Tackling the Neurological Complications of HIV

igor-koralnik-mdBy Igor Koralnik, MD

“I take care of HIV-infected people who have neurological problems and I do research on progressive multifocal leukoencephalopathy.” This is my typical answer to the question:  “What kind of a doctor are you? “Which most often elicits raised eyebrows, puzzled looks and a polite, “Oh, this is so interesting! Now what is it that you are actually doing?”

Most people know that neurologists take care of patients with stroke, seizure, Parkinson’s or Alzheimer’s, but few are aware of the multiple neurological complications of HIV infection. Even fewer have ever heard of progressive multifocal leukoencephalopathy or PML.

So I tell them that I got interested in this area when I was a med student at the beginning of the HIV epidemic. During my first forays on the wards, I saw so many young people coming down with all kinds of neurological diseases of the brain, spinal cord and nerves. Those diseases were either caused directly by HIV, or by other opportunistic infectious agents that took advantage of the patients’ lower immune defense caused by AIDS. This is when I decided to specialize in the neurological complications of HIV, and, by extension, to the care of patients with infections of the nervous system.

The paradox of PML

One of these infectious agents is JC virus, named according to the initials of a patient with PML. After his death, researchers in the U.S. isolated the virus from his brain. JC virus is a fascinating paradox: innocuous in healthy people, it resides in the majority of us as a lifelong infection in the kidneys and gets excreted in the urine without causing any disease; deadly in immunosuppressed individuals, it destroys the white matter of the brain in multiple areas, causing a variety of neurological deficits including paralysis, blindness, language dysfunction and seizures. There is no specific treatment for JC virus. Only half of patients who develop PML survive more than one year.

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Orlando, Pride and the Healing Force of Love

clayton-thomason-prideRush University Medical Center celebrated LGBT Pride Month — and reflected on the recent mass shooting at a gay nightclub in Orlando, Florida — during a reception on June 28. The Rev. Clayton Thomason, JD, MD, chairperson of the Department of Health, Religion and Human Values, began the gathering with this reflection about brokenness and healing.

The Stonewall Riots took place 47 years ago on June 28, giving rise to the modern LGBTQ movement. It’s why June is Pride Month. That movement led one year ago to the Supreme Court’s recognition of marriage equality, and on June 24, President Obama declared the site of the riots, the Stonewall Inn in the West Village of Manhattan, a National Monument.

That movement and its accomplishments, including Rush’s own LGBTQ accomplishments, are what we should be celebrating. But on June 12, pride was interrupted by tragedy, by grief.

There have been many responses in the weeks since the lives of 49 people were taken and 53 more were left injured and bleeding in the Pulse Nightclub. Some responses have been predictable, because — unfortunately — by now in our national life, they are all too familiar.

Stephen Colbert observed on the Late Show, “It’s as if there’s a national script that we have learned. And I think by accepting the script we tacitly accept that the script will end the same way every time. With nothing changing.”

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‘We Can Do More’ to Address Gun Violence

gun-violence-2By Steven Rothschild, MD

This week, the American Medical Association called for urgent action on a growing epidemic in the U.S. In doing so, the AMA joined several other professional societies in declaring that we can no longer continue to ignore a health problem that killed over 30,000 Americans last year (including 1,500 children) and disabled countless more. They cite strong evidence for interventions that have been consistently shown to save lives, but which are not being implemented.

What is this public health problem? AIDS? Cancer? Zika virus? No: It is gun violence.

This past weekend, all of us were horrified by the mass murder at the Pulse nightclub in Orlando. The motivations of the gunman remain unclear, and we may never know whether this was due to homophobia, terrorism, mental illness or a combination of all three. What we do know is that 49 young people were robbed of their lives in a matter of minutes.

We also know that, here in Chicago, since the start of 2016 over five times that many people — 265 as I write this — have been killed with guns. Colleagues in the Rush emergency room tell me that so far this year they have seen more patients with gunshot wounds than ever before.

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Eight Ways to Prevent Stroke and Spot Its Warning Signs

stroke-sarah-songBy Sarah Song, MD, MPH

I recently saw a young man who had suffered a stroke. His wife, who is in the medical field, recognized his symptoms of weakness and numbness as being a possible stroke, and she called 911.

As a result, he got to the hospital quickly and was treated with an intravenous clot-busting drug called tissue plasminogen activator, or tPA, which is the only urgent medication for stroke approved by the U.S. Food and Drug Administration. When I saw him after his discharge, he was in great health with no residual effects. He spoke of playing with his young son and how blessed he felt to have recovered completely.

Know the signs

It was handy that my patient was married to someone who knew the signs of stroke. But everyone, not just medical professionals, can recognize most strokes by following the FAST acronym. In fact, a study showed that the FAST acronym can identify up to 89 percent of all strokes — all we have to do is learn it.

Knowing what FAST stands for — Face drooping (usually on one side), Arm weakness (the arm may drift down or feel numb), Speech difficulty (slurred speech or trouble getting words out or understanding others), and Time to call 911 — can make the difference in stroke recovery and survival.

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Enabling Speech, Transforming Lives

speech-therapy-readingBy Karen Tessler, PhD

As the speech language pathologist at the Rush Craniofacial Center, I have the great honor of working with patients and families who are coping with birth defects that affect the head and face. These families give new and true meaning to the concept of beauty.

Cleft lip and palate is the most common birth defect, affecting about 1 in 800 births per year. In the Craniofacial Center, we see children with those as well as other less common craniofacial anomalies, such as Apert’s syndrome, which affects skull and facial growth, fingers, toes and the palate.

These congenital defects not only cause irregular appearance, they also result in speech deficits such as hypernasality and articulation disorders. These difficulties affect the ability for these patients to produce speech that others will easily understand.

By using assessment techniques and instituting resonance and articulation therapy, speech pathologists help their patients achieve normal or greatly improved speaking ability. This function, which most of us take for granted, is crucial to a child’s cognitive development, social acceptance and educational success.

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Health Care’s Role in Addressing Structural Violence

david-ansell-towerBy David Ansell, MD

A 14-year life expectancy gap separates Hyde Park, the home of the University of Chicago, and the neighborhood of Washington Park to its west. You can walk half a mile across the park and find yourself in a neighborhood with a life expectancy lower than Bangladesh. Take the Green Line six stops from the Loop to Pulaski, not far from Rush University Medical Center, and life expectancy plummets 16 years.

These excess deaths are occurring primarily in high-poverty, predominantly black neighborhoods. While an epidemic of gun violence contributes to these lifespan gaps, heart disease and cancer are responsible for more than half the premature deaths.

These deaths have deep roots in the social and political relationships that have governed life in Chicago for 100 years. To resolve these alarming survival gaps, we have to treat the root causes of hardship and poor health in our abandoned neighborhoods.

Structural violence is a term used to describe the social arrangements that put individuals and populations in harm’s way. The arrangements are structural because they are embedded in the political and economic organization of our city. They are violent because they cause injury and early death to individuals in our most disadvantaged neighborhoods.

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Nurses: ‘Extraordinary’ Caregivers, ‘Worst’ Patients

exner-familyBy Katie Exner, MSN

There’s a saying that nurses make the worst patients. Now I understand why, and it makes me even prouder of my fellow nurses and the work we do every day.

I’m an advanced practice nurse who has worked in Rush for the past three years. I also recently gave birth to my twin sons at Rush.

I was admitted to the hospital in November for gestational hypertension (pregnancy-induced high blood pressure). I was at such risk for pre-eclampsia — a kind of hypertension disorder that’s a leading cause of maternal and infant death — that my doctors determined I needed to deliver a few days after I was admitted. I was 35 weeks pregnant at the time.

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