Barrow Magazine, Volume 21, Issue 2, 2009

A magazine for the friends of Barrow Neurological Institute of St. Joseph’s Hospital and Medical Center

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Volume 21, Issue 2, 2009

B.R.A.I.N.S.

Providing smart care for kids after head injuries

The New Ice Age Saving brain by chilling out

Opening thoughts s the holidays approach, our thoughts turn to the many generous friends who make it possible for Barrow Neurological Institute to help thousands of children and adults each year. It is a simple fact that without your support, much of what we do would not be possible.

Your investments in research, medical education, facility improvements, technology, and patient services all contribute to improved patient care and amazing patient outcomes, such as the ones you’ll read about in this issue. Whether it’s a baby facing life-long damage from insufficient oxygen to the brain, a teenager with a particularly difficult brain abnormality, or a child born with a craniofacial abnormality, Barrow is here to help—thanks to you.

Wonderful examples of the power of philanthropy can be found in abundance within these pages— a new fellowship that will bring together neurologists from Israel and Barrow, a spacious and functional new home for the Barrow Children’s Cleft and Craniofacial Center, and funding for aneurysm and brain tumor research. To each and every one of our benefactors, we thank you for the difference you are making.

Finally, we ask that you consider making a year-end gift to Barrow Neurological Foundation. The economic downturn has hit us, just as it has every other organization, making your support more important than ever. We would be happy to work with you to find a way to give that is meaningful and financially comfortable for you.

Thank you and have a wonderful Christmas and a very happy New Year!

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Sincerely,

Robert F. Spetzler, MD Director, Barrow Neurological Institute

Mary Jane Crist Chief Executive Officer, Barrow Neurological Foundation

On our cover: Cameron Smith sustained a traumatic brain injury while riding his bike in the desert near his home. Read his story starting on page 4.

Correction: Marian Rochelle’s first name was misspelled on page 24 of the last issue of Barrow. We apologize for this error.

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4: B.R.A.I.N.S. New neurology program treats traumatic brain and spinal cord injuries.

8: The new Ice Age Therapeutic hypothermia improves outcomes after brain hypoxia, a lack of sufficient oxygen in the brain.

13: Craniofacial differences Team gives coordinated care to complex conditions, moves into new center.

17: Why I give The Harold and Jean Grossman Israeli Fellowship Program honors woman’s late husband and the man who helped him.

19: Volker Sonntag, MD Barrow icon retires after 31 years of service to neurosurgery and medical education.

Contents

22: St. Joseph’s Amazing Patient stories from the files of Barrow Neurological Institute 25: Roy Patchell, MD New neurology chair looks at broad picture, continues neuro-oncology research.

27: A New Perspective on Life One student’s school essay about her experience at Barrow.

28: Benefactor briefs 30: Research update 32: What’s happening around Barrow 34: The Charitable Gift Annuity Achieving two goals with one asset

Catherine Menor Editor/writer Catherine.Menor@chw.edu

Sally Clasen, Melissa Morrison, Sarah Padilla, Christina Vanoverbeke Contributing writers

Robert F. Spetzler, MD Director Barrow Neurological Institute®

Justin Detwiler Art director/designer

Brad Armstrong; Jeff Noble; D Squared Productions, Murphy/Scully Photography

Mary Jane Crist, CFRE 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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by Sally Clasen

b.r.a.i.n.s.

New neurology program combines medical specialties to treat traumatic brain, spinal cord injuries ameron Smith was a typical outgoing kid who forced Annette and her husband to rush their teenagdid well in school until an accident last er to a pediatric urgent care center where the Smiths December seemed to trigger a slow but dramat- were told to take Cameron immediately to St. Joseph’s. ic change in the 13-year-old’s demeanor. While playOnce at St. Joseph’s, he was admitted and given a ing on his bike near a dirt pile close to his home, series of tests including an MRI, EEG, neurological Cameron fell and hit his head. Onlookers said he exam, and neuropsychological testing. He was diagpassed out for a few minutes but seemed fine and nosed with post-concussive syndrome, or mild traumatic brain injury (TBI). then rode his bike home.

TBI occurs when a sudden trauAt first, Cameron, who was Traumatic brain ma causes damage to the brain, wearing a bike helmet, didn’t disinjury is the leading either from an object hitting the head play any physical side effects except for a bump on his forehead. In fact, cause of death and or piercing the skull and entering brain tissue. Approximately 1.5 milhis mother, Annette, a chiropractor, disability in children lion Americans sustain a TBI each says he looked and appeared noryear, and it is the leading cause of mal. Despite being “grounded” and and young adults. death and disability in children and warned to stay away from the area, Cameron retuned to the dirt mound and fell again, this young adults. Ninety percent of TBI cases are classified as mild, such as Cameron’s, though some still time without a helmet.

He still didn’t show any signs of an injury but then produce severe effects.

The majority of TBI symptoms resolve within three started to display unusual behaviors over the next few months, including lack of focus, aggression, errat- months, but certain patients will have long-term conic moods, and sleep troubles. He also was non-com- sequences and require neuropsychological monitoring and neurorehabilitation. pliant and didn’t want to go to school.

“I was shocked by the diagnosis,” says Cameron’s mother.

“He was walking and talking that day. I’ve A different kid studied neurology, but I didn’t know exactly what In February, Cameron’s personality changes caused TBI meant.

I thought it meant coma or that someone serious consequences when he was expelled from was in a wheelchair.

I didn’t have a clue.” school for writing a threatening letter.

Many misconceptions exist about TBI, according to “Cameron had always liked school and was three neurologist Javier Cárdenas, MD. “It’s a silent epito four levels ahead in learning,” says Annette, who demic.

People look the same—they don’t seem learned that her son also had been hit in the eye by a impaired or look disfigured—but their functioning is hockey puck at some point and tripped on a stage impaired,” he explains. while practicing for a school play in November. “We

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were trying to figure all this out and just were at a loss.

He started having nausea and vomiting and was waking up a lot during the night.”

In early March, his abnormal behavior reached a critical stage when Cameron carried a butcher knife into his parents’ bedroom, put it to his neck, and mumbled that someone was after him. The disturbing event

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A new neurology program launched in July is designed to help families like the Smiths avoid getting lost in a misdiagnosis—and missed treatment opportunities. Called B.R.A.I.N.S. (The Barrow Resource for Acquired Injury to the Nervous System), it is the most

Getting a clear picture

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“It’s a silent epidemic. People look the same...but their functioning is impaired.”

Javier Cárdenas, MD

Cameron Smith began displaying such strange behavior that his parents, Annette Wright-Smith, DO, and Theodore Smith, took him to St. Joseph’s.

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Javier Cárdenas, MD, is a pediatric neurologist at Barrow Neurological Institute.

comprehensive program to treat brain and spinal cord injuries in the state of Arizona. B.R.A.I.N.S. provides a clinical environment that draws on the expertise of numerous medical specialties.

The goal of B.R.A.I.N.S. is to improve the outcomes of mild and moderate neurological injuries through comprehensive individualized care and aggressive medical research, according to Dr. Cárdenas, who is a member of the multidisciplinary team that includes experts from neurology, neuroradiology, neuropsychology, neurosurgery, neurorehabilitation, translational research, trauma, and diagnostics.

As part of the B.R.A.I.N.S. program, Dr. Cárdenas holds a clinic weekly to evaluate patients for the severity of TBI. “We want to make certain that individuals are plugged in early so that we can capture and prevent some of the inefficiencies in care and work on effective treatment results.”

Before coming to St. Joseph’s, Annette and her husband, Theodore, had taken Cameron from one doctor to another in a frustrating series of attempts to find a reason for their son’s abnormal behavior.

“Physicians did examine him and ran tests—even psychological tests—and one suggested his problems were related to attention deficithyperactivity disorder but no one ordered an MRI, a CT scan, or ever made a referral for one,” his mother says. “They did ask us if he had headaches and was dizzy, but he didn’t have those symptoms.”

Cameron’s situation is typical of many children who are incorrectly diagnosed or not diagnosed at all with TBI, says Dr. Cárdenas. “He was lost in the system. TBI has subtle and broad symptoms and is difficult

A long search for answers

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to identify. His parents scheduled doctor’s appointments like they were supposed to, but even classic symptoms of TBI are often missed.”

Headaches, blurred vision, confusion, dizziness, sleep issues, and vomiting are common side effects of TBI, but other symptoms such as attention issues, inability to process, and behavioral problems are overlooked because they are not normally associated with the injury, says Dr. Cárdenas.

“Cognitive and behavioral problems are very typical in TBI, particularly in school when children are the most challenged. A lack of awareness about the symptoms compounds the problem and creates a lot of anxiety—for the child, the family, teachers, and others who interact with those who have TBI.” An important aspect of B.R.A.I.N.S. is making certain that children with brain injuries aren’t lost in the academic shuffle. It is the first program of its kind in the country to include an educational component in a multidisciplinary treatment approach through a partnership with the ASU College of Teacher Equation and Leadership. The collaboration provides opportunities for teachers to learn the common characteristics of students with brain injuries and how those affect educational needs.

“Success is often measured in adults with brain injury at work but not for kids in the classroom. Amodel of education like this hasn’t existed for pediatric brain injuries,” says Dr. Cárdenas, a former special education teacher. In addition, the program has a close relationship with the Brain Injury Association of Arizona (BIAAZ), a community organization that provides social support for those with TBI and spinal-cord injuries.

Annette is pleased about the launch of B.R.A.I.N.S. and the related resources her family is using to deal with Cameron’s lingering TBI issues, which include setting boundaries for his behavior and moods, working with a speech therapist, and changing the way they communicate with him.

“B.R.A.I.N.S. is a necessity. We’ve learned that after a TBI, you have to retrain the brain to think a new way,” she says. In August, the 8th-grader returned to school in Goodyear, where the staff and the Smiths are developing strategies to meet Cameron’s classroom needs while he continues to recover.

“I can’t describe the impact. It’s been very difficult,” says Annette about the toll of TBI on the family. “It’s been hell on earth but it has made us stronger.” She says it’s also made her a better mother—and healthcare practitioner. In a newfound advocacy role, she is distributing literature about TBI in her office, Optimum

Coping with brain injuries

Javier Cárdenas,, MD, director of the new B.R.A.I.N.S. program at Barrow

Chiropractic and Wellness in Avondale.

“If a parent tells me a child hit his head, the first thing I think is: ‘Is it a concussion?’” she says.

Annette is also interested in hosting educational seminars about TBI so others could possibly prevent the months of agony the Smiths endured.

“I’m learning as much as I can so I can put it into terms parents can understand,” she says. “If I could, I would redo everything. I want parents to know that no matter how old or articulate your child is, if he bumps his head, he needs to be evaluated by the right person immediately. Do not take it lightly.” ■

Barrow named lead Arizona center for pediatric brain injury

The Sarah Jane Brain Project has named Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center Arizona’s lead center for diagnosing and treating pediatric brain injuries, the number-one cause of death and disability in children.

As Arizona’s designated center, St. Joseph’s will develop a master plan of care for the state’s children and young adults with brain injuries. St. Joseph’s is the only hospital in Arizona to be named to this collaboration and will partner with 52 other top medical centers across the United States to address pediatric brain injuries.

The Sarah Jane Brain Project was created by Patrick Donohue in 2007 after his daughter Sarah Jane was shaken by a baby nurse when she was five days old, causing a severe brain injury. Donohue began researching and learned that very little was known about traumatic brain injuries, which led him to develop the program.

St. Joseph’s was selected by the Sarah Jane Brain Project to implement the National Pediatric Acquired Brain Injury Plan to better diagnose and treat brain injuries in children.

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Nicole and Phillip Lemieux with Zoe

H Y P O T H E R M I A

by Catherine Menor

the new ice age Hypothermia improves outcomes after brain hypoxia hen doctors or nurses at St. Joseph’s—and certainly parents Phillip and Nicole Lemieux—talk about two-week-old Zoe, they can’t help but smile.

“She’s nursing well. She has good eye contact with her parents. She likes her pacifier, and she has good muscle tone,” says Carlene Danielek, RN, a 15-year veteran of the Neonatal Intensive Care Unit at St. Joseph’s.

“It’s unbelievable how well she’s doing.”

What might seem merely normal for most newborns is amazing for this six-pound infant. Zoe was born with an insufficient supply of oxygen to the brain, likely caused by a kink in her umbilical cord. Her first APGAR score—a measure of a newborn’s pulse rate, reflex, complexion, muscle tone, and breathing—was one out of a possible 10.

She was nearly lifeless.

Doctors at Banner Del E. Webb Medical Center, where she was born, worked quickly to revive Zoe, and when she was three hours old—still with a critically low APGAR score—they transferred her to St. Joseph’s.

They knew that there was one treatment that might reduce the damage that occurs when a newborn’s brain experiences hypoxia, or lack of sufficient oxygen.

That treatment is therapeutic hypothermia, which would involve cooling Zoe’s body for 72 hours and then gradually rewarming her.

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Medicine’s fascination with hypothermia is not new. Doctors have long been intrigued by cases of people who survive long periods in snow or icy water.

What is the mechanism behind hypothermia, they have wondered, and how can it be used to save the brain after a stroke, heart attack, or brain injury?

For decades, though, research into the therapeutic use of hypothermia was disappointing, and hypothermia was used mainly for extreme brain surgeries.

At Barrow, for instance, neurosurgeons have performed a surgery called the hypothermic cardiac arrest since the 1980s to remove otherwise inoperable brain aneurysms. In this complex operation, surgeons cool the body to a state of severe hypothermia, about 15

Harnessing the power of cold

degrees centigrade. Then they stop the patient’s heart and drain the blood from the body. The patient is clinically dead, without heartbeat, breath, or brain waves.

With no blood flow, the aneurysm deflates like a pricked balloon, and the neurosurgical team can operate without the risk of hemorrhage. At such a low temperature, the brain and other organs can survive for as long as 60 minutes, enough time for the surgery.

Since 2000, a resurgence of interest in therapeutic hypothermia for other conditions has occurred because of improved results and promising research findings.

Two major research studies into the use of hypothermia after cardiac arrest—one conducted in Europe and another in Australia—were published in the New England Journal of Medicine in 2002. Both trials found that patients treated with hypothermia after cardiac arrest had better neurological outcomes than similar patients not treated with hypothermia. Because of these and other findings, the American Heart Association included therapeutic hypothermia in its 2005 guidelines for treating cardiac arrest.

Cardiac arrest strikes about 350,000 people in the United States every year. In 2008, one of those people was Russell Vossbrink, then a fit, healthy 37-year-old.

Vossbrink was in a colleague’s office on the Monday after Easter when he collapsed of cardiac arrest.

Fortunately for Vossbrink, his co-workers reacted quickly to the crisis, calling 911 and administering an electrical shock to his heart with an automatic emergency defibrillator stored nearby.

Vossbrink’s fortunes took another positive turn when an emergency medical services team arrived just four minutes later. The EMS team administered medication and performed a newer, more effective CPR technique that uses rapid, forceful chest compressions to maximize blood flow to the heart and brain.

Then, they transported Vossbrink to the nearest hospital, St. Joseph’s—another break for the father of two. St. Joseph’s had just approved a new protocol for using hypothermia to treat cardiac arrest, one of the

The first cardiac arrest patient

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first Valley hospitals to do so. Vossbrink would be the first patient at St. Joseph’s to receive the new therapy.

Resuscitating a patient after cardiac arrest is only the first step in restoring that person to health. Just as important is managing the period after the heart starts beating again and blood rushes back into the brain. During the post-resuscitation period, a whole cascade of damaging chemical events occurs that can cause brain damage. Mild hypothermia seems to prevent those events in many patients.

“Hypothermia slows metabolism and mitigates the effect of the reactions that occur after circulation is reestablished,” says Michael Christopher, MD, an emergency room physician and chief of staff at St. Joseph’s.

Today, hypothermia is a standard part of care at St. Joseph’s for post-cardiac arrest patients who arrive at the hospital within six hours of arrest. Doctors insert a special catheter into a central vein to deliver cool saline into the body. The catheter can be set to a precise temperature for both the cooling and rewarming process.

St. Joseph’s protocol calls for keeping post-cardiac arrest patients in a state of mild hypothermia, between 35 and 32 degrees centigrade, for 24 hours and then gradually rewarming them.

“The brain is what we’re pre“You’re not dead serving,” explains Dr. Christo“We used to think that until you’re warm pher. after five minutes, there was and dead.” permanent brain damage. But we’ve had some people who Michael Christopher, MD were down 40 minutes make a good recovery.

“That’s why we like to say, ‘You’re not dead until you’re warm and dead.’”

It’s all about saving brain

The emergency team at St. Joseph’s began cooling Russell Vossbrink two hours after his collapse at work.

By the time he was transferred to a St. Joseph’s intensive care unit, he was in a state of mild hypothermia.

The next nine hours were difficult as Vossbrink’s heart swung wildly from normal rhythms to severely abnormal and life-threatening rhythms, and even stopped altogether at some points. Heart specialists stayed at his side and used a variety of methods to keep him alive, including ECMO, a device that delivers oxygen throughout the body when the heart is stopped, and 122 more electrical shocks to his heart. They worried that even if Vossbrink survived, his heart might be damaged beyond repair.

The “miracle man”

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Above, Russell Vossbrink has returned to his brain-intensive job as a criminalist. At right is Michael Christopher, MD, a physician in St. Joseph’s Del E. Webb Emergency and Level I Trauma Center.

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Neonatologist Robert Gutierrez, MD, discusses Zoe’s condition with her parents, Nicole and Phillip Lemieux.

On the second day after the arrest, Vossbrink began improving, and eight days later he awoke.

“I remember waking up and trying to piece things together,” Vossbrink says. “I didn’t know what happened. I didn’t know why I was in the hospital.

“My wife, Ann, told me I had essentially been dead,” Vossbrink says. An ICU intensivist concurred.

“He told me they were about six points beyond where they normally go [with a cardiac arrest patient]. He told me, ‘Statistically, you may save the person, but they would have no quality of life.’”

That was not the case for Vossbrink.

Although he had problems walking for a few days, and his short-term memory was poor, cognitive therapy and cardiac rehabilitation eased those deficits.

Three months after the cardiac arrest, the Phoenix man went back to work as a criminalist for the Arizona Department of Public Safety. While he initially had problems with decision-making and multi-tasking, he says his mental function now seems as good as ever.

“So many little lucky things happened,” Vossbrink says. “If one little thing in that chain of events hadn’t happened as it did, I wouldn’t have survived.”

One of the fortuitous events in his journey, he believes, was being treated with hypothermia.

On Oct. 1, 2009, the results of a study into the impact of hypothermia on neontal asphyxia were published in the New England Journal of Medicine.

The TOBY study compared babies who had received both intensive care and mild hypothermia for brain hypoxia to newborns who received intensive care only. The babies were assessed between 18 and 21 months of age to determine the effects of hypothermia on their development. The study found that hypothermia did not significantly reduce the number of babies who died. However, more babies in the hypothermia group survived without severe disability, and fewer had cerebral palsy.

“Hypothermia will not save lives. It will not save severely damaged babies,” says Lawrence Lilien, MD, a neonatologist who led the development of the

Promising results from TOBY

hypothermia protocol for newborns at St. Joseph’s.

“What it will do is help kids who are mildly or moderately damaged have less severe damage.”

St. Joseph’s protocol requires cooling the infant to 33.5 degrees centigrade for 72 hours and then rewarming the baby one half degree per hour. Closely following the protocol is important, says pediatric neurologist Javier Cárdenas, MD. “If you cool for too short a period, you’re not going to arrest the effects of a lack of oxygen. You’ll just postpone the effects. And if you rewarm the patient too quickly, you’ll have the same result.”

Dr. Cárdenas agrees that the goal of hypothermia is to reduce the rate of disability. “When we have a fullterm baby who should have had a normal outcome, but something happens to cause oxygen deprivation, these are the babies we want to save.”

At this point, Zoe Lemieux appears to be an excellent example of the benefits of hypothermia.

Zoe was airlifted to St. Joseph’s just three hours after birth, well within the six-hour window for hypothermia, thanks to Banner Del E. Webb Medical Center’s quick work.

A better chance

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Rather than using a cooling cap to induce hypothermia, specialists at St. Joseph’s used a cooling blanket to achieve total body cooling.

The cooling blanket was fitted into Zoe’s isolette and a blanket put over that. The infant was placed in the isolette, her core temperature constantly monitored by a probe in her esophagus.

After 72 hours at 33.5 degrees, Zoe was gradually rewarmed to a normal body temperature of 37 degrees centigrade.

An MRI done after she was rewarmed was encouraging, says Robert Gutierrez, MD, a neonatologist in St. Joseph’s Neonatal Intensive Care Unit. The scan showed no significant damage to her brain, only tiny stroke marks. “We are optimistic that she may have little if any damage from her difficult start,” he says.

As for Phillip and Nicole, they are grateful for the chance their daughter has been given.

“Doctors said that had she been born five years ago, there’s a good chance she wouldn’t have made it,” says Phillip. “They told us that these babies typically have poor outcomes—cerebral palsy, brain damage, death.”

“We really thought we were going to lose her, and honestly, I don’t think we could have started over if we had,” Nicole says. The couple had three miscarriages before conceiving Zoe. Watching the hypothermia process was difficult, Phillip concedes. “Her arms up to her mid forearm and her legs up to her mid calf were blue. There were tubes and IVs everywhere. It was surreal.”

Still, he has no doubt that hypothermia made all the difference for “our little miracle.”

“I can safely say that hypothermia saved her life.

We have a lot to be thankful for.” ■

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Nicole and Phillip Lemieux say their newborn’s name is very meaningful for them. “Zoe” means “life” in Greek.

The future of hypothermia

Pediatric neurologists Javier Cárdenas, MD, and Stanley Johnson, MD, hope to explore the use of hypothermia in treating children with traumatic brain injuries.

“Hypothermia has the potential to be very beneficial for people who have suffered a traumatic brain injury,” says Dr. Cárdenas. “We may find it beneficial for near-drowning victims, too.

“It’s very exciting to improve an outcome, especially for a child like Zoe, so that she may have a normal life.”

C R A N I O F A C I A L

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by Catherine Menor

craniofacial differences Team gives coordinated care to complex conditions bigail and Evelyn Currence are whirlwinds of activity. They love to draw and color and watch Dora the Explorer on television. And when the kid hit “Yo Gabba Gabba” comes on, they erupt into a frenzy of two-year-old dancing.

The twins seem unfazed by what they’ve been through—multiple procedures and surgeries during their first year and a half. And, if the Barrow Children’s Cleft and Craniofacial Center has its way, Abigail and Evelyn will grow up to be adults who are entirely comfortable with who they are and where they’ve been.

Abigail and Evelyn were born with cleft lip and palate, the most common birth defect of the face. An estimated one in 500 children is born with cleft lip and palate. The defect is more common among Asians and Native Americans and less common among blacks.

All fetuses have clefts, or gaps, in their palates and lips. Normally, these gaps close and fuse early on— lips by five or six weeks after conception, and the palate by about seven weeks. Cleft lip and palate, which experts believe is due to both genetic and environmental factors, occurs when these gaps do not close.

“A lot of diagnoses are being made in utero now, thanks to ultrasounds,” says plastic surgeon Stephen Beals, MD, director of the Barrow Children’s Cleft and Craniofacial Center. “We encourage that because then the parents are more prepared at birth.”

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Keely and Chad Currence were shocked to learn during their fourth month of pregnancy that their twins had cleft lip and palate. “We were devastated,” says Keely, who worked in an obstetrician’s office at the time. “I didn’t work for two weeks because if anyone even looked at me, I would burst into tears.”

Such a reaction is typical, says Dr. Beals, and that’s one reason why the team approach offered by the Barrow Children’s Cleft and Craniofacial Center is so important to the well-being of families touched by this defect.

Grief is a normal reaction

Abigail and Evelyn Currence in October

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The team consists of health professionals from 17 specialties. Core team members include a plastic surgeon, orthodontist, and speech therapist with a psychologist also playing a critical role in most cases.

Team members from other specialties—audiology, counseling, genetics, neuropathology, neuroradiology, neurorehabilitation, neurosurgery, nutrition, ophthalmology, otolaryngology, pediatrics, physical therapy, and social work—participate as needed.

The Currences met with the team before the twins were born. They learned about the treatment their children would likely receive. “This has a huge calming effect on parents and helps them cope with the problem,” says Dr. Beals. “They know they have someone they can call.”

Abigail and Evelyn were born on Nov. 28, 2007. They were eight weeks early and weighed between three and four pounds each. The cleft lip and palate made it impossible for them to nurse normally, so a special bottle was used to feed them.

A child with cleft lip and palate typically undergoes several procedures and surgeries between birth and 21 years of age. These include: • Nasoalveolar molding beginning shortly after birth. This three- to four-month-long process, performed by an orthodontist, moves the segments of the cleft into a more correct position and molds the soft tissue of the nose into a more normal shape. A custom-made molding plate, much like a retainer used in orthodontics, is fixed to the roof of the mouth. Molding is placed inside the nose to lift and shape it, and stents are used to create the columella, the portion of the nose between the nostrils.

• A lip repair typically performed when the child is four to five months old. In this operation, the plastic surgeon closes the gap in the lip.

• A palate repair usually done between nine and 12

Twenty one years of care

Abigail and Evelyn Currence have undergone multiple procedures and surgeries to correct their cleft lip and palate. From the top: January 2008 - Abigail and Evelyn before treatment; March 2008 Evelyn and Abigail begin nasoalveolar molding; July 2008 - Evelyn after her lip repair and Abigail still undergoing nasoalveolar molding; August 2008 Evelyn and Abigail healing from their lip repairs.

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months of age. The plastic surgeon closes the cleft in the palate, or roof of the mouth.

• An alveolar bone graft when the child is six or seven years old. In this procedure, the surgical team, led by the plastic surgeon, removes a piece of bone, usually from the child’s hip, and grafts it into the cleft to give the teeth a stable area to grow into.

• A final lip and nasal reconstruction after the child has reached puberty.

Some children need additional procedures; for instance, about 20 percent of patients need a second palate operation to improve speech before kindergarten, Dr. Beals says.

Abigail and Evelyn have had nasoalveolar molding, a lip repair, and a palate repair, but the twins went through each procedure later than normal. “They were such complicated babies because they were preemies,” explains orthodontist Patricia Glick, DMD. Abigail, whose condition was more severe than her sister’s, had the twin’s last palate repair in January 2009.

Their father, Chad, is very pleased with the results of these procedures. “Their scars are healing really well. Dr. Beals did an amazing job,” he says. In fact, people tell the Currences that they hardly notice the scars at all.

While the physical care of a child with cleft lip and palate is important, “the heart part” is just as important to the child’s ultimate well-being, says Dr. Beals.

“We work with the families and children to help them adjust to living in society with a face is that is different. Kids tease children with facial differences. They ask about it, give them nicknames.”

The Barrow Children’s Cleft and Craniofacial Center offers services to help children develop as normally as possible and to help them and their families deal with the difficulties of having a craniofacial abnormality, such as cleft lip and palate. Speech therapy helps make up for delays in speech and improves speech problems caused by clefts. A psychologist addresses issues of self-image and fitting in. And a nonprofit organization founded by Dr. Beals—the Craniofacial Foundation of Arizona—offers a wide range of services for the “heart part” of healing.

The Craniofacial Foundation of Arizona azcranio.com, provides emotional and finan-

Healing the heart

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Left, Patricia Glick, DMD, treats Maria, a craniofacial patient, in the new orthodontics area of the Barrow Children’s Cleft and Craniofacial Center. Contributions from several benefactors covered the cost of phase one of a facility renovation for the center.

cial support to craniofacial patients and their families, and supports research to improve methods of preventing, diagnosing, and correcting facial abnormalities. The organization sponsors educational programs that increase awareness and acceptance of craniofacial differences, including one program that goes into schools where children with craniofacial differences are being teased. A mentoring program connects patients and their families with specially trained parents of craniofacial patients. And there are several support groups, including one for young adult patients that helps them come to peace with their craniofacial difference.

“They have to finally say to themselves, ‘It’s over, It’s done. I’m okay. I’m going to move on,’” says Dr. Beals of this important step in the healing process.

“Our goal is to help patients reach their potential.”

Abigail and Evelyn Currence have a long road of care ahead, but with people like Dr. Beals and Dr.

Good things ahead

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Key craniofacial team members Deborah Leach, speech therapist, Stephen Beals, MD, plastic surgeon; and Patricia Glick, DMD, orthodontist, admire the renovated lobby of the new center.

Glick behind them, the odds for a healthy, happy life are good. “I love these kids. I just adore them,” says Dr. Glick. “There’s just some specialness about patients who face life’s challenges.”

Dr. Beals has been dedicated to caring for craniofacial kids since he was in his surgical residency. When he moved to Phoenix in 1986, he was the only surgeon in the Valley with craniofacial training.

“I find it extremely rewarding because it makes such a drastic change in their lives.

A relatively small procedure can be truly lifechanging.” ■

Help finish the new center for children with craniofacial differences. Call 602-406-3041 for more information.

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A beautiful home, thanks to donors

On November 2, the Barrow Children’s Cleft and Craniofacial Center opened phase one of a renovation project on the third floor of the Children’s Health Center at 124 W. Thomas Road on the St. Joseph’s Hospital and Medical Center campus.

“This is like moving to the Taj Mahal—clean and bright and modern,” says Patricia Glick, DMD, orthodontist.

The new area houses the orthodontics part of the program and features a digital x-ray room, two exam rooms, a three-chair treatment area, offices, and a lab for making dental devices.

Speech therapy, psychology, plastic surgery, and others in the program have offices in an adjoining area that badly needs remodeling. That area is the target of phase two of the project.

The new facility is a big step forward in reaching the center’s goal of providing families coordinated care with the least stress possible. With the core team now together, families can receive most of the care their children need in one location instead of several.

Generous contributions from Guy and Stephanie Inzalaco, John Dawson, Rusty Lyon, and Shawn Green financed the $700,000 cost of phase one of the project. An additional $400,000 is needed for phase two.

The Barrow Children’s Cleft and Craniofacial Center is the only comprehensive program of its kind in the Southwest. The center cares for about 6,400 children, ages zero-21, with patients coming from parts of Utah, Colorado, New Mexico, and Texas.

Arizona has three other cleft programs—in Yuma, Flagstaff, and Tucson—but the Barrow program is the only one to provide care for more complicated craniofacial disorders, as well as clefts. About two thirds of patients in the Barrow program have clefts; one third have craniofacial deformities.

For information on how you can contribute to this project, call Barrow Neurological Foundation at 602-406-3041.

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why i give Harold and Jean Grossman Israeli Fellowship Program honors late husband and the man who helped him

by Catherine Menor ean Grossman has made a gift to establish and endow the Harold and Jean Grossman Israeli Fellowship Program at Barrow Neurological Institute. It is a gift that brings together two entities near and dear to her heart—Israel and Barrow Neurological Institute—and that honors both her late husband and the man who helped him for many years, Abraham Lieberman, MD, the director of the Muhammad Ali Parkinson Center and Movement Disorders Clinic (MAPC-MDC).

The Harold and Jean Grossman Israeli Fellowship Program will enable a neurologist from Israel to come to Barrow to teach and work in the MAPC-MDC. “The idea of connecting Israel, which is so dear to me and my family and everyone I know, to Barrow seemed like a wonderful opportunity,” says Jean.

The program will encourage research collaborations. It will give Barrow and Israeli movement disorder specialists the opportunity to share ideas about diagnosis and treatment. And, ultimately, it will improve care for patients.

Jean’s husband was diagnosed with Parkinson’s disease in 1995. Dr. Lieberman cared for him until his death in 2005.

Although Parkinson’s ravaged his body, it did not destroy the generous, loving, and giving spirit that made her husband so special, says Jean.

“He was very dedicated to giving back to the community,” she says. “He was very active in many

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community causes in Minneapolis and here until he became ill. He really enjoyed raising money for causes he believed in.”

Jean was born in Sioux City, Iowa. By the time she was a teenager, she was well on her way to becoming a “professional volunteer.” World War II was raging, and she and her friends spent their free time raising money for soldiers and veterans.

“I was on the street corner every weekend with a tin can for veterans,” Jean says.

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She met Harold during her first week of college at the University of Minnesota. He was the president of his fraternity, a fun-loving young man who sometimes neglected his studies but never the people around him. They married three years later in 1948.

They had very little at first.

“We started out in a little rented apartment in a terrible section of town,” Jean says. Then, when she was pregnant with their first child, he rented a double bungalow for $94 a month. “I cried. I didn’t know how we were going to afford it.”

Harold ended up going into the “He lived a terrific life. automobile busiHe did everything with ness in Mingreat gusto.” neapolis with his brother, and the Jean Grossman Grossmans of her late husband, Harold thrived. He volunteered for numerous non-profits, including the American Cancer Society and the Jewish Federation. Jean also became very involved in the community, even founding what was to become the world’s biggest garage sale.

The fundraiser, which benefited the American Cancer Society, began in the Grossman’s garage.

Garage sales were fairly new at that time, Jean says, and she was shocked when she rolled up her garage door on the first morning of the sale to find a huge crowd of shoppers .

By the third year, the American Cancer Society Garage Sale had outgrown the Grossman garage and moved into an empty building provided by a local business at no cost. Other businesses donated delivery trucks, food, advertising, and coffee to the megasale.

In its first 36 years, the sale raised $8 million. “It was such hard work, but it was so much fun,” Jean says. “I still have friends I met through that event, and they are my dearest, best friends.”

Eventually, Harold and his brother invested in a real estate development in Arizona, and Jean flew to Arizona for the first time. It was July 1973, and she was not impressed.

Ironically, Jean ended up liking her new second home so well that she didn’t want to return to Minnesota. “I’m not going back to that white frozen tundra,” she told her husband.

But the two continued traveling back and forth until Harold retired in 1981. In Phoenix, he served on the board of the Heard Museum. Both were involved in the American Cancer Society and the Jewish Fed-

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eration. He loved playing golf and tennis, and the couple traveled extensively.

Then came the diagnosis of Parkinson’s disease.

At the time, he didn’t seem ill, Jean says. But gradually, the disease took its toll, and they were forced to give up their home in 2002 and move into an assisted living apartment.

Throughout those years, Dr. Lieberman stayed in close touch, always willing to answer a question, help with a problem, or make a visit to their home.

“Dr. Lieberman was so wonderful,” Jean says.

“Something would come up and I wouldn’t know what to do. More than once, the phone would ring, and it would be Dr. Lieberman checking up on us.”

Harold dealt with Parkinson’s with strength, Jean says. “All the time he had Parkinson’s disease, he never said, ‘Why me?’ He never complained. “ After his death, Jean found a slip of paper in his wallet. On it were written these lines: I shall pass through this world but once.

If there be any kindness I can show or any good thing I can do, Let me do it now; let me not defer it, or neglect it for I shall not pass this way again.

She had carried the same verse in her purse for years and had even given each of their three children a plaque inscribed with those words.

“Our minds were in the same place,” she says. “I’ve had a great life because I had a great husband.” ■

Abraham Lieberman, MD, director of the Muhammad Ali Parkinson Center and Movement Disorders Clinic

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volker sonntag, md Barrow icon retires in December after 31 years of service

by Sarah Padilla olker K.H. Sonntag, MD, has held many positions over the years, ranging from a Jack in the Box fry cook to a chicken farmer to one of the most accomplished neurosurgeons in the world.

Come next year, he will have a new title— retiree.

In mid-November, Dr. Sonntag performed the final surgery of literally thousands during his more than 31-year neurosurgical career. He will stop seeing patients in mid-December, when his fellow will take over to wrap things up for a few months.

Those who know Dr. Sonntag best say he’s hinted at retirement for some time, but it was a combination of factors—such as celebrating his 65th birthday in November and seeing his youngest son off to college this fall—that helped him decide that 2009 would be the year. Another factor: He’s worked, and worked hard, since the age of 12.

“Ever since I stepped off the boat in 1957, I’ve worked,” reflects Dr. Sonntag. “But it’s been a terrific ride, with lots of ups and some downs.”

The boat he refers to is the vessel that brought a young Volker K.H. Sonntag and his refugee family to the United States from Germany for the beginning of what would become a real-life rags-to-riches story. It’s the story of a teenager who would learn English by watching the Mickey Mouse Club on TV and who would put himself through school by working odd jobs, eventually graduating as president of his medical school class and becoming a pioneer in the field of spinal surgery.

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Left, Dr. Sonntag with his wife, Lynne, and two colleagues on the annual Hike from Hell; below center, a younger Dr. Sonntag with patient Tim Mathias; below right, Dr. Sonntag outside a surgery suite.

Forever modest, Dr. Sonntag attributes much of his success to being in the right place at the right time.

He was operating a busy private practice covering five hospitals in the greater Phoenix area when Robert Spetzler, MD, recruited him to help form Barrow Neurosurgical Associates in 1983. The rest, as they say, is history.

Dr. Sonntag discovered a passion for spine and has since contributed significantly to the understanding of spinal disorders. He has written 500 professional articles, co-edited six major textbooks, authored more than 90 textbook chapters, and made 900 presentations throughout the world. He has been involved in the development of spine instrumentation (the use of rods, plates, and other devices in surgery) and played a major role in the shift of spinal surgery from a mainly orthopedic practice to the field of neurosurgery.

“Instrumentation of the spine was nearly unheard of 10 to 15 years ago. There has been a total paradigm shift,” he says.

“Dr. Sonntag has led and developed an incredibly strong spinal team at Barrow, which has become a place that people seek out for the most complex spinal cases,” says Dr. Spetzler, director of Barrow.

“Although we will miss him terribly, we will continue to benefit from all of the wisdom that he has accrued.”

Dr. Sonntag also discovered a passion for teaching

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young physicians, and he has served as director of the Neurosurgery Residency Program since 1995. Barrow currently has the largest program in the country and one of the most sought after, with 24 active residents.

Since Dr. Sonntag first came on board in 1983, Barrow has trained 138 residents and fellows. Today nearly half of them serve in academic positions.

“I’ve been fortunate to have contributed to the education of such a phenomenal group of residents and fellows, some of which are becoming chairs themselves now. It’s a very satisfying feeling,” he says.

Chief Resident Kumar Kakarla, MD, knew after meeting Dr. Sonntag during a medical school rotation at Barrow many years ago that this was where he belonged.

Today, Dr. Kakarla is pursuing a career in spine largely because of Dr. Sonntag.

“I feel fortunate that I’ve been able to learn from a master and to have witnessed so many breakthroughs in spine at Barrow,” he says. “Dr. Sonntag is a very generous and humble man, and he considers everyone equal. He’s more than a teacher; he’s like a father figure.

His retirement will be a tremendous loss for the residency program.”

In fact, one of the things that Dr. Sonntag says he’ll miss the most is the collegiality between Barrow’s residents and the attendings—something that is relatively unique to Barrow and that he has helped foster through emphasizing that residents are equal colleagues.

He has also been a key player in creating the “work hard, play hard” atmosphere that brings many staff members together after hours and on weekends for regular volleyball games, grueling hikes through the Grand Canyon, the annual Barrow Olympics, and other activities.

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Right, Dr. Sonntag during teaching rounds; below right, Dr. Sonntag with his wife, Lynne; below left, Dr. Sonntag and Dr. Spetzler at their joint 60th birthday celebration.

Future residents, no doubt, will hear stories about Dr. Sonntag’s contributions to neurosurgery.

But they’ll also hear stories about what kind of a person he is—a person that residents refer to as a second dad and a person that Dr. Spetzler refers to as his irreplaceable right-hand man.

They will hear stories about how Dr. Sonntag was able to find a balance between work and family and how he has always said that the three most important things in life are family, patient care, and educating residents and fellows. In fact, he considers his greatest accomplishments to be his 36-year marriage to his wife, Lynne, raising three children, and coaching their soccer teams for 16 years. None of it would have been possible, he says, without their “phenomenal support.”

So, what now? At the top of Dr. Sonntag’s post-retirement list is traveling with his wife. They plan to visit Antarctica and to spend time in California, where two of their children now live. Ironically, the first few months of next year are already booked solid with speaking engagements and visiting professorships.

He has also tossed around the idea of writing an autobiography, acknowledging that his journey to the top has been somewhat unusual. There’s no question that Dr. Sonntag has made a place for himself in the pages of history. What remains to be seen is what the next chapter brings. ■

Dr. Sonntag’s legacy

Given that he has been a Barrow icon for more than 30 years, Dr. Sonntag won’t soon be forgotten.

In fact, his legacy will be honored through at least two separate efforts.

First, the Alumni Spine Chair, an endowed chair that was established to honor Dr. Sonntag several years ago, will be renamed the Volker Sonntag Alumni Spine Chair. Endowed chairs enable nationally recognized physicians and scientists to pursue research and run laboratories, thus insuring continuous scientific contributions within a specialty area.

Also, early next year, a new educational pavilion will be designated the Sonntag Educational Pavilion. The proposed structure will be located outside the entry to the Marley Lobby and will provide much-needed additional space for large events, such as conferences, that are held in the Goldman Auditorium. A special event to dedicate the area and honor Dr. Sonntag is being planned for March 2010.

If you would like to honor Dr. Sonntag, please consider contributing to the fund for the Sonntag Educational Pavilion. For more information, contact Barrow Neurological Foundation at 602-4063041.

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st. joseph’s amazing Patient stories from the files of Barrow Neurological Institute Catherine Kozuch

by Melissa Morrison hat should have been a college student’s Mexican vacation ended with Catherine Kozuch helicoptered to St. Joseph’s Hospital for emergency spinal surgery so she might walk again.

Kozuch was vacationing in Rocky Point with friends in April 2008. The dune buggy she was in careened around a sharp turn, flipping five times before landing upright and slamming her onto the seat at a force of 65 mph. “I remember not being able to breathe, I was just so winded,” she says. She also remembers getting out of the dune buggy by herself.

That would be the last time she walked for nearly three months. When the doctor at a Mexican hospital asked her to move her foot, she couldn’t.

The next day, the ASU sophomore, then 19, was transported by air ambulance to St. Joseph’s Hospital and Medical Center, where she immediately underwent surgery. Nicholas Theodore, MD, removed the fragments of the two thoracic vertebrae that had shattered into her spinal cord.

“There is not much room for error,” says Dr. Theodore, director of the Neurotrauma Program at Barrow Neurological Institute. “The thoracic vertebrae are where the spinal cord is smallest, and there’s not a lot of collateral blood supply, so just a little bit of pressure can paralyze you permanently.”

It is also a very small area in which to stabilize the repairs, so for the most precision the team used the computer-aided surgery for which Barrow has become known. “We literally got a CAT scan in surgery, and used real-time image guidance to put screws in,” the neurosurgeon says.

Still, it was not certain that Kozuch would ever walk again. “In most patients with a thoracic spinal cord injury, they don’t usually get better,” Dr. Theodore says.

He did not tell Kozuch that, however. “My philosophy is to withhold any judgment on making predictions like that because I think when we do, it becomes a self-fulfilling prophecy.”

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Kozuch’s will was formidable. “I never pictured myself in a wheelchair,” she says.

The fateful moment occurred about one month into her ordeal. She focused on her motionless foot, willing it to respond. “I was staring at one of my big toes, saying, ‘Big toe, move. Big toe, move.’ Then my big toe moved the tiniest bit, and I got so happy! … I thought, if my brain can get messages there, I’m going to be okay.”

As the days passed, function began returning to her legs. “All of a sudden my ankle started moving a little bit, the back of my knee started moving a little bit, then my whole left leg started to move,” she says.

Over two months later, on June 14, Kozuch, aided by a walker, was able to walk out of the hospital. She still has a limp and a scar from her ordeal, but has ditched the walker. And she continues to progress.

“Right now I can’t run or wear high heels,” says Kozuch, who is back at ASU, where she is majoring in communications. “I have a pair of high heels by the front door of my bedroom, and every time I walk out the door I say, ‘I’ll be wearing you some day …” ■

Jesse Cook

by Carmelle Malkovich

esse Cook has returned home to Simi Valley, California, after a frightening brush with a nearly inoperable brain abnormality.

“We were told that the type of lesion Jesse had was extremely uncommon for his age and surgery was next to impossible,” says Jesse’s mom, Ann Marie.

“We were prepared for the worst-case scenario and are grateful to Barrow.”

Jesse first noticed symptoms in September when he came down with a stomach virus and complained of excruciating pain in his left arm. His parents took him to an emergency department where he lost feeling in all his extremities. He was paralyzed for nearly 15 hours and had limited function in his arm for six weeks. Doctors diagnosed an arteriovenous malformation (AVM), a rare neurological disorder that causes abnormal tangles of arteries and veins in the spine.

He was sent to Children’s Hospital Los Angeles.

Once at Children’s, Jesse’s team of neurosurgeons detected the complexity of the AVM and referred him to Barrow for treatment. Barrow doctors found that Jesse’s AVM was even more severe than originally believed. The AVM was feeding blood into his spinal cord, increasing his risk for paralysis.

Jesse underwent complex surgery in November at Barrow. Robert Spetzler, MD, director of Barrow, and Felipe Albuquerque, MD, who are experts in the treatment of AVM, led the surgical team, giving Jesse the best chance for a positive outcome.

Without surgery, Jesse had a high chance of becoming a quadriplegic. Because of the location and complexity of Jesse’s AVM, the surgery itself had risks for paraplegia. The neurosurgeons were able to completely remove Jesse’s malformation.

“Jesse’s AVM was very rare and was one of the most difficult cases we’ve handled,” says Dr. Spetzler. “I’m pleased that his surgery was very successful and his prognosis is excellent.”

“We were told by so many people how risky my surgery would be that I was shocked when I woke up after surgery and learned that I didn’t have any bad deficits,” says Jesse. “I’m very thankful.”

After his surgery, Jesse was looking forward to returning home to see his friends and siblings.

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When not in therapy, he stayed Pediatrac physical therapist Holly busy drafting football plays and Wilson works with Jesse Cook in asking hospital staff to sign his the Deborah and Bruce Downey football. Although he may never Neuro Rehabilitation Center at be able to play football again, he Barrow. has big dreams of becoming an attorney to negotiate player contracts.

“Words cannot describe how grateful I am,” says Ann Marie. “My son has a chance to be successful one day because of Dr. Spetzler and Barrow.” ■

Larry Pinson

by Catherine Menor

n the spring of 2009, Larry and Lennelle Pinson of Tulsa, Okla., were facing a crisis. Larry was scheduled to fly to Phoenix for spine surgery at Barrow Neurological Institute. The ex-Marine, who’d always been strong, a model for his six sons, was frightened that he would never be the same.

“What if I come back paralyzed?” he asked Lennelle.

“Give me that phone. I’m going to cancel my surgery.”

Larry’s health problems had begun a year earlier with back pain. A chiropractor discovered the tumor.

It was in a bad place—at the end of Larry’s spinal

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cord where all the nerves travel down to the legs.

Larry consulted several neurosurgeons. One told him, “I’ve never done a surgery like that, but I’ll try.

There might be a 50 percent chance of paralysis.”

Larry didn’t like those odds. He decided to live with his condition. But his symptoms worsened. He had numbness in his legs, difficulty walking. Sheer will was not working.

“I’m going to pray to God to send a surgeon to me,”

he told Lennelle one day. Later that day, they ran into a friend who is an anesthesiologist. He asked about Larry’s limp and asked them to send him Larry’s MRI. He said he’d take it to the best neurosurgeon in Oklahoma.

The neurosurgeon looked at Larry’s MRI and ordered other tests. He told the Pinsons, “If my brother had this, I wouldn’t operate on him. I would send him to Dr. Robert Spetzler.” He sent Larry’s information to Barrow on February 12, 2009.

Soon Larry and Lennelle were in contact with Barrow, and surgery was scheduled for April 7. Larry cancelled. Surgery was rescheduled for April 28, and

Lennelle and Larry Pinson visit with Michele Ellis during Larry’s last day at Barrow.

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Larry cancelled again.

“I was struggling with the fact that I didn’t know anything about this institution, and I had all these horror stories in my mind. I thought I would be paralyzed, that I would lose control of my bowels and bladder, that I might have problems walking,” Larry says.

Lennelle had a good feeling about Barrow. “I did extensive research about Dr. Spetzler,” she says. “I went on the Internet and read all the testimonials, and I saw he was the director of this institute. I felt like God had led us to this place because we knew nothing about Barrow or Dr. Spetzler.”

Larry set a new date for surgery: June 9. But as the day approached, Larry grew more and more anxious.

The morning of their flight, Larry was agitated. “I don’t think I’m going to go,” he told Lennelle. “I think I’m just going to live with it.”

“If you do not go to that surgery, I will never talk to you again,” Lennelle told him.

It was the push Larry needed. Friends and relatives across the country and in the Virgin Islands, where Lennelle is from, were praying for Larry when he was wheeled into a Barrow surgery suite on June 9. Four hours later it was over. The tumor had been removed.

On June 12, a Friday, the Pinsons were preparing to go home. Michele Ellis, who’d scheduled and rescheduled Larry, dropped by to say goodbye to her problem patient, as did Risa Maruyama, a physical therapist, Dr. Spetzler, and other members of the surgical team.

“I’ve enjoyed working with this guy,” said Maruyama. “He’s an ex-Marine, so he’s a hard worker, a tough guy. We’ve had to put limits on him because he overdoes it and then pays for it. He has always taken care of everyone else in his family, and now he needs to take care of himself so he can be there for everyone.”

The smiles on Larry and Lennelle’s faces were reward enough for everyone there. ■

by Sally Clasen

roy patchell, md New neurology chair looks at broad picture, continues significant neuro-oncology research—and keeps on pickin’ oy A. Patchell, MD, the new chair of neurology at Barrow Neurological Institute, did not always want to be a cancer researcher or even a medical doctor. As an undergraduate student at the University of Kentucky (UK), he earned a degree in philosophy but abandoned that pursuit because he “grew tired of arguing about abstractions.”

Changing direction, he earned a medical degree from UK and then did a residency in neurology at Johns Hopkins University. Along the way, he found

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a passion for neuro-oncology and completed a fellowship in that discipline at Memorial Sloan-Kettering Cancer Center in New York City.

For over 20 years, Dr. Patchell’s research focus has been on understanding and treating metastatic tumors—cancers that migrate from one site in the body to another—especially those that spread throughout the nervous system. Internationally recognized for establishing the standard of care for cancers that have metastasized to the nervous system, Dr. Patchell’s clinical trials have led to significant improvements in B A R R O W

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the outcomes and quality of life for individuals who are often given a terminal diagnosis. Because metastatic brain tumors outnumber primary brain tumors 10 to 1, his research efforts have had a wide-ranging impact in the neuro-oncology field.

Pursuing excellence in patient care and research

Before joining Barrow in June 2009, Dr. Patchell was a professor of neurology and neurosurgery at the University of Kentucky. In his role as neurology chair at Barrow, he provides strategic direction for the department and its subdivisions.

“I am looking at the big picture in this position, which is something a little different from what I have done in the past. I do not plan on making sweeping changes right away; Barrow is already a world-class institution. What is needed is a realignment so that the department of neurology is more in sync with the programs of excellence that already exist in the department of neurosurgery and other areas of Barrow,“ Dr Patchell says.

He recognizes that the downturn in the economy will make his duties more challenging. “We are facing tough financial times that have forced changes in healthcare reimbursement and research funding. This has made philanthropy an even more important part of the total picture. The trick is to stay afloat financially while continuing to expand and pursue excellence in patient care and research,” he says.

While administrative duties are his main responsibility, Dr. Patchell is treating patients as well as mentoring residents, experiences that he enjoys.

“After 20 years of being primarily a neuro-oncologist, I am having a good time getting back to basic clinical neurology. It is actually one of my favorite parts of the job. There is just a certain satisfaction that you get from diagnosing and taking care of complicated patients that you can never get sitting in a budget meeting.”

He also is back on the investigative trail and is developing a new clinical trial that will combine the unique skills of Barrow neurosurgeons, radiation oncologists, neuropsychologists, and neuro-oncologists.

A controversy exists whether radiation should be given to patients with metastatic brain tumors after they have been treated with surgery or radiosurgery.

An earlier clinical trial done by Dr. Patchell (and

Research calls

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published in the New England Journal of Medicine) showed that surgery plus radiation was better than radiation alone. A second landmark randomized study by Dr. Patchell, published in the Journal of the American Medical Association, demonstrated that the addition of radiation reduces tumor recurrence after surgery but does not usually result in an increase in survival. It is known that both tumor recurrence and radiation can each affect memory and reasoning ability.

The new study will determine the value of radiation by measuring specifically its impact on quality of life and cognition. “The real question is whether the known beneficial effects of radiation are cancelled out by possible negative side effects, especially those that interfere with memory and the ability to think clearly,” Dr. Patchell explains. “It is really an uncharted area of investigation.”

Despite a recent move across the country, a broader job scope, and getting used to the desert climate, Dr. Patchell has not abandoned another passion: his love for music. He plays more than 20 different musical instrum e n t s , including the banjo, one of which he Dr. Patchell plays 20 different musical keeps in his instruments, including this banjo. office.

“It helps me unwind,” he says. In fact, a visit or call to his office may result in a pickin’ session. “I guess I am just perpetuating a Kentucky stereotype here in Phoenix,” he says with a southern laugh. ■

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a new perspective on life One student’s school essay about her experience at Barrow

by Courtney Basham

ver since my major back surgery, I have seen life in a totally new way. It used to be gray and dreary, full of pain, and I dreaded doing the easiest of things. This experience has humbled me and made me proud because it’s changed me as a person in so many positive ways. Not only has it renewed me on the outside, but on the inside as well. Some things that I used to think or do have taken a 180 degree turn, and now I see the bright side of things and I try to find the positive in every situation that I am confronted with. My life is now bright and sunny, and looks forward to the future.

I remember not wanting to get out of bed in the mornings because I knew I would be in pain from the first couple steps I took. I feared just having to walk.

I would lay there and remember what it feels like when the pain would shoot down my leg like streaming water and my leg would go completely numb. I was in so much pain I felt life had nothing to offer me and there was no reason for me to be. My personal experience has given me hope and faith for every new day.

Before my surgical procedure, I went to a lot of places to figure out what was wrong with me and why I was in pain all of the time. I went to one place where they took a bunch of x-rays and MRIs to see what was going wrong with my spine. They pretty much threw my images away, sat me down and said, “You’re just going to have to live with this for the rest of your life.” That was probably the most upsetting day of my life. I told my mother, “I am not going to let this get in the way of my future and my goals and I am going to find an answer!” She stuck right beside me.

A friend told us about a place called Barrow Neurological Institute. We were a little hesitant about it at first but we knew it wouldn’t hurt anything to try it out. I met my soon to be life saver Dr. Ruth Bristol and the first day I was there she pretty much told me that I was a candidate for surgery and assured me that I didn’t have to live like this for the rest of my life. I was so excited! We scheduled a date for surgery and I told everyone about my wonderful news.

After my operation I was nearly pain free and after I healed I began to enjoy the simplest of things like walking for a drawn out distance, taking a long hot shower, sitting with my family at the dinner

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table, swimming, and going on family vacations. My biggest realization was how this surgery and pain free life also changed my family and my relationships. I did not notice how my pain affected my attitude and how my attitude affected my relationships. My family also became pain free because I was no longer “The Pain.” I enjoy life, especially all the things I can now do for others.

Having had this experience, I have realized that I want to be a nurse and give back to others who have wishes and need to be heard and understood like I was. I want to assure people that it will be alright and to be strong, and keep pushing on and to never take no for an answer. ■

A note from Ruth Bristol, MD, Courtney’s surgeon: Courtney had a right-sided lumbar disk herniation between the fourth and fifth lumbar vertebrae. This results in back and leg pain. Some disks will resolve with time and conservative therapy.

Courtney had already been through many modalities of conservative therapy without relief. We treated her by doing a microdiskectomy at that level. In short, you make a small window in the bone of the back of the spine and take out the herniated disk fragments. I also tried to educate her about keeping her back healthy: doing core strengthening, lifting properly, and maintaining a healthy weight.

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B R I E F S

benefactor briefs Ladies Auxiliary VFW contributes to Barrow brain tumor research

In August, Dixie Hild, then national president of the Ladies Auxiliary VFW, presented $50,000 to Barrow Neurological Foundation for brain tumor research during the group’s 95th national convention in Phoenix.

Hild's aunt waged her own battle with brain cancer, and Hild was so impressed with the level of care she received at Barrow that she wanted to further Barrow’s advances in ending this disease.

Receiving the donation were Kathy Kramer, vice president of leadership gifts at Barrow Neurological Foundation, and Burt Feuerstein, MD, PhD, a Barrow neuro-oncology researcher who talked about major advances in brain tumor treatment.

The Ladies Auxiliary VFW raised $2.6 million in 2008-2009. Each state receives back a portion of its donations to present to cancer research facilities in that state. Members who are undergoing cancer treatment can also qualify to receive financial assistance.

In addition to waging a war on cancer, Ladies Auxiliary VFW members strive to support veterans, active-

Spirit of Giving winners announced

Nancy and Lee Hanley, and Charlene “Pinky” Harris received Spirit of Philanthropy Awards during the 25th Annual Philanthropy Leadership Awards Dinner sponsored by the Association of Fundraising Professionals-Greater Arizona Chapter on Nov. 18, at the Downtown Sheraton Hotel.

The Hanleys have made major contributions to Barrow through their support of the Marguerite Clark Hobbs Ruptured Aneurysm Trial and the Center for Adaptive Brain Function. Nancy is a member of the Barrow Women’s Board, and Lee belongs to the Board of Trustees of Barrow Neurological Foundation.

Harris has made significant gifts to the Children’s Health Center at St. Joseph’s. A retired nurse, she worked in the operating room at St. Joseph’s from 1954 until 1958.

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VFW president Dixie Hild, middle, presents a check for $50,000 to Kathy Kramer and Burt Feuerstein, MD, PhD.

duty soldiers, and their families, as well as serving their communities in numerous ways.

Go to ladiesauxvfw.org for more information about the organization.

Family establishes fund in memory of husband, father

The James R. Reynolds Memorial Fund for Brain Aneurysm Research has been established at Barrow to honor James Reynolds of Maple Grove, Minnesota, who died in March. He was 48.

James’ health problems began seven years ago when he had a series of strokes because of a brain aneurysm. He recovered, but the aneurysm continued to grow. His neurosurgeon referred him to Robert Spetzler, MD, five years ago for surgery.

“We got five extra years,” says Kris Reynolds, James’ wife. “He got to see our three kids through high school.

He was a very outgoing, involved-in-everything, muchloved person.”

Fifteen hundred people attended Jim’s funeral in Maple Grove, a suburb of Minneapolis. Memorial gifts were directed to Barrow’s neurological and endovascular research and the neurological ICU nursing program as “a thank you from Jimmy for his loving care.”

“They were so wonderful,” Kris says of the Barrow staff. “They helped ease some of the burden, as enormous as it was. They kept him as comfortable as they could. They were very patient with me as well.”

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2010 Barrow Grand Ball set for January 16 at Arizona Biltmore

The 2010 Barrow Grand Ball will be held Saturday, Jan. 16, in the Arizona Biltmore Grand Ballroom. Now in its 45th year, the blacktie dinner and dance has raised about $36 million for Barrow Neurological Institute, making it the institute’s largest benefactor. It is one of the most prestigious charitable events in Arizona.

Co-chairs of the 2010 Barrow Grand Ball are Sandy and Mac Magruder at the Ann Denk and Ardie 2009 Barrow Grand Ball Evans. For more information, call Barrow Neurological Foundation at 602406-3041.

Learn about the latest advances at Barrow during Education Day

The Barrow Women’s Board will present Education Day on Thursday, Feb. 11. The half-day event will feature a continental breakfast in the Marley Lobby and presentations in the GoldmanAuditorium on the latest at Barrow Neurological Institute: • Exploring New Frontiers in Depression, Dementia, and Aging Through Neuroimaging, Leslie C. Baxter, PhD, staff scientist and clinical neuropsychologist • B.R.A.I.N.S. (Barrow Resource forAcquired Injury to the Nervous System), Javier F. Cárdenas, MD, pediatric neurologist • International Patients and Global Engagement, Nicholas Theodore, MD, neurosurgeon, and Jaime Chico of Mexico • What’s New in Neurosurgery? Robert F. Spetzler, MD, director of BarrowNeurological Institute.

Co-chairs are Sandy Magruder and Nancy Walker. To reserve your spot at Education Day, call the Barrow Neurological Foundation RSVP line at 602-4063040.

Robert Spetzler, MD, will be one of the speakers at 2010 Education Day, presented by the Barrow Women’s Board.

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Dennis and Nancy Sage, and Mike and Karin Hertzel at the 2009 LGFFG

Great cause, great golf, great grub It’s Lou Grubb Friends Fore Golf!

On April 22 and 23, Lou Grubb Friends Fore Golf will celebrate great golf, great grub, and great friends... all for a great cause.

The fundraiser, now in its 37th year, kicks off on the evening of Thursday, April 22, with a cocktail party, dinner, party putt competition, and silent and live auctions at the Scottsdale Plaza Resort.

The next day, golfers will meet for lunch and warmup activities, and then hit the links for an 18-hole golf tournament at McCormick Ranch Golf Club. A dinner and awards ceremony will immediately follow the tournament.

Lou Grubb Friends Fore Golf benefits Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center. The charity event, one of the most popular in the Valley, is Lou Grubb’s way of thanking the hospital and Robert Spetzler, MD, for the life-saving care he received after suffering a ruptured aneurysm in 1986.

Golf committee members are Greg Anderson, L. Don Brown, Scottie Button, Wayne S. Doran, Hamilton Espinosa, Booker T. Evans, Lou Grubb, Cassandra Groh, William Hunt, Stuart Kirk, Roger Maxwell, Mike Medici, Joshua Miller, Loui Olivas, Anne Robbs, Lee Rosenthal, Tom Reahard, Dennis Sage, Dennis Scully, Julie Alvarado, and Mary Jane Crist.

For information on attending this year’s golf extravaganza and/or being a sponsor, please contact the Foundation Office at 602-406-3041, Monday-Friday, 8 a.m.-5 p.m.

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U P D A T E

research update Barrow researchers identify new brain receptor, possible target for Alzheimer’s disease treatment

Barrow researchers have identified a novel receptor in the brain that is extremely sensitive to beta-amyloid peptide (AB) and that may play a key role in early stages of Alzheimer’s disease. Published in the Journal of Neuroscience, the research, led by Jie Wu, MD, PhD, has identified a new candidate for therapeutic intervention in Alzheimer’s.

The novel receptor was found in the basal forebrain, an area of the brain that plays a critical role in memory and learning, and that is one of the first areas of the brain to degenerate with Alzheimer’s. That degeneration is associated with losses of the chemical messenger acetylcholine and some of the molecules that translate acetylcholine’s messages, called nicotinic receptors. The forming of large aggregates, or plaques, of AB also is a hallmark of Alzheimer’s disease. While these two features have been under examination in Alzheimer’s research, it is not clear how they interrelate.

Dr. Wu and his colleagues made the unexpected find during a study examining the effects of AB on basal forebrain nicotinic receptors. They first found that acetylcholine signaling at those receptors was highly sensitive to blockage even by low levels of AB. They also found that AB as small aggregates—and not large plaques of AB—had this same blocking effect. They next found that the type of nicotinic receptors showing this high sensitivity to AB has a different composition than

other nicotinic receptor types previously identified and shown to be less sensitive to AB. “We now believe that most of the nicotinic receptors in the basal forebrain have this unique composition and high sensitivity to AB,” says Dr. Wu. “Our Jie Wu, MD, PhD hypothesis is that as AB begins to increase, it first blocks acetylcholine signaling at these receptors, perhaps triggering events that eventually lead to neurodegeneration.”

“This is the first time that AB has been proven to block acetylcholine at a concentration that occurs in Alzheimer’s brain and thus could be pathologically relevant,” says Ron Lukas, PhD, who was part of the Barrow research team. “We also helped to implicate small aggregates of AB as being pathologically relevant.

“If we can identify a drug that would selectively keep the unique forebrain nicotinic receptors active even in the presence of AB or block the effects of AB on those receptors, then we might be able to stave off the early steps in the Alzheimer’s disease process,” says Dr. Lukas.

St. Joseph’s selected to be nation’s only location for genetic test

St. Joseph’s has partnered with Castle Biosciences, Inc., to provide the nation’s first genomics-based test for patients suffering from glioblastoma multiforme, the most deadly form of primary brain cancer. The new test is used to help doctors and patients consider different treatment options.

Castle Biosciences chose St. Joseph’s DNA Diagnostics Lab as the sole location to perform this test following an extensive review process. The Greater Phoenix Economic Council facilitated key connections that led to the agreement between St. Joseph’s and Castle Biosciences. Physicians from across the country have

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begun sending cases to Castle for DecisionDX-GBM testing to be run in St. Joseph’s DNA Diagnostics Lab. This molecular diagnostic test can tell a doctor if the tumor is likely to be sensitive or resistant to the standard first-line treatment, thus saving precious time should the tumor be resistant.

The DNA Diagnostics Laboratory is making personalized medicine, based on genomics, possible, says John Stone, PhD, director. “Our offering this test is a prime example of translational genomics closing the loop between the research lab and the clinic.”

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Partnership with Arizona Science Center will expose students, teachers, public to new research

The Arizona Science Center has received a $1.2-million grant from the National Institutes of Health to explore new ways to educate families, students and teachers about advances and research in the bioscience field.

The five-year program will give students and the general public a glimpse into the human body, its parts and processes, and new advances in biomedical research and technology. Called Framing New Pathways to Medical Discovery for Families, Students and Teachers, the project was developed in partnership with scientists at several research institutes in Arizona.

This partnership with Barrow Neurological Institute, the Translational Genomics Research Institute, Arizona State University, and the University of Arizona will expose students, educators, and the public to cutting-edge research through course curriculum and permanent exhibits at the Science Center, according to Shawna Fletcher, project manager of the Pathways project.

U P D A T E

“The project will bring to the forefront current bioscience techniques, involve interactions with leading researchers, and highlight how Adrienne Scheck, PhD local industry is focused on improving the lives of people living in Arizona,” she said.

Adrienne Scheck, principal investigator at Barrow, said the program will put advanced technology in front of students and their families. She will serve as senior research scientist and oversee the development of biomedical research content.

“Biotechnology has become an integral part of forefront medicine, and this program will spark the interest and imagination of the scientists and physicians of tomorrow,” she said.

“El Grupo” members participate in Alzheimer’s research at Barrow

Barrow researchers and aging Hispanic alumni from Phoenix Union High School are partnering on a major research trial to study Alzheimer’s disease in the ethnic community.

More than 20 graduates from the high school, who belong to a social club called “El Grupo,” have joined neuroscientists at Barrow to study memory loss and Alzheimer’s disease among the Hispanic community.

Recent reports suggest that Hispanics are at a greater risk for Alzheimer’s than other groups, lending a greater urgency to this study. There are currently 200,000 Latinos in America with Alzheimer’s, and that number could increase to 1.3 million by 2050, a growth rate of 600 percent, according to the Alzheimer’s Association.

“For some reason, it is hard to get Hispanics involved in these research projects,” says

Jose Burruel, 84, who is part of the study and launched the group’s involvement with Barrow about six years ago.

“El Grupo started out as a social network of old friends, and now the group is also an important participant in scientific research,” says Leslie Baxter, PhD, a staff scientist and clinical neuropsychologist at Barrow.

Dr. Baxter and others from Barrow attend El Grupo’s breakfast meetings and keep members updated on Alzheimer’s research. El Grupo members are participating in various memory studies involving family history, cognitive and blood tests, and MRI evaluations.

“We are so fortunate to have El Grupo members as part of our study,” says Dr. Baxter. “It is a challenge to get participants from ethnically diverse backgrounds involved. This study can affect research across the world.”

St. Joseph’s is one of several local hospitals and research centers participating in the Arizona Alzheimer’s Consortium. This study is part of the Consortium’s broader efforts at Alzheimer’s research.

Leslie Baxter, PhD

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what’s happening around barrow Barrow expands Neuromuscular Program

The Neuromuscular Program at Barrow recently added two new physicians, significantly increasing the program’s capacity and reducing patients’ wait time for appointments. The Neuromuscular Program is a comprehensive clinical, research, and teaching program that covers all aspects of neuromuscular disease.

Saraj Ashok Muley, MD, has joined Barrow as the program’s director. Before coming to Barrow, Dr. Muley was associate professor of neurology and director of the myasthenia gravis program at the University of Minnesota. He is board certified in neurology, clinical neurophysiology, and neuromuscular medicine, and has special interest and expertise in the diagnosis and management of inflammatory neuropathies such as chronic inflammatory polyneuropathy (CIDP), myasthenia gravis, and inflammatory muscle disorders.

Dr. Muley also has proficiency in performing advanced electrophysiological techniques for the diagnosis of neuromuscular junction disorders and is engaged in clinical studies involving CIDP, myasthenia gravis, and other inflammatory neuropathies.

Another recent addition to the Barrow Neuromuscular Program is Erik Ortega, MD. He is board certified in neurology and board eligible in neuromuscular medicine. He has a special interest in inherited, inflammatory, and toxic myopathies, and is skilled at performing and interpreting a wide range of electrodiagnostic techniques as part of the evaluation of neuromuscular disorders. His clinical practice includes inherited, autoimmune, and otherwise acquired disorders of both muscles and nerves.

Shafeeq Ladha, MD, who has been with the program for two years, directs the muscular dystrophy clinic and EMG laboratory. He is board certified in neurology, electromyography, and neuromuscular medicine. Dr. Ladha has specific interest and expertise in the treat-

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ment of inflammatory neuromuscular disorders, the diagnosis and management of amyotrophic lateral sclerosis (ALS), the evaluation of neuropathy, and the use of electrodiagnostic techniques. He is engaged in several research projects involving a variety of neuromuscular disorders.

Components of the Neuromuscular Program include: • The Muscular Dystrophy Association Clinic • The Myasthenia Gravis Clinic • The Neuropathy Clinic.

For more information, call 602-406-6262.

Shafeeq Ladha, MD, Saraj Ashok Muley, MD, and Erik Ortega, MD, in the Neuromuscular Program at Barrow

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Barrow neurologists travel to Iraq to provide professional education

Pediatric neurologists Jack Kerrigan, MD, and Kevin Chapman, MD, were among a group of five physicians who traveled to Bagdad, Iraq, to present an educational conference to Iraqi neurologists. Dr. Chapman’s wife, Cornelia Drees, MD, an adult epileptologist, was also part of the group. The trip was sponsored by International Medical Corps, a non-profit based in Santa Monica, Calif., that works in 35 countries, including some of the most distressed areas of the world.

The medical conference took place at Al Rasheeda Hotel. With its location in the middle of the green zone, the hotel is one of the safest places in Iraq, says Dr. Kerrigan.

Iraq, a country of about 27 million people, has just 35 neurologists and 90 neurosurgeons, Dr. Kerrigan says. Many doctors have left the country, and those left have had little access to medical education. Thirty doctors attended the conference. “The Iraqis were very appreciative we were there and were like sponges for information,” says Dr. Kerrigan.

Curve ball illusion wins international contest led by Barrow researchers

Science has proven what baseball players have known for more than a hundred years: The curve ball is more powerful than the brain.

“The Break of the Curve Ball,” a mind-boggling visual illusion, won the fifth annual international Best Visual Illusion of the Year Contest. The popular contest is led by Barrow vision researchers Susana Martinez-Conde, PhD, and Stephen Macknik, PhD. The two launched the contest five years ago as part of their ongoing research into the human brain’s relationship to visual perception.

“As scientists and medical researchers, we learn from these visual illusions. The knowledge that we will eventually get from studying the ‘Curve Ball’ illusion may be applied throughout our research and far beyond baseball,” says Dr. Martinez-Conde, who heads the Laboratory of Visual Neuroscience at Barrow.

The contest results were announced at the annual Vision Sciences Society meeting where more than 1,000 attendees from around the world voted on the finalists. This year’s entries included illusions from artists, academics, scientists, and even a Microsoft engineer.

During their stay, Drs. Kerrigan and Chapman heard small arms fire, but no sustained gun battles and just one big explosion. They were there when the city buses began running again, and they witnessed attendees of the conference begin reassembling the Iraqi Neuroscience Society.

Dr. Kerrigan admits to being very naïve about neurologists’ and neurosurgeons’ needs there. “I asked about image guidance systems, and a neurosurgeon said, ‘I don’t even have tools.’ They need CTs, MRIs, ORs, surgical equipment,” Dr. Kerrigan says.

“The Break of the Curve Ball,” submitted by a team of academics led by an American University professor, challenges the human visual system and brain to predict the movement of a spinning disk.

“As the curve ball moves closer to the batter, the batter’s mind is tricked because the eye begins looking at the spinning ball’s peripheral which makes it only appear to be curving dramatically,” says Dr. Macknik, who heads the Laboratory of Behavioral Neurophysiology at Barrow. “The great hitters in the game have learned to not listen to their minds when they are hitting a curve ball. They listen to their experience, not their visual system.”

The winning illusion can be viewed online at illusioncontest.neuralcorrelate.com.

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G I V I N G

the charitable gift annuity Achieving two goals with one asset

by Kathy Kramer Vice President, Leadership Gifts

he charitable gift annuity is a perfect example of how our tax laws continue to provide special ways for you to accomplish two objectives with one asset. In fact, a close look at the gift annuity reveals a true win-win proposition.

The gift annuity makes it possible for you to receive high returns on an asset for the rest of your life. Charitable gift annuities are simple. Here’s how it works:

T

• A charitable gift annuity is a contract. Payments are backed by all the assets of the charity.

• You make a gift of $10,000 or more (check, stocks, or bonds).

• We will prepare a Charitable Gift Annuity Agreement in exchange for your contribution.

• Each year for the rest of your life, we will make payments to you. If you prefer, the agreement can run for the lives of you and your spouse.

In addition, two tax benefits add value to the gift annuity. First, you will receive a current income tax deduction—something you will appreciate when you file this year’s tax return. Second, part of each annuity payment we make to you may be tax-free!

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The gift annuity ultimately results in a charitable contribution. So, while you can take steps to secure a high annuity payment for the rest of your life, you can also realize your philanthropic goals.

With the benefits of high payment rates, reduced taxes, and an ultimate gift to charity, it is easy to see why so many friends consider the gift annuity to be the ultimate win-win proposition!

To receive a personalized illustration, please call Barrow Neurological Foundation at (602) 406-3041.

We are open Monday through Friday, 8 a.m.-5 p.m. ■

“So, while you can take steps to secure a high annuity payment for the rest of your life, you can also realize your philanthropic goals.”

Now’s your chance to be a part of

Celebrity Fignt Night XVI Saturday, March 20, 2010 JW Marriott Desert Ridge Resort & Spa Phoenix, Arizona benefiting

Winning the Fight for Charities Call 602-965-1121 or www.celebrityfightnight.org for more details.

CHW Arizona Barrow Neurological Foundation 350 W. Thomas Rd. Phoenix, AZ 85013-4496 www.SupportBarrow.org

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