ADVANCING FALL 2018 HEALTH | News fromI Fthe NebraskaATIO AB MedicineT YOUR HealthHEALTH Network FROM NEBNebraskaMed.comRASKA MED CINE

Holistic Approaches to Breast Cancer Surgery | p 6

New and Epilepsy Clinics Open | p 5 Comprehensive Spine Program Streamlines Care | p 8 Heart and Stroke Teams Earn Recognition | p 12

BELLEVUE MEDICAL CENTER EDITION in this issue leadership update CONTENTS SmokingFall 2018 and Heart Disease: Smoking3 advances andSmoking Heart Disease: andLEADERSHIP Heart Disease: UPDATE Smoking and HeartA• Learn Deadly Disease: more about research Duo trials That Can Be Prevented Smoking and Heart Disease: A Deadly Duo That CanThis is my firstBe opportunity Prevented to write to you in my role A Deadly4-5here news is nothingDuo good briefs about That smoking and Canequally Be as harmful. Prevented “While cigar or pipe assmoking vice presidentis ofinclude Operations nicotine atreplacements Bellevue like Medical the patch and gum; A Deadly Duo That• NewCanits effect scheduling on the Be heart,” options says PreventedhereAbdulrahman is nothing goodMorad, about smokingperceived and as safer, they bothequally contain as harmful. theCenter. same “While carcinogens Fall cigar is ora seasonpipemedications smoking of transition is like Wellbutrin, andinclude change.an nicotineantidepressant; replacements and Chantix, like the patch and gum; here is nothing good aboutMD, cardiologist smoking and with Nebraskaits effectMedicine’sequally on asthe Heartharmful. heart,” says“While asAbdulrahman cigarettes,”cigar or pipe saysMorad, smoking Dr. Morad. is perceived “Smoking as include safer,four cigars they nicotine both is containreplacements thea drug same like that carcinogens the works patch and gum;medications like Wellbutrin, an antidepressant; and Chantix, A Deadly Duo That Can Be Prevented• Help for sleep problems It’s also a good time to reflect on the past and to give here is nothing good about smoking and its effect“equally on the asheart,” harmful.Disease says “WhileAbdulrahman Prevention cigar or Program.Morad, pipe smokingMD, The perceivedcardiologist goal is of the as with safer, Nebraskainclude they bothequivalent nicotine Medicine’s contain replacements to theHeartsmoking same 10carcinogens like cigarettes.as the cigarettes,” patch Marijuana andmedications says gum; Dr. smokingMorad. like “Smoking Wellbutrin, byfour an binding cigars antidepressant; is to nicotine and receptorsa Chantix, drug that in worksthe brain and blocking thanks for the blessings in our lives. its effect on the heart,” says Abdulrahman Morad,MD, cardiologistperceivedprogramT with• Osteoporosisas Nebraskasafer, is to armthey Medicine’s youboth containclinic Heart thehelps sameDisease as carcinogens cigarettes,” Prevention says Program.medications Dr. Morad.increases The goal“Smoking like of heartWellbutrin, the four rate cigars and an antidepressant; bloodisequivalent pressure. toa smoking anddrug The Chantix, ratethat 10 ofworks cigarettes. heart Marijuanathem, causing smoking a person byto getbinding less satisfactionto nicotine receptors from in the brain and blocking here is nothing good about smoking and equally as harmful. “While cigar or pipe smoking is include nicotine“ replacements like the patch and gum; Disease Prevention preventProgram. The bone goal offractures theprogramT is toequivalent arm you to smoking 10 cigarettes. Marijuana smokingincreases heartby bindingrateAs and part toblood nicotine of pressure.that receptors reflection, The rate in the of brainheartI am and proud blockingthem, to causing be part a person of to get less satisfaction from its effect on the heart,” says Abdulrahman Morad, MD,perceived cardiologist as safer, with Nebraskathey both “Medicine’s contain the Heart same carcinogensas cigarettes,”with themedications rightsays Dr. tools Morad. liketo halt Wellbutrin, “Smoking the development four an antidepressant; cigars isof and Chantix,a drug attackthat works right after smoking marijuana is increased by up to smoking. programT is to arm you with the rightincreases tools to haltheart the rate development and blood pressure.of The rate ofattack heart right afterthem, smoking causing marijuana a person to is getincreased less satisfaction by up to fromsmoking. MD, cardiologist with ’s“ Heart Diseaseas cigarettes,” Prevention says Program. Dr. Morad. The “Smoking goal of the four cigars is equivalentheart• 3-D diseasetoa drugsmoking mammography thatand 10 worksstroke. cigarettes. Marijuana increases smoking by bindingfive totimes. nicotine If you receptors have a historyin the brain of heart anda attack,blockingteam smoking committed to “Theexcellence, best way to which prevent is smoking one of isour to start educating programT is to arm you with the right toolsincreases to haltThe theheart chemicals development rate and from blood of smoking pressure.heart damage disease The rate attackthe and of lining stroke.heart right of after your them,smoking causingmarijuana marijuana a person increases is increased to get your less by riskfive satisfaction up for totimes. death If smoking.from youby up have to threefold.”a history of heartyour attack, children smoking at a young age,”“The says best way to prevent smoking is to start educating Disease Prevention Program. The goal of the equivalent to smoking 10 cigarettes. Marijuana smoking breastby binding cancer to nicotine detection receptors in the brain and blocking organizational values at Nebraska Medicine. We strive “ heart disease and stroke. The chemicalsfive times.from smoking If you have damage a history the liningof heart of yourattack, smokingmarijuana increases“The yourbest riskway for to deathprevent by smoking up to threefold.” is to start educatingyour children at a young age,” says programT is to arm you with the rightincreases tools to heart halt therate development and blood pressure. of The rate of heartattackarteries, rightthem, after causing smokingcausing inflammation a marijuana person to and is get increased narrowing, less satisfaction by explainsup to from Dr. smoking. Electronic cigarettes, also known as e-cigarettes or Dr. Morad. “Most people who smoke start as early as 13 or The chemicals from smoking• Nebraska damage theMedicine lining ofarteries, your expands causingmarijuana inflammation increases and your narrowing, risk for death explainsfor bythe Dr.up highest to threefold.”Electronic standardsyour cigarettes, childrenof safety also at aknown andyoung qualityas age,” e-cigarettes says and orwe workDr. to Morad. achieve “Most people who smoke start as early as 13 or with the right tools to halt the development of heart diseaseattack and rightstroke. after smoking marijuana is increased by fiveup to Morad.times. smoking.If These you have chemicals a history cause of heartthe attack, smoking “Thevaping, best way have to beenprevent promoted smoking as is toa safe start alternative educating to 14 years of age. It is much harder to stop smoking than it is arteries, causing inflammationdermatology and narrowing, explainsandMorad. epilepsy Dr. These chemicalsservicesElectronic cause cigarettes, the also knownexceptional as e-cigarettes vaping,results. or have Dr. been Morad. promoted “Most aspeople a safe who alternative smoke startto as early as14 13 years or of age. It is much harder to stop smoking than it is heart disease and stroke. The chemicalsfive times. from If smoking you have damage a history the of lining heart of attack, your smokingmarijuana blood increases to thicken,“The best your which way risk toincreasesfor prevent death bythe smoking up likelihood to threefold.” is to start educatingyour children smoking. at aWhile young e-cigarettes age,” says don’t burn tobacco or tar, they to not start.” Morad. These chemicals cause the blood to thicken,vaping, which have increases been promoted the likelihood as a safe alternative tosmoking. While14 yearse-cigarettes of age. don’tIt is much burn harder tobacco to or stop tar, smoking they thanto not it start.”is The chemicals from smoking damage the lining ofarteries, your causingmarijuana inflammation increases and your narrowing, risk for death explains by up Dr. to threefold.”Electronicof clotsyour forming cigarettes, children inside also at athe knownyoung veins age,”as and e-cigarettes says arteries. Smokingor alsoDr. Morad.still “Mostinclude people nicotineThat who andcommitment smoke other start potentially as early to excellenceas harmful 13 or was recently exemplified by two blood to thicken, which increases the likelihood of clots formingsmoking. inside While the veins e-cigarettes and arteries. don’t Smoking burn tobacco also or stilltar, theyinclude nicotineto not start.” and other potentially harmful arteries, causing inflammation and narrowing, explainsMorad. Dr. These chemicalsElectronic cause cigarettes, the also known as e-cigarettes orvaping, raises have6-9 yourDr. been Morad. heartfeatures promoted “Mostrate and people as blood a safe who pressure. alternative smoke Allstart to of asthis early as 1413 yearsor chemicals of age. It thatimportantis much can harderincrease recognitions. to bloodstop smoking pressure Bellevue than and it your is Medical Center was recognized by the of clots forming inside the veins and arteries. Smokingraises also your heartstill include rate and nicotine blood pressure. and other All potentially of this harmful chemicals that can increase blood pressure and your Morad. These chemicals cause the blood to thicken,vaping, which have increasesbeen promoted the likelihood as a safe alternative to smoking.additional• WhileAdvanced14 years stresse-cigarettes of on age. thebreast It don’t heartis much burn cancer harder tobacco to stop or tar, smoking they thanto not it is start.”risk for heart attack and cancer. raises your heart rate and blood pressure. All of this additional stresschemicals on the that heart can increase blood pressureAmerican and yourHeartrisk for Association/American heart attack and cancer. Stroke Association for our blood to thicken, which increases the likelihood of clots formingsmoking. inside While the veinse-cigarettes and arteries. don’t Smokingburn tobacco also or tar,still they includecan leadsurgeryto nicotine tonot heart start.” and techniquesattack other or potentially stroke. harmful There is a silver lining. “It’s never too late to quit,” says Dr. additional stress on the heart can lead to heartrisk for attack heart or attack stroke. and cancer. commitment toThere ensure is a silver stroke lining. patients “It’s never receivetoo late to the quit,” most says Dr. appropriate of clots forming inside the veins and arteries. Smokingraises also your stillheart include rate and nicotine blood andpressure. other All potentially of this harmful chemicals“The that more can youincrease smoke, blood the pressurehigher your and risk,” your says Dr. Morad. “Your risk for heart attack and stroke declines 15 to can lead to heart attack or• stroke. Triathlete excels after“The successful more youThere smoke, is a silverthe higher lining. your “It’s risk,” never says too Dr. late to quit,”Morad. says Dr. “Your risk for heart attack and stroke declines 15 to raises your heart rate and blood pressure. All of this additional stresschemicals on the that heart can increase blood pressure and yourrisk forMorad. heart “A attack person and who cancer. smokes two packs a day increases his 30 percenttreatment as soon as you according quit. to nationally recognized, research-basedSTOP HEART guidelines. DISEASE IN can lead to heart attack or stroke. “The more you smoke,There the isspine a higher silver surgerylining. your risk,” “It’s says never Dr.Morad. too late “A person toMorad. quit,” who says “Your smokes Dr. risk fortwo heart packs attack a day andincreases stroke his declines 30 15percent to as soon as you quit. STOP HEART DISEASE IN additional stress on the heart risk for heart attack and cancer. or her risk for heart attack or stroke by 900 percent. But the “While quittingThis is smokingimportant can bebecause very difficult, we know that stroke is a time-critical diagnosis, “The more you smoke, the higher your risk,” saysMorad. Dr. “A person Morad.who smokes “Your tworisk packsfor heart a day attack increases andor her stroke his risk fordeclines30 heart percent attack15 to as orsoon stroke as you by 900 quit. percent. But the “While quitting smokingSTOP can be very HEART difficult, DISEASE IN can lead to heart attack or stroke. There is a silver lining. “It’s never too late to quit,” says factDr. is, no number of cigarettes is good for your heart. Less the good news is that we have lots of ways to help ITS TRACKS ITS TRACKS or her risk for heart attack or stroke by 900 percent. Butfact the is, no number“While of cigarettes quitting issmoking good for can your be heart.and very difficult,well-organizedLess the good newsexpert is that care we havecan lotsreduce of ways death to help and disability. “The more you smoke, the higher your risk,” says Dr.Morad. “A personMorad. who “Your smokes risk for two heart packs attack a day and increases stroke declineshis 30 15 percent to 10 as soonin as the you quit. community STOP HEART DISEASE IN Nebraska Medicine’s newNebraska Heart Disease Medicine’s new Heart Disease fact is, no number of cigarettesthan five is cigarettes good for youra day heart. canthan increase Less five cigarettesyourthe riskgood fora newsday heart can is increasethat weyou haveyour quit. lotsrisk The forof waysmostInheart addition, toeffective help you smoking-cessationBellevue quit. The most Medical effective programsITS Center smoking-cessation TRACKS has earned programs full accreditation as a Morad. “A person who smokes two packs a day increasesor her his risk for30 heartpercent attack as soon or stroke as you by quit. 900 percent. But the “While• Patientquitting smoking AssistanceSTOP can be veryHEART Fund difficult, helps DISEASE families IN Nebraska Medicine’s new HeartPrevention Disease Program willPrevention provide Program will provide than five cigarettes a attackday can or increase stroke byyour 40 riskpercent. for attackheart Even or secondhand strokeyou by quit. 40 smoke percent.The most is Even effective secondhandare those smoking-cessationITS that smoke TRACKS combine is counselingprogramsare those withthat combine smoking-cessation counseling with smoking-cessation or her risk for heart attack or stroke by 900 percent. Butfact the is, no number“While of cigarettes quitting smoking is good for can your be veryheart. difficult, Less the good newsstay is together that we have during lots of ways treatment to help Chest Pain Center with Primary PercutaneousPrevention Program Coronary will providea comprehensive Intervention evaluation (PCI)a comprehensive of your risk factorsevaluation of your risk factors attack or stroke by 40 estimatedpercent. Even to besecondhand responsibleITS TRACKSsmoke forestimated 35,000 is deathstoare be responsiblethose from that heart combine for 35,000 aidscounseling deaths to Nebraskaaddress from with heart bothsmoking-cessationMedicine’s the behavioralaids new to Heart address and Disease nicotine both the behavioral and nicotine fact is, no number of cigarettes is good for your heart.than Less five cigarettesthe good anews day canis that increase we have your lots risk of for ways heart to help you quit. The most effective smoking-cessation programs from the American College of Cardiologya comprehensive (ACC). evaluation Thisand ofis yourathe personalized riskfirst factors time plan and weto prevent ahave personalized the plan to prevent the estimated to be responsibledisease for each 35,000 year.” deathsNebraska from heartdisease Medicine’s each newaids year.” Heartto address Disease both theaddictions.” behavioralPrevention and nicotine Program addictions.”will provide than five cigarettes a day can increase your risk for heartattack or strokeyou quit.by 40 The percent. most Eveneffective secondhand smoking-cessation smoke is programsare those that combine counseling with smoking-cessation and a personalized plan to preventdevelopment the of heart disease.development of heart disease. disease each year.” Using forms of tobaccoPrevention other ProgramUsing than forms cigarettes willaddictions.” provideof tobacco can be other than cigarettesSomea comprehensive ofachieved thecan mostbe successful this evaluation levelSome smoking-cessation of of your theaccreditation. mostrisk factors successful aids This smoking-cessation reinforces thataids our patients will attack or stroke by 40 percent. Even secondhand smokeestimated is toare be those responsible that combine for 35,000 counseling deaths from with heart smoking-cessation aids to address 11 health both the behavioral plus+ and nicotine development of heart disease.To schedule an appointment,To schedule please an appointment, please Using forms of tobacco other than cigarettesa comprehensive can be evaluationSome of ofyour the risk most factors successful and smoking-cessationreceive a personalized the planmost aids to preventtimely the and expert care if they experience a heart attack. estimated to be responsible for 35,000 deaths from heartdisease eachaids year.” to address both the behavioral and nicotine addictions.”• Do I need to make an appointment at the To schedule an appointment,call please 800.922.0000 . call 800.922.0000. and a personalized plan to prevent the development of heart disease. disease each year.” Using formsaddictions.” of tobacco other than cigarettes can be Some ofnew the most Plattsmouth successful smoking-cessation Immediate Care aids Clinic? (Read more about both of thesecall awards 800.922.0000 on the. back page.) development of heart disease. To schedule an appointment, please Using forms of tobacco other than cigarettes can be Some of the most successful smoking-cessation aids Transition and change continue to be key themes on our campus in terms • How do youTo scheduleknow when an appointment, to seek please help call 800.922.0000. for chroniccall pain? 800.922.0000. of growing the services we provide and making care more accessible. As one VILLAGEof our POINTE goalsVILLAGE to offer theAESTHETIC mostPOINTE advanced care,AESTHETIC SURGERY we recently began SURGERY |providing | 12 heart and strokeVILLAGE POINTE3-D AESTHETIC mammography. This SURGERYprocedure has been | shown to improve detection VILLAGE• Bellevue POINTE receives chest AESTHETIC pain DREAMS SURGERYrates MEDSPAbyDREAMS as| much as 30 percent. MEDSPA accreditation and recognitionDREAMS for MEDSPA VILLAGE POINTE AESTHETIC SURGERY | EpilepsyBeauty care radiates! is also Feeling coming confident to about the yourBellevue outer appearance area, with positively the openinginfluences of many our other aspects of your life— DREAMSsuperior MEDSPA stroke care Beauty radiates! Feeling confident about your outer appearance positively influences many other aspects of your life— Beauty radiates! Feeling confidentincluding howabout you newyour feel outer onepilepsy the includingappearance inside. clinic how Join positively you us at at feel Twin our influences on holiday the Creek, inside. open many whichJoin house other us at will and aspectsour treatholidaybe of staffedyourself your open life— housethis by holiday board-certified and treat season: yourself this holiday season: DREAMS MEDSPA Beauty radiates! Feeling confident about your outerincluding appearance how you positively feel on the influences inside. Join many usepilepsy at other our holidayaspects specialists. open of your house life— and treat yourself this holiday season: • Meet our plastic surgeons, aesthetic nurses and aestheticians Beauty radiates! Feeling confident about your outer appearanceincluding how positively you feel influences on the inside. many Join other us at aspects our holiday of your open life— house and• Meet treat our yourself plastic this surgeons, Weholiday are season:aesthetic making nurses health and aestheticianscare services more accessible to the residents of • Meet our plastic surgeons, aesthetic nurses and aestheticians• Visit with vendors to learn more about our products and services including how you feel on the inside. Join us at our holiday open houseON and THE treat COVER: yourself Dr. this Jessica holiday Maxwell, season: surgical • Visit with vendors to learn more about our products and services Plattsmouth• Take byadvantage changing of promotional the model packages of care and more to a walk-in friendly Immediate • Meet our plasticoncologist surgeons, and aesthetic oncoplastic nurses surgeon, and• Visit aestheticians Dr. with Pavankumar vendors to learn • Take more advantage about our of products promotional and services packages and more • Take advantage of promotional packagesCare and moreClinic to better serve the residents in that area. • Meet our plastic surgeons, aesthetic nurses and aestheticians• Visit with vendorsTandra, to medical learn more oncologist about our and products Dr. Cheryl and services Williams, radiologist, part of the team of cancer specialists at Follow Village Pointe Aesthetic Surgery | Dreams MedSpa on Facebook or visit SurgeryVP.com to learn more. • Visit with vendors to learn more about our products• and Take services advantage of promotional packages and more Follow Village Pointe ThisAesthetic fall, Surgery I hope | Dreams you’re MedSpa able toon Facebookenjoy the or visitcolors SurgeryVP.com of the season to learn andmore. to give Bellevue Medical Center Follow Village Pointe Aesthetic Surgery | Dreams MedSpa on Facebook or visit SurgeryVP.com to learn more. • Take advantage of promotional packages and more thanks for being part of the amazing Bellevue community. Follow Village Pointe Aesthetic Surgery | Dreams MedSpa on Facebook or visit SurgeryVP.com to learn more. Follow Village Pointe Aesthetic Surgery | Dreams MedSpa on FacebookNOTICE or visit OF SurgeryVP.com NONDISCRIMINATION to learn more. Nebraska Medicine complies with applicable federal civil rights laws and doesNotice not discriminateof Nondiscrimination onNotice the basis of Nondiscrimination of race, color, national origin, age, Notice of Nondiscrimination Nebraska Medicine complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. disability, sex, gender identity or sexual orientation. Sue Nuss, PhD, MBA, RN Notice of Nondiscrimination Nebraska Medicine Nebraskacomplies withMedicine applicable complies Federal with civil applicable rights laws Federal and does civil not rights discriminate laws and ondoes the not basis discriminate of race, color, on thenational basis origin, of race, age, color, disability, national or sex.origin, age, disability, or sex. Español (Spanish) ATENCIÓNATTENTION:: si habla español, If you speak Spanish or Vietnamese,Chief nursing language officer, assistance Nebraska services, freeMedicine of charge, are available to you. Please call 402.559.2010 or 402.559.2496. Notice of Nondiscrimination Nebraska Medicine complies with applicableATTENTION: Federal civil If yourightsATTENTION: speak laws Spanish and does If or you notVietnamese, speakdiscriminate Spanish language on or the Vietnamese, assistance basis of race, services, language color, free national assistance of charge, origin, services, are age, available disability,free of to charge, you. or sex.Please are availablecall 402.559.2010 to you. Please or 402.559.2496 call 402.559.2010. or 402.559.2496. tiene a su disposición serviciosEspañol gratuitos (Spanish) de Vice president of Operations, Bellevue Medical Center Nebraska Medicine complies with applicable FederalATTENTION: civil rights If you laws speak and Spanishdoes not or discriminate Vietnamese,Español on language (Spanish) the basis assistance ofasistenciaEspañol race, color, services, (Spanish) lingüística. national free Llame oforigin, charge,ATENCIÓN: al 402.559.2010age, are disability, available si habla / or to sex. español,you. Please tiene call a su402.559.2010 disposición servicios or 402.559.2496 gratuitos. de asistencia lingüística. Llame al 402.559.2010 / 402.559.2496. ATTENTION: If you speak Spanish or Vietnamese,Español language (Spanish) assistance services, free of charge,ATENCIÓN: are available si habla to402.559.2496ATENCIÓN: you. español, Please tiene .call si hablaa 402.559.2010 su disposición español,Tiếng tiene or serviciosViệt 402.559.2496 a(Vietnamese) su gratuitosdisposición. de serviciosasistencia gratuitos lingüística. de Llameasistencia al 402.559.2010 lingüística. Llame / 402.559.2496 al 402.559.2010. / 402.559.2496. Español (Spanish) ATENCIÓN: si habla español, tiene a su disposiciónTiếng Việt servicios (Vietnamese) gratuitosTiếng Việt de (Vietnamese) asistencia lingüística. CHÚ Ý: Nếu Llame bạn al nói 402.559.2010 Tiếng Việt, có / các402.559.2496 dịch vụ hỗ trợ. ngôn ngữ miễn phí dành cho bạn. Gọi số 402.559.2010 / 402.559.2496. ATENCIÓN: si habla español, tiene a su disposiciónTiếng servicios Việt (Vietnamese) gratuitos de asistencia lingüística.CHÚ Ý: LlameNếu bạn al nói402.559.2010 CHÚTiếng Ý: Việt, Nếu có /bạn 402.559.2496 các nói dịch Tiếng vụ hỗ Việt,. trợ cóngôn các ngữ dịch miễn vụ hỗ phí trợ dành ngôn cho ngữ bạn. miễn GọiAdvancing phísố 402.559.2010 dành Health cho bạn. is / published Gọi402.559.2496 số 402.559.2010 by Nebraska. / 402.559.2496 Medicine. The. information is intended to Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 402.559.2010 / 402.559.2496. educate readers about subjects pertinent to their health, not as a substitute for CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 402.559.2010 / 402.559.2496. consultation with a personal doctor. © 2018 Printed in U.S.A. Developed by StayWell.

Got questions? Sign up for ONE CHART | PATIENT at OneChartPatient.com and ask your provider a question online. 1 2 Advancing Health | FallGot 2018 questions? SignGot up for questions? ONE CHART Sign | PATIENT up for at ONE OneChartPatient.com CHART | PATIENT atand OneChartPatient.com ask your provider a question and ask online.your provider 1 a question online. 1 Got questions? Sign up for ONE CHART | PATIENT at OneChartPatient.com and ask your provider a question online. 1 Got questions? Sign up for ONE CHART | PATIENT at OneChartPatient.com and ask your provider a question online. 1 advances

New Immune Fighting Therapies for Multiple Myeloma Show Promise

Several new, promising CAR T-cell Currently, there is no cure for “Medical centers across the country therapies for multiple myeloma patients multiple myeloma and many patients are eager to offer this therapy to their will be available at Nebraska Medicine receive multiple therapies through the patients. The experience and expertise through two clinical trials that are course of their disease management. we have gained from our early expected to open this year. Treatment for many newly diagnosed involvement in the lymphoma CAR T-cell The therapy is part of a growing myeloma patients typically starts therapy clinical trials has enabled us treatment option in cancer that with chemotherapy, followed by an to be on the forefront of these new harnesses the body’s own immune autologous stem cell transplant, where myeloma studies.” system to attack a tumor. T cells are stem cells are harvested from a donor. Dr. Holstein says hope for long-term white blood cells that help the body “Even though the transplant process disease control for multiple myeloma fight and cancer. These clinical can be very effective at keeping the has never been brighter. “There is much trials involve taking the patient’s own disease under control for long periods of optimism that this may be the next big T cells and programming them to time, the vast majority of patients will breakthrough treatment for myeloma recognize a marker on the cancer cell, still relapse,” says Dr. Holstein. “These patients,” she says. leading the immune system to attack patients never get a break. They typically the cancer. stay on one therapy until it stops “These two trials use the same working and then move to the next one. ❯❯ Learn more about Nebraska overall concept as the new CAR T-cell We hope that CAR T-cell therapy will Medicine clinical trials by visiting therapy that has shown so much change that. NebraskaMed.com/Clinical-trials. success with our lymphoma patients,” says Sarah Holstein, MD, PhD, Nebraska Medicine hematologist and medical oncologist, who specializes in multiple myeloma treatment and research. The two studies will encompass multiple groups of myeloma patients, including newly diagnosed patients with high-risk disease, as well as relapsed/ refractory patients who are no longer responding to chemotherapy. “Early studies have shown a remarkable efficacy for this new therapy,” says Dr. Holstein. “In several studies, more than 90 percent of patients had significant responses and these were patients who had essentially run out of treatment options. The exciting thing about the studies we will be opening is they will allow patients to receive CAR T-cell therapy earlier in the course of their disease. We hope this will result in patients achieving deeper and longer-lasting responses.”

Dr. Sarah Holstein, hematologist and medical oncologist

Looking for a doctor? Call our 24-hour call center: 800.922.0000 | NebraskaMed.com 3 news briefs

Is Sleep Eluding You? Find Out Why

If you are always tired, have trouble falling asleep or staying asleep, snore or stop breathing during your sleep, or need sleep aids, you should be evaluated to find out why. Most sleep problems can be attributed to an underlying cause, whether it’s depression, anxiety, pain or sleep apnea, says Michael Summers, MD, pulmonologist and medical director of the Nebraska Medicine Sleep Disorders Center. Untreated sleep apnea can lead to serious health issues, including high blood pressure, heart rhythm problems, heart attack, stroke, lack of diabetes control, Alzheimer’s disease, decreased seizure threshold and exacerbation of chronic pain. New Scheduling Getting evaluated for obstructive sleep apnea, the most common sleep disorder, can now be done in the comfort of your home. The home sleep Options Available apnea test requires you to wear a finger probe that measures oxygen levels, a belt that goes around the chest to measure effort of breathing and a sensor One Chart | Patient is making it easier under the nose to measure airflow. This data is then evaluated and than ever for Nebraska Medicine interpreted by a sleep medicine specialist. If it is determined that you may patients to schedule appointments have another type of sleep disorder, you may be recommended for an with their providers. overnight sleep study in our accredited sleep lab. Patients registered in the “Our sleep lab is staffed by medical experts specially trained to diagnose portal can now directly schedule and treat multiple sleep disorders to help get you back on the road to a good appointments with established night’s sleep,” says Dr. Summers. “After your evaluation, we will follow up providers at all of our primary care and work with you to resolve or manage your sleep issue.” clinics, which include Family Medicine, Internal Medicine and ➤ Not Feeling Rested? doctors at the Olson’s Center for To schedule an appointment with one of our sleep specialists, call us at Women’s Health. 800.922.0000. Direct scheduling is an online tool that allows you to select the time and day you want to see your provider, including your preferred location. WHAT ARE THE EFFECTS OF SLEEP DEPRIVATION? Available appointment times are displayed with an up-to-date view Decreased Increased More of providers’ schedules. Wellness Disease Accidents In addition to direct scheduling, other popular aspects of the site include the ability to send your provider a personal message. You can also log in to review lab results, imaging and pathology reports, as well as request Sleep deprivation Chronic sleep deprivation Sleep deprivation leads to: puts you at higher risk for: is linked to: prescription renewals, review your • Tiredness and crankiness • High blood pressure • Motor vehicle crashes medical history and pay bills. • Impaired cognition • Heart disease • Industrial disasters and memory • Type 2 diabetes • Medical and other • Weakened immune • Obesity occupational errors ➤ Sign Up for system, making you • Depression more likely to get sick One Chart | Patient • Increased stress and less Not registered yet? Visit control over your emotions • Slower reaction times OneChartPatient.com and select and decreased alertness “Request New Account.”

4 Advancing Health | Fall 2018 You are never too young or too old to improve the health of your bones.

Eat fruits and Avoid vegetables smoking

Eat a well-balanced Limit alcohol diet, including foods intake good for bone health

Get enough calcium Engage in and vitamin D regular exercise

Osteoporosis Clinic Helps Dermatology and Prevent Bone Fractures Epilepsy Services The numbers are staggering. Osteoporosis is responsible for 2 million broken Expanded bones every year in the U.S. and causes 75,000 deaths, according to the National Osteoporosis Foundation. It is estimated that 1 in 2 women and up to Nebraska Medicine has expanded its 1 in 4 men ages 50 and older in the U.S. will break a bone due to osteoporosis. services. A new Dermatology Program Often called the brittle bone disease, osteoporosis causes the bones to recently opened and specializes in all become weak and brittle with age. The problem is, most people don’t know aspects of dermatology, including skin, they have osteoporosis until they break a bone. hair and nail concerns. In an effort to boost the number of patients diagnosed and treated for Our team of board-certified osteoporosis and prevent secondary bone fractures, Nebraska Medicine dermatologists not only treat general recently opened an osteoporosis clinic at the Orthopaedics clinic at Lauritzen dermatology issues, but also have Outpatient Center. received specialized training and “The elderly are at the highest risk for a fracture because their bone is more expertise in areas such as Mohs fragile,” says Laura Graeff-Armas, MD, Nebraska Medicine endocrinologist, micrographic surgery for skin cancers, who specializes in osteoporosis. “Hip fractures could mean the end of life for diseases of the leg veins, high-risk some of these patients. Many of them go to a skilled nursing facility and never skin cancers and autoimmune skin return home. We want to prevent these types of injuries.” diseases, as well as reconstructive surgery of the face, head and neck. ➤ Have You Had Your Bones Checked? “We are excited about bringing a To schedule an appointment for an osteoporosis screening, call 800.922.0000. very comprehensive and high level of advanced dermatologic care to Nebraska Medicine patients,” says Ashley Wysong, MD, Nebraska Medicine dermatologist. 3-D Mammography Improves Detection “Our team is committed to providing a personalized experience with an The latest advancement in breast cancer screening, 3-D mammography, individualized treatment plan that is available at Nebraska Medicine – Nebraska Medical Center, is designed just for you.” Nebraska Medicine – Village Pointe and Bellevue Medical Center. The Epilepsy Program at Nebraska Three-dimensional mammography allows the radiologist to view Medicine is also growing. The program the breast in multiple thin layers or “sliced” images, providing better added three new fellowship-trained detection of smaller masses. epilepsy specialists and opened a new “Three-dimensional mammography decreases callbacks clinic in the Bellevue community. “This by 40 percent due to the greater clarity provided by these images,” expansion allows us to see additional says Cheryl Williams, MD, Nebraska Medicine radiologist. “Overall, patients in a more timely fashion,” it is estimated that it increases breast cancer detection by 10 to says Deepak Madhavan, MD, Nebraska 30 percent. The smaller a tumor is when we find it, the more likely Medicine epilepsy specialist and medical it is that we’ll be able to cure it.” director of the Epilepsy Program. October Is Breast Cancer Awareness Month To find out more about our Call 800.922.0000 to schedule your mammogram now. Dermatology and Epilepsy programs, call 800.922.0000.

Find a location near you. | NebraskaMed.com/Locations 5 featuresfeature CANCERCARDIOLOGY CARE Holistic Approaches to Breast Cancer Surgery

Dr. Shannon Wong, plastic and reconstructive surgeon, performs an advanced breast reconstructive procedure that provides a more natural-feeling breast.

6 Advancing Health | Fall 2018 Holistic Approaches to Breast Cancer Surgery

diagnosis of breast cancer can The breast cancer team at Nebraska Dr. Maxwell also performs a be both physically and emotionally Medicine is committed to providing nipple-sparing mastectomy, which A draining. Even after treatment each patient with a customized plan involves maintaining the entire skin of is over, the physical scars surgery can that addresses the individual’s physical, the breast and hiding the scars in the leave behind can serve as a painful emotional and spiritual needs now skin lines under the breast to provide reminder of that difficult time. Nebraska and in the future. the appearance of a normal breast Medicine offers some of the most “With all the advances in breast contour. “We can also reconstruct the sophisticated breast reconstruction cancer care, women are living for many nipple or refer patients for a 3-D tattoo options to help women feel whole again years after a breast cancer diagnosis,” of the nipple-areola complex,” says after treatment is over. says Jessica Maxwell, MD, Nebraska Dr. Wong. This was welcome news for Erin Aten, Medicine surgical oncologist and who was 29 years old when she received oncoplastic surgeon. “However, the ➤ Breast Cancer Care the devastating news that she had breast results of surgery can often leave women Designed Around You cancer. Having breast reconstructive feeling disfigured and negative about To schedule an appointment with one surgery following a mastectomy was a their bodies and become a constant of our breast cancer specialists, call necessary step to help her move forward reminder of the cancer. Today, we are 402.559.5600. Learn more about breast emotionally and still feel complete. looking at survivorship and how to best cancer care at NebraskaMed.com/Breast. When Aten’s doctors suggested an help women not only survive but thrive advanced breast reconstructive procedure by taking a whole-person approach.” called deep inferior epigastric perforator A “whole-person” approach entails Dr. Jessica Maxwell, surgical oncologist and oncoplastic surgeon (DIEP) flap, she knew that was the the input of all the specialists involved procedure for her. in the patient’s care, from the medical Instead of implants, DIEP flap uses oncologist to the surgeon, radiation excess skin and fat from the abdomen to oncologist, radiologist, pathologist, construct a new breast, which provides a genetics counselor, and plastic and more natural-feeling breast and tends to reconstructive surgeon. age like a natural breast, says Shannon “This multidisciplinary approach Wong, MD, Nebraska Medicine plastic allows us to develop a collaborative and reconstructive surgeon. The DIEP plan that provides the best treatment flap procedure differs from the for the cancer as well as the best traditional free TRAM flap approach in aesthetic outcome,” says Dr. Wong. that it does not use abdominal muscle, Oncoplastic surgery is another making it less physically demanding option that improves the cosmetic on a woman; provides a quicker appearance of the breast while recovery; and carries less risk for other surgically removing the cancer. complications, such as abdominal “The goal is to return the breast to a hernia, says Dr. Wong, one of a few healthy appearance, which can lead surgeons in the region who performs to better quality of life because it the procedure. DIEP flap also involves a improves self-confidence, self- microvascularization technique in which esteem and comfort with intimacy,” the surgeon carefully reattaches the says Dr. Maxwell, the only surgeon blood vessels of the flap to blood in this area who is trained to vessels in the chest. This allows the perform this unique procedure. patient to have feeling in her breasts. Once the tumor is removed, “I wanted my breasts to feel as Dr. Maxwell can reshape the breast natural as possible and didn’t want to to prevent contour deformities, worry about having additional breast realign the nipple and areola, and surgeries in the future,” says Aten. balance the breasts to provide “I trusted my doctors completely and symmetry — all during the same am so happy with my decision.” surgical procedure.

Find a location near you. | NebraskaMed.com/Locations 7 featuresfeature ORTHOCARDIOLOGY CARE Triathlete Back on Top After Spine Surgery

ot many people take up Ironman candidate for surgery, and different competitions in their late 40s, “Dr. Cornett assured procedures are right for different Nmuch less after having spine me that this was the people. I also follow my patients for two surgery. years after their surgery in case we But Renee Spencer did both. And it right procedure and need to tweak things along the way.” won her a first-place spot in her age that there was no “I chose Dr. Cornett because he spent group for the USA Triathlon Age Group so much time explaining the procedure National Championship. Two months reason why it couldn’t and showed concern for my physical later, she finished one person away be 100 percent and mental health,” Spencer says. from qualifying for the world team. “He assured me that this was the right “The only regret I have is that I didn’t successful, so that I procedure and that there was no have the surgery sooner,” says Spencer. could return to training reason why it couldn’t be 100 percent “It was instant relief from my pain.” successful so that I could return to Spencer was 46 years old when she and competing.” training and competing.” decided to start training and competing Renee Spencer, spine surgery patient The specialists at the Comprehensive in Ironman competitions. “I did my Spine Program are trained to treat spine first triathlon and did pretty well and issues from the common to the thought, ‘Wow, I can do this.’ Before I then used to fill the space between the complex. This team of specialists knew it, I was training for Ironmans.” two vertebrae. A metal plate and screws includes physical medicine and An Ironman triathlon consists of a were used to hold the vertebrae in place rehabilitation (PM&R) specialists, 2.4-mile swim, 112-mile bike ride and while the bone grew together. orthopaedic surgeons, neurosurgeons, 26.2-mile run. “Renee’s procedure was so pain specialists, and physical and But then the pain started. It began in successful because a lot of thought occupational therapists who work her legs and wouldn’t subside, even with and planning went into this before she together to ensure patients receive the rest and physical therapy. After seeing had the surgery,” says Dr. Cornett. best and most appropriate care quickly several orthopaedic specialists, Spencer “Successful back and spine surgery is selected orthopaedic surgeon Chris based on selecting the right procedure Dr. Chris Cornett discusses spine imaging Cornett, MD, with the Comprehensive for the right person. Not everyone is a results with patient Renee Spencer. Spine Program at Nebraska Medicine. An MRI revealed that one of her discs was worn to the bone. Dr. Cornett recommended conservative measures first, which included steroid injections and more rest to help alleviate the pain. But it never went away completely, and as Spencer began to rev up her workouts, so did the pain. It was time … Spencer had to make a choice. If she wanted to continue to compete at the same level, she would need surgery. In December 2016, Spencer underwent a spinal fusion surgery. Dr. Cornett accessed the spine by entering near Spencer’s abdomen to avoid going through the back muscle. He then removed the damaged disc and thickened tissues between the two vertebrae. A bone graft and cage was

8 Advancing Health | Fall 2018 Triathlete Back on Top After Spine Surgery

Renee Spencer is back to living a full, active life after her successful spine surgery.

Suffering from Back Pain? We Can Help.

Specialists at the Comprehensive Spine Program can get you in quickly for an evaluation and treatment and ensure you are seen by the appropriate specialist. For an appointment, call 800.922.0000 or learn more at NebraskaMed.com/Spine.

and conveniently. A call to the Comprehensive Spine Program will connect patients to an experienced nurse who will listen to their symptoms and help them schedule an appointment with the most appropriate specialist. Spencer says she was walking the hallways of the the same day as her surgery and was home the next day. “I took one pain reliever the day I came home and never had to take another one again,” she says. Spencer began increasing her walking distance every day. By six weeks, she was aqua jogging; at eight weeks, she was swimming; and by 10 weeks, she was bicycling. By 12 weeks, she had returned to two to four hours daily of competition training. Six months later, she was competing again and winning races. Today, Spencer is training for the USA Triathlon Age Group National Championship and has her goal of winning. “I feel great and I have no pain now, thanks to Dr. Cornett,” says Spencer.

Looking for a doctor? Call our 24-hour call center: 800.922.0000 | NebraskaMed.com 9 in the community

Patient Assistance Fund Helps Families Stay Together

akota Case was born with a rare with everyday needs, such as lodging, hope but optimism, strength and heart defect. By the age of 25, meals, gas cards and transportation. determination to keep fighting,” Dhe had lived through three The fund provided Jennifer and says Dakota. open-heart surgeries and had been Chuck with a place to stay and food “This fund can make it or break listed for a heart transplant. cards during those long, difficult it for some patients,” says Jasmine But the summer of 2015 would prove months in 2015 and 2016, when Silva, a licensed clinical social to be one of the most trying periods of Dakota’s condition was the most fragile. worker. “They literally wouldn’t be his life. His heart was pumping at an “The first summer we had nothing able to receive the care they need extremely low output — too low to coming in,” says Jennifer. “I don’t know here if we weren’t able to use these provide enough blood to sufficiently how we would have done it without the funds to help them with some of the supply his organs. extra help. But being there for Dakota everyday needs of living. The Patient Dakota spent that summer in the was so critical for his recovery. The first Assistance Fund is also another Intensive Care Unit (ICU) at Nebraska week in the ICU he was literally dying. If means that allows us to provide Medical Center, and 40 days of it was we had not been there, he would have a whole-person approach to care. on an extracorporeal membrane lost hope.” It helps relieve the emotional stress oxygenation (ECMO) machine to allow “Having their presence, comfort that financial strains can have on a his lungs to grow stronger. ECMO takes and that familiarity not only gave me patient and family so that they can over the work of a person’s own lungs Jasmine Silva, social worker, provided focus on getting well.” and/or heart by delivering oxygen support services to Dakota Case and his family. It’s exactly what the to the blood. As Dakota’s lungs grew Case family needed. healthier, he was able to receive “To me, this fund is a left ventricular assist device just as important as (LVAD), moving him closer to a the facilities here,” heart transplant. says Jennifer. “It was touch-and-go for a whole “Without it, many month,” says his mother, Jennifer Case. people wouldn’t Jennifer and her husband, Chuck, who be able to get the live in Sioux Falls, South Dakota, left extraordinary care they their home and business that summer need from the amazing so that they could be with Dakota doctors and nurses at during that tenuous time. Nebraska Medicine.” The following spring, Dakota’s Dakota has since condition deteriorated again. This time gotten married and he would be hospitalized until he works at a hospital received a heart transplant. Again, in Sioux Falls, Jennifer had to leave her home and South Dakota, as a family business so that she could cardiopulmonary stay with Dakota during that three- patient care technician. month period before and after the “I like being a source heart transplant. of strength and None of this would have been comfort for others possible without the help of the who are having similar Nebraska Medicine Patient Assistance health problems.” Fund, says Jennifer. The Patient Assistance Fund provides assistance to hundreds of patients and their You can make a difference. Learn how at NebraskaMed.com/Giving. families each year by helping them

10 Advancing Health | Fall 2018 meet our physicians Q & A

Jennifer Gibert, MD, Are appointments necessary at the endocrinologist, enjoys Plattsmouth Immediate Care Clinic? helping patients with Shelley Brown, APRN, nurse practitioner At Nebraska Medicine, we are continually trying to make health lifelong health conditions care more convenient and closer to home. That is why we transitioned our clinic in Plattsmouth to an immediate care Medicine is a model where no appointments are needed. second career for Located at 1938 East Highway 34, the Plattsmouth Immediate Dr. Gibert. After Care Clinic offers care for minor illnesses and injuries without the completing an longer waits typical of an MBA and emergency room. The clinic working as a bills the same as a regular consultant in doctor visit. It is not designed Washington, DC, to handle more urgent for several years, she wanted to do something problems, like chest pain, more meaningful — something that would difficulty breathing or allow her to develop relationships and help fractures with bones showing. others improve their health and well-being. But the clinic is available to Medicine seemed like the perfect platform. handle ailments like colds, So at age 32, Dr. Gibert started medical fevers, flu, rashes and school and began her journey toward a ; X-rays to medical career. “My mother and brother determine the severity of an went to medical school later in their lives, so injury; wound care and it didn’t seem unusual to me,” she says. “I stitches; sprains and splint care for broken bones; and basic wanted to find something that would allow lab testing, such as strep screens, blood work analysis, flu me to use my education and knowledge to vaccinations, pregnancy tests and urinalysis. help people optimize their health through ❯❯ To find a Bellevue physician, call 800.922.0000. lifestyle changes that can help prevent disease and even reverse some conditions.” Dr. Gibert has an clinic at Bellevue Medical Center, where she manages When should I seek help patients with issues like diabetes, obesity for chronic pain? and thyroid disease. “Because these are lifelong conditions Angie Rakes, MD, pain specialist that require ongoing care and management, One of the biggest mistakes people make when it it’s very important for patients to receive care comes to pain is they wait too long to seek help. that is timely, convenient and easily The longer you wait for treatment, the more accessible,” says Dr. Gibert. “Our Bellevue difficult it becomes to treat pain, as this allows clinic allows us to provide that convenience the body to generate a map to pain that is to the people of this community.” difficult to break. If your pain continues longer In her spare time, Dr. Gibert likes cooking than three months after you’ve worked with your and maintaining a garden that includes a primary care doctor and tried conservative measures, such as ice, large mix of fruits and vegetables, like stretching, anti-inflammatories and physical therapy, you may want lettuce, peppers, tomatoes, sweet potatoes, to consider seeing a pain specialist. Our team uses a comprehensive strawberries, blueberries, squash and approach to treating all types of chronic pain that attacks the pain lemongrass. “Gardening and cooking healthy from many fronts and uses some of the most cutting-edge medical helps me practice and pass on the healthy therapies and surgical techniques. This may include medications, eating habits I want my patients to follow.” nerve blocks, steroid injections, ablation, spinal cord stimulators, Botox or acupuncture. You don’t have to live with chronic pain. Chronic pain that is not treated successfully can become physically ❯❯ To schedule an endocrinology appointment disabling and lead to depression, anxiety, loss of sleep, missed in Bellevue, call 800.922.0000. workdays and decreased physical functioning. ❯❯ To find a pain specialist near you, call 800.922.0000.

Find a location near you. | NebraskaMed.com/Locations 11 Nebraska Medicine NONPROFIT ORG 988132 Nebraska Medical Center U.S. Postage Omaha, NE 68198-8132 PAID Nebraska Medicine Join the conversation

Facebook.com/NebraskaMed

@NebraskaMed

YouTube.com/NebraskaMed

Pinterest.com/NebraskaMed

Blogs.NebraskaMed.com

@NebraskaMed 920MB We’re here for you! 24 Hours a Day, 7 Days a Week 800.922.0000 | NebraskaMed.com

Bellevue Receives Chest Pain Accreditation and Recognition for Superior Stroke Care

f you have chest pain, you need to seek collaboration among multiple departments In addition, Bellevue received the care quickly. The longer you wait, the across the system.” association’s Target: Stroke Honor Roll. Imore damage you risk to your heart Bellevue Medical Center also has been This applies to achieving muscle. Now patients in the Bellevue recognized by the American Heart administration of thrombolytic therapy in community can be confident they are Association/American Stroke Association less than or equal to 60 minutes from the receiving the best heart care in the area. for its commitment to ensure stroke onset of symptoms in 50 percent or more Bellevue Medical Center recently patients receive the most appropriate of applicable acute ischemic stroke received full accreditation as a Chest treatment according to nationally patients to improve quality of patient care Pain Center with Primary Percutaneous recognized, research-based guidelines and outcomes. Coronary Intervention (PCI) from the based on the latest scientific evidence. These recognitions are important to American College of (ACC). The hospital received the Get With The the people of Bellevue because we know We were awarded the accreditation based Guidelines® Gold Plus Achievement stroke and heart attack are time critical on rigorous on-site evaluation of the Award, which means it has reached an and expert care can reduce the frequency staff’s ability to evaluate, diagnose and ambitious goal of treating patients with of death and disability. treat patients who may be experiencing 85 percent or higher compliance to core a heart attack. standard levels of care as outlined by the ➤ Need Heart Care? PCI is also known as a coronary American Heart Association/American Make an appointment with a doctor angioplasty. It is a nonsurgical procedure Stroke Association® for two consecutive backed by a proven record of excellence. that opens narrowed or blocked coronary calendar years. Call us at 800.922.0000. arteries with a balloon to relieve symptoms of heart disease or reduce heart damage during or after a heart attack. Hospitals that have earned ACC Chest 2018 Pain Center with Primary PCI accreditation have proven exceptional competency in treating patients with heart attack symptoms and have primary PCI available

STROKE HONOR 24/7 every day of the year. TARGET: ROLL

“We are very proud of this achievement,” says Sue Nuss, PhD, MBA, RN, vice president of Operations at Bellevue Medical Center. “This accreditation is a validation of the excellent care delivered by our health care team and wouldn’t be possible without