Ignite Magazine | Spring 2020 by NEOMED

A P U B L I CAT I O N O F N O RT H E A S T O H I O M E D I CA L U N I V E R S I T Y â&#x20AC;¢ V O L 2 1 .1 S P R I N G 2 02 0

SCALING COMPASSIONATE CARE

hen word got out that the 2019 Novel Coronavirus had possibly made its way to Ohio, Dr. Amy Acton, Chancellor Randy Gardner and other public health officials were brought together to hear about the virus and gain a better understanding of what was occurring. To ensure that we knew what we were facing, the leaders of several universities and health centers convened for the call, along with experts in public health. Though there was a lot to learn as we were briefed about this new virus, the clarity, competence and compassion of the message put us all at ease. And the messenger, Amy Acton, M.D., M.P.H., director of the Ohio Department of Health, resonated with us for a number of reasons. For one, she highlighted patient-centered focused care. She also reflected what I have been hearing from NEOMED’s partners in health care, education and research as I have conducted a listening tour over the past several months, getting to know NEOMED. Many have recognized that NEOMED has a disproportionate share of leaders in the health professions. Dr. Acton, who graduated 30 years ago from our College of Medicine and will serve as the keynote speaker for commencement in May, certainly qualifies as an outstanding leader in health care. And so does Carl Allamby, M.D., a 2019 NEOMED graduate. In this issue, we learn about his “good in us” principles that served as the basis for his journey from mechanics to medicine. In “Medication Assisted Treatment (MAT) and the Fight Against Opioids,” Christina M. Delos Reyes, M.D. (’96), who is board-certified in addiction psychiatry, shows her concern for people struggling with addiction — and their families — as she answers common questions about Medication Assisted Treatment for opioid overuse disorder. Of course, NEOMED isn’t the only developer of compassionate leaders, and that’s a good thing for billions of people all over the globe who need such care. While there are millions of empathetic health professionals, our industry needs to increase its capacity, through use of effective systems and with the support of organizations that make it possible by funding programs and disseminating information. Yet there are communities nearby that are just as undeserved as those abroad. Whether it’s access or distance, technology has no limit that collaboration and compassion can’t overcome. In “Allies for Mental Health,” Laura Barr, M.D., demonstrates this firsthand. She has found a way to stretch her resources by using Project ECHO — multi-point videoconferencing where multi-disciplinary health professionals connect to provide insight on patient cases. “One physician can’t provide everything,” she says. There may be a shortage of physicians across the U.S. and beyond, but there’s no lack of people who have the training and capacity to provide care. There’s also no shortage of funders and technologies to support these health professionals’ abilities to reach every community around the world. As any efficient and effective business does, the health care sector can also achieve scale. We simply need to provide the necessary resources for our greatest assets — compassionate leaders.

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VOL 21.1 SPRING 2020 Northeast Ohio Medical University is a communitybased, public medical university with a mission to improve the health, economy and quality of life in Northeast Ohio through the medicine, pharmacy and health science interprofessional education of students and practitioners at all levels. The University embraces diversity, equity and inclusion and fosters a working and learning environment that celebrates differences and prepares students for patient-centered, teamand population-based care. Ignite magazine (Spring 2020, Volume 21, No. 1) is published twice a year by the Office of Marketing and Communications, 4209 St. Rt. 44, P.O. Box 95, Rootstown, OH 44272-0095 Email: eguregian@neomed.edu President John T. Langell, M.D., Ph.D., M.P.H., M.B.A. NEOMED Board of Trustees Paul R. Bishop, J.D., Chair Richard B. McQueen, Vice Chair E. Douglas Beach, Ph.D. Sharlene Ramos Chesnes Robert J. Klonk Chander M. Kohli, M.D. Darrell L. McNair, M.B.A. Phillip L. Trueblood Susan Tave Zelman, Ph.D. Student Trustees David J. Johnson AuBree LaForce

Editor: Elaine Guregian Contributing Editors: Samantha Hickey, Roderick L. Ingram Sr., Jared F. Slanina Publication Design: Scott J. Rutan Illustrations: Cover and page 4: Elise Radzialowski, University of Akron Myers School of Art (’19); page 12, Malieka Gurrera, University of Akron Myers School of Art (’18); page 16, Emily Wolchko, University of Akron Myers School of Art (’18); pages 20 and 26, Dave Szalay, associate professor, University of Akron Myers School of Art Photography: Eddy Esmail, Chris Smanto, Lew Stamp As a health sciences university, we constantly seek ways to improve the health, economy and quality of life in Northeast Ohio. The Accent Opaque paper used for this magazine has earned a Forest Stewardship Council (FSC) and a Sustainable Forestry Initiative (SFI) certification. Strict guidelines have been followed so that forests are renewed, natural resources are preserved and wildlife is protected. Ignite was printed by Printing Concepts in Stow, Ohio, using soy inks. No part of this publication may be reproduced without prior permission of the editors. Copyright 2020 by Northeast Ohio Medical University, Rootstown, Ohio 44272.

DEPARTMENTS 24 IN THE REDIZONE

32 WHALE WATCHING

26 HUMANITIES IN MEDICINE

34 CLASS NOTES

30 TASTES LIKE HOME

36 DONOR SPOTLIGHT

FEATURES 04 ALLIES FOR MENTAL HEALTH

A physician in Amish country finds a team — virtually.

08 THE MAN YOU SCRIPT FOR THE GOOD IN US Thoughts on leadership and personal growth from Carl Allamby, M.D.

12 THE LMSA EFFECT How a student organization is raising awareness of Latino health needs.

16 MAT AND THE FIGHT AGAINST OPIOIDS An addiction specialist answers questions families ask about Medication Assisted Treatment.

20 MYTH BUSTERS: FAMILY MEDICINE EDITION Veteran practitioners share their best comebacks to the slings and arrows thrown at their beloved field. About the cover: Artist Elise Radzialowski is a 2019 graduate of the Myers School of Art of the University of Akron, a NEOMED partner school.

Ignite magazine won a silver award for its Fall 2018 and Spring 2019 issues in the 2019-2020 Pride of CASE V competition by the Council for Advancement and Support of Education. The competition recognizes the best work in educational advancement in the Great Lakes Region. Ignite's award was in the category of Best Alumni/Institution Magazine 2,999 FTE or fewer.

For web extras, visit neomed.edu/ignite

The magazine won two awards in publication design from the Akron (Ohio) chapter of the American Advertising Federation in 2020. One layout and design award was for the Spring 2019 and Fall 2019 covers and feature articles “The Ketogenic Diet” and “The High Cost of Sugar.” Ignite also won an Editorial Spread/Feature layout and design award for “Taking a Family Approach to Schizophrenia.” Scott J. Rutan is Ignite’s publication designer.

NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

ALLIES FOR MENTAL HEALTH BY ELAINE GUREGIAN

nyone who has tried to find mental health care and been placed on a six-month waiting list for an appointment can tell you: There’s a growing shortage in the psychiatric workforce in the U.S. And people living in rural areas are harder hit than residents of metropolitan areas, according to a 2018 study by the University of Michigan School of Health’s Behavioral Health Workforce Research Center. Laura Barr, M.D., a family physician who trained to practice rural medicine, has found a way to stretch her resources by becoming part of a virtual team. Once a week, she and other health care providers check in online from wherever they may be — hospital, car, office, wherever there’s a strong Wi-Fi signal — to connect by videoconference with a team of mental

Illustration: Elise Radzialowski

health experts gathered in a meeting room at NEOMED. The program, called Integrated Care at NEOMED (IC@N), is one of a group of Project ECHO™ programs at NEOMED. It uses what it calls a huband-spokes model, with NEOMED acting as the hub and community providers — including primary care physicians, psychiatrists and counselors — as the spokes. First, a brief didactic is presented on a topic related to integrated care. Following that presentation, members of the community can present cases or clinical questions from their practices. Last, there is time for the community providers to share suggestions and perspectives regarding the case. The model doesn’t just bring valuable expertise to each provider’s practice. It gives them a whole new group of health care allies.

A DIFFICULT CASE, MADE EASIER One confounding case for which Dr. Barr consulted her ECHO team is not yet solved, though that’s not unusual for complex mental health conditions. The case involved an Amish woman in her early twenties who was living at home and struggling with frequent debilitating migraine headaches. (Some identifying details have been changed to protect the patient’s privacy.) The patient’s symptoms were often precipitated by stress – both bad and good. “She’ll go on vacation and end up in the ER,” says Dr. Barr. One of Dr. Barr’s interests is incorporating mind/body techniques to help manage symptoms. She worked with this patient to use breathing techniques to manage her pain and anxiety, and the

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patient did find them helpful in coping with her symptoms and decreasing the frequency of her emergency room visits. She also had read about some supplements that are used to manage her migraine headaches and asked if she could try them. Dr. Barr notes that Amish patients typically try to manage their health through natural means and do take responsibility for their well-being. While this can be an asset, it can also lead them to self-medicate with multiple supplements. “I’ve had people bring suitcases of over-the-counter supplements to their first appointment. Then, I explain that while I’m not trained in that approach (supplements), I will work with them to safely integrate what they are doing with what I can offer them. The key is to be respectful and clearly communicate why the medicine I’m giving will be effective,” says Dr. Barr. In this case, Dr. Barr did approve the supplements in question, since there was evidence in the literature to support them for this condition. She encouraged the patient to report any side effects that she noticed while taking them. A few months later, the patient began experiencing symptoms of psychosis. Dr. Barr wondered if the supplements might be causing it‚ or was it caused by her headache medicine? While initially she had tried to approach the headaches as a functional issue, it now seemed that the patient had a psychiatric issue as well. Dr. Barr found that the team approach used in Project ECHO complemented her work on this case, and in her practice overall. “One physician can’t provide everything,” she says. She appreciates the backing of a diverse team of mental health experts through her online meetings. And the ECHO group gave Dr. Barr’s migraine patient one more level of integrated care. “Her case isn’t solved yet, but it was helpful to have a psychiatrist, a psychiatric

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NEOMED operates five different Project ECHO programs as public services: • Integrated Care at NEOMED (IC@N), for complex, co-occurring psychiatric and physical conditions • SZconsult, for schizophrenia-spectrum disorders • FIRST Episode Psychosis, offered by the Best Practice for Schizophrenia Treatment (BeST) Center at NEOMED • Ohio Opiate, focused on medication-assisted treatment for opiate addiction • Ohio Systems of Care TeleECHO, for the complex needs of children, youth and families served by Ohio Systems of Care In the last year, NEOMED became a Project ECHO superhub — a center with staff to provide training to launch and support other Project ECHO programs. Project ECHO originated at the University of New Mexico Health Sciences Center in Albuquerque and now operates globally.

pharmacist and counselors weigh in. It was very helpful to have ECHO, along with other strategies for her,” says Dr. Barr. The patient eventually entered SpringHaven, a residential treatment program for the Amish that incorporates group and individual counseling sessions done in an intensive manner while clients live in a plain home on the grounds of the counseling center. The residence home staff is all Amish, so they understand the nuances of Amish culture and can communicate issues they notice to the counseling center staff. At the time of this conversation there was no cure yet. The patient was continu-

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ing to struggle with symptoms flaring (likely due to the change in routine). She decided to stop the intensive residential counseling program but continued to see a psychiatrist for medication management and a counselor for therapy to treat her anxiety related to the chronic headaches — positive steps forward, says Dr. Barr. “We are continuing to investigate (with a referral to a specialist) some rarer physical causes that could explain an underlying cause, looking at the situation yet again with fresh eyes.” – Samantha Hickey contributed to this article.

FIRST, UNDERSTAND

orking in one of the largest Amish communities in the world — Holmes County, about an hour southwest of NEOMED — Laura Barr, M.D., knows it’s important to understand the culture. In her family medicine practice in Wayne and Holmes counties, she sees how a community’s belief system affects attitudes toward health care. As this clinical assistant professor of family and community medicine tells her NEOMED students, it’s critical to let patients know you understand and respect their points of view if you want them to trust you as a provider. Both Amish and Mennonite religious sects are Anabaptists, which splintered from the Protestants after Martin Luther’s Christian Reformation, explains Dr. Barr. While there are many nuances within each group, the Amish followed a more conservative leader when they broke away and continued to be more conservative in their appearance and lifestyle than the Mennonites. “You might see Mennonite people walking down the street and not even realize that they were,” she notes. The general belief system of the Amish is Christian, with an emphasis on community, pacifism, and separation of church and state. People who are not “plain,” as Amish call themselves, are referred to as “English.” Dr. Barr’s patients have included members of one of the plainest groups of Amish, the Swartzentruber Amish, whose austere homes often don’t use running water. They tend to be even more cut off from the world, so they are slower to seek care — and that includes mental health care, says Dr. Barr. For one young patient, a girl now 18 years old who was first brought in by her family, the first encounter was full of common issues. “The young woman was more comfortable conversing in Pennsylvania Dutch (a German dialect) than English, so her sister was interpreting for her. The patient was very skeptical of me – very nervous. For some groups, there is a reluctance to interact with the non-Amish community,” Dr. Barr explains. Still, the plain community is often happier to start by seeing a family doctor rather than a psychiatrist be-

cause there is no stigma about seeing them, unlike seeing a mental health provider. Often Dr. Barr will start care for the patient, and then after trust and rapport are built, the patient is more willing to see one of the counselors or psychiatrists on staff if necessary. Although it was hard to communicate with the patient, she agreed to try an antidepressant (a selective serotonin reuptake inhibitor, known as an SSRI), which has helped her over a period of time now, says Dr. Barr. Her openness to taking psychiatric medication might seem surprising, but among the Amish, Dr. Barr explains, “If there is a pill that can fix it, that means the problem is physical. It’s not a weakness or a failure. God is not punishing them.” Dr. Barr’s assessment of the adolescent patient was that she wanted to take the medicine to feel better but didn’t want to process the problem through therapy. Because medication is often prescribed as just one part of a more comprehensive treatment plan, Dr. Barr has discovered that it’s also important to figure religion into the equation when recommending counseling or therapy for the Amish population. “Their religion doesn’t value individuality; it values the community. If someone is becoming empowered by counseling, they may see that as threatening,” says Dr. Barr. In general, the Amish are willing to participate in counseling if it is at a trusted place, says Dr. Barr, giving an example of a solution that works: The staff at SpringHaven Counseling Center, near Mount Eaton, Ohio, which serves the Amish population with a residential program that employs licensed professional counselors and an Amish staff. The staff members at the house talk to the residents, play games and garden with them. “People bond together though those activities, as patients rotate in and out of the residential program,” says Dr. Barr. As she notes, the key to it all is that the staff understands the culture, because it’s their own — so they can help the physicians and counselors treat the patients in a way that makes them feel at home.

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FEATURE

THE MAN YOU SCRIPT FOR THE GOOD IN US BY RODERICK L. INGRAM SR.

You may have heard about Dr. Carl Allamby, he of the fascinating “mechanic-turned-medical doctor” story that reads like a movie script. From coverage on local, national and international news outlets and talk shows to millions of views on social media, Dr. Allamby’s journey has offered a glimpse into a strikingly warm and positive human spirit. His back story makes him relatable to many — whether it’s the underserved or the unwitting; the middle-aged or those in the midst of completely changing their careers — so how can his story predispose others to see themselves anywhere they want to be? I met with the 2019 College of Medicine

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graduate a few days after he gave the second of two keynote speeches he had been invited to deliver in celebration of Martin Luther King Jr. Day. Dr. Allamby’s emergency medicine residency is with Cleveland Clinic Akron General, but he was spending a month at Akron Children’s Hospital to gain experience in pediatric emergency medicine, so we met in the Murdough Family lobby at Children’s. Not 10 seconds after saying hello, I heard “CARL!” from an associate who happened to be walking by. Dr. Allamby lit up with his big comforting smile and then hugged him. After our interview was done, Dr. Allamby must have greeted dozens of people.

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As I observed him high-fiving a young patient, something dawned on me: Dr. Allamby has a way of bringing joy to people. “When I first met him, I thought he was a third-year resident,” said one nurse who had stopped in the middle of the ER hallway to say hi to Dr. Allamby. “He was just so outgoing and appreciative.” Knowing that there are so many demands on Dr. Allamby’s time, including publishers and producers pitching scripts to his agent — yes, he has one – I began by saying, “You must be tired.” “No, it’s been great. The family and I went skiing last night,” Dr. Allamby said. That’s how the whole conversation went.

Every comment that Dr. Allamby offered reflected something positive. And when asked about his success, every answer seemed to begin with, “There was this (person) ...” to give someone else credit. So I wondered, and I asked him: What could others draw from his experience? Dr. Allamby paused, gave me the extended version of his customary empathic stare, and said, “A lot of it (my career) has been fortuitous.” Eventually, though, the reluctant aphorist began to offer lessons learned that seemed uncannily principled. Surely a leader in any profession would appreciate them, but he offered them with such sincerity and authenticity that any person, no matter the hurdles before them, could embrace them as a manuscript to bring out the good in us — to help others or to become the person who we want to be.

TAKE THE TIME TO ASK SOMEONE IF THEY NEED HELP At 19, Carl Allamby worked in an auto parts store and earned extra money by fixing cars out in the store’s parking lot. Often he’d run into a regular customer, a guy named Clarence Burton, who owned an auto repair shop. One particularly cold day, Burton stopped to say to the young mechanic that he had a few extra spots in his shop. “If you want to pay me a little rent, you can fix as many cars as you want — inside,” he said. Dr. Allamby took him up on that offer. “I was thankful that he saw me out there and offered to help,” says Dr. Allamby. That help was a step toward Dr. Allamby’s successful 25-year career as a business owner.

Photos: Chris Smanto

YOU CAN LEARN AT ANY AGE; DISCOMFORT SHOULDN’T PREVENT YOU FROM LEARNING ABOUT ANYTHING OR ANYONE.”

SEE THE CLASS AS HALF-FULL When the topic of skills gaps in states like Ohio is discussed, some complain that the problem is the people who are not taking advantage of the opportunities at public colleges and universities. Others say that people don’t want to go to “those” schools. But Dr. Allamby sees Ohio’s state colleges and universities as affordable choices brimming with quality. For pre-med coursework, he attended Cuyahoga Community College, where many of the professors are also adjunct faculty at places with bigger names, like Case Western Reserve University. One chemistry professor told him that with the sciences, certain parts of the curriculum are standardized throughout the country. “What they learned at Tri-C was no different than students at Case,” he said. Dr. Allamby concurs: “I got a great education at Tri-C, one of the most undervalued places when it comes to getting a quality education. Class sizes are small and teachers spend a lot of time with you.” Dr. Allamby continued his journey through Ohio’s state colleges and universities. He enrolled in the NEOMED-CSU Partnership for Urban Health at Cleveland

State University to obtain the post-baccalaureate training he needed for medical school. The program’s co-director, Sonja Harris-Haywood, M.D., and the staff told him if he ever needed anything, to just reach out to them. “A lot of the professors who taught me there — we are friends to this day,” says Dr. Allamby.

APPRECIATE THE PERSEVERANCE AND GRIT Though he performed really well on the Medical College Admission Test (MCAT), Dr. Allamby credits Northeast Ohio Medical University for looking at him more holistically when he was accepted — and through his four years. “I think that they (also) respected my position and my life experience and input on qualities to look for other than MCAT scores and grades. Once I was enrolled, they forced me out of my comfort zone to speak publicly and take on leadership roles,” he says. Being appointed by the governor to serve as a student trustee on the University’s board also empowered him to grow. If you’re evaluating someone, don’t just rely on grades or metrics to measure their potential, advises Allamby. “How do you put a number on perseverance and grit and someone overcoming life challenges?”

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Dr. Allamby with eight year-old patient Westen Tafini

TAKE THE TIME TO ASK SOMEONE IF THEY NEED HELP

THE

GOOD IN US

SEE THE CLASS AS HALF-FULL APPRECIATE THE PERSEVERANCE AND GRIT CREATE THE BEST MOMENTS IN YOUR LIFE YOU’RE AN AVERAGE OF THE PEOPLE WHO YOU ARE AROUND THE MOST

ALWAYS HAVE A PLAN B, AND MAYBE A PLAN C

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HOW DO YOU PUT A NUMBER ON PERSEVERANCE AND GRIT AND SOMEONE OVERCOMING LIFE CHALLENGES?”

CREATE THE BEST MOMENTS IN YOUR LIFE The young may not have yet experienced their best moments and the old may have many from which to choose, but by the time he was well into his 20s, Dr. Allamby realized that he couldn’t identify a single “best” moment. “I met two guys, Kenneth Lane and David Headen, at the Severance Athletic Club. We, including a few others, would all jog together,” remembers Dr. Allamby. As they became friends, Dr. Allamby was shocked to learn that they were both physicians — African-American physicians. One time they were talking about their greatest moments in life and each said that college was when they came into themselves. “When they asked me, what was your greatest year in life,” says Dr. Allamby, “I realized that I hadn’t had a college experience like that, or a greatest year. I was missing out on something. After that, I decided I was going to go to a four-year college and earn a business degree.” He did just that at Ursuline College. Later, while enrolled at CSU for pre-med, some of Dr. Allamby’s classmates were his own children’s former high school classmates. No big deal.

“You can learn at any age; discomfort shouldn’t prevent you from learning about anything or anyone,” he says.

YOU’RE AN AVERAGE OF THE PEOPLE WHO YOU ARE AROUND THE MOST Throughout his life, Dr. Allamby has gravitated toward good people. There was something about a biology teacher at Ursuline College, Micah Watts, M.D., — a Cleveland Clinic resident at the time — that made Dr. Allamby seriously consider the thought of becoming a doctor. Then there was the encounter at Severance Athletic Club that was even bigger than that of meeting Drs. Lane and Headen — meeting his wife Kim, who has steadily supported him as he changed careers and they blended families. Dr. Allamby also speaks fondly of Ormond Brathwaite, Ph.D., his chemistry professor at Tri-C, who gave him his daughter’s Kaplan books and other study materials to prep for the MCAT. And then there was Stephanie Gaines, M.D., a University Hospitals emergency department physician who helped Dr. Allamby narrow his post-med school focus on emergency medicine. The dynamic Dr. Gaines allowed him to volunteer or shadow her whenever he could,

recalls Dr. Allamby. She also mentored Dr. Allamby during one of his clinical rotations in medical school. “As a kid, I remember watching Denzel Washington on “St. Elsewhere” (a 1980s NBC television drama series about a decaying hospital). I always thought that it would be great to be like Dr. Philip Chandler,” says Dr. Allamby. It wasn’t until some 30 years later, upon meeting Dr. Gaines, that he realized he wanted to work in emergency medicine, and that it would be great to be like her.

ALWAYS HAVE A PLAN B, AND MAYBE A PLAN C “I’m a planner,” notes Dr. Allamby. “As a businessman, I learned to forecast, not just for tomorrow but for five to ten years from now,” writing down goals and referring to them throughout the year. Suddenly our conversation is interrupted by chimes on the hospital PA, followed by an announcement. Before we hear the announcement, Dr. Allamby says, “I wonder if that is a Code Blue?” He gets a bit antsy about doing the interview in the midst of it all, even though his shift hasn’t started. It turns out the fire systems were simply being tested, so Dr. Allamby resumes his train of thought. “So that’s how I approached studying for the MCAT,” he says. “I set a target date, and I set certain dates that I wanted to complete studying certain sections and materials by.” He never mentions what he would have done had he not passed the entrance exam. Failure is not in his vocabulary. But Dr. Allamby said that even if the results had turned out differently, he doesn’t often get bogged down by bad news. Why should he? There’s more than enough good in all of us to go around. NORTHEAST OHIO MEDIC AL UNIVERSITY

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BY ELAINE GUREGIAN

hen Anibelky Almanzar moved from the Dominican Republic to New York City with her mother and siblings at age 17, she was old enough to realize that back home, people died from preventable illness because of poverty and lack of access to health care. Yes, she was considered poor by U.S. standards, but she was safe, and her mother was able to meet her family’s everyday needs by working as a housekeeper. So on a trip to help immigrants in McAllen, Texas and Matamoros, Mexico over NEOMED’s winter break, Almanzar looked at the people standing in lines waiting for food and clothing and felt her privilege as an American citizen studying

Illustration: Malieka Gurrera

to be a physician. “I have a house, a bed, clean water, clean clothes. Compared to them, I have it all,” says Almanzar. As Latino numbers grow in the United States, so does the need for health care providers who speak Spanish, says the bilingual student better known as Ani. With a group of like-minded classmates in the University’s chapter of the national Latino Medical Student Association (LMSA), Almanzar has been pumping up NEOMED’s Latino profile, bolstering its students’ language skills and cultural competence to meet the demands of a changing demographic. The latest U.S. Census prediction is that by the year 2050, the U.S. population will be more brown than

white as Hispanics become the minoritymajority. In a nomination for NEOMED’s 2019 Diversity and Inclusion awards, the second-year College of Medicine student was called “an amazing role model [and] advocate for diversity and the under-supported and under-resourced.” Not only does she have the potential to change the way health care supports the most vulnerable populations, said her nominator: “She is building a community of care and advocacy right here at NEOMED.” Almanzar has good company in Aviva Aguilar, a second-year College of Medicine student born in Venezuela who came to the U.S. with her family at age two. Each NORTHEAST OHIO MEDIC AL UNIVERSITY

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fluent in somewhat different dialects of Spanish, the two serve as co-presidents of the NEOMED’s chapter of the LMSA – an organization that also welcomes pharmacy students as members. The current chapter is building on the progress begun by Carmen Javier, who started the LMSA chapter when she came to NEOMED from Los Angeles as a first-year College of Medicine student in 2017. At that time, she noticed that NEOMED had a relatively small number of Latino students and needed new guidance. (A student

organization called Hispanic Community Outreach Group had earlier been active.) In the past several years, the whole NEOMED community has been invited to participate in Dia de los Muertos (Day of the Dead) remembrances; an international festival with dancing from around the globe (with Aguilar and Almanzar among the student participants); and oneon-one medical Spanish coaching. Vignettes about significant Latinos circulated on monitors around the University during national Hispanic History Month.

As advocates, the LMSA co-presidents are doing even more. They took a group from NEOMED to Washington, D.C., joining LMSA members from around the country to advocate for Latino health care needs before members of Congress. With the Student National Medical Association (SNMA), Aguilar also helped to start a mentorship program for underrepresented students at the University of Akron. Aguilar has a poise in front of a crowd that’s rare at any age, let alone a 20-something student. When she spoke recently

A TRIP TO THE BORDER

opping floors, making sandwiches, distributing clothing and listening. That’s what was needed, so that’s what Aviva Aguilar, Anibelky Almanzar and their professor Julie Aultman, Ph.D., did when they traveled in a small group organized by Ursuline nuns in Northeast Ohio and supported by the Sisters of Charity Foundation to help at refugee camps in Matamoros, Mexico, and a respite center in McAllen, Texas, last December. NGOs (non-governmental organizations) were providing medical help, and Dr. Aultman also helped connect people with resources for their medical needs. One striking observation by the NEOMED contingent was that many people needed someone to listen to their stories. Dr. Aultman, director of the Medical Ethics and Humanities program at NEOMED, said the remedies that the Northeast Ohio group helped to provide were simple yet profound: food, clothing, a place for children to play. During their weeklong trip, each morning began at a respite center in McAllen, where the group loaded trucks with supplies and delivered them to the camps in Mexico. Dr. Aultman and her students did their best to process their days and decompress by talking together on the one-hour drives back to Texas from Mexico each night. The heartrending stories included tales of those who had died of starvation on their long walks (across the country of Brazil, for some refugees) to reach safety.

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Early one morning, Aguilar met a crying mother who had arrived at the Texas camp late the night before, after holing up with her three-year-old daughter in a house since August. She told Aguilar that she had been held there for ransom, terrified of threats that her family in Honduras would be harmed if she didn’t pay. After escaping and being helped to safety by police, she was distraught. “She just needed that comfort — someone to listen and hug her. Thinking of her, I will remember to keep an awareness of the emotional aspect of disease and hardship — to check in with my patients outside of the physical acute problems that brought them to me,” said Aguilar. The biggest surprise for Aguilar? “I thought I would meet kids whose light had turned off, because of the background of the stories I heard, going in. But all these kids still had so much curiosity and joy, despite the trauma. That was very touching, and it gave me a lot of hope.” Dr. Aultman plans to return to the refugee camp to continue helping and to learn more about the political battles facing the NGOs and local governments — and the barriers to social justice that make safety and wellness so difficulty to achieve for the more than 2,000 in this particular Texas border town. From just this weeklong trip, her students learned volumes about team building by living it, said Dr. Aultman. When you want to lead, “You can’t just rely on one individual. You all need to work together.”

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to a group of NEOMED supporters about her own experience as an underrepresented minority medicine student, she moved away from the podium to be closer to the crowd and talked without notes, visibly capturing her audience. Andre Burton, J.D., vice president for human resources and diversity at NEOMED, calls the LMSA one of the most active student groups promoting advocacy, pointing to their participation in the Ohio Latino Health Summit at Ohio State University and at Breast Amigas health fairs in Cleveland, not to mention their medical Spanish workshops on campus, where students sit down together for hands-on coaching from their peers to prepare them for Spanish-speaking patients. The LMSA is updating a Spanish medical dictionary pocket guide for students to carry with them for patient interviews. (This is the rare case when an analog product beats an app, notes Almanzar.) The LMSA also has built coalitions with other student organizations, particularly the Black Student Association and SMNA, each of which has now started meeting for coffee or dinner with prospective underrepresented minority students on interview days. “Prospective students have told us that no other school has done that for them and that is exactly why NEOMED felt like a special place to them. We provide these students the opportunity to ask questions and be themselves in an informal environment,” says Almanzar.

BUILDING TRUST At Aguilar’s clinical rotation at MetroHealth McCafferty Health Center on Cleveland’s West Side, the vast majority of patients speak Spanish, as does the clinician (Aguilar’s preceptor). When Aguilar interviews patients, she sees their faces light up when they realize that this

physician-in-training speaks their language. “You need a cultural understanding so you don’t scare the patient away,” says Aguilar. “I think that congruency in cul“YOU NEED A CULTURAL ture really opens up a level of UNDERSTANDING SO communication and trust.” Aguilar sees a need for more YOU DON’T SCARE THE Latino providers who understand cultural considerations PATIENT AWAY. I THINK from the inside out. For example, special understanding is THAT CONGRUENCY required to help a Latino patient who has anxiety, she says. IN CULTURE REALLY “The preceptor knows not to recommend medication right OPENS UP A LEVEL OF away, necessarily, because culturally there is a stigma against COMMUNICATION admitting you have mental AND TRUST.” illness and medication isn’t viewed as something people Aviva Aguilar would necessarily be open to. We talk to our patients more about faith and God and family and home. And instead of necessarily recommending a therapist right away, we open that conversation up by showing parallels between going to church and having a spiritual leader they can talk to, and talking with a therapist,” says Aguilar. Almanzar concurs. “A lot of Latinos are very religious. Say someone has cancer: they still believe it is God who cures them,” she says. Physicians don’t need to hold the same beliefs as their patients, but understanding and respecting their patients’ points of view will help them connect with them to provide the care that’s needed, these students agree. Of course, Latino cultures vary from country to country, and so do dialects — as the students noticed when they were interpreting during their visit to Mexico. All the more reason for NEOMED to train more numbers of providers with a breadth of experience in those cultures, they say.

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FEATURE

MAT AND THE FIGHT AGAINST OPIOIDS BY ELAINE GUREGIAN

I have a family member who is addicted to opioids. I’ve heard the term MAT but don’t know what it means or whether it could help my family member. How can I learn more?

ith an epidemic of opioid overuse disorder continuing across the country, urgent questions like these are being asked by people throughout our communities. Health care providers may be asked such questions more often as the public grows more aware of the evidence-based treatment option known as MAT. So, we asked Christina M. Delos Reyes, M.D. (’96), an associate professor of the Department of Psychiatry at University Hospitals in Cleveland who is board-certified in addiction psychiatry, to break down the answers for readers. What is Medication Assisted Treatment? In the addiction field, Medication Assisted Treatment (or “MAT”) refers to the Illustration: Emily Wolchko

use of any medication that supports recovery from addiction. So, a nicotine patch would be an example of MAT for tobacco use disorder and acamprosate [trade name Campral] would be an example of MAT for alcohol use disorder. In the case of opioid use disorders, MAT refers to three different medications that can be used to treat this disorder, namely (1) buprenorphine [trade name Suboxone] (2) naltrexone or (3) methadone. All three of these medications can be considered MAT. A brochure on MAT written by the Substance Abuse and Mental Health Services Administration (SAMHSA) is specifically written for patients, families, and friends, and is the single most useful resource that I know of, to explain how the meds work, and what to expect. How is MAT determined to be suitable for a patient? By doing a comprehensive assessment and evaluation of the patient, a prescriber

(doctor, nurse practitioner, or physician assistant) can make the determination of whether or not MAT is a suitable choice for the patient. Other factors, such as treatment access, insurance coverage, patient preference, pregnancy status, etc., will help to determine which of the three medications would make the most sense in an individual situation. If a facility says it offers medical detox, is that the same as MAT? What questions should be asked regarding patient safety? Medical detoxification, also known as medically supervised withdrawal, is NOT the same as MAT. Medically supervised withdrawal typically lasts three to five days and utilizes a variety of medications to treat the acute symptoms of withdrawal from opioids, alcohol or benzodiazepines. As noted in the NIDA brochure Seeking Drug Abuse Treatment: Know What To Ask (page 4), “Medical detoxification is a NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

necessary first step in the treatment of certain addictions, but by itself does little to change long-term drug use.” Medically supervised withdrawal does not treat the disease of addiction — it only removes drug-related toxins from a person’s body. The individual will need to be referred to ongoing treatment after medically supervised withdrawal, which would typically involve MAT. Who would not be a good candidate for MAT? (What factors might come into play? Age, health conditions, etc.) Different factors relate to the different medications. For example: Pregnancy: Methadone and buprenorphine are preferred/better choice — in fact, methadone is considered the gold standard, with buprenorphine a close second. Naltrexone is less preferred and not considered gold standard, but still can be used in limited cases. Allergies: If a patient were allergic to any of the three medications, then the patient would not be a good candidate for MAT. Medical conditions: For example, if the patient had severe liver damage, they might still be able to take the meds depending on how high their liver enzymes were. Sometimes the dosage of the medication can be adjusted accordingly. If a patient were dealing with chronic pain, methadone or buprenorphine might be preferable to naltrexone. Or, if a patient had an abnormal heart rhythm, buprenorphine or naltrexone might be preferable to methadone. For how long is this treatment usually given? How much does it cost for a full course of MAT? Treatment with methadone or bu-

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prenorphine can be given indefinitely, as long as the patient is benefiting from it and not having any severe side effects from it. So, similar to a patient who takes a “blood pressure pill for life” for hypertension, or a diabetic might need "insulin for life" to control blood sugar, some forms of MAT can be used indefinitely. Theoretically, naltrexone can also be used indefinitely, but in actual practice, patients are usually treated for 9 to 12 months with the monthly injections. Cost will vary according to insurance coverage, dosage and formulation of medication, but here are some rough costs: Methadone – Costs just pennies a day but can only be given out (for addiction) from a special clinic. Naltrexone – As a tablet of 50mg daily, costs about $50/month. As a monthly shot, costs $1300/month. Buprenorphine – Tablets vary from $6 to $10 dollars a pill, and some patients take between 1 and 3 pills a day, so cost would be $180/month up to $900/month. Buprenorphine also comes in a film form, like a Listerine strip — it’s just another way the medication can be delivered. Films are slightly more expensive. A monthly shot costs about $1300 to $1500/month. I’ve heard that methadone can damage your teeth. Is that true? Will people still crave opioids if they are taking methadone? Are there other common side effects from these medications? I would refer patients back to the MAT brochure page 9 and page 12 regarding “common side effects.” If a person is on the correct dosage of methadone, they will not experience cravings for other opioids. As for methadone rotting your teeth, I found the following information on a

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website (crchealth.com/addiction/heroin-addiction-treatment/heroin-detox/ methadone-effects/) and liked it:

MYTH #2 – METHADONE ROTS YOUR TEETH Methadone does not, in itself, have any effect on the teeth or bones Methadone sometimes causes a dry mouth, and since saliva protects the teeth from decay, methadone users may be more vulnerable to dental problems. Additionally, methadone users tend to begin methadone maintenance treatment after a long period of dental neglect. Methadone users can avoid dental problems by visiting their dentist regularly, avoiding sugary foods and drinks, and brushing and flossing regularly. Also, sugar-free gum increases the amount of saliva in the mouth and can counteract the dryness that is sometimes caused by methadone. How can patients obtain MAT if their own physician doesn’t suggest it? There is a national Buprenorphine Practitioner Locator that doctors, nurse practitioners and physician assistants can voluntarily join. Not every prescriber is on this list. Many prescribers choose to NOT identify themselves as buprenorphine prescribers. If you click on your particular state, you should see a list of all providers that can prescribe buprenorphine in your state. You can also use other filters, like a ZIP code, to search. The locator is at samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator.

NEOMED is in the front of the pack of medical schools to train its students in the most current standard of care for office-based MAT. Starting in July 2018, a three-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to NEOMED made it possible for all third-year College of Medicine students to complete what’s known in the industry as X DEA waiver training — learning how to prescribe buprenorphine or naloxone for opioid use disorders. Last September, NEOMED began offering shadowing experiences to all medical students during their clerkships in psychiatry, family medicine, internal medicine, pediatrics or emergency medicine.

Additionally, starting in September 2020, an elective class will be offered to allow fourth-year College of Medicine students to learn more about treating opioid use disorders with buprenorphine/ naloxone via participation in NEOMED's Ohio Opiate Project ECHO programs. Additional shadowing opportunities will be offered. Russell Spieth, Ph.D., licensed psychologist and assistant professor of psychiatry at NEOMED, is the Principal Investigator for the SAMHSA grant. As such, he is responsible for the management and integrity of the educational process, conduct and reporting of project outcomes and for overseeing, monitoring and ensuring the fidelity of any collaborative relationships.

PROJECT ECHO AND OPIOID USE DISORDER TRAINING NEOMED’s Department of Psychiatry has made a commitment to reducing substance use disorders, including Opiate Use Disorder (OUD), through programming for students, doctors and all medical professionals. It offers two MAT Opiate ECHO programs, both open to health care providers. A two-month offering called the Ohio Opiate Mentorship TeleECHO is designed to support the transition of the new MAT professional through a cycle of foundational prescriber-mentor topics, while the Ohio Opiate Continuing Education TeleECHO is a set of ever-changing continuing education topics. Project ECHO® (Extension for Community Healthcare Outcomes) is a model of continuing

medical education that increases workforce capacity by providing networks of expert teams who share best practices for specialty care with community providers via videoconferencing at weekly meetings. Physicians, nurses and other clinicians learn to provide excellent specialty care to patients with complex conditions. Project ECHO began at the ECHO Institute at the University of New Mexico and is now used globally to create learning communities. As a Project ECHO Superhub, NEOMED now trains new teams to establish learning communities and videoconferencing support to them. More information is available at neomed.edu/projectecho/

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FEATURE

MYTH BUSTERS: FAMILY MEDICINE EDITION BY MIKE APPLEMAN, M.A. ED., AND DAVID SPERLING, M.D. (’85)

t’s just human nature: Physicians tend to think that their own specialty is superior to everyone else’s. When medicine students enter the clinical realm, they observe the “turfs” between specialties and notice that each specialty has its own stereotypes — some of them negative. Further complicating the issue, practitioners in each specialty want to recruit the best and the brightest students to their residency programs. Therefore, medicine students observe a fair amount of specialty bashing during their clinical training. This competitive climate shapes students’ perceptions of potential careers and can discourage them from exploring areas that might suit them well. With bashing comes misconceptions, and there are many of them about family medicine — and more broadly, primary care. To be frank, these myths don’t speak highly of the specialty, which is critical to population health — even though it has been shown that when more primary care physicians are available, patient access increases and costs (including the costs of unnecessary procedures) decrease. So in an effort to bust these misconceptions, the NEOMED Family Medicine Interest Group — a student organization — held a Myth Busters: Family Medicine Edition event modeled on the popular show that debunks urban legends. Our group consisted of interest group advisors Mike Appleman, M.A. Ed.; John Boltri, M.D.; Stacey Gardner-Buckshaw, Ph.D.; and David Sperling, M.D. (’85); six residency faculty members of NEOMED’s affiliated family medicine residency programs; 13 third-year College of Medicine students; and two fourth-year College of Medicine Illustration: Dave Szalay

students. Together, we discussed some common misconceptions about family medicine. Following are some comments that family medicine students may encounter — along with responses suggested by experienced physicians including Nancy Flickinger, M.D. (’81), Jon Edwards, M.D., and William Smucker, M.D.

THE FUTURE OF FAMILY MEDICINE IS UNCERTAIN “People are tired of fragmented care and family medicine can make those connections, especially as advocates for women’s health. Someone needs to do obstetrics in rural areas where OB/GYN physicians are scarce or prenatal care is outsourced to urban centers.” “Even hospital administration is paying attention to family medicine because we can reduce costs while improving care. Additionally, there is great evidence that the therapeutic relationship is what improves patient satisfaction. Guess what — that’s what family medicine does best!”

YOU’RE TOO SMART FOR FAMILY MEDICINE “Thank you for the compliment. Family physicians need to be smart to care for the great variety of patients and conditions they manage. Not only that, for several decades, studies have shown that populations with more primary care physicians have better quality of care at lower cost and live longer. I’m looking forward to the challenge!”

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FEATURE

“There is a lot of noise in health care, like uncoordinated care, and family medicine doctors have to be smart to make music out of the noise that is our inefficient health care system.”

YOU HAVE TO KNOW SOMETHING ABOUT EVERYTHING “It’s impossible to know everything, no matter how narrow a field of specialty you choose. Knowing what you don’t know and knowing how to find reliable information efficiently is more important than memorizing lots of facts. Also, I like being comfortable initially managing any patient that comes to my office. That’s why family medicine is a great career.”

ALL YOU WILL BE DOING IS OUTPATIENT MEDICINE FOR THE “WORRIED WELL” “I like doing preventive care. Alleviating my patients’ anxiety is very rewarding. Beyond that, family docs see a huge variety of patients, perform many different procedures, and manage lots of complex patients and conditions. Not only that — I also have the option of subspecializing to further enhance my training. This will give me lots of options to evolve my career in many different directions over time if I want.”

NURSE PRACTITIONERS WILL BE DOING YOUR JOB IN THE FUTURE “Our country faces a huge shortage of primary care providers now and will do so over the next 10-50 years. There is plenty of work to go around. Smart physicians are teaming up with other health care professionals, including NPs, to help manage their patient panels more effectively and allow physicians to actually work most effectively at the ‘top of their license’ — in other words, to full capacity and broader scope. And family medicine is the most recruited specialty in national physician recruiting agencies.”

YOU WILL NEVER PAY OFF YOUR LOANS “Family physicians are in high demand. As the most recruited specialty, they are well paid, with starting salaries on average well over $200,000. Additionally, lots of hospital systems and state and

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federal programs sponsor programs to help family doctors pay off their loans in exchange for service in needed areas.”

MOST FAMILY PHYSICIANS HAVE LOW JOB SATISFACTION OR ARE BURNED OUT “The reality is that ‘burnout’ is very prevalent in all specialties, and we shouldn’t misdiagnose burnout as solely a specialty issue, when it is a systemic issue. For example, anesthesiology and emergency medicine are also prone to burnout. The answer here is complicated, but we should advocate for a health care system that truly operates as a system to deliver patient-centered care, not a health care market where utilization and profit supersede patient and population health goals. A change from fee-for-service to value-based reimbursement compensates providers not for the quantity of procedures performed, but rather for the quality of the care they provide.” Family medicine is a courageous calling, with many fellowship options: geriatrics, sports medicine, adolescent medicine, maternal/women’s health, rural health, preventive medicine, faculty development, hospice and palliative care, hospital medicine, sleep medicine, pain medicine, clinical informatics, global health, integrative medicine, substance abuse, behavioral science, emergency medicine, urgent care, HIV, dermatology and policy/ advocacy/leadership. The Myth Busters session was a fun event to highlight all the great things that practitioners in our field can do. Mike Appleman, M.A. Ed., is an instructor in the Department of Family and Community Medicine and the director of primary care education integration at NEOMED. He is also the associate director of NEOMED’s Rural Medical Education (RMED) Pathway and the new three-year Accelerated Family Medicine Track (AFMT). David Sperling, M.D. (’85), is a professor in the Department of Family and Community Medicine and the senior director of clinical experiential learning. He is also the director of the new three-year Accelerated Family Medicine Track (AFMT).

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One of Many Reasons to Reconnect … “I believe the most important thing that we as alumni can do for our alma mater is act as mentors and role models for the future physicians and pharmacists at NEOMED.” Corrie Stofcho, M.D., is a 2006 graduate of the College of Medicine at NEOMED. She currently serves as the president of the NEOMED Alumni Association Board where she focuses on enhancing alumni engagement and increasing their involvement with students. Dr. Stofcho encourages all alumni to reconnect with NEOMED and get involved through its many opportunities — from engaging in admissions interviews and volunteering on the alumni board to serving as a student mentor and participating in Wasson Center activities.

Corrie Stofcho, M.D. (’06)

Dual board certified — in general pediatrics and pediatric hospital medicine — Dr. Stofcho is a pediatric hospitalist at Cleveland Clinic Hillcrest Hospital. She also serves as a NEOMED Clinical Faculty member.

Reconnect with a Who’s Who of Fellow Health Professionals NEOMED has nearly 5,000 alumni, many of whom are in leadership positions across the country. NEOMED alumni live and practice in every state in the U.S., and many of them return to live, work and lead in Northeast Ohio. They are employed by nearly 200 clinical institutions and pharmacies, and practice in more than 50 fields of health care.

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Save the Date! March 17, 2020

IN THE REDIZONE

SHINING A LIGHT FOR RESEARCHERS BY JARED F. SLANINA

ahagn Ohanyan holds both a medical degree and a Ph.D. — skills that go hand in glove when he’s in the research lab studying cardiovascular preclinical disease models, such as myocardial infarction, heart failure or chemotherapy-induced cardiomyopathy. Over his career, which began in Armenia and has continued with an appointment at NEOMED, Dr. Ohanyan has also found success in another field: as an inventor. When he sees a need, he researches and figures out a way to

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meet it — whether that means building his own sophisticated shish kebab oven (known as a tonir) in his back yard or developing a product to help researchers perform surgery on mice. Dr. Ohanyan developed his latest invention at his CRO (contract research organization) lab in the Research, Entrepreneurship, Discovery and Invention Zone (REDIzone®) at NEOMED — an incubator that supports his own company (Ohan Cardiovascular Innovations lab) in taking inventions from the lab to the mar-

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ketplace. Recently, the physician-scientist has begun marketing a piece of equipment he designed to make it easier for researchers to do intubation (opening the airway with a tube to deliver anesthesia, medicine or oxygen) on mice for preclinical trials (conducted before humans are involved). “In medical school, we are trained to do surgery on people, not on mice,” says Dr. Ohanyan. “But in the research lab, there you are with a tiny mouse and it’s not easy. You need to be precise and accurate.” Consider the difficulty: A mouse’s

mouth opening is just a half-centimeter in size. Additionally, mouse tissue — unlike human skin or organs — offers almost no resistance, making it incredibly easy to accidentally cause major damage. Dr. Ohanyan understood the issues for his fellow researchers and resolved to invent a device to make mouse intubation easier and safer. The Ohan Rodent Intubation System has three components: the Ohan Fiber Light, a fiber cable and a laryngoscope. The most significant invention of the system is the laryngoscope, a one-hand operating device that is about four inches long and has a hand grip. The laryngoscope is a closed air system with a 5x magnifying lens attached to the unit. (Dr. Ohanyan chose this amount after asking a large number of male and female scientists of a wide range of ages and sizes to test it.) The device can be used whether the scientist is right- or left-handed. However, the focal point is only visible when it is in the correct position. This was designed to ensure that the device is being used properly, says Dr. Ohanyan. The system is wired to a small black box, approximately the size of an index card, holding a battery pack. This design allows the laryngoscope to be used anywhere in a lab, not just near a power outlet. The box is made of aluminum so that it does not require a cooling element. The rodent intubation system has been tested by scientists from research laboratories nationally and internationally. In 2019, the device was tested and approved by scientists at Duke University, the University of Kentucky and the University of Wyoming; the National Cerebral and Cardiovascular Center in Osaka, Japan; and the University of Aberdeen (UK), who are now waiting for the product to become commercially available. Dr. Ohanyan credits researchers from the lab of his colleague William Chilian, Ph.D., for their assistance in developing Photos: Lew Stamp

the device. NEOMED’s REDIzone has also been a huge factor in its success, says Dr. Ohanyan. The expertise of NEOMED’s in-house attorney and referrals to specialized legal counsel — in patent law, for example — have been critical. “The REDIzone’s executive director [Elliot Reed, J.D.] helped me through the patenting process, finding a manufacturer, and the steps of advertising and selling the product. Elliot Reed also helps me to successfully manage my CRO,” says Dr. Ohanyan. With this product set to be on the market as of press time, Dr. Ohanyan and his Ohan Cardiovascular Innovation Lab are already underway on another invention project that will be on the market by the

end of 2020. But the physician-researcher says his goals are bigger than simply selling products. “I want to set an example for my students: If there’s a problem, then roll up your sleeves and work towards a solution,” Dr. Ohanyan says. He also hopes that one day soon another scientist will take his idea and invent a similar device that can be used for surgery on humans – eventually completing the circle to create a solution that can keep us healthy and safe. Check out web extras at neomed.edu/ news/category/ignite-web for video of Dr. Ohanyan demonstrating the Ohan Fiber Light.

NORTHEAST OHIO MEDIC AL UNIVERSITY

HUMANITIES IN MEDICINE

HOMELESS, NOT HOPELESS BY ELAINE GUREGIAN

Resolve in your hearts to care. Resolve that the power you have as a physician arrives with great responsibility, and in the end, you need to own it. If the people you’re treating know you care, there’s something that happens that no one can explain. They’ll want to get better.

he meeting room was hold-yourbreath silent as guest speaker Doug Gough delivered those thoughts to students attending a lunchtime

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event planned by the student organization Physicians for Human Rights (PHR). The pizza was eaten and the official presentation was over. Normally, students would now disperse quickly to get to their next class or appointment. Instead, there was a “you can only hear the hum of the fluorescent lights” kind of quiet – the silence of listeners completely taking in this speaker’s message. A year earlier, PHR’s vice president, Marla Bashour, had been moved by

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Gough’s message when he spoke to the group. She was a driving force in calling for his return, and co-presidents Jordan Johnson and Grant Weltlin supported Bashour’s suggestion for a repeat visit. All three second-year College of Medicine students believed that other students needed to hear Gough’s compelling message about caring compassionately for patients — all patients, regardless of their situation. So now, Gough was back, with the goal of helping students see how they can lead

their fellow students — and later, their colleagues in residency and in professional practice — to practice empathy. And the students were hanging on to Gough’s words.

WHEN YOU THINK “HOMELESS” Say “homeless” and people imagine a hobo on a park bench with a fifth of booze, but they should also think of me, said Gough, a robust bespectacled 50-year-old. He took the group back to the first dramatic arc of his story, when he was a 17-year-old giving CPR to his mother for one desperate hour before she died in his arms. A second turning point came at her funeral, when someone slipped him a bag of cocaine. Gough fell away from his affluent large family, including his physically abusive father. Though he made it through his first year of college on a football scholarship, addiction reeled him in. He quit school and started a successful career in sales, but addiction kept pulling him off course. Driving drunk and high, he crashed headon into a cement truck. The part of the story that Gough most wanted to share with the students comes from when he was lying in his hospital bed, seriously injured, and overheard the group of physicians talking as they made their rounds. One of them said to another, “Is this the guy who was on the Life Flight? I wonder if he was worth the fuel.” “To them, I was just a junkie in a headon collision that closed down the highway,” said Gough. The worst part was that he felt the same way, Gough told the students. At the time, he had so estranged himself from his family that no one was willing to take him home, so he was delivered to a homeless shelter: the Rescue Mission of the Mahoning (Ohio) Valley.

Illustration: Dave Szalay

HE WAS LYING IN HIS HOSPITAL BED, SERIOUSLY INJURED, AND OVERHEARD THE GROUP OF PHYSICIANS TALKING AS THEY MADE THEIR ROUNDS. ONE OF THEM SAID TO ANOTHER, “IS THIS THE GUY WHO WAS ON THE LIFE FLIGHT? I WONDER IF HE WAS WORTH THE FUEL.” I’M YOUR DOCTOR Gough reclaimed his Christian faith when he talked with the pastor at the mission that first day, and it changed his life – but that wasn’t all that pulled him up and out of addiction, he said as he continued telling the students his story. As he began getting medical care outside the hospital, Gough was worried. He couldn’t work, due to the extent of his injuries. How would he pay for multiple back surgeries? The physician said he needed narcotics for the pain, but he didn’t want painkillers; he knew they weren’t safe for him. He told the neurosurgeon that he couldn’t afford to pay him, and to his amazement, the physician responded, “I don’t care if you pay me $20 a month for the rest of your life. I’m your doctor. I’m going to see you through this.” Telling the story to the students, Gough paused. “Do you see the difference between this and the Life Flight guy?” he asked them.

The effect of kindness can be profound, said Gough. “It’s amazing to me that one interaction can create a paradigm shift.” After the event, Weltlin reflected, “When he heard the guy say that he wasn’t worth the fuel, it led to Doug’s decision to leave the hospital against medical advice. Yet, hearing a more encouraging message from a different physician brought out an entirely different response from Doug. “I think that is a powerful message for future physicians to hear: You hold power in the way you choose to speak to your patients, and your words and attitude can affect their health outcomes. I think we have more influence than we realize.” It has been 10 years since Doug Gough left that hospital and homeless shelter. Now he is the first former resident to have become a member of its board of trustees. He is also the executive director of The Big Reach Center of Hope, a nonprofit in Greenford, Ohio. Gough lives in Poland, Ohio, with his wife, Dana, and his three stepchildren.

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HUMANITIES IN MEDICINE

PAT PAKAN: TEACHING THE ART OF LISTENING BY ELAINE GUREGIAN

ook into Pat Pakan’s eyes, and you see it: the soul of a listener. Bright against her white hair, her hazel-green eyes never shift their gaze past you, never get distracted by the people coming and going around her. They’re keenly focused to take in every bit of you, wrapping you in an easy, comfortable connection. Patricia Pakan, Ph.D., grew up wanting to be a physician, but becoming a medical doctor wasn’t in the cards. Her family didn’t have the means and anyway, she was a girl at a time when that meant either/or (if you even had a choice): Either have a career or a family. “I never thought I wanted to get married, but when I met the ticket-taker for the Dipsy Doodle at Kennywood Park, that

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was it,” says the great-grandmother of 10. She did become a registered nurse but took time off to raise four children with her late husband, a college professor. (Their oldest son, a NEOMED graduate, is now an orthopaedic surgeon.) It wasn’t until age 60 that Pat returned to school and earned a doctorate of a different kind — a Ph.D. Now on the cusp of her 88th birthday, this longtime NEOMED adjunct faculty member says she found plenty of delayed gratification from working with optimistic, eager students in the medical interviewing and reflective practice classes she teaches. For more than a quarter of a century she has been rewarded by being around these students, says Dr. Pakan. One of the best compliments came from a student who

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thanked her for teaching them to remember to always look at their patients as people. Dr. Pakan admits that there were times, as a nurse, that she didn’t find it so easy to treat each person with compassion. Take the time when she had to provide care for a patient who was a rapist, for example. She tells an interviewer now, just as she confides to her students, that she needed to take a moment alone in the restroom to remind herself of her duty to treat all patients with dignity and respect. But she pulled herself together then, and these days, Dr. Pakan has a storehouse of suggestions for how students can connect on a human level with every one of their patients. She shares a few:

FIRST, FIND OUT WHAT THE ILLNESS MEANS TO THIS PATIENT “I painted my garage door a few years ago and my shoulder hurt. I had a rotator cuff injury. That meant I couldn’t paint my door again. But my granddaughter plays high school volleyball. For her, a torn rotator cuff could mean losing a college athletic scholarship,” says Dr. Pakan. The aspect that bothers a patient most about the diagnosis may not be what you expect, either. A cancer diagnosis might sound like, “I’m going to die” to one patient. To another, it could signal, “I’m going to lose my hair.”

BE YOURSELF: EVERYONE ELSE IS ALREADY TAKEN Dr. Pakan loves that quote, often attributed – though some say wrongly – to Oscar Wilde, a gay English novelist living at a time (the second half of the 19th century) when coming out was definitely not an option. She mentions it to her medicine students because when they begin their training, they often equate professionalism with a cool detachment. “An extroverted person might feel like they can’t be that way,” Dr. Pakan says. By the time they get through their second year, though, students start feeling more comfortable seeing their own personalities in the role of physicians. That’s good, says Dr. Pakan: We connect the best with others when we are truest to ourselves.

PUT THE PATIENT BEFORE THE CHECKLIST Students can get so caught up in working their way through the questions on the boilerplate patient checklist that they may miss key pieces of information. “Did you hear them say they lost their wife when they were answering that question?” Dr. Pakan might ask. The death of a spouse may be pivotal to a patient’s decline. Here’s where it pays to ask follow-up questions.

GIVE EMPATHETIC FEEDBACK

HOLD TIGHT TO YOUR COMPASSION

Anyone who has taken a parent to a medical appointment knows how frustrating it can be when they clam up in the physician’s office, answering questions with, “Fine” when they have been complaining nonstop at home. One way for the physician to draw out more honest answers can be with reassuring, encouraging statements like, “This must be painful for you,” or, “This must be creating a lot of stress for you.”

Dr. Pakan has seen how reality sets in when third-year medicine students start going on rotations and have to keep up with the time limits set on patient visits. Instead of giving up or giving in to cynicism, it’s all the more important at this point for students to think back to what they learned in class. When they observe with all of their senses what the patient is telling them and use those clues, that’s when they are at their best to offer patient-centered care.

OBSERVE THE BODY LANGUAGE “Did you see that patient move the chair back six inches when you asked them that question?” Dr. Pakan sometimes asks her students. As a former marriage counselor, Dr. Pakan knows how people give away their feelings even when they don’t want to.

Photo: Eddy Esmail

A FEW FINAL PIECES OF ADVICE FROM DR. PAKAN: Remain committed to your faith to sustain you. Remain connected to others to nurture you. Remain curious to challenge yourself.

NORTHEAST OHIO MEDIC AL UNIVERSITY

TASTES LIKE HOME

PUTTING WELLNESS ON THE FRONT BURNIER

hen Krithika Sundaram began her first year in the College of Medicine, she soon realized it was time to learn to cook. She wasn’t eating well, and skipping meals was leaving her mentally and physically exhausted. By checking out YouTube cooking channels and getting tips from her mom over winter break, she found ways to get ahead of the cycle. “I feel better now that I am planning my meals and able to cook better for myself,” says Sundaram. “At first, I was very

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scared to cook in general and never believed I could follow a recipe. However, after just googling some things that I wanted to try, I found it really easy. “I know cooking may seem like a chore, but if you can take one to two hours to meal prep your food for a week, it will help you have a happier week and maintain a healthy lifestyle to get you through the semester.”

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THE BEST VEGETARIAN CHILI IN THE WORLD allrecipes.com/recipe/72508/the-best-vegetarian-chili-in-the-world/ Here’s a vegetarian chili recipe by allrecipes.com, with Sundaram’s notes.

You do not need to follow the recipe exactly. Every person has different tastes in food and making minor changes will not affect the overall quality of it. You can add any vegetables that you like to the list — you don’t have to limit yourself to the vegetables here. For example, I added carrots instead of celery because that is what I had in my fridge. And you don’t have to include everything in the recipe. I didn’t add the vegetarian burger crumbles, because I could not find them at the store. I didn’t add canned green chili peppers, because I used the ones my mom had given me from an Indian store. I really like my chili spicy, so I added more chili powder. The first time I made chili, it was good, but I learned things that I should do differently. It takes time to find the modifications you like. Good luck with your cooking journey!

Ingredients: 1 tablespoon olive oil ½ medium onion, chopped 2 bay leaves 1 teaspoon ground cumin 2 tablespoons dried oregano 1 tablespoon salt 2 stalks celery, chopped 2 green bell peppers, chopped 2 jalapeno peppers, chopped 3 cloves garlic, chopped 2 (4 ounce) cans chopped green chili peppers, drained 2 (12 ounce) packages vegetarian burger crumbles 3 (28 ounce) cans whole peeled tomatoes, crushed ¼ cup chili powder 1 tablespoon ground black pepper 1 (15 ounce) can kidney beans, drained 1 (15 ounce) can garbanzo beans, drained 1 (15 ounce) can black beans, drained 1 (15) ounce can whole kernel corn Prep: 15 minutes • Cook: One hour Instructions: 1. Heat the olive oil in a large pot over medium heat. 2. Stir in the onion, and season with bay leaves, cumin, oregano and salt. 3. Cook and stir until onion is tender, then mix in the celery, green bell peppers, jalapeno peppers, garlic and green chile peppers. 4. When vegetables are heated through, mix in the vegetarian burger crumbles. Reduce heat to low, cover pot and simmer five minutes. 5. Mix the tomatoes into the pot. 6. Season chili with chili powder and pepper. 7. Stir in the kidney beans, garbanzo beans and black beans. Bring to a boil, reduce heat to low and simmer 45 minutes. 8. Stir in the corn and continue cooking 5 minutes before serving.

Photos: Chris Smanto

NORTHEAST OHIO MEDIC AL UNIVERSITY

WHALE WATCHING

A SOCIAL PASSPORT TO DIVERSITY BY SAMANTHA HICKEY

hen John (Ikenna) Ogwuegbu began his education at Northeast Ohio Medical University, he saw a need to increase diversity at the University. The Nigerian-born College of Pharmacy student helped form NEOMED’s first Black Student Association — a group that serves as a resource to support and promote understanding the many diverse aspects of black culture. All students, whether in the College of Medicine, College of Pharmacy or College of Graduate Studies, are welcome to participate. Ogwuegbu describes the Black Student Association as “a social passport that will provide students the chance to explore and contribute to the growing diversity emerging at NEOMED.” Together with Theresa Russell, Mariah Carlton, Cecil Ekechukwu, Yaa Bosompim, Nautica McCully, Shadrack Osei Baah and Aisha Osanyinpeju of the Black Student Association, Ogwuegbu is working to create a welcoming environment for black students, as underrepresented minorities at NEOMED. The organization has hosted fashion shows, mentored local youth, presented Black History Month activities and most recently, teamed up with the University’s Office of Admissions to host prospective black students for dinner before they interview at NEOMED.

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“Every student arrives at interview day with mixed emotions of excitement and trepidation, excited to have advanced to the stage of being considered for a coveted seat in professional school through a rigorous admission process, but also a bit pensive, wondering whether they will find the right school for their goals and ‘fit in.’ The interview process can be especially challenging for students from underrepresented backgrounds who don’t always see many students that look like them. Being greeted the night before the interview with a friendly welcome from a current NEOMED student who has lived the same shared experience can be transformative,” says James Barrett, senior executive director of strategic enrollment initiatives. Ogwuegbu says that initiatives like the dinners have become so popular that the Black Student Association has received messages from prospective students on its Instagram account (@neomedbsa) to connect even sooner. His goal is to create a welcoming environment for underrepresented minority students on their initial visits to NEOMED and during their transitions to professional school, especially through their first year of medicine or pharmacy school. He compliments one of his BSA co-founders, Diamanta Panford, a second-year College of Medicine student, who has made an extra effort to make prospective NEOMED students feel at home by housing them in her own apartment the night before their interview and even shuttling interviewees back and forth from the airport.

HONORED FOR HIS WORK Ogwuegbu was honored as NEOMED’s 2019 Pharmacy Diversity and Inclusion Excellence Award recipient after being nominated by more than 30 of his peers. They noted, “Ikenna has helped me feel included into the NEOMED community,” “Ikenna is dedicated to not only bringing diverse individuals together, but making everyone feel comfortable and welcome,” and “Ikenna goes out of his way to welcome new students — regardless of their background.” Whether it be as a co-founder of the Black Student Association, a representative for NEOMED’s Diversity Council or as a board member of the Student National Pharmaceutical Association NEOMED chapter, Ogwuegbu wants to help NEOMED become a campus where diversity thrives. As he puts it: “When students come to campus, I want them to feel like NEOMED is an environment where they can see themselves.”

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corporate social responsibility (CSR)

INVESTING IN POSITIVE CHANGE FOR COMMUNITIES

Huntington Bank’s philosophy is that being a good corporate citizen means making that direct link to the community and to the students and patients that the students will serve one day. With Erin Burrier (center), a third-year College of Medicine student and recipient of the inaugural Huntington Bank RMED scholarship, Stark County and the Mahoning Valley region’s Sandy Upperman (senior vice president, regional marketing and communications manager) and Bill Shivers (president) are effecting positive change in rural areas.

CSR can provide CPR to communities by helping to resuscitate areas with lower-than-average life expectancies and higher-than-average suffering from chronic conditions. In Stark County, which has one of the highest infant mortality rates in the state of Ohio, Huntington Bank provides support so future medical professionals can reverse these trends. “(In rural areas) I think sometimes there’s a misperception that ‘I’ve got to go to New York or Boston or somewhere else’ to have an impact. But every community needs great physicians,” said Shivers. Erin, who grew up on a farm, was excited to learn that she received the $25,000 Rural Medical Education (RMED) scholarship, which is renewable for a second year. She’s passionate about giving back to and making a difference in the community that’s been so good to her. “Sometimes rural areas are overlooked. Huntington’s scholarship for a student in the RMED program will help ensure that there is quality care in rural markets. With NEOMED’s overall reputation and the outstanding quality of their physicians, we thought, how we could honor that in a meaningful way? The RMED Scholarship seemed perfect,” says Upperman.

They Challenge Others to Give

GIVING DAY Through the University’s Blue Fund, Huntington also supports other student resources such as wellness and financial planning programs that help ensure students’ success when they graduate. For the last five years, Huntington Bank has sponsored a Match Challenge on NEOMED’s Giving Day. With a total contribution of $172,000, Huntington has helped the University raise a total of $565,202 on those Giving Days. Huntington will make it six years in a row as it sponsors yet another NEOMED Giving Day Match Challenge. This year's event starts at noon March 17, 2020. More information can be found be at neomed.edu/givingday.

To learn how you can maximize your positive impact on communities and students in need, contact Daniel Blain at 330.325.6261 | dblain@neomed.edu

CLASS NOTES

1981

1990

1995

Jeffrey Bachtel, M.D., was named as the 2019 Family Physician of the Year by the Ohio Academy of Family Physicians.

Albert Cook II, M.D., received the NEOMED Alumni Association Distinguished Service Award at the 2019 Alumni Reunion and Awards Dinner, held Sept. 28, 2019.

Karen Monheim, M.D., received the 2019 Internist of the Year Award from the Ohio Chapter of the American College of Physicians.

1993

Douglas Moses, M.D., has been named as the NEOMED College of Medicine associate dean for admissions and student affairs. Anne Shriner, M.D., has been named as chief medical officer of Nash UNC Health Care, located in Rocky Mount, N.C.

1983

Thomas Boniface, M.D., has been named as system medical director of orthopedic services for Bon Secours Mercy Health, based in Cincinnati. Dr. Boniface also serves as a clinical professor and chair of orthopaedic surgery at NEOMED. 34 I G N I T I N G

Michael Weaver, M.D., was appointed as director to the board of directors of the American Board of Preventative Medicine in August 2019. Dr. Weaver represents the sub-specialties of addiction medicine, clinical informatics and undersea/hyperbaric medicine to the board. He has served as the sub-board chair for addiction medicine since 2016.

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Duane Taylor, M.D., became president of the American Academy of OtolaryngologyHead and Neck Surgery (AAO-HNS) and the Academyâ&#x20AC;&#x2122;s Foundation on September 18, 2019. Elected by AAO-HNS members, Dr. Taylor will serve a one-year term leading the Academyâ&#x20AC;&#x2122;s nearly 12,000 members, who specialize in the treatment of the ears, nose, throat and related structures of the head and neck. Dr. Taylor is the first African American to serve in this position.

1996

Mona Mangat, M.D., received the NEOMED Alumni Association Distinguished Alumni Award at the 2019 Alumni Reunion and Awards Dinner, held Sept. 28, 2019.

Cynthia Zelis, M.D., was named a Distinguished Physician by Cleveland-based University Hospitals, in recognition of her exceptional clinical skills and dedication to patient care. Dr. Zelis is a family physician at University Hospitals Family Medicine Center in Strongsville, Ohio and vice president of clinical integration at University Hospital.

1999

William Hartmann III, M.D., was named medical director of Williams House, an adult psychiatric residential program, in May 2019. Williams House is part of the Lindner Center of HOPE, located in Mason, Ohio. Dr. Hartmann also serves as vice president of the medical staff at Lindner Center of HOPE and is a faculty member at the University of Cincinnati.

2001

2012

Daniel Smith, M.D., and his wife welcomed their son, Leo Parish Smith, on June 17, 2019.

2013

Jessica Lovich-Sapola, M.D., was named as president-elect of the medical staff at MetroHealth Medical Center in Cleveland, Ohio. Dr. Lovich-Sapola will assume the role of president in the summer of 2020. She is the first anesthesiologist to be elected to this position in the history of the hospital.

Maria Rubinstein, M.D., was named as the 2019 Young Investigators Award recipient by Gateway for Cancer Research and the Conquer Cancer Foundation of the American Society of Clinical Oncologists. The award will provide Dr. Rubinstein a one-year, $50,000 grant to conduct research in clinical oncology.

2002

2016

Amol Soin, M.D., was named as chief medical officer of JanOne, a company that formulates non-addictive pain medication and therapies. Dr. Soin currently serves as a pain management representative for the State of Ohio's Medicare carrier advisory committee. He also serves on the prescription drug abuse committee and legislative task force for the Ohio State Medical Association.

Danielle Beltz, Pharm.D., has earned Certified Specialty Pharmacist (CSP) and Multiple Sclerosis Certified Specialist (MSCS) credentials. Dr. Beltz is a clinical specialty pharmacist at Envision Specialty Pharmacy in North Canton, Ohio.

2008 Jonah Moon, M.D., and Teresa (Czaplicki) Moon, M.D. (â&#x20AC;&#x2122;08), welcomed a baby boy in April 2019.

Heather Deem, Pharm.D., has earned Certified Specialty Pharmacist (CSP) and Multiple Sclerosis Certified Specialist (MSCS) credentials. Dr. Deem is a clinical specialty pharmacist at Envision Specialty Pharmacy in North Canton, Ohio.

NORTHEAST OHIO MEDIC AL UNIVERSITY

DONOR SPOTLIGHT

FINDING THE WORDS FOR GRATITUDE BY ELAINE GUREGIAN

hen a researcher receives a federal grant of nearly a million dollars, it might seem like a golden ticket. No doubt, the grant that Sheila Fleming, Ph.D., received from the Department of Defense for Parkinson’s disease research in 2019 gave her the much-needed financial stability to move ahead. And having that amount matched for her research colleague at Michigan State University allowed the two scientists to proceed with assurance. But Dr. Fleming and her colleagues got goosebumps when they were in the room with Alan Woll, a Northeast Ohio resident who has Parkinson’s disease, and Woll announced that he and his wife, Janice, would like to financially support 36 I G N I T I N G

NEOMED’s research on neurodegenerative disease. “You could just see that it was very meaningful to him. Obviously that generosity is incredible. It makes you want to do everything you can — to come in early and stay late. You feel a big responsibility — sometimes even more so than when you’ve competed for a grant, because it feels more personal,” says Dr. Fleming.

A PERSONAL STAKE Woll’s interest in neurodegenerative research extends from Parkinson’s – his own diagnosis — to Alzheimer’s, with which Janice Woll has been diagnosed. In one of the many partnerships that take place among NEOMED researchers in the Neurodegenerative Disease and

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Aging Research Focus Area, Fleming’s colleague and collaborator Christine Dengler-Crish, Ph.D., is studying an exercise hormone called irisin that may have therapeutic potential in Alzheimer’s. Dr. Dengler-Crish’s pilot work has been promising and she expanded the project to include Dr. Fleming’s Parkinson models. Alan Woll’s grant allowed Drs. Dengler-Crish and Fleming to hire a postdoctoral fellow and a graduate student to work on these projects. The collaboration with Dr. Dengler-Crish complements Dr. Fleming’s research studying the effect of exercise on both motor issues (such as difficulty walking) and non-motor symptoms, such as anxiety, depression, cardiovascular issues,

reduced sense of smell or difficulty sleeping, in Parkinson’s. By introducing exercise in animal models at different time points, as the disease progresses, she hopes to discover a means of slowing the progression of the disease.

A NEW DIRECTION For years, the gold standard of treatment for Parkinson’s has been a drug called Levodopa, commonly known as L-dopa. “It tends to work well when people are initially diagnosed, but it doesn’t do anything to stop the progression of Parkinson’s,” says Dr. Fleming. L-dopa loses its efficacy over time and can lead to side effects, such as dyskinesia — involuntary movements like muscle twitches. Photos: Chris Smanto

Researcher Christine Dengler-Crish, Ph.D., explains: “Irisin, a hormone that is released in response to exercise, may protect brain cells against the damaging effects of Alzheimer’s disease. In patients and mice designed to model the disease, there is evidence that this hormone might not be able to do this effectively — possibly because it is not released in sufficient quantities. Our lab is testing whether giving supplemental irisin to mice that develop Alzheimer’s-like characteristics can increase brain levels of this hormone and prevent memory loss/brain damage. The photo shows that irisin (red/pink) is being expressed within a short reach of brain cells that are damaged in early Alzheimer’s disease — but that in this particular mouse’s brain, this amount of irisin looks reduced compared to similar brain sections we have looked at in healthy mice.That’s a potentially promising result. Irisin was only recently discovered, and we are among the first labs to use microscopy techniques like this to visualize it in these specific brain cells.”

“It was so moving to me at our first meeting, when Alan said he wanted to contribute to the effort to find a way to slow the progression,” Dr. Fleming remembers. When Woll visited Drs. Fleming and Dengler-Crish at their labs recently, he hesitated for a moment, mid-sentence. “I lost my train of thought,” he said, clear-

ly having become accustomed to saying that phrase. “That’s why we’re here, doing this work,” responded Dr. Dengler-Crish, with Dr. Fleming nodding in agreement. They paused, and something passed in the air — an understanding of why this research matters so much. NORTHEAST OHIO MEDIC AL UNIVERSITY

DONOR SPOTLIGHT

For Dr. Fleming’s study of exercise’s effect on Parkinson’s, rodents are tested at the end of the experiment to determine the effect of the exercise regimen on motor, cognitive, neuropsychiatric and olfactory function — all behaviors that are affected in Parkinson’s.

Rodents are put through 30-minute physical workouts, Mondays through Fridays. That regimen was chosen because a human could reasonably follow it, too. The goal, Dr. Fleming explained, is to introduce exercise at different phases of pathology. “This will tell us if we can prevent the pathology from starting, or once neurodegeneration has already begun, whether we can slow or stop it with exercise.” The rodents all receive the same injections of synthetic alpha synuclein (to cause Parkinson’s symptoms) but only some of them get the exercise. All of the cages go in the experimental room. One rat is left in the cage while the other is put on a treadmill.

The rodent is put on a tapered beam and recorded as it walks from the widest to the narrowest section into its home cage. Using this test, the researcher can measure gait, postural stability and speed of movement. All of these motor functions are affected in Parkinson’s.

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The researcher puts two identical objects in a bin. For 10 minutes, the mouse is in the bin and allowed to explore and investigate the objects. The mouse is then removed and placed back in the home cage. After one hour, the animal is brought back to encounter one of the objects it has seen before and one new object. It’s normal for the rodent to spend more time investigating the new one, but if they are cognitively impaired, they will investigate the novel and familiar objects for a similar amount of time.

Four numbered blocks are placed in an animal’s home cage for 24 hours, so the blocks take on the scent of that animal. After 24 hours, the blocks are removed from the cage and then presented to the animal for 30 seconds. This procedure is done several times. The typical animal will approach the blocks, sniff them, detect their own scent, and lose interest in them. By the last trial they do not show a lot of interest in the blocks. Then one additional trial is performed. Here, the animal is presented with four blocks again, but one has been switched with another animal’s block so that there are three blocks that smell like the animal in the cage and one block that has the scent of a different rodent. An animal with intact olfaction will detect the different scented block immediately and will sniff it more than the other blocks. If olfaction is impaired, the animal will not be able to detect the different block and will sniff all blocks equally.

To learn more about NEOMED's Research Focus Areas, visit neomed.edu/research.

NORTHEAST OHIO MEDIC AL UNIVERSITY

4209 ST. RT. 44, PO BOX 95 ROOTSTOWN, OHIO 44272

There are less than 20 Project ECHO Superhubs in the world and we're one of them!

NEOMED SERVES AS A

SUPERHUB

We can help organizations design their own Project ECHO using videoconferencing technology to connect physicians, nurses and other clinicians with teams of multidisciplinary experts.

ORGANIZATIONS AND HEALTH PROFESSIONALS MAY ALSO PARTICIPATE IN ONE OF OUR CURRENT PROJECT ECHOs FOR FREE:

Integrated Care at NEOMED • SZconsult (schizophrenia spectrum disorders)

First Episode Psychosis • Ohio Opiate Mentorship TeleECHO

Ohio Opiate Continuing Education TeleECHO • Ohio Systems of Care TeleECHO Visit neomed.edu/projectecho/ to learn more

Northeast Ohio Medical University