While Dr. John Owens does a first-time check up on Scott Dietz, 4, his mother, Carla, anxiously watches the doctor.
Photograph by Jacqueline Ramseyer
Heart Beat
Pediatric cardiologists find a niche for their specialty in Willow Glen
By Erin Mayes
Photographs by Jacqueline Ramseyer
Ron and Angie Giuffre brought their 1-week-old son, Michael, to the standard checkup with his pediatrician. As expected, the doctor listened to Michael's heartbeat with her stethoscope. Angie recalls the doctor pausing and listening closely with a look of seriousness.
It was a heart murmur, the pediatrician explained, something that would need to be looked at by experts.
Because their child seemed perfectly healthy, the Giuffres were confused. They anxiously researched heart murmurs on the Internet when they went home that evening. The next morning, they drove dazedly to Pediatric Cardiology Associates on Willow Street in Willow Glen, the community in which the Giuffres also live.
Dr. Stafford Grady Jr., a pediatric cardiologist, sat the couple down and asked them a series of questions, the same ones he asks all of his new clients: How did the pregnancy go? Did the parents smoke? Did the parents drink? Did the parents do drugs? Was there a history of heart disease in the family?
The Giuffres already had one healthy child, Christopher, and had done nothing differently this time around. During her pregnancy, Angie, now 40, had gone for an amniocentesis and ultrasounds, with results showing no diseases or abnormalities. Grady took an echosonogram of Michael's chest and announced that the boy's condition was more than a mere heart murmur. Michael had a ventricular septal defect, which left an opening between the lower two chambers of his heart. Additionally, the newborn had coarctation of the aorta, a condition in which the main artery that carries blood from the heart to the body is pinched or constricted. Michael would need to go to Stanford Hospital immediately for emergency surgery.
"I was so shocked that I could not absorb it," Angie said. "It just didn't seem like it was really happening."
The Giuffres brought their 8-day-old baby to the neonatal intensive care unit at Stanford Hospital and waited more than four agonizing hours for the surgery to be completed. Surgeons explained afterward that the procedure took longer than expected because they found an area in Michael's aorta that narrowed, necessitating the removal of a vein from his left arm to widen it.
Now 3 years old, the boy has a faint scar below his left shoulder blade from the surgery. Because it wasn't open-heart surgery, the doctors did not have to operate through his chest. Michael is like any 3-year-old, except that he returns to see Grady every few months for checkups. The toddler is also taking a low dosage of a blood pressure medication that thins his blood to ease the passage through his arteries.
Sometimes coarctation of the aorta can recur, and the Giuffres have been told that Michael may eventually need a balloon angioplasty, a procedure in which a balloon-tipped catheter is inserted into a narrowed area of a blood vessel, inflated to stretch the area, and then removed.
Photograph by Jacqueline Ramseyer
Michael Giuffre, shown with mom, Carla, in Grady's patient waiting room
Heart Monitors
The team of four doctors at Willow Glen's Pediatric Cardiology Associates serves infants, children and adolescents.
Dr. John Owens started the practice in the 1970s after moving to the Bay Area from Massachusetts, where he trained at Boston Children's Hospital. Opening his own practice was an unusual move because pediatric cardiologists didn't normally branch off on their own, away from hospitals, Grady said.
Grady, 50, was the second to join the practice, coming on board in 1982. Drs. Rhonda Lappen and Michael Griffin joined the practice in the 1990s. An amiable man with laughing eyes behind his glasses, Grady was once known for wearing bow ties to work, a habit he said he gave up so as not to appear too doctorly and intimidating to children. He may now be seen wearing khakis, a polo shirt and clogs.
Grady's tour of the office features four child-friendly examining rooms with a number of stuffed animals and toys to distract young patients from their exams. Mounted on the wall in one room is a television playing a videotape of Mickey Mouse cartoons. "I put that there so the kids could watch cartoons while we watch their hearts," Grady said.
Learning to Trust: Michael Giuffre, 3, gets a check up from Dr. Stafford Grady Jr. at the Willow Glen's Pediatric Cardiology Associates clinic. Besides being born with a ventricular septal defect, he was also born with coarctation of the aorta, a condition in which the main artery that carries blood from the heart to the body is pinched or constricted.
Photograph by Jacqueline Ramseyer
An electrocardiogram--which shows the electrical impulses produced by the heart--and a cardiac color ultrasound machine sit in the corners of the rooms as if afterthoughts, although they are important parts of everyday exams. One room is dominated by a treadmill with countless wires attached to it; this machine is used for exercise testing.
The practice didn't always have so much space, and the equipment is more advanced than it was 10 years ago. In the 1980s, patients would also have chest X-rays taken, something that is no longer necessary, Grady said.
The office was remodeled and much of its equipment acquired after September 1989, when a fire destroyed the office. Around the same time, a nearby orthodontist's office was set on fire and a dentist's office across the street was torched. People had dubbed whoever set the fires the "Willow Glen serial arsonist." Whoever the arsonist was, he or she used loads of patients' files as tinder for the blaze. Grady described the resulting damage as "a total loss."
Photos of deceased children that had been placed on the wall in remembrance were burned to ashes. Most of Grady's certificates of achievement were yellowed and damaged by water from firefighters' hoses. The certificates proved salvageable, although some of the signatures washed off and the water left rippling stains on the paper. The practice's insurance company suffered a loss of approximately $375,000 due to equipment damage. The cardiologists moved out of their burned-out building into a smaller space for about nine months while repairs were made.
Photograph by Jacqueline Ramseyer
A Perfect Patient: Although a now healthy and rambunctious 3-year-old, Michael Giuffre is a veteran patient of pediatric cardiologist Stafford Grady Jr., of the Pediatric Cardiology Associates in Willow Glen.
Heart in Hand
With the fire more than a decade behind them, the doctors have succeeded in their thriving practice, which continues to grow because more operations succeed and patients are living longer, Grady said.
The majority of the practice's patients are referred by general practitioners or pediatricians who notice something abnormal in an exam. Other clients result from the children's own observations about their health; perhaps they've fainted or even complained that their hearts hurt.
Grady said that in 99 percent of those cases, the children are fine.
Because it is a small, specialized practice, the doctors at Pediatric Cardiology Associates can usually tell parents what is wrong with their children on the same day as the exam, whereas the turnaround on the same tests at large hospitals can take much longer. Parents are always worried by the time they make it to Grady's office, he said.
"When a pediatrician says, even in their most reassuring tone, 'Your child might have a little heart problem,' families start to worry." To help a child's guardian relax, the doctors will try to establish a "human connection" by asking questions--not always health-related--simply to put the family at ease.
"It would be a lot faster if I put everybody in that room and said, 'Take off your clothes' and 'Here's your medication,' " Grady said. "It would take two minutes. You've got to establish a bond of trust with the families."
The doctors will ask the standard questions about cigarettes, alcohol and drugs. "Everybody says, 'I quit after I found out I was pregnant,' " Grady said. "Some people say, 'Why do you ask?', which is a dead giveaway." Grady said he doesn't ask these questions to inspire guilty feelings on the part of the mother, so if the child does indeed end up having a heart condition, "You have to absolve them of guilt. Guilt is not a productive emotion. I will tell them, 'We live in the era and we live in the place where this can be fixed. Be thankful that this is fixable.' "
Dancing around parents' fears and making sure there is an established relationship of trust is all part of the "art of medicine," as Grady calls it, adding, "Most of the time, my job is a happy job."
Michael Giuffre showing the scar left on his back from undergoing heart surgery at Stanford Hospital when he was only eight days old to correct a ventricular septal defect.
Photograph by Jacqueline Ramseyer
Heart Stopper
As the group manager at Pediatric Cardiology Associates, Patricia Pfahnl never imagined her own grandson, Andrew Hickman, would become a patient to the doctors she works with every day.
Like Michael Giuffre, Andrew was diagnosed with coarctation of the aorta and underwent surgery five years ago.
Now 9 years old, he is a healthy third-grader at Willow Glen Elementary School. "You see the devastation when people are told that their child has a cardiac defect," said Pfahnl, who has worked at the practice for 20 years. "You just never know about the anxiety they're experiencing until you're on the other side."
When the Giuffres came in three years ago, Grady guided them toward Pfahnl for reassurance. "I told them, 'Here's a picture of him and he's doing just fine,' " Pfahnl said. " 'You're going to have one of the best doctors operating on him--the same one who operated on my grandson.' I told them things to watch out for and told them they could call me at my house whenever they wanted to. They just felt better knowing Michael would have the same doctor."
Photograph by Jacqueline Ramseyer
Doctor's Pal: Pediatric cardiologist Dr. Rhonda S. Lappen is pictured with patient Jennifer Borba, 3, at Willow Glen's Pediatric Cardiology Associates clinic.
Pfahnl describes the doctors as compassionate and generous. "They give so much," she said. "This is probably the only place that if you really have an infant with a heart problem and are destitute, you can leave knowing your child is going to get the treatment it needs."
The doctors have gone so far as to buy tires for one of their patients, give out money or drive home mothers who would otherwise walk their babies home in the rain.
Grady recalls a time that he circumvented an insurance company in order to save the life of a baby born with Hypoplastic Left Heart Syndrome, which usually results in the death of the child within days or months of birth. The reparative surgery for the condition had its best success rate in Boston, so rather than wait for the insurance company to approve an air ambulance, which could take days and result in the child's death, Grady booked two seats on a flight out of the Bay Area to Boston and had an ambulance meet the mother and daughter when they arrived. That was 19 years ago and the girl is still alive. "It's better to ask for forgiveness than permission," Grady said sheepishly.
Grady said it's hard for him to pinpoint any one reason why he became a pediatric cardiologist and that it's likely a culmination of many things. His own father was a "frustrated doctor" who would have gone into medicine if it had been achievable at the time. Instead, he worked toward a degree in law while putting himself through school and eventually became a prominent figure in his community.
Grady's grandfather died from pneumonia when Grady's father was only 8 years old. The death could easily have been prevented if he'd only gotten sick a few years later. Grady's younger brother, Shaun, was a history major at Stanford University before deciding to earn his doctorate and become an obstetrician/gynecologist.
Before going to medical school, Grady worked as a cardiac bypass surgery lab researcher, gaining a certain comfort level with cardiology. When he started medical school, it was with the intent of becoming an adult cardiologist. That was before he met one of his great mentors, Joe St. Geme, Jr., a famous pediatrician, and ended up applying for an internship with Boston Children's Hospital and being accepted. Combining cardiology and pediatrics was the logical next step.
Photograph by Jacqueline Ramseyer
A Team: Willow Glen's Pediatric Cardiology Associates and its team of doctors is made up of pediatric cardiologists (from left) John Owens, Stafford Grady Jr., Michael Griffin, and Rhonda S. Lappen, not pictured. The doctors have been helping infants, children and adolescents in the Bay Area with heart disease prevention medicine.
Have a Heart
Angie Giuffre had been working for a high-tech company at the time Michael was born. She took the standard three months off and then went back to work part time, but the demands of the fast-paced industry were overwhelming. Her higher-ups were asking her to work more hours and spend time away from her family. "I just really lost interest," Giuffre said. "It just didn't mean that much to me anymore. I wanted to work in a place that meant something to me and my life and my family. What happened with Michael really hit home, [and got me] thinking, 'Life is too short; there's more to life than money.' "
She applied for a position at the American Heart Association, which had an opening for an operations manager. She has worked there for the last two years. As a nonprofit agency, the association's pay isn't nearly as lucrative as the high-tech company's was, but, Giuffre said, "A lot of things outweighed the salary."
Giuffre and her husband have spent many extra hours raising funds for the association and are looking forward to September's Silicon Valley American Heart Walk, which raised more than $500,000 last year. The Giuffres' team of 15 walkers has raised $4,457 in the last two years.
To reach Pediatric Cardiology Associates, call 408.448.2817 or visit them at 1688 Willow Street, Suite C, in San Jose. For more information about the American Heart Association, visit americanheart.org.
Willow Glen, California Since 1992
