What Doctors Know - August 2012

7/27/2019 What Doctors Know - August 2012

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January is National

Blood Donor Month.

Every two seconds someone in the

United States needs blood. We salutethe generous blood donors who help

save lives every day thank you!

Ifyouare interested indonating blood,

please visit us online atredcrossblood.org

orcall 1-800-REDCROSS (1-800-733-2767)

toschedule anappointmentor for

moreinformation.


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On Call with Dr. Porter

Steve Porter, MD

Publisher and Chairman

Oh how time fliesJanuary is here once again.

Traditionally, this is the time to make ourresolutions as we wonder where last year wentand why the same resolutions keep showing upon our lists year after year. Of course, Februaryshows up (all too quickly)and we realize wehave already given up on those resolutions andmoved on to humdrum routine of years past.

Its too bad we start off with great intentionsthat fizzle so quickly. Did you ever wonder

why its so hard to keep the resolutions to livesmarter and healthier which could meanliving longer with a better quality of life?

I think the first mistake is making resolutions without any foundation. For example,so many make a resolution to live smarter and healthier. What does that mean?How well do you know your body? How do you live smarter and healthier? Yourdoctor is the one person who should help you answer those questions. But when

was the last time you had a serious talk with your doctor about your health?

Putting together a magazine like we do here at What Doctors Know has helped the staffrealize how important communication between doctor and patient is. And, as a doctormyself, I always strive to make sure that line of communication is open and honest. Makingsure my patients understand their health conditions is a priority to my staff and I.

Dr. Lisa Masterson is an Emmy nominated talk show host on The Doctors, anextremely popular daytime program featuring doctors proactively communicating

with the audience. Dr. Lisa and her co-hosts are among a growing group ofphysicians who are encouraging patients to have better communication with theirdoctor. Knowledge is power. Getting that knowledge from your doctor will helpyou take control of your healthcare so you can be successful in your resolutions.

In this issue, Dr. Lisa gives some great advice on communicating with your doctor. I encourageyou to read her story and open up those lines of communication between you and your doctor.

As you start a New Year, we hope you find the great variety of topics in this issuehelp you take control of your healthcare so you can have a long and happy life. Wehope you enjoy the magazine. Speaking of communicating, we enjoy hearing fromour readers. So dont be shy, if you have a question or suggestion, let us know.

Heres to a Happy New Year.


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WHAT DOCTORS KNOWAnd you should, too!

Taking Control10 Too Young for a Hip Replacement?

12 A HIRO in Radiology

16 Healthy Help-A Phone Call Away

18 The Time is Now Together,We Will End Cancer

24 Getting Back In the Gameof Life

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Health Hints26 Uncovering Eating Disorder Facts

30 10 Things You Need to KnowAbout Birth Defects

32 Save Your Heart, Spare Your Brain

34 Important Flu Recommendationsfor High-Risk Populations

38 10 Tips to Alleviate Stress

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Vol. 2 Issue 1

01 On Call With Dr. Porter

04 Meet Our Doctors

06 Medicine in the News

22 HealthWatchMD: Know YourBlood Type, It May Save Your Life

41 CDC Vital Signs: More PeopleWalk to Better Health

46 Know Your Specialist:Gastroenterologist

In Every Issue

Contents

08 We Need to Talk!

36 Get Off the CouchLive Longer

48 Can COPD BeHereditary

On The Cover

Inquiring Minds50 Infection During Pregnancy

52 Exercise, Meditation Can fight Cold, Flu Symptoms

54 Folic Acid

58 Lower Risk of Cardiovascular & Cancer Mortality

60 Using the Immune System to Fight Cancer

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Meet Our Doctors

Copyright 2012 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The

Advertising space provided in What Doctors Knowis purchased and paid for by the advertisers.Products and services are not necessarily endorsed by What Doctors Know,LLC.

Calling All Doctors. Our readers want to hear from you. What healthcareissues do you want to address? What do you want to tell patients all

over the country? Whats new in your practice, in your specialty?

Drop us a line and let us know about any healthcare topic you wantto address in What Doctors Know. Remember, we want to inform and

educate our readers. We know, an informed reader has the opportunityto live longer and happier. You can be part of that healing process.

Our readers look forward to hearing from you.

Send story ideas to: [email protected]

Vicki Lyons, MD

Founding memberand chairman of theeditorial advisoryboard of What Doctors

Know, Dr. Lyons is aboard certified and fellowship trainedallergist and immunologist practicing inOgden, Utah. She has been practicingfor 20 years. Contact Dr. Lyons at(801)387-4850 or www.vicki-lyonsmd.com.

Steven Porter, MD

Founder andpublisher of WhatDoctors Know, Dr.Porter is recognizedas one of the topgastroenterologists in the country.He is the medical director of the

endoscopy lab at a leading hospital inOgden, Utah and has been practicingfor more than 25 years. ContactDr. Porter at (801)387-2550.

Timothy J. Sullivan, MD

Contributing editorialadvisory boardmember of WhatDoctors Know, Dr.Sullivan spent 25 yearsin full-time academic medicine at

Washington University, University

of Texas Southwestern MedicalSchool, and Emory University. Hecurrently has a full-time allergy andimmunology practice in Atlanta,Georgia and is a clinical professor atthe Medical College of Georgia.

Patrick T. Ellinor,MD, PhD

Director, Arrhythmia/Step Down Unit at

Massachusetts General

Hospital, Dr. Ellinorjoined the faculty inthe Cardiac Arrhythmia Service in2003. He is currently an AssociatePhysician at MGH and an AssociateProfessor at Harvard Medical School.

William Goodnight,III, MD

Assistant Professor atthe University of NorthCarolina Health Care inthe Division of MaternalFetal Medicine. Boardcertified in Obstetrics and Gynecology

since 2000, Dr. Goodnights currentclinical activities include prenataldiagnosis and management of medicalcomplications of pregnancy.


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WHAT DOCTORS KNOWAnd you should, too!

Published by

What Doctors Know, LLC

Publisher and Chairman

Steve Porter, MD

Editorial Advisory Board

Vicki J. Lyons, MD, Chairman

Editorial and Design Director

Bonnie Jean Thomas

Senior Designer

Suki Xiao

Design Associate

Raulin Huang

Executive Director, MarketingLarry Myers

Production

Kai Xiao, Vice President

IT Manager

Eric Lu

For more information on ad placement orcontributing an article, please email [email protected], or call (801) 825-4600.For information on subscriptions, pleasevisit www.whatdoctorsknow.com

Corporate OfficeWhat Doctors Know

1755 E Legend Hills Dr., Suite100, Clearfeld, UT 84015

(801) 825-4600

Special Thanks To:


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Most women who have doublemastectomy don't need it

ANN ARBOR, Mich - About 70 percent of women who have bothbreasts removed following a breast cancer diagnosis do so despite a

very low risk of facing cancer in the healthy breast, new research fromthe University of Michigan Comprehensive Cancer Center finds.

Recent studies have shown an increase in women with breast cancer choosingthis more aggressive surgery, called contralateral prophylactic mastectomy,

which raises the questionof potential overtreatment

among these patients.

The study found that 90percent of women who hadsurgery to remove both breastsreported being very worriedabout the cancer recurring.But, a diagnosis of breastcancer in one breast does notincrease the likelihood ofbreast cancer recurring in theother breast for most women.

Women appear to be usingworry over cancer recurrenceto choose contralateralprophylactic mastectomy. Thisdoes not make sense, becausehaving a non-affected breastremoved will not reducethe risk of recurrence in theaffected breast, says SarahHawley, Ph.D., associateprofessor of internal medicineat the U-M Medical School.


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New York, NY - A team of researchersled by an epidemiologist at Mount Sinai

School of Medicine has found that beingone of the younger kids in class canaffect a student's academic performance.

The authors of the study believe thatthese findings should be taken intoaccount when evaluating children forattention-deficit/hyperactivity disorder(ADHD). As a result of the study, theteam recommends that educators andhealth care providers take children'srelative age in class into account whenevaluating academic performance andother criteria for ADHD diagnosis.

Helga Zoega, PhD, Post-DoctoralFellow of Epidemiology at MountSinai's Institute for TranslationalEpidemiology, along with researchersfrom Harvard School of Public Healthand the University of Iceland workedon the study, titled "Age, AcademicPerformance and Stimulant Prescribingfor ADHD: A Nationwide CohortStudy." The study appears onlinein Pediatrics on November 19.

These findings should be taken into accountbefore prescribing stimulants for ADHD.

The researchers studied more than11,000 students over a several year

period of nationwide data from Iceland.They looked at the likelihood of thechildren ages 9 and 12 scoring low ontests and how this related to their agescompared to others in their class. Theyalso noted the relative likelihoodof younger versus older childrenbeing prescribed stimulantsbetween ages 7 and 14.

"Our results showed thatchildren in the youngest third oftheir class attained scores more

than 10 percentile points lowerthan students in the oldestthird of the class for bothmath and language arts," said thestudys lead author Dr. Zoega."Children in the youngestthird were 50 percent morelikely than those inthe oldest thirdto be prescribedstimulants for

ADHD."

The researchers found that the effect ofrelative age on academic achievement

might lessen over time, but it is asignificant factor up until puberty.Parents can use these findings to helpinform their decisions about schoolreadiness for children born close to

cutoff dates for school entry.

Latest Technology:Laser Device for

Cataract SurgeriesAurora, Colo - Eye surgeons atUniversity of Colorado Hospital(UCH) are using their scalpelsless and embracing the latesttechnology for removing cataracts:bladeless cataract surgery.

The LenSx machine uses anincredibly precise laser to makeincisions in the cornea, resulting inbetter patient outcomes and fewer

complications compared to traditionalcataract removal surgeries.

A cataract is a cloudiness of thelens inside the eye, which gradually

worsens as we age. Cataract patientsmight need more light to read or seeglare or haloes around lights. Mostpeople with a cataract will experiencea gradual decrease in eyesight.

In addition to the precise, computer-guided incisions, the LenSx laser

will also help break the cataract

into small pieces so it can thenbe more easily removed.

Using precise measurements of theeye obtained prior to surgery, thesurgeon will then place an artif iciallens inside the eye. This lens will

correct the patients vision, and itcan even correct their astigmatism.

The LenSx laser helps make thisentire procedure incredibly quick andaccurate. Patients are home the verysame day and oftentimes state thattheir vision has never been better.

The LenSx femtosecond laser isthe first laser in the United Statesto be FDA approved to performlaser-based, blade-free, cataractsurgeries. Femtosecond lasers emit

pulses with durations of aboutone quadrillionth of a second.


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We Need to

Dr. Lisa Masterson of the Emmy

Award-winning talk show, TheDoctors, stresses the importance ofcommunication between patients andtheir doctors. The board-certifiedspecialist of gynecology, adolescent

gynecology, infertility, obstetrics and family planningexplains the dangers of a lack of communicationbetween patients and their physicians.

The old clich what you dont know cant hurt youcan be very dangerous when it comes to patients health.In fact, in the medical health world the phrase shifts towhat you dont know can kill you. The first step togood health is to speak openly and honestly with yourphysician. We shouldnt be afraid to talk to our doctorsand we must also be sure to ask as many questions aspossible. Keep in mind that good doctors want theirpatients to ask questions because it assists them ingetting to the bottom of your diagnoses, treatments,medical advice, and so forth. Its a mutual benefit andit really helps to ensure that all angles are covered.

Patients are advised to be involved with thehealth process and that starts with agood level of communication.Communication issues typicallystem from the following:

There is no reason to be intimidated. Many doctors areso used to using medical jargon all day long and theysometimes use it with their patients not to confuse orcondescend but because it is an automatic way of speechfor them. Dont feel bad about asking your doctor totranslate what he/she is saying into laymans terms. Youmay misunderstand something critical to your health.

Dont let an expert voice or an authoritative tonefrom your doctor discourage you from inquiringfurther into your current health situation.

If your doctor appears to be too busy for answeringquestions, still continue to ask dont hesitate. If youdont want to ask your doctor to explain further, goahead and feel free to ask the PA (physicians assistant),

MA (medical assistant) or a nurse. Another optionis to reschedule your appointment and let the staff

1) Patients are afraid toask questions.

2) Patients dont knowwhat questions to ask.

3) Patients find it disrespectful orunwise to question their physicians.

Talk!


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know its because you would likeadditional time to discuss yourhealth situation with your physician.

This is not offensive to doctors; itssimply proactive taking controlof your health and your life.

Often, patients simply dont knowwhat to ask or they dont askenough questions. Rememberthat no question is a dumb one,especially when it comes to yourhealth. It cant hurt to ask. Alsoknow that its okay to call yourdoctor a few days after your visit ifsome questions come up for you orto schedule a second appointmentfor more information if need be.In the cases of shocking diagnoses,for example, typically patients dont

know what to ask and they mayneed some time to absorb the newsand to come up with questions

when they have clearer minds.

The internet can be a great help butit must be used wisely. Whereasself- diagnosing is unsafe andirresponsible, the internet is agreat tool for a starting point for aconversation with your physician.In this information-driven society,its acceptable to seek out general

information online. However, thisshould just be used as a tool to startconversations with your physicianabout what you have read, and whatit could possibly imply. It is all tooeasy to overlook serious symptomsas small issues or vice versa.

Information and communicationare paramount where health isconcerned. Open up a healthy andfrank dialogue with your physiciansand ask the right questions. Yourdoctors can only assist you moreaccurately when you have addressedall concerns and when you knowthat you are all on the same page.

They dont expect their patients toknow what they do or to be familiar

with complex jargon so simply startdiscussions and make it a habitto keep up a healthy rapport ofexplanation, clarification and detailedinformation. Your health dependson it!-Lisa M. Masterson, M D


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Too Youngfor

a Hip Replacement?Younger patients are becomingcandidates for hip replacements

Rob Ashurst has always been an activeguy. Into sports and exercise all his life,the 40-year old recently started doinga rigorous cross-fit program at a localfitness club with some office mates. Oneevening, after a hard workout, he felt a

tweak in his hip. That tweak was his first indicationhe had a degenerative condition known as avascularnecrosis, a disruption in the blood supply to the hip

joint, causing the head of femur to die. That led toosteoarthritis and pain that worsened by the month.

Ashurst came to University of Alabama atBirmingham orthopedic surgeon Herrick Siegel,

M.D., who told him that he was a candidate forhip replacement, largely because new advances inmaterials and techniques mean surgeons are nowable to offer hip replacement to younger patients.

There is growing need for joint replacementin general, especially in the baby boomers and

the weekend warriors, said Siegel, as associateprofessor of surgery in the Division of OrthopedicSurgery. Weve improved the surgical process andincreased the lifespan of the implants to a point

where its now viable for a younger populationand for older patients who previously were notcandidates due to other medical issues.

One factor is better materials for the hip implants.Aluminum ceramic and highly cross-linkedpolyethylene provide harder, smoother surfaces thatcause less wear and last longer than more traditional

plastic materials. Other new materials help bone growinto the implant, providing additional strength.

Modern hip replacements are not the samehips that were put in in the 1980s and 1990s,said Siegel. These are hips that have thepotential to last a lifetime in most patients.

Rob Ashurst hopes so. Three months afterhis hip replacement he was back at the gym.He took the hard-core fitness introductoryclass again and, to his surprise, scored better

with his new hip than with his old one.

I really figured Id be one of the slowestin the class, said Ashurst, but I beateveryone in the class the first day.

Siegel says that in some patients, the new hipimplants could last 40 years. He also toutsanother advance, operating from the front of theleg rather than the back. The anterior approach,

as its called, means a shorter recovery time

We come in from the front so we are dividingmuscles rather than cutting through them, Siegelsaid. It produces an earlier return to full function.

The anterior approach is best performed on a specialoperating table. UAB has two and consideringgetting a third. First developed for hip and hip

joint fracture cases, the table allows surgeonsto manipulate the patients hip to provide theaccess needed to use the anterior approach.


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The bottom line is faster recovery, fewer complicationsand a quicker return to the lifestyle that many youngerpatients - and the baby boomers are demanding.

When I first saw Dr. Siegel, he said the point is to getyou back to living the lifestyle that you want to live,said Ashurst. Its like getting up in front of the class

when you have to give a presentation. You either go firstor last but either way you are going to have to do it. Imglad I was able to do the hip transplant now, so I can livethe rest of my life pain free.-This information providedcourtesy of the University of Alabama at Birmingham

Modern hipreplacements are notthe same hips that wereput in in the 1980s and

1990s. These are hipsthat have the potentialto last a lifetime inmost patients.

-Herrick Siegel, M.D.


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A HIRO inRadiology

M

edical imaging has become acrucial tool for diagnosis andclinical research. Imagingservices in an academicmedical institution likethe University of Chicago

Medicine are used by dozens of departmentsfor everyday patient care and clinical trials,making them subject to a bewildering arrayof policies and procedures to protect patientprivacy and preserve the integrity of data.

Navigating this labyrinth of issues can be alogistical headache for researchers, so to solvethis problem a group of imaging scientistsand radiologists at the University of Chicago

Medicine formed an office with a name thatpromises to save the day for investigators whoneed medical imaging for their clinical trials.

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The Human Imaging Research Off ice, or HIRO,may very well seem heroic to clinical trial investigators

who need CT scans, MRI scans and X-ray imagesto go along with the rest of their research data. TheHIRO was established through the Imaging ResearchInstitute (IRI) of the Biological Sciences Division

to coordinate the acquisition, collection, analysisand maintenance of images used for clinical researchinvolving human subjects. Since it was created inearly 2009, the HIRO has assisted with 191 researchprotocols and has delivered more than 44,000,000images and associated reports to researchers.

Samuel Armato III, PhD, associate professor of radiologyand faculty director of the HIRO, said that imaging hasbecome a bigger component of clinical trials in recentyears. Usually imaging isnt the focus of the study,but its quite often used as a measure of whether or notthe drug is working, he said. The drug companies inparticular prefer to have imaging standardized across

all of the sites that are participating in the trial.

These clinical trials have very specific requirements forimages that may differ from the conventional way animage might be created in everyday clinical practice.Laying the groundwork can be a challenge for someone

who isnt familiar with the intricacies of radiology.

Armato said this is where the HIRO comes into play.Clinical trial groups often didnt fully appreciate the

complexities involved with imaging, and they wouldcall around to try and find someone to answer theirquestions. It was just one phone call after anotherthat led to a lot of frustration, he said. We camealong to help bridge that gap between clinical researchand the imaging component of that research.

Nick Gruszauskas, PhD, technical director of theHIRO said, We know that ordering a CT scan ofthe chest isnt like ordering a lab test thats performedthe same way every time. There are several dozenperfectly reasonable and useful ways that we couldperform that CT of the chest. If the investigatorsrequesting the scan dont specify what they want, thenthe radiologist and technologist are going to use theirbest judgment on how to do it. But that may not be

what the drug company wants for the clinical t rial.

Besides making extra work for radiology staff, repeatinga scan for a clinical trial because it was done incorrectly

the first time poses risks for the subject. It could exposethem to radiation a second time unnecessarily. In the

worst case, the window of opportunity to capture animage at a specific time could pass and the subject couldbe removed from the trial. This is a double whammy:

The researcher loses a valuable subject, and the subjectmisses out on the potential benefits of the trial.

Gruszauskas said the confusion over technicalrequirements for research imaging also puts a burden


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on radiology staff. A patient might show up in theirarea with an order for a CT, and then stapled to thatorder would be a 2-3 page pamphlet from the clinicaltrial that describes how this scan is supposed to bedone, he said. Having a patient just show up withthis packet of information that the tech is supposedto implement on the spot is simply inefficient.

The solution, he said, is to collaborate beforehandto iron out these technical details. Someone fromthe HIRO now performs a review on any researchprotocol that goes through the Clinical Trials ResearchCommittee at the medical center. This lets them identifyany potential snags in the imaging requirements, andline up the appropriate resources to make sure theinvestigators get exactly what they need for their trial.

Researchers are not required to submit their trialsto the HIRO, but Gruszauskas said that doing soensures that things go smoothly. We have excellent

relationships with various people in radiology, andwere continuing to build up more infrastructure tohave the process go as smoothly as possible, he said.

The HIRO provides a site visit packet with detailsabout the Department of Radiology infrastructureto pharmaceutical company representatives whoare evaluating the medical center for a trial. Theyalso have a website where they explain the technicalrequirements for every research protocol they have

reviewed. Radiology staff can then refer to thisinformation when its time to perform the scan.

The HIRO website also allows researchers to request copiesof images to be used for research. Such images often havea patients personal health information embedded in themetadata or on the image itself, and the HIRO has staff who

specialize in editing images to adhere to privacy standards.

Armato said that the HIRO is a work in progress, andprobably always will be. Its one of these ongoingprojects that must adapt to the changing needs ofresearchers, he said. Just when we think everything isunder control, some new twist on a theme comes up and

we need to figure out how to enhance the process again.

But both he and Gruszauskas said that the ultimatesuccess of the HIRO lies in overcoming long-establishedhabits that researchers developed from years of tryingto figure out their imaging needs on their own. Once

youve been doing it in an ad hoc manner for years, youmight realize its not the best way to go about it, but youdont have time to figure out another way, Gruszauskassaid. Getting people away from that is difficult.

In the complex and technical world of radiology, inwhich juggling standard patient care with sophisticatedclinical research is commonplace, it helps to have aHIRO take charge and save the day.-Matt Wood,courtesy of the University of Chicago Medicine


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You may n

not

o t

rebut your b

aodys been p

dreparing for

yyears.

So your body s ready when you are.

be ready to have a baby,

You have lots to do before motherhood. But make sure to take folic acid today and every

day. Whether you get it in a pill by itself, in a multivitamin, or in foods l ike breakfast cereals,

breads and pastas, this essential B vitamin helps prevent some serious birth defects in babies.

1-800-232-4636 (CDC-INFO)

01/2009 CS124503 099-6230


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TelephoneTalks

withNurseCan

ReduceHospital

Re-admissions

W

eekly telephone contact with a nursesubstantially reduced hospital re-admissions for high-risk patients,according to results of a Universityof Wisconsin School of Medicine

and Public Health study.The findings, published in the December issue ofHealth Affairs, also determined that health care costs

were decreased by approximately $1,225 for eachpatient enrolled in the program, when comparedto similar patients who were not enrolled.

The study measured the efficacy of CoordinatedTransitional Care (C-TraC), a program used by 605patients discharged over an 18-month period from the

William S. Middleton Memorial Veterans Hospital.

High-risk patients were defined in one of threecategories: having dementia or some other impairmentin memory, over 65 years old and living alone, orover 65 years old with a previous hospitalizationin the last year. Patients in the program were one-

third less likely to be readmitted than similarpatients who were not in the program.

According to Dr. Amy Kind, lead investigatorand assistant professor of medicine (geriatrics) atthe UW School of Medicine and Public Health,patients in C-TraC were phoned by a nurse casemanager 48 to 72 hours after discharge. The nursemet with each patient before discharge to makearrangements for the phone calls and with eachpatients hospital providers to help ensure that thepatients transition home was as smooth as possible.

HealthyHelp

-APhoneCallAway


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The nurse engages the patient in an open-endeddiscussion, she said. They spend a lot of timetalking about medications, follow-up, and theappropriate response to any signs and symptoms thatthe patients medical condition could be worsening.

Kind said most of these discussions involved

the proper use of medications.

Many patients, within two days of discharge, werenot taking their medications properly, she said.They may not have understood what they shouldhave been doing, or became confused about theirmedications when they arrived home. Our nursecan help them work through those issues andmake sure they are doing things as they should.

Kind said the patients got weekly phone calls forup to four weeks or until they were transitionedto a primary-care provider. That provider

was updated at each step of the process andimmediately informed if problems were detected.

Our role is not to complicate the process, but tomore seamlessly bridge the patients journey from thehospital to the home and to primary care, she said.

The study was funded by a grant from the VA. Kindestimates the program saved the hospital $741,125 inhealth care costs over its first 18 months of operation.

This means more money for the VA to providemedical care to veterans in need, she said.

Kind said C-TraC was very popularand only five patients of more than 600approached declined to participate.

Patients dont mind a phone call, she said. Also,since most traditional transitional care programsuse home visits and most of our patients livebeyond the reach of a home visit, transitional care

wasnt even an option for them until C-TraC.

Kind said 75 percent of the patients livedoutside the Dane County, Wisconsin area,and the nurse made phone calls to patientsas far away as South Dakota and Florida.

Because it is phone-based and our nurse doesnt spenda lot of time traveling, we can communicate withmany more patients per month than in traditionalhome visit-based transitional care, she said.

Kind believes C-TraC could eventually be used inother clinical settings, and become a useful toolin lowering the cost burden on the health caresystem while minimizing re-hospitalizations ofpatients with high-risk health conditions, but notesthat the program does need additional testing.

This model requires a relatively small amount ofresources to operate and may represent a viablealternative for hospitals seeking to offer improvedtransitional care as encouraged by the Affordable Care

Act, she said. It provides an option to hospitals thatpreviously could not effectively access transitionalcare services, especially those in rural areas or otherareas challenged by a wide geographic distribution ofpatients, or those with constrained resources.-Thisinformation provided courtesy of the University ofWisconsin School of Medicine and Public Health


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The Timeis

NowTogether, WeWill End Cancer

Inspired by Americas drive generations ago to put a man on themoon, The University of Texas MD Anderson Cancer Center haslaunched an ambitious and comprehensive action plan, calledthe Moon Shots Program, to make a giant leap for patients to dramatically accelerate the pace of converting scientificdiscoveries into clinical advances that reduce cancer deaths.

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T

his pastSeptember,

The Universityof Texas MD

AndersonCancer Center

announced the launch ofthe Moon Shots Program,an unprecedented effortto dramatically acceleratethe pace of convertingscientific discoveries intoclinical advances thatreduce cancer deaths.

Even as the number of cancersurvivors in the US is expectedto reach an estimated 11.3million by 2015, according tothe American Cancer Society,

cancer remains one of themost destructive and vexingdiseases. An estimated 100million people worldwideare expected to lose theirlives to cancer in thisdecade alone. The disease'sdevastation to humanitynow exceeds that of cardiovascular disease,tuberculosis, HIV and malaria - combined.

The Moon Shots Program is built upon a "disruptiveparadigm" that brings together the best attributes

of both academia and industry by creating cross-functional professional teams working in a goal-oriented, milestone-driven manner to convertknowledge into tests, devices, drugs and policiesthat can benefit patients as quickly as possible.

The Moon Shots Program takes its inspiration fromPresident John Kennedy's famous 1962 speech,made 50 years ago this month at Rice University,

just a mile from the main MD Anderson campus."We choose to go to the moon in this decade ...because that challenge is one that we are willingto accept, one we are unwilling to postpone, andone which we intend to win," Kennedy said.

"Generations later, the Moon Shots Program signalsour confidence that the path to curing cancer is inclearer sight than at any other time in history," saidRonald A. DePinho, M.D., MD Anderson's president."Humanity urgently needs bold action to defeat cancer.I believe that we have many of the tools we need topick the fight of the 21st century. Let's focus ourenergies on approaching cancer comprehensively andsystematically, with the precision of an engineer, alwaysasking ... 'What can we do to directly impact patients?'"

The inaugural moon shots

The program, initially targeting eight cancers,will bring together sizable multidisciplinarygroups of MD Anderson researchers and

clinicians to mount comprehensive attacks on: acute myeloid leukemia/

myelodysplastic syndrome;

chronic lymphocytic leukemia;

melanoma;

lung cancer;

prostate cancer, and

triple-negative breast and ovarian cancers -two cancers linked at the molecular level.

Six moon shot teams, representing these eightcancers, were selected based on rigorous criteriathat assess not only the current state of scientific

knowledge of the disease across the entire cancercare continuum from prevention to survivorship,but also the strength and breadth of theassembled teams and the potential for near-termmeasurable success in terms of cancer mortality.

Each moon shot will receive an infusion of funds andother resources needed to work on ambitious andinnovative projects prioritized for patient impact,ranging from basic and translational research tobiomarker-driven novel clinical trials, to behavioralinterventions and public policy initiatives.


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The platforms make the program unique

The institution-wide, high quality scientific andtechnical platforms will provide key infrastructure forthe success of the Moon Shots Program. In the past,each investigator or group of investigators has developedtheir own infrastructure to support their researchprograms. Frequently they were under-funded and lackedthe high level management and leadership requiredto ensure that they were of the highest caliber and inparticular that they were able to adapt to the rapidlychanging scientific and technological environment. The

moon shot platforms will be designed and resourced toprovide expertise that will support the efforts of all ofmoon shots teams. The platforms will provide a criticalcomponent to the success of each moon shot and ofthe overall Moon Shots Program. In particular, they

will leverage the investment across the moon shots.

These platforms include:

Adaptive Learning in Genomic Medicine:Awork flow that enables clinicians and researchers tointegrate real-time patient clinical information andresearch genomic data, allowing understanding of thecancer genome and ultimately improving outcome.

Big Data:The capture, storage and processingof huge amounts of information, much of itcoming from Next Generation Sequencingmachines (genome sequencing).

Cancer Control and Prevention: Community-based efforts in cancer prevention, screening, andearly detection and survivorship to educate andachieve a measureable reduction in the cancer burden.Interventions in the areas of public policy, publiceducation, professional education and evidence-based service delivery can make a measurable andlasting difference in our community, especiallyamong those most vulnerable - the underserved.

Center for Co-Clinical Trials:Uses mouse or cell models ofhuman cancers to test newdrugs or drug combinationsand discover the subsetof patients most likely torespond to the therapy.

Clinical Genomics: Aninfrastructure designed tobank and process tumorspecimens for clinical tests thatcan guide medical decisions.

Diagnostics Development:The development of diagnostictests for use in the clinic toguide targeted therapy.

Early Detection:Using imagingand proteomic technologiesto discover markers thatcan identify patients withearly-staged cancers.

Institute for Applied CancerScience: Developing effectivetargeted cancer drugs.

Institute for Personalized Cancer Therapy:An extensive infrastructure that analyzes genomicabnormalities in patient tumors to direct themto the best treatments and clinical trials.

Massive Data Analytics: A computer infrastructurethat develops or uses computational algorithmsto analyze large-scale patient and public data.

Patient Omics: Centralizing collection of patientbiospecimens (tumor samples, blood, etc.) to profilegenes and proteins (genomics, proteomics) andidentify mutations that can guide personalizedtreatment decisions and predict therapy-relatedtoxicity to improve overall patient outcomes.

Translational Research Continuum:A frameworkto facilitate efficient transition of a candidate drugfrom preclinical studies to early stages of humanclinical trial testing so effective drugs can bedeveloped in a shorter time and clinical trials canbe quicker and cheaper with higher success rates.

MD Anderson's "Giant leap for mankind"

A year ago, when DePinho was named MD Anderson'sfourth president, he proposed the notion of a moonshot moment. "How can we envision what's possible toreduce cancer mortality if we think boldly, adopt a moregoal-oriented mentality, ignore the usual strictures onresources that encumber academic research and use thebreakthrough technology available today?" he asked.

Response from the faculty and staff took the formof initial moon shot proposals that targeted severalmajor cancer types and involved large, integrated MD

Anderson teams, sometimes numbering in the hundreds.

Frank McCormick, Ph.D., director of the University ofCalifornia, San Francisco Cancer Center and presidentof the American Association for Cancer Research, led


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the review panel of 25 internal and external experts thatnarrowed the field to the inaugural six moon shots.

"Nothing on the magnitude of the Moon ShotsProgram has been attempted by a single academicmedical institution," McCormick said. "Moon shotstake MD Anderson's deep bench of multidisciplinary

research and patient care resources and offer acollective vision on moving cancer research forward."

McCormick added, "The process of bringingthis amount of horsepower together in such afocused manner is not normally seen in academicmedicine and is valuable in and of itself."

Most ambitious program MDAnderson has ever mounted

The Moon Shots Program is among the most formidableendeavors mounted to date by MD Anderson, aninstitution ranked the No. 1 hospital for cancer care

byUS News & World Report's Best Hospitals surveyfor nine of the past 11 years, including 2012. As theprogram unfolds and grows, it will be woven into allareas of the institution. Researchers and cliniciansconcentrating on any cancer - not just the first set ofmoon shots - will link to new technological capabilities,data and clinical strategies afforded by the platforms.

In the first 10 years, the cost of the Moon ShotsProgram may reach an estimated $3 billion. Thosefunds wil l come from institutional earnings,philanthropy, competitive research grants andcommercialization of new discoveries. They will notinterrupt MD Anderson's vast research program inall cancers, with a budget of approximately $700million annually. In fact, the program's efforts

will help support al l other cancer research at MDAnderson, particularly with improved resourcesand infrastructure, as the ultimate goal is to applyknowledge gained from this process to all cancers.

Implementation of the program will begin in February2013, and is expected to reach full stride by mid-2013.

"The Moon Shots Program holds the potential for anew approach to research that eventually can be appliedto all cancers and even to other chronic diseases,"DePinho said. "History has taught us that if we put

our minds to a task, the human spirit will prevail. Wemust do this - humanity is depending on all of us."

For more information, including backgrounderson the inaugural moon shots, please visit www.cancermoonshots.org.-This information provided bythe University of Texas MD Anderson Cancer Center


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HealthWatchMD

with Dr. Randy Martin

Provided courtesy of Piedmont Healthcare

Dr. Randy Martin:We have told you about

many factors that canincrease your risk ofstroke, but what if I toldyou something as simpleas your blood type mayincrease the risk? I metwith Dr. Robert Allen, ahematologist at PiedmontHospital, to learn more.

Know Your Blood Type,It May Save Your Life


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There are a few majorblood types themost common typeis type O, explainsRobert Allen, M.D.,a hematologist at

Piedmont Hospital. Theothers include type A, B andAB, where you inherit the genefor type A from [one parent]and type B [from another].

Everyone has a specific proteinon the surface of their bloodcells. For example, if you haveblood type B, you have a differentprotein than type A. If you aretype AB, you have both typesof proteins. A person with typeO has neither type of protein.

Know Your Blood Type

Most people learn whichblood type they have the firsttime they donate blood.

It is always important to do atype and a cross-match in anysituation when you do a bloodtransfusion, he explains.

Blood Type as aPredictor of Stroke

According to a recent studyat Brigham and WomensHospital, researchers believeblood type can be tied to anincreased risk of stroke.

In this study, they looked at90,000 people over a 20-yearperiod and looked at about3,000 instances of stroke,says Dr. Allen. Researchers found that men and

women who had type AB blood had about a 25percent increased chance of getting a stroke. Women

who had type B blood had a 15 percent increased

risk. There appears to be some correlation betweenblood type and your risk for having a stroke.

So how exactly does your blood typeinfluence your risk of stroke?

These proteins, which may be present in other areasof the body in addition to the surface of red bloodcells, are probably somehow related to damage tothe blood vessels and risk for stroke, he says.

Dr. Allen believes that ultimately physicians will identifya patients blood type to determine his or her stroke risk.

However, were not there yet. We dont haveenough information to support this, he explains.Maybe five or 10 years from now, when we have

more information, we can say, If you have type ABblood, we want to control your cholesterol a littlemore carefully than if you have type O blood.

Given this information, just how importantis it to know your blood type?

It cant hurt [to find out], says Dr. Allen. Thequickest and simplest way to find out your bloodtype is to [donate] a pint of blood at the Red Cross.

Theyll give you a card with your blood type whileyoure sitting there. This way youll know your typeand will be doing the country some good, too.

Dr. Randy Martin: As you can see, donating bloodcan have many benefits, from helping someonewho is undergoing surgery or cancer treatmentto learning your own blood type as a potentialpredictor of stroke. I encourage you to get involvedin a blood drive this month and throughout theyear there is no better time to start than now.

AmericanRedCrossBlo

odDrive,

GardenCity,

NY


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Getting Back inthe Game...of Life

Eating disorders are an epidemic in theUnited States today. One populationincreasingly at risk for developing anorexiaor bulimia is athletes. Athletes are farmore prone to eating disorders than non-athletes, especially for females. The risk

increases significantly for those involved in sportsthat necessitate a certain body type or weight,

when success tends to be more appearance-basedthan performance-based, and when the athlete iscompeting at an elite level. This includes sports such

as ice skating, gymnastics, wrestling, diving, rowing,distance running, ballet, and other forms of dance.

Those taking part in judged sports are particularlyat risk. Research indicates that female athletes in

judged sports have a 13 percent prevalence of eatingdisorders, compared to just 3 percent in the generalpopulation. Factors that contribute to risk fordeveloping an eating disorder include: endurancesports, sports with weight categories, individual sportsand lean sports. Sports with revealing clothingare rapidly moving to the top of this list, as sports

attire continues to shrink. With every passing year,players on the tennis circuit or professional volleyballteams are revealing far more skin than ever before.

Athletes struggling with eating disorders are notunlike non-athletes dealing with similar issues. Highlycompetitive, they rarely admit to having a problem,for fear of losing playing time or displeasing coaches,teammates or family members. They may incur moreinjuries and have declining health, as they restrict foodintake and engage in rigorous exercise schedules. Often

times, these dangerous behaviors go unrecognized bycoaches, parents and teammates. In fact, these verybehaviors are frequently encouraged by coaches and/or parents who believe that weight loss and extremetraining will give their athlete a competitive edge.

Tragically, the cost may be the young persons life, sinceanorexia and bulimia are potentially fatal illnesses.

What is important for parents, trainers and coachesto remember is that an athlete who develops an eatingdisorder doesnt have to permanently relinquish his orher involvement in sport. Effective treatment is available


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and recovery is possible, especially if the individualis young and the eating disorder is relatively new.However, though weight may be restored and healthregained, serious thought must be given to when orif the athlete will return to training or competition.

Attention must be paid to what is motivating the

person to return. Is it internal or external? Doesthe athlete want to return to competition due to agenuine love of the sport, or is pressure to return beingapplied by a coach, teammates or even family? Justbecause an individual is highly skilled in a particulararea in no way means he/she must continue toparticipate, especially when first entering recovery.

If a comeback is decided upon, it is imperative for anoutpatient team of professionals to be in place. At the

very least, this team should include a primary carephysician, a psychiatrist, an individual therapist, a familytherapist and a dietitian. A representative from the team

should also be included in the treatment plan. Thissupport network will ensure the athlete is maintainingrecovery as a top priority. Recovery behaviors need to beclearly identified: taking in sufficient nutrition accordingto a meal plan prescribed by a sports nutritionist;sustaining a healthy weight and not exercising to excess;participating in individual, group and family therapysessions; and attending 12 step or othercommunity support groups.Parameters around

weight ranges andrecovery behaviorsnecessary for healthy

participation in sportneed to be developedand explicitlycommunicated to theathlete, parents andcoaches. All partiesinvolved need to supportthe treatment plan inorder for it to work.

There are some instanceswhere return to sportwould be contraindicated.For instance, if an athlete hasunstable vital signs, abnormalelectrolyte levels, significant

weight loss, or engagesregularly in eating disorderbehaviors, he/she should notreturn to sport. If an athlete hasrelapsed with eating disorderbehaviors several times in thepast upon returning to sport, thatperson may need to consider notreturning until at least 1-2 yearsof recovery are achieved, if ever.

It can be a devastating loss for the athlete and familyto let go of the sport as well as the identity, meaning,and accolades that go with it. Grief work for the athleteand family can be an important piece of facilitatinglife-long recovery for those who cannot safely returnto their sport. As tough as grief work is, it is mucheasier to help a patient and family work through theloss of sport, rather than the loss of their childs life.

The good news is many of the same characterist ics thatmake an athlete great make for a successful recoveryfrom an eating disorder. Athletes tend to have bettertreatment prognosis because they are used to beingcoached and taking direction. They also have a built-insupport system to help monitor signs of improvementand slip-ups: coaches, trainers, teammates and family.Finally, because of their love of the sport, many athleteshave a unique motivation for recovery. They know theyneed to get healthy to get back in the game, thus givingthem the internal motivation needed to succeed in a

healthy and long-lasting recovery.-

Kim Dennis, M D,courtesy of National Eating Disorders Association


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Health consequences

In anorexia nervosas cycle of self-starvation, the body

is denied the essential nutrients it needs to functionnormally. Thus, the body is forced to slow down allof its processes to conserve energy, resulting in:

Abnormally slow heart rate and low blood pressure,which mean that the heart muscle is changing.

The risk for heart failure rises as the heart rate andblood pressure levels sink lower and lower.

Reduction of bone density (osteoporosis),which results in dry, brittle bones.

Muscle loss and weakness.

Severe dehydration, which can result in kidney failure.

Fainting, fatigue, and overall weakness.

Dry hair and skin; hair loss is common.

Growth of a downy layer of hair calledlanugo all over the body, including the face,in an effort to keep the body warm.

For females between fifteen to twenty-four years oldwho suffer from anorexia nervosa, the mortal ity rateassociated with the illness is twelve times higher than

Uncovering EatingDisorder Facts

What are Eating Disorders?

Eating disorders are real, complex,and devastating conditions thatcan have serious consequencesfor health, productivity, andrelationships. They are not a

fad, phase or lifestyle choice. Eating disorders areserious, potentially life-threatening conditions thataffect a persons emotional and physical health.

People struggling with an eating disorder need toseek professional help. The earlier a person withan eating disorder seeks treatment, the greater thelikelihood of physical and emotional recovery.

In the United States, nearly 10 million females and 1million males are fighting a life and death battle withan eating disorder such as anorexia or bulimia. Millionsmore are struggling with binge eating disorder.

For various reasons, many cases are likely notto be reported. In addition, many individualsstruggle with body dissatisfaction and sub-clinicaldisordered eating attitudes and behaviors.

More than 80% of women are reported to bedissatisfied with their appearance (Smolak, 1996).


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the death rate of ALLother causes of death(Sullivan, 1995).

(Please note that theheightened mortalityrate applies only tothose with anorexiaand does not mean thatanorexia is the leadingcause of death amongall females aged 15-24in the general public.

The recurrent binge-and-purge cycles ofbulimia can affect

the entire digestivesystem and can leadto electrolyte andchemical imbalances

The incidence of bulimia in women 10-39TRIPLED between 1988 and 1993.

Only 6% of people with bulimiareceive mental health care.

The peak onset of eating disorders occurs duringpuberty and the late teen/early adult years, butsymptoms can occur as young as kindergarten.

More than one in three normal dietersprogresses to pathological dieting.

Eating disorders affect people from all walks of life,including young children,middle-aged women andmen and individuals of all races and ethnicities.

Although eating disorders are potentiallylethal, they are treatable.

Despite its prevalence, there is inadequateresearch funding for eating disorders.Fundingfor eating disorders research is fraction ofthat for Alzheimers disease. In the year 2008,the National Institute of Health (NIH) fundedthe following disorders accordingly:

Illness Prevalence Research Funds

Eating disorders: 10 million $7,000,000*Alzheimers disease: 4.5 million $412,000,000

Schizophrenia: 2.2 million $249,000,000

* The reported research funds are for anorexia nervosaonly. No estimated funding is reported for bulimia nervosaor eating disorders not otherwise specified.

Research dollars spent on eating disorders averaged$.70 per affected individual, compared to$113.00per affected individual for schizophrenia.

in the body that affect the heart and other majororgan functions. Health consequences include:

Electrolyte imbalances that can lead to irregularheartbeats and possibly heart failure and death.Electrolyte imbalance is caused by dehydrationand loss of potassium,sodium and chloride fromthe body as a result of purging behaviors.

Potential for gastric rupture duringperiods of bingeing.

Inflammation and possible rupture of theesophagus from frequent vomiting.

Tooth decay and staining from stomachacids released during frequent vomiting.

Chronic irregular bowel movements andconstipation as a result of laxative abuse.

Peptic ulcers and pancreatitis.

Binge eating disorder often results inmany of the same health risks associated

with clinical obesity, including:

High blood pressure.

High cholesterol levels.

Heart disease as a result ofelevated triglyceride levels.

Type II diabetes mellitus.

Gallbladder disease.

Did you know

40% of newly identified cases ofanorexia are in girls 15-19 years old.

A rise in incidence of anorexia in youngwomen 15-19 in each decade since 1930.

Anorexia has the highest rate ofmortality of any mental illness.


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ReferencesCollins, M.E. (1991). Body figure perceptions and preferences among pre-adolescent children.International Journal of Eating Disorders, 199-208.

Crowther, J.H., Wolf, E.M., & Sherwood, N. (1992). Epidemiology of bulimia nervosa. In M.

Crowther, D.L. Tennenbaum. S.E. Hobfoll, & M.A.P. Stephens (Eds.). The Etiology of BulimiaNervosa: The Individual and Familial Context (pp. 1-26) Washington, D.C.: Taylor & Francis.

Fairburn, C.G., Hay, P.J., & Welch, S.L. (1993). Binge eating and bulimia nervosa:Distribution and determinants. In C.G. Fairburn & G.T. Wilson, (Eds.), Binge Eating:Nature, Assessment,and Treatment (pp. 123-143). New York: Guilford.

Gordon, R.A. (1990). Anorexia and Bulimia: Anatomy of a Social Epidemic. New York: Blackwell.

Grodstein, F., Levine, R., Spencer, T., Colditz, G.A., Stampfer, M. J. (1996).Three-year followup of participants in a commercial weight loss program:can you keep it off? Archives of Internal Medicine. 156 (12), 1302.

Gustafson-Larson, A.M., & Terry, R.D. (1992). Weight-related behaviors and concernsof fourth-grade children. Journal of American Dietetic Association, 818-822.

Hoek, H.W. (1995). The distribution of eating disorders. In K.D. Brownell & C.G. Fairburn

(Eds.) Eating Disorders and Obesity: A ComprehensiveHandbook (pp. 207-211). New York: Guilford.

Hoek, H.W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating

disorders. International Journal of Eating Disorders, 383-396.

Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E. (1991). Alongitudinal study of the dietary practices of black and white girls 9 and 10 years old atenrollment: The NHLBI growth and health study. Journal of Adolescent Health, 27-37.

National Institutes of Health. (2005). Retrieved November 7, 2005,from http://www.nih.gov/news/fundingresearchareas.htm

Neumark-Sztainer, D. (2005). Im, Like, SO Fat! New York: The Guilford Press. pp. 5.

Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eatingdisturbances. International Journal of Eating Disorders, 18 (3), 209-219.

Smolak, L. (1996). National Eating Disorders Association/Next Door Neighbors Puppet Guide Book.

Sullivan, P. (1995). American Journal of Psychiatry, 152 (7), 1073-1074.

American Public Opinion on Eating Disorders

In March 2005, NEDA contracted with Global Market Insite, Inc. (GMI),a leader in global market research, to conduct a 1,500 nationwide sampleof adults in the U.S. Their findings concluded from those surveyed that:

Three out of four Americans believe eating disorders should becovered by insurance companies just like any other illness.

Americans believe that government should require insurancecompanies to cover the treatment of eating disorders.

Four out of ten Americans either suffered or have knownsomeone who has suffered from an eating disorder.

Dieting and The Drive for Thinness

Over one-half of teenage girls and nearly one-third ofteenage boys use unhealthy weight control behaviorssuch as skipping meals, fasting, smoking cigarettes,vomiting,and taking laxatives (Neumark-Sztainer, 2005).

Girls who diet frequently are 12 times as likely to bingeas girls who dont diet (Neumark-Sztainer, 2005).

42% of 1st-3rd grade girls want to be thinner (Collins, 1991).

81% of 10 year olds are afraid of being fat (Mellin et al., 1991). The average American woman is 54 tall and weighs 140 pounds.

The average American model is 511 tall and weighs 117 pounds.

Most fashion models are thinner than 98% ofAmerican women (Smolak, 1996).

46% of 9-11 year-olds are sometimes or very often ondiets, and 82% of their families are sometimes or veryoften on diets (Gustafson-Larson & Terry, 1992).

91% of women recently surveyed on a college campushad attempted to control their weight through dieting,22% dieted often or always (Kurth et al., 1995).

95% of all dieters will regain their lost weightin 1-5 years (Grodstein, et al., 1996).

35% of normal dieters progress to pathological dieting.Of those, 20-25% progress to partial or full-syndromeeating disorders (Shisslak & Crago, 1995).

25% of American men and 45% of American womenare on a diet on any given day (Smolak, 1996).

Americans spend over $40 billion on dieting and diet-related products each year (Smolak, 1996).

www.NationalEatingDisorders.org-Informationand Referral Helpline: 1-800-931-2237

-This information provided courtesy of theNational Eating Disorders Association


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But at this moment, shes fighting cancer.Thats whySt. Jude Childrens Research Hospital spends every moment changing

the way the world treats children with pioneering research and exceptional care.

And no family ever pays St. Jude for anything. Dont wait. Join St. Jude in finding

cures and saving children like Angiel. Because at this moment, she shouldnt just be

dreaming of trips to the beach and the park. She should be there.

Help them live. Visit stjude.org.

Angiels gotstuff to do

St. Jude patient AngBig Dreamer


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What patients and doctors needto know about Atrial Fibrillation

Aquivering heart isnt so romantic after all. In fact, it can be devastating.

Atrial f ibrillation or AFib an irregular or quivering heartbeat isthe culprit in about one out of five strokes. But even though it affects2.7 million Americans, it often goes undiagnosed and untreated.

Many dismiss the flutter or thumping in the chest, the rapid and irregularheartbeat and other symptoms, including chest pain. But AFib is the most

common serious heart rhythm abnormality in people over 65. So if you experience thesesymptoms, see your healthcare provider (and chest pain should never wait; always call 9-1-1).If you do have AFib, you must manage it to prevent a stroke and possibly save your life.

Save Your Heart,Spare Your Brain


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Control your risk

Stroke strikes when a blood vessel to the brain isblocked or bursts. AFib dramatically increases yourstroke risk because the rapid heartbeat lets blood poolin your heart, leading to blood clots that can travel tothe brain and cause a stroke. Although strokes related

to AFib are often major events that could leave youdisabled or even kill you, they can be prevented.

Heres why we have to work together: A recent survey bythe American Heart Association showed that while 30percent of patients with AFib fear stroke the most, theyface five times the risk of suffering a stroke. And AFibstrokes are deadlier. AFib is also costing our nation alot of money: $26 billion a year by one recent estimate.

Although two-thirds of AFib patients have discussedtheir stroke risk with their doctor, only about one-thirdof them recall being told theyre at high risk for stroke.

Start the conversationAFib patients, what should you ask your doctor?Physicians and healthcare providers, what can you do foryour patients? Try tackling these questions together:

(1) Whats my stroke risk?

(2) Do I need to be on a blood thinner? If so, which one?

(3) Is my heart rate well controlled?

(4) Should an attempt be made torestore a normal rhythm?

The No. 1 thing I tell my AFib patients is that being onthe right blood thinner can substantially reduce theirstroke risk. And I remind my colleagues that stroke riskfor patients with AFib is significant, and many patients

who should be on anticoagulation arent. A carefuldiscussion about the benefits and risks of blood thinners

is a must. In most cases, the benefits outweigh the risks.You also need to know your stroke risk and howto control it. You face the biggest risk if you have ahistory of stroke. Being older than 75, a woman orhaving other risk factors such as a history of high bloodpressure, diabetes, congestive heart failure, heart attackor peripheral vascular disease also adds to your risk.

Preventing or controlling high blood pressurecan greatly lower your chances of having a stroke,so be sure and monitor and maintain your bloodpressure, and take any medications as prescribed.

Dont smoke, get regular exercise and maintaina healthy weight. Get plenty of fruits, vegetablesand low-fat dairy products. And try to limit salt,cholesterol and saturated and trans fats in your diet.

In the blink of an eye, a quivering heart coulddamage your brain and change your life forever. Takecontrol by starting the conversation to safeguard yourhealth. For more information about AFib, www.heart.org/afib.-Patrick T. Ellinor, MD, PhD


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Important FluRecommendationsorHigh-Risk

Populations

While it is importantto get vaccinatedagainst the flu virusas early as possible,

it is never too late toreap the benefits of

this vaccine. According to The Centersfor Disease Control and Prevention,the peak months for the spread of theflu virus are January and February andthe season can last into mid-May.

Those at highest risk of complicationsfrom the flu are young children;people 65 and older; pregnant women;and people with health conditionssuch as heart, lung or kidney disease,

or a weakened immune system.

"Adults age 65 and older face thegreatest risk of serious complicationsand even death as a result of influenza.

That is why it is so important that theyget immunized. Even when older adultscontract the f lu after immunization,

which can happen, those cases tend to beless severe and of shorter duration," saysDr. Mark Lachs, director of geriatricsat NewYork-Presbyterian Hospital.


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"It is important that all children get immunized against thisillness," says Dr. Gerald Loughlin, pediatrician-in-chief at thePhyllis and David Komansky Center for Children's Health at

NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Dr. Lachs and Dr. Loughlin offer the followingguidelines to help protect these most vulnerable

populations from catching the flu this winter:

Get vaccinated early.The flu vaccine is mosteffective when administered during the fallmonths, before the onset of f lu season.

It's never too late.The flu seasonbegins in the fall and can lastthrough the spring, so if you donot get vaccinated in Octoberyou can still be immunizedin December or January.

Know your options. A nasalvaccine is available for healthychildren from age two and over,and for adults up to the age of49. There are some restrictionsso check with your doctor first.

Get your family membersvaccinated.The Centersfor Disease Control andPrevention recommends that thefollowing groups get immunizedagainst the flu every year:

Children beginning at six months of age

Pregnant women People 50 years of age and older

People of any age with certain chronic medicalconditions such as asthma, diabetes, cardiovasculardisease, and any form of immunosuppressive illness

People who live in nursing homes andother long-term care facilities

People who live with or care for those at highrisk for complications from flu, including:

Health care workers

Household contacts of persons at highrisk for complications from the flu

Household contacts and out-of-home caregiversof children less than 6 months of age (thesechildren are too young to be vaccinated)

Physicians and nurses at the Komansky Center forChildren's Health at NewYork-Presbyterian Hospital/

Weill Cornell strongly urge parents to have theirchildren immunized early to make sure they haveoptimal protection during December and January whenflu epidemics are at their peak.-This informationprovided courtesy of Weill Cornell Medical College


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Get Of theCouch...

Live Longer

Use it or loose it! Research by the AmericanCancer Society and others is offeringstrong evidence that an individuals riskof developing cancer can be substantiallyreduced by healthy behavior including:

not using tobacco,

getting sufficient physical activity,

eating healthy foods in moderation,

and participating in cancer screening

according to recommended guidelines.The eye-opening message here is the need forphysical activity as part of a total healthy lifestyle.Being active can add years to your life.

The American Cancer Society estimates that of the565,650 cancer deaths that were expected in 2008,about 170,000 cancer deaths would be caused bytobacco use, and another third would be attributedto poor eating habits, overweight and obesity, andphysical inactivity. Sadly, effectively promotinghealthy behaviors, much of the suffering and deathfrom cancer can be prevented or reduced.

A recent letter to the president from the PresidentsCancer Panel to the president noted:

Despite irrefutable evidence that modifiablebehaviors are linked to numerous types of cancer andthe implementation of a multitude of programs tocombat risk-promoting behaviors, many millions ofAmericans continue to practice unhealthy lifestyles.

Healthier behavior could also reduce death andsuffering from other diseases, such as type 2 diabetes,hypertension, coronary heart disease, and strokes.In 1993, researchers documented that modifiablebehavioral risk factors had contributed substantiallyto the number of deaths that occurred in this countryin 1990. Tobacco use accounted for 19% of alldeaths, poor diet and physical activity accountedfor 14%, and alcohol consumption accounted for5%. Risky sexual behaviors and illicit use of drugsalso contributed significantly to mortality.

The researchers concluded that roughly half of all deathsthat occurred in 1990 could be attributed to a limitednumber of largely preventable behaviors and exposures.

A decade later, another team of researchers foundthat tobacco use, poor diet, physical inactivity,and alcohol consumption were among theleading causes of death; combined, the first threeaccounted for more than one-third of all deaths inthe United States. In addition to mortality, theseunhealthy lifestyle behaviors impose significantburdens on society, such as disability, diminished

quality of life, and increased health care costs.

Tobacco

Tobacco use is a known risk factor for 15 types ofcancer. Decreased tobacco use has reduced cancerdeaths among men by at least 40% from 1993 to 2003.

Although much has been accomplished, a considerableamount of work remains to be done. In 1964, 42.4%of adults in the United States smoked. Now, the CDCreports that 21.5% of adults in the United States aresmokers, and 17.5% of adults are daily smokers. About4 out of 10 smokers (42.4%) attempted to quit smoking


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in 2005, but the majority were unsuccessful. Of thedaily smokers, only 40.2% were successful. Recently,smoking rates among adults and high school studentshave leveled off, possibly because of increased tobaccoindustry spending on marketing and promotion.

There are well-agreed-upon standards for

basic nutrition and minimum levels of physicalactivity for sustaining good health. However,much less is known about how to effectivelyencourage people to make healthy choices.

Physical Activity and Food Intake

Increasing evidence has accumulated showing thatphysical activity helps prevent cancer, and yet 38%of adults in the United States do not engage in anyphysical activity in their leisure time. Only 1 in 8adults engages in vigorous physical activity in their

leisure time for the recommended 5 times a week.Lack of exercise and poor nutrition are major factorsin the growing obesity problem in this country.

Almost two-thirds of adults in this country areoverweight or obese, and the numbers are expected

to grow dramatically if the present trend continuesunabated. A 2005 study estimated that 112,000deaths in the United States were associated withobesity, making it the second-leading contributor (aftertobacco) to premature death. Obesity and physicalinactivity may account for 25 to 30% of several major

cancers, including colon, post- menopausal breast,endometrial, kidney, and cancer of the esophagus.

Cancer Screening

Breast cancer deaths have been decreasing since 1990,with breast cancer screening playing a significant role.Unfortunately, the percentage of women who reportthat they have had a mammogram in the past 2 yearshas leveled off, remaining at the same level since 2000.If we can increase the number of women who havemammograms, more women will be diagnosed withbreast cancer at an earlier stage, which dramaticallyincreases their chances of surviving cancer.

Although colorectal cancer screening not only resultsin earlier detection, but also can actually prevent cancerfrom developing, less than half of Americans age 50and older are current for colorectal cancer screening.

The Presidents Cancer Panel

In the . . . immediate term, the principal causes oflung and numerous other cancers are amenable tochange through behavioral and policy/environmentalinterventions, which offer the best chance ofsubstantially reducing the cancer burden.

Promoting Healthy Lifestyles2006-2007 Annual Report of the Presidents Cancer Panel

The Presidents Cancer Panel recently released areport that summarized the findings of four meetingsconvened between September 26, 2006, and February27, 2007, to discuss behaviors that affect cancer risk.8

These meetings examined the evidence regarding theeffects of diet, nutrition, physical activity, tobaccouse, and tobacco smoke exposure on cancer risk.

The meetings also discussed actions ongoing andpotential that could reduce the burden of cancer

by promoting healthier lifestyles. The panels reportcommented that most of the federally sponsoredcancer prevention research emphasizes genetic andother biologic factors, but the work needs to beaccompanied by research that addresses the importanceof physical, social, and cultural contexts in which foodchoices, physical activity, and tobacco use occur.

The overall message from the research is:Getting up off the couch or that chair can addyears to your life.-This information providedcourtesy of the American Cancer Society


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3Make "Me" Time: Carve outtime to wind down for afew minutes before sleep

4No Work Allowed! Usethe bedroom for sleepingand sex, not work

Making the time to take care of your body and fulfill your needs becomes

increasingly more difficult with the pressures and stresses of a demandingschedule, fast-paced job and the increasing number of distractions around us.

Dr. Ana C. Krieger and Dr. Gail Saltz presented these key tips on how tosleep better, have more sex and stress less at the 30th Annual Women's HealthSymposium hosted by NewYork-Presbyterian/Weill Cornell Medical Center:

10Tips toAlleviate Stress

1

Sex is Good! Sex is agreat form of exercisethat enhances bonding

with your partner, fightsaging, reduces your stress andallows you to sleep better

2Sex Alleviates Stress:Sexual problems cancontribute to stress, but

healthy sex can alleviate stress


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7Turn Off TVs and

Smartphones! Beforebedtime and during

sleep, avoid light exposure,even from electronic devices

8Be Cozy: Create a cozybedroom environmentwith a room temperature

between 65-70 Fahrenheit

5The Secret to Sleep: The key elementsof an adequate night's sleep includetiming, duration and quality

6Seven Hours or Bust! Only a fractionof people can function optimallywith six or less hours of sleep

-This information provided courtesyof Weill Cornell Medical College

9Keep a Routine: Establish anight time routine and get upat the same time every day

10Manage your Stress:To better manage

your stresses considerrelaxation training, better timemanagement and problem solving

whatdoctorsknow.com


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Equal Parts Comfort & Style:Therat by Dr. Lisa Masterson

The comfort shoe trend has a strong new contender Therat by Dr. Lisa. Co-developed by Dr. Lisa Mastersonof the Emmy Award-winning television series, TheDoctors, these shoes are designed specically forwomen, and provide cushioning, comfort, style andsupport and are accredited by the National Posture

Institute. The 12-hour shoe for the 12- hour day, as welike to call it, completely transforms lives lled witherrands, household activities, long days at the job,workouts and more.

The wrong shoes can plague the body with insuerableaches, pains and stress. Therat By Dr. Lisa shoes featuremultiple layers and densities that distribute the shock ofeach step downward and outward providing cushioningand support. Theres no need to worry about roughlandings leading to dicult body aches in the mornings.Women are constantly moving. Were always on the goand we want comfortable shoes that move with us, but wewant them stylish enough so we can wear them whereverwere going, says Dr. Masterson. Thats why Therat By Dr.

Lisa shoes were designed to be extra comfortable and torelieve pain in the back, hips, legs and feet.

Thanks to the cushioning and supportive layers, TheratBy Dr. Lisa oers extra comfort for the active woman withtheir patented, innovative technology. The Therat By Dr.Lisa Personal Comfort System (PCS) Technology allowsthe outsole of the shoe to be adjusted to increase ordecrease levels of impact resistance. There are threespecial dual-density Adapters inside the shock-absorbing wedge that may be removed to adjust theresistance and the cushioning.

I know what it is to be a working mom, says Dr.Masterson. Juggling it all and maintaining good health is

a challenge. This shoe is a realistic solution for women toencourage exercise, and bring overall wellness into theirlifestyle. Depending on each womans unique physicalconditions on a particular day or even hour they mayremove the Personal Comfort Adapters to comfort tired,aching feet.

Therat By Dr. Lisa shoes make women look good and feelgood in their active lifestyles constantly on the go. TheDeborah model is for athletic or walking purposes andcomes in ve great colors: pink, black/pink, red, silver/blueand black/white. The work shoe and a greatuniform-appropriate style is the Renee model available inblack or white. Prices for both models start at $95 and theycan be shopped online exclusively via Theratshoe.com.

More styles will launch in the near future as well!

The Therat By Dr. Lisa shoes are a smart choice for activewomen in various styles of living to maintain a balance ofcomfort, support and style.


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www http://www.cdc.gov/vitalsigns

More People Walkto Better HealthMore than 145 million adults now include

walking as part of a physically activelifestyle. More than 6 in 10 people walk fortransportation or for fun, relaxation, orexercise, or for activities such as walking thedog. The percentage of people who reportwalking at least once for 10 minutes or morein the previous week rose from 56% (2005) to62% (2010).

Physical activity helps control weight, but it hother benefits. Physical activity such as walkin

can help improve health even without weightloss. People who are physically active livelonger and have a lower risk for heart diseasestroke, type 2 diabetes, depression, and somecancers. Improving spaces and having safeplaces to walk can help more people becomephysically active.

Want to learn more? Vis

Walking is the mostpopular aerobic physicalactivity. About 6 in 10

adults reported walkingfor at least 10 minutes inthe previous week.

Adults who walk for

transportation, fun, or exercisewent up 6 percent in 5 years.

48%About half of all adults getenough aerobic physical activity*to improve their health.

6 in 10

6%

*Aerobic activities like brisk walking, running, swimming and

bicycling make you breathe harder and make your heart and

blood vessels healthier.

National Center for Chronic Disease Prevention and Health Promotion

Division of Nutrition, Physical Activity, and Obesity


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roblem

Americans need morephysical activity

1. Less than half of all adults get therecommended amount of physicalactivity.

Adults need at least 2 and 1/2 hours (150minutes) a week of aerobic physical activity.This should be at a moderate level, such as afast-paced walk for no less than 10 minutesat a time.

Women and older adults are not as likely

to get the recommended level of weeklyphysical activity.

Inactive adults have higher risk for earlydeath, heart disease, stroke, type 2 diabetes,depression, and some cancers.

Regular physical activity helps people getand keep a healthy weight.

Walkable communities result in morephysical activity.

2.More people are walking, but just howmany depends on where they live, theirhealth, and their age.

The West and Northeast regions have thehighest percentage of adults who walk in thecountry, but the South showed the largestpercent increase of adults who walk comparedto the other regions.

More adults with arthritis or high bloodpressure are now walking, but not those withtype 2 diabetes.

Walking increased among adults 65 or older,but less than in other age groups.

3. People need safe, convenient places towalk.

People are more likely to walk and move aboutPRUHZKHQWKH\IHHOSURWHFWHGIURPWUDIFDQGsafe from crime and hazards.

Maintaining surfaces can keep people whowalk from falling and getting hurt. This alsohelps wheelchairs and strollers and is saferfor people with poor vision.

People need to know where places to walkin their communities exist that are safe andconvenient.

Walking routes in and near neighborhoodsencourage people to walk to stops for buses,trains, and trolleys.

The Guide to Community Preventive Services recommends:

Creating more places for physical activity with information and outreach thatlets people know where these are.

Considering walkability in community design .

Using community-wide campaigns to provide health education and socialsupport for physical activity.To see the full recommendations:http://www.thecommunityguide.org/pa/index.html


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Within1 mile

Within1 mile

Within

3-4 miles

Within

3-4 miles

Within

1 mile

Within

1 mile

Within

3-4 miles

Within

3-4 miles

1%

46%

1%

40%

1%

35%

60%

% of Trips to Work

by Walking>P[OPUTPSLZ 35%

>P[OPUTPSLZ 1%

% of Trips to School or

Church by Walking

>P[OPUTPSL 46%

>P[OPUTPSLZ 1%

% of Trips to Shopsby Walking

>P[OPUTPSL 40%

>P[OPUTPSLZ 1%

% of Trips for Socia

Recreational Fun

by Walking

>P[OPUTPSL60%

>P[OPUTPSLZ5

Percentage of adultswho walk for physical activity

to get to places they want to gowhen places are nearby.

People walk

SOURCE: USDOT, Federal Highway Administration,2009 National Household Travel Survey.

0 20 40 60 80 100 0 20 40 60 80

18-24 yearshite, non-Hispanic

ack, non-Hispanic

Hispanic

Other race

eeds help to walk

Does not needhelp to walk

25-34 years

35-44 years

45-64 years

65+ years

2005

2010

SOURCE: CDC National Health Interview Survey, 2005, 2010.


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www http://www.cdc.gov/mmwr

www http://www.cdc.gov/vitalsigns

For more information, please contactTelephone: 1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348E-mail: [email protected]

Web: www.cdc.govCenters for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Publication date: 08/08/2012

What Can Be Done

US government is

Working with partners to carry out theNational Prevention Strategy to make physical

activity easier where people live, work,

and play www.healthcare.gov/prevention/

nphpphc/strategy/index.html.

Helping people get active through programs

like Community Transformation Grants and

Nutrition, Physical Activity, and Obesity

state programs www.cdc.gov/obesity/

stateprograms/cdc.html, and by working withpartners like Safe Routes to Schools

www.saferoutespartnership.org/.

Studying ways that communities can make it

easy and convenient for people to be

more active.

State and local government can

Considering walking when creating long-range

community plans.

Consider designing local streets and roadways

that are safe for people who walk and other

road users.

Consider opportunities to let community

residents use local school tracks or gyms after

FODVVHVKDYHQLVKHG

Make sure existing sidewalks and walking

paths are kept in good condition, well lit andfree of problems such as snow, rocks, trash,

and fallen tree limbs.

Promote walking paths with signs that are easy

to read, and route maps that the public can

HDVLO\QGDQGXVH

Employers can

Create and support walking programsfor employees.

Identify walking paths around or near the

work place and promote them with signs

and route maps.

Provide places at work to shower or change

clothes, when possible.

Individuals can Start a walking group with friends

and neighbors.

Help others walk more safely by driving the

speed limit and yielding to people who walk.

Use crosswalks and crossing signals when

crossing streets and not jaywalk.

Participate in local planning efforts that

identify best sites for walkingpaths andsid

What Doctors Know - August 2012

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