Leading Medicine Magazine, Vol. 5, No. 2, 2009 by Houston Methodist

LEADING MEDICINE

A PUBLICATION OF THE METHODIST HOSPITAL SYSTEM VOLUME 5, NUMBER 2

HONOR ROLL

ONE KIDNEY SAVED TWO LIVES Getting a good night’s sleep PAD: cruel irony for bypass patients Revision hip replacement

THE METHODIST HOSPITAL One of America’s Honor Roll Hospitals

The Methodist Hospital is the only hospital in the region recognized on the Honor Roll of U.S.News & World Report’s ”America’s Best Hospitals.” • CANCER

• GYNECOLOGY

• ORTHOPEDICS

• DIABETES & ENDOCRINE DISORDERS

• HEART & HEART SURGERY

• PSYCHIATRY

• KIDNEY DISORDERS

• RESPIRATORY DISORDERS

• NEUROLOGY & NEUROSURGERY

• RHEUMATOLOGY

• EAR, NOSE & THROAT • GERIATRIC CARE

• OPHTHALMOLOGY

• DIGESTIVE DISORDERS

• UROLOGY

LEADING MEDICINE

Volume 5, Number 2, 2009

Logon on to methodisthealth.com/readersurveyresults to see the results of our 2008 reader survey!

R.G. GIROTTO President & CEO MARC L. BOOM, M.D.

Executive Vice President JOHN E. HAGALE, C.P.A.

Executive Vice President, C.F.O. & Chief Administrative Officer RAMON “MICK” CANTU, J.D.

Executive Vice President & Chief Legal 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

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MEGHAN DONOVAN BLANTON AMI FELKER HATTIE J. HORN GEORGE KOVACIK

MAUREEN KOVACIK PATTI MUCK GALE SMITH

Contributing Writers BRIDGETT AKIN BRIDESIGN, INC.

Design FANTICH STUDIO

Photography Leading Medicine magazine is published by The Methodist Hospital System Marketing Department for patients, physicians, employees and supporters. © 2009 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, Publications Department 1707 Sunset Blvd. Houston, Texas 77005 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.

CEO MESSAGE

CRUEL IRONY

HEART DISEASE

SWEET DREAMS Overcoming obstructive sleep apnea

LEADING MEDICINE Famed Swedish researcher Jan-Åke Gustafsson joins Methodist

CLOSE TO HOME New imaging centers open in Upper Kirby and west Houston

Orthopedic surgeon tackles revision hip replacement cases

PRIMER

KIDNEY SWAP

Methodist DeBakey Heart & Vascular Center provides holistic approach

CULTURE OF SAFETY Living, breathing and thinking patient safety

RESTORATIVE PELVIC MEDICINE

COMMUNITY HOSPITALS Hyperbaric oxygen therapy heals persistent wounds

Total hip replacement

Young woman saves the lives of mother and stranger

Coronary bypass patients at risk for PAD

Restoring continence and sexual health to men and women

HIP PAIN

38 40

ACCOLADES CLINICAL NOTES

FOUNDATION OF SUPPORT Knuckle Ball supports neurological research HONOR ROLL

Archive editions of Leading Medicine magazine are now available at methodisthealth.com/leadingmedicine

Front Cover: Monique Wisdom saved two lives when she donated a kidney to her mother Annette Kaiser. Read more about it on page 16. Photo courtesy of Dave Einsel VOLUME 5, NUMBER 2

OFFICERS OF THE METHODIST HOSPITAL BOARD OF DIRECTORS

A Message From the CEO Dear Readers, It gives me great pleasure to share some of the exciting things happening at Methodist since our last edition — most notably our stellar ranking on U.S.News and World Report’s Best Hospitals Honor Roll for 2009. For the first time in our history, The Methodist Hospital has earned a prestigious spot on the magazine’s Honor Roll. While we consistently have ranked in a variety of specialties for 17 years, the Honor Roll recognizes the best of the best, confirming our placement among the upper tier of hospitals like Mayo Clinic, Johns Hopkins Hospital and Massachusetts General Hospital. (See page 24 for complete list.) Methodist is the only adult hospital on the Honor Roll in this part of the country, and we are ranked in 15 of 16 specialties — more than any other hospital in Texas. Ten of those specialties ranked in the top 25. It is a tribute to the hard work of our entire organization and our partners. And earlier this year, FORTUNE magazine ranked The Methodist Hospital System No. 8 in the nation on its “Best Companies to Work for in America” list. This is our fourth consecutive year to rank and our third year in the top 10. This ranking is a reflection of our unwavering desire to create an environment of caring for our employees as well as our patients. Recognitions like these confirm that our vision to build a world class academic medical center is the right thing to do for our community. We have committed ourselves to recruiting the best physicians, researchers and staff, and improving access to the best patient care available. In the past six months, we have opened new facilities — the Methodist Cancer Center at Methodist Willowbrook Hospital, the Methodist Breast Imaging Center and Methodist Emergency Care Center in the Upper Kirby District and the Methodist Imaging Center in west Houston — that enable us to bring important, lifesaving services — once only found in the Texas Medical Center — to people all over the Houston area. In this edition, you will read about the physicians, technology and patient care that have earned us Honor Roll distinction. We are honored to play a role in boosting Houston’s reputation as the premier destination for health care. I hope you enjoy this issue!

HON. EWING WERLEIN JR. Chair JOHN F. BOOKOUT Senior Chair ERNEST H. COCKRELL Vice Chair DAVID M. UNDERWOOD Vice Chair R. 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 LAWRENCE W. KELLNER REV. KENNETH LEVINGSTON VIDAL G. MARTINEZ GREGORY V. NELSON REV. DR. TOM PACE KEITH O. REEVES, M.D. WADE ROSENBERG, M.D. JOSEPH C. “RUSTY” WALTER, III ELIZABETH BLANTON WAREING DR. STEVE WENDE SANDRA GAYLE WRIGHT, ED.D., R.N.

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

ADVISORY MEMBERS VICTOR FAINSTEIN, M.D. REV. RICHARD GOODRICH

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Comprehensive sleep disorders program offers

SWEET DREAMS By Gale Smith

or more than 30 years, Daniel Meneses dreamed only of one thing — getting a good night’s sleep. Since he was 13, he woke up in the morning more exhausted and physically achy than when he went to bed the night before. “Almost every day, I would walk into a room and ask myself, ‘Why am I here?’ It got to the point where I was always depressed; I thought I just wasn’t smart because I couldn’t remember anything.” Growing up in his native Colombia, Meneses had little access to resources, so he learned to live with the problem. As he got older, he became more impatient and irritable, to the point where his behavior affected relationships with friends and family. At the age of 48, Meneses knew he needed help when he had to make to-do lists so he wouldn’t forget anything. Just as important, he couldn’t play board games with his wife anymore. “She loves board games, but I couldn’t concentrate,” he said. “I couldn’t even remember my last move during a simple checkers game.”

can’t fall asleep within 30 minutes of lying down, have excessive daytime sleepiness or sleep for seven or more hours and wake up tired, it’s usually a sign they have a more serious sleep problem.

The Sleepover As with all overnight sleep studies conducted at Methodist, Meneses spent the night in a room modeled after an in-home bedroom, decorated with soothing colors, TV, easy chair and an adjacent bathroom. Sleep center technologists attach wires to electrodes, placed on the patient’s head and upper torso to measure brain waves, eye and chin movement, the different stages of sleep, heart rate and rhythm. None of the devices is painful, and there are no needles involved. Additional monitors measure leg movement, breathing, and oxygen and carbon dioxide levels in the blood. Monitoring is done in a nearby control room, and a video record is made of the entire stay.

His wife finally convinced him to seek medical help. Through an Internet search, they found Dr. Aparajitha Verma, a neurophysiologist at The Methodist Hospital. After talking with Meneses about his history and symptoms, Verma recommended a sleep study.

The study begins with “lights out.” At that time, patients are not permitted to read, watch TV, eat, talk on the phone or perform any other activity that may interfere with sleep. They are monitored for approximately eight hours. After being awakened in the morning by the technologist, patients are given an hour to shower and prepare for the day ahead.

Verma, who is medical director of the hospital’s Sleep Disorders Center, says whenever people

Now, more than three decades after his problems began, Meneses knows the reason for his years of sluggishness

VOLUME 5, NUMBER 2

Sweet Dreams

“Whenever people can’t fall asleep within 30 minutes of lying down, … it’s usually a sign they have a more serious sleep problem.” and fatigue. He is one of the 18 million Americans who suffers from obstructive sleep apnea or OSA. Obstructive sleep apnea is the most common form of apnea, which is the Greek word for “without breath.” It is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. When the airway is closed, the person stops breathing repeatedly during sleep. When this happens regularly, sleep is extremely fragmented and of poor quality. “I always thought people with sleep apnea woke up gasping for air, and I never had that problem. I knew I snored a lot and was excessively sleepy during the day,” Meneses said. “After talking with Dr. Verma and doing the study, I now understand that OSA is more prevalent in men than women, and I had the most common symptoms.” After analyzing the sleep study, Verma developed a treatment plan specific to Meneses’ needs. She recommended a second sleep study using a nasal continuous positive airway pressure mask, which is the most common treatment for sleep apnea. The CPAP titration study is standard for people diagnosed with apnea. During this test, the machine pushes air at a pressure high enough to keep the airway open during sleep. This study, however, proved ineffective for Meneses. Because of his severe asthma, the test showed he would need such a high pressure level that he would not be able to use the mask effectively. Verma then consulted with her colleagues within Methodist’s Comprehensive Sleep Disorders Program to see if Meneses would be a candidate for surgery. Dr. Aparajitha Verma

Bedrooms in the Sleep Disorders Center are modeled after an in-home bedroom patient before the study begins (right).

A Dream Realized After reviewing Meneses’ case, center surgeons performed oral surgery on him in January to enlarge his airway. “Before my surgery, I had poor circulation in my legs and feet. I was extremely tired, not able to think clearly in the mornings, and I didn’t feel productive. Now I’m getting six to eight hours of uninterrupted sleep each night. It’s amazing,” he said. Sleep is such an essential part of the human existence that we spend about a third of our lives doing it. Sleep disorders afflict 50 to 70 million people in the United States. In addition to being a major cause of disease and injury, sleep disorders put people at risk for heart attack, stroke, hypertension, obesity, depression and accidents. Methodist’s Sleep Disorders Program is multidisciplinary and comprised of physicians with expertise in the management of patients with various kinds of sleep issues. Patients can be seen by neurologists; ear, nose and throat physicians; oral and maxillofacial surgeons; psychiatrists; and pulmonologists. The program also serves as the focal point of educational efforts and research protocols in sleep medicine. A core component of the sleep program is Methodist’s Sleep Disorders Center, a 10-bed outpatient facility that is accredited by the American Academy of Sleep Medicine, the national leader in setting standards and promoting excellence in sleep medicine. According to Methodist pulmonologist Dr. Mario Gonzalez, good sleep is important to a person’s cognitive function. Patients who have extreme asthma, emphysema or chronic obstructive pulmonary disease are often referred to him when symptoms of wheezing, shortness of breath or chest tightness do not improve.

Epworth Sleepiness Scale The Epworth Sleepiness Scale quantifies the level of daytime sleepiness. Rate how likely you are to fall asleep in certain situations. How likely are you to doze off or fall asleep in the situations described below, in contrast to feeling just tired?* This refers to your usual way of life in recent times. Even if you haven’t participated in some of these activities recently, try to determine how they would have affected you and circle one number. Use the following scale to choose the most appropriate number for each situation. e bedroom (left). Sleep technologist Kelsey Lawrence attaches electrodes to a

“Many of these patients are depressed and have a lack of concentration, all because of lack of sleep,” Gonzalez said. He often sees these signs in patients with neuromuscular disorders, such as amyotrophic lateral sclerosis.

Chance of Dozing Off 0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing

How likely are you to doze off in the following situations?

Patients with ALS, commonly known as Lou Gehrig’s disease, have weaker diaphragms, so sleep issues are more prevalent. ALS patients feel weak, experience more headaches, and overall, are not well rested.

1. Sitting and reading: 0) Never 1) Rarely

2) Sometimes

3) Often

2. Watching TV: 0) Never 1) Rarely

2) Sometimes

3) Often

“Oftentimes, these patients and their caregivers won’t know what kind of help to ask for unless their physician is aware of how diseases affect sleep. We have the ability to provide our patients the comprehensive care they need to treat the entire person, not just one aspect of the problem,” he said.

3. Sitting, inactive in a public place (theater, meeting): 0) Never 1) Rarely 2) Sometimes 3) Often

As for Meneses, the oral surgery greatly improved his condition, but a repeat sleep study in April showed that his OSA, while not as serious, is still somewhat present. He will likely wear an oral appliance, such as a custommade mouth guard, to help move the jaw forward so he can breathe better at night. “Even though I still write to-do lists every day, my memory is so much better. I can function again, and I don’t feel dumb. And no one is calling me ‘Forgetful Jones’ anymore,” he said.

4. As a passenger in a car for an hour without a break: 0) Never 1) Rarely 2) Sometimes 3) Often 5. Lying down to rest in the afternoon when circumstances permit: 0) Never 1) Rarely 2) Sometimes 3) Often 6. Sitting and talking to someone: 0) Never 1) Rarely 2) Sometimes

3) Often

7. Sitting quietly after lunch without alcohol: 0) Never 1) Rarely 2) Sometimes

3) Often

8. In a car while stopped in traffic: 0) Never 1) Rarely 2) Sometimes

3) Often

* If you are already on CPAP or BIPAP, please answer these questions indicating the way you feel when you are using CPAP or BIPAP.

What does your score mean?

For more information about Methodist’s Comprehensive Sleep Disorders Program, visit methodisthealth.com or call 713-790-3333. !

If you score 8 or lower, keep doing what you are doing. You are in good sleep health. If you score a 9 or higher, you may benefit from a consultation by a sleep specialist and/or a sleep study. !

RANKED SPECIALTY

Dr. Mario Gonzalez

VOLUME 5, NUMBER 2

FAMED SWEDISH SCIENTIST JOINS METHODIST TEAM TO DISCOVER NEW APPROACHES TO FIGHT DISEASE By Patti Muck Like generals mapping a battle strategy, Drs. Jan-Åke Gustafsson, Willa Hsueh and John Baxter talk about the next line of attack against the obesity epidemic. “Sixty percent of the U.S. population is overweight, and 30 percent is obese,” Hsueh reminds her colleagues as they discuss the war against diabetes, heart disease and other leading killers. “Drugs for these are desperately needed.” “There’s only one way to move data from the laboratory bench to the bed of the ailing patient, and that is patenting and commercialization — making companies,” Gustafsson points out. As Baxter and Hsueh talk in the conference room of their laboratory at The Methodist Hospital — joined by Gustafsson via telephone from Sweden — their animated conversation moves from one topic to the next, but the focus remains clear: how to translate scientific knowledge into drugs that can help sick people. “We go from atomic resolution — understanding how the drugs work — to biochemical and molecular biology testing to animal testing, and we’re hoping now to expand our program so that we can develop compounds that will have impact,” Baxter explains. Just six months since his arrival in Houston from his native Sweden, Gustafsson already has several research and development strategies under way with Hsueh and Baxter. He leads the developing Center for Nuclear Receptors and Cell Signaling, an integrated joint center between the University of Houston and The Methodist Hospital Research Institute. The center is partially funded by a $5.5 million grant from the Texas Emerging Technology Fund. An expert in nuclear receptors, Gustafsson works closely with Baxter, who heads the Research Institute’s genomic medicine core, and Hsueh, who directs diabetes and metabolism research. This high-powered partnership and crosslaboratory collaboration holds the potential to discover new ways to control nuclear receptors, the docking stations in our cells’ nuclei that regulate cell behavior and control the body’s metabolic and disease processes. As the Research Institute continues adding leading medical experts to its impressive roster, director Dr. Michael W. Lieberman, looks at this latest hire — Gustafsson holds a joint appointment in the Research Institute — as “a very proud hour.” Dr. Jan-Åke Gustafsson

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Drs. Michael W. Lieberman, Jan-Åke Gustafsson, John Baxter and Willa Hsueh

“Though this is a new place and a new culture, these are people who know and like and trust one another, and they’ve worked together for a long time,” Lieberman says. “They’re all creative, they’re all smart, they all talk fast, they all think fast. With Willa, Jan-Åke and John in the same room — you stay out of their way and expect them to do great things.” For three years, Jan-Åke (pronounced Yan á key) Gustafsson explored employment opportunities in the United States. He was approaching retirement age in Europe with no will to quit — “I want to be active until I die, which I hope is many years from now,” he says. He had several good offers, including one from Yale University. But when Baxter, his longtime friend and collaborator, urged him to visit Houston, the next chapter of his internationally acclaimed career started to take shape. During his recent phone conversation with his colleagues, he was tying up loose ends in Sweden and finalizing his permanent relocation to Texas. His wife, Margaret Warner, a fellow research scientist at Karolinska Institutet in Stockholm, is also part of the new team in Houston. Lieberman says working with higher education through partnerships with the University of Houston, Rice University and others makes sense because each partner gains from the others’ knowledge. The universities offer expertise in biomedical engineering, applied mathematics, chemistry, physics and computational science. Combine that with Research Institute physicians skilled at pathophysiology, clinical trials and translational research, and the collaborative potential is limitless. “It’s a culture that encourages risk-taking,” Lieberman says. “It’s interdisciplinary research — we do things around disease problems, not around disciplines. We always have our antennae out; we’re always filtering new leads. It’s a very heady environment.”

Together, he and Baxter cofounded a biotechnology company in the late 1980s. Now, their careers have converged in a rich intellectual melting pot where brainstorming grows the seeds of new ideas with financial and institutional commitment behind them. Hsueh, Baxter and Gustafsson are attacking disease on a broad front. Using nuclear receptors like estrogen receptor beta (ER Beta) and liver X-receptor beta (LXR beta) — both discovered by Gustafsson and his team — the scientists hope to develop compounds targeting atherosclerosis and its complications, including bad cholesterol, triglycerides, lipoprotein and atherosclerotic lesions that cause heart attack and stroke. They believe they can develop medicines that will suppress appetite in the brain and attack inflammation that damages blood vessels. At least three new pills — including one called the “exercise pill” — are under development. One pill will use a nuclear receptor to reduce bad cholesterol, eliminate body fat and reduce atherosclerosis in the arteries — a statin-plus type of drug that mimics the effects of exercise without the actual exercise. Hsueh is working to identify diagnostic markers that will pinpoint patients harboring “angry fat,” or fat that seeps out of its own cells and starts invading other tissues, causing a host of problems throughout the body. “I’ve become known as Dr. Angry Fat because we talk about bad fat, and in my opinion, it’s a primary cause of metabolic syndrome,” she says. All three lament what they see as a regulatory environment that makes it nearly prohibitive to get a new drug to market these days. Most pharmaceutical companies have stopped developing new drugs to combat problems like diabetes and cardiovascular disease, and at a time

Photo by Thomas Campbell, University of Houston

Gustafsson brings with him international fame gained from years of lectures and award-winning scientific

research. He is former chairman of the Nobel Assembly of the Karolinska Institutet and led studies on receptors and hormonal control of liver and prostate cancer funded by National Institutes of Health grants.

son, sueh

VOLUME 5, NUMBER 2

Leading Medicine

when Hsueh, Baxter and Gustafsson say new medications are needed more than ever before. Scientists and academic medicine have a big gap to fill. “We must develop data that becomes so compelling that surely people are going to scream, ‘We need these drugs,’” Baxter says. A partnership like theirs, they hope, gives them the necessary resources and wherewithal to do what pharmaceutical companies have been unable to do.

“What really counts in our souls is if we can say that we have helped patients,” Gustafsson says. “If we can say our research contributed to developing a drug that really helped patients from suffering, then our careers will have been successful. That’s what we are trying to do in Houston now — to set up structures where this might be possible. !

Jan-Åke Gustafsson, M.D., Ph.D. Professor, Department of Biosciences & Nutrition

Education Ph.D., Dept of Chemistry, Karolinska Institutet, 1968 M.D., Karolinska Institutet, 1971

Career/Academic Appointments 1964 Bachelor of Medicine, Karolinska Institutet, Stockholm 1971 Associate Professor in Chemistry, Karolinska Institutet 1976 Professor of Chemistry, Karolinska Institutet 1978 Professor of Chemistry, University of Gothenburg 1979 Professor of Medical Nutrition and Chairman of the Dept of Medical Nutrition, Huddinge University Hospital, Karolinska Institutet 2006-2008 Professor of Medical Nutrition and Chairman of the Dept of Biosciences and Nutrition, Karolinska Institutet

Administrative Positions 1985 Director of the Center for Biotechnology, Huddinge University Hospital, Karolinska Institutet 1987 Founder of KaroBio AB (a campus-situated biotechnology company sponsored by pension and governmental funds with about 80 employees) 2004-present Coordinator for the EU funded CASCADE Network of Excellence

Board Certification Has been member of the Faculty Board of the Karolinska Institutet and regularly carries out various assignments for the President’s Office of the Karolinska Institutet Awards Committee Member, Endocrine Society, USA 2002-06 Elected Member of Council (Board) of Endocrine Society, USA, 2007

Professional Honors & Recognition International/National/Regional 2008 International Member American Philosophical Society 2005 Descartes Research Prize for excellence in scientific collaborative research 2005 2nd Ernst Knobil Memorial Lecture, San Diego, USA 2004 Medal from Biomedicum Helsinki 2004 Bristol-Meyers Squibb/Mead Johnson Award for Nutrition Research 2003 FEBS Lectureship Datta Award 2002 Commandeur dans l’Ordre des Palmes Académiques 2002 Foreign Honorary Member of the US National Academy of Sciences 2002 Chairman of the Nobel Assembly of the Karolinska Institutet 2002 Fred Conrad Koch Award (Endocrine Soceity USA) 2001 The AF Group Prize for the creation of Novum Research Park 2001 Lorenzini Gold Medal, Lorenzini Foundation 2001 Vice chairman of the Nobel Assembly of the Karolinska Institutet 2000 One of ISI Top 258 Researchers in Biology & Biochemistry 2000 Garvan International Fellow

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2000 Burroughs Wellcome Fund Lecture 2000 Foreign Honorary Member of the American Academy of Arts and Sciences 2000 European Medal, British Society for Endocrinology 2000 Curt Nicolin’s Prize for Achievements for the Development of South Stockholm 1999 Medal of the IngaBritt and Arne Lundberg’s Research Foundation 1999 Fogarty Scholar NIH 1998 Adjunct Member of the Nobel Committee of the Karolinska Institutet 1998 The Söderberg Prize in Medicine 1998 Member of the Swedish Academy of Engineering Sciences 1997 Member of the Swedish Academy of Sciences 1994 Gregory Pincus Medal and Award, Worcester Foundation 1992 Keith Harris Lecture, Australian Endocrine Society, Adelaide 1992 The Anders Jahre Prize, Oslo 1992 Medal from Collège de France, Paris 1990 Honorary Member of the American Society for Biochemistry and Molecular Biology 1986 Honorary Member of the Japanese Biochemical Society 1986 Member of the Nobel Assembly of the Karolinska Institutet 1983 The Fernström Prize of the Karolinska Institutet 1982 The Svedberg Prize in Chemistry, Stockholm

University 2008 EMD Serono President’s Distinguished Lecture: “Estrogen Receptor-Beta and Reproduction”. Annual Meeting of the Society for Gynecological Investigation, San Diego. 2008 Honorary Professor at the Beijing Normal University 2008 Honorary doctorate in Medicinal and Pharmaceutical Chemistry at the University of Milan 2007 Honorary Professor at the University of Chongquin, China 2007 Honorary doctorate in Medicinal and Pharmaceutical Chemistry at the University of Milan 2004 Guest Professor at the University of Science and Technology of China, Hefei 2003 J.G. Moore Visiting Professor, UCLA, USA 2003 Marius Tausk Visiting Professor at the Leiden University Medical Centre (LUMC) 2003 McDowell Lecture in Physiology, King’s College, London, U.K. 2002 Burroughs Wellcome Fund Visiting Professor in the Basic Medical Sciences at the University of Texas Medical Branch School of Medicine 2000 Center for Bioenvironmental Research Distinguished Visiting Professor, Tulane University, New Orleans 1995 Sterling Visiting Professor, University of Pennsylvania, Philadelphia 1991 Consultant to The Rockefeller University Hospital 1987 Adjunct Full Professor at the Department of Cell Biology, Baylor College of Medicine, Houston, Texas

Bibliography Has more than 1,300 peer-reviewed publications Biography courtesy of University of Houston

Methodist Breast Imaging Center photos © Aker/Zvonkovic

Patient Focused Care CLOSE TO HOME By Hattie J. Horn

alls slathered in understated tones of desert sand and bamboo. Low, soothing music floats through the air. And frosted, blue windows encase the space, creating a comforting cocoon. Nestled amid the bustling Upper Kirby District, this tranquil oasis isn’t the hottest new spa to hit Houston, it’s the Methodist Breast Imaging Center. A concept meant to engender patient relaxation and a calming atmosphere. The 8,000-square-foot space was especially designed to accommodate the needs of the female patient. Dr. Luz A. Venta, a radiologist and the

center’s medical director, says it’s common for women dealing with breast issues to experience feelings of stress and anxiousness. “We want patients to see the center as a safe harbor where they feel comfortable opening up about their breast issues,” she said. The center, which opened in February, replicates the benefits of the Methodist Breast Center at an easily accessible location. “We’re seeing more patients who don’t want to travel to the medical center. … who want a second, expert opinion and access to our technology,” she said. The center is the only facility dedicated solely to the detection of breast cancer in the Houston area.

Located at Highway 59 and Kirby, the facility is staffed by a team of board certified radiologists and is

“We want patients to see the center as a safe harbor where they feel comfortable opening up about their breast issues.” accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound guided breast biopsy. Methodist was the first hospital in the country to use all digital mammography, meaning it captures an X-ray with a computer rather than conventional film mammography, a better

VOLUME 5, NUMBER 2

Imaging Centers

method, particularly for women with dense breast tissue. That same technology is available at the new center. It is recognized as a Breast Imaging Center of Excellence by the American College of Radiology Commission on Quality and Safety, and the Commission on Breast Imaging. Venta believes providing a convenient and comforting environment reduces barriers for patients seeking breast care. “Early detection is the most effective way to diagnose cancer, and having a mammogram is the first step in fighting breast cancer and reducing mortality. “We ease a lot of anxiety for patients coming in for a mammogram, ultrasound or a biopsy. They can have the procedure, talk to their physician, ask questions and get their results all during the same visit,” she said.

Go West The new Methodist Imaging Center — West Houston sits along the I-10 corridor just outside the 610 Loop near Voss. When patients enter the 10,000-square-foot stand-alone facility, they are greeted by golden-oak walls and deep sofas that suggest an inviting family room. Dr. David Light, the center’s medical director, along with his team of subspecialized radiologists, has welcomed a steady stream of patients for a variety of general imaging procedures since it opened in February. Methodist is continually enhancing and improving its technology, methods and options in patient care. The imaging center offers two types of MRI — traditional and a new highfield open MRI — that use a magnet, radio frequencies and a computer to

Physicians at the center also facilitate referrals, if needed. “This setting and personal, one-onone care between physician and patient really sets us apart from other facilities that don’t provide this type of access,” she said. !

Methodist Breast Imaging Center 2615 Southwest Freeway, Suite 110 Houston, TX 77098 713-441-PINK (7465)

MRI Biopsy — When a suspicious mass is found with breast MRI that cannot be seen in mammograms or ultrasounds, biopsies must be taken through a needle guided by MRI.

Monday – Friday 8 a.m. – 5 p.m.

Breast Ultrasound — A breast ultrasound helps the radiologist determine if a lump or mass is filled with fluid or is solid tissue.

Services include: Mammogram — The most commonly used tool for breast cancer

Ultrasound Biopsy — If a lump is identified as suspicious, physicians may use ultrasound biopsy to remove pieces of tissue with a needle through a small cut in the skin.

detection and screening, mammograms involve taking X-rays of each breast.

Breast MRI — Breast MRI is used in addition to mammograms for women at high risk for breast cancer. 10

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Stereotactic Biopsy — A stereotactic biopsy is similar to an ultrasound biopsy and is guided by mammography.

Methodist Imaging Center photos courtesy of Terry L. Smith

produce detailed images of organs and structure within the body. An open MRI procedure is more comfortable for the patient and provides the same high-quality images effective in detecting a host of disorders. Other general radiology services offered include CT and PET imaging, bone density testing, diagnostic X-rays and ultrasounds. Center

and stand out among their counterparts. They serve as consultants to referring physicians, troubleshoot problems involving procedures and recommend effective approaches in ongoing patient care. He and the staff continue to review and evaluate services to ensure the center is effectively serving the needs of the area.

care The Methodist Hospital is known for, into this community.“ Light adds that the center’s introduction to west Houston aligns with Methodist’s expansion plans to open a 200-bed hospital at I-10 and Barker Cypress in 2010. !

Methodist Imaging Center — West Houston 8333 Katy Freeway Houston, TX 77024 713-797-XRAY (9729) Monday – Friday 7 a.m. – 6 p.m. Services include: CT Imaging Diagnostic/Bone Density MRI Nuclear Medicine (PET/CT) Ultrasound

radiologists access and interpret images through Methodist’s picture archiving and communications system or PACS. The fully digital PACS allows images to be transmitted to all Methodist hospitals within a matter of seconds. As the new kid on the block, Light says the team is taking great measures to strengthen the center’s relationships with the community

“We want to make sure each patient who comes through our doors receives the best we have to offer,” Light said. “We have top radiologists and innovative technology available, which enable us to give the most accurate interpretation of their imaging exams with 24 hours. We have been well received by patients and clinicians, alike, who appreciate our effort to bring the same renowned VOLUME 5, NUMBER 2

PRAYING WITHOUT PAIN

“Methodist has the tools and the know-how to improve the lives of patients who have had a previously unsuccessful outcome.” By George Kovacik Daily mass is Sister Angelica Menta’s sanctuary. Every day for more than 65 years, she’s attended church to give thanks, ask for forgiveness and find peace through prayer. But when it comes to living a healthy, pain-free life, that peace has eluded her. As a farm girl growing up in upstate New York, Menta was tough and very athletic. She could hit, throw and catch a baseball as well as any boy in the neighborhood. But unlike those boys, she had a serious health problem. She was born with a dislocated hip that left one leg shorter than the other, and when it slipped out of place, it caused excruciating pain. At times, even a slight movement caused pain. As she got older, kneeling in church became a big problem. “On a scale of one to 10, the pain was around an eight. My hip always felt hot. … like someone was jabbing me with a sharp object,” Menta said. “I’ve had at least 10 surgeries to repair my hip, including a total hip replacement, but nothing seemed to completely get rid of the pain.” Then she met Dr. Stephen Incavo, an orthopedic surgeon with The Methodist Hospital.

When Incavo examined her, he discovered an infection was causing the constant pain in her right hip. He recommended she undergo revision surgery, a long and sometimes arduous process for both patient and surgeon. “We tackle these cases because we have the expertise, and we are willing to give the time necessary to help these patients,” Incavo said. “Methodist has the tools and the know-how to improve the lives of patients who have had a previously unsuccessful outcome.” A patient may need a hip replacement revised if they fracture around the prosthesis, or the bearing surface wears out and becomes unstable. Revision surgeries are more complicated than initial hip replacements because of poor bone quality and the difficulty in properly securing the revision hip replacements in position. Removing the old prosthesis can require more extensive surgery and can take a toll on patients, who in most cases are older. When a hip replacement is infected, the revision process usually involves at least two surgeries and a recovery period of up to a year. “Once bacteria invade the metal or plastic prosthesis, all of the foreign material needs to be removed, including the replaced parts. The area has to be thoroughly cleaned so the body can heal itself,” Dr. Stephen Incavo

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Heading

“It’s nice to be free after living all these years with so much pain.” Sister Angelica Menta

VOLUME 5, NUMBER 2

Hip Pain

same material used to attach knee and hip replacements), are filled with a high dose of powdered antibiotics. The antibiotics seep out of the spacer over a six week period, delivering them to the infected area. The cement fills the gap and helps heal the infection and gives surgeons more space and soft tissue to work with later on. Additional antibiotics also are given intravenously to maximally treat the infection. A. Menta’s X-ray revealed a loose prosthesis, fractured femur and severe bone loss. B. Replacement parts were removed and an antibiotic-filled spacer was implanted in place of the removed hip replacement. C. After the infection was eliminated, a new hip replacement surgery was performed.

Over the past two years, life for Menta has been “100 percent better.” Incavo said. “Until a few years ago, the patient was left with nothing in the place of the removed prosthesis, and they were confined to bed rest for an extended period of time.” Incavo says the development of antibiotic spacers in recent years has allowed patients to get up and around, using a walker or wheelchair during the revision process. The spacers, made out of traditional bone cement (the

“Once the infection has been eradicated, we can go back in with new implants and once again replace the hip,” Incavo said. “In more than 80 percent of the cases I’ve performed, the infection has not returned.” Incavo says patients will have some pain with the spacers in place, but it is required to fix the problem. The spacers are not as comfortable as a true hip replacement, but he said it is better than strict bed rest or even being in traction. Over the past two years, life for Menta has been “100 percent better.” Her routine includes counseling people on how to stay positive in trying times and spending 45 minutes a day on a stationary bike. Most importantly, she is now able to go to her safe place — daily mass, where she can kneel down and pray pain-free. “The process of going through the surgeries was difficult but well worth it,” Menta said. “After living all these years with so much pain it’s nice to be free.” !

Is Hip Replacement Surgery for You? Whether to have hip replacement surgery should be a cooperative decision made by you, your family, your primary care doctor and your orthopedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopedic surgeon for an initial evaluation. Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability and general health status — not solely on age.

You may beneﬁt from hip replacement surgery if: Hip pain limits your everyday activities such as walking or bending Hip pain continues while resting, either day or night Stiffness in a hip limits your ability to move or lift your leg You have little pain relief from anti-inﬂammatory drugs or glucosamine sulfate You have harmful or unpleasant side effects from your hip medications Other treatments such as physical therapy or the use of a cane do not relieve hip pain Source: American Academy of Orthopaedic Surgeons

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Common Causes of Hip Pain and Loss of Hip Mobility The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis and traumatic arthritis are the most common forms of this disease. Dr. Melvyn Harrington

Total Hip Replacement Primer Total hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball and resurfaces the hip socket in the pelvic bone with a metal shell and plastic liner. The risk of infection for total hip replacements is about one percent and two percent for total knee replacements. Dr. Melvyn Harrington, an orthopedic surgeon who specializes in hip and knee conditions, says 500,000 total knee replacements will be performed this year. He predicts that more than 3 million will take place annually by the year 2030. “What sets Methodist apart from other institutions when it comes to revision surgery is that we have an entire team — from infectious disease specialists to anesthesiologists to experts in pain management — that assists us in getting our patients back on their feet again,” Harrington said.

" Osteoarthritis usually occurs in people 50 years of age and older and often, individuals with a family history of arthritis. It may be caused or accelerated by subtle irregularities in how the hip developed. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. " Rheumatoid arthritis is an autoimmune disease in which the synovial membrane becomes inflamed, produces too much synovial fluid and damages the articular cartilage, leading to pain and stiffness. " Traumatic arthritis can follow a serious hip injury or fracture. A hip fracture can cause a condition known as osteonecrosis. The articular cartilage becomes damaged and over time, causes hip pain and stiffness. Source: American Academy of Orthopaedic Surgeons

The problems that occur right after the initial surgery are easier to fix. However, sometimes the pain does not show up until two to three years after surgery. Symptoms of a diseased hip include feeling feverish or having chills, a reddish incision or swelling around the incision or oozing from the incision. !

To make an appointment with one of Methodist’s orthopedic surgeons, call 713-790-3333.

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VOLUME 5, NUMBER 2

Pay it forward:

College student

saves two lives with one gift By Ami Felker

Counting down the days until her surgery, Monique Wisdom soothed her spirit with a whispered prayer of thanks. Upon learning she was a suitable transplant match for her ailing mother Annette Kaiser, the 23-year-old college student was able to extend a hand of hope. Meanwhile, just 250 miles south in Houston, Jesus and Imelda Martinez spent their days in fear, unsure of their future. Jesus, a 36-year-old shipping and receiving clerk, was on the national waiting list for a kidney transplant, but it could be years before he received a kidney, and time was not on his side.

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Photos by Dave Einsel

He suffered from debilitating kidney disease, and the couple was devastated to learn his wife was not a suitable donor for him. All four were unaware that kidney surgeon Dr. Osama Gaber was pursuing a solution that would bring the two families together for a storybook ending. Through his efforts, both families received a happily ever after but not in the manner they anticipated.

Kidney Transplant

Imelda and Jesus Martinez, Dr. Osama Gaber, Annette Kaiser and Monique Wisdom

Last fall, Wisdom donated her kidney as planned but not to Kaiser. Instead, her kidney was used to save a stranger’s life, Jesus Martinez. Likewise, Martinez’ wife Imelda saved Kaiser’s life by donating a kidney to Kaiser. The families swapped.

“

It all began with a phone call to Wisdom from Gaber, who had looked into a hospital-based kidney swap to help Martinez. Wisdom had universal blood type O, which enabled her to donate to any blood type. And miraculously, Imelda Martinez was an equally good match for Kaiser. Gaber called Wisdom on a Friday, assured her everything would move forward with her mother’s transplant no matter what, but he told her there was an opportunity to leverage her gift to save another life as well. “We talked for quite some time,” said Gaber, who is director of transplantation at The Methodist Hospital. “I told her I didn’t want an answer yet. … for her to think about it and call me when she’d made a decision.” Annette Kaiser and Monique Wisdom

y mom helped save my life when I was young, so I was happy to save hers. And then, I was given a chance to save another person.”

After discussing the idea with her mother and thinking about it over the weekend, Wisdom called Gaber to tell him she would participate in the swap. She had no reason to donate her kidney to a stranger because she was already a good match for her mother. But when Gaber approached her with the idea of saving two lives through her single donation, she knew in her heart it was “the right thing to do.” “My mom helped save my life when I was young, so I was happy to save hers,” she said. “And then, I was given a chance to save another person too. I was worried at first, but once I found out this man’s wife was a match for my mom, I knew everything was good. It’s really neat, and I’m proud of myself.”

VOLUME 5, NUMBER 2

Kidney Transplant

“

can’t express it. It’s something big. I’ll always be thankful. Always — all my life.”

Imelda and Jesus Martinez

Kaiser adopted Wisdom when she was 10, along with her younger brother. Kaiser was a family friend, and when the children’s mother approached her about taking in her two young children because she was dying from the AIDS virus, Kaiser knew she had to do it. “My mom taught me the power of sacrifice and giving,” Wisdom said. “When Dr. Gaber called me about Jesus and Imelda, I knew it was my chance to pass it on.” With both donors and recipients in place, the complicated part began — facilitating four surgeries in four separate operating rooms at one time — a first for Methodist. More importantly, Gaber and his team were determined to keep Kaiser’s and Wisdom’s original transplant date.

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“It was imperative to us to keep all the original arrangements so that the plan never changed for Monique and Annette, except swapping the kidneys,” Gaber said. At 7:30 a.m. on October 24, Wisdom, Kaiser and both Martinez were placed in four adjoining rooms. Surgeons began operating on the donors first to give final assurance that their kidneys were well-functioning and acceptable for transplant. Dr. Lawrence Cisek began surgery on Imelda, while Dr. Richard Link prepared Wisdom. Once both donor kidneys were cleared, Gaber prepared Jesus for transplant and Dr. Richard Knight prepped Kaiser. “We never make irreversible moves because we want to make sure that not only both kidneys will function when transplanted, but also that the donors are indeed healthy enough to sustain the donation,” Gaber said.

Both transplants were successful, and the two kidneys gained color and began producing urine as soon as they were implanted in the recipients. All four patients went home just days later.

“

“I have so much more energy now,” Kaiser said. “I’m doing things around the house that I couldn’t do before.”

ur goal is every donor, every time. If a patient has a willing donor, we will do everything we can to get them a transplant.”

Swaps on the rise Kidney swap is a growing trend. It prevents patients without matching donors from waiting years for deceased donated kidneys. At the same time, living donors help their loved ones receive the lifesaving transplants they need. In most cases, two or more incompatible pairs are crisscross matches, and they swap — usually through networks supported by transplant programs. At Methodist, internal swaps are a key focus. The transplant team continuously looks for opportunities to save more than one life at a time. They meet weekly to discuss all patients being cross-matched for living donor kidney transplants. All donor evaluations emphasize the possibility of swapping. Gaber says internal swaps are “powerful” because patients can help fellow patients from their own transplant programs, who they can visit with and develop strong relationships. But patients with more difficult cases must search for donors externally. Methodist partners with two organizations that facilitate kidney swaps on the regional and national levels. “Our goal is every donor, every time. If a patient has a willing donor, we will do everything we can to get them a transplant,” he said. There is a great disparity between the number of patients waiting for transplants and the number of deceased donor organs available. “Finally the light bulb went off and people began to consider swaps. Everyone wins,” said Knight, who is surgical director of Methodist’s kidney transplant program. He says swaps allow patients to overcome two major obstacles. First, blood type incompatibility is no longer an issue. Another common challenge is transplant antibodies.

Patients who have undergone blood transfusions, previous transplants or sometimes even multiple pregnancies can build up antibodies that reject transplanted organs. “Every person has a genetic makeup that makes them more likely to accept or reject a transplant,” he said. “If lab results show potential for rejection in a recipient from one living donor, we can continue searching for a donor who does not present the same risk.” Since the swap, all four patients are recovering well. Kaiser and Martinez enjoy renewed lives and energy to spend with their families. Martinez’ wife says she is thankful to have her husband back. “Monique is our angel,” Imelda said. “When I saw her for the first time, I hugged her tight and said, ‘my angel, my angel.’” And Wisdom is finishing her college degree with hopes to help raise awareness about living kidney donation. “This experience made me realize there is so much to be done,” she said. “If I speak out, more people may consider donation to save their loved ones.” “I can’t express it,” Jesus said. “It’s something big. I’ll always be thankful. Always — all my life.” !

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VOLUME 5, NUMBER 2

The Methodist Hospital Foundation

Society for Leading Medicine The Methodist Hospital Foundation appreciates members of the Society for Leading Medicine who are helping us transform The Methodist Hospital through contributions of $10,000 or more each year. The follow list recognizes the benevolent visionaries of the Society in 2008. Their generosity not only allows Methodist to provide the very best in patient care, but also advances its vision of becoming an academic medical center of the first rank. If you wish to know more about how you can ensure the health of future generations by joining the Society for Leading Medicine, please contact Meredith Stasny at 832-667-5838 Anonymous (9) Rolaine and Morrie Abramson Aetna Dr. and Mrs. Bobby R. Alford The Alkek and Williams Foundation Mr. D. Kent Anderson M.D. Anderson Foundation The Honorable Hushang Ansary and Mrs. Shahla Ansary Dr. Hiram P. Arnold* and Mrs. Gloria R. Arnold Dr. and Mrs. Thomas D. Barrow Dr. Barbara L. Bass and Mr. Richard S. Marshall, Esq. Mr. and Mrs. Carlton E. Baucum M. R. Bauer Foundation Alice and David C. Bintliff Foundation BioSante Pharmaceuticals, Inc. Carolyn and John Bookout The Bowers Family Fund of the Texas Methodist Foundation Breg, Inc. The Brown Foundation, Inc. Mr. Charles R. Burnett III Cancer Fighters of Houston, Inc. Mr. and Mrs. William A. Carpenter Jr. Mr. and Mrs. Philip J. Carroll; The P and C Carroll Foundation The Cervantes Family Mr. and Mrs. Albert Y. Chao Ting Tsung and Wei Fong Chao Foundation Mrs. Ida L. Clement and Family Mr. and Mrs. M. Samuel Daffin The Solomon D. and Victoria David Foundation DermSurgery Associates, P.A.; Dr. Leonard H. Goldberg The Doré Family Foundation Mr. and Mrs. Charles W. Duncan Jr. Peggy and Gary Edwards The Elkins Foundation Mr. and Mrs. Jerry E. Finger; Jerry and Nanette Finger Foundation Elaine and Marvy Finger; Marvy Finger Family Foundation Finger Furniture Co. The Fondren Foundation Dr. Robert E. Fromm Jr. Drs. A. Osama and Lillian Gaber Golfers Against Cancer The Blanche M. Green Fund The Hamill Foundation Houston Endowment

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Houston Texans JLH Foundation, Inc. Karl Storz Endoscopy-America, Inc. Mr. and Mrs. Lawrence W. Kellner Mr. and Mrs. I. H. Kempner III Mr. Ajay Khurana and Dr. Sapandeep K. Singh Mr. Balwant S. Khurana Mrs. Carol S. Kobb Mr. and Mrs. John P. Kotts Mr. and Mrs. Stephen Y. Leatherwood Barbara and Melvyn Levine Carole Walter Looke Mr. and Mrs. Vidal G. Martinez The Methodist Hospital Auxiliary Mr. and Mrs. John S. Moody Moody Memorial First United Methodist Church Permanent Endowment Fund The Moran Foundation Mosbacher Foundation, Inc. Muscular Dystrophy Association, Inc. Mr. and Mrs. Gregory V. Nelson NMT Medical, Inc. The Oshman Foundation Mr. Robert T. Priddy Mr. and Mrs. Frank H. Richardson The George A. Robinson IV Foundation Roche Laboratories Inc. Drs. George and Lynn Schroth Scurlock Foundation Vivian L. Smith Foundation Dr. H. Dirk Sostman and Ms. Maria Preka St. Thomas Health Services Dr. Dipan J. Shah Ms. Sharon Werlin Staton Taub Foundation T.L.L. Temple Foundation Dr. Valentina Ugolini Mr. and Mrs. David M. Underwood The Vintage Auto Heritage Foundation Ray Walsh Foundation Rusty Walter Martha and Gib Walton The Damon Wells Foundation The Honorable Ewing Werlein Jr. and Mrs. Werlein Stedman West Foundation F.W. Bert and Mae Dean Wheeler Family Trust *Deceased

NIEKROS AND THE KNUCKLE BALL: GOING TO BAT FOR ANEURYSM RESEARCH

Niekro photo courtesy of Houston Astros

By Denny Angelle and Gale Smith

hen Natalie Niekro was a little girl, she often accompanied her dad to work, where she played with the kids of his coworkers on the world’s biggest carpet in the world’s biggest playground. Natalie and her playmates shared some of the most renowned last names in Houston sports history — Niekro, Ryan and Cruz, among others — but if she had any sense that any of this was unusual, it was that she felt they all belonged to a close and very large family. “Those Astros were more than just a team,” she recalls, “They were a brotherhood.”

VOLUME 5, NUMBER 2

Foundation of Support

atalie’s father, Joe Niekro, was one of the greatest pitchers in Houston Astros history. During his 13 years in Houston, he became the team’s first 20-game winner and remains the all-time leader in wins among Astros pitchers. At the peak of his career, Niekro was famous — and feared — for his command of the knuckleball, a crazy corkscrew of a pitch that befuddles hitters and catchers alike. But like a knuckleball, life can take an unpredictable path. In 2006, just as Natalie and her family were making

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preparations for her wedding, her father Joe died of a brain aneurysm. “Dad always looked out for the other guy — a teammate, a friend, a family member,” Niekro recalls. “He was never too tired or too busy to avoid helping other people.” So, in her father’s memory, she has set up an organization with the goal of educating people about brain aneurysms. Through the Joe Niekro Foundation, she also aims to support aneurysm patients and their families, and raise funds to further research into this almost always fatal condition.

She worked with The Methodist Hospital and the Methodist Neurological Institute to present “The Knuckle Ball … a Pitch for Life” Friday, July 31, at Minute Maid Park. A number of Astros players from the past and present were on hand to help Niekro raise more than $400,000 for brain aneurysm research.

Joe Niekro was one of the approximately 30,000 Americans to experience a brain aneurysm that bursts each year, usually resulting in sudden death. As many as one in 15 people in the United States will develop a brain aneurysm in their lifetime. Cerebral aneurysms are caused by a weak spot in a blood vessel that balloons as it fills with blood. It can occur in anyone at any age, but is more common in women than men, in adults rather than children. Methodist treats more patients with brain aneurysms than any other hospital in the region. Dr. Richard Klucznik is director of Methodist’s Brain Aneurysm Center and an interventional neuroradiologist who uses minimally invasive techniques to treat brain aneurysms. Klucznik was part of a team at Methodist that studied and perfected a technique of closing brain aneurysms in the early 1990s. Physicians thread a wire from a small incision in the leg to the site of the aneurysm. The wire coils into the aneurysm, filling it and stabilizing the weakened vessel. “For years, we’ve used platinum coils but lately we’ve seen a trend in the use of bioactive coils to promote healing and better blood clotting,” Klucznik says.

Dr. Todd Task, Dr. Richard Klucznik, Natalie Niekro and Dr. James Rose

any people with brain aneurysms can go through life undiagnosed, but a rupture can cause serious trouble, including sudden, severe headache; numbness or weakness of the face, arm or leg; trouble speaking; vision problems; and sudden nausea and vomiting.

“With this kind of technology, we may be able to offer patients a more permanent cure.” These bioactive coils contain a special filament that helps accelerate the healing process. Many people with brain aneurysms can go through life undiagnosed, but a rupture can cause serious trouble, including sudden, severe headache; numbness or weakness of the face, arm or leg; trouble speaking; vision problems; and sudden nausea and vomiting. Smoking, family history, diabetes and high blood pressure also can lead to a higher risk of brain aneurysms. Dr. Todd Trask, a neurosurgeon with the Neurological Institute, specializes in treating cerebral aneurysms. “Everything we do at Methodist centers around understanding each patient’s situation and providing a rapid response that will best mitigate the damages caused by an aneurysm,” he says.

may recommend surgery, which involves “clipping” the aneurysm. To do this, the neurosurgeon opens the skull and directly places a small clip across the neck of the aneurysm to stop or prevent further bleeding. “Treatment is continually evolving as our understanding improves about the natural history of aneurysms. We’ve improved surgical techniques, as well as imaging to see the location of the clip,” Trask explains. “We’re continually making changes to better manage patient recovery.” There was plenty of work to be done before Natalie Niekro’s first “Knuckle Ball” in July. She spent time with Klucznik and other doctors at Methodist. She also enlisted the help of many of her father’s teammates and fellow players including Joe Morgan, Art Howe, Enos Cabell and others to participate. And there is one person who was most certainly there: Joe’s brother Phil Niekro. Phil is a member of the Baseball Hall of Fame for his years with the Atlanta Braves and other teams. The Niekro brothers combined for 539 wins over their respective careers, making them the most successful brother combination in major league history. And they both figure into one of baseball’s most interesting statistics. In his two-decade career, Joe Niekro hit only one home run — off his brother. “There was some bragging after that,” Natalie Niekro recalls. “Phil may be in the Hall of Fame, but my dad always said he had two things Phil didn’t: a World Series ring and a home run off his brother.” !

If a rupture cannot be closed with a minimally invasive procedure, Trask

VOLUME 5, NUMBER 2

THE HONOR ROLL

Of the 4,861 hospitals analyzed for this year’s Best Hospitals rankings, only about 3 percent managed to rank in even one of the 16 specialties, and only the 21 below — less than two fifths of 1 percent of the total — made the Honor Roll. Unique breadth of excellence was required, based on high scores in at least six specialties. Hospitals are ordered by points. A hospital received 2 points for ranking at or close to the top in a specialty and 1 for ranking slightly lower (more details below).

JOHNS HOPKINS HOSPITAL, Baltimore, 30 points in 15 specialties

MAYO CLINIC, Rochester, Minn., 28 points in 15 specialties

RONALD REAGAN UCLA MEDICAL CENTER, Los Angeles, 26 points in 15 specialties

CLEVELAND CLINIC, 26 points in 13 specialties

MASSACHUSETTS GENERAL HOSPITAL, Boston, 25 points in 13 specialties

NEW-YORK PRESBYTERIAN UNIVERSITY HOSPITAL OF COLUMBIA AND CORNELL, 24 points in 13 specialties

12.

UNIVERSITY OF WASHINGTON MEDICAL CENTER, Seattle, 16 points in 8 specialties

13. UPMC (UNIVERSITY OF PITTSBURGH MEDICAL CENTER), 13 points in 8 specialties

14. UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS, Ann Arbor, 12 points in 8 specialties

15.

STANFORD HOSPITAL AND CLINICS, Stanford, Calif., 11 points in 7 specialties

16.

VANDERBILT UNIVERSITY MEDICAL CENTER, Nashville, 11 points in 6 specialties

17.

NYU MEDICAL CENTER, New York, 10 points in 7 specialties

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MEDICAL CENTER, 21 points in 11 specialties

17.

YALE-NEW HAVEN HOSPITAL, New Haven, Conn., 10 points in 7 specialties

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, 19 points in 12 specialties

19.

MOUNT SINAI MEDICAL CENTER, New York, 9 points in 7 specialties

20.

BARNES-JEWISH HOSPITAL/ WASHINGTON UNIVERSITY, St. Louis, 17 points in 12 specialties

THE METHODIST HOSPITAL, Houston, 8 points in 7 specialties

21.

OHIO STATE UNIVERSITY HOSPITAL, Columbus, 7 points in 6 specialties

10.

BRIGHAM AND WOMEN’S HOSPITAL, Boston, 17 points in 10 specialties

10.

DUKE UNIVERSITY MEDICAL CENTER, Durham, N.C., 17 points in 10 specialties

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*From U.S.News & World Report

The Cruel Irony For patients who thought that bypass surgery fixed them for good, PAD can seem a cruel irony.

Dr. Kevin Lisman

By Patti Muck This is a typical scenario for interventional cardiologist Dr. Kevin Lisman: A 54-year-old male diabetic smoker with high cholesterol, hypertension and a family history of heart disease comes to his office with shortness of breath and difficulty walking. Physicians diagnose him with triple vessel coronary heart disease. Bypass surgery eases his symptoms, he begins to eat better and exercise. But within months, he’s back to Lisman complaining of severe calf pain with every step. “We did an angiogram of his legs and found he had severe vascular disease on both sides in the superficial femoral arteries,” Lisman recalls. “We fixed both legs with stents, he’s lost 50 pounds, stopped smoking and he’s now five years out and hasn’t had any problems.” VOLUME 5, NUMBER 2

Peripheral Arterial Disease

Because he was under a cardiologist’s care, the man got help in time and likely added many years to his life. Like nearly 70 percent of coronary bypass surgery patients, he suffers from advanced peripheral arterial disease or PAD, which is sometimes referred to interchangeably as peripheral vascular disease or PVD. The American Heart Association distinguishes between the two, describing PVD as a disease of blood vessels outside the heart and brain, and PAD as a form of PVD caused by structural changes in blood vessels. Physicians don’t always distinguish between the two terms, although the majority of physicians interviewed for this story believe PAD is the more accurate description. It is a disease intrinsically linked to atherosclerosis, a problem of fatty buildup — plaque — in the arteries throughout the body. Lifestyle changes, medical therapy, surgery and combinations of all three can keep atherosclerosis in remission, even lead to regression of the disease. But it is lifelong and incurable. “If they need cardiac bypass surgery, it means they have atherosclerosis in their heart,” vascular surgeon Dr. Eric Peden explains. “If they have it in their heart, they almost certainly have it in other areas of the body. One of the most common places for people to get atherosclerosis in changes related to the plaques is in the legs.”

Dr. Eric Peden

Plaque buildup restricts blood flow, causing legs to hurt and cramp when exercising. For patients who thought the bypass surgery fixed them for good, PAD can seem a cruel irony. They experience claudication, or leg pain, from vascular insufficiency. “Now their heart is fixed, their engine is working better, and they can walk all day from a cardiac standpoint. Then they get claudication,” Lisman says. “They get really frustrated.” But it’s not something they have to live with. Simple screenings like the ankle brachial index are good indicators for patients at risk. This simple test compares pressure in the ankle to that in the arm. If the ratio is greater than 1, it’s

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normal. If it’s less than 1, the patient has increased risk for heart attack and stroke related to atherosclerosis and plaque. Patients with any of the five risk factors — diabetes, smoking, family history, high blood pressure and cholesterol — should be screened and see a cardiologist. Patients with overwhelming health problems like diabetes or kidney disease requiring dialysis may overlook foot sores or ulcers that signal PAD and may lead to gangrene and limb loss. Peden currently heads a team visiting the 100-plus kidney dialysis centers around Houston to screen 400 dialysis patients for PAD, then report its findings. “The hope is then we can fully establish a screening program on a larger scale and preserve more limbs and prevent heart attacks and stroke,” Peden says. At the Methodist DeBakey Heart & Vascular Center, physicians in several specialties join forces to find solutions for individual patients. Medical therapy has become more important than physicians ever imagined. For example, the relatively new drug Pletal often helps with walking problems. The heart center is involved in a number of clinical trials testing new medications, including one that fights claudication by opening up vessels and allowing more blood flow. Lifestyle changes, including nutrition education and exercise, always go hand-inhand with medical therapy for PAD.

When medical therapy isn’t enough, physicians look at endovascular treatments such as angioplasty and stenting. Traditional stents frequently fail because scar tissue and new plaque grow through them. A relatively new fabric-covered stent shows potential for holding the artery open longer and providing more durable symptom relief. Peden says another new graft on the market is bonded with a blood thinner to prevent clotting. Methodist is also among the selected centers enrolling patients with severe arterial disease — those who are not candidates for angioplasty, stents or bypass surgery — in a stem cell therapy trial. Here, surgeons harvest stem cells from the patient’s hip, process them in the operating room and inject them into the leg tissues around blocked vessels. Early results have shown the stimulation of new blood vessels and dramatic improvement of previously unhealed wounds. When medical therapy, lifestyle improvements and endovascular fixes aren’t enough for a patient with PAD, minimally invasive bypass surgery is a growing specialty that Methodist’s surgeons teach to other physicians around the world. Methodist’s Dr. Mahesh Ramchandani’s course in minimally invasive coronary surgery is booked months in advance. Another course in minimally invasive aortic and mitral valve surgery is in the planning stages. !

“If they need cardiac bypass surgery, it means they have atherosclerosis in their heart. If they have it in their heart, they almost certainly have it in other areas of the body.”

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Another ongoing trial blends Eastern and Western medicine in exploring whether acupuncture can help improve walking and circulation in PAD patients.

VOLUME 5, NUMBER 2

Heart Disease

A holistic approach to heart care By Patti Muck Bill Robertson first felt severe chest pain on the way to his 67-year-old father’s funeral in East Texas. His dad died of a heart attack after a lifetime of health problems, including five heart bypass operations. “You just can’t run from the family history,” Robertson says. Over the next two years, the owner of his own Web design, marketing and photography company received seven catheterizations and three stents, all of which worked for about six months before a heavy pressure feeling returned to his chest. A year ago, Robertson’s cardiologist Dr. Mashesh Ramchandani suggested he take the next step and seek a more permanent fix. Methodist’s multidisciplinary team of experts gave this patient a host of options.

Cardiovascular disease and its complications can be all-encompassing. It is fueled by atherosclerosis, the disease process that affects arterial walls and leads to blockages. It is a systemic and unrelenting disease that demands lifelong vigilance to keep it at bay. Rarely does it limit itself to the heart, so physicians can’t treat just one spot, one area of plaque buildup or one ulcer. The manifestations of atherosclerosis can pop up in the heart, brain, kidneys, legs — any one of the body’s so-called “vascular beds.” A disease with such complexity and overlap demands a team approach, much like the multidisciplinary approach to cancer treatment that has developed over the past decade. The Methodist DeBakey Heart & Vascular Center cultivates this holistic approach to treating its patients with heart problems. Experts in interventional cardiology, vascular and cardiothoracic surgery, electrophysiology and other specialties look at the entire patient before they recommend action. “Really the proper treatment nowadays for a patient with cardiovascular disease syndrome should involve input from a

multidisciplinary team, and very few places offer that,” Ramchandani says. “What we’re doing now at the heart center is recognizing that what we want to treat is the disease, and there’s a convergence of specialties with people who have different types of expertise. It’s a more holistic approach.” When Robertson consulted with Ramchandani, the surgeon recommended he undergo a minimally invasive single bypass operation. A year later, Robertson has a fourinch scar under his left breast. It’s a far cry from his own father’s long zipper-like chest scar, an incision that forced him to hug a little pillow for relief weeks after bypass surgery. Since Robertson’s own internal mammary artery was used for the bypass, he also lacks the 2-foot-long leg scar from the vein harvesting his father endured. An added bonus in Ramchandani’s operating room involved performing the surgery on Robertson’s beating heart, without using the heart/lung machine. Robertson and his wife researched surgery and knew one side effect from the heart/lung machine could be personality changes post surgery. Since surgery, Robertson says his life is different. He watches what he eats, and he exercises more. “I will be 50 this year,” he says. “I see my cardiologist every six months or so, and we do blood work. If the blood work warrants, we may do a stress test. My appreciation for life and my time with my wife is more precious than ever now. I actually got to witness Dr. Ramchandani in surgery recently. It’s just phenomenal.” !

Dr. Mahesh Ramchandani and Bill Robertson 28

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The Culture of Safety

“You can’t manage quality and safety. It must be inspired.”

By Denny Angelle

ne morning this past April, the world came knocking at The Methodist Hospital’s front door for a bit of cultural exchange. As the symposium opened early that morning, representatives from more than 100 hospitals and health care institutions from around the globe sipped coffee and hoped to get a taste of Methodist’s famed culture of quality patient care and safety. Why Methodist? Perhaps because The Methodist Hospital received top rankings last year for quality and accountability from the University Health System Consortium, an organization of U.S. academic medical centers and hospitals. Methodist ranked No. 2 in patient satisfaction and No. 5 in mortality rates. And

perhaps because Methodist has a reputation for not settling for even those kinds of numbers — the bar can always be raised a bit higher. Mary Daffin, a member of the board of directors and chair of the board’s Quality Committee, gave some insight on the reason for Methodist’s success on the quality front. “Leadership at the highest level of this organization is committed to creating a culture of safety here at Methodist,” Daffin told attendees. And she quoted board chairman, Judge Ewing Werlein Jr., who directed, “Make Methodist the safest hospital in the world.” Quality is the most important word in hospital care today. It means keeping patients safe while they are in

the hospital. It means living up to the most basic concept of medical care: First do no harm. This is a 180-degree turn from the state of hospital safety from only 10 years ago. In 1999, an Institute of Medicine safety report assessed the quality of care hospital patients received around the country, and what they found wasn’t good. Their research showed that as many as 100,000 deaths occurred annually due to medical errors. The report also uncovered 1.5 million people who were injured by medication errors. These shocking statistics served to erode the public trust, to be sure, but hospitals recommitted to make quality and safety an integral part of the their mission.

VOLUME 5, NUMBER 2

Patient Safety

“Everyone working at a hosp and think about quality ever The Methodist Hospital System, for its part, recruited Dr. Thomas Knight to be its chief quality officer. “You can’t manage quality and safety,” he says, “it must be inspired.” The key, Knight says, is to make the quest for safe patient care a goal shared by everyone in the organization, from top to bottom. “It should be an emotional investment backed up by action and commitment,” he explains. “Everyone working at a hospital should live, breathe and think about quality every moment.” Methodist has groups representing all phases of medical care — physicians and nurses with other disciplines including food service and patient transporters — examining all aspects of quality and safety at its hospitals. Groups examine statistics representing core measures like mortality, stroke and infection. Others focus on particular patient issues like pressure ulcers and falls. Each group reports to administrators and offers suggestions for improvement initiatives. And it makes an impact — take, for example, simple hand hygiene among hospital staff.

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ore than 2 million patients a year get hospital-based infections, and the Centers for Disease Control and Prevention lists these infections as the 10th leading cause of death in America. Hand hygiene among hospital workers is a proven way to prevent the spread of infection, so in 2005 Methodist launched a far-reaching program to promote hand hygiene. The importance of hand hygiene was emphasized by everyone from the chief hospital administrator on down. A set of hand-washing “rules” was established, outlining all instances when staff should sanitize their hands. More than 4,000 dispensers for alcohol-based hand sanitizer were installed, virtually in every nook and cranny of the hospital and even in office buildings where behind-thescenes employees do not usually come in contact with patients. The hospital designated “secret observers” to watch and quantify handwashing activities among staff and physicians. And Methodist drove home the message that it was time

to change its culture to make simple hand hygiene a priority. As these efforts began to take seed, they were shown to make a big difference. Where the average for hand hygiene compliance is about 50 percent in the nation’s hospitals, Methodist’s compliance rates reached as high as 97 percent in 2006. Currently the compliance rates flutter around the 90 percent mark at all of Methodist’s hospitals. It took hours of conversation, education, training and reminding — and a bonus for all hospital employees when hand hygiene goals were reached — but hand hygiene is now an integral part of the culture. Another group focused on preventing patient falls. They held monthly meetings with staff on units that most needed improvement, sharing best practices and sifting through different tools and strategies to help prevent patient falls. The group even helped to devise a way to identify patients who may be at high risk for falls.

spital should live, breathe very moment.” This effort led to a dramatic reduction in patient falls. And yet, good is not good enough: Each week, caregivers on a different unit are recognized, and their fall prevention tips and techniques are shared across the hospital. No one believes in this effort more than Werlein, who was once chair of the Quality Committee. He can fluently discuss quality measures with physicians or analyze the work flow in an operating room. “There is a lot riding on our ability to improve the health of our patients, the health of our communities and the very nature of our health care system,” Daffin says. “Every person, from the chairman of our board to the people who transport patients around the hospital, is integral to improving quality and safety.” !

You can take a detailed look at quality and safety efforts at all four of Methodist’s hospitals. Go to www.methodisthealth.com and enter “quality and safety” in the search box.

Dr. Thomas Knight

VOLUME 5, NUMBER 2

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RESTORING INTIMACY:

“I knew there had to be someone who could help me.”

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Custom quilt designer Patsy Costlow found help at the Center for Restorative Pelvic Medicine after years of pain and discomfort.

Restorative Pelvic Medicine

Center for Restorative Pelvic Medicine restores continence and sexual health By Maureen Kovacik

romantic evening between husband and wife usually involves a nice candlelight dinner, wine and soft music. Patsy Costlow didn’t have the time for such niceties when it came to being intimate with her husband. They were luxuries she had to live without. “When you have to use lidocaine and tell your husband to ‘hurry up and get ready; we only have a couple of minutes for sex before the pain kicks in,’ it’s not exactly romantic or satisfying,” the 57-year-old mother of two and grandmother of five said. Costlow met her husband Phil more than 40 years ago. She says she fell in love with him the moment she first saw him, but he left for the Navy soon after they met. While he was off serving his country, she married and divorced. When he returned nearly four years later, the couple reconnected. “I knew we would be together forever when we found each other again,” Costlow said. “You don’t find this kind of relationship very often.” The two married in 1970 and like many newlyweds, they sought a reliable birth control method. Costlow chose an intrauterine device, one of the most popular forms of birth control at the time. It was effective, but the device attached itself to her uterine wall causing damage. Doctors then removed it, causing even more damage and forcing her to have a hysterectomy. The couple enjoyed a normal sex life over the years, but one day nearly 10 years ago, Costlow began to experience vaginal pain. Doctors discovered her bladder was falling and she needed surgery to reposition it. The procedure,

called bladder suspension, involves inserting a band of tissue to form a type of sling to reposition and support the bladder. However, after two of these procedures, the pain only worsened. “I had to numb myself because when we had intercourse, it felt like someone was stabbing me with a knife,” Costlow said. “Sex was an important part of our relationship, but every time we did it, the pain just got worse.”

Never Give Up As the pain continued to worsen, she was referred to a urologist who diagnosed her with a chronic bladder infection, believed to stem from her two bladder suspension surgeries. Her body was rejecting the band of skin that was implanted to support the bladder. A year later, Costlow underwent a third surgery to remove the old tissue around her bladder and replace it with a new, wider band of skin. The surgery was successful except for one thing: It left her with only 21⁄2 inches of vagina. As a result, sex with her husband became so painful the couple refrained. “I felt so bad. I know my husband never would have left me, but I felt like that part of our life was dying,” Costlow said. “I wasn’t ready for that. He was faithful to me, and I felt I owed it to him to get this fixed.” Costlow went to a new gynecologist who found lesions in her vaginal area and used dry ice to burn them off. After doing all he could, he referred her to Dr. Tue Dinh, a plastic surgeon at The Methodist Hospital and the Methodist Center for Restorative Pelvic Medicine.

VOLUME 5, NUMBER 2

Restorative Pelvic Medicine

After examining her, Dinh conferred with Dr. Keith Reeves, a Methodist obstetrician/gynecologist. Together they developed a plan to help Costlow. “We have performed similar surgeries in the past, but the causes were usually congenital or cancer-related,” Reeves said. “This one was unusual because it was the result of scarring caused by previous surgeries that didn’t heal properly.”

During a three-hour procedure, the surgeons cut out a flap from what was left of Costlow’s vagina and pulled that flap forward and up. They went through the space they created to access the bladder area where they removed scar tissue. Dinh then took a skin graft from her groin area and sewed it into the space in such a way as to create a vaginal canal of normal length.

Drs. Keith Reeves and Tue Dinh

“It (plastic can also br in a differe improving quality of

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After a three-night hospital stay and about seven weeks of recovery, Costlow was cleared by her doctors to resume sexual relations with her husband. “I was nervous at first, and there was a little bit of pain that first try,” Costlow recalls. “But now sex is great. I knew there had to be someone who could help me.”

The Center Reeves, who is the founder of the center, says the goal is to restore continence and sexual health to both women and men.

Specialists at the center — gynecologists, urologists, colorectal surgeons and plastic surgeons — work collaboratively to restore pelvic function. “We develop a customized treatment plan for patients coping with urinary and rectal incontinence, vaginal reconstruction, sexual dysfunction and rehabilitation following surgery or radiation,” he says. Dinh says plastic surgery doesn’t just create a beautiful appearance. “It can also bring beauty in a different way by improving a patient’s quality of life,” he said. If you don’t believe him, just ask Patsy and Phil Costlow.

The Center for Restorative Pelvic Medicine at The Methodist Hospital offers a

astic surgery) lso bring beauty different way by oving a patient’s ty of life.”

unique multidisciplinary approach to pelvic restoration and reconstruction. The center is the first of its kind in Houston to combine an expert team of leading gynecologists, urologists, colorectal and plastic surgeons dedicated to restoring normal pelvic function and pelvic reconstruction for men and women.

Diseases and conditions treated

Procedures and treatment options

Fecal incontinence

Biofeedback Colorectal testing Coverage of complex wounds Electrical stimulation Estrogen replacement therapy Green laser therapy Irradiation wounds Pelvic floor prolapse Penile reconstruction Pessary Post-operative muscle rehab Post radiation injury Sexual therapy Vaginal absence deformities Vaginal reconstruction Vulvar reconstruction

Pelvic pain Pregnancy and pelvic support Problems secondary to radical surgery of extensive radiation for gynecologic cancer Rectal prolapse Recto-vaginal fistula Sexual dysfunction Urinary incontinence

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To make an appointment at the center, call 713-441-5800.

VOLUME 5, NUMBER 2

DIVING FOR A CURE By Hattie J. Horn Nikki Farkas lay on the small, narrow bed as it slid into the 7-foot-long, glass case. The door closed over her head and she heard a click. She adjusted her oxygen mask for optimal inhalation, moved a bottle of water closer and settled in to watch CNN on the small, flat panel TV mounted above her head. For the next two hours, she caught up on the day’s current news events.

sea divers and later astronauts suffering from decompression sickness, commonly known as “the bends.” HBOT is now used to treat patients who suffer from chronic wounds such as gangrene, vascular disease and radiation injuries, like Farkas who underwent several weeks of radiation therapy for cervical cancer earlier this year.

Program medical director Dr. Boutros Kahla says one of the most persistent and common wounds he sees is the lower extremity ulcer, particularly in the feet of diabetic patients. “An underlying problem for diabetics is that the disease affects blood supply to the extremities,” he said. “They have what is called small artery disease, which affects the eyes-vision and toes. Decreased blood flow to the feet creates dry skin, flaking and cracking, which leads to infection and ulceration.”

Other candidates for this therapy A 71-year-old mother of seven, grandinclude patients whose wounds mother of 10 and great-grandmother are unusual in appearance and are of one, Farkas wasn’t visiting a space30 days old or older; or those who age exhibit at the Johnson Space have wounds that don’t show signifiSometimes diabetic patients also Center in Houston. She was minutes cant progress or response to convenhave neuropathy, a complication of away from her Baytown home, at tional therapies. diabetes that damages the San Jacinto Methodist nerves, eliminates normal Hospital, where she sensation and causes paunderwent hyperbaric tients to develop wounds. oxygen therapy through the hospital’s Wound uses high pressure oxygen to heal. Each session Once a wound is diagand Hyperbaric Treatlasts approximately two hours. HBOT is a medical nosed, a strict regimen ment Program. is incorporated into the treatment that increases the amount of oxygen in the patient’s daily life that The program, which patient’s blood, allowing oxygen to pass more easily includes inspecting feet offers a comprehensive, through the plasma into the wounds to heal them. regularly; bathing and multidisciplinary apcaring for toenails, corns proach to heal complex Clinically approved uses for HBOT include: and calluses; even chooswounds, is the only one • Diabetic Foot Ulcers ing shoes and socks; and of its kind in the Hous• Compromised Skin Grafts/Flaps/Replants taking steps to improve ton area and one of only • Necrotizing Soft Tissue Infections circulation. 10 in Texas. • Thermal Burns

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy or HBOT has been in existence as far back as 1662, but it wasn’t used medically until the U.S. military developed and tested it after World War I. It has been used safely since the 1930s to treat deep-

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• • • • • • •

Radiation Tissue Damage Air or Gas Embolism Problem Wounds Refractory Osteomyelitis Crush Injury/Other Acute Traumatic Ischemias Clostridial Myonecrosis (Gas Gangrene) Exceptional Blood Loss Anemia

For more information, call the San Jacinto Methodist Hospital Wound Care & Hyperbaric Medicine Program at 281-425-2160.

How HBOT works Patients who have a persistent ulcer that does not respond to routine treatment can be referred to the program by their primary care physician. Wound care physicians assess the patient and determine the most effective

Community Hospitals

Dr. Boutros Kahla

Patients inside the HBOT chamber are surrounded with pure oxygen, which helps the wound heal faster.

treatment plan, which is then communicated to the patient’s primary care physician.

down.” She said she felt slight pressure on her eardrums, similar to what one might feel when a plane lands.

A patient who meets the program’s criteria and depending on the stage, or condition of the ulcer, can be prescribed oxygen therapy to be administered five days a week, for six weeks. Patients receive a thorough explanation of what to expect before starting treatment, with particular attention paid to individuals who might be claustrophobic and need to be medicated prior to each session.

Not having heard of hyperbaric oxygen therapy and the diving process prior to her treatment, Farkas laughed at her misconception of what it involved. “When they said I was going to be diving, I thought it meant lying on a water board. I’m a good swimmer,” she chuckled. After seeing the oxygen chamber, she realized it was just a closed-in hospital bed. “I was fine with it. I’m not claustrophobic. I just put my knees up, lie back and watch a couple of TV programs.”

Once inside the chamber, which weighs more than one ton, the patient is surrounded with 100 percent (pure) oxygen at a controlled pressure — typically 2.5 times the normal atmospheric pressure — for two hours. The elevated oxygen level in the blood increases the flow of oxygen to the wound, helping it to heal faster. Farkas knew her oxygen therapy session had started when she experienced a physical sensation of “going

A growing trend Celebrities such as Madonna, Mick Jagger and Michael Jackson turned to oxygen therapy in recent years, claiming that it made them feel younger, more energized and refreshed.

medical benefit to increasing the level of oxygen for normal, healthy individuals. For others, such as diabetic patients, the increased oxygen accelerates the healing process, with some patients experiencing positive results after only two sessions. Farkas was an avid exerciser who worked out 45 minutes a day and rode her bike for hours, but she had lost hope of enjoying her favorite activities because of the tremendous pain associated with her cancer treatment. Ten sessions into her 30-session program, she sat pain-free on her bicycle seat, breathing in the outdoor air as she pedaled down the road. “After my very last treatment, I went home and put some bottled water in a champagne glass. I made a toast to everyone who goes through oxygen treatment after me,” Farkas said. “I hope they feel as good as I do.” !

But the effects of hyperbaric oxygen therapy vary. Typically, there is no

VOLUME 5, NUMBER 2

Accolades ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

TMH nurses honored in ‘Salute To Nurses’ Two nurses from The Methodist Hospital are among the 2009 honorees in the Houston Chronicle’s “Salute To Nurses.” Mary Christo, R.N. (left), and Beverley Lamoth, R.N. (below right), were honored with eight other outstanding nurses at a luncheon on May 12. Christo works in the Medical ICU and has been a nurse for 44 years. Lamoth, a nurse mentor and research resource in the Cell and Gene Therapy Center, has been a nurse at Methodist for 27 years. She has earned a number of accolades over the years including Star of the Year, Employee of the Month and I CARE Award recipient. Last year she was a finalist for the Brown Foundation Inc. Outstanding Nurse Award. !

Immunology expert joins Methodist Dr. Xian Chang Li, a leader in the field of organ transplant tolerance and rejection, has accepted the position of director of immunology in the Immunobiology Research Center at The Methodist Hospital Research Institute. He comes to Methodist from Harvard Medical School, where he served as an associate professor of medicine, and practiced medicine at The Transplant Institute of Beth-Israel Deaconess Medical Center, a teaching hospital of Harvard. Li’s research focuses on understanding how transplant tolerance, rather than the natural rejection of an organ, can be induced and maintained for the life of patients, protecting the organ from rejection and the patient from immune system suppression. !

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San Jacinto laboratories receive accreditation San Jacinto Methodist Hospital’s Main and Microbiology Laboratories have been accredited by the Commission on Laboratory Accreditation of the College of American Pathologists (CAP), based on the results from a recent on-site inspection. This accreditation recognizes excellence of services being provided. There are only 6,000 labs across the nation accredited by CAP, which is recognized by the federal government as being equal to or more stringent than the government’s own inspection program. Educated inspectors examined the laboratories’ records, quality control of procedures for the preceding two years, staff qualifications and the laboratories’ equipment, facilities, safety records and safety program. !

Accolades

Drs. Dinh named among ‘Health Care Heroes’ Drs. Tri and Tue Dinh of The Methodist Hospital were named “Health Care Heroes” by the Houston Business Journal at a luncheon May 20. The doctors were honored for their work in providing health care to residents of central Vietnam. For the past nine years Dr. Tri Dinh, a gynecologic oncologist, has led a team of physicians who train health care providers in the Da Nang region in central Vietnam how to screen for cervical cancer. Dr. Tue Dinh, a plastic surgeon, helps train local physicians on reconstructive surgery and treats indigent patients. The brothers honor the legacy of their father who spent decades treating residents of central Vietnam. !

Dr. Parry Lauzon earns Overstreet Award Anesthesiologist Dr. Parry Lauzon was presented the Dr. John W. Overstreet Award, given annually to a medical staff member at The Methodist Hospital. Lauded for his compassionate manner with patients and staff, Lauzon has been a member of Methodist’s medical staff since 1975. The Overstreet Award goes to a Methodist physician who embodies the best in the medical profession; demonstrates the qualities of compassion, empathy, respect and caring in his interactions with patients, families and staff; and supports the mission of the hospital. !

Former patient becomes Volunteer of the Year At its annual volunteer luncheon in April, Monroe Meinen Jr. was named The Methodist Hospital’s 2009 Volunteer of the Year. Meinen was recognized for his steadfast commitment to Methodist for more than 22 years. As a member of the Volunteer Services office, he answers phones, sorts mail and updates the department’s database, keeping track of vital information for more than 500 hospital volunteers. He began volunteering at Methodist after an accident paralyzed him, damaging his brain function and virtually ending his career as a mechanical engineer. While he was in rehabilitation at Methodist, his psychologist suggested he keep busy by volunteering. !

VOLUME 5, NUMBER 2

Clinical Notes ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

CLINICAL NOTES During the first week of May, the Methodist DeBakey Heart & Vascular Center opened a multidisciplinary valve clinic that provides easy access for patients with complex diseases of the cardiac valves. The clinic is led by national experts in diagnostic cardiac imaging, interventional cardiology, robotic procedures and cardiac surgery to provide the best care possible. The clinic also hosts a valve board and maintains a robust clinical database of complex valve disorders to support research and advances in the treatment of cardiac valve disease.

Cardiologist Dr. Stephen Little is director of the new clinic, which streamlines the diagnosis and treatment process for patients by offering a unique coordination of services. ! ! ! !

Surgical oncologist Dr. Shanda Blackmon is studying an investigational drug that may vaccinate people against lung cancer. The vaccine trial is the largest study ever conducted on treatment for lung cancer. As part of the trial, study participants will be injected with a protein that is found in the tumor so that researchers can study whether the patient’s immune system will recognize and destroy cells with this protein. It is hoped that recurrence of cancer will be delayed or prevented. The study drug is called an antigen-specific cancer immunotherapeutic (ASCI). By incorporating a protein specific of the cancer, this drug will use the immune system to fight the cancer. Even after complete removal of a lung tumor and affected lymph nodes, there is still a risk that the cancer will return. This risk is considered to be high enough to require additional treatment, such as chemotherapy, after surgery. However, even with the most aggressive chemotherapy, the cancer returns in many patients. Both patients who receive chemotherapy after surgery and those who receive surgery without chemotherapy will be included in this study. This study will enroll approximately 2,270 subjects worldwide with MAGE-A3 positive non-small cell lung cancer. !

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Leading Medicine Magazine, Vol. 5, No. 2, 2009

Articles inside

RESTORATIVE PELVIC MEDICINE

CULTURE OF SAFETY

CLINICAL NOTES

COMMUNITY HOSPITALS

HEART DISEASE

PRIMER

FOUNDATION OF SUPPORT

CRUEL IRONY

HIP PAIN

CLOSE TO HOME

LEADING MEDICINE

KIDNEY SWAP

SWEET DREAMS