Page 5 - Mecklenburg_Medicine_March-2017

President’s Letter
Brave New World
By Stephen J. Ezzo, MD
L et me tell you about my mother. Ninety-three years
young, daughter of Italian immigrants, she experienced
the two greatest upheavals of the 20th century – the
Great Depression and World War II. There was no
money for college and as a result she and dad (my Pops, 91, is a
retired cardiologist who received his education thanks to the GI Bill
after serving in the Army in the WWII European theater) made
sure their six children had access to whatever higher education
they desired. As a result there are college and graduate degrees
everywhere you look. She has thirteen grandchildren and seven
great-grandchildren (for now). I like to think when my grandparents
came through Ellis Island, even with all the newness and uncertainty
they faced, this was part of their plan.
Now let me tell you another aspect of my mom. She possessed a
93 year old aortic valve that was stiff, covered in calcium, and barely of knowledge, on a scale unmatched. I realize that this statement
opened, leaving her with episodes of chest pain, shortness of breath,
and near fainting. When she could barely make it from one room to
the next without resting, something had to be done.
So in late 2016 she underwent a TAVR - Transcatheter Aortic
Valve Replacement. The procedure went even better than hoped
for and she was home in two days (Of course it did. As she told my
sister and me as they were taking her back, “Don’t worry. You’re
not getting rid of me yet.”). She is now in outpatient cardiac rehab,
her follow-up echos and EKGs are normal, she is driving again, and
tells everyone she cannot remember the last time she felt this good.
I hear the timbre and strength in her voice increasing each time I
speak with her.
When everything had settled, and my heart rate, chest pain and
cortisol levels had decreased to manageable levels, I had the time
to reflect on what an amazing event had just occurred. Not just
that a 93 year old woman had her aortic valve replaced and went
home in two days – that was incredible (as was the fact her pre-
procedure heart catheterization and carotid ultrasounds were clean,
which means she probably has better arteries than I do). But just as
much so as they were able to replace a valve in her heart through a
puncture wound in her leg.
I first heard about TAVR around four years ago during a
presentation to several physicians. About half way through you
could see everyone thinking, “Wait. Did he just say they could
replace the aortic valve with a new valve folded on to the end of
catheter? Really?” I am sure my jaw was rather slack when the
lecture finished. Little did I know how intimate I would become
with the procedure.
I am reminded once again of the incredible complexities of the
human body, and the near-miraculous advancements we make in our
quest to treat patients. My mother was not a candidate for open-heart
surgery, nor did we want her to undergo this. If this had occurred
just four years ago she would have had no treatment options other
than drug therapy, which would have been merely a form of comfort
measures. As I told mom, “You lived long enough for the technology
to catch up with you.”
We are all so busy trying to provide the best care we can for
our patients that sometimes we fail to see the advancements that
take place every day in medicine, not only in our specialty but in
others. As part of the editorial board of this bulletin, I read monthly
the achievements of our colleagues at Novant Health, Carolinas
Healthcare System, and the Independent Physicians. Take a moment
to read in this magazine what is going on around you – not until you
have finished this of course – we are as cutting edge in many areas
as any place. How reassuring to have so many expert colleagues to
offer our patients when they are in need.
I tell my patients who are considering the medical profession
there are two things that will accompany them their entire careers
– the intellectual stimulation/challenge and the exponential growth
reflects my typical naïve, myopic view – “A man’s got to know his
limitations”1 – and I am sure other professions have similar qualities,
but we have the honor and privilege to partner with the greatest
achievement that God and evolution have designed.
We went into medicine not only because we wanted to help our
fellow man, but also because we are life-long learners. Good thing
too, as the new information never stops coming. We marvel not only
at this, but at cases we see for the first time regardless of how long
we have been in practice. Stay abreast, and at times keep tabs on
what is going on outside your discipline. You never know how close
it may hit to home.
(Note: A big shout out here to Dr. Gary Niess, who assured me
this was the right thing for my mom, and Dr. Yele Aluko, who
walked me through the procedure step-by-step, reviewed the data,
and provided me with all the right questions to ask. Gentlemen, you
were a harbor during the storm.)
1 Inspector Harry Callahan, “Magnum Force”
“Oh, wonder! How many goodly creatures are there here! How
beauteous mankind is! O brave new world, That has such people in ‘t!”
Miranda, “The Tempest”
William Shakespeare
— William Shakespeare
Trivia question:
What is the earliest known depiction of a circumcision?
Answer on page 13.
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