Taking One Step at a Time, Uniquely, Following an Aneurysm Rupture
George Jewell, PhD, speaks during the Tri-State Brain Aneurysm Support Group’s annual symposium at the Vontz Center. Just as no two people are alike, no two experiences with a ruptured brain aneurysm are alike. Aneurysms can differ in size, location and when they strike. “Every person’s brain is a unique and special organism,” George Jewell, PhD, explained this month at the Tri-State Brain Aneurysm Support Group’s annual symposium. “Everyone’s aneurysm is different. And everyone’s outcome is different, even though there is a shared piece that all aneurysm survivors can use to relate to one another.” Dr. Jewell, a neuropsychologist at the UC Neuroscience Institute, Drake Center and the Lindner Center of HOPE, spoke before an audience of 140, a record for the 6-year-old event, at the Vontz Center on the UC Academic Health Center campus. A brain aneurysm, a balloon-like bulge on a blood vessel wall, can be devastating if it becomes stretched so thin that it ruptures. Approximately 27,000 Americans suffer such a rupture each year, and up to 50 percent of those who survive can face significant cognitive changes. Cognition involves memory, reasoning, communicating and the performance of executive tasks, such as planning and decision-making. Recovery can be relative, Dr. Jewell noted. “Sometimes there are really good physical outcomes. An individual will be walking and talking just fine; but there may still be cognitive changes.” The good news, he said, is that cognitive improvements following an aneurysm rupture continue for a longer period than previously thought. “We know that in general there is significant recovery after a ruptured aneurysm,” Dr. Jewell said. “In the early days we believed that cognitive recovery occurred quickly and was complete after the first few months. Over time, however, we have learned that the recovery curve is a lot longer than we believed. Even though significant recovery occurs in the first few months, it does continue – although at a slower pace – throughout the first year.” The larger the rupture, he added, the longer the recovery will be and the longer the timeframe until the individual reaches a cognitive plateau. Memory The most common complaint among survivors involves short-term memory, as memories that have not yet been consolidated into long-term memory may not be recalled, or retrieved. Survivors often have a zone of time, dating from the time of the hemorrhage, which is unlikely to be recalled, Dr. Jewell said. Long-term memory, on the other hand, is less likely to be affected. “Anything autobiographical is very well protected and resistant and is unlikely to be altered by a brain aneurysm or brain injury or disease,” Dr. Jewell said. “This contrasts with what you may see in the movies, which portray people who, after some traumatic event, don’t remember who they are.” Cognitive challenges appear in other forms as well. Survivors can have difficulty concentrating, focusing, or processing visual information accurately or quickly, and they can struggle to perform executive functions, such as problem-solving, that were once routine. Patients who have suffered an aneurysm rupture at the anterior communicating artery, which connects the two anterior cerebral arteries and is one of the most common sites of brain aneurysms, have more problems with memory and executive function than survivors whose aneurysm was located elsewhere. Emotional and personality changes can compound the adjustment, causing survivors to experience anxiety, depression, frustration, anger, irritability and lack of motivation. Medication can help, Dr. Jewell said, and studies suggest that the first medication tried for depression will be successful approximately two-thirds of the time. Dr. Jewell offered the following tips for survivors: Find a hobby and embrace your life Carry a datebook with you Keep a calendar, notepad and pencil near your main telephone Always put important items, such as keys, in the same place Make eye contact with someone who is speaking to you, as this will help you encode what is being said and remember it later Don’t be shy about asking someone to repeat what he or she said As a neuropsychologist, Dr. Jewell helps survivors and family members determine whether an individual has returned to a defined cognitive level. “You should generally wait around three months after an aneurysm rupture before having neuropsychological testing unless there is a reason why you need to know sooner,” he said. “It also works best if you have a clear goal about what you want to know. Does the individual want to return to work? Does he or she want to start driving again?” * * * For more information about the Tri-State Brain Aneurysm Support Group, please call (513) 475-8636 or visit http://www.tsbaconnex.org/ The Tri-State Brain Aneurysm Support Group, one of the first of its kind nationally, was founded in 2002 by Mario Zuccarello, MD, Mayfield Clinic neurosurgeon and Chairman of UC’s Department of Neurosurgery; Laura Sauerbeck, RN, a researcher in UC’s Department of Neurology; and survivor Sandy Ross. The organization meets regularly and engages expert speakers in its quest to help survivors grow and connect with each other throughout their recovery and after. — Cindy Starr
A Safety NETT for Brain Emergencies
Members of Cincinnati’s NETT team, from left: Irene Ewing, RN, Peggy Waymeyer, RN, Sara Stark, MEd, and Principal Investigator Arthur Pancioli, MD. In early 2007 the National Institutes of Health (NIH) established NETT – the Neurological Emergencies Treatment Trials network, a permanent research framework that currently involves 17 university medical centers throughout the United States. The Neurotrauma Center at the UC Neuroscience Institute is part of this large and ongoing program. NETT enables physicians from many disciplines to search for better ways to treat brain emergencies, which include strokes, unrelenting seizures and blunt trauma to the brain. With the enduring framework for NETT in place, researchers can begin new neurological emergency studies whenever new therapies become available for testing. Arthur Pancioli, MD, Professor of Emergency Medicine at UC, is principal investigator for UCNI’s involvement in the NETT framework. Inclusion in the prestigious network is one of the UCNI’s 13 national neuroscience benchmarks. You can think of NETT as a kind of safety net. Under normal circumstances, people participate in clinical trials after careful consideration and after providing their consent. People who suffer a brain emergency, however, are unlikely to be conscious or able to provide informed consent for themselves. In such emergency cases, a relative or guardian can provide consent for the patient. In the event that a relative or guardian cannot be reached, federal law has established a system that allows physicians – when no proven or effective treatment is available — to begin emergency investigational treatment. This is called “exception from informed consent.” This exception from informed consent will be necessary for some clinical trials that are part of NETT. If exception from consent is part of a NETT study, distribution of information about the study and public comment are required before the study begins. Every year 1.1 million Americans suffer a devastating brain or spine emergency – about one every 28 seconds. These emergencies can be caused by strokes, seizures, vehicle crashes, falls or severe blows to the head. Every year 250,000 Americans die from brain and spinal emergencies, and thousands more suffer a loss of independence. NETT was developed because modern medicine cannot cure all sudden brain emergencies. NETT will further researchers’ efforts to develop new therapies that can minimize the damage after an accident, stroke or seizure has occurred. Testing new therapies is part of the process of finding out which therapies works best. NETT studies underway at UCNI or soon to begin include: RAMPART, the Rapid Anticonvulsant Medications Prior to Arrival Trial. RAMPART seeks to figure out whether giving anti-seizure medicine works as quickly and effectively when given as a shot in the muscle as through an IV (a tiny straw or tube in the vein). ProTECT III, the Progesterone for Traumatic Brain Injury – Experimental Clinical Treatment trial. ProTECT will assess whether administering the naturally occurring hormone progesterone in patients immediately after a moderate to severe traumatic brain injury will reduce brain damage and swelling and thereby improve the patients’ outcomes. Individuals who are opposed to being enrolled in a NETT study in the event that they were to suffer a neurological emergency can request an “opt out” bracelet by calling 513-558-NETT (0095). Leave your name and address, and a bracelet will be mailed to you.
Doc Rodgers to be Special Guest at Brain Tumor Center’s Winetasting Fundraiser
Doc Rodgers at work. Photo courtesy of 700WLW. Doc Rodgers, the beloved 700WLW radio personality who is battling cancer, will appear as an honored guest and will provide an inspirational message during the UC Brain Tumor Center’s second annual winetasting fundraiser on April 28. The event will be held from 6 to 8:30 p.m. at the CARE/Crawley Building on the UC Academic Health Center Campus at the corner of Eden Ave. & Albert Sabin Way. Send Doc a big “thank you” on Facebook! » Doc, neither a smoker nor a drinker, had the misfortune to develop non-small-cell lung cancer, which metastasized to his brain. Doc, who was diagnosed in May 2010, has persevered with fortitude throughout his treatment. He continues to host “Extra Innings with Doc Rodgers” on 700WLW, to work as a realtor for Wyoming’s Coldwell Banker West Shell office, and to stay busy as a husband and father. On a recent day he was shuttling one of his children to a basketball practice and the other to a dance class. Doc’s care has involved chemotherapy and periodic radiation treatments for brain metastases at the Precision Radiotherapy Center in West Chester. His radiation treatments have been directed by John Breneman, MD, a radiation oncologist and Associate Director of the UC Brain Tumor Center. A metastatic brain tumor is the most common type of adult brain tumor, with 170,000 cases diagnosed in the United States each year. Brain metastasis occurs in 15 to 30 percent of patients with cancer. Rich Seal, owner of The Wine List and a “Champion” of the UC Brain Tumor Center, is chairing the fundraiser. “We are planning another enjoyable event with lots of great wines to taste and buy and a bigger, better silent auction than last year,” says Rich, a member of the Brain Tumor Center’s Community Advisory Board. “The event will feature tastings of high-quality wines from around the United States and the world as well as a silent auction of excellent, hard-to-find wines.” The silent auction will feature a variety of unique offerings, including a private in-home wine tasting, a 3-day weekend at a vacation home in Park City, Utah, a carting experience for 4, an introduction to Latin dancing, and several bottles of wine that are not widely available, including a 1998 Chateau Cheval Blanc Red Bordeaux and a 2004 Shafer Hillside Select Cabernet. Savory and healthful hors d’oeuvres will be served by Jeff Thomas Catering, and valet parking will be available. Tickets are $50, with proceeds benefiting research at the UC Brain Tumor Center, a multidisciplinary center dedicated to state-of-the-art clinical care and research excellence within the UC Neuroscience Institute. Event sponsors are The Wine List, Tramonte & Sons, Vintage Wine Distributors, Inc., 55 Degrees, Glazer’s Distributors, and The Grand Cru Wine Company. The event will feature a silent auction and the opportunity for guests to purchase tasting wines, which can be delivered or picked up at a later date. For more information about the wine tasting event, please contact Jennifer Dilbert at (513) 558-6903 or [email protected]. –Cindy Starr
From First Craniotomy to First Book, Chief Neurosurgery Resident Travels a Fast Track
Ondrej Choutka, MD, with his most recent accomplishment. Photo by Mary Kemper/Mayfield Clinic. Czech-born Ondrej Choutka, MD, has not only managed the demanding schedule of his sixth and final year of residency in the Department of Neurosurgery, he has also co-authored a recently published book on cervical spine surgery — an accomplishment that normally comes much later in a surgeon’s career. Dr. Choutka, now the Chief Resident at University Hospital, completed this 3-year project with his mentor of almost 20 years, neurosurgeon Petr Suchomel, MD, PhD. The collaboration led to the publication of Reconstruction of the Upper Cervical Spine and Craniovertebral Junction. With persistence to meet the publisher’s September 2010 deadline, the authors spent their summer vacation and much “free” time working over the Internet, reviewing and revising each other’s chapters—Dr. Choutka in Cincinnati and Dr. Suchomel in the Czech Republic. The book was published in December. “It was hard to balance all my commitments — the book, the residency, and my family (a wife and two young children),” Dr. Choutka said. “But, it fit my vision. Even as a 6-year-old boy in Liberec, I wanted to become a surgeon.” “My family laughed at my dream in the beginning,” Dr. Choutka added. “I once fainted at the site of blood.” Like other Czechoslovakian children, Ondrej was expected to choose a career path at age 14. He picked medicine and subsequently left for high school in England. Home on holiday at age 16, a neighbor arranged for Ondrej to meet Petr Suchomel, the town’s sole neurosurgeon. By the next day, Ondrej was observing in his operating room. Memories of that day’s operations remain vivid: “a shunt placement in a newborn, a cervical spine operation to fix a fracture, and a meningioma removal.” Thereafter, many of his vacations were spent shadowing his mentor in surgery. Holding his acceptance letter as proof that he would be attending medical school at Oxford University, 18-year-old Ondrej was allowed to perform his first craniotomy under the guidance of Dr. Suchomel. “However, had I known all the things that could go wrong with a torcular craniotomy, I would not have done it,” Dr. Choutka reflected. “I was young and without fear.” The surgery did go well, with Ondrej using only a hand-held drill, not the pneumatic high-speed drill used today for removal of a portion of the skull. At Oxford, Dr. Choutka received his Bachelor of Medicine and Surgery degree and completed his initial surgical training, which included a post in Australia. He continued to collaborate with Dr. Suchomel, helping to translate medical papers into English. En route from Australia, during a layover in Cincinnati, Dr. Choutka reconnected with one of his Oxford mentors who had since joined the Department of Neurology at the University of Cincinnati. During his brief stay here, Dr. Choutka received an offer to spend 2004-2005 in fellowship training at The Christ Hospital. The fellowship experience persuaded Dr. Choutka to continue his neurosurgery residency training here in 2005 rather than returning to England. “Even if it meant repeating a few years, UC and the Mayfield Clinic offer tremendous neurosurgical training that I would have not gotten in the UK.” Throughout his residency, Dr. Choutka continued his collaborations with Dr. Suchomel. “Petr is an honest and direct person as well as a great surgeon,” Dr. Choutka said. “While he expects a lot from his trainees, he also puts a lot into his relationships with his young surgeons providing them with continuous feedback on what they’re doing right or wrong and helping them improve. There’s no fluff, and I appreciated that.” When Dr. Suchomel was approached by the publisher Springer to write a book about spinal diseases and disorders, he promptly asked Dr. Choutka to join him as co-author. “The idea behind the book was to share Dr. Suchomel’s specialized knowledge about surgery at the craniovertebral junction – the uppermost area of the spine where it connects to the head – with the general spine surgeon, who likely treats fewer patients and sees fewer complex cases of this region,” Dr. Choutka said. “The reader will hopefully appreciate the tricks of the trade as well as many nuances on how to avoid trouble during reconstruction of this part of the spine.” “I have learnt a great deal during this timely and difficult endeavor,” Dr. Choutka added. “And I am very happy to be finally holding a hard copy of the book in my hands.” — Mary Kemper
French Delegation Visits UC Cancer Institute
The rapidly evolving UC Cancer Institute, a close collaborator with the UC Brain Tumor Center, enjoyed some rarefied company Wednesday, as a group of 30 delegates from the French Ministry of Health and French academic hospitals stopped by to learn how UC has envisioned and constructed its cancer center. The French delegation had previously visited the National Cancer Institute in Maryland and the MD Anderson Cancer Center in Texas. Olivier Rixe, MD, PhD, a former Parisian who is Medical Neuro-Oncologist at UCNI and Director of UC’s Experimental Therapeutics Program, is the catalyst who brought the delegation to Cincinnati. UC’s public relations office reported that “Physicians and researchers affiliated with the UC Cancer Institute gave presentations on topics ranging from translational research (phase 1 trials, brain tumor molecular therapeutics) and the impact a unified cancer center can have on fellowship training to the importance of clinician-scientists who cross the divide between ‘researcher’ and ‘doctor’ and the role of advanced-practice nurses in patient care. UC presenters also highlighted the Cincinnati Cancer Center, a collaborative effort of the UC College of Medicine, Cincinnati Children’s Hospital Medical Center and UC Health University Hospital to develop a world-class comprehensive able to provide innovative multidisciplinary cancer research and highly specialized patient care for children and adults in our region.”
Schott Foundation Gift Helps Put a Bull’s-Eye on Metastatic Brain Tumors
Francie and Tom Hiltz have witnessed the virulence of metastatic brain tumors not once, but twice. One family member was treated in a clinical setting, without access to a clinical trial that might have made a difference. Another family member was treated in Cincinnati and elsewhere. “He was making some progress toward remission,” Mr. Hiltz recalled. “But when the cancer metastasized to his brain, his prognosis changed irrevocably, and he rapidly deteriorated.” On Thursday, aided by the Hiltzes’ generosity and recognition that more research is desperately needed in the area of cancer that spreads to the brain, the University of Cincinnati announced the establishment of the Harold C. Schott Chair for Molecular Therapeutics. The endowed chair was established with a $2 million gift from the Harold C. Schott Foundation, of which Francie Schott Hiltz and L. Thomas Hiltz are trustees. An additional $4.5 million committed by the UC College of Medicine and its Departments of Internal Medicine (Hematology-Oncology Division), Neurosurgery and Radiation Oncology—will enable development of the UC Brain Tumor Center Molecular Therapeutics Program, an interdisciplinary program dedicated to translational research and the tertiary care of patients with brain metastasis. The Molecular Therapeutics Program will wed the research and clinical talents of UCNI’s Brain Tumor Center, which is directed by Ronald Warnick, MD, Professor of Neurosurgery, and the rapidly evolving UC Cancer Institute, directed by George Atweh, MD, Professor of Hematology-Oncology. The new molecular therapeutics program will allow UC, over the next 18 months, to build a subspecialized research team that will collaborate with the existing multidisciplinary brain tumor clinicians and surgeons to address the problem of brain metastases through translational research and original clinical trials. “The endowed Harold C. Schott Chair will enable us to recruit a nationally recognized researcher with a track record in the study of molecular mechanisms of brain metastasis,” Dr. Warnick said. “Two additional researchers will be recruited to the research team and will focus on areas of highest potential for translation from bench to bedside.” At a celebratory launch of the program Thursday at UC’s Vontz Center, Olivier Rixe, MD, PhD, Director of UC’s Experimental Drug Trials Program, said that patients with brain metastases have been excluded from most of the world’s clinical trials that test new cancer therapies. “We hope to develop new clinical trials at UC,” he said, “and we will not exclude patients with metastatic disease from Phase 1 or Phase 2 studies. We will also develop specific trials for patients with brain metastases and test new drugs in this context.” “The next frontier is basic and translational science,” Dr. Atweh said. “The catalyst for this is the gift we’re celebrating today. This challenges us to take the Brain Tumor Center to the next level and to make it one of the best in the country. This is the first major initiative, and we’re looking to the future with a lot of excitement.” Dr. Warnick said the new program will target perplexing and unanswered questions about metastatic tumors, which develop in 30 percent of cancer patients. “For example, why is it that some tumors, like melanoma, will go to the brain 70 percent of the time, whereas some cancers, such as ovarian, will metastasize maybe 2 percent of the time,” he asked. “And what about lung cancer patients, who are often first diagnosed with a brain metastasis, whereas patients with breast cancer may develop brain metastasis 5, 10 or even 15 years later. “With all of these unanswered questions, the purpose of UC Brain Tumor Center Molecular Therapeutics Program is to focus on these issues, and others, with the primary goal of developing new therapies for these patients and – if I may be so bold – to ultimately prevent brain metastases from happening. And I think that’s possible. If we can intervene early enough in the process, if we can do the right kind of research, then we can prevent these from happening in the first place. I think that is the Holy Grail, and I think we can do it.” The extraordinary nature of the mission has energized the UC Brain Tumor Center team. John M. Tew, MD, Clinical Director of UCNI, noted that, in his 40-plus years at UC, “This is as exciting a time as I’ve seen.” Dr. Rixe, looking directly at Mr. and Mrs. Hiltz, made this promise: “It is very difficult, but we are excited and will do our best every day.”
A Great Living Cincinnatian Draws Courage from His Patients and Gives Hope in Return
John M. Tew, MD, left, and UC President Gregory Williams at the Cincinnati USA Regional Chamber’s annual dinner. Photo by Cindy Starr/Mayfield Clinic. John M. Tew, Jr., MD, Clinical Director of the UC Neuroscience Institute and a neurosurgeon with the Mayfield Clinic for more than 40 years, was honored as a Great Living Cincinnatian Thursday night by the Cincinnati USA Regional Chamber. He thanked his family, his colleagues and his courageous patients, and he encouraged those in the audience never to give up hope. Only 126 individuals have been named Great Living Cincinnatians since the award’s establishment in 1967. Dr. Tew was joined this year by the Honorable Sandra S. Beckwith, David C. Phillips and Oscar P. Robertson. View videos of the 2011 Great Living Cincinnatians » The following is a transcript of Dr. Tew’s remarks upon his acceptance of the Great Living Cincinnatian award: Good evening. Thank you all for coming to share this moment with us. It’s an honor to stand here with Dave, Oscar, and Judge Beckwith and be recognized for this great Award. What’s a person to say on such an occasion? I must say I feel the need to keep it simple, to say 5 special Thank You’s and leave you with a thought. My first thank you is to my parents and grandparents: brave and committed farmers who instilled in me the values of hard work, love for the land and a thirst for education. I wish they could be with us tonight. Fortunately, my sister Barbara is here. Next I’d like to thank the many dedicated teachers and mentors who nurtured my professional development. One man, in particular, stands out: Dr. Frank Mayfield, my mentor and colleague, and the reason I came to Cincinnati 42 years ago. Frank Mayfield is also a man who created a legacy of neurosurgical excellence that I and my colleagues have sought to carry on at the University of Cincinnati, the Mayfield Clinic and the UC Neuroscience Institute. To my colleagues and associates: thank you for the gifts of your time, your compassion, your philanthropy and your best effort every day to ensure the success of our mission and vision. I have said it again and again, but it remains true: the excellence we have achieved has been accomplished as a team. Tonight’s award is a reflection not on me, but on the efforts of many people who have labored together over the years. Fourth, I want to say a special word of appreciation for our patients and their families. I have learned some of life’s most valuable lessons from them, at the bedside and in the operating room. I have watched families cry together, pray together, and stand fast together in the face of grief. I have seen families faced with heart-rending trials, only to emerge with renewed love for each other and joy in living each day, however fragile life may be. My patients have shown me the face of courage over the years—making me more courageous in the process. And they have always been our most supportive and creative collaborators in clinical research and education. Finally, a word to my family: Thank you to my dear Susan, who has provided the stability and spiritual compass that has guided me and our family throughout our 44-year marriage. And thank you to my children, for your forgiveness and understanding when work prevented my presence at important occasions during your formative years. * * * Finally, I leave you with a thought. In recent months, I was asked to sum up what I learned from a life committed to surgery, patient care, teaching and institution building. This is not the place to give my full answer to that question, but I would like to leave you with a remark by Historian Charles Beard that points to the essence. “When it gets dark enough, you can see the stars.” Many times I have seen a patient confronted with the possibility, even the inevitability, of death. A brain tumor patient and family stare the unknown in the face and are at the depth of despair. For them, in these darkest moments, it is the willingness to hope that perseveres deep in the soul until a cure is realized; or a recognition that a family’s love, a physician’s care, or a firm faith in God is itself light sufficient to dispel the darkness. In these moments, I have seen this light: a natural drive for healing that is present even when a cure is elusive. I think this paradigm quite possibly holds for all of us. It seems to me that any effort—whether in business, education or at home—is susceptible to the threat of stroke, so to speak, to a moment when a dark cloak falls over the endeavor and all appears lost. But friends, all is never lost. Hold fast in the darkness and look for the stars. Flickers of light are there for the eye trained to see them. Look for the light, for the glimmers of hope, and let those guide your way. Thank you. — John M. Tew, Jr., MD
Lessons from the Tragedy in Tucson
Photograph, “Despair,” by Cindy Starr / Mayfield Clinic. The recent tragedy in Tucson was a topic of sobering discussion in academic departments of psychiatry, psychology and social work throughout the United States. Henry A. Nasrallah, MD, Professor and Director, Schizophrenia Program, and Stephen M. Strakowski, MD, the Dr. Stanley & Mickey Kaplan Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine, offer their thoughts in the following essay. Drs. Nasrallah and Strakowski are affiliated with the Mood Disorders Program at the UC Neuroscience Institute. By Henry A. Nasrallah, MD Stephen M. Strakowski, MD The tragic recent events and loss of life in Tucson due to the violent acts of what appears to be a seriously mentally ill young man have shocked our nation and triggered much grief, anger and finger-pointing. Random events like these tend to strike us as senseless and difficult to comprehend. As information about the 22-year-old shooter is released, a picture of a seriously ill individual has emerged, with evidence of bizarre behavior, thought disorder, and emotional impairment that has been longstanding. As with the public reaction to the Virginia Tech mass killings four years ago, the most frequent question begging for answer was – “why was this sick young man not referred for treatment despite numerous prior episodes of bizarre and threatening behavior in multiple venues?” The answers to that question are multiple and reflect our country’s general lack of interest in mental health issues (except briefly following gruesome events such as the one in Tucson). Although mental illness afflicts up to 25 percent of the U.S. population, most individuals with psychiatric disorders do not seek help for reasons that include: Lack of awareness that they have an illness, related to inadequate public education Lack of mental health services that could provide help promptly Social stigma that persists about mental illness and is perpetuated by the media Longstanding discrimination by insurance providers towards mental disorders that makes it much more difficult and expensive to receive treatment compared to other “physical” medical disorders Arcane restrictions about guiding people into treatment and disclosing information about potential dangerousness. These restrictions limit interventions that teachers, police and other professionals can recommend and can even preclude requests for help from the family. We often sadly observe that because of those legal constraints, our patients with mental illness die “with their rights on!” Despite being one of the most developed countries in the world, the United States gravely neglects its citizens who suffer from mental illness. The vast majority of psychiatric hospitals have been closed, and even psychiatric wards in general hospitals have typically been downsized or converted to more lucrative medical or surgical specialties where insurance reimbursement is far more profitable. Public health statistics suggest that urban centers should have 40-60 acute inpatient beds for every 100,000 of its population, but most cities have a fraction of these actually available. An alarming number of patients with psychotic disorders such as schizophrenia and bipolar disorder are being warehoused in prisons instead of cared for in hospitals. States are more willing to construct and/or expand jails and prisons than to build or expand mental health facilities. It is a great source of pain to those of us who care for people suffering from psychiatric disorders to see them transformed from “patients” to “criminals.” The vast majority of psychiatric patients never commit violent crime, but their erratic behavior in public or their exploitation by seasoned criminals often lands them in jail. The suicide rate among persons with schizophrenia, bipolar disorder or a major depression far exceeds the homicide rate, but the media coverage of acts of violence by a mentally ill individual is logarithmically greater than the coverage of death from self-inflicted injuries. Opportunities for prevention of serious behavioral decompensation, like that which occurred in Arizona, are repeatedly wasted. Psychiatric research has long established that adolescence and early adulthood are the most likely times in life for the onset of serious psychiatric disorders such as schizophrenia, bipolar disorder, major depression, anxiety disorders, and substance abuse. Consequently, high school and college years offer the greatest opportunities for early detection and intervention, which could ameliorate the negative outcomes of these evolving mental disorders. Yet many students who develop psychiatric disorders are not identified until their illness becomes severe and their symptoms are serious and threatening to self and others. A systematic screening of all students between 14 and 24 for early warning signs could reap tremendous benefits in terms of prevention and/or pre-emptive treatment as well as decreasing the suffering of these individuals, their families and our society. Pediatricians and family physicians can begin this process by incorporating a routine “mental-health checkup” with the annual physical exam of children, adolescent and adult patients. With more thoughtful and enlightened intervention with our young people, we could prevent tragedies like the one that occurred in Tucson.
Remembering Oliver “Ollie” Waddell: Leader, Humanitarian and Friend
Photo of Virgilee and Oliver Waddell by Melvin Grier / Cincinnati Post. The UC Neuroscience Institute’s clinicians, staff and supporters will remember Oliver Waddell as a devoted family man, successful business executive, and humanitarian whose generosity and empathy for others made the Waddell Center for Multiple Sclerosis possible. Mr. Waddell, who retired early as CEO of Star Bank to become the primary caregiver for his beloved wife, Virgilee, died at home on Oct. 24, surrounded by his children. Virgilee Waddell preceded him in death in October 2009. The Waddell Center was founded in 2002 with a $5 million gift from Mr. Waddell, who wanted to honor the courage and determination of Virgilee, who was diagnosed with MS in 1981 and who gradually lost her ability to walk. Mr. Waddell also wanted to provide for the thousands of other residents of Greater Cincinnati who suffered from this incurable neurological disease. He and Virgilee were both concerned that many patients with MS traveled out of town for optimal care and the opportunity to participate in clinical trials that tested promising new treatments. The Waddells wanted those opportunities to be available here, for people in the Cincinnati region, and especially for those who did not have the means to travel. “Mr. and Mrs. Waddell were opposed to having their name associated with the Center because they did not want to draw attention to themselves personally,” reflected John M. Tew, MD, Clinical Director of the UC Neuroscience Institute. “However, they were convinced that their name would facilitate the support of others and help to establish a more effective center for the care of all people of our region.” “Our father epitomized the best of Cincinnati, giving of himself to help countless others through his community service, business and philanthropic endeavors; most notably, creating a legacy in our Mother’s honor by establishing the Waddell Center for Multiple Sclerosis,” the Waddell family said in a prepared statement. “Although his business accomplishments are well documented, we will remember him first and foremost as a loving, dedicated husband who walked away at the peak of his career to care for our mother following her diagnosis. He displayed the same loving care, compassion and dedication to her as he had shown us throughout our lives. Humble and private, he preferred to lead by example, instilling in us his values of hard work, integrity, compassion, dedication and service to others. He lived a full life and we take comfort that he is now reunited with his beloved Virgilee, receiving the deserved heavenly praise ‘well done my good and faithful servant.’ The family is grateful for the outpouring of prayers, thoughts and expressions of condolence.” “Ollie Waddell is a role model for how to live one’s life,” said Joseph Broderick, MD, Research Director of UCNI. “His commitment to helping others in the community and his family was more important to him than any specific job or title, although he was a man of great accomplishments in business. He was also a man deeply in love with his wife through good and tough times.” “He was a great role model and a giving soul,” added Maria Melanson, MD, Director of the Waddell Center. “I cannot think of a better person to have our center named after.” “The biggest reward is how close we’ve become. I don’t look at it as a chore. She needs help. She would do the same for me.” –Oliver Waddell * Mr. Waddell, a graduate of Duke University, University of Kentucky College of Law and Stonier Graduate School of Banking, joined First National Bank of Cincinnati in 1957. His name would eventually become synonymous with First National and later Star Banc Corporation, now US Bank. Mr. Waddell was elected President and Chief Executive Officer in January 1980 and later served as Chairman and CEO of Star Banc Corporation. “We have been very fortunate. I’ve always said this. We have met people who hate their jobs. The percentage of people working who hate their jobs is beyond my comprehension. And I never felt that way a day I worked in the bank. I really enjoyed it. I never played politics, and the moves up just came.” –Oliver Waddell In May 1993 Mr. Waddell stepped down three years shy of his mandatory retirement to answer a new calling. “I tried to get her to accept outside help, but she just refused to have anybody in the house. She’s pretty independent in that respect. There was gradual deterioration as time went on. I became quite concerned about it. I’d sit down at the bank and then worry about her being by herself. So I decided to take early retirement and stay home with her, which I did.” –Oliver Waddell “One of my favorite memories is of Ollie and Virgilee making the trip to Miami University to be with Team Waddell during the National MS Society’s annual bike ride,” said Dr. Tew. “They visited with the Team Waddell cyclists, stayed overnight, and had breakfast with us. It was a significant effort on their part, and it was typical of the Waddells’ grace in saying ‘thank you.’ Susan and I loved Ollie Waddell, and we will miss him greatly.” “We had a boxer names Blitz. I’d take him for a walk. He had a choker collar. When we took him for a walk, he’d go like crazy. I was tall and skinny. And I probably looked crazy running down the street trying to hold onto him. She [Virgilee] drove by in her father’s car and she was laughing at me. When I got home I said to my mother, ‘That Casey girl was laughing at me walking the dog. For two cents I said I’d call her up and tell her what I think of her.’ My mother said, ‘Why don’t you?’ So I took the challenge and I called her . . . Sexiest-sounding voice on the phone I’d ever heard. And I asked her for
Back in the Game: Tom Tomsick, MD, Produces a Baseball Memoir
Thomas Tomsick, MD, in his office. Behind him, a 1966 photograph, taken by Rocky Colavito, of young Tom with the Cleveland Indians’ pitching coach, inscribed, “Good luck to my Good Buddy Tom — Early Wynn.” Photo by Mayfield Communications / Cindy Starr. As the bullpen catcher for the Cleveland Indians from 1964 to 1966, Thomas Tomsick had a front-row seat to a historical accomplishment that was less than fully appreciated at the time. A college student with a perfect summer job, he watched the Indians build a pitching legacy, strikeout by strikeout, inning by inning, that would go unmatched until the 1990s. Dr. Tomsick, an interventional neuroradiologist with the University of Cincinnati Neuroscience Institute, argues in his new memoir, Strike Three! My Years in the ’Pen, that the Indians’ pitching staff was the top strikeout staff in the history of the American League. He writes that, “Just as Ruth, Maris, and Aaron maintain a revered position in baseball circles for their prior-day season and career home-run-hitting accomplishments, perhaps the Big Three [Sam McDowell, Sonny Siebert and Luis Tiant] should be regarded in a similar light” for their strikeout dominance. Dr. Tomsick will discuss and sign copies of his book ($18.95, Jarndyce & Jarndyce Press) at Joseph Beth Booksellers at 7 p.m. Monday, July 12. The memoir is newsworthy because the Indians haven’t enjoyed the historical status that their feat – accomplished prior to the era of performance-enhancing drugs — arguably deserves. “The Indians set strikeout records from 1964 to 1968,” noted Dr. Tomsick, a full professor since 1985, at his office in University Hospital. “When your staff does it 3-4-5 years in a row, it should be eye-catching. But it wasn’t. Yet those records stood for 30 years.” The Indians’ combined pitching staff logged a major league record of 1,189 strikeouts during the 1967 season, while averaging a stunning 7.2 strikeouts per 9 innings. The total strikeouts stood as an American League record until 1997. McDowell, Siebert and Tiant combined for other records – e.g., fewest hits over 9 innings by three starters on the same team — that still stand. The Indians didn’t accomplish their strikeout prowess in an elite media market, however, and their won-lost records during that period didn’t allow them to spend much time in the national spotlight. Had their hitting matched their pitching, Dr. Tomsick might have written a very different book. Strike Three!, crafted during an 18-month window of opportunity in which his research responsibilities abated and family matters took him almost weekly to Cleveland, is an earnest and periodically funny memoir that segues into his argument about the Indians’ place in pitching history. Dr. Tomsick’s decision to write the book also followed the admission by the Cincinnati Reds’ pitcher Bronson Arroyo that he had used performance-enhancing drugs from 1998 to 2002, providing Dr. Tomsick with an opportunity to shine a light on pitching feats accomplished prior to the steroid era. While most of the discussion of steroid use has centered on its effect on hitting, Dr. Tomsick writes that, “it remains possible, or even likely, that it had some, if not a similar, direct effect on pitching performance and statistics as well.” The book’s title, Strike Three!, alludes not only to the Indians’ pitching records, but also to Dr. Tomsick’s exit from baseball. That magical Cleveland staff was overseen by Early “Gus” Wynn, the legendary pitcher who took over coaching duties for the Indians in 1964 after notching his 300th victory, and then retiring as a player, in 1963. Wynn was a hard-nosed strategist with an eye for talent, and he had reason to believe that the wiry young Tomsick, who did a fair amount of throwing as a bullpen catcher, might, at 6-4 and 200 pounds, do some damage hurling a baseball from a 15-inch mound. Tomsick, on summer break after his first year of medical school, was considering chasing that dream via the minor leagues when, during a semipro game, he suffered a broken finger. Dr. Tomsick writes lovingly about the new catcher’s mitt, “the Popper,” that he purchased for $15 in 1964. “The Popper had exploded to the ‘bullets’ of Colavito and Davalillo during warm-ups,” he writes. “It had caught Hall of Famer Early Wynn during batting practice. The Popper had warmed up Luis Tiant after he joined the Indians in Yankee Stadium July 19, 1964, warmed up Sonny Siebert before his no-hitter in June, 1965, and warmed up to Sam McDowell’s heat before many of his best games, including consecutive one-hitters in 1966. It had warmed up Don McMahon, Gary Bell, Steve Hargan, Ted Abernathy, Stan Williams, Floyd Weaver, Bob Allen, Dick Radatz – names that will forever spell relief in Tribal lore. It warmed up the staff during record-setting strikeout years.” Writing the book was fun, said Dr. Tomsick, who still sports a rangy athleticism at 64. “I tried to recall some stories, things of value. It’s not an expose like Ball Four. I didn’t have comments and quips and quotes written down day after day. I had longer memories but fewer stories.” There are some laughers, as when the future professor is struggling under a wildly spinning popup and caught unawares as a fungo heads his way. The early chapters are rich with detail about bullpens and the toil of yesteryear’s bullpen catchers, whose job involved catching batting practice, warming up the starting pitcher and warming up relievers in the bullpen – without a mask – for $15 a day ($25 for doubleheaders). The book’s final chapters, filled with charts and statistics, offer good fodder for discussion for baseball fans and, especially, Cleveland Indians fans. “You can’t compare the status records of today to yesterday because a lot of what has been accomplished more recently has been accomplished in an era of steroids,” Dr. Tomsick said. “It’s only natural that players want to try to improve themselves, whether it’s through surgery on an elbow, like Tommy John, or something else. My focus isn’t that