USF Health patients now have access to a specialized device meant to reduce back pain, thanks to the donation by Excite Medical.

Excite Medical donated two devices – the DRX9000 and the DRX9000C – as treatment options that may prove helpful to patients not benefiting from other standard non-surgical options for easing back pain, said Nathan Schilaty, DC, PhD, assistant professor and the Lincoln Endowed Chair in Chiropractic and Biomechanics Research in the Department of Neurosurgery in the USF Health Morsani College of Medicine.

USF Health’s Dr. Nathan Schilaty and Saleem Musallam, president of Excite Medical.

“Thanks to our industry partner Excite Medical, we can now offer patients a highly advanced non-surgical option for spinal decompression,” said Dr. Schilaty, who also directs the Center for Neuromusculoskeletal Research.

“In addition to providing patients with this treatment as another tool in our non-surgical arsenal, we are collecting data on the use of DRX9000 through evidence-based, peer-reviewed studies, which will better inform the medical community on its true efficacy. Earlier studies on DRX9000 are promising, and this additional data could not only validate its effectiveness but also provide the empirical data needed to expand availability and help more patients suffering with back pain.”

The DRX9000 and the DRX9000C were provided to USF Health as a gift-in-kind through a grant from the Florida High-Tech Corridor to provide clinical care and research. They are non-surgical spinal decompression devices cleared by the FDA to treat patients suffering from incapacitating lower back pain, sciatica, and neck pain caused by herniated discs, degenerative discs, and posterior facet syndrome. Decompression is currently available for spinal levels C1-T1 (cervical spine) and L1-S1 (lumbar spine).

“It is an excellent first choice for those with disc lesions as it is non-invasive and requires no medications,” said Saleem Musallam, president of Excite Medical. “Many patients can experience relief and excellent outcomes without undergoing surgery, avoiding the complications of surgery, and at a fraction of the cost of a spinal surgery.”

Patients of all ages could benefit from the DRX9000 & DRX9000C, although the treating physician may determine if there are exclusionary criteria from medical history. Even those who have had prior spinal surgery may be eligible for treatment at different levels of that previously operated.

Patients typically receive 20-24 treatments over six to eight weeks with each treatment lasting less than 30 minutes. As low back pain can accompany difficulty laying down or getting up, the table is power adjustable, which enables a patient to get on the table in a standing posture and then be gently lowered to a supine position for treatment. After treatment, it will assist them back to an upright posture. While the patient is undergoing treatment, they lay supine and are gently decompressed 18 cycles during the treatment session.

“It is gentle and relaxing,” Dr. Schilaty said, “and many patients will even often fall asleep, as they experience low-back pain relief.” Both the DRX9000 and the DRX9000C are in the USF Health Morsani Center for Advanced Healthcare on the USF campus in Tampa.  

While the devices are cleared by the FDA, treatment may not yet be covered by some insurance carriers.

Call 813-821-8634 to learn more or make an appointment.

TAMPA, Fla. (March 23, 2021) — Tampa General Hospital, working with USF Health, is one of the first sites in the country – and the first in Florida — to enroll patients in a new national study testing whether a minimally invasive procedure can safely and effectively treat subacute and chronic subdural hematomas, a common type of brain bleed.

Subacute or chronic subdural hematomas often occur in patients who have brain atrophy, a shrinking or wasting away of brain tissue due to age, trauma, or disease, which results in a slow accumulation of blood over several days to weeks or months.

The standard surgical treatment involves drilling a hole in the skull, or opening a larger portion of the skull, to drain the hematoma. This relieves increasing pressure on the brain that can cause debilitating symptoms such as severe headaches, profound body weakness, vision and speech problems, confusion, and impaired memory. However, recurrent subdural hematomas frequently require repeat surgeries that pose risks – especially for more fragile older patients or others with underlying diseases, who may not be good candidates for open surgery.

The multisite randomized, controlled EMBOLISE clinical study will evaluate an emerging minimally invasive treatment, called middle meningeal arterial (MMA) embolization. The procedure will deliver an embolic liquid (Onyx Liquid Embolic System) to block targeted vessels, the underlying source of inflammation and rebleeding promoting the growth of subdural hematomas.

Maxim Mokin, MD, PhD, an associate professor of neurology and neurosurgery at USF Health, is principal investigator for EMBOLISE at the Tampa General Hospital trial site. | Photo by Allison Long, USF Health Communications

“This study is a significant opportunity to expand our scientific understanding of subdural brain bleeds and marks an important step forward in the discovery of an effective treatment,” said Dr. Charles J. Lockwood, senior vice president of USF Health and dean of the USF Health Morsani College of Medicine. “As the first site in Florida to enroll in the trial, USF Health and Tampa General Hospital are at the forefront of national efforts to pioneer new discoveries that improve outcomes for patients.”

With MMA embolization, a neurointerventional neurologist trained in image-guided techniques inserts a microcatheter through a needlestick in the groin or wrist, threading it up to targeted arteries near the brain. Then, an embolic agent is released to stop the persistent bleeding characteristic of chronic subdural hematomas.

“Middle meningeal arterial embolization represents a fundamentally different approach to managing this complex condition – one that shuts down abnormal blood vessels to break the vicious cycle of continued subdural hematoma growth,” said Maxim Mokin, MD, PhD, principal investigator for EMBOLISE at the Tampa General (TGH) trial site and an associate professor of neurology and neurosurgery at the USF Health Morsani College of Medicine. “If it proves to be as effective as preliminary data indicates, this less invasive procedure may offer the potential for a cure.”

Left: CT brain scan before embolization of the middle meningeal artery depicts a large right-side chronic subdural hematoma (brain bleed). Right: Repeat CT scan several weeks after embolization shows reduced size of the subdural hematoma.

The TGH site will enroll up to 36 adults ages 18 to 90 in the EMBOLISE trial, which is expected to include 600 study participants at medical centers across the country.

MMA embolization is still in the investigational stages for subdural hematomas and does not have FDA approval. This trial is an important step in seeking that approval. Larger, more rigorous studies such as EMBOLISE are needed to validate whether the neurointerventional procedure works.

Earlier case studies and smaller trials suggest that MMA embolization, in conjunction with surgery, often significantly reduces the need for repeat surgeries in some patients with subdural hematomas, Dr. Mokin said. “And in patients closely observed who do not require urgent surgery, the embolization procedure alone demonstrates a dramatic reduction in the size of the hematoma and the alleviation of symptoms, often preventing the more invasive surgical procedure.”

Angioplasty showing a case following minimally invasive middle meningeal arterial embolization, which delivered a liquid embolic agent (Onyx Liquid Embolic System) to block targeted vessels.

EMBOLISE study participants diagnosed with chronic or subacute hematoma will initially be enrolled into one of two groups: a surgery group or an observational group monitored for changes in hematoma size determined by CT scans and any worsening symptoms. The surgery group will be randomized into two subgroups: study participants who undergo surgery alone (the standard treatment) and those treated with surgery supplemented by investigational MMA embolization. The observational group will also be randomized into one of two subgroups: study participants who continue to be closely observed only (no treatment), and those who receive the investigational MMA embolization.

The primary outcome measure to assess the effectiveness of investigational MMA embolization will be whether the subdural hematoma recurs or progresses within 90 days following either surgery combined with embolization, or embolization alone.

The trial is sponsored by Medtronic, the manufacturer of the Onyx embolic agent used to stop the bleeding.

Photo by Allison Long, USF Health Communications

ABOUT USF HEALTH
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the Taneja College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences, the Biomedical Sciences Graduate and Postdoctoral Programs, and USF Health’s multispecialty physicians group. The University of South Florida is a high-impact global research university dedicated to student success. Over the past 10 years, no other public university in the country has risen faster in U.S. News and World Report’s national university rankings than USF. For more information, visit health.usf.edu

ABOUT TAMPA GENERAL HOSPITAL
Tampa General Hospital, a 1007-bed non-profit academic medical center, is one of the largest hospitals in America and delivers world-class care as the region’s only center for Level l trauma and comprehensive burn care. Tampa General Hospital is the highest-ranked hospital in the market in U.S. News & World Report’s 2020-21 Best Hospitals, and one of the top 4 hospitals in Florida, with five specialties ranking among the best programs in the United States. It is one of the nation’s busiest adult solid organ transplant centers and is the primary teaching hospital for the USF Health Morsani College of Medicine. With five medical helicopters, Tampa General Hospital transports critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. Tampa General houses a nationally accredited comprehensive stroke center and its 32-bed Neuroscience Intensive Care Unit is the largest on the West Coast of Florida. It also is home to the Jennifer Leigh Muma 82-bed Level IV neonatal intensive care unit, and a nationally accredited rehabilitation center. Tampa General Hospital’s footprint includes 17 Tampa General Medical Group Primary Care offices, TGH Family Care Center Kennedy, TGH Brandon Healthplex, TGH Virtual Health and 19 outpatient Radiology Centers. Tampa Bay residents also receive world-class care from the TGH Urgent Care powered by Fast Track network of clinics, and they can even receive home visits in select areas through TGH Urgent Care at Home, powered by Fast Track.  As one of the largest hospitals in the country, Tampa General Hospital is first in Florida to partner with GE Healthcare and open a clinical command center that uses artificial intelligence and predictive analytics to improve and better coordinate patient care at a lower cost.  For more information, go to www.tgh.org.

A common problem at the end of medical office visits is patients being unable to clearly remember what was talked about, including details about their diagnoses or recommended changes to their diet, activity levels or medications.

In fact, the federal Agency for Healthcare Research and Quality says studies show that patients can forget up to 80 percent of information shared during an office visit and almost half of what they do remember can be inaccurate.

That forgetfulness can obviously negatively affect the patient’s health. It can lead to unnecessary medical complications, added health costs and duplicated effort when the patient or caregivers invariably contact the doctor’s office with follow-up questions.

USF Health’s Department of Neurosurgery is offering a new tool that can avoid many of those issues by providing patients with an online video recording of their visit with their physician, which they and their family can review afterward.

Called the Medical Memory, the service is designed to be HIPAA-compliant and user friendly for both the patient and health care providers. The physician records the visit on a tablet computer, and the recording is then uploaded to a secured website. The Medical Memory emails a link to the video to the patient and anyone else connected to the patient’s account, such as family members or other caregivers.

Fayyadh R. Yusuf, PhD, is the director of physician development in the USF Health Department of Neurosurgery. Dr. Yusuf said he appreciated The Medical Memory’s “simplicity” and how it provides USF Health patients a permanent record of their consult with their physician.

“Knowing that a lot of things get missed in the moment, there’s great security knowing they can simply turn on the video, re-watch it, watch it with family, watch it with their home physician and go, ‘Ok, this is what the doctor said, these are the instructions, this is what we are supposed to do,’” Dr. Yusuf said.

A tablet is used to record a patient-doctor visit.

The Medical Memory, the company that produces the service, was founded in 2015 by Phoenix, Ariz.-based neurosurgeon Randall Porter, MD. According to the company’s website, the company was founded to “improve patient comprehension, satisfaction and trust.”

USF Health was the first health care organization in Florida to adopt the system when it was implemented in January 2020, Dr. Yusuf said and is now part of a pilot project focused on patients in the critical care division. He said having The Medical Memory is useful as the COVID-19 pandemic has limited visitors within the hospital.

“We’re hoping that this really facilitates and eases the burdens on the families that can’t come in and see their loved ones,” he said.

Besides providing videos for patients, physicians can also use The Medical Memory to create libraries of two- and five-minute videos where they can describe health conditions and treatments and then share those videos as part of patient education.

Harry van Loveren, MD, is chair of the Department of Neurosurgery and Vice-Dean of Clinical Affairs in the USF Health Morsani College of Medicine. He said providers have begun regularly using The Medical Memory as part of their clinic hours.

“Why would you have this lengthy in-depth discussion and then not record it?” Dr. van Loveren said.

He said the service has already led to improvements in patient satisfaction and reduced calls to his staff. Dr. Porter’s company said that, in a study involving 400 patients, half of whom used the video recording and upload system and half of whom didn’t, the video patient group generated almost 24 percent fewer calls to their physicians’ offices, freeing up staff time and other resources.

“The number one question (patients) are asked by family members is, ‘What did the doctor say?’” Dr. van Loveren said. “The number one phone call we get about the office visit is, ‘I don’t remember what the doctor told me.’”

The neurology program is also looking to use The Medical Memory to overcome limitations of patients diagnosed with such conditions as dementia or brain tumors, or patients who may have received a critical or even fatal diagnosis and may have trouble processing the rest of what they hear during the visit.

“(With) a diagnosis that might affect clarity or thinking, we are very relieved to know the whole session is being video recorded so their caregivers and significant others can view it,” Dr. van Loveren said, adding, “I think this should be the way that every medical visit is conducted. It is a fantastic record of the visit.”

Video, photos and article by Allison Long

This summer, Jennifer Krawczyk, MS, APRN, helped USF Health break new ground.

Krawczyk in June 2019 became the first graduate of USF Health’s Advanced Practice Provider Neurological Fellowship, a year-long program aimed at giving advanced practice nurses and physician assistants further expertise in neurosurgery.

Jennifer Krawczyk, MS, APRN, AGACNP-BC, was all smiles near her mother and brother during a celebration of Krawczyk being the first graduate of the advanced practice provider neurosurgical fellowship.

The program, co-administered through USF Health Morsani College of Medicine Department of Neurosurgery and Brain Repair and the USF College of Nursing, is the first of its kind in the United States, which weighed on Krawczyk’s decision to apply in 2018.

“The opportunity to pioneer as the first neurosurgical fellow for advance practice providers in the nation was something I couldn’t pass up,” said Krawczyk, who earned her bachelor and master in science degrees from USF in 2014 and 2017, respectively.

She said she chose neurosurgery chiefly because the subject matter was daunting for her.

“Neurosurgery was an area I found challenging,” she said. “What better way to conquer that challenge and reservation about a specialty than to just dive right in?”

As a fellow, Krawczyk was able to experience facets of neurosurgery that advanced practice providers often miss because they typically are working on the floor. She said these experiences helped fine-tune her clinical expertise and provide more in-depth training.

“I think without the fellowship the knowledge and skills I have now would have taken me years to develop,” Krawczyk said.

Jennifer Krawczyk (left), photographed with Harry van Loveren, MD, professor and chairman of USF Health department of Neurosurgery and Brain Repair, during a celebration for Krawczyk for being the first graduate of the advanced practice provider neurosurgical fellowship.

It is that type of opportunity that persuaded officials with the USF Health’s Department of Neurosurgery and Brain Repair and the USF College of Nursing to volunteer to be the first specialty to offer this type of fellowship.

“It (the fellowship) had so many potential benefits, we didn’t think twice about participating,” said Harry van Loveren, MD, a USF Health professor and the neurosurgery department’s chairman. “We are extremely proud that (Krawczyk) was the first student to graduate from this program.”

The complex and varied treatments for conditions and diseases associated with neurosurgery also influenced officials to experiment with helping further develop advanced practice providers.

“We started with neurosurgery because it takes a while to become familiar with the nuances,” said Marcia Johansson, DNPO, ARNP, who is a USF Health assistant professor in the College of Nursing as well as director of the Advanced Practice fellowship.  These nuances, Johansson said, “make it very necessary to have some specialty training.”

Jennifer Krawczyk, MS, APR, with a neurosurgery patient at Tampa General Hospital in August 2019.

Based on Krawczyk’s success, the fellowship will continue. Currently, there are three advanced practice fellows participating in the program, including fellows in neurosurgery, oncology (in partnership with the Moffitt Cancer Center & Research Institute) and otolaryngology.

“They (the advanced care providers) are now ingrained in the systems, they have developed friendships, and they have improved their education,” Dr. Johansson said. “Fellowships are going to become the norm for advanced care providers.”

Advanced practice fellows are hired by USF Health during the year-long program and earn 80 percent of their normal salary as well as benefits.

Krawczyk’s success, ensures the fellowship will continue and future advanced practice provider will be receiving certificates from Marcia Johansson (left), DNP, APRN.

USF Health was part of an international multicenter study analyzing patient outcomes when treating mild stroke deficits caused by an obstructed large brain vessel

Stroke is a leading cause of death and long-term disability worldwide, according to the World Health Organization.

The use of clot retrieval devices to treat patients with ischemic stroke has risen steadily since the technology was first approved by the FDA nearly eight years ago. The minimally invasive procedure, known as mechanical thrombectomy, uses an X-ray guided device to physically remove a blood clot blocking a large vessel in the brain, thus restoring blood flow to the brain.

The endovascular treatment has proved life-saving for many patients with devastating strokes caused by emergent large vessel occlusions (ELVO) when administered up to 24 hours of symptom onset, said Max Mokin, MD, PhD, associate professor of neurosurgery and neurology at the University of South Florida Health (USF Health) Morsani College of Medicine.  “Mechanical thrombectomy also has been shown to reduce disability in major strokes. We see less paralysis, speech problems and other stroke complications, faster recoveries, and less time needed in rehabilitation with these stroke survivors.”

Dr. Mokin is among the co-investigators of a new international multicenter study and comprehensive meta-analysis, published Sept. 23 in JAMA Neurology, which compares best medical management to mechanical thrombectomy (with or without pretreatment with clot-busting drugs) for ELVO strokes classified as “mild.”  The study was led by the University of Tennessee Health Sciences Center.

While the safety and effectiveness of mechanical thrombectomy for treating moderate-to-severe ELVO strokes has been established, questions remain about its benefit for the subgroup of patients (up to 10 percent of all ELVO cases) experiencing mild stroke symptoms when evaluated in emergency departments. Would more conservative “best medical management” with intravenously administered clot-busting drugs like tissue plasminogen activator (tPA) or aspirin alone suffice for these cases, or can mechanical thrombectomy offer superior treatment?

USF Health’s Dr. Max Mokin specializes in neurointerventional surgery.

The retrospective study reported in JAMA Neurology found that overall both treatment approaches showed the same safety and effectiveness in patients with ELVO strokes who presented with milder symptoms – medical thrombectomy was neither more nor less beneficial. The paper’s authors concluded that randomized clinical trials are needed to definitively evaluate the potential effectiveness of thrombectomy compared with medical management in patients with ELVO who exhibit mild neurological deficits.

The researchers pooled data from 16 high-volume endovascular stroke centers in North America, Europe and Asia, including USF Health’s comprehensive stroke center at Tampa General Hospital. They analyzed the outcomes in 251 adult patients with mild ELVO strokes as scored by the standardized National Institutes of Health Stroke Scale, widely used by doctors to measure neurological symptoms such as impaired movement, visual field, facial droop and slurring of speech and to help determine appropriate treatment. The patients had received one of two treatment approaches:  best medical management, or mechanical thrombectomy with or without pretreatment with clot-dissolving medications. The researchers then included this new retrospective study in a meta-analysis of three other outcomes studies comparing medical therapy with thrombectomy.

A lower rate of asymptomatic brain hemorrhage was found in the best medical therapy group, while the rate of functional independence three months after emergency treatment was higher in the medical thrombectomy group. However, their systematic review and meta-analysis of all four studies – the largest to date for this type of minor stroke — did not document any independent associations between the two treatment approaches and patient safety or effectiveness outcomes.

“This study does not answer our question about whether minor strokes should, or should not, be treated with mechanical thrombectomy in this particular patient population,” Dr. Mokin said. “But, it does offer evidence that mechanical thrombectomy is as safe as medical therapy alone. Ethically, that can help us move forward with randomized patient trials to answer the question.”

Dr. Mokin is the principal investigator for a three-year $419,000 grant from the NIH’s National Institute of Neurological Disorders and Stroke, studying how patient brain vessel anatomy interacts with the clot removal devices. The goal is to optimize endovascular approaches for treating acute ischemic stroke, a leading cause of death and long-term disability worldwide.

He led the recent update of the Society of NeuroInterventional Surgery’s standards of practice for treating strokes caused by ELVO.

This image shows a blockage of the right middle cerebral artery (arrow) impeding brain blood flow in a patient with acute stroke.

Image following retrieval of a large blood clot in the brain, now depicting a fully unobstructed vessel

-Images of thrombectomy courtesy of Dr. Max Mokin

USF Health doctors evaluate for refractory epilepsy, experts in treating surgical candidates

Some people pay it forward by donating to a charity or working in a soup kitchen. Six years after her own epilepsy surgery, Letitia Browne-James found an even better way to thank USF Health neurologist and epileptologist Selim Benbadis, MD, and USF Health neurosurgeon Fernando Vale, MD. Browne-James volunteers as a patient advocate.

Singing the praises of Dr. Benbadis and Dr. Vale, Browne-James said the two were a couple of the most compassionate and skilled physicians she has ever worked with. “And, as a way to pay it forward, I wanted to help patients,” she said.

Letitia Browne-James

“I’ve used my education in forms of advocacy for mental health and social justice. I also use it in the medical field by trying to advocate for patients, and teaching them how to get educated and how to self-advocate,” the St. Thomas, U.S. Virgin Islands native said.  “Four patients who suffered from epilepsy – either because they heard my story, or I talked to them and helped them get to the right place — are now seizure free.”

“The delay for patients like Letitia to have epilepsy surgery is more than 15 years, so it is very important to have patient advocates speak up and educate patients about exploring options other than multiple medications,” said Dr. Benbadis, a professor and director of the Comprehensive Epilepsy Program at USF Health and Tampa General Hospital.

Suffering from epileptic seizures since she was a baby, Browne-James was diagnosed officially with epilepsy at age 12.  She suffered seizures throughout high school, college, graduate school and beyond.  After her 27th birthday, the seizures became increasingly violent.  The news at the doctor’s office wasn’t much better.

Browne-James suffered from epileptic seizures since she was a baby. She is pictured here at age 5.

“My doctor at the time said there wasn’t anything we could do, other than switching up the medication frequently. But that action didn’t help,” Browne-James said.

A licensed mental health counselor in Florida, Browne-James found a top-notch psychiatrist to see if she was having pseudo-symptoms, possibly pseudo-seizures. After a psychological assessment, the psychiatrist ruled out pseudo-seizures.  She instead was diagnosed with anxiety due to the seizure disorder and prescribed Xanax.

She had enough and began extensively researching the subject online.  Her Google searches led her to a new kind of a doctor: an epileptologist, a neurologist who specializes in epilepsy that’s hard to diagnose and treat, or refractory.

After an initial meeting with epileptologist Dr. Ahmed Sadek of Neurological Services of Orlando, Browne-James was diagnosed with refractory epilepsy.   

Dr. Sadek explained to Browne-James why years of tests had failed to show seizure activity in her brain. He put her through a different series of tests over a five day period on an epilepsy monitoring unit.  His conclusion: she was a perfect candidate for epilepsy surgery.

Browne-James, right, at her graduation from Charlotte Amalie High School in 1999 (in St. Thomas US Virgin Islands), with friend Yonette Francis.

During a phone consultation with physicians at Mayo Clinic in Jacksonville, they recommended that she contact Dr. Benbadis and Dr. Vale of USF Health because Dr. Vale was an expert in epilepsy surgery and performed it often.

“I thought ‘if the Mayo Clinic says these doctors are good, then they are for me,”’ Browne-James said.

After her initial visits with Dr. Benbadis, she underwent a series of medical tests.  USF Health neuropsychologist Michael Schoenberg, PhD, performed IQ tests to determine if Browne-James would maintain normal cognitive functioning after surgery. These tests were normal and also helped further determine she was an ideal candidate for the surgery.

She was ready to start a fresh chapter of her life.

Browne-James with husband Jonah James, Jr., at their wedding in 2008.

“I had no anxiety whatsoever about having brain surgery, because I knew the way my life was deteriorating from epilepsy could not continue. It would kill me, whether physically or from the emotional stress. I am very grateful to them,” Browne-James said.

Dr. Vale performed the surgery in August 2012, and Browne-James has been seizure free since.  In IQ tests following the surgery, Browne-James scored the same in some areas, but in some areas there were definite improvements.

This summer she will finish her doctorate online at Walden University in counselor education and supervision with a specialization in counseling and social change.  “Reading and comprehension come easier,” Browne-James said.  “My brain feels free, not clouded like it was before the surgery.”

“The reason her mind is clearer is two-fold,” Dr. Benbadis said. “No more seizures, and fewer or no medications. Seizure medications work, but often cause side effects like fatigue, dizziness and mental fogginess.”

An adjunct professor at Stetson University, Browne-James hopes her doctorate will open more doors to further research and teaching.

“My work in the medical field is not exclusive to epilepsy patients,” she said. “I want to get all patients to understand the importance of self-advocacy and being an informed patient.  It’s important to understand your doctor works for you.”

Roni-Kay Lopez looks forward to celebrating her 10^th anniversary of living without seizures or medication

//www.youtube.com/watch?v=RhC_WCQ3zXo

Driving down a busy road, Roni-Kay Lopez knew she had to hurry and pull over.  Frightened, she couldn’t risk her life or the lives of others with what she knew was about to happen, so she drove through traffic to the side of the road. She then braced herself and suffered what she said felt like her millionth seizure.

After it passed and she started to regain her composure – she knew she couldn’t live like this anymore. The 29-year-old put her head on the steering wheel, exhausted. “They never took away my license, because I did feel them coming on and they were controllable.  But I wasn’t confident that would continue,” Lopez said.

Following that close call on the road, Lopez felt like enough was enough so she reached out to neurologist Selim Benbadis, MD, professor and director of the Comprehensive Epilepsy Program at USF Health and Tampa General Hospital. She wanted to find out if she was a candidate for surgery. She went through a thorough evaluation and after several tests, she found out her epilepsy was confined to the left temporal lobe of her brain. A few months later, neurosurgeon Fernando Vale, MD, also with USF Health, performed a left temporal resection on Lopez, removing a small part of the left temporal lobe.

Six weeks later, she begged to go back to work and she’s been going nonstop since.

USF Health neurosurgeon Selim Benbadis, MD, with patient Roni-Kay Lopez, who started the non-profit foundation Seize the Day to benefit people suffering from epilepsy.  Benbadis threw out the first pitch last year at a Rays game, where the foundation hosted a gathering.

Lopez looks forward to celebrating a milestone anniversary this year.  On April 24^th, she will be seizure and medication free for 10 years – the same day she went underwent surgery in 2008.

“If somebody would’ve told me as a kid, “You can do this, and you won’t have seizures.” I would’ve said, ‘yeah right, that’s not happening’. But, it’s happened and it’s been great,” Lopez beamed.

“This successful outcome with surgery is quite common with temporal lobe seizures, but unfortunately the delay before being evaluated for surgery is also very common,” Dr. Benbadis said of Lopez’s case.

Looking back, doctors told Lopez’s parents she would be lucky if she lived to be 16. Since infancy, she averaged almost 10 seizures a day. At times, her daily medications included up to eight tablets of Tegetrol (400 mg. each) and four Keppra (500 mg. each).

Lopez recalled a trip to the zoo with the Girl Scouts when she was 7 or 8 years old – she says she had 108 seizures that day. “It was really hot and humid and I guess the heat got to me,” she said. “My parents had to carry me around the zoo, because I refused to go home.”

Growing up with epilepsy was tough on her – many times she felt all alone.  “I got very tired. I would be doing something, have a seizure and lose all focus. I would try to get back to it, but many times I forgot what I was doing,” Lopez said. Besides seizures, another troublesome side effect included painful sores in her mouth.

Lopez, pictured here as a child, struggled with seizures for more than 20 years before her epilepsy evaluation and surgery by USF Health doctors.

In 2008, soon after the surgery, Lopez created Seize the Moment, a local non-profit foundation to help others who suffered from epilepsy. The foundation hosts many get-togethers, including outings at the Rays, Bucs and Lightning home games. “The Rays and the Lightning have been phenomenal in helping our foundation,” she said.

At a Rays game last year, Dr. Benbadis threw out the first pitch – a fitting tribute for someone who has helped so many.

In addition to hosting fun events for epilepsy patients and their families, the foundation also raises money with an annual bowl-a-thon and golf tournament. In February, Seize the Moment donated $10,000 to the Tampa General Foundation for funds raised in 2017.

To date, Seize the Moment has helped 12 patients and has provided aid to those with epilepsy, from ages 8 to 64.  “We want to put a smile on people’s faces — we are looking to make a difference,” Lopez said.  “In raising money, we aim to help with clinical research, patient care, medications and diagnostic testing.”

After going through so much the first 29 years of her life, Lopez needs only one word to describe how it feels to help her community, “Priceless!”

//www.youtube.com/watch?v=Oh5xsa_Eqzc

-Story by Michelle Young and videos by Freddie Coleman, USF Health Communications and Marketing.
-Photos courtesy of Roni-Kay Lopez

Tampa, FLA (Jan. 17, 2017) — The University of South Florida has launched a neurosciences initiative to integrate the latest treatment and research for a wide range of neurological and psychiatric disorders.

With the state-of-the-art USF Health Byrd Alzheimer’s Institute as its centerpiece and driving force, the new neuroscience initiative is being spearheaded by Dr. Harry van Loveren, vice dean of clinical affairs for the USF Health Morsani College of Medicine and chair of the Department of Neurosurgery and Brain Repair. Dr. van Loveren has a proven track record of highly effective administrative and clinical leadership skills, having served as interim dean of the USF medical school and developed one of its most successful departments. He is widely respected regionally and nationally as a top neurosurgeon and researcher with expertise in skull base surgery as well as microneurosurgical techniques.

Harry van Loveren, MD

The multidisciplinary initiative will bring together medical, surgical and research specialists from USF Health’s departments of neurology, neurosurgery and psychiatry – all dedicated to advancing treatment and prevention of brain, spinal cord and other nervous system disorders.

“The primary goal of this larger neurosciences initiative is to foster and coalesce interdisciplinary research collaboration among USF Health scientists looking at the brain in unique ways to accelerate new discoveries for a broad range of neurological conditions – including Alzheimer’s and related dementias, Parkinson’s, ataxias, epilepsy, multiple sclerosis and stroke – leading to improved treatment and prevention for the patients we serve,” said Dr. Charles Lockwood, senior vice president for USF Health and dean of the Morsani College of Medicine.

“Dr. van Loveren has the expertise and commitment to build a preeminent, strong neurosciences model that will provide an even greater infrastructure for moving neurological discoveries from bench to bedside,” Dr. Lockwood said.

By consolidating disease-specific areas of care for a wide spectrum of neurological conditions, the initiative is expected to strengthen collaborative, complementary research across USF neuroscience disciplines and allow patients to better access the care they need.

“We will build upon the success of the Byrd Alzheimer’s Institute in becoming a vital treatment and research center for Floridians affected by Alzheimer’s disease and other memory disorders,” Dr. van Loveren said.

“The neurosciences initiative will unify and coordinate all resources at the university for neurological and neuropsychiatric disorders so we can expand our neurosciences footprint and serve even more patients and their families. We envision USF Health becoming a national destination for all things related to brain disorders and brain health.

The endeavor will also help position USF to take advantage of new federal funding opportunities such as the National Institutes of Health’s BRAIN Initiative, a pioneering project aimed at revolutionizing the understanding of the brain and accelerating the development and application of new technologies for brain disorders.

                                                                                                                   -USF Health-
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences, the Biomedical Sciences Graduate and Postdoctoral Programs, and the USF Physicians Group. USF Health is an integral part of the University of South Florida, a high-impact, global research university dedicated to student success. For more information, visit www.health.usf.edu

Media contact:  
Anne DeLotto Baier, USF Health Communications
(813) 974-3303 or abaier@health.usf.edu

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

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Over and over again, Harry van Loveren, MD, walks through a surgery in his mind before actually cutting open the brain of his patient, perfecting every step and accounting for everything he will encounter, the expected and the unexpected.

Dr. van Loveren is chair of the Department of Neurosurgery in the USF Health Morsani College of Medicine, senior associate dean for Surgical Subspecialties at USF Health, and chief medical officer of the USF Physicians Group. Along with a brilliant mind and capable hands, his visualization technique has made him an accomplished and much sought after neurosurgeon.

Dr. Harry van Loveren.

“To prepare for the kind of operations I do you have to mentally do the operations a number of times before you walk into the operating room,” he said. “And you have to understand it all – the anatomy, the surgical instruments, the surgical techniques – so your mental experiments are valid, that what you see in your mind is what you will see in the patient’s head. That these things you see in your mind are true and that if it works in your mind it had better work in the operating room. And if I can’t see that in my mind’s eye, I go back to the (training) lab, go back to text books, and review videos and figure it out until I can create a paradigm in my mind where I complete the surgery successfully.”

How does someone decide to become a neurosurgeon? For Dr. van Loveren, it was because it’s considered the most difficult area of medicine and requires the longest amount of training.

“To be honest, I don’t know why other people go into neurosurgery but I know why a lot of us do – because we’re so egotistical and because we want to be the best,” he said. “As we’re going through medical school we look around and ask what would be the hardest thing I could do? What would be the biggest challenge? But I don’t think we’re the only ones who do that. For instance, look at people who go into the police force and say ‘I want to be on the SWAT team’ or go into the military and say ‘I want to be a Navy SEAL.’  There’s an element of that to becoming a neurosurgeon. We’re looking for the greatest challenge.”

Meeting that challenge has made him one of the most sought after neurosurgeons in Florida.

In fact, when he joined USF Health about 10 years ago, he set a goal for his Department to become the go-to neurosurgery department in Florida. Starting with only six neurosurgeons, he has built the Department to about 30 surgeons and nine PhDs, becoming a hub for the most complicated cases.

“My practice is a little bit unique,” he said. “It’s called complex cranial so I do the more complex side of brain operations and a lot of my practice is taking care of patients for other neurosurgeons in the state either for those things they don’t want to do or don’t feel they ought to be doing. That can be a bit of a lonely and frightening position to be in. But nobody wants to see any lack of confidence in us and we don’t really want to feel that lack of confidence.”

His other reason for choosing neurosurgery is because he saw it as the one specialty in which he would never stop learning.

“I chose it because it looked like my learning curve would go on forever,” he said. “When I looked at neurosurgery, I saw older neurosurgeons still making great contributions and the acquisition of experience is so valuable to neurosurgery. So the finish line is, wonderfully, always just beyond our reach.”

He admits, though, that the real reason he chose neurosurgery might truly be because he thinks “the brain is cool.”

“The brain is who we are, it’s what we think, it’s what we believe,” he said. “The ability to affect a person’s life by manipulating that organ is profound and extremely interesting. And we really get some insight into brain function when we’re operating on someone while they’re awake and speaking to you. And with certain stimulation you can bring back very specific old memories for the patient, you can play music, you can run videos. It’s all stored in the brain and you can recall it and make it come out for the patient.”

With a laugh, he added “It’s just a really satisfying career. You should try it sometime.”

By taking some of the most difficult brain surgery cases – the ones other neurosurgeons feel might be outside their scope and skill – Dr. van Loveren has built a solid reputation for helping some of the most vulnerable patients, those whose conditions might otherwise be deemed inoperable. That reputation is based on knowledge and surgical skill, but also involves his ability to relate to patients, to calm them and impart feelings of comfort, but also confidence.

“Taking care of patients, taking care of people, is what this is all about,” he said. “What I try to do is make people feel the way you might feel if you had a serious brain problem and your brother was a neurosurgeon. That kind of comfort level, that your brother is someone you know, someone you trust, someone who knows you, someone who cares about you, and everything your brother tells you will be the truth and the best for you. That’s my approach with patients. With the family and the patient there’s the ability and the need to walk in and say hello and reassure them that I see them, that I’m aware of and care about who they are and how afraid they are, that I’m fully focused on them, that I care. I let them know this is not just another case. And I let them know a little bit about myself, reveal my human side. I hope they gain some comfort from that interaction.”

All this intensity can make for only serious conversations but in chatting with Dr. van Loveren, you will quickly see other sides, including his love for skydiving. In fact, he admits that freefalling to the earth is the only activity he has found that lets him completely stop thinking about neurosurgery.

Photo courtesy of Harry van Loveren.

“Brain surgery is always with you,” he said. “You’re always thinking, wondering, analyzing, or performing surgery. You’re always being nudged by your wife walking down the beach and she says ‘where are you now?’ Which is one of the reasons I’m a skydiver. It is a profound break in concentration and lets me focus completely on something else. I’ve tried a lot of things, from golf to fishing, to be distracted. But I find that throwing the door open at 14,000 feet and getting out of the airplane, that’s when neurosurgery stops for a while.”

Photo courtesy of Harry van Loveren.

Story by Sarah Worth, photos and video by Sandra Roa and Mihaela Madsen, USF Health Office of Communications.

USF stroke experts staff the TGH Stroke Center, providing patients in the Tampa Bay region with 24/7 access to more specialized stroke care, including on-site neurosurgeons and medical teams trained in neurocritical care.

TAMPA, FL (Dec. 8, 2014) – Tampa General Hospital is the first hospital on the west coast of Florida to be awarded Comprehensive Stroke Certification, the highest national designation from the Healthcare Facilities Accreditation Program, a national certification organization recognized by the federal Centers for Medicare and Medicaid Services.

The new state-of-the-art Bayshore Pavillion at TGH has a dedicated Stroke Unit, a Trauma Resuscitation Unit and full capability CT and MRI scan in the Emergency Department; dedicated neuroangiography suites; and a Neurosciences Intensive Care Unit, which is one of the largest in the country.

This elite designation means the hospital meets the highest standards for safety and quality and can treat patients 24 hours a day with the most complex state-of-the-art stroke care.  Tampa General earned the national designation by meeting 21 evidence-based measures of complex stroke care. Continuous on-site neurologists, neurosurgeons, diagnostic radiologists and medical teams trained in neurocritical care are ready to treat emergencies immediately with highly trained and qualified nursing staff. Studies show that stroke patients have better outcomes when these standards are met.

“This provides an external validation for what we’ve known for a long time,” said Dr. W. Scott Burgin, director of Tampa General’s Comprehensive Stroke Center and professor of Neurology and chief of the Cerebrovascular Division at the USF Health Morsani College of Medicine.

“We are providing the highest level of care for our patients at Tampa General. Every stroke is different, and sometimes there are complications that require extremely specialized care that can only be found at comprehensive centers with a team on hand 24 hours a day who are trained to handle those complications.”

USF Health’s Dr. Scott Burgin directs the TGH Comprehensive Stroke Center.

Tampa General is the fourth hospital in the state to receive this national designation for its stroke program. It also is one of 34 Florida hospitals designated as a state Comprehensive Stroke Center, and one of 124 that the Joint Commission certifies as a Primary Stroke Center.

“This certification signifies that Tampa General Hospital has demonstrated and is clearly committed to advancing stroke treatment through innovation and best practice – placing them amongst world leaders,” said Michael Zarski, chief executive officer of HFAP. “Hospitals that have established stroke centers have demonstrated improved treatment, better patient outcomes, and reduced costs. In addition, Comprehensive Stroke centers are a resource to both the community and neighboring hospitals who are not equipped to offer the same level of care.”

Strokes occur when blood flow is disrupted in the brain. A clot can block a blood vessel, or bleeding can occur. If brain cells can’t receive blood and oxygen, they start to die, causing permanent damage. About 795,000 Americans have a stroke each year, making stroke the 4th leading cause of death in the U.S.

A stroke requires immediate emergency treatment and every minute counts. You can use the “FAST” acronym to recognize warning signs of a stroke: “Face drooping, Arm weakness, Speech difficulty, Time to call 911.”

-Tampa General Hospital-

Tampa General is a 1018-bed academic medical center on the west coast of Florida that serves as the region’s only center for Level l trauma, comprehensive burn care, and adult solid organ transplants. It is the primary teaching hospital for the USF Health Morsani College of Medicine. TGH is a comprehensive stroke center and a state-certified spinal cord and brain injury rehabilitation center. For more information, go to www.tgh.org.