UVA Health System Blog

Every July, the UVA volunteers who spend 30 hours providing free healthcare in southwest Virginia leave with many stories, some tragic, some uplifting. Emergency room nurse Tim Cunningham has turned those stories into a powerful one-man play.

Cunningham, according to a University of Virginia story, “conducted intimate, anonymous, one-on-one interviews with more than 30 patients” at the 2009 Remote Area Medical (RAM) clinic in Wise County. He used those interviews to create 11 characters that he portrays in his play, “Out of Their Way.”

I’ve volunteered at RAM for three years and saw Cunningham’s play just before last year’s clinic. It was often poignant, sometimes funny, and I don’t think I was the only one tearing up at the end. This is well worth the 85 minutes out of your day.

Want to go?

The play is Thursday, April 19 at 4 p.m. in McLeod Hall Auditorium. (Driving? You can park in the Central Grounds Parking Garage or at the Corner; the McLeod garage is permit-only until 5 p.m.) It’s free and open to everyone.

Read More about the Remote Area Medical Clinic

We’ve got photos, volunteer stories and more from the 2011 clinic.

As a patient, you have the right to make decisions about your healthcare.

But what happens when you can’t make those decisions for yourself?

What if you’re in a coma or you have a terminal illness? Will your family know what to do? Do you even want your family to make those decisions for you? Maybe there’s someone else — a close friend, perhaps — you trust more.

Make an Advance Directive Today

You can make decisions now about your healthcare in the future. You have the legal right to make an advance directive. An advance directive allows you to:

• Name someone to make healthcare decisions for you
• Tell others about your wishes for care you might need in the future
• Help others make decisions the way you would if you could speak

This booklet provides you with more information about Advance Directives, as well as an advance directive form (PDF). The form is easy to fill out. You don’t need a notary to sign it, but you do need two adult witnesses.

Need More Information About Advance Directives?

• Talk to your doctor, hospital staff or a lawyer.
• Check out the National Healthcare Decisions Day website for legal resources and more.

Eighteen people die each day because there aren’t enough organs available for those in need, according to the U.S. Department of Health and Human Services.

Laurie Miller of Harrisonburg donated a kidney to a stranger in need.

Eighteen.

And there are more than 100,000 people on the waiting list for organs nationwide, including 759 UVA patients. For many of those waiting, time is limited.

Organ Donation: What Can You Do?

Many people agree to donate their organs when they die. It’s called a deceased donation, and it’s as easy as checking a box when you apply for a driver’s license. Some even donate a kidney or a part of their liver to a friend or family member. That’s called a living donation.

Laurie Miller of Harrisonburg donated one of his kidneys as part of a living donation. But Miller donated to a stranger. It’s called an altruistic (or non-directed) donation and it’s fairly uncommon, according to Anita Sites, RN, who coordinates and manages care for patients in UVA’s Living Donor Program. There are about one or two altruistic donations a year at UVA, she says. (more…)

When it comes to conditions that affect the aorta — our body’s largest blood vessel — men and women are very different.

UVA vascular surgeons Gilbert R. Upchurch Jr., MD, and Margaret “Megan” Tracci, MD, are researching and treating aortic aneurysms.

Being aware of these gender differences could be lifesaving, especially for the over-65 set.

Aneurysms Are More Deadly for Women

Aneurysms affect more men, but they are more deadly for women.

The aorta carries blood from our heart to all of our vital organs. In some people, a bulge — a weak area known as an aneurysm — forms in either the chest (thoracic) area or lower (abdominal) part of the aorta.

“It’s a disease that affects four men for every woman. But when women get this condition, it is typically associated with a higher mortality,” says UVA vascular surgeon Gilbert R. Upchurch Jr., MD. “Their risk of dying from surgery is 1.3-fold higher than that of men.” Women also typically develop an aneurysm 10 years later than men.

Treatment Guidelines

What do doctors recommend? Operating on a bulge over 5 centimeters. But this standard can mean different things for men vs. women:

• For men, a 5-cm bulge is two times the normal size of their aorta.
• For women, a 5-cm bulge can be three times the normal size of their aorta.

What should women do? Upchurch suggests women should have their aorta repaired before the bulge reaches five centimeters.

Taking action can mean life or death: Few people survive an aorta that ruptures.

Fewer Treatment Options for Women

For the past dozen years, doctors have been offering a less risky treatment alternative to traditional “open” surgery: endovascular repair. This typically done in an outpatient setting or requires only an overnight hospital stay. Doctors thread a mesh tube (a stent graft) up through a blood vessel in the patient’s leg.

Unfortunately not as many women qualify for this approach. Their vessels are too narrow for a stent to be threaded through, and the bulging area is more likely to be too close to the vital kidney arteries, UVA vascular surgeon Margaret “Megan” Tracci, MD, explains.

Who Needs an Aorta Screening?

Get an ultrasound scan for an abdominal aortic aneurysm if you have major risk factors:

• Older than 65
• History of smoking
• History of high blood pressure

Get screened at a younger age if you have a family history of aneurysms.

If the blood vessel bulge is small enough, treatment usually consists of getting scanned every six months to make sure it’s not getting larger.

Want to Hear More?

Upchurch talked with Dave Koehn, the voice of the Cavaliers, about risk factors and treatment for aortic aneurysm at UVA. Listen to hear what he had to say:

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Find out more about our Vascular Center.

Spring is officially here. That means longer days, vacation planning, planting gardens, hiking … and diseases caused by ticks.

A bite from this dog tick can lead to ehrlichiosis and Rocky Mountain spotted fever.

You probably know someone who’s had Lyme disease, a bacterial infection that starts with a tick bite. But every year, Virginia residents are diagnosed with two other tick-borne illnesses: Rocky Mountain spotted fever and ehrlichiosis.

“I would definitely say cases of Lyme disease are surging here. And I’ve never used that verb before when it comes to increasing incidence of anything,” says James Nataro, MD, PhD, a pediatric infectious disease expert and head of UVA’s Department of Pediatrics.

In 2010, 1,245 cases of Lyme disease were reported to the Virginia Department of Health (VDH) ; in 2001, just 156 cases were reported.

The increase may be due to the bacterium that causes Lyme disease becoming more common in wild mammals and ticks, Nataro explains. And when those wild mammals, like deer, live near humans, the disease spreads easily.

Rocky Mountain spotted fever and ehrlichiosis are not as common as Lyme disease, but UVA sees a few cases each year, Nataro says. (more…)

When Rebecca Lewis began her nursing career in the 1960s, intensive care units were long and narrow, with curtains between beds. “More ward-like,” she says.

Hospitals have come a long way since then.

Our 72 new private patient rooms have large windows to let in lots of light. The green, blue and umber shades of the walls reflect nature themes.

Lewis, who is now a facilities planning administrator and clinical liaison at UVA, says the new rooms and units are designed to:

• Accommodate family members
• Promote privacy
• Reduce noise
• Prevent and stop infections

All these features ultimately promote faster healing and help our staff do their jobs.

Quiet Environments for Patients and Staff

Monitors beep. Phones ring. Staff scurry back and forth. People talk. Patients need rest, but hospitals aren’t always the quietest places.

A University of Chicago study found that noise in hospital rooms was higher than World Health Organization recommendations and could sometimes spike to twice the recommended level. (more…)

My knees hurt.

This is nothing new. After dancing fairly rigorously for 14 years, they started hurting when I was in high school, and I had to quit. Now in my mid-thirties – working at a desk job, wearing heels, running and doing yoga several times a week – it doesn’t surprise me that the old knees give me trouble.

Lo Davis getting rehab after knee surgery

Like many people my age with joint pain, I mostly ignore it. I can just suffer – and shuffle – through it.

“It’s a general principle with the knee,” says David Diduch, MD, orthopedic surgeon at UVA. “When damaged, people try to live with it, and that’s going to create additional problems. People say, ‘It’s not that bad, it just happens sometimes, pain and swelling, it’s not crippling.’ Meanwhile, they are chewing up joint cartilage.“

Well, okay. But surely knee pain, orthopedic surgery, joint replacement and all that stuff is for older people or professional athletes, right?

Not always.

Why Worry About Knee Pain Now?

Meet Lo Davis. He’s young, by my standards, at 42; and while he works in fundraising at the Virginia Athletics Foundation, he’s not a professional athlete.

Still, a few months ago, he had knee surgery. (more…)

Recreation therapist Laurie Sewell sits cross-legged on the floor of a UVA hospital conference room. She’s demonstrating infant massage techniques on a doll while 2-year-old Haley Poore watches her and plays with a colorful toddler toy.

Recreational therapist Laurie Sewell (right) and Mended Little Hearts volunteer Lisa Wickersty demonstrate infant massage techniques at a recent meeting, while patient Haley Poore plays.

Nearby, two parents quietly begin sharing their story: their 1-year-old son has pulmonary atresia, a condition that affects his heart’s ability to pump blood to the lungs. He had surgery a few months ago and is back in the hospital.

Lisa Curcio chimes in — her son, Owain, also has pulmonary atresia. He’s 3 now and running around the room with his brothers and sister, giggling.

This is a typical meeting of Mended Little Hearts of Charlottesville, where families affected by congenital heart defects (CHD) meet for dinner, support and education.

Some families, such as the Poores, come because their child is in the hospital, awaiting a transplant or other surgery. Haley has had two surgeries to manage her hypoplastic left heart syndrome and now needs a heart transplant. She and her family will live at the hospital until she gets it.

Other kids, such as Owain, are past their surgeries; their post-operation healing provides other families much-needed reassurance.

Congenital Heart Disease: The Most Common Birth Defect

“Throughout my pregnancies, no one told me heart defects were the number one birth defect.”

So says Lisa Curcio. She had a normal pregnancy, but several hours after Owain was born, she thought he looked blue. His pulse oxygen level was 40 percent by the time a doctor examined him; normal is between 95 and 100 percent.

Owain was rushed to UVA, where the Curcios learned he had pulmonary atresia and only one ventricle in his heart. A normal heart has two: one to pump blood to the lungs, the other to the rest of the body. Owain’s ventricle only pumped blood to his body, so his lungs weren’t getting any blood.

Even though there were no warning signs and the defect wasn’t preventable, Lisa Curcio still felt guilty. “I had three pregnancies (before Owain) and I was so blindsided by this.”

But congenital heart disease isn’t rare. According to the National Heart, Lung and Blood Institute, for every 1,000 babies born in the United States, eight have heart defects. In 2011, UVA’s pediatric heart surgeon, James Gangemi, MD, performed 210 surgeries to address congenital heart defects, 190 of which were on patients under 18.

Routine prenatal care sometimes catches a congenital heart defect; UVA also offers a fetal echocardiogram service for high-risk mothers that shows a detailed view of the fetus’ heart.

But many parents, like Lisa Curcio, are blindsided.

Support, Sometimes Far From Home

Mended Little Hearts is a national organization. Virginia’s other three chapters are in Lynchburg, Winchester and Richmond, and Washington, D.C., also has a chapter. The Charlottesville chapter meets at UVA and focuses on helping families of kids currently in the hospital, who frequently come from all over the state.

Haley Poore’s family, for example, is from Ewing, Va., 6 hours away.

Mended Little Hearts meetings offer a place for families to feel “totally safe, and everyone knows what they’re going through,” says UVA RN Carol Tatum, who works with pediatric heart patients.

Meetings are monthly and include dinner and childcare so siblings can come. While they have a topic, such as the infant massage demonstration, they’re informal and give parents a chance to share stories and talk.

Besides the meetings, Mended Little Hearts does other social events and projects to help families in the hospital. Lisa Wickersty, whose daughter Isla was born with Tetralogy of Fallot, received a grant to order heart pillows for kids in the hospital. The kids like to hug them; the parents get the other families and staff they meet in the hospital to sign them.

“Not a Death Sentence”

Isla had surgery at six weeks old to close the hole in her heart and help blood get to her lungs. She has an annual check-up to monitor her heart but is a healthy 3-year-old with no activity restrictions.

As for Owain, he’s had three staged surgeries to help his blood circulate in a more normal fashion: a Blalock Taussig (BT) shunt placement, the Glenn procedure and the Fontan procedure. The ultimate goal was to get blood from his heart to his lungs for oxygen and then supply the rest of his body with oxygenated blood.

Doctors expect Owain to live a normal life without more surgeries, but his mom is blunt: His heart is “patched together,” not normal, and something could always go wrong.

While being prepared for the worst, she hopes for the best. She tells parents of newly diagnosed children, “It doesn’t have to be a death sentence. It doesn’t have to be a death sentence at all.”

Do You Have a Child With Heart Disease?

Mended Little Hearts of Charlottesville meets the second Monday of each month, from 4:00-5:30 p.m. in UVA’s NICU conference room.

You can also connect with them through their:

• Facebook page
• Blog
• Website
• Twitter account

And learn more about UVA’s Fetal Heart Program.

Not in Charlottesville? Visit the national Mended Little Hearts website to find a chapter near you.

There’s also a new chapter forming in Roanoke. For more information or to volunteer as part of the leadership team, contact Lisa Curcio.

Is congenital heart disease in your family? Share your story by leaving a comment.

You asked for it!

Download this PDF to get 30 easy-to-follow heart tips!

In February, we gave you a heart tip every day on the blog.

Some of you asked it if would be possible to put all those tips into one easy-to-find location, so we created this heart tip sheet (PDF) that you can print out and put on your refrigerator at home or bulletin board at work.

We hope you find this tip sheet useful, and be sure to keep sending us your ideas!

Happy Heart Health,

The UVA Health Blog Team

Working at a hospital is exciting.

Is there this much drama and romance in a real hospital, or are medical shows like Grey's Anatomy unrealistic?

Every week, the doctors face their toughest cases yet. Every patient is a medical mystery. Nurses and residents duck into closets for a little time together. And some doctors are only 16.

Or at least, that’s what you’d believe if you relied strictly on medical TV shows.

Facebook Poll: Grey’s Anatomy or Nurse Jackie? 

Medical TV show plots are created to boost ratings, but are they really true-to-life? We asked our Facebook fans to vote for the most realistic show. Their options included:

• “Doogie Howser, MD”
• “Grey’s Anatomy”
• “Nurse Jackie”
• “Scrubs”
• “General Hospital”
• “Nip/Tuck”
• “ER”
• “House”

Out of 22 responses on Facebook, “House” was overwhelmingly voted the most realistic, with nine votes.  (more…)