UAB Med Cast

Degenerative mitral valve disease is the most common heart valve abnormality. Panayotis Vardas, M.D., a cardiothoracic surgeon, reviews the distinctions between primary and secondary mitral regurgitation. He describes categories of patients who would be candidates for mitral valve repair, which is the standard-of-care treatment, versus those who might undergo mitral valve replacement. Learn more about the dramatic success rates of mitral valve repair and clinical trials underway that explore new techniques for complex cases.

Some people struggle with symptoms for years and never receive a clear answer on what condition they have. UAB Medicine is part of the National Institutes of Health Undiagnosed Disease Network (UDN), which means they are committed to applying the latest technology to make diagnoses for their regional community. Bruce Korf, M.D., associate dean for Genomic Medicine, explains the various tools the undiagnosed disease team uses, including radiologic imaging, neurological testing, and genomic sequencing. Learn how patients from all demographics may gain access and be evaluated by a multidisciplinary team. He also explains how new diagnoses can help doctors understand the less common ways diseases present.

Mechanical thrombectomy is an effective new procedure for ischemic stroke management that lowers the possibility of damage to brain tissue. Select hospitals designated as thrombectomy-capable stroke centers, such as UAB, are equipped to perform this time-sensitive procedure 24/7. Michael Lyerly, M.D., a vascular neurologist, and Elizabeth Liptrap, M.D., a vascular neurosurgeon, explain how improved coordination with first responders and other hospitals using telemedicine and triage allows UAB to treat more regional patients who might benefit. They describe their multidisciplinary approach to choosing a specific combination of other tools and techniques alongside mechanical thrombectomy

Around 80% of adults experience low back pain, and most are not candidates for surgery. Prentiss Lawson, Jr., M.D., and Christopher Paul, M.D., both anesthesiologists who specialize in pain medicine, discuss a promising new durable therapy for low back pain called restorative neurostimulation. Unlike existing low back pain management options, neurostimulation addresses a root cause, a weak or inactive multifidus muscle. The doctors explain the minimally invasive procedure, which involves sending electric pulses to the multifidus nerves. Learn how this treatment uniquely restores patents’ spinal stability and thereby reduces chronic pain.

Telehealth is impacting nearly every aspect of health care. Zain Hashmi, M.D., a trauma surgeon, discusses the potential of telehealth for improving access to comprehensive trauma care among rural patients. He explains how finding ways for EMS teams to consult trauma experts virtually and closer to emergencies could reduce transfer rates and improve patient care. Dr. Hashmi outlines the challenges of implementing telehealth for trauma care, emphasizing the need for 360-degree stakeholder engagement.

Carotid stenosis, caused by a buildup of plaque in the carotid artery, accounts for around 20% of all ischemic strokes. Mark Harrigan, M.D., and Elizabeth Liptrap, M.D., both neurosurgeons, discuss key aspects of medical management and interventions for carotid stenosis. Learn about two new alternatives to the (still-effective) endarterectomy procedure. The doctors explain how their approach to management and intervention varies by patient.

The Birmingham region grew around heavy industry, including coal mining and steel production. These industries, which still employ thousands today, can pose hazards to workers’ health and others in the community. The UAB Environmental Lung Disease Clinic provides comprehensive evaluations for patients with respiratory conditions related to work exposure or environmental hazards. Kevin Dsouza, M.D., and Crystal Stephens, CRNP, helped found and lead the clinic. They discuss the scope of their work, when providers should refer patients, and how patients can also self-refer.

Over one million people in the U.S. grapple with HIV. Although life expectancy has increased, end-stage organ diseases have a relatively high mortality rate for these patients. Learn about HIV-to-HIV kidney transplants from Shikha Mehta, M.D., director of the UAB HIV and Hepatitis C Transplant Program. She explains how her interdisciplinary team has made successful kidney transplants for over decade despite numerous challenges and comorbidities of those with HIV.

While nonpulsatile tinnitus (constant buzzing sound) is a common condition many people learn to live with, pulsatile tinnitus (sound that occurs with each heartbeat) may indicate dangerous otological or vascular conditions. Erika McCarty Walsh, M.D., a neurotologist, and Jesse Jones, M.D., a neuroradiologist, discuss the complex process of determining whether patients have pulsatile tinnitus, what the causes are, and which treatments might be considered necessary. Drs. Walsh and Jones describe their collaborative approach to making sure that patients address any dangerous conditions and otherwise learn to manage their pulsatile tinnitus.

Around 15% of people in the U.S. have a form of chronic kidney disease (CKD), which is often related to diabetes and hypertension. Claretha Lyas, M.D., a nephrologist, discusses the interdisciplinary approach to treating CKD alongside its root causes. Learn about two new classes of medicine that are slowing the progression of CKD. Find out the best time to refer a patient to a nephrologist, who can manage disease progression and provide a seamless transition to transplant evaluation services if needed.

Many women who have typical symptoms of coronary artery disease actually have coronary microvascular disease (MVD). Gretchen Wells, M.D., a cardiologist, explains why it is important for physicians to proceed with tests for MVD when cardiac catheterization does not indicate coronary artery disease. She explores the common symptoms, proven and potential interventions, and the serious risks posed by MVD. Dr. Wells recommends patients explore multidisciplinary cardiac rehabilitation programs if they are diagnosed with MVD.

Only 60% of age-eligible adults are up to date on their colorectal cancer screenings. Drew Gunnells, Jr., M.D., and Shajan Peter, M.D., discuss why the colonoscopy is still their preferred first-line screening and polyp removal method, while newer at-home screening methods are useful in regions with limited access to care. The doctors discuss advancements in A.I. that they use to improve the detection of polyps during a colonoscopy. Learn more about a local partnership to provide free colonoscopies to residents despite insurance status or other barriers.

Polycystic ovary syndrome (PCOS) can occur in women who have neither obesity nor insulin resistance – two conditions that are often used as clues. William Hurd, M.D., a specialist in reproductive endocrinology and infertility, explains the three signs that help determine if a patient has PCOS. He also discusses working with patients to meet their reproductive planning goals while managing symptoms. Learn how a multidisciplinary team can manage the comorbidities often related to PCOS.

As the prevalence of diabetes increases, so does the variety of treatment and management tools available to endocrinologists. Alexandra Dodd, M.D., an endocrinologist, discusses advancements including continuous glucose monitoring, new types of long-acting insulin, and medicines that help patients control both blood sugar and weight. She describes the common health conditions that result from advanced diabetes and the corresponding specialists she works with to treat those.

Although strokes are complex events involving both the brain and heart, diagnosis and treatment of potential strokes is not always managed by brain and heart doctors working together. Because of this, patients may be having unnecessary procedures and risking future health events. Ekaterina Bakradze, M.D., a stroke neurologist, and Mustafa Ahmed, M.D., an interventional cardiologist, discuss the complexity of stroke diagnoses and management, emphasizing the importance of a multidisciplinary team. The doctors explain how one common cause of stroke called PFO – a hole in the heart – is not always the culprit of a patient’s neurological health condition. Learn more about their work at the UAB Heart Brain Clinic.

Brain health can be maintained with many of the same lifestyle behaviors doctors recommend as being heart-healthy. Ronald Lazar, M.D., a neuropsychologist, explains that brain health has a pathological and a pragmatic component, and it is ultimately individualized. He discusses the impact that primary care physicians can have on patients by helping them connect healthy lifestyle choices (e.g., exercising, quitting smoking, sleeping, maintaining a balanced diet) with preventing cognitive decline and Alzheimer’s. Dr. Lazar emphasizes that optimizing brain health requires an interdisciplinary effort from physicians and patient awareness from an early age.

Diabetes care is changing rapidly with technological advancements such as continuous glucose monitoring, patch insulin pumps, and doctors’ ability to monitor patient data remotely. Ananda Basu, MD, endocrinologist and director of the UAB Diabetes Technology Program, discusses the developments that will make diabetes care more individualized and responsive in the future. Learn more about the educational and socioeconomic hurdles that will need to be cleared along the way.

Molecular diagnostics teams help physicians implement precision medicine that results in better outcomes for patients with a variety of conditions. Craig Mackinnon, M.D., director of the Division of Genomics Diagnostics and Bioinformatics, discusses how molecular pathologists work hand-in-hand with oncologists and pathologists to develop treatment strategies from patients’ molecular profiles (i.e., identifying meaningful mutations). Learn how in-house molecular diagnostics labs allow institutions to deliver care more efficiently.

Prognoses for oropharyngeal cancers have improved dramatically over the past 20 years, reflecting physicians’ better understanding of the role of HPV in driving most of these cancers. Andrew Fuson, M.D., and Hari Jeyarajan, M.D, explain their shift to using surgery as the standard-of-care treatment for oropharyngeal cancers caused by HPV, which has resulted in survival rates of 85-90%. They discuss how robotic surgery and advanced screening methods have improved patient quality of life. Learn about an international clinical trial being conducted at UAB that explores a process for making cancer cells glow so that surgeons can more precisely define tumor removal boundaries.

Pulmonary embolism (PE) is a common life-threatening blood clot that may be encountered across many specialties, and especially in emergency departments, making standardized response and treatment a challenge. Sam McElwee, M.D., a cardiologist, discusses his work helping to lead PERT, the Pulmonary Embolism Response Team. He discusses advances in PE treatment that make quick referrals to PERT imperative. Learn about system-wide standards PERT has established (and shared through education) which determine when a patient will be referred to them. Dr. McElwee makes a case for other providers to give their patients with PE the clear benefit of a team approach.