MUSC Catalyst 10-31-2014

Oct. 31, 2014

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 33, No. 11

‘Iron Man’ makes big splash after surgery

Advances in surgery to correct chest deformities helps teens, young adults improve quality of life By daWn Brazell Public Relations

Photo provided Carson Quick poses for his mom shirtless, something he wouldn’t have done before his pectus excavatum surgery this past summer.

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Final Tribute Colleagues say goodbye to a beloved professor of 30 years.

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They call her son Iron Man now.

Jade Quick of St. Petersburg, Florida, loves that. The stainless steel bar he has in his chest has done wonders for the 12 yearold, who now is active on swim team and has no qualms about shedding his shirt.

That hasn’t been the case until recently.

Carson has a congenital deformity known as pectus excavatum that has caused his chest to have a caved–in appearance that can worsen during the growth spurt of adolescence and affect the functioning of the heart and lungs.

Quick said they noticed it first when Carson was age 2. They took him to a specialist who basically brushed them off, saying the issue wasn’t significant enough to discuss. Fortunately, the next specialist she saw was Andre Hebra, M.D., who was practicing in Florida at the time. He explained Carson’s condition and advised her to keep an eye on it, adding that if surgery becomes necessary, the best time would be his early teens.

Quick said she’ll never forget the experience.

She went from being dismissed by one doctor who told her he had to leave to do an important heart surgery to someone who spent 30 minutes with her patiently explaining a condition she had never heard of before. “I would have gone to Alaska if he had moved there,” she said of her decision to come to Charleston this past summer to have Hebra, director of MUSC’s Division of

Pediatric Surgery, perform the pectus repair for Carson.

Carson’s condition had worsened, and it was affecting his breathing and heart function, she said. It also psychologically was taking its toll. At an age when “they want to be like little ducks in a row -- all the same,” her son avoided being seen without a shirt. He had gotten to the point Watch he was buttoning his a Video shirts up all the way, she said.

The surgery Visit MUSC’s takes careful News Center consideration. to see the full Even though a multimedia minimally–invasive version of the pectus package at www. musc.edu/pr/ correction called the newscenter/2014/ Nuss procedure can pectus.html be done, it is one of the most painful pediatric procedures that is performed. Surgeons insert a steel bar that immediately raises and braces the sternum. The bar remains in the chest for remodeling effects for three years before being removed.

Hebra said he makes sure patients know what they’re getting into. Though he’s done the surgery for more than a decade and perfected many of its techniques, it’s still a major procedure.

Pectus repair used to be done through the Ravitch procedure, which involved a fairly

See Iron on page 7

Advances in Cardiac Care

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Overheard

Cardiac procedure offers hope for artrial fibrillation patients.

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Meet Wendy

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Wellness Column

READ THE CATALYST ONLINE - http://www.musc.edu/catalyst

2 the catalyst, Oct. 31, 2014

Applause Program The following employees received recognition through the Applause Program for going the extra mile: Medical Center

Philip Egloff, Hollings Retail Pharmacy; Lisa Dooley, Radiology; Yvette Edwards, Revenue Cycle Admin; Holli Hoagland, Radiology; Lavonnia Bennett, Patient Transportation; Bret Johnson, ART 4E; Holly Oliver, Radiology; Victoria Boucher, RT ENT; Angela Ford, Guest Services Faye Parker, Guest Services; Evola Dawson, Revenue Cycle Operations; Jessica Howell, ART DDC; Ron Sherman, Engineering and Facilities; Megan Hutchinson, 8 West; Erin Davis, 8 West; Sharon Robinson, Guest Services; Folaina Murray, ART Vascular Lab; Valerie Jamison, PACU; Jessica Johnson, Safety & Security Carol Frank, Dietetic Services; Ana Rosa Virella, Womens Services; Sherri Mixon, MedSurg Registration; Tracy Floyd, Women’s Services; Hanna Epstein , P C I CU; Mary Faith Encarnacion, Laboratory Services; Tina Hinkle, Women’s Services; Angela Washington, Inpatient Pharmacy Services; Brent Paape, 6 West; Kai Jenkins, 6 West; Deborah Cepeda, Revenue Cycle Operations; Arien Rannigan, 7A; Lauren Boone, 7A; Frank Hoyland, Meduflex Team; Teresa Shuler, Sleep Lab; Zora Johnson, Mother Baby Unit; Ruth Christie, 5 East; Danny Williams, Safety & Security; Brenda Brown, HVC; Mechelle Rouse, GI Clinic; Kim Poulakis, ART DDC; Karen Worden, Acute Directional Unit; Kimberly Funk, Acute Directional Unit; Tiffany Carter, Meduflex Team; Sharon Dupree-Capers, Revenue Cycle Operations; Gwendolyn Cohen, Outpatient Registration;

Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425.

843-792-4107 Fax: 843-792-6723 Editor: Cindy Abole catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu Helen Adams, adamshel@musc.edu

Moya McFadden, Radiology; Katherine Wamsley, Hollings Clinics; Sandra Zambetti, Hollings Clinics; Heath Tolliver, ART MSICU; Monica Mallory, MSICU; Carlee Clark, Anesthesia & Perioperative Medicine; Harolyn Smith, Volunteer & Guest Services; Hannah Elder, ART MedSurg Registration; Justin Ravenel, Volunteer & Guest Services; Christina Smith, GI-Bariatric Clinic; Toni Mullins, Clinical Neurophysiology Clinic; Andrea Rentz, 7A; Nancy Nolen, Outpatient Registration; Lawanda Anderson, Revenue Cycle Operations; Ryan Camilon, Otolaryngology; Garrett Rowe, Clinical Radiology; Rebecca Peters, Outpatient Billing; Cindy Stokes, RT Children’s Hem/Onc; Jean Day, Ambulatory OR; Angela Washington, EVS; Jennifer Carullo, ART Card/Vasc/ Surgery; Theresa Ringold, Venipuncture; Debra Nelson, EVS; Lisa Truelove, ART MSICU; Angela Richards, Psychiatry; John Davie, Radiology; Robert Gregowicz, Autopsy Pathology; George Rossi, Pastoral Care & Education; April Lovorn, STICU; CJ Kopeck, STICU; Krystal Haynes, Venipuncture; and Rosie Smith, MUHA Human Resources

University (con’t.) & Facilities and Alvinia Wilson,

Dental Faculty Practice

JI Connector Run benefits scholarships The 16th Annual Charleston James Island Connector Run will be held Saturday, Nov. 1. Race features a 5K and 10K run and bike race starting promptly at 8:30 a.m.

The 10K race route begins and ends at the corner of Ashley Avenue and Bennett Street (close to Ashley Avenue).

Proceeds from the run benefits the Gavalas Kolanko Foundation, a local charity that awards annual scholarships Austin Avrett is joined by MUSC’s Mike Vanderhorst. to Lowcountry students with physical disabilities.

Foundation co-founder Nick Since 1999, the foundation has raised Galavasis is proud to partner once more than $500,000 and awarded again with James Island Connector Run more than 95 scholarships to students organizers. with disabilities attending the College “We’re not just looking for students of Charleston, Charleston Southern with physical disabilities, we’re looking University, The Citadel, Trident for students that have demostrated an Technical College and area institutions. incredible desire to be successful despite In September, MUSC pharmacy their disabilities,” said Galavas. student Austin Avrett was awarded a Race day registration is $40 at the $1,500 scholarship from the foundation registration tent at Cannon Park. Visit for the 2014-2015 academic year. www.jicrun.com.

University

Vickie Chapman, Dental Faculty Practice; Denise Clark, OCIO Endpoint Security Team; Kenneth Ford, Engineering & Facilities; Darlene Hodgkins, Dental Faculty Practice; Zack Huggins; College of Dental Medicine; Gerri Jones, Parking Management; Jason Just, Engineering & Facilities; Elizabeth Pilcher, Dental Faculty Practice; Angela Pinckney, Dental Faculty Practice; The Catalyst is published once a week.

Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.

MUSC Open Enrollment changes due Oct. 31 MUSC’s Employees are encouraged to read the 2014 Insurance Advantage to learn about plan changes, premium increases and benefit updates for the 2015 plan year to include health, dental, vision, life insurance, disability and tax-favored accounts.

Employees will make changes to their insurance benefits through “My Benefits,” the website administered by PEBA Insurance Benefits, a division of the SC Budget and Control Board.

Employees will need the Benefits Identification Number (BIN) from their health insurance card to register for My Benefits. (www.eip.sc.gov/ mybenefits) Enrollment or re-enrollment for Medical Spending or Dependent Care Accounts should be done online with Wageworks. (www.myfbmc.com) Insurance enrollment is from Oct. 1 to Oct. 31, 2014. All premium and plan changes are effective Jan. 1, 2015.

the catalyst, Oct. 31, 2014 3

Foreign travel tips for your smart phones Enabling your Cell Phone for Foreign Travel: 1. Ordering international phone service for smart phones. q MUSC/MUHA owned - Call University Communications (UCT) at 792-4040 one week before travel date. UCT will get the service upgraded, provide information, answer questions, and provide a phone number for customer service.

2.How to use the phone with WiFi and foreign networks? All devices are different and you should refer to your device’s operating instructions; go to network settings on your device and search for wireless networks; select a network to connect to (Note: It is not recommended to connect to an untrusted network).

3. How 2Factor and MDM affect the phone — Information about 2Factor can be found at https://2factor.musc.edu/2fa/ q If you have 2Factor set to call your cellular device and do not have cellular service when you attempt to login, 2Factor cannot reach you; Log in to the 2Factor portal (see above) and follow instructions on how to request a one-time bypass; MDM info can be found at http://carcweb.musc. edu/mdm/(Note: MDM should have no affect when traveling internationally). If you encounter problems with MDM, call +011-843-792-9700.

Cyber Security for mobile devices

By Melanie richardson OCIO Communications Mobile devices are widely used by faculty, staff, students and other individuals to access a variety of MUSC systems that contain sensitive data. While mobile access can provide valuable benefits, there is a significant risk of unauthorized access to sensitive MUSC data if the device is ever lost or stolen. It is estimated that about 35 percent of people in the U.S. have lost a mobile device at one time or another.

To help in this regard, MUSC has implemented two security initiatives, 2Factor Authentication and Mobile Device Management.

2Factor 2Factor Authentication works by calling your phone to verify that you are actually trying to log into a MUSC system such as email, VPN or Webapps.

If you get a call from MUSC asking you to confirm a log in, but you are not actually trying to log in to an MUSC system – do not press pound. Pressing pound will let the hacker in, and the consequences can be serious.

If you are on campus and receive a 2Factor call, that means someone else is trying to hack into your account.

Pastoral Cares Week focuses on spiritual well-being By chaplain GeorGe M. rossi Pastoral Care Services This year's theme, "Spiritual Well–Being," highlights nourishing the well-spring of supporting and inspiring the spiritual well-being of ourselves and others amid times of both ease and challenge.

Spiritual care providers seek to be present, mindful, compassionate and attuned, knowing that our intentions and actions have a ripple effect on the journeys of others and ourselves. While the nature of patients’ journeys may vary by the seasons of our lives, their spiritual well-being may include transcendence, meaning and purpose, reconnecting and renewing, service, sacredness, strength, harmony, hope, compassion, creativity, gratitude, forgiveness, and love.

The paragraph above gives some interpretive insights to this year’s theme “Spiritual Well–Being” for Pastoral Care Week across America’s hospitals. Spiritual wellbeing is the goal.

Spiritual well–being can be sometimes lost as people’s faith, beliefs, values, and core principles of life become eroded when difficult words like cancer, stroke, heart attack, brain injury, and car accident are shared in units and rooms across MUSC. Many clinicians and chaplains work together by identifying spiritual distress symptoms (loss of meaning, loss of faith connection,

anger, disbelief) and working to comfort by alleviating spiritual pain, suffering and loss of meaning.

Spiritual distress presents itself and becomes embodied in hospital patients as they struggle to find meaning amid chronic and acute illness, life-threatening diseases, traumatic events, mental health challenges, and even routine surgeries. When spiritual distress occurs, it is common to see a loss of spiritual wellness in patients and their families. Chaplain and clinician interventions help people to rediscover purpose and connect with their caring communities such as work colleagues, church members, synagogue members, clergy, and even the recreational connections of family members and themselves.

Chaplains seek to help patients rediscover lost purpose and community. The goal is to help people experience love and hope from family, friends and support systems who are important healing agents in the health care matrix. When there is loss of spiritual wellness it is not uncommon for patients to have longer hospital stays and longer healing processes.

Actions like active listening, prayers and referrals to spiritual care providers all help patients to remember that healing and wellness can be achieved. Spiritual care helps patients and families meet the core need of spiritual well-being in patients during times of ease and challenge. (Ref: www.pastoralcareweek.org)

Do not press pound. Pressing pound will let the hacker in, and the consequences can be serious.

MDM (Mobile Device ManageMent) Mobile Device Management forces a passcode lock on your device and provides a way to wipe all MUSC data from a device if it is ever lost or stolen. MDM is required for any device that accesses MUSC email.

For more information, visit BeginsWithMe.musc.edu or any of the Information Security Awareness Pledge Centers around campus. At the centers, you can sign a pledge promising to follow good security practices.

Pledge names will be entered into a drawing for two iPad Air tablets, 25 — $20 gift cards and 50 — $10 gift cards to MUHA cafeteria and Starbucks.

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Overheard at MUSC

By Jane Ma Public Relations

Who Caroline West, MUSC College of Medicine Class of 2016 What West is one of 54 student recipients from around the nation to have received the 2014 Carolyn L. Kuckein Student Research Fellowship. Only one candidate from each school can be nominated and West was chosen from a class of 181 students to receive the MUSC nomination. She was then selected from a pool of national applicants, by a panel of Alpha Omega Alpha Medical Honor Society reviewers, to receive the fellowship.

This national research fellowship was originally established in 1982 by the board of directors of AOA, a national honor society for medical students. Membership in AOA is considered one of the highest honors a student can receive during his or her four years of medical school. Only a small fraction of a class is even eligible for this distinction. West was recently nominated, along with nine of her classmates, to be a junior member of the AOA Society and believes that receiving the Kuckein Fellowship helped her get the AOA nomination.

The fellowship is designed to encourage student–initiated and designed projects under the guidance of an academic mentor. This experience serves to foster the next generation of physicians and scientists and promote leadership abilities within the health care field.

The fellowship comes with a $5,000 award, and up to an additional $1,000 is available for the student to travel to the national meeting to present the results of his or her research.

West’s research project focuses on developing an effective screening model for Type 2 diabetes in rural Tanzania. With the help of the AOA Research Fellowship, along with a grant from

photo provided

Third-year medical student Caroline West, third from right, traveled to rural Tanzania in 2013 to train workers to use a basic screening model for diabetes management.

MUSC’s Center for Global Health, she traveled to Tanzania for three weeks in July as part of a larger research group under her mentor, Michael Sweat, Ph.D. Sweat is a professor and director of the Family Services Research Center in the Department of Psychiatry and Behavioral Sciences, and he also serves as the director of the Center for Global Health. Sweat is the principal investigator of a rigorous three–year National Institutes of Health Phase II randomized control trial that is designed to reduce population-level human immunodeficiency virus incidence in a rural, developing country setting that is experiencing a severe generalized HIV epidemic. West’s project is a sub-study that fits under Sweat’s broader preventive work, and her results will ultimately be used to better equip the local health clinics in Tanzania to manage the growing prevalence of non–communicable diseases.

The larger research group is establishing a prevention center in the Kisarawe district of Tanzania, and one of West’s major

responsibilities last summer was to train workers in basic screening and management of diabetes, as well as gain perspective from health care workers there about the nature of treating chronic disease in their unique environment.

Back in the U.S., she is continuing to work on the project by developing a screening algorithm that will maximize accuracy, minimize costs and address the natural barriers of providing primary care in developing nations.

Her work is especially important because screening and diagnosis of diabetes is very difficult in resource-limited communities.

Utilizing the most accurate methods of diagnosis is not always possible in an environment that often lacks batteries, electricity, sophisticated medical equipment, or the funds to pay for them. Consequently, even the simplest methods that typically would be used for testing — giving a patient a glucometer to track blood glucose levels or sending a blood sample off to a lab — are generally out of the realm of possibility.

Frustratingly, according to West, the cheapest and simplest methods are not very accurate. In addition, very little research has been done on how to address this issue because historically it was thought that diabetes only affected developed nations. But this is not the case: developing and underdeveloped nations are not spared from the epidemic, and West hopes her research can shed some light on how best to diagnose and treat diabetics in this specific environment.

Leading, problem-solving in a globalized context, West is learning about research design and public health care, which will serve to enrich her medical school experience. As the Carolyn L. Kuckein Student Research Fellow, she has an opportunity to set an example as a self–motivated and passionate professional who is interested in finding creative solutions aimed at improving quality of health care even on the other side of the world.

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Meet Wendy

Wendy Dean

Department MUSC Summerville Dermatology How you are changing what’s possible at MUSC By providing the best patient care possible How long at MUSC 4 years Family Son, Cole, age 5 A unique talent you have I’m an amateur photographer.

How would you spend $1 million I would pay off bills and my student loans. I also would donate money to an organization close to my heart, the Hemophilia Foundation of America. My son has severe hemophilia and this organization provides assistance to inidividuals and families in the bleeding disorder community.

Favorite place in the world Cancun, Mexico Favorite quote “It is better to be hated for what you are than to be loved for what you are not.”

—Andre Gide

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Surgeon helps teens correct chest deformities By daWn Brazell Public Relations

I

t’s mid–morning in the operating room and pediatric surgeon André Hebra, M.D., pulls out a suction bell to use on a caved–in area of the chest of an 11–year–old boy. The suction cup is used to lift the boy’s chest enough so Hebra has room to insert a camera and place a strut through a small incision on the side of the chest.

Hebra uses a stainless steel bar as a brace to instantly remodel a congenital deformity that has worsened over the years causing a condition known as pectus excavatum or funnel chest.

“We do all of our work through tiny incisions,” he said of the minimally-invasive surgery for a condition that is more common in boys by a 4–to–1 ratio. The boy is undergoing a pectus repair for a condition that can cause breathing and heart complications as well as psychological distress. The condition occurs in an estimated 1–in–300 to 400 births.

Hebra, who is chief of surgery at MUSC Children’s Hospital, sizes up what bar he’ll be using and checks sizing, noting how to customize the remodeling to the patient’s unique anatomy. He takes the bar “back to the photos by Sarah Pack, Public Relations garage” to a table in the operating room where he has Medical student Ashley Smith, left, holds the camera that goes inside the chest while Dr. André a specialized tool to adjust it so it’s a custom fit. Hebra Hebra and Dr. Mary Jordan, medical resident, rotate a bar during a pectus excavatum surgery. wants the boy’s chest to look as natural and as perfect as still a significant intervention. “You’re working around may lead to significant physical problems, he said. The possible. the heart, the lungs and the vascular structures. It is psychological effects can be even worse.

Most of his Bent and molded, the bar is ready for insertion. an operation that carries significant risks so that’s why Hebra, using camera–guided views slips the bar beneath patients are teenagers, in which this condition impacts it’s extremely important that you must have extensive self-esteem and confidence. the sternum, navigating past lungs and heart. The experience in performing the procedure and having “We see in real life as we take these patients and U-shaped bar has been notched in the middle for a your own way of doing it. You have to eliminate the correct the pectus how much they feel transformed better purchase point beneath the sternum once it gets risks of complications commonly seen during the and how much better they feel. They build confidence turned. At this point, it rests upside down. learning curve when someone is just starting to learn and they actually perform better in sports and social He asks resident Mary Jordan, M.D., if she’s ready. and do the operation.”

Hebra starts the countdown. “1-2-3.” At 3, they rotate activities. Their lives frequently are completely Hebra makes sure his teenage patients know recovery changed.” quickly in unison, like turning the crank halfway on a means several days in the hospital. “We’re bending the wheel. The bar, and thus the chest, pops up. Hebra eyes bone so there is a lot of pain.” Most patients also receive overcoMing Misconceptions their work and smiles broadly. “Bye, bye pectus. See, The best window for treatment is between 8 to 12 a thoracic epidural to help with pain management and the sternum is nicely corrected.” years of age because the rib cage still is fairly soft and reduce side effects from oral pain medications. After a It’s this instant gratification that makes this surgery malleable, and recovery is faster. Most of the patients month patients generally are back to a normal lifestyle, one of his favorite operations, coupled with the are older though, because the deformity tends to though contact sports are discouraged until the bar is technical challenges that it poses, he said. “I’ve been progress as they age. He has had a patient as old as 45, removed. doing this surgery for so many years, I’ve learned a lot he said.

Having trained with pediatric surgeon Donald Nuss, to perfect the techniques, and I’ve learned a lot from “The most common misconception is that a child will M.D., who developed the Nuss procedure in the late other surgeons and from my patients.” grow out of it,” Hebra said, adding that he has never 1980s, Hebra said MUSC stays in the forefront of new Though the effect is immediate, the bars remain in seen it improve and that in 90 percent of cases it will developments that can be offered. MUSC has made patients generally for three years, remodeling the chest worsen. The reality is that because it is a genetic defect significant contributions in developing standards for and preventing it from growing back in. “You watch how the procedure is done and how to best stabilize the them go through it and see the outcome and how happy of the growth of the ribs and sternum, as a patient is growing, particularly in puberty and adolescence, that bar. Today, Nuss and Hebra frequently travel abroad they are and what an impact it has. It makes you feel good about what you do. We put them through a pretty accelerated growth is going to go in the wrong direction. to teach and train surgeons on how to perform this The initial technique to do pectus repairs was the operation. significant intervention, and you watch the impact it Ravitch method, which involved a fairly large incision Bar displacement has been a significant problem, has on their life forever. It is very rewarding.” in the front of the chest and breaking the sternum. The The depressed sternum creates less space for the newer Nuss procedure is minimally invasive, but it’s lungs and can displace the heart to the left side, which See Surgery on page 7

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iron

Continued from Page One

large incision in the front of the chest, removing certain ribs affected and fracturing the sternum to make it flat again. The newer Nuss procedure is minimally invasive.

A steel bar is inserted upside down and then flipped up, immediately repairing the chest depression. It has less scarring and blood loss, but recovery still is painful and requires several days in the hospital to manage pain. Most patients have a thoracic epidural analgesia, which lowers the need for other pain medications that can cause significant side effects for patients, he said.

There are many misconceptions about the procedure even among physicians.

MeDical necessity That was the case for Chelsea Smith, another patient who had the operation this past summer as well. At 23, she’s older than most of the patients who have it done in their teenage years, but Smith decided to wait to do the procedure until it felt medically necessary.

Her father’s family has Smith several members who have had this condition, so it was accepted in her circle. “It was looked at as cosmetic until it became problematic,” she said. Smith was fine until a couple of years ago when she realized her chest would get tight when she would stand a long time or exert herself. She felt lightheaded at times.

When she began fainting during her medical school training in Greenville, she knew it was time, she said.

She consulted experts and the name that kept coming up was Hebra’s.

Since her medical school training would accelerate in her third year, Smith said the timing seemed right to do something. She also didn’t want to have to worry about

surGery

Photos provided

Carson Quick is shown before his surgery (right) and after. The procedure brought psychological as well as physical benefits. He now enjoys being more active and being on the swim team. complications that might arise during pregnancy later in her life, since that may cause symptoms to get worse.

Though her main goal was to deal with the medical issues, she admitted it would be nice to go to Victoria’s Secret and have more than one bra to pick from.

“I tried every bra and only one fit right. It’s been ridiculous. I can get rid of the grandma bras.”

Smith said she has been surprised how fast she recovered from her July 8 procedure and is happy she did it. The last five months before her surgery were

the worst. Her blood pressure and heart rate were going up, she suffered panic attacks and had moderate mitral valve prolapse and tricuspid regurgitation. Those conditions have improved and she has more stamina for her medical school work, she said.

She now can run up and down flights of stairs and can go all day without being worried she’ll pass out.

She went hiking recently and only had to take one fiveminute break.

Another benefit is she has been able to educate colleagues about the benefits of the procedure and correct misconceptions about it. “It’s not just cosmetic.”

Smith had the same nurses for almost her entire stay, which she really liked. “They became advocates for me,” she said, adding that Hebra was very calm during the entire experience and never made her feel flustered.

Quick agreed, saying that Hebra has a gift of putting patients’ fears at ease. “You feel at peace with him. He was talking to Carson like he was a human being. He changed our lives. He’s so dedicated. He came every day to see us. He was like a friend, caring and considerate. I trusted him. I felt like Carson was in amazing hands.”

Quick said before surgery in June her son couldn’t take deep breaths or laugh really hard. It was starting to affect his posture and his breathing. “He would laugh and he couldn’t get a full laugh in. It hurt my heart.”

Quick said Carson was brave about having the surgery, and everything went well. “From start to finish, it was an amazing thing.” She said Carson still talks about the nurses. “It was worth the trip, 100 percent.”

Quick said Carson used to call the depressed area in his chest the hole. “For him it was a big deal. When they wheeled him out and lifted up the covers, and it was like ‘Oh my God!’ He was thumbs up. When he got home and showered and took a good look at himself, he said, ‘I can’t believe it’s fixed. My hole is gone.’”

Carson, who hasn’t had to use his nebulizer since surgery, swims six days a week, has shed some pounds and exudes confidence. “He’s out there with all these other boys showing them his scars.”

Continued from Page Six

happening in one in 10 patients and requiring a reoperation. Hebra developed techniques to prevent this from happening, including the addition of a third point of fixation that secures the bar at the top of the chest to address the issue.

The chances of bar displacement now have dropped to less than 2 percent.

He hasn’t had a case in the last 10 years where he has had to operate on a patient for bar displacement.

“We also are actively involved in teaching other surgeons all over the world in how to do this operation and how to have good outcomes because that’s really what’s it all about — to make sure this is being done safely all across

Dr. Hebra makes adjustments to the bar that’s inserted to provide a custom fit. the world so everyone can have a good outcome.”

Hebra, who has been doing the procedure for the past 15 years, said the

operation has become more popular because there’s more information on the Internet and by word–of–mouth about the advantages of the procedure.

In 1999–2000 there were a few hundred cases done in the U.S., and in 2012 that number had jumped to 50,000 cases worldwide, he said. “The number of cases has grown exponentially. Dr. Nuss and I are part of an international chest–wall interest group so we we have the opportunity to meet once a year with an international group of surgeons that have an interest in pectus surgery and that group now has 370 members from all over the world.”

The international collaboration has led to more awareness of all the different

ways that this condition, also known as funnel chest, presents and of the various options available for treatment.

The group also has learned that the condition is common in Caucasians and Asian people. It is unusual in African– Americans.

Hebra said he’s glad awareness is growing. It allows children and young adults to get the treatment they need.

“It’s fun to watch the patients and their family when you say, ‘Have you seen your chest?’ after surgery. We’ll pull the cover down. The parents go, “Oh, wow” because it’s an immediate result. It’s instantaneous. It’s pretty impressive.

“It’s very, very rewarding to see the relief and happiness on their faces.”

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OT educator remembered for her spirit, dedication

By Mikie hayes Public Relations

T

here are special people who even in the face of personal adversity make the world a better place for others.

Maralynne Mitcham was one of those rare people. For 30 years, colleagues at MUSC more than enjoyed working and spending time with the College of Health Professions’ beloved professor, they looked forward to it. A cheerful and bigger-than-life personality, she made others feel special, valued, included.

Even through an email, you could imagine the twinkle in her eyes and lilt in her voice as she closed with “Cheers from MM tap dancing on her iPad.” On Oct. 17, MUSC lost her following a valiant battle with ocular melanoma.

Faculty, staff and friends knew the day was drawing near for MM, as friends and colleagues called her, but she chose to work up until the week before she passed, not wanting to give up or give in. She drew strength from colleagues and students who meant so much to her.

That was typical of the special brand of grit she knew she had and showed to the world.

In April, Maralynne had been honored with the prestigious Eleanor Slagle award by the American Occupational Therapy Association, the highest award the organization gives. Part of the award called for her to deliver a lecture at the annual meeting

the following year. When word got out that she would be presenting, she drew an audience of 3,500, the event’s largest turnout ever.

As a result, she was featured in the April 18 issue of The Catalyst. While she was being interviewed for that article, she happily shared fun anecdotes about her yearlong preparation and the event.

She wanted to make sure the article would reflect the joy and pride she felt for having hit a home run delivering her “Education as Engine” lecture at the Slagle event and highlight the hoopla that surrounded it, like the bright blue hair pieces everyone wore at the event, and the bracelets everyone wore back at home, to show support and solidarity for her. Mitcham was known for sporting brightly–colored hair extensions.

And while she spoke candidly about her illness, and what she considered to be the inevitable, it was a subject she preferred not to have mentioned in the article. Several times while speaking openly she would say, “Oh, I don’t want that in this article. Save it for the next one.”

I could think of only two other possible articles that she could be referring to, so I asked her, “Maralynne, do you mean an article about your upcoming endowed lectureship at MUSC? She simply replied, “No.” We both knew what she meant.

“I want people to remember my

Dr. Maralynne Mitcham, center, is joined by former Health Professions assistant dean Dr. Becki Trickey, left, and Dr. Ruth Patterson, professor emerita, College of Graduate Studies in July.

photos provided

Dr. Maralynne Mitcham receives a bouquet of flowers from Health Professions Dean Dr. Lisa Saladin at her endowed lectureship event. smile and not my cancer,” she said. “It was interesting,” she explained of her lecture. “I loved every bit about this, but I had never thought about things that way before. I think about things a bit different now. It helps me sort out issues.

I spoke to people in a very different way — probably, I was more personally charged. The content was very personal for people.”

She wanted also to be remembered for making things happen for a greater purpose. “One of my greatest strengths,” she shared, “is I can take my talents and strengths and do the most good at the right time. What I’m able to do is create synergy for more than one constituent group’s benefit because I try to create ‘win–wins.’ Not to sound Polyannaish, but you can orchestrate things that benefit more than one group of people and make quite the difference.”

Having lived to deliver her Slagle lecture, which had been a real concern for her, she set her sights on attending the second annual Maralynne D. Mitcham Lectureship that took place on July 18. While she was not feeling well enough to make a formal presentation, as she had the inaugural year, she was front and center, welcoming guests and greeting all with her signature warmth and genuine smile. Described as the

day’s celebrity, people scrambled to have the chance to hug and talk to her before the lecture began.

After the lecture, College of Health Profession Dean Lisa Saladin, Ph.D., P.T., presented her with a bouquet of flowers and thanked her for her generosity and vision in creating a series that would bring many influential leaders in occupational therapy to the college. Maralynne’s husband, Chris Brumfield, brother–in–law Clyde Brumfield and niece Jessie were there to celebrate her special day with her.

She explained why her endowment was so important. “I started a lectureship here at MUSC as a legacy gift to the college. I so love this college and all the wonderful people in it,” she said.

“A lectureship is a very academic thing to do, and what we perpetuate is the knowledge of our field which is the criteria for global perspective.” When asked if people could contribute to her endowment, she said, “In the next article, if someone were to ask what I wanted for say, my birthday, I would say, ‘Please write a check to the lectureship fund.’”

Born on Dec. 13, 1949, in London, England, her love of the motherland greatly influenced her, from her

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the catalyst, Oct. 31, 2014 9

MitchaM

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contagious British wit to unfailingly enjoying her 3:00 “cuppa” afternoon tea. According to colleagues, she worked tirelessly to make life fun and the little things celebratory, like affectionately referring to her office as the “pink palace” and writing the Pirate’s Newsletter, an account she kept of the procedures and clinical trials she endured, to keep friends apprised of how she was faring.

She served on nearly 50 university committees during her three decades on the faculty, gaining many friends and admirers along the way. Serving as the chair of the Occupational Therapy Department, assistant dean of the College of Health Professions, assistant dean for research, and chair of the Department of Health Professions were just a few of her many accomplishments. During our interview, Maralynne shared that Ray Greenberg, M.D., Ph.D., then MUSC president, thanked her for being the principal voice on campus for interprofessionalism and building it to a level of prominence.

That compliment touched her and fueled her work.

During her distinguished career she won numerous awards, none so meaningful as her Honorary Life Membership Award, which she earned after serving for a year as president of the American Occupational Therapy Foundation and the Eleanor Clark Slagle Award. Her Slagle lecture will be published in the American Journal of Occupational Therapy's December issue.

In tributes to her in her memory book, she is described as captivating, inspirational, gracious, and a blessing to so many. She is called mentor in nearly every message, and to her students, she was that professor who made all the difference in their lives and careers.

Many who were close to her are understandably grappling with their loss.

Saladin said, “Maralynne represented the heart of the College of Health Professions. While she was an internationally recognized scholar and educator, I will remember her most for her ability to make everyone she met feel special and for her selfless acts of compassion and kindness towards others. Some time ago Maralynne told me that she wanted to continue to come in to work until she was truly incapacitated because being around her University family kept her will to live intact.

However, recently as she continued to lose weight and to visibly deteriorate, she asked me if her presence at work was causing distress to our faculty and staff (who adored her). She told me that she would rather give up her work and all that it meant to her if her presence was causing others to suffer. That is just one example of her willingness to put the interests of others first. While this might sound trite, being around Maralynne made you want to increase your awareness of, your compassion for, and your connection with others.”

Nancy Carson, Ph.D., OTR/L, assistant professor and assistant dean for academic and faculty affairs in

CHP, recalls their special relationship: “Maralynne always made you feel like you were one of the most important people in her life. She was a wonderful and compassionate mentor; the most influential one I have had in my career. She encouraged me to see the big picture and stretch my boundaries professionally. I will miss her tremendously and I am very grateful for the many lessons I have learned from her.”

Peter Bowman, OTD, OTR/L, assistant professor and director of Admissions for the OT Division at CHP, remembers his long history with MM: “She treated everyone as special. She would personally bring a fellow Brit a cup of tea brewed for 3 minutes (the official correct amount of time) she had made at 3 p.m., halfway through a long afternoon of lab activities.

When I was thinking of moving to Charleston to complete a master’s degree and she had only known me via one distance class I had taken with her, she insisted my wife and I stay over the weekend with her and her husband. We did move to Charleston with 8–and 10–year–old children. When we arrived we expected to be staying in a hotel until we found a new house.

Maralynne and her husband were going on a trip to England at that time and insisted that we house sit whilst she was away. She was away for two weeks and my wife and I bought a house and moved into it by the time she returned. Ironically the house my wife and I bought was on the same street as her home.”

K. Jackson Thomas, Ed.D., P.T., professor in the Division of Physical Therapy at CHP, shared his grief: “Dr. Mitcham was not only a close colleague, but was one of my closest friends. She was a most unique person and had a natural born wit that always came through, even during the last months of her terminal illness. During her long weeks of treatment at Thomas Jefferson University in Philadelphia and here at MUSC, she regularly sent clever and entertaining emails to her friends and colleagues that detailed her status and progress. The notes were called the Pirate News, and were so informative, but written with humor and an appeal that captured everyone’s sentiment and emotions. Maralynne will be dearly missed by all of us, and she was one of a kind that no will ever be able to replace. My heart is truly broken both by her illness and her passing.”

DeAnna L. Adkins, Ph.D., assistant professor in the departments of Neurosciences in the College of Medicine and Health Sciences and Research in CHP, took time to reflect on her dear friend: “Looking through pictures of Maralynne from past birthdays, holidays or one of the many other gatherings, I tried to recall one specific poignant quote or witticism of hers to share. Although she entertained us with many witty quips, impressions or limericks composed on the fly (accompanied by her signature jig, of course) or touched us with one of her many insightful comments, I realized that words are not how I best remember Maralynne.

Instead, I remember Maralynne embracing life through

action. In each of the pictures I have of Maralynne she is slightly blurred because she was in constant motion either leading us in a rousing song, vigorously pulling a Christmas cracker, or running along the train tracks in the wee hours, as she said she loved doing as a child, waving my husband and me off as we rode away on holiday.”

Mary P. Mauldin, Ed.D., professor and executive director of the Office of Instructional Technology & Faculty Resources and associate director for education Office of Interprofessional Initiatives, mourns the loss of a dear friend: “Maralynne thought big and at the same time, paid attention to the details that made a big difference. She always encouraged you to think conceptually, to synthesize diverse things together for a better solution, all the while offering you a cup of tea while you wrestled together over those big ideas.

Not only was she ‘wicked smart,’ but Maralynne had style. Her fashion sense, bold choice of colors of nail polish, not to mention a hint of a green, blue or red hair extension made you love her even more — who else would have the nerve? Maralynne was fearless, a true lionheart and an example to us all to remember that, ‘This is your life. Do what you love, and do it often,’ from the Holstee Manifesto.”

Hazel Breland, Ph.D., OTR/L, assistant professor in the Division of Occupational Therapy, otherwise known by Mitcham as “Lady B” said, “Maralynne was faithful and reverential in her walk with God — she did not do it to be seen rather she lived to honor Him and all His creation. For everything that our beloved Maralynne Denise Mitcham did in her life — loving God, loving others, fostering humanity, and its capacity, leading the royal court of the College of Health Professions as well as an international band of pirates while living life to the fullest; I say she was a master.

MM was the quintessential occupational therapist, educator, and scholar who added much to the academy as evidenced by her professional accolades, productivity, and reputation; yet, her crowns in glory will come from how she generously gave of herself as a mentor, artist, confidant, friend, humorist, and fashionista. Cheers, tootles, and big love, from Dr. Mitcham’s Lady B tap– dancing.”

Leslie Brady, CHP director of development said, “Maralynne’s unwavering commitment to education through her personal philanthropy is what initially brought us together… her stimulating and inspirational coaching is what kept us united. For that, and so much more, I am forever grateful.”

As her friend and colleague Thomas said, “It’s just now really beginning to sink in that she’s gone. We had her funeral service on Saturday morning, and that really brought us all to reality. She will never be replaced.”

In lieu of flowers, memorials may be made to the MUSC Foundation with a note specifying the Maralynne D. Mitcham Lectureship (CHP) Fund, 18 Bee Street, MSC 450, Charleston, SC 29425-4500.

10 the catalyst, Oct. 31, 2014

Hybrid procedure offers positive benefits for persistent AF

By Mikie hayes Public Relations In what is considered to be a best–of–both worlds approach, an innovative collaboration among two heart surgeons and an electrophysiologist has resulted in MUSC performing its first thoracoscopic MAZE procedure with a novel technology to treat atrial fibrillation.

The Maze procedure was created in the late 1980s

by James Cox. According to Mario Castillo–Sang, M.D., assistant professor of surgery, MUSC Division of Cardiothoracic Surgery, it was the first surgical procedure to treat atrial fibrillation and has since undergone several iterations. Today, for instance, energy sources are used instead of cutting and sewing the heart. “The efficacy is very good even long–term, but it does require a full cardiopulmonary bypass run and cardioplegic arrest of the heart to perform all the lesion set. That is where the hybrid approach comes in,” he said.

The 62–year old patient, who underwent the hybrid procedure, had suffered with long–term, persistent atrial fibrillation, also known as AF or Afib, and had not benefitted previously from typical treatments.

Touted as being less invasive with a shorter recovery, the hybrid surgery was conducted on a Tuesday and the patient was home on Sunday. According to Minoo Kavarana, M.D., associate professor in Pediatric Cardiothoracic Surgery, who was involved in both the surgery as well as initially bringing the surgery to MUSC, the stay can be as short as three days.

Kavarana is extremely optimistic about the prospects of offering this type of surgery to his patients. “In three to four hours, we can minimize time, risks associated with invasive surgery, trips to the EP lab, not to mention the risk of stroke.”

AF is the most common cardiac arrhythmia — or rhythm disturbance — and occurs when the electrical impulses controlling the heartbeat become disorganized, causing an irregular, fast heartbeat. It currently affects over 5 million Americans and is projected to reach a prevalence of approximately 12 million people by the year 2050.

AF is a serious cardiac condition. It increases the risk of stroke by five times. The chance of developing atrial fibrillation increases with age, and people 40 years of age or older have a 1–in–4 chance of developing it in their lifetime.

Cardiac ablation is the common technique used in the treatment of AF. Ablation works by scarring or destroying tissue in the area of the heart that triggers an abnormal heart rhythm. In some cases, ablation prevents abnormal electrical signals from traveling through the heart thereby stopping the arrhythmia.

Cardiac ablation is typically done in an EP lab where

Mario Castillo-Sang, M.D.,

Frank Cuoco, M.D.,

Minoo Kavarana, M.D.,

Assistant professor, Division of Cardiothoracic Surgery

Assistant professor, Division of Cardiology

Associate professor, Pediatric Cardiothoracic Surgery

the electrophysiologist, a cardiologist who specializes in heart rhythms, threads long, flexible tubes, known as catheters, through a vein in the groin and up to the heart and corrects the structural problems that are responsible for the arrhythmia.

Other times, typically in cases of long–standing persistent AF, open-heart surgery may be necessary.

During this surgery, the breastbone is separated to allow access to the chest, the heart is stopped and a heartlung machine is used. Scissors are used to open the pericardium to gain access to the heart. This procedure is considered the most invasive.

Now, there is a third option – hybrid ablation – for these persistent cases. Using a thorascopic approach, the minimally invasive surgery is performed through small keyhole incisions made between the ribs, through which a tiny camera and video-guided instruments are inserted. A cardiac surgeon makes epicardial lesions outside the heart, where catheter manipulation can be difficult. Subsequently, during a separate procedure, an electrophysiologist ablates endocardial tissue inside the heart.

This procedure eliminates the need for separating the breastbone, the heart to be stopped or heart-lung machine to be used, resulting in faster recovery time and a lower risk of infection associated with open-heart surgery. The combined approach is said to increase the likelihood of blocking irregular electrical circuits and improve success rates for patients with certain types of persistent AF who want a minimally invasive treatment option.

Those who have symptomatic AF and have been in AF for a long period of time or have a large left atrium or have failed multiple catheter ablations are appropriate candidates for this procedure.

Frank Cuoco, M.D., assistant professor in the Division of Cardiology, and the electrophysiologist who was involved in this first procedure, explained,

“Atrial fibrillation is an irregular rhythm from the top of the heart that is similar to a rippling pond.Typically, pebbles, or triggers, start the rippling. Most normal hearts will stop rippling on their own after a while if the pebbles — or triggers — stop hitting the electrical ‘pond’ of the heart muscle. We call this paroxysmal AF. However, in patients with persistent AF — that is,

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the catalyst, Oct. 31, 2014 11 Fundraiser benefits MUSC Service Learners Group

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Take five to avoid afternoon slump very early to walk before The September Monthly Mindful we begin our weekend Challenge winner, Nicole Mullinax plans. Also during the Bernier, service excellence manager week, if it’s a nice day, I in Ambulatory Care Services, try to use my lunch break credits her daily walks with a host to take a 10–15 minute of benefits and encourages her staff walk to Colonial Lake to in Ambulatory Care to walk as well. clear my thoughts and Nicole spent a few minutes of her ward off the afternoon busy day sharing her experiences in slump. the challenge and tips for staying Q: Anything else you’d active at work. like to add or comment Q: What changes do you notice on on? the days you do walk?

Susan Johnson Nicole: Walking is a Nicole: Walking helps clear my great low–impact form of mind, gives me more energy and I exercise for the mind and body. It’s great have less back pain. for a five–minute refocus booster or if Q: How did you add interval training exercises into you start and your walking routine, it can be a great what keeps you aerobic, calorie-burning workout. motivated to walk?

Nicole: I have Wellness Events been walking q Mindful Combo Contest — Purchase as a form of a Mindful Combo Meal between Oct. 20 exercise for to Nov. 14 and you’ll be entered to win many years your choice of a Clemson or Carolina (including Barre Fan Kit. Kit features choice of a Clemson and Yoga) and or South Carolina Cut Out and team what keeps me Bernier counter cooler. Combo must include motivated is that Coca-Cola Zero or other Coke product walking is more or a Dasani Water. Submit your receipt than “just exercise.” Walking is great for into the entry box (including your name reducing stress and it’s my quiet time. and email). A winner will be chosen Nov. Q: What challenges do you face and 17. how do you overcome them from q Celebrity Chef Series: Mindful Twist getting away from your workplace to on Chef Marvin Woods Coastal Soul walk?

Seafood Gumbo, 11 a.m. to 1 p.m., Nov. Nicole: There are only so many hours 5 at both cafeterias. Entree: $4.29, add a in a day, so to take time away from 20 oz. bottled water for $1.25 more. your work or desk can sometimes add q Iron Chef Showdown — 6:30 p.m., more stress to an already busy schedule.

Thursday, Nov. 6 at Culinary Institute of Therefore, I add extra steps to my day Charleston’s Palmer Campus featuring by always taking the stairs or using the local and national celebrity chefs. Event second floor indoor walking trail to go hosted by SCHA and Sodexo in partnerto meetings. ship with the CIC and MUSC Office of Q: Do you encourage your staff to Health Promotion. To purchase tickets, walk? visit www.cookingwellsc.com.

Nicole: Absolutely I encourage my q Cooking Well Invitational — 8:30 a.m. colleagues to take a walk. In fact, a to 3:30 p.m., Friday, Nov. 7 at Trident few of us have occasionally held five– Technical College. Cheer on MUSC/ minute walking meetings around the Sodexo chefs as they compete against block. Not only can we address a few statewide teams in a healthy culinary outstanding agenda items, but it helps competition. Visit www.cookingwellsc. with productivity. com.

Q: How often do you walk and where? q Flu Shot Satellite clinics will be held — Nicole: I walk daily at home. During the 9 a.m. to 1 p.m., Nov. 3, ART week, I walk in the evenings after dinner Auditorium, Rm. 1119 and from 6 to 10 and on the weekends, I love to get up p.m., Nov. 6, Children’s Hospital.

Health at work

12 the catalyst, Oct. 31, 2014

atrial

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it does not stop rippling on its own without shocking the heart back into rhythm — there are electrical abnormalities in the substrate or pond of the heart that promote ongoing rippling and cause the AF to persist indefinitely.”

Catheter–based procedures are usually very good at targeting the triggers for AF, as these triggers or pebbles most often originate from the pulmonary veins, which bring back the blood from the lungs to the heart. Electrically insulating or isolating these pulmonary veins is the primary goal of AF ablation, but in patients with persistent AF, there are often many more abnormalities in the substrate of the heart that need to be modified in order to achieve long-term rhythm control. Cuoco said, “The catheter–based ablation approaches these triggers and substrate from the inside of the heart, but often it is difficult to achieve full thickness and or permanent ablation of the heart tissue from the inside alone.”

The hybrid procedure has the advantage of allowing the physicians to better target the triggers, but even more importantly, it targets the areas in the heart that promotes the continued AF. “This combined approach, said Cuoco, “optimizes the best of both procedures, as each is good at targeting particular areas in the heart that serve as triggers or substrate for AF, but not as good as the other in other areas. This is similar to using a ‘George Foreman Grill’ approach to effectively burn or ablate the heart tissue from both sides; as with a well done steak, you need to cook it all the way through in order to make permanent burns that will interrupt the electrical signals that initiate and sustain atrial fibrillation.”

This tailored approach plays an important role in the treatment of patients with persistent AF. Castillo–Sang said, “Right now this procedure is not widely disseminated. We are the only center in the Tri-county area offering a hybrid approach. We know it has huge potential for patients as it offers a very good success rates in the way of AF — freedom of 83 percent at three years in some of the larger more recent series. This compares favorably to multiple endocardial ablations and

open heart surgery.”

He continued, “This is a safe and effective approach to cure patients from atrial fibrillation that also allows for quicker recovery and less trauma from surgery. It has huge benefits for the patient. A more comprehensive approach in which some of the lesions that are very difficult to create endocardially are performed epicardially with minimally invasive surgery and vice versa.”

Kavarana agreed, “Hybrid ablation makes sense because it combines the most effective aspects of AF surgery and catheter ablation. We can achieve higher success rates and fewer complications because cardiac surgeons and EPs can both ablate areas of the heart that are best suited to their specialties’ particular approaches.”

MUSC has installed a hybrid suite with surgical and EP equipment. This area will eventually house everything necessary to both perform the hybrid procedure as well as incorporating electrophysiological testing to confirm that the erratic electrical signals have been blocked. According to Castillo–Sang, the hybrid suite offers the availability of immediate radiographic fluoroscopic imaging, which allows for real– time visualization needed for the catheter ablation procedure in the same operating suite where the surgical part of the procedure is performed.

Only a handful of centers around the U.S. are performing hybrid ablations currently. Previously, some thought this procedure might generate a turf war between cardiac surgeons and EPs. At MUSC that is not the case; this procedure represented a true collaboration that ensured the patient received the best treatment possible for his particular condition.

Kavarana, Cuoco and Castillo–Sang all believe the hybrid procedure holds great promise and opportunities to offer patients a procedure than may be better suited for their particular condition.

MUSC will also be involved in the landmark Dual Epicardial Endocardial Persistent Atrial Fibrillation trial, known as DEEP AF, that should begin within the next six to 12 months. This pivotal study will look at the potential benefits of the hybrid approach to AF ablation compared to standard therapies.