NEWS OF THE TEXAS MEDICAL CENTER — VOL. 6 / NO. 1 — FEBRUARY 2019 Saving Officer Barnes John Barnes confronted the shooter at Santa Fe High School, p. 20
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treatment at the Texas Medical Center are often facing TMC | PULSE a difficult time. A simple act of kindness means a great Vol. 6 No. 1 deal to a family receiving care. February 2019 As president and CEO of the Texas Medical Center, I am often asked: “What keeps you up at night?” My President and Chief Executive Officer answer is always: “The safety of everyone that comes William F. McKeon to the medical center each day.” In our ever-changing Communications Director social landscape, sadly, this concern is elevated. Ryan Holeywell Over the last year, we increased the presence of TMC Police considerably across the campus to Pulse Editor Maggie Galehouse Mark Mulligan/© Houston Chronicle. Used with permission. with Used Chronicle. Houston Mulligan/© Mark maintain and enhance the safety of our employees and [email protected] WILLIAM F. McKEON visitors. This spring, we will open a new TMC Police President and Chief Executive Officer station at the center of the campus at the intersec- Assistant Editor Texas Medical Center tion of Holcombe and Bertner. This will enhance our Cindy George visibility, capabilities and the speed at which we can [email protected] respond to events that warrant police attention. Staff Writers The TMC Police work very closely with the police very morning, I wake up very early and read the Alexandra Becker ETMC Police report that covers all of the activities and security departments of our member institutions, Britni R. McAshan from the previous day and evening. It is fascinating to as well as the Houston Police Department, county Shanley Pierce see, in one document, all that transpires in 24 hours sheriff’s offices, FBI and CIA. Each of these entities across the 1,400 acres of the largest and busiest plays a critical role in protecting and supporting the Photojournalist Cody Duty medical city in the world. medical center. I will never fully rest easy, as potential Members of the TMC Police and Security team threats are ever-present. I do, however, find more NEWSROOM are recruited and trained to protect and serve the comfort as we enhance our collaboration and 713-791-8812 110,000 employees of the medical center and the communications across this amazing medical city. [email protected]
millions of patients and their families we care for each ADVERTISING year. They do so with great pride, recognizing that the Felicia Zbranek-Zeitman people who come from around the world to receive 713-791-8829 [email protected]
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2 t m c » p u l s e | f e b r ua ry 2019 Table of Contents
4 14 34 36
Juul Ad Campaign New HQ for Visit to Dentist Leads How Are We Targets Adult Smokers TMC Police to Heart Diagnosis Most Likely to Die?
6 Curated: The First Time, The Heart (A Portrait of Life 1854-1913)
10 Spotlight: Todd Rosengart, M.D.
15 Vitals: 2019 Predictions
19 Next Med: Mending a Hole in the Heart
38 Field Notes
40 Calendar
on the cover: John Barnes was on duty as a school resource officer at Santa Fe High School when a shooter opened fire.
on this page: Cool Acres, the family ranch of cardiovascular pioneer Denton A. Cooley, M.D., was home to the St. Luke’s family picnic, p. 16. Juul Ad Campaign Targets Adult Smokers Medical experts remain concerned about the adolescent vaping epidemic
By Shanley Pierce
lthough popular e-cigarette “There is no doubt that, if you A manufacturer Juul has have to choose between smoking launched a new ad campaign aimed a combustible cigarette and using at adult smokers, medical experts an e-cigarette, using a regulated remain skeptical of the company’s e-cigarette is actually safer. intended audience and concerned There’s no doubt it has harm- about the spike in adolescent reduction potential,” said U.S. vaping. Surgeon General Jerome Adams, Earlier this year, Juul released M.D., during a recent visit to The a series of 60-second television University of Texas MD Anderson commercials featuring testimonials Cancer Center. “I’m not against from adult smokers who “made the preserving e-cigarettes and vaping switch” to Juul. Ads have also been as an option for adults who want to released online, on the radio and quit smoking, but I absolutely in print. want people to understand that “Our success ultimately depends for young people, this presents a on our ability to get our product in very unique danger.” the hands of the adult smokers and It took decades to change out of the hands of youth,” the com- U.S. Surgeon General Jerome Adams, M.D., displays a Juul device during a recent young Americans’ minds about pany said in a press release. “When visit to The University of Texas MD Anderson Cancer Center. combustible cigarettes, Adams adult smokers try it, it works. And, said, and e-cigarettes have clouded the impact is life-changing.” parties. The ads are playing up this company for deliberately targeting that success. E-cigarettes were initially New York City lifestyle and they’re its products to minors by luring “It took us a long time to deal introduced to the market to offer super fun,” Morain said. “Now you them with a variety of whimsical with advertising and marketing adult smokers a safer alternative to see their Twitter campaign and it flavors, including cool mint, crème to help turn the tide so youth no combustible cigarettes and to wean reminds me of a tombstone ad … brûlée and cool cucumber. longer thought [combustible them off of their tobacco addiction, with very stark, black and white Juul spent approximately cigarettes] were cool. We’re now to but adolescents jumped on the vap- text. What they’re saying is more $10 million on television ads, which a point where, if you talk to most ing bandwagon. The rise in adoles- politically palatable and signaling air on cable channels after 10 p.m., kids, they’ll tell you it’s not cool to cent vaping from 2017 to 2018 was an olive branch, but it doesn’t seem according to Juul spokesman Ted smoke,” Adams said. “Unfortunately, the largest recorded in the past like they’re bringing the same mar- Kwong. The company is flush with with e-cigarettes, kids—like my 43 years for any adolescent sub- keting power to those types of ads, cash after major tobacco producer own son who thought that these stance use outcome in the United which makes me a little skeptical Altria, which manufacturers just contain flavored water—think States, according to the National about how genuine this effort is.” Marlboro, acquired a 35 percent they’re safe and cool. They’re being Institutes of Health’s annual Juul’s about-face comes on the stake—worth nearly $13 billion—in marketed to them through YouTube, Monitoring the Future survey. heels of a difficult year. Throughout the e-cigarette startup at the end of video games, music videos that kids Stephanie Morain, Ph.D., an 2018, Juul came under intense fire 2018. According to Altria, the invest- watch. It shows that some of these assistant professor at the Center for from public health experts and ment places Juul’s market value at companies are, in fact, directing Medical Ethics and Health Policy federal regulators, who criticized the $38 billion. their marketing toward children.” at Baylor College of Medicine, com- pared Juul’s original ads with the The challenge for regulation is that we’re really trying to thread somber, no-nonsense ads of the new campaign. the needle and ensure youth aren’t getting access to these products,
“If you look back to 2015, you while adult smokers who would use them to transition or ideally to quit see these beautiful ads with bright altogether would still have access. colors and individuals who look like they’re maybe 18 to 24 at these — STEPHANIE MORAIN, PH.D. Assistant professor at the Center for Medical Ethics and Health Policy at Baylor College of Medicine
4 t m c » p u l s e | f e b r ua ry 2019 Juul claimed that its flavors, raising the tobacco-buying age to processes for online purchases. adolescents. E-cigarette use, in con- social media marketing and original 21 and invest $30 million over the “I think this is overdue,” Morain trast, surged to staggering propor- ads from 2015 weren’t intentionally next three years to fund indepen- said. “The challenge for regulation tions. The percentage of American designed to attract teenagers; how- dent research, education and com- is that we’re really trying to thread high school seniors who said they ever, beginning in April 2018, the munity outreach initiatives. the needle and ensure youth aren’t vaped in the past year jumped from U.S. Food and Drug Administration In November 2018, the FDA getting access to these products, 27.8 percent in 2017 to 37.3 percent (FDA) turned up the heat by placing announced new steps in response while adult smokers who would use in 2018. The percentage of high Juul under federal investigation. to the astronomical surge of them to transition or ideally to quit school seniors who vaped nicotine Later that month, FDA e-cigarette use among teens. altogether would still have access.” within a month before the survey Commissioner Scott Gottlieb Stopping short of a full ban on At the end of 2018, Adams issued nearly doubled, soaring from 11 per- announced that the agency had most flavored e-cigarette sales in the Surgeon General’s Advisory cent in 2017 to 20.9 percent in 2018. uncovered a litany of violations in retail stores and gas stations across on E-Cigarette Use Among Youth, “The meteoric rise in the use of e-cigarette sales to underage teen- the country—an idea many health only the fourth Surgeon General’s e-cigarettes among our young peo- agers and requested that Juul sub- experts and parents supported— Advisory in the past 13 years. ple,” Adams said, “rose to the level mit company materials, including the agency decided instead to issue His announcement drew data that I felt that I had no choice but to marketing documents and research new rules that limit sales to age- from the Monitoring the Future declare it an epidemic. targeting different age groups. In restricted locations and require survey, which reported a decrease response, Juul said it would support more robust age-verification in opioid and alcohol use among
t m c » p u l s e | f e b r ua ry 2019 5 To create the images, Robleto essentially The Intersection of ARTS and MEDICINE designed a new form of printing. He put By Britni R. McAshan high-resolution scans of the images onto an uncoated machine-finished paperboard. The photo- lithographs were then transferred with transpar- ent base ink onto hand- flamed and sooted paper, brushed with lithotine and fused in a mild solution of shellac and denatured alcohol. “The heart is the only organ in our bodies that we can actually feel and, as a cultural metaphor, it will not budge,” Robleto said. “Even though science moved on to the brain a long time ago, culturally, it doesn’t matter. We still give our hearts to one another. The brain isn’t the symbol on Valentine’s Day … it’s Credit: Courtesy of Inman Gallery Inman of Courtesy Credit: the heart.” But as science moves forward, the cultural impli- n 1977, NASA launched Voyager 1 and 2 into the He found the first pulse tracing of a heartbeat, cations of heart transplants, regenerative medi- Ifar reaches of outer space. Secured on the side completed in the 1850s—half a century before the cine and technology must be considered. of each space probe was a copy of the Golden birth of electrocardiography. A German doctor Robleto has spent time with the Texas Heart Record—an interstellar message-in-a-bottle filled used soot from a candle flame gathered on a piece Institute’s Doris Taylor, Ph.D., who is working on with greetings in multiple languages, along with of paper and human hair to trace the beat of his stripping a pig heart and re-cellularizing it with images and sounds of nature to communicate own heart. human DNA. He also has consulted with William with other life forms in the galaxy. The black and white images on display at “Billy” Cohn, M.D., and the Texas Heart Institute’s But it was the final message in the Golden Inman Gallery are recreations of original tracings O.H. “Bud” Frazier, M.D., who are working with Record that transfixed young Dario Robleto, a produced between 1854 and 1913. They document Daniel Timms, Ph.D., to develop the BiVacor, a local artist and citizen scientist. Decades later, it the heart’s reaction to everything from riding a total artificial heart with no pulse. inspired his work, The First Time, The Heart (A bike to smelling lavender to feeling scared. “Can we assume our hearts will always sound Portrait of Life 1854–1913), photolithographs on “There was a quest to image the invisible—the the same?” Robleto asks. “In all of human history, permanent display at Houston’s Inman Gallery. invisible being the most complicated organ in the no one has ever proposed that you don’t need a Ann Druyan, creative director of the Golden body—and to use hair and soot to image it for the pulsatile heart to be a human, and it is a game Record project, was in love with Carl Sagan, the first time is so beautiful to me,” Robleto said. “It changer. There is a cultural dynamic to the idea late astronomer and author who was leading the is a history of materials as much as it is a history of letting go of our heartbeats and I think that is a group at NASA. Druyan’s final message on the of cardiology.” fascinating question to pursue.” Golden Record was a one-minute recording of her brainwaves as she thought about her love for Sagan, whom she later married. “Her heart is the only heart that has actually exited our solar system,” Robleto said. “I love that both her heart and her brain are represented, The First Time, The Heart (A Portrait of Life 1854–1913) because she’s arguing: Is love in there and can it is part of the permanent collection at Inman Gallery, be deciphered at a later date?” 3901 Main St. Information: 713-526-7800. Robleto realized that to honor Druyan’s story and fully understand the cultural, physical, his- Above: Dario Robleto’s photolithograph of torical and scientific significance of the heart, he First Pulse, 1854, retraced the original image using needed to take a retrospective look at the origins ink, hand-flamed and sooted paper, lithotine, shellac of the first heartbeat recorded in history. and alcohol. Left: Robleto holds one of his prints at Inman Gallery.
6 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 Dating App Taps Genetics and Social Media Scientists offer a new recipe for love
By Britni R. McAshan
physical chemistry and social compared to our own because that rapport. “It’s nothing like designer means that we are not related, so we babies or anything like that. It is, will have a decreased risk of genetic essentially, how do your genes affect disease in our progeny and our who you are attracted to and who progeny will have a more diverse set you jive with the best? How is that of immune system genes and there- inscribed in your genome?” fore be immune to more pathogens,” Nearly a decade and a Ph.D. Barreto explained. from Baylor College of Medicine Animals also prefer mates with later, Barreto set her plan into complementary immune systems action. While attending a workshop and communicate this information hosted by Enventure—a grassroots through olfactory cues. The genes life science startup community in associated with their immune sys- Houston—she met Bin Huang, Ph.D., tems are tethered to pheromones, who became the co-founder and chemicals animals produce and chief technological officer emit that influence all sort of behav- of Pheramor. ior among others in their species— “I pitched the idea at their including sexual attraction. accelerator program and Bin, who But there is no hard science on was a doctoral candidate at Rice humans releasing or picking up University at the time, also pitched on pheromones, in part because an idea, but then at the end, when we animals use the vomeronasal organ had to make teams, he came up to (VNO)—a gathering of sensory cells me and said, ‘Forget my idea, I want in the nasal cavity above the roof of to do your idea,’” Barreto recalled. the mouth—to detect pheromones, “I know the genetics behind attrac- and humans do not have a function- tion and Bin knows the techy side ing VNO. ➟ and he is on the back end writing the algorithm that is literally matching people.” Pheramor brings couples together after analyzing a seg- ment of each candidate’s human leukocyte antigen (HLA) gene Brittany Barreto, Ph.D., is the CEO and co-founder of Pheramor, a dating app. complex—proteins that regulate the immune system—and social media history. It is one of a ears before she became a handful of companies launched Ygenetic scientist, Brittany over the past decade that uses Barreto dreamed of creating a genetics to determine romantic way for people to find love compatibility. through DNA. The HLA complex helps the “I just thought it would be so immune system distinguish cool to connect people on a roman- the body’s own proteins from pro- tic level using their DNA,” said teins made by foreign invaders, Barreto, co-founder and CEO of such as viruses and bacteria. Pheramor, a dating app that aims “We are seeking a partner that to measure compatibility using has a different immune system
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 It’s nothing like designer babies or any- thing like that. It is, essentially, how do your genes affect who you are attracted to and who you jive with the best? How is that inscribed in
your genome?
— BRITTANY BARRETO, PH.D. CEO and co-founder of Pheramor
That’s why Pheramor takes a Pennsylvania, told Wired magazine: cheek swab from clients for DNA “The notion that there are these sequencing, rather than try to magical genes that are somehow link human attraction to smell. associated with smells that perme- (Confusingly, though, the compa- ate the environment and dictate ny’s name merges “pheromone” our attraction to people is total with “amor,” the Spanish word nonsense. If human pheromones for love.) As the company notes actually elicited the kinds of behav- on its website, pheramor.com: iors we see in other mammals, the “Pheramor fully appreciates that subways of New York City would be the science of pheromones requires in a constant state of mayhem with more research.” people hopping all over each other.” Pheramor also recognizes Barreto and Huang launched that humans are highly social. To the Pheramor app officially in Rapid Response account for this in the matchmak- September 2018. ing process, the team at Pheramor “We have thousands of active analyzes candidates’ social media users and have grown 50 percent Wound Care. histories before they are matched month over month,” Barreto said, with potential suitors. but declined to disclose the compa- Whether it’s a severe wound to the lower extremities or “Humans are a more compli- ny’s revenue. a small sore or blister that just won’t heal, Doctor Randal cated animal,” Huang explains. Once users download the app, Lepow has the solution. He is Board Certified in Wound “Fifty percent is genetics, but the they receive a DNA kit, do a cheek other 50 percent is what do you swab, return the kit and wait for their Care and knows the importance of fast intervention and like to do? What are your common sequencing to be done. treatment. He is available to consult with in-hospital interests? We try to extract this “The app is free, but we charge patients or on an outpatient basis. information from your social $30 for the DNA testing,” Huang media data because we don’t explained. “The processing time want people to answer everything for the kits takes 21 business days, Don’t let a small wound turn into a big problem. themselves.” but the processing for us can take Antibiotics alone usually aren’t the answer. Contact our Some research supports around one month.” office today to arrange a consultation. Pheramor’s DNA matchmaking. The DNA kits are processed at a A 2016 study published in Scientific lab and then returned to Pheramor. Reports found that the HLA com- Once the data has been collected, plex mediates mate behavior in users gain access to six profiles humans and that subjects were per day on the app. The profiles generally most satisfied with are weighted based on physical their relationship if their partner proximity of clients first, then on the exhibited a dissimilar HLA type. gender and age each client speci- Researchers found that HLA dissim- fied. If two people like each other’s ilarity correlates with partnership, profiles, they can begin messaging sexuality and enhances the desire one another. to procreate. In the four months the Pheramor But among scientists, the idea app has been live, more than 40+ years of experience of human pheromones remains a 5,000 messages have been shared Board Certified, American Board of Foot and Ankle Surgery hard sell. In 2018, Richard Doty, a between users and 20 couples have professor of otorhinolaryngology deactivated their accounts because and director of The Smell and they have met a solid match, Barreto lepowfoot.com Taste Center at the University of and Huang said.
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8 t m c » p u l s e | f e b r ua ry 2019 Barreto even found her own romantic partner with a cheek swab. “As the CEO of a dating app, it would be unethical for me to meet someone on the app, but occasion- ally I do market research on other dating apps so I have 20 of them on my phone,” she said. “I opened one of the dating apps and I had a message from a lovely man, but the message was about a month old and it was actually a really sweet mes- sage, but he was a redhead. … I’ve never dated a redhead. I like dark features, or so I thought.” The two ended up going on a date and hitting it off, at which point, Barreto asked the redhead if she could swab his cheek to see if they were a match. Barreto and Bin Huang, Ph.D., co-founder and chief technological officer of Pheramor, share a laugh. It turns out they were in the top 10 percentile of compatibility. but it’s in your DNA. I thought I through DNA. They hope to launch the get-go by decreasing the num- “This is why we are changing needed someone with an MBA who it this summer. ber of bad first dates they have to dating by using data,” Barreto said. owned their own company, as well, And to those think Barreto’s go on so they can find compan- “I never thought I wanted a redhead and James is an elementary music work sounds superficial, she has this ionship and be happy. … We are because I thought I didn’t like them, school teacher and we jive so well.” to say: “Instead of working on some- humanizing dating using data. We but I do. I had all of these social con- Barreto and Huang are working thing for a patient who is already are making people give humans a structs in my mind of what I thought on another website for existing in the hospital and super sick, let’s second chance.” I should be looking for in a person, couples to test their compatibility make people’s lives better from
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t m c » p u l s e | f e b r ua ry 2019 9 10 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 Spotlight
Cardiothoracic surgeon. Serial entrepreneur. Inventor. All of these titles apply to TODD ROSENGART, M.D. In 1997, he was part of the team that performed the world’s first viral-based cardiac gene transfer procedure. Later, Rosengart co-founded Vitals.com, a website that allows patients to find and rate doctors, and then XyloCor Therapeutics, a startup that aims to use cardiac gene therapy to treat patients with end-stage coronary artery disease. A professor and chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine and a professor of heart and vascular disease at the Texas Heart Institute, Rosengart also holds 12 United States patents.
Q | What motivates you to create? Q | Is this why you chose to become a Q | How did your interest in fixing things A | I’m definitely a ‘let’s fix it’ type of person heart specialist? lead to entrepreneurship? and I want to make a difference. The work that A | Subconsciously, because he died of heart A | Operating is phenomenal, but being able to I do on behalf of the department or the college— disease, I thought I was going to be a cardiolo- do something that helps many, many people with from fixing someone’s heart or helping other gist. I’m a big believer in serendipity. My mentor the same effort is really cool, too. When I was at surgeons—is very important. at Northwestern was the chief of cardiology— Northwestern, one day I got a phone call—this is Michael Lesch, M.D., who co-discovered Lesch- before Facebook and before cell phones—from an Q | Why do you think you became a Nyhan syndrome [juvenile gout]—and he said: uncle who needed a cardiologist. I gave my uncle medical problem solver? ‘You’re going to be a great cardiologist. I want you a name and I thought: ‘This is so crazy. If my uncle A | My dad passed away doing exercises when to spend the summer at NYU.’ It was all a mistake had not called me, he would not have had access I was 16—from a heart attack. I came home from because I did this as a second-year student and, to good information about a good doctor. Why high school one day and there were ambulances typically, you don’t do a clerkship until you’re a is this?’ I helped start this company called in front of my house on Long Island. This is 1976. third-year student. It took about a month before Vitals.com. We created this website that had infor- Bypass surgery is still relatively new. Even though they figured out that I didn’t belong there, at mation on physicians all over the country to bet- my dad was a recently educated physician, an which point I’d really become a member of the ter communicate with people. It’s very frustrating obstetrician, the news had not gotten to him— team. By the end of the summer, I said: ‘I love when people are forced to make decisions without or at least in a way he understood—that he prob- these surgeons. They’re so cool. They do great information that should be readily available to ably could have had surgery and be alive today. things.’ I went back to Northwestern and told them. So many bad things happen because we Somehow, that was a disconnect. Subliminally, Dr. Lesch I was going to be a heart surgeon don’t communicate well. It’s been a very signifi- that concept of making sure people are well- rather than a cardiologist. I ended up going to cant element of what I’ve tried to do, though I’m informed has been very important to me. NYU and starting my career there. not really involved in Vitals anymore. ➟
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 11 I think we are at an inflec- Q | How did you decide to focus your a little bit of temerity to go beyond where you website on the patient perspective? should be and persevere to do it. If you feel like tion point on how we take A | When we were doing Vitals, my partner— you’re doing the right thing and you’ve done your care of each other and how who is a business guy—said we were going to homework, don’t be shy about persevering on it. we take care of our patients. get the patient perspective. I said: ‘The patients We are now ready to start a new trial here in the don’t understand; we need the doctors’ perspec- Texas Medical Center—same work, taking it to the Between artificial intelligence tive.’ I allowed my partner to convince me I was next level 20 years later. and genetic engineering, I wrong and it turns out the patient perspective, in think we are going to live many ways, was more valuable than the doctors’ Q | What’s the advantage to the body perspective and that’s the way we ended up doing decades longer. I think we are growing its own bypasses? it. At its peak, Vitals.com was getting about 15 mil- A | For some patients who have advanced dis- going to live healthier. I think lion visitors a month. The value was the patient ease, typically because they are diabetics, there is we’re going to look back on perspective. We were early to the online reviews. nothing we can offer them [to restore blood flow how we take care of patients to the heart]. They are literally incapacitated with Q | Can you describe your work with gene angina or chest pain. And when we do bypass or
in 10 years and say: ‘What therapy and heart disease? angioplasty, often we can’t revascularize or get were we thinking?’ A | I was a junior faculty member at Cornell good blood flow to the whole heart. We know [New York-Presbyterian Hospital and Weill statistically that patients who don’t get adequate Cornell Medical Center] and we were doing this blood flow to the entire heart won’t do as well. work with gene therapy and having the heart grow This gene therapy can be used as an adjunct to its own bypasses. We had no business thinking standard therapies like bypass or angioplasties. about injecting a virus into the human heart or About two years ago, I was at a Texas Heart doing cardiac gene therapy. No one had ever done Institute transplant review board and these it before. But we said: ‘Why not?’ We were the first patients had such incapacitating angina that they ones ever to treat someone with gene therapy for were candidates for heart transplants. They were heart disease. I was 38 at the time. It’s something going to take this poor person’s heart out with I talk to my residents and students and junior perfectly good function. This is an alternative. faculty about. Believe in what you’re doing; have
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12 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 HC_WU_TMCPulse_CouplesAlt_GPTW_2_2019.indd 1 1/3/19 2:16 PM Q | What’s the latest on XyloCor? tremendously rich time with my wife, Debbie. We A | In a couple of months, we will be treating golf together. We have two dogs that we love and patients with end-stage coronary disease. that we walk. Truly, my comfort zone is work, but we travel and see friends and family. Q | Is the clinical trial for patients to grow their own bypasses ready to go? Q | You turned 59 in January and have A | Yes. We are finalizing approvals. We have a trim physique. What is your personal FDA approval. We have independent review board health regimen? approval. We are hoping to do our first patient A | I was never a big believer in training until I here at Baylor St. Luke’s before the summer. started doing it. Now I realize: How could you not? I do an hour in the gym two or three times a week Q | You lead hundreds of people at Baylor. and eat well. My dad died of a heart attack, so I How do you approach running one of the am careful on that. One of my other hats is that nation’s largest surgery departments? I am president of the Society of Surgical Chairs. A | We have 150 faculty, 130 trainees and staff. We have a major national initiative to ensure the What I love about being the chairman of the well-being of physicians as we get older in terms department with so many wonderful people is of our cognitive function. We are actually going to Believe in what you’re that everyone becomes a force multiplier. To try to launch a national campaign to teach physi- help everyone become successful really brings cians how to take care of our cognitive aging. The doing; have a little bit of me joy. I give out the book Team of Teams by physician workforce is growing older and there is temerity to go beyond where General Stanley McChrystal all the time. I love a shortage of physicians. We want to make sure you should be and persevere what he said: He is an enabler. He is there to make we train those physicians in their cognitive health it possible for everyone else to do what is within when they are 50 or 60 so that they can continue to do it. If you feel like you’re their ability as a servant-leader. It’s the first book to contribute. I also play backgammon to take care doing the right thing and I underlined in 30 years. He talks about empow- of my mind. you’ve done your homework, ering people, disseminating information, giving
everyone a voice and giving people the ability Q | What’s on the medical horizon that don’t be shy about persever- to get done what they want to get done. What I excites you? ing on it. love about the TMC—and it’s the first thing I talk A | I think we are at an inflection point on how about when we are trying to recruit someone— we take care of each other and how we take care is that everyone supports each other here. If Jim of our patients. Between artificial intelligence Allison wins the Nobel Prize at MD Anderson, I and genetic engineering, I think we are going to am proud of that. That’s rare. You don’t see that in live decades longer. I think we are going to live New York and Chicago. It’s a zero-sum game in healthier. I think we’re going to look back on how many places, unfortunately. we take care of patients in 10 years and say: ‘What were we thinking?’ It’s just very primitive. I think Q | Was there any moment that crystallized artificial intelligence will play a major role in diag- your view of Houston? nosis and picking treatments. We now have com- A | I had not experienced anything like puters that can give us an early warning of sepsis Hurricane Harvey. I did not fully appreciate what that is completely changing the mortality risk happens. When I heard over that weekend that of critically ill patients. That is very simple and the department and everyone else had already yet it’s been a game changer. I think in the next established ‘go’ teams, I said: ‘What?’ People five years we will expand that to 80 or 90 percent took it upon themselves to say: ‘I am here for the of diagnoses and treatment. It’s both scary and duration.’ They did it without being asked and wonderful, which means the role of the physician they did it without being expected to be thanked is going to change dramatically. It is impossible or recognized, which is amazing to me. In the next for physicians now to really keep up with all the thought, I said: ‘Well, of course. That’s what this guidelines in evidence-based medicine and the place is all about.’ That’s what you have to love computers are going to do that. But, just like the about Houston and the Texas Medical Center. pilot monitoring autopilot’s takeoff and landing, We’ve recruited 120 faculty and that sense of we’re going to be there to make sure that it all collaboration and collegiality comes through. fits and that our patients, as human beings, are comforted and supported and helped in the Q | November marked six years since you decision-making—which a computer is never arrived in Houston. You’re an empty nester. going to be able to do. What do you do for fun or outside of your Todd Rosengart, M.D., was interviewed by Pulse assistant various professional pursuits? editor Cindy George. The interview has been edited for A | My son, Eric, is 25. He is in New York—in real clarity and length. estate. Michael is 27 and he’s a clerk for a fed- eral district court judge in Tampa, Florida. It’s a
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 13 New HQ for TMC Police The station will be located in the heart of the campus
By Ryan Holeywell
The new TMC Police station sits at the corner of Bertner Avenue and Holcombe Boulevard.
he Texas Medical Center Police will relocate “It was important to us to have a police station during emergencies. Tto a new, centrally located headquarters this located in the heart of our campus,” said TMC The project also includes improvements that spring in order to better serve the growing President and CEO William “Bill” McKeon. “This make Bertner Avenue—which passes under a TMC community. facility will allow our police and security officers garage—more inviting to pedestrians. The side The new facility, located at the corner of to continue serving the hundreds of thousands of of the police station is outfitted with LED lights, Bertner Avenue and Holcombe Boulevard, brings people who visit our campus every day.” and additional lighting is planned for the ceiling the TMC Police into the core of the medical The move coincides with TMC’s continued above the sidewalk. A right-hand turning lane center. The department was previously headquar- investment in strengthening the police depart- was removed from Bertner Avenue, allowing for tered about a mile ment to provide a an expansion of the pedestrian area outside the away at TMC’s more secure campus. police station. Hermann Park John P. McGovern UN The station includes “This is a major corridor, not just for automo- IVE RS ITY Houston campus, near the BL briefing and training bile traffic, but for pedestrians and bicyclists, as VD Zoo Brays Bayou eastern edge of . rooms, modern dis- well,” McKeon said. “These changes will make the . T the medical center. S patch equipment and 88 street safer and more comfortable for everyone N The new head- I space for police and who uses it.” quarters is located MA Texas Medical Center security officers to FANNINPolice ST. Headquarters in a renovated write reports. Backup
. space that was HOLCOMBE BLVD. E generators will V
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OLD SPANISH TRAIL 14 t m c » p u l s e | f e b r ua ry 2019 Trending topics in health, science and medicine
By Shanley Pierce
E-CIGARETTES ASK THE EXPERTS: PREDICTIONS FOR 2019 REGENERATIVE AND YOUTH MEDICINE “The FDA is focused on regu- “Biologics are no lation. The CDC is focused on longer new tech- surveillance. NIH and NIDA GYNECOLOGIC ONCOLOGY nologies. Both (National Institute on Drug cell therapies “We are at the forefront of incorporating immunotherapy into our treat- Abuse) are focused on more and scaffold ment portfolio and have recently launched a broad range of research. But the reality is, technology are cutting-edge clinical trials in many gynecological cancers. we can’t solve this problem, now established In addition, there will be an increasing focus on personal- this crisis, this epidemic from as effective therapeutic tools. In ized treatments. Genetic testing for ovarian and endome- Washington, D.C. We need states 2019, multiple consortia com- trial cancer patients is key, as there are new drugs that are who control a lot of the retail envi- prised of industry, not-for-profit particularly effective in women with inherited mutations.” ronment to look at the policies, organizations and academia are the parents and teachers who actively engaged in, and com- — KAREN LU, M.D. see use on a day-to-day basis to Professor and Chair in the Department of Gynecologic Oncology and Reproductive mitted to, solving the greatest become aware of these products Medicine at The University of Texas MD Anderson Cancer Center needs to enable manufacturing of and to understand organs and tissues—illustrating the steps they that the field has come of age and can take to is worth the investment.” help us turn around this HEALTH POLICY POPULATION HEALTH — DORIS TAYLOR, PH.D. Director of Regenerative Medicine epidemic.” “This is an “In health care, I expect the polit- Research at Texas Heart Institute ical debate will go in one of two exciting time in — JEROME ADAMS, M.D. directions. One direction will be terms of both U.S. Surgeon General around modifications, expansions unprecedented TECHNOLOGY and improvements in Medicare vaccine access “Operations performed in the GENETICS as a vehicle for ensuring access to and the introduc- abdomen, pelvis, chest, cardiovas- tion of new vaccines. “Genomic technologies, like health care and with a particular cular and neurological systems Unfortunately, opposing these gene editing and low-cost DNA recipe for handling costs. … The will continue to become more exciting trends is a growing and sequencing, will continue to second touchstone is around the targeted with the expanded ominous anti-vaccine movement, transform the fields of human Affordable Care Act, its promise use of ever more sophisticated now well established in North genetics and medicine. In the new and potentially its intraoperative image guidance America and Europe, but working year, we will see continued exam- substitution. The and pre-procedural planning with its way into … Africa, Asia and ples of clinical successes of gene ACA is still enhanced functional and struc- Latin America. … The anti-vaccine therapy and gene editing in the functioning, tural imaging platforms, from CT movement successfully blocked treatment of somatic tissues or but it’s going to to MRI to PET. Gloved surgeons’ vaccination programs for measles, organs, especially in rare genetic undergo some hands will increasingly rarely feel influenza, and other childhood diseases and cancer. In contrast, challenges.” the warmth of the patient’s body vaccines, as well as the introduc- the scientific and ethical opposi- as technologies and tion of new HPV vaccines for cer- tion to germline gene editing will — STEPHEN LINDER, PH.D. devices … fill Associate Director of the vical cancer, so we must continue raise society’s awareness to guard the interface Texas Medical Center our efforts to debunk vaccine against rogue exper- between the Health Policy Institute myths in the years to come.” iments while also surgeon and supporting con- patient’s body.” tinued thought- — PETER HOTEZ, M.D., PH.D. Dean of the National School ful debate on — BARBARA BASS, M.D. of Tropical Medicine at Executive Director of the Houston this topic.” Baylor College of Medicine and Methodist Institute for Technology, Director of the Texas Children’s Innovation & Education (MITIE) — BRENDAN LEE, M.D., PH.D. Center for Vaccine Development Chair of Molecular and Human Genetics at Baylor College of Medicine
t m c » p u l s e | f e b r ua ry 2019 15 Chilling at Cool Acres The Brazos River retreat owned by the late Denton A. Cooley, M.D., was home to the annual St. Luke’s family picnic
By Britni R. McAshan
n 1958, pioneering cardiovascular surgeon as many friends as we could pile in, and go out to transplant in the United States—a bold act that IDenton A. Cooley, M.D., purchased a Brazos what we would call ‘the farm.’” famously fractured his relationship with his River retreat for his family that was not too Located in Orchard, Texas—about 30 miles mentor, Michael E. DeBakey, M.D.—and became far from their Houston home or from Cooley’s south of Houston—the 406-acre compound the first heart surgeon to implant a total artificial patients in the burgeoning Texas Medical Center. spreads across nearly one mile of riverfront heart in a human. He christened the ranch Cool Acres. property. The ranch sits on a bluff 115 feet above He was 96 when he died in 2016. And today, “My father worked seven days a week,” said the Brazos River and includes five homes built Cool Acres is for sale, with an asking price of Susan Cooley, Ph.D., a nurse and former profes- between 1960 and 1982. In addition to a pond $7.3 million. sor at The University of Texas Health Science named Lake Louise—after the surgeon’s wife— For decades, though, Cool Acres was more than Center at Houston, who is one of the physician’s the property holds two tennis courts, a pool, a a place for the Cooley family to play and relax. five daughters. “He worked Saturdays until 2 p.m. roller skating rink and party pavilion, stables The property also served as the site of the annual and then had to be back on Sunday afternoon. for horses and even Orchard’s original post St. Luke’s family picnic for many years. Starting He would come home after Grand Rounds on office building. in 1960, Cooley and his family welcomed staff Saturday, honk the horn and we would all jump Denton A. Cooley was a busy heart surgeon from what was then St. Luke’s Episcopal Hospital. in the car with my mother, the fried chicken and who performed the first successful human heart Doctors, surgeons, nurses, residents and their
16 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 Far left: House No. 4 at Cool Acres appeared in Architectural Digest. Top row, this page: Denton A. Cooley, M.D., left, with O.H. “Bud” Frazier, M.D., center; James “Red” Duke Jr., M.D., with his first wife, Betty. Bottom row, this page: The original Orchard, Texas, post office sits on Cool Acres; The swimming pool on the property was built by one of Cooley’s patients.
families all dropped by. kind of a tradition to go out there,” Todd Frazier Susan Cooley said her parents stopped host- “It was always a funny cast of characters, but recalled. “Those are some of my earliest memories ing the picnic when her dad reached his eighties; there would be volleyball games, softball games, of playing baseball and skeet shooting. It was fun her mother also died in 2016, at the age of 92. barbecue and fireworks—just an afternoon of because the health care professionals from St. But relatives have continued to enjoy Cool everybody relaxing, drinking beer and Cokes and Luke’s who were from all over the world and had Acres for everything from weddings to holiday just having fun,” Susan Cooley said. “Dad always never experienced the Texas countryside could all gatherings. Between the five houses on the thought that people who worked together ought come together.” property—pragmatically referred to as House to know each other personally and play together.” Every year at the picnic, Denton and Louise No. 1, House No. 2, House No. 3, House No. 4 and Guests at the annual picnic included Texas Cooley took all the children on a hayride. the pool house—there are 18 bedrooms, 10 full Heart Institute surgeon O.H. “Bud” Frazier, M.D., “It was an older, historic fire truck and they bathrooms and three half bathrooms. ➟ who trained as a resident under Cooley. would do a hayride at night when all of the fire- Frazier’s son, Todd, who directs the Center for flies were coming out,” Frazier said. “It was just Performing Arts Medicine at Houston Methodist really informal and relaxing and I think he just Hospital, remembers the picnic well. wanted to make everyone feel welcome and show “I went every year when I was a kid; it was them a good time.”
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 17 My father worked seven days a week. He worked Saturdays until 2 p.m. and then had to be back on Sunday afternoon. He would come home after Grand Rounds on Saturday, honk the horn and we would all jump in the car with my mother, the fried
chicken and as many friends as we could pile in, and go out to what we would call ‘the farm.’
— SUSAN COOLEY, PH.D. Daughter of Denton A. Cooley, M.D.
Each structure differs vastly in architectural photographs of Cooley family members with style and interior aesthetics, but all were designed everyone from trauma surgeon James “Red” Duke by Denton A. Cooley. Many of the furnishings of Jr., M.D., the founder of Memorial Hermann Life House No. 4 are originally from the historic Hotel Flight, to Princess Anne, the British royal and only Galvez in Galveston, one of the surgeon’s many daughter of Queen Elizabeth II. business ventures. That house was also featured “Going through their stuff, there are so many Cooley prepares to pitch at the annual picnic’s in Architectural Digest. A former patient was so questions,” Susan Cooley said. “You know, why softball game. (All picnic photos courtesy of inspired by the home, he painted a rendering were we in Italy with Bing Crosby? Why were we Susan Cooley.) for Cooley. visiting the Pope at his summer palace?” “He was a very famous Russian artist and he Her eldest sister, Mary Cooley Craddock, More than two years after the passing of their wanted to paint a picture of the ranch, so he came explained why the family was in Italy that parents, the sisters are eager for another family to out, drew it and then took it back to Russia,” Susan summer. make memories at Cool Acres. Cooley said. “He shipped back this painting of “A very generous patient from Florence “My parents were always here,” Susan Cooley Cool Acres in the snow. It doesn’t snow out here, arranged the whole thing because Dad really said. “I don’t even know what it’s like being here but we still kept it.” wanted to get the Pope’s blessing about the without them.” At the moment, each of the homes on the heart transplant,” Craddock said. “He did property is filled with letters, mementos and give Dad his blessing.”
18 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 New technology and techniques
By Shanley Pierce
Mending a hole in the heart
efore birth, babies rely on their mothers for oxygen. A mother’s oxygen-rich Bblood travels from the right atrium to the left atrium of a baby’s developing heart through a small, open flap called the foramen ovale. All babies are born with this tiny hole in their hearts, but in most cases the hole closes within six months. For a quarter of the population, though, the hole never closes, a condition known as patent foramen ovale (PFO). This opens the door for recurring strokes. Enter Richard Smalling, M.D., director of interventional cardiology with McGovern Medical School at UTHealth and the Memorial Hermann Heart & Vascular Institute-Texas Medical Center. Smalling led an eight-year nationwide clinical trial to study the safety and efficacy of the Amplatzer PFO Occluder, a device that can patch up this congenital heart defect in less than an hour. The trial ended in late 2011 and follow-up data from nearly six years later shows the device reduces the risk of recurrent stroke by 45 to 62 percent. “The beauty of it is: It’s delivered via a catheter that we insert through a vein in the leg,” Smalling explained. The PFO Occluder is outfitted with two discs made of woven nickel titanium mesh, one the size of a nickel and the other the size of a quarter. Before the device is inserted in the catheter, it is stretched to assume the shape of the tube. Once the catheter enters the left atrium through the hole in the heart, the smaller mesh disc expands and tugs against the wall between the heart’s two upper chambers to col- lapse the flap. The second, larger disc springs open as the catheter is retracted in the right atrium. With the flap securely sandwiched between both discs, heart tissue heals over the device within six months, creating a new wall between the two upper chambers of the heart. According to Smalling, the device, which has been approved by the U.S. Food and Drug Administration, provides a simple, yet elegant, solution for many patients. “With the device, we can at least eliminate one cause of recurrent stroke,” he said.
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 19 John Barnes confronted the shooter at Santa Fe High School
By Alexandra Becker
N the morning of May 18, 2018, Officer John a fire alarm pierced the hallway and a rush of students Barnes arrived at work hungry. It was the Friday of poured out of the gymnasium. Gun by his side, he pushed ONational Police Week, and Santa Fe High School through the crowd, craning his neck as he listened for had planned an omelet breakfast for its school resource gunshots and scanning every square inch of his sight line officers—a gesture of thanks and appreciation for keeping for someone with a weapon. students and faculty safe throughout the year. Then, he said, it all went to hell. Barnes can remember the omelets, that they were sup- “People are getting shot in front of me,” Barnes posed to be served that morning. But his memory grows recalled. “And very quickly, everybody either exits out foggy when he tries to recall why he first stepped into the the door or goes past me.” hallway, where a woman approached him to report sounds Barnes was left standing in the hallway, blood smeared of gunfire. Just one month earlier, Santa Fe High, located on the ground in front of him and glass shattering behind about 36 miles southeast of Houston, had ordered a lock- him. Another Santa Fe Independent School District (ISD) down after rumors of an active shooter circulated; Barnes officer, Gary Forward, was close behind. Could there be assumed that this morning’s report, too, would turn out to more than one shooter? One behind and one in front? be a misunderstanding. Never, not once, did Barnes think his confusion would be But then the sting of gunpowder hit his nostrils. The explained away by the wide spray of small metallic spheres smell was unmistakable. from the shell of a shotgun, a weapon worshiped by hunt- Barnes quickly removed his pistol from his belt as ers for its deference to destruction above precision. ➟ t m c » p u l s e | f e b r ua ry 2019 21 Credit: Steve Gonzales/Houston Chronicle via AP via Chronicle Gonzales/Houston Steve Credit: Law enforcement responds to Santa Fe High School on May 18, 2018, after an active shooter was reported on campus.
Barnes barked into his radio, then focused his attention an addition Barnes had initially dismissed as frivolous. down the hallway. Slowly, carefully, and with his gun drawn, “It was like somebody stuck a hose in it and it was just he slid his body along the left side of the wall, using draining out,” Barnes would later say of his wound. He it, and the corner, as a shield. He was going to can remember looking down at the large hole in sneak up on the shooter. With his pistol out his arm and feeling sick. front, he hugged the corner of the wall and The two officers kept their eyes fixed on drew himself out. the hallway, waiting for the shooter to swing The assailant—Dimitrios Pagourtzis, at back around the corner at any second. Barnes the time a 17-year-old student, is accused of the kept telling Forward to leave; the thought of shooting rampage at the school—was standing a colleague taking a bullet while tending to his there with his father’s shotgun, waiting. The teen- arm was unbearable. ager allegedly pulled the trigger as soon as he saw the But Forward refused, and once the tourniquet was officer’s right arm. secure, he held open the door to a nearby dance classroom Only 60 seconds had passed since Barnes first stepped so that Barnes could crawl inside. Then Forward left— out of his office. back to the hallway, to the corner and to the shooter. Soon, a group of officers found Barnes and helped him to his * * feet. He only made it about 10 yards before collapsing to the ground. Shotguns are not loaded with the same slick, ogival- “Drag me, just drag me, just drag me,” he remembers nosed bullets found inside handguns or assault rifles. pleading. With the threat of the shooter looming, one of Instead, they use shells packed with tiny metallic projec- the officers, unthinking, grabbed Barnes’ right arm. Pain tiles known as shot. Once fired, the shot sprays the target, stunned his whole body. creating multiple entry points; if a shooter’s aim is off, he or Ultimately, Barnes was dragged out of Santa Fe High she may still hit a target’s periphery. by his duty belt, leaving a trail of blood behind him. Every shotgun shell holds a certain number of pellets. Paramedics lifted him onto a stretcher as close friend and In Barnes’ case, at least three pellets tore through his right fellow Santa Fe ISD officer Elizabeth “Cibby” Moore rushed arm, shredding his brachial artery, a main thoroughfare to to his side. They could still hear the roar of gunfire inside the heart. Barnes, a husband and father of two, would have the school. bled to death within minutes had it not been for Officer Barnes felt faint, his head somehow both airy and Forward, who pulled a tourniquet from his vest and swiftly weighted, like he was floating under a lead blanket. His wrapped it around his friend’s arm. The team had only blood was everywhere but inside his body. Amid his haze, begun to carry the military-grade devices a month earlier, he could make out that he was riding in an ambulance.
22 t m c » p u l s e | f e b r ua ry 2019 People are getting shot in front Flight pumped two units of blood into his body and he was intubated and fitted with a LUCAS device, a mechanical of me. And very quickly, everybody chest compression system that pulsed his heart with sys-
either exits out the door or goes tematic accuracy, automating its beat. past me. By 8:31 a.m., less than an hour after he had been shot, Barnes was lying in exam room 102 at UTMB. He woke — JOHN BARNES briefly for about 30 seconds, and although he couldn’t open Former school resource officer at Santa Fe High School his eyes or even wiggle a finger, he could hear the trauma team calling out orders. He was lulled back into uncon- sciousness with the assurance that people were trying to Then, he caught a glimpse of a helicopter. A veteran of the save his life. Houston Police Department, Barnes knew Life Flight was his best chance at survival. He turned to the nurse beside * * * * him and mustered the strength to speak. “Get me on that [expletive] helicopter, or I’m going to Trauma teams are charged with preserving life and die,” he said. keeping death at bay. Like school resource officers, police and EMS personnel, they are a first line of defense in a * * * medical crisis. A typical UTMB trauma team is made up of a physician Word of a school shooting in Santa Fe first made its way faculty member, three residents and emergency room to the trauma center at The University of Texas Medical nurses. The team worked on Barnes for 50 minutes in the Branch at Galveston (UTMB Health) when an alert was emergency room; they inserted a catheter, took an X-ray pulsed out over Emergency Medical Services (EMS) dis- at the bedside to peer inside his ruptured arm, and packed patch radio. Abby Anderson, a registered nurse working the wound with QuickClot combat gauze—a fabric impreg- that morning, said that after one of her coworkers got a call nated with a clay derivative that clots blood. A nurse initi- from a student running away from the high school on foot, ated a massive transfusion protocol and, shortly thereafter, she and the trauma team began to prepare for victims. This coolers of blood and plasma and platelets arrived from is real, Anderson remembered thinking. This is happening. the local blood bank. They filled Barnes with five units of Meanwhile, up in the air with helicopter blades whirring packed red blood cells, desperately hoping to replenish all above him, an unconscious Barnes had flatlined—his heart that he had lost. ➟ stopped beating. The nurses on Memorial Hermann Life
Barnes visits exam room 102 at The University of Texas Medical Branch at Galveston, where he was first treated by the trauma team after arriving in the emergency room.
t m c » p u l s e | f e b r ua ry 2019 23 William “Bill” Mileski, M.D., chief of trauma services at UTMB, helped the team stabilize Barnes so that he could be transferred to the operating room for surgery. Described by colleagues as a bear without claws, Mileski can come off as gruff, but if you are in near-irreversible shock from hemorrhaging, you want him in the room. When a body loses as much blood as Barnes’ did, it pools whatever reserves it has left and drives that blood to the core—one last-ditch effort to survive. But if organs like the kidneys and liver are deprived of blood for too long, their cells begin to die. When the condition hits a critical point, it is called irreversible shock. The patient will enter kidney failure, liver failure, respiratory failure, or all of the above, and it is almost always fatal. The trauma team at UTMB worked to get Barnes’ blood pressure up to a point where blood and oxygen could still reach his brain—if only barely. At 9:21 a.m., they packed up the coolers of blood, steadied the gurney and rushed him to the OR.
* * * * * William “Bill” Mileski, M.D., is chief of trauma services at UTMB.
Cibby Moore raced down Interstate 45 toward UTMB in her police cruiser, lights and sirens screaming. Beside swept over Ashley. her was Barnes’ wife, Ashley, at the time a vice principal at “As soon as I heard that I was like, ‘OK, we got this. Wollam Elementary School, located just three miles east of We’re in the arm. It’s not in the chest. He’s alive,’” she Santa Fe High. later recalled. Ashley knew her husband had been shot, but nothing When the two finally reached UTMB’s waiting room, else. Finally, Moore turned to her. “Do you want me to tell Ashley took note of the swarm of police officers. How nice, you what happened?” she thought. But when she was escorted from the main Ashley nodded and braced herself. Moore told her that area to an isolated room nearby, she grew nervous. her husband had been shot in the arm. A wave of relief Why do I have to be in the ‘Your-husband’s-dead room?’
Barnes signs a poster at UTMB during a visit in August 2018.
24 t m c » p u l s e | f e b r ua ry 2019 Ashley took deep breaths. She reminded herself that it was just a gunshot wound to the arm, oblivious to the severity of his injury. Moore remained by her side, her uniform splat- AREA OF IMPACT tered with blood. When Ashley finally noticed, she knew, without question, that the blood belonged to her husband. Family and friends circled through their small room. Police officers came to pay their respects, even Houston Police Department Chief Art Acevedo. Finally, hours after Ashley had arrived, Mileski appeared. “He is very sick,” the surgeon told her. “He is very sick.” Heart * * * * * * Brachial artery In the operating room at UTMB that morning, anesthe- sia was started at 9:23 a.m. The surgeons’ task: determine exactly what damage had been done to Barnes’ body and SHOTGUN what needed to be repaired. Everything was recorded in WOUND what would ultimately become nearly 900 pages of medical Radial records. A “problem list” outlines the severity of Barnes’ artery condition:
Ulnar Gunshot wound artery Traumatic hemorrhagic shock AKI (acute kidney injury) ATN (acute tubular necrosis—kidney disorder from damage to the tubule cells) Shock liver Laceration of right brachial artery Olecranon fracture Shotgun pellets shattered John Barnes’ right elbow, cutting across the brachial artery where it splits into the radial and ulnar arteries of the forearm. Pellets from the shotgun had shattered Barnes’ right Because the brachial artery is a main thorough- elbow, including the tip, known as the olecranon. The blast fare to the heart, Barnes lost blood rapidly and transected the brachial artery just where it splits into the flatlined on Memorial Hermann Life Flight en route radial and ulnar arteries and tore a hole along the front of to UTMB. The severe blood loss left him in a state his forearm. It was no wonder he couldn’t keep blood inside of hemorrhagic shock, indicating a lack of oxygen his body. at the cellular level; his kidneys, lungs and liver By 10:20 a.m., the team began to reconstruct the were threatened. Surgeons at UTMB reconstructed the arteries in his arm using veins from his leg and arteries, harvesting fragments of Barnes’ saphenous forearm. Then, they stabilized his elbow joint and vein (which runs the length of the leg) and right forearm closed the large opening in his forearm, grafting cephalic veins (large veins often used for drawing blood) skin from his leg to cover the area. for the repair. Three-and-a-half hours later, with a strong pulse in place, the team set to work stabilizing Barnes’ elbow joint using pins and an external fixator. Finally, they closed the large opening in his forearm with the help of wound-VAC, a vacuum-assisted technique that decreases * * * * * * * air pressure in and around the wound to promote healing. Last, they grafted skin from his leg to cover the large, Dimitrios Pagourtzis is accused of killing 10 people in delicate area. Santa Fe, Texas, and wounding 13, including Barnes. The surgeries, finally over just after 4 p.m., required More than half a century ago, on Aug. 1, 1966, another expertise verging on perfection, but Mileski would look Texas city ushered in the first mass school shooting in back on those first seven and a half hours and say that it modern America, when a 25-year-old engineering student was nothing heroic. at The University of Texas at Austin climbed the campus “We’re pretty well conditioned to respond to the needs clock tower with an armful of guns and ammunition and of patients and prioritize what we have to do to get them shot and killed 15 people. well,” he said. “You don’t really think that much, as silly Since then, the names of the schools around the country as that sounds. It’s like a football player playing football— where students and faculty have been gunned down are you react to the circumstance, you don’t sit there and run forever fixed in public memory. Columbine. Virginia Tech. through a lot of thought, at least not if you’ve been doing it Sandy Hook. Marjory Stoneman Douglas. Santa Fe. There for 30 or 40 years.” are many, many others. ➟
t m c » p u l s e | f e b r ua ry 2019 25 It’s difficult to describe the ravages of severe hemorrhage. He had lost as much blood as a person can lose and still survive. Honestly, I was
surprised he did survive. I didn’t think his kidneys were going to come back, or his lungs, for as sick as he was. But he got lucky.
— WILLIAM “BILL” MILESKI, M.D. Chief of trauma services at UTMB
Increasingly, districts are hiring school resource Despite more than two decades in law enforcement, officers to protect students from dangerous situations, May 18, 2018 was the first time Barnes had ever been shot. including mass shootings. They are usually armed. School resource officers are commissioned, sworn law enforce- * * * * * * * * ment officers—not security guards—trained to move directly to any threat, as quickly as possible, and then When Ashley was finally able to see her husband in the to neutralize the threat to prevent loss of life or injury, intensive care unit (ICU), his skin was void of color, ashen, according to The National Association of School “almost all the way through,” she recalled. His body was Resource Officers. freezing to the touch. An estimated 20 percent of all U.S. K-12 schools, public Barnes came close to losing all the blood in his body, and private, are served by school resource officers. Mileski said. John Barnes had been a school resource officer for just “It’s difficult to describe the ravages of severe hemor- four months when he rushed toward the sound of gunfire rhage,” the trauma surgeon later explained. “He had lost as at Santa Fe High. Barnes spent nearly 25 years as a police much blood as a person can lose and still survive. Honestly, officer with the Houston Police Department, 10 of those I was surprised he did survive. I didn’t think his kidneys patrolling some of Houston’s toughest neighborhoods and were going to come back, or his lungs, for as sick as he was. another 13 doing detective work, making a name for him- But he got lucky.” self investigating sex crimes. In January 2018, hoping to Barnes cannot recall anything from his first week in slow down a bit and prepare for retirement, Barnes began the hospital. In all, he spent nearly three weeks in the ICU, working at Santa Fe ISD. undergoing dialysis to support his kidney function. On June 6, he was discharged and sent to TIRR Memorial Hermann in Houston for inpatient rehabilitation. Then, on Wednesday, June 20, he was finally well enough to go home. Nine days later, he celebrated his 50th birthday. In August, Barnes made a special trip back to UTMB. He and his wife, with coffees in hand, spent a morning in the ER and at Sealy Hospital, meeting the people who saved his life. Nurse Abby Anderson, one of the first to treat Barnes on that May morning, spoke up. “We never get to see this side. We send people that were in your condition to the OR, or up to the ICU, and then we’re done,” Anderson told Barnes. “We may find out from the trauma team later how they’re doing or, you know, what happened, but that’s it. That’s as far as we get. You know, I’ve been doing this for five years, and there’s always patients that stick with you, and you stuck with me for some reason.” Standing in exam room 102, where crisp white sheets stretched across an empty bed, Barnes grew emotional, thanking those who surrounded him for, in his words, being so good at their jobs. He knew how much that mattered; ballistic analysis would eventually reveal that Barnes’ aggressive march toward the alleged shooter kept the teen- ager contained, that despite classrooms full of students
Barnes gets emotional in August 2018 while visiting with members of the team who cared for him at UTMB.
VISIT TMCNEWS.ORG TO WATCH A VIDEO FEATURING JOHN BARNES.
26 t m c » p u l s e | f e b r ua ry 2019 wish lists on display. A few months prior, Barnes had awoken with a fever, and then a day later, his arm grew warm. Doctors at UTMB discovered a staph infection and operated quickly, leaving a new scar hugging the length of Barnes’ shattered elbow. It would mark his eighth surgery, with more on the horizon. Now, every day at 10 a.m., he will hook the IV to a port in his chest until his bones are finally healed enough for surgeons to remove the plate in his arm—a magnet for bacteria. Barnes believes the infection will set his rehabili- tation back at least six months, a disappointment in light of how far he’d come re-establishing his range of motion. But aside from his goals of mountain biking again and living without pain, Barnes said life is finally feeling settled. He can take trips with his family. He can enjoy a bourbon and a cigar. He can make plans for the future. “It’s as normal now as it’s probably ever going to be,” he said. “This is my life now.” Barnes sits in the dining room of his League City, Texas, home. Barnes has been shown the surveillance video from the day of the shooting. He has counted the seconds on the hiding all around them, Barnes was the last person shot at ticker and analyzed every possible scenario, wondering if Santa Fe High that day. he could have saved anyone else with the information he’d had that day. He has watched the student with the shotgun * * * * * * * * * wait for him as he turns the corner. It’s surreal, Barnes said— even at the time, he felt like he was inside a movie: His body On a Tuesday morning in early January, John Barnes was responding, his brain was reacting, but he still couldn’t sat in his home in League City hooked up to an IV drip believe it was happening. full of antibiotics. His living room still shone with the He has declined to review all the evidence from the relics of Christmas—an unlit tree in the corner, heavy with shooting, though. For now, Barnes is focused on healing. ornaments, a forgotten Elf on the Shelf, his two children’s
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t m c » p u l s e | f e b r ua ry 2019 27 A Bridge for Katlyen Texas Children’s Hospital is the first in the world to implant the Jarvik 2015 pediatric ventricular assist device as a bridge to transplant
By Alexandra Becker
Above: Katlyen Hickman enjoys lunch at Texas Children’s Hospital with congenital heart surgeon Iki Adachi, M.D. Facing page: The Jarvik 2015 pediatric ventricular assist device is the size of a AA battery.
our-year-old Katlyen Hickman “It was clear she was moving keep her alive as she waited for Fhas always been special. Even at in the direction of needing heart a new heart. birth, she defied the odds after she transplantation,” said Iki Adachi, It did—and it also put her name was diagnosed with several critical M.D., a congenital heart surgeon at in the history books. Hickman was congenital heart defects, including Texas Children’s Hospital. “She was the first patient in the United States, aortic arch hypoplasia—meaning admitted to the ICU and her heart and only the second in the world, to the vessel leaving the left side of condition was just getting worse receive the new device. her heart was too small—as well as and worse.” multiple ventricular septal defects, Adachi and his team were AA battery which required her heart to pump determined to give the spunky Ventricular assist devices can be excessively to push blood through young patient the best chance for used in pediatric patients who are her body. Despite numerous heart a long life. So, on Oct. 2, 2018, they in need of a heart transplant as a surgeries and cardiac catheteriza- implanted the Jarvik 2015 ventric- means of sustaining them until
The Future of Heart Health Heart of Future The tions in her first few years of life, ular assist device (VAD) into her they are matched with a new though, her heart was failing fast. chest, confident that it would organ—a bridge to transplant. In
28 t m c » p u l s e | f e b r ua ry 2019 One of the most significant benefits of “The Jarvik 2015 is an internal device, and the only other device we this ventricular device’s support is that we can have for this sized population is on make the patient stronger so that they can the outside of the body, but it’s very
be a better candidate for the next operation, clear that the outcome of the outside device is much worse than an inter- which is usually a heart transplant. nal device,” Adachi said. “That has been clearly shown in the adult pop- — IKI ADACHI, M.D. ulation—internal devices are better Congenital heart surgeon at Texas Children’s Hospital in general than the external devices. There is no question about it.” The Jarvik 2015 turned out to be attached to the rotor—technology The waiting game perfect for Hickman. Not only did that has been associated with As a result of extensive testing the tiny device keep her alive as she significantly improved outcomes in the Texas Medical Center, the waited for her heart transplant, but it in adults. But designing a simi- latest prototype of the Jarvik 2015 actually improved her blood flow so lar technology tiny enough to be has been approved by the FDA for much that her visceral organs recov- implanted in a small child’s chest— a clinical trial. Because it has not ered dramatically in the weeks lead- like Hickman’s—proved nearly yet been approved for commer- ing up to her surgery. Hickman was impossible. The team behind the cialization, Adachi had to obtain stronger and healthier and in much Jarvik 2015, which is approximately expanded access use from the FDA better shape overall to undergo the size of a AA battery, has been for Hickman’s procedure. He was major surgery and rehabilitation. working on its design for more than able to do so because Hickman was “One of the most significant a decade, watching each competitor too small to be a candidate for a benefits of this ventricular device’s give up and move on to a new, per- VAD made for adults, which, while support is that we can make the haps more attainable challenge. not ideal, is what Texas Children’s patient stronger so that they can After the U.S. Food and Drug typically uses on patients in heart be a better candidate for the next Administration (FDA) rejected the failure. All other options are operation, which is usually a heart device twice in 2014, Adachi came external devices, which are hooked transplant,” Adachi said, adding on board to test the current iteration up to the heart through cannulae that the practice aligns with Texas that had undergone substantial (tubing) and remain on the outside Children’s Heart Center’s clinical design modifications, including the of the body. They carry with them philosophy in general. ➟ shape of the blade. That final modifi- increased risks of side effects, espe- cation would prove to be the charm. cially strokes. “The main problem was that the previous iterations caused the red blood cells to break because it was spinning too fast,” explained rare cases, the device helps a heart Adachi, who continued his involve- recover to the point that the patient ment in the project as the principal no longer requires a transplant, and investigator of preclinical testing. in even rarer instances, it can be “So they changed the design of used as a permanent therapy for a the blade and they also increased failing heart. the size of the pump slightly so it What sets the Jarvik 2015 apart didn’t have to spin so quickly, which is that it is the first and only implant- reduced damage to the red blood able ventricular assist device with cells. But it had to stay small, which a continuous flow designed specifi- is the challenge in making a pump cally for small children. for kids versus adults. The pediatric The continuous flow is key: pump has to be smaller, despite Rather than pumping like the heart, the fact that the red blood cells it pushes blood through an impeller are nearly the same size regardless with the help of an agitator blade of age.”
t m c » p u l s e | f e b r ua ry 2019 29 The VAD not only improves survival out- come, but also length of stay in the hospital post-transplant and how quickly a patient is able to get back on their feet and get back into the swing of things as far as their
life is concerned.
— JEFF DREYER, M.D. Medical director of heart failure, cardiomyopathy and cardiac transplantation at
Above: Hickman gets a ride to the playroom at Texas Children’s Hospital. Below: Adachi in his office at Texas Children’s. Texas Children’s Hospital
“Our center is known for making failing heart on a VAD to show some survival outcome, but also length of use approval from the FDA. That pediatric patients better while wait- signs of recovery—and that the stay in the hospital post-transplant patient, like Hickman, is recovering ing for a transplant,” he said. “Unlike younger the patient, the greater the and how quickly a patient is able to well. most other centers, we intentionally chance that a heart in failure may get back on their feet and get back On Dec. 24, 2018, Hickman’s wait before moving forward with recover on this kind of support. into the swing of things as far as Christmas wish came true, and a transplant after we implant an “Most heart centers don’t pro- their life is concerned,” said she was discharged home. As time internal device. We usually wait at vide the pediatric patient with an Jeff Dreyer, M.D., medical director passes, her transplanted heart will least three months with an internal opportunity to recover,” Adachi said. of heart failure, cardiomyopathy grow with her, and although it won’t pump before activating the patient “If you transplant so quickly, you and cardiac transplantation at last forever, science and technol- on the transplant list, and not a lot may miss the opportunity to Texas Children’s. ogy are evolving quickly—and who of pediatric centers are doing this— see some signs of recovery, which Hickman will continue to be knows what therapies will exist in they want to get to transplant as is why we like to wait at least monitored over the next several the future to save her life once again. soon as possible, which is primarily three months.” months and will need lifelong “We’re buying time,” Dreyer said. driven by the sense of urgency to Adachi noted that in Hickman’s follow-up care, Dreyer said, but the “Medicine changes. I can’t exactly avoid potential complications with case, they chose not to wait three frequency of her visits will eventu- predict where things will go, but VAD support.” months since it was only the second ally drop to just three a year—two in what I do know is that the way we Texas Children’s recognizes the time ever the device had been clinic and one for a routine biopsy of practice medicine today isn’t the benefit in waiting—the benefit in implanted in a patient—the first the heart. As Adachi noted, a heart same as what we did 10 years ago re-establishing healthy blood flow being in Italy not long before—and transplant isn’t permanent, and the or 15 years ago, and so I imagine and all that comes with that, but also the first time the device was used as thrice-yearly monitoring helps heart that innovations will likely occur the rare benefit of rehabilitating a bridge to transplant. Still, Adachi centers like Texas Children’s keep over the same period of time going a failing heart, Adachi explained. anticipates that the Jarvik 2015 will an eye on their patients. According forward that will very significantly Such a practice is possible at Texas do well in the upcoming multi-in- to Dreyer, the half-life of a trans- alter the clinical course or prognosis Children’s, which has the world’s stitutional clinical trial—in which planted heart is approximately 15 to of our patients.” largest pediatric VAD program, Texas Children’s is participating— 16 years, meaning that in that period because the team is able to provide and hopes that it will soon become of time, about half stable outpatient management. widely available and lead to a world- of patients will “Occasionally, someone will wide shift in clinical management of need another heart. recover while waiting, and trans- pediatric patients in heart failure. Texas plantation becomes unnecessary,” Children’s has Adachi said. “And recovery is very, Buying time already implanted very important, particularly in a On Nov. 23, 2018, the day after another Jarvik pediatric patient, because while Thanksgiving, Hickman received 2015 in a different heart transplantation is great, it’s a new heart—then proceeded to patient suffer- not really a permanent solution.” amaze everyone with her swift and ing from heart Adachi explained that it takes steady recovery. failure, again at least two or three months for a “The VAD not only improves with expanded
30 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 Harnessing Inflammation to genetically modified to deactivate the gene that produces RhoE (a group known as knockout mice) heart health and the other designed to produce more RhoE Heal the Heart (known as transgenic mice). Researchers discover a new way to control inflammation Results showed that the absence of the protein after a heart attack led the knockout mice to experience severe inflammatory responses after a heart attack and By Shanley Pierce even poorer heart function. Conversely, the mice expressing higher levels of RhoE had a better prognosis in terms of cardiac function, recovery nflammation is the body’s natural response improving outcomes for heart patients, this new time and size of infarction (an obstruction of Ito injury or infection. After a heart attack, the biomarker could lead to targeted therapies for the blood supply to an organ). The researchers inflammatory response is an integral part of chronic inflammation diseases, Chang said, such studied RhoE expression levels in human patients the healing process, but the body must strike a as asthma and arthritis. after myocardial infarction to further confirm delicate balance. Here, the Goldilocks principle When the immune system recognizes any their theory and noticed the same result: applies: Too much or too little inflammation could sign of danger, it dispatches white blood cells to Patients with higher levels of RhoE healed cause irreparable damage to the heart. the site of the injury or infection. The white blood better and faster. “There is a huge challenge to really find out cells produce and secrete cytokines and antibod- “Turned out, this protein targets a factor called how to manipulate inflammation,” said Jiang ies that identify foreign invaders, activating the NF-kB, which is a key transcription factor that Chang, M.D., Ph.D., professor at the Texas A&M inflammatory response. regulates a whole set of inflammatory response Institute of Biosciences and Technology Center Inflammation and cell death occur after a genes,” Chang said. for Translational Cancer Research. “Both over- heart attack, as the body clears out dead heart tis- RhoE physically bonds with and inhibits responsive or less responsive [inflammation] lead sue. Excessive inflammation can cause the body NF-kB—effectively blocking it from turning on to terrible consequences for patient healing.” to destroy healthy tissue, whereas an inadequate too many inflammatory response genes. Chang and a team of scientists at the Texas inflammatory response could prolong recovery. “This is a perfect responsive strategy that A&M Institute of Biosciences and Technology In a recent study published in Circulation, makes sure inflammation is not over or under,” recently discovered a specific protein, called Chang and other researchers tested the correla- Chang added. RhoE, that they believe can be harnessed to reg- tion between RhoE and inflammatory responses ulate inflammation. Beyond RhoE’s potential for in a mouse model, using two groups of mice—one
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 31 Help for Failing Hearts TMC-based startups hope to change the way heart failure is treated
By Ryan Holeywell
ow do we combat heart failure? complications like stroke, blood of the TMC annually for HTwo startups based in the damage and kidney problems Venture Fund. long-term use, Texas Medical Center, CorInnova that can be associated with other Heart failure in part, due to and Alleviant Medical, are working heart devices. occurs when strict eligibil- on novel solutions. Both companies “Not touching the blood is a the heart is no ity require- are part of the TMC Venture Fund big deal, as this feature offers a longer able to ments for the portfolio, which aims to bolster dramatic advantage over standard supply enough surgery— innovation across Houston’s health therapy,” CorInnova CEO William blood to meet generally, care ecosystem. The $25 million Altman said. the body’s those over age fund launched in 2017. The company is housed within needs. There is 65 may not be Johnson & Johnson Innovation’s no cure. Though eligible. Short- A gentle squeeze JLABS @ TMC accelerator. In 2015, the preferred term LVADs A device in development at CorInnova received a $6.1 million method for CorInnova’s device could support (for less than CorInnova aims to use “soft robot- investment from the Wellcome treatment is a patients in the hospital after a short-term seven days’ ics” to prolong the lives of patients Trust, a United Kingdom foundation heart transplant, heart injury. use in the suffering from heart failure. that supports health research and precious few hospital) also The new device wraps around innovation and has said the technol- hearts are available. Long-term touch the blood and many patients the heart and squeezes it to increase ogy could be “transformative.” The devices, known as chronic LVADs can’t use them either. blood flow—but importantly, never TMC Venture Fund announced its (left ventricular assist devices), CorInnova hopes its device can comes in contact with blood itself. investment in CorInnova in 2018. can also be used to help with blood help fill the gap. “If you don’t qualify Leaders at CorInnova say that lack “CorInnova could revolutionize flow, but these pumps require for an LVAD—and 90 percent of of blood contact will make it dramat- the market the way the pacemaker invasive surgery. Furthermore, fewer patients don’t qualify—this would ically safer for patients, reducing did,” said Juliana Garaizar, director than 12,000 LVADs are implanted be an alternative,” Altman said. The device could support patients in the hospital, allowing them to recover and return home after a short-term heart injury. Or, for patients with end-stage failure, the device could extend life by six months to a year in a gentler way, without the risk of blood contact, Altman said. The CorInnova device encases the heart, its saline-filled cham- bers closely hugging the organ. It inflates with air in synchrony with the heartbeat, gently squeezing the heart to increase blood flow. The soft, robotic device is collapsible and can be implanted through minimally-invasive surgery. The company says hospital stays following device implantation would be 80 percent shorter than for long-term LVADs, and adverse effects could be at least 30 percent fewer, compared to both short-term and long-term LVADs. And most patients with heart failure are too CorInnova CEO William Altman holds up a device that encases the heart and squeezes, to increase blood flow.
32 t m c » p u l s e | f e b r ua ry 2019 heart health
sick to be eligible for an LVAD notoriously difficult to treat. anyway, which is where CorInnova Prescription medication can treat believes it can serve as an alterna- the symptoms but does not address tive. CorInnova also says the device the root problem, Kriegel said. can help solve another problem— Other interventions may require heart failure that occurs after heart inserting a stent in the heart, which attack, due to structural changes in also comes with risks. the heart. Outfitting those patients In recent years, Kriegel said, with the device could help prevent researchers have discovered that the heart from enlarging following reducing left atrial pressure can a heart attack by enhancing the improve symptoms. Alleviant’s correct motion of the heart, innovation is a sort of “pressure- Altman said. relief channel” that creates a Since 2015, the device has been connection between the left and tested in 20 large animal studies, right atrium of the heart, allowing primarily at Texas Heart Institute blood to flow from the former to and at Texas A&M University. the latter. “Basically, we’re shifting Preliminary results show that it pressure around to a different area can increase cardiac output by of the heart that can handle it much 50 percent in animals. better,” Kriegel said. For now, the company is focus- In 2017, Alleviant was one of ing on clinical applications in which five firms that received the first the device would be used for about round of investments from the a week, although one device tested TMC Venture Fund. successfully for 100 days. CorInnova “They have already captured a leaders believe that, theoretically, lot of attention from investors and they can create a device that can be strategic partners, so hopefully this used for at least three years. revolutionary method of alleviating Next year, the company will Alex Arevalos, Ph.D., chief technology officer of Alleviant, speaks with Avni Patel, congestive heart failure will soon begin designing a version of the chief operating officer, who is holding a model of the atrial chamber. be available in the market,” said device that is sized for humans, and Garaizar, director of the fund. by the end of 2021, it hopes to com- Alleviant expects its pioneering in testing the device, rather than Alleviant is a “TMC company, plete its first study in 6 to 10 people. therapy to be a good fit for about a conceptualizing and prototyping born and bred,” Kriegel said. The For Altman, the work his quarter of them—those sick enough the device.” device grew out of its founders’ par- company is doing is personal. “My to be hospitalized occasionally, but Congestive heart failure mainly ticipation in TMC Biodesign, TMC’s father-in-law died two years ago healthy enough that they don’t yet affects older adults. Over time, one-year innovation fellowship, and from heart failure,” he said. “He is need a heart transplant. the heart’s pumping mechanism the company matured while it par- precisely the kind of person who The company is making grows weaker and the organ can’t ticipated in TMCx, TMC’s business could have used this device.” rapid progress. The device is being circulate blood effectively. Patients accelerator. Now, it’s based out of tested on pigs at Houston Methodist experience a buildup of pressure in TMCx+, TMC’s coworking space for Pressure-relief channel Hospital and Texas Heart Institute, the left atrium of the heart, leading health care startups. Alleviant Medical is developing a and functioning as intended, to shortness of breath and a feeling “The cardiovascular community new, minimally-invasive device that said CEO and co-founder Jacob often compared to drowning, due to here is strong,” Kriegel said. “I think relieves pressure buildup in the left Kriegel, M.D. a buildup of fluid in the lungs. The it’s been a big advantage for us to atrium of the heart, one of the key “Our early results have been condition can result in several hos- be here.” drivers of heart failure. promising and exciting,” Kriegel pitalizations per year and, eventu- Millions of patients suffer said. “The last couple months ally, may require a heart transplant. from congestive heart failure, and have included a dramatic increase Congestive heart failure is
t m c » p u l s e | f e b r ua ry 2019 33 A Visit to the Dentist Leads to a Heart Diagnosis Dental student takes a patient’s vitals manually and finds a problem
By Britni R. McAshan
Chris Conser, a UTHealth School of Dentistry student, examines Desiree Pearson of Pearland, Texas.
esiree Pearson of Pearland, Shalizeh Patel, D.D.S., an associate Years ago, Patel learned first- “So I did it the old school way DTexas, is grateful that Chris professor at UTHealth School of hand how important it is to pay with the cuff that you inflate and by Conser, a University of Texas Dentistry, about the importance of attention to a patient’s vital signs. feeling her wrist with my finger for Health Science Center at Houston taking vitals manually at the begin- She had a professor who was a pulse,” Conser said. “I started (UTHealth) School of Dentistry ning of every patient visit. passionate about taking vitals taking her blood pressure and student, took the time to check her “I’m a big advocate of students manually, as well, back when it was something was a bit off and I was vital signs before she had a filling taking their time, getting to know a lot less common for dentists to really uncertain, so I took it one or replaced last spring. their patients and taking vital signs do so. Soon after, she went home two more times.” “In March, I had just turned appropriately,” Patel said. “A lot of to visit her family and realized her On this occasion, human touch 63 years old and I was tired and students are in a rush because they dad wasn’t feeling well. She took his proved to be Conser’s most valuable I’ve never been like that,” Pearson are trying to get things done and vitals and found that he was having tool. recalled. “But I just thought it was they get in the habit of using the heart problems. “In Mrs. Pearson’s case, the part of being 63.” electronic cuff monitors and many Similarly, Conser was able to electronic cuff gave a reading of Shortly before treating Pearson, of those are not calibrated or work- detect Pearson’s heart trouble while her blood pressure and pulse, but Conser had attended a lecture by ing properly.” taking her vitals manually. it didn’t provide the rhythm of the
34 t m c » p u l s e | f e b r ua ry 2019 Struggling? Let us help.
We can be your partner in overcoming challenges such as depression or substance use. For more information call 832-720-6688 or visit westoakshospital.com. Pearson was referred to a Serving the needs of children, adolescents and cardiologist at Memorial Hermann adults, West Oaks Hospital offers inpatient and Pearland Hospital, where she was outpatient treatment options. diagnosed with a heart rhythm disorder known as sick sinus syndrome. According to the Heart Rhythm Society, sick sinus syn- drome is a group of symptoms that indicate the heart’s natural 6500 Hornwood | Houston, TX 77074 pacemaker, the sinus node, is Conser takes Pearson’s blood pressure. not working. With limited exceptions, physicians are not employees or agents of this hospital. For language assistance, disability accommodations and the non-discrimination notice, visit our website. 183440 “The cardiologist told me no driving and no stairs, but I live in a pulse and that is how it was three-story house so I would just do missed by her medical doctor,” them really fast,” Pearson said. “He Patel explained. said sick sinus syndrome wouldn’t Conser quickly became con- kill me, but if I was driving down the cerned and went to get help from highway and passed out … you don’t another professor. As part of the have a warning, you’re just out.” curriculum at UTHealth School Within a month of her visit of Dentistry, dental students treat with Conser, Pearson received a patients under the supervision of pacemaker and is feeling like experienced clinical faculty. herself again. “I knew something was wrong,” “It is not just this case,” Patel Conser said. “I could hear the explained. “There are a lot of dis- Why pulse—it is a bit quicker than when eases that have oral manifestations rent you are feeling the wrist—but it just that can be ignored because most sounded weird. I set aside the blood medical doctors don’t look in the when pressure and took her pulse with mouth. That is why it is so important my fingers. The first time I took it, for our students to not only detect you can her pulse was alternating between these diseases, but also to have own? a slower and a faster beat and then the knowledge to treat or to refer again I was still uncertain and the patient to the right health care hoping I was making a mistake. I provider to receive the appropriate took it again and this time her heart treatment.” was outright stopping for seconds Conser said taking the time to From $250,000 at a time.” listen to his professor and patient Garden Homes • East of Main • Just South of 610 The attending professor felt saved the day. Near Stella Link and Willow Bend the same thing and immediately “I didn’t have a special talent; referred Pearson to a doctor. all I did was listen to my professor,” • Below market 100% financing with no PMI available “I had no idea something was Conser said. “Anyone who felt Mrs. • Featuring 3 Bedrooms, 2.5 baths and 2-car garages wrong,” Pearson recalled. “I think it Pearson’s pulse would have noticed was maybe the second or the third something was wrong.” • Gated community with low HOA fees close to the Medical Center time and he said I need to go get my • Ample green space for pets professor, and I was a little nervous. • OPEN HOUSES Thurs & Fri 3-5:30 PM, Sat & Sun, 11 AM- 5:30 PM I was in for a filling and his profes- sor said … ‘You need to go straight to your doctor.’” CONTEMPORARY GARDEN HOMES Call George Balla at 832-455-6411 contemporarygardenhomes.com
t m c » p u l s e | f e b r ua ry 2019 35 How Are We Most Likely to Die? Opioid overdose is now one of the top five causes of death in the United States
By Shanley Pierce
or the first time in United States misused the drugs. In addition, 80 percent of heroin addicts first Fhistory, people are more likely to ODDS OF DYING IN THE UNITED STATES* die from accidental opioid over- used prescription opioids. doses than car crashes. “When you look at the data, According to a recent report Heart disease 1 in 6 there’s definitely a role that the from the National Safety Council, a medical community has played in Congressionally-chartered non- Cancer 1 in 7 this problem,” Harvin said. profit that promotes health and The Joint Commission, an Chronic lower 1 in 27 safety, a person born in 2017 has respiratory disease independent, U.S. nonprofit that a greater chance of dying from an Suicide 1 in 88 administers voluntary accreditation opioid overdose (one in 96) than programs for hospitals and other a motor vehicle crash (one in 103). Opioid overdose 1 in 96 health care organizations, issued This makes opioid overdose, con- pain management standards in Motor vehicle crash 1 in 103 sidered accidental, one of the top 2001 to help address the underas- five causes of death, behind heart Fall 1 in 114 sessment and inadequate diagno- disease, cancer, chronic lower respi- sis of pain. The standards, some ratory disease and suicide. Gun assault 1 in 285 critics charge, encouraged more “For the longest time, injury aggressive treatments that included Pedestrian incident 1 in 556 had been one of the leading causes opioids, leading to the misguided of lost life in young people. Now Motorcyclist 1 in 858 notion that pain was the fifth opioid overdoses and other drug vital sign. overdoses are overtaking that. This Drowning 1 in 1,117 Critics say health care providers happened very quickly,” said John over-prescribed opioids to elimi- Fire or smoke 1 in 1,474 Harvin, M.D., a trauma surgeon at nate pain and unwittingly ushered Memorial Hermann-Texas Medical Choking on food 1 in 2,696 in an opioid epidemic. The Joint Center and associate professor in Commission, it should be noted, the division of acute care surgery Bicyclist 1 in 4,047 disputes this characterization and at The University of Texas Health says its pain standards did not cause Accidental gun discharge 1 in 8,527 Science Center at Houston’s a rise in opioid prescriptions. The McGovern Medical School. “The Sunstroke 1 in 8,912 organization wrote in 2016 that it way that it has exponentially doesn’t endorse pain as a vital sign Electrocution, radiation, 1 in 15,638 increased has been quite shocking.” extreme temperatures, pressure and doesn’t require the use of drugs Illicit fentanyl has largely driven to manage patients’ pain. Sharp objects 1 in 28,000 the opioid epidemic in the U.S. In In an effort to curb the opioid December 2018, the U.S. Centers for Cataclysmic storm 1 in 31,394 overdose crisis, the U.S. Department Disease Control and Prevention’s of Health and Human Services (CDC) National Vital Statistics Hot surfaces and substances 1 in 46,045 launched initiatives around five System report showed that fentanyl- main areas: improving access Hornet, wasp and bee stings 1 in 46,562 involved overdose deaths surpassed to treatment and rehabilitation; the number of deaths from heroin Dog attack 1 in 115,111 increasing access to lifesaving opi- and oxycodone. Fentanyl, a syn- oid overdose reversal drugs, such as thetic opioid painkiller, is 80 to Passenger on an airplane 1 in 188,364 naloxone; expanding public health 100 times stronger than morphine surveillance of opioid use; support- Lightning 1 in 218,106 and 30 to 50 times more potent ing pain and addiction research; than heroin. Railway passenger 1 in 243,765 and promoting pain management More than 130 Americans programs and practices among die each day from opioid over- caregivers. dose, according to the CDC. * The figures here are statistical averages over the whole U.S. population and do not refer to any individual’s “Over time, we’ve learned a odds of dying. Figures are based on the number of deaths, relative to the total, U.S. population, extrapolated Approximately 29 percent of across the average life expectancy of 78.6 years. number of things: First off, you patients who had a prescription Source: National Safety Council “Injury Facts” don’t always need opioids to treat for opioids to treat chronic pain (https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/) patients,” Harvin said. “A lot of
36 t m c » p u l s e | f e b r ua ry 2019 For the longest time, injury had been one of the leading causes of lost life in young people. Now opioid overdoses and other drug
overdoses are overtaking that. This happened very quickly.
— JOHN HARVIN, M.D. Go further. Trauma surgeon at Memorial Hermann-Texas Medical Center and associate professor in the division of acute care surgery At the TWU Institute of Health Sciences – Houston Center, you at UTHealth’s McGovern Medical School can earn your graduate degree in nursing, nutrition, physical or occupational therapy, health care administration or business. Get the support you need every step of the way. this is driven by patient expecta- we haven’t seen in half a century,” Learn more at TWU.edu/houston tions, provider expectations, Ken Kolosh, the National Safety nursing expectations, family Council’s manager of statistics, expectations. The more you said in a statement. “We cannot address that, the easier everything be complacent about 466 lives else becomes because a lot of pain lost every day. This new analysis can be treated with things that reinforces that we must consistently are not opioids.” prioritize safety at work, at home In 2013, the Memorial Hermann and on the road to prevent these Recovery Red Duke Trauma Institute imple- dire outcomes.” mented an opioid-minimizing pain Alex Harding, M.D., an assistant starts here cocktail to treat trauma patients. professor of emergency medicine at Instead of using hydrocodone, Baylor College of Medicine, said the • Mental health and substance use treatment for teens oxycodone or other types of opioids, council’s report sheds light on how this cocktail uses high doses of people tend to overestimate certain and adults acetaminophen, non-steroidal risks of dying and underestimate • Inpatient and outpatient programs anti-inflammatory drugs, gabapen- the real, prevalent problems that are tin, lidocaine and ketamine to help more likely to cause death. • Specialized inpatient program for First Responders patients alleviate pain. “People should be cognizant of • Electroconvulsive Therapy (ECT)* for adults The use of non-opioid analgesics how preventable and actionable was very controversial at the time some of these things are—whether because everyone felt that opioids it’s heart disease, cancer or suicide— No-cost assessments available 24/7. were the pillar of acute pain man- and recognize that we can be cata- Call 281-918-7670 today. agement, Harvin said. Since then, lysts for change and for helping our though, the institute has reduced fellow Americans,” Harding said. in-hospital use of opioids by “We may not recognize what some- 40 percent. one is going through, especially Opioid overdose falls under the when [opioid use and suicides] have category of unintentional and pre- become so prevalent. Addiction is ventable injuries, the third leading truly a disease. If we start treating cause of death, preceded by heart it the same way we do heart disease disease and cancer, respectively, and cancer, with the same kind according to the CDC. of compassion, camaraderie and “We’ve made significant strides respect for your fellow man, then we 17750 Cali Drive | Houston, TX 77090 in overall longevity in the United can go far.” cypresscreekhospital.com States, but we are dying from things With limited exceptions, physicians are not employees or agents of this hospital. For language assistance, typically called accidents at rates disability accommodations and the non-discrimination notice, visit our website. * Individual results may vary. There are risks associated with any medical procedure. Talk with your doctor about these risks to find out if electroconvulsive therapy (ECT) is right for you. 183446
t m c » p u l s e | f e b r ua ry 2019 37 Field Notes
1 | HSIAO-TUAN CHAO, M.D., PH.D., instructor of pediatrics at Baylor College of Medicine and a child neurologist and postdoctoral researcher at the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, has been awarded the NIH Director’s Early Independence Award from the High-Risk, High-Reward Research program...... 2 | DEBORAH GORDON, executive vice president, chief administrative officer and 1 2 chief legal officer at Memorial Hermann Health System, was recognized by the Houston Business Journal as one of 2018’s “Women Who Mean Business.” ...... 3 | During a two-day clinic, therapists at SHRINERS HOSPITALS FOR CHILDREN – HOUSTON worked with patients on adaptive tricycles known as Amtrykes...... 4 | JAMES P. ALLISON, PH.D., an immunolo- gist at The University of Texas MD Anderson 3 42 Cancer Center, received the Nobel Prize in Physiology or Medicine from H.M. King Carl XVI Gustaf of Sweden at the Stockholm Concert Hall on Dec. 10, 2018. Allison and Japanese immunologist Tasuku Honjo, M.D., Ph.D., shared the prize for their discovery of cancer therapies...... 5 | BERT O’MALLEY, M.D., chancellor at Baylor College of Medicine, received the 2018 Louisa Gross Horwitz Prize from Columbia University...... 5 6 7 6 | JACQUELINE T. HECHT, PH.D., associate dean for research, director of the Center for Craniofacial Research and distinguished teaching professor at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, was elected Fellow of the American Association for the Advancement of Science...... 7 | The department of epidemiology and population sciences at BAYLOR COLLEGE OF MEDICINE welcomed a permanent art exhibit focused on the “dirty dozen” cancers at waist level or below: anal, bladder, cervical, colorectal, intestinal, ovarian, pancreatic, penile, prostate, testicular, uterine and vulvar. Local nonprofit Cancer Below the Belt teamed up with artist Corey Scott to create abstract portraits related to each cancer...... 8 | The Houston Exponential Capital Summit held at the TMCx ACCELERATOR in December drew leading investment and entrepreneurship experts from around 8 the country. Credit: Nos. 1, 2, 3, 5, 6, 7, 10, 11, 13 courtesy photos; No. 4, © Nobel Media. Photo: Alexander Mahmoud; No. 9, Rendering Perkins+Will; No. 12, MD Anderson
38 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 9 | THE UTHEALTH CONTINUUM OF CARE CAMPUS FOR BEHAVIORAL HEALTH, a joint project owned by TEXAS HEALTH AND HUMAN SERVICES and operated by UTHEALTH, is shown in a rendering. Construction will begin this summer on the new Houston psychiatric facility that offers 240 beds. Slated to open at the end of 2021, the facility will be the first public mental health hospital built in Houston in more than three decades...... 10 | CARLA ORTIQUE, M.D., an OB/GYN at The Women’s Specialists of Houston at Texas Children’s Pavilion for Women, was honored as Physician of the Year at the 29th Annual Scholarship Gala hosted by the Houston Medical Forum...... 11 | SUSAN GREEN, M.P.H., lead project manager for Joseph Coselli, M.D., vice-chair of surgery and chief of cardiothoracic surgery at Baylor College of Medicine, was selected 9 as a 2019 Michael E. DeBakey Fellow in the History of Medicine by the National Library of Medicine, part of the National Institutes of Health. The fellowship includes a $10,000 grant to support her research...... 12 | JOHN MENDELSOHN, M.D., president emeritus of The University of Texas MD Anderson Cancer Center and a scientist whose research helped pioneer a new type of cancer therapy, died Jan. 7 at his home in Houston at age 82. The cause of death was glioblastoma, an aggressive form of 1013 11 12 brain cancer...... 13 | A ribbon cutting for the DAN L DUNCAN COMPREHENSIVE CANCER CENTER AT BAYLOR COLLEGE OF MEDICINE, which moved into its new clinic space on the 7th floor of the McNair Campus, included Ted Yank, administrator; Brandon Smaglo, M.D.; Matthew Ellis, M.D., Ph.D.; Mothaffar Rimawi, M.D.; Kent Osborne, M.D., director; Carolina Gutierrez, M.D.; Karla Sepulveda, M.D.; Edward Yen, M.D.; and Samantha Khan, nurse manager.
13
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t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 39 Calendar
February 2019
2/7 2/12 – 21 2/14 – 15 Speaker Bradford G. Hill, Ph.D., ReelAbilities Houston Medical Oncology and associate professor of medicine Film & Arts Festival Hematology 2019: at the University of Louisville Dedicated to showcasing films Multidisciplinary Approaches School of Medicine by or about people with disabilities that Improve Coordination of Care James T. Willerson, M.D., Various times and locations Conference Cardiovascular Science Seminars Free; reserve tickets at Thursday – Friday Thursday, 4 – 5 p.m. reelabilities.org 7 a.m. – 5 p.m. Texas Heart Institute [email protected] MD Anderson Cancer Center Denton A. Cooley Auditorium 832-786-0361 Dan L Duncan Building (CPB), 6770 Bertner Ave. Floor 8, Conference Center [email protected] 1155 Pressler St. 832-355-9144 Registration starts at $50; Register at mdanderson.org [email protected] 713-563-7388
2/19 2/21 2/26 Advances in Medicine Update on Trans-Catheter Safety Net Programs During the American Civil War Interventions in Congenital Texas Medical Center History of Medicine lecture series Heart Disease Health Policy Course presented by Baylor College Houston Methodist DeBakey Tuesday, 5:30 – 7 p.m. of Medicine, featuring Heart and Vascular Center— Third Coast Restaurant Eugene Boisaubin, M.D. Grand Rounds with 6550 Bertner Ave. Tuesday, noon – 1 p.m. Jamil Aboulhosn, M.D. Free; registration encouraged. Baylor College of Medicine Thursday, 8 – 9 a.m. To register and view a live stream Cullen Auditorium Houston Methodist Hospital of the event: 1 Baylor Plaza Dunn Rio Grande www.tmc.edu/health-policy/course/ [email protected] 6565 Fannin St. [email protected] 713-798-6590 [email protected] 713-791-8809 346-238-5391
FOR MORE EVENTS, VISIT TMC.edu/news/tmc-events
40 t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019 February 2019
OUTSMARTING CANCER TAKES LEADING MEDICINE.
At Houston Methodist Cancer Center, our teams of nationally recognized specialists are finding new ways to outsmart cancer, while delivering the The Woodlands most advanced treatments and comprehensive care available. From screenings to diagnosis and cutting-edge treatments, our leading cancer care is available at all seven locations across Greater Houston, so you can focus on healing, surviving and thriving. Willowbrook
Visit houstonmethodist.org/outsmartcancer or call 713.790.2700 to find a doctor in your area. West Houston-Katy Baytown Texas Medical Center
Sugar Land Clear Lake FOR MORE EVENTS, VISIT TMC.edu/news/tmc-events
t m c » p u l s e | f e b r ua ry 2019 t m c » p u l s e | f e b r ua ry 2019