Saving the Smallest

What medicine can do now for babies born too soon.

Published in DukeMed, Spring/Summer 2006. Download PDF file here.

Of the hundred odd nights they spent in Duke Hospital’s intensive care nursery, the one Jim and Tara Glandorf learned that their son was showing signs of kidney failure may have been the worst.

Aiden had weighed just two pounds when he was born at 26 weeks with twin sister Olivia, who was even tinier but much stronger than her brother.

Modern medicine had already saved their young lives more than once. Both had spent time on special ventilators and received surfactant, a drug specially developed to open up their immature lungs — a therapy Duke neonatologists helped make possible.

Aiden had also weathered two spinal taps to test for meningitis and survived bleeding in his brain, a serious and common problem in extremely low birth weight infants.

But that night, Aiden turned a shade of gray, and “My husband just lost it,” says Tara. “We thought we were going to lose our son. A doctor came in and didn’t say anything, but just put her arm around Jim. There were many babies in the nursery that needed attention; it just meant the world to us that she would do that.”

Cycles of Light

Published in DukeMed, Spring/Summer 2006

(Sidebar to “Saving the Smallest“)

Most ICNs are kept in near-darkness to simulate the womb, but neonatal clinical nurse specialist Debra Brandon may have found a better alternative.
In an NIH-funded study, she provided premature infants with periods of light (mimicking daytime), filtered through a netting similar to car sunshades, and periods of near-darkness (nighttime), in which their incubators were blanketed with a coverlet.

Brandon found that babies who received the day/night cycled light earlier in their post-gestation period gained weight faster than those who received it later.

“Cycled light mimics the circadian rhythm cues that are established for full-term babies in the womb,” says Brandon, an assistant professor of nursing and pediatrics. “Circadian rhythms are important to everyone’s health and well-being, and establishing a good circadian pattern seems to benefit preterm babies in terms of sleep, immunological function, and digestive system function.”

Brandon’s follow-up research will chart the long-term developmental effects of cycled light.

Article Copyright 2006 DukeMed magazine

The earliest medicine: Combating congenital defects

Published in DukeMed, Summer 2006

(Sidebar to “Saving the Smallest“)

Physicians are getting better and better at treating infants who, whether premature or full-term, enter the world with medical problems. But Duke researchers like Erik Meyers, MD, and Margaret Kirby, PhD, are chasing the Holy Grail of early-life medicine: preventing the problem before the sperm meets the egg.

Both Meyers and Kirby study the causes of congenital heart defects, which result in more deaths in the first year of life than any other birth defect.

Because the heart forms in the embryo in the first two months of gestation, often before the mother knows she’s pregnant, it’s also one of the earliest defects possible.

Egg Hunters

Making babies goes high-tech

published in DukeMed, Fall/Winter 2005. Download PDF file here.

Even now, Debbie Greer can’t help but visit the infertility message boards online. Nowhere is there quite so much hope and love mingled with such heartache and desperation. It flows out from the multitude of acronyms and abbreviations: IVF, ICSI, BFP. It blinks passionately from emoticons that flash smiling icons and sobbing symbols. There are women here who suffer from polycystic ovary syndrome, women whose husbands have severe male factor infertility, women who speak of egg retrieval and follicles and embryo transfers with the familiarity of a scientist. Women who have tried every assisted reproductive technology available, over and over again, for as many as 11 years.

Only a few months ago, Greer was one of those women, and like a member of some secret society, she continues to read the message boards to remind herself how fragile the journey from infertility to parenthood is. Because in July, she became one of the lucky ones. After undergoing in vitro fertilization at the Duke Reproductive Endocrinology and Fertility division, she received what she had wanted for more than four years: a BFP-Big Fat Positive pregnancy test.

Mixing Faith and Science

Published in DukeMed, December 2005

(Sidebar to “Egg Hunters“)

Rarely do you see a physician wear his religion on his sleeve. But David Walmer, MD, PhD, wears his quite literally around his neck, in the form of a green, gold, and maroon tie patterned with crosses, fish, and the word “faith.” As chief of the Duke Reproductive Endocrinology and Fertility division, Walmer knows his attire is not only a revelation of his character, but an outward symbol of what anyone–Christian, Jewish, Muslim, or agnostic–must possess to face the emotional and physical roller coaster of infertility treatment.

You have to believe, deeply, to go through these procedures–if not in God, then in science. Walmer happens to believe in both. For many of his patients, that’s a welcome fact. In fact, not only do more patients keep the dialogue on faith open with him through their medical journeys than not, many couples specifically come to Duke to see Walmer because of his Christian-focused practice. Many ask Walmer to pray with them before embryo transplants. Some just want the knowledge that they are cared for by a physician who unabashedly shares their faith. Others seek advice on reconciling the ethical issues that abound in assisted reproductive technology (ART) with their intense desire to begin a family.

The Lowdown on Rubdowns

Sports massage may be one of the most important parts of your training program. Here’s why.

Published in Runner’s World, June 28, 2004

Loretta Ulibarri, 49, is training for her 49th marathon this summer, which will put her on target to reach 50 marathons by her 50th birthday. Achieving this feat, which has sometimes required tackling four marathons a year, took more than guts, grit, and lots of running shoes. “If it weren’t for massage, I wouldn’t be able to do this,” says Ulibarri, who lives in Denver. “I had a lot of inflammation problems and ongoing soreness that interfered with my training. Ten years ago, I started getting a sports massage every three weeks, and since then, I’ve been injury-free and able to train year-round.”

A Physician’s Guide to Fixing Leaks

It’s not what you know. It’s what you don’t.

The New Physician, March 2001
 
We need to talk.

Yes, I see you there. Big smile, brand new medical degree. A certain air of newly found authority. Nice white coat you’re wearing. Something pleasingly snug about it. In fact, you’ve probably tried it on in front of the mirror a couple times, haven’t you? Maybe you even added some dialogue, nice and slow and definitive:

I am a doctor.

Well. Got a piece of advice for you. Find a good tailor.

Sorry. Don’t mean to be rude. See, you know your way around a clinic. There’s no denying that. You’ve got book smarts, too. Malignant neoplasms, hypertension, scoliosis, acute myocardial infarction, endometriosis, epilepsy, pneumonia, asthma—you know them all like the back of your hand. But trust me, eventually you’re going to want something a little more, shall we say…functional, than that white coat. Perhaps a garment with a little more elbow room in it. After all, you’re going to need it to fix the leaky pipes.

“What?” you ask?

Just listen to my story. Then you’ll understand.

A Natural High

From tiny Woodburn, Ind., to Washington, D.C., Food and Drug Administration Commissioner Dr. Jane E. Henney never faced a hurdle she couldn’t leap.

The New Physician, November 1999

She was homecoming queen. If you know any facts about Jane E. Henney, this is probably not one of them. It’s not that it’s a great secret, a diamond of a tidbit unearthed from the past. Just four words notable for their simplicity. One of the nation’s most accomplished women doctors, with a résumé as ongoing as her Midwestern roots, once stood before her peers at Manchester College in Indiana wrapped in the swath of the traditional female popularity contest. A tiara of tradition.

It is, quite probably, a disservice to old-school feminists to begin a story about the rise of the first woman commissioner of the Food and Drug Administration (FDA) in this way. A crown, some flowers, the idea of a man presenting you on his arm while leading you down a path—too much style, not enough substance. But this is not a narrative about fitting a mold, or not fitting a mold. It’s about a woman who grew with her small-town values, who worked hard, loved fairness but not politics and dreamed big even when dreaming seemed impossible.

Doc Niswander saw the dreaming in action—in fleeting, riotous, exuberant action—one day in 1968. He peered out the window of his house near the Manchester campus where he taught anatomy and physiology, and there was quite a sight: Janie Henney, smile stretching and legs flying, beating a path like Achilles to his door with a golden ticket in her hand.

“She had just pulled it out of her mailbox,” Doc says. “It was her letter of acceptance to medical school.”