An Interview with Dr. Pat Elwood

Dr. Pat Elwood is a professor of neurology at the University of Illinois College of Medicine at Peoria, corporate director of neurosciences at OSF Heathcare, and director of Illinois Neurological Institute at OSF Saint Francis Medical Center. He recently stepped down as head of the Department of Neurosurgery at the University of Illinois College of Medicine at Peoria.

Elwood began private practice in Peoria in 1961, bringing with him aneurysm and brain tumor surgery, signifying the establishment of Peoria as the surgical treatment center for neurological disease within central Illinois. A few of his accomplishments over the years include helping to form the Illinois Neurological Institute at OSF, establishing the first LINAC radiosurgery program in downstate Illinois, and founding a comprehensive stroke service and network.

He and his wife have three grown children.

Tell about your background, schools attended, family, etc.

I was born in Peoria in 1932 at Methodist Hospital. I grew up in the country west of Peoria and attended a two-room grade school, then Woodruff High School. Three teachers there had a remarkable influence: Mildred Martins in mathematics, Dorthea Martins in English, and Andrew Heflin in American history and government. I attended Bradley University and was remarkably stimulated by Dr. John Shroyer in chemistry. After three years, I went to the University of Illinois College of Medicine, graduating in 1956. I did a rotating internship in Minneapolis, Minn., at Minneapolis General Hospital, then came back to a general surgery residency at the University of Illinois Research and Educational Hospitals with Dr. Warren Cole. A residency in neurology and neurological surgery with Dr. Eric Oldberg followed, and I came to Peoria in 196l to begin the practice of neurosurgery.

My wife, Gladys, was a nurse at the Minneapolis General Hospital and a student at the University of Minnesota. She taught at Cook County Hospital and Rush while I was a resident. We have one daughter, Katherine, and two sons, Eric and John Patrick. Eric recently joined the faculty in the Department of Surgery here in the section of Plastic Surgery.

I've been associated with the University of Illinois since entering the College of Medicine in 1952. I was the first department head appointed when the College of Medicine at Peoria was established and served as professor and head of the Department of Neurosurgery until January 1. We established a residency in neurosurgery in 1980, and Dr. Olivero, our current residency program director, was our first resident.

Who or what influenced you to become a physician? To specialize in neurosurgery?

My interest in science was solidified with my experience with John Shroyer at Bradley. His persistence in pushing me to achieve my best encouraged me to attend graduate school; it was obvious to me that I would be unhappy as a laboratory scientist, and medicine seemed a good alternative. In medical school, the nervous system was the most interesting area I studied, and a single book sealed my fate: Wilder Penfield's Epilepsy and Functional Anatomy of the Human Brain. This detailed his experience operating on patients with epilepsy while they were awake and simultaneously studying human brain function. I read it in a long weekend, and this was the basis for my career choice. I had some deviations along the way because, at that time, neurosurgery was believed to be an impractical field filled with eccentrics. In addition, there were already 350 people in the field, so it was felt to be full. For me, it was clearly the right and probably only choice.

You'll retire from some of your responsibilities this fall. Why did you make the decision at this time?

I hope to become Emeritus Professor of Neurosurgery October 1, after leaving the headship of the Department January 1. I was the first permanent department head appointed at the medical school here, and I felt a new department head would supply a new vision and enthusiasm. I also wanted to concentrate on my two major interests: the development of a comprehensive radiosurgery program using the Gamma Knife, Cyberknife, and IMRT and the development of the Illinois Neurological Institute as a leading center for neurological care, research, and education in the Midwest.

Your career has spanned more than 40 years and includes surgeon, teacher, researcher, and lifesaver. What have you enjoyed the most? Of what are you proudest?

I believe my most significant achievement is the establishment of residency training programs in neurology and neurological surgery at this campus. The neurosurgery residency is now 22 years old and has gradually became a stronger program as the result of a great deal of work on the part of each member of the faculty. Dr. Henderson was an intern on our neurosurgery service, and Drs. Olivero, Tracy, Dinh, and Lin were all residents in neurosurgery here and are now faculty members. We've had many medical students enter neurosurgery careers, beginning with Dr. Richard Lister. Day-to-day neurosurgical care of patients has been probably the major source of enjoyment in my life here in Peoria, although at times mixed with anxiety and sadness.

Talk about helping to bring about the University of Illinois College of Medicine at Peoria. Why did you believe Peoria should have a school of medicine?

I really wasn't a significant factor in the decision to start the medical school at Peoria. That was the result of the Campbell report and a realization on the part of the university that we were exporting many doctors trained in Chicago to California and other places, and downstate needs weren't being met. I was quite involved after it became evident that we would have a school. I asked the new dean, Dr. Cotsonas, to have a clinical neurosciences department and was chairman of the committee for instruction the first four years. We were heavily influenced by the Organ system curriculum at Case-Western because Dr. William Albers had attended Case. I was excited by the opportunity because I felt it would be a unique opportunity to participate in the development of medical education with a small class and the resulting close relationships with the students. In the early days, many of the students entered neurosurgery training from the school, and in 1980, we had the opportunity to begin a residency in neurosurgery here.

How has the understanding of neurology and neurosurgery changed through the years? What breakthroughs or treatment options do you believe the future holds?

I believe neurology and neurosurgery has suffered from serious misconceptions in medical education-that they deal with very rare or unimportant conditions, it's something general physicians need not know, and they really have little to contribute beyond a diagnosis. In some respects, these things were true many years ago. In the past decade, neurology and neurosurgery have been remarkably productive, with new diagnostic tools and remarkable new treatments that have significantly changed many formerly disabling conditions. The management of stoke, many tumors, and spinal injury have all been vastly improved.

Deep brain stimulation is changing Parkinson's disease and movement disorders, endovascular surgery is changing the care of stroke and ruptured aneurysms, and non-invasive techniques has drastically changed how spine surgery is done. The ability to non-invasively look at brain and spinal cord structure and function will change our diagnosis and treatment. The potential for gene therapy, stem cell transplantation, and other molecular biology techniques to change the care of brain tumor, stroke, and degenerative diseases is exciting and eminent.

Tell about the Gamma Knife: what it is, its benefits, etc.

The Gamma Knife is an instrument used to deliver very precise, high-dose radiation to problems in the brain. It uses a large cage, rather like a football helmet, with 201 Cobalt 60 sources, all directed at the same target. We use it to treat metastatic brain tumors, some benign tumors in the base of the skull, acoustic tumors, and arteriovenous malformations (AVMs). We also use it to treat the severe facial pain of trigeminal neuralgia. It avoids an open operation; the patient stays overnight or may go home that afternoon and often can go to work the next day. It's a very non-invasive treatment. There are now about 120 centers worldwide-65 in the U.S.-and it's been used to treat perhaps 180,000 to 200,000 patients. It certainly has changed the treatment of acoustic tumor, some AVMs, and metastatic brain cancer. We have a number of patients with metastatic melanoma who've responded quite well.

Tell about the Illinois Neurological Institute at OSF Saint Francis Medical Center.

The Illinois Neurological Institute at OSF Saint Francis Medical Center is a hospital within a hospital, much like the Children's Hospital of Illinois, but younger and less developed in some respects. It integrates the activity of neurology, neurosurgery, neuroradiology, neuropathology, and physical medicine and rehabilitation. The INI has residencies in neurology and neurosurgery and fellowships in stroke, spine neurosurgery, and neuroradiology.

There are 12 neurologists, eight neurosurgeons, four neuroradiologists including an endovascular neuroradiologist, a pediatric craniofacial plastic surgeon, one neuropathologist, and two physiatrists on staff, with six neurosurgery residents and eight neurology residents.

We have many specialized services-cerebrovascular and endovascular neurosurgery, epilepsy monitoring and surgery, complex spinal surgery, movement disorder care and surgery, pituitary center, a muscular dystrophy clinic, a nerve and muscle service, multiple sclerosis clinic, pediatric neurosurgery and neurology, pediatric craniofacial and spina bifida clinics, neuropthalmology clinic, vertigo clinic, headache center, peripheral nerve service, and radiosurgery with a Gamma Knife center. We have a very large neurological intensive care and a comprehensive neurological rehabilitation program.

The Illinois Neurological Institute provides the full spectrum of complex care for illness affecting the brain, spinal cord, and peripheral nerve and also provides graduate education and research in these areas. All of our staff are faculty members in the appropriate University of Illinois department. Our brain tumor neurosurgeons work with Dr. Jasti Rao in brain tumor biology research, and Dr. Lin has a hydrocephalous research program at Bradley University.

Have the numbers and/or types of brain tumors increased in the past decade?

Our service cares for many more brain tumors, but the incidence hasn't increased in the population. Because of our radiosurgery program and our research program, we have an opportunity to care for a large number of referred patients with brain tumor.

You've recruited many surgeons to the area. What's the reputation of the quality of services in central Illinois?

I believe the INI has gradually been recognized as a unit that can provide the full spectrum of care for neurological problems. This has made recruitment of talented physicians less difficult because they feel there's an opportunity here to do high-quality work, teach, and do clinical research.

Tell about the comprehensive stroke service and network. What are its missions, activities, etc.?

A number of years ago, it became apparent that stroke care could be improved, much as cardiac care had improved in the United States. At that time, stroke units in hospitals were just in their infancy, and Cincinnati had the only effective stroke network in the U.S. I invited their director as a visiting professor, and we made plans to develop a stroke network in Illinois that differed from Cincinnati in that it would be largely rural and, hence, have different demographics. We were able to recruit Dr. David Wang in November 1995, and he's developed a network of 23 hospitals.

Shortly after his arrival, the paper on IV thrombolysis was published, and it gave a real boost to this development in that it was a flag to rally around. The purpose of the unit and the network is to improve the prevention and care of stroke in the central portion of Illinois and to do research that has general application. We've just developed a stroke fellowship that will enhance the research program. Close integration with Dr. Fraser in interventional neuroradiology, Dr. Zagardo and Dr. Larry Wang in MRI, and Dr. Lanzino in neurosurgery makes this a very comprehensive program.

What, if any, misperceptions may people have regarding stroke? What do you want everyone to know about stroke?

Historically, there's been a fatalism on the part of patients and their doctors that nothing could be done for stroke and, hence, there was no urgency about care. Both patients and doctors are gradually changing, and the slogan "time is brain" has made progress. The most important concept is that if there's a change in brain function or truly sudden onset of headache, immediate evaluation by a physician knowledgeable about stroke must be done.

Peoria has big plans to raise its profile as a research and treatment destination. With your background, what, in your opinion, are the necessary steps the city must take to make its goals a reality?

Patients seek out answers to their problems, and increasingly, they're able to obtain good information about service. It's critical to recruit outstanding specialists to provide a very comprehensive service. These people must be articulate and develop both a regional and national reputation. Our medical institutions and the University of Illinois must develop each medical specialty service to be comprehensive, with high-quality research and graduate education programs. The latter two items are critical to recruit and retain high-quality specialists. Unfortunately, the infrastructure to begin research programs and fellowships is expensive and can't be funded by patient care dollars. In most mature medical centers, these programs have been started with philanthropy. After the programs have developed a bit, if they're good, they become self-supporting from extramural grant funding.

In recruitment, we compete with institutions with substantial endowments that can offer a new physician substantial laboratory support. I feel my most important job at this point is raising those funds so very high-quality people will feel they can have a fruitful career in this medical center.

What are your future plans?

Currently, I'm developing a very active clinical program in radiosurgery with the Gamma Knife for brain tumor and AVM. I'm using the Cyberknife at the Community Cancer Center in Bloomington to develop radiosurgery techniques for spinal tumor. We'll add another type of image guided linear accelerator in the next year or two to further extend radiosurgery as a treatment entity. We're fortunate to have three radiation oncologists and three medical physics staff who are quite enthusiastic about this task. This is one portion of our neurosurgery department's commitment to developing minimally invasive treatments for the brain and spinal cord.

I'm the director of the Illinois Neurological Institute, dealing with the day-to-day administration with the support of a wonderful enthusiastic staff. We still have a great deal of infrastructure to develop, as the technology changes by the month. Finally, fund raising to develop research laboratories remains a critical priority.

Is there anything else you'd like our readers to know?

I sincerely appreciate the opportunities I've had in Peoria, my hometown. OSF Saint Francis Medical Center, over the years, has been remarkably willing to take risks. I talked a lot with Sister Canisia and Ed McGrath, and they often made commitments on very limited data: the first CT scan, MR scan, and neurological ICU in Illinois. I believe in some respects it's possible to develop a successful medical referral center in a city the size of Peoria because it can be easy for patients' families when contrasted to a large metropolitan area. I do feel it's essential that the public leaders recognize this is possible, that it's happening, and they should support it. It'll provide them with the kind of city that will cause their own talented children to return. My son, Eric, a pediatric craniofacial plastic surgeon, returned, to the great pleasure of my wife and me. I thought he would spend his entire career in Atlanta, but the development of our medical center seemed to him to have great potential.  IBI