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Focus on Brad Warner, MD

Brad Warner, MDBrad Warner, MD, is the Jessie L. Ternberg, MD, PhD Distinguished Professor of Pediatric Surgery and chief surgeon for the St. Louis Children’s Hospital. In addition to general pediatric surgery, his surgical specialties include short bowel syndrome, necrotizing enterocolitis and inflammatory bowel disease. Dr. Warner sees patients at St. Louis Children’s Hospital, One Children’s Place, 1st floor, Suite A.

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What happened in the course of schooling to influence you to choose your specialty?

My interest in surgery began before I even started medical school -- my mom was a nurse and I was fascinated with her nursing books and the stories she told about working in a hospital.

I attended medical school at University Missouri Kansas City (UMKC) and my interest in pediatrics was sparked during my pediatric rotation. My desire to be a surgeon and my love of treating children really came together during my pediatric surgery rotation at Mercy Children’s Hospital in Kansas City. It was there that I had the opportunity to work with two outstanding pediatric surgeons, Tom Holder, MD and Keith Ashcraft, MD. They were in the prime of their practice and I was able to see the entire spectrum of pediatric surgery -- from appendectomies to hernias to open heart surgeries. It was certainly a combination of all my experiences, before and during medical school, that brought me to pediatric surgery.
Dr. Warner and happy patient

What types of conditions do you specialize in?

I’m particularly interested in short bowel syndrome -- also known as short gut syndrome. This condition can occur because the intestine twists on itself and dies or necrotizing enterocolitis develops in premature infants (the bowel suddenly dies). In order to save the life of the baby, we have to remove a large length of intestine – resulting in inadequate length to absorb and digest food normally. As a consequence, nourishment must be directly into a vein. Unfortunately, the long term complication of this is liver failure with the possibility of a liver and/or small intestine transplant.

I also perform operations for inflammatory bowel disease -- ulcerative colitis and Crohn’s disease. Of course I take out a lot of appendices, and fix hernias. Another condition I frequently see is pyloric stenosis. Babies who are otherwise healthy will start throwing up at four to six weeks of age. The lower muscle of their stomach is enlarged, preventing food from passing through. We cut through this muscle to correct the problem.

What brought you to Washington University?

Most of my childhood was spent in St. Louis -- my mom and sisters still live here, so there was a family link. I had been in Cincinnati for 25 years and was considering several chief of surgery positions at other institutions. When Washington University stood up against the other institutions, I had a hard time thinking I could do any better than what’s right here. It’s such a world class medical center/medical school.

Part of me didn’t want to come back to St. Louis, because I’d already spent a lot of my childhood here. I thought if I was going to accept a chief position somewhere, I wanted to go to a coast or the mountains – someplace different or unusual. But, honestly when I look at the map of the United States, and consider the other possibilities -- there’s nothing better than where I am right now. The department of surgery has a tremendous reputation and is absolutely fantastic. St. Louis Children’s Hospital has all these creative people working together to help care for children and is one of the top five children’s hospitals in the United States. The medical school attracts the brightest and best students.

Tim Eberlein, MD, chairman of surgery here, has an international reputation. He’s been a great mentor and advisor. Lee Fetter, president of St. Louis Children’s Hospital is a visionary leader and has been very supportive, doing everything he can to help advise me in my role as surgeon-in-chief. It’s an ideal situation.

Which aspect of your practice is most interesting?

In addition to my clinical interests, there are three other facets of my practice that are very rewarding.
I love to teach. I enjoy being in an environment where people are so bright and ask great questions. I love when I’m teaching and the light goes on – it’s that “ah-ha” moment. I’m very proud of the number of residents who want to go into pediatric surgery after their experience here at Children’s Hospital.

I also have a passion for research. I like to write, publish and spread new knowledge. This interfaces with teaching because we have a lot of young residents who come from all around the country to spend time in my laboratory. Many of them have not had any significant research experience. I enjoy seeing them progress from a fairly naïve approach to research, to knowing how to ask questions and design experiments that directly answer those questions. It’s gratifying when they leave here with a fire in their belly for research – it’s like throwing out seeds that will grow into plants.

From the administrative side, I’m very proud of the group of surgeons I’ve assembled thus far. Their different strengths complement each other. Running a division gives me the ability to be at the table to make long-range decisions about the future of the hospital and surgical services. That’s been satisfying as well.

What new developments in your field are you excited about?

We are working to understand the specific proteins that change in response to loss of intestine in patients with short bowel syndrome. Because the long-term survival of small intestine transplants is about 50%, we’d like to devise growth factors or medication to help the bowel grow back.

Right now, to avoid small intestine transplants, we can operate to lengthen the baby’s own intestine. One method involves cutting the small intestine into two tubes – this is possible because it’s extremely dilated. The tubes are sewn end to end -- doubling the length of the intestine.

There is a new technique where alternate cuts are made in the intestine. This creates a channel that is narrow in caliber, but longer in length.

If either of those are two operations aren’t as successful as we hope, the next step is a small intestine transplant.

Other exciting developments include embracing minimally invasive surgery for children. A recent operation to remove a large ovarian mass cyst traditionally would have meant an incision from the patient’s chest to her pelvis. But with minimally invasive techniques, we were able to decompress the cyst and pull it out through a small incision in her belly button.

We are also studying the mutations in specific genes that give children a propensity for cancer of the thyroid gland, adrenal tumors and pituitary tumors. This would enable us to remove these organs before they actually develop cancer.

Where are you from?

I was born in North Dakota. My family moved to St. Louis when I was four. Every summer we would go back to North Dakota to visit my grandparents – I’m very proud of those roots.

Is there a particular award or achievement that is most gratifying?

One achievement I am most proud of is receiving National Institutes of Health (NIH) funding for my research. UMKC was a great medical school, but it was primarily a clinical medical school, with the intent of training students to become primary care physicians. There was not as much emphasis on basic research. So, the fact that after medical school I got into a surgical program which led me to what I’m doing today was something I never dreamed possible.

I’m also very proud of the E. Grey Diamond, MD Take Wing Award received from my medical school in 2008. It’s an alumni achievement award given each year to a medical student alumnus from UMKC. It meant a lot that my medical school would recognize me in that regard. I had the chance to go there with my family and give a talk at the commencement.

What is the best advice you’ve ever received?

The best piece of advice came from my father. When I was in high school, I played trombone in band, marching band, jazz band, combo groups and orchestra. I thought I was pretty good. At that same time I knew I wanted to be a doctor, so I was taking advanced biology, chemistry and calculus. I was spread very thin -- the grind of science and my other activities were becoming less enjoyable. I remember calling my dad from the pay phone at school (my parents were divorced and he lived in a different state) to ask him if I should forget the medicine idea and go into music. I specifically asked him if he thought I would be able to succeed in music. My dad was a college band director and he said, “No”. He told me kids that make it in music are not only incredibly talented, but it’s their passion and life. He said I was somewhat talented, but not remarkably talented, and I would probably fail. If I went into music, it would become a job and I wouldn’t have anything outside of that job to enjoy. If I went into medicine, I would always have music as a release.

I was shocked to hear that advice. But it was honest and helped me stay on the right track.

The other piece of advice was from my former chairman of surgery. He instilled in me the importance of making the patient Number One. Whether in academics, private practice, research or administrative duties – never let my patients down and always do the very best for them.

You and your wife are both physicians, how do you balance your lives?

It led to some tense times when I was junior faculty in Cincinnati. I’d be dead tired from being up all night and come home to my wife as she was leaving for the hospital. Her instructions as she headed out the door were, “You know how to make dinner and you know when the baby needs to be fed. I won’t be home until tomorrow.” It really forced me to be a part of our girls’ lives and I wouldn’t trade it for anything
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We totally understand the demands, the stress and time commitment of each other’s jobs. My wife never gives me any grief if I need to be here. I definitely married up, that’s for sure.

If you weren’t a doctor, what do you think you’d like to be doing?

Black and white photograph of mountains taken by Dr. WarnerOne of my hobbies is photography -- I enjoy landscape and wild life photography. But again, it gets back to what my dad originally said, when it becomes work, it’s less fun and you don’t enjoy is as much. I like photography because I can dabble at it – I’ve had three photos published in the New England Journal of Medicine.

Whether I do it well or not, photography is not my life, it’s not my income. I could also see myself teaching high school biology.