As the weather finally starts to get seriously cold, we thought this would be a good time to revisit our conversation with Dr. Ginard Henry on Cold Hands Syndrome. While it seems like your frozen fingertips could be fixed by simply wearing a good pair of gloves, Cold Hands Syndrome is a real medical condition caused by a range of different diseases that restrict blood flow to extremities. It can strike at any time, not just the dark days of winter.
For more, check out our four-part video Q&A with Dr. Henry:
Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine. When a person who has celiac disease consumes gluten, a protein found in wheat, rye and barley, the individual’s immune system responds by attacking the small intestine and inhibiting the absorption of important nutrients into the body. At least 1% of Americans, or nearly 3 million people, have celiac, but 97% of them are undiagnosed.
The University of Chicago Celiac Disease Center is an international center of excellence providing comprehensive patient and professional education, expert diagnosis and treatment for both children and adults, groundbreaking bench and clinical research, and active leadership in advocacy efforts. Their goal is finding a cure for celiac disease by 2026. We spoke to Dr. Stefano Guandalini, medical director of the Celiac Disease Center, about this unique, comprehensive research and treatment approach. We also discussed the link between celiac and diabetes, and asked pediatric dietitian Lara Field from Comer Children’s Hospital how people with both diseases manage their diets. Lara also discussed how children with celiac disease can learn to go gluten-free.
The hepatitis C virus has always been an unusual disease. Largely symptom-free in its early stages, many people are unaware for many years that they have contracted the virus. But if left untreated, hepatitis C can eventually cause severe liver damage that may necessitate an organ transplant. Until recently, physicians have had only limited success in combating the hepatitis C virus, administering a lengthy combination of two drugs that completely cured less than half of the patients treated.
However, in recent months the forecast for curing hepatitis C patients became much sunnier. The near simultaneous FDA approval of not one, but two new therapies for the virus - called telaprevir and boceprevir - promises to dramatically improve the cure rate for the disease and prevent serious cases of liver cirrhosis and cancer. The two drugs are members of the same protease inhibitor class that has revolutionized HIV treatment, and adding one to the previous two hepatitis C therapies (forming what’s known as “triple therapy”) promises to increase cure rates to as high as 80 percent.
But new therapies bring loads of new questions and considerations for patients. At the University of Chicago Center for Liver Disease, which takes care of hundreds of hepatitis C patients, physicians Donald Jensen and Andrew Aronsohn organized a series of patient education sessions to address how the new therapies change the landscape of the disease. While many patients have been waiting years for the approval of telaprevir and boceprevir, choosing the right time to begin therapy is no simple decision. Because the therapy still takes between 24 and 48 weeks to complete, and must be closely monitored to make sure the protocol is successfully followed by the patient, hepatitis C clinics can only start treating so many patients at a time. In an editorial for the journal Hepatology, Jensen and Aronsohn explained why the University of Chicago has thus chosen to treat the sickest patients first, asking hepatitis C patients in the earlier, less severe stages of the infection to delay their therapy with the new agents.
To further spread information about these decisions, the basics of hepatitis C, and the impact of the new therapies, Jensen and Aronsohn agreed to film a series of videos for ScienceLife. Watch as the two physicians explain how the new therapies work, what patients can expect from the new treatment protocol, and why it is important for patients and their physician to choose the right time to start therapy.
Endoscopy and colonoscopy are well-known tools of the physician, minimally invasive devices that navigate the channels of the digestive system to spot cancers, ulcers, and other defects once difficult to spot without major surgery. In the shadow of these procedures lies bronchoscopy, which uses similar technology to explore the labyrinth of the lungs. With the flexible tube of the bronchoscope, a pulmonologist can detect potentially cancerous lesions, take samples for pathological testing, help remove dangerous nodules, and apply heat or install valves to help treat asthma and emphysema. We discussed this exciting new world of bronchoscopy with D. Kyle Hogarth, assistant professor of medicine at the University of Chicago Medical Center and an expert on the field. Hogarth discusses the basic warning signs and risk factors for lung disease, talks about the innovative new bronchial thermoplasty treatment for severe asthma, and gives an overview of how bronchoscopes help physicians locate and remove lung cancers.
The concept of viral cancer has only recently begun to take root in public awareness, predominantly through the disease of cervical cancer. Nearly all cases of cervical cancer are now known to be caused by the human papilloma virus, HPV, which is transmitted through sexual contact. The 2006 approval of Gardasil, a vaccine against HPV, has offered a preventive measure against infection and cervical cancer.
But it’s becoming increasingly clear that the cervix is not the only place that HPV-positive cancer can appear. Since the 1980’s, physicians have found the virus in certain cases of head and neck cancer, primarily in younger patients with oropharyngeal tumors. Since then, the incidence of HPV-positive head and neck cancer has increased by 3 percent each year, said Ezra Cohen, an assistant professor of medicine and an expert on the disease.
“Many people are beginning to call this an epidemic, and I think that’s a fair description,” Cohen said. “Three percent may not sound like a lot, but if you multiply that over 30 or 40 years then you have a dramatic increase in the number of cases we are seeing, to the point where now…the majority of patients with oropharyngeal cancer we see in the United States and Western Europe are HPV-positive.”
As a result, the rates of head and neck cancer in the United States have remained steady despite drop-offs in smoking behavior, another major risk factor. Like cervical cancer, the spread of HPV-positive head and neck cancer appears to occur via sexual transmission - in this case oral sex - and the disease may be prevented by early use of the vaccine in both females and males.
In these videos, Cohen explains how the link between HPV and head and neck cancer was originally discovered and how researchers currently think the virus causes cancer to form. Cohen also discusses the use of HPV vaccines in preventing head and neck cancer and the use of HPV as a biomarker for determining the most effective and appropriate treatment for a patient.
On the grim top 10 list of the most common cancers in the United States, familiar faces sit at the top of the charts. Prostate cancer for men, breast cancer for women, lung and colon cancer for both sexes - all are diseases that have inspired massive awareness and fundraising efforts to inform patients and bolster scientific research. But the #5 cancer on the list (the #4 most commonly diagnosed cancer in men) has not gotten nearly as much attention as the Big Four. Bladder cancer was diagnosed in an estimated 71,000 people last year, according to the Bladder Cancer Advocacy Network, but does not have the high profile of its kin.
Bladder cancer survivors and physicians hope to change that with the first Bladder Cancer Awareness Day, to be held this Saturday, July 17 with events around the country. It seemed like a good opportunity to sit down with our resident expert on bladder cancer, Dr. Gary Steinberg, for a comprehensive overview of the disease. Steinberg, the Bruce and Beth White Family Professor at the University of Chicago Medical Center, is a surgeon that specializes in the treatment of bladder cancer - both the removal of tumors and the bladder reconstruction that sometimes follows.
The risk factors for bladder cancer are not unique - smokers are twice as likely to develop the disease, while several industrial chemicals have been linked with tumors of the bladder, Steinberg says. As with many cancers, it’s a misnomer to think of bladder cancer as just one disease. Steinberg talks about the different types or “grades” of bladder cancer, and the range of treatment options available to patients with those diagnoses. He also describes ongoing research efforts to improve those treatments, from work with the Cancer Genome Atlas to find novel therapeutic targets for chemotherapy drugs to trials using stem cells to construct new urethras and bladders.
As the weather warms in the Chicago area, it might seem like a strange time to be talking about cold hands. But for some people, uncomfortably cold hands is not just an artifact of the long Midwestern winter, but a medical syndrome that may require treatment. Defined by its primary symptom rather than a single cause, Cold Hands Syndrome is marked by, well, cold hands, as well as pain, numbness and occasionally discoloration or even tissue damage. The source of these symptoms is a loss of circulation to the hands and fingers, but the cause of that decreased blood flow can range from Raynaud’s Disease to blood clots to arteriosclerosis to lupus to scleroderma. As Ginard Henry, assistant professor of surgery at the University of Chicago Medical Center, describes it, Cold Hands Syndrome is “a range of different diseases” that cause similar symptoms in one’s extremities.
“Your hands are almost like a lawn at the end of a street, and you are giving the lawn water to grow,” Henry said. “If anything disrupts that flow of water then the lawn doesn’t grow and you have a problem.”
Henry and colleagues Lawrence Zachary, associate professor of surgery, and Nadera Sweiss, assistant professor of medicine, have launched the Cold Hands Clinic at the Medical Center, uniting expert physicians from a number of disciplines to focus on this unusual problem. I sat down with Henry to ask him about Cold Hands Syndrome: what it is, how it’s diagnosed, and how it is treated. Befitting the diverse causes of the disorder, there are a number of different treatments, including measures as simple as moisturizing and the use of drugs such as Viagra and Botox for, shall we say, purposes other than their primary use.
Here in the Upper Midwest, the first sustained period of spring sunshine draws everyone outdoors to stare at that big orange circle in the sky we haven’t seen in months. But as good as it feels to bask in the sun after a long winter of cold rain and snow, that enthusiasm must be tempered with an awareness of sunlight’s ability to harm. Not to be a killjoy, but skin cancer rates have steadily climbed over the last 20 years in the United States, and while many of those cancers are easily treated, several thousand a year are fatal. The good news is that skin cancers are also easy to prevent with simple measures such as wearing sunscreen, protective clothing or avoiding the peak hours for harmful ultraviolet rays.
The medical field of dermatology is progressing rapidly in finding new ways of treating skin cancer, from creams to photodynamic therapy to surgery. Hospital-based dermatologists have the advantage of seeing patients in a collaborative environment, where patients with rare or special circumstances can be treated by doctors from several different disciplines. At the University of Chicago Medical Center, Dr. Maria Tsoukas, assistant professor of medicine and dermatologist, is working with oncologists to provide skin cancer prevention and treatment in vulnerable patients with weakened immune systems due to chemotherapy. In the videos below, Tsoukas talks about that effort, while also offering general tips for skin cancer prevention, summarizing how skin cancer is diagnosed and treated in the clinic, and discussing current frontiers of research in the field.
There are probably few medical topics more plagued by online misinformation than stem cell transplants. Part of this confusion is down to people mixing up embryonic stem cells, which have yet to be adapted to clinical use, with hematopoietic stem cells, which have been used in transplants for over four decades. Hematopoietic stem cells are found in bone marrow and circulating blood and are less versatile than their embryonic counterparts, as they are only capable of turning into blood cells. But for patients with blood disorders and cancers such as leukemia or multiple myeloma, a transplant of stem cells from a healthy, compatible donor can be a life-saving procedure.
This weekend, dozens of stem cell transplant patients and their families will come to the University of Chicago Medical Center for a reunion event to celebrate the impact the procedure made on their lives. Many will also reconnect with the physicians and nurses who helped them through their transplant experience, which involves strong chemotherapy and very careful (and sometimes lengthy) screening for compatible donors. Lucy Godley, assistant professor of medicine, is one of the Medical Center’s stem cell transplant experts, serving in both the clinic and the laboratory to help patients and push forward the frontiers of the procedure. We sat down to talk about the basics of stem cell transplants: what diseases it is used for, what the experience is like for donors and patients, and how research is expanding the number of patients eligible for the treatment.
Enjoy the videos, and tune in next week for interviews and footage from the stem cell patients’ reunion.
When we chatted with University of Chicago psychiatrists about the proposed changes to the DSM-V - the diagnostic manual for mental disorders - there was one much talked-about piece missing: eating disorders. Many media outlets writing about the DSM-V draft mentioned a change in the chapter on eating disorders that sounds small but could be highly clinically significant, the addition of binge eating disorder as the chapter’s third discrete condition alongside anorexia nervosa and bulimia nervosa. Unlike those two more-established disorders, which can result in dangerous weight loss, binge eating disorder could produce weight gain. Inclusion of binge eating in the chapter on eating disorders thereby could signal a shift toward medically treating overeating, like undereating, as a mental illness.
Daniel Le Grange, professor of psychiatry and behavioral neuroscience and director of the eating disorders center at the University of Chicago Medical Center, said that may be true - researchers and physicians in his field are looking more and more at uncontrollable overeating as a disorder. But binge eating disorder itself is not an entirely new condition; instead, it has long existed in the diagnostic limbo of “eating disorders not otherwise specified,” a catch-all term for less common or less discrete conditions. Still, if the DSM-V draft recommendations are approved, binge eating disorder may receive more attention from doctors and scientists, leading to treatment advances in an area where effective treatments, even for anorexia and bulimia, are relatively new and sometimes lacking in supporting evidence.
In this week’s Dr. FAQ, Le Grange talks about the proposed changes to the DSM-V chapter on eating disorders and binge eating disorder in general. He also explains what treatments are currently used for eating disorders, and what is known about the causes of those conditions (spoiler alert: very little). Finally, Le Grange talks about the eating disorders research being conducted at the University of Chicago, including his work on the Maudsley Approach, a family-based treatment for eating disorders in adolescent patients. Le Grange will be speaking at a conference for families of adolescents with eating disorders in Chicago on April 26th.
The latest in our video series where experts from the University of Chicago Medical Center answer frequently asked questions about popular medical topics. To suggest a topic or a question, please contact the editors.
Over the last decade, bariatric weight loss surgery evolved from a curiosity to a routinely-performed procedure, an increasingly popular option for people suffering from severe obesity. According to the American Society for Metabolic & Bariatric Surgery, roughly 220,000 Americans had weight-loss surgery in 2008, almost 20 times the number of patients who had such surgery performed in 1998. As those numbers have grown, the procedure itself has changed and improved - most bariatric surgery is now performed using minimally-invasive, laproscopic techniques, and there are a variety of different surgical options available to each patient.
The University of Chicago Medical Center was among the first hospitals to offer bariatric surgery for weight loss, and are today the only medical center in the area to offer all four surgical options currently approved and available. The strategy behind these options falls into two general groups: reducing the size of the stomach, and rerouting the digestive system to bypass the stomach or large sections of the intestines. In one procedure, called the duodenal switch, both of these strategies are employed, with the stomach reduced to a much smaller “sleeve” while the small intestine is rerouted so that absorption can only occur in the final three feet.
Last fall, the ASMBS accepted one half of the duodenal switch surgery - the stomach reduction portion - as a stand-alone procedure called vertical sleeve gastrectomy. Shortly thereafter, the Medical Center began offering the vertical sleeve gastrectomy procedure as an option to patients seeking weight-loss surgery. I sat down with Dr. Vivek Prachand, who performs all four of the bariatric surgery options, to talk about how the vertical sleeve procedure differs from the other surgeries. We also spoke more generally about what types of patients are appropriate for bariatric weight-loss surgery, common myths surrounding the procedure, and the importance of follow-up care in many dimensions to truly produce a healthier lifestyle in severely obese patients. Enjoy the videos.
Autoimmune disorders are a strange type of disease, a case where the body’s biology isn’t breaking down but rather is functioning too well. In disorders such as Type I diabetes, arthritis and multiple sclerosis, the body’s natural defenses stage something of an internal coup, mistakenly attacking the body’s own tissues instead of viral or bacterial invaders. In a lot of these diseases, the immune system chooses just one system to mistakenly attack - the pancreas in diabetes, or the joints in arthritis. But one autoimmune disorder is less specific, striking out against multiple targets that can differ from patient to patient - lupus.
Known clinically by its longer name, systemic lupus erythematosus (SLE), lupus afflicts roughly 1% of the American population, according to CDC statistics. But that number could also be three times higher, the CDC cautions, an imprecise figure partially down to the difficulty of diagnosing the disease. As Tammy Utset, associate professor in the Section of Rheumatology at the University of Chicago Medical Center describes in the videos below, lupus can present with any number of different symptoms, from fever, rash and fatigue to hair loss, joint pain and kidney disorders.
“It’s a little tricky because the symptoms are so varied from person to person,” Utset said. “That’s why it can take a long time for lupus to come to diagnosis after the symptoms start, because the symptoms early on can be relatively non-specific.”
The diverse range of symptoms is only one of lupus’ mysteries. The disease also has a very skewed incidence between genders, with 9 out of 10 cases in women. Across ethnic lines, lupus strikes minority populations more often - the CDC states that the disease is three times more likely to strike African-American women than Caucasian women, and symptoms tend to be more severe in these populations. At the University of Chicago, the Gwen Knapp Center for Lupus and Immunology Research has been grappling with research questions regarding this discrepancy and potential genetic factors in the development of lupus. Tomorrow, I’ll discuss some of the genetic research coming from that group, but today, here are four videos of Dr. Utset talking about the unique clinical character of this unusual, but hardly rare, autoimmune disease.
The latest in our video series where experts from the University of Chicago Medical Center answer frequently asked questions about popular medical topics. To suggest a topic or a question, please contact the editors.
If you’re a frequent reader of the sports pages, you probably have a pretty good familiarity with the terminology of sports medicine. Concepts like ACL tears, plantar fasciitis, Tommy John surgery and arthroscopic surgery are all frequent mentions of the injury report, lending sports fans at least a surface-level grasp of the common injuries and procedures. One treatment that has recently received a boost of mentions amid the box scores and locker room interviews is platelet-rich plasma therapy - PRP therapy for short.
Many first heard about PRP therapy in early 2009 after Pittsburgh Steelers stars Hines Ward and Troy Polamalu praised the procedure for helping them recover from injuries in time for their Super Bowl XLIII victory. Recently, a second uptick of attention has resulted, somewhat infamously, from news reports about the doctor that helped treat Tiger Woods’ knee injury in 2008 - Anthony Galea, a Canadian specialist under investigation for administering performance-enhancing drugs. But lest PRP therapy (a safe, legal treatment) be confused with the more unsavory treatments that also show up in those articles, I went to J. Martin Leland, an assistant professor of surgery in the orthopaedic sports medicine group at the University of Chicago Medical Center, to learn the facts.
Leland told me that the idea behind PRP therapy - using a patient’s own blood to assist the healing process - has been around for decades, but has gained momentum among sports medicine professionals over the past couple years. The procedure is easy (able to be completed in one doctor’s visit), safe, and relatively cheap (though not covered by most insurance plans). But Leland cautioned that PRP therapy is not a magic solution for all sports injury woes, and that much more clinical research must be done to determine just how effective the treatment is in combination with more established surgical procedures. Those topics, and more, are discussed in the videos below.
Update: On January 13, the day after we posted these videos, an article in the Journal of the American Medical Association found no significant effect of PRP therapy upon pain and activity in patients with chronic achilles tendinopathy. Dr. Leland commented:
A Dutch study published in the Jan. 13, 2010 issue of the Journal of the American Medical Association (JAMA) found that an injection of platelet-rich plasma (PRP) performed no better than saline for chronic Achilles tendinopathy patients who were treated with eccentric exercises. This is an important study because it is one of the first of its kind regarding the effectiveness of PRP when used for the treatment of different issues in humans. However, this is only one of the first studies to come out and rash decisions should not be made based upon its findings alone. I feel that physicians and patients should remain “cautiously optimistic” regarding the use of PRP. Over time, more and more studies will be published regarding the effectiveness of PRP. This study is a perfect example that PRP is not the solution to every problem. However, this is only one study on one specific disorder in the human body. Much more research is needed to determine if this study can be reproduced in other studies as well as what the effectiveness is of PRP on other parts of the body. In my opinion, the risks of PRP use are low and the benefits, in certain situations, may warrant its use. However, only research in the future will be able to specifically determine when and where PRP is specifically effective.
More information on the JAMA finding is available here.
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The hepatitis C virus has always been an unusual disease. Largely symptom-free in its early stages, many people are unaware for many years that they have contracted the virus. But if left untreated, hepatitis C can eventually cause severe liver damage that may necessitate an organ transplant. Until recently, physicians have had only limited success in combating the hepatitis C virus, administering a lengthy combination of two drugs that completely cured less than half of the patients treated.
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