Lisa Newport Helps People Get Stronger With Aquatic Exercise
Lisa Newport, UC Health aquatics instructor, at the Daniel Drake Center for Post-Acute Care. Photo by Michelle Cordy. Lisa Newport has been an aquatic specialist at Daniel Drake Center for Post-Acute Care for nearly 20 years. She is certified with the Aquatic Exercise Association, and she teaches water exercise classes and does personal training. Many of her classes are specialized for people with arthritis, stroke rehab and other neurologic conditions treated by the multispecialty teams within the University of Cincinnati Neuroscience Institute. She understands the limitations from these neurologic conditions so that patients exercise appropriately during a workout. How did you get started as an aquatics specialist? “There has always been some connection for me with the water. I grew up in Twin Lakes, Ohio, and spent my summers at the lake. I started lifeguarding when I was 16, and I used to teach swim lessons in high school and college. I received my bachelor of science in therapeutic recreation from Kent State University. I have worked with many different populations, including people with physical handicaps. I really like working in rehab. I think you could say I found my niche in life.” What is your favorite part of the job? “I really love the patients—they become like family. There is a gentleman in his 90s who was in my very first arthritis exercise class 20 years ago. I told him that he can never quit. He laughs, but he keeps coming back. I also enjoy watching the progress in my stroke class. As they tone and get stronger, then they are able to walk better. One woman used to be a swimmer before her stroke in her 20s. She’s the most positive person you’d ever meet. She’s now starting to swim without a brace. We videotape her swimming so she can see the difference in how she’s progressed. Seeing that progress is wonderful. My patients are very dear to my heart.” Can anybody take an aquatics class? “Yes, there are general exercise classes for the public with no membership requirement, so anybody can take a class. We also have classes adapted for people with health conditions, and people with conditions like arthritis, fibromyalgia, chronic pain, brain and spinal cord injury or stroke can participate in those classes. Anybody who can do the exercises independently is welcome in the class, or a friend or family member can get into the pool to help them with the exercises. If a person is not able to exercise independently, I will work with the person individually until they are strong enough to join a class.” What is the benefit of warm-water exercise? “Warm-water exercise provides joint protection during exercise. It increases circulation and respiration; strength and endurance; muscle tone; mobility and range of motion; balance, coordination, and head and trunk control; and spatial and sensory awareness. In addition, warm-water exercise can reduce pain and stress, promote relaxation, provide psychological benefits and improve body image.” What do you do in your spare time? “In the summer, I am an avid gardener, and I plant flowers and vegetables. I also love to kayak, and I take my kayak to the lake most weeks—I enjoy the peaceful scenery. In the winter, I enjoy knitting, crocheting and reading. The last book I read was by Ken Follett, but I also like historical books.” Contact Information: The UC Health Aquatics Center is located at Daniel Drake Center, 151 W. Galbraith Road in Hartwell. Look online for a class schedule, call 513-418-2727. — Audrey Ronis-Tobin
Absorbing a Difficult Diagnosis: Seeking Balance after Loss
In the fields of neuroscience, few diagnoses are easy for patients and families to absorb. Whether the diagnosis is achieved gradually, after many tests, or whether it arrives like a bolt out of the blue, as with a stroke or seizure, lives are usually altered forever. “I think as a neurologist 90 percent of time we’re talking to patients about a difficult diagnosis,” says Patricia Colapietro, MD, a neurologist at UC Health. “Almost always we are talking about diseases that have no cure, or that have limited or no treatment, or that can recur in an attack, or that can be terminal.” The result is that patients, families and clinicians at the University of Cincinnati Neuroscience Institute travel an intimate and challenging path together, from the moment when a new reality emerges through periods of acceptance and denial, hope and fear, and, finally, resolution and healing. Individual paths vary according to the suddenness of the diagnosis, the severity of the disease, and the personality of the patient. But some events appear immutable: delivering a difficult diagnosis is an art for the physician; absorbing the diagnosis and moving forward is a deeply personal rite of passage for the patient and his or her family. Delivering the news with normalcy At the UC Neuroscience Institute, a partnership of the UC College of Medicine and UC Health, specialists do their best to deliver a neurological or psychiatric diagnosis in a manner that best serves the needs of patient and family. When Dr. Colapietro acquires the results of a test or brain scan, she schedules an appointment with the family as soon as possible. She wants to deliver the news in person, and she wants to discuss the thought process and tests that led up to it. When she delivers the result, she wants to be sitting down, meeting the patient or family eye to eye. She wants this doctor’s visit, in spite of its potency, to proceed like all the previous visits. She wants to restate why she ordered the tests. She wants to show evidence – brain scans, blood work, or a positive lumbar puncture – and to explain what the evidence means. Following a cardiac arrest that has caused severe brain damage in a patient, John Quinlan, MD, often finds himself delivering sorrowful news to a group of family members. Honesty, kindness, plain language, sufficient time, and a private setting are important to him. “If the family is dealing with a tough diagnosis, you want to make sure you have the right amount of time and a good setting where you can discuss the situation,” says Dr. Quinlan, a neurologist and Medical Director of the UC Neuromuscular Center. “If you find you’re in a bad setting, you try to find a better one. When I’m communicating I try to do it very slowly, beginning with a topic sentence. If there has been brain damage, I say, ‘This looks to me like it’s a bad situation.’ I try to let them know that I wish I had better news. It’s really important not to move too fast. When you say, ‘I think we have a bad situation here,’ the person will need 10 seconds just to let that register. Then you can move on to a more clear description of what you think has happened. It may take the patient’s family member a half a minute or more to let that sink in. And then I move slowly and give them a chance to ask questions. If they don’t ask the next question, they have absorbed all they can handle at that time.” Dr. Colapietro, following the advice of a mentor, Dawn Kleindorfer, MD, a neurologist and Co-Director of the UC Comprehensive Stroke Center, follows her heart when delivering bad news. “You can’t be afraid to show vulnerability,” she says. “If you have to cry, you will cry. If the family asks you to pray, and it doesn’t go against your beliefs, then you pray with the family. If the family asks a question you don’t know how to answer, I tell them I don’t know. It’s OK to be honest and true during such a difficult time when we have the privilege of being in such an intimate relationship with our patient. We should not be afraid of being ourselves. We should be afraid of being superficial.” There is no right or wrong response to bad news. Doctors say they can never gauge how a patient or family will react. Individual responses, clinicians say, will reflect how people lead their lives and how they cope with stress. Some will remain calm, while others – perhaps most — will break down. Phases of grief: are they really true? When we think of the “phases of grief,” we are often referring to the Kübler-Ross model, a series of emotional stages expressed by the Swiss psychiatrist Elisabeth Kübler-Ross in her book, On Death and Dying. She defined the stages as denial, anger, bargaining, depression and acceptance. Scott Ries, MSW, LISW, Associate Professor of Psychiatry and Administrative Director of the UC Mood Disorders Center, notes that although the stages play out in that order for many people, research has not found them to be strictly true. “The stages aren’t the result of a study of thousands of patients,” he says. “Nevertheless, the initial stage of denial is often present. And you will see stages of anger and bargaining, but not necessarily in clear stages. Sometimes you see anger and bargaining in the same stage. And sometimes you see acceptance and a return to anger or denial.” Dr. Colapietro says she prepares herself to deal with patients and families who may be in any one of the phases of grief. “When you give someone a diagnosis, there is loss,” Dr. Colapietro says. “Your life won’t be exactly the same, and there will be a grief process associated with that. Someone might go through denial, or be angry at you, or try to bargain.” Dr. Colapietro
You WILL Feel Better after Endoscopic Pituitary Surgery: Just Give It Time
Members of the skull base team: From left, Drs. Mario Zuccarello, Norberto Andaluz, Lee Zimmer, and Jeffrey Keller at the recent Keller Lecture on endoscopic skull base surgery at the UC College of Medicine. Photo by Tonya Hines. If a surgeon removes a tumor from inside your head, you might logically expect to feel better right away. However, if the tumor rests on the pituitary gland and the surgeon removes it in a minimally invasive procedure through the nose, you might not feel better for several weeks. That is the conclusion of a recent study led by Lee Zimmer, MD, PhD, a skull base expert at the Brain Tumor Center at the University of Cincinnati Neuroscience Institute and Director of Rhinology and Anterior Skull Base Surgery at UC Health. “The facts about quality of life in the short term after pituitary surgery are important for doctors and patients to know,” Dr. Zimmer says. “They need to have realistic expectations. Patients will not feel better right away after endoscopic pituitary surgery. In fact, for a short time they may actually feel worse than they did before surgery. They may experience increased sinus congestion and a compromised sense of smell. “But within three months of their surgery, their symptoms are likely to have resolved,” Dr. Zimmer continues. “At three months patients are likely to feel better than they did before their surgery, and their quality of life is likely to have significantly improved. Patients can also expect to experience reduced feelings of sadness, frustration and fatigue while enjoying improvements in concentration and productivity.” Dr. Zimmer’s research, the first to explore short-term quality of life after endoscopic pituitary surgery, was published in the Journal of Neurological Surgery. His co-authors included Jeffrey Keller, PhD, and former resident John DePowell, MD, from UC’s Department of Neurosurgery. Skull base surgery, which involves the removal of lesions – typically pituitary or meningioma – from the lower part of the brain, traditionally was performed through an incision (craniotomy) in the skull. Today, about half of pituitary tumor surgeries are performed through the nose with endoscopes, long narrow tools that include a small camera and light. Surgery performed in this manner offers significant benefits to the patient, including shorter hospital stays and an absence of visible scarring. A national leader in skull base research Dr. Zimmer, who leads the UC Brain Tumor Center’s skull base team, is a national leader in skull base research. In addition to his recent study about quality of life following endoscopic pituitary surgery, he and his colleagues have contributed numerous articles to the evolving field of neuroanatomy, which shows surgeons which path through the skull base is safe and accessible and which landmarks cannot be crossed or touched. Surgeons must have a precise understanding of the complicated anatomy so as not to cause bleeding or harm to the patient. Two recent articles, published in World Neurosurgery, explore the difficulty in approaching tumors from a tiny hole in the nose, below the tumor, rather than from a craniotomy above the tumor. Approaching from above, surgeons enjoy a three-dimensional view of the brain’s surface and interior. Approaching with an endoscope from below, through a far smaller opening, surgeons are restricted further by the endoscope’s two-dimensional presentation. While viewing around hidden corners with angled lenses, surgeons must picture in their mind’s eye the entire region where they are operating, the path they are traveling, and what nerves or arteries are connected to, or lurking behind, the lesion. In the World Neurosurgery articles, Dr. Zimmer and his colleagues clarified and re-classified the endoscopic appearance of the internal carotid artery, a complex vessel characterized by multiple bends. Viewed in two dimensions, the artery’s segments can be difficult to distinguish from each other. The research performed by Dr. Zimmer and his colleagues will help fellow surgeons orient themselves safely when viewing the internal carotid artery in a two-dimensional endoscope. It is one more way that clinician researchers at the UC Brain Tumor Center are providing – and improving – advanced specialty care at UC Health. — Cindy Starr
Dr. Angela Stillwagon: Getting Patients Back on Their Feet with PM&R
Angela Stillwagon, DO, a physical medicine & rehabilitation physician, at the UC Medical Center. Photo by Cindy Starr. Helping patients recover function and quality of life after stroke, traumatic brain injury, or musculoskeletal or spinal cord injury is the prime objective of Angela Stillwagon, DO, a new member of the UC Neuroscience Institute’s Physical Medicine & Rehabilitation team. Dr. Stillwagon answers questions about her specialty and how she and her colleagues can help people whose injuries or chronic musculoskeletal conditions cannot be surgically healed. Q: Tell us about physical medicine and rehabilitation, which is often referred to as PM&R. A: PM&R is often called the “quality of life” profession because we focus on enhancing patient performance. Our goal is to reduce pain and restore functional ability and quality of life with a comprehensive program that is medical, social, emotional and vocational. Q: What types of patients do you see? A: We see a wide range of individuals who have conditions related to the brain, muscles, tendons, joints or bone. Some have suffered an injury or multiple injuries. We help patients who have experienced brain injury, spinal cord injury, low-back injury, stroke, amputation, arthritis, carpal tunnel or tarsal tunnel syndrome, and bladder or bowel dysfunction. Essentially, we treat any orthopedic problem that is not surgical. Many of these conditions are a result of car accidents, work-related accidents and accidents that occur during sports and recreational activities. We see many stroke survivors. And we also provide what we call “after care” to people who are being treated for cancer, multiple sclerosis, spina bifida, cerebral palsy and osteoporosis. The UC Cancer Institute and Waddell Center for Multiple Sclerosis regularly send us patients who experience musculoskeletal issues related to their illness. Q: What diagnostic services to you provide? A: When a patient comes to us, we do a thorough medical history and physical exam. We may order labs or scans. We may do an ultrasound evaluation of a joint or area of concern. We may conduct an EMG (electromyography exam) to evaluate a pinched nerve in the back or neck. We also evaluate people who have amputations. Q: What treatment options to you offer? A: All of our treatments are provided on an outpatient basis. We use some medications, and we work closely with physical therapists and occupational therapists. We order bracing and at-home equipment. We can provide botulinum toxin injections to patients who experience spasticity from spinal cord injury. We perform wheelchair evaluations and prosthesis evaluations. For some of our patients with chronic pain, we offer ultrasound-guided steroid injections. Q: Which specialists to you work with most frequently? A: We work with neurologists, neurosurgeons, urologists, rheumatologists, podiatrists and psychologists. We also work with therapists (speech, occupational and physical) and social workers. Q: How important is PM&R in a patient’s overall continuum of care? A: After suffering an injury, our patients typically go to inpatient rehabilitation at Drake Center. During that time, they recover, they feel safe, and they have significant support. But it’s a whole new world when they return home. As much as we try to prepare people for the transition, it can still be very challenging. We’re here to help the family as well as the patient learn about the progression of the disease or their recovery, or to help keep them at their baseline and maintain their quality of life. They have definitely had a diagnosis that changed their lives, and we want to help them live with their new changes and maximize their independence. Q: Do you provide education to families and caregivers? A: Absolutely. When people get home, they don’t always realize how much harder it will be. Sometimes there are cognitive issues after brain injury or stroke, and patients can be irritable. Caregivers can get tired. We try to educate families about the normal process of recovery. Q: Is the Ekso™ bionic exoskeleton part of the PM&R program at UC Health? A: Yes, at any given time, between one and five patients use the device at Drake Center. The wearable robot, or exoskeleton, enables people with lower-extremity paralysis or weakness to stand and walk during specially arranged sessions. Q: Are there other specialty clinics that you would like to mention? A: We offer our musculoskeletal clinic at Drake Center, and this spring we will be starting a multidisciplinary spinal cord injury clinic at Drake. For the first time, patients living with spinal cord injury will be able to have a complete annual exam in one visit. They will be able to see a doctor, urologist, physical therapist and case manager, one after the other on the same day in the same location. Q: How did you decide to become a PM&R physician? A: I had never heard of PM&R before I went to medical school. But when I learned about all the things they do, I was definitely attracted to this specialty. It is rewarding to help patients and their families adjust to impairments that are life-altering. It is very rewarding to help someone who is bedridden get up and start doing simple things that most of us take for granted.” — Cindy Starr
Memorial Gift Will Help ALS Clinic Serve Patients’ Complex Needs
Tim Brown with his late wife and soul mate, Linda Link Brown. Harry “Tim” Brown honored his wife and soul mate during her final years by stepping firmly into the role of primary caregiver. He installed chair lifts and wheelchair ramps, rearranged the house, administered medication and nutrition through a feeding tube, and treated his wife to one last memorable cruise. After Linda Link Brown passed away from amyotrophic lateral sclerosis (ALS) last fall at the age of 64, Tim honored her again with a generous $100,000 gift to the ALS Fund at the Neuromuscular Center at the University of Cincinnati Neuroscience Institute. The funds will be used to support the UC Health ALS Clinic and the social and therapeutic services that are vital to families who are coping with ALS, a progressive motor neuron disease for which there is no cure. As the disease progresses, patients lose muscle mass and mobility; eventually, they are no longer able to walk, talk or eat. Tim, who was Linda’s primary caregiver during the last six months of her life, knows well how cruel ALS can be. The disease ran in Linda’s family, with seven documented cases since 1936. Linda was relishing a life filled with family, friends, gardening and travel when she developed what was initially diagnosed as “trigger finger,” a painful complication in which a finger (or thumb) catches or locks when bent. The finger became progressively worse, and Linda’s condition was eventually correctly diagnosed as ALS. “We originally went to the Cleveland Clinic for a second opinion because we wanted to make sure,” Tim recalls. “But in the end the diagnosis was the same: You do have ALS.” For Linda, as for all patients with ALS, little could be done. The one FDA-approved medication for ALS, an antiglutamate drug called riluzole, was shown in clinical trials to prolong life expectancy for two to three months. Tim attended a support group session that featured a presentation by Robert Neel, MD, Director of the UC Health ALS Clinic, and he was struck by Dr. Neel’s “caring, pro-active manner.” Linda became one of Dr. Neel’s patients the very next day. Later, after Linda’s death, Tim and Dr. Neel spoke about how a significant gift could be used. “Going through the various phases of ALS takes time and effort,” Tim says. “You need something locally for people in your community, a place where they can get occupational help and appliances. But they already had that. I talked to Dr. Neel about his need to bring in someone as a coordinator, someone who could make sure patients are getting the treatment they need.” A clinic manager is needed to help families with scheduling and to help them coordinate their needs in between doctor visits, Dr. Neel says. “Currently we do not have anyone to do that, especially when families are looking for help with social services, pulmonary (breathing) issues, feeding tubes or wheelchairs. Who do you call when you need to see the pulmonary doctor and you can’t get in for 3 months? Who do you call when you need advocacy for a loved one’s disability? Who do you call when you need to know how to coordinate home services and get these arranged?” Dr. Neel also would like to have a part-time nutritionist on the ALS team; he would like financial support for the physical therapy evaluations that his patients desperately need; and, for the benefit of patients who can no longer speak, he would like the clinic to acquire its own speech generation device equipment with an eye-gaze tracking system so that the clinic’s speech therapist can work with patients and ensure that they truly understand how the device works. “We don’t want our patients to spend $5,000 on a device and not ever use it,” Dr. Neel says. The ALS Clinic also would benefit from having a psychologist, both Tim and Dr. Neel agree. “ALS does not involve a pleasant ending,” Tim says. “Not everybody ends up like Stephen Hawking. The pain that a family goes through watching this disease progress is horrible, and what the patient goes through is horrible … I think families with ALS would benefit from having access to a psychologist or psychiatrist – someone who could help bring the anxiety level down for the patient and help the family cope as the disease progresses. Right now they don’t have that. I was seeking that for my wife and couldn’t find it.” — Cindy Starr
Dr. Rhonna Shatz: Building a New Approach to Brain Health
Rhonna Shatz, DO, right, with Jennifer Molano, MD, both of the UC Memory Disorders Center, at a community event. Photo by Cindy Starr. Toolbox in hand, Rhonna Shatz, DO, has arrived as the new Medical Director and the Sandy and Bob Heimann Chair in Research and Education of Alzheimer’s Disease at the UC Memory Disorders Center. She brings no ordinary toolbox, and she will not be undertaking any ordinary construction project. Working from the ground up, she hopes to build a new approach to brain health for cognitive specialists, primary care providers and the citizens of Greater Cincinnati and Northern Kentucky. A new approach is needed, Dr. Shatz says, because cognitive decline is a complex, lifelong process. It is not hereditary in most people, and three or more decades may pass before a single symptom emerges. And while no single pill will address all types of dementia, individually tailored strategies may help vast numbers of people delay or avoid dementias, including Alzheimer’s disease. “We need to build a different infrastructure and model of how we approach brain health,” Dr. Shatz says. “We need to approach it in an entirely new way.” Dr. Shatz (rhymes with hats) comes to Cincinnati having built a comprehensive memory disorders center at Detroit’s Henry Ford Hospital, where she served as Director of Behavioral Neurology and the Clayton Alandt Chair. She was among the first in the nation to pilot the National Institutes of Health Toolbox, and she is implementing that protocol in one of her first initiatives at the UC Memory Disorders Center, a center of excellence at the University of Cincinnati Neuroscience Institute. The NIH Toolbox “The Toolbox is a cognitive test meant to elevate the way doctors evaluate cognition,” Dr. Shatz explains. “We want to pick up the very earliest changes, and the Toolbox is refined for very, very, early, non-memory-related changes – the things that happen before function is affected.” Cognition, like cancer, involves multiple pathologies. Although family history is important, it is not destiny. Cognition is also impacted by medical disorders such as high blood pressure, obesity and lack of exercise, as well as by psychological issues such as anxiety and depression. The most accurate way to evaluate whether a person’s cognition has changed, Dr. Shatz asserts, is to compare individuals to themselves from year to year. “If we can follow you and determine that a change occurred between Point A and Point C, we can take a look at what that change is,” she says. “Because a change doesn’t mean inevitable decline. It means something happened. So let’s find out what it is. Let’s intervene.” Laying the foundation During the next year Dr. Shatz will establish her clinic with the new model, establishing baseline cognitive profiles of her patients. She will begin to acquire information about how the model impacts families; she will work with the Greater Cincinnati Chapter of the Alzheimer’s Association to determine which interventions are working and which are not; and she will work to determine the Toolbox’s effectiveness in differentiating among the various types of dementias. Differentiation is vital in the emerging era of “precision medicine,” as doctors move away from one-size-fits-all treatments, which may help some patients but not all, and embrace therapies targeted to disease sub-types and specific genetic mutations. “There are many more pathologies in cognitive decline than we once realized,” Dr. Shatz explains. “Each pathology seems to add a little color to the profile, which makes a big difference. For example, if a pathology called TDP-43 is the cause of your memory loss, you are not going to be helped by any anti-amyloid medication.” Diagnosing the pathologies has proved problematic, Dr. Shatz says, in that what looks like Alzheimer’s isn’t always Alzheimer’s. “This may be why clinical trials have failed: because we include people who didn’t even have the disease.” Imaging research also will play a role in helping to determine which interventions work and which do not. For while games like Lumosity and Sudoku are challenging, fun and much publicized, Dr. Shatz says they have “not been proven” to prevent or delay dementia. Whether interventions involving music and drama can make a difference, Dr. Shatz hopes to find out through collaborations with UC’s College Conservatory of Music, Neurosensory Disorders Center specialists, and community outreach programs that others have already created. Prevention & primary care Dr. Shatz’s short-term focus will be on the education of primary care providers and prevention. “We want to incorporate brain health as an annual focus of primary care from the get-go, not after you’re having symptoms,” she says. She is implementing that mind-set today in clinics at the Memory Disorders Center and has assembled a team of healthcare providers eager to spread the word. With support from primary care physicians, the new infrastructure will help set the stage for clinical trials involving interventions aimed at preventing dementia, slowing progression and, in cases where dementia has taken hold, maximizing quality of life. A community-wide challenge Dr. Shatz expects to reach out to the Cincinnati community for ideas and support. “Many people need to be part of this, and they’re not all medical,” she says. “We tell people to exercise and everybody groans, but there are so many ways we could do this. We need help from our sociology colleagues, our marketing colleagues, about how to frame these messages in a way that is motivating.” Access is another hurdle. Studies have shown that the incidence of dementia has peaked and is falling among affluent, educated populations globally. But not everyone has received the message. “There are people who are clued in and have access,” Dr. Shatz says. “And there is a group of people who are very high risk and don’t have access.” Spreading the word through primary care physicians, health clinics and public symposia will be among Dr. Shatz’s most important first steps in building a robust Memory Disorders Center for the Greater Cincinnati-Northern Kentucky community. — Cindy Starr
Ohio Collaborative Seeks to Broaden Clinical Trial Access
Bob Kehm, a clinical trial participant, with his doctors, Norberto Andaluz, MD, left, and Richard Curry, MD, right, of the UC Brain Tumor Center. Photo by Cindy Starr. The day may soon arrive when all Ohio residents can gain access to a promising clinical trial within a short drive of their home. That is the hope behind the Ohio Clinical Trials Collaborative, which seeks to create a research medical corridor that makes new treatments accessible to all Ohioans. The 2-year-project, a state-funded initiative supported by Governor John Kasich, includes the University of Cincinnati, Case Western Reserve University, The Ohio State University, and Wright State University, as well as the Cleveland Clinic, Cincinnati Children’s Hospital Medical Center and other hospitals in the state. Neuroscience and neuro-oncology (brain cancer) are two early focal points. In a medical world churning with competing health systems, the Ohio Clinical Trials Collaborative arrives as a breath of fresh air: a scenario in which academic health centers are working together for the betterment of all patients. “We are breaking down barriers of competition, something that is almost unheard of in healthcare,” says Ronald Warnick, MD, Medical Director of the UC Brain Tumor Center and the John M. Tew, Jr., MD, Chair in Neurosurgical Oncology. “Institutions that normally compete with one another have agreed to work together to overcome those competitive hurdles so that we can truly optimize our patients’ care and outcomes.” “One of the Ohio Clinical Trials Collaborative’s short-term goals is to unite these centers in order to provide brain tumor trials for patients throughout the state of Ohio,” says Richard Curry, MD, a neuro-oncologist with the UC Brain Tumor Center. “In the area of brain tumor research, there is strength in numbers,” Dr. Warnick says. “The greater the number of patients in a clinical trial, the more valuable and accurate our data will be. And the more sites that offer these clinical trials, the greater the opportunity for our patients, who can gain access to new therapies without leaving their geographical area.” The State of Ohio is providing each participating center with a modest amount of funding for research assistance, nursing support and data collection, while corporations provide funding for the new treatments or therapies. The collaborative was founded by the Center for Clinical and Translational Science and Training at UC and the translational research centers at Case Western and Ohio State University. Additional research collaborators from the UC Neuroscience Institute include otolaryngologists Ravi Samy, MD, and Myles Pensak, MD, who are affiliated with the UC Neurosensory Disorders Center and the UC Brain Tumor Center. UC Neuroscience researchers who specialize in stroke and emergency medicine are also embraced by the collaborative through their membership in two national consortiums: the Neurological Emergencies Treatment Trials Network (NETT) and the Network for Excellence in Neuroscience Clinical Trials (Neuro NEXT). As the Ohio Clinical Trials Collaborative gains traction, it is focusing on neuroscience, oncology, primary care, pediatrics and a streamlined internal review board (IRB) system that allows for the one-size-fits-all design and approval of clinical trials for multiple participating centers. The collaborative is also working to create a centralized Protocol Review and Monitoring Committee, which reviews the scientific merits of proposed cancer trials before they are presented to the IRB. The stringent IRB process is required by federal law for the protection of patients who decide to enroll in studies of new treatments. “Our main purpose for the next two years is to see how successful this enterprise can be,” Dr. Curry says. “The oncology portion of the collaborative is at present limited to brain tumor clinical trials, including those in pediatric neuro-oncology. If we are successful in opening two to three new trials, the collaborative hopes to expand to include other cancers, such as breast and lung.” The collaborative’s oncology goals include boosting Ohio’s high-tech job market, as money for new clinical trials must come from outside the state. This win-win objective – developing new treatments and driving job growth – is illustrated by the collaborative’s first oncology study, a Phase II Trial of NovoTTF-lOOA with Bevacizumab (Avastin) in patients with recurrent glioblastoma. The study involves treating patients with 1) Avastin, a drug that inhibits the growth of new blood vessels; and 2) NovoTTF-lOOA tumor treating fields therapy, which involves the delivery of a low-intensity electric field with electrodes placed directly on the skin in the region surrounding the tumor. The electric field disrupts cell division and leads to subsequent cell death (apoptosis). Investigators at the recent Society for Neuro-Oncology meeting in Miami released promising initial results from a large randomized Phase 3 trial, which used the Novo TTF-100A tumor treating fields therapy in addition to temozolomide (chemotherapy) in patients newly diagnosed with glioblastoma. The trial was halted early because of its success in increasing the survival of study participants. Novocure, an international oncology company whose U.S. operations are based in Portsmouth, N.H., and New York, is sponsoring the new Avastin-NovoTTF-100A study, which is open at UC, Case Western and the Cleveland Clinic. The study expects to enroll about 40 patients. In the meantime, patients across Ohio are likely to gain greater access to clinical trials that typically are not widely available. “Often times, if people want to get into a brain tumor clinical trial, the reality is that they will have to drive or fly to another center for that opportunity,” Dr. Curry says. “With this initiative, patients won’t have to travel long distances to get something that is state-of-the-art. This collaborative takes that enormous time commitment out of the equation.” — Cindy Starr
2014: A Year for Transformation, Discovery & Thanks
The physicians, researchers, managers and associates of the University of Cincinnati Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health, extend a heartfelt “thank you” to all of our friends who supported our tripartite mission throughout 2014. With your help we continued to build upon our efforts to provide the best available treatments and family-centered care, to aggressively pursue new therapies and potential cures for neurological disease, and to educate future physicians and the public. During the past year we have touched the lives of thousands of individuals. Our work has been steadfastly supported by donors, sponsors, private foundations, volunteers and the leaders of our Community Advisory Councils, who together have contributed millions of dollars and hundreds of hours in support of our research and patient education programs. We are grateful for the millions of research dollars we have received from tax-supported institutions that include the National Institutes of Health (NIH), the Department of Defense and the UC College of Medicine. And we are indebted, above all, to our study participants, whose selfless role in clinical trials fuels our research and makes future discoveries possible. From this memorable year, here is a sampling of highlights: TRANSFORMATION and MILESTONES From left, members of the extended Gardner Family: Peggy Gardner Johns, Gary Johns, Lori Gardner Sommer, Laura Mueller, Adam Mueller, Keri Young and Eric Mueller. Photo by Jay Yocis / University of Cincinnati. The UC Neuroscience Institute celebrated its 15th anniversary on November 1 with a transformational, $14 million commitment from the James J. and Joan A. Gardner Family Foundation. Peggy Gardner Johns, the daughter of James and Joan Gardner, announced the gift before an audience of donors, physicians and researchers. The gift continued the Gardner Family’s philanthropic involvement with the UC Neuroscience Institute, where Joan Gardner has been treated for Parkinson’s disease. Mrs. Johns said the $14 million commitment would help provide the Institute with a new home that is “a vibrant space alive with comprehensive care, multi-disciplinary clinics, and the kind of animated brain-storming that leads to revolutionary new treatments.” Read more » Joseph Broderick, MD, Professor of Neurology and an internationally known stroke researcher, transitioned to Director of the UC Neuroscience Institute from his previous role as Research Director. John M. Tew, MD, Co-Founder and a leader of the Institute for 15 years, was tapped to lead the development of UC Health Integrative Medicine in the positions of Vice President of Community Affairs at UC Health and Executive Director of Community Affair at the UC College of Medicine. Dr. Tew also celebrated 45 years of service to UC’s Department of Neurosurgery. He was the only UC faculty member honored for that length of service CLINICAL CARE The UC Medical Center earned a “Get With The Guidelines–Stroke Gold-Plus Quality Achievement Award” for implementing specific quality improvement measures outlined by the American Heart Association/American Stroke Association for the treatment of stroke patients. The National Association of Epilepsy Centers named the UC Epilepsy Center a Level 4 Center, the highest level possible, for a 10th consecutive year. The UC Medical Center, led by the UC Brain Tumor Center team, continued to perform seven times more brain tumor surgeries than any other area hospital. The Institute’s Neuromuscular Program became a little more muscular as it joined nine other neuroscience specialties as an official Center of Excellence. The news was welcomed by patients and families affected by the spectrum of adult neuromuscular disorders, which include muscular dystrophy, myasthenia gravis, and acquired neuropathies, to name a few. The UC Health ALS Clinic was established at Daniel Drake Center for Post-Acute Care with a gift from the Barbara V. Peck and Justin Friedman Fund for research in ALS. The UC Mood Disorders Center opened new clinics: one for youth in transition to adulthood and one for people with especially challenging cases. We provided superlative tertiary and quaternary care to our patients, who often shared their stories with the public: • For Janis, Parkinson’s trial was a life-changer • For Brenna, recovery and a “thank you” following a rare type of stroke • For Jim, a hopeful continuum of care following spinal cord injury RESEARCH The Comprehensive Stroke Center continued to serve as a founding member of two elite NIH-funded clinical trial networks: StrokeNet and NeuroNext, while serving as the national coordinating center for StrokeNet, which directs all of the NIH-funded stroke trials in the United States. The UC Department of Neurology, an important component of the UC Neuroscience Institute, ranked 17th nationally during 2014 with $9,427,452 in research grants from the NIH. Neurologist Daniel Woo, MD, MS, above, Associate Director of Clinical Research for the UC Neuroscience Institute, ranked No. 9 among all principal investigators nationally with $6 million in NIH grants. The Waddell Center for Multiple Sclerosis enrolled more patients in an NIH clinical trial for progressive MS than any other U.S. center. Atsuo Sasaki, PhD, a researcher with the UC Brain Tumor Center, received two prestigious national awards to support his work on brain cancer: 1) a $1.67 million grant from NIH and a $50,000 grant from the American Brain Tumor Association. Yvonne Ulrich-Lai, PhD, with James Herman, PhD. Photo by UC Academic Health Center Communications Services. A $2 million gift from philanthropist George Wile helped us create a neuroscience research endowment, which helped launch the Neurobiology Research Center. “Our goal is to foster growth of basic and translational research across entire UC community,” said the center’s Director, James Herman, PhD. “We aim to develop partnerships between basic scientists and clinical scientists so that we can move molecular discoveries to animal models and then potential treatments, therapies and biomarkers.” Vince Martin, MD, Co-Medical Director of the UC Health Headache & Facial Pain Program, made international news as the lead author of a study that showed that women have an increased number of migraines around menopause. Kim Seroogy, PhD, Director of the Selma Schottenstein Harris Lab for Research in Parkinson’s, and Dr. Herman provided the first tangible demonstration that
A Young Adventurer Seeks Restoration, Rehabilitation and Hope
Jim Harris with his parents, Mary Pat Schoeny Harris and Jeff Harris, at the UC Medical Center several days after Jim underwent complex spinal surgery. There was always an element of risk. Jim Harris traveled in the adventure world as an accomplished writer and photographer, capturing an alternate universe of powder, mountains and electric blue skies for publications like National Geographic and Men’s Journal. It was a breathtaking and beautiful world, with stops in places like Mongolia, Bolivia and Antarctica. It was also a world of ice, isolation and bursts of weather. Jim, a native Cincinnatian who went west to college and settled in Utah, was living his adventure-life to the fullest when calamity struck on November 24. Jim and his colleagues were preparing for a month-long, 350-mile expedition across Patagonia in southern Chile, hoping to become the first Americans to successfully cross the polar ice cap. They had just spent a frustrating day in the town of Punta Arenas negotiating permits and other bureaucratic requirements for their trip, whose route traversed a long stretch of the border between Argentina and Chile. That evening, they decided to unwind by going out into a field and flying the wind kites that would soon be pulling them across the ice cap like sailors across the sea. It was spring in Chile, blustery. “The wind was howling all day, whipping the tree tops around,” Jim remembers. Jim was strapped into the kite harness, the wind lifting him up onto his toes, when a sudden gust lifted him three to four feet off the ground. “I was not able to control my acceleration,” he recalls. “Even so, I wasn’t totally terrified. It’s not unheard of to be lifted off the ground.” Jim was moving at a speed of 20 to 30 miles per hour when he crashed against the earth. “That’s the last thing I remember,” he says. I do remember being loaded into a Chilean ambulance out in the field. An hour to 2 hours had passed. The accident happened at 7 p.m., and I think it was about 9 when I got to the ambulance. I remember knowing at that point that I couldn’t move my legs. I remember being terrified but also really confused and just pretty much out of it.” At the regional hospital in Punta Arenas, doctors confirmed that Jim had suffered spinal and cranial injuries. He was paralyzed from the waist down. Over the next several days, Jim’s parents, Mary Pat Schoeny Harris and Jeff Harris of Cincinnati, became full-time advocates for their son. They explored Jim’s options, which included having him undergo surgery in Punta Arenas, having him transferred to a larger hospital in Santiago, or bringing him home. “It was a long plane ride,” reflects Jim’s father, Jeff. “The downside risk was the possibility of turbulence, which could have caused further injury to Jim’s spine.” Ultimately, the Harrises secured a medical evacuation that transported Jim 6,400 miles to the University of Cincinnati Medical Center, and the UC Neuroscience Institute, for surgery. The only patient on the flight, Jim was accompanied by a medical team as well as the flight team. His transportation costs, which were covered by rescue insurance, would exceed $200,000. Richard Curry, MD, a neuro-oncologist with the UC Neuroscience Institute and a friend of the Harris family, helped smooth Jim’s arrival at the emergency department, where Jordan Bonomo, MD, a neurocritical care specialist, oversaw his initial care. On November 28, Jim’s family met with Charles Kuntz, IV, MD, a neurosurgeon and Director of Spinal Trauma at the UC Neuroscience Institute. On December 1, his 33rd birthday, Jim underwent complex spine surgery led by Dr. Kuntz, and a week later he was moved to the Daniel Drake Center for Post-Acute Care. Jim, a graduate of St. Xavier High School, is receiving assistance from the Kairos Foundation, which helps families of St. Xavier alumni and faculty who face financial hardship because of prolonged disability. Since the accident, Jim has found himself in an unanticipated spotlight, as e-mails and letters expressing support and empathy have flooded in. “I have heard from strangers, people who have had injuries that were similar, or not similar, to mine,” Jim says. “I’ve heard from people who have experienced extensive trauma or life-altering processes. The number of people who have reached out to empathize has been astonishing.” His doctors have been supportive, he says, but have offered no guarantees that he will ever walk again. “I don’t know what to anticipate or how long my rehab will last or whether I will be a paraplegic forever or maybe I’ll regain the use of my legs. To hear success stories about people who have come back from injuries that are similar to mine — or even worse — is really inspiring and gives me hope that maybe I can recover. But nobody’s guaranteeing that by any stretch.” Smiling and speaking in an upbeat tone, without tears or anger, Jim radiates an attitude of stoic acceptance. It keeps the heartbreak in his room at bay, mostly, but does not eliminate it. “Maybe things are busy enough and I’m surrounded by people enough that I haven’t had the opportunity to feel that darker side,” Jim reflects. “But even in Chile, before I knew the full extent of my injuries, I had come to terms with it in some way. I guess it never felt abstract. It was like, I can’t believe this happened, but it did. And what do I do next? I haven’t had a lot of anger or denial. “I feel like my life plans, work plans, have gone out the window. Adventure has been the focus of my life since I graduated from college. But I feel I do have other interests and areas of expertise if it turns out that I don’t walk again. I still have work to do. This will probably push me in ways I would not have pushed myself if I had the ability to be
Conquering Depression Symposium Inspires Confidence
Carol Williams, news anchor at WCPO-TV, shown at left as a volunteer emcee at NAMI Walks and at right as the 2014 recipient of the UC Mood Disorders Center’s Award for Mental Health Advocacy. A community symposium organized by the UC Mood Disorders Center – Conquering Depression: Different Approaches for All Ages – packed the room November 15 at the Daniel Drake Center for Post-Acute Care. The guest speaker was Carol Williams, news anchor for WCPO-TV. She shared news stories that she has covered, and she talked about the difficulty of finding people willing to openly discuss mental illnesses because of the stigma surrounding these disorders. She observed that people are often afraid to speak openly about their issues because they fear they might lose their job or their friends. Then she discussed her own experiences. She talked about how she personally dealt with anxiety early in her career, and about how she helped friends and loved ones who were affected by depression and Tourette’s syndrome. She noted how important it was for her to learn from others who had shared experiences. She also noted that, for her, focusing on helping other people instead of focusing on her own goals was helpful. For her years as an outspoken champion of mental health issues, Caleb Adler, MD, and Melissa DelBello, MD, MS, Co-Directors of the Mood Disorders Center, presented Ms. Williams with the Center’s Award for Mental Health Advocacy. “Through her work, she has made a major and contributing impact on understanding mental illness and combating stigma in the tri-state area. Today, we honor Carol for her achievements,” Dr. Adler said. Topics at the conference included depression at different points in the life cycle – from depression in children, to post-partum depression, to depression as we age – as well as discussions of medications, using mindfulness to address symptoms of depression, and approaches to treating depression without medications: • Treating Depression without Medication – By Debra Schroeck, MS, PA-C • Parting with Post-Partum Depression – By Jyoti Sachdeva, MD • Depression – The “Mindful” Way Out – By Richard Sears, PsyD, MBA • When Your Child Has Depression – By Jeffrey R. Strawn, MD, FAPA • Medication 101 – By Erik Nelson, MD • Depression as We Age – By Muhammad Aslam, MD To view slides from the symposium, click here >> – Audrey Ronis-Tobin