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Mon, May 4 5:00am · Rising Above Two Challenging Health Conditions

For years, Joey Del Toro has lived with medical conditions that have affected his abilities and appearance. But Joey hasn't let his health concerns define him. Instead, he's focused his energy on moving beyond them and excelling at the sports he loves.

For years, Joey Del Toro has lived with medical conditions that have affected his abilities and appearance. But Joey hasn’t let his health concerns define him. Instead, he’s focused his energy on moving beyond them and excelling at the sports he loves.




The landscape of Joey Del Toro’s youth was colored by medical experiences. Treatments for Joey’s two health conditions filled his calendar and required frequent road trips from his family’s home in Woodbury, Minnesota, to Mayo Clinic in Rochester. But medical appointments weren’t the only events populating Joey’s schedule as a child. An avid athlete, sports also filled Joey’s days.

During elementary school and middle school, Joey participated in football, hockey and lacrosse. Then, while navigating treatment for a life-threatening cardiac syndrome called Wolff-Parkinson-White syndrome with Mayo Clinic pediatric cardiologist Bryan Cannon, M.D., Joey switched course, trading in his cleats, sticks, and skates for skis.

“When
Dr. Cannon gave me the green light to go ahead with endurance sports, I didn’t
know at that time if I wanted to excel at Nordic skiing or cross-county running,”
Joey says. He eventually chose Nordic skiing and biathlon, which combines
skiing and precision rifle shooting. Today, he’s a collegiate athlete at Saint
Michael’s College in Vermont.

“I’ve enjoyed seeing him do the things he loves, and I enjoy seeing him accomplish these life goals.”

Megha Tollefson, M.D.

Joey’s sports require stamina, speed, precision and focus. And it’s the ability to focus in particular that has served him well as he’s weathered his health concerns, including ongoing therapy for alopecia areata — a skin condition in which the body’s immune system attacks hair follicles and causes patchy hair loss.

“Even
though I know that (his condition) really has affected him so much on a
personal level, I feel like he has not allowed it to hold him back,” says Megha
Tollefson, M.D.
, a Mayo Clinic pediatric dermatologist
and a member of Joey’s care team. “I’ve enjoyed seeing him do the things
he loves, and I enjoy seeing him accomplish these life goals.”

Living
with Wolff-Parkinson-White syndrome and alopecia has had a significant effect
on Joey and his family. But the individualized care he’s received from his Mayo
Clinic team has provided the support they’ve needed.

“Probably
the most fearful piece of this was Joey’s heart condition, and Dr. Cannon was
able to solve that for the rest of his life,” says Joey’s dad, David. “Whereas
the hair — which should be less traumatic from a health perspective — is the
part that lingers on and on. They’ve been compassionate, supportive, understanding
and very good with Joey.”

Alarming symptoms

Joey
was about 10 when he began experiencing episodes of an accelerated heart rate —
a symptom of Wolff-Parkinson-White syndrome. “My heartbeat would go up to
220 beats per minutes,” Joey says. “I learned the best way to stop it
was to flip myself upside down and wait for several minutes. After that, it
would stop, and I would be tired but OK.”

Wolff-Parkinson-White
is characterized by extra electrical connections in the heart. “When the
heart develops, it starts as a straight tube and folds in on itself. When it
does that, all of these primitive connections that most people have go away,”
Dr. Cannon says. “But in 1 in 750 people, they don’t go away.”

As
a result of the extra connections, the electrical signal that usually travels
up and down the normal fibers of the heart, triggering it to pump, instead
travels across the abnormal fibers and creates an unusually fast heartbeat.

“In
Joey’s case, his heart was beating at 220 beats per minute having this abnormal
heartbeat,” Dr. Cannon says. “He was pretty active doing sports, and
it was interfering with his participation.”

Sometimes,
months separated the occurrences. Other times, it was weeks. Occasionally, it
was only a day. When he felt the fast heartbeat during practice or sporting
events, Joey would sideline himself. In time, as the episodes became more frequent,
Joey’s football coach told the family that he was concerned with Joey’s
participation on the team.

Straightforward treatment

While certain maneuvers, such as inversion, coughing and breath-holding, can disrupt the cycle of abnormal electrical misfiring and slow a rapidly beating heart, the only cure for Wolff-Parkinson-White syndrome is removing the extra connections through a procedure known as ablation.

Joey and his family were aware of ablation as an option, but it wasn’t until they sought treatment at Mayo Clinic for Joey’s other health concern that they learned he was a candidate for the procedure.

“When
we called Mayo and said we wanted to see a dermatologist for alopecia, they
asked if he had any other medical conditions,” says Joey’s mom, Mary. “We
said he had Wolff-Parkinson-White syndrome, and they said they’d need to see
him first for that before they started doing anything with his hair.”

“We were able to completely get rid of (the abnormal electrical misfiring), and he hasn’t had any problems since.”

Bryan Cannon, M.D.

At Joey’s initial appointment in Mayo’s Department of Cardiovascular Medicine, he underwent an EKG and echocardiogram. Afterward, they met with Dr. Cannon and learned that ablation might be an option. Dr. Cannon, who helped write international guidelines for treatment of Wolff-Parkinson-White syndrome, says there is no advantage to waiting to do the treatment after age 8.

“Some
people get nervous about treating younger patients. But at Mayo Clinic, we have
more experience doing it on younger patients and more complex patients,”
Dr. Cannon says. “We were basically able to say, ‘We’re comfortable doing
this, so let’s do it now.'”

In
October 2013, Dr. Cannon performed Joey’s ablation procedure, which involved
inserting a catheter equipped with a camera through a blood vessel in Joey’s
leg and threading it to his heart.

“We
figure out where the extra fiber connection is, and we heat it up,” Dr.
Cannon says. “Once we do that, he is cured. We were able to completely get
rid of it, and he hasn’t had any problems since.”

Personalized care

With
Joey’s heart condition under control, his care shifted to treating the
alopecia, which is the most common cause of hair loss in children. “Alopecia
areata can range from small patches that aren’t noticeable to complete hair
loss,” Dr. Tollefson says. “Joey fell somewhere in the middle. Through
the years, it fluctuated and has gotten better and worse.”

Several
treatment options are available for alopecia areata. None cure the condition, however.
“A lot of the time, the treatment we recommend will help the hair grow
back, but we cannot prevent the flares from happening,” Dr. Tollefson
says.

“This care has definitely allowed me to grow without having to worry about my condition and helped me to accept a lot more, especially with the alopecia.”

Joey Del Toro

For Joey, the treatment that’s produced the greatest benefit has been injectable steroids administered directly to the scalp. Every six to eight weeks for the past six years, Joey and his parents have traveled to Mayo Clinic’s Department of Dermatology for the shots.

The
injections are painful and cause some bleeding at the injection sites, but they
work to block Joey’s follicles from his immune system, allowing his hair to
grow back. “Every appointment, we would take a picture, and then look at
the picture at the next appointment to track progress and to see where the hair
had started growing,” Joey says. “If I had shots in the early spring,
by the summer, the hair would be a lot thicker, and I would be like, ‘This is
actually worth it.'”

As
a way to channel his emotions over the years, Joey has focused his energy on
athletics. As a freshman in high school, he joined the cross-country running team.
The next year, he joined his school’s Nordic ski team. During his junior year, after
watching biathlon events in the 2018 Winter Olympics, Joey’s dad registered him
for a nearby novice competition. After participating in that event, Joey was
hooked.

Joey
excelled in skiing and biathlon events through his senior year and focused his
college search on schools with a Nordic ski team that were near a biathlon
training venue. He and his family ultimately decided on St. Michael’s, where he
now studies engineering. Nearly every weekend during the winter, Joey skis with
his college’s Nordic team or competes in biathlon events with a local club.

Joey
receives ongoing follow-up for both of his medical conditions from his Mayo Clinic
team. The treatment he receives gives him the freedom to live without being
mired in stress, he says. “This care has definitely allowed me to grow
without having to worry about my condition and helped me to accept a lot more,
especially with the alopecia.”


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Mon, Apr 27 5:00am · Elated After Life-Changing Orthopedic Surgery

For four years, Mallory Owens lived in a world of pain. Constant, intense shoulder pain interfered with her work and disrupted her sleep. Mallory's search for a way out of the pain led her to a Mayo Clinic orthopedic surgeon who finally was able to offer the solution Mallory needed.

For four years, Mallory Owens lived in a world of pain. Constant, intense shoulder pain interfered with her work and disrupted her sleep. Mallory’s search for a way out of the pain led her to a Mayo Clinic orthopedic surgeon who finally was able to offer the solution Mallory needed.




Mallory Owens had been to 300 doctors’ appointments and undergone nearly 20 imaging scans by the time she arrived at Mayo Clinic in November 2017. Four years earlier, when she was 22, Mallory was involved in a devastating car accident that, among other injuries, left her with persistent shoulder pain that perplexed physicians.

The
pain, says Mallory, felt like a lion mauling her left shoulder. The ever-present
pain spiked when she coughed, raised her arms or sat up straight in a chair. Any
effort to relieve the pain, such as physical therapy, only worsened it. While wearing
back braces helped control the pain, it was never far away.

“I
couldn’t get dressed. I couldn’t do my hair. I had to wear two braces to get in
my car and drive,” says Mallory, who lives in Raleigh, North Carolina. “I
tried to conceal the world of pain that I was living in from other people
because I didn’t want my pain to define me.”

When
Mallory failed to get relief from local providers, she broadened her search for
a remedy. Late at night, unable to sleep due to the pain and frustrated by a
lack of answers, she read research studies. “I would look up medical
journals for pain similar to my own,” Mallory says. “I looked up
authors, contributing doctors. I looked up where they practiced and their
medical institutions.”

As time passed, Mallory worked her way down the list of specialists she had compiled during her late-night reading. She visited medical centers in Florida, Illinois, Kentucky and New York. Near the end of the list was Bassem Elhassan, M.D., an orthopedic surgeon at Mayo Clinic in Rochester. During one Mallory’s out-of-state appointments, she was referred to Dr. Elhassan. When she read about his pioneering work in scapular repair, she believed she might have found someone who could help.

A
few weeks later, Mallory’s phone rang. When she picked up, Dr. Elhassan was on
the other end. “He said, ‘Hi, this is Dr. Elhassan, and I heard you have
some questions about tendon surgery,'” Mallory says. “Never in my
life have I felt so relieved to know there was a doctor who was not only able
to help me, but very compassionate about his patients and so devoted to work. It
was a turning point in my long road to recovery.”

At an appointment in Mayo Clinic’s Department of Orthopedic Surgery several weeks later, Dr. Elhassan told Mallory he had experience with her kind of injury, and he offered a surgical repair to correct the problem. “I was proactively, on a daily basis, trying to find a doctor who could help me, and it took four years until I got to Mayo,” Mallory says. “Without Mayo and Dr. Elhassan, I am convinced that I would have never recovered.”

A multifaceted mystery

From
the time Mallory was young, her shoulder blades, or scapulae, were different
from other children. When she lifted her arms out in front of her body, her
shoulder blades visibly stuck out like small wings. That condition — known as
scapulo-thoracic abnormal motion, or STAM — is caused by abnormality in the
muscles or bones around the scapulothoracic region. One of the most common
reasons it develops is dysfunction or paralysis of the serratus anterior muscle
— a large band of muscle that wraps around the rib cage and connects to the
scapula.

While
the condition can be debilitating and lead to limited upper body function, it
didn’t significantly affect Mallory’s ability to exercise or work. But it did interfere
with some activities. “I always thought I had a weak, small-boned upper
body,” Mallory says. “If you compare me to an average person, I have
a harder time performing daily activities, such as opening doors, carrying
groceries and driving a car.”

“Every doctor I met with would say that something was definitely wrong with me, but they didn’t have any answers or weren’t able to help.”

Mallory Owens

When
the car accident occurred, Mallory’s obvious injuries, including bone and nerve
damage to her left hand, wrist and arm, were treated promptly and slowly
healed. After several months of recovery and rehabilitation, Mallory returned
to work. Two weeks after resuming her job, however, her left shoulder blade,
which had always stuck out, began hurting terribly.

“I’d
be at work some days, and the pain would get so bad that I would have
neurological side effects like hand tremors and slurred speech,” Mallory
says.

The specialists Mallory visited for help with her scapular pain ordered an array of tests, including, MRIs, CT scans and electromyographs, to assess the health of her muscles and the nerve cells that control them. The results all came back normal. While several specialists recognized that there was a unique aspect to Mallory’s condition, none offered a solution.

“Every
doctor I met with would say that something was definitely wrong with me, but
they didn’t have any answers or weren’t able to help,” Mallory says.

Experienced, precision care

What
was wrong with Mallory was quite difficult to identify, says Dr. Elhassan. “Sometimes
when the scapula is not working well, and patients have a lot of pain, the
nerve exam and testing might look normal, and nothing in imaging shows muscle
damage,” he explains. “Scapulo-thoracic movement is very unique, and
in my opinion, a detailed physical examination based on very good understanding
of anatomy and biomechanics of this movement is much more important than
imaging and other testing.”

During
Mallory’s exam, Dr. Elhassan looked at whether the muscles surrounding her
scapula were functioning normally. While Mallory’s individual muscles didn’t
show evidence of paralysis or damage, that didn’t necessarily mean her muscles
were activating in a normal sequence for movement. “If the muscles are
working in an abnormal sequence of activation, then this will cause STAM and,
in this case, cause dysfunction of the shoulder and pain,” he says.

The
car accident caused Mallory’s serratus anterior muscle to stretch and further
disrupt the stability and motion of the scapula on her chest wall. When the
muscle healed, even though it had relatively normal contraction, it retained
the abnormal elongated shape and motion. “By the time I saw her, the
muscles were recovered,” Dr. Elhassan says. “But the muscle anatomy,
the length of the muscles, the position of the muscle, and the way they
activate around the scapula were abnormal.”

As a result, the sequence of muscular contractions required for movement was out of order. Instead of the scapula being stabilized on the chest wall, the persistently elongated serratus muscle, and its inability to maintain the scapula’s position on the chest wall, led to ongoing STAM and winging of the scapula off the chest wall.

To
restore function and eliminate pain, Mallory needed surgery. The repair would
reanchor the muscles responsible for scapular movement to her chest wall.
Surgery also would encourage the distorted muscle to regain its earlier shape.

Mallory’s
operation, which took place in March 2018, was one of the first such repairs
that Dr. Elhassan performed at Mayo Clinic. During the procedure, Dr. Elhassan
made a hole in the bottom tip of the scapula bone. Inserting a donor tendon
through the hole, he wrapped the tendon around one rib and fastened it on
itself. “If we pull the scapula in and force it to stay on the chest wall
for a while, then the muscle will shorten over time,” Dr. Elhassan says. “Over
three, four, five months, the scapula will be able to move freely. By that time,
the brain will be able to give the sequence of movements that are more
organized to restore normal mechanics of the motion.”

Dramatic, enduring results

Mallory’s
shoulder was immobilized for three months after surgery. She moved back home
with her family and depended on caregivers to help her through her days. “It
was a really tough recovery, but it was well worth it,” Mallory says.

When
her restrictions were lifted, she moved her left arm in ways that were
impossible before. Some motions that should have been pain-free, however,
continued to cause discomfort. That pain was related to inflammation of the
bursa — a lubricating tissue beneath the scapula, between the scapula and the
chest wall.

“Mayo Clinic, with its holistic approach and exceptional level of care for your well-being, is everything that a patient could ever imagine.”

Mallory Owens

In September 2018, Mallory underwent a second operation, also performed by Dr. Elhassan. This surgery, a scapulothoracic bursectomy, involved removal and debridement of the inflamed bursa, as well as removal of a small portion of scapular bone that typically causes bursitis.

After
that, the change in her shoulder pain was like night and day, Mallory says. Unfortunately,
as the shoulder pain diminished, other accident-related pain became more
apparent. “When I look back to two years ago when I had a lion mauling my
shoulder, I also had other underlying sources of pain. I wasn’t able to feel that
due to the intense pain I was constantly enduring,” Mallory says. “Although
the lion was tamed through surgery, I’m still working with Dr. Elhassan on
resolving the few lingering sources of pain.”

There
is no question in Mallory’s mind that Mayo Clinic is the place that will give
her the best chance at a full recovery. “Mayo Clinic, with its holistic approach
and exceptional level of care for your well-being, is everything that a patient
could ever imagine,” she says. “Mayo is a truly special place, and I will
always hold it very close to my heart. Whatever happens in the years to come, I
know I’ll always be in good hands, thanks to Mayo Clinic.”


HELPFUL LINKS

Mon, Apr 20 5:00am · Medical Solutions Found Where a Medical Career Began

For Cori Kirkpatrick, going back to the place where her husband received his medical training brought with it a well of emotions — excitement, nostalgia, anxiety. Mayo Clinic had always represented possibility and hope for her, but those sentiments took on more meaning when Cori returned to Mayo searching for a solution to her own illness.
Cori and John Kirkpatrick

For Cori Kirkpatrick, going back to the place where her husband received his medical training brought with it a well of emotions — excitement, nostalgia, anxiety. Mayo Clinic had always represented possibility and hope for her, but those sentiments took on more meaning when Cori returned to Mayo searching for a solution to her own illness.




Corinne “Cori” Kirkpatrick remembers well the initial impressions Mayo Clinic left on her when she first arrived in Rochester, Minnesota, as the 25-year-old wife of a resident physician.

“The
marble, glass and steel structure rising out of the cornfields was such an
impressive facility,” Cori says. “You just knew you were going to be
well-cared for.”

The
three years in the mid-1970s that Cori and her husband, John, lived in
Rochester were busy ones. Cori’s life revolved around having and raising their children.
John’s days, and sometimes nights, were spent learning to care for patients in
the collaborative, patient-centric
care model
established by the Mayo
brothers
a century earlier.

“This
meant collegial, empathetic medical teamwork that put the patient’s needs first
and that never, ever gave up on an elusive diagnosis,” Cori says.

Forty-five
years have passed since Cori and John lived in Rochester. Following John’s internal
medicine residency at Mayo Clinic, the couple moved back to their hometown of
Seattle. But the familiar aura of compassion and commitment was immediately apparent
to Cori when she returned in January 2019 seeking her own elusive diagnosis.

“Your
doctors were just going to keep after this until they figured out what was
wrong with you and figured out what they could do about it,” Cori says. “That
sense was still there.”

For Cori, those values of dedication and understanding shone through in the comprehensive testing and collaboration that ultimately yielded a name — giant cell arteritis — for the painful and debilitating inflammatory condition of the blood vessels that had been wreaking havoc on her life.

“To
have a place like this to turn to when you’re really sick and no one knows what’s
wrong, it’s really something,” Cori says. “I feel so grateful that I’ve
been able to access care like this.”

Alarming, rapid deterioration

The decades since she left Rochester were largely healthy ones for Cori. In spring 2018, however, Cori experienced an odd type of pain. Even slight exertion, such as walking, caused her calves to ache and her feet to go numb. But it usually subsided if she continued walking. The problem, Cori later learned, was called claudication — pain caused by too little blood flow to muscles during exercise.

Cori
mentioned the symptom to her physician during a routine checkup in Seattle. At
the appointment, her doctor recommended an ankle-brachial index. During the
test, which is performed while the patient lies down, Cori’s blood pressure was
found to be extremely high. That led to an appointment with a kidney
specialist, who recommended magnetic resonance angiography, or MRA — a test
that uses a magnetic field, radio waves and a computer to evaluate blood
vessels.

The
images revealed that a number of Cori’s arteries — the blood vessels that take
oxygen from the heart to the rest of the body — were narrowed, impeding her
circulation. Arteries to her kidney and bowel, as well as femoral arteries,
were all affected.

“I was down to 113 (pounds), and I could not gain it back. It was awful. I felt just horrible.”

Cori Kirkpatrick

The resulting diagnosis, atherosclerosis, couldn’t have come at a worse time. Cori and John were about to embark on a European vacation with 16 members of their family to celebrate their 70th birthdays. “Everyone was hesitant. Should they send me (on the trip)? Should we do a surgery?” Cori says. “They ended up putting me on a statin drug, so I wouldn’t develop further atherosclerosis, and on a blood thinner, and we went on the trip.”

Cori
made it through the trip with only slight changes to their itinerary. But upon
her return, she became fatigued and lost her appetite. “Over the last year,
I’d lost 10 pounds,” Cori says. “I’m not quite 5’8″ and weigh
between 120 and 125. I was down to 113, and I could not gain it back. It was
awful. I felt just horrible.”

Cori
stopped wanting to see friends, and she abandoned most of her usual activities.
“All I wanted to do was read,” she says. “I didn’t feel like
myself, and it wasn’t normal for me.”

During this time, John had been in communication with friends and medical colleagues who asked if they’d considered seeking a second opinion. The conversations ignited a spark that led John to reach out to an old Mayo Clinic colleague, who referred Cori to Mayo Clinic’s Vascular Center. There she was seen by vascular specialist Ana Casanegra, M.D. and rheumatologist Kenneth Warrington, M.D.

Collaborative, comprehensive approach

When Cori and John arrived at Mayo Clinic in Rochester in January 2019 for a week of evaluation and consultation, a lifetime of experiences had changed them, but much about Mayo Clinic and Minnesota remained constant.

“We’d
forgotten about Minnesota. That everybody there was so nice and helpful and
sensitive and concerned, so that was really pleasant,” Cori says. “The
other thing that was fun to see again was the convergence of the people at Mayo.
You stand in that lobby area by the grand piano, and you see every walk of life
— and I think that makes it a really special place. You really feel like they’re
caring for the world there.”

The spirit of collaboration among physicians also was unchanged by the passage of time. During the first week Cori spent at Mayo, a team of physicians, including vascular medicine specialists, rheumatologists, nephrologists and interventional radiologists, evaluated her.

That
team approach was critical to identifying Cori’s hard-to-diagnose illness. “She
came to the Vascular Center, which is basically a clinic that takes care of
blood vessel problems,” Dr. Warrington says. “Within the Vascular Center
is embedded a multispecialty Vasculitis Clinic.”

“Collaboration and communication are our everyday practice.”

Ana Casanegra, M.D.

Vasculitis was not immediately suspected when Cori arrived at the Vascular Center, Dr. Casanegra says. But a slate of tests, including blood tests, CT scans and MRIs, and an interdisciplinary review of the results, honed in on the illness. When a form of vasculitis was identified as the source of Cori’s symptoms, Dr. Warrington, an expert in vasculitis and inflammatory conditions, was brought onto the team.

“We
are very fortunate to have a Vasculitis Clinic in the Vascular Center,”
Dr. Casanegra says. “It makes a difference to work on an interdisciplinary
team that can cover all the needs of patients with any type of vascular
diseases. Collaboration and communication are our everyday practice.”

In
addition to the collaboration, blood work and advanced imaging technologies aided
in Cori’s diagnosis, “She had complex imaging tailored to evaluating
patients with vasculitis,” Dr. Warrington explains. “So the
availability of that advanced imaging at Mayo Clinic is what allowed for a
better diagnosis.”

After
the week of evaluation, Cori and John flew home to Seattle but still lacked a
name for Cori’s condition. A week later, she returned for additional testing. The
second set of tests included another MRA. This one focused on the thoracic
aorta, which is the primary blood vessel carrying blood from the heart to the
rest of the body. The test revealed the wall of the thoracic artery was thickened
and inflamed, but it did not contain any fatty deposits.

“That
was the definitive test,” Cori says. “They knew by seeing that. They
knew something else was going on.”

Unusual symptoms

The condition affecting Cori was giant cell arteritis. A form of vasculitis, giant cell arteritis is an autoimmune disorder that causes changes to the blood vessels that eventually can lead to organ damage.

“The moment when Dr. Casanegra said, ‘We’ve figured it out,’ I was so excited and grateful.”

Cori Kirkpatrick

“Most
patients present with cranial symptoms, such as headache and jaw pain with
chewing,” Dr. Warrington says. “Some people may lose vision or go
blind, and that is why it’s so serious. Ms. Kirkpatrick didn’t have those
symptoms. Her vascular problems were in the aorta and lower extremities. It was
an atypical presentation which likely led to the delay in diagnosis.”

Although
Cori had never heard of giant cell arteritis, learning the name of the
condition was a transformative moment. “The moment when Dr. Casanegra said,
‘We’ve figured it out,’ I was so excited and grateful,” she says.

Cori learned that the condition frequently occurs in people who’ve also been diagnosed with polymyalgia rheumatica, or PMR. “I had no idea that one-third of the people who have PMR go on to develop giant cell arteritis. I had PMR in my 50s, and 15 years later developed giant cell arteritis.”

Life-changing treatment

Treatment for giant cell arteritis has historically been glucocorticoid (steroid) therapy. To jump-start Cori’s recovery, she immediately began taking daily doses of prednisone.

“Since
the 1940s, prednisone was recognized as being very effective at alleviating
patients’ symptoms and at preventing blindness from the disease,” Dr.
Warrington says. “The main concern with prednisone is that it has a long
list of possible side effects. So for the last 70 years, researchers have been
looking for a suitable alternative.”

In
2017, the first steroid-sparing agent for the disease that was approved by the
Food and Drug Administration became available. “The medicine has a similar
effect on the immune system as what we’re trying to achieve with prednisone
without as many side effects,” Dr. Warrington says.

Cori
started on that drug in May 2019. Delivered via an injection under the skin or
as an infusion, the medicine doesn’t offer a cure, but it reduces inflammation
to the point where, eventually, a patient may be able to stop taking it.

Since
beginning treatment, Cori’s pain has decreased substantially. “It’s not
like it was before all of this started, but I feel so much better,” she
says.

Getting
her health back has increased Cori’s appreciation of life’s little details. “I’ve
had a really wonderful life, and I could not ask for more,” she says. “I’ve
got three great kids and eight wonderful grandchildren, and John and I have had
a wonderful marriage. So as I was circling the drain I thought, ‘If this is how
my life is going to end, it’s OK because I’ve been so lucky.’ But then when you
find out this (condition) is treatable, and you’ve got a lot of good days
ahead, you really start appreciating just reading the Sunday paper together and
lingering over coffee.”


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Fri, Apr 17 9:38am · 'Wear a Mask and Be Safe' -- Mayo Clinic and the 1918 Influenza Pandemic

This look back to 1918 and how Mayo Clinic responded to the influenza pandemic is written by Matthew Dacy, director of Mayo Clinic Heritage Hall.


Headlines tell the story.

“New Disease Is In Rochester Now.” This brief notice appeared in the Rochester Daily Post and Record on Sept. 21, 1918. Taking up barely two inches of newsprint, the statement described a single patient undergoing treatment for an obscure disorder — but such an event hardly stood out amid the newspaper’s extensive coverage of the First World War, which was raging overseas, and the public’s preoccupation with the harvest at home.

Yet for most people at Mayo Clinic, this modest announcement was perhaps their earliest exposure to what became a cascade of coverage for one of the greatest disease outbreaks in human history: the 1918–1919 influenza pandemic.

Scattered early cases quickly multiplied and spread in successive waves of infection since travel by motorcar, railroad and ocean liner connected people in far-flung locations, and large-scale public events such as Liberty Bond rallies brought crowds together in close proximity. Standards of personal hygiene varied widely among individuals and communities. There was little general knowledge of germ control and risky behaviors.

Its nickname, the “Spanish Flu,” is a misnomer. Even today, the pandemic’s exact point of origin is not known. Some of the first news reports came from Spain, which was neutral during World War I and not subject to the wartime censorship that suppressed initial coverage in other countries. Wherever it began, the disease spread worldwide.

According to the U.S. Centers for Disease Control and Prevention, it struck an estimated 500 million people — about one-third of the earth’s population at the time — and caused 50 million deaths, far surpassing the approximately 8.5 million combatants who died in four years of fighting during World War I. The United States experienced about 675,000 fatalities related to the pandemic. In addition to children and the elderly, the population segments typically at risk, this particular strain of influenza was particularly hazardous for otherwise healthy adults between 20 and 40 years of age.

The disease subsided in 1919, possibly due to mutation into less-lethal forms or for other reasons. More than a century later, key aspects of the influenza pandemic remain a mystery.

Values and mission

Mayo Clinic’s experience with the fast-breaking crisis of influenza pandemic aligned with its foundational values and threefold commitment to patient care, research and education. This story also reflects Mayo’s impact, which ranges from the local community to the international sphere. Its lessons link the generations.

“The disease broke out in a mild form in the town first,” wrote Helen Clapesattle in “The Doctors Mayo,” her acclaimed biography, “then suddenly and virulently in the hospital itself.”

Thanks to providence and sound planning, Saint Marys Hospital had a new resource to meet the challenge: an isolation unit, close to but separate from the main facility. The Sisters of Saint Francis had recently purchased the Lincoln Hotel, originally a large private home, which stood near the hospital. They adapted it for treatment of communicable diseases, and opened it in June 1918. The isolation unit stood ready for an influx of patients, but soon was stretched to the limit.

“Within a week the new unit was packed,” wrote Clapesattle, “even to cots in the hallways.”

Her account continues: “Every doctor, nurse, technician and secretary worked wherever needed most at the moment, often until late at night. Relatives or friends with any time to spare were called into service, Dr. Will’s younger daughter Phoebe among them. The doctors worked on the Clinic floors … and then started out on drives through the countryside, sending the worst cases they found to the isolation unit at Saint Marys.”

According to the “Annals of Saint Marys Hospital”: “The Sisters in charge were in great straits … they had to get the (isolation unit) heated up, prepare beds, do the cooking for their patients, and attend to all the nursing. … Saint Marys was so short of nurses and general help that everyone felt it her duty to assist to the limit of her endurance, wherever the need was greatest. The supervisor of nurses, Miss Ledwidge, with nurses from the floors, was sometimes to be seen working in the laundry, where help was utterly depleted.”

Communication technology proved invaluable. Telephone calls — a rarity for many people at the time — hit new volumes as relatives and friends deluged Mayo Clinic and its affiliated hospitals, seeking news of their loved ones. The telegraph and Rural Free Delivery of mail helped speed information along with local newspapers, national magazines and silent movie newsreels.

“Rochester to Fight Disease” was the headline on Oct. 2, describing a Red Cross initiative to make 2,500 “contagious ward masks” for public use — all within one week. From houses of worship to neighborhood groups, sewing circles were mobilized to produce masks according to widely published plans and patterns.

For many women in Rochester and throughout the nation, most of whom did not work outside the home, this was an early foray into the “public sphere.” The confidence and assertion they felt by making a difference in fighting influenza and other wartime endeavors helped pave the way to women winning the right to vote barely two years later.

“We must put forth our best efforts to do this greatly needed work,” a Red Cross executive said at a meeting in Rochester. Soon, however, large social events would be disbanded.

“Rochester closed down because of flu”

“Wear a Mask and Be Safe,” the Rochester Daily Post and Record urged readers on Oct. 16, while also announcing “Rochester Closed Down because of ‘Flu’: Theaters, Pool Rooms, Churches, Sunday Schools, Meeting Places; All Shut Because of Contagious Disease…”

The article quoted local officials: “In view of the fact that we are a city of hospitals, we think it best to take this action in such time that we hope to prevent the disease (from) spreading.” On the same page, an advertisement titled “Banking by Mail” described helpful new ways to conduct business while limiting personal contact and risk of contagion.

At Saint Marys Hospital, from mid-October 1918 “through May the next year, 360 flu patients were cared for including some of the Sisters and many of the lay nurses. … although some of the Franciscan Sisters were ‘dangerously ill’ according to a request for prayers sent to the entire membership, none of them died. Isolating the patients and applying rigorous standards of cleanliness prevented cross infection and saved many lives.”

Total statistics for influenza patient care at Mayo Clinic during the pandemic are not known.

Saint Marys Hospital has remained in continuous service since opening in 1889, and its meticulous records from 1918–19 are available. At the same time, patients with influenza also were treated at several hotel-hospitals managed by the Kahler Corporation in downtown Rochester. Kahler opened a nursing school in 1918 to meet wartime and influenza demands, and provided about the same number of hospital beds as Saint Marys. In 1954, however, the Kahler Corporation ceased its medical activities, which transitioned to Rochester Methodist Hospital. The Kahler hospital records did not survive. In addition, along with Saint Marys and Kahler hospital care, many people with influenza were treated in the outpatient offices of the Mayo Clinic building, which had opened in 1914 (site of the Siebens Building today) or at home by Mayo physicians and visiting nurses who made house calls.

“The Clinic is making a sacrifice”

The Rochester Post and Daily Record published “Uncle Sam’s Advice on Flu” on Oct. 21, connecting efforts of the federal government with state and local initiatives. But it was clear that individuals played a key role in fighting the disease. An illustrated announcement in that edition of the paper brought home the message: “Coughs and Sneezes Spread Diseases,” equating influenza contagion with the poison gas being used in World War I combat.

Mayo Clinic responded to the crisis on multiple fronts. Laboratory personnel investigated the strain of influenza with efforts that underscored the importance of clinical trials and other protocols that are now the foundation of medical research. Educational outreach engaged patients, staff and the public about how to limit the spread of influenza.

Mayo Clinic was a destination medical center, attracting patients from throughout the region, the nation and abroad. As a matter of public safety, however, Mayo Clinic leaders made the difficult decision to curtail what today would be called elective procedures: “Why, at the Clinic, daily, numerous letters are answered (from) patients who desire to come to Rochester, asking them to remain at home until the epidemic conditions now existing all over the country are quite eliminated. Hence it is to be seen that the Clinic is making a sacrifice of no small proportions to assist our city in ridding herself of this infectious disease.”

These words come from Dr. Gertrude Booker Granger, the first woman physician who joined the Mayo medical practice. Starting several years before the pandemic, she also served as deputy director of public health for the city of Rochester, working closely with the director, Dr. Charles H. Mayo. Her interview was published on Nov. 15, four days after the Armistice ended hostilities overseas, underscoring Mayo’s commitment to public service.

Dr. Booker Granger drove home the importance of personal responsibility: “The Board of Health has warned people as a whole not to have crowds at their homes (and to) absent themselves from all gatherings or crowds of any sort.”

“The ills of today must not cloud the horizons of the future”

Through its commitment to America’s armed forces, Mayo Clinic helped fight influenza internationally as well as at home. Soon after the United States entered World War I, Mayo Clinic and the University of Minnesota collaborated in establishing Base Hospital 26, which was deployed to the Western Front near Allerey, France. The hospital and its mobile surgical units provided essential care during periods of intense fighting — and then came the flu.

According to a history of Base Hospital 26, influenza struck “during the period of greatest activity at the hospital.” Recognizing the importance of halting contagion, hospital officials established special wards for infectious disease. “The bed capacity of the hospital was repeatedly taxed to the utmost, so that even the Red Cross recreation hut had to be requisitioned for use as a ward, all wards and tents having been filled to capacity.”

Nell Bryant was born in Louisiana and graduated from the Saint Marys School of Nursing. She served at Base Hospital 26 and with its mobile surgical units that went close to the fighting. She wrote detailed letters to her “Dear Sis” and nephew Charles at home, describing the devastation of war, including aerial attacks on her medical unit. The experience of influenza established a common bond with her family back in the States. “I am sorry that Charlie has the ‘Spanish flu,'” she wrote from France about the same time that Dr. Booker Granger gave her newspaper interview in Rochester. “Hope he is all right by this time, we are having an awful time with it here.”

In addition to injured and ill Allied soldiers, “practically all of the German prisoners” in the region, “wounded or sick, were admitted to Base Hospital 26,” the unit’s historian reported. “Needless to say, all these men received the same attention and care as was given to our own men.”

During the First World War and influenza pandemic, the Mayo brothers were among the most respected physicians in the United States and abroad. As both a practicing surgeon and a statesman of medicine, Dr. William J. Mayo maintained a long-term perspective as Mayo Clinic responded to the immediate crisis.

Even while the influenza pandemic was under way, Dr. Will commissioned a study of best practices in hospital design for “the organization and methods of contagious disease services,” which involved research and benchmarking at leading medical centers throughout the country. The published results were presented to the staff of Mayo Clinic and community-based medical societies elsewhere in the United States, showing the wide applicability of its findings.

Looking to the future, the study concluded: “If professional knowledge is quick to take advantage of an aroused public interest, a new cooperation between physician and layman will bring about advances comparable to those which war has stimulated in other fields of medical practice.”

As a result, Mayo Clinic’s leadership helped inform medical progress long after the crisis of war and pandemic had passed. This positive outcome was consistent with Dr. Will’s forward-looking vision. As he wrote, “The ills of today must not cloud the horizons of tomorrow.”


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Thu, Apr 16 9:56am · Mayo Clinic Nurses Answer Call to Service, Carry out Mission on USNS Comfort During COVID-19

Lynn Houston went from her role as a nurse manager at Mayo Clinic in Florida to the operating room aboard the USNS Comfort, stationed in New York City.

Lynn Houston went from her role as a nurse manager at Mayo Clinic in Florida to the operating room aboard the USNS Comfort, stationed in New York City.




When Lynn Houston went to nursing school 30 years ago, she never imagined that her decision would one day lead her to join the fight against a devastating global pandemic.

But the COVID-19 pandemic swept her from her nurse manager role in the Transplant Department at Mayo Clinic in Florida to her current address: aboard the USNS Comfort — a U.S. Navy hospital ship stationed in New York City.

From its home base in Norfolk, Virginia, the ship has journeyed to its destination alongside a pier in Manhattan, accepting trauma, emergency and urgent care patients. While the ship was originally brought to New York to treat an overflow of patients without COVID-19, it has since been authorized to treat patients with COVID-19. The capacity of the ship has been reduced from 1,000 beds to 500 beds to allow for the extra room that patients with COVID-19 require.

Commander Houston is among approximately 123 Navy reservists who have been called to work in a medical capacity aboard the Comfort, treating patients with COVID-19 and other conditions.

“They called me on a Sunday night at 10:30 p.m. and told me to be ready to fly on Wednesday. So I flew to Norfolk, Virginia, on March 25,” says Houston, who is working as a perioperative nurse in the operating room on the ship.

Houston is aboard the ship with with another Mayo nurse, Minerva Davis-McClintock, who she calls her “battle buddy.”

Houston is assisting mostly with general surgeries. Like her fellow Navy reservists, she’s practicing universal precautions with personal protective equipment under the assumption that everyone she treats may be COVID-19 positive. She considers it an honor to serve her country during these unprecedented times.

“We are definitely ready,” she says. “Medical is at the tip of the spear right now, not artillery. It’s flipped.”

She views her current assignment as an amazing adventure that seamlessly blends active duty and reservists into one integrated team.

A typical day

A typical day aboard the USNS Comfort begins with breakfast at 6 a.m. Houston then heads to the operating room for her room assignment and supplies. She sees patients through 5 p.m. and also participates in continuous training with the perioperative crew.

Although many miles separate Mayo Clinic in Florida from New York harbor, Mayo Clinic’s mission is never far from her mind.

“Mayo ingrained in me how to treat patients,” Houston says. “The needs of the patient come first.”

It’s a sentiment echoed by her supervisor, who also has served in the military.

“This ship sailed into the harbor to provide comfort to the city. I feel accomplished every day to provide great, quality care.”

Lynn Houston

“As a retired Air Force colonel and Military Treatment Facility commander, I understand that when the call comes, you go,” says Michelin Joplin-Beale, nursing administrator in the Transplant Department at Mayo Clinic in Florida. “Lynn is a servant leader who embodies hard work and compassion for people. Our Transplant team misses her, but we know she’s doing well and taking excellent care of the patient population she’s been called to serve.”

Houston has her orders through May 29, but the timeline could be shortened or extended, depending on the need.

When this mission is accomplished and the Comfort sails for home, the crew can take comfort in knowing they’ve helped take the wind out of the sails of the coronavirus.

“I know we’re making a difference,” Houston says. “We’re all here for a common goal and cause. Here in New York, people put signs on the pier thanking us for the job we do every day. This ship sailed into the harbor to provide comfort to the city. I feel accomplished every day to provide great, quality care.”


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Mon, Apr 13 5:00am · Walking Pain-Free Again After Hip Replacements

After hip replacement surgeries, Mara Olson feels no pain and is back to the activities she enjoys. That's just the result her surgeon and her two dogs wanted for her.

After hip replacement surgeries, Mara Olson feels no pain and is back to the activities she enjoys. That’s just the result her surgeon and her two dogs wanted for her.




Mara
Olson and her dogs, Ellie and Tea, had a good thing going. Every day, they’d
walk in the fields behind her home. Then one day, Mara found herself struggling
to walk up the small hill leading back to the house. “I had pain in my
left groin,” she says.

That was the beginning of the end of Mara’s walking days. Over the next few years, the pain would come and go. Eventually, it became a constant companion and began limiting Mara’s range of motion. Twice-weekly physical therapy sessions made things worse, she says. She tried cortisone injections to no avail. “They didn’t touch the pain,” Mara says.

That’s when Mara’s primary care provider referred her to Michael Eckstrom, M.D., an orthopedic surgeon at Mayo Clinic Health System in Albert Lea and Austin, Minnesota. Imaging exams revealed that Mara had arthritis and a torn labrum, which involves damage to the cartilage around the hip joint. Based on those findings, Dr. Eckstrom recommended hip replacement surgery.

“The surgery was absolutely remarkable. I never had pain after surgery. To be able to move and not hurt brought tears to my eyes.”

Mara Olson

“I
was nervous,” says Mara, who then was 50. She now knows that she didn’t
need to be. She spent just one night in the hospital after surgery and her
mobility improved dramatically. “The surgery was absolutely remarkable. I
never had pain after surgery. To be able to move and not hurt brought tears to
my eyes.”

For
Dr. Eckstrom, it’s gratifying to be able to help patients like Mara. “It keeps
me motivated and inspired to continue my work,” he says. “Helping to
change a patient’s pain, mobility and productivity for the positive is
incredibly rewarding.”

Two
years after her first hip replacement, Dr. Eckstrom got the chance to help Mara
again when she needed to have her other hip replaced. “When my right hip
started feeling the same as my left, I didn’t wait for years to take care of it
this time,” she says.

“I’m back to feeling good again. I could walk all day.”

Mara Olson

For
both of Mara’s hip replacements, Dr. Eckstrom used a surgical approach that
involves performing the procedure from the side. It tends to cause less pain
and have a shorter recovery time than front or back approaches.

After
her surgeries, recovery took about five weeks. During that time, Mara performed
exercises at home to strengthen her new joints. She also used a walker and then
a cane for support until she was able to walk without assistance.

Today,
she has returned to roaming the fields with her dogs. “I’m back to feeling
good again,” she says. “I could walk all day.”

Mara
has high praise for the team that got her back on her feet. “My husband
and I were impressed by Dr. Eckstrom,” she says. “We had a lot of
questions, and he had a lot of answers. He’s down-to-earth and easy to chat with.
He and his whole team were so kind and so thoughtful. They are incredibly
compassionate people.”

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


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Mon, Apr 6 5:00am · Embracing His Heart's Passion, Despite Congenital Heart Defect

Woody Hust, an athlete and outdoorsman, is living his dream in the Rocky Mountains. It's a picture-perfect existence made even more special because he's achieved his goals despite having a congenital heart defect. Thanks to the lifelong, personalized care Woody's received from his Mayo Clinic cardiologist, the sky continues to be the limit for him.

Woody Hust, an athlete and outdoorsman, is living his dream in the Rocky Mountains. It’s a picture-perfect existence made even more special because he’s achieved his goals despite having a congenital heart defect. Thanks to the lifelong, personalized care Woody’s received from his Mayo Clinic cardiologist, the sky continues to be the limit for him.




For
nearly as long as he’s walked, Woody Hust has skied. Fitted into his first pair
of skis at just 17 months by his ski instructor parents, he grew up on the
slopes. By his teen years, his talents and love of the sport had propelled him
to competitive racing, where he qualified for the Junior Olympics when he was
15.

“It’s
probably my biggest passion,” says Woody, who’s now 25. “I don’t know
what I would do without skiing. When I’m skiing, I’m just in my happy
place.”

Woody’s devotion to the sport and savvy on the slopes are all the more remarkable because he was born with a congenital heart defect. The condition, called critical aortic valve stenosis, has required him to undergo five open heart surgeries — three of them at Mayo Clinic

While
many factors contribute to Woody’s athleticism, the encouragement of his
parents and the supportive care offered by his Mayo Clinic pediatric cardiologist
Allison
Cabalka, M.D.
— who became Woody’s doctor when he was
in utero — rank high on the list of reasons for his continued success.

“I’m
lucky,” says Woody, who lives in Whitefish, Montana, and works as a ski
instructor and a forester for the state of Montana. “I’ve come a long way,
and I’ve gotten to do everything I’ve wanted to do, and I credit that to Mayo
Clinic. I feel fortunate to be able to get the care that I’ve gotten at Mayo.”

As
is the case with some people who have congenital heart defects, Woody lives
with activity restrictions to protect his heart health. In Woody’s case, those
restrictions have been carefully developed through years of testing his limits.

“Woody
has always been an avid outdoorsman and athlete with downhill skiing, and now
living in Montana with outdoor activities and working in the forest
industry,” Dr. Cabalka says. “I think he’s coped very well with his
limitations. He might be a little superhuman.”

Treating a life-threatening defect

Woody’s
history of defying the odds started just after birth, says his mom, Heidi,
explaining that when Woody’s heart defect was identified at 6 months’ gestation,
Dr. Cabalka — who at the time worked at a medical center in Minneapolis —
became his cardiologist. “His aortic valve was a lump, and he had critical
valve stenosis,” Heidi says.

Just four hours after he was born, Woody underwent his first open-heart surgery. During the valve repair, his misshapen and narrowed aortic valve, which is the main pump to the body and normally has three cusps to regulate blood flow, was opened up and reformed into a bicuspid valve.

For
six weeks after surgery, Woody remained connected to breathing support in a
neonatal ICU in the Twin Cities, and he struggled to heal. More than once, doctors
told his parents their son would not survive the night. During this time, members
of Woody’s surgical team urged the family to allow them to give Woody an
artificial heart valve, emphasizing that without a new valve, he wouldn’t
thrive.

But
Dr. Cabalka was firm in her belief that Woody would fare better if left to grow
and develop without an artificial valve. “So we let him sit and grow. Dr.
Cabalka was adamant that was the best solution,” Heidi says. “And he
was fine. He pulled out his own breathing tubes at 6 weeks old and started
eating. It was amazing. He was so strong. He’s a really tough kid.”

Overcoming significant hurdles

Woody’s
resilience was tested time and time again. As a kindergartener, he required his
second open-heart surgery, which was performed at a hospital in Michigan. Known
as a Ross-Konno procedure, the surgery entailed replacing Woody’s abnormal
aortic valve with his own pulmonary valve. In place of the pulmonary valve, a
human donor valve was placed.

“We were so grateful we followed Allison (Cabalka) down to Mayo because we definitely got the cutting-edge care that was right for Woody.”

Heidi Hust

When Woody was 15, Dr. Cabalka, who by then was working at Mayo Clinic in Rochester, recommended a third surgery. This operation, which was performed by Mayo Clinic cardiovascular surgeon Joseph Dearani, M.D., replaced the valve and aortic root, which is the portion of the aorta closest to the heart. In addition, the pulmonary valve that had been implanted a decade earlier was replaced with a bovine valve.

Nine
months after surgery, however, the bovine valve became infected with a rare, hard-to-identify
microbacteria. The infection required a month-long hospitalization and a fourth
surgery to replace the damaged valve, giving Woody a new pulmonary valve.

“We
were so grateful we followed Allison (Cabalka) down to Mayo because we
definitely got the cutting-edge care that was right for Woody,” Heidi says
“They looked at what Woody needed and when he needed it. We had so much
confidence in Dr. Dearani when we met him. We were just really scared, and he
helped.”

For
Woody, managing his hospitalizations and recovering from surgery has always
been closely linked to skiing. “Whenever I was having a hard time in the
hospital, I’d visualize myself skiing and imagine I was in my favorite
spot,” he says. “I kind of use it as my benchmark after surgery: How
quickly can I ski again?”

For
Woody’s parents, encouraging their son to pursue his goals while guarding his
health was a balancing act. “Raising him was difficult because he didn’t
outwardly show these signs,” Heidi says. “We always raised him that
he should just try anything, but sometimes it’s a modification. While we
understood the risk, we let him try things once.”

Changing course

Following
back-to-back open-heart surgeries as a teen, Woody realized that he would be unable
to pursue a career as a competitive skier, but that didn’t stop his dreams of earning
a living on the slopes. Following high school, he moved to Montana and took a
position requiring familiarity with the nature in forested, mountainous
regions.

Woody’s
job is physically demanding, often entailing 5- to 6-mile hikes to job sites. During
his off hours, he routinely practices backwoods skiing, which involves skiing
in areas not outfitted with lifts, boundaries or safety patrols. Despite the
physicality his job and hobbies require, Woody embraces his active lifestyle.

“Sometimes
I have to be a little careful, but I am open with my friends about it and tell
them what is going on,” Woody says. “People are open and accepting of
it, and I’m still able to do everything I want to do.”

In
fall 2019, however, the demands of the work began weighing on him. “I could
feel myself slowing down,” Woody says. “I’d get home after a hard day
of hiking, and I just had to go sit on the couch and recover for the next two days.”

“After the operation, I felt like a different person, in a really good way.”

Woody Hust

At
his next appointment with Dr. Cabalka, the decision was made to refer him to Dr.
Dearani for his fifth open-heart surgery. “His aortic valve worked really
well for many years, and then eventually started to leak,” Dr. Cabalka
says. “The leakage caused blood to back up into Woody’s heart and
necessitated another surgery where Woody received an artificial, mechanical aortic
valve.”

“After
the operation, I felt like a different person, in a really good way,” Woody
says. “I have more energy. My heart rate is not as high. My heart doesn’t
pump when I’m doing those activities, and all around I feel a lot better.”

The best part for Woody, who was back to skiing six weeks to the day after his surgery, was how the operation enhanced his performance on the slopes. “It’s definitely improved my ability to ski. It’s a big positive to have gotten that surgery.”

Forging close relationships

With
the mechanical valve keeping his blood flowing smoothly, Woody should not need
another open-heart surgery for a long time, Dr. Cabalka says. “We hope these
valves will be really durable for most of his life. Barring infection or other
issues, they could last many, many years.”

When
the time comes for Woody to receive a new pulmonary valve, the hope is that the
valve can be replaced with a transcatheter valve, which would use a catheter
inserted through the femoral artery, rather than open-heart surgery, to place
the valve, Dr. Cabalka says.

To
ensure that his heart valves and his heart function remain normal, Woody will
continue visiting Dr. Cabalka annually for checkups. The visits are something
he looks forward to. “It’s been cool to go on this journey, from when I
had that first surgery at Mayo at 15 to now, to be able to go back, just to say
hi,” Woody says. “I feel so cared about and valued there. I know a
lot of other people with congenital heart defects who go elsewhere, and they
don’t have the same stories.”

Visits with Woody and his parents are happy occasions for Dr. Cabalka. “We do have the medical visit, but then we spend the rest of the time chatting about their family and my family,” she says. “It’s always nice to have the personal relationship. It’s this rewarding part of the doctor-patient relationship in Pediatric Cardiology that we really appreciate. As someone who’s been able to care for Woody through his entire life so far, it really is a privilege to be able to see this young man grow up to the amazing person that he is.”

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Wed, Apr 1 5:00am · Telemedicine Helps Provide the Right Care at the Right Time During Unexpected Delivery

When Lizzie Stoltz went into labor more than two months early with her second child at Mayo Clinic Health System in Bloomer, Wisconsin, she and the baby needed specialized care. They got it, thanks to a connection with a Mayo Clinic neonatologist who guided the delivery from more than 100 miles away.

When Lizzie Stoltz went into labor more than two months early with her second child at Mayo Clinic Health System in Bloomer, Wisconsin, she and the baby needed specialized care. They got it, thanks to a connection with a Mayo Clinic neonatologist who guided the delivery from more than 100 miles away.




Lizzie
Stoltz was pregnant and 10 weeks shy of her due date. But that didn’t matter to
baby Madelyn. She was ready to make her entrance. Her parents, Lizzie and
Shaun, couldn’t have been more surprised. “He said right away, ‘You’re
kidding.’ I said, ‘No, I’m positive my water just broke,” Lizzie says of
informing her husband about the imminent arrival of their second child.

The couple had planned on welcoming Madelyn into the world at Mayo Clinic Health System in Eau Claire, Wisconsin, approximately 30 miles from their home in Bloomer, Wisconsin. Given the increasing intensity and frequency of contractions, however, Lizzie and Shaun were forced to switch plans, stay close to home and make a beeline for Mayo Clinic Health System in Bloomer. Physician assistant Jon Farm and a team of others were awaiting their arrival. “That’s the first thing that crosses my mind, to summon the appropriate resources and team to be able to take care of the patients that are coming in,” Farm says.

With no in-house labor and delivery service or neonatal intensive care unit in Bloomer, Farm knew that he and his colleague Phillip Skaar, M.D., a physician in Family Medicine, would need some assistance. “I called the transfer line in Rochester and told them, ‘I’m going to need some telemedicine help, as well,'” Farm says.

First used by Mayo Clinic Children’s Center in 2013, Mayo’s telemedicine program allows Mayo Clinic neonatologists to consult with Mayo Clinic Health System care teams in real time with the help of a two-way video screen.

“It was literally like having a specialist looking over your shoulder.”

Phillip Skaar, M.D.

“We
have controls in order to zoom in other parts of the room, improve our audio,
talk to providers with a handset if needed. Short of us standing right there
with the team, it’s the next best thing,” says Christopher
Collura, M.D.
, a Mayo Clinic neonatologist who
participates in the telemedicine program.

For
Farm, Dr. Skaar and the Stoltz family, having Dr. Collura on a telemedicine
video screen in Bloomer to help guide Madelyn’s early arrival was just the
support that was needed. “It was literally like having a specialist
looking over your shoulder,” Dr. Skaar says of Dr. Collura’s involvement
in the delivery process from approximately 100 miles away in Rochester.

Unfortunately, Dr. Collura’s involvement would not end with Madelyn’s arrival. “She was very limp and blue, and not breathing,” Farm says. So with Dr. Collura still providing guidance via the telemedicine screen, Farm and members of a Mayo Clinic flight crew worked to intubate Madelyn, who weighed just 3 pounds, while a second Mayo Clinic neonatal flight crew flew from Rochester to Bloomer to transport Madelyn to Mayo Clinic in Rochester.

Madelyn
received specialized care in Rochester for 44 days before being discharged home.
Since then, she’s been making her own unique mark within the Stoltz family. “It’s
broken sleep with lots of smiles. That’s what it is,” Shaun says of having
a thriving Madelyn at home. “She’s going to be demanding. She’ll be a
fighter, that’s for sure.”

Learn
more about Madelyn’s story in this video:


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