“Here’s where you’re going to change. Place all of your personal effects in one of the lockers. Do you have any tattoos? No earrings, right? Good. What about any piercings we can’t see?”
The checklist of instructions and questions is extensive, but the last two are the most important. Because even the smallest piece of metal could send Jennifer, a mid-30s multiple sclerosis patient, hurtling into the magnetically sensitive Siemens 3 Tesla MRI—price tag: about $1 million—with enough force to kill her. Jennifer (not her real name) has returned to the Cleveland Clinic Lou Ruvo Center for Brain Health for a follow-up brain scan to determine if the meds she’s been taking are working to control her MS. Key word: control. Because there is no cure.
Lying on her back, Jennifer slowly slides along the track as two technicians on the other side of the glass periodically communicate with her, mostly to offer words of encouragement. The images displayed on the screens in front of the technicians? Not so encouraging: lesions. In three places. This doesn’t necessarily mean Jennifer’s symptoms are worsening. But it doesn’t mean they’re subsiding, either.
There is, however, good news for Jennifer and for the dozens of other patients who will walk through the doors of the Ruvo Center today … and tomorrow … and in the months and years to come: Inside the walls of the most fascinating piece of architecture in Las Vegas, several of the world’s finest neurological physicians—plus a large supporting cast of physician assistants, nurses, physical therapists, social workers, administrators and volunteers—are working feverishly to give Jennifer and others afflicted with MS, Alzheimer’s, Parkinson’s, Huntington’s and other brain diseases hope. Hope that someday there will be, if not a full-blown cure, a miracle drug that will not only extend life, but improve the quality of that life—both for patients and the loved ones who care for them.
This is the story of how, less than five years post-ribbon cutting, Frank Gehry’s building in the center of town has become a building of massive import, for Las Vegas and beyond. It’s also the story of how one of the community’s most influential men, thanks to boundless tenacity and a star-studded Rolodex, wound up honoring the memory of his father in a way more profound than he ever expected.
Lou Ruvo’s buddies. An employee at Spago. And a billionaire who built his fortune on hair-care products and tequila.
Without these main players and their serendipitous convergence, there’s a good chance that the corner of Bonneville and Grand Central avenues upon which the center stands would still be nothing but a plot of hard dirt.
It was February 18, 1995, a year to the day of Lou Ruvo’s passing from complications with Alzheimer’s disease. At the urging of some of Lou’s longtime friends, his son, Larry—the onetime business partner of Steve Wynn who had come to build Southern Wine & Spirits of Nevada into one of the biggest liquor distributors in the country—organized a dinner to simply “tell Lou Ruvo stories.”
Ruvo dialed up his close friend Wolfgang Puck, who agreed to host the dinner at Spago, Puck’s eponymous restaurant in the Forum Shops at Caesars. As family and friends reminisced in a room upstairs, John Paul DeJoria—the co-founder of both Paul Mitchell hair products and Patrón tequila—walked into the restaurant. “Hey,” a Spago employee said to DeJoria, “your buddy Larry Ruvo is upstairs.”
DeJoria went to say hello to his friend.
DeJoria: What are you all doing here?
Ruvo: We’re telling Lou Ruvo stories.
DeJoria: Wait, your dad died of Alzheimer’s, right?
Ruvo: Yeah. A year ago today he passed away.
DeJoria: I’m giving $5,000 to Alzheimer’s.
DeJoria took out his checkbook, and—peer pressure being what it is—others in the party did likewise. “By the end of the night,” Ruvo recalls, “I had $35,000. So I waited until the dinner was over and I went to Wolfgang and said, ‘Hey, Wolf, this was easy. Let’s do another dinner.’”
Puck agreed, under one condition: He wanted a different chef to oversee the dinner—a relative unknown with a single restaurant in Los Angeles. “The trajectory of his career,” Puck told Ruvo, “is going to be like a rocket ship. This guy’s going to be that good.”
Puck revealed the chef’s name. Didn’t ring a bell with Ruvo. Or Wynn. Or anyone else in Ruvo’s prominent food-and-beverage inner circle. That chef: Nobu Matsuhisa.
“We raised $375,000 with that first dinner in 1996 with Nobu,” Ruvo says. “Next dinner, I raise $1.1 million. Next dinner, $2 million. And I’m doing it all with this formula of [celebrity] chefs, then honoring people and then ultimately bringing in big celebrities.”
It was the start of what is now known as the Keep Memory Alive Power of Love gala. And by the early 2000s, Ruvo’s charity dinners had pumped $35 million into Keep Memory Alive.
Donna is all smiles when she enters the exam room on the second floor of the Ruvo Center. But it’s difficult to determine if the smile is voluntary or more the result of the effects from a series of strokes, which have robbed the 72-year-old of much of her ability to speak. Ronald, Donna’s husband of 56 years, is by her side and says he started sensing something was amiss with his wife’s memory about four years ago. He learned of the Ruvo Center in the local newspaper and has been bringing Donna to see Léger for about a year.
Today, in addition to giving his patient a brief motor-skills and memory exam—“Is the president male or female? Caucasian or African-American?”—Léger wants an update on how Donna is being affected by a recent change in medications. Most of his questions are directed to Ronald, who gives the doctor a rundown of his wife’s daily routine, as well as her mood swings, sleeping and eating patterns and bouts of forgetfulness.
“Is she better, worse or the same since she was last here?” Léger asks.
“Same. Except for the memory lapses. That’s worse. Although last week she almost seemed like herself for several days.”
Léger admonishes Donna about her diet and need for exercise, stressing that she could improve her symptoms by simply cutting back on fatty foods, red meat and wine, while adding 30 minutes of daily aerobic activity.
“She knows what to do,” Ronald says. “But she’s not motivated unless I’m standing there, telling her to do it.”
As he continues providing Léger with a status report, Ronald is generally upbeat and simultaneously exasperated.
The doctor directs another question to Donna’s primary caregiver: “So how are you doing?”
It was early 2005, and Ruvo had $35 million burning a hole in his back pocket, every dime earmarked for Alzheimer’s research. And he knew exactly what to do with it. He went to see his friend and renowned Alzheimer’s expert, Dr. Leon Thal—the same Leon Thal who for several years treated Lou Ruvo at the University of California, San Diego. Ruvo presented Thal with a check and a request:
“Leon, I want you to build a building for my dad in San Diego. And then I’m done.”
“Larry, I work for UCSD. If you give me $35 million, by the time I get it, with the bureaucracy, it’ll be worth $20 million. And you’d be doing a really big disservice to the people of Las Vegas. There’s no primary care there for Alzheimer’s patients. We need to do something in Las Vegas.”
Ruvo knew this all too well. He spent several frustrating years shuttling his dad around town to see various doctors—all of whom were consistent in their misdiagnosis—then another several years traveling to San Diego so his dad could get the quality care from Thal he couldn’t find here.
“So I told Leon, ‘OK, I’ll do it if you’re going to run it, because I don’t know anything about this.’ And Leon said, ‘I can’t come for five years, because I just got a $55 million grant from the government. But I’ll operate it and we’ll run it from afar, and I’ll have all the right guys, and then at the end of five years, I’ll look to come up there.’ Handshake agreement.”
Tragically, Thal would never be able to honor that agreement in full: On February 3, 2007, he died when the plane he was piloting crashed in the desert northeast of San Diego. “One of the great guys in the world, Leon Thal,” Ruvo says. “He was in a league of his own.”
By this point, though, Ruvo had committed to putting an Alzheimer’s facility in his hometown. And after receiving an initial sketch of the building’s design, he proudly showed it off to some close friends at dinner.
“They look at the [design],” Ruvo recalls, “and they go, ‘Ah, OK.’ I said, ‘What do you mean, Ah, OK?’ They say, ‘It’s a nice building.’
“And then it hit me later at my daughter’s volleyball game: I know what a celebrity chef will do for a restaurant, and in my business, I know what packaging and marketing does. I’ve got to package and market this so the world knows we’re serious.”
In a nondescript room on the second floor of the Ruvo Center, five beauty shop-like chairs are lined up in a row under a window, each with an adjacent metal stand from which to hang IV bags. This infusion services room, as it is known, is empty right now, but it’s been a godsend for MS patients who experience acute flare-ups. Those patients visit the infusion services room, where they’re administered steroid treatments to control inflammation in the brain. The treatments take 20 to 30 minutes and are given on three successive days. Symptoms usually subside within a week or so, but sometimes as quickly as the next day.
“Our goal when we opened up our MS center here was to try to create a one-stop shop,” West says. “Anything you need, no matter where you are in MS, we want you to be able to get here. If you have aggressive MS, we want to be able to shut it down. And this keeps our patients out of the ER—they don’t ever need to go back there again. Because it’s awful, it’s expensive, it’s a sap on the system and it’s a [brutal] experience.”
West would certainly know about the physical and mental distress associated with MS, and not just because it’s his chosen field of medicine. His mother has been living with the disease as long as he’s been alive. “As far as I can tell,” he says, “her very first symptom was right after I was born. Both of her hands went numb on the fourth and fifth digits.”
His mother’s disease didn’t aggressively progress until West was in high school, but when it seeped into her spinal cord 15 years ago, she lost her ability to walk. “People with MS have a lot of relapses, then at some point, they just start to decline,” West says. “Like my mother. She’s at the point where she’s not having attacks anymore. She’s just gradually getting worse. And there’s no treatment for people like her. So our next clinical trial is going to be an oral medication that treats progressive MS. It’s the first oral medicine for progressive MS that’s ever been attempted.”
As with all medically related services at the Ruvo Center, only registered patients can access the infusion services room. However, West makes himself available to the Valley’s entire MS community—there are 2,500 Southern Nevadans registered with the National MS Society—by working one day a week at the University of Nevada School of Medicine and also participating in Volunteers in Medicine of Southern Nevada. “I want to make very sure that if anybody has MS in this state, they can see me if they need to—even if you have no insurance.”
It’s a far cry from a decade ago, when there wasn’t a single dedicated MS center or MS fellowship-trained neurologist in the state.
Larry Ruvo didn’t just want to create a facility that would help people stricken with neurocognitive disorders, like the one that took his father. He wanted to create a showstopper, an architectural wonder on the level of anything ever constructed on Las Vegas Boulevard. So in early 2006, he pulled some strings and secured a 45-minute meeting with one of the world’s most famous—and most cantankerous—architects. Upon arriving in Frank Gehry’s office in Los Angeles, Ruvo extended his hand and introduced himself. Gehry—seated in his chair, head down—promptly and curtly dismissed his guest’s pleasantries and his request.
“I won’t repeat the profanity I used,” Ruvo recalls, “but I’m standing over him and I said, ‘First of all, you didn’t get out of your chair to shake my hand. And you made me fly down here to tell me that you’re not going to do a building in Las Vegas? You have to be the nastiest, the meanest human,’ and I start swearing. And he yelled, ‘Sit down!’”
Ruvo began telling his story to Gehry, and 45 minutes turned into 3½ hours, and “I’m not building a building in Las Vegas” turned into “Well, let me think about it.”
Three weeks later, Ruvo returned to Los Angeles with his wife, Camille, and by now Gehry had made up his mind. “Frank looks at Camille and says—it was a great line—‘Did you ever make mud pies when you were young?’ She says, ‘Yeah.’ He says, “Well, you never make mud pies with your enemies. I’m getting older. I want to make mud pies with your husband. I like him. I’m doing the building.’”
After coming to Las Vegas to survey the 4-acre site, Gehry asked his new client what exactly he was looking for. Ruvo laid out his plans: Inside an eye-popping exterior, he wanted a small campus of multiple independent structures, including a medical facility to treat patients and conduct research; a building for rehabilitation; a small courtyard café; and a dazzling, multidimensional event center in which to house private and corporate gatherings, the funds from which would be used to fuel the entire nonprofit organization. Gehry processed this information and within a few hours came up with a rough design of what eventually became the structure that exists today.
Now that Ruvo had secured the perfect packaging to promote his product, it was time to focus on the content inside. “In my business, it’s about the liquid,” he says. “I could have a great package, but if the product tastes lousy, who’s going to drink it?”
So he set about finding the ideal institution with which to partner. After meeting with representatives from UCLA and other esteemed medical institutions, he signed a deal in February 2009 with the Cleveland Clinic. Known worldwide as a leader in cardiovascular research and treatment, the Cleveland Clinic—which in addition to Ohio has locations in Florida, Toronto and, beginning next year, Abu Dhabi—was also recognized for its work in neurology.
Around the time an agreement was reached, Cleveland Clinic President and CEO Toby Cosgrove shared his goal with Ruvo: “The last frontier is the brain. We want to do for the brain what we did 30 years ago for cardio.”
Per Larry Ruvo’s insistence, there are no patient waiting rooms in the Cleveland Clinic Lou Ruvo Center for Brain Health. Rather, there are small “tranquility rooms,” where patients check in before being quickly dispatched to an examination “suite.” It’s one of many details—some noticeable, some not—that are unique to the main four-story clinical, research and administrative building. Other examples: soft lighting that points upward (because direct light can irritate those with neurological disorders); different colored furniture in the lobby of each of the floors (to help patients with memory problems recall where they are); and striking art pieces in most common areas (most of the art is for sale, with the proceeds benefiting Keep Memory Alive).
All of this speaks to the center’s “patients-first” philosophy. But just as important as the patients are the loved ones who care for them. This in part explains why Dr. Léger made a point to ask his patient’s husband, “So, how are you doing?” It also explains why there’s a public lending library on the fourth floor, filled with hundreds of books, videos and online resources to help people learn about the different stages of various cognitive disorders. And why there are disease-specific support groups available for caregivers, as well as counseling services and educational programs, such as the weekly brown-bag Lunch & Learn series. This one-hour lunchtime seminar features rotating topics that range from legal and financial planning to health and wellness exercises to teaching caregivers various techniques and strategies to better understand and respond to those who are struggling with a brain disorder. The Lunch & Learn sessions, which last year attracted more than 2,200 people, are even broadcast via videoconference to Pahrump, Elko and Carson City.
“These diseases not only impact the patient, but they impact all of those around them. These are diseases of the family,” says Susan Hirsch, who oversees a staff of six as the Ruvo Center’s director of social services. “And it’s our hope that people feel comfortable connecting with us in a way that works for them. Because in many instances, caregivers are at risk for developing illness after they start caregiving—the actual act of caregiving puts them at greater risk. And we really want to mitigate that as best we are able.”
Dr. Jeffrey Cummings, one of the world’s preeminent neurological minds, was at an Alzheimer’s disease meeting in Washington, D.C., when he stepped out to take a phone call from Larry Ruvo. He readily admits, “That was the first time I’d ever been compared to Babe Ruth!”
Cummings was familiar with what Ruvo was in the process of building in Downtown Las Vegas, but he was also fully entrenched in Los Angeles, where he had spent two decades leading UCLA’s neurological program, including serving as the director of the Mary S. Easton Center for Alzheimer’s Disease Research at the university. He was flattered, he says, but moving to Las Vegas was the furthest thing from his mind.
Then, much like Frank Gehry, Cummings began to have second thoughts. “During that period, I had become more and more passionate about clinical trials and the need to develop new treatments for Alzheimer’s disease and other brain disorders,” he says. “What that requires more than anything else is high patient flow, and I could see that that was the strength of Cleveland Clinic—their devotion to clinical excellence and therefore their ability to establish a high flow of patients who had an allegiance to the institution. So for me the draw was, ‘I can come here and do clinical trials, and that’s what I think is most important.’”
Not only did the Ruvo Center land Cummings as its new director, but also his wife, Dr. Kate Zhong, who was brought on board to direct the clinical-trial program. Zhong had previously spent more than a decade doing clinical and pharmaceutical research, including for AstraZeneca, one of the world’s leading pharmaceutical companies. It was easy enough for Cummings to convince his wife to sign up. He thought it would be much tougher to persuade other top neurological physicians and researchers to come to Las Vegas and be part of a fledgling program. Instead, his pitch was greeted with enthusiasm. “The recruitment of my staff here has exceeded expectations,” says Cummings, who also directs the Cleveland Clinic’s Neurological Institute in Cleveland and Weston, Florida. “You walk down this hall, our 11 faculty are as competitive as any university in this country.”
Dr. Dylan Wint is part of that faculty. He came to the Ruvo Center from Atlanta’s Emory University School of Medicine in 2010 and currently serves as the director of the Fellowship in Behavioral Neurology and Neuropsychiatry, as well as director of Education in Neurodegeneration. “I don’t know of another place like this that integrates clinical care, research, caregiver support and then the type of education that we do, which is very, very broad-based in the community,” he says. “It’s not just educating neurology residents and behavioral neurology fellows, but trying to educate the entire community about what these diseases are and what they mean.”
Indeed, a significant portion of Wint’s work requires him to more or less be a teacher. However, he’s just as likely to play the role of student: “I often say that this is the first place I’ve worked where I’m sure I’m not the smartest person.”
More than 20 clinical trials are ongoing at the Ruvo Center—nine of which are open for enrollment—but one of these trials doesn’t involve a drug at all. On the first floor of the main building, in a space the size of a dental exam room, is something called a neuroAD chair. Invented by the Israeli company Neuronix, the chair and its attached parts look like something out of a science-fiction movie, and today, Victor, a 76-year-old patient whose Alzheimer’s is in the early-to-moderate stage, is taking it for a spin. First, a technician affixes a rectangular device to a precise spot on Victor’s head (the device is moved to other parts of his head throughout the hourlong session).
Once the machine is powered on, noninvasive electromagnetic energy stimulation—which can be heard through periodic “zaps”—is sent to different areas of Victor’s brain. While receiving the stimulation—as with all clinical trials, some subjects receive a placebo, but this patient unknowingly is getting the real deal—Victor simultaneously performs cognitive exercises that test his memory capabilities on a touchscreen in front of him. The machine tracks Victor’s responses, and the difficulty level is altered accordingly.
Here’s what Neuronix believes it has hit on: By combining magnetic stimulation and cognitive tasks, the connection between nerve cells in the brain is strengthened, which is vital to one’s memory. While the hope is that the neuroAD device, if approved for mass consumption, could help alleviate memory loss, it would not be marketed as a cure.
“The hardest part of this kind of work is that, at least right now, we know that our patients will get sicker and will die, either from this disease or from something else,” Wint says. “These diseases can’t be stopped. So you know going into this work that you’re not going to be curing anyone. A lot of the time, you’re not going to even be slowing things down very much. You have to have the attitude that what you’re trying to do, at any point in this process, is make life easier, less stressful and happier for the patient and the caregiver.”
Still, just as with cancer and AIDS and every other incurable disease, the goal forever remains stumbling upon a wonder drug that will give brain-disorder victims like Victor, Donna and Jennifer a piece of their life back. Which is why patient-participatory trials—as well as research components like the ongoing Fighters Brain Health study, launched in April 2011, of more than 400 boxers and mixed martial arts fighters—are as crucial as any of the work being done at the Ruvo Center, which as recently as 2012 saw about 7,500 patient visits, including 1,500 new patients.
“The key to the future of all therapies is in the hands of the patient,” Cummings says. “We can bring the compound to a population, but if nobody gets into a clinical trial, we will never know whether it works, and it will never be made widely available if it’s successful. That’s why this alliance between us and the community is so critical to advancing new therapies. Because both of those pieces have to be in place in order for a drug to succeed.”
As he makes this proclamation, Ruvo is standing in the Keep Memory Alive Event Center, which is the crown jewel of the one-and-only Las Vegas project in Frank Gehry’s portfolio. It’s late on a warm winter afternoon, and the sun shines brightly through the room’s 199 windows, no two of which are alike in shape. It’s part of Gehry’s genius: With the help of automatic shades and natural light by day, and state-of-the-art lighting at night, those windows make the look and feel of every party staged in this space—from an Estée Lauder corporate gathering to a rock ’n’ roll benefit for chef Kerry Simon—different than the next.
As for the walls in this circular space, they’re stark white and bare, save for one vertical spot where a large oil painting by pop artist James Rosenquist hangs, a gift from Ruvo’s longtime pal. “When Steve Wynn walked in here for the first time, he looked up and said, ‘OK, listen. One piece of art, that’s all you need—a James Rosenquist on that wall. No other art. The building is the art. The building is the statement.’”
At this point, Ruvo excuses himself. He has a call scheduled with singer Gloria Estefan and her husband, Emilio, both of whom will be feted April 26 at the 18th annual Power of Love gala at the MGM Grand, the star-studded, celebrity-chef-inspired extravaganza that grew out of that very first dinner at Spago in 1995—one that’s now raised in excess of $170 million. Before he leaves, Ruvo cues up a video presentation that features remarks from four U.S. presidents (George H.W. Bush, Bill Clinton, George W. Bush and Barack Obama); one former chairman of the Joint Chiefs of Staff (Colin Powell); and one Nobel laureate (Dr. Stanley Prusiner, who chairs the Scientific Advisory Board of the Cleveland Clinics in Las Vegas, Cleveland and Weston, Florida). To a man, they all laud the facility and its visionary.
“This Frank Gehry building is going to be a Las Vegas landmark for a long time to come,” says the younger President Bush during a visit in February 2010. “Larry wanted to honor his dad with this magnificent facility. He’s worked hard to do so, and his care and compassion to his fellow citizens is a great testament to his heart.”
Shortly before the video concludes, Ruvo returns. There’s one final question to pose: What would his father have thought had he lived to see a brain institute built in his honor?
Ruvo pauses, searching for the right words. “If somebody would’ve come to him and said, ‘Here’s what will happen if you’re stricken with this disease’—if he would’ve been able to see the future—he’d have said, ‘Take me right now.’ He was a very unselfish guy. He would’ve sacrificed his life to have this.
“He loved Las Vegas, and he would be proud of his friends and the community that rallied behind his son. And he would give the accolades to the people of Las Vegas for believing in a dream.”
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