Pediatric Cardiologist Andrew Maxwell Takes His Work to Heart

By Nicole Zaro Stahl, Hacienda Network Staff Writer

There aren't too many doctors like Andrew Maxwell. For one thing, he spends a lot of time in his car. Driving some 3,000 miles a month, he makes weekly rounds to offices in Brentwood, Tracy, Pleasanton, Fremont, and San Mateo, not to mention responding to urgent consultations on newborns and children in the 10 local community hospitals he attends. Maxwell maintains the five clinic locations for one basic reason: "so patients don't have to travel as far." This consideration is typical of the patient-centric approach of his practice, attending not just to a patient's medical condition but to the family's psycho-social needs as well.

Maxwell's patients are, indeed, very special. As a pediatric cardiologist, he has treated some of the sickest children imaginable. Those experiences inspired a vision which was fully realized last November, with the opening of his Heart of the Valley pediatric heart center at 5933 Coronado Lane.

The center offers several programs to head off childhood heart disease and subsequent complications. Kids in Action focuses on "developing healthy nutrition, activity, and psychological habits through education and behavioral change," in both the youngsters and their families. The Human Performance Laboratory tests athletes at all levels, from recreational to elite, for "various physiological variables including aerobic capacity, resting metabolic rate, pulmonary function, and body composition."

These initiatives are aimed at attacking some of the prime causes of today's new and unsettling disease trends. Many of his patients' problems are caused by poor exercise and dietary habits, Maxwell indicates, expressing concern that medications for high blood pressure, high cholesterol, or complications from being overweight are not likely to offer a life-long cure.

"It still boils down to diet and exercise," he insists. Unfortunately, a healthy diet is not all that obvious to the modern-day family. "People from our generation are not actually taught how to eat well. I can't assume that when I tell parents their kids need healthier diets, they understand.

"I spend a lot of time teaching these principles and how to apply them to the kinds of foods they like eating," he continues. Helpful tools include the lessons of Michael Pollan, especially those incorporated in his recent book, "Food Rules: An Eater's Manual." Another is the South Beach Diet book.

On the activity side, Maxwell helps the children (and their families) find an appropriate physical outlet. "If it's not a sports team, then it's Tai Kwan Do," he notes, adding, "we make sure they follow up and demonstrate the changes they are making."

Getting There

Maxwell's career plans went through several iterations before he settled on pediatric cardiology. Most of those changes were refinements on an early attraction to biology.

In college in his home state of Indiana he wanted to be a research scientist. Then he realized he would need a medical degree to do the type of research in which he was interested. He was already an excellent student, the result of being a middle child, with one younger and two older brothers, twins. "The middle child has to strive for attention a little harder than most," Maxwell explains. "You can take the route of doing bad things - or extra good things." He chose the latter, and one of the ways it showed up was a constant quest for perfect grades.

He was accepted at Johns Hopkins medical school, where his interests continued to expand. "I fell in love with working with kids, and then I fell in love with surgery," he recalls. It was easy to combine the two as a pediatric surgeon, but he still had to figure out how to insert research into the equation.

Considering some of the arduous training that lay ahead, he decided to do a residency in general pediatrics, "in the funnest place I could think of." From his Baltimore vantage point, that turned out to be San Francisco. He came out to UCSF with a couple of friends from medical school in the summer of 1989, "just before the Loma Prieta earthquake." Undeterred, he and his classmates reveled in their new environment. "We had the time of our lives," he remembers. "We were finally earning an income after so many years of being in school, in this fun city with its beautiful outdoors, and events like Fleet Week and the Blue Angels."

During his pediatrics residency, he discovered his true calling lay in pediatric cardiology. It was the "perfect marriage" of everything he had been looking for: hands-on research with critically ill kids and a mix of exciting new technology.

Individualized Private Practice

By then a confirmed Bay Area resident, Maxwell secured a fellowship at Stanford and started working with "really, really sick kids," including heart transplant patients. He became very attached to these patients and their families, in such desperate need of support.

"I trained with some very wonderful mentors, who guided me through a different type of cardiology than I might have found in other places," Maxwell reflects. "They were compassionate doctors who taught me how to take a lot of time and care with every patient, on an individualized basis," an approach he has incorporated since opening his own practice in 2002.

One new area of concern is the recent spate of sudden athlete deaths, in the Bay Area as well as on college and professional teams. Maxwell says they point to the need for more thorough screening of every athlete, starting around age 10, as is mandatory in Europe. The Pleasanton school district has asked him to speak to its teams about this screening, which in Italy has proven to cut the sudden death rate from six per 100,000 to one per 100,000.

"We don't do this in the U.S. because of the health care system," he explains. "Insurance companies are not going to pay for those odds. I am offering this screening at minimal cost, and hopefully it will catch on."

There are already signs that this will happen. Alameda County is considering partnering with Maxwell in an effort to promote the screening by having emergency medical technicians administer EKGs at sports nights across the county. A specialist like Maxwell would read and review the screening questionnaire and either clear the athlete or suggest further testing.

Downtime

Maxwell's two children, Daniel and Nicole, are in their last and first years of high school, respectively. Both are athletes, running cross-country and track. Nicole also plays tennis. Not surprisingly, given their dad's profession, once a year they get on the treadmill to measure their cardiac and pulmonary functions to make sure they are in top shape - "no hidden asthma or other thing that would be slowing them down." The three ski together and like to spend time hiking and camping. This summer they will get their exercise backpacking for three weeks in Europe.

It will be a refreshing break for a man who spends so much time in the midst of childhood illness. Sometimes it's hard being with kids that are really sick, he concedes, "but it's just so rewarding to spend my life this way. There is no question in my mind that when I go to work, considering everything else I could be doing, this is well worth whatever other opportunity I'm giving up."

Also in this issue...