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School of Medicine discoveries

25
2019

Why, yes, it is rocket surgery

The Class of 1979's Richard Williams (third from left), former chief health and medical officer for NASA, returned to the MCV Campus.

The Class of 1979’s Richard Williams (third from left), former chief health and medical officer for NASA, returned to the MCV Campus at the invitation of the newly formed Aerospace Medicine Student Interest Group.

Space travel grabbed the public’s attention in the 1960s, and it seemed every little boy wanted to be a NASA astronaut. But Richard S. Williams had a different dream. He aimed to be a pilot.

But though being diagnosed with below-standard eyesight for military pilots kept him from training when he was young, Williams eventually held an even rarer title: “There’s only one NASA chief health and medical officer in the world.” He was just the second person to hold the position, beginning in 2002 and bridging the end of the space shuttle program and the start of the International Space Station era.

A 1979 VCU School of Medicine alumnus, Williams recently returned to Richmond to speak to medical students in the newly formed Aerospace Medicine Student Interest Group about what it’s like to work in the aerospace field, including some of the unusual physical effects of space flight on the body. Astronauts have higher exposure to radiation than any other occupation, he said, and risks include cancer, cataracts, and acute radiation sickness.

During his time as chief health and medical officer, NASA optometry experts noticed increased farsightedness with optic nerve swelling that occurs only after returning from space. Known as Spaceflight Associated Neuro-Ocular Syndrome, or SANS, “It can possibly progress to blindness if not treated,” Williams says, and it affects male astronauts more often than female. “We think this is associated with high intracranial pressure, but the true cause has not yet been determined.”

Williams also was there when the Columbia Shuttle broke up during re-entry in February 2003, a “devastating tragedy,” he says.

“As a group, they understood the risk,” Williams says of the seven lost astronauts. And the other qualified astronauts on the ground — then, about 130 people — “They grieved, they understood.”

Williams, who grew up around the world as part of an Air Force family, graduated from the College of William & Mary. As an Explorer Scout in the early 1970s in Hampton, Virginia, he visited the MCV Campus’ Sanger Hall and recalls being fascinated by the anatomy lab and facilities. Then he saw the movie “M*A*S*H” about wartime surgeons and their hijinks, and he decided he wanted to be a physician.

Entering medical school in 1975 was a “very humbling experience for me,” Williams says. “I went from fairly accomplished to fairly mediocre.” But as he got his footing as a medical student, his experience improved. That drew him back to VCU, when he returned to get a master’s degree in public health in 1996. “The faculty here was just outstanding.”

Medical student Nilan Vaghjiani, who started the aerospace medicine interest group, grew up in California’s Antelope Valley, where Boeing, Lockheed Martin’s Skunk Works, NASA’s Dryden Flight Research Center and the Edwards Air Force Base have manufacturing plants and test facilities. He was thrilled when Williams was available to talk to him and his classmates about his experiences, and hopes that they’ll be able to schedule an astronaut to speak to the group sometime in the future.

“The feedback was great,” Vaghjiani says. “Some students really didn’t know that aerospace medicine was a field.” Now, though, he and a few other students are looking into a rotation in Houston that specializes in spaceflight medicine.

After finishing medical school 40 years ago, Williams completed a general surgery residency, working 120 hours per week. He served as a general surgeon and a flight surgeon in the U.S. Air Force, commanding a field hospital during the first Gulf War in 1990.

“That toughened me up,” says Williams of his war experience. “It prepared me to succeed everywhere I went.”

It also led to some unexpected opportunities. He spent time on network morning shows discussing the medical care of soldiers, and received fan mail and even a marriage proposal.

He joined NASA on detail from the U.S. Air Force as the director of the Office of Health Affairs, and was selected as NASA’s chief health and medical officer when he retired four years later.

After 15 years of studying and treating astronauts’ medical issues and advocating for health care for retired astronauts, Williams retired in 2017. He remains active as a senior aviation medical examiner for the Federal Aviation Administration and as director of the Three Rivers Health District for the Virginia Department of Health, a return to his interest in public health.

Working in eastern Virginia not far from the Langley Research Center in Hampton, Williams oversees health care for at-risk populations in the Three Rivers district. His staff of health care workers, he says, “reminds me a lot of NASA — very selfless.”

By Kate Andrews

25
2019

Vascular surgeon Chip Sternbergh, H’95, shares pioneering approaches at H. M. Lee Lecture

Vascular surgeon Chip Sternbergh, H'95, returned to the MCV Campus to present the Department of Surgery's annual H. M. Lee Memorial Lecture.

Vascular surgeon Chip Sternbergh, H’95, returned to the MCV Campus to present the Department of Surger’s annual H. M. Lee Memorial Lecture.

Being a successful physician requires a commitment to lifelong learning. That’s the firm conviction of vascular surgeon and housestaff alumnus W. Charles “Chip” Sternbergh III, M.D., H’95, who returned to the MCV Campus March 28 to present the Department of Surgery’s annual H. M. Lee Memorial Lecture.

Sternbergh believes continuing education is essential in all medical specialties, and particularly vascular surgery. “At least two-thirds of what I do now I never did in my training,” he says. “If I didn’t keep up my education, I’d be a dinosaur.”

Instead, he is professor and chief of vascular and endovascular surgery at Ochsner Medical Center in New Orleans. The invitation to guest lecture enabled him to contribute his own expertise to the education of tomorrow’s vascular surgeons in memory of Lee, under whom he trained for seven years during his general surgery residency.

“He was a master teacher, technician and surgeon — someone you’d like to emulate,” Sternbergh says. “And he really cared about the people he was helping to train.”

After Hyung Mo “H. M.” Lee’s death in 2013, his family, friends and colleagues made gifts in his memory to create the memorial lecture that bears his name. The focus of the annual lecture alternates between the Divisions of Transplant Surgery and Vascular Surgery.

Sternbergh credits his “superb” MCV Campus training with giving him the comfort and confidence to make sound clinical decisions while operating on critically ill patients.

Decision-making when treating vascular patients is rarely black and white, Sternbergh says, adding “Judgment plays a huge role.” About 80 percent of his patients don’t receive surgical intervention and, instead, are treated medically. His favorite pearl of wisdom for aspiring vascular surgeons? “You may make your living by operating, but you’ll make your reputation by not operating.”

Sternbergh is nationally recognized as an expert on vascular disease and is the author of more than 100 scientific publications and book chapters on the subject. He wrote the leading textbook on the endovascular treatment of abdominal and thoracic aortic aneurysms and is regarded as a pioneer in minimally invasive intervention for hepatic artery stenosis during liver transplantation, his topic for the H. M. Lee lecture.

Mark Levy, M.D., chair of the Division of Vascular Surgery, lauded Sternbergh’s lecture and how it engaged his audience. “I don’t know when I last saw so many questions at the end of Grand Rounds.”

The minimally invasive interventions to treat stenosis that Sternbergh spoke about in the lecture can be unforgiving and difficult, experts agree. Nevertheless, Sternbergh’s experience with the procedures has enabled him to develop a reliably safe algorithm so he can now remedy such stenosis with relatively low risk.

In 1996, Sternbergh joined Ochsner, home to the busiest liver transplant program in the country and where he has performed 150 interventions for hepatic artery stenosis — the largest amount at a single center in the world.

Vascular surgeon Clayton Brinster, M.D., has worked with Sternbergh at Ochsner since 2015 and calls him “one of the best mentors I’ve ever had.” In addition to helping Brinster refine his technical operating skills and leadership abilities, Sternbergh has provided him with “advice and countenance without judgment,” which can be challenging in a high-stress field, Brinster says. “He’s been a real asset to my personal development as a surgeon.”

By Beth Shamaiengar

25
2019

Mentors pay it forward

The Department of Internal Medicine celebrates the awarding of the inaugural Thames-Kontos Mentoring Award.

The Department of Internal Medicine celebrates the awarding of the inaugural Thames-Kontos Mentoring Award. L-R: Marc Thames, M’70; inaugural recipient Antonio Abbate, M.D., H’07; Hermes Kontos, M.D., H’62, PhD’67; and Todd Gehr, F’87, interim internal medicine chair.

“It was critical to my career development.” That’s how Marc D. Thames, M’70, describes the mentorship of Hermes A. Kontos, M.D., H’62, PhD’67 (PHIS), and its impact on his life and career. Thames calls his medical school years a magical time and says, “Dr. Kontos was the most impactful part of the magic. I always felt like I could talk to him about anything.”

Thames began working in Kontos’ cardiac research lab after completing his first year of medical school and the two quickly established a bond that continues today.

“I realized right away how lucky I was to have Hermes Kontos as a mentor. He never said ‘I don’t have the time.’ He shared my excitement for the science that served as the basis for the work we did together, and was always available to come to the lab when help was needed with the technical aspects of the experiments we performed.”

Kontos was just beginning his 41-year tenure on the MCV Campus when he and Thames first started to work together. He would go on to become medical school dean and later vice president for health sciences and CEO of VCU Health System. He always saw mentoring as part of his role.

“To establish a younger generation of academic physicians, you have to get them interested in science early on,” Kontos says. “Be there for them when they come to you with a problem or need career advice. It doesn’t take much time to suggest what you think is best for them.”

But it can be the critical difference in the career development of a young physician. What Thames received from Kontos inspired him in his own work with students, residents and fellows throughout his career at Temple University, Case Western Reserve University, VCU (based at McGuire Veterans Affairs Medical Center) and University of Iowa. Today his academic career and mentoring continue at Emory University in the School of Medicine’s Division of Cardiology.

“It became very clear to me that mentoring is such a critical part of career development for young people,” Thames says. “I’ve worked to pay it forward by being a good listener and trying to help young people to pursue a direction that excites them and makes them want to work hard.”

In honor of mentoring relationships and their power to change lives, and as a way for him to express his gratitude to the institution that was so critical to his own career development, Thames made a generous gift to the School of Medicine to establish the Thames-Kontos Mentoring Award. Housed in the Department of Internal Medicine, the award celebrates faculty who have had a significant impact on the lives of medical students, residents, fellows and junior faculty through exceptional mentorship or professional guidance. It also serves as annual recognition of the mentoring relationship between Thames and Kontos.

“Without his mentorship, my career would have taken a completely different path. He opened my mind to the possibilities of what could be done, and got me excited about an area that ultimately became the focus of my research career,” says Thames, referring to his research on the autonomic nervous system and how it regulates the heart and circulation.

Who was your mentor?
Do you have a memory of a favorite mentor from your time on the MCV Campus? Email us at MedAlum@vcu.edu and share your story.

Housestaff alumnus Antonio Abbate, M.D., Ph.D., the James C. Roberts, Esq. Professor in Cardiology, received the inaugural Thames-Kontos Mentoring Award on Feb. 8, 2019.

Kenneth A. Ellenbogen, M.D., Martha M. and Harold W. Kimmerling Professor of Cardiology, wrote one of Abbate’s multiple nomination letters. In his letter, Ellenbogen cited the outstanding guidance of his own mentor — Marc Thames.

In the 1980s, Kontos had recruited Thames back to Richmond, Virginia, to serve as professor of medicine and chief of the cardiology section at McGuire Veterans Affairs Medical Center. Then Thames recruited Ellenbogen from Duke University to lead the development of cardiac electrophysiology at the VA.

Now chair of VCU Health’s cardiology division, Ellenbogen wrote, “Dr. Thames created an enthusiasm for research and work that was contagious and an environment that was always inspiring and exciting … I have never been more stimulated to ask questions in my life. Marc taught me that the questions were what was important and the techniques and technology were just tools. He taught and inspired so many young cardiologists, many of whom went on to very successful careers in academic medicine.”

Ellenbogen says Abbate has created the same type of palpable enthusiasm and excitement among today’s junior faculty. “He is a gifted and highly productive clinician scientists who gives selflessly of his time and effort to support trainees and faculty in cardiology. It’s very fitting that he is the first recipient of this special award.”

Thanks to the Thames-Kontos Mentoring Award, the cycle of mentorship will be celebrated for many years to come.

By Polly Roberts

28
2019

‘Opening the door for students like me’

The Class of 2020's Shevani Sahai

The Class of 2020’s Shevani Sahai, assistant district representative for the American Academy of Pediatrics’ Section on Pediatric Trainees

While our understanding of what it means to be a doctor has shifted over the centuries, nearly all have placed on doctors the unique responsibility of self-regulation: of ensuring that the medical tradition lives up to the high standards that have always shaped its evolution.

Such a mission requires leaders. And within VCU’s School of Medicine, more and more students are answering that call.

Susan DiGiovanni, M’84, H’87, F’89, senior associate dean for medical education and student affairs, notes that increasing numbers of SOM students are looking beyond their local classrooms toward leadership roles in the broader community.

“Today we see more and more students who are interested in health care policy, interested in the national level, interested in what’s going on internationally,” she says. “Physicians should definitely have access to leadership skills, and we do encourage our students to take on these roles as students so they can develop them in an environment where they can be mentored.”

DiGiovanni says leadership positions can be a valuable part of medical training. “I get to work on making lasting impressions on the way we practice medicine,” says Shevani Sahai, an M3 student at VCU’s Inova Fairfax campus who serves as an assistant district representative for the American Academy of Pediatrics’ Section on Pediatric Trainees.

For Emily Lee, an M2 who was recently elected to the American College of Physicians Council of Student Members, the leadership opportunity offers a chance to help shape other students’ perspectives and experience of medicine.

“ACP has a lot of resources for students,” she says. “The challenge is how to reach those students.”

Given the rigors of the medical curriculum, taking on a leadership role as a student requires a deep-seated passion for medicine. That’s certainly the case for both Sahai and Lee.

Sahai made the decision to attend medical school in high school, when she was accepted by VCU’s Guaranteed Admission Program in medicine.

“At 17, I basically knew I was going to be a doctor,” she says. And when it came to choosing pediatrics as her specialty, “It’s basically been written on my forehead.”

The American Academy of Pediatrics quickly proved influential in her training. “I felt like I had found my people,” says Sahai of her introduction to the academy. Sahai jumped at the opportunity to become involved in the AAP’s Section on Pediatric Trainees and was appointed to the role of medical student delegate last year, a position in which she acted as a liaison between the AAP and VCU’s School of Medicine.

From there, she moved up to her current role of assistant district representative, connecting students at all medical schools in Kentucky, North and South Carolina, Tennessee, and Virginia with the Academy; next year, she will be promoted to district representative.

The Class of 2021's Emily Lee

The Class of 2021’s Emily Lee, who sits on the American College of Physicians Council of Student members

Lee was attracted to ACP’s role in the advocacy and reform of various policies, and the resources it offered. As a new medical student, she reflects, “I wanted to gain a broader perspective of medicine through better understanding the current policies at stake and how they can impact our careers and our patients in the future.”

The San Francisco native came to VCU via Wellesley College in the greater Boston area, where she developed an interest in medicine through laboratory research in pediatric hematology and oncology.

“I enjoyed not only learning about the science in a laboratory setting but actually understanding how the treatments can be applied to people and hopefully improve their lives,” she recalls.

On the MCV Campus, her interest in the ACP was encouraged through her membership in the Internal Medicine Student Interest group and faculty sponsor Steven Bishop, M.D., H’13.

VCU M.D.-Ph.D. student Chelsea Cockburn, who is serving as chair of ACP’s 13-member Council of Student Members, also helped spark Lee’s involvement in the group. While Lee is just getting started in her new leadership role, Sahai is already forging ahead with brainstorming what she describes as “innovative ways to change the way that we practice pediatrics.

“It’s so easy to think that as a medical student, I can’t cause people to change the way they practice medicine,” she said. But that, she points out, isn’t true. As an example, she cites one project by the AAP Section on Pediatric Trainees that works with police departments to provide free gun locks to families who have indicated to a doctor that they own guns.

Both Sahai and Lee hope to use their leadership roles to get more students involved in the profession, whether by taking advantage of opportunities to publish and engage in broader dialogues within the medical community or by harnessing the talents and time of students on particular issues at the national level.
At the end of the day, Sahai says, it’s all about “opening the door for more students like me.”

By Sarah Vogelsong

28
2019

Alumnus turns making coffee into life-saving surgeries

The Class of 2015's Larry Istrail founded Pheo Coffee, where freshly ground coffee beans delivered to your door can directly fund someone's health care.

The Class of 2015’s Larry Istrail founded Pheo Coffee, where freshly ground coffee beans delivered to your door can directly fund someone’s health care. As author and cardiologist Eric Topol said on Twitter, “When coffee is good for other people’s health.”

The Class of 2015’s Larry Istrail has never lacked for curiosity. So during medical school when he discovered his attending also made a hobby out of roasting coffee beans, Istrail did what he often does: ask plenty of questions.

Pawan Suri, M.D., happily shared the process he had learned from a former colleague known for his sublime coffee. Two things stuck with Istrail: freshly roasted coffee is unparalleled in taste and doctors really, really love their coffee.

Now a hospitalist at Inova Fairfax Hospital in Northern Virginia, Istrail combined his passion for coffee and medicine to tackle another goal: funding medical care in developing countries. In 2018, he launched Pheo Coffee with the mission of using one of the most consumed beverages in the world to raise money for those who lack access to basic medical care due to cost.

Even as Istrail continues to pay off student loan debt, he has chosen to donate a portion of Pheo Coffee’s proceeds to Watsi, a nonprofit that uses 100 percent of its donations to crowd-fund medical and surgical treatments around the world.

The endeavor has earned Istrail praise in the Washington Post, The Washingtonian and Daily Coffee News, among others.

“We’re all physicians and artists,” says Suri, associate professor and emergency medicine-internal medicine residency program director. “We’re interested in humanity. That’s what inspires physicians to grow coffee, write or paint. I’ve always encouraged stimulating the right brain and it looks like Larry is one of those people who got a spark by it.”

Istrail shared with us more about that spark, Pheo Coffee and how his time on the MCV Campus influenced both.

First, tell us about the name. How did you come up with Pheo Coffee?
It started as a silly idea. I was on endocrine consults and we were seeing a patient with a pheochromocytoma. It is a rare condition in which your body releases far more adrenaline than is necessary, so it was memorable on its own. A ‘Pheo’ is a shorthand name of this condition and I remember walking out of the room thinking, “she looked like she had too many cups of coffee!” I mentioned it to my medical friends and they all loved the name.

How did your time in medical school play a role in Pheo Coffee’s creation?
My experience at VCU played a large part in the development of the business. I thought back to my time at VCU as a med student, when I was lucky enough to have Dr. Pawan Suri as my attending for a week. He was probably the most interesting, kind and inspiring attending I’ve ever had. So knowledgeable about so many topics, one of which is roasting coffee. He is the person who got me into the idea of buying unroasted coffee beans and roasting them yourself. I experimented with it briefly in medical school, but couldn’t get the taste right. But this new experience with the patient with Pheo inspired me to look into it again. I ordered more raw coffee beans and started roasting them in an iron skillet, and that is how Pheo Coffee started. Fortunately I have since outsourced the roasting to a local, professional roaster and the coffee is exponentially more delicious.

What are your fondest memories from medical school?
My favorite memories at VCU all revolved around the incredible classmates I had. Every day I was inspired by their work ethic and genuine, good-hearted nature. We were all in a four-year battle together to come out the other end as doctors, a time that was incredibly difficult but ultimately so rewarding. Most of the best friends I’ve made in my life came from VCU, and I’m really thankful for that.

Why is it important to you to make time for this business when you are already a busy physician helping others on a daily basis?
I LOVE start-ups. I also love medicine, but they stimulate different parts of your brain. Medicine is about hard work, analytical thinking and drawing from a vast knowledge base to treat one individual or a small group of individuals. At the same time, I really yearn for a more creative outlet toward achieving long-term goals. Start-ups offer the opportunity to be creative and develop things other people would want to use, with the hopes of helping a much larger group of people. The idea of starting a company with a medical angle is really the best of both worlds for me.

What inspired you to donate part of your profits to fund surgeries in developing countries?
I wanted to start a for-profit company that can help people in a tangible way. Ultimately, I believe creating a sustainable health care fund by tapping into the 400 million cups of coffee consumed per day in the U.S. is an innovative, elegant solution to helping the roughly one billion people around the world who lack basic funds to pay for life-saving surgeries.

Each order comes with a card introducing buyers to the person their coffee purchase has helped. What are some of the success stories of surgeries funded through Pheo Coffee?
All kinds of people from a 3-year-old from Tanzania in need of an orthopaedic surgery to a tooth extraction in Malawi to an Ugangan high schooler in need of a hernia repair. Probably the most memorable, though, was a teenager from Burma who was born with Tetralogy of Fallot, a congenital cardiac disease that can only be repaired with surgery. It is a classic cardiac disease we learn about in medical school, and I was surprised to see she had made it to her teenage years without a surgical repair. When I learned that she had gotten her cardiac surgery, in part due to Pheo Coffee sales, I was pretty emotional. Seeing a photo of her after the surgery with a huge smile on her face is all the motivation I need to keep going with this unorthodox endeavor.

By Polly Roberts

28
2019

M2 Shivam Gulhar went blind for two weeks. Then he found his calling.

In February, the Class of 2021's Shivam Gulhar will present findings from his stroke patient research at Johns Hopkins Hospital.

In February, the Class of 2021’s Shivam Gulhar will present findings from his stroke patient research at Johns Hopkins Hospital at the Association of Academic Physiatrists annual conference in Puerto Rico.

In high school, the Class of 2021’s Shivam Gulhar dreamed of becoming a computer engineer and changing the world through technology. But plans shifted his junior year when a misdiagnosed cornea ulcer left him blind for two weeks.

Suddenly, Gulhar found another calling, inspired by the care of an ophthalmologist he met at Johns Hopkins Hospital.

“He was my first exposure to how a doctor could really help a patient,” Gulhar says. “I was extremely upset — if my scar had been a centimeter down, I would have needed a transplant — but he quickly put me at ease. The care he provided saved me from permanent blindness and made me realize the importance of medicine.”

The Maryland native went on to shadow his ophthalmologist several times before coming to Virginia Commonwealth University as an undergraduate biology major with aspirations for a medical career. In 2017, he was accepted to the VCU School of Medicine.

His decision to study on the MCV Campus was reinforced when he learned he’d been awarded the Sarah Snyder Laughon Medical Scholarship.

The scholarship had been established upon Laughon’s passing, when she bequeathed a generous gift to the School of Medicine for scholarship support to deserving medical students. Her daughter, S. Katherine Laughon Grantz, is a 2000 graduate of the School of Medicine.

“While I worked hard to realize my dreams, I did not entirely understand the price that it would cost me,” Gulhar says. “Now that I have begun medical school, the financial burden is astonishing. But just as I was shown how medicine is the path for me earlier on in my life, I felt that earning a scholarship was nothing short of a sign that I truly deserved to be here and that medicine was my calling.”

Last summer, Gulhar returned to Johns Hopkins for a research rotation in the hospital’s Motion Analysis Lab at the Kennedy Krieger Institute. Through the Rehabilitation Research Experience for Medical Students, provided by the Association of Academic Physiatrists, he researched gait patterns of stroke patients and healthy adults with the ultimate goal of finding the best way to teach stroke patients how to improve their walking.

While on a treadmill, patients walked wearing oxygen masks and electrodes attached to nine different leg muscles, sending data to a computer to create a patient model. “Then we can develop a model that mimics stroke patients, giving physical therapists tools to target the most affected muscles during therapy and providing patients with the best treatment possible,” Gulhar says.

In February, he will present the lab’s findings at the Association of Academic Physiatrists annual conference in Puerto Rico.

“With the increasingly competitive nature of the residency match, being able to present his research at a national conference will distinguish Shivam from other applicants regardless of his eventual specialty choice,” says Christopher Woleben, M’97, H’01, associate dean for student affairs.

1838 Scholarship Campaign
The School of Medicine’s 1838 Campaign aims to increase the number and size of scholarships to students. Full- and half-tuition scholarships are most urgently needed and serve as one of the medical school’s best resources for recruiting and rewarding top students. Learn more about how you can help a medical student escape debt.

Originally drawn to ophthalmology, Gulhar says the summer research experience — suggested to him by his sister, a medical student at Howard University who had worked with stroke patients — opened his eyes to other specialties where patient interaction plays a prominent role.

Luckily, thanks to the Sarah Snyder Laughon Scholarship that pays a portion of his tuition and fees, he has the freedom to let his interests (and not his student loans) decide his ultimate path in medicine.

“Debt can cause students to choose fields for monetary reasons,” Gulhar says. “I’m glad I don’t have that constraint. This scholarship allows me to choose what I want to do.”

By Polly Roberts

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