In this issue Edward B. Diethrich talks to Vascular News about his life, his career and plans for the future. It is hard to imagine a vascular surgeon who has had a higher public profile. Once featured on the cover of Life magazine wearing a T-shirt with the words “Ted Terrific”, he pioneered direct to patient advertising and promotion decades before others. Founder of the Arizona Heart Institute with one of the busiest clinical practices in the United States, serial inventor and sucessful businessman who has started six companies, Dr Diethrich has been at the forefront of the endovascular revolution and was one of the founders of the International Society of Endovascular Specialists (ISES).The early years
Ted Diethrich was born in Hillsdale, a small town of 7000 people in Michigan. He started by telling Vascular News how he became involved initially in medicine and why he became a surgeon. “My father had a restaurant. My uncle was a general surgeon in Canada. My mother was a registered nurse and early in her career she worked in ophthalmology. When I was born she stopped working. Then she went back and did private duty nursing. My mother was a classical nurse. She looked like the perfect nurse.” He was intrigued by his mum’s work and sat with her. She told him what she was doing and soon Diethrich developed a real interest in the whole hospital setting.
Next his mother decided to go into operating room (OR) as a circulator nurse and scrub nurse. So he had the opportunity to visit the OR in his early teens. “She allowed me to wash instruments and quizzed me on the name of the instruments .So I learned all the different instruments. It was very exciting.”
At school Diethrich was model student and was editor of the student paper as well as a member of the student council He was also very athletic and loved sports and was on the teams for football, basketball and track. He was also very active in the Presbyterian Church. But he still found time for medicine. At 15 he decided to work on weekends as an orderly. He did not put down his age as he needed to be 16. This caused controversy but he got away with it by arguing that he was going to be 16 in three months. His responsibility was to transfer patients from the floor to the OR and discharge. Diethrich soon became interested in taking care of patients. “I quickly learned how to take temperature, pulse, respiration and make a bed. I was very intent and good and looked to expand my opportunities. So I became an ambulance chaser. As soon as I heard the ambulance, I went to the hospital to see trauma cases and spend time in the OR. On Saturdays practitioners did common operations like tonsils and vasectomies. These were “old duffer” surgeons and I assisted them.”
Diethrich loved the mechanics of medicine and patient care. “I liked to see patients get well as well as figure out what was wrong with them.” An epidemic of polio in the area brought the next excitement. “The University of Michigan was about one hour away from Hillsdale. So I rode with the patients to the University of Michigan in the ambulance. About 20 minutes from Hillsdale one patient died. I took his pulses and got the ambulance to turn back. There was no point going on.” It caused a stir having someone so young pronounce a patient died, but the hospital authorities backed him up and told him that he had done the right thing.
A young surgeon
There was no question of Diethrich studying anything other than medicine at college. He had a number of choices for college but his mother got sick. So he went to University of Michigan nearby. “I got a scholarship and went to Ann Arbor. I was also a musician and took trumpet lessons so I could play in the University of Michigan marching band. At summer school I decided to apply to be an orderly at St Joseph Hospital. I was terrified of nuns under Sister Mary Xavier. She told Peggy Early to take me to OR4. So somehow I became a scrub tech instead of orderly.” This gave Diethrich the opportunity to see Prof Bagley at work who was one of the world famous orthopaedic surgeons at the time. He worked nights, took call and became an expert at scrubbing. Diethrich even started doing animal work under the supervision of Dr Crook, a general surgeon. ” On Wednesday and Saturday I worked in the lab on dogs as premed student. I was interested in vascular grafts and my early papers were on this.”
From Detroit to Houston and DeBakey
So very early on Diethrich decided that he wanted to do surgery. He took a general surgical residency with a vascular rotation with Emerick Szilagi in Detroit, Michigan. Diethrich was also interested in engineering and developed the sternal saw which was the first saw to open the sternum. So Diethrich started his first company in his 20s. But he stopped his involvement as he was told that he could not go to Houston if he was involved in a commercial endeavour. “This was before anyone had ever heard of Tom Fogarty.”
Diethrich desperately wanted to be alongside the great Michael DeBakey in Houston. “I went to interview for 3 days. I never saw Dr DeBakey. I was always told that he was really busy and that I should go to the dome. On the third day I saw Dr DeBakey and chased after him. All Dr Debakey said to me in response was “ugggh”. I thought there was no way that I would get the thoracic residency but I got it.” Diethrich presumed that it was because of his work on a modified Vinberg to put vein in from the descending thoracic aorta instead of using the internal mammary artery. Apparently Dr Ed Garrett who was an associate of DeBakey’s had independently worked on the same thing.
So in 1965 Diethrich started to work with Denton Cooley when suddenly he got call from another resident who pleaded with him to go to work for Dr DeBakey on his next rotation as he was so afraid DeBakey would fire him. “It was a brutal environment. Somehow he persuaded me and so I started a 3 month rotation with DeBakey instead. I was meticulous in preparing for rounds with Dr DeBakey. I prepared sheets with a summary for every patient which I would do and redo until they were perfect. Rounds were a big deal with a whole entourage following Dr DeBakey. It was hard work and for four weeks I never went to the OR. Then Polly, his PX, told me that Dr DeBakey wanted me to scrub in room 2 as second assistant. I then became 1st assistant. But things went downhill. At one point DeBakey said to me “you are not helping”. I did the rounds and never talked back. One Saturday morning I did the drapes for a carotid and DeBakey just walked in and tore them off without a word. This happened three times. I knew how to drape patients and I did them perfectly. Eventually he said. “Dr Diethrich does not know how to drape patients, Dr Garratt do it.”
One day Polly called Diethrich saying Dr DeBakey wanted him to expose a patient for a fem pop. He went ahead and waited 45 minutes after exposing the artery. From the dome his fellow residents began to encourage Diethrich to do the bypass, motioning with their hands that he should start sewing in the graft. So Diethrich went ahead with the bypass and sewed in the graft and did the angiogram. Then he waited another 45 minutes before deciding to close up “Dr DeBakey came in and said nothing. I was convinced that I was going to be fired. The next day Dr DeBakey was doing his rounds and suddenly told me that starting from tomorrow I should go to OR 4 where all the most difficult cases were performed. From that day I passed the test. I had been an outsider who had not been through the programme. So he was testing me to see whether I could stand it. From that day I never left DeBakey’s service. By my second year I was a junior associate of Dr DeBakey.”
Working alongside DeBakey also gave Diethrich the opportunity to travel. “DeBakey had developed a valve at that time. So there was a trip to Italy and Yugoslavia with team of 10 people. Dr Garrett told me that he was not going with the “old man”. He was already making plans to go to Atlanta. So I went to Milan and saw Edmundo Malan. For many years I went back to operate with friends.”
Soon Diethrich became DeBakey’s right hand man. “With Ed Garrett leaving and Jimmy Hill remaining, who was a super technician but not a scientist or writer, I became first assistant to DeBakey. It was a fantastic time. He never said no to anything. I developed all kinds of things leading up to heart transplantation and preservation of the human heart. Money was not an issue. ”
Dr Diethrich did not elaborate on the famous story on Denton Cooley doing the first mechanical heart and the subsequent consequences. But the first heart transplant patient on Michael DeBakey’s service was Diethrich’s patient. “At the time I organised not only to get the heart from a patient but also the lungs, two kidneys and the corneas. It was a monumental event.”
From Texas to the Arizona desert
“DeBakey knew that I would not stay. I was learning and publishing a lot. I worked closely with the two sisters who were medical writers (Lois and Selma). I learned AV skills and directed ten 16mm movies in 3 weeks. DeBakey tried to encourage me to become a Professor of Surgery at a University but I wanted to be a clinician and do research. Cooley invited me to join him. There did not seem to be a clear pathway for me. I had ideas but the environment was like an assembly line. There was no interest in preventive medicine and early detection of disease. Then there was an opportunity to go to Phoenix as cardiologists from there were already sending patients to me in Houston. I started my cardiovascular programme planning in 1970 and created the Arizona Heart Institute. I did the first case in Phoenix in the fall of 1971. I designed and built the Arizona Heart Institute.” Diethrich had sported the demographic situation in Arizona with the growth of the retirement communities. He protected the name Arizona Heart Institute which at first was an outpatient building 20 blocks from the hospital. He was one of the first to do coronary arteriography as an outpatient and this raised a lot of eyebrows. The Arizona Heart Insitute focused on outpatient testing including CV screening and exercise testing. Diethrich quickly developed a total programme with pre-operative and post operative assessment and modification of risk factors which was an area that he felt had been neglected
His operating facilities had the first permanently mounted C Arm from Philips in the OR as he could see that imaging was crucial; However, Diethrich quickly outgrew space in his Phoenix hospital. “St Joe’s did not want to support research so I moved to an old doctor’s hospital that had just been purchased by Humana. They asked if I wanted a Heart Hospital. So we moved the in-patient service to Humana and built a full cardiovascular center. Humana was very successful and things were working well up to the point that they decided to become an insurance company.. Attitudes changed suddenly and the quality of nursing deteriorated. Then MedCath came and I turned them down. Eventually I struck a deal. A 51/49 partnership and we built a hospital. I became Medical Director and was put on the Board. Now it is in its seventh year and is a very successful formula. The clinicians control the hospital. We have a very good partnership, high quality staff and patient satisfaction. It is a super way to practice.”
In his business career Diethrich has started 6 companies. His first was the Sarns Company for a sternal saw and heart-lung bypass equipment. Then he founded the first ultrasound company which was sold to Squibb for obstetrics. More recently he has started both Endologix and EndoMed for aortic endografting.
Diethrich is almost synonymous with the endovascular revolution and promoted endovascular therapy at a time when there was great resistance from the surgical community. “I tried so hard to prove that endovascular is the way of the future in the face of great resistance. Ar the time the SVS would not accept an abstract if it was endovascular. So I started ISES in the face this resistance.” Diethrich was one of the first vascular surgeons to acquire catheter skills. He learned his catheter skills from doing arteriography. He started early with laser technology which he learned from Rod White. “Then a BSC lady with whom I had a close relationship told me to go to Barry Katzen’s and Amir Motarjeme’s meetings to see what the IRs were doing.”
Diethrich is also proud of how he has developed his practice. “I have a brilliant practice. I see 30-40 patients in the morning, then operate. Often patients come as final hope and this is very satisfying.” Previously there had been no emphasis on teaching the public about heart and blood vessel disease and how to prevent cardiovascular problems. His focus on prevention and early detection and teaching the public about the risk factors for heart disease received an overwhelming response. It is often said that Diethrich could run for Governor of Arizona and win such is the level of esteem that he is held in by the retirement communities.
Dr Diethrich is certainly not slowing down. In the week Vascular News interviewed him, he lectured on carotid stent training and credentialing in Miami and survival strategies for CT surgeons in Tampa and managed to fit in two full days of operating in between,”
Diethrich remains very interested in cell technology and myoblasts.. The first clinical case with a NOGA mapping system was performed at the Arizona Heart Institute on November 30 2004. The FDA has just approved a Phase 1 single site clinical trial there for endovascular myoblast transplantation for ischemic cardiomyopathy. There will be a full day on this subject at his International Congress meeting in Phoenix next month which has grown to be one of the leading endovascular meetings in the world.
Finally Diethrich remains frustrated by the failure of the training programme for vascular specialists to meet future challenges. So he is keen to create a training paradigm for the future. “What should the future vascular specialist look like? It should include vascular surgery, catheter skills, imaging, tissue engineering. I would like to start rotations for fellows. We may even secure NIH funding.”
Last word for vascular surgeons
“As for vascular surgery, the writing is on the wall. They must adapt and learn catheter skills. They are set to lose carotid endarterectomy. Cardiologists have vascular surgeons on the run. The biggest expansion is in venous disease and the cardiac surgeons are already looking to retrain. 30% of new customers for the endovascular venous procedure are cardiac surgeons.”
Fact File: Ted Diethrich
Born: August 6, 1935; Toledo, Ohio
University of Michigan, Ann Arbor, Michigan
AB, 1956; MD, 1960
1960-1961: St. Joseph’s Mercy Hospital in affiliation with the University of Michigan, Ann Arbor, Michigan
1961-1962: St. Joseph’s Mercy Hospital and the University of Michigan Medical Center, Ann Arbor, Michigan
1962-1964: Henry Ford Hospital, Detroit, Michigan
1964-1965: St. Joseph’s Mercy Hospital and the University of Michigan Medical Center, Ann Arbor, Michigan
1965-1966: Thoracic/Cardiovascular Surgical Residency: Baylor College of Medicine, Houston, Texas,
1966: American Board of Surgery
1967: American Board of Thoracic Surgery
1965-1966: Assistant Instructor in Surgery, Baylor College of Medicine, Houston, Texas, (Concurrent with Thoracic Surgery Residency)
1966-1967: Instructor in Surgery, Baylor College of Medicine
1967-1971: Assistant Professor of Surgery, Baylor College of Medicine
1971-now: Medical Director and Chief of Cardiovascular Surgery and Endovascular Surgery, Arizona Heart Institute, Phoenix, Arizona
1987-1998: Director and Chairman, Department of Cardiovascular Services; Director and Chief, Cardiovascular Surgery, Columbia Medical Center, Phoenix, Arizona
1995-now: Voluntary Professor of Surgery, University of Kentucky, Chandler Medical Center, Lexington, Kentucky, 1995-present
1997-now: Medical Director and Chief of Cardiovascular Surgery, Arizona Heart Hospital, Phoenix, Arizona
2001-now: Voluntary Adjunct Professor, Division of Clinical Education, Arizona College of Osteopathic Medicine, Midwestern University
2002-now: National Advisory Council Member, Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI