By Leslie A. Deane, MD
Bladder cancer can be a devastating diagnosis, especially when the deep muscle of the bladder is involved. It affects approximately 76,000 people in the United States annually, with 18,000 deaths. Men are affected three times as often as women.
The treatments for this condition are life-changing, to say the least, and the goal of surgeons treating patients is to minimize the morbidity and hasten recovery, attempting to normalize quality of life thereafter.
Robotic surgery has changed the approach to patients with this disease, allowing duplication of open techniques, albeit with a less invasive alternative. We have been able to remove the bladder, remove the lymph nodes and reconstruct the bladder using the small intestine, all inside the body (intracorporeal).
By Fernando De Maio, PhD, Patricia O’Campo, PhD, David Ansell, MD, MPH, and Raj C. Shah, MD
Health inequities — differences that are avoidable, unnecessary and unjust — are a striking feature of cities in the United States, including Chicago. While it is true that all of our city’s 77 communities have experienced an improvement in some key health indicators over the past three decades, inequities between communities have grown over this time.
New research from the Center for Community Health Equity — a collaboration of Rush University Medical Center and DePaul University — explores the prevalence of low birth weight deliveries in Chicago communities. (Our study defined this prevalence as the percentage of live births at less than 2,500 grams, or roughly 5.5 pounds.) This statistic is an important indicator of population health and is widely used to study the health effects of racism.
Good health, as we have seen again and again, is a product of social justice, and Chicago’s deep-rooted racial/ethnic segregation harms the health of its residents. Across Chicago communities, the proportion of low birth weight is 10 percent, with the best-off communities near 3 percent and the worst-off communities approaching 20 percent. Segregation plays an important role in explaining these differences: The most highly segregated African-American communities, among them Avalon Park and Washington Heights, have the most prevalent low birth weight rates. Accounting for 70 percent of the differences between communities are segregation, unemployment and low educational attainment, which are factors that all highly correlated with low birth weight.
By Kyran Quinlan, MD, MPH
When he was 3 years old, Zamari was at home, waiting for his soup being heated in the microwave. His mother was home with him, but involved in a conversation. Zamari could tell that the microwave had finished cooking and it was time to eat. He couldn’t wait. He left where he was with his mother and went into the kitchen. He opened the door of the microwave and removed the bowl of soup from it, and as he did, it spilled on him. On his chest. Scalding hot soup on his chest.
And he screamed. He says it felt like someone had put a torch on him.
His mother heard his cries and came running. She took his shirt off and pulled his burned, peeling chest skin off with it. He was brought to the hospital and was admitted to the burn unit for care of his wound. He was in tremendous pain. His wound required dressing changes in the operating room. The hospital stay lasted a week and left him with a permanent large scar on his chest.
Jorge O. Galante, MD, MDSc, a trailblazing orthopedic surgeon, inventor and professor who revolutionized the science of joint replacement, died on Feb. 9 on Sanibel Island, Florida. He was 82.
At the time of his death, Galante was a life trustee and the Grainger Director Emeritus of the Rush Arthritis and Orthopedic Institute at Rush University Medical Center in Chicago.
Galante joined Rush, previously known as Presbyterian-St Luke’s, in 1972 as the first chairperson of its newly established Department of Orthopedic Surgery, a position he held until 1994. Over the years, he made Rush home to one of the country’s leading orthopedic programs. U.S. News & World Report currently ranks it as the country’s fourth best orthopedic program in the United States and the No. 1 program in Illinois.
An exceptionally talented surgeon himself, Galante nurtured generations of orthopedic surgeons and scientists at Rush, many of whom still practice today. He also established the Rush’s Motion Analysis Lab, which studies the functional performance of people during activities of daily living in order to improve the physical capabilities of people suffering from musculoskeletal ailments.
By Susan Frick
At our last Without Warning meeting, Bob, whose wife passed away from younger-onset Alzheimer’s disease several years ago, told me something interesting. He realized that during the 10 years he has been attending Without Warning meetings, he has learned how to share his story. While sharing your story might seem like a small task, I’ve grown to realize that it is a profound and healing skill.
Without Warning, a 13-year-old support program of the Rush Alzheimer’s Disease Center, is for families living with younger-onset Alzheimer’s disease. Younger-onset Alzheimer’s means the person is diagnosed by the age of 65 or younger. This is a young age to be experiencing Alzheimer’s disease. Group members might still be working, raising children, driving and have friends who aren’t experiencing such a life-changing disease. Alzheimer’s at any age can make someone feel isolated and different, but these feelings only intensify when someone is young.
‘Agony of an untold story’
The author and poet, Maya Angelo once said, “There is no greater agony than bearing an untold story inside you.” As a group facilitator, I have seen the agony of an untold story in both the person with Alzheimer’s and their family members, and there are numerous reasons their stories are not heard or told.
By Patricia Graham, MD
As a primary care physician and internist, I have spent more than nine years building relationships with patients.
I explain to my patients that I am their coach and their medical detective helping them sort through their medical problems and referring them to specialists as needed. Teaching patients is one of the aspects of my practice that I most value, as it draws on my background in nursing and as a teacher to medical students as an attending physician.
A foundation of trust
Along with teaching, another key foundation of my practice is building trust with my patients. I believe it is extremely important to build trustful physician-patient relationships in order to work together on the challenges of an illness or chronic condition. In order to have a relationship in which my patients feel comfortable with my recommendations, they must first trust me: trust that I am both listening to them and that I’m providing them with the most up-to-date medical advice. In this way, trust is the foundation of compliance and good health, which includes taking medications as directed, following up for cancer screenings, and keeping follow-up visits.
By Antonio C. Bianco, MD, PhD
Within two weeks of each other, two patients arrived in my office with almost identical stories. Both were middle-aged teachers who had lost their jobs months after being diagnosed with hypothyroidism, or an underactive thyroid. They had gained weight, lost energy and had trouble focusing.
Yet their hypothyroidism was under control, as judged by medical standards. They were taking the go-to medication that has been prescribed for hypothyroidism for 40 years, a synthetic thyroid hormone called levothyroxine. Blood tests revealed that the women had normal thyroid-stimulating hormone (TSH) levels, which is the lab value physicians look at to diagnose and manage hypothyroidism. Frustrated over their lingering symptoms, both women had sought second opinions from numerous endocrinologists. All of these specialists assured the women that their lab tests were normal and they should feel fine.
About 15 percent of people with hypothyroidism, including 2 million Americans, remain symptomatic despite following what we physicians call the standard of care, which has been recommended by the American Thyroid Association. Just like my two patients, these patients are fatigued, sluggish. Their cognition is compromised and they gain weight that they can’t lose. They are commonly depressed, and their lives are significantly impaired.
Search for evidence
Physicians often dismiss these complaints from hypothyroid patients as “all in their heads.” I should know. I used to be one of those physicians. Then eight years ago, because of these two patients and their strikingly similar stories, I started to listen more closely to what my patients were saying. As a result, I started to believe them.