Q&A: Brain Tumor Research, Treatment Options and Recovery

Tuesday, May 20, 2014 1:03 PM comments (0)

brain tumorIt’s normal for the diagnosis of a brain tumor to inspire of fear, anger and confusion. And it will for the estimated 70,000 people who will be diagnosed with a primary brain tumor—a tumor that begins in the brain—and the countless more who will be diagnosed with a metastatic brain tumor—a tumor that begins as cancer in another part of the body and spreads to the brain—each year. Acquiring the correct information both from your doctor and your own research is the key to finding a way through those initial feelings and deciding on a course of treatment.

As a part of National Brain Tumor Awareness Month, Ryan Merrell, MD, Neuro-Oncologist at NorthShore, answers our questions on brain tumors, both primary and metastatic, from current treatment options and on-going clinical trials at NorthShore, to potential causes of brain cancer and more: 

Often the first question after a brain cancer diagnosis is what the chances of survival are. What would be your answer to that question for patients with a metastatic brain tumor?
Survival in metastatic tumors depends heavily on the type of tumor. For example, many patients with metastases, which are tumors that spread from other areas of the body, from breast cancer have better survival than patients with metastases from melanoma. 

Also, within a particular tumor type, some subtypes do better than others. For example, certain mutations associated with non-small cell lung cancer often have better outcomes. Also, the extent of disease in the body is very important. If a patient has a cancer that has not spread to multiple organs, survival odds are better. We see some patients with metastatic brain tumors with long-term survival.

If you are diagnosed with brain cancer, would it be better to see a neuro-oncologist than an oncologist?
Most neuro-oncologists train in neurology first and then specialize in neuro-oncology. They are often better trained to tackle the specific neurologic challenges of brain tumors. That doesn’t mean that a medical oncologist (oncologist) is not capable. In fact, many medical oncologists at top centers specialize in taking care of brain tumors. I would make your decision more on how many brain tumor patients the physician sees per year and if that is a substantial portion of their practice.

Are there minimally invasive surgery options available for brain tumors or is a craniotomy still the only way to remove a tumor?
This is a provocative question. My sense is that the future of brain tumor surgery is moving towards less invasive procedures. For now, open craniotomies (big surgeries) are the gold standard. However, neurosurgical techniques are becoming more and more refined. For example, we are now using an endoscopic technique that allows the surgeon to make a smaller incision and disrupt less of the normal brain during surgery. The idea is that this will lead to shorter recovery times and better long-term outcomes. We also have a minimally invasive thermal laser ablation technique that we are currently using to treat metastatic tumors that develop delayed swelling after radiation (radiation necrosis). This technique allows a patient to go home the day after the procedure. We are looking to expand this procedure to the direct treatment of tumors as well.

What makes a brain tumor inoperable? If you are told you have an inoperable tumor, what can be done?
The location of the tumor in the brain is important. For example, tumors in the brainstem, motor cortex and deep brain structures (basal ganglia, thalamus) cannot be removed safely without harming the patient. These areas can be biopsied. 

Other brain locations are difficult but can be operated on by skilled neurosurgeons. I highly recommend getting a second opinion if you are told that a tumor is inoperable because it may be that the neurosurgeon you are seeing is not comfortable doing that surgery. At NorthShore, we are aggressive at operating on any tumor location, but are also very cautious not to undertake a surgery that would cause permanent neurologic harm to a patient.

Is rehab always necessary after brain surgery?
Not always. This depends a lot on the age of the patient, the presence of other medical problems and the location of the tumor. For example, an 80-year-old patient is more likely need rehab than a 40-year-old patient. A tumor that is near the motor cortex, which could cause weakness on one side of the body, would also likely require the patient to undergo rehab after surgery. We do, however, have many patients that go directly home after surgery. We have an outstanding inpatient rehab unit at Evanston that allows us to directly transfer patients to the unit a few days after surgery if necessary.

After surgery to remove a tumor, what is the typical treatment that follows?
This depends highly on the type of tumor, metastatic or primary, and covers a wide spectrum. Most tumors will require either radiation and/or chemotherapy after surgery. There are some malignant tumors—low-grade gliomas, for example—that can be watched after surgery. At a minimum, all malignant tumors require close follow-up with serial MRI scans after surgery.

What factors should be considered in deciding when to discontinue chemotherapy?
That depends a lot on the context. Stopping chemotherapy when the tumor is not growing or when it’s growing. For example, in glioblastoma, there is no evidence that giving more than 12 cycles of the chemotherapy drug temozolomide leads to better outcomes when the tumor is not growing. When a tumor is growing and we have exhausted all treatment options and the patient can no longer tolerate treatment, we have to make the difficult decision to stop the chemotherapy. Of course, the patient's decision is the most important. The patient has the right to stop chemotherapy at any time.

What percentage of malignant brain tumors in the US are caused by environmental factors vs. genetic factors or both?
The simple answer is that this is unknown. There are no known environmental risk factors for malignant brain tumors. The cell phone studies have not been revealing. It’s rare that malignant brain tumors occur in families. Even having a first-degree relative (sibling, child or parent) with a brain tumor doesn’t put a patient at increased risk. There are rare tumor syndromes associated with brain tumors. At NorthShore, we’re involved with an international study that studies both genetic and environmental risk factors for brain tumors. We hope to uncover some answers in the next few years.

So do cell phones cause brain tumors?
The answer is probably not. There have been several cell phone studies but none have shown definitively one way or another if cell phones are a risk factor. Many of my colleagues and I believe that the exposure a cell phone emits is theoretically too small to cause the development of a brain tumor, but, like many things in the brain tumor world, the jury is still out. It’s most likely fine to talk on cell phones with regard to brain tumor risk.

What are some of the best clinical trials for brain tumors? Are there any at NorthShore?
Unfortunately, there is no “best” clinical trial. Nobody in the world can make that claim. That is why they are trials. We participate in several clinical trials, the majority of which are for glioblastoma. Current clinical trials for glioblastoma involve targeted therapies and immunotherapies. We have both and have phase I, II and III trials. 

Find out more information on clinical trials at NorthShore here

How do you decide which clinical trial is the best one for you?
This is a tough question. There is no way for anyone to know which trial is better than another. If a particular trial appeared to be producing home run results, we all would steer patients to that trial. That has not happened yet.

I tell patients to choose trials based on the science behind them. Does a trial seem scientifically more interesting than another? Also, what does the trial require in terms of time commitment? Does the trial require weekly visits and a lot of travel time? Some patients prefer open label trials over randomized trials. Some patients prefer trials that allow crossover at the end, meaning that they can get the study drug if they were in the placebo group initially.

What is the brain tumor vaccine? Who does this work for?
Most vaccine therapies are designed for high-grade gliomas, and usually for glioblastoma (the highest grade glioma). We currently have three trials involving vaccines therapies for glioblastoma with two different types of vaccines.

On a national level, there are many different types of vaccine trials. A vaccine is just a term that implies immunotherapy, meaning that you are trying to engineer the immune system to mount a response against the brain tumor in a specific way.

What are your thoughts on the use of medical marijuana to help treat the symptoms that arise from having a brain tumor?
Like many physicians, I’m on the fence here. I think there are some symptoms—pain and nausea—that would clearly could benefit from medical marijuana; however, often, we are able to treat those symptoms by more traditional methods. I am open to the idea of using medical marijuana in select patients. We are waiting to hear from the state of Illinois and NorthShore regarding the logistics of how we will be able to prescribe it.

Dr. Merrell will be speaking on the subject of Malignant/High Grade Tumors: Update in Treatment and Care at American Brain Tumor Association’s Patient & Family Conference on Saturday, July 26th in Chicago. More information here


Nurse Cheryl Vinikoor Discusses Highland Park Hospital's SANE Program

Monday, May 12, 2014 12:42 PM comments (0)
Sane nurses

NorthShore Highland Park Hospital launched its Sexual Assault Nurse Examiner (SANE) program in August 2013 after five nurses—Michelle Haussermann, Cheryl Vinikoor, Lauren Lumpp, Mary Ann Bogacki and Vilma Castro—completed the extensive, yearlong training required of a SANE. Kay Meyer, Senior Nursing Director, and Ellen Weatherhead, Clinicial Nurse Manager of Emergency Department, support the program administratively. With five nurses, Highland Park now had enough forensic-trained medical professionals to ensure that it was capable of providing coverage 24 hours a day, seven days a week, for sexual assault patients who present to the Emergency Department (ED). 

Each NorthShore Highland Park SANE nurse has other responsibilities in Highland Park’s ED, becoming a SANE is an expansion of her role within the organization. And it is a role she voluntarily spent one year of her life pursuing. It is a passion project for each of them, a passion for providing extraordinary care and employing exceptional skills in an extremely difficult situation. [Image: Kay Meyer, Cheryl Vinikoor, Ellen Weatherhead]

Cheryl Vinikoor, RN, SANE Coordinator, tells us what being a SANE nurse means to her and why she’s so proud to finally have the program at Highland Park Hospital:

What is the role of a SANE? 
The role of the SANE nurse is to provide comprehensive and sensitive patient-focused care to the person presenting to the ED after a sexual assault. A sexual assault case can take five or six hours to complete. The SANE stays with the patient throughout that process.  We were taught to obtain a good history of the assault, which guides us in the forensic evidence collection.  It takes precision and a great deal of expertise to collect evidence including DNA.  Though the SANE completes the forensic examination and completes the evidence collection kit, if we find injuries that require care we partner with the emergency physician to determine what additional procedures the patient might need. 

This is an expanded role for the RN at NorthShore. I feel the SANE provides competent care to this very complicated patient because of our training.   In addition we have only one patient to concentrate on, and can focus on the specific needs of that person. 

What does it take to become certified as a SANE nurse? 
The SANE at Highland Park have successfully completed the training required by the Office of the Attorney General in Illinois. This included a 40-hour course, which is done in the classroom and online as well as numerous mandatory experiences before the state would consider us qualified and allow us to practice as SANE, Adult and Adolescent. In the future we can obtain additional training to allow us to care for the pediatric sexual assault patient.  

SANE certification is accomplished by passing an examination administered by the International Association of Forensic Nurses (IAFN).  It is our goal in the future to have the nurses certified by IAFN.

Why did you want to become a SANE nurse? How did you begin?
I have wanted to do this since 1998 while I was in the emergency department. I’ve found forensic evidence collection fascinating. I had often observed a degree of insensitivity from law enforcement in situations of sexual assault, and I wanted to make a difference.

I read the literature about the programs starting across the country.   I was very active with the Emergency Nurses Association and networked with forensic nurses who were passionate about their role as a SANE, and their expanded role in the emergency department.  I never thought I would have the opportunity to become a SANE nurse, and that there would be a SANE program at Northshore before I retired. It is because of the trust, vision and compassion of the administration of Highland Park Hospital that we have a program.  I thank them, more than anything, for supporting us in this new project. This is not a program that creates revenue. In addition it is a huge change in practice for emergency services for the nurse to make recommendations and provide direction for the case.  I think it has gone very well so far and there seems to be a sense of trust and collegiality.

Before all of this, a nurse would have been pulled out of staffing to care for the survivor for several hours. Having a SANE nurse is often a relief for the other nurses in the ED. In addition, the physicians now realize we are capable of doing everything, including the pelvic exam and the documentation required for the Sexual Assault Evidence Collection Kit. And since it was such a long time coming, it feels quite gratifying that when a case comes in now, the physician’s first response is to say, “Page the SANE nurse!”

What is the most rewarding aspect of your role as a SANE nurse?
I think my most rewarding part is when I really feel that I have connected with the patient, that they trust I will not hurt them and that I believe them. I’m also very lucky to be working with people from the Lake County Sexual Assault Team who are passionate about what they are doing, and sensitive to the needs of the patient.  This includes the prosecutors, law enforcement and the Zacharias Sexual Abuse Center advocates.

What is the most difficult part?
The examination can take several hours. When we are called in, the patient has often been waiting already and they are frequently anxious to finish quickly. We have to try our hardest to make that trust relationship quickly and do the absolute best for the patient we can within what they will allow. 

As far as how if affects my family, it mainly affects my husband. I’m often coming home late or not somewhere when I planned to be, but after 40 years of marriage and 40 years of nursing he knows this is who I am. We both have our passions in our work.

How do the SANE nurses at Highland Park work together and support one another?
We meet once a month in the evening to have dinner and review cases. And we support each other by discussing our cases and helping each other find out what we did well and could have done better.

When things are complicated and become difficult we consult with the advocate group, nurses from other programs and our team from the Lake County State Attorney office. They are always so wonderful. We also have a great relationship with the local police departments and can call them if we need advice. They are happy to help if we have problems with a case. 

What do you think are the most important characteristics of a SANE nurse?
A SANE nurse has to be independent, confident, assertive and, most important, passionate about caring for the patients.  

This week you can Say Thanks And Recognize (STAR) NorthShore's remarkable nurses by contributing to our Nursing STARs Scholarship Program here.


Nurse Kathy Patelski Challenges Herself and Educates Her Patients

Wednesday, May 07, 2014 9:57 AM comments (0)

Kathy PatelskiKathy Patelski has been a nurse at NorthShore Skokie Hospital for five years but she has been caring for patients in various nursing roles since 1979. Her passion for the medical field developed early and has only grown over the years. Not content to rest on her laurels, Kathy never misses a chance to seek out new challenges and opportunities for personal and professional growth. She currently works in ambulatory surgery, but four years ago she jumped at the opportunity to become a part of the Patient Education Program at the NorthShore Total Joint Replacement Center. In these patient-focused classes, she prepares prospective total joint replacement patients for the journey ahead.

As part of Nurses Week, Kathy tells us what first inspired her to become a nurse and why a “thank you” from a patient means so much: 

What brought you to nursing? Was there something that inspired this career choice?
Many years ago, I used to watch Marcus Welby, M.D. and some of the other medical shows on TV and I just thought, that looks like such a cool, fun thing to do. And that’s just where it all started. 

From there, I started as a nursing assistant when I was in high school, and even before that I was a candy striper. Throughout, I always thought, this feels good. I can do this. As I was going through college in nursing school, a good friend’s father, who was an anesthesiologist, gave me some advice. He told me that when I got out of school, I should go immediately to an ICU or an ER. He said, “That is where you continue your education. That’s where you don’t develop bad habits. That’s where you get all the good habits.” He emphasized, “Go to those two departments and you will become a better nurse because you will have to.” And it’s true because you have to think on your feet and react quickly.

So that’s what I did. I listened to him and I worked in the ICU for many years, and, now ambulatory surgery. And now with NorthShore, I have this nice perk of working with joint patients.

You work in ambulatory surgery at NorthShore but you're also part of the Patient Education Program at NorthShore’s Total Joint Replacement Center. What role do you play in the patient education process?

[Note: The Patient Education Program guides patients through the entire process of total joint replacement. Patients are asked to attend a class prior to surgery conducted by specially trained nurses. The class educates patients on how to achieve the best possible outcome before, during and after surgery.]

Patients come in just wanting to have a knee or a hip replaced. And in our experience, patients aren’t necessarily breaking down our doors to come to the class, which isn’t required but recommended prior to surgery. Most are told that they need to come by their doctors. But at the end of every class I heard, “You know I really didn’t want to come. I was really pushing my doctor not to make me come, but I’m so glad I did. It put my mind at ease. I’m not as afraid as I used to be.” And I like being a part of doing that. 

The nurses who teach the classes get to help patients know more and be less afraid. They’ve heard lots of different information from friends, family and all kinds of people telling what this surgery is going to be like.  Some come to the classes and they are in so much pain, hobbling and limping. They’re using canes and walkers and they are just looking miserable. And to be a part their transition … that’s a great thing to see. 

Why do you think educating patients is so important?
Patients that are educated understand what’s coming. The nurses on the floor can always tell if a patient has been to class or not. The educated patient knows what the treatment plan is and they know what their part in it is as well. The patients that have been to class are like, “Okay let’s get going. Let’s get moving and do it.”

Orthopaedics isn’t part of your day-to-day job in the ambulatory surgery department. Why did you decide to take on an extra task like this?
I thought it was a neat opportunity. I had worked orthopaedics years and years ago while I was still in nursing school. It’s something in medicine that is great to see. Patients come in one way—hurting and in a lot of pain—and then they leave almost with a new lease on life. They’re just feeling so much better and they can see that their walking, sitting, bending are in a better place, and will only improve. When the opportunity to be a part of it arose, I thought I should give it a try.  

It’s a great spectrum of experience. So while we don’t directly oversee the care of the patients after surgery, we do have input into their care. And it is fun to teach a patient class and then see them the day of surgery. They come in and they are little nervous and then they see your face, a face they recognize, and they immediately feel that someone’s in their corner, someone is going to take care of them. 

And then I always see them after and ask, “Did the class help?” And 99 percent answer, “Everything you said, it happened exactly as you said it would.” When a patient says that what I taught helped, that’s music to my ears. 

Do you have a favorite memory from your career thus far?
It’s just when patients thank you. Not just a, “Hey thanks,” but when it is from their heart. You can tell. Or when someone from their family comes up to you to say that you really made a difference in how we handled this process, when they just genuinely want to say thank you.  You didn’t do anything but do your job, but they appreciate it so it feels good. 

This week you can Say Thanks And Recognize (STAR) NorthShore's remarkable nurses by contributing to our Nursing STARs Scholarship Program here.


Healthy Recipes for a Happy Cinco de Mayo

Monday, May 05, 2014 9:27 AM comments (0)

Cinco de Mayo is a time to get together with friends and family to celebrate Mexican culture and, of course, food.  This year, try one or all of these delicious vegetarian recipes and keep your Cinco de Mayo happy and healthy. 

Katrina Herrejon, RD, Certified Diabetes Educator, Adult Endocrinology Group at NorthShore, shares three of her favorite Cinco de Mayo recipes: 

gazpacho“Mexican-Style” Gazpacho
Traditional Spanish gazpacho is a tomato-based vegetable soup that is served cold.  This “Mexican-style” gazpacho is also served cold (or at room temperature), but it’s more like a fruit and vegetable salad.  If you have never had this type of gazpacho before, you may be surprised how well the sweet, salty, tart and spicy aspects enhance the natural flavors of the fruit and vegetables.    

Serving size 1 cup
Recipe makes 4 servings
1c fresh pineapple, finely chopped
1c cucumber, finely chopped
1c jicama, finely chopped
1c mango, finely chopped
1/4c freshly squeezed orange juice
2 tbsp lime juice
1 tsp your favorite dried chili powder or cayenne pepper or paprika
1/4c queso fresco  (optional) 


  • Combine all ingredients in a large bowl and mix.
  • Distribute gazpacho evenly among 4 serving dishes and enjoy.

Nutrition Information (without cheese)
Calories: 80
Total Fat: 0g
Total Carbohydrate: 19g
Fiber: 3g
Protein: 1g

Nutrition Information (with cheese)
Calories: 104
Total Fat: 2g
Total Carbohydrate: 19g
Fiber: 3g
Protein: 2.5g


Some people avoid avocados because they are high in fat.  Luckily, avocados contain unsaturated fats, which, when eaten in moderation, are a delicious part of a healthy diet.  And it’s not Cinco de Mayo without a little guacamole. By serving guacamole with carrot and jicama sticks, you will be able to enjoy this tasty side dish without the extra calories and fat of tortilla chips.

Serving size 1/4c
Recipe makes 10 servings  
3 ripe avocados, halved, seeded and peeled
1 Roma tomato, diced
½ of a medium onion, diced
1 serrano pepper, seeded and minced
1 tbsp cilantro, finely chopped
1 lime, juiced
Salt to taste
2.5c carrot sticks (for dipping)
2.5c jicama sticks (for dipping) 


  • Place avocado pulp in a large bowl and mash. 
  • Fold tomato, onion, peppers, cilantro and lime juice into avocado. 
  • Serve immediately with carrot and jicama sticks. 

Nutrition Information
Calories: 106
Total Fat: 6g
Total Carbohydrate: 11g
Fiber: 2.5g
Protein: 2g


peppersPoblano Peppers and Onions
This traditional dish is often made with high fat crema Mexicana and/or cheese.  By using light sour cream and omitting the cheese in this recipe, the calorie content is greatly reduced and the star ingredients—the poblano peppers and onions—can really shine.

Servings size 3 tacos
Recipe makes 4 servings
5 poblano peppers
1 large onion, sliced
Cooking spray
3/4c light sour cream
12 corn tortillas
Salt to taste


  • Char the poblano peppers by placing them directly over a flame. 
  • Place the charred peppers in a plastic bag and seal. 
  • Remove the skins, seeds and stems from the peppers. 
  • Slice the peppers into strips. 
  • Coat a nonstick pan with cooking spray and heat.
  • Place onions in pan cook until golden. 
  • Add the pepper strips to the pan and cook for an additional minute. 
  • Remove pan from heat and stir in sour cream. 
  • Distribute pepper and onion mixture evenly among warmed tortillas. 

Nutrition Information (without tortillas)
Calories: 92
Total Fat: 4g
Total Carbohydrate: 9g
Fiber: 2g
Protein: 5g

Nutrition Information (with tortillas)
Calories: 242
Total Fat: 6 g
Total Carbohydrate: 39g
Fiber: 6.5 g
Protein: 8g

What are your favorite Cinco de Mayo recipes?


Finding a Style of Yoga That’s Right for You

Thursday, May 01, 2014 1:42 PM comments (0)

yogaIntrigued by yoga but not sure where to start? For beginners, yoga’s many styles and moves might be a bit overwhelming but don’t be deterred. Yoga is a great exercise for people of all ages, activity levels and body types; it’s just a matter of finding the one or combination of styles that’s right for you.

Finding the right style of yoga comes down to assessing your current level of fitness/ability and determining what you hope to achieve by adding yoga to your fitness routine.  Some styles are better suited to athletes looking to increase flexibility and stamina, while other more gentle styles are ideal for those with injuries or chronic medical conditions. But no matter the style, all yoga increases strength, flexibility and balance, while also releasing tension and calming the mind. After all, the goal of yoga is to create a bond between the mind and the body. 

Join us for Total Care for the Athlete at Heart on Saturday, May 3rd from 8-10:30 a.m. to learn more about Meditative Yoga as a Fitness Cool Down. Register for this free event by clicking here

Polly Liontis, Yoga Instructor and Licensed Massage Therapist, highlights some popular styles of yoga and discusses the health benefits and required fitness levels of each:

Hatha yoga focuses on breathing exercises and basic poses. Its more basic approach makes it an ideal style for beginners who need to accustom themselves to yoga’s poses and relaxation techniques.
Benefits: Hatha reduces stress, increases concentration and promotes a feeling of overall relaxation. It’s also great for the core.
Who can do it? Anyone, regardless of age or ability, can do Hatha!

Iyengar yoga is a form of Hatha yoga that focuses on alignment and precision during movement. Often straps, blankets and blocks are used to enable beginners and those with injuries to achieve the correct positioning without putting excess stress on muscles and joints.
Benefits:  Like all styles of yoga, Iyengar is a mind and body exercise. It promotes balance, builds muscle and can help with recovery after an injury.
Who can do it? Iyengar yoga is a gradual yoga. By including props and allowing one to progress slowly from one move to the next, it’s great for just about anyone, especially those with less mobility after an injury.

Vinyasa yoga seeks to synchronize movement with breath. The key to Vinyasa is to flow smoothly from one movement to the next, which is why it is also frequently referred to as Vinyasa Flow.
Benefits: Vinyasa gets you moving more than Hatha so there’s the added cardiovascular benefit. It also builds lean muscle, improves strength and flexibility, and tones abdominal muscles.
Who can do it? It’s a bit more physically demanding and fast-paced than Hatha, but Vinyasa is still great for beginners and those looking to move from beginner to intermediate level. 

Ashtanga yoga is a form of power yoga that is fast-paced and intense with lunges and push-ups. The six-move sequence flows rapidly from one strenuous pose to the next and is paired with Vinyasa-style breathing. 
Benefits: Like with any style of yoga, Ashtanga reduces stress and improves coordination and balance. It’s quite a workout too, which means the added benefit of potential weight loss and full-body toning. 
Who can do it? Ashtanga yoga is best for fit people who wish to maintain or increase their strength and stamina. It would be helpful to be familiar with the six basic poses in the Ashtanga sequence before jumping into an Ashtanga class.

Bikram yoga, also known as hot yoga, is practiced in a humid room with temperatures kept at 95 - 100 degrees. All Bikram sessions are 90 minutes and consist of the same 26 poses and two breathing exercises.
Benefits: The heat of Bikram facilitates a deeper stretch, and increased perspiration helps flush and cleanse toxins from the body. It’s a gently intense workout with weight-loss possibilities.
Who can do it? The heat might make it a bit of a stretch (no pun intended) for beginners but after you’ve gotten the hang of the heat and the poses, it’s a good yoga style for intermediates looking to push themselves to new levels.



Childhood Vaccines: Myths, Misconceptions and the Important Health Benefits

Wednesday, April 30, 2014 11:23 AM comments (0)

vaccinated babyWith so much conflicting information circling Internet about vaccines and whether they are safe or unsafe for children, especially via social media and blogs, Leslie Deitch Noble, MD, Pediatrician at NorthShore, reminds us why childhood vaccines are so important and addresses some of the common myths and misconceptions that parents encounter online:

“I love being a general pediatrician because of the unique privilege I have of getting to know families in a meaningful way and seeing the children in those families grow up over weeks, months and years. There is no greater reward than helping a child become and then stay happy and healthy. To that end, it is my goal to not only treat a child’s illness and address immediate problems, but, more importantly, to prevent illness whenever possible. That’s why I’m so passionate about immunization for my patients and my own loved ones.” 

Should I have my child vaccinated? Why?
The simple answer: to prevent your child from contracting life-threatening illnesses. Vaccines have been incredibly successful at reducing the prevalence of diseases like polio, measles, whooping cough, meningitis and chicken pox, but these diseases have not been completely eradicated, especially in other parts of the world. We live in a global society, and thanks in part to lapses in vaccine rates throughout the U.S., we are seeing a resurgence of vaccine-preventable diseases in our country. The ability of vaccination to reduce the incidence of disease depends on herd immunity, meaning the vaccination of a significant portion of the population. So, if children are vaccinated, that provides protection for everyone in the community, including those receiving chemotherapy for cancer who are unable to receive the inoculations themselves.  

Vaccination Schedule for Infants & Children 

  • Birth: HBV (Hepatitis B)
  • 1-2 months: HBV second dose
  • 2 months: DTaP (Diphtheria, tetanus, acellular pertussis), Hib (Haemophilus influenzae type b), IPV (Inactivated poliovirus), PCV (Pneumoccoccal conjugate), Rota (Rotavirus)
  • 4 months: DTaP, Hib, IPV, PCV, Rota
  • 6 months: DTap, Hib, PCV, Rota
  • 6 months and annually: Influenza
  • 6-18 months: HBV, IPV
  • 12-15 months: Hib, MMR (Measles, mumps, rubella), PCV, Chickenpox
  • 15-18 months: DTaP
  • 4-6 years: DTaP, MMR, IPV, Varicella
  • 11-12 years: HPV, Tdap (tetanus, diphtheria pertussis booster), Meningococcal vaccine and then a booster at 16

Do vaccines cause autism?
No. Vaccines, especially the MMR (measles, mumps and rubella) vaccine, were inaccurately linked to the rise in autism rates. This claim, which grew from Andrew Wakefield’s small (only 12 subjects) and now discredited 1998 case report, has been disproven in large-scale studies.

Another reason that MMR may have been linked to autism is due to the timing of the vaccine, which is administered between 12 and 15 months of age. Autism also begins to present itself around 12 months when affected children do not meet social and language skills milestones.  But it has been proven repeatedly in large-scale studies that there is no link between vaccines, including the MMR, and autism.  

Are vaccines “too much” for children’s immune systems?
Our immune systems, including those of babies and children, are exposed to tens of thousands of foreign substances (i.e., antigens) every single day, which is significantly higher (1000-fold) than what children are exposed to in a vaccine. Administering multiple vaccines at the same appointment is both safe and effective. Combining vaccines into one visit also leads to fewer appointments and, more importantly, fewer tears.

Are preservatives in vaccines harmful?
Preservatives (the purpose of which are to keep vaccines hygienic and free from bacteria) and stabilizers in vaccines have also been proven in many large, controlled studies to cause no harm.  Babies are exposed to larger amounts of preservatives in their natural environment, including preservatives transferred from mother to baby in breast milk.

What about “alternative”, “slow”, or “delayed” vaccine schedules?
No. The medical community (The Centers for Disease Control, The American Academy of Pediatrics, The Institute of Medicine, The American Medical Association) advocates following the Recommended Immunization Schedule for Persons 0-6. This schedule has been specifically designed, researched, and tested to be the safest and most effective way to immunize children. Deviation from this schedule leaves children vulnerable to vaccine-preventable diseases and illnesses like whooping cough, meningitis, measles and more, all of which can be life-threatening. 

Where can I go to read reliable information about vaccines? Your child’s pediatrician is the best person to come to with any questions, concerns or the recommended schedule of vaccinations. The following are links to reputable organizations and studies for more information:

  1. Summaries of numerous studies on vaccine safety, including those referenced in this post.
  2. The CDC on Basics and Common Questions   
  3. Every Child By Two
  4. VaccinateYourBaby.org
  5. The American Academy of Pediatrics’ parent website
  6. AutismSpeaks.org



Put Your Best Face Forward: Skin Care and More

Tuesday, April 22, 2014 9:44 AM comments (0)

The natural aging process, sun exposure and the everyday wear and tear of the elements can take a toll on the look and feel of your skin. Achieving and maintaining truly healthy skin requires more than just an occasional wash with soap and water. That's why it's important to protect and nourish your skin with a thorough daily skin care regimen.

In our latest  infographic, we share some simple ways for men and women to protect their skin, from sun up to sun down. Click on the image below to view the full infographic of healthy skin care tips from the experts at NorthShore University HealthSystem.
Skin care infographic 


Psoriasis: Do You Know Your Triggers?

Friday, April 18, 2014 12:56 PM comments (0)

psoriasisPsoriasis, which can first show symptoms between the ages of 15 and 25, often has a severe impact on an individual’s physical health as well as their confidence. A chronic condition, psoriasis occurs when new skin cells replace the old too quickly, creating areas of skin with thick, scaly red patches of various sizes. In some cases, the skin condition also creates swelling and pain in the joints, called psoriatic arthritis. Approximately 7.5 million Americans or 2.2 percent of the population suffers from psoriasis, according to the National Psoriasis Foundation.

Fortunately, there are treatments available for psoriasis that can reduce the severity of the symptoms. For example, your dermatologist may prescribe medicated skin products, UV treatments, or other systemic  medications  to reduce symptom severity, although it may take time to determine which course of treatment will yield the best results. 

For most, symptoms often become worse following certain triggers. Therefore one of the best steps you can take in controlling your psoriasis is to identify and avoid those triggers that can cause flare-ups. Stephanie Mehlis, MD, Dermatologist at NorthShore, highlights some common psoriasis symptom triggers:

  • Infection
  • Scratching the skin
  • Medication
  • Smoking
  • Stress/anxiety
  • Sunburn

How do you cope with symptoms of psoriasis? What triggers your symptoms?


Finding Her Voice: Bonnie Lee Fusfeld on Her Daughter's Journey from Silence Back to Laughter

Wednesday, April 16, 2014 4:23 PM comments (0)

Hannah Fusfeld

On April 14, 2013, Hannah Fusfeld lost her voice, and within a couple of hours she was visibly ill. It was the first day of what would become nearly four months of missed school days, ice-skating practices and time away from and inability to communicate with her friends, family and community. Hannah’s illness made it impossible for her to communicate even her most basic needs. She was eventually diagnosed with combination of mononucleosis, or mono, and whooping cough. 

Hannah and her family saw three different doctors before deciding they needed to look for help outside Green Bay. After nearly four months with no voice at all, Hannah and her parents found the NorthShore Voice Center. Aaron Friedman, MD, Otolaryngology, and Christine Buth Martin, Speech Therapist, helped give her back her voice in one three-hour session. 

Hannah’s mom, Bonnie Lee Fusfeld, shares the experiences of the entire family, the downs and eventual ups, in their NorthShore Patient Story:

As a parent, when your child is ill, there is a vise that grips your heart. It doesn’t matter who you are or what you do, the constriction of fear is present every second of every day.  The constant unanswered questions like, “What are we missing?” and “What hasn’t been found yet?” are isolating.  

After four months of what seemed like constant questions, it felt like a gift to sit in Dr. Friedman’s office and have him research Hannah’s history, assess, accurately diagnose and then, not only provide treatment, but actually show us what was happening. Dr. Friedman scoped Hannah with a type of scope that had not been used on her before. He videotaped what was happening in the musculature of Hannah’s vocal cords; he taught us about our daughter’s health problem.  

The word “healer” gets bandied around a lot these days and means many things to many people. To me a healer is someone who opens the door for change to occur, someone who creates hope. Dr. Friedman did this the first time he sat down with us. Christine took that opened door and pushed it wide open. Christine not only treated Hannah with vocal massage and literally unthawed her vocal cords, but she helped us, as a family, unthaw as well. Fear, worry, hope, joy and laughter all came into that room and Christine facilitated that without being intrusive. She was only kind, compassionate and extremely skilled.

This experience has been a tremendous gift to our family, a gift that quite literally saved us. We had the understanding of friends, business associates and Hannah’s educational community and her KICKS Synchronized Skating family but it was still extremely hard.

Our family still has some hurdles to overcome. It’s been a year since the onset of Hannah’s illness and she’s doing great. She’s 17 now and back in school full time. She’s looking for colleges and works as a coach at the skating rink and as a receptionist at our local chiropractor’s office. And, she is skating again. Hannah is active and busy but she still has challenges, like making sure to watch her fatigue level, but she is learning. We are learning too. We are learning how to guide a 17-year-old young woman, who is heading into adulthood, on how to make good health decisions for herself. Hannah knows even though she is recovering, she is still building her strength. For example, a two-day flu for most would take Hannah down for a week—she has to learn to manage that. And sometimes she just doesn’t have the strength to do it all, but the amazing thing is that she keeps trying, she keeps going. That is what I respect most about my daughter: no matter what knocks her down, she just picks herself back up and moves forward.

Thank you to the Cornerstone Community Center for graciously donating ice time during the filming of our NorthShore Patient Story. 


Parkinson's Disease Research at NorthShore Strives to Lead to Better Patient Outcomes

Friday, April 11, 2014 1:11 PM comments (0)


As part of National Parkinson’s Disease Awareness Month, Demetrius Maraganore, MD, Chairman of Neurology at NorthShore, shared some of the findings of his ongoing research into the genetic factors that influence Parkinson’s disease progression and outcomes. He also tells us why research like this is so important for Parkinson’s disease patients and their families: 

Why is funding for and research into Parkinson’s disease so important? 
It’s important because the treatments that we have available don’t prevent Parkinson’s disease (PD) or slow or halt its progression.  PD is characterized by progressive motor and cognitive impairment.  PD patients have a seven-fold increased risk of nursing home placement and a two-fold increased risk of death.  The annual cost of PD in the U.S. exceeds $23 billion. Presently 2% of people will develop PD during their lifetime, and the prevalence of PD is expected to double by 2030. The cumulative burden of PD to society is and will be staggering.  Our patients and their families deserve methods to predict, prevent and halt PD and those will only come through research.

How long have you been conducting research into Parkinson’s disease?  
My research in Parkinson’s disease (PD) started in 1989, when I was an honorary clinical and research fellow to the late Professor C. David Marsden at the National Hospital for Neurology and Neurosurgery in London, England.  Dr. Marsden was the founder of the international Movement Disorders Society and its official journal, Movement Disorders.  His associate, Professor Anita Harding, was a pioneer in the field of neurogenetics.  Together, we launched the first genetic studies of Parkinson’s disease.  

That has remained the focus of my research, including for 20 years on the faculty of the Mayo Clinic in Rochester, MN, and in the four years that I have been Chairman of Neurology at NorthShore. While my research at Mayo focused on identifying genetic factors that contribute to the cause of PD, my research at NorthShore has focused on understanding how those genetic factors influence disease progression and outcomes.  Our research aims to develop methods to predict outcomes in PD, and to use that information to improve neurological health.

Why have you focused the bulk of your career on the study and treatment of Parkinson’s?  
As a clinician, it’s very gratifying that there are many treatments that we can employ in the first many years to reduce the burden of the disease on patients and families.  However, I recognize that the benefits of the existing treatments wane with time, and I’m driven by the sense of urgency to identify the factors that contribute to the progression of Parkinson's disease. Our goal is to target those factors so that every individual patient can have the best possible outcome. 

For more information on the NorthShore Neurological Institute and the research being done at NorthShore, click here. 

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