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Surgery

In the News, Pediatrics, Stanford News, Surgery, Transplants

Parents’ heroic effort help 12-year-old daughter receive a new heart and lungs

Parents' heroic effort help 12-year-old daughter receive a new heart and lungs

Fewer than 10 children received a heart-lung transplant in the United States last year. One of them was 12-year-old Katie Grace Groebner, who was diagnosed with pulmonary hypertension in 2008 and given a year to live.

Determined to save their daughter’s life, Katie Gracie’s parents sold their house in Minnesota and most of their belongings and moved to the Bay Area so she could be treated by Jeffrey Feinstein, MD, director of the Center for Pulmonary Vascular Disease at Lucile Packard Children’s Hospital Stanford.

As reported in the NBC Bay Area segment above, the Groebners understandably call Katie’s doctors and nurses “heroes,” but Feinstein says it’s the other way around. “You want to find a hero? Talk about the parents,” he says in the video. “If you look at the amount of work that I did, compared to amount of work Katie Grace’s parents did? There’s no comparison.”

Previously: Living long term with transplanted organs: One patient’s story, Stanford study in transplant patients could lead to better treatment, Anatomy of a pediatric heart transplant and ‘Genome transplant’ concept helps Stanford scientists predict organ rejection

Media, Podcasts, Surgery

CNN’s Sanjay Gupta, MD: journalist, surgeon, advocate

CNN's Sanjay Gupta, MD: journalist, surgeon, advocate

Gupta - smallWhen the history about medical marijuana’s path to legitimacy is written, CNN’s chief medical reporter Sanjay Gupta, MD, may be more than a footnote. Gupta famously authored a 2009 TIME magazine column decrying efforts to legalize marijuana for medicinal purposes. In a 180-degree turnabout in August 2013, he issued an apology and said he was wrong. He wrote that he didn’t look hard enough at the “remarkable research” indicating that for some illnesses marijuana provided a relief. He told me in this 1:2:1 podcast that while he’s cautious about the impact of marijuana on some brain and psychiatric disorders, he feels that the evidence is clear for certain diseases like epilepsy, neuropathic pain and muscle spasms brought on by MS that cannabis has the power to heal.

I wanted to talk to Gupta for this special issue of Stanford Medicine on surgery not only because of his controversial yea-and-nay positions about weed as medicine but because he’s also a neurosurgeon who still spends time with patients in and out of the OR  between covering health crises around the globe. And in recognition of his clinical and advocacy skills, he was also personally asked by President Obama to consider taking the position of U.S. Surgeon General. (He turned down the offer as the timing just wasn’t right for him.)

And what about this new campaign to Just Say Hello that he launched on Oprah.com? He tells me that if we were a friendlier society – neighbor greeting neighbor -  perhaps we could heal some of the loneliness out there and become a more civilized society.

I asked Gupta, since he travels internationally, whether there’s one universal truth that he finds all human beings seek. “Most everyone wants to do good by their bodies, understand health and how they can improve the health of their family members. I think that the desire for good health and desire for improved function is a universal thing,” he told me. And in his storytelling, what impact does he want to make with the viewer?  What does he want the audience to understand about the world as seen through his eyes?  He said:

If I can explain to them that as the bombs came raining down the same family that was driving their kids to school the day before, grocery shopping after that, stopping at a bank to withdraw some money, that they are now fleeing with whatever few possessions they could garner and run for the border… that they are a lot like families in your own neighborhood… That’s really important to me as a reporter.

Previously: Stanford Medicine magazine opens up the world of surgery and The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe
Illustration by Tina Berning

Medicine and Literature, Patient Care, Stanford News, Surgery

Surgery: Up close and personal

Surgery: Up close and personal

gholami - smallTens of millions of patients undergo surgery every year in the United States, yet very few have the opportunity to be on the other side and observe a surgical procedure in action.

I had that rare privilege recently in the course of writing a story for Stanford Medicine magazine about surgery and how far the field has come in recent decades. The operating room, I discovered, is a world unto itself. It’s governed by a strict set of rules to help safeguard patients, but within those strictures, there is an elaborate kind of dance and much artistry in the way clinicians work together and finesse the tools to help heal their patients.

Sepideh Gholami, MD, a six-year surgery resident at Stanford who is featured in the story, said it was in part this sense of artistry – the movement, rhythm and pacing – that attracted her to the profession. And like many surgeons, she found it gratifying to be able to use her hands to fix a problem to quickly restore a patient’s well-being. She describes one of her early experiences, assisting in a procedure to remove a life-threatening tumor from a young man’s colon.

“I remember going to the family afterward, saying that we were able to get it all out, and seeing the glow in their faces,” she told me. She said it was reminiscent of the experience of her own mother, who had a tumor extracted from her breast: “This is how it happened for my mom, who is now disease-free,” she said.

In the story, Gholami talks about her rather unusual path from an early childhood in revolutionary Iran to becoming a surgeon in the United States, as well as the changes in the profession that have opened the way  to young women like her. The story also explores the remarkable innovations in technology that have made the patient experience today far less invasive and less painful. Those innovations, as well as new workplace rules that limit trainees’ hours, have dramatically changed the way young surgeons like Gholami are being trained to become the independent, skilled practitioners of the future.

Previously: Stanford Medicine magazine opens up the world of surgery
Photo of Gholami by Max Aguilera-Hellweg

Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine opens up the world of surgery

Stanford Medicine magazine opens up the world of surgery

surgeon hands - 560

It used to be “big hole, big surgeon” — but no more, according to Stanford’s chair of surgery, Tom Krummel, MD, who’s one of the surgeons featured in Stanford Medicine magazine’s report on surgery and life in the operating room, “Inside job: Surgeons at work.”

During his career of more than 30 years, Krummel has seen a massive shift from open surgeries to minimally invasive procedures — major surgeries conducted with tools that work through small openings.

“We do the same big operation. We just don’t make a big hole,” he said in the article leading off the report.

In the same issue, CNN’s chief medical correspondent, neurosurgeon Sanjay Gupta, MD, talks about why he’s “doubling down” on his support for medical marijuana.

As the editor, I’m biased — but I think it’s worth a read, along with the rest of the issue, which includes:

The issue also includes a report on research on Alzheimer’s disease, and an excerpt from Surgeon General’s Warning, a new book by Associated Press medical reporter Mike Stobbe on the fall from power of the U.S. surgeon general. The digital edition offers audio interviews with Gupta, Stobbe, Stanford surgeon and humanitarian-aid volunteer Sherry Wren, MD, and photographer Max Aguilera-Hellweg, MD.

Previously: The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, From womb to world: Stanford Medicine Magazine explores new work on having a baby and Factoring in the environment: A report from Stanford Medicine magazine
Photo by Max Aguilera-Hellweg

Stanford News, Stem Cells, Surgery, Videos

Stanford reconstructive surgeon Jill Helms reminds us that “beauty isn’t defined by our faces alone”

Stanford reconstructive surgeon Jill Helms reminds us that "beauty isn't defined by our faces alone"

Jill Helms, PhD, a professor of plastic and reconstructive surgery at Stanford, leads a team of scientists that are working on methods to activate a patient’s own stem cells at the site of an injury to speed up tissue healing. In this TEDxStanford video, Helms discusses how surgical scars can sometimes impede growth of a patient’s body, such as the repair of a child’s cleft palate, and the potential of using stem cells to enhance the body’s natural healing process.

As previously mentioned here, Helms delivered a talk on the topic of beauty reconsidered, and she reminds us at the end of the video that “beauty isn’t defined by our faces alone.” She says, “Beauty is compassion, kindness and warmth, and that’s internal beauty. That’s the most important beauty.”

Previously: A spotlight on TEDxStanford’s “awe-inspiring” and “deeply moving” talks and Stanford study shows protein bath may rev up sluggish bone-forming cells

Neuroscience, Stanford News, Stroke, Surgery, Videos

Raising awareness of moyamoya disease

Raising awareness of moyamoya disease

Today isn’t just May 6, it’s also World Moyamoya Day. Well, not officially – but one patient is trying to change that.

Moyamoya, a rare cerebrovascular disease is often overlooked by neurologists, and its symptoms confused with those of chronic migraines. Tara MacInnes spent most of her childhood suffering from excruciatingly painful headaches and bouts of numbness and tingling in her hands, face and legs. Like many others with moyamoya disease, these episodes were overlooked by her pediatric neurologists. By age 16, when an especially bad episode led to an MRI and eventually a correct diagnosis, both sides of her brain had already suffered damage from strokes.

But MacInnes was lucky: She happened to live close to Stanford, where Gary Steinberg, MD, PhD, one of the world’s leading experts on moyamoya treatment, practiced. And like many patients, what MacInnes needed was more than just surgery – she needed a sense of belonging and the ability to interact with others who had gone through a similar experience.

Shortly after her surgery here MacInnes began volunteering at the Stanford Moyamoya Center, talking with patients and their families. The more she met with people, the quicker she realized it wasn’t just the general public that didn’t know much about the disease, but that many medical professionals had never heard of it. Now, 10 years after her successful surgery, MacInnes has become a devoted advocate and is determined to raise awareness about the disease; you can sign her petition to help spread the word and make World Moyamoya Day official.

Previously: How patients use social media to foster support systems, connect with physicians

Cardiovascular Medicine, In the News, Stanford News, Surgery

Looking at aortic valve replacement without open-heart surgery

SM heart imageSome patients with aortic stenosis undergo open-heart surgery to replace a constricted heart valve in an attempt to stave off heart failure. But others, such as elderly adults, aren’t candidates for this type of surgery. In 2011, the FDA approved a non-surgical alternative procedure called TAVR, or transcatheter aortic valve replacement, but the new method, as discussed in the New York Times earlier this month, also carries certain risks.

In the current issue of Stanford Medicine magazine, my colleague Tracie White digs into the surgery-or-TAVR debate and follows the story of one aortic stenosis patient who was treated by the newer method. Maryann Casey, at 62, is younger and healthier than the average TAVR candidate, but she had faced an increased risk for complications during open-heart surgery because of radiation treatment for breast cancer decades ago.

From the magazine piece:

Casey was lucky. Her Stanford oncologist, Frank Stockdale, MD, PhD, the Maureen Lyles D’Amrogio Professor of Medicine Emeritus, was well-informed about treatment options for aortic stenosis, a calcification of the heart valve. This new nonsurgical approach to valve replacement involves placing an artificial heart valve, made of cow tissue supported by a stainless steel mesh frame, inside the damaged valve. Referred to as “transcatheter aortic valve replacement” or TAVR, the procedure is designed for patients with severe, symptomatic aortic stenosis who have health conditions that make the preferred treatment, open-heart surgery, very high risk.

On Oct. 16, 2012, Casey became one of the more than 120 patients that year at Stanford to undergo the TAVR procedure. The first catheter-based aortic valve transplant was in 2002 in France. It has been approved for use for the past six years in 40 other countries including most of Europe, with a total of 45,000 procedures conducted worldwide.

In the United States, institutions such as Stanford, the Cleveland Clinic, Columbia University and the University of Pennsylvania have been leaders in introducing the new procedure and determining its effectiveness through the clinical trials.

Careful patient selection is key to the successful use of the procedure, says [D. Craig Miller, MD, the Doelger Professor of Cardiovascular Surgery], and that sometimes means not recommending TAVR for a patient who is too old or too sick with other illnesses to benefit from the device.

“That’s a very sobering point,” says surgeon Miller. For patients who are too old or ill, undergoing the procedure may not increase their quality of life or life expectancy; Miller says that the boundary line between TAVR “utility and futility” is still being defined.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questionsAsk Stanford Med: Answers to your questions about heart health and cardiovascular research and Major advancement for once inoperable ailing heart valves
Art, which originally appeared in Stanford Medicine, by Pixologicstudio

Research, Stanford News, Surgery

Stanford-developed device shown to reduce the size of existing scars in clinical trial

Stanford-developed device shown to reduce the size of existing scars in clinical trial

scar_2.10On the inside of my left hand is a thick oval scar – a result of a procedure performed more than a decade ago to remove a melanoma. I’m thankful that the skin cancer appeared on my palm, where the scar is largely concealed, rather than on a more exposed area. Many others are forced to face the public with far extensive scarring that can be unsightly and, in certain cases, make movements difficult or painful.

But a device invented by School of Medicine researchers has demonstrated in a small clinical trial that it can help decrease the size of existing scars when used after scar-revision surgery. In a story published today in Inside  Stanford Medicine, my colleague Christopher Vaughan explains the research, writing:

Currently, scar revision surgery does not work very well. Scars are cut out, the edges of the incision are closed, and surgeons work to make the new scar less obtrusive than the old one. But the revision surgery using current methods doesn’t work very well, [senior author of the study Michael Longaker, MD,] said. “Most of the time, after a year the patient feels that the scar is just as bad as it ever was,” he says.

In this clinical trial, surgeons cut out old scars on each of 10 patients and then placed the scar-reduction device over half of the incision; the other half they closed using traditional methods. After the study, patients were offered the chance to have the traditionally revised section of the scar closed using either of the two methods so that the two sides matched.

Six months after surgery, photos of the two halves of the scar were compared by four independent surgeons who did not know which sides of the scars had been treated with the device. Using a visual scoring system, the judges determined that the scar on the side treated with the scar-reduction device was significantly smaller. “It was pretty obvious,” Longaker said. “It was not even subtle.”

Previously: Stanford researchers reveal how mechanical forces contribute to scarring and In scar wars, a new hope
Photo by DrSam

Cancer, Research, Stanford News, Surgery

Chemistry technique improves cancer surgery

Chemistry technique improves cancer surgery

mass spectrometer

For many cancers of the stomach and intestinal tract, removing the tumor is the best way of treating a patient. The problem is that the cancerous cells don’t necessarily look any different from the normal cells. I wrote recently about a new technique to pick out those cancerous cells and help surgeons completely remove the tumor.

What’s fun about this story is that the idea started with a chemist, Livia Eberlin, PhD, who’s a post-doc in lab of chemistry professor Richard Zare, PhD. Zare is a member of Stanford’s Bio-X and from that has experience working with colleagues across campus. He suggested to Eberlin that she find a surgeon who would be willing to collaborate with her and test her approach to identifying the cancerous cells.

Eberlin knew that surgeons rely on pathologists during a surgery to help them figure out if they’ve removed the entire tumor, but the initial results aren’t always accurate. In some cases, pathologists find out days later, when results of a slower, more accurate test are complete, that the patient might need to come back for another surgery to remove more tissue.

Eberlin called up surgeon George Poultsides, MD, to see if he’d like to collaborate on her idea. As I wrote in my piece:

Eberlin’s expertise is in mass spectrometry, a tool not commonly used in a hospital setting. It takes a sample in one end, turns the molecules into charged particles, then detects how long it takes each charged molecule in that sample to migrate down a vacuum tube. The result is a jagged mountain range of tens of thousands of peaks, each representing a single chemical in the sample. The height of the peak indicates how much of that chemical the sample contained.

The idea was that maybe some of those peaks would be different in tissue samples that had cancerous cells versus those that didn’t. If it worked, this mass spectrometry approach might end up being more accurate than the approach being used now.

It took a team of statisticians, pathologists, surgeons and chemists to develop and test Eberlin’s idea. In the end, their approach seemed to be more accurate than what’s being used now. They are going to try their approach on a larger group of stomach cancers and in other cancers to see if it can help improve the odds of completely removing all cancerous cells during surgery.

Previously: Good-bye cancer, good-bye stomach: A survivor shares her tale
Photo – of Livia Eberlin, PhD, at a mass spectrometer used to identify cancerous cells in tissue samples – by L.A. Cicero

Applied Biotechnology, Microbiology, Patient Care, Research, Stanford News, Surgery

Staphylococcus aureus holes up in upper nasal cavity, study shows

Staphylococcus aureus holes up in upper nasal cavity, study shows

nostrilsA posse led by Stanford microbe sleuth and microbiologist David Relman, MD, has apprehended Staphylococcus aureus, one of the most notorious sources of serious infections, lurking in formerly unsuspected nasal hideaways. The discovery may explain why attempts to expunge S. aureus from the bodies of hospitalized patients being readied for surgery often meet with less than perfect results.

About one in three of us are persistent S. aureus carriers, and another third of us are occasional carriers. This bacterial shadow, which abounds on skin (especially the groin and armpits) and is quite at home in the nose, does us no harm most of the time. But if it gets into the bloodstream or internal organs, it can cause life-threatening problems such as sepsis, pneumonia and endocarditis (infection of heart valves). That makes S. aureus not such a good thing to be coated with if you’re about to have your skin punctured by a catheter or pierced by a scalpel.

This is exacerbated by the all-too-frequent presence, particularly in hospital settings, of S. aureus strains resistant to an entire family of antibiotics related to methicillin. In 2011, more than 80,000 severe methicillin-resistant S. aureus infections and more than 11,000 related deaths occurred in the U.S. alone, along with a much higher number of less-severe such infections.

In a study just published in Cell Host & Microbe, Relman – who pioneered the use of ultra-high-volume gene-sequencing techniques to sort out the thousands of species of microbes that communally inhabit our skin, orifices and innards – and his team used this method to show that mucosal sites way up high in our nose, where standard S. aureus-elimination techniques may not reach, can serve as reservoirs for S. aureus. That may, at least in part, explain why efforts to rid patients of this potentially nasty bug have so often fallen short of the mark, as I noted in my news release about the new findings:

Rigorous and somewhat tedious regimens for eliminating S. aureus residing on people’s skin or in their noses do exist, but it’s typically a matter of weeks or months before the bacteria repopulate those who are susceptible. The new study offers a possible reason why this is the case.

Previously: Cultivating the human microbiome, Anti-plaque bacteria: Coming soon to your toothpaste? and Eat a germ, fight an allergy
Photo by OakleyOriginals

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