What Doctors Know - Vol 1 Issue 2

Vol 1. Issue 2

What's The Rush? A New Approach to Allergy Relief

Should I Treat My Child's Fever?

What Women Need to Know About Preventing and Treating Breast Cancer

"Doctor, do I Have to Take These Medications the Rest of My Life?"

Is This a Snack or a Meal?

Prostate Surgery Enters the Robotic Age

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Every year January becomes the month we make resolutions and while we mean well, the staff and doctors of What Doctors Know would like to challenge our readers to make a more serious and more

realistic resolution. We think a resolution to take better care of yourself and your family makes sense. In fact, we think it should be more than a resolution. We think it should be a realistic commitment to a healthier way of life.

Frankly, most of us take better care of the family automobile. Maybe that’s because most cars come with a maintenance schedule to tell us what preventive maintenance is necessary and when.

So, in our quest to help with that sensible New Year’s resolution combined with our goal to inform and educate our readers, we are providing a maintenance schedule in a “quick glance” format broken down in age categories for children, women and men. The charts start on page 73 and provide some general information on tests, procedures and even immunizations suggestions.

Of course, these charts are a guideline and should never be substituted for professional medical care. Always follow your healthcare professional’s instructions. We hope they help you make healthier and more realistic resolutions for 2012.

As always, if you have specific health questions you would like answered by one of our healthcare specialists, feel free to e-mail your question(s) to [email protected]

We would love to hear from you.

Scheduled Maintenance-Not just for your car

Send us your questions or a topic and we will have one of our knowledgeable doctors give you the answers...simplified. We want to hear from YOU! [email protected] or write us at, What Doctors Know,585 West 500 South, Ste. 200, Bountiful, UT 84010

Realistic Resolutions

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Build It and They Will Come

On Call with Dr. Porter

In the movie Field of Dreams, Kevin Costner’s character, Ray Kinsella, heard a voice say: “Build it, and he will come”. The line is often misquoted as “build it and they will come” which is a better fit for What Doctors Know, where we came from and where we are rapidly going.

Using the altered quote as a reference, we built “it” and “they” have come. In this case

“it” is a bridge between doctors and patients. “They” are doctors helping build the bridge to reach “they”, the scores of patients across the globe who haven’t

been able to find the right bridge through the jungle of healthcare information.

Our bridge began as a footpath started by myself and a handful of local doctors who wanted to show patients a way to better health. The word spread and as more doctors embraced our concept, the footpath grew from a few pebbles spread across the road, to the beginnings of a bigger, better road to essential healthcare information.


The word spread more and before long our doctors were joined by healthcare systems and the roads became overcrowded with patients anxious for healthcare information. Today, that road is a massive bridge connecting doctors with patients, doctors with doctors and healthcare systems with doctors and patients.

We have been told time and time again that “it” has been long overdue. We built it and they came. It is all so true.

Subscribers have come. Our subscriptions have grown steadily and this growth has made us realize that quarterly isn’t enough. Beginning with our March edition, we will start publishing What Doctors Know monthly. We will be able to make this switch because so many prestigious health care systems, so many medical centers, so many medical schools and so many private doctors have come to us and asked to help keep the information coming.

With that, I would like to thank such institutions as the Cleveland Clinic, John Hopkins Medicine, Mt. Sinai Hospital New York, Cornell Food Labs, Brigham and Women’s (Harvard), Baylor University, Mayo Clinic, UCLA Medical Center, University of Florida, University of Miami, Loyola University, Vanderbilt University and so many more who have agreed to provide information for our readers. Virtually every day the list grows.

Many have been impressed by these institutions agreeing to be part of our bridging the gap between healthcare providers and patients. While I am thrilled, I’m not surprised these institutions are embracing our magazine. Their mission, as with every physician, is to improve the health of patients. Our magazine is merely an ideal opportunity for them to inform and educate. For that, I applaud each and every one for joining us in our quest to make healthcare more understandable.

Keep in mind that being on the Barnes and Noble Nook newsstand means consumers all across the globe can download the Nook app and enjoy our magazine on a Nook, on an Ipad, any android based tablet and of course, any PC. But we have plans.

In addition to the move from quarterly to monthly, we will be printing the magazine and it will be available in all the Barnes and Noble stores across the country as well as in the lobbies of all our contributors.

Patients are coming to read the information in our magazine. Doctors and healthcare systems are coming to help inform and educate. And to help keep that bridge strong and up to date, we encourage our readers to suggest healthcare topics and to ask. Drop us a note, send us an e-mail and let us know about a subject you would like addressed. We welcome all suggestions.

Knowledge is power.

On Call with Dr. Porter

Steve Porter, MDPublisher and Chairman


HEADlines

WHAT DOCTORS KNOW And you should, too!

22 WhatWomenNeedtoKnowAboutPreventingandTreatingBreastCancer

24 ScoliosisCareatAnyAge

26 The411onShoulderPain

28 CeliacSprue

30 CouldCTScansforLungCancerSaveLives?

12 What’sTheRush?Anewapproachtofastallergyrelief

14 VividResultsForCataractSurgery

16 ShouldITreatMyChild’sFever?

17 OneInFiveAmericansHaveHearingLoss

18 MissingTeeth:MoreThanAesthetics.It’saMatterofHealth

20 Short-TermHormoneReplacementTherapyMayBenefittheBrainofPostmenopausalWomen

21 KeepVisioninYourFuture

32 NewApproachtoThyroidSurgeryEliminatesNeckScar

34 AnUndercoverKiller…PeripheralVascularDisease

36 “Doctor,doIhavetotakethesemedicationstherestofmylife?”

39 NewHipReplacementsforActiveLifestyles

40 FetalPrograming:ReducingYourBaby’sRiskforDiseaseLaterinLife

42 IsThisaSnackoraMeal?

44 WhyDoesMyHeelHurtSoMuch?

46 ColonCancer:TheSilentKiller

48 SensibleSolutionsforObesity

IN THE TRUNK

BELOW THE BELT

P20

P24

P40


50 SpeakUp!52 GoodSleepHabitsEssentialtoChildren’s

HealthandDevelopment54 PainManagementTherearenoeasyanswersorcures56 KeeptheResolutionandKeepYourHealth58 FluSeasonisHere60 HowMuchCaffeineisOkayforKids?62 KnowtheSignsofSkinCancer

contents / WINTER 2012

On the Cover12 What'sTheRush?ANew

ApproachtoAllergyRelief16 ShouldITreatMyChild'sFever?22 WhatWomenNeedtoKnowAbout

PreventingandTreatingBreastCancer36 "Doctor,doIhavetotakethese

medicationstherestofmylife?"42 IsThisaSnackoraMeal?66 ProstateSurgeryEnterstheRoboticAge

MIND, BODY, AND SOUL

64 BeamMeUp66 ProstateSurgeryEntersTheRoboticAge68 ArtificialPancreasaReal-World

SuccessforDiabetesPatients70 SimMan

TECHNOLOGY & YOUR HEALTH

02 OnCallWithDr.Porter

08 MeetOurDoctors

10 HouseCalls

32 IntheNews

In Every Issue

P60

P70

Vol 1. Issue 2

What's The Rush? A New Approach to Allergy Relief

Should I Treat My Child's Fever?

What Women Need to Know About Preventing and Treating Breast Cancer

"Doctor, do I Have to Take These Medications the Rest of My Life?"




MULLEN#: BNN1-11-XXXX-XXX MEDALLION#: 108007 FILE NAME:108007.NOOK COLOR 200 WHAT DR.V1R1

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Experience NOOK Color at your neighborhood Barnes & Noble or visit NOOK.com

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Published byWhat Doctors Know, LLC

Publisher and ChairmanSteve Porter, MD

Editorial Advisory BoardVicki J. Lyons, MD, Chairman

Timothy J. Sullivan, MD

Editorial and Design DirectorBonnie Jean Myers

Senior DesignerSuki Xiao

Design AssociateCayden Chan

Executive Director, MarketingLarry Myers

Production Kai Xiao, Vice President

IT ManagerEric Lu

For more information on ad placement or contributing an article, please email

[email protected], or call (801) 299 -1122.

For information on subscriptions, please visit www.whatdoctorsknow.com

Copyright 2011 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 Know is purchased and paid for by the advertisers. Products and services are not necessarily endorsed by What Doctors Know,LLC.

Corporate OfficeWhat Doctors Know

585 West 500 South, Ste. 200Bountiful, UT 84010

(801) 299-1122

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

over the country? What’s new in your practice, in your specialty?

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

educate our readers. We know, an informed reader has the opportunity to 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]


WHAT DOCTORS KNOW And you should, too!

Steven Porter, MDFounder and publisher of What Doctors Know, Dr. Porter is recognized as one of the top gastroenterologists in the country. He is the medical director of the endoscopy lab at a leading hospital in Ogden, Utah and has been practicing for more than 25 years. Contact Dr. Porter at (801)387-2550.

Vicki Lyons, MDFounding member and chairman of the editorial advisory board of What Doctors Know, Dr. Lyons is a board certified and fellowship trained allergist and immunologist practicing in Ogden, Utah. She has been practicing for 20 years. Contact Dr. Lyons at (801)387-4850 or www.vicki-lyonsmd.com.

Timothy J. Sullivan, MDContributing editorial advisory board member of What Doctors Know, Dr. Sullivan spent 25 years in full-time academic medicine at Washington University, University of Texas Southwestern Medical School, and Emory University. He currently has a full-time allergy and immunology practice in Atlanta, Georgia and is a clinical professor at the Medical College of Georgia. Contact Dr. Sullivan at (404)255-2918 or www.trittbreatheandsleep.com.

Carlos Lerner, MDCertified by the American Board of Pediatrics, Dr. Lerner practices at the UCLA Children’s Health Center in Los Angeles, California. Contact Dr. Lerner at (310)206-6987.

Phillips Kirk Labor, MDInternationally known for his work in refractive surgery and cataract expertise for more than 20 years. Dr. Kirk Labor is a board certified ophthalmologist in the Dallas, Texas area with affiliations to the American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American College of Eye Surgeons, and Society for Excellence in Eye Care. Contact Dr. Labor at (817)410-2030 or www.eyectexas.com.

Mark Newey, DDSBoard certified oral and maxillofacial surgeon, Dr. Newey started his private practice in 2005. He belongs to a number of organizations including, American Oral & Maxillofacial Society, and American Society of Dental Anesthesiologists. Contact Dr. Newey at (802)825-1116 or www.neweyoralsurgery.com.

Richard Hostin, MDMedical director at the Baylor Scoliosis Center, Dr. Hostin is a fellowship trained orthopaedic spine surgeon who treats spinal diseases including pediatric and adult spinal deformity, degenerative conditions of the spine, as well as spinal trauma, tumors and infections. Contact Dr. Hostin at www.thebaylorscoliosiscenter.com.

Dann C. Byck, MDArthroscopy Association of North America’s Master Instructor, Dr. Byck instructs orthopedic surgeons throughout the country on how to perform and perfect arthroscopic procedures of the shoulder, elbow, and knee. He has been practicing in Northern Utah for more than 9 years. Contact Dr. Byck at (801)917-8000 or visit www.utahorthopaedics.com.

Caroline R. Tadros, MDSpecializing in inflammatory bowel disease and therapeutic endoscopy, Dr. Tadros completed her residency at New York University Medical Center and her fellowship in gastroenterology at the University of Vermont. Contact Dr. Tadros at (801)387-2550.

Christopher Y. Kim, MDBoard certified in cardiovascular disease and internal medicine, Dr. Kim completed his residency in internal medicine at the University of Texas Medical School in Houston and his fellowship in interventional cardiology. Contact Dr. Kim at (801)776-0174.

Yale M. Samole, MDBoard certified in cardiovascular disease, internal medicine and nuclear cardiology. Dr. Samole has been practicing for more than 40 years and is currently with Baptist Health South Miami Heart Center. Contact Dr. Samole at (305)661-8539.

Aaron Hofmann, MDFounder of The Hofmann Arthritis Institute, Dr. Hofmann is a board certified orthopedic surgeon and implant designer of hip and knees at The Center for Precision Joint Replacement on the campus of Salt Lake Regional Medical Center. Contact Dr. Hofmann at (866)431-WELL (9355).


Meet Our Doctors

Special Thanks To:

Melinda S. Sothern, PhDCurrently serves as a professor with tenure and directs the Section of Health Promotion in the Division of Behavioral and Community Health at the Louisiana State University (LSU) Health Sciences Center, School of Public Health and the Prevention of Childhood Obesity Laboratory at the LSU Pennington Biomedical Research Center.

Brian Wansink, PhDDirector and the John Dyson Professor of Marketing of the Cornell Food and Brand Lab in the Department of Applied Economics and Management at Cornell University in Ithaca, New York. Contact Dr. Wansink through the Cornell Food and Brand Lab website at [email protected].

Jeffrey J. Rocco, MDSpecializing in foot and ankle reconstruction and lower extremity trauma Dr. Rocco is a board certified orthopedic surgeon. He is also on the research review board for First Endurance and writes sports nutrition articles for the company blog at http://blog.firstendurance.com. Contact Dr. Rocco at (801)917-8000 or visit www.utahorthopaedics.com.

Megan Wolthius Grunander, MDFellowship trained in trauma/surgical critical care at Cedars-Sinai Medical Center in Los Angeles. Dr. Grunander currently practices in Northern Utah. Contact Dr. Grunander at (801)475-3000.

Brent Williams, MDDebbie WilliamsCertified in bariatric medicine and a member of the American Society of Bariatric Physicians, Dr. Williams has been a family physician for more than 25 years. Debbie is also a member of the American Society of Bariatric Physicians and is a certified bariatric assistant. Contact Dr. Williams at (801)528-9078.

Lisa Meltzer, PhDAssistant Professor of Pediatrics at National Jewish Health, Dr. Meltzer specializes in the treatment and research of pediatric sleep disorders and the sleep of caregivers of patients with chronic illnesses.

Raul Weston, MDAnesthesiology residency completed from the University of Utah, Dr. Weston is a fellowship trained specialist in interventional pain medicine. Contact Dr. Weston at (801)294-7246.

Heather LaChance, PhDAssistant Professor of Medicine at National Jewish Health, specializes in smoking cessation and helping people overcome other addictive behaviors.

Chad W. Tingey, MDFellowship trained skin cancer and reconstructive surgeon and dermatologist. Dr. Tingey completed his dermatology residency at Loma Linda University Medical Center and ACGME Procedural Dermatology fellowship in Mohs and laser surgery at Scripps in San Diego, California. Contact Dr. Tingey at (801)475-3000.

Stuart A. Chalew, MDProfessor of Pediatrics and Head of the Division of Pediatric Endocrinology at LSU Health Sciences Center New Orleans School of Medicine. Contact Dr. Chalew at (504)896-9441.

Michael Van Bibber, MDReceived extensive training in general surgery and completed his urology residency at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Dr. Van Bibber practices in Northern Utah. Contact Dr. Van Bibber at (801)475-3000.

House CallsQ:

I’ve been thinking

about Botox to clear up

some wrinkles on my face.

Is it safe and how does it

work? –Kathi, MI

A:Botox has been a popular and minimally invasive way to reduce the appearance of wrinkles and

prevent underarm sweating. Botox causes controlled muscle

weakness when injected into specific areas of the face and body.

If considering Botox, there are things to know before, during, and after your

procedure. Avoid alcohol two days before the treatment and do not take aspirin or anti-

inflammatory medications two weeks before the treatment. This will prevent bruising.

Remember that it takes three to 14 days to see full results. Don’t expect the injection

to last forever; the effects of Botox last about three to four months before it’s time

for another appointment. However, with repeated treatment, wrinkles often appear

less severe with time because the muscles are being trained to be less active.

Patients who are pregnant, breastfeeding, or have a neurological disease should not use

Botox. Minor bruises and temporary headaches are the most common side effects

following a procedure. And Botox doesn’t work for all wrinkles, so check

with your dermatologist or plastic surgeon before committing. –

Silvia Rotemberg, MD at Dermatology Plastic Surgery Institute at Cleveland Clinic

whatdoctorsknow.com�0

Disclaimer:The information contained in the magazine is intended to provide broad understanding and knowledge of healthcare topics. This information should not be considered complete and should not be used in place of a visit, call, consultation or advice from your physician or other healthcare provider. We recommend you consult your physician or healthcare professional before beginning or altering your personal exercise, diet or supplementation program.

Q:My resolution this year is to take care of my body. What should I include

in my resolution for this year? –Eric, AZ

A:

That’s a great question. Too many

people make unrealistic resolutions that

are destined for failure. To make your goal for

a healthier body more realistic, we have created a

maintenance schedule for virtually every age group

and gender. The schedule starts on page 73 and

provides a guideline for the basic check-ups,

tests, etc., you will need for healthier you in

2012. –Steve Porter, MD, Publisher

of What Doctors Know

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whatdoctorsknow.com��

What's The Rush?A new approach to fast allergy relief.

Rush Immunotherapy is a method for providing rapid relief from allergies. What is this new procedure and where does this fit into the treatments we already have?

Seasonal or persistent nasal itching, sneezing, runny nose, nasal congestion, sinus headaches, postnasal drainage, sleep disturbance because of nasal

obstruction, as well as itching and burning of the eyes (allergic conjunctivitis) affects 10-25% of people in Western countries. Pollen and airborne substances arising from molds, animals, mites and other insects are common causes of these problems.

Allergic reactions in the lungs result in asthma in approximately 5% of the world’s population. Tightness in the chest, shortness of breath, wheezing, and coughing are common asthma symptoms. Asthma can limit activities, disrupt sleep, and have a very negative effect on quality of life. Acute respiratory tract infections or exposure to allergic triggers can cause severe or even fatal worsening of asthma.

The goals of therapy for upper airway allergic reactions (allergic rhinitis, hay fever) include relief from annoying symptoms, relief from disturbed sleep, and avoidance of complications such as middle ear infections or sinus infections. Antihistamines, decongestants, nasal steroid sprays, and other nasal allergy sprays often provide relief.

The goals for asthma are control of the symptoms, prevention of limitations on activities, and protection from severe worsening during respiratory tract infections or exposures to allergic triggers. Bronchodilators, inhaled steroids, oral asthma medications, and other medications can provide symptomatic relief for some patients.

Allergic rhinitis, allergic conjuctivitis, and allergic asthma, often need immunotherapy (allergy shots). These injections provide control of symptoms and then


resolution of the allergies. Currently this is the only therapy that can actually reduce or eliminate the body's unwanted allergic reactions to environmental substances.

Rush Immunotherapy is a new injection procedure that is revolutionizing how we treat allergies.

Traditional immunotherapy typically involves injections twice a week with increasing amounts of antigens (the substances that cause the allergies). This process usually takes 16 weeks to reach full treatment doses (maintenance doses).

The Rush Immunotherapy revolution has centered on the recently acquired knowledge that relief from allergy symptoms requires lower doses of antigens than are required to make the allergies go away entirely over time. Research in United States and Europe has led to Rush Immunotherapy procedures that allow us to reach levels of antigens that begin to relieve symptoms in one day rather than over a period of 2-3 months.

Patients are given high doses of allergy suppressing medication to minimize reactions at the sites of injections, or in the rest of the body. Typically 8 injections are given over a period of 5 hours and the patients are then observed for 2 more hours as the materials are absorbed into the body.

Rush immunotherapy can be a great convenience for patients with demanding work or school schedules. While the procedure requires a full day in the office, we avoid nearly 3/4 of the visits needed to build up to maintenance doses. A day in the office also affords time for the patient to ask questions about allergic disease and treatment. There is time to discuss and demonstrate how to deal with unexpected late allergic reactions.

As allergy symptoms improve after Rush Immunotherapy, patients are much more likely to return for the final doses to build up to maintenance. These higher doses are required not to relieve symptoms, but rather to gradually eliminate or markedly decrease the severity of the allergy itself.

Not everyone is a good candidate for Rush Immunotherapy. If asthma control is not stable, if lung functions are not near normal, Rush Immunotherapy may not be safe.

Preschool children may be good candidates from the point of view of clinical improvement, but being kept in a relatively small space can be very difficult for them. For many patients, Rush Immunotherapy is an alternative with several advantages over medications alone, or traditional immunotherapy.

Any form of immunotherapy carries a risk that the patient may have a troublesome reaction at the injection site, or that a more severe reaction involving the whole body may occur. This could include hives (urticaria), swelling of the eyes, lips, or other structures (angioedema), even anaphylaxis (reactions that cause trouble breathing or decreases in blood pressure).

The possibility of an allergic reaction is why allergists rely upon patient education, observation in the office after injections, and having an emergency plan for dealing with rare severe reactions. Rush Immunotherapy patients are taught about the characteristics of the late allergic reactions, are given medications to use in case of a reaction, and are taught the use of self-injectable epinephrine.

Rush Immunotherapy provides a method for achieving clinical improvement very rapidly and greatly reduces the number of visits required to achieve long lasting freedom from allergy. -Vicki Lyons, MD and Timothy J. Sullivan, MD

Advantages of Rush Immunotherapy • Convenience for patients with limited time. • Doses of immunotherapy that begin giving relief of symptoms

can be reached in one day, rather than over 2-3 months. • The time required to reach full treatment maintenance doses is markedly reduced. • Both the patient and the doctor can quickly determine whether

or not this form of therapy will be successful.


Vivid Results ForCataract Surgery

Cataract surgery technology has evolved to the extent that, compared to earlier procedures, eye surgeons can accomplish what was once considered unthin kable. Yet, until now, determining a patient’s post-surgery vision quality took weeks or even months. This article describes how an unprecedented new technology, called ORange®, is changing all of this for the better.


Cataracts, the clouding of the eye’s natural crystalline lens, are a fact of life for many of us as we get older. Typical symptoms include

blurred or distorted vision, increased sensitivity to light and glare, poor night vision, and difficulty in distinguishing colors. More importantly, cataracts can lead to blindness. Fortunately, cataracts can be corrected fairly easily through surgery. Cataract surgery is, in fact, one of the simplest and safest procedures performed today.

Without question, technology has reduced the time it takes to perform a cataract procedure. It has also reduced recovery and healing time. Patient discomfort is practically eliminated – almost a thing of the past, you might say. Most importantly, surgery results have improved dramatically.

But until recently, one critical component was missing: Surgeons were not able to evaluate surgery results in the operating room, during the procedure. ORange is a new technology that has changed that. Developed by WaveTec Vision, ORange allows the eye surgeon to assess the patient’s vision quality when it matters most – in real time during the cataract procedure. Before ORange technology became available, both doctor and patient had to wait for weeks or even months to determine the ultimate result of the procedure. Consequently, cataract surgery can now be performed more accurately and reliably than ever.

In cataract surgery, the patient’s cataract is removed and replaced with an artificial – or intraocular – lens implant, resulting in clearer vision and less dependency on eyeglasses or bifocals. Lens implant accuracy and

astigmatism correction (an irregularly shaped cornea) are extremely important to achieving the best overall cataract surgery results. ORange allows a more accurate analysis of both.

Our society is so “tech-savvy” that my patients often ask, “exactly what is an ORange?” It is an intraoperative wavefront aberrometer, or, in simpler terms, a diagnostic instrument that measures aberrations, or imperfections, caused by the cataract. It works by directing a beam of low intensity laser light into the eye, reflecting off the retina. Sensors then analyze the reflected light exiting the eye for an accurate measurement of its unique focusing capabilities.

Because this happens in real time, during the cataract procedure, surgeons can make adjustments and corrections on the spot with more accuracy. The result is better vision for the patient – better than ophthalmic surgeons have ever been able to achieve before.

ORange is officially the first of its kind in the world. I am proud to say that our practice was the first in the Dallas/Fort Worth metro area to use ORange technology, and the results have been extremely positive. ORange has made my decision-making in the operating room better than ever, because I am now able to make very fine corrections as I operate. This is a great advantage for me, but I consider the greatest advantage to be for the patient who

benefits the most from this amazing new innovation. ORange definitely provides my patients with the most up-to-date treatment option for the best possible cataract surgery result.

Like any surgery, cataract surgery comes with some risks. This is why keeping tabs on your vision health is so necessary. Although important at any age, starting in your late 50’s annual eye exams become even more important, as this is when doctors begin to look for early signs of cataracts. If you have cataracts, a thorough cataract screening or evaluation is needed to determine if you need surgery, and to provide a clearer picture of your overall health.

The main thing to remember is that cataract surgery is common, simple, and can make a tremendous difference in your vision. While ORange is an elective part of the cataract procedure, it is a valuable breakthrough that can further improve surgery results.

Please Note: As this article goes to publication, WaveTec Vision announced that, in early 2012, it will change the name ORange to ORA. This will also include refinements to further enhance cataract surgery accuracy, and provide even more benefits for the patient. Any ophthalmology practice should be alert to these changes, to help patients fully understand what this means, and how it will benefit them the most. -Phillips Kirk Labor, MD


Should I TreatMy Child's Fever?

A child’s fever can be anxiety-provoking for many parents, who often do anything possible to bring their child’s temperature back to normal. But parents should understand that a fever may actually benefit generally healthy children.

A current report from the American Academy of Pediatrics (AAP) attempts to clarify guidelines for treatment of fevers and to remind parents that a fever is usually just the body’s natural defense mechanism against infections. Lowering a fever may actually prolong an illness. The AAP recommends that, in general, parents should only treat a fever if it makes their child feel uncomfortable.

A low-grade fever is considered to be a temperature of 100.4 degrees Fahrenheit and a high-grade fever to be anything above 102 degrees. “Parents need to know the temperature itself is not the primary problem,”

explains Carlos Lerner, M.D., pediatrician, Mattel Children’s Hospital UCLA. “Instead of focusing on the number on the thermometer, parents should be watchful of their child’s general appearance and behavior.”

“We stress that the reason to reduce the fever is for the comfort of the child, and not to reduce the temperature,” Dr. Lerner explains. “Thus, if a child seems comfortable, behaves and appears normal, there is no reason to treat the fever with acetaminophen or ibuprofen,” advises Dr. Lerner. “Sometimes treating the fever may cause adverse side effects that are worse than leaving the fever alone.” Fever reducers such as acetaminophen and ibuprofen are generally very safe when given correctly, but they can have rare but serious effects. Aspirin should never be given to children.

Home remedies, such as a tepid bath, are rarely necessary to treat fevers and have not been shown to be effective in lowering temperatures. Keeping your child well hydrated, well rested and comfortable is usually the best treatment. Parents should monitor their child’s behavior and appearance and contact their healthcare provider for advice if they are concerned.

Treating a feverIn most cases, a child with a fever can be observed and/or treated at home by letting the illness run its course. “It is important for parents to know when a child with a fever needs to be evaluated by a healthcare provider, when the fever should be treated, and to be aware of the proper medications and dosage guidelines for treating the fever,” notes Dr. Lerner. -This information is provided courtesy of the pediatricians at Mattel Children's Hospital UCLA.

Symptoms parents should watch for: • Labored or rapid breathing • Poor interaction with others• Dehydration • Unusual purple rashes• Lethargy and discomfort • Any fever in infants under 3 months

whatdoctorsknow.com �7

Nearly a fifth of all Americans 12 years or older have hearing loss so severe that it may make communication difficult, according to

a new study led by Johns Hopkins researchers and published in the Nov. 14 Archives of Internal Medicine. The findings, thought to be the first nationally representative estimate of hearing loss, suggest that many more people than previously thought are affected by this condition.

Study leader Frank Lin, M.D., Ph.D., an assistant professor with dual appointments in both the Department of Otolaryngology-Head & Neck Surgery at the Johns Hopkins School of Medicine and in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public

Health, explains that several previous estimates of hearing loss focused on various cities or populations, such as children or elderly patients. However, no estimate successfully encompassed the entire U.S.

“I couldn’t find a simple number of how common hearing loss is in the U.S.,” Lin says, “so we decided to develop our own.”

Lin and his colleagues used data from the National Health and Nutritional Examination Surveys (NHANES), a research program that has periodically gathered health data from thousands of Americans since 1971. The researchers analyzed data from all participants age 12 and over whose hearing was tested during NHANES examinations from 2001 to 2008. Unlike previous estimates, NHANES includes men and

women of all races and ages, from cities scattered across the country, so it’s thought to statistically mimic the population of the U.S.

Using the World Health Organization’s definition for hearing loss (not being able to hear sounds of 25 decibels or less in the speech frequencies), the researchers found that overall, about 30 million Americans, or 12.7 percent of the population, had hearing loss in both ears. That number jumps to about 48 million, or 20.3 percent, for people who have hearing loss in at least one ear. These numbers far surpass previous estimates of 21 to 29 million.

Hearing loss prevalence nearly doubled with every age decade, with women and blacks being significantly less likely to have hearing loss at any age. Lin and his colleagues aren’t sure why these groups appear to be protected. However, he notes that the female hormone estrogen, as well as the melanin pigment

in darker skin, could have a protective effect on the inner ear—topics they plan to research in future studies.

In the meantime, Lin says, the new numbers greatly inform the work he and other researchers are doing on hearing loss and its consequences, which, according to previous studies, include cognitive decline, dementia, and poor physical functioning.

“This gives us the real scope of the problem for the first time and shows us how big of a problem hearing loss really is,” Lin says.

Other researchers who participated in this study include John Niparko, M.D., of the Johns Hopkins University School of Medicine, and Luigi Ferrucci, M.D., Ph.D., of the National Institute on Aging. -Information is provided courtesy of Johns Hopkins Medicine.

One In Five Americans Have Hearing LossNew nationally representative estimate shows wide scope of problem


Too many people think living with a lost tooth is no big deal. Knowing the long-term effects can quickly make people realize, it is a big deal. Not replacing a missing tooth increases the risk of loosing the adjacent tooth and the gap left

from the lost tooth takes away stability and increases the possibility for this adjacent tooth to loosen and fall out.

It gets worse. There is a vast amount of bone loss that can follow tooth loss, which can progress rapidly over time. Bone loss can affect the shape of the jaw, the bite, and the future of your teeth. You may find it difficult to chew food properly and this can contribute to your health and diet since you will

be limited in what you can eat. In turn, you may find yourself fighting obesity and perhaps diabetes – because of a poor diet – caused by lost teeth.

If you wear dentures, you may develop the inability to use full or partial dentures and you may even find denture wearing painful due to bone structure changes caused by a simple missing tooth.

Then there’s the matter of facial muscles becoming out of shape or deformed. Your teeth and jaw act as a foundation for your facial muscles and bones. When the foundation starts to crumble, the shape of the remaining teeth, muscles and bone begin to change. In some cases it can cause social embarrassment because the face becomes distorted or older looking.

Missing Teeth: More Than Aesthetics. It’s A Matter Of Health


Finally, bone loss beneath conventional bridges can cause food to become impacted, increase the incidence of gum disease and believe it or not, tooth loss can increase the possibility of heart disease and stroke.

Missing a tooth is a big deal.Replacing a missing tooth can be done in several ways. Among the methods are a tooth supported bridge, a removable partial denture or a dental implant.

Dental Implants have quickly gained preference from oral surgeons and patients because of the long-term benefits. The up front cost of a dental implant may be a little more, but over time, the implant becomes the better value. With normal care, implants can last for years without any worry about failure. Along with longevity, dental implants can be installed without destroying or sacrificing adjacent teeth. Other methods may require taking out an adjacent tooth for a bridge. Be it one tooth or several teeth, dental implants are definitely the preferred method of replacing missing teeth.

What are dental implants?Dental implants are a dental restoration system composed of a titanium screw and a crown. The dental implant process includes a small-diameter hole (pilot hole) is drilled for the titanium screw. Once in place, this titanium screw holds the dental implant in place. Surgeons often use surgical guides when placing the dental implants.

After the pilot hole has been drilled, the implant screw is placed. Once in place, the surrounding gum tissue is secured over the implant and a protective cover screw is placed on top to allow the site to heal. After the healing is complete, the surgeon will attach an abutment, which attaches a crown to the implant. With the abutment in place, the surgeon will then create a temporary crown. The process is completed when the temporary crown is replaced with a permanent crown.

Dental Implants Care and Longevity Once an implant has been placed, maintaining diligent oral hygiene habits is required to ensure proper fusing of the implant and bone structure. If cared for properly, an implant restoration can remain in place for more than 40 years.

Healing from the surgical procedure to place the dental implant(s) takes up to six months, while the fitting and seating of the crown(s) can take up to two months. Again, this timeframe depends on individual cases and treatments. Follow-up appointments with your treatment coordinators are essential for monitoring your progress.

Implant Surgery Follow-up and AftercareFor five to seven days after surgery, your diet should be restricted to soft foods. If stitches are present, they may need to be removed by your surgeon; however, self-dissolving stitches that do not require removal are typically used.

Failure to floss and brush is the leading cause of implant failure. Infection can also occur if the implant and surrounding areas are not cleaned properly. Smoking has been shown to cause high failure rates with dental implants and should be avoided following implant procedures.

For more information, contact your Oral Surgeon. -Mark Newey, DDS


The Short-TermHormone

Replacement Therapy May

Benefit The Brain of Postmenopausal

Women

Short-term estrogen treatment increased the volume of the brain’s gray matter in postmenopausal women, making a case for the potential benefit of short-term hormone replacement therapy, according to a study presented this

week by Vanderbilt’s Paul Newhouse, M.D.

Newhouse, professor of Psychiatry and director of the Center for Cognitive Medicine at Vanderbilt University Medical Center, presented the information at the annual

meeting of the Society for Neuroscience in Washington, D.C. The research was done while Newhouse was at the University of Vermont College of Medicine where he was professor of Psychiatry and director of the Clinical Neuroscience Research Unit and Brain Imaging Program. He joined Vanderbilt’s faculty in October.

The brains of 25 healthy postmenopausal women who took either estrogen or a placebo for three months were imaged for the study. After treatment, the women who took estrogen had more gray matter in the parietal, temporal and prefrontal areas of the brain, areas that are known to be involved in attention, decision-making and memory.

The findings show that long-term hormone treatment, shown to have adverse effects in older postmenopausal women, may be unnecessary for cognitive benefit. The ideal length of treatment will be decided in further studies.

“My focus the past 10 years has been studying the effects of how estrogen affects the cholinergic system in the brain, the system that deteriorates in Alzheimer’s disease,” Newhouse said. “Estrogen enhances that system.

“Our findings suggest the brain remains responsive to estrogen treatment even after menopause, and that this responsiveness or plasticity is important for preserving cognitive functioning, especially in the early postmenopausal period,” he said. “Short term estrogen treatment in normal postmenopausal women is sufficient to increase gray matter in the brain.

Newhouse said when estrogen levels decline after menopause, the brain has to adapt. “It’s been seeing estrogen for decades and it has enormous effects on brain development, growth and maintenance.”

Newhouse has also studied the effects of nicotine on the aging brain, particularly in those with mild cognitive impairment.

At Vanderbilt, Newhouse plans to use functional magnetic resonance imaging (fMRI) to study how estrogen changes the emotional response in the brain. “One of the reasons I came to Vanderbilt is that I saw an opportunity to take this work to the next level, in terms of the collaborations that are here and in terms of interacting with basic science investigators, molecular specialists and pharmacologists.”

Newhouse is currently recruiting faculty for Vanderbilt’s Center for Cognitive Medicine which should be fully operational in about two years.

Newhouse’s estrogen research was supported by the National Institute of Aging. -Nancy Humphrey. This information provided courtesy of Vanderbilt University Medical Center.


NIH’s National Eye Institute has been focusing attention on a group of diseases called glaucoma. Left untreated, glaucoma can damage the optic nerve and destroy eyesight.

Glaucoma is a leading cause of blindness in the U.S. More than 4 million people nationwide have it, but nearly half of them don’t realize it. That’s because the condition has no early warning signs. Fortunately, glaucoma can be detected through a comprehensive dilated eye exam. Early detection can lead to earlier treatment, which can control the disease and prevent future vision loss.

Anyone can develop glaucoma, but some people are at higher risk than others. Those at increased risk include African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of glaucoma. If you are at higher risk, you should get a comprehensive dilated eye exam every 1 or 2 years.

During the dilated eye exam, you receive eyedrops that dilate, or widen, the pupil in the center of your eye. This allows your eye care professional to see inside the eye and detect subtle signs of glaucoma.

The exam can also show if you have additional risk factors. In some people, certain medicated eyedrops can cut the risk of developing glaucoma by about half.

Protect your eyesight. Be sure to get regular eye exams, and spread the word about glaucoma to your family and friends. -Information courtesy of National Institutes of Health • Department of Health and Human Services • newsinhealth.nih.gov

For more information visit: www.nei.nih.gov/glaucoma www.healthyvision2010.nei.nih.gov/hvm

Optic Nerve: A bundle of nerve fibers that connects the back of the eye to the brain. A healthy optic nerve is needed for good vision.

Keep Vision in Your Future


What Women Need to Know About Preventing and Treating Breast CancerCompared to other forms of cancer, breast cancer gets a lot of attention. But that attention is well-deserved, because the chances of a woman developing breast cancer are greater than nearly any other form of cancer. In fact, one in eight women will experience breast cancer during her lifetime, according to the American Cancer Society.

The good news is advances are being made every day to catch breast cancer earlier and treat it effectively once it's caught. Being diagnosed with breast cancer is far from a death sentence - five -year survival rates are 93 percent

for those who catch it in its earliest stage. Due partially to its prevalence and improved treatment, approximately 2.5 million breast cancer survivors are living in the United States today.

In addition to the sheer number of people affected by the

disease, breast cancer presents patients with many difficult, and often scary, decisions. "People forget that one of the unique aspects of breast cancer is the fact that most women do have a choice," says Dr. Elisa Port, co-director of the Dubin Breast Center of The Tisch Cancer Institute at The Mount Sinai Medical Center in New York. They have a choice between lumpectomy and mastectomy, and oftentimes those choices are very equal - and that's just one example."

Finding the information necessary to make these decisions and the support to get through cancer treatment procedures and beyond can be difficult. Dr.


"Our goal for the Dubin Breast Center is to provide patients with seamless care," says Dubin. "From breast cancer screening to diagnosis to treatment and survivorship, patients will receive personalized, comprehensive care in a welcoming, private and reassuring setting." The center provides all-in-one facility that offers a soothing atmosphere for breast cancer patients and survivors.

Since early detection is key when battling breast cancer, The Mount Sinai Medical Center urges anyone experiencing the following symptoms of breast cancer to visit a physician:

• A lump or thickening near the breast, in your underarm area or in your neck

• A change in the size or shape of a breast

• Nipple discharge or tenderness, or the nipple becoming pulled back or inverted into the breast

• The skin of your breast becoming ridged or pitted, similar to the skin of an orange

• Any change in the way your breast looks or feels

-For more information on breast cancer and treatment visit www.dubinbreastcenter.org.

Eva Andersson-Dubin, a breast cancer survivor, doctor and former Miss Sweden, helped fund and develop the recently opened Dubin Breast Center, along with co-directors Dr. Port and Dr. George Raptis, in hopes of providing a facility where patients could find these services and information under one roof. If you're dealing with breast cancer, or are a survivor, Dubin recommends looking for the following type of care:

• Finding a care center where all services are located under one roof can greatly ease much of the stress that comes along with your fight against cancer. Choosing a facility that allows you to have one electronic medical record, while also offering screening, treatment and counseling services, can streamline your experience and allow you to devote all of your attention to getting better.

Through her own experiences and from talking to other women who have dealt with breast cancer, Dubin found that lugging scans and paperwork from appointment to appointment is one of the largest sources of frustration for patients.

• Beating cancer means more than just winning the physical battle. Much of the fight against cancer and the life changes it brings is psychological. Look for a treatment facility that cares for the whole patient by offering services like oncofertility (reproductive health for cancer patients), nutrition and psychological counseling, and possibly even massage therapy. A treatment center that involves the whole family in your treatment and offers counseling services to them as well as you can play a huge role in helping you beat the disease.

• Ask if your care center has radiologists who specialize in mammography, breast ultrasound, breast MRI and breast biopsy. You might also ask if the center has digital mammography and any new technology such as 3D mammography - an advanced version of a conventional mammogram. 3D mammography, called tomosynthesis, helps radiologists see through layers of breast tissue facilitating the early diagnosis of breast cancer and reducing callbacks for additional screening, which can cause stress and anxiety.

• Look for a care center that offers care options well after your treatment has finished. Because a brush with cancer is a life-altering experience, having someone there to provide counseling services or answer questions as you go forward is an invaluable resource.

Experts in the field of breast cancer treatment agree that a comprehensive, lifelong approach to treatment is best. "Those with breast cancer benefit enormously from a comprehensive approach to their care that also focuses on their needs as individuals," says Nancy G. Brinker, founder and CEO of Susan G. Komen for the Cure.


Scoliosis Care at Any Age

Many people think of scoliosis as a childhood condition. While many cases are discovered in childhood or early adolescence, the condition can still be treated in adulthood as Megan Wright learned.


“I’m a new person now,” she says. “I don’t hurt and I don’t have to take pain medication.” She can go shopping again, an activity she had given up because she could hardly stand. She cooks dinner every night, tackles the laundry and joins her two sisters for regular walks. “On one walk, I ran across the street to beat the red light and my sisters were overjoyed. They hadn’t seen that kind of movement in me in a long time,” Jordan says.

She’s careful not to pick up heavy objects and is sure to bend properly, but otherwise she can mostly do what she wants. “I can take my grandbaby to the park—I wasn’t able to do that before,” she says.

Dr. Hostin encourages people with scoliosis to learn about the current treatment options. Even people like Darleen Jordan who have had several surgeries might find a new alternative. “Severe scoliosis is a tremendous disability, and there’s a huge amount of potential for improvement,” Dr. Hostin says.

Jordan should know. “Since surgery I am different. I am fabulous. I am basically a new person,” she says.

People with scoliosis can find online support through Baylor’s Facebook group at www.BaylorHealth.com/ScoliosisSupport whether or not they have been to the Baylor Scoliosis Center. For more detail on the Center, visit www.TheBaylorScoliosisCenter.com -Richard Hostin, MD

Wright, now 28, discovered she had scoliosis after a routine school screening at age 11. Doctors watched her curve’s progression but didn’t think it needed surgical treatment. At age 17, she stopped going to her

checkups. “To me scoliosis was something embarrassing. I didn’t have any pain, but I was bothered with how I looked,” she says. “I wanted to just forget about it.”

However, in her early 20s the pain started. By age 24, she decided to seek help from the Baylor Scoliosis Center in Plano, Texas. She was offered corrective surgery, and although afraid, she decided it was her best option. Wright’s operation took place in January 2009. “It was the best thing I ever did. It changed my life. I don’t have pain anymore,” she proclaims.

Wright is now able to work out and has started running, something she could never do without pain before. “Now I can wear clothes that fit me and feel comfortable with how I look. I feel like everyone else, and that’s amazing,” she says.

Richard Hostin, M.D., medical director of the Baylor Scoliosis Center and an orthopaedic surgeon on the medical staff at Baylor Regional Medical Center at Plano, explains how screening and treating people with scoliosis can improve their quality of life.

Children and adolescents, whose spines are still growing, typically don’t have pain with scoliosis. “But unchecked curves can lead to problems, including back pain and disability, as they get older,” Dr. Hostin explains.

Adults with large curves often struggle with pain and disability. Dr. Hostin notes that people who have been told elsewhere that their scoliosis can’t be treated may find new options at the Baylor Scoliosis Center. “A lot of centers don’t treat adults, but we do, and if you’re struggling with pain, we have a lot of good options.”

Dr. Hostin also says, with regard to patients who need surgery, the younger they are the better because younger people tend to recover faster. But, there is no age limit for surgery as a treatment option. If symptoms interfere with everyday life, people of any age may be considered for surgery.

Darlene Jordon, 56, had surgery to treat her scoliosis back in 1972. “I had 35 good years,” she says. But over time, she started battling back pain again. “I had numerous surgeries and I was still miserable. I was tired of being grumpy all of the time,” she says. She needed pain medication just to get through the day. And between the pain itself and the side effects of the pain medication, she got to the point where she could no longer drive. She relied on her husband to get her to and from work and her appointments.

Three years ago, extensive surgery at the Baylor Scoliosis Center to help reconstruct and reinforce her spine gave Jordan her life back.


What is the rotator cuff?The rotator cuff is actually four muscles and their tendons which run from the scapula, or shoulder blade, to the humerus—the upper arm bone. (The top of the humerus is a ball

shape and rests on the glenoid, or socket, to make the two parts of the shoulder joint.) These muscles perform the duty of lifting and rotating your arm as well as helping to keep the shoulder joint in place or stable.

The main rotator cuff muscle is the supraspinatus. This muscle is by far the most commonly affected by injuries and impingement. The supraspinatus is the rotator cuff muscle and tendon that lies directly under the acromion, or the bone on the top of the shoulder. When the arm is lifted out to the side or to the front, the supraspinatus may be pinched between the humerus and the acromion. This is known as impingement or impingement syndrome. Between the rotator cuff and the acromion lies the bursa-a slippery sack that lubricates those two structures.

Impingement also occurs when the supraspinatus weakens and the humerus can shift upwards towards

the acromion. Some of us have a curved or hooked acromion known as a spur. This will reduce the space for the rotator cuff and bursa even more. Activities associated with impingement include overhead-motion sports-such as tennis, volleyball and baseball- repetitive job-related activities or just the duties of daily life.

Combine the lack of adequate space with a naturally poor blood supply to the supraspinatus and over time the rotator cuff can simply degenerate and give way or tear. Often referred to as ‘wear and tear,’ this represents a vicious cycle that leads to rotator cuff tears. Rotator cuff tears can also occur with trauma. This is often a fall onto the shoulder or outstretched hand. Other common ways to tear your rotator cuff are car accidents, throwing injuries or lifting heavy objects.

How do you know when you have impingement syndrome versus a rotator cuff tear?That’s the $64 million question. Both can be extremely painful. Both can be debilitating. Both will be painful with use of the arm, particularly lifting objects overhead. The pain is often on the outside of the upper arm and radiates downwards to the middle of the

Have you ever experienced shoulder pain? Most of us have. In fact, shoulder pain is one of the most common complaints seen in the orthopedist’s office. And many of your primary care physicians will see shoulder pain on a weekly basis. Of those complaints, most are related to the rotator cuff. Other causes of shoulder pain include arthritis, tendonitis, pinched nerve, frozen shoulder, muscle spasms and fibromyalgia.

The 411 on Shoulder Pain


upper arm. Impingement will not lead to significant weakness, whereas those with a rotator cuff tear will be weak and won’t be able to overcome the weakness. Night pain usually means there is a rotator cuff tear as well. If pain persists longer than two weeks you will benefit from an examination. Waiting too long often leads to other complications. The examination to differentiate a rotator cuff tear and impingement is difficult and is best performed by an experienced shoulder specialist. Most importantly, the exam should test your strength. Pain may come and go, but strength loss due to a rotator cuff tear does not improve. MRI studies can also be helpful. X-rays will show the acromial spur, but not rotator cuff injuries.

What do I do when shoulder pain occurs?If you have a fall or a trauma, see your doctor or an orthopedic surgeon. The treatment of shoulder pain depends entirely on the cause of the pain. If you have impingement syndrome, nonsteroidal anti-inflammatories (NSAIDs) such as Advil or ibuprofen and waist-level exercises or physical therapy will often help you resolve the symptoms. The physical therapy will lower the humerus and decrease the intensity of the impingement. Occasionally, the pain just does not decrease. In this case, injections are very helpful. If your symptoms persist, smoothing the spur and shaving the bursa may be necessary to alleviate your symptoms. Although this is surgery, it is easily tolerated and recovery is swift.

If you have the more serious rotator cuff tear, the treatment often requires surgery. Physical therapy

can help keep your range of motion, but lifting overhead will only damage your tear further. Also, time is not on your side. The longer you live with your rotator cuff tear, the larger the tear will become and the more your rotator cuff muscle will shrink or atrophy. In addition, if you have had more than two injections for bursitis (inflammation of the bursa) you should see an orthopedic surgeon because you likely will have a rotator cuff tear.

So, your rotator cuff tear means a visit to the orthopedic surgeon. Your surgeon will discuss options, which will include surgery if you wish to have your problem fixed. There are different ways to fix rotator cuff tears. Historically, an open incision was required to perform your repair. Now the gold standard has shifted to repairs that are performed entirely through the arthroscope. The scope is used to see the tear better because it is magnified and a more anatomic repair may be possible. In addition, arthroscopic repairs do not violate the deltoid muscle, which is an important assistant to the rotator cuff. With all arthroscopic repairs there are also fewer infections and many believe it is a less painful recovery—although this is difficult to prove. Arthroscopic rotator cuff repair is technically difficult and only few surgeons are able to perform it routinely, especially in cases where the tear is large or massive.

The bottom line?If you have a rotator cuff injury, see your physician. Seek an orthopedic surgeon who is willing and able to offer you the state-of-the-art arthroscopic rotator cuff repair. -Dann C. Byck, MD

11www.localhealthcaretoday.com LOCAL HEALTHCARE TODAY

Clavicle

CoracoidProcess

Bursa

Humerus

Acromion

Torn Rotator Cuff Tendon

• Impingement or Rotator Cuff Tear = Pain and/or ache outside of shoulder to mid-upper arm

• Rotator Cuff Tear = Weakness and pain• Impingement = No weakness

The 411 on Shoulder Pain

The rotator cuff is actually four muscles and their tendons which run from the scapula, or shoulder blade, to the humerus—the upper arm bone.


Five years ago we rarely saw the phrase “gluten-free” on a menu. Now it is everywhere: at restaurants, bakeries, at the supermarket, and now even beers tout a “gluten-free” label. It is a billion dollar a year industry that is anticipated to double

over the next two years. Is this just the latest fad to sweep the country? Is there really a health benefit to this diet, and if so, what is the science behind it? Who should be on a gluten-free diet and why? The demand for gluten-free products over the last five years parallels the increase in the number of patients diagnosed with a condition called celiac sprue.

Celiac sprue is known by many names: celiac disease, sprue, gluten-sensitive enteropathy, or non-tropical sprue. It is a digestive disorder that prevents the body from absorbing nutrients from the foods you eat. Celiac sprue results from a sensitivity to gliadin or gluten. Gliadin is a protein that is found in wheat, barley or rye. Oats do not naturally contain gluten, but they are often contaminated with this protein because they are processed in facilities that manufacture gluten containing products. The association between grains and celiac disease was made by a Dutch pediatrician, Dr. Willem Dicke in the middle of the 20th century. Dr. Dicke noticed that his patients with celiac disease improved during WWII when grains were scarce in the Netherlands, and relapsed after the war when the supply of grains was restored.

Celiac disease was once thought to be a rare condition, however over the last few years, increased awareness and improvements in testing have proven that it is a relatively

common disease. Celiac sprue is a genetic, or inherited, disorder that is most commonly seen in people of Northern European and Italian descent. Approximately 1 out of every 250 individuals in this population has sprue. The true prevalence of this disease in the United States is unknown. It was previously thought that one out of every 3,000 Americans had sprue, but studies in healthy blood donors have estimated the prevalence to be approximately 1:300. Celiac disease is very rare in people of African American, Asian or Caribbean ancestry. Because it is inherited, there is an increased incidence in family members. If you have a family member with sprue, your risk of having the disease increases to 1:22.

WHAT CAUSES CELIAC SPRUE?Celiac sprue is an autoimmune disorder in which the patient’s immune system attacks the small intestine. The immune system is not normally activated by the foods that we eat; however in celiac disease, the immune system becomes activated and forms antibodies when the small intestine is exposed to gluten. Antibodies are proteins that are designed to eliminate foreign substances from the body. The small intestine is specifically designed to absorb nutrients. Small finger-like projections called villi line the small intestine and increase the absorptive surface of the bowel. When the immune system is activated, cells migrate to the lining of the small intestine and cause inflammation. This inflammation results in villous blunting (swelling of the villi), destruction of the digestive enzymes that line the surface of the bowel, and ulceration. The villous blunting decreases the absorptive surface of the bowel and leads to impaired nutrient absorption, especially calcium, iron, folate, and fats.

Celiac Sprue


COMPLICATIONSUntreated celiac disease is a risk factor for the development of small intestinal lymphoma (a form of cancer). Cancer of the head, neck, and esophagus have also been associated with celiac disease however studies have demonstrated that the risk of cancer drops to that of the general population in patients who were on a strict gluten free diet for at least five years.

TREATMENTCeliac sprue is treated by adhering to a strict gluten free diet. Patients can notice an improvement in symptoms as early as 48 hours, but most patients improve within a few weeks of initiating the diet. Exposure to even the smallest amount of gluten is sufficient to activate the immune system and cause damage to the intestines and a relapse of symptoms. Patients often meet with a nutritionist when they are initially diagnosed. Although there are many gluten free products on the market, it is a very difficult diet to maintain because gluten is used as a filler in so many products including medications, lipsticks, communion wafers, drink mixes/herbal teas, fermented beverages, salad dressings, and marinades to name a few. If a person is diagnosed with sprue, the best way for them to avoid exposure to gluten is if their entire household maintains a gluten free diet. Rarely, symptoms of sprue persist despite compliance with a strict gluten free diet and steroids or other medications that suppress the immune system may be necessary.

CONCLUSIONCeliac sprue is a growing health concern. It is an inherited digestive disorder that impairs the body’s ability to absorb nutrients. Symptoms are non-specific and include diarrhea, weight loss, bloating and abdominal pain. The diagnosis can be made by a combination of blood tests and endoscopy. The mainstay of therapy is maintaining a strict gluten free diet which can be difficult given that gluten is a commonly used filler in foods, cosmetics and medications. The quality of life of patients with celiac disease is improving as there are more dietary options available-a trend that that it expected to continue over the next few years. -Caroline R. Tadros, MD

SYMPTOMSThe symptoms of celiac sprue can be very different from patient to patient. The most common symptoms are related to malabsorption and include diarrhea, bloating/flatulence, weight loss, floating stool (due to a high fat content), and abdominal pain. It is important to note that these symptoms are not specific to celiac disease and can be seen in many other disorders. The injury to the small bowel caused by sprue leads to impaired absorption of calcium and vitamin D which causes osteopenia (thinning of the bones). Anemia (low blood count) results from iron and folate malabsorption. Patients may also notice increased bleeding or bruising due to the impaired absorption of vitamin K which is necessary for normal clotting to occur. Epilepsy has also been associated with celiac disease, but the exact mechanism remains unknown. Rarely, patients may experience muscle weakness, numbness, tingling, and difficulty walking. Nutrient malabsorption can also lead to infertility in both men and women. There has been a high incidence of spontaneous abortions and intrauterine growth retardation in women with untreated celiac disease. Infertility often resolves on a gluten free diet. Failure to thrive is common in children with untreated sprue. If there is severe malabsorption patients may have oral ulcers or swelling in the legs due to protein loss from the gut. Defects in dental enamel are also common. Patients may develop a rash called dermatitis herpeteformis.

DIAGNOSISCeliac sprue used to be considered a pediatric disease, however it is being diagnosed more often in adults. The mean age at diagnosis is 45 and approximately 25% of patients that are diagnosed are over the age of 60. Sprue is more common in patients with other autoimmune diseases such as rheumatoid arthritis, lupus, thyroid disease, and type I diabetes. The physical examination is often normal. When celiac disease is suspected, physicians often look for antibodies in the blood. There are three antibodies that are often ordered: anti-tissue transglutaminase (tTg), endomysial, and anti-gliadin antibodies. These blood tests are not always abnormal in patients with sprue, and if there is a high clinical suspicion, your physician will schedule an upper endoscopy (EGD). This is a test that involves advancing a fiberoptic scope through the mouth to the beginning of the small intestine. Biopsies are taken from the bowel and the tissue is then examined under a microscope. It is very important that patients are not on a gluten free diet when these tests are performed, because the antibody levels and biopsies can normalize after a short time on a gluten free diet.

Normal tissue Celiac tissue

Dr. Christopher Hall, McKay Dee Hospital Pathology


Could CT Scans forLung Cancer Save Lives?


Lung cancer kills more people each year than any other form of cancer.

However, a recent medical study found that one screening procedure for those who are at the most risk for lung cancer could be helpful in catching lung cancer in its early stages.

The National Cancer Institute recently released the initial results of its National Lung Cancer Screening Trial that showed that the mortality rate for those at the most risk for lung cancer could be reduced by 20 percent with the help of regular screening using low-dose CT scans - a diagnostic procedure that produces detailed three-dimensional images of the body.

The ongoing study examined the effectiveness of both chest X-rays and CT scans used for screening in current and former heavy smokers ages 55 to 74. Screening using chest X-rays was not proven to reduce mortality rates in the individuals being studied, yet it was shown that CT scans had the ability to detect tumors at earlier stages.

The results are consistent with previous findings by The Mount Sinai Medical Center physician Dr. Claudia Henschke. Her findings have shown that annual screening with CT scans could help detect lung cancer in its early and more treatable stages, data that were corroborated by the NCI study.

"The NCI findings confirm what our researchers have believed for quite some time - those at the most risk for lung cancer should talk to their physicians about a low-dose CT lung screening," says Dr. Raja Flores, Chief of Thoracic Surgery at The Mount Sinai Medical Center. Dr. Flores notes that 60 other medical sites across the world follow Mount Sinai's lung cancer screening CT scans are not recommended for those who aren't at high risk for lung cancer. But the prospect of early detection makes lung cancer screening a good option for those who are at high risk, says Flores.

So who should contact their doctors about CT scan screening? The Mount Sinai Medical Center

While those at the most risk for lung cancer should get screened, those who aren't at high risk should take the following precautions to avoid developing lung cancer: • Don't smoke and if you do, quit. Smoking accounts for 87 percent

of lung cancer deaths, according to the American Cancer Society. • Avoid places where people are smoking, as exposure to

secondhand smoke can also lead to lung cancer. • Test your home for radon gases and asbestos. Have

these substances removed if they are in the home. • Do not work in a place with exposed asbestos.

recommends that current and former smokers older than 40 with a smoking history of at least a pack a day for 10 years or more ask their doctor whether screening would be a good option for them.

To take a CT scan, the patient lies still on a table connected to the CT scanner. The CT machine is shaped like a doughnut and the table simply slides through the doughnut in 20 seconds. No injections or medications are needed.-For information on lung cancer, prevention and treatment options, visit www.mountsinai.org/lungscreening.


In The News

As the rate of thyroid cancer continues to climb, doctors are urging patients to be more cautious about thyroid nodules, a common disorder that is responsible for a small but growing number of thyroid cancer cases. Thyroid nodules affect nearly 13 million Americans and are a result of

abnormal cell growth on the gland. Until recently, the only way to remove nodules and rule out cancer was through surgery that required a five centimeter incision across the front of the neck. The procedure, and the large scar that resulted, was a deterrent for many patients who feared altering their appearance for something that may not be life threatening. Today however, a new option exists that allows surgeons to access the neck through the armpit, allowing for a biopsy of tissue with no visible scar.

“We now have a minimally invasive way of determining if a thyroid nodule is cancerous,” said Jose Dutra, MD, head and neck surgical oncologist and director of the at Thyroid Surgical Clinic at Northwestern Memorial Hospital. “It’s an approach that more patients are comfortable pursuing. If we can identify cancerous cells earlier we increase the chance of removing the cancer before it spreads.”

The procedure, transaxillary robotic thyroid surgery, utilizes 3D cameras and specially designed robotic arms to create a small incision within the armpit, the mechanical arms work just like hands allowing the specialized surgeon to operate remotely with precise control and movements to remove suspicious nodules.

“The underarm area has fewer nerve endings than the anterior neck area, so there’s less pain, no scarring on the neck, and with good care, the incision will heal faster,” said Dutra who is also an associate professor at the department of otolaryngology/head and neck surgery at Northwestern University Feinberg School of Medicine.

This summer, Socorro Delaluz became one of the first patients at Northwestern Memorial to undergo transaxillary thyroid robotic surgery. The mother of two was impressed to have the option that left no visible scar and the quick recovery associated with the technique.

“I didn’t want to be reminded constantly, every morning when I get dressed that I had a scar across my neck. I would have to explain to everyone what happened all the time,” expressed Delaluz.

Another benefit of the minimally invasive approach is that the precision of the robot allows physicians to remove all of the potentially cancerous tissue while sparing more of the structure surrounding the gland.

“The thyroid gland controls how the body uses energy. Changes to the gland can cause a myriad of health issues,” explained Dutra, member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Thyroid nodules are six-times more common in women than men and can be difficult to diagnose

New Approach to Thyroid Surgery Eliminates Neck Scar


because they often do not present signs or symptoms. Most nodules are small and are often found incidentally during a routine physical or imaging for an unrelated condition. Conditions that can cause one or more nodules to develop in the thyroid gland range from overgrowth of normal thyroid tissue, tumors, a cyst, inflammation and goiters. Individuals should routinely check their neck and should talk with their doctor if they notice any lumps or experience symptoms such as swelling, trouble swallowing, and pain in the throat or hoarseness of the voice.

Robotic surgery is currently widely used for minimally invasive heart and lower abdominal procedures, only recently have the robotic arms been applied to the confined space involved in neck and head surgery. The benefits for robotic thyroid surgery include shorter recovery period, less pain in neck following surgery and better preservation of the laryngeal nerves and the parathyroid glands.

Jennifer Panaro recently had a large nodule removed from her thyroid gland by way of transaxillary thyroid robotic surgery and was back on the tennis court just six weeks after her surgery. The 28 year old was impressed with the speedy recovery and was pleased her voice was protected. “I was thrilled to not experience any changes in my voice or to have deal with a large scar on my neck. As an accountant, I talk to clients all day and I would be self conscious about having a foreign mark across my throat,” said Panaro, patient at Northwestern Memorial.

While the new technology has great advantages, Dutra stresses this option is not the best for all patients and not all tumors can be removed with this approach.

For more information about minimally invasive surgery or to schedule an appointment at Northwestern Memorial Hospital, please call 312-926-0779.


An Undercover Killer...Peripheral Vascular Disease

An estimated ten million adults in the United States are affected by peripheral vascular disease – and they don’t even know. Even worse, patients who have relatively minor peripheral vascular disease symptoms face a five-year mortality rate

of up to 30% from primarily cardiovascular causes (stroke, heart attack). Almost one-third of patients with peripheral vascular disease die within a five-year period.

What is peripheral vascular disease?Peripheral vascular disease (PVD) is a disease of the blood vessels (arteries and veins) located outside the heart and brain. Peripheral vascular disease refers to blockages in the arteries and veins forming the circulatory pathways between the heart and the rest of the body. When one of these arteries becomes blocked with plaque, the results can be disastrous. The proper term for narrowing of an artery is stenosis; and the disease process causing stenosis, or even complete obstruction, is called atherosclerosis.

What is atherosclerosis?Atherosclerosis is a gradual process of hard cholesterol substances (plaques) that build-up on arterial walls. These plaques narrow openings, making it more difficult for proper blood flow. The clogging can start in the teen years from poor diet, smoking and lack of exercise. As we get older and the blockages become more severe, the real problems start.

In milder atherosclerosis cases, arteries are not substantially narrowed and there are no symptoms. We all have millions of “plaque-like” substances sticking to artery walls every day. Proper blood flow and a healthy vessel lining (the endothelium) help cleanse these toxic substances from the walls. When the endothelium becomes damaged as a result of high blood pressure, smoking and diabetes, the plaques begin to accumulate, leading to blockages.

What Are the Signs and Symptoms?Symptoms and signs depend on the disease’s progress.


In milder cases, symptoms could be aches and pains in the legs or arms – just from walking or mild exercise. One common symptom in milder cases is called “Restless Leg”. The patient usually complains about one or both legs aching, burning or just feeling uncomfortable at night. In order to sleep, the patient may drop the leg over the side of the bed for comfort, not knowing they are simply using gravity to help blood flow through a partially blocked artery.

Another manifestation of PVD is wounds that won’t heal. When the body isn’t doing its job, such as healing a wound, it’s a sign something is wrong. Advanced cases of the disease can cause gangrene, death of tissue, and if left untreated can lead to the need for amputation.

More dramatic consequences of atherosclerotic disease are strokes and heart attacks. However, peripheral vascular disease is under-diagnosed and under-treated. I want to emphasize that atherosclerosis is a systemic disease; if you have

blockages in one part of your body, chances are extremely high you have blockages in other parts.

Patients often write off many symptoms as old age. Young or old, when you don’t take care of your body, bad things happen. Just like an automobile, if you use the wrong fuel or don’t perform proper maintenance, it will break down.

When you see your doctor for any medical problem, and if you have any symptoms of PVD, discuss them with your doctor. Many patients have come to me after ignoring the early warning signs as a last gasp effort before amputation. I want to catch this disease early and prevent it from ever getting too far.

There are risk groups - such as diabetics - we assume already have the disease, but there are other groups who are potential candidates for the disease because of their lifestyle choices. These include:• Smoking. The arterial wall lining (endothelium)

constantly fights the good fight. The poisons in smoke actually stun the endothelium and break down an important line of defense against atherosclerosis.

• Hypertension. Higher blood pressures mean stiffer blood vessels and more turbulent blood flow that can damage the vessels and contribute to blockages.

• Sedentary lifestyle. Contributes to obesity and leads to diabetes, hypertension and high cholesterol.

• Poor Diet. Goes hand-in-hand with a sedentary lifestyle.

• Age. We can’t do anything about age, but we certainly can keep the body healthy through proper diet, exercise and treatment of risk factors. Don’t use age as an excuse. The older we get, the more aggressive we need to be about upkeep.

Caught early, treatment for peripheral vascular disease is relatively simple. It could be a prescription of diet, exercise and/or medication. Initial screening is simple, quick and non-invasive. The more advanced the disease, the more involved the treatment and screening. -Christopher Y. Kim, MD


"Doctor, do I have to take these medications the rest of my life?" Maybe, not


Who would want to take a medication every day unless there was a very good reason to do so? Do we have alternatives that actually are effective? Can we take medications just until other

measures become effective? These are very important questions that are studied in carefully controlled clinical trials. The results of these studies allow us to answer many of these questions based on data – what has been called “evidence based medicine”.

High blood pressure (hypertension), diabetes, heart rhythm problems, and congestive heart failure are examples of potentially deadly diseases that may best be treated with medications taken every day. Drugs to reduce high cholesterol levels or chronic aspirin therapy are examples of proven interventions that decrease the likelihood of damaging or fatal illnesses in some situations. Luckily, evidence based medicine also has shown that for some people there are effective ways to avoid medications or to phase out the need for medications.

High Blood pressure (Hypertension):Sustained high blood pressure puts abnormal strain on your heart and arteries and can lead to heart attacks (myocardial infarction), heart failure, strokes, and kidney failure. Treatment of hypertension can greatly reduce the risk of these problems. Most hypertension is caused by a genetic predisposition and /or stress. Hypertension often runs in families. Our goal is to keep the blood pressure less than 140 (the peak pressure in your arteries after the heart contracts)/90 (the lowest blood pressure between cardiac contractions). Some reports indicate a systolic blood pressure reading (the top number of the reading and the measure of blood pressure when the heart is beating) of 130 may be pre-hypertension, but we are not yet certain if medications are needed. Systolic blood pressure over 130 should make you aware and to begin to take steps to deal with your blood pressure. When it does come time to treat hypertension, there are several kinds of medication that can be effective. Often there are generic drugs, relatively inexpensive, that are effective. You can monitor your own blood pressure at home and make certain that the medication is effective. Since we have many

choices for blood pressure medication, there usually are effective alternatives if you have troublesome side effects.

So, if your blood pressure is elevated, your doctor may recommend a medication to control it. Reducing salt in your diet can help. Losing weight, stress management, and exercise also will give you will a chance to avoid or reduce the need for medication. Some individuals have hypertension only at times of great stress, and require treatment but only for that brief stressful period. Monitoring your own blood pressure will help determine when medication is needed, and help determine when medication no longer is necessary.

Diabetes (Diabetes mellitus, high blood sugar)Juvenile diabetes usually results from destruction of the beta cells in the pancreas that produce insulin. This can be a fatal illness unless insulin is given to control the blood sugar. Diabetes requiring insulin can occur at any age.

A more common form of diabetes is related to diet and to being overweight. Your pancreas may begin to fail and not be able to produce enough insulin. When we start this group of patients on medication, they want to know if it is forever. We can now reliably tell them that weight loss and exercise may restore normal blood sugar control. In fact, large scale studies involving thousands of patients have shown that lifestyle changes (diet, exercise) over time can be more effective than medication alone. Medications usually can keep blood sugar at safe levels, but controlling the sugar metabolism with diet and exercise is very important and may be sufficient to eliminate or avoid the need for medications.

High Cholesterol:High levels of some forms of cholesterol in the blood increase our risk of damage to arteries and therefore our risks of vascular illnesses such as heart attacks, strokes, and proper blood flow throughout the body. Studies have documented these risks, and have documented decreased risks of vascular disease when the cholesterol is controlled. When there is a strong family history of vascular disease, diabetes, or established vascular disease, regardless of the cholesterol level, you need a medication to lower the cholesterol level. In those cases even if your cholesterol is in the normal range, it may be abnormal for you and the association of progressive vascular disease is much too high. Although we practice preventative medicine, lifestyle change is still of great added benefit.

Diet, weight loss for those who are overweight, and exercise can be very helpful or even can eliminate the need for medication in people with none of the serious risk factors.

When gastric bypass patients lose a lot of weight we often can reduce or eliminate medications for hypertension, increased cholesterol, and diabetes.


Palpitations (Rapid or Irregular Heart Rate):Persistent or episodic rapid heart rate or irregular heart rate can indicate the presence of very serious disease or can be annoying, but harmless. Persistent or episodic heart rhythm problems usually should be assessed by a physician.

There are many different types of harmless but troublesome rhythm disturbances that cause palpitations. Among the most common is the sensation of the heart pounding. This often is associated with a somewhat elevated heart rate between 120 to 140/minute. These usually occur in young women. The second most common complaint is episodes of “fluttering" which last 3 to 4 seconds at a time, and are not associated with dizziness or shortness of breath. These usually occur when the person is lying quietly in bed or watching TV late at night. These seem to affect both men and women evenly.

These benign events can be controlled by medication, but we are treating the symptoms. There are some things a person can do to manage this themselves. Cut out the caffeine!! At least cut down. Coffee, tea, many soft drinks, “power” drinks, some sports rehydration drinks, some chocolate products, some ice creams, some chewing gums, some candies, and other commonly used foodstuffs contain caffeine. Also, watch out for oral decongestants such as pseudoephedrine, that are present in many over the counter allergy medications, and in some prescription allergy medications. Vasoconstrictor nasal sprays sometimes can cause palpitations. If you can’t cut down, and the palpitations are found to be harmless, be prepared to ignore the palpitations.

Congestive Heart Failure:When the heart is unable to pump blood efficiently, congestion builds up in the lungs, in the rest of the body, or both. Shortness of breath, decreased exercise tolerance, difficulty lying flat to sleep, and swelling of the ankles can be manifestations of heart failure.

Congestive heart failure can be mild, but this is a potentially fatal problem. There are many causes and several medications that are known to be effective, depending on the cause and the individual person’s situation. The development of congestive heart failure should trigger careful assessment

of possible causes or contributing factors, and careful assessment of the success of therapy.

The mainstay of treatment is diuretics, medications that help remove accumulated fluid from the body. We also can use other medications such as ACE inhibitors (drugs that inhibit the angiotensin converting enzyme that generates angiotensin that in turn can have undesirable effects in heart failure patients) and beta blockers (drugs that block some actions of the body’s own epinephrine and norepinephrine).

Diuretics, at least initially, cause increased amounts of urine in people with congestive heart failure and fluid accumulation. This can be disruptive day and night. Naturally this leads the person to ask, “Do I have to take these diuretics the rest of my life?” The answer might be yes, but in some patients avoiding excessive fluid intake, or fluid intake late in the day, can limit the problem of urinary frequency.

Aspirin:Low dose aspirin therapy has been shown to lower the risk of heart attacks and strokes in some patient groups. Your physician can assess the value of daily aspirin therapy based on family history, blood pressure, cholesterol levels, smoking history, diabetes, and other factors that influence the benefits and also the risks of low dose aspirin. If you do need aspirin, that means forever to decrease the risk of a heart attack or a stroke.

Aspirin is not for everyone. It increases the risk of bleeding although the risk is small. At this time there is not enough evidence to say the benefits outweigh the risks for every adult in our population to take aspirin to protect against heart attacks or strokes.

There are many examples of medical situations in which daily medications may be crucially important. In some of these situations however, changes in lifestyle can minimize or eliminate the need for medications. Knowing when and how to modify lifestyle factors and/or medications under the care of a physician can help patients with these problems regain and maintain a healthier life.-Yale M. Samole, MD, FACC


In today’s world where “50 is the new 30,” people are pursuing their recreational passions even later in life. And as generations age, that increased activity – coupled with the nation’s

overweight population – leads to more and more people experiencing increased wear and tear on their joints and grappling with the fear of losing the activities they love.

But thanks to advances in material and surgical technologies in recent years, hip replacement is now an option for patients of various ages, opening the door for continued recreation – from leisurely walks to cycling, tennis, even downhill skiing.

Simple design, advanced solutionsThe hip joint is a ball and socket joint. A protrusion at the top of the femur fits neatly inside the pelvic bone, where a wide range of smooth motion is provided by the surrounding cartilage, which acts as a lubricant for the joint.

As people age and tens of millions of rotations accumulate on the joint

over a lifetime, problems can set in and have profound effects on an individual’s range of motion and comfort. This breakdown, which to some extent is a natural part of aging, can reach a point where a patient’s quality of life is severely impacted and a hip replacement procedure is identified as the best course of action.

A lifelong solution for any ageAs recently as a decade ago, patients undergoing a hip replacement were told they would have to come back approximately 10 years after the surgery to have a new “liner” installed in the artificial joint – as the man-made materials would succumb to the same wear cycles that impacted the original joint.

But today, advances in materials technology are making it easy for patients as young as 50 to reasonably expect the high-tech artificial “cartilage” polymer to last a lifetime.

The advanced materials also permit the rigors of most athletic activities, allowing for a high quality of life so patients can pursue the things they love.

New Hip Replacements for Active Lifestyles

For many people, having a hip replacement is not an end, but a beginning.

Using ‘Pre-Hab’ to minimize recovery timeWith any surgical procedure, there’s plenty of focus on rehabilitation during the weeks and months after going home from the hospital. But to maximize the body’s ability to recover, patients should also engage in “pre-habilitation” to get ready for a hip replacement.

Depending on the length of time before the procedure is scheduled, pre-hab can include everything from weight loss to conditioning of the upper extremities (for handling crutches afterward). Patients may even spend time learning to use a walker or crutches in a comfortable environment prior to surgery.

In addition to preparing themselves physically, pre-operative education gives patients and their family members access to valuable information about what to expect and how to best accommodate the recovery period.

Walk in, Walk outWhen the big day finally arrives, patients can expect a procedure that is very different from the original hip replacements of 50 years ago. Advanced – even robotic – surgical procedures allow for quick and precise installation of the artificial joint, making it easy to for patients to get back on their feet.

After arriving at the hospital for a hip replacement, most patients leave within 48-72 hours, having walked with assistance and navigated stairs before being discharged. Just six weeks after the procedure, patients can expect to have 80 percent of their recovery behind them. Within six months they can be back to enjoying their hobbies and activities at 100 percent.

InsuranceThough each insurance provider varies, insurers, including Medicare, cover most joint replacement procedures. Scheduling a consultation with a joint replacement specialist can help determine a patient’s eligibility. -Aaron Hofmann, MD


Fetal Programming: Reducing Your Baby's Risk for Disease Later in Life

There is a growing amount of research that shows the body can be programmed to gain weight during several critical stages—and also programmed to lose it. Scientists have long known that certain unlucky people harbor “thrifty” genes left-over from our hunter and gathering ancestors. These genes work to slow the metabolism, turn down fat-burning, and turn up hunger and cravings for sweets and fats. New research, however, suggests it takes more than just thrifty genes to cause weight gain. Something must turn the genes on. That’s where genetic and

early environmental programming comes in. A growing number of experts now believe in a theory called the Barker hypothesis. According to this theory, certain thrifty genes can be switched on during several critical stages during life, starting in the womb and reaching into puberty. Also, early life experiences can work together with these genes to alter metabolism and, thus, the way the body burns and stores fuels like fats and carbohydrates. This not only leads to obesity, but also to diabetes and heart disease.


All of these conditions can increase your baby’s risk for developing the metabolic syndrome, which leads to diabetes and heart disease. And all kinds of stressors can cause these periods of malnutrition during pregnancy like emotional stress, smoking, alcohol or substance abuse, physical stress, under nourishment and excessive weight gain. In addition, what happens right after the baby is born can either add to or improve the condition. For example, breastfeeding is associated with lower levels of obesity later during adulthood. If you elect to breast feed your baby you may help reduce his or her risk for developing metabolic diseases later in life. In contrast, short and small babies who are over fed during the toddler years in an effort to promote “catch up” growth, actually have a higher risk of developing diabetes and heart disease.

Emerging science shows, just as “thrifty” genes can be turned on, they can also be turned off. You may be able to alter early, subtle changes in your baby’s metabolism that work in conjunction with these genes through diet and exercise. High fiber diets rich in fruits and vegetables are associated with improvements in diabetes and heart disease risk. So, sticking to a healthy diet is essential to your baby’s healthy metabolism. Exercise training studies in children show improvements in weight, blood pressure, cholesterol and insulin levels. Making sure that your baby has plenty of opportunities to be physically active is key to preventing obesity, diabetes and heart disease later in life.

Don’t believe that “nature” will take care of your baby’s nutritional needs during pregnancy at the expense of yours. Both mom and baby are equally at risk for developing health problems related to malnutrition, physical and emotional stress during pregnancy. Make sure you eat a healthy diet, stay physically active and keep your weight gain to recommended levels. Most importantly speak with your doctor about any problems you may experience during pregnancy. -Melinda S. Sothern, PhD

Recent discoveries suggest that people who develop diseases such as diabetes and heart disease grew differently during pregnancy, infancy and childhood. According to a phenomenon called “developmental plasticity”, individuals have critical periods when their systems are sensitive to environmental changes or are "plastic". This is followed by a loss of sensitivity which then makes the altered profile permanent or programmed (like a computer). For most of the body’s organs and systems this happens during pregnancy, in particular during the third trimester. The Barker Hypothesis identifies four different situations during pregnancy that promote specific diseases later in life:

1) Full-term, thin and small (< 5.5 lbs.) babies adapt to under-nutrition during pregnancy by under-development of skeletal muscle tissue, kidneys and liver. The subsequent endocrine and metabolic changes lead to insulin resistance or pre-diabetes. Also, these babies lack skeletal muscle which cannot later be regenerated.

2) Full-term, short and small (< 5.5 lbs.)babies develop a narrow hip area due to malnutrition during pregnancy resulting in a diversion of blood flow to the brain at the expense of the trunk. They have abnormal liver function which later leads to high cholesterol, diabetes and heart disease.

3) Full-term, short and large (>10 lbs.) babies are the result of excessive weight gain by the mother prior to and/or during pregnancy, which causes and imbalance in the supply of glucose and other nutrients to the fetus. The resulting high blood sugar levels ultimately lead to Type 2 diabetes later in the baby’s life.

4) When the placenta is large in relation to the baby, there is an adaptive response as the baby tries to extract more nutrients from the mother. This condition is associated with high blood pressure later in life.



What three months are worse for your diet?They start the week before Halloween and they end the day after February's Super Bowl. During this time, the typical person packs on 2-5 lbs.


During this time, all of America conspires against us to make us fatter. It starts when we buy 100 mini-size Halloween candy bars, hoping that there’s a Biblical-sized rain and that only 20 trick or treaters stop by, leaving the candy for

us. It ends on Super Bowl Sunday in January when we appoint ourselves Left Guard of the buffet table and watch it with more intensity than the game.

During these three months, we party hardy: Halloween, Thanksgiving, Office Party, Church Supper Party, School Choir Party, Random-neighbor-but-we’d better go party, Holiday Party, New Years Party, Back-to-School Party, and the Who’s-Playing-in the Super Bowl Party.

When it comes to food these parties and receptions are ambiguous. It’s never really clear which ones are supposed to be dinners versus elaborate adventures in grazing. Herein lies one huge booby-trap of the party season: Is this a meal or a snack?

One of our new Cornell Food and Brand Lab studies shows that if you view that upcoming Royal Order of the Water Buffalo Holiday reception as a meal – instead of as a snack – you’ll thank yourself later.

In our study, we found people who think a reception is a meal eat 23% more calories than those who see it as a snack. But – and this is important – these “meal folk” don’t go home and eat dinner on top of what they just ate. They eat more at the reception, but they report eating less later on. A lot less.

Why do people see a reception as a meal and others as a snack? It has to do what’s around them. If someone

sees paper plates and napkins, they think “snack.” They graze around and then go home or to a restaurant to eat dinner. Those who saw real plates, cloth napkins, and metal silverware viewed it as a meal. They ate more food at the time – a meal’s worth – but nothing later on.

When Holidays call you to receptions and parties, if there’s anything healthy to eat – even if it’s just a vegetable plate – you might be a whole lot better off making it a meal, than making it your appetizer. You can save yourself a dinner, and save yourself regret.

Have a great holiday party season. May it be full of great meals (and not snacks).-Brian Wansink, PhD


Heel pain is a common problem. There are a number of potential causes of heel pain, but the most common culprit is plantar fasciitis.


Why Does my Heel Hurt So Much?


local healthcare today www.localhealthcaretoday.com20

Plantar

achilles tendon

Plantar Fascia can cause heel pain

Almost 100% of the time, plantar fasciitis (fash-eye-tis) is caused by a tightness in the calf muscle known as the gastrocnemius, or gastroc for short. The gastroc crosses the ankle through the plantar fascia. Plantar fasciitis is simply

inflammation of the plantar fascia, a dense, fibrous structure along the sole of the foot and just beneath the skin that starts on the bottom of the heel bone (or calcaneus) and extends toward the ball of the foot. The plantar fascia acts as a tension band that helps to maintain the arch of the foot when your weight is on it.

The pain of plantar fasciitis tends to be at its worst with the first step out of bed in the morning and also following high-impact activities. Typically this pain will subside somewhat after that first step, and then may be more painful again by the end of the day.

Symptoms of plantar fasciitis can be severe enough to interfere with everything from basic daily activities to intense athletic training. In athletes, heel pain will most often increase during phases of higher-intensity and higher-volume training.

Some common risk factors for heel pain are overuse, pregnancy and obesity. Patients with a body mass index (BMI) greater than 30 are 5.6 times more likely to have plantar fasciitis than patients with a BMI less than 25. Overweight women are six times more likely to have plantar fasciitis than overweight men. Of course, weight loss is extremely difficult without exercise, and exercise is even harder with heel pain from plantar fasciitis.

What can I do if I have plantar fasciitis?There are a number of recommendations for non-operative treatment of plantar fasciitis. Night splints, physical therapy to stretch the calf muscles and foot, over-the-counter antiinflammatory medications and massage can also provide some relief. Modifications to footwear can also help alleviate plantar fasciitis. Cushioned running shoes are best for support and absorbing shock. Many running shoe specialty stores have an experienced fitter to make sure you get the best shoe fit and type for your foot. It’s important to remember that the shock absorption of running shoes decreases dramatically after about six months or 500 miles, so be sure to replace your running shoes in accordance with these guidelines. Custom or prefabricated shoe inserts, called foot orthotics, have also been used to treat plantar fasciitis. However, recent studies have shown limited benefits of orthotics used specifically for plantar fasciitis.

More aggressive treatments of plantar fasciitis include cortisone injections and extracorporeal shockwave therapy, like that used to break up kidney stones. The results of these treatments have been mixed. Traditionally, surgical treatment has focused on heel spur surgery or plantar fascia release, which involves

* “The Gastroc Slide for Chronic Plantar Fasciitis,” presented to American Orthopaedic Foot and Ankle Society by M. Chilvers, J. Rocco and A. Manoli in July 2007. Read the entire presentation online at www.utahorthopaedics.com.

cutting a portion of the plantar fascia to relieve pressure and inflammation. Some providers have reported success with these treatments, but plantar fascia release has been implicated in painful arches, increased and new foot pain and even continued heel pain.

Surgical lengthening of the gastroc muscle has been effective in treating resistant, chronic plantar fasciitis, and in improving and maintaining ankle flexibility. In fact, a recent study has shown that 93.6% of patients experienced good or excellent results, which were relief of pain and return to sports, including running.* This procedure is called the “gastroc slide” because the gastroc muscle slides apart as it is lengthened. The gastroc slide is performed as an outpatient procedure through a small incision. The procedure can be performed in about 10 minutes. Following surgery, patients are allowed to walk with full weight-bearing in a walking boot. The boot is worn during sleep for one month following surgery. The boot can be removed for walking as soon as the patient feels comfortable doing so. Most patients are able to walk in a regular shoe three to seven days after the procedure.

Greater than 80% of heel pain gets better with non-operative treatment. The gastroc slide procedure, however, has been successful where other treatments have failed. -Jeffrey J. Rocco, MD

If you have heel pain:• Stretch regularly—especially the calf muscles.• Replace your running shoes regularly.• Seek medical treatment if necessary.


Colon Cancer: The Silent Killer

Colon cancer can grow for years without any symptoms. That’s why there is such a push from the medical community for colonoscopies. Merely being age 50 or older is the number one risk factor for colon cancer. However, if you have a family history, you should be aware of the ten-

year rule. That means if colon cancer has shown up in one of your family members at age 50, you should get tested at 40 – ten years before the first family member was diagnosed.

Colon cancer has no bias. It affects women equally as it does men. Even though we highly recommend patients at age 50 or more get a colonoscopy, I have seen patients as early as age 20 and as old as age 80 with colon cancer.

Because colon cancer can silently grow without any warning signs, there are some early body indications we all need to be aware of just in case there is a presence of cancer growing. Colon cancer symptoms come in two general varieties: Local and Systemic.

Living With a Colon Cancer DiagnosisColon cancer is categorized in four stages.

Stage I is when the tumor has spread just beyond the lining of the inside of the colon. During this stage, treatment consits of removing the colon segment affected by the turmor. The five year survival rate is 95 percent.

Stage II is when the tumor cells have spread deeper into the colon wall and possible through the outer lining of the colon and into nearby tissues or organs. Treatment is surgical removal of all tissues affected. Survival rate for five years is 60 percent.

Stage III is the cancer has spread into the surrounding lymph nodes. The five year survivial rate is 35 percent.

Stage IV is when the cancer has spread to distant organs such as the liver, lungs or bone. The five year survival rate is about five percent.

Most patients diagnosed with colon cancer will require surgery. Surgery may then be followed with chemotherapy treatment. Rectal cancer, however, may be treated with radiation therapy and chemotherapy followed by surgery and then more chemotherapy.

Surgery for early colon cancer may be the removal of the polyp with the aid of a thin, lighted tube called a laparoscope.

Three or four tiny cuts are made into the abdomen and the tumor and part of the healthy colon are removed. Nearby lymph nodes are also removed during the surgery and examined for possible spread of the cancer.

The success of colon cancer surgery depends upon the stage of the disease and how it has affected the other tissues in the body. Early detection, as with any cancer, increases survival rates. Growing and spreading silently with no signs, is colon cancer’s greatest danger.

Public education and awareness of colon cancer has helped dramatically drop the incidence of this deadly cancer and as a result we are saving lives. -Megan Wolthius Grunander, MD


Local Colon Cancer SymptomsLocal colon cancer symptoms affect your bathroom habits and the colon itself. Some of the more common local symptoms of colon cancer include:• Changes in your bowel habits, such as

bowel movements that are either more or less frequent than normal

• Constipation (difficulty having a bowel movement or straining to have a bowel movement)

• Diarrhea (loose or watery stools) • Intermittent (alternating) constipation and diarrhea • Bright red or dark red blood in your stools

or black, dark colored, "tarry" stools • Stools that are thinner than normal ("pencil stools") or

feeling as if you cannot empty your bowels completely • Abdominal (midsection) discomfort,

bloating, frequent gas pains, or cramps

Systemic Colon Cancer SymptomsSystemic colon cancer symptoms are those that affect your whole body, such as weight loss, and include:• Unintentional weight loss (losing weight

when not dieting or trying to lose weight) • Loss of appetite • Unexplained fatigue (extreme tiredness) • Nausea or vomiting • Anemia (low red blood cell count or

low iron in your red blood cells) • Jaundice (yellow color to the skin

and whites of the eyes).If you experience any of these for two or more weeks, call your doctor right away to discuss your concerns and arrange for tests to get to the bottom of your symptoms.


Sensible Solutions for Obesity

Obesity is a major threat to the health of many people in America. Obesity is as serious a threat to health as smoking and more serious than other known lifestyle risks. In spite of continued awareness programs and warnings of the known serious problems, obesity is increasing in the United States.

According to a recent article published in the Journal of the American Medical Association (JAMA January 13, 2010,) about one-third of

U.S. adults (33.8%) are obese, and another third are overweight. No state has met the nation’s Healthy People 2010 initiative to lower the obesity prevalence to 15%.


Obesity related health conditions include heart disease, stroke, type 2 diabetes, hypertension, metabolic syndrome, and at least nine types of cancer. In 2008 it was estimated that medical costs associated with obesity were over $147 billion. Fat is considered the largest endocrine organ in the body and emits over 100 biochemicals into the body. Only two of these substances are beneficial to health.

The American Society of Bariatric Physicians (ASBP) is a professional association of physicians, nurse practitioners and physician assistants who treat patients who are overweight or obese. It is also the primary source for clinical education and training for non-surgical medical management of obesity. They have established guidelines for weight management that are evidence based and have proven to assist patients to reduce weight, improve overall health, and prevent future metabolic diseases. By restructuring the diet to increase protein and reduce carbohydrate intake, TimeLess Medical Spa & Weight Loss Clinic has created a diet plan that is effective, sustainable and easy to maintain.

There are many benefits of a high protein diet including:• Protects muscle

o Increases protein synthesis in muscleo Decreases body fato Increases burning of calories – “thermogenesis”

• Treats or prevents: Obesity, Metabolic Syndrome, Type 2 Diabetes, Sarcopenia (loss of muscle), Osteoporosis, Hypertension, and Heart Disease

• Stabilizes blood sugar• Increases satiety resulting in long term compliance

Meal replacements can be a very effective part of a weight management program. Using meal replacements that are nutritionally sound and high in protein help patients by controlling calories, restricting serving sizes and making sure adequate protein is consumed. Once a goal is reached, patients who use at least one meal replacement a day have been successful in keeping the weight off according to data from the National Weight Loss Registry.

At TimeLess, we have implemented the recommendations of the ASBP to create weight management programs that work. Patients are evaluated by Brent Williams, MD, who has been trained in bariatric medicine. Patients are given an initial work-up including a short history and physical. This is important because some medical treatments can contribute to or cause weight gain. Frequently, alternatives are available to aid in weight loss.

Patients are placed on a personalized diet program to meet their specific needs. Weekly counseling and body compositions are provided by trained bariatric

assistants to ensure that fat is being lost while preserving muscle. When weight goals are met, we help fashion a plan for maintaining weight loss. Meal replacements are available at TimeLess that are high in good quality protein, nutritionally sound and delicious.

Losing weight and keeping it off is a journey, but a journey worth taking to keep you healthy, active and looking great.-Brent Williams, MD

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6112 S. 1550 E. #3, South Ogden, UT

Speak Up!

Become a Partner in Your Health Care



Tips for Your Doctor Visit: Make a list in advance of the things you want to discuss at your appointment.• If you don’t understand something your doctor is saying,

ask questions until you do understand. • Take notes, or get a friend or family member to take notes for you. • Ask your doctor to write down instructions for you. • Ask your doctor for printed material about your condition or

suggestions for where you can get more information. • Don’t forget that other members of your health care team, such as nurses

and pharmacists, can be good sources of information. Talk to them, too.

During your visit, make sure to ask questions if anything is unclear to you. Bring up any problems or concerns you might have, whether or not the doctor asks about them. Ask about different treatment options. And don’t hesitate to tell the doctor if you have concerns about a particular treatment or change in your daily life.

You might also consider bringing a family member or close friend to your appointment with you. Let him or her know in advance what you want from your visit. Your companion can remind you what you planned to discuss with the doctor if you forget, or take notes for you and help you remember what the doctor said.

Take an active role in your own health care. Do everything you can to get the best care possible.

-Source: NIH News in Health, May 2007, published by the National Institutes of Health and the Department of Health and Human Services. For more information go to www.newsinhealth.nih.gov

Many people go to the doctor ready to just listen and let the doctor take the lead. But the best patient-doctor relationships are partnerships. You and your doctor can work together as a team that includes nurses, physician

assistants, pharmacists and other health care providers to address your medical problems and keep you healthy.

Your first step is to find a main doctor (your primary doctor or primary care doctor) that you feel comfort-able talking to. Your doctor needs to understand your health concerns and problems. He or she will help you make medical decisions that suit your values and daily habits, and will keep in touch with any other specialists you may need. So spend some time finding a doctor you can trust and with whom you can talk openly.

Try drawing up a basic plan to help you make the most of your appointments, whether you’re starting with a new doctor or continuing with the one you’ve seen for years. Make a list in advance of the things you want to discuss. Do you have a new symptom? Are you concerned about how a treatment is affecting your daily life? If you have more than a few items to discuss, put them in order with the most important ones first.

Good communication is key to good health care. Tell your doctor if you have vision or hearing problems so he or she can accommodate you. Ask for an in-terpreter if the doctor doesn’t speak your language.

Some doctors suggest you put all your prescription drugs, over-the-counter medicines, vitamins, and herbal remedies or supplements in a bag and bring them with you. You should at least bring a complete list of everything you take. A recent survey found that nearly two-thirds of older Americans use some form of complementary and alternative medicine—health practices outside the realm of conventional medicine, such as herbal supplements, meditation, homeopathy and acupuncture. Less than one-third of them, however, discuss these practices with their doctors. This news is a cause for concern because your doctor needs to have a full picture of everything you’re doing to manage your health.


Good Sleep Habits Essential to Children's Health and Development

After-school activities, school work and sports can have children leading busy lifestyles, often making for late bedtimes. So much activity can take away from sufficient sleep time, which can have a significant

impact on a child’s health and development..

Inadequate sleep can effect a child’s development, including learning, processing and remembering information. Lack of sleep can prevent a child from paying attention in school or focusing on learning.

A child’s mood and ability to regulate emotions can be affected by their lack of sleep; every parent knows the tired-child meltdown. Repeated emotional outbursts can negatively impact interactions with others.

Growth hormones are released when a child sleeps. It is important that a child gets enough sleep in order to receive the proper amount of growth hormones.

A child’s immune system can also weaken without enough sleep, making it more difficult to fight off infections and stay healthy.

Pediatric sleep specialist, Lisa Meltzer, PhD, offers several tips for helping your child get enough sleep to stay healthy and happy:

Understand your child’s sleep needs. Children rarely admit they are tired, and often show it in different ways than adults, making it difficult to tell if your child is getting enough sleep. There are some key indicators, however, that a child is not getting enough sleep at night.

• Difficulty waking after a full night of sleep; a well-rested child should wake easily, even without an alarm.

• Falling asleep at school or needing to take naps every day for school-aged children.

• Lack of emotional regulation, such as an outburst or emotional meltdown in the middle of the afternoon.

• Hyperactive or wild behavior.


Have a consistent bedtime routine. Have your child go through a regular routine each night before bed like reading or taking a warm bath. That can help them know when its time to wind down and prepare to sleep.

Be firm and consistent with a child’s delay tactics. We know the stall tactics that children will use. It’s important to let a child know that bedtime means exactly that.

Maintain a relaxing and comfortable sleep environment. Keeping the bedroom dark and the room at a cool temperature will help your child’s body relax and fall asleep.

Maintain a consistent bedtime and wake time. It can be tough to get to bed at the same time each night and up at the same time each morning, especially on the weekends. Doing this, however, helps train the body to go to sleep and wake up easily. Dramatically altering sleep hours on weekends and holidays makes it more difficult to get back into the rhythm during the week.

Avoid stimulating activities before bedtime. Activities such as rough play, TV watching and playing on the computer can increase the time it takes for the body to wind down. It is best if the electronics are shut off within 1-2 hours of bedtime.

Keep technology out of the bedroom. TVs, cell phones and computers should be kept out of children’s rooms. The bedroom should be reserved as a place for sleep. All these devices can keep children from going to sleep or falling asleep.

- Lisa Meltzer, PhD


Pain Management – There are no easy answers or cures


Chronic pain frequently pushes people to make irrational choices. Desperate to relieve pain, the distressed can be convinced to endeavor in just about anything. However, making the wrong choice can delay appropriate treatment,

cause further damage, or intensify one’s pain. If they are lucky, they may only do damage to their pocket book.

Constant pain can be a never ending agony and there is rarely a quick cure. Every person reacts differently to stimuli, medications, and therapy. Medicine is no exact science and there is no one size fits all fix.

The prudent way to get relief is to begin with a physician who is fully trained and focused strictly on pain management. Unfortunately, there are many facilities and so-called practitioners in the world today who make claims of “miracle cures” with ornate, elaborate, and sometimes, harmful methods. Only therapies that have been properly tested through accepted medical research and review can be relied upon to provide relief. Without proper research neither the safety not effectiveness of pain therapies are known.

I tell my patients legitimate, medically trained and licensed physicians base their practice on “evidence based medicine”. This means the procedures, methodologies, medications and treatments we use have been tested, analyzed, and reviewed under controlled and medically accepted conditions.

Proper pain management starts with a thorough examination by a qualified pain management specialist.

Just as with any bona fide medical specialty, a physician dedicating his or her efforts to pain management must go through years of additional training to understand, identify and learn how to treat the complexities of pain.

Pain management requires exhaustive training in anatomy, physiology, pharmacology, neurological and many other complex factors that can trigger or stop pain. Be wary of “fad medicine” or “miracle” therapies. At best, these experimental techniques merely temporarily mask the pain – and then it returns. The result with those techniques is usually another treatment or another adjustment.

It reminds me of the old anecdote about the man who hit his thumb with a hammer so he wouldn’t think about his migraine headache. He may have forgotten about the migraine for a short time, but eventually his situation became worse. He now had a broken thumb and a migraine.

While in medical school, we had to treat a number of cases that had gone the “miracle cure” route resulting in more damage. It’s unfortunate to

see how pain can drive people to unconventional and potentially dangerous measures.

If you are one who suffers from chronic pain, there are things you should know and expect from your doctor.

First and foremost, you should expect a thorough examination to isolate the pain and its source. Our nervous system and physiology are very complex. Once the pain has been isolated and identified, the next step is to devise a program to provide as much relief as possible. Every body is not the same and the source of every body’s pain is different. We try our best to alleviate pain – many times we succeed, and sometimes we don’t. There are cases where all we can do is make the patient as comfortable as possible.

Going to a true pain management physician means you have a full palette of evidence based medicine – no magic bullet or experimental treatment. I use multiple modalities to customize treatment to each individual patient instead of one single method for every patient. I call it A to Z pain management. The solutions could be as simple as prescribing or changing medication or it could involve a minimally invasive procedure performed in our office. Overall, we try to minimize medication and maximize cure. For more advanced cases the solution may require treatments in a hospital setting.

A word of advice I offer my patients; avoid waiting for the pain to become unbearable.

Just like so many medical conditions, getting to a qualified physician before the pain progresses is the smart choice. So many conditions caught early are minor. Caught too late they become serious.

Finally, when you make the choice to see a physician for pain management, check credentials. Qualified physicians in any specialty are proud of the extra years they spent in medical training to offer patients the best possible care. Never be afraid to ask what makes your doctor qualified to treat you for your condition. A qualified physician will be glad you asked. And so will you. -Raul Weston, MD



As the old saying goes, “It is easy to quit smoking — I’ve done it hundreds of times.” The difficult task is not quitting tobacco; it is sticking with the program. The same applies for dieting. Assistant Professor of Medicine Heather LaChance,

PhD, offers insight into the difficult task of preventing a relapse when you are dieting or quitting tobacco.

QWhy do so many people relapse when they try to quit tobacco or overeating?

A One of the biggest reasons people relapse in their tobacco-cessation or weight-management efforts is

because they attempt to change without a plan. Tobacco is one of the most addictive substances known, and eating is an elemental survival behavior. Both are very difficult habits to change. Most people try to wing it, without a specific plan to cope with the inevitable ups and downs of dieting and quitting tobacco.

Q What kind of plans should people make?

A One is to write down all the high risk situations for relapse: the people, events or places most

likely to make you feel like overeating or smoking a cigarette. It could be your habit of lighting a cigarette when you first sit down to your desk or while driving in your car. Or it could be the birthday party and cake at work or your favorite restaurant where they serve delicious, but fattening, nachos. Then you have to develop strategies in advance for dealing with those situations. With tobacco, you have to find ways to avoid those situations, and if you can’t avoid them,

then develop alternatives to the unhealthy behaviors, such as nicotine patches, toothpicks, or chewing gum. For dieters, it is important to know how you are going to handle high-risk situations, either by having a healthy fat-free protein shake before you go out to eat or by finding other techniques to reduce overeating.

You also should write down the excuses you are likely to make just before you have a relapse. “I have been so good, I deserve to splurge a little.” “No one will know.” Then think of things you can tell yourself to counter those excuses, something I call positive self talk. “Smoking won’t solve my money problems or depression.” “I will feel so much better if I can stick with my diet. I can jump this hurdle.” “My craving will pass if I can just hang in there for 10 minutes.”

Q Good planning can’t be all there is to quitting. Don’t you have to want it, to be motivated?

A Yes. Motivation is an important element of changing your behavior. You can’t succeed

unless you are motivated to quit. But motivation is an emotional factor that inevitably waxes and wanes with the natural variations in your emotional state.

You also need commitment. Commitment is the conscious promise you make to yourself, and to others, that you will stick with your plan no matter what obstacles come up. On a bad day you may not be motivated to work out at the gym, but your commitment will get you there and through your workout. Remember, discipline is not something you do, it is something you have. -Heather LaChance, PhD

Keep the Resolution and Keep Your Health


Flu Season Is HereThe start of the flu season is here. Health officials as well as the CDC (Center of Disease Control) are concerned about this year. They don’t know how forceful or violent the virus will become. To be safe, both departments are recommending seasonal flu vaccines.


Seasonal flu vaccines protect against the three influenza viruses that research indicates will be most common during the upcoming season – including the Swine Flu. The viruses in the vaccine can change each year based on international surveillance

and scientists’ estimations about which types and strains of viruses will circulate in a given year. About 2 weeks after vaccination, antibodies that provide protection against the influenza viruses in the vaccine, develop in the body. The CDC makes the following recomendations for influenza immunization this year.

When to Get VaccinatedThe CDC recommends that people get their seasonal flu vaccine as soon as vaccine becomes available. The vaccine is available at many pharmacies. Vaccination before December is best since this timing ensures that protective antibodies are in place before flu activity is typically at its highest. The CDC continues to encourage people to get vaccinated throughout the flu season, which can begin as early as October and last as late as May.

Vaccine EffectivenessThe ability of a flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or “match” between the viruses or virus in the vaccine and those in circulation.

Vaccine Side Effects (What to Expect)The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are:• Soreness, redness, or swelling

where the shot was given • Fever (low grade) • Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions.

Who Should Get VaccinatedEveryone 6 months and older should get a flu vaccine each year at the start of the influenza season. While everyone should get a flu vaccine each flu season, it’s especially important that the following groups get vaccinated either because they are at high risk of having serious flu-related complications or because they live with or care for people at high risk for developing flu-related complications: 1. Pregnant women 2. Children younger than 5, but especially

children ages 6 months to 2 years old3. People 50 years of age and older 4. People of any age with certain

chronic medical conditions 5. People who live in nursing homes and

other long-term care facilities 6. People who live with or care for those at high

risk for complications from flu, including: • Health care workers • Household contacts of persons at high

risk for complications from the flu • Household contacts and out of home caregivers

of children less than 6 months of age (these children are too young to be vaccinated).

Who Should Not Be VaccinatedThere are some people who should not get a flu vaccine without first consulting a physician. These include: • People who have a severe allergy to chicken eggs • People who have had a severe reaction

to an influenza vaccination • People who developed Guillain-Barre syndrome

(GBS) within 6 weeks of getting an influenza vaccine • Children younger than 6 months of age (influenza

vaccine is not approved for this age group) • People who have a moderate-to-severe

illness with a fever (they should wait until they recover to get vaccinated)

-For more information and store locations go to www.smithsfoodandrug.com and www.cdc.gov//flu/protect/keyfacts.htm


Many parents who consider coffee unsuitable for their children are serving them sodas, cocoa and other food and beverages that contain as much caffeine as a cup of joe.

How Much Caffeine is Okay for Kids?


Caffeine Consumption Although the number of foods and beverages containing caffeine has multiplied significantly over the past decade, the Food and Drug Administration has not yet developed pediatric guidelines for caffeine consumption. Parents who wish to limit their children’s consumption of caffeine need to read the labels of foods and drinks they serve the children, Dr. Lerner says. Older children who want to consume caffeinated beverages should do so in moderation, he adds.

A new study in the Journal of Pediatrics confirms that as many as three out of four children consume significant amounts of caffeine, a common stimulant found in hundreds of foods and beverages.

The study found that children between the ages of 5 and 7 consumed about 52 mg per day, more than the amount found in a shot of espresso, while children ages 8 and 12 consumed 109 mg per day, the equivalent of three regular-sized cans of soda.

The study also found that children who consumed the most caffeine slept less than the nine hours per night recommended by the Centers for Disease Control and Prevention. “When kids sleep poorly, it manifests in subtle ways,” says Carlos Lerner, M.D., medical director for the UCLA Children’s Health Center. “They may have difficulty paying attention in school and show signs of hyperactivity or behavioral problems. Sleep deprivation and caffeine consumption can mimic signs of ADHD.”

Children who consume sodas and other sugary drinks are also at greater risk for obesity, which is associated with a host of health problems including heart disease, high blood pressure, diabetes, depression, breathing problems and sleep disturbances.

“Children under 12 should have no caffeine at all,” Dr. Lerner says. “Reducing soda consumption is a high priority for pediatricians. Sodas are packed with sugar and have no nutritional value.”

Setting Limits“Adolescents commonly have problems with sleep so adding caffeine to the mix only makes things worse,” Dr. Lerner says. “Older kids should limit caffeine to a reasonable or minimal amount and if they do choose to consume caffeinated drinks, they shouldn’t do it close to bedtime.” -This information is provided courtesy of the pediatricians at Mattel Children's Hospital UCLA.


Know The Signs of Skin Cancer

By the third quarter of 2011, there were more than 70,000 reported cases of melanoma and nearly 9,000 deaths in the United States. For that same period, there were nearly 1 million cases of other non-melanoma cancers reported with less than one thousand deaths.

There are many forms of skin cancer and just like virtually every other cancer, the sooner the diagnosis, the higher the chance of survival.

Skin cancer mostly develops on the sun-exposed areas of the skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails, the spaces between your toes or under your toenails, and your genital area.

What could be misunderstood as a pimple that just won’t heal or a dark spot on the skin could be a form of skin cancer in its early stages. If you have any skin changes that worry you, see a doctor. Not all changes in skin are cancer,

but considering with early diagnosis, the better chance for cure, it’s best to seen by a doctor.

Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in those with dark skin tones, it's more likely to occur in areas not normally considered to be sun-exposed.

Sun spots, called actinic keratosis, are early warning signs of cancer that are still very close to the top of the skin. These can be frozen and drop off. In more advanced cases when skin cancer is diagnosed, the patient may be faced with the need to have it surgically removed. In these cases, your doctor most likely will be using “Mohs Surgery” to remove the cancer.

I prefer Mohs because it is one of the most effective and advanced treatments for most types of skin cancer today. It offers the highest potential for cure - nearly 100 percent in some studies. It is the treatment of choice when the skin cancer has been previously treated by another method.

Preventing Skin Cancer: When ultra violet light comes down from the sun, it scrambles your DNA. Your body works hard at fixing the damage all day long. When it becomes too much and the body can’t fix it anymore, the result is skin cancer. The first step in preventing skin cancer, of course, is to avoid overexposure to the sun – including tanning beds. Always use a good SPF sunscreen and a hat or long sleeves can help a lot. Recent research, however, has also demonstrated that people avoiding the sun can become low in Vitamin D, therefore getting healthy amounts of Vitamin D from your diet is important too.


In the days before Mohs, the surgeon would remove the tumor and even though it was given the all clear by pathology 10-15% would grow back and need further surgery.

Not acceptable if it’s your nose the tumor is growing on! The problem is that most skin cancers have growths – like river tributaries – that grow below the surface without any specific pattern so the surgeon had to take a wide area to try and remove everything. Often, to avoid the regrowth problem, more tissue than necessary was removed causing a larger wound. Mohs makes the entire process more accurate.

The main reason Mohs surgery is so effective is because the removed tissue is microscopically examined, carefully mapped out and evaluated by the surgeon at the time of the surgery. The patient doesn’t have to wait days for the slides to be read and face the return of another surgery. Mohs nearly eliminates the chance of the cancer growing back and minimizes the amount of healthy tissue lost.

Surgeons usually perform Mohs surgery as an outpatient procedure in their office, which will have an on-site surgical suite and a laboratory for immediate preparation and microscopic examination of tissue.

Local anesthesia is administered around the area of the tumor and the patient is awake during the entire procedure. The use of local anesthesia in Mohs surgery versus general anesthesia provides numerous benefits, including the prevention of lengthy recovery and possible side effects from general anesthesia.

When the surgery is complete, the physician will assess the wound and discuss options for cosmetic reconstruction and repair of the affected area. Most often, the surgery starts early in the morning and in most cases is completed the same day.

Take care of your skin and if you are unsure, see your dermatologist. -Chad W. Tingey, MD


If you’re one of the 26 million Americans who have diabetes, would you be surprised to learn that your skin could be an important guide to future complications? And that it yields information through a new test that is simple, noninvasive, and painless?

Beam Me Up


Not any more. We recently completed and published a clinical research study at Children’s Hospital in New Orleans using a new machine SCOUT DS made by VeraLight that measures skin AGEs by simply shining a light on the patient’s forearm. No biopsy, no blood, no needles, no pain. And the results are immediate. The light energy excites electrons in skin AGEs and causes them to fluoresce and emit light back to the device. The fluorescence is then measured by the SCOUT DS, to estimate the amount of skin AGEs

We found that skin AGEs in children with type 1diabetes were closely related to hemoglobin A1c levels but not average blood glucose levels. Here too, factors besides average blood glucose also influence skin levels of AGEs. Furthermore, we compared skin AGEs in our kids who had diabetes, with their parents who don't have diabetes. The amount of AGEs in the skin of the kids was similar to their parents, who were 20 to 30 years older. This suggests that diabetes may have sped up their aging process by about 20 to 30 years. Unlocking the secrets of why some people form very different levels of hemoglobin A1c and skin AGEs yet have the same average glucose level may lead to new ways to prevent complications of diabetes.

This Star Trek-like technology that just beams light through you without the need for a skin biopsy isn’t on some distant horizon. Already approved in Canada, with FDA filing planned for 2012 in the US, the device is providing knowledge to help us target new therapies to reduce risk and improve life all around for people with diabetes. -Stuart A. Chalew, MD

Poorly controlled diabetes can lead to devastating complications like blindness, amputations, kidney failure, nerve damage, strokes, and heart

attacks. One of the most common indicators of risk for these complications is Hemoglobin A1c, which is formed when glucose attaches to the oxygen-carrying protein hemoglobin in red blood cells. Hemoglobin A1c is commonly used to estimate average blood glucose. However glucose is not the only factor that determines hemoglobin A1c levels. Many people can have the same average glucose levels and yet have very different

hemoglobin A1cs. We found in our research that patients who had higher hemoglobin A1c yet the same average glucose level still had greater chance for kidney and eye damage. Thus your risk of getting diabetes complications is not just about how high your blood glucose levels are, but also related to who you are and personal factors which increase glucose attachment to proteins such as hemoglobin in the body.

Besides hemoglobin, glucose can attach to other proteins in the body. Over long periods of time proteins with glucose attached may form what are called advanced glycation end-products (AGEs), which no longer function normally, leading to tissue damage. We have known for some time that AGEs are normally present in the skin as part of the natural aging process, but they become quite elevated in people who have diabetes. High levels of skin AGEs have been linked to a higher chance of diabetes complications. Until recently, however, the only way to measure skin AGEs was through a skin punch biopsy that usually required a stitch to close and that had to be analyzed through a complex test available at only a few academic labs.


“Minimally Invasive” and “Robotic” surgery have become the medical community’s new buzz-words. Robotic surgery is becoming the standard in some areas and almost every day physicians are finding new

ways to apply minimally invasive and robotic surgery.

The fight against prostate cancer is no exception. The use of robotics to perform an operation known as “radical prostatectomy” is one of the best applications for this new robotic technology.

As a urologist, I am excited about the benefits of using robotics in the fight against prostate cancer, but realize, as physicians we must remember patients facing a cancer diagnosis need more than technology. They also need comfort and education.


What is Robotic and Minimally Invasive Surgery?Robotic surgery is laparoscopic surgery performed with the assistance of a high tech robot under the control of the surgeon. The surgeon is at a panel with monitors and controllers – not unlike a powerful video gaming console– performing the procedure. Imagine major surgery performed through the smallest of incisions (minimally invasive), with improved optics (3-D vision and easy magnification and zoom) and small, precise, wristed instruments that can work in tight places.

Imagine having the benefits of a definitive treatment but with the potential for significantly less pain, less blood loss, shorter hospital stay and faster return to normal daily activities.


Call Your Doctor About Prostate Cancer If: • You have a painful or burning sensation during

urination or ejaculation or have abnormal symptoms such as blood in the urine or semen.

• You have dull, incessant deep pain or stiffness in your lower back, pelvis, upper thighbones, or other bones in that area. Ongoing pain without explanation always merits medical attention. Pain in these areas can have various causes but may be from the spread of advanced prostate cancer.

• You experience unexplained weight loss or loss of appetite, as well as fatigue, nausea or vomiting.

• You have swelling of the lower extremities.• You experience weakness or paralysis in

your legs and/or difficulty walking.

We are also seeing anecdotal evidence that robotic prostatectomy is resulting in faster return of urinary continence and higher level of recovery of sexual function following surgery.

Thanks to this breakthrough surgical technology, the Ogden Clinic is now using the da Vinci® Robotic-Assisted Prostatectomy as a tool in the fight against prostate cancer in the Weber County area. Three of our staff urologists have been extensively trained in this amazing robotic surgical system. Always remember, the robotic surgical system does not replace your surgeon at the controls. Your surgeon is always in control of every aspect of the surgery with the assistance of the da Vinci robotic surgical system.

In prostate cancer treatment, millimeters matter. Nerve fibers and blood vessels are attached to the prostate gland. To spare these nerves, they must be delicately and precisely separated from the prostate before its removal. Surgeons use the precision, vision and control provided by the da Vinci to assist them in removal of the cancerous prostate while preserving important nerves and blood vessels.

Prostate Cancer FactsOne in six American men will develop prostate cancer sometime in their lifetime. According to the Center for Disease Control and Prevention prostate cancer is the most common cancer in men.

The American Cancer Society noted that more than 203,415 men were diagnosed with prostate cancer in 2006 (the most recent data) and 28,372 men died from the disease that year.

There are no warning signs or symptoms of early prostate cancer. Screening is based on examination of the prostate with a digital exam and the use of screening blood and urine tests—most commonly the blood test known as a PSA. Your doctor will examine your prostate gland to determine whether it is enlarged, inflamed with an infection, or may have cancer. -Michael Van Bibber, MD

©2011 Intuitive Surgical, Inc.


For the first time ever, patients with Type 1 diabetes have controlled their disease in a real-life setting using an artificial pancreas system developed by University of Virginia researchers. This milestone means researchers are even closer to revolutionizing diabetes

care for millions of people with Type 1 diabetes.

At the heart of the system is a novel hand-held device developed by a University of Virginia research team, led by Patrick Keith-Hynes, PhD, and Boris Kovatchev, PhD. The device uses a “smart” algorithm that automatically delivers insulin and regulates a person’s blood sugar levels -- taking much of the burden of constant monitoring off the patient.

Artificial Pancreas a Real-World Success for Diabetes Patients

Global Artificial Pancreas ProjectThis first outpatient study marks the latest milestone in the Juvenile Diabetes Research Foundation’s Artificial Pancreas Project, which involves an international research consortium including teams from the University of Virginia, the University of California in Santa Barbara, Montpellier University Hospital (France), and the Universities of Padova and Pavia (Italy).

Researchers in Europe recently announced the trial results. The study took place in France and Italy.

In the study, two patients with Type 1 diabetes attained near-normal glucose levels after spending one night

University of Virginia Researchers Celebrate First-Ever Outpatient Success of Artificial Pancreas



“Today, there are no fully-automated insulin delivery systems available on the market, and that's why JDRF has made accelerating the development and delivery of these technologies a priority," said Dr. Aaron Kowalski, assistant vice president of treatment therapies at the Juvenile Diabetes Research Foundation. "This latest research milestone is incredibly exciting and shows us that the first generation of an artificial pancreas is no longer a dream.”-This information provided courtesy of the University of Virginia.

outside of a hospital while using the artificial pancreas system. The patients were able to eat a restaurant meal and spend one night at a hotel while using the device.

“We at UVA have enjoyed successful inpatient trials of the artificial pancreas and we continue to do so,” says Kovatchev, professor of psychiatry and behavioral sciences and director of the UVA Center for Diabetes Technology. “But the success in an outpatient, real-world setting is an enormous and encouraging milestone. This is a day for all of us involved with the artificial pancreas project to truly celebrate.”

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Meet SimManMedical pros hone their skills with the help of mannequins, robots and other virtual tools.

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In a quiet hospital corridor, an elderly man lies on a wheeled bed, forlorn and in discomfort. A passing resident notices him. “How are you doing, sir?” the resident asks.

“Doc, I feel like I could die,” rasps the patient, Mr. Perez. “I can’t breathe and my chest hurts.”

“Let me listen to your chest,” the resident says, arranging his stethoscope.

He calls for backup. The man’s heart stops — a nurse detects no pulse.

“Call a code!” the resident yells. In a matter of seconds, Cleveland Clinic staffers stream in, until a crew of 15 is working bedside. They hook up Mr. Perez to monitors and a defibrillator, do three cycles of chest compressions, and administer drugs intravenously. After about 20 minutes, vital signs pick up. “I feel better now,” he announces flatly.

If that response sounds a bit robotic, it’s because Mr. Perez is not a flesh-and-blood human being. He’s SimMan — a training mannequin that is as realistic a fake patient as you can get these days. SimMan can talk, wheeze, sputter, “bleed” distilled water mixed with red food coloring, and urinate Mountain Dew. Put your ear to his chest and you can hear his heartbeat. Press his wrist with your finger and you can feel a pulse.

A nurse controls SimMan’s actions, speech and vital signs from behind a half-wall. “I call this The Wizard of Oz area,” says Joan Kavanagh, MSN, RN, Associate Chief Nursing Officer, Clinical Education and Professional Development at Cleveland Clinic. “There’s just a little laptop back here, but this is command central.”

Call it The Wizard of Oz meets Star Trek. Technologically sophisticated mannequins, robots with 3-D vision, and computers that can “feel” are part of the cutting-edge technology that Cleveland Clinic uses to train its medical personnel. The expectation is that medical staff will be better prepared when they encounter actual patients.

Training DaysSimMan is the pièce de résistance of the Stanley Shalom Zielony Center for Advanced Nursing Education’s simulated critical care area, a large room set up exactly like an Intensive Care Unit (ICU), with a few key differences: a built-in audiovisual system that can record simulated hospital procedures from various angles and distances so it can be viewed and parsed later, and monitors that not only read the pseudo-patient’s vital signs but also transmit them back to the control area so the instructor can make SimMan’s software respond accordingly.

The software is scripted before a simulation, but teachers can improvise depending on the trainees’ actions. “If they do something that really would have an adverse effect on the mannequin,” like not using the defibrillator when they should, “I can change the heart rhythms,” says Leslie Simko, RN, BSN, MS, Nursing Simulation Coordinator. “I can put the mannequin into flatline, and his other physiological parameters will continue to deteriorate

until the participants administer treatment.” She also can make the patient talk: “I’m really not feeling well.”

And she can do it with different voices for different scenarios, says Ms. Simko, who spent 17 years as a critical-care nurse before earning her master’s degree in nursing informatics, specializing in simulation. If the “patient” is an adolescent (SimMan can be dressed to look like SimWoman or SimTeen), she has her nieces and nephews record voices and statements into the software.

On a recent weekday morning, SimMan trainees included a dozen nurses from several departments who were honing their skills, plus two or three residents who were there as part of their training.

During a debriefing session, trainees watched video of themselves to critique their performance. Under Ms. Simko’s direction, they found some areas that needed attention.

“Let’s talk about the bedside monitor for a second,” Ms. Simko told them. “If you walk into the patient’s room, the patient’s just lying on a bed, not hooked up, and not talking. You know there’s something going on. You called for a nurse to hook him up. What could you have done in that situation? Hooked him right up to the defibrillator. You don’t even need to use the bedside monitor.”

“The debriefing session is probably more important than the actual scenario,” Ms. Kavanagh says. “This is a safe place for nurses, for doctors and respiratory therapists to develop critical thinking and judgment.”

The simulation center might seem space-age, but its technology may eventually be a necessity. “This is the future,” says Ms. Kavanagh, whose nurse’s training took place back in the day when students practiced by giving IVs to oranges. “Physicians down the road will have to have so many hours of simulation to maintain their license, their certification. I’m sure the same thing will happen for nursing, as well.”

SimMan is just one component of Cleveland Clinic’s high-tech nursing simulation program. The center also is equipped with an untethered mannequin that trainers can wheel to various parts of the hospital for on-site surgeries, and a SimBaby that can cry at an ear-splitting volume.

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The center also has a virtual component — computers with haptic, or tactile, software for practicing techniques such as inserting IVs. Students click and drag a mouse to select the equipment (tourniquet, gloves, dressing) and procedures (washing hands, turning the arm this way or that), then the computer grades them on whether they made the right choices in the right order. Then they insert a needle into a device, and the computer “reads” their competence. If it’s the right spot, they feel the appropriate pressure. “You get that ‘pop’ that you would when you put it into a vein,” Ms. Simko says.

“It’s kind of like a video game,” she adds. “Our younger generation takes to this stuff, because they grew up with it. My 14-year-old niece was in here for her student day, and she did so much better than I ever could, because she’s just used to it.”

Bringing It TogetherOn a small scale, the Nursing Simulation Center is a model for what Cleveland Clinic is planning in terms of an interdisciplinary, high-tech training center, scheduled to open first quarter of 2012.

“We have pockets of simulation capability right now,” says James K. Stoller, MD, MS, Chair of Cleveland Clinic’s Education Institute and the Jean Wall Bennett Professor of Medicine. A new training center will bring everything together, he says. A faculty of 10 to 15 Cleveland Clinic professionals will create curricula for skills they want to develop in trainees.

“The goal is to have all the resources in place — building, technology, people — so a doctor could call and say, ‘I would like to schedule a session on central line placement,’ and schedulers would know exactly what algorithms to use and would arrange the session like scheduling a room for a lecture,” he adds.

Training will be available to a variety of healthcare professionals throughout Cleveland Clinic such as nurses and allied health professionals and will consist of three components: team-based sessions (simulated surgery using mannequins or actors); procedure-based sessions (practicing basic skills, such as suturing, at a virtual station); and clinical examinations,

in which students practice taking medical histories and giving physical examinations to actors who are pretending to be patients. (At some point in the future, Dr. Stoller says, the “patients” may be computer-generated avatars.)

J. Eric Jelovsek, MD, Cleveland Clinic’s Director of Surgical Education, will direct the new training center. The new facility will re-create urgent care, the emergency room, the trauma bay, and the labor and delivery room. “Everything from the exact lights, storage cabinets, placement of the light switches, a telephone that works,” he says. “All of those things have to be strategically placed to re-create the team interaction.”

Simulation training centers are becoming an essential element of medical education. “It’s getting to be that many of the specialties are requiring simulation as part of their maintenance of certification,” says David Brown, MD, Chairman of Cleveland Clinic’s Anesthesiology Institute and a member of the training center’s development team. Some residency programs, such as general surgery, are requiring it as part of training today.

According to Dr. Jelovsek, simulated training started to become more of a priority in medicine around 2000, when a seminal report by the Institute of Medicine, To Err Is Human: Building a Safer Health System, focused on the problem of doctors making more errors as medicine became more specialized.

“Plus, with healthcare reform, there’s been an increase in accountability,” he says. “It’s no longer acceptable to learn on a patient.”

Training staff on simulators could help reduce medical errors, says Grace Peng, PhD, Program Director at the National Institute of Biomedical Imaging and Bioengineering.

“The idea is to have more checks and balances within the field of medicine,” Dr. Peng says. “A lot of this includes practicing skills with simulators to emulate the environment of the operating room. Most medical errors occur during the first 100 patients operated on, and errors decline dramatically after that.” Simulations can also change the surgical workflow and help the staff work better as a team. “A lot of times,

people don’t want to contradict the surgeon. This is the time gross errors can occur.”

Along with a multimillion dollar commitment from the capital budget, two philanthropy-driven projects on the drawing board figure heavily into Cleveland Clinic’s plan: the Debra Ann November Pediatric Airway Simulation Program and the Dr. Archie Brain Difficult Airway Simulation Center. Both will use simulation to teach physicians and other clinical personnel — including, as appropriate, first responders, nurses, allied health providers, and physicians — how to insert breathing tubes into patients. It’s a tricky procedure that, when done incorrectly, can lead to injury and death in medical emergencies. Cleveland Clinic proposes to develop a program that will fill gaps in education and translational science. -Laura Putre.This information was provided from Cleveland Clinic.Photography by Greg Ruffing

MAINTENANCE FOR CHILDREN AND TEENS

PROCEDURE AGE FREQUENCY

Dental Care One year to adolescence Every six months

Hearing All Children Age 4 or before start of school

Obesity Children 6 and up At routine exams

Vision All Children Age 4 and again during adolescence

IMMUNIZATIONS AGE FREQUENCY

Human papillomavirus (HPV)HPV2 or HPV4. All girls age 11 and 12. HPV4. All males ages 9 to 18

Three doses. Second dose two months after the first. Last dose six months after first

Diptheria All children First dose between age 4 and 6. Booster between age 11 and 12

Tetanus Toxoids All children Initial dose between age 4 and six. Booster between 11 and 12.

Acellular pertussis All children Initial dose between age 4 and 6. Booster between age 11 and 12.

Measles, mumps, rubella (MMR) All children Second dose between 4 and 6

Chicken Pox (varicella) All children Second dose between 4 and 6

Pneumococcal (polysaccharide) Those at risk Based upon physician recommendation

Influenza All children Annually. During flu season

Inactivated poliovirus All children A final dose between 4 and six if the series was completed by age 4

Meningococcal (conjugate) All childrenOne dose between age 11 and 12 or by age 18 if not vaccinated before. High risk groups should receive one dose between age 2 and 10

Hepatitis A Those at risk Should be full vaccinated by age 2. If not, consult your physician.

Hepatitis B Those not previously vaccinated Three dose series for Monovalent Hep B. Two dose series for Recombivax HB for children ages 11 to 15.


MAINTENANCE FOR WOMEN AGED 18-39


Anemia All adults and pregnant women At prenatal visits, especially the first

Asymptomatic Bacteriuria (with urine culture)

All pregnant women At 12 – 16 weeks or the first prenatal visit.

Blood pressure All adults Yearly for systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure.

Every two years if blood pressure reading <120.80 mm Hg.

Breast Cancer Women age 20 and older. Clinical breast exam every three years

Cervical Cancer Women age 21 and older who have been sexually active and have a cervix. For women under 20, consult your physician.

Consult your health care provider. The American Cancer Society (ACS) recommends a pap test every two years.

Chlamydia Sexually active women age 24 and younger, pregnant women age 24 and younger and women at increased risk for infection.

At routine exams

MAINTENANCE FOR WOMEN 40-49


Anemia All adults and pregnant women At routine exams

Asymptomatic Bacteriuria (with unine culture)

All pregnant women At 12-16 weeks gestation or the first prenatal visit.



Blood pressure All adults Yearly if systolic blood pressure reading of 120 to 139 mm Hg or diastolic blood pressure.

Every two years if blood pressure reading <120/80 mm Hg.

Breast Cancer All women Yearly mammogram and clinical breast exam

Cervical Cancer Women who have been sexually active and have a cervix

Consult your healthcare provider. The American Cancer Society ACS) recommends a pap test every two years.

Chlamydia Women at increased risk for infection and pregnant women

At routine exams

Diabetes Mellitus, type 2 Adults who are asymptomatic with sustained blood pressure.

At routine exams

Hepatitis B virus All pregnant women At first prenatal visit

Lipid Disorders All women 45 and older at increased risk for coronary artery disease.

At least lest every five years

Obesity All adults At routine checkups

Rh (D) Incompatibility All pregnant women First prenatal visit

Preeclampsia All pregnant women First prenatal visit

Rubella All pregnant women First prenatal visit

IMMUNIZATION AGE FREQUENCY

Tetanus/diphtheria/pertussis (Td/Tdap) booster

All adults TD: Every 10 years.

Tdap: Substitute a one-time dose of Tdap for a Td booster once after age 18.

Chickenpox (varicellas) All adults ages 19 – 49 and those who have no prior evidence of vaccinations.

Two doses. Second dose four to eight weeks after first.

Measles, mumps, rubella (MMR)

All adults 19-49 and those who have no prior evidence of vaccinations.

One or two doses.

Flu vaccine People at risk Yearly

Hepatitis A vaccine People at risk Two doses

Hepatitis B vaccine People at risk Three doses

Meningococcal People at risk One or more doses

Pneumococcal (polysaccaharide) People at risk One or two doses


MAINTENANCE FOR WOMEN 50-64


Blood Pressure All adults Yearly is systolic blood pressure reading of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg.

Every two years if blood pressure reading is <120/80 mm Hg.


Cervical cancer Women who have been sexually active and have a cervix

Consult your healthcare provider. The American Cancer Society (ACS) recommends a pap test every two years.

Chlamydia Women at increased risk for infection

At routine exams

Colorectal cancer All adults Consult your healthcare provider.

Diabetes Mellitus, type 2 Adults who are asymptomatic with sustained blood pressure.

At routine exams.

Lipid Disorders All women age 45 and older at increased risk for coronary artery disease

At least every five years.

Obesity All adults At routine exams.

Osteoporosis, Postmenopausal Women

Women at age 60 who are at increased risk for osteoporotic fractures

Consult your healthcare provider.

Tuberculosis Anyone at increased risk for infection

At routine exams.


MAINTENANCE FOR WOMEN 65+


Blood pressure All adults Yearly is systolic blood pressure reading is 120 to 139 mm hg or the diastolic blood pressure reading is 80 to 89 mm Hg.

Every two years if blood pressure reading is less than 120/80 mm Hg.


Cervical cancer Women ages 21 to 65 who have been sexually active and have a cervix

Consult your healthcare provider.

Chlamydia Women at increased risk for infection

At routine exams

Diabetes mellitus, type 2 Adults who are asymptomatic and have sustained blood pressure.

At routine exams.

Lipid disorders All women ages 45 and older at increased risk for coronary artery disease.

At least every five years

Obesity All adults At routine exams

Osteoporosis, postmenopausal Women ages 65 and older Bone density test at age 65


Consult your healthcare provider



All adults Td: Every 10 years

Measles, mumps, rubella (MMR)

All adults age 65 and older who have not been vaccinated or who lack prior infection

One dose

Chickenpox (varicella) All adults age 65 and older who have not been vaccinated or lack prior infection

Two doses.

Flu (seasonal) All adults Yearly during flu season

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Hepatitis A vaccine People at risk Two doses

Hepatitis B vaccine People at risk Three doses

Meningococcal People at risk One or more doses

Pneumococcal All adults One dose

Zoster All women age 65 and older One dose

MAINTENANCE FOR MEN 18-39


Blood Pressure All adults Yearly if systolic blood pressure reading is 120 to 139 mm Hg or the diastolic blood pressure reading is 80 – 89 mm Hg.

Every two years if blood pressure reading is less than 120/80 mm Hg

Colorectal cancer All adults Consult your healthcare provider to make a decision based on family history, current medical condition and personal values.

Diabetes mellitus, type 2 Adults who are asymptomatic and have sustained blood pressure (treated or untreated) greater than 135/80 mm Hg.

At routine exams

Lipid disorders All men age 35 and older, and younger men at high risk for coronary artery disease.

At least every five years.



Check with your healthcare provider


MAINTENANCE FOR MEN 40-49


Blood pressure All adults Yearly if systolic blood pressure reading is 120 to 139 mm Hg or the diastolic blood pressure reading is 80 – 89 mm Hg

Colorectal cancer Men diagnosed with specific inherited syndromes and inflammatory bowel disease

Consult your healthcare provider. Decisions about screening should be based on family history, current medical condition and personal values.

Diabetes mellitus type 2 Adults who are asymptomatic and have sustained blood pressure (treated or untreated) greater than 135/80 mm Hg

At routine exams

Lipid disorders All men age 35 and older and younger men at high risk for coronary artery disease

At least every five years



At routine exams

Tobacco use and tobacco-related disease

All adults Every visit

IMMUNIZATION AGE FREQUENCY


All adults Td: every 10 years. Tdap: Substitute a one-time dose of Tdap for a Td booster after age 18

Measeles, mumps, rubella (MMR)

All adults age 19-49 who lack evidence of immunity (no proof of prior immunization)

One or two doses

Chickenpox (varicella) All adults 19-49 who lack evidence of immunity (no proof of prior immunization)

Two doses. The second dose should be given four to eight weeks after the first dose.

Flu (seasonal) People at risk Yearly during flu season

Hepatitis A People at risk Two doses

Hepatitis B People at risk Three doses

Meningococcal People at risk One or two doses (consult your healthcare provider)


MAINTENANCE FOR MEN 50 - 64


Blood pressure All adults Yearly if the systolic blood pressure reading is 120 to 139 mm Hg or the diastolic blood pressure reading is 80 – 89 mm Hg.

Every two years if the blood pressure reading is less than 120/80 mm Hg

Colorectal cancer All adults Consult your healthcare provider. Decisions about screening should be based on family history, current medical condition and personal values .

Diabetes mellitus, type 2 Adults who are asymptomatic and have sustained blood pressure (treated or untreated) greater than 135/80 mm Hg

At routine exams

Lipid disorders All adults At least every five years

Obesity Anyone at increased risk At routine exams


Consult your healthcare provider

Aspirin for primary prevention of cardiovascular events

Men ages 45 to 79 when the potential benefits from a decrease in myocardial infarctions outweigh the harm or risks form an increase in gastrointestinal hemorrhage

When diagnosed with risk for cardiovascular/heart disease. Consult your physician.

MAINTENANCE FOR MEN 65 +PROCEDURE AGE FREQUENCY

Abdominal aortic aneurysm Men ages 65 – 75 who have ever smoked

One-time screening by ultrasonography

Alcohol misuse All adults At routine exams


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What Doctors Know - Vol 1 Issue 2

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