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More than 28 million Americans — three times more women than men — suffer from migraine, a type of headache that’s often severe. Although any head pain can be miserable, migraines are often disabling. With a “complex migraine” symptoms can include weakness, loss of vision, or difficulty speaking in addition to a headache – often mimicking a stroke.
In the video David Dodick, M.D., neurologist, Mayo Clinic in Arizona, explains the symptoms, triggers and treatment for complex migraines. A nationally recognized expert on headaches, Dr. Dodick is the president of the American Headache Society, Editor-in-Chief of Cephalalgia, Director and Founder of the Headache Program and Headache Fellowship Program at Mayo Clinic in Arizona. He is also the Medical Director of the Mayo Clinic Comprehensive Concussion Program.
Mayo Clinic and Arizona State University (ASU) have signed an agreement that represents a formal commitment to enhance the collaborative relationship that has been building steadily over the past eight years. This agreement will pave the way for Mayo and ASU to deepen their mutual engagement across a full spectrum of activities related to healthcare, medical research and education.
Victor Trastek, M.D., VP, Mayo Clinic, CEO, Mayo Clinic, Arizona says this will result in high value patient care.
The Mayo Clinic and ASU relationship has flourished since the early 2000s. Joint programs have included a nursing education program, seed funding for collaborative research projects, faculty appointments and dual degree programs. To date, these activities have been primarily limited to Mayo Clinic’s Arizona campus, but new programs may span across all Mayo campuses in all three shields of practice, education and research.
The success of the earlier initiatives has led to this broader, formal collaboration agreement, which builds on the accomplishments while setting an ambitious vision for an enhanced level of cooperation and partnership in the future.
“For Mayo Clinic, this will mean engagement with ASU at all levels across the entire organization, spanning activities in all three shields of practice, education and research,” says John Noseworthy, M.D., president and CEO, Mayo Clinic. Together with ASU, we will design and implement new ways to deliver high-value health care.”
In the first significant development from the enhanced Mayo ASU collaboration, plans are under way for the ASU Department of Biomedical Informatics to move from downtown Phoenix to the Scottsdale campus of Mayo Clinic by late summer.
A new study in the Journal of the American Medical Associationdiscussed in today’s The New York Times finds many women with early stage breast cancer tumors with involvement of one or two lymph nodes may not need removal of additional lymph nodes from the armpit. The study shows removal of these lymph nodes does not change the treatment plan, or improve survival or recurrence rates.
Judy Boughey, M.D., Mayo Clinic breast surgeon, notes this is a practice-changing study, but patients must meet specific criteria:
Study statistician Karla Ballman, Ph.D., of Mayo Clinic’s Cancer Center, discusses study methodology and concerns about the study’s sample size below:
In addition to Drs. Boughey and Ballman of Mayo Clinic in Rochester, Minn., Mayo has numerous experts who are available for comment on this study, including Sarah Ann McLaughlin, M.D., of Mayo Clinic in Florida, and Barbara Pockaj, M.D., of Mayo Clinic in Arizona.
The session, entitled Stories from the Heart: Survival Stories from WomenHeart Champions, featured four women panelists with heart disease who are sharing their powerful stories on hope and survival. The WomenHeart Champions advocate for prevention, early detection, accurate diagnosis and proper treatment for women with heart disease. Their stories put a face on heart disease and make the statistics on women’s heart disease come to life.
Diane McDaniel – She was diagnosed with congestive heart failure during pregnancy in 1970, she was hospitalized from when she was five months pregnant until her daughter was two weeks old. Her daughter has played an important role in her journey with heart disease and emphasizes the importance of family members being educated on the treatments, symptoms, prevention and what to expect if your family member has heart disease. Diane has had heart valves repaired and replaced and has had four Transient Ischemic Attacks (TIA). Diane now has a pacemaker implanted and is on medication to control her condition.
Diane went from “being a young, very productive woman to being young and sick; she wasn’t ready for that.” She understood that part of living with the illness is about being healthy; she made lifestyle changes and also began exercising, eating right and maintaining a healthy weight. “My heart disease has shaped me in some ways, but it does not defeat my aspirations to excel personally or professionally. While having this condition has made a major impact on my life, it as has not barred me from having a full life. I have a 40 year old healthy daughter. I completed Law School in my thirties and I am the presently employed as a lawyer in New York City.”
Nadine Jenkins – She has cardiomyopathy and suffered a silent heart attack before age 34. She now benefits from an implanted defibrillator to manage her arrhythmias and protect her from sudden cardiac death. Nadine’s husband and children have supported her through all of her challenges. She’s had several episodes where her defibrillator has shocked her and she’s thankful it worked and to be here today. She’s a doctoral student at the University of Medicine and Dentistry of New Jersey in pursuit of a PhD in health science.
“Today, I am living with heart disease and have taken my experience and passion about healthcare to another level.” Nadine volunteers at several organizations and participates in many advocacy events for women with heart disease. Physically, she looks very healthy – she’s thin, tall and doesn’t smoke, but because people often related heart disease to males and older individuals, they often are surprised when she tells people she has heart disease. “You can have everything that looks great on the outside, but have this silent killer lurking inside you. People are blown away when I tell them I have heart disease.”
“I know that it is through grace and mercy that I am still here today, and I hope to inspire others who are at risk or already have suffered as a result of heart disease. You can be young and beautiful and still have heart disease; look at me.”
Maxine Levy – She was a heart attack survivor at age 41. Now in excellent health, this bank executive credits her angioplasty, medication and, most of all, her healthy lifestyle and commitment to regular exercise to living well with heart disease. She tells women to be strong. If you feel you are having a heart attack, be your own advocate, as she illustrates in her story.
“I firmly believe that I can attribute my prolonged good health to my daily exercise routine. I’m up at 5AM every weekday and working out on my elliptical for 40-45 minutes. On Sunday’s I meet my girlfriends for a 4-mile walk in a park. I consider this regimen as important as any medication.”
“15 years ago, when I had my heart attack, I doubted I would live to see my 5 year-old son’s bar mitzvah. Today, I have lived to celebrate his bar mitzvah, his older brother’s wedding and I firmly believe that I can live to dance at the bar mitzvahs and weddings of my yet unborn grandchildren.”
Brendaa Hayes – At age 40, she collapsed on her kitchen floor and was then diagnosed with several heart rhythm abnormalities. “Without warning, family history or injury, I was thrust into a life of heart disease.” She’s been treated with medications, catheter ablations and a pacemaker. She is a mother and college professor who has overcome many challenges of living with heart disease. She deals with her condition daily and never knows when she’ll have a bout of supraventricular tachycardia, atrial fibrillation and bradycardia. It worries her children greatly and they are nervous about what can happen to her at any moment.
Her teenage children have been through a great deal of stress as Brendaa went through her surgery. Her daughter has had to help out a great deal around the house and had to mature quickly; her son who is autistic, has had difficulty understanding what is going on. “I’m very lucky to have a wonderful group of lady friends willing to come over to her home and help out.”
“Each day I give thanks for waking up in the morning and hope that I can have 24 hours without an incident. They are few and far between.”
As part of a Special Briefing for News Media at The Paley Center for Media in New York today, one panel discussion delved into the many unique aspects of heart disease diagnosis, treatment and prevention for those conditions that occur predominantly in older women.
Panelists:
• C. Noel Bairey Merz, M.D., Director,Woman’s Heart Center, Cedars-Sinai Medical Center in Los Angeles. Dr. Bairey Merz’s research interests include mental stress and heart disease, the role of exercise and stress management in reversing disease and the role of nutrition in heart disease. She is a recognized authority on heart disease and stress.
• Patrice Desvigne-Nickens, M.D., Program Director, Division of Cardiovascular Diseases, National Heart, Lung and Blood Institute (NHLBI), Bethesda, MD. Dr. Desvigne-Nickens, who is responsible for scientific development of research programs focused on prevention, recognition and treatment in cardiovascular medicine, is particularly interested in developing ways to personalize medicine that can improve cardiovascular health for women and minorities.
• Alexandra Lansky, M.D., Director, Yale Women’s Heart Center, New Haven, Conn. Dr. Lansky has served as the principal investigator on numerous angiographic and intravascular ultrasound core laboratory studies. Under her leadership, the Yale Women’s Heart Center pursues gender-based outcomes research and education in interventional cardiology and prevention.
• Ileana Piña, M.D., Professor of medicine, professor of epidemiology/biostatistics Case Western Reserve University Cleveland, Ohio. Dr. Piña, a cardiologist and heart failure/transplant expert, is internationally recognized for her research in rehabilitation and recovery of heart failure patients and how heart failure presents differently in men and women. She is a recurrent presenter/speaker in the World Congress of Cardiology in Spain, Argentina, Germany and China.
• Chet Rihal, M.D., Chairperson, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Dr. Rihal Rihal’s clinical interests are interventional cardiology (particularly structural heart disease intervention), use of ventricular support devices for high-risk angioplasty and management of acute coronary syndromes. He’s a recognized expert on apical ballooning syndrome — also called broken heart syndrome. This condition mimics heart attack symptoms of shortness of breath and chest pain and can be triggered by severe emotional stress. It most often affects postmenopausal women.
Jonathon LaPook, M.D., a medical correspondent for the “CBS Evening News with Katie Couric” and an associate clinical professor of medicine at Columbia University Medical Center, moderated the panel discussion.
Young women and heart disease? It’s not on everyone’s radar screen, but it should be . The number one killer of women in the United States, also impacts women of child bearing age. Over 40,000 have heart problems during pregnancy, while others have pre-existing conditions – obesity, Type II diabetes, high blood pressure – that affect pregnancy and the health of children born of those pregnancies. Overall, 47 million women are at risk for heart disease. Over a half million women die from heart disease annually.
A panel of experts showcased these problems in New York on Tuesday during a media briefing on women and heart disease sponsored by Mayo Clinic and the Paley Center for Media. Moderator Soledad O’Brien of CNN emphasized that this topic is critical for journalists to understand and wondered why people aren’t “screaming about it in the streets,” given the number of people who die every year.
Dr. Heidi Connolly of Mayo Clinic told the audience that many women with heart disease can have successful pregnancies provided they have proper medical care. One type of problem, congenital heart disease – a condition present since birth – is one that doesn’t preclude pregnancy with proper care, but a small percentage of those mothers can pass on the condition. She pointed out that far too many women with coronary symptoms do not seek care early in pregnancy…which adds increased risk to both mother and baby. In fact, most women don’t think about their heart when considering potential problems during pregnancy. The most common symptom for these women (and sometimes the only one) is a shortness of breath. She cautioned that experiencing chest pain during pregnancy may not mean indigestion…it may be a heart problem and should be mentioned to a physician. Dr. Connolly emphasized the need for cross disciplinary care if heart disease is diagnosed. For instance, in women in a heart condition, the preference is to deliver naturally and NOT by caesarian, as it is risky for the mother. She advises women to think about heart health prior to pregnancy.
Dr. Elizabeth Ofili of Morehouse Medical School in Atlanta caught everyone’s attention with her first statement: “One woman dies of heart disease for every minute we are sitting here.” Why? And why especially is the risk greater during pregnancy? She pointed to the growing prevalence of heart complications due to high blood pressure and obesity. She also emphasized the need to take care of women across the medical specialties. An OB-Gyn specialist may recognize hypertension, but should also consult with a cardiologist on the case. African Americans are at increased risk when pregnant. She explained that while 1 in 4 in a general population may be at risk during pregnancy due to these factors, it’s 1 in 3 in African American populations. She says the familiar case is a women who goes into a pregnancy with high blood pressure and overweight, then the stress of the pregnancy itself – plus medical, family, and social stressors – can cause a cascade of problems. However, she says now enough is known that doctors can effectively treat blood pressure and not harm the fetus. Likewise women who develop toxemia..or preeclampsia – can have a normal outcome of pregnancy if treated properly. In preeclampsia something happens to the blood vessels, making them more likely to retstrict in reaction to stress and toxins develop around vessels. Unfortunately we still don’t know all of the predictors, but research is ongoing. Another warning sign: the death rate among women aged 35-55 is increasing due to obesity. Gestational diabetes, seen in 2-12 percent of pregnancies, is higher in minorities. This is dangerous if it’s undetected, as it can cause fetal abnormalities. Her bottom lines: Manage care with a multi-disciplinary team can help avoid medication later on.Women should talk about how they feel to the primary physician, keep to a heart healthy diet and the best way to help pregnant women with heart problems is an early diagnosis.
Dr. Nakela Cook of the National Heart, Lung and Blood Institute shared her concerns about health care delivery, making the point that not all improvements in cardiac care are being shared equally across the country or across disparate populations. In other words, where you are living can impact your care. Risk factors in pregnancy go up White – 6.9 percent, but 7.8 for African Americans. Poverty, income, housing , Insurance, health education and education levels, are all limitations, as are the quality of patient-provider relationships and how quickly research findings are applied to medical practice in one area over another. Responding to a question, she said that solutions have to be complex because the situation is complex. What’s needed is a systemic, broad integrated approach. She said there is some indication that overall quality improvements in hospitals, and moves toward evidence-based care (care approaches based on science) can help minorities as well. One of her biggest priorities is racial and gender equality in heart health care.
The fourth panelist, Dr. Rakesh Suri, talked about the advantages of minimally-invasive surgery for repairing heart defects in women. Robotic techniques can save women a long recuperation, avoid breaking the breast bone, avoid a disfiguring scar, and limit pain and discomfort. The new techniques and technology has been available for only a decade or so, but they are still not widely available. The option exists only at major medical centers or research hospitals, and, again, is probably less likely to be offered as an option to women in disparate populations. The surgery uses incisions “the size of a finger, rather than a hand” and can allow a patient to be back to normal activities in six weeks rather than six months.
Overall this panel went a long way to highlight how vulnerable women are – at a very young age – when undetected heart disease and pregnancy multiply risk. Awareness and education is critical and young women need to understand that heart problems is not necessarily a problem of age.
Mayo Clinic today announced long-time patient and philanthropist Richard O. Jacobson has given a $100 million gift to help establish the multi-site Mayo Clinic Proton Beam Therapy Program. This is the largest outright gift in the clinic’s history, as well as the largest gift Mr. Jacobson has made to any single institution.
Mayo’s program will include new facilities on the Rochester and Phoenix campuses; the Rochester building will be named in Mr. Jacobson’s honor. Mayo Clinic announced plans last November to establish the Mayo Clinic Proton Beam Therapy Program as part of Mayo’s national three-site cancer center in Minnesota, Arizona and Florida. The new program will employ intensity modulated proton therapy — based on pencil beam scanning — which is a more precise form of proton therapy treatment that allows greater control over radiation doses, shorter treatment times and fewer side effects. It is also believed to be more cost effective in selected patients.
“What a profound demonstration of trust and passion for Mayo Clinic,” says John Noseworthy, M.D., Mayo Clinic president and CEO. “Mr. Jacobson’s awe-inspiring generosity will benefit adults and children from all walks of life. Our new facility will be a lasting legacy to honor his gift.”
John Noseworthy, M.D., Mayo Clinic president and CEO, thanks Richard O. Jacobson for this extraordinary $100 million gift and talks about the impact this will have in helping improve patient care.
Richard O. Jacobson, said his dream has always been to establish a major new facility for Mayo Clinic. In his opening statement, Mr. Jacobson reflected on how this serves patient needs.
Duke University also is participating in the study, and women do not need to live near either of the centers (in Minnesota or North Carolina) to participate. For more details, see the study profile on ClinicalTrials.gov. Also see the related Facebook group for more information.
The NCCTG Junior Faculty Academic Community Partnership Award was established in 2009 to recruit, train, mentor and support selected junior-level physicians at NCCTG member sites who will, in turn, become cancer research leaders within their local community practices. Bret Friday, M.D., Ph.D., an oncologist at Duluth Clinic in Duluth, Minn., received the first NCCTG Junior Faculty Academic Community Partnership and is currently conducting neuro-oncology research under the mentorship of Mayo Clinic oncologist Evanthia Galanis, M.D.
NCCTG is a national clinical research group sponsored by the National Cancer Institute, comprised of a network of more than 1,000 community-based cancer treatment clinics in the United States and Canada that work with Mayo Clinic to conduct clinical studies for advancing cancer treatment.
