UVA Health System Blog

Stories about the patients, staff and services of UVA

 

Pioneering a World Without Cancer

On March 27, 2015 | At 8:43 am

Cancer touches all of us. Despite our greatest scientific achievements, far too many lives are cut short by this disease. But there is reason to hope. For the first time, we’re unlocking mysteries of how cancer develops, grows and spreads at the molecular and cellular levels — insights unknown even five years ago.Todd Bauer, MD

Here, we’re united by a common goal — not another life devastated by this disease.

Join us for a free education series to learn how our Cancer Center researchers and physicians are defeating “the emperor that is cancer” through clinical trials, nanotechnology and targeted treatments.

Register now for our education series, Cancer: Defeating the Emperor.

When: Thursday, April 9, 7 p.m.
Where: The Paramount Theater

Hear UVA Cancer Center director Thomas P. Loughran talk about this valuable event on Caring Beyond Cancer with Joe Thomas in the Morning.

WVPT Public Television will record the presentation and produce a television special to be broadcast in late June.

Also, don’t miss the upcoming film premiere, ”Cancer: The Emperor of All Maladies.” This free screening is Monday, March 30 at 6:30 p.m. at The Paramount Theater

Register now!

 
 

Podcast Tuesday: New Prospects for Treating Brain Cancer [AUDIO]

On March 24, 2015 | At 8:51 am

Filed under : Cancer,Neurosciences,Podcast Tuesday,Research | By
Comments : 0 |
 
 

Maternity Monday: Stacy Lynn’s Miscarriage Story

On March 23, 2015 | At 9:38 am

It’s a common story, about miscarriage — that there is no story. People don’t talk about it, and yet it can be a truly traumatic loss.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

It’s also a fairly common one; studies show that anywhere from 8 to 25 percent of all known pregnancies end in miscarriage. Despite the silence around miscarriage, many women have experienced it.

That’s certainly what Stacy Lynn found to be true. The more she broke the silence, the more she discovered other women who had had miscarriages. She told me her story to help others know they are not alone

Getting the Bad News

I hadn’t heard the heartbeat yet. They tried to find it. They said, “We don’t hear it, but that doesn’t mean anything. Sometimes we just can’t find it, so we have to do an ultrasound.”

And then the woman giving the ultrasound said, “I’m sorry.” And in my head, I think, “So sorry about what?”

Then the doctor comes in and gives me a hug. “I’m really sorry; sometimes this happens.  The fetus stopped growing at 8 weeks.” And then it hit, and I just bawled, and she hugged me.

I am tearing up just thinking about it. I didn’t think I would.

After the Miscarriage

My husband came rushing over. He told me, “If we can survive this, we can survive anything.” He really helped me. So I had to have a D&E, so I had to sit with it all weekend and just deal with it.

After the D&E, I developed an infection. I woke up a few days later, shivering and so sick. I called. They had left tissue inside; I had to have another procedure. During that entire process, I wanted to move on but couldn’t. I was pretty depressed.

My husband said really good things to me. He is my life support. He let me cry, he never judged me, he had lunch with me every single day to check on me. He would give me silly tasks to do, tell me, “The car needs an oil change, can you do me a favor and go do it?” Things like that to get me out of the house. Which was really good.

My sister in law had a baby a couple days before my miscarriage, so I didn’t want my family to come down. It was really hard to be around a friend of mine who was pregnant and had a healthy baby. I didn’t want my friends to visit. I was a mess.

After a couple weeks, I was still really depressed. My husband said, “I don’t want this to define you. This is not who you are. You are very happy. You always see the good in everything. This happened, and it’s sad, and we can be sad about it. But this cannot define you. I want you to live your life.” He really pulled me out of depression. I’m so thankful for that.

Getting Pregnant Again

I worried I wouldn’t get pregnant again. My husband said, “It will happen when your body is ready. Don’t stress about this. We know you can get pregnant.” We ended up getting pregnant five months later; it turned out my body was ready.

Throughout the pregnancy, I was a nervous wreck. I had kidney stones from five weeks until I delivered, so I would see blood and was so terrified. We didn’t tell anyone, and then only close friends and family. We did not post anything on Facebook. We didn’t plan on having a baby shower – we’re Jewish so we don’t have baby showers anyway; it’s bad luck. We were not acknowledging him until we held him in our arms.

After a miscarriage, Stacy had her son, Remi.

New Hope

My son was born early, at 32 weeks, in the UVA NICU. It was one year since the miscarriage.

We named him Remi, a name we picked flipping through the channels when I was about six months along. Remi was the name of a French contestant on American Ninja Warrior, which created a spark in us, since we had traveled to Paris between the miscarriage and this pregnancy. Little did we know that name would be so fitting for Remi, who had to fight to live right from the start. At 21 months now, he is no longer my little nugget, but a precocious toddler who is succeeding in numerous ways.

A lot of people are asking if I’m going to have a second child, but mentally I’m not there, because I’m terrified of having another miscarriage, and I’m terrified of having a micropreemie.

I will tell you I had the most amazing experience at UVA with Dr. James, who will be delivering any future children of mine, as she was wonderful and made the whole situation, which was scary at times, better. Looking back, I think what a great experience it was.

Healing From Stigma and Blame

I think if more people talked about miscarriages, it would make a person going through it not feel as alone. I felt so alone. It seemed like nobody else had this experience, everyone got pregnant right away, and it was all so easy. If people could talk more about it there wouldn’t be this stigma.

My mom gave me advice. She actually had a baby, born at 28 weeks, back in the 70s, and he lived for a couple of hours. When I had the miscarriage, she said, “I’m so sorry, Stacy; I’ve been in your situation. I understand. It is out of your control. You did nothing wrong. You can’t control it. As women, we like to control things. But there’s nothing you could have done differently.”

As horrible as the miscarriage was, if I hadn’t had that, I would not have had Remi. He’s the best thing that ever happened to me.

Share Your Story

Have you had a miscarriage? Let us know in the comments below what helped you heal. 

 
 

Podcast Tuesday: Treatment Options for Early-onset Scoliosis [AUDIO]

On March 17, 2015 | At 10:10 am

Filed under : Orthopedics,Podcast Tuesday | By
Comments : 0 |
 
 

Maternity Monday: Miscarriage, A Common Taboo

On March 16, 2015 | At 9:48 am

I thought a quick scan through a Google search about miscarriage would reveal more information than I could fit into this blog post.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

I was wrong. In fact, my quick scan turned into a lengthy search, and the very large gap of information underscored a sentiment that seems pervasive:

You don’t talk about miscarriage.

But why? I wanted to know. Everyone online and the women I talked to for this story expressed the same thing: There’s silence around miscarriage. And it needs to be broken, because this taboo makes it a lonely, isolating experience, on top of the already-difficult physical and emotional loss.

The closest thing I could find for an answer was that the lack of medical reasons for miscarriage—and there’s more often than not no clear reason for it—leaves the why of what happened a blank. As Diane Rozycki, MD, told me, “Miscarriages can happen due to a variety of reasons. They can also be unexplained, with chromosomally and structurally normal fetuses in apparently healthy women.”

As with most mysteries humans face, we tend to fill in the gaps. Women who have miscarriages often feel responsible, at fault and ashamed; the pregnancy “fails,” and they feel they have failed, too.

Miscarriage Risk Factors

But even when a cause is implicated, most of the risk factors for miscarriage aren’t something a woman can control, like:

  • Maternal age: Risk increases with age
  • Maternal disease, acute infection as well as endocrine disorders (uncontrolled diabetes and thyroid disease, for example)
  • Structural abnormalities of the uterus
  • Fetal chromosomal abnormalities or congenital anomalies

Two risk factors, a woman being extremely overweight or exposed to certain medications and substances, can, in some cases, be controlled, but they certainly are not predictors of miscarriage.

Miscarriages Are Common

And the thing is, miscarriages happen more frequently than generally assumed. Rozycki again: “Miscarriage in early pregnancy is common. Studies show that about 8 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy; 80 percent of these occur in the first 12 weeks. Loss of unrecognized or subclinical pregnancies is higher.” (That is, you can have a miscarriage without even knowing you’re pregnant. You might experience symptoms, like pain and/or bleeding, but not necessarily.)

The situation seems like a catch-22: No one knows how common miscarriages are because we don’t talk about them, and we don’t talk about them because we don’t know how common they are. It doesn’t help that in the US, cultural convention tells us to hide pregnancy until after the first trimester, the time when most miscarriages happen. So paradoxically, the time when women arguably need the most support, feel the most tired and nauseaus as well as the most worried, is exactly when they are supposed to hide their pregnancy and, should it happen, their miscarriage.

One article talking about the misconceptions people have about miscarriage reported:

The survey of more than 1,000 women and men found 65 percent believe miscarriage is rare, when in reality it occurs in one in four pregnancies. While knowledge of miscarriage rates was low, respondents accurately assessed that it is traumatic, with 66 percent believing the emotional impact is severe and potentially equivalent to the loss of a child. Research shows understanding the cause of miscarriage can reduce feelings of guilt or blame; however, currently the origin is only identified in 19 percent of patients.

Life After Miscarriage

The good news about miscarriage is, it may be beyond your control, but it doesn’t mean you’re beyond hope for having a baby.

“If you have had a prior miscarriage, you can be at increased risk for another,” Rozycki says. “But it does not mean you are infertile. Even women with recurrent pregnancy loss (three consecutive miscarriages) have a good chance of eventually having a successful pregnancy.” She does advise that women wait for two to three months before getting pregnant again.

And, whatever the taboo or misperceptions, you are not alone. As one woman told me, “It’s still painful right now, looking back at it, but I have to say time decreases the intensity of what happened. Do whatever self-care works for you. Give yourself time, and reach out for support.”

Odds are, when you do, you’ll find someone who knows exactly what you’re going through.

Next Monday, we’ll hear a personal story about the mix of emotions that can occur with a miscarriage.

Worried About Miscarriage?

The best bet: Talk to your doctor. Find a caring, expert OB/GYN:

 
 

The History of Cancer: A Timeline

On March 12, 2015 | At 10:54 am

Throughout its 4,000-year history, cancer has left doctors, scientists and patients with questions that the medical and science fields could not even start to address until recent decades. For centuries, the question has lingered: Will there be a time when we find a way to control or even cure this disease?

Cancer FIlm

UVA Cancer Center presents a Ken Burns documentary “Cancer: The Emperor of All Maladies.” Sign up for a free screening March 30.

Today, in 2015, researchers and scientists finally understand on a cellular level what cancer actually is and how it spreads and have discovered many successful, targeted ways of treating it – surgically, medically and with radiation.

Almost daily, new discoveries about cancer are made, critical ones like the key to cancer’s spread.

How did we get to this momentous time in the history of cancer? Based on “The Emperor of All Maladies: A Biography of Cancer” and Cancer Progress’ timeline, here are some of the most noteworthy cancer-related achievements and failures.

19th Century

1840s

  • “Anesthesia,” the idea of making a patient unaware of pain, was first applied in surgery at Massachusetts General Hospital.

1850s

  • After reading multiple similar reports, German researcher Rudolf Virchow published his report about a patient whose autopsy revealed massive amounts of white, milky cells above the red blood upon examination of blood specimens. He named the condition leukemia from the Greek word leukos, meaning white.
  • Virchow discovered that cancer was, in its simplest form, the uncontrolled growth of cells, called hyperplasia. This led to the term neoplasia (neo meaning new), a term that is still used today to describe cancer.

1860s

  • A Scottish surgeon named Joseph Lister recalled Louis Pasteur’s experiment, which found that meat exposed to air began to ferment. But the air was okay in a sterilized, sealed jar of meat broth. Lister realized bacteria would affect an open wound the same way, so he tried treating an open wound with an antibacterial agent and then closed it. It healed and resulted in another major discovery in the treatment of cancer: infection control.

1890s

  • William Stewart Halsted started collecting data on a new procedure for breast cancer, hoping to prove radical mastectomies would prevent cancer recurrence.
  • A German lecturer discovered radiant energy that came to be known as X-ray.
UVA Researcher Examines DNA

UVA researcher Tom Parsons examines DNA of viruses and cancer in 1983

20th Century

1900-1910s

  • Marie Curie identified radium, named from Latin for light.
  • The surgical community discovered that cancer recurrence was determined by whether the cancer had spread prior to a mastectomy, and how far, not by how invasive the surgery was.

1920s -1930s

  • Radiation therapy exploded in the United States; the extensive side effects of radium surfaced among workers – both acute, including skin, bone and tooth necrosis, and long-term, including cancers of the blood and sarcomas.
  • President Franklin D. Roosevelt approved the establishment of the National Cancer Institute (NCI).

1940s

  • Sidney Farber, a pathologist turned clinician researched and tested chemicals (named chemotherapy) that showed promising results in treating childhood leukemia.
  • A Greek pathologist named George Papanikolaou invented pap smear tests were invented to prevent cervical cancer.
  • Cancer became highly publicized and politicized – finally a topic of international discussion, resulting in abundant funding for research.

1950s

  • Farber raised more than $150,000 for his own treatment center for leukemia patients.
  • Combination chemotherapy for leukemia showed promise but had limitations.
  • The U.S. Senate authorized the NCI to initiate a coordinated effort on the research of chemotherapy drugs, called the Cancer Chemotherapy National Service Center (CCNSC).

1960s

  • A four-drug regimen to treat leukemia showed grossly toxic effects in trial populations. However, it could put patients in remission if they survived the side effects.
  • Results based on St. Jude’s and other research tests proved chemotherapy regimens could cure 80 percent of those treated.
  • Based on numerous studies dating back to the early 1900s and data published by the American Cancer Society, the Surgeon General issued a report linking cigarette smoking to cancer.
UVA Cancer Center Employees

University of Virginia Cancer Center employees (year unknown)

1970s

  • President Nixon signed the National Cancer Act and funds were poured into the trials of new chemicals for cancer treatment.
  • The NCI designated 20 Comprehensive Cancer Centers, hospitals with dedicated cancer centers
  • Radioactive seeds for internal radiation were used for prostate cancer and other cancers (Brachytherapy).
  • Genes reemerged as the focus for researchers studying cancer.

1980s

  • Researchers identified the roles of oncogenes and antibodies, and started using them as targeted cancer treatments.
  • Advances in breast cancer research included the successful use of the hormonal drug Tamoxifen to achieve remission with little side effects.
  • Doctors began initiating palliative care for many untreatable cancers, using opiates to reduce pain and anti-nausea drugs to relieve vomiting.
  • Hospice care was established at hospitals around the world.
  • H. pylori infection was found to be a cause of gastric cancer.
  • Many hospitals began performing bone marrow transplants.

1990s

  • Herceptin was proven a successful drug for breast cancer.
  • Early detection and prevention showed promise, but data showed confusing and conflicting mortality rates both across ages and by cancer type. No conclusions could be determined except that there was a great deal still to be learned about cancer.

21st Century

2000s

  • Historical medicine and research paired with modern science started to show an impact in the mortality rates of cancer.
  • 24 new cancer drugs were brought to market.
  • Targeted therapies showed promise but were not reliable.
  • Researchers shifted back to the focus on prevention and underlying causes of cancer.
  • The Human Genome Project (sequencing of the normal human genome) was complete, allowing the sequencing of gene mutations for cancer types to be studied. By 2009, researchers revealed mutations in pancreatic, ovarian, and lung cancer and leukemia.

2010s

  • Major strides have been made in the areas of immunology, metabolism, gene regulation, and cancer metastasis.
  • Clinical trials for targeted cancer treatments are available worldwide and offer opportunity for patients to benefit and for researchers to forge ahead in finding a cure based on what proves to be effective.
  • Procedures such as “image-guided intraoperative radiotherapy” (only available at UVA Cancer Center) allow patients with early stage breast cancer to have surgery and radiation in a single visit.
  • The relatively new combination of imaging, radiology and surgery results in treatment options that are more convenient and effective and less expensive and invasive.
  • Cancer survival rates have dramatically increased due to early detection through screening programs, preventative measures and advanced treatment options.
  • There are now 68 NCI-designated cancer centers; UVA Cancer Center is one of them.
 
 

Podcast Tuesday: Considering Bariatric Surgery? [AUDIO]

On March 10, 2015 | At 9:03 am

Filed under : Digestive,Podcast Tuesday,Surgery | By
Comments : 0 |
 
 

Maternity Monday: Prenatal Vitamins & Other First Trimester FAQs

On March 9, 2015 | At 10:15 am

Parenting books and baby blogs are great resources, but they can also supply an overwhelming amount of information for newly expectant mothers. I took a look at some common questions for the first trimester of pregnancy and caught up with Vanessa Gregg, MD, for the answers.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Do I Need Prenatal Vitamins? 

Yes — prenatal vitamins are beneficial for both the mother’s changing body and the developing fetus. It’s ideal to begin taking prenatal vitamins before conception. Although most women get the nutrients they need via their diet, prenatal vitamins provide that extra boost.

Gregg warns moms that it may take some self-discipline to include all of the major food groups in the diet during pregnancy, especially when you have cravings, but it’s important to try.

What’s Important in Prenatal Vitamins? 

Dr. Gregg tells her patients that one important ingredient in prenatal vitamins is folic acid.

What is that and what are the benefits, you ask? Folic acid:

  • Is a type of B vitamin
  • Helps produce red blood cells to prevent anemia for mother and baby
  • Helps form the neural tube (the brain and spinal cord) to decrease the number of potential defects while the fetus is forming

Before conception, you should take about 400 micrograms of folic acid. Bump up the dose to 600 micrograms during pregnancy. “It’s one thing you can easily do to help have a better outcome,” says Gregg.

Prenatal vitamins also contain many other valuable ingredients, including iron, which many pregnant women need more than they would outside of pregnancy.

Should I Avoid Any Particular Food?

One important thing to be wary of is raw or undercooked food like meat, eggs and fish, as these foods can lead to food-borne illnesses. Some types of fish have higher concentrations of mercury, which has been linked to birth defects.

Prenatal vitamins contain folic acid and other nutrients for expectant moms and their babies.

Look for folic acid in your prenatal vitamin of choice.

Safe options for expectant moms are:

  • Shrimp
  • Salmon
  • Catfish
  • Pollock
  • White (albacore) tuna, limited to about six ounces a week

You should also be cautious of listeria infection, a food-borne illness caused by bacteria. Listeria infection can lead to miscarriage, stillbirth and premature delivery. As a precaution, women should avoid unpasteurized milk products, and heat lunch meats like hot dogs and cold cuts before eating.

Gregg also advises expectant mothers to peel all food skins themselves and thoroughly wash fruits and vegetables. She tells her patients, “If you’re in doubt, skip it and eat something else!”

Am I Really Eating for Two?

You may want to indulge all of your cravings, but there is no increased caloric need within the first trimester. Over the course of a pregnancy, the caloric intake will increase to about 300 extra calories per day — not an outrageous amount!

While it’s important to have a healthy weight gain during pregnancy, the expected weight gain for each mother varies depending upon her pre-pregnancy weight. The average weight gain for a single pregnancy in a woman of normal body weight is between 25 and 35 pounds. But, as Gregg reminds expectant mothers, gaining too little or too much weight can create pregnancy complications later on.  Your obstetrician or other prenatal care provider can advise you as to how much weight gain is appropriate for you.

What Bodily Changes Should I Expect?

There aren’t many changes that occur within the first trimester. Some women may notice a temporary thickening of the hair or hair growth in unexpected areas like their face, chest, abdomen and arms. However, it isn’t until the baby further develops and grows that changes like stretch marks and darkening areas of the skin may occur.

The most common experiences during first trimester are:

  • Fatigue
  • Breast tenderness
  • Morning sickness, the body’s way of processing new hormones

Is There Really Such a Thing as ‘Pregnancy Glow’?

While there isn’t necessarily a medical reason for the “glow,” Gregg certainly believes it exists. However, she attributes it to the rounding of the expectant mother’s face or the positive, excited attitude and outlook she exudes. In addition, hormonal changes of pregnancy may change the texture or oiliness of the skin, which can contribute to the “glow” of pregnancy.

“Pregnancy is an amazing time. It’s phenomenal, the changes the body goes through to accommodate a growing person,” says Gregg. She encourages all her patients to enjoy the experience and look forward to the joy of a new addition to the family.

 
 

Vote! Help Us Pick a New Name

On March 5, 2015 | At 9:11 am

Voting has ended, but stay tuned for the new name! 

We’re preparing to launch a brand new version of the UVA Health System Blog, and we need your help! The blog will be completely redesigned and feature a new name.

Filed under : New at UVA | By
Comments : 0 |
 
 

Celebrating Heart Month: February 2015 Roundup

On March 4, 2015 | At 10:21 am

February is National Heart Month, and we kicked it off with a post featuring Lawrence Gimple, MD, talking about heart attacks in men from prevention to recovery. We also hosted some fun events — check out the photos!

Heather and Dr. Liu

Despite having neurosurgery in early November, Heather was miraculously on target to successfully complete her fall semester before the 2015 spring semester began.

Other blog stories you may have missed:

Our weekly podcasts featured some exceptionally tough topics:

UVA In the News

Some of our stories made the news: