Changing the World One Step at a Time
UT Health Austin clinicians participate in community engagement and advocacy efforts to improve patient outcomes
Reviewed by: Dorothy De La Garza, S. Joga Ivatury, MD, MHA; Aaron Laviana, MD, MBA; and J. Stuart Wolf, Jr., MD, FACS
Written by: Ashley Lawrence
In early September 2016, at age 72, Dorothy De La Garza was diagnosed with Stage 2 muscle-invasive bladder cancer. “I was blindsided by this grim news,” explains Dorothy. “For a few years before, I had been prescribed antibiotics for frequent UTIs. Then, I was told I had an overactive bladder and given another prescription. But bladder cancer is a very sneaky disease.”
In most cases, bladder cancer is treatable, but early diagnosis is critical. While men are four times more likely to develop bladder cancer, women experience significant delays in diagnosis, which results in a more advanced disease and leads to worse outcomes.
“Too many providers are quick to assume a woman is experiencing leakage simply because she’s getting old,” shares Dorothy. “My message to women, especially those in their 50s and 60s and older, is to not ignore the most basic symptom of blood in the urine. Do not be guided by doctors associating it with menstruation or menopause. Always seek a second and third opinion.”
Care Close to Home
In fall 2016, while teaching at St. Andrew’s Episcopal School, Dorothy underwent neoadjuvant chemotherapy in Austin, Texas. She was then advised to travel for surgery to UT Health San Antonio, where she underwent a cystectomy to remove her bladder. Formation of scar tissue later developed in her ureters, the thin tubular structures that transports urine into the bladder. This is a common side effect of bladder removal surgery.
The scar tissue buildup can cause the ureters to become narrow, preventing urine flow. As the flow of urine becomes obstructed, urine backs up into the kidneys, which causes pain and discomfort and can lead to infection or long-term kidney damage. One option for addressing this is for patients to undergo ureteral stenting, an outpatient (same-day) procedure in which stents (thin, flexible tubes) are placed in the ureters to hold them open and allow proper urine drainage from the kidney.
“The usual plastic stents in my ureters required replacement four times a year since they only lasted maybe three to four months at a time,” explains Dorothy. “In early 2020, at a Bladder Cancer Advocacy Network (BCAN) conference, an out-of-state physician-researcher mentioned to my husband that the Dell Medical School at The University of Texas at Austin had recruited a very promising urologic oncologist. That’s how we met Dr. Aaron Laviana, who has successfully exchanged my plastic stents for metal stents that now last a year. His annual same-day surgery procedure for the past three years is a welcome change, especially since it’s available so close to home.”
Aaron Laviana, MD, MBA, is a board-certified urologist and fellowship-trained urologic oncologist in Urology, a clinical partnership between Ascension Seton and UT Health Austin, the clinical practice of the Dell Medical School. Dr. Laviana specializes in utilizing robotic, minimally invasive, and open techniques to treat prostate, bladder, kidney, testicular, and penile cancer. He is also an assistant professor in the Dell Medical School Department of Surgery and Perioperative Care and a courtesy faculty member in the Dell Medical School Department of Oncology.
“Dr. Laviana became a beacon to my whole bladder cancer journey,” shares Dorothy. “He isn’t simply a provider. He’s a partner. He makes himself available to help his patients navigate every possible alternative to losing their bladder. He also respects your wishes and never takes decisions away from you.”
Connecting Patients With Patients
“After getting to know Dr. Laviana, he asked if I would like to mentor others patients of his,” says Dorothy. “To me, this seemed like such a rare opportunity. Since, Dr. Laviana has introduced me to a dozen patients by first exchanging emails and phone calls. Then, we were able to set up meetings with one another. I recently enjoyed driving one delightful woman to her chemo treatment and, later, her same-day surgery. Bladder cancer is a medical marathon, and when you feel like you’re walking through a storm, it’s reassuring to have somebody who’s walking through it with you.”
<br>“Connecting my patients with other patients who are able to offer guidance and support by answering any questions they have about their healthcare journey, has been one of the most satisfying aspects of what I do,” shares Dr. Laviana. “By bringing patients together to help each other out and provide support for one another, we’re creating a bladder cancer community right here in Austin, and it has been a life-changing experience.”
Involvement in Community Events
Dorothy and Vickie Dunlevy, one of her first mentees, now organize the annual Walk to End Bladder Cancer in Austin to raise funds for BCAN, the only national advocacy organization devoted to advancing bladder cancer research and supporting those impacted by the disease. Donations received help fund bladder cancer research, education, and support programs – but, most importantly, save lives.
If you are interested in donating to the Bladder Cancer Advocacy Network, visit here.
<br>The annual Walk to End Bladder Cancer is also where Dorothy met J. Stuart Wolf, Jr., MD, FACS, a board-certified urologist in Urology and the Medical Director of UT Health Austin’s Ambulatory Surgery Center. With over 20 years of experience, Dr. Wolf specializes in endourology, which is the management of urologic disease through minimally invasive surgery using endoscopes and laparoscopes. He is also a professor and serves as both the Associate Chair of Clinical Integration and Operations and the Chief of the Division of Surgical Subspecialties for the Dell Medical School Department of Surgery and Perioperative Care.
“I was surprised to meet Dr. Wolf at the Bladder Cancer Walk last year and delighted when he reached out to let me know he’d be attending again this year,” says Dorothy. “It’s impressive to see his support of his colleagues and their patients by actively participating in these events.”
“Bladder cancer has a significant impact on patients and their families,” shares Dr. Wolf, “so it’s important to me to participate in these annual walks to help raise awareness and funds for bladder cancer support, research, and education.”
<br>Providing Top-Notch Care Through Community Support
On June 1, 2023, S. Joga Ivatury, MD, MHA, will speak at the Ostomy Association of Austin (OAA), a local voluntary non-profit ostomy support group. “I’m looking forward to hearing Dr. Ivatury, whom I met last August at the grand opening of his Ostomy Clinic through Ascension,” says Dorothy, a longtime OAA member.
“I enjoy working with the Ostomy Association of Austin, because partnering with people that are going through these lived experiences is absolutely necessary for us to be able to provide good clinical care,” explains Dr. Ivatury.
If you are interested in donating to the Ostomy Association of Austin, visit here.
<br>Dr. Ivatury is a board-certified colon and rectal surgeon in both Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, and UT Health Austin’s Surgical Oncology Clinic. He specializes in colon and rectal surgery. He is also an associate professor and serves as the inaugural Chief of Colon and Rectal Surgery for the Dell Medical School Department of Surgery and Perioperative Care.
“Traditionally, there hasn’t been a place in Austin for people to get basic care after ostomy surgery,” says Dr. Ivatury. “This has been a major gap that has existed in the community for a long time.” To address this gap in care, Dr. Ivatury established Texas Ostomy Services at Digestive Health, a clinic that offers ostomy supplies, support, and treatment for the community of Austin.
“We recently received funding to develop a health communication guide for people with ostomies,” continues Dr. Ivatury. “We’re working in collaboration with the Moody College of Communication at UT Austin and the United Ostomy Association of America is interested in including this guide as a resource on their national websites.”
“I recently celebrated the sixth year of my cancer-clear journey,” shares Dorothy. “Over the years, I have had support from skilled medical professionals, caring friends and family, and I am fortunate that I have never walked alone.”