Expanding the Footprint: VCU in Your Neighborhood

Although she just moved here last fall from the West Coast, Dr. Phoebe Ashley quickly learned something about her patients at MCV Physicians at Ridgefield: They really like the office’s convenience.

“Many of our patients are quite elderly, and being able to travel to a nearby location, with easy parking, is very appealing to them,” says Dr. Ashley, a cardiologist and former medical director of the Oregon Heart and Vascular Institute’s Cardiovascular Wellness and Rehabilitation Center and the St. Peter’s Rehabilitation Center in the state of Washington.

Located in an attractive brick building in Richmond’s West End, MCV Physicians at Ridgefield is close to many neighborhoods and assisted living communities. The suburban cardiology practice, which opened in August 2014, is the latest venture by the VCU Pauley Heart Center to expand its physical presence beyond the parameters of downtown to areas where many of its patients live.

Story-1_Dr_Phoebe_AshleyIn addition to Ridgefield, the heart center offers outreach cardiology services at Stony Point, Williamsburg and South Hill, says Jalana McCasland, vice president of Ambulatory Services for VCU Medical Center. The first standalone facility, Stony Point, opened in October 1993. “We have about 4,546 adult cardiology patient visits each year at our outreach centers—and that number is growing,” she says.

At these facilities, “We can do some diagnostic testing; we can see them as outpatients. Of course, when they need a more advanced diagnostic or therapeutic procedure, downtown is the place to come,” says Dr. Kenneth Ellenbogen, chair of the Cardiology Division at VCU. “But we can at least make being seen by a VCU physician easier.”

At Ridgefield, Dr. Ashley and cardiologist Dr. Roshanak Markley provide consultations to their adult patients as well as testing with 3-D-capable echocardiograms and Holter monitoring. (Four highly regarded pediatric cardiologists, Dr. Doug Allen, Dr. Kerri Carter, Dr. Scott Gullquist and Dr. William Moskowitz, of Children’s Hospital of Richmond at VCU, also offer office hours at the practice.)

In addition to convenience, “The number one thing that patients love about this practice is that we spend a lot of time with them,” says Dr. Markley. “I think a lot of the time heart disease can be a complex problem. And if you really want to help your patients change their behavior to prevent heart disease you have to spend time with them and get to know them at a personal level.”

Originally from Tehran, Dr. Markley received her medical degree at the Medical College of Georgia, served her internship and residency in internal medicine at VCU and completed her fellowship in cardiovascular medicine at Vanderbilt University.

Dr. Ashley, a Eureka, California, native, received her M.D. from the Medical College of Wisconsin, where she also conducted her internal medicine residency. She completed her cardiovascular fellowship at University of New Mexico Health Sciences Center.

“Dr. Ashley is an exceptionally good cardiologist, whose interests include women and cardiology, prevention of heart disease, and exercise. She is a very holistic cardiologist,” says Dr. Ellenbogen. “Dr. Markley is an excellent clinical cardiologist, with special interests in imaging and prevention of heart disease.” He adds, “Patients love both of them; they’re just wonderful doctors.”

Lori Edwards sits on an examining room table at the Ridgefield office, dressed in stylish athletic clothing and tennis shoes. At 44, the school clinic assistant is the picture of health. But then she pulls out her iPhone and, gliding her finger over the screen, reveals another picture of herself from last December, in a hospital bed.

“It happened the Saturday before Christmas,” she says. “I was just driving down the interstate with my 9-year-old and two dogs in the car.” Then, without warning, “I went into cardiac arrest and wrecked the car.” Edwards had a blood clot in her heart artery that led to an ST-elevation myocardial infarction—a dangerous heart attack known as a STEMI. “Because of the clot, my heart was beating about 200 beats per minute and that’s what caused me to pass out.”

She adds, “I had a little bit of high cholesterol, not terrible, my total cholesterol was 190. I had never smoked. But my father passed away at 59 from cardiac arrest, a heart attack, and my brother passed away at 41 from a heart attack.”

Fortunately, her family was not injured in the wreck, and Edwards received CPR and AED treatment from several people who stopped to help. After receiving initial treatment at Sentara Williamsburg Regional Medical Center, she was flown by helicopter to VCU Medical Center, where she remained for 18 days.

Dr. Markley, who was assigned to her case, visited or called to check in on her every day, says Edwards. “I felt very confident with her. She took great care of me.”

Story-1_Dr_Roshanak_MarkleyThe doctor helped Edwards make necessary changes in her life, following her discharge—including cardiac rehabilitation, stress reduction and the movement toward a low-sodium, more plant-based diet. The mother of two also takes medication and wears an external defibrillator known as a Life Vest. When she first came home from the hospital, she could barely walk to the mailbox. Now, she can walk 1 ½ miles.

“Since December, she has been making great progress,” says Dr. Markley. “She has had a remarkable attitude and has been a source of inspiration to people who know her.”

Today, at Edwards’ three-month check-up, her echo shows significant improvement, particularly with her ejection fraction—the amount of blood pumped out by the heart. “I left the hospital at 30 percent and today’s echo showed close to a 45% ejection fraction,” she says. “I feel great.”

Dr. Markley’s commitment to her patients is no surprise to Dr. Antonio Abbate, vice-chairman, Division of Cardiology at VCU, who served as her mentor during her residency. “I have known Roshi for many years. She was one of the brightest trainees I have ever had. Her enthusiasm for medicine is exceptional— and contagious,” he says. “She is the doctor that everyone would want to have: knowledgeable, caring and passionate.”

Downtown, the phones ring nearly nonstop in the reception area for the Noninvasive Cardiology Laboratories. The chairs are filled with patients awaiting appointments. It’s a big change from the calm at Ridgefield—but Dr. Ashley enjoys coming down here. Like Dr. Markley, she visits the main campus at least once a week to read studies, see inpatients and, as she puts it, “to stay on top of things.”

“It’s important to not be an isolated outpatient cardiologist. I have a whole group of colleagues who I can call upon to say, ‘You know, what about this? What would you do for this?’ It’s really nice to have that,” she says.

Dr. Ashley is sitting in an office with several other cardiologists. On her computer screen is a moving black-and-white image of a beating heart. This full-study echo—involving about 80-120 images—was taken during a patient’s stress test. With her computer mouse, she clicks through the images, occasionally freezing the screen to take a measurement. With the echo’s 3-D capability, she is able to move around the heart, to see it from many angles.

With the study, “We’re looking at the overall function of the heart, the ejection fraction, the thickness of the ventricular wall, all of the chamber sizes, all the valves—their structure and function, the great vessels and the pericardium, the sac that holds the heart. And we’re also getting an estimate of the pressure within the lungs.”

On busy days, she and another cardiologist may read 50-60 of these studies, involving a great variety of cases.

At Ridgefield, Dr. Ashley enjoys getting referrals for complicated cases—patients with atypical chest pain, for instance. “I like diagnostic dilemmas, so I think I get some of the patients who are a little more challenging sometimes.”

Although she is new to VCU, she has already gained the respect of her co-workers. “Dr. Ashley is a wonderful colleague. She is eager to help, approachable and consistently pleasant,” says Dr. Hem Bhardwaj, director of Cardiology Consultation Services for VCU. “She is an outstanding physician who is thorough, detail-oriented and dedicated to achieving optimal outcomes for her patients. She is a charismatic educator and role model—a terrific addition to our cardiology team.”

Dr. Ashley, a dedicated volunteer with the American Heart Association out west, plans to get more involved with community education here. “I really think education is critical to the success of what we do,” she says. “People are not just a heart and blood vessels—they are a whole being. And each of the different organ systems impacts the cardiovascular system. I think you have to look at an individual holistically and try to optimize each of those things.”

More expansions are in the works for Ridgefield and other neighborhood clinics, says McClasland, VCU’s vice president of Ambulatory Services. VCU hopes to add an evening clinic at Ridgefield, and possibly add new services such as stress tests, electrophysiology testing and device management.

The Pauley Heart Center is also looking to expand its offerings in South Hill and Stony Point, and open a new office in Emporia. “We are currently looking at sites there now,” she says. The office will specialize in the care of heart failure patients. As with all the clinics, “We are trying to work as a partner with local physicians to supplement the services that are already in the communities.”

The notion of a hospital being in one location is changing, says Dr. Ellenbogen. “The best places in the world, places like [Johns] Hopkins, realized that you can’t just have one hospital in downtown Baltimore, you have to be able to branch out, and that’s what we’re doing. We’re bringing world-class medicine, world-class cardiovascular specialists to your neighborhood.”