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Advances: Medical News for Patients November 2018

Amazing Stories: Lana Guerro

Lana Guerro

Lana Guerro was in bliss. The 29-year-old newlywed was pregnant with her second child when she had a strange bout of what she thought was morning sickness.

“I started feeling really sick, and I thought it was just morning sickness. But it didn't feel very normal,” she says. Concerned about persistent stomach pains, Lana decided to go to the emergency department at NewYork-Presbyterian Queens. When an ultrasound was performed, doctors found a tumor in her pancreas.

“It was very scary. I had heard that pancreatic cancer is one of the fastest growing cancers. It’s very quick and aggressive,” she says. “I immediately thought, ‘Okay, I have cancer. I'm pregnant, and maybe they're going to tell me I need to have an abortion because I need to go into some sort of treatment.’”

Lana was immediately referred to Pierre Saldinger, MD, FACS, chair of the Department of Surgery and surgeon-in-chief at NewYork-Presbyterian Queens. “When I had met Dr. Saldinger, he asked me, ‘What do you want to do?’ He gave me my options, which I was grateful for.”

Dr. Saldinger had a magnetic resonance imaging (MRI) test performed to determine if Lana’s tumor was an aggressive cancer. Based on the MRI results, he believed the tumor was not aggressive. With that information, Lana and her husband worked with Dr. Saldinger and her obstetrician to devise a plan to carry her baby to term.

“This was the hardest thing, for me. I had just found out I was having a boy. I was already thinking about names,” she recalls. “I was thinking, ‘Am I not going to see my sons grow up?’ I thank God for my husband because he has been the best at this. He always said, ‘Don't worry, we'll see what happens. You know, God will take care of everything.’”

The doctors continued to monitor the growth of the tumor. At about 30 weeks pregnant, an updated MRI scan showed what the radiology technician thought was significant tumor growth. Lana was told she needed to go to Dr. Saldinger’s office immediately, as she might need to be induced.

“We planned that if in August, it was growing, then I would have to be induced,” she says. “I was afraid because I worked for the Early Intervention program, which is an agency that does evaluations for little kids; so I knew a little bit about having an early childbirth and all of the health concerns that can come from it and the lungs and all these different things.”

But when she arrived at the office, Dr. Saldinger told Lana the reading was incorrect. The tumor hadn’t grown. Lana went home, and on October 14 — his due date — she gave birth to an eight-pound, six-ounce baby boy that she named Nathan.

To give Lana time to recoup from childbirth and bond with her son, Dr. Saldinger waited four months to remove the tumor. As time drew closer to Lana’s surgery date, she grew anxious about the possible outcomes.

“I thought the worst; I've never had surgery. So I was like, ‘I am not going to handle the surgery. It's going to be too much for me,’” she says. But with much convincing from her husband, Lana underwent surgery, which lasted about eight hours. When Dr. Saldinger removed the tumor, which was about 6-8 centimeters in size, he determined it was a solid pseudopapillary epithelial neoplasm (SPEN) – a rare form of pancreatic cancer which if not caught in time could have grown to become a life-threatening problem. Dr. Saldinger told Lana there was no specific reason she developed this cancer and this type of cancer. He also noted that this type of cancer typically is found by chance because the tumor doesn’t have associated symptoms. He suspected Lana’s pain was probably related to something else.

Since the surgery, Lana’s life has normalized — she cares for her two sons as she awaits the birth of her third child. She says she is grateful for the life-saving treatment she was offered by the doctors and nurses at NewYork-Presbyterian Queens.

“There’s no words for all that [Dr. Saldinger] has done for me, you know, taking care of everything. He always made me feel that everything was going to be fine,” she says. “The nurses were just awesome. They helped me breathe through anxiety attacks and were just super attentive. Even my sister was like, ‘Man, I would love to be a nurse like you.’ Because they came all the time to help, for any little thing.”

To learn more about cancer services at NewYork-Presbyterian Queens, visit nyp.org/queens. To find a specialist in Queens, call 800-282-6684.


Hope is on the Horizon for Pancreatic Cancer

Pancreas diagram

There is hope on the horizon in the battle against pancreatic cancer, the fourth leading cause of cancer-related death in the United States. Deemed a “silent” killer because it has no symptoms in its earlier, more treatable stages, pancreatic cancer is often too advanced at diagnosis to be effectively treated. As a result, more than 90 percent of pancreatic cancer patients die within five years of diagnosis and only 7.7 percent survive beyond five years. However, earlier intervention in people at risk and the development of new therapies for pancreatic cancer offer some promise to save more lives.

While the exact cause of pancreatic cancer is unknown, people with certain risk factors are more likely than others to develop the disease. For instance, smokers are two times more likely to develop pancreatic cancer compared to non-smokers. Obesity is another significant risk factor, as well as diabetes, a family history of pancreatic cancer, and chronic pancreatitis (inflammation of the pancreas).

Additionally, people with certain gene abnormalities have a higher risk for pancreatic cancer. For instance, BRCA1 and BRCA2 gene mutations, long associated with breast and ovarian cancers, are linked to pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer. Men and women who carry BRCA gene mutations are estimated to be at three to four times the risk for pancreatic cancer. For this reason, BRCA-positive pancreatic cancer patients may want to undergo screening for ovarian and breast cancers, and vice versa. Also a genetic disorder called Lynch syndrome is known to be associated with colorectal cancer as well as pancreatic cancer and cancers of the endometrium (the lining of the uterus), ovary, and small intestine.

People with a strong family history or genetic abnormalities associated with pancreatic cancer may be monitored to detect early signs of the disease before symptoms emerge. This is done with imaging tests such as endoscopic ultrasound or blood tests that screen for the presence of CA19-9, a tumor marker for pancreatic cancer.

Current treatment for pancreatic cancer may include surgery, chemotherapy, and radiation therapy. New approaches to pancreatic cancer treatments are constantly being explored in clinical trials, such as targeted therapies that attack specific pancreatic cancer cells and immune therapies that harness a person's immune system to fight the disease. 

Because pancreatic cancer is curable in its earliest stages, it is critically important to be diagnosed and treated at a comprehensive cancer center where the patient can access a multidisciplinary team with extensive experience in assessing and designing individual treatment strategies.

NewYork-Presbyterian /Columbia University Irving Medical Center (CUMC) and NewYork-Presbyterian/Weill Cornell Medical Center have been designated as Centers of Excellence for both pancreatitis and pancreatic cancer care by the National Pancreas Foundation (NPF). The designation recognizes centers that provide comprehensive, multidisciplinary care to patients undergoing treatment for pancreatitis and pancreatic cancer, respectively. NewYork-Presbyterian is the only health system in New York to receive both designations at more than one location.

To learn more about pancreatic cancer and cancer care at NewYork-Presbyterian, visit nyp.org/cancer. To find a cancer specialist, please call 877-697-9355.


Latest trends in diabetes treatment and care

Doctor testing patient patient's glucose

It is known as the “silent” disease because symptoms often develop slowly and might not be noticeable at first. Type 2 diabetes and its growing prevalence has become a topic of concern and health professionals are doubling down on their efforts to educate the public to its dangers and underscore the importance of its prevention.

According to Adriana Kuker, MD, an endocrinologist at NewYork-Presbyterian, “Diabetes is an endocrine disorder that causes blood glucose (sugar) levels to rise higher than normal. The most common form is type 2 diabetes, where the body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. Initial warning signs people should watch for include increased thirst, increased urination, fatigue, and slow healing of sores.”

Although research has yet to fully understand why some people develop diabetes, there are some known risk factors and topping the list is excess weight. Says Katie Campbell, a registered dietitian and certified diabetes educator at NewYork-Presbyterian Lawrence Hospital, “The more fatty tissue you have, the more resistant your cells become to insulin.” But there are other factors that come into play, such as leading a sedentary lifestyle, a family history of the disease, and age. “Type 2 diabetes usually develops as a person gets older, especially after age 45. But these days, we’re seeing a dramatic increase in children and usually for the same reasons – unhealthy diet and inactivity.”

Uncontrolled diabetes can lead to serious and even life-threatening complications. “Rapid and extreme rises in blood sugar can lead to dehydration, a buildup of acid in the blood, organ damage, coma, and even death, if not treated promptly,” explains Dr. Kuker, who also notes that diabetes is a leading cause of preventable blindness, non-traumatic leg amputations, kidney damage, as well as heart attack and stroke.

Diabetes management: collaborative care is key

There are many types of medications for diabetes management, ranging from pills to injections to personal infusion pumps, all of which are approved by the Food and Drug Administration. “It is important that patients take medications as prescribed and monitor their blood sugar levels regularly in order to avoid dangerous fluctuations,” advises Dr. Kuker. “Beyond that, diabetes care is now evolving to include medical teams to better address specific goals, barriers and challenges that are unique to each patient. We’re finding that the best approach is a collaborative one that includes not only the patient and physician, but specialists such as endocrinologists, pharmacists, nurse practitioners, dietitians, certified diabetes educators, and social workers.”

Educating patients on topics such as nutrition, exercise, and the importance of regular glucose monitoring helps empower them to be decision makers in their own care; much of diabetes care depends more on patient behavior than clinical interventions. “For example, if you are overweight or obese, a weight loss of 5-10 percent of your body weight can improve your heart health, lower blood pressure and cholesterol, and improve your blood sugar,” notes Ms. Campbell. “Choose a variety of plant-based sources such as beans, fruits, vegetables, and whole grains.  Always practice mindful eating behaviors such as portion control and reading nutrition labels. It’s also important to increase exercise by walking an extra 30 minutes a day, which can help shed pounds and lower blood sugar levels.”

While the condition may be considered a “silent” one, the statistics are loud and clear: more than 29 million people in the United States have diabetes, up from the previous estimate of 26 million in 2010, according to a report by the Centers for Disease Control and Prevention. Says Dr. Kuker, “With greater patient education and involvement, the diabetes can be better managed, and many may avoid developing it altogether.”


Using meditative movement to reduce stress, effects of chronic illness

group doing pilates

Today’s fast-paced and demanding world can take a toll on our health. There are pressures in virtually every aspect of life, from the workplace to relationships with family and friends, and health concerns. These stresses in life have been found to contribute to the onset of chronic diseases, such as depression and heart disease.

Meditative movement — exercises like yoga and Pilates that focus on breathing and a cleared state of mind aimed at a deep state of relaxation — has been found to be an effective way to combat chronic illness and aide in the healing process for patients undergoing surgery or cancer treatment.

“These exercises focus on synchronizing your breathe with the movement and being very aware of your body at that moment. This activates the parasympathetic nervous system,” says Chiti Parikh, MD, an internist and co-director of the Integrative Health and Wellbeing program at NewYork-Presbyterian in collaboration with Weill Cornell Medical Center. “The nervous system is split in two — the fight-or-flight response, which is the sympathetic system, and the relaxation response, which is parasympathetic system. During the course of the day, we constantly go back and forth between the two. But for most of us, throughout the day, are stuck in that fight-or-flight response. ”

This paralysis, she says, can increase blood pressure, heart rate, mood, stress hormone level, and affect brain wave patterns.

“When you breathe a certain way it activates the vagus nerve that controls the relaxation response. By breathing a certain way, you are manually stimulating that nerve and putting your body in the relaxation phase and out of the fight-or-flight response,” Dr. Parikh says.

Research studies have shown that the regular practice of yoga, an ancient Indian spiritual practice, may produce many health benefits, including weight loss, improved cholesterol, and lowered blood pressure. It also helps improve flexibility, increase muscle strength and tone, and is an effective weight loss method. Pilates, an exercise system that was initially created for bed-bound World War I survivors, has been found to help with chronic back pain.

“Pilates is mostly focused on core strengthening, a lot of back pain actually happens because the core is weak. So Pilates is good at core strengthening and not just abs. The back is actually the biggest part of the core muscles,” Dr. Parikh says. “It is also interesting to see that Pilates has been shown to be very good in the elderly population, specifically muscle strength, balance, and gait. So it decreases the risk of fall and has been shown to help with osteoporosis or bone density.”

The Integrative Health and Wellbeing Program at NewYork-Presbyterian offers guided yoga and Pilates courses for members of the community and patients. These courses can be customized to the individual needs of the participants, particularly for those with injuries or certain medical conditions.

“The Integrative Health and Wellbeing Programs focuses on a more holistic model where all types of care are integrated under one roof. What we do is combine the best of conventional medicine with top-notch doctors along with these integrative modalities,” she says. “We’ve taken a lot of care in assembling a team that has a lot of experience, especially in a clinical setting. So to have a Pilates instructor who knows how to work with cancer patients or a yoga instructor who knows how to work with someone who has had knee surgery or osteoporosis is very important.”

Located in the David H. Koch Center at NewYork-Presbyterian, the Integrative Health and Wellbeing program’s spa-like environment and services compliment medical therapies that clients are undergoing. The center has courses specifically designed to help patients heal following surgery and during cancer treatment. Participants in the “Prepare for Surgery, Heal Faster™” course have been found to have less anxiety before surgery, use 23 to 50 percent less pain medication after surgery, and heal faster than those who do not take the course.

The center also offers classes for strength and balance, mindful meditation, and revitalizing flow yoga.

“No matter where you are on your health journey — whether you’re a 30-year-old trying to work on your abs of steels or a 70-year-old trying to work on your balance — we can help you create that customized health plan to reach your end goal,” Dr. Parikh adds.

Join us for a class!

Book a class

Monday, November 12, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mindfulness Meditation at 6:00 PM

Mat Pilates at 6:00 PM

Wednesday, November 14, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mat Pilates at 5:00 PM

Friday, November 16, 2018
Restorative Yoga at 11:30 AM

Monday, November 19, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mindfulness Meditation at 6:00 PM
Mat Pilates at 6:00 PM

Wednesday, November 21, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM

Friday, November 23, 2018
Restorative Yoga at 11:30 AM

Monday, November 26, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mindfulness Meditation at 6:00 PM
Mat Pilates at 6:00 PM

Wednesday, November 28, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mat Pilates at 5:00 PM

Friday, November 30, 2018
Restorative Yoga at 11:30 AM

Monday, December 3, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mindfulness Meditation at 6:00 PM
Mat Pilates at 6:00 PM

Wednesday, December 5, 2018
Vinyasa Yoga at 7:10 AM
Revitalizing Flow Yoga at 8:10 AM
Mat Pilates at 5:00 PM

Visit nyp.org/integrativehealth for the full listing of upcoming classes.