MUSC Catalyst 2-19-2016

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February 19, 2016

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 34, No. 23

3-D skull technology a no-brainer in neuro cases

By Dawn Brazell brazell@musc.edu

I

t’s a good thing Rhett Bausmith was child No. 4.

It meant his mom, Crystal Bausmith, didn’t panic when she found out something was really wrong with her son. Bausmith recalls that they had no warning there were going to be problems.

“We knew it wasn’t right, but we weren’t quite sure what.”

After the birth, a neurologist came to consult with Crystal and Timothy Bausmith to explain what was wrong.

Their son’s head was misshapen because he had craniosynostosis, a birth defect in which the bones in a baby’s skull join together too early. He would need to be referred to MUSC. Ramin Eskandari, M.D., a pediatric neurosurgeon, and Jason Ulm, M.D., a plastic surgeon, joined forces to figure out the best way to help Rhett. Imaging showed his skull had not one, but two sutures (fibrous joints on babies' skulls that turn into bone) that had prematurely closed.

Often in these cases it’s just one suture that closes, but Rhett’s case was rare, Ulm says. The two sutures that had fused were affecting brain growth and the formation of Rhett’s face. Already one section of the skull that encases the eye, the orbital rim, had pulled back.

Ulm discussed options with colleagues in Boston. “We usually don’t see something this severe.”

Ulm and Eskandari requested MUSC’s bioprinting labs to take Rhett’s scans and make 3–D skulls. Ulm says

3

photo by Sarah Pack, packsa@musc.edu

MUSC neurosurgeon Dr. Ramin Eskandari, left, examines Rhett Bausmith as his parents, Crystal and Timothy Bausmith, look on. only a handful of medical centers in the country are using bioprinting technology to create replicas of patients’ skulls to better plan surgical procedures. It also opens a new frontier in the training of residents and in creating a powerful tool to educate families about what can be very complex surgical cases.

Eskandari, a new father himself, says he understands how hard it is for parents to get bad news. In severe cases, it can

photo provided

See Skull on page 6

duke GrAnt Helps pAtients Sickle cell network to be established.

LIKE US

Photo of Rhett Bausmith taken before the first surgery.

4

AlumnA nAmed CmO

2

Employee of the Month

Capella–MUSC Health Network continues to improve.

5

Meet Lydia

10

Employee Wellness

Medical University of South Carolina — FOLLOW US

@ Catalyst_MUSC

2 The CaTalysT, Feb. 19, 2016

Medical Center

‘Making a difference every day’ Employee of the Month Award

Kristen Brammer Peds Sickle Cell “Kristen uses her creativeness to help improve the sickle cell clinic and involve patients and families to help make their environment more festive. This year Kristen used those skills to help decorate our unit’s Christmas tree. Kristen found two simple Christmas tree decorations, purchased most of the supplies on her own and then asked for our volunteers to help the patients make these ornaments while in clinic for their treatments and visits. On days that we had no volunteers available, she made time to help the patients and families with the decorations. Her idea not only brought Christmas joy to the clinic, but it also gave the patients and families a break from the normal clinic routine and allowed them to express their own creativity through Kristen’s generosity and desire to help others. The patients and families proudly displayed their ornaments on the unit’s Christmas tree, and it was truly worthwhile to see the happiness that Kristen’s idea brought to the patients and the clinic.

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

Thank you.”

Nominated by Michelle Cooper

compassion.”

Nominated by Allison Jones

Natausha Cancer

Takenya Glover BMT Transplant Program “Takenya Glover was nominated for this award to recognize her innovative cost– saving ideas.

She saved the department over $5,000 per year by independently developing a new process for printing education materials. Takenya requested to purchase a notebook binder and replace the individual notebooks being purchased to hold the patient education materials. The binder provided the same professional look while saving the department thousands of dollars per year. The team was very impressed with this simple strategic idea that was extremely cost– effective. Within five years, this project will save our department $25,000 from Takenya thinking of innovative ways to cut costs. We applaud Takenya for her amazing efforts to contribute to the success of MUSC.” Nominated by Cindy Kramer

9East– Neuroscience “Friday morning, Natausha Cancer saw a fellow 9East employee that she barely knew fall into a deep puddle in the rain while getting on the MUSC bus in Summerville. Natausha and other employees got off the bus and came running to her assistance in the rain to lift her out of the cold water. The injured employee knew she was going to need an ambulance. Natausha told the bus driver to leave, and she would take care of her. Natausha went to get her car to put the employee in, so she could sit out of the rain until the ambulance could come. By the time EMS came, there were no more buses running, so Ty Morris went and picked up Natausha to give her a ride to work. Natausha went to make sure the employee was OK in the ER before starting her shift.

Natausha was wonderful support to our employee, and we really appreciate her 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., 843-958-7480 or 843-937-4803. E-mail: sales@moultrienews.com.

Wanda Shotsberger-Grey CH Histopathology “Wanda Shotsberger is a histopathology technician in the Department of Pathology and Laboratory Medicine. Not only does she perform her duties at the highest level on a daily basis, but I am frequently impressed by the extra efforts she makes on a consistent basis to improve care for our patients. Just this morning, a lung biopsy arrived in our department which was designated by the submitting physician for rush processing due to the severity of the patient’s illness. She noticed the unusual clinical information submitted along with the biopsy tissue and called me immediately to inquire what, if any, special studies might benefit the patient, and I wished to request they be initiated from the start.This step is so unusual and so unexpected, and yet so characteristic of Wanda to anticipate the possible needs of the patient to make sure that the patient has the opportunity to get an accurate diagnosis as soon as

See EOM on page 12

The CaTalysT, Feb. 19, 2016 3

Sickle cell network to bring specialized care to rural S.C.

By J. ryne Danielson daniejer@musc.edu

M

amie Taylor suffers from sickle cell disease, a hereditary blood disorder that afflicts approximately 100,000 people in the United States, the vast majority of them of African-American decent. Another 3 million carry the sickle cell trait.

Those with the disease have sickleshaped hemoglobin — the proteins in red blood cells that carry oxygen throughout the body — and over time, these can damage blood vessel walls, decreasing blood flow to muscles, bones and organs and starving them of oxygen. SCD causes severe pain akin to the pain of frostbite.

“It hurts very badly. I get sick when I get too cold, too hot or when a bad storm comes,” Taylor said. “It’s painful and scary.”

Taylor lives in Andrews, South Carolina, and travels to MUSC at least once a month for a blood transfusion.

The drive is two hours each way. She leaves early so she can arrive before 8 a.m. and often doesn’t head home before late afternoon.

Her experience is typical of many rural sickle cell patients, said Julie Kanter, M.D., director of sickle cell disease research at MUSC. A chronic disease, sickle cell requires a sustained, comprehensive approach to care — blood testing, transfusions and close monitoring of medications. Anyone with SCD not lucky enough to live near a specialty clinic either must make a long drive or do without specialized care and rely instead on nearby emergency rooms and local hospitals.

“Many of the patients I treat haven’t seen a blood doctor in over 10 years,” Kanter said. “They’re on no diseasemodifying therapy and have no idea what they need to do to better care for themselves.”

Because the disease’s predominant presenting symptom is pain, many patients are stigmatized as drug seekers and don’t receive the proper treatment or pain medications at the proper doses.

“Unfortunately, pain can’t be easily measured or treated, and even medical professionals lack proper education about SCD. I’ve had unfortunate

photo by J. Ryne Danielson, daniejer@musc.edu

Dr. Julie Kanter, left, introduced South Carolina Senator Tim Scott to sickle cell patients at the MUSC Children’s Hospital on Feb. 12.

in and out of the hospital every week.

Doctors didn’t listen. Her doses of pain medications were far too low to be effective, and she wasn’t receiving any long–term treatment for SCD. Many

times, she said, doctors sent her home still in pain.

“They didn’t know what to do,” she said. “The doctors said, ‘We don’t really deal with sickle cell patients.”

Since Taylor started seeing Kanter, her condition is being managed much more effectively. She’s only been admitted to the hospital once in the past year.

“These patients have multi-system problems that don’t fit easily into the typical family medicine clinic,” Kanter said. “The way medicine is these days, patients may only get ten minutes with their doctor. You can’t take an incredibly complicated patient that hasn’t been seen in ten years and diagnose them in ten minutes.”

Kanter has a solution. With the help of a grant from the Duke Endowment, she hopes to build a statewide network of clinics that specialize in the treatment of SCD. The South Carolina Sickle Cell (SC2) Network will enhance access to care for people living with SCD and help

See Sickle Cell on page 10

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experiences with many hospitals across the state,” Kanter said. “If patients just wanted drugs, they could get them cheaper and easier on the street.”

Another problem Kanter mentioned was the misdiagnosis of other diseases in patients with SCD. “Often patients are told that whatever they walk in the door with is just a symptom of SCD, that there’s nothing the doctor can do. I have SCD patients now who have been diagnosed subsequently with rheumatoid arthritis, lupus, sarcoidosis. All these patients were initially told, ‘Oh, it’s just your sickle cell.’”

These are issues Taylor has experienced firsthand. Before she started seeing Kanter last March, Taylor said she was

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Alumna named CMO for Capella-MUSC network hospitals

By Mikie hayes hayesmi@musc.edu

T

allulah (Tullie) Fellers Holmstrom, M.D., was recently named chief medical officer (CMO) for the two South Carolina hospitals that make up the Capella–MUSC Health Network: Carolina Pines Regional Medical Center in Hartsville and KershawHealth in Camden.

The new position is a part–time role, enabling Holmstrom to continue serving patients in her internal medicine practice.

Her primary responsibilities as CMO for the Holmstrom network will be to ensure that both hospitals are delivering the highest possible quality of care to their patients and communities, while helping to fully leverage the resources of the partnership with MUSC Health to facilitate greater access to care and improved quality for both communities. She will also work closely with both hospitals’ senior leadership teams and medical staff leaders along with Vishal Bhatia, M.D., chief medical information officer for Capella Healthcare.

Holmstrom graduated from the MUSC College of Medicine in 1992.

She subsequently completed both an internship and residency at MUSC and was selected to serve as chief medical resident. She recalls her time at MUSC with great fondness, remembering, too, that chief strategic officer Mark Lyles was her student when she was chief resident.

“Look at him now,” she said with a smile and a bit of pride.

When offered the position of CMO for the Capella–MUSC Health Network, she accepted the new role with enthusiasm. “I’m excited about this opportunity,” she said, “Especially being an alum of MUSC and with Camden and the Midlands being my home. I look forward to figuring out

“Dr. Holmstrom was uniquely qualified to take on this position, having served effectively in other leadership positions, and on the BOT while also practicing in Camden over the past two decades.”

Patrick Cawley, M.D. ways to extend the expertise of our state’s flagship academic health center into our local communities. With its many areas of specialty, such as its National Cancer Institute designation, MUSC has been the safety–net hospital for this state for decades upon decades and can impact the health of patients around the entire state every day. My relationship with MUSC has really come full circle since my days as a medical student and chief resident.”

MUSC Health CEO Patrick Cawley, M.D., applauds the appointment. “I am pleased that Tallulah Holmstrom, M.D., an MUSC alumna, was named chief medical officer for the hospitals involved in the Capella–MUSC Health Network. Dr. Holmstrom was uniquely qualified to take on this position, having served effectively in other leadership positions and on the board of trustees, while also practicing in Camden over the past two decades. We are pleased to be involved in this important alliance — one that leverages the strengths of both organizations and positions our affiliated hospitals to better serve these communities.”

In late 2014, MUSC Health and Capella Healthcare partnered to form a clinically integrated network that enables the organizations to enhance the health and wellness of the families and communities they serve in South Carolina.

This network allows the health care providers to work together; share and better align resources to improve access to higher levels of care; and to be able to

deliver the highest quality of care in the most efficient manner possible.

According to Cawley, this initiative combines both organizations’ strengths: MUSC Health’s academic expertise

and commitment to education, research and patient care and Capella Healthcare’s proven expertise in hospital management. “This patient–focused partnership brings the best of MUSC Health and Capella together and to the people of South Carolina.”

Holmstrom, a native of Camden, is board certified in internal medicine as well as hospice and palliative medicine.

She founded Sentinel Health Partners, a multi–disciplinary practice in 1996 and has practiced in Camden for the past two decades. She has served on the medical staff of KershawHealth, and held numerous leadership positions, including chief of staff and chair of the Department of Medicine. Currently, she is enrolled in the Physician Executive MBA program at the University of Tennessee.

The CaTalysT, Feb. 19, 2016 5

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6 The CaTalysT, Feb. 19, 2016

skull

Continued from Page One

be hard for families, who often are in shock, to understand the complexity of the surgery. “Even with Rhett, where you could see something really was wrong, it’s not until now, when there’s been a significant correction, where his mom says, ‘Oh my God, my baby was messed up.’”

It also lets him do a better job of obtaining informed consent, which prepares families for the upcoming treatment and its possible risks. “No matter how much you talk to a family about what you’re going to do as a surgeon, if you ask them even hours later, they have very little idea,” he says.

“Real–life visuals help with the process of getting better informed consent and lead to better questions from the patient or parent.” preppinG fOr surGery The parents, especially when they heard how many cuts would need to be made into their son’s skull, had lots of questions.

Rhett, born May 1, 2015, was slotted for surgery Dec. 17. Ulm and Eskandari decided to do a two–stage repair.

Doctors like to wait longer to do surgery to allow for more bone growth in the skull so there’s enough bone to perform reconstruction, but Rhett’s condition was progressing quickly. They needed to relieve pressure on his brain so they opted to go ahead with the first surgery.

Rhett’s eye had started to pull up — a condition called a harlequin eye — and a part of the forehead area was pushing forward. The first step was to take away bone from the sutures that had prematurely fused. “That’s when this comes in really handy,” he says, turning the 3–D model in his hand. “We used these to plan the cuts.”

Since Rhett’s brain needed room to expand, the surgeons also did a technique called a barrel stave osteotomy.

“The barrel stave sort of describes it.

You make slits in the bone — it’s like the Blooming Onion from Outback,” he said, explaining a crisscrossing of cuts in the skull.

“The cuts give it the extra ability to grow faster. By relieving the pressure from the bone by doing the barrel staves, it forces the brain to grow in the direction you want it to grow faster.”

Following surgery, the doctors also

photo by Emma Vought vought@musc.edu,

Neurosurgeon Ramin Eskandari, center, and plastic surgeon Jason Ulm, right, work on correcting Rhett Bausmith’s skull. opted to do helmet therapy to really force growth in the directions they wanted. “He’s gotten a good correction,” says Eskandari. “His brain growth is significant in the early stages and the cuts and the helmet all worked together to get a good reconstruction.”

When Rhett is about 18 months old, they’ll perform a second surgery to remove the frontal bone and reconstruct the forehead and eye area. Because the orbits or eye sockets have really been affected, they will do an orbital osteotomy. Ulm, a father of three, is glad to see the progress Rhett already has made. It’s one of the parts of his job he enjoys the most.

“It’s amazing the difference you can make in kids and see the immediate and profound change that you can make in their appearance and development at that age.” trAininG Of tHe future Ulm says he and Eskandari often work complicated cases such as this as a team.

“We’re both young, fresh and eager to improve the methods by which we treat babies with these conditions to make surgery safer and more effective.”

Eskandari agrees, adding that Ulm is so laid back, it’s hard to get a rise out of him. “He’s so even keeled, and he’s so cerebral. He’s very meticulous and very thoughtful.”

Their differing backgrounds as a neurosurgeon and a plastic surgeon allow them different perspectives. They capitalize on each other’s expertise, and both embrace using the new 3-D bioprinting technology, Eskandari says.

Ulm agrees, adding that the technology helps plastic surgeons better plan where to make the cuts. “We can see what parts of the skull we want to move and how we can move those pieces around, sort of like a jigsaw puzzle, to reshape the head into a more normal position. We can draw on it and then simulate the cuts like you would in the operating room.

The idea is to decrease the operative time because you have already simulated the operation before in the lab.”

Eskandari says the next step with the 3–D skulls is to get drills that can be used with them to better train residents.

A long—term goal is to not only print the skull but the dura or soft tissue underneath as well. Eventually

they could replicate the whole brain including the blood vessels and mimic an aneurysm, for example. “So literally, you could do the whole approach on an adult skull to treat an aneurysm. You literally have a mock version of your surgery with absolutely no risk.”

The advantage of that is like comparing a scratch–and–sniff version of a muffin to eating a muffin, he says.

“From a surgeon’s standpoint to be able to manually do that the night before — not from a 3–D scan on a computer — but really manually do it — that muscle memory is very important in surgery.

The potential benefit from a training standpoint and in terms of what that does for patient safety is huge.”

The bottom line is better patient care, Eskandari says.

“When you see the results years later, and the child just looks so much better and you know what you’ve done is not just cosmetic, it’s really a life changer.

Some of these kids would look extremely abnormal as children and young adults.

That already puts them in a very precarious situation in this day and age with so much emphasis on looks and image.”

The Bausmiths already are fans of the new technology.

Rhett’s mom, Crystal, says having the 3–D skull was very helpful, especially in understanding the eyes and how the orbits were misshapen. It also helped when the doctors were explaining what they were going to do. “We could hold it and look at it and see it,” she says. “I kept showing the kids and my family.

It was his little head. It’s really cute.

Especially if you’re a visual person, you’ve got to see it.”

Her husband, Timothy, an engineer, also liked having it. “When you have the skull, it helps you get your head wrapped around it.”

Fortunately, Rhett is doing well, and they’ve noticed no developmental delays so far. His mom says the difference the one surgery made has been amazing. “It’s very reassuring. As messed up as his head was, we were surprised how well he’s doing.”

Rhett’s dad agrees, adding that they were excited to be able to take one of the skulls home.

“Hopefully all he will have of this one day is a cool scar. That will be the only thing and maybe a 3-D model skull.”

The CaTalysT, Feb. 19, 2016 7

Personal mission: Inside the world of 3-D printing

By Dawn Brazell brazell@musc.edu At the punch of a button, Mark Semler can leave the room that houses his lab’s 3–D printer and know when he comes back 24 hours later, he will have a skull.

Recently, it was a replica of the skull of baby Rhett Bausmith, who was born with a genetic condition that caused his head to be misshapen. Surgeons used the replica of Rhett’s skull to help plan his treatment and explain to the family what was to be a very complicated surgery to treat the birth defect called craniosynostosis. Now with one surgery successfully done, Rhett is well on the road to recovery. Semler, who is chief technology officer for the Zucker Institute for Applied Neurosciences (ZIAN) at MUSC, says it’s one reason he loves his job.

“You’ve seen MRIs on a screen — that’s a nightmare — you’re trying to figure out what you are seeing. You’re trying to visualize a kid’s 3–D skull. If a picture is worth a thousand words, this is worth a million. This is the patient’s actual skull shape and the issues that are inside. If it can comfort them and give them more information, it’s a very powerful tool.”

MUSC has two labs that handle 3–D printing, including ZIAN and the Advanced Tissue Biofabrication Center (ATBC), which also produced a replica of Rhett’s skull for the use of his surgeons to prepare for the case. Michael J. Yost, Ph.D., director of general surgery research at MUSC, said the 3–D models Images from patients’ scans are put into special software to make replicas usng 3-D printers.

help in two main ways.

“First, it provides the surgeon a trueto–life–size 3–D model of the anatomy to use to plan the procedure. We can print multiples of these models, we can print different sections or cut them apart and reassemble similar to the surgical procedure. It allows the physician to complete several dry runs before actually performing the procedure.”

They also serve as important communication tools among the patient, the family, the surgical care team and the physician.

Yost said the main mission of the ATBC is to develop advanced biofabrication techniques, including 3–D printing and bioprinting. “We are to then translate these technological developments into useful tools to improve patient care, improve outcomes and reduce overall health care costs.”

Early work in 3–D tissue biofabrication was spearheaded by investigators at Clemson University and MUSC. The lab has a Palmetto Printer, a fully automated bioprinter designed by MUSC and Clemson researchers at the ATBC. It also has a MakerBot Replicator 2 to introduce students to 3–D printing technology.

Among the center’s accomplishments, it has succeeded in printing microvascular structures using living cells. These structures, measuring 100 microns by 10 millimeters, mimic the design of blood vessels or tissues.

For the creation of the skull for the Bausmith family, the process was to get computerized tomography scan data and

photos by Sarah Pack, packsa@musc.edu

Replicas of Rhett Bausmith’s skull were printed on two different 3-D printers at MUSC. Surgeons used them to plan his surgical treatment and explain to his family what was to be a very complicated surgery to treat the birth defect craniosynostosis. reconstruct Rhett’s skull in 3–D using a software package. It cost about $250 to create the model. “We translate the reconstruction into data the printer can understand. We print the anatomy, and we cross–check the anatomical landmark dimensions from the scans and the printed object.”

Semler said the process is similar at ZIAN. ZIAN’s 3–D printer uses a photopolymer material that prints with an accuracy of .004 inches. CT scans are fed into software that translates them into stereolithography files that can be read by the 3–D printer. They load the machine with the correct material and print. “It tells you to come back in 24 hours, and you come back and scrape the skull off with a spatula and you start cleaning it."

The 3–D printer, which functions much as an inkjet printer would, uses a liquid plastic that turns to a solid when it’s exposed to ultraviolet light. As the print head comes across, it lays down either the clear scaffold material or the colored solid material (in this case, white). The UV light comes right behind it, and turns it into a solid.

Semler says the software translates the imaging scans down to the millimeter to match the patient’s physical geometry.

“You get a very clear idea of what you’re going to see before you start cutting the skin.”

Semler, who has been involved in 3–D printing for 20 years, said 3–D printing is not new. What has radically changed is pricing and software tools to make the

technology much more accessible and affordable. His lab has an Objet 30– pro printer that comes with a $60,000 price tag for an upgraded model. It has superior accuracy and ability to print multiple materials, including clear, multiple solid color and high temperature variations. Rhett’s skull cost about $350 in materials to produce.

Semler said he’s glad to see the Department of Neurosurgery embrace the technology, especially given the sensitive nature of what they do. “Every teaching hospital should have this type of support. It’s the next frontier, and neurosurgeons are always trying to figure out how the brain works and this is the next technology that can help them do that. They’re inventive.”

3–D printing obviously has a promising future, he said, including new materials that are emerging, such as metals that can be implanted. As 3–D printing becomes more commonplace, it will be easier to get insurance coverage for preoperative planning. The ultimate will be the printing of organs.

Semler, a mechanical engineer, went into medical devices because of family reasons. He lost both parents when he was in high school, his father from cancer and his mother, a heart attack from complications of an asthma attack.

“I suffered losses as a kid, and every skill that I had I wanted to devote to improving patients’ lives. When they come and say they have a kid — a brand new life — absolutely, I want to improve all patients’ lives, but you want to be able to help kids. This is a no–brainer.”

8 The CaTalysT, Feb. 19, 2016

Boy turns tables on mother with special dietitian’s help Harry and Marlo Burgess talk with Janet Carter about a model showing cholesteral levels in food. Carter is the first dietitian in South Carolina to be certified as a lipid specialist.

By Dawn Brazell brazell@musc.edu

I

photos by Dawn Brazell, brazell@musc.edu

is through lifestyle modification and risk reduction.

What experts have learned, though, is that it takes more than telling parents to adopt a healthier lifestyle.

Heart Health uses a hands–on approach using the

See Dietitian on page 9

Harry Burgess holds a model of a blob of fat that reminds kids what can happen if they overeat and don’t exercise. may or may not be overweight,” Carter says.

This includes children with something called familial hypercholesterolemia, which is a genetic disorder characterized by high cholesterol levels.

“This can be pretty serious. As a dietitian, I work with them on the diet portion of the treatment of these disorders. Diet may not always get folks to their goal and often medication is necessary, but diet and exercise can always improve the situation. Sometimes, even in severe cases, it can help them to have success with lower doses of medication, which often means diminished side effects.”

Heart Health has operated since 2004 as both the weight management program of the Children’s Hospital and the preventive cardiology service of the Children’s Heart Center at MUSC. This design is unique among children’s hospitals and important to the program’s developer and medical director, Melissa Henshaw, M.D. She says the best way to promote cardiovascular health

C52-1423485

t started out as a simple question.Third–grader Harry Burgess saw his mother, Marlo, had joined Weight Watchers and asked if he could too.

His mother asked his pediatrician, and instead, he suggested MUSC’s Heart Health Program for Harry.

Now the pressure’s on. Her son, now 12, has had great success and hassles her about getting more active and eating better.

Marlo smiles. The tables have turned, and she wouldn’t have it any other way.

Her son has been the spark in getting her family on a healthier path. First, they realized how poorly they were eating, she says. “It was a huge eye-opener to find out about all the things you don’t know about. We realized how many calories he was drinking in a day was just huge and how much fat was in things like a slice of pizza that we just didn’t realize.”

Harry nods, enthusiastically. “Yeah, I can’t remember the last time I drank a Coke.”

“Yeah, success,” yells Janet Carter, a dietitian with the Heart Health Program who meets regularly with the family to track Harry’s progress. Within the first six months he was in the program, she watched Harry drop 10 pounds, a significant amount for that age, and he no longer has hyslipidemia, a condition involving abnormal cholesterol levels. Carter knows that will keep Harry from developing a host of chronic health problems down the road.

One of the recent highlights for Carter was seeing Harry cross the finish line in the last leg of the Charleston Youth Marathon. Marlo says it meant a lot to the family to have her there cheering him on.

Carter, who’s known for going the extra mile to help her patients, recently met a milestone of her own. She became the state’s first dietitian to be certified as a lipid specialist with the National Lipid Association, which makes her an expert on cholesterol as it relates to heart disease.

“The certification exam is not different for doctors, dietitians, nurses, pharmacists and other health professionals, so it is extremely rigorous,” she says of the two years it took to prepare. It was worth it. She has found physicians are more comfortable referring complex cases to her because she understands the complexities of treating such conditions as dyslipidemia of obesity, where a child’s lipid panel is abnormal because he or she is overweight.

These problems, unless dealt with at a young age, can cause lifelong issues and can be harder to solve in adulthood when lifestyle patterns get set. An estimated 25 percent of children in South Carolina are obese, and that doesn’t include children of a normal weight who have cholesterol conditions.

“We also have become a lipid clinic, which means that we see and treat children with lipid disorders who

The CaTalysT, Feb. 19, 2016 9

DieTiTian

Continued from Page Eight

collective expertise of the team to help families meet and reach their goals over time, building success in a step-wise, sustainable way.

“Emerging research is confirming the longstanding impact of childhood obesity and dyslipidemia upon the development of cardiovascular disease in adulthood.

Heart Health was designed to keep the role of cardiovascular prevention at the forefront of our weight management focus.”

While some of these children will need medication for cholesterol control, lifestyle counseling can have a dramatic impact, especially when introduced during childhood, she says. Carter’s additional training will help the program expand its impact in counseling dyslipidemic families. “Identifying features of the metabolic syndrome and combined dyslipidemia of obesity in our families and targeting cardiometabolic risk factors for improvement, along with weight management counseling, allows Heart Health to have a broader focus than most other comprehensive programs in the U.S.,” Henshaw says.

Carter, who joined Heart Health in 2006, is glad to see the expansion and development of a focused dyslipidemia counseling core. About 10 percent of Heart Health’s referrals are not affected by obesity but have a history of elevated fasting LDL or bad cholesterol, often with a family history of early-onset atherosclerosis.

Research over the past decade has identified important markers for children and teens that are precursors of cardiovascular disease, Henshaw says.

“Many children and adolescents with obesity also have features of metabolic syndrome, including elevated waist circumference, blood pressure, triglycerides and glucose levels, as well as low HDL levels, which has been associated with early-onset cardiovascular disease in adults.”

An interesting obesity–related lipid disturbance, the combined dyslipidemia of obesity (CDO), has been better defined in recent years, she explains. Among children and adolescents with obesity, it is estimated that about one-third have features of CDO. While comprehensive lifestyle education remains the core treatment strategy for CDO, MUSC Heart Health will soon begin participating in a novel medical treatment protocol for CDO via the Pediatric Heart Network and the National Heart, Lung and Blood Institute, Henshaw says.

The CDO protocol will study whether statins, which are currently used for elevated LDL levels that don't respond adequately to lifestyle therapy, will also help as an adjunct to counseling to treat CDO in children, Henshaw says. “It will be a milestone study across multiple sites in the U.S. and Canada. It’s very exciting.”

Another development Carter is excited about is Heart Health’s expansion into telehealth. Carter says the problems of obesity and other conditions that put children at high risk for developing cardiovascular

photo provided

Harry Burgess completed the Charleston Youth Marathon.

disease have to be addressed aggressively. Families need support.

“We have six slots for telehealth patients every Friday and have been able to successfully enroll more kids from outside the greater Charleston area, mainly Georgetown so far, who need our services.”

In the end, it’s the families and kids, such as Harry, who keep her inspired. Carter is careful to prioritize goals in small steps for children to feel successful.

Harry’s mom, Marlo, says she’s glad the program is designed so that kids tackle a few goals at a time because making lifestyle changes can be overwhelming.

“We did do small steps, but they’re also very motivating.

I mean, I think they think their job is to inform us, but their job really is to motivate him. Coming back without his star chart filled out, especially when he was younger, was a big deal.”

Marlo says they stuck to one change long enough for it to become a habit. “The biggest thing that keeps him going is that he doesn’t even consider now drinking a Coke or not eating breakfast because that was one of his goals for a long time: to eat breakfast. He doesn’t even have to focus on it because it has become such a habit.”

Long term, it means Harry will have a better quality life, says Carter.

“There’s been evidence that kids as young as 2 can start to develop atherosclerosis if they have dyslipidemia, so for him that’s huge to get it down at this age. If kids catch this situation before they’re in their early 20s, they can turn around the situation and get their arteries back to like perfectly healthy arteries.

Whereas if you catch it later on in your 30s, 40s or 50s, you can improve the situation, but it’ll never get back to perfectly healthy arteries again,” she explains.

“So, for him, to be where he is now, is going to be huge for him.”

Register for one of two MUSC teams: Team 1: Mattilyn Williams williama@musc.edu or Team 2: Jennie Ridgeway at nemcicj1@musc.edu

10 The CaTalysT, Feb. 19, 2016

Spotlight on Wellness: HVC commits to fitness on their floor As the health care landscape changes, MUSC is moving towards a preventative approach to health care and our new strategic plan — Imagine MUSC 2020 — includes a goal to create healthier communities, beginning with our own.

Starting with our most senior leaders, Patrick Cawley, M.D. announced the addition of a new Population Health Goal to engage the entire MUSC community in leading by example to improve the health of our fellow employees and MUSC Health Plan members. As a result, departments across MUSC Health are implementing creative wellness initiatives addressing a variety of health and wellness issues. We would like to share some of these programs here as a way of recognizing these great efforts and to motivate others departments to get fit.

Our first spotlight story comes from the Heart and Vascular Center’s Prep and Recovery unit.

With the beginning of a new year and expectations associated with the new Population Health goal, Heart & Vascular Center Prep and Recovery group decided to start a fitness initiative

musc.edu to see your of their own, offering 15– department in the “Spotlight minute exercise classes in the on Wellness” series. conference room at least three times per week. Their goal Wellness Events is to promote the physical and mental health of their q February Mindful employees and to provide a Challenge — “Know time for everyone to have the your numbers, show opportunity to do so. your heart some love.”

The first class was held on Take the initial survey Jan. 6. A charge nurse led at www.musc.edu/ohp/ 10 participants in a variety monthlymindfulchallenge. of exercises (visit MUSC html and complete the final Susan Johnson Employee Wellness Facebook survey at the end of the page for photos and videos). month for a chance to share “It was great. All employees in HVC your story in our “Spotlight on Wellness” are welcome and anyone can lead series. the classes,” said facilitator Melissa q Worksite Screening: Wednesday, Southand, outpatient clinic manager Feb. 24 at Wellness Center Auditorium.

III. “Our goal is to do a variety of This screening, valued at about $350, different exercise classes, in 15 minutes is available to employees with the State (or less), so that bedside clinical staff Health Plan (including MUSC Health can participate.” As an added incentive, Plan) at no charge for the basic test they provide free sweatbands to anyone in 2016. For information, including who joins their exercise class. They’re updated pricing for optional tests and to committed to creating a “corporate register, visit musc.edu/ohp/employeeculture of good health.” Have a wellness wellness/worksite-screening.html. story to share? Email musc-empwell@ q Be one in a million hearts —

Participate in the BHAC National Challenge: Learn the ABC’s of cardiovascular disease.Prizes will be awarded to the top three institutions with the most participants. The Office of Health Promotion will give away a Fitbit in a random drawing of all MUSC students and staff who complete the Million Hearts Module. To enter for a chance to win, email certificate of completion to johnsusa@musc.edu. For more information, visit millionhearts. osu.edu or email johnsusa@musc.edu.

1. Visit http://go.osu.edu/millionhearts 2. Select “BHAC Million Hearts Challenge” from the course list 3. Log in if previous user or select “create new account” 4. Select MUSC from the Affiliated Organization drop down list 4. New users will receive a confirmation email containing an activation link.

Once the link is clicked, the enrollment process is complete.

For more information, email Dr. Susan Johnson at johnsusa@musc.edu or Suzan Whelan at whela@musc.edu.

siCkle Cell

SCD. “These programs don’t share the same goals or the same measures of success,” Kanter said.

“And often they’re spending money to do the exact same Kanter thing.”

Another aspect of the project involves partnering with regional health care providers to better serve rural areas of the state.

“Using a hub and spoke model, we’re going to create new, small SCD centers throughout South Carolina. These centers will be connected to the hub at MUSC both through outreach and telemedicine.”

Current partners include Palmetto Health Richland, Tidelands Health Systems, Beaufort Memorial Hospital and Greenville Health Systems. Kanter also hopes to find a partner in the Florence area. Each of these groups has

affects predominantly people of Northern European ancestry — SCD suffers from a significant lack of funding.

And because of a history of abuse in research, many African–Americans feel wary of participating in research studies — studies that may lead to the development of new drugs. In the Tuskegee experiment, researchers with the U.S. Public Health Service intentionally infected poor African– American sharecroppers with syphilis.

Such incidents still cast a long shadow to this day, Kanter said.

That SCD, a complex disease in its own right, is further complicated by issues of race and poverty is a significant challenge, but not one that can’t be conquered. “The stigma of this disease can very easily become discriminatory,” Kanter said. “But I’m very grateful to the Duke Endowment and to the MUSC leadership for recognizing what an important project this is. We as an institution, and as a state, have an opportunity to become role models in improving care for sickle cell disease.”

Continued from Page Three

educate local providers on how to treat and manage the disease.

“My biggest goal is to make sure that individuals living with SCD have access to a specialist,” Kanter said.

To meet this goal, Kanter’s project will harness the efforts of stakeholders across the state — patients, physicians, community–based organizations and the Department of Health and Environmental Control — to coordinate care and set a common agenda. These groups will also establish common measures of success to accurately gauge South Carolina’s progress in addressing this disease as a matter of public health.

“The methodology is called collective impact,” she explained. “We want to merge what everybody’s already doing; set specific, measurable goals; and make sure we’re not duplicating efforts so that we can use our limited funding as well as possible.”

Currently, for example, managed–care organizations, hospitals and the Sickle Cell Disease Foundation all have their own case management programs for

Health at work

agreed to provide substantial in-kind resources including clinic space and nursing and physician support.

“These institutions have agreed that we need to improve the care of individuals living with SCD and are working with MUSC to develop a sustainable treatment model across the state,” Kanter said. “In Georgetown, for example, we’re working with Tidelands to establish a clinic that doesn’t exist yet. It will be run by an advanced practice provider with help and support from emergency room and Med–Peds (a specialty that combines internal medicine and pediatrics) doctors. I’ll come monthly to do comprehensive care and establish individualized treatment plans, and I’ll also be available when needed by telehealth for acute care.”

The Duke Endowment grant brings much–needed funding to a historically underfunded disease, Kanter said.

“We’ve known about SCD for 106 years, and we have only one FDA–approved drug. That’s pretty pathetic.”

The reasons for this, Kanter said, are twofold. Compared to other genetic diseases, like cystic fibrosis — which

The CaTalysT, Feb. 19, 2016 11

MUSC – Let Us Hear From You!

M

USC is conducting a communications audit to hear what employees have to say about our efforts. This brief, anonymous survey is designed so that employees and students can feel free to comment on any aspect of our communications work. How effectively we, as an enterprise, communicate will have a tangible impact on our ability to achieve MUSC’s strategic goals.

Please take five minutes to complete this survey and return it to us by March 1. You may already have received this survey online. Please only complete the survey once. Your responses are confidential. Thank You. PosT–survey insTruCTions Once you’ve completed the form, please do one of the following: q Drop it off at any of the nine designated drop boxes located at the first floor security or information desks of the following buildings: – University Hospital – Clinical Science Building – Children’s Hospital – ART – Rutledge Tower – MUSC Wellness Center – Harborview Office Tower – MUSC Health East Cooper – MUSC Parkshore Office Center q Scan and email to pubrelat@musc.edu q Mail your form using an interoffice envelope to: MUSC Office of Public Relations 135 Cannon Street Suite 403, MSC 189 Attn: Survey q Fax it to 843-792-6723 q Take a photo using your cellphone and email it to pubrelat@ musc.edu.

Survey deadline is March 1.

12 The CaTalysT, Feb. 19, 2016

nursinG sCHOlArsHips AwArded

eoM

Continued from Page Two

possible so that the appropriate treatment cannot be delayed. We know that even a few minutes or hours can make an enormous difference for patient outcomes, and Wanda recognizes this reality and consistently goes out of her way to make sure not only that the biopsy tissue is processed in a rush manner as required, but also that the pathologist is alerted promptly to clinical information so that appropriate studies be performed promptly. MUSC is fortunate to have such an outstanding professional who consistently exceeds the expected standards of excellence in performance of her duties, and whose efforts help deliver the highest level of care for our patients.”

Nominated by Ellen Riemer

photo by J. Ryne Danielson, daniejer@musc.edu

MUSC chief nursing officer Dr. Marilyn Schaffner, fourth from left, and MUHA chief operating officer, Matt Wain, far right, join MUSC nurses receiving $2,500 scholarships from Western Governor’s University: Laura Brigada, from left, TaCorey Campbell, Rachel Johnson, Wayne “Zeh” Wellington and Ashley Bukay.

Your Source for Tax-advantaged Income

YES Family Fund Grant Applications accepeted The YES Family Fund is providing grants to projects that impact MUSC. Apply at http:// academicdepartments.musc.edu/ development/help/YESgrant.html.

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