I first met Dr. Richard Belkin in June of 2010. After years of struggling with deteriorating lung issues I finally got a referral to him. He specialized in treating adult CF patients with the Santa Barbara Pulmonary Group in Santa Barbara, CA. I knew I was a CF carrier as I lost a sister to CF in 1971, but I had never been diagnosed with CF. Here I was 64 years old and thinking I might not make it through too many more bouts of pneumonia. Well thanks to Dr. Belkin I am still here and feeling better than I have in 10 (ten) years or more. He was willing to participate in an interview and share his views and experiences about working with CF patients.

B - Thank you Dr. Belkin, for your willingness and time to participate in this interview.

Dr. - I am happy to be able to participate.

B - How long have you been working with CF Patients?

Dr. - I started working with CF patients when I was a first year fellow at the University of Pennsylvania Medical Center in 2001.   I sought advanced training in the care of CF patients during my last year of fellowship.

B - What made you decide to specialize in pulmonary medicine?

Dr. - My personal statement for application to internal medicine residency, which I started in 1997, opened with this story, “As far back as I can remember I spent many nights kept awake by my older brother David’s cough.  I vividly remember my father “pounding” on David’s back.  I also remember David having to use a nebulizer machine to loosen secretions in his lung.  As a young child I had a difficult time understanding why he was sick as a result of “bad” genes passed on from my parents.  I questioned why I was not suffering from the same disease.  My brother carries a diagnosis of cystic fibrosis (CF).  He is now 27 and is doing reasonably well, largely as a result of the significant medical advances in the treatment of his frequent lung infections.”

My parents and I subsequently endured the pain of watching David require more frequent hospitalizations and develop worsening lung function.  David was placed on the lung transplant list at the University of Pennsylvania Medical Center, where I had just completed medical school.  In early 1998 his condition deteriorated rapidly and his infections became increasingly resistant to intravenous antibiotic therapies.  David died of chronic respiratory failure in April of that year at the age of 30.

David’s daily battle with CF was the genesis of my interest in medicine and the biological sciences.   After completing my undergraduate degree at Brandeis University I attended medical school at the University of Pennsylvania where I decided to specialize in internal medicine.  During my residency training at Stanford University Medical Center and after my brother’s death, I made the decision to pursue a career in pulmonary and critical care medicine which would enable me to pursue a career in clinical care in cystic fibrosis and research.

My residency and fellowship research focused on CF patients awaiting lung transplantation.  Lung transplant remains the only treatment available to prolong life in CF patients with end-stage lung disease.  It is very difficult to predict the course of CF.  At the time of my brother’s death as many as 40% of CF patients awaiting lung transplant died waiting for a new pair of lungs.  My research developed improved methods for predicting end stage progression of CF and optimal timing for referral of CF patients for lung transplant.  I was the lead author of an original research article published in the American Journal of Respiratory and Critical Care Medicine in 2007 entitled “Risk Factors for Death of Patients with Cystic Fibrosis Awaiting Lung Transplantation.”  My research was recognized in the Year in Review at the 2007 American Thoracic Society Meeting. 

B - Why did you decide to pursue a CF Center at Santa Barbara Cottage Hospital? How many patients does the CF Center serve?

Dr. - After Fellowship training, I moved to Santa Barbara, CA where I have been practicing pulmonary and critical care medicine since 2004 in private practice.   I initially served as the adult Co-Director of the Pediatric Diagnostic/Ventura CF Center from 2005 through 2012.  I realized there was a need for comprehensive CF care on the Central Coast of California and beyond.  I founded and became the director of the multidisciplinary Santa Barbara CF/bronchiectasis Center in 2012, which was accredited by the CF Foundation as an official affiliate of USC Medical Center in May 2014.  We now have over 35 active adult CF patients in our Center and continue to grow, serving the entire Central Coast of California. 

B - How did you put together staff for CF Center?

Dr. - We have been working with CF patients at Santa Barbara Cottage Hospital since my arrival to Santa Barbara in 2004.  Over time, nurses, respiratory therapists, physical therapists, nutritionists, and pharmacists began to work on a regular basis with our CF patients.  As soon as the word spread that we were starting a local CF Center, I was amazed at the number of healthcare providers who showed interest and stepped up to be part of the CF program.

B - What drives you to serve CF patients?

Dr. - In addition to my personal interest in CF, it is very rewarding to care for patients with chronic illness and develop long lasting relationships with the patients and their families.  Once a patient comes to our center, they are a “patient for life.”

B - What significant changes have you seen in the CF population since you have been treating those with CF?

Dr. - The biggest impact I have seen in the 10 years I have been in practice has been the FDA approval of CFTR modulator therapies.  Currently, I have three patients on Kalydeco (Ivacaftor) who have experienced remarkable improvement in lung function, reduction in exacerbations and improvement in quality of life.

B - What is the age of the oldest patient you have treated?

Dr. - In 2005 our center diagnosed the oldest CF patient at the time of diagnosis, 82 years of age.   She had been labeled as having idiopathic bronchiectasis and pancreatic insufficiency for years before the diagnosis was made.  Unfortunately, the patient passed away six months after her diagnosis.

B - Am I your oldest patient now?

Dr. - Yes

B - How important do you think exercise is for CF patients? Do you encourage your patients to exercise? 

Dr. - Exercise is extremely important for the care of CF patients. In specific an active exercise program assists with airway clearance and is a critical part of their overall general health.

B - Have you seen improvement in patient’s lung function with regular exercise programs? Does it help patients avoid exacerbations? 

Dr. - There is no question that regular aerobic exercise leads to preservation of lung function and ultimately helps avoid pulmonary exacerbations and improvement in quality of life.

B - With the breakthrough of Kalydeco and hopefully soon Orkambi, what will change in treatment plans for CF patients?

Dr. - I do want to stress that despite advances in treatments with new CFTR modulator therapies, it is still very important for the patient's to continue their regular treatment plans with antibiotics, bronchodilators, mucolytics, and aggressive airway clearance and an exercise program to maximize pulmonary and nutritional health.

B - What do you think the CF population will look like in 20 years or more? 

Dr. - My hope is that we will have found a cure for CF in 20 years.  In the least, I expect we will be seeing CF patients die with CF, not from CF.

B - Has working with CF patients changed you in any way? 

Dr. - There is no doubt that caring for CF patients has impacted me in many ways. Those with CF are a unique patient population.  My patients are my teachers and serve as a huge inspiration and driving force for always striving to improve the care I provide.  My long lasting relationships with patients and families, day to day interactions, and working with our multidisciplinary team to care for CF patients has been very rewarding for me. 

B - What do you like to do for recreation in your free time?

Dr. - I enjoy spending time with my family (wife, Liza and two children, Danya, age 13 and Ryan, age 11), playing tennis, golf and running with my dog daily.

B - Do you have any comments you would like to add?

Dr. - It has been one of my passions to be a healthcare provider and researcher in CF.  I consider the founding of the CF program that serves our local and surrounding communities in Santa Barbara to be one of my most proud accomplishments.

B – Thanks so much for your time and I will see you at my next clinic appointment.

 

For additional biographic information on Dr. Belkin click here

For information on the Cystic Fibrosis/bronchiectasis Center click here

 

 

Barbara Morris Harison lives in Ventura, CA and serves on the CFLF Board.  She was diagnosed with CF at age sixty four (64) years.  She lost a sister to CF forty-three (43) years ago. She established the Loretta Morris Memorial Fund with CFLF in 2010 to award recreation grants to CF patients. Barbara is retired after a long career in public parks and recreation administration and later managed her own consulting business, Harison & Associates for twenty (20) years. 

 

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