Gene W. Kallsen, MD, an EM trailblazer
By Barbara Anderson
UCSF Fresno’s Gene W. Kallsen, MD, finished his final shift as an emergency medicine physician in December, culminating a medical journey that began five decades ago at the very beginnings of Emergency Medicine.
Dr. Kallsen started medical school in 1968 – at the height of the Vietnam War – and the same year that the American College of Emergency Physicians formed.
The Vietnam War had shown the need to educate physicians at home on Emergency Medicine, Dr. Kallsen said. “It became clear to a lot of people that for a given severity of injury you’d be better off having the injury in the rice paddies of Vietnam than on the highways of America because we didn’t have much of a system.”
UCSF Fresno founded its Emergency Medicine residency in 1974, one of a handful of programs in the country. Dr. Kallsen applied in 1977. At that time Emergency Medicine was not officially recognized, and Dr. Kallsen admitted he had some trepidation. “It’s kind of dangerous to commit your life to training in something that is not a specialty yet, and might never become one,” he said. “But it was clear to me that the need was so clear.”
In 1979, when Dr. Kallsen completed his UCSF Fresno residency, the American Board of Emergency Medicine was approved, and Emergency Medicine became the 23rd and youngest-recognized medical specialty.
Dr. Kallsen became a trailblazer and leader in emergency medicine.
As the first director of Emergency Services in Fresno County in 1981, Dr. Kallsen helped develop many of the original EMS policies and protocols that continue to be used today. “His contribution to EMS and emergency care is tremendous and it has saved lives,” said Dan Lynch, division manager of Fresno County’s Emergency Services.
Dr. Kallsen served as chief of the UCSF Fresno Emergency Medicine Program for about 23 years, helping to build the four-year ACGME-accredited residency into one the most sought in the country.
Michael W. Peterson, MD, associate dean at UCSF Fresno Medical Education Program, first met Dr. Kallsen when interviewing for the position of Chief of Medicine for UCSF Fresno in 2001. Dr. Kallsen chaired the search committee, and he and Dr. Peterson shared a Midwestern background. Both graduated from the University of Minnesota Medical School (although not in the same years).
In considering the position of Chief of Medicine, Dr. Peterson said he carefully looked at the success Dr. Kallsen had achieved. “I felt that if under Gene’s leadership, Emergency Medicine could develop the type of national stature that they had, Medicine had a similar opportunity. I decided to accept the position.”
Overseeing residents has been rewarding, Dr. Kallsen said. “At the beginning of those four years, most of them are a little on the insecure side. Obviously by definition, they’re ‘green as grass.’ When they walk out the door four years later, they’re heroes in my mind.”
As past president/chairman of Central California Faculty Medical Group (CCFMG), Dr. Kallsen remains a member of the executive committee. CCFMG is the faculty medical group for UCSF Fresno. To honor his work and service to UCSF, a professor emeritus title is in process for Dr. Kallsen. And his legacy will continue with the endowed chair named in his honor. Endowed chairs, associated with the most prestigious educational institutions, are held by distinguished faculty. Dr. Kallsen and wife Pam Kallsen were generous supporters of the endowed chair.
Dr. Kallsen said he plans to travel and spend time with his family. But he added: “I’ll probably do a little bit of part-time work just to keep out of couch potato status.”
UCSF Fresno toxicologists provide higher level of care
By Barbara Anderson
Emergency responders were told the three young men had snorted cocaine, but Nicklaus Brandehoff, MD, a UCSF Fresno toxicologist, had doubts. The patients’ repeated pinpoint pupils and depressed breathing despite treatment made him suspect a synthetic opioid, like fentanyl.
The next day, toxicologist Patil Armenian, MD, research director and associate professor of clinical emergency medicine at UCSF Fresno, ordered blood and urine tests sent overnight for rapid screening to a University of California, San Francisco affiliated hospital. The test results confirmed her suspicion: The men had snorted fentanyl, a powerful synthetic opioid that is 50 times more powerful than heroin.
One of the men died at Community Regional Medical Center (CRMC) following the Jan. 7 overdose. The other two were rescued in time and were treated and released.
The quick laboratory confirmation made it clear that Fresno had not escaped the opioid that has killed people in epidemic numbers in other states. A news conference to alert the public of the drug’s presence in the community soon followed in which Dr. Armenian participated.
“Hopefully with all the warnings that went out, maybe we saved a life,” Dr. Armenian said.
Being able to identify the ill effects of an illicit street drug is part of the job for the toxicology team of Drs. Armenian, Brandehoff and Michael Darracq, MD, who see inpatients at CRMC. The toxicology team is a division of the UCSF Fresno Department of Emergency Medicine and the physicians are board certified in emergency medicine and toxicology.
The inpatient toxicology team is among a handful in California. Most hospitals rely on calls to poison control centers when they have a poisoning, overdose or snakebite but the UCSF Fresno/CRMC bedside toxicology service provides a higher level of care. And toxicology teams have proven benefits for patients and hospitals, Dr. Darracq said. Data show that care by inpatient hospital toxicologists results in shorter patient stays and less testing, he said.
The toxicologists, who describe themselves as “medical detectives,” spend much of their time piecing together medical puzzles. In about 60 percent of the ingestion cases, toxicologists never know the specific agents the patients took but by knowing the signs and symptoms of toxicity (toxidrome) they can point to a class of medications and suggest an appropriate treatment, said Dr. Darracq, an associate professor of clinical emergency medicine at UCSF Fresno. “One of the things I emphasize with our residents is that toxicology is very physiology based. It’s understanding mechanisms and understanding general trends and themes.”
The toxicologists also rely on each other for help in patient diagnosis. “If one of us is on call and there’s an odd case, we’re on the phone with one another,” Dr. Armenian said.
The toxicologists treat patients from babies to centenarians.
Many of the poisonings they see are of young children, especially toddlers. The children accidentally swallow a household chemical or medications that are in the home. CRMC has a pediatric intensive care unit, and along with the inpatient toxicology team “we really are the highest level of care for a poisoned pediatric patient,” Dr. Armenian said.
Poisonings of adults often are from exposures to a chemical in the workplace or the home, Dr. Armenian said. And overdoses (both intentional and accidental) are all too common.
The toxicologists treat every type of patient but they have special interests. Dr. Brandehoff, a health sciences assistant clinical professor of emergency medicine at UCSF Fresno, has an interest in herpetology and he helped develop snakebite protocols for the Fresno Chaffee Zoo, where there are several varieties of venomous snakes.
Brandehoff also is a founding member of Acelpius Snakebite Foundation, an international team of clinicians and scientists who work to reverse tragic snakebite outcomes through a combination of innovative research, clinical medicine and education-based public health initiatives.
With the nearby foothills home to Northern Pacific rattlesnakes, the toxicology team is an important asset for the community. “There’s a lot of nuances to treating a snake bite,” Dr. Brandehoff said. “If not treated correctly, there can be lifelong complications.”
There’s no predicting the poison, drug, snake or animal bite the toxicologists will confront and the job keeps them constantly reading and studying. But there’s a consensus on its rewards, as Dr. Darracq voiced: “It’s very satisfying where you make that diagnosis and you direct the providers in the right direction and a life is saved.”
Offer Potential Treatments for
Non-Alcoholic Fatty Liver Disease
By Barbara Anderson
Four clinical trials at the UCSF Fresno Liver Program could help people who have scarring of the liver that did not result from alcohol abuse.
Scarring of the liver can be caused by several things, including chronic alcoholism, Hepatitis B or C, but for a growing number of people, the cause is an excessive accumulation of fat in the liver – a condition known as nonalcoholic fatty liver disease.
The double-blind placebo-controlled trials are part of multi-national trials to study the potential of medications for patients who have nonalcoholic fatty liver disease.
Approximately 100 million Americans have too much fat in their livers. In some people, there are no complications from fatty liver, but others develop nonalcoholic steatohepatitis (NASH), in which the fat in the liver triggers inflammation. Inflammation can damage healthy liver cells, causing scarring that affects the organ’s ability to function properly.
“Fatty liver disease is as serious as having a drinking problem,” said Marina Roytman, MD, FACP, and director of the UCSF Fresno Liver Program. “It can lead to cirrhosis of the liver and to liver cancer.”
Risk factors for fatty liver disease include diabetes, high blood pressure, high cholesterol, sedentary lifestyle, as well as being overweight or obese.
Obesity rates across the United States are increasing and so is the prevalence of fatty liver disease, including in Fresno County. According to the most recent data, 78.6 percent of Latino adults in Fresno County are overweight or obese; 64.9 percent of Caucasians are overweight or obese and 35.4 percent of Asian adults are overweight or obese.
Fatty liver disease can be reversed with weight loss, healthy eating and exercise, Roytman said. “The cool thing about the liver is, if we allow it, it can heal itself.”
But changing eating and exercise habits is not an easy remedy for many people, and up to this point, there is no approved drug therapy for NASH patients, Roytman said.
The four clinical trials are aimed at reduction of steatosis (fat) and fibrosis (scarring) of the liver. The trials involve patients in varying stages of NASH, and target different points in disease development (from fat to inflammation to scarring). The scarring that causes progression to cirrhosis is the most important target, Roytman said.
The UCSF Liver Program is part of the Gastroenterology and Hepatology Fellowship. Fellows receive training in the diagnosis and management of all liver diseases.
Patients and providers interested in the clinical trials can contact Sonia Garcia, clinical research coordinator at the UCSF Fresno Clinical Research Center, by telephone (559) 499-6637 or firstname.lastname@example.org.
UCSF Fresno Educates Women on Heart Health with Free Event
By Brandy Ramos Nikaido
Heart disease is the leading cause of death for women in the U.S., according to the Centers for Disease Control and Prevention. To help increase awareness and improve heart health among women, UCSF Fresno will hold the Fifth Annual Women’s Heart Fair, from 10 a.m. to 2:30 p.m., Saturday, March 2, at the UCSF Fresno Center for Medical Education and Research, located at 155 N. Fresno St. in downtown Fresno.
As one of just a few female cardiologists in Fresno, Teresa Daniele, MD, FACC, chief of cardiology at UCSF Fresno is the motivation behind the UCSF Fresno Women’s Heart Fair.
“Heart disease is often considered a man’s disease, but the reality is one in four women will die from cardiovascular disease,” said Dr. Daniele. “Our goal is to share easy-to-understand information and provide health screenings that help women take control of their heart health with the goal of preventing heart disease and enhancing management of it.”
At the event, Dr. Daniele will explain how heart disease differs in women than men. She will be joined by faculty colleagues Leigh Ann O’Banion, MD, assistant clinical professor in the UCSF Fresno Department of Surgery and Marina Roytman, MD, health sciences clinical professor and director of the UCSF Fresno Liver Program. Dr. O’Banion will discuss venous disease. Dr. Roytman will speak to the link between heart disease and the liver.
In addition to lectures, the event will feature food, fun, prize drawings and important health screenings, including blood and glucose; Hepatitis C Point of Care; blood pressure; height, weight and body mass index; liver scan; and a relaxation station.
The UCSF Fresno Heart Fair is presented in partnership with Community Regional Medical Center, University Centers of Excellence and the American Heart Association’s Central Valley Division.
UCSF Fresno’s success and growth over the past 43 years are a direct result of the dedication and inspiration of our faculty, staff, residents, fellows, students, alumni, partners, donors and friends. Starting with the previous issue of Focus, we began introducing you to the people who contribute to the greatness of UCSF Fresno through informal interviews.
In honor of February as the month of love, we are featuring two individuals who share a love for one another and medicine.
Wife and husband and UCSF faculty members at UCSF Fresno Erica Gastelum, MD, and Nicholas Gastelum, MD. She is an assistant clinical professor and medical student site director. He is a clinical instructor.
Where are each of you from originally?
We are from Southern California. Nick is from San Diego and Erica is from Irvine.
Where did you go to high school, undergraduate and medical school?
Nick went to Valhalla High School in San Diego and then UC San Diego. Erica went to Mater Dei High School in Santa Ana then UCLA. Both went to UCSF for medical school.
How did you meet? Was it love at first sight? How long have you been together and married?
We met when we were checking out UCSF during accepted students’ weekend and were deciding where to go to medical school. We clicked from the get-go and the rest is history. We’ve been together for 11 years and will be married seven years later this year.
What was your first experience with UCSF Fresno and what led both of you to stay on as faculty?
Our first experience with UCSF Fresno was as third year medical students who rotated here as part of the Longitudinal Integrated Fresno Experience (LIFE) Program. We stayed on because we felt a connection to the community, the patients and our colleagues.
Why did you go into medicine and your chosen specialties?
We both had a passion for underserved communities and enjoyed the clinical and humanistic aspect of medicine. Erica is a pediatrician and Nicholas is an emergency medicine physician.
What is the most rewarding aspect of your job(s) at UCSF Fresno?
We enjoy many aspects. We enjoy teaching. We enjoy working with the residents. We love the people we work with. Having been here since medical students and being part of the growth in both of our departments, we’ve enjoyed growing with our programs.
As busy physicians, faculty members and parents, what makes your relationship work? How do you merge love and medicine?
We understand that life is not perfect, and we are not perfect. In fact, we feel like we are constantly trying to catch up in life. We keep each other grounded, vent to one another at home, and make each other laugh. We both know the stress of studying for boards, losing patients, or having a rough day. We celebrate small victories together.
When we were residents we did little things for each other like bring the other one food. Now that we have a hectic schedule with the kids, we take turns picking up and dropping off.
What’s on your couple’s or family’s bucket list?
Disneyworld, Disney cruise and a weekend of doing absolutely nothing work-related.
What else would you like to add?
We’re grateful to have each other and two amazing kids! And we’re thankful for every single person who has shaped us as physicians along the way since we first came to UCSF Fresno as third year medical students many moons ago (nine years to be exact).
Supporting UCSF Fresno
Gifts of Good Health
UCSF Fresno Receives More than $1 Million for Medical Education and Research
By Brandy Ramos Nikaido
UCSF Fresno recently received contributions of more than $1 million from two development companies and families known for giving back to the local community. The donations will enable UCSF Fresno to further develop its physician training and research programs.
The Kolligian, Arakelian and Kashian families of River Park Properties donated $1 million. Fresno developer and philanthropist Edward M. Kashian is the general partner of River Park Properties and CEO of Lance-Kashian & Company, a local real estate development and management firm in the Central Valley.
“We are incredibly appreciative and grateful for the generosity of Mr. Kashian and the partners of River Park,” said Michael W. Peterson, MD, associate dean at UCSF Fresno. “This contribution is an investment in the health of Fresno and the San Joaquin Valley. It will help support medical students in the UCSF San Joaquin Valley Program in Medical Education and enable us to continue engaging in research that addresses Valley health issues.”
California is expected to face a shortfall of up to 4,100 primary care clinicians in just 10 years, according to the California Future Health Workforce Commission. The gifts come at the same time the Commission released a report underscoring the need to support residency and medical student education, specifically SJV PRIME, to meet future health care needs. The Commission is co-chaired by UC President Janet Napolitano.
“Our focus is on giving back to the local community to improve the quality of life,” said Kashian. “Every donation we make, every development project we take on, serves to enrich the place we call home. Enhancing access to high-quality health care by training physicians and keeping them here where they are needed most to care for Valley residents is from my perspective one of the most important and much needed investments we can make in the region.”
UCSF Fresno also received $75,000 from Spano Enterprises, a development company headed by Stanley Spano. Stanley and his wife Darlene are Fresno natives and devoted local-area philanthropists. They have two adult children, including Susanne Spano, MD, who is an associate professor of clinical emergency medicine at UCSF Fresno and program director of UCSF Fresno’s Wilderness Medicine Fellowship Program.
“It is truly gratifying to receive this gift from Mr. Spano,” said Dr. Peterson. “We thank him and his family, including our very own faculty member Dr. Susanne Spano, for their contribution.”
“My daughter went to medical school across the country in Philadelphia,” said Stanley Spano. “Thankfully she came home for residency and fellowship training at UCSF Fresno and then stayed on board as faculty. There is an outstanding medical education continuum in place at UCSF Fresno. I look forward to the day when Valley medical students can stay in the region to do most of their training and I am pleased to be a part of efforts to make that happen.”
UCSF Fresno trains more than 300 medical residents and fellows each year and another 300 medical students on a rotating basis. Up to 50 percent of the physicians who complete training at UCSF Fresno stay in the Valley to care for community members.
The UCSF School of Medicine received approval from the Liaison Committee on Medical Education in July 2018 to establish UCSF Fresno as a branch medical campus to lead the SJV PRIME. The training program is designed to prepare medical students to address the unique health needs of the region’s diverse and underserved populations.
Up to six students will start in the fall of 2019, with the goal of admitting 12 SJV PRIME students in 2020. Students enrolled in the program will spend 18 months at UCSF in San Francisco and then move to Fresno for the remainder of their medical school training.