Reeling in the Years Lives extended by 21st-century health care, Texas Medical Center
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NEWS OF THE TEXAS MEDICAL CENTER — VOL. 6 / NO. 8 — SEPTEMBER 2019 Reeling in the Years Lives extended by 21st-century health care, p. 20 THE TMC’S MOST INSTAGRAMMABLE PLACES, p. 6 TURNING THE ANTI-VACCINATION TIDE, p. 10 DeBAKEY HIGH GRADS: WHERE ARE THEY NOW? p. 34
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President’s Perspective TMC | PULSE Vol. 6 No. 8 September 2019 President and Chief Executive Officer William F. McKeon Communications Director Mark Mulligan/© Houston Chronicle. Used with permission. Ryan Holeywell Pulse Editor Maggie Galehouse, Ph.D. firstname.lastname@example.org Assistant Editor Cindy George email@example.com Staff Writers WILLIAM F. McKEON Alexandra Becker President and Chief Executive Officer, Texas Medical Center Britni R. McAshan Shanley Pierce Photojournalist A s president and CEO of the Texas Medical Center, I interact every day with other leaders from the institutions that comprise the largest medical city in the world. Because I work with such a diverse group of constituents—more than 60 member institutions, representing Cody Duty NEWSROOM 713-791-8812 more than 100,000 employees—I often reflect on an experience I had nearly a decade ago that firstname.lastname@example.org influences my approach today. ADVERTISING The Harvard University Program on Negotiation taught me important lessons that help Felicia Zbranek-Zeitman me to understand the unique needs of each of our members. Before the three-day program, 713-791-8829 participants prepare for roles they’ll play in simulated negotiations. The exercise forces email@example.com everyone to take a position and argue for it, regardless of their personal convictions. For example, one person might represent an offshore drilling company while another DISTRIBUTION makes the case for environmental protection. As you might imagine, the facilitators encour- firstname.lastname@example.org aged us to defend our positions vigorously. But we soon saw how that passion led us to READ US ONLINE move swiftly away from any chance at reaching a mutually beneficial outcome. We became tmc.edu/news entrenched, and our own opinions became obstacles to progress. I learned a great deal about FOLLOW US myself and how to better engage in productive negotiations. @TXMedCenter The lessons I learned long ago continue to help me better understand the Texas Medical @texasmedcenter Center institutions I work with in this unique ecosystem. Some CEOs and leadership teams @thetexasmedicalcenter are naturally collegial, while others may view collaboration as dilutive or contributing to a loss of full control. Fortunately, the Harvard program identified these different styles of nego- TMC Pulse is an award-winning tiation, and I often find myself recognizing them in the course of a discussion. monthly publication of the Texas So what’s the key to negotiating? The answer seems simple, but it requires a great deal Medical Center in Houston, Texas. of commitment and much more time than a three-day program. My life experiences have Permission from the editor is taught me that it is most important to patiently build meaningful, trusting relationships over required to reprint any material. time. In both our personal and professional lives, it is the richness of these relationships that determines our happiness and success. I recognize that this seems obvious, but so often I observe people either intentionally or unintentionally creating barriers that obstruct the path to forming sound and productive relationships. I continue to learn every day. Some of the most challenging situations I face are often the most exciting and satisfying to work through. The journey continues as I learn more about myself and the incredibly diverse talent at all levels of the Texas Medical Center. 2 tmc » p u l s e | s e p t e m b e r 2 01 9
Table of Contents 8 28 30 32 Scarless Treating Adults with Distracting Kids Saving Health Care Surgery Intellectual Disabilities Before Surgery in America 9 Curated: Dance for Parkinson’s 12 Spotlight: Major General Rick Noriega 15 Vitals: High risks and high costs for young blood 27 Next Med: Did you take your pill? 38 Field Notes 40 Calendar on this page: Former elite cyclist Sinead Miller leads a medical device startup, p. 16 on the cover: Ted Adderly prepares to fish near his home in Missouri City, Texas.
Remembering Chernobyl Two physicians flew to Moscow in 1986 to treat patients exposed to radiation By Shanley Pierce H BO and Sky Atlantic’s recent miniseries, “Chernobyl,” drama- tizes the nuclear accident that took Due to the limited resources avail- able in Moscow, Reisner shipped 16 crates of supplies to build his small place on April 26, 1986 in the former lab in a Russian hospital. Soviet Union. But the medical after- Over the course of two weeks in math of that event was part of a real- Moscow, Reisner, Champlin and the life drama for two Texas Medical other two doctors performed bone Center doctors who traveled to marrow transplants on 13 patients. Moscow to treat first responders Only two survived. Credit: HBO courtesy photo exposed to excessive amounts of “The bone marrow transplant radiation at the scene. worked in those two patients and, The disaster occurred after oper- ultimately, their own bone marrow ators disabled the control system slowly recovered over time, but the on the nuclear reactor as part of a transplant helped them survive the safety test, creating unstable power The miniseries “Chernobyl” dramatizes the 1986 nuclear accident in the former immediate effects of the radiation,” levels. Combined with a flawed reac- Soviet Union. Champlin said. “They were very tor design, this caused a massive sick and, in many cases, too sick, explosion and fires that pumped that might help them was a bone carry any radiation dosimetry and received too much radiation to at least 5 percent of the radioactive marrow transplant, since radia- devices to measure the doses of their GI tract for the bone marrow core into the air, according to the tion is primarily toxic to the bone radiation they received, doctors transplant to save them.” World Nuclear Association. marrow and suppresses your blood ran biological tests to estimate Champlin brought his insights Within two weeks of the acci- counts where people then die how much radiation was absorbed. and experience from treat- dent, four doctors from the United of infections.” According to Champlin, they ing Chernobyl patients to MD States arrived in Moscow, where As a result of the nuclear reactor received 500 rads of radiation. Anderson, where he uses bone victims—primarily firefighters explosion, 134 people involved with “For the victims involved, they marrow transplantation to success- who were the first on the scene of the clean-up were confirmed to have had terrible injuries. No treatment fully treat leukemia, lymphoma and the explosion and exposed to high acute radiation syndrome. Within could have saved most of them,” blood cancer. amounts of radiation—were evacu- a few weeks, 28 of them died due Champlin said. “Bone marrow trans- Chernobyl was “an international ated for treatment. to radiation. plantation is of very little benefit event with a lot of interest around Depictions of the victims in “When people are exposed to in the overall scheme of things in the world in the outcome of the the Emmy-nominated five-episode high doses of radiation, it can cause managing patients with radiation treatment of the patients,” he said. miniseries were extremely realistic, fatal bone marrow suppression,” injuries. The primary lesson is to “It was an exciting medical opportu- according to Richard E. Champlin, Champlin said. “With radiation prevent this type of accident from nity, but, obviously, a tragic event for M.D., who was among the doctors accidents, if you receive a low happening in the future.” the victims involved.” who worked with a Russian hospital dose of radiation, you don’t need a One of the other doctors For Reisner, it was not only a to perform potentially lifesaving transplant, but if you are exposed recruited to treat radiation exposure poignant medical and scientific bone marrow transplants. He was to a dose that is around 300 to 500 after the Chernobyl disaster was experience, but a human experience, a part of the bone marrow trans- rads of radiation [a rad is a unit of immunologist Yair Reisner, Ph.D., as well. plant program at the University of absorbed radiation dose]—that is now a professor in the department “Being there during the Cold California, Los Angeles at the time. potentially fatal. You can be saved of stem cell transplantation at MD War with the Russians, for me, as “It was an emergency in which with a bone marrow transplant. If Anderson. Reisner specialized in a young man, was very special … people had received, in many you get much higher doses of that, bone marrow transplantation from to be able to talk to them, learn cases, lethal doses of radiation,” it unfortunately destroys other mismatched donors and had devel- about their lives and so on,” Reisner recalled Champlin, now chair of the organs of the body and that is what oped a procedure to avoid graft recalled. “It’s not less important department of stem cell transplan- happened to many of the victims in versus host disease, a condition than the science.” tation and cellular therapy at The Chernobyl. They died of gastroin- in which the donor bone marrow University of Texas MD Anderson testinal toxicity and radiation.” and the recipient’s own bone Cancer Center. “The one treatment Although the victims did not marrow attack each other. 4 tmc » p u l s e | s e p t e m b e r 2 01 9
Health is our middle name. We’re proud to be recognized as our city’s healthiest extra-large employer. As your public health system, we’re here to help Harris County residents lead long, healthy lives. As residents ourselves, we take that responsibility to heart. We want our teams to be strong, healthy and happy, too. Making health a priority within our own organization is good for us. And better for everyone we serve. Join our team and see how we’re transforming health in our community. ONEFORALL harrishealth.org
The TMC’s Most Instagramm T he Texas Medical Center is known around the world for its patient care, education and research—but it’s also a city in and of itself. Every day, thousands of employees, A patients and visitors walk past unforgettable landmarks and striking architecture. With the approach of our 75th anni- versary in 2020, we put together a list of some of the most photographed places here in the world’s largest medical city, but it is by no means complete. We encourage you to share your favorite places and moments in the TMC on social media, and be sure to tag us using #TMCsnapshots. A J AMES TURRELL’S “TWILIGHT C T EXAS CHILDREN’S D EPIPHANY” SKYSPACE HOSPITAL SIGNAGE Suzanne Deal Booth Centennial 6621 Fannin St. Pavilion, West Quadrangle, Rice University Campus Reminiscent of a whimsical storybook, the colorful, halo-lit, painted aluminum “Twilight Epiphany” is the 73rd in a letters placed among flowerbeds also worldwide series of light-filled architec- serve as a wayfinding tool that spells tural spaces created by the famous artist. out T-E-X-A-S C-H-I-L-D-R-E-N-’S At sunrise and again at sunset, LED H-O-S-P-I-T-A-L. lights cast against the Skyspace slowly change colors, complementing the sky’s natural transformation. D WORTHAM PARK Corner of Holcombe Boulevard and Main Street B T HIRD COAST RESTAURANT John P. McGovern TMC Commons, Constructed by John Burgee Architects 6550 Bertner Ave., 6th floor in 1991, the row of towering waterfall foun- G tains is a perfect backdrop for portraits or Whether you’re grabbing a quick break- quiet moments of reflection. fast before clinic, enjoying a lunch meeting or sneaking in a happy hour with colleagues, the upscale restaurant run E LABOR AND DELIVERY UNITS by executive chef Jon Buchanan offers Multiple hospitals in the TMC plenty of photo-worthy dishes and drinks, including blueberry buttermilk pancakes. Welcoming a baby into the world is often described as one of the best days of a parent’s life, so it’s no wonder that new- born photos taken during those very first moments are shared far and wide. This photo shows Tessy Carpenter and her son, Calvin Carpenter, born on January 6, 2019 at Texas Children’s Hospital’s Pavilion for Women. Credit: E, Jessica Pierce with Bella Baby Photography; H, MD Anderson Cancer Center 6 tmc » p u l s e | s e p t e m b e r 2 01 9
mable Places By Alexandra Becker B C F BILL COATS BRIDGE Hermann Park, southwest of MacGregor Drive and Almeda Road The 290-foot suspension bridge for cyclists and pedestrians connects natural areas at the edge of the medical center to the heart of Hermann Park. G SURVIVOR BELLS Multiple cancer centers and hospitals in the TMC Patients who have completed cancer treat- ment are often offered the opportunity to a ring a bell signifying the end of chemo- E F therapy or radiation. Shauntelle Tynan, pictured at Texas Children’s Cancer and Hematology Centers, traveled from Ireland for treatment. H T HE DOROTHY H. HUDSON MEMORIAL GARDEN AT THE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER Main entrance to the campus, 1515 Holcombe Boulevard The iconic garden contains more than 500 roses and is a cherished place for employees, patients and loved ones to rest, reflect and recharge. H I I T HE WATERWALL John P. McGovern TMC Commons, 6550 Bertner Ave. Equal parts soothing and mesmerizing, the TMC’s waterwall is illuminated for national health observances or major milestones—like our hometown Astros winning the World Series. tmc » p u l s e | s e p t e m b e r 2 01 9 7
Scarless Surgery A new technique for thyroid surgery makes small incisions inside the lower lip By Shanley Pierce T oward the end of 2018, Tracy Faustermann began experienc- ing a host of unusual symptoms. After two weeks of heal- ing and reduced swelling, there’s virtually no visible Her blood pressure was skyrocket- sign of surgery. ing, she had terrible heartburn and “Someone passing you her bones were weakening. on the street, even maybe “I thought I was just getting your relatives, wouldn’t old,” Faustermann, 35, said. “It’s even know you had surgery,” just life. I guess I got bad genes.” Grogan said. One day, her stomach issues Currently, there is worsened to the point where no data to indicate that she needed to see a doctor. Her this approach is more primary care physician initially advantageous than the suspected that her condition might Tracy Faustermann had transoral endocrine surgery to remove her parathyroid glands. traditional surgical method be due to diverticulitis, inflamma- beyond cosmetics. tion or an infection along the wall of the intestines. Her test results came back But value in medicine, Grogan said, is multi-dimensional. There is normal, but her calcium levels were abnormally high. monetary value (Could this technique help reduce costs?) and clinical value After running more tests, Faustermann’s doctor discovered her high calcium (Will this technique reduce risks and complications and improve outcomes?). levels, called hypercalcemia, were due to overactive parathyroid glands secret- However, there’s also patient-centered value. This is where the real benefit of ing an excess of parathyroid hormone, which regulates calcium in the blood. the operation lies. “My doctor said, ‘We’re just going to watch this for a few years.’ But at this “People don’t look into the deeper understanding of what that cosmetic point, I had been reading the most recent research on hyperparathyroidism,” value actually is for patients. They just say, ‘They have a scar on the neck. recalled Faustermann, a technical specialist at Corning Life Sciences. “I said, So what? What’s the big deal?’ … I think that’s a wrong way of looking at it,” ‘You know what? That’s not a good enough answer for me.” Grogan said. “The truth of the matter is it’s a scar on the front of the neck. It In search of a more aggressive course of action, Faustermann found an can never be hidden. It will always be there. That’s more than not wanting that endocrinologist who diagnosed her with severe hyperparathyroidism. The scar. There is more than just vanity. … It’s a constant reminder that you had only treatment was to surgically remove the affected parathyroid glands. surgery. If it was for cancer, then it’s a constant reminder that you had cancer.” Being a meticulous researcher, Faustermann scoured the internet and On Dec. 13, 2018, Grogan removed Faustermann’s parathyroid glands. Not scientific literature to better understand her condition and her options for having a visible scar was a major selling point for Faustermann. minimally invasive surgical treatments. “Being on the business and sales side, I don’t want to have attention drawn “I had read a bunch of horror stories. If [doctors are] not specialized in that to me,” she said. “If someone has a scar on their neck, it’s really obvious. area, don’t do it,” she said. “There were only two doctors in the area I would let People stare. It wouldn’t have been that big of a deal or been the end of the touch me.” world, … but I really like that I don’t have to have the scar.” One of the doctors was Raymon Grogan, M.D., associate professor of Although Faustermann still has some temporary numbness in her mouth, surgery at Baylor College of Medicine and section chief of endocrine surgery she said she feels “a lot better than I did before I had the surgery.” She no lon- at Baylor St. Luke’s Medical Center. Grogan is one of a small cadre of experts ger suffers from heartburn and has stopped taking blood pressure medicine. in the country who perform a novel, innovative surgical technique called tran- “If I have another enlarged parathyroid at some point in life, we could do it soral endocrine surgery, which avoids scarring on the neck. Currently, Baylor again if we had to, and I would do it again,” Faustermann said. “If you have to St. Luke’s is the only center in Texas where this procedure is performed. have surgery, it was the best experience.” Typically, surgeons make an incision in the neck to remove the thyroid Grogan is collecting data to support transoral endocrine surgery as a or parathyroid glands, leaving behind a visible scar. Although less apparent, valuable surgical option. Thus far, preliminarily findings show that, besides other surgical techniques—such as those that remove the glands through the the cosmetic benefit, there is a reduced risk of injury to the parathyroid, which armpit or areola—still scar. is one of the possible complications of surgery on the thyroid, but more safety However, using the transoral endocrine surgical technique, Grogan makes and efficacy data will be needed before this technique becomes mainstream. three small incisions—ranging from 3 to 10 millimeters wide—inside of the “Upwards of 140,000 people per year in the United States could have this bottom lip to create three ports. He can then snake a laparoscope down the operation, so even the smallest benefit to a single patient when you start center port, and retracting and cautery tools down each side port. extrapolating it out to hundreds of thousands of people per year adds up to Once the glands are laparoscopically removed, Grogan stitches up the a very large benefit on a societal level,” Grogan said. “That also shouldn’t be incisions. On average, parathyroid removal takes an hour to perform— ignored or be minimized.” two hours for a thyroid lobectomy and three hours for a total thyroidectomy. 8 tmc » p u l s e | s e p t e m b e r 2 01 9
T apping, swaying or marching to a beat might not sound difficult or tripping, so we always try to have that forward path- to most of us, but for The Intersection of ARTS and MEDICINE way to turn around.” those suffering from By Britni R. McAshan The class stim- Parkinson’s, the physical ulates participants’ stiffness and difficulty cognitive abilities with balance that are by prompting them hallmarks of the disease to learn movement can make independent movement extremely snapping, tapping and twisting to warm combinations and remember fellow class challenging. up every muscle before standing to do members’ names. Parkinson’s is a neurological disorder barre work. Although most individuals with that can cause tremors, shakiness, stiffness, “You’re warming up certain areas in the Parkinson’s are diagnosed around the age loss of coordination and impair a person’s body to get students prepared to engage of 60, the class has no age limit—participants ability to walk and stay balanced. Dance their muscles so it’s not such a foreign thing are encouraged to bring friends and loved for Parkinson’s, a partnership between when they stand up,” Richmond said. “Then ones to dance along with them. the Houston Area Parkinson Society and we go to the barre, we do pliés and test their Ten years after its inception, Dance for Houston Ballet, gives participants a chance balance, and then we do across-the-floor Parkinson’s is the founding program of a to build physical strength and move confi- work. The class builds so they are not taken full adaptive dance suite offered by Houston dently in dance class. off guard as far as their balance goes.” Ballet, which modifies dance for populations Krissy Richmond, a former principal Each week, 15 to 25 individuals with with specific needs. dancer with the Houston Ballet, became the Parkinson’s attend the class; all present with “I talk about the physical and cognitive founding instructor for Houston’s Dance for differing degrees of the disease. Instructors benefits of the class, but you cannot underes- Parkinson’s class in 2009 at the urging of tailor the lessons to make them safe for stu- timate the social impact of the class as well,” Houston Ballet’s now executive director, dents to move independently. Sommers said. “We get together and we have Jim Nelson, whose father had just been “In any ballet class you go to, you would fun. We are learning together. We are not a diagnosed with Parkinson’s. do several turn combinations, but turns are community of people who have Parkinson’s— “We take the structure of a warm-up from not a thing we do in this class,” said Jennifer we are a community of people who dance and a regular class, but do the basics in a chair so Sommers, Dance for Parkinson’s instructor move together every Monday.” our students don’t have to think about bal- and director of education and community ance,” Richmond explained. “It is remarkable engagement at Houston Ballet. “We do To participate in Dance for Parkinson’s, which is how much you can accomplish in a chair.” change the facing of the room—we go from free, contact the Houston Area Parkinson Society Throughout the one-hour class, students traveling from the east side of the room to at 713-626-7114 or visit hapsonline.org. perform variations of tap, ballet and modern the west side. If you turn too much … there dance—using arm movements that combine is a chance for getting your feet tangled up tmc » p u l s e | s e p t e m b e r 2 01 9 9
Turning the Anti-Vaccination Tide The medical community is devising new strategies for talking to parents about the safety and success of vaccines By Alexandra Becker N ineteen years ago, the Centers for Disease Control and Prevention (CDC) declared that measles—a highly contagious and potentially It is important to focus on a specific concern, she said, and then help parents understand the informa- tion around that concern. “It’s not a conversation that will necessarily turn the parent around immediately—it might take deadly disease—had been eradicated from the several visits to talk about it and hear what it is they have questions about, but I think it’s essential to United States thanks to an effective vaccine, a maintain that relationship and help them find their way. It’s really about being an ally,” Wootton said, robust vaccination emphasizing the importance of patients having a medical program and a strong home where there is a trusting relationship between the public health system. patient and the provider. Fast forward to It is also necessary to address any vaccine myths August 2019, and head-on by debunking them first, then labeling them, more than 1,200 stating why they are not true, and finally replacing the cases of measles have myth with accurate information, she added. been confirmed in 30 “You want to provide them with the truth that fills in states in 2019 alone. that biggest concern,” Wootton said. According to the CDC, Finally, she cited a shift in language termed the this is the greatest “presumptive approach.” number of cases “This is when a doctor comes in and says, ‘Today we’re reported in the U.S. going to do your flu shot,’ rather than coming in and saying, since 1992. ‘Do you want to have your flu shot?’” Wootton explained. What happened? “A presumptive framing is more effective than the ask, and An increasing num- that’s a simple thing to train providers on.” ber of parents began In August, STAT News published a story about an ini- declining vaccinations. tiative in Québec that stationed a new workforce of vaccine Known as anti-vaxxers, counselors in maternity wards. Their goal was to employ vaccine-hesitant, and a “no-pressure strategy,” using a technique called motiva- vaccine choice activ- tional interviewing to speak to parents about their opinions ists, the group gained about vaccinations and then offer to answer any questions momentum after or concerns they may have. Andrew Wakefield, a Other methods are in the works. At the annual meeting British doctor who has of the European Society for Paediatric Infectious Diseases, since been stripped of Saad B. Omer, MBBS, Ph.D., director of the Yale Institute his medical license, for Global Health, encouraged pediatricians to frame the published now widely conversation in a way that focuses on the disease and its disproven research potential consequences rather than the safety of vaccines, linking certain vac- according to a June article published in Pediatric News. cines to autism But one of the issues at hand is not simply how the con- spectrum disorders. versations are being framed, but if a meaningful conversa- The medical com- tion can take place at all. munity is fighting back. “Most parents aren’t deeply dug in—they’re just scared and inundated with misinformation, and it To quell the fears of hesitant parents and requires a conversation, and sometimes that can go on for 20, 30 minutes,” said Peter Hotez, M.D., Ph.D., deliver the truth about vaccines, more physicians dean of the National School of Tropical Medicine and director of the Texas Children’s Hospital Center for and other medical professionals have started Vaccine Development at Baylor College of Medicine. “The problem you get into is the logistics of having employing methods used by pediatricians to a 30-minute conversation in a busy pediatric practice.” communicate with parents and address their It makes sense, then, that the initiative in Québec included a new classification of employees— most immediate concerns. rather than tacking on a time-consuming yet critical task to the caseloads of already-busy pediatricians “There’s a lot to learn about these conversa- and nurses. tions and what conversations work,” said Susan Wootton, M.D., infectious disease specialist and Agreement and divergence associate professor of pediatrics at McGovern The anti-vaccination movement continues to rise, in part because its members are vocal, social-media Medical School at The University of Texas Health savvy and appeal to some of the most basic of human desires: that of a freedom to choose and a longing Science Center at Houston. to keep loved ones safe. 10 t m c » p u l s e | s e p t e m b e r 2 01 9
And therein lies the crux of the issue: While the medical community has proven time and again that parents to listen to their physicians rather than vaccines are safe and effective in preventing a multitude of diseases, many vaccine-hesitant parents still what they’ve read online. conclude that the safest choice for their children is letting nature take its course. “Although physicians educate their patients, “The one thing we can all agree on is that we want our chil- they also need dren, and we want our families, to be safe and healthy,” said Rekha to advocate for Lakshmanan, MHA, director of advocacy and public policy at The strong, sound Immunization Partnership, a Houston-based nonprofit that promotes The one thing we can all immunization vaccination through education initiatives, policy efforts and commu- agree on is that we want our policies and edu- nity outreach initiatives. “Where there is some divergence, however, is cate policy mak- where and how you get the information, and what information you use children, and we want our fam- ers,” she added. to make that informed decision.” ilies, to be safe and healthy. “Physicians are According to experts, parents are increasingly turning to the inter- Where there is some divergence, not only a trusted net as their voice of authority on the topic. voice to patients, “There is a lot of misinformation, and I think it’s really hard to however, is where and how you they are a trusted navigate what’s out there—we call it ‘Dr. Google,’” Wootton said. get the information, and what voice to policy Hotez noted that the latest data suggests there are at least 480 information you use to make decision makers.” anti-vaccine websites, many of which are widely circulated through- At the that informed decision. out social media. moment, the num- “You’re more likely to download misinformation than you are real — REKHA LAKSHMANAN, MHA ber of unvacci- information,” Hotez said. “Most of the time, parents are willing to have Director of advocacy and public policy nated children in their kids vaccinated; it’s a very small percentage of parents who are at The Immunization Partnership Texas is rising. deeply dug in. It’s just that they’re scared because they download all “We’ve got the misinformation, which is ubiquitous on the internet.” over 64,000 kids Lakshmanan echoed Hotez’s assertion that the anti-vaccination not getting vacci- movement is small but powerful. nated, and these are the ones we know about— “At the end of the day, people who are opposed to vaccines are a relatively small group of people, but we don’t know anything about the home-schooled they are extremely vocal and engaged in advocacy, and as a result of their loudness, they look and feel a kids,” Hotez said. “This issue is not going to go lot bigger than what they really are,” Lakshmanan said, adding that The Immunization Partnership urges away any time soon.” tmc » p u l s e | s e p t e m b e r 2 01 9 11
Spotlight MAJOR GENERAL RICK NORIEGA has been CEO of Ronald McDonald House Houston for two years following an impressive career in public service. He spent a decade in the Texas legislature representing Houston’s east side, served in Afghanistan and oversaw the conversion of the George R. Brown Convention Center into a massive shelter as Houston welcomed Hurricane Katrina evacuees in 2005. The native Houstonian discusses how his experiences have influenced his leadership and what’s next for Ronald McDonald House Houston. Q | During your time in the from lieutenant governor after convention center around 10 a.m. Texas legislature, you were the George W. Bush became president, and by 6 p.m., buses were rolling primary author of the Texas so he had yet to run a race for gov- in. People were wet and everything, Dream Act, which provides ernor. Under the radar in 2001, the coming directly from New Orleans in-state college tuition for governor signs the bill. and the Superdome. It’s pretty undocumented immigrants amazing what this city is capable who have lived in the state Q | So, what happened to the of. It was remarkable. for three years before graduat- young man who sparked the ing from high school or receiv- Texas Dream Act? Q | How did you connect ing a GED and are seeking A | Rosendo Ticas is an aviation with Ronald McDonald House legal status. How did that mechanic today. He’s married and Houston? come about? has three kids. He owns a house and A | In civilian life, I had retired A | That’s what I’m going to have a rental house. He became a citizen from another nonprofit in San on my tombstone. Being a person and voted in the last presidential Antonio, AVANCE, and returned to called to public service, sometimes election. Houston in May 2017 to take care A | We set a decision point for it’s as simple as someone calling of my mother, who will be 88 in families about two days out: Are you your office to say they can’t get Q | Readers also might September. She was by herself and going to go to the hospital, go home, into Houston Community College remember your role in my siblings were out of town. I had stay with a friend or are you going because they’re an immigrant Houston’s response to a little over a year before my Army to stay here with us and wait it out? kid—a Salvadoran refugee—and the Hurricane Katrina in 2005. retirement and I had made brigadier We got in our workroom, called in college is trying to charge inter- A | At the time, I was on leave from general, so I was being asked to do all our employees, pulled out our national tuition. He was trying to deployment in Afghanistan and more. I was going to turn over rocks emergency plan and went through do the right thing and go through tri-hatted, serving as a state repre- for a while in Houston when I got it line by line. Who’s going to do the process. He wanted to be an sentative, a traditional Guardsman approached for this opportunity what? Who’s going to be where? aviation mechanic. His dream was and working for CenterPoint Energy in the spring of 2017. I started in All the generators were gassed up to work for Boeing. I thought: This is in the economic development July 2017. and we moved the [portable toilets] probably not unusual—especially in department. I had been home for a out so that they wouldn’t become the district I represented [East End/ few weeks in the summer of 2005 Q | You began your tenure projectiles. I headed back to Austin Ship Channel area]—and how many burning my leave time going to the by guiding the expansion of in my role with the Texas Army other kids are affected? I had the beach, then Katrina and Rita hit. Holcombe House, the tempo- National Guard and we huddled University of Houston do a survey The Astrodome was about filled up rary residence for sick children on calls every morning. The water by a demographer asking some and Mayor Bill White decided to and their families that now came up on the back patio, if that. questions to see the depth of the open up the convention center. I was offers 70 rooms. A month later, Topographically, we are on the high issue. The political dynamic at the invited to the meeting and they said Hurricane Harvey hit amid con- point of the Texas Medical Center. time in Texas was that Rick Perry I was going to run things as incident struction. How did you manage We were super-proud of the fact that had ascended to the governorship commander. I walked through the that crisis? we maintained operations during 12 tmc » p u l s e | s e p t e m b e r 2 01 9
Harvey. We were pretty much and children, I feel confident that respecting people, learning from improve recovery times and hospital isolated for 72 hours, but none of we are going to do the operational people. It’s given me the knowledge stay times and it helps the family the kids through that period of time things better than anybody else. base to deal with a lot of different to be healthier and stay together missed an appointment or a treat- One of the principles of the military things. In this position, you get to through an incredible crisis to keep ment. The ones that were still here, is that you’re always improving your see the most amazing children—the them whole. we were able to help. We were also position. We are open to changes beauty, the resilience, the love— super-fortunate to finish construc- and new ideas. every day. I am still learning, having Q | You have expressed an tion on time and under budget. fun and feeling incredibly blessed. interest in collecting data to Q | You completed your mili- determine if staying at Ronald Q | Have those successes influ- tary service last year. Explain Q | How does Ronald McDonald McDonald House Houston enced your ambition for Ronald your honorary boost from brig- House Houston help families during treatment improves McDonald House Houston? adier general to major general— beyond shelter and food? outcomes for patients. How far A | With our board, staff and from one star to two stars. A | Our intervention in this social along is that project? volunteers, I have learned that we A | I retired from the Army in space, which is family-centered care, A | We have the assistance of a can walk and chew gum at the same February 2018. It’s a ceremonial helps them to get better and to be grant from the Baxter Trust. That time. We were totally operational in promotion at retirement honoring better. Our intervention of caring for gift allowed us to embark on a the middle of a construction project you at the next highest rank. families beyond their basic needs research strategy we are pursuing and a major hurricane. We are helps alleviate stress and helps as a part of our long-term sustain- changing our advancement model Q | What specific skills do you them with all types of collateral ability plan. ➟ to feed the beast with 40 percent transfer from the military to things they may be dealing with, more capacity. As we look at our your current role? such as mental health and support new normal serving more families A | People skills—liking people, systems. That intervention helps tmc » p u l s e | s e p t e m b e r 2 01 9 13
Spotlight It allowed us to do our self-evalua- Hospital. We also have an embed- a county that abuts Harris County. A | Our local restaurant owners tion by collecting our own numbers ded 20-bedroom house in Texas We are funded through grants, and operators do—but that’s in family activities, early childhood Children’s and we have sleep rooms primarily from our local founda- still local. development, nutritional data— in Children’s Memorial Hermann tions and family foundations that understanding what we do. I believe, Hospital. Parents may need to sleep we’ve had relationships with for 40 Q | You’ve been in leadership in the greatest medical center in the over to be trained by the nurses on years. We have our Boo Ball, which positions for decades, but what world, we should be at the forefront how to care for the child or for is our famous Halloween event, and does it feel like being a CEO? of understanding family-centered grieving purposes. our golf tournament—the Ronald A | If I ever need a dose of reality, I care and how what we do makes a McDonald House Cup—and our go play with the kids or Mogie [the difference. Doctors will report that Q | What do you wish peo- Spirit of Hope volunteer luncheon. 1-year-old Australian Labradoodle patients say that it’s very import- ple understood better about Then we have a run, the Trafigura who lives at Ronald McDonald ant for them to stay at Ronald Ronald McDonald House Run for the House, which is spon- House Houston and serves as its McDonald House, but I want us Houston? sored. I want folks to know that we canine comfort ambassador]. The to have empirical evidence to be A | We’re not funded by Ronald receive occasional support from stories are very humbling. This able to demonstrate that it helps McDonald. We are almost entirely Ronald McDonald House Charities. place has an incredible history and families recover. funded by local community grace Otherwise, everything’s local. We because of the foundation that we’re and benevolence. We get minus- want the local community to know on here at the Texas Medical Center, Q | With 70 beds, is Holcombe cule federal money for a family that that we need them. I look at us as a the best days are yet to come. House one of the largest Ronald might qualify for Medicaid, like $25 real symbol of this city, our core val- McDonald House facilities in a night, but the cost for a family to ues and what’s best about Houston. Major General Rick Noriega was interviewed by Pulse assistant editor the country? stay here is about $200 a night for That’s what makes me proud as a Cindy George. The conversation was A | We’re in the top 10 percent in the food, lodging and transporta- native Houstonian. edited for clarity and length. the United States. We have family tion. There are a whole lot of other rooms in MD Anderson Cancer restrictions and issues. You can’t Q | Does McDonald’s Center and Texas Children’s be a resident of Harris County or contribute? February 21-22, 2020 // Houston, TX Come connect with global health experts, missionaries and organizations; be inspired by over 35 speakers; and find your mission in the M3 Conference Exhibit Hall with over 75 organizations working in the areas of medical missions, orphan care, water, sanitation, hygiene, human trafficking, education, and more! Register today at m3missions.com Save $5 with code: TMCPULSE2020 Connect with others. Be inspired. Find your mission. 14 t m c » p u l s e | s e p t e m b e r 2 01 9
By Shanley Pierce High risks and high costs for young blood A California-based biopharmaceutical clinic announced in August that its proprietary mixture made of plasma from young donors stopped cognitive decline in mild-to-moderate Alzheimer’s patients blood in experiments with mice. In 2013, Stanford University research- ers conjoined the veins of an old mouse to a young mouse to share the same blood circulation, resulting in the reversal of cardiac hypertrophy after six months. (the abnormal enlargement of the heart muscle) and some improve- In a randomized study by the company, Alkahest, 39 patients intra- ments in cognitive abilities in the older mouse. venously received either 100 milliliters or 250 milliliters of the plasma However, clinics selling plasma from young donors are not repli- for five consecutive days during the first week and again for five con- cating the same experimental conditions, said Vivien Sheehan, M.D., secutive days during the 13th week. Ph.D., assistant professor of hematology-oncology at Baylor College No detailed data on the study has been released yet, but Alkahest of Medicine. said in a press release that “these plasma fractions enhance neurogen- One California-based company, Ambrosia, sold participation in a esis, improve age-related deficits in learning and memory, and reduce clinical trial that offered each client one liter of human plasma har- neuroinflammation” in animal models. vested from young adults. Ambrosia charged $8,000 for that one liter, Plasma can be life-saving or potentially life-threatening, depending but since the FDA warning, the company has shut down. on the medical situation. Over the past few months, this straw-colored The Ambrosia trial raised major safety concerns. component of blood—which carries blood cells and proteins, contains “I’ve never seen an alleged trial that only had one inclusion criteria: antibodies, glucose, clotting factors, electrolytes and hormones—has that you be over 35,” Sheehan said. “There were no other safety mea- been shrouded in controversy. sures taken to make sure you’ve never had a transfusion reaction, to In legitimate emergency situations (such as trauma and burns) and make sure you can handle the volume, to make sure you’re not hyper- rare chronic conditions (such as autoimmune disorders and hemo- coagulable. There was nothing in there to protect the individual and philia), plasma is essential for survival. The World Health Organization screen out people for whom this would be more dangerous. … This was includes fresh frozen plasma on its WHO Model List of Essential clearly just an advertisement masquerading as a clinical trial. I can’t Medicines, which outlines the most important and integral medicines emphasize enough how disturbing it is that patients are being put at for a basic health care system. risk for something that is so unproven. The thing that is proven is that But in other scenarios, including using plasma infusions from plasma can kill you. The thing that is unproven is that it would have young donors to tap into a so-called “fountain of youth,” medical any benefit whatsoever, so the risk-benefit ratio is completely off.” experts say plasma can be life-threatening. Jesse Karmazin, CEO of Ambrosia, recently opened a new venture Earlier this year, the U.S. Food and Drug Administration (FDA) and is continuing to sell 1 liter of blood plasma for $8,000 and 2 liters issued a warning against the use of plasma infusions from young for $12,000. donors in hopes of treating dementia, Alzheimer’s disease, Parkinson’s “Ambrosia was dissolved, but Ivy Plasma is open for business. Ivy disease, multiple sclerosis, heart disease, post-traumatic stress disorder Plasma provides off-label plasma treatments, which is legal,” Karmazin and other age-related conditions. wrote in an email to TMC Pulse. “I can’t comment on the “When companies are giving plasma just to deal with neu- potential risks or benefits of this treatment due to restric- rologic symptoms without any good medical evidence, it’s a tions on off-label marketing of medications by the FDA.” risky thing to do,” said Modupe Idowu, M.D., associate professor Ultimately, scientific evidence that shows young of hematology at The University of Texas Health Science Center blood plasma can counteract age-related diseases at Houston’s McGovern Medical School. remains sparse. Risks include transfusion-related acute lung “If there are some factors in younger blood Plasma injury, transfusion-associated circulatory (about 55%) that could be helpful to an older patient, the overload and allergic and anaphylactic key would be to identify them, do the real work reactions, along with infections, febrile of fractionating and identifying what proteins non-hemolytic transfusion reactions and or micro RNA or factor that would be ben- hemolytic transfusion reactions. eficial to older people, then find a way A single unit of plasma contains 250 to either deliver it pharmacologically milliliters of plasma, typically from four to or genetically,” Sheehan said. “The eight donors, according to Idowu. whole plasma approach is kind of a White blood cells “It’s exposing the patient to multiple and platelets dumb strategy.” donors at the same time,” she said. (about 1%) Studies have explored the benefits of young Red blood cells Structure of Blood (about 45%) tmc » p u l s e | s e p t e m b e r 2 01 9 15
Shifting Gears A former competitive cyclist finds a new passion leading a medical device startup that diagnoses bacterial infections to fight sepsis By Shanley Pierce S inead Miller walked away from competitive cycling after a serious brain injury left her unable to compete on a world-class level. Motivated by her own trauma, she decided to pursue a career in neuroengineering. “I wanted to make some impact in the health care space to help peo- ple like me,” Miller, 29, said. After earning a B.S. in chemistry from Marian University and a B.S. in biomedical engineering from Purdue University, Miller began graduate school at Vanderbilt University in 2014. While working on her doctorate, she focused her research on the use of iron core nanoparticles to magnetically extract bacteria from blood. That research laid the ground- work for her next move—combating sepsis, a life-threatening infection to which the body has an overactive, outsized response. She picked up funding from the Department of Defense to help treat soldiers return- ing from Iraq and Afghanistan with drug-resistant bacteria. At least 1.7 million American adults are affected by a sepsis infection each year, resulting in nearly 270,000 deaths, according to the Centers for Disease Control and Prevention. One in three hospital deaths are due to sepsis. “It’s the biggest killer in our hospitals right now,” Miller said. “I had this idea for a device that doesn’t use nanoparticles but uses kind of a similar technique to bind bacteria and pull them out of blood. I used the knowledge that I had to Sinead Miller, a former elite cyclist, poses with her bike at Memorial Park. 16 t m c » p u l s e | s e p t e m b e r 2 01 9
fabricate this device that was for and associated toxins and flows the cleaning blood, pulling bacteria I wouldn’t even say that I’m recovered. clean blood back into the patient. out. And it worked.” I still don’t feel normal. It took me two years Creating a medical device and In early 2017, Miller partnered to get to a point where I could function like taking it to market is a process not with Alex Wieseler, whom she for the faint-hearted. Miller knows met while working for a nutra- a normal person, where I didn’t really slur my it’s a journey as arduous as it is ceuticals company in Nashville, words and I could go do normal things like go rewarding. She’s been down a Tennessee, to start a biomedical out to dinner and things like that. similar road before. device company. PATH EX is part of the current cohort of biomedical — SINEAD MILLER Born to ride device companies at TMCx, the CEO of PATH EX At the age of 3, Miller could be TMC Innovation Institute’s found on her bike, pedaling around accelerator program. device takes a five-milliliter blood In addition, PATH EX has the race track while her father, for- Miller’s device, which fits in sample from a patient suspected of developed a therapeutic device mer superbike racer Rex Miller, was the palm of a hand, can diagnose having sepsis or a bacterial infec- to treat infected patients. Similar competing. Her mom waited on the bacterial infection in the blood by tion, separates the bacteria from the to a hemodialysis machine, the sidelines, ready in case her father capturing and removing pathogens clean blood and allows doctors to device circulates the patient’s blood needed a tune-up. ➟ and their associated toxins. The immediately test the bacteria. continuously, captures the bacteria tmc » p u l s e | s e p t e m b e r 2 01 9 17
Even as a young child, Miller’s focus Miller works in her lab at JLABS @ TMC, and ability to visualize a far-off goal where she and her company, PATH EX, have been located since joining the was apparent. She entered her first TMCx medical device 2019 cohort. BMX racing competition when she was only 4 years old. Boys domi- nated the BMX scene back then, and the van and leave. But that’s what being a girl in a sport that was very we had to do so that I could race much a boy’s club made competing and improve.” impossible. There weren’t any girls Miller’s training paid off. to race. As a sophomore at South Park “I was a tomboy growing up and High School in her hometown of I always wanted to play with boys. I Pittsburgh, she earned a national always would ride at the BMX track level in BMX and turned pro at the with boys, my friends were boys and, age of 15. But she later retired from naturally, I wanted to race boys, too. her BMX racing career to focus on There were rules in BMX at the time her true passion: road cycling. where you couldn’t,” she said. “It would seem BMX and road Miller was determined to train cycling are really similar to a lot with the boys in order to reach the of outsiders because they’re both top of her game, so her parents bicycles,” Miller said. “If you think took her to races in different states, of, say, running, for example, you tucked her long blonde hair under can’t be the best sprinter and the her bike helmet and told people she best marathon runner. It’s totally was a boy. different. The same goes for cycling. “No one knew us. We’d just hide BMXers are your pure sprinters.” that I was a girl, put my hair up Miller had her sights set for the under my helmet, send me out, race long haul and seemed destined for the boys and then come back into cycling greatness. Arriving Early 2020 Tell us your love story and you could win a wedding valued at over $55,000! ENTER & VOTE: WESTINHOUSTONMEDICALCENTER.COM/ KEY DATES: WEDDING-CONTEST Contest Entry Deadline: Sep. 15, 2019 Top 10 Finalist Announcement: Sep. Se 30, 2019 Public Voting on Top 10 Finalists: Oct 1 – 22, 2019 Winner Announcement: Nov 1, 2019 Win Your Westin Wedding Date: Feb 14, 2020 PRIZE PARTNERS: Pompon Florists, JPL Entertainment, C. Baron Photography, Royal Luxury Events, Houston Flower Wall Co. Revelry Goods, Fresh Prints of Belaire, Flour and the Girl and Houston Diamond Girl 1709 DRYDEN, HOUSTON, TX 77030 | 713.730.2404 | SALES@THEWESTINHOUSTON.COM 18 tmc » p u l s e | s e p t e m b e r 2 01 9
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