In Memory of Dr Jonathan Dine Wirtschafter, Age 69, professor of ophthalmology, neurology, and neurosurgery at the University of Minnesota (Minneapolis) and likewise, fromerly at the College of Medicine, University of Kentucky, Lexington, Kentucky died on August 9, 2004. of Mpls. Preceded in death by daughter, Sara. Survived by loving wife of 45 years, Carol; children, Jacob, Benjamin, Joshua, David and Brooke; children's partners, Gary Larson, Colette Wirtschafter, Diane Schon Wirtschafter, Shana Sippy, Jonathan Golub; 10 grandchildren; brother & sister-in-law, David & Barbara Wirtschafter. Funeral Service WEDNESDAY, 3PM, TEMPLE ISRAEL, 2324 Emerson Ave. S., Mpls. Memorials preferred to ALS Foundation, Jewish Community Action Council, or donor's favorite charity. SHIVA 2700 Chowen Ave. S., Mpls. (Wed.-Mon. eve., 7PM). Hodroff-Epstein 612-871-1234. Published by Pioneer Press on Aug. 11, 2004.
During Dr Micheal B Minix Sr MD FICS College of Medicine, University of Kentucky clinical years, third and fourth, Mike developed a love for ophthalmology, following an elective with Dr. Jonathan Wirtschafter, director of the Division of Ophthalmology. Wirtschafter recommended him for a clerkship in Miami, FL.
Dr Micheal B Minix Sr MD FICS completed a clerkship his senior year at Bascom Palmer Eye Institute, Jackson Memorial Hospital, Miami, Florida. World-renowned Doctor Edward Norton was chairman of ophthalmology at the institute. Mike fell in love with Bascom Palmer, his preceptors, and Dr. Norton, who were brilliant. Mike learned extensively about external eye disease from a very brilliant, inspiring resident teacher, Richard K. Forster M.D., who, in later years, became Professor of Ophthalmology and Chairman of The Richard K. Forster Corneal and External Ocular Diseases Department at Bascom Palmer Institute, named for Richard, which was a colossal honor and well deserved. Forster was the impetus for his continued study of external disease
Dr. Jonathan Wirtschafter became the first chief of the Department of Ophthalmology, College of Medicine, University of Kentucky. His credentials were impeccable. His training began with his graduation from Reed College, Portland, Ore, in 1956. He then attended Harvard Medical School, graduating in 1960. Following a master’s degree in physiology from Linfield College in 1963, he completed residencies in neurology at Good Samaritan Hospital in Portland in 1963, followed by an ophthalmology residency in completed in 1966 at the Wilmer Eye Institute, an internationally-renowned eye institution for the diagnosis and management of complex medical and surgical eye disease at Johns Hopkins. Those trainings were followed by a fellowship at Columbia Presbyterian Hospital in neuro-ophthalmology. He was board certified in both ophthalmology and neurology.
Following his extensive training, Dr. Wirtschafter was recruited to start a residency training program in ophthalmology. In the beginning, he was the director of ophthalmology, which was a division of the Department of Surgery and under the direction of Chairman Dr. Ben Eiseman. Mike was in UK Medical School when Jonathan arrived at UK. Jonathan took “The Missile” under his wing.
During Dr. Jonathan Wirtschafter early organization of the Division of Ophthalmology, during Mike’s ophthalmology elective in medical school, he trailed the professor around the UK Med Center on consultations, into surgery, and routine clinic examinations. Unfortunately, space for an ophthalmology division was limited, but, amusingly, the professor would sniff (sic) around every floor in the med school and hospital and ferret-out a room here and a broom closet there, until he had enough secure space to place the sophisticated equipment that he purchased from his grant monies. His education dictated grant money. Not many were trained as Jonathan was trained.
Wirtschafter acquired an exotic pupillography machine for measuring the size and reactions of the eye pupils with documented still photography and videography and housed it in a broom closet he scavenged. As was often the case, the professor used Mike as his first examined guinea pig for the equipment. His plan wasn’t immediately apparent. The professor acquired enough space that he had it pieced together in an accumulated square foot layout, and submitted the layout to his administrators including the equipment required for the formation of a new, legitimate Ophthalmology Department. Wirtschafter was so well respected, he received permission from the board and the Department of Ophthalmology, UK College of Medicine was birthed. Dr. Jonathan Wirtschafter, subsequently, began the resident training program and was the first chairman of the Department of Ophthalmology, College of Medicine, University of Kentucky, Chandler Medical Center in Lexington, KY. Felix Bongiorno, MD, was the first resident.
Dr. Wirtschafer was an extremely dedicated, energetic, caring, empathetic, respected physician with an unyielding passion for ophthalmology. When he first arrived on the scene at UK, Mike immediately took an ophthalmology elective under his instruction during his junior year of med school in 1967. During the elective, he learned how to use complex ophthalmology equipment, about eye disease, and eye treatments. The professor gained respect for his enthusiasm and work.
Jonathan recruited Dr. John Garden, who became a geographic part-time instructor and simultaneously private practiced with Dr. Claude Trapp in Lexington. John was very popular among the residents and students. Had there been funding, he would have been a full-time “white coat” because he loved teaching and had a remarkable capacity for unusual eye disorders and minutia.
John and Mike clicked academically because John enjoyed teaching and Mike appreciated learning.
Mike sought to model himself after Dr. Wirtschafter. He soon became his mentor of human mentors. Of course, Jonathan was a member of the Mensa IQ society, the oldest high IQ society in the world, open to people who score at the 98th percentile or higher on a standardized, supervised IQ or other approved intelligence tests. Dr. Minix was impressed with intelligence and enjoyed learning from the maestros. Mike, of course, was “The Missile”, not a rocket or MIT Rocket Scientist. However, he was intelligent enough to become a doctor, extremely passionate for ophthalmology, and very industrious, but not a Mensa. 1.
Wirtschafter participated in the early trials of botulinum toxin injections (Botox), developed the use of doxorubicin hydrochloride, a chemomyectomy agent, pterygia and neovascularization, the cause of papilledema and muscle satellite cells. Wirtschafter was a scientist, a great clinician, teacher, and researcher and an extraordinary human being, who loved the world and everything in it. He had a scientific processing mind. One of Mike’s greatest honors was to be able to study under Jonathan and not only learn ophthalmology, but Jonathan’s philosophies on life.
The “Missile’s” residency class was the third ophthalmology group and totaled three residents. UK ophthalmology residency involved significant hands-on difficult work and study. Eye trauma surgery was a huge portion of resident training. Many patients were referred to UK for routine eye examinations, injuries, diseases, and primary, secondary, and tertiary surgeries.
He was taught the art of refraction for eyeglasses and contact lens prescriptions. That was not a stimulating area of ophthalmology for him, but a necessary discipline. Prescribing eyeglasses was not his idea of the practice of medicine. Use of the slit lamp, intraocular pressure measurement for glaucoma, and handling the direct and indirect ophthalmoscopes were more down his alley. Of course, ophthalmic trauma surgery, cataract, eye muscle, glaucoma, and other important surgeries were extremely interesting. Eye surgery was very intriguing, fascinating, and exciting. He had good, precise, meticulous hands and obvious surgical ability. Wirtschafter recognized his ability.
Consequently, Mike was often called on to assist the chief and often took over the surgical case with Wirtschafter’s supervision. Eventually, he was the first surgeon on eye cases. Other advanced residents had innate surgical skills and shared their knowledge with him. Acceptance to an ophthalmology residency was difficult. Only a small percentage of doctors who applied were accepted. Ophthalmology residents were the cream of the crop. Many pursued an eye residency, but few slots were available and few were accepted. Mike was blessed and thankful.
During the second residency year, UK’s Drs. Minix and Al Jolsen, who was also a board-certified internist, attended the Stanford University Basic Science Course in Palo Alto, California. The course was the best in the nation. The didactic curriculum was complete with educational topics for every aspect of ophthalmology. Renowned professors from around the U.S. lectured. Dr. Jerome W. Bettman founded the Stanford Basic Science Course in 1970 and taught. The course included Dr. Phillips Thygeson, who lived to be 99 and “who served as director of UCSF's Francis I. Proctor Foundation for Research in Ophthalmology from 1957 to 1970. He worked as a consultant to the World Health Organization and established the Alta California Eye Research Foundation in 1968 and began working with Dr. Francis I. Proctor, and the two discovered that the cause of trachoma was a filterable microbe, now known as chlamydia. In 1939, the pair discovered that sulfonamides cured trachoma.” Trachoma was the leading cause of blindness in the world at that time and a vital discovery. 2
The teaching staff included many other notable ophthalmologists. Dr. Minix was over-awed by his leaning opportunity at Stanford. He befriended Gary, his surname forgotten, a resident from Texas and former football athlete. They studied together and “aced” nearly every exam. Mike didn’t see much of his residency colleague, Al Jolsen, who doodled around on his own. Many attended the course from across the nation and many foreign countries.
Mike and his buddy excelled in ophthalmic pathology, a specialty for post mortem examinations of eyes, similar to the entire body autopsy. Dr. William Richard Green was a world-renowned ocular pathologist-ophthalmologist and influential teacher and head of the eye pathology laboratory of the Wilmer Eye Institute at Johns Hopkins Hospital, where many enucleated (removed) eyes were referred for autopsy. Green instructed the Stanford eye pathology course. He and Gary did very well in his pathology course and Green, to their surprise, invited both of them to apply for his ophthalmology pathology residency program. Green was, to Mike’s amazement, a graduate from Paducah Tilghman High School in KY 1952, and earned a bachelor's degree from Centre College in Danville, Ky. 1955. However, neither accepted his offer. Gary had plans for a retina fellowship and Mike planned for a general ophthalmology practice in Eastern Kentucky. It was truly a small, wonderful world.
Dr. Micheal Minix was a very sociable, outgoing, and friendly person. He met many people in Palo Alto, as usual. He chatted with many doctors during breaks in the Stanford Course. However, an unexpected meeting happened on Mike’s way to completion of the Stanford basic science course. He met a doctor who was also a Hell’s Angel. Yes, he said he was a legitimate Hell’s Angel. He told Mike his shocking requirements for admission into the club. The requirements were “eye-openers” (sic). The young ophthalmologist said that he trained in cornea transplantation at Columbia Presbyterian Medical Center in New York under Ramon Castroviejo, M.D, who had performed the first-ever cornea transplant in 1936. One weekend evening he took Mike and another person to a Hell’s Angel dance club in a warehouse on the wharf in San Francisco. Mike wasn’t forewarned, but all the attendees were Hell’s Angels. That was exactly where he did not need to be. There were a few tense moments when his friend left Mike sitting at the table. He became suddenly surrounded by members with nasty on their minds. Mike’s friend saw the situation and returned to the table in time to diffuse the problem. “The Missile” decided soon after that he should, with proper guidance, propel out of that space.
Wirtschafter gave “The Missile” an assignment during his rotation with the professor. Mike researched all of the literature concerning pterygia and neovascularization of the eye, areas of Wirtschafter’s concentrated research. He learned in the process that neovascularization, a pathological reaction in the body resulting in eye, kidney, other secondary organ dysfunction, bleeding and neovascularization, also supplemented tumor growth. Neovascularization inhibition factor was hypothesized as the answer to many neovascular conditions and the answer to the starvation of cancerous tumors, that became the focus of many research projects.
Jonathan, during academic years 1973–1974, took a sabbatical leave with his wife and five children and traveled throughout Europe in a Volkswagen bus. At the outbreak of the Yom Kippur War, he worked at a Jerusalem hospital providing care to all wounded, regardless of nationality.
Dr. Micheal B. Minix, Sr., M.D., Ophthalmology Chief Resident, standing furthest left. Seated in front of residents are the Ophthalmology faculty, L to R - George Chin, cornea and anterior segment, Richard Kielar, Glaucoma and Ocular Pathology, Jonathan Wirtschafter, neuro-ophthalmology, and Department Head, Wilbur Blount, Retina.
Dr. “Mike the Missile” Minix was named Ophthalmology Chief Resident his final residency year, which was accompanied by many responsibilities, including hospital rooms for inpatients, organizing and scheduling patients for the UK ophthalmic surgery schedule, and other clinic duties.
Beds were a premium in the UK hospital. Thus, he spent many hours communicating and visiting the hospital admissions office. The President of Morehead State University had been kicked in the face and eye by his trusty horse and required surgical repairs. The ER doctor at St. Clair Hospital, Morehead, called Mike. There were no empty beds in the UK hospital. The hospital was running over with patients. He was desperate to find a room for the President. Thankfully, his friends in admissions were able to switch and squeeze other patients, who were not as critical, around among rooms. Their kind attention to this problem was not required. A very quiet, private room became available. The President’s wife was very appreciative. His injury was very serious and he could have sustained loss of his vision, but he was blessed. The surgery was successful and he fully recovered. Politics and socialization during medical school, internship, and residency were very important. Servicing the outside referral doctors and hospitals was important to the ophthalmology program.
Mike was an expert in PR, had many contacts, was well known to community docs because of sports and general practice. Thus he helped the program grow. Hospital bed appropriations, admissions, and scheduling surgery in the overcrowded UK hospital and OR often took some doing. Dr. Minix wasn’t a rocket or an MIT Rocket Scientist, but he was “The Missile” and a skilled “schmoozer”.
Dr. Minix and Dr. Wirtschafter performed right intracapsular cataract surgery on a famous college basketball coach. He complained that he could no longer see the far end of the floor and scoreboards. Curiously, he also complained that he could no longer see bobby pins lying on the sidewalk outside the hotel that he sought for good luck prior to away games.
In those days, cataract patients were hospitalized for 5 days and lens implants had not been approved by the FDA and were not available. Cataract surgery was very uncomfortable post-operatively in those days because black silk sutures, much larger in size then and painful, were the only FDA eye approved sutures stout enough for eye surgery. Hence, recovery was more painful and lasted longer. Improved sutures began gaining FDA approval after 1976.
Therefore, the heralded coach was aphakic. He had no lens in the right eye and was anisometropic. “Taking it to the goats,” his two eyes had unequal refractive or eye correction power. His right eye was extremely farsighted, requiring a high powered plus lens, which was normal following cataract surgery in those early archaic years. Since he did not have a cataract in the left eye, that did not require surgery, the left eye had near-normal lens power. That left him visually unbalanced. Restoration of his visual balance required the next best device.
Continuous extended wear contact lens had recently been FDA approved. Coach was treated with the new lens in the right eye to reduce his farsightedness. That balanced his vision, both eye images were equal in size and he required no eyeglasses. With the lens on his right eye, the powers of each eye were near equal, which was perfect for him, since he was so vain he wouldn’t wear eyeglasses anyway, even when they were necessary. A former player stated that during basketball practice before surgery, he and his teammates shot layups on the other end of the floor. Coach could not see that distance down the other end of the floor. After they completed the layup, they continued their run into the tunnel under the bleachers, where they took turns drinking water and resting. His cataract surgery with continuous wear contact lens halted that trick, he said.
That was just the beginning. Sometimes on the weekend, after an arduous “post-game analysis” with his assistants, he would lose his extended wear contact lens. Mike and the other residents were frequently meeting him at the UK ER and inserting a new extended wear lens in his right eye. Every resident knew in which clinic cabinet to find the Coach’s special lens. It was just part of the drill. He was very important and our “eye team” was dedicated to keeping him seeing.
Dr. Minix trained in real-time ultrasonography ophthalmology under Richard Dallow M.D. at Mass Eye and Ear, Boston, Mass. Another Kentucky phenom, Dr. Richard Dallow was born in Kenton County, KY. He was a very patient, good-natured, and intelligent instructor. Contact ophthalmic ultrasound was a new diagnostic tool, but real time under a saline water bath was revolutionary. Few were adept at real time. With the patient supine, a water bath was created with a plastic eye drape sealed and watertight around the brow, nose, and cheek. After it was tented-up like an open trash bag with the uppermost edges supported on a metal ring and open, saline was poured into the bag, forming a bath on and above the closed anesthetized eye. The eye was then opened by the patient under the liquid saline solution. The ultrasound probe was supported two inches above the eye with the tip beneath the saline liquid surface, sounding like an egg beater and shooting ultrasound waves through the saline and down through the open eye. The system was similar to a submarine shooting high-frequency sonar at a target under ocean water.
Graphically, the reflected sound waves revealed the eye and its contents from the cornea in front to the retina and optic nerve in the back. Still pictures were taken and live videos were recorded. It was the same principle for visualizing submarines, torpedos, and ship bottoms beneath the ocean. It was a remarkable, revolutionary diagnostic ophthalmology tool. The eye, its contents including tumors, retinal detachments, cataracts, and many other pathologies could be visualized and recorded. It was an amazing diagnostic innovation. 3. 4. 5.
Dr. Minix was the first in Kentucky and one of the first in the nation to purchase a real-time ophthalmic ultrasonographic instrument and make it available for his patients in Eastern Kentucky and rural Appalachia. He was determined to practice ophthalmology in the manner he was trained, state of the art, no matter the rural impoverished location and cost. Mr. Bill Lindgren founder of Xenotec and Linscan produced and marketed the first real-time A and B Mode ultrasound, sold and installed it for Dr. Minix in 1978. Mike utilized this diagnostic tool frequently. Because there was so much pathology in East KY, the ultrasound enabled him to diagnose many unusual eye conditions, locally, without distant referral.
A fine gentleman referred from Ashland, KY became a patient of attending, Dr. Richard Kielar, M.D., in the UK Eye clinic. Mike was on Kielar’s ophthalmic service at the time, working-up and treating patients. Dr. Kielar was a UK ophthalmology faculty member, who specialized in ophthalmic pathology. Dick was an excellent instructor and an extremely talented eye pathologist. In other words, he autopsied eyes like Dr. Richard Green did at Johns Hopkins.
The elderly gentleman from Ashland, KY had a malignant melanoma beneath his retina in the choroidal layer in the back of the eye. Dr. Minix and Dr. Kielar removed his eye and Kielar did the post-mortem examination, which revealed the pathology required for the melanoma diagnosis.
Dr. Minix and Dr. Kielar took excellent care of the patient. Both were very kind and compassionate to the patient. The patient’s friend, Doc Lenard Layne, retired pharmacist and owner of Layne’s pharmacy, corner of Blackburn and 13thStreet, was particularly struck by Mike’s superb bedside manner and care. He did the daily patient care that residents usually accomplished and Layne learned he was soon to complete his residency. Ashland was underserved, as was the entire Eastern Kentucky area, for ophthalmology doctors in particular.
Dr. Minix continued to work the Highlands Regional Medical Center Emergency Department on alternating weekends during his residency. He drove 120 miles from Lexington to Prestonsburg after finishing Friday’s resident duties and time with his family. He usually arrived Friday evening at about 7:00 to 8:00 PM. Dr. Minix worked Friday night, Saturday, until Sunday evening and then traveled back to Lexington. His residency duties began at 7:30 AM Monday. Mike didn’t fear hard work. That and moonlighting were commonplace among doctors in training.
Mike was co-author of tworesearch publications following research during his clerkship and residency. Each, as usual, required a few years following review to reach publication:
I. Dislocation of Lens Diagnosis by Ultrasonography, Minix, M.B., Wirtschafter, J.D. and Cantor, H.E., Journal of the American Medical Association, J.A.M.A., 207:1354-1355, 1969.
II. Persistent Primitive Trigeminal Artery and Ipsilateral Acquired Blepharoptosis Phillip A. Tibbs, MD; John W. Walsh, MD; Michael B. Minix, MD, Archives of Neurology, Arch Neurol. 1981;38(5):323-324.
References:
- 1. [Mensa is 65 years a Society, on 1st October – how Brilliant is that?". Mensa International. 30 August 2014]
- 2. [Ryan Kim, S. F. Chronicle, August 5, 2002]
- 3. [Dallow RL (ed): Ophthalmic ultrasonography: Comparative techniques. Int Ophthalmol Clin 19:4, 1979]
- 4. [ Introduction to Ophthalmic Ultrasonography" Diseases of the Orbit, edited by Ira S. Jones, M.D. and Frederick A. Jakobiec, M.D., Harper and Row, Inc., New York, NY, 1979, Chapter 4, pp. 63-72. D. Jackson Coleman, M.D. and Richard L. Dallow, M.D.]
- 5. [Ultrasonic Evaluation of Intraocular Tumors" Ocular and Adnexal Tumors, edited by F.A. Jakobiec, M.D., Aesculapius Publishing Company, Birmingham, AL, 1978, pp. 281-310. Stanley Chang, M.D.; Richard L. Dallow, M.D.; and D. Jackson Coleman, M.D.]
