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eHealthLines Summer 2012


When it’s Not Just a Stomachache

Pancreatitis

The occasional stomachache affects everyone from time to time. But if you ever experience acute pancreatitis, you'll know immediately that it's something more serious.

“Acute pancreatitis is an acute inflammation of the pancreas that usually occurs suddenly,” said Cleveland Clinic gastroenterologist Luis Lara, MD. “Most patients land in the hospital or see their doctor because the pain is something they've never experienced before.”

The pancreas is a small organ located behind the stomach in the top part of the abdomen. “It's an important organ because it serves two significant functions,” Dr. Lara said. “It produces the hormones that regulate our blood sugar—insulin, glucagon, and other hormones—and secondly it produces pancreas juice, which contains enzymes that are extremely important to break down foods to the small substances that are then absorbed in our intestines.”

When patients arrive at Cleveland Clinic Florida with a stabbing abdominal pain, doctors must determine whether it's coming from the pancreas, or another organ, such as the stomach, or even the heart. Once it has been established that the issue is indeed the pancreas, doctors must then detect the cause. “It's important to determine whether it's something that is curable by other specialties,” Dr. Lara said. “For example, if it's due to gallstones, you may have to have your gallbladder removed. Or it could be due to another serious issue that has to do with the pancreas itself, such as chronic pancreatitis, a pancreatic cyst, or pancreatic cancer.”

For acute pancreatitis patients, the goal is to prevent organ damage. “You have to be in a hospital setting because you must receive IV fluids and pain control medication as we try to find the cause. It may be reversible or treatable,” Dr. Lara said.

The causes are often the key to treating the condition. “Since the two most common causes of acute pancreatitis are gallstones or alcohol, we can usually affect one or the other and treat the condition successfully.”


Know Your Options

Heart Disease

Last year during the holiday season, Christopher DiMarcantonio and his family received an unwelcome surprise. A regular visit with his endocrinologist revealed that he had severe heart disease.

“We were surprised because the only symptom I had was tightness in my chest after a vigorous workout, but I had no chest pain,” said DiMarcantonio, who turned 50 last year and is a physically active, well-controlled diabetic. He did have high cholesterol, but had no idea about the severity of his heart problems.

His endocrinologist sent him to see a cardiologist. During his visit, he experienced chest pain during a stress test, so the cardiologist performed a catheterization the next morning. “After the procedure I was wheeled into recovery, and told that I needed a triple bypass,” DiMarcantonio said. “Upon hearing the news, my wife nearly fell to the floor. I was also petrified.” Against his doctor's advice to immediately undergo surgery, he sought a second opinion.

“I left the hospital and went straight to the Internet, searching for things like ‘best cardiology’ and ‘hospital rankings,’” he said. “I found one consistent repeating result to my search: The Cleveland Clinic.” Although he lives out of state, he promptly set up an appointment with Dr. Edward Savage for a surgical evaluation.

DiMarcantonio went to his appointment thinking he would need bypass surgery. Instead, he got another surprise. “Mr. DiMarcantonio was only 49 at the time. Surgery was not wrong, but not absolutely necessary,” Dr. Savage said. “I walked over and showed his catheterization study to Dr. Fromkin who agreed that a stent might be a better option for him to try before surgery”.

On Christmas Eve, DiMarcantonio was able to leave Cleveland Clinic Florida after Dr. Fromkin had performed a multi-vessel angioplasty with drug eluting stents, including re-opening a chronically occluded coronary artery. “I could not have asked for a better Christmas present,” DiMarcantonio said. “My other doctor was annoyed that I wanted a second opinion. He was using scare tactics. But at Cleveland Clinic Florida, Drs. Savage and Fromkin gave me confidence.”

Dr. Savage said that DiMarcantonio's case highlights what is special about Cleveland Clinic. “Because of the way the clinic is structured, our model of medicine enables a team approach to care,” he said. DiMarcantonio is grateful for the collaborative approach of his doctors. “I can't say enough about Cleveland Clinic. Everyone goes above and beyond. They gave me an alternate route, and I’m very thankful.”


Unique Collaboration of Treatment

Epilepsy

There’s a reason epilepsy patients come from around the world to Cleveland Clinic. The Cleveland Clinic Epilepsy Center is a unique integration of programs in Cleveland, Ohio, and Weston, Florida, providing patients with state-of-the-art resources for diagnosis and treatment, and a highly specialized, multidisciplinary team of physicians.

Epilepsy is a chronic condition marked by epileptic seizures, in which abnormal electrical discharges from brain cells alter the brain's function. Up to 1 percent of the population is affected by epilepsy, making it one of the most common neurological disorders. Since it manifests quite differently among patients, accurate and specific diagnosis is essential to effective treatment.

In order to understand a patient's particular case of epilepsy, Cleveland Clinic Florida features a self-contained, four-bed Epilepsy Monitoring Unit as well as two mobile units. In addition to a round-the-clock staff of specialists, these units feature the latest in noninvasive imaging technology.

“This unique unit allows us to diagnose seizure disorders as well as to design individualized treatment programs that will provide the best possible outcome for each patient,” said Cleveland Clinic neurologist Adriana Rodriguez, MD. The Epilepsy Center features Higher Resolution Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) to gain views of a patient's brain. It also offers Functional MRI (fMRI) to map language and motor functions, and Diffusion Tensor Imaging (DTI) to map connections between areas of the brain.

Once patients are diagnosed, Cleveland Clinic Florida doctors work in cooperation with the epilepsy team at Cleveland Clinic in Cleveland, Ohio, to provide patients with the best possible treatment. “At Cleveland Clinic Florida, we recommend a course of treatment based on an individual’s medical history and needs,” said Dr. Rodriguez. The program brings together epileptologists, neurosurgeons, pharmacologists, dietitians, psychiatrists, and other specialists in order to help patients overcome epilepsy – which many are able to do.

“Most people with epilepsy lead lives essentially unimpaired by their condition,” Dr. Rodriguez said.


A Second Opinion Provides a Second Chance

Blood Cancer

Magda Villegas thought she was out of options. She had been diagnosed with blood cancer, and her doctor told her she wouldn’t live. “My other doctor, at the other hospital, sent me home to die,” Magda says.

Blood cancer, or hematologic cancer, refers to a variety of disorders including leukemia, Hodgkin’s lymphoma, and multiple myeloma. Leukemia is a cancer of the blood and bone marrow that results in an overproduction of abnormal white blood cells, leaving patients at risk for bruising, bleeding, and infections. Hodgkin’s lymphoma is a cancer of the lymph system, which is the part of the immune system that aids proper blood function. It can cause symptoms that include swollen lymph nodes, fever, night sweats, and weight loss. Magda had been diagnosed with multiple myeloma, a cancer of the bone marrow that prevents the marrow from making healthy blood cells.

Although Magda was about to go into hospice care at the recommendation of her doctor, she sought a second opinion from oncologist James Hoffman, MD, at Cleveland Clinic Florida’s Cancer Institute. “We see a lot of patients coming in for a second opinion – people who have received many treatments and have been told they are out of options,” Dr. Hoffman said.

When patients like Magda come to Dr. Hoffman, his first step is to find out what other doctors have tried. “My goal in this circumstance is to get complete records, to go step by step through their prior treatment, and determine what options still remain,” he said. Dr. Hoffman then works with other Cleveland Clinic doctors, such as radiologists and pathologists, to develop an individualized treatment plan. “Complicated cases like Magda's require input from many specialists,” he said. “Being part of a multi-specialty team of physicians who communicate and work together is a huge benefit to our patients.”

Luckily for Magda, there was a class of drugs that her previous doctor hadn't tried—and they worked. Her cancer has been in remission for close to two years. “People who know me think I am a miracle, and I think it's true,” Magda said. “I say Dr. Hoffman is my guardian angel.”

According to Dr. Hoffman, treatments for blood cancer are becoming more effective and more tolerable. “It's a very optimistic time for people with blood disorders and cancers,” he said. “I would encourage blood cancer patients to make sure they are seen at centers with cutting-edge treatments because outcomes are getting better all the time.”

Dr. Hoffman says Magda's story gives hope to other blood cancer patients. “Magda is inspirational,” he said. “This is what we’re striving for—to change people’s lives in this way.”