the fantastic five
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The Fantastic Five
April, 2010, Page 222
Photography by Johan Alp
Abraham Lieberman, M.D.
Meet five of the Valley’s most innovative physicians who are taking patient care into the next frontier.
Abraham Lieberman, M.D.
At age 6, Abraham Lieberman was struck with polio, which temporarily paralyzed him and left him with a permanent limp and a conviction to become a neurologist. But by the time he finished medical school, the polio vaccine had been developed. However, the medical community was just making breakthroughs in another serious movement disorder: Parkinson’s Disease.
Lieberman eventually became one of the leading figures in Parkinson’s, a disorder caused by the death of dopamine-producing cells that can lead to symptoms including tremors, slowed movement, balance problems and dementia.
Lieberman introduced a class of drugs to treat PD called dopamine agonists, which, he says, are like synthetic dopamine. He was one of the first doctors to utilize Levodopa – now the main drug for Parkinson’s – and a class of drugs called MAO-B inhibitors, which block an enzyme in the brain that contributes to the progression of the disease. He was one of the first doctors to describe a group of people who look like they have PD but don’t because they don’t respond to the same drugs. He has also helped develop specialized treadmills and balancing equipment to use in physical therapy for Parkinson’s patients.
Locally, he is best known for starting the Muhammad Ali Parkinson Center at Barrow Neurological Institute, located at Phoenix’s St. Joseph’s Hospital. He also co-started Celebrity Fight Night, which partially funds the center, in the 1990s. After a stint as the medical director of the National Parkinson Foundation in Florida, Lieberman returned to St. Joseph’s in 2007, promptly quadrupled the number of patients at the center and spearheaded the creation of the new 10,000-square-foot, state-of-the-art Muhammad Ali Parkinson Center that opened in December.
“What I hope it does is set a standard,” Lieberman says of the center. “My vision for the center had always been that it would be a place where once you went there you wouldn’t want to go to any other place.”
Christina Kwasnica, M.D. (right)
Christina Kwasnica, M.D. Neurorehabilitation
Imagine you have just sustained a traumatic brain injury (TBI). You have to overcome memory loss and relearn tasks you’ve been doing for years. Now imagine you’re a child with TBI. You must learn things for the first time with an injured brain, plus deal with school getting more difficult every year and the social and psychological struggles of adolescence.
That’s where Dr. Christina Kwasnica steps in. She’s one of two board-certified pediatric rehabilitation specialists in the state, and the only one who also treats adults. That means she’s the only neurorehabilitationist who can help children with TBI through years of intense therapy and continue with them as they meet the challenges of adulthood.
“I really enjoy that longevity of seeing patients over a long period of time and seeing what therapy has done to help them improve,” says Kwasnica, medical director of neurorehabilitation at Barrow Neurological Institute in Phoenix. “And for families it’s a comfort point to know they have someone that can be with them throughout the course of their lifetime.”
Last September, Kwasnica and child neurologist Dr. Javier Cárdenas started B.R.A.I.N.S., a multidisciplinary evaluation clinic at Barrow for children and adults with mild TBI. It’s the only clinic of its kind in the country. When children go to the ER with concussions or mild brain injury, they can be referred to the clinic, where they’ll be evaluated by multiple specialists, receive brain imaging and undergo cognitive testing. Physicians follow up with neurological exams, and an educational specialist ensures the children transition well back to school and receive necessary accommodations in the classroom.
“It’s been hugely successful,” says Kwasnica, who adds that the clinic is particularly busy during football season. That’s why her next goal is to start the country’s first dedicated pediatric sports concussion clinic.
More kids are participating in sports and are in danger of concussion than ever, says Kwasnica, who wants the clinic to offer evaluation and treatment as well as increase awareness about the potentially severe, long-term effects of concussions. “We’re going to prevent a lot of long-standing injuries and hopefully educate families,” she says.
David Rizik, M.D.
David Rizik, M.D.
“Interventional cardiology is like a jealous lover,” says Dr. David Rizik, medical director of Invasive Cardiology at Scottsdale Healthcare Shea Medical Center. “It really does require a lot of your focus.” That’s because, day and night, he’s stalking a killer that could strike without warning: the heart attack.
In 2008, NBC newsman Tim Russert’s unexpected death from previously asymptomatic coronary artery disease sparked interest in identifying risk factors for sudden heart attacks. Enter the LipiScan.
Think of the LipiScan as the night vision goggles of cardiology. Physicians performing angiograms are in the dark when it comes to detecting potentially deadly plaque in the arteries called lipid core: It simply can’t be seen. But using this new infrared technology, they can view an artery’s chemical content in living color: Red indicates low lipid, yellow reveals high lipid. It’s like putting on infrared night goggles and suddenly seeing all the things in the dark waiting to attack you.
Last summer, Rizik performed the state’s first LipiScan procedure. Now, he and his Scottsdale Healthcare team have the most experience of the 12 centers in the world using the device. “What we are seeing now in terms of lipid core in the blood vessel, it required autopsies to see before,” Rizik says.
This plaque may be a reason why Russert and others with minimal disease die suddenly. “We believe a high content of lipid is the thumbprint of coronary arteries that are vulnerable to worsening,” Rizik says.
The next step is building on this technology to identify which patients are most vulnerable, so physicians can “interrupt the pathologic process and prevent heart attacks and sudden death,” Rizik says.
Rizik, who was principal investigator on the first U.S. drug-eluting stent trial and performed the world’s first bifurcation procedure using drug-eluting stents (i.e., stenting a two-pronged artery), is also working on new stent technology. In conjunction with Abbott Vascular, he is helping develop bioabsorbable stents that scaffold the artery for nine months before breaking down into natural materials.
He and his colleagues are also experimenting with infusing super-saturated saline into the coronary artery after angioplasty. This, Rizik says, reduces the amount of damage in the heart muscle from about 25 percent to about 18 percent.
Daniel Von Hoff, M.D.
Daniel Von Hoff, M.D.
Dr. Daniel Von Hoff may never have become one of the nation’s foremost oncologists if his last name didn’t start with a “V.” When he began his medical training in the 1970s, cancer was literally considered a dead end. So when the doctors were assigned clinical rotations alphabetically, by the time they got to Von Hoff, only the least desirable field remained: oncology. “But I found the [patients] so fantastic and tough. They were an inspiration,” Von Hoff says. “So I was glad my name began with a ‘V.’ As they say, the last shall be first.”
First, indeed. Von Hoff is chief scientific officer at Scottsdale Healthcare’s Virginia G. Piper Cancer Center and physician-in-chief at Translational Genomics Research Institute (TGen) in Phoenix.
He has given the first patients in the world numerous cancer therapies that have dramatically increased survival. He has conducted national clinical trials with more than 200 new anti-cancer agents – more than any other researcher. In 2009, he was lead investigator on the first trials of a new drug that successfully treats advanced basal cell carcinoma – a type of skin cancer that is the most common cancer in the world and is usually treated by surgery. Von Hoff has “high hopes” the drug could treat other types of cancer including a common brain tumor in children.
Recently, he and his colleagues at TGen began using Horizon’s new GENESIS and X-MAN technologies, which allow them to mutate a specific gene on a non-cancerous cell to create a cancerous cell that matches the mutation in a given patient’s tumor. They can then test potential treatments on the cell pairs to see which one kills the cancer cell but not the normal cell.
He and his colleagues are also targeting support cells – normal body cells recruited by cancer cells to feed and shield the tumors from the immune system and drug treatments. They are also examining some tumors’ voracious metabolism, looking for what Von Hoff calls an “Achilles heel” – a weakness present in cancer cells but not normal cells.
The goal? “To cure cancer,” Von Hoff says. “But remember, cancer is 200 different diseases. I’m certain it can be cured, but you’ve got to cure it one cancer at a time.”
Ashish Pershad, M.D.
Ashish Pershad, M.D.
In 2004, former President Bill Clinton underwent quadruple-bypass surgery, getting blood vessels from his chest and leg grafted onto his heart to detour around clogged arteries. In 2005, he was treated for complications resulting from the bypass. This February, he had stents inserted into one of the grafted arteries, which had become completely blocked. What Clinton may not have known is that even when he wasn’t in the hospital, another form of bypass was being performed on him – by his own heart.
“The heart is an amazing organ, because it creates a lot of bypasses on its own,” says Dr. Ashish Pershad, interventional cardiologist at Banner Good Samaritan. When a person has blocked arteries, the heart recruits normally closed microchannels to open up and accommodate blood flow.
“What intrigued me,” Pershad says, “was why can’t we use some these bypass channels that the heart creates and insert tiny microcatheters and wires to make the connection that the heart has already created, and then use that as a conduit to open up the artery that’s completely closed?”
It’s called the retrograde approach to coronary recanalization, and it could be an alternative for thousands of patients like Clinton who repeatedly need bypass surgery, and the only option for some high-risk patients being treated with medication or nothing.
Currently, Pershad is one of about a dozen doctors in the country, and the only one in Arizona, who does it.
Pershad is also the principal investigator on a national trial for the Impella, a new, minimally invasive device that helps a weak heart pump while surgeons insert balloons or stents into the arteries. “That allows us to take on complex, difficult procedures with a safety net we never had before,” Pershad says.
In addition, Pershad is one of a few doctors in the country certified in endovascular medicine, which involves using catheters and stents to open blood vessels throughout the body. He’s one of the only doctors in the western U.S. treating abdominal aneurysms percutaneously – using no incision, just a needle. This, like the other minimally invasive procedures Pershad performs, means patients can go home sooner and recover faster.
But don’t think all these achievements are going to Pershad’s head. This friendly doc lives according to what he calls his four H’s: Hard work, Honesty, Humility and, of course, Heart.
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