Leading Medicine Magazine, Vol. 5, No. 4, 2011 by Houston Methodist

A PUBLICATION OF THE METHODIST Hospital System® VOLUME 5, NUMBER 4, 2011

LEADING MEDICINE

THE Changing face of medicine Pictured: Neurologist Ericka Simpson

Heart disease: No. 1 killer of women Weight-loss surgeon takes his own advice Health screenings for women of any age

Officers of The Methodist Hospital Board of Directors

A Message From the CEO Dear Readers, The year 2010 will no doubt go down in the history of The Methodist Hospital System as one of the most transformative our organization has ever experienced. We are growing by leaps and bounds, and each milestone represents another step closer to achieving our Leading Medicine vision of becoming an academic medical center of the first rank. We celebrated the 473,000-square-foot expansion of Methodist Willowbrook Hospital in northwest Houston, more than doubling the capacity for patient beds; and in July, we opened our new 1.6 million square-foot Outpatient Center, enhancing convenience and personalized care for our patients. In the fall, we unveiled our new, state-of-the-art translational research building, which houses The Methodist Hospital Research Institute. The 12-floor, 440,000-squarefoot building will ultimately accommodate 90 principal investigators and 800 staff. The Research Institute has already leveraged Methodist as an attractive research setting, and we recently recruited two prominent leaders to join our stellar team of researchers. Renowned scientist Dr. Mauro Ferrari joined Methodist as the Research Institute’s president, CEO and director. A leader in his field, Ferrari developed the National Cancer Institute’s nanotechnology program, which remains the largest nanomedicine program in the world. Dr. Jenny Chang, a prominent breast cancer physician and researcher, joined us as director of the Methodist Cancer Center. You can read more in this edition about these gifted researchers and some of the exciting things happening in their laboratories. Our Leading Medicine vision is based on our commitment to excellence in patient care, and we continue to receive accolades for our performance in this area. U.S.News & World Report listed The Methodist Hospital among the nation’s 2010 Best Hospitals in 13 of 16 specialties — far more than any other hospital in Texas. These rankings confirm what we strive for every day — to provide our community with the best health care available. We brought this commitment to the west Houston area in December with the opening of Methodist West Houston Hospital, the fourth in our network of community hospitals. With a strong medical staff, sophisticated services like neurosurgery and robotic surgery, and our Leading Medicine philosophy, Methodist West Houston is well positioned to become the market leader in this area of Houston. We’re excited about these changes and what they mean for improvements in your health care. We are also excited about what’s not changing — our commitment to your better health. This edition reflects our commitment as we delve into the complex issues of women’s health, from the latest in treatments to promising research. I hope you enjoy reading more about your health and what we are doing to improve it in this edition of Leading Medicine.

Ewing Werlein Jr. Chair John F. Bookout Senior Chair David M. Underwood Vice Chair R.G. Girotto President and CEO D. Gibson Walton Secretary Emily A. Crosswell Assistant Secretary Robert K. Moses Jr. Assistant Secretary Carlton E. Baucum Treasurer

Board of Directors Morrie K. Abramson Mary A. Daffin Connie Dyer Gary W. Edwards Bishop Janice Riggle Huie Lawrence W. Kellner Rev. Kenneth Levingston Vidal G. Martinez Gregory V. Nelson Dr. Tom Pace Keith O. Reeves, M.D. Wade Rosenberg, M.D. Joseph C. “Rusty” Walter III Elizabeth Blanton Wareing Dr. Steve Wende Sandra Gale Wright, RN, Ed.D.

Advisory Members Rev. Rick Goodrich

Ron Girotto President Chief Executive Officer The Methodist Hospital System

2 I methodisthealth.com

Victor Fainstein, M.D. Rev. B.T. Williamson

LEADING MEDICINE

Volume 5, Number 4, 2011

R.G. Girotto President and CEO Marc L. Boom, M.D.

Executive Vice President John E. Hagale, C.P.A.

Executive Vice President, CFO and Chief Administrative Officer Ramon “Mick” Cantu, J.D.

Executive Vice President, Chief Legal Officer and Strategy and Business Development Officer

H. Dirk Sostman, M.D.

Executive Vice President, Executive Vice Dean and Chief Medical Officer Susan H. Coulter

Senior Vice President for Development

2 CEO Message

Erin Skelley

3 THE CHANGING FACE OF MEDICINE

Director of Marketing Executive Editor Emma V. Chambers

Managing Editor

Denny Angelle Emma V. Chambers Sheshe Giddens Linda Gilchriest Donna Hurst

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. © 2011 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.

4 ADVANCING THE DEBAKEY LEGACY

Research Institute CEO focuses on game-changing innovation

38 25 Q&A

Four female physicians give their views on medicine

32 LIFELONG INSPIRATION

50-year nurse lives the expanding role of nurses

35 JENNY CHANG

7 HEART DISEASE

38 ON THE BATTLEFIELD

Female cardiologists nab the No. 1 killer of women

10 ELEVATING PATIENT CARE

Outpatient Center offers new model

14 THE GIFT OF LIFE Surgeon goes behind the numbers to increase organ donation

New director takes reins at the Methodist Cancer Center Colorectal surgeons fight cancer

42 HEALTHY LIVING

Screenings help keep women healthy at any age

ACCOLADES

48 CLINICAL NOTES

17 WEIGHT MANAGEMENT

Physicians practice what they preach

20 FOUNDATION OF SUPPORT Front Cover: Dr. Ericka Simpson, codirector of the MDA/Neuromuscular Clinic at the Methodist Neurological Institute, specializes in the diagnosis and treatment of Lou Gehrig’s disease. Archive editions of Leading Medicine magazine are now available at methodisthealth.com/leadingmedicine.

Volume 5, number 4 I 1

Officers of The Methodist Hospital Board of Directors

Advisory Members Rev. Rick Goodrich

Ron Girotto President Chief Executive Officer The Methodist Hospital System

2 I methodisthealth.com

Victor Fainstein, M.D. Rev. B.T. Williamson

The

Of Medicine

Changing Face By Emma V. Chambers

ost thought it was a joke. Elizabeth Blackwell applied to nearly every medical school in the nation but was denied admission. It wasn’t because her grades weren’t good enough or her essay wasn’t eloquent. It was because she was a woman.

The numerous rejections only made Blackwell more determined to achieve her dream of becoming a physician. Running out of schools, she applied to Geneva Medical College in upstate New York, where administrators decided to let the students decide if she should be admitted. Thinking it was a prank, the all-male student body overwhelmingly supported her admission. And so in 1847, Elizabeth Blackwell entered medical school at what is now known as SUNY Upstate Medical University. Ostracized and even banned from some demonstrations early in her training because they were deemed inappropriate for a woman, Blackwell was not deterred. Two years later, she graduated first in her medical class and became the first female physician in the United States in the modern era. Some 164 years later, female physicians aren’t just sprinkled among the medical profession, they are fixtures in the exam room, operating suite and research lab, comprising one-third of the profession. In addition, females represented 47.9 percent of the 2008-2009 first year enrollment in the nation’s medical schools. This assimilation into medicine is not an anomaly; it is merely a reflection of women’s increased presence in the workforce as a whole. Turn the pages to read about Dr. Sherilyn Gordon Burroughs, one of only three female African-American liver transplant surgeons in the United States, and Kelly Gilmore-Lynch, who enlisted in the Army to pay for college and medical school. You’ll also read about Norma Salahshour, a dedicated nurse at The Methodist Hospital for nearly 50 years; and Connie Dyer, a philanthropist and member of The Methodist Hospital’s board of directors for more than 20 years. These women are changing the face of medicine. This edition of Leading Medicine is dedicated to women’s health and the more than 500 female physicians on staff at Methodist’s network of hospitals, as well as the thousands of female nurses, technicians and support staff who work around the clock, 365 days a year to advance Methodist’s mission of providing the highest quality patient care in a spiritual environment of caring. n

Volume 5, number 4 I 3

Game-

Dr. Mauro Ferrari, president, CEO and director of The Methodist Hospital Research Institute 4 I methodisthealth.com

The Methodist Hospital

Research Institute

e-changing innovation

ist

By Linda Gilchriest

“Our ultimate objective is to change the history of medicine.”

r. Mauro Ferrari speaks with the enthusiasm of a head football coach sending in his team for the big game. As the new president, CEO and director of The Methodist Hospital Research Institute, his goal is to assemble the best team of researchers and clinicians to make the institute the leading facility of its kind in the world.

medicine today in key areas such as cancer, cardiovascular pathologies and neurodegenerative diseases.

“We are focusing on innovative technologies and translating them into the clinic, taking advantage of the unbelievable privilege that we are working in such close proximity with world-renowned clinicians in many different specialties,” says Ferrari, who holds the Ernest Cockrell Jr. Distinguished Endowed Chair.

“Clearly the two major problems in cancer are one, early detection and two, the treatment of metastatic disease. We are going to tackle these problems straight on,” Ferrari says. He points to the cancer stem cell team headed by Dr. Stephen Wong as the kind of work the Research Institute will advance.

“With cancer and coronary disease, the key challenges are identifying the tools to pinpoint the problem, detecting the problems as early as possible and personalizing the treatment.

“Our ultimate objective is to change the history of medicine,” he says. The key to effect this change is putting together the best collaborative teams and giving them the freedom to devise the technological innovations to transform medicine.

“Wong is able to identify — out of existing drugs — what kind of uses and combinations you can come up with that have not been tapped yet. Sometimes we have the right drugs, but we use them for the wrong cancer. Some of the drug combinations are incredibly complex.

Ferrari, 51, came to Methodist from the University of Texas Health Science Center at Houston where he was chairman of the Department of Nanomedicine and Biomedical Engineering. He joined Methodist last year, mindful of Dr. Michael DeBakey’s legacy.

“So he does something that integrates very deep knowledge of pathways with some very sophisticated mathematical modeling so that you can pick,” Ferrari says. “The treatment of metastatic disease must be personalized. This is the type of challenge we are going to focus on.”

The DeBakey legacy “Dr. DeBakey is the example that we can point to in history of someone changing huge fields of medicine based on clinical primacy and the focus on new technologies,” Ferrari says. “Pretty much everything we have today in cardiothoracic surgery points back to something Dr. DeBakey invented or was the first to bring into the clinic, adopting it from the research laboratory. So technology and clinical primacy are the two key elements of what we are doing here.” Ferrari wants to build on that legacy by creating an environment of innovation, attracting specialists who think outside the box to develop new ways to tackle the biggest problems in

The same is true for coronary disease, but Ferrari says neurodegenerative diseases are a different story. “The work on neurodegenerative diseases will involve studying biological fluids extracted from the blood stream or exhaled air to help establish the probability of the patient developing the disease. It also will be used to tailor the treatment to the specific findings. “It is largely a technology proposition, so we are going to be the world-leading place that develops the technologies and validates them across different disease processes,” Ferrari says. “Experts in different diseases are going to learn from each other’s experiences: the cancer people are going to learn with the diabetes people, and the orthopedic people are going to learn with the plastic surgeons, and so on. This is the Volume 5, number 4 I 5

The Methodist Hospital

Research Institute advantage of focusing on cross-cutting technological innovation and biological processes that are common for different medical conditions.”

Conquering the unattainable Ferrari is a big proponent of collaboration. At other institutions where he worked, including Ohio State University, University of California-Berkeley, National Cancer Institute and UT, he assembled teams of researchers from several institutions to work on projects. “I have been working across institutional boundaries my whole life,” Ferrari says. “Working together, we have achieved things that we could not have done on our own; so there is an added advantage to each institution to work together. It is not a zero-sum game. We do more things; we get more resources, we can conquer otherwise unattainable objectives.” Ferrari has been offered leadership positions at other institutions, but always turned them down — until now. “There is nothing like this (institute) in the country, I would say in the world, at this time,” he says. “It is a unique proposition. … an opportunity to build from the early goings, working in close connection with the best hospital in the country — perhaps in the world — with this vision, focusing on clinical translation and the DeBakey legacy. That’s perfect.”

And Ferrari has a new, 12-story facility to call his home. The 440,000-square-foot Research Institute building adjacent to The Methodist Hospital houses six floors of laboratories and space for clinical trials. Ferrari’s entire program in nanomedicine has relocated to the building with 100 researchers working on current projects in cancer therapy, tissue regeneration and early detection of diseases. Ferrari will continue to lead research in his laboratory. He says communication is important and has been lacking between clinicians and researchers at other institutions. “The hardest part is to get together the technology world, the science world and the clinical world. There are tremendous untapped resources, but I would estimate 99 percent of the research ideas that could yield clinical advances end up not making it because of communication problems and the various ‘death valleys’ of clinical translation,” Ferrari says. “Our great strength at this research institution is that the focus on explosive technology is deeply ingrained in the clinic. Our focus is and will always be the translation of game-changing innovation into the clinic. That is the nature and the mission of our institute. “We want to be the No. 1 place in the world when it comes to translating medical innovation and bringing it into the clinic. When people think of new, enabling medicine, we want them to think of Methodist,” Ferrari says. n

Mission: n

To reduce the burdens of disease and suffering by conducting groundbreaking research that will lead to new treatments for disease and new approaches to prevention

Building: 440,000 total square feet 12 stories n 150 lab benches n 6 laboratory floors n n

People: n n

90+ principal investigators 1,000+ credentialed researchers

Capabilities: Nine departments including infectious disease, radiology, bioinformatics, bioengineering, transplant biology, nanomedicine, cancer, cancer pathology, radiation oncology n Centers for computational biology and bioinformatics n State-of-the-art imaging including commercial-grade SPECT, wide-bore MRI and PET n 2 biosafety labs n Good manufacturing practices facility to produce pharmaceutical samples and nanoparticles for testing and research n Methodist Institute for Technology, Innovation & Education (MITIESM ), a surgical training and virtual hospital facility with 15 procedural skills stations, one cardiothoracic operating room and three research ORs n 700 ongoing clinical trials

6 I methodisthealth.com

Aker/Zvonkovic Photography

heart

disease: the No. 1 killer of women By Linda Gilchriest

“Once you identify your risk factors, you have to take the appropriate measures to fight them.”

udy Blackburn was stunned and frustrated. She had always considered herself to be healthy. Yes, she had diabetes, but she kept it under control, and she watched her calories. She and her daughter even climbed a mountain together in Arizona. Imagine her surprise when a simple heart screening test came back with a red flag that translated into a 95 percent blockage in one of the arteries in her heart. “I was shocked,” says Blackburn, a billing rep at a local ambulance service for more than 15 years. “I monitor my diabetes, and I’m a lifetime member of Weight Watchers,” the Tomball resident says. “To earn lifetime status, you must control your weight to within just pounds of your goal.” Dr. Valentina Ugolini, a cardiologist with the Methodist DeBakey Heart & Vascular Center, says that while Blackburn might appear to be the picture of health to most of us, she is fairly representative of the female heart patient who does not show the traditional symptoms of coronary disease. Heart disease in women often does not present with the same symptoms as in men. In many cases, there are no shooting pains down the left arm or grabbing pain on the left side of the chest. Ugolini says the symptoms can be as subtle as fatigue or have the characteristics of indigestion. Also, women are not aware that they are at the same risk as men of having a heart attack. “Heart disease is the No. 1 killer for women, but most women are surprised by this,” says Ugolini, who is board certified in internal medicine and cardiology, and

Heart patient Judy Blackburn

Volume 5, number 4 I 7

heart disease: practices at Methodist Willowbrook Hospital. “When you ask women what illness they fear most, the vast majority of them say cancer. And many of them will say breast cancer. “They don’t realize that all cancers combined account for half or less of the deaths caused by cardiovascular disease in women,” she says.

Know the risk factors Dr. Sangeeta Saikia, a board certi fied cardiologist, says everyone should be aware of their risk factors. Saikia, who practices at Methodist Sugar Land Hospital, says nearly every woman has one risk factor or another after a certain age. “Some risks you have no control over; you can’t change your family history,” Saikia says. “But there

are other aspects you can modify with lifestyle or medications, and those are important. The high blood pressure, diabetes, weight, diet, level of exercise — all these you can change.” After seeing a morning talk show segment on TV about women and heart disease, Blackburn, 58, scheduled a calcium scoring CT scan. “They said the test would only take 10 minutes, and I wouldn’t even have to remove my clothes,” she said, “so I called.” The screening identified a blockage, so Blackburn made an appointment with Ugolini, who was her husband’s cardiologist at the time. She says her family history, coupled with diabetes and high blood pressure, were her risk factors. “My mother was 68 when she had open heart surgery,” Blackburn says. “She had her first heart attack after knee surgery. The only symptom we noticed was dehydration. Women’s symptoms for heart disease are so different.” Ugolini says when women develop heart disease, they are more likely to have comorbidities such as diabetes, obesity, high blood pressure or cholesterol issues. “When they finally seek medical attention, dealing with the coexisting problems is more challenging,” she says.

women & heart disease by the numbers

83 46 432,000 77

Percentage of coronary events that may be prevented if women adhere to five lifestyle choices involving diet, exercise and nonsmoking

Percentage of women who were unaware that heart disease is the leading cause of death among women Number of American women who die of heart disease, stroke and other cardiovascular diseases each year Percentage of women age 40 and older who are likely to survive a year after their first heart attack

Dr. Sangeeta Saikia Methodist Sugar Land Hospital

8 I methodisthealth.com

“… all cancers combined account for half or less of the deaths caused by cardiovascular disease in women.” Both doctors agree smoking is one factor every woman should avoid. “Smoking is the biggest risk factor we see,” Saikia says. “If you stop smoking, you will neutralize your risk of developing heart disease after about three years. Stopping can give you an unbelievable advantage.” Saikia points to research that shows that while the number of men dying of heart disease has slowly decreased since 1984, the number of women dying of the disease is increasing. Being a woman in today’s fast-paced world creates its own heart disease risk factors say the doctors. “Many people have sedentary jobs and don’t make time to exercise daily,” Ugolini says. “Meal preparation becomes another hindrance, so we let the food industry take care of that for us. Many of the foods we buy are full of salt, sugar and fat.” “When a woman works in a stressful job, that is only one part of her life,” Saikia says. “She goes back home where she is a mother and ‘homekeeper,’ equally stressful jobs, and the stress is doubled. This is another reason we are seeing more women being diagnosed with heart disease.” Sometimes, even when you do everything right, you may still get the disease, Saikia says. “Once you identify your risk factors, you have to take the appropriate measures to fight them,” she says.

Dr. Valentina Ugolini Methodist Willowbrook Hospital

Breaking the cycle Both cardiologists say women need to take preventive measures to correct bad lifestyle habits, but they also need to pay attention to their bodies and get the appropriate testing to guard against the threat of heart disease. After discussing her test results and an appropriate plan of action with Ugolini, Blackburn underwent balloon dilatation and stent placement in her blocked artery on a Friday and returned to work the following Monday. She continues to watch what she eats and exercises daily. “Patients who are more aware, read and take interest in their health are the ones who are diagnosed more appropriately and in a timely manner,” Saikia says. “Usually, the patient is the best person to raise the red flag. Be aware of your risk factors and pay attention to little things that don’t feel right. Take the step to be screened.”

“If women don’t feel comfortable after the initial medical visit, they should ask for testing,” Ugolini says. “If they don’t feel they are being heard by their primary doctor, they should consult a specialist, a cardiologist. It is much more likely that a cardiologist will perform the necessary testing.” Blackburn advises women to exercise, eat healthy and get regular checkups. “Chat with your doctor about preventive measures and put them into action. I’m grateful I took the steps to do it,” she says. n To learn more about Methodist’s heart services, visit debakeyheartcenter.com or call 713-DEBAKEY.

Ranked Specialty

Volume 5, number 4 I 9

New Outpatient Center elevates patient care By Emma V. Chambers

Maggie Duplantis, project director Methodist Outpatient Center

10 I methodisthealth.com

ter

“Health care is moving from an inpatient to outpatient setting. … This is a major step in accommodating the desires of our patients.”

t was 1969. The first baby boomers turned 20; the Mets won their first World Series and the medical drama Marcus Welby, M.D. debuted on TV. Dr. Welby was a kindly doctor who still made house calls. Each week by the end of the hour, Welby had diagnosed, treated and cured whatever ailment befell his patients. That was also the year my family had its own medical drama when my mother entered The Methodist Hospital for gastrointestinal surgery. But this episode didn’t have a quick TV resolution. Typical of those days, Mom arrived at the hospital the day before, spent the night and had surgery the following day. I don’t remember how long she remained in the hospital after surgery, but it was at least a week. Through the wide, innocent eyes of a 9 year old, it seemed like months. Now, as I walk the halls of The Methodist Hospital, I see the phenomenal progress that’s been made in the past four decades — 3-D digital images have replaced film X-rays, sophisticated diagnostic equipment can not only detect the most minute tumor but also predict whether a patient is at risk for potential life-threatening conditions like heart disease and stroke. And many surgeries like the one my mom had more than 40 years ago can be performed safely and laparoscopically with patients going home in a matter of a few days or even hours — not weeks.

Evolving model in patient care Last summer, Methodist opened its new $350 million outpatient center — a facility encompassing 1.6 million square feet and 1,370 parking spaces — to meet the growing demand for outpatient services. The building houses most of the hospital’s outpatient services including radiology, heart and cancer services, orthopedic and maxillofacial surgery, as well as the Methodist Weight Management Center and Methodist Wellness Services. Hospital officials anticipate that the center will handle about 310,000 patients each year. “Health care is moving from an inpatient to outpatient setting,” says hospital senior vice president Roberta Schwartz. “As recently as 10 years ago, patients only had one choice — to go to a hospital for surgery and other procedures. This is a major step in accommodating the desires of our patients.” Advances in imaging capabilities, the shift to minimally invasive surgeries and increased use of chronic disease management programs, which reduce hospital admissions, have led to this evolution in patient care. According to the American Hospital Association’s Trendwatch 2010, U.S. outpatient surgeries increased by a whopping 87 percent to more than 17.3 million between 1988 and 2008.

Volume 5, number 4 I 11

the Outpatient center

Pre-op Room

TOTAL OUTPATIENT VISITS IN MILLIONS 7 6 5

624,098,296

4 3

Meditation Room

2 1 0

Year

Source: Avalere Health Analysis of American Hospital Association Annual Survey

“It’s our job to identify the aspects that make for a positive patient experience and manifest those elements.” Outpatient visits mirror this trend with a 73 percent increase to more than a half a million. Conversely, inpatient surgeries dropped 11.2 percent during the same time period. Patients who undergo outpatient procedures in the Outpatient Center do so by appointment only. A patient who visits his or her doctor’s office and requires subsequent testing will receive those services in other areas of the campus. “Our outpatient guests won’t be bumped by hospital patients who need immediate care,” Schwartz says.

Patient-centered approach The Outpatient Center, which is the largest building in the Texas Medical Center dedicated solely to patient care, is an outgrowth of the Methodist Experience — a patient-centered concept that melds the science of medicine with the science

12 I methodisthealth.com

of personalization. Special attention was given to design elements that promote healing — large windows facing scenic views, muted lighting, free-flowing spaces and modern furnishings. The interior design and décor are what you notice first when you enter the building, but exceptional service, quality and safety are at the core of the Methodist Experience and the Outpatient Center. “We asked ourselves, ‘What would I need, and how would I like to be treated,’” says Maggie Duplantis, project director for the center. “It’s our job to identify the aspects that make for a positive patient experience and manifest those elements.” Duplantis, a registered nurse and Methodist employee for 22 years, led the effort to outfit the building, which took 44 months to build, with 12,500 light bulbs, 616 miles of electrical wire and 8,857 panes of glass — not to mention the millions of dollars in medical equipment. Patients who arrive at the Outpatient Center can sign in with the receptionist on any floor or at one of the many computer kiosks adjacent to the elevator bank on each floor. Family rooms, formerly called waiting rooms, are equipped with Wi-Fi, computer stations and a beverage bar.

Family Room

inpatient/OUTPATIENT Surgeries IN MILLIONS 20 18 16

Outpatient 17,354,282

14 12

Lobby

inpatient 10,105,156

8 6

Aker/Zvonkovic Photography

4 2 0 Year 89

Source: Avalere Health Analysis of American Hospital Association Annual Survey

“Patients are our guests,” says Randy Kirk, head of Methodist Experience training. “Our goal is to anticipate their needs. Many patients are anxious, and oftentimes, obtaining medical treatment can be stressful. We want to make them as comfortable as possible.”

Infusion Therapy

For that reason, patients are asked to complete a questionnaire that provides staff with information on their preferences for music, snacks and how they’d liked to be addressed. Kirk says this attention to detail relaxes patients and makes visits less intimidating. One example of this attention to detail is the infusion therapy area. Chemotherapy patients have the option to undergo therapy in a private room where they can rest or watch a DVD from the center’s library. Or if they prefer, they can join others who also are receiving treatment in a pod that serves four patients. Therapy rooms are situated just steps from windows so patients can look out over the medical center or nearby Hermann Park. Duplantis says raising health care to a higher level requires a culture shift. “We’re here to take care of patients and their families. It’s a team approach, and everyone works together to make that happen.” n

Volume 5, number 4 I 13

transplant surgeon gives

the gift of life By Denny Angelle

herilyn Gordon spent her childhood in Kansas City, America’s heartland. Traveling frequently to visit relatives on the coasts and abroad, she was able to see the world around her. Far beyond the high, wooded ridges of Missouri, she discovered a country, and people living in it, in need of healing.

“While I like long-term interactions with patients, I thrive off the immediate gratification of seeing people get better quickly,” she explains. “As a transplant surgeon, I get that gratification when the organ comes out of ice and begins to work almost immediately in a patient. In medicine, it can’t get any more instant than that.”

At a young age, she realized she was unlike her peers. “I was a first-generation American child of immigrant parents, living in the middle of the country during the 1970s,” she says. Her parents were from Jamaica — her father was a microbiologist and her mother taught high school English. An only child and an “ethnic kid who loved school,” she sensed there was a distinct place in society where her identity could be cultivated.

Behind the numbers

“Beyond my parents, there weren’t many role models who looked like me,” she says. “So I quickly learned that I could not rely on my physical or cultural similarities with people to determine who I would emulate or relate to.” Now a liver transplant surgeon for the Methodist Center for Liver Disease & Transplantation, Dr. Sherilyn Gordon Burroughs is one of only three practicing African-American female liver transplant surgeons in the country. “When I was told that the process of becoming a surgeon would be difficult, if not impossible, I wanted it even more,” she says. The path to becoming a physician led from Missouri through college in Washington, D.C., medical school in St. Louis and residencies and fellowships in Washington, Pittsburgh and Los Angeles. Gordon Burroughs came to Methodist a year ago, from a faculty position at the UCLA Transplant Center in California.

14 I methodisthealth.com

But Gordon Burroughs acknowledges that only a small percentage of patients with failing organs can experience this miracle — and she sees so many more die waiting for an organ they will never receive. She cites statistics showing that ethnic minorities are less willing to consent to donate organs, just as they are less likely to seek advanced medical care for treatable ailments. “The statistics repeatedly bear out this unfortunate trend,” says Gordon Burroughs, “but behind the numbers are people who are paralyzed by confusion and mistrust. They have a wrong idea about the inner workings of the transplant system.” It is true that African-Americans receive fewer transplants overall, but it is not because of unfair practices. Minority populations are more susceptible to some diseases of the heart, kidney, liver, lung and pancreas that require transplantation, and as a result, African-Americans represent a higher proportion relative to the general population on some transplant lists. That means more African-Americans will die while waiting. Kidney failure is two times more likely to affect African-Americans than any other ethnic group. So African-Americans make up 34 percent of the 90,000 Americans waiting for a

Dr. Sherilyn Gordon Burroughs

“ W hen I was told that the process of becoming a surgeon would be difficult, if not impossible, I wanted it even more.” kidney transplant and fewer than 17 percent of all donors. At least a third of these people will die waiting for an organ. Gordon Burroughs knows that the way to rectify this situation is through education, but her suggestion is to begin in the places and institutions that people trust. “If you can get one person to understand the importance of organ donation, then that person can go back and share the message with family and friends,” she says.

Leveling the playing field People of all ages and races can be organ donors. “We encourage everyone, young and old, to place their name on

statewide donor registries to show medical personnel they have agreed to be a donor in the event of their death. But they must let family members know their intentions. “The key is to get the conversation started, within your family, with your parents and siblings, neighbors and friends,” she says. Gordon Burroughs also finds that the use of patient advocates — people who have received transplants as well as donated their loved one’s organs — also help clear up misperceptions about organ donation. The national organ allocation system is effective and fair, Gordon Burroughs says, because it levels the playing field so that anyone can receive an organ. “It’s the best system in

Volume 5, number 4 I 15

Transplant

TRANSPLANT RECIPIENTS BY ETHNICITY JAN.1, 2000 - JULY 31, 2010

20,000

“We encourage everyone, young and old, to place their name on statewide donor registries.”

18,000

WHITE

16,000

14,000

12,000

10,000

8,000

BLACK

6,000

HISPANIC

4,000

the world,” she adds, “but the cruel fact is when there aren’t enough organs to go around, the system will have serious limitations.”

ASIAN

2,000

2000

2002

2004

2006

2008

2010

“We’re humans, and we weren’t meant to be homogenous. … When we encounter people like ourselves, people we can relate to, we often trust them the most, particularly in matters concerning our health” she says. “If I can relate to you as a patient, and you can relate to me as a doctor … if I can impart information in a culturally similar way, talk to you in a language you understand, then the message has the potential to be more effective.”

DONORS BY ETHNICITY JAN.1, 2000 - JULY 31, 2010

9,000

8,000

7,000

The transplant surgeon has seen this theory in action — when a patient is overjoyed to see a doctor who looks like him or her. “As painful as this bias may be, if you understand it as human nature, it can be used as a tool to save lives,” Gordon Burroughs says.

6,000

WHITE

5,000

Gordon Burroughs feels that countering generations of mistrust will take an understanding of what she calls the “natural bias of the world.”

The heart of the problem, and perhaps the key to its solution, could be the lessons a little girl learned in the heartland of America. n

4,000

3,000

2,000

BLACK 1,000

HISPANIC ASIAN 2000

35,000

2002

2004

2006

2008

2010

WAITING LIST BY ETHNICITY AS OF OCTOBER 15, 2010

30,000

25,000

WHITE

20,000

BLACK HISPANIC

15,000

ASIAN 10,000

5,000

KIDNEY

LIVER

PANCREAS HEART

LUNG

Source: Organ Procurement and Transplantation Network

16 I methodisthealth.com

From left: Surgical assistant Majed Khalifa, and Drs. Sherilyn Gordon Burroughs and Ashish Saharia prepare the donor liver for implantation.

Dr. Patrick Reardon

Practicing and Preaching

Photo by William Stewart

Healthy Weight Management By Donna Hurst

iving life in the fast lane often translated to the drivethru lane for bariatric surgeon Dr. Patrick Reardon. Fast food meals on the run, fat and calorie laden snacks and anything else tempting and quick were standard fare for the busy surgeon. On the other hand, Reardon regularly preaches to his patients about the importance of maintaining a healthy weight. But after being appointed medical director for The Methodist Hospital’s Bariatric Surgery Program, Reardon knew he wasn’t practicing what he preached. “I didn’t like the old picture on my physician profile for the Methodist Weight Management Center because of my weight and appearance,” he says. “Also, I knew my wife had been losing weight successfully on Methodist’s high-protein diet.” Reardon’s wife, Dr. Debra Harvey, a family medicine physician, had been exercising four days a week prior to enrolling in the Step LITESM program but was unable to lose weight. “After joining the program, I learned a lot about why I had a hard time losing,” Harvey says. “I wasn’t eating enough protein, and I was eating way too many carbohydrates. I also learned a lot

about portion control. I was able to lose 29 pounds in the first four months.” His wife’s success led Reardon to become a patient of the Methodist Weight Management Center, and he started the Step LITE program of powdered supplements combined with appropriate eating behavior at work and home. “After about three months on the program, I had already lost 30 pounds,” Reardon says. “I am healthier than I’ve been in years.”

A Weighty Matter Like Drs. Reardon and Harvey, many people struggle with weight issues. For some, a few pounds of weight loss is all that’s needed. However, others who have substantial weight to lose may have other health problems impacting their quality of life such as high blood pressure, joint problems, low energy or type 2 diabetes, making the need for weight loss that much more important. Research shows that individuals who lose as

Volume 5, number 4 I 17

Weight Management

“Bariatric surgery is one of the best things I’ve done for myself, and I’d do it again in a heartbeat.” Dr. Leslie Cohan

little as five to 10 percent of their body weight can achieve noticeable improvements to their health, putting them on a path to a more positive lifestyle. Losing weight often requires more than just diet, exercise or willpower. For lasting weight loss, individuals need the right tools and knowledge. The Methodist Weight Management Center offers a comprehensive array of programs that provide patients extensive resources and support from dedicated dieticians, psychotherapists, pharmacists and nurses. One component, Medical Weight Management, is a safe, medically monitored dietary program, designed for qualified patients with a body mass index (BMI) of 30 or above. The program helps patients achieve a slightly more rapid weight loss than is likely with a standard diet. The three-phase approach starts with a healthy meal replacement beverage, transitions to food through a guided, reduced calorie diet and finally moves to the last stage, which encompasses education and group support to assist in maintaining a healthy weight.

Tipping the Scales in Favor of Better Health For some obese individuals, diet, exercise and medication are not enough. Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people who have not been successful in their attempts to lose weight through conservative measures. Methodist surgeons perform gastric bypass and LAP-BAND® surgeries using safe, up-todate techniques.

18 I methodisthealth.com

Reardon says bariatric surgery is safe and effective in helping patients to lose weight. The risk of complications is very low, and the health benefits are very high. “The surgery not only improves your health and extends your life, but significantly improves the quality of your life,” he says. “Our goal is to help patients achieve these benefits in a safe, efficient, cost-effective and minimally invasive manner. In addition, we are an American College of Surgeons Center of Excellence for weight loss surgery.” Bariatric surgery improves or resolves many of the diseases associated with morbid obesity. On average, the lowest weight loss follows the laparoscopic adjustable gastric band, the gastric sleeve is next best, and Roux-en-Y gastric bypass is the best at achieving excess weight loss. Reardon performed Methodist’s first laparoscopic Roux-en-Y gastric bypass surgery about 14 years ago. A study by the National Center for Biotechnology Information found that in short-term outcomes for laparoscopic Rouxen-Y gastric bypass in 275 patients: n

Excess weight loss at 24 and 30 months was 83 percent and 77 percent, respectively

In patients with more than one year of follow-up, most of the comorbid diseases such as hypertension and diabetes were improved or resolved

95 percent reported significant improvement in quality of life

Eat Right with

Step LITE

A moderate weight management program Losing a few pounds isn’t always easy. Getting started can be just as tough. The Methodist Hospital’s weight management team has a program for people who want to lose a moderate amount of weight. Methodist’s Step LITE program offers a realistic approach to healthy nutrition and weight loss and will provide an option to anyone who desires up to two pounds of safe weight loss per week (varies with body type and activity level) and lifestyle change.

ouston-area obstetrician/gynecologist Dr. Leslie Cohan, a patient of Reardon’s, has seen life-changing results since undergoing Roux-en-Y gastric bypass surgery four years ago.

“I was huge and wanted to lose about 140 pounds,” she recalls. “I was able to lose some weight on my own, but I was tired of trying and couldn’t do it anymore.” Obesity sometimes has a genetic component, and it runs in Cohan’s family. Other family members also have had bariatric surgery and some others are planning to. “It was tough to be an obese physician,” she says. “I was having trouble doing what I needed to do. I was out of breath going up stairs, and my legs, knees and hips hurt. I knew I couldn’t keep doing what I was doing the way things were going.” Since having the surgery, Cohan can now run several flights of stairs, walk and hike — and breathe easier. She has been successful in keeping the weight off by no longer feeling compelled to clean her plate and by regularly participating in Zumba®, an exercise class based on Latin dancing. After seeing Cohan’s results, several of her patients also have had bariatric surgery. “I can eat most things that I like, and I don’t feel like I’m sacrificing anything,” Cohan says. “Bariatric surgery is one of the best things I’ve done for myself, and I’d do it again in a heartbeat.” n

The program is designed to improve health and produce the weight loss results that individuals want. Licensed, registered dietitians and licensed, professional counselors share the tools needed to lose weight and begin a healthier lifestyle. Unlike The Methodist Hospital’s Medical Weight Management Program, which is very low calorie, the Step LITE flexible, personalized eating plan includes the same great tasting products available only through the Medical Weight Management Program, plus a low-calorie food plan including meal replacements with bars, beverages, soups and snacks. Those enrolled in the Step LITE program attend weekly check-in and group sessions. Led by licensed professionals, sessions cover a variety of topics including lifestyle change, healthy eating, grab-and-go eating, stress reducers and more. Sessions focus on group activities that promote a healthy lifestyle.

Take the first step ... Step LITE Call 713-441-5964 and register for the Step LITE start-up class of your choice.

“Our goal is to help patients achieve these benefits in a safe, efficient, cost-effective and minimally invasive manner.”

Volume 5, number 4 I 19

Leading by e

“… that’s what makes us an effective board, we believe in the product.” Connie Dyer

20 I methodisthealth.com

y example board member gives time, talents and treasure By Linda Gilchriest

onnie Dyer grew up in a modern American home. Both parents worked to put food on the table, clothes on their backs and money in the bank for their children’s college.

In that fast-paced world, Dyer says her mother never had time to do the kind of volunteer work Connie herself has come to love so much. Dyer, a member of The Methodist Hospital board of directors, says when she married and settled into her life as a wife and mother, she was fortunate to not have to work outside the home. And with that free time, she felt a desire to make life better for those in need. And that is what she has been doing almost every day of her life since. “I gained a lot of satisfaction serving others. The friends we had were involved in the community, and it just grew from there,” she says. Essence of philanthropy Dyer is humble about the role she plays in the workings of The Methodist Hospital, but those on Methodist’s staff who work with her attest to the significance of her participation. Methodist President and CEO Ron Girotto, who has worked with Dyer for more than 22 years, says he’s developed a deep respect for her dedication to Methodist and its patients. “Her roll-up-hersleeves work ethic has made a significant impact on the organization and the community,” he says. Some philanthropists only give their time, some their resources, while others donate their talents, but Dyer is different according to Nan Duhon, senior director of development for The Methodist Hospital Foundation and staff liaison to the Methodist DeBakey Heart & Vascular Center Council, which Dyer chairs. “Connie understands the true essence of philanthropy, of giving,” she says. “She gives it all — time, talent and treasure. She’s one of the most generous people I know.” Dyer may be modest, but you can’t talk with her very long about what Methodist does in and for the community before the cheerleader in her comes out.

Volume 5, number 4 I 21

Foundation of Support

“She’s thoughtful and compassionate. … She makes her presence felt.” “I think everyone who works here, including those who work at no salary — like the board — is responsible for being a cheerleader or wants to be a cheerleader. I honestly think that’s what makes us an effective board, we believe in the product.”

“It’s something Methodist is not particularly known for, but all of the area clinics know of our involvement. The general public is usually surprised that we are providing such important service to the underserved.”

Dyer, a native of San Antonio, has served on The Methodist Hospital board of directors for 22 years. “Every board member is a working member and serves on at least two committees, and most of us serve on four,” she says.

The fall is a busy time for Dyer. Community Benefits proposals come in for committee review in August. She and others make visits to each site. When those inspections are completed and the proposals reviewed, Dyer’s committee sends its recommendations to the board, which makes the final funding distribution.

Dyer, a wife, mother of three adult children and grandmother of six, serves on the Finance Committee, Spiritual Care and Values Committee and Governance Committee. She also is vice chair of the Health Centers board and chair of the Community Benefits Committee. “I love all the work I do on all committees, but I guess my passion is the Community Benefits Committee,” she says. The Community Benefits Committee administers external grants Methodist awards to grassroots, nonprofit organizations that provide health care to the underserved in the Houston area. The committee currently grants more than $5.5 million in direct and in-kind funding to 24 agencies.

A better model “Helping these clinics and organizations provide this service to the community is a better model than our going out and trying to run primary care clinics ourselves,” Dyer says. “It’s a lot more workable situation, and we are much more effective helping these organizations thrive and survive.” She says she is pleased with how the board has allocated its community funds. “The clinics and organizations have good administrators. We know they are using our funds wisely, and we also help them. When other funders see that we are funding an organization or clinic, it validates the work they are doing, and other funders know that they are going to fund a worthwhile organization.” As a committee member, Dyer makes site visits to some of the agencies making application for funds. She says the inspections are worthwhile and gratifying. “We like to think we are actively involved, in that we carefully follow what they do and help them in a lot of other ways,” she says.

22 I methodisthealth.com

Although she works hard, Dyer doesn’t think she works any harder than others do. “I’m not an unusual member of the board,” she says. “Every board member does this in some capacity or other. It is a very hard-working board, and there is a wealth of talent.”

Saving lives Dyer also is passionate about the Methodist DeBakey Heart & Vascular Council. The advisory group is responsible for putting in place projects for the center. One is a project that Methodist cardiologist Dr. Valentina Ugolini spearheaded, a mass training weekend to teach the community how to operate a defibrillator. The event, Save a Life Community Heart Training Day, has trained 2,000 in English and Spanish. The next session is scheduled for Saturday, Feb. 12. “We are the liaison between the heart center and the public – trying to promote ways in which we can educate the people of Houston about what the heart center is doing. There are just wonderful things that are happening that the general public needs to hear about it.” Another one of those wonderful projects, she says, came from Dr. Alan Lumsden, chairman of Methodist’s Department of Cardiovascular Surgery and medical director of the center. Lumsden, after a conversation with a patient who was a petroleum engineer, came up with a seminar in which heart specialists and petroleum engineers could discuss the similarities between pumping oil and gas through pipes and pumping blood throughout the human body. The mechanics and science of pumping are similar in both professions.

Connie Dyer has served on The Methodist Hospital System’s Community Benefits Committee for more than 15 years. In that time, she has seen numerous community agencies grow and prosper with Methodist’s assistance. “There are a number of clinics in the city that have done a wonderful job with our funds,” Dyer says. Among them are:

San Jose Clinic One of the oldest charity clinics in the United States, the clinic has provided health care to the uninsured since 1922.

Good NeighboR Clinic Located in the Fourth Ward, the clinic provides medical, dental, optometry, women’s health and behavior health care.

Denver HarboR Clinic

Legacy HealthCare

The clinic provides health care services to residents who might not be able to pay. The Methodist Family Medicine Residency Program provides physicians for the clinic.

The clinic specializes in HIV/AIDS testing, education, treatment and social services, and provides care for other chronic health conditions like diabetes and high blood pressure.

For more information on the agencies The Methodist Hospital System supports, visit methdisthhealth.com/communitybenefits.

“Together, they devised an idea of getting together a group of cardiovascular physicians and petroleum engineers to find out what they had in common and what their common problems were. That led to a seminar that was cosponsored by the Heart & Vascular Center and ExxonMobil,” Dyer says. “This has triggered several projects and has pulled in bigger and bigger crowds each year. That all came from that little conversation. They are pooling information, and it is an established program now.”

A quiet presence Dyer has not limited her volunteerism to Methodist. She serves on the board of trustees of the Houston Grand Opera and Literacy Advance of Houston. She also is on the board of directors for Memorial Assistance Ministries. Dyer and her husband, Byron, a retired independent oil and gas executive, have a home in Santa Fe, N.M. where she loves to relax and entertain. She also enjoys the Houston Symphony and Theatre Under The Stars.

Dyer may feel that there are others who are more involved and more committed, but you don’t have to look too far within the halls of The Methodist Hospital to find those who will disagree with her assessment. Just ask Cathy Easter, president and CEO of Methodist International, who serves with Dyer on the Community Benefits Committee. “She’s thoughtful and compassionate,” Easter says. “She’s not the loudest, but she makes her presence felt. When she asks a question, she’s coming from a place of substance. “Her style has helped me better understand governance,” Easter says. “A board should be concerned with strategy, not micromanaging. Let the staff do their jobs. She leads by example.” n

“Helping these clinics and organizations provide this service to the community is a better model. ...”

Volume 5, number 4 I 23

CREATE A LEGACY.

Lead the Way.

Creating a legacy of giving that continues beyond your lifetime requires leadership, vision and a commitment to the future. Your legacy gift to The Methodist Hospital Foundation can advance leading medicine for years to come. Your generosity will also qualify you for membership in the prestigious Norsworthy Legacy Society. To learn more about planned giving, contact us at 832-667-5816 or visit plannedgiving.methodisthealth.com.

Please join us

5K RUN/WALK Saturday, March 5, 2011 Rice University Register online at MethodistStride4Stroke.com

All proceeds benefit the Methodist Neurological Institute and its stroke outreach education throughout The Methodist Hospital System.

24 I methodisthealth.com

the Changing

Face of Medicine By Emma V. Chambers

Four female physicians give their views on health care, an aging population and the Internet

eacher, mom, model. These were customary responses from young girls in the 50s and 60s when asked the age old question, ‘what do you want to be when you grow up.’ If they ventured into the medical arena, the answer was nurse. That was then. As women’s career opportunities burgeoned as a result of the women’s movement of the 60s and 70s, so have their choices. Medicine, and physician in particular, is one of the leading career choices for today’s woman.

Barbara I. Held, M.D. Specialty: Obstetrics/gynecology Medical School: State University of New York Health Sciences Center at Brooklyn Residency: Columbia Presbyterian Board certified in obstetrics and gynecology

Recently, I sat down with four female physicians on The Methodist Hospital’s medical staff to discuss a variety of topics. These respected clinicians and researchers are but a few of the women who comprise nearly 26 percent of the hospital’s medical staff: obstetrician/ gynecologist Barbara Held, M.D.; cardiologist Karla Kurrelmeyer, M.D.; neuro logist Ericka Simpson, M.D.; and gastroenterologist Karen Woods, M.D.

Volume 5, number 4 I 25

Female

Physicians

Your success is an example of how women have integrated the medical field. What experiences or lessons would you like to share with up-andcoming female physicians?

Karla Kurrelmeyer: Two

of the most important things for upand-coming female physicians to know are one, that you really need to be organized, and two, you need to learn to delegate. It can be difficult — as far as your family and your profession — but both need to be in place to succeed at work and at home. It’s very important to realize that you can find invaluable help both in the office and at home.

Karen Woods:

There’s so much guilt that goes into being a working mom, particularly when you get called out, even today. You get called out during a baseball game, you get called out during an important event,

but you do your best. My kids will both say ‘mom made it for everything that was important. She couldn’t for some stuff, and we understood.’ It’s so important to share with your kids. Let them know that when you’re not there, it’s not because you don’t want to be. It’s because it’s work, and mommy has to go and help somebody who’s very, very sick right now, and really needs me more than you need me right at this very second.

mising your professionalism, get used to speaking for yourself on your cases, conferences and in general interaction with colleagues.

KK:

I appreciate what you said about medical school. That can definitely happen. I found that you’ve got to work harder, be more organized and efficient, and be a good communicator. If you

Female Medical School Graduates

Ericka Simpson:

I remember as a medical student, transitioning from sitting in the classroom to rotating on clinical services. I was bright-eyed and bushy-tailed, but I soon felt isolated as a short, little female medical student surrounded by male surgeons, male PAs and nurse practitioners. I was ignored; it was devastating. When I did speak, I was shut down in a very aggressive manner, and I withdrew for about a week. I didn’t feel confident speaking out. I finally shook myself out of it and thought ‘OK, I better be just as out spoken.’ I think young women need to learn up front to not withdraw into the background. Without compro-

8,000

7,412 6,676 6,228

7,000 6,000

5,231 4,904

5,000 4,000

3,497

3,000 2,000 1,000 0

1,706 700 391 503 1962 65

Leading the way Dr. Susan La Flesche Picotte is the first female Native American to obtain a medical degree.

Dr. Elizabeth Blackwell becomes the first woman in America to graduate from medical school.

1889 Dr. Mary Edwards Walker is the first and only woman ever to receive the Medal of Honor.

1876

1849 1864 Dr. Rebecca Lee Crumpler becomes the first African-American to become a physician in the United States.

26 I methodisthealth.com

1866

Dr. Sarah Ann Hackett Stevenson becomes the first female member of the American Medical Association.

ale

KK:

aren’t, you’ll be unhappy at work and at home, and therefore, likely ignored. It’s not blatant. It’s more about being up front. … Voice your opinions.

Another message to up-andcoming female physicians is that medicine has to be something you have a passion for. If you don’t have a passion for it, and you don’t think you’re doing something for the betterment of society, you won’t want to invest the time or energy that’s required.

KW:

I’ve been on the medical staff here for 20 years. When I first started, there were very few female physicians. I don’t know the percentage now, but it’s much more even. It took two years to build a practice here, which is probably average, but I had to work hard at being visible and at being accessible. If you do your best, always try to do the right thing and give good care, eventually people will send you patients, and you’ll become successful whether you are male or female.

Are there really people who go through medical school and all the years of training who don’t have a passion for it?

Barbara Held:

Medicine is a field with many opportunities for women who want to balance work and home. Of course that depends on the specialty and place of employment. There are fields that are amenable to “practice sharing” — a pediatrician friend of mine practice shares. There’s also the opportunity for self-employment — private practice — in which you are in complete control of your schedule, so that you can design a work day/ week that best accommodates your home life.

KK:

Karen Woods, M.D. Specialty: Gastroenterology Medical School: University of Missouri Kansas City Residency: Baylor College of Medicine Gastroenterology Fellowship: University of Texas Southwestern in Dallas Board certified in gastroenterology and internal medicine

1925 Dr. Lillian H. South becomes the first woman to hold the position of vice president in the AMA.

1913

Dr. Priscilla White began pioneering research on pregnant women with diabetes.

Oh yes, I think some people believe the only talent required to become an excellent physician is an aptitude for science. It also requires hard work, long hours and good people skills.

KW:

And then they get out in the real world and you know what, this is not an easy profession. You don’t go into this just because you think it’s a good profession, or it’ll make you some good money. You have to have the passion, or else you will burn out quickly.

ES: If you have passion, if you really want to help people, and you think this is the best way you can do it, then do it. But if you’re only thinking about becoming a physician because you are good at science, your parents/family desire it for you or solely for monetary gain, it’s not the profession for you. I would encourage those individuals to consider another field.

1930s

Dr. Florence R. Sabin is the first woman elected to the National Academy of Sciences.

Timeline images courtesy of: SUNY Upstate Medical University; Drexel University College of Medicine; homeofheros.com; National Library of Medicine; National Library of Medicine; PM Dunn; World-Telegram photo, Library of Congress, Prints & Photographs Division, NYWT&S Collection, [LC-USZ62-131540]; commons.wikimedia.org; nasaimages.org; AstraZeneca; defenseimagery.mil.

Volume 5, number 4 I 27

Female

Physicians

Dr. Dorothy Hansine Anderson is the first person to identify cystic fibrosis and the first American physician to describe it.

Some of the provisions of health care reform went into effect recently. How do you think health care reform will affect health care delivery? Will we have a healthier America?

1930s

Dr. Janet G. Travell is first female doctor to be the personal physician to a sitting U.S. president.

1950s

1961

Dr. Virginia Apgar founded the field of neonatology and developed the Apgar test to assess the health of newborns.

Leading the way

KK:

It does look like it’s meant to lead to a healthier American population by covering more people who don’t receive health care coverage now, like people with pre-existing conditions. In my field (cardiology), that includes people who have congenital heart disease. I see it over and over again. They have undergone corrective cardiac surgery, but they cannot get health insurance. So in that respect, more people who

were not insured before will be insured, but ultimately, there will be a cost to society — since health care reform will also provide more preventive services and more health care to other disadvantaged groups. The most interesting thing will be how our society absorbs that cost.

Karla Kurrelmeyer, M.D. Specialty: Cardiology Assistant professor of medicine, Weill Cornell Medical College Medical School: University of Minnesota Internship, residency: Washington University Cardiology Fellowship: Baylor College of Medicine Board certified in internal medicine, cardiovascular disease and adult comprehensive echocardiography

28 I methodisthealth.com

ES:

Groups of the population will now have access to health care, but the question is how these reforms will affect the quality of that health care. They’ll have access that they didn’t have before, but it doesn’t mean that what they receive will be quality. Will it be easily accessible, will it be complete? It’s a two-edged sword. I think in some situations it will help, but I’m not clear on if it will lead to a healthier America.

BH:

I think we need to wait and see how the reforms affect the system. Theoretically, more people will have access to care, so we should become a healthier society. With that said, I think that individuals still need to take responsibility for their own health and make healthier choices with respect to diet and exercise. As a gynecologist, I see more and more young women in their early 20s already overweight with an above normal BMI. This, to me, is the root of our health care dilemma. It starts in childhood — poor eating and exercise habits that are epidemic. I hope health care reform will help — giving more children/families access to care for early intervention to prevent obesity later in life. But there also needs to be reform in the home.

1990

Dr. A Nove first first serve Gene

Dr. Jane E. Henney is the first woman to serve as commissioner of the U.S. Food and Drug Administration.

Dr. Mae Jemison is the first AfricanAmerican woman to travel in space.

Dr. Antonia Novello is the first woman and first Hispanic to serve as Surgeon General.

1998

1998 1992

Will the influx of newly insured patients create an issue of supply and demand?

ES: This will be an issue for patients

and physicians. Patients may have less time with their physicians. … ‘So I have 10 or 15 minutes with the doctor versus the 20 or 30 minutes I used to have.’

KK:

Absolutely, because there’s a fixed number of providers, and you’re right. If you open those gates, there’s going to be more and more people seeking care. It’s an issue that’s going to exist.

KW:

This is an example of what happened years ago when HMOs first came about. The reason HMOs disappeared was because the American public couldn’t tolerate asking permission to see a particular specialist and then risk having that access denied. They don’t want to ask permission to see a heart doctor; wait a week for a referral and another three weeks for the appointment. They couldn’t stand for that sort of outside control.

Dr. Nancy Dickey is inaugurated as the first female president of the AMA.

The most common causes of death, illness and impairment have been diseases of aging, where research funding is decreasing. What do you think can be done in research and/or practice to overcome these challenges?

KK:

That’s a difficult question. I think it’s tied in with the new health care reform. I think in the end, society needs to make choices. The big question is who’s going to decide because we have expensive treatments that allow patients to continue to live on, but those additional years might not necessarily equate to a good quality of life.

KW: I think we should focus on end-

of-life issues. And we don’t do that very well. We… the public still has a perception that my elderly parent or grandparent, who is 97, incapacitated and has had another stroke should live on, and everything should be done. I don’t think we can globally make decisions just be-

2001 Dr. Eleanor Mariano is the first woman to serve as the director of the White House Medical Unit.

cause of age, for certain, but I do think we need to begin doing a better job at educating the public that it’s OK to die. We’re all going to die, and we should die with dignity. We should die with support from the health care system in the right way.

ES: My practice is made up of a large

number of aged patients with a variety of neurodegenerative disorders. Specifically, I specialize in Lou Gehrig’s disease, and currently, a cure doesn’t exist. We deal with patients who have been on ventilators for years, and those who, along with family, have to face decisions regarding end of life. We’re starting to address these issues long before we get to that level. We can make a greater difference for our patients by engaging them earlier in their disease. Most physicians don’t feel comfortable addressing these issues or don’t know how to approach them. Bench work has its place when you’re dealing with cultures and cells, but there’s been a big push for translational research, where you take that research and translate it straight to patients. Now there are studies looking at if you begin treatments early, how long can you delay progression and improve patient

Volume 5, number 4 I 29

Female

Physicians

Ericka P. Simpson, M.D. Specialty: Neurology Assistant professor of neurology, Weill Cornell Medical College Codirector, MDA/ALS Research and Clinical Center Director, The Methodist Hospital Neurology Residency Program Medical School: University of Texas Health Science Center, Houston Internship, residency and fellowship: Baylor College of Medicine Board certified in psychiatry and neurology

30 I methodisthealth.com

We’ve seen a proliferation of direct-to-consumer advertising and medical websites pop up in the last few years. Patients are self-diagnosing and going to their doctor’s office asking for a specific drug. Are you experiencing this in your practice?

KW:

I don’t mind it, especially if they’ve been to a reputable website. An educated patient, in my mind, is the best kind of patient to have because they want to be involved in their health care and decision making. You can usually get them to listen to what you have to say and explain to them why what they read about is correct or incorrect in their circumstance. I like to give them educational brochures and references.

KK:

I agree. They already know what they should be doing so it becomes a patient/physician relationship, rather than just the doctor telling them what to do. I prefer educated patients. The educated patient is going to be more compliant, and more involved in their health care, and therefore, we’ll be more successful in treating their disease.

TOTAL Medical School ENROLLMENT 100 90 80

Do you have any feelings about receiving e-mail from patients?

KW:

There’s too much liability associated with it at this point in time. It’s not really set up to handle the volume. We get volumes of calls a day. If all of those started coming to my e-mail, I’d be overwhelmed. I couldn’t handle it.

70 PERCENTAGE

function and quality of life. That’s where we can make a difference. Maybe that’s worth concentrating on. Shrinking funding is a challenge, so scientists / investigators are scrambling for funding from private resources and foundations such as the Michael J. Fox Foundation for Parkinson’s.

60 50 40

KK:

30 20 10 0 1961 64 69 74 79 84 89 94 99 04 08

FEMALE ENROLLMENT MALE ENROLLMENT

I receive 200 e-mails a day. It could be devastating if there’s an important one I miss when I quickly scan through them because I don’t have time to go through each one thoroughly every day. I do get e-mails, but I discourage it. I ask patients to call my medical assistant or my nurse so they can triage urgent issues appropriately.

BH:

ES:

That’s exactly how I feel. I think most doctors want an educated, motivated patient because even if the resource is not reputable, it fosters a conversation between you and the patient. It ensures that you discuss it with your patient. This is always good for the patient’s care.

I’m old fashioned. I actually like to talk to patients. I believe it’s critical in the evaluation of a problem. As much as I find e-mail convenient for many things in my practice, dealing with clinical issues is not one of them. I’m sure that will change as technology progresses, but I’m afraid that taking the personal contact out of the physician/patient relationship will weaken it.

Most of my patients call. I try to BH: There is a lot if information on the ES: call them back within 12 to 24 hours if web, and not all of it is good. With that said, I think the abundance of information is good in that it helps people play a proactive role in their health care. It allows the patient to learn about alternative options for treatment, as well as helps them formulate questions to ask their physician. Advertising can also increase patient awareness of what’s available, but ultimately, it’s the physician’s responsibility to decide on the therapy. I would prefer that drug companies spend those dollars on research or lowering the costs of their products.

it isn’t an emergency. For a few of my long-term, stable patients, I correspond via e -mail to answer general, nonemergent questions. However, my patients are informed that e-mail communication in no way replaces telephone communication, especially in emergent circumstances. n

Volume 5, number 4 I 31

Nurse has seen change and history over a

50 year career

By Denny Angelle

As she approaches a monumental milestone of work at The Methodist Hospital, Norma Salahshour asserts that very little has changed since she was a fresh-faced graduate beginning her first job. In July, Salahshour will celebrate 50 years of working at Methodist, every second of it as a nurse. Is it even possible to hold the same job for 50 years? Just a few years ago even Salahshour would not have been able to answer that question. “It has always been about helping people when they need help the most,” she explains. “That has never changed, as far as I know.” Although The Methodist Hospital and the nursing field have evolved radically over the years, Salahshour finds the same inspiration to come to work today as she did five decades ago. “It all starts in your heart,” she says. “I have always been interested in helping people.” Fifty years as a registered nurse is incredible enough, but five decades working at the same hospital is an even greater achievement. “Being a colleague of Norma’s has been one of the most significant gifts I’ve had in my career as a nurse,” says Ann Scanlon McGinity, Ph.D., RN, chief nursing executive for The Methodist Hospital. “Norma is a wise, compassionate and knowledgeable woman who has continuously influenced our nursing organization on its journey towards excellence. … She is the spirit and heart of what we all aspire to be as leaders of nurses,” she says. Salahshour has been a nursing administrator virtually all of her time at Methodist. A native of Nederland, Texas, she came to Houston in 1961 to seek work as a nurse in the Texas Medical Center. 32 I methodisthealth.com

“At that time, a female only had a few choices if she wanted to work,” she says. “You could become a secretary or a teacher, or if you wanted to go to school for it, you could become a nurse.” She was inspired to become a nurse by a childhood friend, who in first grade asked Salahshour if the two could become nurses together. “That stayed with me all of my life,” she says. “My friend did indeed go into nursing, and I did too.” Upon graduation from Beaumont’s Baptist Hospital/Lamar Col lege nursing program, Salahshour and two of her fellow graduates sought out the best-paying nursing jobs they could find. The search led them to Houston and The Methodist Hospital.

The Methodist experience After working as a staff nurse for two years, she was promoted to head nurse of Methodist’s cancer treatment unit in 1963.

Norma Salahshour Today she remains the nursing director of the hospital’s Main 8 Northwest cancer unit, consistently one of the top-performing hospital departments for patient satisfaction and quality care. “I just believe that everyone who comes to this floor deserves the best care we can give them,” she says. One wall of the nursing unit is covered with framed photographs, plaques and other keepsakes from the families of patients who were treated on Salahshour’s floor. One day recently, a man appeared in her office doorway — he was the husband of a cancer patient who was treated there and died 17 years ago. “I don’t really know why they come back. I think they remember the nurses and the care they received, even if the outcome wasn’t what they wanted,” she reflects. “We make a very deep personal connection with our patients.”

With Salahshour’s blessing, staff members have occasionally organized special parties or events for patients who have grown close to the nurses. Last year, the unit’s nurses staged a surprise baby shower for a patient who had her baby before she began receiving chemotherapy to treat cardiac sarcoma, a rare form of cancer where tumors grow in or around the heart. Salahshour is often involved in getting members of the Houston Astros and the Houston Texans to visit patients on her unit. “We had a patient here a few years ago, and we were able to get a couple of the Astros to visit because he was a big baseball fan,” Salahshour recalls. “When the players were in his room, the patient began to cry because he was so pleasantly surprised. He died about a week later, and I am really glad we were able to create such a happy moment for him.”

Volume 5, number 4 I 33

Nursing The nurses and other staff on Salahshour’s unit are inspired by their director, and they reflect her deep compassion and dedication. Many of the staff have worked for Salahshour for many years — Melva Perdido, a nursing manager who has worked on the unit for 25 years, has been a nurse for 44 years. When nurses new to the profession or new to the hospital begin work on Salahshour’s unit, she tells them two things: One, get to work on time. And two, always follow policies and procedures. Salahshour swears she’s always gotten to work on time. However on number two, she has bent the rules a bit. “There used to be a rule that small children couldn’t visit patient rooms. … We had a patient who was dying and wanted to see his kids one more time. They were able to visit,” Salahshour says. “And before we had pet visits, another patient wanted to see his dog. … I told the family to bring the dog after hours. How can you tell someone ‘no’ when they are in that position?” Salahshour has never considered seeking another job for a more prestigious position or more money. “Like any job there have been ups and downs, but I know that I could never come up with a good reason to leave Methodist,” she explains. “I don’t feel that I have made any sacrifices. I feel the same today as I did when I started in 1961: This is the place where I can do my best.”

Evolution of nursing Half a century at work is a great vantage point to witness change, and Salahshour has certainly seen the role of nurses evolve over the years. “Nurses have become more accountable and responsible for patients’ care, and physicians depend on nurses more than ever for patient care,” she says.

“It has always been about helping people when they need help the most. That has never changed.” Nurse Norma Salahshour consults with Dr. Dan Lehane in this 1980 photo.

34 I methodisthealth.com

The science of nursing has matured to keep pace with the evolution of the science of medicine, Scanlon McGinity says. “Skills of nurses have moved further into research and technology, which has created a greater demand for the knowledge and intellectual offerings that nursing can contribute,” she explains. “Nursing contributes to the community far beyond just caring for folks in hospitals.” As the importance of quality and patient safety have become a major focus in health care, nursing has been identified as a vital factor in maintaining a high level of quality care. “Because of that, nurses have many more responsibilities than they did in past decades,” Scanlon McGinity says. “Today’s nurses have more opportunities to move into administration and education. Nurses are involved in the addition and use of technology, and have an important say when units are being built or renovated.” For example, Salahshour was involved in the creation of Methodist’s Bone Marrow Transplant Unit, which is now housed on the same floor as her unit. In the late 1970s, she also wrote a proposal for a novel use for two four-bed wards on her 30-bed nursing unit. “I suggested we use the space and beds in those two wards as an outpatient unit,” she says. “It was Methodist’s first dedicated space for outpatients.” What keeps Salahshour at Methodist? “I’ve never really wanted to work any place else,” she says. “This really is a great place to be.” In 1968, Salahshour’s son Jeffrey was born at Methodist, and her three grandchildren were born at Methodist Sugar Land Hospital. “All of the people I’ve worked with, and still work with each day, are like a second family to me,” Salahshour says. “Believe it or not, I still enjoy getting up and coming to work every day.” n

Breaking down silos to advance

Dr. Jenny Chang

Cancer Research Treatment

Dr. Jenny Chang strides swiftly down the halls of The Methodist Hospital as she surveys her new domain. She says she feels somewhat refreshed, having gotten two whole hours of sleep after putting together a $12 million National Cancer Institute grant proposal for the hospital’s cancer center. This is just one element of her job as the center’s new director. Chang is yet another of the leaders at Methodist who sees the future of medicine based on collaboration and multi-institutional projects. “I think medicine has changed from the competitive days of past decades,” Chang says. “By pursuing it alone, I don’t believe we’re going to make a significant impact.” She believes that the key is collaboration; it’s the only way for anyone to succeed. “If we are afraid that someone else will solve a problem first and are only interested in our own silos, we are not going to move forward,” she says. “I really want to emphasize this collaborative spirit — for the good of medicine and the patient — which I hope is echoed throughout all the institutions.”

By Linda Gilchriest

She says collaboration is the only way to crack the code for cancer. “Methodist is a very collaborative place. The patient always comes first; our greatest strength is clinical care, and we’re unsurpassed.” Chang came to Methodist from Baylor College of Medicine where she was medical director of the Lester and Sue Smith Breast Center and chief of the Breast Medical Oncology Unit at Ben Taub Hospital. She received her medical degree at Cambridge University in England. She is board certified by the American Board of Internal Medicine and received board accreditation in medical oncology in the United Kingdom. Her love is clinical research, and she will not have to give that up to take on her administrative duties at Methodist. “I continue to see patients. I want to offer them the best clinical trials there are,” she says. “Our goal is to have more clinical trials. Hopefully, to have studies in which we can understand the scientific rationale, something that is logical and will make significant steps forward.”

Volume 5, number 4 I 35

Cancer Research

&Treatment

“Methodist is a very collaborative place. The patient always comes first; our greatest strength is clinical care, and we’re unsurpassed.”

Replicating a proven model

Focus on triple-negative breast cancer

Chang will incorporate an interdisciplinary approach similar to Methodist’s Second Opinion Clinic for Prostate Cancer where the patient meets with specialists in all fields to develop the best treatment to fight his or her particular cancer.

Chang has earned her widest acclaim both nationally and internationally for her work on breast cancer. She continues to work in this area and hopes to discover ways to treat all cancers but particularly triple-negative breast cancer.

“We will bring everybody together — the patient, radiation oncologist, radiologist and medical oncologist to establish the best management plan of care,” she says.

“Triple-negative breast cancer is the most lethal breast cancer because we don’t have treatments directed against what drives the disease,” Chang says. “Unlike estrogen-driven cancer, we don’t know what the molecular base is behind this.”

“Along with a plan, the patient receives an overview of what the next few weeks and months will involve — the course of chemotherapy and medicines he or she will receive.” This approach accomplishes two things: The patient learns as much as possible about their disease and gets to ask questions of the specialists involved in the treatment. In turn, the experts get a better opportunity to communicate with each other about the individual patients. Under Chang’s leadership, communication is key. She says scientists, biologists, mathematic specialists and clinical physicians all have a role in finding cures and treatments. “Finding the root causes of cancer and stopping them is the single most important thing for me. I can’t do it alone; I don’t have the mathematical background to do it,” she says. “I value the input of other specialists in their fields who are on the same quest to cure and treat cancer. As an academic doctor, my role is to interact as widely as possible to bring all the expertise to bear upon this disease.”

36 I methodisthealth.com

Research presented at the American Association for Cancer Research International Conference on Molecular Diagnostics in Cancer Therapeutic Development in late September showed that although triple-negative breast cancer accounts for only 15 to 20 percent of breast cancer incidents, it accounts for half of all breast cancer deaths. “One of our visions is to start a triple-negative clinic to bring all our expertise together and determine how to treat this patient the best. And that is one of the most important things we will concentrate on in the next decade. “It is usually diagnosed at a late stage of development because the cancer grows so quickly,” she says. “It also, very interestingly, occurs a lot more in younger women and women of minority decent. These are women in their 40s, still in the prime of their lives, who are struck down with a cancer for which we do not have a molecular therapy.

What is triple-negative breast cancer? “For survival, we rely on chemotherapy, which is good, but not good enough. We are about to open a clinical trial with an extremely promising triple-negative cancer treatment,” she says. Another goal for the center, she says, is prevention. “If we can identify those women who are at risk for breast cancer or prostate cancer for men, we can prevent them from getting these diseases. And that would be a very critical step forward,” Chang says.

Building for the future

Triple-negative breast cancer is a subtype of breast cancer. Although breast cancer is often referred to as a single disease, there are many types of breast cancer tumors.

Who gets triple-negative breast cancer? About 13-25 percent of all breast cancers in the United States are triple-negative. Anyone can get triple-negative breast cancer, but research has shown that it occurs more often in:

She is eager to incorporate her vision in the Cancer Center. “One of the greatest joys is selecting the right people to lead different programs,” she says. “We are in the process of finding the very best. We are interested in Phase I, very early trial development so we can bring the very latest drugs to our patients.

Younger women

African-American women

Hispanic/Latina women

Women who have BRCA1 mutations

“Having spent 15 years as a clinical trialist and researcher, this is very gratifying,” Chang says. “But it also will be gratifying to engage young people who want to make a difference and have the initiative and the leadership to build a program at the Methodist Cancer Center.”

What makes triple-negative breast cancer unique?

Chang admits to being a workaholic. “I’m not very nice company sometimes. I work too much,” she says with a laugh. She likes to run and she has her dogs to keep her company. “But I really enjoy my work,” she says. “I would love in fiveyear’s time to say, ‘We have a great program. Look at Dr. X: he’s built this wonderful program in genitourinary (urinary or genital tract) cancer that is world class. There’s Dr. Y, and she has taken lung cancer and made this new discovery.’ It will be a wonderful sense of achievement once we accomplish that.”

Often it’s an aggressive tumor

Compared to other breast cancers, it tends to grow faster, and it is less likely to be seen on an annual mammogram

It is more likely to spread to other parts of the body early

It seems to recur more often than other subtypes of breast cancer

Treatment options

To learn more about Methodist’s cancer services visit methodisthealth.com/cancer or call 713-790-3333.

Because these tumors lack hormone receptors, hormone therapy can’t be used, and no targeted therapies exist at this time. However, chemotherapy is an effective treatment. In fact, research shows that triple-negative breast cancer may even respond better to chemotherapy than other types of breast cancer. Surgery and radiation therapy also are used.

Ranked Specialty

Source: Susan G. Komen for the Cure®

Volume 5, number 4 I 37

By Donna Hurst

olon and rectal surgeon Dr. Kelly Gilmore-Lynch is fighting to cure colorectal cancer with the same persistence and determination as when she pursued medical school. Gilmore-Lynch did not take the usual route through medical school, enlisting in the United States Army at age 17 where she served as a wire systems operator, executive secretary and legal specialist to help pay for college. “I wanted to go to college but didn’t have the means for it,” she says.

Gilmore-Lynch quickly discovered that being a woman in the military was no easy task — she had to labor twice as hard as her male counterparts to gain respect. “I learned that the same skills I needed to excel in the military applied to the surgical arena as well,” she says. During four years of enlistment, she became a certified paratrooper and won a host of commendations for tours of service and exemplary performance. Her perseverance paid off; she earned enough money to study biology and military science at Sam Houston State University. While in college,

Dr. Kelly Gilmore-Lynch 38 I methodisthealth.com

she maintained her military connection, serving in the Reserves and participating in ROTC, where she became the first woman commander in the university’s history. Gilmore-Lynch re-entered the Army after college to serve as a medical service officer at Fort Hood and a treatment platoon leader when she was deployed to Saudi Arabia after the Gulf War. After discharge, her dream of medical school came true when she enrolled in the Universidad Autonoma de Guadalajara in Mexico and earned her medical degree. She completed her residency and a fellowship at the University of Texas Health Science Center. “It was a roundabout way to get here, but I wouldn’t change it for the world,” she says. “I attribute my success to the Army.”

Identifying a need Gilmore-Lynch developed a particular interest in colon and rectal surgery after her general surgery rotation with Methodist colorectal surgeon Dr. H. Randolph Bailey. “I chose colon and rectal surgery because I felt like I could make a difference in multiple areas and realized there was a need for women colon and rectal surgeons,” she says. “Privacy is important, and having a female physician often helps women feel more at ease.” Surgery is a brutal field, she says, but due to her military training she had “thicker skin” and knew what had to be done. The wife and mother of two toddlers sees her future focus on women’s health, especially early prevention and detection of colon and rectal disorders. Only a small percentage of colorectal cancers are hereditary so Gilmore-Lynch stresses the importance of screening. “The majority of colorectal cancers (about 75 percent) are not hereditary, so don’t think you can’t get it if it doesn’t run in your family,” she says. “If it does run in the family, you need to be screened early.” Almost all colorectal cancer starts in glands in the lining of the colon and rectum. Although there is no single cause for colon

There may be no symptoms associated with colorectal cancer. Warning signs can include: n

n n

Abdominal pain and tenderness in the lower abdomen Blood in the stool Diarrhea, constipation, or other change in bowel habits

Intestinal blockage

Narrow stools

Unexplained anemia

Weight loss with no known reason

cancer, Gilmore-Lynch says some studies indicate that a lowfiber diet that is high in red meat may be a factor in developing colon cancer. However, calcium supplementation and regular exercise are showing promise for helping prevent the disease. Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer.

“Molecular profiling of colorectal cancer helps oncologists know which therapies will be effective for a particular patient.” Life-saving tests According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer-related deaths in the United States. The good news is early diagnosis often leads to a cure. That’s why screening is so important. A fecal occult blood test or FOBT may detect small amounts of blood in the stool, which can indicate colon cancer. However, this test is often negative in patients with colon cancer. Therefore, sigmoidoscopy (used to examine the lower portion of the colon) or colonoscopy (the only screening that can examine the entire colon) must be performed along with FOBT. “It is absolutely necessary for people to do the preparation correctly prior to colonoscopy to achieve good results,” Gilmore-Lynch explains. “If the colon isn’t completely clean, it diminishes the effect of the colonoscopy.” A colonoscopy proved to be a life-saving test for Dorothy McDonald, an 84-year-old patient of Dr. Bridget Fahy, a surgical oncologist at Methodist. Fahy performed a colon resection on McDonald after colorectal cancer was discovered during a colonoscopy. “I take a prescription blood thinner because I have a stent in my heart,” McDonald says. “I was passing a large amount of blood, which I thought could have been related to the blood thinner, but I knew something was wrong.” McDonald underwent a colonoscopy, which identified the tumor in her colon. She was then referred to Fahy for surgery. Fahy, who is an assistant professor of surgery with Weill Cornell Medical College, found that the cancer was contained — it hadn’t spread to nearby lymph nodes — and chemotherapy wasn’t needed. Knowing that McDonald was a cardiac patient, Methodist’s medical staff monitored her at all times during her stay and assigned a cardiac specialist to her. “Dr. Fahy kept me well-informed. I knew what was going on all the time,” McDonald says.

Volume 5, number 4 I 39

Colorectal Cancer

“The majority of colorectal cancers (about 75 percent) are not hereditary.” Lights, Camera… Chromoendoscopy Methodist continues to expand its reach when it comes to colorectal cancer diagnostics and treatment. One leadingedge technology, chromoendoscopy, offers more intensive inspection than colonoscopy and helps to better detect flat lesions in some patients that colonoscopy may have missed. Chromoendoscopy involves applying stains or pigments topically to improve tissue localization, characterization or diagnosis during endoscopy. According to a study by the American Association for Cancer Research, chromoendoscopy detected more adenomas (benign polyps that can be precursors to cancer) and hyperplastic polyps (the most common benign polyps and aren’t considered to be precancerous) compared to colono scopy using intensive inspection alone.

“Globally, we’re moving more toward personalized medicine and trying to determine who will benefit from chemotherapy,” Fahy explains. “Molecular profiling of colorectal cancer helps oncologists know which therapies will be effective for a particular patient.” Molecular profiling allows pathologists to examine features of tumors removed from colorectal cancer patients. As a result, they can report their findings to the patient’s oncologist who can select the best chemotherapy treatment for the patient. “In addition, Methodist is a member of the Southwest Oncology Group, a regional cooperative group of researchers,” Fahy adds. “As a member of the group, Methodist will sponsor large, multicenter clinical trials for all types of cancer.” Cancer physicians will work collaboratively on projects and are in the process of determining which trials will begin at Methodist in the very near future. Fahy says, “The trials that will be open to our patients will expand our efforts in cancer prevention and treatment and help us understand cancer causes and risks even more.” n

Dr. Bridget Fahy

4040 I methodisthealth.com I methodisthealth.com

Volume 5, number 4

Four Myths About Colorectal Cancer Myth:

Colorectal cancer cannot be prevented. Truth: In many cases, colorectal cancer can be prevented. Colorectal cancer almost always starts with a small growth called a polyp. If the polyp is found early, doctors can remove it and stop colorectal cancer before it starts. These tests can find polyps: double contrast barium enema, flexible sigmoidoscopy, colonoscopy or CT colonography (virtual colonoscopy). To help lower your chances of getting colorectal cancer

Maintain a healthy weight

Exercise

Limit your alcohol intake

Eat a diet with a lot of fruits and vegetables, whole grains, and less red or processed meat

Myth:

African-Americans are not at risk for colorectal cancer. Truth: African-American men and women are diagnosed with and die from colorectal cancer at higher rates than men and women of any other U.S. racial or ethnic group. The reason for this is not yet understood.

Myth:

Age doesn’t matter when it comes to getting colorectal cancer. Truth: More than 90 percent of colorectal cancer cases are in people age 50 and older. For this reason, the American Cancer Society recommends you start getting tested for the disease at age 50. People who are at a higher risk for colorectal cancer — such as those who have colon or rectal cancer in their families — may need to begin testing at a younger age. Talk to your doctor about when you should start getting tested.

Myth: Patient Dorothy McDonald

To learn more about Methodist’s cancer services, visit www.methodisthealth.com/cancer or call 713-790-3333.

It’s better to avoid testing for colorectal cancer because it’s deadly anyway. Truth: Colorectal cancer is often highly treatable. If it’s found and treated early (while it is small and before it has spread), the 5-year survival rate is about 90 percent. But because many people are not getting tested, only about four out of 10 are diagnosed at this early stage when treatment is most likely to be successful.

Ranked Specialty

Source: American Cancer Society

Volume 5, number 4 I 41

Seven tests

to keep your health on track By Sheshe Giddens

oo often many of us take a reactionary approach to our health, especially when struggling to balance all of the demands in our lives. Women, in particular, are often pulled in many directions. Between the kids, work, marriage, parents and community activities, caring for themselves and their health becomes an afterthought.

The reality is that each stage of our lives brings its own health concerns, and getting the recommended health screening is a great way to be proactive about your health, especially if there is a family history. Even if the tests confirm suspicions, early detection is critical. You may think that just because everything feels OK, nothing can be wrong, but not being screened is like telling the kids they don’t have to wash their hands if they don’t see any germs. Health screenings can give patients a glimpse into the future. They can help determine the risk for developing certain diseases or help catch diseases early. Many screenings simply involve drawing blood and/or conducting a physical exam. The following are some basic guidelines for various health screenings. Talk to your physician about which screenings you need, and when you need them. Many illnesses, when detected early, can be more effectively treated or cured.

42 I methodisthealth.com

Healthy Living

Type 2 Diabetes When should you be screened? Healthy patients should be screened every three years beginning at age 45. Patients with a body mass index (BMI) greater than 25 and have one other risk factor should be screened annually.

What are the risk factors? If you are overweight or obese, have a family history of type 2 diabetes, live a sedentary lifestyle, have low HDL (the good cholesterol), high blood pressure or triglycerides, or are of a certain racial and ethnic group which includes AfricanAmericans, Hispanics, Asians and Native Americans/Alaska natives, then you are high risk.

How is screening performed? Screening for diabetes involves a simple blood test to determine the fasting blood glucose.

Why is screening important? Due to the nation’s expanding waistline, type 2 diabetes is now a national epidemic. A disease traditionally associated with older adults, now afflicts children as well. Diagnosing type 2 diabetes early is essential. Besides the long list of complications when the disease is not well-managed, it doubles a person’s chances of developing heart disease and stroke.

Colorectal Cancer When should you be screened? Both men and women should be screened starting at age 50.

What are the risk factors? The risk increases with age, so anyone over 50 or who has the presence of polyps, a family or personal history of colorectal cancer, ulcerative colitis or Crohn’s disease is at risk. A diet high in red meat and low in fiber also puts you at risk.

How is screening performed? The preferred screening tool is colonoscopy, which is a procedure in which the doctor utilizes a long, flexible tube with a small camera mounted on it. The tube is inserted into the anus and guided through the rectum and colon. Usually a mild sedative and narcotic are administered before the procedure.

Cholesterol When should you be screened? Women should begin screening at 55.

What are the risk factors? Patients who eat a poor diet, are overweight or have a family history of high cholesterol should be screened.

How is screening performed? A cholesterol screening is performed by a blood test.

Why is screening important? High cholesterol is a major risk factor for developing heart disease. “Since cholesterol can lead to heart disease, it is important for patients to know his or her numbers,” says Dr. Rebecca Gladu, associate director of the San Jacinto Methodist Hospital Family Medicine Residency Program. “In adults, I often order a lipid profile along with a complete blood count as part of my patients’ regular checkup. The number that I am really interested in is the patient’s LDL, also known as the bad cholesterol. This is where diet, exercise and medication can have the most impact.”

Why is screening important? Colorectal cancer is the second leading cause of cancer-related death in the United States. With proper screening, 60 percent of those deaths could have been avoided. “On a national level, people are not getting the screening they need,” says Dr. Gulchin Ergun, medical director of The Methodist Hospital Digestive Diseases Department, Reflux Center and G.I. Physiology Lab. Ergun notes that precancerous polyps can be found in the colon and rectum up to 10 years before cancer develops. “That is why patients with who have a family history of colon cancer should start screening 10 years before their close relatives developed cancer,” she says.

Volume 5, number 4 I 43

Bone Density When should you be screened? Women over 65 years old should have a bone mineral density (BMD) test performed to assess their risk for osteoporosis.

What are the risk factors? Risk factors for osteoporosis include having a bone fracture when over age 50; a history of rheumatoid arthritis, chronic kidney disease or an eating disorder; early menopause; history of hormone treatment for breast cancer; a family history of osteoporosis and loss of height. Also, women who are either white or from Southeast Asia are at a higher risk.

“Long-term use of steroids such as prednisone increases the risk of osteoporosis. Also, taking certain hormones like progesterone long-term can increase one’s risk,” Gladu says.

Cervical Cancer

How is screening performed?

When should you be screened?

As we get older, we loss bone density. The scan checks for calcium and other key minerals in the bones. The less dense the bones, the higher the risk for bone fractures, which can be a sign of osteoporosis.

Women should begin screening at age 21 or within three years of first having sexual intercourse, whichever comes first. Women over 30 years old should have the human papillomavirus (HPV) test every three years.

What are the risk factors? Women who have contracted HPV, taken birth control pills for more than five years, smoke cigarettes or have given birth to three or more children.

How is screening performed? The Pap and HPV tests are used to check for precancerous or cellular changes on the cervix.

Why is screening important? Cervical cancer is one of the most preventable gynecological cancers. Women are often screened during their annual well-woman exam. “Some patients are under the impression that the Pap screens for all gynecological cancers and it doesn’t,” says Dr. Jane Starr, an obstetrician/gynecologist at Methodist Sugar Land Hospital. “It only checks the cervix. Women over 30 should discuss HPV testing with their doctor. Recommending this testing to patients is becoming more of the norm.”

44 I methodisthealth.com

A DEXA scan, which uses low-dose X-rays, measures the amount of calcium and other minerals in your bones.

Why is screening important?

Breast Cancer When should you be screened? Women should have their first mammogram at age 40.

What are the risk factors? Women with a family history of breast cancer or who are overweight, used long-term hormone replacement therapy, have never given birth, have breast cancer-related genes BRCA1 or BRCA2, or have taken birth control pills have an increased risk of developing breast cancer. “Most of my breast cancer patients are post-menopausal because a woman’s risk increases with aging,” says Dr. Anna Belcheva, an oncologist at Methodist Willowbrook Hospital. “Regardless, following the recommended guidelines is important because breast cancer does affect younger women.”

How is screening performed? A mammogram is a form of imaging that is used to detect abnormalities in the breasts. Women should also perform a monthly breast self-exam to note any changes in the breast.

Why is screening important? “Most women who develop breast cancer do not have any risk factors,” says Dr. Luz Venta, medical director of the Methodist Breast Center. “Since the onset of annual screening mammography in the 1990s, the mortality rate from breast cancer has decreased by 30 percent. This increased survival is no doubt the result of early detection, as well as advances in treatment.”

Healthy Living

Glaucoma When should you be screened? According to the American Academy of Ophthalmology, healthy patients should be screened once between ages 20 to 39 and every three to five years if they are high risk. Patients ages 40 to 64 should be screened every two to four years. Patients 65 and older should be screened every one to two years.

What are the risk factors? Patients who are over 60, have a family history of glaucoma, African-American or Hispanic are at higher risk. Glaucoma is the leading cause of blindness in African-Americans, who are six to eight times more likely to be affected by glaucoma than whites.

How is screening performed? During a routine eye exam, drops are used to numb the eyes and then a tono meter measures the intraocular pressure. Glaucoma is associated with an excessive buildup of eye pressure. Because the pressure normally fluctuates daily, the optic nerve also needs to be evaluated.

Why is screening important? “Glaucoma initially affects peripheral vision, and individuals are often unaware of the change. By the time patients are aware of it, the disease has progressed significantly and has affected the central part of the patient’s vision,” says Dr. Hilary Beaver, an ophthalmologist with Methodist Eye Associates. “At that point, the damage is often irreversible. That is why glaucoma is known as the silent ‘thief of sight.’”

Health Screenings by AGE Screening

18–39

40–49

50–64

65+

Screening Method

Diabetes (type 2) Start at 45, then every three years Diabetes with risk factors Colorectal cancer

Start at 50, then every five to 10 years

Colorectal cancer with risk factors

Breast cancer

Colonoscopy

Start at 45 if African-American or earlier if family history

Bone density Cervical cancer

Fasting blood glucose

Annually with BMI ≥ 25 and patient has one other risk factor

Annually for women over 65 Start at 21 or with onset of sexual activity, then annually (Pap) Start at 30, then every three years (HPV testing) Start clinical breast exam at 21, then every three years

Cholesterol

Pap and HPV test

Start mammogram at 40, then every one to two years

Breast self-exam and mammogram

Start at 55, then every five years

Lipid profile –triglycerides, total cholesterol, HDL and LDL

Glaucoma 20–39, one screening

65 and older, every one to two years

Glaucoma with risk factors

65 and older, every one to two years

20–39, every three 40–64, every two to four years to five years

Bone densitometry test (DEXA scan)

To learn more about any upcoming health screenings offered by The Methodist Hospital System throughout the greater Houston area, visit methodisthealth.com or call 713-790-3333.

Volume 5, number 4 I 45

Accolades

he Methodist Transplant Center’s lung transplant program received a Bronze Award from the Health Resources and Service Administration, an arm of the U.S. Department of Health and Human Services. The transplant program is the largest in the United States. The award measures performance, based on post-transplant survival rates, transplant rates and mortality rates after patients have been placed on the waiting list. Only 22 percent of transplant programs in the United States receive this award. n

Dr. Timothy Boone, chairman of the Department of Urology at The Methodist Hospital, has been named president of the American Board of Urology. The organization certifies urologic physicians who meet its educational, professional peer review and examination criteria. n

Dr. Bobby Alford has step ped down as chairman of the otolaryngology programs at The Methodist Hospital and Baylor College of Medicine. Alford, chairman of Methodist’s Department of Otolaryn gology since 1967, was instrumental in developing the hospital’s Neurosensory Center, which includes the Institute for Head and Neck Surgery. He is an internationally recognized leader in otolaryngology and under his leadership, the Baylor and Methodist otolaryngology departments rose to preeminence in patient care, post-graduate education and research. n

46 I methodisthealth.com

Randee Regan, RN, CNOR, has been named the Brown Foundation Inc. Outstanding Nurse for 2010, at The Methodist Hospital. Regan is a charge nurse in the Main operating room, where she coordinates use of the da Vinci surgical robot and is also a resource nurse for urology cases. With more than 26 years of nursing experience, she is the 21st nurse to receive this annual award. n

Rosemary Moreno is the first employee in the more than 90-year history of The Methodist Hospital to reach 50 years of service. Moreno, who has always worked in the Ophthalmology Surgery Department, has served in various capacities since she began on June 1, 1960 at the age of 17. She now works as the department’s receptionist. Moreno was selected to push the detonator button to bring down the Diagnostic Clinic Tower on Fannin Street in 2006. The building was demolished to make room for the Methodist Outpatient Center, which opened last year. n

ACCOLADES

he Methodist Hospital has received full accreditation by the Accreditation Council for Graduate Medical Education. This is a full accreditation, following the initial approval received upon beginning the medical education program in 2005. The hospital has 24 residency programs. 

Robert “Bob” Kidd has been named director of The Methodist Hospital’s Spiritual Care and Education Department. Kidd, who is a board certified chaplain, has more than 23 years of experience as a chaplain at Methodist. He recently served as president of the board of directors of the American Association of Professional Chaplains. 

Stephanie Garee, M.S.N., RN, CEN, received the 2010 Good Samaritan Excellence in Nursing Gold Award. She was selected from hundreds of nominees from 13 counties comprising the greater Houston area. Garee, who is a nurse manager on the orthopedic unit, accepted her award at the Sixth Annual Excellence in Nursing Awards Luncheon on Sept. 16. 

Youli Zu, M.D., Ph.D., has received a $1.57 million NIH grant Zu, a hematopathologist in the Department of Pathology at The Methodist Hospital, will use the funding to support his research to develop a bifunctional nanomedicine for specific imaging and targeting therapy of anaplastic large cell lymphoma, a relatively uncommon type of non-Hodgkin’s lymphoma that arises from T-cells. 

enisha Rayfus, a unit secretary on Jones 9 at The Methodist Hospital, has been named as the first recipient of the hospital’s Nursing Support Team Appreciation and Recognition (STAR) Award. The program was established to recognize nursing support team members who exhibit compassionate care, possess a great work ethic and demonstrate a willingness to go above and beyond the call of duty. 

he Methodist Hospital System is ranked No. 19 among FORTUNE magazine’s 2011 “100 Best companies to Work For,” making the list for the sixth year in a row. It is the highest ranked health care organization in the country and the only hospital system ranked in Texas.

Methodist was selected based primarily on a confidential survey sent to randomly selected employees, who were asked questions on the level of trust, pride and camaraderie within their workplace. Methodist also submitted documentation about its work environment, from benefits to corporate policies to employee demographics. 

VOLUME 5, NUMBER 4 I 47

Clinical Notes Dr. Robert Grossman, chairman of neuro surgery at the Methodist Neurological Institute

Grossman serves as the primary investigator for translational research into treatments for military men and women with spinal cord injuries. The research, under the auspices of the Christopher & Dana Reeve Foundation’s North American Clinical Trials Network, is funded, in part, through a two-year, $5.4 million grant from the United States Department of Defense. Launched by the Reeve Foundation in 2006, NACTN research sites include Houston, Philadelphia, Baltimore, Miami and Toronto. n

Dr. John Baxter, director of the Genomic Medicine Program and codirector of the Diabetes Research Center at Methodist

Baxter has received a $3 million grant from the National Institutes of Health to study promising treatments for heart disease and obesity. Baxter’s study is aimed at creating drugs or compounds to control hormones created by the thyroid gland and reduce cholesterol, body fat and liver fat. n

Dr. Karla Kurrelmeyer, cardiologist at the Methodist DeBakey Heart & Vascular Center

Kurrelmeyer presented her research findings at American Heart Association Scientific Sessions in Chicago in November. Her study showed that a drug called spironolactone prevents the decline of symptoms of advanced heart failure in elderly women (average age of 70 years). These symptoms include shortness of breath, weakness and lack of energy. The drug also decreases fibrosis or stiffness in the heart muscle as measured by blood markers or echocardiography. n

48 I methodisthealth.com

Save a Life 2011 COMMUNITY HEART TRAINING DAY

Adult CPR & AED Training Saturday, February 12 Methodist Training Center at Reliant Park Right off Kirby, near 610 Loop

Choice of two sessions: 8 a.m. - 12 p.m. or 1 - 5 p.m. $10 per person Participants must be 12 years of age or older. Upon successful completion of the class, participants will receive Red Cross certification in adult CPR and AED use. Space is limited and participants must pre-register. To register or for more information, visit HoustonSaveaLife.org Groups welcome! Call 832-667-5857 to complete registration for your group. Spanish language training is available Saturday, Feb. 12, 8 a.m. - 1 p.m. Greater Houston Area Red Cross, 2700 Southwest Freeway, Houston, TX 77098

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

6565 Fannin Houston, TX 77030 A Founding Member of the Texas Medical Center

LEADING MEDICINE The Methodist Hospital System ®

Hospitals The Methodist Hospital

6565 Fannin Houston, TX 77030 713-790-3311

Methodist Sugar Land Hospital 16655 Southwest Freeway Sugar Land, TX 77479 281-274-7000

Methodist West Houston Hospital

18500 Katy Freeway Houston, TX 77094 832-522-1000

Methodist Willowbrook Hospital

18220 Tomball Parkway Houston, TX 77070 281-477-1000

San Jacinto Methodist Hospital 4401 Garth Road Baytown, TX 77521 281-420-8600

Research The Methodist Hospital Research Institute

6670 Bertner Houston, TX 77030 713-441-1261

Imaging Methodist Breast Imaging Center

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

Methodist Imaging Center

8333 Katy Freeway Houston, TX 77024 713-793-XRAY (9729)

Emergency Care Methodist Emergency Care Center

2615 Southwest Freeway at Kirby Houston, TX 77098 713-441-ER24 (3724)

Physician Referral/ Health Information 713-790-3333 Health information via the Internet methodisthealth.com

Wellness Methodist Wellness Services 713-441-5978

Philanthropy The Methodist Hospital Foundation

1707 Sunset Blvd. Houston, TX 77005 832-667-5816

Leading Medicine Magazine, Vol. 5, No. 4, 2011

Articles inside

ACCOLADES

HEALTHy LIVINg

WEIgHT MANAgEMENT

Q&A

LIFELONg INSPIRATION

THE gIFT OF LIFE

ON THE BATTLEFIELD

ADVANCINg THE DEBAKEy LEgACy

THE CHANgINg FACE OF MEDICINE

HEART DISEASE