LEGACYACHIEVEMENTS IN HEALTHCARE, MEDICAL SCIENCE, AND PHILANTHROPY

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C H I L D M A G A Z I N E J U S T S U M M E D I T U P.

“ R A I N B O W I S A M O N G T H E T O P T H R E E

C H I L D R E N ’ S H O S P I TA L S I N A M E R I C A . ”

Advanced Care. Advanced Caring.®

For the name of a Rainbow pediatric specialist, call 216-844-UHHS (8447) or visit www.rainbowbabies.org.

Child magazine ranks Rainbow Babies & Children’s Hospital among the topthree in America, with the nation’s #1 Neonatal Intensive Care Unit (NICU).Which is awfully good news for kids around here. Even if yours haven’tarrived yet.

In its comprehensive survey of children’s hospitals, Child magazine namesRainbow #3 in the entire USA, based on factors including: • 24/7 availabilityof pediatric specialists • Family-friendly rooms and floors • Successfuloutcomes, especially with premature babies and in complex areas such as cancer

and cardiology • Advanced clinical trials • Research & development of new treatments specifically for children.

And with the best NICU in the country right here, parents and parents-to-be have even more reason to trusttheir newest family members to Rainbow Babies & Children’s Hospital.

These rankings are based on facts, not opinions. And they all add up to the same powerful conclusion.When it comes to the best care for your child, it’s Rainbow.

Departments

3 Highlights

30 Philanthropic Spirit

33 ReflectionsNursing – an exceptional calling

Special Sections

2 A Message from the Senior Vice President for Development

Features

6 Anatomy of a $25-Million DecisionIris S. and Bert L. Wolstein make the largest single philanthropic giftin UHC history. by Eileen Korey

10 Actor Christopher Reeve Receives New Breathing Device at UHCNearly eight years after the accident that left Christopher Reeve paralyzed and dependent on a ventilator, the 50-year-old actor andactivist has hopes of breathing more normally, with the aid of a surgically implanted investigational device. by UHHS-UHC Marketingand Communications, and Development staff

14 A New Era in Pediatric Surgery at RainbowWhether your child’s operation is routine or complex, there are manyadvantages before, during and after surgery that can only be offered bypediatric surgeons in a facility dedicated solely to the comprehensivecare of children, like Rainbow Babies & Children’s Hospital. by Ann Bungo

18 On Top of the WorldIn the last year, Donald J. Goodman, D.D.S., has been on the top ofthe world - both literally and figuratively. by Alicia Reale

22 A Passion for Research, a Mission to HealAs a youth in Pittsburgh, Pennsylvania, it might have been difficultfor Ellis D. Avner, M.D., to imagine he would one day assume therole of chief medical officer at Rainbow Babies & Children’s Hospital,and build a life in Pittsburgh’s archrival city. by Mary Elizabeth Sokol

26 MacDonald Team Helps Couples Become FamiliesOne in every seven couples of childbearing age has difficulty conceiving. The good news is that recent medical advances available at University Hospitals of Cleveland MacDonaldWomen’s Hospital make pregnancy possible for most couples pursuing treatment. by Patricia Faller

University Hospitals of Cleveland

LEGACYUniversity Hospitals Health System

Volume 11, Number 1

Thomas F. Zenty IIIPresident andChief Executive OfficerUniversity Hospitals Health System

Fred C. Rothstein, M.D.President andChief Executive OfficerUniversity Hospitals of Cleveland

Robert B. Daroff, M.D.Chief of Staff and Senior VicePresident for Academic Affairs

Gary W. WeimerSenior Vice President forDevelopment

Marcia Meermans AghajanianEditor and Assistant Director forDevelopment

Ann Bungo, Leigh Blakemore, Patricia Faller, Eileen Korey, AnnMcGuire, Alicia Reale, PatriciaRossman, Mary Elizabeth SokolContributing Writers

Marcia M. Aghajanian, Jerry Domian, Joe Glick, Anthony Gray, Don McClung,Kevin Reeves, Don SnyderPhotographers

Epstein Design Partners Inc.Design

On the WebFor more information aboutUniversity Hospitals Health System,visit our website at www.uhhs.comand www.rainbowbabies.org

Legacy is published by the Department of

Development, University Hospitals of Cleveland,

11100 Euclid Avenue, Cleveland, Ohio 44106-5062.

Telephone: 216-844-1590. Third-class postage

paid at Cleveland, Ohio. Postmaster: Send address

corrections to the Department of Development at

the above address. Printed by SP Mount.

SPRING/SUMMER 2003

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a messagef r o m t h e S e n i o r V i c e P r e s i d e n t f o r D e v e l o p m e n t

* For information on Leave a Legacy initiatives in northern Ohio, call 216-696-8822 or go to www.LALOhio.org

Plan a bequest and ‘Leave a Legacy’

Leave a Legacy is a national planned giving initiative that promotes the bene-

fits of giving wisely to your favorite charity and encourages individuals to

remember nonprofit organizations in their wills. As one of the premier cen-

ters of academic medicine in the nation and the leading provider of high qual-

ity healthcare in the region, UHHS applauds the Leave a Legacy program and

its farsighted participants. Philanthropic support is more essential than ever to

advance medicine and healthcare at UHHS and make a difference in the lives

of generations to come. For this reason, I urge you to Leave a Legacy*. As you

review your estate plans, please consid-

er making a charitable estate provision

in support of lifesaving research, com-

passionate patient care, and training

future leaders in medicine at UHHS.

Other features in this issue of Legacy magazine include:

Actor Christopher Reeve’s notable minimally invasive surgery

at University Hospitals, which attracted international media attention

The adventures of world traveler and grateful University Hospitals

Ireland Cancer Center patient Donald J. Goodman, D.D.S.

A review of groundbreaking research in polycystic kidney disease,

conducted by Ellis D. Avner, M.D., at Rainbow Babies &

Children’s Hospital

Recent advances in pediatric surgery and fertility treatments.

For more information about how your philanthropy can help UHHS and

UHC continue this critical work and meet future challenges, please call

the Department of Development at 216-844-1590 or visit our website at

www.uhhs.com and click on “Community,” then “How to Make a Gift.”

G a r y W. We i m e r

It is a time of great opportunity for University Hospitals Health System

(UHHS) and University Hospitals of Cleveland (UHC) as we embark on our

landmark 50-year partnership with Case Western Reserve University

(CWRU) under the guidance of a new leadership team and look forward to

celebrating the new Iris S. and Bert L. Wolstein Research Building.

Wolsteins pave way for biomedical research advances

In January, UHHS and CWRU together received a $25-million gift from Iris

S. and Bert L. Wolstein to name the new Case Research Institute building.

Loyal supporters of both institutions, the Wolsteins see their gift as an oppor-

tunity to give back to the city they love while, at the same time, investing in

the future of medical discovery in America. The building will be dedicated

this fall.

New UHHS/CWRU partnership

The Wolsteins’ extraordinary gift was announced one month after UHHS and

CWRU announced their 50-year partnership to promote innovative biomed-

ical education, research and clinical care. Under this watershed agreement,

University Hospitals and CWRU will serve as the nation’s strongest model for

a relationship between a research university and a teaching hospital.

New leadership team

In this issue of Legacy, we introduce the leaders guiding UHHS and UHC in

this new era of collaboration and discovery. Thomas F. Zenty III was appoint-

ed in December as president and chief executive officer of UHHS. He brings

more than 20 years of experience in healthcare administration and a track

record of accomplishment at leading academic medical centers and complex

healthcare delivery systems.

Fred C. Rothstein, M.D., was appointed in February as president and chief

executive officer of UHC. Dr. Rothstein served as acting president and chief

executive officer of UHHS prior to Mr. Zenty’s arrival, during which time he

helped craft the CWRU partnership.

Directing the jointly owned and operated Case Research Institute is Ralph I.

Horwitz, M.D., who joined University Hospitals and CWRU from Yale

University School of Medicine this spring. Dr. Horwitz is also vice president

for Medical Affairs at CWRU, and dean of CWRU’s School of Medicine.

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High l igh ts

UHHS-CWRU forge 50-year partnership

The Boards of University Hospitals Health System (UHHS) and CaseWestern Reserve University (CWRU) approved a 50-year partnershipbetween CWRU School of Medicine and University Hospitals ofCleveland (UHC). The goal: to promote innovative biomedical edu-cation, research and clinical care to, in turn, develop one of the topacademic medical centers in the world. The agreement significantlystrengthens the historical relationship between the entities by devel-oping a joint strategic plan for all research initiatives.

“This partnership truly represents a shared vision — the existence ofa great academic medical center is dependent upon the success of bothUniversity Hospitals and the CWRU School of Medicine,” saidHenry L. Meyer III, then chairman of the Boards of Directors ofUHC and UHHS. “We will build on each other’s strengths and workas one to attract some of the best and brightest minds to Cleveland.”

Thomas F. Zenty III appointed new UHHS president and CEO

Thomas F. Zenty III was elected the new president and chief execu-tive officer of University Hospitals Health System. Mr. Zenty bringsmore than 20 years of experience in healthcare administration toUHHS, and a track record of proven accomplishment at leading aca-demic medical centers and complex healthcare systems.

“His keen sense of the healthcare industry,his deep respect for healthcare professionals,his long-held commitment to communityservice and his strong managerial skills makehim an ideal choice to lead UHHS in theyears ahead,” said Henry L. Meyer III, thenchairman of the Boards of Directors ofUHC and UHHS, in announcing theappointment by the Board.

“University Hospitals Health System has become a national model forhow a superb academic medical center can transform itself into anintegrated regional delivery network, while maintaining its reputationfor outstanding care and service to the community,” said Mr.Zenty. “This is a great organization and I look forward to workingwith its community, its boards of directors, and its dedicated physi-cians, researchers, faculty, employees and volunteers to build on itstradition of excellence.”

Mr. Zenty came to UHHS from Cedars-Sinai Health System in LosAngeles, where he was executive vice president for Clinical CareServices and chief operating officer. Prior to joining Cedars-SinaiHealth System in 1995, he held executive positions at MercyHealthcare, Arizona; St. Joseph’s Hospital and Medical Center,Phoenix; Franciscan Health System of New Jersey; and St. MaryHospital, Waterbury, Connecticut.

T I M E L I N E O F L A N D M A R K E V E N T S

Wolsteins make $25-million gift to UHHS-CWRU

University Hospitals Health System and Case Western ReserveUniversity received $25 million from Iris S. and Bert L. Wolstein toname the new research building jointly owned and operated by thetwo institutions. It is the largest single philanthropic gift in the histo-ry of University Hospitals. The facility will be named the Iris S. andBert L. Wolstein Research Building, and is scheduled for completionthis summer. Mr. Wolstein, a nationally renowned leader in the devel-opment industry, is the founder of Developers Diversified RealtyCorporation, and of the Heritage Development Company, which buildsshopping centers, hotels, restaurants, and golf courses.

“Iris and I are thrilled to see these two Cleveland institutions workingtogether in a partnership that will have national and international

impact,” said Mr. Wolstein. “We have always been supportive of inno-vative educational and healthcare initiatives. This research buildingbrings together both worlds, with scientists and physicians workingside by side to spur new discoveries.”

In a joint statement announcing the gift, Fred C. Rothstein, M.D.,then acting president and chief executive officer of UHHS, andEdward M. Hundert, M.D., president of CWRU, said, “We aredeeply grateful to Iris and Bert Wolstein for their extraordinary gift. Itsends a clear message about the strength of the CWRU-UHHS part-nership. It sends a clear message that we are creating one of thenation’s top academic medical centers. And it sends a clear messageabout the vibrant future of Cleveland as a center for pioneering bio-medical research.”

2002December

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High l igh ts

Ralph I. Horwitz, M.D., selected as CRI chief

Ralph I. Horwitz, M.D., took the helm April 1 as director of the CaseResearch Institute (CRI) and as vice president for medical affairs anddean of the School of Medicine at CWRU. Dr. Horwitz joinedCWRU and UHC from Yale University School of Medicine, where hewas chairman of the Department of Internal Medicine.

“I am extremely excited about the appointment of Dr. Ralph Horwitz,who brings to the position a special sensitivity to the challenges fac-ing academic medical centers,” said Fred C. Rothstein, M.D., UHC

president and CEO. “He understands the interactive dynamics ofeducation, research and patient care, as well as the influence of eco-

nomic issues on residency training and med-ical reimbursement. He is joining us at a his-toric moment when UHC and the medicalschool have begun a unique partnership inresearch, teaching and recruitment. We lookforward to his leadership and a close collab-orative relationship as we move forward inthis new era.”

T I M E L I N E O F L A N D M A R K E V E N T S

2003February

2003Apr i l

Fred C. Rothstein, M.D., named UHC president and CEO

Fred C. Rothstein, M.D., a widely respectedpediatric gastroenterologist and healthcareadministrator, was elected president and chiefexecutive officer of University Hospitals ofCleveland (UHC). His election by the hospi-tal’s Board of Directors was unanimous follow-ing the recommendation of Thomas F. ZentyIII, president and chief executive officer ofUniversity Hospitals Health System (UHHS).

Dr. Rothstein served as acting president and chief executive officer of UHHS since June 2002. During his tenure, University Hospitalscrafted a 50-year partnership with Case Western Reserve University(CWRU) and received the largest single philanthropic gift in its history- $25 million from Iris S. and Bert L. Wolstein - given to UniversityHospitals and CWRU.

In announcing the appointment, Mr. Zenty said, “I am very impressedwith Dr. Rothstein’s knowledge, his counsel and his strong commit-ment to UHC and the patients we serve. He is highly regarded as aphysician, as an administrator and for his dedication to the very high-est ideals in academic medicine. I am extremely pleased that he hasaccepted this important position, and look forward to working closelywith him as we move forward.”

“It is a terrific honor to be asked to head a hospital with such a greathistory of outstanding patient care, forward-thinking medical educa-tion and pioneering research,” said Dr. Rothstein, who started hisUHHS career in 1996. “With our dedicated staff of physicians, nurs-es and employees, and our new partnership with Case WesternReserve University, I continue to see wonderful things ahead for ourhospital and its potential to make major contributions to Ohio andthe nation.”

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The National Institutes of Health (NIH) hasawarded a $1.3 million grant to Case ResearchInstitute (CRI) to purchase Magnetic Reso-nance Imaging (MRI) equipment unique tonorthern Ohio and invaluable as a tool for bio-medical research.

The High-End Instrumentation Grant will fundequipment for biological MRI imaging investi-gations, with anatomical detail that has been unavailable in this region. According tothe principal investigator on the grant, Dr.Jonathan Lewin, vice chairman for Research

and Academic Affairs and director of MagneticResonance Imaging for the Department ofRadiology at University Hospitals of Cleveland,the equipment will provide up to 50 timeshigher level of detail than a standard MRI.

C A S E R E S E A R C H I N S T I T U T E R E C E I V E S $ 1 . 3 M I L L I O N F R O M N I H

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Child magazine has named Rainbow Babies

& Children’s Hospital one of the top three

children’s hospitals in America. The maga-

zine’s editors also selected Rainbow’s

Neonatal Intensive Care Unit (NICU) as

the #1 NICU in the country, based on a

comprehensive survey of survival rates,

pediatric specialties and services, commit-

ment to research and patient safety, family-

friendly policies and child-life programs.

Meri B. Armour, senior vice president and

general manager, Women’s and Children’s

Services, UHHS-UHC, praised the entire

staff of Rainbow and Ellis D. Avner, M.D.,

then chief medical officer, for achieving this special recognition. In particular, she noted the

success of the neonatal staff and its leadership, Richard J. Martin, M.D., and Avroy Fanaroff,

M.D., whose “vision and tenacity over the past 25 years, have led the efforts to study and

improve the care of the most fragile patients. Rainbow’s Division of Neonatology has long been

a leader in caring for newborns, and its survival rates for premature babies are among the high-

est in the country. Dr. Michele Walsh, director of the NICU, in concert with her neonatology

colleagues, continue this legacy of clinical excellence.”

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James K.V. Willson, M.D., director of UniversityHospitals of Cleveland Ireland Cancer Centersaid, “This award will enable researchersaccess to imaging technologies that promiseto revolutionize how we manage cancer byenhancing our capacity to painlessly search

out tiny colonies of cancer cells in the bodyand to monitor effectiveness of treatments.”

The grant is a critical step toward creating astate-of-the-art In Vivo Cellular and MolecularImaging Center at University Hospitals ofCleveland and Case Western Reserve University.

Thanks to the leadership of U.S. Senator Mike

DeWine (R-OH), Rainbow Babies & Children’s

Hospital will receive $1,025,000 in funding ear-

marked for pediatric research as part of the 2003

Omnibus Appropriations Bill. President George W.

Bush signed the bill in February.

The funds awarded to the Rainbow Center for

Child Health will support studies in neonatal

health and disease; lung biology and disease;

heart development and congenital abnormali-

ties; kidney development and polycystic kidney

disease; gastric and bowel disease; and the influ-

ence of environmental stimuli on child health.

“Unquestionably, the single most precious

resource we have is our children, and Rainbow

Babies & Children’s Hospital has long been a

noble guardian of their interests. The doctors

and nurses at Rainbow are experts at caring for

these young people. I am extremely pleased

that we were able to secure such significant

financial resources for Rainbow,” said Senator

DeWine, a member of the Senate Appropria-

tions Committee.

Fred C. Rothstein, M.D., University Hospitals of

Cleveland president and CEO, thanked Sen.

DeWine for his support. “The Senator is very

sensitive to the fact that academic medical cen-

ters and children’s hospitals, in particular, have

suffered deep cuts in federal and state funding,

especially as it applies to Medicaid reimburse-

ment. His efforts to secure this appropriation

will help us maintain our commitment to pio-

neering and advancing medical treatments for

all children.”

CHILD MAGAZINE RANKSCHILDREN’S HOSPITALS IN U.S.

RAINBOW SPECIALISTS #1 IN NEONATOLOGY AND #3 IN OVERALL PEDIATRIC CARE

+Rainbow receives $1 million-plus for pediatric research

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W O L S T E I N S D O N A T E L A R G E S T S I N G L E C H A R I T A B L E G I F T I N U H H I S T O R Y

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n Wednesday, December 18, 2002, Bert L. Wolstein read the front page of

The Plain Dealer and made a $25-million decision.“I was thrilled,” he says

in describing what he felt upon reading about the 50-year partnership

agreement between University Hospitals Health System (UHHS) and Case

Western Reserve University (CWRU). “I was thrilled to see something was

finally going to happen between these two institutions that would have a

huge positive impact locally, nationally and internationally.”

Mr. Wolstein placed two phone calls that morning: first, to his old friend

Michael L. Nochomovitz, M.D., president and chief medical officer of

University Primary and Specialty Care Practices at UHHS; and second, to

a newer friend, Mohsen Anvari, Ph.D., dean of the Weatherhead School of

Management at CWRU. Wolstein and his wife, Iris, had recently provided

a gift of $2.5 million to the Weatherhead School, for both renovation and

the establishment of a professorship in management design.

“I had never heard anyone be so specific about his intentions,” recalls Dr.

Nochomovitz. “He wanted to make a gift toward the new building for Case

Research Institute, and he saw this building as a symbol of the partner-

ship that would carry UHHS and CWRU into the future, as something that

would contribute to the region and beyond. And he wanted involvement

in a bigger vision for Cleveland.”

Then, Mr. Wolstein called his wife, his personal partner of 55 years. “Bart

shared his thoughts and asked for mine,” says Iris S. Wolstein. “There are

some organizations and some charities that are not a perfect fit, but

this appealed to us both. I liked the fact that it was in Cleveland and

we would be able to see what it would accomplish in the years to come.”

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L E G A C Y S P R I N G / S U M M E R 2 0 0 38

“Iris and I have always been interested in philanthropy with respect to

education and health,” says Mr. Wolstein, the founder of Developers

Diversified Realty Corporation and the Heritage Development Company,

which builds shopping centers, hotels, restaurants and golf courses. “The

new research facility being built by UHHS and Case appealed to both of our

passions. It represented these two great institutions working together to

improve the lives of all mankind. We wanted to be part of that future.”

The 320,000-square-foot facility currently under construction on Cornell

Road and scheduled for completion this summer will be called the Iris S.

and Bert L. Wolstein Research Building. It is designed to accommodate

900 research investigators and a so-called “mouse house” with 28,000

cages in a sub-basement vivarium (Mrs. Wolstein jests: “Better in that

Wolstein house than mine!”). The scientific emphasis will be on transla-

tional research, the kind of laboratory work that “translates” into

improved clinical care. Often termed bench-to-bedside research, it

requires close collaboration among physician/scientists. The building

will be part of the Case Research Institute (CRI), a joint research effort

that spans the CWRU and UHC campuses and is directed by the Dean of

the School of Medicine, Ralph I. Horwitz, M.D.

In announcing the 50-year partnership, the leadership of UHHS and CWRU

pledged to invest $50 million jointly over the next five years to recruit

“the best and the brightest” scientists from around the country, people

who will be attracted to a research environment that is vibrant, growing,

and grounded in a community-wide commitment to biotechnology and

biomedical research. “The kind of researchers we will be able to bring here

to new research space will help us develop our research technologies and

our research focus going forward for years and years to come,” said Fred

C. Rothstein, M.D., who, as acting president and CEO of UHHS, had suc-

cessfully negotiated the partnership with CWRU (Dr. Rothstein has since

been appointed president and CEO of University Hospitals of Cleveland).

The concept of bringing new researchers and scientists to Cleveland — a

place they may not have considered before — excited the Wolsteins.

Within days of the partnership announcement and his first phone calls,

Mr. Wolstein held face-to-face meetings with Dr. Rothstein and CWRU

president Edward M. Hundert, M.D. “These two men can make things hap-

pen,” Wolstein remarked. “Fred has vision, compassion, and was easy to

talk to. Ed was cooperative, understanding, and responsive. This $25-

million gift decision got done overnight.”

The intensity and resolve of the discussions surprised no one who knows

Mr. Wolstein. “The speed and decisiveness with which Bart responded to

Fred and Ed is very typical of Bart’s own personality and his ability to

make decisions and act on them,” says Dr. Nochomovitz, his friend and

personal physician. “As a physician, I’m always inspired by patients who

are able to deal with significant medical problems in a decisive way.

There is no training for these coping skills. Bart has always shown

tremendous determination to overcome any adversity. So once he called

and told me he was going to do this deal, I had no doubt that it was going

to happen . . . and fast.”

Mr. Wolstein is more nonchalant in discussing his own medical chal-

lenges. He freely talks about his bout with prostate cancer (in fact,

appearing on television news programs as part of a University Hospitals

campaign to promote prostate screening tests). His wife recalls how

physicians at UHC presented all the many options for prostate cancer

treatment after the initial diagnosis — “all the pros and cons, and like

everything else, we made the decision together and quickly.”

The Wolsteins have developed close relationships with UHHS physicians

over the years. When Mr. Wolstein owned Cleveland’s first professional

indoor soccer team, the Force, more than a decade ago, he selected

University Hospitals to care for the athletes. Dr. Nochomovitz evaluated

pulmonary function during exercise testing. Donald Goodfellow, M.D.,

chief of sports medicine at UHC, tended to their orthopaedic needs. In

gratitude for their care and friendship, Mr. Wolstein sponsors an annual

golf outing each year for his physician friends. And despite the fact that

Mr. Wolstein no longer owns a soccer team, the relationship he forged

continues today, with UHC as the official health care sponsor of the new

Cleveland Force (formerly the Crunch).

On his many trips to see physicians at University Hospitals, Mr. Wolstein

watched the research building on Cornell Road rise from the ground and

take shape. As a real estate developer himself, he could look beyond the

metal, concrete and glass, and see the promise of a structure that will be

home to innovation and experimentation. How fitting that it will have the

name of a man who is a self-made millionaire, whose brilliance and per-

severance took him from the working class neighborhoods of Glenville to

the executive suite in Moreland Hills, who describes himself as a non-

conformist and unconventional.

“People can help a community grow in many different ways and not

always through the traditional channels,” says Mr. Wolstein. “Cleveland

is our home and we want good things to happen here. Iris and I believe

that Cleveland needs all the help it can get, and if you’re in the financial

position to give back to the community that raised you, you’re duty-

bound to do so.”

“We feel like we can only live in one house at a time, we can only drive so

many cars and go on so many vacations,” says Mrs. Wolstein. “So what do

you do with the money? You give it back to the community from which you

have reaped so many benefits. This gift is actually selfish in some ways,

because we’re going to be able to see what the money will accomplish,

how discoveries made inside those walls will contribute to a better qual-

ity of life for so many people.”

When a Plain Dealer reporter pressed the Wolsteins to discuss what they

expected in return for their generous gift, Mrs. Wolstein responded:

“There was only one thing we asked for – that the two of us live to be 120

and in good health! We just want these doctors and scientists to come up

with discoveries that will improve health and save lives. We’ve been

active contributors to research in arthritis, cancer, and cerebral palsy.

There are so many diseases, and if our money can help to find some

cures, that will satisfy us.” Eileen Korey is director of news services in the

Department of Marketing and Communications at University Hospitals of Cleveland.

As of April 1, The Iris S. and Bert L. Wolstein Building project was 80 per-

cent complete. In addition to the foundation superstructure and “enve-

lope” (exterior walls, windows, doors and roof), completed construction

included interior partitions, stairs, elevators, heating and air-condi-

tioning systems, plumbing, telecommunication systems, laboratory

furnishings and installed equipment, interior finishes, exterior ‘hard-

scaping’ and landscaping. The remaining 20 percent of construction will

involve completion of the interior, equipment and systems start-up, and

exterior work, including walks, flower beds, lighting and signage. Other

interesting particulars about the building follow.

Initial occupancy of floors 1-3 is expected in August; total occupancy is

expected in late September.

The exterior of the 320,000-square-foot building is Valders limestone – a

high-quality stone quarried in Wisconsin – in a curtain wall of metal pan-

els and glass. Glass represents about 40 percent of the exterior.

The steel-reinforced, concrete frame will minimize vibration in the build-

ing, which would interfere with microscopic research. The foundations;

below-grade walls, columns, and floors; and the above-grade super-

structure incorporate 25,000 cubic yards of concrete and 5 million

pounds of reinforcing steel bars.

The foundation rests on undisturbed shale, 40 feet below street level.

This depth allows for two, high-ceiling basements. Charles “Bud” Truax,

vice president of construction programs for University Hospitals of

Cleveland, describes the foundation as a heavy base slab and a water-

tight “tub.”

In addition to the two stories below ground, six stories are above ground.

Each floor is approximately 40,000 square feet.

A pedestrian bridge will allow sheltered access from the Wolstein

Building to other buildings at University Hospitals and Case Western

Reserve University.

On average, there were 245 workers a day on site.

a hardhat tour of the wolstein building

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Working through a small laparoscope in an outpatient procedure,

surgeons placed electrodes in Mr. Reeve’s diaphragm muscle. The

electrodes are attached through wires under the skin to a small exter-

nal battery pack that electrically stimulates the muscle and the

phrenic nerves, causing the muscle to contract and air to enter the

lungs. Diaphragm contraction accounts for most of the ventilation

required for normal breathing.

early eight years after the accident that left Christopher Reeve paralyzed and dependent on a ventilator, the

50-year-old actor and activist has hopes of breathing more normally, with the aid of a surgically implanted

investigational device. On February 28, 2003, Mr. Reeve underwent minimally invasive surgery at University

Hospitals of Cleveland, where a team led by Raymond Onders, M.D., and Anthony DiMarco, M.D., implanted the

device, developed in partnership with biomedical engineers at Case Western Reserve University.

N

Because the surgical placement of the device is performed in an outpa-

tient setting through minimally invasive techniques, risks and costs of

this diaphragm pacing system are significantly less than standard pro-

cedures to electrically activate the diaphragm. The standard technique

requires surgeons to make large incisions in the chest (thoracotomy) to

place electrodes in direct contact with the phrenic nerves. That proce-

dure carries substantially more risk and requires a prolonged hospital

c o n t i n u e d o n p a g e 1 2

Actor Christopher Reeve receives new breathing device at UHCsystem may ultimately replace ventilator

by u h h s - u h c m a r k e t i n g a n d c o m m u n i c a t i o n s , a n d d e v e l o p m e n t s ta f f

Raymond Onders, M.D., and his team perform

laparoscopic surgery on Christopher Reeve at University Hospitals

of Cleveland to implant a diaphragm pacing device.

a l l p ho t o s DON McCLUNG

How he learned of the clinical trials in phrenicpacing at UHC: I was working actively withPaul Davenport and Danny Martin at theUniversity of Gainesville in Florida. Also,credit goes to Dr. John McDonald (atWashington University in St. Louis), who hashelped me regain motor function and sensoryrecovery. He was pretty aggressive in callingthese guys and told them I might be a candi-date. So it was a combined effort.

But no exception was made for me. There is arigid test to pass. The gold standard is that youhave to be examined under fluoroscopy(which) is like a moving X-ray. Tests were performed that showed I could move mydiaphragm on my own.

Another test was called “conduction time.”You would expect after eight years that (my)phrenic nerves would have atrophied. It turnsout I was still at the top end of normal, thanksto the breathing work I began during rehabili-tation after my injury.

About phrenic pacing: I will still need nursingcare 24/7. But clearly this necktie I’m wearingis not my favorite and I look forward to the

day when it will go. I started out as a patientlooking at the big picture. But I’ve learnedover time that while pursuing that ultimategoal, the incremental steps along the way arevery important.

About next steps: I will incorporate phrenicpacing into my overall routine of physicaltherapy, which includes aqua therapy and aspecial bike I ride. All of that will worktogether for immediate health benefits - car-diovascular, skin integrity, bone density andthe ability to keep the immune system up tofight off infection.

We should emphasize that the FDA makes itvery clear that at no time can I be without crit-ical care supervision, because if the batteryfails while I’m breathing on the diaphragmpacing system, someone needs to be there tostart the vent, and that will continue for quitea long time.

So it’s a very exciting moment, but one thatneeds to be put into perspective, in terms ofwhat rehab really is – which is a process. Ittakes discipline and it takes time. It also takesa tremendous support team.

Christopher Reeve

At a University Hospitals of Cleveland (UHC) press conference March 13, actor,

director, and activist Christopher Reeve gave his perspective on the new

breathing technology – a diaphragm pacing system – developed by Case

Western Reserve University and UHC scientists and physicians, and surgically

implanted in his chest by UHC surgeons. Following are excerpts from his

remarks at the press conference.

About rediscovered senses: While on phrenicpacing, with the tube from (my) ventilatorremoved, I found I was able to smell thingsagain. So I said, ‘let’s put this to a test’ andthey brought in various things for me to smell.The first one was coffee. So I actually woke upand smelled the coffee.

The second day we tried it, they threw me acurve ball. We did several different objects,(including) salad dressing and other things.Then someone put a eucalyptus cough drop –still in the wrapper – under my nose. And Icouldn’t get it, but neither could anyone elsein the room, so I felt good about that.

Another high point occurred during one ofthe 15-minute sessions when I said, ‘ok afterwe’re going for a couple of minutes, let’s turnoff the ‘vent’ and enjoy the silence.’ So weturned off the ventilator. Everyone was stand-ing by in case I needed help. And then we weretotally quiet in the room. The only sound youcould hear was me breathing – regular, rhyth-mic breathing through my nose . . . for thefirst time in nearly 8 years.

I hadn’t heard that sound since May 1995. Itmeant a tremendous amount.

On his family’s thoughts about the procedure:My family is so used to me being willing totry the next thing, that this is par for thecourse. My wife, Dana, is very much the sameway. It’s safety first, but even after being avent-dependent quadriplegic for eight years,it still must be looked at as an adventure. I seemyself in a leadership position. I’d do it any-way, but I must be out there trying things thatwill help other patients. It doesn’t mean any-thing if it doesn’t translate into better care forother patients.

“ I a c t u a l l y w o k e u p a n d s m e l l e d t h e c o f f e e ! ”

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L E G A C Y S P R I N G / S U M M E R 2 0 0 31 2

stay. The standard procedure typically costs more than $100,000

(device plus surgery, hospitalization and follow-up), whereas the

laparoscopic surgery and implantation of the new device could cost less

than half that amount.

The development of the investigative diaphragm pacing system is cur-

rently being supported by a Food and Drug Administration Orphan

Products Development grant to Dr. DiMarco as principal investigator,

and a U.S. Surgical Corporation grant to Dr. Onders as principal

investigator, with additional support from the Elisabeth Severance

Prentiss Foundation.

Dr. Onders, a surgeon and director of Minimally Invasive Surgery at

University Hospitals of Cleveland, and assistant professor of surgery at

CWRU, implanted the first such device in a patient nearly three years

ago. The 36-year-old patient had an injury similar to Mr. Reeve’s, hav-

ing damaged the upper part of his spinal cord in a swimming accident.

The patient has been successfully breathing without the need for

mechanical ventilation for more than two years.

“This device allows patients to breathe and speak more normally, and

it increases mobility,” explains Dr. DiMarco, professor of medicine

and physiology at CWRU. “Patients realize an improved sense of

smell.” Moreover, in social situations, diaphragm pacing gives the

appearance of normal breathing whereas mechanical ventilation has

ventilator tubing and constant ventilator noise.

Since the implantation of the first device by Dr. Onders three years

ago, biomedical engineers J. Thomas Mortimer, Ph.D., professor

emeritus of biomedical engineering at CWRU, and Anthony R.

Ignagni, project director and chief biomedical engineer, have

improved the pacing device.

Mr. Reeve became a candidate after a thorough evaluation and

determination that his phrenic nerve function is normal, as demon-

strated in nerve conduction studies and fluoroscopic examination of

diaphragm movement. On February 28, he underwent a 4-1/2 hour

outpatient surgical procedure at University Hospitals of Cleveland

to implant the electrodes and lead-wires. “Our initial test in the

operating room to activate Mr. Reeve’s diaphragm yielded impres-

sive results,” says Dr. Onders. “As the diaphragm contracted, his

lungs filled with air and the volume of air that was exhaled and

measured was certainly adequate for us to believe that this device

would provide successful breathing support.” Mr. Reeve returned

home the following day.

Mr. Reeve returned to Cleveland on March 9 to begin the recondition-

ing process of strengthening the diaphragm through a series of intermit-

tent stimulations at the National Institutes of Health-funded CWRU

General Clinical Research Center at MetroHealth Medical Center.

“Each electrode is individually evaluated to determine the degree of

diaphragm contraction and resulting inspired volume of air,” explains

Guided by laparoscopic video, surgeons pinpoint

locations for precise electrode placement within the diaphragm.

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L E G A C Y S P R I N G / S U M M E R 2 0 0 3 1 3

Dr. DiMarco. Since the diaphragm is atrophied from disuse, a period

of gradually increasing stimulation is necessary to regain normal

strength and endurance. Mr. Reeve will continue the conditioning

process at home, with the ultimate goal of eliminating the need for the

mechanical ventilator.

Of the 10,000 new cases of spinal cord injury each year in the

United States, approximately 1,000 patients require mechanical ven-

tilation for some period after injury. Researchers believe that

implanting this device shortly after the spinal cord is damaged may

enable some to maintain diaphragm muscle strength and prevent

atrophy, which develops on mechanical ventilation. Many of these

individuals eventually are able to breathe on their own, as the nerves

that control breathing recover from the initial injury. Others, like

Mr. Reeve (perhaps 300 cases each year), would benefit from life-

long breathing support as the implanted device itself activates the

nerves that inspire breathing.

Said Mr. Reeve, “The constant and high cost of care for ventilator

dependent patients not only exhausts most insurance policies but con-

tributes to strain on families and caregivers. Once this procedure

receives FDA approval, these patients and their caregivers should be

able to achieve significant improvements in their quality of life.

Diaphragm pacing unlocks a door to greater independence, one of the

most important goals for all people living with disabilities.”

The development of the investigational diaphragm pacing system has

been a collaborative effort involving numerous physicians and engineers

at several institutions in Cleveland, including University Hospitals of

Cleveland, Case Western Reserve University, the Veterans Administra-

tion Medical Center, and MetroHealth Medical Center. Drs. Onders

and DiMarco currently work closely with Mr. Ignagni and with Dr.

Mortimer, who devoted more than 20 years of research to electrically

activating the nervous system at the Applied Neural Control Laboratory

in the biomedical engineering department at CWRU.

Synapse Biomedical, Ltd., of Cleveland, is developing the investiga-

tional diaphragm pacing system, portions of which were patented

by CWRU. Funding assistance was provided by the Food and Drug

Administration, U.S. Surgical Corporation, University Hospitals of

Cleveland, the Veterans Administration Medical Center, and the

National Center for Research Resources of the National Institutes

of Health.

More information about this clinical investigation can be found at

our website, www.uhhs.com/christopherreeve. Individuals interested

in becoming candidates for the investigational diaphragm pacing

system can also call 216-844-8594. For information about funding

opportunities to further the investigation, please call the

Department of Development at University Hospitals of Cleveland at

216-844-1590.

Raymond Onders, M.D., draws four lead-wires

from the diaphragm inside the abdomen for connection

to a pacing device outside Christopher Reeve’s body.

L E G A C Y S P R I N G / S U M M E R 2 0 0 31 4

A N E W E R A I N P E D I AT R I C S U R G E R Y AT R A I N B O W

“Rainbow is one of the finest children’s hospitals in the country with a

first-rate team of pediatric surgeons,” says recently appointed Surgeon-

in-Chief Alan R. Cohen, M.D., who also has served as chief of Pediatric

Neurosurgery at Rainbow since 1994. “Some places have a reputation

for having a strong cardiac team or a strong orthopaedic team, but here

we have strength in virtually every surgical subspecialty.”

“It’s a new era in pediatric surgery at Rainbow,” Dr. Cohen adds.

“Several surgical specialists joined our existing team of outstanding sur-

geons in 2002,” including: Walter J. Chwals, M.D., director of Rain-

bow’s Level I Pediatric Trauma Center; Hani A. Hennein, M.D., chief

of pediatric cardiothoracic surgery; Jeff L. Myers, M.D., Ph.D., pediatric

cardiothoracic surgeon; and Robert L. Parry, M.D., pediatric surgeon.

“We have a very closely knit group – we often

work together to cross the boundaries of different

disciplines,” Dr. Cohen says. “So, if a child has,

for example, curvature of the spine, or scoliosis,

we may do a neurosurgical intervention on the

spinal cord and then an orthopaedic surgical stabilization of the

spine. For craniofacial malformations, we’ll do reconstructive surgery

with neurosurgeons working alongside plastic surgeons. With

advancements in technology and the ability to work across bound-

aries, we can do things at Rainbow that can’t be done other places –

our teams work very well together.”

In contrast to general community hospitals, all of Rainbow’s sur-

geons are pediatric specialists – devoted to taking care of the emer-

gency and elective surgical needs of children from newborns to young

adults. Rainbow’s multidisciplinary team includes pediatric specialists

in: cardiothoracic surgery; dermatologic surgery; general surgery;

neurosurgery; ophthalmology; oral and maxillofacial surgery;

By Ann Bungo

Whether your child’s operation is routine or complex, there are many

advantages before, during and after surgery that can only be offered by

pediatric surgeons in a facility dedicated solely to the comprehensive

care of children, like Rainbow Babies & Children’s Hospital.

Rainbow’s Pediatric Cardiothoracic team, led by Hani Hennein, M.D.,

performed over 150 surgical repairs on children with congenital

heart defects in 2002.

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Rainbow Surgical Associates Opens in Strongsville

To provide more convenient follow-up access to your

surgeon, Rainbow has opened a new Rainbow

Surgical Associates Specialty Center at University

Hospitals Health System Southwest General Health

Center on Pearl Road in Strongsville. The Center,

which opened in January 2003, includes Rainbow

specialists in: general surgery, otolaryngologic sur-

gery, orthopaedic surgery, and urologic surgery.

The Rainbow Surgical Associates Specialty Center

features a child-friendly atmosphere with soothing

waiting and exam room space. If necessary, on-site

lab and radiology services allow tests to be per-

formed and quickly read.

Rainbow surgeons also see patients at two other sub-

urban Rainbow Pediatric Specialty Center locations:

Mayfield Heights

University Hospitals of Cleveland Health Center

at Landerbrook

5850 Landerbrook Drive

Westlake

University Hospitals Health System

Westlake Medical Center

960 Clague Road

For an appointment, or information about the services

provided at any of our Rainbow Pediatric Specialty

Centers, call 440-250-2433.

otolaryngologic surgery; orthopaedic surgery; plastic and recon-

structive surgery; solid organ, blood and marrow transplantation;

and urologic surgery.

Fine-tuning minimally invasive surgery

Rainbow’s surgeons strive to develop and refine surgical approach-

es to minimize the invasiveness and trauma that children experience

with surgery. Rainbow neurosurgeons are currently developing new

instruments and operative approaches in the laboratory. For exam-

ple, they have developed miniaturized neuroendoscopes that enable

them to perform brain surgery through minimally invasive tech-

niques. An endoscope is a miniaturized telescope that can be insert-

ed into the body through a tiny incision. Special microchip cameras

can project the images to video monitors in the operating room.

Such minimally invasive procedures, which Rainbow is known for

in all disciplines, minimize pain and scarring by eliminating the

need for large incisions. In addition, minimally invasive techniques

developed at Rainbow shorten children’s post-operative recovery

periods and, in some cases, allow surgeons to perform previously

inoperable surgeries.

Designed exclusively for children

Rainbow’s Elisabeth Severance Prentiss Pediatric Surgery Center – a

$10.8 million project funded entirely through philanthropy, includ-

ing generous leadership support from the Elisabeth Severance

Prentiss Foundation – is the only surgical facility in northeast Ohio

designed specifically for pediatric patients. Its eight state-of-the-art

operating rooms feature advanced imaging and microsurgical tech-

nology. There also is a trauma room for patients from Rainbow’s

Level I Pediatric Trauma Center – the highest ranking attainable in

children’s emergency care.

“Here, children also undergo surgery in a physically distinct unit that

was designed, built, stocked and staffed specifically for children,”

notes David K. Magnuson, M.D., chief of Rainbow’s Division of

Pediatric Surgery, who was recruited to join Rainbow in 2001. “That

is a huge advantage. And we have outstanding subspecialists on site

to handle anything unexpected. Why go just anywhere for even a rou-

tine operation when you have one of the nation’s great children’s hos-

pitals within easy driving distance of home?”

Rainbow also is the only pediatric facility in Greater Cleveland with

primarily private patient rooms. Rooms in Rainbow’s Leonard and

Joan Horvitz Tower – also funded by generous donor support – are

designed to encourage parents to be actively involved in their child’s

care, and include sleeping and full-bath accommodations for parents.

&c onveni ent & c l o s e

*

*

Helping Families, Calming Fears

Rainbow specialists know that being in the hospital

can be frightening and confusing – for child and

parent, alike. “Our Family and Child Life Services

Department helps make the hospital experience

more manageable,” says Toni F. Millar, director of

Rainbow’s Child Life Department.

Child Life provides pre-admission and orientation

tours to help ease anxiety. On the day of surgery,

specialists are available, if desired, to provide emo-

tional support and activities for relaxation and

diversion while awaiting surgery, and help parents

accompany their child into the operating room

during anesthesia induction. Following surgery,

Child Life experts try to “normalize” hospitalization

through an activity center, videos, video games and

therapeutic interventions, like medical play.

Referrals also may be made to Rainbow’s art thera-

pist or music therapist.

Rc omfor t ing & supp or t i v e

L E G A C Y S P R I N G / S U M M E R 2 0 0 31 6

Other features of the Horvitz Tower are: the Patient-Family

Learning Center, where parents can practice skills needed to care for

their child at home; the Family Resource Center, with a children’s

library, video collection, computers and Internet access, for families

to obtain medical information and learn about support services; and

the Sibling Care Center, which offers much-needed child care when

parents are visiting their hospitalized child.

Carol H. Butler Pediatric Intensive Care Unit dedicated

Rainbow’s newly renovated Pediatric Intensive Care Unit (PICU)

was also designed in keeping with the hospital’s commitment to

family-centered care. The $6.5 million project was dedicated in

April, creating a new 23-bed unit.

Demand for Rainbow’s PICU services has surged over the years, as

an increasing number of parents and referring physicians rely on

Rainbow for advanced medical and surgical critical care. The PICU

serves more than 1,700 critically ill children annually.

The new PICU features a unique blend of 21st century medical tech-

nology and a warm, supportive environment for healing. Glass-

enclosed, private rooms with sleeping accommodations for parents,

replace previously open patient rooms. A television, VCR, CD player,

and small desk with a reading light and Internet access are included in

every patient room. Advances in patient monitoring allow staff to

respond more efficiently and quietly to individual patient needs, with-

out disturbing other patients and their families.

Maxwell Ahmadi and mom, Sandy.

MEMORIAL DAY ‘SURPRISE ’ NOW THRIVES

By Ann McGuire

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Alan R. Cohen, M.D., Rainbow’s first surgeon-in-chief, and patient Julie Kendall.

Other features of the PICU include state-of-the-art medication

delivery systems, radiology reading rooms, telemetry beds with mon-

itoring capabilities, an educational conference room, on-call rooms

for residents and surgical fellows, and an enhanced communication

system that allows all team members to communicate via wireless

pagers/telephones.

Highest-level anesthesia care

When a child needs surgery – whether minor or complex – the

expertise of not only the surgeon, but also the anesthesiologist,

should be considered.

At Rainbow, a team of eight pediatric anesthesiologists manages

pediatric anesthesia patients. These experts are all diplomates of the

American Board of Anesthesiology. Four also are board-certified

pediatricians, and many have advanced training in other subspe-

cialty areas, including critical care.

Maxwell was born two-and-a-half months prema-

turely with a tracheoesophageal fistula (TEF),

meaning that a section of his esophagus was fused

to his trachea. One year and 18 surgical procedures

later, Maxwell loves his bottle, is partial to bananas

and is preparing to have his feeding tube perma-

nently removed. He owes his remarkable progress

to the outstanding surgical care he received at

Rainbow Babies & Children’s Hospital.

Sandy Ahmadi, Maxwell’s mother, attends a region-

al TEF support group where she sees preschoolers

unable to take food by mouth. A registered nurse

who worked in critical care before Maxwell was

born, Mrs. Ahmadi knows her baby received out-

standing treatment at Rainbow.

Maxwell’s surgeon, David K. Magnuson, M.D., says

Maxwell has indeed progressed better than expected.

“This can be attributed, in part, to early and aggres-

sive treatment of his esophageal stricture, so he could

take at least small amounts of oral feedings early on,”

notes Dr. Magnuson, who estimates he has per-

formed 40 to 50 TEF surgeries in his career.

Maxwell came as a Memorial Day 2002 surprise

when his mother was visiting family in Iowa. After

initial surgery there to divert his esophagus away

from his trachea, Rainbow’s transport team brought

a still-critical Maxwell to Rainbow.

Mrs. Ahmadi and her husband, Kevin, recall their

first impression of Dr. Magnuson. “He was very

informative; he had done far more of these surger-

ies than we expected; and he had a plan for

Maxwell,” she says. That plan included a series of

surgical procedures to open up Maxwell’s by then

string-like esophagus. These dilations were repeated

roughly every two weeks last fall while Dr.

Magnuson waited for Maxwell to gain enough

weight to face his next challenge: stomach surgery.

In November 2002, Dr. Magnuson performed

Nissen fundoplication, a delicate operation to cor-

rect the reflux that had eroded Maxwell’s esophagus.

A week after the surgery, Maxwell went home to

Medina. He gradually took more and more nour-

ishment by mouth, and now – with his first birth-

day under his belt – he continues to thrive.

“What distinguishes us from many other hospitals is that, here,

parents can always count on a well-trained pediatric anesthesiology

specialist 24 hours a day, 365 days a year,” says Paul A. Tripi, M.D.,

chief of Rainbow’s Division of Anesthesiology.

“Parents frequently ask me, ‘if it were your child, what would you

do?’” Dr. Cohen adds. “I have two boys who are now 15 and 18.

Both have been treated at Rainbow for broken bones in years

past. I can honestly say, if my child had any surgical or medical

need, I would immediately bring him to Rainbow. I don’t say that

just because I work here; I say that because this is where the best

care is available.”

One-year-old Maxwell Ahmadi is starting to crawl, says “mama” and “dada,”

eats table food and generally delights in life. He squeals with glee at the

sight of a new face.

Ann McGuire is a manager/writer in the Department of Development at University Hospitals of Cleveland.

Ann Bungo is an account manager in Marketing/Corporate Communications.

Marcia Meermans Aghajanian, assistant director of Development and Legacymagazine editor, contributed to this article.

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In the last year, Donald J. Goodman, D.D.S.,has been on the top of the world - both literally and

figuratively. The 80-year-old retired dentist and his wife,

Ruth, recently returned from the trip of a lifetime to the Arctic

Circle. The expedition to the North Pole, which fewer than 4,000 people

have completed, was even more meaningful to the Goodmans because it marked

their first significant journey since Dr. Goodman’s successful battle with cancer.

D O N A L D J . G O O D M A N , D. D. S .

world

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A world traveler, Dr. Goodman has visited 263 countries and islanddestinations. He has taken jungle walks in Borneo, followed mission-aries in Cameroon and Zaire and gone on countless safaris. He andMrs. Goodman were among the first Americans to visit China andTibet when those countries opened their gates. The Goodmans, whoare among six married couples worldwide to have earned the presti-gious Travelers’ Century Club’s Special Award for visiting more than250 nations and islands, have made about three overseas trips annu-ally; recent destinations included tribal areas in Ghana, and theislands of Kiribati and Nauru.

Their itinerant lifestyle came to an abrupt halt October 25, 2000,when Dr. Goodman was climbing the stairs and felt as if a bolt oflightning had pierced his body from head to toe. “Ruth - 911 - I’mdying!” he remembers calling out. He was rushed to the nearest hos-pital and then transferred to University Hospitals of Cleveland,where he soon was diagnosed with acute myelogenous leukemia, avirulent and most often fatal form of cancer. His white blood celland platelet counts were dangerously low and blood transfusionswere begun immediately. “I was about as close to death as you canget,” he recalls.

Dr. Goodman was initially told he needed intensive chemotherapybecause he exceeded the age requirement for a bone marrow trans-plant. Because of his medical background, he knew his condition wasvery serious and his prospects were slim. He calculated that he hadabout two weeks to live.

And then Mary Laughlin, M.D., walked into his room on the sixthfloor of Lerner Tower and everything changed. Dr. Laughlin, a leukemiaexpert, explained to the Goodmans that he was a candidate for a novel,targeted chemotherapy treatment called Mylotarg. This monoclonalantibody, which targets and then attacks cancer cells, had been used pri-marily for patients with recurrent leukemia, but Dr. Laughlin (who Dr.Goodman affectionately calls “Dr. Mary”) believed it would help him asa primary treatment, instead of more-toxic, non-specific chemotherapy,which destroys healthy as well as malignant cells, making patients verysick and suffer severe side effects.

“With conventional therapies he would only have had, at best, a 50 to 60 percent chance of attaining a complete remission,” says Dr.Laughlin, director of the Allogeneic Transplantation Program at Uni-versity Hospitals of Cleveland Ireland Cancer Center. “Dr. Goodmanhad mild heart failure and reduced kidney function that would haverendered standard chemotherapy more risky. He was, therefore, thefirst local patient to receive Mylotarg as a primary treatment and hewas a great candidate for it.”

On November 1, Dr. Goodman received an eight-hour injection ofMylotarg as his vital signs were checked every 15 minutes. By his side,Mrs. Goodman describes his attitude as upbeat. “He said he was goingto fight this and win.” He was right on the mark; 12 days later theywere told that Dr. Goodman was leukemia-free.

“I could not believe the news,” Dr. Goodman recalls. “I knew how closeI was to not being here. The treatment was nothing short of miracu-lous. There are no words to express the overwhelming feeling there is tobe told after 12 days that your body is completely free of cancer.”

Dr. Goodman’s remarkable response helped pave the way for otherpatients to receive the monoclonal antibody as a first line of treatment.“New treatments for leukemia, including Mylotarg, have resulted in asignificantly higher number of patients who attain complete remissionand ultimately cure their disease,” says Dr. Laughlin. “Mylotarg hasnow been incorporated into clinical trials as front-line therapy forpatients with acute myeloid leukemia, based on our experience inpatients with relapsed disease. Results of these studies thus far point toimproved rates of complete remissions in these patients.”

During the rest of his 30-day hospital stay, Dr. Goodman receivednumerous transfusions of red blood cells and platelets – a total of 44by the time he was discharged. His blood counts slowly rose and hisfinal transfusion was from a donor with similar Human LeukocyteAntigens (HLA), which boosted his levels significantly. “I couldn’tbelieve what was happening,” says Dr. Goodman. “Dr. Mary and thisnew drug saved my life.”

Two years later, Dr. Goodman is in excellent health. His bloodcounts have remained in the normal range and he has returned to hisdaily routine. He exercises nearly every day by walking or swimmingand returns to University Hospitals every four months to see Dr.Laughlin and undergo testing. “Everything has gone up and stabi-lized,” he says. “The tests say I am in excellent condition – there havebeen absolutely no setbacks of any kind.”

The treatment Dr. Goodman received is one of the many new thera-pies in development and early clinical use, which are designed to tar-get, to attack and kill cancer cells. “Over the last decade, cancerresearchers have made stunning progress in understanding the funda-mental nature of cancer,” says James K.V. Willson, M.D., director ofthe Ireland Cancer Center. “These discoveries have already led topowerful new drugs that specifically target a cancer, giving maximumresults with lower side effects.”

After he was discharged from the hospital, Dr. and Mrs. Goodmancalled their attorney to make changes in their charitable estate plan-ning. The Goodmans made a provision in their wills through The

“ T h e r e a r e n o w o r d s t o e x p r e s s t h e overwhelming f e e l i n g t h e r e i s t o b e t o l d a f t e r 1 2 d a y s t h a t y o u r b o d y i s completely free o f c a n c e r .”

_GOOD HEALTH

L E G A C Y S P R I N G / S U M M E R 2 0 0 3 2 1

Cleveland Foundation for a bequest to the Ireland Cancer Center, aswell as to the American Cancer Society and the American HeartAssociation. They also have established two professorships at the CaseWestern Reserve University School of Medicine in hematology andcardiology. “We determined that we wanted to do something good thatwill help other people,” Dr. Goodman says. “Giving back throughmedical research will give people hope and help lengthen lives.”

As he stood at the ice-covered top of the world last summer, Dr.Goodman truly felt overwhelmed by how fortunate he was to bealive and able to take that journey. Armed with his cameras, hestepped back from the nuclear-powered icebreaker and his 87 fellowpassengers to contemplate the momentous occasion in his life. As

snow gently fell on the ice, he looked around and thought of thephysicians who helped him beat life-threatening leukemia and gavehim a second chance at life.

“It was a very touching moment,” he recalls. “I thought ‘what a luckyman I am to be here - to be a cancer survivor and be at the geograph-ic top of the world.’ The medical expertise I received was so excellentand allowed me to participate in the greatest adventure of our lives. Tobe at the top of the axis on which our Earth revolves, where everythingcomes together and to have survived this dreadful disease - I felt veryhumble as I stood there.”

Alicia Reale is a Media Relations Specialist for University Hospitals of Cleveland.

A novel collaboration between University HospitalsIreland Cancer Center and Hospice of the WesternReserve is changing the way physicians, patients, andfamilies regard cancer care across the nation. ProjectSafe Conduct combines clinical treatment with a full-range of hospice support for cancer patients who arenearing the end of life.

"Patients have a sense of being incredibly cared for and have a menu of services to choose from,"says Nathan Levitan, M.D., an Ireland Cancer Centeroncologist who specializes in lung cancer. "It is pos-sibly the best cancer care."

Meri B. Armour, senior vice president and generalmanager, Ireland Cancer Center, says Project SafeConduct was created to offer a new model of palliative care for lung cancer patients. However,referrals for other illnesses are now accepted.

The project was one of 22 selected from 700 appli-cants for a $450,000 Robert Wood Johnson Foun-dation grant. The grant, and the support of localfoundations, infused Project Safe Conduct with $2.4million to establish the program. Today, Safe Conductis so integrated into Ireland Cancer Center’s culturethat, after its initial grant ended, the cancer centerchose to continue funding the program itself.

everything with me. They truly cared about me andmy family’s well-being." Dr. Coleman’s family subse-quently gave a $1.5 million gift to Ireland CancerCenter to endow a chair for a distinguished physicianscientist who will research novel treatments to curelung cancer and other cancers.

Since its inception in 1999, Project Safe Conduct hastouched the lives of 233 Ireland Cancer Centerpatients and their families, leading to a:

° Six-fold increase in the number of patients choosing hospice care

° Ten-fold increase in the average number of days patients spent in hospice care

° Decrease by half in the number of unplanned hospital admissions and emergency-room visits

° Two-thirds reduction in pharmaceutical costs incurred by patients, mostly due to better pain management.

In addition, many enrollees have participated in clini-cal trials of new medications, and families say theyappreciate being included with patients in makingcare decisions.

For more information on Project Safe Conduct, call800-641-2422.

PA R T N E R S H I P Y I E L D S I N N O V AT I V E A P P R O A C H T O H O S P I C E C A R E

B y L e i g h B l a k e m o r e

In April, Project Safe Conduct was featured at a National Coalition for CancerSurvivorship symposium in Cleveland that called attention to the need for high-quality, coordinated palliative (or pain management) care for cancer survivorsthroughout their illnesses, rather than only in the final weeks of life. A video ofthe symposium may be viewed at canceradvocacy.org/programs/townhall.aspx.

Project Safe Conduct was one of four programs – chosen from 80 nomineesnationwide – to receive a 2002 Circle of Life Award sponsored by the American

Hospital Association, the American Medical Association, the National Hospiceand Palliative Care Organization, and the American Association of Homes andServices for the Aging. The award celebrates innovation in end-of-life care forcancer patients. Each recipient received $25,000 through a grant from theRobert Wood Johnson Foundation.

Circle of Life awards recognize programs that raise standards for end-of-lifecare, show innovation, and build awareness of the importance of serving termi-nally ill patients well and supporting those close to them.

Leigh Blakemore is a coordinator in the Department of Development at University Hospitals of Cleveland.

The Safe Conduct team is composed of a nurse prac-titioner, a social worker, and a spiritual care coun-selor. A psychologist and a pain specialist serve asconsultants. The team works collaboratively withoncologists to enhance patient care.

Kathleen A. Coleman, widow of Lester E. Coleman,Jr., Ph.D., calls Project Safe Conduct "invaluable."Recalling the care her husband received, she says"The Project Safe Conduct Team went above andbeyond the call of duty without intruding." Even afterher husband died, Mrs. Coleman says, the team wasat her side. "They took time to talk about anything and

Project Safe Conduct team members from Ireland

Cancer Center include (left to right) Stephen Adams,

Lisa Szcepaniak, Laura Betchkal, and Nathan Levitan, M.D.

PROJECT SAFE CONDUCT: NATIONALLY ACCLAIMED PROGRAM

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As a youth in Pittsburgh, Pennsylvania, it might have been difficult for Ellis

D. Avner to imagine he would one day assume the role of chief medical offi-

cer at Rainbow Babies & Children’s Hospital, and build a life in Pittsburgh’s

archrival city. However, eight years after arriving in Cleveland, Dr.

Avner has recruited over 90 new medical staff, increased pediatric

research funding from about $9 million to approximately $36 million,

built a first-rate research program in polycystic kidney disease (PKD),

and played a key role in guiding Rainbow to the heights of national

recognition the hospital currently enjoys.

Dr. Avner originally chose quite a different professional path. As an

undergraduate at Princeton University, he majored in religion, with a

primary research interest in the Dead Sea Scrolls. Upon graduation,

and after a year of graduate studies in the Department of Religion at

Harvard University, Dr. Avner says he had a revelation, “The distance

between religion and medicine is far closer than people think. All

physicians who treat patients are somewhat spiritual.”

Combining interests in people’s feelings with their reactions to life’s

issues, Dr. Avner decided to pursue a career in medicine and earned

his medical degree from the University of Pennsylvania. “In this secu-

lar age, I wanted to make a difference and have a major impact on

people dealing with clear, physical-related issues,” he says.

A Missionto Heal

A Passion forResearch

By Mary Elizabeth Sokol

Effective June 1, 2003, Ellis D. Avner, M.D., chief medical officer, Rainbow Babies &

Children’s Hospital, and chairman of the Department of Pediatrics at University

Hospitals of Cleveland, began a one-year sabbatical to focus on his academic work,

specifically his nationally-renowned research in polycystic kidney disease (PKD). An

interim chairman will be appointed by July 1 to assume his administrative duties.

Late-BreakingNewsAvner begins research sabbatical

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After completing his medical degree, Dr.

Avner’s further training and career in

medicine took him to some of the most

prestigious children’s hospitals in the

nation, including Children’s Hospital

Boston, Children’s Hospital of Pittsburgh,

Children’s Hospital and Medical Center

in Seattle, and Rainbow.

Delicate Balancing Act The concept of balance has always been vital to

Dr. Avner. First, as a student of religion, he explored philosophical

questions such as the perpetual balance of good versus evil. In his

medical career, he finds the quest for balance deeply rooted in the

inner workings of one of the human body’s most vital organs. “The

kidney fascinates me as the organ that maintains balance, which is

always on my mind. Balance in life, balance in your profession.”

While training as a pediatric nephrologist, Dr. Avner discovered that

the clinical setting was a powerful motivator in choosing his specialty,

PKD. “I had a group of patients with PKD that challenged elements

of my personal and professional character that had never been chal-

lenged before,” he recalls. Despite advice from mentors who believed

the study of PKD was too complex, Dr. Avner plunged into an area of

scientific research and medical treatment,

which at the time (the early 1980s), was an

absolute conundrum. “It became my long-

term goal to make the lives of these chil-

dren better,” he says.

What is PKD? Polycystic Kidney Disease

(PKD) is a condition in which millions of

cysts proliferate in kidney tissue. It is the

most common genetic, life-threatening disease affecting more than

600,000 Americans and an estimated 12.5 million people worldwide.

In fact, PKD affects more people than cystic fibrosis, muscular dystro-

phy, hemophilia, Down syndrome and sickle cell anemia – combined.

PKD can enlarge a normal kidney, which should be the size of a fist,

to the size of a football. The fluid-filled cysts crowd healthy tissue in

the kidney, reducing the organ’s capacity to act as one of the body’s

most powerful agents of equilibrium, crippling its ability to filter

waste. Most patients with PKD develop high blood pressure, kidney

failure, and eventually, end-stage renal disease.

The majority of PKD cases are inherited, although an acquired form

of the disease exists and is a direct result of life-long chronic kidney

disease and treatment. There are two genetically acquired forms of

L E G A C Y S P R I N G / S U M M E R 2 0 0 3 2 3

“The kidney fasc inates me as the organ that mainta ins balance , which i s a lways on my mind.”

normal kidney PKD kidney

Dr. Avner’s work as principal investigator and director of the Rainbow Center for PKD

Research has reached an exciting area of translational development. Phase I clinical

trials are expected to begin within one year. With Dr. Avner’s increased focus in this

area, University Hospitals will be one of the principal sites in the country to test new

therapeutic regimens.

PKD can enlarge a kidney – usually the size of a fist – to the size of a football.

L E G A C Y S P R I N G / S U M M E R 2 0 0 32 4

PKD: autosomal dominant (ADPKD) and autosomal recessive

(ARPKD). Formerly known as adult PKD, ADPKD usually develops

between ages 30 and 40, but more recently has been diagnosed in

childhood and is one of the most common renal genetic diseases.

ARPKD can be diagnosed prenatally, and uncovering the abnormal-

ities of this form of the disease is the current focus of Dr. Avner and

his talented team of clinical and laboratory researchers at Rainbow.

ARPKD is one of the leading forms of kidney malformation and

chronic renal failure in children with congenital problems. When Dr.

Avner first studied ARPKD in the early 1980s, the disease was

thought to be categorically lethal. However, as Dr. Avner attests, there

are hundreds of patients throughout the United States who prove that,

because of advancements in neonatal intensive care and treatment for

end-stage renal disease, the prognosis can be altered. The mortality

rate of ARPKD is in the 30-40 percent range during the neonatal peri-

od, meaning more than 60 percent survive and require complex med-

ical regimens to maximize quality of life. The 15-year survival rate of

those children is 80 percent, although most eventually require dialysis

or transplant. In the third world, ARPKD remains a death sentence

for most neonates. Patients fortunate enough to survive as newborns

must contend with healthcare delivery systems in which sophisticated

end-stage renal disease therapies are not available or are too expensive.

Renal transplants are a patient’s only option for complete recovery

from kidney complications from PKD. The genetic defect that leads

to the disease resides in the tissue of the kidney and liver. Therefore,

when a patient receives a new, healthy kidney, that kidney remains

healthy, but progressive liver abnormalities may require complex ther-

apy or hepatic transplantation. Organ transplantation is not a viable

option for all patients, due to the difficulty of finding a suitable match

or donor. There are no specific therapeutic agents to treat cyst forma-

tion and enlargement in PKD, but Dr. Avner and his team make it

their mission to find one.

Building a Team and Hope for the Future Throughout his career, and as

early as his residency, Dr. Avner realized the power of bench-to-bed-

side medicine. “The only reason I went into the lab was to work on

patient-related issues,” he says. “The ability to take a patient-related

problem into the lab where you can isolate it from all of the variables,

study it and come back with answers, which might lead to improving

treatment of patients - that’s very exciting.”

It is with this fervor for translational medical research that Dr. Avner,

in addition to serving as the chief medical officer of Rainbow and the

chairman of Pediatrics at Case Western Reserve University, also serves

as principal investigator and director of Rainbow’s Center for PKD

Research. This center is one of only four federally funded PKD cen-

ters in the nation, and the only center to conduct research solely on

PKD in childhood. Collaboration between Rainbow and Case

Western Reserve University has brought together leading clinicians

and researchers: Cathleen Carlin, Ph.D., Calvin U. Cotton, Ph.D.,

Ira Davis, M.D., Katherine MacRae Dell, M.D., Noel Murcia,

Ph.D., William E. Sweeney, M.S., and Beth Vogt, M.D., to answer

“The abi l i ty to take a patient-re lated problem into the lab where you can i so late i t f rom a l l of the var iables ,

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L E G A C Y S P R I N G / S U M M E R 2 0 0 3 2 5

one question: How does a normal kidney

develop into a cystic kidney?

To understand the development of a cystic

kidney, researchers at Rainbow have exam-

ined the problem on the molecular and

cellular level, and identified the over-

expression and misplacement of the epi-

dermal growth factor receptor (EGFR) in

the polycystic kidney. This location expos-

es kidney cells with EGFR to high levels of

growth factors that trigger the receptor’s

activity. Scientists have found that this overstimulation is largely

responsible for the multiplication of cystic kidney cells that lead to

cyst development and enlargement.

In understanding this process, Dr. Avner and his team made a con-

nection between possible treatments for PKD using a model similar to

those used to treat cancer. Because chemotherapeutic agents success-

fully attack a similar abnormality in the cells of certain cancer

patients, they speculated that an analogous approach for PKD might

be comparably successful.

In conjunction with Wyeth-Ayerst Research, researchers at Rainbow

have shown that specific drugs being developed as chemotherapeutic

agents, which block the activity of the EGFR or prevent triggering of

the receptors by growth factors, dramatically decrease kidney cyst

development and liver abnormalities in many experimental models

and human PKD cells.

While research is still in the experimental

stage, Dr. Avner hopes this group of

drugs, now in Phase I clinical trials to

determine the balance of effectiveness

versus toxicity, will be approved for clini-

cal use by the FDA. If approved, clinical

trials of these drugs in PKD patients

could begin soon after.

The use of such therapy to treat ARPKD

is heartening news, not just to patients

with this childhood form of the disease.

The EGFR abnormalities noted in cystic kidney cells are common to

both ARPKD and ADPKD.

If human trials are approved, the Rainbow Center for PKD Research

will be one of the nation’s first to bring this promising new therapy

to patients. For Dr. Avner, the day drug treatment becomes available

to specifically treat PKD will culminate a lifetime of research. “A

clinical problem has been dissected at the molecular and cellular

level in the laboratory, and those findings have been translated into

therapies to benefit patients. Such treatment in PKD has the poten-

tial to minimize pain and suffering, and normalize the lives of chil-

dren and adults with a life-threatening, genetically determined

chronic disease,” he says. “We will come full circle in the best tradi-

tion of translational research.”

Mary Elizabeth Sokol is a manager in the Department of Development at UniversityHospitals of Cleveland.

s tudy i t and come back with answers , which might lead to improving t reatment of pat ients - that’s very exc i t ing . ”

Members of Rainbow’s Nephrology Division include (left to right): KatherineMacRae Dell, M.D.; Ellis Avner, M.D.; Lisa Metz, R.N.; Stephanie Orellana,Ph.D.; Melanie Klein, R.N.; Ira Davis, M.D.; William Sweeney, M.D.; andBeth Vogt, M.D. (Not pictured: Cathleen Carlin, Ph.D.; Calvin Cotton, Ph.D.;and Noel Murcia, Ph.D.)

L E G A C Y S P R I N G / S U M M E R 2 0 0 32 6

The MacDonald Fertility & IVF (In Vitro Fertilization) Program offers anationally recognized, board-certified team of fertility experts who pro-vide comprehensive treatment to couples who need help conceiving. It isthe only comprehensive fertility and IVF program in northeast Ohio locat-ed entirely within a hospital. A multi-disciplinary team of physicians,nurses, psychologists, nutritionists, laboratory staff members, and a pro-gram coordinator helps couples become families. Couples who are suc-cessfully treated in the MacDonald Fertility and IVF Program may chooseto complete their pregnancy under the care of their own obstetrician.

“We are committed to the most clinically-advanced and sensitive explo-ration of every avenue available for each situation. We believe no coupleshould give up trying to conceive before exploring all their options,” says J. Ricardo Loret de Mola, M.D., chief, Division of Reproductive

MacDonald IVF team helps become

couplesfamiliesby Patr ic ia Fal ler

One in every seven couples of childbearing age has difficulty conceiving. The

good news is that recent medical advances available at University Hospitals of

Cleveland MacDonald Women’s Hospital make pregnancy possible for most

couples pursuing treatment.

Endocrinology and Infertility, who also notes that nearly 2,000 patientsfrom across the nation and abroad have been treated in the MacDonaldFertility and IVF Program since it opened in October 2000. “Our first goalis to seek out and correct the cause or causes of infertility; we provideaccurate information and dispel the myths.”

Numerous conditions cause infertilityMost fertility experts agree that infertility is the appropriate diagnosiswhen pregnancy has not occurred after a full year of unprotected inter-course. Approximately 50 percent of infertile couples have difficultybecoming pregnant due to problems experienced by the woman, another35 percent involve the man, and in the remaining 15 percent of cases,both male and female factors prevent conception.

L E G A C Y S P R I N G / S U M M E R 2 0 0 3 2 7

Common complications experienced by women are:Ovarian problems caused by endocrine disorders that can result in irreg-ular menstrual cycles; infertility; or recurrent miscarriages.

Problems with the fallopian tubes or other pelvic organs that disrupt themenstrual cycle.

Fibroids, or tumors, forming from the muscle of the uterus and distortingthe uterine cavity.

A woman’s age; experts now believe a woman’s ability to conceive beginsto decrease around age 35.

Although recurrent pregnancy loss may sound like a different problemthan infertility, women who have had two or more consecutive mis-carriages before the 20th week of pregnancy should be tested by areproductive endocrinologist to determine the cause of the mis-carriages. Bacterial infections, specific toxins, a progesterone defi-ciency and immunological factors are some of the possible causes.Even after several miscarriages, women can be treated and can havesuccessful pregnancies.

Tom and Ann (Topoly) Raglow never thought they would have trouble conceivinga second child. After all, their first child, Tom Jr., was born without complication16 years ago. After a decade or so of focusing on their careers, the Concord, Ohio,couple assumed a second pregnancy would be equally trouble free.

But when Mrs. Raglow did not become pregnant after three years, the coupleturned to University Hospitals of Cleveland’s MacDonald Women’s Hospital.

In April 2001, the Raglows went to MacDonald’s Division of ReproductiveEndocrinology and Fertility for a consultation and learned that Mrs. Raglow’s fal-lopian tubes were blocked and infected. After surgery to remove her damagedtubes, Division Chief J. Ricardo Loret de Mola, M.D., performed a successful InVitro Fertilization (IVF), in August 2001.

The Raglows recall their first impression of the MacDonald team. “They were pro-fessional, friendly, caring and very encouraging,” Mrs. Raglow says. “We werenervous and anxious to start the process, but felt we were in the best possiblemedical care. Dr. Loret de Mola’s team was there for us every step of the way andreally put us at ease.”

On May 4, 2002, at University Hospitals, Mrs. Raglow gave birth to Jolina, ahealthy, happy girl. Jolina will be about 18 months old when her new brother orsister, also conceived through IVF, is born in the fall. The Raglows’ dream of a“nice-size family” is coming true.

“The couples we know who went through the IVF program at MacDonald Women’sHospital say many of the same things we do about this group,” notes Mr. Raglow.“From the office manager, to the doctors, nurses, ultrasound technicians, andembryologists, they are all first-class professionals who love what they do anddeeply care about their patients.”

Common complications experienced by men are:Anatomic abnormalities that obstruct sperm, and lack of proper devel-opment of the internal reproductive organs.

Hormonal abnormalities that can affect sperm production.

Abnormal dilation of the veins in the testicle (varicocele), an abnormal-ity found in approximately 25 to 35 percent of infertile males.

A distinguished, caring teamEach MacDonald fertility specialist is a member of the Society forReproductive Endocrinology and Infertility (SREI), a distinguishedorganization of physicians who are certified by the American Board ofObstetrics and Gynecology for their knowledge and proficiency in theevaluation and treatment of reproductive disorders, including infertility.There are fewer than 800 members of the SREI in the United States.

Patients who require reproductive surgery can rely on these physicians,who are among the nation’s leaders in surgical treatment for reproduc-tive issues and have received special credentials from the Accreditation

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MacDonald IVF program helps dream come true for Concord couple

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The physicians and laboratory personnel at MacDonald Women’s Hospital are actively

involved in reproductive medicine research and are faculty members of Case Western Reserve

University School of Medicine. Current areas of research include:

Abnormalities in insulin metabolism among infertile women with polycystic ovarian

syndrome (PCOS).

The role of the insulin-like growth factor system (IGFS) in reproduction.

Hormone replacement therapy in menopausal women.

Genetics of male infertility.

Methods to increase uterine blood flow in women with uterine lining abnormalities or

who have problems with embryo implantation.

“The program’s outstanding laboratory contributes significantly to our successful pregnancy

rates,” says Dr. Loret de Mola. The program yielded a 62 percent pregnancy success rate in

2001 – considerably higher than the national average of 27 percent. The fertility team’s suc-

cessful track record is attributable, at least in part, to sophisticated assisted reproductive

techniques and expertise.”

MacDonald Fertility & IVF Program medical staff

J. Ricardo Loret de Mola, M.D., chief, Division of Reproductive Endocrinology; medical director,Fertility & IVF Program, reproductive endocrinologist and infertility specialist.

James H. Liu, M.D., chief, Department of Obstetrics and Gynecology, reproductive endocrinologistand infertility specialist.

Francisco Arredondo, M.D., reproductive endocrinologist and infertility specialist.

Allen D. Seftel, M.D., urologist and male infertility specialist.

Sheryl A. Kingsberg, Ph.D., clinical psychologist.

researchand academicaffiliations

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J. Ricardo Loret de Mola, M.D.

L E G A C Y S P R I N G / S U M M E R 2 0 0 3 2 9

Council for Gynecologic Endoscopy (ACGE), a certifying arm of theAmerican Association of Gynecologic Laparoscopists.

“We recognize the difficulties of coordinating complicated care, thereforeour program incorporates all the components that would allow couples tobecome parents,” says Dr. Loret de Mola. “We have a Male and FemaleInfertility Clinic where couples are seen by a multi-disciplinary team ofreproductive endocrinology and fertility experts and urologists who spe-cialize in male infertility. Psychologists and psychiatrists are anotherintegral part of the team and provide counseling to assist couples in theemotional process of becoming parents. Nutritionists attend the clinics todiscuss the importance of a healthy diet for a normal pregnancy.”

After a thorough assessment to determine a couple’s cause(s) of infer-tility, the MacDonald Fertility & IVF Program team discusses all availableoptions with each couple.

“Infertility does not necessarily need to be a final diagnosis,” says Dr.Loret de Mola. “We also offer most of our services at University Hospitals’facilities in Cleveland’s eastern and western suburbs to make treatmentas convenient as possible.”

For more information on The MacDonald Fertility & IVF (In Vitro Fertiliza-tion) Program, visit their website: www.uhhs.com/fertility or telephone:216-844-1514, or e-Mail: fertility@uhhs.com

Staff is available 24 hours a day, seven days a week.

womenCORRECTING ANATOMIC PROBLEMS Problems with the fallopiantubes, uterus or cervix require immediate attention. After diagnosingthe problem, fertility specialists may perform minimally invasive sur-gery to correct anatomic problems.

OVULATION INDUCTION Infertility can be related to problems withovulation commonly caused by polycystic ovarian syndrome (PCOS),excessive weight gain or loss, age, excessive exercise and extremeemotional stress. Medications are available to stimulate ovulation.

INTRAUTERINE INSEMINATION (IUI) Also known as ArtificialInsemination, IUI is a simple, painless non-surgical office procedure inwhich sperm from the male partner is placed into the woman’s uterus.

IN VITRO FERTILIZATION (IVF) IVF is a procedure in which eggsremoved from the ovaries are fertilized in the laboratory with spermfrom the male partner. The fertilized eggs develop into embryos overthree to five days in the laboratory, then are placed in the woman’suterus. IVF is used in cases where the fallopian tubes are blocked, andalso where other diagnoses, conventional medical treatments and sur-gery have not been successful. It is also possible to develop fertilizedeggs in the laboratory for up to five days, the stage when embryos arereferred to as blastocysts, before transfer back into the uterus.Because blastocysts are much further developed, fewer are neededfor IVF, and the risk of multiple births is reduced.

OOCYTE (EGG) DONATION If testing determines that the femalepartner does not have sufficient eggs to get pregnant, the couple maychoose oocyte donation as an alternative. The donor’s eggs and themale partner’s sperm are combined during the in vitro fertilizationprocess. When the resulting fertilized eggs develop into embryos, they

Treatment options for

are transferred to the female partner to carry the pregnancy. Donorsundergo extensive genetic and medical testing and complete a thor-ough questionnaire before they are approved for the program.

SURROGATE HOST (GESTATIONAL CARRIER) Women under age42 and ovulating, but for whom pregnancy is inadvisable or not possi-ble, may wish to consider having a surrogate host carry their geneticchild. Circumstances that might make this an appropriate optioninclude health problems, recurrent miscarriages or absence of auterus due to hysterectomy or being born without a uterus. Followingin vitro fertilization of the couple’s eggs and sperm, the couple’s bio-logical embryos are placed in the uterus of the surrogate host.

menBetween 35 and 50 percent of infertile couples can trace problems tothe male partner or to a combination of male and female factors. Theconservative treatment of male infertility may involve medical thera-pies such as hormonal stimulation, antibiotics, antihistamines or a vari-ety of surgical procedures to improve the quality or motility of semen.

NON-SURGICAL SPERM ASPIRATION (NSA) NSA is a procedureto obtain sperm directly from the testicle. It is used when spermcounts are exceptionally low or when there is no sperm in the semendue to vasectomy or other types of duct obstructions. NSA also is analternative to vasectomy reversal.

INTRACYTOPLASMIC SPERM INJECTION (ICSI) ICSI, a recent revolu-tionary breakthrough in fertility treatments, is another means of unit-ing sperm and eggs in the laboratory setting. In this procedure, a sin-gle sperm is injected directly into an individual egg retrieved from thewoman’s ovaries. ICSI can result in pregnancy even in the most severeforms of male infertility as long as there are viable sperm available.

Patricia Faller is a Marketing/Communications account manager at University Hospitals of Cleveland.

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The

Philanthropic�piri�C O N T R I B U T O R S : M A R C I A M E E R M A N S A G H A J A N I A N , A N N M C G U I R E , PAT R I C I A R O S S M A N

A bit of Hollywood came to Cleveland in November, when designerBarbara Lazaroff and celebrity chef Wolfgang Puck received theUniversity Hospitals of Cleveland 2002 Samuel Mather Award forPhilanthropy, which honors individuals, corporations and foundationswhose exceptional generosity and civic vision have had a lasting and profound impact on the hospital.

Ms. Lazaroff and Mr. Puck have raised more than $2.5 million forUniversity Hospitals Ireland Cancer Center* by spearheading - since1987 - the hospital’s bi-annual Five Star Sensation benefit. The galadinner, which is a sellout event each year, features fine cuisine fromchefs and vintners from around the world.

This year’s benefit was June 21 at University Health Center atLanderbrook in Mayfield Heights.

Ms. Lazaroff has made an indelible imprint on the restaurant industrywith her innovative interior designs; Mr. Puck is acclaimed for hisincomparable cuisine. Their culinary empire includes restaurants,catering, publishing, cookware, consumer packaged foods, televi-sion/radio/internet programming, merchandising and more.

P U C K A N D L A Z A R O F F R E C E I V E U H C ’ S H I G H E S T P H I L A N T H R O P Y H O N O R

University Hospitals of Cleveland benefactors David and Carole Carr, and Henry L.

Meyer III, former chairman of the boards of UHHS and UHC, present the hospital’s

Samuel Mather Award for Philanthropy to Barbara Lazaroff and Wolfgang Puck.

Funded by a generous grant from Mt. Sinai Community Partners,

University Hospitals of Cleveland has taken a crucial step forward

in the prevention and treatment of genetic diseases that afflict

Jewish populations with the creation of the Mt. Sinai Center for

Jewish Genetic Diseases.

This new center, part of UHC’s Center for Human Genetics, will

institute an array of research, education and screening programs

designed to identify individuals at risk for diseases that more often

affect Jewish populations. The Center also will endow an ongoing

annual lecture series, drawing on the expertise of leading scientists

Mt. Sinai Community Partners Give $535,000 to establish Center for Jewish Genetic Diseases at UHC

and educators to heighten awareness and understanding of genetic

diseases in the Jewish community.

“By undergoing genetic testing prior to any signs or symptoms of

disease, people may be alerted to a potential health problem and

then begin treatment or screening exams in a timely manner,” says

Georgia Wiesner, M.D., director of the Center for Human Genetics.

“Likewise, educating parents about health risks in their children will

empower the community to improve the health of future generations

of Cleveland’s Jewish community.”

* Ireland Cancer Center of University Hospitals of Cleveland and Case Western Reserve University was recently redesignated by the National Cancer Institute as a Comprehensive Cancer Center – it

is the only hospital in northern Ohio to hold this distinction. Moreover, U.S. News & World Report ranks Ireland Cancer Center the “Best Cancer Center” in Ohio.

L E G A C Y S P R I N G / S U M M E R 2 0 0 3 3 1

A youth theater group performsmonthly for Rainbow Babies &Children’s Hospital patients. A corporate foundation makes adonation. A Brownie Troop hosts a “baby shower” for patients. Andmembers of the United StatesSecret Service volunteer to hold a golf benefit.

All of these initiatives – and a dozen more – were inspired by a new community outreach program, the Rainbow Circle ofFriends Association, a group dedicated to “raising friends andfunds for Rainbow.”

The idea is for individuals or organ-izations to form their own circles offriends – family members, co-work-ers, or neighbors – who will help

Rainbow and, in the process, raisethe visibility of the children’s hos-pital U. S. News and World Reportranked #1 in the Midwest.

Since its launch in December2002, 22 new circles have formedto benefit Rainbow in a variety ofcreative ways, from corporate spon-sorships, to scout service projects,to “in-kind” donations of talentranging from marketing, to websitedesign, to holiday decorating ofRainbow playrooms.

“Your imagination is your onlylimitation,” says Circle of FriendsDirector Sharon Klonowski.“Having fun and strengtheningfriendships while doing somethingworthwhile is what Circle ofFriends is all about.”

RAINBOW’S CIRCLE OF FRIENDS

The 20th Annual Rainbow Golf Classic is set for Monday, August 25, at theKirtland Country Club. As one of Rainbow’s premier fundraising events, the GolfClassic raised nearly $120,000 in 2002. Each year, approximately 120 corporateleaders enjoy spectacular golf, a barbecue-style lunch, cocktail party, awardceremony, and raffle. This year’s event will honor committee chairs and long-time corporate sponsors. The 2003 Rainbow Golf Classic Committee chair isRichard D. Weber, managing director, Energy Investment Banking for McDonaldInvestments, Inc. Co-chairs representing Rainbow Babies & Children’sCorporation Board of Trustees are Theodora S. Wolf and Constance Croasdaile.

For further information, contact Judith Hunter, assistant director, Departmentof Development at 216-844-1590.

to form your own Circle of Friends, call 216.844.8728.

Richard D. Weber, Rainbow Golf Classic Committee chair in 2002 and 2003, and David K.

Magnuson, M.D., chief of Rainbow’s Division of Pediatric Surgery, accept a “check” highlighting

proceeds from last year’s event. Mr. Weber is also managing director, Energy Investment Banking

for McDonald Investments, Inc.

b r o a d e n s

c o m m u n i t y

o u t r e a c h

Rainbow Golf Classic is August 25th

LOOKING FOR JUST THE RIGHT GREETING CARD? Rainbow Kids Cards, pro-fessionally printed greeting cards featuring the artwork of Rainbow patients, arenow available for all occasions.

These colorful cards – previously available as “Season’s Greetings” only – nowfeature cheerful pictures suitable for any greeting. At $14.95 per box of 20,proceeds still benefit special programs at Rainbow, and Kids Cards are now onsale all year at Heinen’s Fine Foods and the Atrium Gift Shop at UniversityHospitals of Cleveland. As of August 1, 2003, Kids Cards will be availableonline at www.rainbowkidscards.org.

In 2002, Kids Cards netted more than $25,000, up from $9,000 in 2001.Heinen’s accounted for almost half of last year’s proceeds. “We can’t thankHeinen’s enough,” says Kids Cards Coordinator Bridget Troy.

Since 1990, Kids Cards have raised more than $300,000 and helped supportRainbow’s Child Protection Program, Pediatric Closed-Circuit Television,Creative Arts Therapy Department, the Social Work Welfare Fund, the ChildSafety Seat Initiative of the Pediatric Trauma Unit, and the W.O. FrohringFamily Resource Center. This year, proceeds will support the Starbright pro-gram, an interactive therapeutic activity for patients and their siblings.

Call 216.844.CARD or email kidscards@rainbowbabies.org for more infor-mation on volunteer opportunities.

Kids Cards Available Year ‘Round

L E G A C Y S P R I N G / S U M M E R 2 0 0 33 2

vv v

Adopting children from other coun-tries brings excitement and love tothe entire family. But the uncertain-ty of an adopted child’s medical his-tory can cause concern.

Allison Huegel and James Sergiunderstand that concern. Marriedfor 12 years, the residents of PepperPike and San Francisco decided in2001 to adopt. They turned to theAdoption Health Service at Rain-bow Babies & Children’s Hospital –part of the Rainbow Center forInternational Child Health – whichoffers pre- and post-adoption servic-es to help new families get off to ahealthy start.

For six Saturdays last fall, Ms.Huegel and Mr. Sergi attendedclasses to prepare for the adoptionprocess and post-adoptive period.They loved the program and werethrilled to meet other couples goingthrough the same experience.

Well aware of the high costs ofinternational adoption, Ms. Huegeland Mr. Sergi asked how they could

help. They learned that healthinsurance does not cover pre-adop-tion programs, and often does notreimburse medical fees associatedwith post-adoption and follow-upcare. They also learned that becauseAdoption Health Service is a non-profit center, most of its pediatri-cians work on a pro bono basis.

To help others defray these costs,Ms. Huegel and Mr. Sergi, (whohope to adopt a little boy fromKorea this year) made a generousgift to Rainbow Adoption HealthService to help cover fees for fami-lies unable to afford AdoptionHealth Service programs; medicalstaff expenses; and research studieson adoption health issues.

“We appreciate Allison’s and Jim’sfinancial support, as well as theirbelief in the importance of our services to internationally adoptedchildren and their families,” saysAnna Mandalakas, M.D., director,Adoption Health Service.

GCouple Makes Gift

to Rainbow Adoption Health Service

vv

Wi th a leadership gi f t f rom an anonymous benefactor, University Hospitals of Cleveland creat-

ed a green “oasis” on busy Adelbert Road last summer, which came into ful l bloom for the f irst

t ime this spring. Gif ts from the John P. Murphy Foundation and The Second Foundation also

supported the project .

Lakeside Garden replaces a parking lot in front of the former Lakeside Hospital with wide

grassy spaces, f lowering trees, perennials and park benches. The founders of University Circle

would be happy. Their original plan was to s ituate an array of renowned cultural , educational ,

and medical inst itutions in a park- l ike sett ing. Lakeside Garden certainly af f i rms that v is ion.

Lakeside Garden AN OASIS ON A BUSTLING BLOCK

Miracles happen when communities band together tosupport children’s healthcare. That’s why Rainbow Babies& Children’s Hospital is one of 172 nonprofit children’s hospitals nation-wide affiliated with Children’s Miracle Network, an organization that rais-es funds to benefit its member hospitals and the 14 million children theyserve annually.

An important vehicle for this support is the annual Children’s MiracleNetwork Celebration, which aired in northeastern Ohio May 30-31, andJune 1 on WEWS NewsChannel 5. The broadcast featured young patients,their parents and doctors from Children’s Miracle Network hospitals acrossthe country sharing their hospital and healing experiences. Punctuatingthis national “Celebration,” Rainbow’s own programming was broadcastlive from the Atrium at University Hospitals of Cleveland. WEWS newsanchors volunteered their time to host local “Celebration” coverage.Joining them were WMVX radio personalities, Brian Fowler and JoeCronauer, who will host the “Brian and Joe Rainbow Radiothon” July 31through August 2.

Viewers responded enthusiastically throughout the three-day event. In2002, Children’s Miracle Network raised more than $1 million to help sup-port Rainbow’s lifesaving medical treatments and technologies, and itspatient- and family-centered programs.

CelebrationC H I L D R E N ’ S M I R A C L E N E T W O R K

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L E G A C Y S P R I N G / S U M M E R 2 0 0 3 3 3

reflectionsN U R S I N G – a n e x c e p t i o n a l c a l l i n g

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The nursing profession has been repeatedly recognized as

a vital contributor to community health throughout the

world in the modern era. And although the practice of

nursing is of critical importance, in the eyes of many, the

profession merely performs a series of necessary custodi-

al and technical tasks, instead of the complex practice of

helping people maintain optimal health.

Simply put by legendary nursing theorist, Virginia Henderson, the goal ofnursing is: "To help people, sick or well, in the performance of activitiescontributing to health or its recovery (or a peaceful death) that theywould perform unaided if they had the necessary strength, will or knowl-edge. It is the unique function of nurses to help people gain independenceas rapidly as possible."

This definition, which serves as the foundation of nursing care atUniversity Hospitals of Cleveland (UHC), requires nurses to have thesame scientific knowledge base as physicians; knowing the diagnosis,treatment and pathophysiology of diseases – to help patients adjust theirlives in order to meet treatment goals. The practice of nursing alsorequires a sound knowledge of the behavioral and social sciences.

Recently, a serious international nursing shortage has forced the profes-sion to carefully consider and make known what was not widely recog-nized in the past – that nursing is a profession with its own body ofknowledge and cognitive processes, and with a cadre of theorists andresearchers who work to enhance nursing practices for the benefit of ourpatients. In essence, nursing is much more than the demonstrative taskspatients see from their hospital beds. Moreover, it is the responsibility ofthe nursing profession – whose practice is based on scientific knowledge– to assert the importance of nursing as a profession delivered in a caringand compassionate manner.

Throughout history, nurses have practiced in a variety of settings. BeforeWorld War II, nurses worked: directly within the community, as part ofcity and county public health efforts; as private duty within patients’

homes; and in home care agencies such as visiting nurse associations. Afterthe war, the practice of nursing moved radically toward the burgeoninghospital environment, in parallel with a similar move by physicians.

With the advent of new technology, such as radiology, complex surgicalprocedures and sophisticated laboratory testing, centralization of servicesinto the hospital setting proved to be the most economical and efficientsolution for physicians to practice medicine. Nurses became the vital linkbetween technology and humanity, aiding individuals in their recovery.Patients may be drawn to the hospital for technological advancements,but patients stay for the care of nurses, who provide the necessary servic-es and information the patients need to recuperate.

Even as technology advances and the need for skilled nursing continues toincrease in the hospital setting, nurses can be found in diverse profession-al settings – schools, manufacturing plants as occupational health nurses,consulting firms, and within the ranks of countless social service agencies.UHC understands the exceptional organizational and crisis managementskills of nurses, and here, nurses engage in a wide range of career tracks –senior hospital administrators and leaders, recruitment strategists,research coordinators, as well as traditional clinical and managerial patientcare professionals. Each nurse has significant opportunities to advance hisor her career in both clinical and administrative roles in a collaborativeworking environment.

From its early days of caring for patients in their homes, nursing has beenboth a challenging and supremely rewarding profession, tremendouslyadaptable in its practices. However, throughout the years, the essence ofnursing has remained the same - to help people attain, manage and main-tain their own health.

Charlene Phelps, M.S.N., R.N., F.A.A.N., has played a significant role inadvancing the profession of nursing at University Hospitals of Cleveland(UHC) for over 30 years. Ms. Phelps, now senior vice president for NursingIntegration, was recently honored by University Hospitals and the ElisabethSeverance Prentiss Foundation through the establishment of the CharlenePhelps Nursing Scholars Program. The program provides educational grants,renewable for three years, to students enrolled in four-year nursing programsat five area colleges and universities, in exchange for their service to UHCafter graduation. Ms. Phelps is widely recognized for her exemplary commit-ment to the nursing profession, and is a main reason why University Hospitalsis known for providing the highest quality of nursing care in northeast Ohio.

University Hospitals Health System

(UHHS) is the region’s premier

healthcare delivery system, serving

patients at more than 150 locations

throughout northern Ohio, as shown

on the map at right. The flagship of

the system is University Hospitals

of Cleveland (UHC). Founded in

1866, this 974-bed academic medical

center and tertiary care hospital is

the largest center for medical research

in Ohio and the primary teaching

affiliate of Case Western Reserve

University. Included in UHC are

Rainbow Babies & Children’s

Hospital, among the nation’s best

pediatric hospitals; Ireland Cancer

Center, northern Ohio’s only

National Cancer Institute-designated

Comprehensive Cancer Center (the

nation’s highest designation); Case

Research Institute; and MacDonald

Women’s Hospital, Ohio’s only

hospital for women.

Un ivers i ty Hosp i ta ls o f C leve land 11100 Euc l id Avenue C leve land, Oh io 44106

University Hospitals of Cleveland

LEGACYUniversity Hospitals Health System