San Antonio abdominal transplant surgeon Juan Palma calls it one of those medical mysteries that no one seems able to solve. For some mysterious reason, Hispanics seem highly susceptible to Hepatitis C, a debilitating virus that can lead to cirrhosis of the liver, liver failure and/or liver cancers.
Why are Hispanics so at risk? Why does the virus act so aggressively in this ethnic group? Why isn’t the condition being diagnosed sooner when there’s still hope?
“There are plenty of questions and very few answers,” reflects Palma, an independent practitioner with the Texas Transplant Physicians Group. “But I can tell you this: We definitely need more screenings to catch the condition in its early stages and more funding for research into the matter. These things need to be among our priorities in medicine.”
Dr. Juan Palma-Vargas (he customarily uses just the first part of his hyphenated name) chose medicine as his career early in life—not just because he was interested in Hispanic health, but because he wanted to bring better health to people of all nationalities and ethnic backgrounds.
Growing up in Guadalajara, Mexico, he vividly remembers being taken to see a great aunt who had just gone through an appendectomy. A surgical drain had been inserted and, “It really freaked me out,” he says with a laugh. Once the initial shock was over, though, he grew to deeply respect and admire the way surgeons could remove or repair diseased body parts.
“I just thought it was the coolest thing to be a doctor and have the chance to cure sick people,” he recalls. “From day one, my goal was to be a physician and I don’t think I even considered becoming something else.”
He studied biology at the University of Guadalajara, got a medical degree from Guadalajara’s Automous University and served his residency in general surgery at the Western Medical Center’s Mexican Institute for Social Health, becoming fascinated with transplantation—especially difficult and demanding liver transplants–along the way.
Sadly, he discovered that there was little opportunity to pursue such a specialty in his native country where medical resources and young doctors were pointed toward preventive medicine. So, the physician headed to the United States to follow his dreams.
Specialization took him to Michigan State University and Borgess Medical Center where he completed a research fellowship in kidney transplantation; Maine Medical Center in Portland, where he did his residency in general surgery; and Duke University Medical Center in Durham, N. C., where he became a certified multi-organ abdominal transplant fellow.
About three years ago, he settled in San Antonio and has come to be regarded as a key member of the Methodist transplant team as well as a skilled expert in laparoscopic surgical procedures.
Dr. Preston F. Foster, surgical director of the Liver Transplant Program at Methodist Specialty and Transplant Hospital, has high praise for Palma’s surgical talents.
“I have followed the accomplishments of Dr. Palma for more than four years and have worked with him on a daily basis over the last six months in our hepatology and liver–transplant programs,” Foster says. “I’ve witnessed his dedication to medical education in the wards … I believe he will produce further achievements that will be of service to his patients, our institution and both the national and international communities.”
Palma’s medical achievements already are enviable. Along with his transplant team, he transplants on an average of 180 kidneys, 40 livers and 12 pancreases a year. All are challenging and rewarding operations, but dealing with the liver is the most technically demanding, in his opinion—and for this very reason, the procedure is his surgical favorite.
A complete liver can be transplanted if taken from a deceased donor, he explains. If taken from a live donor, only part of the organ can be removed for transplantation. If a child is the recipient, the donated portion can come from the left side. If an adult is the patient, then the donation must come from the liver’s right side because the left portion will be too small.
Furthermore, the patient, who almost always is a very sick individual, must be closely monitored. So, it’s little wonder the complicated process requires a multiple- surgical team!
Dealing with complicated transplantation issues means that Palma often has to work around the clock, miss dinner with his family (he has two young boys, Joseph, 5, and Alexander, 3) skip social occasions and take emergency phone calls in the middle of the night necessitating a return to the hospital.
“I’m lucky that my wife (Cristel) is a physician’s assistant and understands the demands of medicine,” the surgeon says. “We met while I was studying in Michigan, and she has always been so supportive of me and my career.”
And it’s a career that’s not only unpredictable in its hours, but unpredictable in its cases. Not every patient who walks through the door needs a transplant, you see. Take Dawn Waits for example.
Thinking she was having a stroke, she landed in the emergency room one night. Turned out that it wasn’t a stroke at all but a growth called hemangioma. Likely present since infancy, the strange ball of cells was firmly attached to her liver and had increased in size until it was causing weird stroke-like feelings and stomach problems.
Naturally, Waits wasn’t too happy thinking about a big incision and surgical removal of the odd benign tumor that measured about 10 centimeters. But she also didn’t want to have to keep checking back with doctors to be sure the growth wasn’t getting even bigger, doing irreparable damage to vital organs or pushing insides out of place. So, she conferred with “one of the best liver men in town”—Juan Palma—and an operation was scheduled.
“Dr. Palma is an expert in laparoscopic surgical methods as well as transplants,” Waits says. “He ended up doing two tiny incisions and, in some way that’s still a mystery to me, pulled that whole hemangioma out. It was amazing—and so is he!”
