Taking on the killers

Doctors talk about advances that help us live longer

Dr. Mark Adams, photography by Neal Bruns
Dr. Roy Robertson, photography by Neal Bruns
Dr. Christopher Danby, photography by Neal Bruns
Dr. John Fouts, photography by Neal Bruns
Dr. John Crawford, photography by Neal Bruns

A baby born in Indiana in 2015 has an expected lifespan of 77.6 years – the highest ever.

Lots of changes, big and small, make that possible, but none are more crucial than the medical advances Northeast Indiana residents have come to count on. Modern medicine and medical research enable us to be healthier and heal us more effectively when we are ill.

As Fort Wayne Magazine celebrates its annual recognition of the area’s 2015-2016 Best Doctors, using the list created and maintained by Best Doctors in America®, we decided to ask several of the 2015-2016 Best Doctors in America® selected from the Fort Wayne area what they see happening as human longevity increases. Their viewpoints are fascinating and their expert advice is compelling as they share what they are doing as they help Fort Wayne residents live longer, healthier lives.

Dr. Mark Adams
One area that’s contributed to America’s increasing lifespan, according to Fort Wayne Pediatrics’ Dr. Mark Adams, is the development of vaccines that protect children (and adults) from former killers such as measles, diphtheria and tetanus.

“Back when I first started in 1983, there was bacterial meningitis, a terrible disease (that caused) death, major handicaps, brain injuries,” Adams said.

The development of a vaccine in the late 1980s that confers lifelong immunity against the disease has virtually wiped it from developed areas, Adams said, noting that younger doctors in practice today may have never even seen one case.

“The first six months (of practice), I had 12 cases I personally took care of. Six (patients) died, three didn’t do well with brain injuries and cerebral palsy, and three did OK. One of those kids is now bringing his baby to me. To have a baby wake up in the morning time, and then get the call (for help) and by that time (you get to the hospital) they’re dead” is terrible, Adams said.

“People still don’t get it! These (diseases) cause death! They cause death and terrible diseases, especially the bacterial ones. We don’t take anyone who won’t vaccinate,” at Fort Wayne Pediatrics, where Adams practices. “All of us agreed that if they don’t want to vaccinate, we don’t want to expose our families to that.”

Adams, a Fort Wayne native and Indiana University School of Medicine graduate whose father, E. Wade Adams, started the practice that would become Fort Wayne Pediatrics in the 1950s, said the long-discredited theory that vaccines can cause autism has done a terrible disservice to confused new parents.

“We’re talking death – dying – versus a healthy baby, a healthy child,” Adams said. Anti-vaccine parents “just don’t know. My choice is never to have to take care of a baby or child like that because I’ve done that and I never want to pronounce a child dead like that because they didn’t get vaccinated when we have all of these options.”

Still, Allen County (at 59 percent) and Indiana (at 66 percent) fall behind the national rate of recommended vaccines. Nationally, nearly 72 percent of children have completed the series of recommended vaccinations by 35 months of age, according to the Centers for Disease Control and Prevention.

“There is so much bad press that is totally unsanctioned at all, and it drives us all crazy,” Adams said. “There’s still killers out there. You just have to talk to a family that’s had a death. They never get over it. They move on, but they never get over it.”

“Vaccination is considered the most successful and cost-effective medical intervention ever introduced. A recent publication from the U.S. Centers for Disease Control and Prevention suggests that this distinction continues to hold, reporting that for children born in the United States during the period 1994-2013 vaccines will have prevented 322 million illnesses, 21 million hospitalizations, and 732,000 premature deaths, saving $295 billion in direct medical costs and $1.38 trillion
in total societal costs,” reports the National Academy of Sciences.

Infant mortality has declined over the past two decades in Indiana, too, which has helped raise overall longevity, according to the CDC.

“Back in the old days, “Adams said, “if we had a 25-weeker (gestation fetus) and their eyes weren’t open, we didn’t do anything” to try to keep the premature infant alive. “Now we have surfactants (that help tiny lungs open and absorb oxygen) and all the advances in the NICU (neonatal intensive care units). It’s incredible.”

Adams said despite the advances, there are challenges ahead, particularly in fighting what he called the obesity epidemic.

“Obesity is a biggie for us, and it’s going to be terrible for mortality,” Adams said. “We’re seeing it
every day.”

Dr. Roy Robertson
Hoosiers’ increasing waistlines are being blamed for the fact that our life expectancy is below the national average of 78.8 years. Local doctors warn that we need to change our behavior if we want to live longer. Indeed, the National Center for Health Statistics (part of the federal Centers for Disease Control and Prevention) notes that increasing obesity is a factor in a leveling-off of what had been a steady increase in longevity.

Obesity is a factor in cardiac disease, which is Dr. Roy Robertson’s area of practice. A physician with Parkview Physicians Group – Cardiology and medical director of the Parkview Heart Institute, Robertson treats the effects of obesity on the heart, along with other forms of heart disease. Heart disease is the leading cause of death in America, and he said recent declines in heart-related deaths have come from new technologies and treatments, plus a drop in the smoking rate.

“There’s a lot of things we can do in cardiology,” Robertson said. “Technology has led us to do all these things. We have a very strong network to expand our knowledge base. That leads to implementation, that leads to earlier recognition and that leads to better outcomes. Better treatment equals better outcomes.”

Robertson, who graduated from the University of Nebraska College of Medicine in Omaha, did his residency at the Indiana University School of Medicine in Indianapolis before joining Fort Wayne Cardiology (now Parkview Physicians Group – Cardiology) in 1994. He’s now the director of the Aortic Valve Clinic, the Transcatheter Aortic Valve Replacement Program and the Specialty Hypertension Care Clinic, where he works with patients to reduce their blood pressure to take the strain off their hearts and blood vessels.

New types of stents, tiny mesh tubes that prop open arteries to allow blood flow and reduce the chance of a heart attack, are now coated with drugs that help them work better, which helps reduce death rates from cardiac causes. Transcatheter aortic valve replacements have also greatly reduced mortality, Robertston said.

“We see (patients) every day who would have been dead without” these new technologies, he said. Advances in prescription medicines have helped as well, such as the use of beta blockers to improve heart function and ACE inhibitors to reduce blood pressure. High blood pressure, which can be caused by obesity, can cause heart attacks, stroke and kidney failure.

Dr. Christopher Danby
Dr. Christopher Danby, a Lutheran Medical Group surgeon who specializes in cardiovascular and thoracic surgery, agreed that advances in cardiac research have greatly improved both the quality and quantity of cardiac patients’ lives. The Boston University School of Medicine graduate served as a staff general surgeon at Winn Army Community Hospital in Fort Stewart, Georgia before completing his cardiothoracic surgery residency at Walter Reed Army Medical Center, where he served as a staff cardiothoracic surgeon for several years. Danby earned the rank of major while serving in the U.S. Army Medical Corps before coming to Fort Wayne in the late 1990s.

“Cardiothoracic surgery has always been on the cutting edge” of medical research, Danby noted. Saving lives and extending longevity is “the crux of what thoracic surgery is all about.”

The development of the LVAD, the left ventricular assist device, has helped people waiting for heart transplants live longer while they wait for a heart to become available, Danby said, and more research is under way to refine that and other life-extending procedures and medications.

“The people who develop these devices continue to improve them,” Danby said. “We’re seeing less invasive procedures that help older people” who might be too frail for conventional treatments. And there have been many advances in robotic surgery that can be more precise and targeted both for heart surgery or thoracic oncology (lung cancer) surgeries.

“The use of the robot is much more ubiquitous,” Danby said. But he still needs to be the best doctor he can be.

Though cardiac surgeons are “given a fair amount of latitude” by their patients, Danby said, “you have to keep up your end of the bargain.”

Dr. John Fouts
Dr. John Fouts, a pulmonologist with Parkview Physicians Group who treats people with advanced lung diseases, says the gradual decline in cigarette smoking has definitely increased lifespans. That said, there’s still progress to be made.

“Our batting average with lung cancer (survival rates) is improving,” Fouts said, “but it’s not great.” He noted that it sometimes takes decades for lung cancers to occur after a person stops smoking, and Americans’ love affair with the cigarette peaked in the early 1970s. So the declines in lung cancer rates should improve further in the future. Lung cancer causes more deaths than colorectal, breast and prostate cancers combined. An estimated 158,040 Americans are expected to die from lung cancer in 2015, accounting for approximately 27 percent of all cancer deaths, according to the American Lung Association.

Fouts, a DePauw University and Indiana University School of Medicine graduate who came to Fort Wayne to practice in 1977, said the treatment for lung diseases has changed “drastically” since he began practicing.

“There have been changes in procedures and in technology,” he said. “We’re doing more endoscopies, sending more people for (lung) transplants.”

Still, “the basics haven’t changed” in treating lung diseases. Fouts also sees many patients with COPD, chronic obstructive pulmonary disease, which is largely caused by cigarette smoking and exposure to occupational chemicals. New medications and treatments have helped people delay the advance of the disease, and they’ve helped improve the quality of COPD patients’ lives.

Dr. John Crawford
Improving lives is why Dr. John Crawford, a Fort Wayne City Council member, spearheaded the city’s smoking ordinance in the 1990s, a move that cost him his at-large city council seat (which he has since regained). The New Orleans native attended Louisiana State University for undergraduate and medical school, then came to Fort Wayne in 1976. In 1983, Crawford co-founded Radiation Oncology Associates, after serving as Chief Resident in Radiation Oncology at the Medical College of Virginia and practicing with Fort Wayne Radiology from 1976 to 1983.

“My philosophy is that government shouldn’t get involved unless (an activity) hurts someone else. Three hundred people a year die in Allen County from secondhand smoke, whether that’s from cancer or heart attacks. Even 30 minutes of exposure increases the clot-ability of the blood which leads to heart attacks,” Crawford said. “I just don’t think it’s right to hurt anyone else.”

Crawford said the secondhand smoke issue, which he successfully used to help the city become one of the first in Indiana to pass strict anti-smoking measures, means fewer people are being injured by exposure to someone else’s nicotine addiction. A gradual decline in the nation’s smoking rates has helped improve the health of even nonsmokers, he noted.

The field of radiation oncology has advanced tremendously since Crawford began practicing, he said.

“The technological improvements have been breathtaking,” he said. “When I started, the cure rate for all cancers was around 35 percent. Now it’s at around 55 percent. Every year, it’s 1 to 2 percent better. We have many more combinations of surgery, radiation and chemotherapy that not only improves the cure rate, (but also) the quality of patients’ lives.”

Radiation oncology uses targeted radiation to damage the DNA of fast-replicating cancer cells to kill tumors or reduce their size. According to his website, Crawford takes a special interest in intraoperative radiotherapy, intracavity brachytherapy and combined modality radiation-chemotherapy treatments.

“We have technologies I never dreamed of,” when he was in medical school, including CyberKnife, which delivers extremely accurate beams of high-dose radiation to tumors, focusing treatment on the cancerous cells while sparing nearby tissue.

“When I started out, we couldn’t even dream of that,” Crawford said. “The improvements in our field, from surgeries that are much easier on the patients, to tons of new therapies in medical oncology, targeting, genetics and more – every year there’s something new that we didn’t have before.”

First appeared in the November 2015 issue of Fort Wayne Magazine.

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