UVA Health System Blog

Stories about the patients, staff and services of UVA

 

From Cystic Fibrosis to Marathon Ambitions: How a Lung Transplant Changed a Mom’s Life

On April 14, 2014 | At 8:07 am

Tina Tinsley’s dream was to be a mother, and her wish was granted after years of trying. But because of cystic fibrosis, she couldn’t do basic tasks that most moms take for granted. She couldn’t go to the grocery store or give her children baths. When she left the house, she had to take an oxygen tank along with her.

Tina Tinsley with her husband, Phillip and twins Sara and Cole

Lung transplant recipient Tina Tinsley with her husband, Phillip, and twins Sara and Cole

It wasn’t always this way. Tinsley, now 38, was a physically active child, but cystic fibrosis changed all that as she got older.

A hereditary condition that develops during childhood, cystic fibrosis primarily affects the respiratory system, pancreas and sweat glands. The body produces excess mucus that clogs the bronchi, which are the main passageway into the lungs. This leads to breathing difficulties and infections.

Infertility and IVF

Cystic fibrosis also causes infertility. Tinsley, who lives in Staunton, Va., was told she’d never have children, but she wasn’t one to take no for an answer. She and her husband, Phillip, kept trying. After numerous procedures and two in vitro fertilization (IVF) attempts over eight years, they were successful, and twins Cole and Sara were born in 2009.

Her faith in God kept her going through the long and often-disappointing process, she says. The twins were in the NICU for many weeks after their birth. “UVA took excellent care of them and made sure they were coming home,” she says.

After the birth of the babies, her cystic fibrosis symptoms worsened. “My husband says it really took a toll on my body,” she says. “But even if I knew that, if I had been warned, I don’t know if I would’ve listened. I really wanted to have kids.”

Family History of Cystic Fibrosis

Things took a turn for the worse in October 2013, when Tinsley was admitted to UVA with a lung infection and put on a ventilator and feeding tube. “I nearly left here. I almost died,” she says. For Tinsley, that was a very real possibility. Her brother died of cystic fibrosis three years ago at the age of 39. She also has two cousins with the condition, one of whom died from it.

Antibiotics controlled her infection, and eventually she was strong enough to be put on the lung transplant waiting list. Still, she wasn’t ready to admit she needed a transplant. She thought she might still get better and needed the convincing of her doctor, Max Weder, MD. “He said I wasn’t going to live if I didn’t have the transplant,” Tinsley says. “He’s by far the best physician I’ve ever had. We make a good team. The whole transplant team is just phenomenal.”

Tinsley also got support from other members of the transplant team at UVA, including social worker Bill Potts and pre-transplant coordinator Heidi Flanagan, RN.

“Heidi knew how nervous I was, and she was so compassionate. She told me to look ahead a year to what my life was going to be like.”

Potts, she says, asked her what she wanted from the rest of her life. “I told him I just wanted to be a mama to my babies. He said, ‘Transplant can give you that.’”

Lung Transplant and Recovery

While Tinsley was in the hospital, Phillip, Tinsley’s husband of 18 years, would drive 40 miles from Staunton to Charlottesville to be with her and then drive home to be with their children.

Christine Lau, MD, performed Tinsley’s lung transplant, which lasted almost 10 hours. Tinsley was removed from the ventilator the first day after her surgery. “I was up sitting in a chair the next day and walking in the hallways the day after that.”

She stayed in the MICU (medical intensive care unit) for two weeks following the surgery and worked with a respiratory therapist, physical therapist and nutritionist to regain normal function. Tinsley also takes immunosuppressants, drugs that prevent her body from rejecting her new lungs. Transplant recipients take anti-rejection medications for the rest of their lives.

Weder says Tinsley’s case is a special one. It’s not often that patients go from being near death to walking out of the hospital several weeks later. “She is a unique case and serves as a great example of how everyone on our MICU and transplant teams work together in difficult transplant cases.”

Along the way, the Tinsley family received lots of help. People in their Staunton community raised funds to help cover some of their transplant medical expenses. Another group made sure the children had presents under the tree this past Christmas when neither parent had the time or resources to go shopping. The Tinsleys’ church community donated weeks of meals during her hospitalization. The Tinsleys also received a grant from a nonprofit that paid for one round of their IVF procedure.

Tinsley, whose motto is “Live to fight another day,” says she feels better now than she’s felt since she was a child. She can give her children those baths, she goes to the grocery store and the oxygen tank is gone. She hopes to share her story with local churches and maybe write a book someday. Her new goals also include running a marathon. “I know I can do it,” she says.

More Transplant Information

Find out more about UVA’s lung and other transplant programs.

Meet Dr. Weder

Learn more about his interests and research.

 
 

The Magic Week: Waiting for a Healthy Baby

On February 26, 2014 | At 8:07 am

To many women, having a baby at 37 weeks may seem about the same as having the baby at 39 weeks. Why endure another two weeks of backaches and swelling when you could induce labor?

Pregnant belly image

Babies born at 37 weeks are more likely to require NICU admission than babies born at 39 weeks.

Does it really make a difference for your child?

UVA obstetricians sometimes see expecting parents who want to schedule an induction at 37 or 38 weeks for logistical reasons. And that used to be considered OK.

But now doctors know that there’s a big difference between 37 and 39 weeks. Babies do best if delivered at 39 weeks or later.

The “Magical Gestational Age” of 39 Weeks

At 39 weeks, babies have better developed organs, including the brain and lungs, and:

  • Maintain temperature better
  • Eat better
  • Have a lower risk of breathing problems
  • Are less likely to need extensive medical care and interventions, including the neonatal intensive care unit

“It’s important to mention that most babies born spontaneously or due to medical necessity between 37-39 weeks do well,” says obstetrician Vanessa Gregg, MD. “But statistically, 39 weeks or beyond is best for babies.”

That’s why UVA does not schedule expecting moms for elective early deliveries, which is induction or Cesarean section before 39 weeks. The March of Dimes recently recognized UVA and just 12 other hospitals in Virginia for low elective early delivery rates and for implementing a delivery policy.

UVA had no elective early deliveries in 2012 and the first half of 2013 (numbers are not yet in for the second half of last year), compared to a national mean of almost 8 percent of all births.

“When we explain to women and their families that babies are better off if born after 39 weeks, they’re receptive to waiting until that magical gestational age for delivery,” Gregg says.

Earlier Deliveries

However, deliveries before 39 weeks can still happen if the mother goes into labor on her own. There are also medical reasons to induce, including:

  • Maternal high blood pressure
  • Maternal diabetes
  • Twins or other multiples
  • Fetal anomalies that need special care outside the womb
  • Abnormal placental development
  • Prior uterine surgeries that make the uterus too fragile to wait
  • Growth restrictions due to the fetus getting too big

Are you pregnant or thinking about having a baby? Find out more about our:

Filed under : Children's Hospital,Women's Health | By
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Vim & Vigor: Angelina Jolie, Genetic Testing & Controlling Diabetes

On February 7, 2014 | At 8:39 am

In August 1982, Thomas P. Loughran Jr., MD, was working in Seattle when a woman with a mysterious blood illness was transferred to his hospital. That patient and her condition changed the path of Loughran’s research forever.

Sudden cardiac arrest patient Helen Trimm with dog

Read about patient Helen Trimm’s cardiac arrest scare in Vim & Vigor.

Loughran and his research are featured in the Spring 2014 issue of UVA’s family health magazine, Vim & Vigor. Check it out for stories about:

  • Angelina Jolie’s double mastectomy and BRCA1 and BRCA2 genetic testing
  • Controlling diabetes without drugs
  • How much to hover when your kids are playing
  • The jobs that are hardest on your heart

Read the online version now.

Live in Virginia? Sign up to get Vim & Vigor in the mail for free.

 
 

Sleep, Belly Fat, and Making Weight-Loss Last: Q&A Part 5 Fad Diets

On January 25, 2014 | At 9:16 am

In this final installment of our Fad Diets Q&A series, UVA nutritionists Carole Havrila and Katherine Basbaum explain how sleep and belly fat relate and give us their best advice for sticking to a diet plan.

Healthy foods & a balanced diet still rank the as the best way to lose weight and stay fit.

Healthy foods and a balanced diet still rank as the best way to lose weight and stay fit.

Q: Tell me about how sleep and belly fat relate to weight-loss.

Havrila: There is science that validates that elevated cortisol levels (a stress hormone) happen when we lack enough sleep or are consistently stressed out. While these states are correlated with higher cortisol levels and more belly fat, the only way to get that off is to care for the whole body. You must reduce calories and exercise to lose total body weight.

Basbaum: The stomach or abdominal area is indeed one of the more dangerous places on the body to carry excess weight: As fat accumulates and “pads” the spaces between the abdominal organs (“visceral fat”), you have increased risk of metabolic disturbances, cardiovascular disease and type 2 diabetes.

Regarding lack of sleep, that can indeed lead to weight gain; there are specific hunger and satiety hormones (ghrelin and leptin) that can get thrown off if you’re consistently not getting a good night’s sleep. This means that not only will you be likely to consume more calories throughout the day, you will also have more trouble burning them off.

Q. Best tips for sticking to a diet or weight-loss plan?

Havrila: Accountability is a very powerful thing, so if you are really worried you will gain weight then keep a daily log of what you are eating/drinking (you can do this online with apps like MyFitnessPal or Sparkpeople). These keep a tally of your calories and can be helpful to keep you on track when you are considering that extra cookie.

Fad Diets: Final Thoughts

Fad diet advertisements often distort key facts about the body in order to sell their products.

Here are 5 things from this series to remember the next time you’re tempted to believe otherwise:

  1. Detox-diets, cleanses and any plan that removes a food group entirely could put you at risk of missing nutrients you need. If you have health issues, fasts and cleanses can even hurt you.
  2. Diets that focus on eating large amounts of saturated fat found in many meats, butter, full-fat dairy, etc., can be bad for your heart, and that hurts your overall health.
  3. Extreme diets are often so hard they backfire.
  4. You don’t need to cleanse; your body detoxifies itself.
  5. Every weight-loss plan requires diet and exercise to be successful.

What do YOU think?

Was this series helpful? What surprised you? What diet will you try — or try to avoid — next? Tell us below.

Filed under : Healthy Living,Nutrition,Women's Health | By
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Detox, Gluten-Free, Vegan: Best & Worst Diets, Q&A Part 4 Fad Diets

On January 24, 2014 | At 9:08 am

Which are worth trying, which will prove a wash?

Gluten-free foods are gaining popularity.

Gluten-free foods are gaining popularity. But are they really healthy for everyone?

In this fourth installment of our Fad Diet Q&A series, UVA nutritionists Carole Havrila and Katherine Basbaum make their picks for best and worst diets on the popular market.

Q. What about the diets that got top ratings in a recent US News & World Report article: DASH, TLC diet, Mayo Clinic, Weight Watchers, Flexitarian, Volumetrics, Biggest Loser, Ornish, Engine 2, Flat Belly diet, Abs diet?

Havrila: I believe that these diets mentioned do work and can work if followed, and the calories are not severely limited (below 1200 calories for women and 1500 for men). The DASH diet, Mayo Clinic, Weight Watchers, Flexitarian, Volumetrics and vegan/vegetarian diets are all reasonable diets that work successfully when followed. Vegan diets require planning to make sure that important nutrients are included but are healthy diets in general.

Basbaum: For the fourth year in a row — when taking into consideration ease of use, nutrition, safety, effectiveness for weight loss and protection against diabetes and heart disease — US News & World Report has named the DASH diet as the best overall diet for 2014. Why? Because it’s smart, balanced, realistic, tried and true.

 Q. What fad diet makes you cringe the most?

Havrila: Detox diets that advocate large amounts of dietary supplements in addition to restrictive diets and enemas or other detoxification methods. These could potentially be dangerous to those on prescription medications and/or having cancer treatment.

Basbaum: Definitely the gluten-free craze that has been happening for the past couple of years. If you have a genuine, medically diagnosed intolerance to gluten, or if you have celiac disease, then a gluten-free diet is warranted. But as a weight-loss tool, it’s potentially dangerous and may even cause weight gain if you don’t do it right.

Next Up: Sleep, Belly Fat, and Making Weight-Loss Last, Fad Diets Q&A Part 5

 
 

Diet Dangers for Cancer & Heart Patients, Q&A Part 3, Fad Diets

On January 23, 2014 | At 8:45 am

It’s one thing to experiment with fad diets when you’re relatively healthy. But people dealing with health issues, especially cancer and heart problems, need to be extra careful.

In this third installment of our Fad Diet Q&A series, UVA nutritionists Carole Havrila and Katherine Basbaum tell us what diet elements could be dangerous and which could help.

Q. If someone has a heart condition or is in cancer treatment, are there certain diets to avoid?

Havrila: For cancer, any diet that would be restrictive in total calories or protein or both would likely worsen the nutritional status of a patient receiving cancer treatment and would not be recommended. This includes:

  • Fasts (juice or otherwise) that are prolonged
  • Severe macrobiotic diets that eliminate many foods and are very low in total calories
  • Any diet that would include the use of high amounts of dietary supplements, as they may interfere with medicines patients use or even interfere with cancer treatments

Basbaum: For heart disease, I’d say stay away from the Atkins-type diets, the ones that encourage large amounts of high-fat animal protein like steak and bacon. These foods are high in sodium and saturated fats, two of the things we recommend eating in moderation when eating for heart health.

Q. What kind of diets aid prevention of heart issues and cancer?

Havrila: In terms of cancer prevention, plant-based diets rich in legumes and beans, fruits and vegetables and whole grains. Meat is a “condiment” and not the centerpiece of the meal. Diets for cancer prevention are controlled in calories to help patients maintain or achieve a healthy weight. Processed meats are eaten sparingly, if at all, and red meat is limited to 18 ounces a week.

Basbaum: For heart health, your diet should focus on high-quality lean protein (both plant and animal-based), low-fat dairy, whole grains, low sodium (less than 2000 mg/day), and having the majority of dietary fat coming from either polyunsaturated or monounsaturated fat sources, i.e. olive oil, canola, nuts, seeds, avocado.

Next up: Detox, Gluten-Free, Vegan, Fad Diets Q&A Part 4

 
 

Weight-Loss Wonder Ingredients: Q&A Part 2, Fad Diets

On January 22, 2014 | At 8:54 am

I know, I know: You can’t always trust an infomercial. But we live in a fast-food world, and those of us interested in losing weight would love to find a single magic ingredient to do the work for us.

Coconut oil, turmeric, & other supplements supposedly encourage healthy weight-loss.

Coconut oil, turmeric and other supplements supposedly encourage healthy weight loss.

In this second installment of our Fad Diet Q&A series, UVA nutritionists Carole Havrila and Katherine Basbaum offer a reality check.

Q. What about weight-loss claims for wonder ingredients? Recently, I’ve been curious to see magazines touting turmeric, coconut oil or garcinia cambogia. Can adding just one of these or other ingredients really make you lose weight all by themselves?

Havrila:

  • Be skeptical if the product or diet promises a quick fix, if it recommends approaches based on limited, hard-to-find studies or a single study, if it lists good and bad foods or if it sounds too good to be true.
  • Do some research on credible websites.
  • Ask your dietitian, doctor or pharmacist to help.
  • Understand that diet pills and dietary supplements are not regulated as drugs are. Therefore there is a risk of contamination or a risk that products marketed and sold with these ingredients may not even have these ingredients in them.
  • Remember, some weight loss or diet pills have been associated with liver failure and even death.

Basbaum: When it comes to specific foods or herbs that are touted in the press as miracle weight-loss foods, remember a couple things:

  1. If it sounds too good to be true, it probably is.
  2. Even if there is some solid evidence that supports its weight-loss claims, you still have to do all the other things that are traditionally needed for weight loss if you want to see significant results, i.e., healthy diet and exercise.

Next up: Diet Dangers for Cancer & Heart Patients, Fad Diets Q&A Part 3

Filed under : Healthy Living,Nutrition,Women's Health | By
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Juice Cleanse? Think Before You Drink: Q&A Part 1, Fad Diets Series

On January 21, 2014 | At 8:10 am

I’ve known people who have gone on juice-only diets for months and lost tons of weight, as well as people who have lasted only a day. I’ve been tempted to try one myself. After all, who doesn’t like juice? Who doesn’t want to be clean?

Juice cleanses have high sugar.In this first installment of our Fad Diets Q&A Series, UVA nutritionists Carole Havrila and Katherine Basbaum give their take on juice cleanses and other plans that remove entire food groups from your diet.

Q.  Juice cleanses: They’re very popular right now. Do they really work?

Havrila: Any plan that eliminates entire food groups (except for vegan diets) and has people eating only select foods for a length of time is very hard to follow. A juice cleanse is hard for many to do as it is a fast of sorts. People need to be prepared for hunger and possible GI side effects of an all-juice diet. Anyone with diabetes or significant health issues runs the risk of dangerous side effects from a juice diet.

Basbaum: “Cleanses” that last 2-3 days may help someone jumpstart a weight-loss effort, but unless you plan to transition immediately from the cleanse to a healthy eating and exercise plan, as soon as you return to solid food, the weight will return.  And as far as the “cleansing” abilities of these diets, it is unnecessary; your body naturally detoxifies itself every single day.

Also, since so many of my heart patients also struggle with type 2 diabetes or pre-diabetes, I would hesitate to recommend a diet that included so much liquid sugar.

Q. The Mediterranean diet hit the news this year, and I constantly run into people who rave about the Blood Type Diet. Thoughts on those two?

Havrila: Studies have shown that people eating vegan diets or a Mediterranean diet have less incidence of some diseases. These two diets often are followed by people who have healthier lifestyle practices in general.

The Blood Type diet, however, is one of those diets that does not have the science behind it, yet has people avoiding certain foods entirely, so they may be risking missing out on some important nutrients. (What is the Blood Type Diet? There’s new research about it out today.)

What do you think? Have you tried these diets? Did they work?

Tell us in the comment section below.

And come back tomorrow for Weight-Loss Wonder Ingredients: Fad Diets Q&A Part 2

 
 

Fad Diets Q&A: The Truth Behind the Hype

On January 20, 2014 | At 10:00 am

I’m a sucker for fad diet advertisements. And it’s hard to escape them. They’re everywhere, from the grocery aisle to TV to Facebook. Fat-melting miracle pills, body-shaping supplements, diet plans that are easy and fast and require no exercise at all.

Such amazing claims! If you’re like me, you can’t help but fixate on them. Crammed between pictures of anorexic celebrities and mountains of shiny candy, these diets seem like they could be real. If one of them works, I could eat the candy and look like a celebrity, no problem.

There are actually quite a lot of problems with most fad diets. Like many at this time of year, I’m embarking on a challenge to get fit and lose weight.

The fit part is key. As a woman in my late 30s, I know that heart disease is the number one killer of women. It’s time to get in good shape.

Could Any of These Fad Diets Help?

The short answer? No, according to nutritionists Carole Havrila and Katherine Basbaum. Havrila works for the UVA Cancer Center, while Basbaum is a clinical dietitian for UVA’s Heart & Vascular Center.

Fad diet books tout quick weigh-loss plans.

Fad diet books tout quick weight-loss plans. How many do YOU own?

Their advice? When it comes to weight-loss, “if it sounds too good to be true, it probably is,” Basbaum said.

So, which diets deliver and which offer empty promises and calories?

Stay tuned for our nutritionists’ answers to all your fad diet questions, including:

  • Are juice cleanses safe?
  • Which fad diets work?
  • What are the most effective of the popular diet plans?
  • What diets prove healthy for people with cancer or heart concerns?
  • Do wonder ingredients really make a difference?
  • What does sleep and belly fat have to do with weight loss?

First up: Juice Cleanse? Think Before You Drink, Fad Diets Q&A Part 1

Look for Part 1 tomorrow!

 
 

Cervical Cancer and the HPV Vaccine

On January 6, 2014 | At 10:15 am

January is Cervical Cancer Awareness Month. In 2012, 13,000 women in the U.S. were diagnosed and 7,000 died, according to the International Agency for Research on Cancer (IARC). These rates have dropped sharply in the past 40 years, thanks to pap tests that help healthcare providers catch and treat precancerous lesions.

Preteen girls image

Virginia has mandated the HPV vaccine for girls entering sixth grade.

So why Cervical Cancer Awareness Month? Why this blog post?

Worldwide, cervical cancer is the fourth most common cancer in women, with 528,000 cases and 266,000 deaths in 2012, the IARC reports. Most cases occur in less developed regions, which have much higher incidence and death rates than the U.S.

And this cancer is preventable. Nearly all cases are linked to the human papilloma virus (HPV). Pap tests catch precancerous lesions, but the HPV vaccine prevents those lesions from even forming.

How HPV Leads to Cervical Cancer

Almost all women — 80 percent of those in the U.S. who are sexually active — will be exposed to the HPV virus at some point, according to the Centers for Disease Control and Prevention.

Many people hear HPV and think of genital warts. But the HPV strains that cause warts are different from the ones that lead to cervical cancer. And if you have those strains, you won’t see any symptoms.

Most women exposed to the genital wart-causing strains will clear them within a couple of years, says Linda Duska, MD, but they’re less likely to clear the strains that cause cervical cancer.

“Even if a woman has been exposed to HPV, or has had an abnormal pap smear, she should still get the vaccine,” Duska says.

If you clear the strain, you won’t get cervical cancer from it but are still susceptible to other strains. And if you don’t clear it, these cancer-causing strains of HPV can integrate themselves into the DNA of your cervical cells, Duska explains. The cells can then become pre-cancerous.

Some pre-cancerous lesions resolve on their own, Duska says. Other cases require removing part of the cervix.

And if these lesions aren’t caught by a pap test and you develop cervical cancer, the treatment is brutal. If your cancer is stage 1, which is confined to the cervix, you’ll need a hysterectomy. For more advanced cancers, you’ll also need chemotherapy and radiation. You won’t be able to have children afterward.

“Advanced cervical cancer is a horrendous disease,” Duska says. “It invades your bladder and your rectum and makes you bleed.”

Vaccinating Teens for HPV

There are two HPV vaccines, and both require three doses:

  • Cervarix, which only protects against cervical and certain head and neck cancers
  • Gardasil, which also protects against genital warts and cancers of the vulva, vagina, penis and anus. Gardasil is the only vaccine available for males.

In 2009, Virginia became the first state in the U.S. to mandate the vaccine for girls entering sixth grade. Parents can opt their children out, and consequently, only about half of all adolescent girls in Virginia are receiving the first dose, and fewer than one-third receive the last dose, according to the CDC.

These numbers frustrate Duska, who says adolescents should be vaccinated before they have a chance to be exposed to HPV. “If you look at the number of teens who are sexually active in the U.S., the numbers are staggeringly high.”

The vaccine is very safe, she adds; the most common complications are fainting and pain at the injection site.

It’s too soon to see whether HPV vaccines are affecting U.S. cervical cancer rates, especially with so few girls completing the vaccine course. Australia, however, implemented a school vaccination program in 2007. A British Medical Journal study reported:

  • 83 percent of adolescent girls got the first dose of the vaccine in 2010
  • 73 percent got all three doses

The results? Significant decreases in genital wart diagnoses for women under 30. For women under 21, rates dropped by 92.1 percent. And with this, the rates of the cervical abnormalities that lead to cancer also dropped.

Vaccinating Older Women?

In the U.S., the vaccine is only FDA-approved up to age 26. By then, most women will have been exposed to HPV and cleared the virus, although the vaccine will still protect against any strains they haven’t been exposed to.

The age restrictions are also related to biology: The part of the cervix that’s most susceptible to HPV-related tumors is on the outside of the cervix at that age. As women get older, this area goes up inside the cervix and is less susceptible, Duska says.

However, Merck, the vaccine manufacturer that makes Gardasil, now has data for women up to age 44 and is asking the FDA to extend the age limit, Duska says.

Should Boys Be Vaccinated for HPV?

The CDC now recommends routine vaccination for boys. Read more.

Get the Vaccine

If you live in Virginia, you can get vaccinated through: