A mutation found in the BRCA1 and BRCA2 genes puts women at an increased risk for developing breast and ovarian cancer. After learning that both her aunt and mother had the BRCA1 mutation,
Sivan Schondorf was tested for the mutation at 24 years old and discovered that she was also positive. She began frequent surveillance for breast and ovarian cancer immediately. At 28, when she felt that surveillance was no longer enough, she
opted to take control of her risk and undergo a preventative, nipple-sparing mastectomy with reconstruction at NorthShore.
With BRCA1 and BRCA2 in the news, she shares her story so that other women know how to find the correct information about their risks and options.
What were your initial thoughts when you learned you tested positive for the BRCA1/BRCA2 gene mutation?
I was sad and worried to learn I had a BRCA 1 mutation, but I was able to push a lot of that fear aside because I was still years away from the recommended surgery time. I was 24 years old at the time.
What prompted you to get tested for this mutation? And then why did you decide to undergo a risk-reducing, nipple-sparing mastectomy with reconstruction.
My maternal aunt had what is now known as a triple negative BRCA1 breast cancer that metastasized and resulted in her passing before she was 50 years old. Our family OBGYN, Dr. Lapata, had good instincts and recommended that she test for the BRCA mutation.
The red flags being that she had a cancer that was premenopausal and aggressive, and that she was of Ashkenazi Jewish descent.
This was in 2000, so it wasn't something any of us had heard of. Once my aunt tested positive for the mutation, my mother found out she had the mutation as well. I was subsequently tested in 2005 and with a positive result, I opted for surveillance. At 24,
I thought I was years away from any possible surgical interventions; however, after only after three years of surveillance, I felt the threat of cancer looming. I realized that surveillance wasn't protecting me; it was only enabling me to discover it at an
early stage. The only way to significantly lower my risk was mastectomy, so I scheduled my surgery for the next year, which was around my 28th birthday.
The nipple-sparing one-step was the best option for me because it required less surgery than having expansion over time. I was also comfortable keeping my nipples because, aside from the more natural, aesthetic result, research shows that keeping one's nipples
is safe as long as the surgery is done preventatively rather than when cancer is present.
How has this decision impacted your life?
In the very short-term, I felt different from my friends because I was thinking about things that women my age don’t normally have to think about. My thoughts were often on my situation. Five years later, as a working mother and wife, I hardly ever
think about it, except at my yearly clinical exam. It's something from my past that I faced head on.
I’m so much more comfortable now that my risk for breast cancer is so much lower. I do still monitor my ovaries at least twice a year. I have not yet pursued surgical intervention because I’m not done having children and do no feel the cost-benefit of beginning
menopause at 31 is worthwhile. I’m looking at having an oopherectomy by age 40.
It’s been a few years since you had this surgery. How are you doing?
I'm great! Having a baby (and now expecting my second) has done far more to change my body than the mastectomy did. I don't regret it for a second. I would do anything to improve my chances of being around to see my children grow. I want to be there
for them as long as I possibly can. Clearly, Angelina Jolie felt the same way, and I’m proud to have been one of her trail blazers!
What advice would give to women who are at an increased risk of developing breast cancer?
Every woman comes to a decision and place of acceptance differently. We all have different perceptions of our bodies and what we can and can't live without. Some have lost mothers due to this mutation and some find out about BRCA unexpectedly, without
even knowing about the elevated risk of cancer in their families.
Each woman must decide what level of risk she can live with. After watching my Aunt Linda die so quickly from this insidious disease, and also having my mother as a role model for me when she had her surgery, I decided that surgery at an early age was right
for me. It doesn't mean its right for everyone.
The most important thing is for women to have the most accurate information, which they can get from genetic counselors and doctors. They should also seek support from the local BRCA community so they can make informed decisions and have the emotional support
that a community can provide. FORCE (Facing our Risk of Cancer Empowered) has provided my family with that support, and we try to give back to our community as much as possible.
Is there any other information you’d like to share?
I filmed my surgery process at NorthShore’s Evanston Hospital and at home in order to help empower other women and to make the experience more meaningful for myself. Because I'm not a filmmaker, I have not yet been able to edit the hours of footage.
Seeing Angelina Jolie come out to the public has reignited my passion to finish this short film, which I hope will help other women.
There are many rewards but also many responsibilities that come with palliative caregiving. And while many caregivers say that those
rewards make the effort worth it, there is no denying that the responsibilities caregivers shoulder on a daily basis can be stressful. Studies show that between 40-70% of caregivers suffer significant levels of stress and about half of significantly stressed
caregivers meet the criteria for major depression.
Recognizing and celebrating those rewards and learning to acknowledge when stress levels are too high are essential for the physical and mental well-being of all caregivers, both familial and professional.
Michael Marschke, MD, palliative care physician at NorthShore, shares his recommendations on how caregivers can best cope with and manage
Remember that in order to provide quality care to a family member or a client you have to care for yourself too. Once you do, the rewards of caregiving will be that much richer.
Have you ever cared for an elderly or disabled family member? Are you currently employed as a palliative caregiver? If so, how did you cope with stress?
Mother's Day might have passed but every day can be a celebration of moms, moms-to-be and the many adventures of motherhood. For expectant mothers, the experts at NorthShore University HealthSystem have created a checklist for the stages of pregnancy, week
by week. Every mommy-to-be can learn how to take care of herself during each and every stage of pregnancy and track her baby’s developments along the way.
Click on the infographic
to learn more about the stages of pregnancy and how a mommy-to-be can prepare for baby.
They are everywhere, from drugstores to dedicated brands. It’s impossible to miss all the makeup, moisturizers, anti-aging serums and cleansers with the words “natural” and “chemical-free” written in bold on their packaging. But are these “natural” options
any better for your skin than more conventional skincare products? The only way to find out is to ask your skin.
When it comes to skincare, it’s what your skin wants and how it reacts to what you put on it that should matter most. Certain skin types are just as likely to react to natural ingredients as they are to non-natural ingredients. Natural also doesn’t necessarily
mean the product is safer for your skin or that it will produce more impressive results.
Give any product a month or more to determine its effectiveness. If you like what you see, you might have found a good match. If you react poorly, discontinue use and try all over again with something new.
If using natural products is important to you,
Sarah Kasprowicz, MD, dermatologist at NorthShore University HealthSystem, shares some tips how to find the best product for your skin and what to look out for before buying:
1. Read the ingredients. Make sure to read the ingredient label on all skincare products like you would a food label. It will help you get to know the ingredients you are putting on your skin. The word “natural” doesn’t necessarily mean
the product contains only “all natural” ingredients. In fact, it might contain some of the same ingredients as its non-natural counterparts.
2. Keep an eye out for these natural ingredients:
3. Use sunscreen. Always include a sunscreen in your skincare routine. Look for a sunscreen that is labeled as “broad spectrum,” which means the product has been tested and proven to protect against deeply penetrating UVA rays and shorter-waved
UVB rays. Zinc oxide, a physical blocker, is considered more “natural” than many of the other ingredients found in sunscreen.
Have you gone natural with your skincare regimen? Why or why not? What’s worked for you?
Obesity is a condition that affects nearly one third of men and women in the United States, and its risk factors can cause
severe and often life-threatening illnesses, such as diabetes, heart disease, stroke and an increased risk for developing breast, prostate and colon cancers. While a healthy diet and consistent exercise routine are the best ways to stay fit, that combination
might not be enough for everyone to maintain a healthy weight.
For those who struggle with severe weight loss problems, bariatric surgery, or weight loss surgery, can offer life-changing solutions. The procedures that fall under the category of bariatric surgery reduce the size of the stomach in various ways, restricting
the amount of food patients can eat and increasing their ability to lose weight rapidly.
These procedures include:
Woody Denham, MD, bariatric surgeon at NorthShore, shares some of the basic criteria one must meet for weight loss surgery:
As with any surgery, it is important to discuss what treatment options would be best for you with your physician. The weight loss journey doesn’t end with surgery. Losing weight will still require basic lifestyle changes, including diet and exercise.
To learn more about bariatric surgery and to determine if you’d be a good candidate, attend one of NorthShore’s
Bariatric Information Sessions. This free session is offered the 3rd Tuesday of every month from 6-7p.m. at 501 Skokie Blvd. in Northbrook.
What do you do control your weight? Have you had weight loss surgery?
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.
Demetrius Maraganore, MD, and
Ashvini Premkumar, MD
Is 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
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.
Over the last 30 years, childhood obesity rates have tripled in the United States, with nearly 1 in 3 children considered overweight
or obese. Left unchecked, childhood obesity can lead to serious health issues in children, including diabetes, high blood pressure, high cholesterol, asthma and sleep apnea.
The good news is that small changes in snacks, like swapping those high in fat, sodium and calories for healthier, more filling options, can make a big impact.
Felissa Kreindler, MD, pediatrician at NorthShore, shares some healthy snack options that won’t send the kids running … unless, that is, they always follow a healthy snack with some equally healthy exercise.
What healthy snacks do your kids love?
8 teaspoons dried minced onion
1 tablespoon dried parsley
½ teaspoon paprika
2 teaspoons salt
2 teaspoons pepper
1 ½ teaspoons garlic powder
1 cup nonfat yogurt
1 cup fat-free sour cream
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.
Ashvini Premkumar, MD
What are the most effective medications for the treament of Parkinson’s disease?
The most effective medications for the treatment of Parkinson’s disease are the dopaminergic medications. Carbdiopa/levodopa is by far the most effective, followed by dopamine agonists and lastly mao-b inhibitors. Non-dopaminergic medications include anticholinergics,
which are sometimes useful for treatment of tremor but have to be used with caution because of the side effect profile, particularly in elderly patients.
What are the most common side effects of carbidopa/levodopa?
The most common side effects for carbidopa/levodopa that we see clinically include: nausea/vomiting, lightheadedness, sleepiness, hallucinations, and dyskinesias.
Do you recommend the early use of carbidopa/levodopa? Delay its use?
The early vs. delayed use of carbidopa/levodopa has been debated for many years. The crux of the debate rests on the concern that early use of carbidopa/levodopa may increase one’s risk for motor complications, namely fluctuations (“on” and “off”
periods) and dyskinesias. The risk is approximately 40 percent within four to six years, particularly among young patients. Whether or not to start carbidopa/levodopa has to be highly individualized decision, which will be based on many factors, including
disease severity, age, co-existing symptoms (i.e. cognitive impairment) and occupational concerns.
Please discuss Neupro transdermal therapy
Neupro transdermal therapy, or the rotigotine patch, is dopamine agonist that is FDA approved for the treatment of Parkinson’s disease. It can be used in early Parkinson’s disease. It also can be used as an adjunctive medication in advanced Parkinson’s
disease as it was shown in studies to reduce “off” time by roughly one hour a day. It has also been approved in the treatment of moderate to severe restless legs. The side effects include: nausea/vomiting, somnolence (sleep attacks), reactions at application
site, dizziness, anorexia and compulsive behavior. The specific benefit of Neupro, like other extended-release dopamine agonists, is that it maintains as constant a level of drug as possible throughout the day.
Some say that exercise eases Parkinson's diease symptoms. What exercises or physical activities are recommended for people with Parkinson’s disease?
We recommend an exercise program that combines aerobic activity and core muscle strengthening. And this should preferably be complemented by exercises aimed at balance and stretching (i.e. yoga and Tai Chi).
Is it safe to ride a bicycle with PD?
This question needs to be routinely addressed by the patient’s treating neurologist. In general, in the early stages of PD, where balance is not significantly affected, it’s considered safe. However, once postural instability becomes noted, either
by reported falls or upon routine examination, then it would be advisable to ride only stationary bicycles.
How can I prevent falls if I have PD?
Prevention of falls should be emphasized at each clinic visit with one’s treating neurologist. The best way to prevent falls is to be educated as to what causes falls in Parkinson’s disease and then to take every precaution to avoid those “missteps.”
We often think that eating healthy means spending more money. You don’t necessarily have to sacrifice on flavor and
the foods you love when trying to eat on a budget. Saving some green in your pocket book can be as easy as becoming a better planner both at the grocery store and in the kitchen.
When you think about stretching your dollars with your food, remember that making smart choices is a small price to pay when it comes to your overall health and wellness.
Kimberly Hammon, registered dietitian at NorthShore, shares the following recommendations for maximizing nutritional value and minimizing costs:
What do you do to reduce your grocery bill? What cost-saving tips do you have?
Aikaterini Markopoulou, MD
What is DBS?
Deep brain stimulation is a type of surgical treatment for Parkinson’s disease. It involves the insertion of electrodes into specific areas of the brain that control movement. The electrodes are connected to a battery that is placed under the skin in the upper
part of the chest. Electrical current that passes through the electrode stimulates these brain areas on one side of the brain. This stimulation results in improvement of tremor and slowness or stiffness on the other side of the body.
Who is a good candidate for DBS?
To be a candidate for DBS surgery a number of conditions have to be met:
Is DBS covered by Medicare?
Yes, DBS is covered by Medicare.
When a patient has bilateral DBS is it necessary to have two stimulators, or will one suffice?
In the majority of Parkinson’s cases, symptoms affect both sides of the body; therefore, electrodes are inserted in both sides of the brain. In some cases where the symptoms affect mostly one side, the electrode can be inserted only in the opposite site of
If you have DBS, how does it affect your ability to get through airport checks, metal detectors, etc.?
Each patient is provided with an identification card that includes information about the implanted stimulator. The TSA agent should offer a private screening or screening with a manual wand instead of the patient walking through a metal detector.
What percentage of DBS surgeries result in complications? What complications might a patient encounter?
The DBS surgery may result in complications both during the implantation and after surgery, which include bleeding at the electrode insertion site that can be fatal, hardware malfunctioning, and infection and symptom worsening. In a large multicenter clinical
trial, 7.5% of patients developed intracranial hemorrhage, 10.6% device-related infection and 8.1% one-sided weakness.
How long is DBS effective?
Studies that have followed patients for ten years have been published and the DBS remained effective throughout the ten-year interval.
Are there any long term risks associated with DBS?
DBS therapy remains a safe treatment option for Parkinson’s patients for at least ten years.