More than 3 million people in the U.S. have atrial fibrillation, an irregular heartbeat where the upper chambers of the heart beat chaotically, causing palpitations and shortness of breath.
When blood is not moving regularly through the heart, it’s likely to form clots, which can migrate to the brain and cause a stroke. The most common treatment has been to prescribe blood thinners, like Coumadin, to dissolve clots. These drugs can cause excessive bleeding that only exacerbates the situation, with few other choices — until now.
“Watchman is the only device which has shown that it is better than Coumadin in reducing the bleeding stroke in the brain while having a lower risk of complication,” says Dr. Rizwan Sardar, cardiac and structural heart disease interventionalist at Aultman Hospital.
The Food and Drug Administration-approved Watchman device is about the size of a quarter, made from a metal alloy that has shape memory, which allows it to conform to whatever geometry makes up the destination it’s implanted in.
“When [the Watchman] is deployed, it needs to go into the appendage and take the shape of that structure,” says Sardar, who’s done 80 or 90 Watchman surgeries, more than any other physician in The 330.
To implant the Watchman, the patient is under general anesthesia as doctors enter a vein in the leg and use both X-ray and ultrasound to guide catheters into the heart and situate the device. Over about 45 days, tissue grows over the device, permanently sealing the troublesome area where clots can form. The result is freedom from medication.
“Patients who get this device can be without blood thinners for the remainder of their life after 45 days of placement,” Sardar says.
Right now, patients go home the day after surgery, if all goes well. Soon, though, it may be easier. “We are developing techniques to avoid general anesthesia,” Sardar says. “We have done a few cases where the patient was totally awake. That is a very exciting frontier.”
While the #MeToo movement is still emerging, the need to heal following an assault is not.
Dr. Jennifer Savitski, chair of obstetrics and gynecology at Cleveland Clinic Akron General, knows this too well. She noticed two patients had answered “yes” to being sexually assaulted during the admission process. This unsettling discovery made her realize there was a need to create a center that would ensure survivors receive safer, more compassionate care. So along with the Ohio attorney general and several others, Savitski started a violence and sexual assault crisis center at Akron General in 2015.
Now with a dedicated space in Akron General’s brand-new emergency department, the Providing Access to Healing Center fills a void for survivors of sexual assault created after St. Thomas Hospital in Akron closed its emergency room in 2014. The center has a separate waiting area, a private shower and an exam room with supplies and storage for sexual assault forensic exam kits. Some patients come to the center from elsewhere in the hospital or are referred by an outside agency.
“We go where the patient is — and not just women; we help men too,” says Savitski.
The center does more by offering trauma-informed care: a holistic, tailored approach that encompasses all aspects of care for survivors of sexual assault, domestic violence, human trafficking and elder abuse. That means the center links survivors to community services such as counseling, and legal and economic assistance.
“When we care for people who have experienced trauma, we have to care for not just physical trauma but mental, emotional and psychological,” Savitski says.
Over 16 specially trained nurses are available around the clock to work with law enforcement in gathering forensic evidence that follows state and national regulations. This all-encompassing approach and the more open #MeToo landscape have aided Path in helping about 500 survivors in 2018, a hefty increase since its opening.
“We want to be that one-point person for those patients almost in a case management of sorts, to make sure that all their needs are addressed,” Savitski says.
Austin Mariasy
There are no Food and Drug Administration-approved treatments for mitochondrial diseases, but there is still hope for patients.
As one of 15 mitochondrial centers working with the North American Mitochondrial Disease Consortium, Akron Children’s Hospital is researching treatments of mitochondrial diseases that affect 1 in 2,000 people.
A part of the cells in our body, the mitochondria convert the food we eat into energy needed for bodily functions. Chemical reactions take place inside the mitochondria that produce ATP, comparable to a rechargeable battery. The process also creates free radicals, which can damage our body. Those with mitochondrial disease have more free radicals and errors in bodily function, such as seizures, liver failure and brain injury.
While progress has been made in achieving a more accurate and faster diagnosis, doctors are only able to manage the symptoms of the disease. To explore treatments, Akron Children’s is involved in numerous clinical trials. One is for EPI-743, an oral drug that appears to improve mitochondrial function and aims to increase ATP production and lessen free radical production. Patients in the trial have had fewer hospitalizations and adverse events.
“The syndrome is viewed as progressive and a sometimes fatal illness, and the patients on this drug seem to be doing better based on data. In other words, they are living,” says Dr. Bruce H. Cohen, director of the Neuro Developmental Science Center at Akron Children’s.
The other main trial Akron Children’s is doing is an injectable drug called elamipretide, which modifies mitochondrial function by stabilizing the mitochondrial structure. It aims to increase ATP production and reduce free radical injury.
“Patients who are moderately affected in terms of muscle weakness tend to walk further,” he says. “They also have fewer complaints of fatigue.”
Both drugs are still in the trial phase and are hopefully on the path to FDA approval. Since mitochondria are the basis of common diseases like heart failure, Parkinson’s disease and Alzheimer’s disease, this research could open the door for treating not only mitochondrial diseases but other diseases where mitochondiral dysfunction is at the root.
The future is in robotic hands.
Dr. Joshua Nething is using robots to treat and remove urological cancer. Operating out of Summa Health with a team of other specialized doctors, Urologic Oncologist Nething uses a robotic surgical system called the da Vinci Xi to perform minimally invasive surgery that results in less pain, faster recovery times and lower risk of infection.
The da Vinci requires only a few small incisions, eliminating the need to make a larger, more invasive cut to reach the area of treatment. These small incisions heal faster than a larger cut, which means significantly less pain and a faster recovery. And when an open wound is smaller and heals faster, the risk of infection shrinks, and there’s less blood loss.
When using the da Vinci robot compared to traditional laparoscopic surgery, doctors are able to magnify the area of treatment in three dimensions on a large screen. Then they use joysticks to control the robot’s arms, eliminating even the most natural, minute tremors of the human hand, which is crucial in urological surgery.
“The prostate is the worst location in the human body. It’s very deep in the pelvis,” says Nething. “When we do [the surgery] with robotics, we’re able to not only get into the pelvis very easily but also to see it up close.”
Five years ago, Nething became the first urologist fellowship trained in advanced robotic surgery in The 330, and Summa has the only da Vinci Xi in the Akron area. Prior to the da Vinci, there were more open surgeries for bladder, prostate, kidney and testicular cancer patients, which meant a long, difficult procedure for Nething and a much longer recovery for patients. Now, patients come from all over the state to receive the quicker, more precise robotic procedure.
“The Xi can work in multiple quadrants in the abdomen; there’s less instrument clash,” Nehting says. “And really, it increases the things we can do robotically, so we keep expanding our horizons.”
In 2006, Mercy Medical Center opened the nation’s first dedicated heart catheterization lab inside an emergency department.
Partitioned off in its own space 5 feet to the right of the ambulance entrance, the fully functioning and fixed cath lab contains identical equipment and supplies to Mercy’s inpatient cardiovascular cath lab on the third floor. Plus, it has the added benefit of a cardiac care team on call 24/7.
Emergency room doctors can help patients in many ways, but heart attacks are difficult to diagnose yet require very quick action. “Time is muscle,” says Dr. Ahmed Sabe, interventional cardiologist, heart valve specialist, executive director of Mercy Heart Center and co-director of Mercy Emergency Chest Pain Center. A heart attack occurs when an avenue to the heart either ruptures or is blocked by a clot, preventing blood from reaching the heart. And the longer your heart is deprived of blood, your chance of surviving plummets and the risk of surviving with serious impairment soars.
“If your life is saved, your activity, function [and] productivity will depend on the speed the procedure was performed and how much muscle is not damaged,” Sabe says.
Catheterization — inserting a tube with a tiny balloon at the end into an artery, then inflating the balloon to unblock it — is the best way to get the heart pumping again. But most cath labs are located elsewhere in a hospital, and emergency room staff traditionally have to call in a cardiac specialist, await his arrival and then move the patient to the cath lab for the procedure.
“Nobody wants that patient to keep suffering for another 45 minutes while you’re getting people ready,” Sabe says. So in 1998, he started a pilot cath lab program in Mercy’s emergency department and proved it successful with patient outcomes.
Now, Sabe and his team hold the record for door-to-balloon time — the time it takes for a doctor to catheterize a patient’s heart upon arrival — of five minutes.
Beyond the kudos, though, Sabe sees this as the new standard of best practices. “That’s what medicine is for, to alleviate pain and suffering of a brother or sister in humanity,” he says.
