DiversityNursing Blog

By SYDNEY LUPKIN

http://abcnews.go.com 

Formerly conjoined twins Knatalye Hope and Adeline Faith Mata celebrated their first birthday with a "Frozen"-themed party at the hospital.

A team at Texas Children's Hospital separated the girls on Feb. 17 in a 26-hour surgery. They are still in the pediatric intensive care unit and have each had a few surgeries since the separation, but their mother, Elysse Mata, decorated their room with snowflakes and balloons.

"It's been a year," Mata said, surrounded by presents as the hospital filmed her. "It went by so fast. I feel like just yesterday they were born."

Earlier in the week, Mata had a party for everyone at the hospital who helped her babies over the last year. She said she was sad to leave some of the doctors from before the separation, but she knows it's a positive thing.

"Now they're good and healthy and hopefully headed towards home," said Mata, 25, of Lubbock, Texas.

Mata was shocked to learn the twins were conjoined when she was pregnant with them, she told ABC News in July.

"I was speechless, it was so unexpected,” she said.

The girls were born on April 11, 2014 at Texas Children's Hospital. They shared a chest wall, diaphragm, intestines, lungs, lining of the heart and pelvis. Their middle names are Hope and Faith because you can't have one without the other, she said.

"Nightline" was at the hospital in February as 12 surgeons operated on the Mata twins, and Elysse, her husband and 20 family members camped out in the waiting room.

http://news.nurse.com 

Surgeons are no longer removing most of the lymph nodes in the underarm area when a biopsy near the area shows cancer, a major change in breast cancer management, according to a study published in the Journal of the American College of Surgeons.
Researchers evaluated data from 2.7 million patients with breast cancer in the U.S. and learned to what extent surgeons were following recommendations from the American College of Surgeons Oncology Group Z0011, or ACOSOG Z-11 trial, published four years ago.

They reported that most early-stage breast cancer patients with tumors in their sentinel lymph node who undergo lumpectomy do not benefit from surgical removal of the remaining lymph nodes in the underarm area, called completion axillary lymph node dissection or ALND, according to a news release. They found no difference in cancer recurrence and five-year survival between patients who underwent ALND and those who did not.

Researchers found a dramatic increase in the proportion of lumpectomy patients who underwent only a sentinel lymph node biopsy — SNB — without an ALND. The SNB-alone rate more than doubled — from 23% in 2009 to 56% in 2011, according to the study.

“As far as I know, our study is the first to show that the findings from the ACOSOG Z-11 trial have changed clinical practice for breast cancer patients nationwide,” lead author Katharine Yao, MD, FACS, director of the Breast Surgical Program at NorthShore University HealthSystem in Evanston, Ill., and clinical associate professor of surgery at the University of Chicago Pritzker School of Medicine, said in the release. “The Z-11 trial has had a huge impact because of the lower risks for patients who undergo SNB alone.”

Investigators found that 74,309 patients (of the 2.72 million cases diagnosed between 1998 and 2011) met criteria for having SNB alone but underwent lumpectomy and radiation therapy to the whole breast, according to the press release.

The rate of SNB alone cases reportedly increased from 6.1% in 1998 to 56% in 2011. 
Yao said findings suggest that some practitioners may feel uncomfortable not performing ALND in high-risk patients, and called for more education for surgeons.

JOE PALCA

www.npr.org 

A promising technique for making brain tumors glow so they'll be easier for surgeons to remove is now being tested in cancer patients.

Eighteen months ago, Shots first told readers about tumor paint, an experimental substance derived from scorpion venom. Inject tumor paint into a patient's vein, and it will actually cross the blood-brain barrier and find its way to a brain tumor. Shine near-infrared light on a tumor coated with tumor paint, and the tumor will glow.

The main architect of the tumor paint idea is a pediatric oncologist named Dr. Jim Olson. As a physician who treats kids with brain cancer, Olson knows that removing a tumor is tricky.

"The surgeons right now use their eyes and their fingers and their thumbs to distinguish cancer from normal brain," says Olson. But poking around in someone's brain with only those tools, it's inevitable surgeons will sometimes miss bits of tumor or, just as bad, damage healthy brain cells.

So Olson and his colleagues at the Fred Hutchinson Cancer Center in Seattle came up with tumor paint. They handed off commercial development of the compound to Blaze Bioscience.

After initial studies in dogs showed promise, the company won approval to try tumor paint on human subjects. Those trials are taking place at the Cedars Sinai Medical Center in Los Angeles.

Dr. Chirag Patil is one of those surgeons. He says it's remarkable that you can inject tumor paint into a vein in a patient's arm, have it go to the brain and attach to a tumor, and only a tumor. "That's a concept that neurosurgeons have probably been dreaming about for 50 years," he says.

Patil says they've now used tumor paint on a about a half dozen patients with brain tumors. They use a special camera to see if the tumor is glowing.

"The first case we did was a deep tumor," says Patil. "So with the camera, we couldn't really shine it into this deep small cavity. But when we took that first piece out and we put it on the table. And the question was, 'Does it glow?' And when we saw that it glows, it was just one of those moments ...'Wow, this works.' "

In this first study of tumor paint in humans, the goal is just to prove that it's reaching the tumor. Future studies will see if it actually helps surgeons remove tumors and, even more importantly, if it results in a better outcome for the patient.

That won't be quick or easy. Just getting to this point has been a long slog, and there are bound to be hurdles ahead.

And even if tumor paint does exactly what it's designed to do, Dr. Keith Black, who directs neurosurgery at Cedars-Sinai, says it probably isn't the long-term solution to brain cancer. "Because surgery is still a very crude technique," he says.

Even in the best of circumstances, Black says, surgery is traumatic for the patients, and tracking down every last cell of a tumor is probably impossible. Plus, it's inevitable that some healthy brain tissue will be damaged in removing the tumor.

"Ultimately, we want to eliminate the need to do surgery," says Black. A start in that direction will be to use a compound like tumor paint to deliver not just a dye, but an anti-cancer drug directly to a tumor. That's a goal several research groups, including Jim Olson's, are working on.

Shefali Luthra

Source: www.cnn.com

You know the one. It might as well have been stitched together with paper towels and duct tape, and it usually leaves the wearer's behind hanging out.

"You're at the hospital because something's wrong with you -- you're vulnerable -- then you get to wear the most vulnerable garment ever invented to make the whole experience that much worse," said Ted Streuli, who lives in Edmond, Okla., and has had to wear hospital gowns on multiple occasions.

Put another way: "They are horrible. They are demeaning. They are belittling. They are disempowering," said Camilla McRory of Olney, Md.

Hospital gowns have gotten a face-lift after some help from fashion designers like these from Patient Style and the Henry Ford Innovation Institute.

The gowns are among the most vexing parts of being in the hospital. But if efforts by some health systems are an indicator, the design may be on its way out of style.

The Cleveland Clinic was an early trendsetter. In 2010, it introduced new gowns after being prompted by the CEO, who often heard patient complaints when he was a practicing heart surgeon. That feedback led to a search for something new, said Adrienne Boissy, chief experience officer at the hospital system.

The prominent academic medical center ultimately sought the help of fashion icon Diane von Furstenberg, settling on a reversible gown with a front and back V-neck, complete derriere coverage, and features such as pockets, softer fabric and a new bolder print pattern.

Patients "loved the gowns," Boissy said. "People felt much more comfortable in the new design, not just physically but emotionally." In recent years, she added, "hospitals are looking at everything they do and trying to evaluate whether or not it contributes to enhancing the patient experience." 

It's all part of a trend among hospitals to improve the patient reviews and their own bottom lines -- fueled in part by the health law's focus on quality of care and other federal initiatives. The Centers for Medicare & Medicaid Services increasingly factors patients' satisfaction into its quality measures, which are linked to the size of Medicare payments hospitals get.

Sometimes the efforts involve large capital improvement projects. But they can also mean making waiting rooms more comfortable, improving the quality of food served to patients or, as in this case, updating hospital gowns.

Ultimately, this focus leads to "a better patient experience," said John Combes, senior vice president of the American Hospital Association.

The Detroit-based Henry Ford Health System is in the process of updating its gowns, an initiative that began when the system's innovation institute challenged students at the city's College for Creative Studies to identify and offer a solution to one hospital problem.

The students responded with the suggestion to redo the garment that has often been described by patients as flimsy, humiliating, indecent and itchy. The process took three years, but last fall, the institute unveiled a new and improved version. It's made of warmer fabric -- a cotton blend -- that wraps around a patient's body like a robe and comes in navy and light blue, the hospital's signature colors.

Patient expectations are part of the calculus. They "are demanding more privacy and more dignity," said Michael Forbes, a product designer at the Henry Ford Innovation Institute.

When the institute tested his gown design, Forbes said, patient-satisfaction scores noticeably increased in a few days.

The new gown "was emblematic...of an attitude that was conveyed to me at the hospital -- that they cared about me as a whole human being, not just the part they were operating on," said Dale Milford, who received a liver transplant during the time the redesign was being tested. "That was the subtext of that whole thing, was that they were caring about me as a person and what it meant for me to be comfortable."

But replacing the traditional design is no easy task. What patients wear needs to be comfortable yet allow health professionals proper access during exams, meaning it must open and close easily. The gowns also need to be easily mass-manufactured, as well as efficiently laundered and reused.

New designs, though, can be expensive. After Valley Hospital of Ridgewood, N.J., switched to pajamas and gowns that provide extra coverage, costs went up $70,000 per year, said Leonard Guglielmo, the facility's chief supply chain officer, because the new garments cost more to buy and maintain.

Beyond cost, more ingrained cultural expectations might also play a role in what hospitals think patients should wear, said Todd Lee, an assistant professor of medicine at McGill University, who co-authored a 2014 study in the journal JAMA Internal Medicine, examining whether gowns were important and whether patients might be fine wearing their own or hospital-provided pants, instead of or along with gowns.

Often, doctors reported that pants or undergarments beneath gowns would have been okay, but patients said they were never given those options. Traditional gowns make it easier to examine patients quickly, and several doctors Lee spoke to seemed shocked at the idea that patients might wear garments other than the open-backed gown during their stay.

But the most common challenge isn't necessarily doctor expectations or costs. It's navigating hospital bureaucracies, said Dusty Eber, president of the California-based company PatientStyle, which designs and sells alternative gowns. In his company's experience, hospital decisions are often made by committees, not individuals.

Dr. Edward Soffen

Source: www.livescience.com

Dr. Edward Soffen is a board-certified radiation oncologist and medical director of the Radiation Oncology Department at CentraState Medical Center's Statesir Cancer Center in Freehold, New Jersey. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

As a radiation oncologist, my goal is to use radiation as an extremely powerful and potent tool to eradicate cancer tumors in the body: These techniques save and extend patients' lives every day. 

Historically, radiation treatments have been challenged by the damage they cause healthy tissue surrounding a tumor, but new technologies are now slashing those risks.

How radiation therapies work

High-energy radiation kills cancer cells by damaging DNA so severely that the diseased cells die. Radiation treatments may come from a machine (x-ray or proton beam), radioactive material placed in the body near tumor cells, or from a fluid injected into the bloodstream. A patient may receive radiation therapy before or after surgery and/or chemotherapy, depending on the type, location and stage of the cancer. 

Today's treatment options target radiation more directly to a tumor — quickly, and less invasively — shortening overall radiation treatment times. And using new Internet-enabled tools, physicians across the country can collaborate by sharing millions of calculations and detailed algorithms for customizing the best treatment protocols for each patient. With just a few computer key strokes, complicated treatment plans can be anonymously shared with other physicians at remote sites who have expertise in a particular oncologic area. Through this collaboration, doctors offer their input and suggestions for optimizing treatment. In turn, the patient benefits from a wide community of physicians who share expertise based upon their research, clinical expertise and first-hand experience. 

The result is safer, more effective treatments. Here are five of the most exciting examples:

1. Turning breast cancer upside down

When the breast is treated while the patient is lying face down, with radiation away from the heart and lungs, a recent study found an 86 percent reduction in the amount of lung tissue irradiated in the right breast and a 91 percent reduction in the left breast. Additionally, administering prone-position radiation therapy in this fashion does not inhibit the effectiveness of the treatment in any way.

2. Spacer gel for prostate cancer

Prostate cancer treatment involves delivering a dose of radiation to the prostate that will destroy the tumor cells, but not adversely affect the patient. A new hydrogel, a semi-solid natural substance, will soon be used to decrease toxicity from radiation beams to the nearby rectum. The absorbable gel is injected by a syringe between the prostate and the rectum which pushes the rectum out of the way while treating the prostate. As a result, there is much less radiation inadvertently administered to the rectum through collateral damage. This can significantly improve a patient's daily quality of life — bowel function is much less likely to be affected by scar tissue or ulceration. [Facts About Prostate Cancer (Infographic )]

3. Continual imaging improves precision

Image-Guided Radiation Therapy (IGRT) uses specialized computer software to take continual images of a tumor before and during radiation treatment, which improves the precision and accuracy of the therapy. A tumor can move day by day or shrink during treatment. Tracking a tumor's position in the body each day allows for more accurate targeting and a narrower margin of error when focusing the beam. It is particularly beneficial in the treatment of tumors that are likely to move during treatment, such as those in the lung, and for breast, gastrointestinal, head and neck and prostate cancer. 

In fact, the prostate can move a few millimeters each day depending on the amount of fluid in the bladder and stool or gas in the rectum. Head and neck cancers can shrink significantly during treatment, allowing for the possibility of adaptive planning (changing the beams during treatment), again to minimize long term toxicity and side effects.

4. Lung, liver and spine cancers can now require fewer treatments 

Stereotactic Body Radiation Therapy (SBRT) offers a newer approach to difficult-to-treat cancers located in the lung, liver and spine. It is a concentrated, high-dose form of radiation that can be delivered very quickly with fewer sessions. Conventional treatment requires 30 radiation treatments daily for about six weeks, compared to SBRT which requires about three to five treatments over the course of only one week. The cancer is treated from a 3D perspective in multiple angles and planes, rather than a few points of contact, so the tumor receives a large dose of radiation, but normal tissue receives much less. By attacking the tumor from many different angles, the dose delivered to the normal tissue (in the path of any one beam) is quite minimal, but when added together from a multitude of beams coming from many different planes, all intersecting inside the tumor, the cancer can be annihilated. 

5. Better access to hard-to-reach tumors

Proton-beam therapy is a type of radiation treatment that uses protons rather than x-rays to treat cancer. Protons, however, can target the tumor with lower radiation doses to surrounding normal tissues, depending on the location of the tumor. It has been especially effective for replacing surgery in difficult-to-reach areas, treating tumors that don't respond to chemotherapy, or situations where photon-beam therapy will cause too much collateral damage to surrounding tissue. Simply put, the proton (unlike an x-ray) can stop right in the tumor target and give off all its energy without continuing through the rest of the body. One of the more common uses is to treat prostate cancer. Proton therapy is also a good choice for small tumors in areas which are difficult to pinpoint — like the base of the brain — without affecting critical nerves like those for vision or hearing. Perhaps the most exciting application for this treatment approach is with children. Since children are growing and their tissues are rapidly dividing, proton beam radiation has great potential to limit toxicity for those patients. Children who receive protons will be able to maintain more normal neurocognitive function, preserve lung function, cardiac function and fertility. 

While cancer will strike more than 1.6 million Americans in 2015, treatments like these are boosting survival rates. In January 2014, there were nearly 14.5 million American cancer survivors. By January 2024, that number is expected to increase to nearly 19 million. 

But make no mistake — radiation therapy, one of the most powerful resources used to defeat cancer, is not done yet. As we speak, treatment developments in molecular biology, imaging technology and newer delivery techniques are in the works, and will continue to provide cancer patients with even less invasive treatment down the road.

Source: www.livescience.com

  PAULA SPAN

What she wanted, the patient told the geriatricians evaluating her, was to be able to return to her condominium in Boston. She had long lived there on her own, lifting weights to keep fit and doing her own grocery shopping, until a heart condition worsened and she could barely manage the stairs.

So at 94, she consented to valve replacement surgery at a Boston medical center. “She never wanted to go to a nursing home,” said Dr. Perla Macip, one of the patient’s geriatricians. “That was her worst fear.”

Dr. Macip presented the case on Saturday to a meeting of the American Academy of Hospice and Palliative Medicine. The presentation’s dispiriting title: “The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?”

Like Dr. Macip, a growing number of physicians and researchers have grown critical of 30-day mortality as a measure of surgical success. That seemingly innocuous metric, they argue, may actually undermine appropriate care, especially for older adults.

The experience of Dr. Macip’s patient — whom she calls Ms. S. — shows why.

Ms. S. sustained cardiopulmonary arrest during the operation and needed resuscitation. A series of complications followed: irregular heartbeat, fluid in her lungs, kidney damage, pneumonia. She had a stroke and moved in and out of the intensive care unit, off and on a ventilator.

After two weeks, “she was depressed and stopped eating,” Dr. Macip said. The geriatricians recommended a “goals of care” discussion to clarify whether Ms. S., who remained mentally clear, wanted to continue such aggressive treatment.

But “the surgeons were optimistic that she would recover” and declined, Dr. Macip said.

So a discussion of palliative care options was deferred until Day 30 after her operation, by which time Ms. S. had developed sepsis and multiple-organ failure. She died on Day 31, after life support was discontinued.

The key number here, surgeons and other medical professionals will recognize, is 30.

Thirty-day mortality serves as a traditional yardstick for surgical quality. Several states, including Massachusetts, require public reporting of 30-day mortality after cardiac procedures. Medicare has also begun to use certain risk-adjusted 30-day mortality measures, like deaths after pneumonia and heart attacks, to penalize hospitals with poor performance and reward those with better outcomes.

However laudable the intent, reliance on 30-day mortality as a surgical report card has also generated growing controversy. Some experts believe pressures for superior 30-day statistics can cause unacknowledged harm, discouraging surgery for patients who could benefit and sentencing others to long stays in I.C.U.s and nursing homes.

“Thirty days is a game-able number,” said Dr. Gretchen Schwarze, a vascular surgeon at the University of Wisconsin-Madison and co-author of an editorial on the metric in JAMA Surgery. Last fall, she led a session about the ethics of 30-day mortality reporting at an American College of Surgeons conference.

“Surgeons in the audience stood up and said, ‘I can’t operate on some people because it’s going to hurt our 30-day mortality statistics,’” she recalled. The debate is particularly urgent for older adults, who are more likely to undergo surgery and to have complications.

Those questioning the 30-day metric point to potential dilemmas at both ends of the surgical spectrum. Surgeons may decline to operate on high-risk patients, even those who understand and accept the trade-offs, because of fears (conscious or not) that deaths could hurt their 30-day results.

At a hospital in Pennsylvania, for instance, a cardiothoracic surgeon declined to operate on a man who urgently needed a mitral valve replacement. He wasn’t elderly, at 53, but he was an alcoholic whose liver damage increased his risk of dying.

Dr. Douglas White, the director of ethics and decision-making in critical illness at the University of Pittsburgh School of Medicine, was asked to consult. According to Dr. White, the surgeon explained that “we have been told that our publicly reported numbers are bad, and we have to take fewer high-risk patients.”

Other surgeons at the hospital, under similar pressure, also refused. A helicopter flew the patient to another hospital for surgery.

An outlier case? A study in JAMA in 2012 compared three states that require public reporting of coronary stenting results to seven nearby states that didn’t report. Older-adult patients having acute heart attacks had substantially lower rates of the stenting in the reporting states. Doctors’ concerns about disclosure of poor outcomes might have led them to perform fewer procedures, the authors speculated; they might also have weeded out poorer candidates for surgery.

Perhaps as important for older people, when things go wrong, surgical teams concerned about their 30-day metrics may delay important conversations about palliative care or hospice, or even override advance directives.

“There are no good published studies on this, but it’s something we see,” Dr. White said. “Surgeons are reluctant to withdraw life support before 30 days, and less reluctant after 30 days.”

That may have been what happened to Ms. S. Or perhaps her aggressive treatment resulted from a surgical ethos that has little to do with mortality reports.

“We want to cure patients and help them live, and we consider it a failure if they don’t,” said Dr. Anne Mosenthal, who heads the American College of Surgeons committee on surgical palliative care.

With surgeons already prone to optimism and disinclined to withdraw life support, the effect of reporting failures, if there is one, is subtle. Surgeons tell themselves, “Maybe if we wait a little longer, he’ll improve; there’s always a chance,” Dr. Mosenthal said.

But many older patients, and their families, have different ideas about what makes life worth sustaining and might welcome a frank discussion before a month passes.

“The 30-day mortality statistic creates a conflict of interests,” said Dr. Lisa Lehmann, an associate professor of medical ethics at Harvard Medical School. “It can lead to the violation of a physician’s duty to put patients’ interests first.”

Leaders at the nonprofit National Quality Forum, which just endorsed 30-day mortality as a measure for coronary bypass surgery, find such fears overblown. The forum evaluates quality measures for Medicare and other insurers, and went ahead with its endorsement despite some physicians’ objections.

“There is some concern,” said Dr. Helen Burstin, the chief scientific officer of the forum, but “certainly no evidence” that the metric is unduly influencing patient care.

“Is it better not to measure and compare, just because we can’t get it perfect?” added Dr. Lee Fleisher, a co-chairman of the forum’s surgery standing committee.

But critics think other quality measures might serve better. Perhaps the benchmark should be 60- or 90-day mortality. Perhaps patients having palliative surgery to relieve symptoms should be tracked separately, because comfort is their goal, not survival.

Maybe quality should include days spent in an I.C.U. or on a ventilator, Dr. Schwarze said.

“Medicine isn’t just about keeping people alive,” she said. “Some of it is about relieving suffering. Some of it is about helping people die.”

Source: www.nytimes.com

JESSICA FIRGER

Have you ever wondered what happens during a heart transplant operation? The surgical team at Baylor University Medical Center (@BaylorHealth) in Dallas understands the curiosity. On Monday night, the hospital offered the public an intimate look at the process of one patient's heart transplant journey using the hashtag #HeartTXLive and also #heartTX.

While hospitals have tweeted about organ transplant surgeries before, this is believed to be the first one to be tweeted in real time. The hospital says they chose to tell the story from the patient's point of view, and also documented the surgery with photos and video. 

Dr. Gonzo Gonzalez (@HRTTRNSPLNTMD), chief of cardiac surgery and heart transplant and mechanical circulatory support at Baylor University Medical Center assisted with the live tweets, while Dr. Juan MacHannaford performed the surgery. 

To protect the patient's identity, the hospital used pseudonyms for the patient and her husband, referring to them as Jane and John in the tweets. Jane was born with cardiomyopathy, which causes an enlargement of the heart muscle and structural problems. In Jane's case, she was born with an abnormal left ventricle, and had a bacterial infection at 3 months old that caused her to go into cardiac arrest. 

The live tweets paint a picture of the stress that comes with performing such a high-profile and high-risk surgery -- from waiting for the donor organ's arrival to the complex process of removing the patient's heart, implanting the new one and ensuring it's beating and circulating the patient's blood inside her body. Here are some highlights:

Dr. Juan MacHannaford is performing Jane's #hearttx tonight. #heartTXlive pic.twitter.com/5LOFirFIg8

— Baylor Health Care (@BaylorHealth) February 17, 2015

Jane's new heart arrived back in Dallas just moments ago. #HeartTXLive pic.twitter.com/3dGWX1uaTc

— Baylor Health Care (@BaylorHealth) February 17, 2015

Dr. Raj Malyala entering the operating room with Jane's new heart. #HeartTXLive pic.twitter.com/Tnrivzl07h

— Baylor Health Care (@BaylorHealth) February 17, 2015

The heart-lung machine keeps Jane alive while her heart is out of her body #HeartTXLive pic.twitter.com/lsh4sNkwJc

— Baylor Health Care (@BaylorHealth) February 17, 2015

VIDEO: Jane's old heart is removed, moments before donor heart is implanted. #HeartTXLive pic.twitter.com/OCj9frOJSu

— Baylor Health Care (@BaylorHealth) February 17, 2015

Jane's new heart crosses w/old heart on the way in. (Donor's heart at top, Jane's old heart below). #HeartTXLivepic.twitter.com/kay7BmNICL

— Baylor Health Care (@BaylorHealth) February 17, 2015

The fourth connection is completed and Jane's new heart kickstarts immediately as seen on the EKG. #HeartTXLivepic.twitter.com/Pknn58Y0Li

— Baylor Health Care (@BaylorHealth) February 17, 2015

Source: www.cbsnews.com

By Ryan Grenoble

Moments after Jacob "Jake" Boddie woke from surgery to remove a tumor in his pelvis, his father, Kyle Boddie, said to his 2-year old son, "Hey, Jake, bust a move!" Although he was still groggy, the toddler smiled. One tiny shoulder, then the other, wiggled in time to a beat. 

Kyle and Jake's mother, Ashley McIntyre, say Jake started dancing long before he could walk. "And now that's all he does," Kyle said. "He loves it. You can't stop him."

During his yearlong treatment for a rare cancer, Jake danced with his nurses, child life specialists and doctors at the University of Chicago Medicine Comer Children's Hospital. He boogied in his hospital room, in the hallways, and even on the way to the operating room. His parents say dance helped Jake recover from his treatments and surgery. It helped them cope with their son's illness. 

"Even though Jake went through so much, he uplifted us," Ashley said. "We thought, if he can have fun through all of this, why can't we?"

Kyle and Ashley knew something was wrong when Jake wasn't acting like himself at a Fourth of July picnic in 2013. Agitated and restless, the toddler wasn't his "silly self" and refused to dance or play with the other children. A few days later he began limping. An ultrasound performed in the emergency room at Comer Children's Hospital showed a large mass resting in the lower part of his abdomen and reaching into his pelvis.

A biopsy revealed the mass to be a sarcoma, a fast-growing cancer. "The tumor was 4 inches in diameter, about the size of a small grapefruit," said pediatric oncologist Navin Pinto, MD, an expert on sarcoma treatment. In addition to his clinical work, Pinto leads a personalized medicine initiative at Comer Children's Hospital that is sequencing the genetic makeup of pediatric tumors from every patient to help guide treatment.

For Jake, several rounds of chemotherapy were needed to shrink the tumor to half its original size. It was then small enough to be removed, but Jake's surgery would be complicated. The tumor was wrapped around critical blood vessels as well as the right ureter, a tube that brings urine from the kidney to the bladder. 

On the morning of the surgery in January 2014, Ashley and Kyle danced with Jake to the song "Happy" as they headed toward the operating room doors; there they turned him over to the surgical team. "Jake knew something was going on," Ashley recalled, "but I think it made him feel better to see us laughing and dancing."

Pediatric urologist Mohan Gundeti, MD, and pediatric surgeon Grace Mak, MD, worked together in the surgical suite. First, Gundeti used an endoscopic approach, placing a stent in the ureter to mark its location and keep the fragile tube open. Mak then surgically removed as much of the tumor as possible, meticulously separating it from the vessels and ureter while avoiding nearby nerves. 

"Jacob recovered beautifully and bounced back quickly after the operation," Mak said, adding, "he was eating -- and doing his moves -- a few days later."

Completing Jake's treatment required both chemotherapy and radiation to eliminate any lingering cancer cells. In addition, the lower section of the right ureter had narrowed, leading to pressure on the right kidney, and needed attention before it became completely obstructed. 

Gundeti performed reconstructive surgery, moving the right kidney down a few centimeters and making a new tube for the ureter using a flap from the bladder. Again, Jake recovered quickly from an extensive surgery.

Today, the 3-year-old visits Comer Children's Hospital regularly for follow-up care with the nurses and doctors who cared for him. 

"He feels comfortable at the hospital; he's always laughing and having a good time," Kyle said. "Everyone knows him now. And everyone dances with him."

Source: www.uchicagokidshospital.org

Fifty-one years ago, Arthur Lampitt of Granite City, Illinois, smashed his 1963 Thunderbird into a truck. This week during surgery in suburban St. Louis, a 7-inch turn signal lever from that T-Bird was removed from his left arm.

Dr. Timothy Lang removed the lever Wednesday during a 45-minute operation. Lampitt, now 75, is recovering at home.

The St. Louis Post-Dispatch ( http://bit.ly/1EOtGa6 ) reports that the accident broke Lampitt's hip, drawing attention away from the arm, which healed.

A decade or so ago, his arm set off a metal detector at a courthouse. An X-ray showed a slender object the length of a pencil, but since it caused no pain or hardship, Lampitt was told to let it be.

He was moving concrete blocks a few weeks ago when the arm began to hurt for the first time.

"Everything was fine until it started to get bigger," Lampitt's wife, Betty, said. "The arm started bulging."

Lampitt decided to have surgery. He initially wasn't sure what was in the arm. He wondered if perhaps a medical instrument had been left during the emergency room visit in 1963.

He unearthed a collection of old photos of the mangled Thunderbird taken by a friend at the scene. He noticed the metal blinker lever was missing from the left side of the steering column. He figured that was it, and surgery at City Place Surgery Center in Creve Coeur, Missouri, confirmed it.

"Seven inches long," Lang told Betty.

"Oh, my God," Betty said.

Lang said a protective pocket grew around the lever.

"We see all kinds of foreign objects like nails or pellets, but usually not this large, usually not a turn signal from a 1963 T-Bird," Lang said. "Something this large often gets infected."

Lampitt wasn't sure what he'd do with the lever ? maybe make a key chain out of it.

"We'll figure out something, I am sure," he said.

Source: http://abcnews.go.com