A PUBLICATION OF KECK MEDICINE OF USC
2018 ISSUE 1
BACK LIFE â„¢
10 A young athlete turns to USC Hills Hospital to 18 AVerdugo 6 Pfind umprelief Up the Big Win for Weight Loss fromVolume an undiagnosed injury.
Sp ec i Ve al In r s Ho dug ert sp o H for ita ill U l s SC
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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-based medical systems in the Los Angeles area. Encompassing academic and clinical excellence, the medical system attracts internationally renowned physicians and scientists who strive to provide worldclass patient care at Keck Hospital of USC, USC Norris Comprehensive Cancer Center, USC Verdugo Hills Hospital and more than 40 outpatient facilities, some at affiliated hospitals, in Los Angeles, Orange, Kern, Tulare and Ventura counties. In 2017, U.S. News & World Report ranked Keck Medical Center of USC, which consists of Keck Hospital of USC and USC Norris Comprehensive Cancer Center, among the top 15 in ophthalmology and cancer care and among the top 50 hospitals in the United States for orthopaedic surgery, geriatric care and urology. For more information, go to keckmedicine.org. Thomas Jackiewicz, MPH Senior Vice President and CEO of Keck Medicine of USC
Editor
Amanda Busick
Editorial Advisers
Jeana Rettig, Sara Reeve
Contributing Writers
Martin Booe, Adriana Cho, Lex Davis, Hope Hamashige, Matthew Kredell, Candace Pearson
Graphic Design Lime Twig Group
Printer
ColorGraphics
Photography
Ricardo Carrasco III, Phil Channing, Neil Kremer, Michael Munoz Romero, Van Urfalian
©2018 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 Health System Marketing and Communications, SST-2830, 2011 N. Soto St., Los Angeles, CA 90032, (323) 442-2830.
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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 (800) 872-2273 for free language assistance services. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (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 (800) 872-2273.
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ON THE COVER 2 Back to Life
Minimally invasive spine surgery helps a woman get her active lifestyle back; Intraoperative navigation and imaging make surgery safer than ever.
FEATURES 6 A Special Place for Specialty Care Norris Healthcare Center, a new, state-of-the-art building on the Health Sciences Campus, is now open.
13 Shared History A woman’s liver transplant needs are filled by a generous friend and by Keck Medicine.
14 About Face
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A man’s journey through skin cancer treatment leaves him facing a positive future.
16 A Better Beat
A patient’s unusual atrial fibrillation trigger leads to an ablation procedure for a complex and unpredictable condition.
18 A Family Affair
A son guides his father to Keck Medicine for bladder cancer treatment — following the son’s treatment for the same issue years earlier.
20 Healthoughts: Medical News You Can Use
A clinical trial for more accurate mammograms, the dangers of binge drinking and the live donor program flies its flag at Keck Hospital.
NEWS FROM USC VERDUGO HILLS HOSPITAL 9 Convenient and Comprehensive Continuity A new clinic opens at USC Verdugo Hills Hospital to make pre- and post-operative care convenient and easy.
10 Swing for the Fences A young athlete searches high and low for answers to his elbow pain, and finds solutions at USC Verdugo Hills Hospital.
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12 Step in the Right Direction Stepping Stones is a program that is designed to help relieve emotional and personal distress for individuals 50 and older.
KeckMedicine.org
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COVER STORY
BACK L FE to
by Candace Pearson
At the USC Spine Center, minimally invasive spine surgery enables patients to return to their lives more quickly.
Karen Sartoris believes in keeping her muscles moving, which is why she has been athletic her whole life, including cycling, running and playing fast-pitch softball. “I love the wind in my hair,” she says. In volleyball, her main sport, she typically was the setter, taking charge of the team’s offensive strategy in the moment. So, when she needed to find someone to help her with unrelenting back pain, she took charge and made things happen.
All of her beloved sports fell by the wayside. Nothing helped — not over-the-counter medication, pain specialists, acupuncture, cupping (an ancient Chinese procedure said to draw toxins from the body) or even surgery to address two herniated discs.
Her back problems started gradually with a twinge here and there, but quickly escalated. Sartoris couldn’t get on the elliptical at the gym for five minutes without a searing electric shock running down her back and legs, and her feet going numb. “It just kept getting worse and worse,” she recalls.
Finally, a friend told her to go see neurosurgeon Patrick C. Hsieh, MD, professor of clinical neurological surgery at the Keck School of Medicine of USC, and c0-director of the neurosurgical spine program at Keck Medicine of USC. “He can fix anything,” she said.
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The friend had known a woman who fell from a second-story balcony and crushed her
spine, but recovered. Hsieh, who also was appointed recently to the Todd-Wells Professorship in Neurological Surgery at the Keck School, was her physician. “I wanted the best doctor,” Sartoris says. “I found him.” Hsieh is a specialist in minimally invasive spine surgery at the USC Spine Center, which has one of the highest volumes of cases in the region, giving its surgeons invaluable experience. Keck Medicine surgeons use minimally invasive surgical techniques for a comprehensive range of conditions — from degenerative disc disease such as Sartoris experienced (the
I feel very fortunate. There’s nothing bad about being a success story.
KeckMedicine.org
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most common procedure), to herniated discs and spinal stenosis (narrowing) to spinal trauma, infection, complex tumors and multi-level spinal deformities. While many of these conditions are only tackled elsewhere with traditional open spinal fusion surgery, the doctors of Keck Medicine are expanding what minimally invasive surgery can do. “We are developing cutting-edge techniques and technologies, which are enabling us to approach cases once thought too complicated,” Hsieh says.
Less Pain, Shorter Recovery
The advantages of minimally invasive surgery are numerous. Open procedures call for larger incisions and muscle stripping as surgeons push aside the muscles of the spinal column in order to operate. Minimally invasive procedures use small incisions, perhaps an inch in length, through which the surgeon can insert specialized instruments to obtain a magnified and illuminated view of the surgical area. The approach typically results in less blood
loss during surgery, lowered risk of wound infection and post-surgical complications, less pain, and shorter recovery time.
candidates for minimally invasive surgery,” he says. “That’s not necessarily true — it depends on the institution’s capabilities.”
Sartoris describes herself as “pretty desperate” at her first meeting with Hsieh in fall 2013. When the staff asked about her quality of life, she burst into tears. By then, she was unable to walk to her mother-in-law’s home five houses away.
At Keck Medicine, those capabilities are backed by a research program aimed at miniaturizing endoscopic technology even more to allow additional surgeries on an outpatient basis. Clinical trials using similar minimally invasive surgical techniques are underway with the hope that recovery can be improved and the number of serious complications, such as spinal fluid leaks, meningitis and headaches, can be reduced.
The solution: a transforaminal lumbar interbody fusion (TLIF). To repair her degenerated discs, Hsieh began with two small incisions in her back, into which he inserted tiny tubes, then an endoscope. He stabilized the back portion of her lumbar spine with metal rods and screws, as well as a bone graft alongside the spine bones. He replaced the damaged vertebrae with a bone graft spacer. As the grafts healed, the newly mended spine would fuse.
Prescription: Second Opinion
Hsieh encourages patients to do their research and get a second opinion when facing spinal surgery. “We frequently see people who have been told somewhere else that they are not
Sartoris went home from Keck Hospital after a few days and began her rehabilitation. The first day, she walked to the front door, then the porch, then the sidewalk. These days, she has her athletic life back. To protect her new spine, she decided to forgo volleyball, running and softball. Instead, she upped her cycling time and took up swimming and a new sport — pickleball — a paddle sport that combines elements of tennis, badminton and pingpong. “I feel very fortunate,” Sartoris says. “There’s nothing bad about being a success story.”
LL OF THE PHYSICIANS IN THE USC SPINE CENTER ARE SPINE FELLOWSHIP-TRAINED IN SPINAL SURGERY A AND INTERVENTIONS. EACH OF THE FACULTY HOLDS APPOINTMENTS AND ACADEMIC TITLES IN BOTH THE DEPARTMENT OF NEUROLOGICAL SURGERY AND IN THE DEPARTMENT OF ORTHOPAEDIC SURGERY. THE USC SPINE CENTER TEAM APPROACH ENSURES THAT EACH PATIENT RECEIVES THE VERY BEST CLINICAL AND SURGICAL EVALUATION OF THEIR INDIVIDUAL SPINE PROBLEM, WHICH ALLOWS FOR THE OPTIMAL MULTIDISCIPLINARY TREATMENT FOR THEIR CONDITION. JEFFREY C. WANG, MD, Co-Director, USC Spine Center
THEDOCS OF THE USC SPINE CENTER The USC Spine Center maintains a robust training program for residents and fellows in orthopaedics and neurosurgery, which has a global impact: 10 to 15 international fellows come to the USC Spine Center each year to train in minimally invasive spinal surgery.
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JEFFREY C. WANG, MD Co-Director, USC Spine Center JOHN C. LIU, MD Co-Director, USC Spine Center
FRANK L. ACOSTA, JR., MD
BETTER TO SEE YOU At Keck Medicine of USC, Intraoperative Navigation and Imaging Improve Outcomes
W TH
One key element to a successful outcome in any surgery is the ability of the surgeon to clearly see what is happening at the surgery site. In the past, physicians relied upon their eyesight alone, but modern minimally invasive surgery methods that don’t use an open incision technique need something more than the naked eye. Luckily, new, cutting-edge technologies have been developed that can help surgeons see beyond what is on the surface. Spine surgeons at Keck Medicine of USC and USC Verdugo Hills Hospital are not only experts in minimally invasive surgery, they also have access to the latest technologies in intraoperative imaging and navigation equipment. These cutting-edge, specialized machines provide quick and detailed visual aids for complex surgeries. The majority of surgeries in the United States are performed without this navigational assistance. The imaging system delivers a fast and precise 3-D representation of a patient’s anatomy
THOMAS C. CHEN, MD, PHD
during surgery, and the guidance system then uses this 3-D image to ensure that implants, such as screws, are placed in the spine with millimeter precision. Compared to traditional surgical methods, this navigational technique improves accuracy, requires a smaller incision and reduces
postoperative pain. It also produces less radiation than a CT scan, improving outcomes by making complex cases more effective, safe and accurate.
Learn more at: spine.keckmedicine.org
MARK J. SPOONAMORE, MD
PATRICK C. HSIEH, MD
RAYMOND J. HAH, MD
CHRISTOPHER C. ORNELAS, MD KeckMedicine.org
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A SPECIAL PLACE
SPECIALTY CARE for
Norris Healthcare Center, now open, brings added services, more coordinated care and more patient privacy for the complex needs of patients across Southern California.
by Adriana Cho
The USC Health Sciences Campus recently welcomed its first new clinical building in more than a decade as Norris Healthcare Center (HC3) opened to the public in January. The highly anticipated facility further enhances Keck Medicine of USC’s ability to provide outstanding care to patients, allowing services to expand clinical offerings that were located in the Willametta Keck Day Healthcare Center (HC2) and USC Norris Cancer Hospital.
PRIVACY AND COMFORT
T his new center is an important step during our journey to become the leading health care provider in Southern California. TOM JACKIEWICZ, MPH senior vice president and CEO of Keck Medicine
HC3 is a seven-story, 116,000-square-foot building, designed with patient privacy and comfort as its top priorities. Patient care floors are equipped with the latest diagnostic and treatment technologies and feature welcome centers and waiting areas. Large, floor-to-ceiling windows on upper floors offer views of the San Gabriel Mountains and foothills, downtown Los Angeles and Dodger Stadium, and let plenty of natural light into the building. KeckMedicine.org
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T he building puts the needs of our patients and their families first, further elevating the high caliber of our care. ROD HANNERS, COO of Keck Medicine and CEO of Keck Medical Center of USC
“The Norris Healthcare Center is a beautiful, modern facility that will provide a new, first-class space for our specialty care,” says Tom Jackiewicz, MPH, senior vice president and CEO of Keck Medicine. “This new center is an important step during our journey to become the leading health care provider in Southern California.” A lead gift of $15 million from the Kenneth T. and Eileen L. Norris Foundation allowed for the groundbreaking and construction to begin on the site in 2013. The Norris Foundation’s relationship with the USC Norris
Light-filled spaces with sweeping views bring a relaxing feel to waiting areas.
Comprehensive Cancer Center goes back to a lead gift that made possible groundbreaking for the cancer center in 1979.
A NEW HOME HC3 is the new home for the USC Institute of Urology; an infusion center for both cancer and non-cancer patients; a women’s specialty care and breast imaging center; and the USC Transplant Institute. The Outpatient Surgery Center transferred from its location in Healthcare Center 4 into HC3, which has some of the largest operating rooms on campus.
Coming soon to the facility will be new retail space, as well as new dining options for patients, their families and staff to enjoy. “The building puts the needs of our patients and their families first, further elevating the high caliber of our care,” says Rod Hanners, COO of Keck Medicine and CEO of Keck Medical Center of USC. An additional valet parking station is now available in front of HC2 to accommodate patients for both HC2 and HC3. Self-parking for HC3 patients is available in the Keck Hospital Parking Structure adjacent to HC3.
WHAT’S IN NORRIS HEALTHCARE CENTER? Level 5 > Urology Level 4 > Treatment Center (Infusion) Level 3 > Women’s Specialty Care and Breast Imaging Level 2 > Transplant Level 1 > Lobby, Gift Shop, Concierge and Blood Draw Level LL > Terrace Café with Starbucks and Au Bon Pain* Level LG 8 (800) USC-CARE
> Outpatient Surgery
*opening Soon
USC VERDUGO HILLS HOSPITAL
EXPANDS SURGERY OFFERINGS
by Lex Davis
As part of its efforts to serve an even greater segment of the Southern California community, Keck Medicine of USC is expanding its surgical offerings at USC Verdugo Hills Hospital (USC-VHH) with a new location at 1808 Verdugo Blvd. Patients in the area previously had been able to undergo surgery with Keck Medicine physicians at USC-VHH, but had to commute roughly 13 miles to Keck Medical Center of USC for clinical visits and consultations. The added convenience of the new clinical location continues Keck Medicine’s mission of delivering patient-centered care. The new space offers state-of-the art technology to ensure that surgeons and staff can deliver high-quality service. Surgical options now available at USC-VHH include bariatric; colorectal; plastics and reconstruction; upper GI and general (including breast cancer surgery); and vascular surgery and endovascular therapy. • The plastics and reconstruction physicians will be coordinating with the general surgery team to create a satellite of Keck Medicine’s multidisciplinary Harold E. and Henrietta C. Lee Breast Center at Norris Healthcare Center, allowing patients to work seamlessly with breast oncology surgeons and breast reconstruction surgeons. In addition, the plastics and reconstruction team will focus on wound healing and aesthetic surgeries.
• Bariatric team members are available to consult on both surgical and nonsurgical weight management options. They also are highly skilled in bariatric revision surgeries, including revisions of failed gastric band (LAP-Band) surgeries.
• Each member of the colorectal team has been nationally recognized for expertise in minimally invasive treatments. The team performs 90 percent of surgeries laparoscopically, compared with dramatically lower rates nationwide, and the program is one of only a few programs in the nation to perform combined endolaparoscopic surgery to remove difficult colon polyps. • The vascular surgery and endovascular therapy team offers the latest noninvasive diagnostic imaging technology and minimally invasive treatments. The vascular team integrates with other divisions to provide individualized care and is committed to using advanced endovascular techniques to allow for smoother, shorter recoveries. Physicians are now seeing patients at the new space. Call (800) USC-CARE to make an appointment.
Learn more at: uscvhh.org
“ Exceptional care is about more than top-notch skills and leading-edge technology. We’re pleased to offer our patients in the Verdugo Hills area a welcoming environment that’s close to home.” VAUGHN STARNES, MD, Distinguished Professor and chair of surgery, and H. Russell Smith Foundation Chair for Stem Cell and Cardiovascular Thoracic Research at the Keck School of Medicine of USC USCVHH.org
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SWING FENCES FOR THE
by Martin Booe
COOPER WAY HAS LOVED BASEBALL SINCE HE FIRST PICKED UP A BAT AT AGE 6. AS A CATCHER FOR HIS HIGH SCHOOL TEAM, HIS SKILLS AND IMPRESSIVE BATTING AVERAGE SEEMED TO POSITION HIM WELL FOR AN ADMIRABLY LEVEL-HEADED AMBITION: TO REDUCE COLLEGE EXPENSES WITH AN ATHLETIC SCHOLARSHIP. THAT GOAL WAS JEOPARDIZED ABOUT THREE YEARS AGO DURING A TOURNAMENT GAME. HE WAS RETURNING THE BALL TO THE PITCHER WHEN A BOLT OF EXCRUCIATING PAIN SHOT THROUGH HIS RIGHT ARM.
AFTER THAT, IT EVEN HURT TO HOLD A PEN. SUDDENLY, I’D PRETTY MUCH LOST THE USE OF THAT ARM.
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Thus began two years of frustration — starting with six months of being unable to play — as Way visited doctor after doctor seeking an answer. “The first doctor said nothing was wrong with me,” Way says. “He sent me to physical therapy for six months to strengthen the arm. After that, I went back to playing but I still had problems.” He was still performing well enough to get top rankings in successive tournaments, including making it to final tryouts for the USA Baseball Team — all while playing in severe pain.
High-performance injuries call for highperformance solutions. Fortunately, Weber is adept at performing ulnar collateral ligament reconstruction, also known as Tommy John surgery, in recognition of the legendary major league baseball pitcher and former Dodger whose career it saved.
A neurologist referred him to an orthopaedic surgeon who referred him to another neurologist, and so on. Multiple tests for nerve damage followed and he had so many X-rays he “thought I was going to glow in the dark.” The unsatisfying conclusion was always the same: “It’s just a strain.”
While Way may seem young to need such advanced surgery, overuse and repetitive overhead athletics injuries are increasingly common in young athletes, Weber says. Not too long ago, “There were no pitch counts or restrictions,” he says. “Kids were going from one tournament to the next and pitching in multiple games in a weekend.” In 2007, however, the American Orthopaedic Society for Sports Medicine spearheaded the STOP Sports Injuries initiative, a national campaign to prevent overuse injuries in young athletes.
Finally, as the pain was becoming unbearable and Way began to fear that a college scholarship was about to be rained out, he was referred to Alexander Weber, MD, assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC and expert surgeon at the USC Epstein Family Center for Sports Medicine, who saw Way at USC Verdugo Hills Hospital. The problem was a little more serious than a strain, Weber found. In addition to tearing his ulnar collateral ligament, Cooper was suffering from irritation of his ulnar nerve. The ligament is particularly important for high-performance overhead throwing athletes, according to Weber. “In most cases, the ligament becomes partly or completely torn from overuse,” Weber says. “Cooper’s situation was even more advanced — the ligament was not only torn badly but the continued attempt to play baseball following the injury caused irritation to the ulnar nerve.” Both the ligament and the nerve would have to be surgically addressed, which would involve reconstructing the ulnar collateral ligament using a strand of tendon from Way’s arm and actually relocating the nerve to eliminate further irritation.
As advanced as the surgery is, it is an outpatient procedure. Way was back at school the next day. However, there were restrictions to his athletic activities for nine months while he rehabilitated and returned to throwing.
Way blames his injury on poor form. “I was a pitcher and outfielder for seven years so when I went to catching, my arm motion was way too long,” he says. “So that just strained my arm.” Weber, a former student athlete himself, works with many young athletes at high schools in the area that surrounds USC-VHH. But the USC Epstein Family Center for Sports Medicine is not just for young athletes like Way. “We treat everything from the weekend warrior who plays pick-up basketball to the 85-year-old who has arthritis of the shoulder,” Weber says. “We are a great first call for anything related to an achy joint.” Meanwhile, Way has experienced a complete recovery. The arm pain and nerve irritation he was having prior to his surgery are gone and his elbow motion is back to what it should be. Now graduated from high school, he is on the California Baseball Academy collegiate team for the summer and will be playing for a college team this fall. He plans to become a teacher and coach baseball at the high school level.
THEDOC
ALEXANDER WEBER, MD assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC
WE TREAT EVERYTHING FROM THE WEEKEND WARRIOR WHO PLAYS PICK-UP BASKETBALL TO THE 85-YEAROLD WHO HAS ARTHRITIS OF THE SHOULDER. Learn more at: uscvhh.org/ortho USCVHH.org
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A STEP IN THE RIGHT by Adriana Cho
DIRECTION
OLDER PATIENTS WITH A MENTAL HEALTH DIAGNOSIS MAY FEEL HELPLESS IF TRADITIONAL WEEKLY THERAPY NO LONGER MEETS THEIR NEEDS. FOR THESE PATIENTS AND THEIR FAMILIES, A HOLISTIC THERAPY PROGRAM AT USC VERDUGO HILLS HOSPITAL OFFERS A SOLUTION. Stepping Stones is a geropsychiatric program at USC Verdugo Hills Hospital that is designed to help relieve emotional and personal distress for individuals age 50 and older. “Caring for our patients’ mental health is a priority,” states Keith Hobbs, MBA, CEO of USC-VHH. “The Stepping Stones program is an important part of our push to provide holistic medical care for the many communities that surround our medical center, and we will continue to expand the scope of the program’s offerings to reflect the needs of the area.”
There’s something magical about the whole thing. It’s so rewarding to see people get better. LUKE JACKSON, MBA, JD, program director of Stepping Stones
Through inpatient and outpatient programs, the experts at USC-VHH employ a variety of therapeutic options, including medical management, cognitive behavioral therapy, psychoanalysis, art, music and movement therapy to help patients. The inpatient unit can accommodate 24 patients, while the outpatient program currently serves 40 patients, with capacity for 75. Outpatients generally attend three or more therapy hours a day for two to four days a week, depending on the need of the patient, for a duration of two to six months. Stepping Stones provides one-on-one and small group therapy to help patients who are uncomfortable in larger group settings. With techniques like recreational therapy, which involve going for walks and getting outside,
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patients also slowly learn to socialize again and interact with others. “Socialization is a huge part of the process in getting patients back into having normal relationships with other people,” says Luke Jackson, MBA, JD, program director of Stepping Stones. “That’s a really important part of their recovery.” The program continues to strive to improve treatment methods and patient outcomes. The nursing staff uses communication techniques developed specifically for patients with mental health diagnoses or cognitive impairment. The existing forms of therapy, such as music, help patients go beyond passivity to being more interactive. Stepping Stones also works to help patients with dementia regain their memories through creative therapy methods and allow them to maintain as much independence as possible. For example, memories often can be accessed through smell, music or movement. “There’s something magical about the whole thing,” Jackson says. “It’s so rewarding to see people get better.”
Learn more at: uscvhh.org/stepping-stones
by Hope Hamashige shortage of cadaveric organs, many patients don’t survive on the waiting list. Their death can be caused by a variety of complications of their liver disease, if the liver transplant is not performed on time.” Though she knew that a living donor transplant was her best shot of survival, nobody in her immediate family qualified as a donor. Though not a blood relative, Warren turned out to be a match. The pair had their surgery in January of 2017 and both women recovered nicely, though Heilman noted that she takes extra precautions not to get sick. She has now transferred back to her regular physician, but she remains in touch with the team at Keck Medicine, who is keeping tabs on her.
Joanne Heilman and Kay Warren, her sister-in-law’s sister, had known each other for decades and, although they were always friendly, they had never been close. Still, when the pair saw each other in May of 2016, Warren didn’t hesitate when she learned that Heilman had a life-threatening liver disease and needed a transplant. “I told her that I would absolutely do that,” recalls Warren, who asked Heilman to put her in touch with her doctors to find out if she was a match. It was a persistent rash combined with a feeling of lethargy that ultimately led Heilman to make an appointment with her doctor who, after performing several tests, delivered the news that she had end-stage liver disease. Her primary care physician recommended that she get in
Warren has returned to work and to her workouts in the gym. She says that many people have asked her why she would have undergone an operation that wasn’t necessary for her, given that she was not sick. “The question shouldn’t be why would you do something like that, it should be why wouldn’t you?” she responds.
touch with the USC Transplant Institute at Keck Medicine of USC. Her doctor explained that Keck Medicine had pioneered living donor transplants, a procedure in which a healthy person donates a portion of his or her liver to a patient whose liver is failing, and was the only living donor liver transplant program in Los Angeles County. “We started to perform living donor liver transplants to save the lives of patients like Heilman,” says Yuri Genyk, MD, professor of clinical surgery at the Keck School of Medicine of USC and surgical director of the liver transplant program. “Due to the
THEDOC YURI GENYK, MD professor of clinical surgery at the Keck School of Medicine of USC
Learn more at: transplant.keckmedicine.org KeckMedicine.org
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ABOUT
by Hope Hamashige
“IT WAS ONE OF THE MOST PAINFUL DAYS OF MY LIFE. AND, SOMEHOW, I KNEW THEY DIDN’T GET IT ALL. I ALSO KNEW THAT I DIDN’T WANT THEM TO CUT ME AGAIN. I NEEDED SOMETHING BETTER.”
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FOR SOME PEOPLE, OUTDOOR ACTIVITIES LIKE SWIMMING AND CYCLING ARE A FUN OCCASIONAL PASTIME. BUT THERE ARE ALSO PEOPLE LIKE MARK FOIST, FOR WHOM SPENDING TIME OUTDOORS IS A WAY OF LIFE. A former competitive water polo player and ski instructor, Foist has run in 20 marathons and completed two grueling Iron Man triathlons. When he wasn’t training under the desert sun of Southern California, he often volunteered to help others prepare for marathons or cycling competitions. And so, in 2004, when he was told that he had both squamous and basal cell carcinoma on his lip, he wasn’t exactly floored by the news. In addition to his love of being outside, he also has a strong family history of cancer. He had the cancer removed by a respected dermatologist near his home in Redlands, but it returned three years later, this time on his lip and nose. The second time he was treated, he spent 12 hours at his dermatologist’s office for surgical procedures on nine different areas of his face. “It was one of the most painful days of my life,” Foist recalls. “And, somehow, I knew they didn’t get it all. I also knew that I didn’t want them to cut me again. I needed something better.” When the skin cancer recurred for a third time in 2014, his dermatologist confirmed that he needed a level of care higher than she could offer. After consulting with other doctors and reaching out to friends and family for recommendations, a trusted family member told him to make an appointment at Keck Medicine of USC. Because his cancer was becoming more widespread and had multiple occurrences, Foist was immediately categorized by the team at Keck Medicine as high-risk and his case was brought before the USC Multidisciplinary Cutaneous Tumor Board, a group of 15 skin cancer specialists that includes dermatologists, oncologists, radiation oncologists, otolaryngologists and plastic surgeons. “The skin cancer treatment experience at Keck Medicine is unique because of the skin cancer tumor board,” explains David Peng, MD, MPH, chair of the Department of Dermatology at the Keck School of Medicine of USC. “The tumor board offers the opportunity for multiple experts to come together to discuss one
patient’s case and to combine all of their expertise to generate a customized plan of care for each patient.” In Foist’s case, removing 100 percent of the cancer also meant removing a portion of his face, including parts of his left nostril and upper lip. The team also found, during the Mohs procedure, that Foist had perineural invasion, meaning the cancer had started to grow along the nerves. To reduce the risk of the cancer recurring, Foist underwent six weeks of radiation treatment before the team could begin reconstruction work on his face. Foist says one of the benefits of having his treatment at Keck Medicine is having his team of specialists all in one location. His care was overseen by the Mohs surgery team, but all members of his team could track his progress. Following radiation, one of the otolaryngologists reconstructed his nostril by taking skin from other parts of his body and a vessel from his forehead. Following the surgery, some additional laser and reconstructive procedures were used to minimize the scarring on Foist’s face, and he’s now on a strict regimen of prevention that includes both medication and solid advice about sun safety. Although forced to take a break from his outdoor activities while he was undergoing treatment, Foist says it was worth it. “I’m really happy with the results and I get all of my health care at Keck now,” Foist says. “I found that at Keck, you get some of the best doctors in the world who also happen to be people you’d want to play golf with.”
WHAT IS MOHS PROCEDURE? Mohs procedure is a micrographic surgery. It is done under local anesthesia and has a high cure rate in treating high-risk skin cancer. It also allows the surgeon to preserve as much tissue as possible, which minimizes the extent of reconstruction the patient will need following treatment.
But never without sunscreen and never during peak sun hours.
“ I FOUND THAT AT KECK, YOU GET SOME OF THE BEST DOCTORS IN THE WORLD WHO ALSO HAPPEN TO BE PEOPLE YOU’D WANT TO PLAY GOLF WITH.” Learn more at: dermatology.keckmedicine.org KeckMedicine.org
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A Better Beat by Hope Hamashige
For 15 years, Richard Meyer lived with infrequent episodes of atrial fibrillation (AF or A Fib), sometimes only experiencing two episodes a year before he developed an unusual trigger. Suddenly, swallowing started making his heart skip beats and flutter inside his chest, putting him in a nearly constant state of AF. “It was really starting to become a nuisance,” Meyer says. The frequency was also putting his health at risk because it is during these episodes, when the heart is beating irregularly, that people with AF are at risk of having a stroke or a heart attack. “I knew then that I may need to talk to a doctor about ablation.” “What causes it is the million-dollar question,” says Rahul Doshi, MD, associate professor of clinical medicine at the Keck 16 (800) USC-CARE
School of Medicine of USC. “We know it is associated with age and that there is some genetic component to it, but we are far from being able to predict who will get this.”
carry on for weeks at a time. The frequency of these episodes is also unpredictable and can come along every month, for example, and then not recur for years.
AF is just as unpredictable in the way people experience the disorder. Some people with AF may get so light-headed and nauseated during episodes that they cannot function. Other people live with AF for years, never noticing that their heart is beating irregularly. The episodes can last for hours or they may
“You tell yourself that you don’t have a life-threatening condition, but the first half-hour of every episode I would have a lot of anxiety,” Meyer says. “You start to
It is this inability to predict episodes that makes AF, while not considered extremely life-threatening, so hard to live with.
I was always worried that I would have an episode on top of a mountain somewhere and not be able to get down. Or that I would have an episode when we were scuba diving and I wouldn’t have access to my doctor.
learn to live with it, but it is the kind of thing that is always on your mind.” Meyer loves the outdoors and in his free time can be found mountain biking in the hills around Los Angeles. He and his family also love to scuba dive, and their family vacations are typically in an exotic location where they can enjoy diving together and exploring the ocean. “I was always worried that I would have an episode on top of a mountain somewhere and not be able to get down,” Meyer says. “Or that I would have an episode when we were scuba diving and I wouldn’t have access to my doctor.” Some people eventually identify triggers, such as alcohol or coffee, and manage their episodes by avoiding them. There are also medications that can help control the heart rate during AF to help reduce the risk of stroke. When his AF started to be triggered by swallowing, he consulted with Doshi, who is also director of cardiac electrophysiology at Keck Medicine of USC, who determined that
Meyer should undergo ablation, a procedure that can correct the condition. The procedure involves threading a catheter to the heart and using radiofrequency waves to destroy the heart tissue that is causing the AF. Doshi, who has been performing ablation for nearly two decades, notes that the technology has changed rapidly in recent years, allowing physicians to treat complex arrhythmias, like Meyer’s. Because the swallowing trigger is unusual, it required precise mapping of the heart in advance of the procedure. Doshi said the team at Keck Medicine has a variety of mapping and imaging technologies, as well as years of experience, to help them individualize the procedure for each patient. Shortly after his ablation procedure in February of 2016, Meyer had two short episodes of AF, which is common right after ablation for many patients. Now, however, it has been more than a year since the last occurrence. “I am extremely happy I found Dr. Doshi and I am very happy with the results,” Meyer says.
Learn more at: cvti.keckmedicine.org/a-fib
FACTS ABOUT AF Most common type of heart arrhythmia 5 million+ people affected in the U.S. More common among: • older people • people with leaky heart valves, thyroid problems or structural heart defects Also can affect people like Meyer who are otherwise healthy and young.
THEDOC RAHUL DOSHI, MD associate professor of clinical medicine at the Keck School of Medicine of USC KeckMedicine.org
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A Family
Affair by Matthew Kredell
RECEIVING A DIAGNOSIS OF BLADDER CANCER IS NOT EASY AT ANY AGE, BUT LARRIE WANBERG, PHD, HAD SOMEONE CLOSE WHO HAD BEEN TREATED FOR IT SUCCESSFULLY TO GUIDE HIM THROUGH THE PROCESS — HIS SON. Twelve years earlier, Lars Wanberg got his life back on track by going to Keck Medicine of USC for a radical cystectomy with urinary diversion. “I said, ‘I know exactly what we’re going to do — we’re going to see Dr. Djaladat,’” Lars says of Hooman Djaladat, MD, associate professor of clinical urology at the Keck School of Medicine of USC, who had taken over his care in recent years. “From the minute we walked in the door, there was the feeling that we were in good hands because they really care about their patients, family and extended family.” It’s unusual for a son to have bladder cancer before a father, but Lars’ experience with the USC Institute of Urology and USC Norris Comprehensive Cancer Center allowed him to take care of the man who had raised him and three siblings following the untimely death of their mother in a horse-riding accident. Lars was only 42 when he got his diagnosis, young for a disease that strikes at a median age of 70. Surgery was an easy choice — the only choice. At 85, Larrie could have decided to accept this ending to his life. He had already lived it fully enough for three lifetimes — receiving the 18 (800) USC-CARE
Legion of Merit award and reaching the rank of colonel in the U.S. Army for his 27 years providing social services at military hospitals, dedicating another quarter century to the University of North Dakota as an adjunct professor in community medicine, and in his retirement becoming a journalist and Norwegian historian. However, Larrie had another chapter in mind for himself. With the elderly population on the rise, USC Norris sees many octogenarians with bladder cancer, even operating on a patient over 90.
“Not many centers would consider such a radical treatment at this age,” Djaladat says. “They’d say he’s too old and it would probably be better just to do a palliative treatment, but that’s not the mentality we have at USC. We really push hard and fight on with this disease.”
Options for Active Lifestyles
The radical cystectomy was similar for father and son — removal of the bladder, prostate, seminal vesicles and nearby lymph nodes. Larrie received four months of chemotherapy before the surgery, which increases the survival
rate by 5 to 6 percent in patients with invasive bladder cancer, according to Djaladat. Their experiences diverged at the urinary diversion. Lars got a neobladder in which a piece of the small intestine is made into a pouch that is connected directly to the urethra. For octogenarians, the most common method involves a urostomy bag. To fit Larrie’s active lifestyle — even at his age, he was freelancing for newspapers in North Dakota and serving as features editor for a Norwegian-American newspaper — he and Djaladat decided on an Indiana pouch, a reservoir made from intestine and connected to the belly button through which a catheter is used intermittently to drain. “The whole culture of going there is uplifting, even though you might be going in with some
discouraging health issues,” Larrie says. “I always went away feeling really good inside.”
Enhanced Recovery After Surgery
Djaladat noted that USC Norris has pioneered an “Enhanced Recovery After Surgery” protocol that has decreased the median length of hospital stay for this complex procedure from an average of nine to 10 days down to four. Patients recover faster after surgery with lower complications and readmission rates. “With an elderly person, there’s a lot more a doctor needs to deal with in terms of the psychological state of the patient,” Lars says. “I saw how Dr. Djaladat dealt with my dad, always asking about his writing and talking about getting him on an airplane back to North Dakota. He knew how to motivate him.”
Larrie, who turned 87 in February, still hopes to return to North Dakota at least to visit. He has been living in Santa Ynez with his daughter, near Lars in Santa Barbara and close to his nine great-grandchildren. He has plans for the years to come, chief among them to partner with the charity BraveHearts for Kids to be editor of an online magazine featuring children with cancer telling their stories.
THEDOC
HOOMAN DJALADAT, MD associate professor of clinical urology at the Keck School of Medicine of USC
“I’m very grateful for the extension on life I received and want to make value and fulfillment come from it,” Larrie says. “I want to move to a new challenge.”
Learn more at: urology.keckmedicine.org/bladder KeckMedicine.org
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Healthoughts Some good things to know.
Sign of Something Serious? WHEN TO SEE A UROLOGIST FOR FEMALE PELVIC HEALTH CONDITIONS Pelvic and urinary tract conditions are more common as women age, and knowing when to see a urologist instead of a primary care physician can prevent painful or even dangerous complications down the road. More serious or recurring issues, such as the following, may require seeing a urologist.
New Ultrasound Technology Targets Dense Breast Tissue THE RESEARCH PROJECT
> A new research project at USC Norris Comprehensive Cancer Center is actively recruiting women with dense breast tissue to examine the effectiveness of a novel breast ultrasound device.
> U SC Norris is the only site in Southern California for this nationwide trial. THE TECHNOLOGY
> S oftVue is the world’s first 3D, whole-breast ultrasound system that might better assist physicians in distinguishing normal breast tissue from cancers.
> B ecause dense breasts can mask potential cancers on mammography, the sensitivity for detecting cancer is lower. Handheld ultrasound can detect cancers not seen on mammography, but these exams can be time-consuming and are operator-dependent. They also have a high rate of false positives, resulting in unnecessary biopsies.
Urinary Incontinence Urinary incontinence refers to a loss of bladder control. Common symptoms include urine leakage and suddenly having the overpowering urge to urinate — and sometimes not being able to get to the bathroom in time. Symptoms may also include leaking urine when coughing, sneezing or exercising. Recurrent UTIs Urinary tract infections are common among women of varying ages, but multiple UTIs in a single year can indicate a larger, more serious issue. Pelvic Organ Prolapse Over time, the pelvic floor, a group of muscles and tissues that keep the pelvic organs in place, can weaken, especially after pregnancy and childbirth. This can cause pelvic organs to drop, or prolapse, from their normal place in the pelvic region.
> T he scans, which take two to four minutes per breast, are conducted while the woman is face down with her breast supported in a warm water bath.
PROJECT PARTICIPATION
>W omen who have been told they have dense breast tissue on mammography are encouraged to enroll. Call: (323) 442-9299 Email: SOFTVUE@USC.EDU
20 (800) USC-CARE
“OUR HOPE IS THAT THIS TECHNOLOGY WILL ENABLE US TO DETECT CANCERS MUCH SOONER IN WOMEN WITH DENSE BREAST TISSUE, SO WE CAN PROVIDE BETTER OUTCOMES FOR THOSE WITH CANCER AND PEACE OF MIND FOR THOSE WITH A NEGATIVE STUDY.” Mary Yamashita, MD, assistant professor of clinical radiology at the Keck School of Medicine of USC and the national principal investigator of the research project
For more information, visit: urology.keckmedicine.org
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Keck Hospital of USC and USC Transplant Institute now will honor brave donor families and living donors who made the decision to say “yes” to organ donation by participating in the Donate Life Flag Program.
QUICK. EASY. SECURE. When you sign up for myUSCchart, you will have 24/7 access to your medical records. You can also send secure messages to your physician, view your medical history, check lab results, manage your prescriptions and request appointments.
> B eginning on the day the donation occurs, the Donate Life flag will fly for a week directly below the USC Flag.
> T his alerts community members and staff of
STEP 1: T ext KECKPORTAL to 313131 or visit myUSCchart.keckmedicine.org
the important, lifesaving gift that was given.
> I t is a meaningful reminder of the role that everyone plays in helping to make the gift of life possible.
Text KECK PORTAL to 313131
GIVING THE GIFT OF LIFE IS ONE OF THE MOST SELFLESS LEGACIES A PERSON CAN LEAVE BEHIND.
STEP 2: R equest your medical record number from your care provider or by calling (800) USC-CARE (800-872-2273)
READ UP BEFORE YOU DRINK UP HOW MUCH IS CONSIDERED HEAVY DRINKING?
MORE THAN
MEN
IN A WEEK
MORE THAN
WOMEN
IN A WEEK
LIVER DAMAGE: Increased risk of fatty liver, alcoholic hepatitis, fibrosis and cirrhosis BRAIN FUNCTION: Impaired cognitive function, memory, sleep and mood STRESSED HEART: Risk of stroke, high blood pressure, high cholesterol and irregular heartbeat
A “DRINK” IS DEFINED AS
regular beer
HEAVY DRINKING’S NEGATIVE EFFECTS
wine
distilled spirits
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes one alcoholic drink as containing 14 grams of pure alcohol
INCREASED CANCER RISK: Throat, mouth, breast cancers WEAK IMMUNE SYSTEM: More frequent illness, risk of pancreatitis
CONCERNED ABOUT HEALTH PROBLEMS FROM ALCOHOL? SCHEDULE AN APPOINTMENT WITH ONE OF OUR SPECIALISTS. CALL: (800) USC-CARE (800-872-2273) > VISIT: KeckMedicine.org/request-an-appointment
To learn more about the procedures and services featured here or to schedule an appointment
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THE KECK EFFECT What sets Keck Medicine of USC apart? Our relentless approach. Our unwavering passion to heal. And, something else ... we’re warriors. Each day, we fight for our patients — battling the most serious and complex conditions imaginable and doing everything possible to ensure a positive outcome.
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