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Winter 2012

A Courageous Journey

Coronary Artery Disease

When Beverly Lawson recounts her experience with coronary artery disease (CAD), she immediately acknowledges her good fortune. “I’m lucky to be sitting here today,” she said, grateful for the team of doctors at Cleveland Clinic Florida who collaborated to provide her with lifesaving treatment, and helped her overcome reluctance about surgery.

Ms. Lawson’s CAD came as a surprise. She originally sought treatment for leg pain, not heart problems. According to Cleveland Clinic cardiothoracic surgeon Edward Savage, MD, this is common. “A lot of patients who have coronary disease also have peripheral vascular disease (PVD),” he said.

CAD is a narrowing or blocking of the arteries that carry blood to the heart. When blood flow is restricted, the heart may not receive enough oxygen. A heart attack occurs when blood flow is cut off completely. PVD is similar, involving blocked arteries in the lower extremities. These blockages can cause severe pain, especially in the calves.

After investigating Ms. Lawson’s leg pain, Cleveland Clinic primary care physician Paige Morris, MD suggested that she consult with Kenneth Fromkin, MD, Cleveland Clinic Florida interventional cardiologist. Dr. Fromkin conducted a diagnostic test called an angiogram. “The angiogram showed a lot of blockages in her heart arteries and also confirmed the ones in her legs,” Dr. Fromkin said. “I treated her peripheral artery disease (PAD) with stents in the arteries of her legs, and referred her to our cardiothoracic surgeon, Dr. Edward Savage, as I recommended surgery as the best treatment option for her CAD.”

“She had very significant narrowing in all three major distributions of the arteries of the heart,” Dr. Savage said. Because of these blockages, she needed to have coronary artery bypass graft surgery.

But Ms. Lawson refused surgery. “I was just in big-time denial,” she said. “Heart attacks were prevalent in my family, but without symptoms I thought I was fine without surgery.”

About three months later, Ms. Lawson developed numbness in her right arm. This, and a persistent feeling of light-headedness, helped to change her mind about surgery. “I knew I was seriously at risk, and finally agreed to the surgery” she said.

The results of her surgery couldn’t have been better. Ms. Lawson now encourages skeptical patients to give treatment a chance. “Cry and complain if you must, but don’t give up! Life is truly a gift—make the most of it.”

Innovative Treatments Provide Hope

Lung Cancer

When you meet Marisol Stanham, you’d never guess she has been battling lung cancer. She looks healthy, and her voice is full of optimism. Her experience highlights the power of innovative cancer therapies.

Lung cancer occurs when abnormal cell growth destroys healthy lung tissue. When these abnormal cells accumulate, they form a tumor. As the tumor grows it can impair lung function, making breathing difficult. Lung cancer is the leading cause of cancer mortality in the United States.

Rogerio Lilenbaum, MD, oncologist, and Chair of the Cancer Institute at Cleveland Clinic Florida, said Ms. Stanham’s case is unusual because she was diagnosed quite young, at age 45. “The other unique thing about her case is that she never smoked. Smoking is a factor in 90 percent of all lung cancer cases, so Ms. Stanham fell within the other 10 percent”, according to Dr. Lilenbaum.

“One of the first signs that I had was a cough,” Ms. Stanham said. “I went to my primary care physician and he said, ‘Let’s just do an X-ray.’ And that’s when it all began. They saw something like a shadow on one of my lungs.” Other lung cancer symptoms may include shortness of breath, chest pain or coughing up blood.

“The beauty of Cleveland Clinic is the multidisciplinary approach. We collaborate with a number of specialists on our team,” Dr. Lilenbaum said. Cleveland Clinic Florida brings together pulmonologists, pathologists, oncologists, thoracic surgeons, radiologists and pain management specialists to treat lung cancer in the most effective way. Patients benefit from the wisdom of this collaborative effort, as well as the latest diagnostic and therapeutic options that are available today.

“Ms. Stanham has been treated with the most innovative drugs that we have had for lung cancer recently,” according to Dr. Lilenbaum. “Her disease is under control.”

“When I spoke with Dr. Lilenbaum, after I heard his opinion, it gave me a lot of confidence,” Ms. Stanham said, “Cleveland Clinic Florida has made my life livable, enjoyable…it makes you realize how blessed you are.”

Diagnostic Tool Can Jump-start Parkinson’s Treatment

DaT Scan Testing

Cleveland Clinic Florida is offering the first and only diagnostic testing tool to identify neurodegenerative movement disorders like Parkinson’s disease. Often called a DaT Scan, this tool uses SPECT scan imaging along with a radiopharmaceutical dye to detect dopamine transporters (DaT) in the brain. It has recently been approved by the FDA.

“This revolutionary tool will enable us to definitively confirm a diagnosis and differentiate essential tremors such as the involuntary shaking of the hands, head and face from tremors due to Parkinsonism,” said Nestor Galvez-Jimenez, MD, chairman of the Department of Neurology at Cleveland Clinic Florida.

Parkinson’s disease and other Parkinsonian syndromes are neurodegenerative movement disorders that affect nerve cells in the area of the brain responsible for movement, the basal ganglia. When the body is healthy, the cells in this part of the brain produce dopamine, a chemical that controls emotion and helps the body move smoothly and fluidly. Parkinsonian syndromes cause these cells to die more quickly, leading to a lack of dopamine in the brain.

Parkinson’s disease is usually identified by four main components: slowness, stiffness, mild tremors and a shuffling or unsteady gait. However, according to Dr. Galvez-Jimenez, these identifiers can be subtle and easily mistaken for other problems, including essential tremors, anxiety and the normal aging process. Because of this, Parkinsonian syndromes have been difficult to diagnose accurately.

“In the past, the physician might have felt uncertain about the diagnosis of Parkinson’s,” said Dr. Galvez-Jimenez. “The physician might have said something like, ‘We’ll follow up in three months and see.’” This test allows physicians to bypass the “wait-and-see” process, making it possible to confirm the diagnosis earlier.

“We will be able to diagnose patients sooner and prescribe medications to alleviate their symptoms and improve their quality of life,” Dr. Galvez-Jimenez said. “The DaT Scan allows us to open the discussion with our patients. Together, doctor and patient can take the first steps toward treatment.”

Use Your Head for Safer Sports

Sports concussions

For parents, coaches and athletes, concussions can be an alarming subject. Often considered the invisible sports injury, a concussion may show subtle signs and symptoms. Concussions can also be difficult to prevent, especially in collision sports like football and ice hockey, according to Cleveland Clinic Florida sports medicine specialist David Westerdahl, MD, team physician for the Florida Panthers NHL hockey team.

A concussion is a short-term brain injury caused by a player collision or blow to the head. “It’s a complex neurologic process affecting the brain,” he said. “After a concussion, there are metabolic changes to the brain.” These changes cause symptoms that can include headache, nausea, balance problems, blurred or double vision, sensitivity to light and noise, depression, fatigue or unexplained sleepiness, trouble concentrating, and changes in sleeping patterns.

Athletes who suffer a concussion are three to five times more likely to suffer another concussion. “Multiple concussions can result in longer duration of symptoms, memory problems and communication difficulties. They can also increase the risk of other mood disturbances,” Dr. Westerdahl said.

That’s what makes recognition and treatment of concussions essential. “It’s important for team medical personnel to know their players as well as possible, so they can recognize when someone ‘isn’t right,’” he said. The treatment for concussions is complete mental and physical rest. Athletes should not return to the playing field until they are free of symptoms and have been evaluated by a physician.

At Cleveland Clinic, doctors use Immediate Post-Concussion and Cognitive Testing, also known as ImPACT, for this kind of evaluation. The test is first administered during the pre-season, measuring the athlete’s baseline cognitive functions to develop a point of comparison. Later, if the athlete suffers an injury, the ImPACT test can be given again—this time to determine if a concussion exists and how severe it might be.

With its outstanding concussion management program, Cleveland Clinic Florida offers peace of mind. “We offer a multidisciplinary team of sports medicine fellowship-trained physicians, neurologists, athletic trainers and physical therapists,” said Dr. Westerdahl. “Our physicians have direct experience treating high school, collegiate and professional athletes for concussions.”