Photodynamic Therapy Is an Alternative to Removal of Esophagus

LEXINGTON, Ky. (April 5, 2006) — When you think of heartburn, you probably think of greasy food, not cancer. You may not know that chronic heartburn is linked to esophageal cancer.

Most people experience occasional heartburn. But when heartburn is severe or occurs frequently over an extended period of time, it is called Gastroesophageal Reflux Disease or GERD. Over time, untreated GERD damages the lining of the esophagus. As a result, one in 10 people with GERD develop Barrett’s esophagus, a potentially dangerous change in the lining of the esophagus. Barrett’s esophagus occurs when acid-resistant cells, similar to those found in the stomach and intestinal lining, grow in the esophagus.

“Many patients with Barrett’s esophagus experience no symptoms,” said Dr. Luis Peña, UK College of Medicine Assistant Professor, Division of Digestive Diseases and Nutrition. “It is important to go to your doctor, if you are experiencing persistent or severe heartburn. If acid reflux is controlled, you may not develop Barrett’s esophagus.”

Preventing Barrett’s esophagus could be a matter of life or death: Those with Barrett’s esophagus may be 30 times more likely than the average person to develop esophageal cancer. Survival rates for the nation’s fastest growing cancer are staggering: Only 16 percent survive five years after diagnosis. The American Cancer Society estimates that nearly 14,000 will die from esophageal cancer this year.

It is standard to monitor Barrett’s esophagus for dysplasia, or abnormal cell changes, through endoscopy. During an endoscopy, the patient is sedated and a thin, lighted tube is inserted down the throat, allowing the doctor to examine the lining of the esophagus for abnormalities and to biopsy, or collect tissue samples for testing. In patients with high-grade dysplasia, 20 percent may develop cancer. Thus, serious measures must be taken.

Typically, this means undergoing an esophagectomy, the removal of the esophagus. But this procedure has its risks – complications such as problems swallowing and a three to 13 percent mortality rate, depending on the expertise of the surgical center.

“This is major surgery, and for some patients it is not an option,” Peña said. “If a patient is too ill or elderly to undergo an esophagectomy, we offer an alternative in photodynamic therapy.”

The University of Kentucky HealthCare Chandler Medical Center is one of only two centers in Kentucky offering photodynamic therapy, which reduces the incidence of esophageal cancer. The outpatient procedure involves injecting the patient with a photosensitizer intravenously. Two days later, the photosensitizer is activated with a laser, and abnormal cells are destroyed. The patient must return for an endoscopy in three months and the process can be repeated if necessary.

Although photodynamic therapy carries much less risk of death than esophagectomy, patients need to be aware of its risks. There is a 20 to 40 percent chance of stricture, an abnormal narrowing of the esophagus, which is treated with dilation. Patients will be severely light sensitive for four to six weeks after the procedure and must take care to cover their entire body before exposure to sunlight. They can gradually increase sun exposure as the photosensitizer dissipates from their system. Patients can expect chest pain and/or difficulty swallowing for a week or two after the treatment. Pain can be controlled with medication.

“Right now, we don’t have long-term data on outcomes,” Peña said. “In time, photodynamic therapy could become the first line of treatment, or a more widely used alternative to esophagectomy.”

For more information, or to make an appointment, contact the UK Division of Digestive Diseases and Nutrition at 859-323-5575.

Ambassador of Kentucky Children’s Hospital Meets President Bush

LEXINGTON, Ky. (April 5, 2006) — Taylor Lake, 11, daughter of Elizabeth and Patrick Lake of Berea, recently represented UK HealthCare’s Kentucky Children’s Hospital as a national ambassador for children’s hospitals.

As representatives of the Children’s Miracle Network, Taylor and her parents spent a fun-filled week at Disney World and then it was off to meet the President of the United States.

International ambassadors frequently visit The White House, but child ambassadors from each state met with President Bush as representatives of 17 million hospitalized kids. These remarkable children have triumphed despite severe medical challenges and were chosen to represent their state as part of CMN’s Champions Across America, presented by CO-OP Network. The mission of these young ambassadors was to share the message that their lives are better because of the tremendous work of children’s hospitals.

Taylor Lake is a straight-A student and a beauty pageant queen. Seeing her poise on the pageant stage, no one would guess that she once had a serious medical problem that kept her from growing normally and playing like other kids could.

For years Taylor had trouble eating and suffered from chronic gastrointestinal problems. “We went through years worried because she looked bad and felt bad,” said her mother, Elizabeth Lake. “I knew something was wrong with my baby.” But Taylor’s parents could not figure out what, exactly, was wrong with her.

At age 6 Taylor suffered a severe intestinal attack and was taken to Kentucky Children’s Hospital, where a devoted doctor was determined to find the cause of her symptoms. A diagnosis was found within days: an inflammatory bowel disease called ulcerative colitis. A treatment plan was implemented immediately.

Though she remains on medication and is closely monitored for complications, Taylor’s disease is in remission and she is thriving like never before. Her medical team, led by Dr. Harohalli Shashidhar, a pediatric gastroenterologist at Kentucky Children’s Hospital, and the Lake family, work hard to treat the condition to enable her to have a healthy, normal life.

“Taylor’s case was challenging in that she did not react well to the usual steroid treatments and when we found drugs that worked for her we had difficulty locating them in pediatric doses,” said Shashidhar. Ulcerative colitis can impede nutrition, creating many other problems and Taylor has undergone surgery to treat septic arthritis of her hip joint. Shashidar says Taylor and her family, along with her medical team, must keep a close watch on her growth, joint health, eyes and bone density.

“We are proud at the Kentucky Children’s Hospital to have Taylor Lake represent Kentucky in the Champions Across America tour for Children’s Miracle Network,” said Loralyn Cecil, manager of community relations, Kentucky Children’s Hospital. “She has been an inspiration to all of us as a patient and as a supporter to the hospital through our annual holiday card campaign and through ‘Taylor’s Art Factory.’”

Taylor was one of the hospital’s patient artists for the 2005 Holiday Card campaign. She and her family set up tables in the mall in Richmond and at the Berea Wal-Mart to encourage people to purchase the cards and support the hospital.

Taylor also started her art factory in the fall of 2005. She and her family create kits with art and craft supplies to distribute to patients in Kentucky Children’s Hospital. Taylor was inspired to create the art factory by Jarrett Mynear with his “Jarrett’s Joy Cart.”

Devoted KCH Physician Supports Development of Both Patients and UK

Erika Price had taken her baby to two hospitals before he was two-weeks old. She feared the worst for her son, Jaxson, when a Lexington hospital recommended a higher level of care for him and an emergency vehicle transported him to Kentucky Children’s Hospital at UK. She arrived at the Hospital and soon met Dr. Joe Iocono, Assistant Professor of Surgery and Pediatrics at Kentucky Children’s Hospital. When she placed her baby in his care, Dr. Iocono said simply, “I am going to take care of him.”

“I trusted him immediately,” she said.

Jaxson’s stomach was hard and swollen. An ultrasound detected a mass in his stomach but could not identify its cause. Erika had just lost an aunt to cancer so she feared the worst. Even though he didn’t know the exact cause, Dr. Iocono knew surgery was necessary.

It was three days after surgery when Erika learned what caused the mass that had grown into her son’s intestines, bowel and liver. She was given the technical term lymphangioma. Basically, Jaxson had caught an infection that had become trapped in a series of lymph nodes that had been blocked even before birth. Soon after Dr. Iocono removed the mass, he was able to give Jaxson a clean bill of health. Now, Jaxson is eight months old, healthy and crawling. His mother is elated.

“I owe my world to him,” Erika said about Dr. Iocono.

Erika is one of many who think Dr. Iocono is a blessing to children. Shelia David, co-chair of the Makenna Foundation, said Dr. Iocono’s participation in the foundation has strengthened the group’s efforts as they raise funds to benefit Kentucky Children’s Hospital.

“He adds a whole dimension of excitement. He brought a whole new energy to the Makenna Foundation,” she said. “He is not someone who says, ‘If I were you, I would…’ He makes it happen. He comes in with ideas, actions and his checkbook.”

Dr. Iocono has joined an impressive number of development efforts for Kentucky Children’s Hospital. In addition to serving on the Board for the Makenna Foundation, he works with the SaraCare Fund, established by the Kennedy Family in Berea in the memory of their daughter, Sara, who wanted to support children and families and the work of health care providers at the Kentucky Children’s Hospital. He has attended the Blast, which benefits the hospital and the Tubby Smith Foundation; participated in walk-a-thons; and he has been interviewed repeatedly for radiothons and telethons. Dr. Iocono’s family joins him at many events.

Dr. Iocono has supported the work of people in the community because he believes private support makes the difference in the care Kentucky Children’s Hospital is able to offer children in Kentucky. “Insurance money does not provide enough for a very sick child’s care – regardless of whether that child came from a comfortable background. Insurance money does not make a hospital great. It is community support that can transform a good hospital into a magnificent resource for everyone. We can offer services for every child in Kentucky and we can offer the best services when we have private support from the community.”

“Kentucky Children’s Hospital is blessed by these families who have seen and support the work of the doctors, nurses and staff at Kentucky Children’s Hospital. We need the families of the thousands of healthy children to join us in supporting the hospital,” said Dr. Iocono.

Dr. Iocono has led by example as he rallies support for the hospital. “He has devoted his life to helping children,” Erika said.