‘A brand-new life’

When a spot showed up on David Kidder’s lung X-ray, he turned to a minimally invasive approach for his biopsy and surgery.

‘A brand-new life’

David Kidder didn’t have time for lung cancer.

He didn’t even want to slow down for a biopsy.

A fit and active 79-year-old, David had lumber to haul and crops to plant. And while building a 2,000-square-foot addition to his house, he worked shoulder-to-shoulder with the crew.

When an X-ray revealed a suspicious spot on his upper right lung, David worried it could put the brakes on his active life.

With a little research, however, he learned Spectrum Health has pioneered a minimally invasive biopsy technique—requiring no incision.

And even when the biopsy revealed stage 1 cancer, a surgeon removed it with a minimally invasive operation.

“This is a gift from God,” said David, as he took a break from his construction project at home. “I can do anything. Wow, I am blown away. I have no effects—nothing.”

Retired from the lumber business, David lives with his wife, Alvera, on a 480-acre country property in Hesperia, Michigan.

Last winter, he thought he had a bronchial infection, so he went to a local doctor’s office.

“The doctor came back and said, ‘Mr. Kidder, you have a little spot on your lung.’”

David couldn’t believe it.

“I have never smoked a cigarette in my life,” he said.

A minimally invasive approach

The doctor urged him to get a biopsy to see if the spot was cancerous.

The first specialist David consulted said, given the location of the lesion, he would need two incisions to reach the nodule and lymph nodes for a biopsy.

David worried about how long it would take to heal from the procedure. So, he began to research his options.

His search led him to Spectrum Health’s pulmonology department and their procedure that combines three technologies—robotics, electromagnetic navigation and a cone beam CT scanner to provide real-time scans of a patient’s lungs during the biopsy.

Spectrum Health doctors became the first in the nation to perform the advanced technique in 2019.

“The minimally invasive approach used for diagnosing his lung cancer is only being done in a handful of hospitals in the country,” said Gustavo Cumbo-Nacheli, MD, a Spectrum Health interventional pulmonologist.

Early on a February morning, David went into the operating room for the biopsy.

A screen above the operating table showed a map of his airways. In the upper right lung lay a spot less than an inch wide, about the size of a grape.

Dr. Cumbo guided a Monarch Auris bronchoscopy scope, equipped with a camera, into his airway and then into his right lung. An electromagnetic navigation system guided him through the twists and turns of David’s airways to the upper lobe—a difficult area to reach.

“This is a really hard case, really hard, as it is far out there,” he said.

When he reached the lesion, he deployed the needle to take a sample for a biopsy. Before doing so, however, he checked the placement of the needle using a cone beam CT scanner.

The medical team, wearing lead aprons, backed away from the operating table as the scanner moved around the table, creating a 3D image of the lungs.

In the control room, Dr. Cumbo examined the image. It showed the needle sat 2 centimeters away from the lesion.

He returned to the operating table and again navigated toward the lesion. This time, the real-time CT scan showed the needle in the center of the spot.

Fight back against lung cancer

“This is a win for this technology,” Dr. Cumbo said. “The beauty of doing this, even though it took one hour extra, is that we can provide patients with personalized medicine in a safe way.”

Without the CT scan to confirm placement of the biopsy needle, David would have needed a repeat biopsy.

Dr. Cumbo hopes the approach soon will be used not only to biopsy a tumor, but to treat it. Researchers are investigating the use of the procedure to perform an ablation or deliver chemotherapy directly to a tumor.

It would be a welcome development in the treatment of lung cancer, which kills 150,000 Americans each year and accounts for 25% of all cancer deaths.

“With lung cancer being the one of the most aggressive cancers, we need to fight back,” Dr. Cumbo said.

Next step: surgery

After the procedure, David said he felt no discomfort.

“I never had one bit of repercussion from the whole thing,” he said. “It was just awesome.”

The biopsy revealed the lesion was cancerous. But the biopsies of nearby lymph nodes showed no sign of cancer.

David soon learned surgery to remove his tumor also could be performed with a minimally invasive approach.

“When I left the doctor that day, I couldn’t believe it,” he said. “The sun was shinier. The trees were brighter.”

In early March, Geoffrey Lam, MD, a Spectrum Health cardiothoracic surgeon, performed a robotic, minimally invasive surgery to remove the upper lobe of David’s right lung.

The surgery required only four small incisions in his chest, each about the size of a fingertip, to accommodate the tools and camera needed for the operation.

After Dr. Lam removed the lobe, he placed it in a bag and cinched the drawstring, compressing the tissue small enough to be removed through a narrow tube. He also removed 28 lymph nodes for examination.

“Fortunately, his final pathology report showed he had stage 1A lung cancer, and therefore he would not need any chemotherapy or radiation after surgery,” Dr. Lam said. “He will just undergo periodic surveillance CT scans of the chest for monitoring purposes.”

For David, the news brought relief, as well as gratitude for the medical team that brought him through lung cancer.

“Dr. Cumbo and Dr. Lam are so dedicated and professional, and their efforts saved my life,” he said. “Their kindness and caring were so apparent, and it followed through to every person who cared for me at Spectrum Health Meijer Heart Center.

“I believe it is only by the grace of God that I am here, because he led me to Spectrum Health and the wonderful physicians there.”

A second chance

After four days in the hospital, David went home to recover.

“I was on the John Deere tractor one week after I got home,” he said.

By day 10, he walked 2 miles a day and no longer needed prescription pain medication.

After he received the all-clear to resume his activities, David jumped back into the chores around the house and farm. He used a chainsaw to cut down two large cherry trees. He planted 10 acres of corn.

He enjoys quieter pursuits, as well—like watching the deer that wander through his property.

“This morning I was watching mama with her two twins,” he said. “She had her buck fawn with her. The babies were nuzzling the small buck and mama kind of pawed at him.”

After a year of construction, David has nearly finished the addition on his home. Soon, he will open the entry between the house and spacious new room.

“It’s like a brand-new life,” he said. “I’m thankful to God that he gave me another chance.”

Source : Health Beat More   

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Brain plasticity in drug addiction: Burden and benefit

The brain's neuroplasticity — its ability to adapt and change — makes it possible for us to learn new skills and solve complex problems, but it also makes some people more vulnerable to the consequences of substance use disorders. This same ability also makes it possible for a person to make cognitive modifications in order to change an addictive behavior. The post Brain plasticity in drug addiction: Burden and benefit appeared first on Harvard Health Blog.

Brain plasticity in drug addiction: Burden and benefit

The human brain is the most complex organ in our body, and is characterized by a unique ability called neuroplasticity. Neuroplasticity refers to our brain’s ability to change and adapt in its structural and functional levels in response to experience. Neuroplasticity makes it possible for us to learn new languages, solve complex mathematical problems, acquire technical skills, and perform challenging athletic skills, which are all positive and advantageous for us. However, neuroplasticity is not beneficial if we develop non-advantageous learned behaviors. One example of non-advantageous learning is habitual drug misuse that can lead to addiction.

Our brain learns to respond to drugs of abuse

Our first decision to use a drug may be triggered by curiosity, circumstances, personality, and stressful life events. This first drug exposure increases the release of a molecule (neurotransmitter) called dopamine, which conveys the feeling of reward. The increased changes in dopamine levels in the brain reward system can lead to further neuroplasticity following repeated exposure to drugs of abuse; these neuroplasticity changes are also fundamental characteristics of learning. Experience-dependent learning, including repeated drug use, might increase or decrease the transmission of signals between neurons. Neuroplasticity in the brain’s reward system following repeated drug use leads to more habitual and (in vulnerable people) more compulsive drug use, where people ignore the negative consequences. Thus, repeated exposure to drugs of abuse creates experience-dependent learning and related brain changes, which can lead to maladaptive patterns of drug use.

Views on addiction: Learning and disease

A recent learning model proposed by Dr. Marc Lewis in New England Journal of Medicine highlights the evidence of brain changes in drug addiction, and explains those changes as normal, habitual learning without referring to pathology or disease. This learning model accepts that drug addiction is disadvantageous, but believes it is a natural and context-sensitive response to challenging environmental circumstances. Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), and many addiction researchers and clinicians, view addiction as a brain disease triggered by many genetic, environmental, and social factors. NIDA uses the term “addiction” to describe the most severe and chronic form of substance use disorder that is characterized by changes in the brain’s reward, stress, and self-control systems. Importantly, both learning and brain disease models accept that addiction is treatable, as our brain is plastic.

We can adapt to new learned behaviors

Our brain’s plastic nature suggests that we can change our behaviors throughout our lives by learning new skills and habits. Learning models support that overcoming addiction can be facilitated by adopting new cognitive modifications. Learning models suggest pursing counseling or psychotherapy, including approaches such as cognitive behavioral therapy (CBT), which can help a person modify their habits. NIDA suggests that, for some people, medications (also called medication-assisted treatment or MAT) can help people manage symptoms to a level that helps them pursue recovery via strategies such as counseling and behavioral therapies, including CBT. Many people use a combination approach of medications, behavioral therapies, and support groups to maintain recovery from addition.

Neuroplasticity can help us modify behaviors relevant to addiction

CBT is an example of a learning-based therapeutic intervention; thus, it utilizes neuroplasticity. Scientific evidence suggests that CBT, alone or in combination with other treatment strategies, can be effective intervention for substance use disorders. CBT teaches a person to recognize, avoid, and learn to handle situations when they would be likely to use drugs. Another example of evidence-based behavioral therapy that has been shown to be effective for substance use disorders is contingency management. Contingency management provides a reward (such as vouchers redeemable for goods or movie passes) to individuals undergoing addiction treatment, to reinforce positive behaviors such as abstinence. This approach is based on operant conditioning theory, a form of learning, where a behavior that is positively reinforced tends to be repeated. Overall, multiple evidence-based approaches are used for the treatment of substance use disorders that require learning and utilize neuroplasticity.

The bottom line

Our brain is plastic, and this trait helps us learn new skills and retrain our brain. As the brain can change in a negative way as observed in drug addiction, the brain can also change in a positive way when we adopt skills learned in therapy and form new, healthier habits.

References

Targeting Behavioral Therapies to Enhance Naltrexone Treatment of Opioid Dependence: Efficacy of Contingency Management and Significant Other Involvement. Archives of General Psychiatry, August 2001.

Efficacy of Disulfiram and Cognitive Behavior Therapy in Cocaine-Dependent Outpatients: A Randomized Placebo-Controlled Trial. Archives of General Psychiatry, March 2004.

Cognitive Behavioral Therapy and the Nicotine Transdermal Patch for Dual Nicotine and Cannabis Dependence: A Pilot Study. American Journal on Addictions, May-June 2013.

Brain Change in Addiction as Learning, Not Disease. New England Journal of Medicine, October 18, 2018.

Cognitive Behavioral Therapy for Substance Use Disorders. The Psychiatric Clinics of North America, September 2010.

Neurobiologic Advances from the Brain Disease Model of Addiction. New England Journal of Medicine, January 28, 2016.

The post Brain plasticity in drug addiction: Burden and benefit appeared first on Harvard Health Blog.

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