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Pulse Magazine Summer 01 Issue

In this issue...

Beating the Big "C"(Cover Story)

Bridging The Blood-Brain Barrier

Peaceful Passage

Pure Medicine

Rounds - News, Views and Trends

The Last Word: The Humorous Side of Health Care

BEATING THE BIG "C": Physicians, Researchers Gaining Ground In Battle Against Cancer
By Andrea Watson

When Elizabeth Perez first heard the word "cancer," she associated it with a death sentence. After all, the only experience she had with the disease was when her father was diagnosed with lung cancer and died about three months later.

However, through the treatment she received at the Southwest Cancer Center, she realized cancer doesn't always have to mean death.

"My first experience with it was death," she said. "But, there wasn't much they could do for my father. With me, they did everything they could. I had chemotherapy and radiation, and, since my cancer was so aggressive, I had a bone marrow transplant."

Many people still automatically associate a cancer diagnosis with death, said Everardo Cobos, M.D., an oncologist at the Southwest Cancer Center and chief of oncology in the Department of Internal Medicine at Texas Tech University Health Sciences Center.

"I think that there are still some misconceptions that exist," he said. "They're mostly a holdover from the past. I think almost all patients understand that this is a serious illness, but we do see some patients that are able to see how things have evolved. I think patients, just like physicians, are inundated with the new advances in treatment, so I think that some of them are able to understand that there are going to be a lot of cancer patients who are going to survive."

Jay Haggard was one of those patients.

"I knew I was going to be all right," Haggard said. "I knew I could handle whatever they threw at me and that I was going to get through this. I kept thinking that this was something I was going to beat. I was going to control the cancer."

Haggard was diagnosed with Hodgkin's lymphoma in August 1999. When he first began treatment, he had a football-sized tumor in his chest which had caused one of his lungs to collapse.

"I had been trying for so long to find out what was wrong with me that having a diagnosis was actually a relief," he said.

Haggard first knew something was wrong in June 1998, when he began experiencing severe itching in his legs. By November 1998, the itching had spread to his entire body. He saw dermatologists who diagnosed scabies and eczema, but treatments for both conditions proved unsuccessful. By the following August, Haggard said the problem had become so severe he feared he might have a breakdown.

In a final attempt to determine what was wrong, Haggard saw a doctor in the TTUHSC Department of Dermatology. "He asked about my blood tests, and I told him the other doctors hadn't done any," Haggard said. "He ran the tests, knew it wasn't a skin problem and immediately sent me to Internal Medicine."

Within about a week and a half, Haggard, then 29, had his diagnosis and was preparing to undergo chemotherapy followed by radiation.

"Before, it had been such a long, drawn-out process, but once I came to the health sciences center, I had some answers in a hurry," he said. "I was very impressed with the way everything was handled.

"The day I was diagnosed, Dr. Cobos spent more than an hour and a half answering the questions my wife and my mother and I had. He put things at ease for everyone. One of the first things he told us was that this disease was very treatable and very curable. That made a big difference."

Cobos said everyone at the cancer center makes an effort to treat both the physical and emotional needs of each patient, which is a change from how things used to be handled.

"We never used to pay attention to how the patient was doing emotionally," he said. "One of the things that we have come to realize is that some of these cancers create major side effects, and even with cancers that are treatable, we're asking the patient to undergo some very intensive types of treatment, so we realize that we have to focus on the person. That means utilizing a team approach. We're dealing with issues of work, family problems and dealing with the side effects. No one person can do it all, so a team approach works well."

Cobos said the team approach combines doctors from a number of specialties including oncology, radiology, social work, nursing and clinical research. For example, the team that would treat a patient with lung cancer would include a pulmonologist, a surgeon, a medical oncologist, a radiation oncologist, a social worker, a physical therapist, a psychologist, a team of nurses and researchers to help determine if the patient can be enrolled in any clinical trials.

Perez said she also appreciated the attention given to her emotional needs and the emotional needs of her family.

"Everyone was so good about asking how I was doing as a person, not just as a patient," she said. "The doctors could tell I was interested in my disease and what I could do to win this battle and they would talk to me about it. My son would go with me to my treatments and the nurses would let him play the video games they have for the pediatric patients. They did things to make him feel more comfortable. He was scared to be there, but he wanted to be there for me. Because the nurses made him feel so comfortable, he was able to help other children who were there with their parents."

Perez, then 37, was diagnosed with breast cancer in May 1998. She immediately had a mastectomy, followed by her chemotherapy, radiation and bone marrow transplant. Eventually, she had the other breast removed to reduce the risk of a reoccurrence.

During her treatment, Perez began to lose her hair, which is a typical side effect of many types of chemotherapy.

"That was the hardest thing to deal with," she said. "I cried like you couldn't believe. It's traumatic because it would just come out in clumps. So I shaved my head. I wore a lot of wigs and bandanas. I think losing your hair is actually worse than losing a breast. Your hair is something you've had all your life. When you lose it, it feels like you're losing part of your identity."

Perez said she had three or four different wigs she would wear, often just to make herself and her family laugh.

"I had my church wig, my Tina Turner wig, my Church's Chicken lady wig and a long reddish-blonde wig," she said. "I even had a T-shirt that said 'Too sexy for my hair.' I felt like I had to laugh about it all or I would get depressed and I didn't want to do that. There was no way I was going to let the cancer beat me."

She actually was able to look at wigs and even breast prostheses while undergoing treatment. The cancer center offers a fitting room to help patients find wigs and mastectomy products that will meet their needs.

The fitting room is run by Gwynn Broome and Rene Coke, both employees of Family Oxygen and Equipment.

"We're here for the patient," Broome said. "We want to make them feel good about themselves. They've been traumatized enough. What we do is help alleviate some of the trauma."

The women fit patients with the appropriate size breast prostheses and bras as well as wigs and turbans to replace what has been lost through surgery, chemotherapy or other treatments.

"The technology has changed so much," Broome said. "There's more being done and it's all come a long way, whether in breast forms or wigs, even surgery."

Coke said new products are being developed all the time that allow them to meet each patient's needs.

"We have to stay on the cutting edge because there are always problems with what exists," she said. "Now there's even a partial breast form for women who've only had a portion of the breast removed."

Manufacturers are also making more lines of specialty clothing, such as swimsuits and workout wear, that have pockets made to hold a breast form, she said.

One of the most important parts of helping a patient find the right wig or the right prosthesis is making them feel better about themselves, Coke said.

"We've had women come see us in tears and leave laughing and joking," she said. "That's so awesome. There's a spiritual component to all of this. We see people come in feeling broken and they leave feeling more whole."

Cobos said the cancer center has committed space to the fitting room because the staff understands the importance of helping patients develop that sense of wholeness and well being.

"The whole philosophy is that if you look good, you'll feel better," he said. "One of the things about cancer and its treatment is that it distorts a patient's body image, so it's important to our self-esteem and how we cope. We've found that paying attention to a person's body image is just as important as treating them with chemotherapy."

Although greater importance has been given to focusing on the patient's mental status, most work involving cancer centers is on technological advances and new treatments for incurable cancers.

"Things have changed dramatically over the last 25 years," Cobos said. "Whereas in the past we were mostly focused on trying to keep the patient comfortable, now we are still emphasizing that with all of our new technologies, but there's also been a huge number of cancers that were considered incurable at one time that are now highly treatable and can be controlled. Some have even moved into the curable stage. There's been a tremendous amount of advancement in understanding the basic biology of cancer. Now we understand how a cancer cell works."

Raul Martinez-Zaguilan, Ph.D., a professor in the Department of Physiology, is one of the TTUHSC faculty members examining the functions of cancer cells. Martinez-Zaguilan's lab is examining how cancer cells utilize proton pumps found on the cell surface to metastasize and to induce angiogenesis, the formation of a blood supply network to a tumor, particularly in breast cancer. The lab has found evidence that the more proton pumps a cancer cell has and uses, the more aggressive it will be.

"At the most basic level, we're trying to address those cancers and tumors that are very hard to kill," Martinez-Zaguilan said. "In the lab, we can very well suppress these aggressive cells by suppressing the proton pump, but we want to be sure this actually has clinical significance. I think if we do our homework and continue this research, we'll get solid data to support its relevance."

Understanding how cancer cells work has made developing cancer-type-specific treatments possible, Cobos said. New surgical techniques and immuno-therapy also are new developments in treating a wide range of cancers.

"There are new types of chemotherapy that are able to target selective cancer cells, sparing more of the normal cells," he said. "It's very complicated now. There are so many things to consider to determine the best treatment for the patient."

There has also been increased research and progress in creating early screening and prevention techniques, which can help make treatments more effective and the disease less devastating, Cobos said.

"The big problem that we have as physicians is that we need to educate the public on the concept of early detection for some cancers," he said. "That's also a big area that has evolved in the last few years. We now have effective screening tools for breast cancer, prostate cancer, colon cancer and cervical cancer. But there are also things that can be done throughout a lifetime to reduce the risks of these cancers."

There is increasing research in developing dietary preventions for a variety of cancers, said Barbara C. Pence, Ph.D., associate vice president for research, associate dean for research and the Graduate School of Biomedical Sciences and a professor in the Department of Pathology.

"There are a number of studies that are looking at how people can alter their behavior to reduce their risk of cancer," she said. "I've always been intrigued by the possibility that through lifestyle changes you can prevent cancer. This isn't like screenings. This is something you can start developing in young adults to prevent cancer from happening."

Pence is currently researching how the mineral selenium may be used in preventing skin cancer. She has previously done research on how calcium supplements can help prevent colon cancer.

Having the cancer center associated with the academic resources of the health sciences center also helps the facility to be part of the cutting-edge research and treatment development, Cobos said.

"We've tried to assemble a team of basic scientists and clinicians working together to try to make improvements in particular types of cancer," he said. "The various departments are networking and collaborating with the clinic so that we're able to develop the best treatments. That translates into an enthusiasm and I think the patients sense that. They can sense the fact that there's hope, they can sense the fact that there are new treatments and they can appreciate the fact that a team of people is working for them. Even though they realize that their cancer may not be curable, they know that during the time that they have this illness, they're going to have a better quality of life because there's a team working to help them deal with this illness."

Hopefully, by combining the academic resources of the health sciences center with the clinical resources of the cancer center, the institution can become a nationally designated cancer center, said Joel Kupersmith, M.D., dean of the School of Medicine.

"To do that, you have to have research and education," he said. "To offer what we can offer to the patient, you have to be part of an academic center. With cancer it is particularly important to offer the latest technology because it is still such a severe disease. It's important to offer the latest drugs and clinical trials."

Kupersmith said that because of the partnership, the health sciences center and the cancer center have made great strides in every area of research and patient care.

"Our knowledge is increasing exponentially," he said.

While the research is valuable to the institutions, the biggest impact is felt in what it all means to the patient, Cobos said.

"Many times, even if a patient dies, we can take comfort in knowing the we used all of our capabilities to help them and that we provided relief of their pain and suffering," he said. "Of those that you are able to treat effectively or cure, then you get the satisfaction of knowing that you helped them in some way. Above all, we're here to help the patients, to help them deal with this illness and make it through this journey."

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BRIDGING THE BLOOD-BRAIN BARRIER
by Michael Hughes

Robert Frost once articulated many people's feelings about their lives with one phrase, "with miles to go before I sleep."

That line of poetry certainly describes Kevin Fitzpatrick, a third-year student at Texas Tech School of Pharmacy in Amarillo, who recently earned the school's first Gateway Grant for his work to penetrate the mysteries of the blood-brain barrier.

Fitzpatrick was awarded a $5,000 Gateway Research Grant from the American Foundation for Pharmacy Education (AFPE) to help him develop a computer model of the choline transporter, a binding site for proteins that may be valuable for getting therapeutic drugs to diffuse across the blood-brain barrier, he said.

"This (blood-brain barrier research) is really the nuts and bolts of what's going on in the pharmaceutical sciences department," Fitzpatrick said, crediting his mentor, David Allen R.Ph. Ph.D., with the opportunity to join the efforts of many other faculty and graduate students working on the blood-brain barrier.

Allen, assistant professor of pharmaceutical sciences, said Fitzpatrick has done good research and made several "tremendous" presentations at national meetings.

"One of my colleagues made the comment to me that it must be nice to have a graduate student of Kevin's abilities," Allen said. "I've interacted with a lot of pharmacy students in my career and Kevin is easily in the top five. He could make significant tracks in research if he so chooses."

Allen said studies of the blood-brain barrier might someday yield treatments for many addictions, as well as conditions like Alzheimer's and Parkinson's.

"These proteins are Mother Nature's gift to us," he said. "Kevin is using computer molecular modeling techniques to model the binding site of the protein known as the choline transporter. He's been working with me for going on two years and it's been a pleasure."

Fitzpatrick said he looks forward to presenting his work at other national and international meetings and sticking with blood-brain barrier research even after he finishes his doctor of pharmacy degree.

"It's hard to see where research is eventually going to go," he said "You just have to be confident that what you're working on is eventually going to lead to something."

Allen said Fitzpatrick has the academic credentials to go almost anywhere.

"He's a special student," Allen said.

Fitzpatrick said graduate studies are definitely in his future, either at Texas Tech or somewhere else with a Ph.D. program in pharmaceutical sciences.

Clearly, he is a man with miles to go before he sleeps.

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PEACEFUL PASSAGE
by Julie Toland

Fear. Sadness. Panic. Pain. Loss. These are just a few of the emotions associated with death. But health care providers at Texas Tech University Health Sciences Center are striving to bring terminal patients something else - peace.

"End-of-life issues have always been around, but it tends to be hush-hush," said Cathleen Collins, RN, MSN, instructor of clinical nursing and a hospice nurse. "But now the baby boomers are getting older, and it's being talking about. Palliative care has moved to the forefront."

An interdisciplinary team at TTUHSC is doing more than talk about palliative care. Experts in hospice care, geriatric care, pharmacy, medicine and counseling have applied for a grant that will allow them to provide training in end-of-life care at the Mildred and Shirley L. Garrison Geriatric Education and Care Center, as well as at Carillon.

Donna Scott-Tilley, RN, MSN, assistant professor in the School of Nursing and a hospice nurse, said elderly patients don't always get the benefit of a good palliative care approach to treatment. "Combining the geriatric care expertise with our hospice training, we believe, is a good foundation for care at the new Garrison Center," she said.

The team hopes to be of benefit to elders living in rural areas across West Texas, as well as to Garrison Center clients. "We know hospice works at home," Scott-Tilley said. "That's what hospice does - it utilizes an interdisciplinary team, and the application of that team's abilities makes for happier families, happier patients, better control of symptoms, better quality of life and more cost-effective care."

Tracey Woodward Sanders, RN, MSN, instructor of clinical nursing at TTUHSC, is working toward a geriatric nurse practitioner degree and brings geriatric care expertise to the multidisciplinary team. "One of pieces is we're going to be able to share different perspectives as we pull this team together," she said.

Sanders was selected to travel to Harvard in April for an intensive week of training in palliative care. After six months of mentoring TTUHSC team members, she will return to Harvard in November for another week of training.

The interactive Harvard program includes experts in spirituality, ethics, pain management, family group dynamics and counseling. "Selection to attend the program is based on the need for implementing such a program in your region of country," she said. "It's a terrific opportunity to bring that content back to this area. So as region, we are going to receive a perspective from Harvard, which does a beautiful program in palliative care. Our team will have the hospice perspective and another major medical center's perspective."

Getting personal

Working with terminal patients might seem difficult to most, but the decision came easily to Collins, who specializes in bereavement issues. "To me, it's knowing you were there in probably one of the most intimate moment of someone's existence," she said. "Knowing you were there helping the family and that you made it better. It's hard to see people die, but at the same time, you know you made it the best experience it could possibly be."

Collins has found it's easier to have closer, more personal relationships with hospice patients. "With hospice patients, I always know what they did before; I know their families and how they met and all the neat stuff," she said. "And when I worked in the hospital, I would take care of a patient maybe several weeks but I never knew them on a personal basis like I do hospice patients. I would read the obituaries on these people I would take care of in the hospital and I was amazed at the things they had done. It made me feel awful to know this person had contributed so much and I didn't know any of it."

Scott-Tilley agreed that getting to know patients and their families well is a very rewarding aspect of the job. "That's what's attractive about this - you get to tend to the family, too," she said. "You tend to all the needs.

"Hospice was very appealing to me because it was about quality of life," she continued. "Patients are not in the hospital connected to tubes, family members not able to visit because of restricted hours. To me, hospice represented what death should look like."

Sanders said that many issues come up with families who are struggling with end-of-life decision making. "Families aren't ready to let Dad go, and Dad clearly has said, 'I don't want any more than just to go peacefully,'" she said. "And because I've been working with the elder population for a long time, over and over what's been expressed with aging has been once they've reviewed their life, they are more than ready to go peacefully.

"So having the opportunity to counsel with the family and help people express ideas, I'm not sure that happens as well as it could," she continued. "Clearly, none of us went into nursing to see people pass away. We all went because we wanted to make a difference and make them healthy and able to go home. But we're all finding that death is as much a part of living as anything else."

Growing interest

Collins and Scott-Tilley both noted that interest in palliative care is strong among students and educators. They will travel to Cleveland in June for an End of Life Nursing Education Consortium, a three-day course on how to implement palliative and end-of-life care issues into the curriculum.

"Right now there are many research opportunities in this area," Scott-Tilley said. "There is so much we don't know - what the right interventions are, what we need to provide the best care. The interest is certainly there and we are talking about creating a minor in gerontology.

"We talk about end-of-life issues relating to nursing home care and hospice care, but it is everywhere," she continued. "It affects every subspecialty of nursing. These students have to know how to deal with these issues. And that's training we didn't get when we were in nursing school."

Collins noted that people today demand the best for their families and understand that they have many options.

"This approach is completely new," she said. "So that's what this whole project is about, what's the best quality of life at the end of life."

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PURE MEDICINE
by Patricia R. Kalderis Williams

Imagine living without electricity, air conditioning, heating - or medicine. When members of Texas Tech's Christian Medical & Dental Society (CMDS) spent a recent Saturday in Juarez, Mexico, setting up five makeshift medical clinics, they came away with an eye-opening realization. To those living in the outermost region of Juarez, access to health care, for the most part, is nonexistent.

"If we can help at least one person, we accomplished something," said Celina Mendoza, a Texas Tech certified medical assistant. "That's our mission."

The medical mission of about 130 Tech medical students, nursing students and staff was to provide those living in colonias with free diagnostic care, dental supplies and medications. "It doesn't hit you until you see it," said Erica Fleckenstein, sophomore nursing student. "Everyone needs access to healthcare."

Skyrocketing hypertension and uncontrolled diabetes were some of the most frequently diagnosed conditions. Fouad Abedi, a first-year medical student, said he didn't realize how important preventive medicine was until this visit. "Many here have waited until their condition has really progressed."

Texas Tech students and staff have participated in CMDS medical mission trips for about 10 years. Texas Tech donates the cost of the buses. Pharmaceutical companies donate the medications. Everyone donates his or her time. "Help is something you can give, and there are different types of help," said Mario Nutis, M.D., a second-year family practice resident. "If you know something, share what you know - not just money."

"This is a great learning opportunity for students to see the importance of community health and how each member of a health care team can make a difference," said Michael Moon, assistant professor of clinical nursing in Lubbock. "It gives me greater appreciation for the extras available in our health care system."

"I feel good about what we did," said Reeni Abraham, a second-year medical student, and one of the coordinators of this year's trip. "To see the joy on my peers' faces really impacts me."

"It puts things into perspective while studying medicine," said Matt Bayazitoglu, a third-year medical student. "It's pure medicine - treating people directly. No insurance. No income. We just treat people. I'm able to step back and know why I chose medicine."

While an eye-opening experience, it also leaves some volunteers feeling a bit helpless after leaving patients with their newly diagnosed conditions. "We go to another country, then leave. They're still left having to face their problems," said Abraham.

"You wish you could take them home and help them all you can," said Oscar A. Noriega, M.D., Texas Tech family practice physician. "We know that's impossible and have to be realistic. As Christians, we know that God can do anything - there are no limits to His giving. We pray He watches over them. The church, community workers and pastors pick up where we leave off. Hopefully they'll follow up with whatever resources they have."

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Rounds: News, Views & Trends

BUESSELER CLINIC OPEN AT CHCL

Community Health Center of Lubbock and Texas Tech University Health Sciences Center hosted the grand opening of the John A. Buesseler Eye Clinic in January at the Community Health Center of Lubbock, 1318 Broadway.

The clinic has been open to patients since Nov. 1. Dr. Terry Nelson is available to treat residents of Lubbock and the surrounding areas who have limited access to eye care.

"This community will benefit greatly from the Buesseler Eye Clinic which has been in the process of development for the past year by Texas Tech University Health Sciences Center Department of Ophthalmology, CHCL, Covenant Health Systems, University Medical Center and Reese Center," said Michael Sullivan, chief executive officer of CHCL.

Matthew Driskill, senior clinical administrator for the TTUHSC Department of Ophthalmology, said the clinic, with a central Lubbock location, will make it easier for residents to get to their scheduled eye-care appointments. CHCL is located on all of the major bus routes in Lubbock.

"This clinic will allow patients to get the routine eye care they need," Driskill said. "If a problem is found, then we can get them into the TTUHSC system quickly to give them any specialized care they need."

The clinic is named for John A. Buesseler, M.D., the founding dean of the TTUHSC School of Medicine. Dr. Buesseler also served as the founding chairman of the Department of Health Organizational Management and as chairman of the Department of Ophthalmology. He also has been a long-time supporter of the Community Health Center of Lubbock.

Buesseler was conferred with emeritus distinction last May in recognition of distinguished and faithful service, visionary leadership and standards of academic and clinical excellence.

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STUDENTS LEAD APHASIA GROUP

Three graduate students in the Department of Communication Disorders at Texas Tech University Health Sciences Center are going above and beyond to make speech-language therapy available to stroke victims.

Speech-language pathology students Suzanne Oetzel, Laura Williams and Leslie Baker, under the supervision of Assistant Professor Melinda Corwin, offer a weekly group therapy session for patients who have aphasia subsequent to a stroke.

"The students coordinate the group activities and provide the speech-language therapy," Corwin said. "We now have eight aphasia group members. We also have just started a caregivers support group, as well, with four members."

Corwin said paying for therapy often is a problem because patients have used all of their insurance or Medicare funding, and even a modest fee can be prohibitive for those on a limited income.

"To help offset the cost of therapy, the students who coordinate the aphasia group also organize fund-raisers," Corwin said. "This year they raised nearly $2,000, which will be used to cover a portion of the costs of the group therapy sessions."

Students participated in the Red Raider Road Race and sold program T-shirts, window decals and candles to raise funds.

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VARMA PRESIDENT OF MEDICAL SOCIETY

dUniversity Distinguished Professor Surendra K. Varma, M.D., a pediatric endocrinologist at Texas Tech University Health Sciences Center, has been elected president of the Lubbock-Crosby-Garza County Medical Society.

Varma, the first society president from the TTUHSC, was elected by the society's more than 600 members. He has previously served as vice president and president-elect.

"I'm honored to be president," Varma said. "I feel privileged to serve and to be the first one from the Health Sciences Center. I've been active in the society for many years."

During his one-year term, Varma's duties will include ensuring the availability of continuing medical education programs and workshops for society members, working to improve relationships between doctors and area hospitals and establishing a continuing relationship with the TTUHSC students and residents.

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NURSING STUDENTS STAMPEDE TO NEW SCHOLARSHIP EVENT

The Texas Tech University Health Sciences Center School of Nursing hosted the first annual Scholarship Stampede Jan. 31.

The reception was intended to bring students and donors together, said Alexia Green, Ph.D., dean of the TTUHSC School of Nursing.

"This is an opportunity for scholarship donors to meet the students who have benefited from their generosity," she said, "as well as for students to say thank you."

The event included the presentation of new scholarships, and donors were presented special gifts, as well. Nursing students also learned about additional scholarship opportunities and picked up scholarship application materials.

Exa Jackson, director of student related services in the TTUHSC School of Nursing, said scholarships are a crucial part of attracting students to a profession that is seeing increasing shortages.

"Nursing shortages are becoming an international concern," she said, noting that aging baby boomers will need more and more nursing care in the coming years. "And at an estimated cost of $3,000 per semester for tuition, fees, books and other miscellaneous costs, the majority of nursing students need financial assistance, especially those who attend school on a full-time basis."

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RESEARCHERS LOOK AT HOW BRAIN THINKS

New, high-tech equipment in Texas Tech University Health Sciences Center's School of Allied Health is helping researchers unravel some of the mysteries about how the brain works.

The school's Center for Functional Brain Mapping and Cortical Studies in the Department of Communication Disorders recently began using electronic brain-mapping equipment, which offers a look at the responses of the brain to different sounds.

"Basically, what we're doing is watching the brain think," said Dwayne Paschall, Ph.D., assistant professor in the TTUHSC Department of Communication Disorders. "The way that the brain works is to send small electrical signals from one location to the next. And by putting electrodes on the outside of the head, we can watch it send that electrical signal from location to location. Then we can draw this information onto a visual image of the patient's brain and see which parts are working.

"This allows us to create a map to watch how the brain is sending signals all over the head," he said.

Paschall said brain mapping is useful in a variety of situations - hearing loss, brain damage and many kinds of speech problems. It is especially effective in assessing those who have difficulty communicating verbally. For example, a young child who has difficulty hearing can be tested while asleep. "We can give them different sounds to listen to and see how the brain is functioning to process those sounds," he said.

"In an older patient who may have had an accident or a stroke, we can measure how the brain is recovering after that particular incident, and monitor the change in language. And sometimes in coma patients, we can measure brain changes and determine with some success when that patient is likely to recover."

The brain-mapping unit also can be used in the operating room to monitor the patient's nerves or neural function during surgery. "We monitor several different modalities during an operating room session," Paschall said. "We have electrodes in different parts of the body, which is especially useful if the surgeon is working around nerves."

Paschall said a difference between this technique and MRI or PET brain-mapping methods is that it allows measurement of activity over the entire surface of the brain, rather than just one nerve or one neuron, and on a very fast time scale.

"We know that the brain has a lot of different parts, and we know different parts are involved with doing a single activity," Paschall said. "So something as simple as writing or listening in a noisy environment involves multiple areas of the brain, and if we're just looking at one part, we're missing how the brain functions as a whole. This equipment allows us to do that, to look at the whole brain and see how all the different parts come together to solve one particular problem."

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EL PASO HONORS TECH EMPLOYEES

Texas Tech El Paso employees Oscar Noriega, M.D., and Rosa Petrozza were honored recently for their contributions to the greater El Paso community.

Noriega, assistant professor in the Department of Family Medicine, was recognized by the Association of American Medical Colleges for the Humanism in Medicine Award. He was nominated by Texas Tech El Paso medical students as one of 47 physicians nationwide to be selected for the honor.

Petrozza, a breast cancer survivor and coordinator for support services in the University Breast Care Center, received the YWCA's REACH Award.

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BROOKE SELECTED TO LEAD GROUP

Paul P. Brooke Jr., Ph.D., dean of the Texas Tech University Health Sciences Center School of Allied Health, has been elected president of the Texas Society of Allied Health Professions.

Brooke was named president-elect at the Fall 2000 TSAHP meeting and will serve as president-elect for one year before assuming the duties of president. He will serve on the TSAHP Board of Directors for a total of three years - as president-elect, president and immediate past president.

"It is an honor to be selected for this position by my peers," Brooke said, "and I look forward to the opportunities this presents for expanded contributions on behalf of TTUHSC and the School of Allied Health."

David R. Smith, M.D., TTUHSC president, said Brooke's leadership skills continue to bring prestige to the health sciences center.

"Dr. Brooke has brought the School of Allied Health to the forefront both regionally and nationally with new degree programs and clinical services," he said. "His leadership role in this organization will only enhance TTUHSC's reputation for excellence."

TSAHP, a state-wide, nonprofit scientific and professional organization, was founded to serve the needs of educators, practitioners, professional institutions and others interested in improving allied health education and the delivery of health services. An affiliate of the American Society of Allied Health Professions since 1978, the TSAHP seeks to serve as a united voice for allied health in Texas and provides a forum in which allied health educators and practitioners can address and act on issues of mutual concern.

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THREE FACULTY RECEIVE NURSING FELLOWSHIPS

Three faculty members in the Texas Tech University Health Sciences Center School of Nursing have been awarded $20,000 Fellowships in Gerontological Nursing.

The recipients are Paula DiBenedetto, RN, MSN, instructor of clinical nursing; Donna C. Owen, Ph.D., RN, associate professor; and Tracey A Woodward Sanders, RN, MSN, instructor of clinical nursing.

Funding for the fellowships is provided through the TTUHSC Agency of Aging and the School of Nursing. The goal of the fellowships is to build academic geriatric nursing capacity in the School of Nursing.

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TECH DIABETES CENTER PROGRAM RECOGNIZED

Texas Tech Diabetes Center, located at Texas Tech Medical Center Southwest, received the Education Recognition award from the American Diabetes Association Dec. 16. This recognition assures the center's approved education programs have met the National Standards for Diabetes Self-Management Education Programs. Recognition also helps consumers to identify a quality program.

Gene Bell, R.N. and center director, said self-management education is an essential component of diabetes treatment.

"Management of diabetes, 90 percent of the time, is done by the person who has it," Bell said. "We give them the knowledge and skills to do this at home."

The center's program includes diabetes self-management education for Type1, Type2, gestational and pediatric clients and is reimbursed by Medicare and most commercial insurance companies. Courses are available to clients of all ages in both one-on-one and group settings. Previously diagnosed, as well as newly diagnosed, clients are welcome.

Janice Fry, registered dietitian, said the center provides 40 years of experience in diabetes education.

"The experience and knowledge is here, and we care about clients getting the education to take care of the disease," Fry said.

The program's curriculum includes: stress and psychosocial adjustment; family involvement and social support; foot, skin and dental care; medical nutrition therapy; as well as benefits, risks and management options for improving glucose control.

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QUALITY SERVICE AWARDEES NAMED

Two Texas Tech University Health Sciences Center Permian Basin employees were awarded Quality Service Awards. Dee Sredonavich, Resident Coordinator in the Department of OB/GYN, and Christa Shanks, Manager of Marketing/News and Publications were honored.

The Chancellor's Award of Excellence was presented to Amy Buchanan, Senior Administrative Assistant in the School of Allied Health. Carol Bergquist, M.D., Professor in the Department of OB/GYN, received the President's Academic Achievement Award.

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GERIATRIC CENTER MAKING PROGRESS

Construction continues on the new Mildred and Shirley L. Garrison Geriatric Education and Care Center on Fourth Street across from the Texas Tech University Health Sciences Center campus. The building is scheduled to open in November or December said Mel Trafford, executive director of the center.

The center is a partnership between TTUHSC and Sears Methodist Retirement Systems Inc. The center was originally scheduled to open in August or September, but weather has delayed construction by nearly two months, Trafford said.

"The workers are doing everything they can to get the center open and functional," he said. "The problem is, every time we have a wet day where water gets into the ground, it takes several days for it to dry out. That's where most of the delays have come from."

Once the facility is open, it will provide both traditional nursing care and specialized Alzheimer's disease care.

For two nights in April, the sadness and frustration that often accompany Alzheimer's disease took a brief holiday to allow the humorous dimension of the disease to have its hour upon the stage as TTUHSC's Institute for Healthy Aging and the Department of Theatre Arts at Texas Tech University co-sponsored a fund-raising play at the Maedgen Theatre.

"Last Lists of My Mad Mother" was written by Julie Jensen, a West Texas native, from her experience with her mother's battle against Alzheimer's disease. The play explored the observations and tribulations of two sisters caring for their mother, who suffers from dementia, as they try to adapt and help her accept personal losses with dignity. The play shows the humor of humanity and the frailty of life.

Randolph Schiffer, M.D., scientific director of the Institute for Healthy Aging, said the two performances raised about $5,500 for the J. Robert Haag Endowed Chair in Alzheimer's Disease.

"It was a very moving production for the people that attended," Schiffer said. "This was a creative way to use the theater. We had the chance to use a dramatic presentation to further the best interests of science. This brought in a lot of people from the community and was a very moving performance for everyone that attended."

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ORTEGA RETIRES AFTER 24 YEARS

It was recently rumored in the hallways of Texas Tech El Paso that longtime employee Olga Ortega, 61, would officially retire March 30, 2001.

The retirement announcement had been made several times in the past, but Ortega's co-workers always convinced her to stay on 'just a little longer.' Now the grandmother of five, with husband Pancho already retired, decided that after 24 years working at Tech, she will spend her time with family, grandkids, and hobbies.

Although her official position at Tech was Manager of Student Services, Ortega's unofficial duties included things she wanted to be while growing up. As a little girl inspired by her Catholic school upbringing, she aspired to be either a nurse or a nun. Later, counseling high school students also crossed her mind. "My love for young people inspires me to treat them like the special people they are. They have so much to offer the world," she said.

Indeed, as Manager of Student Services for many years, Ortega has helped hundreds of third- and fourth-year medical students with registration, financial aid, counseling, scheduling, testing, and witnessing firsthand their transformation into physicians. Unofficially, she has also been their surrogate mother and mentor. She has celebrated with, and comforted, students during countless Match Days.

One notable student and resident who became faculty is the present El Paso campus Regional Dean Manuel de la Rosa, M.D. "I've witnessed Dr. de la Rosa's growth and it is wonderful to see these accomplishments by one of our very own medical students and native El Pasoans," Ortega said.

Ortega said if she could tell people one thing about Texas Tech, it would be that it has so much to offer to the community, its patients, employees, medical students, residents and faculty. "We are all winners. After having worked at Tech, I have developed a remarkable bond with everyone," she concluded.

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SCREENING INFANTS BECAME TEXAS LAW 20 YEARS AGO

For just over 20 years, babies born in the state of Texas have benefited from the efforts of one Texas Tech University Health Sciences Center doctor and a Lubbock-area politician and father.

In 1976, former Lubbock mayor Alan Henry and his wife, Sandy, had fraternal twin daughters. However, it quickly became apparent that one of the girls was not developing at the same rate as her sister.

"We were lucky we had fraternal twins or we probably wouldn't have realized anything was wrong," Alan Henry said.

The couple consulted with their doctor and were referred to Dr. Surendra Varma, a University distinguished professor in the Department of Pediatrics and a pediatric endocrinologist at TTUHSC.

"Dr. Varma suspected it was congenital hypothyroidism," Sandy Henry said. "He took blood to run the tests and they had to send it all they way to California. That's when Dr. Varma began telling us about some states that had mandatory screening processes for this. So, we worked with Dr. Varma and State Sen. Kent Hance to get something done in Texas."

Alan Henry said they also involved parents' organization and the Texas Department of Health. Finally in 1977, the Legislature passed a bill requiring all newborns to be screened for congenital hypothyroidism. However, funding for the program was not provided until the next legislative session, Varma said. Galactosemia, phenylketonuria, congenital adrenal hyperplasia and sickle cell disease are the other diseases included in the state screening program.

"We finally started screening infants in February 1980," he said. "In the beginning, all the samples came here for confirmation of the diagnosis."

Varma said one in 4,000 newborns suffer from congenital hypothyroidism. If left untreated, the condition can lead to mental retardation and slowed growth. To effectively treat the condition, the children are on thyroid replacement medication for the rest of their lives.

"If treatment begins before age 3 months, the chances of normal mental development are 90 percent," he said.

After diagnosis, the Henrys began giving their daughter her daily medication, which she still takes.

"She's just fine," Sandy Henry said. "She graduated from Texas Tech and leads a normal life. Our family is very pleased that we played a part in this major step in children's health care. All of this is a great credit to our local doctor, the health sciences center and to Dr. Varma."

Today, Varma's efforts are focused on helping to create a global screening initiative.

"The awareness is there," he said. "This is a law in all 50 states, Japan, much of Europe and Australia. The problem is the third-world countries. We're missing out on diagnosing a very significant number of babies."

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NURSING SCHOOL LAUNCHES "ROAR"

The School of Nursing at Texas Tech University Health Sciences Center Permian Basin held a grand opening ceremony for its Reach Out and Read (ROAR) program on March 28, 2001.

Reach Out and Read (ROAR) is a program that encourages parents to read to their children starting at an early age, typically from 6 months to 5 years. Each child visiting the Nursing Center or a WIC clinic will receive a new book in keeping with the goal of building a personal library of 10 books.

The ROAR program utilizes volunteers and members of the TTUHSC staff to read to children in the waiting areas of the clinics.

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MEDICAL STUDENTS 'CHIP' IN SUPPORT

The School of Nursing at Texas Tech University Health Sciences Center Permian Basin held a grand opening ceremony for its Reach Out and Read (ROAR) program on March 28, 2001.

Reach Out and Read (ROAR) is a program that encourages parents to read to their children starting at an early age, typically from 6 months to 5 years. Each child visiting the Nursing Center or a WIC clinic will receive a new book in keeping with the goal of building a personal library of 10 books.

The ROAR program utilizes volunteers and members of the TTUHSC staff to read to children in the waiting areas of the clinics.

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SAY 'AHHHH' TO TELEDOC

Texas Tech University Health Sciences Center at El Paso has launched a new telemedicine initiative into the remote reaches of far West Texas. Using video conferencing technology and high-speed telephone lines, the new telemedicine system now will electronically deliver Texas Tech doctors to patients miles away.

An electronic ribbon-cutting demonstrated a "hands-on" medical exam via the new TeleDoc telemedicine network March 9 at the Texas Tech Family Practice Center in northeast El Paso.

Patti Patterson, M.D., vice president for rural and community health at TTUHSC, said the first remote telemedicine connections from El Paso will be to Fort Hancock, 60 miles away, and Sierra Blanca, 90 miles away. "Both of these Hudspeth County communities are located in rural areas of Texas with very limited access to health care," she said.

Manuel de la Rosa, M.D., regional dean of TTUHSC at El Paso, said that without the TeleDoc, residents of Fort Hancock would be without a community doctor. "The telemedicine system will provide the two communities with electronic access to primary care physicians and specialists at the TTUHSC El Paso campus, as well as the full Texas Tech system," he said. "The project is designed to provide support to the sole physician in Sierra Blanca with specialty and subspecialty care for his patients, as well."

The new project cost $250,000 and is a collaborative effort between Texas Tech, the Texas Department of Health and the Texas Infrastructure Fund.

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TTUHSC CAMPUS GOES SMOKE FREE

Tobacco use is the leading cause of preventable death and disability in the United States. And as of January 1, smoking is no longer allowed on the Texas Tech University Health Sciences Center campus.

TTUHSC President David R. Smith, M.D., says it's the right thing to do. "We don't believe we should be an environment that exposes people to risks," he said. "We should lead by example by making the entire campus smoke free, and we're backed up by the scientific evidence that exists about correcting health risks related to smoking and secondhand smoke."

In addition to making the campus smoke free, TTUHSC joined forces with Texas Tech to create the Tobacco and Prevention Control Center. Donna Bacchi, M.D., director for the center, says Tech needed to address this issue in order to have healthier students and staff.

"Our mission is to be a state-of-the-art center that provides information on education, to do research in areas in order to reduce tobacco use in high-risk populations, and help people enact policy change to reduce the use of tobacco, which in the long run will increase the health of the population," says Bacchi.

College students are one of the main focuses of the center. Bacchi says a survey on smoking was done on the Tech campus. The results showed that 36 percent of college students smoked, and 29 percent of those smoke daily. The national average is 32 percent.

"That is why we decided to focus on students and do an educational campaign," says Bacchi. "The tobacco industry is now shifting and marketing to the 18- to 22-year-olds, and now we see the dramatic increase in tobacco use on college campuses."

Dr. Smith says he is aware of the criticism on the smoking issue. "This is not a popularity contest. There's going to be some criticism about this, but I think that when it comes to health care and standing up for what is right, Texas Tech needs to demonstrate leadership for the state and nation," he said. "We cannot shy away from this."

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WOMEN'S HEALTH TAKES CENTER STAGE

On April 28, Texas Tech Medical Center and KAMR Channel 4 hosted the "Speaking of Women's Health Symposium" at the Ambassador Hotel. Panhandle women took part in health screenings, discussions on women's health in the 21st century and breakout sessions covering topics like building better bones, self defense and cooking for healthy living.

During the symposium, several women were honored for their contributions to the health of the Panhandle community. The honorees for the first Women Making a Difference Award are Louise Evans Bruce, who helped bring the Texas Tech School of Medicine to Amarillo; Suzanne Clarke, a long-time volunteer and community activist who helped found the Women in Touch cancer support group; Eunice King, RN, a nurse who helped found the school of nursing at West Texas State University - now West Texas A&M; Estelle Marsh, a philanthropist who promoted many health causes; and Ernestine Smith, M.D., one of the first female doctors in the Panhandle.

The Women's Health Research Institute of Amarillo on March 15 awarded12 grants to area researchers to study issues affecting women's health. This is the second round of grants awarded by the WHRI since its inception in January 2000.

Tech also will establish the "Bush-Emeny Endowed Lectureship in Women's Health Research" made possible by the financial gifts of Amarillo resident Caroline Emeny. In additional to financial gifts to the medical center, the Emeny family donated all of the land on which the medical center facilities were built.

The Women's Health Research Institute's main objective is to advance knowledge of women's health issues and facilitate collaborative development of research in a wide range of problems affecting women's health. The institute is a joint effort of the Texas Tech School of Medicine, School of Pharmacy, Northwest Texas Hospital, West Texas A&M, Amarillo College, Harrington Cancer Center and the Amarillo community.

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The Last Word: THE HUMOROUS SIDE OF HEALTH CARE
By David R. Smith - President, TTUHSC

There just seem to be those patients in our lives who add to our education and compassion for caring. The marks on our psyche are indelible and their impact on our lives is immortal. Mr. Foster was just such a gentleman.

Mr. Foster entered my domain on the third floor of a larger inner city general hospital while I was a lowly third-year medical student. As a third-year student I was frequently too tired and too uncertain of my skills to recognize the power of science and the art of medicine. Mr. Foster was about to change all of that and teach me some lessons in life, medicine and the therapy of laughter.

That Thursday in September was a busy one and I had just been "assigned" my first patient. It was a time of anxiety and anticipation. Here was an opportunity for me to apply the knowledge that had been heaped upon me during the first two years of medical school. I was about to venture into a hospital room with the expressed intent of "curing" a fellow human being and Mr. Foster was that opportunity.

Mr. Foster, it turned out, was an elderly African-American gentleman who was being transferred from a local nursing home because of a loss of appetite, weight loss and a persistent state of confusion. As a third-year medical student, many of these symptoms were indeed ones to which I could personally relate. Any honest medical student will tell you that they have believed at one time or another that they have harbored every major pathogen and horrific disease symptom known to man. (Generally this occurs just hours or days after that disease was reviewed in class or appeared on an exam.)

Well, with all the zeal of a newborn calf, I assaulted Mr. Foster with my armamentarium of medical knowledge and lack of clinical experience. I was convinced that I could diagnose the evil unknown culprit responsible for his symptoms and return him to his family. For I was cognizant that Mr. Foster had only recently become the resident of the nursing home because of his deteriorating mental state.

After a thorough history (acquired predominantly from his wife) and a meticulous physical exam, I began to develop a list of likely diagnostic suspects. My medical team comprised of other medical students and residents were less convinced. After all, they had collectively seen hundreds of frail elderly patients transferred from nursing homes who never improved and who would be readmitted weeks to months after discharge often with the same lingering diagnosis. Their doubt did not dissuade my enthusiasm. Mr. Foster was "my" patient and he would get better under my care period, end of statement.

Well my medical acumen pointed me in the direction of hypothyroidism (or low thyroid). I was convinced that Mr. Foster's slow reflexes, eyelid lag and anemia all pointed to the obvious. Never mind that the noon lecture from two weeks earlier was about thyroid disease, I believed I was on the verge of my first "cure." I continued to find little enthusiasm for my medical sleuth work but I pressed onward.

Without asking for academic approval, I drew Mr. Foster's blood, sent it to the laboratory and waited expectantly like a child on Christmas night for the results. That afternoon the laboratory paged me to call them immediately. My level of anticipation grew. The results of Mr. Foster's serum analysis had indeed supported my diagnosis, hypothyroidism. I immediately relayed the results to my supervising resident who remained skeptical but compliant. I believe had he known that timeless Texas saying of "even a blind squirrel can find an acorn sometimes," he would have employed it at that very moment. Yet he capitulated and we ordered medication to correct this hormonal abnormality.

I watched and waited with anticipation over the next few days to witness the miraculous recovery of Mr. Foster, and I was not to be disappointed. Mr. Foster was a new man; in fact his new name at morning rounds was "ricochet rabbit." He was now a man with a mission and no longer a bed-bound senior citizen. My own emotions were soaring and now I waited for the ultimate ratification of my skills, the return of his wife to witness this blessed event.

Several days later Mrs. Foster returned to visit her husband. She had not been at his bedside for several days and I will always remember her facial expression and verbal utterances for the rest of my life. She stood at the foot of his bed as I beamed with pride. She then proceeded to lose control of her lower jaw (it dropped to the floor). Still waiting for her expression of gratitude, the first sentence out of her mouth was a shock to me and the nurses. "I think I liked him the way he was," she proclaimed as my euphoria was shattered. However, we all laughed as we watched the interlude between a stunned wife and her newfound husband who was just as spry as an 18-year-old adolescent.

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