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:
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
Gestational 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.
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.
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.
Ready to hit the roads, trails and sidewalks this spring and summer? Before you lace up your running shoes and head out the door, check out these top running tips for all fitness levels from the experts at NorthShore University HealthSystem.
Scroll below for our full running tips infographic, from improving endurance and when and how to stretch to running-friendly snacks and injury-prevention:
This year, spring clean your diet, too. "Clean" eating means to create a balanced diet of fresh, unprocessed foods with the central focus on fruits and vegetables. The health benefits of clean eating are many, such as possible weight loss and the reduction
of one's risk for diabetes and some types of cancer, including colon cancer.
The experts at NorthShore University HealthSystem have created an infographic that illustrates the benefits of clean eating and breaks down the most important clean eating
guidelines. Click on the image below to view the full infographic.
Henry “Mark” Dunnenberger, PharmD, Senior Clinical Specialist Pharmacogenomics,
NorthShore Center for Personalized Medicine, believes that personalized or precision medicine is the “next generation” of medicine, an approach that will not only treat disease but also predict and potentially prevent many diseases too. His
field within personalized medicine, pharmacogenomics, stands to make a revolutionary impact on patient treatment and outcomes.
Here, Dr. Dunnenberger defines pharmacogenomics, describes its impact now and in the future, and tells
us why working in this revolutionary field is so rewarding:
What is pharmacogenomics? Pharmacogenomics is the study of how your DNA affects your response to medications. It’s because of small differences in DNA
that two patients can receive the same medication at the same dose for the same indication and still have different responses. The medication may work well for one patient, while the other patient may receive no benefit or experience side effects. By
analyzing genetic variation, we can predict who is more likely to experience these undesirable outcomes.
How can it help patients? How does it change treatment for diseases like cancer?If we know a patient’s genotype when
a medication is prescribed to them, we are able to make a more informed decision to treat patients with the conventional dose, alter the dose or chose a different medication all together altogether. These actions will reduce the risk that a patient will
experience a negative drug-related outcome. This all leads to safer, more effective treatment for each individual. It can be paraphrased as: The right drug, at the right dose, for the right patient, the first time.
What is the role of
pharmacogenomics in the NorthShore Center for Personalized Medicine?Personalized medicine is the next step in the evolution of medicine. It can be thought of as the tailoring of medical treatment to the individual characteristics, needs
and preferences of a patient during all stages of care, from prevention and diagnosis, to treatment and follow-up. NorthShore is instituting personalized medicine through the Center for Personalized Medicine. This center brings together clinical,
research and bioinformatics genomics experts from across the health system. Pharmacogenomics is a piece of the Center and one of the first to launch. (NorthShore’s pharmacogenomics clinic launched March 2015.)
What’s next for
pharmacogenomics? What developments do you see in the near future?Pharmacogenomics is advancing in numerous ways. First, we are learning more about differences in DNA, known as variants, which have an effect on drug therapy. This
will increase the number of drug/gene pairs we can implement in clinical care. Second, we are figuring out which patient populations will benefit the most from pharmacogenomics-based interventions. Third, we are discovering the best ways to deliver
pharmacogenomics data to all practitioners. Soon we will be increasing the number of genes we preemptively screen from 14 to 231.
What do you hope you’ll be able to do in the future?Travel to space … but really,
in the future, I hope every patient at NorthShore will have their individual pharmacogenomics data in their health record before they even need it. I hope we will have developed a system that can make the data actionable to improve their care when they need
What brought you to this field?I am drawn to this field because of the challenges it presents and potential rewards when those challenges are conquered. By working in the field of pharmacogenomics, I can help build a
system that could impact the care of every patient that walks through the doors of NorthShore. I cannot think of a more rewarding job.
What do you find most rewarding about your work at the NorthShore Center for Personalized Medicine? It’s a tie between working with some of the most intelligent people I’ve ever met and having them broaden my horizons every day, and helping improve the care of the patients at NorthShore.
Find out more about the NorthShore Center
for Personalized Medicine by clicking here.
There are many risk factors for colon cancer that are beyond your control—being over the
age of 50, family history of colorectal cancer, personal history of polyps, inflammatory intestinal conditions like Crohn’s disease or ulcerative colitis. There are, however, risk factors you can mitigate by making some simple and some not-so-simple
changes to your lifestyle.
Susannah Spiess, MD, Gastroenterologist at NorthShore, encourages everyone to make these healthy
lifestyle changes to help lower the risk for colon cancer:
Eat a high-fiber, low-fat diet. Studies have shown that diets high in fat and lower in fiber may increase your risk for developing colon cancer. These same studies also
indicate an increased risk for those who consume large quantities of red meat regularly. Shift the focus of your diet away from meat, particularly red meat, and give fresh fruits, vegetables and whole grains top billing on your plate.
and move. This doesn’t just mean 30 minutes of exercise a day. Get up and move throughout the day. An inactive, sedentary lifestyle can increase your risk of developing colon cancer. If you spend most of your day sitting behind a desk, stand
up and move every 20 minutes or whenever possible.
Lose weight. Changing your diet and increasing your activity level will work wonders on your waistline as well. Obesity significantly increases one’s risk for not only developing
colon cancer but also dying from the disease if diagnosed.
Break the habit. It’s a terribly unhealthy habit. Smoking increases your risk for a number of serious health issues, from lung cancer and heart disease to stroke and,
you guessed it, colon cancer. The time to break the habit is now.
Cut back. The excessive consumption of alcohol raises your risk for several types of cancers, including cancer of the colon and rectum. Monitor your daily and weekly
consumption of alcohol and ensure that it is no more than 14 units of alcohol per week and no more than three in any single day.
Get a colonoscopy. While adopting these lifestyle changes could reduce one’s risk for colon
cancer, screening colonoscopy is the only proven method of preventing the disease.
Have you made an appointment to get your first colonoscopy? Find out more
Susan Ripka, a busy mother of 5-year-old twin girls, just didn’t
feel right. She’d been dealing with recurring digestive issues but when she noticed blood in her stool, she made an appointment to see NorthShore gastroenterologist Laura Bianchi, MD. At the appointment, Dr. Bianchi recommended a screening colonoscopy, an outpatient procedure that would ultimately save Susan’s life.
At only 43, Susan was diagnosed with colorectal cancer.
Thankfully, Susan’s cancer was discovered at its earliest stage and after surgery performed by Joseph Muldoon, MD, Susan is now cancer free.
Here, she tells us about her experience at NorthShore, why she strongly recommends seeking medical
advice if something doesn’t feel right and how a difficult diagnosis renewed her outlook on life:
What stood out most about your treatment at NorthShore and your experience with Dr. Bianchi and Dr. Muldoon?The
entire process, from the colonoscopy to surgery, was very smooth and well organized at NorthShore. Dr. Bianchi was very patient, thorough and informative during the process. She also had a personal, caring approach that helped keep me at ease.
blessed to have Dr. Muldoon as my surgeon. He came highly recommended and I felt very confident in his skill and approach to my surgery.
What does your care plan look like going forward? How often will you continue to be screened?Right
now, I am continuing follow-up appointments with Dr. Muldoon, and since the pathology report came back negative, I will only require annual screenings.
What would you tell other women your age who are experiencing unusual digestive issues?After hearing my story, women have told me about their own symptoms and I always strongly recommended they seek an evaluation.
What would you tell someone who is afraid to have a colonoscopy performed either out of fear of pain or
embarrassment?I tell people the process and procedure is much simpler than they would expect. I also share how important it is to work through that fear because in my case it saved my life.
What’s next for you and your family?
What do you look forward to the most? I have a renewed outlook on life. I look forward to watching my kids grow up and spending as much time with my family as possible!
What did you learn through this experience?I learned that God is in control of my life. He demonstrated love and care through orchestrating events that revealed the cancer early and set me on a path with the most highly skilled medical team. I believe each staff member, nurse, doctor (namely
Dr. Bianchi and Dr. Muldoon) were a gift from God. I only need to remember this experience and I am thankful and praising God for what He did for me and hope He blesses all the hands that helped me!
Many women know what to expect during pregnancy but do you know what changes could be in store
for your body after your bundle of joy has arrived? Whether you’re wondering how long to wait before engaging in exercise or sex again, or if pelvic prolapse surgery might be right for you, find the answers here.
Roger Goldberg, MD, Director of the Division of Urogynecology at NorthShore and author of “Ever Since I Had My Baby,” answers “Body After Baby” questions.
Is moderate pain, like a pulling sensation,
normal in a c-section incision site after the incision itself has healed? Certainly any abdominal incision—including cesarean—can cause certain symptoms that are slow to fully resolve. This can include pulling or even sharp
pain on occasion. The likelihood of any serious issue with the symptoms you describe are small, and symptoms like these typically linger for awhile and then fade on their own. Certainly if this or any symptom continues or gets worse, happens frequently, or
disrupts your quality of life, have your surgeon re-check the area.
Are there things a woman can do prior to or during labor to minimize tearing and nerve damage, and improve and/or speed recovery?
There are. Here are some
After childbirth, there is the option of pelvic floor physical therapy. We work closely with our physical therapists
here at NorthShore, and they're a great resource for rehabilitating muscles and tissues that have undergone change due to pregnancy and childbirth
How long after pregnancy and labor should you wait to exercise? There's
not a great deal of science to "prove" the right answer to this question. Assuming you are feeling well, walking and general aerobic activity can usually be resumed around four weeks for your overall health and well being. However, I would be concerned about
heavy weightlifting, excessive squatting and high-impact activities at a time when pelvic tissues are still recuperating. The pelvic tissues in terms of strength and tone look very different at one month postpartum compared to three months postpartum. As a
doctor and surgeon who deals regularly with women that have prolapse symptoms, I would recommend to err on the side of caution by waiting three months postpartum for high-impact activities. Always check with your obstetrician to be sure.
pain during sex normal after childbirth? How long could pain last? What remedies are there? The perineum (tissues between the vagina and rectum) can be very tender after childbirth. Some patients require more time, some require less, for
pain to resolve. Studies have shown that roughly 25% of women will still have some sexual complaint at six months after “normal” vaginal birth. The good news is that many of these resolve spontaneously with time and patience.
If the area
is extremely tender, check with your physician because in rare cases, a quick surgical revision may be required; however, for most, pain subsides with time, patience, lubrication and perhaps some estrogen cream.
When should you be concerned
about pain after childbirth?I want to emphasize that pain is not normal if it doesn't slowly but surely resolve on its own. If you're getting better and the pain is disappearing, there isn’t a problem; however, if you're
experiencing worsening or persistent pain in the pelvic area, consider seeing a urogynecologist for a basic evaluation.
Is it normal to leak urine when coughing or sneezing? This is called stress incontinence, and it's
reported to some degree by up to 50% of post-childbearing women by age 40. While it is common, it’s not normal and not something you must simply accept. Fortunately, stress incontinence is amazingly treatable.
When would you recommend surgery for pelvic prolapse? How long is the recovery after surgery?
This is a personal decision for every woman. It’s important to note that there is rarely a medical reason to rush the decision. Minimally invasive surgical options are available, so some women opt for surgery rather than trying non-surgical methods.
I perform 95% of surgeries without any abdominal incision, the majority of cases take less than an hour and many involve no hysterectomy. This has translated into a quick recovery for most, but, we always need to acknowledge that recovery can be slower
than expected for some. In my current practice, nearly all patients go home the next day, use pain medication for only a short of number of days.
My overall advice is that if you're considering surgery, the most important factor is that your
surgeon has a lot of experience with the technique being performed. Part of the reason we believe our patient outcomes are so strong here at NorthShore is that we're committed to being the experts in these areas.
Have questions about
recovery following childbirth or advice to offer other new moms? Join our new online community The Parent 'Hood to start a conversation.
Colon cancer is the second leading cause of cancer death in the United States, claiming nearly 29,000 men
and women each year. It is surpassed only by lung cancer. Colon cancer also happens to be one of the most preventable cancers. Studies have shown that a colonoscopy can reduce the risk of developing and dying from colorectal cancer by 90%. A colonscopy can
enable a physician to identify and remove polyps before they even become malignant.
David Labowitz, DO, MPH, Gastroenterology at NorthShore,
addresses some of the damaging myths about colonoscopy that discourage many from getting this lifesaving procedure when they should:
Myth #1: The “prep work” is terrible. You do have to empty your colon before a colonoscopy.
This is the hardest part of the exam, but the most important. I always tell patients that without a good prep, it’s like driving through fog—you cannot see where you are going. However, the prep does not have to be a terrible experience.
The day before the procedure, you should stop eating solid food and consume only clear liquids; however, you can have more than just water. Incorporating variety—tea, Jell-O, sports drinks and broth—into your 24-hour clear liquid diet will help
make it more bearable.
The most common complaint is the volume of colonoscopy prep electrolyte solution that must be consumed to clear the bowels. To make this easier, we actually split the drinking of the prep into two different time periods (the evening
before and a couple of hours before the procedure). This not only is an easier way for patients to accomplish the prep, but has been shown in national studies to be a better way to prep for the procedure. Think about the prep this way: the cleaner
your colon, the faster and easier the procedure the next day. Unfortunately, if your colon isn’t clear because you have failed to drink the solution, polyps and lesions could go undetected or the results could be inconclusive. Further, the procedure
may need to be repeated. It’s all about doing it right the first time.
Expert Tips! Make the Prep a Little Easier
Myth #2: The procedure is painful. A colonoscopy is a very tolerable procedure. Further,
it does not take very long and most of the time is completed within 20-30 minutes. Before the procedure begins, you will be given a sedative to help you relax. In fact, most patients will sleep through the entire procedure and wake up not remembering any of
it. Those who remain awake during the procedure report nothing more than slight cramping or pressure in the abdomen, similar to the feeling of having a bowel movement.
Myth #3: It’s embarrassing. Our NorthShore gastroenterologists
perform over 35,000 GI procedures each year—the majority being colonoscopies—so they have a lot of experience making sure patients are as comfortable with the process as possible. Patients can also make an appointment with their gastroenterologist
before the procedure to meet face to face and ask any questions that will help them feel more comfortable.
Myth #4: There is a high risk of complications. Complications during or after a colonoscopy are very rare. The bottom
line is your risk of developing colon cancer is far higher than your risk of suffering a complication due to a colonoscopy. It is, however, important to schedule your colonoscopy with a physician who is certified to perform this procedure.
#5: Colonoscopies aren’t necessary for women. Colorectal cancer affects men and women in nearly equal numbers. It’s not a man’s disease; therefore, screening colonoscopies are for everyone. Women need to schedule their first
screening colonoscopy starting at age 50, just like men. More than 90% of colorectal cancer is diagnosed in people who are 50 or older. Those with a family history of the disease and other risk factors—a history of inflammatory bowel disease (IBD), history
of polyps, type 2 diabetes, obesity and smoking—might need to start screening early and undergo screening more often. Ask your doctor when you should begin screening.
For more information on colonoscopies and to make an appointment, click here.
Parents, it starts with you. You are the first and most important
influence on the current and future health of your children. The example you set could put your children on a course for a lifetime of healthy living, especially when it comes to heart health. The health risks posed by a sedentary lifestyle, poor diet and
obesity are immediate because heart health matters at any age, even in young children.
Najman, MD, Cardiology at NorthShore, shares some easy ways that parents can set a heart-healthy example for their children while also improving their own health:
Healthy diet. If you want your children to eat fruits and vegetables,
you need to set the example by eating fruits and vegetables yourself. Include your children in the decision making and help guide them by discussing the benefits of the delicious fruits, vegetables and whole grains that you will eat together as a family
every night. If children grow up eating healthy foods together with their parents, eating those same foods as young adults and adults won’t feel strange or difficult at all; those same foods will be what they ate growing up.
Show your children that exercise is important by maintaining a regular workout routine. And, as often as you can, get every member of the family involved in a fun, physical activity. Jog together as a family; ride bikes together as a family; go on a brisk
evening walk together as a family. Children experience the same health benefits of exercise as adults—strong bones and muscles, maintenance of a healthy weight, lower blood pressure and cholesterol, and a regular exercise routine reduces one’s
risk for heart disease, diabetes, some cancers and more. Get your kids moving now and they will likely maintain that active lifestyle later in life. Lead by example!
Smoke-Free. If you quit smoking, your kids are less likely to start.
Smoking is more common in teenagers whose parents smoke. If you are still smoking, quit. Secondhand smoke is linked to lung cancer but it also increases the risk of multiple types of cancers, heart disease, diabetes and many other medical issues as well.
Maintain a healthy weight. Today in the U.S., one child out of three is considered obese or overweight. Type 2 diabetes and high blood pressure, once common health issues encountered only in adulthood, have developed in children as young
as seven. Obese children are also more likely to become obese adults, increasing their risk of developing heart disease later in life. Don’t focus on weight with children; instead, shift to leading a healthy lifestyle as a family. Lifestyle changes
like eating right as a family and exercising can make all the difference.
What do you do to set a heart-healthy example for your children?