Leading Medicine Magazine, Vol. 4, No. 4, 2008

A PUBLICATION OF THE METHODIST HOSPITAL SYSTEM • VOLUME 4 • NUMBER 4 • 2008

CANCER DIGESTIVE DISORDERS EAR, NOSE & THROAT ENDOCRINOLOGY GERIATRICS HEART KIDNEY DISEASE NEUROLOGY & NEUROSURGERY OPHTHALMOLOGY ORTHOPEDICS PSYCHIATRY RESPIRATORY DISORDERS RHEUMATOLOGY UROLOGY

The Methodist Hospital ranks among the nation’s top centers in 14 specialties

CONGRESSIONAL Gold Medal

I

n October of 2007, Dr. Michael E. DeBakey was awarded the Congressional Gold Medal, the highest civilian award bestowed by the U.S. Congress. DeBakey, a medical trailblazer and the recognized “Father of Heart Care,” has pioneered techniques and surgical equipment that have revolutionized medicine and saved thousands of lives.

A researcher, educator, creator, innovator and mentor, DeBakey, 99, has many accomplishments to his credit.

From the creation of the mobile army surgical hospital (M.A.S.H.), to the invention of the Dacron graft to the first successful coronary artery bypass surgery and the development of the DeBakey Ventricular Assist Device™, DeBakey has inspired innumerable physicians worldwide.

The Methodist Hospital is privileged to be the home to DeBakey for nearly 60 years. Methodist DeBakey Heart & Vascular Center physicians continue the visionary work begun by DeBakey and his associates. Their work is an extraordinary tribute to an American pioneer.

LEADING MEDICINE LEADING MEDICINE Volume 4, Number 4, 2008

R.G. GIROTTO President & CEO

MARC L. BOOM, M.D. Executive Vice President

Contents

JOHN E. HAGALE, CPA Executive Vice President, CFO & Chief Administrative Officer

R AMON “MICK” CANTU, J.D. Executive Vice President & Chief Legal Counsel

H. DIRK SOSTMAN, M.D. Chief Medical Officer Chief Academic Officer

MARK E. KIMBELL Senior Vice President & Executive Editor

ERIN R. SKELLEY Director of Marketing

EMMA V. CHAMBERS Managing Editor

DENNY ANGELLE STEFANIE ASIN MARY BROLLEY EMMA V. CHAMBERS ERIN FAIRCHILD AMI FELKER GEORGE KOVACIK MAUREEN KOVACIK PATTI MUCK PAULA R ASICH GALE SMITH Contributing Writers

BRIDGETT AKIN / BRI DESIGN, INC. Design

FANTICH STUDIO Photography Leading Medicine is published by The Methodist Hospital System Corporate Communications Department for patients, physicians, employees and supporters. ©2008 The Methodist Hospital System All rights reserved. Materials may be reproduced with acknowledgement for noncommercial and educational purposes. Permission from the editor required for any other purpose.

Send address corrections and letters to: Leading Medicine The Methodist Hospital System Corporate Communications 8060 El Rio Houston, Texas 77054 Tel: 713.790.3333 or esource@tmhs.org If you wish to cancel your free subscription to Leading Medicine magazine, contact us at 713.790.3333 or esource@tmhs.org.

7

37

CEO MESSAGE...........................2

ENDOCRINOLOGY Diabetes: a public health epidemic for America............................................29

ORTHOPEDICS A new alternative to total hip replacement..3 HEART 3-D technology and robots advance mitral valve repair ...................................................7 UROLOGY A less invasive approach to a common kidney problem............................10 NEUROLOGY & NEUROSURGERY The Brain Trust: Methodist Neurological Institute............................................13 LEADING MEDICINE Renowned Research Institute recruits collaborate to shape the future of medicine.......................16 CANCER Clinical trials may give stage-IV patients more time........................................20 KIDNEY DISEASE Husband and wife share more than love ..24

42

PSYCHIATRY Psychiatrists and neurologists collaborate to affect patient outcomes.........32 OPHTHALMOLOGY How diabetes affects eyesight............34 EAR, NOSE & THROAT Have chronic sinus infections?

Try Balloon Sinuplasty...............37 DIGESTIVE DISORDERS High-tech devices help physicians pinpoint causes of some digestive conditions .....................40 RESPIRATORY DISORDERS GPS-like device navigates the lungs to locate potentially cancerous lesions .........................42 RHEUMATOLOGY First-of-its-kind study zeros in on rheumatoid arthritis ...............43

GERIATRICS Living with dementia..........................................27

VOLUME 4, NUMBER 4 䡲 1

A MESSAGE FROM THE CEO Dear Readers, Every summer, hospitals around the country eagerly await the annual U.S.News & World Report “Best Hospitals” issue, which reports the top rankings of teaching hospitals in 16 different specialties.

These rankings are a high-profile indicator of the quality care a hospital offers its patients. We were honored to be ranked in 14 of the 16 specialties — the most in Texas. Earlier this year, FORTUNE magazine ranked Methodist No. 10 in the country on its “Best Companies to Work for in America” list.

This is our third consecutive year to be ranked and our second year in the top 10. These rankings validate the work we do every day for our patients to provide the best quality health care in a spiritual and healing environment.

Here’s a list of our ranked specialties: Cancer Digestive Disorders Ear, Nose & Throat Endocrinology Geriatrics Heart Kidney Disease

Neurology & Neurosurgery Ophthalmology Orthopedics Psychiatry Respiratory Disorders Rheumatology Urology

In this issue of Leading Medicine, you can read about some of our innovative treatments and research; and our world-class physicians and scientists who work in the above specialties. You’ll get a peek into the robotic surgery used by surgeons in the Methodist DeBakey Heart & Vascular Center, and clinical trials in kidney, lung and prostate cancer. Also in the magazine you will read about the Himes family — a touching story of how a wife’s love led her to donate one of her kidneys to her husband, giving them and their young son a second chance at a normal life together.

We don’t have enough space to introduce you to all of our great physicians, but hopefully you will get a glimpse of why we are leading the rankings, and Leading Medicine. Enjoy! 䡲

OFFICERS OF THE METHODIST HOSPITAL SYSTEM BOARD OF DIRECTORS HON. EWING WERLEIN JR. Chair

JOHN F. BOOKOUT Senior Chair

ERNEST H. COCKRELL Vice Chair

DAVID M. UNDERWOOD Vice Chair

RONALD G. GIROTTO President & CEO

D. GIBSON WALTON Secretary

EMILY A. CROSSWELL Asst. Secretary

ROBERT K. MOSES JR. Asst. Secretary

CARLTON E. BAUCUM Treasurer

JACK S. BLANTON Asst. Treasurer

BOARD OF DIRECTORS MORRIE K. ABRAMSON REV. DR. W. EARL BLEDSOE MARY A. DAFFIN CONNIE DYER GARY W. EDWARDS JAMES A. ELKINS III BISHOP JANICE RIGGLE HUIE ROBERT E. JACKSON, M.D. SANDRA SMITH JACKSON, R.N., ED.D. LAWRENCE W. KELLNER VIDAL G. MARTINEZ GREGORY V. NELSON REV. DR. THOMAS PACE PLINY C. SMITH, M.D. JOSEPH C. (RUSTY) WALTER III REV. DR. STEPHEN P. WENDE D.D.

ADVISORY MEMBERS REV. RICK GOODRICH

R. G. Girotto President Chief Executive Officer The Methodist Hospital System

WADE R. ROSENBERG, M.D.

2 䡲 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

It’s Hip to Resurface “I chose this procedure because I knew I could remain active and still be in line for a hip replacement when I get older and slow down a bit.”

I

Stephen Andrews

IT WAS A RED-LETTER DAY WHEN YOU TIED YOUR SHOELACES FOR THE FIRST TIME. You stood there, beaming with pride when your mom and dad told you what a wonderful job you had done. It was a rite of passage because after all, “only big boys and girls can tie their shoelaces all by themselves.”

For 58-year-old Stephen Andrews, tying his shoelaces was a painful experience. He couldn’t tie them without feeling like someone was stabbing him with a knife.

WWW.METHODISTHEALTH.COM

BY GEORGE KOVACIK

VOLUME 4, NUMBER 4 䡲 3

IT’S HIP TO RESURFACE

H

HE BEGAN TO WALK WITH A NOTICEABLE LIMP. And as a civil litigation attorney, it was uncomfortable for him to approach the bench or sit for any length of time — both of which made it difficult for him to practice.

He couldn’t get a good night’s sleep, which also affected his work, and performing any type of physical activity such as hiking was almost impossible.

It was time to take action.

After a year of experiencing constant pain in his left hip, Andrews resigned himself to the fact that he would have to have a total hip replacement.

“I was a little apprehensive about a total hip replacement because I thought I would have to give up my active lifestyle and have to start watching my diet more closely,” Andrews said. “But I knew I had to take some kind of action because the pain was really making my life miserable.”

He then met Dr. Kenneth Mathis, chairman of the Department of Orthopedic Surgery at The Methodist Hospital, who told him about an alternative to total hip replacement,

a new procedure called Birmingham Hip Resurfacing (BHR).

BHR was developed in 1997 in Birmingham, England, as a way to preserve bone and joint stability in young, active people. Tens of thousands of patients have undergone the procedure in Great Britain, Canada, Australia, Japan and throughout Europe. The Food and Drug Administration approved it for use in the United States in 2006.

Hip resurfacing involves placing a metal cap over the ball of the hip joint rather than completely removing the ball, hip socket and diseased parts of the hip joint (total hip replacement), helping a patient retain more bone than a total hip replacement.

The best candidates for BHR are men who are in their 30s, 40s and 50s, although active women in this age group who don’t have early osteoporosis may be candidates as well.

“Men in these age groups who are very active and receive a total hip replacement are more susceptible to damaging or loosening of the implant because of their active lifestyle,” Mathis said. “If the implant

loosens or fails, the patient has to undergo revision surgery. Every time you do this you have to place the revision implant deeper into the remaining undamaged bone to obtain solid fixation.”

Hip resurfacing seems to give patients more of an athletic hip as

CUP

BIRMINGHAM HIP RESURFACING BHR implant (left), total hip replacement implant (right).

The BHR System relieves hip pain and improves hip function by replacing the parts of the hip that have been severely damaged by degenerative joint diseases.

4 䡲 VOLUME 4, NUMBER 4

CAP WITH STEM

The cup replaces the damaged surface of the hip socket. Bone grows into the socket adding increased stability. The cap covers the ballshaped bone at the top of the thigh. The cap has a small stem that is inserted into the top of the thighbone.

WWW.METHODISTHEALTH.COM

THE METHODIST HOSPITAL’S BONE AND JOINT CENTER is among the largest and most comprehensive orthopedic centers in the United States. From joint replacement and spine surgery to sports medicine and foot/ankle surgery, Methodist physicians treat approximately 5,000 patients and perform more than 10,000 surgeries annually. Methodist is often a referral site of choice for even the most complex cases, attracting patients from across the nation and around the world.

METHODIST ORTHOPEDIC SUBSPECIALTIES UPPER EXTREMITY: SHOULDER, ELBOW UPPER EXTREMITY: HAND/WRIST

Dr. Kenneth Mathis

SPORTS MEDICINE SPINE LIMB RESTORATION

well as preserves the bone. Many patients have reported returning to very high activity levels and participating very actively in sports.

During a one hour surgery, the surgeon smooths out the rough surfaces of the hip joint bones and covers them with a more durable high carbide cobalt chrome metal cap.

If the patient needs a total hip replacement later, it will seem like they are undergoing hip surgery for the first time because the femoral shaft bone was not compromised during the hip resurfacing. 䡲 䡲 䡲 䡲 䡲 “MANY ACTIVE PEOPLE REQUIRE HIP SURGERY BECAUSE OF ARTHRITIS OF THE HIP, a disease that wears away the cartilage between the femoral head and the acetabulum (the cup-shaped cavity at the base of the hipbone), causing the two bones to scrape against each WWW.METHODISTHEALTH.COM

other,” said Dr. David Lionberger, a Methodist orthopedic surgeon.

When this happens, the joint becomes pitted, eroded and uneven, resulting in pain, stiffness and instability. This can severely limit movement in the leg. Oftentimes people first notice pain in their groin area when taking part in weight-bearing exercises or walking.

“To have a procedure that acts as a spacer while sparing more of the native bone is a marvelous step forward in preserving options for the future in this very active group of patients,” Lionberger said.

Andrews had surgery on his left hip March 1, 2007. He said the heavy duty hip pain was gone when he woke up after surgery. He was riding a stationary bike just six weeks later.

At four months post-surgery, he was back hiking a little more than nine miles with his family in Acadia National Park in Maine, just like he does every summer. The difference

JOINT REPLACEMENT RHEUMATOLOGY LOWER EXTREMITY: HIP, KNEE, FOOT/ANKLE

For more information or to make an appointment, call 713.790.3333

this time is that he did it pain-free.

He says hip resurfacing has changed his life for the better. He’s now able to get a good night’s sleep, he can get in and out of the car without a problem and he can tie his shoelaces.

“I chose this procedure because I knew I could remain active and still be in line for a hip replacement when I get older and slow down a bit,” he said. “I believe it’s one of the best decisions I have ever made.” 䡲

VOLUME 4, NUMBER 4 䡲 5

Leading Medicine Heart disease is the leading cause of death in America for both men and women. It doesn’t discriminate against its victims and in spite of our attempts to prevent it; it often finds a way of creeping into our lives. “Leading Medicine,” a 30-minute television special produced by The Methodist Hospital, offers lifesaving information on how to prevent and treat heart disease.

To order your free DVD of this program that aired on KHOU-TV (channel 11), call 713.790.3333.

6 䡲 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

3-D imaging and robots allow physicians to detect, diagnose and treat heart conditions before symptoms occur

B Y

P A T T I

M U C K

U

nder Mike Trevathan’s right armpit are four small scars that mark the major heart surgery he underwent last summer. Except for occasional tightness when he first raised his arm, the wounds never hurt.

Weeks after a leaky mitral valve in his heart was diagnosed and surgically repaired at The Methodist Hospital, Trevathan returned to teaching and went on his annual duck hunt near Trinity Bay, Texas.

Thanks to surgeon Dr. Gerald Lawrie, his well-trained team and a robot named da Vinci, Trevathan’s life barely skipped a beat and his heart is ticking like new.

“I feel real fortunate they didn’t have to split me open,” Trevathan says. “I feel as good as I did before I went in. They found my problem real quick. When Dr. Lawrie told me my options, I said let’s try the robot.”

Gateway to the heart The mitral valve is the gateway into the heart’s left ventricle, which supplies oxygen-rich blood to the rest of the body. When the valve does not shut tightly, blood flows back into the atrium, decreasing blood flow to the body and forcing the ventricle to pump harder. Leakage — or regurgitation — can be present from birth or can develop as a result of damage from rheumatic fever. It also can occur from a ballooning out or prolapse of the valve.

WWW.METHODISTHEALTH.COM

Dr. Gerald Lawrie

VOLUME 4, NUMBER 4 䡲 7

O

utwardly healthy and robust at 62, Trevathan had never been seriously ill in his life. Except for having his tonsils removed as a child, he’d never had surgery of any kind or been in a hospital. But when the longtime teacher, administrator and coach had his annual physical last summer, his doctor heard a heart murmur.

Through advanced imaging technology — a 3-D echocardiogram and a TEE or transesophageal echocardiogram — doctors pinpointed the source of the murmur, Trevathan’s leaky mitral valve, and rated its leakage at 52 percent.

Trevathan was lucky. His heart problem was detected, diagnosed and treated before he felt a single symptom. The use of the da Vinci robot to help Lawrie perform the surgery was an added bonus — it substantially cut his hospital stay, recovery time and pain.

“We’re a center of excellence for several of the leading imaging companies,” says Dr. William Zoghbi, medical director of the heart center’s Cardiac and Vascular Imaging Center and the William Winters Endowed Chair in Cardiovascular Imaging.

“Any of the latest and newest technology starts here.”

The use of 3-D echocardiography offers a real-time picture of the heart — almost as if the surgeon is holding

Leading medicine Keeping up with the latest developments doesn’t happen overnight, Quiñones says. “Every revolution in medical technology is followed by a five- to 10-year lag time as researchers and physicians learn how to best use that technology to help patients.”

Lawrie followed the medical evolution of the da Vinci robot for nearly a decade before it reached the maturity and the right mix of instrumentation

Evolving technology As imaging and treatment technologies evolve, and as physicians learn how to apply newfound knowledge and tools in more innovative and creative ways, Methodist physicians hope to see more patients just like Trevathan.

“Technology is allowing us to detect some heart conditions even before the patient develops symptoms,” says Dr. Miguel Quiñones, medical director of the Methodist DeBakey Heart & Vascular Center and chair of the Department of Cardiology. “Things that sometimes took days, weeks, now can be done almost immediately.

8 䡲 VOLUME 4, NUMBER 4

The da Vinci robot allows surgeons flexibility to perform more complicated surgeries laparoscopically. The surgeon using the robot operates while seated at a console (left), viewing a 3-D image of the surgical field.

it in his or her hands — says Zoghbi, and this imaging technology continues to develop. “You can even call it 4-D technology because there is a time element,” he says. “You can see clearer images with the help of much faster processing and more physiologic information about how the heart is beating and functioning.”

WWW.METHODISTHEALTH.COM

“Things that sometimes took days, weeks,

now can be done almost

Photo courtesy of Intuitive Surgical, Inc.

immediately.”

for cardiac applications. The enhanced magnification and the need for only tiny incisions made the robot popular for prostate and gynecological surgeries at Methodist and in hospitals nationwide, but not until recently did da Vinci’s instrumentation advance enough to find its way into a few cardiac suites.

“We spent more than six months training to make sure we could accomplish our technique in an identical fashion with the robot,” Lawrie says. “We’re the only center that’s performing the standard full-scale operation with the robot.”

Lawrie is famous for the “American Correction,” his adaptation of a 15year-old procedure used to perform complex mitral valve repairs. Success

Dr. William Zoghbi (L) and Dr. Miguel Quiñones

_

rates of near 100 percent attest to its superiority over the predecessor technique — the “French Correction.”

Lawrie does not cut out heart valve leaflets and he uses Gore-Tex strings to replace the heart’s damaged chordae, unlike the French version.

The chordae tendonae are the “heartstrings” that attach the valve leaflets to the heart muscle like the strings on a parachute. They can become damaged or elongated, and surgeons found the durability and elasticity of goretex material could replace the damaged chordae and improve function.

Lawrie and his team also developed a series of maneuvers to simultaneously adjust the various components of the complex and dynamic mitral valve.

En Garde

differences between the two procedures. While Lawrie says both showed benefits, the American Correction was the clear winner in time elapsed and patient outcome.

Already responsible for training about 20 percent of practicing U.S. cardiac surgeons in the procedure, Lawrie says the demonstration prompted even more interest in his technique.

And now, the American Correction can be performed with da Vinci.

Instead of standing at an operating table, Lawrie sits at a console, removes his shoes and works the two hand controls and five pedals with his hands and feet, much like an organ player. A 3-D camera for each eye means a clear and lifelike view of the heart, says Lawrie, and his hands and feet work as if they’re directly connected to the instruments inside the chest.

The dream is to one day perform the procedure on a beating heart — without using the heart/lung machine to stop the organ. That may be 10, 15 or 20 years away, but the conceptualizing has already begun. 䡲

At a recent medical conference, Methodist’s “Robot Team” participated in a cordial duel with Dr. Alain Carpentier, developer of the French Correction, to demonstrate the

The advanced technology tools used in Trevathan’s case — the da Vinci robot and 3-D echocardiography — are among the advanced services that continue to help Methodist’s heart service garner top spots on U.S.News & World Report’s “America’s Best Hospitals” list.

To learn more about mitral valve repair and the da Vinci robot, order your free DVD copy of the 30-minute TV special “Leading Medicine.” Call 713.790.3333 today.

WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 9

It’s the little things B Y

M A U R E E N

K O V A C I K

Dr. Richard Goldfarb 10 䡲 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

Methodist urologist uses less invasive approach to fix common kidney problem A handful of coins — a few quarters and dimes — can be the difference between hunger and a full stomach for a homeless person who will sleep under a bridge tonight. It’s the little things in life — small, seemingly insignificant things that can have a huge, positive impact.

On the other hand, a minuscule blockage the size of a grain of rice, can wreak havoc on the body and lead to kidney failure, but luckily, a surgical advance using incisions just millimeters long can improve treatment for patients who suffer from a urological condition called ureteropelvic junction obstruction.

about six weeks for the kidney to stop functioning.” In cases when the blockage is partial, progressive loss of kidney function can occur over many years.

In addition to UPJ, Goldfarb says the blockage also can occur due to kidney stones and chronic conditions such as cancer or scar tissue.

A minimally invasive fix

One of the most common ways to fix UPJ is a procedure called pyeloplasty, in which the surgeon removes scar tissue from the blocked area and connects the healthy part of the kidney to the healthy portion of the ureter. Doctors at Methodist are now routinely Ureteropelvic junction obstructions (UPJ) occur when performing this procedure laparoscopically (using the renal pelvis, the area that connects part of the kidney small incisions). to the ureter, is blocked. The condition is most commonly Pyeloplasty was originally performed surgically congenital, meaning it was present prior to the patient’s through a 10-inch incision made in the patient’s side, birth. The symptoms are usually slow to develop but, if but during the 1990s, doctors were looking for a more left untreated, can lead to the destruction of the kidney. minimally invasive approach.

UPJ causes sudden pain in the side, usually after “We are always looking for ways to make surgery drinking large quantities of fluids. The kidneys produce and the recovery process easier on patients,” said urine more quickly than the ureters, the tubes that bring Methodist urologist Dr. Richard Link. “Laparoscopic the urine to the bladder, can drain it from the renal pyeloplasty provides the same benefits as the traditional pelvis because of the blockage. The kidneys surgical method but with more rapid recovery times then swell, creating pressure in the pelvis. and less pain.”

This swelling is called hydronephrosis.

The procedure involves making three to A patient who ends up in the four incisions the width of a small pencil. doctor’s office with symptoms Most patients go home in 24 to 48 hours, such as back pain, a urinary tract experience less pain and wound complicainfection and/or fever, a kidney tions and fully recover in four to six weeks. infection, bloody urine, and/or a The majority of patients (>95 percent) lump in the abdomen may be also experience no more symptoms after suffering from hydronephrosis. the surgery, and the loss of kidney function “If there is an infection in addition is halted. to the blockage, this can take as little Link not only has performed a large volume of regular laparoscopic procedures, as three days to occur,” said Dr. Richard but also pioneered the use of the da Vinci Goldfarb, a urologist with The Methodist FEMALE surgical robot for pyeloplasty at Methodist. The Hospital. “However, in most cases, it takes

The problem presents itself

WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 11

Little things

“As the field of laparoscopic surgery advances, we want to move with it and remain on the cutting edge of technology that will give patients a chance at the best outcomes and the quickest recovery time.” da Vinci robot uses advanced optics to allow the surgeon to view the operation at a high magnification and in 3-D as opposed to the 2-D perspective of standard laparoscopic surgery. It also provides surgeons with a wider range of motion, and maneuverability than standard laparoscopic surgery. (See page 7 for more information on da Vinci.)

“At Methodist, we most likely treat the largest number of patients in the Houston area with this technique,” said Link, an associate professor of urology at Baylor College of Medicine and director of the Division of Endourology and Minimally Invasive Surgery. “About 65 percent of our patients are new and the other 35 percent come to us for a repair after their initial surgery elsewhere was unsuccessful.”

In the know Not only are doctors at Methodist performing laparoscopic pyeloplasty successfully, but they also are teaching it to others. Link, for example, teaches the

Dr. Richard Link

procedure for the American Urological Association’s Mentored Laparoscopic Course.

“As the field of laparoscopic surgery advances, we want to move with it and remain on the cutting edge of technology that will give patients a chance at the best outcomes and the quickest recovery time.” 䡲 To obtain a physician referral, call 713.790.3333 or visit methodisthealth.com.

The Methodist Hospital’s urology service ranks No. 10 on U.S.News & World Report’s “America’s Best Hospitals” list. Up six spots from last year, urology, which includes the treatment of prostate cancer, has ranked in the top 20 for 10 consecutive years.

12 䡲 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

The Brain Trust B Y

D E N N Y

A N G E L L E

W

hen the brain goes wrong, the human body goes haywire. A single neuron misfiring or a blow to the head can change the way we think, turn simple emotions into a frightening funhouse mirror or slowly steal away our humanity. Brain disorders are costly, they take away people’s jobs and destroy families.

Each year, head injuries devastate the health of 600 people out of each 100,000 in the United States. Stroke and spinal disorders also affect tens of thousands every year.

The Methodist Neurological Institute is one of only four centers in the United States dedicated solely to exploring the mysterious, myriad channels of the brain and its disorders.

Established in 2004, this center is dedicated to finding the most effective treatments for Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS) and multiple sclerosis. Doctors and researchers at the institute are seeking genetic solutions for malignant brain tumors and pioneering new treatments for cerebral aneurysms and stroke.

As the brain guides the body, two internationally acclaimed physicians with more than a half century of experience between them guide the Neurological Institute as it explores the most puzzling of human organs. Dr. Robert Grossman and Dr. Stanley Appel share leadership of this important organization, working to guide scientific discovery and usher new therapies into reality.

They — and their colleagues in the Neurological Institute — are the Methodist brain trust.

WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 13

The Brain Trust

The Past Meets the Future

I

n 2005, Methodist created its Neurological Institute — the first of its kind in the southern United States — and sought the expertise and leadership of Grossman, who became its director.

“Our institute is a great opportunity to create a concentration of expertise that can make breakthroughs on a number of fronts — in creating molecular therapies for brain tumors, for perfecting techniques to repair arteriovenous malformations (AVMs), as well as better treatment for traumatic head injuries,” Grossman says.

For decades, The Methodist Hospital has been well known for its neurosurgery program, not only in Houston but around the country.

Methodist had one of the first dedicated neurosurgical intensive care units and it had a history of being a leader in all of the neurosciences.

“It is that rich history that has enabled us to take the steps toward becoming a great center for the neurosciences,” Grossman says.

Innovation and medical breakthroughs go hand-in-hand at the Neurological Institute. One example is the Medtronic O-arm imaging system, a multidimensional surgical navigation system for orthopedic and spine surgeries. The gantrymounted, portable scanner allows doctors to peer into the patient at any time before or during a surgery.

It produces 3-D pictures in a matter of seconds, saving valuable time

14 䡲 VOLUME 4, NUMBER 4

Dr. Robert Grossman

while a patient is on the operating room table.

The future also offers bright promise for the treatment of brain tumors, using an innovative technique to identify tiny pathways that may be used to safely deliver medication to cancer cells.

Researchers at the Neurological Institute developed a technique to identify nanotubes, structures within cells that are too tiny to be seen even through a microscope.

This new technique could one day give researchers a new view into cancer cells, proteins and molecules and allow doctors to administer medications directly into a cancer while sparing surrounding healthy tissue.

Researchers at the Neurological Institute also are helping to develop the North American Clinical Trials Network for New Therapies for

Spinal Cord Injury, supported by the Christopher Reeve Foundation.

Reeve is the former actor who became a champion for spinal cord injury research after an accident left him paralyzed. This network promises to bring therapies from the laboratory to clinical trials to benefit patients being treated with spinal cord injuries more quickly.

Pathways of the Brain

D

edicated to the treatment of patients with Lou Gehrig’s disease (ALS) and committed to neurological research, Dr. Stanley Appel is chairman of the neurological side of the Neurological Institute.

Appel created the MDA (Muscular Dystrophy Association)/ALS Research and Clinical Center at Methodist, one of the world’s top centers for the

WWW.METHODISTHEALTH.COM

The Methodist Hospital’s neurology and neurosurgery services are ranked No. 9 in the nation by U.S.News & World Report’s “America’s Best Hospitals” list. Methodist has ranked in the top 20 in this field for the past 10 years.

treatment of these neurological disorders. The first multidisciplinary clinic in the United States dedicated to patient care and research for ALS patients, Appel’s clinic is the standard by which all other MDA/ALS clinics are modeled.

Appel says the breakthrough that could give a clue to a cure or a cause could be just around the corner. He believes that the immune system can play a significant role in the development of ALS. The MDA/ALS Clinic and Research Center is the first and one of the nation’s largest multidisciplinary clinics for these conditions.

Last year, researchers here published research that may lend insight into genetic clues to the cause of sporadic (non-inherited) ALS, the most common form of the disease.

“The only way we are going to make a breakthrough is to share research and get everyone who is looking into it at the same level,” Appel says.

In 2006, the Neurological Institute launched the Taking Strides4Stroke: Community Awareness Campaign to educate the community about the signs and symptoms of stroke. The major event and fundraiser, the Taking Strides4Stroke 5K Walk/Run, drew 2,800 participants to Rice University Stadium and raised more than $760,000 in this, its second year.

Funds raised through these activities benefit the Eddy Scurlock Stroke Center at Methodist. Its 18 beds make it the largest dedicated stroke unit in Texas, and its physicians and staff are leaders in all forms of stroke research and treatment.

WWW.METHODISTHEALTH.COM

For example, researchers at the center are applying a new investigational treatment to stroke patients who receive tissue plasminogen activator, or tPA, the only FDAapproved treatment for stroke.

They are studying an investigational drug containing microscopic bubbles that, when combined with saline, may improve the breakdown of blood clots in the brain when combined with an ultrasound and standard treatment. Research shows that ultrasound improves the effects of tPA, which, in turn, improves the rate of blood flow in the brain.

On another front, researchers have teamed with surgeons to offer a surgical solution to epilepsy for people who do not respond to anticonvulsant medication to control their seizures. Doctors have developed advanced techniques and technologies to remove the affected area of the brain, or to implant a nerve stimulator to send bursts of electricity to the brain and control seizures.

“This type of teamwork, or synergy, enables us to team up and advance the knowledge that we have here,” Appel says. “We have one of the best teams in the world.”

Team members at the Neurological Institute have dedicated their lives to finding causes and cures for some of the

most devastating diseases of modern times. Gifted clinicians, teachers and researchers, who have made an impact on the health and lives of innumerable patients, have the future at their fingertips. 䡲

Dr. Stanley Appel recently received the 2008 John P. McGovern Compleat Physician Award. This national award, given by the Houston Academy of Medicine, recognizes a physician who embodies exemplary service to humanity and whose career reflects medical excellence, humane and ethical care and commitment to the medical humanities.

Appel holds the Peggy and Gary Edwards Distinguished Endowed Chair for the Treatment and Research of ALS, commonly known as Lou Gehrig’s disease.

Dr. Stanley Appel

VOLUME 4, NUMBER 4 䡲 15

䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲

Stellar Research Institute Team Changing the World of Medicine B Y

P A T T I

M U C K

The collaboration has begun.

Over the past two years, top-notch researchers, scientists and physicians from around the nation have gathered at The Methodist Hospital Research Institute.

With expertise in a wide range of specialties — including bioinformatics, molecular imaging, diabetes, liver disease, medical genomics, proteomics and more — these recent recruits join a stellar cast of team members to shape the future of medical care.

Methodist’s new director of the diabetes and metabolism research program, Dr. Willa Hsueh, (pronounced Shoy) has just arrived in Houston and is already collaborating with Dr. Stephen Wong and Dr. King Li on how bioinformatics and imaging might aid her research on diabetes.

“The resources and the interdisciplinary spirit, combined with the establishment of crucial core facilities, brought me here,” Hsueh says. “I now realize this move has allowed my research to expand exponentially.”

“The spirit of the Research Institute is to promote translational research and allow us to study our discoveries in humans.”

From Harvard and the National Institutes of Health on the East Coast and from UCLA and the University of California, San Francisco on the West Coast, medical brain power is converging in Houston to take part in a collaborative mission to seek better treatments and cures for patients around the globe. Dr. Michael W. Lieberman, The Methodist Hospital Research Institute (TMHRI) founding director, calls it “building a bridge from the laboratory to the bedside.” 䡲 䡲 䡲 䡲 䡲 The most recent TMHRI recruits include Wong and Li, who came aboard within the last two years, and Hsueh, who moved here in February. Also joining the Research Institute team in early 2008 are Dr. John Baxter and Dr. R. Mark Ghobrial, both from California. All cite Methodist’s commitment, vision and resources as driving factors that motivated their moves in the midst of remarkably successful careers elsewhere.

But the biggest incentives attracting them to Houston are the promises of collaboration and the freedom to explore their disciplines without boundaries.

“There is huge potential here, mainly because of the quality of the people, the organization and the location within the Texas Medical Center,” says Li, former chief of the Radiology and Imaging Sciences Program at the

䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 16 䡲 VOLUME 4, NUMBER 4

Dr. Willa Hsueh

WWW.METHODISTHEALTH.COM

䡲 䡲 䡲 䡲䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 “It struck me as much more open here with fewer boundaries.

It’s a wonderful place for doing translational research.”

National Institutes of Health. As Methodist’s new chief of radiology, Li was surprised by the “warmth of the people and their openness to collaborate” when he arrived here in June 2007. “This spirit of collaboration is not just within Methodist but all over the Texas Medical Center, including Rice University, the University of Houston and Weill Cornell (through its affiliation with The Methodist Hospital). This is a huge bonus to a newcomer.”

He is working on a multitude of projects, including a lung cancer screening and image-guided therapy treatment study, and the development of a multimodality image-guided therapy suite combining CT and various types of imaging technologies, expected to be running in April 2008.

Li’s enthusiasm for Methodist and the Texas Medical Center was contagious. During a telephone conversation with colleague Wong, Li suggested his friend visit. “I paid

a courtesy call, and I liked it here,” Wong recalls. “It struck me as much more open here with fewer boundaries. It’s a wonderful place for doing translational research.”

The former director of bioinformatics at the Harvard Center of Neurodegeneration and Repair and also director of the Functional and Molecular Imaging Center at Brigham and Women’s Hospital in Boston is now Methodist’s chief of medical physics and head of bioinformatics for the Research Institute.

A skilled and knowledgeable scientist in both bioinformatics and radiology — and the inventor of the inkjet printer production system — Wong describes himself as one who “puts it all together” with technology interplay that can help in the treatment and prevention of all diseases.

Wong and Li are working together on image-guided diagnosis and therapy systems. Wong also is working on biomarkers for early detection and combination drug treatment; neuroimaging and informatics for neurodegeneration and neurological disorders; and on-the-spot

“There is a huge potential here, mainly because of the quality of the people, the organization and the location within the Texas Medical Center.”

䡲 䡲 䡲 WWW.METHODISTHEALTH.COM

Dr. Stephen Wong

Dr. King Li

VOLUME 4, NUMBER 4 䡲 17

Research Institute

䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 diagnosis to shorten the care cycle for patients, making it quicker and more economical. Fusing all the relevant data — putting it all together — can change the way medicine is practiced, he says.

Both Li and Wong welcomed Hsueh in mid-February when she arrived in Houston by brainstorming collaborative strategies for the coming months and years. As former chief of the Endocrinology, Diabetes and Hypertension Division at the UCLA School of Medicine, Hsueh has spent more than two decades studying diabetes and its related health problems. She brought eight California team members with her and hopes to craft an unparalleled diabetes research center at Methodist.

“The spirit of the Research Institute is to promote translational research and allow us to study our discoveries in humans,” Hsueh says. “We are focusing on approaches using nuclear receptors and also treatments that inhibit inflammation as important avenues to pursue.”

Her codirector in the Diabetes and Metabolism Research Program is Baxter, who also will serve as director of the Genomic Medicine Program. A member of the National Academy of Sciences and the Institute of Medicine of the Dr. John Baxter National Academies, Baxter is former chief of the Endocrinology Section and director of the Metabolic Research Unit at the University of California, San Francisco. He is an entrepreneur, scientist and physician who has made a name for himself in genetic engineering and the study of hormone action.

Baxter sees the Research Institute and its environment as a conduit to get proven concepts to patients more quickly.

Baxter brought four key team members from California and will keep his group intact through subcontracts supplemented with new hires in Houston.

“The biggest problem now is we have all these concepts, and they’re not getting out to people,” Baxter says.

“You feel like you’ve learned something and people are still dropping off with heart attacks every 25 seconds — I find that very disturbing.” He sees the Research Institute and its environment as a conduit to get proven concepts to patients more quickly.

Ghobrial, the newest Research Institute recruit, left his positions as director of the Living Donor Liver Transplant Program and the Pancreas Transplantation Program at UCLA because of “a unique opportunity here to change our business.”

As director of the Comprehensive Liver Center and liver transplantation, as well as director of the Immunobiology Research Center, Ghobrial believes the resources on hand and on the way will push the Research Institute to the forefront of international prominence.

“You achieve greatness by putting the three good resources together: hard work, a great hospital and vision,” he says.

“The vision and greatness are here.”

And now the hard work begins.

Ghobrial, Baxter, Hsueh, Wong and Li join their previously recruited Methodist and Research Institute colleagues, including TMHRI president/CEO and director Lieberman; Dr. James Musser, executive vice president and codirector of TMHRI;

䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 18 䡲 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲

䡲 䡲

Dr. Richard Robbins, chairman of the Department of Medicine; Dr. Barbara Bass, chair of the Department of Surgery and developer of The Methodist Institute for Technology, Innovation and Education; Dr. Osama Gaber, head of the Division of Transplantation in the Department of Surgery; and others.

As recruitment efforts continue, Research Institute goals include increasing clinical trials from 700 to more than 1,000 and building on — and adding to — Methodist’s nationally recognized strengths in the fields of cancer, neurosciences, heart and other specialties. 䡲

“You achieve greatness by putting three good resources together: hard work, a great hospital and vision.”

Dr. R. Mark Ghobrial

The guarantees of teamwork, collaboration and resources brought them to Methodist, but the Research Institute’s star recruits also came here to accomplish big things in their fields. The following question was posed to Methodist’s newest leading physicians:

What do you hope to accomplish here?

Dr. Baxter: My big focus right now is developing thyroid hormone-like and other types of compounds to treat atherosclerosis, obesity and diabetes that do not elicit bad side effects. If we can successfully harness these compounds, it may be the most potent treatment we have for preventing/treating heart attack, stroke, obesity and diabetes.

Dr. Ghobrial: The need here is to create a comprehensive center for treatment of liver problems — a onestop shop that builds a bridge between medicine, surgery, clinical and basic science research. The country right now is moving toward collaborative multidisciplinary approaches that cross link different specialties to provide the best benefit to our patients and to advance meaningful research. The Methodist environment is probably the best hospital in the world to foster this multidisciplinary approach to liver disease.

Dr. Hsueh: I want to build a discovery program for diabetes that will allow us to prevent and treat the disease and its complications. Prevention, treatment and then TMHRI’s approach to promote commercialization of our discoveries — all of this is important.

Dr. Li: My vision is to build a highly innovative, unique and world-class imaging sciences program. The future will be our ability to combine all the information we have and practice the four ‘Ps’ of medicine, which are to predict, prevent, personalize and prognosticate. If we can do all four, we can truly change how medicine will be practiced.

Dr. Wong: My specialty is a cross between bioinformatics and medical imaging, and I’m especially interested in the interplay of the two. They are becoming the cornerstones for the next generation of medical care, and they will permeate all specialties. The key is to integrate this tidal wave of technology so patients can get seamless, better and cost effective medical care. 䡲 WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 19

Cancer tr B Y G E O R G E K O V A C I K

F

or as long as I can remember, my grandfather smoked cigars.

Unless he was in church, he usually had one lit up. Then one day he developed a cough he couldn’t shake.

He knew something was wrong when he didn’t have the energy to play golf every day — something he did for more than 20 years.

Doctors told him he had stage-IV lung cancer, and after a short, painful battle, he passed away.

20 䡲 VOLUME 4, NUMBER 4

Dr. Shanda Blackmon

Stage IV is the most advanced stage of any cancer because it has spread (metastasized) to the bones or other organs. Survival rates, unfortunately, are very low at this stage. Most stage-IV lung cancer patients, for example, do not last a year, while those with kidney cancer may survive for up to five years.

Researchers at The Methodist Hospital are conducting new studies for advanced cancer that may benefit stage-IV patients like my grandfather Ben Russotto. He probably wouldn’t have been cured, but he certainly would have had a little more time in life if he had been on the right side of a breakthrough in this field.

Researchers are testing the drug EC-145 in studies designed to treat people with stageIV lung cancer; and advanced and recurrent ovarian and endometrial cancer. Made up of components that prevent changes in DNA that may lead to cancer and anticancer drugs that inhibit cancer cell growth, EC-145 targets the tumor and kills cancer cells.

WWW.METHODISTHEALTH.COM

rials may give stage-IV patients more time Cutting-edge research being conducted at The Methodist Hospital is not only breaking new ground and looking for cures, it also is providing hope to people who just might not have any left.

The drug then quickly filters out through the kidneys, reducing toxicity to the rest of the body.

Researchers liken EC-145 to the video game Pac-Man. The drug weaves its way through the body’s maze and chases down cancer cells. Once it finds them, it grabs and eats them, Pac-Man style.

LUNG CANCER

tion to see which part is highlighted and where the tumor is located.

“Conventional chemotherapy circulates throughout the entire body and can cause toxic side effects,” said Blackmon, an assistant professor of surgery at Weill Cornell Medical College.

“The hope is that EC-20 will act as a guide for us to direct the EC-145 drug to the tumor and kill just the cancer cells.”

Researchers hope to enroll 20 patients who have failed at least two chemotherapy regimens.

“We are trying to design clinical trials that don’t affect the work already being done by oncologists,” Blackmon said. “We are trying to fill gaps and offer other types of therapy to patients who are running out of options and time.”

Lung cancer kills more people than any other cancer. The American Cancer Society estimates that in 2006, lung cancer accounted for 13 percent of all new cases in males and 12 percent of the new cancer cases in women. In more than 90 percent of the cases, smoking is responsible.

The lung cancer trial, led

by Dr. Shanda Blackmon, a Methodist thoracic surgeon, is testing the effectiveness of EC-145 along with a drug called EC-20. Given to patients before they take an imaging scan, EC-20 causes the tumor to “light up.”

Doctors then correlate the picture of the scan with a CT scan that was taken prior to the drug combina-

WWW.METHODISTHEALTH.COM

OVARIAN CANCER There is no known cause for ovarian cancer and very few cases are caught before it has spread because it is difficult to diagnose early.

Many of its symptoms — weight loss, diarrhea and discomfort in the lower abdomen — may be ignored because they resemble other conditions or medical problems.

More than 30 different types of ovarian tumors have been identified, some of which are benign.

Normal ovarian cells can begin to grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries.

The five-year survival rate is more than 90 percent for ovarian cancer patients who are diagnosed early.

Dr. Alan Kaplan

VOLUME 4, NUMBER 4 䡲 21

CANCER TRIALS

The EC-145 drug weaves its way through the body’s maze and chases down cancer cells.

Once it finds them, it grabs and eats them, Pac Man style.

More than 20,000 women will be diagnosed this year, and about 15,000 will die. But for the 25 percent of patients who are diagnosed early, the five-year survival rate is more than 90 percent.

Dr. Alan Kaplan, chairman of Methodist’s Department of Obstetrics and Gynecology, along with Methodist principal investigator Dr. Tri Dinh and his fellow researchers were pleased with Phase I of the trial. Patients who took EC-145 exhibited only minimal toxicity.

During Phase II, which began recently, the goal is to enroll 40 patients with advanced and recurrent ovarian and endometrial cancer.

22 䡲 VOLUME 4, NUMBER 4

Dr. Robert Amato

“We are encouraged by the early results and are hopeful that we can provide better outcomes for these patients,” said Kaplan, a professor of obstetrics and gynecology at Weill Cornell.

KIDNEY CANCER Kidney cancer is another of the silent cancers. Like pancreatic cancer, patients experience very few, if any, symptoms. The only real sign that something is

wrong may be blood in the urine.

In most cases, the tumor is located in the back of the abdomen, making it hard to detect.

It can grow quite large before it is discovered, and in more than 30 to 50 percent of patients, the cancer has already spread to other parts of the body.

The disease hits men harder than women and smokers are twice as likely as nonsmokers to contract kidney cancer.

Researchers led by Dr. Robert Amato, medical

director of the Genitourinary Oncology Program at Methodist, are examining the effectiveness of an experimental vaccine designed to control the spread of cancer cells in people with stageIV kidney cancer.

The goal of the TroVax Renal Immunotherapy Survival Trial (TRIST) is to determine whether the TroVax vaccine, working in concert with standard kidney cancer treatments (low dose Interleukin 2, Interferon Alpha or Sunitinib), can prolong

WWW.METHODISTHEALTH.COM

The kidney cancer vaccine is designed to turn on the body’s production of antibodies and kill cancer cells. the lives of these patients, who are usually given only 11 to 12 months to live at the time of diagnosis.

The experimental vaccine is made up of the virus found in the smallpox vaccine. Researchers have taken the virus and combined it with a gene for the protein called 5T4, which is found on kidney cancer cells. The vaccine is designed to “turn on” the body’s production of

antibodies and kill cancer cells in a similar fashion to the way the body fights bacteria or other viruses.

An early result in more than 50 patients has shown that the vaccine has been effective in killing the kidney cancer cells and prolonging the lives of patients. This worldwide study is looking for 700 stage-IV kidney cancer patients over a two-year period. Amato also is con-

ducting a similar trial for prostate cancer.

“Once kidney cancer has spread to the rest of the body, the best we can hope for is to slow the progression of the disease,” he said. “The hope is that the TroVax vaccine will do just that and give these patients a little more time to be with their loved ones.”

The cutting-edge research being conducted

5-YEAR SURVIVAL RATES 1996 -2003 LUNG, KIDNEY AND OVARIAN CANCERS

Rate Per 100,000 Population

100

My grandfather had a license plate that read “Let Me Tell You about My Grandchildren.” If he would have been part of one of these trials, who knows — he might still be doing just that. 䡲 To find out more about the TRIST study, call 713.441.7949.

OVARIAN KIDNEY

80

at The Methodist Hospital is not only breaking new ground and looking for cures, it also is providing hope to people who just might not have any left.

LUNG

60

40

20 ALL STAGES

LOCALIZED

REGIONAL

DISTANT

UNSTAGED

Localized: limited to one area within a region Regional: extends to an adjacent area within a region Distant: metastasized Unstaged: undiagnosed Source: SEER Cancer Statistics Review, National Cancer Institute

WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 23

BY AMI FELKER

A different kind of list The first chore on most husbands’ weekend “honey do” list is cleaning out the garage or mowing the lawn, but Troy Himes’ list was different. No. 1 on his list? Undergo four hours of kidney dialysis every Saturday.

A Type 2 diabetic since the age of 13, Himes’ condition slowly deteriorated until he developed end-stage kidney failure and his kidneys could no longer function on their own.

For three years, he underwent kidney dialysis treatments in his home three times a week. The treatments themselves were not painful, but they left him tired and lethargic. His rockbottom energy level even left him unable to play with his baby son Damien.

Planning family vacations was a chore because he had to locate and make special arrangements with a dialysis center near their destination so he could maintain his treatment regimen. While many young families took trips to exotic locations, the Himes stayed relatively close to home and visited family in South Carolina.

When it was determined that Himes needed a kidney transplant, his wife Cassandra immediately agreed to be tested to determine if she could donate one of her kidneys. “We had just had our son and I knew he needed a father so I jumped at the chance to see if I could give Troy another chance at life,” she said.

The high school English teacher said she knew before the tests came

Cassandra, Damien and Troy Himes. Troy encourages more people to become organ donors because there are thousands of people waiting on a transplant.

24 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

“We share more than just love now.

A part of her is inside me.” back that she would be a match. When the results were in she said, “This was just confirmation that we’re the perfect match.”

On Jan. 31, 2006, the couple underwent the transplant that would join them forever. Now, two years later, Troy Himes has a renewed zest for life. He is energetic and has returned to a normal life, caring for his loving wife and son, now four years old.

“Now I’m able to go places, dedicate myself to my job, and life has just been great,” he said. “I’m looking forward to enjoying the rest of my life with my family.”

H

imes, now 36, is among more than 20 million Americans who suffer from diabetes, according to the American Diabetes Association. Type 2 diabetics like Himes don’t produce sufficient insulin or their body ignores the insulin it does produce. Type 2 diabetes, which accounts for approximately 95 percent of diabetes cases, is rising by epidemic proportions in the United States due in large part to obesity.

“We do everything we can to help prevent kidney failure in our diabetic patients,” said Dr. Horacio Adrogué, transplant nephrologist at The Methodist Hospital.

This includes tight control of the diabetes through medications and lifestyle; control of blood pressure and cholesterol; and restriction of excess salt. “We are continually researching additional ways to prevent

kidney failure, including the role of diet, modest protein intake and not smoking,” he said.

If and when a patient’s kidneys do start losing function, dialysis — which performs the mechanical function for the kidneys — and kidney transplants currently are the only treatment options. Methodist physicians encourage all kidney failure patients to consider preemptive transplant, which involves seeking living donors before they need dialysis.

“Dialysis is certainly a life preserving treatment, but it greatly affects a patient’s quality of life. Preemptive kidney transplants from living donors can help patients prevent that intrusion on their lives,” said Dr. Graham Guerriero, surgical director of kidney transplantation at Methodist. “Patients who receive kidneys from living donors tend to do better than those transplanted with kidneys from deceased donors.”

Today, there are more than 75,000 people across the United States on the kidney transplant waiting list. In 2006, less than 11,000 of those waiting received kidneys from deceased donors, while 6,500 received kidneys from living donors. Adrogué says that more people are added to the waiting list every day, so live donation is absolutely critical to help loved ones have longer, healthier and happier lives.

Guerriero, who has been part of the kidney transplant program at Methodist since it began in 1963, said the patients who do best are those who are compliant with the medication and lifestyle requirements.

Methodist Transplant Center is committed to exceeding the expectations of those it serves through comprehensive evaluation, extensive patient education and team-oriented care. Transplant Center physicians and staff are prepared to meet all patient needs, from transplant evaluation to long-term follow-up care after transplant. State-of-the-art facilities and technology ensure patients receive leading-edge care.

In addition to transplant procedures, the following services are provided by Methodist’s transplant team: Coordination of care by organ-specific transplant nurse coordinators Ongoing communication with referring physicians throughout the transplantation process 24-hour accessibility to the transplant team Relocation and accommodation assistance Financial counseling services

WWW.METHODISTHEALTH.COM

Access to cutting-edge clinical research trials Multidisciplinary transplant education classes Active monthly caregiver support groups Weight loss programs Smoking cessation classes

VOLUME 4, NUMBER 4 25

list

“Like most things in life, what you put in is what you get out of a kidney transplant.”

He says it’s important to know that kidney transplants do not change diabetes, but rather free patients from the need for dialysis and restore their ability to filter their own blood. “Like most things in life, what you put in is what you get out of a kidney transplant,” he said.

H

imes is among one of the quickly expanding group of patients who receives a kidney from living donors — mothers, fathers, children, siblings, friends and even fellow church members.

He and his wife work hard to care for his new kidney, and to help raise awareness about the priceless gift of

organ donation. He encourages more people to become donors because there are thousands of people on the waiting list.

He says it’s a great feeling not to have to worry about undergoing dialysis. He is eternally grateful to his wife for her personal sacrifice for their family. “This confirms the love she has for me. We share more than just love now, a part of her is inside of me,” he said.

Methodist expands transplant program Dr. Osama Gaber, division director of transplantation at The Methodist Hospital, is expanding the hospital’s kidney, pancreas and islet cell programs. World renowned for his clinical care and research in transplantation, he has published nearly 250 articles and more than 300 abstracts about kidney, pancreas, liver and transplant surgery. Much of his research has become standard practice in the field.

Prior to coming to Houston, Gaber served as medical director of transplant research at Methodist University Transplant Institute in Memphis, TN.

Donation and Transplantation Myth Busters MYTH: Organs can be purchased on the black market in the United States.

BUSTED!

The National Organ Transplant Act (NOTA) prohibits the sale of human organs, stating, “It shall be unlawful for any person to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration for use in human transplantation.”

And due to the complexity of transplantation, piracy is virtually impossible.

The process of matching donors with recipients and the need for highly skilled medical professionals and modern medical facilities make it highly unlikely that this system could be duplicated in secrecy. Even living donors are screened by social workers and psychologists to ensure there are no financial motives and that the donor’s intentions are completely altruistic.

National Organ Transplant Act P.L. 98-507

26 VOLUME 4, NUMBER 4

MYTH: Physicians may not do everything they can to save an organ donor’s life.

BUSTED!

Physicians involved in a patient’s care during an emergency or critical care setting are prohibited from having anything to do with transplant programs. The law states “in order to avoid conflict of interest, the physician who determines and/or certifies the death of a potential organ donor should not be involved in the organ removal or in subsequent transplantation procedures or responsible for the care of the potential recipients of these organs.”

The organ donation center is not involved until all lifesaving efforts have been made.

World Medical Association Statement on Human Organ Donation and Transplantation Adopted by the 52nd WMA General Assembly in 2000 and revised by the General Assembly in 2006

MYTH: People can recover from brain death.

BUSTED!

A person cannot recover from brain death. Brain death indicates that there is irreversible loss of all brain and brain stem function, and there is zero probability of recuperating from this. At Methodist, physicians determine brain death through clinical tests that measure primitive brain reflexes and blood flow that are present in all living humans. These tests are conducted when a patient is considered to be brain dead as manifested by a complete loss of consciousness, vocalization and spontaneous movement.

The Methodist Hospital Official Procedure PC/PS 08 Also see: Sec. 671.001(b) of the Texas Health & Safety Code

For more information on how you can become an organ donor, visit www.methodisthealth.com.

WWW.METHODISTHEALTH.COM

When your loved one no longer recognizes you

BY ERIN FAIRCHILD

As many as 6 million people in the United States are currently living with dementia: 6-to-8 percent of people over the age of 65 and nearly 30 percent of those over 85 have dementia.

Dementia and the vulnerability it imposes on its victims is one of the most profound hardships endured by the fast-growing population of Americans over 65. The condition slowly robs people of their dignity and their life-long memories — memories that make them who they are or at least who they were.

“The impact of dementia is so great; it deeply affects not only the patient but also the patient’s family and loved ones,” said Dr. George Taffet, geriatrician and chief of the Geriatrics Section at The Methodist Hospital and Baylor College of Medicine. “The families feel powerless as they see their father, grandmother or spouse grapple with the frustrations of being aware of their own mental decline. Then, the dementia robs the awareness as the one they love slowly fades away.”

WWW.METHODISTHEALTH.COM

What is it?

Taffet says dementia is a manifestation of a number of progressive neurological disorders with symptoms that include memory loss; loss of the ability to problem solve, perform normal daily activities and control emotions, among other things. Personalities may change.

Patients may become agitated, delusional or see things that are not there.

Geriatric patients often are plagued with a myriad of afflictions that can be devastating to their quality of life and their sense of independence.

Diseases that are common in the elderly run the gamut of medical specialties — from rheumatology to endocrinology to psychiatry.

At Methodist, geriatric patients have access to world-class physicians, leading-edge technology and research, and an extensive array of patient services to address their health concerns. The Methodist Hospital ranked in geriatrics on U.S.News & World Report’s

“America’s Best Hospitals” list because it provides excellent geriatric clinical care and because of its comprehensive centers in areas that most affect older patients such as neurology, heart, cancer and orthopedics; and palliative care, rehabilitation and pain management services.

For patients with dementia, there are medications and treatments available to help reduce the neurological decline for some types of conditions, but oftentimes some of the best medicine is the use of support services to help those with dementia live with it.

Methodist’s Institute for Palliative Medicine encompasses an interdisciplinary team that includes medical professionals, social workers, chaplains and therapists to work in conjunction with medical treatment to provide support, while addressing physical, psychological and quality-of-life issues often faced by patients with dementia. Having a solid support team in place is critical VOLUME 4, NUMBER 4 䡲 27

DEMENTIA

because dementia patients may not be able to comply with discharge orders such as taking medicine properly.

What causes it?

There are many causes of dementia, including Alzheimer’s disease and stroke. According to the National Institute of Neurological Disorders and Stroke (NINDS), Alzheimer’s disease is the most common cause of dementia in people aged 65 and older. As many as 6 million people in the United States are currently living with dementia: 6 to 8 percent of people over the age of 65 and nearly 30 percent of those over 85 have dementia.

Other diseases that can cause symptoms of dementia include Huntington’s disease, Parkinson’s disease and Creutzfeldt-Jakob disease. Reactions to medications, metabolic and endocrine problems, and nutritional deficiencies are among the numerous conditions that also can cause dementia and dementialike symptoms.

Early detection and understanding the underlying cause of dementia is important in order to effectively treat it. If you or a loved one is experiencing any of the following symptoms, consult a physician: 䡲 impaired memory, thinking and behavior 䡲 confusion 䡲 restlessness 䡲 personality and behavior changes 䡲 impaired judgment 䡲 impaired communication 䡲 inability to follow directions 䡲 language deterioration 䡲 impaired visiospatial skills 䡲 emotional apathy 䡲

28 䡲 VOLUME 4, NUMBER 4

Tips for patients and their families who are dealing with loved ones who have dementia.

USE MEMORY AIDS.

BE ACTIVE AND INVOLVED.

Many times long-term memories are intact, but shorter-term memory is compromised. This makes it hard to learn new tasks such as a new process on the computer or how to find a new restaurant.

Sometimes it is difficult to recall whether the doors have been locked or the washing machine is turned on.

Writing down directions and posting reminders can be very helpful and can relieve stress and anxiety.

Participate in activities that you enjoy.

Engage not only your mind but also your body. Exercise, walk, bowl or volunteer your time.

PLAN. As early as possible, it is smart to review wills, discuss endof-life issues, and designate medical and financial powers of attorney.

Making plans now rather than later ensures that family and loved ones can honor the patient’s wishes.

Discuss with loved ones that there may come a time when driving is not a safe option, and make plans on how to deal with that scenario.

DISCOURAGE FRAUD. Memory loss and other symptoms of dementia leave patients open to vulnerabilities that can be exploited by unscrupulous solicitors. To limit access to potential confrontations, join the national Do Not Call lists and remove addresses from unwanted mailing lists. Invest in a computer security and monitoring program.

ELIMINATE DAILY TASKS THAT CAUSE STRESS OR ANXIETY DUE TO ILLNESS. Many banks offer automatic bill paying services. Grocery stores will deliver. Home cleaning services that may have seemed like a luxury earlier in life may now be a very therapeutic and healthy option for people with symptoms of dementia, as well as their care givers.

TALK TO CLOSE FRIENDS ABOUT YOUR MEMORY LOSS. This may seem difficult. It may seem easier to try to hide it or to avoid people. Friends may not know how to react, but an open discussion leads to understanding and support.

GET SUPPORT. Contact one of the many organizations that provide services for people with dementia and Alzheimer’s. Good places to start include www.alz.org, www.nlm.nih.gov/medlineplus/dementia. 䡲

WWW.METHODISTHEALTH.COM

DIABETES: A CATEGORY 5 HURRICANE FOR AMERICA B Y

E R I N

F A I R C H I L D

H

mm, I’m in my mid-40s, have a family history of diabetes and I’m overweight. That’s really not so bad, Pearl Franklin thought to herself. After all, I’m smaller than everyone else in the family.

Sound familiar?

Franklin didn’t educate herself about her diabetes or ways to control it. She reminisced about how her diabetic father would sneak candy and other sweets when her mother wasn’t looking. And he was OK. Sound familiar yet?

For years she ignored her diabetes until the day she found herself in her doctor’s office with chest pains. She was having a heart attack. Her refusal to come to grips with her medical condition had made her a statistic.

Dr. Dale Hamilton

WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 29

DIABETES

c

A person with diabetes has the same high risk of having a heart attack as someone who has already had an attack.”

Franklin, like thousands of other diabetics, was unaware that there is a close relationship between diabetes and heart disease. “I was in denial,” she said, now 10 years later. “That heart attack was a blessing. I realized right then and there that I wanted to be around a little longer.”

Diabetes researcher and endocrinologist Dr. Dale Hamilton says diabetes doesn’t get the attention that heart attack does because people don’t make the connection between the two although both can be deadly.

“A person with diabetes has the same high risk of having a heart attack as someone who has already had an attack,” Hamilton says.

“And if someone with diabetes has a heart attack, he is four times more likely to develop heart failure.”

The heart muscle burns fat and glucose, or blood sugar, as fuel. A diabetic heart can’t receive glucose to burn and this can leave it starved for energy. So the diabetic heart burns a mixture rich in fat (triglycerides) from the blood. The body then reacts by increasing the amount of blood sugar, raising triglycerides and reducing the amount of good cholesterol (HDL) in the patient’s blood.

These compensatory changes accelerate the formation of plaque in the blood vessels, which hardens the arteries and increases the patient’s

METABOLIC SYNDROME RISK FACTORS Risk Factor

Defining level

Body Mass Index

> 30 kg/m2

Triglycerides

>= 150 mg/dl

HDL-cholesterol

Men < 40 mg/dl Women <50 mg/dl

Fasting glucose

>= 110 mg/dl

Blood pressure

>=130/>=85 mmHg

Clinical identification of the metabolic syndrome is defined by presence of at least three of the five risk factors.

30 䡲 VOLUME 4, NUMBER 4

risk for heart attack and stroke. A vicious cycle is silently set in motion, a cycle of increased risk at a time when the heart muscle is weakened.

“It’s a tragic sequence, and it can go on for years,” Hamilton says. “The patient doesn’t feel acutely ill while this is going on, just sluggish, so it is easy to ignore. The patient may attribute it to aging and believe that nothing is wrong medically.”

But in fact, it’s like a storm brewing in the Gulf of Mexico, gaining force, eyeing the shore where it will bring torrential rain, raging winds and destruction. According to Hamilton, it’s a public health epidemic — a category 5 hurricane — for America.

Nearly 21 million Americans have diabetes. According to the American

WWW.METHODISTHEALTH.COM

the storm turns into a hurricane.

By reducing abdominal fat, a patient can dramatically reduce his or her risk for heart attack and stroke.

By controlling the diabetic blood sugar, the patient’s risk is even further reduced.

Complacency in the early years of this process, however, can have an adverse effect on long-term survival and quality of life. Over the long-term (12 to 15 years), diabetes can reach an irreversible state, but before then it is reversible.

Dr. Hamilton and nurse practitioners (from left) J.R. Rollins, Eunice Ihaza, Paula Westergren and Saundra Hendricks discuss patient treatment plans.

Diabetes Association, only 14.6 million have been diagnosed, leaving nearly one-third of diabetics unaware that they even have the disease.

The prevalence of diabetes grows exponentially as Americans accumulate characteristics of the metabolic syndrome — a group of conditions that increase your risk for heart disease and diabetes (see table).

Body fat located in the hip area, for example, is inactive. Body fat located in the central abdominal region of the body (between the rib cage and belly button) is the most dangerous kind of fat because it secretes toxic substances and chemicals (hormones) that contribute to heart and vascular disease. When a patient combines that with the increased risk from elevated diabetic blood sugar,

WWW.METHODISTHEALTH.COM

DIABETES HEART PROGRAM Hamilton collaborated with the Methodist DeBakey Heart & Vascular Center to develop the Diabetes Heart Program, designed to help patients prevent the progression of diabetes and complications — heart attack and stroke — associated with it. Hamilton’s program, the largest in the country, is one of only two in the nation. His clinic sees approximately 3,000 patients a year.

Establishing a long-term relationship with each patient is essential to the success of the program, Hamilton says. “We must maintain a high-level continuity of care to be able to provide each individual with qualified, experienced people who have time to pick up the phone and answer the multitude of questions that arise when their patients are trying to control their blood sugar,” he said. “Managing diabetes is a daily

struggle, and the program provides personal interaction and assistance whenever needed.”

The program provides medical nutrition therapy to help patients lose weight and maintain a healthy weight because diabetes often can be cured with weight loss.

Before joining the Heart Diabetes Program, Franklin had no energy. She was “tired and sluggish — just existing.” Now an active participant in the program, she has controlled her diabetes for a year. She says she knows more about how diabetes affects her body and how to treat it.

“Now I am in control of my body and the disease,” she said. “It doesn’t control me.” 䡲 For more information about the Diabetes Heart Program, call 713.441.4452.

Internationally recognized diabetes researchers join Methodist Drs. Willa Hsueh and John D. Baxter, two of the nation’s foremost physician-scientists in the fields of diabetes and cardiovascular disease, have joined The Methodist Hospital Research Institute, expanding its ability to find better treatments and a potential cure for diabetes and its complications, such as heart attack and stroke.

(See page 16 for more about these renowned physicians.)

VOLUME 4, NUMBER 4 䡲 31

A meeting of the minds B Y

When we think of legendary stage and screen actor Kirk Douglas, we think of a tough guy.

He was Spartacus and Doc Holiday in “Gunfight at the O.K. Corral.” The characters he portrayed were always looking for a fight.

In real life, however, Douglas almost gave up the fight.

32 䡲 VOLUME 4, NUMBER 4

M A U R E E N

In 1996, at the age of 79, Douglas suffered a debilitating stroke that severely impaired his speech. In his book “My Stroke of Luck,” he describes feelings of hopelessness. He couldn’t speak, he couldn’t act.

The cleft-chinned movie icon whose career spanned 40-plus years and more than 90 films had lost his ability to continue his life’s work.

What did he have to live for? Through his steely blue eyes — the ones that had caused thousands of young girls to swoon — he saw no future worth having.

K O V A C I K

Severe depression and despair led the three-time Academy Award nominee to put a gun in his mouth, but suicide was not his fate. He bumped his tooth, started to laugh at his failed attempt, and decided he, in fact, did want to live.

DEPRESSION CAN HINDER RECOVERY Depression after an illness such as a stroke or chronic medical condition like heart disease, diabetes or kidney disease is not uncommon. In fact, 10 to 27 percent of stroke patients suffer from major depression; and the number grows to 40 to 65 percent of patients who

suffered a heart attack.

Comorbid psychiatric disorders — psychiatric disorders that exist simultaneously and usually independently of another medical condition — such as depression, anxiety, psychotic symptoms or behavioral and cognitive changes are frequently seen in patients in a hospital setting.

“It is important to recognize mood disorders, such as depression in a timely manner because untreated clinical depression hurts the recovery process,” said Dr. Ranjit Chacko, vice chair of psychiatry at The Methodist Hospital.

WWW.METHODISTHEALTH.COM

Neurologists and psychiatrists collaborate to affect patient outcomes after potentially catastrophic illnesses

“Methodist psychiatrists collaborate with neurologists, neuropsychologists and rehabilitation physicians and therapists to provide the best possible outcome after a potentially catastrophic illness.”

In addition to this team approach, patients benefit from treatment at Methodist because the hospital has the only inpatient psychiatric unit in the Texas Medical Center.

The hospital’s unique psychiatric service provides psychiatric acute care to the medically ill inpatient. Patients are evaluated in neurology, medical or intensive care units, such as the stroke unit, or transferred to the psychiatric unit, for management of safety and behavior, as required.

Symptoms of depression may be more difficult to identify in the medically ill patient but generally are similar to patients who develop the disorder independently. They include sadness, loss of interest, unexplained weight loss, insomnia, fatigue, and negative or suicidal thoughts.

Depression may be directly caused by damage to critical areas of the brain, which deplete neurotransmitters — chemicals within the brain that

WWW.METHODISTHEALTH.COM

or interact with those given for the medical condition.

“Also, medications that are used to treat the physical problem may affect a patient’s mood,” said Methodist psychiatrist Dr. Priscilla Ray. “Known as secondary depression, doctors have to rule out such side effects before they provide treatment.”

Dr. Ranjit Chacko

enable nerve cells to communicate with each other.

When these neurotransmitters are damaged, mood symptoms may occur.

A stroke, for example, can damage an area of the brain that may alter the patient’s mood, cognition and behavior. Patients with Parkinson’s disease or multiple sclerosis are other examples of neurological disease where mood disorders are frequently seen and require careful evaluation and treatment.

Under these circumstances, depression is more difficult to treat. The physician must be skilled in the selection of antidepressants because certain medications may compromise

THE ROOTS OF NEUROPSYCHIATRY Ancient psychiatry began around the fifth century B.C. with the belief that mental disorders came from supernatural sources. By the Middle Ages, psychiatric “hospitals” were established, but the concept of treating mental disorders medically didn’t really take hold until the 20th century.

“There is a considerable overlap between the fields of neurology and psychiatry,” Ray said. “Sigmund Freud was originally a neurologist and was among the first to realize that not all disorders stem from a neurological source.” Modern psychiatry now involves an interdisciplinary approach involving biological and social science. Neurology is an integral part of this approach.

“Recent research indicates that patients with

recurrent (occurring time after time) depression, who are not adequately treated to remission, may be more likely to develop dementia later in life,” said Chacko, who is also professor of psychiatry and behavioral sciences at Baylor College of Medicine.

“Effective treatment to remission of severe mood disorders could even help prevent future development of dementia. Here at Methodist, we have some of the best minds and best technology to help improve the outcomes of these patients,” he said.

As for Kirk Douglas, he battled his way out of depression with the help of his physicians, the proper medication, speech therapy, friends and family. He even returned to the big screen in the 1999 movie “Diamonds,” where he portrayed an ex-prizefighter who, with heart and determination, fought back after a stroke. 䡲

VOLUME 4, NUMBER 4 䡲 33

Sight save B Y

M A R Y

B R O L L E Y

“Eye changes in diabetics can occur quickly. Eyes can be normal one year and severely damaged the next.”

For a growing number of Americans diagnosed with diabetes, a simple hour-long test can help ensure that they not only experience life’s most touching moments, but witness the wonder and beauty of them, too.

Whether it’s seeing the joy on a daughter’s face as she floats down the aisle to take her wedding vows, or the wobbly determination of a baby taking his first steps, this test — a complete dilated eye exam — can make a significant difference in a diabetic’s quality of life.

That’s because diabetes can damage the blood vessels in the eyes, resulting in diabetic retinopathy — a disease that can cause vision loss or even blindness. It occurs when the retina becomes damaged by leaking or obstructed blood vessels.

There are four stages of diabetic retinopathy, ranging from mild nonproliferative retinopathy, where microaneurysms — small areas of balloon-like swelling in the retina’s blood vessels — develop, to proliferative retinopathy, its most advanced stage.

In most cases, there are no symptoms in the early stages of the disease. By the time warning signs appear, the disease may be well under way. The longer you have diabetes, the more likely you are

34 䡲 VOLUME 4, NUMBER 4

to develop diabetic retinopathy.

Further, between 40 to 45 percent of Americans diagnosed with diabetes have some stage of the disease.

“Eye changes (in diabetics) can occur quickly,” says Dr. Tien Wong, an ophthalmologist at The Methodist Hospital. “Eyes can be normal one year and severely damaged the next.”

Fortunately, new drug treatments currently in clinical trials at Methodist and the Cullen Eye Institute at Baylor College of Medicine may decrease the need for laser surgery, now the standard of care for treating the disease.

New treatments are needed because diabetic retinopathy — the most common diabetic eye disease and a leading cause of blindness in American adults — will likely rise as Baby Boomers age and, increasingly, succumb to diabetes. In fact, ophthalmologists expect a 65 percent increase in the disease by 2020.

Increasing Awareness Diabetic retinopathy is one of five age-related eye diseases that have spurred the launch of an awareness campaign — “EyeSmart”— sponsored by the American Academy of Ophthalmology.

WWW.METHODISTHEALTH.COM

rs

Dr. Tien Wong

EyeSmart was developed in response to studies indicating that Americans are largely unaware of the risks they face from age-related eye diseases. For example, although the consequences of diabetic retinopathy are severe, few Americans seem concerned about their risk of developing it.

Wong strongly urges newlydiagnosed diabetics of any age to have a complete eye exam promptly, and follow up with their ophthalmologist every year without fail.

The exam should be a dilated exam so that the doctor can establish a baseline picture of the condi-

WWW.METHODISTHEALTH.COM

tion of the patient’s eyes and vision.

After the baseline exam, the ophthalmologist will be able to advise the frequency of subsequent exams.

Diabetic retinopathy causes two main problems: macular edema, a swelling in the back of the eye; and new blood vessel growth. The latter is the body’s automatic response to the existing damage, spurring the growth of more blood vessels to heal the retina but doing more damage in the process.

In its early stages, diabetic retinopathy may be controlled by monitoring blood sugar, blood pressure and blood cholesterol. But if the disease

progresses to proliferative retinopathy, treatment nearly always involves laser surgery.

“Laser treatments are the mainstay — the only proven treatment,” says Dr. Eric Holz, an associate professor of ophthalmology at Baylor College of Medicine.

For macular edema, eye surgeons cauterize the swollen and leaking vessels with a laser to stop them from leaking. For new blood vessel growth, they zap the diseased peripheral retina to save the central retina, which is crucial for reading, driving, etc.

VOLUME 4, NUMBER 4 䡲 35

Sight savers

Dr. Eric Holz

“We turn sick retina (on the edges) into dead retina,” Holz says.

“This may stop retinal detachments from happening.”

Finding what works best The new clinical trials test the effectiveness of sustained-release steroids and injections of anti-angiogenic drugs that have been effective in treating macular degeneration.

(The studies are in the early stages, so neither physician was able to comment on their progress.)

Because these anti-angiogenic drugs block the growth of new blood vessels, they may be an improvement over lasers.

36 䡲 VOLUME 4, NUMBER 4

“Laser treatment is destructive,” Wong says. “If we can minimize the amount (of lasers) used, we can preserve more retina and hence, more vision.”

Data gathered from Wong’s patients is contributing to the Diabetic Retinopathy Clinical Research Network, a national database of research on diabetesinduced retinal disorders. “Our patients are helping us discover what works best,” he says.

Holz says his patients value their sight greatly and are willing to make lifestyle changes and participate in experimental trials to save or keep their vision. “Nothing is as concrete as vision to a patient,” he says. “The impact of my work is very apparent to the patient and the doctor.”

The ultimate goal of the studies, Holz says, is the discovery of a safe and effective drug that can be packaged in a sustained-release capsule for implantation in the eye, providing longer-term protection from the ravages of the disease.

Wong, too, believes these new treatments are a promising option for saving the sight of Americans afflicted with diabetes. “Diabetologists expect an epidemic increase in diabetic retinopathy in years to come,” he says. “This (the clinical trials under way) is exciting stuff. I love being at the cutting edge of retinal treatments.” 䡲 To obtain a physician referral, call 713.790.3333 or visit methodisthealth.com.

WWW.METHODISTHEALTH.COM

Have chronic sinus infections?

Try balloons B Y

G A L E

S M I T H

D

r. Henry Vu hated his occasional nose bleeds. They were as annoying as the smog he thought caused them. He figured the Houston air and pollution wreaked havoc on everyone’s sinuses, so why should he be any different?

Eventually, the bleeding became more frequent and even more annoying. Between the single father’s hectic work schedule as an anesthesiologist in the Texas Medical Center and spending time with his young daughter, he didn’t have the patience to deal with this problem.

But a conversation with a colleague stunned him, and the 44-year-old Vu started paying attention.

While working in an operating room one day, his nose started bleeding heavily. He asked a colleague to check him out.

The biopsy result shocked him. He had nasopharyngeal (nose) cancer. The annoyance had become his worst nightmare.“Initially, I didn’t believe the biopsy.

This kind of cancer is common in Chinese men, and I’m Vietnamese, so I thought it was a mistake,” Vu said.

Dr. Mas Takashima WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 37

Sinus Infections

“Being in the medical field, I wanted something noninvasive and effective so I could return to my life quickly.”

B

“

ut when I finally accepted the diagnosis, I was worried for my daughter’s future. My doctor told me I would have six months to live if I didn’t undergo the treatment regimen.”

Vu persevered through the six months of radiation and chemotherapy, and through the pain and fatigue, all the while remembering that he had to survive for his young daughter. He beat the cancer.

Environmental irritants not to blame But within weeks of becoming cancer-free, his nose started bothering him again. This time, he experienced a different set of problems — a runny nose, severe facial pain, headaches and nasal congestion. Once again, Vu thought the Houston air was to blame. Turns out, the cancer treatment left scarring in his nasal passage, causing him to have severe sinusitis.

“I tried saline irrigation and steroids. Nothing worked,” he said.

He talked with colleagues and knew traditional sinus surgery would have been too invasive, since radiation decreases blood supply to the surrounding tissues, and traditional surgical manipulation in these areas can cause non-healing wounds or bone infections.

After living with the sinus infections for more than a year, Vu had enough. He had heard about a minimally invasive procedure called Balloon Sinuplasty™. He turned to his long-time friend, Dr. Mas Takashima, a head and neck surgeon at The Methodist Hospital. He knew Takashima performed this procedure and, more importantly, he trusted him.

“Being in the medical field I wanted something noninvasive and effective so I could return to my life quickly,” Vu said.

Although Takashima was one of the first surgeons in Texas to use this technique for routine sinus infections, Vu turned out to be Takashima’s first nasopharyngeal cancer patient to undergo the procedure.

“It is much like angioplasty of the heart arteries, but instead, the balloon expands the opening of the sinuses,”

38 䡲 VOLUME 4, NUMBER 4

said Takashima, assistant professor of otolaryngology at Baylor College of Medicine.

During Vu’s procedure, Takashima inserted a small balloon catheter to quickly open and expand the blocked sinuses. In Vu’s case, his right maxillary sinus was infected. The small, flexible balloon catheter was placed through the right nostril into the blocked sinus passageway.

Takashima inflated the balloon, causing microfractures to the bone like crackled paint on a 16th century vase. These small fractures gently restructured the nasal passageway, allowing Takashima to create a larger opening in the sinuses. By doing so, he restored normal drainage and function to Vu’s nose with virtually no tissue trauma.

Patients who undergo Balloon Sinuplasty have significantly less bleeding, trauma and nose swelling, and many who undergo this endoscopic (use of scopes to see inside the nasal cavity) procedure are able to return to normal activities within 24 hours.

“The biggest complaint I receive from patients who have had traditional sinus surgery is that they don’t like having their noses packed after surgery. With Balloon Sinuplasty, we don’t have to do that.”

A chronic health problem Sinusitis is one of the most common chronic health problems in the United States, afflicting 37 million Americans each year. Sinus problems can significantly impact a person’s physical, functional and emotional quality of life.

According to Takashima, the nose protects itself from environmental irritants such as allergens and pollution by creating mucus. As this occurs, the nasal passages swell, and the small opening to the sinuses becomes blocked. Once the fluid in the sinus area stagnates, bacteria sets in, causing infection and more swelling occurs, perpetuating the cycle.

Until recently, sinusitis patients were limited to two treatment options — medical therapy, such as antibiotics

WWW.METHODISTHEALTH.COM

and topical nasal steroids, or conventional sinus surgery, which requires bone and tissue removal to open blocked sinus passageways.

“Balloon Sinuplasty is a great advance in sinus care because it means faster recovery times and less discomfort afterward,” according to Dr. Gene Alford, a plastic facial and reconstructive surgeon at Methodist who performs the procedure, as well as trains other physicians on how to perform it. “This procedure also can work for people who have undergone traditional surgery but continue to suffer from sinusitis or scar tissue.”

Balloon Sinuplasty is most effective for the frontal sinuses, located in the forehead, because they are difficult to access by traditional surgical means, but the procedure also can be used for most other sinuses.

Takashima and Alford have performed nearly 70 of these procedures at Methodist. Alford also has trained seven physicians, using sinuplasty equipment and demonstrating the placement of the balloon catheter, inflation and other aspects of its use.

As for Vu, he is breathing much easier these days.

The cancer is gone, and he spends quality time with his daughter. He hopes other nose cancer patients in similar situations will be able to have Balloon Sinuplasty if it is the best option available for their care.

“I’m doing great,” Vu said. “No more chronic sinusitis and no more antibiotics. This was the perfect solution for me.” 䡲 To obtain a physician referral, call 713.790.3333 or visit methodisthealth.com.

Patients who undergo Balloon Sinuplasty have significantly less bleeding, trauma and nose swelling.

Ranking reflects commitment and quality Physicians like Drs. Mas

services that ENT

Takashima and Gene Alford

patients have

play a significant role in The

access to at

and stereotactic radio-

tive care, a pain manage-

Methodist Hospital’s commit-

Methodist. These

surgery, which deliv-

ment program, rehabilitation

ment to quality of care for

include: a single-

ear, nose and throat (ENT)

occupancy room

radiation to a targeted

patients. This commitment is

designed to mini-

area in as few as one

reflected nationally in

mize the possibility

U.S.News & World Report’s

of infection through the use

2007 Best Hospitals rankings,

of controlled ventilation, air

U.S.News also recognized

on U.S.News & World

where Methodist’s ENT

pressure and filtration;

Methodist’s ENT Department

Report’s “America’s Best

(otolaryngology) department

a positron emission tomo-

for the numerous services

Hospitals” list. 䡲

is ranked 18th in the nation.

graphy scanner, which pro-

offered to make patients’

One of the reasons for this

vides ENT physicians with

hospitalizations as comfort-

recognition is the advanced

images showing the functional

able and worry-free as

WWW.METHODISTHEALTH.COM

performance of the heart, brain and other organs;

ers a high dose of

treatment session.

possible. Services offered include hospice care, pallia-

care and translators.

For the past four years, Methodist’s ENT Department has ranked in the top 20

VOLUME 4, NUMBER 4 䡲 39

B Y

P A U L A

R A S I C H

&

E M M A

or people who live with unexplained chest pain, difficulty swallowing, heartburn or a persistent feeling like something is stuck in their throat, obtaining an accurate diagnosis can be challenging. But in the last two years, two high-tech breakthroughs for the most common esophageal tests — manometry and pH monitoring — have made it easier for doctors to pinpoint the precise cause of some digestive conditions.

V.

C H A M B E R S

“ManoScan technology gives us the ability to obtain a clear picture of the muscle movement of the esophagus, helping us to determine if the cause of the patient’s discomfort is muscular,” said Dr. Gulchin Ergun, clinical chief of the Digestive Disease Section at The Methodist Hospital.

“We can look into the esophagus with X-ray or endoscopes, but the only way to evaluate the wave patterns of the esophagus is with manometry,” she said. Esophageal

manometry measures and records muscle pressure within the esophagus, the muscular tube that connects the throat to the stomach. ManoScan, which uses high resolution manometry, delivers a reconstructed topographic map of the pressures obtained during that recording.

The ManoScan measures whether or not peristalsis (successive waves of involuntary contraction) or sequential contraction is actually occurring, whether or not there

Dr. Gulchin Ergun 40 䡲 VOLUME 4, NUMBER 4

WWW.METHODISTHEALTH.COM

is enough vim and vigor to the squeeze to push food through, and whether or not the muscle that separates the esophagus from the stomach relaxes appropriately when you eat.

Prior to high resolution manometry, standard manometry was used, but it was limited because it only measured pressure from a few points inside the esophagus. ManoScan’s advanced technology, which collects measurements from 36 different locations, alerts physicians to what is triggering a patient’s symptoms, enabling them to choose the best possible therapy. It decreases the chances of misdiagnoses, inappropriate treatments and technical mishaps. “If you don’t go this extra step, a patient could be mistreated,” Ergun said.

During a two-hour procedure, in which the patient sits or lies on his side, the physician threads a catheter through the nose into the esophagus. Then the patient is instructed to swallow saliva or water.

Sensors on the catheter then record, transmit and translate information to a contour map image shown on a computer screen.

The ManoScan collects the measurements and assembles that information to create a topographic contour of the esophagus during swallowing. This test is faster and more comfortable than standard manometry and allows doctors to collect all information about the squeeze of the swallow in one picture.

WWW.METHODISTHEALTH.COM

Patients can’t eat or drink for eight hours prior to the test but can eat and resume normal activities immediately following the test.

GOING WIRELESS or the 15 million Americans who experience the common symptoms of gastroesophageal reflux disease — heartburn and acid indigestion — a new less cumbersome testing method increases patient comfort and allows physicians to gather more information.

Instead of checking for acid exposure in the esophagus with burdensome monitoring equipment, doctors now can track esophageal pH (acid) levels by clipping an acid-sensing capsule, the size of a pencil eraser, to the inside of the esophagus.

The capsule, which contains an acid sensing probe, battery and transmitter, is attached to a catheter and threaded through the nose or mouth into the esophagus where it is attached to the lining.

The catheter is then removed. The patient goes home and eats, sleeps and works normally.

Doctors can capture the pH contents of the esophagus every six seconds for up to 48 hours. The information is recorded through a receiver the patient wears on a belt.

A low pH for long periods indicates frequent abnormal backflow (reflux) of stomach acid into the esophagus or gastroesophageal reflux disease.

The capsule transmits for two days and the battery dies. Five to seven days later, the capsule detaches

HIS ADVANCED TECHNOLOGY ALERTS PHYSICIANS TO WHAT IS TRIGGERING A PATIENT’S SYMPTOMS, ENABLING THEM TO CHOOSE THE BEST POSSIBLE THERAPY. from the esophagus and is passed through the patient’s stool.

“The beauty of this wireless capsule is that patients are much more comfortable and you get 48 hours worth of data instead of 24,” Ergun said. “Because there is a longer study interval, it allows you to gather more information to discover the underlying problem.”

Esophageal acid measurement helps determine if chest pain is being caused by acid reflux. “When you insert a pH sensing device, you can see if a patient has an abnormal amount of acid, and if so, you can be confident about performing surgery,” she said.

People with unexplained chest pain may benefit most from these tests. “These days we have more and more ways to assess how the body functions beyond X-ray or endoscopy.

These advances give us great tools to determine whether a patient’s symptoms are a result of an esophageal muscle dysfunction or abnormal acid contact,” Ergun said. 䡲 To obtain a physician referral, call 713.790.3333 or visit methodisthealth.com.

VOLUME 4, NUMBER 4 䡲 41

Doctors navigate the lung’s dark passages with new magnetic positioning device B Y

D E N N Y

A N G E L L E

Unlike other cancers (colon, prostate, breast) lung cancer has no screening test, so early detection of the disease is crucial.

L

ost? Today’s intrepid explorers just flip on their global positioning system (GPS) tracker and bounce their location off a satellite high above the planet. Within seconds, their pinpointed position is blinking on an amazingly detailed map.

This nifty bit of technology is yet another bit of fantasy swiped from the pages of science fiction and turned into a real-world tool for techno-fanatics. But now, imagine: shrink yourself to microscopic levels and use GPS-like tracking to navigate through the human body, like Raquel Welch and her fellow scientists did in the 1966 movie “Fantastic Voyage.”

Now, instead of miniaturizing yourself, picture a tiny probe guided by a physician, searching for lesions in the dark corners of the human lung guided by electromagnetic navigation like GPS. The captain of this real-world voyage is Dr. William Lunn, chief of Pulmonary Services at The Methodist Hospital and an assistant professor of medicine at Baylor College of Medicine. He uses a tool called navigational bronchoscopy to travel to the distant regions of the lungs and find tiny lesions that could be cancerous or malignant.

“It’s a system that enables us to see far beyond where we can visualize with our current scopes,” he says.

The inReach System, approved by the Food and Drug Administration for use in the United States in 2006, has just been installed at The Methodist Hospital.

42 䡲 VOLUME 4, NUMBER 4

Lunn says the system takes the guesswork out of identifying potentially cancerous lesions in the lung.

Often it is difficult to obtain a good biopsy from a small lesion, so surgeons have to remove it completely.

“For patients who are not good surgery candidates due to their age or other conditions, the new system is a blessing,” Lunn continues. “For a small, potentially treatable lesion we can go in and take a good biopsy and use radiofrequency ablation or ultrasound to kill it off and not affect much healthy tissue surrounding it.”

It helps make earlier diagnosis and treatment of cancer possible and allows patients to avoid more invasive techniques that could cause complications.

This system creates a 3-D road map of the lungs by using computerized tomography (CT) images to pinpoint trouble spots for physicians.

The technology was originally developed to give the Israeli military the ability to place a ballistic missile into the breakfast bowl of its enemies; a company in Israel adapted the same concepts for medical use.

Once the patient has had the CT of the suspicious spot in the lung, he or she lays Dr. William Lunn on a special blanket that creates a magnetic field around “For patients who the patient’s body. The physiare not good cian uses a probe to locate surgery candidates known points in the body, and due to their age or once six of those landmarks are located, the computerized other conditions, system draws an amazingly the new system is detailed map for the physician. a blessing.”

“Instead of sending our location into space, we send it to the computer, which pinpoints our trouble spot to the millimeter,” Lunn says.

WWW.METHODISTHEALTH.COM

Zeroing in on a disabling disease Currently, Methodist is one of the few locations in Houston and the Southwest to have the new navigational bronchoscopy system. Fewer than 50 centers nationwide currently have the system.

“One of the beta test sites for the system in 2004 was in Heidelberg, Germany, where I happened to be training at the time,” Lunn explains.

“So I was able to learn how to use the system and bring it to Houston.”

Unlike other cancers (colon, prostate, breast) lung cancer has no screening test, so early detection of the disease is crucial. Navigational bronchoscopy’s GPS-like detection capabilities will enable it to become another effective tool for the clinician, alongside X-ray, positron emission tomography, magnetic resonance imaging and the CT scan.

As the successes with this new technology accumulate, Lunn believes more pulmonologists will use navigational bronchoscopy.

“This tool can reach deep into the periphery of the lung, where many of these masses begin. We also can use it to explore lymph nodes and accurately determine how far along a person’s cancer is on the timeline.”

Patients require less time for recovery, and procedures can be done on an outpatient basis. “Early diagnosis and reduced trauma is a real plus,” Lunn says. “Happily, we are able to use really up-to-theminute technology to make life better for our patients.” 䡲

B Y

A

P A U L A

RTHRITIS IS ONE OF THE MOST COMMON BUT LEAST UNDERSTOOD CHRONIC ILLNESSES IN AMERICA. More than 40 million people suffer from some type of arthritis. Yet in the past decade, the understanding and treatments for rheumatoid arthritis (RA), the most serious form, have accelerated at a rapid pace.

One of the most important discoveries has been this: considerable joint damage happens within the first two years of onset, and an early diagnosis followed by aggressive treatment with today’s newer drug therapies can prevent the worst

R A S I C H

effects of the disease. This once crippling condition can now be put into remission.

Still, to a large extent, diagnosing RA, an autoimmune disease characterized by inflammation in the lining of the joints, can be challenging. So research illuminating how various factors trigger the disease may help doctors zero in on ways to prevent it, as well as intervene earlier in its course to decrease the cost and disability associated with it.

What generates even more excitement for rheumatologist Dr. Sandra Sessoms is research exploring the underlying biological and social

With this study, they hope to be able to determine how to alter the outcome of the disease beginning much earlier in life.

WWW.METHODISTHEALTH.COM

VOLUME 4, NUMBER 4 䡲 43

Zeroing in on a disabling disease

“

Although researchers know a lot about the actual mechanism of arthritis, they know very little about the complex way our bodies develop this disease.

”

In rheumatoid arthritis, joint deformity is a common physical symptom of the disease. Early in its progression, the joints of the wrists, hands, feet and knees are most commonly affected.

mechanisms that work together to influence the development of RA, and the ability to detect it long before it can do any serious damage.

The next major advance against this chronic illness will be pinpointing why some people get RA and others don’t. Inherited susceptibility and environmental factors such as viruses and bacteria only provide a part of the answer.

“Although researchers know a lot about the actual mechanism of arthritis, they know very little about the complex way our bodies develop this disease,” Sessoms said. “I suspect there are a series of events that influence the development of rheumatoid arthritis.”

44 䡲 VOLUME 4, NUMBER 4

A first-of-its-kind study Set to begin May 2008, Sessoms and her colleague orthopedic surgeon Dr. Bradley K. Weiner will conduct a study that examines all factors that may influence how RA and degenerative disc disease progress. The study will enroll and collect extensive data on 2,000 patients.

Its purpose is to determine how patients’ lifelong exposures to risk factors such as stress and, environmental and biological influences interact to precipitate and impact the severity and progression of these diseases. “We’ve been consumed in trying to treat the condition, rather than trying to prevent it or understand the course of it,” Weiner said.

The second arm of the project will be an ongoing 20-year prospective study following children from childhood into adulthood.

For reasons that scientists have yet to determine, RA affects more than 2 million Americans, mostly women between the ages of 30 and 50.

So far, researchers know that a glitch in the body’s immune system causes it to malfunction, resulting in chronic inflammation that erodes bone and cartilage, eventually causing disability. About half of the people with RA are unable to work within 10 years of onset.

A breakthrough in understanding the complex ways that our bodies develop varying severities of chronic illnesses will lead to more effective treatments and prevention strategies.

Weiner says they hope to determine how to alter the outcome of the disease beginning much earlier in life.

“In the past, we have been able to look at a disease and develop medical interventions that halt or reverse the process,” Sessoms said. “A new approach is a life course approach, where we focus not only on the disease itself but also on factors that influence its progression throughout a patient’s life.” 䡲

WWW.METHODISTHEALTH.COM

LEADING MEDICINE

SM

THE

METHODIST HOSPITAL SYSTEM

HOSPITALS

RESEARCH

WELLNESS

THE METHODIST HOSPITAL

THE METHODIST HOSPITAL RESEARCH INSTITUTE

METHODIST WELLNESS SERVICES

6565 Fannin Houston, TX 77030 713.441.1261

713.441.5978

6565 Fannin Houston, TX 77030 713 .790.3311

METHODIST SUGAR LAND HOSPITAL 16655 Southwest Freeway Sugar Land, TX 77479 281.274 .7000

METHODIST WILLOWBROOK HOSPITAL 18220 Tomball Parkway Houston, TX 77070 281.477.1000

SAN JACINTO METHODIST HOSPITAL

PHYSICIAN REFERRAL / HEALTH INFORMATION

PHILANTHROPY THE METHODIST HOSPITAL FOUNDATION 8060 El Rio Houston, TX 77054 832.667.5816

METHODIST PHYSICIAN REFERRAL 713.790.3333

HEALTH INFORMATION VIA THE INTERNET methodisthealth.com

4401 Garth Road Baytown, TX 77521 281.420.8600

6565 Fannin Houston, TX 77030

A Founding Member of the Texas Medical Center

Non-Profit Org. U.S. Postage PAID Houston, Texas Permit No. 6311