Dr. Bowdish is a heart surgeon, specializing in adult cardiac surgery.
He hopes to help more lung patients breathe easier: News story features Dr. Egan and his transplant research
Read the article here.
Gifts of new lungs, great friends: Transplant patient of Dr. Haithcock's talks about her experience.
Since her release from the hospital after her transplant, Sawyers has been living at the SECU Family House in Chapel Hill, a 40-bedroom hospital hospitality house that provides comfortable, convenient and affordable housing for adult patients undergoing treatment for critical illness and trauma and family members of those patients.
Sawyers' new lungs are working well. She is staying in Chapel Hill to undergo physical therapy, additional testing and routine monitoring. To read a story about Sawyers, her transplant and her experience at SECU Family House, click here.
These doctors are also listed in the November 2009 issue of
Only 3 to 5 percent of U.S. physicians are included in the Best Doctors database. The Best Doctors database contains the names and professional affiliations of approximately 45,000 doctors in the United States, all chosen through an exhaustive peer-review survey that asks: “If you or a loved one needed a doctor in your specialty, to whom would you refer them?” The peer review process as well as additional research conducted by Best Doctors determines selections for each list. To read the UNC Health Care release about the listings, click here
The National Heart, Lung, and Blood Institute has awarded Thomas M. Egan, a professor of surgery at the University of North Carolina, a $1.47 million, two-year grant for research on perfusion and ventilation of lungs outside the body before transplant. The research could lead to a significant increase in the number of lungs available for transplant.
Dr. Egan, a surgeon in the UNC Division of Cardiothoracic Surgery, is internationally known for his research on lung transplantation, which has been under way since he came to UNC in 1989 to start its lung transplant program.
His new grant was awarded under the NHLBI’s Translational Research Implementation Program, a two-stage program designed to translate fundamental research ideas into proof-of-concept efficacy testing in patients. This Stage 1 grant is supported by the American Recovery & Reinvestment Act's Grand Opportunities (GO) grants program, for large-scale research projects that the National Institutes of Health says have “a high likelihood of enabling growth and investment in biomedical research and development, public health, and health care delivery.” NHLBI is part of the National Institutes of Health.
Dr. Egan’s project will perfect a technique to perfuse and ventilate human lungs outside the body (ex vivo) to determine if they are suitable for transplant, and will demonstrate safety of transplanting human lungs after ex-vivo perfusion in a pilot clinical study.
Lung disease is the fourth leading cause of death among Americans. Lung transplantation helps patients with end-stage lung diseases and improves survival, but transplants are critically limited by an inadequate supply of suitable lungs from conventional organ donors – people who have been declared brain-dead after a lethal brain injury and have been on ventilation before a controlled cardiac arrest when organs are retrieved for transplant. Lungs that have been offered for donation frequently cannot be used because lung function in the donor is poor, due to inflammation or infection or fluid build-up (edema) that occur after trauma and emergency treatment.
Even if the lungs are suitable for use, they are still vulnerable to problems. During transplant, the stopping and restarting of circulation to the lungs can cause ischemia-reperfusion injury, which damages cells in the lung and leads to problems with lung function after transplant.
Only about 1,400 lung transplant procedures are performed each year in the United States; since 1995, 6,022 people have died while on the waiting list for lung transplants. This week, 1,867 people were on the national waiting list for lung transplants, according to the Organ Procurement and Transplantation Network, part of the U.S. Department of Health and Human Services.
Dr. Egan has designed an ex-vivo perfusion and ventilation circuit in which lungs are placed for evaluation and possible treatment before transplant. Ex-vivo perfusion and ventilation allow for lung function assessment, and also for possible treatment of lungs to reduce ischemia-reperfusion injury in transplant. Thus, the lungs treated this way could have less graft dysfunction or failure and the transplant recipient could have an improved chance of survival. This would revolutionize lung transplantation, and could have a major impact on other types of organ transplants.
Michael Knowles, M.D., a pulmonologist in the UNC Division of Pulmonary and Critical Care Medicine and a collaborator on Dr. Egan’s project, called the research project “groundbreaking.”
“I have been involved in lung transplantation from its inception at UNC, and have seen, first-hand, the suffering and unnecessary death that results from the shortage of lung donors in the U.S.,” Dr. Knowles said in a letter of support for the research.
The project has support of lung transplant physicians at several other universities in the U.S. and Canada as well as from Carolina Donor Services, the organ procurement organization serving most of North Carolina.
For the Stage 1 project, Dr. Egan’s research team will use lungs from conventional organ donors that have been declined for transplant because of concerns about lung function, as well as lungs from DCD (donation after cardiac death) donors, patients who are not brain dead but whose next-of-kin have decided to withdraw life support because the patient's condition is so poor. The lungs will be assessed and treated in the ex-vivo perfusion and ventilation circuit.
In a Stage 2 study, Dr. Egan’s project will also plan a large multi-center clinical trial to use the ex-vivo lung perfusion/ventilation system to evaluate human lungs retrieved after death from non-heart-beating donors, patients who have died of sudden cardiac arrest outside the hospital or in the emergency room. Using animal models, Dr. Egan was the first scientist to show that lungs could be retrieved from non-heart-beating donors after death and safely transplanted. His research has shown that lungs are viable for substantial periods of time after circulation stops, because lung cells do not rely on perfusion (circulation of blood or other fluids) for cellular respiration.
Widespread use of lungs retrieved from non-heart-beating donors followed by ex-vivo assessment could provide much larger numbers of human lungs for transplant that may function better and last longer than lungs currently being transplanted from conventional brain-dead organ donors.
Investigators for the project, entitled “Ex-vivo perfusion and ventilation of lungs to assess transplant suitability,” are:
• Thomas M. Egan, M.D., M.Sc., Professor, Division of Cardiothoracic Surgery, UNC Department of Surgery (Principal Investigator), UNC School of Medicine
• Peadar G. Noone, M.D., Associate Professor, Division of Pulmonary and Critical Care Medicine, UNC Department of Medicine, UNC School of Medicine
• Paul Stewart, Ph.D., Research Associate Professor, Department of Biostatistics, UNC Gillings School of Global Public Health
• Eileen Burker, Ph.D., CRC, Associate Professor, Division of Rehabilitation Counseling and Psychology, Department of Allied Health Sciences, and Adjunct Associate Professor, Department of Psychiatry, UNC School of Medicine
• Benjamin E. Haithcock, M.D., Assistant Professor, Division of Cardiothoracic Surgery, UNC Department of Surgery, UNC School of Medicine
• William K. Funkhouser, M.D., Ph.D., Professor, Department of Pathology and Lab Medicine, UNC School of Medicine
• Katherine Birchard, M.D., Assistant Professor, Department of Radiology, UNC School of Medicine
• R. Duane Davis, M.D., Ph.D., Professor, Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine
For more information, contact Dr. Egan at (919) 966-3383.
To read the NHLBI release about the grant, click here.
In July 2010, the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill will begin a new six-year integrated residency program, which residents will enter directly from medical school. The Residency Review Committee for Thoracic Surgery, the national residency accrediting body, approved the program in July 2009. UNC is one of just a few institutions in the United States that offer such a program.
Students at North American medical schools may apply for the program through the Electronic Residency Application Service (ERAS). The deadline for applying for the 2010 residency has passed, but students may apply from September 2010 to January 2011 for the six-year residency program that begins in July 2011.
The new program will replace UNC’s traditional three-year cardiothoracic surgery residency program and the general surgery residency that precedes it. UNC’s three-year program will be phased out as residents in the integrated six-year program fill the early years of the program.
The three-year residency program will start its final resident in 2013; that person would complete the three-year program in 2016 (application for this position would be in the fall of 2011, with interviews in winter 2011-2012). For more information on the three-year program, click here.
The six-year curriculum includes rotations in vascular interventional radiology, endoscopy, cardiology, and endovascular surgery, and will provide residents with the background and experience using these new techniques in order to build a career as future “cardiothoracic specialists.” The program has been carefully designed to balance cardiovascular and thoracic care, and includes extensive exposure to fields relevant to thoracic surgery such as GI endoscopy, surgical oncology, and gastrointestinal (foregut) surgery. Completion of the program will lead to certification by the American Board of Thoracic Surgery. At UNC, the new program shortens the current ABTS certification process by two years.
Michael R. Mill, M.D., is chief of the UNC Division of Cardiothoracic Surgery and is director of the residency program.
UNC Division of Cardiothoracic Surgery faculty members believe that this tightly focused, comprehensive curriculum will produce better trained cardiothoracic surgeons and will be gratifying to the resident physicians who complete the program.
The field of cardiothoracic surgery has evolved tremendously over the decades, offering patients many more options for the treatment of intra-thoracic disease. The complexity of cardiothoracic surgery has increased and it has become more dependent upon a multi-disciplinary team approach, involving primary care physicians, cardiologists, pulmonologists, anesthesiologists, intensivists, radiologists, pathologists, cardiac perfusionists, nurses, clinical coordinators, social workers, and others. Hence, the objective of this training program is to provide a more comprehensive and rational immersion in the diagnosis and management of all aspects of cardiovascular and thoracic diseases through multi-disciplinary training. All aspects of the new curriculum are based on proven models of education currently available at the University of North Carolina. The curriculum preserves the significant contribution of general surgery and vascular surgery training to the development of a well-rounded cardiothoracic surgeon.
For more information on the new six-year program, click here.
Russell Ford received a heart transplant at UNC Hospitals in July 2009 after suffering from congestive heart failure for 10 years. Dr. Michael Bowdish of the UNC Division of Cardiothoracic Surgery was his transplant surgeon. In "Family House Diaries," written by Elizabeth Swaringen for UNC Health Care, Mr. Ford tells the story of his illness, his surgery and the experience his family had at SECU Family House at UNC Hospitals. The Family House is a non-profit hospital hospitality house, offering housing and other support services to adult patients and their families.
(Includes information from a blog by Keith Kocis, M.D., team leader for the Uganda mission.)
A UNC medical team provided heart surgery for 10 children with complex congenital heart defects during this year's two-week medical mission to Mulago Hospital, Makerere University, in Kampala, Uganda. All of the children were doing well when the UNC team left Kampala on Wednesday, Oct. 7.
This was the third year that the UNC team had visited Uganda, where they are training health care providers at the Uganda Heart Institute. The missions aim to help the pediatric cardiac surgery program become self sufficient in providing care for children with heart disease. The UNC team includes physicians (a pediatric heart surgeon, a pediatric anesthesiologist, a pediatric cardiologist and pediatric intensive care doctors); a pediatric nurse practitioner and a physician’s assistant who specialize in cardiac surgery; operating room and intensive care unit nurses; respiratory therapists; a perfusionist; and a biomedical engineer.
The team members left North Carolina on Sept. 26, carrying 900 pounds of medical equipment and supplies with them on their flight. When they arrived at the hospital in Uganda, the team quickly set up the operating room, perfusion equipment, and intensive care unit. Team members Karla Brown, Ruben Bocanegra, Katherine Desrochers, and Jennifer Ditto had collected and prepared the supplies and equipment for shipment, a months-long process.
Dr. Michael Mill, a pediatric heart surgeon from UNC, performed two operations a day for the first four days of the visit, with one additional operation on Oct. 3, and one on Oct. 5. This year, the children receiving surgery were smaller and younger than those who received surgery on past visits, and this year's patients had more complex congenital heart lesions. Seven of the children who received surgery weighed less than 10 kg (about 22 pounds). The team cared for the children 24 hours a day, overcoming challenges such as brief power outages, equipment breakdowns and repairs, and illnesses of team members.
The children who had the surgery are all recuperating well, and their spirits, energy, and appetites have markedly improved, team members reported. Without surgery, the children would have died from their heart defects; now, they can live normal lives.
The Uganda heart program mission has generous support from Samaritan's Purse and the UNC Institute for Global Health & Infectious Diseases. A team from the Children’s National Medical Center in Washington also participates in Uganda missions. After the UNC team's last mission in October 2008, partners from Children's National Medical Center returned in April 2009 and operated on an additional 10 children while advancing the Uganda program. The Ugandan team in-country has successfully repaired three additional children.
The 2009 UNC team members:
Keith Kocis, MD, UNC pediatric intensive care unit (PICU) physician; team leader
Michael Mill, MD, UNC pediatric heart surgeon
Eugene Freid, MD, anesthesiologist from Nemours Children's Clinic, Jacksonville, Fla.
Stacey Peterson-Carmichael, MD, PICU physician from Duke
Parvin Dorostkar, MD, PICU cardiologist, University of Minnesota
Ruben Bocanegra, PA-C, UNC physician's assistant
Karla Brown, RN, MSN, PNP, UNC pediatric nurse practitioner for cardiothoracic surgery
Greg Griffin, UNC perfusionist
Jennifer Ditto, RN, PNP, UNC surgical scrub nurse
Katherine Desrochers, RN, UNC PICU nurse
Susan Van Fleet, RN, UNC PICU nurse
John Bryson, RN, UNC PICU nurse
Diane Yorke, RN, PhD, UNC School of Nursing faculty
Jeannie Koo, RN, PNP, PICU pediatric nurse practitioner from Duke
Sheila White, RRT, UNC respiratory therapist
Lupe Haynes, RRT, UNC respiratory therapist
Elizabeth Smith, UNC medical engineer, and her husband
Read the blog written by UNC participants in this year’s mission.
The work at Mulago Hospital began after a group of UNC physicians established the Amal Murarka International Pediatric Health Foundation in memory of their colleague, Dr. Amal Murarka, a UNC PICU physician who died in a traffic accident in 2003. The foundation sent a medical team to Kampala to establish the country's first pediatric intensive care unit at Mulago Hospital, where Dr. Murarka had previously conducted research. Subsequent work in 2007, 2008 and 2009 has focused on pediatric cardiac surgery. The teams have established a cardiac ICU and have performed more than 30 life-saving pediatric cardiac surgeries. Team members have trained nurses at the Ugandan hospital in post-surgical care of pediatric heart surgery patients.
In 2008 the Murarka foundation partnered with the Institute for Global Health and Infectious Diseases to establish UNC Project-Uganda.
To make a gift in support of UNC-Uganda, click here.
To read a recent Carolina Alumni Review article about the team's 2008 mission to Mulago Hospital, click here. (To get rid of the black pop-up box, click on the "x" at the top right hand corner of the box.)
The Thoracic Surgery Directors Association has renamed its Resident Award the Benson Wilcox Award for Best Resident Paper in honor of Benson R. Wilcox, M.D., former president of the TSDA. Dr. Wilcox is a professor of surgery at the University of North Carolina at Chapel Hill and is emeritus chief of the UNC Division of Cardiothoracic Surgery.
The Best Resident Paper award is presented annually at The Society of Thoracic Surgeons' annual meeting for the best scientific abstract submitted by a cardiothoracic surgery resident.
TSDA is a group of doctors who are directors of cardiothoracic surgery residency programs across the United States. Dr. Wilcox was instrumental in establishing TSDA and drafting the association’s bylaws. Dr. Wilcox, a heart surgeon, is a longtime leader in cardiothoracic surgery education and was TSDA’s first secretary/treasurer from 1977-1980. He also served as president-elect from 1983-1984 and as president from 1985-1986. TSDA was formed to improve cardiothoracic surgery education.
The North Carolina Biotechnology Center has made a $30,000 loan to X-In8 Biologicals Corp., a new biotechnology company founded by Thomas M. Egan, M.D., M.Sc., a faculty member in the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill. The company is a spinoff from work that Dr. Egan has done in his lab at UNC-Chapel Hill.
The company plans to use the loan to finalize its business plan and prepare to seek financial backing from investors and federal grants. Until now, Dr. Egan's research has been supported by the National Institutes of Health, the Cystic Fibrosis Foundation, and the UNC Lung Transplant Research Fund.
Dr. Egan is working to develop therapies that might thwart inflammation and related damage (ischemia reperfusion injury) that occurs as blood flow is restored to tissues after a period of restricted blood supply. The compounds he is developing might keep naturally occurring immune-system proteins from contributing to IRI, reducing tissue damage after organ transplants. The research also could be useful in treatment of patients who have had heart surgery, strokes and heart attacks.
Read the North Carolina Biotechnology Center's news release.
Thirty-two new cardiothoracic surgery resident physicians from across the nation attended the second annual Thoracic Surgery Resident Boot Camp July 31-Aug. 2 at the University of North Carolina at Chapel Hill. During 2½ days of intensive simulator-based training, the incoming residents learned and practiced basic cardiothoracic operating skills that will help them as they begin their residencies. More than 40 medical educators assisted with training on Cardiopulmonary Bypass Skills, Large/Small Vessel Anastomosis, Bronchoscopy/Mediastinoscopy, Open Lobectomy and Orientation to Aortic Valve Surgery.
The training was directed by Dr. Richard Feins of the Division of Cardiothoracic Surgery at UNC-Chapel Hill, Dr. James Fann of Stanford University and Dr. George Hicks of the University of Rochester, and was held at UNC's William and Ida Friday Center for Continuing Education in Chapel Hill. It was sponsored by the Thoracic Surgery Directors Association under a grant from the Joint Council on Thoracic Surgery Education, Inc. with support from these companies: CryoLife, Ethicon Endo-Surgery, Immersion Medical, Karl Storz Endoscopy, Medtronic, Olympus America, Inc., Teleflex Medical, Scanlan International, Sorin Group and St. Jude Medical.
For related article, see You Never Know Unless You Try, published in the Annals of Thoracic Surgery and the Journal of Thoracic and Cardiovascular Surgery.
In its July 2009 issue, American Journal of Physiology - Lung Cellular and Molecular Physiology published a paper, "Novel critical role of toll-like receptor 4 in lung ischemia-reperfusion injury and edema," from the lab of Thomas M. Egan, M.D., M.Sc., of the UNC Division of Cardiothoracic Surgery.
The manuscript adds to the growing body of evidence that the innate immune system contributes to non-infectious lung injury and proposes a completely new role for toll-like receptor 4 (TLR4) – regulation of acute microvascular endothelial cell permeability. Because of phenotypic similarity to many other types of acute lung injury, the Egan lab's findings have far-reaching implications. The research provides evidence that functional TLR4 on pulmonary parenchymal cells is responsible for very early and profound pulmonary edema following lung ischemia and reperfusion.
Dr. Egan’s research has focused for many years on lung ischemia-reperfusion injury (IRI), particularly as it relates to the possibility of lung retrieval after an interval of warm ischemia for possible transplant from cadavers, or non-heart-beating donors (NHBDs). If this became widely practical, it could eliminate the critical shortage of lungs for transplant.
The first author of the article, Giorgio Zanotti, MD, was a visiting research scholar in Dr. Egan's lab from the University of Pavia, Italy. He is now a surgery resident at Duke University. The other authors were Monica Casiraghi, MD; John B. Abano, MD; Jason Tatreau, BS (now a UNC medical student); Mayura Sevala, PhD; Hilary Berlin, BS; Susan Smyth, MD, PhD; William Funkhouser, MD; Keith Burridge, PhD; Scott Randell, PhD; and Dr. Egan.
Reference for the article:
Zanotti G, Casiraghi M, Abano JB, Tatreau JR, Sevala M, Berlin H, Smyth S, Funkhouser WK, Burridge K, Randell SH, Egan TM. Novel critical role of toll-like receptor 4 in lung ischemia-reperfusion injury and edema. Am J Physiol Lung Cell Mol Physiol 2009; 297(1):L52-63.
On UNC-TV's "North Carolina People," host Bill Friday recently interviewed Brett Sheridan, M.D., about heart surgery and heart health. Dr. Sheridan replaced Mr. Friday's aortic valve last winter, and Mr. Friday asked him questions about this surgery. Dr. Sheridan is associate professor of surgery at UNC and is director of adult cardiac surgery at UNC Hospitals. Mr. Friday was president of the University of North Carolina for 30 years and hosts "North Carolina People" weekly on UNC-TV.
(Images and web link used by permission of UNC-TV.)
In its Spring 2009 issue, the UNC Medical Bulletin traces the development of the heart and lung transplantation programs at UNC Hospitals. Dr. Michael Mill and Dr. Thomas Egan, both still on the faculty at UNC, started the programs after they were recruited by Dr. Benson Wilcox in 1988 and 1989, respectively. Today, UNC has six transplant surgeons; the transplant program includes a skilled team of transplant coordinators, nurses, perfusionists, anesthesiologists, surgeon's assistants, cardiologists, pulmonologists and pathologists.
To read the article in the UNC Medical Bulletin, click here. (Article begins on page 4 of the PDF.)
The elderly are at high risk of acute coronary syndrome (ACS) but receive less cardiac medication and invasive care than other groups. Two factors may explain this: limited data from randomized clinical trials and uncertainty about benefit and risk with advancing age.
In two articles published recently in the journal Clinical Geriatrics, Dr. Brett Sheridan (right) and colleagues in the UNC School of Public Health, UNC Division of Cardiology, and Sheps Center for Health Services Research reviewed the use of therapies for ACS and the challenges of diagnosing and treating ACS in the elderly. They also examined outcomes results of invasive therapies (percutaneous coronary intervention and coronary artery bypass grafting).
Given the benefits observed in recent trials, age alone should not prevent consideration of invasive treatment of ACS in the elderly, but rather should intensify it, the group concluded.
The research was supported by an NIH R01 grant (Acute coronary syndrome outcomes in Medicare patients) on which Dr. Sheridan is co-principal investigator.
Read the articles:
Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Intervention in Older Persons with Acute Coronary Syndrome - Part I (Sheridan BC, Stearns SC, Massing MW, Stouffer GA, D'Arcy SP, Carey TS). Clinical Geriatrics 16(10):39-44, 2008.
Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Intervention in Older Persons with Acute Coronary Syndrome - Part II (Sheridan BC, Stearns SC, Massing MW, Stouffer GA, D'Arcy SP, Carey TS). Clinical Geriatrics 16(11):40-46, 2008.
|Dr. Benjamin Haithcock talks to patient Glenda Frazier about her lung surgery. (Copyright NBC 17 TV.)|
In a recent interview on NBC 17 TV, Benjamin E. Haithcock, MD, a UNC cardiothoracic surgeon, discusssed disparities in treatment of lung cancer. He discussed the same topic at a Lung Cancer Awareness Symposium at UNC's Lineberger Cancer Research Center on Nov. 17.
Glenda Frazier, 40, came to UNC from Fort Bragg after a doctor found a spot on her left lung. Dr. Haithcock biopsied the lung, discovered cancer, and then removed part of Frazier's lung using minimally invasive surgery.
Frazier was lucky because of the early diagnosis, but also because she got the right treatment.
Haithcock says she's an exception. He believes too many people, especially African Americans, don't try to seek specialized care or learn about treatment options that could save their lives. He says patients should always talk to their doctors about their options before agreeing to treatment.
|Dr. Haithcock says patients deserve a thorough explanation of treatment. He uses a drawing to explain a patient's cancer and surgery. (Copyright NBC 17 TV.)|
Dr. Benjamin Haithcock of the UNC Division of Cardiothoracic Surgery was featured in a television interview about minorities and treatment of lung cancer. The interview was broadcast on WNCN TV (NBC 17, Raleigh) on Nov. 16, 2008.
Knowing Options May Prevent Deaths From Lung Cancer
By Julie Henry
©NBC-17 TV, Raleigh
Nov. 16, 2008
At just 40 years old and an avid runner, Glenda Frazier hardly fits the picture of a lung cancer patient.
But last spring, a spot on her lung brought her from her home at Fort Bragg to see a doctor at UNC's cancer center.
"He said, ‘We'll go in, I'll biopsy it while you're asleep’... amazing!" said Frazier. " ‘If it's cancerous, we'll go ahead and take it out and remove it.’ "
Thoracic surgeon Dr. Benjamin Haithcock confirmed it was cancer and did a minimally invasive procedure to remove the lower lobe of Frazier’s left lung.
Frazier didn't have any follow-up chemotherapy or radiation. She was lucky because she was diagnosed early, but also because she got the right treatment. Haithcock says she's an exception to the rule. He believes too many people, especially African Americans, don't try to seek specialized care or learn about treatment options that could save their lives.
"I think there is a reluctance to have an operation, I think there is a reluctance to see any kind of surgeon," said Haithcock. "And I think there is still that reluctance, especially in elderly African Americans, of just going to a physician."
Haithcock says more blacks die within five years of diagnosis than whites, but with proper treatment, whether it's medicine or surgery, the survival rate is the same. He says patients should ask questions of their doctors and get more information before any kind of treatment.
Glenda Frazier is living proof.
"Do your research, talk to your doctors, talk to a specialist, not just some general person, and also talk to your friends," said Frazier. "Don't settle for no."