The groundbreaking ways Central Ohio doctors are healing us
Photos by Tessa Berg | Illustrations by Michaela Schuett
Eighteen hours after accidentally cutting off her hand, Pat Marvin could once again wiggle her fingers.
A medical connector tool, developed by Riverside’s Dr. Lar Lubbers, had this Columbus resident’s hand reattached and functioning within hours.
I was redoing my deck
in September 2011, using my table saw to cut the side rails early one morning. I had my left hand on top of the saw and I heard something, so I turned and my hand just went down on the blade. I saw something fly off out of the corner of my eye, and I looked behind me and saw a hand. I didn’t even realize it was mine until I saw my ring on it—that’s when I thought to myself, “I really messed up here.” It didn’t really hurt when it happened, but I was in shock. I went upstairs to call 911, but I couldn’t find my phone, so I went out onto my porch to call for help. I was going to start walking to look for someone to call for me, but I just had the thought, “If you leave this yard, you’ll die.” I was screaming for help. A guy walked by. He was a total stranger, but he called 911 and he stood with me until the ambulance came, and then I never saw him again. He was like a guardian angel.
In the ambulance on the way to Riverside, I started to feel it. I don’t remember how it felt, just that it hurt. When I got to the hospital, they gave me some medication. I don’t really remember anything. I just remember being in pain.
When I woke up, I felt a lot of tightness but my hand was reattached. I wasn’t sure what was going to happen, but Dr. Lubbers had me wiggle my fingers and I could do it. That gave me hope. He told me it was going to be a long recovery, but I was determined. I don’t like to be put on hold. My hand was weak at first—I couldn’t even pair my socks together. A month and a half after surgery, I refinished my living room by myself. It’s taken a while, but I can move my thumb almost all the way again. I don’t have a lot of feeling in the hand and I still wear a glove for support, but I can use it just fine. And I still use my saw all the time. I actually just finished my deck, too.
—As told to Carrie Schedler
Once Pat Marvin arrived at the hospital, orthopedic surgeon Dr. Lar Lubbers of Hand and Microsurgery Associates began cleaning the hand. He labeled some of the major arteries and tendons to expedite surgery and sawed off some of the rough edges of bone at the site of the cut. In a typical year, the OhioHealth physician sees just one or two completely amputated limbs in surgery—often farm-equipment mishaps or home-repair accidents like Marvin’s. He reattached each individual tendon using a metal connector called the Teno Fix that he helped develop in the late ’90s, which places metal anchors in separated tendons and connects them using a small rod. He also placed screws in some plates to stabilize the bone—all in about eight hours of operating time. Lubbers credits the Teno Fix with giving Marvin back her range of motion—in the past, surgeons just used sutures to reattach body parts, which often required several follow-up operations to get muscles to work again, if at all. “We were using technology from two centuries ago and we were getting poor results,” Lubbers says. “The Teno Fix is so much more reliable, and it lets you have that early motion.”
An uncommon reattachment procedure allowed this teen, then 10 years old, to keep part of his leg and get back to normal.
I was limping at baseball. Nobody knew what was wrong. On the last day of fourth grade I fell and broke my leg. Something on the X-ray was wrong. Doctors sent us to Columbus that night. I didn’t understand as much about cancer then. When I was younger, every time I heard “cancer,” all I thought was, “people die.” Then I learned I wasn’t. There was a chance to make sure the tumor above my knee didn’t spread by amputating part of my leg. Dr. Mayerson left the decision up to my parents and they left it up to me. I had to look at all these surgery options, but I picked rotationplasty so I would be able to run and jump and do what I needed to be successful in sports, especially baseball.
After months of chemo, I had surgery. Then I had six more months of intensive chemo to make sure the cancer would never come back. It was hard at first. But I’m getting good with my leg now, with moving and running. It’s made of a DonJoy knee brace, the one a pro lineman would use. A Flex-Foot is one of the best ankles you can have. In sixth grade I played basketball and baseball. I was so excited, especially for baseball. To me that’s life. I just walk on the field and smell the grass.
It made me a better person. It made me more mature inside. It made me want to help people. It makes me want to make prosthetics for other kids. I’ll be able to understand more. And it changed my life in a better way. God has a reason for everything.
—As told to Beth Stallings
“Dugan had a malignant tumor the size of a softball,” explains Dr. Joel Mayerson, an orthopedic oncologist at Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. Mayerson performed his first rotationplasty on Dugan Smith in August 2009, and has done several more since. In the procedure, everything in the middle of the leg is cut, except the nerve. The foot is turned backward and reattached. “By turning it around, his calf has become his thigh and his ankle his knee,” he says. And as Smith grows, the leg continues to grow, too. It’s an uncommon surgery, Mayerson admits, but it has proved successful in children and young adults with bone cancer. Plus, it allows greater athletic ability as a prosthetic can be attached at the ankle/foot, acting as a below-knee amputation which requires only 20 to 30 percent more energy to walk; an above-knee amputation takes 70 percent. “Dugan can throw a 70-mile-an-hour baseball,” Mayerson says. And the surgery will last the rest of his life, as opposed to a prosthetic reconstruction that can wear out over time.
Virtual Ankle Replacement
Until this year, patients needing an ankle replacement would receive an implant placed close to where the original joint existed, but not close enough to ensure the implant would be more than a temporary fix, lasting roughly 10 years. To ensure a more accurate fit, Dr. Gregory Berlet of the Orthopedic Foot & Ankle Center helped develop a virtual ankle procedure that allows surgeons to perform the operation on a computer screen before ever entering the operating room. Known as the PROPHECY INBONE Pre-Operative Navigation Alignment Guides, the software uses an image of the patient’s ankle to establish a sort of paint-by-numbers plan, outlining where to cut and place the implant during actual surgery. With this technology, surgeons can also create implants specific to each patient’s case. “The advantage of the virtual surgery is accuracy, which means a more normal-feeling ankle and one that should last longer,” says Berlet, who performed the first procedure of this kind in January at OhioHealth Dublin Methodist Hospital.
- Taylor Swope
Scar-Free Brain Surgery
Jennifer Anderson had no sense of smell. But the surgery to remove the malignant tumor at the base of her skull that caused this inability would have meant weeks of recovery and disfiguring scars.
Surgeons at Ohio State University Wexner Medical Center offered another option: remove the tumor through Anderson’s nose. Using a method they pioneered in 2010, Dr. Daniel Prevedello and his team—including an ear, nose and throat surgeon—passed instruments and a camera through her sinuses and removed the tumor. This way, surgeons avoid cutting into the patient’s face or removing large parts of the skull. And recovery time is reduced from three weeks to two or three days.
“It’s less traumatic because there is no disfiguration at all,” says Prevedello, director of Ohio State’s Minimally Invasive Cranial Surgery Program. “Before, removing a large skull-base tumor would require removing sides of the head to reach the tumor.” Today, surgeons from around the world visit Ohio State to learn the procedure, which is performed regularly there.
- Kelly Lecker
After nearly 10 years of debilitating headaches, brain surgery helped one OSU graduate student find relief.
Since I was 13 or 14 I had headaches like someone shot me in the head. My ears rang. I’d get double vision and vertigo. At 22, it was 24 hours a day. I had horrible insomnia. I’d gone from falling maybe once a week to two to three times a day. I hadn’t felt my arms and legs in years. After I started my master’s degree last fall, I could barely do my reading assignments. After two months I’d had enough.
A battery of MRIs showed I have Chiari malformation. I was so happy initially: I knew what was wrong with me, and I knew they could do something. That was empowering. Then they found I had a syrinx (fluid-filled cyst) wearing away the spinal cord in a spot. An MRI showed if I didn’t have it treated quickly, I’d be in a wheelchair. I didn’t have an option. I had to have brain surgery. That was scary, but the most important thing Dr. Seaman told me was, “We can give you your life back.”
My brain was so compressed when they opened up the area they had to wait and let the pressure off for 25 or 30 minutes. I’m now missing my first cervical vertebrae and part of my second. I’m missing a big portion of my skull. You should see people’s faces when they cut my hair. Priceless.
When I woke up, I was sure I was dead. My head didn’t hurt, my ears didn’t ring. The nurse started holding my hand. It had been years since I’d felt someone holding my hand. I cried. If that was all I had gotten that back, it would have changed my life.
About a year after I feel like I’ve started to get my energy back. My headaches are back and we are treating them. But they are a pebble next to a boulder compared to before. I’ve had straight A’s since the operation. Dr. Seaman got me back on the Dean’s List.
— As told to Beth Stallings
In Chiari malformation the hindbrain (back brain) is distorted, sliding down toward the opening of the base of the skull, explains neurosurgeon Dr. Brian Seaman of Neurological Associates at OhioHealth. This causes pressure, restricting the flow of spinal fluid, and can lead to debilitating headaches, ringing in the ears and difficulty with coordination. Katrina Swinehart’s case was so severe, her hindbrain had fallen to the second vertebrae. So Seaman treated her condition with decompressive surgery—a procedure that creates space in the back of the brain and high part of the spine by removing bone at the base of the skull, as well as necessary parts of vertebrae. “It’s really just creating room back there,” Seaman explains, adding no two doctors perform the surgery the same way. “The key difference is that we do a duraplasty.” It’s an artificial graft of soft tissue that helps support the now-boneless areas. The surgery is essentially a cure, he says, although the outcome is never guaranteed: Sometimes symptoms will disappear; other times they just won’t get worse.
Better Beats in Women’s Health
Dr. Martha Gulati was in medical school at the University of Toronto when she learned there was a gaping hole in cardiovascular research. “It was the late 1990s, and women weren’t even included in the studies,” says Gulati, who is now the director of Preventive Cardiology and Women’s Cardiovascular Health at Ohio State University Wexner Medical Center. She decided then to focus her career on heart health for women. One of Gulati’s most significant achievements came in 2010, when she developed a target heart rate for women: 206 minus 88 percent of their age. Before, the high standard heart rate was designed for men—a rate many women could never achieve. This past year, she continued to revolutionize the industry by showing an old-school practice—stress tests, which help detect heart disease—can now more accurately assess a woman’s heart and whether they are at risk for heart disease.
- Kelly Lecker
The concept of bloodless surgery isn’t new, but its importance at OhioHealth Grant Medical Center is. Established to serve patients who refuse blood transfusions for religious beliefs or worry of blood-borne illnesses, the Center for Blood Conservation has used bloodless surgery to reduce blood usage at Grant by 20 percent over the past two years. This helps conserve the hospital’s blood supply for emergency situations, says the center’s medical director Dr. Norman Smyke. Here’s how it works: Before surgery, medications can stimulate a patient’s bone marrow in order to produce more red blood cells. Surgeons can also use a heated scalpel to seal off vessels as incisions are made. A cell saver machine can capture lost blood, purify it, and return the supply to the patient’s body. “All surgical cases at Grant are approached with the intent to minimize blood loss as much as possible, using the latest innovative surgical devices, pharmacologic agents, and anesthetic techniques,” Smyke says.
- Taylor Swope
John Williams—well known by his customers at Weiland’s—had a heart deemed too weak for traditional surgery. A new, less invasive procedure made it stronger than ever.
I couldn’t walk 100 yards without being out of breath. I couldn’t work right. I was always really tired, and my energy level was very, very low. I was ready to put up my hands and thought I wasn’t going to make it. My doctors were treating me like the problem was my lungs. But it wasn’t my lungs—it was my heart. After a few years, they figured that out and decided they needed to open me up and put a heart valve in. So I went into surgery, and afterward Dr. Yakubov came in and said he had good and bad news—the bad news was that they opened me up and there was so much calcium built up in my valves they couldn’t do anything. But the good news was there was a new procedure they could try where they didn’t have to open up your chest.
They threaded a new valve in through a vein in my clavicle. Most of the time with this procedure, they thread it through a vein in your groin, but my veins weren’t suitable there so they found a good one in my shoulder instead. I went in on a Tuesday for surgery. I went home on Friday. Normally with heart surgery you’re in the hospital for a while afterwards and then you’re really weak. I started to get better right away and I just kept getting better. With a new heart valve, you’re suddenly getting more oxygen and blood. It’s been about a year since I had this done and I’m getting back to where I was before: I’m working eight, 10, even 12 hours a day at the store. I’ve put my weight back on.
I can walk without getting out of breath. The incision they made was only about
4 inches, so I don’t have a big scar. I’m 74, so I don’t feel 34, but I’m doing well for my age. And at my last physical, my doctor said I’m in better health now than I was 10 years ago. It’s really pretty amazing to me. I’m back doing what I want to do.
—As told to Carrie Schedler
Dr. Steven Yakubov knew right away when he opened John Williams’ chest that he didn’t have many options to save him. “His aorta was just too calcified, and he’d been to the hospital several times in profound heart failure,” Yakubov says. Plus, the risks from an intensive, open-heart procedure—stroke, pneumonia, inability to walk—were too great. After a battery of cardiac tests, Williams qualified for a trial of the CoreValve system at OhioHealth Riverside Methodist Hospital—one of 45 hospitals across the country to test the less-invasive surgery. Doctors poke a hole using a needle into an artery (normally in the groin) and carefully thread a stent through it to the aorta using a wire. The surgery is done under general anesthesia and takes just a couple of hours, and most patients leave the hospital less than five days later. “The short recovery let him go back to a lifestyle that doesn’t require constant hospitalization and care,” Yakubov says. “John has done nothing but continue to get better.”
Ultrasound Clot Removal
For the more than 900,000 Americans who develop blood clots in their veins and lungs each year, the prescription is often blood thinners and waiting until the strain on the heart gets bad enough for serious surgery. But at Mount Carmel East doctors are participating in a new national study to treat clots sooner, before patients are stuck battling unbearable chest pain, fatigue and the risk of heart failure. For the past year, Dr. Noah Jones, one of Mount Carmel’s researchers on the study, has been implanting a small catheter near the site of the blood clot that delivers both clot-dissolving medication and ultrasound waves. The latter, he says, break up the clot much faster than medication alone and can get patients’ enlarged and overworked hearts back to normal faster. “We see improvement right away in heart function,” Jones says. “It’s satisfying to be able to use this as another option.” qCarrie Schedler
Virtual Doctor Visits
Dublin-based company HealthSpot has a vision: Someday, you’ll be able to step into a booth at your local pharmacy or office and connect instantly over the Internet to your doctor’s office for a visit—a kind of medical ATM. That’s the idea behind the Care4 Station. HealthSpot’s 8-foot-by-5-foot kiosk features a high-definition video connection to a doctor’s office that specializes in common ailments such as colds. It comes with devices including a camera-equipped otoscope that lets doctors see inside your ears. “The Care4 Station allows us to see people more at their place of work, which is perhaps the next phase of this,” says Dr. Robert Stone of Westerville’s Central Ohio Primary Care Physicians, where eight doctors are testing the first-ever Care4 Station. Another benefit, Stone adds, is that unlike many retail clinics, patients can continue to see their own doctor.
- Erin Edwards
Fighting a Newborn Disease
Even after five decades of research, necrotizing enterocolitis (NEC)—a disease that kills intestinal tissue in newborn babies—remains devastating and fatal. “I’m faced with having to tell parents their babies are not going to survive, and that’s an incredibly hard thing to do,” says Dr. Gail Besner, the chief of pediatric surgery at Nationwide Children’s Hospital. An accomplished investigative surgeon, Besner recently identified a protein that helps to heal intestinal wounds; she’s now developing therapies using the protein that can easily be administered via baby formula. And she’s found this protein also protects intestinal stem cells from getting NEC in the first place—which researchers could soon use to wipe out the disease completely.
- Erin Edwards
20 months, Grandview (as told by his mom, Melissa DeGraw Metz)
Care guidelines developed just for premature babies helped a fragile Grandview infant grow into a rambunctious toddler.
I had some sort of infection around my appendix, so it needed to come out. What they didn’t realize was that it spread to Nicholas. Three weeks later, I got very sick again, and we had to take him out. I didn’t even know you could have a baby that early. We’d just found out that he was a boy. It was
He was born 1 pound 11 ounces at 24 weeks. He had all these tubes and wires and everything coming out of him. You could actually fit my husband’s wedding ring all the way up his leg. He was in the hospital a total of four months. Four months early, and now look at him. So big!
When they first let me hold him, I was red, sweating, very nervous because I didn’t want to break him, he was so tiny. They don’t push you. They walk you through it. At Children’s they are a big proponent of kangaroo care, skin-to-skin (contact). They didn’t know why I was infected, so I couldn’t hold him for a whole month. It was horrible not being able to hold him. But when I was able to hold him, skin-to-skin, you could actually see on the monitor he would relax and then I would relax. I could control his body temperature with mine. It’s amazing, all these things. He would know that it was me, so then he could go to sleep. And the more sleep he got the more he could grow properly.
We had a very good support system both with our family and friends and then at the hospital. And we still keep in contact with some of his nurses and some of the people there. We saw them every day and they saw him through his most critical time. They want to know how he’s doing and we want to share that with them. They are the ones who helped him get this far. They’re the ones who took care of him health-wise. You create a bond with them that is very, very special.
—As told to Kristen Schmidt
In the early 2000s, when a baby was born as small as Nicholas, his chance of survival hovered around 23 percent. But Dr. Edward Shepherd, chief of Nationwide Children’s Hospital’s neonatology unit, says that survival rate is now closer to 90 percent. Why? He and several other doctors at Children’s developed the Small Baby Guidelines, a set of “best practices” for treating babies born before 27 weeks gestation that have since been implemented at hospitals across the country. That includes breastfeeding early on to help the baby’s immune system develop, lining the baby’s bed with cushions that mimic the mother’s womb and daily “kangaroo care,” in which the infant is swaddled skin-to-skin against the mother’s chest. And, Shepherd says, if you look at Nicholas, you can see how well these recommendations have worked: “He’s walking, he’s got a sense of humor, he’s interacting with his parents—all signs he’s going to grow up to be a bright, healthy kid.”
A Healthier Appetite
For newborns, eating is as complex as an orchestra performing a symphony, says Dr. Sudarshan Jadcherla. Everything, from the mouth to the food pipe and stomach, has to be coordinated with the brain as the conductor. But that doesn’t always happen. So the director of the Neonatal & Infant Feeding Disorders Program at Nationwide Children’s Hospital is taking a one-of-a-kind approach that considers the brain, gut and airway together when treating infant feeding disorders such as acid reflux or problems swallowing. These disorders affect about 25 percent of healthy infants. “It’s a passion for this problem,” Jadcherla says. ”Once a disease is created, it’s very difficult to undo the pathological process.” His program is already helping newborns get off to a good start and to reduce healthcare costs associated with expensive feeding tubes.
- Erin Edwards
High Blood Pressure
Sometimes lowering blood pressure isn’t as simple as changing your diet or taking a pill—the problem could be a hyperactive nervous system, says OhioHealth Riverside Methodist Hospital cardiologist Dr. Mitch Silver. For people whose blood pressure is not lowered by lifestyle changes, a trial procedure known as Symplicity renal denervation could provide relief by regulating the nervous system through the kidneys. A catheter with a radio frequency tip, inserted in an artery near the groin, delivers several zaps of energy along each renal artery. These zaps send signals to kidneys, which stirs a chain reaction through blood vessels to the brain, and the brain to the sympathetic nervous system. The result is essentially tricking the brain to lower blood pressure. “Completed studies in Europe have shown a 30 point drop in systolic blood pressure,” says Silver, adding the procedure was approved by the European Union in 2010. qTaylor Swope
56, Mount Vernon
With cancer spreading throughout this former teacher’s abdomen, the outcome didn’t look great. But the use of an old procedure in vogue again gave him hope.
In the spring of 2011,
I started to get in shape. It was going great, but toward the end of the summer I noticed my stomach wasn’t shrinking, and I had a little discomfort. A few years before, I had an umbilical hernia and thought maybe I ripped it again. A CT showed I had fluid all over my abdomen. But they weren’t sure where it was coming from. At this point I looked like I was pregnant. To relieve discomfort, they drained me a few times—pulling out almost three gallons of fluid. After the second draining I got an infection and they sent me to Riverside. It took almost a week to figure out I had a tumor on my appendix. I was mentally ready to hear cancer. I just felt like this is all going to be in God’s hands. He’ll take care of me whichever way it goes. A doctor told me he’d seen cancers like this and people survive two weeks or two years. That was the first shocking moment—that I might not even make it to Thanksgiving.
I had hot chemo bath surgery on Nov. 7, the day before my birthday. The cancer had spread. Have you ever had your car egged? You know if you wipe it off right away, no problem. But if you let it sit, you’ll have to scrape it off. That’s the way the cancer was in my abdomen. They took out my spleen, gall bladder, omentum, half of my large intestine and a third of my small intestine. Then they ran tubes that carried the heated chemo in and jostled me around like a bathtub where water sloshes all over the place. Cancer is sneaky. The chemo needed to get into all the nooks and crannies.
According to my family, I smiled that first night. There’s a 60 to 80 percent survival rate beyond five years, and Dr. Arrese thinks I am going to reach that. I loved teaching chemistry, but I retired in June and I’m enjoying the time off.
—As told to Beth Stallings
If the procedure doesn’t sound new, that’s because it isn’t, says OhioHealth Riverside Methodist Hospital surgical oncologist Dr. David Arrese. Though the technique has been in use roughly 20 years, hot chemo baths only recently gained popularity, available at roughly 20 health centers nationwide. Used mainly to treat colon, some ovarian, and—in Paul Arnold’s case—appendix cancers, hyperthermic intraperitoneal chemotherapy offers a direct-contact treatment in two parts. First, visible cancer is surgically removed from the abdomen. Next, the incision is sealed and two tubes are inserted to control a 90-minute-long inflow and outflow of heated (to about 108.5 degrees) chemo drugs. “The heat will kill tumor cells and not normal cells,” explains Arrese, who treated Arnold last fall. This treatment has none of the side effects of traditional intravenous chemotherapy, such as hair loss and nausea. It’s also more direct, Arrese says, adding the 10-year survival rate is 85 percent. “And it’s a one-time deal,” he says.