Mission Summer 2018 by UT Health Science Center San Antonio

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A DESCENT INTO CHAOS, M I S E R Y, A N O T H E R W O R L D

Mission SUMMER 2018 | Vol. 44, No. 1

In this Issue 04 PRESIDENT'S MESSAGE 34 ACCOLADES 05 UNIVERSITY IN MOTION 38 PHILANTHROPY 42 PARTING SHOT

Dignity, love, compassion

Helping the homeless offers students lessons in empathy.

Treasures of the P.I. Nixon Library The collective wisdom of thousands of years of medical exploration lies waiting to be discovered anew.

Operating in the new normal

Trauma surgeons Ronald Stewart, M.D. ’85, and Lillian Liao, M.D., M.P.H. ’04, respond to emergency calls routinely. But this call, of a mass shooting in nearby Sutherland Springs, made U.S. history. COVER STORY

Dementia

Six minutes in a Virtual Dementia Tour is a descent into chaos, misery and another world. The experience offers caregivers enhanced empathy for those struggling with memory loss.

His fight to survive. Their commitment to science. The ultimate victory.

CURED Page

Photo by Mark Sobhani

Tomorrow, long before sunrise, we will begin again For the United States, 1968 was a year of moments, high and low, that changed the world. The triumphs of the first 747 jumbo jet and of the first manned space mission to orbit the moon were tragically darkened by the assassinations of two visionaries, the Rev. Martin Luther King Jr. and Robert F. Kennedy. In San Antonio, the year witnessed the dedications of two of the community’s most far-reaching prizes, The University of Texas Medical School at San Antonio, now named the UT Health San Antonio Joe R. & Teresa Lozano Long School of Medicine, and the Bexar County Teaching Hospital, now called University Hospital. Today, as I think about the transformational events that have shaped our institution over the past 50 years, what has remained as a constant thread in this story has been the inspiring voice of promise and possibility. It is the promise of this burgeoning, bustling-with-life, beacon-of-hope university that propels us forward and gives wings to all that we can imagine—to a future that could be. It is the promise of this place that lifts burdens and relieves suffering. It is the promise of an always brighter tomorrow, despite frailty and the limitations of the human condition. A place of possibility, UT Health San Antonio has embraced learning and discovery, healing and serving, every single day since its dawning. With this issue, we celebrate 50 years of dreams, toils and striving. Fifty years of promise that have given our community 35,800 graduates and the creation of the Palmaz stent, listed among the top 10 patents that changed the world. These five decades have resulted in today’s university community, comprised of a workforce of 6,627 faculty and staff, a student body of 3,270 and 915 residents and post-graduate trainees. Ours is a mission that blends the forces of mind, heart and vision for one purpose: to find answers that will lead to hope and powerful new pathways to make lives better. Yet even as we celebrate achievements, we can never be complacent, never be satisfied that we have done all we can to fulfill our role of instigator of promise. For tomorrow, long before sunrise, we will begin again. We will re-commit to moving forward, poised on the shoulders of all those who have preceded us over these 50 years—and all of you who support us through your passion and compassion, without fail. As we continue to evolve, we thank you for your confidence and pride.

William L. Henrich, M.D., MACP President and Professor of Medicine UT Health San Antonio

UNIVERSITY in motion

Revolutionary new tool could change pancreatic cancer therapies By WILL SANSOM Pancreatic cancer kills 91 percent of patients within five years of diagnosis. Advances in new therapies have been negligible, and chemotherapies only extend survival by a few months. A new tool is urgently needed to find a better approach, and Bruno Doiron, Ph.D., assistant professor of medicine, believes he has found one that provides a truer picture of the disease and how it affects humans. For years, scientists have studied pancreatic cancer by genetically engineering mice to develop the disease or by transplanting tumors into them to test drug activity. The resulting tumors provide an artificial picture of the human disease, Dr. Doiron said. So he and his lab team have found a way to inject a modified virus into healthy adult mouse pancreases. The virus serves as a vehicle for two pro-cancer molecules, present in human pancreatic tumors, to be delivered into the organ. Once injected, the virus permeates the pancreas, yet it doesn’t affect any areas outside of the organ. When the mice reach 28 to 30 weeks

Researchers are injecting a modified virus into adult mouse pancreases. The virus delivers pro-cancer molecules that are in human pancreatic tumors. When mice reach 28 to 30 weeks of age, tumors develop that resemble human pancreatic cancer.

28 weeks post-injection

of age, tumors develop that resemble human pancreatic cancer. “This bypasses the artificial manipulation introduced by other methods, and spontaneous cancers develop that mimic those found in people,” Dr. Doiron said. The lab team uses mice of different breeding and from different parents to ensure the development of the cancer is random, similar to how the disease behaves in humans. The invention, which has a U.S. patent pending, is significant because “it demonstrates that all previous methods of study are obsolete,” Dr. Doiron said.

29 weeks post-injection

30 weeks post-injection

This more accurate picture of the human disease could also revolutionize studies of pancreatic cancer initiation and progression, and spur new drug development, said Ruben A. Mesa, M.D., FACP, director of the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center. “This important work by Dr. Doiron and colleagues will allow us to better predict which treatments for the devastating disease of pancreatic cancer will be effective," he said. "These discoveries are a much-needed advance on efforts to cure pancreatic cancer.” Summer 2018 | uthscsa.edu/Mission | 5

UNIVERSITY in motion

Is stroke in your genes?

A landmark international study of DNA samples from 520,000 people around the world, including 67,000 stroke patients, identified 22 new genetic risk factors for stroke. It is the largest genetic study of stroke to date, and could lead to stroke drug development, said Sudha Seshadri, M.D., co-author of the study published in Nature Genetics. It also has implications for dementia treatment. “Understanding these newly identified risk factors for stroke should also enable us to find novel treatments for dementia,” said Dr. Seshadri, founding director of the university's Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases. “Vascular disease in the brain—a series of strokes— can lead to dementia.” The risk factors identified were for all major subtypes of ischemic stroke, the most common stroke that occurs when

a blood vessel supplying the brain is blocked. The study found the largest correlation between genetic risk factors and blood pressure. Hypertension is a major risk factor for stroke. Vascular health is important for brain function. The brain does not store energy and requires a constant supply of blood and oxygen, as well as blood glucose. “Any disruption can lead to cognitive problems,” Dr. Seshadri said. “The most obvious example of that is stroke. There is a deficit in the blood supply and that is associated with very obvious changes in cognitive function.” In another study, Dr. Seshadri and colleagues from the Framingham Heart Study found a trend, over 30 years, of people showing signs of dementia later in life. This is partly attributable to greater control of blood pressure, she said. “We are looking at other causes,

such as lower burden of multiple infections because of vaccination, and possibly lower levels of lead or other pollutants in the atmosphere,” she said. “Early education and nutrition might also play a role.” Both studies illustrate the strong connection between heart health and brain function. “What’s good for your heart also seems to be very good for your brain,” she said.

Changing the standard of cancer care Bladder cancer patients who received the chemotherapy drug gemcitabine had significantly lower recurrence of their cancer, a clinical trial has revealed. The multi-institution trial involved 406 patients with newly diagnosed bladder cancer or low-grade bladder cancer that had not invaded the muscle wall. Those who received gemcitabine-saline treatment directly into the bladder within three hours following surgery had an estimated recurrence rate of 36 percent within four years. There was a 48 percent recurrence rate in the same time frame for those receiving a saline-only treatment. “This is a huge difference in recurrence rate and demonstrated that gemcitabine is a safe and welltolerated drug,” said Robert Svatek, M.D., the university’s study leader and a genitourinary oncologist. “We expect this study to change the standard of care.”

This is a huge difference in recurrence rate and demonstrated that gemcitabine is a safe and welltolerated drug.” –Robert Svatek, M.D. There were no significant side effects for patients in the study, and gemcitabine, which is already approved by the Food and Drug Administration to treat several types of cancer, is less expensive than many other therapies frequently used in the U.S.

| Mission | The University of Texas Health Science Center at San Antonio

36% 48%

RECURRENCE RATE GEMCITABINE-SALINE TREATMENT RECURRENCE RATE FOR SALINE-ONLY TREATMENT

BLADDER CANCER IS THE FOURTH MOST COMMON CANCER IN MEN RATES OF NEW BLADDER CANCERS HAVE BEEN DROPPING IN WOMEN. IN MEN, INCIDENCE RATES HAVE ALSO BEEN DECREASING. American Cancer Society, 2018

Chlamydia in your gut could protect you

Medical cannabis

When a Food and Drug Administration advisory committee in April unanimously approved the first cannabidiol (CBD) medicine for prescription use in epilepsy, it based its decision partly on recommendations of Jose E. Cavazos, M.D., Ph.D., professor of neurology and physiology at UT Health San Antonio. “I was asked to evaluate the scientific credibility of the evidence—whether there was sufficient research data—to recommend approval of this drug to treat Lennox-Gastaut and Dravet syndromes, which are two types of catastrophic epilepsy,” he said. The syndromes produce multiple seizures daily and treatment options are limited. CBD is derived from the Cannabis sativa plant, famous as the source of marijuana. CBD is a non-addictive component of the plant, in contrast to tetrahydrocannabinol (THC), which is a component that produces the high of marijuana and is addictive. The drug, sold under the brand name Epidiolex, is a proprietary oral solution of plant-derived CBD that contains less than 0.1 percent THC and does not produce euphoric effects. Clinical trials indicate the medication can decrease the frequency of “drop attacks” and other symptoms of Lennox-Gastaut. In these attacks, a person suddenly stiffens and falls with the head

facing forward. Children with LennoxGastaut may wear helmets to prevent head injuries. Controlled CBD use has been legal in Texas since 2015, when lawmakers passed the Texas Compassionate Use Act. CBD oil dispensaries allow families of children with epilepsy to obtain the oil with physician authorization, but it is a lower dose than the pharmaceuticalgrade CBD and is not covered by insurance. Linda Leary, M.D., clinical associate professor of neurology and pediatrics, said physicians at UT Health San Antonio will assist families who want to try CBD in their children with difficultto-control epilepsy. “One reason we are willing to do this is that at least we can help families to use it safely,” Dr. Leary said. “CBD is not viewed as a miracle, but is one more medication that could work to control seizures.” The FDA decision affects insurance status and provides safety guidelines and dosing instructions.

Exposing the gut to chlamydia protects against subsequent infection in the genital tract and other tissues, researchers have discovered. Chlamydia is the nation's most common sexually transmitted disease and causes infertility, ectopic pregnancy and pelvic inflammatory disease if untreated. The protection from exposing the gut to the disease is very robust and is across tissues, which is called transmucosal immunity. Protected sites include the genital tract and the lungs, said Guangming Zhong, M.D., Ph.D., professor of microbiology, immunology and molecular genetics. Human exposure to chlamydia is unpredictable, and can come through genital or non-genital sexual contact with an infected partner and perhaps through contact with contaminated materials. The researchers used a mouse model to study the bacteria’s transmission. They found if the gut was the first site to be colonized by chlamydia bacteria, the mice were immunized against further disease. The gut infection was benign. But if the genital tract was the first to be infected, the resulting disease was harmful, causing a worse disease prognosis, including the possibility of infertility because the disease is advanced before symptoms are present. The bacterium that causes the disease could be used as an oral vaccine in the future, the researchers believe. “We take probiotics for our GI health,” Dr. Zhong said. “In the future, we may add chlamydia as a probiotic for the gut. Once the bacteria are established in the GI tract, they don’t spread.” Summer 2018 | uthscsa.edu/Mission | 7

UNIVERSITY in motion

Power to the patient Personalized, or precision, medicine is expected to be the new normal in medicine in the future. The Graduate School of Biomedical Sciences has launched a new master’s degree in personalized molecular medicine that will train students in personalized medicine approaches and provide the knowledge and skills required to explore molecular medicine pathways. Students will study the complex and integrated biological systems, and will receive firsthand experience in the use of technologies in next-generation sequencing, single-cell analysis, computational biology, epigenomics, proteomics, drug design, animal models of human disease, system approaches and instruction in mining human disease databases.

Herbal hope for oral cancer Mother Nature has a way of hiding cures for diseases in plants and minerals, awaiting human discovery. This may be the case with thymol, a compound found in several plants, including thyme, oregano, rosemary and bay leaves. “Thymol is already known to have antimicrobial, anti-fungal, anti-inflammatory and anti-oxidant properties,” said Cara Gonzales, D.D.S., Ph.D., associate professor in the Department of Comprehensive Dentistry. Due to its medicinal properties, thymol is already an ingredient in a leading mouthwash, cosmetics and other products. Dr. Gonzales and her team recently conducted laboratory and animal research that showed thymol may have merit as a preventive agent and treatment for oral cancer. They found that thymol was effective in preventing the proliferation of oral cancer cells. In animal models of human oral cancer, the team showed thymol to be effective as an anti-tumor agent. “Our findings provide the first evidence of thymol’s novel anti-tumor effects against oral cancer in animals,” Dr. Gonzales said. The team further discovered thymol selectively kills cancer cells by acting on

their highly active mitochondria, which produce energy to allow cancer cells to grow. “We show that thymol induces mitochondrial dysfunction and cell death, and it may be effective against several types of cancer,” she said. Dr. Gonzales’ research was published

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in the Journal of Oral Pathology & Medicine. UT Health San Antonio has a patent on a thymol mouth rinse to prevent oral cancer and on its mechanism of action to use as a treatment for oral cancer. She hopes to conduct human clinical trials in the future.

Stemming the spread of cancer

The trauma of youth Nearly 4 in 5 Latino youth suffer at least one traumatic childhood experience such as poverty or abuse, and lack the proper care, support and environment they need for healthy development, according to Salud America!, a national network for healthy change at UT Health San Antonio. The research review, “The State of Latino Early Childhood Development,” shows 77.8 percent of Latino youth suffer poverty, neglect, abuse or household dysfunction. The report calls for policy and practice changes, including increased spending on childhood education, comprehensive and continuous preventative health care and developmental/behavioral screening, and increased access to grocery stores and farmers markets.

OF LATINO CHILDREN SUFFER 4+ ADVERSE EXPERIENCES

LATINO PRESCHOOLERS who get individually and culturally tailored independent learning have test scores ABOVE the national average. LATINO KIDS EXPOSED TO MANY TRAUMAS ARE AT RISK FOR: » obesity

» future health issues » anxiety and aggression

» substance use

» lower language, literacy and math skills

Scientists at UT Health San Antonio and UTHealth in Houston were awarded $6 million in grants from the U.S. Department of Defense to expand studies of a therapeutic antibody. The antibody-based drug would be used to stem the spread of breast cancer to bone. This spread, called metastasis, is linked to a dramatic reduction in survival rates. The lead principal investigator is Jean Jiang, Ph.D., an Ashbel Smith Professor at UT Health San Antonio and the associate director of the Joint Biomedical Engineering Graduate Program of UT Health San Antonio and The University of Texas at San Antonio. “Antibodies are part of the body’s natural defenses and can be optimized to perform specific tasks,” Dr. Jiang said. “In this case, an antibody activates the connexin channels in bone cells, which protects skeletal tissue from breast cancer colonization and invasion.” UT Health San Antonio received $3.2 million for preclinical testing in the joint project. “Research from my laboratory shows the functional role of these channels in suppressing breast cancer invasion and bone metastases. This provides a potential therapeutic target for drug development in breast cancer,” said Dr. Jiang, professor of biochemistry and structural biology. McGovern Medical School at UTHealth in Houston received $2.8 million for drug development. The researchers hope to develop a less toxic treatment and reduce deaths tied to the spread of breast cancer to the bone. At the end of the study, they would like to have a drug that can advance to clinical trials.

Summer 2018 | uthscsa.edu/Mission | 9

UNIVERSITY in motion

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as 2018 marks the 50th anniversary of the school. Ninety-four of those matched will stay in Texas, with the majority, 37, remaining in San Antonio, and 23 heading to Houston. The others are scattered between Dallas, Austin, Amarillo, Tyler and Temple. Students not staying in Texas will venture out to 30 other states across the U.S., from California to New York and everywhere in between.

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Matchmaking Each year, graduating medical students anxiously wait to see where residency will take them for the next three to eight years. Match Day is a national day of anticipation and excitement for thousands who have worked hard to get to this point in their medical practice journey. This year, 203 students from the Long School of Medicine were matched to 85 residency programs across the nation. They were also part of something special,

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Summer 2018 | uthscsa.edu/Mission | 11

Dignity

LOVE compassion Helping the homeless offers students lessons in empathy

By NORENE CASAS Photos by MARK SOBHANI

Mikaela Miller, a second-year medical student, reviews a patient chart at Haven for Hope.

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ushing his walker across the floor tiles, the man shuffled into the clinic on a rainy Wednesday evening. Every two steps he took advanced his walker just an inch more. Finally making it to the examination room, he sat still as a doctor began studying his weathered face and frail arms, identifying each pink, scaly spot as precancerous. Medical students gathered closely to learn. “We will freeze this one,” said the doctor as he pointed to one of the spots. “This one I want to take a deeper look at as it might already be cancerous.” As one of the city’s estimated 3,000 homeless, the man’s years spent in the punishing South Texas sun were scarred into his skin. The doctor provided muchneeded medical attention, and students from the Joe R. & Teresa Lozano Long School of Medicine scribbled notes. This wasn’t a routine class in a lecture hall or lab. These students were learning more than can ever be taught in a classroom. Since Haven for Hope opened its doors in 2010, UT Health San Antonio has offered a Student-Faculty

Collaborative Practice at the resource center that provides services for more than 1,500 men, women and children every year who are experiencing homelessness in Bexar County. From addressing chronic pain to emergency dental care to vaccines and treatment for skin ailments, the students put into practice what they learn in the classroom under the direction and supervision of faculty. In return, they offer the care that many homeless people lack. According to the Centers for Disease Control and Prevention, the homeless population has a mortality rate that is four to nine times higher than those who are not homeless. There are an estimated 40 million people in the U.S. living in poverty, 19 million experiencing housing insecurity and 28 million who lack health insurance. The risk of homelessness and poor health is a concern for 1 in 8 Americans, the CDC reports. Because of their broad reach and deep impact, the Haven for Hope clinics offer valuable experience for students from all disciplines, said

Richard P. Usatine, M.D., professor in the Department of Family and Community Medicine and assistant director of medical humanities education through the Center for Medical Humanities and Ethics at UT Health San Antonio. “It’s about humanity. It’s about realizing that there are 7 billion people on this planet and we are all the same,” he said. Dr. Usatine helped start the university’s first student-faculty collaborative practice in 2005. Over the years, it has expanded into a network throughout San Antonio that now offers six clinics—including the one at Haven for Hope— operated by medical, dental, nursing and allied health students. “They can see that what they are really headed for is a life of service, not a life of memorization and

Holly Ann Ardoin, a fourth-year dental student, sets up an examination space in a gathering room at Haven for Hope. She and other dental students offer free exams to those experiencing homelessness.

Summer 2018 | uthscsa.edu/Mission | 13

UT Health San Antonio has offered student-faculty clinics at Haven for Hope since 2010. They provide emergency dental care and vaccines, and treat chronic pain and skin ailments.

Above: Sabrina Lincoln and Adrian Frausto from the physical therapy doctoral program. Top right: First-year medical student Tommy Pham is student director of the Haven for Hope dermatology clinic. Bottom right: Richard P. Usatine, M.D., medical student Mikaela Miller and Pham examine a patient. Opposite page: Pham volunteers weekly at Haven for Hope.

testing,” Dr. Usatine said. “Their eyes are opened to so many different truths and things that extend their compassion.” Within a year of the School of Medicine opening its clinic at Haven for Hope, students and residents of the School of Dentistry followed using clinic space in partnership with San Antonio Christian Dental Clinic to provide a wide range of dental services. It has since expanded to offer immediate emergency dental care. The physical therapy clinic began in 2016, and gives students the opportunity to treat chronic pain in the homeless, most of it caused by poor health care and sleeping in inadequate conditions. “People here are the least likely to receive health care in a private doctor’s office and, because they have the greatest needs, they are the most vulnerable,” Dr. Usatine said.

In addition to practicing techniques and procedures, students get the opportunity to practice empathy. Students often believe “people living on the streets are different,” Dr. Usatine said, but after serving at Haven for Hope, they walk away with a story or two that impacts how they will provide health care in the future. Holly Ann Ardoin changed her career plans after her rotation at the dental clinic. The fourth-year dental student saw patients who were around her age, but with teeth blackened and rotted by long-term methamphetamine use. “I delivered a denture to a 25-year-old girl, and it showed me how strong addiction is,” she said. “I always felt like I was going to give back, go overseas and do dental work there, but I now feel there is so much need at home. There is work here to be done.”

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Although it takes a lot of training to care for patients, it doesn’t take a lot to care. That’s an important message that Dr. Usatine wants students to take away from their time at Haven for Hope. “We are all human beings, and everyone needs to be treated with dignity, love and compassion,” said Dr. Usatine. “Whether a person is homeless or using alcohol or heroin or methamphetamines, they deserve health care. They deserve to be treated well.” Every time he sees a patient at Haven for Hope, first-year medical student Tommy Pham thinks about his brother. As the student director of the Haven for Hope dermatology clinic, Pham volunteers weekly and often serves patients who struggle with alcoholism and depression—two things his brother also struggled to overcome.

It was Pham who first saw the old man who slowly shuffled into the clinic on a rainy Wednesday. Pham and other students examined his weathered skin imprinted with the brand of too much sun—too many days spent outside, without shelter. When his appointment was over, Pham walked with him to the door and told the man how much he appreciated his patience with him and the other medical students. “He finally looked up and looked me in the eyes. He had that old, really soft smile, and said, ‘Thank you.’ That is all he said. Really gently, just ‘thank you,’” Pham said. “That look in his eyes, seeing him smile for the first time all night—it gave me a sense of hope. Then he turned around with his walker and went back to Haven.”

Summer 2018 | uthscsa.edu/Mission | 15

Hep

The road to survival and the journey of discovery intersect to forge one of the greatest successes in scientific research By ROSANNE FOHN

oey Libby, 26, holds a job at a call center and does odd jobs for extra cash. While the outside work he does on weekends is demanding, especially as the temperatures rise, he does it willingly because for eight years—most of his teens and early 20s—his life was limited by a disease that few survived at that time. Joey was just 15 when he was diagnosed with hepatitis C. The symptoms came quickly and were punishing. “I wasn’t keeping any food down, not even water. It seemed to me that I had a stomach bug,” he said. “I tried medicine and I rested, but my mom had an instinct that she needed to take me to the hospital. She said, ‘Something’s just not right.’” Joey went through a series of tests. Then the diagnosis was delivered—and the news that he was in liver failure. “They told me that if I had not come to the hospital that day, I might have died,” Joey said. Hepatitis C is a blood-borne virus that slowly destroys liver

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function. About 3.5 million people in the U.S. have chronic hepatitis C and 70 to 80 percent of them do not have symptoms until the disease has significantly progressed. According to the Centers for Disease Control and Prevention, more Americans die from hepatitis C than any other infectious disease. Hepatitis C also is a major cause of liver cancer. Yet finding a cure for the disease that wasn’t even known or named until 1989 has been hailed as one of the biggest modern success stories in scientific research. In record time, scientists say, the virus has gone from unknown to almost 100 percent curable. It has claimed many lives in the process: In 2014, deaths associated with hepatitis C reached an all-time high of 19,659, surpassing the combined number of deaths from 60 other infectious diseases, including HIV, pneumococcal disease and tuberculosis. But Joey wasn’t one of them. Instead, his path to recovery helped lead the way for researchers to find a cure. It wasn’t an easy road.

cirrhosis again within five years,” said Fred Poordad, M.D., professor of medicine at UT Health San Antonio and chief of hepatology in the Liver Transplant Program at University Transplant Center, a partnership between UT Health San Antonio and University Health System. It is unclear exactly how Joey contracted hepatitis C. Most people are diagnosed when they are age 50 or older, but both of his parents had the virus. Hepatitis C is found worldwide and is spread through contact with blood or semen, including using shared drug injection needles, inadequate sterilization of medical equipment, unscreened blood or blood products, accidental needle sticks and sexual intercourse with a person who has hepatitis C. The disease can also be spread from mothers to children during birth. Baby boomers, those born between 1945 and 1965, are the most affected because of exposure during medical procedures after World War II, when injection and blood transfusion technology was not as safe. Many of these baby boomers unknowingly transmitted it to others. A few years after Joey was diagnosed, his father died. His mother, Doris Libby, had learned she had the disease a few years before, but had refused treatment because fatigue was her only symptom. Then she met liver specialist Eric Lawitz, M.D., a professor of medicine at UT Health San Antonio. Dr. Lawitz was conducting clinical trials through his medical practice, the Texas Liver Institute. “I was in Dr. Lawitz’s office and I told him about Joey,” she said. “He told me about one of the trials, and the way he expressed it, he was bursting with enthusiasm and excitement. He wanted both of us to go on the study.” The trial was for patients in two groups who had not benefitted from previous treatments—those, like Doris, with hepatitis C who had advanced liver disease, and patients like her son, who had received a liver transplant but whose liver disease had returned because of hepatitis C. The year was 2014. By then, Dr. Lawitz had seen many treatments for hepatitis C come and go, with limited success. But this one seemed different.

A long road It was 2007 when Joey was diagnosed with the disease. He was placed on the liver transplant list and started the standard hepatitis C treatment for that time—daily shots of an antiviral drug called interferon. The drug had severe side effects, with only 10 to 20 percent of patients being cured. “When I was sick I couldn’t play sports, I couldn’t work out, I was depressed. For a while I even considered suicide. It was just too much,” he said. Joey returned to school, but his eyes and skin turned yellow because of low liver function, and he was retaining fluid in his abdomen. As his condition worsened, he was homeschooled. He got a reprieve with a liver transplant on June 19, 2008; however, the good news was tempered. “Unless the hepatitis C is cured, the virus continues circulating in their blood and infects the new liver, usually within a few months of transplant. One-third of them get

Dr. Lawitz was in medical school when hepatitis C was first discovered. The first standardized treatment— interferon—was approved by the Food and Drug Administration in 1991. As his medical training progressed, first in internal medicine and then with fellowships in gastroenterology and hepatology at Brooke Army Medical Center in San Antonio, he became involved in some of the early research to improve treatments. One of the challenges of finding a cure for hepatitis C is that there are six strains of the disease, based on the geographic location where the strain developed. In the U.S., genotype 1 is the most common type. Another variable is the extent of liver scarring called fibrosis, which when severe is called cirrhosis. When Dr. Lawitz opened his private practice in 2004, it included cutting-edge liver disease research. Interferon, given to boost the body’s immune system and reduce the growth of cancer and viral cells, was the standard treatment Summer 2018 | uthscsa.edu/Mission | 17

Left: Joey Libby was just 15 years old when he was diagnosed with hepatitis C. Both he and his mother, Doris Libby (right), were cured of the disease after participating in a clinical trial. Right: Joey Libby’s journey to health was a decade-long process. Today, he’s free of the disease that almost killed him and is exercising regularly to stay fit. Photos by Mark Sobhani

for hepatitis B. But to treat the chronic and deadly hepatitis C, he knew it wasn’t enough. Interferon has terrible side effects, including flu-like symptoms, fatigue and depression. While it helped the body recognize viruses and eliminate them, as soon as patients stopped taking it, the virus would come back. “Back then with our research, we were just inching along, trying to squeeze another 5 percent cure rate out of interferon by changing the dose or duration of therapy,” Dr. Lawitz said. Then doctors began adding an antiviral drug, ribavirin, to their treatment regimen. The pills seemed to work at preventing relapse and more than doubled cure rates from 10 or 20 percent to about 40 percent. But it also had adverse effects such as anemia, gastrointestinal issues and rash. Attempts to keep interferon in the bloodstream longer meant patients were given weekly long-acting injections of interferon and up to six pills daily for months. While Joey endured these difficult regimens with limited success, the field of medicinal chemistry was beginning to blossom with a new approach. Instead of focusing on strengthening the body’s immune system to fight the virus using existing treatments, scientists began studying the use of direct-acting antivirals to target specific parts of the virus and prevent it from reproducing. These new drugs held the promise of a shortened treatment length, minimal side effects and, because they targeted the virus itself, improved response. Several physician-researchers around the country were invited to evaluate the new drugs in clinical trials. Among them were Dr. Lawitz and Dr. Poordad, who at that time was chief of hepatology and liver transplantation at Cedars-Sinai Medical Center in Los Angeles. “If they worked, we knew direct-acting antivirals would change the field forever,” Dr. Poordad said. They were on the cusp of finding a cure for the disease that seemed unconquerable. The first clinical trials of direct-acting antivirals began in 2008 by adding them to standard immune-building treatments. Amazingly, three short years later, the FDA 18

approved the first two direct-acting antiviral therapies for genotype 1. Cure rates escalated to 79 percent with some treatments. “With these two regimens, we got high cure rates, but we still had significant adverse events, so it helped in one way but it wasn’t patient-friendly in the other,” Dr. Lawitz said. So, the physician-scientists teamed up, and the work went on. Having met at various professional research meetings, Dr. Lawitz invited Dr. Poordad to join his practice in 2012, when both also became professors of medicine at UT Health San Antonio. Their academic backgrounds and clinical success provided them with opportunities to assist and advise pharmaceutical companies in the design and conduct of some of the major hepatitis C clinical trials, including Harvoni, now a common drug used in the treatment of hepatitis C, Dr. Lawitz said. Then came the study that changed the lives of Joey and his mother. In this clinical trial, patients received a 12-week course of a direct-acting antiviral drug combined with an inhibitor of a key viral protein found in hepatitis C. The trial showed an overall cure rate of 94 percent for patients with a liver transplant and returning hepatitis C, like Joey, and a cure rate of 83 percent for patients with advanced cirrhosis, like his mom. “The medicine didn’t make me feel bad and it was all pills, which was cool because I didn’t have to take shots,” Joey said. The trial was a highlight of Dr. Poordad’s career, and he presented the results at the International Liver Congress of the European Association for the Study of the Liver. The combination therapy received FDA approval in 2015. But the study had a much more profound effect on the Libbys. Both Joey and his mother were cured.

A game changer

In June 2016, the first agent to treat all six forms of hepatitis C in adults, called Epclusa, was approved. Drs. Lawitz and Poordad have investigated myriad drugs now approved by the FDA. Their work has appeared in premier research journals and helped shape guidelines in the treatment of hepatitis C.

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DISCOVERY TIMELINE 1989: Hepatitis C is identified for the first time. It has six types, or genotypes, based on the geographic location where the strain developed. Genotype 1 is the most common in the U.S.

1991: Interferon is approved by the FDA to treat hepatitis C. There are many classes of interferons, which are used to boost the immune system to fight viruses, not directly kill viral or cancerous cells. Cure rate: about 10-20 percent.

1992: Blood tests are

perfected to screen for the hepatitis C virus. These tests effectively eliminated the virus from the blood transfusion supply.

The most recent drug approved by the FDA was Mavyret in 2017; it treats all genotypes of hepatitis C. Some of the drugs have also been approved for use in pediatric patients. “The bottom line is that in a little more than a decade, we have conquered hepatitis C,” Dr. Lawitz said. “We now have many direct-acting, all-oral medications that cure 95 to 100 percent of patients in eight to 12 weeks of therapy with very minor side effects. Additionally, we can successfully re-treat 96 percent of [previous direct-acting antiviral] failures.” Only 1 in 1,000 patients in the hardest-to-treat categories cannot be cured. “To me, the biggest surprise was how quickly the pace of development occurred,” Dr. Lawitz said. “The incremental steps from drug to drug and clinical trial to clinical trial were fairly big. To get from 40 percent to nearly 100 percent cure rate with only minor adverse effects in that short of a time is unheard of.” However, it didn’t come without drawbacks. “Liver disease has a high death rate. I’ve seen too many patients pass away. There is not one patient who stands out for me. I’d say that many stand out. They helped drive me and helped me remember why we do this work,” Dr. Poordad said. “We’re very thankful to the many patients along the way. Without them we wouldn’t have had these successes. They trusted us with their lives.” While finding a cure happened in record time, the doctors know there is more work to be done. They want to see the fruits of their labor made available throughout the world to aid in total eradication of the disease. A vaccine could help achieve this goal. For Joey, the journey to health was more than a decadelong process that ended a year after his father died. Today, Joey is just glad to be able to lead a normal life, working two jobs and exercising regularly. Doctors still routinely check his liver function “and I’m still doing well,” Joey said. “I’m just living my life.”

1998: Ribavirin, an

antiviral medication, is added to the standardized treatment of interferon. Cure rate: about 40 percent.

2001: Pegylated interferon

is introduced to help interferon stay active in the bloodstream longer. Treatment regimens include injections and up to six ribavirin pills daily for six months. Cure rate: about 41 percent.

2003: A combination of

interferon and ribavirin is approved for treating pediatric patients.

2005: Hepatitis C cells

are grown in a lab for the first time, leading to the first study of the virus' life cycle.

2006: A new class of oral

drugs, called direct-acting antivirals, is developed. The drugs are aimed at directly stopping the spread of hepatitis C in the body by targeting specific steps in the virus’ life cycle.

2007: Sofosbuvir, an inhibitor

of a key viral protein in hepatitis C, is designed to decrease the amount of hepatitis C virus in the body and shows promise when used with standardized treatment. A series of clinical trials showed a cure rate of more than 90 percent in 12 weeks for genotypes 1, 2 and 3.

2008: The first clinical trials

of direct-acting antivirals begin.

2011: Direct-acting

antivirals are approved by the FDA to treat hepatitis C. These include boceprevir, used in combination with pegylated interferon and ribavirin, for a cure rate of up to 66 percent in genotype 1 patients. Telaprevir also was approved in combination with pegylated interferon and ribavirin for a 79 percent cure rate of genotype 1.

2014: Ledipasvir, another

direct-acting antiviral, used in combination with sofosbuvir, is approved by the FDA for genotypes 1, 4, 5 and 6. Known by its brand name Harvoni, the drug was the first hepatitis C treatment contained in one pill. Cure rate: 95 percent within eight weeks.

2015: The FDA approves

a 12-week course of the direct-acting antiviral agent daclatasvir combined with sofosbuvir, with and without ribavirin, for genotypes 1 and 3. Overall cure rate: 94 percent for patients with a liver transplant and returning hepatitis C. Cure rate for patients with advanced cirrhosis: 83 percent.

2016: Epclusa, a

combination of sofosbuvir and velpatasvir antiviral medications, is approved by the FDA to treat all six forms of hepatitis C in adults. Cure rate: 95 percent in 12 weeks.

2017: Mavyret, a

combination of the viral inhibitor glecaprevir and the antiviral agent pibrentasvir, is approved by the FDA to treat all genotypes of hepatitis C. Cure rate: 92-100 percent in eight weeks. Sources: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, the Hepatitis C Support Project, Eric Lawitz, M.D., Fred Poordad, M.D.

In the U.S., people born between 1945 and 1965 are the most vulnerable to hepatitis C. People in this age group are urged to contact their general practitioner to have a one-time blood test for hepatitis C to detect the virus and begin treatment before significant liver damage occurs.

Summer 2018 | uthscsa.edu/Mission | 19

A TORTUROUS UNR AVELING

OF THE MIN

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tabbing pains shot through my feet with every step, every turn. My

vision was chalky and distorted. I ran into objects, couldn’t pick up a fork or knife without a struggle, and heard nothing but a god-awful, buzzing white noise. The small apartment was vaguely familiar yet foreign. Disoriented and confused, I kept trying to complete simple tasks I had been assigned, but couldn’t even remember the instructions. I felt slightly stupid and strangely lost inside what used to be my body. And under my breath, or so I thought, I cursed my predicament quite freely. Most of all, for six excruciating minutes, I just wanted it to be over.

By JOE MICHAEL FEIST

On this sunny spring day, I felt fine, but in a matter of minutes was about to find out what it would be like to lose my mind. The Virtual Dementia Tour is a controlled simulation of dementia symptoms and part of the overall Caring for the Caregivers program run by the School of Nursing. The tour aims to give caregivers a greater understanding of dementia and an enhanced sense of empathy for those struggling with it. Dementia is the torturous unraveling of memory and brain function. It occurs most often in those of an advanced age, and so it’s often accompanied by other symptoms such as vision and hearing loss, neuropathy— which causes numbness or weakness in the arms or legs—and loss of dexterity. Because of the cognitive decline associated with the disease, those with dementia are often unable to communicate or explain their feelings and behaviors. It can be a nightmare for caregivers as well, most of whom are family members with little or no training or understanding of the illness—or how to cope with an uncommunicative and seemingly uncooperative patient. The Virtual Dementia Tour, developed

by Atlanta-based Second Wind Dreams and licensed to UT Health San Antonio, is meant to give caregivers “a glimpse into the world of dementia,” said Deborah James, M.S.N., RN, a clinical assistant professor in the School of Nursing and director of the dementia tour. And, she added, a better understanding of the challenges dementia patients face can only lead to better caregiving. This is especially critical in light of some startling facts. Age is the greatest risk factor for developing dementia, and the number of Americans over 65 is expected to double by 2060. In Texas, according to the Department of State Health Services, a new person develops Alzheimer’s disease every 65 seconds, and current projections indicate that this rate will increase to one new case every 33 seconds by 2050. Alzheimer’s disease, the most common form of dementia, affects an estimated 5.7 million people in the U.S.; 380,000 are Texans. The disease disproportionately affects women, African Americans and Hispanics. For the tour, which lasts only six minutes, I was outfitted with inserts in my shoes that have probes that dig into the feet. “That’s to Summer 2018 | uthscsa.edu/Mission | 21

simulate neuropathy or diabetic neuropathy, like pins and needles in your feet,” James explained. Then a padded glove was placed on my dominant hand to impede dexterity. Thick glasses distorted my vision and simulated glaucoma and other vision problems. Headphones with white noise caused hearing loss and added to the general confusion. Uncomfortable and a bit bewildered, I was given five simple tasks, which I was to perform in a room furnished like a small apartment. But like many who take the tour, the white noise and the disorientation meant that I didn’t clearly understand the verbal instructions or recall them later. I was told to “put the coffee in the refrigerator,” but only heard the words “coffee” and “refrigerator.” I was asked to “buckle the belt,” but only heard “belt.” Of the tasks assigned, I completed none. “All of the things being simulated are very common in those with dementia or those with Alzheimer’s,” James said. My tour was a marathon of frustration, pain, embarrassment and defeat. I fearfully thought, “If this is what dementia is like, God spare me.” That emotion is common, according to the Centers for Disease Control

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and Prevention, which found that Americans fear losing their mental functions twice as much as they fear losing their physical abilities. After the tours, which are closely monitored, James debriefs the participants so that they more fully understand what transpired and how it might relate to their caregiving. The experience, the sudden realization of what dementia feels like, can be life changing for the caregiver. And raw emotions sometimes overwhelm the tour participant, James explained. “One man said, ‘I feel so ashamed,’” she recalled. “He said, ‘I try to protect my wife, but I never realized that it hurts so bad just to get your damn shoes on. I didn’t know she was in that kind of discomfort. And I never thought that she couldn’t hear me.’” Like other caregivers, the man thought his wife simply didn’t want to cooperate. Sheran Rivette, who works part time in the Caring for the Caregiver program, was the full-time caregiver for her husband, who had Alzheimer’s disease, for six years before his death in February 2017. She now cares one day a week for a man with Alzheimer’s, giving his wife a much-needed respite.

She recently experienced the dementia tour, but, for her late husband’s sake, wishes she had had the chance to do it years ago. “At first, after doing the tour,” she said, “I had sadness because I had not been as sensitive in understanding his conditions and his actions as I could have been. Should have been.” Her voice trailed off. “Wish I had been,” she added softly. Almost worse than the disease itself are the moments of clarity, in which the person with dementia realizes how much they’ve lost. “I think the person is disappointed when they can’t complete simple tasks,” Rivette said. “I think they’re embarrassed because they feel foolish, they feel stupid. My husband often said, ‘I’m just stupid. I don’t know anything.’” Now, she added, with the man she cares for weekly, she’s more patient, more tolerant, more willing to try different approaches to break through the fog of the disease. “I would encourage every caregiver to take this tour,” Rivette said.

MY TOUR WAS A MARATHON OF FRUSTRATION, PAIN, EMBARRASSMENT AND DEFEAT. I FEARFULLY THOUGHT, “IF THIS IS WHAT DEMENTIA IS LIKE, GOD SPARE ME.”

“To empathize is different than to sympathize. I believe empathy is huge. We need to put ourselves in other people’s shoes.” By far, family members provide most of the care for loved ones with dementia or Alzheimer’s disease, said nursing professor Carole White, Ph.D., RN, who directs the Caring for the Caregiver program. In 2017, an estimated 15 million Americans provided 18 billion hours of unpaid care for family members and friends with Alzheimer’s and other dementias. Often, Dr. White said, it comes at “great personal cost to their physical health, their emotional health, their social and financial health.” That’s why the comprehensive Caring for the Caregiver program that offers education, skills training, research and community engagement is so needed, she said, especially in light of the coming “tsunami” of people with Alzheimer’s disease and other dementias. After my dementia tour, as I massaged my aching feet, regained my balance, was told how much I swore and was reminded of how I didn’t really do the things I was asked to do, James added a sobering shot of reality. “Remember,” she said. “This was only six minutes of your time. It’s every minute of some people’s time.” The School of Nursing and the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases work together to support the health and well-being of people with dementia and their family members. To learn more about the Caring for the Caregiver program and the Virtual Dementia Tour, visit UTcaregivers.org, call 210-450-8487 or email masoud@uthscsa.edu.

The Virtual Dementia Tour is meant to give caregivers a glimpse into the world of dementia and the confusion that envelops patients. Participants are outfitted with shoe inserts that simulate neuropathy, a padded glove to impede dexterity, thick glasses to distort vision and headphones to simulate hearing loss.

Summer 2018 | uthscsa.edu/Mission | 23

TREASURES OF THE

P.I. Nixon Library By JOE MICHAEL FEIST Photos by SUSAN BUENTELLO AND BR ANDIE JENKINS

Tucked away on the fifth floor of the Dolph Briscoe Jr. Library, the collective wisdom of thousands of years of medical exploration lies waiting to be discovered anew. The treasures of the P.I. Nixon Medical Historical Library reveal the evolution of medicine and the methodical untangling of many a mystery. Included are some of the rarest and most beautiful medical texts ever created. The Nixon library, a part of the overall Briscoe library, is named for Patrick Ireland Nixon, an early 20th-century San Antonio physician and book collector who in 1919 founded the Bexar County Medical Library Association. Through the years, with Dr. Nixon overseeing the library and purchasing many books himself, the association acquired thousands of priceless works on medicine and health. In 1970, some 6,000 books from the association were donated to UT Health San Antonio, forming the core of the Nixon library. “Any student at UT Health San Antonio can benefit from the early books in health care, which are basically the origin of the fields they’re going into,” said Andrea Schorr, the Briscoe library’s head of resource management. “It gives them perspective as to what has been done historically and what is happening now.” Mellisa DeThorne, special collections assistant, said the Nixon library contains works on general medicine, most specialties, dentistry, nursing and many other aspects of health care. But the books transcend medicine, she added. “Anyone who has an appreciation for art can appreciate the books in the Nixon library, because they are works of art.” In addition to the core collection of books, the Nixon library also includes some 200 medical devices, photographs, artifacts and other historical items. Here are a few gems from the Nixon.

De Medicina, by Aulus Aurelius Cornelius Celsus (c. 25 B.C.–c. 50 A.D.)

Milan, 1481, second edition Significance: The Latin De Medicina is the oldest book in the Nixon library collection. The work, consisting of accounts of medicine in Roman times, is the only remaining portion of a much larger encyclopedia by Celsus and is generally considered among the greatest medical classics. Worth knowing: Hippocrates used the Greek word carcinos, meaning crab or crayfish, to refer to malignant tumors. It was Celsus who translated the Greek term into the Latin cancer, also meaning crab.

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Tables of the Skeleton and Muscles of the Human Body, by Bernhard Siegfried Albinus (1697–1770)

London, 1749 Significance: Albinus, a German anatomist, along with his artist Jan Wandelaar, is highly regarded for this work of magnificent engravings. Aiming for absolute precision and scientific accuracy, they used a unique grid pattern technique for copying the anatomical specimens.

Worth knowing: The work is almost as well known for its lush, whimsical backgrounds of nature and, especially, Clara the rhinoceros. Albinus did this “in order to relieve the harshness of the figures,” Schorr said. “He decided to create the illusion of three-dimensionality in his illustrations.”

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Cupples Casebooks, by Dr. George Cupples (1815â&#x20AC;&#x201C;1895) Significance: Fascinating tales of Texas frontier medicine fill these two, beautifully hand-written volumes of casebooks by pioneer physician George Cupples. Dr. Cupples was a Scottish-born surgeon who moved to Texas in 1844 in the hopes the climate would revitalize his ailing wifeâ&#x20AC;&#x2122;s health. He subsequently served as surgeon for the Texas Rangers in the Mexican War and then for the Confederate Army. The cases, which cover the period from 1850 to 1877, include detailed accounts of everything from a gunshot wound and amputation, to a penetrating knife wound to the heart, to opioid addiction, to a 60-hour labor and delivery complicated by a cervical tumor.

Worth knowing: Dr. Cupples was renowned as an innovative surgeon and is believed to be the first physician in Texas to use anesthesia.

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De humani corporis fabrica libri septem (The Fabrica), by Andreas Vesalius (1514–1564)

Basel, 1543, first edition Significance: The Fabrica is the rarest and most valuable book in the Nixon library. It’s also the most viewed. “It was Vesalius who first dissected a human body and described what he found in great detail, and therefore had a far better understanding of the way our bodies work than [Greek physician, surgeon and philosopher in the Roman Empire] Galen,” DeThorne said. “Vesalius is the father of modern anatomy.” Worth knowing: When it was purchased by Dr. Nixon in 1939 from Yale University for $765, it was said to be one of only 16 copies in the United States and fewer than 200 in the world.

Ophthalmodouleia, by Georg Bartisch (1535–1606)

Dresden, 1583, first edition Significance: Bartisch established ophthalmology as a separate medical specialty and his Ophthalmodouleia was a landmark publication. His descriptions and illustrations of eye surgeries and the anatomy of the eyes were striking and revolutionary. Worth knowing: In German, Ophthalmodouleia was one of the first medical books to be written in the vernacular rather than Greek or Latin.

Summer 2018 | uthscsa.edu/Mission | 27

Canonis libri V, by Abu ‘Ali al-Husayn ibn Sina (known in the West as Avicenna) (980–1037)

Venice, 1486 Significance: The book in the Nixon collection is one of five in an encyclopedia of medicine by the 11th-century Persian philosopher, scientist and physician Abu ‘Ali al-Husayn ibn Sina, translated as Avicenna in Latin. Canonis libri V is devoted to compound drugs. Worth knowing: Avicenna’s work attests to the fact that medicine in the Middle East at the time was often more advanced than in Europe.

Micrographia, by Robert Hooke (1635–1703)

London, 1667 Significance: Robert Hooke is known as a “Renaissance Man” of 17th-century England. His work in the sciences covered astronomy, physics and biology as well as medicine. Micrographia, his most important writing, documented experiments with a microscope. An artist as well as a scientist, he did all of his own illustrations. Micrographia is basically the origin of microbiology. Worth knowing: In Micrographia, Hooke coined a new scientific/medical word: “cell.”

Medical bag and instruments belonging to Dr. John Matthews (1908–1995)

Dr. Matthews, an ophthalmologist, was a prominent member of San Antonio’s medical community. Active in local medical organizations, he played a significant role in the establishment of the South Texas Medical Center. On the board of the San Antonio Medical Foundation and president of the Bexar County Medical Society, Dr. Matthews secured the endorsement of the Texas Medical Association for the development of a medical center and medical school in San Antonio in the 1950s. He was elected as the first president of the Friends of the P.I. Nixon Medical Historical Library in 1971.

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Bloodletting instruments

While it undoubtedly did more harm than good, bloodletting was a popular medical treatment for a variety of ailments for centuries. By the 18th and 19th centuries, technologyâ&#x20AC;&#x201D;in the form of the scarificator and a spring lancet such as these in the Nixon libraryâ&#x20AC;&#x201D;had replaced knives and other instruments for cutting or lancing. The brass scarificator has 13 blades and dates between 1833 and 1855. It is cocked by pulling the lever, then a button releases the blades resulting in 13 uniform quarterinch deep cuts. A cup then suctioned the blood.

The P.I. Nixon Medical Historical Library is open by appointment Monday through Friday from 8:30 a.m. to 4:30 p.m. Tours of the library, including viewings of the rare books, can also be arranged. Contact Andrea N. Schorr, 210-567-2403, Schorr@uthscsa.edu or specialcollections@uthscsa.edu.

Worth knowing: Massive bloodletting in his final hours probably contributed to the death of George Washington in 1799.

Summer 2018 | uthscsa.edu/Mission | 29

Alumni Profile

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t wasn’t the first time they had seen the ravaging effects of high-velocity gunshot wounds on a body, or the first time they had to rush to prepare multiple operating rooms at once, bracing for a group of trauma patients to arrive. It wasn’t the first time trauma surgeons Ronald Stewart, M.D., and Lillian Liao, M.D., M.P.H., had lost a patient in the operating room. But this time was different. It was a mass shooting in a church. On a Sunday, during a worship service. There were kids. So many kids. The rampage in the quiet town of Sutherland Springs on Nov. 5, 2017, the one that made Texas history for being the deadliest mass-shooting event in the state and ranks as one of the largest mass-shooting events in modern U.S. history, threw the trauma surgeons, both alumni of UT Health San Antonio, on the frontline of what they call a national public health crisis. As surgeons in University Hospital’s Level 1 trauma center, the only Level 1 pediatric trauma center in South Texas, they had drilled for mass-shooting events dozens of times with their partners from San Antonio Military Medical Center, the city’s other Level 1 trauma center. They knew what to do. But this was real. This was close. This was theirs. If there is a first time for everything, those firsts come with a sobering reality—they’re typically not the last. This, the surgeons fear, could be the new normal.

Operating

in the

new

7: 0 0 A . M .

If there is anything fortuitous about the day of the Sutherland Springs shooting, perhaps it is that the entire trauma leadership team was already gathered in a conference room in University Hospital on an otherwise quiet Sunday morning, reviewing the results of a site visit with members of the American College of Surgeons. “Sutherland Springs happened in a rural area in South Texas that has an outstanding trauma system,” Dr. Stewart said. “That trauma system is essentially the backbone, or the framework, for disaster response in South Texas.” And that morning, nearly every one of its trauma surgeons was already in the building at 11:20 a.m. when a lone gunman began firing on worshippers inside First Baptist Church, using a variant of an AR-15 rifle. “Normally we have two attending trauma surgeons on call on weekends in addition to our very large team of residents and physician extenders—our physician assistants and nurse practitioners—who are here taking care of the trauma that comes in.,” Dr. Liao said. “But we were all already here. So in a way we were kind of lucky.” When the first emergency alert sounded, nearly every phone in the conference room lit up.

normal

By LET Y L AUREL

Summer 2018 | uthscsa.edu/Mission | 31

12 : 0 5 P. M . | E M E R G E N C Y

A L E R T

“Wilson County is responding to a mass shooting, the possibility of 30 patients. Update yourselves.” As soon as they heard it was a church shooting, they knew there would be kids. The trauma surgeons immediately left the conference room and ran upstairs to prepare. They didn’t know how long they’d have before the first patients began arriving, but they knew they would be ready. “We paged everyone and said this is real. Trauma surgeons started coming in. Anesthesia. By the time we received our first patient, we were prepared to run 15 rooms,” Dr. Stewart said. But they wouldn’t need them. Of the 46 people shot, 26 died before ever making it to a hospital. It takes time before the first emergency medical service responders can get to the injured at a mass-shooting event. Police have to make sure it is safe for anyone to enter. As the minutes tick away, people die from blood loss. “There were more people who died on the scene than who made it,” Dr. Stewart said. 12 : 45 P. M .

After the rooms had been prepared and the blood bank notified, the surgeons and their teams waited. “We were just like ‘Where are they? Where are they?’ Then we started getting the children first,” Dr. Liao said. “You don’t know the number of injured that are going to come in because it could be zero. We got a total of nine patients. Four of them were children.” It took nearly an hour for all the patients to arrive, many of them with multiple gunshot wounds. Among them was 5-year-old Ryland Ward, who was shot five times. His 7-year-old stepsister arrived later with severe abdominal injuries. “You have nine patients with gunshot wounds with a high-velocity firearm at close range and a mix of children and adults. That’s not common. That’s different. Almost all of them needed an operation. That’s not true in ‘normal’ situations,” Dr. Stewart 32

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said. “You’re trying to find family members. And you have in the back of your mind that they’re not here because they’re dead.” 12 : 50 P. M .

Ryland’s body was riddled with bullet wounds to his leg, arm, bladder and kidney. While Dr. Liao worked on controlling the hemorrhage in his arm and leg, another surgical team worked to close the holes in his intestines. “AR-15 type weapons are high-velocity firearms, so at close range, it creates a big blast. It’s a lot on a small body,” Dr. Liao said. It wasn’t the first time she had seen traumatic wounds from high-velocity rifles. But it was the first time she’d ever seen so many at once. She’s never served in a war zone, and that used to worry her about her preparation for mass-casualty events, she said. “I never thought it would happen here,” she said. “We drill two or three times a year, and you always think you’ll be ready for it. The real test comes when it happens.” When it did, her eight years as a UT Health San Antonio trauma surgeon kicked in. “In this day and age, in this country, you get to see all that as a trauma surgeon,” she said. “Mass shootings are becoming more common. And I think we’ll see it again.” 2 : 2 0 P. M .

While the patients came in, Dr. Stewart took on the role of triage officer, assigning the most critical patients to surgical teams. After the last patient was assigned, he went into the operating room of the 7-year-old girl. She was unstable. After hours, multiple units of blood and several resuscitation attempts, there was nothing more that they could do. Dr. Stewart turned the operation over to his former student, Dr. Liao, so he could speak with family members and let them know that despite everything they tried, they couldn’t get her back.

Trauma surgeons Lillian Liao, M.D., M.P.H. ’04, and Ronald Stewart, M.D. ’85, both graduates of UT Health San Antonio, treated several injured victims of the First Baptist Church shooting in Sutherland Springs. Photo courtesy of Rachel Denny Clow/ Corpus Christi Caller-Times

She was the only victim from the Sutherland Springs shooting to die in the hospital. “I think probably the one thing that I’ll remember the most from that day was just pronouncing her dead,” Dr. Liao said. “It’s always the one thing that you remember—the patient you couldn’t save.” 7: 0 0 P. M .

It was finally quiet. After the controlled chaos of the last few hours, the exhausted surgical teams gathered together to decompress. They talked about their patients’ operations. They gave each other updates on their wellbeing. They sketched out a plan for the next day. They did not talk about Sutherland Springs, or the shooter, or the fact that now they had joined an ever-growing number of surgeons to respond to yet another mass shooting. “You don’t have time for the emotional aspect of what just happened,” Dr. Liao said. “Your mind is still running through ‘What do I need to do tomorrow to take care of the patients?’ “None of us asked how we felt. We were all glad we stabilized the patients and took care of their injuries. I didn’t think about the magnitude of this experience until weeks later.”

T O DAY

It would take two months for Ryland to recover enough from his wounds to go home. He was the last survivor of the church shooting to leave the hospital. He returned to a new, harsh reality. While he survived, his stepmother and two stepsisters died in the massacre. Dr. Liao watched him leave the hospital Jan. 12 in a bright red fire truck, driven by the first responder who found him wedged between the floor and the body of his stepmother, and carried him to safety. “Him going home was great for Sutherland Springs and for us. It was symbolic. It was really emotional,” she said. But the tragic event should never have happened. There is no widely accepted definition of “mass shooting,” but it is loosely defined as an event in which four or more people are killed at random in a public place by one or two shooters. Over the last 10 years, they have become more frequent and more deadly, placing the U.S. at the top of the world in the number of massshooting events. All horrific in their savagery, the worst of them have become known simply by their locations: Mandalay Bay in Las Vegas, the Pulse nightclub in Orlando, Sandy Hook Elementary

School in Newtown and, frighteningly close to home, First Baptist Church in Sutherland Springs. “I don’t think any of us [trauma surgeons] thought a mass shooting was going to be a routine day for us until recently,” Dr. Liao said. In 2017, there were 346 mass shootings. In 2018, the numbers have continued to climb, reaching 134 by June, according to the Gun Violence Archive. In the months since Sutherland Springs, both trauma surgeons have traveled around the country advocating for a “common-ground approach to make firearm ownership as safe as reasonably possible, and for training the general public on bleeding control,” Dr. Stewart said. The way to address a public health crisis such as this, they said, is to approach it as any scientist would: by focusing on prevention strategies, while simultaneously working to improve treatment. “We all own this epidemic of violence,” Dr. Stewart said. “And we all must take steps to address the crisis of mass violence. It’s unacceptable that nearly 50 people sitting in church on a Sunday morning were brutally attacked, assaulted and murdered. We can, and we must, work together to end this type of violence.”

Summer 2018 | uthscsa.edu/Mission | 33

Accolades

Research gets a $24 million boost

This funding also emphasizes maintaining the health of our communities and not just the treatment of illness.” –Robert A. Hromas, M.D., FACP

For the third time in 10 years, UT Health San Antonio has garnered highly competitive National Institutes of Health grants to speed the translation of research discovery into improved patient care. The university will receive $24 million over the next five years under the Clinical and Translational Science Award Program. The university is a CTSA Program hub and collaborates with eight regional partners, including University Health System, San Antonio Military Health System and The University of Texas at San Antonio. “This is an enthusiastic vote of confidence in our institution’s ability to affect the future,” said William L. Henrich, M.D., MACP, president of UT Health San Antonio. “We are proud of our track record of accomplishment in advancing community health.” The program will bring cutting-edge treatments to San Antonio in new clinical trials to affect the most complicated illnesses, said Robert A. Hromas, M.D., FACP, dean of the Joe R. & Teresa Lozano Long School of Medicine and vice president for medical affairs at UT Health San Antonio. “This CTSA Program funding emphasizes maintaining the health of our communities and not just the treatment of illness,” he said. It will also enable the university to compete for other research awards open only to CTSA institutions, said Andrea Giuffrida, Ph.D.,

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vice president for research and professor of pharmacology. UT Health San Antonio received its first CTSA designation in 2008 and repeated in 2013. “We compete with many other prestigious institutions for this funding,” said Robert A. Clark, M.D., MACP, director of the Institute for Integration of Medicine and Science, which administers the CTSA Program at UT Health San Antonio. “There are only approximately 60 of these CTSA Program hubs throughout the nation, and it’s all the best places.” Moreover, the university is one of only 43 academic medical centers to function as a CTSA Program hub while at the same time meeting the needs of patients and families through medical practices, including the UT Health San Antonio Physicians practice and the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center, a National Cancer Institute-Designated Cancer Center. CTSA funding does not focus on research of a specific disease but is very broad-based, Dr. Clark said. It supports pilot projects in cancer, heart disease, diabetes, regenerative medicine, aging, neuroscience and a plethora of other areas. Pilot projects are funded based on their potential to mature into major research investigations that can benefit humanity.

Accolades

Innovation in research and education recognized The Max and Minnie Tomerlin Voelcker Fund has One objective is to develop the academy as a national awarded $1.45 million to support three innovative research model of life sciences educational pipeline programming, projects and one pilot research project, all conducted by rising Dr. Henrich said. young faculty studying cancer and cardiovascular disease. The Voelcker Biomedical Research Academy began in The new Voelcker Fund Young Investigator Awards 2009 and has been continuously supported by the Voelcker will assist Myron Ignatius, Ph.D., assistant professor of fund from the outset. It has expanded its curriculum to include molecular medicine and member of the Greehey Children’s fundamentals in population health, precision medicine, Cancer Research Institute; April Risinger, Ph.D., assistant bioinformatics and biotechnology commercialization, professor of pharmacology; and Carolina Solis-Herrera, M.D., Dr. Giuffrida said. assistant professor of medicine and member of the UT Health Physicians clinical practice. A Voelcker Fund Pilot Research Award will support David Libich, Ph.D., assistant professor PILOT RESEARCH of biochemistry and structural AWARD biology and member of the Greehey ■■ David Libich, Ph.D. institute. Heat shock protein as a “This vital program of the novel target to induce Voelcker fund targets young programmed destruction investigators to support their in tumor cells careers,” said UT Health YOUNG San Antonio President William INVESTIGATOR L. Henrich, M.D., MACP. “Their initial research is evaluated by peer AWARD reviewers who are scientists on the ■■ Myron Ignatius, Ph.D., is using zebrafish to national level. The selection of our learn how stem cell biology causes 30 percent of children who have a rare muscle cancer to relapse young faculty members for these and not respond to treatment. grant awards is meritorious and highly important for San Antonio.” ■■ April Risinger, Ph.D. Andrea Giuffrida, Ph.D., vice Anticancer efficacy of president for research, said the microtubule targeting agents and the ability Voelcker Fund Young Investigator of these agents to alter Awards are “a trampoline to launch signaling pathways the researchers into the next associated with cancer phase of their careers as National initiation and tumor Institutes of Health-funded progression researchers studying diseases such ■■ Carolina Solisas cancer that are specifically Herrera, M.D. targeted by the Voelcker fund.” Mechanisms to explain The Voelcker fund board of cardiovascular benefits observed in high-risk trustees also allocated $846,930 Type 2 diabetes patients to continue the Voelcker treated with a class of Biomedical Research Academy at medication called a the university through 2021. The SGLT2 inhibitor academy is a two-year immersive summer experience for high school students ages 16 and older to learn about and conduct biomedical research in preparation for college and for careers in science and health care. All high school participants are mentored by UT Health The academy recruits diverse and academically San Antonio faculty, postdoctoral fellows and graduate accomplished high school students from San Antonio school students, who offer an individualized training plan and assess districts for hands-on training in biomedical research at the students’ scientific progress. UT Health San Antonio. This is in preparation for their transition to college.

Summer 2018 | uthscsa.edu/Mission | 35

Accolades

Top recruit

Patrick Sung, D.Phil

The Cancer Prevention & Research Institute of Texas awarded $6 million to UT Health San Antonio to support the recruitment of internationally known biochemist Patrick Sung, D.Phil. Dr. Sung’s discoveries have increased understanding of how DNA can repair damage induced by radiation, carcinogens and other causes. Cancer cells are particularly effective at repairing their DNA, which makes them harder to kill. Hindering this capability is a major target for development of therapeutics. Dr. Sung will occupy the Robert A. Welch Distinguished Chair in Chemistry and will be appointed professor in the Department of Biochemistry and Structural Biology. Additionally, he will serve as associate dean for research in the Joe R. & Teresa Lozano Long School of Medicine, and lead a new research program in genetic integrity at the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center. Dr. Sung has served as professor of molecular biophysics and biochemistry, therapeutic radiology and epidemiology at Yale University in New Haven, Conn. His appointment will bring him back to UT Health San Antonio, where he worked from 1997 to 2003, first as assistant professor and later as the Zachry Distinguished Professor of Molecular Medicine. From 2001 to 2003, he was co-director of a National Cancer Institute-funded training program in DNA repair at the university. Dr. Sung plans to bring a lab team of more than a dozen members with him to San Antonio in early 2019.

NEWS MAKERS Thomas G. Boyer, Ph.D.,

professor of molecular medicine, received two related National Institutes of Health R01 grants to study uterine leiomyomas, also called uterine fibroids. The first grant

was for $1.56 million; the most recent, a five-year award for $3.8 million, was a multi-PI grant.

Daniel J. Dire, M.D., clinical professor in the Department

of Emergency Medicine, has been appointed as the Army Deputy Surgeon General for Mobilization and Reserve Affairs. Dr. Dire is a major general and is the senior ranking physician in the Army Reserve.

Robert Esterl Jr.,

Francisco G. Cigarroa, M.D., former chancellor of The

University of Texas System and former president of UT Health San Antonio, has been elected chairman of the Ford Foundation’s board of trustees. The foundation, based in New York, is an independent, nonprofit grant-making organization. Dr. Cigarroa joined the board in 2014 and serves as chair of the finance committee, while also serving on the executive committee, the investments committee, and the Democracy, Rights, and Justice program committee. Dr. Cigarroa is head of pediatric transplant surgery and division head of liver transplant surgery at UT Health San Antonio.

M.D., associate dean for undergraduate medical education and transplant center surgical director, received the 2018 Regents’ Outstanding Teaching Award from The University of Texas System. The award includes $25,000 in recognition of his commitment to student success.

Xianlin Han, Ph.D.,

professor in the Department of Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, received a $300,000 STARs award from the UT System. Dr. Han’s laboratory focuses on lipidomics, a relatively new field of biomedical research that involves complex

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lipidome analysis. The Science and Technology Acquisition and Retention program supports enhancement of UT System institutions.

of Comprehensive Dentistry, received the Diamond Pin Award for 2018 from the American Academy of Oral Medicine.

Kenneth M. Hargreaves,

Ellen Kraig, Ph.D., professor

D.D.S., Ph.D., won the Outstanding Research Accomplishment (Individual/ Academia) Award from the Military Health System Research Symposium. The award recognizes outstanding research contributions on the health and well-being of the military by an individual research scientist.

Jeffery Hicks, D.D.S.,

professor of comprehensive dentistry, was appointed commissioner for postdoctoral general dentistry on the Commission on Dental Accreditation for years 2017-2021. The commission develops and implements accreditation standards for dental education programs.

Michaell A. Huber, D.D.S., professor in the Department

in the Department of Cell Systems and Anatomy, was awarded the 2018 Regents’ Outstanding Teaching Award from The University of Texas System. The recognition includes $25,000 for her commitment to student success.

George Kudolo, Ph.D.,

FAIC, FAACC, was appointed chair of the Department of Health Sciences. Dr. Kudolo previously served as interim chair of the department and is a professor with tenure.

Yui-Wing Francis Lam,

Pharm.D., FCCP, professor of pharmacology, was named a 2018 Piper Professor as selected by the Minnie Stevens Piper Foundation. Dr. Lam received a $5,000 award, certificate and gold pin.

Accolades

Attacking the opioid epidemic Lisa Cleveland, Ph.D., RN, assistant professor of nursing, has been awarded two grants totaling more than $4 million to educate Bexar County first responders on how to identify and reverse opioid overdose. The grants were from the Texas Health and Human Services Commission. The first was a four-year, $2.2 million contract to purchase naloxone to provide training to first responders—including friends and family of opioid users—to identify and reverse an overdose using the medicine, and teach them where to refer users for further treatment. The second grant was for $1.87 million for the first year of a two-year program to bridge the gap between EMS response and the referral of opioid users into recovery and substance use treatment services, and to purchase naloxone.

David Morilak, Ph.D.,

professor of pharmacology, director of UT Health San Antonio’s Center for Biomedical Neuroscience and member of the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center, received a $899,547 research award from the Cancer Prevention & Research Institute of Texas. The funds will be used to study mechanisms and new treatments for cognitive impairment associated with a type of hormone treatment used in men with prostate cancer.

Robert H. Quinn, M.D.,

professor and chairman of the Department of Orthopaedic Surgery, was named chairman of the American Academy of Orthopaedic Surgeons Council on Research and Quality.

Amelie G. Ramirez, Dr.P.H., director of the Institute for Health Promotion Research, has been named one of 12

new Komen Scholars by Susan G. Komen, the world’s largest nonprofit funder of breast cancer research. Dr. Ramirez will receive $600,000 over three years to study Latina breast cancer.

Ruben Restrepo, M.D., RRT,

FAARC, professor of respiratory care, was inducted as a Fellow of the American College of Chest Physicians.

Adriana Segura, D.D.S., was named interim dean of the School of Dentistry, effective June 1. Dr. Segura, professor of comprehensive dentistry, served as the school’s associate dean for academic, faculty and student affairs.

Robert M. Taft, D.D.S., FACP, professor and the chair of the comprehensive dentistry department, was installed as president of the American College of Prosthodontists.

Amy Tawney, M.B.A.,

SPHR, a human resources professional with more than

25 years of experience in a variety of industries, has been named vice president and chief human resources officer for UT Health San Antonio.

Richard P. Usatine, M.D., professor of dermatology and cutaneous surgery, and professor of family and community medicine, was elected to the board of the International Dermoscopy Society.

Jeremy Viles, D.N.P.,

M.B.A., RN, was named the inaugural chief nursing officer for the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center, and as assistant dean of the clinical practice in the School of Nursing.

Susan Weintraub, Ph.D.,

professor of biochemistry and structural biology, was named a Fellow of the American Association for the Advancement of Science.

Ruben A. Mesa, M.D., director of the Mays Cancer Center, the newly named home to the UT Health San Antonio MD Anderson Cancer Center, has been named to the board of directors of The Leukemia & Lymphoma Society. The Leukemia & Lymphoma Society funds blood cancer research around the world, provides free information and support services, and is an advocate for all blood cancer patients seeking access to quality, affordable, coordinated care. Dr. Mesa has been principal investigator or co-principal investigator in more than 70 clinical trials for patients with myeloid disorders and played a lead role in various FDA approvals. He has been a funded investigator from the National Cancer Institute throughout his career and currently is co-principal investigator of the NCI-funded Myeloproliferative Neoplasms Research Consortium. Dr. Mesa was named director of the cancer center in August 2017. He is a professor and holds the Mays Family Foundation Distinguished University Presidential Chair.

Summer 2018 | uthscsa.edu/Mission | 37

Philanthropy

A triple blow to cancer Philanthropic gifts celebrate partnership of two leading cancer centers By ROSANNE FOHN

n 2018, an estimated 1.7 million cases of cancer will be diagnosed in the United States, and the number of new cancer cases per year worldwide is expected to rise to 23.6 million by 2030, according to the National Cancer Institute. “Almost everyone is touched in some way by cancer, and our family is no different,” said Kathryn Mays Johnson, president of the Mays Family Foundation. Johnson, both her parents—Peggy and Lowry Mays—and her brother are cancer survivors. With this medical diagnosis so prevalent in their family and a commitment to help their community, the Mays Family Foundation has supported cancer research and treatment for decades. In January, the Mays family announced an increase in their legacy gift to $30 million to support UT Health San Antonio’s cancer center, which recently affiliated with MD Anderson Cancer Center. In recognition of the Mays’ gift, the UT System Board of Regents authorized calling it the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center. “My parents’ vision has always been to strengthen this community, the community in which they live, the community in which we live,” Johnson said. “It is our hope that this will be a place close to home where all of San Antonio and South Texas can come when they hear those words ‘You have cancer.’ And I can assure you, those words are life altering.” The combined contributions from the Mays Family Foundation will provide an endowment to perpetually support the director of the cancer center and to establish up to 10 new permanent distinguished endowed chairs to support faculty recruitment and retention. The gift also establishes the Mays Cancer Center Excellence Endowment to support top priorities for future success and long-term sustainability, said UT Health San Antonio President William L. Henrich, M.D., MACP. “Cancer has been aptly called the ‘emperor 38

Top: UT Health San Antonio President William L. Henrich, M.D., MACP, greets Lowry and Peggy Mays at the announcement of the family’s legacy gift increase to $30 million in support of the cancer center. In recognition of the gift, UT System Board of Regents authorized naming the cancer center the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center.

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Philanthropy

It is our hope that this will be a place close to home where all of San Antonio and South Texas can come when they hear those words ‘You have cancer.’ Those words are life altering.” —Kathryn Mays Johnson, president of the Mays Family Foundation

of all maladies,’ the disease which is the most difficult to diagnose accurately and treat with precision,” Dr. Henrich said. “Defeating its complexity requires leadingedge science, teamwork, perseverance and courage, each in equal measure. “The overwhelming major beneficiaries of this gift are patients who will seek and receive life-saving care here.” The vision for improved cancer care in South Texas was set when former UT System Chancellor Bill McRaven challenged UT System institutions to collaborate and build on their strengths. Then, in November 2016, UT Health San Antonio and MD Anderson Cancer Center announced their affiliation to create a comprehensive and clinically integrated cancer care program in San Antonio. At the announcement, the board of the San Antonio Cancer Foundation, formerly the CTRC Foundation, pledged $17 million to support the new comprehensive and clinically integrated cancer care program in San Antonio by funding recruitment of new physicians and scientists, facility renovations and specialized equipment for the cancer center. “Our cancer center brings a long history of testing cancer breakthrough therapies through our world-renowned, early-phase cancer treatment program, the Institute for Drug Development, and we are proud of having founded 40 years ago the San Antonio Breast Cancer Symposium that is now the premier international meeting for both researchers and clinicians focused on breast cancer,” said Ruben A. Mesa, M.D., FACP, director of the cancer center. “We are thankful to the Mays family for their exemplary long-standing support, and we are deeply grateful that they have partnered with us to further develop the Mays Cancer Center for the future. We also owe enormous thanks to the board of

the San Antonio Cancer Foundation for their enduring and generous contributions.” Peggy and Lowry Mays and their family have been key supporters of the cancer center since the early years. Peggy Mays, a former member of the cancer center’s board of governors, founded the annual fund program—the Cabinet—in 1996. The Cabinet has raised nearly $8 million to date. Cabinet gifts provide support for innovative cancer research, equipment, cancer education and patient care programs. In addition to serving as president of the Mays Family Foundation, Johnson is a member of the Mays Cancer Center Board of Governors and is a past president of the SA Cancer Council, formerly known as the Cancer Center Council. Over the past 33 years, the council has supported the cancer center through fundraising, volunteer services, community outreach, and patient education and assistance. The SA Cancer Council has contributed more than $4.7 million to support the mission of the cancer center. “As longtime supporters and advocates for our cancer center in San Antonio, we are pleased to provide significant financial support at this critical time,” said Lowry Mays. “We are inspired by the cancer center’s exceptional leadership, mission, vision and goals, and we are especially pleased that our investment will support the Mays Cancer Center as we continue to develop the affiliation with MD Anderson Cancer Center. “We are very proud that our family name will forever be associated with this cancer center, which serves millions of people in San Antonio and across South Texas.”

In honor, to help Peggy and Lowry Mays will be honored for their support in the fight against cancer at the 2018 President’s Gala Sept. 29 at the Grand Hyatt San Antonio. The gala is an annual event that raises money for the university and to support the work of faculty and students. This year’s event also marks the 50th anniversary of the Joe R. & Teresa Lozano Long School of Medicine. Proceeds from the gala will establish the Peggy and Lowry Mays Patient Care Endowment. The endowment will support the Patient Supportive Care Program at the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center. The program helps people diagnosed with cancer by providing critical support, from transportation for daily treatments to prescription drug assistance, nutritional supplements, temporary lodging for out-of-town patients and funds to meet patients’ other emergency needs. The endowment also will provide wellness and survivorship programs to cancer patients, helping individuals prepare for a healthier life after treatment. For more information, go to makelivesbetter.uthscsa.edu/gala or call 210-567-2508.

Long School of Medicine celebrates golden anniversary Alumni are invited to attend a 50th anniversary celebration before the President’s Gala at 6 p.m. Sept. 29 at the Grand Hyatt San Antonio. To RSVP, call 210-567-2508. Summer 2018 | uthscsa.edu/Mission | 39

Philanthropy

Giving starts here

icolette Speer, who graduated in August with a bachelor’s degree in nursing, believes that the concept of giving back is especially important in the health care field. “By being involved in philanthropy, you have the ability to impact more lives beyond your patient population,” she said. The university is supported by about $70 million a year in philanthropic gifts. These contributions establish endowed professorships or chairs, fund new scholarships, support research or name a laboratory, center or school. Familiarizing students with the importance of giving back is the goal of the Student Legacy Council, said Sabrina York, director of donor and alumni relations in the Office of Institutional Advancement. “The council is laying the foundation to keep students involved as alums,” York said. “The council’s goal is to promote awareness of philanthropy and the difference it makes to their experience as students so that when they graduate, they will be inspired to give back as alumni of their schools.” The council, established in 2016, has 25 student members, five from each school in the university, who seek to involve fellow students. “Whether you’re donating to a cause that you feel passionate about or giving your time volunteering, your small act of giving can make a difference in peoples’ lives,” said Speer, a member of the council.

In gratitude

oe R. and Teresa Lozano Long, for whom the UT Health San Antonio School of Medicine and the central campus are named, received the UT System Board of Regents highest honor—the Santa Rita Award.

The Longs, who have contributed approximately $100 million to UT Health San Antonio, UT Austin and UT Rio Grande Valley, have created numerous student scholarships, faculty chairs and professorships, and contributed programmatic funds in various disciplines, including medicine, law, business, education, pharmacy, music and art. First presented in 1968, the Santa Rita Award shares a name with Santa Rita No. 1, the first producing oil well on university lands in West Texas. The well hit oil in 40

| Mission | The University of Texas Health Science Center at San Antonio

1923 and jump-started the growth of the Permanent University Fund, which has provided transformational resources for UT System and Texas A&M institutions. Only 25 Santa Rita awards have been presented by regents over the past 50 years. The award is given to individuals or organizations who demonstrate a record of commitment to furthering the purposes and objectives of the UT System and serving as the highest example of selfless and publicspirited service. “Joe and Terry’s love story is

Joe R. and Teresa Lozano Long, longtime supporters of UT Health San Antonio, received the Santa Rita Award, the highest honor from the UT System Board of Regents. Photo courtesy of Austin American-Statesman

one that touches all of our hearts. They decided as a couple that their devotion to one another would include extending educational opportunities to others who could benefit from their successes,” said Board of Regents Chairman Sara Martinez Tucker. “Among their many generous acts is ensuring that firstgeneration students can attend medical school without debt and return to their communities as physicians, serving countless individuals who need their healing expertise. “Multiply that over the years, with the more than 200 students who have already been ‘Long Scholars’ or ‘Long Physicians’ at UT Health San Antonio, and one can easily see that the Longs will have made a difference beyond measure and will touch millions of lives over many generations to come,” Tucker added. The medical school and campus at UT Health San Antonio are both named for the Longs in honor of their commitment of more than $61 million to build a significant future pipeline of physicians, nurses and other health care providers from South Texas.

These future health care providers will in turn serve regions throughout Texas during their professional careers. The fund, which supports faculty and student endowments and other critical research needs, has since positioned UT Health San Antonio as one of the nation’s leading medical schools for graduating Hispanic physicians. The Lozano Long Institute for Latin American Studies at UT Austin, an internationally acclaimed scholarly institute, bears Teresa Lozano Long’s name and integrates more than 30 academic departments in educational and research activities to promote a greater understanding of, and close scholarly and cultural relationships with, Latin America. Teresa Lozano Long, the daughter of a dairy farmer, grew up in Premont, Texas. As valedictorian of her high school, she attended UT Austin, earning Bachelor of Science and Master of Education degrees. She also was the first Hispanic woman to earn a doctorate in health and physical education at UT Austin. She has served on state and national boards and commissions, including the National Endowment for the Arts, and is a Distinguished Alumna of UT Austin and a member of the Texas Women’s Hall of Fame. Joe Long received a bachelor’s degree at what is now Tarleton State University in Stephenville, Texas, a part of the Texas A&M University System. After graduation, he met his future wife when they were both teachers in Alice, Texas. She had an interest in returning to UT Austin for a doctorate, and he wanted a law degree. They both achieved their educational goals at UT Austin, and Joe Long began his professional career as an attorney, first with the State Securities Board, then with the attorney general’s office before transitioning into private banking. He also is a Distinguished Alumnus of UT Austin and has served on and chaired many boards, including the Austin Symphony Orchestra. “Terry and I are extremely pleased to be given this highest honor from the University of Texas System and its regents,” Joe Long said. “We hope that our giving will encourage others to do the same.”

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Brandie Jenkins, Mark Sobhani Mission is published by Marketing, Communications & Media, and printed by UT Print, UT Health San Antonio. Letters to the editor, address changes, permission to reprint or to be removed from our magazine mailing and contact lists should be sent to mission@uthscsa. edu or mailed to Lety Laurel, Marketing, Communications & Media, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.

The University of Texas Health Science Center San Antonio (UT Health San Antonio) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. UT Health San Antonio does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Language assistance services are available to you free of charge. Contact the clinic where you will be treated or call 210-450-6101. Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 210-450-6101. Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 210-450-6101.

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Parting Shot

Splish, splash

At Morgan’s Inspiration Island water park, water sprays from holes in the ground and spigots overhead. High-tech, air-powered waterproof wheelchairs splash through the water, allowing people of all abilities to play. These specially designed wheelchairs are lightweight—only about 80 pounds compared with a typical wheelchair’s 400 pounds—run on compressed air and can be modified for all heights, sizes and needs. The water park is a part of Morgan’s Wonderland in San Antonio, an amusement park built to accommodate people with special needs.

Before the water park opened in 2017, Ana Allegretti, Ph.D., OTR, assistant professor of occupational therapy, and occupational therapy students helped train park employees and volunteers on making adjustments to the chairs, which include rigid models for those who can propel themselves independently, a reclining style and pneumatic chairs powered by compressed air. Guests requiring personalized support and settings can be accommodated with these modifications.

The partnership between the School of Health Professions and the park has continued, and Dr. Allegretti and students offer training before each summer season begins. In recognition of her work enabling mobility for all, Dr. Allegretti was selected as a Wall of Fame honoree at the park. “Mobility has always been my passion,” Dr. Allegretti said. “This is not just a water park that everybody can come to. The social interactions that happen are beautiful.” Photo courtesy of Robin Jerstad/Jerstad Photographics

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