Archive for the ‘Medical Education’ Category

A Brief History of General Thoracic Surgery in Northern California, Sacramento and UC Davis

Posted on May 25th, 2016 in Medical Education, Uncategorized | No Comments »

A Brief History of General Thoracic Surgery in Northern California, Sacramento and UC Davis

John R. Benfield, MD

John R. Benfield, M.D.

Professor of Surgery Emeritus

UC Davis and the David Geffen School of Medicine at UCLA

(Prepared for the Department of Surgery Grand Rounds, June 2nd 2015)

Paul C. Samson, an impressive 6’6” former football player and 1928 Olympic swimmer, was the first thoracic surgeon in the East Bay after completion of the University of Michigan’s first in the world residency that focused entirely upon Thoracic Surgery.  He became a Chairman of the American Board of Thoracic Surgery, and the first President of the Society of Thoracic Surgeons – now the world’s largest and most influential group in our specialty.  In the East Bay, Samson and his partner David Dugan, preached and implemented their conviction that it is in the best interest of patients if only certified thoracic surgeons do thoracic surgery.  In San Francisco, superb thoracic surgical leaders like Leo Eloesser, Victor Richards and others, believed thoracic surgery to be a component of general surgery.  I shall refer to them as The San Francisco School.

Paul C. Sampson, MD

Paul C. Sampson, MD

In 1978, F. William Blaisdell, of The San Francisco School, became successful and deservedly much revered as chairman of the UC Davis (UCD) Department of Surgery.   There had been no accredited program in cardiothoracic surgery at UCD for nearly a decade, when Dr. Blaisdell sent Marvin Derrick, one of his excellent general surgery residency graduates to work with me for a year with the intent that Derrick would return to UC Davis to spearhead General Thoracic Surgery.  Derrick instead, elected to complete 2 more years and to become certified by the American Board of Thoracic Surgery, and not to return to UCD.   Dr. Blaisdell, a leader of the highest caliber,  recruited me in 1988.

F. William Blaisdell, MD

F. William Blaisdell, MD

When I arrived, cardiac surgery in Sacramento was very strong, but regionally general thoracic surgery was mostly in the hands of general surgeons.  In Sacramento, the only general thoracic surgeons certified by the American Board of Surgery were the late Jack Baker, formerly at of Ohio State University, Donald Hopkins, formerly at the Mayo Clinic and M.B (Beau) O’Neill in the Kaiser Hospitals.   At UCD Medical Center, cardiac surgeons Herbert Berkoff, formerly the head of the University of Wisconsin’s Division of Cardiothoracic Surgery, and David M. Follette, formerly at UCLA, joined me at UCD Medical Center.  Baker, Hopkins, O’Neill, and cardiac surgeons like Paul Kelly, Steve Rossiter, Brad Harlan, and others welcomed us graciously.  We narrowed the gap between the community and the university.   Our newly approved residency in Thoracic Surgery attracted excellent people, including Hiran Fernando, the current professor and head of General Thoracic Surgery at Boston University, Andrea J. Carpenter the incoming president of the Southern Thoracic Surgical Association who is a professor at the University of Texas in San Antonio, and Capt. Peter Roberts the former head of the Navy’s largest and most successful program in cardiothoracic surgery who is now the Deputy Commander of the Tripler Army Hospital.

In 1964, the STS was founded to be inclusive – for cardiothoracic surgeons in the community as well as in academics.  The STS database was formed in 1989 in response to a misleading article in The New York Times about cardiac surgery results that was contrary to the interests of patients.   Paul Ebert, formerly the head of cardiothoracic surgery at UCSF, and eventually the Executive Director of the American College of Surgeons, took the initiative that led to the STS database.  The purpose was to provide patients and surgeons with accurate, risk-adjusted data about cardiac surgical outcomes.  It did not take long for Medicare, insurance companies and industry to acknowledge the STS database as exemplary in health care.  In my STS presidential address in 1996, I called for the expansion of the database to include general thoracic surgery.   I am pleased that this has become reality.

I am delighted that Dr. Cooke will discuss the STS database today.  Congratulations to him and the Division of Cardiothoracic Surgery and the Department of Surgery for their accomplishments and continuing insistence on excellence.

May 25, 2015

March 19th, around 10AM PT, UC Davis will be Live Tweeting a Patient’s Experience Undergoing Surgery for Lung Cancer. Why?

Posted on March 17th, 2015 in Blow Your Mind Technology, Lung Cancer, Medical Education | No Comments »

“Is there a cure for lung cancer?”  That is a very common question for me.  We all know the statistics.  Lung cancer has around a 15% five year survival rate.  But the truth is in the details.  The majority of patients diagnosed with lung cancer are diagnosed at an advance stage, i.e. stages III and IV (there are four stages).  Only 25% of people diagnosed with lung cancer are diagnosed at the earliest stages, stages I and II.  The standard of care treatment for the physically fit person with stage I and II lung cancer is surgery, or removal of part of the lung where the cancer is located.  The five year survival for someone treated with surgery for Stage I lung cancer is around 80%.  That means 80% of those individuals are effectively cured of their lung cancer.

This is great news right?  What’s the hesitation?  We all know that the information bin on lung cancer is a black box.  Public awareness about lung cancer and the treatment modalities to fight it is minimal…though improving.  Forums like #LCSM Chat, the American Lung Association and Addario Lung Cancer Foundation, are leading the charge to disseminate evidence-based information.  But the bottom line is: people are afraid of surgery.   Patients view thoracic surgery (surgery on the contents of the chest, in this case the lungs) as high risk, with potentially prohibitive complication rates.  “Are you going to crack my chest open?” another common question I receive.  I usually reply “You are not a walnut.”

Just as the treatment of advanced stage lung cancer has evolved (such as molecular testing, personalized therapy, immunotherapy, etc.) so has the surgical treatment for early stage lung cancer.  In most cases of stage I lung cancer, surgery can be performed minimally invasively with small incisions and a high definition camera.  If you had a friend who had their gall bladder removed in the past 10 years, most likely it was removed in a similar manner.  With the gall bladder, it is called laparoscopic surgery.  With lung cancer it is called thorascopic surgery (scopic meaning camera, thora or thorax meaning chest: chest surgery with a camera.  As I tell my students, 90% of surgery is common sense; the other 10% is finding a pair of scrubs that actually fit.)  Thorascopic surgery, also called video-assisted thoracic surgery or VATS, results in smaller incisions, shorter stay in the hospital, less need for pain medicine and faster return to work and activities of daily living.  Moreover, VATS has the same cancer survivor results as traditional open surgery, where we have to make a larger cut and spread the ribs (again, we’re not “crackin’” anything).

On March 19th, around 10AM PT, At UC Davis we will be performing a Live Lung Cancer Surgery on Twitter (Don’t worry, we won’t be tweeting while operating, our public relations people will!).  One of our patients who has a keen interest in education was excited to volunteer and share her story.  She will undergo a right VATS lower lobectomy (removal of the bottom third of the right lung) for early stage lung cancer.  Now the focus of this Twitter project is not the surgery itself.  There are plenty of videos on YouTube that can show you how to do a VATS lobectomy (when I say “you” I mean your board certified thoracic surgeon…please leave your neighbors pets alone.).  The focus of this project is of course our patient, her story, her experiences on this important day, and the clinical care processes that will support her recovery.

Our patient’s case highlights some very important issues:

1)      Surgery for lung cancer has evolved.  Now with minimally invasive approaches, small incisions, and state of the art treatment during and after surgery, we are able to “stack the deck” in our patients favor to ensure their successful results.

2)      You only need lungs to get lung cancer.  She is a never smoker, and has no appreciable risk factors.

3)      Lung cancer is the number one cancer killer of women, yet only 1% of women when polled identify this fact (source: Lung Force Women’s Lung Health Barometer),

4)      Up to 80% of patients with stage I of lung cancer such as hers (early stage) are cured after treatment, and that is not the public perception.

The event will follow her day through the preoperative check in process, the operation, postoperative recovery, and follow her tumor through pathology processing, and whisking the tumor off to our research folks and tissue banking group.

The surgery is March 19th around 10am PT.  Please follow with the #LCSM hashtag or #UCDVATS.

“I never smoked, how could I have lung cancer?”

Posted on November 21st, 2014 in Lung Cancer, Medical Education | No Comments »

A patient’s perspective on lung cancer in never smokers

By Elizabeth A David, MD FACS

November is Lung Cancer Awareness Month, however, disappointingly few Americans are aware of many important truths about lung cancer.  Lung cancer is the #1 cause of cancer related deaths in the US, and it is estimated that 160,000 people will die of lung cancer in 2014.  Most of us are aware of the relationship between lung cancer and tobacco use.  However, new cases of lung cancer in people who have never smoked are on the rise. In 2007, approximately 10% of lung cancers were diagnosed in people who never smoked. That number has tripled to 30% of cases in 2014; roughly 66,000 Americans who have never smoked will be diagnosed with lung cancer this year.  “Never smokers” who are diagnosed with lung cancer tend to be younger and their disease is more serious when they are diagnosed.

John’s perspective

For Lung Cancer Awareness Month, our patient Mr. John Leung was willing to share his experience as a never smoker who was recently diagnosed with lung cancer and treated by our lung surgery team at UC Davis, in the hopes of, as John puts it, “breaking the mindset that lung cancer only happens in people who smoke.” 

John, only in his 50’s, experienced a cough for four years.  The cough would get better and worse and at times improved after he took medicine for post-nasal drip.  He had a chest x-ray when the cough began, and he had another this summer when the cough worsened.   John remembers feeling “apprehensive and worried” when his doctor told him that there was a mass on his chest x-ray.  “It wasn’t until my CT scan was abnormal, that I knew something had to be dealt with and I felt that it was highly likely to be cancer.” John said.  He felt like it was probably cancer because he knew it had not been present on his original x-ray four years earlier. John was diagnosed and treated with a minimally invasive (VATS) lobectomy for stage-1 non-small cell lung cancer in September.

How did he handle the diagnosis?

When John was told that his lung mass might be cancer, he immediately started “looking for a reason for why this would happen to me and looking for someone to blame.  I even tried to blame LA because I lived there in the smog.” John said.  “I wondered if it happened because of something I had done.”  He and his wife embarked on the journey of finding doctors and information that would help them. “I needed to have a doctor who could explain a process that I could understand and buy into.” He wanted to have something done quickly, but he needed to feel comfortable with the plan. So he sought several opinions.

Fear of the unknown has been a part of John’s lung cancer experience.  Initially, he was worried about how bad the cancer was, whether it was local or if it had spread to other organs.  Then he worried about surviving surgery. Now, he worries about whether it will recur soon, but he is learning to accept his fears just as he has accepted his diagnosis, knowing that he did nothing to cause it.

His family and friends have played an immense supporting role during the time of diagnosis, surgery and recovery.  His wife encouraged him to write questions down the night before his doctor visits, so they knew what they wanted to know before the visit was over. Everyone in his family is supportive, including his mom and siblings.

How does he feel about having Lung Cancer?

Some patients with lung cancer feel ashamed or embarrassed to be diagnosed with lung cancer, but not John. If anyone asks him he is honest with them and tells them about his diagnosis.  He sent his work colleagues an email every two weeks informing them of what was happening and how he was feeling.  He is a member of a Rotary club and he stood up and told his story at a meeting. He hopes that by telling his story it will help people understand that anyone can develop lung cancer, not just people who have smoked.  

In essence John has become an “ePatient”: educated, empowered and empathic.  “I have noticed that there is a lack of lung cancer awareness.” John points out.  “There seems to be pockets of people who are willing to drive the agenda because of personal experience, but there does not seem to be a general awareness of lung cancer like there is for other cancers.  People think that lung cancer is a penalty for the vice of smoking, but there doesn’t seem to be awareness that lung cancer occurs in people who never smoked.  The first question anyone asks me when I tell them I have lung cancer is – were you a smoker? And then they want to know why I have lung cancer.”

During the course of his diagnosis and treatment, John has learned that medicine and science have moved much further than he realized when it comes to lung cancer. He’s been “amazed at the progress.” He hopes that in the future, people won’t have preconceived notions about lung cancer and its treatment options. There are treatment options and hope for patients with lung cancer. “I didn’t think I would have it so easy if I had lung cancer.”  Of course, nothing is easy.  But it doesn’t have to be impossible either.

John has been very brave to share his experience to raise awareness about lung cancer in people who have never smoked. It is important to remember that chest pain, shortness of breath and cough are symptoms that should not be ignored. Unfortunately, most patients with lung cancer do not have symptoms until they have advanced disease. For patients with a long history of smoking, screening with a low-dose CT chest is currently recommended, please click here for more information. There are no screening recommendations for people who have never smoked at this time. Please remember that lung cancer can happen in anyone and treatment options are available.

For more information, please see these references:

  3. Subramanian JGovindan R. Lung cancer in never smokers: a review. J Clin Oncol. 2007 Feb 10;25(5):561-70.
  4. Hasegawa YAndo MKubo AIsa SYamamoto STsujino KKurata TOu SHTakada MKawaguchi T. Human papilloma virus in non-small cell lung cancer in never smokers: a systematic review of the literature. Lung Cancer. 2014 Jan;83(1):8-13. doi: 10.1016/j.lungcan.2013.10.002. Epub 2013 Oct 31.


Introducing the UC Davis Lung Cancer Chat Room

Posted on January 10th, 2013 in Lung Cancer, Medical Education | No Comments »

The UC Davis Lung Cancer Chat Room is an interactive meeting of learning and support for patients, families, friends and caregivers affected by lung cancer.

This support group is proudly sponsored by the UC Davis Comprehensive Cancer Center.

The UC Davis Lung Cancer Chat Room provides a time for education, sharing and an opportunity to connect face-to-face with people who can relate the realities of lung cancer. Special guest speakers are invited to give presentations on topics of interest to patients. Educational and support materials are provided.

3rd Thursday of each month
UC Davis Comprehensive Cancer Center
4501 X St. Sacramento, CA
Room #1103

For more information about this group, please contact Jena Cooreman, LCSW at 916-734-5198

2013 Calendar of Group Speakers

February 21st

David Copenhaver, MD, MPH
Director of Cancer Pain, Division of Pain Medicine
Pain Management

March 21st

David Tom Cooke, MD, FCCP, FACS
Section Head of General Thoracic Surgery
Lung Cancer Surgery: When is it Necessary?

April 18th

Kathleen Newman, RD, CSO
Senior Clinical Dietician
Nutrition and Cancer Treatment

May 16th

Elizabeth A. David, MD
Minimally Invasive Lung Cancer Surgery: What Are We Doing Now, What’s on the Horizon?

June 20th

Valerie Kuderer, RN
Thoracic Surgery Nurse Coordinator
Recovery After Lung Cancer Surgery

July 18th

Karen Kelly, MD
Associate Director of Clinical Research
We Might Have a Clinical Trial for That

August 15th

Megan Daly, MD
Advances in Radiation Oncology

September 19th

Marlene von Friederichs-Fitzwater, PhD, MPH
WeCARE! Cancer Peer Navigation Program

October 17th


November 14th

Tina Li, MD
Personalizing Lung Cancer Therapy: How Tumor Molecular Testing Can Help Your Cancer Care