Rounding at Rush

Rush University Medical Center's neurocritical care team treats patients with complex, emergent neurological conditions, providing them with advanced care that is available 24 hours a day, seven days a week. In this episode of Rounding at Rush, Rajeev Garg, MD, chief of the Division of Neurocritical Care at Rush, talks about how Rush clinicians collaborate closely with stroke specialists and neurosurgeons to treat patients with a range of severe neurological injuries, including aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, large ischemic strokes, traumatic brain injuries, status epilepticus and spinal cord injuries. “Time is brain. The longer an injured brain remains without treatment, the worse the damage and the worse the outcomes. As neurointensivists, our goal is to limit damage to the brain and provide patients the best possible outcomes for recovery.”

Rush cardiologists use sophisticated diagnostic and therapeutic tools and work in a collaborative, interdisciplinary manner to provide superior outcomes for patients with advanced heart failure. Featured in this episode of Rounding at Rush are Tisha Suboc, MD, a cardiologist and the medical director of Advanced Heart Failure at Rush, and Karolina Marinescu, MD, a cardiologist and the director of the Infiltrative Cardiomyopathy Program at Rush. “When we see patients, we see them on a continuum,” says Dr. Suboc: When we see them in the hospital, the care doesn't just stop once they're discharged. We take care of them from the time they're in hospital to when they're discharged and follow them long-term. It's not just the patients' heart failure team; they're seen by their cardiologist, endocrinologist, electrophysiologist and primary care doctor. The multidisciplinary approach we use at Rush has brought us success in managing these types of patients.”

Highly skilled clinicians at RUSH MD Anderson Cancer Center diagnose, treat and prevent all types of skin cancer and other skin conditions. One treatment tool at their disposal is Mohs micrographic surgery, an advanced, minimally invasive and highly effective treatment for skin cancer. In this podcast, Miriam Mafee, MD, the division chief of Dermatological Surgery at Rush University Medical Center and a Mohs micrographic surgeon at RUSH MD Anderson, discusses how and when to use Mohs surgery, its advantages, as well as how this type of surgery continues to evolve. “We use appropriate use criteria (AUC), which helps separate less severe from more severe cases of skin cancer. This helps to maximize the utilization of Mohs surgery. We don't use Mohs surgery for every single skin cancer patient or every single skin cancer case. There are times where it really makes sense to be used and times where it doesn't. AUC, which you can find on an app, is a great help with this.”

RUSH MD Anderson Cancer Center's Breast Cancer Risk Assessment and Personalized Screening Program incorporates sophisticated diagnostic and therapeutic tools that Lisa Stempel, MD, and her colleagues use to determine the most effective care pathway for patients who are at high risk for breast cancer. Dr. Stempel is a diagnostic radiologist at RUSH MD Anderson. She is chief of the Division of Breast Imaging and director of the High-Risk Cancer Screening Program at RUSH MD Anderson. “Screening mammography is a great model we can use for early detection for other types of cancers. For example, if we can catch breast cancer in its early stages, say stage 0 or 1, there's a 99.9% cure rate. Even if it's stage 2, we have a 93% cure rate. Early detection applies to almost all types of cancers, too. What we've learned is that with mammography and the addition of supplemental screening tests, we can find breast cancer at the earliest stages.”  

The Rush Neurosurgery program is a nationally recognized leader in neurosurgical care, incorporating the most advanced surgical and nonsurgical therapies to treat brain, spine and nervous system conditions. Rush neurosurgeons collaborate with neurologists, neuroradiologists, physiatrists and otolaryngologists to address these conditions, providing patients with individualized and disease-specific approaches in several subspecialty clinics and centers across Chicago and surrounding communities. Vincent Traynelis, MD, is the interim chair of the Department of Neurosurgery at Rush University Medical Center. He is also the vice chair of academic affairs and the director of the Spine and Peripheral Nerve Section at Rush. “At Rush, our surgeons are highly trained and specialized in performing skull base surgery. They have the skill set to handle complex tumors and they work hand –in hand with our colleagues in otolaryngology. They discuss these tumors preoperatively. They consider all of the options. They have the latest equipment. And I believe what sets us apart is that we have the right people with the right focus who can get along and work well together.”

RUSH MD Anderson Cancer Center offers leading-edge treatments for GI cancers, including targeted therapies, immunotherapy, chemotherapy, and minimally invasive surgical options. Our multidisciplinary team of medical oncologists, gastroenterologists, surgical oncologists, colorectal surgeons and interventional radiologists work together to provide our patients with tailored treatment plans to each patient's specific diagnosis and needs. Audrey Kam, MD, is the director of GI medical oncology at RUSH MD Anderson, as well as the research director of GI medical oncology at RUSH MD Anderson. She specializes in treating gastrointestinal cancers including colorectal, esophageal, gastrointestinal, liver, pancreatic and stomach cancers. Sam Pappas, MD, is the Division Chief of Surgical Oncology at Rush University Medical Center. He specializes in treating upper abdominal cancers, including ones in the esophagus, stomach, pancreas, liver and bile duct. “We love collaborating in immediate proximity to each other within RUSH MD Anderson. This helps to ensure coordinated, multidisciplinary discussions that are patient-focused,” explains Dr. Pappas.

In this episode, Ihsan Kaadan, MD, MS, discusses how he and Rush clinicians provide tailored, wraparound care for patients with peripheral artery disease (PAD) and chronic venous insufficiency. We also profile Dr. Kaadan's unique role in guiding Rush's multidisciplinary approach to treat these conditions, where he works with cardiologists, vascular surgeons and interventional radiologists to deliver optimal patient care. Dr Kaadan is a vascular medicine specialist in the Rush University System for Health; he evaluates and treats patients with complex arterial and vein disorders. “It's a one-stop shop at Rush, which sets us apart. A patient can come to the vascular medicine clinic, get evaluated for their disease, then start treatment either with me or one of my colleagues in cardiology or interventional radiology. Patients can also receive cardiac rehab and occupational and physician therapy, so they're supported throughout their entire experience

At RUSH MD Anderson Cancer Center, oncologists provide patient-centered, cutting-edge care, such as immunotherapies, targeted therapies and minimally invasive surgeries for the treatment of lung cancer. In addition, RUSH MD Anderson clinicians offer patients access to some of the most innovative clinical trials available nationwide. In this episode, Helen Ross, MD, discusses some of the exciting new clinical trials that Rush is participating in, as well as rising rates of lung cancer in young adults and how to best care for them. Helen Ross, MD, is a thoracic medical oncologist and an expert in the care of patients with cancers of the chest, including lung cancers, mesothelioma and thymic cancers. Dr. Ross is director of research and clinical trials at RUSH MD Anderson. She is also a professor in the Department of Internal Medicine and serves as interim chief of the Division of Hematology, Oncology and Cellular Therapy. “We're only opening clinical trials onsite that are the right fit for our patients. We have an expedited review at RUSH MD Anderson to cut activation time and are working to further reduce that time to bring those trials more quickly to our patients.”

The Rush Cell Therapy Lab provides stem cell transplants, bone marrow transplants and other advanced cell therapy treatments for patients with leukemia, lymphoma, multiple myeloma, and other hematological malignancies. In addition, the lab will soon function as a contracted manufacturing facility partner for the production and quality control and release of cell and gene therapies, representing a significant leap in decentralized hospital based cellular therapeutic manufacturing. Mahzad Akbarpour, PhD, is the Director of the Rush Cell Therapy Lab at RUSH MD Anderson Cancer Center and is also an Assistant Professor of Internal Medicine in the Division of Hematology, Oncology, and Cell Therapy. “When CAR-T cells first came on the market a few years ago, Rush was one of the first centers in the nation to provide this therapy to its patients. We've also been involved in several clinical trials to advance care and we'll soon be able to manufacture our own cells on-site.”

The older adult population is the largest-growing cohort of epilepsy patients in the United States. One in four newly diagnosed patients is 65 and older, and that number is set to double by 2055. With the signs of epilepsy presenting in more subtle ways than in younger patients, older adults tend to be late- and mis-diagnosed. In addition, the geriatric population is often excluded from clinical trials because of age. Thus, this group is underrepresented and its clinical impressions from epilepsy are not well understood. Rebecca O'Dwyer, MD, is a neurologist and epileptologist in the Rush Epilepsy Center and is the Director of the Epilepsy Clinic for Older Adults at Rush. Her clinical expertise is in epilepsy and cognition, as well as epilepsy and seizures in the older adult population. “A lot of us in the epilepsy, neurology and lay community associate epilepsy with being a disease of the youth. But we see this bimodal distribution of cases in younger patients as well as older ones. For older adults, epilepsy can present as a symptom of an underlying disorder.”

Danny Luger, MD, is a cardiologist in the Rush University System for Health and the co-founder of the Rush Metabolic Health Consortium. He runs the Rush Center for Prevention of Cardiovascular Disease at Rush Oak Park whose goal is to prevent patients from developing cardiac disease. When meeting with patients, Dr. Luger helps them identify their barrier to achieving a healthy lifestyle, whether it is sedentary behavior, multiple risk factors for cardiovascular disease, high blood pressure, high cholesterol, or diabetes. After getting to know his patients, he creates individualized medical plans to help them overcome those factors. “The model that we're trying to put forth is preventive, where we can engage people in health and wellness well before they develop manifestations of disease. Eighty percent of cardiovascular disease is preventable, so we know this is an effective strategy. It's a matter of changing the way that our system approaches chronic diseases and the way that patients conceptualize seeing a doctor.”

With expertise in neurosurgery, neuro-oncology, radiation oncology and palliative care, clinicians in the Rush Spine Tumor Clinic are able to provide patients with comprehensive, tailored treatment plans when they have benign or malignant spinal tumors. Depending on the location and size of the tumor, as well as the patient's age and overall health, the treatments that Rush provides can help patients regain a better quality of life by lessening their symptoms, such as mobility and memory challenges, pain, speech difficulties and seizures. John O'Toole, MD, MS, is a neurosurgeon and the co-director of neurosciences service line at Rush, as well as the co-director of the Coleman Foundation Comprehensive Spine Tumor Clinic. Ken Tatebe, MD, is the clinical director of stereotactic radiosurgery, the neuro-oncology research director and is a radiation oncologist at Rush. “It can be a struggle for patients to obtain the best care at multiple different institutions, especially when their care providers may not all be on the same page for treatment. We strongly feel that providing this kind of interdisciplinary care under one roof really results in the most optimal treatment plans for patients,” explains Dr. O'Toole.

Endoscopic sleeve gastroplasty (ESG) is a novel, outpatient endoscopic approach to treat obesity. Without using permanent anatomical alterations, clinicians who incorporate ESG into their care suture the inside of the stomach as a way of reducing the stomach's volume down to the size of a banana, allowing patients to get full faster. In the continuum of weight loss therapies, including medication and surgery, ESG is a viable approach for patients looking for a minimally invasive approach to achieve their weight loss goals. Christopher Chapman, MD, is a gastroenterologist at RUSH University Medical Center whose expertise is in interventional and bariatric endoscopy, with a focus on providing patients minimally invasive approaches in their care. “Surgery is a very effective therapy, but is more invasive. Pharmacotherapy, at least before the introduction of GLP-1s, was minimally invasive, but also wasn't as effective [as surgery]. Endoscopy [such as ESG] is in the middle of being a little bit more invasive, but also more effective than medications.”

In this episode, Salina Lee, MD, a gastroenterologist at RUSH University Medical Center, will discuss how the detection and removal of adenomas is key to helping gastroenterologists prevent patients from developing colorectal cancer. Additionally, she will profile several colorectal cancer screening tools, as well as the latest advancements in colonoscopy, including the use of GI Genius that helps to produce higher adenoma detection rates. “GI Genius is a novel artificial intelligence that's built into our processor to help us identify potential adenomas. You may wonder if GI Genius is helpful even amongst gastroenterologists who already have an adequate, or even good, adenoma detection rate. There's research that shows it does increase the detection of polyps when compared to humans alone, even if they were considered experienced.”

The RUSH Multiple Sclerosis Center features a team of world-class clinicians and researchers, dedicated to offering the most advanced, comprehensive and individualized treatment protocols to patients affected by multiple sclerosis (MS), neuromyelitis optica (NMO), spectrum disorders (NMOSD) and other autoimmune disorders affecting the central nervous system. In this episode, Augusto Miravalle, MD, the Chief of the Section of Multiple Sclerosis at RUSH, discusses the importance of whole brain health for MS patients, his work to reach and treat underserved populations, and the vital role patient education plays for beneficial short and long-term outcomes. “One of my priorities is to improve healthcare literacy [about MS]. It's been demonstrated that patients who have a high level of literacy do better [in their care]. They have better clinical outcomes and they have a better understanding of the importance of certain types of lifestyle interventions.”

Catheter-based approaches to treat congenital and structural heart diseases are providing patients with a minimally invasive option for care when they are not eligible for traditional surgery. Hussam Suradi, MD, an interventional cardiologist at RUSH who specializes in treating patients with complex coronary and peripheral artery disease, will talk about several of these interventional approaches, including TAVR, or transcatheter aortic valve replacement, and TEER, or transcatheter edge-to-edge repair to their patients. The podcast will also profile several promising new clinical trials that are evaluating the use of the next generation of catheter-based intervention in TAVR, TEER and TTVR, or transcatheter tricuspid valve replacement. Dr. Suradi is fellowship-trained in structural heart interventions and is skilled in treating patients with heart valve conditions, such as tight or leaky valves, and those who are born with heart defects. He is also the director of the Cardiac Catheterization Lab and the Structural Hybrid Lab. “At RUSH, we specialize in the treatment of a variety of different structural heart conditions using cutting-edge transcatheter approaches. We're also excited to take part in several trials that are helping to move patient care forward.”

Bladder cancer is a condition that primarily affects elderly patients, causing symptoms such as blood in urine, changes in urinary habits and pain during urination. It's the fourth most common cancer among men and the eighth most common cancer among women in the United States. In this episode, Gary Steinberg, MD, discusses the challenges in managing bladder cancer, which can range from low-grade and non-invasive to high-grade and invasive. He also highlights the importance of providing patients with an early diagnosis and profiles the range of treatments available for patients today. Dr. Steinberg is a urologist at RUSH and a national authority in the surgical treatment of bladder cancer and continent urinary tract reconstruction. He is a recognized expert in translational bladder cancer research and has made significant contributions to the understanding of both non-muscle invasive and invasive bladder cancer. “Treatment for patients with intermediate risk, non-muscle invasive bladder cancer is an unmet need. Most patients with intermediate risk bladder cancer have a low risk of progression, but  their risk of recurrence is quite high. Our standard form of treatment, chemotherapeutic agents, is inadequate, but we're changing the way we deliver them. We think these new ways could improve the delivery of the drugs to the bladder lining cells.”

Clinicians in the RUSH Cancer Center are continually providing tailored cancer treatment to their patients. In today's episode with Jessica Slostad, MD, a breast oncologist in the RUSH University System for Health, she profiles one possible, future avenue for personalized medicine--organoid drug screening. Although they are still being evaluated, tumor organoid drug screening may play a key role in the evolution of personalized cancer care. This type of screening could help clinicians test the effectiveness and side effects of therapies prior to giving them to patients. Later in the episode, she profiles the ways she treats women with pregnancy-associated breast cancer, along with the unique challenges mothers and their babies encounter during treatment. Dr. Slostad is an assistant professor of Medicine in the Division of Hematology, Oncology and Cellular Therapy at RUSH and specializes in breast cancer management. Her research interests include clinical and translational research with a focus on precision oncology and organoid technology. “As we get more data and if [that data] supports the hypothesis that tumor organoids can be used as a drug screen to predict response, we would eventually look to see if we can use the tumor organoid to pick which therapy for the patient. Our data is not there yet; we first need to establish that there is concordance between the drug screen and what the patient is getting.” CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/490159/

Genetic testing plays a crucial role in the diagnosis and management of neuromuscular illnesses. Testing can help provide a definitive diagnosis in cases where clinical symptoms alone may not be conclusive. Neuromuscular disorders often share overlapping symptoms, making it difficult to distinguish between them based solely on clinical presentation. Rabia Malik, MD, is a neuromuscular physician in the Department of Neurology at RUSH University Medical Center and is the director of the RUSH Muscular Dystrophy Association Care Center Clinic. Rich Dineen, MS, CGC, is a certified genetic counselor in the section of Neuromuscular Diseases at RUSH. Dr. Malik explains that “having the right clinical question is definitely the most challenging piece of neuromuscular illness [care]. You need expertise and experience in recognizing what particular neuromuscular disorder you may be dealing with because that would subsequently help with [choosing the right] genetic testing.”   CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/489637/

The RUSH Parkinson's Disease and Movement Disorders program treats over 7,000 patients with movement disorders, the majority of whom have Parkinson's disease (PD). RUSH is currently conducting about 150 research projects related to movement disorders; half of those focus on PD. Research on PD at RUSH encompasses a wide breadth of inquiry, from clinical phenotypes to pharmacologic interventions and much more. Deborah Hall, MD, is a neurologist and movement disorder specialist and the Division Chief of the Section of Movement Disorders at RUSH University Medical Center. She also co-leads the novel RUSH PD GI Clinic, a novel multidisciplinary clinic focused on the gastrointestinal health of patients with PD and other movement disorders. “Gene-based therapies are a particularly exciting area of research. Over the last five years, RUSH's goal has been to personalize treatment for PD patients. This particular strategy coincides very nicely with the worldwide gene discovery effort to look at the genetic causes of Parkinson's disease.”   CME Link:  https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/489645/

RUSH electrophysiologists treat patients with atrial fibrillation through a number of pharmacologic, non-surgical and surgical approaches, while also helping them modify risk factors to slow down progression of this chronic disease. Our providers treat newly diagnosed, paroxysmal, persistent and permanent atrial fibrillation. RUSH clinicians coordinate patients' care before, during and after treatment, tailoring a multidisciplinary treatment plan that specifically meets their needs. Dr. Erica Engelstein is an electrophysiologist in the RUSH University System for Health and an expert in treating atrial fibrillation. Her clinical interests include evaluation and treatment of patients with suspected or documented arrhythmias, including catheter ablation of atrial fibrillation and ventricular tachycardia. “Some patients are best managed with rate control and anticoagulation so that we don't expose those patients unnecessarily to an invasive procedure. However, if the chances of restoring and maintaining a normal heart rhythm are good--and a lot of patients fit that profile--then they may be better managed with a more aggressive approach including catheter ablation.” CME Link:  https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/488912/ 

Through its participation in several stage III and IV lung cancer clinical trials, RUSH is a leader in identifying future treatments for patients with early and late-stage non-small cell lung cancer. By studying genetic mutations and analyzing genetic sequencing, RUSH is also developing new hypotheses about lung cancer progression through its partnership with Tempus. Mary Jo Fidler, MD, is a thoracic oncologist and professor of Internal Medicine at RUSH University Medical Center. She is the Medical Oncology Section Chief in the RUSH Cancer Center and is the national principal investigator for the ADAURA trial, which is studying the effects of postoperative Osimertinib in resected EGFR+ lung cancer patients. “We have at our fingertips an enormous amount of data [on non-small cell lung cancer]. When we generate hypotheses for tumor resistance and cancer cachexia, it is really helpful to have this large data set as we try to make sense out of the multitude of gene rearrangements, amplifications and RNA sequencing changes.”   CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/489638/

Clinicians in the RUSH Spine Center take an integrated, multidisciplinary approach with the assessment and management of spine problems. They provide patients with innovative, evidence-based and individualized non-surgical and surgical treatment plans aimed at rapidly restoring function and quality of life. Hong Wu, MD, is a physiatrist and the Director of the RUSH Spine Center. Ricardo Fontes, MD, PhD, is a neurosurgeon and the director of the RUSH Neurosurgery Residency Program. “The success of the multidisciplinary approach is just the recognition that nobody has a set recipe for every patient,” says Dr. Fontes. “This model is very versatile and can offer a gamut of options to our patients. Surgery is not the solution for most patients and some may do very well with non-operative treatments.”

Whether cancer patients are newly diagnosed, currently receiving treatment or having completed treatment, the role of a physiatrist is to optimize their function and quality of life. While physiatry has grown in its incorporation in cancer care nationwide, RUSH is one of a small number of hospitals offering dedicated physical medicine and rehabilitation care for its cancer patients. Obada Obaisi, MD, is an assistant professor in the RUSH Department of Physical Medicine and Rehabilitation and is the director of cancer rehabilitation at RUSH University Medical Center. “My role [as a physiatrist] is to maintain or restore function, minimize symptom burden, maximize independence and ultimately improve quality of life for cancer survivors. Cancer rehabilitation involves a large, multidisciplinary team that includes myself, physical therapists, occupational therapists, speech language pathologists, dieticians and psychologists. I often tell patients I'm their quarterback for their function, so I can help identify which of these services the patient may need and coordinate with them based on their impairments.” CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/488832/

Critical limb ischemia is the end stage of peripheral arterial disease (PAD). With early detection and intervention of PAD, RUSH providers can prevent critical limb ischemia and major amputation for patients. RUSH is one of the only academic medical centers in Chicago and the Midwest to perform complex revascularization to restore blood flow and salvage limbs. Kumar Madassery, MD, is the director of the Peripheral Vascular Interventions and Critical Limb Ischemia Program in the RUSH University System for Health. He is also an associate professor of Vascular Interventional Radiology and is the director of the Advanced Vascular Interventional Radiology Fellowship at RUSH. “One providers specialize in treating patients with peripheral arterial disease that has progressed where they need some type of surgical or endovascular intervention. Over the last 10 to 15 years, we've seen an exponential growth of revascularization strategies and techniques that have helped to save patients from amputation.” CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/488817/ 

Clinicians in the RUSH Department of Urology are some of the country's leading laparoscopic and robotic surgeons who offer patients the most advanced diagnostic capabilities for diagnosing urologic cancers, including prostate cancer. Once a timely, accurate diagnosis has been made, RUSH urologists create tailored treatment plans that leverage leading-edge treatments to improve patient outcomes and their quality of life. Edward Cherullo, MD, is a urologist and the chief of the Department of Urology at RUSH University Medical Center. Under his leadership, Dr. Cherullo has expanded the Department's efforts to provide comprehensive subspeciality care that incorporates the latest minimally invasive technologies. As a result, the Department of Urology is a regional and national leader of urologic care and is currently ranked No. 14 in the country by U.S. News & World Report. “Prostate cancer is a very infiltrative cancer, which can be invisible on CT scan and even standard MRI. The advanced diagnostic technologies we use allow us to see the prostate gland in detail, including some of its metabolic activity and the cancer with 85 to 90% accuracy, which is good. That accuracy helps us make more accurate decisions regarding treatment.” CME link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/487011/

The DRAGON 1 and 2 trials are large, multicenter, international trials that are evaluating the use of combined portal and hepatic vein, or double vein, embolization, to treat advanced liver cancer and metastases. Double vein embolization has the potential to become a new standard of care that could provide patients with life-extending and even life-saving treatment. Erik Schadde, MD, FACS, FEBS (HPB), a transplant surgeon at RUSH University Medical Center, spearheaded the creation of the trial and has been at the center of some crucial discoveries in the use of double vein embolization. “Sometimes liver tumors are so big or there are so many that you have very little liver left in the body if you want to remove them. In the past, those tumors haven't been resectable. But we've actually found that you can grow the liver, so even very small liver remnants can now serve as a future liver remnant. Double embolization is an exciting new method that's allowing us to do that.” CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/486727

RUSH University System for Health has a high-volume program for breast cancer treatment and reconstruction, incorporating a multidisciplinary approach that involves our plastic surgery, surgical oncology and medical oncology teams. This approach ensures our patients are treated with a coordinated, individualized care plan. RUSH also performs a wide range of leading-edge implant and flap breast reconstruction procedures after mastectomy or lumpectomy. Rosalinda Alvarado, MD, is a breast surgeon experienced in breast conserving surgery, mastectomy including nipple-sparing mastectomy, oncoplastic surgery, sentinel node biopsy and breast cancer prevention and risk reduction. Deana Shenaq, MD, specializes in both implant-based and autologous reconstruction after breast cancer and in microvascular techniques for lymphedema treatment, including lymph node transfer and lymphovenous bypass procedures. “It's very important that Dr. Alvarado does what she needs to do to get the cancer out safely and have a negative margin,” says Dr. Shenaq. “My main goal is not only to prevent recurrence, but also to do the reconstruction in the most aesthetically pleasing way possible.” CME link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/486749

The RUSH University System for Health is nationally recognized for its delivery of timely, effective stroke care and expertise in treating some of the most complex stroke cases. Within the past year, three multidisciplinary subspecialty clinics were opened at RUSH to provide an even greater level of specialty stroke care for patients. Rima Dafer, MD, is a vascular neurologist and the director of the Comprehensive Outpatient Cerebrovascular Diseases Clinic at RUSH University Medical Center. She has been a principal investigator on numerous clinical trials in acute stroke intervention and secondary stroke prevention. Her clinical interests center around stroke occurrence in young adults and the association of stroke and atrial fibrillation. “Our stroke-cardiology and stroke-neurosurgery clinics provide patients with a personalized individualized care plan tailored to their unique needs depending on their condition. And our stroke prevention clinic plays such an important role in helping patients understand very simple risk factors that aid in primary stroke prevention.”   CME link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/486244

Led by Mark Wiet, MD, the RUSH Acoustic Neuroma Program offers personalized specialty care for patients with acoustic neuroma, a benign and often slow-growing tumor of the nerve that connects the ear and the brain. The program brings together specialists in neurotology, neurosurgery, radiation oncology, neuro-oncology, neuroradiology, audiology and physical therapy, who have extensive expertise in the diagnosis and treatment of this rare condition. Dr. Wiet is the head of the section of otology, neurotology and lateral skull base surgery at RUSH University Medical Center. Board certified in otolaryngology and neurotology, he specializes in the comprehensive management of acoustic neuroma and lateral skull base tumors, pediatric and adult implantable hearing devices, including cochlear implants and bone anchor hearing aids and pediatric and adult general otology.  “We offer all of the broad treatment options for acoustic neuroma--observation, radiation and surgery--and because of that, we offer an unbiased opinion of care. We have a full complement of providers all working together to help patients achieve their best possible outcome.”    CME link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/486241/

As the no. 3 ranked neurology and neurosurgery program in the country, RUSH University Medical Center is at the forefront of providing leading edge care and participating in pathfinding neuro-interventional research. At the center of this work is R. Webster Crowley, MD, who discusses Rush's use of the CorPath robotic system, Woven EndoBridge Embolization System and the RIST catheter. He is the chief of the Section of Cerebrovascular and Endovascular Neurosurgery, as well as the surgical director of the Comprehensive Stroke Center. He is also the director of the Endovascular Neurosurgery Fellowship and his research interests include stroke, aneurysm treatment, pseudotumor cerebri and subarachnoid hemorrhage. “We were one of the first programs to use the CorPath endovascular robot, which is used to diagnose cerebral angiograms, but has the potential for broader interventional uses with aneurysm and stroke treatment in the future. Rush also performed the first surgery in the world using the RIST catheter, which helps neurosurgeons access cerebral aneurysms with a better safety profile. Our neuro interventional program allows us to expand the ways that patients have access to the latest minimally invasive care.”   CME Credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/485661 

Polyvascular disease is the presence of atherosclerosis in more than one arterial bed. While it is not a new phenomenon, polyvascular disease has been brought to the forefront in recent years through the expansion of clinical and research endeavors that include non coronary atherosclerosis, specifically lower extremity peripheral artery disease and cerebrovascular disease. The relevance of polyvascular disease is centered on its associated heightened risk for cardiovascular death, myocardial infarction and ischemic stroke. Faisal Hasan, MD, FACC, FSCAI, is the Clinical Division Chief of Cardiology at RUSH University Medical Center and the Co-Director of the Cardiovascular Service Line at RUSH. Dr. Hasan is also an associate Professor in the Department of Internal Medicine, Division of Cardiology, at Rush Medical College whose recent work has focused on investigating outcomes in patients who present with myocardial infarction and have coexisting polyvascular disease. “[In treating polyvascular disease], the patient is at the center of the care management team and all care providers, regardless of their subspecialty, come together and unify to treat these complex patients. We have noticed that this kind of collaborative approach leads to improved coordination of care leading to better patient outcomes.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/485203

The RUSH Cancer Center has a deep commitment to accelerating innovations that bring cutting edge research to the bedside. Two examples of those innovations that Steven Gitelis, MD, and RUSH have an active role in developing are 3-D printed models, which can help to preserve healthy tissue when treating benign and malignant bone and soft tissue tumors, and hybrid cold plasma, which can help stop the recurrence of cancer after surgery. Steven Gitelis, MD, is a highly regarded expert in the area of orthopedic oncology and limb reconstruction and currently serves as the Director of Musculoskeletal Oncology at the RUSH Cancer Center and the Director of the RUSH Center for Limb Preservation. He has been repeatedly voted as one of Chicago's best doctors by Chicago Magazine and one of America's top doctors by Castle Connolly.  “Any patient who has bone cancer where you're trying to do limb salvage and preserve as much healthy tissue as possible, they are all good candidates for 3-D printed technology. The laboratory efficacy is well established in modeling, but we're all anxious to see the clinical outcomes and prove that these patients have better function, which is my hope and expectation.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/485026  

The movement disorders neurology group at RUSH University Medical Center is one of the largest and most experienced groups in the world, with clinicians who specialize in managing the symptoms of Parkinson's disease and other movement disorders. One of the treatment modalities they use to treat these patients is deep brain stimulation (DBS). DBS helps patients with movement disorders control their symptoms of tremor, rigidity, stiffness, slowed or abnormal movements and walking problems. RUSH treats the largest number of DBS patients in the Midwest. Dr. Neepa Patel is a neurologist in the RUSH University System for Health and the director for the Movement Disorder Interventional Program in the Department of Neurological Sciences. Her interests include improving the quality and delivery of care for patients receiving deep brain stimulation (DBS) and education to improve the utilization of new therapies in movement disorders. She is also part of the RUSH team caring for essential and Parkinsonian tremor patients with MR-guided focused ultrasound, an incisionless treatment designed to reduce hand tremor. “We work in a very comprehensive, multidisciplinary, team-based approach at RUSH to treat patients with movement disorders using DBS. We share our ideas and experiences because everyone comes from different training backgrounds, different expertise and years of experience in managing patients. This helps us take care of patients who are nontraditional, but who still could benefit from this therapy.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/484707/  

The vascular and interventional radiology department at RUSH University Medical Center provides the most current and clinically comprehensive care to patients. Several of Rush's internationally renowned interventional radiologists have helped to pioneer and advance many interventional techniques used today. By performing the latest procedures and engaging in advanced research, our providers are working to uncover new uses for interventional radiology approaches as well as refine current techniques, in specialties such as oncology, peripheral arterial disease and women's health. Jordan Tasse, MD, an interventional radiologist at RUSH University Medical Center, profiles the cutting edge procedures performed through interventional radiology care at RUSH. As one of the few places nationwide to provide the full spectrum of vascular and interventional procedures, interventional radiology care at RUSH has transformed the lives of many of its patients, particularly those affected by cancer. Dr. Tasse is also the Director of Interventional Oncology at RUSH and is an Associate Professor of Radiology and Vascular and Interventional Radiology at RUSH Medical College.  “We have a really great atmosphere of collaboration between different specialties. Our approach is grounded in a multidisciplinary fashion where we have medical oncologists, hepatologists, liver surgeons, colorectal surgeons, radiation oncologists, and interventional oncologists all talking at multidisciplinary tumor boards and developing the best approach to each patient's cancer care.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/484420

The RUSH Center for Skull Base and Pituitary Surgery, a leading program in the treatment of  skull base disorders, brings together experts from more than 10 specialties to provide personalized, comprehensive care for patients with complicated skull base pathology such as pituitary adenoma, acoustic neuroma, meningioma and cerebrospinal fluid leak/encephalocele. Pete Batra, MD, the Chair of the Department of Otorhinolaryngology – Head and Neck Surgery at RUSH University Medical Center, highlights Rush's unparalleled expertise, its use of leading-edge treatments and how it's developing novel therapies for rare types of cancers. Batra, an internationally recognized rhinologist and anterior skull base surgeon, serves as the co-director of the RUSH Center for Skull Base and Pituitary Surgery and medical director of the RUSH Sinus, Allergy and Asthma Center. “We can provide patients with the highest quality outcomes in the nation through our investment in the next generation of surgical navigation platforms. Having the latest and greatest tools, devices and instrumentation is important, but the most critical aspect is expertise, which I really think is the key ingredient to [our] success.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/484209/

RUSH University Medical Center and the RUSH Center for Congenital Structural Heart Disease have been at the forefront in developing state-of-the-art therapies for congenital and acquired structural disorders. Minimally invasive innovations, such as transaortic valve replacement (TAVR), MitraClip and the CoreValve, have helped patients enjoy faster recovery times, less pain and, typically, less cardiac rehabilitation. Clifford Kavinsky, MD, PhD, joins the podcast to profile the next generation of minimally invasive cardiac care, including several clinical trials that RUSH is participating in. Dr. Kavinsky is the Director of the RUSH Center for Adult Structural Heart Disease, the Chief of the Section of Structural and Interventional Cardiology and the Associate Director for the Cardiovascular Disease Fellowship Program. He is an expert on catheter-based therapies for heart and vascular disease and is an internationally recognized leader in the use of novel treatments for adults with congenital and structural heart disease. “It's a really exciting time to practice cardiovascular medicine when there's such an explosion of technology and thrust towards less invasive techniques that historically we've always done with large surgical procedures. It's particularly satisfying to be able to put a new valve in a patient and send them home the next day.  When you think about surgery and how they used to be in the hospital for a week and recover for six to 12 weeks, it's quite remarkable.” CME link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/483920/    

Five years ago, RUSH University Medical Center was treating very few patients with fibrolamellar carcinoma. Today, RUSH treats the largest number of patients in the country with this rare type of liver cancer, which typically affects adolescents and young adults. During that span, RUSH has developed innovative, cutting edge treatments and is considered a national leader in the treatment of this disease. Paul Kent, MD, a pediatric hematologist-oncologist and the medical director of the fibrolamellar carcinoma program at RUSH, profiles the forward thinking treatments RUSH developed. Patients who were previously unable to have their liver tumors surgically removed became surgical candidates at RUSH. And some patients who were once on hospice care were given second chances through the groundbreaking work of Dr. Kent and his colleagues. “When you have a very rare, terrible disease that we know most people can't survive without some dramatic [intervention], then that's your opportunity to try something new. As long as what you're trying has scientific rationale, is logical and, equally important, that you follow very closely for any side effects, then you publish those results, good or bad, so the world can learn from it.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/483689

Cardiac positron emission tomography (PET) perfusion with flow quantification is the latest advancement in nuclear stress testing and is used to examine how well blood flows to the heart muscle. RUSH is the first and only hospital in Illinois to offer this technology. Dr. Rupa Sanghani, a cardiologist in the RUSH University System for Health, discusses the ways RUSH incorporates cardiac PET perfusion in its complement of cardiac diagnostics and care, the benefits of using it and when cardiac PET should be implemented. Dr. Sanghani is the director of RUSH University Medical Center's nuclear cardiology and stress laboratory and the associate director for the RUSH Heart Center for Women. Her clinical expertise is in cardiac imaging, cardiovascular risk assessment and counseling, coronary artery disease and with women who either have heart disease or are at risk for it. “It's a huge boon to offer our patients and referring physicians cardiac PET perfusion. We can use information from it to provide patients with a comprehensive risk assessment for their cardiac health. Flow and flow reserve is what people are most excited about with PET. The advantage to cardiac PET is that we're not just looking at relative perfusion, but we can actually quantitate the myocardial blood flow.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/483393

The RUSH System for Health excels in stroke prevention and care. RUSH University Medical Center is certified as a Comprehensive Stroke Center by the Joint Commission and RUSH has two certified Primary Stroke Centers in Oak Park and Aurora/Fox Valley. Given the time-sensitive nature of stroke care, RUSH seeks to expand current treatment windows and improve technologies used to treat emergency strokes as quickly and effectively as possible to minimize damage to our patients. Michael Chen, MD, a professor of neurology, neurosurgery and radiology at RUSH University Medical Center, discusses the ways RUSH is efficiently diagnosing stroke, how it is differentiating actual cases of large vessel occlusion stroke with false positives and how RUSH handles the benefits and challenges of using thrombectomy. Dr. Chen has authored over 100 peer-reviewed scientific publications and also serves as a senior editor for the Journal of Neurointerventional Surgery. Dr. Chen currently serves as President-Elect for the Society of Neurointerventional Surgery. “There's strong evidence that highly effective therapies exist for stroke and they're also very time sensitive. If you have a large vessel occlusion stroke, 75% of the time patients are not going to do well. Thrombectomy can reduce that chance of a horrible outcome by half. The question is not necessarily whether you can make the diagnosis and what you do, but what work you have done ahead of time to prepare for the event when that patient does come into your emergency room.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/483128

The head and neck cosmetic and reconstructive surgery specialists at RUSH University Medical Center treat patients whose appearance, ability to speak, swallow or smile has been affected by cancer surgery or radiation therapy. They also provide a wide range of in-office facial cosmetic procedures and surgical rejuvenation techniques. Peter Revenaugh, MD, the head of the section of Facial Plastic and Reconstructive Surgery at RUSH University Medical Center, joins the podcast to talk about how RUSH's comprehensive approach translates to excellent patient care, the research RUSH is conducting around reconstructive procedures and how the COVID-19 pandemic affected the demand for cosmetic procedures. “What makes RUSH stand apart is the expertise of our physicians. We can help patients with facial paralysis. We can offer microvascular procedures to help with facial movement. We're pioneering procedures for synkinesis or abnormal facial movements after paralysis that aren't being done anywhere else in the country.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/482889

Launched in 2020, RUSH's breast cancer risk assessment program systematically assesses the risk of breast cancer, offering patients who qualify opportunities for supplemental screening in order to improve their breast cancer detection rate. Mia Levy, MD, PhD, the director of the Cancer Center at RUSH University Medical Center and the system vice president for cancer services at the RUSH University System for Health, joins the podcast to talk about RUSH's program, what she sees as the evolution for this type of learning system at RUSH, and what are some of the early findings--and questions--that have come up thus far. “We want to learn from the experiences of every patient who's coming through our breast cancer screening program--not just the patients who are participating in clinical trials. In this way, we are optimizing our workflows and data collection to evaluate the outcomes of the program and continuously improve on our screening guidelines and our workflows in order to optimize the best outcomes for our patients.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/482640

As pioneers in the treatment of multiple sclerosis and other neurologic conditions, RUSH delivers life-changing treatment for patients in its state-of-the-art infusion program. Thomas Shoemaker, MD, a neurologist in the RUSH University System for Health, joins Rounding at Rush to discuss RUSH's infusion program, what he and his colleagues have learned about infusions during the COVID-19 pandemic and where the future of neurologic treatments is heading at RUSH. Dr. Shoemaker specializes in treating neuro-immunologic conditions such as multiple sclerosis, neuromyelitis optica spectrum disorder, neurosarcoidosis and acute disseminated encephalomyelitis. The RUSH Multiple Sclerosis Center has been recognized as a Center for Comprehensive Care through the National Multiple Sclerosis Society. Rush's Neurology and Neurosurgery programs, which include the MS Center and infusion program, are ranked number four in the nation and best in Illinois by U.S. News and World Report. “For our MS patients, it seemed like our only treatment was IV corticosteroids for the longest time, which would often require inpatient admission for three to five days,” explains Dr. Shoemaker. “In the infusion center, we can quickly administer corticosteroids and IV immunoglobulins to many patients on an outpatient basis so that they can go home for the day and return again on an outpatient basis to finish their treatment. Infusing patients this way naturally makes it less cumbersome on them.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/482333   

Rounding at Rush welcomes John O'Toole, MD, to the show to discuss spinal tumor care at RUSH University Medical Center. RUSH is known for its use of minimally invasive procedures, interdisciplinary nature that streamlines care and success in creating better quality of life outcomes for its patients. Dr. O'Toole is a neurosurgeon in the RUSH University System for Health, specializing in spinal oncology, minimally invasive spine surgery, complex spinal reconstruction and spinal radiosurgery. He is the Co-Director of the Coleman Foundation Comprehensive Spine Tumor Clinic and a Professor in the Department of Neurosurgery at RUSH Medical College. “We reduce morbidity, recovery times and blood loss through the use of minimally invasive surgical techniques,” says Dr. O'Toole. “For the cancer population we treat, that's incredibly important. These patients don't have a lot of time to recover from major operations before they get on to radiation treatments and other systemic treatments for their cancer. We've been leaders in the use of these techniques, making a big difference in both the short-term and long-term outcomes for patients with spinal tumors.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/482099

Parikshit Sharma, MD, MPH, joins Rounding at Rush to discuss His bundle and conduction system pacing, which involves placing permanent leads anywhere along the AV conduction system to maintain biventricular pacing and synchrony. Dr. Sharma is a cardiac electrophysiologist at RUSH University System for Health who specializes in managing rhythm disorders of the heart. He is the section chief of cardiac electrophysiology, the director of the electrophysiology lab and an associate professor of medicine at RUSH Medical College. “We can decrease heart failure hospitalizations in patients with His bundle pacing compared to right ventricular pacing,” says Dr. Sharma. “And while right ventricular pacing can be associated with adverse clinical outcomes, such as cardiomyopathy, heart failure hospitalizations, atrial fibrillation and associated mortality, His bundle pacing can essentially prevent a lot of them from occurring.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/481815

Sepehr Sani, MD, joins Rounding at Rush to discuss MR-guided focused ultrasound, a safe, incisionless treatment designed to reduce hand tremor in patients with essential and parkinsonian tremor. It targets a specific area of the brain with high-intensity focused ultrasound, guided by magnetic resonance imaging (MRI). Dr. Sani is a neurosurgeon at RUSH University Medical Center and an associate professor of neurosurgery at RUSH Medical College. Among his many clinical interests, Sani focuses on deep brain stimulation, Parkinson's disease, essential tremor and vagal nerve stimulation. “MR-guided focused ultrasound represents a paradigm shift,” says Dr. Sani. It is a “really life-changing treatment without having to have any anesthesia, without having to have a single incision … they literally walk in and walk out. In the neurosurgical realm, … to be able to offer a treatment to a patient without using a knife, is a first. It's pretty amazing." CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/481403/