NEWS OF THE TEXAS MEDICAL CENTER — VOL. 4 / NO. 5 — JUNE 2017

Bracing for MEASLES Is Texas poised for an outbreak? p. 18

TECO: POWERING THE TMC, p. 6 THOMAS STREET: A LEADER IN HIV/AIDS CARE, p. 15 MATERNAL MORTALITY IN TEXAS, p. 32 BARTLETT STREET LANDING

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TMC | PULSE Vol. 4 No. 5 June 2017

President and Chief Executive Officer William F. McKeon

Vice President of Communications Christen Bagley

Pulse Editor Maggie Galehouse [email protected]

Digital News Editor Shea Connelly [email protected]

Staff Writers Alexandra Becker Shanley Chien Christine Hall Britni N. Riley Mark Mulligan/© Houston Chronicle. Used with permission. with Used Chronicle. Houston Mulligan/© Mark Photojournalist Cody Duty WILLIAM F. McKEON President and Chief Executive Officer, Contributing Photographer Texas Medical Center Nick de la Torre

ublic attitude toward certain diseases and conditions can be perplexing, as this month’s NEWSROOM Pcover story on measles suggests. Over the course of my own life, I have noticed this most 713-791-8812 acutely in regard to mental illness. While I have observed some progression of society’s under- [email protected] standing and support of mental illness, we’ve got a long way to go. During my formative years, mental illness carried a social stigma of shame. It was never dis- ADVERTISING cussed. I remember two classmates of mine who were clearly suffering from mental illness and Felicia Zbranek-Zeitman then suddenly disappeared from school, never to return. Treatment alternatives at the time were 713-791-8829 extremely crude, often involving isolation, heavy sedation and/or rudimentary shock therapy. [email protected] I often wonder if my classmates were ever able to recover and return to productive lives. Over the past decades, though, we have begun to address the stigma attached to mental DISTRIBUTION illness. Today, adolescents are certainly more open to seeking help and discussing mental Daniel Martinez health issues. While progress has been made in developing therapeutics that are more refined 713-791-6136 in addressing symptoms, the time spent and side-effects endured when finding the optimal [email protected] drug can be daunting. New technologies utilizing DNA sequencing and analysis, however, offer new hope in determining the ideal drug for each patient. READ US ONLINE Finally, legislation in recent years is attempting to bring parity to reimbursement for tmc.edu/news mental illness treatment to match that of physical illness. This is long overdue and an important step forward in addressing the multiple layers of shame and discrimination associated with FOLLOW US mental illness. @TXMedCenter There is no vaccine for depression, for bipolar disorder, for an eating disorder. Thousands @texasmedcenter of years ago, we understood the essential connection between our mental and physical health. @thetexasmedicalcenter Perhaps we need to look back to move forward.

TMC Pulse is an award-winning monthly publication of the Texas Medical Center in Houston, Texas. Permission from the editor is required to reprint any material.

2 tmc» pulse | june 2017 Table of Contents june 2017

5 13 25 26

A Bath and For Mothers and Babies, My Favorite Patient Died Headaches You Can a Shower Safety First Because She Had a Set Your Clock To ...... Pre-Existing Condition ...... Experts offer summer food The March of Dimes Perinatal ...... Researchers are studying the circa- safety tips. Safety Center launches. An essay by Dr. Tim Garson. dian rhythm of cluster headaches.

10 Spotlight: Denise Castillo-Rhodes

28 Solutions

29 Curated: Humanae (work in progress)

37 On the Side: Stacey Berg, M.D.

38 Field Notes

40 Calendar

Madisson Somero at MD Anderson’s Prom Party Palooza. Story on page 30.

on the cover: Exeldy Perez, a licensed vocational nurse at Harris County Public Health & Environmental Services, holds a single dose of the MMR II vaccine.

tmc» pulse | june 2017 3 Houston’s Iconic Luxury High-Rise

Mosaic on Hermann Park Apartments 5927 Almeda Rd. Houston, TX 77004 855-228-8025 www.LiveMosaicHouston.com [email protected]

4 tmc» pulse | june 2017 A Bath and a Shower Experts offer summer food safety tips

By Britni N. Riley

ummer means backyard barbecues and picnics Sin the park. But as temperatures rise in Houston, bacteria blooms in the summer foods we love. “As much fun as it is to cook during the sum- mertime, it is important to remember that food is a main way that disease can be spread,” said Richard When it comes to Bradley, M.D., professor of emergency medicine at preparing raw fish and McGovern Medical School at The University of meats, such as sushi or beef Texas Health Science Center at Houston (UTHealth). carpaccio, using extra caution “The risk can be easily managed if we follow sound is the key to avoiding illness. steps to make sure that we maximize our safety.” “Any time you serve raw meat The Centers for Disease Control and Prevention or fish, you are going to increase the risk of estimates that 48 million cases of foodborne illness, or foodborne illness,” Bradley said. “To manage that food poisoning, occur in the United States each year. The number one cause of risk, it is best to make sure the meat comes from a reli- These cases come in the form of well-known patho- foodborne infection in the U.S. able source ... Make sure it is prepared the exact way it

gens, including salmonella, norovirus and E. coli, in at the present time is produce— is supposed to be prepared and minimize the amount addition to several caused by “unspecified agents”— of time it sits at room temperature.” a group of less understood bacteria that can cause spinach and lettuce. Both doctors also recommend taking extra severe stomach sickness. care when barbecuing anything from chicken to Bacteria on food grows faster in warmer tempera- — HERBERT L. DUPONT, M.D. cheeseburgers. tures, and the conditions under which most people Director of the Center for Infectious Diseases at “There is an E. coli pathogen that produces a very cook and eat outdoors are not always favorable. So it’s UTHealth School of Public Health severe disease called Shiga toxin-producing E. coli— a double whammy. and that is found in beef,” DuPont said. “When you Herbert L. DuPont, M.D., director of the Center Because of this, DuPont recommends giving grind up the beef, you’re putting the surface of the beef for Infectious Diseases at UTHealth School of Public raw produce a “bath and a shower” before serving it in the middle of the patty. For that reason, if you have Health, said the best way to avoid food-related illness to guests. a hamburger, it’s got to be cooked all the way through. this summer is to take precautions with every step of “You take the lettuce, spinach or carrots or what- I wouldn’t eat a hamburger that had a pink center the food preparation process. ever you are going to eat, you put them in a sink with because of the danger of picking up this E. coli bug.” “The number one cause of foodborne infection water, mix them all up, and then you put them in a col- Both doctors agree that the risk of food poison- in the U.S. at the present time is produce—spinach ander and let water run through them,” DuPont said. ing is greatly reduced by cooking meat at the proper and lettuce,” DuPont said. “You need to not assume “And with that, you will render all of these food items temperature, not leaving it out at room temperature that lettuce and spinach has been cleaned… even if safe. You should be doing the same thing with berries for long periods of time and not placing cooked meat it says ‘three times washed’ ... We have cultured those and grapes—give them a bath and a shower, let them where raw meat has been without cleaning the lettuce leaves and they are very contaminated.” dry out, and it will be a big factor in reducing disease.” area properly. Foodborne illnesses can result in nausea, vomiting, abdominal cramps, diarrhea and, occasionally, fever. TIPS FOR SUMMER COOKING Symptoms can last anywhere from four to 24 hours, and sometimes longer. • Hot food must stay hot • Don’t cross-contaminate • Wash hands with warm • Keep food refrigerated “If you have tried some Imodium or another and cold food must raw and cooked foods water and soap for at until it is ready to over-the-counter medication and that has not helped stay cold least 15 seconds after be eaten and you are beginning to feel light-headed, pale, touching raw meat, sweaty, confused and dehydrated, that is certainly chicken and fish a good time to call your health care provider,” Bradley said.

tmc» pulse | june 2017 5 Powering the TMC TECO cools and heats the Texas Medical Center

By Shanley Chien

Located at 1615 Braeswood Blvd., TECO’s central plant includes an 8.8 million-gallon thermal storage tank and a modified jet engine that can power a Boeing 747. Facing page: TECO’s East Chiller Building contains four 8,000-ton chillers. At 120,000 tons of generating capacity, TECO is the largest district cooling system in North America.

ehind a brown brick façade the medical center gets 24/7 coverage.” E. Cullen in front of Baylor College of producer of chilled water in North Bdecorated with black and white Much like the heart supplying blood Medicine, occasionally delaying and America, housing 27 chillers (including double helixes—an homage to the to the body through the veins, TECO rerouting traffic, to the frustration of four 8,000-ton chillers) and a 150-foot district it serves—the Thermal Energy pumps chilled water and steam to the medical center employees. tall thermal energy storage tank that Corporation (TECO) is busy cooling medical center through a vast network But as TECO’s CEO Steve Swinson holds nearly nine million gallons of and heating the Texas Medical Center. of pipes. Thirty-six miles of steel pipe said: “If we don’t do what we do, then water. There’s even a jet engine—strong “In reality, we’re a big part of the turn and wind below the TMC campus. they don’t do what they do.” enough to power a Boeing 747—that can med center, but we’re a quiet part,” said How far below? The equivalent of a TECO’s state-of-the-art central generate backup electricity in the event Charlie Michalak, maintenance man- five-story building. plant, which sits on six acres between of an electrical blackout. ager and long-time TECO employee. Sometimes, that massive under- Pressler Street and Brays Bayou, houses TECO’s services play an import- “Two hundred thousand people come ground infrastructure requires a dis- a district energy and combined heat ant role in medicine, patient care and in and out of this place every day. You ruption above ground. Recently, TECO and power (CHP) system that produces research. Chilled water provides air would think they would know a little construction crews have been hard at chilled water, steam and hot water conditioning to keep buildings cool. bit about us, but we don’t make a lot of work outside the John P. McGovern that is piped out to 46 buildings in the Not only does this give patients and noise. We just stay back to the side and Texas Medical Center Commons on medical center. The not-for-profit also employees respite from the oppressive do what we’ve got to do and make sure Bertner Avenue, and up the street on holds bragging rights as the largest heat and humidity during Houston

6 tmc» pulse | june 2017 In reality, we’re a big part of the med center, but

we’re a quiet part. — CHARLIE MICHALAK Maintenance manager and long-time employee of TECO

All the ingredients for a unique memorial. summers, but researchers gain envi- or surgical instruments. At the Texas ronmental control in their laboratories. Medical Center, a place that hosts more Maintaining a comfortable interior tem- than 10 million patient visits, delivers perature allows equipment to function more than 25,000 babies and performs properly and ensures that research and 180,000 surgeries every year, sterilized experiments aren’t compromised. tools and instruments are paramount to WE BELIEVE IN CELEBRATING the individual. So “A lot of the research specimens and patient safety and healthy outcomes. if that means arranging a BBQ memorial with all a lot of experiments have evolved so “When somebody goes home from the trimmings, consider it done. Let your Dignity that the environment is much more sen- the medical center, I know they don’t tell Memorial® professionals take care of all the details sitive to them than it would normally their family, ‘If it weren’t for the doctors for a farewell with flavor. be,” Swinson said. “A small change in and TECO, I wouldn’t be here,’” Swinson temperature, a small change in humid- said. “But we do kind of know it—not in ity, a small change in light intensity can an arrogant way. It is really personally adversely affect that.” fulfilling to do what we’re doing.” In addition to heating buildings, Since it was established in 1969, pressurized steam is used to sterilize TECO has focused on efficiency and laboratory, medical and surgical instru- reliability. Standard power plants ments and waste materials (including typically use one-third of the fuel they pathogenic hospital waste) in auto- produce, with the rest going unused. claves—industrial pressure chambers. TECO’s system reuses and recycles The moist heat from pressurized steam electricity and waste heat produced FUNERAL HOME AND CEMETERY LOCATIONS THROUGHOUT causes the proteins in various micro- from the plant, reducing emissions by THE GREATER HOUSTON AREA, INCLUDING: organisms to denature and coagulate, 32,700 tons of carbon dioxide annually. effectively destroying the cell mem- Despite the grand scale of TECO’s MEMORIAL OAKS EARTHMAN branes and cooking the microorgan- work, every tunnel in its infrastruc- Funeral Home & Cemetery Funeral Directors – Hunters Creek isms to death. ture is dug by hand, an old-fashioned HOUSTON HOUSTON 281-497-2210 713-465-8900 This sterilization process is espe- method that would seem to contradict cially important to prevent patients the state-of-the-art technology and > DignityHouston.com < from contracting diseases and infec- scientific advancements being made tions caused by bacteria on medical across the campus. (continued) www.prepaidfunerals.texas.gov

tmc» pulse | june 2017 7 Today, TECO is one of the most efficient, reliable plants in North America. We really are to district energy what Texas Children’s is to pediatrics, what Texas Heart Institute is to cardiovascular disease, what

MD Anderson is to cancer.

— STEVE SWINSON CEO of TECO

TECO’s combined heat and power system includes a jet engine that generates 48 mW of electricity. The heat-recovery steam generator captures heat from the turbine’s exhaust and turns it into steam.

8 tmc» pulse | june 2017 and the third for steam supply and As the Texas Medical Center around what will be the TMC3 transla- condensate return. Construction continues to grow and add new tional research campus, scheduled crews install oak boards to the inside facilities, TECO is also continually to open south of the medical center perimeter of the tunnels every expanding. The cooperative is currently in 2022. 6 inches, then lay down a set of tracks. extending its network of pipelines to “Today, TECO is one of the most Once pipe casings have been installed three buildings: Memorial Hermann- efficient, reliable plants in North in each tunnel, the chilled water and TMC’s Hermann Pavilion 2, Houston America,” Swinson said. “We really are steam pipes are connected to existing Methodist Hospital North Tower and to district energy what Texas Children’s distribution pipes. Ben Taub Hospital. In addition TECO is to pediatrics, what Texas Heart Because TECO serves the vast crews have already completed the Institute is to cardiovascular disease, majority of buildings in the Texas construction of distribution lines what MD Anderson is to cancer.”

Credit: Courtesy photo Courtesy Credit: Medical Center, individual institutions TECO CEO Steve Swinson. do not have to house, manage and oper- ate their own cumbersome heating and But Swinson said excavating tunnels by cooling equipment in large mechan- hand is the cheapest and most effec- ical rooms. Not only is this a more tive way to install large distribution cost-effective and efficient system, but lines that range from 6 to 60 inches for institutions are able to save valuable chilled water pipes and 2 to 16 inches for real estate for other things. steam pipes. TECO received the U.S. Environ- “Because of the size of the pipe, mental Protection Agency’s 2015 it’s not possible to dig open ditches,” Energy Star CHP Award and was Swinson said. “They would be so large, named a participant in the United they would totally disrupt the flow of Nations Environment Program Global traffic and pedestrians in the area.” District Energy in Cities Initiative for The tunneling process begins by its reputation in efficiency and sustain- digging three 5-feet-by-5-feet square able, renewable energy. tunnels—one for chilled-water supply, The TECO plant has had only one A TECO employee walks the roof of the plant. Massive fans help cool chillers that are used to the second for chilled-water return significant outage in 40 years. generate chilled water and keep temperatures comfortable in more than 20.3 million square feet of building space on the TMC campus.

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tmc» pulse | june 2017 9 Spotlight

DENISE CASTILLO-RHODES, Q | Did you always dream of a career in finance? Q | What was it like growing up in El Paso? A | Growing up in El Paso, I thought I wanted to be A | Life was simple and easy. I was blessed with two executive vice president and a math teacher. My sophomore year in high school, I loving and wonderfully supportive parents, an older sis- got a job working at Baskin-Robbins and worked there ter and two younger brothers. Neither one of my parents chief financial officer of the through most of my college years. Eventually, the had a college education, however. From a very early age Texas Medical Center, spoke owner let me run one of his three stores, which was they instilled in us that we would attend college. what inspired me to aim for a career in business. While When I attended UTEP, which is located on the with Pulse about growing up in at Baskin-Robbins I not only learned the ropes of the west side of town about 20 miles from my parents’ art of scooping ice cream, but, more importantly, the home, I could easily see the cardboard shacks that were El Paso, saying yes to profes- business side of the operations. When I graduated just across the border in Juárez, Mexico. The only thing from high school I enrolled at The University of Texas separating those shacks from where I stood was a trace sional challenges, volunteering at El Paso (UTEP) and declared business management of a very shallow Rio Grande. I remember watching lit- in Ghana and Guatemala, and as my major. I later changed my course of study when tle boys and girls playing outside their shacks or swim- my accounting professor pulled me aside to encourage ming in the river. I felt so sorry for these young children, getting her motorcycle license. me to consider accounting as my major after I scored but as time went on I came to realize how happy these a perfect 100 on my very first accounting exam. children seemed. This experience certainly played a role in my interest in humanitarian efforts.

10 tmc» pulse | june 2017 Q | What brought you to Houston? For me, balance includes He said, ‘I don’t know, kiddo, just come on board and A | I graduated from college with a degree in account- we’ll figure it out.’ ing and a desire to work in the tax department of one of self-care, so that my body, mind Here I am a single mom and this job offer is, ‘we’ll the Big 8 firms—Big 4 these days. and soul are being refreshed figure it out?’ Then, a few days later I received a call Unfortunately, they only hired people with daily. I do this by making deliber- from TMC to offer me a job as Business Manager, a graduate degrees, which is why I signed up for the position that was created just for me. This new job Master of Taxation program at UTEP. A few months ate choices about which opportu- took me completely outside of my area of expertise into the program, the IRS came knocking at my nites to pursue and which into three areas that I had absolutely no experience in,

door—not because I was delinquent on my taxes, but to decline ... including commercial leasing, marketing and business because they were looking to recruit recent graduates development. I accepted with some trepidation but I into a new program they just started in Houston. I understanding of all facets of the business world. The realized this was an opportunity to try something new. was torn because I always prefer to finish what I start. University of St. Thomas gave that to me. By being willing to learn a completely new side Ultimately, I finished my first semester and packed my By this time, my son was almost four. Our family of business, it allowed me to get my foot in the door bags to move to Houston. I figured that the experience routine became rather hectic again and, unfortunately, at the greatest medical center in the world. I’d gain in the IRS program in one year would take me two semesters into the MBA program my husband two years to learn in the classroom. I was right; the and I divorced. I could have dropped the program Q | You have such a strong commitment to training I received was phenomenal. At the end of the altogether, but I recognized that this MBA would be community outreach and charity. Where does program I was selected as one of the top three trainees. our path to greater opportunities down the road. that come from? I sent my resume to two of the Big 8 accounting firms. So I forged ahead, but it was not without short-term A | When I was a student at UTEP and I saw what I saw I received offers from both firms and chose Ernst & sacrifices including, at times, missing my son’s activ- across the border, I thought to myself: when I finally Whinney—Ernst & Young or EY today—where I worked ities, and always being the first parent to drop off my have the time to be able to do more for society, I’m for about four-and-a-half years. son at school and the last parent to pick him up after definitely going to do it. Once Jeff went to college and school. There was a lot of emotional guilt. This guilt I had a little bit more flexibility at the office and started Q | Was it challenging to raise your son, Jeff, was worse than the Catholic guilt I felt for missing meeting new people, I just made the time for it. You in the midst of a demanding career? church on Sundays. just have to decide it is time, and you just do it. It’s like A | Jeff was born when I was at Ernst & Whinney. I brushing your teeth or working out. took a few months off and when I went back to work it Q | In 2015 you were named one of the most (continued) became very challenging for me to meet the demands of influential women in Houston by Houston Woman my clients, the firm and my family. I remember spend- Magazine. In 2016 you won one of the Houston ing my lunch and dinner hours driving home to breast Business Journal’s Women Who Mean Business feed my baby, grabbing a quick bite and then rushing Awards. This year, you were one of eight Outstanding back to the office. Back then there were no lactation Women in Banking and Finance honorees by the rooms for mothers to pump milk. My insensitive boss Women’s Resource of Greater Houston. What helps would tell me, ‘There are 24 hours in a day, Denise.’ you excel, professionally and personally? After months of this very hectic schedule, my hus- A | For me, balance includes self-care, so that my body, band and I decided it was better for me to stay home mind and soul are being refreshed daily. I do this by with our son. I truly loved being home with my son, but making deliberate choices about which opportunities to after eight months I became somewhat bored with my pursue and which to decline; recognizing that at times routine. I could only play tennis so many times a week, home takes priority over work and vice versa but, at the go to the zoo and ride the train, etc. end of the day, it all balances out; and forming a strong One day, my husband received a call from a head- network of behind-the-scenes emotional supporters. hunter. My husband was not interested in changing jobs, but he said: ‘My wife is really bored at home and Q | You worked with Nabisco until they closed driving me crazy. Do you have any jobs for accoun- the Houston plant. Since then, you have been with tants?’ As luck would have it, he did. At Nabisco. the Texas Medical Center. Can you describe that The timing was perfect because Jeff was attending shift in your life? a Montessori school and loved it. I took the job at A | I have been fortunate to serve as CFO at the Texas Nabisco, where I found a better work-life balance Medical Center (TMC) since 2004. When I first arrived, which allowed me to spend more time with my family. TMC was in the middle of diversifying its assets. TMC purchased the Nabisco cookie factory, where I was the Q | You received an MBA from the University of controller for 12 years until the factory was sold to TMC. St. Thomas. Why was that such an important TMC’s CEO asked me to send him my resume. A few decision for you? days later he called me and said, ‘Kiddo, I’d like you to A | Having a young son and a full-time job made come work for me.’ I thanked him and asked him what getting my master’s degree very challenging. But I knew I would be doing if I accepted. I asked this question Castillo-Rhodes speaks at the 2017 Wrapped in Red Luncheon, that if I wanted to advance my career, I needed a better because I knew they already had a controller and a CFO. benefiting the American Red Cross. She co-chaired the event.

tmc» pulse | june 2017 11 I volunteer for several organizations, including encouraged me to take the classes with him. I agreed The Post Oak School, Medical Bridges, Greater and, keep in mind, I had never driven a standard vehicle Houston Women’s Chamber of Commerce, the in my life, so I really didn’t know how to mechanically University of St. Thomas, St. Thomas High School operate a standard shifting vehicle. and the American Red Cross. The course was classroom training and training with an actual motorcycle. I was good in the classroom Q | Can you share a volunteer experience that was and horrible on the riding, but I am one of those peo- particularly rewarding? ple… I just don’t give up. The instructor finally asked A | I traveled to Ghana with a group of women me ‘Do you really want to do this?’ and I said ‘No, but executives, where we equipped a small clinic in a I’m going to finish this course, dang-it!’ remote village with medical supplies. On another trip I managed to get through each of the obstacles to Guatemala with a Methodist church in Denton, we they had given us, passed the written test with flying helped build a medical clinic in a small village that— colors and on the riding portion of the test, I was the before our visit—had no dedicated medical facility at all. last one and I actually scored better than Bob, who was Castillo-Rhodes volunteering in Ghana. the best rider in the class, which was amazing because Q | What are your favorite things to do outside I was the worst rider in the class. of work? that let us experience cultures that differ quite a bit I didn’t want to be out there, but I also didn’t want A | I work out just about every day, twice a week with from our everyday lives in Houston. Last year we went to give up because I wanted to see this through. I now a trainer and cardio and Pilates other days. It is a great to the Balkans, visiting Northern Greece, Albania, and have my motorcycle license, but I have never ever stress burner that allows me to decompress after a busy Macedonia. This year we will be exploring the Baltics— driven a motorcycle since that day. day at work. But my favorite thing to do is spend time Estonia, Latvia, and Lithuania—and because we’ll be in with my husband, Bob Sergesketter, my recently- the neighborhood, we’ll spend a couple of days in the Denise Castillo-Rhodes was interviewed by Pulse married son, Jeff, and his lovely bride, Elyse, and our small Russian seaport of Kaliningrad and then we’ll reporter Britni N. Riley. This interview was edited goofy 115-pound Newfoundland, Wilson. wrap up the trip in Minsk, Belarus. for clarity and length. After a long week, Bob and I love watching sappy rom-coms at home. He’ll kill me for sharing this with Q | What is something people would be surprised to everyone. My favorite movie is Sabrina with Audrey learn about you? Hepburn. But we also love to travel, so we take one A | I always like to finish what I start. Bob decided he long vacation overseas every year. We really enjoy wanted to buy a motorcycle and, before he bought it, he visiting places that are a bit off the beaten path and decided he wanted to take some riding lessons and he

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12 tmc pulse | june 2017 Menninger» ad on treatment-resistent depression for TMC Pulse 4-2017.indd 1 4/6/2017 11:50:39 AM For Mothers and Babies, Safety First A first-of-its-kind research center devoted to perinatal safety launches at the medical center

By Shanley Chien

hildren’s Memorial Hermann Our ultimate goal CHospital and McGovern Medical School at The University of Texas is to really improve the Health Science Center at Houston culture of patient safety. recently partnered with the March of Dimes to establish the first research We think we are a safe center in the country dedicated to organization. We think improving maternal and infant safety we do everything safely. and preventing unnecessary illness and death. But can we measure it so The March of Dimes Perinatal we identify the hot spots Safety Center is designed to identify and how to make

sources of patient harm and develop it better? techniques and training tools to minimize human error and close the — KUOJEN TSAO, M.D. gaps in health care through pregnancy, Principal investigator for the labor, delivery, postnatal care and March of Dimes Perinatal Center the transition home. The institutions will use the information gathered to develop a blueprint for best practices that other hospitals around the country barriers within the health care system can implement. that can create medical errors along The research initiative is funded by the way. a three-year, $2 million grant from the “We know that once you hit the hos- Gordon and Betty Moore Foundation pital, you are taken care of … by people, and the Joe Kiani/Masimo Corporation and people make mistakes,” Tsao said. to the March of Dimes. It will not “We usually have systems for obstetri- occupy a designated space; rather, cians or systems for the NICU, but it’s everyone involved will collaborate from really about creating one entire system their existing offices and facilities. for two patients from the beginning.” “We certainly know that a lot of The journey through the hospital hospitals, like Children’s Memorial system can be even more complicated Hermann and many other hospitals, do Premature babies, including Addison Clark, above, born 1 lb. 4 oz. at 23 weeks, will benefit from for premature babies who require extra a fantastic job of taking care of patients the new March of Dimes Perinatal Safety Center. care. On average, a premature baby and babies when they’re here, support- will stay in the NICU for four months, ing the families that are here,” March School and co-director of The Fetal specialties—including high-risk preg- according to Amir Khan, M.D., med- of Dimes president Stacey D. Stewart Center at Children’s Memorial nancy, NICU and neonatal care and ical director of Children’s Memorial said. “But like a lot of other industries, Hermann Hospital. pediatric trauma—and has one of only Hermann Hospital NICU and admin- everyone’s always interested in how you “Our ultimate goal is to really four Level IV NICUs in the state to care istrative director of neonatology at can do better, how you can improve the improve the culture of patient safety,” for the most critically ill babies. McGovern Medical School. outcomes and how you can make sure Tsao said. “We think we are a safe orga- Throughout a mother’s pregnancy, “You have to do everything right that every baby is as safe as possible. nization. We think we do everything labor and delivery, she typically tran- every day for 120 days, which basically There’s no room for error.” safely. But can we measure it so we sitions from outpatient care with her means you have to make sure that the … While it’s important for hospitals identify the hot spots and how to primary OBGYN doctors to inpatient 20 to 30 nurses, about five to six doctors to be highly reliable, “it’s easier make it better?” care with a team of delivery specialists and a whole bunch of other people are said than done,” said the center’s Children’s Memorial Hermann at the hospital. Once the baby is born, trained enough to take care of that spe- principal investigator, KuoJen delivers more than 5,200 babies and mother and child are handed off to cific baby for that period of time,” Khan Tsao, M.D., the Children’s Fund, Inc. performs close to 5,800 pediatric sur- another team of neonatal specialists. said. “Sustaining it is the hardest part. Distinguished Professor in Pediatric geries every year. The hospital offers The various teams of specialists work- One mistake can result in a very, very Surgery at McGovern Medical more than 40 maternal and pediatric ing in silos can lead to blind spots and bad outcome.” (continued)

tmc» pulse | june 2017 13 The March of Dimes Perinatal NICU had a higher rate of hospital Safety Center will focus on four readmission and death during main goals: their first year of life. The March • Increasing the use of antenatal of Dimes Perinatal Safety Center corticosteroids (ACS) for plans to develop an app that women at risk of preterm birth will help parents take care of to help fetal lung development: their babies after they leave Administering a single course of the hospital. corticosteroids to women who were • Reducing the number of med- at risk of premature birth has been ically unnecessary deliveries shown to reduce the baby’s risk of before 39 weeks of gestation: death by approximately 30 percent. According to the March of Dimes, Children’s Memorial Hermann will early elective deliveries after continue to administer the cortico- 37 weeks and before the full steroids to at-risk women between 39 weeks of gestation can put the 24 and 34 weeks of gestation. baby at risk for NICU admissions, • Increasing maternal immuniza- transient tachypnea (a breathing tions for flu and whooping cough disorder), respiratory distress, ven- to protect newborns: Vaccines Stacey D. Stewart, president of the March of Dimes, speaks at a press event at Children’s tilator support, sepsis and difficul- for flu and whooping cough are Memorial Hermann Hospital to announce the March of Dimes Perinatal Safety Center. ties feeding. safe for women during pregnancy. By the end of the three years, Tsao Because pregnancy can change a 20 babies die each year from can protect the baby before and hopes the center will be able to develop woman’s immune system, contract- whooping cough and approxi- after birth. a perinatal safety toolkit with recom- ing the flu can cause women to mately half of babies under the age • Improving the transition from mendations and best practices. Other become seriously ill and puts their of 1 will need to be treated in the hospital to home for mother and hospitals could then use this as a tem- babies at risk for developmental hospital for the disease. Getting baby: According to the American plate for their own needs. problems and premature birth. The vaccinated for whooping cough Academy of Pediatrics, babies Centers for Disease Control and and flu during pregnancy allows who were born preterm with low Prevention reported that up to the body to create antibodies that birth weight and treated in the

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14 tmc» pulse | june 2017 From Crisis to Prevention Thomas Street Health Center has been leading HIV/AIDS care for decades

By Britni N. Riley

n between seeing patients at Thomas Street Health perhaps instead of always having this emergency and ICenter—a freestanding HIV/AIDS clinic—Charlene a fire drill, it would be better to just be on something Flash, M.D., takes a phone call from Ben Taub Hospital. once a day,” Flash said. A homeless patient concerned about contract- There are currently 1.2 million Americans living ing HIV through risky sexual behavior asked Harris with HIV/AIDS, as well as another 1.2 million men Health System for medicine to prevent him from and women with a substantial risk of contracting getting the virus. Until recently, this wouldn’t have the disease based on their lifestyles. To address this, been a possibility. Harris Health System has increased their testing “The clinic used to be a place where we served HIV efforts substantially. infectious people only,” said Flash, assistant medical “When I started at Harris Health, we established director of HIV prevention services for Harris Health a new testing program for HIV/AIDS called Routine System and assistant professor of medicine in the Universal Screening for HIV, or RUSH,” said Ken division of infectious disease at Baylor College of Malone, HIV project analyst at Harris Health System. Medicine. “Our care focus has shifted and there are “I get mad sometimes at the fact that he had the “We make it a routine practice throughout Harris drugs available now that help us prevent patients from audacity not only to take his own life in his hands, but Health to test patients for HIV/AIDS unless the patient contracting the disease.” mine, also,” Harris said. “Because of PrEP, I feel like I opts out. We have now done over 600,000 tests.” A drug called PrEP (Pre-exposure Prophylaxis) have taken the control back.” is prescribed to patients who possess a high risk of For patients who are not on PrEP, like the homeless This mysterious disease contracting HIV/AIDS. PrEP contains two HIV medi- man who reached out to Flash for help, there is also For more than 30 years, Harris Health has offered a cations, tenofovir and emtricitabine, bundled into one hope. Nonoccupational Postexposure Prophylaxis, safe haven for patients suffering from HIV/AIDS. pill trademarked as Truvada that must be taken once a or nPEP, is a two-pill regimen of anti-HIV drugs that In 1989, Harris Health took their care to the next level, day to be effective. must be taken once a day for 28 days and must be opening Thomas Street Clinic—now known as Thomas PrEP saved Regina Harris’ marriage and her life. taken within 72 hours of engaging in risky behavior. Street Health Center. The staff is proud to say that “For me, May 16 is a day that is drilled in the back “If you are in a network of people where HIV is they work for the first free-standing AIDS clinic in of my mind,” Harris said. “It’s the day my husband common and you think that you are at high risk, then the United States. (continued) of 20 years was diagnosed with HIV through sexual contact with another person.” Harris has been on PrEP since September 2016. Because she takes her pill every morning at 8 a.m. and visits the health center once every three months, she has not contracted HIV from her husband. “As a provider, it is very empowering to have this tool to offer my patients,” Flash said. “If you have been married for 20 years and you don’t want to desert your husband when he is sick, PrEP is something that allows you to maintain the emotional security of the relationship without this ongoing fear.” Because of their children and the life she and her husband have built together over the past two decades, Harris is committed to staying in her marriage.

For me, May 16 is a day that is drilled in the back of my mind. It’s the day my husband of 20 years was diagnosed with HIV through sexual contact with

another person. — REGINA HARRIS Patient at Thomas Street Health Center

tmc» pulse | june 2017 15 “The first cases of HIV/AIDS in Houston were In an innovative and unconventional move, Harris identified in the early ’80s,” said Thomas Giordano, Health acquired a building from the city of Houston M.D., medical director of Thomas Street Health to house the clinic. Built in 1910 as Sunset Hospital— Center. “The first patients were being seen by clini- a Southern Pacific Railroad Hospital—Thomas Street cians at Harris Health in the tuberculosis clinic and Clinic did not look particularly innovative. chest clinic because there was this recognition in the “We were in the basement in a very primitive area beginning that people with AIDS had higher rates of and it was almost kind of dangerous,” said Wayne TB. They were scattered with all of these other depart- Shandera, M.D., an infectious disease specialist at ments and there was this recognition that we needed Thomas Street Health Center/Ben Taub Hospital and some sort of centralized clinic to treat patients with assistant professor of internal medicine and infectious HIV/AIDS.” disease at Baylor College of Medicine. “We were worried about our blind patients falling down the elevator shaft.” Before working at the clinic, Shandera served on the front lines of the HIV/AIDS epidemic in Los … We went from treating the disease with Angeles. On a summer morning in 1981, while he was one drug, to two, and then when the three-drug serving as the epidemic intelligence services officer cocktail came out in the mid ’90s, that changed for the Centers for Disease Control and Prevention (CDC), five mysterious cases of pneumonia appeared everything. The disease became so much more on his desk. manageable and it became unusual to have an “I saw this disease since its inception,” Shandera

AIDS-related death. said. “There were three gay men who all had an unusual pneumonia at UCLA and a fourth at Cedars- — WAYNE SHANDERA, M.D. Sinai and that very day there was another case on my desk from Santa Monica—St. John’s Hospital. We described this unusual pneumonia that had only been seen in starvation victims in eastern Europe or kids with leukemia. And these were healthy young men who were getting it and we didn’t exactly under- stand why.” Before fax machines and email, getting the word out quickly about an outbreak meant publishing it in the CDC’s Morbidity and Mortality Weekly Report, which gathers data on infectious and chronic dis- eases from state health departments. On June 5, 1981, Shandera and his colleagues published the first report on this puzzling disease, referring to it as pneumocystis pneumonia. More cases started popping up around the country. Men in New York were covered in purple splotches and red lesions. Haitians in south Florida showed symptoms of Hepatitis B. Heroin addicts with unex- plained swelling of the lymph nodes were heading to hospitals in droves. “No one could pin it down and it was hard to identify,” Shandera said. “At the time, I knew it was an outbreak, but I had no idea it was going to be one of the pandemics of the century.” A Texas native, Shandera returned to his roots and began his work with Harris Health. “In those days, we weren’t curing patients,” he said. “We would have one or two patients die each week.” But by the early 1990s, the conditions at Thomas Street and treatment for the devastating virus had improved. After a mathematician determined how rapidly the virus was multiplying in the bloodstream, doctors realized it needed to be attacked with force. “We went from treating the disease with one drug, to two, and then when the three-drug cocktail came out in the mid ’90s, that changed everything,” Shandera said. “The disease became so much more manageable Top: Charlene Flash, M.D., assistant medical director of HIV services for Harris Health System and assistant professor at and it became unusual to have an AIDS-related death.” Baylor College of Medicine. Below: Wayne Shandera, M.D., infectious disease specialist at Thomas Street Health Center/Ben Taub Hospital and assistant professor of internal medicine and infectious disease at Baylor College of Medicine.

16 tmc» pulse | june 2017 … HIV/AIDS has gone from being a death sentence to a chronic manageable disease. We can give our patients legitimate hope to live for decades after their diagnosis. Some of the patients I had when I first started here 20 years ago are still here and we have watched each other

grow old. — THOMAS GIORDANO, M.D. Medical director of Thomas Street Health Center

Because of the three-drug cocktail, the virus “Even though we do really powerful work in taking became something more than manageable. It became care of people with HIV/AIDS through testing, there undetectable. are some people who despite the counseling that “People who are first infected have over a mil- is given, you just feel as though eventually they are lion copies of virus in each milliliter of blood,” Flash going to get infected,” Flash said. “Before, you felt like explained. “Once they get on medication, that number there was nothing you could do. You were just waiting offer all of the specialty care that a patient will need,” comes down. The lowest amount that our machines for them to get infected so you could take care of them Malone said. “Our doctors are excellent and we have can measure is less than 20 copies and once it gets and put them on medication, but now there is some- both medical schools, UT Health and Baylor, which to 20 copies, we call that undetectable. With older thing you can do.” is unique; we are lucky to have both of them here for medicine it would take about six months to get there, Today, the center offers a complete health care our patients.” three months with newer medicine. That doesn’t mean home to 6,000 Houstonians currently living with HIV/ The center also spearheads research initiatives to that the person is cured, but it does mean that in their AIDS. Those services include primary care, oncology, provide the most effective and efficient care. plasma there is no circulating virus.” endocrinology, pain management, dermatology, rheu- “HIV/AIDS has gone from being a death sentence matology, women’s health, adolescent health, ENT, to a chronic manageable disease,” Giordano said. Watching each other grow old neurology, treatment and management of hepatitis C, “We can give our patients legitimate hope to live for Although Thomas Street Health Center has shifted its pharmaceutical services, physical therapy, psychiatry decades after their diagnosis. Some of the patients I focus to preventative care to reduce the rates of new and counseling services. had when I first started here 20 years ago are still here HIV/AIDS cases, the threat of infection remains. “We have 20 clinics within Thomas Street that and we have watched each other grow old.”

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tmc» pulse | june 2017 17 BRACING FOR MEASLES Is Texas poised for an outbreak?

By Shea Connelly Credit: Gopal Murti — Medicalimages.com Credit:

An electron micrograph of the measles virus.

18 tmc» pulse | june 2017 he spots started on the back of his neck. Ariel Loop’s 4-month-old son, Mobius, was battling his first illness. THis fever was 102 when Loop noticed the telltale rash— flat red spots that started on his head and gradually spread throughout his body. “I thought I was crazy. There’s no way,” Loop said, laugh- ing incredulously. Even two years later, the experience is sur- real. Loop, a nurse, knew some of the signs of the measles, but they didn’t spend much time studying it in nursing school, she said. Who expects to see cases of an eliminated disease, let alone in their own child? The Loops had taken their son to Disneyland a couple of weeks earlier, in mid-January 2015. Living in Pasadena, Is Texas poised for an outbreak? California, Disneyland was a regular destination. Ariel and Christopher Loop were married there. It’s where they announced they were expecting Mobius, and it was only a matter of time until they visited the park as a family. The Loop family at Disneyland. By Shea Connelly As the spots spread and the fever wouldn’t break, real- ity sank in: Mobius had caught the measles at Disneyland. declared eliminated in the United States in 2000. In the years Knowing how contagious the disease is, the couple called since, however, misinformation about the safety of vaccines ahead to warn the emergency department of their local hospi- has caused immunization rates to reach dangerous lows in tal. They were ushered through a back door and whisked into a number of places throughout the country, including some a negative pressure room where their infant was treated by areas in Texas. A recent outbreak among unvaccinated doctors and nurses in protective gear—medical experts who people in Minnesota has public health experts wondering— had never seen measles in person. could Texas be next? The hospital did bloodwork, warned them of complica- “We’ve got about 50,000 kids whose parents have opted tions and sent them home under quarantine. Four days later, them out of getting vaccinated for non-medical reasons, and the test came back positive for measles. this has accelerated precipitously,” said Peter Hotez, M.D., Ph.D., dean of the National School of Tropical Medicine One of the most contagious diseases at Baylor College of Medicine and president of the Sabin Distill the threat of measles down to its quantitative essence Vaccine Institute and Texas Children’s Hospital Center for and you’re left with a number between 12 and 18. That’s its Vaccine Development. R0, or basic reproduction number. On average, one person Non-medical reasons to forgo vaccinations—known as with the measles will infect 12 to 18 others. Each one of those conscientious exemptions—are often based on religious or people infects a dozen or more, and each one of them infects philosophical beliefs. another dozen. That’s how an epidemic begins. One cough or The key to preventing measles from spreading is “more sneeze sends the measles virus airborne. There, it can linger, than 95 percent immunity through a two-dose vaccina- able to infect for up to two hours. The R0 of influenza? Two tion regimen,” the World Health Organization says. In the to three. The R0 of SARS, the respiratory illness that in 2003 2015-16 school year, 97.6 percent of Texas kindergarteners infected more than 8,000 people worldwide? Two to five. had received both doses of the measles, mumps and rubella Measles is one of the most contagious of all infectious vaccine (MMR), according to the Texas Department of State diseases, but the development of a vaccine in the 1960s led Health Services. While this is above the recommended rate, to dramatically decreased rates of infection. It was officially the number of exemptions still poses a threat, because unvac- cinated children are not spread evenly throughout the state. “They tend to be concentrated more in the Travis County, We’ve got about 50,000 kids whose parents Austin area and around Denton, Texas,” Hotez said. “I think have opted them out of getting vaccinated for that’s where we’re going to start seeing measles outbreaks.” When more people are immune to a disease through

non-medical reasons, and this has accelerated vaccination, it’s more difficult for the disease to spread. High precipitously. vaccination rates protect those who can’t be vaccinated for — PETER HOTEZ, M.D. health reasons, a concept called herd immunity. Low vaccina- Dean of the National School of Tropical Medicine at tion rates threaten herd immunity and put vulnerable com- Baylor College of Medicine and president of the Sabin Vaccine Institute munities—children too young to be vaccinated, individuals and Texas Children’s Hospital Center for Vaccine Development with compromised immune systems, people who are severely allergic to certain vaccines—at risk. (continued) Credit: Gopal Murti — Medicalimages.com Credit:

tmc» pulse | june 2017 19 “It’s a global world, and higher immunization rates * are safeguards to keep us from being susceptible to these CONSCIENTIOUS VACCINE EXEMPTIONS diseases,” said Brian Reed, M.D., director of disease control IN TEXAS, BY COUNTY and clinical prevention at Harris County Public Health and Environmental Services. “Parents may be thinking they’re doing the right thing for their child, but they’re inadvertently harming the community.” The consequences of reducing herd immunity can currently be seen in action in Minnesota, where a measles Lubbock outbreak has been spreading since April. Dallas El Paso Minnesota-Austin connection T E X A S Like all epidemics, the Minnesota measles outbreak started Austin out small. In early April, Hennepin County reported three Houston cases of the disease. Two months later, that number has grown San Antonio to about 70—the worst outbreak the state has seen in 30 years. Conscientious Like Texas, Minnesota’s vaccination rates are over 90 percent. Exemption Rate The current outbreak can be traced to a Somali immigrant 0.0% 4.8% community in Minneapolis, where the vaccination rate in 2014 was reported to be 42 percent—a significant decrease Source: Texas Department of State Health Services, 2015-16 Annual Report of since 2008, when the same community had some of the Immunization Status. Includes data reported by independent school districts and highest vaccination rates for two-year-olds in the state. accredited private schools. * Includes DTaP, Hepatitis A and B, MMR II, Polio, Varicella 2 This swift decline is a result of targeting by anti-vaccine advocates. Most notable: Andrew Wakefield, the British doc- damage had been done. Despite numerous studies debunk- tor who rocked the medical community with his 1998 paper, ing the link between autism and vaccines, the myth persists. published in The Lancet, claiming a link between autism and Wakefield continues to campaign against vaccines and the MMR vaccine. parents continue to listen. In 2008, he visited the Somali- In 2010, the U.K. barred Wakefield from practicing med- American community in Minneapolis and vaccination rates icine and The Lancet formally retracted his paper, but the have been decreasing ever since.

MEASLES MERCK begins distribut- ing an improved vaccine, VACCINE: JOHN ENDERS, PH.D., the only measles vaccine and colleagues license the used in the U.S. since it A HISTORY first measles vaccine in was licensed. the United States.

1954 1958 1963 1968

THOMAS PEEBLES, M.D., isolates measles virus in the lab of John Enders, Ph.D., at Boston Children’s Hospital, using the blood SAM KATZ, M.D., working in of an infected 13-year-old boy. That isolated conjunction with Peebles at Boston virus was used to create a series of vaccines. Children’s Hospital, tests the first Just three years earlier, measles erupted measles vaccine on 11 children. in southern Greenland for the first time. Only five people out of 4,262 did not contract the disease.

20 tmc» pulse | june 2017 When questioned by The Washington Post regarding the recent outbreak, Wakefield said he was simply providing information about vaccines and autism. About 50,000 were hospitalized per year “The Somalis had decided themselves they were partic- before the vaccine. It was unbelievably danger- ularly concerned. I was responding to that,” he said. “I don’t ous to our population, and if we were hospitaliz-

feel responsible at all.” ing 50,000 kids a year for a different disease So, what does an outbreak in Minnesota have to do with Texas? Although Wakefield travels the country promoting it would be a national disaster. his anti-vaccine agenda, he lives in Austin. He speaks at anti-vaccine rallies on the steps of the state capitol building, — RICHARD LYN-COOK, M.D. and he holds screenings of his film, Vaxxed: From Cover-Up Medical director of Harris Health School-Based Clinics and to Catastrophe, throughout the state. Meanwhile, non-medi- assistant professor at Baylor College of Medicine cal vaccine exemptions have increased since 2003, when the state enacted some of the loosest vaccine exemption laws Lyn-Cook has a different take. in the country. At least one private school in Austin has an “About 50,000 were hospitalized per year before the exemption rate of more than 40 percent. vaccine,” he said. “It was unbelievably dangerous to our pop- “In 2003, we had less than 5,000. In 2016 we had 45,000 to ulation, and if we were hospitalizing 50,000 kids a year for a 50,000 exemptions,” said Richard Lyn-Cook, M.D., medical different disease it would be a national disaster.” director of Harris Health School-Based Clinics and assistant Internationally, 2017 has been a bad year for measles. In professor at Baylor College of Medicine. “It just takes one Europe, the largest outbreaks have occurred in Romania and person to come in contact with a traveler who was not vac- Italy. According to the European Centre for Disease Prevention cinated and can spread it to a child less than one, the most and Control, most immunization rates in affected areas have vulnerable population.” fallen below the 95 percent threshold, due to skepticism about A common refrain among vaccine critics is that the the vaccine and adults being ill-informed about how suscep- measles is not dangerous. Robert “Dr. Bob” Sears, M.D., a tible they are to the disease. Some locations have extenuating California pediatrician and high-profile proponent of “alter- circumstances. In Guinea, where a full-scale epidemic is raging, native” vaccine schedules, wrote in a Facebook post: “Ask any vaccinations dropped during the 2014-2015 Ebola epidemic, grandma or grandpa (well, older ones anyway), and they’ll according to Doctors Without Borders. Vaccination activities say, ‘Measles? So what? We all had it. It’s like chicken pox.’” were suspended due to the risk of infection. (continued)

In the decade after the Andrew Wakefield publishes his Merck licenses a measles, MMR vaccine is licensed, paper in The Lancet CLAIMING A mumps, rubella (MMR) MEASLES CASES DROP CONNECTION BETWEEN THE COMBINATION VACCINE. DRAMATICALLY. MMR VACCINE AND AUTISM. Rubella is also known as The paper was later retracted and German measles, though it’s Wakefield was banned from practic- ENDEMIC MEASLES not as infectious or, generally, ing medicine in the U.K. DECLARED ELIMINATED as serious as the measles. IN THE U.S.

1971 1981 1989 1998 2000

LOW VACCINATION RATES lead to a resurgence of measles cases.

Credit: Egg photo: World Health Organization, John Enders portrait: Harvard University, Measles must go van: CDC, Measles virus particle: CDC/Cynthia S. Goldsmith; William Bellini, Ph.D., College of Physicians of Philadelphia, timeline and photos

tmc» pulse | june 2017 21 normally. But Loop still worries about SSPE. “I have to worry about that for such a long time,” Loop said. “I know it’s a pretty rare complication, but it’s hard not to think about that sometimes, that he could drop dead out of nowhere in the next 10 years.” After Mobius recovered, Loop had a new mission: lobby- ing California state lawmakers to require all schoolchildren to be vaccinated barring any medical issues. She testified before California legislators, and Senate Bill 277 was signed into law June 30, 2015. Within two years, the measles vaccination rate among the state’s kindergarteners had risen from a danger- ously low 92.6 percent in 2014 to 97.3 percent in 2016. “It’s the silver lining,” Loop said. “Ultimately, the goal is to prevent other children from having to go through this. I’m glad that something positive has been able to come from it.”

Texas lawmakers debate vaccines Watching the vaccination rates rise in California has medi- cal professionals in Texas thinking state lawmakers should follow suit. “We need to close all non-medical exemptions,” Hotez said. “The California legislature woke up and said, ‘Enough is enough.’ The Texas legislature needs to do the same.” Vaccines have been a hot topic in the state capitol in 2017. A 1-year-old boy receives the measles vaccine at the Aldine House Bill 1124 proposed granting parents the ease of filing Community WIC. for an exemption online. It was an alarming step in the wrong direction for health experts. Symptoms “Well-meaning people are introducing measures for more The most common symptoms of measles are a high fever, freedom for exemptions,” Lyn-Cook said. “That may work for cough and runny nose. Three to five days later, a rash breaks some things but it doesn’t work for vaccination. That’s like out, starting on the face and head and spreading downward. saying it’s optional for you to wear a seatbelt.” Fever can spike to over 104 degrees. Lindy McGee, M.D., a Texas Children’s Hospital Children under five and adults over 20 are most likely physician and assistant professor at Baylor College of to experience complications from measles. One in every 10 Medicine, is co-chair of the physician advisory board of The children will develop an ear infection, which can result in per- Immunization Partnership. As part of the organization’s goal manent hearing loss. One in every 20 children will develop “to eradicate vaccine-preventable diseases by … advocating pneumonia, the most common cause of death from measles. for evidence-based public policy,” McGee testified against One in 1,000 will experience encephalitis, brain swelling that HB 1124 in front of the House Committee on Public Health. can leave a child with lifelong disabilities. “Plenty of data from other states show that anything The most serious complication is subacute sclerosing you do to allow exemptions to be easier increases the rate panencephalitis (SSPE), a progressive, deadly brain disorder. of unvaccinated children,” McGee said. “We are extremely SSPE takes seven to 10 years to develop after contracting concerned about any legislation that would make it easier to measles. Throughout those years, the person may seem fully get an exemption.” recovered, until symptoms like forgetfulness, unusually poor During the meeting, she was grilled by committee mem- school performance and sudden personality changes appear. ber Rep. Bill Zedler, who claimed more people have died It is most common in children who contracted measles under the age of 2. While SSPE is rare, recent studies have shown it is not as rare as once thought. Original estimates had it affecting 1 in It’s a global world, and higher immuniza- 100,000. A study of cases stemming from a major measles tion rates are safeguards to keep us from being outbreak in California in the late 1980s indicates 1 in 1,400 children under five and 1 in 600 infants under age 1 later susceptible to these diseases. Parents may be developed SSPE. thinking they’re doing the right thing for their

“Measles is a killer infection, and the ones that are the child, but they’re inadvertently harming most vulnerable are infants below the age of 1 who are not eligible to receive the vaccine,” Hotez said. “Those are the the community. — BRIAN REED, M.D. ones who are going to get sick, and those are the ones who Director of disease control and clinical prevention at Harris County could die.” Public Health and Environmental Services Ariel Loop’s son, Mobius, recovered from his bout with measles. Today, he is a happy toddler who is developing

22 tmc» pulse | june 2017 from the measles vaccination than from the measles. Zedler reached this conclusion by comparing data about vaccine injuries from the Vaccine Adverse Event Reporting System (VAERS) to CDC data about measles deaths. The problem? Anyone can report an “adverse event” to the VAERS database, which is run by the CDC and the Food and Drug Administration. On the VAERS website, the CDC notes: “studies help determine if a vaccine really caused an adverse event. Just because an adverse event happened after a person received a vaccine does not mean the vaccine caused the adverse event.” In other words, correlation does

not equal causation. photo Courtesy Credit: “I could break my arm the next day and I can report that to Peter Hotez, M.D., Ph.D. that reporting system,” McGee explained to Zedler. “It’s not necessarily due to the vaccine.” “We want parents to know how their school is doing in Zedler responded, “For you to get up and tell this commit- terms of vaccine coverage so they can make an informed tee in essence they can put anything down there they want is choice,” Hotez said. “If they see vaccine coverage is very low quite dishonest.” at their school, they can decide, ‘This school isn’t safe for McGee said she sent documentation the next day that my child.’” supported everything she said in her testimony. McGee noted that in addition to helping parents make “It’s frustrating to go to the legislature to argue facts,” informed school choices, House Bill 2249 “would help us as she said. “I am always happy to answer a parent’s legitimate vaccine educators to know which schools to target and figure concerns about vaccines. My frustration is with people on the out what’s going on if the rates are low.” public health committee who are supposed to be protecting But the bill died in the House on May 11. public health.” The Immunization Partnership also lobbied for House Protecting Harris County Bill 2249, known as the “parents’ right to know” bill. This bill Lack of legislative action regarding vaccines is challenging would have required the state to report vaccination exemp- for the medical and public health experts who know all too tion data at the individual school level rather than the school well what will happen if the anti-vaccine movement gains district level. more traction. (continued)

GERMANY No. of Cases: 272 BELGIUM No. of Cases: 288 ROMANIA No. of Cases: 4,793 ITALY No. of Cases: 1,739

SYRIA No. of Cases: 350

SOMALIA No. of Cases: 5,700 GUINEA No. of Cases: 3,468

MEASLES CASES IN 2017

≤ 10 ≤ 50 ≤ 100 ≤ 500 ≤ 2,500 ≤ 5,000 > 5,000

Source: Council on Foreign Relations

tmc» pulse | june 2017 23 “We need our elected leaders to talk about the importance has active measles and those at higher risk,” Reed said. The of vaccinating and why there’s no link between vaccines and high-risk group includes pregnant women, immunocompro- autism,” Hotez said. “We don’t really hear from the Office of mised individuals and young children. the Surgeon General. We don’t hear from the White House.” A measles vaccine may still prevent the disease after an While vaccine-related bills stall in the state legislature, unvaccinated person has been exposed to it, if the vaccine is medical and public health professionals in Houston do what given within 72 hours, Reed explained. Immune globulin, a they can to protect the community. Organizations like Harris blood product containing antibodies that the county would Health System, Texas Children’s Hospital and Harris County also offer to vulnerable citizens, can lessen the severity of the Public Health and Environmental Services (HCPHES) main- disease if given within six days of exposure. tain mobile health clinics to provide vaccinations at schools, In terms of advocacy and awareness, groups like community and WIC centers, and other locations throughout The Immunization Partnership campaign for legislation the county. to promote vaccination and work to educate and HCPHES officials also discuss what actions they would encourage parents. take in the event of a measles outbreak in Harris County. “We offer webinars and toolkits on increasing immuni- “We would have additional resources to provide immuni- zation rates and also work with school nurses,” McGee said. zations to people who have had contact with someone who “A grassroots parents campaign is working to counteract anti-vaccine groups in the state and raise awareness.” While medical professionals do what they can to pro- vide vaccine access, education and resources, there are still We need our elected leaders to talk about parents they can’t reach. The ones convinced through their the importance of vaccinating and why internet research that vaccines are dangerous. The ones who there’s no link between vaccines and autism. trust Andrew Wakefield over licensed pediatricians. Like all We don’t really hear from the Office of the parents, they want what is best for their children. After seeing measles infect her child, Ariel Loop has some advice for them. Surgeon General. We don’t hear from the “Trust people who have spent their lives focusing on this,”

White House. she said. “As helpful as Google can be, it’s not the same thing — PETER HOTEZ, M.D., PH.D. as going to school for a decade. Find people who are experts, and trust science. It’s science—it’s not an opinion.”

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24 tmc» pulse | june 2017 My Favorite Patient Died Because She Had a Pre-Existing Condition

By Arthur Garson Jr., M.D., M.P.H.

y favorite patient was born with the same con- Mgenital heart condition as Jimmy Kimmel’s son and had exactly the outcome that Kimmel predicted. My first night as a pediatric cardiology trainee, I helped care for a 5-year-old who had just had surgery for her heart problem, Tetralogy of Fallot with pulmo- nary atresia. She had been a blue baby; because of her heart condition, blood had trouble flowing to her lungs to pick up oxygen for her body. Her heart stopped three times, and three times I went to tell her parents and grandparents that I did not think she would make it. But she did—and we all bonded. I went to her graduation ceremonies from gram- mar school and high school. She became a wonderful young adult with a phenomenal sense of humor. She was not able to do physical work, but was capable of desk jobs. Although she developed a dangerous irregular heartbeat, we were able to control it with medication. Her parents had few resources, yet she was covered by Medicaid. But six months to the day after her 19th birthday, her mother called barely able to speak: They had found her dead in bed. They did some checking and she had

not refilled a prescription for her medication—after Images Holmes/Getty Randy By Credit: her Medicaid ran out—six months previously. She had Jimmy Kimmel, right, host of Jimmy Kimmel Live on ABC, listens as Dr. Mehmet Oz explains the heart condition affecting a pre-existing condition that no one in her small town Kimmel’s infant son, Billy. Tetralogy of Fallot with pulmonary atresia is a condition that includes a malformed pulmonary valve would cover, and there were no large employers. This and a hole in the tissue between the lower chambers of the heart. experience devastated all of us and made me go back and get a degree in public health, with the goal of as they do one of the following: “reduce average people to the ranks of the uninsured, they expect the helping the uninsured. premiums for health insurance coverage in the State; Senate to fix everything. This is similar to the House This was the situation 27 years ago. increase enrollment in health insurance coverage; jumping out of a plane without a parachute and For the past seven years, however, the Affordable increase the choice of health plans in the State.” expecting the Senate to rescue it and guide the both Care Act (ACA)—also known as Obamacare—covered Imagine how easy it will be for the state to add just of them to safety. pre-existing conditions. Although the ACA surely one health plan and meet the criteria, thus allowing I surely hope the Senate has a strong para- has its failings and needs major surgery, many people pre-existing exclusions. The bill also requires that chute. My patient would have been alive under the with pre-existing conditions got access to health care. states that allow pre-existing exclusions have in place Affordable Care Act Prior to that, between 2007 and 2009, a Congressional ways to help people with pre-existing conditions, such and dead with the investigation of the four largest insurance companies as high-risk pools allowing people with high medical recent legislation. found that 651,000 people were denied coverage—one expenses to be paid for separately. of every seven who applied—because of pre-existing Texas has a high-risk pool, but only 2.6 percent of Arthur “Tim” Garson conditions. All perfectly legal. The pre-existing condi- eligible people actually participate. Why? The rates Jr., M.D., M.P.H., is tion exclusion was the only “stimulus” to have healthy are higher than current insurance rates, which people director of the Texas people buy insurance. And it worked. While this was a can’t afford to begin with, and the pre-existing condi- Medical Center’s horrendous provision, it was effective: healthy people tion exclusion requires the ill person wait a year Health Policy did buy insurance. before coverage. Institute. The American Health Care Act (AHCA) that No wonder people don’t sign up for high-risk pools. passed the House of Representatives in early May A number of U.S. members of Congress from both allows each state to apply to the federal government sides of the aisle have said after the passage of the to permit pre-existing condition exclusions, as long bill in the House, which is projected to add 23 million

tmc» pulse | june 2017 25 Headaches You Can Set Your Clock To Researchers are studying the circadian rhythms of cluster headaches

By Christine Hall

ost people have heard of vomiting and sensitivity to light. They The time of day and time of week matters. Some Mmigraines. But there is a lesser- can last from two to 72 hours. known type of headache—a cluster By contrast, cluster headaches, patients are so worried about when the next headache

headache—that is often referred to as which occur in clusters, or patterns, will occur that they actually trigger a headache. a “suicide headache” because the pain tend to follow certain rules, Burish says. is so intense that patients have taken Typically, an intense pain is felt on one — CORY KENNEDY their own lives to escape it. half of the face, and some features of Co-founder and CEO of SensorRx The pain from a cluster headache the headache can be outwardly appar- is worse than childbirth, patients say. ent. On the painful side of the face, the Worse than kidney stones. More like eye may be droopy, bloodshot, swollen Same time every year most people with cluster headaches get getting shot in the head or being jabbed and watery—to the point where the Cluster headaches have been around them the same time every year. in the eye by a sharp object. patient may go through an entire box for centuries, but only properly diag- “A lot of them can say something This is where Mark Burish comes of tissues. nosed over the past 20 years. In part, like, ‘On Jan. 1 at 11 a.m., I will get a in. A neurologist and Ph.D., Burish is “Patients also get agitated and that’s because very little research headache, and it will go on like that for director of the Will Erwin Headache restless and may rock back and forth,” has been done on them. Between about a month,’” he said. “They go away Research Center, part of the Memorial Burish said. “That is different from a 1997 and 2007, the National Institutes and come back the next January. You Hermann Mischer Neuroscience migraine, where the person wants to lie of Health funded just two cluster can set your watch to it.” Institute at the Texas Medical Center still in a dark room.” headache studies. Diagnosing cluster headaches is and The University of Texas Health One of the newer pieces of tricky because doctors often take into Science Center at Houston. Burish’s research relates to the account the time of year, the runny Burish and his team of neurologists, timing and circadian rhythm nose and the watery eye and assume nurses, scientists and industry start- of cluster headaches. a patient is suffering from a sinus ups hope to demystify and find new They tend to last three infection, Burish said. Doctors may also treatments for cluster headaches and hours or less, Burish prescribe steroids and antibiotics that migraines at the center, which gets its said, and might tend to alleviate cluster headaches for name from a man who suffered from happen many times short periods. cluster headaches and ended his life per day. In addition, Burish’s team intends to build a when he was unable to find relief. laboratory model of a cluster headache Some 47 percent of adults suffer to study its patterns. from some type of headache disorder. Treatments for cluster headaches Migraines can vary from person include oxygen, certain types of blood to person and tend to incorpo- pressure and seizure medications, and, rate pulsing pain, nausea, more recently, electrical stimulation of nerves in the head and neck, Burish

Mark Burish, M.D., Ph.D., said. In addition, there is a drug for a neurologist and migraine and cluster headaches in director of the clinical trials that blocks the activ- Will Erwin Headache ity of a molecule called calcitonin Research Center, gene-related peptide. demonstrates one In April, a new non-invasive of the tools he uses when examining device to treat headaches patients with called gammaCore was cluster headaches. approved by the U.S. Food and Drug Administration.

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tmc» pulse | june 2017 27 Solutions: TMC Innovations

Under Pressure Alleviant Medical’s transcatheter device treats heart failure

By Christine Hall

utting a hole in the heart to treat to the heart. At that point, an expand- Ccongestive heart failure may sound able blade will cut a hole in the wall counterintuitive, but a Texas Medical separating the left and right atria. The From left, Alex Arevalos, Ph.D., Avni Patel, M.E., and Jacob Kriegel, M.D., co-founders of Center (TMC) startup company hopes blade and tissue will be pulled back into Alleviant Medical, demonstrate their device, which cuts a hole in the wall separating the left and to do just that. the device, which will then be removed. right atria to alleviate a build-up of pressure in the heart. Alleviant Medical is developing This hole will help blood flow from the a transcatheter device to treat diastolic left chamber to the right chamber of “It’s a very morbid condition, so it A hole may drastically improve heart failure, which occurs when one the heart. rose to the top of the list as an import- quality of life for older patients, keeping or both of the ventricles do not fill up Over the past 20 years or so, medical ant unmet need,” Kriegel said. them independent and out of the hospi- properly with blood and are unable devices, treatments and drugs have Kriegel and his colleagues, Alex tal. “The hole we create will be the least to pump enough blood to the rest of helped people with heart disease, Arevalos, Ph.D., Albertien Greijdanus, of their problems, and we believe it will the body. but there are few options for people MSc, and Avni Patel, M.E., examined alleviate their symptoms,” Kriegel said. The device will enter the body near suffering from heart failure, said Jacob several hundred unmet needs as part Current treatments for heart failure the groin, travel through the body via Kriegel, M.D., co-founder and CEO of of TMC Biodesign, a one-year fellow- include a diuretic, or water pill, but the femoral vein, and then gain access Alleviant Medical. ship program that gathers people with that medication has side effects that diverse backgrounds to solve health include kidney failure. Other treatment care problems via medical devices or options include inserting a stent—an at the Teen digital products. expandable mesh tube, usually made of Innovation “As a cardiac surgery trainee, I had stainless steel—to create a passageway seen hundreds of heart failure patients, between the left and right atria that Boot Camp but for me, it took sitting down with allows blood to flow more freely. But all on Medicine engineers to see the problem through implantable devices come with the risk new eyes,” Kriegel said. “Our perspec- of blood clots—which can grow around and New tives merged with market opportunity.” the device—and stroke. Technology Kriegel and his colleagues under- Alleviant Medical’s device packs the stand that creating a hole in the heart severed tissue down inside the device comes with risk. But if the hole is pre- and removes it safely from the body. July 11-15 cisely sized, it can distribute the correct That’s important, because any particle (FOR TEENS 9-12TH GRADE) amount of pressure from the left atrial or foreign material left can flow into the to the right atrial without dramatically brain and cause a stroke, Kriegel said. The Health Museum’s Global Teen Medical Summit for 9-12th increasing the right-sided pressure— Though the company is less than graders, will provide unparalleled access and interaction a therapeutic benefit while minimizing a year old, it has gained traction in with medical thought leaders and the chance to discover risk. The hole will allow blood to flow the business plan competition circuit. how cutting edge technologies are revolutionizing today’s naturally from the left chamber to the Already, Alleviant Medical has won medicine. right chamber, lowering the pressure challenges at Rice University and the • GAIN real-world medical career experience on the left and slightly increasing the University of Massachusetts. The team • ENGAGE in real-life simulated surgical procedures pressure on the right, where it is already plans to continue at the Texas Medical • MEET leading minds from area Texas Medical low, Kriegel said. Center, joining the upcoming TMCx Center institutions With every heartbeat, it is medical device accelerator. • PARTICIPATE in the Innovate team challenge — expected that 30 percent of the blood “These competitions have been create a medical device with 3D printer in the left atrium will transfer into good learning experiences for us • ENJOY some heart-pumping fun the right atrium, and the remaining because we have received validation 70 percent will get pumped forward on our device,” Kriegel said. “We’ve along its natural pathway into the been able to see where our risks are, left ventricle and out to the body, he where we have proven the technology added. The blood that gets sent into and what people are concerned about. the right atrium will travel to the lungs Overall, we hear good things, and that and then continue along through the people are looking for a new solution to SPACE IS LIMITED. TO REGISTER AND FOR MORE INFORMATION: normal circulation. the problem.” www.thehealthmuseum.org/teensummit

28 tmc» pulse | june 2017

razilian photographer The most import- BAngélica Dass has been fasci- nated by color her entire life. ant things in my Born into a multiracial family, photos are exactly Dass sees herself and her relatives not in black and white, but in what you can see. shades of chocolate, cinnamon You can’t see the and vanilla. nationality, you can’t “I remember when I was see who is the poor younger there was this skin- colored crayon—flesh-colored— and the rich, the that, of course, was not mine,” refugees. You don’t

Dass said. “I have this brown skin know who has and curly hair and, of course, I am black. But I’m also proud to disabilities. be white, to be native Brazilian. Inside my home, things look — ANGÉLICA DASS equal. But outside, it seems that Photographer and creator this color brown has a lot of tags of Humanae and stereotypes, and I was treated in a different way because of the Although she has photo- The Intersection of ARTS and MEDICINE color of my skin.” graphed close to 4,000 faces, the Inspired by her longing to exhibit displays just 250, grouped By Britni N. Riley understand the social impli- together in a sort of oversized cations of race and color, Dass cubist jungle gym. began a photography project, “I wanted to make this space Humanae (work in progress), kind of like a playground,” Dass now on display at The Health said, “because I want to have this Museum. The exhibit is made up talk with children. To change the of portraits of individuals from mind of our youth to really make around the world, each labeled them feel connected with this idea with the number from Pantone’s that we are completely different, industrial color palette that corre- and we need to receive the same sponds to the subject’s skin tone. treatment—be equal and different “I really believe that, linguisti- at the same time.” cally, we are using this separation Dass’ popular 2016 TED Talk, of colors exactly to separate peo- “The Beauty of Human Skin in ple,” Dass said. “I want to cele- Every Color,” will run in The brate this colorful world, all of the Health Museum’s theater for the differences, and to embrace it.” duration of the exhibit. In the beginning, Dass took “Houston is one of the most photographs to explore the diver- diverse cities in the country and sity of color in her own family, but we are looking into what diversity that quickly grew to photograph- really means for Houston,” said ing men, women and children of Melanie Johnson, Ed.D., president all races and ethnicities from and CEO of The Health Museum. 17 countries. Humanae has gar- “There is only a .5 percent genetic nered international acclaim. difference in all of us, so it is “The most important things in important for us to speak about my photos are exactly what you diversity on the surface—cultural can see,” Dass said. “You can’t differences and cultural common- see the nationality, you can’t see alities. And that is exactly what who is the poor and the rich, the Humanae does.” refugees. You don’t know who has disabilities.” Humanae (work in progress) will be Using her Canon EOS 5D on display through Sept. 5 at The Mark II, Dass shoots against a Health Museum, 1515 Hermann Drive. white backdrop. She then takes a Information: 713-521-1515 or color sample from the subject’s thehealthmuseum.org. nose and finds Pantone’s corre- sponding color, which she uses as the background for the photo. Top: A visitor contemplates Humanae (work in progress) at The Health Museum. Bottom: Angélica Dass, upper right, poses with part of her exhibit.

tmc» pulse | june 2017 29 FIRST PROM

Prom Party Palooza at MD Anderson Cancer Center

By Maggie Galehouse

Clockwise from top left: Roberto Borjas is fitted for a tuxedo at MD Anderson; Roberto waits for the elevator to Prom Party Palooza; Mauricio Cordova takes a prom selfie; Madisson Somero, center, and Brittni Lafolette laugh on the dance floor; Roberto poses for a photo with his brother, David.

30 tmc» pulse | june 2017 oberto Borjas had modest hopes Once, he threw up on the carpet in a close-cropped hairstyle and a short with food from several area restaurants. Rfor the second annual Prom Party the middle of the night. dress, originally bought for her broth- “For a lot of the parents, it’s the Palooza, held at The University of Texas “I did?” Roberto interjected, as he er’s wedding. first time they’re able to interact in a MD Anderson Cancer Center. listened to his mother tell the story. “She’s here in honor of her friend, social setting with other parents going “I’m hoping that prom has some “And I was angry about the vomit Ashley, who passed away in March,” through the same thing,” Nguyen said. good food,” said the soft-spoken on the carpet,” Sandhu said, wiping said Jessica’s mother, Kelly Taylor. “A lot of parents don’t feel comfortable Roberto, who wears glasses with fash- away tears. “That was her buddy.” leaving their kids, so this is a great ionably thick frames and identifies as Roberto is currently taking oral and Madisson Somero, 17, accessorized support system.” an “old-style type of gamer” who loves intravenous chemotherapy, visiting MD her white, strapless gown with a neck- Meanwhile, Roberto got into an Donkey Kong. Anderson for treatment once a week. lace from the Kendra Scott booth set up elevator with others bound for prom Roberto, 13, is a sixth-grader who is “Things that used to be fun for me for prom, a black headband, false eye- and headed up to the observation deck being treated for acute lymphoblastic were going outside, riding my bike, lashes and red high-top Chucks. At last on the 24th floor. leukemia (ALL). playing with my cousins, and karate,” year’s prom, she was in the first stages “Every kid looks forward to their he explained. For now, though, most of of her leukemia diagnosis and didn’t Prom Party Palooza prom, and part of the sadness for these his physical activities are suspended. have much energy. This year, she said, A wave of nausea swept over Roberto kids is they have to miss out on school His immune system is weak, thanks to she and her friend Brittni Lafollette— on the elevator. activities,” said Thomas Nguyen, the chemo, and doctors don’t want him who wore white high-top Chucks with “I don’t like taking chemo,” he said. founder of Prom Party Palooza and to catch a cold or the flu. her prom dress—were ready to dance. When the elevator doors opened, he chief marketing officer and partner stepped onto a red carpet that led to the at Houston’s Peli Peli restaurant. “We observatory, a room with tall windows want them to feel as comfortable as on three sides and a panoramic view possible. They can bring siblings, of Houston. J-Mac, a radio personality best friends.” from 97.9 FM The Box, encouraged A few days before prom, Roberto people to dance. and other attendees were fitted for tuxe- “Just move,” he told the crowd. “If dos and gowns—donated by Al’s Formal you can’t move on the dance floor, move Wear, Stage Stores and others—at where you are. But you’ve got to move.” MD Anderson’s The Pavilion. Roberto stood off to the side, at one Roberto was excited. It would be his point ducking into another room to first prom. He picked out a black tux grab an ice cream. He didn’t know any- with a hot pink bow tie and vest. Those one, but he didn’t seem to mind. Several pops of color promised to be bright people—other teens and volunteers— spots in a dark year. came up to talk with him. Every prom has a life of the party. Super tired On this night, it was 14-year-old In May 2016, Roberto was diagnosed Mauricio Cordova, a ninth-grader who with ALL, a blood cancer that occurs lives in Venezuela and comes to MD Roberto Borjas on the dance floor at Prom Party Palooza. when abnormal white blood cells, Anderson for leukemia treatments. known as lymphoblasts, accumulate Mauricio rocked a slouchy cap with his in bone marrow and spread to other Roberto used to attend Paul Sarah Whittaker, 21, who’s been tux. He was the guy in the middle of organs, inhibiting the production of Revere Middle School, but he is now under treatment for lupus for nine the dance floor, surrounded by friends, normal cells. ALL makes up the largest homeschooled. years, showed off her new manicure mugging for a prom selfie. percentage of leukemia diagnoses in “He is a shy boy,” his mother said. as boyfriend Travis Guillory, also 21, Every prom also has someone who children under 15. “But I’m jolly,” Roberto added. “I pushed her wheelchair. Sarah wore a says little but sees all. On this night, “When someone tells you your make my days happy. Look at the bright sky blue dress that matched her nails, that was Roberto. Leaning against a son has cancer, you think it’s the end side and turn your frown upside down.” and Travis wore a dress, as well—a tai- window, slowly eating his pink and of the tunnel,” said Dunia Sandhu, lored brown garment that fell just below blue ice cream pop, he took it all in. Roberto’s mother. Prom prep the knee. The swirling lights. The sequined In the weeks leading up to his diag- On prom night, Roberto wasn’t feeling “There weren’t any suits left,” he tablecloths and pillows. The kids in nosis, Roberto said he “started to feel well. From 3 to 6 p.m., as other teens explained. “So I decided I wanted to be wheelchairs, on crutches, standing and tired. Super tired. Even when I woke up came to pick up their formal wear, his a princess to make her smile.” dancing in groups. I was tired, light-headed and queasy.” tux waited on a hanger. Half an hour before prom was set to Since his diagnosis, Roberto has Sandhu shook her head when she But the place was buzzing, as start, Roberto arrived with his mother, grown a little bolder, a little more recalled how hard she’d been on her son families mingled in The Pavilion. stepfather Rajinder Sandhu, and 5-year- outgoing. After several songs, and during that time. At first, when doctors Pageboy, a Houston-based app that lets old brother, David. with a little encouragement, he strode didn’t think his symptoms amounted customers call stylists to their homes, “I look good,” said David, sporting a onto the dance floor, flashing a smile so to anything serious, she had started to set up a special salon for prom-go- vest and tie. wide it looked like he was hosting his wonder: Was Roberto faking it? Was he ers where Jessica Taylor, 12, got her After posing for photos, Roberto’s own party. saying he didn’t want to go to karate makeup done. Diagnosed with Ewing’s family headed off to a special party for because he was lazy? sarcoma two years ago, Jessica sported parents at The Park at MD Anderson,

tmc» pulse | june 2017 31 Maternal Mortality in Texas Unpacking the truth behind the state’s spike in pregnancy-related deaths

By Alexandra Becker

t’s 8 a.m. on a Thursday, and Jammie force found racial disparity among the I(pronounced Jay-me) has just mothers dying in Texas. Black women finished a prenatal checkup. She is were found to bear the greatest risk for 19 weeks and three days pregnant— maternal death, with a rate nearly three with twins—and has been coming to times higher than other women. In 2011 The Center for Children and Women and 2012, black women were responsi- in Southwest Houston for her prenatal ble for 11.4 percent of births in Texas, appointments. It’s a unique clinic— but they also claimed 28.8 percent of all part of Texas Children’s Health Plan— maternal deaths. By comparison, white designed to provide a full spectrum women accounted for generally equal of health care under one roof. Without proportions of total births and total the center, Jammie isn’t sure she’d be maternal deaths, and Hispanic women able to get all the services she needs, and women of other ethnic and racial especially while carrying multiples. In groups accounted for a lower propor- Texas, that could mean the difference tion of total maternal deaths than between life and death. total births.

Reprinted with permission from the DSHS Office of Program Decision Support Center for Children and Women. Based on death certificates, the Worst in the nation task force also determined that cardiac In 2016, the publication of two inde- events, drug overdoses and hyper- pendent reports suggested that the When examining maternal mortal- a rate significantly higher than the tensive disorders like pre-eclampsia maternal mortality rates in Texas had ity trends in the U.S. between 2000 CDC’s annual national benchmarks (formerly called toxemia) were the doubled within the past decade, rank- and 2014, a group of Maryland-based over that same period, which ranged leading reasons for the maternal deaths ing Texas the worst in the nation and on researchers found Texas to be an from 19.3 in 2011 to 21.5 in 2014. recorded, and that the majority of the par with economically underdeveloped outlier. According to their data, Texas That 2011 increase in Texas was deaths didn’t occur in the delivery room countries. The findings were shocking maternal mortality rates showed “a the focus of the other major report, or shortly thereafter, but more than to investigators and the public alike, modest increase” from 2000 to 2010, published prior to the Obstetrics & 42 days after delivery. sparking a media frenzy that pointed to from a rate of 17.7 in 2000 (calculated Gynecology research, by a state- “These findings were informative the state’s severe anti-abortion leg- per 100,000 live births) to 18.6 in 2010. appointed Maternal Mortality and concerning,” Hollier said. “They islation and reintroduced the phrase But after 2010, “the reported maternal and Morbidity Task Force and the reinforce the need for detailed reviews “everything’s bigger in Texas.” mortality rate for Texas doubled within Department of State Health Services. of maternal deaths so that the problems But the reality is far more complex a two-year period to levels not seen in Comprised of 15 Texas-based multidis- can be understood and the right solu- than any headline could suggest, and other U.S. states.” ciplinary experts and chaired by Lisa tions identified to correct them.” investigators are still analyzing data to According to data collected by Hollier, M.D., professor of obstetrics Advocates for women’s reproduc- truly understand the facts behind the the Centers for Disease Control and & gynecology at Baylor College of tive rights were quick to blame Texas numbers and, most importantly, how Prevention (CDC) and the National Medicine and medical director at Texas lawmakers for the state’s spike in to reverse the trend. Center for Health Statistics, the rate Children’s Health Plan, the task force pregnancy-related deaths, citing the Original research published in the of maternal mortality in Texas jumped used additional metrics to analyze the 2011 decision to slash the state’s family September 2016 issue of the medi- to 30.2 per 100,000 live births in deaths between 2011 and 2012. In addi- planning budget by more than $70 mil- cal journal Obstetrics & Gynecology 2011, then spiked to 38.7 in 2012 and tion to finding an increase in reported lion and the 2013 mandate that abortion launched the first public outcry. remained above 30 through 2014— deaths during those years, the task clinics meet ambulatory surgical center requirements—resulting in the shutter- ing of numerous women’s health clinics Every maternal death is a tragedy and we should strive for a case rate of zero. throughout the state. But when you look at the data ... it suggests that the potential increase in maternal (continued) deaths is not occurring at delivery or in the immediate postpartum period, but the

time period from 42 to 365 days after birth—thus, outside the hospital. Facing page: Erica Giwa, M.D., an OBGYN with Texas Children’s Hospital and assis- tant professor of obstetrics and gynecology — SEAN BLACKWELL, M.D. at Baylor College of Medicine, examines a Maternal-fetal medicine specialist at Children’s Memorial Hermann Hospital and department chair patient during a prenatal checkup at for obstetrics, gynecology and reproductive sciences at McGovern Medical School at UTHealth The Center for Children and Women.

32 tmc» pulse | june 2017 Recommendations from the Maternal Mortality and Morbidity Task Force Report

1. Increase access to health services during the year after delivery and throughout the interconception period to improve continuity of care, enable effective care transitions, promote safe birth spacing, reduce maternal morbidity, and reduce the cost of care in the Medicaid program.

2. Increase provider and community aware- ness of health inequities and implement programs that increase the ability of women to self-advocate.

3. Increase screening for and referral to behavioral health services.

4. Increase staffing resources in support of the task force.

5. Promote best practices for improving the quality of maternal death reporting and investigation.

6. Improve the quality of death certificate data.

Source: Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report, July, 2016.

tmc» pulse | june 2017 33 Access to care There are a lot of Shortcomings in record-keeping physiologic changes that aside, experts agree there has been occur with pregnancy, an increase in maternal deaths in Texas. Their challenge is understand- so women who may have ing why. more pre-existing dis- Sean Blackwell, M.D., explained that ease may be at higher the primary issue isn’t that medical care in Texas hospitals is worsening risk. We do know that or below par, but rather that too many when we looked at the women are not receiving care. numbers, we found that “Every maternal death is a tragedy high blood pressure, and we should strive for a case rate of zero,” said Blackwell, maternal-fe- diabetes, obesity, tal medicine specialist at Children’s cesarean delivery and Memorial Hermann Hospital and late prenatal care were department chair for obstetrics, gynecology, and reproductive sci- all seen more commonly ences at McGovern Medical School at in those women who died UTHealth. “But when you look at the

compared to those who data, and all of the improvements in safety and quality on labor and delivery did not. units within Texas hospitals, it suggests that the potential increase in maternal —LISA HOLLIER, M.D. deaths is not occurring at delivery or Professor of obstetrics & gynecology in the immediate postpartum period, at Baylor College of Medicine but the time period from 42 to 365 days and medical director after birth—thus, outside the hospital. at Texas Children’s Health Plan If anything, I would argue our hos- But while both decisions undoubtedly pitals are getting better. The major created gaps in care for many Texas current opportunity for improvements women, the timing doesn’t quite synch. is related to making sure women have “I put it this way,” Hollier said. “The access to care, especially our most vul- time-course of the increase doesn’t nerable patients who are underserved fit with the time-course of the clinic and have chronic or severe medical closures, so it’s unlikely that the clinic conditions. We sorely need to have the closures caused the increase.” system infrastructure and the ability to follow these women through that first Disentangling the data year post delivery.” It is important to note that the data For low-income women who qualify used for the maternal mortality studies standard death certificate and included identified in the 2011-2012 evaluation for Medicaid, benefits are available was unusually difficult to analyze and checkboxes for whether an individual included incorrect classification coding during pregnancy and up to only two potentially shaped some of the results, was pregnant within the past year, preg- for the cause of death, further muddy- months after birth, creating an abrupt since the studies used varying bench- nant at the time of death, not pregnant ing the data. end of care despite evidence that marks for measuring maternal mortal- but pregnant within 42 days of death, The inconsistencies were so perva- women remain at risk for the first year ity ratios. not pregnant but pregnant 43 days to sive that both studies acknowledged after their pregnancy has ended. For the Texas task force’s analysis, one year before death (considered later the fallibility of the data in their reports The task force ranked cardiac events a pregnancy-associated death was maternal death), or if she was unknown and the task force dedicated three of and hypertension/eclampsia as the defined as any woman who died within to be pregnant within the last year. its six recommendations for improving first and third most common causes 365 days of birth or fetal death from any Not all states adopted the revised maternal mortality rates to the area of of maternal deaths in Texas, statistics cause; the analysis examined all mater- death certificate in 2003, so some data data collection. experts believe may be exacerbated by nal deaths during the 2011-2012 time was based on a 42-day standard time “We identified multiple problems a general population that is growing period, excluding motor accidents and frame while some had nonstandard with the consistency of the evaluation unhealthier across the board, making non-pregnancy related cancers. time frames. Texas didn’t adopt the of the maternal deaths,” Hollier said. “I pregnancies more complex. By contrast, the national Obstetrics new death certificate—and with it, the think there are opportunities for educa- “The number of women we see who & Gynecology report relied on death revised “pregnancy question”—until tion as well as standardization regard- have a BMI over 40, who have diabetes certificate questions related to preg- 2006, and researchers noted that these ing those evaluations to ensure that the and hypertension, is definitely rising,” nancy, which changed during the variations in the death records led to appropriate information is collected Blackwell said. “Today, well over half time period measured, 2000 to 2014. findings that required adjustments. In at the time of death so that a complete of women who are having babies in the A so-called “pregnancy question” was addition, the Texas task force found assessment of the cause of death can state of Texas are obese. Our popula- added to the 2003 revision of the U.S. that a number of maternal death cases be made.” tion is getting sicker.”

34 tmc» pulse | june 2017 According to Hollier, the task force behavioral health services. found that the rate of complications Already, state-run programs and increased across all racial and ethnic institutions throughout the Texas Nail it this groups in Texas between 2005 and 2014. Medical Center are working to address “There are a lot of physiologic some of these issues. changes that occur with pregnancy, The state-funded Healthy Texas so women who may have more pre- Women program, which was intro- Father’s Day. existing disease may be at higher duced last year, focuses on helping risk,” Hollier explained. “We do know low-income women gain access to that when we looked at the numbers, family planning services, STD testing, we found that high blood pressure, breast and cervical cancer screenings, diabetes, obesity, cesarean delivery and postpartum depression screenings, late prenatal care were all seen more and help with chronic diseases related commonly in those women who died to obesity, even after their Medicaid compared to those who did not.” benefits from pregnancy expire. Another observation: it’s difficult Harris Health System offers an to measure how much the surge in OB Navigation Program that provides prescription opioids and drug over- pregnant patients with enhanced doses dovetails with maternal mortality care coordination and support in Texas, yet the task force did identify throughout their pregnancy and many missed opportunities for screen- postpartum period. ing and referral to treatment during The Center for Children and prenatal care, delivery hospitalization Women, which is open to families and postpartum care for mental enrolled in the Texas Children’s Health health conditions. Plan through Texas Children’s Hospital, “There’s no doubt that mental health provides a new kind of medical facility and access to care for underserved that combines a full network of care women are major drivers,” Blackwell under one roof—including pediatrics, said, “but are they ‘pregnancy issues,’ or obstetrics, psychology and more. is that more of a societal issue?” Children’s Memorial Hermann This question speaks to one of Hospital has increased its focus on the most complicated components preconception and interconception in the analysis of the maternal mortal- health—the time period between ity numbers: the distinction between pregnancies—which minimizes risk pregnancy-related deaths and factors by helping women plan for their pregnancy-associated deaths. pregnancy through education and “Pregnancy-related deaths are ongoing access to preventative care. due to any cause related to or aggra- The hospital has also partnered with vated by a woman’s pregnancy or its the March of Dimes to create a new management, so this would exclude Perinatal Safety Center to research and some of the opioid-related deaths, streamline maternal and infant care. the homicides, and possibly some of The Texas Department of State the suicides,” Hollier explained. “But Health Services is in the process of when we talk about Texans being establishing an electronic database increasingly unhealthy, that contributes to track cases of pregnancy-related significantly to maternal mortality, deaths. And in late May, Texas legis- and pregnancy-related mortality does lators passed Senate Bill 1929, which include women who develop pre- renewed funding for the task force and eclampsia more commonly now outlined specific directives, including because they have pre-existing hyper- postpartum depression services for tension or, for example, because they low-income women. are older.” “I am optimistic that we are making progress with improving access to care, No quick fixes and the spotlight that has been shone Where do we go from here? The task on the problem will help make it a prior- force made six major recommendations ity among all the other health care chal- in their report, half focused on better lenges that exist in our state and across Surprise Dad this Father’s Day with the data collection and analytics and the the U.S.,” Blackwell said. “The issues rest concentrating on improving access related to improving maternal mortality perfect gift: warm cookies, delivered. and continuity of care, tackling health in Texas are not quick fixes.” inequities, and increasing screening for

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tmc» pulse | june 2017 35

cookiedelivery.com cookie delivery On Target for Demo Day TMCx accelerator companies aim to leave their mark on the Texas Medical Center

By Christine Hall

ntrepreneurs from around the world utilization and efficiency in the operat- Ecome to the Texas Medical Center ing room. (TMC) to fine-tune their digital health He has a few other prospects at the solutions and target health care orga- moment, including one with a large nizations that will benefit from their medical device manufacturer. Mecca is innovative ideas. pitching to angel networks (groups of

Twenty-one startup companies investors who have organized to invest Fountain Gary Credit: conclude a four-month TMCx accelera- collectively) and investment firms in an TMCx company ConsultLink, led by CEO Alexander Pastuszak, M.D., is a mobile workspace for tor digital health program with a Demo effort to raise a $1 million seed round— care team members to streamline and improve patient care. Day on June 8. Many will leave with an where investors would subsidize the agreement to test their products at one company in exchange for an equity of the relationships I made here were may not make the sale to the hospital,” of the medical center’s 21 hospitals. stake in it. If Mecca can get the funding by chance—definitely not something I he added. Joshua Mecca, co-founder of M&S he needs, he might shift his headquar- could have done remotely.” M&S Biotics and ConsultLink are Biotics, has already secured letters of ters to Houston. Meanwhile, Alexander Pastuszak, just a few examples of success that intent with two hospitals and a medical “I have done more in the past three M.D., CEO of ConsultLink, based in TMCx companies have had in the school. His Scranton, Pennsylvania- months than I did in a year and a half,” Houston, will leave the TMCx program Texas Medical Center. Others, like based company combines artificial Mecca said. “I knew if I was going to with a letter of intent from a hospital Washington, D.C.-based Babyscripts, intelligence and radio-frequency come down to Houston, I was going to deploy a trial run of his product: which offers a remote-monitoring kit to identification technology to improve to have to put both feet in. Plus, most a mobile workspace for care team better identify high-risk pregnancies, members to streamline and improve is working with a TMC institution to patient care. have its kits distributed to patients. But getting that far for both startups Minneapolis-based Vios Medical, A Pear-fect was not easy. which created a patient management “Our solution is for the care team, information system, secured four Stay in Pearland so identifying the right solution in pilots aimed at patient data for clinical the right organization is a challenge,” decision-making. Whether you’re taking Pastuszak said. “We had to learn what Leaders in the TMC Innovation advantage of the world renowned the good routes were.” Institute, which runs the accelerator TMCx opened up that network for program, say all of the traction is evi- Medical Center or events at NRG Pastuszak and his team, and helped dence that TMCx, which launched Park, Pearland offers a convenient them identify high-value targets. in 2014, is becoming more mature. solution for an affordable stay with “It was reaffirmation that we are not TMC’s member institutions are great dining and shopping. crazy in terms of our approach,” he said. more aware of the program and more “Plus, we had a chance to talk to other willing to engage with the companies, Choose from 11 Pearland Hotels companies in TMCx, and ask how they said Erik Halvorsen, Ph.D., director • Best Western were doing it. Some were further down of the TMC Innovation Institute. The • Candlewood Suites the line than us, so it was good to know program has also gained greater vis- • Comfort Suites we were on the right track.” ibility. More members of the medical • Courtyard by Marriott Startups must navigate each hospi- center community are participating as • Hampton Inn by Hilton • Hilton Garden Inn & Conference Center tal’s unique infrastructure. Often, one advisors and mentors. • Holiday Inn Express & Suites (2) of the initial challenges is finding a “The Texas Medical Center has • La Quinta Inn & Suites physician—or someone impacted by the 21 hospitals and 100,000 employees • Sleep Inn & Suites MEDICAL problem the entrepreneur is trying to in 58 member institutions,” Halvorsen • SpringHill Suites by Marriott CENTER solve—to champion the concept. said. “That’s a lot of organizations to NRG STADIUM But even with that person, there are meet in a short period of time. This always others higher up the food chain class has been more successful at that need to be brought on board, and creating those engagements than that doesn’t always happen. Pastuszak ever before.”

PEARLAND said he came to understand that a Indeed, this class has raised close hospital’s director of innovation was to $44 million in funding and departs not always the person who cared about on June 8 after securing more than 281.997.5970 • VisitPearland.com the product. 80 agreements or partnerships. [email protected] “They may say this is interesting and see the potential need, but they 36 tmc» pulse | june 2017 puls_med_cntr_ad_2.indd 1 2/8/17 10:27 AM HOW TMC EMPLOYEES SPEND THEIR SPARE TIME ON SIDE THE

somebody or trick somebody or this or that. It doesn’t take much NAME: Stacey Berg, M.D. finagle somebody into doing the to give you an idea of where work. They can do it.” something could be, just a little OCCUPATION: Director of the Palliative Care At a young age, Berg bit further than where we are.” immersed herself in The Jungle We’re not able to clone Program and the Developmental Therapeutics Book, The Chronicles of Narnia humans now, she said, but we Program at Texas Children’s Hospital and A Wrinkle in Time. These will probably be able to one day. stories allowed her to escape the We may decide not to do it, she humdrum nature of everyday life added, but it won’t be a technical INTEREST: Writing science fiction

and transport herself to other limitation. By Shanley Chien worlds of endless possibilities. Berg’s scientific training and s a physician-scientist, group of insurgents is threat- “It’s the magic of magic,” keen attention to detail help her AStacey Berg, M.D., has ened when she falls in love with Berg said. create vivid, progressive scenes. co-authored more than 100 a rebel leader and begins to Berg recently joined a panel The whole point is to “convey a papers on pharmacology and doubt her purpose. The novels of science fiction writers at lot of flavor and make you feel experimental therapeutics, explore Echo Hunter 367’s inter- Houston’s Comicpalooza to dis- like there’s a whole world there,” specifically on the development nal struggle to choose between cuss her double life as a doctor said the author, who is already of new anticancer drugs for chil- the woman she loves and duty, and author. working on her next novel. dren. But in her spare time, Berg while focusing on her strength She often relies on her “When you’re a scientist,” writes speculative fiction that and courage—qualities Berg said medical research background to she said, “one of the things explores the imaginative world were rarities in the books she flesh out the futuristic science that you do is really try to look of science fiction and fantasy. read as a child. and technology in her stories. at very specific facts and try To date, Berg has written two “I like big adventure stories With her knowledge of genetic to understand what this fact novels, Dissension (2016) and with lots of strong women in research and engineering, she is is telling you … and what next Regeneration (2017), published them,” Berg said. “One of the eager to explore the possibility question to ask or what experi- by HarperCollins. Set in a dysto- really nice things to see is all the of human cloning in her books. ment you should do to produce pian future, her duology follows stories that are out there for girls “Science is so amazing,” Berg the next fact.” the story of a female clone and young women that show said. “Every day I come into soldier named Echo Hunter 367, them that they can save the work and say, ‘Wow, by a year whose mission to hunt down a day. They don’t have to wait for from now, we might be doing

tmc» pulse | june 2017 37 Field Notes

[ 1 ] Thousands participated in the MARCH FOR SCIENCE – HOUSTON to support research, med- icine and technology. Several faculty members of TMC institutions addressed the crowd at City Hall...... [ 2 ] SINCHITA ROY CHOWDHURI, M.D., PH.D., assistant professor at The University of Texas MD Anderson Cancer Center, Department of Pathology, received a 2017 Shirley Stein Scientific Endowed Research Award.* ...... [ 3 ] BURTON DICKEY, M.D., professor in 2 3 the Department of Pulmonary Medicine at MD Anderson, was the recipient of the Finneran Family Prize for Translational Research.* ...... [ 4 ] GIOVANNI DAVOGUSTTO, M.D., UDAY SANDHU, M.D., and RAYMUNDO “ALAIN” QUINTANA QUEZADA, M.D., internal medi- cine residents at McGovern Medical School at UTHealth, were named champions at the Doctor’s Dilemma national competition in San Diego.* ...... [ 5 ] TEXAS WOMAN’S UNIVERSITY held the 1 4 school’s first family graduation. Andrea Brooks, Ph.D., RN, PNP, who received her doctorate in nursing, brought her children, Elizabeth Amos and Mikayla Wimberly.* ...... [ 6 ] The Giving Back to the Future Gala raised more than $650,000 for NORA’S HOME. Margaret Alkek Williams, left, was honorary chair of the gala honoring Lynda Knapp Underwood, right, and her late husband, David Underwood, longtime chair of the TMC Board of Directors...... 5 [ 7 ] DARIO MARCHETTI, PH.D., right, director of the Cancer Biomarker Research Program at Houston Methodist Research Institute, received a research grant from the Avon Foundation for Women.* ...... [ 8 ] KELLY HACKETT, managing director of family office services for Salient Partners, L.P., has joined The Menninger Clinic Board of Directors...... [ 9 ] PHILIP C. JOHNSON, M.D., vice chair of the Department of Internal Medicine and director 7 6 of the Division of General Medicine at McGovern Medical School at UTHealth, was honored with the Anne and Edward H. “Ted” Patton, Jr. Award.* ...... [ 10 ] NICHOLAS NAVIN, PH.D., assistant professor in the Department of Genetics and Bioinformatics at MD Anderson and an Andrew Sabin Family Fellow, received the Jack and Beverly Randall Prize for Excellence in Cancer Research.* ...... [ 11 ] An article by MICHAEL J. PALDINO, M.D., neuroradiologist at Texas Children’s Hospital, was 8 9 10 11 selected as the Lucien Levy Best Research Article by the American Journal of Neuroradiology.* Credit: No. 6: Daniel Ortiz Photography, No. 8: Michael Hart, No. 13: Jenny Antill, No. 16: Michael Hart, No. 17: Alexander’s Fine Portrait Design, No. 18: S. Kramer/Texas Children’s Hospital and Chinh Phan, *Courtesy photo

38 tmc» pulse | june 2017 [ 12] ELISE COOK, M.D., far right, associate professor in the Department of Clinical Cancer Prevention at MD Anderson, was honored by the YWCA during the 31st annual Outstanding Women’s Luncheon. Also pictured are YWCA board members Jolyn Brand and Jacqueline Bostic McElroy.* ...... [ 13 ] Elizabeth Vargas, center, co-host of ABC’s 20/20 news program, was the keynote speaker at THE MENNINGER CLINIC’S Annual Signature 12 13 Luncheon, co-hosted by Jeff and Paula Paine, left, and Dorothy and Ronny Cuenod, right...... [ 14] THE TEXAS MEDICAL CENTER ORCHESTRA, led by founder and artistic director maestra Libi Lebel, was awarded The American Prize as best community-based orchestra in the United States for the 2016-2017 season...... [ 15 ] SIMONA SHAITELMAN, M.D., assistant professor of radiation oncology at MD Anderson, was named one of the 2017 recipients of the Shirley 15 16 Stein Scientific Endowed Research Award.* ...... [ 16 ] ANN GORDON TRAMMELL, of Trammell Interests, has joined The Menninger Clinic Board of Directors...... [ 17 ] The AMERICAN HEART ASSOCIATION HOUSTON Go Red For Women Luncheon raised $1.1 million for the fight against heart disease and stroke. Journalist, author and television host Joan Lunden, center, who was guest of honor and key- note speaker, posed with 2017 campaign co-chairs 14 17 John and Vicki Crum...... [ 18 ] An Evening with a Legend, which benefited TEXAS CHILDREN’S CANCER CENTER, honored Olympic swimmer Michael Phelps. Television sports journalist Andrea Kremer interviewed Phelps about his gold medal journey and the next phase of his life.

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tmc» pulse | june 2017 39 Calendar FOR MORE EVENTS, VISIT TMC.edu/news/

June 2017 Credit: Scott Dalton Scott Credit: Fresh, locally grown food is sold at the Rice University Farmers Market on Tuesdays throughout the year, 3:30 to 6:30 p.m. The market is located at parking lot entrance 13B, 5600 Greenbriar Drive.

TMCx Demo Day 9 The Future of Obamacare: 10 ScienceDay 14 Off Script: Stories from the 8 Pitches from 21 digital Knowns and Unknowns Hands-on activities for Heart of Medicine health startups Lecture by Vivian Ho children ages 4 – 12 Live storytelling Thursday, 1 – 2:30 p.m. Friday, Noon – 1:30 p.m. Saturday, 12:30 – 4 p.m. Wednesday, 5:30 – 7 p.m. and 3 – 7p.m. Rice University Houston Methodist McGovern Medical School TMC Innovation Institute James A. Baker Hall Research Institute 6431 Fannin St., Rm. 2.135 2450 Holcombe Blvd., Ste. X 6100 Main St. 6670 Bertner Ave. Free Free Registration required: Free [email protected] [email protected] $50; lunch included [email protected] 570-780-4435 713-791-8855 [email protected] 713-363-9049 713-348-4336

FREE WELLNESS SEMINARS IN JUNE Held every Wednesday at Whole Foods Market on Post Oak and San Felipe.

Topic I: Celebrate Freedom from Pain & Pain Medications June 7 @ Noon & June 14 @ 6pm JUNE 27: NATIONAL HIV TESTING DAY Topic II: No More Belly Fat, Balancing Stress and Hormone

June 21 @ Noon & June 28 @ 6pm June 27, recognized as National HIV Testing Day, raises awareness about the importance of testing Seating is Limited - RSVP Required for HIV/AIDS. Currently, 1.2 million people in the Call 713-572-3888, ext. 106, or United States are living with HIV/AIDS and another E-mail: [email protected] to reserve your seats! 1.2 million face a substantial risk of contracting it. Dr. Bing You and Dr. Tao Ma are Doctors of Integrative Medicine. In 2000, Drs. You and Ma By participating in regular testing, practicing were invited from China to train physicians and graduate students on Acupuncture, Herbal safe sex through the use of condoms, and having Medicine, and Integrated Medicine, and they have provided integrated medicine services to conversations with partners about their sexual history, Houstonian’s ever since. individuals can greatly reduce their risk of contracting Drs. You and Ma have been invited to speak at St. Luke’s, MD Anderson, Methodist, and Memorial Hermann Hospitals as well as the UTMB and Rice University. They are available for the disease. Corporate Wellness Events, patient referrals, and health fairs. Weekly wellness seminars are For more information about HIV/AIDS prevention available in the Galleria area at no charge. and for testing locations, visit the Texas Department For more information about our events, or to schedule an event with your office, of State Health Services website: please call our Education Team at 713-572-3888, ext. 106. www.dshs.texas.gov/hivstd/services/service_h.shtm Tao Ma, MD (China), LAc., PhD Bing You, MD (China), LAc. Licensed Acupuncturist and Herbologist Licensed Acupuncturist and Herbologist

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