A PUBLICATION OF KECK MEDICINE OF USC
2018 ISSUE 2
BACK IN CIRCULATION
US Ho C V sp erd i Ed tal ugo iti Sp H on ec ill ial s
MELANIE RODRIGUEZ IS ON TRACK WITH HER LIFE AGAIN FOLLOWING THE COLLABORATIVE EFFORTS OF THE USC CARDIOVASCULAR THORACIC INSTITUTE
18 Flintridge 12 6 A team gets a La Cañada back onLoss his feet Pumpeffort Up the Volume A Big Winman for Weight
A PUBLICATION OF KECK MEDICINE OF USC
Keck Medicine of USC is one of only two university-based medical systems in the Los Angeles area. Its internationally renowned physicians and scientists provide world-class patient care at Keck Hospital of USC, USC Norris Comprehensive Cancer Center, USC Verdugo Hills Hospital and more than 40 outpatient locations in Los Angeles, Orange, Kern, Tulare and Ventura counties. In 2018, U.S. News & World Report ranked Keck Medical Center of USC, which consists of Keck Hospital of USC and USC Norris Cancer Hospital, among the top three hospitals in Los Angeles and top seven in California. The medical center also ranked in the top 10 in urology; top 20 in ophthalmology, geriatrics and cancer care (the highest-ranked in Southern California); top 25 in orthopaedics; and top 50 in neurology and neurosurgery, gynecology, nephrology and cardiology and heart surgery. For more information, visit KeckMedicine.org. Thomas Jackiewicz, MPH Senior Vice President and CEO of Keck Medicine of USC
Editor
Graphic Design
Production Coordinator
Printer
Contributing Writers
Photography
Amanda Busick Tasha Arana
Lex Davis, Hope Hamashige, Matthew Kredell, Melissa Masatani, Candace Pearson, Erica Rheinschild
Lime Twig Group Lithographix
Ricardo Carrasco III, Phil Channing, Kremer-Johnson Photography
Editorial Advisers
Sara Reeve, Jeana Rettig
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© 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. 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 in Circulation
Complications from a cardiac ablation bring Melanie Rodriguez to Keck Medicine of USC for a life-saving collaboration at the USC CardioVascular Thoracic Institute.
FEATURES 6 Second Nature Many reasons can prompt a patient to get a second opinion from the experts at USC Orthopaedic Surgery.
8 Baby Makes Three A young couple seeks to become a trio… and succeeds with the right treatment and advice.
15 A Good Position to Be In
Radiation treatment for breast cancer is safer and more comfortable with prone positioning.
16 A Leg Up
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John Privett is himself again after surgery for lymphedema, thanks to the expert work of Ketan Patel, MD.
18 Now Hear This
A husband, father and physician follows his world-renowned otolaryngologist to Keck Medicine to find relief for his hearing loss.
21 Clinical Trials 101
What is a clinical trial exactly, and who benefits from participation? (Spoiler alert: Everyone does!).
22 Healthoughts: Medical News You Can Use
Major study examines prostate cancer in African-Americans; an existing technology is approved for easier follow-ups for bladder cancer survivors; is the new shingles vaccine worth it; Keck Medicine of USC gets accolades locally and nationally.
NEWS FROM USC VERDUGO HILLS HOSPITAL 11 Safe Haven USC Verdugo Hills Hospital’s new state-of-the-art NICU stands at the ready for complications in childbirth.
12 An Unexpected Journey When a man who doesn’t slow down for anything is admitted to the
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USC-VHH Emergency Department, all of Keck Medicine steps up to help the whole family.
14 In Good Hands The USC-VHH emergency nursing department gets national recognition for their efforts with an award from the Board of Certification in Emergency Nursing.
KeckMedicine.org
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COVER STORY
AT 21 YEARS OLD, MELANIE RODRIGUEZ DID NOT EXPECT TO BE IN A MEDICAL TRANSPORT HELICOPTER ON HER WAY TO GET LIFE-SAVING TREATMENT AT KECK MEDICINE OF USC’s CARDIOVASCULAR THORACIC INSTITUTE. BUT A CARDIAC ABLATION FOR AN IRREGULAR HEARTBEAT AT ANOTHER HOSPITAL HAD DEVELOPED COMPLICATIONS THAT NEEDED KECK MEDICINE’S SPECIALTY CARE.
BACK IN CIRCULA by Hope Hamashige
While still a freshman in high school, Rodriguez was diagnosed with bigeminy, a type of irregular heartbeat, after she felt sick and passed out in a hallway at her school in the San Fernando Valley. She lived with the condition for several years before her doctor recommended that she have the ablation procedure. “The doctors thought I should have it done because I was young and it would be better to do it while I could bounce back right away,” recalls Rodriguez. If all goes well with a cardiac ablation, it can be a quick recovery. Some patients are discharged the same day and quickly return to normal life. Unfortunately, this was not the case for Rodriguez when the ablation was performed at her community hospital. Still, she was released and returned home.
THEDOCS AMY HACKMANN, MD Assistant Professor of Clinical Surgery at the Keck School of Medicine of USC 2 (800) USC-CARE
RAY MATTHEWS, MD Professor of Clinical Medicine at the Keck School of Medicine of USC
She soon developed blood clots, which is a possible side effect from this procedure. One of her feet was swollen and she was struggling to get around. Looking back, she says her head was telling her that she must be alright because she had been discharged from the community hospital. Her gut, on the other hand, was telling her that something was really wrong.
ATION
I am so super blessed and so much more than grateful that I ended up with Dr. Matthews and the whole Keck Medicine team.
KeckMedicine.org
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Knowing that she was supposed to walk as part of her recovery, she took a walk with her boyfriend Richard Gutierrez a few days after going home. As the young couple sat down to eat lunch, she went pale and he caught her just as she was about to pass out.
The Right Expertise to Help An ambulance sped her to the nearest hospital where an emergency room doctor instantly recognized that she had developed blood clots that were lifethreatening. Although they didn’t have the proper training or equipment to treat her, he promised Rodriguez that he would find help. He made a call to the USC CardioVascular Thoracic Institute. Even though Rodriguez had never been seen at Keck Medicine before, he knew they had the right expertise to help her. By the time the helicopter that carried Rodriguez to Keck Hospital was met by Ray Matthews, MD, professor of clinical medicine at the Keck School of Medicine of USC and chief of the division of
cardiovascular medicine, Rodriguez was on a ventilator because she was no longer able to breathe on her own. The blood clots in her leg had moved into her lungs, sending her into cardiogenic shock. Because the clots were so large, her body was no longer capable of circulating blood. In addition to affecting her heart and lung function, this also caused her kidneys and liver to fail. Though blood clots are common and many community hospitals can safely and effectively treat them, Rodriguez’s were too big and too extensive to be treated at most medical institutions. Saving her life would involve bringing together two areas of expertise, so Matthews reached out to Amy Hackmann, MD, assistant professor of clinical surgery at the Keck School and director of mechanical circulatory support at Keck Hospital, to keep Rodriguez alive long enough so that he could treat her. “She needed an unusual treatment for an unusual problem, which is essentially what we do,” says Matthews.
The closeness of these relationships between disciplines, because we are in a collaborative environment, is really beneficial to our patients. RAY MATTHEWS, MD
A Shot at Survival Matthews is one of only a few physicians in the area with experience treating large blood clots. Treatment can involve inserting a catheter into the lung vein, which would drip a medication directly onto the clot to dissolve it. This procedure also carries significant risk because the medication used is stronger than other blood thinners, but it was also Rodriguez’s only shot at survival. Unfortunately, dissolving large clots can take a few days and Rodriguez did not have that much time. “We needed to get her on ECMO or she probably wouldn’t have survived,” explains Hackmann. ECMO, or extracorporeal membrane oxygenation, is performed by a machine that works in place of the heart and the lungs, essentially breathing and keeping blood flowing for patients who cannot do this on their own. Hackmann is also surgical director of lung transplantation at Keck Medicine and one of the most experienced physicians in Southern California in using ECMO on adults. Putting Rodriguez on ECMO was the only way to keep her alive long enough to let Matthews administer the drugs and let them do their job. Neither component of Rodriguez’s treatment is widely available in Southern California. According to Matthews, most doctors rarely see patients with blood clots the size of Rodriguez’s and so most don’t have the technical expertise to dissolve them. “Because a situation like this is so unusual, this procedure is not commonly employed outside of major medical centers,” he says. Likewise, there are few area hospitals that have ECMO machines. Hackmann adds that Keck Medicine has the largest program in Los Angeles and one of the largest on the West Coast for using ECMO.
Working in Concert
4 (800) USC-CARE
Using ECMO bought Rodriguez critical time for the medication to rid her lungs of the clots that put her life in peril. While most patients who need help from ECMO are transplant patients, Hackmann says that she often collaborates with doctors from other departments who need help from this life-saving device.
Mitral Valve
NEW COLLABORATIVE VALVE REPLACEMENT BENEFITS PATIENTS AND PHYSICIANS ALIKE by Lex Davis In July 2018, a team led by Vaughn A. Starnes, MD, chair and Distinguished Professor of Surgery and Ray Matthews, MD, professor of clinical medicine at the Keck School of Medicine of USC, successfully completed a transcatheter mitral valve replacement with a new device as a part of a clinical trial — the first successful procedure with that device in California.
This type of cross-disciplinary effort is another benefit for patients at Keck Medicine. “There are a lot of opportunities to work in concert,” says Matthews. “The closeness of these relationships between disciplines, because we are in a collaborative environment, is really beneficial to our patients.” The teamwork of the physicians from Keck Medicine saved her life, but Rodriguez had a way to go before she was herself again. After nearly two weeks in the intensive care unit, a team of physical therapists helped her rebuild her strength in her arms and get back on her feet. “I had no strength at all for a while and had to work up to things like brushing my teeth by myself,” she recalls. Finally, the time came to head home. After leaving Keck Hospital, Rodriguez remained on blood thinners for about a year, which
meant she had to use extra caution not to injure herself in any way. Now, however, Rodriguez’s health crisis is squarely in the past. She is completely free of blood clots and has been weaned off the blood thinners. She has seen Matthews every six months for follow-ups, and he has given her a clean bill of health. “I am so super blessed and so much more than grateful that I ended up with Dr. Matthews and the whole Keck Medicine team,” she says. “Without them, I wouldn’t be here and I wouldn’t be thinking about my future. They saved my life.”
Learn more at: keckmedicine.org/UH5 (213) 238-6128
Mitral valve replacements are particularly challenging because of their shape. The team has to do extensive pre-planning, measuring potential new valves against CT scans to make sure they have a precise fit. The minimally-invasive procedure allows the team to deliver the new valve through a small incision in the patient’s side, instead of opening up the chest as is done in a traditional heart surgery. Starnes, who is executive director of the USC CardioVascular Thoracic Institute (CVTI), found the procedure particularly rewarding because he created the CVTI to foster exactly this kind of close collaboration between different disciplines. “Valve replacements typically involve two cardiac surgeons and two cardiologists working together,” he explains. “It’s a front-row seat to appreciate the other physicians’ skill.” Matthews agrees: “Cardiologists and cardiac surgeons have historically had a bit of a rivalry, because we were seen as competing for the same patients. This has taken our relationship to a whole different plane. It has become a mutual admiration society. That’s good for everyone — especially the patient.” KeckMedicine.org
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SECONDnature by Hope Hamashige
MANY OF US SEEK A SECOND OPINION WHEN CHOOSING A RESTAURANT. SO WHY DON’T WE SEEK ONE BEFORE UNDERGOING A COMPLEX ORTHOPAEDIC SURGERY? There are times when even seasoned orthopaedic surgeons want their patients to receive a second opinion from an expert team at an academic health system like Keck Medicine of USC. There may be unusual risks associated with a surgery or the procedure may be complex or rarely performed. In these cases, having a more specialized surgeon evaluate the problem can be of great benefit to the patient. “Patients are often sent to us because they know our surgeons are very specialized and can manage complex problems. We have joint replacement, foot and ankle, knee and hip, sports medicine, hand, spine, trauma and tumor specialists,” notes Jay Lieberman, MD, professor and chair of the Department of Orthopaedic Surgery at the Keck School of Medicine of USC. “There are times when a patient or their doctor wants an evaluation by a specialist because they may know more about the latest treatments in that area.” Academic medical centers push the frontiers of modern medicine with cutting-edge research and clinical trials that lead to breakthroughs in patient care.
“ Patients are often sent to us because they know our surgeons are very specialized and can manage complex problems. We have joint replacement, foot and ankle, knee and hip, sports medicine, hand, spine, trauma and tumor specialists.” JAY R. LIEBERMAN, MD
Some patients may also have other health problems that can raise the risk of a straightforward orthopaedic surgery procedure. The orthopaedic surgeons at Keck Medicine regularly collaborate with doctors from other specialties to create treatment plans for a patient’s particular needs. “A multidisciplinary approach is essential if a patient has multiple medical problems in addition to their musculoskeletal problem,” Lieberman, who is also director of Keck Medicine’s USC Orthopaedic Surgery, explains.
Lieberman goes on to say, “Everything we do is for one reason: We want to enhance the care of our patients. We have special expertise and we believe that is the best way to optimize results, whether it be a straightforward or complex problem.”
Learn more at: keckmedicine.org/UH6 (213) 699-2579
Second opinions do not always come before surgery. Many patients seek second opinions after they have had a procedure and did not attain the desired outcome. Keck Medicine’s surgeons are adept at revising procedures that did not achieve optimal outcomes, such as fractures that did not heal or unsuccessful spine fusions. Keck Medicine’s physicians can also skillfully perform simple orthopaedic procedures and have pioneered techniques to reduce discomfort and shorten hospital stays, including minimally invasive and nonsurgical procedures, for the most common orthopaedic problems
THEDOC JAY R. LIEBERMAN, MD Professor and Chair of the Department of Orthopaedic Surgery at the Keck School of Medicine of USC
Q: DO YOU KNOW WHEN TO SEEK A SECOND OPINION? A: W HEN YOU’VE RECEIVED A DIAGNOSIS OF A COMPLEX ORTHOPAEDIC CONDITION, IT’S VALUABLE TO SEEK A SECOND OPINION. Keck Medicine of USC’s orthopaedic surgeons are experienced in treating complex problems such as multiligament knee injuries, revision anterior cruciate ligament and rotator cuff repairs, complex spinal deformities, brachial plexus injuries, fracture nonunion and revision joint replacements. They are also skilled in performing cutting-edge procedures such as vascularized fibula grafts, free muscles flaps, osteotomies for spinal deformity, bone transport procedures, stem cell treatments for osteonecrosis of the hip and knee, and limb salvage procedures for tumors.
BRACHIAL PLEXUS INJURIES
ROTATOR CUFF REPAIR
COMPLEX SPINAL DEFORMITIES
STEM CELL TREATMENTS FOR OSTEONECROSIS OF THE HIP AND KNEE
REVISION ANTERIOR CRUCIATE LIGAMENT REPAIR
REVISION JOINT REPLACEMENTS: SHOULDER, HIP AND KNEE
MULTILIGAMENT KNEE INJURIES VASCULARIZED FIBULA GRAFTS
COMPLEX FOOT AND ANKLE DEFORMITIES KeckMedicine.org
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Baby Makes Three
by Matthew Kredell
Rocky Walker is a man’s man: He’s a muscular, tattooed, Harley-riding prison guard who lives in the blue-collar town of Bakersfield. But masculinity doesn’t exempt someone from needing male fertility treatment.
8 (800) USC-CARE
When Walker and his wife Valerie Valdez decided to have a baby and were having difficulty getting pregnant, they had an idea of what might be the problem. Five years earlier, he had started feeling fatigued and gaining weight. At the gym, he could barely do a single push-up. He went to his doctor and found out that his testosterone was low, so he was put on a testosterone supplement gel. While this treatment helped him feel like himself again, it also lowered his sperm count — an effect that many people are not aware of. They thought that perhaps the low testosterone, combined with the trouble conceiving, meant he also was dealing with a lack of sperm. A home sperm test confirmed their fears, and Walker felt resigned to accept that he wasn’t meant to produce a child. Valdez wasn’t going to give up that easily. A nurse for the Bakersfield City School District, she searched the internet and found that a male fertility specialist from Keck Medicine’s USC Institute of Urology, Mary Samplaski, MD, regularly sees patients in Bakersfield. Samplaski, assistant professor of clinical urology at the Keck School of Medicine of USC, is an internationally recognized expert in male infertility, andrology and microsurgery. She spearheaded the Male Infertility Program at USC in 2015. “I pretty much figured, well, that’s just how it is,” Walker says. “I was born sterile and that’s just life. Valerie wanted to find a local doctor to see if there was any hope there. I told her, ‘How can there be hope if there’s already a test that says zero sperm?’ But she’s the more hopeful person. She said, ‘Well, let’s just go talk to the doctor and see what happens.’” A year later, what happened was that the couple had a healthy baby boy they named Alex. For Walker and Valdez, it had been about a year before they sought help. Walker was apprehensive going into his male fertility appointment after searching the internet and seeing the invasive methods that can be used to extract sperm in difficult cases. Valdez made the appointment and drove him there to be sure he went. However, once he arrived, Samplaski quickly put him at ease.
Every single person who struggles to have a baby knows how heartbreaking it is, and so helping them overcome that is a beautiful thing. MARY SAMPLASKI, MD
“When I started talking to Dr. Samplaski, she spoke to me like she was my next-door neighbor, like a real person,” Walker says. “During my first visit, I sat in her office for quite some time talking about both medical and non-medical topics. She made me feel extremely comfortable in believing that we would eventually have a baby. There were no sharp objects going near my testicles. We merely had a conversation about my low testosterone, and from that she identified the problem.” “In men with Rocky’s condition, infertile after treatment with testosterone replacement, most of them will have resolution of sperm to the ejaculate with medical treatment,” Samplaski says. The testicular gel he had been using was indeed bad for sperm production. Samplaski switched his medication, and that’s all it took. His testicular function recovered, both with respect to sperm and testosterone function. “Not all doctors know that these medications can hurt sperm production,” Samplaski says. “Some doctors think you should treat infertility with testosterone, which is exactly the wrong answer. Testosterone has actually been investigated as a male hormonal contraceptive.” Walker couldn’t believe it was such an easy fix. “That was quite a relief when she said it would likely be simple little pills that would cure me,” he says. “I was like, ‘Oh, no knives, no digging in, no cutting? I’m down for that.’”
He was in even greater disbelief three months later when Valdez woke him up at four in the morning shouting that she was pregnant. Walker had reached his late 30s unsure if he wanted to have children, but that quickly changed. “I knew he felt that way, but I had seen him before with his nieces and he always had this really good bond with them, so I always thought he was going to be a good dad,” Valdez says. “It turned out that I was right. It’s been amazing to see how much he loves Alex.” Like many people, he wondered if he could continue living his life while taking care of another. Having Alex completely altered his perspective. “I don’t know what life would be like without him,” Walker says. “I’m quite glad he’s here. Raising a child that’s happy to see you when you come in the room is an incredibly uplifting feeling.” Even though Samplaski’s work was done early in the process, she stayed involved by keeping in touch with Walker to get status updates on Valdez’ pregnancy and Alex’s birth. “She does a lot of follow-up work, and still today she emails me here and there to see how I’m doing and asks for pictures of the baby,” Walker says. “She’s so friendly,
FACTS ABOUT MALE INFERTILITY
50%
OF INFERTILE COUPLES have reproductive problems in the male
1 IN 25
MEN are affected by infertility
90%
OF THE CAUSES of male infertility can be treated KeckMedicine.org
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WHEN TO CONSULT A FERTILITY SPECIALIST
Stop with your egotistical pride and go check it out!
Samplaski suggests that couples seek help from a fertility specialist if they have: Tried unsuccessfully to conceive for a year Tried unsuccessfully to conceive six months if the female partner is older than 35 Any other concerns
CHANGE OF HEART? A common reason why men do not have sperm: they’ve had a vasectomy. Approximately 5 percent of men who have a vasectomy will decide to have a reversal. Q Do these procedures actually work? A Yes! Approximately 90 percent of men will have return of sperm to the ejaculate after this surgery.
GOOD TO KNOW Vasectomy reversal is more cost effective than IVF, and it gives couples multiple opportunities to achieve a conception. Samplaski, who also sees patients at Keck Medical Center of USC in Los Angeles and at USC Verdugo Hills Hospital in Glendale, is specialty trained in doing this delicate surgery, which is performed under an operative microscope at a same-day surgery center.
THEDOC MARY SAMPLASKI, MD Assistant Professor of Clinical Urology at the Keck School of Medicine of USC 10 (800) USC-CARE
outgoing and easy to talk to. I think she’s just super nice and super helpful, and a really genuinely caring individual. She is also incredibly intelligent and skilled at helping men become fathers: I think this combination is important for fertility issues.” “Every time I get an email from a patient saying they’re pregnant with an ultrasound or with a picture of their newborn baby, it’s special because I know what they went through,” Samplaski says. “Every single person who struggles to have a baby knows how heartbreaking it is, and so helping them overcome that is a beautiful thing.” In the three years since Samplaski started the male fertility program at Keck Medicine, Walker is the first patient who has been interested in sharing his journey. Many men are afraid to talk publicly about infertility issues. These are deeply personal issues, which can be emasculating and scary to share with the world. Samplaski says. “Women are much more willing to talk about their fertility struggles.” Samplaski encourages men to get checked for fertility issues, even if they don’t have immediate plans to have a child, because emerging evidence shows that infertility may be the marker for other underlying non-fertility medical issues.
“If you take all the men who have a male fertility evaluation, about 5 percent will have some underlying condition that could be a threat to their life — including testicular cancer, prostate cancer or thyroid issues,” Samplaski says. “So the underlying issue that’s hurting their sperm production would have otherwise have gone undetected.” Walker doesn’t mind if he gets a little ribbing from his fellow corrections officers at North Kern State Prison. He wants to encourage them and males everywhere not to be afraid to see a male fertility specialist if they’re having trouble conceiving. “Stop with your egotistical pride and go check it out,” Walker says he would tell those men. “It doesn’t hurt to walk into some place, and you might find out that you like it there, the way I found out that there was a way for me to both have a baby and keep my testosterone.” He also likes the result of his visit — a future hog-riding bundle of joy.
Learn more at: keckmedicine.org/UH10 (213) 205-0959
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afe haven
EVEN THE HEALTHIEST AND MOST CAREFUL EXPECTANT MOMS CAN EXPERIENCE UNFORESEEN PROBLEMS DURING PREGNANCY OR CHILDBIRTH. UNDERSTANDING THAT PREGNANCY CAN BE FILLED WITH UNEXPECTED CHALLENGES, USC VERDUGO HILLS HOSPITAL RECENTLY OPENED A NEW STATE-OF-THE-ART NEONATAL INTENSIVE CARE UNIT (NICU.)
by Hope Hamashige
“There are many things that can happen that you don’t expect,” says Melissa Stehlin, BSN, RN, clinical director of the Women and Family Center at USC Verdugo Hills Hospital (USC-VHH). Stehlin added that the NICU was created as an extension of support and resource to expecting women in the area who develop high-risk issues during pregnancy, such as preterm labor, gestational diabetes or gestational hypertension as well as those who could develop more serious complications or unanticipated events. The NICU at USC-VHH opened in March 2018 to provide a higher level of care and extra piece of mind for all patients planning to deliver their little ones at USC-VHH in the event that either their pregnancy or delivery doesn’t go as planned. The NICU can tend to the needs of premature newborns delivered after 32 weeks, many of whom need extra help, particularly with breathing, while they continue to develop. It is also a safety net for those newborns who experience unanticipated problems shortly after they are born. Unlike many NICUs, the facility has private rooms for families, affording parents the opportunity to spend more time with their newborn and to be more involved in their care. Understanding that some babies may have to spend weeks or even months in the NICU, it is also outfitted with NICView cameras so that parents can check on their family’s newest addition by smartphone or computer should they need to leave its side.
Samantha Bechtel, RN, cares for a patient in the NICU.
Though designated a Level 2 NICU, USC-VHH is outfitted with some technology typically only found in Level 3 NICUs. Investing in new technologies like state-of-the-art ventilators and incubators is another way the team at USCVHH hopes to give its littlest patients top care. “The addition of the NICU at USC-VHH allows moms and families to stay close to home,” says Keith Hobbs, MBA, chief executive officer of USC-VHH. “Our NICU is outfitted with leading-edge technology and best-in-class service to provide exceptional care to the very newest members of our community and their parents.”
Learn more at: keckmedicine.org/UH11 (818) 918-3358 USCVHH.org
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AN
UNEXPECTED
OURNEY JONATHAN CURTIS HAS A “TYPE A” PERSONALITY. SO WHEN HE WAS HIT WITH SUDDEN, SEVERE PAIN IN HIS ABDOMEN LAST OCTOBER, HE SIMPLY GRABBED SOME ANTACIDS TO SETTLE HIS STOMACH SO HE COULD GET BACK TO WORK.
by Hope Hamashige
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Instead of improving, the pain got worse. Within a few hours, Curtis was wheeled into the emergency room at USC Verdugo Hills Hospital (USC-VHH), where blood work and a CT scan showed that he had necrotizing pancreatitis. Pancreatitis occurs when the pancreas becomes inflamed and, while painful, it is usually resolved simply. Physicians administer fluids and pain medication and keep a watchful eye while the inflammation subsides. Unfortunately for Curtis, his was an acute necrotizing case which can, and did, become life-threatening. Curtis, who serves on the La Cañada Flintridge City Council and is the city’s former mayor, was admitted to USC-VHH and was quickly transferred to the intensive care unit when his blood pressure dropped, his heart rate became irregular and he developed confusion — all signs that his pancreas was not stabilizing. He was evaluated by several of the hospital’s specialists who determined he needed a higher level of care within Keck Medicine of USC because the systemic inflammation was beginning to shut down his other organs. He was swiftly transferred via medical transport to Keck Hospital of USC’s Intensive Care Unit (ICU.) “We have built a seamless system to provide the highest-quality care to our patients and their families,” says Keith Hobbs, MBA, chief executive officer of USC-VHH. He added that the doctors at USC-VHH and Keck Hospital can access records on incoming patients automatically. “Seamless information-sharing improves safety when we transfer patients to Keck Medical Center for life-saving specialty care and for those who return to USC-VHH.”
TOO SICK FOR SURGERY Damon Clark, MD, assistant professor of clinical surgery at the Keck School of Medicine of USC, and associate medical director of the surgical intensive care unit at Keck Hospital explains that Curtis’ pancreatitis led to multisystem organ dysfunction. “Part of his pancreas was dead, his kidneys were failing, he needed mechanical ventilation because his lungs were failing, his cardiovascular and nervous systems were compromised, too.”
Since gallstones can lead to pancreatitis, removing the gall bladder is a common intervention, but Curtis was too sick to undergo surgery. They were able to put him on continuous renal replacement therapy to supplement his kidneys function, a life-saving treatment that is not widely available. He was also closely monitored by a large, multidisciplinary group of doctors who intervened when complications, including a couple of incidents of atrial fibrillation, arose.
CONNECTIONS PROVIDE SUPPORT Clark adds that while Curtis was seriously ill, it became clear to the staff that he wasn’t the only one in need of care: His family was also suffering at his side. Curtis’ wife Lisa and their daughters Melissa and Lauren connected gratefully with Reverend Phil Manley from Keck Medicine’s chaplaincy program, who offered prayers and emotional support throughout the 21-day ICU stay. Lisa adds that the nurses in the ICU were generous with their time, talking her through her husband’s condition during many latenight phone calls. “As a nurse, I understood all of the complications that can arise from this and almost all of them did,” Lisa recalls. The staff also arranged for one of their daughters, who was in graduate school at the time, to use an empty office where she could study and Skype into her classes so that she didn’t fall behind.
WE HAVE BUILT A SEAMLESS SYSTEM TO PROVIDE THE HIGHEST-QUALITY CARE TO OUR PATIENTS AND THEIR FAMILIES. KEITH HOBBS, MBA, CHIEF EXECUTIVE OFFICER OF USC-VHH
ABOVE AND BEYOND Though he is more careful about his diet now and may still need to have his gall bladder removed, Curtis is back at work and looking forward to walking both of his daughters down the aisle next year at their weddings. “I was fortunate to have a wonderful hospital for local care with the benefits of immediate access to a large medical and research institution with experts in every field. I am eternally grateful to the many doctors, nurses, therapists, ministers and other caregivers of Keck Medicine for their devotion and expertise. They saved my life, both physically and spiritually. This challenge has heightened my appreciation for every moment we have here on earth.”
Learn more at: keckmedicine.org/UH13 (818) 975-3778 USCVHH.org
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USC-VHH is the first hospital in California to receive BCEN Honorary Certification Recognition, an award that is bestowed on one small and one large health care facility each year.
SC-VHH was chosen from a U group of 85 small health care facilities for this year’s award. BCEN, a nonprofit organization that provides certification for emergency nurses, established the BCEN Honorary Certification Recognition program in 2008. Recognition is bestowed on organizations that have demonstrated outstanding promotion of specialty certification in emergency, flight, critical care ground transport, pediatric emergency nursing and/or trauma nursing.
In Good Hands
by Erica Rheinschild
When a patient finds themselves in the unfortunate situation of needing emergency care, often the first person they get treatment from is a registered nurse. USC Verdugo Hills Hospital takes pride in having a highly-trained, expert staff of nurses for their emergency department. Because of this dedication, USC Verdugo Hills Hospital (USC-VHH) is being recognized for its exceptional support of emergency nursing certification with the Board of Certification in Emergency Nursing (BCEN) Honorary Certification Recognition. The award was presented September 28, 2018 at the Emergency Nurses Association annual Conference in Pittsburgh. The award reflects USC-VHH’s recent efforts to encourage emergency nursing certification among its staff. “Certification is a way to elevate basic nursing practice to expert practice,” says Theresa Murphy, RN, MSHA, USC-VHH’s chief nursing officer. “It communicates to the public that we deliver nursing care with a higher level of training and performance.” In the last year, USC-VHH has provided ER nurses several opportunities to expand their skill set. Courses included emergency nursing for pediatrics (ENPC), Certified Emergency Nursing (CEN) review and triage. The hospital also launched a CEN certification bonus program to reward nurses for their efforts.
14 (818) 790-7100
“Nearly 100 percent of our registered nurses have passed the ENPC,” says Jessica Thomas, RN, MSN, associate administrator of USCVHH’s emergency department. “We also have eight CEN nurses, with many more actively studying for the exam in the next few months. The team is energized about certification and providing outstanding care.” “The end outcome of all of these efforts is providing excellent care and driving safe care — values that are consistent with our commitment to our community and being part of an academic health system,” Murphy says. USC-VHH’s ER boasts an average wait time of less than 30 minutes, and through its affiliation with Keck Medicine of USC, the hospital provides easy access to highly specialized care for patients with complex health care needs. Photo Top: Bien Niloban, RN, attends to the needs of a patient in the USC-VHH emergency room. Photo Left: Theresa Murphy, RN (left), chief nursing officer of USC Verdugo Hills Hospital, and Jessica Thomas, RN, MSN, associate administrator of USC-VHH’s emergency department.
A GOOD
TO BE IN
POSITION Prone positioning radiation treatment is available at Keck Medicine of USC for patients with early stage breast cancer.
What is it?
Prone positioning means the patient lies face down while receiving radiation treatment. A specialized prone breast board makes it more comfortable, easier and safer for patients.
Why is it better?
It allows gravity to pull breast tissue away from the chest wall, reducing or eliminating exposure to radiation in the heart and lungs.
Who can benefit?
Patients who need radiation for breast cancer that has not spread beyond the breast or axillary lymph nodes.
How does advanced imaging improve the treatment even more?
In addition to the prone breast board, the treatment machine captures 3-D CT scan images to know exactly what area to target with radiation. The USC Norris Comprehensive Cancer Center is one of the few sites in Southern California to offer this approach.
“ Most radiation oncologists aren’t typically trained in this technique. And most radiation oncology practices don’t have the specialized equipment that we do here — only about 10 percent of practices use this technique.” JASON YE, MD Assistant Professor of Clinical Radiation Oncology at the Keck School of Medicine of USC
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He knew exactly what was going on. One meeting with Dr. Patel, and we knew we were going with him.
A LEG
USC alumnus John Privett has been active his whole life and running triathlons since the 1980s. When he experienced ankle pain after a normal run, his general practitioner told him not to worry about it. When the symptoms worsened and were no longer able to be ignored, Ketan Patel, MD, of Keck Medicine of USC stepped in to help.
16 (800) USC-CARE
JOHN PRIVETT
by Lex Davis
After the initial pain, the swelling started: first his ankle, then up to his calf. Privett thought it might be a muscle tear at first, then knew it couldn’t be. He tried to keep going, even completing a half–Iron Man competition by using compression socks to manage the swelling. But his condition was getting worse. “Next thing you know, my leg was ballooned up,” said Privett. He’s good humored about the situation now, but at the time the swelling, which was from fluid retention, was frustrating to a man who was used to being on the move. He couldn’t fit his calf into a ski boot, couldn’t fit his foot into a stirrup. Soon his leg wouldn’t fit into his jeans. It didn’t hurt, but it was heavy and uncomfortable. “I had a Coke bottle of fluid in my ankle, foot and calf!” Privett recalls.
“Supermicrosurgery” He spent a year chasing a diagnosis. One doctor thought he might have an abdominal tumor. Though Privett was relieved when it turned out that he didn’t have cancer, it did mean that he was back to scouring the internet for clues. Privett was finally diagnosed with lymphedema tarda, a congenital condition in which the
lymphatic pathways are underdeveloped. Lymphatic fluid wasn’t properly draining from his system, and was building up in his foot and leg. Now that he knew what was wrong, Privett just had to find a doctor who could deal with this condition properly. This turned out to be more difficult than he expected. Lymphology isn’t a common study for many doctors, so they tend to shy away from lymphedema cases. In the end, it was Privett’s wife Cissy, also a USC graduate, who found Ketan Patel, MD, associate professor of clinical surgery at the Keck School of Medicine of USC. Patel is one of the few surgeons in the world who is trained to do lymphovenous bypasses and vascularized lymph node transfers — leading-edge microsurgical techniques that can help reduce the swelling and pain of lymphedema. He underwent perhaps the most well-known fellowship for microsurgery in the world with Ming-Huei Cheng in Taiwan. “I just found it fascinating,” Patel says. As Cheng taught him the surgical techniques, Patel combed through textbooks and learned about the lymphedema disease process on his own. Microsurgery is already a technical challenge. When performing typical microsurgery, surgeons use a microscope and very fine sutures to work with diameters of just 2–3 millimeters. But when the procedure is for lymph vessels, it becomes “supermicrosurgery,” Patel explains, with vessels a single millimeter — or less ‚ in diameter. “It’s an extreme type of microsurgery,” Patel says. “It’s exponentially more difficult. You’re using special instruments just for lymphatic procedures. It’s just so small.” Patel was recently appointed director of Keck Medicine’s new Center for Advanced Lymphedema Treatment and Surgery. With a mission to provide surgical and non-surgical treatment for lymphatic disease, the center boasts the only multi-disciplinary lymphedema treatment team in the greater Los Angeles area.
Finding a Pathway Patel most frequently works with breast cancer patients who have secondary lymphedema that can develop when the lymph nodes are
THEDOC KETAN PATEL, MD Associate Professor of Clinical Surgery at the Keck School of Medicine of USC
damaged or removed during treatment for breast cancer. In fact, it was an article about breast cancer treatment and reconstruction that led the Privetts to Patel. Privett said that Patel understood his situation right away. “He knew exactly what was going on. One meeting with Dr. Patel, and we knew we were going with him.” Patel brought Privett in for a lymphovenous bypass, a painstaking procedure in which the surgeon connects lymphatic vessels to smaller veins in order to give the fluid a pathway out of the patient’s system. The grueling procedure took seven hours. “It’s fatiguing and can be frustrating,” explains Patel. “That may be why there are only a couple dozen people in the world who are doing much of this.” But the work paid off. In two months, Privett’s swelling went down. He’s now back to triathlons, riding horses and surfing, and is a favorite with Dr. Patel’s staff when he comes in for his annual check-ups. “He was a great patient with a good outcome,” says Patel. “We’re always glad to see him doing well.”
Learn more at: keckmedicine.org/UH17 (213) 354-8271 KeckMedicine.org
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NOW
HEAR
A DOCTOR FROM CENTRAL
CALIFORNIA FOLLOWS RESPECTED OTOLARYNGOLOGIST JOHN S. OGHALAI, MD, TO HIS NEW HOME AT KECK MEDICINE OF USC WHEN A PREVIOUS HEARING LOSS ISSUE DEVELOPS IN HIS OTHER EAR. 18 (800) USC-CARE
As a husband and father, an emergency medicine physician and volunteer medic with the San Luis Obispo Sheriff ’s Office Special Enforcement Detail, KRISTOPHER LYON, MD, had an increasingly busy life. And a noisy one. Then one day he couldn’t hear his wife, Rachel May, speaking as they drove in the car, and he got worried. The diagnosis deepened his concerns: otosclerosis.
THIS by Candace Pearson
Derived from the Greek words for ear (“oto”) and hard (“scler-o”), otosclerosis is an abnormal bone growth that fuses the bones of the inner ear together in an immovable mass, preventing the transmission of sound. The progressive hearing loss typically begins in the early 20s, but many people don’t become aware until their 40s or 50s. Lyon was only 35.
Lyon, who has no known family history of otosclerosis, was determined to identify “the best doctor for the job,” he says. He found John S. Oghalai, MD, an internationally recognized otolaryngologist with expertise in ear and skull base surgery and now chair of the USC Tina and Rick Caruso Department of Otolaryngology – Head & Neck Surgery. At the time, four years ago, Oghalai was on staff at Stanford University. Lyon, who lives in San Luis Obispo and works in Bakersfield as an ER doctor and head of Kern County’s Emergency Medical Services, went to see him. The good news was that Lyon had the form of otosclerosis in which the bone overgrowth immobilizes the stapes bone in the middle ear, causing conductive hearing loss. In a second, more difficult-to-treat form, the ossified bone affects the entire bone around the cochlea, requiring a cochlear implant. “That diagnosis meant we could treat him with hearing aids or surgery,” Oghalai says, “both of which help bypass the fixation spot and restore hearing.” Lyon first tried a hearing aid in his right ear, unsure how it would affect his work and family life. He soon discovered “there’s no good method of using a stethoscope with one bad ear and one good ear,” he says. And if he took his hearing aid out at night when he slept, he couldn’t hear his son, Owen. So Lyon opted for a stapedectomy, an intricate outpatient procedure done under local or general anesthesia. “It’s one of the most delicate surgeries that ENT (ear, nose and throat) physicians do,” says Oghalai. In fact, most ENT physicians prefer to refer their patients to expert surgeons like Oghalai. Working with a high-powered operating microscope, he removed the arch of the stapes bone in Lyon’s right ear. He then used a laser to make a tiny (.7 mm) hole and secure a lightweight titanium prosthesis .6 mm in diameter. Lyon could hear out of his right ear again, but his left ear was already showing signs of trouble. He hoped he could beat the odds. Yet within several months, the precipitous hearing loss was too severe to ignore.
By then, both men’s lives had changed. Lyon and May had a second son, Noah. Oghalai had joined the team at the USC Caruso Department of Otolaryngology – Head & Neck Surgery, drawn, he says, by “the most enthusiastic and committed group of faculty, staff and trainees I have ever seen.” That was all Lyon needed to know. His confidence in USC had another, family origin: His parents met at and graduated from the university. His father, the late attorney and conservationist Roger Lyon, was an AllAmerican swimmer for USC, while his mother, Susan Briles Lyon, majored in art history.
Oghalai suggests getting a hearing test for a proper diagnosis. With his hearing fully restored, Lyon is among Oghalai’s many happy patients. He can pick up subtle conversations, even in field training sessions and a busy emergency room. When he spends time at the family’s property near San Luis Obispo, every word — or moo — that’s said, he can pick up. Before he had the procedure, his youngest son learned to speak louder. Now, when Noah turns up the volume, his dad can say, “It’s ok, buddy. You don’t have to yell.”
Once again, Lyon opted first for a hearing aid in his left ear, waiting until his sons got a bit older. This past May, Lyon, now 39, had his second stapedectomy, this time at Keck Hospital of USC. Following the hour-long procedure, Oghalai packed Lyon’s ear to protect the ear drum during recovery. When Lyon returned to USC a week later, Oghalai removed the packing. The sound, says Lyon, was “quite loud.” For Oghalai, the procedure also is a source of satisfaction. This form of hearing loss can actually be fixed. “You can completely restore a sense that was lost,” he says, “and for most patients, their hearing is like it was when they were kids.” Because otosclerosis symptoms can be confused with age-related hearing loss,
THEDOC JOHN S. OGHALAI, MD Chair and Professor of Otolaryngology – Head and Neck Surgery, Leon J. Tiber and David S. Alpert Chair in Medicine at the Keck School of Medicine of USC
Learn more at: keckmedicine.org/UH19 (213) 320-6883 KeckMedicine.org
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# CANCER CARE Top-Ranked Provider in Southern California
USC Norris Comprehensive Cancer Center of Keck Medicine of USC is Southern California’s number-one ranked cancer care provider — with cancer outcomes ranked number one in California and number two in America.
Learn more about our leading cancer services at KeckMedicine.org/Cancer
© 2018 Keck Medicine of USC
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CANCER CLINICAL TRIALS 101 WHAT IS A CLINICAL TRIAL? ARE THEY SAFE FOR CANCER PATIENTS? WHO CAN PARTICIPATE, AND HOW DOES THE PROCESS WORK?
by Melissa Masatani Every advancement in cancer treatment begins its pathway to the patient in a laboratory. Researchers make observations and test their results for years before patients can participate in a clinical trial or study. Clinical trials are bridges that allow novel discoveries and therapies to reach patients and improve cancer treatment. There are a variety of types of cancer clinical trials, including trials that focus on identifying safe and effective doses of approved medications, and trials that compare new therapies to an existing approach. The USC Norris Comprehensive Cancer Center offers a variety of clinical trials for patients with all types and in all stages of cancer.
HELPING THE CANCER COMMUNITY Clinical trials often are the only way to answer very important scientific questions that can affect the medical care, treatment guidelines and health of both current and future cancer patients. Clinical trial participants provide enormous contributions to advances in biomedical research and ultimately to the types and manners of medical care provided to the public.
HOW DO I KNOW IF I AM A CANDIDATE?
WHAT SHOULD I KNOW BEFORE VOLUNTEERING?
Every cancer patient is a potential candidate for a clinical trial. “Trials are not only for patients who have no standard options available or have run out of options,” says says Anthony El-Khoueiry, MD, associate professor of clinical medicine at the Keck School of Medicine of USC, phase I program director and chair of the Clinical Investigations Support Office at the USC Norris Comprehensive Cancer Center.
Clinical trials have several levels of oversight to ensure patient safety. Every clinical trial in the U.S. is required to be reviewed and approved by an Institutional Review Board (IRB) — an independent committee of physicians, statisticians, community advocates and others who ensure a clinical trial is ethical and the rights of study participants are protected. All institutions that conduct or support biomedical research involving people must, by federal regulation, have an IRB that approves and periodically reviews the research.
There is a broad range of trial options that are designed to address different needs. A few examples include: • A trial may test the ability of a new drug to improve the odds of cure after cancer surgery. • Another trial may test the addition of a new drug to standard of care to see if it can make the existing standard therapy work better or longer. • A brand new drug may be tested in a trial to see if it is safe and determine the right dose in patients. Current active clinical trials at USC Norris are testing important concepts, such as stimulating the immune system to fight the cancer or personalizing the treatment based on specific genetic changes in the tumor.
Before enrolling in a clinical trial, a participant reviews what will happen in the trial, including possible side effects or risks, with the trial staff or investigators. Patients should look at their participation in the trial as a partnership between themselves and the physician, with the doctor as a resource for information about the background of the study or its design.
Learn more at: clinicaltrials.keckmedicine.org or call (800) USC-CARE (800-872-2273) KeckMedicine.org
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Healthoughts Some good things to know.
Top Doctors Recognized by Pasadena Magazine Physicians of Keck Medicine of USC and Children’s Hospital Los Angeles have been recognized by Pasadena Magazine in its annual Top Doctors issue. Pasadena Magazine’s Top Doctors issue lists practicing physicians in Pasadena and surrounding cities in the San Gabriel Valley who are considered by their peers to be the best in their specialties.
Keck School Leads Study on Prostate Cancer in African-American Men Recruitment has begun for a $26.5 million effort to conduct the first large-scale study on AfricanAmerican men with prostate cancer, led by Keck School of Medicine of USC.
> T he study aims to better understand why African-American men are at higher risk for developing more aggressive forms of the disease and why they are more likely to die from it.
> Researchers hope to recruit 10,000 African-American men nationwide to participate. “ NOT ONLY ARE AFRICAN-AMERICAN MEN MORE LIKELY TO DEVELOP PROSTATE CANCER, BUT THEY ARE TWICE AS LIKELY TO HAVE AN AGGRESSIVE, MORE LETHAL FORM OF THE DISEASE, AND WE DON’T KNOW WHY. IT’S A HEALTH DISPARITY THAT NEEDS TO BE ADDRESSED. CONSIDERABLE MONEY, TIME AND EFFORT HAS GONE INTO STUDIES IN MEN OF EUROPEAN ANCESTRY; IT IS TIME FOR A LARGE-SCALE EFFORT DEVOTED TO MEN OF AFRICAN ANCESTRY.” Principal Investigator Christopher Haiman, ScD, professor of preventive medicine at the Keck School
For more information about the study and how to participate, visit: RESPONDSTUDY.ORG 22 (800) USC-CARE
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PHYSICIANS ASSOCIATED WITH KECK MEDICINE OF USC
SPECIALTIES WERE REPRESENTED
READ THE WHOLE STORY ON PAGE 14
USC-VHH Emergency Nursing Shines The USC Verdugo Hills Hospital nursing staff now has national recognition for its exceptional support of emergency nursing certification. It is the first hospital in California to receive BCEN Honorary Certification Recognition, an award that is bestowed on one small and one large health care facility each year by the Board of Certification in Emergency Nursing. Photo: Bien Niloban, RN, and patient.
Don’t Be Chicken About New Shingles Vaccine Chickenpox and shingles generally won’t kill you, but for some adults, they could result in a trip to the hospital. So with a new shingles vaccine now available, should you consider vaccination to avoid chickenpox and shingles as an adult? Chickenpox is an infection caused by the varicella zoster virus, for which there is a vaccine. In children, chickenpox usually runs its course in five to 10 days and requires no medical intervention. But in those who develop chickenpox as teens or adults, there’s a risk of complications, including pneumonia, skin infections and brain swelling. Q What is shingles? A A dults can develop shingles if they’ve already had chickenpox. Shingles is a reactivation of the virus that causes chickenpox. After you recover from chickenpox, the virus doesn’t entirely disappear — it lies dormant in nerve tissue near your spinal cord and brain. When it springs into action again as a painful skin rash, that’s shingles. Q Who should get a shingles vaccine? A H ealthy people between 30 and 50 years old don’t need either vaccine, according to Orrange. There are some exceptions, including health care workers, pregnant women, teachers and those who are HIV-positive.
OVER
50?
People who are 50 or older can and should get the new shingles vaccine, Shingrix, whether or not you remember getting chickenpox in childhood. It’s given as a shot in two doses, two to six months apart.
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Healthoughts Continued.
Shedding Light on Bladder Cancer Recurrence
Keck Medicine Hospitals Ranked Among the Country’s Best for 10th Straight Year
When Anne Schuckman, MD, says, “Bladder cancer is a surveillance-heavy disease,” she is referring to the high recurrence rate, which necessitates routine follow-up cystoscopies for survivors.
For the 10th consecutive year, Keck Medicine of USC’s hospitals have been ranked among the country’s best hospitals by U.S. News & World Report. The annual rankings encompass overall patient care and specialized treatment areas ranging from cancer to urology.
There are two different types of light that are used for cystoscopy: white light doesn’t detect as many tumors, and blue light, until recently, was only used under full anesthesia with a rigid scope.
U.S. News evaluated more than 4,500 medical centers nationwide. In the 16 specialty areas, only 158 hospitals were ranked in at least one specialty. This year, Keck Medical Center of USC, which includes Keck Hospital of USC and USC Norris Cancer Hospital, was ranked: Among the top 50 nationwide in nine specialties In the the top three in metro Los Angeles In the top seven in California
Left: Bladder image using white light cystoscopy Right: Bladder image using blue light cystoscopy In May, the FDA approved flexible blue light cystoscopy for use in an office setting. Blue light cystoscopy has been shown to increase bladder cancer detection rates and decrease recurrence. The USC Institute of Urology participated in the clinical trial for this new technology and is now the only site in California equipped to offer this service to patients. Schuckman, who is an assistant professor of clinical urology at the Keck School of Medicine of USC and Sia Daneshmand, MD, associate professor of urology, director of urologic oncology and director of clinical research at the Keck School, were two of the trial’s lead investigators and are experts in performing flexible blue light cystoscopy. Both physicians are now performing flexible blue light cystoscopies at Keck Medicine of USC for bladder cancer survivors. “Bladder cancer survivors need to be proactive about their follow-up exams, and using the flexible blue light scope for cystoscopies removes one significant barrier — the anesthesia — from the equation,” says Daneshmand. Due for a follow-up cystoscopy? Call 8o0-USC-CARE for an appointment. 24 (800) USC-CARE
Nine specialties placed in the nation’s top 50 Urology: No. 9
Orthopaedics: No. 22
Ophthalmology: No. 12
Neurology and Neurosurgery: No. 26
Cancer: No. 17 (Highest cancer specialty in Southern California; No. 2 nationally for outcomes)
Gynecology: No. 35
Geriatrics: No. 17
Nephrology: No. 35 (in a three-way tie) Cardiology and Heart Surgery: No. 45
The 2018–19 Best Hospitals rankings are available at health.usnews.com/best-hospitals and will appear in the forthcoming U.S. News Best Hospitals 2019 Guidebook.
DEMENTIA
9
WAYS TO REDUCE YOUR RISK
IN
Some of Keck Medicine’s nursing staff celebrates their hard-earned success with a sparkling cider toast.
cases of dementia could be prevented by addressing these lifestyle factors
Keck Hospital’s Nursing Achieves Magnet Recognition More than 150 Keck Medicine of USC nurses, executives, physicians and employees gathered in a conference room at Keck Medical Center of USC shortly before 8 a.m. on July 18, awaiting a phone call they’ve worked toward for several years. The crowd erupted in cheers, tears and applause as the American Nurses Credentialing Center (ANCC) announced over speakerphone that Keck Hospital of USC has joined a select group of health care facilities in achieving Magnet recognition, one of the highest honors in nursing excellence. The ANCC Commission on Magnet Recognition voted unanimously on the designation.
MAGNET ACCREDITATION IS A RESOURCE-INTENSIVE PROCESS THAT TAKES AN AVERAGE OF 4.25 YEARS TO COMPLETE In order to earn Magnet recognition: Organizations must provide ANCC both qualitative and quantitative evidence on patient care and outcomes. ANCC also conducts a site visit to determine whether a facility meets the criteria for Magnet status.
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THERE ARE APPROXIMATELY MAGNET FACILITIES WORLDWIDE
INCREASE Education Physical Activity Social Contact
Research shows that Magnet recognition is associated with positive outcomes such as:
DECREASE Hearing Loss Hypertension Obesity Smoking Depression Diabetes
Higher patient satisfaction Lower risk of 30-day mortality Higher job satisfaction among nurses
Source: Lancet Commission on Dementia Prevention and Care
To learn more about the procedures and services featured here or to schedule an appointment
CALL (800) USC-CARE (800-872-2273)
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RANKINGS LIKE these SPEAK FOR THEMSELVES Keck Medicine of USC is proud to be ranked among the top three hospitals in Los Angeles and number seven in all of California. Our advanced care has been widely recognized for excellence, with high rankings in nine specialties.
To learn more, visit KeckMedicine.org For appointments, call: (800) USC-CARE
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