After nearly 43 years of health care service, primarily within UW Health, Ann Dodge, NP, Division of Pediatric Cardiology, will step away from her pediatric patients and their parents, her close colleagues, and her students to retire in May.
After Dodge graduated from James Madison Memorial High School (now Vel Phillips Memorial High School) in Madison, Wisconsin, she was not convinced she wanted to go to nursing school. Her father, a physician, wanted at least one of his children to go into medicine; Ann’s four brothers were not interested. She decided to attend Duke University because its Bachelor of Science in Nursing program allowed a student to take liberal arts courses for the first two years: she only had to commit to the program by her junior year. She took Spanish classes and was asked to volunteer as an interpreter in Duke Hospital (in the days before official interpreters). That experience gave her an unusual entrée and perspective of hospital work. By the end of her sophomore year, she had decided to complete a Bachelor of Science in Nursing at Duke.
Dodge’s early nursing positions were in pediatrics. First at the University of Minnesota Hospital, and then, from 1985 on, primarily at the University of Wisconsin, where she worked in pediatric intensive care units and emergency air-ground transport. She worked for more than 12 years as a pulmonary/asthma-allergy clinical research nurse coordinator, where her duties ran the gamut from patient recruitment to protocol design and review, data management, and the co-authoring of research manuscripts. As she worked in these diverse areas, Dodge learned where she most wanted to focus her attention and skills.
“I knew I wanted to help children avoid the pitfalls, avoid the choices that aren’t healthy for them,” Dodge said.
By teaching children how to make life choices, Dodge could work to prevent disease and suffering later in their lives — for example, from tobacco-related illnesses and from cardiovascular disease and diseases arising from poor diet and other consequential life choices.
In 2009, after completing UW–Madison School of Nursing’s Master of Science in Nursing: Pediatric Nurse Practitioner Program, Dodge applied to join the Department of Pediatrics as a pediatric cardiology nurse practitioner. She had previously worked throughout the UW Health system implementing successful tobacco cessation programs and was very interested in developing a pediatric preventive cardiology program. When she was interviewed for a position in the Department of Pediatrics Division of Cardiology, J. Carter Ralphe, MD, professor and chief of the division, asked her what her goals were. She told him that she would love to start a pediatric prevention clinic. He gave her the green light when she was hired and assured her that he would support her in any way. Ralphe’s ongoing support would be a key to the initiation and development of the future clinic.
In 2010, Amy Peterson, MD, MS, associate professor, Division of Cardiology, joined the department, and in 2011 became the program’s director, which is now the American Family Children’s Hospital Pediatric Preventive Cardiology Clinic (PPCC). Dodge and Peterson recognized each other as kindred spirits from the moment they met. They shared a vision about what was possible for the program and have worked side by side in the PPCC for 12 years, striving to reduce or eliminate risks of early heart disease in children. Their pediatric patients are at a greater risk of cardiovascular disease than their peers because of family history, including tobacco use; medical conditions, such as diabetes or familial hypercholesterolemia (FH); or obesity.
“Together, Amy, Erin Marriot, another nurse practitioner in cardiology, and I developed the program, and it just exploded. One in five children already have elevated blood lipids. We teach kids about what’s going on in their bodies and motivate them to make changes,” Dodge said. “Our screening also identifies the one in 250 kids who have the genetic condition, familial hypercholesterolemia, FH, early enough to prevent the harm — often an early heart attack —that FH often causes.”
FH is an inherited disorder that leads to very high levels of LDL cholesterol; it causes premature cardiovascular disease. It is the most common life-threatening inherited metabolic condition, affecting one in 250 people, and it can increase a person’s chance of an early heart attack six- to 20-fold. FH is not caused or affected by diet: many kids with FH are thin and athletic; some are vegans. Early identification is critical so that lipid-lowering treatments can be started. Only lipid screening can identify them.
The American Academy of Pediatrics (AAP) published guidelines for lipid screening of children in 2011, which resulted in more parents bringing their children to the PPCC. The clinic is now recognized internationally, and Peterson, often with Dodge, attends all the relevant conferences. Peterson’s research group, which includes Dodge, has published more than 25 papers on pediatric lipid disorder topics.
The research is focused on these areas:
- Systematic measurement and promotion of universal lipid screening in children
- Early detection and treatment of familial hypercholesterolemia, atherogenic dyslipidemia, and other lipid disorders
- Cascade screening of relatives to identify familial hypercholesterolemia
- Impact of the COVID-19 pandemic on cardiac risk factors in children
- Clinical trials for novel treatments of lipid disorders in children
Through the lipid screening of children, Dodge noted, they have sometimes found that parents of an FH child have never been screened; they have identified parents who were possibly only a few years away from an imminent heart attack. This “cascade screening” of relatives can be a lifesaver.
Most of Dodge’s pediatric patients have abnormal blood lipids not because of FH but because of diet choices and not enough exercise. Educating them about where they are and how they can improve, she lets them know that they are not helpless: they have the power to change. She wholly engages them with visual aids, such as her very popular series of large cut-away models of arteries that show the effects of plaque build-up, from clear and clean to nearly occluded with years of build-up from poor diet and lack of exercise. She helps them with making food choices and planning an exercise routine based on their interests or passions.
“Ann is a force of nature in the clinic,” Peterson noted. “She never gives up on anyone and she finds a way to motivate and empower all her patients.”
Not every state has a pediatric lipid clinic; this kind of clinic is rare. Consequently, Dodge has dedicated much time to teaching students in the NP program what they need to know about abnormal pediatric lipid disorders, to transfer her knowledge to the next generation of clinicians. She has NP students in the clinic with her every semester, and lectures in the UW’s Doctor of Nursing Practice (DNP) program on pediatric lipid disorders. She is heartened by the interest.
“I cannot express enough both my amazement and gratitude at how my career has been more than I could have dreamed of,” Dodge said. “And I know that in my retirement Amy and her dedicated team will continue driving the clinic and its work forward.”
It has been a dream of Dodge and Peterson to get screening for FH on the newborn screening panel, since full blood lipid evidence of it now can only be identified in a child at age two. That would require an identifiable genetic marker on the newborn bloodspot used for the screening.
“I know that dream will come true because of the focus and dedication of Amy and the team she has around her,” Dodge continued. “They will continue to develop and conduct the research needed to reach that goal.”
After 12 years as Dodge’s colleague in the PPCC, Peterson has nothing but praise as Dodge steps away from this chapter of her life in healthcare.
“Ann has been fundamental in making this program what it is today,” Peterson said. “She is not only a gifted clinician, but she brought her research experience to the program as well, and has been a great teacher, mentor, colleague, and friend. I can’t wait to see what she does next!”
Ralphe offered similar sentiments about Dodge.
“Ann is a wholly unique individual in her passion, skill, and relentless enthusiasm,” he said. “We are so very fortunate that she spent this chapter of her career here at AFCH helping so many children live healthier lives.”
After she retires in May, Dodge plans to continue her work in health advocacy. She is chair of the American Heart Association’s Wisconsin Advocacy Committee, which is currently working on laws that involve tobacco control funding, mandatory CPR training for high school students, and 911 dispatcher training for CPR phone coaching.
Dodge is also intent on changing advance medical directives to allow people to make choices in the way they are cared for in case of severe dementia. “Too many people are kept alive for years beyond what they would have chosen,” Dodge said. “More choices relevant to dementia in an advance medical directive, such as the choice to refuse hand feeding, would prevent enormous suffering.”
Ann Dodge, NP, clearly intends to begin a new chapter of her life in health care.