Pioneers of Hope

At 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 doctors profiled here represent only a sampling of the physicians working tirelessly to make Children’s Hospital a place of unwavering hope. In each issue, we also include a profile to highlight our long-standing partnership with our community pediatricians who help ensure all children receive the best care each and every day.

 

Gregory A. Mencio, M.D., grew up in a small mill town, Naugatuck, Connecticut, known for producing ProKeds sneakers. His experience with medicine was limited to routine physician visits.

As an all-round athlete, Mencio earned spots on the football and baseball squads at Duke University in North Carolina. He played catcher for the baseball team and was center and guard for Blue Devils football. It was there that Duke’s charismatic team doctor, Frank Bassett, M.D., gave him his first real exposure to medicine as a career choice.

“He was the guy we all saw as athletes. He became a role model for me. He taught an undergraduate course in anatomy and if you had any interest in medicine, you could spend time shadowing him,” said Mencio, director of Pediatric Orthopaedics at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “It was pretty neat to have access like that, to see the way he carried himself and engaged his patients in the office and even in the operating room,” Mencio added.

He remained at Duke for medical school, leaving briefly after graduation to do preliminary residency in general surgery at the University of Pittsburgh, where he met his wife Madelyn. He returned to Duke to do his training in orthopaedic surgery, which included a rotation at Shriners Hospital for Crippled Children. That’s where he decided pediatric orthopaedics was his passion.

“I thought I might want to do sports medicine, but as an athlete, I had spent my share of time in the locker and training rooms,” he said with a chuckle. “I enjoyed playing sports, but I didn’t think I’d much enjoy taking care of athletes as a profession. We did a rotation at the Shriners hospital and I really enjoyed doing pediatrics. You get to treat a broad spectrum of conditions, over a wide age range and potentially impact people over their lifetime. That’s where I decided what I wanted to do.”

Mencio went on to Newington Children’s Hospital (now Connecticut Children’s Medical Center) in Newington,

Connecticut, for a fellowship and remained there on staff for four years before a former fellow resident suggested he consider a job at Vanderbilt. Mencio arrived in Nashville in 1991 with his wife and two daughters to join Vanderbilt’s Department of Pediatric Orthopaedics and work under Neil E. Green, M.D. Mencio is now the Neil E. Green, M.D., Professor of Pediatric Orthopaedics.

For 24 years, Mencio has helped in the evolution of care for children in orthopaedics, honing his clinical focus on treatments for scoliosis, an abnormal curvature of the spine, and orthopaedic trauma.

“We still treat scoliosis the same way—that is, we brace it, watch it or operate on it. We still don’t know what causes it, though we are starting to get a handle on that, but the evolution has been mostly the surgical approach to it,” said Mencio.

“We understand the deformity better, we have better implant systems, and as a result we are able to achieve better and more lasting correction than in the past. The next advances are going to be in identifying what causes scoliosis and identifying the gene sequences or markers that are associated with progression and from there to implement strategies to treat these curves before they get bigger.”

Outside the hospital, Mencio brings his expertise to children who don’t always have access to top facilities and orthopaedic care. Since 1989, he has done mission trips once a year for 10 days to other countries, including Mexico, Guatemala, El Salvador, Dominican Republic and Colombia. Along with a team of nurses and doctors, as many as 150 children are seen and treated.

Closer to home, until recently, he dedicated himself for 23 years to making monthly trips to Blanchfield Army Community Hospital in Fort Campbell, Kentucky, to provide specialized care to families.

Mencio and his wife, Madelyn, who is a nurse, have been married 31 years. They have two adult children, Alyson Mencio Stevens and Marissa Mencio. When not working on bones, he’s playing golf and taking an occasional ride on his bike.

“I like golf, but I’m a lousy golfer, and I like to bike, but I’m not in very good shape at the moment,” Mencio joked.

– by Christina Echegaray

•••

Transplant surgeon Douglas Hanto, M.D., Ph.D., describes his first operating room experience—his own appendectomy when he was in 7th grade—like a scene from a best-selling novel. It was a life event that led him into medicine and encouraged him to be a surgeon.

“I went into the OR with its bright silver lights, hooked up to a long IV, and the next thing I knew, I was back in my room with a little white dressing over my right lower quadrant. My family doctor had reached inside me and removed my appendix, and it was the most amazing thing I had ever experienced.”

It’s no accident that the new associate director of the Vanderbilt Transplant Center, who has been working with the Departments of Pediatrics and Surgery to develop a comprehensive pediatric liver center at Monroe Carell Jr. Children’s Hospital at Vanderbilt, tells the story so vividly.

When Hanto isn’t immersed in administrative duties or doing what he loves most—transplant surgery—he’s writing a medical novel. But right now, he dedicates most of his time to getting Children’s Hospital’s liver transplant program up and running.

“There is no better place in Tennessee than Children’s Hospital to care for infants, young children and adolescents who have liver disease, and that should include the option of liver transplantation,” said Hanto. “The Vanderbilt Transplant Center has always had a spectacular reputation both nationally and internationally. Similarly, so does Children’s Hospital.

“Our goal is to build a liver center that would include medical, surgical and transplant components. Not only is there a need for such a program,” he said, “but the expertise and support are already here.”

Before coming to Vanderbilt, Hanto was at Washington University School of Medicine in St. Louis, where he was professor of Surgery and associate dean for Continuing Medical Education. Prior to that he was chief of the Division of Transplantation at Beth Israel Deaconess Medical Center in Boston and Lewis Thomas Professor of Surgery at Harvard Medical School for 11 years. He also helped start liver transplant programs at the University of Cincinnati and at Washington University in St. Louis.

Hanto earned his bachelor’s degree from St. Olaf College in Northfield, Minnesota, and was first in his class at the University of Arizona College of Medicine. He completed his general surgery and transplant training and earned a Ph.D. at the University of Minnesota in Minneapolis.

Initially he planned to become a cardiac surgeon, but after his first internship rotation at the University of Minnesota, “the transplantation mecca,” he was sold on transplantation instead. “I never turned back. Transplantation was where the new frontier was.”

At Vanderbilt Hanto will continue his research into the ability of inhaled carbon monoxide (CO) at low concentrations to reduce preservation injury (nonimmunologic graft damage that results from the perioperative procedures involved in the harvesting, transportation and reperfusion of the donor liver) and improve survival in kidney transplantation. Using animal models, he has shown that the treatment is effective in restoring kidney function more rapidly after transplant.

The method is presently being studied in the kidney, but Hanto hopes to expand the studies to include all transplanted organs. “The goal is to bring this to the patient.”

Hanto has three children, six grandchildren, a fiancée, Mary Klingensmith, who is a general surgeon at Washington University, and two stepchildren. He also enjoys running, skiing, hiking, golfing—“anything outdoors”—and is an avid reader.

And the medical novel he’s writing? “It’s about medical ethics and how we make certain ethical judgments about medical situations when it involves someone else,” he said. “But when it becomes personal and involves us or our loved ones, our perspective and ethical judgments may change.”

– by Nancy Humphrey

•••

Growing up in small-town Iowa, Kathryn Edwards, M.D., said she was always fascinated by microbes, the microorganisms too small to be seen by the naked eye.

“I loved my microbiology course my first year in medical school,” she said. “And I also was intrigued by how one person could encounter a microbe and get sick and the next person could encounter a microbe and not.”

The relationship between the pathogen, a disease-causing microorganism, and the host “was really something that I just found unbelievably intriguing.”

Edwards carried that fascination with her through medical school at the University of Iowa to the faculty of Vanderbilt University, which she joined in 1980. She is now professor of Pediatrics, director of the Vanderbilt Vaccine Research Program and the Sarah H. Sell and Cornelius Vanderbilt Professor. Over the last 35 years, she has tested vaccines for H1N1 flu, H5 avian flu, pertussis, pneumococcus, smallpox and anthrax, among many others.

“Over these three and a half decades, some really exciting things have happened in pediatrics,” she said. “Probably the thing which I find the most exciting is that the widespread use of vaccines that have been developed against many of the common pathogens and microbes have markedly reduced the disease burden on children and why children are being hospitalized. At any one time when I first came here, there were probably three or four children with bacterial meningitis, and now on the wards there is scarcely one at any one time. That has made an enormous difference.”

If anything, vaccines have become a victim of their own success. As they have vanquished diseases, some parents have questioned their necessity, resulting in resurgences of conditions such as measles. Edwards said that it’s important that doctors educate their patients about vaccines with real-life examples, not just statistics.

“As physicians, we need to communicate better,” she said. “We often need to use our own stories. I don’t hesitate when I talk about vaccines to say that I have grandchildren. All of them are fully immunized, on time. I couldn’t be happier about that. Use your personal experiences, because it tells the patients that you believe in these things.”

Edwards leads by example, continuing to see patients in addition to teaching classes and conducting research. She has a lot to be passionate about.

She recently published an article in the New England Journal of Medicine that found that most pneumonia today is due to viruses, not bacteria. The Vanderbilt study found that 81 percent of cases examined were caused by viral infections, while only 8 percent were caused by bacterial infections and 7 percent were bacterial and viral. The findings could focus future research on how to treat viral infections, while curtailing the use of antibiotics.

Edwards is also excited about studying the effectiveness of immunizing pregnant mothers for diseases that may affect their babies. Children younger than 6 weeks cannot be vaccinated, but they may carry immunity from their mother. She’s working on a vaccine for Group B strep, the most common cause of meningitis in children.

“It’s been shown that if the mothers have antibody to Group B strep, their babies don’t get sick,” she said.

Her work is also taking her into systems biology—the study of the systems of biological components, involving computer and mathematical models and a team of professionals to decipher the expanding pools of data.

“These technologies are very complicated, because they have genetic readouts and there’s so much data that you can’t begin to wrap your arms around it,” she said. “It really takes a bigger village.”

When she’s not teaching, seeing patients or doing research, she likes to cook and sew. Her husband, four children and five grandchildren all live in Nashville, but she still feels a kinship with her Iowa home.

“I really relish my Midwestern roots,” she said.

– by Matt Batcheldor

•••

Twenty years ago, toward the end of his pediatrics residency at Vanderbilt University Medical Center, Michael Ladd, M.D., was weighing a few job offers. Ultimately his decision was greatly influenced by the close-knit atmosphere of one hospitable local group.

The six pediatricians at Green Hills Pediatric Associates were friends as well as colleagues. They ate lunch together every day.

“As a pediatric resident, I got to know the groups in town, and I had great respect for this group,” he said. “The doctors at Green Hills got along well together. They sat down together for an hour over lunch and talked about medical cases and things going on in their lives. That breeds a certain congeniality. They were certainly on my short list, and I was honored that they talked to me in the first place. Joining Green Hills was a good choice.”

Ladd, a native of Knoxville, Tennessee, received his undergraduate degree from Duke University, and his medical degree from Vanderbilt University School of Medicine. He joined Green Hills Pediatric Associates in 1995, immediately following his residency at Vanderbilt.

Ladd said he is now seeing the children of children he took care of in his first days as a community pediatrician. “It’s a lot of fun,” he said, adding that even though health care is rapidly changing, he still practices as he did 20 years ago.

“I love kids, and I enjoy their parents. I understand, from my time as a parent, that when your child is sick you have the right to be anxious, the right to be angry. We spend a lot of time with our patients. We are very lucky in that regard.”

Ladd said having Monroe Carell Jr. Children’s Hospital at Vanderbilt nearby is comforting, both as a pediatrician and a parent. “We are lucky to have such a great place for subspecialty referral so close to our practice. It’s a luxury to have such quick access to pediatric infectious disease docs, as well as rheumatologists and other specialists. We can call and speak directly to them, and we can get our patients into Children’s Hospital clinics easily. Also, the residents are top notch. Vanderbilt takes very good care of our patients.”

Like many parents in Nashville and the surrounding area, Ladd and his wife, Kathy, have had personal experience with Children’s Hospital as well. Their youngest son, Luke, developed viral myocarditis, an inflammation of the heart muscle, when he was 7 days old, and spent 51 days at Children’s Hospital, 37 in the Pediatric Intensive Care Unit (PICU) and six on extracorporeal membrane oxygenation (ECMO), a technique of providing both cardiac and respiratory support to patients with severe heart and lung damage. He received a new heart when he was 25 days old. Several years later, he was back in the PICU after a near-drowning incident. “He’s an eighth grader, will be 14 in June and is absolutely as healthy as he can be,” Ladd said.

The Ladds have two other sons—Josh, 20, who attends Rhodes College in Memphis; and Jack, 18, who finished high school this year at Hume-Fogg Magnet High School.

Ladd looks back to his early days of practice with fondness about how the group of pediatricians worked together. When there was a complex case, it was routine for younger pediatricians to call in an older pediatrician for another opinion. “They’re called gray-haired consults. It’s reassuring to parents,” he said.

The tradition continues, with one slight change. “I’m the gray-haired consult now,” he laughed.

– by Nancy Humphrey