MyGeorgetownMDFall 2018

A MedStar Georgetown University Hospital Publication

IN THIS ISSUE 2 Daughter’s Immune Cells Defeat

Father’s Cancer4 Philanthropic Support Allows Early

Childhood Innovation Network to Thrive

5 Shoulder Replacement Surgery Provides Pain Relief

MedStar Georgetown’s First Proton Therapy Patient Grateful for Highly Precise Treatment to Fight Cancer By Marianne Worley

Kidney Transplant Recipient Finds Her Donor Because of Mutual Love for Rescuing Dogs By Susan Walker

A love of dogs brought together kidney donor Gary Simmont, 64, of Pasadena, Maryland, and kidney recipient 49-year-old Laurel Weetall of Germantown, Maryland. They met through a German Shepherd rescue group a few years ago. When Laurel shared with her Facebook friends that she needed a kidney due to a painful condition

3 Type 2 Diabetes: Managing Your Risk

Proton therapy helped save Martha Ramos’ life.

After receiving treatment for a recurrent brain tumor at MedStar Georgetown University Hospital, the 54-year-old mother of two is back to enjoying a happy and active life in Germantown, Maryland.

Her success is due in part to a cutting-edge treatment called proton therapy—so cutting-edge, in fact, that Martha was the very first patient to receive proton therapy

when the MedStar Georgetown University Hospital Proton Therapy Center opened its doors in March.

MedStar Georgetown is the first and only hospital in the Washington, D.C., metropolitan area to offer proton therapy and the first in the world to offer proton therapy with HYPERSCAN™ technology. HYPERSCAN produces beams that are sharper than other proton systems and treats patients faster.

Laurel Weetall received a kidney transplant from a friend she met through a German Shepherd rescue group.

Martha Ramos was the first patient to receive treatment at MedStar Georgetown University Hospital’s Proton Therapy Center. Here, she celebrates at the grand opening with Michael C. Sachtleben, President of MedStar Georgetown University Hospital and Senior Vice President of MedStar Health (left), and Anatoly Dritschilo, MD, Professor and Chairman, Department of Radiation Medicine, MedStar Georgetown University Hospital (right).

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Daughter’s Immune Cells Defeat Father’s Cancer By Leslie A. Whitlinger

When a CT scan revealed some unidentifiable and suspicious spots throughout Dean Brooks’ torso, the otherwise healthy 47-year-old didn’t want to take any chances. Instead of searching for a specialist in his Southern Maryland community, Dean and his wife drove straight to MedStar Georgetown University Hospital where he knew he would get exactly what he needed.

Especially if he had cancer.

“Over the years, I watched as a friend of my son’s and the husband of one of my colleagues both underwent cancer treatment at MedStar Georgetown,” he says. “And I was so impressed with the caliber of care and compassion they received. I just

knew if I ever needed to

be hospitalized for something serious, that was the place for me.”

As it turns out, Dean’s instincts were on target. He had an extremely aggressive variant of non-Hodgkin lymphoma—known as “double-hit” lymphoma—which would, indeed, need the full resources of MedStar Georgetown, home to the renowned Lombardi Comprehensive Cancer Center—the only National Cancer Institute-designated comprehensive cancer center in the Washington region. Within days, its experts had him on the first line defense, powerful chemotherapy.

But 12 months later, Dean relapsed. And that’s when he and his family opted for his best chance at an actual cure: stem cell transplantation.

Fortunately for him, MedStar Georgetown has the area’s only Stem

Cell Transplant and Cellular Immunotherapy Program. It’s also one of just 100 or so programs in the United States to be recognized by the Foundation for the Accreditation of Cellular Therapy

for all adult cell-based therapies: autologous (using a patient’s own cells), allogeneic (using cells from a donor), and the newest advancement, CAR T-cells.

“Because of Dean’s relative youth and previous health, we believed he had a good shot at getting better,” explains Pashna N. Munshi, MD, a hematologist and associate director of the Stem Cell Transplant and Cellular Immunotherapy Program. “But while some cancers can be cured using

the patient’s own stem cells, double-hit lymphoma is not one

of them. We needed to find a well-matched, related donor.”

Dean’s two adult children and his brother volunteered. His then-23-year-old daughter Taylor was the best candidate.

On November 8, 2017, Taylor’s stem cells were removed from her body through an IV. Hours later, her young and healthy cells were infused into her father’s body, planting the seeds for a whole new immune system to grow and overcome his cancer. And unlike solid organ transplant, both procedures were done without any incision or surgery for either patient or donor.

Dean was home with his family in Waldorf in time to celebrate Christmas together. By mid-April 2018—six months after transplant— he returned to work. Today, he’s cancer-free.

“Fighting cancer is hard, time-consuming, and a major challenge,” Dean admits, “but MedStar Georgetown and the stem cell process have given me and my family a real second chance at life.”

That’s been the goal of Scott Rowley, MD, director of the Stem Cell Transplant and Cellular Immunotherapy Program, ever since the program began a mere five years ago.

“Stem cell transplantation and cellular immunotherapy can offer a definitive survival advantage for many patients,” he says. “As the only full-fledged, full-service transplant program between Baltimore and Central Virginia, we’re honored to meet the needs of our area’s most critically ill residents, close to home.”

For more information, visit MedStarGeorgetown.org/StemCell or call 202-444-3736 to make an appointment.

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Thanks to a stem cell donation from his daughter Taylor, right, Dean Brooks is healthy and enjoying life.

According to the Centers for Disease Control, over 9 percent of the adult population of Washington, D.C., has a diabetes diagnosis. About 90 percent of diabetes cases nationwide are type 2 diabetes, a condition that is often preventable.

Below, you’ll find some tips on reducing your risk from the Centers for Disease Control (CDC) and my experience in the MedStar Georgetown Emergency Department.

Type 2 Diabetes: Managing Your RiskBy Brendan Furlong, MD, Chief of Service, Emergency Department, MedStar Georgetown University Hospital

women during pregnancy; type 1 diabetes, a non-preventable autoimmune disease; and type 2 diabetes, a metabolic condition that begins as a condition called prediabetes. Prediabetes is diagnosed when a person’s blood sugar levels are unusually high, but not high enough to qualify for diabetes diagnosis.

Risk factors for prediabetesPrediabetes typically does not cause any symptoms, so many people do not know that they have this condition. It is important to know whether you are at risk.

Risk factors for prediabetes include a high body mass index (BMI), infrequent exercise, a family history of the disease, a personal history of developing gestational diabetes during pregnancy, polycystic ovary syndrome (PCOS), and high blood pressure. People aged 45 and older are at elevated risk, as are people of African American, Alaska Native, American Indian, Asian American, Hispanic, or Pacific Islander heritage.

Prediabetes can be diagnosed with a simple blood test. If you have a high body mass index (BMI) and one or more other risk factor, you should talk to your primary care physician about whether a blood test might make sense for you.

Healthy habits make a differenceIf left untreated, most people with prediabetes will develop type 2 diabetes within ten years. Lifestyle changes can often stop prediabetes from progressing. By managing your weight, exercising, and eating a healthy diet, you can dramatically lower your risk for type 2 diabetes.

Possible complications of type 2 diabetesType 2 diabetes can be managed by carefully monitoring blood sugar, making lifestyle changes, and taking medication and/or insulin injections. If the disease is left untreated or improperly treated, however, it causes serious issues. These include problems affecting the heart, kidneys, eyes, circulatory, and nervous systems. Even prediabetes can cause damage to the body over time.

In the Emergency Department, we sometimes see the most severe effects of untreated or poorly controlled diabetes. Dangerously high or low levels of insulin or glucose in the blood can trigger medical emergencies, including kidney failure, strokes, and comas. Although these severe diabetic complications are rare, they are a reminder that it is important to take prediabetes seriously.

Visit MedStarGeorgetown.org/ED for more information about the Emergency Department.

Brendan Furlong, MD, discusses type 2 diabetes.

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By managing your weight, exercising, and eating a healthy diet, you can dramatically lower your risk for type 2 diabetes.

Lifestyle changes can dramatically lower your risk for type 2 diabetes.

What does it mean to have diabetes or prediabetes?The body breaks down food into glucose, a type of sugar. A hormone called insulin allows glucose to leave the blood and enter cells, fueling the body’s functioning. People with diabetes produce too little insulin or cannot use insulin effectively.

There are three types of diabetes: gestational diabetes, a temporary form of the disease that can affect

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Philanthropic Support Allows Early Childhood Innovation Network to Thrive By Kate Mattern

nation’s capital. ACEs are highly stressful events that commonly impact children and families, including untreated maternal depression, abuse or violence at home, hunger, and unsafe housing. When pregnant women or young children are exposed to ACEs, these experiences can trigger changes in children’s development, a reaction known as toxic stress.

Toxic stress is associated with long-term changes to a child’s brain functioning, behavior, and educational achievement—as well as increased risks for chronic health conditions later in life, including obesity, cancer, and mental illness. More than half of children in Washington D.C., experience at least one ACE. However, positive adult support and strong relationships between children and caregivers can mitigate the negative effects of ACEs.

“During the first five years of life, the brain is developing more rapidly than at any other time,” says Dr. Biel. “Early life experiences—both positive and negative—have a lasting effect on physical and mental health. In order

To support ECIN, visit MedStarGeorgetown.org/Contribute or call the Office of Philanthropy at 202-444-0721.

to support children’s well-being at this critical age, we need to develop effective strategies to best support the adults who care for them.”

Collaborating closely with community leaders and families, ECIN supports safe and nurturing environments in order to buffer against the effects of ACEs and enhance resilience. This work includes mental health and developmental supports for children and parents in pediatric clinics; training and support for early childhood educators; training parents and teachers in mindfulness skills to improve adult well-being and enhance caregiver-child relationships; and mental health screening and treatment for pregnant women. ECIN includes a strong clinical research team and a legislative advocacy group to promote citywide policies in health and education that will promote child and family well-being.

A $6 million, five-year commitment to MedStar Georgetown and Children’s National Health System from the J. Willard and Alice S. Marriott Foundation in 2016 set the stage for philanthropic support of ECIN. Since the Marriott family’s groundbreaking gift, the Howard and Geraldine Polinger Family Foundation, the Bainum Family Foundation, and D.C. Health have all joined the community of ECIN funders.

“The J. Willard and Alice S. Marriott Foundation's investment has sparked a wave of giving,” says Pam Maroulis, the Hospital’s vice president of Philanthropy. “With ongoing philanthropic support from foundations and individuals, ECIN will sustainably expand its reach and services to children and their families for years to come.”

ECIN partners with Educare, one of the nation's most effective early childhood education schools.

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The Early Childhood Innovation Network (ECIN) is dedicated to helping the smallest members of our community grow up to accomplish big things.

Formed as a partnership in 2016 between MedStar Georgetown University Hospital and Children’s National Health System, ECIN develops strategies to support children and caregivers in Washington, D.C., and advocates for positive changes to public policy. ECIN has grown into a network that includes community organizations, educators, government and social services agencies, and local healthcare providers. Matthew Biel, MD, MSc, chief of Child and Adolescent Psychiatry at MedStar Georgetown University Hospital, serves as co-director with Lee Beers, MD, a pediatrician and Medical Director of Municipal and Regional Affairs at Children’s National Health System.

ECIN was created to promote new strategies to address Adverse Childhood Experiences (ACEs) in marginalized communities in the

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Shoulder Replacement Surgery Provides Pain Relief By Jennifer Davis

Chris Furin has a sweet job.

A self-taught cake designer, he runs his own business, Cakes by Chris Furin. Chris bakes and decorates extraordinary custom-made confections and delivers them all over the Washington, D.C., area. He has even baked for the White House.

For years, however, daily and debilitating shoulder pain made his life anything but a piece of cake. It started in his 20s, a constant ache caused by intense bodybuilding and weightlifting. By the time he was in his 40s, the pain was so bad that delivering cakes was becoming difficult and sleeping felt impossible.

“I’d wake up every night. My shoulder would be stiff, and I would be in so much pain. Nothing would fix it,” Chris recalls. “That was the point where I said, ‘I can’t take this anymore, I have to do something.’”

Chris reached out to Brent Bowie Wiesel, MD, chief of the Shoulder Service at the MedStar Orthopaedic

Thanks to shoulder replacement surgery, Chris Furin is delivering his amazing cake creations, without pain.

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Institute at MedStar Georgetown University Hospital, to learn about total shoulder replacements.

“You don’t realize how much you move your shoulder until you have a problem,” Dr. Wiesel says. “You can rest a bad ankle or knee, but a painful shoulder hurts all the time.”

Dr. Wiesel knows this firsthand. He injured his own shoulder while preparing for the 1996 Olympics as a member of the USA Canoe/Kayak whitewater slalom team. The injury and two subsequent surgeries prevented him from competing in the Olympics, but he returned to the sport recreationally and went on to focus his medical practice on helping others with similar injuries.

“You know it’s time for a replacement when joint surfaces that used to be smoother than ice start to look like a gravel road. That is what causes the pain,” Dr. Wiesel explains. “Many people put off surgery hoping the pain will go away, but it just worsens over time.”

Specialized computer software allows Dr. Wiesel and his team to plan out surgeries in 3D, create custom surgical instruments, and use patient-specific implants that closely replicate each individual patient’s own bone. These advanced technologies allow for the best possible outcomes, with 85 percent of modern shoulder replacements working well even after 15 years.

Chris had his right shoulder replaced in November 2015. It reduced his pain so dramatically that he got the left one replaced just over a year later. After surgery, patients typically spend one night in the hospital, six weeks in a sling, and four months improving

MedStar Georgetown University Hospital is part of the MedStar Orthopaedic Institute, with more than 35 orthopaedic surgeons and locations throughout D.C., Maryland, and Virginia. Visit MedStarOrthopaedicInstitute.org for a complete listing of physicians and locations.

their strength and range of motion in physical therapy.

“I would definitely recommend this to someone who is considering it. I never wake up at night in pain anymore and to not be in constant discomfort is just amazing,” he says.

Chris says Dr. Wiesel was realistic, telling him he would regain 70 percent of his mobility and drastically reduce his pain. Post-surgery life has required a few adaptations, such as exercising in other ways instead of lifting weights, but it’s been worth it.

“My wife says I am less grumpy now,” he says with a laugh. “She’s right. Life had gotten a little rough because when you are in pain for so long, it affects everything. It’s about so much more than your shoulder. You can’t do the things you love and that is tough psychologically. It’s all so much better now.”

Dr. Wiesel hears this often. “After surgery, patients often tell me that the only thing they are upset about is that they didn’t do it sooner. When they’re no longer living with shoulder pain, life is so much better.”

For more information, visit MedStarGeorgetown.org/PainRelief or call 202-295-0549 to make an appointment.

Meet Brent Bowie Wiesel, MD

Visit MedStarGeorgetown.org/ WieselVideo to watch Dr. Wiesel discuss shoulder and elbow surgery.

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MedStar Georgetown’s First Proton Therapy Patient Grateful continued from page 1

My recovery from the proton therapy was surprisingly fast.

Martha Ramos, Patient

For more information, visit MedStarGeorgetown.org/ProtonNow or call 202-444-4639 to make an appointment.

“I was a little bit nervous to be the first patient at MedStar Georgetown to get proton therapy,” Martha says, “but I trust my medical team wholeheartedly. After the first treatment, I knew what to expect and was very happy.”

Martha was first diagnosed with a brain tumor called oligodendroglioma in 2006. She had surgery to remove the tumor, but in the fall of 2017, routine follow-up imaging revealed that her tumor had returned.

In January 2018, MedStar Georgetown Neurosurgeon Vikram Nayar, MD, removed the second tumor, about the size of a golf ball, in a very complex operation. However, there were some cells deep within Martha’s brain that couldn’t be completely removed with surgery.

“There was a little bit of tumor that was left after her surgery,” explains Martha’s Neuro-Oncologist, Deepa Subramaniam, MD, director of the Brain Tumor Center at MedStar Georgetown. “She needed radiation after the surgery to get rid of what was left.”

For Martha, nothing mattered more than pursuing treatment that would allow her to have more time to be a mother to her children. “I want to be very healthy so I can be there for them and help them in life,” she says.

Ensuring that the remaining cells were removed with as few side effects as possible was important to both Martha and her care team.

“Martha has a long life expectancy, so we wanted to eradicate the remaining cells from this second tumor while still preserving her excellent quality of life,” says Brian Collins, MD, Martha’s radiation oncologist and director of the MedStar Georgetown Proton Therapy Center. “We chose proton therapy because we could irradiate a significantly smaller area of the brain than we could have with conventional radiation.”

Dr. Collins explains that, with conventional radiation, the photons or X-rays travel through the entire brain without stopping. With proton therapy, the radiation is unleashed just inside the target, then stops. That means there is no exit dose to harm healthy brain tissue.

“For Ms. Ramos, proton therapy was advantageous because we could deliver radiation just to the tumor without affecting other areas,” says Dr. Collins. “This results in fewer

side effects like dementia or memory loss.”

The treatment achieved great results. “I feel that I responded very well to the proton therapy treatment,” says Martha. “My recovery from the proton therapy was surprisingly fast.”

“I’m very excited for Ms. Ramos,” says Dr. Collins. “After a short time, she’s back to living her normal life and we expect her to make a full recovery. Proton therapy was an excellent option, and it was a pleasure helping her get through this.”

“I am very, very grateful that my medical team at MedStar Georgetown told me about proton therapy,” says Martha. “I now look forward to a long and happy life.”

Martha Ramos was all smiles at the grand opening of the MedStar Georgetown University Hospital Proton Therapy Center.

Meet Brian Collins, MD

Dr. Collins is the director of the MedStar Georgetown Proton Therapy Center. Visit MedStarGeorgetown.org/CollinsVideo to watch Dr. Collins discuss this innovative therapy.

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Kidney Transplant Recipient Finds Her Donor continued from page 1

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called polycystic kidney disease (PKD), Gary came forward to help. He had donated platelets dozens of times and was listed as an organ donor on his Maryland driver’s license but had not considered living organ donation.

“I had no idea you could donate a kidney,” says Gary, who rehabilitates cars at his collision repair center. “I saw what she was going through and wanted to help. I learned that the risks were minimal to me and the benefits to her were so huge. It was not a tough decision.”

Pain relief, at lastLaurel was diagnosed with PKD, a genetic disorder that causes cysts on the kidneys, in her mid-thirties. “I had been living with extreme pain for 13 years,” she recalls. “I was always so sick.”

When kidney failure became imminent, her nephrologist told her the best place to undergo her transplant was MedStar Georgetown Transplant Institute (MGTI). Laurel’s initial assessment for transplant was done at the MGTI location in Frederick, Maryland.

“It was so much easier and more convenient to go to Frederick, which is only 20 minutes away from my house, especially since I was feeling so sick all the time,” Laurel explains. “The staff was extremely supportive and helped me navigate the assessment process and ensured I was prepared for my transplant.”

Laurel then underwent a combined procedure to transplant the new kidney and remove her diseased ones. Matthew Cooper, MD,

medical director of MGTI’s Kidney and Pancreas Transplantation Program, worked with Transplant Surgeon Seyed Reza Ghasemian, MD, to perform the complex surgery. In an operating room next door, Jennifer Verbesey, MD, director of the Institute’s Living Kidney Donor Transplant Program, removed Gary’s kidney.

“MGTI is one of the few centers in the United States to offer this combined procedure,” says Dr. Cooper. “With more than 90,000 people on the waiting list for a kidney in the U.S., we explain to our patients that a kidney from a living donor is really the best option,” says Dr. Cooper. “Organs from living donors last longer. The transplant can usually be done sooner and can be scheduled at their convenience, rather than waiting for an organ from a deceased donor.”

“Our kidney donors are amazing for giving of themselves in this way,” adds Dr. Verbesey. “We encourage people who need an organ to discuss what they’re going through with family members and friends who just might be willing to donate. Organ recipients can find their donors in so many different ways.”

“Saying ‘thank you’ to Gary hardly seems like enough,” says Laurel. “We both have a strong passion for saving animals, and I think he just has rescue in his heart. He rescued me. He gave me the gift of life.”

I learned that the risks were minimal to me and the benefits to her were so huge. It was not a tough decision.

Gary Simmont, Kidney donor

For more information, visit MedStarGeorgetown.org/GermanShepherd or call 202-444-3714 to make an appointment.

Laurel Weetall (left) received a living kidney from Gary Simmont (right) after meeting through a German Shepherd rescue group.

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WritersBrendan Furlong, MDJennifer DavisKate MatternSusan WalkerLeslie A. Whitlinger Marianne Worley

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Mindfulness-Based Stress Reduction Improves Quality of Life

Mindfulness-Based Stress Reduction (MBSR) has been shown in over 1,000 research studies to help patients with medical and mental health conditions and those simply wishing to reduce stress or find more balance in life. The course also helps professional and family caregivers prevent personal burnout and care more effectively for others. MedStar Georgetown University Hospital offers eight-week MBSR courses for adults as well as a special course for teens, year-round.

“MBSR teaches you to be aware of what is happening in every moment, both within and around you; to respond intentionally to stressful situations rather than reacting in ways that actually worsen stress; to be kinder and more compassionate to yourself and others; and to develop a better relationship with your body,” says Paul Jones, MD, MAT, MBSR course director and assistant professor of Psychiatry and Pediatrics at MedStar Georgetown.

To learn more or to register for an upcoming course, visit MedStarGeorgetown.org/Mindfulness or call 202-944-5392.