Bariatric Surgery Program: Losing the High Risks of Obesity

For over three decades, Jose Rodriquez knew his weight, sometimes topping 375 pounds, put his health at great risk of heart disease, stroke, diabetes, and other serious health conditions. He sought bariatric, or weight loss surgery, more than once. But physicians said his other health issues made surgery too risky. That changed when he moved to Miami.

“From the first seminar I went to at Cleveland Clinic Florida’s Bariatric Institute, I fell in love with everyone in the program,” he says with a wide grin. “The surgeons and staff, the support, the entire program — everything about Cleveland Clinic Florida put me at ease.” They told him they could help, and he now considers the date of his surgery: February 26, 2013, “my new birthday,” he calls it. Now three years later, the 50-year-old just completed his first-ever 5K run “without even breaking a sweat,” when before he couldn’t walk across a room without gasping for air.

Results like this require a lifelong commitment from both the patient and the bariatric team, says Samuel Szomstein, MD, a bariatric surgeon at Cleveland Clinic Florida. We offer a comprehensive range of services for our patients’ for life.

And the team’s experience matters. Research shows that patients have greater success with high volume surgery centers. At Cleveland Clinic Florida, our team has treated over 6,000 patients with bariatric surgery.

“For all of our patients, the rewards of this program are remarkable,” says Dr. Szomstein. “But for those who have other serious health conditions, it can be life-saving.”

Still a regular member of the bariatric support group, Mr. Rodriquez continues to steadily lose weight and has dropped from a BMI of 44 to 33. “I thank God for placing this group in my path and the team for saving my life,” he says.


New Program Holds Promise for Early Lung Cancer Cure

Lung cancer is the No. 1 cancer killer. But physicians at Cleveland Clinic Florida have the expertise and technological resources in place, in order to turn that tide.

With a specially trained physician using highly advanced equipment, we’re now able to diagnose lung cancer at the earliest stages ever possible—without the need for surgery.

“We’re using computer-guided technology to reach even tiny areas deep inside the lungs, to get samples of small areas that might be early cancer. And it’s a 45-minute outpatient procedure, instead of surgery,” says Sajive Aleyas, MD, a Cleveland Clinic Florida pulmonologist. Dr. Aleyas specializes in interventional pulmonary medicine, or the diagnosis and treatment of lung conditions. “This is a game-changer, because it’s much easier to cure lung cancer when we catch it early.”

When a screening exam using CT imaging finds a nodule or tissue that might be cancer, Cleveland Clinic Florida’s specialists use electromagnetic navigation bronchoscopy, or ENB, to safely reach this tissue. ENB utilizes computer navigation–much like a GPS in a car–to guide a tiny bronchoscope, cameras and other tools through the lung’s natural pathways to get a tissue sample. ENB requires advanced training and experience, and Dr. Aleyas is one of the few physicians in Florida who is fellowship trained as an interventional pulmonologist.

“ENB allows us to reach up to 85 percent of nodules under two centimeters (or about 8/10ths of an inch), compared to 20 percent before,” Dr. Aleyas says. “And for patients who are not healthy enough to undergo surgery, it can be their only option to confirm they have lung cancer so we can begin treatment.”


Cutting Colon Cancer Out of the Family Tree

About five of every 100 people with colon or rectal cancer have the disease because of a gene passed down through their family. Researchers at Cleveland Clinic Florida are investing in specialists and resources to identify these families at risk, with the goal of preventing inherited colorectal cancer from ever developing at all.

The focus is on familial adenomatous polyposis, or FAP. “Familial” means inherited, or passed down through families. Adenomas are specific types of polyps that can become cancer. People with FAP have a 100 percent chance to get colorectal cancer, and parents with FAP have a 50/50 chance of passing it down to their children.

“We want to get the word out about our program, so we can let as many people as possible know if they’re at risk, educate others in their family and offer each one the latest medical care, education and support,” says Giovanna DaSilva, MD, a Cleveland Center Florida colorectal surgeon and researcher.

The centerpiece of the program is the Jagelman Registry, a database of patient information of families with FAP. Using this data, physicians at Cleveland Clinic Florida work with teams elsewhere to research the condition and share the latest medicines and other treatments. Besides colon polyps, FAP can also cause growths or cancer in the stomach, pancreas, bone and other areas. The earliest preventive care ranges from medicines that stop the growth of polyps to simple colonoscopies to remove those that have not yet become cancer.

“Using the registry, we’re able to let patients know what screenings they should have and how often. That can save their lives and those of their family members,” Dr. DaSilva says. “We’re definitely very proud of our program, and we’re looking forward to helping more and more patients through it.”


New Heart Transplant Program Aligns Life-saving Care With Local Patients’ Needs

Since the age of 15, Peter Lividini has had a rare heart condition that in time would require a heart transplant. Fortunately for Mr. Lividini, when that time came early in 2015, Cleveland Clinic Florida had already established a program that brought the highly specialized care he needed almost to his doorstep.

 

“I would have had to move from Florida to Ohio to wait for a transplant at the main Cleveland Clinic campus,” says the Fort Lauderdale resident, now 36. Transplant centers require patients to live close by. “But it was like a miracle to learn we now have the same program here, close to home and my family, right when I needed it.”

Some patients with serious heart conditions such as congestive heart failure or cardiomyopathy (a disease of the heart muscle) need a heart transplant as soon as they’re diagnosed, says Viviana Navas, MD, a cardiologist and medical director of heart failure, transplantation and mechanical circulatory support at Cleveland Clinic Florida.

Others can wait a decade or longer, and during this waiting period, Cleveland Clinic Florida’s team provides specific tests and medical support that are not available at all facilities. This ensures that they remain healthy enough for the transplant. That level of care and experience was important to Mr. Lividini, whose heart failure was caused by a rare type of muscular dystrophy called Desminopathy.

Last April, just months after the first heart transplant was performed at Cleveland Clinic Florida, Mr. Lividini received his new heart. Along with the strong support of his family, he credits his medical team for his new chance at life.

“Before the transplant, I was dying. The transplant team gave me an unbelievable new start,” he says. “The best way to explain my appreciation for them is to say that Cleveland Clinic Florida is family to me, now.” And while he understands that living with Desminopathy will be a challenge, he is sure that Cleveland Clinic Florida will be there to help him navigate the road ahead.


Getting the Right Diagnosis for Rare Diseases of the Brain and Nerves

For conditions that affect the nervous system and brain, the wrong diagnosis can lead to treatment that can actually cause harm. That’s the case with a rare condition called NMO, short for neuromyelitis optica, and also called Devic’s Disease. Symptoms are similar to those of multiple sclerosis, or MS.

So physicians at Cleveland Clinic Florida are helping educate both physicians and patients about NMO to ensure they accurately address the sometimes-devastating symptoms, which include blindness and paralysis.

“It’s not uncommon for patients with NMO to be misdiagnosed as having MS. And sometimes it is only diagnosed properly after having undergone several failed treatments for MS,” says Karen Nater Pinero, MD, a Cleveland Clinic Florida neurologist. “But NMO is a completely different disease, and treatments for MS can make them worse.”

With NMO, the immune system attacks the person’s body, destroying cells in the eyes and spinal cord. As with MS, symptoms include weakness or paralysis, and loss of bladder or bowel control. And though both conditions can cause lesions, or “scars,” on the spinal cord and brain, the location is slightly different. Though there is no cure today, symptoms can improve with the right care. Without it, damage can be permanent.

About five years ago, Cleveland Clinic Florida physicians began using a screening test that can identify NMO and rule out MS, but even this test isn’t accurate about a third of the time, Dr. Nater Pineiro says. “It takes careful consideration, knowledge of the most recent research, and retesting to come to the right diagnosis.”

She encourages people with NMO or those with MS who aren’t improving to look for a medical center with specialists in diagnosis, prevention and long-term recovery. “That’s what we have here,” she says. “And our patients appreciate that it’s all in one place.


Advanced Cancer Technology Calls for a Strong, Experienced Team

When a medical center brings patients advanced cancer-fighting tools like the Varian Edge™ Radiosurgery System, the investment should extend well beyond the technology. At Cleveland Clinic Florida, the commitment involves a great investment in people who understand how to harness the power and precision of radiosurgery so patients gain the most benefit. (“Radio” refers to surgery using radiation, versus traditional surgery.)

“People don’t realize the complexity involved in delivering radiation with powerful equipment like the Varian Edge™,” says Mihir Naik, DO, a radiation oncologist at Cleveland Clinic Florida. “Having the right team in place so we can accurately target cancerous tissue while protecting healthy tissue, is a very important part of what we do for each patient.”

Physicians use the Varian Edge™ for selected patients with cancer of the brain, spine, lung, liver and prostate. Its advantages include the ability to focus very high doses of radiation precisely on the cancer. This allows the course of treatment to be shortened, sometimes by weeks or even months. “Achieving the necessary precision takes a large team of experienced professionals,” Dr. Naik says, so there are multiple specialists, each responsible for a particular step in care. “As a patient, you might see some of these experts during your treatment,” he says, “but typically not all of them. However, they all perform a very important function of your care.”

For example, the first step in each patient’s plan is a meeting of Cleveland Clinic Florida’s “tumor board,” which is comprised of specialists who discuss treatment options, and decide on the best choice for each individual patient. For Varian Edge™ treatments, licensed radiation therapists, dosimetrists and medical physicists work with physicians to develop customized radiation treatment plans and perform frequent quality assurance ensuring that radiation is delivered precisely. This level of attention continues in real-time throughout a patient’s actual treatment session.

“When treating brain lesions, millimeters matter,” says Badih Adada, MD, neurosurgeon at Cleveland Clinic Florida. “The Varian Edge™ has intricate checks and balances to make sure we’re precisely targeting the area to be treated. And during treatment, we can scan and rescan to make sure we remain on target.”

“Radiation oncology is a team sport, and every member of our team is excellent at what they do,” Dr. Naik says. “We’re experienced in using advanced technology, so our patients can get the care they need, then return home or to work as quickly as possible.”