Leading Medicine Magazine, Vol. 5, No. 1, 2008

A PUBLICATION OF THE METHODIST HOSPITAL SYSTEM • VOLUME 5 • NUMBER 1 • 2008

Photo by Sandy King

Dr. Michael E. DeBakey An American Pioneer 1908-2008 The Methodist Hospital family joins the world in mourning the passing of Dr. Michael E. DeBakey, a pioneer of modern medicine and a brilliant physician who dedicated his life to improving the health of mankind.

More than any single person, Dr. DeBakey is responsible for the growth of The Methodist Hospital into a world-class organization. He came to Methodist in 1948 and in the ensuing years he performed many of his historic and groundbreaking surgeries at the hospital.

In a career spanning nearly 70 years, he performed more than 60,000 operations. Other surgeons have used his innovations in cardiovascular surgery worldwide to save the lives of countless millions.

Dr. DeBakey trained thousands of surgeons who now practice around the world. A number of them now head medical schools and departments of surgery.

Many of the top cardiovascular surgeons at Methodist were mentored by Dr. DeBakey.

Over the years, Dr. DeBakey earned an impressive reputation as an international medical statesman. He served as an advisor to nearly every United States president for the past 50 years as well as to heads of state throughout the world. His efforts helped establish the National Library of Medicine, which is now the world’s largest and most prestigious repository of medical archives.

He is one of the most honored physicians in the world. Among his many accolades are the Lasker Award for medical research, the Presidential Medal of Freedom, the United Nations’ Lifetime Achievement Award and the U.S. Congressional Gold Medal, which is the highest civilian award in this country.

Dr. Michael E. DeBakey’s brilliant work is a catalog of many of the greatest accomplishments in the history of medicine. His lifelong commitment to advancing medical research, education and patient care has preserved the health and lives of people everywhere.

LEADING MEDICINE

NS OF EDITIO E IV H ARC ICINE G MED LEADIN INE MAGAZ LE AT VAILAB A W O .COM/ ARE N EALTH H T IS D INE METHO GMEDIC LEADIN

LEADING MEDICINE Volume 5, Number 1, 2008

R.G. GIROTTO President & CEO

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

Contents

JOHN E. HAGALE, C.P.A. Executive Vice President, CFO & Chief Administrative Officer

R AMON “MICK” CANTU, J.D. Executive Vice President, Chief Legal Counsel & Strategic and Business Development Officer

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

MARK E. KIMBELL Senior Vice President & Executive Editor

ERIN SKELLEY Director of Marketing

EMMA V. CHAMBERS Managing Editor

DENNY ANGELLE STEFANIE ASIN DARLA BERRY MARY BROLLEY ERIN FAIRCHILD AMI FELKER SHESHE GIDDENS GEORGE KOVACIK PATTI MUCK GALE SMITH Contributing Writers

BRIDGETT AKIN / BRI DESIGN, INC. Design

FANTICH STUDIO

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22

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

IN HIS SHADOW Behind the scenes with a neurosurgical resident .......................................... 23

RESEARCH INSTITUTE Summer program gives students a taste of research ....... 3 MAGNETIC RESONANCE IMAGING Technology advances breast cancer detection .......................................... 6

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.

THE PATIENT PERSPECTIVE The life and times of Dr. Michael E. DeBakey ............. 9 UPCOMING EVENTS ........... 14 LESSONS LEARNED Interventional cardiologist shares knowledge, expertise and insight ................................... 15 MITIE Robotic training lab blends technology, imaging and surgery .................................. 18

39

SPIRITUAL CARE Reaching out to patients in times of serious or terminal illness ...... 28 ERICA Eye-tracking computer empowers ALS patient to continue making music .......... 30 ACCOLADES ............................ 33 CLINICAL NOTES ................. 34 HEALTHY LIVING Headaches, what kind do you have? ............. 35 COMMUNITY HOSPITALS Anterior hip replacement — an alternative to traditional surgery ........................................... 38 MY TURN In awe of the Code Blue Team .......................... 40

FOUNDATION OF SUPPORT ................................... 22

Front Cover: Dr. Michael. E. DeBakey was an accomplished researcher and author.

In his 60-plus year career, he published more than 1,400 medical articles, chapters and books. Photo by Sandy King, circa 1992

VOLUME 5, NUMBER 1 䡲 1

A MESSAGE FROM THE CEO Dear Readers, Just before printing, Hurricane Ike stormed into Houston, and Methodist was focused on keeping its patients, employees and physicians safe. We came through the rough times like we always do — stronger and proud to be part of this community. Even with this consuming effort to get Houston back to normal, we can never forget our grief for the loss of our legendary heart surgeon Dr. Michael E. DeBakey.

While this also is sad news for our community, Leading Medicine affords us the opportunity to share his greatness with all of you.

It allows us to give our readers an idea of what an important physician and pioneer Dr. DeBakey was, and how he personally changed the world. In this edition, we pay our respects to Dr. DeBakey, who saved thousands of patients’ lives over six decades at The Methodist Hospital.

You’ll read about the impact Dr. DeBakey had on patients, rich and poor. You will hear from grateful patients whom Dr. DeBakey saved in their most troubled times. It is through these patients and others like them, that he left his true legacy, which is one of excellence in medicine.

So, too, is the legacy of the late Dr. Ralph D. Feigin, who was physician-in-chief at Texas Children’s Hospital until his recent passing. Like Dr. DeBakey in cardiovascular surgery, Dr. Feigin was widely respected for his contributions to the field of pediatrics.

Inspired by the example of these pioneers, Methodist continues to lead medicine. In July, U.S.News & World Report released its 2008 rankings, and once again we ranked in more specialties than any other hospital in Texas.

This year the magazine ranked us as one of the best in 12 specialties (see page 17 for listings).

Of the 5,462 hospitals nationwide that are eligible to be ranked this year, only about 3 percent were ranked in one or more specialties.

This accomplishment shows the incredible commitment of our physicians and employees — and our commitment to excellence. Just like Dr. DeBakey’s.

I hope you enjoy this issue. 䡲

OFFICERS OF THE METHODIST HOSPITAL 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

BOARD OF DIRECTORS MORRIE K. ABRAMSON MARY A. DAFFIN CONNIE DYER GARY W. EDWARDS JAMES A. ELKINS III BISHOP JANICE RIGGLE HUIE ROBERT E. JACKSON, M.D. SANDRA GAYLE WRIGHT, 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 ELIZABETH BLANTON WAREING REV. DR. STEPHEN P. WENDE

ADVISORY MEMBERS REV. RICK GOODRICH WADE R. ROSENBERG, M.D.

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

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Research Institute gives students a taste of research B Y

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he best way to lure the brightest young minds to biomedical research is to give them the opportunity to work in the laboratories of some of the nation’s top scientists, in the most exciting and growing fields of medicine.

Let them participate in solving the mystery of why cancers metastasize or let them image the brain and shed light on what makes a grandmother develop Alzheimer’s disease.

Let them taste the excitement of seeing how their education affects the real world, real patients and real diseases.

The Methodist Hospital Research Institute has created just that environment for students from around the country, who participate in the Research Institute Summer Internship Program.

“Through this experience, our interns really see how their field of study can affect patients, whole populations and the world,” said Dr. Patricia Chévez-Barrios, ophthalmic pathologist director of the program. “They better appreciate the importance and the value of what they’re learning in school.

Jim Elder, a sophomore at Rice University, was one of 22 students who interned in The Methodist Research Institute’s Summer Internship Program.

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Research Institute

“We expect that several of our interns — who are only undergraduate students and medical students — will have publishable scientific results from their participation in this program.”

“It’s all theory in their studies.

Here, they get to experience first hand the issues that are stumbled upon in translational and clinical research as we’re trying to solve the mysteries of a disease process.”

In the program, they see from a different point of view, so they might have a different — better, more realistic, more enthusiastic — approach to their field when they return to school.

“I’m interested in research, and this gives me hands-on experience in proteomics — the cutting edge of science,” said Jim Elder, a sophomore Rice University bioengineering student. Elder, who interned in the lab of Dr. John Baxter, said he wasn’t just following someone around with a clipboard. “I was on the front line, seeing where it all starts.”

Baxter, who arrived at the Research Institute earlier this year, is one of the world’s most prominent pioneers in hormone action. “Text-

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books will one day show pictures of what’s going on at the Research Institute today. I got a thrill out of being part of it if only for a few weeks,” Elder said. “Plus, it was a paying job, so my mom was happy.” (See Leading Medicine, volume 4, #4 for more information on Baxter’s work.)

Elder applied to the intern program because The Methodist Hospital Research Institute is at the forefront of medical exploration. Dr. Michael Lieberman, director of the Research Institute and founder of the intern program, has brought in heavy hitters, and it’s been “wildly successful.” Major research teams from Harvard, The National Insti-

tutes of Health, University of California at San Francisco and UCLA have all gravitated here to Methodist.

“Not many kids at major universities get to do this stuff,” Elder said.

“These are the all-stars.”

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he program had 22 students from renowned undergraduate universities this year including Rice, Johns Hopkins, University of Texas at Austin, Rensselaer Polytechnic Institute, Emory University, Rhodes College, University of Houston and others.

Five participants were medical students from Monterrey Tec

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Front row, left to right: Ellen Chang, Benita Mathai, Jamie Xu, Laura Aragon, Dr. Patricia Chévez-Barrios, Jesus Garcia, Sherry Lee. Middle row, left to right: Austin Sanford, Larkin Luo, James Elder, Indrajit Nandi, Andres Hernandez, Austin Head, Cesar Jaurrieta.

Back row, left to right: Jennifer Barker, Nithya Mani, Nina Guo, Alexandro Martagon, Meaghen Krebsbach, Shaun Khan, Jose Antonio Franco. Not pictured: James Villanueva and Muthia Vaduganathan

(Tecnológico de Monterrey), the MIT of Mexico, whose medical school is one of the most highly rated in Mexico. They are working towards a dual M.D./Ph.D. degree granted by Monterrey Tech and The Methodist Hospital Research Institute.

“We want to give these students a real research experience,” said Baxter, program mentor, director of the Genomic Medicine Program and co-director of the Diabetes Research Center at the Research Institute. “We expect that several of our interns — who are only undergraduate students and medical students — will have publishable scientific results from their partici-

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pation in this program. That’s the holy grail for many M.D.s and Ph.D.s over their entire careers.”

Baxter is no stranger to highprofile published research. His lab cloned several of the first classes of genes and demonstrated the power of DNA technology for developing treatments for diseases. He was recently recognized for his efforts in the development of compounds to treat obesity, atherosclerosis and diabetes.

This summer’s class worked in the labs of pathologists, cardiologists, radiologists and specialists in infectious disease, diabetes, various cancers and bioinformatics (the use of applied mathematics, informatics, statistics, computer science and other related disciplines to solve biological problems usually on the molecular level).

Each week, the students heard presentations and interacted with some of the most prominent physicians and researchers in their fields, such as Nobel laureate Dr. Ferid Murad, who lectured about his discovery of the way nitric oxide helps blood vessels dilate.

Diabetes expert Dr. Willa Hsueh (pronounced Shoy), founder and former head of the NIH-sponsored Diabetes and Endocrine Research

Center at UCLA and University of California-San Diego, discussed the ties between obesity, insulin resistance and diabetes, and the process by which diabetes damages the heart, blood vessels, liver and kidney. (See Leading Medicine, volume 4, #4 for more information on Hsueh’s work.)

“The laboratory is the best place to give talented young people a taste of research,” Lieberman said.

“For many, it becomes their life passion. I suspect that’s how many of our investigators got their start.” 䡲 To learn more about The Methodist Hospital Research Institute, visit tmhri.com.

“Not many kids at major universities get to do this stuff.

These are the all-stars.”

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MRI technology advances breast cancer detection B Y

Dorothy

A M I

F E L K E R

Strauss breathed a sigh of relief when the lump removed from her left breast was found to be benign. She was only 19.

Over the next several years, she had three additional lumps removed — all benign. Later, in her mid-40s, the frequency of her masses increased. She had six to eight biopsies during that time, again all benign. But last September, Strauss received devastating news — doctors found a cancerous mass.

“It was a shock because I’d had so many benign masses,” said Strauss, now 52. “Because of my medical history, I had to undergo mammograms every six months. Having mammograms, ultrasounds and biopsies just became another one of my routines.”

Strauss’ September test was unlike her previous tests, and it may have saved her life. Rather than a conventional mammogram, she underwent a breast magnetic resonance imaging (MRI) test at the Methodist Breast Center.

“I have very fibrous breasts, and I’ve been told my mammograms are extremely difficult to read,” she said.

Dense breast tissue, which is made up of less fat and more glands and ligaments, appears as white areas on a mammogram. The problem is that tumors also show up as white areas on film.

“In many cases, dense breast tissue or breast implants obscure the standard mammogram, making it difficult to pick up small cancers,” said Dr. Luz A. Venta, medical director of the Methodist Breast Center.

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“With an MRI, you get a 3-dimensional image of the breast, which allows a physician to see the detailed anatomy, down to the arteries and veins of the breast. It’s a more precise view of the breast tissue,” she said. MRI also differs from the standard mammogram in that a woman lies on her stomach instead of stands. There is less compression, which means less discomfort.

Venta and her team found a 9 mm mass (about the circumference of a AAA battery) in Strauss’ breast and after a biopsy, determined it was cancerous.

“I am so very thankful I underwent the MRI,” Strauss said. “With the density of my breasts, they probably would not have seen the mass on a mammogram.

The MRI was a tool that worked and was very successful for me.”

Thankfully, Strauss’ tumor was small enough to remove without her undergoing radiation or chemotherapy. However, she did decide to undergo a bilateral mastectomy (removal of both breasts) and reconstruction.

She still undergoes regular screening because there is always a chance for another mass to show up in the chest cavity or remaining breast tissue, but she said, “I’m very blessed to have the experience I did.”

In addition to women with dense breast tissue, Venta says MRI also is recommended for women who have a higher risk for breast cancer. “It can distinguish the tumor from the tissue around it,” she said. “This technology can prevent a potentially devastating misdiagnosis.”

Who should have one MRI is a relatively new tool for breast cancer. Most doctors only recommend it for women with a higher risk or a strong family history of breast cancer. In most cases, insurance will cover the cost of an MRI if the woman has dense breast tissue or is high risk.

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Breast Cancer 5-Year Relative Survival Rates 1996-2003 100

98.0% 80

88.6% 83.5%

60

56.9% 40

20

0

26.7%

All stages

Localized

Regional

Distant

Unstaged

Dorothy Strauss underwent a breast MRI test at the Methodist Breast Center. The test revealed a small cancerous mass. Because it was detected early, she avoided radiation and chemotherapy.

Source: SEER Cancer Statistics Review 1975-2004, National Cancer Institute Localized: cancer that is limited to the organ in which it began without evidence of spread Regional: cancer that has spread beyond the original (primary) site to nearby lymph nodes or organs and tissues Distant: cancer that has spread from the primary site to distant organs or distant lymph nodes Unstaged: cancer for which there is not enough information to indicate a stage

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MRI technology

Mammogram and breast MRI of a 46-year--old woman. Her physical exam was normal. The mammogram (left) is normal, showing dense breast tissue and a benign (noncancerous) calcification. An MRI (right) of the same breast was obtained in the same week and shows a small cancer (arrow).

A three-year research study, conducted at 17 different sites throughout the United States, Canada and Germany, found that MRI was twice as effective as a regular mammogram in detecting tumors in more than 1,000 women with suspicious lesions on their mammograms.

“We have seen several high risk patients, some with implants and dense breast tissue, whose mammograms were normal, but MRI showed cancer,” Venta said. “For these women, we were able to start treatment more quickly and give them a better chance at survival.”

MRI’s ability to better pinpoint small cancers gives women a chance to explore treatment options other than mastectomy, including lumpectomy with radiation.

“The goal is to save as many lives as possible, and this gives us another tool with which to do that,” Venta said.

As with most cancers, early detection is the key. “Not all mammograms or breast MRIs are created equal and not all medical institutions can detect and test masses with the same accuracy,” said Venta, adding, “women should do their homework. Make sure you can get your screening and biopsy at the same place so you’re not shifted from one place to the next.” 䡲

Guidelines for the early detection of breast cancer in average-risk, asymptomatic women AGES 40 AND OLDER 䡲 Annual mammogram 䡲 Annual clinical breast examination 䡲 Monthly breast self-examination (optional) AGES 20-39 䡲 Clinical breast examination every three years 䡲 Monthly breast self-examination (optional) Source: American Cancer Society: Breast Cancer Facts & Figures 2007-2008

To learn more about the Methodist Breast Center, visit methodisthealth.com. To schedule an appointment or request a second opinion, call 713.441.PINK (7465).

Dr. Luz A. Venta 8 䡲 VOLUME 5, NUMBER 1

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An acclaimed researcher and author, DeBakey published more than 1,400 medical articles, chapters and books.

Photo circa 1992

The world came to

DR. MICHAEL E. DEBAKEY During his illustrious 60-year career in Houston, people knew how to find Dr. Michael E. DeBakey. Letters arrived from across the city and around the globe; some simply addressed “Dr. Michael DeBakey, Houston, Texas.” And they usually found him.

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After DeBakey died on

July 11, people came to him once again. Quietly and reverently, they filed past his flag-draped casket in Houston’s City Hall, the first time any person had been so honored in the city. They came in the midday heat to a downtown cathedral — the powerful, the wealthy and the working man sitting together to honor a great healer of hearts.

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At The Methodist Hospital, where

this most famous of all surgeons performed many of his miracles, people were drawn to the lobby where an imposing bronze bust of DeBakey stands. There, they placed flowers and cards and wrote their thoughts and condolences on the pages of a small memory book.

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Dr. Michael E. DeBakey

“At 15, my heart started enlarging from a birth defect, and I was not expected to live more than two years. As he announced to my mother that I was going to live a long life, she asked ‘what can we do for you besides paying your bill.’

His reply was, ‘just pray for me’.”

SHARON MOORE DALLAS, TX*

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wo doctors — Quynh Mai, a pediatrician, and her husband Phan The My, an obstetrician/gynecologist, came from Ho Chi Minh City in Vietnam, on vacation. When they learned of DeBakey’s passing while visiting a relative in Houston, they asked the relative to take them to The Methodist Hospital.

Houstonian Earline Hargrove saw the flowers near DeBakey’s statue and mourned the surgeon. Her husband Willie has heart problems and received a ventricular assist device and eventually, a heart transplant.

On one visit to Methodist, they recognized and spoke briefly with DeBakey, who encouraged Willie to get treatment and take care of himself.

In the days after his death, it seemed as if everyone knew of DeBakey. People could recite many of his accomplishments; they knew he invented medical devices and surgical instruments, created the M.A.S.H. wartime hospitals and pioneered heart bypass procedures.

And for every person who traveled to the lobby of The Methodist Hospital or to the cathedral and City Hall, there were many more who could not come physically, but they came in spirit, making a

It was commonplace for DeBakey to have observers in the operating room.

Photo date unknown

virtual pilgrimage to honor the man who repaired their hearts and touched their lives.

Hope from the Newspaper In 1961, Louise Grathwohl was worried about her husband, George. As a child, he twice had rheumatic fever, which damaged his heart. He tried to enlist in the Air Force during World War II but was not accepted because of his heart condition. Sixteen years after he and Louise married, they and their three children moved to the Florida Keys where he operated a charter fishing boat business.

Grathwohl could see her husband growing weaker by the day. “The doctors in Florida told us there was nothing more they could do,” she recalls.

Then, one Sunday morning she turned to a magazine story in the Miami Herald.

“There were three pages on this miracle worker in

Texas,” she says, “Dr. Michael DeBakey.”

Why not take a chance and write to him, she thought. She did — and about a week later, a telephone call came from Houston. “A secretary said, ‘Dr. DeBakey wants you to come, and we will do whatever we can for your husband,’” Louise says. “I told them we would have to make financial arrangements. … the secretary said, ‘Don’t worry.’”

They borrowed money for plane tickets and flew to Houston. The DeBakey team replaced two heart valves in George Grathwohl and afterward, the great doctor walked down the hall to where Louise was waiting.

She remembers DeBakey kneeling next to her and talking in his soft voice.

“People immediately fell silent when he walked down the hall,” she says.

After five weeks in the hospital, the Grathwohls went back to Florida.

Daughter Georgia Grathwohl was only seven years

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old, but she remembers her father resuming a full life after his surgery.

“He was vigorous; he worked and won fishing tournaments. My father had a great life after that first surgery,” she says. Seven years later George had a second surgery. He died in 1973.

“I guess to some, those nine years might not seem like a long time. But they made all the difference for me,” says Georgia, now Georgia Dardick. Her mother Louise, now 86, adds, “Dr. Michael DeBakey gave my husband his life back, and that was a miracle.”

Former newscaster and talk show host Phil Donahue (center) visits with DeBakey and one of his colleagues.

Photo date unknown

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“When he walked into my room, a peace came over me, and I knew that I would be OK. He took my hand and told me, ‘Ms. Austin, you are going to be OK,’ and somehow I knew this to be true. I am not anyone famous just another person.

But to Dr. DeBakey, I was treated like royalty.”

33-year-old working in Houston. “Not a day goes by that I don’t thank the Lord for Michael DeBakey,” Halbison says.

WANDA J. AUSTIN HOUSTON, TX* Like Louise Grathwohl, Helen Halbison put a loved one’s fate in the hands of DeBakey. In 1978, she took her 18-month-old son Mark to Methodist. He was born with a heart murmur and doctors later discovered he had a hole in his heart. The cardiologist at Methodist told Halbison her son would require surgery.

It was almost a surprise to Halbison when DeBakey appeared at the door of the waiting room. “He was very quiet. … he walked right up and kneeled down, took both of my hands and said my son was going to be fine,” she says. “He was very confident, very gentle, and I never saw him again.”

Today Halbison’s son, Mark Busey, is a healthy,

DeBakey with President Lyndon Baines Johnson. The 36th President of the United States appointed DeBakey chairman of the President’s Commission on Heart Disease, Cancer and Stroke. Photo 1964

A Father’s Concern In the summer of 1962, Myra Woodley was a 12 year old with a serious cold. The family doctor, Dr. Charles Fellows of Sulphur, LA, ordered a chest X-ray to check for pneumonia.

He found a lemon-sized cyst on Woodley’s heart, pressing against her lung and esophagus.

*Quotes from Honoring Dr. Michael E. DeBakey blog. To read more tributes or to leave your own, visit debakey.mymethodistblog.com.

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Dr. Michael E. DeBakey

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er father, who worked at an oil refinery, got off work and drove immediately to the doctor’s office.

He asked the physician, who had five daughters of his own, “If this were one of your daughters, what would you do?”

“I was a pale, frail little girl,” Myra Woodley Nunnally recalls. “Apparently the cyst was pushing on vital organs and affecting my health. But my daddy came home that day and said Dr. Fellows recommended Dr. Michael DeBakey in Houston.”

At Methodist, she recalls being in a ward with three other girls about the same age. “I was terrified, mainly of the unknown. But Dr. DeBakey came in to talk with me. … he sat on the edge of the bed and told me in a soothing voice what kind of surgery I was about to receive,” she says.

“I wasn’t afraid anymore. … he put me completely at ease.”

Woodley recalls being impressed — later, as a teenager — that DeBakey took care to make the incision under her right arm, so it would not be conspicuous.

“Dr. DeBakey was not only an amazing surgeon, but he also was a down-

“He operated on me when I was eight years old in 1976 and I am alive today because of him. … I tried to do my bit and helped a few poor patients in need. I hope I will be able to sponsor many more poor patients in India to have heart surgeries performed in memory of Dr. DeBakey.”

MOHAN KOPPISETTY, HYDERABAD, INDIA*

to-earth, humble man,” she says. The sixth-grader wrote a letter to the surgeon and told him she

was doing well. “I received a nice reply and he requested an occasional update. That is a letter I’ll always treasure.”

Five years later, in the same month as her surgery, Woodley encountered DeBakey once more. She was traveling to Europe with family, and her aunt spotted him in the airport.

“He had just flown to Lake Charles from Houston to visit his family who still lived here. He not only remembered me and my family, but he also knew the details of my case,” she recalls. “We were all stunned that he recalled so much about a surgery he performed five years prior.

He smiled that lovely smile of his and seemed genuinely glad to see I was doing well.”

Woodley toured Europe and came back to graduate high school and attend Louisiana State University, where she met and married her college sweetheart. They have been married 36 years and have

DeBakey, actor Hugh O’Brien (left) and Texas Medical Center President Dr. Richard Wainerdi visit with members of the Hugh O’Brien Leadership Youth (HOBY). More than 1,500 HOBY members were in Houston for their World Leadership Congress. Photo 1986

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President George W. Bush, Speaker of the House Nancy Pelosi and Senate Majority Leader Harry Reid present the Congressional Gold Medal to DeBakey during a ceremony Wednesday, April 23, 2008, at the U.S. Capitol. White House photo by Chris Greenberg

two daughters and a son — and two grandchildren.

“I think Dr. DeBakey would be proud of they way my life turned out,” she says, “thanks in large part, to him.”

Hill of Heroes Under a sunny July sky, World War II veteran Dr. Michael E. DeBakey was laid to rest in Arlington

National Cemetery in Virginia. Family and friends were joined graveside by the U.S. Secretary of Defense and the Secretary of Veterans Affairs.

He is interred among heroes — close by are World War I Commander Gen. John J. Pershing and Ira Hayes, who raised the flag on Iwo Jima.

From humble beginnings in Louisiana, DeBakey became a surgeon that many people consider to be the world’s greatest.

From the surgeries he performed on the front lines of war, to the medical miracles he created at The

Methodist Hospital in Houston, DeBakey’s greatest accomplishments are surely the lives he saved.

Some of them, their children or their grandchildren may one day seek out the great Dr. Michael E. DeBakey. They will go to tell him how they might not be here if not for his work and dedication.

And they will find him on a small, quiet hill — finally at rest among this nation’s greatest heroes. 䡲

DeBakey and Dr. Antonio Gotto Jr. (now dean of Weill Cornell Medical College) pose for a photo to promote “The Living Heart Diet,” a book on nutrition and health penned by the two along with dietitians Lynne Scott and John Foreyt. Photo 1985

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UPCOMING EVENTS

DECEMBER 2-9 HOUSTON TEXANS BLOOD DRIVES DECEMBER 2 SAN JACINTO METHODIST HOSPITAL 4401 GARTH ROAD 11 A.M.- 5 P.M.

DECEMBER 4 THE METHODIST HOSPITAL 6565 FANNIN 10 A.M.- 5 P.M.

DECEMBER 5 METHODIST WILLOWBROOK HOSPITAL 18220 TOMBALL PARKWAY 9 A.M.- 5 P.M.

DECEMBER 8 SAN JACINTO METHODIST HOSPITAL ALEXANDER CAMPUS 2610 NORTH ALEXANDER 11 A.M.- 3 P.M.

DECEMBER 9 METHODIST SUGAR LAND HOSPITAL 16655 SOUTHWEST FREEWAY 9 A.M.- 4 P.M.

For more information, call 713.441.3415.

The Methodist Hospital System is the official health care provider for the Houston Texans, Houston Astros and Houston Dynamo. 䡲

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“As a student under Dr. Kleiman, nothing is handed to you on a silver platter.

He makes you think.”

Dr. Sonia Jacob Dr. Neal Kleiman

“I view young physicians as a talent pipeline.”

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One hallmark of a genuine leader is the desire to mentor to others — to enrich the world by passing along lessons learned. One such leader is interventional cardiologist Neal Kleiman, a premier researcher who possesses an innate ability to find meaning in massive volumes of research data. Kleiman has shared his insight and expertise with more than 150 fellows who have studied with him.

Kleiman is one of the nation’s foremost researchers in the area of blood clots and antiplatelet therapy (the use of medications to prevent platelets from clumping and blood from clotting). His research lab is recognized nationally for platelet research. There, Kleiman and his associates examine the effects of antiplatelet therapy in patients with coronary artery disease, who undergo angioplasty procedures.

LESSONS LEARNED: Leading interventional cardiologist mentors up-and-coming researchers B Y

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F A I R C H I L D

VOLUME 5, NUMBER 1 䡲 15

LESSONS LEARNED

Over the years, Kleiman has gained prominence, and he has shared more than his knowledge of cardiovascular medicine; he also has mentored up-and-coming physician researchers.

“I view young physicians as a talent pipeline,” Kleiman said. “Our real aim is to advance the entire field. Despite the prevailing wisdom, you can’t do that if you don’t have a constant stream of new ideas and viewpoints.

“Young investigators or fellows can’t contribute much if they don’t have the sense that their ideas and input are taken seriously and viewed respectfully by their mentors.”

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Dr. Juan Granada, medical director of the Skirball Center for Cardiovascular Research at the Cardiovascular Research Foundation at Columbia University Medical School in New York, said Kleiman stands

apart from other researchers partly because of his transparency.

Because of Kleiman, Granada says he is equipped with the knowledge to design and write a scientific manuscript, which is, “a skill that is very 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 difficult to acquire.

“Dr. Kleiman is a true academician,” he said. “I believe his greatest legacy is that he teaches fellows (physicians in advanced training) how to read data. He changed the way I studied under Kleiman for 18 months as part of a general look at data, research and analysis.” cardiology fellowship and later completed an interventional Kleiman was Granada’s direct supervisor cardiology fellowship with him. during his cardiology fellowship at The “Dr. Kleiman is a very patient, very humble man who always Methodist Hospital and was his mentor puts the patient first,” Jacob said. “He never gives up. Where during Granada’s interventional cardiology others might quit, he always has other options for the patient.” fellowship. After completing the fellowships, She says that while he’s a brilliant scientist, it’s not just in the he worked for Kleiman for two years. catheterization lab where Kleiman has impact; he has a real Granada is now building a reputation of focus on patient care. his own at Columbia in the validation of “As a student under Dr. Kleiman, nothing is handed to you on emerging technologies to diagnose the harda silver platter. He makes you think,” she said. “He makes you to-detect vulnerable plaques that cause heart do everything yourself but with his guidance. Because he attacks and strokes. He also is involved in helped me figure out how to help the patient, he has helped research on the use of stem cells for myocarbuild my character as I deal with my own patients. He showed dial repair (the repair of damaged heart me how to think for myself, and he demonstrated a great care tissue) and drug eluting stents. for the patient above all else.”

Kleiman gave his fellows scientific depth, Kleiman says that after a certain point, one’s academic career Granada said. “He’s a different kind of scienis no longer measured in terms of publications and awards but, tist because he also really enjoys clinical work “By how much one has developed a group of junior investiga— interacting with patients. He showed us tors — this is how one spawns a field.” 䡲 that there is real potential to be a scientist and still maintain clinical skills,” he said.

Granada also says Kleiman is a model for how physicians can apply the positive results of research to patients in their practices. “Dr. “He changed the way I look at Kleiman does both very well. Plus, he’s a master of data, research and data analysis.” 䡲 Dr. Juan Granada

Cardiologist Sonia Jacob, who is now in private practice at Methodist,

analysis.”

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

Dr. Guillermo Torre-Amione, who is medical director of cardiac transplantation at the Methodist DeBakey Heart & Vascular Center, has gained a national reputation as a heart failure researcher. He too was a Kleiman protégé. “Dr. Kleiman instilled in me the ability to offer an unbiased analysis of research in the cardiovascular arena,” he said.

He attributes Kleiman’s guidance as a key factor in his ability to conduct quality research. “Without the mentoring I received from Dr. Kleiman, I would not have the skills I’ve needed to help my patients manage and overcome heart failure,” he said.

Torre, whose research focuses on heart failure and transplantation, divides his time between an active clinical practice and research. He has 15 active research protocols and 12 planned protocols that are in varying stages of development. His investigator-initiated research (research that is not funded by a pharmaceutical company) includes a study with cardiac Dr. Guillermo transplant patients Torre-Amione designed to impact the cardiac hypertrophy “I am grateful for the knowledge, (enlargement of the heart) expertise and insight that Dr. Kleiman that naturally follows shared with me.” transplantation.

It also includes a novel study for advanced heart failure patients that involves plasma exchange — a process in which a patient’s plasma is removed and exposed to stresses, then injected back into the body, triggering an inflammatory response that helps heal the heart muscle.

“Because of what I learned from Dr. Kleiman, I have been confident in submitting investigational new drug applications to the FDA for approval, and I have seen these ideas turn into wonderful success stories for my patients and their families,” Torre said. “I know I speak not only for myself but for many of my patients and their loved ones when I say I am grateful for the knowledge, expertise and insight that Dr. Kleiman shared with me.” 䡲

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The Methodist Hospital is ranked among the country’s top hospitals in12 specialties in U.S.News & World Report’s 2008 “America’s Best Hospitals” issue. Methodist is ranked in more specialties than any hospital in Texas.

The magazine ranked the country’s top 50 hospitals in 16 specialties based on a combination of clinical data, number of discharges and reputation.

Cancer

33

Heart/heart surgery

28

Ear, Nose & Throat

26

Gastroenterology

17

Geriatrics

37

Kidney

31

Neurology & neurosurgery

12

Ophthalmology

14

Orthopedics

34

Psychiatry

17

Rheumatology

24

Urology

11

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The MITIE Mission

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SHARING MEDICAL KNOWLEDGE HERE AND AROUND THE WORLD B Y

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omewhere in Costa Rica, a patient awaits arrival of the latest laser technology to vaporize his enlarged prostate. Dr. Carlos Calvaso, at Hospital CIMA in San Jose, is trained and ready to treat patients with the powerful 120-watt GreenLight™ High Performance System laser as soon as it arrives.

The experienced urologist has treated prostate conditions for years, but he learned how to use the newest, most advanced technology at the Methodist Institute for Technology, Innovation and Education — MITIE,™ for short. In a two-day session in MITIE’s temporary headquarters, Calvaso joined urologists from around the world for a series of lectures, live surgery observations and hands-on practice using GreenLight laser in bull prostates.

“No hospitals in Latin America or anywhere have a lab like The Methodist Hospital,” Calvaso says.

GreenLight uses a small fiber inserted into the urethra through a cystoscope. Laser energy heats the prostate tissue and vaporizes the enlarged portions. The procedure opens the channel for urine flow

INANIMATE SKILLS LABORATORY A neurosurgery team practices establishing an airway while protecting the “patient’s” spine from injury.

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THE PROCEDURAL SKILLS LABORATORY Dr. Brian Dunkin (right) teaches a new procedure in flexible endoscopy to a gastroenterologist. without the negative side effects associated with more traditional invasive surgery. (See LEADING MEDICINE, Vol. 3, #3 for more information on GreenLight.)

“I appreciated the ability to watch live operations and see how difficult cases were handled,” Calvaso says. “The lab was very useful for us — it is an important issue in Latin America.”

Calvaso is one of about 500 physicians who have trained at MITIE in the last year. Sessions like this reflect MITIE’s mission to share medical knowledge and raise the bar for health care professionals in every specialty. “That’s what we’re here for,” says Dr. Brian Dunkin, medical director for MITIE and head of endoscopic surgery at Methodist.

“We’re here to train the world.”

Methodist urologist Dr. Ricardo Gonzalez helped acquire this latest technology and led the May sessions, which were attended by 30 urologists from eight countries. Methodist has since become a center of excellence for treatment and training with GreenLight laser.

A conference room was used for didactic and video instruction and discussions. Those in attendance then watched Gonzalez perform four live surgeries telecast from the main urology operating room, during which they could ask questions in real time.

Mini-MITIE

Since MITIE set up temporary headquarters within the last year, doctors from around the state, nation and globe as well as nurses, allied health care professionals and medical residents from Methodist, have used the 17,000-square-foot facility.

Using the training space and stateof-the-art equipment, they have learned and practiced everything from airway and sedation management to sophisticated robotic mitral valve surgery and radiofrequency ablation for esophageal disease.

Dunkin affectionately refers to MITIE’s temporary headquarters as “Mini MITIE.” When The Methodist Hospital Research Institute building opens in 2010, “big” MITIE expands to 40,000 square feet and will include a virtual hospital, 15 procedural training stations, five research operating rooms, six conference rooms and a med-presence room for high quality remote viewing of VOLUME 5, NUMBER 1 䡲 19

The MITIE Mission

THE PROCEDURAL SKILLS LABORATORY

This area contains multiple mini-operating rooms where hands-on training takes place for all types of surgical and endoscopic procedures.

This recognition gives MITIE access to a high-end network of shared educational scholarship and unlimited opportunity for valuable research partnerships both here and abroad. Collaborations under way include several joint research projects between Methodist and the University of Houston Computer Science Department.

In just one example, Bass is collaborating in experiments to understand and quantify stress during surgical training and study its link to performance. Using surgical faculty and

MITIE RECENTLY RECEIVED ACCREDITATION ONE COMPREHENSIVE EDUCATION INSTITU AMERICAN COLLEGE OF SURGEONS the operating room and other procedural areas. Administrators and their industry partners already are developing and designing areas with all boom-mounted equipment, including imaging screens and visual training aids.

“MITIE is a fermentation vat for creative ideas,” says Dr. Barbara Bass, chair of Methodist’s Department of Surgery and executive director of MITIE. “Even in its current form, MITIE really is unprecedented.”

MITIE focuses on primary learners as well as experienced physicians, nurses and other health care professionals, who must retool to keep up with technological advances in their fields.

“When you come to MITIE, you don’t just come and perform a procedure,” Bass explains. “You have the opportunity to see surgeons in practice who use this on a regular basis. The more clinical experience you can link to retooling, the more real it becomes.”

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MITIE recently received accreditation as a level one Comprehensive Education Institute from the American College of Surgeons. Its focus on continuing education for surgeons and health care professionals in practice was noted as an area of distinction, Bass says. “Our program was approved without contingency or the requirement for early progress reports — a unique accomplishment.”

resident volunteers, the researchers use thermal mapping to track changes in the face while the volunteers practice laparoscopic procedures.

“The hypothesis is when people are still learning a skill, they show signs of stress,” Bass explains. Finding a metric to measure skill acquisition would provide an important scientific tool in any field, not just surgery, she says.

ENDOVASCULAR SIMULATION SUITE

Samantha is a full patient mannequin simulator on which team training can be performed to treat all types of vascular diseases from the brain to the heart to the aorta.

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Samantha and iStan Hundreds have trained in MITIE’s simulation suite, home of Samantha, a high-tech mannequin with the capacity to offer practice on an unlimited number of medical scenarios. Interventional radiology, catheterization, endovascular procedures — Samantha handles them all and more.

“She can exhibit many different abnormal heart rhythms, blood pressure complications, stroke and even death,” explains Methodist’s

AS A LEVEL UTE FROM THE Michael Donovan, director of surgical education for MITIE. During a recent tour of MITIE’s temporary headquarters in the hospital’s West Pavilion, he talks with an industry representative putting the finishing touches on iStan, a high fidelity, wireless patient simulator.

Not only does iStan have the capability to change into a female patient, but, “His nose can drip blood, he has sites for chest tube insertion, he can even have a urinary catheter placed, if needed.

The main point of this device is to train teams on advanced cardiac life support so they can better prepare to help patients in need of their skills,” Donovan says.

Just around the corner at MITIE, two daVinci robots are available for practice in mitral valve repair, prostatectomies and other procedures. Here Dr. Gerald Lawrie, one of the most experienced heart valve repair surgeons in the world,

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TELEPRESENCE

An example of the type of audio-visual communication being installed in operating rooms at Methodist.

brought his entire operating room team to practice and perfect his own technique for robotic mitral valve repair. MITIE has become one of the busiest robotic training labs in the country.

In another MITIE operating room, leading gastroenterologist Dr. Atilla Ertan learned to perform radiofrequency mucosal ablation 360 90 using the BÂRRX Halo and Halo devices. This minimally invasive flexible endoscopy technique is used to heat and remove damaged esophageal tissue. Ertan, one of the world’s leaders in managing diseases of the esophagus, is now considered an expert in the Halo radiofrequency energy ablation system, and Methodist is among the leading centers offering the technology.

Methodist’s surgery and critical care team has taken over one of MITIE’s research operating rooms to set up a mock intensive care unit. Here they work to create a better model to display information. Currently, most critical patient information is located outside the room or on a confusing template that makes interpretation time consuming and difficult. The team believes it can design a way caregivers can stay at the bedside and let technology record data.

Ideally, physicians, nurses and supporting caregivers should be able to access important information and interact with it on a touch panel display at the bedside. It’s one among hundreds of innovative concepts taking shape at MITIE. “MITIE allows us unlimited creativity,” Bass says. “Its multidisciplinary approach and blending of technology, imaging and surgery are really exceptional.”

One of MITIE’s key research focuses is the development of teleproctoring, where communication and imaging links will allow Methodist experts to walk physicians through a case in real time, no matter where they are in the world.

MITIE offered 16 training programs in the last eight months, not counting the robotic training labs.

Dunkin hopes to increase that number to at least 40 in the next year. When “big” MITIE comes on line, the possibilities for training and research are limitless. 䡲

To learn more about MITIE, visit methodisthealth.com.

Photos courtesy of MITIE

VOLUME 5, NUMBER 1 䡲 21

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A FOUNDATION OF SUPPORT

mily Herrmann had a close-knit circle of friends and family. She worked with many of them at Walter Oil & Gas Corporation, where she served as treasurer and controller for the family-owned business for 24 years. She was a trusted employee, confidant and friend, first to founder Joe Walter and later to his son Rusty, whom she considered an adopted brother.

When Herrmann was diagnosed with breast cancer in 1998, her husband Mike and her family at the energy company formed a support network. They advised her about physicians to consult and covered her work duties when she couldn’t. They admired the woman who kept her strength, humor and dignity through the trials of living with cancer. The extended family proved invaluable during her 10-year battle, but unfortunately, Herrmann succumbed to the disease in the fall of 2007.

Herrmann’s story inspired the Walter family to generously fund breast cancer research at The Methodist Hospital Research Institute. The family hopes their philanthropy will motivate others to follow their lead in supporting important research that may one day produce a cure for the disease that claims more than 40,000 lives annually.

The Walter’s philanthropy led to the creation of a research lab named in Herrmann’s honor. At a luncheon commemorating the opening of the Emily Herrmann Breast Cancer Research Lab in June of last year, Herrmann spoke about her disease and her gratitude to the Walters for their generosity and support throughout her illness: “… I had been at Walter Oil & Gas for 15 years when I was first diagnosed with breast cancer in 1998.

Not only Rusty, my ‘adopted brother,’ but the entire Walter family of employees was incredibly supportive of me and my family.

My oncologist, Dr. Frank E. Smith, told me that each person’s battle with cancer is different and has to be diligently followed and watched. He also told me that a positive attitude was imperative in cancer treatment and survival. I soon realized that a battle with cancer was bigger than I was, so I immediately turned my battle over to God and entrusted my care and guidance to Him. Cancer is a terrible disease and a cure needs to be found. I will continue to pray that a cure is found soon and that this new cancer research facility will be instrumental in finding it. My thanks again to the Walters for this great honor, to Dr. Smith for his continued good care, to my precious husband for his love and support and mostly to God for allowing me to be here today …”

The Walter family is just one example of family tradition at Methodist. Joseph C. Walter Jr., who is now deceased, was a mainstay for the hospital starting in the 1960s, when he served on the hospital board of directors for more than 20 years. Shortly after he joined the Methodist board, Walter became a heart patient at Methodist where he underwent two successful bypass surgeries and a heart transplant.

Similarly, Rusty Walter has carried on the family tradition of service and philanthropy at Methodist. He serves as a director for both The Methodist Hospital and The Methodist Hospital Research Institute.

In addition to establishing an endowed chair in cardiovascular disease, Walter’s sister Carole Looke and his mother Elizabeth Keeney, serve on the Methodist DeBakey Heart & Vascular Center Council. The council is comprised of community leaders devoted to raising awareness and advocacy for the work of the heart center.

“Everyone can become involved in some way in helping find solutions for today’s health care issues,” Walter said.

“My family has been impacted by these diseases, and I want to help work toward solutions.” 䡲

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A DAY IN THE LIFE:

DR. MARC MOISI, NEUROLOGICAL SURGERY RESIDENT STORY AND PHOTOS

BY DENNY ANGELLE

L

ike any big city, Houston wakes up gradually: first glimpses of daylight glint off the top-floor glass of tall buildings, and people begin to find their way to work. Even as Houston opens its eyes, people are flowing through The Methodist Hospital like the day’s first coffee.

Dr. Marc Moisi pulls on a white lab coat over his blue scrubs. He has been at work since 5 a.m., making rounds and seeing patients. Moisi is a neurological surgery resident in the third year of his graduate medical training. He has received his medical degree, now he is training to be a neurosurgeon.

Moisi goes to the room of a patient who has had back surgery. After washing his hands, he snaps on a pair of gloves and begins to change the bandages on the patient’s back. “It looks good,” Moisi tells the patient. “How is the pain?” The patient still has some pain when he stands.

The doctor assures the patient he can be discharged after staying one more night. That seems to reassure both the patient and his wife. Moisi reminds them the attending surgeon who performed the procedure would be checking on the patient later in the day.

It’s all about the patient: Moisi doesn’t say it, but he knows it, lives it, breathes it. What he does say is, “I really love what I do. Some people may say it but they don’t believe it. But I really do love this kind of work.”

Moisi is 30 years old. He is from Queens, New York, a graduate of New York University and Columbia University. He served his internship at Weill Cornell Medical College and chose the program at Methodist because of the reputations of the physician-teachers here.

It’s all about the patient: Moisi doesn’t say it, but he knows it, lives it, breathes it.

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A DAY IN THE LIFE

AT A GLANCE

18

Number of Methodist sponsored ACGME* accredited programs

Blood Banking/Transfusion Medicine, Cytopathology, Family Medicine, Hematology (Pathology), Internal Medicine, Neurological Surgery, Neurology, Neuropathology, Obstetrics and Gynecology, Orthopaedic Adult Reconstructive Surgery, Orthopaedic Sports Medicine, Pathology (Anatomic and Clinical), Plastic Surgery, Selective Pathology (Hematopathology), Selective Pathology (Ophthalmic), Selective Pathology (Surgical), Surgery (General), Transitional Year

2

Number of Methodist sponsored non-ACGME accredited fellowships

Minimally Invasive Surgery, Mohs Dermatologic Surgery

150

Number of Methodistsponsored residents

More than 200 residents are at Methodist at any given time. Over the course of a year, between 600 and 800 residents rotate through.

Other institutions whose residents rotate through The Methodist Hospital: Baylor College of Medicine, University of Texas Health Science Center at Houston, University of Texas Medical Branch at Galveston, University of Texas MD Anderson Cancer Center, SAUSHEC (San Antonio Uniformed Services Health Education Consortium — the military programs), University of Kentucky, University of New Mexico, Louisiana State University * American Accreditation Council for Graduate Medical Education is responsible for post-MD medical training in the United States.

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“

took a look at who the leaders of the neurosurgery program are at Methodist — starting with Dr. Robert Grossman (chairman of Neurosurgery), who is at the top of his field and neurosurgeon Dr. David Baskin, the residency program director — and I realized if I came here I would be learning from the absolute best,” Moisi says.

Born in Romania, Moisi’s family moved to New York when he was about two years old. His parents are engineers, and for a while Moisi wanted to be one too. He earned his engineering degree, but the field of medicine captured his imagination.

“Deep down, I always wanted to be a doctor,” he says. Now he is the first physician in his family.

“My parents are proud of me, sure,” he laughs. “They are happy I got my engineering degree.”

CENTER FOR MEDICAL EDUCATION Over the past three years, Methodist has turned itself into a top center for medical education and research. The hospital now trains 150 future physicians in 18 accredited residency programs.

Neurosurgery residents like Moisi practice under the supervision of physicians from the Methodist Neurological Institute (NI), which has a staff of 13 neurosurgeons, 10 neuroradiologists and eight neurologists. Physicians at the NI performed more than 3,500 major neurosurgeries and 400 neuroradiological interventions last year.

“This is an impressive center where physicians see all kinds of patients,” Moisi says. “The doctors here are the best of the best. Many of the faculty physicians trained here too, so you can see there’s a tradi-

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“The doctors here are the best of the best. Many of the faculty physicians trained here too, so you can see there’s a tradition of excellence in this field and it’s the reason I came to train at Methodist. I think I’m very fortunate to be taught by these physicians.”

tion of excellence in this field, and it’s the reason I came to train at Methodist. I think I’m very fortunate to be taught by these physicians.”

Moisi’s residency track is seven years. He will devote one year to research — he is still deciding what his research focus will be, but he thinks it may involve working with Grossman to study spinal cord injuries. He may also spend some time in pediatric neurosurgery at either Texas Children’s Hospital or in New York.

Moisi expects to complete his residency in 2012, when he will be 34 years old.

Most of his days are a mixture of making rounds to see patients, performing surgery, attending some educational sessions and lots of reading and study.

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Residencies require long hours at work, and surgical residents can see their workday stretch into the night.

But the Accreditation Council for Graduate Medical Education, which accredits Methodist’s residency programs, limits work hours for resident physicians to 80 hours a week and a straight shift is limited to 30 hours.

“It’s a good rule — tired people tend to make mistakes, and this is not the place to be making any kind of mistake,” Moisi explains. Most days he arrives at Methodist between 5 and 5:30 a.m., and goes home between 5 and 6 p.m. He will be “on call” from the Emergency Department and can go in after hours to handle patient care emergencies. He lives about a mile and a half from the hospital — when called he can be at the hospital within minutes.

He can see as many as 30 patients in a day and will scrub in for as many as three surgeries.

IN THE SURGICAL SUITE Today Moisi is scheduled to perform surgery alongside Dr. Paul Holman, a neurosurgeon on staff at Methodist. The patient needs a lumbar laminectomy to decompress nerves in her back, and the doctors will further strengthen her spine by fusing some vertebrae.

Moisi heads up to the third floor of Methodist’s Dunn Tower, where the operating rooms are located. He hangs his lab coat on a row of hooks bearing many more white coats and picks up a paper head covering and mask for the sterile operating room.

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A DAY IN THE LIFE

T

he surgical team is already in the operating suite, prepping the patient. Moisi checks the imaging and the patient’s medical information. He will first assist general surgeon Dr. Patrick Reardon who will open a path to the patient’s spine. Then Holman will step in to work on the vertebrae. They plan to strengthen the spine using parts of cadaver bone, which will be reinforced with screws.

Moisi and the other surgeons will each wear a pair of optics — glasses with special lenses inset to magnify their work and a light attached to illuminate the field. Moisi puts the apparatus on his head and

washes his hands. In the surgical suite, he and the entire team wear lead vests for protection when an X-ray is used; a dark green surgical gown goes over all of that.

Wearing a bright red cap, Reardon comes in and begins work. When he is done, he steps away and Holman approaches the patient. He will call for a number of scans to check the progress of the work; the entire surgery will last about six hours.

SOLVING MEDICAL MYSTERIES Taking a break between surgeries and seeing patients, Moisi reflects on the work he has done and the work he hopes to do in the future.

“Every year there’s something new on the horizon. … some new technology that will help in the treatment of disease, and we, as residents, need to stay on top of that,” he says. “But on the other hand, medicine is totally an art and it’s firmly in the hands of people who will use this technology as the tool to find out what’s wrong with a patient.”

He compares his work to that of a detective. “Every patient is a new case,” Moisi says. “Some are straightforward, others are a bit of a mystery.

You talk to the patient, you use your powers of observation and come to a conclusion only after you gather as much information as you can.”

“EVERY YEAR THERE’S SOMETHING NEW ON THE HORIZON. TREATMENT OF DISEASE, AND WE, AS RESIDENTS, NEED T

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Then, the technology — the machines — can help the doctor confirm what he or she suspects is wrong with the patient. “Helping other people doesn’t always mean taking them into surgery,” Moisi continues. “You have to be relentless in getting to the source, the cause — the doctor may not always be right, but unfortunately, the disease is always right.”

The daily interaction with patients as well as with other physicians and health care workers appeals to Moisi the most. “Compassion is the absolute most important attribute you can have as a physician,” he says. “It becomes second nature to remember to treat everyone with the same

respect and compassion — you treat them as though they are part of your own family.”

MEDICAL PERSONALITY After surgery, Moisi checks on more patients. When he goes home in the afternoon, he relaxes a bit and does some reading.

“You always have to be on top of medicine, on top of the technology,” Moisi explains. “One way to do that is to be up on the latest articles, the things that are written about your field.”

As he explains it, he is slowly building a medical personality. Each attending physician he works with, each teacher he encounters, shares a

bit of knowledge and experience that Moisi makes his own. “As Dr. Grossman says, you take a little from here and a little from there,” Moisi says, “and you slowly emerge with your individual medical personality.”

And the experiences of each day add to that character construction.

“There are good days and bad days, like with any other line of work,” he says. “I could have those kinds of days as an engineer. But I’m a neurosurgeon. For us, for any physician, the stakes are much higher.” 䡲

… SOME NEW TECHNOLOGY THAT WILL HELP IN THE O STAY ON TOP OF THAT.”

“Compassion is the absolute most important attribute you can have as a physician. It becomes second nature to remember to treat everyone with the same respect and compassion — you treat them as though they are part of your own family.”

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VOLUME 5, NUMBER 1 䡲 27

Compassionate Care: prog B Y

M A R Y

B R O L L E Y

Gale Smith sat at her desk typing a news release for distribution when the phone rang. As a public relations manager with The Methodist Hospital System, she often receives urgent phone calls from the media requesting an interview with a physician or patient.

Smith knew she had to respond immediately, but this call wasn’t a media request. She needed to visit a patient at The Methodist Hospital, and she needed to get there quickly.

Smith drove to the hospital, clumps of traffic making the minutes drag.

Nevertheless, within a half hour she was at the bedside of a dying woman.

For several hours, Smith sat with the patient, speaking gently and reading Bible verses. She remembered from previous visits that the Book of

Psalms was one of the woman’s favorites. When the woman struggled to breathe, Smith touched her hand and quietly said, “If you need to go now, it’s okay.”

Shortly after, the patient took her last breath.

Smith will never forget this poignant experience.

For the past year, she has volunteered for two innovative Methodist programs designed to provide companionship and human comfort for hospitalized patients, even in their final hours.

Established by the hospital’s Spiritual Care and Education Department, the No One Dies Alone program offers a human touch for terminally ill patients who may be isolated from family and friends. Specially trained Methodist employees and other volunteers provide a bedside presence for these patients.

Volunteers comfort patients by offering reassuring words, playing soothing music or reading aloud. These caring expressions create a calming atmosphere, which can lessen a patient’s fear, loneliness or anxiety.

Gale Smith is a volunteer with the No One Dies Alone program.

28 䡲 VOLUME 5, NUMBER 1

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grams lend encouragement and support Because Smith had been the woman’s Patient Partner, she knew the patient’s family lived several hours away. Although they tried to visit regularly, it was difficult for them to maintain a regular schedule of visits as the patient’s illness wore on. When the patient took a turn for the worse, no family members were near.

Smith empathizes with families who are scattered in different cities or parts of the country. An only child whose parents live in Louisiana, she is increasingly concerned about being far away from her own parents as they age. If one or both of them had a health crisis before she could get there, “I would so want someone to be with them,” she said.

“In extreme circumstances, when families can’t be with their loved ones in their final hours, No One Dies Alone is the bridge,” said Denice Foose, bereavement program manager.

She says sometimes family and friends aren’t able to be there, or patients outlive their friends and family.

“There’s a term for them — elder orphans,” she said.

“Ultimately, it doesn’t

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matter why these patients don’t have family near them in their final hours.

We do our best to ensure that they’re not alone.”

No One Dies Alone was adapted from a 7-year-old program that began in the northwest United States.

Since Methodist adopted the program a little more than a year ago, 23 patients have been served.

The success of No One Dies Alone spurred the creation of Patient Partners, in which staff visitors befriend patients who must remain hospitalized for longer periods of time. The volunteers for this program, called Patient Partners, are trained to be active listeners to gauge the patient’s needs. They engage patients in meaningful conversation and explore their interests and hobbies. More than 200 patients have been served

by Patient Partners.

Methodist is the first hospital in the Texas Medical Center to implement these programs.

Patients in both programs are referred to the Spiritual Care Department by medical staff. When a physician or nurse sees that a patient is lonely or could use a visit, he or she

contacts Foose or bereavement coordinator Ramon Olachia, who selects a partner from the ranks of Methodist employees who have signed up and gone through the required training session.

There are 135 volunteers in the Compassionate Companion programs — nine out of 10 of them are employees, Foose says.

“At first we thought we might need to go out into the community to recruit volunteers,” she said.

“But we’ve had an overwhelming response from our staff.”

Volunteers range from hourly staff to executives.

The one-on-one training for both programs emphasizes sensitivity to the patient’s religious preferences and a nonjudgmental approach to patient interactions.

The Rev. Ted Smith, director of Spiritual Care and Education at Methodist, advocates for both programs. “They are a concrete example of our I CARE values (Integrity, Compassion, Accountability, Respect and Excellence),” he said. “We respect this person in extremis (at the point of death); we are accountable to meet these human needs.”

Smith says she is not surprised that employees from all religious backgrounds are eager to volunteer for these programs. “Methodist is the first place I’ve worked where values are more than just words on a mission statement. I CARE is truly what people here are expected to live by.”

Being a Patient Partner and Compassionate Companion has been gratifying and valuable for her. “It’s the right thing to do,” she said. “I’m glad I could be with a patient who’s ill, who’s dying, and let them know that someone knows and cares about them.” 䡲 To find out how you can refer a patient to one of these programs, call 713.441.6297.

VOLUME 5, NUMBER 1 䡲 29

making e, f li of y it al qu e iz as h p “We em omen m y er ev e ak m to ow h d underst an n, becaus ai ag c si u m g in ak m is ie d d Fre

Guitarist silenced by ALS is making music again B Y

D E N N Y

A N G E L L E

His fingers fly over the guitar strings, pouring out notes in a torrential melody.

The right hand shoots into the air, but the music still tumbles out, all tuneful, all picked by lightning fingers along the fret. The crowd explodes with applause.

All hail Freddie Everett, guitar god.

30 䡲 VOLUME 5, NUMBER 1

PHOTO BY FRANK CASIMIRO

Freddie Everett was well known in Houston and Texas for his fluid and super-fast guitar skills.

PHOTO BY ANGELA WALLING

The video ends and the sound stops. That was Freddie Everett four years ago, before amyotrophic lateral sclerosis (ALS) unplugged his guitar.

What ALS could not stop was the music — it continued to play in his head.

Today, Everett is a different picture. He is wheelchair bound and it is difficult for him to speak and at times, breathe. But he has found a way to create and play his music once again.

While undergoing treatment and evaluation at the Methodist Neurological Institute, speech pathologists suggested Everett try a new system called ERICA — Eyegaze Response Interface Computer Aid — a camera-aided device that allows him to operate a computer merely by moving his eye.

Using this technology, Everett has created enough music for a new album. “(The ERICA system) has been a godsend,” says Everett, 49. “My music is the most important thing in the world to me, and I can make my music again.”

Wearing a Jimi Hendrix T-shirt, he demonstrates how the ERICA system allows him to maneuver around a computer screen, playing tic-tac-toe or pressing buttons that in turn control other devices. If needed, the system can even talk for him in its own electronic voice.

As ALS closed in around him, Everett felt helpless and depressed.

His wife, Annette, says he would sit for hours and stare helplessly at his silent guitars. She would help by writing down the music and lyrics he composed, then even that faded away.

Getting the ERICA device a few months ago enables Everett to compose and synthesize his music on a computer. He also can use the system to control his environment — turning the lights on and off, changing channels on the TV. “He was watching a basketball game the other day and I left the room,” recalls Annette, who was Everett’s manager. “Hours later, he was still watching basketball and I realized … it was a different game, he had changed the channels.”

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ilies am f r ei th d an ts n ie at p r ng ou that t ea gr is t “I s. in la p ex el p nt count ” Ap im.” h to t an t or p im so is it se

Treatment and Hope Dr. Stanley Appel, chairman of Neurology at The Methodist Hospital, is treating Everett. Over his career, Appel has cared for more than 3,000 ALS patients — more than any other physician in the country — and he knows that keeping the mind active and strong is vital, even while this disease slowly consumes the body.

“We emphasize quality of life, making our patients and their families understand how to make every moment count,” Appel explains. “It is great that Freddie is making music again because it is so important to him.”

According to the ALS Association, about 5,600 people in the United States are diagnosed with ALS each year, averaging about 15 new cases a day. Because ALS patients are living longer, as many as 30,000 Americans can have the disease at any given time.

The disease can strike anyone, mostly between the ages of 40 and 70, but it also can affect people in their 20s and 30s. About 20 percent of

those affected will live at least five or more years after diagnosis; about 10 percent will live more than 10 years after diagnosis. Generally the disease occurs in higher percentages as people grow older.

Appel created the MDA (Muscular Dystrophy Association)/ALS Research and Clinical Center at Methodist, and it has become one of the world’s top centers for the treatment of these neurological disorders. The first multidisciplinary clinic in the United States dedicated to patient care and research for ALS patients and one of the country’s largest, Appel’s clinic is the standard by which all other MDA/ALS clinics are modeled.

“We have been doing this for about 25 years, and our team has been together almost that long,” Appel says. “The thing about ALS patients is that they are all warm,

Freddie Everett continues to make music with the use of the ERICA system. The device tracks eye movement with an infrared camera and sends the information to a computer.

courageous, nice people. … they want us to make a breakthrough, find a cure, not just for themselves but to help others.”

There is no cure for ALS, but researchers including Appel are working to identify risk factors that can help with early diagnosis and possible causes.

Appel believes the breakthrough that could give a clue to a cure or a cause could be around the corner.

He recently participated in a research project that revealed genetic changes in a brain with ALS, and the paper Appel co-authored appeared in the New England Journal of Medicine.

Gathering research knowledge over decades, Appel persists in his belief that the immune system can play a significant role in the development of ALS. Many who at first criticized this approach are now coming around, as separate independent studies are beginning to reinforce Appel’s theories.

“From the very start, we involve the family of a patient in their care because they are very important to the patient as he or she progresses through ALS,” Appel explains.

“Families caring for an ALS patient can’t afford to burn out, even though they’re going 24 hours a day. We work hard to provide them a sense of hope that we can find some way to treat this condition.”

PHOTO BY DENNY ANGELLE

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VOLUME 5, NUMBER 1 䡲 31

Quality Of Life When Appel first met Everett, the musician wanted to know why he was having trouble playing a guitar.

Everett was legendary in Houston and Texas music circles for his fluid and super-fast guitar skills. He and his band opened for Ted Nugent, Alice Cooper and Sammy Hagar. He recorded with Double Trouble, formerly Stevie Ray Vaughan’s band.

Beside his prodigious musical skills, Everett was also renowned for his onstage showmanship, influenced by 1960s guitar legend Jimi Hendrix. In 2004, Everett was forced to stop playing his guitar after 25 years because his fingers refused to move where he wished. Two years later, Appel diagnosed him with ALS. “All of us have a different definition of quality of life,” says Appel, “and for Freddie his quality of life is all about music. He made a lot of people happy with his music, and we wanted to find a way to help him preserve that as long as we could.”

Both of the Everetts were excited to first hear about, then test the ERICA system. It has made a real difference in his attitude toward his illness, Annette says.

“He has his music back. He has something to look forward to once again,” she says. In June, he received a tracheotomy to help his breathing.

“Our social worker told us, ‘you have to take control of this disease and not let it control you,’” she says.

“I tell Freddie everything’s in God’s hands. … I think it’s a gift from God that Freddie is able to make music again.”

Freddie agrees. “My music has always given me happiness. … I want to share my music with others and give them happiness, joy and peace.”

When Everett’s ALS symptoms first appeared, his son Jesse, 22, who is also a guitarist, played with the Freddie Everett Band to fulfill their commitments. Then he went back to his own music and his own heavy metal band.

Eye Response Interface Computer Aid (ERICA) allows people who can’t move or talk to communicate. The device tracks eye movement with an infrared camera.

How ERICA Works Step 1. Infrared light from the camera shines into the eye, making the pupil glow and creating a bright spot, known as the glint. The camera then takes a picture of the eye and sends it to the computer.

Step 2. The distance and direction of the glint from the center of the pupil determines where you are looking.

Step 3. You click by staring at what you wish to select. With an on screen keyboard, you may type and speak the letters you focus on.

W E S

R D

X

32 䡲 VOLUME 5, NUMBER 1

But lately, Annette says, Jesse has come back to his father’s music.

“Jesse is playing Freddie’s music more and more,” she says. “He is kind of a mini-Freddie. … he has his father’s mannerisms and style, and many people who see him play remark on the resemblance. Jesse is going to keep his father’s music alive.” 䡲

Glint

Fast Facts ■ Medicare approved ■ Less than 10 lbs.

■ Mounts to wheelchairs ■ Runs for six hours off its battery ■ Communication and Computer Access – Speaks what you type – Controls any software in Windows – Allows voice banking – Provides integrated e-mail and Web browsing

Illustration by Sheshe Giddens, The Methodist Hospital System

Guitarist

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Accolades

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

Dr. William Zoghbi, director of the Cardiovascular Imaging Center at

the Methodist DeBakey Heart & Vascular Center, was elected president of the American Society of Echocardiography. He assumed the duties of leading the respected 14,000 member organization on June 9 in a ceremony in Toronto.

Zoghbi, who holds the William L. Winters Endowed Chair of Cardiovascular Imaging at Methodist, is a leader in the field of echocardiography and Doppler ultrasound. He has devised new noninvasive techniques to evaluate valve disorders and cardiac function. He has authored more than 175 original publications in the field of cardiovascular imaging and frequently speaks on these topics around the globe. 䡲

Dr. Gerald Lawrie

Dr. Gerald Lawrie, cardiothoracic surgeon at the Methodist DeBakey Heart & Vascular Center, has received the Michael E. DeBakey Endowed Chair for Cardiac Surgery. Lawrie, a pioneer in valvular surgery, invented a technique called the American Correction, with which he has a 100 percent success rate for repair of diseased mitral valves. In 2007, Lawrie was the first to use a surgical robot to successfully repair a mitral valve using this advanced technique. The DeBakey Endowed Chair will help fund research and advancements in the treatment of heart and valvular disease. 䡲 a senior vice president at Roberta ,The Hospital, has Schwartz beenMethodist named among the 2008 Yoplait Champions, men and women from across the country who are honored for doing extraordinary things in their communities to help in the fight against breast cancer.

A breast cancer survivor, Schwartz and two other women created the Young Survival Coalition, an organization dedicated to improving the quality and quantity of life for those under 40 with breast cancer. Since its inception in 1998, the organization has grown to more than 15,000 members and has had a significant impact on the lives of thousands of young women.

Twenty-five 2008 Champions represent 17 states and comprise breast cancer patients, survivors and advocates as well as husbands, mothers, daughters and friends of those touched by breast cancer. Each champion has a unique tie to the disease, but all share a passion for raising awareness and educating others. 䡲

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The Methodist Hospital received an Arbor Day Award from Trees For Houston for its support of the organization through its employee bereavement program and tree replanting project. Methodist was honored for its donation of trees to the Tribute Grove in Hermann Park and for its careful relocation and replanting of trees taken from the future site of The Methodist Hospital Research Institute.

As part of its bereavement response program, Methodist makes a monetary donation to Trees for Houston when an immediate family member of an employee dies. When an employee passes away, the hospital makes a larger monetary gift and donates a 15-gallon tree for the Tribute Grove, along with one year of maintenance. 䡲

VOLUME 5, NUMBER 1 䡲 33

Accolades 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲

Methodist Breast Center has been awarded a three-year term of accreditation in stereotactic breast biopsy imaging services by the American College of Radiology (ACR).

After a peer review process, the ACR, headquartered in Reston, VA, awards accreditation to facilities that exhibit high practice standards. ACR is a national organization

The Methodist Hospital recently joined Houston Grand Opera’s (HGO) family of supporters as the “Official Health Care Provider to Houston Grand Opera.”

The five-year partnership provides HGO’s local and visiting artists with full access to Methodist physicians, nurses and staff who specialize in treating professional singers and musicians.

serving more than 32,000 diagnostic interventional radi-

The HGO partnership makes Methodist the official

ologists, radiation oncologists, and nuclear medicine and

health care provider of three of Houston’s leading per-

medical physicists with programs focusing on the prac-

forming arts organizations — Houston Ballet, Houston

tice of medical imaging and radiation oncology, and the

Symphony Orchestra and the Houston Grand Opera. 䡲

delivery of comprehensive health care services. 䡲

CLINICAL NOTES DR. DAVID BROWN, ophthalmologist and retina specialist at The Methodist Hospital, served as local principal investigator in a multicenter study that recently determined that traditional laser treatment is more effective than corticosteroid treatment in the preservation of eyesight in diabetic patients with diabetic macular edema (DME). The study, funded by the NIH’s National Eye Institute and conducted through the Diabetic Retinopathy Clinical Research Network, demonstrated that laser therapy is not only more effective than drug therapy, but it also has far fewer side effects. Nearly 700 patients with DME participated in the randomized study at 88 sites across the United States.

In the corticosteroid-treated group, 28 percent experienced substantial vision loss as compared to 19 percent in the laser-treated group. In addition, about one-third of the patients treated with laser therapy showed substantial improvement in vision. 䡲 PHYSICIANS AT THE METHODIST DEBAKEY HEART & VASCULAR CENTER now close certain types of leaky heart valves through a tiny puncture in the groin, using live 3D imaging for precise guidance. Methodist offers this combination treatment as an alternative to open heart surgery.

Cardiologists NEAL KLEIMAN, SASHI GUTHIKONDA and STEPHEN LITTLE recently used an image-guided catheter to close a leak surrounding a 65-year-old patient’s mitral valve, rather than exposing her to a potential fourth open heart surgery. The leak was causing such damage to her blood that she was constantly weak and needed multiple blood transfusions. The minimally invasive technique, called percutaneous paravalvular leak repair, is performed in a catheterization lab rather than in an operating room. 䡲 DR. MIGUEL VALDERRABANO, cardiologist at the Methodist DeBakey Heart & Vascular Center, recently was the first in Houston to use a robotic catheter to treat irregular heart rhythms (arrhythmias). More than 2.5 million Americans have arrhythmias, which cause problems such as strokes. These catheter-based procedures are typically done manually. By using the robot, cardiologists have more control when reaching pinpoint places in the heart that cause the disease.

Valderrabano is chief of the Division of Cardiac Electrophysiology at The Methodist Hospital. 䡲 34 䡲 VOLUME 5, NUMBER 1

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HEALTHY LIVING

Coffee, tea or headache?

B Y

If you typically start your morning with a caramel macchiato or grab an iced café mocha in the afternoon, you may want to reconsider. Rituals like these can lead not only to your favorite coffee house but also to chronic headaches.

Almost everyone has an occasional headache. They can range from a mild ache or throbbing sensation to pain so severe that sufferers report that they feel like their head is going to explode.

The National Headache Foundation estimates that more than 45 million Americans have chronic, recurring headaches. Just the daily METHODISTHEALTH.COM

S H E S H E

G I D D E N S

stress from trying to balance home and work or even diet can trigger one. Headaches have become such a fixture in our culture that now the word is commonly used to mean a problem.

Certain foods and external sources are known to trigger headaches in some people. Although caffeine, which is a stimulant, is thought to trigger headaches, it is not the caffeine itself but the withdrawal from it that is the trigger. In fact, caffeine is commonly found in many headache medications.

Sources of caffeine include coffee, tea and chocolate.

Most of the time, sufferers find ways to cope. Many take over-thecounter medication or turn to triedand-true home remedies. But when none of these options work, it’s time to see a doctor.

“Patients should seek medical attention when they have their first or worst headache, and also if there is weakness, numbness, tingling or convulsions accompanying the headache,” said Dr. Howard S. Derman, a neurologist and director of the Headache Clinic at the Methodist Neurological Institute.

It is important to heed warning signs that indicate a more serious VOLUME 5, NUMBER 1 䡲 35

36 䡲 VOLUME 5, NUMBER 1

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Triggers (stress, caffeine, sleep deprivation, etc.)

Time to headache relief

Time of dose

Dose

Type of medication

Time of treatment 2 (dose)

Time of dose

Dose

Type of medication

Time of treatment 1 (dose)

Type of headache

Headache symptoms (nausea, throbbing, disability)

Severity of worst pain (0 = no pain 10 = severe pain)

Time of pain onset

Symptoms prior to onset of pain

Dates

DAY OF WEEK

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

SAMPLE WEEKLY HEADACHE DIARY THURSDAY

FRIDAY

SATURDAY

Coffee, tea or headache?

condition, said Derman, an associate professor at Weill Medical College of Cornell University. Headaches that change in pattern, frequency and/or severity also should be brought to a doctor’s attention, he added.

“Patients have to ask themselves, ‘do my headaches interfere with my daily activities?’ If they do, then they need to see a doctor,” Methodist neurologist Dr. Greg McLauchlin said. “Patients assume that their headaches are caused by high blood pressure, eye strain or sinus disease, which are almost always not the cause.”

What kind is it?

Headaches differ in type, duration, symptoms, triggers and severity.

And knowing which type of headache you have is the first step in effectively treating it. A migraine sufferer, for example, may see auras (flashing lights or zigzag lines) and/or experience nausea and debilitating pain.

Migraines tend to run in families and affect women more often than men. The cause is not clearly understood, but it is thought to be a result of the opening and narrowing of blood vessels and the release of certain chemicals that cause an imbalance of brain chemicals.

Often people with migraines are sensitive to light and noise and will seek out a dark, quiet room.

Hormonal variations also play a role; and women with migraines will often experience headaches around their menstrual cycle.

A cluster headache — a variant of the migraine — occurs in cycles or clusters over a period of time and is more common in men. It usually comes on as a sudden, severe headache but like a migraine, only affects one side of the head. A tension headache is often triggered by stress and is the most common form of headache. It can last for less than an hour or as long as a week.

A person with a tension headache may experience pressure that feels like a vise is squeezing his or her head. Fortunately, even the most severe headache usually isn’t a harbinger of another underlying condition.

Recurrent migraines, tension or cluster headaches are known as primary headache disorders because these types are not caused by other medical conditions. According to the National Institutes of Health, the exact causes of these types of headaches are unknown. The majority of headaches fall into this category. And some people are able to successfully manage these headaches without consulting a physician.

On the other hand, secondary headaches can result from a wide range of conditions including sudden onset of severe high blood pressure, brain tumor, sinusitis, stroke, subdural hematomas or infections such as meningitis.

What type of headache do you have?

SYMPTOM LOCATION OF PAIN One side of the head

MIGRAINE

CLUSTER

3

3

TENSION

Around eyes, cheeks and/or forehead Band of pressure around the head Over one eye Throbbing pain

3

3

3

SINUS

3

INTENSITY OF PAIN Moderate to severe

3

3

3 3

3

3 3 3

3 3 3

Mild to moderate

3

Mild to severe Debilitating Dull, squeezing pain like a vise around the head

3

OTHER SYMPTOMS Light and/or noise sensitivity Nausea Experience auras, eye “floaters” or flashes Accompanied by congestion Accompanies neck and/or shoulder discomfort Worse in the morning and worsened by downward head movement

3

3 3

Information courtesy of National Institutes of Health and Drs. Howard S. Derman and Greg McLauchin

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VOLUME 5, NUMBER 1 䡲 37

COMMUNITY HOSPITALS

Coffee, tea or headache?

“Depending on the symptoms, we may order an MRI to rule out other conditions. Despite some patients’ fears, it is fairly rare for a tumor to be the source of their headaches,” McLauchlin said. “If you have a headache that switches sides, it is a primary headache.

Also, neck problems can give patients the impression that the pain originates from the base of the head.”

Anterior hip replacement, a new alternative

Avoiding triggers

B Y

Determining the type of headache a patient has is key to developing a treatment strategy.

In managing headaches, both Derman and McLauchlin recommend trigger avoidance as the first step.

Common triggers include stress; improper diet; sleep deprivation; cigarette smoke; food additives such as MSG and nitrates; and foods with high levels of tyramine, a substance found naturally in some foods that forms from the breakdown of protein as foods age. Sources of tyramine include aged cheese; smoked, cured or processed meats; alcohol; and some fruits and vegetables.

Keeping a headache diary that tracks foods, medications and activities can be helpful in determining what is triggering a migraine (see page 36).

“Headache sufferers should also look at their lifestyle and sleep patterns; and consider diet modification. You should not arbitrarily remove all possible food triggers from your diet at once but examine them one by one,” Derman said. 䡲 To schedule an appointment at the Headache Clinic, call 713.790.3333.

38 䡲 VOLUME 5, NUMBER 1

A M I

J

F E L K E R

ust four weeks after her hip replacement, 72-yearold Joan Frith walks with little pain, no swelling and complete relief from her arthritis.

It’s quite a different story from her previous experience with hip replacement surgery five years ago. She spent time in rehab after her hospital stay, experienced extensive swelling and used a walker for nearly two months.

“I did great with the first hip replacement and had no unexpected problems, but the technology and new procedure available now just cut the recovery in half. I went right home,” Frith said. “I had been dreading the second hip replacement and kept putting it off. But I knew if I didn’t do something I’d be in a wheelchair before the year was out.”

Frith underwent both of her surgeries at Methodist Willowbrook Hospital with orthopedic surgeon Dr. Alain Elbaz. He is one of only a few surgeons in the Houston area to perform anterior hip replacement — an alternative to traditional hip replacement surgery.

“This approach allows me to work between the muscles without detaching them from the hip or thighbones,” Elbaz said.

“When these important muscles are left relatively undisturbed, patients can expect to be on their feet much faster, making quicker steps toward recovery.”

Frith, a wife, mother of seven and grandmother to 10, says she feels “wonderful.” She looks forward to enjoying time with her family and helping her husband run their convenience store on a lake in East Texas.

“The arthritis was eating away my bones, and I was in terrible pain,” said Frith, who was restricted to walking with a cane before her hips were replaced. “I can already feel the difference. I would recommend this new procedure to anyone who needs a hip replacement.”

Frith works with a physical therapist, and she said the key to a successful and quick recovery is exercise. She performs approved exercises twice a day, which help improve her mobility.

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Dr. Alan Elbaz

Methodist Willowbrook Hospital is a 119-bed community hospital with: 䡲 inpatient and outpatient services

P

atients who undergo anterior hip replacements can usually walk independently, drive and return to their normal activities within a few weeks,” Elbaz says. “Since we do not have to cut muscle, the new modern hardware aligns better with joints and preserves the length of patients’ limbs, making joints last longer and feel more natural.”

Using technologically advanced operating tables and instruments also aid surgeons because they precisely position the hip for surgery. “Today, doctors are focusing on ways to help reduce recovery time and improve comfort after the operation,” Elbaz said. “Every patient responds differently, but our goal is to cut the three-month recovery time at least in half.” 䡲

“

To schedule an appointment, call 713.790.3333

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䡲 surgery center 䡲 digital cardiac catheterization laboratory 䡲 birthing center 䡲 Level II nursery 䡲 orthopedic unit 䡲 intensive care unit 䡲 intensive medical unit 䡲 24 hour emergency room and pastoral care The hospital has continually expanded since its opening to meet the demands of the community.

Current expansion plans include increasing to nearly 400 beds.

VOLUME 5, NUMBER 1 䡲 39

MY TURN

“I was the bystander who

watched in awe as the superheroes once again defeated the villain.”

B Y

S T E F A N I E

For the past 10 years, I have walked the halls of The Methodist Hospital scurrying off to a meeting or the cafeteria, often pausing to help patients find their way. I pass men and women in white coats and scrubs going about their daily work of saving lives and caring for the sick.

It is not a shock anymore to see a seriously ill patient being wheeled down the hall, or a grieving family comforting each other in a waiting room. You don’t become numb to it, but you grow accustomed to peeking at these little snapshots of life every day.

Recently, I saw something for the first time since I started working here. I was sitting in my office when I heard a thud outside. A young employee had fallen, apparently fainting in the hallway. When she could not be aroused, someone called the hospital’s Code Blue Team. It’s sort of like our internal 911 call. I was familiar with this team because at least a few times a week I hear an ominous voice from the overhead speaker. … “Code Blue, Dunn Building, Room 123.” “Code Blue, Jones Building, Room 456.”

I knew it was a call for an emergency response team trained to rush to the aid of any patient in the hospital with cardiac or respiratory emergencies. I knew somewhere in the hospital caregivers were stopping

40 䡲 VOLUME 5, NUMBER 1

A S I N

their regular duties and rushing down stairs and elevators.

I expected to see a few very skilled professionals arrive within a few minutes to save the day.

What I didn’t expect was a swarm of Methodist employees and physicians coming from different directions, sweeping in like a pack of superheroes. Each was armed with technology and expertise to save a person’s life, and all knew their role in helping this employee who had suddenly become a patient.

There by this young employee’s side was an intensive care unit (ICU) physician, pharmacist, respiratory therapist, ICU nurse and lab technician, among others. Additionally, there was a chaplain, social worker and a recorder who documented all that went on. In all, about 10 health care workers left their regular routine to respond to a code blue page.

Code blue team members are assigned by individual departments for each shift every day. When the pager goes off, that member leaves for the code unless they are performing a task that cannot be interrupted. The hospital averages about 11 code blues every week.

When this team arrived, they quickly administered oxygen and checked the employee’s vitals. They stabilized her and prepared her for transport to the emergency room. It was an impressive sight, which made me burst with pride as a fellow employee at Methodist — a place where the well-being of our patients and employees is always priority.

I was the bystander who watched in awe as the superheroes once again defeated the villain. Later I learned the frightened young employee returned to work the next day. And I returned to my nearby office — feeling a little bit safer in the world. 䡲 Asin is director of Public Relations for The Methodist Hospital System.

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