Tag Archives: MD

Enlarged Prostate

January 16, 2015 by

Trouble urinating. Weak urine flow. Frequent urination or frequently getting up in the middle of the night. While many men chalk these symptoms up to “getting older,” they are often a sign of an enlarged prostate.

An enlarged prostate is one of the most common problems among men over 50.  The good news is that, in many cases, the symptoms caused by an enlarged prostate can be relieved with medical advice, says Chad LaGrange, MD, urologist at Nebraska Medicine. By age 60, about a half of men will have an enlarged prostate and by age 85, that number climbs to 80 percent.

Living with these symptoms can be uncomfortable, embarrassing, and can prevent you from getting a good night’s sleep, notes Dr. LaGrange. Some men may even avoid leaving the house for any longer length of time for fear of bladder leakage.

“Many men will put up with these symptoms for months until they become intolerable before seeing a doctor,” says Dr. LaGrange. “This can result in permanent damage to the kidneys and bladder. It’s always important to see a doctor early on to determine if it’s something that needs treatment and to rule out more serious problems like an infection or prostate cancer.”

The prostate grows throughout a man’s life. As it enlarges, the layer of tissue surrounding it stops it from expanding. This causes the gland to press against the urethra like a clamp, which can obstruct the flow of urine. Over time, the constant straining of the bladder muscle may cause it to become thicker and overly sensitive, causing it to contract with just small amounts of urine, resulting in the need to urinate frequently. Eventually, as the urethra opening becomes more restricted, the bladder cannot completely empty, which can lead to a urinary tract infection or kidney and bladder damage.

“Oftentimes, an enlarged prostate is not a serious problem and can be treated with lifestyle changes and behavior modification,” says Dr. LaGrange. “Medications are available that can shrink the prostate and relax the muscles in the prostate so the flow is better. Our goal is to avoid surgery until
absolutely necessary.”

Ultimately, treatment will depend on your symptoms, how severe they are, and whether you have other medical conditions, notes Dr. LaGrange. If you are not able to urinate at all, have significant bleeding, kidney failure, or are not responding to medical therapy, you may be a candidate for surgery. Resection of the tumor growth that is pressing against the urethra is the most common surgery for an enlarged prostate. The risks and benefits should be discussed thoroughly with
your physician.

“A lot of men think these problems are a normal part of aging and they just have to live with them,” notes Dr. LaGrange. “Just remember, if you are experiencing these symptoms, you are not alone, and in most cases, we can help you greatly reduce your symptoms with the appropriate medical therapy.”

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CPR Essentials

December 12, 2014 by

According to the American Heart Association (AHA), for every minute a cardiac arrest victim goes without life-saving CPR and defibrillation, the chances of survival decreases 7 to 10 percent. Learning the basics of CPR is especially vital for seniors.

The statistics are frightening: About 92 percent of sudden cardiac arrest victims die before reaching the hospital.  “But if more people knew CPR, more lives could be saved,” says Jennifer Redmond, executive director of the AHA. “Immediate CPR can double, or even triple, a victim’s chance of survival. What most people don’t realize, is that almost 80 percent of cardiac arrests occur at home. So most likely, the life you save will be that of a loved one.”

Several years ago, the AHA issued guidelines for hands-only CPR, hoping that this would encourage the use of CPR among bystanders.

“Hands-Only CPR is recommended for use by people who see a teen or adult suddenly collapse in an “out-of-hospital” setting such as at home, at work, or in a park,” explains Redmond. “In a national survey, Americans who had not been trained in CPR within the past five years said they would be more likely to perform hands-only CPR than conventional CPR on a teen or adult who collapses suddenly.”

However, there are times when conventional CPR with rescue breathing may provide more benefit than hands-only CPR. The AHA recommends CPR with a combination of breaths and compressions for all infants up to age 1; children up to puberty; anyone found already unconscious and not breathing normally; any victims of drowning, drug overdose, collapse due to breathing problems, or prolonged cardiac arrest.

To administer chest compressions correctly, place the heel of your hand in the middle of the chest on the breastbone between the nipples. Put your other hand on top of the first with your fingers interlaced. Compress the chest at least two inches at a rate of 100 compressions per minute.

Haysam Akkad, MD, an interventional cardiologist at The Nebraska Medical Center, stresses the use of hard, fast chest compressions, which keeps the blood circulating to vital organs. “You want to see the chest wall moving up and down,” he says. He also recommends that you always start CPR immediately and then call for help. Chest compressions should continue until help arrives. If an AED is close by, use that instead of CPR, he says.

Sudden cardiac arrest is a leading cause of cardiovascular death and is not the same as a heart attack. Sudden cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating.  A heart attack occurs when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest. Currently, only about 41 percent of cardiac arrest victims get CPR from a bystander.

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Jodi Saso’s 
Heart for Running

February 18, 2014 by
Photography by Bill Sitzmann

For many avid runners, qualifying for the Boston Marathon is considered the pinnacle of their running career. For 35-year-old Jodi Saso, completing the Boston Marathon was that and so much more.

Not only did it mark a major feat in her running career, but Saso crossed the finish line just 10 weeks after undergoing major heart surgery. Completing the marathon was a personal confirmation that she had risen above her heart condition and could continue “life as usual,” despite this unexpected setback.

“I didn’t want to be a victim of my circumstances and lay around feeling sorry for myself,” says Saso. “It was all about determination and not wanting to live that life. I figured I had one shot to do this, and I wasn’t going to let my surgery get in the way.”

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This is all even more amazing when you consider the fact that Saso had taken up running just several years ago when she decided she need to do something to get herself and her dog into shape. The pounds began to fall off, running became easier, and it wasn’t long before Saso had developed a new passion.

Saso found running to be a natural fit, and before long, she had started training for marathons. By 2012, she had run eight marathons in one year in addition to several half marathons and a 50-mile run. She was hooked and breaking her own records with each race. Saso felt wonderful physically and emotionally.

But an annual check-up with her doctor told her otherwise.

When Saso was very young, her pediatrician suspected that she might have Marfan syndrome, a rare genetic disorder that affects the connective tissue. The most serious complications of Marfan are defects of the heart valve and aorta. However, Saso never received a firm diagnosis. When she began seeing a new family practitioner in her late 20s, he too suspected Marfan syndrome and recommended they monitor her heart on a regular basis. A heart echo performed at her 2012 visit revealed an aortic aneurysm—a stretched and bulging section in the wall of the aorta.

“When the aorta becomes stretched, there is a big risk of the aorta dissecting or tearing or, even worse, rupturing and causing death,” says Traci Jurrens, MD, cardiologist at Nebraska Methodist Hospital, who performed the echocardiogram. “Jodi’s aorta had reached the threshold for repair.”

Because of the difficulty of the procedure, most cardiac surgeons replace both the valve and aorta during surgery, which requires lifelong anticoagulation with the blood-thinning drug called Coumadin, explains Dr. Jurrens. Coumadin can have a host of side effects, including easy bruising and bleeding.

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“Since she was so young, we determined that it would be worthwhile for Saso to go to the Mayo Clinic, where cardiac surgeons were able to perform the surgery without removing her own valve,” notes Dr. Jurrens.

Saso’s surgery was scheduled for Jan. 31, 2013. The timing could not have been worse. She had qualified for the Boston Marathon the spring before. The run was scheduled for April 15, just 10 weeks after her surgery. It was a dream she was not willing to let go so easily. “I asked my doctors if there was any way that I could still run the race,” she says. “They were doubtful, but they said it was contingent upon how the surgery and recovery went.”

Following surgery, Saso says she was in so much pain that she thought she would never leave the hospital. “Before I left the hospital, they told me that I had to walk the entire floor six times a day,” she says. “That first day, I could barely walk 10 feet.”

But that’s when Saso’s determination kicked in. “My goal was to run the Boston, and I was going to do everything I could to make that happen.” By day three, she was off pain medications. By day five, she was doing two laps instead of one six times a day and was released from the hospital to go home.

Encouraged by her quick recovery, Saso was on a fast track from then on, she says. By two weeks, Dr. Jurrens had released Saso to return to work. Four weeks after surgery, Saso finished an entire stress test—Dr. Jurrens’ first patient to do that. Jurrens cleared her to run the Boston as long as she promised to run it over four hours.

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Donning a T-shirt that read, “I had open heart surgery 10 weeks ago. Let’s do this!” Saso proudly crossed the finish line in 4:08:15.

“I felt amazing,” she says. Luck continued to be on Saso’s side. Having mistakenly booked her return flight extremely close to the race finish time, she had no time to hang out and celebrate. Instead, she left the race immediately to catch her flight. A short time later, she heard about the 2013 Boston bombings. “Someone was looking over me,” she says.

“Jodi has done remarkably,” says Dr. Jurrens. “It is quite a difficult procedure, but Jodi had excellent results. Because Jodi was in such great shape, she was able to get through surgery very well. In general, great functional capacity prior to surgery predicts better recovery from cardiac surgery. That being said, we really do not know what is safe for Jodi in regard to running, and we do discourage excessive exercise. But running is Jodi’s life, and she is going to make her own decision in regard to running.”

Saso completed five marathons in 2013 but says she is planning to slow down the pace for her own health benefits. “I’m going to do just two marathons a year in the future,” she says. “I want to be smart about this, and I really don’t want to have surgery again.”

The pace may be slower, but her determination to live life as usual is stronger than ever, says Saso. She recites one of her favorite quotes, which she says she applies both to running and life: “The body does not want you to do this. As you run, it tells you to stop, but the mind must be strong. You can always go too far for your body. You must handle the pain with strategy…it is not age. It is not diet. It is the will to succeed. Let’s do this!”