September–October 2014 volume 9 • no. 5 medical staff news save these dates : cancer center moves toward specialty clinics Several Mass General subspecialists now at Emerson 4 Active Staff Meeting The Mass General Cancer Center at Emerson HospitalBethke has made impressive progress toward the longstanding goal of creating specialty clinics that bring a new level of academic expertise to the community. This directly benefits area patients, who need to travel to Boston less often. Tuesday, September 9, 12:00 noon Cheney Conference Room 4 MCDMMS Luncheon Tuesday, September 30, 12:00 noon Cheney Conference Room 4 Annual Physician Recognition Dinner Thursday, October 16, 6:15 pm Nashawtuc Country Club 4 MCDMMS Annual Breakfast Friday, October 24, 7:30 am breakfast 8:00 am speaker Stephen Corn, MD, on Medical Marijuana 4 Medical Education Conferences Fridays at 8:00 am, Cheney Conference Room • Glucose Monitoring & the “Virtual Pancreas” September 12 Steven J. Russell, MD Diabetes Unit, Massachusetts General Hospital • Fertility Preservation September 19 Sam Pauli, MD Reproductive Endocrinology, Emerson Hospital • When the Throat Makes Weird Noises September 26 Jennifer Setlur, MD Otolaryngology Service, Mass Eye and Ear at Emerson Hospital • The D-Lightful Vitamin D for Health October 3 Michael F. Holick, MD Department of Medicine Boston Medical Center • The Management of Breast Cancer October 10 Amy Comander, MD Hematology/Oncology Service, MGH-Emerson • An Update on Multiple Sclerosis October 17 James M. Stankiewicz, MD Neurology Service, Brigham and Women’s • Optimizing Cognitive Aging October 31 James Ellison, MD, MPH Geriatric Psychiatry Program, McLean Hospital M e d i c a l S ta f f N e w s (Right to left) Ashok Muniappan, MD, a Mass General cardiothoracic surgeon, attends the weekly thoracic oncology tumor board at Emerson, along with other physicians, including Jon DuBois, MD, and Jack McGrath, MD. “We’ve made a good deal of programmatic progress in bringing sub-specialized experts to Emerson,” says Jon DuBois, MD, medical director of medical oncology. “We’ve always had specialists capable of handling most of the cancer cases we see. What we continue to build at Emerson echoes the clinical model that takes place in Boston.” continued on page 2 4 medical library e - resources continue to expand Greg Martin, MD, Chief Medical Officer and Senior Vice President for Clinical Affairs If you’ve visited Emerson’s medical library recently, you may be wondering where all the journals have gone. The answer: to the cloud. Since 2011, the library’s collection has gradually migrated to an electronic format. Instead of dusty, bound journals, we have multiple workstations from which you can access our collection online. As those with remote access know, you don’t even have to be on campus. TDNet provides constantly updated, single-source access to all of the library’s electronic resources. If you have Citrix and an IP address that is recognized as part of the Emerson network, you have access to TDNet without the need for an additional user name or password. To open TDNet, look under the Clinical References tab on the Emerson intranet home page, and click on Electronic Journals. This will bring you to the TDNet welcome screen, from which you can search our e-resources. TDNet can also be accessed directly on the web at tdnet.com/ emerson. continued on page 2 i s ava i l a b l e o n t h e h o s p i ta l i n t r a n e t at h t t p : / / i n t r a n e t . e m e r s o n h o s p . o r g . 4 1 cancer center continued from page 1 The thoracic oncology clinic exemplifies this approach to comprehensive, sub-specialized care. Ashok Muniappan, MD, a Mass General cardiothoracic surgeon, attends the weekly tumor board at Emerson and consults on patients. Dr. Muniappan is beginning to perform minor thoracic procedures and minimally invasive surgery at Emerson—mainly VATS (video-assisted thorascopic surgery) wedge procedures to remove lung nodules. In recent months, other Mass General colleagues have begun spending time at Emerson, including for attendance at tumor boards. With the addition of Amy Comander, MD, a medical oncologist, the cancer center now has two dedicated breast oncologists. Each Tuesday, Dr. Comander joins Susan Sajer, MD, to provide expert opinion and second opinions. “Lung cancer is an area where we are steadily becoming fullservice,” notes Jack McGrath, MD, chief of radiation oncology. “Emerson radiologists offer low-dose CT screening for lung cancer, and we again have surgery being performed thanks to Dr. Muniappan.” Janet Murphy, MD, a Mass General medical oncologist who specializes in gastrointestinal cancer, is now on site at Emerson each Thursday, when she attends the center’s tumor board. Dr. Murphy adds expertise to the care of patients with GI cancer, whether it is provided at Emerson or, in the case of more complex cases, at Mass General. On the radiation oncology side, Dr. McGrath is hopeful that the cancer center will be able to offer patients stereotactic body radiation in the future. The therapy delivers a targeted radiation dose to a tumor and is effective in treating lung cancer. Finally, Amy Bessnow, MD, and James Weitzman, MD, hematologist-oncologists from Mass General, now work closely with Dr. DuBois with the goal of developing specialty clinics in both benign and malignant hematology. Mass General oncology subspecialties: “With the addition of all these subspecialists, we expect our volume of patients to grow as we lessen the need to travel into Boston and further realize our goal of providing care close to home in the community setting,” notes Dr. DuBois. Amy Comander, MD – breast cancer Ashok Muniappan, MD – cardiothoracic surgery Future plans include full-service clinical trials Janet Murphy, MD – gastrointestinal cancer Amy Bessnow, MD, and James Weitzman, MD – hematologic oncology Additional expertise at tumor boards and for consults The thoracic oncology clinic serves as the model for other multidisciplinary clinics, including breast and GI oncology. In addition to the weekly thoracic oncology tumor board, Emerson holds a breast tumor board and a multispecialty tumor board, where all other cases are reviewed, twice monthly. “We’d like to expand that list to include other specialties,” says Dr. McGrath, who attends the breast, lymphoma and lung cancer tumor boards at Mass General. medical library e - resources With increasingly specialized cancer care comes the need for a clinical trials program at Emerson. “The physicians from our home base, Mass General, will help with the development of a new, comprehensive clinical research program,” says Dr. DuBois. Dr. McGrath agrees. “We want to be in the position to perform research and offer our patients full-service clinical trials,” he says. As the cancer center evolves, the medical staff is aware of the need to maintain a commitment to personalized care. “From the first discussions about creating a cancer center at Emerson, the question was: can we provide cutting-edge, expert care in the community with the personal touch?” says Dr. DuBois. “We’ve done that. We are excited to build the academic and scientific side of oncology at Emerson, and we’ll continue to deliver the compassionate care for which the center is known.” continued from page 1 We currently have more than 300 electronic journal subscriptions from which you can read or download the full-text version. In addition, TDNet provides access to more than 3,000 journals through PubMed and other sources—a combination of full-text and abstracts. In the future, we will also have electronic access to our core collection of textbooks. Plans are underway to renovate the medical library to bring it in line with its current function, which is to support primarily electronic, rather than print, media. We will ensure that the library continues to offer a comfortable environment where you can read newspapers and research reference materials. At Emerson, we pride ourselves on providing a personal touch in all the services we provide. Our librarian, Melinda Marchand, will continue to be there to assist you. Melinda is an expert in searching the medical literature and will be glad to perform searches for you that support your clinical activities. She is also available to teach you how to navigate TDNet and take full advantage of the library’s resources. In fact, Melinda has been instrumental in ensuring that our medical library resources at Emerson have been steadily modernized. As a result, we have a lot less paper but provide access to far more information. get to know: Charles Wasserman, MD I probably put too much pressure on myself, as caring for kids made me anxious. Their constant developmental changes made it seem as though I was encountering a new patient with each visit. When did you decide to go into psychiatry? For Charles Wasserman, MD, psychiatrist, a typical day could start with ECT and proceed to seeing patients on North 5, in the Emergency Department and throughout Emerson. There were clinicians in his family—an uncle who was a surgeon and a brother who is an optometrist—but early on, Charles Wasserman, MD, an Emerson psychiatrist, says he gravitated toward political and social interests. He served as a VISTA volunteer with a legal services organization in rural Indiana and considered practicing pediatrics before an emergency department rotation sparked Dr. Wasserman’s interest in mental health. What drew you to attend medical school? I took a circuitous route. After VISTA, I applied to law school and had a job working with developmentally disabled adults and children. I was working with a 12-year-old boy who had cerebral palsy and realized how much I enjoyed it. I believe that was the first time I seriously thought about clinical work—initially as a physical therapist. Then a friend encouraged me to go to medical school. When I got to Tennessee for medical school, I thought in terms of pediatrics because I always felt comfortable working with kids. But that first pediatric rotation changed my mind. I had studied psychology in college at Albany, but while doing an emergency department rotation in medical school I began seeing a lot of patients with behavioral health issues. I was fascinated by the mental health problems I observed, which led me to apply for a psychiatry residency at Stony Brook. Residents rotated through the geriatric psychiatry clinic there, and I found I enjoyed working with elders. I became specifically interested in the overlap of medical and psychiatric problems. I followed my residency with a fellowship in geriatric psychiatry at McLean Hospital, where I stayed on as an attending. The hospital was looking to establish relationships with nursing homes; I helped develop their consultation program. What are your observations of older patients? I think most older folks are fairly well adjusted, content with their lives and have conquered age-related developmental challenges they may have had. I don’t find that most older people tend to be in despair or worried about death. Having said that, many of the folks I do see have been dealing with problems, such as medical issues, pain or bereavement and don’t have the resilience one needs to deal with life’s losses, both physically and emotionally. What brought you to Emerson? With a growing family, I was looking to be able to work closer to home. Emerson was looking for someone to practice inpatient adult psychiatry and to offer ECT—electroconvulsive therapy— so I joined the medical staff in 2005. Although I hadn’t performed ECT since residency, with a refresher course at Duke I was able to continue the service, which is provided in the PACU. We’ve kept it small—no more than three patients per week. ECT can be effective for major depressive disorder, psychotic depression and in patients who exhibit mania or catatonia. In coming to Emerson, I returned to general adult psychiatry and performing ECT, but I continue to see some geriatric patients, including as a consultant for dementia units at two nursing homes. What is a typical day like for you? I see a caseload of seven to ten patients on the North 5 unit who have the full range of psychiatric problems. They might include an 18-year-old with first-break schizophrenia, geriatric patients, patients being detoxed for alcohol and opiate addiction, as well as individuals with depression and bipolar disorder. There are family and team meetings to attend, and I help cover the psychiatry consults throughout the hospital. I’m on call one day/night a week for the Emergency Department and also on North 5, and I perform ECT three mornings a week. What do you enjoy in your spare time? I spend a lot of time with the kids. I coach soccer and baseball, volunteer at school, and we’ve started fishing. I’m the official baiter. We’ve gone on road trips to see family in the Midwest and Long Island, and in 2011 we all went to Paris where I attended an Alzheimer’s conference. I enjoy exercising, and I’m also interested in getting back to things I did before we had kids. For example, I’ve always loved music, so about two years ago I bought an electric guitar and started taking lessons. I stopped taking lessons, but I still have the guitar. snapshot Age:58 Grew up in: Long Island, New York Resident of: Concord (nine years) Personal: Married; children age seven, eight and ten Reading habits: Biographies of Bob Dylan, Don Zimmer; The Eve of Destruction: How 1965 Transformed America by James T. Patterson 3 charles s . keevil , jr ., md , annual lecture is established An annual lecture has been established to memorialize Charles S. Keevil, Jr., MD, who died in April. Dr. Keevil was an internist at Lincoln Physicians and beloved member of the Emerson medical staff since 1959. A task force was charged with identifying a way to memorialize Dr. Keevil and recommended that a lecture be established in his name. Members of the medical staff pledged $2,000, which was matched by Emerson’s administration. “This is a good example of the medical staff and hospital administration working together—in this case, to honor Dr. Keevil, who was a great man,” says James Street, PhD, MD, chair of anesthesia and president of the medical staff. A lecture committee recently formed and will begin planning the first lecture, which is tentatively scheduled for spring 2015. Committee members include Robert Cantu, MD, Donald Driscoll, MD, Sheila Kennedy, MD, Gregory Martin, MD, Robert Stern, MD, and Christine Schuster. The committee decided that the lecture should be open to the entire Emerson community. “This reflects the fact that Dr. Keevil meant so much to so many different people,” notes Dr. Street. “We anticipate that physicians, staff and volunteers, as well as Dr. Keevil’s patients and family, will want to attend the lecture.” Most who knew Dr. Keevil have a story or recollection. “I had the opportunity to provide his anesthesia care when he had shoulder surgery, which was performed by Dr. Re,” says Dr. Street. “Not surprisingly, Dr. Keevil was charming, humble and a delightful patient in every way. It was an honor to take care of him.” clinical pearls practice suggestions from the medical staff Submitted by Priyal Amin, DO Allergist/Immunologist • Physicians should be aware of a medication for treatment of allergic asthma that has proven to be highly effective. Omalizumab (Xolair) is the first monoclonal antibody approved by the FDA for patients with asthma; as such, it represents a new class of medication. It prevents asthma exacerbations, decreases the required dose of inhaled and oral corticosteroids, decreases rescue medication use, improves pulmonary function and increases overall quality of life. Omalizumab is appropriate for those between ages 12 and 65 and is generally well tolerated. Although the greatest efficacy is seen in those with moderate to severe asthma, patients are universally pleased with omalizumab—mainly because they are relieved to stop or decrease their intake of oral corticosteroids and thus avoid the numerous negative side effects associated with oral steroids. The medication also is associated with fewer asthma-related hospitalizations and emergency room visits and, in general, a reduction in the cost of asthma care. What have you learned in your practice? Share your “pearl” by sending your suggestion to Bonnie Goldsmith at bgoldsmith@emersonhosp.org. If it is published, you will receive a $100 gift certificate to Legal Sea Foods. emerson physicians cycle to support cancer treatment and research Three Emerson physicians participated in the Pan-Mass Challenge (PMC), the annual cycling event that raises funds for Dana-Farber Cancer Institute, on August 2 and 3. Michelle Sanders, MD, pediatrician, Jack McInnis, MD, orthopedic surgeon, and Jon DuBois, MD, medical oncologist (not shown), were among 5,500 cyclists who braved the worst weather in the bike-a-thon’s 35 years to raise more than $31 million for cancer treatment and research. Cyclists travel across Massachusetts on one of 12 routes, logging between 25 and 190 miles. There is still time to donate; the PMC is accepting donations through October 1. 133 ORNAC, Concord, MA 01742 978-369-1400 www.emersonhospital.org 4 If you have comments on Medical Staff News or would like to suggest a topic for a future issue, please contact Bonnie Goldsmith at bgoldsmith@emersonhosp.org or a member of the editorial committee: Drs. Stephen Hoenig, Greg Martin, David Rose, Stephen Schloss, James Street or Henry Vaillant. FSC LOGO