Pioneers of Hope

At the Monroe Carell Jr. Children’s Hospital at Vanderbilt, our physicians’ work extends beyond patient exam rooms. They are also searching for discoveries to offer better treatments, and hopefully, find cures for their pediatric patients. The four doctors profiled here represent only a sampling of the physicians working tirelessly to make Children’s Hospital a place of unwavering hope.

 

Hernán Correa, M.D., chief of Pathology at Monroe Carell Jr. Children’s Hospital at Vanderbilt and medical director of the Division of Pediatric Pathology, inherited two things from his father: a desire to be a pathologist and a heart for children.

Correa grew up in Colombia and spent weekends on the family’s farm, tending gardens, chickens and cows, and riding horses to the nearby village where his father, also a pathologist, volunteered to treat the locals’ tropical diseases.

“He would show us the parasites or explain how a person gets these worms in their intestines. Medicine was always around, and I never thought about being anything else but a doctor,” Correa said.

In 1970, the family traveled to the United States for Correa’s father to continue his cancer research at the National Institutes of Health. What they thought would be a sabbatical year turned into a permanent move when communist guerilla fighting made it too dangerous to return home.

Correa, however, always wanted to return to Colombia and attended medical school at Universidad del Valle, where his father and grandfather had both been professors.

During residency at Louisiana State University and Children’s Hospital of New Orleans, Correa discovered the exciting new subspecialty of pediatric pathology, which combined his love for pathology with his desire to help children. After a fellowship at British Columbia’s Children’s Hospital in Vancouver, Correa returned to New Orleans to practice for 14 years.

In the aftermath of Hurricane Katrina, Correa looked for new opportunities for growth and learned that Vanderbilt needed a pediatric pathologist for the Children’s Hospital. At the time, all pathology was located at Vanderbilt University Hospital, but as the complexity of the patients seen at Children’s Hospital increased, the need for pathologists specialized in pediatric cases became evident. Correa was brought to Vanderbilt to lead the Pediatric Pathology division, which now has five pathologists and welcomes its first fellow in July.

Pathologists are an important part of the care team, along with clinicians and surgeons. A pathologist will evaluate body fluids, like blood or urine, or thin slices of tissue to interpret their changes and help make a diagnosis.

“The pathologist is the behind-the-scenes doctor,” Correa explained. “I like being part of the patient care team. The clinicians and surgeons routinely join us in the review of the slides and to discuss cases. Although pathologists may never see the patient, we stay informed of their outcomes. I find this participation in their care a very rewarding experience.”

One of Correa’s research interests is eosinophilic esophagitis (EE), a type of inflammation of the esophagus that may be allergic in origin. It usually causes heartburn, difficulty swallowing and food impaction. He has developed a large database of pediatric esophagus biopsy samples taken in the last 15 years.

“I’m trying to decipher the different microscopic features of the inflammation, looking for clues of its causes. I believe there are many ways to get to this end result of EE. It could be food allergies, environmental allergies, a genetic predisposition, or a combination of these, and understanding the different changes may help us pinpoint the cause,” Correa said.

Correa is married and has three daughters—a 16-year-old and 13-year-old twins. They have inherited his curiosity about science and his love for soccer.

– by Leslie Hill

•••

Gretchen Purcell Jackson, M.D., Ph.D., vividly recalls her days as the chief resident on the pediatric surgery service nearly a decade ago.

The regime, which called for her to be available 24/7, meant she slept on the floor of her office between cases and spent more time at the hospital than anywhere else. It was a grueling routine, but Jackson loved it.

“When I did pediatric surgery as a fourth-year resident, I just fell in love with it. I loved every minute on the service.

“I pretty much always wanted to be a doctor and a surgeon, especially after my heart surgery when I was 10 years old. I think being a patient who has spent a lot of time on the cold end of the stethoscope makes me a better doctor. “

Diagnosed with pulmonary stenosis when she was 6 months old, Jackson underwent a pulmonary valvuloplasty to repair the condition that caused the flow of blood from her heart to her lungs to be slowed by a deformity on the pulmonary valve.

Jackson came to Monroe Carell Jr. Children’s Hospital at Vanderbilt in 2006, where she is an assistant professor of Surgery, Pediatrics and Biomedical Informatics. She graduated from Stanford University with a B.A. in Electrical Engineering and Biological Sciences in 1989, a medical degree in 1996, and a Ph.D. in Medical Information Sciences in 1997. She completed her residency at Duke University Medical Center in 2004, followed by a fellowship in Pediatric Surgery at Children’s Hospital of Pittsburgh.

She was drawn to Vanderbilt because “it was one of a few places in the country where she could have a career as a surgeon, clinician and informatics researcher.” Vanderbilt houses one of the largest informatics programs in the country and has also pioneered work in the development of patient portals to allow patients to interact with a health care system through secure online applications. Vanderbilt’s Web-based system is called My Health At Vanderbilt.

Jackson has several research projects related to My Health At Vanderbilt. Her work focuses on empowering patients and their families to take an active role in managing their health by using communication technologies.

Her team is currently evaluating the level of medical care being delivered by patient and provider messaging through the portal.

“Care is being delivered through our patient portal,” she said. “We have been able to show that new problems are identified; complications and adverse effects of medications are reported; medications are adjusted; and new consultations and referrals are made. Those online interactions between the patient and medical team can be considered outpatient encounters, but the patient does not need to drive to Vanderbilt.”

With the increased availability of information and technology to support patients in the management of their own health, there is great opportunity, she said, for people to become healthier.

Jackson recently created a self-management tool for the portal which allows patients to track health-related goals to modify their diet, exercise and lifestyle. This tool has the potential to help patients with a wide variety of chronic health conditions and to allow them to take responsibility for their own health outcomes through behavioral adaptations, she said.

“My long-term goal is to provide patients and their families with the information and tools to ensure that they are getting the best care possible,” Jackson said. “At Vanderbilt, there is such emphasis on personalized medicine and these tools can help us deliver truly individualized care.”

When not in doctor/researcher mode, Jackson enjoys outdoor activities with her husband, Heath, and two daughters, Brynn and Olivia.

– by Jessica Pasley

•••

Sari Acra, M.D., MPH, chief and medical director of the D. Brent Polk Division of Gastroenterology, Hepatology and Nutrition at Monroe Carell Jr. Children’s Hospital at Vanderbilt, has a newly discovered species of extinct insects named after him called Chimerhachiberotha acrasarii.

Acra, his siblings and father unearthed Lebanese Amber glass and found the 120-million-year-old insect imbedded within. They spent a lot of time excavating the amber, polishing it and photographing the extinct bugs, collaborating with museums of world history from around the globe.

As an amateur archeologist, Acra enjoyed using his hobby—archeology—to dig for information and the art of research. It was that same sense of discovery, instilled by his father decades ago, that drives his current medical research as a pediatrician.

His work with partner Maciej Buchowski, M.D., in the Human Energy Balance Lab at Vanderbilt focuses on studying the role of energy expenditure in the development, mitigation and monitoring of chronic diseases in children and adults. Specifically, his team has developed technical tools to measure physical activity and its associated energy consumption in non-laboratory conditions.

He hopes that having the ability to assess the energy needs of patients with chronic illnesses will help improve treatment options for medical conditions like obesity, sickle cell, sleep apnea and cirrhosis of the liver.

“Our team has worked to determine the physical activity habits of lean and obese individuals to learn how these habits relate to the development and propagation of obesity,” said Acra.

“The results of these studies indicate that engaging in sedentary activities is more of a determinate of overall daily energy expenditure, more so than the lack of participating in a vigorous physical activity, an important distinction when trying to promote a change in daily habits.”

Recently, his team developed a highly effective tool to measure physical activity and its associated energy consumption under free living or non-laboratory conditions. The result – a non-invasive, portal device based on accelerometry that can predict a patient’s energy expenditure with 95 percent to 99 percent accuracy.

The goal is that this tool will enable physicians to detect changes in a patient’s disease state before the patient is aware that his or her condition is declining.

“We can use this device to study different diseases in an effort to make a difference in the management and monitoring of varied health conditions,” said Acra. “A person’s well-being from any chronic disease is affected and/or reflected by activity levels.

“Nowadays, with our rapidly expanding technology, a person will be able to download a profile to a mobile device, which in turn will have the capability to configure his well-being and signal that a physician needs to be alerted.”

In the past, health care professionals have relied on patient input to assist with overall assessments of an individual’s condition. But, as many patients can attest, recall about physical activity or the perception of exertion levels is not always accurate.

Acra, who came to Vanderbilt in 1989, has authored more than 30 scientific publications including journal abstracts and book chapters. A summa cum laude graduate of the North Carolina State University in 1985, he received his medical degree from the American University of Beirut in 1989 and his master’s in Public Health from Vanderbilt in 2005. Acra completed a research fellowship, his pediatric residency and a clinical fellowship all at Vanderbilt.

– by Jessica Pasley

•••

David Parra, M.D., knew since he was a young boy growing up in Quito, Ecuador, that he wanted to be a physician. With no physicians in his family, he cannot pinpoint what influenced his interest in medicine. But he believes it was a “calling.”

That calling brought him to Monroe Carell Jr. Children’s Hospital at Vanderbilt in 2004, just as the new freestanding Children’s Hospital was set to open. He had been doing his Pediatric Cardiology Fellowship at the University of Michigan in Ann Arbor when he received a phone call from Thomas P. Graham Jr., M.D., former chief of the Division of Pediatric Cardiology.

“Dr. Graham wanted to start a cardiac MRI (magnetic resonance imaging) program at Children’s Hospital,” said Parra, assistant professor of Pediatrics, whose focus is in pediatric cardiac imaging. “I loved the group here and the opportunity to train in cardiac MRI as a faculty member. There really wasn’t any cardiac MRI program at the time and we have grown exponentially. My first year, we did maybe 60 patients and now we do close to 300 patients a year.”

Parra enjoyed the challenges of echocardiography and MRI, a painless way to take images of the heart to examine structure and blood flow patterns. He combined that interest with his passion for helping children, a devotion he honed at Miami Children’s Hospital during his residency. He earned his medical degree at the Universidad Central del Ecuador in 1993.

Born in New York City, Parra wanted to return to the United States to carry out his medical training and became fascinated with cardiac imaging.

“You follow patients, and you see them through their diagnosis, their operation and post-operative recovery. You see every evolution as you go through these challenges they have,” said Parra.

In addition to growing the cardiac MRI program at Children’s Hospital, Parra is also involved in several research projects, including studying imaging of myocardial function in heart transplant patients to look for early signs of rejection. With certain types of contrast dyes, doctors can see scarring, a sign of rejection, earlier than on more common surveillance modalities such as an echocardiogram.

He also is involved in a study to use MRI to do T1 mapping on Duchenne Muscular Dystrophy to detect early cardiomyopathy, heart muscle disease.

Parra, now director of non-invasive imaging for the Division of Pediatric Cardiology, came to Vanderbilt with his wife, Adriana Bialostozky, M.D., assistant professor of Pediatrics in the Division of General Pediatrics at Children’s Hospital. He credits his wife with helping him study for his exam to become a board-certified doctor after they met in New York and then moved to Miami where they did residency together.

Outside the hospital, Parra loves music, taking advantage of visits from friends and family to listen to live music and all Music City has to offer. He’s a fan of rock ‘n’ roll, bluegrass and Americana. Parra also has two sons, Sebastian, 12, and Martin, 10, and travels frequently around the region to watch Sebastian’s travel soccer team.

–Christina Echegaray