA BERKOVICH, MD, PHD assistant professor of clinical neurology at the Keck School of Medicine of USC
Learn more at: ms.keckmedicine.org KeckMedicine.org
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SIGN
On her first day of graduate school, ANDREA DU BOIS’ sports psychology professor asked the students to play a game of telephone. It was an exercise in communication, which du Bois felt certain she had failed.
LISTENING TO THE by Hope Hamashige
“The person next to me whispered in my ear and I had no idea what they said,” she recalls. By that time, du Bois knew something was wrong with her left ear. It often felt plugged, causing voices to sound muffled much of the time. But she was otherwise a healthy 20-something who loved running, skiing and school and her hearing wasn’t getting in the way of any of her activities, so she ignored it. “I put it off because I felt like I was functioning,” she says.
“I DON’T THINK ANY OTHER PLACE WOULD HAVE TREATED ME THE WAY THEY DID AND I AM SO GRATEFUL TO HAVE BEEN PUT IN THEIR HANDS.”
18 (800) USC-CARE
ACOUSTIC NEUROMA Hearing loss in one ear is one sign of a rare brain tumor called an acoustic neuroma that develops on a nerve that runs from the inner ear to the brain.
Hearing loss in one ear is one sign of a rare brain tumor called an acoustic neuroma that develops on a nerve that runs from the inner ear to the brain. Because acoustic neuromas are rare, Rick Friedman, MD, PhD, professor in the USC Tina and Rick Caruso Department of Otolaryngology–Head and Neck Surgery at the Keck School of Medicine of USC, notes that many people don’t realize that single-sided hearing loss or difficulty with balance can be signs of a serious problem. Du Bois, who is a doctoral student in the USC Division of Biokinesiology and Physical Therapy, eventually got her hearing tested by an audiologist at the USC Caruso Department of Otolaryngology–Head and Neck Surgery. She also was given an MRI, which revealed the source of her trouble: a 2-centimeter, slow-growing acoustic neuroma. Although an acoustic neuroma is a benign tumor, larger tumors can cause displacement of the cerebellum and brain stem and can be life-threatening.
Du Bois knew she was in good hands with her surgeons, Friedman and Steven Giannotta, MD, chair and professor of neurological surgery at the Keck School, who is a member of the multidisciplinary team at the USC Acoustic Neuroma Center. Their expertise in acoustic neuroma surgery, and the fact that the center is the top rated academic program in the country, draws patients from all over the world. She was confident that their experience would help her avoid the more serious complications of the surgery, including facial palsy or cerebral spinal fluid leaks. “One thing that makes us different is that we take a very patient-centered approach,” says Friedman, who is also director of the USC Acoustic Neuroma Center, where the entire team specializes in the care of patients with this rare tumor. She was surprised, though, at how the rest of the team rallied around her to get her ready. The center’s patient navigator, Kris Siwek, lined up appointments for du Bois and became an important source of information about what to expect during her recovery. Siwek, a former patient of Friedman’s, also sat with du Bois following her surgery, talking her through her dizziness and discomfort. Du Bois’ physical therapists met with her prior to surgery, to evaluate her before her operation and create a plan to get her back on her feet, as it is common for patients to struggle with balance in the aftermath. Though her recovery wasn’t without difficulty, du Bois was back on her feet in a short amount of time and, before returning to school in August, her balance had recovered enough for her to join her mom and sister for a 5K run.
THEDOCS
RICK FRIEDMAN, MD, PHD (left) professor of otolaryngology– head and neck surgery at the Keck School of Medicine of USC and director of the USC Acoustic Neuroma Center STEVEN GIANNOTTA, MD chair and professor of neurological surgery at the Keck School of Medicine of USC
Looking back, du Bois knows it wasn’t wise to ignore her early symptoms. The one benefit of waiting until she was a student at USC was being treated by the team at the USC Acoustic Neuroma Center. “I don’t think any other place would have treated me the way they did and I am so grateful to have been put in their hands,” says du Bois.
Learn more at: acousticneuroma.keckmedicine.org
KeckMedicine.org
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Healthoughts Some good things to know. Keck Medicine of USC Hospitals Among Nation’s Best For the eighth consecutive year, the hospitals of Keck Medicine of USC have been named among the best in the country by U.S. News & World Report, a distinction only 3 percent of the analyzed hospitals receive. U.S. News and World Report compared nearly 5,000 medical centers nationwide in their annual ranking process. Keck Medical Center of USC, comprising Keck Hospital of USC and USC Norris Cancer Hospital, maintained its Top 3 ranking on the list of Best Hospitals in metro Los Angeles (No. 3). The medical center also moved up in ranking for the Best Hospitals in California (No. 8), gaining one spot over last year’s ranking.
TOP 50 PLACEMENT IN SEVEN SPECIALTIES USC Gayle and Edward Roski Eye Institute: remained the institution’s top-performing service line for the 23rd consecutive year (No. 11). USC Institute of Urology: largest increase since 2015 out of the hospital’s specialties and received its highest-ever ranking (No. 15). USC Norris Comprehensive Cancer Center: moved up considerably for its highest ranking ever (No. 18). Keck Medical Center: increased its ranking in geriatrics (No. 21), and is newly ranked in orthopaedics (No. 22), nephrology (No. 37) and cardiology (No. 48). Gastroenterology & GI surgery; neurology & neurosurgery; pulmonology; diabetes & endocrinology were ranked as High Performing service lines.
“KECK MEDICINE OF USC IS HONORED TO BE RANKED AMONG THE COUNTRY’S BEST HOSPITALS AND CLINICAL PROGRAMS FOR THE EIGHTH YEAR RUNNING. OUR FACULTY PHYSICIANS, NURSES AND STAFF WORK TIRELESSLY TO ENSURE WE PROVIDE EXCEPTIONAL MEDICINE TO OUR PATIENTS AND I AM DELIGHTED TO SEE THEIR EFFORTS RECOGNIZED ON A NATIONAL SCALE.” Tom E. Jackiewicz, MPH, senior vice president and CEO of Keck Medicine of USC 20 (800) USC-CARE
USC Physicians Recognized LOS ANGELES MAGAZINE Sixty-six Keck Medicine of USC physicians in 19 specialties were recognized in the annual Los Angeles Magazine 2016 roster of Super Doctors© Rising Stars℠. The honorees were selected by their peers for their expertise and achievement in their first 10 years of practice.
PASADENA MAGAZINE Pasadena Magazine’s 2016 Top Doctors issue also honored Keck Medicine physicians, singling out 516 doctors associated with the medical center, Norris Cancer Hospital, USC Verdugo Hills Hospital, Children’s Hospital Los Angeles and LAC+USC Medical Center. This prestigious, peer-nominated list also appears annually and recognizes outstanding physicians and the exceptional care being provided by all of Keck Medicine and the affiliated hospitals.
3 million NEARLY
PEOPLE IN THE U.S. CURRENTLY LIVE WITH ATRIAL FIBRILLATION
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Atrial Fibrillation DID YOU KNOW? It is often called AFib or AF, and is the most common type of heart arrhythmia, or abnormal heart rhythm. It involves the two upper chambers (atria) of the heart. Its name comes from the fibrillating or quivering of the heart muscles of the atria, instead of the standard, coordinated contraction typically found in healthy hearts. Atrial fibrillation may occur in brief episodes, or it may be a permanent condition.
GOOD TO KNOW!
For more information, visit: cvti.keckmedicine.org
Š 2016 Keck Medicine of USC
The physicians at the USC Center for the Comprehensive Treatment of Atrial Fibrillation comprise a team of specialists whose diagnostic and treatment skills are focused on patients with atrial fibrillation. For more information, visit: keckmedicine.org/diabetes-program
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