Penn Medicine News Blog Posts by Jessica Mikulski

Can sleeping actually make you MORE tired? For many patients with obstructive sleep apnea (OSA), they awake each morning thinking they had a full night’s rest, only to feel exhausted and unfocused day after day. This counterintuitive situation occurs because OSA sufferers may wake up dozens of times an hour or more each night without even realizing it due to pauses in breathing that can jolt a person out of sleep. The staggered breathing is the direct result of the airway collapsing or becoming blocked during sleep.

That was the case for Penn Medicine patient Daniel Sheiner. At 32, his exhaustion was starting to become an issue while he was at work. He would wake up each morning believing he had slept through the night, but never actually felt any of the restorative benefits. After seeking medical help and undergoing a sleep exam, doctors determined that he had a very severe case of OSA. After many failed attempts with standard front line therapies such as lifestyle changes, mouthpieces, and breathing devices, Daniel learned about a new surgical approach for OSA being pioneered at Penn Medicine.

A scientist's life is a busy one, and sometimes it can include interacting with the news media to share the findings of their research. But talking to reporters is not something most scientists learn in school. The first Penn Media Training Workshop, aimed at science and medical faculty from across the entire University, was designed to fill that gap.

Held on April 5^th and organized by the Office of University Communications and the Penn Medicine Department of Communications with funding sponsorship from the Burroughs Wellcome Fund, the program provided training for 30 researchers from the schools of Medicine, Arts and Sciences, Engineering and Applied Science, Veterinary Medicine, Dental Medicine and Nursing.

In their final post, Jon and Martha Kole, fourth year students at the Perelman School of Medicine, reveal how Match Day unfolded and where they will be heading for their residencies. Congrats to all the students and check out the photo series from this year's ceremony!

Jon and Martha on Match Day

Our wish to match in “a city starting with the letter P” has been granted…P is for Providence! We are both excited to have matched into great programs in Providence, Rhode Island! Martha will be completing her OB/GYN residency in the renown and beautiful Women and Infant’s Hospital, while Jon joins the small cohort nationwide to enter the Triple Board training in Pediatrics, Adult Psychiatry and Child Psychiatry. We are proud to be part of Brown University and enjoy coastal living in the Ocean State. It seems like fate, as Martha’s maiden name is none other than Brown.

Match Day is here! At the stroke of noon, 161 Perelman School of Medicine at the University of Pennsylvania students (77 women and 84 men) will gather in an emotion-filled ceremony to open their “residency placement” envelopes and learn where they will spend the next few years receiving their advanced medical training.

Jon and Martha Kole, our Match Day bloggers, will be among this group of excited students...find out how they spent the week leading up to today's life changing experience.

On Friday, March 15, 2013 at noon, fourth year medical students at the Perelman School of Medicine at the University of Pennsylvania will learn where they are headed for their residency training, marking the transition from medical school into a lifetime of healing.

This year, students Jon and Martha Kole will be sharing their thoughts and perspectives during this exciting week of their lives! Married and matching, they have a unique perspective on this major stepping stone into a doctor’s future. We'll check back with the Koles throughout the week!

On Tuesday, September 29^th 2009 we sat next to each other for the first time at a Phillies game sponsored by the School of Medicine Alumni Office. We were both 1^st year medical students at the Perelman School of Medicine. Jon, playful and optimistic, and Martha, passionate and pragmatic, couldn’t have been more perfect for each other. Sparks flew and we were engaged 12/12/10, married 4/14/12 and on 3/15/13 we will ‘Match’ together, hopefully in a city that starts with the letter P. Jon hopes to match in a Triple Board program which will allow him to be certified in Pediatrics, Child Psychiatry and Adult Psychiatry. Martha’s dreams are to provide for women within the field of Obstetrics and Gynecology. But until March 15^th, we will continue to keep our fingers (and our toes) crossed!

The process has been long, tiring, expensive, and anxiety provoking (Martha) while exciting, engaging, educational, and enriching (Jon). As with any married couple, the truth lies somewhere in the middle. Our ‘Couples Match’ journey started on September 15^th at 10:01am as we sat in bed frantically pounding the submit buttons on our computers. At 10:11am our applications were officially sent to a combined 47 programs at 16 cities across the United States. The waiting game began.

Fresh off our Heart Month blog series and straight into National Sleep Awareness Week, we’re taking a look at the major role that sleep plays in heart health.

“Obesity, heart disease, and diabetes are major diseases facing our population. As our knowledge about these conditions increases, we are learning that many aspects of our health, especially when it comes to our hearts, are intertwined with how we sleep,” says Michael Grandner, PhD, Instructor in Psychiatry and member of the Center for Sleep and Circadian Neurobiology at Penn. “The connections are complex and we are just starting to scratch the surface.”

Mariell Jessup, MD

 To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all areas of Penn Medicine.

As we wrap-up our Heart Month blog post series, I asked Penn Medicine’s Mariell Jessup, MD, medical director of the Heart & Vascular Center and the president-elect of the American Heart Association, to weigh in on some of the hottest topics in research and clinical care in the cardiovascular community.

Perils of being sedentary

As a physician, I can’t stress this enough…regular physical activity is critical to the achievement of mental, physical, and cardiovascular health, and contributes substantially to that elusive state of well-being that most people strive for.  A sedentary lifestyle increases the risk of heart disease, diabetes, and stroke.

The American Heart Association recommends 30-60 minutes of aerobic exercise three to four times per week to promote cardiovascular fitness, but any little bit of exercise helps!  Even taking three 10-minute walks throughout your day counts towards your fitness goals.  Make an effort to build exercise into each day, walking the stairs instead of taking an elevator, or choosing a space at the far end of the parking lot to get in more walking as you enter a store.

Depression is one of the most common types of mental illness. Estimated to affect over 17 million people in the United States, it can afflict anyone at any time. Patients commonly report feelings of sadness, fear, hopelessness, and worthlessness, even if everything else in their lives seems to be going well.  Depression can impact anything from sleeping and eating patterns to concentration and memory, and often occurs with other serious medical conditions including heart disease, cancer, and stroke. While there are many effective therapies available for patients today, such as medications and talk therapy, depression may be resistant to these treatments.

In 2008, patients were granted a potential reprieve from this life altering condition when the FDA approved the use of repetitive transcranial magnetic stimulation (rTMS, often referred to as just TMS) for treatment resistant depression. TMS is a non-invasive technique that excites neurons in the brain via magnetic pulses passed through the scalp. It is a safe and effective, non-drug treatment with minimal side effects for patients with major depression who have not responded to other treatments.  Penn’s Department of Psychiatry was at the forefront of researching the use of this breakthrough therapy for patients with major depression and continues to be a leading center utilizing this approach.

Penn Medicine is currently one of the first research sites in the country that is testing the effectiveness of another non-invasive, medication-free treatment called synchronized transcranial magnetic stimulation (sTMS). This is a new brain stimulation treatment that may also help alleviate symptoms of depression. The sTMS system uses low energy, synchronized transcranial magnetic stimulation synchronized to an individual’s natural brain rhythms as opposed to the stronger, high-frequency pulses utilized with traditional rTMS.  Penn is one of only 16 sites in the country testing this new technology.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all areas of Penn Medicine.

In honor of Heart Month and Valentine's Day, we're revisiting some of our most inspirational heart health patient stories from the last year. Penn performs approximately 18,000 heart and vascular procedures each year, but every patient's story is unique. Young and old, these Penn Medicine patients, with the help of their care teams, overcame great health obstacles and we are proud to be part of their stories.

Taking a look back, 2012 has been a year marked by breakthroughs in medical research, system-wide growth, and landmark philanthropic support for Penn Medicine. As we set our sights on the year ahead, we also celebrate the past year's accomplishments and give thanks to the outstanding faculty, staff, and students that are the foundation of Penn Medicine.

Click below for a sampling of research, education, and patient care highlights from 2012 and stay tuned in the coming weeks for our 2013 edition of the Penn Medicine Facts & Figures brochure and the 2013 edition of Simply Because to learn more about how Penn Medicine is committed to a tradition of pioneering medical discoveries and innovations; excellence in training tomorrow’s physicians and scientists; safe and compassionate patient care; and service to the community.

Steven Berkowitz, MD, is a child and adolescent psychiatrist and an associate professor of Clinical Psychiatry at the Perelman School of Medicine. He is also the director of the Penn Center for Youth and Family Trauma Response and Recovery. The Center was founded in 2009 in order to offer the most effective treatments for children, adolescents and their families who are suffering from symptoms of traumatic stress and other difficulties after exposure to violence, crime and abuse.

In this blog post, Dr. Berkowitz outlines some strategies for helping children and teens process their feelings in the aftermath of the Sandy Hook Elementary School shooting.

Despite their use in approximately 60,000 surgeries per day in the U.S. alone, medical researchers don’t know exactly how anesthetics cause unconsciousness – or what the true long-term impact of their use could be on the brain and the rest of the body.

"The development of anesthetic drugs has been hailed as one of humankind's greatest discoveries in the last thousand years," Max B. Kelz, MD, PhD, assistant professor of Anesthesiology and Critical Care, said in a recent US News & World Report article. "Anesthetics are annually given to over 230 million patients worldwide. Yet as a society, and even within the anesthesia community, we seem to have lost our curiosity for how and why they work."

But research advances by Dr. Kelz and other faculty in the Penn Medicine Center for Anesthesia Research, one of the largest programs of its kind in the world, are helping to get to the bottom of this 160-year-old mystery.

Penn patient Elliot Gordon (right) completes a 12k after open-heart surgery

I signed up for my second 5K last week, but I’ve been struggling to find the motivation to keep up with my runs. It seems so much harder now that it’s colder and gets dark hours earlier in the evening. But the next time I start to make up a new excuse for why I can’t get my sneakers on, I’m going to remind myself of Penn patient Elliot Gordon, profiled in today’s edition of the Philadelphia Inquirer.

In April 2009, he was training for the Boston Marathon, what would have been his 43rd such race.  But on the morning of April 5, out of the blue, the usually healthy Gordon started to feel dizzy at his home in Princeton Junction, NJ. Within moments, he passed out.

Elliot was suffering from an aortic dissection, the same condition that killed actor John Ritter in 2003. This serious heart condition results from a small tear in the inner wall of the aorta, causing blood to flow between the layers of the wall of the aorta and force the layers apart. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs.

After being rushed to a local hospital, it was determined that he needed emergency heart surgery.  He was transferred to the Hospital of the University of Pennsylvania (HUP).

At HUP, Joseph Bavaria, MD, vice chief, Division of Cardiovascular Surgery and director, Thoracic Aortic Surgery Program, performed an open-heart procedure to have Gordon’s torn aorta removed and replaced with a synthetic graft.

Left ventricular assist devices (LVADs), surgically implanted medical pumps that take over most of the heart's circulatory duties, offer hope to patients experiencing end-stage heart failure. For those who are not medically suited for a heart transplant, implantation of a “destination” LVAD – meaning they will have the device for the rest of their lives – often becomes their only treatment option. A News Blog post from earlier this year details the amazing advances in medical technology that have allowed many patients with ailing hearts to continue to live productive lives with the aid of these small devices.  

While this procedure can extend life and improve health for many, patients and their families will also be taking on a tremendous responsibility in managing their new device and coping with the lifestyle and psychological ramifications of life with a battery operated heart.  Two recent multicenter studies by Penn Medicine researchers have explored some of the issues involved in helping patients understand how the device will impact end-of-life planning and what is needed from a destination LVAD patient’s caregiver.

Family Room at the Inpatient Hospice Unit at Penn

Perhaps the most important thing I’ve learned in this short time is just how extensive and intensive the training process is – and needs to be – to become a hospice volunteer.

It’s no easy assignment and volunteers need to be fully prepared for a variety of issues in their new roles. Research has revealed that hospice volunteers face ethical issues, including dilemmas about gifts, patient care and family concerns, issues related to volunteer roles and boundaries.

Other studies have looked at how the stress of volunteering can take a toll on the individuals, with some studies (although there are few) finding attrition rates as high as 43 percent. There is very little research that has focused on volunteers, but stress plays a major role (both personal and while volunteering) in why some people choose to stop.

These issues, and many that go unreported due to the dearth of research in this area, compel hospice programs to spend a lot of time and resources to train their volunteers.

What if you felt the uncontrollable need to wash your our hands up to 100 times per day? Or were over an hour late for work each day because you had to keep returning home to make sure your front door is locked? Or couldn’t stop yourself from imagining horrible disasters striking everyone you love, or worse, imagining yourself being the cause of those horrible disasters?

Most people can’t conceive of living with these kind of obstacles, but for patients with obsessive compulsive disorder (OCD), these type of issues are fundamental to their daily lives.

People with OCD have intrusive, upsetting, unwanted thoughts, worries, or superstitions so excessive that they cause significant life distress or disruption. They sometimes spend hours each day performing behavioral or mental rituals to temporarily quell their anxiety. Most people with OCD recognize that their fears are irrational, yet feel unable to resist the obsessions and compulsions. The disorder affects up to 4 million people in the United States, but remains a relatively misunderstood condition.  Events such as OCD Awareness Week, held this year from October 8 – 14, seek to educate more people about this condition.

To help OCD patients, a team of Perelman School of Medicine researchers, led by Edna Foa PhD, director of the Center for the Treatment and Study of Anxiety, are conducting the first study that examines whether one of the most effective forms of psychotherapy for obsessive compulsive disorder (OCD), exposure and ritual prevention (EX/RP), can help people with OCD achieve and maintain wellness after they stop taking the medications their doctors prescribe for their OCD.

Tonight I’m taking part in my first volunteer training session for Penn Wissahickon Hospice, where I’ll be learning how to greet visitors and answer incoming calls to our inpatient hospice unit. This unit was the first such inpatient unit opened in the Philadelphia-area back in 2008. I’m excited and nervous.

I first learned about volunteering with our hospice program through our own Penn Medicine News blog. My colleague, Gregory Richter, wrote a post about an innovative program using Reiki Therapy to help our hospice patients with pain management and to relieve stress and anxiety. His post detailed the hard work of a hospice volunteer, Sharon Civa, Entity Information Officer, Corporate Information Services at Penn Medicine, to get funding for this new program. Sharon has been a volunteer for over 12 years. She first became involved after seeing firsthand how important hospice care is for many patients.

By definition, hospice is a concept of care, designed to provide support to patients and their families when they are facing an end of life situation. Hospice does not prolong life, nor does it hasten death. Hospice programs are designed to comfort and provide physical support, emotional support and spiritual support, including pain management, counseling, and medical care.

To CPAP or not to CPAP, that is the question that an estimated 100 million Americans who suffer from obstructive sleep apnea (OSA) might face in their quest for a better night's sleep. And for many of these patients, this CPAP conundrum -- whether or not and when to wear the device's mask -- may actually revolve around their romantic relationships, a new Penn study has shown.

OSA (commonly referred to as just sleep apnea) is a sleep-related breathing disorder that occurs when the tissue in the back of the throat collapses and blocks the airway, causing the body to stop breathing during sleep. OSA disrupts sleep (both the patient’s and their bed partner’s) and can increase the risk of other health problems such as heart disease and stroke. It can also have a major impact on a person's energy levels and mood.

The gold standard treatment for OSA is continuous positive airway pressure or CPAP. The steady flow of air from a CPAP machine keeps the airway open and restores normal oxygen levels during sleep. This helps maintain a steady, healthy level of breathing through the night.

But even though doctors know that CPAP is extremely effective in helping patients with OSA, research has proven time and again that many patients can’t or don’t want to use the device on a nightly basis.  In fact, one study found that up to 83 percent of patients with obstructive sleep apnea have reported they aren’t sticking with the treatment.

Patients commonly cite a variety of concerns with CPAP therapy -- from the noise the machine creates to facial discomfort from the Darth Vader-like mask they must wear. But the new study from a team of researchers at the Perelman School of Medicine at the University of Pennsylvania, Boston College, and the University of Illinois at Chicago, pinpointed another common, and often difficult to admit, reason that they leave their machines at the proverbial bedroom door: less intimacy with their non-CPAP using partners.

Last Friday, 163 first-year medical students at the Perelman School of Medicine started their journey to becoming doctors at the annual White Coat Ceremony. And for the first time in school history, in addition to receiving two of medicine’s most time honored symbols -- the white coat and stethoscope -- Penn Medicine also equipped these budding doctors with an Apple iPad 3.

The new program represents the latest step in a 15 year technology investment by the School to bring medical curriculum into the digital age, and enables students to have access to a multipurpose learning tool that they will use throughout medical school, in the hospital, with patients, and beyond, says Gail Morrison, MD, senior vice dean for Education and director of the Office of Academic Programs.

In the wake of the tragic shootings in Colorado last week, people across the country are still in shock as they try to contemplate the meaning behind such an evil act of human nature. Twelve people were killed and 59 more are struggling to recover from the injuries they sustained in the violent attack. And while many of them will make full physical recoveries, the memories of the shootings will persist.  Mental health experts are now weighing in to help both the victims and the general public cope with the inevitable fear, anxiety and depression that can follow traumatic events like this.

At the Penn Medicine Center for the Treatment of Anxiety, Edna Foa, PhD , a world renowned expert on post-traumatic stress (PTSD) and director of the Center, says that the people who were injured in the shootings and the people who lost loved ones are the most likely to develop long-term symptoms of conditions like PTSD.

Common symptoms include nightmares and difficulty sleeping, intrusive thoughts about the shooting,  nightmares, and flashbacks about the shooting, resulting in strong emotional (sadness, fear, guilt) and physical (heart racing, sweaty, upset stomach, shaky) reactions. Some people will also have a loss of interest in their usual activities and experience hyper-vigilance and hyper-arousal. 

“Symptoms immediately following a trauma like this should be expected and viewed as a natural part of the healing process,” she stresses. “We must let these people go through their own process for digesting what happened to them that night. In the coming weeks, support from loved ones can be extremely beneficial to their recovery.”

Heart failure is a common condition that occurs when the heart doesn’t pump as well as it should. More than five million Americans are currently living with heart failure and about 500,000 new cases are diagnosed in the U.S. each year.  Heart failure patients are monitored routinely in their doctor's office by gauging changes in their weight which can indicate fluid building up in the body – a rather crude measure. Patients also sometimes need monitoring of pressures inside the heart, which involves a hospital procedure.

But now, cardiologists at Penn Medicine are testing devices that  allow patients to be monitored from the comfort of their own homes instead of having to make trips to and from the hospital.

A sensor is implanted in the heart or one of the lungs to take pressure readings which are transmitted automatically to the doctor’s office by phone. Medications can be adjusted based on the pressure readings. Depending on the severity of the patient's condition, the provider may check these statistics on a daily or weekly basis to determine the best course of treatment.

Evidence has mounted in recent years that survivors of critical illnesses, such as sepsis and acute organ failure, experience long-lasting cognitive and psychiatric effects long after they have been discharged from the hospital. But many questions about these connections remain. Researchers at the Perelman School of Medicine are uncovering some answers through their research on how patients with acute lung injury (ALI) are impacted by neuropsychological impairments, and potentially learning new ways to help prevent these late effects. 

In the United States alone, 200,000 patients will develop ALI each year. ALI, also referred to as acute respiratory distress syndrome (ARDS), is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Medical advances in ALI treatment have led to a dramatic increase in survival, resulting in an expanding population of survivors who must return home coping with problems that stand to impact every aspect of their lives.

Mark E. Mikkelsen, MD, MSCE, assistant professor of Medicine , along with a multi-institutional team of investigators led by Jason Christie, MD, MSCE, section chief, Medical Critical Care, recently published new research examining how ALI survivors from a multi-center trial are being impacted by a variety of long-term impairments. The study appears in the latest edition of the American Journal of Respiratory and Critical Care Medicine.

Climatologists recently predicted that the 2012 allergy season might be one of the worst on record and based on my own experiences so far this spring, I’m inclined to agree. I’ve been hit hard by congestion, itchy eyes, and worst of all, chronic bouts of uncontrollable sneezing. So when I learned that researchers in the Perelman School of Medicine Department of Otorhinolaryngology: Head and Neck Surgery are in the midst of some interesting research looking at the biology of sneezing, I was quite curious to get the inside scoop.

It might seem obvious -- allergens attack (in the form of pollen, dust mites, and pet dander) and our immune system feels compelled to expel these foreign invaders through a powerful sneeze. But it’s much more complicated than that, especially for patients who already have chronic sinus issues, says Noam Cohen, MD, PhD, assistant professor of Otorhinolaryngology: Head and Neck Surgery. Dr. Cohen is the senior author of a new study, out in the May issue of the Journal of the Federation of American Societies for Experimental Biology , that examined the biology of the effects of a sneeze on the inner structures of the nose.

“Very little is known about the effects of sneezing on the cells within the nose and sinuses,” he says. “As a matter of fact, almost nothing is known about sneezing.  As an ear, nose, and throat physician who deals with problems of the nose, frequent sneezing is a very common complaint I encounter from my patients.  So we wanted to know: why do people with problems with their noses, such as the common cold, chronic sinusitis, or allergies, sneeze more than people with no problems in the nose or sinuses.”

The Perelman School of Medicine, and other schools from around the University of Pennsylvania, has partnered with an innovative new learning platform to make Web-based courses, taught by some of the world’s foremost experts, available free to the general public.  The platform, Coursera, is the first to host content from multiple world-renowned universities (including Princeton University, Stanford University and the University of Michigan) at one online destination.

"We are delighted to participate in this innovative collaboration that will make high-quality learning opportunities available to millions of people around the world," said Gail Morrison, MD, senior vice dean for Education at the Perelman School of Medicine. "Expanding access to medical science and technology is an invaluable opportunity to better educate the public at large about the true art and science of medicine.”

The online courses include video lectures -- available to anyone, anywhere in the world, with an internet connection -- that feature interactive quizzes, mastery-building interactive assignments and collaborative online forums. Beginning in June, Perelman School of Medicine faculty will provide courses on a variety of medical topics, from cardiac resuscitation to neuroscience.

Approximately 12 million Americans are seen in U.S. emergency departments each year for mental health-related symptoms. Of those patients, around 650,000 are evaluated for suicide attempts. For many of these people, it’s a frightening stop on the long and painful road of suffering that results from depression, anxiety, and substance abuse.

The usual care for these suicidal patients seen in the ED and other emergency settings is to assess their level of risk in terms of how likely they are to actually harm themselves and then refer them to the appropriate level of care. Typically, when suicidal patients are evaluated in the ED and hospitalization is not determined to be necessary, they are provided with information for outpatient mental health treatment and sent home. But that approach doesn’t necessarily meet the needs of patients or their physicians, who may worry about discharging patients in the midst of a crisis.

“This  ‘assess and refer’ approach can be disconcerting to patients and their families,” says Gregory K. Brown, PhD, research associate professor of Clinical Psychology in Psychiatry in the Perelman School of Medicine. “It can also leave clinicians feeling like they didn’t do enough due to the dire consequences associated with suicidal thoughts in patients.”