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Quality of Life Interventions from the Columbia University Department of Surgery
How Lung Assessment Works
Joshua R. Sonett, MD
Chief, Section of General Thoracic Surgery
High-Risk Lung Assessment Program
Columbia University Medical Center
In Affiliation with NewYork-Presbyterian Hospital
Phone: 212-305-8373

The term
lung disease refers to a variety of conditions, including pulmonary fibrosis, mesothelioma, lung cancer, and
COPD (chronic obstructive pulmonary disease). COPD, a group of conditions including emphysema and chronic
bronchitis, is the fourth leading cause of death in the U.S.

While a person’s lung disease risk may be influenced by heredity, exposures—to environmental toxins such as cigarette
smoke, asbestos, dust, and hazardous chemicals— play a significant role in many lung conditions. Those at risk from
environmental exposures require screening, and if abnormalities are found, appropriate follow-up by a specialist. If you
think you are at risk, our team recommends an initial visit with a pulmonologist to determine your risk and what type of
screening is appropriate for you.  From there, your physician can help you take measures to avoid lung disease or slow its

When a suspicious lung nodule is found, follow-up is critical and must be undertaken by an experienced clinical team. Not
all lung cancers grow aggressively, and may require a “watching-and-waiting” approach with repeated imaging tests to
facilitate decisions about surgery and chemotherapy. When intensified screening becomes necessary, biopsies can now be
performed minimally invasively. Endobronchial ultrasound, conducted via a tube inserted through the mouth and into the
esophagus, provides sophisticated staging of nodules in patients with lung cancer.

Every year, hundreds of thousands of people are diagnosed with lung disease. The High-Risk Lung Assessment Program
at Columbia is founded on the imperatives of screening and expert follow-up, which can help individuals at risk live
longer, more comfortable lives.
Quality of Life Interventions from the Columbia University Department of Surgery

Diseases of the Pancreas: Risk factors, Interventions, Treatments

John A. Chabot, MD
Medical Director,
Pancreas Center
Columbia University Medical Center
Phone: 1.800.227.2762

Situated behind the lower portion of the stomach, the pancreas plays an essential role in converting the food we eat into
fuel for our body's cells. There are several disorders that affect the pancreas, including pancreatitis, precancerous
conditions, and pancreatic cancer.
Quality of Life Interventions from the Columbia University Department of Surgery

Vascular Disorders Large and Small

James McKinsey, MD
Site Chief, Division of Vascular Surgery
Columbia University Medical Center
In Affiliation with NewYork-Presbyterian Hospital
Phone: 212-342-3255

Disorders of the major arteries of the vascular system are common and can cause problems ranging from life-threatening
to cosmetic.
Vascular Disorders: Types

Aortic Aneurysm
—A “ballooning” of the main arteries carrying blood throughout the body, that if untreated a rupture
could be fatal.

Atherosclerosis—Also known as “hardening” or “narrowing” of the arteries, this accumulation of plaques on the walls of
the arteries results in limitation of blood flow to critical organs.

Carotid Stenosis— The carotid arteries are responsible for most of the blood supply to the brain and are located one on
either side of the windpipe. Narrowing of these major arteries can mean an increased risk for stroke.

Deep Vein Thrombosis (DVT)—inflammation and blood clots occurring in the deep veins, usually in the legs. The most
significant danger of DVT is that part of a blood clot will break off and travel to the lung, where it can be fatal.

Lower Extremity Arterial Occlusive Disease—This narrowing of the arteries in the lower extremities often presents
with claudication (exercise induced pain), severe pain with elevation, gangrene or severe infection.

Varicose Veins—While not life-threatening, these protruding veins resulting from faulty valves within the surface vessels
of the legs can be unsightly. Treatments include use of laser or radiofrequency technology to seal off the veins and cause
them to collapse and disappear or surgically removing the troublesome vein from the leg.

Vascular Disorders: Treatments

Treatments for vascular disorders include lifestyle modification, , and a variety of procedures, most being minimally
invasive, although some require surgery.

For the major, life-threatening vascular disorders, vascular surgeons frequently employ sophisticated minimally invasive
catheterization procedures in which a long hollow tube is inserted into the large blood vessels in the groin. The catheter is
used to treat the vascular disorder  through insertion of a reinforcing structure (stent) or inflation of a small balloon to
open up a blocked vessel. These procedures have less instance of death and complication rates compared to open surgery.

Whether a patient is a candidate for a minimally invasive procedure depends on the extent and location of the the disease
and should be discussed with the vascular surgeon.

Vascular Disorders: Risk and Avoidance

While it is difficult to prevent some kinds of vascular disease, which may occur due to advanced age or complications of
specific health conditions, there are measures you can take to significantly lower your risk. These include eating a diet low
in cholesterol, avoiding excessive alcohol use, stopping smoking, and staying active.
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Columbia University Dept.
Of Surgery Library.
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Quality of Life Interventions from the Columbia University Department of Surgery
Breast Cancer: Defenses and Interventions
Sheldon Feldman, MD
Chief, Breast Surgery Section
Comprehensive Breast Center
Columbia University Medical Center
In Affiliation with NewYork-Presbyterian
Phone: 212-305-0728
The second leading cause of death in women after lung cancer, breast cancer claimed the lives of approximately
40,000 women during 2007. Fortunately, effective treatments are available, and most women who develop breast
cancer enjoy a long life.

Lowering risk of developing the disease is a woman’s first line of defense. The steps our team recommends include:
•        finding out from your doctor whether you are at high risk;
•        following a screening regimen appropriate for your age and risk level;
•        maintaining a healthy lifestyle that includes regular exercise, limiting alcohol intake to less than one drink per day,
and maintaining a normal body weight (findings suggest obesity increases the risk of breast cancer).
As breast specialists, our goal for our patients with breast cancer must be multifaceted. We strive first to provide
treatments to ensure a patient’s long-term survival, second to prevent recurrence, and third to address quality of life
issues including cosmetic outcomes through techniques such as oncoplastic surgery.

Our multidisciplinary approach to breast health includes risk-assessment, medical care, educational programs, and
support groups. The center also offers clinical trials of new prevention techniques and breast cancer therapies such as:
•        interventions for women at higher risk of developing breast cancer;
•        a new therapy known as accelerated partial breast irradiation, or APBI, which may shorten the course of
radiation from six or seven weeks to just one week;
•        a breast cancer vaccine clinical trial beginning in 2008.
Breast cancer exacts an enormous toll throughout our society, striking women of all ages and backgrounds; the good
news is that the numbers tell only part of the story.

For more information, please visit
Quality of Life Interventions from the Columbia University Department of Surgery
Advanced Procedures that Make Cardiac Surgery Safer

Craig R. Smith, MD
Division of Cardiothoracic Surgery
Columbia University Medical Center
Phone: 1-800-227-2762

Traditionally, heart surgery required all patients to have a chest incision 9-10 inches in length and to
be placed on the heart-lung machine to pump the blood while the heart was stopped. Both of these
factors represent increased risk and discomfort for patients.  

Today, many cardiac surgery procedures involve smaller incisions, with the surgeon accessing only
the section of the heart being operated upon. These minimally invasive procedures reduce
postoperative pain, minimize scarring, and speed recovery time. Hand-in-hand with minimally invasive
techniques, many heart surgeries can now be performed
off-pump, without stopping the heart.
Procedures affected by these advances include the following

•        Coronary artery bypass surgery, in which the surgeon attaches a new vessel and reroutes blood
around a blockage, can now be performed by restraining a small area of the beating heart to sew on
the new vessel.

•        To correct the abnormal heart rhythm condition known as atrial fibrillation, a procedure called
atrial fibrillation ablation creates incisions inside the heart to form scar tissue. This
procedure can be performed as a minimally invasive procedure and without stopping the heart.

•        A faulty mitral valve can be repaired by threading a slim tube called a catheter through the
vessels and into the heart to bind the valve’s leaflets together and prevent leakage of blood backwards
from the left atrium into the left ventricle. The heart continues beating throughout the procedure, and
the patient usually leaves the hospital within 48 hours.

•        An aortic aneurysm (ballooning of the vessel wall) may involve damage to the valve connecting
the aorta and the heart. Both problems may be addressed simultaneously using a catheter threaded
through the vessels to deliver a new valve and a supportive mesh stent.
This list includes some of the most advanced procedures available. Ultimately, a highly experienced
surgeon will be the best judge of what procedure is right for you or someone you love.
Quality of Life Interventions from the Columbia University Department of Surgery
Thyroid and Parathyroid Disorders
William B. Inabnet, MD
Director, Columbia University New York Thyroid/Parathyroid Center
Columbia University Medical Center
in Affiliation with NewYork-Presbyterian Hospital
Phone 800-227-2762

Thyroid disorders are extremely common in the U.S., with over 20 million people
undergoing treatment. Women are especially vulnerable, as thyroid disease is up to eight
times more common in women than in men. Parathyroid disorders are generally less
common, occurring twice as often in women. Because these disorders tend to have
multiple symptoms, may involve ongoing medical consultations, and sometimes require
specialized surgery, a dedicated center such as the New York Thyroid/Parathyroid Center
of Columbia University can be a good approach to treatment.

Located just above the collar bone, the thyroid gland secretes hormones the body depends
upon to regulate metabolism. The four parathyroid glands surround the thyroid gland and
secrete hormones that regulate blood calcium levels.

Thyroid and parathyroid disorders include:

Hypothyroidism—thyroid gland produces too little thyroid hormone. Symptoms include
fatigue, weight gain, joint pain, increased sensitivity to cold, and depression.

Hyperthyroidism—thyroid gland produces too much hormone, speeding up metabolism.
Symptoms include sudden weight loss, a rapid or irregular heartbeat, sweating,
nervousness and irritability, goiter (enlarged thyroid).

Thyroid nodules/lumps—can indicate the presence of cancer, but most often are
noncancerous with no symptoms. Symptoms of thyroid cancer include hoarseness, or
trouble swallowing or breathing.

Hyperparathyroidism—parathyroid glands produce too much parathyroid hormone.
Symptoms include fatigue, frequent urination, bone demineralization (osteoporosis) and
kidney stones.

Diagnosis of thyroid and parathyroid disorders is often simple, consisting of a blood test
and a physical examination. If you have a sudden onset of symptoms resembling a
thyroid or parathyroid disorder, you should not hesitate to visit your primary care
Quality of Life Interventions from the Columbia University Department of Surgery

Kidney Transplantation

New and Better Options for Patients and Donors

Lloyd E. Ratner, MD
Renal and Pancreatic Transplantation
Department of Surgery
Columbia University Medical Center
In affiliation with NewYork-Presbyterian Hospital
Phone: 800.227.2762

Those with advanced kidney disease or kidney failure find their lives transformed by kidney transplant, which has become
the most common and successful organ transplant.

Obtaining a suitable donor organ can be one of the greatest challenges for a transplant candidate. Some are fortunate enough
to receive a kidney from a relative or friend. Others must join the national waiting list, which can mean enduring their
kidney disease for several years longer.

The good news regarding live kidney donation is that availability of minimally invasive laparoscopic techniques for removing
a kidney from a live donor (also known as harvesting the kidney) has greatly improved the safety and comfort of this
procedure. This in turn increases the number of individuals willing to be donors. Laparoscopic techniques also permit some
individuals who would not have been considered good candidates for an open procedure, such as older individuals, to
donate an organ. Laparoscopic kidney harvesting has rapidly been adapted as a standard of care worldwide because of its
considerable advantages.

Our team employs all available strategies to maximize transplant opportunities and reduce waiting times, including:

  • Use of “extended criteria” organs, from donors who are older or whose health or a mild kidney injury might
    otherwise prevent their donating. Extended criteria organs help transplant centers meet the needs of those too sick to
    wait for a kidney;

  • “Kidney swaps” enable two or more patients whose donors are blood-group or antigen incompatible to swap donors
    in order to receive a compatible organ. By agreeing to exchange recipients—giving the kidney to an unknown, but
    compatible individual—the donors provide healthy kidneys where previously no transplant would have been possible;

  • Plasmapheresis, cleaning the recipient’s bloodstream of mismatched antibodies to prevent rejection of the
    transplanted organ.

Recent statistics show that 17,000 Americans undergo a kidney transplant yearly. Our goal is to increase this number every
year by offering the widest range of options to individuals facing end-stage kidney disease.
Columbia Surgery
Columbia University Dept Of Surgery

Heart Failure
Yoshifumi Naka, MD, PhD

Director, Heart Transplantation and Mechanical Circulatory Support Programs

Columbia University Medical Center

In Affiliation with NewYork-Presbyterian Hospital

Phone: 1-800-227-2762

Heart failure can be life-threatening—prognosis of advanced heart failure is worse than any type of solid cancer—and heart
failure worsens over time. But it can also be controlled, improving quality and length of life.

Factors increasing risk of heart failure include: smoking, high cholesterol, hypertension, diabetes, obesity, coronary heart
disease, and a personal or family history of heart problems. If you are at risk for heart failure, consult your primary care
physician to find out if you require regular checkups and testing.

Symptoms of heart failure include:

feeling tired and unable to perform usual activities;
shortness of breath with minimal exercise, even while lying in bed;
swelling in the ankles, legs and abdomen;
pounding heart beats or a fast or irregular rhythm;
feeling dizzy, weak, or faint.
Treatment depends upon the severity, or stage, of the condition. Advanced-stage heart failure may be controlled by
medications that lower blood pressure, open blood vessels, help expel extra water and salt, and help the heart pump more

For end-stage heart failure, therapies beyond drugs are often recommended. Heart transplantation is an effective treatment,
but may not be an option because of waiting time for a donor heart and physical stresses associated with the procedure. A
cardiac assist device provides an additional option to support a patient’s life until a donor heart becomes available. An assist
device may also provide a long-term option for patients who are physically unable to undergo transplant.

Our team’s advice is: DON’T WAIT. If you are at risk, get evaluated. If you already have heart failure, evaluate all options
at a facility offering access to cardiologists, cardiac support experts, and surgeons, as well as the most current treatment