Kansas City brims with new and improved health-care techniques and treatments.
Clot retrieval device
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A new center for advanced breast cancer patients. Robust advancements for stroke, and Alzheimer’s and Parkinson’s disease patients. Innovative immunotherapy not only for cancer patients, but for others as well.
Kansas City is ripe with new and improved health-care techniques and treatments. In fact, neurosurgeon Dr. Paul Camarata at the University of Kansas Hospital puts Kansas City’s health-care grade card at an A-minus.
“I think it’s fabulous,” he says. “We’re doing everything they are in the major centers. There’s always room for improvement, but I would say anybody really can get the best health care here in Kansas City if they get to the right place.”
As we start 2017, 435 Magazine offers a glimpse at just a few of the many innovations that keep our city on the cutting edge of health care.
Immunotherapy, a pioneering treatment being used at the University of Kansas Cancer Center and other area institutions that boosts the body’s own immune system to fight cancer, is also being used in other ways. For example, Children’s Mercy Hospital is using oral immunotherapy to help kids with food allergies.
Dr. Chitra Dinakar, a pediatric allergy and immunology specialist at CMH, says that up to 15 million Americans have food allergies and that 6 million of them, or 1 in 12, are children. The economic burden to their families is $4,600 a year on average.
“Food allergies insinuate into every aspect of your life because of the risk of anaphylaxis and death,” Dinakar says. Ordinary things like going to the mall or school or even just sitting in the bus next to somebody who offers a candy bar with peanut butter in it can be a scary proposition.
“We had no option for these patients except to feel bad for them and say, ‘I’m sorry, but you really need to strictly avoid the food,’” Dinakar says, which means reading labels constantly and worrying about the safety precautions of the manufacturers. “That makes life really hard. But now we have a strategy called immunotherapy.”
Basically, oral immunotherapy occurs when the food allergen — a commercially manufactured powder mixed with a harmless food like applesauce — is administered slowly in small but steadily increasing doses until the patient is desensitized to it. CMH is involved in studies on oral immunotherapy.
Dinakar says she get at least one email a day from patients in the region who want to participate in the studies.
“I would say Children’s Mercy is on the map of leading institutions,” regarding this area of health care, she says. “It’s really amazing now to have an option that can make their lives better. I’m really glad Children’s Mercy and our food allergy center are able to offer these options.”
Did you know that boxing helps patients with Parkinson’s disease? Boxing centers here, such as Overland Park’s In Your Corner and Title Boxing Club 119th, offer Rock Steady Boxing, a program new to the area that enables Parkinson’s patients to fight their disease with non-contact boxing-style fitness by requiring continual movement and coordinated footwork.
Dr. Stanley P. Fisher, a Saint Luke’s Medical Center physician whose specialties include Parkinson’s and Alzheimer’s disease, says he routinely tells his Parkinson’s patients that exercising, such as boxing or tango dancing or tai chi, are beneficial for them because the disease effects the area of the brain that is responsible for smooth and appropriate movement.
In other Parkinson’s-related news, Fisher is particularly excited that, for the first time, a dedicated medication for Parkinson’s disease is available that helps patients with the psychosis sometimes associated with it.
“Parkinson’s patients often suffer from hallucinations, mostly visual hallucinations, as well as delusions,” he says. “The most common delusions are delusions of infidelity and delusions of abandonment. It can be very disruptive and very damaging to a spousal relationship and family life. If you suspect your spouse of constantly cheating on you, or if you think your house is being sold and you're being put in a nursing home, as you can understand that can put stress on a family.”
The new drug, Nuplazid, is the first drug that is not anti-psychotic, he says.
“Anti-psychotics block dopamine, that’s how they stop hallucinations,” Fisher explains. “But Parkinson’s patients already don’t have any dopamine. So blocking more dopamine in them can worsen their disease. So we always had that significant dilemma of how to treat their psychosis. Now we have a new drug that works differently and, therefore, seems to be a lot safer.”
More drugs to help Parkinson’s disease patients are in the pipeline, he says.
“Parkinson’s disease has become the truly most treatable neurological disease to such a point that when I diagnose Parkinson’s patients, I tell them ‘I have good news for you. You have Parkinson’s disease.’ They say, ‘how is that good news?’ And I say, ‘Well, we already knew something was wrong, right?’ They say, ‘of course, that’s why I’m here.’ And I say, ‘Well the best diagnosis you could get is Parkinson’s disease. Provided that your symptoms are real, the stiffness, the tremors, the difficulty walking, the difficulty writing, then the best possible diagnosis you can get is Parkinson’s disease because it’s the most treatable neurological condition versus anything else like Lou Gehrig’s disease, Huntington’s disease, Alzheimer’s disease, brain cancer, multiple sclerosis, stroke.’”
As with Parkinson’s disease, headway has also been made for Alzheimer’s disease, Fisher says. Every year, he attends the Alzheimer’s Association’s International Conference, which in 2016 was in Toronto.
“This was the first time in a decade that there was actually excitement and buzz,” he says. “Believe it or not, in 20 years there has not been a single new therapy approved for Alzheimer’s. There was a little change in formulations in existing drugs, but the last new drug was 20 years ago.”
What’s thrilling is that a study drug has shown to significantly benefit cognitive and functional outcomes, and the slowing of brain atrophy. In addition, Fisher is excited about clinical trials that are studying imaging as a way to diagnose Alzheimer’s disease.
“So far, we’ve enrolled about 25 patients, and half the time the imaging is different than what we were thinking,” he says. “Either they had Alzheimer’s and I didn’t think they had it, or they didn’t have it when I thought they had it. Obviously, I wouldn’t enroll them if I had a doubt, but I was betting on one thing and imaging showed another.”
It’s all in an effort to know as early as possible whether a patient has Alzheimer’s disease. Right now, the only way to diagnosis it is through autopsy.
“Wouldn’t you want to know if you don’t have it and if you have it, you want to know early to plan your life,” Fisher says. “We talk about optimization of cognitively competent years. That became a buzz in our field. And, importantly, if we ever find a really good treatment, it will have to be utilized early, not by the time you don’t know who you are.”
He says “cure” for Alzeheimer’s is a loaded word.
“Cure means we eradicated a problem,” he says. “I think people now more and more are concentrating not on that but on long-term aggressive management because you don’t care if you have Alzheimer’s, but you care if you remember to pee in the bathroom instead of your closet.”
Dr. Timothy Pluard consults with a breast cancer patient. photo by Dean Shepard, Saint Luke's Health System
Metastatic Breast Cancer
Saint Luke’s Hospital in late 2016 launched its Koontz Center for Advanced Breast Cancer, which combines the latest scientific research, medical treatments and knowledge of integrative therapies to treat women with advanced breast cancer. Its director, Dr. Timothy Pluard, said the center is something he’s envisioned for a number of years. The center offers comprehensive care that includes nutrition, exercise, acupuncture, behavioral health, massage, yoga and spiritual support.
“Some of those therapies have been available to women with advanced breast cancer if they were to seek them out, but we’re really trying to make them just a natural part of the treatment,” Pluard says. “So a woman who comes for a first visit will see not only the oncologist but a nutritionist, an exercise physiologist, a psychologist, a social worker. We’re really trying to ensure that we have comprehensively assessed and addressed any of her needs.”
With more women living much longer with breast cancer, a specialized center was needed to bring patients the latest treatments and clinical trials, and to focus and study how an integrative approach in nutrition, exercise and behavioral health can not only affect the quality of their life, but may also affect their longevity and outcome.
“I went to a metastatic breast cancer meeting about accelerating therapies, and there were a lot of advocates for advanced breast cancer there, and they were incredibly excited when they heard about the center because there isn’t one really anywhere,” Pluard says. Doctors at the KU Cancer Center, while not having designated clinic space for metastatic breast cancer, have also developed leading-edge clinical trials and have a number of patients who are cared for by physicians who treat it as a chronic disease, adding years of quality life.
Pluard says clinical trials are a huge component of improving the outcome for patients at the Koontz Center.
“Our goal is to have a clinical trial available for every patient and every point in their disease,” he says. “We’re actually going to be studying these interventions in exercise and nutrition to see if they can actually impact the outcome. Not only does it give women access to yet unavailable therapies, but it’s how we advance care for all women in this situation. The unfortunate reality, which is changing slowly, is that if you look at the amount of money that is allocated to breast cancer research, only about 7 percent of it is allocated to Stage IV breast cancer. Rightfully, there’s a lot of emphasis both from a funding and an advocacy standpoint on early detection and all those interventions trying to prevent Stage IV disease from developing, but the reality is that about 6 to 8 percent of women at the time of diagnosis will be metastatic, and another 20 percent or so of early-stage disease will ultimately relapse and become metastatic. So it’s really a sizeable population. It’s not a reportable event when someone relapses, so the numbers are a little bit hard to pin down, but it’s about 55,000 women a year in the U.S. get metastatic disease.”
In the Kansas City region, that’s about 1,500 women, and they’re living longer, he says.
“One of the things that is really unique as well is the way we structure our initial visits,” Pluard says. “They see everybody on the team, then the team meets and sort of collectively develops a plan, and then we sit down and we meet with the patient and family, and we actually video record the consultation so that when they leave they get a CD with the consultation on it so they can review it at home, share it with family, do whatever. We know that women in that situation are so stressed, and there are studies that show they retain about 10 percent of what’s discussed.
“We also have the ability to not only provide consultations so that women who may live a fair distance can send records and scans and all their imaging, and we can review that and through telehealth do a remote consultation for them from their home. We really think this is transformative for this group of women.”
clot retrieval device
Doctors at the University of Kansas Hospital and Saint Luke’s Hospital are using a cutting-edge procedure that drags blood clots from the brains of stroke patients. Called thrombectomy, the clot-retrieval procedure uses a catheter and a device that looks like a mesh net. The catheter is snaked through a major artery, usually in the thigh, and then up to the brain to the clot. The clot is then removed from the brain with the netlike device.
“There’s more to it than just the device being available at the hospital,” says Saint Luke’s neurologist Dr. Coleman Martin. “You need a team of at least three physicians who do the procedure routinely to be able to do it quickly and effectively. The reason you need three physicians is this is a type of procedure that if a hospital is going to commit to it, they’re committing to it 24/7, so you always have to have someone available day or night.” In 2015, Saint Luke’s Marion Bloch Neuroscience Institute performed 107 thrombectomies, and as of early November 2016, 115 were performed.
When it comes to stroke, minutes count.
“That’s another thing we’ve discovered in our scientific trials,” Pluard says. “For every 15 minutes a patient is delayed to us, or for every 15 minutes that an artery remains closed, the chances of a good outcome falls by about 5 percent. That’s why it’s important that if a patient comes to a hospital that doesn’t offer this therapy, that they be transferred immediately.”
He says the hospitals have done enough of these cases now that a large group of stroke survivors has formed.
“We are up-and-coming relating to health care, particularly in the neurosciences,” he says. “We’re really very, very strong in stroke care in Kansas City. We’ve got a good group of stroke-care physicians. We all know each other. We all work very collegially with each other, and I think it pays off for the community.”
See the next page for Q&As with five of Kansas City's Top Doctors.