Stanford Amyloid Center: From Start-up to Premier Status

by | Feb 26, 2024 | 2019, caring for our patients 2019

Baldeep Singh, MD, with staff at Samaritan House

RONGLIH LIAO, PHD (left), reviews research data with lab instructor SEEMA DANGWAL, PHD.

Stanford Amyloid Center: From Start-up to Premier Status

RONGLIH LIAO, PHD (left), reviews research data with lab instructor SEEMA DANGWAL, PHD.

Stanford Amyloid Center: From Start-up to Premier Status

Although Kevin Anderson had committed no crime, he was facing a death sentence when he came to Stanford in 2007.

Anderson was dying from end-stage cardiac amyloidosis, an abnormal accumulation of proteins (amyloid fibrils) in his heart.

He had recently visited the Mayo Clinic in Minnesota to ask about a heart transplant, which at that time was the only viable treatment option for his disease. Because the amyloidosis was mostly in his heart and not in other parts of his body, Anderson qualified for a transplant.

Anderson, a urologist, lived near Sacramento, California. His proximity to Stanford brought him in contact with Ronald Witteles, MD, who at the time was a new faculty member, just starting the Stanford Amyloid Center.

Not long after Witteles met Anderson, the Stanford heart transplant team gave Anderson a second chance at life.

“Without the transplant, Dr. Anderson would not have survived that year. Now, more than a decade later, he remains alive and well, is back to work as a urologist, and he is thriving,” says Witteles, associate professor of cardiovascular medicine.

Antibodies and Light Chains
Anderson was afflicted with AL (primary) amyloidosis, which is related to a type of bone marrow cancer. Normally, plasma cells in the bone marrow produce antibodies. If a plasma cell becomes cancerous, it may produce extra pieces of antibodies called “light chains” (the L in AL amyloidosis). The light chains circulate in the bloodstream and can deposit in the heart and other major organs throughout the body, causing damage.

“A generation ago, a diagnosis of AL amyloidosis often was a death sentence, particularly when it involved the heart, but in the last 10 years treatments have improved by leaps and bounds so we can now give very effective treatments to many patients with the disease,” Witteles says.

Transthyretin (TTR) amyloidosis is the other main type of the disease. It is not related to cancer, and one of its two forms is inherited from those carrying a genetic mutation. The mutation is present in about 1 in 30 African Americans in this country; about 7 percent of the people with the mutation will develop the disease. Another form of TTR amyloidosis, which is not hereditary, first strikes people usually between ages 60 and 80 and causes mainly heart dysfunction. Up to a quarter of men in their 80s and 90s have significant deposits present in their hearts.

A Synergistic Approach
AL amyloidosis, the bone marrow type of the disease, is by definition a cancer, but it endangers other organs — including the heart, the kidneys, the liver, the gastrointestinal tract, and the nerves. Optimum patient care requires a true multidisciplinary approach in which amyloidosis specialists closely collaborate with experts in various medical specialties.

Witteles had that approach in mind when he first contacted Stanley Schrier, MD, professor of hematology, about an opportunity for a Stanford team to form a multidisciplinary group to battle this disease. Colleagues in other disciplines also expressed interest, including Richard Lafayette, MD, a professor of nephrology; Sally Arai, MD, an associate professor of blood and marrow transplantation; and Gerald Berry, MD, a professor of pathology. That first group of physicians wanted to learn everything they could about the disease, and they were willing to work collaboratively to contribute to the body of knowledge. That meant patients who would be coming from great distances could see all their specialists in one coordinated visit.

RONALD WITTELES, MD

Although Kevin Anderson had committed no crime, he was facing a death sentence when he came to Stanford in 2007.

Anderson was dying from end-stage cardiac amyloidosis, an abnormal accumulation of proteins (amyloid fibrils) in his heart.

He had recently visited the Mayo Clinic in Minnesota to ask about a heart transplant, which at that time was the only viable treatment option for his disease. Because the amyloidosis was mostly in his heart and not in other parts of his body, Anderson qualified for a transplant.

Anderson, a urologist, lived near Sacramento, California. His proximity to Stanford brought him in contact with Ronald Witteles, MD, who at the time was a new faculty member, just starting the Stanford Amyloid Center.

Not long after Witteles met Anderson, the Stanford heart transplant team gave Anderson a second chance at life.

“Without the transplant, Dr. Anderson would not have survived that year. Now, more than a decade later, he remains alive and well, is back to work as a urologist, and he is thriving,” says Witteles, associate professor of cardiovascular medicine.

Antibodies and Light Chains
Anderson was afflicted with AL (primary) amyloidosis, which is related to a type of bone marrow cancer. Normally, plasma cells in the bone marrow produce antibodies. If a plasma cell becomes cancerous, it may produce extra pieces of antibodies called “light chains” (the L in AL amyloidosis). The light chains circulate in the bloodstream and can deposit in the heart and other major organs throughout the body, causing damage.

“A generation ago, a diagnosis of AL amyloidosis often was a death sentence, particularly when it involved the heart, but in the last 10 years treatments have improved by leaps and bounds so we can now give very effective treatments to many patients with the disease,” Witteles says.

Transthyretin (TTR) amyloidosis is the other main type of the disease. It is not related to cancer, and one of its two forms is inherited from those carrying a genetic mutation. The mutation is present in about 1 in 30 African Americans in this country; about 7 percent of the people with the mutation will develop the disease. Another form of TTR amyloidosis, which is not hereditary, first strikes people usually between ages 60 and 80 and causes mainly heart dysfunction. Up to a quarter of men in their 80s and 90s have significant deposits present in their hearts.

A Synergistic Approach
AL amyloidosis, the bone marrow type of the disease, is by definition a cancer, but it endangers other organs — including the heart, the kidneys, the liver, the gastrointestinal tract, and the nerves. Optimum patient care requires a true multidisciplinary approach in which amyloidosis specialists closely collaborate with experts in various medical specialties.

Witteles had that approach in mind when he first contacted Stanley Schrier, MD, professor of hematology, about an opportunity for a Stanford team to form a multidisciplinary group to battle this disease. Colleagues in other disciplines also expressed interest, including Richard Lafayette, MD, a professor of nephrology; Sally Arai, MD, an associate professor of blood and marrow transplantation; and Gerald Berry, MD, a professor of pathology. That first group of physicians wanted to learn everything they could about the disease, and they were willing to work collaboratively to contribute to the body of knowledge. That meant patients who would be coming from great distances could see all their specialists in one coordinated visit.

RONALD WITTELES, MD

From a Modest Start, the Center Quickly Grew
“It turned out that there were many more of these patients than anyone realized, and there was no other center for the disease within a thousand miles of here. Also, by luck of timing, the formation of our center occurred just as new treatments for AL amyloidosis were poised to take off and newer treatments for TTR amyloidosis were being studied and ultimately would be successful and on their way to approval,” Witteles says.

Elucidating the Basic Mechanisms of the Disease
Then came the recruitment in 2017 of Ronglih Liao, PhD, a professor of medicine whose expertise is in the basic science of amyloidosis.

“She and a very talented trainee, Kevin Alexander, MD, a fellow in advanced heart failure and transplant cardiology, moved their lab from Brigham and Women’s Hospital in Boston to Stanford to continue doing remarkable work in elucidating many of the basic mechanisms of the disease,” says Witteles.

The lab has been at the forefront of investigating questions like how amyloid deposits injure organs and why amyloidogenic immunoglobulin light chain proteins are so much more toxic than transthyretin.

The devotion of the Stanford Amyloid Center physicians and staff as well as the leadership in the Department of Medicine were factors that attracted Liao to Stanford.

“I was impressed with the recognition of the critical importance of basic and translational research. There is an understanding of how that research contributes to the continued success in providing top-quality patient care,” Liao says. “We are optimistic that at this center our scientific discoveries can rapidly be translated back to the clinic and we can use our patients to accelerate the discovery process, with each part helping the other. This will set up a feed-forward system that we hope will allow us to develop new therapies in record time.”

Enriching the Reputation
Prior to Liao’s arrival, Stanford was known for being on the cutting edge of some clinical treatments like transplants and newer chemotherapy approaches. Now, the basic science expertise is enriching its reputation.

Today, with about 125 new amyloidosis patients per year, several hundred others receiving regular care, and many enrolled in various clinical trials, the Stanford Amyloid Center is one of the largest such centers in the world. Witteles and Liao lead the center along with Michaela Liedtke, MD, an associate professor of hematology. The staff includes 14 faculty from three departments and five divisions in the Department of Medicine, a dedicated clinical trials coordinator, and two full-time nurse coordinators.

In August 2018 the FDA approved the first drug ever for treating TTR amyloidosis, and two more drugs are expected to receive approval in the coming year. All three of these drugs and many more that are on the way, including AG-10, which was first identified at Stanford, represent classic bench-to-bedside development: An initial understanding of the mechanism of the disease led to treatment approaches based entirely on that understanding.

What that all means is a leading role for the Stanford Amyloid Center in promising bright futures for patients like Kevin Anderson.

From a Modest Start, the Center Quickly Grew
“It turned out that there were many more of these patients than anyone realized, and there was no other center for the disease within a thousand miles of here. Also, by luck of timing, the formation of our center occurred just as new treatments for AL amyloidosis were poised to take off and newer treatments for TTR amyloidosis were being studied and ultimately would be successful and on their way to approval,” Witteles says.

Elucidating the Basic Mechanisms of the Disease
Then came the recruitment in 2017 of Ronglih Liao, PhD, a professor of medicine whose expertise is in the basic science of amyloidosis.

“She and a very talented trainee, Kevin Alexander, MD, a fellow in advanced heart failure and transplant cardiology, moved their lab from Brigham and Women’s Hospital in Boston to Stanford to continue doing remarkable work in elucidating many of the basic mechanisms of the disease,” says Witteles.

The lab has been at the forefront of investigating questions like how amyloid deposits injure organs and why amyloidogenic immunoglobulin light chain proteins are so much more toxic than transthyretin.

The devotion of the Stanford Amyloid Center physicians and staff as well as the leadership in the Department of Medicine were factors that attracted Liao to Stanford.

“I was impressed with the recognition of the critical importance of basic and translational research. There is an understanding of how that research contributes to the continued success in providing top-quality patient care,” Liao says. “We are optimistic that at this center our scientific discoveries can rapidly be translated back to the clinic and we can use our patients to accelerate the discovery process, with each part helping the other. This will set up a feed-forward system that we hope will allow us to develop new therapies in record time.”

Enriching the Reputation
Prior to Liao’s arrival, Stanford was known for being on the cutting edge of some clinical treatments like transplants and newer chemotherapy approaches. Now, the basic science expertise is enriching its reputation.

Today, with about 125 new amyloidosis patients per year, several hundred others receiving regular care, and many enrolled in various clinical trials, the Stanford Amyloid Center is one of the largest such centers in the world. Witteles and Liao lead the center along with Michaela Liedtke, MD, an associate professor of hematology. The staff includes 14 faculty from three departments and five divisions in the Department of Medicine, a dedicated clinical trials coordinator, and two full-time nurse coordinators.

In August 2018 the FDA approved the first drug ever for treating TTR amyloidosis, and two more drugs are expected to receive approval in the coming year. All three of these drugs and many more that are on the way, including AG-10, which was first identified at Stanford, represent classic bench-to-bedside development: An initial understanding of the mechanism of the disease led to treatment approaches based entirely on that understanding.

What that all means is a leading role for the Stanford Amyloid Center in promising bright futures for patients like Kevin Anderson.

Revitalizing Veteran Care

A Breakthrough Drug Facilitates Safer Bone Marrow Transplants

by | Feb 26, 2024 | 2019, caring for our patients 2019

Baldeep Singh, MD, with staff at Samaritan House

DAVID MIKLOS, MD, PHD

A Breakthrough Drug Facilitates Safer Bone Marrow Transplants

DAVID MIKLOS, MD, PHD

A Breakthrough Drug Facilitates Safer Bone Marrow Transplants

Within the walls of the Center for Clinical Sciences Research, scientists are hard at work developing life-saving treatments for patients with blood and bone marrow cancers.

Since 1987, Stanford has performed more than 7,000 adult bone marrow transplants, long considered the gold standard for treating people with these cancers. However, a potentially serious complication of bone marrow transplantation is graft versus host disease (GVHD).

GVHD is caused when immune cells from a donor start attacking the normal tissues of a recipient. This can lead to painful, debilitating problems in organs from the skin and mouth to the liver and lungs, including itchy rashes, nausea and vomiting, muscle weakness, and breathing difficulty.

For those needing a bone marrow transplant, the ideal option is to find a donor within the patient’s family, but the odds for a match of antigens between family members are at best only one in four. The next best option is a transplant of cells from an unrelated donor, known as a hematopoietic cell transplant. However, the risk for GVHD increases with unrelated donors.

Corticosteroids were the conventional treatment for GVHD, but the long-term use of steroids has many side effects, and GVHD frequently re-emerges when steroids are stopped.

Researchers had been working for years to find a more reliable treatment than steroids, and they found it in ibrutinib, the first drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of GVHD.

A team led by David Miklos, MD, PhD, associate professor of blood and marrow transplantation, contributed greatly to the development of ibrutinib.

“We’d been looking for a long time for targeted effective therapies to get patients with chronic GVHD off steroids. But other drugs, even those that showed early promise, all ended up failing to show benefit in randomized clinical trials,” Miklos says.

Miklos discovered that B lymphocytes — one type of immune cell — are critical to the development of chronic GVHD. Blocking B cell activity, he hypothesized, could prevent or treat the disease. Ibrutinib — a drug first developed to treat B cell cancers and already approved for multiple cancer types — was able to potently deplete B cells from a hematopoietic cell transplant donor.

Within the walls of the Center for Clinical Sciences Research, scientists are hard at work developing life-saving treatments for patients with blood and bone marrow cancers.

Since 1987, Stanford has performed more than 7,000 adult bone marrow transplants, long considered the gold standard for treating people with these cancers. However, a potentially serious complication of bone marrow transplantation is graft versus host disease (GVHD).

GVHD is caused when immune cells from a donor start attacking the normal tissues of a recipient. This can lead to painful, debilitating problems in organs from the skin and mouth to the liver and lungs, including itchy rashes, nausea and vomiting, muscle weakness, and breathing difficulty.

For those needing a bone marrow transplant, the ideal option is to find a donor within the patient’s family, but the odds for a match of antigens between family members are at best only one in four. The next best option is a transplant of cells from an unrelated donor, known as a hematopoietic cell transplant. However, the risk for GVHD increases with unrelated donors.

Corticosteroids were the conventional treatment for GVHD, but the long-term use of steroids has many side effects, and GVHD frequently re-emerges when steroids are stopped.

Researchers had been working for years to find a more reliable treatment than steroids, and they found it in ibrutinib, the first drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of GVHD.

A team led by David Miklos, MD, PhD, associate professor of blood and marrow transplantation, contributed greatly to the development of ibrutinib.

“We’d been looking for a long time for targeted effective therapies to get patients with chronic GVHD off steroids. But other drugs, even those that showed early promise, all ended up failing to show benefit in randomized clinical trials,” Miklos says.

Miklos discovered that B lymphocytes — one type of immune cell — are critical to the development of chronic GVHD. Blocking B cell activity, he hypothesized, could prevent or treat the disease. Ibrutinib — a drug first developed to treat B cell cancers and already approved for multiple cancer types — was able to potently deplete B cells from a hematopoietic cell transplant donor. Miklos approached Pharmacyclics, the Sunnyvale-based company that makes ibrutinib, about launching a clinical trial of the drug for GVHD; the company agreed.

We’d been looking for a long time for therapies to get patients with chronic GVHD off steroids

Miklos and his colleagues presented favorable results of that trial at an annual meeting of the American Society of Hematology. On the heels of that research, the FDA fast-tracked its approval process, and in August 2017 the FDA approved ibrutinib for the treatment of patients with chronic GVHD who have failed at least one systemic treatment.

More recent insights come from senior scientist Bita Sahaf, PhD, who has worked in the Miklos lab since 2007. Sahaf presented the mechanism for ibrutinibchronic GVHD during a top abstracts session at the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation in early 2018.

“Our research is focused on B and T cells, two important components of the immune system. The overall research goal is the characterization of adaptive B and T cell immune responses that cure cancer while avoiding GVHD,” Miklos explains.

Now, Miklos and his colleagues are working on a randomized placebo-controlled trial of 185 patients to see if ibrutinib is effective in patients with earlier stages of GVHD. They expect to have results by the end of 2019.

“Perhaps most exciting, the Stanford Bone Marrow Transplant program has initiated its own clinical trial to see if ibrutinib immediately following transplant can prevent chronic GVHD from developing months later,” Miklos says.

We’d been looking for a long time for therapies to get patients with chronic GVHD off steroids

Miklos approached Pharmacyclics, the Sunnyvale-based company that makes ibrutinib, about launching a clinical trial of the drug for GVHD; the company agreed.

Miklos and his colleagues presented favorable results of that trial at an annual meeting of the American Society of Hematology. On the heels of that research, the FDA fast-tracked its approval process, and in August 2017 the FDA approved ibrutinib for the treatment of patients with chronic GVHD who have failed at least one systemic treatment.

More recent insights come from senior scientist Bita Sahaf, PhD, who has worked in the Miklos lab since 2007. Sahaf presented the mechanism for ibrutinibchronic GVHD during a top abstracts session at the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation in early 2018.

“Our research is focused on B and T cells, two important components of the immune system. The overall research goal is the characterization of adaptive B and T cell immune responses that cure cancer while avoiding GVHD,” Miklos explains.

Now, Miklos and his colleagues are working on a randomized placebo-controlled trial of 185 patients to see if ibrutinib is effective in patients with earlier stages of GVHD. They expect to have results by the end of 2019.

“Perhaps most exciting, the Stanford Bone Marrow Transplant program has initiated its own clinical trial to see if ibrutinib immediately following transplant can prevent chronic GVHD from developing months later,” Miklos says.

Integrating Medicine with Basic Science

by | Feb 26, 2024 | 2019, caring for each other 2019

Baldeep Singh, MD, with staff at Samaritan House

JUSTIN ANNES, MD, PHD

Integrating Medicine with Basic Science

JUSTIN ANNES, MD, PHD

Integrating Medicine with Basic Science

Justin Annes, MD, PhD, assistant professor of endocrinology, gerontology and metabolism, and ChEM-H faculty fellow, feels that he owes a great deal of credit for his unique research program to the ChEM-H Institute, which stands for Chemistry, Engineering & Medicine for Human Health. “What they do,” he says, “is take a physician scientist like me and enable me to bring chemistry into the laboratory in a really significant way.” Envisioned by Chaitan Khosla, PhD, professor of chemistry, ChEM-H is co-directed with Carolyn Bertozzi, PhD, professor of chemistry, “both outstanding scientists and wonderful leaders,” Annes says.

He continues: “ChEM-H has allowed me to unleash chemistry in an informed and supported way. One important person for me has been Mark Smith, PhD, director of the ChEM-H Medicinal Chemistry Knowledge Center, who is an engaged partner in our drug-development programs. Another is Justin Du Bois, PhD, associate professor of chemistry, who has generously provided the chemists in my group an environment and culture of chemistry. We recently developed a first-generation ‘smart drug’ that applies the principles of chemistry to selectively target a regenerative medicine to insulin-producing β-cells. We hope someday this medicine will be used to reverse diabetes.”

Annes has also developed an interdisciplinary research effort that integrates engineering, chemistry, and biology. “My collaboration with Amin Arbabian, PhD, an electrical engineer, and Richard Zare, PhD, a chemist, aims to develop a new nanoparticle-based drug-delivery microdevice to reverse life-threatening hypoglycemia in diabetic patients. This is a uniquely Stanford project as it reaches across scientific disciplines that normally don’t interact. My role as leader of the Stanford Diabetes Research Center enrichment program, which fosters cross-disciplinary work, was instrumental in developing this collaboration.”

Justin Annes, MD, PhD, assistant professor of endocrinology, gerontology and metabolism, and ChEM-H faculty fellow, feels that he owes a great deal of credit for his unique research program to the ChEM-H Institute, which stands for Chemistry, Engineering & Medicine for Human Health. “What they do,” he says, “is take a physician scientist like me and enable me to bring chemistry into the laboratory in a really significant way.” Envisioned by Chaitan Khosla, PhD, professor of chemistry, ChEM-H is co-directed with Carolyn Bertozzi, PhD, professor of chemistry, “both outstanding scientists and wonderful leaders,” Annes says.

He continues: “ChEM-H has allowed me to unleash chemistry in an informed and supported way. One important person for me has been Mark Smith, PhD, director of the ChEM-H Medicinal Chemistry Knowledge Center, who is an engaged partner in our drug-development programs. Another is Justin Du Bois, PhD, associate professor of chemistry, who has generously provided the chemists in my group an environment and culture of chemistry. We recently developed a first-generation ‘smart drug’ that applies the principles of chemistry to selectively target a regenerative medicine to insulin-producing β-cells. We hope someday this medicine will be used to reverse diabetes.”

Annes has also developed an interdisciplinary research effort that integrates engineering, chemistry, and biology. “My collaboration with Amin Arbabian, PhD, an electrical engineer, and Richard Zare, PhD, a chemist, aims to develop a new nanoparticle-based drug-delivery microdevice to reverse life-threatening hypoglycemia in diabetic patients. This is a uniquely Stanford project as it reaches across scientific disciplines that normally don’t interact. My role as leader of the Stanford Diabetes Research Center enrichment program, which fosters cross-disciplinary work, was instrumental in developing this collaboration.”

This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.

Annes’ research and clinical interests, which are in diabetes and hereditary endocrine disorders, have led him to work with patients who have two neuroendocrine tumor-related conditions, pheochromocytoma and paragangliomas. While at Brigham & Women’s Hospital, says Annes, “I became the pheochromocytoma and paraganglioma guy, and when I came to Stanford I continued to see these patients, extending my practice to neuroendocrine tumors in general. I got to know Pamela Kunz, MD, assistant professor of oncology, a leader in neuroendocrine tumors on the oncology side. Over the years we’ve brought our clinics together, and now we have an endocrine cancer clinical program.”

When not seeing patients, Annes can be found in his lab where, he says, “our driving principle is to harness the power of chemistry to deliver new insights into biologic function and to develop a regenerative therapeutic for diabetes and improved chemotherapeutics for our neuroendocrine tumor patients.”

His lab spans the spectrum of preclinical drug development. His biologists, chemists, and biochemists work with animal models to understand pathophysiology and identify the molecular basis of disease, in-vitro systems to identify lead compounds for therapeutic targets, and test tubes where they build drugs from individual components. And then they take those drugs back into cell systems and animal models to demonstrate their activities.

Asked to describe a good day, Annes returns to the lab: “One of my favorite days is when I go into the lab, and a couple of my graduate students are trying to stay calm despite being exuberant about a new experimental result. I get to sit down and see what the science is, what they’ve discovered, how fulfilled, motivated, and off-the-wall happy they are by the new discovery.”

“This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.”

This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.

Annes’ research and clinical interests, which are in diabetes and hereditary endocrine disorders, have led him to work with patients who have two neuroendocrine tumor-related conditions, pheochromocytoma and paragangliomas. While at Brigham & Women’s Hospital, says Annes, “I became the pheochromocytoma and paraganglioma guy, and when I came to Stanford I continued to see these patients, extending my practice to neuroendocrine tumors in general. I got to know Pamela Kunz, MD, assistant professor of oncology, a leader in neuroendocrine tumors on the oncology side. Over the years we’ve brought our clinics together, and now we have an endocrine cancer clinical program.”

When not seeing patients, Annes can be found in his lab where, he says, “our driving principle is to harness the power of chemistry to deliver new insights into biologic function and to develop a regenerative therapeutic for diabetes and improved chemotherapeutics for our neuroendocrine tumor patients.”

His lab spans the spectrum of preclinical drug development. His biologists, chemists, and biochemists work with animal models to understand pathophysiology and identify the molecular basis of disease, in-vitro systems to identify lead compounds for therapeutic targets, and test tubes where they build drugs from individual components. And then they take those drugs back into cell systems and animal models to demonstrate their activities.

Asked to describe a good day, Annes returns to the lab: “One of my favorite days is when I go into the lab, and a couple of my graduate students are trying to stay calm despite being exuberant about a new experimental result. I get to sit down and see what the science is, what they’ve discovered, how fulfilled, motivated, and off-the-wall happy they are by the new discovery.”

“This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.”

Tamara Dunn in Focus

by | Feb 26, 2024 | 2019, caring for each other 2019

Baldeep Singh, MD, with staff at Samaritan House

TAMARA DUNN, MD

Tamara Dunn in Focus

TAMARA DUNN, MD

Tamara Dunn in Focus

A steady hum of energy and activity seems to constantly surround Tamara Dunn, MD, clinical assistant professor of hematology. Perhaps it’s the time of day — it’s early evening, a notoriously hectic time, and she’s toggling between the end of her work day, her children’s after-school commitments, patients’ schedules, and her dog’s veterinary appointment. But, after an hour of conversation, it becomes clear that this is a more permanent state — a reflection of the passion and attention she brings to each sphere of her busy life.

Dunn was one of those kids who “always knew” she wanted to be a physician. She was raised in Kansas City and her father’s job as a dentist gave her an insider’s glimpse into the medical field.

“My dad had a lot of friends who were physicians. In fact, his best friend was my pediatrician,” she explains. “I was very fortunate to be surrounded by this group of black professionals who inspired me. It was completely the norm. ” The early exposure planted the seeds for what would become one of her causes: building — and fostering — inclusive communities in medicine.

After a post-college break spent living in France and New York, performing “off-off-Broadway,” singing – and recording a demo – with a band, and toying with a career as a financial trader, Dunn found her way back to her childhood love — medicine.

She received her MD from SUNY Downstate Medical Center and came to Stanford for her residency, where she’s remained ever since, treating patients at Veterans Affairs, working alongside residents and fellows on the diversity council, and playing a role in the establishment of the Adolescent and Young Adult Cancer Program. In the process, she’s emerged as a champion for diversity and inclusion — at Stanford, at the American Society of Hematology, and beyond. Dunn shared more about performing, medicine, and her diversity work in a recent interview.

How did you first become interested in medicine?
I always wanted to be a physician, but I took a very unconventional path. When I arrived at Stanford as an undergraduate I was taking all the  premed courses — I began as a human biology major — but I changed my major after my sophomore year to French.

I had already performed quite a bit in high school, but I really cultivated my abilities during this time. I was in an a cappella group that performed world music focusing on the African-American diaspora, I was involved in Stanford’s theatrical society and was performing in shows every year, and I was in a funk band that performed at campus parties. My mother died when I was 15, and I realized how quickly life could change. Since then I’ve had a “carpe diem” attitude and have never taken anything for granted — I believe in following your passion and that anything is possible.

After graduation, I went to performing arts school at the American Musical and Dramatic Academy in New York City, and did some more theater work — performing off-off-Broadway and auditioning. Then, I took a 180 degree turn into finance. I got licensed and was working on the trading floor on the sales side. I was offered a position in the trader training program but had already enrolled in the post-bac pre-med program at Hunter College.

A steady hum of energy and activity seems to constantly surround Tamara Dunn, MD, clinical assistant professor of hematology. Perhaps it’s the time of day — it’s early evening, a notoriously hectic time, and she’s toggling between the end of her work day, her children’s after-school commitments, patients’ schedules, and her dog’s veterinary appointment. But, after an hour of conversation, it becomes clear that this is a more permanent state — a reflection of the passion and attention she brings to each sphere of her busy life.

Dunn was one of those kids who “always knew” she wanted to be a physician. She was raised in Kansas City and her father’s job as a dentist gave her an insider’s glimpse into the medical field.

“My dad had a lot of friends who were physicians. In fact, his best friend was my pediatrician,” she explains. “I was very fortunate to be surrounded by this group of black professionals who inspired me. It was completely the norm. ” The early exposure planted the seeds for what would become one of her causes: building — and fostering — inclusive communities in medicine.

After a post-college break spent living in France and New York, performing “off-off-Broadway,” singing – and recording a demo – with a band, and toying with a career as a financial trader, Dunn found her way back to her childhood love — medicine.

She received her MD from SUNY Downstate Medical Center and came to Stanford for her residency, where she’s remained ever since, treating patients at Veterans Affairs, working alongside residents and fellows on the diversity council, and playing a role in the establishment of the Adolescent and Young Adult Cancer Program. In the process, she’s emerged as a champion for diversity and inclusion — at Stanford, at the American Society of Hematology, and beyond. Dunn shared more about performing, medicine, and her diversity work in a recent interview.

How did you first become interested in medicine?
I always wanted to be a physician, but I took a very unconventional path. When I arrived at Stanford as an undergraduate I was taking all the  premed courses — I began as a human biology major — but I changed my major after my sophomore year to French. I had already performed quite a bit in high school, but I really cultivated my abilities during this time. I was in an a cappella group that performed world music focusing on the African-American diaspora, I was involved in Stanford’s theatrical society and was performing in shows every year, and I was in a funk band that performed at campus parties. My mother died when I was 15, and I realized how quickly life could change. Since then I’ve had a “carpe diem” attitude and have never taken anything for granted — I believe in following your passion and that anything is possible.

After graduation, I went to performing arts school at the American Musical and Dramatic Academy in New York City, and did some more theater work — performing off-off-Broadway and auditioning. Then, I took a 180 degree turn into finance. I got licensed and was working on the trading floor on the sales side. I was offered a position in the trader training program but had already enrolled in the post-bac pre-med program at Hunter College.

What drew you to hematology, your current specialty?
It was always an interest of mine. I was just excited to look at blood smears — I thought the cells looked so beautiful on the slide. And all the diseases intrigued me, especially leukemia. I fell in love with how intense the field was and how deep of a relationship you form with your patients and their families. So, I went right into a hematology sub-specialty training program at Stanford, and I loved it.

What does an average work day look like for you?  
One thing I love about my job is that every day is unique. Some days I’m focused on my clinic patients, some days I’m performing inpatient consults at the VA or Stanford Hospital, some days are fellowship heavy. I also work on research for our Adolescent and Young Adult (AYA) Cancer Program. I recently did a study where we gave all the AYA patients receiving therapy Fitbits and an iPad to encourage physical activity because we believe it can improve cancer-related fatigue and quality of life. We also gave our patients a quality of life assessment tool, and using the technology did in fact improve their score.

Does your artistic background ever come into play when you’re practicing medicine?
Not quite yet, although I’m hoping when things calm down and life is a bit less crazy I’ll be able to perform more. Music is so powerful, especially for patients. I will tell you this: I always sing to every patient in my clinic when it’s their birthday – they get a big happy birthday song from me, and many have come to expect it. I was also able to sing at the Survivor’s Day celebration at the VA. That was really special. When I was a resident and fellow I used to sing on the units.

You’ve become a voice for diversity and inclusion – which is a pressing issue in all of higher education – in the Department of Medicine. How are you bringing communities together?
I’ve been working alongside Wendy Caceres, MD, clinical assistant professor of primary care and population health, for the past couple of years as a faculty advisor on the diversity council, which is composed mostly of residents and fellows. Having a community is one thing — we know we should improve our diversity — but I think making the people who are currently here feel comfortable is where the inclusion piece comes in. Once the community is formed and people are feeling acclimated, strong, and important, that’s when you start to attract more underrepresented minorities.

I’ve hosted informal get-togethers at my home where we share dinner and discussion, and that is a valuable space. We have a few initiatives in the pipeline: We’re trying to incorporate diversity into the weekly medicine grand rounds by encouraging a more diverse speaker roster. We also have taken a larger role in the recruitment process. We’re doing more distance travel meetings and making sure that we’re bringing diverse faculty to the table. I am also a member of the Graduate Medical Education’s Diversity and Inclusion Committee where we are trying to promote diversity on a broader level.

You were recently named an American Society of Hematology (ASH) ambassador. What will this new job entail?
The ASH ambassador program is in its inaugural year, and Stanford was chosen to be one of 16 participating institutions. The ambassadors serve as liaisons between the society and trainees. The goal of the program is to recruit and retain diverse trainees into hematology.

Underrepresented minorities are even more underrepresented in subspecialties like hematology, and representation decreases from med school, to residency, to fellowship, to faculty positions. So, ASH has established a minority recruitment initiative, and the ambassador program is a function of this. One of our primary goals is getting the word out about the awards ASH has to offer — for example, their minority medical student awards programs. These awards not only provide funding for students, but more importantly, they provide mentorship.

What do you consider to be some of the biggest challenges and the biggest successes in your diversity work?
It’s often hard to talk about diversity-related issues, because we know we have a lot of work to do. We all have biases, which are a natural thing, but defensiveness does not allow us to make progress. Research shows that we are all better when our environments and communities are more diverse — we’re better doctors, better people, and better researchers.

I’m proud to be an underrepresented minority in a leadership position,  because I know that impacts people who are applying. This year the hematology division has more female fellows than male fellows, and it’s wonderful to see young women achieving so much. The men are outstanding as well; it’s just that since I can remember the men have outnumbered the women disproportionately. It’s been an honor to work alongside Wendy Caceres, who has worked tirelessly to build a more diverse and inclusive community. I’m also heartened that diversity and inclusion have come to the forefront of discussion at Stanford, and that Stanford is showing that these issues are important.

What drew you to hematology, your current specialty?
It was always an interest of mine. I was just excited to look at blood smears — I thought the cells looked so beautiful on the slide. And all the diseases intrigued me, especially leukemia. I fell in love with how intense the field was and how deep of a relationship you form with your patients and their families. So, I went right into a hematology sub-specialty training program at Stanford, and I loved it.

What does an average work day look like for you?  
One thing I love about my job is that every day is unique. Some days I’m focused on my clinic patients, some days I’m performing inpatient consults at the VA or Stanford Hospital, some days are fellowship heavy. I also work on research for our Adolescent and Young Adult (AYA) Cancer Program. I recently did a study where we gave all the AYA patients receiving therapy Fitbits and an iPad to encourage physical activity because we believe it can improve cancer-related fatigue and quality of life. We also gave our patients a quality of life assessment tool, and using the technology did in fact improve their score.

Does your artistic background ever come into play when you’re practicing medicine?
Not quite yet, although I’m hoping when things calm down and life is a bit less crazy I’ll be able to perform more. Music is so powerful, especially for patients. I will tell you this: I always sing to every patient in my clinic when it’s their birthday – they get a big happy birthday song from me, and many have come to expect it. I was also able to sing at the Survivor’s Day celebration at the VA. That was really special. When I was a resident and fellow I used to sing on the units.

You’ve become a voice for diversity and inclusion – which is a pressing issue in all of higher education – in the Department of Medicine. How are you bringing communities together?
I’ve been working alongside Wendy Caceres, MD, clinical assistant professor of primary care and population health, for the past couple of years as a faculty advisor on the diversity council, which is composed mostly of residents and fellows. Having a community is one thing — we know we should improve our diversity — but I think making the people who are currently here feel comfortable is where the inclusion piece comes in. Once the community is formed and people are feeling acclimated, strong, and important, that’s when you start to attract more underrepresented minorities.

I’ve hosted informal get-togethers at my home where we share dinner and discussion, and that is a valuable space. We have a few initiatives in the pipeline: We’re trying to incorporate diversity into the weekly medicine grand rounds by encouraging a more diverse speaker roster. We also have taken a larger role in the recruitment process. We’re doing more distance travel meetings and making sure that we’re bringing diverse faculty to the table. I am also a member of the Graduate Medical Education’s Diversity and Inclusion Committee where we are trying to promote diversity on a broader level.

You were recently named an American Society of Hematology (ASH) ambassador. What will this new job entail?
The ASH ambassador program is in its inaugural year, and Stanford was chosen to be one of 16 participating institutions. The ambassadors serve as liaisons between the society and trainees. The goal of the program is to recruit and retain diverse trainees into hematology.

Underrepresented minorities are even more underrepresented in subspecialties like hematology, and representation decreases from med school, to residency, to fellowship, to faculty positions. So, ASH has established a minority recruitment initiative, and the ambassador program is a function of this. One of our primary goals is getting the word out about the awards ASH has to offer — for example, their minority medical student awards programs. These awards not only provide funding for students, but more importantly, they provide mentorship.

What do you consider to be some of the biggest challenges and the biggest successes in your diversity work?
It’s often hard to talk about diversity-related issues, because we know we have a lot of work to do. We all have biases, which are a natural thing, but defensiveness does not allow us to make progress. Research shows that we are all better when our environments and communities are more diverse — we’re better doctors, better people, and better researchers.

I’m proud to be an underrepresented minority in a leadership position,  because I know that impacts people who are applying. This year the hematology division has more female fellows than male fellows, and it’s wonderful to see young women achieving so much. The men are outstanding as well; it’s just that since I can remember the men have outnumbered the women disproportionately. It’s been an honor to work alongside Wendy Caceres, who has worked tirelessly to build a more diverse and inclusive community. I’m also heartened that diversity and inclusion have come to the forefront of discussion at Stanford, and that Stanford is showing that these issues are important.

Residency Training with a Side of Wellness

by | Feb 26, 2024 | 2019, caring for each other 2019

Baldeep Singh, MD, with staff at Samaritan House

ANGELA ROGERS, MD: LEE BROCKUS, MD and his wife; ROBERT HARRINGTON, MD; SHRIRAM NALLAMSHETTY, MD; KAI SWENSON, MD

Residency Training with a Side of Wellness

ANGELA ROGERS, MD: LEE BROCKUS, MD and his wife; ROBERT HARRINGTON, MD; SHRIRAM NALLAMSHETTY, MD; KAI SWENSON, MD

Residency Training with a Side of Wellness

It’s a crisp, bright Sunday morning in Palo Alto, and over a dozen residents have congregated at the entrance to the Dish, a satellite structure reached by a popular 3.9-mile hiking trail that winds through the foothills behind Stanford’s campus. They’re joined by Bob Harrington, MD, the Arthur L. Bloomfield Professor of Medicine; Angela Rogers, MD, assistant professor of pulmonary and critical care medicine; Shriram Nallamshetty, MD, clinical assistant professor of cardiology; and several staff members from the Internal Medicine Residency Program.

This group has gathered for the pleasure of exercising and socializing, of course, but also to recognize the importance of well-being.

Over the last year, events like this one have happened with increasing frequency. They’re part of a new initiative called REACH (Resiliency, Education, Advocacy, Community, Health), which is committed, broadly, to resident wellness.

It’s no secret that medical residency training is intense, and the structure — long hours, compromised sleep, packed schedules — leaves little time for self-care. REACH, Karina Delgado-Carrasco, the residency program manager, says, is designed to help mitigate these stressors.

The program began as many in academia do: with a review of current research on the topic. “We read lots of publications on residency wellness and identified several domains that we wanted to cover,” Delgado-Carrasco details. 

These findings were shared and discussed with the Internal Medicine Residency Wellness Committee — composed primarily of current residents — and “everyone we identified as important to resident well-being.” The result? A multifaceted approach to wellness and burnout built on five pillars that Delgado-Carrasco believes “touch different aspects of residents’ lives.”

Fostering RESILIENCY with Laughter
Resiliency — the ability to recover, and learn from, stressful circumstances and adversity — is a prized characteristic in the medical field, and one that’s difficult to cultivate during stressful residency years. REACH is taking steps to change that through a monthly lecture series entitled “Residency Resilience” and other initiatives.

“Building resiliency skills can help prevent burnout and also promote a consistent feeling of wellness,” notes Neera Ahuja, MD, clinical professor of hospital medicine and associate residency program director. “A large part of resilience is being able to see life through a positive lens: being optimistic about the future and believing that one can overcome any obstacle and learn from the process.”

A key component to fostering this mindset, Ahuja explains, is to “seek and savor positive moments throughout one’s day.” To that end, the REACH program strives to “creatively sprinkle” exciting team-building activities throughout a resident’s work day. These moments create an opportunity for house staff to “laugh and bond together — even for only 15 minutes before returning to the wards — which can have a lasting, positive impact.”

ROBERT HARRINGTON, MD (far left) and ANGELA ROGERS, MD (far right) hike alongside residents.

It’s a crisp, bright Sunday morning in Palo Alto, and over a dozen residents have congregated at the entrance to the Dish, a satellite structure reached by a popular 3.9-mile hiking trail that winds through the foothills behind Stanford’s campus. They’re joined by Bob Harrington, MD, the Arthur L. Bloomfield Professor of Medicine; Angela Rogers, MD, assistant professor of pulmonary and critical care medicine; Shriram Nallamshetty, MD, clinical assistant professor of cardiology; and several staff members from the Internal Medicine Residency Program.

This group has gathered for the pleasure of exercising and socializing, of course, but also to recognize the importance of well-being.

Over the last year, events like this one have happened with increasing frequency. They’re part of a new initiative called REACH (Resiliency, Education, Advocacy, Community, Health), which is committed, broadly, to resident wellness.

It’s no secret that medical residency training is intense, and the structure — long hours, compromised sleep, packed schedules — leaves little time for self-care. REACH, Karina Delgado-Carrasco, the residency program manager, says, is designed to help mitigate these stressors.

The program began as many in academia do: with a review of current research on the topic. “We read lots of publications on residency wellness and identified several domains that we wanted to cover,” Delgado-Carrasco details. These findings were shared and discussed with the Internal Medicine Residency Wellness Committee — composed primarily of current residents — and “everyone we identified as important to resident well-being.” The result? A multifaceted approach to wellness and burnout built on five pillars that Delgado-Carrasco believes “touch different aspects of residents’ lives.”

Fostering RESILIENCY with Laughter
Resiliency — the ability to recover, and learn from, stressful circumstances and adversity — is a prized characteristic in the medical field, and one that’s difficult to cultivate during stressful residency years. REACH is taking steps to change that through a monthly lecture series entitled “Residency Resilience” and other initiatives.

“Building resiliency skills can help prevent burnout and also promote a consistent feeling of wellness,” notes Neera Ahuja, MD, clinical professor of hospital medicine and associate residency program director. “A large part of resilience is being able to see life through a positive lens: being optimistic about the future and believing that one can overcome any obstacle and learn from the process.”

A key component to fostering this mindset, Ahuja explains, is to “seek and savor positive moments throughout one’s day.” To that end, the REACH program strives to “creatively sprinkle” exciting team-building activities throughout a resident’s work day. These moments create an opportunity for house staff to “laugh and bond together — even for only 15 minutes before returning to the wards — which can have a lasting, positive impact.”

Prioritizing EDUCATION through Mentorship
Faculty mentorship is seen as a way to supplement residents’ education and propel them into successful professional and academic careers. Mentors meet with mentees throughout a resident’s career, collaborating on research and providing career guidance. Other events, like the first-ever Residency Research Symposium, provide a forum for trainees to share their work with the broader Stanford community.

ROBERT HARRINGTON, MD (far left) and ANGELA ROGERS, MD (far right) hike alongside residents.

Supporting ADVOCACY by Providing a Seat at the Table
Through internal REACH advocacy committees, such as the Committee on Residency Reform and the Diversity Group, residents are provided avenues to effect change and make their voices heard.

“The committee is composed of elected resident class representatives, chief residents, and program directors and administration,” says Ron Witteles, MD, associate professor of cardiology and the residency program director. “It allows for a true ‘ground-up’ approach to program reform and is designed to turn feedback quickly into action. Residents work really hard; it’s important for them to know they have an outlet to effect change.”

Additional opportunities for advocacy abound and extend beyond the Stanford campus: A new diversity lecture series trains residents to better care for diverse patients, and tracks like Homeless Outreach and Social Medicine prime residents to care for the broader Bay Area community.

Building COMMUNITY over Quality Coffee
On September 28, 2018, as bleary-eyed residents filed into Stanford’s Grant building for their morning report, they were met with a small surprise: artisanal coffee that had been brought in for them to celebrate National Coffee Day. Another morning, they received boba tea. At a scheduled lunch, unknowing residents were paired to complete an Amazing Race–style scavenger hunt all over campus.

These events, known informally as “pop-ups,” are an important tenet of REACH and have a marked positive impact on residents. Delgado-Carrasco explains the thought process behind these small gestures: “It’s about surprising residents to show that we appreciate them, to let them know that we know how hard they’re working.”

Other, larger events — like free tickets to Stanford’s homecoming football game — are specifically designed to connect residents with each other and the community around them, to carve out space for them to build rapport.

“These events bring people together so they can meet and support each other,” Delgado-Carrasco says. “That’s how we build community.”

The group stops for a photo in fron to fthe dish satellite structure

Prioritizing EDUCATION through Mentorship
Faculty mentorship is seen as a way to supplement residents’ education and propel them into successful professional and academic careers. Mentors meet with mentees throughout a resident’s career, collaborating on research and providing career guidance. Other events, like the first-ever Residency Research Symposium, provide a forum for trainees to share their work with the broader Stanford community.

Supporting ADVOCACY by Providing a Seat at the Table
Through internal REACH advocacy committees, such as the Committee on Residency Reform and the Diversity Group, residents are provided avenues to effect change and make their voices heard.

“The committee is composed of elected resident class representatives, chief residents, and program directors and administration,” says Ron Witteles, MD, associate professor of cardiology and the residency program director. “It allows for a true ‘ground-up’ approach to program reform and is designed to turn feedback quickly into action. Residents work really hard; it’s important for them to know they have an outlet to effect change.”

Additional opportunities for advocacy abound and extend beyond the Stanford campus: A new diversity lecture series trains residents to better care for diverse patients, and tracks like Homeless Outreach and Social Medicine prime residents to care for the broader Bay Area community.

Caring for Residents’ HEALTH on — and off — the Yoga Mat
REACH provides myriad ways for residents to care for their physical — and mental — health. Yoga aficionados will have the opportunity to unroll their mats and take a private yoga class taught by Ahuja later this spring. And each year, residents can lace up their sneakers and hit the softball field with their families, interns, program directors, and faculty for annual softball days. “It’s fun to get everyone and their families out to that event,” Delgado-Carrasco says.

REACH prioritizes mental health by clearly communicating available resources and destigmatizing the process of asking for help. Delgado-Carrasco elaborates: “We let all the residents know what’s available to them through Stanford Hospital — like access to mental health programs and wellness coaches. We post these resources on a poster board every day. We want them to know that if you need to reach out to someone, there are people — and resources — available.”

At the end of the Dish hike, residents, faculty, and program administrators chat with each other before heading home to enjoy the rest of their respective weekends. Pictures from the event broadcast the group’s enthusiasm — everyone has wide grins and cheeks flushed from outdoor exercise. This happy image is one Delgado-Carrasco is committed to continuing as REACH looks into the future. “We’re committed to supporting our residents during their time here and promoting their wellness, and we want them to know that everyone is invested in their well-being.”

The group stops for a photo in fron to fthe dish satellite structure

Building COMMUNITY over Quality Coffee
On September 28, 2018, as bleary-eyed residents filed into Stanford’s Grant building for their morning report, they were met with a small surprise: artisanal coffee that had been brought in for them to celebrate National Coffee Day. Another morning, they received boba tea. At a scheduled lunch, unknowing residents were paired to complete an Amazing Race–style scavenger hunt all over campus.

These events, known informally as “pop-ups,” are an important tenet of REACH and have a marked positive impact on residents. Delgado-Carrasco explains the thought process behind these small gestures: “It’s about surprising residents to show that we appreciate them, to let them know that we know how hard they’re working.”

Other, larger events — like free tickets to Stanford’s homecoming football game — are specifically designed to connect residents with each other and the community around them, to carve out space for them to build rapport.

“These events bring people together so they can meet and support each other,” Delgado-Carrasco says. “That’s how we build community.”

Caring for Residents’ HEALTH on — and off — the Yoga Mat
REACH provides myriad ways for residents to care for their physical — and mental — health. Yoga aficionados will have the opportunity to unroll their mats and take a private yoga class taught by Ahuja later this spring. And each year, residents can lace up their sneakers and hit the softball field with their families, interns, program directors, and faculty for annual softball days. “It’s fun to get everyone and their families out to that event,” Delgado-Carrasco says.

REACH prioritizes mental health by clearly communicating available resources and destigmatizing the process of asking for help. Delgado-Carrasco elaborates: “We let all the residents know what’s available to them through Stanford Hospital — like access to mental health programs and wellness coaches. We post these resources on a poster board every day. We want them to know that if you need to reach out to someone, there are people — and resources — available.”

At the end of the Dish hike, residents, faculty, and program administrators chat with each other before heading home to enjoy the rest of their respective weekends. Pictures from the event broadcast the group’s enthusiasm — everyone has wide grins and cheeks flushed from outdoor exercise. This happy image is one Delgado-Carrasco is committed to continuing as REACH looks into the future. “We’re committed to supporting our residents during their time here and promoting their wellness, and we want them to know that everyone is invested in their well-being.”

New Cardiology Faculty

by | Feb 26, 2024 | 2019, caring for each other 2019

Baldeep Singh, MD, with staff at Samaritan House

NITISH BADHWAR, MD (left), in the electrophysiology lab.

New Cardiology Faculty

NITISH BADHWAR, MD (left), in the electrophysiology lab.

New Cardiology Faculty

The cardiovascular medicine division has added two new faculty members, both of whom have skills that complement and supplement those of the rest of the division. Both Nitish Badhwar, MD, and Fatima Rodriguez, MD, MPH, have hit the ground running and are greatly enjoying their challenges and accomplishments.

Nitish Badhwar is busily settling in as clinical professor of cardiovascular medicine. “I came to Stanford in part because of my expertise in ablating complex cardiac arrhythmias, particularly catheter ablations of ventricular tachycardia, and in part because of my interest in leading a fellowship program to develop future electrophysiologists. There is no shortage of patients with challenging arrhythmias, and the fellowship program will soon be expanding.”

One obvious reason for the growth in the arrhythmia population is the success cardiologists have had in treating other heart conditions. “In cardiology we have increased the lifespan of patients through drug therapy and preventive cardiology,” says Badhwar. “As patients who might have died in their sixties are now getting older, they are developing arrhythmias that affect their quality of life.”

Stanford has a large heart failure population and a very busy cardiac transplant center; the first U.S. adult heart transplant was completed at Stanford 50 years ago.

For those who cannot qualify for a heart transplant, there are other options, including left ventricular assist devices (LVADs), which help with the pumping function of a weakened heart, and bi-ventricular implantable cardioverter defibrillators (ICDs), which are internal devices that stop deadly arrhythmias by delivering a shock to the heart.

“Most patients with severe heart failure have ventricular tachycardia,” explains Badhwar, “and that leads to shocks from ICDs or makes LVADs less efficient. Ultimately, the ventricular tachycardia (VT) has to be treated, but medications are not that effective. We often end up taking the patient to the electrophysiology lab to eradicate the ventricular tachycardia by ablating it when possible.”

Another of Badhwar’s interests is idiopathic VT, where patients have normal heart function as opposed to heart failure. Badhwar has published the characteristics of idiopathic VT arising from the crux of the heart and, he says, “for this arrhythmia I am collaborating with my colleague, Marco Perez, MD, assistant professor, on a research project to identify the culprit genes.”

Badhwar has had a great deal of experience with atrial fibrillation (Afib), an increasingly common arrhythmia that puts patients at risk of stroke from blood clots that arise in the atrial appendage.

While at UC San Francisco, he helped develop and publish a new technique to control the rhythm of the heart in patients with persistent Afib. This technique uses a catheter-based approach through a vein in the leg to tie off the left atrial appendage. A multicenter clinical trial called the aMAZE trial is currently testing the technique. “The trial is very near and dear to my heart,” says Badhwar. “Stanford is recruiting patients now.”

Leading a Fellowship Program
The fellowship program for electrophysiology (EP) trainees plays a large role in Badhwar’s work. “Because I had enjoyed training EP fellows at UCSF, I wanted to develop the electrophysiology training program here. One of my passions is teaching fellows, and it’s been very satisfying for me since I’ve been here. At UCSF I worked with Dr. Melvin Scheinman, one of the pioneers in this field, and I was very proud to use unique training tools such as teaching anatomy using cadaveric hearts in collaboration with pathology. I’ve also started intracardiac conferences for EP fellows and a national cardiology EP fellows program.”

The EP training program is also likely to expand because, says Badhwar, “It is clear that we are going to be doing more complex and novel procedures. My focus will be to make Stanford a magnet for US and international fellows for world class electrophysiology training.”

The influences in Fatima Rodriguez’s life began early. A child of immigrants, she was raised by a single mother who developed a pivotal illness: “My mom had rheumatic heart disease discovered when I was 15. I wanted to be just like her cardiologist who had made a life-changing diagnosis with just the use of his stethoscope.” Additional influences came her way at Harvard Medical School, where she arrived wanting to “just be a good clinical doctor.”

“There I had wonderful mentors who opened my eyes to public health research as well as taking care of individual patients. I received a Zuckerman Public Policy Fellowship in the John F. Kennedy School of Government, where I got to work with people across such sectors as business and law with a common goal of improving parts of health care that are not related to the medical system.”

Today, Rodriguez is a new assistant professor in the cardiovascular division with a particular interest in health disparities and improving cardiovascular risk prediction for understudied populations. As a general and preventive cardiologist, she encounters her research subjects at every clinic and during each two-week period of inpatient care. “My clinical work always influences my research questions,” she says. And, with 75 percent of her time devoted to research, she is able to think broadly about, and often test, new approaches to improving the health outcomes of her patients.

FATIMA RODRIGUEZ, MD (center), rounding with residents ERIK ECKHERT, MD (left) and KYLE CATABAY, MD (right).

The cardiovascular medicine division has added two new faculty members, both of whom have skills that complement and supplement those of the rest of the division. Both Nitish Badhwar, MD, and Fatima Rodriguez, MD, MPH, have hit the ground running and are greatly enjoying their challenges and accomplishments.

Nitish Badhwar is busily settling in as clinical professor of cardiovascular medicine. “I came to Stanford in part because of my expertise in ablating complex cardiac arrhythmias, particularly catheter ablations of ventricular tachycardia, and in part because of my interest in leading a fellowship program to develop future electrophysiologists. There is no shortage of patients with challenging arrhythmias, and the fellowship program will soon be expanding.”

One obvious reason for the growth in the arrhythmia population is the success cardiologists have had in treating other heart conditions. “In cardiology we have increased the lifespan of patients through drug therapy and preventive cardiology,” says Badhwar. “As patients who might have died in their sixties are now getting older, they are developing arrhythmias that affect their quality of life.”

Stanford has a large heart failure population and a very busy cardiac transplant center; the first U.S. adult heart transplant was completed at Stanford 50 years ago. For those who cannot qualify for a heart transplant, there are other options, including left ventricular assist devices (LVADs), which help with the pumping function of a weakened heart, and bi-ventricular implantable cardioverter defibrillators (ICDs), which are internal devices that stop deadly arrhythmias by delivering a shock to the heart.

“Most patients with severe heart failure have ventricular tachycardia,” explains Badhwar, “and that leads to shocks from ICDs or makes LVADs less efficient. Ultimately, the ventricular tachycardia (VT) has to be treated, but medications are not that effective. We often end up taking the patient to the electrophysiology lab to eradicate the ventricular tachycardia by ablating it when possible.”

Another of Badhwar’s interests is idiopathic VT, where patients have normal heart function as opposed to heart failure. Badhwar has published the characteristics of idiopathic VT arising from the crux of the heart and, he says, “for this arrhythmia I am collaborating with my colleague, Marco Perez, MD, assistant professor, on a research project to identify the culprit genes.”

Badhwar has had a great deal of experience with atrial fibrillation (Afib), an increasingly common arrhythmia that puts patients at risk of stroke from blood clots that arise in the atrial appendage. While at UC San Francisco, he helped develop and publish a new technique to control the rhythm of the heart in patients with persistent Afib. This technique uses a catheter-based approach through a vein in the leg to tie off the left atrial appendage. A multicenter clinical trial called the aMAZE trial is currently testing the technique. “The trial is very near and dear to my heart,” says Badhwar. “Stanford is recruiting patients now.”

Leading a Fellowship Program
The fellowship program for electrophysiology (EP) trainees plays a large role in Badhwar’s work. “Because I had enjoyed training EP fellows at UCSF, I wanted to develop the electrophysiology training program here. One of my passions is teaching fellows, and it’s been very satisfying for me since I’ve been here. At UCSF I worked with Dr. Melvin Scheinman, one of the pioneers in this field, and I was very proud to use unique training tools such as teaching anatomy using cadaveric hearts in collaboration with pathology. I’ve also started intracardiac conferences for EP fellows and a national cardiology EP fellows program.”

The EP training program is also likely to expand because, says Badhwar, “It is clear that we are going to be doing more complex and novel procedures. My focus will be to make Stanford a magnet for US and international fellows for world class electrophysiology training.”

FATIMA RODRIGUEZ, MD (center), rounding with residents ERIK ECKHERT, MD (left) and KYLE CATABAY, MD (right).

The influences in Fatima Rodriguez’s life began early. A child of immigrants, she was raised by a single mother who developed a pivotal illness: “My mom had rheumatic heart disease discovered when I was 15. I wanted to be just like her cardiologist who had made a life-changing diagnosis with just the use of his stethoscope.” Additional influences came her way at Harvard Medical School, where she arrived wanting to “just be a good clinical doctor.”

“There I had wonderful mentors who opened my eyes to public health research as well as taking care of individual patients. I received a Zuckerman Public Policy Fellowship in the John F. Kennedy School of Government, where I got to work with people across such sectors as business and law with a common goal of improving parts of health care that are not related to the medical system.”

Today, Rodriguez is a new assistant professor in the cardiovascular division with a particular interest in health disparities and improving cardiovascular risk prediction for understudied populations. As a general and preventive cardiologist, she encounters her research subjects at every clinic and during each two-week period of inpatient care. “My clinical work always influences my research questions,” she says. And, with 75 percent of her time devoted to research, she is able to think broadly about, and often test, new approaches to improving the health outcomes of her patients.

As a general cardiologist in a tertiary care center, Rodriguez works on the general cardiology service as an inpatient consultant and as part of a team that includes residents and medical students. She also has two weekly clinics: “I have an outpatient clinic in prevention focusing on risk factor control and risk assessment, and I see patients with advanced lipid disorders. I also have a general cardiology clinic, where I have a particular interest in caring for Spanish-speaking patients, since limited English proficiency directly impacts patient health and adherence.”

Dealing with patients’ medications is often a challenge. She explains: “In cardiology we have many very wonderful medications, and most of them are generic and therefore cheap and readily accessible. But they can’t work if you don’t take them. I often struggle with patients about their resistance to taking statins, which unfortunately get such bad press. I have a deal with my patients where I usually don’t start a new medication without taking something else away.”

Taking on Telemedicine
Proximity to Silicon Valley has had an effect on Rodriguez as well.

“I am the research director of our telemedicine clinic, which is called CardioClick. We are piloting it in the Stanford South Asian Translational Heart Initiative (SSATHI), a program designed for South Asians because of their higher risk of heart and vascular disease than any other ethnic group. Once CardioClick shows that it helps the SSATHI population understand their risk factors and develops targeted treatment plans for them, we will expand the services to the rest of preventive cardiology. We want to show not only that it’s convenient, because our patients can access us on the computer or iPhone, but also that it improves clinical outcomes. We’re also tracking patient satisfaction and engagement, factors that are important for the expansion of the program.”

Having had wonderful mentoring throughout her early career, Rodriguez naturally drifted toward passing it forward. “What is becoming important to me now is mentoring others,” she says, “especially underrepresented minorities and women. I hope to be able to continue to support people in that way.”

As a general cardiologist in a tertiary care center, Rodriguez works on the general cardiology service as an inpatient consultant and as part of a team that includes residents and medical students. She also has two weekly clinics: “I have an outpatient clinic in prevention focusing on risk factor control and risk assessment, and I see patients with advanced lipid disorders. I also have a general cardiology clinic, where I have a particular interest in caring for Spanish-speaking patients, since limited English proficiency directly impacts patient health and adherence.”

Dealing with patients’ medications is often a challenge. She explains: “In cardiology we have many very wonderful medications, and most of them are generic and therefore cheap and readily accessible. But they can’t work if you don’t take them. I often struggle with patients about their resistance to taking statins, which unfortunately get such bad press. I have a deal with my patients where I usually don’t start a new medication without taking something else away.”

Taking on Telemedicine
Proximity to Silicon Valley has had an effect on Rodriguez as well.

“I am the research director of our telemedicine clinic, which is called CardioClick. We are piloting it in the Stanford South Asian Translational Heart Initiative (SSATHI), a program designed for South Asians because of their higher risk of heart and vascular disease than any other ethnic group. Once CardioClick shows that it helps the SSATHI population understand their risk factors and develops targeted treatment plans for them, we will expand the services to the rest of preventive cardiology. We want to show not only that it’s convenient, because our patients can access us on the computer or iPhone, but also that it improves clinical outcomes. We’re also tracking patient satisfaction and engagement, factors that are important for the expansion of the program.”

Having had wonderful mentoring throughout her early career, Rodriguez naturally drifted toward passing it forward. “What is becoming important to me now is mentoring others,” she says, “especially underrepresented minorities and women. I hope to be able to continue to support people in that way.”