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School of Medicine discoveries

20
2015

Alumnus and faculty member Mark Hom teams up with cycling legend to spotlight the science of fitness

Mark Hom, H’92

His interest in physical fitness led Mark Hom, H’92, to write a book that focuses on the crucial role mitochondria play in exercise, disease prevention and nutrition. Here he’s pictured breaking away on a Richmond Area Bicycling Association club ride. Photo by Allan Cooper

As he approached his 50th birthday, Mark Hom, H’92, made a pact with his wife that they would try to stay in great shape as they got older. They both took up cycling and, after struggling to pedal only a few miles when they first began, they now log thousands of miles on their bikes each year. His interest in physical fitness, and in cycling specifically, led him to write a book on the subject. “The Science of Fitness: Power, Performance and Endurance” focuses on the crucial role mitochondria play in exercise, disease prevention and nutrition.

In a recent article in the Richmond Times-Dispatch by Louis Llovio, Hom described how mitochondria – the power plants of our cells – convert food and body fat into the energy we need to exercise. Mitochondria multiply in response to intense exercise and diminish from lack of activity. Because their role in fitness and health is so central, it’s important to take care of your mitochondria to ensure top physical performance and to prevent the diseases of the modern age such as type 2 diabetes, obesity and metabolic syndrome.

“My analogy is that since mitochondria are inside your body and inside your cells, it is up to you to be a good shepherd to your mitochondrial flock by feeding them, making them strong and protecting them.” That translates into supplying them with good nutrition and exercising with intensity, while avoiding toxins that might weaken them.

“The Science of Fitness: Power, Performance and Endurance” can be found online at Amazon.com. The book is also available in Richmond at Barnes and Noble’s Libbie and Short Pump locations.

When he began writing the book, Hom, an assistant professor of radiology at the School of Medicine, started thinking about examples to demonstrate the importance of mitochondria’s role in fitness. As a cyclist, his thoughts quickly turned to one of the sport’s legends: Greg LeMond. LeMond. The two-time World Champion and three-time Tour de France winner obviously had superior mitochondria to power those wins but also suffered a near-fatal hunting accident in 1987 that knocked him out of cycling at the peak of his career.

After he recovered from his wounds, LeMond rebuilt his fitness to win again, but later suffered from muscle weakness and a lack of endurance. A muscle biopsy revealed the hallmark ragged red fibers of mitochondrial myopathy.

Mark Hom, H’92

Mark Hom, H’92

Hom, familiar with LeMond’s story, says this diagnosis was a seminal event in mitochondrial disease awareness. The lead shotgun pellets from the accident leaked toxins into LeMond’s body, damaging his mitochondria and prolonging his recovery time. Diagnosed with mitochondrial myopathy, LeMond was forced to retire from bike racing in 1994 when he still should have been in his prime years.

Because LeMond’s story presents such a poignant example of the connection between mitochondria and fitness, Hom decided on a whim to send an early draft of his book to the famous cyclist.

To his surprise, LeMond responded with a long email and agreed to co-author the book. LeMond, who always sought coaches knowledgeable in physiology, says that physical training needs a more scientific approach as described in this book, something that trendy fitness books tend to lack. He has also gained a deeper understanding of how mitochondria shaped the high and lows of his cycling career.

Hom hopes that his book can be a guide for others looking to get in shape and understand the science behind fitness.

“My book is meant to help anyone at any age or fitness level to be as energetic and healthy as possible. We have different chapters on exercise, nutrition, maintaining muscle mass, slowing the aging process, and staying mentally sharp. Getting older is difficult enough. You don’t want to get old and have diseases too, especially diseases that can be largely prevented with exercise. For younger readers it explains why exercise should begin at an early age, in this era of childhood obesity.”

For his part, Hom plans to continue tending his mitochondrial flock on long, intense bike rides with his wife.

By Jack Carmichael

20
2015

Alumnus Patrick Stover, Ph.D. named president of the American Society for Nutrition

Patrick Stover

Patrick Stover, PhD’90 (BIOC)

The American Society for Nutrition has elected Patrick Stover, PhD’90 (BIOC), president of the national organization that seeks to bring to together top researchers, clinicians and industry leaders to advance the understanding and application of nutrition. He plans to use his term as president to increase engagement between the diverse institutions that study nutrition by promoting collaboration between chemists, physicians, economists, politicians and others who make up the field.

Stover, professor and director of the Division of Nutritional Sciences at Cornell University, said in an article for ASN’s newsletter that he will rely on his experience engaging students and academic departments as he seeks to create greater cohesiveness across the diverse field of nutrition. “Individuals, especially academics, have lots of choices these days, and one of the questions is how do you create loyalty – that is, establish real, firm connections between your organization and your membership.”

He has identified five initiatives that he hopes will increase ASN’s value to its members and foster a sense of belonging in the organization. He hopes to strengthen ASN’s connections with academic departments, develop a system of graduate student organizations around the world, expand ASN’s global visibility and authority, assure that ASN programming meets the diverse needs of its members and develop a new strategic plan for the organization.

These goals make clear just how expansive the field of nutrition is, as well as how important ASN’s role is in promoting collaboration and communication among its members. “We need to reach out to all members of the society and think about how we’re going to position ourselves as the leading authority in nutrition and the go-to academic home for nutrition research,” Stover said.

He wants the organization to move away from expressing its own, sometimes divisive, opinions and ideas, as was the case in the past when nutritional information was often based on opinion rather than evidence-based science. Rather, he sees ASN’s role as a “trusted and neutral broker” that promotes the exchange of ideas between members.

“People who want blue bananas can argue for blue bananas and people who want yellow bananas can argue for yellow bananas. We just look at the merits of those arguments and identify what we need to move forward to solve those problems.”

By promoting inclusiveness and collaboration, Stover aims to make the organization a home for everyone during his time as ASN’s president and welcomes faculty, practitioners and students with an interest in nutrition to engage with the organization and attend its scientific meetings.

By Jack Carmichael

26
2015

Students organize Richmond’s first Camp Cardiac for high school students interested in medicine

Ameya Chumble watches Ryan Melchior demonstrate surgical knots

Camp organizer Ameya Chumble watches cardiology fellow Ryan Melchior, M.D., leads students through the surgical knots workshop.

When Ameya Chumble was in high school in Martinsville, Va., summertime educational opportunities were slim to none. Especially in specialized areas such as medicine.

Now he’s a rising second-year student at the VCU School of Medicine. During his first year on VCU’s MCV Campus, he learned about Camp Cardiac, a national day-camp for high school students interested in learning about medical careers. He jumped at the chance to establish a Richmond site of the program.

With the help of medical school faculty members – all volunteers – Chumble and a team of 14 medical students created an impressive schedule of presentations and activities. From obtaining CPR certification and learning suturing techniques, to hearing case studies and observing a live surgery, the high school students spent an action-packed week on campus.

Most of the 25 campers came from high schools in and around the Richmond metro area. One exception was a Seattle, Wash., student who attended the camp while her family visited the area during an extended vacation.

To apply, campers submitted a 300-word essay outlining their interest in attending, what they hoped to learn from the experience and why they were interested in the health care field. Scholarships were available to help cover the cost and meals were provided at no charge by the national Camp Cardiac organization.

“Since this was our inaugural year, we didn’t know what to expect of the campers,” Chumble says. “We ended up with a highly motivated and impressive group of individuals. Our students were flying through materials and tasks people usually don’t see until their first year of medical school. It was amazing.”

Camp Cardiac Staff acting as patients

Camp Cardiac Staff acted as patients so the campers could get a taste of what it’s like to take a patient’s medical history.

Established in Chicago in 2010 by cardiac surgeon Richard Lee, M.D., and three medical students, Camp Cardiac introduces high school students ages 15 and older to the real world of medicine. It focuses on both classroom teaching and hands-on experiences. It also serves as a springboard for students to develop self-awareness of a heart healthy lifestyle.

The importance of healthy living became all too clear during a presentation by Jordana Kron, M.D., associate professor of cardiology and program director of the Clinical Cardiac Electrophysiology Fellowship. Kron and her patient, Mel Shaffer, provided a living example to illustrate the students’ weeklong coursework.

“I remember hearing patient stories when I was in school,” Kron says. “To hear something from a patient’s point of view means so much more.”

Shaffer told his first-hand account of how chest pains at the gym turned into sudden cardiac death: a disruption of his heart’s electrical system resulted in a potentially deadly malfunction. The unexpected condition can sometimes be successfully treated with CPR or defibrillation as it was in Shaffer’s case. He was shocked 11 times after being brought to the emergency room.

Kron presented Shaffer’s electrocardiogram history to the students and asked them to interpret the readout. After hearing his story, they peppered him with questions about his pacemaker and stents as well as his lifestyle changes.

“The students were very attentive and asked a lot of great questions,” Shaffer says. “They were very responsive, which showed they were not only listening attentively, but were comprehending complicated concepts. They had an obvious interest in a career in medicine based on their response and participation.”

Amit Varma shows students artificial heart technology

Campers get an up-close look at the technology that powers artificial hearts with cardiology fellow Amit Varma, M’06, H’12.

Kron will definitely volunteer to be a part of next year’s Camp Cardiac.

“I hope I’m asked to do it again,” she says. “The week’s itinerary was outstanding and it was a great success.”

Chumble and his team started planning the camp nearly nine months in advance.

“Finding professors took time, but they were very gracious,” he says. “We couldn’t have done it without the Departments of Anatomy and Neurobiology, Cardiology and Cardiothoracic Surgery. Their interest and support was overwhelming.”

The 2015 Camp Cardiac was so successful, the MCV Campus now is eligible to host its sister camp, Camp Neuro.

Chumble hopes to serve in an advisory capacity for next year’s camps, but most of the program’s leadership and coordination will be passed onto interested students in the Class of 2019 so that Chumble and his teammates can concentrate on their studies. In early 2016, they’ll take Step 1 of the USMLE national boards and then will move into clinical rotations and the chance to work with more patients like Shaffer.

“This year’s event was a lot of fun. I couldn’t have thought of a better way to spend a week out of my summer.”

By Nan Johnson

19
2015

Resident and student take top honors in skills competition at vascular surgery conference

Dan NewtonIn addition to participating in the surgical skills competition, third-year general surgery resident Dan Newton, M’12, presented original research: Contemporary Outcomes of Isolated Iliac Artery Aneurysm Repair.

Dozens of medical students and surgical residents faced off in a skills competition at the 2015 Vascular Annual Meeting. Organized by the Society for Vascular Surgery, the meeting was held June 17-20 in Chicago.

The clinical skills competition drew 40 residents and 48 fourth-year medical students. Dan Newton, M’12, and student Grayson Pitcher had known about the opportunity beforehand, but had not known what it would entail.

While there was no way to specifically prepare, “the vascular surgery rotation at the VA Medical Center gave my technical skills a huge boost,” said Newton, a third-year general surgery resident. “Out there we primarily work with Dr. Michael Amendola, who has been an incredible teacher and mentor, and really sparked my interest in vascular surgery.”

“Our residents get extreme exposure,” noted Amendola, M’02, H’07, F’’09, pointing out that the McGuire Veterans Administration Medical Center has the fifth busiest vascular surgery schedule in the nationwide VA system.

Newton was one of three residents to receive perfect scores on five timed stations that tested different skills like suturing, suture identification and knot tying without putting any stress on the item being tied.

Newton plans to apply for a vascular surgery fellowship this year. “The field has a great mix of big open cases and minimally invasive endovascular procedures,” he said. “It is also based heavily in physics and geometry, so it just sort of clicks for me.”

Grayson Pitcher during the skills competitionRising fourth-year student Grayson Pitcher during the skills competition at the 2015 Vascular Annual Meeting.

Rising fourth-year student Pitcher also was awarded a perfect score along with two other student participants. The fourth-year medical student competition’s tasks included a two-minute station at which they had to tie knots to the tab of a lightly weighted soda can without moving the can from a designated circle. Another event involved closing a 3 cm slit on a plastic tube.

Dr. Rahul Anand does a phenomenal job with the M3 surgical clerkship,” Pitcher said. “Because of him and the rest of the surgical faculty, I believe every third-year student at VCU has an advanced set of surgical skills and knowledge after their clerkship.”

For Pitcher, though, the event was less about the competition and more about the ability to network with vascular surgeons who were assigned to judge each station. He met faculty from across the country and was able to learn more about vascular surgery programs at a number of medical schools. That knowledge will be useful when he applies to vascular surgery residencies this fall.

Pitcher grew up with a balance of art, music and sports in his life. As a result, “I love anything creative, and it reflects in my personality in that I am very patient and obsessive compulsive about projects and detail. I always thought surgery would be a great fit. I loved how intricate and meticulous the vascular procedures were.”

He, too, credits the mentorship of assistant professor Amendola for his success. “My experience inside and outside the operating room with him has been an instrumental reason for choosing vascular surgery.”

Amendola, in turn, points to his experiences when he was a trainee with Richmond vascular surgeon Ronald K. Davis, M’63, H’69, and his MCV-trained practice partners. Amendola emulates the examples they set and prioritizes his role as a mentor, knowing it’s one of the most influential factors when students choose a specialty.

“The real reward in academic medicine is influencing the surgeons of tomorrow,” he said. “Dan and Grayson are going to be fantastic vascular surgeons.”

16
2015

Doctoral candidate Wafa Tarazi wins award for captivating research presentation

Wafa Tarazi, MHPA

Doctoral candidate Wafa Tarazi, MHPA, in the Department of Healthcare Policy and Research

For healthcare policy researchers like Wafa Tarazi, MHPA, explaining the results of their studies to people from different fields can often be a significant challenge. When your audience can’t understand small things, like certain terms or concepts, they’re liable to miss the overarching significance or impact of a study altogether.

To address this obstacle, AcademyHealth, a health services research and policy organization, sponsors an annual competition that challenges students to successfully explain a research paper in layman’s terms.

This year, Tarazi, a doctoral candidate in the Department of Healthcare Policy and Research, and three other students presented on Austin Frakt’s “Plan–Provider Integration, Premiums, and Quality in the Medicare Advantage Market.” The article discusses how integration between Medicare plans and healthcare providers relates to plans’ premiums and quality ratings. Each student had about seven minutes to present and had to act as if the audience had no expertise in health care.

Tarazi chose to construct a narrative as a way of expressing the article’s complex material.

“I used my grandma as the main character of the story, and showed pictures of seniors, a hospital, a health insurance company, and the Affordable Care Act to demonstrate the interactions between them. In addition, I talked slowly in a way that would make the audience easily imagine the story of my grandma and realize how policy changes could affect her health insurance plan.”

Tarazi’s approach worked, as both the panel of judges and the audience picked her as the winner of the competition. They highlighted her use of personal connection and vivid imagery as being particularly effective.

Although she appeared to breeze through the competition, Tarazi initially struggled to find the right tone for her presentation. After writing an abstract and being accepted into the competition, she took a few weeks to digest the article and produce a presentation. She then gave a practice presentation to faculty members Bassam Dahman, MS’07, PhD’09 (BIOS), Tiffany Green, PhD, and Lindsay Sabik, PhD.

“They didn’t like the first version of the slides. Although they liked the content and how I presented the important issues in the study, they thought the clipart and animations I used in the slides were distracting. To be honest, I wasn’t happy with the feedback at first, but as I thought about it more carefully I saw what I needed to change. I prepared my second version of the slides in two days and had a unique opportunity to present them at a meeting of the Advanced Richmond Toastmasters club. I proudly took my slides to the competition at AcademyHealth.”

The feedback from her third presentation, of course, was all positive. Tarazi says she felt an enormous sense of pride seeing a group of her professors and colleagues in the audience clapping for her after winning the competition.

Tarazi says she learned a lot about presenting complex subjects in easy-to-understand language. She will need to call on her newfound skills soon, as she works to complete her dissertation on breast cancer screening and disparities in care before her expected graduation in 2016.

By Jack Carmichael

02
2015

Piece of the past

Piece of the PastThe young doctor stares in disbelief at his patient. How could this be? No blood, no torn flesh, no bullet wound.

This is, after all, 1942 North Africa. World War II wages all around. But this latest patient shows no sign of trauma. He is, however, suffering from chronic tonsillitis and needs surgery. With no medical equipment readily available to handle a procedure unrelated to combat, the resourceful surgeon fabricates a tonsil snare out of an aluminum propeller from a downed French airplane.

“Necessity is the mother of invention,” said Jodi Koste, university archivist and head of Tompkins-McCaw Library’s Special Collections and Archives. “It certainly shows the ingenuity of the surgeons during that time.”

The tonsil snare is one of about 6,500 pieces in the library’s Medical Artifacts Collection. When J. Warren Montague, M.D., H’41, donated the piece in 1982, he told Koste the story of how he created it while serving in North Africa during World War II. When faced with the unanticipated tonsillectomy, he and an Air Force sergeant improvised. They carved the finger pieces from the aluminum propeller, while the other parts were made from a drill rod, part of a typewriter and a bicycle spoke.

Montague used the snare to remove the tonsils of about 300 U.S. servicemen throughout the course of the war in both Africa and southern France.

“This is how many medical instruments were developed,” Koste said. “Surgeons would work with a bioengineer to develop a piece that would help them become more proficient. It still happens today based on need or to make a procedure simpler and less invasive.”

Few, however, are fabricated on the spot by a quickwitted surgeon like Montague. Koste said only about one percent of the school’s collection was fabricated, the rest manufactured.

“It is not unusual for medical schools to have a collection of medical artifacts,” she said. “And there are larger ones out there. But we are proud of our collection here because of the stories it can tell about the unusual.”

By Janet Showalter