Rick Amparan had a badly scarred liver after decades of heavy drinking – and a grim prognosis of only three to six months to live – when he made an appointment four years ago to see Marina Roytman, MD, FACP, a UCSF Fresno liver diseases specialist and Liver Program director.
Dr. Roytman told Rick, 69, of Clovis, his liver would eventually stop working properly and he would need a transplant. But she could help him stay healthy for as long as possible and prepare for a transplant, if he followed these steps: maintain sobriety, regularly attend substance use meetings and have a support system, among other requirements.
She pushed him mentally, physically, and emotionally, but foremost she gave Rick hope. “She was a very positive person. She didn’t give up on me.”
Dr. Roytman remembers having a lot of “heart to hearts” with Rick about the importance of attending support group meetings. “That did not fully hit home for a while,” she says.
With the support of his wife, Debbie Rogers, Rick maintained his sobriety and met the criteria to be on a list for a liver transplant at UCSF in San Francisco. In December 2021, he received a donor liver.
His journey to sobriety was not easy, Rick says. He started drinking as a teenager and over many years the use of alcohol increased. “The alcoholism is a lot stronger than your mind. And it’s easy to just say, ‘tomorrow I’m going to slow down.’”
Alcohol misuse is a disease, Dr. Roytman says. “And we should approach it as a disease rather than a moral failure.” Rick is doing great, she says. “He’s committed to sobriety. He’s helping others in his situation. He is an amazing, amazing role model.”
Increasingly, she is sounding an alarm about alcohol use and liver disease. And her concern goes beyond patients like Rick whose chronic alcohol use led to cirrhosis of the liver. Since the COVID-19 pandemic, she is seeing younger patients in severe liver injury who have alcohol related hepatitis or severe inflammation of the liver. The condition develops much quicker and can be just as life-threatening as cirrhosis.
“Instead of literally years and decades of excessive drinking, we may see weeks or months of excessive drinking and instead of the liver being small and shrunken like in cirrhosis, we’re seeing massively enlarged and inflamed livers,” Dr. Roytman says. “This is the hallmark of alcohol related hepatitis.”
Cases of alcohol related hepatitis have skyrocketed since March 2020, the beginning of the pandemic. A UCSF Fresno study, led by Dr. Roytman, found a 51% increase in admissions for severe alcohol related hepatitis in 2020 as compared to 2019, and a 64% increase in 2021 as compared to 2019.
The study looked at patients seen at Community Regional Medical Center, Clovis Community Medical Center and Fresno Heart & Surgical Hospital.
Women and patients younger than 40 years of age are suffering the most from alcohol related hepatitis. In women, hospital admissions were up 129% in 2020 from 2019 and increased 179% in 2021 from the baseline. Similarly, patients younger than 40 years of age had a 100% increase in hospital admissions in 2020 and a 136% increase in 2021 from the 2019 baseline.
This year, Dr. Roytman and her team looked at a National Inpatient Sata sample of 800,000 patients and saw a massive increase from 2019 to 2020 in hospital admissions for alcohol related hepatitis with particularly startling increases for women and young patients.
Patients with alcohol related hepatitis sometimes recover slowly, but “the hardest thing is we really are not able to fully predict with 100% certainty who is going to recover and who is not going to recover,” she says. “Patients may die just as well from alcohol related hepatitis as they are from alcohol related cirrhosis – and sometimes even faster.”
She recalls at least a half a dozen patients in the first half of 2023 who were referred to transplant centers, but that is an underestimate of those in need. “These are the good candidates. They have good support systems; they understand they got into trouble with drinking; they are willing to engage in treatment; they have a car to get to the transplant center.”
Dr. Roytman gets asked why alcohol related hepatitis has increased since the start of the COVID-19 pandemic and its ensuing lockdowns and surges. “Our hypothesis is that COVID-19 created this perfect storm. Early in the pandemic we had a mental health crisis. People were terrified, people were depressed, people were anxious. There were shelter in place orders, which created easy access to alcohol as well as lack of distraction from consuming it,” she says. Additionally, the economy was taking a nosedive. People were losing their jobs, and some were losing their homes. “So, lots of stressors there.”
Now, more than three years into the pandemic, Dr. Roytman says alcohol related hepatitis cases remain high – perhaps driven now by the stresses associated with rising inflation, and more so by the habits of heavy alcohol consumption acquired during the pandemic years – and she is doing her best to increase awareness. “We really need a large public awareness campaign to recognize that this is a huge problem.”
Her prescription for individuals: “I really want us to remember how life was before the pandemic. Let’s go outside. Let’s have a picnic at the park. Let’s go back to the gym. Movie theaters are open. Let’s find other things that give us joy rather than focus on alcohol.”
She recognizes the stigma surrounding alcohol use disorder remains a roadblock to sobriety for many. “I feel it is more stigmatizing than smoking. So, we absolutely need that government public education campaign and I think we can find patients, like Rick, who could be our spokespeople.”
Rick and wife, Debbie, support Dr. Roytman’s efforts to educate the public about alcohol use disorder and health consequences. “He would not be here if it were not for her. We know that deep down inside,” Debbie says. “We know she is the one who helped me to help him believe that he had a chance.”
There’s no doubt Dr. Roytman saved his life, Rick says. Since his transplant, and his strength is returning, he freely expresses his gratitude at appointments. “She’s just been my angel,” he says tearfully. “She turned my life around. She really, really did. God, I’m just so thankful for that.”
Research is vital to UCSF Fresno’s mission to improve health in the San Joaquin Valley and Central California. Faculty investigators at UCSF Fresno conduct government, industry, and private-sponsored outpatient (and inpatient) research. UCSF Fresno’s priorities include investigating health conditions relevant to the region and securing clinical trials that bring new treatments to the area before they are available more broadly.
The UCSF Fresno Clinical Research Center (CRC) consolidates research at UCSF Fresno into one centralized location on the UCSF School of Medicine regional campus in downtown Fresno. The CRC opened in 2013. It has grown significantly and now encompasses 11 full-time clinical staff including research coordinators, a regulatory specialist, phlebotomists, an on-site dedicated pharmacist and two pharmacy technicians.
Eyad Almasri, MD, assistant dean for Research at UCSF Fresno and core faculty in the Department of Medicine, the Division of Pulmonary Critical Care, and Sleep Medicine, oversees the coordination of research at UCSF Fresno and says the center is crucial for faculty.
“Medication storage, grant applications, shoring up resources, blood draws, different sample collections, research-related procedures and tests like EKG, pulmonary function testing, it all takes place in this center,” Dr. Almasri said.
Also available are two fully equipped patient exam rooms with EKG machines and blood pressure monitors, a phlebotomy and blood processing room with refrigerated centrifuge, an investigational drug pharmacy with the ability to store room-temperature and refrigerated investigational products, a secure file room for storage of confidential subject charts, a specimen storage room with -20 and -80 degree freezers, a consultation room for one-on-one interviews and a conference room for research meetings.
The equipment and staff at the center are available to support all UCSF Fresno departments, faculty and students who are conducting research.
Infectious Diseases physician Geetha Sivasubraminian, MD, is actively involved in several research projects at UCSF Fresno and says the work she does is dependent on the research center.
“It’s phenomenal to have something so accessible. I can come in here in the middle of my work or my rounds without driving several miles out,” said Dr. Sivasubraminian. “Not all training programs have a research center right in the middle of their campus so it’s unique that UCSF Fresno has it available to trainees which means they can come in here and work with the coordinators and staff on their research projects. I don’t think that’s readily available for folks across the country.”
Dr. Almasri said the center is important to faculty and trainees to conduct research but also because it is constantly being considered as a potential study site for multinational studies that are conducted throughout the world. “Having this independent space that is not tied directly to clinical care allows us to coordinate with other sister institutions like UC Merced and Fresno State and other institutions in the San Joaquin Valley.”
Every day there are research studies being conducted including research visits, new studies being considered, new studies being launched, and follow-up after a study.
There are currently 73 active clinical trials, 41 public service and 38 open studies. Current studies include research projects involving cirrhosis, end-stage liver disease, Mycobacterium avium complex, AC lung infection, Chronic Obstructive Pulmonary Disease, interstitial Lung Disease, RSV (respiratory syncytial virus), sepsis, pulmonary hypertension, community acquired pneumonia, Valley fever, bacteremia, observational volunteer OB/GYN Dream Study discovering cancer risks from environmental exposures, COVID and other viral infections.
“I have been here for the last fourteen years, and I have seen this research institution grow gradually. It started as a very small research enterprise with a few coordinators and a couple assistants, and now we have a full staff. I have seen the growth of this institution firsthand, and I'm excited for its future,” Dr. Almasri said.
UCSF San Joaquin Valley Program in Medical Education (SJV PRIME) students and UCSF Fresno Mobile Health and Learning (Mobile HeaL) provided health care and resources at the first Koom Tes Tiv Thaiv: Hmong Health and Culture Fair on July 8 at Fresno Interdenominational Refugee Ministries (FIRM), a non-profit organization in Southeast Fresno.
Organized in collaboration with UCSF Fresno and FIRM’s Advancing Health Literacy program, the goal was to improve health literacy and to promote preventative health measures within the Hmong community in a fun and culturally relevant and responsive manner.
SJV PRIME Program Director Loren I. Alving, MD, said students choose SJV PRIME with the desire to give back to their community over the course of their professional career. During the summer between their first and second years, SJV PRIME classes return to the Valley to do ASPIRE (AHEC-affiliated Summer Program Including Research and Community Engagement for SJV PRIME) - a program that includes community engagement as well as clinical and research portions.
“Supporting and encouraging our students to get involved in these types of events allows them to not only develop an understanding of the problems facing those communities but also to develop connections and ties to the community members and leaders, which will allow them to increase their effectiveness as physician leaders when they practice in the underserved communities of the San Joaquin Valley,” Dr. Alving said.
This year, medical student Viangkaeo Lee and her classmate Lillian Vang organized the event and chose FIRM as a community partner because of their service to the Hmong community and refugees. They also invited other students and Mobile HeaL to help host the event and provide resources.
“It’s a hybrid between a health fair and a Hmong culture celebration with the understanding that the Hmong people are a very unique population who experiences barriers to medical and educational resources and understanding that culture is a big part of their lives,” Lee said. “We wanted to combine both so they can get the resources they need while celebrating their culture.”
FIRM Community Health Worker (CHW) Nou Chi Her and Lee have worked together in the past and are passionate about community work. Through her work, Her has learned that for many people in the Hmong community, going to the doctor is frightening because of the language and cultural barriers. She believes events like the health fair, show community members that health is a priority, that they are not alone, and that there are people who look like them, speak their language and understand their culture, who can support them towards achieving optimal health.
“The partnership between UCSF Fresno and FIRM allowed for this event to be successful and resourceful for community members. They both worked to meet in the middle and provide the best experience for community members,” Her said. “We hope that this event inspired our community members to be proactive about their health.”
Over 350 people attended the event and visited more than 20 resource vendors. UCSF Fresno’s Mobile HeaL staffed a COVID-19 vaccine clinic and worked with the students to provide blood pressure screenings, blood glucose and cancer screening education, and an introduction to ultrasound.
FIRM facilitated the rest of the event with the assistance of the planning committee that consisted of UCSF SJV PRIME students, FIRM CHWs, and aspiring health care professionals.
Incoming first-year medical student (MS1) student Tou Bee Thao volunteered at the event and said it re-emphasized his decision to go into the medical field and his desire to serve the community.
“It’s very encouraging knowing that I’m going to a school that supports whatever endeavors I choose whether it is community engagement or research, they’re very supportive of it. It made me realize that I chose the right school,” Thao said.
Community members expressed their appreciation because the event allowed them to learn more about their health and connect with other organizations for services.
UCSF Fresno’s success and growth are a direct result of the dedication and inspiration of our faculty, staff, residents, fellows, students, alumni, partners, donors and friends. In each issue of Focus, we introduce you to the people who contribute to the greatness of UCSF Fresno through informal interviews.
Hispanic Heritage Month is a fitting time to highlight the newest addition to our Communications team who is helping enhance communications with Spanish-speaking communities.
This month, meet Lucero Guadalupe Benitez Vega, bilingual communications specialist in the UCSF Fresno Public Affairs, Communications and Government Relations Office.
What is your name? Nickname?
My full name is long. I carry a first name, middle name, and both of my mother’s last names. It is Lucero Guadalupe Benitez Vega. My nickname is Lucy.
What is your hometown? Where did you go to school? High School? Undergrad? What were your majors?
My hometown is Salinas, California, where I went to four elementary schools, two middle schools and two high schools. I graduated from Alisal High School in East Salinas. My major was Mass Communications and Journalism with a minor in Spanish at Fresno State. From what I remember, I was one class shy from a minor in theater.
What is your title and role at UCSF Fresno in the Public Affairs, Communications and Government Relations Office? How long have you been in this role?
I am a Bilingual Communications Specialist and have been in this role for a little over a year. I continue to learn so much each day and still feel like a new hire.
Why did this position and UCSF Fresno appeal to you?
This position appealed to me because it was listed as a position where Spanish was required. I am a Mexican native whose first language was Spanish, and I pursued a minor in Spanish because I knew my Spanish needed to improve if I wanted to be a news reporter for Telemundo. I knew I needed to be able to read, write and speak the language grammatically correctly. While I was in news, I reported for NBC and Telemundo simultaneously for over eight years. When I left news and transitioned into Communications in higher education, I was not using my Spanish skills or working with the Spanish-speaking community as much as I had hoped. I missed that part of my job. Having grown up in East Salinas in an agricultural community, my intention was always to serve the Spanish-speaking community. Based on the job description, I felt I would be able to get that part of my career back. I think it’s extremely important not only to represent the Hispanic community in a professional field but also to be able to provide a service to them. I aspired to be in a position where I could serve my community but also where I could hopefully inspire them.
What are the most challenging and rewarding aspects of your job?
The most challenging aspect is learning about UCSF Fresno. Learning the departments, differentiating fellowships from residencies and understanding each program and position takes time. I feel like I need flowcharts for everything! The most rewarding aspects are making connections with people. I really enjoy interviewing people, learning about who they are, what they do and then building on that to produce a video or write a story. Watching the result and receiving positive feedback fills my cup.
What is at the top of your professional to-do list right now? What is at the top of your personal to-do list?
At the top of my professional to-do-list is to be able to shoot and produce video segments with me as a host. I would be interviewing our campus community and sharing their expertise and telling their stories. There’s so much power in social media now. I think about how far a video can reach and the impact that the topic can have on someone’s life – whether it means inspiring them to pursue the medical field, find answers to medical questions or find guidance to move forward. I’ve always wanted to share as much as I possibly can to inspire and motivate others and if I could do it in English AND Spanish, that’s a major plus.
At the top of my personal to-do-list is to compete in a bikini fitness competition. I’ve always admired the willpower and discipline athletes must have to achieve their goals and the incredible strength of our bodies. I didn’t play sports growing up and I always told myself that if I was brave enough, I would compete in a fitness competition before I turned 40. Because I’m constantly reminding my kids they can be or do anything, I needed to follow that myself. I’m turning 40 in January, and I’ve trained for 16 weeks to compete in mid-September. I checked that off my list and it feels so surreal!
The zombie apocalypse is coming. Who would you pick from UCSF Fresno to be on your team and why?
I feel like I have to say Sierra Anderson in Emergency Medicine because well, she’s in Emergency Medicine. Kidding, I would choose her because I’ve worked with her in the past and have known her for a few years. She’s strict on following the rules, being on time and doing things right so I feel like she would make sure she knew exactly where the zombies are and how to stay away from them. My colleague Barbara Anderson would also be on my team because she would make sure we’re not being tracked, and that we stay warm during our trek to save ourselves. She has a heater and gloves in our office which is always freezing. Finally, Brandy Nikaido would join us because she’s a true leader. She would keep us calm and make sure we were not going into any danger. If we did go into danger, she would negotiate with the zombies and save us all.
What do you like to do in your off time?
In my off time, I love being with my kids. As much as they drive me crazy, they keep me sane. I have a 17-year-old daughter who is loving and caring. She is my peace and calm, although at this age I must bribe her to hang out with me. My 7-year-old daughter is my wild child. She says it how it is and keeps me grounded but also reminds me that it’s OK to break the rules and have fun; although sometimes I’m a little much for her and her constant phrase is “Mom, please stop, just stop.” My 5- year-old son is smart and witty. He gives me all the hugs and kisses the others don’t, but it can be a little much because he won’t leave me out of his sight and that can drive me a little crazy. I would say the best times with them are when we are together, not doing anything or being spontaneous. I love being spontaneous with them because of their reactions. Something so simple like a surprise trip to Dollar Tree can bring them so much joy.
I also like hanging out with the father of those three beautiful children, my partner Freddy. Whenever I'm at the tip of making a crazy decision (like leaving my family behind for a dream job opportunity in the Bay Area, getting out of news to spend more time with my family or training for a fitness competition), he gives me the push I need to go for it without doubting myself. It’s been 19 years and he’s still holding on through my craziness. I think he’s a keeper.
What is the most important thing you would like people to know about you? Or what else would you like to add about you, your background, family, or career?
I take a lot of pride in what I do and how much I have accomplished. My family and I immigrated from Mexico and that really built my character and has always been my motivation to continue to grow professionally and personally. When I feel stalled, I remind myself that nothing is holding me back. My family overcame so much more so that I had the opportunities to move forward and grow personally and professionally.
I come from a single parent home, was raised by my grandparents and their nine children, but was the only one to graduate high school and go to a university. I completed my bachelor’s degree in four years with a 1-year-old daughter. I then made every move I needed to pursue a career in news. I went from reporting news in my hometown to reporting news in market No. 6 in the Bay Area while hauling a little girl along with me. I faced many challenges but held myself to a higher standard because of the name I carry. I don’t know much of my family history, but want to make sure that my kids, grandchildren and so on, are able to see how much a Benitez Vega accomplished. And I want them to do even greater things.
Valley fever (Coccidioidomycosis) is a lung infection caused by breathing the microscopic spores of the Coccidioides fungus that grow in soil. The fungus is endemic in the San Joaquin Valley and other parts of California and the southwestern United States. The number of reported Valley fever cases in California has increased three-fold in recent years. In 2022, nearly half of the 7,546 cases in the state were reported in the nine-county region between Stockton and Bakersfield. It is likely more illnesses occur than are reported and people may be misdiagnosed because they are not tested for Valley fever.
Many people infected with Valley fever do not show any symptoms, while others may experience cold-like symptoms that last from weeks to months. In some cases, the disease can be serious and even fatal as the fungus travels from the lungs to other organs of the body including the skin, liver, kidneys and brain. More clinical research is needed so that people can be correctly diagnosed with Valley fever and receive the appropriate treatment early on to hopefully avoid later complications.
Research at UCSF Fresno is vital to our mission to improve health and access to quality health care in Central California. The UCSF Fresno Clinical Research Center is a hub for pioneering research collaborations investigating health conditions relevant to the Valley - like Valley fever - as well as clinical trials that bring new treatments to the area before they are available more broadly.
Clinical research to improve patient outcomes requires accurate databases of patient information. Currently, research teams rely on administrative and clinical systems to obtain their data, and these have limitations because they were not designed for research purposes. Special databases known as research registries are needed to support long term research and evidence-based medicine practices to ensure accurate and efficient data collection and retrieval.
Thanks to support from the Roger K. Larson Distinguished Visiting Professorship Endowment, a multidisciplinary team of faculty physicians at UCSF Fresno, with support from the UCSF Fresno Clinical Research Center, have embarked on the establishment of the UCSF Fresno Valley Fever Research Registry. This team of experts includes Geetha Sivasubramanian, MD, FIDSA, interim division chief of Infectious Diseases and program director of the Infectious Diseases Fellowship; Mohamed Fayed, MD, pulmonary critical care specialist; Robert Libke, MD, director of Infection Control; and Eyad Almasri, MD, assistant dean for Research.
“While there are research and efforts underway to improve our management of patients with Valley fever, our combined expertise across specialties is needed to combat this problem unique to the Central Valley,” says Dr. Sivasubramanian.
This one-of-a-kind registry for Valley fever will use a secure, HIPPA-compliant software system to collect and maintain important data from patients with Valley fever in the region including demographics, clinical features, laboratory and imaging findings, treatment, and outcomes. Researchers will use the registry to access a wide variety of relevant clinical data that can be used for their respective Valley fever studies. This will make it easier to enroll patients in Valley fever clinical trials and also avoid lengthy delays in obtaining accurate data.
“At completion, the UCSF Fresno Valley Fever Registry will be one of the largest registries of Valley fever patients and will be available to all faculty at UCSF Fresno for research purposes,” said Dr. Sivasubramanian.
Your generous support of the UCSF Fresno Clinical Research Center helps ensure our faculty have the resources they need for innovative projects like the Valley Fever Research Registry in an era of rising research costs and fluctuating federal funding. Your gifts enable researchers to approach long-standing, intractable problems like Valley fever from a new perspective while also allowing them to pivot in real-time to address new health concerns like COVID-19.
To learn more about how your gift to UCSF Fresno can inspire a healthier future for the Valley and beyond, please contact Kathleen Smith, assistant director of Development at (559) 499-6426 or [email protected]
Learn more about Dr. Sivasubramanian’s efforts to promote awareness of Valley fever in our community here and Dr. Fayed’s research to study the prevalence and outcomes of Valley fever here.
Kudos
UCSF Fresno named Vipul Jain, MD, as Chief of Medicine. The decision followed a diligent search in collaboration with Talmadge E. King, Jr., MD, dean, UCSF School of Medicine; Robert Wachter, MD, chair, UCSF Department of Medicine; and Central California Faculty Medical Group (CCFMG). Dr. Jain will also serve as Vice Chair for the UCSF Department of Medicine. These appointments are effective immediately.
Dr. Jain has served as interim chief since September 2022. During his time as interim chief, Dr. Jain developed the Department of Medicine Cabinet, a team of leaders who contributed individual expertise and leadership to the Department in their roles as Vice Chairs in the areas of Education, Faculty Affairs, External Affairs, and Outpatient Operations. In addition, he appointed four “advisory council” members from the department who provided further knowledge and advice in their clinical areas and began holding regular, all-faculty meetings for the Medicine Department.
Prior to assuming the Interim Chief position, Dr. Jain served as the Executive Vice Chief for the Department of Medicine at UCSF Fresno since 2018. In 2019, he was appointed Division Director for Pulmonary, Critical Care and Sleep Division and effectively led the division through the challenge of the COVID-19 pandemic. During his tenure on the faculty, he directed the Chronic Lung Disease Program and served as president of the California Thoracic Society. He has authored many book chapters and published over 30 peer-reviewed articles. Dr. Jain was recognized with the UCSF Fresno Research Award in 2016. In addition to Dr. Jain’s dedication to the department and divisions, he has served on the CCFMG Executive Committee and Board of Directors since 2019 and has been a valuable leader and advocate for the department.
Congratulations to Narayana S. Ambati, MD, FACS, urologist and volunteer faculty in the UCSF Fresno Department of Surgery. Dr. Ambati was recognized with the 2022-2023 Charlotte C. Baer Memorial Award presented by the UCSF School of Medicine Volunteer Clinical Professor Advisory Board. This award is named in honor of Dr. Charlotte C. Baer, who was a practicing internist in San Francisco and a member of the volunteer clinical professors for almost 30 years. She was an outstanding clinician with exceptional humanistic qualities who served as a role model and teacher to hundreds of UCSF students and residents. Dr. Ambati exemplifies these same qualities and his contributions to UCSF Fresno echo what Dr. Charlotte Baer represented. This award recognizes Dr. Ambati’s contributions since joining the faculty at UCSF Fresno in 1986.
Kudos to John E. Garry, MD, FACS, a colon and rectal surgeon and volunteer faculty with the Department of Surgery at UCSF Fresno since 2007. Dr. Garry was selected by the Volunteer Clinical Professors Advisory Board at the UCSF School of Medicine as a recipient of the 2022-2023 Special Recognition Teaching Award. The Special Recognition Teaching Awards are presented to volunteer clinical professors who have made contributions through excellence in teaching and significant contributions in the field of medicine.
Congratulations and best wishes to Francis Fung, Senior Graphic Designer, on his retirement in June after nearly 22 years with UCSF Fresno.
Kudos to Lynn Keenan, MD, faculty in the Department of Medicine and former director of the UCSF Fresno Sleep Medicine Fellowship, and Karl Van Gundy, MD, also faculty in the Department of Medicine specializing in Pulmonary Critical Care Medicine and Sleep Medicine. Both retired recently. We thank them for their years of caring for patients and their contributions to UCSF Fresno. We wish them well.
