Jack and Jane Rose met Dr. Paul Gurbel in 2012 when they wanted a second opinion.
Jack Rose’s father and two half-brothers died from heart disease before they were 50, and when Jack suffered a heart attack in 1984 in his 40s, he feared he might follow in their footsteps, especially after doctors told him “not to bother putting more money in my pension” and gave him about five years to live.
Jack, whose son later perished to heart disease, said he’s always approached life with a proactive, positive attitude, so he consulted with several other cardiologists. Finally he met a young doctor who thought more could be done; he sent Jack to Washington, D.C. for an angioplasty procedure — his first of several — that successfully opened a blocked artery.
Today at a youthful 75, Jack jokingly refers to his health care team
as the “electricians, plumbers and carpenters” that have successfully performed multiple catheterizations for angioplasty and stent insertion, cardioversion (electric shock therapy) to correct atrial fibrillation, two bypass surgeries and a pacemaker insertion. Jack leads an energetic life with wife Jane, 62, and is active with AIPAC and the Jewish National Fund; and is a vice president and advisor to construction at the Cordish Companies.
“I have a condition but keep it attended to,” he said.
Jack is a much more informed patient now and pays close attention to diet and exercise, he added, but the biggest message he heeds is “get a second opinion,” a crucial lesson the couple faced about two years ago.
In January 2012, Jack landed in New York returning from a JNF Israel trip and felt so exhausted he had to stop every couple of blocks while walking around Manhattan with his friend, but he attributed it to the bracing winter cold. From New York he was scheduled to fly to Portland, Ore., to visit family a couple of days later.
But the day before flying west he visited a doctor who discovered his heart was in atrial fibrillation, a state of irregular heart rhythm. Jack consulted his doctor in Baltimore, and she recommended a standard cardioversion procedure that shocks the heart back into regular rhythm and scheduled him for the procedure at Sinai Hospital. He canceled the Portland trip and traveled back to Baltimore, but serious chest discomfort the night before his scheduled procedure prompted an earlier visit to Sinai by way of an ambulance.
A day after the cardioversion, Jack’s doctor said he could go home with medication.
“I didn’t feel good,” Jack recalled. “I’d had [procedures] done several times before, and I didn’t feel well but she said [it would] be fine.”
Neil Meltzer, president and CEO of LifeBridge Health and a casual friend of Jack’s, heard he was at Sinai and stopped by his room to say hello. When Jack and Jane explained that they weren’t comfortable with the diagnosis from the first doctor and were considering a second opinion, Meltzer suggested his own cardiologist at Sinai, Dr. Paul Gurbel.
Gurbel “had been doing surgery and came to my room with his assistant in his scrubs,” said Jack. “He’d had [the assistant] pull all my records, so by the time he came in to talk to me, he knew everything about me.”
After questioning Jack some more, Gurbel recommended catheterization to determine more precisely the condition of Jack’s heart. In the meantime, Jack’s pain increased to the point where he was given morphine.
After catheterization, the “analysis was that [my heart] was 98 percent blocked,” said Jack. Gurbel “said if this would have happened at home, it could have been fatal.”
Eventually Jack had arterial stents inserted and ultimately had a second bypass surgery after Gurbel and the team at Sinai discovered problems with the first deteriorating bypass.
“In addition to treating patients, Gurbel does research,” said Jack. “And I think his research made him do what he did. He went to the records … and saw what he was looking for.”
In addition to treating complex cardio patients, Gurbel is the director of the Center for Thrombosis Research at Sinai. The center is unique, he said, because it exists in a nonacademic community hospital instead of a traditional university system.
Since 1998, Gurbel and his team’s findings have prompted the American Heart Association to adjust prescription guidelines for stent patients and driven the pharmaceutical industry to design new drugs.
Gurbel’s desire to study the complexities of thrombosis began when he was chief resident in the Department of Medicine at Duke University in the late 1980s. There, Gurbel and his team were the first in the southeastern United States to insert stents, but later clotting became a problem.
“In the late ‘80s early ‘90s we just didn’t know how to deal with [the clotting], we were trying all sorts of cocktails, and it intrigued me, the mechanism of the clotting process,” recalled Gurbel. The doctors would also catheterize patients to open up arteries, “but then it would clot off again. That’s one of the major reasons why I study platelets and the role they play in the clotting process.”
In 1990, Gurbel went to University of Maryland Hospital as its director of interventional cardiology and started an experimental lab, where he developed methods to model heart attacks to study why arteries get blocked by clotting cells.
In 1998, Dr. Bart Chernow recruited Gurbel to Sinai.
“So he brought the research operations I had at University of Maryland to Sinai,” Gurbel said, “and we began studying what happens in humans, to their platelets when they have a heart attack. And we wrote papers on it.”
The team was first to measure the effects of the drug Plavix, also known as Clopidogrel, which is used to prevent blood clotting in heart patients, particularly those who received stents to open blocked arteries.
Because of the research lab’s proximity to patients in the cardiac catheterization lab, the Sinai team could precisely measure medication effects around the clock and record “how fast it worked, how uniformly it worked and how potently it worked,” said Gurbel.
“So I took the risk to write the first paper,” said Gurbel, “and I had ultimate confidence in the results.
“It took a long time to get the work published [in 2003]. The drug was a $9 billion a year drug at that time,” he added. “This was a drug that was being heavily relied upon, then this report came out that it wasn’t really working.”
Gurbel’s team ultimately discovered the effective dosage of Clopidogrel for a stent patient was actually double the amount originally prescribed. In 2005, they published a landmark paper in the Journal for the American College of Cardiology and in Circulation, the journal of the American Heart Association, that “showed patients who had stents inserted and then developed heart attacks after their procedures were poor responders to Clopidogrel,” said Gurbel. “This was the first link between a lab test of high platelet reactivity to event occurrence.”
The Center for Thrombosis Research conducts testing for pharmaceutical companies — its research led to Astra Zeneca’s blood clot inhibitor Brilinta — and projects sponsored by the
National Institutes for Health. The lab’s research methods have been replicated around the world.
Jack is grateful for the research.
“I’m like an old car, you gotta keep taking it back to the shop,” said Jack, laughing. “Some of the docs I see say to me, what haven’t you had? But I’m still here. And I’m still really grateful to the team at Sinai who have taken care of me.”