What Doctors Know - October 2012

7/27/2019 What Doctors Know - October 2012

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Heart disease is still the No. 1

killer of women, taking the life

of 1 in 3 women each year.

Give the women you care about the

power to save their lives at

GoRedForWomen.org.

2012, American Heart Association. Also known as the Heart Fund

TM Go Red trademark of AHA, Red Dress trademark of HHHS.

5/12DS5882


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On Call with Dr. Porter

Steve Porter, MD

Publisher and Chairman

February is Heart Month a month we give flowers, candy

and express our love for those special people in our lives.As a health information magazine we focus on mattersof the heart, but the heart we focus on is the physicalone. The heart that, when ignored, can be deadly.

Theres nothing wrong with gett ing caught up in the loverslane version of the heart. However, our message this monthstresses the need to balance the physical heart with the emotionalheart both are important to a happy and healthy life.

Sadly, bad hearts kill too many Americans every year. Sad,because so many of these deaths could have been avoided bychanges in everyday lifestyles. Thats why its appropriate forFebruary to be the month for love and your heart. When

you read the information in this months issue, youll seewhy its important to love and respect your heart.

Another focus in this months issue is cancer. World Cancer Dayis February 4 and while having an official day is important, oneday out of the year to bring attention to cancer isnt enough. Justas taking care of your heart is a year round battle, cancer doesntraise its ugly head one day a year. Its a yearlong fight. Unliketaking care of your heart however, with cancer, sometimes nomatter how healthy we have lived, it can strike. The medicalprofession has made great strides in the battle against cancer,and while we cant tell when, who and how, it will strike. We doknow early detection and diagnosis is key to survival. Become

informed about cancer. It could save you or someone you love.At What Doctors Know, we realize taking control of our health isnteasy, but the rewards are more than worth the effort. Not only can youlive longer, but the quality of your life will be so much better.

As always, if you have any health questions, send them along to ourstaff and well get answers from our medical experts.


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WHAT DOCTORS KNOWAnd you should, too!

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Health Hints26 Uncovering Eating Disorder Facts

36 Love Your Heart

40 Myth 1: Cancer Is Just A Health Issue

42 Save Your Heart, Spare Your Brain

44 Important Flu Recommendationsfor High-Risk Populations

46 Team Up. Pressure Down.

48 Get Off the CouchLive Longer

50 10 Tips to Alleviate Stress

57 Screening and Preventing Cancer

62 Change Your Salty Way in Only 21 Days

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Taking Control08 We Need to Talk!

10 Too Young for a Hip Replacement?

20 HIRO in Radiology

24 Healthy Help-A Phone Call Away

26 The Time is Now Together,We Will End Cancer

32 Getting Back In the Gameof Life

34 New Head Lice TreatmentNow Available

35 Ignoring the Flu Can Be Deadly


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Vol. 2 Issue 2

01 On Call With Dr. Porter

04 Meet Our Doctors

06 Medicine in the News

30 HealthWatchMD: CommonType of Heart ConditionOften Overlooked

53 CDC Vital Signs: GettingBlood Pressure Under Control

66 Know Your Specialist: Cardiologist

In Every Issue

Contents

12 Be True to YourHeart-You Won'tLike the Break Up

58 Uncovering EatingDisorder Facts

72 Your Childs Oral Health

On The Cover

InquiringMinds

64 10 Things You Need toKnow About Birth Defects

68 Can COPD Be Hereditary

70 Infection DuringPregnancy

74 Lower Risk ofCardiovascular &Cancer Mortality

76 Exercise, Meditation CanFight Cold, Flu Symptoms

77 Using the ImmuneSystem to Fight Cancer

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Meet Our Doctors

Copyright 2013 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The

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

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

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

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

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

Our readers look forward to hearing from you.

Send story ideas to: [email protected]

Steven Porter, MD

Founder andpublisher of WhatDoctors Know, Dr.Porter is recognizedas one of the topgastroenterologists in the country.He is the medical director of theendoscopy lab at a leading hospital inOgden, Utah and has been practicingfor more than 25 years. ContactDr. Porter at (801)387-2550.

Timothy J. Sullivan, MD

Contributing editorialadvisory board member of

What Doctors Know, Dr.Sullivan spent 25 yearsin full-time academicmedicine at Washington University,University of Texas Southwestern

Medical School, and Emory University.He currently has a full-time allergyand immunology practice in Atlanta,Georgia and is a clinical professor atthe Medical College of Georgia.

William Goodnight, III, MD

Assistant Professor atthe University of NorthCarolina Health Care inthe Division of MaternalFetal Medicine. Boardcertified in Obstetrics and Gynecologysince 2000, Dr. Goodnights currentclinical activities include prenataldiagnosis and management of medicalcomplications of pregnancy.

Vicki Lyons, MDFounding memberand chairman of theeditorial advisoryboard of What DoctorsKnow, Dr. Lyons is aboard certified and fellowship trainedallergist and immunologist practicing inOgden, Utah. She has been practicingfor 20 years. Contact Dr. Lyons at(801)387-4850 or www.vicki-lyonsmd.com.

Patrick T. Ellinor,MD, PhD

Director, Arrhythmia/Step Down Unit at

Massachusetts GeneralHospital, Dr. Ellinor

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

Francisco Ramos-Gomez, DDS, MS, MPH

Professor in the Divisionof Pediatric Dentistryat the UCLA School ofDentistry, Dr. Ramos-Gomez has been apediatric dentist for more than twentyyears with specific focus and researchin the areas of early childhood cariesprevention, oral disease risk assessment,and commnity health with an emphasison underserved populations.

Kenneth H. Kim, MDAssistant Professor in the Division of GynecologicOncology at the University of North Carolina,Dr. Kim has special interest in advanced surgicaltechnologies, novel therapeutics in treatment ofovarian cancer, as well as HPV & cervical cancer.


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WHAT DOCTORS KNOWAnd you should, too!

Published by

What Doctors Know, LLC

Publisher and Chairman

Steve Porter, MD

Editorial Advisory Board

Vicki J. Lyons, MD, Chairman

Editorial and Design Director

Bonnie Jean Thomas

Senior Designer

Suki Xiao

Design Associate

Raulin Huang

Executive Director, MarketingLarry Myers

Production

Kai Xiao, Vice President

IT Manager

Eric Lu

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

Corporate OfficeWhat Doctors Know

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Atlanta, GA - The Advisory Committee forImmunization Practices voted 14 to 0, withone abstention, to recommend providers of

prenatal care implement a Tdap immunizationprogram for all pregnant women. Health-care personnel should administer a dose of

Tdap during each pregnancy irrespective ofthe patients prior history of receiving Tdap.

This builds upon a previous recommendationmade by ACIP in June 2011 to administer

Tdap during pregnancy only to women whohave not previously received Tdap. By getting

Tdap during pregnancy, maternal pertussisantibodies transfer to the newborn, likelyproviding protection against pertussis in

early life, before the baby starts getting DTaPvaccines. Tdap will also protect the motherat time of delivery, making her less likelyto transmit pertussis to her infant. If not

vaccinated during pregnancy, Tdap shouldbe given immediately postpartum, beforeleaving the hospital or birthing center.

The U.S. remains on track to have the mostreported pertussis cases since 1959, with morethan 32,000 cases already reported along with16 deaths, the majority of which are in infants.

Tdap Recommended For Pregnant Women


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Dallas,TX - Women who are light-to-moderate cigarette smokersmay be significantly more likelythan nonsmokers to suffer suddencardiac death according to newresearch in Circulation: Arrhythmia& Electrophysiology, an AmericanHeart Association journal.

The findings indicate long-termsmokers may be at even greater risk,but quitting smoking can reduceand eliminate the risk over time.

Cigarette smoking is a known risk factorfor sudden cardiac death, but until now,

we didnt know how the quantity andduration of smoking effected the riskamong apparently healthy women, nordid we have long-term follow-up, saidRoopinder K. Sandhu, M.D., M.P.H.,the studys lead author and a cardiacelectrophysiologist at the University of

Albertas Mazankowski Heart Institutein Edmonton, Alberta, Canada.

Researchers examined the incidenceof sudden cardiac death among more

Moderate Smoking Associated WithSudden Death Risk In Women

than 101,000 healthy women in theNurses Health Study, which hascollected biannual health questionnairesfrom female nurses nationwide since1976. They included records datingback to 1980 with 30 years of follow-up. Most of the participants were

white, and all were between 30 to55 years old at the studys start. Onaverage, those who smoked reportedthat they started in their late teens.

During the study, 351 participantsdied of sudden cardiac death.

Other findings include:

Light-to-moderate smokers, defined inthis study as those who smoked oneto14 cigarettes daily, had nearly twotimes the risk of sudden cardiac deathas their nonsmoking counterparts.

Women with no history of heartdisease, cancer, or stroke whosmoked had almost two and a halftimes the risk of sudden cardiacdeath compared with healthywomen who never smoked.

For every five years of continuedsmoking, the risk climbed by 8 percent.

Among women with heart disease,the risk of sudden cardiac deathdropped to that of a nonsmoker

within 15 to 20 years after smokingcessation. In the absence of heartdisease, there was an immediatereduction in sudden cardiac death risk,occurring in fewer than five years.

Sudden cardiac death results fromthe abrupt loss of heart function,usually within minutes after theheart stops. Its a primary cause ofheart-related deaths, accounting forbetween 300,000-400,000 deathsin the United States each year.

Eating Disorders AreSerious Medical IssuesLos Angeles, CA - Eating disorders such as anorexianervosa, bulimia nervosa and binge eating are seriousmedical illnesses that can significantly disrupt lives,harm physical health and, in some cases, prove fatal.But, in addition to the several million Americans

who have a diagnosable eating disorder, many moreshow symptoms that, while not meeting the criteriafor a diagnosis, should be cause for concern. Experts

at the UCLA Eating Disorders Program say theseindividual too, should see a trained professional forconsultation and, when warranted, treatment.

Rough estimates suggest that about one percentof U.S. females have symptoms of anorexianervosa, such as preoccupation with dieting and amisperception of their actual size, but they do notexperience the extreme weight loss characteristicof the disease, says Michael Strober, Ph. D., theResnick Professor of Eating Disorders and directorof the UCLA Eating Disorders Program.

Eating disorders are not limited to adults. Thelikelihood of a child eventually showing symptoms of aneating disorder can be reduced by promoting a healthyself-esteem and strong sense of self. Parents and othersignificant adults in childrens lives should demonstratethat there are many qualities that contribute to thechilds value beyond appearance and weight, Dr.

Cynthia Pikus, Ph.D. associate director of the UCLAEating Disorders Program. That can be conveyedboth verbally and by modeling whats important.


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We Need to

Dr. Lisa Masterson of the Emmy

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

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

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

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

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

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

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

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

1) Patients are afraid toask questions.

2) Patients dont knowwhat questions to ask.

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

Talk!


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

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

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

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

when they have clearer minds.

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

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

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

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

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


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Too Youngfor

a Hip Replacement?Younger patients are becomingcandidates for hip replacements

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

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

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

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

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

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

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

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

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

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

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

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

with his new hip than with his old one.

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

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

as its called, means a shorter recovery time

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

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

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


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

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

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

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

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

-Herrick Siegel, M.D.


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Be True toYour Heart- You Won't Like the Break Up

According to the American Heart Association, 2,150 people die every day from

cardiovascular disease thats one person every 40 seconds. Between 1999and 2009, the rate of deaths from cardiovascular disease (CVD) fell 32.7percent, but still accounted for nearly one in three deaths in the nation.

In 2010, the American Heart Association set a goal to improve cardiovascular health of allAmericans by 20 percent and reduce heart disease and stroke deaths 20 percent by 2020.

However, according to projections in a 2013 American Heart Association report, heart health mayonly improve by six percent if current trends continue. The biggest barriers to success are projectedincreases in obesity and diabetes, and only modest improvements in diet and physical activity. Ona positive note, smoking, high cholesterol and high blood pressure rates are projected to decline.

Among heart disease and stroke risk factors, the most recent data shows:

Moreadultsage20andoverareobese(34.6percent)thannormalorunderweight(31.8percent);68.2percentareoverweightorobese.

Amongchildrenages2-19,31.8percentareoverweightorobese.

Thirty-twopercentofadultsreportnoaerobicactivity;17.7percentofgirlsand10percentofboys,grades9-12,reportlessthananhourofaerobicactivityinthepastweek.

13.8percentofadultshavetotalcholesterolof240mg/dLorhigher.

Thirty-threepercentofadultshavehighbloodpressure;African-Americanshaveamongthehighestprevalenceofhighbloodpressure(44percent)worldwide.

8.3percentofadultshavediagnoseddiabetes,and8.2percenthaveundiagnoseddiabetes;38.2percenthaveprediabetes.


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HEART HEALTH AND CAREWe all know we have to eat healthy and exercise toavoid heart problems, but we still need to know thesymptoms of heart problems because seconds count.

Mount Sinai Heart is one of the top ten cardiologytreatment centers in the United States so we took ourheart questions to the experts and we got answers.

What Is Coronary Artery Disease?

Coronary artery disease (CAD) is the most commonform of heart disease. In coronary artery disease,fatty deposits known as plaques collect on the inner

wall of the blood vessels. Coronary artery disease

occurs when the coronary arteries become partiallyblocked or clogged. This blockage limits the flowof blood from the coronary arteries, which are themajor arteries supplying oxygen-rich blood to theheart. The coronary arteries expand when the heartis working harder and needs more oxygen. Arteriesexpand, for example, when a person is climbing stairs,exercising, or having sex. If the arteries are unable toexpand, the heart is deprived of oxygen (myocardialischemia). When the blockage is limited, chest painor pressure, called angina may occur. When theblockage cuts off the flow of blood, the result is heartattack (myocardial infarction or heart muscle death).

Healthy coronary arteries are clean, smooth, andslick. The artery walls are flexible and can expandto let more blood through when the heart needs to

work harder. The disease process in arteries is thoughtto begin with an injury to the linings and walls ofthe arteries. This injury makes them susceptibleto atherosclerosis and blood clots (thrombosis).

Over time, the plaques thicken and arteries narrow(atherosclerosis), making it harder for the heart topump blood throughout your body. Left untreated,atherosclerosis can lead to a heart attack. Diet,stress, activity level, and family history all playa role in developing coronary artery disease.

Coronary artery disease is usually caused byatherosclerosis. Cholesterol and other fatty substancesaccumulate on the inner wall of the arteries. They

attract fibrous tissue, blood components, andcalcium, and harden into artery-clogging plaques.

Atherosclerotic plaques often form blood clots that alsocan block the coronary arteries (coronary thrombosis).Congenital defects and muscle spasms can also blockblood flow. Recent research indicates that infectionfrom organisms such as chlamydia bacteria may beresponsible for some cases of coronary artery disease.

A number of major contributing factors increase the riskof developing coronary artery disease. Some of thesecan be changed and some cannot. People with more riskfactors are more likely to develop coronary artery disease.

Coronary artery disease begins quietly duringchildhood, starting as early as age 3. Although anumber of factors contribute to the developmentof coronary artery disease, lifestyle choices top thelist. "All human beings start with normal, pristinearteries, like pipes in a newly built house, explains

Jonathan Halperin, MD PhD, Professor of Cardiologyand Director of Clinical Cardiology Services at Mt.Sinai. But gradually, over time, we pollute them."


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Risk Factors for Coronary Artery Disease

Major risk factors significantly increase the chance of developing coronary arterydisease. Some risk factors can be changed and controlled, while others cant.

Those that cannot be changed are:

HeredityPeople whose parents have coronary artery disease are more likely to develop it. African Americansalso are at increased risk because they experience a higher rate of severe hypertension than whites.

SexMen are more likely to have heart attacks than women and to have them at a younger age.Over age 60, however, women have coronary artery disease at a rate equal to that of men.

AgeMen who are 45 years of age and older and women who are 55 years of age and older are more likely to havecoronary artery disease. Occasionally, coronary disease may strike a person in the 30s. Older people (those over 65) aremore likely to die of a heart attack. Older women are twice as likely as older men to die within a few weeks of a heart attack.

Ethnicity weighs heavily in your likelihood of developing coronary artery disease. African Americansare at higher risk for early death and have higher mortality rates from cardiovascular problems in general. African-

American women with coronary artery disease are more likely to have a heart attack than Caucasian women.

Major risk factors that can be changed are:

SmokingSmoking increases both the chance of developing coronary artery disease and the chanceof dying from it. Smokers are two to four times more likely than are non-smokers to die of suddenheart attack. They are more than twice as likely as non-smokers to have a heart attack. They also aremore likely to die within an hour of a heart attack. Second hand smoke also may increase risk.

High cholesterolDietary sources of cholesterol are meat, eggs, and other animal products. The body alsoproduces it. Age, sex, heredity, and diet affect one's blood cholesterol. Total blood cholesterol is considered high atlevels above 240 mg/dL and borderline at 200-239 mg/dL. High-risk levels of low-density lipoprotein (LDL cholesterol)begin at 130-159 mg/dL, depending on other risk factors. Risk of developing coronary artery disease increases steadilyas blood cholesterol levels increase above 160 mg/dL. When a person has other risk factors, the risk multiplies.

High blood pressureHigh blood pressure makes the heart work harder and weakens it over time. It increases the riskof heart attack, stroke, kidney failure, and congestive heart failure. A blood pressure of 140 over 90 or above is consideredhigh. As the numbers rise, high blood pressure goes from Stage 1 (mild) to Stage 4 (very severe). In combination withobesity, smoking, high cholesterol, or diabetes, high blood pressure raises the risk of heart attack or stroke several times.

Lack of physical activityLack of exercise increases the risk of coronary artery disease.Even modest physical activity, like walking, is beneficial if done regularly.

Diabetes mellitusThe risk of developing coronary artery disease is seriously increased fordiabetics. More than 80% of diabetics die of some type of heart or blood vessel disease.

Signs and Symptoms of Coronary Artery Disease

In popular media, a heart attack victim clutches his or her chest and falls to the ground. However, symptomsof coronary artery disease are often far less obvious, ranging from mild discomfort to extreme pressure or

pain. If one or more of signs or symptoms is present, call a doctor or seek emergency care immediately.

Signs and symptoms of a heart attack include:

Pressure, tightness, and a squeezing pain in your chest Shortness of breath Pain radiating down your arm, shoulders, jaw, neck, and back, particularly on the left side Dizziness, sweating, weakness Anxiety, feeling of impending doom Indigestion or nausea and vomiting

Heart attack symptoms can vary significantly. Seek emergency medicalassistance if you suspect you may be having a heart attack.


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Preceding a heart attack, women willoften experience the same symptomsof pressure or pain in the chest thatmen do. But they have a greater chanceof experiencing less obvious signs:

Excessive fatigue

Pressure in the chest or middle of the back

Cold sweats

Hormone replacement therapyEvidence from a large trial called theWomen's Health Initiative released in2002 and 2003 found that hormonereplacement therapy is a risk factorfor coronary artery disease inpostmenopausal women. The therapywas once thought to help protect womenagainst heart disease, but in the trial, it wasdiscovered that it was harmful to womenwith existing coronary artery disease.

Women's Heart Disease Symptoms

"It's important for women to understand that heartdisease is also a woman's disease," says Mary Ann

McLaughlin, MD, Associate Professor of Cardiologyand Director of the Women's Cardiac Assessmentand Risk Evaluation (CARE) Program at MountSinai Heart. "The warning signs of heart attackin women can differ from the classic ones, and

Mount Sinai cardiologists are well versed and veryknowledgeable about the specific risks for women."

As part of her mission to help women take heart diseaseseriously, Dr. McLaughlin gives talks at middle schoolsand nursing homes, country clubs and churches. She

participates in health fairs, where she and her colleaguescheck blood pressure, measure body mass index, andoffer cooking demonstrations. Dr. McLaughlin hasbeen a regular on television shows such as "Martha"and is widely quoted in newspapers and magazines.

Detection and Diagnosis of Coronary Artery Disease

It's easy to recognize coronary artery diseaseafter someone suffers a heart attack. It is morechallenging to detect it in people who showno signs or symptoms of heart disease.

"The whole paradigm is shifting away from targeting

the person who is at the edge of the cliff, and towardidentifying the patient well before he reaches that edge,"says Jonathan L. Halperin, MD, Professor of Cardiologyand Director of Clinical Cardiology Services at MountSinai Heart. "It's not only being able to identify the disease

when it is there, but identifying it before it is threatening."

Mount Sinai's cardiologists use hands-on methodsto identify heart disease. Valentin Fuster, MD, PhD,Professor of Cardiology and Director of MountSinai Heart, sometimes asks patients in his officeto do a series of sit-ups, then listens to their hearts.Dr. Fuster's diagnostic skills, honed by decadesof experience, enable him to tell just by hearing

the heart's sounds after exertion whether blockedarteries have caused the vessel walls to stiffen.

"For every patient, there is an appropriate test."says Annapoorna Kini, MD, Associate Professor ofCardiology and Associate Director of the MountSinai Cardiac Catheterization Lab. "If one test isnot giving us the answer we're looking for, wealways have another, whether it's an angiogram,ultrasound, or checking the pressure gradient inthe arteries. We have everything we need."

Assessing Your Heart Disease Risk

A thorough physical examination isthe first step in any comprehensive

heart health assessment. But atsome point, physicians may needto peer inside your body.

Diagnostic tests can:

Confirm a diagnosis

Predict long-term outcomes

Identify patterns of disease associatedwith an adverse prognosis

Identify patients who might benefitfrom more aggressive interventions

Judge the risk of cardiac events

Assessing a patient at risk of coronaryartery disease depends on his or herhealth, age, and significantly, gender.


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TreatmentCoronary artery disease can be treated many ways. The choice of treatment depends on theseverity of the disease. Treatments include lifestyle changes and drug therapy, percutaneoustransluminal coronary angioplasty and coronary artery bypass surgery. Coronary artery diseaseis a chronic disease requiring lifelong care. Angioplasty or bypass surgery is not a cure.

To maintain heart health, the physician considers a series of factors as they determine the method of treatment.These factors may involve lifestyle changes, medications, and in more advanced cases, surgery and rehabilitation.

People with less severe coronary artery disease may gain adequatecontrol through lifestyle changes and drug therapy. Many ofthe lifestyle changes that prevent disease progressiona low-

fat, low-cholesterol diet, weight loss if needed, exercise, and notsmokingalso help prevent the disease from developing.

Drugs such as nitrates, beta-blockers, and calcium-channel blockersrelieve chest pain and complications of coronary artery disease, butthey cannot clear blocked arteries. Nitrates (nitroglycerin) improveblood f low to the heart. Beta-blockers (acebutelol, propranolol) reducethe amount of oxygen required by the heart during stress. One typeof calcium-channel blocker (verapamil, diltiazem hydrochloride) helpskeep the arteries open and reduces blood pressure. Aspirin helps preventblood clots from forming on plaques, reducing the likelihood of a heartattack. Cholesterol-lowering medications are also indicated in most cases.

Factors that determine the course oftreatment for heart disease include:

Overall health

Age

Progression of the disease

Risk factors

Patient preferences

Prognosis

PhotocourtesyofMountSinaiMedicalCenter


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Heart Bypass Surgery

Sometimes coronary artery bypass graft surgery(CABG) is the best option for people with coronaryartery disease. In this procedure, surgeons replacediseased arteries with healthy ones. Blood vesselsremoved from the chest, legs, or arms find a newhome in the heart, keeping it well nourished.

In coronary artery bypass surgery, a healthy artery orvein from an arm, leg, or chest wall is used to builda detour around the coronary artery blockage. Thehealthy vessel then supplies oxygen-rich blood to theheart. Bypass surgery is major surgery. It is appropriatefor those patients with blockages in two or three major

coronary arteries, those with severely narrowed left maincoronary arteries, and those who have not respondedto other treatments. It is performed in a hospital undergeneral anesthesia. A heart-lung machine is used tosupport the patient while the healthy vein or artery isattached past the blockage to the coronary artery. About70% of patients who have bypass surgery experiencefull relief from angina; about 20% experience partialrelief. Only about 3-4% of patients per year experiencea return of symptoms. Survival rates after bypasssurgery decrease over time. At five years after surgery,survival expectancy is 90%, at 10 years about 80%,at 15 years about 55%, and at 20 years about 40%.

Mount Sinai Heart features the daVinci SurgicalSystem, a robotic device surgeons use to performminimally invasive bypass surgery. The technologymakes use of fingertip-size incisions, allowing patientsa shorter hospital stay and a speedier recovery.

Another technique is the off-pump bypass, or "beatingheart" surgery. Surgeons often perform bypass surgeryusing a heart-lung machine, which stops the heart frombeating, allowing surgeons to operate on a motionless,blood-free surface. The machine draws blood out of theheart and sends it to an artificial lung outside the body,

where it receives oxygen. The newly oxygenated blood isthen sent back into the bloodstream through the aorta,

where it circulates throughout the rest of the body.

"For the right patients, off-pump graft surgeryis a better option than conventional surgery,"says Ramachandra C. Reddy, MD, AssistantProfessor of Cardiothoracic Surgery. For this typeof surgery, the heart-lung machine is not used.Using stabilizing techniques, the surgeon grafts thebypass onto the heart while it continues to beat.

Off-pump bypass surgery offers many benefits.These benefits include a reduced need for bloodtransfusions, less risk of bleeding, stroke, andkidney failure, and reduced chance of nerve damage.Hospital stays are shorter, and patients can makea quicker return to day-to-day activities.

Percutaneous transluminal coronary angioplasty andbypass surgery are procedures that enter the body(invasive procedures) to improve blood flow in thecoronary arteries. Percutaneous transluminal coronaryangioplasty, usually called coronary angioplasty, isa non-surgical procedure. A catheter tipped with aballoon is threaded from a blood vessel in the thighinto the blocked artery. The balloon is inflated,compressing the plaque to enlarge the blood vesseland open the blocked artery. The balloon is deflated,and the catheter is removed. Coronary angioplastyis performed in a hospital and generally requires a

stay of one or two days. Coronary angioplasty issuccessful about 90% of the time, but for one-third ofpatients, the artery narrows again within six months.

The procedure can be repeated. It is less invasive andless expensive than coronary artery bypass surgery.

Various semi-experimental surgical procedures forunblocking coronary arteries are currently beingstudied. Athererctomy is a procedure in which thesurgeon shaves off and removes strips of plaque fromthe blocked artery. In laser angioplasty, a catheter

with a laser tip is inserted into the affected artery toburn or break down the plaque. A metal coil called astent can be implanted permanently to keep a blocked

artery open. Stenting is becoming more common.


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Traditional imagingtechnologies include:

Exercise stress testing: Patientsexercise on a treadmill whileclinicians monitor their hearts

Nuclear stress testing: Combinesexercise or medical stress testingwith nuclear images of bloodflow to the heart, improving theaccuracy of coronary diseasedetection as compared withconventional stress testing

Calcium scoring: Tests for hardplaque build-up in artery walls

Echocardiography: Uses sound toform a moving picture of the heart can be combined with stresstesting (stress echocardiography)for detection of coronary disease

Medical Therapy forCoronary Artery Disease

Medical therapy for coronaryartery disease consists of singleor combined medications toreduce major contributingfactors to diseased arteries.

Medications include:

Aspirin, which thins bloodto prevent clots

Cholesterol medications, such asstatins, which can reduce and evenreverse the buildup of plaques

Beta blockers, which improveblood flow by reducing theheart's need for oxygen

Nitroglycerin, which opens thecoronary arteries to increaseblood flow to the heart

ACE inhibitors, which lower

blood pressure and allow moreblood to get to the heart

Calcium channel blockers, whichrelax and open the musclearound the coronary artery

Emerging therapies such as thepolypill, an exciting advancementfrom Mount Sinai Heart that iscurrently being tested worldwide

RESCUE YOUR HEARTPrevention

A healthy lifestyle can help prevent coronary artery disease andhelp keep it from progressing. A heart-healthy lifestyle includeseating right, regular exercise, maintaining a healthy weight, nosmoking, moderate drinking, no recreational drugs, controllinghypertension, and managing stress. Cardiac rehabilitation programsare excellent to help prevent recurring coronary problems for people

who are at risk and who have had coronary events and procedures.

Eating right

A healthy diet includes a variety of foods that are low in fat, especiallysaturated fat, low in cholesterol, and high in fiber. It includes plenty

of fruits and vegetables, nuts and whole grains, and limited sodium.Some foods are low in fat but high in cholesterol and some are lowin cholesterol but high in fat. Saturated fat raises cholesterol and, inexcessive amounts, increases the amount of the clot-forming proteinsin blood. Polyunsaturated and monounsaturated fats are good for theheart. Fat should comprise no more than 30% of total daily calories.

Cholesterol, a waxy substance containing fats, is found in foods suchas meat, eggs, and other animal products. It also is produced in theliver. Soluble fiber can help lower cholesterol. Dietary cholesterolshould be limited to about 300 milligrams per day. Many popularlipid-lowering drugs can reduce LDL cholesterol by an averageof 25-30% when used with a low-fat, low-cholesterol diet.

Fruits and vegetables are rich in fiber, vitamins, and minerals.They are low calorie and nearly fat free. Vitamin C and beta-carotene, found in many fruits and vegetables, keep LDL cholesterolfrom turning into a form that damages coronary arteries.

Excess sodium can increase the risk of high bloodpressure. Many processed foods contain large amounts ofsodium. Daily intake should be limited to about 2,400milligrams, about the amount in a teaspoon of salt.

The "Food Guide" Pyramid developed by the U.S. Departmentsof Agriculture and Health and Human Services provides easy-to-follow guidelines for daily heart-healthy eating. It recommends

6 to 11 servings of bread, cereal, rice, and pasta; three to fiveservings of vegetables; two to four servings of fruit; two to threeservings of milk, yogurt, and cheese; and two to three servingsof meat, poultry, fish, dry beans, eggs, and nuts. Fats, oils, andsweets should be used sparingly. Canola and olive oil are betterfor the heart than other cooking oils. Coronary patients shouldbe on a strict diet. In 2003, the American Heart Associationadvised a diet rich in fatty fish such as salmon, herring, trout,or sardines. If people cannot eat daily servings of these fish,the association recommends three fish oil capsules per day.


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Regular exercise

Aerobic exercise can lower blood pressure, help controlweight, and increase HDL ("good") cholesterol. It maykeep the blood vessels more flexible. The Centers forDisease Control and Prevention and the AmericanCollege of Sports Medicine recommend moderate tointense aerobic exercise lasting about 30 minutes fouror more times per week for maximum heart health.

Three 10-minute exercise periods also are beneficial.Aerobic exerciseactivities such as walking, jogging,and cyclinguses the large muscle groups and forcesthe body to use oxygen more efficiently. It also caninclude everyday activities such as active gardening,climbing stairs, or brisk housework. People withcoronary artery disease or risk factors should consulta doctor before beginning an exercise program.

Maintaining a desirable body weight

About one-fourth of all Americans are overweight andnearly one-tenth are obese, according to the SurgeonGeneral's Report on Nutrition on and Health. People

who are 20% or more over their ideal body weight havean increased risk of developing coronary artery disease.Losing weight can help reduce total and LDL cholesterol,reduce triglycerides, and boost HDL cholesterol. Italso may reduce blood pressure. Eating right andexercising are two key components of losing weight.

Avoiding recreational drugs

Smoking has many adverse effects on the heart. Itincreases the heart rate, constricts major arteries, andcan create irregular heartbeats. It raises blood pressure,contributes to the development of plaque, increases theformation of blood clots, and causes blood plateletsto cluster and impede blood flow. Quitting can repair

heart damage caused by smoking. Even heavy smokerscan return to heart health. Several studies have shownthat ex-smokers face the same risk of heart disease asnon-smokers within five to 10 years after quitting.

Drink in moderation. Modest consumption of alcoholmay actually protect against coronary artery diseasebecause alcohol appears to raise levels of HDLcholesterol. The American Heart Association definesmoderate consumption as one ounce of alcohol per day,roughly one cocktail, one 8-ounce glass of wine, ortwo 12-ounce glasses of beer. However, even moderatedrinking can increase risk factors for heart disease for

some people (by raising blood pressure, for example).Excessive drinking always is bad for the heart. It usuallyraises blood pressure and can poison the heart andcause abnormal heart rhythms or even heart failure.

Do not use other recreational drugs. Commonly usedrecreational drugs, particularly cocaine and "crack," canseriously harm the heart and should never be used.

Seeking treatment for hypertension

High blood pressure, one of the most common andserious risk factors for coronary artery disease, can becontrolled completely through lifestyle changes andmedication. Moderate hypertension can be controlled

by reducing dietary intake of sodium and fat, exercisingregularly, managing stress, abstaining from smoking, anddrinking alcohol in moderation. People for whom thesechanges do not work or people with severe hypertensionmay be helped by many categories of medication. "-Thisinformation provided courtesy of Mount Sinai Heart


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A HIRO inRadiology

M

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

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

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

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



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

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

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

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

all of the sites that are participating in the trial.

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

who isnt familiar with the intricacies of radiology.

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

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

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

what the drug company wants for the clinical t rial.

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

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

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

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

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


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

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

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

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

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

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

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

specialize in editing images to adhere to privacy standards.

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

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

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

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

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


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CANCER - DID YOU KNOW?There are many myths out there. On 4 February 2013 get the facts.

worldcancerday.org

_ _ _ / /


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TelephoneTalks

withNurseCan

ReduceHospital

Re-admissions

W

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

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

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

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

William S. Middleton Memorial Veterans Hospital.

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

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

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

HealthyHelp

-APhoneCallAway


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

Kind said most of these discussions involved

the proper use of medications.

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

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

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

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

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

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

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

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

wasnt even an option for them until C-TraC.

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

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

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

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

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


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The Timeis

NowTogether, WeWill End Cancer

InspiredbyAmericasdrivegenerationsagotoputamanonthemoon,TheUniversityofTexasMDAndersonCancerCenterhaslaunchedanambitiousandcomprehensiveactionplan,calledtheMoonShotsProgram,tomakeagiantleapforpatientstodramaticallyacceleratethepaceofconvertingscientificdiscoveriesintoclinicaladvancesthatreducecancerdeaths.

whatdoctorsknow.com


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T

his pastSeptember,

The Universityof Texas MD

AndersonCancer Center

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

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

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

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

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

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

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

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

The inaugural moon shots

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

clinicians to mount comprehensive attacks on: acute myeloid leukemia/

myelodysplastic syndrome;

chronic lymphocytic leukemia;

melanoma;

lung cancer;

prostate cancer, and

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

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

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

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


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The platforms make the program unique

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

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

will leverage the investment across the moon shots.

These platforms include:

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

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

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

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

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

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

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

Institute for Applied CancerScience: Developing effectivetargeted cancer drugs.

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

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

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

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

MD Anderson's "Giant leap for mankind"

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

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

Anderson teams, sometimes numbering in the hundreds.

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


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

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

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

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

Most ambitious program MDAnderson has ever mounted

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

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

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

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

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

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

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

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


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HealthWatchMD

with Dr. Randy Martin

Provided courtesy of Piedmont Healthcare

Dr. Randy Martin: Heartfailure is a major problem inthis country, but there is acommon type of heart failurethat is often overlooked. Imet with fellow cardiologistDr. Winston Gandy to gethis views on this condition.

Common Typeof Heart ConditionOften Overlooked

Heart failure symptoms

Shortness of breath Dizziness

Fatigue Fluid in the lungs

Swelling in the ankles Irregular heartbeats

Chest pain Nausea

Difficulty Sleeping


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Defining heart failure

Heart failure occurs when the heartis unable to pump enough bloodout of the heart, and either throughleakage of the valves or the heart notsqueezing normally, the condition

raises the pressure in the lungs, says WinstonGandy, M.D., a cardiologist at Piedmont Hospital.This creates a sensation of shortness of breath.

Dr. Gandy says that heart failure does notnecessarily mean the heart is failing; it is rathera constellation of symptoms that cause theheart to not pump as well as it should.

Systolic vs. Diastolic Function of the Heart

The squeezing component [of heart function] is thesystolic function and the relaxingcomponent is the diastolic function,says Dr. Gandy. To determine a

persons blood pressure, physicianslook at both of these functions.When the heart squeezes, that

will generate the top number,when the heart relaxes, that willresult in the bottom number.

Diastolic Dysfunction

A study from the Cleveland Cliniclooked at outpatients who hadechocardiograms, or ultrasoundimaging of the heart, for variousreasons. Researchers looked at

the flow patterns when the heartspumping chamber was being filled,says Dr. Gandy. What they noticed

was a certain pattern that they termeddiastolic dysfunction. It turned outthat a large group of individuals, themajority of patients, have some typeof abnormality with that inflow.

In this particular study, in thosepatients who had moderate andsevere diastolic dysfunction,there was an increase in the

incidence of heart failure events.Who is at risk for diastolicdysfunction?

Those with longstanding highblood pressure are at risk, saysDr. Gandy. Patients who sufferfrom coronary heart disease arealso at risk, as are some diabeticsbecause they can experiencediffused disease that causesscaring in the heart over time.

Dr. Randy Martin: As Dr. Gandy noted, diastolic

heart failure can lead to serious consequences.Remember that high blood pressure especially if itsnot adequately treated is one of the major causes ofdiastolic heart failure. While medication is one of theways to treat hypertension or high blood pressure, keythings you can do include cutting way back on salt inyour diet, exercising regularly and losing weight. Youshould also know the symptoms of heart failure andbe sure to check with your doctor if you have any.

Treatment for diastolic dysfunction

We want to treat the cause of the diastolicdysfunction, but most of the medicines

we have available to us are multifactorialin what they can do, says Dr. Gandy. Headds that doctors can choose to control

hypertension, high blood pressure,renal failure or diabetes to treat diastolicdysfunction. There may be drugs that notonly help lower blood pressure, but alsobetter enable the heart muscle itself to relax.

His key message: When you have moderate tosevere diastolic dysfunction, it should promptthe clinician to look for other related issues so

we can identify someone who may be at risk.


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Getting Back inthe Game...of Life

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

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

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

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

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

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

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

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

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

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

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


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

Attention must be paid to what is motivating the

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

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

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

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

weight ranges andrecovery behaviorsnecessary for healthy

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

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

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

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

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

healthy and long-lasting recovery.-

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


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New Head Lice Treatment

Now Available

About Head LiceHead lice are wingless parasites that feed on

human blood and live close to the human scal

They move by crawling and are mainly spreadby head-to-head contact, most commonly

among preschool children attending childcareelementary schoolchildren and the household

members of infested children. Infrequently,transmission may occur by contact with items

recently used by an infested person, suchas clothing, brushes, towels or pillows.

For more information, please see Full Prescribing Information forSklice Lotion located at www.Sklice.com or call 855-4-SKLICE.

In the United States, infestation with head lice is most common among preschoolchildren attending childcare, elementary school children, and the household membersof infested children. Although reliable data on how many people in the UnitedStates get head lice each year are not available, an estimated 6 million to 12 millioninfestations occur each year in the United States among children 3 to 11 years of age.

Sanofi Pasteur, the vaccines division of Sanofi has made its Sklice, head licetreatment shampoo available by prescription in U.S. pharmacies. The productis for the topical treatment of head lice infestations in patients 6 months of age

and older, and to be used as part of an overall lice management program.Sklice Lotion was developed as an effective head lice treatment option welltolerated in children 6 months of age and older. In clinical trials, Sklice Lotion wasproven to resolve most head lice infestations with one well-tolerated, 10-minuteapplication. Two weeks after the initial treatment, 71-76 percent of patients treated

with Sklice Lotion were lice-free. The most common side effects included eyeredness or soreness, eye irritation, dandruff, dry skin and burning sensation ofthe skin, none of which occurred in more than one percent of treated patients.

Sklice Lotion should be used as part of an overall lice management program,which includes washing (in hot water) or dry-cleaning all recently worn clothing,hats, used bedding and towels, as well as washing personal care items such ascombs, brushes and hair clips in hot water. No nit combing is required; however,if desired, a fine-tooth comb may be used to remove dead lice and nits.

Sklice Lotion contains a broad-spectrum antiparasitic agent, ivermectin,which was developed from a soil bacterium that produces a family ofcompounds (avermectins) shown to bind selectively and with highaffinity to certain ion channels present in invertebrate nerve and musclecells but not in mammals. The resulting increased permeability ofthe cell membrane causes paralysis and death in certain parasites.

Developed by Topaz Pharmaceuticals, which was acquired bySanofi Pasteur in October 2011, Sklice Lotion was approved bythe U.S. Food and Drug Administration (FDA) in February2012. Sklice Lotion is only available by prescription. Parents mustcontact their health care provider before going to the pharmacy.

Sklice Lotion is a prescription medication for topical useon the hair and scalp only, used to treat head lice in people

6 months of age and older. The product should be used aspart of an overall lice management program including:

Washing (in hot water) or dry-cleaning all recentlyworn clothing, hats, used bedding and towels.

Washing personal care items such as combs,brushes and hair clips in hot water.

Using a fine-tooth comb or special nit combto remove dead lice and nits.

Sklice Lotion should only be used under the direct supervisionof an adult. Avoid getting Sklice Lotion in the eyes.


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Ignoring the FluCan Be Deadly

On December 20, 2009,32-year-old actressBrittany Murphydied of flu related

complications in herBeverly Hills, California

home. Five months later her husband,Simon Monjack, was found dead inthe same home with the same causeof death flu related complications.

Ignoring the flu can certainly bedeadly. Far too often, confused withthe common cold, the flu (influenza) isa contagious respiratory illness causedby influenza viruses. They are uniqueamong respiratory viruses because theyre

amazingly adaptable and have a historyof drifting and shifting into other,sometimes more lethal combinations.

Thats why a new influenza vaccinehas to be prepared every year.

Flu season is from late Novemberthrough March. Each year 35 to50 million people are infected withinfluenza. Annual deaths from influenzain the United States have ranged fromas few as 3,000 to as high as 49,000.

People who develop flu may quicklydevelop influenza pneumonia. If youbegin to have a rapid breathing rate,rapid heart rate, lightheadedness, or

shortness of breath you should goto the emergency room or call yourdoctor. The virus also can damagethe lungs and set up a pneumoniacaused by bacteria. If you developshaking chills, chest pain or pain

when you breathe, or bring up sputumcontaining blood, you should go to theemergency room or call your doctor.

Influenza can be spread to otherpeople beginning one day before anysymptoms develop and up to seven

days after becoming sick. When peoplecough, sneeze, or talk, droplets spreadthe virus. Less often, touching asurface a flu virus can lead to infection.

A flu vaccine def initely is the bestprotection against influenza. However,those with severe allergy to chickenegg, anyone who has had a severeallergic reaction to the influenza

vaccine in the past, and childrenyounger than six months should not be

immunized. If you are sick and have afever, you should wait until you haverecovered before getting the flu shot.

Theres a lot you can do to helpprevent the spread of germs that causerespiratory illnesses like the flu.

Cover your nose and mouth with atissue when you cough or sneeze.Discard the tissue in the trash.

Wash your hands often withsoap and water. If soap andwater are not available, use analcohol-based hand rub.

Avoid touching your eyes, nose ormouth. Germs spread this way.

Try to avoid close contact with sickpeople. If you are sick with flu-like illness, the CDC recommendsthat you stay home for at least 24hours after your fever is gone.

Be prepared in case you get sickand need to stay home for a weekor so. Have a supply of over-the-counter medicines, hand sanitizer,tissues and other related itemsto avoid trips out in public whileyou are sick and contagious.

-Vicki Lyons, MD andTimothy J. Sullivan, MD

whatdoctorsknow.com


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Love YourHeartTakeStepstoReduceHeartRisks

February is American Heart

Montha time to ref lecton the sobering fact thatheart disease remainsthe number one killer ofboth women and men in

the United States. The good newsis you have the power to protectand improve your heart health.


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NIH and other government agencies have beenworking to advance our understanding of heartdisease so that people can live longer, healthier lives.Research has found that you can lower your risk forheart disease simply by adopting sensible health habits.

To protect your heart, the f irst step is to learn your

own personal risk factors for heart disease. Riskfactors are conditions or habits that make youmore likely to develop a disease. Riskfactors can also increase the chancesthat an existing disease will get worse.

Certain risk factorslike gettingolder or having a familyhistory of heart diseasecant be changed. But youdo have control over someimportant risk factors suchas high blood cholesterol,

high blood pressure, smoking,excess weight, diabetes andphysical inactivity. Many peoplehave more than one risk factor. Tosafeguard your heart, its best tolower or eliminate as many as youcan because they tend to gang upand worsen each others effects.

A large NIH-supported study publishedlast month underscores the importanceof managing your risk factors. Scientistsfound that middle-aged adults with one ormore elevated risk factors, such as high blood pressure,

were much more likely to have a heart attack or othermajor heart-related event during their remaininglifetime than people with optimal levels of risk factors.

For example, women with at least 2 major risk factorswere 3 times as likely to die from cardiovasculardisease as women with none or 1 risk factor, says Dr.Susan B. Shurin, acting director of NIHs NationalHeart, Lung and Blood Institute. You can andshould make a difference in your heart health byunde

Documents

What Doctors Know - October 2012