Friday, July 27, 2012

Living donor gives sister liver transplant

Judith Lattin
STANFORD, Calif.--A liver failure patient is enjoying a new lease on life after Stanford surgeons transplanted a portion of her sister’s liver, which later regenerated into the full-size organ.

At 48, Judith Lattin was diagnosed with liver failure. Over the next nine years, Lattin fought that condition and its complications, enduring procedures and an unpleasant regimen of medications to control a bleeding esophagus, an enlarged spleen and major vein blockages. She was unable to walk at times, but she was not sick enough to be high on the list for a transplant.
She nearly lost all hope when doctors told her that the complications stemming from her liver disease made them uncomfortable with trying a transplant.

But then she met with the liver transplant team at Stanford Hospital & Clinics, led by surgeons who trained with Thomas Starzl, the American physician who pioneered successful liver transplantation. For Lattin, that changed everything. At her first meeting with Stanford’s chief of clinical transplantation, Waldo Concepcion, MD, “He said, ‘Yes,’ they could do it, and there was hope. I saw light at the end of the tunnel again,” Lattin said. “When you’ve been told that surgery is not an option for you, that’s basically a death sentence. It can be a very uncomfortable death. I had seen that as inevitable for me.”
But, Lattin still faced another obstacle — where and how to find a kidney donor. According to the United Network for Organ Sharing (UNOS), while the waiting list for liver donors is continually growing and currently averages between 16,000 and 18,000, the number of available deceased-donor livers has been stable at about 6,000 each year for the last decade. One in seven patients dies before receiving a new liver. There is no equivalent of kidney dialysis or cardiac-assist devices for the liver.
Luckily, Stanford was willing to do something else that many other hospitals would or could not: use a piece of Lattin’s sister’s liver as a transplant. Instead of having to wait on the list for a deceased-donor liver, Lattin could get that life-saving transplant as soon as Stanford’s team approved the donation from Lattin’s sister, Christine Webb. She was nine years younger and in good health, a strong candidate for the procedure.

At about 3 ½ pounds, the liver is the body’s largest solid organ by weight. Its functions are crucial. It detoxifies the blood, stores vitamins, breaks down fats and sugars, generates hormones and, most vital when surgery is involved, it produces the substance that clots blood. It is also the one organ in the body whose tissues respond to loss by regrowing to restore the organ’s original volume. That remarkable quality is what enables someone to give away as much as 60 percent of a liver without repercussions, assuming the surgery is done well. For that to happen, surgeons must control bleeding in an organ that’s rich with blood vessels and pumping through 1 ½ quarts of blood each minute.

“It’s a challenging, difficult surgery,” said Stanford Transplant Division Chief Carlos Esquivel, MD, PhD. “The risk of life-threatening hemorrhage is ever present, but we do this because there aren’t enough organs to go around.”

Despite this, Lattin and Webb were confident. “I had faith in the Stanford medical team that took care of me,” Webb said. “I knew that they were some of the best in the world, and that they don’t go into these surgeries lightly at all. I knew they would leave nothing unchecked, so I really trusted them.”
Only the most senior surgeons are allowed to do this type of operation, Esquivel said. The surgery to remove the diseased liver and the surgery to remove the donor liver portion take place simultaneously, followed by the surgery to connect the transplant, so Esquivel, Concepcion and their colleague, C. Andrew Bonham, MD, all worked the sisters’ surgery day.

The living donor procedure emerged in the late 1990s. Stanford performs three to five living donor transplants each year and 50 to 60 deceased donor liver transplants each year; its government-reported results place it in the top ranks for safety and survival. In addition to the wisdom gained from doing many procedures, advances in imaging used by Stanford surgeons also have improved safety, said Walid Ayoub, MD, who has been Lattin’s pre- and post-transplant hepatologist. With that imaging, “surgeons can see all the vessels ahead of time. They have a road map of the liver that allows them to stay clear of large veins and partition the liver safely.”

The team also uses instrumentation and tools to reduce blood loss, and it carefully calculates just how much liver to take. Every step has been developed to protect the donor and recipient.
Lattin’s and Webb’s operations took place on Dec. 20, 2010. Lattin was in the hospital for a month. Webb was released after four days. Lattin lives carefully, following the rules for her medication, diet and exercise. “I have energy to do things,” she said. “I have just so much more of a joy for life. I waited nine years for a transplant, and I didn’t realize just how much I had declined until after transplant when I started to feel so much better, and then I just started to do things.”
Webb, too, felt rewarded following the surgery. “There’s not a feeling in the world that is better than when doctors come to you and say, ‘You saved two people.’ I saved my sister, but I also saved the person who will now get the deceased donor liver my sister won’t need. It really brings it home when you think about it that way.”
To watch the video of this story, go here.

Salmon Fishing in the Yemen

A charming love story that is worth watching again ... and again.  I've often wondered what would be the perfect plot. This one is near perfect because it adds the querkiness of personality with the charm of a love story.  While the movie has its bad guys and intrigue, the main plot surrounds its main three characters who frankly are "nice" people.  It's refreshing to find characters with strong values.  I've seen the movie directed by Lasse Hallstrom; now I'd like to read the book by Paul Torday.

This is how Redbox described the movie story:
Dr. Alfred Jones (Ewan McGregor), a fisheries scientist in London, is approached by a mysterious sheikh (Amr Waked)about an outlandish plan to introduce the sport of salmon fishing into the desert in Yemen. The Sheikh's absurd vision of bringing faith and hope to his people fails to resonate with the faithless, unhappy Brit. However, after initially refusing the proposal, Dr. Jones is swayed by the British government, the Sheikh and the Sheikh's glamorous real estate rep Harriet (Emily Blunt)into accepting the job. The result is a ridiculous look at the dysfunction of government bureaucracy and the importance of faith in the face of impossibility.

Beating Asthma: 7 Simple Principles

By Stephen J. Apaliski, MD

New book empowers millions of asthma sufferers to take control over the disease

More than 34 million Americans have been diagnosed with asthma some time during their life, of which roughly one-third are under the age of 18. Dr. Stephen Apaliski, MD, an expert in the field of Pediatrics and Allergy and Immunology, has found in his 30 years of experience that for as many individuals who live with asthma, few really have it under control, leading to further health complications and death. In his new book, Beating Asthma: Seven Simple Principles, Dr. Apaliski teaches the important basics of asthma care, empowering readers with the information needed to take full control of their own, or a loved one’s asthmatic condition.

“When questioned about their asthma, 71% of patients say it is well or completely controlled,” says Dr. Apaliski. “When these same patients were analyzed using objective measures of control, only 29% were well controlled, so 71% were, in fact, poorly controlled. When not in control, patients’ quality of life is greatly reduced, and they are faced with potential emergency room visits, poor sleep, missing school or work, medication overuse, and depression.”       

The lack of knowledge and understanding of asthma is coupled with the fact that there are simply not enough allergists and other asthma specialists to care for all those who deal with the condition. With the release of Beating Asthma: Seven Simple Principles, Dr. Apaliski raises awareness of the standard of care needed for asthma sufferers so they will come to expect nothing less – and hopefully combat the nearly 4,000 deaths that asthma causes each year.

Beating Asthma: Seven Simple Principles empowers asthma sufferers and their caregivers to gain better control over their condition buy paying attention to the 7 P’s:

Problem – understand how asthma works and know the basics of the condition
Prevention – avoid those things in your environment that trigger asthma
Pulmonary function tests – Know how well your lungs are functioning and use this information to guide your treatment plan
Pharmaceuticals – know that medication is an essential part of keeping your asthma under control
Plan – set your asthma action plan, a roadmap that tells you when and what to do when things go wrong
Patient-Physician – having open communications with your physician is a crucial part of treating asthma
Positive mindset – remaining optimistic, taking ownership of your responsibilities to treat asthma, and becoming dedicated to keeping control over the position will increase quality of life amongst asthma sufferers

“I have believed for years that people with asthma and any other chronic condition are best served by being empowered and developing a great relationship with a good, empathetic, and caring physician,” adds Dr. Apaliski.

Dr. Apaliski has been a practicing physician for over 30 years. He first trained as a pediatrician at the Children’s Hospital of Pittsburgh and later as an allergist at Wilford Hall United States Air Force Medical Center in San Antonio, Texas. In 1990, he served as a flight surgeon in the first Gulf War.

Dr. Apaliski is Board Certified in Pediatrics as well as Allergy and Immunology. In addition, he is a Fellow of the American College of Allergy and Immunology and a Board Member of the Allergy and Asthma Foundation of America—Texas chapter. He is also certified by the Association of Clinical Research Professionals as a Certified Physician Investigator. In addition to seeing patients in his medical practice at the Allergy & Asthma Centers of the Metroplex and conducting Clinical Trials as the Medical Director of Discovery Trials-Arlington, Dr. Apaliski is on the medical staff at THR Arlington Memorial Hospital in Arlington, Texas.

Dr. Apaliski is also a speaker for various pharmaceutical companies, helping to educate physicians and other health care providers about the diagnosis and treatment of asthma and allergic diseases.


Beating Asthma: Seven Simple Principles is available for purchase on the website listed above and on

Thursday, July 26, 2012

Reducing hospital stays

ANN ARBOR, Mich. — A unique University of Michigan Health System program that helps older patients transition from the hospital to sub-acute care facilities has significantly reduced hospital stays and readmissions, according to new findings published in the Journal of the American Medical Directors Association.

Creating seamless patient transfers between hospitals and long-term care facilities has become a growing national concern. Previously reported studies have shown that these patients are particularly vulnerable to medication errors, hospital readmissions and other adverse effects on their care.

The six-year-old UMHS Sub-Acute Care Service – which coordinates care between the hospital and care facilities commonly called nursing homes – has proven a successful model of providing safe transitions for hospitalized patients. The average length of stay at UMHS before transfer to a skilled nursing facility dropped from 10.6 days to eight days, and hospital inpatient stays for patients in the program were reduced by nearly 2,908 days a year, authors say.

The findings come as new Medicare data released this month show that hospital readmission rates are stubbornly stagnant, costing Medicare $17.5 billion in inpatient spending. In October, Medicare will begin to penalize hospitals with higher than expected readmission rates, a mandate of new federal health laws.

The UMHS paper – whose lead author is U-M geriatric physician Darius K. Joshi, M.D.,– appears alongside a JAMDA editorial that lauds the U-M transition program.

“The data presented by Joshi and colleagues are compelling and the program ought to be monitored as a potential model for other health systems,” reads the editorial, titled “Climbing out of the Black Hole of Subacute Care.”

The UMHS sub-acute care program involves a close partnership between UMHS and selected skilled nursing facilities in the Ann Arbor area. It has dramatically changed the relationship between the hospital and facilities by deploying U-M physicians and nurse practitioners to skilled nursing facility partners. This U-M team follows patients after discharge and manages their care on-site.

“These patients are often elderly with chronic illness and other health concerns and require medical care and rehabilitation in skilled nursing facilities after hospitalization,” says Joshi, who is director of the sub-acute program and a clinical instructor in the geriatric medicine division of the U-M Medical School’s Department of Internal Medicine.

“We aimed to break down the silos that are such a big problem in healthcare and improve the continuity of care. We found that an investment like this by a large health system does produce returns by improving the overall quality of coordinated care for patients discharged to care facilities.”

Another critical piece of the sub-acute service is enhanced communication. The slower-paced setting of the care facility grants patients and their families more face time with physicians, whereas conversations may seem “rushed” in hospitals, Joshi says. This helps prevent misunderstandings over patient care.

The UMHS program also coordinates access to electronic health records between the hospital and facility, including inpatient notes, consultant reports, medication lists and allergies to avoid errors that could lead to hospital readmissions. When there is a “bounce back” – a readmission to the hospital from the nursing facility - easy access to data avoids confusion among hospital physicians on why the patient may have returned, the authors note.

“Previously, the post-discharge care off-site was a black hole, invisible and fragmented,” says co-author Tony Denton, executive director of University Hospitals and U-M Hospitals and Health Centers chief operating officer.

“But now, these private nursing facilities are key to safe, timely and coordinated placement of our patients. These carefully selected sub-acute providers are a valuable extension of the excellent care provided inside our hospitals.

“We are bridging communication gaps between the hospital and sub-acute providers, sharing a commitment to quality care.”

Additional Authors: Rick A. Bluhm, J.D.; Preeti N. Malani, M.D., MSJ; Steve Fetyko, MPA, CPA;, JD; Caroline S. Blaum, M.D., M.S. All are of the U-M Health System.

Citation: “The Successful Development of a Sub-Acute Care Service associated with a large academic health system:” doi:10.1016/j.jamda.2012.03.001.

The Misdiagnosed Child

By Dr. Joel Warshosky, author of How Behavioral Optometry Can Unlock Your Child’s Potential

Children presenting with behavior disorders often have associated reading/learning difficulties and are commonly characterized as being difficult children by their teachers and parents. ADD (attention deficit disorder), ADHD (attention deficit disorder hyperactivity), LD (learning disabilities), ODD (oppositional defiant disorder) and Dyslexia (difficulty deciphering symbols) are a few of the diagnosis that have been used to identify these children. Typically, it’s the child’s pediatrician, pediatric psychiatrist and/or neurologist who routinely prescribe medications: Ritalin, Concerta, Adderall and/or Prozac to name a few, used to create order and quiet in a child’s behavior.

Understandably, professionals are pressured to find answers for these children with behavioral and associated reading/learning problems. The school system and individual teachers are also pressured to create an environment where these children labeled as lazy, a class clown, day dreamer, slow, or uncooperative, can become socially and academically functional within the mainstream classroom. Medication may promote a child’s behavior to be more predictable and even appear to cause a child to stay on task better. However, if the underlying problems children experience are not medical in nature, these children will not learn or read any easier. In fact, they may become frustrated because they don’t feel right not knowing what’s wrong with them. Side effects of medications may create additional change in how children feel resulting in fatigue, restlessness, loss of appetite and a feeling of despair. Medicating without success reinforces a child to feel unstable about them self.

Medications may seem to cause less disruption in class and children may appear to better stay on level. However, if what was thought to be a chemical imbalance is truly a behavioral vision disorder, he will still not be comfortable processing visual information.

Children suffering from a behavioral vision disorder commonly have difficulty converging their eyes inward (inefficiency turning eyes inward), have difficulty focusing (inefficiency identifying) and are not be able to track (follow from one point to another). Misdiagnosis may not only support visual inaccuracy, it can diminish self esteem and even develop into the “Failure Syndrome.” Children with this syndrome believe that in not being able to perform a task correctly, they are incorrect.

Misdiagnosed children may not be considered “at risk” because medication has appeared to ease the situation. However, they will most likely be affected by a lack of self worth that the misdiagnosis has instilled within them. This may ultimately lower a child’s professional expectation and cause him to accept a vocation or profession lower than his actual potential.

What would have happened had these children been introduced to a behavioral vision approach? Not only could they have achieved success in reading and learning but they may have actually reached their life’s potential and subsequent joy.

Parents and child study team members may feel a false sense of security believing that they’ve taken the child to the eye doctor who said, your child’s eyes are fine, they see “20/20.” Seeing with clarity is important and yet a child’s visual concerns may have nothing to do with eyesight and everything to do with efficient, effective and effortless eye coordination, focus and tracking ability.

A lack of visual coordination results in two sets of eye muscles not working together.  One muscle system controls focus, for clarity, while the other system controls seeing single, not double.  These two systems are linked. Inaccuracy in one system will typically create a mismatch in the other creating inefficiency between the two.  Classical symptoms of a motivated  child trying to overcome visual dysfunction is eye strain associated with excessive eye rubbing/burning, headaches after visual activities and blurred vision during near activities. Symptoms of eye avoidance, typical of an unmotivated child, are double vision, omissions, or substituting words while reading, difficulty finishing school work and the most common symptom loss of place while reading.  Nonreaders have no symptoms at all simply because they avoid any situation which calls for them to read for any considerable length of time.

The success of vision therapy depends on the motivation of the team: inclusive of the child, parents and Behavioral Optometrist.  If the condition is recent and academic lags have not yet occurred, the program is quite simple often resulting in complete remediation.  When the condition is long standing, academic and/or emotional concerns can become secondary problems which must be addressed along with the primary visual. The more complex the situation the more involved the treatment strategy.  When secondary issues are evident the team must include the appropriate professionals. With academic involvement, reading, learning and special education professionals need to be resourced.  Social workers/psychologists consulted if emotional concerns have surfaced. Occupational and Physical therapists utilized for the development of fine and gross motor skills and Speech and Language therapists responsible for treatment of receptive and/or expressive language delay.

Parents, teachers and school administrators have the power to advocate for our children especially when they realize that symptoms of these labeled children can mimic behavioral vision dysfunction. Throw open your child’s door of opportunity and success and advocate for your bright and intelligent child’s ability to read, write and learn accessing the freedom of visual self-discovery through the benefits of a vision therapy program.

One of the most common and enthusiastic statements parents in my office make is “guess what, my child just picked up a book to read all by herself.”

Early and appropriate intervention is essential when changing a child’s course of development from one of frustration and lack of ability to one which encourages belief in oneself through success in a task.

About Dr. Warshowsky:

Joel H. Warshowsky is a behavioral and developmental Optometrist. He is Associate Clinical Professor and founding Chief of Pediatrics at SUNY State College of Optometry, where he has taught for over 35 years. He served as Optometric Consultant to numerous schools for child development throughout New York and New Jersey. Dr. Warshowsky has lectured internationally and is published widely in the field of optometry, and is a Fellow of the American Academy of Optometry and College of Optometrists in Vision Development. He maintains two pediatric practices in New York and New Jersey.

Dr. Warshowsky is available for speaking engagements


How Behavioral Optometry Can Unlock Your Child’s Potential: Identifying and Overcoming Blocks to Concentration, Self-Esteem and School Success with Vision Therapy can be purchased from,, and through all major booksellers.

Handling hidden home ownership expenses

San Francisco broker Tara-Nicolle Nelson lists six hidden expenses and how to handle them.

  1. Property tax increases.  Understand how property taxes work and deduct them on your tax return.
  2. Utilities. Do an energy audit so that your can stop leakages and reduce costs.
  3. Unexpected repairs. Reduce home repairs by keeping home systems well maintained.
  4. HOA dues increases. Get to know your neighbors and get them to help keep HOA expenses down.
  5. Special assessments. Stay involved in HOA and knowledgable about local government so you have input into special assessments.
  6. Basic maintenance. Plan for maintenance, putting money aside for regular maintenance.

 Go to Trulia to get more information.

Society Obsessed by Numbers

Exercising but aren't losing weight? Obsessed with counting each and every calorie you put in your mouth?

You might be caught in the 'numbers game.'

“Our society is obsessed by numbers, rules and strict diet plans, all so we can fit into the ‘accepted’ body image, size and look,” says Angela Lutz, a personal trainer and life coach with more than a decade of experience in the health and fitness industry. “And it really only leads to a society of people suffering from negative body images and beliefs. We have to break free from that outlook."

Lutz explains her philosophy - as well as other tips on avoiding "disorderly eating" in her new health guide, Bound by Numbers.

Bound by Numbers is a thoughtful approach to healthy living that begins by addressing internal issues first. Based on extensive research and real-life examples,  readers will learn how to jump off the treadmill of harmful ideas and jump into a brand-new life free from the past.