2013 Annual Report

Connecting For The Future

See Our Stories of Hope

  • A Future As Bright As Her Smile
  • Two Families Share the Gift of Life
  • A Tiny Device Turns a Life Around
  • Advanced heart procedure
    re-energizes "Mr. Mayor"

A Future As Bright As Her Smile

When Nicole Graham smiles, she doesn't hold back, and she brightens everything and everyone around her.

The positive attitude behind that smile has helped Nicole and her family through unimaginably difficult times in the past year. In September 2012, the normally healthy, active 16-year-old went to her doctor with back pain, a rash and shortness of breath. A blood test yielded a shocking diagnosis: leukemia.

Nicole immediately began treatment at Yale-New Haven Children's Hospital and was preparing for her third chemotherapy session when she went into septic shock. Nicole was placed in a medically induced coma. While in the coma she suffered strokes on both sides of her brain.

Three times that week Michele and Bruce Graham were told they might lose their daughter.

But Nicole fought – spending almost three weeks in YNHCH's Pediatric Intensive Care Unit. When she came out of the coma, Nicole couldn't move any part of her body aside from blinking her eyes. During these dark days, her family, friends and hospital caregivers helped her through. But there were also many times when Nicole flashed that famous smile, inspiring everyone with her determination to get better.

Nicole's caregivers were also determined to help her live the life she wanted, Michele said.

"We have been surrounded by people who are so positive and upbeat. They're incredibly selfless, doing whatever was in Nicole's best interest."

From YNHCH Nicole went to a pediatric rehabilitation hospital where she was expected to spend four to six months. Just over two months later, she miraculously walked out, and once medically cleared began working out to prepare for sports. In fall 2013 she was back on the field with her field hockey teammates.

"It was an emotional moment, because a year before I had just been diagnosed with cancer," Nicole recalled. "I don't think any of us expected me to be doing so well this soon."

Nicole's cancer is in remission, but she has two years of monthly maintenance chemotherapy infusions and takes oral chemo and seizure medications daily. Still, she excels at Greenwich High School; is co-captain of the lacrosse, field hockey and indoor track teams; and has earned awards for her performance in sports and school. She will attend Dartmouth College in the fall.

"Nicole is a wonderful example of how excellent medical care, a positive attitude and the support of loved ones and friends come together to help a person overcome seemingly insurmountable challenges," said Gary Kupfer, MD, Nicole's oncologist and section chief of Pediatric Hematology/Oncology at Smilow Cancer Hospital. "She has inspired us all."

Two Families Share the Gift of Life

The 40th birthday isn't a happy milestone for everyone.

But for Jason Belinski, it was a wonderful reminder of the new life he'd been given by a total stranger six months before.

On January 31, Yale-New Haven Hospital surgeon Peter Yoo, MD, transplanted a donor kidney into the Shelton man, who suffered from focal glomerulosclerosis (FSGS), a rare condition that causes kidney scarring.

In 2010, Jason had been feeling sluggish, but attributed it to working 60 hours a week as a night custodian at Fairfield schools. He reduced his hours, but was still fatigued, and had frequent headaches and hot and cold spells. He finally went to his primary care physician, and after multiple tests and consultation with a nephrologist, learned he had FSGS.

"I was shocked," Jason said.

When his kidney function dropped to 10 percent, Jason was forced to undergo dialysis for three hours a day, three times a week.

"At first I hated every minute of it," he said. "I was 38. I was young, and I had to be hooked up to this machine if I wanted to keep on living."

As a U.S. Marine, Jason has learned to overcome significant challenges, and he eventually accepted his situation. For 13 months, he continued dialysis and waited for a donor kidney – along with more than 90,000 people nationwide on the transplant waiting list. His mother, Heather Meyernick, had joined the donor list but was not a match for Jason.

In December 2012, Yale-New Haven's Transplantation Center called Jason with great news: They had found a donor in Connecticut resident Tasha Tucker, who had signed up for the donor list in the hopes of donating a kidney to her mother, Gloria Jones.

Transplantation Center staff discovered that while Tasha was not a match for her mother, she was a perfect match for Jason. Amazingly, Jason's mother, Heather, was a perfect match for Gloria.

During a four-hour operation, Yale-New Haven surgeons transplanted Tasha's kidney into Jason and Heather's kidney into Gloria.

These "kidney paired donations" (KPDs) are becoming more common, said Peter Schulam, MD, PhD, YNHH chief of Urology, who removed Tucker's kidney. Schulam has participated in a number of KPDs throughout his career, including two at YNHH.

"The transplant waiting list is still extremely long, but KPDs are helping," Dr. Schulam said. "Most healthy people can donate a kidney without any adverse effects, and that donation – whether to a loved one or stranger – can transform the recipient's life."

Nearly a year later, everyone involved the transplant is doing well. Jason is still overwhelmed by Tasha's and his mother's "selfless acts" and he encourages others to follow their example.

"There's no way I can repay Tasha," he said. "She gave me a healthy life."

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A Tiny Device Turns a Life Around

Gabe Anderson will never forget the time he found himself seated in the middle of a busy intersection.

Actually, Gabe doesn't remember most of the experience, including walking 14 blocks to the intersection. One minute he was in the University of Kansas student center; the next thing he knew a car was swerving to miss him.

Gabe had experienced a complex partial seizure – the most common type among adults with epilepsy. These seizures can last 30 seconds to several minutes, during which the person has no control or awareness of his or her actions.

Gabe had been having 20 or more seizures a month since age 18. Medication helped very little, and the condition was taking a toll.

"I was getting to the point where I was too tired to go to class, but I would go anyway," said Gabe, now 31. "I had trouble with my short-term memory. I couldn't drive."

Because Gabe's seizures originate on both sides of his brain he wasn't a candidate for most epilepsy surgeries, which involve removing a small portion of the brain where seizures start. But Gabe's father, Tim, discovered a clinical trial for a device called the Responsive Neuro-Stimulator (RNS).

In 2004, Gabe and Tim traveled from Kansas to New York-Presbyterian/Columbia Medical Center, where, after extensive evaluation directed by neurologist Lawrence J. Hirsch, MD, Gabe had the device, including its mini-computer and battery, implanted. The small neurostimulator is connected to electrodes placed on or in the brain where seizures are suspected to originate. The device continuously monitors brain waves for signs of an impending seizure, and upon detecting abnormal activity, delivers electrical stimulation to prevent the seizure.

"Gabe was one of the first patients who convinced me the RNS might really work," said Dr. Hirsch, who came to Yale-New Haven Hospital in 2011 and is chief of Epilepsy and EEG, co-director of the hospital's Comprehensive Epilepsy Center and a professor of neurology at Yale School of Medicine.

Yale-New Haven is the only Connecticut hospital offering the now FDA-approved device. The hospital has been closely involved in the RNS clinical trials for the past decade, with Robert B. Duckrow, MD, as principal investigator.

Gabe now has just one to four seizures a month. He finished college and enjoys a career counseling people with substance abuse. He still sees Dr. Hirsch, traveling to Yale-New Haven every six months for follow-up care.

"Thanks to Dr. Hirsch and the RNS device, Gabe was able to finish college, start his career and get married," Tim Anderson said.

Added Gabe, "My life has turned around."

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Advanced Heart Procedure Re-energizes "Mr. Mayor"

When Ralph Cuomo awoke from a procedure to replace his aortic valve last August, his daughter, Anna, asked how he was feeling.

"I feel like a 40-year-old!" exclaimed Ralph, who was 77 at the time.

Nine months (and one birthday) later, Ralph said he still feels great, and Anna confirms that he is back to his usual spirited self. In fact, she has a hard time keeping up with her father on the crossword and word search puzzles they both love.

Last spring, Ralph was definitely not himself, feeling tired and weak. With his symptoms and a history of heart trouble – he had a heart valve surgically replaced nine years ago at YNHH – Ralph's cardiologist, Ricardo Cordido, MD, ordered an echocardiogram. Results showed the aortic valve was failing due to severe narrowing. With narrowing – frequently due to calcium deposits -- the heart must pump harder, increasing the risk of heart failure and causing symptoms such as fatigue, fainting, and chest pain.

Ralph was referred to the Transcatheter Heart Valve Clinic at Yale-New Haven Hospital and John K. Forrest, MD, director of the hospital's Structural Heart Disease Program and assistant professor of medicine at Yale School of Medicine.

In the past Ralph's only option would have been a high-risk, repeat open-heart surgery to replace the valve, but Dr. Forrest and the valve team were able to offer a new option: Transcatheter Aortic Valve Replacement (TAVR).

Using this advanced technique, introduced at Yale-New Haven Hospital in 2012, Dr. Forrest fitted a new bioprosthetic aortic valve onto the end of a catheter, which he inserted through a sheath in the femoral artery. He then positioned and deployed the new heart valve while Ralph's heart was still beating, without the need for bypass surgery.

"TAVR is less invasive and offers a much shorter recovery time compared to surgical aortic valve replacement," Dr. Forrest said. "Data has shown that in patients with increased surgical risk, survival at one year is improved with TAVR compared to similar patients who undergo open-heart surgery."

Ralph was happy to get back to the home in Wallingford where he's lived for 40 years, to be with Anna and their rescue dog, Nacho. He was also happy to see his "second family," staff and patients at the dialysis center where he's treated three times a week.

"I have a nickname there," says the naturally gregarious Ralph. "One of the staff members calls me 'Mr. Mayor.'"

The second youngest of 13 children, Ralph easily ticks off the names and ages of his beloved siblings, noting that many are in their 80s and 90s.

Ralph has every intention of getting there – and beyond.

"I told my daughter, 'I'm going to live to 140.'"

2013 Our Stories of Hope [PDF]

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