Category: Category: health

Breast cancer survivor urges women to get regular screenings and mammograms, thanks local non-profit ‘The Rose’

October 14, 2020
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The first time Ediana Quijada found a lump in her breast, she was laughed off and told “it was happening because of her period and nothing to worry about.”

It was far from nothing. After a six-year battle with metastatic breast cancer, the cheerful Houston native is happy to share her story with other young women, advising regular breast exams, early detection having made a key difference in many cases.

In the fall of 2012, 29-year-old Ediana was finishing her construction management internship at the University of Houston.

The internship did not offer health insurance but UH hosts free mammography screenings in October in honor of Breast Cancer Awareness month. However, when she told the nurses about her lump, they assured her, with a cursory glance, that she was too young to worry about cancer. She was sent away without a mammogram.

Reassured and a little abashed about being paranoid, she busied herself with assignments as the stresses of the semester took over. The second of four siblings (two sisters, one little brother), Ediana said she had no reason to suspect the worst because there was no history of cancer in her family.

But the lump wouldn’t stay quiet.


“I started feeling that the little lump was getting bigger and bigger,” Ediana said. “I could measure it; it was an inch now. Or is it in my head? Then I would calculate, my period must be coming, that’s why the lump’s getting big … and my breast is turning pink.”

A visit with her mother’s doctor in December confirmed the devastating news — a large mass in her breast. Could be a tumor. Clearly, the cancer had made good use of the two-month delay.

“I didn’t have insurance, so my mother took me to a walk-in clinic,” Eidana said. “The doctor said, ‘oh my God, why didn’t you come before?’”

A few hours and one $100-ultrasound later, she was advised to do a biopsy.

“The biopsy cost over $2,000, I thought ‘I can’t do that right now,’ and he (the doctor) referred me to The Rose,” Ediana said.

That first encounter with The Rose marked the beginning of Ediana’s long, painful but ultimately successful battle with breast cancer. A Houston-based nonprofit group, The Rose provides breast cancer screenings and treatment regardless of patients’ ability to pay. They began Ediana’s treatment by conducting another ultrasound, this one costing only $10.

A little monster inside your breast.

Ediana was paired with a patient navigator who helped her through the system and set up her appointments.

“It turns out I was Stage 3, Type C, which is borderline Stage 4,” said Ediana. “Very aggressive and very bad. They said, ‘it looks like you have a little monster inside’.”

Given the tumor’s massive size, treatment had to begin immediately. When three painful rounds of chemo (each lasting around eight months), one round of radiation and one surgery failed to eliminate the cancer, her doctors put Ediana on an–at the time–experimental drug called T-DM1.

“This

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Here’s what’s happening Wednesday with COVID-19 in the Chicago area

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Chicago on Tuesday added neighboring Indiana to its emergency travel order that requires travelers returning to the city from there to stay inside for two weeks because of high COVID-19 case counts. The Hoosier state’s inclusion on Chicago’s self-quarantine list was expected.



a man standing in front of a pool: Shelley Gavin, 55, gets a free COVID-19 test provided by Community Organized Relief Effort at I Grow Chicago in West Englewood on Aug. 31, 2020.

© Zbigniew Bzdak / Chicago Tribune/Chicago Tribune/TNS
Shelley Gavin, 55, gets a free COVID-19 test provided by Community Organized Relief Effort at I Grow Chicago in West Englewood on Aug. 31, 2020.

Starting Friday, people traveling into Chicago from Indiana, including Chicagoans who have traveled to Illinois’ eastern neighbor, to will be expected to quarantine themselves for 14 days. Violators can face a fine, though the city has taken few steps to enforce the rules and there are exceptions for essential workers.



a close up of a toy: A worker packages a COVID-19 test swab from a client at Prism Heath Lab, 2322 W. Peterson Ave., in Chicago, on Aug. 6, 2020.

© Jose M. Osorio / Chicago Tribune/Chicago Tribune/TNS
A worker packages a COVID-19 test swab from a client at Prism Heath Lab, 2322 W. Peterson Ave., in Chicago, on Aug. 6, 2020.

The move came as Illinois health officials announced 2,851 newly confirmed cases of COVID-19 and 29 additional deaths, pushing the state’s death toll past 9,000.



a person sitting in a car: Workers conduct drive-thru COVID-19 testing at Swedish Covenant Hospital on Oct. 13, 2020, in the Ravenswood neighborhood of Chicago.

© Erin Hooley / Chicago Tribune/Chicago Tribune/TNS
Workers conduct drive-thru COVID-19 testing at Swedish Covenant Hospital on Oct. 13, 2020, in the Ravenswood neighborhood of Chicago.

It was the seventh day in a row with more than 2,600 cases. That brings the state total to 324,743 confirmed cases and 9,026 deaths. The seven-day statewide positivity rate is 4.5% for the week ending Oct. 12.

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COVID-19 in Illinois by the numbers: Here’s a daily update on key metrics in your area

COVID-19 cases in Illinois by ZIP code: Search for your neighborhood

Chicago’s travel quarantine list: Here’s what you need to know to avoid a large fine

Illinois coronavirus graphs: The latest data on deaths, confirmed cases, tests and more

Here’s what’s happening Wednesday with COVID-19 in the Chicago area and Illinois:

6:55 a.m.: Challenges to Pritzker’s COVID-19 restrictions back in court

After months of maneuvering, attorneys will be in court in Sangamon County Wednesday arguing over Gov. JB Pritzker’s powers to impose controls to curtail the spread of the coronavirus.

The hearing involves multiple cases filed by attorney Thomas DeVore on behalf of clients in six counties who contend that the coronavirus pandemic is not a public health emergency under the definition of Illinois law.



a person wearing a costume: Workers prepare for a drive-thru COVID-19 testing participant at Swedish Covenant Hospital on Oct. 13, 2020, in the Ravenswood neighborhood of Chicago.

© Erin Hooley / Chicago Tribune/Chicago Tribune/TNS
Workers prepare for a drive-thru COVID-19 testing participant at Swedish Covenant Hospital on Oct. 13, 2020, in the Ravenswood neighborhood of Chicago.

Because of that, the lawsuits argue that Pritzker doesn’t have the authority impose restrictions like limit on businesses in order to control the spread of COVID-19.

The essentially identical lawsuits were originally filed in Edgar, Bond, Richland, Clinton, and Sangamon counties. In each case, plaintiffs want the court to declare a public health emergency does not exist and that Pritzker be barred from exercising powers under the Emergency Management Act in those counties.



a person sitting in a parking lot: A warning sign alerts passersby as vehicles are lined up at a COVID-19 testing site at Saucedo Scholastic Academy on Oct. 13, 2020, in Chicago.

© John J. Kim / Chicago Tribune/Chicago Tribune/TNS
A warning

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Taysha Gene Therapies Receives Rare Pediatric Disease Designation and Orphan Drug Designation for TSHA-102 as a Treatment for Rett Syndrome

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Program leverages novel miRARE platform technology used to control transgene expression on a cellular basis

TSHA-102 anticipated to submit Investigational New Drug application in 2021

Taysha Gene Therapies Inc. (Nasdaq: TSHA), a patient-centric gene therapy company focused on developing and commercializing AAV-based gene therapies for the treatment of monogenic diseases of the central nervous system in both rare and large patient populations, today announced that it has received rare pediatric disease designation and orphan drug designation from the U.S. Food and Drug Administration (FDA) for TSHA-102, an AAV9-based gene therapy in development for the treatment of Rett syndrome. Taysha anticipates that it will submit an Investigational New Drug (IND) application for TSHA-102 to the FDA in 2021.

Rett syndrome is one of the most common genetic causes of severe intellectual disability worldwide, with a prevalence of over 25,000 cases in the U.S. and European Union (EU). It is an X-linked disease that primarily occurs in females, but it can be seen very rarely in males. It is usually recognized in children between six to 18 months of age as they begin to miss developmental milestones or lose abilities they had developed. Individuals with Rett syndrome also show symptoms that include loss of speech, loss of purposeful use of hands, loss of mobility, seizures, cardiac impairments, breathing issues and sleep disturbances.

“Patients with Rett syndrome are currently managed with symptomatic treatments as there are no therapies approved to treat the underlying cause of disease,” said Berge Minassian, M.D., Chief Medical Advisor of Taysha and Chief of Pediatric Neurology at the University of Texas Southwestern Medical Center (UT Southwestern). Dr. Minassian is credited with describing the CNS isoform of the MECP2 gene which is responsible for neuronal and synaptic function throughout the brain. “Gene therapy offers a potentially curative option for patients suffering with Rett syndrome.”

Rett syndrome is caused by mutations in the MECP2 gene. TSHA-102 is designed to deliver a healthy version of the MECP2 gene as well as the miRNA-Responsive Auto-Regulatory Element, miRARE, platform technology to control the level of MECP2 expression. “TSHA-102 represents an important step forward in the field of gene therapy, where we are leveraging a novel regulatory platform called miRARE to prevent the overexpression of MECP2,” said Steven Gray, Ph.D., Chief Scientific Advisor of Taysha and Associate Professor in the Department of Pediatrics at UT Southwestern. “In collaboration with Sarah Sinnett, Ph.D. to develop miRARE, our goal was to design a regulated construct that allowed us to control MECP2 expression to potentially avoid adverse events that are typically seen with unregulated gene therapies.”

The FDA defines a rare pediatric disease as a serious or life-threatening disease in which the disease manifestations primarily affect individuals aged from birth to 18 years. Pediatric diseases recognized as “rare” affect under 200,000 people in the U.S. The Rare Pediatric Disease Priority Review Voucher Program is intended to address the challenges that drug companies face when developing treatments for these unique patient populations. Under this program, companies are

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Med students on how COVID pushed them into action, highlighted health care inequities

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It was on a Saturday in mid-March when Abby Schiff, then a third-year medical student at Harvard working through surgery clinical rotations, found out she wouldn’t be going back to the hospital.



a group of people on a sidewalk: Medical student Francis Wright (top left) during a mask drive early on in the pandemic with his classmates (clockwise) India Perez-Urbano, Kara Lau, Lane Epps, Ninad Bhat, Laeesha Cornejo and Hunter Jackson, the last of whom came up with the idea.

© Courtesy Francis Wright
Medical student Francis Wright (top left) during a mask drive early on in the pandemic with his classmates (clockwise) India Perez-Urbano, Kara Lau, Lane Epps, Ninad Bhat, Laeesha Cornejo and Hunter Jackson, the last of whom came up with the idea.

She had worked the day before, but with the coronavirus threat growing quickly, Schiff, like thousands of other medical students across the country, was sidelined when the Association of American Medical Colleges issued a temporary suspension of clinical rotations in hopes of protecting students and patients, and conserving personal protective equipment (PPE).

She didn’t sit around waiting, though. As nurses came out of retirement and medical school professors pressed pause on teaching to answer the call to action on the front lines, Schiff also got to work. Within hours, she and a group of other students started building a crash course on COVID-19 for medical professionals.

“At the time, a lot of Harvard medical students were talking about what was going on, and [it] felt like we suddenly had a lot of time on our hands,” Schiff told ABC News. “There was this crisis going on. How can we best contribute?”



a woman standing in front of a book shelf: Abby Schiff, a fourth-year medical student at Harvard Medical School, helped to create the school's COVID-19 curriculum and still keeps it updated on a regular basis.

© ABC News
Abby Schiff, a fourth-year medical student at Harvard Medical School, helped to create the school’s COVID-19 curriculum and still keeps it updated on a regular basis.

In less than a week, 70 of Schiff’s colleagues, including students and faculty, had put together a comprehensive, open-source COVID-19 curriculum.

“So we had about 80 pages of content — all referenced, all freely available — including things like thought questions, quiz questions… helpful information about how to put on masks and PPE, run ventilators,” she said. “And then also an explainer about basic epidemiological terms, about sort of the basics of virology and immunology and the clinical manifestations that were known at the time.”

Seven months later, the curriculum is still being updated with the latest science on a regular basis. Today, it includes modules on mental health, global health and communication, all meant to “dispel misinformation and myths,” said Schiff.



graphical user interface, application: Fourth-year Harvard medical student Abby Schiff (second from top left) attends a video meeting with her fellow students to discuss updates to their school's open-source COVID-19 curriculum.

© Courtesy Abby Schiff
Fourth-year Harvard medical student Abby Schiff (second from top left) attends a video meeting with her fellow students to discuss updates to their school’s open-source COVID-19 curriculum.

As co-chair for outreach, she said her role is to reach out to students and groups that are using the curriculum to get an idea of their needs and how they can best be met, as well as recruiting students to contribute. The curriculum has already been implemented in 32 medical schools across the country as either an elective or mandatory course, and it has been translated into 27 languages and used in at least 110 countries, Schiff said.

“It’s had a really wide reach, including in areas where

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Beyond Celiac Chosen by 9 Meters Biopharma as Exclusive Patient Organization to Recruit for First-Ever Phase 3 Clinical Trial

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Premier Patient Recruiter for Celiac Disease Research, Beyond Celiac Taps Extensive Network to Advance Study

Go Beyond Celiac, an online patient database launched in 2017, allows its thousands of users to participate in research by sharing their celiac disease stories and experiences and learn how to become involved in research studies such as the Phase 3
Go Beyond Celiac, an online patient database launched in 2017, allows its thousands of users to participate in research by sharing their celiac disease stories and experiences and learn how to become involved in research studies such as the Phase 3
Go Beyond Celiac, an online patient database launched in 2017, allows its thousands of users to participate in research by sharing their celiac disease stories and experiences and learn how to become involved in research studies such as the Phase 3

Philadelphia, PA, Oct. 14, 2020 (GLOBE NEWSWIRE) — Beyond Celiac, the leading catalyst for a celiac disease cure in the United States, today announced it has been chosen by 9 Meters Biopharma, Inc. (Nasdaq: NMTR) as the exclusive patient organization to recruit for the first-ever Phase 3-stage clinical trial therapeutic for treatment of celiac disease. Beyond Celiac will use its unrivaled connection to the celiac disease community and its powerful online patient database to recruit participants for the study of larazotide acetate, which aims to address leaky gut in celiac disease.

“We really listen to our community’s wants and needs. Because of our extensive connection to the people and commitment to connecting researchers with our community, Beyond Celiac has become the partner of choice for leading biotechnology and pharmaceutical companies such as 9 Meters,” said Beyond Celiac CEO Alice Bast. “This is the furthest a celiac disease clinical trial has gone, and it’s an exciting opportunity for our organization to play a vital role in fulfilling its promise.”

9 Meters Biopharma is evaluating larazotide acetate for celiac disease patients who continue to experience gastrointestinal symptoms while following a gluten-free diet. Designed to tighten junctions between intestinal cells, larazotide acetate would act like shoelaces to help restore leaky junctions to a normal state and would be used in addition to the gluten-free diet. It is being tested at more than 100 clinical sites, with a goal of 525 study participants. Results are expected by the end of 2021.

By partnering with Beyond Celiac for recruitment, 9 Meters Biopharma now has access to the power of Go Beyond Celiac, a secure online patient database with thousands of users who share their celiac disease stories and experiences with researchers and seek to become involved in studies.

“Our conservative estimate is that our celiac disease program is at least two years ahead of everyone else’s,” said John Temperato, president and CEO of 9 Meters Biopharma. “Beyond Celiac is going to help us across the finish line in developing the effective treatments that celiac patients deserve.”

Celiac disease is a serious genetic autoimmune disorder that affects an estimated 1 in 133 Americans, more than half of whom are still undiagnosed. The disease causes damage to the small intestine, resulting in debilitating symptoms, and if left untreated, can lead to serious long-term health problems including infertility and some types of cancer.

 

About Beyond Celiac

Founded in 2003,

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Health systems, govt responses linked to virus tolls

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BERLIN (AP) — Scientists say a comparison of 21 developed countries during the start of the coronavirus pandemic shows that those with early lockdowns and well-prepared national health systems avoided large numbers of additional deaths due to the outbreak.

In a study published Wednesday by the journal Nature Medicine, researchers used the number of weekly deaths in 19 European countries, New Zealand and Australia over the past decade to estimate how many people would have died from mid-February to May 2020 had the pandemic not happened.

The authors, led by Majid Ezzati of Imperial College London, then compared the predicted number of deaths to the actual reported figure during that period to determine how many likely occurred due to the pandemic. Such models of ‘excess mortality’ are commonly used by public health officials to better understand disease outbreaks and the effectiveness of counter-measures.

The study found there were about 206,000 excess deaths across the 21 countries during the period, a figure that conforms to independent estimates. In Spain, the number of deaths was 38% higher than would have been expected without the pandemic, while in England and Wales it was 37% higher.

Italy, Scotland and Belgium also had significant excess deaths, while in some countries there was no marked change or even — as in the case of Bulgaria — a decrease.


While the authors note that there are differences in the compositions of populations, such as age and the prevalence of pre-existing conditions that contribute to mortality rates, government efforts to suppress transmission of the virus and the ability of national health systems to cope with the pandemic also played a role.

Amitava Banerjee, a professor of clinical data science at University College London who wasn’t involved in the study, said it was well designed and had used standardized methods.

He noted that the comparison between death rates in the United Kingdom and New Zealand, where the age of the population and the rates of pre-existing conditions such as obesity are similar, supports the argument that other factors contributed to the differing mortality figures.

“Even if vaccines and better treatments for severe (COVID-19) infection are developed, the way to minimise excess deaths is to reduce the infection rate through population level measures,” said Banerjee.

These include lockdowns, protecting high risk groups,and establishing effective “test, trace and isolate” systems, he said.

___

Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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Do Musical Instruments Spread the Coronavirus?

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As with pretty much every other activity right now, having the quintet gather outdoors is a great idea. If any neighbors complain, explain that the backyard practices are part of a global effort to keep them from dying. If anyone happens to be infected, any virus that emanates in the heat of performance will likely fade into the sky and disperse like the music itself. Indoors, as any parent of a child who’s learning an instrument knows, everything is trapped and can echo around the room indefinitely.

Some instruments do seem to pose more risk than others. Obviously, string instruments can be played without even opening your mouth, but it sounds like your daughter’s quintet is too far along to take kindly to a suggestion that they all learn new instruments. Because the virus is sent into the air by talking, coughing, and singing—any forcible exhalation of air through the pharynx—playing a woodwind or brass instrument would logically pose a risk. These instruments are effectively designed to amplify what’s coming out of our mouths and to carry the sound. A 2011 study of vuvuzelas (the long, straight plastic horns that people blow at soccer games) found that their capacity for spreading infections could be tremendous. Compared with shouting, blowing through the horn sent several hundred times more particles into the air.

Thankfully for everyone, kids don’t train for vuvuzela quintets. Woodwind and brass instruments send air through a maze of twists and turns, and buttons create turbulent airflow patterns that don’t simply shoot everything out in a piercing plume. Breathing into a convoluted contraption such as a saxophone or a tuba, then, actually serves as a sort of filter that collects the larger droplets you might be spewing out. This is familiar to anyone who has emptied a spit valve and seen what pours out.

The real question is the potential danger of smaller, aerosolized particles that can blast out of an instrument and linger in the air. In May, the Vienna Philharmonic reported that it had conducted a study of the aerosols from various instruments. Researchers hooked tubes up to musicians’ noses, and as they played, they inhaled an aerosolized salt solution that could be visualized when it was exhaled. The researchers mapped the clouds of air around musicians while they were playing and reported that none of the instruments sent respiratory droplets beyond the commonly recommended radius of six feet. In most cases, no significant amount of the aerosolized salt particles were detectable coming out the end of the wind and brass instruments. Flutes were the worst offender, passing a “large amount” of aerosol in a cloud covering two and a half feet.

In July, another study in Germany offered findings and hope similar to those from Vienna. But neither study measured actual coronavirus particles, and the overall evidence is still thin. Doctors at the University of Iowa have expressed concern about the rigor of both findings, given

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First Databank Selected as Drug Database Provider for CliniComp, Intl.’s Full-Service EHR Pharmacy Solution

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Healthcare industry’s most trusted drug database to drive streamlined inpatient pharmacy workflows for hospitals using CliniComp’s EHR

First Databank, Inc. (FDB), the leading provider of drug and medical device knowledge that helps healthcare professionals make precise decisions, has been selected to supply the drug database for a new and expanded EHR pharmacy module to be offered by CliniComp, Intl., a global provider of hospital-wide clinical documentation systems and electronic health record (EHR) solutions.

CliniComp will integrate the FDB MedKnowledge® database into its EHR to drive a single, full-service pharmacy and medication management system designed to simplify all inpatient pharmacy workflows, including computerized physician order enter (CPOE), medication dispensing and administration.

“Hospitals today need a more robust integrated pharmacy workflow management system within the EHR to make ordering, conflict checking, documenting and dispensing medications easier and more accurate,” said Nancy Pratt, RN, MSN, Senior Vice President Clinical Product Design of CliniComp, Intl. “FDB MedKnowledge will support CliniComp to deliver a more intuitive, easy-to-use solution across all medication workflows, while facilitating meaningful clinical decision support [CDS] alerts, seamless interoperability and smarter data analytics.”

Pratt explained: “We also chose MedKnowledge because the database features excellent organization and structure. This will enable CliniComp to furnish clinicians with access to the right medication information appropriate for their contexts, as well as detailed drug product classifications for more precise selection of drugs.”

Bob Katter, President of FDB, said the alliance will streamline pharmacy workflows to make ordering and dispensing medications more efficient for clinicians. “We will provide CliniComp’s users with meaningful, targeted and actionable medication guidance to support their clinical decision-making,” Katter said. “This will help further improve patient care and safety.”

The new CliniComp pharmacy system powered by FDB MedKnowledge will:

  • Save clinicians time with faster order processing via intelligent dispensing. The system will automate package choice and medication ordering based on criteria such as patient-specific parameters and medication inventory.

  • Save hospitals implementation time via the use of prebuilt medication concepts offered within MedKnowledge. The new full function pharmacy system will provide a foundation from which hospitals can more quickly tailor a solution to meet specific needs.

  • Save hospitals time and resources in updating medication information while ensuring the latest drug data is readily available to clinicians. MedKnowledge will facilitate automated medication updates with minimal post-load maintenance, so there is no downtime.

In addition to FDB MedKnowledge, CliniComp plans to implement the FDB Interoperability Module™ to enhance medication reconciliation and interoperability with external hospital systems, such as automated dispensing cabinets.

About First Databank (FDB)

First Databank (FDB) is the leading provider of drug and medical device knowledge that helps healthcare professionals make precise decisions. We empower our information system developer partners to deliver valuable, useful, and differentiated solutions used by millions of clinicians, business associates, and patients every day. For more than four decades, our medical knowledge has helped improve patient safety, operational efficiency, and healthcare outcomes. For a complete look at our solutions and services, please visit www.fdbhealth.com and follow us on

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Most governments listen to scientists

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Billionaire philanthropist Bill Gates criticized the U.S. response to the coronavirus, telling CNBC the nation ranks “quite low compared to other countries” in executing testing and delivering a clear message on safe social practices such as wearing masks.

“Our response in most respects has not been very good. And we would have expected it to be good,” the Microsoft co-founder told “Squawk Box” co-host Becky Quick in an interview that aired Wednesday.

President Donald Trump, recovering from Covid-19 himself, has been dismissive of masks and even mocked Democratic presidential nominee Joe Biden in their first debate for wearing them. Trump, who returned to the campaign trail this week, has also repeatedly flouted advice from medical experts on the importance of social distancing by holding packed rallies with spotty mask-wearing among supporters. Trump has defended having crowds at his recent campaign events, saying they’re being held outside, where coronavirus transmission is less likely than indoors.

Without mentioning Trump, Gates said that unlike the U.S., many countries have “done very, very well” using the behavioral tools available to help blunt the spread of the coronavirus. The founder of the Bill and Melinda Gates Foundation, which works to tackle complex global health challenges, said it has nothing to do with politics.

“That’s a purely technical thing, not a political thing. Most governments take advantage of their scientists and listen to them. They don’t undermine them and attack them,” he said. “Mask compliance in the United States is quite poor. And yet the cost of the mask and the productivity lost from [not wearing] the mask, it’s quite an intervention.”

Gates also pointed out that social measures such as masks, social distancing and hand-washing are the primary tools to fight Covid-19 until “therapeutics or vaccines get out there in big numbers.”

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Surgical protocol reduces opioid use for breast reconstruction patients

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Breast cancer surgeries can be quite painful, so a team at Houston Methodist West Hospital has worked to develop pain management protocols that help some patients while reducing the use of narcotics.

Dr. Candy Arentz, a breast surgical oncologist, and Dr. Warren Ellsworth, a plastic surgeon, have been using an enhanced recovery after surgery (ERAS) protocol with non-narcotic medications and nerve blocks to lessen pain and the need for narcotics in reconstructive surgeries.

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A DIEP flap reconstruction uses tissue and fat from the abdomen and other areas to reconstruct the breast after a lumpectomy or a mastectomy. Ellsworth said the reconstruction can be beneficial because it can look more natural than implants and can last the rest of a patient’s life. But it can be more painful because of the extra incisions. He recognizes that opioid overuse is an issue and said that is just one reason why he and Arentz are working to reduce opioid use.

“We have also, I would say, across the entire house of medicine known about this opioid overuse, opioid dependence and all these challenges that our narcotics impose on our patients, not only the basic side effects of narcotics like nausea, vomiting, constipation, but of course, the dependency,” Ellsworth said.

The ERAS protocol helps patients with pain starting the day before the surgery. “So it prepares their body for the surgery and the pain that could occur, and then we continue the pain control throughout the surgery and then of course postoperatively and have found a significant reduction in the use of narcotics because of this protocol,” Ellsworth said.

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As Arentz and Ellsworth were coming up with the protocol, Ellsworth consulted with plastic surgeons at the University of Pennsylvania and Stanford University, modeling the Methodist West protocol after their programs. But according to Ellsworth, Methodist West is the first in the Houston area to make the non-narcotic protocols a priority with their patients in the area of DIEP flap reconstructions.

Ellsworth said starting ERAS required bringing in others in the hospital on board, including the head of anesthesiology so that anesthesiologists could administer nerve blocks, or long-lasting numbing injections into patients’ nerves, and the head of the ICU (intensive care unit) because the new protocols were a big change in pain management. Arentz said it required patient buy-in as well.

“It starts with our conversations in clinic and assuring the patients that they will have decreased pain afterwards than probably what they were expecting,” Arentz said, adding that the protocol is done without using IV medications, which is what most people expect when they are going to have surgery.

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Arentz and Ellsworth had planned to start using ERAS in February or March, but COVID-19 shifted it back some. So they started in April. Ellsworth said that all

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