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School of Medicine discoveries

25
2015

How a career in emergency medicine introduced the Class of 2007’s Laura Diegelmann to helicopters and kangaroos

Laura Diegelmann sitting in a plane

Early in her career, emergency medicine physician Laura Diegelmann, M’07, spent a year in Australia with the Royal Flying Doctors.

Laura Diegelmann, M’07, was mesmerized by the stories her father used to share around the dinner table.

She was a teenager then, but remembers vividly the detailed accounts of life and death he gave while volunteering with the local rescue squad. She knew then that what she was hearing would shape the rest of her life.

“I think it was the excitement that drew me in,” she said. “I wanted to be a part of that.”

When she turned 16, Diegelmann signed up as a volunteer EMT with the rescue squad near her Richmond-area home. Her father, Robert Diegelmann, Ph.D. — a longtime faculty member in the Department of Biochemistry and Molecular Biology &mdashl was often the driver, and the two headed out on calls together.

“It was amazing,” she said. “That sealed the deal for me.”

Her experience as an EMT confirmed her desire to work in emergency medicine. After earning a bachelor’s degree in chemistry from VCU in 2002, she worked for a year on the MCV Campus as a tech in the emergency room. She entered medical school the following year.

During her third year, she completed an internal medicine rotation in Alaska. While there, her supervising physician introduced her to the crew of Guardian Flight. Diegelmann flew a few times with them to remote areas of the state providing emergency care to those in need. The adventure exposed her to a whole new world.

Laura Diegelmann sitting in a plane

While in Cape Town, South Africa, to teach ultrasound to emergency medicine residents, Diegelmann also had the chance to share the technology with local school children.

“It combined all the ambulance stuff I love – and then you get to throw an airplane into the mix,” she said. “Who could ask for more?”

Diegelmann completed her emergency medicine residency at the University of Maryland, then packed her bags for Australia, where she spent a year with the Royal Flying Doctors.

“Living somewhere I’d never been before was exciting in itself,” she said. “But then I’m putting on a flight suit and rappelling out of helicopters to treat patients. Wow!”

Many of her missions involved transferring patients from small clinics in the Outback to larger hospitals. She also responded to traumas at farms or to other medical emergencies, such as a heart attack or stroke. Many times, the places she flew to were so remote that she didn’t see a house for miles. She and her team often landed next to open fields.

“Sometimes we would have to circle around to scare the kangaroos from the airstrip,” she said.

While she loved the adventure, one year away from her parents and four siblings was enough. She returned to the states and completed a fellowship in emergency medicine ultrasound at the University of Maryland.

Laura Diegelmann with a leopard

In her travels overseas, Diegelmann has visited gorillas in Rwanda and this leopard in South Africa.

In 2013, the travel bug hit again. This time, she ventured to Cape Town, South Africa, to teach emergency ultrasound at a local hospital. She also was involved with an ongoing study that continues to examine whether the early intervention of ultrasound in severely septic patients makes a difference in treatment plans.

“I really formed an attachment to South Africa,” Diegelmann said. “You really feel appreciated there. Patients there can travel all day just to see a doctor. They are there because they truly need help — they truly need you. It makes me realize why I became a doctor in the first place. To help people.”

After South Africa, Diegelmann headed to Rwanda and has been back a second time teaching emergency ultrasound at the main hospital there. She leaves at the end of August for Liberia, where she will spend a month teaching emergency ultrasound to the residents at JFK Hospital.

All the while she remains on faculty and as an emergency room physician at the University of Maryland.

“I really start to miss home when I am gone,” Diegelmann said. “Every time I go, I say this will be my last one. But it’s hard to walk away from. It’s so rewarding. I’m not only expanding my own knowledge and experience, but I know I’m making a difference. I think that’s why most of us go into medicine in the first place. We want to do our part.”

By Janet Showalter

04
2015

Class of 1979’s Rebecca Bigoney returns to campus to talk medical ethics with incoming first-year students

Rebecca Bigoney, M79Rebecca Bigoney, M’79

When students first arrive at medical school, they expect to dive right into the hard science that will form the basis of their medical knowledge. This year, Rebecca Bigoney, M’79, got the chance to show incoming first-year students another side of medicine that is equally important, yet often overlooked by students early in their medical education. This fall she returned to the MCV Campus to talk about medical ethics and the puzzling dilemmas the members of the Class of 2019 will assuredly encounter at some point in their careers.

Bigoney has confronted a wide variety situations involving medical ethics over the course of her career, which includes 18 years in private practice and a term as vice president of medical affairs at Mary Washington Hospital in Fredericksburg, Va., where she now works as chief medical officer.

She shared some of her experiences with students as a guest speaker for the “Patient, Physician, and Society” curriculum. Her talk illustrated the complex situations that doctors can encounter at what Bigoney called “the intersection of ethics, liability, policy and reality.”

She told the stories of a patient who declined kidney surgery because a travelling preacher told her she had been cured, factory workers exposed to dangerous heavy metals with no protections from their company and a wife who tried to interfere with her husband’s treatment because of the race of his doctor.

These types of situations, Bigoney explained, require doctors to weigh medical, ethical and procedural decisions to arrive at acceptable, though often imperfect, conclusions.

For many of the assembled students these were new situations and questions they hadn’t previously considered. Students asked frequent questions throughout Bigoney’s presentation, wanting to clarify the decisions she’d made to resolve certain situations. At a student’s prompting, she walked the class through her logic in a hypothetical mass casualty situation — which patients would receive priority, how limited hospital resources might be divided up and how legal liability factors into such decisions.

Bigoney made sure to remind the students that “the ethical problems you face most likely will not be catastrophic or dramatic like the ones I’ve described, but you’ll encounter ethical challenges every day.”

Mark Ryan, M’00, an assistant professor in the Department of Family Medicine, was also on hand to help facilitate the presentation. He praised Bigoney for showing students that “being a good doctor is more than knowing biochemistry or physiology — it is about learning to work with people, and the often complicated and difficult situations in which they find themselves.”

Even after the presentation was over, students lined up to ask her questions one-on-one. Although they may be years from having their own patients and making ethical decisions on their own, the Class of 2019 showed Bigoney that they intend to fully explore these complex questions so that they too can make the right ethical decisions when the time comes.

By Jack Carmichael

01
2015

Medical student Lex Tee one of 30 nationwide to be selected for AAFP leadership program

Alexandra “Lex” Tee

The Class of 2018’s Alexandra “Lex” Tee

The Class of 2018’s Alexandra “Lex” Tee is part of the inaugural class of the American Academy of Family Physicians Foundation’s Family Medicine Leads Emerging Leader Institute. She was one of 30 students selected for the program, which is designed to give leadership opportunities to family medicine-minded medical students and residents who demonstrate leadership potential.

As an M2, Tee is still exploring what the different fields of medicine have to offer and is eager for any experience or mentorship she can get along the way. “I decided to apply because I would get to attend AAFP’s national conference and work with a mentor and a project of my choice. I always enjoy learning from physicians and older students and residents, and this opportunity seemed like the perfect environment for growing and learning.”

The Institute offers three tracks that participants can choose from: Policy and Public Health Leadership, Personal and Practice Leadership and Philanthropic and Mission-Driven Leadership.

Tee is pursuing personal and practice leadership and hopes she will learn how to handle increased levels of responsibility as she continues her education and career. Both the national conference in Kansas City, Mo., and the institute offer exceptional opportunities for her to network and continue learning about the field.

“I think it will be helpful for me because I am so early in my medical training and this track emphasizes remaining effective and focused as I transition to greater levels of responsibility, autonomy, power and expectations. I hope the program will foster my commitment to lifelong learning and teach me more about growing and excelling in the practice of family medicine.”

Group photo of inaugural class of the AAFP’s Emerging Leader Institute

As part of the inaugural class of the AAFP’s Emerging Leader Institute, the Class of 2018’s Alexandra “Lex” Tee traveled to Kansas City, Mo., to develop her leadership skills and learn more about family medicine. (She’s on the far left, middle row)

As she looks for mentors who can counsel her through choosing a specialty and applying to residency, she is quick to acknowledge the people who have guided her thus far. Lex completed her undergraduate work at the University of California, Berkeley, where she studied public health. Her favorite professor also worked as a physician, and he encouraged her to pursue medicine, so she began shadowing physicians in the San Francisco community.

The more she learned about family medicine, the more she liked it.

“My interest in family medicine grew because the physicians that I shadowed worked in schools and in areas of the community that they cared deeply about, and they were willing to give me some valuable mentorship.” Now on the MCV Campus, she’s part of the fmSTAT program that nurtures students in their pursuit of a family medicine career. Tee lists the relationship she has developed with her fmSTAT mentor, Phil Sherrod, M’74, H’77, as one of the highlights of medical school.

By Jack Carmichael

31
2015

“You don’t have to leave the United States to find a need.”

Kelli McFarling

This summer, the Class of 2018’s Kelli McFarling (second from right) traveled to both Honduras and Wise County, Virginia, to help provide health care to the underserved. She was struck by the similarities shared by the patients she met.

The Class of 2018’s Kelli McFarling knew the need for medical care was great in Honduras. But she had no idea how overwhelmed she would feel trying to do her part.

“I know any little dent we can make is a good thing,” said the rising second-year medical student. “But it’s frustrating to see how much needs to be done.”

Kelli was one of about 32 students from the VCU School of Medicine to participate this summer in HOMBRE (Humanitarian Outreach Medical Brigade Relief Effort). Started in 2006, this medical mission trip, organized by first-year students under guidance of faculty from the schools of medicine and pharmacy, takes place the summer before their second year. What began with mission trips just to Honduras has grown over the years to include four sites – Honduras – Norte; the Dominican Republic; Peru; and Honduras – Pinares.

“I learned so much about disease from both a pathological and population health perspective,” Kelli said. “It definitely makes me want to be a doctor even more.”

A few weeks after returning from Honduras, Kelli hit the road again, but this time she remained in the United States. As a member of the RAM (Remote Area Medical) team, she traveled to Wise County with 11 other medical students in July to a temporary clinic that provides free medical, dental and eye care to more than 2,500 patients from 16 states.

Did you know?

HOMBRE was first organized as the Honduras Outreach Medical Brigada Relief Effort when students and faculty were traveling only to Honduras. As HOMBRE grew to include more sites, the name changed last year to reflect that growth. HOMBRE is now known as the Humanitarian Outreach Medical Brigade Relief Effort.

“It was an incredible experience to go to both places and see what it was like to be in a third-world country, and then come right back here to Virginia and see the similarities,” Kelli said. “You don’t have to leave the United States to find a need.”

This marked RAM’s eleventh year at Wise. The 12 medical students were among 1,000 volunteers on this year’s RAM team that included physicians, nurses, dentists, pharmacists, podiatrists, respiratory therapists, lab technicians and radiologists.

“Our patients here don’t have access to medical care because the area is so rural,” said Kevin J. Lee, M’09, who led VCU’s RAM team this year. “In addition to not having health care facilities, many can’t afford health insurance, or the insurance they can afford has huge deductibles.”

The three-day clinic is an invaluable experience for students, Lee said, because it takes them outside their comfort zones.

Kevin J. Lee

Kevin J. Lee, M’09, has volunteered with Remote Area Medical in Wise County, Virginia, for five years. This summer he led VCU’s RAM team.

“They are seeing things they may not necessarily be exposed to otherwise,” he said. “For example, in school they generally listen to normal heart and lung sounds, or somewhat well managed chronic problems. Here, they tend to hear far more unusual murmurs or lung sounds, as well as complex medical conditions stemming from longstanding untreated chronic medical problems and a significant lack of resources.”

At this year’s clinic, many patients waited in line all day to see a doctor. When they first entered the triage area, they were seen by volunteer nurses. The general medical team then met with them, with third- and fourth-year medical students conducting interviews and evaluations under the supervision of attending physicians. From there, they were either set up with a treatment plan or directed to other specialties.

“I was all over the place,” Kelli said. “I helped with pelvic exams, I helped remove skin lesions and even assisted with tooth extractions. That’s what makes RAM so special – the interprofessional care. It was amazing as a student to have this kind of experience.”

HOMBRE provides interprofessional care as well, with medical, pharmacy and physical therapy students working alongside faculty from VCU’s Medical College of Virginia Campus to treat the medically underserved. This summer, for example, the Dominican Republic team treated about 900 patients over a 10-day period.

“We empower the students to be the primary care providers,” said Mark Ryan, M’00, a site leader for the Dominican Republic team and assistant professor for the Department of Family Medicine and Population Health. “We are asking a lot, but they answer to it. We have a lot of confidence in them.”

A working medical student

Twelve VCU medical students were among 1,000 volunteers on this year’s RAM team. Physicians, nurses, dentists, pharmacists, podiatrists, respiratory therapists, lab technicians and radiologists provided care to more than 2,500 patients from 16 states.

Students worked in pairs. A medical student might have been paired with a pharmacy student, for example, so they could experience team-based care. They conducted patient interviews, performed exams and presented their findings to faculty. They worked as a team to formulate a treatment plan. This approach allows student teams to independently evaluate patients, while ensuring necessary supervision and teaching takes place.

“They are not only providing meaningful service, but come out of it with significant professional growth,” said Ryan, medical director of the Hayes E. Willis Health Center. “They are seeing such a wide range of cases, which really builds their confidence.”

Whether the students are volunteering with RAM or HOMBRE, the cases they see can be quite similar. Patients are often suffering from hypertension, diabetes, high cholesterol, depression, chronic back issues, arthritis and tooth decay. In Wise, where long-term tobacco use is common, many patients also suffer from respiratory issues and even cancer.

“The similarities were shocking,” Kelli said. “In Honduras, I became appreciative of the aspects of health related to infrastructure. Lack of clean drinking water, working plumbing and health literacy were all major factors negatively impacting patients’ health. Lasting impacts in Honduras require more than just a few day’s work. In rural Virginia, the basic infrastructure was in place, but access to health care is limited by costs and distance.”

In both locations, patients return year after year, often seeking out the same doctor or student they saw the year before.

“This summer, a man I see every year came up and gave me a big hug,” said Lee, who has been traveling to Wise for five years. “He had this smile on his face as he told me he had found a job and would have health insurance. He was so proud.

“The best part was he was there this year to sign up as a RAM volunteer. After all those years of being the one in need, he was back to serve. That was so incredible to hear and very emotional for me. What a testament to how much the people in the community feel we are making a difference.”

By Janet Showalter

31
2015

Medical Student Zachary Maas one of 8 chosen for research training program at Case Western

Zachary MaasAs an intern with the Heart, Lung and Blood Summer Research Program at Case Western Reserve University, medical student Zachary Maas had the chance to present his findings in a poster presentation this summer.

As a child growing up in the foster care system, the Class of 2018’s Zachary Maas never imagined he could one day become a doctor.

But that’s the path he is now taking.

“Growing up, I received medical care at free clinics,” he said. “I certainly didn’t have the pedigree to become a doctor, but this is something I really want. I’m working hard to make it happen.”

Zachary is a rising second-year student at the VCU School of Medicine. He was one of eight medical students from across the country to participate this summer in the Heart, Lung and Blood Summer Research Program at Case Western Reserve University in Cleveland. The eight-week program is designed to engage students in state-of-the art biomedical research in cardiovascular, pulmonary, hematological and sleep disorders research.

Zachary’ research delved into the role of HIF, a transcription factor involved in establishing the oxygen supply of growing or injured tissue. This is critical, Zachary said, to the understanding of chronic vascular disease, bone marrow therapies, and tumor resistance to chemotherapy. He presented his research in the form of a poster to the Case campus on July 31.

“Zach did extremely well,” said Diana Ramirez-Bergeron, Ph.D., Zachary‘s mentor and an assistant professor in the Department of Medicine and the Case Cardiovascular Research Institute. “A lot of students come in to get the experience, a letter of recommendation and then move on. That’s not Zach. He’s incredibly dedicated.”

Zachary spent early mornings and late evenings in the lab, fascinated with the research side of medicine.

Zachary Maas“A lot of students come in to get the experience, a letter of recommendation and then move on,” said Diana Ramirez-Bergeron, Ph.D., Zachary’s mentor at Case Western. “That’s not Zach. He’s incredibly dedicated.”

“A lot of people have an interest in helping the underserved, and my interest in research sort of stems from that,” Zachary said. “I see research as a way to fight for better outcomes in groups of patients who could really use our help. I’ve always admired people who look at medicine that way. It takes so much dedication because research can take so long to even make a dent.”

As a pre-teen, Zachary doubted his ability to achieve success in life. He was taken out of his Mountain View, California home at age 8 and placed in foster care. He bounced from foster home to foster home for years. But when was 11, he found solid ground with his second-grade teacher, who opened her home to him.

“My life was going nowhere,” he said. “It had been constant turmoil. But after I moved in with her, my grades improved and things got much, much better.”

The summer after high school graduation, a friend told him about a documentary following physicians’ careers at Johns Hopkins. Zachary watched it and was amazed.

“I thought if I could be like anyone in this life, it would be like those doctors,” he said. “Their dedication and the impact they were making was incredible. I made it my mission to be that good.”

He signed up for the toughest classes he could find at the University of Southern California and graduated with degrees in biology and economics. He also served as co-captain of his school’s dragon boat team.

“Beginning at USC, I felt like I didn’t even deserve to be there,” Zachary said. “But I decided to focus on just getting better. And I think I carry a lot of that same mentality with me, even here in medical school.”

On VCU’s Medical College of Virginia Campus, he calls himself fortunate to be surrounded by physicians who encourage and challenge him every day.

“Every day I’m looking for them,” he said. “I’ve been lucky to find several amazing doctors here to look up to. I love that feeling of finding people who embody what I want to emulate, and I have that here. I’m learning what it means and what it takes to be a great doctor. I have found what I want to be.”

After his experience at Case Western, Zachary is more convinced than ever that he can help patients by devoting his life to research. He is not yet sure how many years of research he’ll be able to fit in his training, but he is anxious to leave his mark wherever he can do the most good.

“When you see someone who suffers from a terrible illness or disease, the human in you is simply moved to do something about it,” Zachary said. “With research, I can combine this intense intellectual interest with the beautiful act of helping a group of people in need. Success stories in research are far from guaranteed, but by just working hard every day and doing our best, I know that my colleagues and I can change people’s lives together.”

By Janet Showalter

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