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Jul 28, 2016 · Patient gets best birthday gift ever – a new, life-saving liver

UCLA Liver Transplant Team

UCLA Liver Transplant Team

This year, patient Steve McDowell received what is arguably the best birthday present ever – a life-saving liver transplant – at Ronald Reagan UCLA Medical Center.

Not only was the operation an amazing birthday gift, it was a landmark procedure – UCLA performed its 6,000th liver transplant, a national milestone accomplishment based on the United Network of Organ Sharing database.

McDowell, a man in his 50s who lives out of state, was in the end stages of advanced liver disease when he underwent the operation June 30. He had been in and out of the hospital since November, and had been on the list for an organ transplant since January.

“I was getting weary, and I was really worried,” McDowell said of the days leading up the transplant, which was performed by Dr. Ronald W. Busuttil, Distinguished Professor and Executive Chairman of the Department of Surgery at the David Geffen School of Medicine at UCLA and Chief of the Division of Liver and Pancreas Transplantation.

“The week before they called me to tell me they had a liver it was touch and go. I was scared I wouldn’t make it,” said McDowell, who was released from Ronald Reagan UCLA Medical Center July 11.

McDowell and his wife, Lisa, expressed their immense gratitude to the anonymous organ donor who made the transplant possible.

“I can’t imagine the generosity of someone who would donate their organs. The gratitude I feel toward the donor is difficult to express,” Steve McDowell said. “Moving forward, I hope to use this experience to help people that are waiting for organs, help them to educate themselves. I still haven’t fully gotten my arms around this yet and how lucky I was that someone offered me the gift of life.”

Lisa McDowell agreed.

“This experience has made us realize the life and death magnitude of organ donation and how important it is,” she said.

Busuttil, an internationally renowned surgeon who also serves as the director of the Dumont-UCLA Transplant Center and the Dumont-UCLA Liver Cancer Center, credited a team-based, multidisciplinary approach for the center’s success.

“This landmark 6,000th liver transplant reflects the work of our incredibly dedicated and talented team at UCLA and also underscores the importance of organ donation for the many thousands of patients who await the precious gift of life,” Busuttil said. “I could not be more proud of what we have accomplished together – saving lives. That’s what it’s all about.”

The liver transplant team includes more than 100 dedicated health care professional including; surgeons, physicians, nurses and other professionals. So far this year, it has performed more than 90 liver transplants. To date, 421 patients are on the UCLA waiting list for a new liver.

How it began
The UCLA liver transplant program, one of the first five in the nation, was established in 1984 by Busuttil, who has directed it since its inception. The Dumont-UCLA Transplant Center has become one of the largest and most respected programs in the world in the areas of research, education and patient care.

“Consider that in the 32 years since its inception, the UCLA Liver Transplant Program has performed roughly one liver transplant every other day,” said Johnese Spisso, president of UCLA Health and chief executive officer of UCLA Hospital System. “By all measures, that is a remarkable feat, and it exemplifies our commitment to working on the leading edge of clinical care and research to advance treatments and cures to benefit society.”

Housed in the Pfleger Liver Institute at the Ronald Reagan UCLA Medical Center, the Dumont-UCLA Transplant Center combines innovative surgical technique, advances in immunosuppressive drugs and multidisciplinary clinical care to save the lives of thousands of adults and children with end-stage liver disease. The program has trained hundreds of transplant surgeons and physicians, many of whom currently lead top centers throughout the United States and abroad.

Starting the program was no easy feat. Liver transplantation was in its infancy three decades ago. Only the University of Pittsburgh had established a significant program, under the leadership of pioneering transplant surgeon Dr. Thomas E. Starzl. There were a few other, smaller centers, but the operation was still considered by most to be experimental, Busuttil said.

But Busuttil was determined that UCLA would establish the first successful program west of the Mississippi River. Other institutions in the West had tried, but were not successful.

Frustration with the inability to offer patients with end stage liver disease this life saving procedure was the impetus for wanting to launch a program, Busuttil said. As a vascular surgeon, he could successfully manage a patient’s bleeding from circulation problems in the stomach or esophagus that developed from liver disease. But too often, these patients subsequently went into liver failure and died.

“If a patient has kidney failure, there’s a machine that can keep them alive for years. If a patient has liver failure, there is no such option,” Busuttil said. “The only hope for patients in that situation is a transplant.”

Busuttil’s early efforts to initiate a liver transplant program at UCLA were met with skepticism. Ultimately, his request was approved, but with restrictions on the number of cases he could perform, and the implication was clear that he must succeed from the outset or his program would be cancelled.

In the end, Dr. Busuttil and his team ended up doing 22 transplants in the program’s first year, with a survival rate of close to 80 percent.

A benefit to humankind
The UCLA liver transplant program has benefited more than patients at UCLA.

The surgeons trained at UCLA in advanced transplantation techniques have taken their skills to patients in other hospitals, states and nations, improving survival and outcomes. In particular, UCLA has been at the forefront of advancements in scientific discovery utilizing new surgical techniques that use the limited resource of donor organs more effectively. The program is one of the first to show both in the laboratory and clinically that marginal liver grafts could be resuscitated prior to transplantation and successfully transplanted. Additionally, they have one of the largest experiences in split liver transplantation, in which a single donor organ is divided and transplanted in to two patients.

Further, the UCLA program has been on the vanguard of clinical research, offering patients access to the latest innovations in immunosuppressive therapy and treatment for transplantation-related complications such as rejection and infection.

“We have grown up a lot since that first patient in 1984, but the fundamental mission, saving lives, has not changed,” Busuttil said.

Jun 17, 2016 · So you think you know about vasectomies? UCLA urologist debunks 5 myths

Men can be very concerned about what happens during, and after, a vasectomy – specifically how it will affect them personally. Dr. Jesse Mills, a clinical professor of urology and director of The Men’s Clinic at UCLA, says the many myths surrounding the procedure can make men rethink what is often a smart choice for them.

“One of the things I get all the time, questions in my clinic, are men who ask about vasectomies,” he said. “They want to know what’s going to happen to them.”
Here, he debunks the common myths about vasectomies.

Myth #1: Men stop ejaculating after a vasectomy.
A man’s ejaculate, or semen, is made up of three organ system fluids – testicular fluid or sperm, which makes up 1 percent; fluid from seminal vesicles, paired structures that contribute the sugar and fluid component that keep sperm healthy and alive; and prostate gland fluids, which help propel the semen into the urethra. In a vasectomy, doctors disconnect the sperm tubes only.

“So 99 percent of your ejaculate that you had before the vasectomy will not be affected,” Mills said.

Myth #2: Men stop making sperm after a vasectomy.
Sperm are still made, but because they’re not used, they get absorbed into the body and remade again later. Nothing happens to sperm production after vasectomy.

“They’re just hanging out, waiting for their day in the sun,” Mills said.

Myth #3: It’s easier for a woman to undergo surgical birth control than for a man.
“It really is time to man up here, guys,” Mills said.

Tubal ligation, the permanent birth control option for women, is much more invasive. Vasectomy is a 10- to 15-minute procedure that, most of the time, requires only local anesthetic. Usually, men fully recover within a week.

Myth #4: Vasectomy causes cancer.
“I’ve had men come in and ask me to reverse their vasectomy because they’re worried about getting prostate or testicular cancer,” Mills said.

In reality, hundreds of thousands of men get vasectomies in this country every year, with no correlated increase in cancer risk.

Myth #5: Vasectomy is going to kill my mojo.
“This is what guys are so worried about, that vasectomy is going to get rid of their testosterone, and they won’t have any interest in sex anymore,” Mills said.

However, the opposite is true. Vasectomy has very little to do with testosterone production. Testosterone is made in the testicles and gets secreted into the blood stream, which physicians don’t alter during vasectomy. All blood vessels present before vasectomy are present afterward. What vasectomy does for most men is liberate them. They can relax and enjoy sex more without worrying about pregnancy.

Jun 16, 2016 · Father’s Day: The journey to fatherhood starts with a health check

Joel Mecklenburg and his daughter, Annika Elliana

Joel Mecklenburg and his daughter, Annika Elliana

Joel Mecklenburg and his wife, Stacey, wanted very much to have a child. They tried. And tried. For 3 ½ years.

Finally, they decided it was time to see their doctors.

“I was a big, healthy guy. I was thinking there’s no way it was my issue,” said Mecklenburg, now 38. “But I went to get tested anyway.”

Then his doctor called with bad news. All Mecklenburg’s sperm were dead.

“That hit me like a punch in the stomach,” he said. “Me. It’s really me?”

He was referred to a urologist and underwent all the same tests he had done before. The urologist didn’t have any better news. Mecklenburg was told he had three choices – use a sperm donor, adopt or opt not to have children.

“I said, ‘Don’t we have any hope here? Can’t we try?’ My first urologist told me there was no hope,” he said. “I thought to myself, man, this is not the doctor for me. I need someone who is on my side.”

That doctor was urologist Dr. Jesse Mills, director of The Men’s Clinic at UCLA and a specialist in male infertility. Mills was direct. He told Mecklenburg it was a huge uphill battle, but he would do what he could to give the Mecklenburgs a chance for a family.

“He had two problems,” Mills said. “He had a low sperm count, and the ones he had were not moving.”

Sometimes, tweaking the balance of hormones and making lifestyle factors can boost sperm health in men, Mills said. Another option was surgery — what’s known as a microdissection, in which the sperm are extracted directly from the testes.

At Mills direction, Mecklenburg and his wife first dedicated themselves to making lifestyle changes. He already exercised, so he continued to do so. He underwent acupuncture every week, ate healthier, took supplements and made sure to stay cool. Mills says excessive heat can impact sperm health.

“I wanted to be all in,” said Mecklenburg, who relied on his faith to keep him going. “I didn’t want to have any regrets. So I literally did everything I could to heal.”

For months, he returned to Mills for sperm testing, but the results were the same. No live sperm. He and Mills began to consider the surgery, but then Mills decided to test his sperm one last time. After analyzing the sample, Mills walked back into the treatment room.

“What did you do,” he asked Mecklenburg? “You’re healing, getting healthier. You have moving sperm.”

Mecklenburg’s jaw dropped.

The number of live sperm fluctuated over the next few months, but eventually Mecklenburg produced enough to initiate a pregnancy through IVF.

**

On June 18, Mecklenburg and his wife will celebrate his first Father’s Day with his five-month-old daughter, Annika Elliana, whose first name means “in God’s grace” and whose middle name means “God has answered our prayers.” They have nothing special planned, just being together as a family.

One tiny baby washed away all the stressful years of trying to conceive, all the disappointments.

“It’s the best thing ever,” Mecklenburg said of fatherhood. “Never for a second did I think I wasn’t going to have a kid. I just love every second with my daughter.  I just don’t want to be without her, ever.”

Shortly after he and his wife discovered she was pregnant, Mecklenburg called Mills with the news.

“I was elated. This is a great example of a couple who were really at the margins, whose chances were not great. But they kept trying,” Mills said. “My message is always the same: Whenever a couple is trying to conceive, if they’re not successful after six to eight months, they both should get tested. Many men are like Joel, healthy like he is, and can still have problems with fertility. It’s very easy for men to get their sperm tested.”

Joel and Stacey Mecklenburg still have four fertilized eggs, which are frozen and awaiting implantation. They plan to grow their happy family again, hopefully by the end of the year.

“I couldn’t be happier,” Mecklenburg said. “And I want to tell my story in order to give people hope.”

Jun 15, 2016 · New Men’s Clinic at UCLA serves as gateway to comprehensive male healthcare

Mills1

Dr. Jesse Mills, urologist and director of The Men’s Health Clinic at UCLA

Getting a man to go to the doctor can be difficult – very difficult.  In fact, a 2011 health care report by the federal Centers for Disease Control and Prevention found that men are 80 percent less likely than women to use a regular source of health care.

The problem is particularly acute in younger men. Half of men ages 18 to 50 don’t even have a regular source of health care, other research has shown, and one national survey revealed that a third of men in this age group hadn’t had a checkup in more than a year.

UCLA Health is trying to change that by launching The Men’s Clinic at UCLA.

“In general, guys don’t seek medical care until they absolutely have to,” said Dr. Jesse Mills, an urologist and director of the clinic. “Men wait until they’re on the brink of collapse, they have a bone sticking out or someone forces them to see a doctor.”

The Men’s Clinic, which opened in January, is the first UCLA Health clinic to focus on providing healthcare services specifically for men. The goal is to help them take better care of themselves. The lure are evaluations of urologic, sexual and reproductive health, Mills said.

Services include fertility treatments, including on-site sperm testing and vasectomy reversals; assistance with sexual problems such as erectile dysfunction and premature ejaculation; and hormone therapy for low testosterone levels.  Once a patient is comfortable with the concept of seeing a physician, health care workers can then recommend other, non-urologic health screenings.

“If a problem is affecting a man’s sex life or his sense of masculinity, then he’ll see a doctor,” Mills said. “We see The Men’s Clinic as a gateway, or first step, toward getting men the healthcare services they might not even realize they need.”

The Men’s Clinic seeks to provide an environment in which men are comfortable opening up about the sometimes embarrassing physical and mental aspects of their lives.

“Often during an exam, I’ll learn that a patient has endured back pain for years, or I’ll notice symptoms that may indicate he’s struggling with depression,” Mills said.

Sometimes, an underlying health condition, such as diabetes or high blood pressure, may be contributing to a man’s urological or sexual issues.

“At The Men’s Clinic, we can get him the help he needs,” Mills said. “Everyone in our office has specialized training in men’s health and understands the importance of treating our male patients with the utmost discretion and professionalism to make them feel at ease.”

The Men’s Clinic at UCLA is located in a newly remodeled section of the Frank Clark Urology Center at UCLA Medical Center, Santa Monica.

Apr 29, 2016 · Ovarian cancer: Mother fights to 'move forward' after loss of daughter

Paulinda Babbini and her daughter, Robin Babbini

Paulinda Babbini and her daughter, Robin Babbini

It’s been five years since West Hollywood resident Paulinda Babbini lost her daughter, Robin, at age 20 to advanced ovarian cancer. She grieved, but she also decided to act to prevent another mother from experiencing the devastation she suffered.

Babbini became a fundraiser for Dr. Sanaz Memarzadeh, whose G.O. Discovery lab is working on a better detection tool for ovarian cancer. Memarzadeh is also researching why some ovarian cancers appear to respond well to treatment, but then recur. In 2010, Babbini founded the Ovarian Cancer Circle/Inspired by Robin Babbini. To date, Babbini officially has raised $200,000 to fund Memarzadeh’s research. In reality, she’s done so much more.

Memarzadeh leveraged those funds to gather data that has so far resulted in $1.4 million in grants.

“Losing a child is an anguish no parent should ever experience. It is devastating. But how to move forward becomes the next challenge,” Babbini said. “I knew I had to give her brief life a lasting purpose. Committing myself to fundraising to fight ovarian cancer keeps her in my heart.”

On Sunday, May 1, Babbini will oversee her sixth annual fundraiser, Happily Ever Laughter, at the Comedy Store in West Hollywood, with all the proceeds going to UCLA. The comedians donate their time, and Whole Foods provides dinner. More information can be found about the event at http://www.theovariancancercircle.org/events/. Tickets can be purchased at the organization’s website, by calling 323-842-8100 or by emailing.

The event is Babbini’s way of going forward.

How the event began

Robin Babbini was initially diagnosed with stage three ovarian cancer in 2004 when she was 17. She was an active teenager and honor student, co-captain of the cheerleading squad and her school’s homecoming queen. It was unthinkable that she would have the disease at such a young age.

But Robin did have ovarian cancer, which will strike nearly 22,000 American women this year alone, killing more than 14,000. Ovarian cancer accounts for 5 percent of cancer deaths among women, and causes more deaths than any other cancer of the female reproductive system.

Robin2

Robin Babbini

Robin underwent a total hysterectomy, followed by chemotherapy. Initially, it looked as if the treatment had worked, so Robin completed her classes, graduated from high school and began her freshman year at UC Santa Barbara.

Six months later, Robin learned that her cancer had returned – and spread. She underwent another surgery, and fought on, joining the Kappa Kappa Gamma sorority and continuing her studies. She served as co-captain of her team at the American Cancer Society’s Relay for Life event. Just six weeks later, Robin lost her battle with ovarian cancer.

Donations from Babbini’s organization have enabled Memarzadeh and her team to make critical steps in understanding how ovarian cancers work, allowing them to delve into untested ideas that would not qualify for traditional grants.

Ovarian cancer is known to be highly responsive to chemotherapy, but the reasons for relapse have remained a mystery. Recently, by studying patient tumor samples gathered by Memarzadeh from UCLA patients, the G.O. Discovery Lab team has identified a subpopulation of ovarian tumor cells that are resistant to chemotherapy. They believe these chemotherapy-resistant cells, called serous cancer stem cells, are the culprit for high rates of relapse in ovarian cancer patients.

“The good news is that we have made major progress in finding ways that could eliminate these chemotherapy-resistant ovarian tumor cells,” Mermarzadeh said. “Through a collaborative effort with top-notch scientists at UCLA, myself and my team hope to refine these therapeutic strategies and once that’s done, the next step will be launching clinical trials.”

Fund-raising for such research is satisfying and meaningful, Babbini said.

“It has been an extraordinary experience to meet women of all ages throughout Los Angeles and at regional/national conferences,” Babbini said. “This networking deeply inspires me and continually renews my commitment, passion and dedication to the mission of the circle. It’s critical to educate, heighten awareness and to raise funds for ovarian cancer research. We must work together to help each other. No one should suffer like my Robin.”

Apr 27, 2016 · The ability to ‘age in place’ may get a hand from a robot

 Sunnie So, an undergraduate researcher with UCLA Engineering, poses with a robot that can serve as a medical companion for elderly people recovering from injury or illness.

Sunnie So, an undergraduate researcher with UCLA Engineering, poses with a robot that can serve as a medical companion for elderly people recovering from injury or illness.

 

Most adults would prefer to age in place—that is, remain in their homes as long as possible. Too often, that doesn’t happen. Although the AARP reports that 90 percent of adults over the age of 65 would prefer to stay in their current residences as they age, the rising risk of illness and injury often puts that desire beyond many people’s grasp.

Doctors from the David Geffen School of Medicine at UCLA and engineers from the UCLA Henry Samueli School of Engineering and Applied Science may have found a solution.

They’re collaborating on an effort that could allow people to recover in their homes after injuries and hospitalizations despite the need for greater health monitoring. Together, these experts from different fields are developing a cohesive system that uses wireless smart watches, state-of-the-art motion sensors, air monitors and even a robot that can serve as a medical companion and aid in such recuperative activities as exercise.

Working together, engineers, computer scientists, clinicians, biomedical researchers and information technologists have formed the UCLA Center for Systematic, Measurable, Actionable, Resilient and Technology-driven Health, or Center for SMART Health.  This multidisciplinary team is developing and testing health care devices and systems to address challenges in the way health care is delivered to the elderly, while also decreasing emergency room visits and hospital readmissions.

The center’s first project, called the SMART Home Lab, is a mock residence on the UCLA campus where researchers can simulate the responses of theoretical patients, monitor their recovery and assess their physical activity, such as how long patients linger in bed or how much time it takes them to navigate across a room. That information is transmitted to a smart watch, is privacy encrypted, and is then sent to a server and saved, providing an accurate picture of what these imaginary patients are doing while at home.

The next step is to assess the system using real patients.

The sensors will be tested in 300 L.A. area homes later this year as part of a research study. Eventually, if proven successful, these sensors could be routinely installed in patient homes to help them get healthy and avoid long stays at skilled nursing facilities.

Upcoming projects from the center, based at the Geffen School of Medicine, will focus on diagnostic and treatment technologies. The center’s co-directors are Dr. Arash Naeim, an associate professor of medicine and school’s chief medical officer for clinical research, and Majid Sarrafzadeh, a distinguished professor of computer science and electrical engineering at UCLA Engineering, and a co-founder of the UCLA Wireless Health Institute.

Naeim, who also is an associate director of the Clinical and Translational Science Institute at UCLA, said the new effort will be strengthened by cooperation between the schools.

“UCLA has some of the greatest medical and engineering minds in the world, and the SMART Health Center represents a great opportunity for them to collaborate on solutions to some of the biggest challenges in health care delivery,” he said. “The SMART Health Center will be a real game changer for UCLA, and it will open the door to innovative joint ventures with technology companies and the health care industry.”

But the biggest beneficiaries will be the patients.

“One of our goals is to determine the best way to monitor elderly, frail patients who are undergoing treatment for an illness or recovering from a hospital admission, and to ensure they are able to stay independent and living in their homes for as long as possible,” Naeim said.

Apr 26, 2016 · Moving closer to better options for ovarian cancer patients

 

Ovarian cancer patients need better treatment options. Finding those options has become the life work of UCLA gynecologic surgeon Dr. Sanaz Memarzadeh.

With support from the UCLA Broad Stem Cell Research Center, Memarzdeh is moving ever closer to a clinical trial for a combination therapy that she believes will give hope to women with a particularly dangerous form of ovarian cancer, known as epithelial ovarian cancer.

“So why is it that epithelial ovarian cancer, an aggressive subtype, often recurs despite standard therapy? Our research shows that a pre-existing population of tumor cells is simply resistant to standard chemotherapy treatments. These cells are not only therapy resistant but are also the cancer stem cells that regenerate the tumor and are likely responsible for high rates of relapse,” she wrote in a recent blog post. “This may seem like a daunting problem but our work has uncovered vulnerabilities in these cancer stem cells that can be exploited.”

In her post, “4 Facts About Ovarian Cancer You Should Know & Spread,” Memarzadeh shares information that she encourages others to share as well, such as the statistics and signs of ovarian tumors.

She concludes: “ It’s hard to catch ovarian cancer early, and the treatment options are not as effective as they should be. We can, we must do better.”

Her work is an important step. Learn more about it at G.O. Discovery Lab.

Apr 8, 2016 · Gene sequencing expert: Test could speed diagnosis of rare diseases

GeneSequencing-1

Some people suffer for years from rare neurological diseases that have no known cause and, accordingly, few clear treatment choices. Those causes could become easier to diagnose – if doctors had the right tool.

Some UCLA researchers say that they already do. Using a state-of-the-art genetic test — paired with a patient evaluation and family history — could greatly improve the speed and accuracy with which doctors can diagnose neurogenetic disorders, they contend. Doing so, they add, could lead to better care for people with spinocerebellar ataxia, leukodsystrophy, spastic paraplegia and many other rare, often fatal, conditions.

How the test works

First, some background: Genes are DNA segments that instruct cells how to behave – but not all of the genes in a body are activated, or expressed. Whether or not a gene is expressed affects how the body performs. The new test, called exome sequencing, determines the precise order of all the expressed – or activated — genes in a person’s genome. Assessing the order of gene expression can help researchers determine the root cause of puzzling symptoms.

Dr. Brent Fogel, first author of a review that appeared in the April issue of Neurology: Clinical Practice, points out that use of the test is currently limited due, in part, to its relative newness, complexity and expense. Using it more widely, he says, is not only doable, but worthwhile for doctors and patients alike

Arriving quickly at a proper diagnosis could end what for many patients is an agonizing, years-long journey to even find a name for their condition, let alone a treatment. And using exome sequencing is more efficient and less costly than the traditionally more common types of genetic testing, Fogel said in the review.

Who should pay?

Insurance coverage for the test has been spotty – at best. But the benefits to patients should lead to greater coverage, said Fogel, director of the Neurogenetics Clinic at UCLA and an associate professor of neurology and human genetics.

“Despite extensive literature supporting the use of this technology, many insurance companies still consider it to be investigational and may refuse coverage,” Fogel said. “Our article outlines the appropriate use, benefits and limitations of exome sequencing that these companies need to consider when making coverage decisions.”

Leader in the field

UCLA has been a leader in using clinical exome sequencing diagnostically since 2012. Fogel and his team were among the first adopters of this new technology into routine neurological practice, and he has been a strong advocate for promoting the widespread use of this technology.

This review follows a study by Fogel and colleagues published in the Journal of the American Medical Association Neurology in 2014. That study demonstrated the effective use of exome sequencing in patients with spinocerebellar ataxia, in which people lose control of the muscles in their limbs. The team demonstrated that more than 20 percent of patients could be diagnosed immediately, and that useful diagnostic information could be identified in more than 60 percent, regardless of age of onset or family history.