Breakthrough Medicine
 
New Procedures Easing the Aches of Pain

Never mind the traffic. Forget the cost of living. When illness strikes, having immediate access to top-of-the-line medical care makes up for many of the stresses of Northern Virginia life.

Sarah Markel and Lindsay Holst / Photography by Jonathan Timmes

From Head to Toe
Medical technology that is changing and saving patient lives

Just over half a million doctors are currently practicing in the United States. And right in our own backyard, the latest innovations in the treatment of life-threatening illnesses are increasingly being developed and tested. Here are the doctors pushing the envelope every day in search of minimally invasive, more effective procedures that save lives.

Dr. William O. Bank

BRAIN
Dr. William O. Bank
Washington Hospital Center
Bi-plane X-Ray

Until recently, the prognosis had been dire for patients with cerebral aneurysms and tumors in the head, neck and spine. Aneurysms in the brain are notoriously hard to detect and difficult to access. Once they rupture, the brain is flooded with blood, often resulting in death.

For those who did survive, the only recourse was open brain surgery. Dr. William O. Bank, director of neuro interventional radiology at Washington Hospital Center, has a better way. Bank combines a state-of-the-art Bi-plane X-ray, which allows him to see inside the brain from every possible angle, with endovascular procedures to treat aneurysms without traditional surgery.

“The Bi-plane X-ray has been around for 20 years,” Bank said. But only recently has the technology gone digital. “Now it is more precise,” he said. “I can look through two different directions at the same time.”

The digital Bi-plane X-ray instantly transfers brain images to the computers at Bank’s worktable, where he then measures the aneurysm to hundredths of a millimeter. After consulting with neurologists and surgeons, Banks quickly returns to the patient. Using the Bi-plane X-ray as his eyes, he threads tiny platinum coils up through the groin into the aneurysm so that blood cannot enter it.

A lover of the impressionists, he takes inspiration from the works of Monet and Van Gogh. “The practice of medicine and surgery is not an exact science. What I do is an art,” Bank said. “And I have to do it well every day.”—SM

Dr. Lowell Satler

HEART
Dr. Lowell Satler
Washington Hospital Center
Heart Valve Replacement without Open Surgery

The telltale sign of heart surgery, that pale vertical chest scar, may one day become a thing of the past, thanks to Dr. Lowell Satler, director of cardiac interventions at Washington Hospital Center. Satler is leading an investigational trial to study the safety of inserting an artificial aortic valve through a large needle puncture in the leg rather than through open heart surgery.

Currently the study is only open to elderly patients too weak to undergo surgery. “For the higher risk subset, surgery is not a good option,” Satler said. “Many patients succumb to chest pain, are hospitalized and eventually die. This is an alternative strategy.”

Pricilla O’Donnell’s 95-year-old father was one of the first patients to undergo this minimally invasive procedure. The valve replacement has given her more time with her father. More importantly, she said, it has given her dad the freedom he thought he had lost. “He is now able to walk unassisted and without oxygen. He feels like this procedure was nothing short of a miracle for him. He is really loving life now.”

Satler hopes one day that more patients will be able to undergo valve replacement via catheterization. “This has the potential to replace open heart surgery if the valves demonstrate durability.”—SM

Dr. Richard Neville

VEINS
Dr. Richard Neville
Georgetown University Hospital
Propaten Vascular Graft and Silverhawk

Dr. Richard Neville, chief of vascular surgery at Georgetown University Hospital, has devoted his career to saving legs. Patients, particularly the elderly and diabetics, too often ignore the pain that comes from clogged arteries in the legs. Sometimes they leave it so long that the only recourse is amputation.

Neville will try just about anything to avoid taking a leg, including inventing his own procedures to create systems for blood to bypass clogged arteries. He is currently testing the Propaten Vascular Graft, a minimally invasive bypass that “tricks a vein into thinking it’s an artery,” Neville explained. Neville was the first surgeon to use the graft below the knee. He also helped develop the Silverhawk, a tool used to scrape out the clogged veins of patients too sick for bypass surgery.

“Sixty percent of what we do is endovascular,” Neville said. “That allows us to work through a small needle puncture.” Patients come from across the country to see Neville. Very rarely today does he have to tell them there is nothing he can do to save the leg. “And even then,” he said, “I can often think of something.”—SM

Dr. David Deaton

ABDOMEN
Dr. David Deaton
Georgetown University Hospital
Aptus Endograft

Ed Mooney’s abdominal aortic aneurysm gave him no trouble. “I didn’t have any symptoms,” said Mooney, 71, whose aorta, the main blood vessel in the abdomen, had swelled to nearly five centimeters, more than twice a normal size. Left untreated, the chances of sudden death from aortic aneurysm hover at about 90 percent.

In 2006, Mooney’s doctor noticed the aneurysm during a routine ultrasound and referred him to Dr. David Deaton, chief of endovascular surgery at Georgetown University Hospital. Deaton, who is recognized as the foremost authority in his field, is leading a clinical trial to test a new, minimally invasive approach to repairing abdominal aneurysm by stapling a synthetic vein, or Aptus endograph, to the aorta. Mooney became the first patient in the United States to receive the Aptus endograph.

“It took about three hours,” Mooney said. “I was in the hospital overnight. They let me out the next day.” Deaton explained that traditionally aortic aneurysms are repaired through open surgery, followed by several days in ICU and a week in the hospital. “With the endovascular surgery, we replace the aorta with a catheter through a groin incision. There’s no pain and less trauma to the body.”

A native of North Carolina, Deaton’s style is as relaxed and unassuming as his accent. “I like to say it’s like being able to go to California on a jet plane instead of a horse,” he joked. For Mooney, being on the vanguard of experimental medicine gave him no qualms. “Dr. Deaton is so calm and straightforward. When he explained the procedure to me I thought, This makes sense.”—SM

Dr. Tom Fishbein
Georgetown University Hospital
Multiple Organ Transplant Surgery

When the Washington, D.C. State Health Planning and Development Agency (SHPDA) granted Georgetown University Hospital, in collaboration with Children’s National Medical Center, a Certificate of Need to allow physicians to perform life-saving small bowel transplants, doctors were able to bring hope to many cases that hadn’t seen any for a while.

In small bowel transplantation, a surgeon transplants a portion of the small intestine from either a living donor or a cadaver. The surgery can restore intestinal function when the intestine has failed due to illness or trauma and when intravenous feeding is no longer an option. Only about 100 patients receive a new small intestine each year in the United States, and Georgetown’s program is the only one of its type in the Mid-Atlantic region. Dr. Tom Fishbein, Georgetown’s director of small bowel and pediatric liver transplantation, has done as many as six organ transplants at one time and has performed small bowel transplantations in a wide range of patients, from small babies to older adults.

Fishbein is a nationally recognized surgeon and has performed approximately 20 percent of all intestinal transplants in the United States.—LH

Dr. Ali Fazel
Inova Fairfax Hospital
Endoscopic Mucosal Resection

Inova Fairfax Hospital’s Center for Advanced Endoscopy, which made a spring 2007 announcement that it would use endoscopic procedures on patients with benign and malignant diseases of the digestive tract, pancreas and bile ducts, is the first program of its kind in Northern Virginia. In the center, a multidisciplinary team that includes surgeons, oncologists and gastroenterologists uses endoscopic techniques to treat Gastroesophageal Reflux Disease and the damage that can result from the disease; remove large colon polyps that would have previously required surgery for their removal; manage digestive cancers, primarily of the esophagus, stomach, bile ducts, pancreas and colon; and treat benign blockages, stones and inflammation in the pancreas and bile ducts. It’s a one-stop center that offers a wide range of cutting-edge endoscopic services. The doctors use endoscopic ultrasound and techniques such as endoscopic mucosal resection (EMR) to earlier detect and remove digestive cancers. “EMR allows the endoscopist to shave off the inner layers of the digestive tract without causing damage to the deeper layers,” said Dr. Ali Fazel, the center’s medical director. “Because cancerous and precancerous legions of the digestive tract arise from the innermost layer, by shaving it off, you’re able to remove cancerous legions.” Fazel, who was in charge of a similar endoscopy program at the University of Florida, is very pleased with the program’s growth. “This is such a strong medical community, and this is just one service that happened to be lacking. We’re very happy to be able to fill that niche,” he said.—LH

Dr. Ivan Ducic

NERVES
Dr. Ivan Ducic
Georgetown University Hospital
Peripheral Nerve Surgery

Dr. Ivan Ducic, chief of peripheral nerve surgery at Georgetown University Hospital, has built a devoted following among migraine sufferers nationwide. Patients who have failed one treatment after another come to Ducic because he refuses to take a routine approach to migraine pain.

“In about 25 percent of cases there are strong individual characteristics,” said Ducic, who is renowned for the extensive amount of time he devotes to puzzling out the source of a given patient’s problem.

“When you have patients who have seen a number of good specialists, and they are still continuing to have problems that affect the quality of their lives, you need to start thinking outside the box.”

Accordingly, Ducic, who has a Ph.D. in addition to his medical degree, tries to reconstruct the events leading up to nerve pain so that he can better treat it surgically. “Unless you understand the source of a problem,” he insisted, “you can’t fix it.”—SM

Dr. Keith Sterling

BLOOD
Dr. Keith Sterling
Inova Alexandria
EKOS Clot-Busting Treatment

Dr. Keith Sterling, Inova Alexandria’s medical director of cardiovascular and interventional radiology, is combining ultrasound energy with thrombolytic drug-containing catheters that administer medicine into a clot-containing vein.

The high-frequency ultrasound enhances the drugs’ ability to quickly dissolve the clot in a procedure that typically takes less than 24 hours. The tool is essentially a catheter lined with tiny transducers whose ultrasound energy pushes the drug into the clot, which the ultrasound also alters.

Sterling said that the ultrasound energy makes the dissolving process quicker and allows the doctor to use a lower lose of the clot-busting agent. The first hospital in the D.C. area to conduct this new therapy, Inova Alexandria has found great patient success with the procedure. “We use the EKOS catheter system for three main areas: blockages in arteries, veins and the brain,” Sterling noted. Sterling said the EKOS ultrasound-enhanced clot-busting procedure provides more safety and efficacy than traditional procedures, and patients are often able to leave within 24 hours “with a Band-Aid.”—LH

Dr. Andy Engh

BONES
Dr. Andy Engh
Inova Mt. Vernon
Birmingham Hip

Someone who is 55 years old has a good chance of success with a regular hip replacement—a procedure in which the doctor cuts off the ball and inserts a metal rod into the thigh bone, which holds the new ball, lasting them the rest of their life. However, someone who is younger than 55 or more active than the typical 55-year-old is likely to eventually need a second operation.

“A high-demand, highly active patient is more likely to wear his or her hip out. These are the patients that might want to take a chance on the newer technology, which is why hip resurfacing is so appealing to high-demand patients,” said Dr. Andy Engh of Inova Mt. Vernon Hospital, which features this advanced procedure.

When using the Birmingham Hip Resurfacing procedure for hip replacement, the doctor does not cut the ball off, but rather trims the edges and puts a high-carbide cobalt chrome cap on it. Laboratory research has shown that the metal-on-metal joint may be more wear-resistant than the traditional metal-on-plastic joints, but doctors say only time will tell. “What we believe right now is that the resurfacing saves more bone—nobody will debate that it’s a bone or a skeleton-preserving hip replacement,” Engh said. “So if I do a regular total hip replacement on one 50-year-old and a resurfacing on another 50-year-old on the same day, and they both go bad 15 years down the road, I will have more bone to work with and the operation should be easier with the resurfacing patient than with the total hip.”

Dr. Mark P. Madden
Reston Total Joint Center
Joint Replacement

At Reston Hospital Center’s Total Joint Center (TJC), it isn’t unusual for a joint replacement patient to be walking the afternoon of their procedure, nor is it strange for the patient to be discharged from the hospital in just three days.

The TJC, formed in 2002 and recognized as a Center of Excellence by Mid Atlantic Medical Services, Inc., represents the collaborative efforts of orthopedic surgery, rehabilitation and anesthesia professionals.

Loraine Zolkiwsky, who had her knee replaced at the TJC in January 2007, said that the informational nature of the center made her experience “just fabulous.”

“I think half of the problem with many surgeries is that there’s this mystery aspect; all the patients know is that they have to show up at the hospital that day,” she said. “At the TJC, you had to attend a class ahead of time and everything was broken down almost to-the-minute. Nothing was a mystery when you went in.”

“We’ve got not just one mind or set of eyes looking at a problem, but four or five. It’s an organized plan rather than a hit-or-miss strategy,” said orthopedic surgeon Dr. Mark Madden.

The team Madden refers to consists of physician’s assistants, physicians, physical therapists, nurses and discharge planners. The center has features like “joint camp,” where patients attend a preoperative class with their own coach, learning to mentally and physically prepare for their joint surgery. Camp continues after surgery, as do group exercise and therapy sessions and educational classes on living with a new joint.

“For lots of people, there’s this mental block when it comes to big surgeries. But if you have the information and are mentally prepared, it really works. It can be a really positive experience,” said Zolkiwsky, who has been fully recovered from her surgery for months and feels “15 years younger.”—LH

Dr. A. Daniel Laurent

PROSTATE
Dr. A. Daniel Laurent
Reston Hospital Center
GreenLight PVP

Previous treatment for Benign Prostatic Hyperplasia (BPH), a condition common in males over the age of 50 where the prostate becomes enlarged and puts pressure on the urethra, required patients to stay at the hospital for several days and nearly a month away from work.

“Up until approximately four years ago, the ‘gold standard’ for treatment for symptomatic BPH was the TURP, or transurethral resection of prostate,” said Dr. A. Daniel Laurent, urologist at Reston Hospital Center, which began offering the GreenLight procedure three years ago. Physicians at Reston Hospital Center said the TURP procedure posed a high risk of complications and several unpleasant side effects in patients. GreenLight PVP (photoselective vaporization of the prostate), a laser procedure offered by urologists at the center, is far less invasive than previous procedures, while providing the same favorable outcome.

“The main issue with TURP was the increased risk for bleeding both during the procedure and after,” Laurent said. “Patients were typically hospitalized for two to three days with a catheter, and even after going home were told to avoid strenuous activity and car riding for several weeks to avoid delayed bleeding, which could at times be severe. In rare instances after having a TURP procedure, men developed urinary incontinence and impotence.”

According to Laurent, the GreenLight laser procedure offers an effective treatment without an ugly aftermath. “The end effect of the procedure is identical to that of a TURP, in that a wider urinary channel is created, immediately relieving the blockage. However, the laser energy simultaneously vaporizes the obstructing tissue and seals the blood vessels. This allows an almost bloodless procedure,” Laurent said.

As such, a return to normal life can occur simply after an extended weekend of rest. “Reston Hospital Center is unique in that it provides the GreenLight technology on a full-time basis, which offers greater flexibility in scheduling. We have had a very positive response to the treatment. The results have been excellent, and the complication rate is very low.”—LH

Dr. John Carroll

CANCER
Drs. John Carroll and Nadim Haddad
Georgetown University Hospital
Endoscopic Ultrasound

Short of having a family history, it’s hard to say who is considered “high risk” for pancreatic cancer, and it used to be that when doctors had any suspicions of the cancer in patients, they would use a CAT scan to get a better look.

“A CAT scan just didn’t give as good of a resolution. You would just see a density and wouldn’t know exactly what it was,” said Dr. John Carroll, a gastroenterologist at Georgetown University Hospital. “At that point, you could do exploratory surgery in advance … or just watch and wait.”

Carroll and fellow Georgetown University doctor Nadim Haddad are now using endoscopic ultrasound techniques to diagnose the cancer before the disease advances to an inoperable point. In this procedure, the doctors pass an endoscope with an ultrasound component through the patient’s mouth and into the stomach. With the standard endoscope, doctors only see the inner lining of the digestive tract; with the ultrasound imaging, they can see all the layers and surrounding structures, including the adjacent pancreas, getting close enough to look for any masses, cysts or abnormalities. Some patients’ cancers cannot be seen on the CAT scan, but are detectable using the endoscopic ultrasound imaging. “Endoscopic ultrasound has been around for a while now, but the scopes are getting better, and the needles that we use are better as well, so that when we see a small cancer, we can get a biopsy early on,” said Carroll, who began training in endoscopic ultrasound in 1997.

“The accuracy and the reliability—both from the equipment standpoint, our experience and the pathologists’ experience—it’s all a lot better.”—LH

Dr. Gregory Gagnon
Georgetown University Hospital
CyberKnife

Some cancers are inoperable. Ask Joan Schwab. A former smoker, she had already lost part of her right lung to a cancerous growth. Afterward, breathing became difficult.

So when doctors at Georgetown found cancer again, this time in the left lung, 67-year-old Schwab knew surgery was out of the question. Instead, she was referred to Georgetown’s new state-of-the-art robotic radiosurgery system called the CyberKnife. This $6 million machine delivers an intense beam of radiation to tumors from as many as 1400 different angles. For weaker patients like Schwab, or those with inaccessible cancers, the CyberKnife is their last and best resort.

“The first surgery was quite awful,” recalled Schwab, who is now cancer-free and back to walking her dog. “The CyberKnife was different. I lay down, got up and drove home. No pain or anything.”

Dr. Greg Gagnon, chief of radiation medicine at Georgetown University Hospital, leads the CyberKnife team. “This is 10 times more precise than standard radiation, and because the dose fall-off is so abrupt, we can deliver a high dose to a very small area. It’s like a knife, in a way.”

With traditional radiation, patients are exposed to a high degree of excess radiation, which causes damage to surrounding organs. “There are dosage limitations with standard radiation,” said Gagnon. “With CyberKnife, it’s so accurate that you can use a higher dose.”

Perhaps most exciting are the unexpected benefits of CyberKnife. “Some cancers, like prostate, seem to have a radiobiologic response,” Gagnon said. “They are sensitive to this intense radiation.”

For now, CyberKnife is reserved for patients who cannot undergo surgery. But Georgetown University Hospital staff members are ready for the day when they become the first choice for certain cancers; they just bought a second CyberKnife.—SM

Death Defying
 
Patients Who Beat the Odds and the Doctors Who Helped Them

By Jan Linley / Photography by Jonathan Timmes

Eight patients faced with very different life-changing medical challenges discovered that having the best of the best in medical care goes a long way toward survival. While these patients are different in many ways, they have more than a few things in common. Each is inspirational, brave and trusting. And each has a top doctor using cutting-edge medical technology.

Clinton Johnson/Pat Divinnie | Survivor/Donor


Sun Hae/Young Hwang | Donor/Survivor

The Best Birthday Gifts
Clinton Johnson was diagnosed with sarcoidosis (an inflammatory disease that produces granule-sized lumps of cells in various organs in the body) in 1995. It affected his kidneys. Three years ago doctors told him he needed to prepare for dialysis. The 58-year-old Johnson was opposed to the treatment, but went ahead with dialysis classes. After his last class, he made up his mind to find a kidney.

He understood that putting his name on a wait list for kidney donation would mean just that—waiting. There are 850 on Washington Hospital Center’s list, 2,200 in the area and 70,000 in the country. The wait time can be up to five years. Johnson became proactive and put the word out that he needed a kidney. “I didn’t ask, I told them. I need a kidney.” He had willing donors, but none were a match.

His wife Pat Divinnie knew she was not a match for her husband, but that didn’t mean she wasn’t a match for someone else. She volunteered to go on the list as a healthy donor for another recipient, moving Johnson up on the list as a result.

It was about a month before they met their match. Divinnie, 55, was the match for Young Hwang, a 64-year-old diabetic who had already started dialysis. His organ failure was the result of the diabetes; the kidney problem presented itself while he was on a three-day fishing trip and his face “swelled up like a round ball.” Hwang was on the transplant wait list for more than two years. His 63-year-old wife, Sun Hae, was also on the list as a donor. She never thought she might be the match for Johnson.

Johnson chose Washington Hospital Center because he knew about Dr. Jimmy Light, director of transplantation services. Years ago they had both worked at Walter Reed Army Medical Center. Light, 63, has been doing transplants since 1971, almost as long as the field has been in existence. “At the time it was very, very challenging, very new. It was absolutely clear people would really benefit.”

Johnson, who is a former professional football player, insisted on having the operation after the Super Bowl. Four operating rooms were simultaneously prepared Feb. 12, 2007, two days before Valentine’s Day, three days before Sun Hae’s birthday, and four days before Johnson’s birthday. Reza Ghasemian, 49, director of transplant and urology, was Sun Hae’s surgeon. “Transplant surgeries are very satisfying. You see the results almost immediately. You remove the kidney; it’s transplanted and starts working immediately after the connection. Three to four hours after the surgery, the patient feels the difference.”

The couples stay in touch, but so far have no plans for an anniversary celebration. Maybe because they have all been too busy traveling recently, one of many activities made possible by the transplants.

The Little Girl Who Could
Renay Hannon was 34 and had a perfectly normal pregnancy when she gave birth to her daughter, Caleigh Haverland, in September 2000. So when she went in for Caleigh’s two-week checkup and was told her daughter had a heart murmur, she wasn’t too concerned. “A lot of kids have that. I didn’t think it would be a big deal.”

Caleigh was born with Tetralogy of Fallot, a congenital heart condition in which there exists a hole between the two ventricles of the heart, allowing blood to go from the right to left ventricle and then through the aorta, never passing through the lungs for oxygen as it would normally. Caleigh’s condition was further complicated because her left pulmonary artery was not connected to her lung.

Her first surgery to connect the pulmonary artery took place when she was about 4 months old and her heart was about the size of a plum. At 9 months, Caleigh had surgery to repair the hole in her heart.

In November 2006, Caleigh underwent her third heart surgery. She had outgrown the graft that connected the pulmonary artery to the rest of her heart. After each surgery, Hannon, a flight attendant, told herself everything would be fine and that she would soon be “able to be like the regular moms.”

Caleigh’s first surgeries were performed by the late Dr. Bechara Akl. Hannon was understandably concerned about who would perform the next one. She and her husband met with Dr. Irving Shen, director of pediatric cardiac surgery at Inova Hospital for Children. “He was just amazing right off the bat,” Hannon said. Shen, 45, explained a number of possible scenarios and how they would be handled.

It is common for children like Caleigh to have multiple surgeries as they get older and outgrow their original surgeries. Each time a surgery is performed, scar tissue grows around the heart, which can complicate subsequent surgeries. Shen said, “You have to tease everything up.”

He refers to pediatric cardiac surgery as a team sport. Between him, Dr. Lucas Collazo and a team that includes other cardiologists, anesthesiologists, nurses, interventionists and assistants, approximately 300 pediatric surgeries are performed annually at Inova Fairfax Hospital for Children.

Both Shen and Collazo, 42, spend a great deal of time thinking about the surgeries they perform and the children and families they treat. “We orchestrate the whole operation in our heads. We do it again and again,” Shen said, likening the process to athletes’ mental preparations.

Caleigh, who turned 7 in September, is very social and loves most of the things kids her age do—camp, play dates with friends and especially dance classes. Her mom is thrilled. “It’s the most wonderful thing ever to have Caleigh, and I’m so thankful.”

Tom Shaw | Stroke Survivor

Racing Against the Clock
As the owner of Outcome Communications, Inc., a health care marketing and educational company, 60-year-old Tom Shaw knew exactly what was happening when he suffered a massive stroke in a nearly empty movie theater in the middle of a December afternoon. He also knew he had three hours to get treated before any long-term serious damage set in. “It was the ultimate race of my life.” A throat cancer survivor, Shaw had a laryngectomy and uses an electrolarynx for speech. He usually uses his right hand to operate the device, but the stroke had incapacitated the right side of his body. He managed to use his left hand and turn enough in his seat to ask one of the two other patrons there that day to get the theater manager.

When paramedics arrived on the scene Shaw was coherent enough to ask to be taken to Alexandria Hospital, where his wife Karen is technical supervisor in the Cardiovascular and Interventional Radiology Department.

Interventional radiologists Dr. Keith Sterling and Dr. James Cooper treated Shaw at Alexandria. Cooper, 46, explained that most people have four main arteries, two carotid that supply blood to the front of the brain and two vertebral that supply blood to the posterior part of the brain. Unbeknownst to Shaw, he had been living with only one functioning vertebral artery, most likely since birth. So when the stroke happened due to an extensive clot in the other vertebral artery, the blood supply to the back of the brain was cut off. “People can live off of three arteries and not skip a beat their whole life,” said 43-year-old Sterling.

Strokes are typically caused by a pea-sized clot in one of the arteries. Shaw’s clot was “extensive,” blocking the entire vertebral passage. When Cooper and Sterling saw Shaw’s CT scans, they weren’t optimistic. Cooper said, “There’s no cookbook for what he had.” Sterling agreed. “We pulled out all the stops.”

Interventional radiologists perform minimally invasive procedures to treat a wide range of conditions throughout the body. Using X-rays, MRIs and other imaging, they advance a catheter, usually through an artery to the source of the problem. In Shaw’s case, Sterling and Cooper and their team first performed an angiogram to locate the clot. They gave Shaw tPA, a clot-busting drug, and removed the clot using small catheters to suck it out. They widened a narrowing in the artery by using stents (wire metal mesh tubes) to prop it open. All of this was done through one small incision in the leg and in less than three hours.

Shaw was lucky but also well-informed. Cooper and Sterling stressed the importance of stroke awareness. “The key is to know when you develop symptoms to seek medical attention.”

Choosing Life Over Existence
The first thing you notice about Alice Gaines is her striking beauty. It is incongruent with the Parkinson’s disease she’s had for the past 14 years. Now 49, she was just 35 and pregnant with her second child when first diagnosed. Initially she sought treatment for knee pain, thinking she had arthritis. About six months later her leg began to drag intermittently. Doctors diagnosed Alice with depression and put her on muscle relaxants and antidepressants. When she started experiencing muscle rigidity in the form of a stiff neck, doctors thought it was stress.

It wasn’t until after she gave birth and discovered she couldn’t walk that doctors prescribed Sinemet. A positive response to this drug confirmed Parkinson’s disease.

For five years Gaines functioned on Sinemet, but the Parkinson’s continued to progress. Although driving and handwriting became difficult, she stayed at her job full time. It was about this time Gaines lost her mother, then six months later her 40-year-old husband to a massive coronary.

Eventually she could no longer drive or write. Getting out of bed took two hours, and her vision became so poor it was difficult to watch television. “I was just existing.”

One night she saw a television program that featured Georgetown University Hospital’s Dr. Christopher Kalhorn performing deep brain stimulation (DBS) on a Parkinson’s patient. Gaines phoned for an appointment the next day. To gain eligibility for DBS, patients must undergo detailed motor testing and still be responsive to the Parkinson’s drugs Sinemet or Levodopa.

Kalhorn, the 36-year-old director of epilepsy and functional and pediatric neurosurgery at Georgetown, was first exposed to DBS in the late ‘90s through his medical training at Baylor College of Medicine. “I thought, there’s an operation where you really impact on someone’s quality of life.”

The DBS surgery takes about five hours. Two electrodes are implanted bilaterally in the brain with sub-millimeter accuracy. The patient is heavily sedated and anesthetized, but still awake so they can respond to the implants as the surgery proceeds. Kalhorn singles out neuron-anesthesiologist Dung Q. Tran for keeping patients comfortable during the surgery.

A month after the brain surgery, a pacemaker is implanted underneath the collarbone in the chest. It operates similarly to a cardiac pacemaker, but delivers electrical stimulation to the brain, overriding faulty signals and reducing tremors and some of the other symptoms of Parkinson’s patients. Medication is still required, but usually at lower doses.

Being able to be there for her sons RJ, 14, and Sam, 11, motivated Gaines to have surgery. Now she can enjoy some of the routine mom activities again, like playing board games, going to festivals and even throwing the football around.

DBS is not a cure for Parkinson’s, but it does improve quality of life for those who are able to undergo it. Current data indicates that patients do significantly better with motor movement five years after the surgery than prior to it.

Kalhorn views his “role as a neurosurgeon as a great privilege.”

Gaines sees it a different way. “He gave me my life back.”

Mia Shearer | Cancer Survivor

It’s Not Allergies—It’s Cancer
When 44-year-old Maureen Shearer, also known as Mia, started having trouble breathing, she thought she had a stubborn cold or was developing allergies. Then one day while doing a handstand in yoga her teacher told her to close her mouth and breathe through her nose. That’s when Shearer discovered, “I couldn’t breathe at all.”

She went to urgent care, where she was diagnosed with sinusitis and given antibiotics and later Allegra and Flonase. When nothing helped she saw her family physician, Dr. Michael Rodriguez, who took a look in Shearer’s nose and sent her to have a CT scan with Dr. Betsy Vasquez. Vasquez discovered a mass. Surgery was scheduled, but Shearer remained unconcerned that it was anything serious. The mass was removed and biopsied.

Within two days of her surgery Shearer had lumps on her neck. She and her husband assumed her lymphatic system was crashing. They phoned Vasquez, who told Shearer’s husband David that Mia had nasopharyngeal cancer, a cancer that is rare in Caucasians and much more common in Asian men. Vasquez had already made an appointment for Shearer with Dr. Kin-Sing Au, a radiological oncologist at Inova Loudoun Hospital.

Shearer and her husband had no idea what to expect when they first went to see Au. “He made us feel like everything was going to be OK,” Shearer recalled.

After meeting with her, the 52-year-old oncologist thought Shearer would be a good candidate for intensity-modulated radiation therapy (IMRT). Historically, because there are a lot of critical organs in the area, patients treated with radiation for nasopharyngeal cancer have suffered from long-term side effects including hearing loss, jaw problems, vision problems, brain damage and tooth loss from dry mouth caused by the loss of saliva glands. Au explained that IMRT is a very targeted form of radiation that approaches the tumor area from multiple directions, shooting beamlets of radiation at the unhealthy tissues and avoiding healthy surrounding tissues. Shearer was the first patient treated with IMRT in Northern Virginia. Au scheduled her right away to get a mask made for her face. The mask is marked so the radiation hits precisely the right spots each time it is beamed at the patient. IMRT was then performed in tandem with chemotherapy.

Au’s team consists of several top-notch people, including a dosimetrist and a medical physicist. The dosimetrist is responsible for radiation dose calculations. The physicist assists with those calculations as well as doing quality assurance calibrations on the equipment. Because the team, including Au, had not done this IMRT before, Au himself stayed well into the night on several occasions and figured out the calculations for Shearer’s treatment.

Shearer’s successful treatment lasted about seven weeks, five days a week. Au said, “That’s the rewarding part of my specialty, a patient like Mia.”

Small Patients, Big Treatments
 
Advancements at the Children’s National Medical Center

By Sarah Markel / Photograpy by Jonathan Timmes

Children’s National Medical Center, in Northwest Washington, is the area’s only medical system devoted entirely to caring for children and infants. Because Children’s Hospital has outpatient centers across the region, including two in Fairfax, those in need of care can better access most of its 367 pediatric specialists, many of them leaders in their respective fields. These doctors never forget that they aren’t just saving lives. They’re saving families.

Dr. Michael Boyajian
Pediatric Plastic Surgery

Approximately one in 700 children is born every year in the United States with cleft palates. In the Mid-Atlantic region, most of those babies will see Dr. Micheal Boyajian, director of plastic and reconstructive surgery at Children’s Hospital.

Boyajian’s specialty is craniofacial surgery. He rebuilds faces, repairing cleft palettes so well that the scars are barely visible and correcting malformed infant skulls, often within hours of delivery.

Recently, medical advances have changed the landscape for children recovering from plastic surgery. It used to be that doctors fixed bones using titanium screws. Boyajian now uses screws made of absorbable material.

“It takes about a year to be fully absorbed,” he warned. But for growing bodies, this means no leftover materials to get in the way of facial growth, particularly unformed teeth.

Boyajian is always looking for ways to improve upon his work. Children’s was the first hospital in the country to modify the absorbable screws into pegs so they could be pushed into place using ultrasonic waves. This technique saves time and offers a better grip.

Pediatric plastic surgeons earn far less than their adult counterparts, but that doesn’t upset Boyajian. “I love my work,” he said. “To be able to close a cleft lip and bring it to a point where the deformity is small enough that it is below the threshold of what people can pick up, that is a big deal, and it’s privilege for me to be able to do it.”

Dr. Richard Jonas, Dana F. Higdon (mom) and
Walter Higdon (patient)

Richard Jonas
Neonatal Cardiac Surgery

Dr. Richard Jonas, chief of cardiovascular surgery and co-director of the Children’s National Heart Institute, has been a pioneer in the field of early intervention for congenital heart abnormalities. About eight in 1000 babies are born each year with such defects. Formerly, doctors preferred to postpone corrective surgery until the child was older.

Jonas disagreed. “You are better off giving a child a normal circulation as early in life as possible. It benefits the brain, and the child will achieve normal developmental milestones,” he said while stuck in traffic after a day in which he completed three neonatal heart surgeries.

For more than two decades, this Australian father of three has been repairing the hearts of tiny patients, some as small as 2 pounds. He and a massive team of doctors and staff work with clocklike precision, using magnifying telescopes. “We have to work fast. The heart can’t withstand having no blood supply for a couple of hours.”

Some of Jonas’ earliest patients are now college students. The trio of babies he operated on recently? They’re fine.

Dr. John Myseros Deborah Triggs (mom) Jessica Triggs
(sister) Matthew Triggs (patient)

Dr. John Myseros
Pediatric Neurosurgery

When a CT scan revealed a massive tumor on the right side of 9-year-old Matthew Triggs’ brain, his mother, Debbie Triggs, thought the news couldn’t get worse. But finding a neurosurgeon willing to take on the case proved challenging, as the dangers of bleeding and brain damage were so high.

Luckily, their pediatric oncologist, Dr. Marianna Horn at Inova Fairfax, referred them to Dr. John Myseros, a pediatric neurosurgeon at Children’s Hospital.

At 43, Myseros is something of a surgical wunderkind. He is already one of the leading experts in removing tumors from children’s brains, and he has a reputation for pushing the boundaries of what neurosurgeons can and will do to save lives.

Matthew’s tumor was so tangled in his brain that conventional treatments would have removed a significant amount of healthy tissue along with the tumor. His parents were warned he could wind up on a ventilator for life. That was, if he survived.

Myseros spent hundreds of hours studying Matthew’s MRI and conferring with other doctors to develop a novel approach for removing the tumor. He called in neuro interventional radiologist Dr. William Bank from Washington Hospital Center to perform an embolization to block off the blood to the tumor. The procedure reduced the bleeding so Myseros would have time to work.

“I know I can do this,” Myseros had assured Triggs before beginning the 12-hour operation. The surgery, in which he painstakingly unpicked the tumor from the nerves that control Matthew’s breathing and the movement in his face, was an unqualified success. As Myseros put it, “Matthew is now a neurologically normal boy.”

“When you are dealing with a life-or-death situation, you want someone who is confident,” Triggs said. “That man is larger than life.”

(February 2008)