There are many kinds of heart disease, but one stands out as the most common and deadly: coronary artery disease, caused by a hardening of the arteries or atherosclerosis.
In fact, coronary artery disease is the leading cause of death of people over the age of 35 in the industrialized world, according to Robert Zipkin, M.D., Mills-Peninsula interventional cardiologist. “This year alone in America, there will be one million heart attacks,” he says in the below video segment from Healthpoint TV.
Are you at risk for heart disease? Some of the risk factors include:
- kidney disease
- high blood pressure
- elevated cholesterol
- family history of heart disease
In the world of modern medicine, not all heart surgery is the same. Often, what used to take large incisions in the chest to expose and repair the heart, can be done today with tiny openings and miniature tools. But occasionally, it’s best to have all the options available and ready to save a life.
That’s why a new “hybrid” operating suite has been developed, and will soon be added to the high-tech offerings at the Mills-Peninsula Medical Center in Burlingame. “This new $4 million operating suite will allow us to perform a combination of minimally invasive and open surgery in the same room,” says Mills-Peninsula vascular surgeon, Raju Gandhi, M.D.
Traditionally, damaged arteries outside the heart were dealt with using “open” surgery in which a doctor makes an incision to expose the organ and complete the bypass surgery or repair an aneurysm. But technological advances now allow surgeons to perform minimally invasive surgery. By inserting a reed-thin catheter into the groin or leg through tiny punctures, doctors can use advanced X-ray imaging to navigate their instruments through the body to the site of the procedure. When the surgery is over, the tiny incisions allow a much quicker patient recovery.
Best of Both
“With vascular procedures, every now and then you still have to do open surgery to access certain arteries,” explains Dr. Gandhi. “A hybrid room is ideal for this purpose,” he says. “The environment is set up and equipped in such a way that it allows us to continue to perform advanced imaging cases but transition to open surgery if needed without having to move the patient to another operating room.”
The technology is being funded through the Mills-Peninsula Hospital Foundation in partnership with community donors.
One Room, Many Uses
“This room will be used for advanced vascular cases, such as aortic surgery, aortic valve replacements, aneurysm repairs and other cases,” says Mills-Peninsula vascular surgeon, Dirk Baumann, M.D.
Two of the current 10 operating rooms at Mills-Peninsula are already equipped with advanced imaging technology, while the others can be accessed with portable imaging equipment. But in the current advanced imaging operating rooms, either the X-ray machine or the operating table has to move in order to capture images of different parts of the body. In the new hybrid room, a corner-mounted X-ray device will extend on a robotic arm where it can be moved around the patient in myriad positions, then quickly retracted out of the way. This allows the surgical and anesthesia staff to continue working without having to stop and reset the room.
“Setting up and resetting equipment takes time,” says Dr. Baumann. “And for critically ill patients, every moment counts.”
Vascular surgery is often done on older patients who frequently have other serious conditions including diabetes, high blood pressure and heart disease. So the faster and less invasive the procedure, the more successful the outcome. “The problem has always been, we’ll do this big surgery on a 90-year old,” says Dr. Gandhi. “The surgery goes smoothly, but because of the invasion into their body, they do poorly afterwards.
“A hybrid room markedly diminishes the time and invasiveness, so the patients do much better,” he continues. “We’re very excited because this room will be a major step forward in our treatment of vascular disease.”
This is a very exciting time in the history of the treatment of lung cancer, says Kent Adler, M.D., Mills-Peninsula medical oncologist. “Low-dose, 30-second X-rays called Computed Tomography (CT) lung scans, provide early detection, while new treatments are helping save lives.”
Most common; Most deadly
Lung cancer is one of the most common cancers in the U.S. It is also the most common cause of cancer death, accounting for 160,000 fatalities each year. That’s more than the next three most common causes of cancer death – colon, breast and prostate cancer – combined.
“The dominant cause of lung cancer is cigarette smoking,” says Dr. Adler. “If people didn’t smoke, we could eliminate 90 percent of lung cancer altogether. But non-smokers can get lung cancer, too.”
Ten Years of Breathing Easy
Andy Lee, a 54-year-old San Bruno resident, started smoking at 19. By the time he entered the workforce, he was a chain smoker.
In 1985, Lee caught a bad case of flu, which made cigarettes taste awful, and provided the impetus he needed to finally kick the habit. He became an avid runner and tennis player. But by 2001, Lee found himself short of breath and coughing up dark, red blood. A CT scan and biopsy revealed Lee had lung cancer – a tumor the size of a grapefruit.
“I was shocked,” says Lee. “I didn’t feel anything.”
Later he learned that, because there are no pain-sensing nerve endings in the lung, a lung cancer can grow and spread undetected. Dr. Adler prescribed chemotherapy and radiation. In six months, the tumor vanished. Then, four months later, it reappeared.
“Dr. Adler was still very positive,” says Lee. “He said, ‘We can beat this.’ But I wasn’t so sure. I really thought this might be it.”
Dr. Adler recommended that Andy participate in a clinical trial being conducted to evaluate a drug known as IMEX CA0001. The tumor began shrinking. Five months later, it was gone.
“That was a decade ago,” says Lee, “and I am still cancer-free.”
In August 2006, social worker, mother and non-smoker, Rosa Mendez, was diagnosed with lung cancer quite by chance when her job required her to take a tuberculosis test. A subsequent X-ray and biopsy revealed a tumor in her left lung.
“I was lucky to get an early diagnosis, because I had no symptoms,” she recalls. She underwent surgery to remove the tumor followed by three months of chemotherapy.
In 2009, the cancer returned as a nodule in the right lung. This, too, was surgically removed. A year later, the cancer reappeared a third time. This time Mendez tried a new drug called Erlotinib (Tarceva®) and has been taking it ever since.
“I’m doing really well now,” she says. “All my CT scans show that I am in remission. I have no symptoms of cancer and no problems with the medication. People need to talk to their doctors because there are many options available to help them fight this disease,” she continues. “You don’t need to feel like just because you have lung cancer, it’s the end of the world. Because it’s not.”
“With our new technologies and medications, and increasing access to smoking cessation programs,” Dr. Adler adds, “we may just be on the verge of eradicating this most deadly of cancers.”
Deepak Khuntia, M.D., didn’t plan to become a cancer doctor.
He was on track to practice primary care when a stint in a cancer unit during his fourth year of medical school opened his eyes to the challenge and excitement of fighting cancer.
“We were treating a young patient with Hodgkin’s lymphoma,” he says. “With my math and science background I was intrigued by what they were doing in radiation oncology. I loved the high-tech nature of the field and the application of physical sciences to medicine.”
Today, years after he first glimpsed the plight of that young Hodgkin’s patient struggling to beat the odds, Dr. Khuntia is part of a cancer care team helping improve people’s chances against cancer.
As a radiation oncologist — a doctor who specializes in killing cancerous tumor cells with radiation – Dr. Khuntia treats patients at Mills-Peninsula’s Dorothy E. Schneider Cancer Center.
Before moving to the Bay Area in November 2010, Dr. Khuntia was associate professor and director of the Radiation Oncology Residency Program at the University of Wisconsin, where he was actively involved in education of medical students, residents and faculty. He is internationally recognized for his work in treating brain tumors, lung cancer and head and neck cancers. Today, he continues an active role in education and research and leads several national clinical trials.
Dr. Khuntia is excited to get his hands on two new technologies that will soon be working in tandem to fight cancer at Mills-Peninsula Medical Center.
In the spring of 2012, construction began on Mills-Peninsula’s new, state-of-the-art linear accelerator called the TrueBeam STx. Also referred to as a linac, a linear accelerator delivers beams of radiation that destroy cancer cells.
One of the advanced features of the new linac is its radiosurgery capabilities. During radiosurgery, a strong dose of radiation is delivered with exceptional precision, targeting only the tumor and sparing surrounding tissue. Traditional radiation treatments for cancer use smaller doses of radiation in daily treatments over many weeks. Radiosurgery treatment can be competed in a single dose or in as few as five treatments. The new linac should be up and running at the hospital this summer, Dr. Khuntia says.
A Powerful One-Two Punch
By the end of the year, a new PET/CT (positron emission tomography/computed tomography) scan will join the linac, creating a potent tumor-fighting team in the oncology unit.
By looking closely at the behavior of tumor cells — particularly at how quickly the cells consume glucose, for example — a PET/CT scan can identify the exact location of a tumor. Before the scan, doctors inject a patient with a radioactive sugar molecule. Because tumor cells consume sugar faster than healthy cells, the scan will light up where nutrients are quickly metabolized.
“Looking at the scan, we see a bright area where there is a tumor,” the doctor says.
The PET/CT scan’s ability to pinpoint the tumor’s exact location and shape enables the linac to be more accurate and effective.
“The linac and PET/CT scan work hand-in-hand, allowing us to treat just the tumor and not the normal tissue around it,” he says.
Moreover, the linac’s radiosurgery function would not be possible without knowing the precise location of a tumor, Dr. Khuntia says.
“Old CT scans just gave an approximation of the tumor location. For radiosurgery, we need to be accurate. This new PET/CT scan generates clear images that allow us to get within one to two millimeters of accuracy, and sometimes even less than one millimeter accuracy,” he says.
Improving the Odds
Although doctors use it to find all kinds of cancers, the PET/CT scan is particularly useful in locating lung tumors and improving outcomes for lung cancer patients.
Because a lung tumor can cause parts of the lung to collapse, a tumor can be difficult to find using traditional scans.
“The PET/CT scan can spot the tumor, so we don’t treat the collapsed lung tissue. We can use a smaller volume of radiation and there are fewer side effects,” he says.
The key to beating any type of cancer is finding it as early as possible, and the linac and PET/CT scan used together improve early detection.
“The cure rate might be 10 to 15 percent for a stage three cancer,” Dr. Khuntia says. “But for cancer caught early at stage one, the cure rate can jump to 80 percent or higher.”
“These technologies used together open the door for us to catch tumors earlier,” he says.
Imagine having a limited water supply and no working toilet. It could happen in the case of a disaster or emergency. So how to prepare? Assemble at least a 7- to 10-day supply of sanitation and personal hygiene items, says Deborah Tauscher, emergency preparedness coordinator at Mills-Peninsula.
Many such supplies can be purchased, such as body wipes for personal cleanliness and portable toilets with sewage-treatment chemicals. But, you can also prepare in do-it-yourself fashion. Read on for some simple suggestions.
• If water lines are damaged or shut down in an emergency, do not flush the toilet. If you still have access to your toilet, but you are not able to flush it, you may still be able to use it with proper preparation. This is the most convenient, cost effective and least stressful method. To prepare, remove all water from the bowl and line it with a heavy duty plastic bag. Double line and then just replace one layer after each use. Simple disinfectants that you use for cleaning can be added to control odor. Then securely tie the bag and dispose of in a large trash can specifically designated for this waste with a tight fitting lid.
• If you do not have access to your toilet, you can use a medium-sized bucket with a tight lid. In your supplies, be sure to include heavy duty plastic garbage bags and ties and zipper storage bags to keep items clean and dry, as well as toilet paper.
Personal Hygiene Supplies
• Personal hygiene items will be a matter of personal preference, so we’ll list the basics here and suggest you customize your kit. Some general items to include in your personal care kit include: pre-moistened hand or baby wipes and hand sanitizers to help extend your water supply, washcloth, towel, soap and shampoo (waterless shampoo is a great addition), comb or brush, nail clippers, deodorant, feminine supplies, razors and shaving creams. If you wear contacts you will need to include lens solution and case. Items that are frequently forgotten in the kit include insect repellent, lip balm, sunscreen and a mirror.
Tip: You can stock your personal hygiene kit with the sample size items from hotel and dentist visits, which are also available for purchase at most drug stores.