Health News

Travel and Leg Swelling: What, Me Worry?

by Columbia Surgery on February 28, 2012

Seven-hour flight. Coach class. Hotel room. Swollen left calf.
Choices: Drinks with colleagues in the bar?
Nap before the dinner meeting?
Jog to stretch your legs?
Visit the local Emergency Room?
All are good choices. How do you make the best choice?

Vein disease and blood clots plague the frequent traveler. Dick Cheney, Richard Nixon, and David Bloom (NBC Reporter) all had life threatening complications of vein disease. Some died (Bloom) and some lived (Cheney, Nixon). Blood clots can affect any traveler even if he is not famous.

The best answer to the question above, then, is to make sure you don’t have something in your leg that can kill you or maim you, i.e. a blood clot. After your visit to the emergency room and everything is okay, then go for a jog, have a drink and take a nap all in that order. Now you’ll feel better.

Deep Vein Thrombosis (DVT) is the formation of a thrombus – a clot – in a deep vein, most often in the legs or pelvis. DVT If a clot breaks away and travels to the heart or lungs (pulmonary embolus), it can cause significant damage or death. Not everyone develops these life threatening complications, but clots that remain in your legs can still cause significant long-term damage and symptoms such as swelling, aching, throbbing, skin changes and ulcers at the ankles. It’s important to not only diagnose the problem early, but to treat it early too. Prompt treatment prevents leg- and life-threatening problems.

Q: What causes blood clots?

Factors that increase the risk of forming blood clots include inherited clotting disorders, a family history of blood clots in veins, early heart attack in parents or siblings (under age 50), early stroke, recent surgery, obesity, pregnancy, hormonal medication, cancer, varicose veins, age above 40-years, fracture of leg bones, and plane, train or auto trips greater than four hours.

Q: How can I prevent blood clots?

Simple preventive measures can help to minimize some of the risk factors listed above. It is very important to flex your leg muscles and move about during long travel trips, to keep your blood flowing as well as possible. Dehydration, especially during plane trips, can cause the blood to be “thicker,” so it is important to drink more water before and during long trips. I also recommend wearing over-the-counter or prescribed graduated compression knee high stockings on long plane or car trips, as these help to maintain good blood flow to the legs.

Q: How do I know if I have a blood clot?

You don’t. Even the most experienced vascular surgeons are only right 50% of the time by just examining a patient; we may as well flip a coin. The gold standard for detecting blood clots is ultrasound (doppler), which uses sound waves to look at the leg veins and “see” if any blood clots are present. In experienced hands the ultrasound test is almost 100% effective in identifying life-threatening blood clots. The ultrasound exam is completely non-invasive and painless, requires no preparation, and lasts approximately 20 minutes. It may also identify other reasons for the symptoms of calf tenderness and swelling.

Q: What are the treatment options for blood clots?

If a clot is found, treatment is needed to dissolve it so that it does not damage the leg veins or travel to the heart or lungs. The most common form of treatment is medication to ‘thin’ the blood. There are two types of blood thinners; one type works immediately but requires injections or intravenous treatment and the other type is a pill that takes a few days to begin its effect. Usually we begin with the immediate type (heparin, Lovenox) and give the oral type until it begins to take effect, then we stop the immediate type and continue oral blood thinner for at least six months. Most treatment can be done as an outpatient, and injections of the immediate-acting blood thinners can be self-administered at home. If a patient has significant risk factors, he or she may be hospitalized for a few days until the oral medication takes effect.

For patients whose clots are too extensive or the risk of blood thinners too great, additional protection may be needed through placement of a vena cava filter. The vena cava is the main vein in the abdomen, and both leg veins lead to the vena cava. A vena cava filter can be thought of as a “strainer” or “colander” that traps any blood clots that are traveling from the leg veins to the heart, preventing life-threatening complications of a pulmonary embolus. This filter is designed in such a configuration that it is self-cleaning, i.e. once a clot is trapped, it slowly dissolves over time.

The newest minimally invasive methods of clot dissolution include mechanical and chemical techniques. With one small needle stick, surgeons can now dissolve clots by softening them and vacuuming them out of the body in a matter of hours. These approaches remove clots quickly and reduce the risk of blood damaging the leg veins or traveling to the heart. Patients can get back to living their lives more quickly than with traditional methods of DVT management.

Steve Elias, MD, Director, Columbia University Division of Vascular Surgery Vein Programs

Tagged as: deepveinthrombosis, Elias

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Spotlight on Pediatric Congenital Heart Surgery: Atrioventricular Canal Defect

by Columbia Surgery on February 24, 2012

“Ten fingers and ten toes” is the traditional measure of a healthy newborn. If only it were that simple. A more apt assessment would be, “four heart chambers separated by two functional valves and two complete septa.” It’s not quite as catchy, but when the count comes up short, it can make for a challenging start to life.

A normal heart consists of four distinct chambers that direct blood to the right place, sending oxygen-rich blood throughout the body and oxygen-poor blood to the lungs to “restock.” A child born with atrioventricular canal defect (AV canal) has one or more abnormalities in the heart structure:

  • In an atrial septal defect, there is an opening in the atrial septum, the wall that divides the heart’s two upper chambers.

  • Ventricular septal defect is similar, but the opening is in the wall between the two lower chambers.

  • Instead of a separate mitral and tricuspid valve, one large valve straddles both ventricles.

These abnormalities interfere with the heart’s ability to function properly. With oxygen-rich and oxygen-poor blood mixing freely, oxygen-poor blood circulates through the body, depriving the organs of oxygen. The abnormal pressures in the heart and valves can also damage the heart muscle and valves and lead to lung disease, inflammation of the lining of the ventricles, and other problems.

Baby having a check up

These abnormalities interfere with the heart’s ability to function properly. With oxygen-rich and oxygen-poor blood mixing freely, oxygen-poor blood circulates through the body, depriving the organs of oxygen. The abnormal pressures in the heart and valves can also damage the heart muscle and valves and lead to lung disease, inflammation of the lining of the ventricles, and other problems.

How are AV canal defects treated?

AV canal is treated surgically, with the treatment plan tailored to each child. The atrial septal defect and the ventricular septal defects are closed, and the single valve is separated and modified into 2 separate valves, mimicking the tricuspid and mitral valves. Other forms of treatments may be necessary both before and after the operation, including medication and nutrition supplementation. The goal is to repair the abnormalities before the lungs become damaged from excessive pressure. Most children will undergo surgery by the age of six months. During surgery, the septal defects are closed using a patch made from either the membrane covering the outside of the heart or synthetic material. Valve repair techniques will depend on the child’s specific abnormalities.

The Congenital Heart Center at Morgan Stanley Children’s Hospital of New York (MSCHONY) performed 133 AV canal repairs between 2007-2010, and consistently and significantly outperforms the national average for positive patient outcomes.

Many children who have had an AV canal defect will lead healthy lives with normal activity levels, appetite, and growth. Some children will still have a valve abnormality after the initial surgery, and may require an additional operation. The cardiac specialists at the Congenital Heart Center care for children with every form of congenital heart disease and are dedicated to working closely with each family to achieve the best outcome for each child.

For more information on the causes, symptoms, diagnosis, and treatment of atrioventricular canal defect, please visit childrensnyp.org or call 212.305.2688.

Tagged as: congenitalheartdisease

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NYPH Participates in Largest Ever Kidney Swap

by Columbia Surgery on February 22, 2012

In an unprecedented organ transplant chain at NYPH and ten other hospitals across the U.S., thirty patients with renal failure received a new kidney in the largest organ swap ever performed. The intricately coordinated exchange enabled more recipients to have transplants, and to receive better matched organs, than if they had remained on the organ wait list – or if they had received transplants directly from their loved ones.

See the full story and video in the Feb. 18, 2012 edition of The New York Times here.

Tagged as: kidney, transplant

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How is LVRS Performed?

by Columbia Surgery on February 15, 2012

It may seem peculiar that removing part of the lung can improve its function, but that’s the basis of Lung Volume Reduction Surgery (LVRS). Normally, inhaled air travels through branched tubes in the lung to collections of tiny balloon-like sacs. These sacs, called alveoli, are where oxygen enters the blood and carbon dioxide is removed so it can be exhaled. In people with emphysema, a form of Chronic Obstructive Pulmonary Disease (COPD), the alveoli and supporting tissue are gradually destroyed, leaving the lungs with less surface area for gas exchange and a diminished ability to push air out.

Topography of Lungs

Topography of Lungs

During LVRS, surgeons remove the most damaged tissue, up to 30% of the lung. This allows the remaining lung to work more efficiently. Air that might have previously become trapped in impaired alveoli can now be exhaled more completely, and the major muscle involved in breathing, the diaphragm, can do its job without struggling against overinflated lungs. Like cleaning out your closet so that your best clothes hang more comfortably, LVRS improves the environment for the healthiest lung tissue. The surgery is performed by a minimally invasive thoracoscopy, in which a camera and lung reduction tools are inserted through small slits between the ribs. Patients normally undergo pulmonary rehabilitation both before and after the operation.

The National Emphysema Treatment Trial (NETT), completed in 2003, showed that for the right candidates, LVRS can improve both lung function and life expectancy compared to medical treatments for people with emphysema. NewYork-Presbyterian Hospital/Columbia University Medical Center has been designated by the National Institutes of Health as a center of excellence in LVRS.

Tagged as: COPD, emphysema, LRVS

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Frontiers in Medicine: Hybrid and Catheter-based Surgery for Babies with Congenital Heart Defects

by Columbia Surgery on February 9, 2012

Approximately 30,000 children are born each year with congenital heart defects (about one percent of all live births) in the United States, and .2 to .3 of these children will require cardiac surgery. The Congenital Heart Center at NewYork-Presbyterian Morgan Stanley Children’s Hospital (NYP-MSCHONY) brings together an integrated team of specialists to provide seamless collaboration and a continuum of care for these young patients.

Treatment options are tailored to the diagnosis and presentation of symptoms for each patient and any other medical conditions that may need to be taken into consideration. Increasingly, many congenital heart defects can now be effectively treated with minimally invasive catheter-based interventions that reduce both risk and recovery duration. These treatments often require only a single day of hospitalization, and can eliminate the need for open-heart surgery. The Congenital Heart Center has particular expertise in pediatric interventional cardiology, a specialty that involves non-surgical treatment of congenital and acquired cardiovascular disorders.

Additionally, the Congenital Heart Center is also one of only a few in the U.S. to have a hybrid program for infants and children who do require surgery but could benefit from a minimally invasive surgical procedure in combination with catheter-based interventions. Hybrid heart surgery refers to techniques that combine conventional surgical procedures with minimally invasive, catheter-based interventions. These alternatives typically involve only a small incision through the breast bone or right chest, and advantages include less pain, elimination of the heart-lung machine (and its associated risks), a faster return to normal activities, as well as cosmetic advantages.

Congenital Heart Center

Congenital Heart Center

In Surgery, Less is More

According to Emile Bacha, MD, Chief of Congenital and Pediatric Cardiac Surgery, patients at the Congenital Heart Center are always evaluated for less invasive treatment options first. In some cases, a hybrid approach will allow the surgeon to treat a condition with a single operation rather than a series of surgeries, or to treat conditions that would otherwise be inoperable. Dr. Bacha explains, “As with any treatment options, hybrid techniques may not be appropriate for every child. Some babies still benefit from more traditional surgical procedures, and surgeons evaluate each patient to determine which procedure carries the best possible benefits and outcomes.”

Hybrid techniques can offer significant benefits for some patients, including infants with difficult-to-treat conditions. Surgeons at the Congenital Heart Center have been successfully using a less invasive hybrid technique for a very difficult-to-treat defect in newborns known as hypoplastic left heart syndrome (HLHS). To survive, babies born with this anomaly must undergo surgery during the first week of life, and until recently the only treatment available was the Norwood procedure, requiring three difficult standard open operations and carrying a 10-20 percent greater risk of mortality (based upon national statistics). Because infants with HLHS require treatment at a very young age, hybrid procedures can be used to provide immediate interventions and delay more invasive surgeries until infants are older and stronger.

Surgical outcomes are currently comparable between the hybrid approach and the Norwood procedure, but the hybrid approach is thought to be safer for high-risk patients such as in infants with a low birth weight or who are born prematurely, in large part by avoiding the use of a heart-lung bypass machine.

The Congenital Heart Center has been widely recognized for excellence in treating congenital cardiac conditions in infants and children. Minimally invasive and hybrid procedures are just another set of state-of-the-art techniques the Congenital Heart Center is able to employ to minimize risks and maximize positive patient outcomes. Incorporating significant experience, expertise, and tailored treatment plans, the Congenital Heart Center is able to provide exemplary treatment and care for young patients across the spectrum of congenital cardiac conditions.

For more information about pediatric heart surgery, please visit childrensnyp.org, download the NewYork-Presbyterian Congenital Heart Center brochure or call 212.305.2688.

Tagged as: Bacha, congenitalheartdisease, pediatric

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What is Acute Respiratory Distress Syndrome?

by Columbia Surgery on February 6, 2012

Drs. Daniel Brodie, left, and Matthew Bacchetta, right

Drs. Daniel Brodie, left, and Matthew Bacchetta, right

We all know what it’s like to bump an elbow or jam a finger and watch it swell up like rising dough. This swelling, due to increased fluid in the injured tissue, is part of the body’s attempt to promote healing. However, when it occurs in the lungs, it can have dangerous consequences.

Acute respiratory distress syndrome (ARDS) occurs when the millions of tiny air sacs in the lungs, called alveoli, fill with excess fluid. This can be the result of any kind of injury to or illness in the lung. Pneumonia, trauma, sepsis, and inhalation of stomach contents or smoke can all cause the body to initiate an inflammatory response, sending excess fluid to the lungs.

In healthy lungs, the alveoli fill with inhaled air, transferring oxygen into the blood carried by small neighboring vessels. The oxygen-rich blood can then travel throughout the body to deliver its cargo to the kidneys, brain, liver, and other organs. But when fluid accumulates in the alveoli, they can no longer fill with air, and oxygen cannot pass as easily into the blood. Soon after the initial injury or illness, blood oxygen levels decline, and breathing becomes fast and difficult as the body tries to compensate. There may also be signs, such as confusion or low blood pressure, that the vital organs aren’t getting enough oxygen. In some patients, the lung may try to heal itself, creating scar tissue that decreases the lung’s elasticity and makes it still harder to breathe. The majority of patients recover, but around 40% die in the setting of ARDS, says Daniel Brodie, MD, Director of the Medical ECMO Program at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Treatment for ARDS aims to restore oxygen levels. This may be done with a mechanical ventilator, or through a process called extracorporeal membrane oxygenation (ECMO), in which the blood is removed from the body and oxygenated externally before it is returned. In November 2011, NewYork-Presbyterian Hospital/Columbia University Medical Center opened the Center for Acute Respiratory Failure, which specializes in ECMO. Accompanying the Center’s launch was an article on ECMO for ARDS in adults by the Center’s co-directors, Daniel Brodie, MD, and Matthew Bacchetta, MD, published in the New England Journal of Medicine.

The ECMO program’s innovative approach has been highly successful: every adult ECMO patient has recovered and is now thriving. Click here to read their stories.

Tagged as: acuterespiratorysyndrome, Bacchetta, ECMO

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Young, Obese, and In Surgery

by Columbia Surgery on January 13, 2012

“It’s like having a precancerous condition that you can treat rather than waiting till it’s cancer,” says Jeffrey L. Zitsman, Director of the Center for Adolescent Bariatric Surgery at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, in a New York Times article January 8, 2012. Yet despite the prospect of a lifetime of obesity, ostracism, and diseases such as diabetes for such patients, nearly half of pediatricians and family doctors say they would never refer a teenager for obesity surgery.

Full Article: Young, Obese and in Surgery

Prevalence of Obesity Among US Adolescents

Prevalence of Obesity Among US Adolescents, aged 12 - 19, 2007-2008


*Obesity defined as BMI ≥ 95th percentile. Total includes racial and ethnic groups not shown separately. Source: National Health and Nutrition Examination Survey, 2007 – 2008.

Tagged as: pediatric, weightloss, Zitsman

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NewYork-Presbyterian/Columbia Surgeons Are First in NYC Area to Implant Total Artificial Heart

by Columbia Surgery on December 14, 2011

Yoshifumi Naka, MD, PhD

Yoshifumi Naka, MD, PhD

Total Artificial Heart Improves Patient Survival to Transplant While Reducing Some Risks of Transplant Surgery

Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center performed the first Total Artificial Heart implant in the New York City area to replace a patient’s dying heart.

“For patients who will die without a heart transplant, the Total Artificial Heart helps them survive until they can get one. By replacing the heart, we are eliminating the symptoms and the source of heart failure,” said lead surgeon Dr. Yoshifumi Naka, director of Cardiac Transplantation and Mechanical Circulatory Support Programs at NewYork-Presbyterian/Columbia and associate professor of surgery at Columbia University College of Physicians and Surgeons.

Similar to a heart transplant, the SynCardia temporary Total Artificial Heart replaces both failing heart ventricles and all four heart valves. Once implanted, the Total Artificial Heart provides immediate blood flow of up to 9.5 liters per minute. This high volume of blood flow helps speed the recovery of vital organs, including the brain, liver, kidneys, and GI tract, helping make the patient a better transplant candidate.

During the surgery, Dr. Naka and his team remove the patient’s heart; sew “quick connects” into the atria, aorta and pulmonary artery; then attach the Total Artificial Heart. According to surgeons, the Total Artificial Heart makes the subsequent transplant less demanding because the patient’s heart has already been removed and the device is easily detached via the quick connects, thus reducing risk for surgical bleeding.

“The artificial heart does more than improve a patient’s chances of surviving to transplant. It reduces some of the risks of the transplant surgery itself. When we implant the device, we are already preparing for transplant,” says Dr. Naka.

For patients who have already had a heart transplant and are rejecting their donor heart, there is another advantage to using the Total Artificial Heart: Since their donor heart is removed, they can be taken off immunosuppressive drugs, reducing risk for infections and other side effects such as kidney failure.

Despite increased demand, there are only approximately 2,000 donor hearts available annually in the United States. It is estimated that each year, as many as 100,000 people in the U.S. alone could benefit from mechanical circulatory support devices.

The Total Artificial Heart, manufactured by SynCardia Systems Inc., was first introduced in the mid-1980s, and more than 950 patients have been implanted with the device since. A 10-year clinical study led by the University of Arizona, Tucson, and published in the Aug. 2004 New England Journal of Medicine showed that 79 percent of patients receiving the Total Artificial Heart survived to transplant, representing the highest bridge-to-transplant rate for a heart device. Later that year, the device received FDA approval.

Artificial hearts represent the next stage in the evolution from left ventricular heart assist devices (LVADs), introduced in the 1990s, and biventricular assist devices (BiVADs), introduced in the 2000s.

NewYork-Presbyterian/Columbia performs more than 1,600 open-heart procedures annually, including a nation-leading 84 heart transplants in 2010. U.S.News & World Report has ranked NewYork-Presbyterian/Columbia in the top 10 for Cardiology & Heart Surgery among “America’s Best Hospitals” for eight years running. The Hospital has more than 30 years of experience in caring for cardiac transplant patients and developing new treatments that extend their lives.

Tagged as: cardiac, heartfailure, LVAD, mechanicalcirculatorysupport, Naka, transplant

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Good to Know: Growing Library of Podcasts Keeps Patients Well Informed

by Columbia Surgery on December 8, 2011

Are you or a loved one facing the prospect of surgery in the near future? Or just curious about a particular condition or procedure?

The Department of Surgery is pleased to offer a growing library of videos and podcasts to help you learn about all types of surgical procedures. Created by expert physicians and surgeons at NYP/Columbia, these easy-to-understand presentations provide direct information and answers from top physicians in their field. According to one patient, “These podcasts are great because they are an informal venue where doctors can speak freely and share their views.”

The most recent of over 50 podcasts include Diseases of the Gallbladder and their Management, by Melissa Bagloo, MD, and Aortic Root Surgery Procedure: Bioroot, by Allan Stewart, MD.

Open to the public, these presentations are available on the Department of Surgery (DOS) website, Facebook, and this blog.

Topics include all types of surgeries, including aortic surgery, breast surgery, cardiac, endocrine, esophageal, thoracic, pancreatic, liver, kidney, pediatric surgeries, and more.

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Advances in Breast Surgery: New Tissue Expansion System for Breast Reconstruction Patients Under Study

by Columbia Surgery on November 18, 2011

Jeffrey A. Ascherman, MD, FACS

Jeffrey A. Ascherman, MD, FACS

After the jubilation of beating cancer, many women who seek breast reconstruction have another journey to complete. Before they can receive a permanent breast implant, they must first undergo a process to create the space to house the new implant – a process which can be uncomfortable at times and may take many months.

“Traditionally, women undergoing breast reconstruction have had to endure a long process of inconvenient and sometimes uncomfortable saline injections every 2 to 3 weeks to create a pocket for the permanent implant following a mastectomy,” said Jeffrey Ascherman, MD, Site Chief, Division of Plastic Surgery, NewYork-Presbyterian/Columbia. According to some women, this process can also involve a significant time burden, since they must visit their doctor’s office every few weeks for an average of four to six months.

Dr. Ascherman is now the first physician in the United States to be enrolling patients in a study of a new, needle-free tissue expansion method that may allow women to achieve the same preparation for reconstructive surgery in a much easier manner.

The clinical trial at NewYork-Presbyterian/Columbia, which was the first center in the U.S. to receive Institutional Review Board (IRB) approval for the trial, involves a novel, needle-free tissue expansion method that eliminates the need for frequent saline injections and office visits. This investigational method first requires implantation of a normal-sized tissue expander device. Once at home, the patient uses a remote-control device to release small amounts of compressed carbon-dioxide from a valve in the expander. In a recent study of the device in Australia, the daily expansion resulted in creation of a pocket in an average of 15 days that was comparable to those created after several months of saline injections. Patients can use the new needle-free technology while at home, at their own pace and comfort level.

The randomized controlled clinical study is designed to directly compare the outcomes of traditional saline expansion method to the investigational, remote-controlled tissue expander. NewYork-Presbyterian/Columbia is the only hospital in New York, and one of only approximately ten hospitals in the U.S., to participate. The U.S. Food and Drug Administration (FDA) has granted an Investigational Device Exemption (IDE) to conduct the study, and the trial has received approval for enrollment by the Columbia University Medical Center IRB.

Eligible patients include non-obese women between 18 – 65 years of age who do not smoke, have not had previous tissue expansion or radiation therapy, and who want breast reconstruction with tissue expansion after mastectomy.

For more information about this trial, see clinicaltrials.gov.

To inquire about enrolling in this study, or to refer a patient, please contact:

Jeffrey Ascherman, M.D.
Site Chief, Division of Plastic Surgery
NewYork-Presbyterian Hospital/Columbia University Medical Center
Tel: (212) 305-9612

Tagged as: Ascherman, breast, cancer, plastic

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