UVA Health System Blog

Stories about the patients, staff and services of UVA

 

Podcast Tuesday: Diagnosing ALS and Other Neuromuscular Disorders [AUDIO]

On July 29, 2014 | At 8:15 am

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The Ache is Gone: How Elbow Surgery Can Help

On July 23, 2014 | At 9:39 am

The story follows up on a previous blog post, Tennis Elbow: To Operate or Not, That is the Question.

Lisa Green has graduated.

Elbow surgery left a scar, but removed the tennis elbow pain from this elbow.

Elbow surgery left a scar, but removed the pain.

Today was her last checkup with Angelo Dacus, MD, the orthopedic surgeon who operated on her tennis elbow back in May – successfully, it turns out.

“It’s July 7, and I’m back,” she says, excited. “Back on my bike, back on the kayak in the water, now I can mow my grass and do the things I need to do to run the household. I have no more appointments.”

Choosing Elbow Surgery

Back when Green first saw Dacus, the question of whether or not to have surgery was a tricky one. It was possible that enough rest and physical therapy could allow her elbow to heal by itself; however, it was also possible that after several months, if her elbow did not heal, she would still need surgery.

Green’s goal was to get back to her active lifestyle as soon as possible. So, she chose to have surgery, opting for what she hoped would be a quick recovery time and less time overall out of commission.

It turns out Green made the right decision. “When he was in there doing the surgery, he said my tendon was a mess, and it was a good thing we were having this done.”

Two months later, Green is elated. “How do we give this guy enough praises?” she says, about Dacus. “He’s phenomenal. He does not rush in; you’re not just a case number. He listens, actually, literally listens to what you have to say. And that is what is hard to find in doctors today. I did not feel like I was on an assembly line.

Was she glad she had elbow surgery?

Green answers without hesitation. “Absolutely. I have no pain. I’m aching from getting back to strength. But the constant, everyday ache, 24 hours a day, is gone.“

What’s next for Green? “I tried to get Dacus to do my hip, but that’s not his specialty. So I asked him if he had a clone who did hips. He gave me a recommendation. I want to run again.”

Is Elbow Surgery for You?

You, yourself, can have a consultation with Dacus or any of the team at the UVA Hand Center. Call for an appointment today.

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Podcast Tuesday: Spotting and Treating Aortic Aneurysms [AUDIO]

On July 22, 2014 | At 9:24 am

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Poetry Friday: Insomnia

On July 18, 2014 | At 9:07 am

Every week for the past few months, we’ve published the winning poems from April’s medical poetry contest. This week’s poem, a runner-up in Category III: Grab the (Black) Bag: Miscellaneous Medical Moments, is the last one. Thanks again to all who submitted! Read all of the winning poems.

Insomnia
By Rabita Alamgir

Eyelids fail to block
late chats with the moon.
I’m lucky, it mocks,
that I can admire its beauty.
I don’t get nightmares,
but I’m robbed of sweet dreams.
I read to my soul’s content
then forget everything in a day.
I notice with useless clarity
the murmurs of the wind,
the drone of the heater.

Purple bags, my physician remarks,
are but a metonymy
for my endless despondence.
Yes, too saturated with bitter optimism,
sunlight always stings my eyes.
I have no right to be so melancholy,
yet I’m always awake and
alert, hopeful
sleep might come. Still,
My eyes never sparkle.

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Brugada Syndrome: A Dangerous Family Trait

On July 17, 2014 | At 10:09 am

This is the second story in a two-part series about genetic heart rhythm disorders. Yesterday, we told you about how genetic testing gave a family answers after a tragedy.

Adrian Chance, 40, has always been the picture of health. He’s a former high school football star and works as a personal trainer in Charlottesville for ACAC Fitness & Wellness Centers. He also stays fit keeping up with three young sons.

Adrian Chance, who has Brugada Syndrome, with his family

Adrian Chance with his family

But on Sept. 16, 2012, in the middle of the night, his heart suddenly stopped pumping. Three weeks later, it happened again. Fortunately, his wife woke up both times and performed life-saving CPR until paramedics arrived to rush Adrian to UVA Medical Center.

Blood tests eventually revealed that Chance inherited a rare heart disorder that can trigger nocturnal sudden cardiac arrest because of a dangerous heart rhythm. He is one of very few people to survive two cardiac arrests.

Diagnosing Brugada Syndrome

His condition is known as Brugada syndrome, which can be passed down from parent to child. Doctors originally thought Chance had long QT syndrome — the most common type of genetic heart defect seen in the U.S. There are several types of LQTS, and one was similar to Chances’ condition, in which a low heart rate during sleep or rest can be the trigger.

With LQTS, there is a lengthening of the time it takes for the heart to fire off a contraction and recover electrically. Chance’s EKGs (electrocardiograms) that record a heart’s electrical activity were normal.

“People with Brugada and LQTS can have a normal EKG, making it really difficult to determine,” says Rohit Malhotra, MD, a UVA cardiac electrophysiologist who specializes in heart rhythm disorders.

Genetic Testing for Heart Disease

Knowing he inherited a life-threatening trait, Chance’s concern immediately turned to the health and safety of his family. At the Cardiovascular Genetics Clinic, Chance and his wife met with Matthew Thomas, a genetic counselor who specializes in inherited heart disease. Thomas explained that each of their three boys had a 50 percent risk of carrying the same genetic disorder.

“Fortunately, all of his boys tested negative,” Thomas says. “It was truly a best-case scenario. This is one of the few times in medicine where you can definitively say someone is not at risk for something.”

Chance doesn’t know any other family members with heart issues. But recent genetic tests have revealed that his father, aunt, brother, sister and two of his sister’s four children share the same genetic disorder. As a precaution, his brother and sister, like Chance, have a defibrillator device implanted next to their hearts. His sister’s two children are being closely followed by a cardiologist. “It makes me feel good that they are getting tested and being proactive about their health,” Chance says.

You and your children should be checked for an inherited cardiac defect if anyone in your family has had unexplained sudden cardiac death (especially at a younger age) or unexplained fainting episodes or seizures.

If you’re concerned about your family’s risk for a heart problem, talk to your doctor about a referral to the UVA Cardiovascular Genetics Clinic.

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Long QT Syndrome: Family Turns Tragedy Into Triumph

On July 16, 2014 | At 8:31 am

Kathy Cundiff loves the waves of the ocean, especially since she was raised on the coast of Virginia. Now that she is a mother of two in Culpeper, she is focused on waves of a different kind — the electrical waves of her heart. Doing so just may have saved her life, and the lives of her two daughters.

Kathy and her daughters all have long QT syndrome, a form of abnormal heart rhythm

Kathy Cundiff (center) and daughters Molly Winstead (left) and Emily Phillips

It all started three years ago. Kathy and her husband were driving on a beautiful summer evening when the couple received a tragic phone call. Kathy’s sister had died mysteriously in her sleep. “She was only 40 and she was very healthy,” she says. “We had no idea what happened and no one could give us any answers.”

There were no clues, until Kathy’s niece almost experienced the same fate. At age 24, she collapsed and her heart stopped beating. Fortunately, she was revived with CPR. Medical tests revealed that Kathy’s niece had a heart problem called long QT syndrome.

Long QT Syndrome and the Heart’s Electrical System

“Long QT syndrome is an inherited disorder with the electrical system of the heart,” explains Rohit Malhotra, MD, a UVA cardiologist with special training in electrophysiology, the electrical patterns of the heart. “It can cause fainting and seizures due to abnormal heart rhythms that lead to a drop in blood pressure,” he says. It can also cause sudden death.

An amazing power station located in the heart generates electrical impulses telling it when to beat. These are the up and down waves seen on an EKG. The letters P, Q, R, S and T are used to label EKG waves, and QT is a specific interval. In long QT syndrome, the QT interval is longer than normal.

Often there are no warning signs that someone has long QT syndrome. Because the disorder is inherited, genetic testing can play an invaluable role in revealing who is at risk for the condition. Kathy, her niece and two daughters all tested positive.

“Our first thought was, what can we still do? Can we ride roller coasters? Can we scuba dive?  What can trigger the problem?” Kathy says.

Malhotra provided reassurance and advice. Long QT syndrome can be managed with medication or an implantable cardioverter-defibrillator if needed. Malhotra says common drugs can cause a longer QT interval, such as certain:

  • Antihistamines
  • Antidepressants
  • Antibiotics

These need to be avoided, as well as caffeine.

“This was the hardest part for me,” Kathy says. “You always saw me with a Redbull before I found out I had this condition. I cut back of some on the volunteering I was doing, but one day I still hope to scuba dive.”

Armed with the knowledge that long QT syndrome can be managed, Kathy doesn’t let fear stop her. She says being under the care of a cardiologist with training in the electrical system of the heart brings her peace of mind.

Trips to the beach will always remind Kathy of her sister, and they also remind her that her family’s hearts are safe.

Do You Have a Heart Condition?

Find out more about our cardiologists and Heart & Vascular Center.

Make sure to check back tomorrow to find out why a personal trainer’s heart suddenly stopped beating.

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Podcast Tuesday: Treating Sarcomas, A Rare Cancer [AUDIO]

On July 15, 2014 | At 9:41 am

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Who Lives Well? Understanding What Makes People Flourish

On July 14, 2014 | At 9:58 am

While some people thrive throughout their lifetimes, other struggle.

Peggy Kern, postdoctoral fellow at University of Pennsylvania

Peggy Kern, a postdoctoral fellow at the University of Pennsylvania, researches well-being.

Peggy Kern, a postdoctoral fellow at the University of Pennsylvania, wants to know why.

Her research seeks to answer fundamental questions she posed to UVA employees during a recent presentation.

“How can we understand who lives a healthier life than others?” she asks. “How can we help people live the best life they can within whatever circumstances they have?”

To answer those questions, it’s important to adopt a lifespan perspective, or in other words, understand “where a person’s been, where they are now and where they’re going,” Kern says.

Extraverted? Agreeable? Linking Personality and Health

Using the Terman Life Cycle Study, Kern looked at how five personality traits — extraversion, agreeableness, conscientiousness, neuroticism and intellect — are linked to a person’s health and well-being over time.

The Terman study began in 1922 with 1,528 gifted children. It followed up with the participants in intervals of five to ten years throughout their lives, building a comprehensive collection of interviews and questionnaires about a wide array of topics.

Kern found elements of the participants’ personalities at age 30 predicted measures of wellbeing 45 years later at age 75.

For example, those high in extraversion and agreeableness at age 30 reported higher levels of social competence and subjective well-being at age 75.

Kern also found that conscientiousness predicted longer life, which prompted to her combine the results of 20 studies with more than 9,000 participants that measured both traits.

“It wasn’t always significant, but it was always protective,” she says. “Conscientiousness had a stronger effect than socioeconomic status or intelligence. It produced a two to four year difference in when people died.”

Kern also found other ways that personality influenced well-being in the Terman study participants:

  • People who were more successful in their careers tended to live longer, but conscientiousness made a difference: Unsuccessful but highly conscientious people also had a lower mortality risk.
  • Men who scored high in neuroticism were less active than men who scored lower, but neuroticism made no difference for women.

“Oftentimes we look at someone at a single point in time and try to tell them what to do,” Kern says. “But that doesn’t take into account who they are as a person and where they are in their life journey. Understanding that is important.”

By looking at personality, “we can start to tailor things in ways that are going to better fit with intervention and hopefully be more effective,” Kern says.

“When personality is ignored, interventions can be shortsighted, wasting precious time, energy, and resources,” she says.

Well-being: Lack of Disease or Something More?

At the University of Pennsylvania’s Positive Psychology Center, Kern’s work is part of a shift in focus from traditional psychology’s mission to eradicate mental illness to positive psychology.

“In positive psychology, we’re saying neutral is not enough,” she says. “We want people to thrive. We focus on what’s going good in life and how we can start to build more of that.”

Kern’s latest work has focused on social and mental well-being, specifically “how we can use measures as a way to shift some of these perspectives,” she says.

The first step to improving well-being is to measure it, Kern says.

“We measure what we value and we value what we measure,” she says.

To that end, Kern worked with other well-being experts to develop a brief questionnaire to measure five areas of well-being — positive emotion, engagement, relationships, meaning and accomplishment.

They also developed a similar measure for adolescents.

“Using the measures, we can compare things, gain insight and provide a metric of change,” Kern says.

In recent studies, Kern measured well-being in the workplace and in general.

“Feeling engaged and positive relationships with coworkers were most important for job satisfaction,” she says. “For life satisfaction, a sense of meaning was much more important.”

Kern also recently partnered with linguists and computer scientists to look at “big data” from social media.

The studies revealed that the words people use correlate to personality traits, life satisfaction, and likelihood of disease.

Overall, Kern has an important goal for her research.

“We hope to figure out who lives well and help more people do that,” she says.

Get more information about Kern’s research.

Tips for Your Wisdom and Well-Being

Kern’s presentation was the first in the Wisdom and Well-being Speaker Series, sponsored jointly by the Center for Appreciative Practice, School of Nursing and Mindfulness Center.

“This series is intended to start a conversation across our health system about how we can become our very best selves together,” says Dorrie Fontaine, dean of the UVA School of Nursing. “We want wisdom and well-being to be a signature of the health system.”

Presentations are free and include lunch.

View additional dates and speakers in the series.

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Poetry Friday: Blink

On July 11, 2014 | At 9:47 am

Every week we’re publishing the winning poems from April’s medical poetry contest. This week’s poem was a runner-up in Category III: Grab the (Black) Bag: Miscellaneous Medical Moments.

Blink
By Callie Bateman

For my cousin Lindsey, a cancer survivor

She was seven and didn’t really understand, so she tuned out the anxious buzzing of their voices and counted the number of times the fluorescent lights flickered at the front of the room, sending tiny balls of blue bouncing off the colorless walls. They loomed over her with frowns and furrowed eyebrows, while foreign words drizzled out of their mouths and dripped like beads of burgundy onto the bleached floor. Her father leaned down and stroked her forehead, tried to remember the first time he cradled her head to his chest, when tiny ringlets of hair dusted her skin in golden patches. His fingers trailed the path of violet stains across her shoulders, and he began to shake with heavy sobs, while she still gazed up at the flickering lights and wondered how long they’d been broken.

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Summer Severe Weather: 4 Things You Can Do To Prepare

On July 9, 2014 | At 8:03 am

With summer comes severe weather, so it doesn’t hurt to be prepared for storms, extreme heat and floods. It’s important to be able to recognize an impending hazard and know how to take action so you and your family can stay safe. Here are steps you can take for any emergency:Be as prepared as possible for storms, extreme heat and floods.

1. Make a Family Emergency Plan

Families aren’t always together during an emergency, so it’s important to plan ahead. Download the Family Communication Plan for Parents and Kids and fill it out together, so everyone knows what to do. This covers important information, like where to meet and how to contact each other during an emergency. Look into emergency preparedness plans at places where your family members spend the most time (school, work, sports events, etc). If no plans exist, volunteer to make one! Get started planning with these critical questions.

2. Build a Go-Kit (Emergency Bag)

A disaster go-kit contains any household items that you and your family could need in an emergency. Because there’s a chance you’ll have to survive on your own after an emergency, the kit should have food, water and other supplies to last you at least 72 hours.Your kit should also include supplies that don’t require electricity, gas or water, as these might be inaccessible during a disaster. Find out what you need in your emergency preparedness go-kit.

3. Download an App

FEMA offers an Apple iOS and Android app that contains:

  • Disaster safety tips
  • An interactive emergency kit list
  • Meeting location information
  • A map with open FEMA shelters

Ready Virginia also offers an emergency preparedness app, which provides you with information about local weather and public health alerts. The Ready Virginia app is similar to FEMA’s and offers maps of nearby American Red Cross shelters, hurricane evacuation routes and “This Day in Hazard History” trivia.

4. Listen to the Radio

Stay updated on severe weather by listening to the local radio. Remember to keep a battery-operated radio on hand in case you lose power in an emergency. If you have access, NOAA Weather Radio broadcasts warning and post-event information for all types of emergencies, including natural events, environmental accidents and public safety concerns.