Tuesday, April 3, 2012 When Jane Waltz went to the emergency room at Christiana Hospital, she felt silly saying she was there for a headache. But her decision to go helped save her life.
A CT scan showed that she was experiencing a subarachnoid hemorrhage caused by a ruptured brain aneurysm. That meant blood was leaking into the space around her brain because a tiny section of an artery had bulged like a blister and then bled.
“Suddenly, I had this incredible pain in my head,” Ms. Waltz remembers. “My head literally felt like it was going to explode. It was a different headache from any headache I’ve ever had, and my neck was stiff, too.” 
Her condition was critical. Without immediate treatment to stop the bleeding, she risked suffering a hemorrhagic stroke, brain damage and possibly even death. So a combined neurovascular team led by neurosurgeon Paul T. Boulos, M.D., and neurointerventionalist Sudhakar R. Satti, M.D., immediately went to work to treat Ms. Waltz.
Her treatment began with an external ventricular drain to reduce the pressure that the blood was placing on the brain. During this procedure, Dr. Boulos surgically placed a plastic tube through the skull and into a fluid-filled cavity within the brain to drain excess fluid. Then Dr. Satti performed five hours of neurointerventional surgery to treat the ruptured aneurysm.
Ms. Waltz’s case was especially complicated. She experienced a rare blister aneurysm, which is a smaller protrusion of the blood vessel and more prone to rupture than the typical saccular, or berry, aneurysm. 
Dr. Satti says a blister aneurysm typically cannot be repaired with open surgery. Instead, he and his team successfully treated Ms. Waltz with a stent-supported coil embolization, which is a less invasive style of treatment performed under general anesthesia.
The procedure involved cutting a small incision near the groin and inserting thin plastic tubes and wires in the femoral artery. These tubes were used to navigate through the blood vessels to the site of the rupture. To stop the bleeding, Dr. Satti placed a metal cylinder – a stent - across the base of the aneurysm and then filled the expanded artery with a coil of platinum threads. Highly advanced X-ray equipment was used during the procedure to allow the surgeon to see his work. 
The small size of the blister aneurysm – which was about as tiny as the tip of a No.  2 pencil – added to the challenge of repairing the rupture. The traditional microsurgical clip to close the aneurysm with open surgery would be difficult or impossible given the size, shape and location of the aneurysm. Using the coil embolization technique alone wouldn’t work either because the aneurysm was not deep enough to hold in the metal coils. Adding the stent to the process, however, provided enough support to keep the coils in place.
Ms. Waltz is thankful that the minimally invasive surgery is available at Christiana Care. Until she underwent the endovascular procedure, she had no idea it existed.
“The level of care I received at Christiana Care was excellent, from beginning to end.” she says. “I’m so thankful to live near a big hospital that was able to provide the team of doctors I needed.”
Statistically, Ms. Waltz is lucky. Dr. Satti said typically only about 30 percent of people who experience a ruptured aneurysm will survive to one year without a major disability.
Ms. Waltz had her emergency surgery in December 2010. Today, the 41-year-old from Bear, Del., is back at her job as a reporting analyst in the technology sector.
“Everything looks great,” she says. “I’m so lucky to be alive, and without any brain damage.”

When Jane Waltz went to the emergency room at Christiana Hospital, she felt silly saying she was there for a headache. But her decision to go helped save her life.

A CT scan showed that she was experiencing a subarachnoid hemorrhage caused by a ruptured brain aneurysm. That meant blood was leaking into the space around her brain because a tiny section of an artery had bulged like a blister and then bled.

“Suddenly, I had this incredible pain in my head,” Ms. Waltz remembers. “My head literally felt like it was going to explode. It was a different headache from any headache I’ve ever had, and my neck was stiff, too.” 

Her condition was critical. Without immediate treatment to stop the bleeding, she risked suffering a hemorrhagic stroke, brain damage and possibly even death. So a combined neurovascular team led by neurosurgeon Paul T. Boulos, M.D., and neurointerventionalist Sudhakar R. Satti, M.D., immediately went to work to treat Ms. Waltz.

Her treatment began with an external ventricular drain to reduce the pressure that the blood was placing on the brain. During this procedure, Dr. Boulos surgically placed a plastic tube through the skull and into a fluid-filled cavity within the brain to drain excess fluid. Then Dr. Satti performed five hours of neurointerventional surgery to treat the ruptured aneurysm.

Ms. Waltz’s case was especially complicated. She experienced a rare blister aneurysm, which is a smaller protrusion of the blood vessel and more prone to rupture than the typical saccular, or berry, aneurysm. 

Dr. Satti says a blister aneurysm typically cannot be repaired with open surgery. Instead, he and his team successfully treated Ms. Waltz with a stent-supported coil embolization, which is a less invasive style of treatment performed under general anesthesia.

The procedure involved cutting a small incision near the groin and inserting thin plastic tubes and wires in the femoral artery. These tubes were used to navigate through the blood vessels to the site of the rupture. To stop the bleeding, Dr. Satti placed a metal cylinder – a stent - across the base of the aneurysm and then filled the expanded artery with a coil of platinum threads. Highly advanced X-ray equipment was used during the procedure to allow the surgeon to see his work. 

The small size of the blister aneurysm – which was about as tiny as the tip of a No.  2 pencil – added to the challenge of repairing the rupture. The traditional microsurgical clip to close the aneurysm with open surgery would be difficult or impossible given the size, shape and location of the aneurysm. Using the coil embolization technique alone wouldn’t work either because the aneurysm was not deep enough to hold in the metal coils. Adding the stent to the process, however, provided enough support to keep the coils in place.

Ms. Waltz is thankful that the minimally invasive surgery is available at Christiana Care. Until she underwent the endovascular procedure, she had no idea it existed.

“The level of care I received at Christiana Care was excellent, from beginning to end.” she says. “I’m so thankful to live near a big hospital that was able to provide the team of doctors I needed.”

Statistically, Ms. Waltz is lucky. Dr. Satti said typically only about 30 percent of people who experience a ruptured aneurysm will survive to one year without a major disability.

Ms. Waltz had her emergency surgery in December 2010. Today, the 41-year-old from Bear, Del., is back at her job as a reporting analyst in the technology sector.

“Everything looks great,” she says. “I’m so lucky to be alive, and without any brain damage.”

Wednesday, January 25, 2012

A gift of love

When he was diagnosed with kidney failure in 2008, Henry Rose, 37, a Wilmington firefighter and emergency medical technician with three small children, didn’t want to lose any time getting better.

“I wanted to have the transplant as soon as possible, because I did not want to be in a situation in which I was on dialysis and not able to provide for my family,” he says.

His wife Erica was a good match, but Henry was hesitant to allow her to donate a kidney. The cause of his kidney disease was unknown. What if it was genetic in origin and one of their children needed a donor some day?

Erica’s reply: “Let’s think positive.”

On June 2, 2009, Henry received his transplant, without ever having to go on dialysis.

“He was able to go back to saving lives — and living his own life,” says S. John Swanson, M.D., FACS, chief of Christiana Care’s Kidney Transplant Program. “Having a spouse who was able to donate made all the difference.” 

Wednesday, January 25, 2012

Bond of lifelong friends is closer than ever through organ donation

Bob Tobiason and Bob Hayes have been buddies for more than 30 years — since they were boys growing up in Wilmington’s Albertson Park neighborhood. They married sisters. They both sell auto parts. When Tobiason, 42, learned he needed a kidney transplant, Hayes was the first to volunteer to be tested for a match, even though the two men are not related.

“We have always been like brothers,” says Hayes, 44. “As it turns out, I was such a good match for Bob that the people in the transplant program asked if we were related.”

Thanks to vast improvements in drugs that suppress organ rejection, the pool of live kidney donors has grown deeper, says S. John Swanson, M.D., chief of transplantation surgery at Christiana Care. “You don’t have to be a sibling — or even a blood relative,” Dr. Swanson says. “In fact, spouses make up one of the largest growing groups of donors.”

Dr. Swanson performed the first kidney transplant at Christiana Care on Jan. 15, 2007. Thirty-two people received organs and a new shot at life in 2011, including Tobiason, who returned to work six weeks after his May 11 surgery.

Hayes did not expect any reward beyond the good feeling for helping. But word of his generosity got around, and he received a special merit award from Cranston Heights Fire Company, where he is a volunteer, for saving a life by being a living kidney donor.

“Life threw me a curve ball — but I was able to hit it out of the park, thanks to my friend and the great team at Christiana Care,” Tobiason says.

Previously, Delaware patients had to go to Philadelphia or Baltimore for care. Dr. Swanson says some individuals who desperately needed a transplant opted not to get on the waiting list for a donor because they did not want to go out of state for treatment.

About one-third of transplant patients at Christiana Care receive a kidney from a living donor. There are significant advantages to live donation, including eliminating the wait for an organ from a deceased donor, which can take four years or longer.