Janet Christenbury

Brain tumor patient gives back and moves forward

Jennifer Giliberto

Don’t sweat the small stuff.

That’s the motto 36-year-old Jennifer Giliberto now lives by after recently welcoming a third child into the world. Late night feedings, diaper changes, mounds of dirty laundry and caring for two older boys (ages six and eight) would certainly be a challenge for most moms. But this mom is different.

Four years ago, Giliberto was diagnosed with a brain tumor – a slow growing Grade II astrocytoma located in her posterior right temporal lobe. The shocking diagnosis left Giliberto and her family with many choices and decisions to make.

Giliberto’s inspiring story was profiled on CNN on Aug. 16, 2011 in a special “Human Factor” segment, which takes a look at people accomplishing something significant after overcoming the odds.

The Long Road Ahead

After her second child was born in 2005, Giliberto began noticing a pattern of problems with her fine motor skills. Neurological testing revealed little, but an MRI (magnetic resonance imaging) revealed a lesion and possible tumor in the brain. Follow-up MRIs over the next year showed no new growth, but in June 2007, a definite brain tumor was detected by MRI.

While taking the watch and wait approach to determine if the tumor would grow, she became involved with the Southeastern Brain Tumor Foundation (SBTF) as a volunteer. She focused her efforts on raising money to support critical brain and spinal tumor research. She also met Emory neurosurgeon Costas Hadjipanayis, MD, PhD.

Hadjipanayis, an assistant professor in Emory’s Department of Neurosurgery, would soon become Giliberto’s physician. He confirmed her diagnosis and recommended surgical removal of the tumor.

Costas Hadjipanayis, MD, PhD and patient Jennifer Giliberto

On August 18, 2008, at Emory University Hospital Midtown, Hadjipanayis removed Giliberto’s brain tumor. “Jennifer underwent a craniotomy and had a gross total resection of the tumor, with no complications,” explains Hadjipanayis, who is chief of neurosurgery at the hospital. “She spent one night in the neurosurgical ICU and her recovery afterwards went well.”

Then he encouraged her to embrace life and live it to the fullest. Giliberto has taken her doctor’s orders to heart, and lives life with a new purpose than before.

Giving Back

To support and encourage other brain tumor patients, Giliberto serves as a patient and family advisor at Emory University Hospital Midtown. She visits with hospitalized patients and their families who are in similar situations as the young mother of three.

“This has been a very fulfilling experience and an outlet to give back,” says Giliberto. “Being a patient is lonely, even when you know you have support. Working to assist other patients and families and improve a system goes a long way to ease that lonely journey of the patient experience.”

Patient and family advisors also work to improve hospital processes and procedures from a patient perspective.

She also serves as vice president of the Southeastern Brain Tumor Foundation, continuing the mission to raise funds for research. The SBTF consistently funds innovative brain tumor research at Emory’s Winship Cancer Institute.

And she is a devoted wife and mother.

Moving Forward

Last year, when Giliberto and her husband decided they would like to expand their family of four, she consulted with Hadjipanayis. He, once again, encouraged her to live life and move forward. They did, and their youngest child was born in July 2011.

While Giliberto has remained stable since her surgery in 2008, she continues to have MRI’s every six to nine months to check for any tumor recurrence. Astrocytomas, even once removed, can recur and can also become cancerous.

But for now, it’s on with life as she knows it – stable, moving ahead and enjoying every day with a new sense of hope.

And as for the small stuff – Giliberto’s learned there’s just no reason to sweat it at all.

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Emory researchers receive grants to further work in pediatric brain tumor research

Dr. Castellino explains his research on medulloblastomas to participants attending the SBTF’s Grant Award Ceremony.

Two Emory researchers are being recognized by the Southeastern Brain Tumor Foundation (SBTF) for their work in pediatric brain tumor research.

Tracey-Ann Read, PhD, assistant professor in the Department of Neurosurgery, Emory University School of Medicine and director of the Pediatric Neuro-Oncology Laboratory at Emory was awarded a $75,000 grant for her work. She is studying the cell of origin that is responsible for the highly malignant pediatric brain tumor known as an Atypical Teratoid Rhabdoid Tumor (AT/RT). She is also developing a mouse model to study this very lethal brain cancer that occurs in early childhood.

Robert Craig Castellino, MD, assistant professor of pediatrics at Emory and pediatric hematologist/oncologist at Children’s Healthcare of Atlanta at Egleston received $50,000 to support his research efforts. He is studying how the childhood brain cancer, known as medulloblastoma, can metastasize from the brain to other sites in the body, specifically the spine. Medulloblastoma is the most common pediatric malignant brain tumor.

SBTF board members and researchers who were awarded grants pose following the April ceremony.

Read and Castellino received the awards at the SBTF’s Grant Awards Ceremony in April at Emory University Hospital Midtown. Two other researchers from Duke University were also presented with grant money for their contributions in brain tumor research in adults.

Emory neurosurgeon Costas Hadjipanayis, MD, PhD, is the president of the Southeastern Brain Tumor Foundation. He says research, from young investigators such as these, is crucial in the race to find a cure for brain tumors. As federal research funding becomes even more difficult to obtain with cuts in funding, private foundation grants, such as from the SBTF, can permit researchers to start important research projects that can provide preliminary data for bigger grant proposals.

The SBTF awards $200,000-300,000 each year to major medical centers throughout the Southeast in support of cutting-edge brain and spinal tumor research.

 

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Pilot simulation lab trains students, residents and staff at Emory University Hospital Midtown

EUHM simulation lab laparoscopic console

A new pilot simulation laboratory at Emory University Hospital Midtown (EUHM) is providing medical students, residents, nursing students and staff with hands-on training to develop, perfect and maintain their skills. Located in the former obstetrics/gynecology (OB/GYN) operating rooms, space that wasn’t currently being utilized, the lab focuses on team building, clinical competencies and research. This is the first simulation lab of its kind at EUHM.

The simulation lab is a joint venture of Emory Healthcare and Emory University School of Medicine, both providing equipment to outfit the lab and a wealth of expertise. Nursing Education, a department within Emory Healthcare, and the Emory School of Medicine have worked together in the development of the simulation lab. Some equipment being used has been donated or given to the hospital for training purposes.

One side of the simulation lab is set-up to train OB/GYN residents and students in deliveries and laparoscopic surgeries, cardiac arrests, mock codes and low volume/high risk procedures.

The other side of the lab focuses on nursing training, nursing education, central-line and intravenous insertion and medication dispensing. It is also being used by nursing for competency validation for new nursing employees and for annual skills assessment of current nursing staff.

Those instrumental in setting up the nursing side of the simulation lab are Sharlene Toney, PhD, RN, executive director, Professional Nursing Practice for Emory Healthcare, and Beth Botheroyd, RN, BSN, MHA/INS, nursing education coordinator for Emory Healthcare.

Toney says the lab is a critical part of the training and education of new nurses and current nursing employees, while also focusing on process improvement activities concentrated on patient safety. Nurses also have the opportunity to test their skills on training simulators and new equipment while in the lab.

Douglas Ander, MD, associate professor of emergency medicine and director of the Emory Center for Experiential Learning, and Jessica Arluck, MD, assistant professor of gynecology and obstetrics and associate director of the OB/GYN residency program at Emory, both oversee the training of residents and medical students in the simulation lab.

Ander describes the lab as a “proof of concept” center, with the small set-up being only the first step in the process. Down the road, he envisions a larger simulation center for all Emory Healthcare employees, Emory’s School of Medicine and even the community.

EUHM simulation lab - Noelle

Arluck observes as resident Hudson performs an ultrasound on Noelle, the birthing simulator.

Arluck says she uses the simulation lab regularly with OB/GYN residents, teaching them the basics of laparoscopic surgery on a training module and monitor. She also teaches students with the help of an adult-size doll named Noelle, which simulates delivering a baby and going into cardiac arrest.

The simulation lab has also opened the door to medical education research. Emory pulmonary critical care fellow, Jenny Han, MD, is studying to see if a standardized, advanced cardiac life support simulation training has any effect on real patient outcomes in the hospital.

In the future, plans include adding cardiac catheterization simulator capabilities, as well as emergency department and nursing station simulation space.

 

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Clinical trial for patients with atrial fibrillation tests implantable device in place of blood-thinning drug

Clinical Trial for Patients with A-fib

A new clinical trial underway for patients with atrial fibrillation will test an implantable device in place of a common blood-thinning medication, according to researchers at Emory University Hospital Midtown.

Atrial fibrillation (commonly called A-fib) is a heart condition in which the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to pool and form clots in the left atrial appendage (LAA). If a clot forms in this area, it can increase the chances of having a stroke.

Many patients with A-fib are prescribed blood-thinning medications, such as warfarin (brand name Coumadin), to prevent blood from clotting. This medication is effective in reducing the risk of stroke, but may cause side effects such as bleeding. It also requires frequent blood draws to monitor dosage levels.

The trial, called PREVAIL (Prospective Randomized EVAluation of the Watchman LAA Closure Device In Patients with Atrial Fibrillation Versus Long Term Warfarin Therapy), involves implanting a small, umbrella-shaped mesh device called the Watchman closure device, into the heart chamber via catheter. This is a confirmatory study (and the third study testing the implant), which will also look at safety and efficacy of the device.

David De Lurgio, MD, associate professor of medicine in the Division of Cardiology, Emory University School of Medicine, is the principal investigator of the trial. He explains that by implanting this device into the left atrial appendage of the heart, it closes that area off. That, in turn, prevents blood clots from escaping and entering the blood stream, which could lead to a stroke.

Patients are randomly selected by computer to either receive the device or remain on Coumadin without the device (control group). Those selected to receive the device will remain on Coumadin for 45 days following implant. If the heart tissue has healed after those 45 days, participants will be taken off Coumadin and placed on aspirin therapy and possibly clopidogrel (Plavix), an anti-platelet medication.

Researchers will then follow study patients with and without the device for five years, monitoring those who are no longer taking Coumadin very closely. If the FDA approves the device at the end of this clinical trial, participants in the control group will then have the option to receive the device.

De Lurgio and his colleagues have had five years of experience with this technology, thus far. Emory Healthcare is the only health system in Georgia providing access to this device through participation in this clinical trial.

For more information, please call 404-686-2504.

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Emory University Hospital Midtown rings in New Year with new babies

Elijah Jacobs Westbrook and mom, LaSonta Westbrook

Twins Sidney and Taylor Mency and mom Jazmin Mency

Emory University Hospital Midtown (EUHM) rang in 2011 with some new bundles of joy. The hospital’s first baby of the New Year was born at 1:35 am. Little Elijah Jacobs Westbrook made his surprise appearance about six weeks early, says his mother, LaSonta Westbrook. The 4 lb., 6 oz. little boy was quickly greeted by his three big sisters, who enjoyed seeing him through the nursery window. As the first boy in the family, Westbrook says Elijah can expect lots of “mothering” from his sisters.

A little more than an hour later, EUHM welcomed its first set of twins in 2011. At 2:49 a.m. and 2:58 a.m., twin girls Sidney and Taylor Mency were born. Also a little early, mom Jazmin Mency says the gift of her girls is a wonderful way to begin the New Year.

The hospital ended up delivering 14 babies on January 1, 2011 (including the three mentioned), a busy way to kick off the New Year.

Emory University Hospital Midtown features a comprehensive maternity center that combines all maternity services on one floor, including labor and delivery, mother-baby suites and general and special care nurseries. Its design reflects the hospital’s unique philosophy of developmentally supportive care, encouraging family involvement and ensuring optimal infant development.

EUHM opened the first neonatal intensive care unit (NICU) in the Southeast in 1981, and currently, it serves as the Emory Regional Perinatal Center, one of five centers in the South designated to care for high-risk infants. With a Level III-designated NICU, the hospital’s skilled neonatal nursery staff has the expertise and technology to care for and treat almost any medical or surgical complication in sick and premature infants.

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Summer travel may require a stop at Emory TravelWell

As the weather gets warmer and schools wind down for the year, many around the metro Atlanta area begin making plans for summer vacation and travel.

African continent

Eco-touring or “giving back” trips have become popular, as have mission trips to developing and underserved countries. Both types of travel can enrich the lives of the travele rs and give a vacation experience. But before boarding the plane or boat, experts say don’t forget pre-travel care and immunizations.

Emory’s TravelWell clinic, located at Emory University Hospital Midtown, provides pre-travel care before journeying abroad, including a travel health education, immunizations, as well as medications, if illness occurs while traveling. The clinic also offers post-travel care, if needed, once back home.

Phyllis Kozarsky, MD

Phyllis Kozarsky, MD, medical director of TravelWell, says, “Travelers need to get the proper travel health education, including immunizations and prophylaxis medications, to safeguard themselves against preventable diseases and illness before leaving the country.”

The clinic has been caring for local travelers for 22 years – missionaries, families, students, educators and business men and women traveling abroad, many for extended stays. It also cares for immigrants and refugees coming into the country who need these services.

Read more

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Families reunite at Emory for annual “preemie” party

They are the hospital’s tiniest patients, and many must overcome the odds of prematurity and severe illness to survive. These premature babies, often called “preemies,” are cared for by the physicians and staff in the Special Care Nurseries at Emory University Hospital Midtown (EUHM).

The state-of-the-art nursery, designated a Level III nursery, provides the widest variety of advanced care available for premature and sick newborns. The neonatologists and nursery staff are all highly skilled in caring for these little babies and their many needs after birth. They also must teach the parents to care for their little ones when they go home.

Baby in the NICU

Baby in the NICU

Some of the infants are there for just a week or two. Others are there for months. And during their stay, special bonds are formed and many precious milestones are shared between the families and their caretakers.

Each December, doctors, nurses and staff in the Special Care Nurseries come together with the “preemie graduates” and their families to celebrate life and renew acquaintances at the hospital’s annual “Preemie Party.” The Special Care Nurseries held its 27th annual Preemie Party with more than 100 families in attendance.

It’s a time for grateful family members to once again thank those who cared for their babies when they were so fragile and sick. And it’s a time for the hospital staff to see how the little ones are growing – many now toddlers, school-aged children, teenagers and some even in their 20s return.

Ann Critz, MD, chief of Pediatrics and medical director of Nurseries at EUHM, says, “This annual party gives us the opportunity to visit with ‘our babies’ and their families again to see the progress they’ve made since leaving the hospital. It’s wonderful to see these children developing and thriving now, when they were once so small and medically fragile. This gathering is a very sentimental time for me each year.”

Critz, who is an associate professor of pediatrics, Emory School of Medicine, has cared for hundreds of preemies during her 29-year tenure at Emory University Hospital Midtown.

Susan Horner, RN, nurse in the Special Care Nurseries and Preemie Party coordinator, says, “It’s a joy to reconnect with the little ones and their family members who spent so many hours in our nurseries nurturing their preemies before taking them home.”

All babies born at the hospital, including preemies, experience a concept called “family-centered care,” which encourages parents to assist in caring for, rocking, holding and feeding their babies daily. Despite all of the tubes and monitors needed for the preemies, this family-centered care is vital.

Critz notes that the technique is extremely important in the neonatal intensive care unit, called the NICU. Bonding with even the smallest infants in the early stages is critical for the baby’s development. She and her colleagues have found the more parents are involved with the care of their preemies, the better the babies thrive.

EUHM has been a leader in neonatal care for as far back as the 1940’s. The hospital’s NICU opened in 1981 and currently serves as part of the Emory Regional Perinatal Center, one of six regional perinatal centers in the state to care for high-risk infants. Learn more about the maternity center at EUHM.

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Importance of flu vaccinations for pregnant women

Pregnant women are at the top of the Center for Disease Control and Prevention’s priority list when it comes to vaccinating people against the novel H1N1 flu virus this year. Not only should pregnant women receive the 2009 H1N1 vaccine, they should also receive the usual seasonal flu vaccine, say Emory experts.

Staying healthy in pregnancy

Staying healthy in pregnancy

Because pregnancy weakens the immune system, a pregnant woman who gets any type of flu has a greater chance for serious health problems. Pregnant women who contract H1N1 flu are more likely to be admitted to the hospital, compared with other people in general that get H1N1 flu. Pregnant women are also more likely to have serious illness, including pneumonia and death from this particular novel strain.

Both vaccines are made with a dead, or inactivated, flu virus and are given as an injection, usually in the arm. The other type of flu vaccine is a nasal spray and is not recommended for pregnant women. The nasal spray vaccine is safe for women after they have delivered, even if they are nursing.

A recent study by Emory researchers found that seasonal flu vaccination of pregnant women can benefit both mothers and infants, says Kevin Ault, MD, associate professor in the Department of Gynecology and Obstetrics at Emory.

Saad B. Omer, MBBS, MPH, PhD, assistant professor of global health at Emory’s Rollins School of Public Health, served as senior author on the report, published in the American Journal of Obstetrics & Gynecology. The study shows that there is substantial evidence that vaccination is not only safe for pregnant women but that it is critical for protecting women and their infants against serious complications from the flu.

Other members of the research team included Ault and Carlos del Rio, MD, professor and chair in the Hubert Department of Global Health, Rollins School of Public Health, Emory University.

The seasonal flu shot has been given to millions of pregnant women over several decades . Flu shots have not been shown to cause any harm to pregnant women or their babies. The 2009 H1N1 flu vaccine is being made in the same way and by the same manufacturers as the seasonal flu vaccine, explains Ault.

Ault also serves as principal investigator of a seasonal flu vaccine clinical trial underway at Emory Vaccine Center involving pregnant women.

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Stopping teen dating violence a priority for Jane Fonda

Jane Fonda, founder/chair of the Georgia Campaign for Adolescent Pregnancy Prevention (GCAPP), along with local teenagers and Atlanta community groups have launched the Start Strong: Building Healthy Teen Relationships Program. Its goal is to stop teen dating violence and abuse before it starts.

The Jane Fonda Center at Emory was chosen as one of 11 community organizations nationwide to receive $1 million in funding through the Robert Wood Johnson Foundation’s national Start Strong initiative. This is the largest national public health initiative ever funded, targeting 11-to-14-year-olds, to stop teen dating violence.

Jane Fonda speaks at the event

Jane Fonda speaks at the event

Fonda says the initiative, both locally and nationally, promises to educate and empower teens and their surrounding communities that dating violence and abuse among teenagers must be stopped before it ever starts.

With teen dating abuse a significant public health issue in this country, Fonda wants to focus on teaching young people to develop healthier and more positive relationships at an early age.

As part of this four-year initiative, Start Strong Atlanta will rally the entire community, including teenagers, parents, caregivers, educators, coaches and community leaders to build environments that support healthy relationships and ensure violence and abuse are never tolerated.

Students perform at the Start Strong event

Students perform at the Start Strong event

Melissa Kottke, MD, MPH, assistant professor in the Department of Gynecology and Obstetrics, Emory School of Medicine, is the director of the Jane Fonda Center. She notes that October is Domestic Violence Awareness Month and the campaign’s launch was the perfect tie-in. Kottke is also the principal investigator of the national initiative at Emory.

The Jane Fonda Center along with its partners, Atlanta Public Schools and Grady Memorial Hospital Teen Services Program, have together developed a comprehensive community plan for this initiative. This plan will focus on four core strategies involving education, policy change, community outreach and social marketing campaigns to empower local teens to develop healthier relationships.

Learn more about Start Strong Atlanta and other related events going on during Domestic Violence Awareness Month. Find out what Fonda said about the event on her blog.

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Obesity ups risk for endometrial cancer

Increasing numbers of obesity in both men and women nationwide are resulting in a growing rate of multiple health consequences. Recent research suggests that overweight women are at an increased risk of developing endometrial cancer, especially if menopause occurs in women younger than age 45.

One study has found that women with a body mass index (BMI) of greater than 35, who experienced their last menstrual period at an age younger than 45, had more than 20 times the risk of developing endometrial cancer than normal-weight women.

BMI is a measure of body fat based on height and weight that applies to both adult men and women. A BMI of 18.5 to 24.9 is considered normal weight, 25 to 29.9 is considered overweight and a number over 30 is considered obese.

Mary Dolan, MD, MPH, assistant professor of gynecology and obstetrics, Emory School of Medicine, notes that experts already know that obesity is linked to cardiovascular disease, high blood pressure, diabetes, joint complications and other diseases. Now the connection between obesity and endometrial cancer is on experts’ radar.

Mary Dolan, MD, MPH

Mary Dolan, MD, MPH

Endometrial cancer forms in the tissue lining the uterus or endometrium – the lining that is “shed” monthly during menstruation. Endometrial cancer is more common in older women and fortunately is usually diagnosed early since it causes abnormal bleeding, says Dolan.

In a report published recently, Dolan and colleagues from the Centers for Disease Control and Prevention (CDC) discuss findings from a review of data from the Cancer and Steroid Hormone study from the 1980s. This study examined the relationship between oral contraceptive use and breast, ovarian and endometrial cancers in women ages 20-54 years.

Since many of the study patients with endometrial cancer were overweight, the study gave researchers an opportunity to look at the risk for endometrial cancer among younger, overweight women using BMI.

The study found that women who were younger than 45 when they had their last period and had a BMI over 35 had a 21.7 times greater risk of developing endometrial cancer than a woman of normal weight.

In comparison, older women with a BMI of 35 or higher, who had their last period at age 45 or older, had a 3.7 times greater risk of developing endometrial cancer than a woman of normal weight.

Elevated risks were also seen for women who had been overweight or obese at age 18 and who had their last period before age 45.

Dolan says obesity can lead to higher levels of estrogen because of chronic “anovulation,” where a woman fails to ovulate. Because the condition brings on irregular or no menstruation, estrogen levels remain high while opposing progesterone levels remain low. Experts believe this combination leads to an increased risk of endometrial cancer.

Dolan says physicians need to counsel patients even more to maintain a healthy weight. By both losing weight and then maintaining it, a woman’s risk for endometrial cancer likely decreases.

This study is one of only a few which have focused on younger women and the relationship between obesity and endometrial cancer. The results were published in the July 2009 issue of Obstetrics & Gynecology

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