Cutting-Edge Nursing: Annette Sereika on the Challenges and Rewards of an Oncology Nurse

Wednesday, May 06, 2015 10:27 AM comments (0)

  Annette SereikaAnnette Sereika, APRN at the Kellogg Cancer Center and NorthShore Center for Personalized Medicine, comes from a family of nurses; in fact, you could say nursing is in her genes. The natural progression of her career, from NorthShore’s Neuro-Oncology Clinic to the Center for Personalized Medicine, reflects her passion for providing the best possible care and acquiring in-depth knowledge about the cutting-edge treatments that could dramatically improve outcomes for her patients. 

NorthShore is proud to have been the professional home Annette chose at the outset of her career and is honored that she has stayed with us. This National Nurses Week, we extend our thanks to Annette and every single one of our nearly 2,500 NorthShore University HealthSystem nurses.

Annette shares her story, from what brought her to NorthShore’s Kellogg Cancer Center to the rewards of caring for her patients:

When did you know you wanted to be a nurse? Was there a particular moment or experience that led to you this area of the medical field? 
There was no “lightning bolt” moment for me. Actually, I can’t remember a time when I did not want to be a nurse.  Providing healthcare seems to be in my “genes”—three of my sisters are in healthcare-delivery fields, as well as two aunts and several cousins.

Why oncology as a specialty?
It’s more like oncology chose me. I was given the opportunity to work in the Kellogg Cancer Center (KCC) in the early 1980s.  At that time, I was a young nurse looking for a change and a challenge.  A colleague who worked in the KCC recommended I interview for an open position. I still remember the group interview so clearly.  That was 1984 and I never left.

I learned quickly that this is a very special place to work.  The KCC exemplifies what it means to have a “team approach” to patient care, where physicians, nurses, pharmacists, psychosocial support and the administration all work together to provide the best comprehensive care possible.  

Why was continuing your education by becoming a nurse practitioner with advanced practice certification in oncology so important to you?
I graduated from Loyola University with my BSN in 1981 but science and medicine have evolved so much since then.  I wanted to know more so that I could be a part of those changes in healthcare, especially in the field of oncology. 

Having an advanced degree as a nurse practitioner has provided me with more autonomy as a healthcare provider, but, it’s my years of direct-to-patient care that has given me an appreciation of the important role everyone plays in care.  My advanced degree has also enhanced my role as an educator, not just for my patients but for staff too.  I’m involved in the recent launch of the Personalized Medicine education module that is available to all clinicians on DevelopU.

Why have you now decided to work more closely with NorthShore’s new Center for Personalized Medicine?
Oncology is one of the first fields of medicine to recognize the role genetics plays in preventing, diagnosing and treating diseases.  For many years I worked in NorthShore’s Neuro-Oncology Clinic within the KCC.  I was involved in several clinical trials that used a patient’s genetic information to determine their treatment options, which was different from previous trials where everyone received the same therapy.  This was life changing for many of my patients; the ability to provide molecular analysis of a patient’s brain tumor played a huge role in determining the best treatment options and delivery strategies, which improved responses and minimized side effects.  For one young woman, molecular testing helped us create a treatment strategy that minimized her side effects.  This allowed her to continue her work as a nurse and raise her family. Similarly, another patient was able to continue to exercise throughout her therapy program and ran a marathon shortly after its completion. 

What impact has this new personalized treatment had on patient outcomes?
NorthShore’s ability to provide genetic and genomic testing has transformed our ability to tailor treatment decisions for patients not only in oncology but in other fields like cardiology, endocrinology, and neurology.  In March of this year, NorthShore launched the first pharmacogenomics clinic in the Chicago area.  The specialists in this clinic use genetic testing to provide information about a patient’s response to certain medications, including an adverse response. This allows doctors to provide the right drug at the right dose the first time. Our patients are medically savvy, and many are participating in NorthShore’s Genomic Health Initiative as they recognize the need for “cutting-edge” research to advance our understanding in this field.

What do you find most rewarding about your job?
I have met incredible, inspirational people, both patients and colleagues that have had a profound impact on my life. By far, the most rewarding aspect of my job is the relationship I develop with patients and their families.  And while in some cases the treatments provided don’t change the course of the disease, I’m convinced that the personalized, compassionate care we provide enhances their quality of life.

What do you find most challenging? 
Unfortunately the economics associated with healthcare are often very frustrating.  The costs of medical care and some medications can be thousands of dollars monthly and many people don’t have the insurance coverage or the finances for that.  Also, many insurances companies are still investigating their responsibility for coverage on some of the “cutting edge” areas of medicine. I spend a lot of time obtaining authorizations and appeals for recommended treatments.

What would you tell other men and women contemplating a career in nursing?
I think a career in healthcare is an excellent choice and the nursing field has a wide variety of possibilities: inpatient care, outpatient care and research are all available within many medical disciplines.  There are many opportunities for advancement.  Most importantly, as a nurse, you have the chance to make an important and meaningful impact on the lives of others. I am very proud to say I am a nurse.

This National Nurses Week, honor and recognize a NorthShore nurse by sharing your story or making a gift that will go to the Nursing STARS program at NorthShore. Find out more by clicking here.  

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Foodborne Illness: What Are the Symptoms and When Should You See a Doctor?

Wednesday, April 29, 2015 12:49 PM comments (0)

foodborne illnessFoodborne illness is in the news, from listeria recalls across the country to botulism in Ohio. Foodborne illness should always be taken seriously. Prevention is key—cooking meat properly and ensuring that raw food is thoroughly washed before serving—but knowledge of symptoms and treatment options can keep foodborne illnesses from becoming much worse. 

Jerrold B. Leikin, MD, Medical Toxicologist discusses five food-borne bacterium, including symptoms and required treatments:

Listeria is a bacterium that is found in soil, water and animal feces. The bacteria can find its way into food, however, typically via raw vegetables that have not been properly cleaned, animal protein, unpasteurized milk or foods that include unpasteurized milk and some processed foods like soft cheese and deli meats.  Recently, outbreaks due to contaminated ice cream, cole slaw, alfalfa sprouts and  hot dogs have occurred. 
Symptoms: Exposure to the listeria bacteria can cause fever, muscle aches, diarrhea and nausea. Symptoms can develop as quickly as a few days after exposure or take as long as two months to appear. If the infection is more severe and spreads to the nervous system, symptoms could also include headache, stiffness in the neck, confusion or inability to remain alert, loss of balance and convulsions. These symptoms could indicate bacterial meningitis, which is life-threatening, and will require immediate medical attention.
Treatment: If you have eaten food that has been recalled because of a concern over listeria and believe you are experiencing any of the symptoms listed, seek medical attention as soon as possible. If you are pregnant, see your doctor immediately as even a mild infection can cause severe harm to your baby. 

Salmonella is most commonly found in meat and eggs but raw vegetables can also be contaminated if they are handled by unwashed hands.  If meat and eggs are undercooked or vegetables are not properly washed, salmonella can cause mild to severe gastrointestinal illness.  Unpasteurized milk can also harbor salmonella.
Symptoms: Those who have salmonella poisoning will run a fever and experience diarrhea and abdominal cramping. Symptoms usually develop 12 to 72 hours after exposure and symptoms can last from four to seven days.
Treatment: Most people will not require treatment. Babies and older adults who have weaker immune systems should be carefully monitored as dehydration could cause more severe reactions. 

Escherichia coli (E. coli) is harmless in some cases and can cause serious illness in others. E. coli exposure could result from the consumption of contaminated raw vegetables and undercooked ground beef.
Symptoms: Diarrhea and abdominal cramping can occur. In particularly virulent strains, cramps are accompanied by bloody stools and vomiting. Symptoms are generally more severe for young children and older adults and, while rare, both groups have a greater risk of developing a form of life-threatening kidney failure known as hemolytic uremic syndrome.
Treatment: There is no medication that can treat an E. coli infection. Less severe infections will merely require rest and fluids. Anti-diarrheal medication is not recommended because it slows digestion, which will ultimately remove the infection from the body. For those suffering an infection from a more severe strain (called enterohemorrhagic or E. coli 0157:H7) that can cause kidney problems, hospitalization will be required. 

Botulism is a rare but very serious illness that is caused by consuming food contaminated with the botulinum toxin. Unlike other foodborne illnesses that affect mostly the gastrointestinal system, botulism attacks the nervous system causing paralysis from top to bottom, starting with the eyes and face.  It is usually found in home-canned foods, poorly preserved meat, marine products, or liver pâté.  Infant (intestinal) botulism can occur in babies under one year old and has been correlated with ingesting spores found in honey.  Initial symptoms of infant botulism include lethargy, poor feeding, weak cry, constipation, and progressive weakness.  
Symptoms: The symptoms of botulism can be severe.  In addition to paralysis, other symptoms include: fatigue, vomiting, nausea, difficulty swallowing, blurred or double vision, muscle weakness and lack of fever.
Treatment: Botulism must be treated and it must be treated quickly. If identified early, victims can be treated with an antitoxin that prevents the infection from spreading into the bloodstream. If not treated early, botulism can result in permanent paralysis or even death. 

Shigella is a highly infectious bacterium, most commonly found in potatoes, milk products, tossed salads, stewed apples and raw oysters.  Outbreaks of food poisoning usually occur in the summer.
Symptoms: Acute onset of fever, abdominal cramping and a large volume of very watery diarrhea can occur within 3 days of exposure.  The fever usually resolves within 48 hours; however the diarrhea can turn bloody.  Reactive arthritis can occur after diarrhea resolves, but rarely.  
Treatment:  Most people will not require specific treatment.  Babies and the elderly should be carefully monitored for dehydration.  Anti-motility (anti diarrhea) agents are usually avoided due to its potential for worsening the infection in the colon. 

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Arthritis: Pain Management, Treatment and More

Tuesday, April 28, 2015 4:40 PM comments (0)

dr branderThe pain of arthritis can range from mild to debilitating but there are treatments that can help manage it.  Victoria Brander, MD, Physical Medicine and Rehabilitation, answers common questions on how to cope with arthritic pain, from how to slow the advance of arthritis and manage pain non-surgically to when surgery might be the best option:  

Could knee pain after exercise be arthritis? 
First, it’s important to get a diagnosis. Knee pain can be from arthritis, inflammation of soft tissues, or even from hip or spine problems. Start with ice, rest and an anti-inflammatory cream. If you can tolerate these, the next steps would be to start an anti-inflammatory over-the-counter medication like ibuprofen or naproxen. Depending on how long the pain has been going on and whether it resolves itself, see a physician who will likely order an X-ray. If it is arthritis, physical therapy, an exercise program and other interventions, like injections, would help. 

What is left for patients who have tried prescriptions, physical therapy, chiropractic work, acupuncture and supplements to manage pain? 
Chronic pain is very difficult. It usually takes a combination of interventions: medication to restore sleep, pain medication, structured exercise/physical therapy, centrally acting medication to reduce brain "hypersensitivity" to pain, stress management, etc.

It’s also important for a patient and physician to form a relationship of trust, which leads to better patient compliance, a lessening of fears and better outcomes. Many patients with chronic pain due to arthritis are "kinesthesiophobic,” or have fear of movement, so they need to trust that their doctors are not going to hurt them with recommendations of exercise and increased mobility. However, the single best predictor of outcome is a patient's own belief in his or her abilities to overcome difficulties. We encourage a positive belief system through education in classes and by example—patients seeing other patients with the same problems undergoing the same treatment.

Can exercise make arthritis worse? 
Exercise is the single best treatment for arthritis. It is the only treatment ever shown to change the "natural history,” or deterioration, caused by arthritis. The type of exercise would depend on the individual patient and the joint affected. For knee arthritis, exercises should focus on strengthening the quadriceps, gluteal and abdomina muscles, as well as working on flexibility of the hips and the knees in order to normalize the pattern of walking. A bicycle is a great exercise for hip and knee osteoarthritis. I strongly believe that yoga is the best choice for exercise classes for almost all patients with arthritis.

Should you wait until pain restricts your activity to consider surgery or have it done before arthritic pain becomes severe?
That's a great question. You want to wait until pain is bad enough that it starts to limit your activities, but not so long that you are disabled. People with disabling pain have a more difficult time recovering from surgery. It’s very important to reduce your joint pain before surgery with medications or injections so that you can begin an exercise regimen preoperatively. I like to send my pre-operative hip and knee surgery patients to physical therapy for customized exercise. But, I would say that most people know deep down inside when the time is right for surgery.

What can be done for those suffering from arthritis in their hands and fingers? 
Unfortunately, there is no known treatment that slows the "natural history" of arthritis of the hands. I sympathize because I have arthritis in my hands too! The best strategies: 1)Keep your hands strong and knuckles flexible; 2) Use a brace for the thumb, especially at night to reduce movement and inflammation; 3) Try a topical anti-inflammatory cream—such as diclofenac cream—up to 4 times a day; 4) Take adequate vitamin D (2000 international units a day); 5) Eat an anti-inflammatory diet, which means avoiding sugars, alcohol and carbohydrates); 6) Keep your hands warm in the winter (I use a paraffin—hot wax—bath for my hands and then follow that with stretching); 7) And finally, use modified/built up handles on your kitchen tools. 

Is long-term use of an over-the-counter anti-inflammatory okay?
For many people, yes. I suggest to my patients that if they are taking an anti-inflammatory every day, they need to come in for a visit every six months so we can monitor their blood pressure, look for leg edema, question them about heartburn and get blood tests. Patients who have diabetes, disorders of the kidneys or liver, heart disease, reflux, stomach ulcers, or those who are very frail or elderly, on blood thinners, and those on multiple medications are at high risk for complications and need to re-consider taking daily anti-inflammatories. 

 For more information on the NorthShore Arthritis Center click here

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Parkinson's Disease: Symptoms and Progression

Friday, April 24, 2015 2:34 PM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Demetrius Maraganore, MD, and Ashvini Premkumar, MD

symptomsIs it possible to detect PD before symptoms begin?

There is no established method of detecting Parkinson’s disease before symptoms begin.  Because patients with Parkinson’s disease may lose their sense of smell decades before the onset of their movement disorder, some investigators have explored the use of smell testing as a method of detecting Parkinson’s disease in at-risk subjects (e.g., persons who carry a rare gene mutation known to cause Parkinson’s disease). Persons can lose their sense of smell for many unrelated reasons though (e.g., following an upper respiratory infection, head trauma, or if they smoke). Loss of smell can precede other brain degenerations such as Alzheimer’s disease, so smell testing lacks the specificity needed for a predictive test.

A more promising approach is brain imaging using a radiopharmaceutical called DATSCAN. This is a compound that is injected into a vein and that binds to the endings of dopamine nerve cells in the brain. In Parkinson’s disease, dopamine nerve cells degenerate; hence, there is less binding of DATSCAN. The uptake and binding of DATSCAN can be measured using a single photon emission computerized tomogram or “SPECT” camera.  We are currently conducting a study at NorthShore to determine if persons with mild to moderate traumatic brain injury, who are at an 11-fold increased risk for Parkinson’s disease, have lower DATSCAN binding than persons without a history of brain injury. This study would demonstrate that it’s possible to detect Parkinson’s disease in at-risk subjects before symptoms begin. 

DATSCAN could prove useful as a method to develop asymptomatic Parkinson’s disease in at-risk subjects who could then be prescribed treatments or lifestyle changes that might delay or possibly even prevent the onset of Parkinson’s disease symptoms.  My research associate Dr. Ying Wu is also exploring the use of automated MRI brain measurements in the same brain injury population to see whether MRI may prove effective in detecting preclinical Parkinson’s disease changes in at-risk subjects.

Are PD symptoms or outcomes different between men and women? Between races?

My research collaborators and I have conducted several studies of gender differences in Parkinson’s disease. At every age men are 1.5 times more likely to develop Parkinson’s disease than women. We observed no convincing difference in survival for men and women with Parkinson’s disease. While there was no difference in motor outcomes, we observed that the risk for dementia was greater in men than in women with Parkinson’s disease. It's possible that estrogen protects against dementia in women.

My collaborators and I observed no important differences in the rates of Parkinson’s disease worldwide, and I’m not aware of any convincing data to suggest that symptoms of Parkinson’s disease or its outcomes differ according to race or ethnicity.

What are some of the later complications of Parkinson’s disease?

Typically we associate Parkinson’s disease with movement disorders. As the disease progresses, patients may develop balance difficulties that result in falls. As a result, patients become increasingly dependent on assistance in walking. For example, they may need a cane or a walker or someone to walk with them.  As the movement disorder progresses more, patients may be entirely unable to stand or walk even with assistance

Parkinson’s disease is not just a movement disorder though. About one in three patients develop a significant decline in memory and mental faculties, or what we call dementia.  Both falls and dementia are dreaded late complications of Parkinson’s disease because they are resistant to medical or surgical treatments and because they carry an increased risk for nursing home placement and even death. Predicting falls and dementia as late complications of Parkinson’s disease is a research priority of the Department of Neurology at NorthShore and a current focus of my research.

Is there a way to slow or halt the progression of PD?

There is no proven method of slowing or halting the progression of Parkinson's disease. Treatments that have been studied and that failed to provide evidence of neuroprotection are: selegiline, vitamins E and C, pramipexole, ropinerole, and COQ10.  There is some statistical evidence that carbidopa/levodopa therapy may slow motor progression in Parkinson's disease, but the benefits are trivial.

Azilect is being promoted as a neuroprotective agent, but it’s dubious because the beneficial effects were observed at smaller and not higher doses. The drug is also very expensive and prone to multiple drug-diet and drug-drug interactions. At best, the benefits are nominal. A recent medical advisory panel to the FDA voted 17 to 0 that Azilect should not be approved as a neuroprotective therapy in Parkinson's disease.

Inosine dietary supplementation, to increase blood uric acid levels, may be neuroprotective; however, it may also increase the risk for heart disease, stroke or dementia. There is some evidence that vitamin D deficiency is a risk factor for Parkinson's disease; however, there are no clinical trials to suggest that vitamin D therapy slows the progression of Parkinson's disease. Similarly, observational studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) or cholesterol lowering medications (statins) are associated with a reduced risk for Parkinson’s disease, but clinical trials evidence of neuroprotection is lacking. There are some early clinical trials of the calcium channel blocker isradipine, which may have neuroprotective effects in animal models of Parkinson's disease. Though, the animal models of Parkinson's disease are not always informative, and some calcium channel blockers can actually cause reversible parkinsonism.

One big hope on the near horizon is therapies targeting the alpha-synuclein protein in Parkinson's disease, including a vaccine that is in early phase clinical trials.  However, while genetic studies have indicated that alpha-synuclein is neurotoxic prior to the onset of Parkinson’s disease symptoms, my research team recently provided genetic evidence that alpha-synuclein may be neuroprotective late in the disease process. So it’s unclear if therapies targeting alpha-synuclein in Parkinson’s disease will be effective and safe. 

Recent studies have suggested that exercise might slow the progression of Parkinson’s disease. Apart from exercise, I have no recommendations regarding neuroprotection at this time.

Once dementia starts is there anything that can be done to reduce the loss of memory?

There are certain “cognitive enhancing” medications that may be useful in improving cognitive symptoms and slowing the progression of dementia in patients with Parkinson’s disease. These include a class of drugs entitled cholinesterase inhibitors (rivastigmine, galantamine, donepezil). The Exelon patch in particular was specifically studied in Parkinson’s patients and obtained FDA approval for treatment of Parkinson’s related dementia. Memantine, an NMDA receptor antagonist, has been FDA approved for treatment of Alzheimer’s dementia; however, in clinical practice, it has also been found to be helpful in certain patients with Parkinson’s disease related dementia. In addition, nonpharmacological interventions including exercise, social stimulation, and cognitive rehabilitation can be helpful in the treatment of dementia in Parkinson’s disease.

Apart from genes, are there any environmental risk factors for PD? 

My research team was funded by the National Institute for Environmental Health Sciences for more than ten years to study both genetic and environmental risk factors for Parkinson’s disease. We found that pesticide exposure, both occupational and gardening-related, was associated with a two-fold increased risk for Parkinson’s disease. In particular, exposure to herbicides carried an increased risk. Of the herbicides recalled by our study subjects, the one most significantly associated with Parkinson’s disease was 2,4-Dichlorophenoxyacetic acid, a major component of Agent Orange. There have been reports that Vietnam War veterans are at an increased risk for Parkinson’s disease. Pesticides may contribute to an increased risk for Parkinson’s disease by causing the alpha-synuclein protein to misfold and form toxic accumulations within vulnerable nerve cell regions.

My research team also observed that head trauma may be a risk factor for Parkinson’s disease. A closed head injury that produced loss of consciousness or that required hospitalization was associated with an 11-fold increased risk for Parkinson’s disease.  Head trauma may contribute to an increased risk for Parkinson’s disease by causing an acute spike in alpha-synuclein levels.

While my research team observed no evidence for an interaction of pesticide exposures and alpha-synuclein gene variants, a research team from California recently reported an interaction of head trauma and alpha-synuclein gene variants in Parkinson’s disease. Currently, my research team at NorthShore is conducting a brain imaging study of mild traumatic brain injury to determine if there are Parkinson’s disease-like abnormalities in the brain scans of persons exposed to head trauma, even in the absence of symptoms of Parkinson’s disease. We will also consider the interaction of traumatic brain injury and alpha-synuclein gene variations in that study.

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Braving the Great Outdoors: Tips for Combating Seasonal Allergies [Infographic]

Tuesday, April 14, 2015 4:26 PM comments (0)

For the estimated 30% of Americans who suffer from seasonal allergies, increased levels of pollen and mold common in spring can bring on symptoms like sneezing, congestion, runny nose and itchy, watery eyes. In other words, spring is in the air—literally. But, don’t let that keep you inside this season.

The experts at NorthShore University HealthSystem compiled some top tips and simple allergy remedies into our seasonal allergies infographic. This year don’t just brave the great outdoors enjoy them. 

allergy infographic

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Q&A Mia Boelen: Parkinson's Disease Physical Therapist

Monday, April 13, 2015 11:22 AM comments (0)

ParkinsonsMiriam “Mia” Boelen, Physical Therapist at NorthShore and author of “How to Live Well with Parkinson’s: Advice from a Physical Therapist” and “Health Professionals Guide to Physical Management of Parkinson’s Disease,” discovered her passion straight out of high school. After visiting an uncle who had been diagnosed with Parkinson’s disease 10 years earlier, she knew that helping people in similar situations was what she wanted to do with her life.

Mia tells us why physical therapy is such an important part of Parkinson’s disease treatment and shares stories of success that she attributes fully to the strength and determination of her patients:

How long have you been working as a physical therapist?
I have been a physical therapist since 1978 and have been working with people with Parkinson’s disease (PD) since 1990. 

What attracted you to the field of physical therapy, in particular specializing in the treatment of those with Parkinson’s disease?
I became interested in physical therapy when I traveled to the Netherlands after high school to visit my uncle. He had been diagnosed with Parkinson’s a decade earlier. It was the first time I assisted an individual with walking and realized I wanted to help other people who had similar physical challenges. 

In 1988, I started working at Glenbrook Hospital. Later, I volunteered to help a movement disorder neurologist who was searching for a physical therapist to treat his patients with Parkinson’s disease. I quickly developed a passion for treating people with Parkinson’s and similar movement disorders. 

Why is physical therapy for the treatment of Parkinson’s disease so important?
Physical therapy is important for people with Parkinson’s from the time the individual is initially diagnosed and functioning well through all the stages of PD. In the early stages, we teach prevention—it is less work to prevent muscles from getting weak/tight than it is to “catch up” later. Exercise is critical to controlling the motor symptoms of Parkinson’s. The physical therapist helps to create the optimal exercise program for patients, which often requires an individualized approach since PD affects everyone differently.  

Parkinson’s affects the part of the brain that controls movement so it requires individuals to pay more attention to their movements, even walking and getting in and out of chairs and bed. Movements are typically smaller and can require more effort to normalize. In therapy, we teach people how to effectively use their attention to improve all aspects of moving, which results in reduced difficulties with walking and transfers. Some people with Parkinson’s may need more assistance and in such cases the therapist can teach both the individual and his or her caregiver/spouse how to assist so there is less strain.

What would you say is the biggest challenge you often have to work with your patients to overcome in terms of physical therapy for Parkinson’s disease?
The biggest challenge is often helping individuals understand the benefits of using an assistive walking device such as a cane or walker/rollator. There are some individuals who opt to become sedentary to avoid falling or feeling very unsteady. Or, worse, they fall and become injured. Becoming more sedentary to avoid falls is not necessarily done deliberately but this situation results in a progressive loss of strength and further decline of balance. All of this can be avoided by using a walking aid that allows an individual to become more active in a safe way. This is important because remaining active has a multitude of functional and health benefits.

What do you find most rewarding about your job?
I frequently see individuals who are stressed about how Parkinson’s affects them and the lack of control or knowledge they have about PD. My ability to see my patients for consecutive appointments, one-on-one, addressing all of their questions, allows me to see much of their uncertainty and stress dissolve to a more manageable level for them. I simply guide these individuals. After that, I pass the baton to them so they can self manage. It’s very rewarding to see them improve physically and emotionally, to impart a greater sense of control over a situation they previously thought they couldn’t control.

Do you have a favorite story of success that you could share?
Over the years, I have accumulated many success stories and every one of them is due to the hard work and perseverance of my patients. I have the easy job; my patients do the hard work. 

Here are just a few moments of success: 

Patients who questioned their ability to travel to their country of origin to visit relatives and were able to make the trip after treatment.

  • A father who wanted to walk his daughter down the aisle without a walking aid and with treatment was able to do so. 
  • A woman who thought she’d lost her ability to walk regained her confidence and mobility with the help of a walking aid. 
  • The many spouses and family members who felt overwhelmed before starting therapy were able to come to a better understanding of how to manage daily activities and reduce their stress levels.
  • An individual who was incapable of lifting his head, but due to his hard work (after I discharged him), he returned and surprised me with his head held high!

Find out more about Mia Boelen and her work with Parkinson's disease on her blog here and more information on the treatment options for Parkinson's disease at the NorthShore Neurological Institute here

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Parkinson's Disease: Genetic Risk Factors, Family History and Research

Thursday, April 09, 2015 12:54 PM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Demetrius Maraganore, MD:

laboratoryAre the children of a parent with Parkinson’s disease likely to inherit the disease? Is there a greater risk if the father or the mother has the disease?
My research team conducted family studies that defined the risk of inheriting Parkinson’s disease. The children of Parkinson’s disease patients carry a two-fold risk for Parkinson’s disease. They are twice as likely to get Parkinson’s disease compared to the children of persons without Parkinson’s disease. However, one needs to consider that the lifetime risk for Parkinson’s disease in the general population is 2%, so the risk of Parkinson’s disease for the children of a patient is 4%, or twice the baseline risk for the general population. That’s a pretty low risk and I wouldn't recommend any specific lifestyle changes or preventive therapies for the children of patients with Parkinson’s disease.
 
That said, about 5% of Parkinson’s disease cases are due to an inherited gene abnormality (mutation). In families where multiple members have Parkinson’s disease, the risk may be as great as 50% to the children of an affected person. When there are multiple family members with Parkinson’s disease, I refer patients for genetic counseling and in some instances we also perform genetic testing. 

What are the most important genetic risk factors for Parkinson’s disease?
There are two types of genetic factors that are important to Parkinson’s disease: 1) genes that rarely cause familial Parkinson’s disease (multiple affected members in the same kindred), and 2) genes that are not causal but that slightly increase the risk for Parkinson’s disease in populations worldwide (susceptibility genes). About a dozen genes have been identified as rare causes of familial Parkinson’s disease, and about a dozen genes have been identified as common risk factors in populations worldwide. The causal gene mutations are rare, accounting for less than 5% of all Parkinson’s disease cases. The susceptibility gene variants are common—e.g., occurring in 25% of persons in the general population—but they have small effects (no more than doubling the risk for Parkinson’s disease). 

Of all of the Parkinson’s disease genes, the most important is alpha-synuclein because it is both a causal gene in some families and also a susceptibility gene in populations worldwide. In other words, rare variants (mutations) cause Parkinson’s disease in rare families, while common variations (polymorphisms) increase the risk for Parkinson’s disease worldwide.

The alpha-synuclein gene holds the code for making the protein alpha-synuclein. The protein alpha-synuclein accumulates abnormally in the brain cells of every patient with Parkinson’s disease regardless of the causes. Many scientists believe that it holds the key to understanding and curing Parkinson’s disease. Our research team at NorthShore has led many of the most important studies of alpha-synuclein and Parkinson’s disease, including studies in families and in populations worldwide. We were also amongst the first to study the interaction of alpha-synuclein with other genes or environmental factors, or to study the association of the alpha-synuclein gene with motor and cognitive outcomes in Parkinson’s disease. 

Are there genetic research studies of Parkinson’s disease at NorthShore? How can I participate?
At NorthShore we are conducting a genetic study called the DodoNA Project. We aim to discover genetic factors that predict how neurological diseases progress in severity and that predict disease outcomes. We aim to use this information to individualize the care of our patients and to halt the progression of neurological diseases. One of the diseases we are studying is Parkinson’s disease. 

We will enroll at least 1,000 Parkinson’s disease patients into the study, and follow them at least annually for several years. To be eligible for the study you need to be new to our Movement Disorders practice within the past year, a resident of Cook or Lake County and willing to provide a blood sample for DNA extraction and storage. We also require your permission to compare your genetic code with the information that we collect in your medical record.

If you wish to participate, the best thing to do is to request an appointment to be seen as a patient in the Department of Neurology at NorthShore. We can then enroll you into the study after your office visit. 

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Who Gets Oral Cancer? Symptoms and Risk Factors

Friday, April 03, 2015 9:10 AM comments (0)

oral cancerOral cancers, which include cancers of the lips, cheeks, tongue, hard and soft palates, sinuses and throat, or pharynx (also known as oropharyngeal cancer), often appear first as growths or sores in the mouth that do not go away. In addition to these lumps, bumps and sores of the mouth, potential symptoms include:

  • Unexplained bleeding in the mouth
  • Numbness/increased tenderness anywhere on the face, mouth or neck
  • Chronic sore throat
  • Feeling of something caught in the throat
  • Hoarse voice or a change in your voice
  • Any difficulty chewing, swallowing, speaking or moving the jaw/tongue

As with any cancer, early detection and treatment is paramount. Your dentist can conduct oral cancer screenings during your regular dental exam. NorthShore University HealthSystem is also offering a free oral cancer screening on Sunday, April 27th from 9 to 11:30 a.m. at the John and Carol Walter Ambulatory Care Center at Glenbrook Hospital. Scroll through and register for an available time here

Though everyone should be examined for oral cancer, Nicholas Campbell, MD, Medical Oncology, shares some of the risk factors that can increase your chances of developing the disease:

Smoking. Lung cancer isn’t the only cancer smokers need to worry about. Smokers of cigarettes, cigars and pipes are far more likely to develop oral cancer than those who have never smoked. 

Use of smokeless tobaccos. Smokeless tobacco is also hazardous to your health. The use of chewing tobacco and snuff greatly increases a user’s risk of developing cancer of the lips, gums and cheek. 

Consumption of alcohol. The excessive consumption of alcohol has been linked with an increased risk of oral cancers.

Family history. A history of cancer in the family increases one’s risk of developing many types of cancer, including oral and oropharyngeal.

Sun exposure. Multiple severe childhood sunburns not only increase one’s risk for certain types of skin cancer but can increase one’s risk for cancer of the lips as well. 

Men over the age of 50. Studies by the American Cancer Society say that men are twice as likely as women to develop oral cancer in their lifetime. Men over age 50 are at the greatest risk for the disease. 

HPV exposure.  A particular virus, the human papillomavirus (HPV), is the most common sexually transmitted infection in the United States.  This virus also increases risk for oropharyngeal cancers.

NorthShore University HealthSystem with the Head and Neck Cancer Alliance is hosting a ree oral cancer screening event at Evanston Hospital on Sunday, April 12th starting at 9 a.m. Find out more and register here

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In the Lab: Dr. Karen Kaul

Monday, March 30, 2015 9:00 AM comments (0)

Karen Kaul

Karen Kaul, MD, PhD, Chair of the Department of Pathology and Laboratory Medicine at NorthShore, loves science and the science behind the practice of medicine. She specializes in molecular medicine and has devoted her career to developing the field of molecular pathology. She also leads the Molecular Diagnostics Laboratory within the NorthShore Center for Personalized Medicine.

While most patients will never meet their pathologist or the many professionals working in laboratory medicine, Dr. Kaul leads a remarkable team that works behind the scenes for their patients every single day. Here, she describes that groundbreaking work and the impact it will have the on the next generation of medicine: 

Pathologists don’t often interact directly with patients but what do they do behind the scenes for their patients? 
Virtually all patients benefit from the work of professionals in pathology and laboratory medicine.  These physicians and lab directors interpret biopsies and complex laboratory tests, as well as oversee the operations and quality of the labs. 

At NorthShore, we perform nearly five million clinical tests each year, as well as 100,000 microscopic examinations of samples removed via biopsy or surgery. The information these tests generate determines much of the clinical treatment for each patient; we serve a critical role in healthcare delivery.  

What does the NorthShore Molecular Diagnostics Laboratory do now? What do you think it will be capable of accomplishing in the future for patients and treatment outcomes?
The lab does testing for cancer, certain genetic diseases and also many infectious diseases for which we can detect the DNA of the microbe more quickly than traditional methods. We can also use DNA-based techniques to identify antimicrobial resistance (or antibiotic resistance) and thus tailor treatment when traditional options might not be as effective.  

The NorthShore Molecular Diagnostics Laboratory also recently implemented Next Generation Sequencing and will soon set up testing for pharmacogenomics, which is the study of how a person’s DNA affects their reaction to certain medications. The goal of pharmacogenomics is to ensure that each patient gets the right dose of the right drug the first time.

Our pathology department also includes the NorthShore Biorepository, which procures research samples of tumors, blood, and also procures the genomic samples for the Genomic Health Initiative; these samples will be critical in the research that will advance our knowledge and the future of medicine.

And part of the future of medicine is personalized, or precision, medicine. What is your role in the NorthShore Center for Personalized Medicine?
I have been working in molecular pathology, the lab that performs DNA-based diagnostic testing, since the mid-1980s, and established the first molecular diagnostics lab at NorthShore in 1992.  With the dramatic advances in our knowledge of the genetics of disease, and the technological advances in our ability to more rapidly analyze DNA, the capabilities of molecular diagnostics are the starting point for personalized medicine. 

By helping to determine the best treatment for many types of cancer, our pathology medical staff do remarkable work every day to determine the gene mutations in tumor samples. While I am less involved in the daily operation of the lab, I am deeply involved in the Center for Personalized Medicine here at NorthShore and am pleased to see the ongoing teamwork and progress on the clinical and research aspects of the program, and the use of electronic medical records and our strength in healthcare information technology, that will all be a part of creating novel capabilities to care for our patients.

What impact do you think personalized, or precision, medicine will have on healthcare?  
I expect that in time these novel capabilities will be routine in how we practice medicine, leading to better diagnoses, more effective treatment and better outcomes for patients.  As we learn more, we may be able to more broadly predict disease risk and prevent diseases from developing. 

What led you to medicine? What led you to this field in particular?
I always loved science, and especially enjoyed being able to use science to make people’s lives better.  While a desire to help people leads many of us to medicine, and I enjoyed patient care, I found that the ability to combine science, research, and caring for patients together was what suited me best and that led me to pathology. This field was certainly not on my career list when I began medical school, but I’m very fortunate to have discovered it, particularly during this era of such rapid advances.

What do you find most rewarding about the work that you do?
I love seeing the tremendous advances in medicine.  Pathology and laboratory medicine has a tremendous impact on patients, which is incredibly rewarding even though we generally do not meet the patients directly.  I also enjoy working with the wonderful and dedicated team we have working in the labs.  We also have training programs at NorthShore for both medical technologists and pathology residents—our mission includes training the next generation of laboratory professionals, and I have very much enjoyed my involvement in these programs over the years.

What has been the biggest challenge of your career so far?  
Time! There is a never-ending list of things to be done.

This Doctors' Day, recognize a doctor by sharing your stories of exceptional care or making a contribution in his or her honor by clicking here

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Healthy Mother & Baby: Gestational Diabetes

Wednesday, March 25, 2015 2:40 PM comments (0)

gestational diabetesGestational diabetes develops during pregnancy, typically between the 24th and 28th weeks. Most women will experience some change in glucose levels during pregnancy due to fluctuating hormone levels. Gestational diabetes develops when glucose levels rise but a woman’s pancreas is unable to produce enough insulin to regulate blood sugar levels. Developing gestational diabetes does not mean a woman was diabetic prior to her pregnancy, however approximately 20% of women with gestational diabetes will go on to develop type 2 diabetes later in life.  Women with gestational diabetes must make lifestyle changes to ensure their health as well as their baby’s. 

Rebecca Jacobson, MD, Obstetrics/Gynecology, discusses when women should be screened and what changes an expectant mother should make after diagnosis:

Women are screened for gestational diabetes approximately 24-28 weeks into pregnancy. However, women who are at a higher risk for developing gestational diabetes—risk factors such as obesity, previous instance of gestational diabetes, family history of diabetes—will likely require earlier screening. 

It’s important to keep gestational diabetes in check to prevent complications that could affect your baby, such as excessive birth weight, increased risk of cesarean section, increased risk of birth trauma, premature birth, low infant blood sugar at birth, and an increased risk for type 2 diabetes and obesity later in life. Left untreated, gestational diabetes can also result in a baby’s death. 

Treatment options:

  • Monitor blood sugar. Expectant mothers diagnosed with gestational diabetes will likely have to monitor blood sugar upwards of four to five times a day—in the morning and after meals— to keep levels within a healthy range. 
  • Maintain a healthy diet. The right foods and portion sizes, as well as steering clear of sugary snacks and drinks, will help keep sugar levels in check and prevent excess weight gain during pregnancy. Women newly diagnosed with gestational diabetes should work with their doctors and a nutritionist to create a balanced diet plan with weight gain goals because weight loss is not recommended during pregnancy. 
  • Exercise regularly. Exercise is important during pregnancy both for mother and growing baby. Exercise lowers blood sugar levels because the body transports glucose into cells, which produces the energy for physical activity. Moderate-to-vigorous exercise, with a doctor’s permission, is recommended nearly every day of the week.
  • Supplement with medication. Changing one’s diet and regular exercise might not be enough to combat gestational diabetes. Some women will require additional treatment with medication, which can be administered orally or as an injection. 

Have questions about gestational diabetes or advice to offer other women newly diagnosed with gestational diabetes? Join our new online community The Parent 'Hood to start a conversation today. Click here to find out more. 

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