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Pulse Magazine Winter 00 Issue

In this issue...

The Fifth Vital Sign

Help for Migraine Pain

Drugs and Pain

Gaining on Pain

Donor Profile

Alum News & Notes

Rounds - News, Views and Trends

The Last Word: The True Test of Caring - It's OK to Cry

THE FIFTH VITAL SIGN
By Josh Murray

Pain is persistent. Pain is uncomfortable. And pain is challenging for the patient and for the health care provider. Treating the pain is the sum of many pieces, both physical and emotional.

"Pain is an enigma," said Phillip S. Sizer, M.Ed., P.T., assistant professor in the Department of Physical Therapy at Texas Tech University Health Sciences Center. "The challenge is determining the process at the heart of the problem and addressing all the factors of the pain."

And assessing the pain can be difficult.

"Pain is sometimes considered to be the fifth vital sign," said Melanie Fowler, R.N.C.S, M.S.N, F.N.P., assistant professor in the School of Nursing and interim director of Tech's Wellness Center in East Lubbock. "Many times you can't see the source of the pain and just because it is not seen, patients begin to fear the pain doesn't exist."

And what cannot be seen is often destructive to a person's daily life.

"How people use their time is one way people perceive and describe who they are," said Judy Day, occupational therapist and professor in the TTUHSC Department of Rehabilitation Sciences. "When people experience chronic pain, they often lose sight of their occupational roles and they lose sight of who they are and what they do."

Health professionals, regardless of their role, give patients an opportunity to express their emotions about the pain before grief, confusion or depression set in.

"Taking time with individuals is a blessing," said Day. "By making a connection with our patients, we can learn enough to find their needs."

According to Day, an individual's needs include what they like to do and what they have lost as a result of the pain. After each assessment, a plan of action can be developed.

For people who like to travel, to cook or to farm, they must learn a new way of doing things.

"Expectations have to be realistic," said Day. "People are used to doing for themselves and we try to encourage people to take day trips or cook parts of a meal rather than expecting to do everything."

By incorporating medical, psychological and physical therapy evaluations, a customized treatment plan can be tailored to the patient, said Raquel Contreras, Ph.D., director of psychological services at the Texas Tech International Pain Institute.

One psychological approach to pain management is the cognitive/behavioral approach, which involves looking at the patient's thoughts and behavior and introducing possible interventions. "The goal is change, helping the patient learn to adapt," Contreras said.

Another approach might be biofeedback, an evaluation of how the body responds to what is going on in the head. And meditation and hypnotherapy offer additional ways to help patients mentally cope with pain.

Physical therapy also is an integral part of pain management. "We target specific problems through relaxation, mobilization, exercise and functional activities," said Sizer. "Our ultimate goal is a for the patient to function pain free."

Touching a person's spiritual life also can be effective.

"It depends on a person, but often a courageous person realizes that the pain is bigger than he or she is," said Day. "At that point, the patient is able to make a plan for himself or herself. They work with their limitations, their strengths and then develop new occupational roles or adapt in their old roles."

Treatment is as unique as the patient. "I strongly believe there is not one cause of pain and not one treatment for pain," said Fowler. "We look at the individual, we look at their social life and we look at their home life to find the right treatment."

A multidisciplinary approach to treating pain - both physical and emotional - helps convey hope and belief that a productive life is possible.

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HELP FOR MIGRAINE PAIN
by Rose Kuhn

Most everyone knows of a family member, co-worker or friend who suffers from debilitating migraines. Sometimes the severe headaches begin very early in life and have no known trigger. Other times, migraines begin after a head injury. Sometimes the headaches are triggered by certain foods, or by stress. Other times, they seem to materialize for no apparent reason.

"I didn't even know what a migraine was until after I fell from a vehicle in the early '80s," said Irma Vincent, an administrative assistant at Texas Tech University Health Sciences Center. The accident triggered the migraines and she still suffers from them, the pain so extreme that sometimes she must isolate herself in a cool, dark room away from noise, hoping to assuage the throbbing ache around her eyes.

For many sufferers, the headache hits early in the morning before waking up. They experience sensitivity to light, even moonlight, which seems to intensify the throbbing pain that radiates from behind the eyes.

Russell C. Packard, M.D., psychiatrist, neurologist and professor in the TTUHSC Department of Neuropsychiatry, specializes in treating migraines and other head injuries and came to the Health Sciences Center to help establish a clinic specifically for that purpose.

Packard's private practice experience and the appeal of teaching brought him to the HSC. He sees headache and head injury cases on Tuesdays and Thursdays and currently sees six patients each day. The new Headache and Concussion Care Clinic is located within the Department of Neurology.

"It's a service for people who suffer from migraines and other head injuries," he said. "I mostly do consultation and provide the patient's doctor with a treatment idea. Some patients are here to be treated and I provide several options for them to consider." Packard evaluates the patient's history to determine if the headaches are migraines by observing frequency, intensity and location of the pain

Packard said a doctor must rely on what his patient tells him about migraines. "A lot of patients will come to me and I am the first doctor who is listening to them," he said." Headache patients were ignored for a long time. With new medications and several alternative therapies, these patients are now getting relief."

Packard noted that women are three times more likely to suffer from migraines than men are. And while about 15 million women in the United States suffer from the headaches, only about 5 million see a doctor.

Options for treatment vary from prescribing medication, such as triptans, to alternative therapy, such as learning deep muscle relaxation, exercises and physical therapy; and/or counseling to determine stress factors or triggers. Physical therapy and relaxation exercises are individual, as each person relates to therapy differently. For instance, if a patients is experiencing neck pain and it is radiating up, the therapy can be aimed at trying to relax the neck muscles and getting the inflammation down, Packard said.

Preventive options focus on diet - avoiding certain foods, which can trigger migraines. Chocolate, aged cheese and red wine are a few foods to steer clear of. "Most people know when they have a diet trigger and they've learned to avoid it," said Packard. "Some patients are asked to keep a diary, to look back over the last 24 hours at what they ate and maybe a third of those people will pick up a trigger that they had not recognized before. Some foods, however, have a delayed affect resulting in a headache a day later, so keeping a diary is really helpful."

Over-the-counter migraine medication can be of help to some patients, but for others, prescription medication can be taken daily to stave off migraines. For the severe migraine that takes patients to the emergency room, an injection of Imitrex will help within hours. "Imitrex is one of the first triptans that came out," Packard said. "Triptans are probably the first medicines that specifically target migraines. They are very similar; about three or four triptans are available today."

Patients are usually desperate for medications; they are willing to try just about anything. And often they come in hoping there is something new, said Packard. Surgery, in which nerves are cut, burned or frozen in hopes of relieving the pain, has been attempted as a treatment option, but the headaches ultimately return, Packard said.

Head injury also can lead to migraines. "After a head injury concussion, you can get any kind of headache," said Packard. "But it can set off migraines. It can aggravate migraines for a person who already has them, or it can actually trigger a migraine-type headache if that person has never had one. If you take 100 people with head injuries, maybe 10 will have migraine-type headaches and the other 90 will have other types of headaches."

Learning to identify and then avoid migraine triggers, whether it is certain foods, stress, strong perfumes or allergies, is a good first step in migraine prevention. But when such precautions don't ward off the inevitable, migraine sufferers can take comfort in knowing that effective treatment is more readily available.

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DRUGS & PAIN: Many Chronic Pain Patients Under-Treated
by Michael Hughes

Of mankind's visual depictions of pain, perhaps no image reflects the unrelenting malady quite as accurately as Edvard Munch's painting, "The Scream."

Unfortunately, many chronic pain patients say they literally feel like screaming in their futile efforts to find relief for legitimate medical conditions, said Dr. Robert B. Supernaw, associate dean for curriculum and students at Texas Tech University Health Sciences Center's School of Pharmacy in Amarillo.

Supernaw, a doctor of pharmacy who also serves as editor-in-chief of the American Journal of Pain Management, said that most pain is under-treated and should be considered a health condition in and of itself.

"The analogy I like to give to the students at the medical school and the pharmacy school is that if you had an exaggerated blood pressure, you wouldn't be happy if they corrected it 40 percent," he said. "So often, physicians, pharmacists and nurses will feel pleased if their patient's pain is diminished 40 percent."

This happens for two reasons. First, pain is subjective and not easily measured, and second, because prescription analgesic drugs are treated differently than any other type of medication.

"We're too timid in their use because we have this preconceived notion that narcotics are such dangerous drugs and that every other patient is a drug-seeking patient."

Supernaw said studies have proven that the vast majority of pain patients do not become addicted to narcotics. Moreover, he said most drug addicts find it easier to get street drugs than to con doctors out of pain medication.

Supernaw said he is confident that new classes of medication will relieve pain without dependence and addiction, even as the stigma against patients seeking legitimate pain relief eases.

Until then, he said new laws must allow doctors who have prescribing powers - such as medical doctors and doctors of osteopathy and dentistry - to relieve pain without being fearful of prosecution by federal authorities.

"There has been so much discussion of pain management recently and so much discussion of drug abuse that we get the two issues confused," Supernaw said. "And that is why we have two competing bills in Congress right now."

One is the Pain Relief Promotion Act, which Supernaw said is disguised as an aid to improve patients' access to adequate pain relief. "It charges the Drug Enforcement Agency with responsibility to put doctors out of business if they prescribe a drug that is used inappropriately," he said. "The net result will be that fewer patients will be treated appropriately because of the intimidation factor," he said.

On the brighter side, Supernaw said the Conquering Pain Act of 1999 will expand access to pain control by providing easy-to-understand guidelines authorizing physician peer organizations to review pain management at the local level, and requiring the department of Health and Human Services to establish standards for measuring the quality of care.

Supernaw said new drugs and delivery systems also on the horizon would relieve many people's pain without putting them and their doctors on the wrong side of the law.

A new class of drugs called COX-2 inhibitors offers many of the anti-inflammatory and pain relief properties of aspirin, ibuprofen and naproxen without causing stomach discomfort and bleeding associated with those medications at high dosage levels.

Supernaw said researchers also are experimenting with new drugs that plug into the narcotic receptors in the brain, relieving the pain without causing some of the negative and addictive side effects normally associated with narcotics.

He said innovative dosage forms now match pain medication with their best route of absorption. These include computerized pumps, medicated lollipops for rapid absorption of certain narcotics, nasal sprays, rapidly disintegrating tablets and oral films. So patients are able to receive their medicines in a form that will benefit them the most.

State medical boards must respond by encouraging doctors to relieve pain whatever its cause. "Medical boards have been very accepting of the prescriptive rights of physicians treating cancer patients and post-operative patients," Supernaw said. "They're not quite up to the state of the art of using narcotics for non-cancer related pain, such as Lou Gehrig's Disease, sickle cell anemia and severe back pain and headache."

Eventually, Supernaw said the technology of pain relief would meet people's comfort level when it comes to relieving pain. In the meantime, patient advocacy groups must continue to pressure their elected leaders at the state and federal level to update their thinking so that acute and chronic pain sufferers can experience true relief without turning themselves and their doctors into criminals.

"Quite frankly, if you go out on the Internet and read about some of these patient advocate groups, they admit that, 'Yes we are drug seeking, but just as a diabetic seeks insulin, I seek pain medication.'"

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GAINING ON PAIN

Backaches. Headaches. Cancer. Fibromyalgia. The types of pain are endless. Pain can be sudden, perhaps due to an accident, or it can be chronic, as in arthritis. But whatever its cause, pain diminishes quality of life.

An estimated 50 million Americans live with chronic pain, and a recent Gallup survey reported that Americans with moderate or severe pain typically have lived with it for a year and a half.

"Pain is everywhere," said Alan Kaye, M.D., Ph.D., chairman of the Texas Tech University Health Sciences Center Department of Anesthesiology. "A very large percentage of patients who come to the hospital have as their chief complaint inadequate pain relief, either from a disease state or from surgery."

But doctors at Texas Tech's International Pain Institute are finding innovative ways to eliminate pain from patients' lives.

"Other physicians, usually primary care physicians, do the best they can," Kaye said, noting that many large cities are without pain experts. "But at Texas Tech not only do we have people who practice pain management via an anesthesia residency and a fellowship in pain, but we also have a highly interventional pain practice here.

"We're not talking about simply modifying or modulating drugs, and we're not talking about very simple procedures like trigger-pulling injections," he continued. "We're talking about very complex intervention techniques that go to the source of the pain and really improve people's quality of life."

World leaders

Gabor Racz, M.D., professor of anesthesiology and director of Texas Tech's International Pain Institute, is world-renowned for the equipment and procedures he has pioneered. The Racz Needle and Racz Catheter, for instance, are used by anesthesiologists around the world. And lysis of adhesion, in which a painful nerve root is freed, is one of his many trademark procedures.

"We learned years ago that most pain generators tend to be in front and lateral of the spinal canal," said Racz, the first chair of Tech's Anesthesiology Department. "There was no equipment available. But with the catheters we developed, suddenly we were able to get to the ventral-lateral epidural space. And by injecting directly at the site of the pain, we are able to prevent patients from having to undergo major back surgery."

Racz, who has been at Tech for 24 years, noted that doctors from around the world visit the pain clinic weekly to observe the new, innovative techniques performed here. "We don't have any secrets," he said. "By the time other doctors learn our procedures, we are already doing something new."

Prithvi Raj, M.D., co-director of Tech's pain clinic, has pioneered procedures as well, such as epiduroscopy, which involves inserting a fiberscope into the lower back through the tailbone to pinpoint exactly where the pain is originating.

"This procedure allows us to go directly to the pathology which may be causing lower back pain," Raj said. "Then we can confirm visually the problem area and administer proper treatment."

Raj, who also is president of the World Institute of Pain, said he believes that the innovative treatments being performed at Tech's pain center are revolutionizing pain management. "This pain center is not local, it's not even national," Raj said. "It is international, and it is very unique."

Drs. Racz and Raj both are listed among the world's top 10 anesthesiologists/pain management specialists in the publication The Best Doctors in America.

Their patients have included a German soccer star who was able to play at the international level in the German Cup final only a few weeks after undergoing a lysis of adhesion procedure in Lubbock. The player had read about Tech's pain clinic on the Internet.

Among other patients were an international diplomat and a U.S. admiral's wife. Patients who visit the clinic come from all walks of life, and all parts of the globe. "It isn't just local people who come here," Kaye said. "They come from all over the world. They even come in their private Lear jets, and they wait in line and they watch TV in our hallways so their pain can be taken care of by the best doctors in the world."

Areas of focus

Doctors in the clinic, under the tutelage of Drs. Racz and Raj, are continually learning new techniques. Miles Day, M.D., who has been published extensively in areas of pain management, is particularly adept at lysis of adhesion and treating atypical facial pain, Racz noted.

One procedure Day and others perform, Intradiscal Electrothermal Therapy (IDET), treats painful bulging or herniated discs providing an alternative to surgery for younger patients or for those who have had multiple surgeries.

The procedure involves inserting a needle into the disrupted disc, then through the needle inserting a catheter that coils between the disc's layers, Day said. Heat is then applied, which once at 45 degrees Celsius, damages nerve endings alleviating the pain. Additional heating, up to 60-65 degrees Celsius, is believed to further relieve back pain by stabilizing or strengthening the collagen within the disc.

An area of concentration for Susan Anderson, M.D., is vertebroplasty, which specifically targets postmenopausal white females. The outpatient procedure involves injecting "cement" into a compression fracture in the back to stabilize the bone, Anderson explained. The cement is first heated to 45-50 degrees Celsius, which is also believed to provide an analgesic effect.

Leland Lou, M.D., along with Raj, is involved with radio frequency oblation, where doctors actually isolate the nerve and destroy that pain pathway. "Dr. Lou also has been assuming many of the responsibilities that I couldn't," Racz said.

Kaye said Texas Tech anesthesiologists are more than up for the challenge of staying at the forefront of pain treatment techniques. "I think what's really exciting is that the field of pain management is always changing," he said. "It's in its infancy, and I mean that because people like Dr. Racz and Dr. Raj are pioneers in many of the techniques that they employ, techniques that bear their names.

"And now we have a new generation with Dr. Day, Dr. Anderson, and Dr. Lou," he continued. "They're all disciples, they've all done the fellowship here. And they all have techniques that they're learning about and they are making a name for themselves."

A multidisciplinary approach

Using a variety of weapons, in additional to interventional treatments, is the most effective way to attack stubborn pain conditions, experts agree. Combinations of physical therapy, psychotherapy, relaxation techniques and innovative drugs can help break the cycle of pain and bring it to a manageable level.

"When you incorporate medical, psychological and physical therapy evaluations, a customized treatment plan can be tailored to the patient," said Raquel Contreras, Ph.D., psychologist at the Texas Tech International Pain Institute. "I believe that when we address these three areas, we can more effectively treat pain."

Contreras noted that pain is subjective and is different for each individual. "One misconception that often causes pain patients to be defensive is that others think the pain is in their heads," she said. "Pain is not in their heads, but there are psycho-social stressors that can magnify pain.

"For example," she continued, "when you stub your toe, the pain might feel worse to you if you also are behind on the bills or have other stressors going on at the same time."

Racz said in years past, the tendency was to shift blame onto patients, rather than look for where the pain was actually coming from. "I couldn't relate to the idea, other than to realize that psychologists are very important players on a pain management team," he said.

One psychological approach to pain management is the cognitive/behavioral approach, which involves looking at the patient's thoughts and behavior and introducing possible interventions. "The goal is change, helping the patient learn to adapt," Contreras said.

Another approach might be biofeedback, an evaluation of how the body responds to what is going on in the head. And meditation and hypnotherapy offer additional ways to help patients mentally cope with pain.

"Meditation allows the patient to clear the mind and focus on breathing," Contreras said. "Patients don't see results overnight, however. But with steady practice, over time the patient becomes calmer. Meditation is not a short-term treatment, it is a lifestyle change."

Relaxation and anger management techniques can help patients learn to control pain's impact on their lives, Contreras said. "We help patients learn to see pain as just one more thing in their life, to see that it's not everything."

Striving for excellence

Although the pain center recently has more than doubled in size and has expanded to a Southwest Lubbock location, it already has outgrown the area, Racz said. "I believe if you provide excellence, it will be recognized," he said. "But we also want to keep our referral base of more than 750 physicians that we have worked so hard to build, and we can only continue this if we maintain our current level of productivity."

Racz's dream is to see the construction of a freestanding Texas Tech International Pain Institute on the TTUHSC campus.

"Our desire is to be involved in basic research, clinical research, specialized pain conditions and to work with the equipment and pharmaceutical industries to improve our ability to treat patients," he said, adding that the pain specialists also would participate in competitive funded research.

"If we have a home base, we can continue to grow," he said. "It would be tragic for Texas Tech if there is no such facility in the future to maintain and build on what we are doing, to attract the best physicians and researchers in the world."

New teaching methods will be explored, as well, through distance learning via Texas Tech's Healthnet system, and by designing a web site to reach anyone in the world who suffers from pain, Racz said.

Another challenge facing Tech's pain specialists is insurance reimbursements, Racz said. Some insurance companies are denying payment for certain pain procedures, citing the procedures as experimental "This is unreasonable when you consider the savings involved particularly in treating a patient without surgery," he said.

Racz pointed out that one major advantage has been the national recognition of the lysis of adhesion code in the CPT 2000 book, a publication that lists all currently approved medical procedures.

"This listing requires prospective randomized, published data in peer-reviewed journals, as well as multi-center and multi-specialty support before the American Medical Association approves the listing," Racz said.

He noted a 1987 court ruling that reflects the evolution of accepted pain treatments. "Back in '87 when an insurance company's panel attempted to label treatments as 'experimental,' the judge ruled that every accepted procedure was at some time experimental, which does not make it invalid," Racz said. "This forced the reluctant company to pay the physicians. Furthermore, the judge ruled that to require all physicians to agree on any treatment modality may deny patients the best treatment available."

Higher level of functioning

The ultimate goal of all health care providers involved in pain management is helping the patient achieve their maximum level of functioning.

"So at Texas Tech, we treat acute pain, which dovetails with our anesthesia in the operating room, and we communicate every day as we transfer our patients from anesthesia to our pain service," Kaye said. "Then we have chronic pain and chronic disease states that involve various therapeutic and interventional pain procedures.

"Then we have people that have terminal diagnoses that we comfort," he continued. "I think it is so important that we ease their pain with medication, and in this country doctors do a poor job. They think a typical dose for someone who doesn't have a terminal condition, or a typical dose for someone who has developed a tolerance should equate with the dosage for someone who has a terminal condition. This clinic does a superb job in doing what it needs to in terms of comforting the patients when they're in the last stages of their lives."

He pointed out that sometimes even the most aggressive efforts don't eliminate a patient's pain. "I think it's important to note that a certain percent of patients we cannot fix," he said. "It's very acceptable for us to make them comfortable so they can function."

In the meantime, Texas Tech's International Institute of Pain continues to lead the charge in the fight against pain.

Racz noted that most patients have seen between eight and 12 doctors before they come to Texas Tech for treatment. "There is just far too much pain and suffering," he said. "And it can really limit and destroy lives. No patient should have to live with that."

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DONOR PROFILE

The city of Amarillo continues to support Texas Tech University Health Sciences Center in its mission to provide first-rate health care to West Texans.

Ground-breaking ceremonies were held Oct. 4 on a $24 million Texas Tech Medical School and Allied Health Center, allowing the school to expand its programs in women's health, agriculture medicine, genetics and pediatrics.

The Amarillo community was instrumental in raising the funds to launch the Amarillo-based Texas Tech School of Pharmacy, which began training pharmacists in 1996. And now the city has once again pulled together, raising $1.7 million for the new 158,000-square-foot facility, which is expected to be completed within 18 months.

Texas Tech is part of a city-wide complex in Amarillo that includes 17 health facilities such as Baptist St. Anthony's Health System, Northwest Texas Healthcare System, a VA hospital and the Don and Sybil Harrington Cancer Center. The complex treats more than one million patients each year from Texas, Oklahoma, Kansas, Colorado and New Mexico. "Having a university-based medical center like Texas Tech in our city is extremely important," said Michael Bourn, executive director of the Amarillo Economic Development Corporation. "It's one of the things we talk about with great pride."

And Texas Tech University Health Sciences Center shares in the pride of teaming with a city focused on providing the best possible health care to its residents and those in the surrounding communities.

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ALUM NEWS & NOTES

1975

  • John Etlinger, M.D. lives in San Antonio, Texas, with his wife, Brenda, and their three children ranging in age from 13 to 19. He has a practice in general surgery. John's hobbies include golf, tennis, the outdoors and coaching baseball.
  • Bill H. Gorman, M.D. has a solo practice of plastic surgery. He lives in Austin with his wife, Nancy. They have three children - Christine (27), Tate (24) and Ashleigh (16).
  • Henry T. Grinvalsky, M.D. is married to Patricia S. Holm. They have four children ranging in age from 19 to 33. He is currently an Associate Professor of Neurology at University of Cincinnati and the Chief of Staff at Cincinnati VA Medical Center.
  • H. Andrew Hansen II, M.D. lives in Lubbock, Texas with his wife, Kathy, and their four children. He is a cardiovascular surgeon in private practice with academic appointments at Texas Tech, Baylor and Texas A&M.
  • Guy Hirsch, M.D. is a radiologist with Lubbock Radiology Associates. He and his wife, Reta, have two children (Rachael - 22 and Benjamin - 19). He is also the 2000-2001 President of the Texas Tech Medical Alumni Association.
  • J. E. Mendez, M.D. lives in Midland, Texas with his wife, Constance Wagner Mendez, and their three children. His specialty is gynecology. His hobbies include tennis, boating, mountain biking and motorcycles.

1980

  • Charles E. Geyer, M.D. is the medical director of the Arrington Cancer Center and vice chairman of the NSABP Breast Committee. He lives in Lubbock, Texas with his wife, Joni Anne, and their four children.
  • Michael Nacol, M.D. works in internal medicine in Georgetown, Texas. He and his wife, Jean, have three children. Michael's hobbies include hunting and fishing.
  • Robert Panzarella has worked in emergency medicine since 1983 in the Houston area. He made an independent film 'Joey Goes To Jail' in 1999. He lives in Humble, Texas with his wife, Beth, and their four children.
  • Philip Samuels, M.D. is an associate professor at Ohio State University in maternal-fetal medicine. He is also director of the residency and fellowship programs. He and his wife, Elizabeth (Betsy), live in Worthington, Ohio, and have two children.
  • David Turner, M.D. is a plastic surgeon with his own private practice in Austin, Texas. He is married to Maureen and has two children. David's hobbies include golf, hunting, fishing and music.
  • Steve Wilson, M.D. lives in Round Rock, Texas, with his wife, Keitha, and their two sons. He has practiced orthopedics in Round Rock since 1985. He likes to run, play golf, coach and ride his Harley-Davidson.

1985

  • Denise Baskind, M.D. and her husband Stephen have been married since 1976. The couple has two children (Daniel - 17 and Eli - 12) and lives in Dallas. Denise has worked in emergency medicine at the Doctor's Hospital in Dallas since 1988. In addition to her family and pets, Denise's hobbies include backpacking, camping, traveling, Boy Scouts and Venturing.
  • David Bradford, M.D. lives in Riverside, Washington. His specialty is OB/GYN. He and his wife have four children (Elizabeth, Bryce, Cheryl and Chase).
  • John Brady, M.D. is the chief of staff and a private attending at Baylor Medical Center. He lives in Waxahachie, Texas with his wife, Yolanda, and their two children, Logen and Gable.
  • Drs. Rick and Sharon Chatwell live in Lincoln, Nebraska. Rick has a full-time practice in rheumatology. Sharon's interests include writing, inspirational speaking, cooking and music. Rick's hobbies are woodworking and old house renovations. They have four children (Christopher, David, John and Anna).
  • Elizabeth (Colonna) Eyre, M.D. has been in private practice in anesthesia in San Antonio, Texas for the past 10 years. She and her husband, Dr. Keith Eyre, are going to adopt a baby boy from the Ukraine in the near future.
  • Carmen T. Garza de Levcovitz, M.D. works in a pediatric group in San Antonio, Texas. She and husband, Dr. Henrique Levcovitz, have two sons. Carmen enjoys planting trees, gardening, and listening to Jazz, Bosa Nova and Spanish music.
  • James Jew, M.D. lives in Gilbert, Arizona, with his wife, Lisa, and their three children (Stephen, Brandon and Gabrielle Grace). His specialty is OB/GYN, and his personal interests include martial arts, music and family.
  • Kirk Vestal, M.D. lives in Nacogdoches, Texas with his wife, Kathy Greer, and their son Hadyn. His professional interests include DNA molecular biology and pathological diagnosis. His hobbies include BMW motorcycling, day trading, history, opera and his two dogs.
  • Mark C. Wilson, M.D. is the residency program director at Wake Forest University. His specialty is internal medicine. He and his wife, Mary Beth Fasano, live in Winston-Salem, North Carolina with their two children.

1986

  • Maria D. Perez, M.D. has been promoted to associate professor of pediatrics at Baylor College of Medicine. She would also like to announce the birth of her second child. Andrew Grant Schroeder was born November 30, 1999. His big sister Mariel Elizabeth is 2 years old.

1987

  • Senja Collins B.S.P.T. has been the supervisor of UMC's Outpatient Therapy Center in Lubbock since it opened in 1990. She is opening a new clinic for UMC in December called Health Point focusing on women's health. She also teaches several classes for women including Post Partum Recovery, Breastfeeding, Kegels and Osteoporosis.
  • Nicky Holdeman, O.D., M.D., published a book in 1999 called "Ocular Therapeutics Handbook: A Clinical Manual" with Bruce Onofrey, O.D., and Leonid Skorin, O.D., D.O. He is also the executive director of the University Eye Institute (which was recently named the 8th largest medical facility in Houston).
  • Valerie Nail Miller, BSN would like to announce the birth of a son, William Jay Miller II, on April 2, 1999. She also earned a M.S. in Nursing at Georgia State University in May 2000.

1989

  • Peter Rappa, M.D. works at the Baylor University Medical Center in Irving, Texas, as the medical director for Physical Medicine and Rehabilitation. He also works with traumatic brain injury rehab at the Centre for Neuroskills. He and wife Monica have been happily married for 13 years. The Rappa triplet girls are now 5 years old and are starting kindergarten.

1990

  • Drs. John and Suzanne Hernried live in Davis, California, where John works with the Kaiser Group and is also the medical director at the Obesity Treatment Center. Suzanne's specialty is OB/GYN and she works with the Permanente Medical Group. They have two children, Benjamin and Daniel.
  • Mahmood Moradi, M.D. lives in Houston, Texas where he is a neurosurgeon in private practice. He and his wife, Lida, have one child with another on the way.
  • Rosemary H. Roderick-Roseberry, M.D. is a pediatrician in private practice with a multi specialty group. She also performs some resident teaching. She and husband, Chris Roseberry, have one child, Daniel, and another due in December. In her spare time, Rosemary enjoys gardening and reading.
  • Jeanette Baird Vaughan, MSN works as a trauma nurse for the Neurosciences/Trauma Unit at Baylor University Medical Center in Dallas, Texas. She was selected as the only American nurse chosen to work at the Olympics in Sydney, Australia. She worked in the Olympic press box. She had the distinction of being one of only two foreign nurses selected to be a part of the Olympics medical staff. Vaughan began the lengthy application process in 1998. One of the biggest difficulties was meeting the requirements to receive a license to practice nursing in New South Wales, where Sydney is located. Vaughan went to Sydney as a representative of Baylor, and while there was also involved in field research comparing Australian trauma nursing with that in the U.S.

1991

  • Carol E. Mattes, PhD, M.D. just graduated from the University of Pittsburgh School of Medicine. She is now beginning a residency in family medicine at the George Washington University Hospital in Washington, D.C.
  • Scott A. Smith, M.D. has joined Texas Orthopedics in Austin and opened an office in Round Rock, Texas. He and his wife, Shelley, have four children and live in Northwest Austin.
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Rounds: News, Views & Trends

SMITH AWARDED FOR PUBLIC HEALTH EFFORTS

David R. Smith, M.D., President of Texas Tech University Health Sciences Center, received the 2000 Award for Excellence from the American Public Health Association (AHPA). The award was presented at the 128th APHA annual meeting and exposition Nov. 12-16 in Boston.

The Award for Excellence recognizes individuals who have made significant contributions to the improvement of public health. The APHA Committee recognized Smith's commitment and his advocacy on behalf of those with nonexistent or limited access to health care.

During his career, Smith has worked on examining issues such as primary care, school health, infant immunizations, tuberculosis and the prevention of neural birth defects.

As former commissioner of the Texas Department of Health and a member of the U.S. Health and Human Services National Vaccine Advisory Committee, Smith chaired a subcommittee that addressed strategies for childhood immunizations. He has served as a reserve officer in the U.S. Public Health Service Commissioned Corps since 1987.

MASTER'S IN ATHLETIC TRAINING AVAILABLE

Texas Tech University Health Sciences Center's School of Allied Health has launched a rehabilitation sciences graduate program like no other in Texas.

The new master of athletic training program, one of only three that exists in the country at a university medical center, was approved by the state Higher Education Coordinating Board in July, said LesLee Taylor, program director.

"This fall we have 13 students taking courses," she said. "But the first official full class of 20 students will begin next summer. Once they have completed this 53-hour graduate program, students will be ready for the national certification exam and the licensure exam of the Texas Department of Health."

H.H. Merrifield, Ph.D., associate dean for the School of Allied Health and chair of the Department of Rehabilitation Sciences, said the new program is just one of many ways TTUHSC is meeting changing needs in health care delivery. "With health care becoming increasingly specialized, we think this program will provide not only career opportunities for graduates, but also serve the needs of people in West Texas and across the nation," he said. Taylor noted there is a national movement toward entry-level athletic training graduate programs, giving students with a broad range of undergraduate degrees the opportunity to become certified in athletic training.

"In the past at Texas Tech, if someone wanted to be certified in athletic training, they had to complete 1,500 internship hours and pass the certification exam," she said. "By 2004, the internship route will no longer be an option anywhere in the nation."

Taylor said one focus of the program is to cater to the West Texas community. "Most graduates from programs like this tend to stay in the West Texas area," she said.

ONCOLOGIST JOINS AMARILLO FACULTY

Dr. Mark A. Arredondo has joined the faculty of Texas Tech School of Medicine at Amarillo as a full professor and chief of the division of surgical oncology.

Arredondo has returned to his native Texas after extensive training, research and clinical practice in cancer surgery. He brings a comprehensive approach to surgical treatment of cancer of the head and neck (to include oral cancer), breast, thyroid, parathyroid, adrenal gland, the entire gastrointestinal tract, and skin (to include melanoma and sarcoma).

He is trained in techniques of sentinel lymph node mapping and ablative liver surgery. He is board certified in surgery and holds fellowships with both the Society of Surgical Oncology and the American College of Surgeons. He earned his doctor of medicine degree at University of Texas Southwestern Medical School in Dallas and completed a residency in general surgery at Medical College of Ohio in Toledo.

Arredondo also completed a National Cancer Institute-sponsored fellowship in experimental therapeutics cancer research at Roswell Park Cancer Institute in Buffalo, New York, and a Society of Surgical Oncology-approved fellowship in surgical oncology at the institute.

HSC PROFESSOR NAMED AHA BOARD PRESIDENT

Thomas E. Tenner, Jr., Ph.D., professor, Texas Tech University Health Sciences Center Department of Pharmacology, has been named president of the American Heart Association Texas Affiliate Board of Directors.

The first Lubbock resident to serve as president, Tenner will be responsible for all medical, scientific and public health matters. Tenner will preside over annual meetings and appoint all standing committees. In addition, he will consult with the chairman of the board of directors on matters such as public policy.

It has been a 10-year journey to Tenner's role as president. Since 1990, he has served on numerous committees at the American Heart Association, including the affiliate research allocations and advisory committee, central research review, public affairs, budget and finance and the medical and scientific committees. In 1991, Tenner was named president of the American Heart Association Lubbock Division.

NURSING SHORTAGE POSES LOCAL, NATIONAL CONCERN

An aging workforce, declining enrollment in U.S. nursing schools and increasing market demand are just a few of the reasons jobs for registered nurses are expected to grow 23 percent in the next six years, according to the U.S. Bureau of Labor Statistics.

And in today's increasingly complex health care system, a shortage of nurses, particularly RNs, is beginning to plague hospitals across the country.

"The pendulum has swung the other direction," said Alexia Green, Ph.D., dean of the Texas Tech University Health Sciences Center School of Nursing. "Health care has been in turmoil during the past few years because of managed care, but now things are starting to change."

Green said during the past 10 years, managed care has focused on a business model of operating hospitals and has trimmed a majority of costs by decreasing nurse staffing. "They began to cut RNs and nurses with advanced training," she said. "This has led to a decrease in quality which in turn increases costs because many patients have to return to the hospital.

"Now because of public outcry, hospitals are increasing nursing staffs," she continued. "It doesn't pay in the long run when patient satisfaction is down and errors increase."

Many hospitals are now offering signing bonuses and other incentives, such as relocation bonuses and tuition reimbursement programs, to recruit nurses. In Lubbock alone, there are currently at least 230 nurse vacancies.

Green noted that declining enrollment in nursing schools poses a challenge in meeting the increasing demand for nurses. According to Harvard Nursing Research Institute, enrollments across the U.S. dropped by 20.9 percent from 1995 to 1998.

"Students have other options," Green said. "Many people today are seeking opportunities in technology or other areas, leaving traditional service-based jobs like teaching and nursing unfilled."

TTUHSC's School of Nursing plans to address this shortage by increasing enrollment in both its undergraduate and graduate education programs. And a new specialty in geriatric nursing care and long-term care administration, including the preparation of geriatric nurse practitioners, is being developed.

GRANT FUNDS BORDER HEALTH RESEARCH, SUPERCOMPUTER

Texas Tech University and Texas Tech University Health Sciences Center jointly received a $750,000 grant from the Houston Endowment Inc. The grant will be used to support a border health research project in neuropsychiatric disease as well as complete funding for supercomputer support at The Institute of Environmental and Human Health (TIEHH).

The research project is headed by Randolph B. Schiffer, M.D., chairman of the TTUHSC Department of Neuropsychiatry. Other researchers include: Lou Chiodo, Ph.D., assistant director for science at TIEHH; Darryl M. Williams, M.D., director of border health/rural health at TTUHSC El Paso; and Walter Lajara-Nanson, M.D., instructor of neuropsychiatry at TTUHSC.

The research efforts of the group are aimed at better understanding environmental risk factors for certain late-life neuropsychiatric diseases, primarily Parkinson's disease, but also Alzheimer's and depression. The study will research the possibility of a link between environmental factors and susceptibility to these diseases.

The research will be conducted at two colonias-predominantly Mexican-American communities-in the El Paso region. "We think populations on the border have special environmental exposures which might interact with genetic risk factors to produce disease," Schiffer said. The population of the colonias will be screened for diseases, then research will be conducted on the air, water, dirt and other environmental factors.

The project involves researchers from TTUHSC, TTUHSC El Paso and TIEHH. "The Institute for Environmental and Human Health is committed to advancing knowledge about the impact of the environment on human diseases," Schiffer said. "Historically, this area has been neglected in American medical science and we aim to position Texas Tech at the forefront of this research."

SANCIBRIAN TO SERVE ON LEGISLATIVE COUNCIL

Sherry Sancibrian, M.S., speech-language pathologist and program director for the speech-language pathology program in the Department of Communications Disorders at Texas Tech Health Sciences Center, has been elected to the American Speech-Language Hearing Association's (ASHA) legislative council.

"Sherry continues to excel," said Paul Brooke, Ph.D., dean of the TTUHSC School of Allied Health. "Her latest appointment should give the School of Allied Health a strong voice at the national level in such issues as accreditation standards and the overall direction of the profession."

ASHA is the international professional association for more than 98,000 speech-language pathologists, audiologists, and speech, language and hearing scientists. In addition to promoting professional interests, ASHA also works as an advocate for people with communication disabilities.

RESIDENCY PROGRAM TO BEGIN IN ABILENE

Texas Tech University Health Sciences Center, in partnership with Hendrick Medical Center, is launching a family practice residency program in Abilene.

The program will allow new doctors fulfilling residency requirements to spend one year on the Lubbock campus and then relocate to Abilene for their second and third years of training, said R. Mike Ragain, M.D., of the TTUHSC Department of Family Medicine and residency program director. Richard Homan, M.D., chair of the TTUHSC Department of Family Medicine, is helping develop the program.

"This will further enable us to fulfill our mission at Texas Tech, which is to provide primary care to West Texans, who traditionally have been under-served when it comes to medical care," Ragain said.

Most residents practice within 65 miles of where they train, Ragain continued. "These doctors will train to practice in rural areas," he said. "We hope to encourage them to stay in West Texas."

The program was accredited by the Residency Review Committee of the American Council on Graduate Medical Education.

"For us to be fully accredited nationally the first go-around as a family practice training site is something Texas Tech is very proud of," said David R. Smith, M.D., president of TTUHSC. "We owe a debt of gratitude to Tech Regent Nancy Jones and the state legislature who gave this project the support it needed, as well as to Hendrick and the Abilene community."

State-of-the-art facilities will be available via telemedicine, thanks to the generosity of the Dodge Jones Foundation, said Joel Kupersmith, M.D., dean of the TTUHSC School of Medicine. "Projects like this take teamwork," he said. "And we are proud to team with the Abilene community in helping physicians focus on rural health."

TTUHSC SEEKS NEW REGIONAL DEAN

Wayne J. Daum, M.D., F.A.C.P.E., resigned as regional dean of the School of Medicine at Texas Tech University Health Sciences Center in Odessa effective Sept. 25.

Daum came to Texas Tech from Cleveland, Ohio, where he was chairman of the Department of Orthopaedics and director of orthopaedic residency at St. Lukes Medical Center. He had been at TTUHSC since September 1998.

Texas Tech's School of Medicine Dean Joel Kupersmith, M.D., said, "We would like to express our thanks to Dr. Daum for his service at Texas Tech over the last two years. He has been an integral part of our community."

Donald Loveman , M.D., regional chairman of the Department of Internal Medicine, will serve as interim regional dean.

Donald Wesson, M.D., chairman of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, will serve as chairman of the search committee. "We plan to do a thorough national search for Dr. Daum's successor," said Kupersmith.

CARILLON, HSC TEAM UP FOR GERIATRIC RESEARCH

Texas Tech University Health Sciences Center researchers are participating in an innovative geriatric program with Lubbock's Carillon Senior Living Campus. Carillon House's Research and Education Center held grand opening ceremonies Aug. 18.

The $13 million Carillon House, the first phase of a $44 million expansion of the Carillon campus, will provide a dual approach to geriatric care, said Richard V. Homan, M.D., chairman of the TTUHSC Department of Family and Community Medicine and medical director of Carillon House. "In addition to a clinical setting, the facility will provide a research component allowing us to look at new drugs for chronic diseases that occur in the elderly, such as Alzheimer's," he said.

Randolph B. Schiffer, M.D., chairman of TTUHSC's Neuropsychiatry and Behavioral Science Department, will coordinate research efforts at Carillon House. James E. Rohrer, Ph.D., and Barbara Rohland, M.D., of the TTUHSC Department of Health Services Research Management, also are involved in Carillon House research programs.

Carillon House also will be linked to TTUHSC's telemedicine network in an effort to evaluate the uses of telemedicine in an assisted living facility, as well as reduce emergency room and hospital visits, Homan said.

The center is one of only three in the nation conducting this type of comprehensive geriatric research.

PENCE PART OF NATO PROJECT IN UZBEKISTAN

A Texas Tech Health Sciences Center researcher is part of an international team in a NATO-funded project to investigate incidence of cancer in the former Soviet Union.

Barbara Pence, Ph.D., professor of pathology and associate vice president for research at TTUHSC, recently traveled to the Republic of Uzbekistan with her son and team member, Spencer Wells, Ph.D., head of the Population Genetics Group at Wellcome Trust Centre for Human Genetics at Oxford University. The researchers joined forces with two Uzbek doctors to investigate whether people living in the geographic area around the Aral Sea in the Republic of Uzbekistan are at increased risk for developing cancer because of exposure to agricultural chemicals, causing genetic damage to DNA.

"The incidence of esophageal cancer around the Aral Sea is very high - perhaps the highest in the world - especially in western Uzbekistan," Pence said. "We think this is primarily due to increasing levels of agriculture chemicals contaminating the water supply and soil. In addition, the loss of water volume in the Aral Sea has produced a highly irritating airborne dust. So the interaction of these two factors is likely to contribute to the increase in esophageal cancer in the region."

Pence said many people are dying of cancer in the region and the life expectancy is now in the late 30s or early 40s. "It is tragic, the number of relatively young people who have this tumor," she said.

Blood and tumor tissue were collected from patients with esophageal cancer and from farm workers who have been exposed to pesticides. Most of the DNA analysis will be performed at Oxford, while some will be done in Lubbock.

Dr. Ruslan Ruzibakiev, director of the Institute of Immunology at the Uzbek Academy of Sciences and a project team member, will travel to Lubbock in the spring to observe first hand the analysis being done here.

COMMUNICATION DISORDER NOW ON TTUHSC CAMPUS

The Texas Tech Health Sciences Center's Department of Communication Disorders has relocated to the TTUHSC campus from Tech's general academic campus.

The department has been part of TTUHSC's School of Allied Health since 1993.

A grand opening for the new multimillion-dollar facility on the second floor at TTUHSC was held Oct. 6. The new facility includes 16,000 square feet with 11 treatment rooms for the speech clinic, 5 treatment rooms for the audiology clinical area, classrooms and faculty offices.

"This will make it much more convenient for patients to access our clinics since they are in one place," said Sherry Sancibrian, speech-language pathologist and program director for the speech-language pathology program in the Department of Communications Disorders.

TTUHSC TO POLL ELDERLY IN AREA

Texas Tech University Health Sciences Center is conducting the largest health poll to date of elderly West Texas residents. The poll is being funded through a cooperative agreement with the U.S. Administration on Aging.

The poll, which will be conducted through December, will assess health status, access to health care, health concerns, and health needs of a cross section of 5000 West Texans who are 65 or older.

"Because of its scope, we believe this poll can have a major impact on the future availability of health care and health services for elderly residents of West Texas. However, the poll's credibility depends upon the willingness of these citizens to respond to our questions," said James Rohrer, Ph.D., director of the Texas Tech 5000 Senior Poll.

Rohrer said the results of the poll will be used to help channel health program and funding where they are needed most, and to assist in identifying and assessing the needs of elderly West Texans, particularly ethnic minorities and those who live in small towns and rural areas. The poll will be conducted by telephone in English or Spanish according to the desires of the respondents. Rohrer emphasized the confidential nature of the survey.

"No one is going to be using the information we obtain to try to sell anyone anything," he said. "The poll results are going to be carefully analyzed by Texas Tech staff members and made available, without personal identifiers, to health policy makers, health officials, and others at the state and federal level with responsibility for addressing the health needs and concerns of the elderly."

PHYSIOLOGY NAMED CENTER OF EXCELLENCE

The Department of Physiology at Texas Tech University Health Sciences Center received $125,000 in funding and was designated a Center of Excellence, President David R. Smith, M.D. announced.

The funding will help create a Center for Imaging Cellular Physiology and Pathophysiology. Imaging uses state-of-the-art technology in which ions or molecules within cells are tagged with fluorescent dyes. These dyes are excited by lasers and images from different planes are captured by computer and reconstructed into a three-dimensional image.

"Imaging is a form of research where seeing is believing," said John Orem, Ph.D., chairman of the Department of Physiology. "In the past we looked at dead tissue under a microscope, but now we are able to view living tissues, living cells and the processes within these cells as they perform their function."

The center will collaborate with the TTUHSC School of Pharmacy in Amarillo, the Department of Chemical Engineering and the Department of Biology at Texas Tech University as well as other investigators at institutions within the United States and abroad. This will allow interested faculty in the broad field of imaging to interact with one another.

"The additional funding for the imaging center will create a training environment that uses state-of-the-art cell visualization techniques," Smith said. "It will be exciting to see all types of students and departments interacting together."

Texas Tech researchers who will staff the Center for Imaging Cellular Physiology and Pathophysiology include: Raul Martinez-Zaguilan, Ph.D., assistant professor of physiology; Sandor Gyorke, Ph.D., associate professor of physiology; Richard Nathan, Ph.D., professor of physiology; Narine Sarvazyan, Ph.D., assistant professor of physiology; and Ariel Escobar, Ph.D., assistant professor of physiology.

Centers of Excellence are designed as an opportunity for support within the university. Designation as a Center of Excellence requires extraordinary recognition, complete institutional commitment, measurable outcomes and sustained excellence in service, education and research.

NORIEGA RECEIVES AAFP DEGREE AT DALLAS EVENT

Oscar Noriega, M.D., assistant professor in the Texas Tech Department of Family Practice in El Paso, achieved the degree of Fellow of the American Academy of Family Physicians during the AAFP's recent Annual Scientific Assembly in Dallas.

The AAFP is the national medical association representing 89,400 family physicians, residents in family practice and medical students. Established in 1971, the AAFP recognizes family physicians who have distinguished themselves through service to family medicine and ongoing professional development.

CANADA PRESENTED TEACHING AWARD

The American College of Nurse-Midwives Teaching in Excellence Award recently was presented to Linda Canada, CNM, of the Texas Tech El Paso Department of Ob/Gyn. The award was created to honor the teachers who educate, mentor and serve as role models to midwifery students.

RESEARCH AWARDS NEARLY DOUBLE

Federal research dollars awarded to Texas Tech University Health Sciences Center in fiscal year 2000 were 2.3 times the amount for fiscal year 1998. And overall research funding for fiscal year 2000, totaling $12,950,422, was almost double the amount for fiscal year 1998, which was $6,758,280. Total federal funding for fiscal year 2000 was $7,250,858, while federal awards for fiscal year 1998 totaled $3,124,648. Barbara Pence, Ph.D., associate vice president for research and associate dean for research and the Graduate School of Biomedical Sciences, says the jump in funding is largely due to the school's strategic plan for research.

"We have made great strides in supporting research by encouraging more participation in seed grant programs, purchasing new equipment and hiring new recruits," Pence said. "We also have seen a big increase in research grant applications by TTUHSC faculty."

The National Institutes of Health awarded Raul Martinez-Zaguilan, Ph.D., of the Department of Physiology, $1,678,000 for his research project, "Proton ATPases in Microvascular Endothelial Cells and Diabetes." By measuring proton movements inside of living microvascular endothelial cells, Martinez-Zaguilan hopes to find avenues to ameliorate problems associated with diabetes.

TTUHSC also continues to break new ground in research areas such as Alzheimer's disease, cancer, border health issues and sick building syndrome to name just a few, said Joel Kupersmith, M.D., dean of the School of Medicine and the Graduate School of Biomedical Sciences.

ALL 51 PHARMACY GRADS LICENSED

AMARILLO - All 51 members of Texas Tech School of Pharmacy's first class passed the North American Pharmacist Licensure Examination.

With its 100 percent passing rate, Tech ranks above both the state and national passing rates. Every state except California requires pharmacists to pass this exam before they can receive their license to practice pharmacy.

Arthur Nelson, R.Ph. PH.D., dean of the School of Pharmacy, said achieving a perfect record is not impossible, but it takes a major dedication on the part of the faculty to prepare the students and for the students to actively prepare themselves for this exam. Nelson said the passing rate shows the new curriculum used at Texas Tech is effective.

"They have shown a remarkable level of accomplishment," he said, noting the 51 members of the founding class set a high mark for the future graduates.

WELLNESS CENTER TARGETS CHILDREN

EL PASO - Groundbreaking ceremonies for the joint Texas Tech/Socorro ISD venture, The Wellness Center, took place July 14 at Montwood High School.

Gilbert Handal, M.D., pediatric chairman at Texas Tech Medical Center, approached Socorro ISD late in 1998 with the vision of a community center dedicated to the comprehensive care of children, birth through age 18, in the Montwood area.

The center will depend greatly on schools and the community to encourage families to care for their children. By monitoring each child's progress, Handal aims to prove that all children, regardless of family income, receiving the appropriate attention during youth should do better in school and live productive lives as adults.

Socorro ISD is contributing the land, building, maintenance and custodian for the project. Texas Tech is providing doctors, nurses and equipment, and El Paso Community College is training certified community advocates to help in various capacities. Social workers and Health and Human Services personnel will play a major role in supporting families. A team of researchers will provide continuous evaluation and measurement of outcomes.

"This is an excellent opportunity to coordinate resources from multiple agencies to provide health services and research in a school community," said Manuel de la Rosa, M.D., dean of Texas Tech Medical Center in El Paso.

Also, Texas Tech Medical Center pediatricians Hassan Salloum, M.D., and Ruben Roncallo, M.D., have established a new pediatric clinic in central El Paso. Ribbon-cutting was July 20. The clinic, across from Southwest General Hospital, was established to provide some relief to pediatricians in the area who are swamped with patients.

CONFERENCE PROMOTES DIABETES AWARENESS

EL PASO - Community leaders and health officials gathered Aug. 24 at Texas Tech El Paso to focus on awareness and prevention of diabetes.

El Paso area doctors and business leaders attended the session. "Diabetes puts a tremendous load on the health care systems and our communities," said Manuel de la Rosa, M.D., dean of Texas Tech Medical Center in El Paso. "We need to bring up the level of awareness of this disease if we are to make progress against it."

"The number of diabetics in the United States is expected to more than double in the next quarter century," said State Rep. Manny Najera (D-El Paso), one of the conference organizers. Education efforts and an awareness of diabetes would help in the effort to find better treatments, he said.

RESIDENCY PROGRAMS GET FULL ACCREDITATION

EL PASO - Texas Tech's Departments of Psychiatry and Orthopaedic Surgery have received notices of full accreditation by the Accreditation Council for Graduate Medical Education. The orthopaedic residency is a joint program between Texas Tech and William Beaumont Army Medical Center.

"The faculty and staff in these programs are congratulated for this achievement since it reflects their commitment to high quality medical education and patient care," said Manuel Schydlower, M.D., assistant dean for medical education. "All 10 Texas Tech El Paso residency programs are now fully accredited by the ACGME."

MARTINEZ NEWS & PUB ASSOCIATE DIRECTOR

Suzanna Cisneros Martinez has assumed the role of associate director of news and publications at Texas Tech University Health Sciences Center. She previously served as associate director of video services for Texas Tech's Department of News and Publications.

"TTUHSC faculty and staff have worked with Suzanna extensively in the past on video and other projects," said David R. Smith, M.D., president of TTUHSC. "She has a solid knowledge of the Health Sciences Center, and we all look forward to working with her on new projects to promote Texas Tech."

Martinez, a lifelong Lubbock resident, brings invaluable knowledge of the community and West Texas, said Cindy Rugeley, associate vice chancellor for news and information at Texas Tech. "Suzanna has been instrumental in developing the 'President's Prescription' television programs with Dr. Smith," Rugeley said. "I know she will work hard to ensure that TTUHSC is well represented here in Lubbock and at the state and national level."

GRADUATE PROGRAM AVAILABLE ONLINE

LUBBOCK - A new master of vocational rehabilitation program at Texas Tech University Health Sciences Center will allow students to take courses while spending only about 10 percent of their time in a classroom.

While two "pilot" courses currently are available, the program will officially begin in January, said John Vellacott, program director. "This degree program will be 90 to 95 percent online using technology such as the Internet and Healthnet," he said. "We hope in the next two years to use video streaming technology, but for now most courses are available from virtually anywhere via the Internet." Online technologies also are fully compatible with disabled access requirements, he noted.

Paul Brooke, Ph.D., dean of the TTUHSC School of Allied Health, said very few master of vocational rehabilitation programs are available in the United States. "Texas Tech Health Sciences Center is repeatedly on the forefront of health care delivery with innovative programs like this," he said. "And soon, people will be able to take these graduate courses from anywhere in the world."

Vocational rehabilitation is defined as the process of assisting individuals in accessing meaningful and gainful work or employment, Vellacott said. "This is done by identifying strengths, interests and aptitudes of individuals, and then matching them with the work opportunities or career options that are available to them by developing an action plan. Then follow-up is needed to ensure that the action plan works.

"Vocational rehabilitation is really about planning and counseling," he said.

MEDICAL STUDENTS LEADERS FOR TTUHSC

Several Texas Tech students are providing examples of how medical students can collectively fight to improve patients' health.

Aaron Miller, a fourth-year Texas Tech medical student, was appointed in July to a one-year term on the Liaison Committee on Medical Education by the American Medical Association's Council on Medical Education, a co-sponsor of the committee along with the Association of American Medical Colleges.

"This will be a great learning opportunity into the maintenance and operation of a medical school," Miller said, who plans a career in academic medicine after his ophthalmology residency.

Teams from the LCME conduct site visits to medical colleges in the U.S. and Canada and then report back to the full committee, which then votes to grant or deny accreditation status to the medical college in review.

Student members on the committee participate as team surveyors responsible for gathering data during the team's site visit as well as help prepare the team's report for review by the full committee. Miller will serve on a team scheduled to make its site visit in February.

"Aaron has displayed the leadership qualities and has the depth of knowledge to serve on such a committee," said Joel Kupersmith, M.D., dean of TTUHSC's School of Medicine.

And in a major victory for childrens' health, TTUHSC medical students Chris Clinkscales and Ashis Barad authored the resolution to increase the excise tax on tobacco, which passed with a majority vote in the Texas Medical Association House of Delegates. Their resolution persuaded the Texas Medical Association to lobby the Texas Legislature to raise taxes on tobacco products, with the money generated to be used for effective anti-smoking programs for the children of Texas.

Texas Tech medical student Angela Siler-Fisher was elected student delegate for the American Medical Association-Medical Student Section in June. She is the single medical student voice in the House of Medicine, which consists of physician representatives from all aspects of medicine both by region and specialty. She is one of five voting members of the AMA-MSS Governing Council. But as delegate, Siler-Fisher is the only student who actually speaks on the floor of the AMA House of Delegates.

"I am the single student voice," she said of the one year office. "I have the responsibility of representing the 44,700 medical students across the country."

SOM GRADUATE MAKES TV DEBUT

When Dustin Reid was a medical student at Texas Tech School of Medicine in Amarillo, he quickly made a name for himself both academically and personally. In October, Reid made his national debut on The Learning Channel's "Trauma: Life in the ER."

The Learning Channel visited Good Samaritan Regional Medical Center in Phoenix, where he is a surgical resident. Reid was profiled on the show that gives viewers a glimpse into emergency rooms across the country.

At first Reid said he didn't want to do the show, where cameras stalk the doctors as they work on their cases. But the awkward feeling of having his every move recorded soon went away. Reid was shown testing for nerve damage on a victim of a domestic dispute and probing a knife wound to see if it pierced the abdominal cavity. Reid reattached a man's scalp with such careful precision the stitches were hardly visible under his patient's hair.

When he was a medical student in Amarillo, Reid's prankishness reached legendary status. That sense of humor came through as he worked with his patients and the staff at the hospital. Reid said his sense of humor helps set his patients at ease.

"I have a great time, even when I'm at work," he said.

Dr. Marita Sheehan, M.D., M.P.H., assistant academic dean at Texas Tech School of Medicine in Amarillo, said people don't remember Reid without a smile on his face. He has a very upbeat personality and a contagious sense of humor, but she said he was always serious when it came time to get to work.

"To have a combination of being very bright and being so personable is very unique," Sheehan said.

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The Last Word: The True Test of Caring - It's OK To Cry
By David R. Smith - President, TTUHSC

In medical jargon, we often have a way of communicating that efficiently gets to the essentials. But with efficiency, one frequently misses the entire point. I can remember with great fondness and admiration one of my first patients as a senior medical student. He was a 34-year-old white male who was in his usual state of good health until two weeks prior to admission when he noticed blood in his urine. STOP!!!! This does not define this man. I have fallen back into the trap of communicating with the utmost efficiency but failing to tell the story.

His name was Patrick, or Pat, as he liked to be called. He was a young executive with a wonderful family huddled around him as we wheeled him on his stretcher to his room on the seventh floor. His young wife clutched at his left arm and seemed drawn and pale - the look of someone who has not slept for several nights. His two children were mesmerized by all the lights and smells of a hospital.

Patrick and his wife had recently purchased their first home, a two-story house with four bedrooms, anticipating an expanded family in the years to come. Patrick was stoic and even somewhat annoyed that this medical interlude had pulled him away from his new job and the comfort and smells of a new home. The culprit of this theft of time and family was a rare form of leukemia that was replacing his infection-fighting white blood cells with a chaotic cousin. And his platelets, a kind of circulating container of glue designed to plug holes in blood vessels, were being crowded out of his bone marrow by this sinister form of white blood cell. Pat was a battleground of aberrant genetics and uncontrolled cell growth. The blood in his urine was a clue to this hideous assault on his body.

In the next three weeks, Patrick and his family became my tutors. They anticipated my early morning interruption of their fitful sleep and held out hope that I could bring sense to this unthinkable disease which had overtaken Pat's bone marrow. Pat and his wife hung on my every word, looking for hope but expecting the truth. It was easy at times of personal discomfort to revert back into the scientific jargon of medicine, a kind of hideout for my insecurities and frustration. Pat just wanted the truth - a prescription with more potency than anything I could muster from the hospital pharmacy. He did not want false hope nor did his gracious family. My time and ability to listen superceded any of my abilities to recite facts and statistics regarding his conflict with his own bone marrow.

Without question the most powerful tool in my medical armamentarium was that of touch. For by my willingness to touch Patrick, I expressed my concern and respect for the man and family in front of me. This was not the "leper" from biblical times and this disease did not create a lesser man. Touching was healing and acceptance. There are times when there is nothing else to be done, but one can always express compassion and caring through this powerful therapeutic modality. There is no reimbursement code for "touching" or a body of scientific literature that definitively extols its virtue, but Patrick and his family demonstrated its effectiveness to me.

My maturation as a healer reached adulthood with this man and his family. I remember the morning well. The sun was shining through the blinds and, in a strange way, illuminating Pat. He sat up abruptly that morning wanting to demonstrate his unwavering spirit, perhaps as much to me as to his family. Chemotherapy had been very difficult and his platelets were not holding up well to the tug of war between his disease and treatment. I can remember his smile that morning just before his face became blank and he fell backward onto his pillow. The glue in his platelets had failed him and he had suffered a terrible hemorrhage into his brain. Our efforts to reverse this tragedy were futile, as were my own efforts to rationalize this death.

I do know that the only relief I could give to a grieving family and a grieving doctor-to-be was to share this moment with Patrick's family and cry. There was no embarrassment on my part, only comfort and a feeling of contribution and understanding about a great man and his family. I am convinced that I will never forget Patrick, nor should I.

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