I was on a conference call or, more precisely, I was called when relative of mine went in to

see a Cardiologist at the University of North Carolina. The phone was put on speaker and the

UNC Cardiologist was told who I was and that I would be advising the family. At least this

was a cardiac issue. Most of the time I am asked, like probably many of you, to consult on

something totally outside my specialty. My favorite had been at a wedding where a relative

took off her shoe and ask me to look at her bunion. Another great one occurred when I was

called out of Medical Grand Rounds for an emergency phone call. It turned out it was my

sister- in-law who wanted me to tell my nephew that he needed to get his tonsils taken out.

But I digress. So I started listening to this call while the UNC cardiologist explained the re-

sults of the physical exam and then the echo. The patient is asymptomatic but the primary

care physician detected a very loud grade 5/6 systolic murmur resulting in the cardiac referral.

The initial thought by the primary care doc was that this was probably a benign PDA. The

cardiologist didn’t think so and ordered an Echocardiogram that was done immediately even

though an echo was done by the primary care doc and didn’t show anything.

Well, this echo was different. It showed severe pulmonary stenosis with some atresia of the

pulmonary artery and a gradient across the pulmonic valve of over 100 mmHg. In addition,

not surprisingly, the right ventricle in response was significantly hypertrophied.

It was amazing that the patient was asymptomatic but that wouldn’t last much longer. Either

he was heading for right heart failure, syncope or even sudden death given this gradient. Af-

ter this bad news was absorbed, the cardiologist went on to discuss the options which were

limited. The best option was balloon dilation of the valve which would not be easy given the

atresia of the pulmonary artery. However, if successful (without rupturing the pulmonary

artery) a good lifespan could be expected although additional dilations might be needed. The

risk to the procedure would not be small but the only other options were to do nothing or to

try a difficult surgical procedure which the cardiologist knew of only two places that attempt

this, one in Colorado and one in London.

Prior to the dilation a CT angiogram had to be done to make sure there were no coronary

anomalies which often accompany this type of pulmonary stenosis/atresia. The cost for all

this since the patient did not have insurance was in the $3-4,000 range. Including the CT and

catheterization and dilatation but not the extensive follow up that would be needed.

Sounds cheap right. Well the patient was an 11 week old French Bull Dog (puppy) and the

cardiologist was a veterinarian specializing in cardiology. He was so busy that he thought he

couldn’t fit the procedure in for at least a few weeks. He also thought the breeder of this dog

should refund the payment for it and be told to never breed the two dogs used to produce this

puppy again.

So what would you do? Balloon dilation? Trip to Colorado or London? Put the dog down?

Or do nothing. So they turned to Uncle Alan for

advice. I told him to leave his tonsils alone and

try antibiotics and went back to Grand Rounds.

October 2019 Volume 23, Issue 10

GW Medicine Notes A Monthly Publication of the GW Department of Medicine

From the Chairman

Alan G. Wasserman, M.D.

Here we go again!

save the Date Faculty/housestaff

Holiday Party Friday, December 6, 2019

Renwick gallery Washington DC

Soon you will be seeing 4th year medical students

from schools around the country and the world

scampering around the hospital and offices. We

begin interviews the end of October and continue

thru the end of January. As previously, interviews

take place on Monday, Wednesday and Fridays with

occasional breaks for the holidays.

Given the number of students we interview we

need a lot of help. So please volunteer when asked

if your clinic schedule allows. We will be reaching

out to all of you to fill the dates.

It is also important that you know some basic

information about the program and the various

unique aspects that we offer. Things change every

year and we don’t look good if we can’t answer

basic questions that the applicants have. So I would

like everyone who is interviewing to attend one of

the three Faculty Development sessions we will be

having during this month

1. Monday, October 7, 2019: 12:00 – 1:00 pm, MFA

8th Floor Conference Room, Suite 8-416

2. Wednesday, October 9, 2019: 7:30am – 8:30 am,

MFA 8th Floor Conference Room, Suite 8-416

3. Thursday, October 10, 2019: 5:00pm – 6:00pm,

MFA DGIM Conference Room, Suite 5-416

Conference Call Dial-In Number:

Number: 605-475-6700

Access Code: 1348419

The most important feedback we receive from

previous years is that the students, who have many

choices of where to go, feel disrespected if they are

kept waiting a long time or the person they are

supposed to interview with doesn’t show up. So

make sure you block off the time and be there on

time. In last month’s newsletter I printed the few

“please don’t ask these questions” list. Take a look

and be cognizant that there are inappropriate

things to ask around other programs, their rank list

and things like age, gender, religion, sexual orienta-

tion and pregnancy just to name an important few.

We have great programs to offer: Primary Care,

Preliminary and Categorical and I thank all of you

for helping us in showing off to the students.

Department of Medicine October 2019 Grand Rounds

Page 2 GW Medicine Notes

Resident Lecture Series October 2019 Noon Conference

MAR 1 Journal Club MAR 2 GME Core Lecture

MAR 3 Medicine Grand Rounds MAR 4 Chairman’s Rounds

MAR 7 “Oral Health in Primary Care”- Dr. Pierre Carter MAR 8 Mortality & Morbidity-

Drs. Dana Kay and JoeDelio MAR 9 “Genetic Screening”- Dr. Macri and Andrew Nance, MS4 MAR 10 Medicine Grand Rounds

MAR 11 Chairman’s Rounds MAR 14 TBD

MAR 15 “Chronic Disease Prevention and Management: A Dentist’s Perspective”- Dr. Pierre Carter

MAR 16 GME Core Lecture MAR 17 Medicine Grand Rounds

MAR 18 Chairman’s Rounds MAR 21 “Special Topics in Adult Oral Healthcare: Geriatrics,

Oropharyngeal Cancer, Infectious Disease Prevention, and Women’s Health”- Dr. Pierre Carter MAR 22 Clinicopathologic Conference-

Drs. Abeer Alfaraj and Rami Al Sharif MAR 23 TBD

MAR 24 Medicine Grand Rounds MAR 25 Chairman’s Rounds MAR 28 TBD MAR 29 TBD

MAR 30 TBD MAR 31 TBD

OCT 3 “Is there an ideal IV Fluid”

Ehsan Nobakht, MD

Assitant Professor of Medicine

Division of Kidney Disease and Hypertension

Department of Medicine

GW Medical Faculty Associates

OCT 10 “Pancreatic Cancer”

Lynt Johnson, MD, MBA

Professor of Surgery

Executive Director, Liver and Pancreas Institute for Quality

GW Medical Faculty Associates

OCT 17 “Fundamental Challenges to the Development of a

Preventative HIV Vaccine and a Possible Solution”

Adan Rios, MD

Professor of Oncology

University of Texas Health Science Center (UTHealth)

McGovern Medical School

OCT 24 “Kidney Transplantation”

Rohan Paul, MD

Assitant Professor of Medicine

Division of Kidney Disease and Hypertension

Department of Medicine

GW Medical Faculty Associates

OCT 31 “Burn Management”

Kevin Chung, MD

Professor of Medicine

Chair, Department of Medicine

Uniformed Services University of the Health Sciences

Bethesda, MD

The George Washington University Medical Center (GWUMC) is accredited by

the Accreditation Council for Continuing Medical Education (ACCME) to

sponsor continuing medical education for physicians. GWUMC designates this continuing medical education activity on an hour-for-hour basis in Category I of

the Physician’s Recognition Award of the American Medical Association.

(AMA).

JULY 1 JULY 4 HOLIDAY

JULY 5 “Intro to HIV”- Dr. Marc Siegel JULY 6 “Hospital Wound Care”- Kathleen Kurntke

JULY 7 Medicine Grand Rounds

JULY 8 “Oral Health”- Pierre Cartier JULY 11 “Sepsis”- Dr. Katrina Hawkins

JULY 12 Mortality and Morbidity- Drs. Sara and Tina JULY 13 “Thyroid Nodules”- Dr. Jill Paulson

JULY 14 Medicine Grand Rounds JULY 15

JULY 18 “Drug Allergies”- Dr. Richard Nicklas JULY 19 “TBD”- Dr. Khaled el-Shami

JULY 20 “Radiology”- Dr. Michael Burke

JULY 21 Medicine Grand Rounds JULY 22

JULY 25 “Reading CXR”- Dr. Jalil Ahari JULY 26 “Neutropenic Fever”- Dr. Afsoon Roberts

JULY 27 JULY 28 Medicine Grand Rounds

JULY 29

OCT 1 Journal Club OCT 2 GME Core Lecture

OCT 3 Medicine Grand Rounds

OCT 4 Chairman’s Rounds OCT 7 NEJM Case

OCT 8 Patient Safety Conference OCT 9 “Amenorrhea”- Dr. Jill Catalanotti

OCT 10 Medicine Grand Rounds OCT 11 Chairman’s Rounds

OCT 14 TBD

OCT 15 CPC OCT 16 TBD

OCT 17 Medicine Grand Rounds OCT 18 Jeopardy

OCT 21 ILD– Dr. Morgan Delaney

OCT 22 TBD OCT 23 Social Lunch

OCT 24 Medicine Grand Rounds OCT 25 Chairman’s Rounds

OCT 28 Recruitment OCT 29 “Pattern Management”- Tamara Swigert

OCT 30 Recruitment

OCT 31 TBD

Medicine Team Contacts

Need to find a Resident on an

inpatient team?

Please use Tiger text to reach the appropriate physician. Go to

gwu.medhub.com/paging; password: GWUPublicCall; Select Internal

Medicine.

Alternatively

GWUH Defining Medicine Intranet: Go to Applications \ Inactive-Non-

Production \ Directory Contact System

GWUH Citrix Portal—https://gwportal.gwu-hospital.com/vpn/index.html

MFA URL— http://192.168.254.132/miTeamWebWA/Home (Logon) -

http://192.168.254.132/miTeamWebAL/Home (View Only)

If you have trouble with your MedHub account, please contact Deborah

Corvalan at dcorvalan@mfa.gwu.edu.

Cardiology Grand Rounds

5:00 PM, Ross Hall, Room # 227

OCT 2 M & M OCT 9 HOLIDAY OCT 16 David Gooray, MD Washington Adventist Hospital SGLT2/Heart Failure OCT 23 Igor Efimov, MD Department Chair, Alisann and Terry Collins Professor of Biomedical Engineering GW Biomedical Engineering Dept Defibrillation Technology OCT 30 Dr. Tim McCaffrey Professor of Medicine Professor of Microbiology, Immunology and Tropical Medicine GW SMHS Genomics

GW Medicine Notes Page 3

Please Join Us In Welcoming

Our Newest Addition to the

Department of Medicine

Chairman’s Rounds GWU Hospital Auditorium, 12:00

All Faculty Invited to Attend

OCT 4 Dr. Puya Jafari Dr. Dembi Iyekegbe OCT 11 Dr. Ameet Piryani Dr. Daniel Beatty OCT 25 Dr. Caroline Bockus Dr. Haneen Ismail

Sherrell Apugo, MSN, RN, FNP-BC, PCCN, joins us as a board-

certified Nurse Practitioner in the Division of Cardiology at the GW

Medical Faculty Associates.

Sherrell received her Bachelor’s degree in Nursing Science from

Howard University. She then moved back to her home town of

Baltimore, Maryland where she worked at Johns Hopkins Hospital.

Sherrell soon obtained her Master’s in Nursing from the Johns

Hopkins University School of Nursing and then became certified as

a Family Nurse Practitioner by the American Academy of Nurse

Practitioners. She is a member of the Sigma Theta Tau International

Honor Society of Nursing and is certified by the American Associa-

tion of Critical Care Nurses in Progressive Care Nursing. Sherrell is

licensed to practice in Washington, DC and Maryland.

Before joining the GW Medical Faculty Associates, Sherrell worked

as a clinical nurse on a Progressive Cardiac Care unit where she

cared for patients requiring advance heart failure therapies (Heart

Transplant, LVAD, inotropes, etc.) and various other cardiac disor-

ders. Sherrell has a special interest in heart failure and preventative

cardiology.

Sherrell is very excited to join the GW MFA team— she is looking

forward to making a lasting impact in the lives of her patients and

learning more about the field of Cardiology.

Dr. Cohen has been a fixture at the GW-MFA since he joined the faculty in 1985 as an Assistant Professor of Medicine in the Division of Endocrinolo-gy. He will be retiring from clinical work at the end of October. Josh received his MD at New York University School of Medicine and trained in Internal Medicine at the University of Michigan Medical Center. He was a Fellow at the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases, at the National Institute of Health and then a Post-Doctoral Fellow in the Division of Endocrinology and Metabolism at Johns Hopkins. Josh has been listed as one of America’s Best Physicians and has been a Washingtonian Top Doctor for more than 20 years. Although his practice has encompassed all aspects of Endocrinology, he has a special area of expertise in endocrine disorders of pregnancy. He has been the go to Endocrinologist in the area for women with gestational diabetes. Josh has been involved and Chaired countless number of School, Hospital and MFA committees. He was on and Chaired the Medical Center Faculty Senate Executive Committee for many years; and has been the invaluable Chair of the MFA’s Credentials and Privileges committee since 1996. Dr. Cohen has a national presence in medical societies, clinical research and medical education. He has published over 75 manuscripts, book chapters and abstracts. When Ken Becker, MD stepped down as Director of the Division of Endocrinology in 2011, Josh assumed the title which he has held since. He was also the Fellowship Director from 2011 to 2016. His committee work, his educational endeavors, his clinical expertise with one of the largest patient panels in the MFA, has made him an invaluable member of the Medical Center. While we understand his desire to spend more time with his family and grandson, he will be in many ways irreplaceable. He will be stopping his clinical work at the end of October, but we hope he will remain in an administrative role until the end of December. I have relied on Josh’s wisdom, guidance, clinical acumen and friendship for these last 34 years, as have many others in the MFA and School. He has made a difference which is what most of us hope can be said of us when we retire.

Josh Cohen, MD

Honduras

The GWU Cardiology Brigade 2019. 10th Annual Trip to Honduras for

Evaluation and Treatment of Patients with Arrhythmia.

Picture from left to right: Dr. Marco Mercader, Dr. Cynthia Tracy, Maria

Fernanda Cruz, Ana Bueso, Zaida Paz, Lily Dastmalchi, Tran Nguyen,

Dorys Chavez

Faculty Awards Ceremony

On September 19, 2019 at the School of Medicine Faculty

Awards Ceremony, Dr. Katalin Roth was presented with the

SMHS Distinguished Service Award by Dr. Jeffrey S. Akman.

Dr. Gail Povar received her Emeritus recognition.

The George Washington University Medical Faculty Associates

Department of Medicine, Suite 8-416

2150 Pennsylvania Avenue, NW

GW Medicine Notes Page 4

Rheumatology Academic Conference Schedule

October 2019

2300 M Street, N.W., Suite 3-332 8AM—11:30 AM

Questions: Call (202) 741-2488

OCT 3: 8:00 Radiology Rounds Dr. Kathy Brindle - Hospital 1st floor OCT 3: 9:30 AM Clinical Case Conference- Drs. Chand, Aggarwal, Almackenzie OCT 3: 10:30 AM Fellowship Interviews OCT 10: 8:30 AM EMG and Nerve Conduction Studies Dr. Mohammed Abu Rub OCT 10: 9:30AM Fellowship Interviews OCT 10: 10:30 AM Clinical Case Conference Drs. Chand Aggarwal, Almackenzie OCT 17: 8:30 AM Immunodeficiency Dr. Anjeni Keswani OCT 17: 9:30 AM Fellowship Interviews OCT 17: 11:00AM Tour and Lunch OCT 24: 8:30 AM Intracity Grand Rounds Location:NIH OCT 24: 9:30 AM Research Project Meeting OCT 24: 11:00 AM Clinical Case Conference Drs. Chand Aggarwal, Almackenzie OCT 31: 8:30 AM Journal Club OCT 31: 9:30 AM Clinical Case Conference Drs. Chand Aggarwal, Almackenzie OCT 31: 10:30AM Division Meeting– Fellowship Ranking

Kudos and Congratulations

Kudos…to Dr. Marc Siegel, Infectious Diseases, on a pa-

tient from the hospital, “Dr. Marc Siegel is a really

good doctor. Everyone loves him and says he is the

best. Every nurse said that he is the best one we have.

Thank you.”

Kudos…to Dr. Kevin Fu, Nephrology Fellow, on a patient

compliment, “Dr. Fu provided me with wonderful care

during my hospitalization.”

Congratulations….to Dr. Katalin Roth, Geriatrics, as she

was recognized at the Faculty Awards Dinner on Sep-

tember 19th with the Distinguished Service Award, as

well as Dr. Gail Povar for receiving Emeritus status.

Congratulations…to Dr. Dominic Raj, Renal, for being

presented with the A. Peter Lundin, MD Award at the

National Kidney Patients Meeting. This awards is giv-

en by AAKP to a physician for significant contribu-

tions to the care and well-being of kidney patients.

And to… Dr. Paul Kimmel for his AAKP National

Public Service Award.

Kudos…to Dr. Christina Prather, Palliative Care, on a

letter of praise from a patient, “I cannot think of

enough good things to say about Dr. Prather. We are

eternally grateful to her and will never forget her.”