A year before his death Johns Hopkins, a multi-millionaire Baltimore businessman, banker, Quaker philanthropist, created a visionary plan for a university and hospital that would bear his name and would be forever linked – in a previously unimagined way – to foster the science of health care. John Hopkins’ seven million-dollar bequest, then the largest gift of its kind (estimated to be worth upto eleven billion dollars today), ensured that the Johns Hopkins Hospital in Baltimore, USA, opened in 1888. Pari passu the Johns Hopkins University School of Medicine was launched in 1893. The two became intertwined as innovators in clinical care, teaching and discovery – changing the way medicine is practiced, taught and advanced throughout the world. The innovative methods pioneered here became the benchmark for hospitals and medical schools everywhere. Johns Hopkins Medicine continues setting the standard for patient care, medical education and research in a diverse, inclusive and intellectually exciting environment. According to US News and World Report the Johns Hopkins Hospital has been ranked as the “numero uno” in the Nation for 22 years, until recently, another two giants, the Massachusetts General Hospital and the Mayo Clinic surged ahead.
To me it was a great honour and privilege to be invited as a Visiting Professor to this prestigious institution which gave me a golden opportunity to solidify and enhance my skills and expertise in several modalities of adult and paediatric/fetal echocardiography including stress, 3D/4D, strain, transesophageal, structural heart disease, fetal, pediatric and adult congenital echocardiography. With my own eyes I witnessed the dedicated and passionate manner in which each doctor works in this top-notch Institution. It would be difficult to mention all that I had the privilege and opportunity to experience but the superb feeling of rubbing shoulders with world stalwarts is something that defies description.
I was very impressed with their digital echo lab. The main functions of the digital echo laboratory are: 1. Digital acquisition, archiving and retrieval of still images and image sequences. 2. Production and archiving of the echo report. 3. Diagnostic, scientific, educational, and administrative digital management of the echo lab (random access to images, image reproduction without loss of original quality, simplified side by side comparison of online and archived images, remote retrieval of studies).
I was astounded with their “Hypertrophic Cardiomyopathy Center of Excellence” which ranks among the topmost in the world. Hypertrophic Cardiomyopathy (HCM) is the leading cause of death in young athletes. It happens in around 75 athletes annually. Some of the notable cases who succumbed from HCM are British comedy actor Leonard Rossiter, Marc-Vivien Foé of Cameroon and “Miki” Fehér, both soccer stars, Gaines Adams and Derrick Faison, NBA players and the long distance runner Ryan Shay.
About one out of every 500 among the general population has HCM. Echocardiography is the perfect “workhorse” for the diagnosis and follow-up of patients with HCM. In my own thirty years of echo practice in Goa I must have seen at least 3000 patients of HCM. But unlike in advanced places most of our patients take the diagnosis and medical advice lightly and more often than not do not come for follow-up. It is also very difficult to convince asymptomatic siblings of probands to get tested in a disease that is genetically determined.
HCM is an illness of unknown etiology in which the heart muscle becomes abnormally thickened. The hardened heart muscle makes it more difficult to empty itself. HCM may be of the “obstructive” or “non-obstructive variety”. It often goes undiagnosed because people with the disease have few symptoms and can lead normal lives with no significant problems. However, in a small number of people with HCM, the thickened heart muscle can cause shortness of breath, chest pain or problems in the heart’s electrical system, resulting in life-threatening abnormal heart rhythms.
At Hopkins patients are fortunate to have experts capable of providing state-of-the-art therapies which range from genetic counselling or simple life-style adjustments to cardiac transplantation. Patients at risk for sudden cardiac death receive life-saving cardiac defibrillators. Those with drug-refractory symptoms due to obstruction of cardiac outflow receive “septal reduction” either by open heart surgery or by catheter ablation. Hundreds of patients who would not have survived even for a few years are given a new lease of life. What is more, even those with occupations involving heavy physical work return to their previous employment.
Now back in Goa, full of enthusiasm, it is my dream to digitize my Echo Lab and if possible create a HCM registry. Soon I am also going to introduce the highly informative “Dobutamine Stress Echo” (DSE) for those who are unable or unwilling to perform the treadmill test. I have already acquired the expensive state-of-the-art “Transesophageal Live Real Time 3D probe”, another first to add to many milestones achieved at my Echo Centre. Admittedly, every innovation comes at a cost. But I am committed to serve better my patients and to provide more and more information to my wonderful doctor colleagues who through the years have reposed confidence in me and helped me to learn from my mistakes. Above all I thank God. There have been bad times and tragedies in my life, but abundant blessings too. May He crown my humble efforts and let a hundred flowers blossom!
(Dr. Francisco Colaço is a seniormost consulting physician.)
