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3 days ago · Straightforward Approach Fixes Fibroids

When Karen Pauly began looking for treatment to address her painful uterine fibroids, she needed a care team that could take all her medical concerns into consideration. Karen took her quest to Mayo Clinic, where she received minimally invasive therapy that has dramatically improved her life.
Karen Pauly, left, with her family, Jamison, Nathan and Autumn.

When Karen Pauly began looking for treatment to address her painful uterine fibroids, she needed a care team that could take all her medical concerns into consideration. Karen took her quest to Mayo Clinic, where she received minimally invasive therapy that has dramatically improved her life.




When
it comes to health care interventions, less is more for Karen Pauly.

Karen, a school psychologist, wife and mother of two teenagers, lives with a coronary microvascular disease that causes painful spasms of the small vessels around her heart. Because her condition is sensitive to stress and hormone fluctuations, Karen opts for low-impact treatment options to manage other health issues that arise.

So when Karen developed symptoms related to uterine fibroids, she set out to find a medical provider who not only understood the complexities of her underlying disease, but also respected her desire for minimally invasive care.

Mayo Clinic was the only one that seemed to have knowledge about the spasms, and that brought me to Drs. Breitkopf and Stockland,” Karen says. “They definitely recommended being careful about how best to treat the fibroids and a using a conservative treatment.”

The option presented to Karen by Andrew Stockland, M.D., in the Department of Radiology, was uterine artery embolization. Dr. Stockland used the procedure to treat two uterine arteries that were supplying blood to Karen’s fibroids. Within a few months, the bothersome symptoms related to her fibroids were all but gone.

“I
was so impressed with the doctors and the respect they treat their patients
with,” Karen says. “They were very understanding about what I was
going through.”

Stressful symptoms

Karen
developed the small vessel condition in 2014. When an episode hit, it hit hard.
“It feels like a heart attack, actually,” Karen says. “I’d get
left-side pain in my chest and shortness of breath. I had to leave work a few
times. If I was at home, I had to stop what I was doing and wait it out.”

At the time, Karen sought help from specialists near home in St. Peter, Minnesota. Finding no answers locally about her unusual symptoms, she turned to Mayo Clinic. At the Women’s Heart Clinic, Karen met cardiologist Joseph Murphy, M.D., who identified the syndrome and recommended treatment options.

“He
was able to treat it, and in time, slowly, I got a little better,” Karen
says. “We started recognizing that one of the triggers for my coronary
artery spasms was hormone fluctuation.”

A
few years after developing the small vessel condition, Karen noticed changes in
her menstrual cycle. The duration increased from seven to 10 and then 14 days.
At times, the flow became unmanageable. “The bleeding would get pretty
significant to where I kind of got lightheaded,” Karen says. “It
limited my daily activities and social life.”

“I was nervous about where to go for treatment because I wanted them to understand the coronary artery spasms and the relationship to hormones. That’s why I ended up going back to Mayo Clinic.”

Karen Pauly

Karen
sought medical care for her heavy bleeding from her local gynecologist. Ultrasound
imaging revealed she had developed uterine fibroids. “[The physician] wasn’t
too concerned and said to just watch it, but the symptoms kept getting worse
each month,” Karen says.

Fibroids
are the most common, noncancerous pelvic mass in women. And unlike Karen’s
situation, they don’t always cause symptoms. Uterine fibroids often are
discovered during a routine pelvic exam or on an imaging test, such as an MRI,
CT scan or ultrasound.

When
fibroids cause symptoms, they can include heavy menstrual bleeding, extended
periods, bleeding between periods, painful periods, back pain, pelvic pain, leg
pain, increased frequency of urination, or bowel habit changes.

Collaborative approach

In
addition to physical changes in her cycle, Karen experienced hormonal changes
linked to the fibroids. It was an association that exacerbated her coronary
issues and complicated a search for medical care.

“I was nervous about where to
go for treatment because I wanted them to understand the coronary artery spasms
and the relationship to hormones,” Karen says. “That’s why I ended up
going back to Mayo Clinic.”

In Mayo Clinic’s Department of Obstetrics and Gynecology, Daniel Breitkopf, M.D., joined Karen’s medical team and offered a variety of potential treatment options. This led to a meeting with Dr. Stockland.

“We take a multidisciplinary
approach to our patients, with input from a variety of specialists,” Dr.
Stockland says. “This allows us to tailor the treatment options to each
individual patient, keeping in mind the patient’s needs, concerns, expectations
and safety.”

The premise of uterine artery
embolization, which has been offered at Mayo Clinic for nearly 20 years, is straightforward,
Dr. Stockland says. “We decrease the blood supply to the fibroids, and
they shrink over time.”

Expert care, ideal outcome

To prepare for the approximately
90-minute embolization procedure, which was performed using X-ray and video
imaging equipment in a special, highly sterile procedure room, Karen was given
a strong sedative and local anesthesia on the site near the incision on her
upper thigh.

Dr. Stockland made a small incision into
Karen’s thigh to access her femoral artery and inserted a vascular sheath into
the blood vessel. Through the sheath, a small catheter, just a few millimeters
in diameter, was inserted and guided under real-time X-ray video equipment into
Karen’s right and left uterine arteries. Dye material injected into the
catheter confirmed blood flow to the uterus and fibroids. Then tiny particles
were mixed with the dye and slowly injected until blood flow to the fibroids stopped.
The procedure, explains Dr. Stockland, treats all of a patient’s fibroids,
regardless of whether she has one or many.

After the procedure, Karen was
admitted for overnight observation and given medications to control cramping
and nausea that can occur as a result of the procedure.

“For patients like Karen who have multiple medical problems, improving one issue can sometimes have a positive domino effect on other symptoms.”

Andrew Stockland, M.D.

“The doctor told me I would get
sick and then get better, and that is what happened,” Karen says. “Initially,
I was violently ill, and I had to take narcotic pain relievers to help with the
symptoms. But after two days, it did get batter. By the end of the week, I felt
completely normal again.”

The maximum benefit from the
embolization procedure occurs between six and nine months after the procedure,
but frequently symptoms improve within a few months. “We anticipate at
least a 30 percent reduction in the size of each fibroid, and studies show the
potential for even greater size reduction,” Dr. Stockland says. “The
overall size of the uterus decreases, as well, also contributing to symptom
improvement.”

Following the procedure, Karen
noticed spasms related to her small vessel condition also seemed to get better.
“I can’t be sure if it’s
related to the procedure, but it sure coincided with when I got the procedure
done,” she says.

“For patients like Karen who have
multiple medical problems, improving one issue can sometimes have a positive domino
effect on other symptoms,” Dr. Stockland says. “It was great to hear
that not only her fibroid symptoms improved, but her general health overall
improved. That is extremely satisfying to all of the members that took part in
her care.”

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5 days ago · Going From Gang Life to Taking Care of Others' Lives

Sophorn Khoun spent his childhood and teen years immersed in inner city gang culture. Now Sophorn has moved beyond that and made a new life for himself centered on helping and healing.

Sophorn Khoun spent his childhood and teen years immersed in inner city gang culture. Now Sophorn has moved beyond that and made a new life for himself centered on helping and healing.


Editor’s note: Marked with tattoos and scars from bullet wounds, Sophorn Khoun doesn’t look like the average health care worker. As a child running with a Southeast Asian gang in Salt Lake City’s poorest neighborhoods, he couldn’t fathom that one day he’d be working to heal others.

But when Sophorn was 20, he extricated himself from gang life and built a new one for himself in Rochester, Minnesota. In 2014, he was given an opportunity to pursue a path toward helping people when he received a position at Mayo Clinic. The job introduced him to individuals, ideas and opportunities that didn’t exist in his previous life.

In December 2018, Sophorn’s hope to help people heal took another step forward when he received his advanced nursing assistant certificate from Rochester Community and Technical College through the Bridges to Healthcare Program. The program is a collaboration among Mayo Clinic, Rochester Community and Technical College, Workforce Development and Hawthorne Education Center. In this story, Sophorn shares how he left the gang life to pursue a career in health care.


By Sophorn Khoun

I grew up during the 1990s and lived in the projects of the inner city of West Valley City, Utah. Our neighbors were other Cambodians, Vietnamese and Laotians who’d migrated after wars. I was exposed to gangs growing up. At that moment, it was cool. But more than that, I was more inspired by the love, loyalty and unity within the neighborhood. We had so much love and loyalty and didn’t know how to project it in the most efficient way. We integrated it into street philosophy. We had no guidance, like a serpent with no head.

Gangs really didn’t guide me in the right direction. I was young, and it is nothing to be proud of. When I was 16, on Sept. 11, 2000, I got shot four times during a gang shootout at a nearby pool hall. I lost a lot of blood. I broke a rib and, fortunately, it didn’t puncture my lung. I got one in the neck. It was a skid. The one in the arm went right through. The one in my leg — luckily my wallet was there — hit the wallet and barely nicked me. I was in the hospital for two to three weeks.

Shootouts and shootings weren’t new to me. Every day where I lived, I witnessed it. Drug dealing, prostitution, the gang life, the shooting and the domestic violence in the neighborhood — I saw all of that. I was in jail for 18 months, and when I came out, I started to see friends and cousins disappearing. They were either dead or in jail. I talked to my dad and said, “I can’t do this.” I couldn’t be around that type of energy anymore. I needed find my way out.

My sister was living in Minnesota. She was married, and I asked my dad if I could come out here. I moved to Rochester in 2004 when I was 20.


“I was seeking self-growth, and my first step started with the man in the mirror.”

Sophorn Khoun

When I first came here, the city was small. It wasn’t like the inner city. I found it very quiet and mellow. I could find peace. I didn’t have to worry about anybody trying to kill me. I really wanted to start my life here.

I’d dropped out of high school when I was 18. But when I moved here, I didn’t think of continuing school. I worked 9 to 5. I was very comfortable. I didn’t see myself going back to school. I thought it was too late. But later on, I had kids. I bought a home and had a family, and started to see bigger things in life. I saw that I could still make a difference. I sensed the opportunity was there for me. Now all I had to do was make that move. So I wrote it down and followed through. At the end of the day, my motivation was my children. I do this for them.

In Utah, I didn’t know you could leave the neighborhood. I didn’t know you could go skiing. I didn’t know about Zion Canyon or anything outside the neighborhood. No one was talking about college or high-paying jobs. It was just bandanas, guns and gangs. That was the life I wanted. The lack of options we endured had us feeling caged and very limited from the outside.

In 2014, with four kids who are now between 8 and 12 years old, I started my GED. I was trying to improve my life and evolve. In 2014, I also started working at Mayo in Environmental Services.

Mayo Clinic really gave me a chance. It opened many doors for me. I hadn’t wanted to be a nurse or anything in the Nursing Department. I just wanted to do what I did. But in the hospital setting, lives were being saved. That’s what I wanted to do. I’m not God, but the least I can do is take care of a patient.


“Mayo Clinic really gave me a chance. It opened many doors for me.”

Sophorn Khoun

There was so much opportunity to advance within Mayo. I was going to school at Hawthorne, and they gave me the option for the Bridges Program. It just fell into place. I could pursue the goal I wanted while I worked at Mayo. After getting my GED, I went for the Certified Nurse Assistant Program and moved forward from that to the Advanced Nursing Assistant Program.

When I started at Mayo, there was a nurse on my floor. She always said hi and always would talk to me. She would listen unconditionally. She was so sweet. She didn’t discriminate and wasn’t afraid of me because of my tattoos. I’ve seen that a lot. People would walk away from me when I got into the elevator or hold onto their purses. I am a human being. I don’t bite. But she accepted me, and there was that respect and love.

I was seeking self-growth and my first step started with the man in the mirror. Two years ago, as I was going through classes and work and everything, I found a spiritual practice and started meditating. That has been so beneficial in my daily life and helping me in being a better person. I integrate meditation into my daily life and believe it’s gotten me through many barriers and helped connect me with my inner self. It’s helping me find compassion for myself and others, and has really given me a new perspective on life.

One day, I hope to be an inspirational/motivational speaker. I was offered the opportunity to speak in a psychology class. I was humbly grateful for the opportunity to impact another individual with my experience. Perhaps they may reconsider their path. I believe everyone has a purpose in life, and I believe this is mine. I really want to help youth to step away from the streets — to tell them there is so much potential, to not throw your life away on the street life. You can start right here, right now. You can start giving back, and that’s what I want to do. All of the time I was taking from society, I just want to give back. Just like the lotus flower, which symbolizes rising from the dark place as in a rebirth, we also are capable of rising from the mud and blooming out of the darkness. No mud, no lotus. Be the lotus.


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Fri, Apr 12 5:00am · Back on Track After Heart Bypass Surgery

A suspicious finding during a routine physical led to a diagnosis of coronary artery disease for Mark Guthrie. Heart surgery quickly followed, and now the longtime track and field coach is back to work and feeling great.

A suspicious finding during a routine physical led to a diagnosis of coronary artery disease for Mark Guthrie. Heart surgery quickly followed, and now the longtime track and field coach is back to work and feeling great.


Mark Guthrie knows how to build a winning team. The longtime collegiate track and field coach has helped guide dozens of teams to divisional and national titles. He’s earned a few titles himself along the way, too, including being named Division III National Coach of the Year eight times.

So Guthrie had experience to draw on when he needed to assemble another kind of team last year after a routine physical with Jacob Erickson, D.O., at Mayo Clinic Health System — Franciscan Healthcare in Onalaska, Wisconsin, pointed to a problem with his heart.

“I had a quick EKG as part of my physical, and they told me they thought they saw something,” Mark says. “They asked me how I felt. I’d just laid nine yards of mulch. I felt great.”

Even so, Mark scheduled a stress test to check how his heart worked during physical activity. “I failed after six minutes,” he says. That led to another test: a coronary angiogram, which uses X-rays to check the flow of blood in heart vessels. The test revealed he had coronary artery disease.

“Two of my arteries had 80 percent blockage, and two had 40 percent blockage,” Mark says, a fact he attributes to his less-than-heart-healthy diet.

“I’d had blood work done with my physical, and my blood sugar was around 400, and my A1C was around 12. I was pretty proud. Those were big numbers,” Mark jokes.

But he knew the truth was no laughing matter. Those test results revealed he had diabetes, which greatly increases the risk of developing heart problems.

Innovative care, lower risk

Mark met with Tahir Tak, M.D., Ph.D., a cardiologist at Mayo Clinic Health System — Franciscan Healthcare in La Crosse, to discuss his treatment options. He could have an angioplasty, which is a minimally invasive procedure performed through a small incision to place stents to open blocked arteries. Or he could undergo coronary bypass surgery, which is an open-heart procedure that redirects blood around the blocked arteries. Because Mark had four blocked arteries, Dr. Tak recommended bypass surgery over angioplasty.

“In the long term, the best way to treat this was bypass,” Mark says. “So I decided to go the full monty.”


“I liked [Dr. Wiechmann] right away. I liked his personality and his temperament. He was knowledgeable and put me at ease.”

Mark Guthrie

Because open-heart surgery isn’t performed in La Crosse, Mark had another decision to make: where to have the procedure done. Dr. Tak suggested Robert Wiechmann, M.D., a cardiovascular surgeon at Mayo Clinic Health System in Eau Claire, Wisconsin. A meeting with Dr. Wiechmann sealed the deal.

“I liked him right away,” Mark says. “I liked his personality and his temperament. He was knowledgeable and put me at ease.”

During the operation, Dr. Wiechmann and his team used arteries from Mark’s chest wall and arm to create bypasses around the blocked arteries in his heart. The procedure was completed without ever stopping Mark’s heart — a process known as off-pump bypass. It lowers the risks associated with bypass surgery, including stroke, infection and memory problems after surgery. Only 5 percent of hospitals in the U.S. offer off-pump bypass, but it’s used in 98 percent of the procedures at Mayo Clinic Health System in Eau Claire.

New habits, renewed health

After a short hospital stay, Mark was able to return home. “My care in the hospital was outstanding,” he says. “Going in, I felt confident in the Mayo name. I was never worried about the outcome. I knew I was in capable, caring hands.”

Those caring hands continued to guide Mark during his recovery. He attended 12 weeks of cardiac rehabilitation in La Crosse, where he worked with exercise physiologists to gradually return to his presurgery activity level.

“They kept pushing me to do a little more each day,” Mark says. “As a coach, that was really comfortable to me.”

Less comfortable were the dietary changes Mark needed to made as a result of his diabetes diagnosis. “I can’t eat whatever I want anymore,” he says. “I was drinking way too much soda. Green beans are now my friend.”


“I feel exactly the way I did before surgery, and I felt good then. I’m pretty doggone happy.”

Mark Guthrie

Those new eating habits — together with medication — have helped Mark bring his blood sugar level down to a healthy range. And while his diet is different, much of the rest of his life has remained the same since his diagnosis and surgery.

“I’m back at work, and I feel great,” Mark says. “I feel exactly the way I did before surgery, and I felt good then. I’m pretty doggone happy.”

He’s also feeling grateful for the team that helped heal his heart, ensuring that he was able to get to know a new member of his home team. “I got to meet my newborn grandson, who I would possibly have never met without the great care I received,” Mark says.

Mark’s thankful, as well, to all those who provided support and encouragement to him during his recovery. “So many of my former athletes reached out to me when they heard what was happening,” he says. “It makes you realize that success is not always about wins and losses. It’s the friendships you make along the way.”

Note: A version of this story previously was published in Hometown Health.


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Wed, Apr 10 5:00am · Battling a Brain Tumor, Finding Grace

As a pastor, Johann Lochner believes his life's journey is guided by a higher power. Nowhere was that knowledge made clearer for Johann than at Mayo Clinic, where he encountered a team of physicians whose care and surgical talents in removing an insidious brain tumor gave him his life back.

Johann Lochner, second from left, with his family – Andre, left, Ethan, Ellie, Stephanie and Annalize Lochner – and Mayo physicians Terence Burns, M.D., Ph.D., center, and Michael Ruff, M.D.

As a pastor, Johann Lochner believes his life’s journey is guided by a higher power. Nowhere was that knowledge made clearer for Johann than at Mayo Clinic, where he encountered a team of physicians whose care and surgical talents in removing an insidious brain tumor gave him his life back.


When Johann Lochner boarded a plane bound for his native South Africa to visit a relative who had cancer, he knew he’d be spending time in medical facilities. What the 51-year-old pastor never imagined was that he would be the one requiring care.

Days after landing in South Africa in April 2017, Johann was admitted to the hospital when he began to have problems moving the right side of his body. An MRI showed a mass on the left side of his brain. His South African surgeon diagnosed it as a rare tumor known as PXA, or pleomorphic xanthoastrocytoma.

And the situation only got worse. After a communication breakdown with his care team, Johann was unable to receive treatment for his condition. His wife, Stephanie, was desperate.

“I see my husband declining physically,” she says. “I’m in the middle of Africa. No one wants to help us, and I’m having such a struggle to coordinate care.”

Then, in early June, Stephanie made a call to the one place she believed could help her husband: Mayo Clinic. Stephanie’s call made its way to the Brain Tumor Program at Mayo Clinic’s Rochester campus. And it jump-started a whirlwind trip that brought the Lochners back to America, where Johann met a Mayo medical team ready to treat him.

Soon after Johann arrived at Mayo Clinic, a 12-member surgical team led by neurosurgeon Terence Burns, M.D., Ph.D., performed precision awake brain surgery to remove Johann’s tumor.

“We had just the most amazing experience,” Johann says. “The people there, you can clearly see they are so compassionate. They are not in it for the money, or the prestige or the power. They really care.”

Confidence in the face of risk

When the Lochners met Dr. Burns, he told them he hoped that the diagnosis of PXA was correct, but he was concerned that the rate of growth could suggest a more ominous cancer. Dr. Burns recommended Johann have a functional MRI, with special sequences to see the brain fiber tracts. That would allow the surgical team to better assess how the tumor was affecting his brain. What the test revealed helped explain Johann’s symptoms.

“The tumor was right in the middle of motor and sensory cortex — the parts of the brain that control voluntary movement and sensation,” Dr. Burns says. “Because the tumor had a large cyst, the fibers carrying information to and from his right arm and leg were getting stretched and splayed out around the tumor. That’s why he was deteriorating so quickly.”


“Dr. Burns is the most gentle and gracious and sympathetic and caring doctor that we’ve had.”

Stephanie Lochner

The functional MRI also showed that the tumor was not only pushing on Johann’s brain fibers, but it had infiltrated them, which substantially increased the risks of surgery. After the scan, the Lochners met with Dr. Burns. They were hoping to find out if, after the surgery, Johann would recover his ability to move freely. The answer was difficult to hear.

“Dr. Burns is the most gentle and gracious and sympathetic and caring doctor that we’ve had,” Stephanie says. “With as much compassion and empathy that he had, he looked me in the eye and told me that the trauma of going into the brain could be enough to paralyze somebody. He said Johann was probably not going to move his right side for a long time after surgery.”

“We needed to decompress the cyst and open things up enough so the cyst wouldn’t reform,” Dr. Burns says. “We also wanted to remove as much of the tumor as we could safely, without permanently compromising his ability to walk and write. Unfortunately, just operating near these sensitive fibers can be enough to shut them down for a while. I cautioned him that he’d likely not be able to move the right side for some time after surgery and that he’d require some pretty extensive rehab.”

Johann and Stephanie knew the news wasn’t good. But rather than fear the unknown, they did what they’d been doing since the start of their journey. “We teach our kids that if we win, we praise Jesus. But if we lose, we praise him, too,” Johann says. “So when Dr. Burns gave us this bad news, that’s what we decided to do. And all of that stuff just lifted off of us.”

Hopeful indicators

In the predawn hours of June 20, 2017, Johann arrived at Mayo Clinic Hospital — Rochester, Saint Marys Campus for the operation. “When I went into the surgery room, I thought I was in the movies with all the lights,” Johann says. “In South Africa, there was a little operating room with one light. Here they have tens of people all doing different things. There were all these monitors. I was so impressed and thought, ‘Hmmm, I think I have a good chance.'”

During the approximately six-hour operation, portions of which Johann was conscious and responsive, Dr. Burns used electrical stimulation to map critical areas of Johann’s brain and used Johann’s responses to help guide him.

“I told him that it was going to be a team effort in the operating room. With his help, we would work together to determine how much we could safely remove,” Dr. Burns says. “He did a fantastic job helping us to know exactly how far we could go before impacting his function.”

The combination of Johann’s input in the operating room and the space the tumor had created between fibers controlling arm and leg movement allowed for removal of most of the mass. “With his help, we were able to safely remove quite a lot more than initially anticipated,” Dr. Burns says.

The expectation was that Johann wouldn’t be able to move his right side for several weeks after surgery. That’s not how it turned out.

“I walked into Johann’s room, and the first thing I saw was Johann using his right leg to push himself up in his bed. With his right arm, he’s tugging at his gown and pulling at the blanket and sheets trying to get comfortable,” Stephanie says. “It was just another confirmation that God was saying, ‘Relax, I got this.'”

The next day, Johann was standing. Within a few days, he was discharged from the hospital. He and Stephanie were driven by friends from Minnesota to their home in Aledo, Texas.

Added diagnosis reveals more

After Johann’s surgery, the pathology report for his tumor came back and confirmed Dr. Burn’s initial suspicion. Johann’s tumor was not PXA, but anaplastic astrocytoma. Molecular testing showed the tumor had the characteristics of a stage 4 glioblastoma, with an unusually high number of genetic mutations. Back home, Johann’s team of neuro-oncologists concurred that the tumor was a glioblastoma. To target the remaining tumor tissue in his brain, Johann was started on chemotherapy and radiation.

A few months later, Johann received another shocking diagnosis. He had stage 3 colon cancer. Johann underwent surgery in Texas to remove the cancer from his colon. In February 2018, Johann learned his cancer has spread. A month after that, he received a third diagnosis: skin cancer.

The combination of his cancers led a research team to diagnose him with Lynch syndrome, an inherited syndrome associated with developing different types of cancer. That diagnosis led to immunotherapy — a treatment Johann had first discussed with neurologist Michael Ruff, M.D., during his time at Mayo Clinic.

“Dr. Ruff, way ahead of time, mentioned my brain tumor might benefit from immunotherapy, but that immunotherapy wasn’t approved for the brain,” Johann says. “Because of the fact that I got the colon cancer, that opened the door for me and allowed me to be put on the immunotherapy.”

Stephanie says that throughout their journey discovering Lynch syndrome and treating Johann, the guidance they’ve received from Dr. Ruff has been invaluable. “He answered so many of my questions and went out of his way to order additional tests when we needed them in Dallas,” Stephanie says. “He even returned calls over the weekends.”


“It is amazing how God used all of these people to encourage us along the way.”

Johann Lochner

The reason immunotherapy is effective against Johann’s cancer is because of its bizarre genetic makeup, explains Dr. Ruff. While typical glioblastomas have 70 or fewer driver mutations, Johann’s likely has thousands of mutations.

“In most patients with glioblastoma, immunotherapy to date has been largely ineffective. But for Johann, the difference is the number of mutations,” Dr. Ruff says. “The higher the number of mutations in a cancer, in general, the more likely immunotherapy is to be effective. It’s the immunotherapy that’s controlling his tumors right now.”

As a result of the treatment, all of Johann’s tumors, including his brain tumor, are either stable or decreasing in size. “We know God has been opening and closing doors, and facilitating every single step we take,” Stephanie says.

Even as they left Mayo Clinic, this belief was reinforced. “Dr. Burns came to say goodbye when we were released. I said thank you and that I had an incredible experience,” Johann says. “He is an incredible surgeon, and I will never forget this.”

“He put his hand up and pointed toward the sky and said: ‘I had some help. I think God has more work planned for you,'” Stephanie recalls.

“It is amazing how God used all of these people to encourage us along the way,” Johann says. “He has given us the most incredible care, the most incredible doctors. When I look at Dr. Burns and Dr. Ruff, for me, they are servants of the Lord, whether they know it or not.”


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Mon, Apr 8 5:00am · Rising Above a Rare, Debilitating Disorder

Diagnosed with stiff-person syndrome — an extremely rare autoimmune neurologic condition — Tara Zier looked to Mayo Clinic for help. There she found valuable guidance and gained a new outlook on how to manage her condition.

Left to right are Cameron, Tara and Kenna Zier.

Diagnosed with stiff-person syndrome — an extremely rare autoimmune neurologic condition — Tara Zier looked to Mayo Clinic for help. There she found valuable guidance and gained a new outlook on how to manage her condition.


For three years, Dr. Tara Zier went from specialist to specialist in the Washington, D.C. area trying to find out what was causing the unexplained symptoms she had been experiencing: shortness of breath, fatigue, difficulty walking and excruciating back pain.

On her fourth visit to a local emergency department, the dentist from Bethesda, Maryland, remembers lying on a hospital bed crying. “My hips were stiff, and I was having a hard time walking,” Tara says. “I had no idea what was going to happen. I was really scared.”

Her symptoms began in January 2015 after a weeklong bout of pneumonia and three months after her former husband died. “I was devastated,” she says. “The level of stress was way off the charts. It was nothing I could even describe.”

Grief-stricken and trying hard to help her two children through their grief, the active 45-year-old started having difficulty exercising, and she experienced extreme fatigue. Despite taking kickboxing for years, she was getting short of breath during classes. She also experienced panic attacks regularly, which landed her in the emergency department several times.

“My kids were 12 and 14 at the time,” she says. “I was worried they would lose me, too.”

An anxious quest for answers

Tara’s symptoms persisted, and the following year she started battling severe neck pain. “It felt like a deep spinal pain,” Tara says. “I backed off from kickboxing and martial arts, but I was still short of breath and just didn’t feel great.”

Multiple MRIs and consults with several neurologists revealed Tara had spondylosis in her neck. She decided against surgery and instead sought relief through physical therapy and chiropractic visits. But her condition continued to deteriorate.


“I was pale. I couldn’t eat. I was down to 107 pounds. My body was in crisis.”

Tara Zier

After two years of searching for answers, Tara says things came to a head one night in March 2017 when she took her children out for a family dinner. “I was pale. I couldn’t eat. I was down to 107 pounds,” she says. “My body was in crisis.”

She went to her primary care doctor who suggested Tara take the antidepressant Cymbalta, which can be used to treat certain forms of pain. She then went on to seek the opinion of an endocrinologist, psychiatrist, rheumatologist, a general cardiologist and an electrophysiology cardiologist. But her symptoms persisted, disrupting daily life.

“My in-laws moved in with me for three weeks during the time I couldn’t function,” Tara says. “I hired a woman to cook and help around the house, and had to hire someone to drive my daughter to soccer practice.”

When a friend who has postural tachycardia syndrome described symptoms similar to hers, Tara asked her primary care doctor for a referral to a local neurologist who specialized in dysautonomia — disorders of autonomic nervous system, such as postural tachycardia syndrome.

“He told me that stress can throw your nervous system into fight-or-flight mode,” Tara recalls. “He thought that all of the stress I had been through had caused the dysautonomia, and in a year and a half I would recover. I thought, ‘OK, maybe there’s a light at the end of the tunnel.'”

The neurologist put Tara on a medication to treat nerve and muscle pain, a beta blocker and a skin patch for chronic pain. But instead of improving, her symptoms got worse. She started feeling numbness on the left side of her face, and she noticed itching in her abdomen and between her shoulder blades.

A one-in-a-million diagnosis

Tara found a new primary care doctor in summer 2017 who did a full body CT scan and referred her to another neurologist who ordered several blood tests. The results revealed a rare disorder: stiff-person syndrome. Tara’s primary care doctor recommended she consider going to Mayo Clinic.

Tara made an appointment with Andrew McKeon, M.B., B.Ch., M.D., a neurologist who is part of the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology and co-director of the Neuroimmunology Laboratory.

“Stiff-person syndrome is a very rare autoimmune disease of the central nervous system that was discovered at Mayo in 1954. It has a one-in-a-million diagnosis,” Dr. McKeon says. “We only saw 100 patients with this condition between 1984 and 2008 as part of a large cohort study Mayo conducted on our Rochester campus, where we have a specialized clinic for people with rare central nervous system autoimmune diseases.”

People who experience stiff-person syndrome typically have other autoimmune diseases, such as Type 1 diabetes or autoimmune thyroid disease. There are three presentations of the disorder: stiff limb, which only involves the legs; stiff trunk, which affects the back; and classical stiff-person syndrome, which involves both the back and the legs.

“Dr. Zier has a more limited type of the disorder affecting her neck and back, where she experiences a lot of spasms which cause her a great deal of pain and trouble breathing,” Dr. McKeon says.

A way to regain control

Prior to her first consult with Dr. McKeon in December 2017, Tara underwent six days of immunotherapy infusions recommended by her local neurologist. Unfortunately, the therapy didn’t relieve her pain, and it made her feel worse. On Dec. 10, Tara was transported to Mayo Clinic’s Rochester campus by air ambulance. “I hadn’t been driving in months and wasn’t well enough to fly commercially, so this was the safest way to travel,” she says.

When she arrived at Mayo, Tara spent a week undergoing a battery of tests. “No stone was left unturned,” she says. “Every part of me was evaluated from my brain all the way down.”


“Dr. McKeon is a great listener. I think of him as top-notch. He’s very committed to helping me get better.” 

Tara Zier

“When I first saw her, she was on several medications that weren’t helping. Very often the conversation is really about trying to think outside the box to provide pain relief,” Dr. McKeon says. “We treated her spasms and pain with Valium and continued our efforts to find individualized approaches that could improve her quality of life.”

“Dr. McKeon is a great listener. I think of him as top-notch,” Tara says. “He’s very committed to helping me get better.”

In an effort to help Tara live a full life despite her pain, Dr. McKeon referred her to Mayo Clinic’s Pain Rehabilitation Center.

Staffed with an integrated team of health care professionals, including those who specialize in pain medicine, physical therapy, psychology, occupational therapy, biofeedback and nursing, the Pain Rehabilitation Center offers a three-week program for adults. It helps patients like Tara regain strength and stamina, and shift their focus away from pain.

“A lot of patients come in and are afraid of movement. So, they lose faith,” says Ross Pollert, a physical therapist assistant in the center. “Dr. Zier came in here afraid of moving. By the time she left the program, she was independent. She was a different person. It was nice to see her having faith in her own ability.”

“The center taught me to incorporate more physical activity into my day despite my pain and to do things in moderation. Now I do tai chi instead of kickboxing,” Tara says. “The program also taught me the importance of following a regular schedule to help gain control of my life.”

After she successfully completed the three-week program, Tara returned to the center’s six-month aftercare program in December 2018. She plans to come back to Rochester for the one-day class every six months.

“It keeps me in check,” Tara says. “The nicest part is I get to see Dr. McKeon and reconnect with some of the people I’ve met who have become friends.”

An effort to inspire

Dr. McKeon last saw Tara during a video consult in February. “Ultimately, she’s been doing better. The fluidity of her walking has improved,” Dr. McKeon says. “I think she’ll likely have some symptoms going forward. But the more active she becomes, the better her quality of life will be.”

Daily life for Tara is easier now, and she’s been able to start driving again. She’s also working to manage her health by exploring holistic therapies that include a restricted diet and light therapy.

In an effort to raise awareness about stiff-person syndrome that will lead to more research into the rare and often misdiagnosed condition, Tara’s in the early stages of writing a book about her journey. “It’s an effort to take this crappy thing and hopefully end up inspiring and helping people,” she says. “Instead of waking up angry about your illness, how do you befriend it and live with it?”


“If something is not right, and you’re not getting better, you need to keep going to other doctors until you get the answers you need.”

Tara Zier

As she reflects on what she’s been through, Tara says one of the most significant lessons she’s learned is the importance of taking control of your own health. “If something is not right, and you’re not getting better, you need to keep going to other doctors until you get the answers you need,” she says.

That’s what brought her to Mayo Clinic, and she’s glad it did. “I would recommend Mayo to anyone. It’s fantastic,” Tara says. “It’s so true that your environment does make a difference in your healing and overall well-being. If you’re at Mayo for a week, and you’re in a happy and positive environment, you can actually feel better. It’s about people being human and caring.”


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Fri, Apr 5 5:00am · Difficult Diagnosis Inspires Corinne Berg to Empower Others

Corinne Berg was a little girl when she saw firsthand the devastating effects that breast cancer had on her family. Read the story of how Berg learned of her own risk for breast cancer and how she has used that experience to educate herself and others.

Corinne Berg was a little girl when she saw firsthand the devastating effects that breast cancer had on her family. Read the story of how Berg learned of her own risk for breast cancer and how she has used that experience to educate herself and others.


By Corinne Berg

I grew up in fear of breast cancer because my mom’s only sister was diagnosed with breast cancer in her 30s and struggled with it for 12 years. We would have family events, and she would be sick, bald and miserable. Years later, I graduated with a bachelor’s in sports management from Minnesota State University, Mankato. While I enjoyed it, I knew there was something more I was called to do.

By then, I was married and had a mother-in-law and sister-in-law who were both nurses at Mayo Clinic, and they loved it. In fact, my mother-in-law has now worked for Mayo for 45 years. To try my hand at nursing, I first took a nursing assistant course, and I loved it. I decided to go back to school for nursing and work as a patient care assistant to gain some experience.

During this time, I read an article about a girl with Ashkenazi Jewish ancestry who had a BRCA mutation that increased her risk of breast cancer. My mom encouraged me to bring the article to my doctor given our Jewish ancestry and the fact that there were family members on both sides of my family who had breast cancer. My physician was in support of me being tested for the BRCA mutation, but I thought I’d be best suited to see a genetics counselor to review my risk.

After meeting with the counselor, she didn’t think I’d have the BRCA mutation because there weren’t enough family members with the disease. We went ahead with the test anyway. I’ll never forget the day she called me with the results. She was crying and said, “Cori, I’m sorry to tell you this, but you do have the BRCA2 mutation.”

At this point, I didn’t know which parent passed it down, and I was scared for them and my sister. My mom and sister were tested and found out that they had the BRCA2 mutation, as well. I scheduled a prophylactic bilateral mastectomy for a month later. Having a mastectomy has decreased my risk of breast cancer. I am at less risk than the average female.


“I was able to bring my own experiences and provide empathetic care to my patients.”

Corinne Berg

After graduating from nursing school, my first job was at Mayo Clinic Hospital — Rochester, Methodist Campus. I worked with people who had the BRCA mutation and also those with breast cancer undergoing treatment. I knew what it was like to lose a part of yourself and not always be in control. I was able to bring my own experiences and provide empathetic care to my patients. My passion has always been in education and empowering patients to make the decisions that are best for them.

Now I work side by side with genetic counselors as a nurse in predictive genomics in the Center for Individualized Medicine. We offer a unique service to executive health patients who want to know more about their genetic risks, including cancer and cardiovascular issues. We are working on developing education materials for men with BRCA because we want others to know it’s not just women who have a BRCA mutation. It can affect males and females, and cause breast, ovarian, pancreatic, melanoma and prostate cancer.

I also volunteer for Facing Our Risk of Cancer Empowered as a peer-to-peer navigator, providing resources to those who have an increased genetic risk for cancers. The organization is a nonprofit devoted to those with hereditary breast and ovarian cancer. I also run a support group once a month at Mayo Clinic’s Dan Abraham Healthy Living Center for those with hereditary cancers.

Right now, I am pursuing my master’s in nursing education and feel I am right where I’m supposed to be. I am helping educate and empower people.


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Wed, Apr 3 5:00am · From Sadness to Smiles: Art Inspires Emotional Healing

When Bill Hoffman arrived at Mayo Clinic's Inpatient Rehabilitation Unit, he was so weak he could barely move. Not only was his strength gone, his happiness had disappeared, too. That began to change when Bill picked up a paintbrush and immersed himself in the creative process.

When Bill Hoffman arrived at Mayo Clinic’s Inpatient Rehabilitation Unit, he was so weak he could barely move. Not only was his strength gone, his happiness had disappeared, too. That began to change when Bill picked up a paintbrush and immersed himself in the creative process.


Bill Hoffman, a retired neurosurgeon, never considered himself very artistic, and he didn’t think much of painting. But last fall, while Bill was recovering from a serious medical complication following surgery that left him a shell of his former self, it was painting and recreation therapy that opened the door for him to return to normal.

Artmaking at Mayo Clinic’s Arizona campus gave Bill and Mariann, his wife of 54 years, time to escape the physical, mental and emotional stress that accompanied Bill’s prolonged hospital stay. The art sessions are a collaboration between the Recreational Therapy Program in Mayo’s Department of Physical Medicine and Rehabilitation, and the Center for Humanities in Medicine, which works with professional artists to facilitate programming. Phoenix-area artist Richard Retter has been with the program since it began in 2014.

“Recreational therapy explores those things that just allow us to be human,” says Carol Graziano, a Mayo Clinic recreation therapist who worked with Bill. “It creates a full experience of having a safe space where patients can relax.”

The time they spent in the art room was an escape for Bill and Mariann. “It removed me mentally,” Bill says. “All of a sudden, I had a little break in time every day doing something I kind of enjoyed. I was able to feel like I could just do this, and it was fun and relaxing.”

Intense recovery

For a time, fun and enjoyment seemed impossible for Bill and Mariann. After surgery for bladder cancer in October 2018, Bill experienced a myasthenic crisis that triggered extreme muscle weakness and fatigue. As a result, Bill lost his ability to walk, eat and talk.

Fighting the effects of his condition was a daunting task. But with consistent support and encouragement from Mariann and the couple’s four adult children, in addition to the comprehensive care provided by his Mayo Clinic medical team, Bill pulled through.

“I have nothing but the highest regard for the Mayo intensive care unit,” Mariann says. “Anywhere else, and he would not be alive. I know that. Our daughter, a physician, knows that, and our whole community of physician friends knows it.”

Bill spent three weeks in the ICU — two of which he cannot remember — before he was transferred to the hospital’s Inpatient Rehabilitation Unit. When he arrived, Bill was so weak he could barely turn over in bed. In addition to the serious physical effects he experienced, Bill’s medical situation took a heavy toll on his emotional health. “I was really bummed about everything,” he says.


“We focus a lot on reintegration after something medically has happened. How to get them back into something they like to do — or may not realize they like to do.”

Carol Graziano

To help him recover, Bill participated in physical, occupational and recreational therapy during his four-week stay in the rehabilitation unit. The physical and occupational therapy programs focus on helping patients regain strength and function. Recreational therapy compliments those efforts and centers on the psycho-social elements of recovery.

“We focus a lot on reintegration after something medically has happened,” Graziano explains. “How to get them back into something they like to do — or may not realize they like to do.”

When Bill arrived in the unit, he was as low as he’d ever been, says Mariann. “So depressed, stressed, as far down as you get.”

Bill’s physical and occupational therapists told him they were going to work him hard, and they did. “They were really great, but it was difficult,” Mariann says. “And then they said, ‘We would like for you to come to the art program.’ I thought: ‘No way is he going to do that. He doesn’t leave the room, doesn’t put the television on, speaks in monosyllables to those he allows to visit.'”

One day, however, Mariann decided she wanted to paint. She told her husband she was going to an art session. “I remember thinking as I was sitting there: ‘I am going to do this. I am going to learn.’ And he decided to go because I wanted to go, and everything changed for him.”

Enjoyment with a purpose

In the art room, Bill and Mariann found warm, friendly staff members supporting participants through the creative process. “There’s something to say about the people who were running the class, who were so positive and so pleasant,” Bill says. “You almost had to enjoy yourself doing it.”

For Bill, who initially lacked interest in socializing with other patients, the art sessions connected him to the community without forcing him to leave his comfort zone, Mariann says.

“Going to art classes, he didn’t have to talk to anyone. However, his ears were listening, and he was aware of people around,” Mariann says. “People were commenting. They would look at his. He would look at theirs. I think it brought him out of his shell. There wasn’t much smiling before that.”

One aspect of Bill’s care that could bring out a smile at that time was daily visits from his physician, Mitchell Humphreys, M.D., in the Department of Urology. “He was the doctor and friend and counselor that brought a smile to Bill’s face with every visit,” Mariann says. “He helped to keep us sane during the difficult times and went above and beyond his duties.”


“It gave me a period of time to do something with my hands and brain, which I enjoyed doing. It was something normal.”

Bill Hoffman

The artist-in-residence hoped to help Bill make more personal connections like that. Noticing Bill’s hesitation to socialize with his peers, Retter approached Mariann after class one day and asked how he might be able to connect with Bill.

“The art instructor said to me, ‘Is there anything we can get him to talk about?'” Mariann recalls. “I said, ‘Well, he played football for 12 years.’ And he said, ‘Perfect!’ The next time he came in, the instructor says nonchalantly, ‘Hey Bill, I heard you played football.'”

This type of oversight and engagement is a purposeful part of the program. While patients participate in recreational therapy, the therapists watch and advise.

“We’re still looking at their function but in a more creative way,” Graziano says. “They are so focused on the medical issues and the rehab program. They don’t realize that we can think about wellness and ways of getting better while having fun.”

Treasured time

For Bill, the focus wasn’t to become a better artist. It was about feeling responsible for creating something. “I’m not very artistic, but I enjoyed picking different colors and blending them, and I enjoyed making an object,” he says. “It gave me a period of time to do something with my hands and brain, which I enjoyed doing. It was something normal.”

As Bill’s recreation therapist, Graziano says that it was exciting to watch Bill and Mariann embrace the art program. “They brought in family members. They were able to do it as a family therapy project, and they all had pieces to take with them,” she says.

Bill was discharged from the Inpatient Rehabilitation Unit in late November 2018, and he continues to receive outpatient physical therapy twice a week. Although Bill cannot remember all of the time he was in the hospital, the hours spent making art are ones he and Mariann have come to treasure. Both Bill and Mariann brought home the canvases they painted during the art sessions.

“The very first one that Bill and I painted separately we didn’t like. The instructor drew a squiggle on the canvas, and he said, ‘Turn this into something.’ Bill’s turned into a duck, and mine turned into an alien,” Mariann says. “Well, I hung them up in the hallway. And Bill said, ‘That is so weird.’ But it was a great memory, and it shows us how far we’ve come.”


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Mon, Apr 1 5:00am · Flashback: 1938 -- Gift of Classic Anatomy Book Rooted in Respect and Care for All

Given in gratitude for the consideration and compassion that the Mayo family showed to the Strassmann family in the late 1930s, a pivotal 16th century anatomy text now housed at Mayo Clinic is a testament to the enduring connection of friendship.

Erwin Strassman, M.D. with his father, Paul Strassmann, M.D.

Given in gratitude for the consideration and compassion that the Mayo family showed to the Strassmann family in the late 1930s, a pivotal 16th century anatomy text now housed at Mayo Clinic is a testament to the enduring connection of friendship.


The W. Bruce Fye History of Medicine Library at Mayo Clinic’s Rochester campus holds many treasures from far-flung times and places. One volume, an influential 16th century book on human anatomy by physician Andreas Vesalius, marked a turning point in the history of medicine. But the book has other tales to tell, too. One of its stories revolves around how the iconic text came to be at Mayo Clinic.

In the early 1900s, the Mayo brothers made dozens of international trips to seek out best practices and share information. Their itinerary included Germany, a center of medical innovation. While in Berlin, they befriended the Strassmann family, who had established a highly regarded clinic that specialized in women’s health. Paul Strassmann, M.D., who founded the clinic, sent his son, Erwin Strassmann, M.D., to study at Mayo Clinic. Friendships and collaborations flourished between the Strassmanns and the Mayos.


“It would be a joy to leave this classic work in the place where medicine is practiced best.”

Erwin Strassmann, M.D.

But conditions in Germany changed rapidly when Adolph Hitler came to power. The Strassmanns were of Jewish descent and found themselves engulfed in persecution. Dr. Paul Strassmann was forced to sell the clinic. He died soon after, mourning the life he loved. Dr. Erwin Strassmann could not imagine life under the Nazis and decided to emigrate.

At that time, bureaucratic red tape made it difficult to enter the U.S. Under mounting pressure, Dr. Erwin Strassmann reached out to friends at Mayo Clinic. Ultimately, William J. Mayo, M.D., made it possible for Dr. Erwin Strassmann to study at Mayo in 1938. This meant he could bring his wife, Ilse Strassman, and their three children to Rochester. Dr. Mayo called this opportunity “breathing space” while the Strassmanns settled in America. The Strassmanns said it saved their lives. Their relatives and friends who remained in Europe experienced hardship and death during World War II and the Holocaust.

After studying at Mayo, Dr. Erwin Strassmann established a practice in Houston. In gratitude, he and Ilse Strassmann gave the Versalius book from their collection to Mayo Clinic. “It comes from the heart,” said Dr. Strassmann. “The spirit and efficiency of the clinic was America at its best. It would be a joy to leave this classic work in the place where medicine is practiced best.”

The story of that gift and the Strassmanns’ connection to Mayo Clinic is the subject of the Mayo Clinic Heritage Film, “Breathing Space: One Family’s Journey From Nazi Germany to Mayo Clinic,” which premiered in June 2018.

The film about the Strassmann-Mayo friendship is part of an award-winning series made possible by benefactors John and Lillian Mathews. While the film was in production, the Mayo Clinic Alumni Association announced plans to hold its first meeting in Berlin — 80 years after Dr. Mayo helped the Strassmanns amid the gathering storm of World War II.


“The Strassmann and Mayo relationship dates back more than 100 years. It is personal, professional and philanthropic, representing the ideals of friendship and generosity.”

John Noseworthy, M.D.

At that meeting, Eddie Greene, M.D., chair of the Doctors Mayo Society, read a letter from John Noseworthy, M.D., Mayo Clinic’s emeritus president and CEO: “The Strassmann and Mayo relationship dates back more than 100 years. It is personal, professional and philanthropic, representing the ideals of friendship and generosity.”

In her response, Diana Strassmann, Ph.D., said, “My grandparents’ gift to the Mayo Clinic was made with deep consciousness of the much larger gift the Mayo Clinic made to them.” She noted that issues of ethnicity and immigration remain pressing topics today: “We are pleased to support the Mayo Clinic in its mission of respecting and caring for all people.”

Watch “Breathing Space: One Family’s Journey From Nazi Germany to Mayo Clinic“:


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