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Chronic Disease, Events, Stanford News

A reminder before World Diabetes Day: “We need more people educated about the disease”

A reminder before World Diabetes Day: “We need more people educated about the disease"

Bay Area native Anna Simos had always been the healthy one in her family — never a candy eater, she said — but, at 15, she was diagnosed with what had been the traditional family illness: diabetes. “My grandmother and uncle had Type 1 diabetes and my father Type 2, so with that diagnosis, I knew what it meant,” she said. “It was sobering and I knew there was no easy way out.” She remembers that day quite clearly. “The doctor brought in a syringe with insulin and told me to give myself a shot. I asked him how many times do I do this every day? Probably four to six, he said. I was not happy.”

Over the years, and through a pancreas and two kidney transplants, Simos learned how to balance her diet, lifestyle, medications and essential medical equipment to live a life with Type 1 diabetes. “I had figured it out for myself, but I began meeting others with diabetes and I decided I would do something with this on-the-job training.” She also earned a master’s degree in public health and a master’s degree in the epidemiology of diabetes.

She received so much of her medical care at Stanford Health Care, she began to dream about what she could do to help there, too. Today, Simos, now a certified diabetes educator and diabetes clinical research coordinator at Stanford, will see one of her combined personal and professional goals met: Stanford Health Care’s first Diabetes Prevention and Wellness Health Fair, being held today in recognition of the upcoming World Diabetes Day.

The fair is a free, public event, and Charlie Kimball, a Formula 1 Indy car driver who has diabetes, will be there to talk about how his experience living with diabetes. Among the other features of the event: Fifteen non-profits and vendors, clinicians from Stanford Health Care and Stanford Children’s Health, and other diabetes education experts will offer free risk assessments, updates on diabetes care technology, food demonstrations and nutrition education. “Everyone’s coming together for the first time,” Simos said. “You’re going to learn something if you come, because it’s not just about diabetes — it’s also about prevention.”

Simos is pushed by the numbers: The Centers for Disease Control and Prevention estimates that 387 million adults have a form of diabetes. About 86 million American adults— more than 1 in 3 are pre-diabetic. That condition, defined by blood sugar levels that are above normal but not high enough for a Type 2 diagnosis, increases the risk of heart disease, stroke and Type 2 diabetes. “Diabetes and pre-diabetes are at epidemic levels,” Simos said. She knows how much easier it is to make the dietary and behavior changes than to develop the disease and possibly suffer the worst of its consequences. “We want to help prevent the transplant, the amputation, the blindness — that we can turn around with care,” she said. “We need more people educated about the disease. If we can just get people to start thinking about their risk factors, we can take a different approach to diabetes: prevention.”

Previously: A conversation about the diabetes epidemic and The role of nutrition in diabetes prevention and management
Photo, of Anna Simos meeting with patient Ed Grey earlier this week, by Norbert von der Groeben

Chronic Disease, Patient Care, Pediatrics, Stanford News

Helping kids with chronic medical conditions make the jump to adult care

Helping kids with chronic medical conditions make the jump to adult care

With just one dramatic example from her practice, Stanford pediatric critical care specialist Yana Vaks, MD, recently illustrated for me the importance of better adult health care for children who survive a catastrophic childhood illness or endure an incurable medical diagnosis.

“There was an 18-year-old who came to the hospital in crisis,” she said. “He had a liver transplant when he was 8, but when he turned 18 he wanted to start a new life and decided he was done with all that extra health consciousness his transplant meant.” The patient had stopped taking the drugs necessary to keep his body from rejecting the transplant and neglected to see his doctor regularly. By the time Vaks saw him, his transplanted liver had begun to fail, starting a catastrophic process that affects all body systems. “It was a shocking case,” she said. The teenager died the next day.

His mother told Vaks that the biggest challenge had been the 18th birthday, that legal coming of age where parents can no longer control what medications their children take.

As I did the reporting for a Stanford Medicine story called “When I Grow Up,” I was shocked to learn just how many young adults fall into the categories of survivor or chronically ill: They may soon represent 10 percent of the U.S. population ages 15 to 25. Before advances in treatment began saving so many lives, that population was just 1 percent.

The specialists who treat these growing children have long recognized the challenges related to this patient population: Young adults may be grown in body, but they aren’t always ready psychologically or socially to take full responsibility for consistently following complicated medical routines and practicing lifestyle restrictions. Nor are most adult care doctors trained in the after-effects of childhood cancer, for instance, or the lifelong need to monitor adults with childhood heart repairs.

What’s needed is something called transition care — but no one had studied just what that should look like. The Clinical Excellence Research Center, established in 2010 to study, design and demonstrate ways to improve health care while reducing costs, identified transition care as a good candidate for the changes it hopes to effect with its work. For two years, CERC gathered information, reviewed research, interviewed patients and families and visited hospitals around the country, and it has launched pilot programs – including one at Stanford Children’s Health – to test its recommendations:

The CERC team’s recommendations emphasize that pediatricians and pediatric specialty teams must be guides in this process: equipping patients and parents with information so they can anticipate the transition, coaching patients to develop the confidence and skills needed to manage their health, and locating and being available to specialists and primary care physicians who will need certain medical knowledge to care for their patients as adults.

Previously: Stanford Medicine magazine tells why a healthy childhood mattersStudy highlights childhood cancer survivors’ increased risk of future health problemsQuestioning whether physicians are equipped to care for childhood cancer survivors and Chronic illness in childhood: One patient’s story
Illustration by Daniel Horowitz

Patient Care, Stanford News, Videos

A new tool to treat atrial fibrillation

A new tool to treat atrial fibrillation

The first time Susan Klein’s heart stopped, and then started again, she was very frightened. But she didn’t run for the phone to call a doctor. Klein had a pretty good idea of what had happened: Six other women in her immediately family had experienced heart palpitations, or, what they called “the little mouse running around their chest,” Klein said. “I had a history — and it was to be expected in my family.”

Klein’s palpitations, however, became so frequent and debilitating that, even with medication, she didn’t have enough breath to make it across a street. By then, of course, she knew that her diagnosis was officially atrial fibrillation, an irregular heartbeat most often called afib. More than two million people in the United States and an estimated 30 million worldwide suffer from what is the most common type of heart rhythm disorder. Before I interviewed Klein this year for a Stanford Health Care video, I was naïve about the seriousness of afib and the challenge of treating it with any certainty of full recovery.

Afib symptoms can include shortness of breath, weakness, fatigue, heart palpitations, light-headedness, and chest or abdominal pain. Some patients with afib feel no symptoms – making it more difficult to diagnose the disease early enough to prevent its most serious consequences: an increased risk of heart failure and a five-times-more-likely incidence of stroke. Afib accounts for about 15 percent of strokes in the United States.

Afib in some people can be managed with medications. Those didn’t work for Klein. Ablation, the standard interventional procedure, often had to be done more than once or even several times. That wasn’t good enough for Klein. “To spend six to seven hours under general anesthetic with only a 40 percent success rate? I wasn’t satisfied,” she said.  Then she heard about Sanjiv Narayan, MD, PhD, a Stanford doctor with a very particular specialty: cardiac electrophysiology. Narayan, who now directs Stanford’s atrial fibrillation program and its electrophysiology research, had long been interested in detecting the points of electrical chaos in the heart that cause afib.

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Cancer, Patient Care, Stanford News, Transplants, Videos

Immunosuppression brings higher risk for skin cancer – and need for specialized care

Immunosuppression brings higher risk for skin cancer – and need for specialized care

An estimated 50 million Americans must take immunosuppressants to treat more than 80 autoimmune disorders, according to the National Institutes of Health. These medications are particularly vital to the survival of people who have undergone organ transplants to prevent their bodies from rejecting their donor organ.

While immunosuppressants can be life-saving, their very action of reducing the body’s innate defense systems can have negative side-effects. One particularly dangerous concern is an increased risk for skin cancer, particularly for those individuals with fair skin or an inherited tendency to develop skin cancers. (My colleague Tracie White told the story of one transplant patient’s struggle here earlier this summer.)

To address the specialized needs of patients taking immunosuppressants or with compromised immune function, Stanford dermatologists recently launched the High-Risk Skin Cancer Clinic.

In this Stanford Health Care video, the clinic’s Carolyn Lee, MD, PhD, explains the particular vulnerabilities of transplant patients to aggressive skin cancer and the importance of a dedicated clinic to meet their needs. “What we hate to see — and it’s easily preventable — is someone who’s been waiting for a transplant to finally get it, only to be felled by skin cancer,” she says.


Previously: Rebuilding Cassie’s smile: A lung transplant patient’s struggle with skin cancer and This summer’s Stanford Medicine magazine shows some skin

Cardiovascular Medicine, Patient Care, Stanford News

“This reinforced why I went into nursing”: The story of two nurses who resuscitated plane passenger

"This reinforced why I went into nursing": The story of two nurses who resuscitated plane passenger

Woo and BinghamStanford Health Care cardiac nurse coordinators Angela Bingham, RN, MSN, CNL, and Sophia Loo, RN, MSHCA, have cared for hundreds of patients with serious heart disease. And they’ve had access to sophisticated technology and colleagues who are skilled at teamwork. Then came the one time that none of that was at hand – and a life was at stake.

Last December, Loo and Bingham had just boarded a plane back home to San Jose from a national health-care conference when they heard a call for help. Both rushed forward and found a male passenger in obvious cardiac distress. They recognized instantly that he was near death, and what followed was a classic case of making the best of what they had.

In a story in yesterday’s Inside Stanford Medicine, Bingham and Loo share their experience and how much it meant to be able to do something they knew made a difference. “This reinforced why I went into nursing,” Loo told me for the story. “I was so humbled and grateful that I could do something; that Angela and I knew what to do.”

Photo by Norbert von der Groeben

Nutrition, Stanford News, Videos

Stanford dietitian explains how – not just what – you eat matters

Stanford dietitian explains how - not just what - you eat matters

Recent posts, including this one from last week and this one from earlier today, offered sound advice to help avoid overeating around the holidays. Of course, we all know that at times we overindulge. But Stanford’s Neha Shah, a registered dietitian with expertise in digestive issues that affect nutritional intake, knows that how we eat is important, too; it’s not just about what we put in our stomachs, but how we do that. In this Stanford Health Care video, titled “How You Eat Matters,” sit back and learn some techniques that might just make your digestive system much happier. And you, too, of course.

Previously: Easy-to-follow tips to avoid overeating this holiday

Cardiovascular Medicine, Stanford News, Videos

Stanford patient benefits from total artificial heart

Stanford patient benefits from total artificial heart

Mechanical support for failing hearts is not a new idea. Size, however, matters. In 1966, Michael DeBakey, MD, successfully implanted the first device to replace the pumping action on the left side of the heart. Now, at medical centers like Stanford, the LVAD, or left ventricular assist device, about 3 inches long, is a workhorse that enables many people with heart disease to live a normal life. Sure, if you have an LVAD implanted in your chest, you have to wear a power pack and a reserve power pack outside your body, but most find that burden acceptable. Your heart also remains in your body. If the whole heart is failing, that’s another matter.

In 1969, Denton Cooley, MD, removed Haskell Karp’s diseased heart and replaced it with an artificial one intended only to keep the 47-year-old alive for the three days it took to find an appropriate human heart for transplant. He died two days after that transplant. The heart was driven by an air pump the size of a washing machine. By 1983, when William DeVries, MD, put an artificial heart in Barney Clark’s chest, it was because Clark was too sick for a transplant. The pump supporting the artificial heart was still the size of a washing machine. Clark would never be able to leave his hospital room even to walk down a hospital hallway. He died 112 days later.

A little over a year ago, Stanford cardiovascular surgeons removed the heart of chess teacher Vaness French. French had lived with heart disease for decades, altering his diet, upping his exercise, doing everything he could until one summer day in 2013, when he went into cardiac arrest at a baseball game. Luckily, he was with a friend who knew CPR and kept French alive. In the months before, his Stanford cardiologist, Dipanjee Banerjee, MD, had fine-tuned French’s medications and ablation had been tried to stabilize the atrial fibrillation French experienced frequently. Now, the only option to keep him alive was a human heart transplant or an artificial heart.

French’s survival until a transplant was available was seriously in doubt. French agreed to let a team of Stanford surgeons, led by Richard Ha, MD, implant an artificial one. Remarkably, in footage shot just two weeks after that implantation of the total artificial heart, French is up and around, albeit a bit slowly. The support machine for the artificial heart is now small and lightweight enough so he could leave his room, with a bit of help, of course. Two weeks later, even before he received a support machine so small and portable he would have been allowed to return home, the right human heart came French’s way. In the recently-released video above you can see an artificial heart implantation procedure – and hear how it changed French’s life.

Previously: “Liberated from LVAD support”: One patient’s story and Dick Cheney on his heart transplant: “It’s the gift of life itself”

Cancer, Stanford News, Videos, Women's Health

The squeeze: Compression during mammography important for accurate breast cancer detection

The squeeze: Compression during mammography important for accurate breast cancer detection

After nearly 30 years of reluctantly enduring the pain of mammography, I finally understand why I shouldn’t complain. In fact, I think I should embrace the pain and ask the technician to squeeze my breasts even more tightly between the shelves of the mammography machine.

It’s only a brief moment of pain, after all, but it can make the difference between a breast cancer detected and a breast cancer missed. In a recent video on the topic, Stanford Health Care’s Jafi Lipson, MD, an assistant professor of radiology, explains the very important reasons for women to step up and take the squeeze without complaint. It will only take 30 seconds of your time – and it might save your life.

Previously: Despite genetic advances, detection still key in breast cancer, NIH Director highlights Stanford research on breast cancer surgery choices and Breast cancer patients are getting more bilateral mastectomies — but not any survival benefit

Cancer, Neuroscience, Stanford News, Technology, Videos

Stanford celebrates 20th anniversary of the CyberKnife

Stanford celebrates 20th anniversary of the CyberKnife

Just about 30 years ago, Stanford neurosurgeon John Adler, MD, traveled to the Karolinksa Institute in Sweden, home to Lars Leksell, MD, and a device Leksell had invented called the Gamma Knife. Leksell had long been a visionary figure in neurosurgery, and Adler – inspired by the device that enables non-invasive brain surgery – began to imagine a next step, driven by the addition of computer technology.

Coming up with an idea, of course, can happen in a matter of minutes. Adler had no idea that it would take 18 years before his next step, the CyberKnife, would treat its first patient. Stanford Hospital was the first to own a CyberKnife, and Adler unhesitatingly admits that without the agreement of hospital administrators to purchase that very first device – designed to treat tumors, brain and spine conditions, as well as cancers of the pancreas, prostate, liver and lungs – its development would not have been completed.

This year, Adler and his Stanford colleagues are celebrating the 20th anniversary of the CyberKnife. Stanford has two, one of just a handful of medical centers with that distinction, and it has accumulated the longest and largest history of patient care with the device. To honor Adler and those Stanford physicians who continue to explore its ever-lengthening list of applications to patient care, a new video featuring Adler was created. It’s a quick glimpse of the determination – and luck – required to make that leap from inspired idea to groundbreaking therapy.

Previously: CyberKnife: From promising technique to proven tumor treatment

Cancer, Genetics, Stanford News, Videos, Women's Health

Despite genetic advances, detection still key in breast cancer

Despite genetic advances, detection still key in breast cancer

Just a few years before the launch of the first national breast cancer awareness month, I found a small lump in my left breast. I still remember the cold chill that ran through me – and stayed with me until several days later when a surgeon discovered that the lump was not a tumor. His parting words have never left me: “Remember how you’ve been feeling.” He wanted to make sure I would go on to have regular mammograms.

Spreading the word about the disease and the importance of detecting it in its early stages was – and is – the point of the national awareness campaign. In the almost 30 years since that first campaign, advances in imaging technology have enabled earlier detection of breast cancer, genome sequencing has identified some of the mysteries behind the development risk, and selecting the most effective surgery and chemotherapy is more and more of an individualized choice.

Stanford has a powerful team of physicians addressing all aspects of breast cancer science and care. On Oct. 16, breast-imaging specialist Jafi Lipson, MD, assistant professor of radiology, and breast cancer surgeon Amanda Wheeler, MD, clinical assistant professor of surgery, will give a free lecture, “The Latest Advancements in Screening and Treatment for Breast Cancer,” at the Sheraton Palo Alto. And throughout the month, Stanford Health Care will post short educational videos and infographics on a variety of breast-cancer topics, including types of breast cancer, options in surgical reconstruction, and why enduring the pain of compression in mammography is worth the effort. Today, Stanford Health Care kicks off the month with a video featuring Stanford breast cancer expert Alison Kurian, MD, explaining the role that genetics play in disease development (above).

Because one in eight women will develop breast cancer in her lifetime, I would urge all of us to keep in mind the reality of this disease – and to honor those we know who have survived, or not, by paying attention.

Previously: NIH Director highlights Stanford research on breast cancer surgery choicesBreast cancer patients are getting more bilateral mastectomies —  but not any survival benefitBreast cancer awareness: Beneath the pink packaging and At Stanford event, cancer advocate Susan Love talks about “a future with no breast cancer”

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