Russian Cardiologist Finds Opportunity at Gill Heart Institute
LEXINGTON, Ky. (July 9, 2014) -- In the mid-1990's, Dr. Maya Guglin was a cardiologist in Volgograd, Russia.
"I was working in a 1,000-bed university hospital treating critically ill patients in the critical care unit (CCU)," Guglin says. "I had some terrific teachers and wonderful colleagues. But I felt as if something were missing…..that there were opportunities to expand my knowledge and experience that I couldn't get in my home country."
Today, Guglin has a very different professional life. As director of the Mechanical Assisted Circulation Program at the Gill Heart Institute, she oversees the care of patients with heart failure.
"Contrary to how it sounds, heart failure is actually a complex diagnosis," Guglin explains. "It's really a thinker's specialty, and that appealed to me professionally."
Guglin was recruited to UK HealthCare for her skill in ventricular assist devices (VADs), which boost the heart's pumping action in desperately sick cardiac patients. Sometimes a VAD is a "bridge" for transplant patients who have not yet found a donor heart. However, VADs can also be used as a permanent solution -- much like a pacemaker -- and, in a few instances, VADs act like crutches for the heart, taking over the work while allowing distressed heart muscle to rest and repair. In these cases, the VAD can be removed once the patient's heart has recovered enough to pump on its own.
When Guglin arrived in Lexington for a visit to the campus, she was skeptical. "I thought, this is an awfully tiny town to have such a big hospital," she remembers. But once she realized that UK HealthCare's patient base was so geographically immense, her enthusiasm soared. "I was drawn immediately to the institution's commitment to grow the program, to provide outreach, and to provide top-quality quaternary care to the sickest Kentuckians," she says.
Guglin's journey to Lexington from the town known as Stalingrad during the "Iron Curtain" days began in 1995, when she served as an interpreter for three Russian physicians who came to Cleveland as part of the Sister Cities Program. She was wowed by the state-of-the-art facilities and immediately began planning a move to the U.S.
"From the smallest clinic in Oberlin, Ohio to the Cleveland Clinic, the standard of care really impressed me," she says. "I wanted to be a part of that."
Already a medical doctor (both her parents were physicians as well), she took classes whenever possible and borrowed textbooks from a friend to prepare for the medical licensing exams required of all foreign physicians who wish to practice in the United States. Because the tests were not offered in the Soviet Union, Guglin travelled to Hungary and Poland to take them.
She landed back in Cleveland for her residency, then on to New Jersey for a fellowship at the Robert Wood Johnson Medical School. After a stop in Boston for transplant training and three years as an assistant professor at Wayne State University, Guglin arrived at the University of South Florida as director of their Heart Failure Program. Seven years and a promotion to full professor later, Guglin felt she had, in her words, "hit her limit there." She came to the Gill Heart Institute in January and is already settling in, managing 13 VAD patients in just six months.
She laughs when comparing her professional life in the Russia with her current situation.
"In the U.S.S.R., we were allowed one X-ray per patient per week," she says. I used to give the radiologists chocolate to get them to do more than one."
"There was still no Internet in my hometown when I left. We did not use computer tomography and did not have troponin or creatinkinase assay to diagnose heart attacks. We did it the old-fashioned way: by symptoms and ECG."
Guglin says there are other examples of her life here that weren't possible in Volgograd.
"I love having the luxury of seeing fewer patients, but investing more time in them, which is to their benefit," she explains. "I am particularly drawn to the 'why?' -- Why is my patient experiencing this, or doing that? And so being here affords me the opportunity to explore each patient's particular situation and decide the best course for them, especially since our patients here have so many co-morbidities, which can really complicate treatment."
Another attraction: research. Guglin is drawn to research; her primary interests are the role of diuretics in treatment of heart failure, the concept of congestion as a leading factor in the pathogenesis of heart failure, the similarity of neurogenic stunned myocardium and takotsubo (stress induced) cardiomyopathy, and chemotherapy-induced cardiomyopathy.
Of particular note is her recent work on diabetes in patients with VADs. "Anecdotally, we've seen that glucose levels in diabetes patients with VAD implants seem to improve post-implantation and persist for up to a year," Guglin says. "We were able to use patient data to demonstrate a link between the two phenomena. Now the interesting part comes: Why is this so?"
One of Guglin's first priorities at UK is to establish a proprietary patient database. That way, she says, if she or one of her colleagues have an idea, they can quickly access data to test their hypothesis and determine whether it merits further exploration.
Again, the VAD patients with diabetes question served as a catalyst for her plan. "We had to search dozens of patients’ charts manually, and then enter every piece of data into a spreadsheet. If we could, instead, use database information to demonstrate a link between the two, the work could be done much faster."
The changes in Guglin's personal life reflect her professional ones. Since she moved to the U.S., she has learned to drive a car and put a "1" in front of the number when dialing long distance. After seven years in Florida, she was not thrilled with the Kentucky winter. "My friends assure me it wasn't a typical winter, and they'd better be right," she says. But even with the adjustments she's had to make, Guglin embraces the opportunities being in the U.S. -- and in Kentucky -- has afforded her.