A magazine for the friends of Barrow Neurological Institute of St. Joseph’s Hospital and Medical Center
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Volume 22, Issue 2, 2010
Joe Garagiola
Back in the game after health scare
Barrow Brain Tumor Research Center Barrow launches center dedicated to advancing care for neuro-oncology
Opening thoughts he future of Barrow Neurological Institute and the fundraising that supports it is the topic of this issue of Barrow. I hope you will take some time to read about the exciting things that are happening at Barrow. I am proud to introduce a new Barrow center of excellence—the Barrow Brain Tumor Research Center (BBTRC). While Barrow has long been a referral center for difficult brain tumors, the BBTRC will significantly advance our work in this area. Clinical advances for brain tumors have lagged the progress made in other areas of neuroscience. As a result, patients with malignant tumors, such as glioblastomas, face life expectancies similar to those of patients 30 years ago. We hope to change that through patient-focused research at the BBTRC. The BBTRC, which is headed by neurosurgeon Nader Sanai, MD, will focus on developing clinical trials at Barrow that are based on laboratory discoveries. Our goal is to speed up the pace of translating science into better treatments for patients. I hope you will consider supporting this important initiative through a gift to Barrow Neurological Foundation. We need $8 million to endow the center and ensure its ongoing viability. The future of fundraising in general and Barrow Neurological Foundation (BNF) in particular is the topic of two other articles. Patti Gentry, the chairwoman of the Barrow Neurological Foundation Board of Trustees, describes her family’s efforts to foster generational giving on page 25, and on page 34, we introduce the new chief executive officer of the BNF. Ronald Mirenda will step into the role filled so capably by Mary Jane Crist for the past 13 years. Mary Jane will now assume a broader focus as CHW Arizona service area leader of philanthropy. On behalf of all of us here at Barrow Neurological Institute, I want to thank Mary Jane for all she has done to support Barrow through her leadership in philanthropic excellence. And as always, I thank you, our donor, for the critical role you play in what we do.
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Sincerely,
Robert F. Spetzler, MD Director, Barrow Neurological Institute P.S. You can learn more about the Barrow Brain Tumor Research Center at www.SupportBarrow.org. Click on the “Events & Campaigns” button on the left-hand navigation bar and look for “Barrow Brain Tumor Research Center.” Online giving is available.
On our cover: Joe Garagiola and announcer Daron Sutton discuss a Diamondbacks game in the broadcast booth. Gargiola was sidelined by a meningioma in 2009. Read his story starting on page 4.
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4: Back in the game For Joe Garagiola, life is good after a tumor scare. 8: Barrow Brain Tumor Research Center Barrow launches center dedicated to neuro-oncology. 13: The Balance Study Research sheds light on brain tumors during surgery. 15: Brain mapping Barrow surgeons use high-tech tools to remove more tumor, improve patient outcomes. 18: Glioblastoma Barrow team uses aggressive, multiprong treatment to give patients best chance against tumor. 20: Pituitary tumors Big surgical improvements made possible by tiny camera. 22: Off-Centered Experience Craft ale lovers gather to raise funds for the Barrow Brain Tumor Research Center.
Contents
24: United by passion Members of the BBTRC Steering Committee share drive to find solutions to brain tumors. 25: Family philanthropy Teaching the next generation about the importance of giving. 27: Why we give Nephew’s care inspires couple to give. 28: A real Health & Wealth Raffle winner 30: The next step in healing New center helps children deal with the aftereffects of brain injuries. 32: Saddle up Lawyer roping again after neck surgery. 34: Foundation News 35: Benefactor Briefs
Catherine Menor Editor/writer Catherine.Menor@chw.edu
Lindsey Burke, Sally Clasen, Andrew Wachtel Contributing writers
Robert F. Spetzler, MD Director Barrow Neurological Institute®
Justin Detwiler Art director/designer
Brad Armstrong, Jeff Noble Photography
Ronald F. Mirenda CEO, Barrow Neurological Foundation
Panoramic Press • How to Reach Us • Barrow is published twice a year. We welcome your comments, suggestions and requests to be added to or deleted from our mailing list. Call 602-406-1041 or send mail to Barrow, Office of Philanthropy, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013. Please include your name, address, and telephone number in all correspondence. Visit us online at www.SupportBarrow.org.
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back in the game For Joe Garagiola, life is good after tumor scare
by Catherine Menor
“Mine was the easy part. I was either going to make it or not. If not, I’d be catching pop fouls for St. Peter.” Joe Garagiola
“That’s true. But I didn’t want to be remembered as the guy who traded Joe Garagiola to the Angels.” Joseph Zabramski, MD
Joe and Audrie Garagiola
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y the time baseball legend Joe Garagiola reached Barrow Neurological Institute in January 2009, he felt like he was batting last in the bottom of the ninth inning of a critical ball game—with the tying run on third base and two strikes against
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him. Just a week earlier, Garagiola had learned that a large tumor was the cause of his bulging left eye. The tumor was pushing his eye forward and downward, and threatening his vision. He had already seen two respected eye specialists, and now he was on his way to meet a third doctor, neurosurgeon Joseph Zabramski, MD, who specializes in challenging neurosurgical cases, including cases involving the orbit and nerves of the eye. “I’d already seen two doctors, and both said they couldn’t do anything for me,” Garagiola says. “I thought, ‘I’ve got something really serious.’”
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Dr. Zabramski reviewed Garagiola’s scans. He saw a large tumor behind the left eye that was extending into the orbit, compressing the optic nerve, and displacing the eye forward. There was also evidence that the tumor was spreading across the midline of his brain toward the right eye. Untreated, the tumor would eventually affect the vision in both eyes and could cause a stroke, speech difficulties, and other neurological problems. Already, the vision in Garagiola’s left eye was so bad that he could read only the headlines in the morning paper. Dr. Zabramski knew that the operation would be long, difficult, and complex. He also knew that at Barrow, he had the team members and resources he needed to successfully complete the operation and care for Garagiola afterward. Dr. Zabramski looked Garagiola in the eye and spoke the four words the baseball legend swears he will never forget: “I can do that.” “When Dr. Z said, ‘I can do that,’ it was like a bright light went off,” Garagiola says. “It’s like the Pope saying ‘Do it, man.’ He didn’t hesitate. He said, ‘I can do that.’” On Feb. 11, the day before his 83rd birthday, Garagiola underwent a six-hour-long operation to remove the tumor. The procedure was challenging, says Dr. Zabramski, because the tumor was located behind the eye and in the orbit, and was growing into the bone. Dr. Zabramski’s goal was to remove as much of the tumor as possible without harming the remaining vision or nearby healthy tissue. The Barrow neurosurgery team used a stereotactic guidance system during the operation to identify and remove tumor tissue, while decreasing the risk to surrounding normal structures. Dr. Zabramski says those hours flew by for him and his team, but that was not the case for Audrie, Garagiola’s wife. As the hours plodded by, her anxiety increased. Finally, Dr. Zabramski emerged. “He’s in recovery now, and everything went fine,” he told her. Audrie’s first glimpse of her husband after surgery was a shock. “Oh, he looked terrible,” she said. “His eye was swollen shut, and there were tubes everywhere.” All the pressure was on his wife and Dr. Zabramski, says Garagiola. “Mine was the easy part. I was either going to make it or not. If not, I’d be catching pop fouls for St. Peter.” “That’s true,” Zabramski said, “but I didn’t want to be remembered as the guy who traded Joe Garagiola to the Angels.”
A challenging surgery
Joe Garagiola with his surgeon Joseph Zabramski, MD, at Barrow.
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This MRI study of Joe Garagiola shows the meningioma within the orbital cavity (red arrow head) that was compressing the optic nerve. Additional tumor was located behind the orbit (yellow arrows). The patient is oriented nose up. A biopsy of the tumor showed that it was a grade I meningioma, a benign type of tumor with potential for slow regrowth. Postoperative imaging revealed that some tumor remained, so in November 2009—after several other medical problems had resolved—Garagiola returned to Barrow for radiosurgery, also called “knifeless surgery.” Neurosurgeon Andrew Shetter, MD, and radiation oncologist David Brachman, MD, had both Gamma Knife and CyberKnife radiosurgery at their disposal, something few neuroscience centers can boast. Both use highly targeted radiation beams to destroy lesions in the body, but CyberKnife can be programmed to deliver smaller doses of radiation over three to five consecutive days rather than a single large dose. “The optic nerve is the structure in the brain that is most sensitive to radiation, and giving smaller doses of radiation in five daily sessions is less likely to injure the nerve,” Dr. Shetter explains. “Because the remaining tumor was located near the optic nerve, we felt that CyberKnife would be the best way to prevent the tumor from progressing and to preserve the vision in his left eye.” Garagiola says that the hour-long CyberKnife treatments were painless. “The toughest part was lying on that hard table and being unable to move,” he says. Since his surgery, Garagiola has made a real comeback. He works out regularly to rebuild his strength and returned to the broadcast booth this season to provide color commentary for some of the Arizona Diamondbacks home games. Most importantly, he’s enjoying life with his beloved wife of 60 years and their three children and eight grandchildren. It wasn’t his time to go, says Garagiola. “God’s still got a job for me.” ■
Knifeless surgery
W hat is a meningioma?
Meningiomas are tumors that arise from the meninges, three thin layers of tissue that cover and protect the brain and spinal cord. Meningiomas are diagnosed most often in people over 60. The majority of meningiomas are benign, grade I, slow-growing tumors that are localized, have distinct borders, and do not infiltrate the brain. Symptoms occur usually from compression of the brain rather than from the tumor growing into brain tissue. Left untreated, compression by the tumor can lead to permanent injury, and, therefore, evaluation and treatment by a neurosurgical expert is essential.
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barrow brain tumor research center Barrow launches new center dedicated to improving treatments for neuro-oncology by Nader Sanai, MD, Director Barrow Brain Tumor Research Center
very year, 63,000 patients are diagnosed with a primary brain tumor in the United States, with the most prevalent form called a glioma. Glioblastoma is the most common subtype of glioma, representing 70 percent of all cases and considered one of the most lethal cancers known to man. In spite of this, clinical advances in the treatment of gliomas have been virtually nonexistent: 30 years ago, the average survival was 1012 months, while today, maximal therapy affords a life expectancy of 12-14 months. In the public eye, attention was recently drawn to this struggle by Senator Ted Kennedy and political commentator Robert Novak, who were both diagnosed with glioblastoma in 2008. Despite world-class medical and surgical treatment, both succumbed to the disease within 12 months. Beyond gliomas, meningiomas are typically benign tumors that nevertheless can have neurological effects nothing short of devastating. These tumors grow along the lin-
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ing of the brain, relentlessly compressing brain tissue and compromising function. For patients with aggressive meningiomas, survival has been similarly untouched despite 30 years of medical progress. Together, gliomas and meningiomas are the two most common brain tumors in nearly every age group in the United States and, therefore, represent the primary targets of laboratory and clinical research at Barrow Neurological Institute. Barrow brain tumor specialists recognize the challenge that these tumors present. They use every tool currently available to extend survival while preserving quality of life—aggressive surgery, rapidly initiated chemotherapy, advanced radiation therapy, and daring clinical trials. Nevertheless, it will be the science of brain tumors, not the steel of the surgeon that will provide the ultimate answer. Unfortunately, not all brain tumor cells are created equal, and it is the cellular heterogeneity of a glioma that is its most devastating biological feature. Current therapies often fail because of the dogged persistence of a relatively small proportion of glioma cells that adapt to survive surgery, radiation, and chemotherapy, and then repopulate and disseminate the disease. Recent discoveries in neuroscience, however, have altered the landscape of brain tumor biology. For decades, glial cells—supporting cells that normally
Gliomas: the ultimate survivors
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comprise half of the brain’s Yong Wang, MS, MBA, content—were thought to works in one of five be the only dividing cells laboratories planned for in the brain and, therefore, the Barrow Brain Tumor the only brain cells suscep- Research Center. This lab is tible to becoming cancer- studying brain tumor stem ous. cells. Recent discoveries The human brain, long have linked mutations in thought to be a static and normal stem cells with fully-differentiated organ, brain tumor formation. is now known to contain discrete populations of stem cells. In the last five years, a series of critical discoveries have emerged to link mutations in normal stem cells with brain tumor formation. As a consequence, we now know that the most potent subpopulation within a glioma is comprised of brain tumor stem cells. While the development of this brain tumor stem cell hypothesis represents a watershed moment in neurooncology, brain tumor specialists finally on the precipice of a breakthrough suddenly face a crumbling national program for neuroscience support. Historically, research funded by the National Institutes of Health (NIH) and the National Cancer Institute (NCI) enabled the United States to operate at the forefront of the field. These funding streams, however, have dried up in recent years, limiting the translation of science to therapy.
Crumbling support for research
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And, while several new therapeutic strategies have shown early promise, the infrastructure to support new clinical trials has also eroded: in the past 12 months, NIH and NCI funding for brain tumor clinical trials has been cut by more than 40 percent, effectively ending any hope for large-scale trials in the near future.
“It will be the science of brain tumors, not the steel of the surgeon, that will provide the ultimate answer.� Nader Sanai, MD Despite the continuous pruning of nationally-funded neuroscience efforts, an opportunity exists to establish a new paradigm for brain tumor research. In decades past, promising basic science was slowly adapted to generate outsized, costly, and dawdling multicenter clinical trials. These flagship programs, with few exceptions, have now sunk. Today, a more logical choice involves the coupling of clinically-focused laboratory research with homegrown, rapid-sequence clinical trials. Assembling such a translationally-oriented laboratory effort enables efficient pursuit of scientific innovation with near-
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term clinical implications. This combination can foster clinical breakthroughs with efficiency and pace far exceeding the sluggish progress of decades past.
Core elements in place for national tumor research center
Barrow embodies this paradigm shift in brain tumor research—clinically-directed scientific investigation with the capacity to translate innovations into homegrown clinical trials. Perhaps more than any other institution, nationally or internationally, we now have the core elements to navigate the current environment: (1) one of the highest brain tumor patient volumes in the world, (2) a stateof-the-art neuroscience research infrastructure, and (3) clinical leadership in neurosurgical oncology, neurooncology, and radiation oncology. Taken together, these elements will combine to form a unified clinical-translational brain tumor research unit without comparison. Simply put, Barrow is now in a position to ascend to the international forefront of brain tumor research and clinical care. To make this leap, we have created the Barrow Brain Tumor Research Center (BBTRC), which is composed of integrated clinical-translational subunits designed to catalyze scientific discovery, improve interdisciplinary collaboration, and serve as a national and international center for brain tumor clinical trials.
Core of new research center: five independent laboratories
The scientific platform for the BBTRC consists of five independent laboratories, investigating distinct yet interrelated mechanisms driving brain tumor biology: 1. Regulation of glioma cancer stem cell growth 2. Metabolic signatures identifying cancer stem cells 3. Immune-mediated evasion by migratory glioma cells 4. Heritable pathways governing meningioma development 5. Non-genetic (epigenetic) systems that alter brain tumor genomes.
Barrow neurosurgeons employ the latest techniques to safely and effectively remove brain tumors. For instance, Barrow was the first center to integrate functional MRI mapping with the Stealth navigation system, creating a kind of GPS for the brain. Left, neurosurgeon Kris Smith, MD, has employed this sytem in more than 100 brain tumor operations at Barrow.
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New therapies on the horizon
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Each laboratory functions as a collaborative workspace, where a team of graduate students, postdoctoral fellows, and residents under the direction of a principal investigator work alongside neurosurgeons, neurooncologists, and neuropathologists. Together, these teams unify basic science, translational, and clinical research elements into novel strategies targeting brain tumor diagnostics, monitoring, and therapy. Barrow’s robust patient volume fuels a clinical trial infrastructure comprised of neurosurgical oncologists, neuro-oncologists, radiation oncologists, and neuroimaging specialists. Because of our unmatched capacity for patient recruitment, homegrown Phase I and II clinical trials will be conducted rapidly, and candidates for large, multicenter Phase III studies will be identified efficiently. While the Barrow Brain Tumor Research Center is both ambitious and unconventional, its objectives are practical and achievable. Under the stewardship of our BBTRC Steering Committee, a fundraising effort is underway to develop new avenues for translational research, introduce a bold clinical trials program, and add Barrow’s fire and drive to the national and international brain tumor community. At a time when state and federal support for biomedical innovation is collapsing, we are confident that Barrow and its community will respond. ■
Help us improve care for brain tumors
The Steering Committee of the Barrow Brain Tumor Research Center (BBTRC) seeks to raise $8 million for the new center. These funds will go toward endowing the center, establishing laboratories, and providing seed funding for research. If you are interested in getting involved or in making a donation, please contact Barrow Neurological Foundation at 602-406-3041 or visit us online at www.SupportBarrow.org. Information about the BBTRC can be found in the “Events and Campaigns” section of our website. Gifts can be made online.
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key people Barrow Brain Tumor Research Center NEUROSURGICAL ONCOLOGY
Nader Sanai, MD Director
Kris Smith, MD
Randall Porter, MD
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Roy A. Patchell, MD
NEUROPSYCHOLOGY
William Shapiro, MD
Lynn Ashby, MD
RADIATION ONCOLOGY
David Brachman, MD
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Leslie Baxter, PhD
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Eyoung McBride, MD
NEUROPATHOLOGY
Stephen Coons, MD
Robert F. Spetzler, MD
Emad Youssef, MD
Jim Pipe, PhD
John Karis, MD, PhD
Virginia Prendergast, NP-C, CNRN
Denita Ryan, NP
NEURO-ONCOLOGY NURSING
Jenny Eschbacher, MD
Charlotte Schiestel, NP
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the balance study Shedding light on brain tumors during surgery
by Sally Clasen
The confocal probe magnifies brain tissue to the cellular level.
etecting cancer cells in the brain can elude even the most well-trained professionals, but some tumors won’t be able to hide out much longer—thanks to a new light being shed in the operating room. Neurosurgeons at Barrow Neurological Institute are using fluorescent technology to target gliomas in a new clinical trial, the Barrow 5-ALA Intraoperative Confocal (BALANCE) study. The research study is being conducted at the Barrow Brain Tumor Research Center (BBTRC). Neurosurgeon Nader Sanai, MD, director of the BBTRC, is the principal investigator of the BALANCE study. He and his colleagues are specifically examining the effectiveness of 5-ALA, an amino acid compound, during brain surgery in identifying cancer cells and improving tumor removal in patients with high- and low-grade gliomas. Gliomas are the most common—and deadliest—primary brain tumor in the United States with an overall survival rate of 12 to 14 months for their most common subtype, glioblastoma.
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As part of the three-year study beginning in the fall of 2010, approximately 160 patients with gliomas will be evaluated during surgery and followed postoperatively to determine the efficacy of 5-ALA in improving surgical results and enhancing brain cancer control. Select patients involved in the clinical trial will be given an oral dose of 5-ALA, a natural compound that is metabolized by glioma cells, three hours before surgery. During the procedure, surgeons will use a microscope that emits ultraviolet light onto the tumor tissue. When the light hits the tumor, the compound reflects a blue fluorescence that glows in the dark, allowing the surgeon to better pinpoint tumor margins and identify errant cancer cells. According to Dr. Sanai, by identifying and removing more cancer cells, surgeons can slow progression and improve survival rates for a category of brain cancer that is often incurable. “The more tumor cells you remove in surgery, the better patients do in terms of survival, and the slower they progress towards a malignant state,” he says.
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When ultraviolet light hits tumor tissue in a patient given 5-ALA, the tumor glows in the dark, allowing the surgeon to better target tumor margins.
Currently, the use of fluorescent technology in brain surgery is not FDA-approved in the United States, although Dr. Sanai and his colleagues believe the BALANCE study will produce significant results that will eventually make 5-ALA standard-of-care for brain tumor surgery. A recently-completed multi-center study from Germany demonstrated substantial improvements in brain tumor resection for high-grade gliomas with 5-ALA blue fluorescence technology, but investigators did not examine the application for low-grade gliomas nor did they examine its impact on overall survival. Because low-grade gliomas have a lower cellular metabolism and divide less frequently than highgrade gliomas, it is difficult to distinguish between the abnormal and normal cells. The result is a higher chance of leaving cancerous tissue intact during surgery. In the BALANCE trial, Barrow neurosurgeons will go one step further than their European counterparts by adapting this fluorescent technique to the removal of low-grade gliomas. To enhance the efficacy of 5-ALA in removing lowgrade gliomas, Barrow neurosurgeons will introduce the use of an intraoperative confocal microscope, a handheld device the size of a laser pointer, according to Dr. Sanai. “The confocal microscope amplifies the signal several-fold,” he says. “With this technique,
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our signal detection will be at the cellular and subcellular level.” The BALANCE trial marks the first time an intraoperative confocal microscope will be tested in a randomized trial for brian tumors and the first time the device will be used in conjunction with 5-ALA. “From an oncology standpoint, the BALANCE trial is a natural next step. The neurosurgical community has long sought a tool to show us where the tumor cells are hiding,” Dr. Sanai says. “We’ve had disappointing results for the last 30 years in terms of glioma survival rates,” he adds. “In bringing this technique to the mainstream, we hope to push the boundaries of treatment, both in the United States and worldwide.” ■
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by Lindsey Burke
Barrow surgeons use brain mapping to remove more tumor, improve patient outcomes
patient waking during an operation is the last thing a surgeon would typically want. But during an awake craniotomy, it’s just what the doctor ordered. The day before her surgery, Jeanette Bronson, 54, received instructions on what to expect during the awake portion of her procedure from neurosurgeon Nader Sanai, MD, director of neurosurgical oncology and the Barrow Brain Tumor Research Center. The instructions included a set of questions she would answer and a list of activities she would perform while in the operating room—with her brain fully exposed. “I’m nervous, but I just want to do what Dr. Sanai asks me to do during surgery so we have the best outcome,” Bronson said prior to surgery. Bronson came to Barrow after experiencing a seizure at her home in Globe, Ariz.
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“I didn’t have any symptoms prior to that,” Bronson said. “No headaches…nothing.” Luckily, Bronson’s husband, Joe, was at home at the time of her seizure and dialed 9-1-1. Local paramedics airlifted her to Scottsdale Healthcare Osborn where she was assessed and referred to Barrow. MRIs revealed a brain tumor on the left side of her brain. Dr. Sanai scheduled an awake craniotomy paired with cortical mapping. “With an awake patient, we can assess the functional portions of the brain and determine the best approach to the tumor and resect as much as possible,” said Dr. Sanai. “When a tumor is located near areas of the brain that control speech or sensory perception, having the patient awake to respond to stimulation of these areas can reduce the risk of damage to critical brain functionality.”
scalp could be opened and a portion of the skull removed to expose the area of the brain adjacent to the tumor. With the brain prepared, anesthesiologists awoke Bronson from sedation so that she could assist with her part of the procedure—cortical mapping.
Dr. Baxter joined the operating room team to facilitate the mapping portion of the procedure. Cortical mapping involves delivering stimulation to areas of the brain via a low-current electrical probe. The patient feels nothing because the brain has no pain receptors. With Dr. Baxter seated directly in front of Bronson, Dr. Sanai began delivering current to her brain. Bronson was asked to report a twitch or other sensation experienced during application of the electrical pulse. “Do you feel anything, fMRI plus “..when we map the brain, we Jeanette?” Dr. Sanai asked. “In my tongue,” she StealthStation= know how to preserve function said after several pulses surgical GPS were delivered. Before surgery, Bronson The process continued and can be more aggressive underwent several tests, on other areas. Bronson was including a functional MRI with the tumor resection. The asked to count to determine administered by Leslie Baxareas of speech arrest. “If I ter, PhD, clinical neuropsy- more tumor I can remove, the stimulate an area of speech chologist at Barrow. “An arrest, she’ll simply stop fMRI is a type of MRI that better off the patient will be.” counting,” Dr. Sanai said. maps brain function,” said “But as soon as the current Dr. Baxter. “Specifically, the is removed, she’ll resume Nader Sanai, MD patient engages in certain counting where she left activities while an MRI is off.” taken. The final product is Another test required a colored map of brain activity with regard to a par- Bronson to say the names of a series of objects shown ticular function. on a computer screen in front of her. “Pineapple,” she “The fMRI map is overlaid onto a high-resolution said as an image of a pineapple flashed on the screen. brain image that shows any brain abnormalities, like “Light bulb, pear, piano…” a tumor. The final composite map is used in the oper“These tests help determine which areas are critiating room via the StealthStation to show the neuro- cal to motor, sensory, or speech pathways. Those areas surgeon where the tumor is and where brain activity are marked and avoided during tumor removal,” Dr. is as well, giving the surgeon a picture of these regions Sanai said. Small numbered pieces of sterile surgical that coordinates with their surgical tools.” paper are placed directly on areas of the brain associMuch as a GPS guides a driver to his destination, the ated with functions. “Every patient’s brain is different,” combination of fMRI images and real-time data deliv- sohe said, “which is why mapping is important.” ered via the StealthStation guides the surgeon through When the exposed area of Bronson’s brain was the brain to the tumor with pinpoint accuracy. fully mapped, Dr. Sanai had a clear route to the tumor During surgery, a liberal dose of local anesthetic was that would be the least invasive. injected directly into Bronson’s scalp to ensure she Not all brain tumors call for an awake craniotomy. felt no pain when her head was positioned in a May- Some are treated with chemotherapy and/or radiation; field skull clamp. The clamp prevents head move- others are removed under general anesthesia when the ment during surgery. risk of damaging critical brain matter is low. Once in position, Bronson was lightly sedated with a combination of short-acting anesthesia so that her
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Awake brain surgery
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Improving patient outcomes through brain mapping
“This type of surgery requires a high-volume operating room with special equipment; it’s not something than can be done just anywhere,” Dr. Sanai said. “While there certainly can be some additional risks associated with this type of approach, including the reduced ability to control the patient through anesthesia, the benefits outweighed the risks in this case because when we map the brain, we know how to preserve function and can be more aggressive with the tumor resection. The more tumor I can remove, the better off the patient will be.” Two days after surgery, Bronson was released from the hospital. “It’s hard to believe I just had brain surgery,” she said. “A few days post-op my tongue felt a little swollen, and I was having a bit of difficulty getting some words out, but that has gone away. “I’ve felt so well taken care of at Barrow,” she said. “Dr. Sanai is just awesome. He took the time to explain everything about the surgery and answer all of my questions. And when he shared the pathology report, Dr. Ashby and Dr. Youssef made themselves available immediately to set up the next step of my care.” Bronson’s care will continue at Barrow with chemotherapy and radiation overseen by neuro-oncologist Lynn Ashby, MD, and radiation oncologist Emad F. Youssef, MD, to treat the anaplastic astrocytoma tumor. “I am so grateful to everyone for the excellent care I received,” Bronson said. “Everything has been so impressive. I certainly have no complaints.” ■
Top, Barrow neurosurgeons operate on Jeanette Bronson. Bottom, Leslie Baxter, PhD, assisted with the cortical mapping portion of Bronson’s surgery.
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by Catherine Menor
glioblastoma Barrow team uses aggressive, multi-prong treatment to give patients best chance against most lethal tumor
hen neurosurgeon Kris Smith, MD, reviewed surgical team their exact location in the brain during Michal Sieluzycki’s MRI images on June 30, he each step of the complex operation. The Stealth system was pleased by what he didn’t see. integrates brain images taken before surgery into the There was no trace of the large glioblastoma mul- surgical microscope so that neurosurgeons can see tiforme that three months earlier had loomed near the their position in the brain in 3D. speech areas of Sieluzycki’s left temporal lobe, causing Dr. Smith and his team also used confocal laser severe speech problems for the electrical engineer. microscopy and florescent dye to identify cancer cells By the time the MRI scans were taken, Sieluzycki had during the operation. Injected into the brain during the undergone aggressive surgery, operation, the dye turns cancer radiation, and chemotherapy— cells florescent, making them “The first surgery has to Dr. Smith’s first line of defense visible through the laser microagainst a glioblastoma, the most scope. The confocal laser probe, remove as much of the aggressive and deadly type of placed inside the tumor or next tumor as possible. It’s the to it, magnifies brain tissue to malignant brain tumor. “The first surgery has to the cellular level. difference between six remove as much of the tumor Dr. Smith used a refined months of decline versus technique of endopial removal as possible,” Dr. Smith says. “It’s the difference between six the chance of a real win.” to take out diseased tissue up to months of decline versus the the borders of normal tissue, chance of a real win.” thus preventing vascular injury Kris Smith, MD The problem is that glioblaswhile still removing all areas toma cells quickly grow and infiltrated with tumor cells. infiltrate normal tissue, making complete removal difficult if not impossible. Dr. Smith’s strategy is to remove Life after a tumor as much of the tumor as possible during surgery, givSix months have passed since Michal Sieluzycki’s ing radiation and chemotherapy the best chance for brain surgery. He has undergone both chemotherapy killing any remaining cancer cells. and radiation therapy. Today, the 52-year-old man sits In Sieluzycki’s case, Dr. Smith was dealing with a in an outpatient chemotherapy infusion room at St. large tumor located near the speech areas, the brain stem, Joseph’s Comprehensive Cancer Center with his wife, and the blood vessels that feed the left hemisphere of Ania. Sieluzycki is now participating in a clinical trial the brain, putting the West Valley man at risk for stroke. of a chemotherapy drug not yet approved for his con-
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The Barrow surgical team, led by Dr. Smith, spent six hours on March 18 meticulously removing Sieluzycki’s tumor. Sieluzycki had undergone fMRI and brain mapping before the operation so that the surgeons could avoid still functional areas adjacent to areas of the brain that were infiltrated with cancer cells. The Stealth integrated navigation system, which is installed in all 11 Barrow surgery suites, provided the
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dition. The trial is a double-blind trial, meaning that Sieluzycki may be getting the medication under study or he may be getting a placebo. Sieluzycki is optimistic despite lingering problems with speech and thinking. Originally from Poland, the accomplished engineer has always relied on his agile brain to develop innovative engineering solutions. While the information is still there, he struggles to come up with words—proper nouns in particular—and to switch quickly from one line of thought to another.
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with English. He is strongest in Polish and Russian, which he learned as a child. “Why should I feel bad?” says Sieluzycki. “From time to time I do, but not that often. Will it help me? No. I still have everything I had. The knowledge is there. I just have problems getting it out.” Dr. Smith shares his patient’s optimism. That’s because he has similar patients who remain tumor free more than six years after treatment. He and neurologist Lynn Ashby, MD, stay in close contact with these patients through a clinic where patients are seen every two months for the first three years. “I want to know how they’re doing for the rest of their lives and to act as quickly as possible, should there be a recurrence,” Dr. Smith says. The possibility of a recurrence is a difficult part of life after a glioblastoma. When glioblastomas recur, they often do so with a vengeance. Which is why continued research into better treatments and an eventual cure for brain cancer is so important, says Dr. Smith. “As a neurosurgeon, you realize that surgery doesn’t cure patients with this disease, but it does allow for better long-term outcomes, along with other therapies.” ■
Hope for the future
“Now, I have to finish one thing and write it down before going on to something else,” he says. “By the end of the day, I’m tired. If something’s not finished, I have to write it down to remember it the next day.” Before the surgery, Sieluzycki was fluent in four languages—Polish, Russian, English, and French—but he has lost most of his ability to speak and understand French, the last language he learned, and has problems
What is a glioblast oma?
Glioblastoma multiforma is the deadliest and most common form of malignant brain tumor. Because these cancer cells often survive radiation and chemotherapy, the initial surgery is critical to a patient’s outcome. Here are MRI images of Michal Sieluzycki’s brain before treatment (top) and after.
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pituitary tumors Big surgical improvements made possible by tiny camera hen Norma Villarreal, 69, began experiencing excruciating pain in her lower back and leg, doctors told her she might have suffered a heart attack. “I’m a bit of a jokester,” Villarreal said, “so I told them that if my heart was in my rear end, then perhaps it was a heart attack.” An additional panel of tests revealed an issue with Villarreal’s pituitary gland: a tumor had developed on the gland, and it was too large to ignore. The pituitary gland, a pea-sized gland that sits at the base of the brain, controls peripheral endocrine glands including the adrenal and thyroid glands and glands that produce growth hormone, testosterone in men, and estrogen in women. If Villarreal’s tumor were allowed to grow, it could put pressure on adjacent areas of the brain, causing blindness, loss of brain function, or even death. Villarreal was referred to Barrow where neurosurgeon and pituitary disorder specialist Andrew S. Little, MD, made the initial assessment. “Norma had no symptoms that would lead you to immediately suspect a pituitary tumor,” Dr. Little said. “But the walnut-sized tumor was close to her brain stem, optic nerve, and carotid artery, and might eventually affect her hormone levels.” Dr. Little, together with Barrow neurosurgeon Peter Nakaji, MD, planned Villarreal’s surgery using an advanced endoscopic approach. In this procedure, the entire tumor removal is done through the nostrils without making a skin incision, reducing the patient’s pain and shortening the hospital stay. “The endoscopic approach adds a new dimension to a standard operation,” Dr. Little said. “Instead of placing a microscope at the opening of the nostril, we are able to use a tiny camera attached to the end of a scope that is less that four millimeters in diameter, but provides an unmatched view of the surgical field. You can see places you just can’t with a traditional microscope, and this results in better tumor resections.” Villarreal’s post-operative MRI showed complete tumor removal. While the endoscopic approach is considered a less common technique for pituitary tumor removal, Barrow physicians routinely use it with extraordinary
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by Lindsey Burke
results. So extraordinary, in fact, that Dr. Little and Dr. Nakaji were asked by Visionsense, a Palo Alto, Calif., company, to help develop 3D technology to enhance traditional endoscopes. “Staying ahead of the curve with new technology makes surgery safer and allows us to do a better job,” Dr. Little said. “I did a lot of research before my surgery,” Villarreal said. “I read about the different surgical options and was so happy to know that Dr. Little was using the endoscope. The risk factors were so low and recovery so much faster.” Villarreal was discharged from the hospital two days after surgery. “The only pain I felt was some soreness in my nose, but that was expected,” she said. “I was told to take it easy for about 10 days, but then I was able to go back to my dog grooming business and do all the things I was doing before. “I’m a healthy woman, so that was a relief. Dr. Little was beyond anything I could imagine. He was absolutely wonderful.” ■
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‘’Staying ahead of the curve with new technology makes surgery safer and allows us to do a better job.” Andrew Little, MD
Andrew Little, MD, John Milligan, MD, and Peter Nakaji, MD, use endoscopes to remove a pituitary tumor at Barrow.
Collaboration is key to success of Barrow Pituitary Center
Barrow’s staff has more experience treating patients with pituitary disorders than any other facility in the Southwest. The Center evaluates and treats patients who are suffering from neuroendocrine disorders and pituitary tumors such as adenomas, prolactinomas, craniopharyngiomas, Cushing's disease, acromegaly, and gigantism. Patients are treated through a multidisciplinary approach that draws on the expertise of specialists in many disciplines, including endocrinology, neurology, neurosurgery, neuropsychology, ophthalmology, and radiation oncology. Key Pituitary Center team members are pictured at right: Andrew S. Little, MD, neurosurgeon; Burt Feuerstein, PhD, neuro-oncology researcher; Laura A. Knecht, MD, faculty physician in endocrinology, Department of Internal Medicine, and medical director of the Pituitary Center; and William L. White, MD, FACS, chief of surgical endocrinology.
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off-centered experience Craft ale lovers gather to raise funds for BBTRC Photographs provided by David Weingarten of GoldenEye Photography
early 500 beer aficionados gathered on Oct. 2 at the Scottsdale Plaza Resort to sample 60 of the world’s finest craft ales and raise funds for the new Beer for Brains Foundation in support of the Barrow Brain Tumor Research Center. The Off-Centered Experience, which raised an estimated $30,000, was the brainchild of Louis Dolgoff, whose wife, Laurie, died of a brain tumor in August 2009. She received care at Barrow Neurological Institute where the BBTRC is being developed. Dolgoff promised Laurie that he would raise funds for brain tumor research. “She was not only my love but my best friend,” he says. “I have this vengeance against brain cancer. I want to do everything I can.” Stormy weather did not dampen participants’ enthusiasm. Entertainment included bellydancers, a silent auction, raffle, and three live bands—La La Lust, Gooder, and the Bad Cactus Band. As these photos show, the OffCentered Experience was a night to remember. ■
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united by passion Members of the BBTRC Steering Committee share drive to find solutions to brain tumors he 18 people on the Barrow Brain Tumor Research Center Steering Committee share a goal: to help solve the problem of brain tumors by raising awareness and funds for the new center. Each member has been touched by a brain tumor either personally or through their work at Barrow. • Yo Yo Allalouf, who serves on the Barrow Foundation UK board of directors, has a family member who has been affected by a hypothalamic hamartoma. • Barbara Barone’s mother died of a brain tumor 25 years ago at age 59. • Reid Butler’s father was diagnosed with a brain tumor in 2008 and is doing well. • Louis Dolgoff lost his wife to a glioblastoma in 2009. • Abraham Romo Garcia, owner of the largest printing company in Mexico, is a Barrow patient. • Paula Hardison is the vice president of The Wellness Community, a non-profit that provides support, education, and hope to people affected by cancer. • Vianne Kucera is a close friend of Joe and Angela Melczer, whose son died of a brain tumor. • Jane Maretz’s late husband was a patient at Barrow, and a young relative of hers was recently diagnosed with glioblastoma. • Angela and Joe Melczer’s son died of brain cancer nine years ago when he was just 26. • Bret Michaels’ aunt died of a brain tumor. • Shannon and Keith Mishkin lost Keith’s mother last year to the disease. • Carrie Morgan’s dad has had surgery, radiation, and chemotherapy for a tumor found last year; he is now on another round of chemo. • Kathleen Norton, vice president of fund development at Barrow Neurological Foundatiion and St. Joseph’s Foundation, lost a close friend to a brain tumor.
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Several of the BBTRC Steering Committee members are shown above at a recent meeting: back row, Joe Melczer, Phil Pomeroy, Keith Mishkin, Reid Butler, Louis Dolgoff; front row, Kathleen Norton, Barbara Barone, Shannon Mishkin, and Carrie Morgan.
• Phil Pomeroy is the vice president of neurosciences at St. Joseph’s Hospital and Medical Center. • Dr. Nader Sanai’s aunt died of brain cancer; he is the director of the BBTRC. • Robert Spetzler, MD, is the director of Barrow. Members say that serving on the BBTRC steering committee is a way to join in the search for answers. “It’s a way I can make a difference,” says Morgan. The committee meets monthly. Their goal is to raise $8 million to endow the BBTRC, support initial laboratory start up, and provide seed funding for research. If you would like to get involved or make a donation, please contact Barrow Neurological Foundation at 602-406-3041 or email Kathleen.Norton@chw.edu. Gifts can be made online at SupportBarrow.org. Click on the “Events & Campaigns” button for information about the Barrow Brain Tumor Research Center. ■
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family philanthropy Teaching the next generation about the importance of giving by Patti Gentry, chairman, Barrow Neurological Foundation Board of Trustees t was my grandfather, Arthur Keating, who established our family’s foundation, the Burns Family Foundation, for the benefit of my mother, Lucy Burns, in Chicago, Ill., in the 1960s. By then, he had grown EKCO Products Company into a Fortune 500 company and, thus, was able to establish a culture of philanthropy for our family. What a wonderful gift he gave us! From the time we were children, my five sisters and I learned about the importance of giving back to the community. We learned the ins and outs of philanthropy and the joy of helping others. Eventually, the six of us took over the reins of the Burns Family Foundation. Today, all of us live far from Chicago. Wendy and I live in Phoenix, Julie lives in Idaho, Laurie and Robin live in New Mexico, and Loni lives in California. We remain close, not only for the typical family reasons but also because of our family foundation. Once a year, we hold an official foundation board meeting by phone. Each of us shares the projects in our community that we are most interested in supporting. Together, we agree on the non-profits we will give to that year. For me, our yearly gifts are a wonderful way to thank Phoenix for the many benefits I have received during my 45 years here. It is here that I received my college education, developed my real estate business, married my husband, and rejoiced as other family members relocated to Arizona. My life has been enriched in so many ways by this community that it is only fitting I give back. One of our charities of choice is Barrow Neurological Foundation (BNF). That’s because of the important role Barrow Neurological Institute has played in our family’s health. Both Wendy and Julie have been the recipients of Dr. Robert Spetzler’s amazing skills, and for that, my family will be forever grateful. I feel truly blessed to be able to help Barrow through both financial and leadership gifts. After several years of serving on the BNF Board of Trustees, I became the chairman of the board in July. My mission as the board chair is to encourage fellow board members to choose an area of the hospital that is meaningful to them and raise $10,000 for that area each year. I will also work hard to be a good ambassador for Barrow throughout the Valley. On a personal level, my sisters and I are preparing the next generation of our family to become involved in and assume the leadership of our family foundation. What my parents did for me, I want to do for my nieces and nephews. I am happy to report that Erin and Christopher Collins are now involved at non-profits in their communities, including St. Joseph’s Hospital and Medical Center. I am proud to be a third-generation philanthropist and determined to keep the spirit of philanthropy alive in our family. I encourage you to pass along your passion for giving to the next generation. ■
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Join us for a once-in-a-lifetime
Ecotour of Ecuador and the Galapagos Benefiting Barrow Neurological Institute August 2011 Most ecotravelers have dreamed of one day visiting Ecuador and the Galapagos Islands with their bounty of unique, rare, and extraordinary wildlife. This intimate group tour (limited to 20) will combine three amazing areas into one unforgetable ecotour. * A week of our trip will be spent in the Galapagos Islands aboard our own vessel. We will visit most of the principal islands and see many animals and plants found nowhere else in the world. * On the mainland of Ecuador, we will travel several days in and around the capital city of Quito, which lies in an Andean valley. The snow-capped mountain tops will form a backdrop for our visits to colonial parts of the city and the Otavalo Indian market. * An hour’s flight from Quito begins the western margin of the huge Amazon Basin. Here we will stay in a deluxe tourist lodge on the Rio Napo and have four adventurous days to canoe down quiet tree-canopied forest streams, walk forest trails with an Indian guide, fish for pirahna in the cocha lakes, or climb to a large platform in the canopy to view wildlife. The tour is planned so that you can join the Galapagos portion or the Quito-Amazon portion or both. It will be led by Mitch Lysinger, a resident of Ecuador and a tour leader for Field Guides, Inc. (Austin, Texas) for 13 years, and David Pearson, a professor in the ASU School of Life Sciences who has written several tourist guides, including Travellers’ Wildlife Guide to Ecuador and the Galapagos, and who has conducted biological research in Ecuador since 1972. While we are still working out details, the trip will run approximately two weeks and cost about $9,000 per person (excluding airfare from the U.S.), with a portion of that coming back to Barrow Neurological Foundation as a tax-deductible gift. If you are interested in participating in this adventure or would like more information, please call the Foundation Office at 602-4063041 during normal business hours or email Julie Alvarado at Julie.Alvarado@chw.edu.
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Nephew’s care inspires couple to give to Barrow efore his nephew’s traumatic brain injury, real estate developer Guy Inzalaco had never crossed paths with Barrow Neurological Institute. But once he did, “I discovered a jewel within our community,” he said. “They did an amazing job helping my nephew Brent recover while in the hospital and through his rehabilitation.” Not long after Brent’s release from the hospital, Inzalaco contacted long-time friend and Barrow Neurological Foundation board member Patti Gentry. Gentry encouraged Inzalaco to join the Foundation’s volunteer board. “My family strongly believes in giving back to our community,” says Inzalaco. “Barrow is such a huge part of our lives now that we felt that supporting Barrow would be time and money well spent.” Inzalaco and his wife, Stephanie, donated funds to support a rehabilitation gym in the Bruce and Deborah Downey Neuro Rehabilitation Center at Barrow. The gym, which serves spine rehab patients, was named Brent’s Gym in honor of the Inzalacos’ nephew. The Inzalacos are continuing their commitment to Barrow by supporting a renovation of the Barrow Children’s Cleft and Craniofacial Center. The new center will be renamed in honor of the Inzalacos when it is formally dedicated. “The doctors in the craniofacial area are amazing,” Inzalaco said. “It’s impossible to not be moved by what some of these kids are going through. I walked out of their presentation in tears.” The center’s multidisciplinary team of professionals work with the referring physician and family to develop the best possible outcome for patients of all ages—from newborns to adults. Barrow’s specialists understand how to treat the complexities associated with craniofacial disorders and are extremely sensitive to the personal nature of these conditions. “The kids and their families are dealing with daily challenges requiring numerous surgeries over many years,” Inzalaco said. “The physicians are incredibly dedicated and stand by their patients’ side for the long term in order to help them lead as normal a life as possible. They become a part of their extended family. “The bottom line is that we wanted to be a part of something special. And by supporting Barrow, we are.” ■
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Guy and Stephanie Inzalaco’s first gift to Barrow Neurological Foundation funded a gym for spine patients in the Bruce and Deborah Downey Neuro Rehabilitation Center. The gym was named “Brent’s Gym” in honor of the couple’s nephew.
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a real raffle winner
by Sally Clasen
Ticket buyer later receives care at Barrow for brain injury hen Ryan Perry first bought a Health & Wealth Raffle ticket in 2009, he wanted to win one of the great prizes offered in the biannual give-away. At the time, Perry was laid off from his job as the head of maintenance for a chain of family fun parks, and it was difficult to come up with the $100 ticket price. The 34-year-old Valley man figured if he didn’t win, at least his investment was going to a good cause. Little did he know that he’d eventually benefit from that cause. In January 2010, Perry was preparing to ride a gaspowered, off-road mountain board with his buddies. After packing his safety gear, which included a helmet, he decided to make a last-minute adjustment to his carburetor with a test drive. The ride—less than 200 yards at 10-15 mph—proved to be life changing. The motorized board fishtailed, pitching Perry onto the street. Although Perry didn’t pass out, it was soon apparent that he had hit his head and was in trouble. “I thought I was fine and got up to walk towards the house,” says Perry. “I started walking diagonally, and my vision was blurry. I sat down, and then the hearing in my right ear went out with a solid ring.” Perry was reluctant to seek medical care because he had no health insurance, but he was finally convinced he needed treatment and was taken to Paradise Valley Hospital. There, a CT scan indicated a brain bleed. “At that point, my words were slurring. I don’t remember much except the nurse telling me I was going to take a helicopter ride. When I was in the helicopter, I thought, ‘I’m finally in a helicopter, and I can’t see a view of the Valley,’” he recalls. His destination was Barrow, where experts confirmed a traumatic brain injury (TBI)—a skull fracture and subdural hematoma with bifrontal contusions. Perry spent eight days at Barrow as staff worked to reduce pressure on his brain caused by fluid. Since then, it’s been a bumpy road for Perry. “It’s the most difficult thing I’ve ever had to deal with. Life as you knew it is over,” he says of the immediate and long-term effects of TBI. Loss of smell, difficulty concentrating, and a lack of energy are some of the lingering symptoms Perry experiences daily. Yet, the constant pain in his head, neck, and shoulders remains his biggest challenge. “It’s a double-edged sword. I’m lucky to be here, but I live with the effects every day. The pain is mad-
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dening. There’s no break. I’ve had broken limbs, been in a wheelchair, beat up and burned, and nothing compares to head trauma pain,” he says. The physical setbacks compounded Perry’s already shaky financial situation. He owns a handyman service (www.repairguysaz.com), but because of pain and limited energy, he’s only able to work 15 hours a week. Despite the hardship, he is grateful for the care he received at Barrow. “Everyone was amazing, caring, and intelligent. I could tell they personally cared.” Perry is monitored once a month at the Barrow Resource for Acquired Injury to the Nervous System (BRAINS) clinic and is working through the pain and emotional changes that often come with TBI. And though the auto and motorcycle enthusiast isn’t afraid to get back on a fast-moving vehicle, Perry says his pursuit of adventure will take on a new look. “In the past, I was the macho guy going 70 mph on my chopper through the city,” he says. “I’ll do it again, but with a helmet this time.” ■
Ryan Perry says his care at Barrow Neurological Institute was “amazing.”
THANK YOU, ARIZONA FOR SUPPORTING ST. JOSEPH’S HOSPITAL & BARROW NEUROLOGICAL INSTITUTE
ARIZONA’S ORIGINAL RAFFLE WILL BE BACK AGAIN IN FEBRUARY 2011!
YOUR SUPPORT IS MAKING A DIFFERENCE! NOW THAT THE FALL 2010 HEALTH & WEALTH RAFFLE HAS ENDED, WE WANT TO THANK YOU FOR BEING A PART OF THIS AMAZING PROJECT.
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the next step in healing New Children’s Center for Neuropsychological Rehabilitation helps children dealing with the aftereffects of brain injuries by Andrew Wachtel en-year-old Sophie Powell still faces challenges after undergoing successful surgery at age 7 to remove a lesion in her brain that had caused her to experience as many as 30 seizures a day from the time she was 4 years old. In November 2007, a team of Barrow surgeons led by Harold Rekate, MD, removed a cortical dysplasia—an area of abnormally developed brain cells in her right frontal lobe—that was causing Sophie’s seizures. According to Sophie’s mother, Leea Powell, the surgery was a miracle. “She never had another seizure again,” she said. “As soon as she woke up, she asked for a pen and paper so she could write a poem about how she was feeling.” Indeed, neuropsychological assessments performed by George Prigatano, PhD, at the Children’s Center for Neuropsychological Rehabilitation at Barrow showed Sophie to be bright and intelligent. Yet, as Sophie has progressed in school, she has experienced some social difficulties that Powell suspects are residual symptoms of her disorder.
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According to Powell, Sophie maintains one or two friendships at a time, is introspective, and shows little interest in play dates or other social activities. “It’s hard to tell if it’s just the usual drama that you see in girls that age or if it is something more, something related to everything she’s been through.” These concerns led the Powell family back to Barrow and the Children’s Center for Neuropsychological Rehabilitation, where Sophie will participate in a friendship training workshop designed for children who have had a traumatic brain injury, epilepsy, or other brain disorder. Both the friendship training and the center as a whole, said Dr. Prigatano, have been “a long time in coming.” Dr. Prigatano’s interest in working with children who have suffered from brain injuries or disorders was borne of his work with the neuropsychological rehabilitation of adults in their early twenties who had suffered similar maladies. “One of the things that really jumped out at me about these patients was the social isolation,” he said. “They had fewer friends than many other people their age.”
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This made him wonder if patients’ outcomes could be improved if they started receiving treatment at an earlier age. Beginning in 2000, Dr. Prigatano and his team began to study the attitudes that the parents of about 100 children had toward their children’s brain injuries, asking them what disabilities and difficulties they perceived their children as having and what types of treatment and therapy they thought would be beneficial. “We were well-positioned, after conducting that research, to understand what was necessary to help. I had money left over from the grant to help pay for the infrastructure, and St. Joseph’s was kind enough to get us space and to help us hire different personnel to start the children’s center,” says Dr. Prigatano. The center, the first of its kind, offers a wide range of services, from initial and ongoing neuropsychological assessment, to academic tutoring, psychotherapy, and behavior modification. Also, beginning in the summer of 2011, Dr. Prigatano and his staff will offer a 10-week summer day-treatment program in a simulated classroom setting that will encompass all of the services offered at the center, including the friendship training Sophie Powell and her parents look forward to attending.
Improving children’s outcomes
Jennifer Wethe, PhD, associate director of the center, said that friendship training focuses on teaching children the unwritten rules of making friends. “After experiencing a brain injury or recovering from a brain disorder, children have a hard time picking up the social signals that their peers are sending them,” said Dr. Wethe. “They need to be taught these skills, and they need to practice.” According to John Fulton, PhD, a neuropsychologist at the center, parental involvement often plays a key role in making sure children are able to practice the skills they learn at the center—a reason why Dr. Prigatano and his staff place such a large emphasis on attending not only to the needs of the child, but also those of their parents and even their school. Sophie is optimistic that this approach will help her make a more complete recovery. “I think Dr. Pri-
Learning the rules of friendship
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‘’This sounds like it’s going to help me.” Sophie Powell
gatano helped me triumph, but I have been having some problems with friends at school,” she says. “This sounds like it’s going to help me.” Her mother feels this guidance will be helpful not only for Sophie, but also for her as her daughter prepares to enter her teenage years. She is also looking forward to working with the Barrow staff again. “We have never met a doctor at Barrow that we didn’t like,” said Leea. “I love this hospital.” ■
Team members include Jennifer Wethe, PhD, George Prigatano, PhD, and John Fulton, PhD, above, and educator Linda Barr, right.
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saddle up
by Lindsey Burke
Lawyer returns to roping after neck surgery at Barrow teve Savage charged out of the box on horseback after his steer. As the header on a two-man roping team, it was his job to rope the horns of the steer and then turn to his left, giving his partner, the heeler, an opportunity to rope the steer’s hind legs. With his rope firmly in place, Savage began to turn. He had done this thousands of times before; but this time, as he pulled the steer, it ran behind his horse, lodging the rope under his horse’s tail. Spooked, the horse bucked, and Savage was thrown into the air, landing on his head. “It all happened so fast,” he said. “I really didn’t know what had happened.” He got up and immediately noticed pain in his neck and shoulders. “I figured I had just pulled muscles or torn ligaments.” Savage waited for his friend, who had driven him to the arena in north Phoenix, to finish roping. The two loaded their horses into the trailer and headed home. His immediate concern was the swelling that had developed. At home, he surrounded his neck with ice packs and rested. “I remember that it was difficult to lie down without holding my head for support,” he said. The following morning, he dressed and went to work for a 7 a.m. conference call at the law offices of Ballard Spahr, LLP, where Savage works as an attorney. After the call, he phoned his primary care physician and explained the discomfort, which had not subsided. Without hesitation, the receptionist told him to go to the nearest emergency department. Savage’s assistant drove him the short distance to St. Joseph’s. “I remember going over speed bumps in the parking lot. They certainly didn’t help.”
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In the emergency department, Savage’s neck was immediately immobilized, yet he remained unconvinced that anything serious had happened. “I was still working...reading contracts by holding them straight
up over my head. I had no idea how serious my injury was.” Diagnostic images revealed a type II acute odontoid fracture, a hairline fracture at the base of the peg on the C2 vertebra, the vertebra responsible for rotation of the head. Nicholas Theodore, MD, FACS, chief of the spine section at Barrow Neurological Institute, was assigned to Savage. Dr. Theodore determined the fracture to be stable, and opted for nonsurgical treatment, using a cervical collar to brace the neck, which would allow the fracture to heal in proper alignment.
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Savage followed orders dutifully, wearing his neck brace for months, hoping that with proper healing, he would eventually return to roping. But a CT scan revealed the worst: the fracture hadn’t healed together. Instead, the bone fragments had healed as two separate pieces and would require surgery. “Surgery was the last thing I wanted because I wanted to rope again,” Savage recalled. “I felt surgery would prevent that from ever happening.” He discussed the surgical approach with his son, a medical doctor at Johns Hopkins Hospital in Baltimore, MD. “I actually put my son on the phone with Dr. Theodore. At the end of the conversation, he said to me, ‘Dad, you have to do this,’ and I knew it was the only option.” Dr. Theodore and his team fused the C1 and C2 vertebrae together, placing a graft of bone harvested from Savage’s rib between the two. Multiple screws held everything in place. “With this procedure the bones are stable, but about 50 percent of the neck’s ability to rotate is lost,” said Dr. Theodore. Savage healed remarkably well. “He was the ideal patient,” said Dr. Theodore. “His motivation was to get back to what he loves the most.”
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“Dr. Theodore used his best judgment, and he spoke to me in plain English,” Savage said. “He was great. He’d talk about the risk factors of engaging in certain activities, and, of course, I asked him about roping.” Dr. Theodore talked to Savage about the dangers of roping. “I encouraged him to try another hobby and told him, ‘You’re never as good after surgery as you were before,’ and that it wasn’t so much the horseback riding that was risky—it was the possibility of facing a repeat injury.” Savage weighed the risk and decided he couldn’t stay away from roping. But he moved from heading to heeling in the roping arena, because it doesn’t involve as much neck rotation. “Other than that, I am able to do just about everything I did before surgery. In fact, you could say it has actually helped my golf game,” Savage joked. “Because I’m limited in how far I can rotate my neck, it’s easier to keep my eye on the ball.” ■
“I am able to do just about everything I did before surgery. In fact, you could say it has actually helped my golf game. Because I’m limited in how far I can rotate my neck, it’s easier to keep my eye on the ball.” Steve Savage
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N E W S
foundation news Ron Mirenda named CEO of Barrow Neurological Foundation onald F. Mirenda has been named vice president of philanthropy at St. Joseph’s Hospital and Medical Center. In this role, Mirenda will serve as the chief executive officer of St. Joseph’s Foundation, Barrow Neurological Foundation, and The Congenital Heart Foundation, three support foundations that raise funds for clinical care, medical research, and professional education at the hospital. “I’m excited to welcome Ron and pleased he will be leading the next evolution of our philanthropic efforts,” says Mary Jane Crist, CHW Arizona service area leader for philanthropy. Crist has led Barrow Neurological Foundation and St. Joseph’s Foundation for the last 13 years. Mirenda has more than 35 years of experience in fundraising, strategic planning, public relations, and communications, and has had significant leadership roles in fundraising campaigns with combined goals of more than $750 million. In the fundraising arena, Mirenda has designed and managed campaigns, and developed leadership gift strategies. His experience includes 15 years as chief advancement officer or senior development officer at prestigious institutions such as the University of Chicago, Case Western Reserve University, Provenant Health Partners, and the University of St. Thomas. In addition, Mirenda has worked with organizations such as the National Air and Space Museum, The Smithsonian Institution, the Fine Arts Museums of San Francisco, and University of California, Irvine. He is the founder and owner of Mirenda & Associates, which provides strategic fundraising counsel to organizations in the arts, education, healthcare, and human services. He also co-founded DonorNet™, an e-commerce company dedicated to helping nonprofits use the vast marketing and fundraising opportunities of the internet. "I look forward to working with our board members, physicians, and volunteers to build upon the significant accomplishments of Mary Jane Crist and the foundation staff, and to take the level of philanthropy for St. Joseph’s Hospital and Medical Center to new heights," Mirenda said.
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Ron Mirenda brings more than 35 years of fundraising, strategic planning, public relations, and communications experience to St. Joseph’s.
A member of the Association of Fundraising Professionals, Mirenda serves on the board of the Greater Los Angeles Chapter. He also belongs to the Association of Healthcare Philanthropy. He has chaired and been a faculty member and presenter at numerous fundraising conferences nationwide. He holds a master of arts degree in educational administration and a bachelor of arts degree in English from the University of St. Thomas, St. Paul, Minnesota. Most recently, Mirenda lived in Los Angeles. His first day at St. Joseph’s was Nov. 1. ■
B E N E F A C T O R
B R I E F S
benefactor briefs 2011 Barrow Grand Ball set for January 15
The 2011 Barrow Grand Ball will be held Saturday, Jan. 15, in the Arizona Biltmore Grand Ballroom. Now in its 46th year, the black-tie dinner and dance has raised nearly $40 million for Barrow Neurological Institute, making the Barrow Women’s Board the institute’s largest benefactor. It is one of the most prestigious charitable events in Arizona. Co-chairs of the 2011 Barrow Grand Ball are Women’s Board members Shan Francis and Angela Melczer. For more information, call Barrow Neurological Foundation at 602-406-3041.
Karen and Robert Hobbs and Sandy and Mac Magruder at the 2010 Barrow Grand Ball
Women’s Board invites you to Education Day on February 10
The Barrow Women’s Board will present Education Day on Thursday, Feb. 10, in the Goldman Auditorium and Marley Lobby at St. Joseph’s Hospital. The morning event will begin with a continental breakfast and continue with presentations by Barrow physicians and researchers about new directions at Barrow: • Roy A. Patchell, MD - The future of Barrow • Darin Okuda, MD - Barrow’s multiple sclerosis program • Nader Sanai, MD - the new Barrow Brain Tumor Research Center • Stephen Macknik, PhD, and Susana Martinez-Conde, PhD - the neuroscience of magic • Virginia Prendergast, NP-C, CNRN - nursing at Barrow • Robert Spetzler, MD - closing remarks. Co-chairs of this event are Harriet Friedland and Janis Lyon. To reserve your spot at Education Day, call the Barrow Neurological Foundation RSVP line at 602-406-3040.
Jazz and Blues Festival held to benefit MAPC
“Knock Out Parkinson’s Jazz and Blues Festival,” sponsored by the Parkinson Network of Arizona, was held Nov. 7 at the Scottsdale Plaza Resort. Net proceeds from admissions and a silent auction will be donated to the Muhammad Ali Parkinson Center at Barrow. Last year’s event raised $10,000.
2010 Education Day
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R E S E A R C H
U P D A T E
research update American Heart Association awards grant to Barrow imaging researcher
James Pipe, PhD, has been awarded a $132,000 two-year grant from the American Heart Association for improving methods to assess the morphology and function of the vascular system. The funded research will explore new ways to use “phase-contrast” MRI to measure blood flow more reliably and in less time than conventional methods. The quantitative information provided by phase-contrast MRI is of interest for
a range of clinical problems, including diagnosis of stroke, atherosclerosis, vascular malformations, aneurysms, Alzheimer's, and multiple sclerosis, but the technology currently requires very long scan times. This research may open up the technology to routine clinical use.
Researcher: Natural killer cells improve MS symptoms
Fu-Dong Shi, MD, PhD, studies natural killer cells, a type of immune cells, in his laboratory at Barrow Neurological Institute. Natural killer cells are believed to boost autoimmunity under certain circumstances by acting on other immune cells in the lymph nodes. Recently, he and his colleagues at Barrow and Tianjin Medical University General Hospital, China, reported that natural killer cells have a stronger effect on autoimmunity in the central nervous system. In his research, Dr. Shi found that natural killer cells limit inflammation and the immune response against myelin antigens in a mouse model of multiple sclerosis. Increasing the number of natural killer cells was protective against the disease, while limiting the cells made the disease symptoms worse. Dr. Shi and his colleagues speculate that drugs used to treat MS may have a positive effect because they increase the number of natural killer cells. Dr. Shi’s original findings were recently published in the highly respected Journal of Experimental Medicine and also highlighted in the August issue of Nature. .
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Vision researchers’ book now available in bookstores
Stephen L. Macknik, PhD, and Susana MartinezConde, PhD, vision researchers at Barrow Neurological Institute, are the authors of Sleights of Mind: What the Neuroscience of Magic Reveals about Our Everyday Deceptions. The book became available in book stores in November. The book is the result of the authors' worldwide exploration of magic and how its principles apply to human behavior. Magic tricks work because humans have hardwired processes of attention and awareness that are hackable.
N E W S
what’s happening around barrow St. Joseph’s names new Chief Operating Officer
St. Joseph’s Hospital and Medical Center has named Gregg Davis as its new chief operating officer. Davis was previously at Norton Healthcare in Louisville, Ky., where he served as both system vice president of orthopedics, neurosurgery and spine, and executive director of the Norton Neuroscience Institute. Norton Healthcare is Kentucky’s largest healthcare system and, like St. Joseph’s, is a faith-based, not-for-profit organization. “St. Joseph’s has been the leader in healthcare in Arizona for more than 115 years,” said Davis. “I’m proud to be part of this organization and hope I can help lead it to even greater success.” Davis has nearly 20 years in healthcare leadership. He received his undergraduate and graduate degrees from Murray State University. “Gregg has a proven track record in building new programs, working with physicians, and creating new revenue streams,” says Linda Hunt, president of St. Joseph’s and Arizona service area president for parent company Catholic Healthcare West. As St. Joseph’s chief operating officer, Davis will be responsible for overseeing patient care, ancillary and support services, information technology, facility development, strategic planning, and business development.
U.S. News & World Report names Barrow to top-10 list
U.S. News & World Report has named St. Joseph’s Hospital and Medical Center one of the 10 best hospitals in the United States for neurology and neurosurgery. U.S. News & World Report’s annual listing of top hospitals is the most respected of all national rankings. St. Joseph’s is routinely ranked in the top 10 for neurology and neurosurgery and has the highest ranking of any hospital in the state. St. Joseph’s ranked number eight in this year’s neurology and neurosurgery category.
St. Joseph’s named a most admired company
St. Joseph’s Hospital and Medical Center has been selected by Arizona Business Magazine and Best Companies AZ as one of 43 winners for the inaugural Arizona’s Most Admired Companies awards. Arizona’s Most Admired Companies are selected based on how a company has performed in the following areas: workplace culture (as voted by employees), leadership excellence, corporate and social responsibility (community and environment), and customer opinion (as assessed by customers). “These companies truly exemplify what it means to be a good corporate citizen,” says Cheryl Green, vice president of marketing for Arizona Business Magazine.
Barrow neuropsychologist named a Health Care Hero
Leslie Baxter, PhD, a clinical neuropsychologist at Barrow, received the Researcher/Innovator Award at the Phoenix Business Journal's Health Care Heroes event held in August at the Arizona Biltmore Resort. Dr. Baxter was recognized for her innovative work in the use of functional MRI for presurgical brain mapping and for her collaborative research into Alzheimer’s disease.
Miracle Tour schedule set
This year’s Miracle Tour schedule includes these tours: • • • • • • • •
Nov. 18 - Comprehensive Cancer Center Jan. 13 - Brain Tumors and Their Treatment Feb. 10 - Comprehensive Cancer Center March 10 - Women’s Services April 14 - Emergency/Level I Trauma Center April 21 - Brain Tumors and Non-Invasive Surgery May 12 - Moving Electrons Instead of Atoms May 18 - New Innovations in Cardiac Surgery.
All tours begin at 9 a.m. and run two to three hours. The tours on Nov. 11, Jan. 13, Feb. 10, March 10, April 14, and May 12 offer an optional lunch after the tour. For more information or to register for a tour, call 602-406-1038 M-F, 8 a.m.-4:30.
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P L A N N E D
G I V I N G
charitable gift annuity “For it is in giving that we receive” – St. Francis of Assisi by Kathy Kramer Vice President, Leadership Gifts
he words of St. Francis of Assisi—”For it is in giving that we receive”—aptly describe how a charitable gift annuity works. You give a gift of either cash or appreciated stock to Barrow Neurological Foundation, and in return for as long as you live, you will receive income. A charitable gift annuity is just what the name says…part gift and part annuity. The payout is based on your age and your life expectancy. The older you are, the higher the payout. For example, if you are 60 years old, you would be eligible for a payout rate of 5.2 percent, but if you are 80, your payout rate would be 7.2 percent. In addition to income for life, making a gift to Barrow through a charitable gift annuity offers other benefits. For instance, you may be able to claim an immediate charitable tax deduction, a portion of the payments you receive may be tax-free, and you may be able to bypass a portion of capital gains tax if you fund the charitable gift annuity with appreciated stock. If you are interested in learning more about charitable gift annuities or if you would like a personal illustration, please contact Kathy Kramer at 602- 4061042 or Kathy.Kramer@chw.edu. ■
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“A charitable gift annuity is just what the name implies... part gift and part annuity.”
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