what doctors know - vol 1 issue 4

7/27/2019 What Doctors Know - Vol 1 Issue 4

http://slidepdf.com/reader/full/what-doctors-know-vol-1-issue-4 1/84

Special thanks to: Sharon Osbourne,

Sir Elton John, Dr. Edward Phillips,

and Cedars-Sinai Medical Center of

Beverly Hills.

Vol.1, Issue 4 $ 4.99

Acid Reflux

Fertility Advance

Science to Get Excited About

PARKINSON'S RESEARCH:

Bring Help & Hop

The Burning Issu



THE MONSTER ISN’T

UNDER THE BED.

IT’S IN THE fRIDgE.

People with eating disorders often distort the size of their food, so they’ll eat less. They distort thesize of their body, so thin looks fat. Which yields a fact that isn’t distorted at all—without treatment,

many won’t survive. But to read about those who have, go to myneda.org

National

Eating

Disorders

Association



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Welcome to the April/May issue of What Doctors Know. April is one of my favorite months because it signals the end of the cold and bitter winter monthsand the start of the amazing sights, sounds and smells of Spring.

This month we have added a number of Medical Centers who are embracing ourquest to bring readers current and cutting edge healthcare information.

We are especially grateful to Michael J. Fox and his foundation for its participationin our efforts to educate and inform. However, the Michael J. Fox Foundation doesmore than inform and educate. This is a dedicated group – lead by the endless energy of Michael J. Fox – passionately committed to finding a cure for Parkinson’s.

We are thankful for celebrities like Michael J. Fox who do more than loan their name for publicawareness. These are celebrities who are genuinely involved – because they have been affected personally.

Last month, we had Sharon Osborne on our cover for her drive to gainattention to colon cancer prevention and the need for screenings.

In addition to bringing attention to Parkinson's disease, in this issue we are offeringextensive information on acid reflux. Because it is a difficult subject to cover in oneissue, over the months we will be offering a collection of articles on the subject.

As you read this issue, you may have ideas, thoughts and suggestions. We are alwaysinterested in hearing from our readers. Let us know your thoughts. We appreciate readerfeedback about the content of the magazine and will continue to improve with input from readers like you. Send us a note at [email protected]. If you are aphysician or medical professional interested in writing for the magazine, don’t hesitateto contact us with your ideas and suggestions at [email protected].

Help us, educate and inform.

Don’t forget, it’s spring, so take a moment to go outside and smell the flowers.

Till next month.

Steve

Steve Porter, MD

Publisher and Chairman

On Call with Dr. Porter

Special Thanks To:



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HEADlines

20 Setting the Record Straight: Why Mammograms Remainthe Gold Standard

22Heart Disease

24 Don’t Let Your AllergiesBloom This Spring

27 Luella Love: New Lungsfor a New Life

6 Hitting Sports Injuries“Head On”

8 How to Handle My Child’sDental Emergencies

10 Otoplasty for Outstanding Ears

12 Could Hearing LossContribute to Dementia?

14 “The Answer is in All of Us”

29 Flu, Cold or Virus

32 Acid Reflux: TheBurning Issue

36 When Surgery is Needed to Correct Acid Reflux

38 Reflux in Redux

45 Grumbling Guts?

46 Boys Get EatingDisorders, Too

48 The Emotional Road to Family Life

IN THE TRUNK

BELOW THE BELT

P45

51 When Eating Goes to Extremes

53 Through Thick & Thin

56 Fertility AdvancesBring Help & Hope

WHAT DOCTORS KNOWAnd you should, too!

P6

P27



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Vol. 1 Issue 4

On the Cover14 “TheAnsweris

inAllofUs”

32 AcidReflux:TheBurningIssue

56 FertilityAdvancesBringHelp&Hope

66 HealthWatchMD: Arthritis

68 The Nutritional Gatekeeper & The 72% Solution

70 New Melanoma Drug

72 Osteoporosis: Get the Facts

76 Steer Children Clear of Lawn Mower Injuries

78 Sunscreen: Looking Beyond the Numbers

MIND, BODY, AND SOUL

60 Identifying Parkinson’s Disease

62 Partial Hearing Loss & TheHybrid Cochlear Implant

64 “Brain Pacemaker” –BringingHope to Parkinson’s Patients

TECHNOLOGY & YOUR HEALTH

01 OnCallWithDr.Porter

04 MeetOurDoctors

66 HealthWatchMD:Arthritis

In Every Issue

P72

Special thanksto: SharonOsbourne,

SirEltonJohn, Dr. EdwardPhillips,

andCedars-SinaiMedicalCenterof

Beverly Hills.

Vol.1,Issue4 $ 4.99

Acid Reflux:

Fertility Advances


PARKINSON'S RESEARCH:

Bring Help & Hope

The Burning Issue

P64

Contents

Cover photography by Mark Seliger



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Meet Our Doctors

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

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

Brian Wansink, PhD

Director and the JohnDyson Professor of

Marketing of theCornell Food and Brand Lab in theDepartment of Applied Economicsand Management at Cornell University in Ithaca, New York. Contact Dr.Wansink through the Cornell Food

and Brand Lab website at www. [email protected].

Rosalynn Crawford-McKendall, DDS

Assistant Professorin the Department of Pediatric Dentistry at LSU Health SciencesCenter New Orleans School of Dentistry. Dr. Crawford-McKendallreceived her doctor of dental surgery and certification in pediatric dentistry from New York University (NYU)College of Dentistry. She was aclinical assistant professor in thePediatric Dentistry Department of NYU College of Dentistry.

Scott K.Thompson, MD

Board certified inboth facial plastic and reconstructive surgery, as

well as otolaryngology.Dr. Thompson has joined a select group of surgeons from Boston and Rochester, New York who travel toEcuador and Guatemala twice a year ona charitable journey to correct congenitalear deformities on local children.

Visit Dr. Thompson’s website for more information at www.utahfacialplastics.com

Steven Porter, MD

Founder and publisher of What Doctors Know, Dr.Porter is recognized as one of the topgastroenterologistsin the country. He is the medicaldirector of the endoscopy labat a leading hospital in Ogden,Utah and has been practicingfor more than 25 years. Contact Dr. Porter at (801)387-2550.

Vicki Lyons, MD

Founding memberand chairmanof the editorialadvisory board of What DoctorsKnow, Dr. Lyonsis a board certified and fellowshiptrained allergist and immunologist practicing in Ogden, Utah. Shehas been practicing for 20 years.

Contact Dr. Lyons at (801)387-4850 or www.vicki-lyonsmd.com.

Timothy J.Sullivan, MD

Contributing editorialadvisory board memberof What DoctorsKnow, Dr. Sullivanspent 25 years in full-time academicmedicine 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 professorat the Medical College of Georgia.Contact Dr. Sullivan at (404)255-2918 or www.trittbreatheandsleep.com.



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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

Timothy J. Sullivan, MD

Editorial and Design DirectorBonnie Jean Myers

Senior DesignerSuki Xiao

Design AssociateCayden Chan

Executive Director, MarketingLarry Myers

ProductionKai Xiao, Vice President

IT ManagerEric Lu

For more information on ad placement or contributing an article, pleaseemail [email protected], or call (801) 825-4600.

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

Corporate OfficeWhat Doctors Know

1755 E Legend Hills Dr., Suite

100, Clearfeld, UT 84015(801) 825-4600

Haydee Ojeda-Fournier, MD

Assistant professorof clinical radiology and medical directorof breast imagingat University of California SanDiego Moores Cancer Center.

LeGrand Belnap,MD, FACS

A member of severalmedical societiesincluding the AmericanCollege of Surgeons,the American Society for BariatricSurgery and The American Society of Transplant Surgeons. Dr. Belnapis a board certified general surgeon

who has received extensive training at the University of Utah, University of

Minnesota, University of Californiaand the University of Pittsburgh.He is currently a clinical professorof surgery at Utah-LDS Hospital.

Jeffrey Kahn, MD, PhD

Children’s MedicalCenter of DallasInfectious DiseaseExpert and UTSouthwestern

Medical Center Professor. Dr. Kahnis a pediatrician, board certified

in both general pediatrics and pediatric infectious diseases.

Russell A. Foulk, MD

Internationally

renowned expert in thetreatment of infertility.Dr. Foulk is an associateclinical professor at theUniversity of Washington, Department of OB/GYN and at the University of

Nevada, School of Medicine. He hasset up several IVF centers in Nevada,Idaho, Utah, Hawaii, Belgrade and Serbia. Recently serving as President of the Pacific Coast ReproductiveSociety, Dr. Foulk has been on theBoard of Directors of the Society

for more than eight years. Visit Dr. Foulk’s website at www.utahfertility.com



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A grant from the

NCAA will kick off

a groundbreaking,long-term study of concussion and other head injuries

among athletes, led by University of Michigan researchers and theircolleagues around the country.

The NCAA will provide$400,000 to begin to fund alongitudinal study by the NationalSport Concussion OutcomesStudy Consortium, a new groupthat includes three foundingmembers from the University of

Michigan: Jeffrey Kutcher, M.D.,associate professor of neurology;

James T. Eckner, M.D., assistant professor in physical medicineand rehabilitation; and StevenBroglio, Ph.D., assistant professor of kinesiology.

With the NCAA grant, theConsortium will study more than1,000 male and female collegeathletes who compete in 11 sports

at three schools. Researchershope to track those athletesthroughout their lifetime to monitorlong-term effects of head injuries.

But the Consortium has even biggerplans. Kutcher says the group isseeking funding to expand theeffort and begin enrolling athletesas early as high school, thenfollow them through college and even into professional careers.

“We’re hoping this could become aFramingham heart study for sportsconcussion,” says Kutcher, referringto the study that began in 1948

with more than 5,000 people and has led to the identification of majorcardiovascular disease risk factors.

“This study will be essential toimproving our understanding of the

risk to brain health for those who play sports. There is no data

like this, it’s groundbreaking.It will define the landscape.”

Kutcher and the U-M faculty founded the Consortium withKevin Guskiewicz, Ph.D.,chair of the Department of Exercise and Sport Scienceat the University of NorthCarolina; Chris Giza, M.D., of the Department of Neurology at UCLA; and Michael

McCrea, Ph.D., professorof neurosurgery and neurology and director of brain injury research at the

Medical College of Wisconsin.

“There’s a tremendous need for data that describe both theshort and long-term healthconsequences of concussions,”says Kutcher, who also is directorof the Michigan Neurosport Concussion Program at U-M.

“There are some hints, and

a series of case reports in theliterature, but no well-controlled study that addresses the long-termquestions. To do that study, and do it correctly, requires following apopulation of athletes over time and documenting their brain function,

while controlling for other variables.”

David Klossner, the NCAA’sdirector of health and safety, said supporting the consortium’s study

Hitting Sports Injuries

"Head On"Groundbreaking study of head injuries amongathletes kicks off with NCAA grant



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will aid efforts to promote a safecompetitive environment.

“The NCAA is seeking to fosterinnovative research among its memberuniversities to increase knowledge

about the short-term and long-termneurological consequences of

playing sports,” Klossner said.“In addition to monitoringtrends in concussionsthrough the Association’sinjury-surveillancesystem, this research is

another important stepto enhance student-athlete safety.”

In this f irst phase of the study, the Consortium

researchers will study athletes in

contact sports in men’s football, soccer,basketball ice hockey, and lacrosse; women’s water polo, soccer, basketball,field hockey, and lacrosse. Non-contact sport participants also willbe recruited from the track and field and swimming and diving teams.

Kutcher believes the data thestudy collects will provide a morecomprehensive understanding of concussions. The short-term effectshave been examined for several years,and technological advancements have

helped improve the understanding of impacts on the brain by using shock sensors embedded in players’ helmets.

“There has been considerable attentionpaid to concussion recently, by the mediaand others, spurred by reports of NationalFootball League players, hockey players

— people who have had a long history of contact — having a very particularkind of dementing illness,” says Kutcher.

“But that story is only beginningto be told. We need to do theappropriate research to figure out the scope of the problem.”

Kutcher also directs the NBA’sconcussion program, is a consultant tothe NHL Players Association and theteam neurologist for the University of

Michigan Athletic Department. Hehas been instrumental in crafting theconcussion policies of the NCAA, Big

Ten and Mid-American Conference.He has testified before U.S. Congresson helmet and equipment safety.

For more information and freeonline courses about recognizingand responding to concussions, go tohttp://www.michiganneurosport.com/ -This information provided courtesy of the University of Michigan Health System

Dr. Jeffrey Kutcher, M.D., examines one of his young patientsat the Michigan Neurosport Concussion Program.



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How to Handle My Child'sDental Emergencies

Children experiencedental emergencies daily.

Most pediatric dentalemergencies involvecavities and trauma.Dental emergencies can

range from a toothache and swelling,to trauma of teeth, surroundingbone, and any soft tissue, such as lips.

According to the American Academy of Pediatric Dentistry (AAPD), children

experience the greatest amount of trauma to the primary (baby) teethduring the ages of 2 to 3 when they aredeveloping their motor coordination.

The AAPD also mentions that injuriesto permanent teeth most commonly happen secondary to falls, trafficaccidents, violence, and sports. Allsports have some risk for injuries tothe face and teeth. Proper management of dental emergencies could prevent

long term problems. It is key toestablish a dental home for your child by age 1, so that you can learn about your child’s dental health and receiveinformation on trauma prevention.

What should I do if mychild has a toothache?

Call your child’s dentist immediately to schedule an emergency appointment if your child is having a toothache.

In cases of visible swelling to theface with or without a fever, you cancall your dentist on the way to yournearest hospital emergency room. It is important to get your child seen,because infectionsspread quickly inchildren. Somechildren requirea hospital stay to be givenIntravenous (IV)

antibiotics.

What should I think about if mychild falls and breaks a tooth?

First, if your child lost consciousness

during the fall, is vomiting, or isbehaving abnormally he or she willneed to go to the emergency room tobe evaluated for head trauma and any internal bleeding. Also, look for othercuts and injuries to the body. If you did not witness the accident and are not sure, take the child to the emergency room. After the child is stabilized,they will be sent for a consultation

with the dentist. Know when yourchild’s last tetanus was given.



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Primary (Baby) broken tooth:

For a tooth with a small chip or alarge chip with or without bleeding,you can try to have the child bite ona clean towel or gauze to stop thebleeding and call your dentist regardingthe emergency appointment. If thebleeding does not stop, you will need to proceed to the emergency room

with your child. Any damage to a

baby tooth during trauma can havean effect on the permanent teethranging from a discolored tooth, toa white spot, or defect on the tooth.

The damage caused wil l not be seenuntil the tooth erupts into the mouth.

Permanent broken tooth:

Call your dentist for an emergency appointment if your child has arecent broken tooth. If there is a largebroken piece, place it in milk and take it to the dentist with you. The

sooner these teeth are restored, even with a temporary, the more likely they will be able to keep them.

Some dental emergencies may be temporarily managed with medications.It is best to establish a dentist for your child and contact them first in an

emergency to see what is best for your child’s individual needs.

Some helpful tips:

• Stay calm in the emergency. Try tocalm your child down and evaluateyour child’s situation so that you canseek the care needed for them.

• Establish a dental home foryour child by age one or within6months of the 1st tooth erupting– dental emergencies are bestmanaged by your own dentistwho is known and trusted.

• Make sure your child is usinga mouthguard and protective

gear when playing sports• When choosing a dentist, make sure

they see children for after hoursemergencies. Do not ignore yourchild’s complaints of toothaches

• Keep the names and phonenumbers of your child’s dentistand pediatrician nearby

• Know the location of yourclosest hospital

• Know when your child had theirlast tetanus vaccination

• Place an ice pack to the area, if there is

a recent injury to the lips or soft tissueto help decrease swelling on the wayto the dentist/ER/or pediatrician

What if my child’s tooth isknocked out (avulsed)?

Primary (Baby) tooth knocked out:

Do not reimplant an avulsed baby tooth back into the mouth. Placingan avulsed baby tooth back in themouth can cause damage or possibleinfection to the permanent toothunderneath. If you are not sure thetooth is a baby or permanent, callyour child’s dentist immediately.

Permanent tooth knocked out:

Time is critical for an avulsed permanent tooth. It is very important for the tooth tobe reimplanted immediately. If you see thetooth is avulsed, immediately try to locatethe tooth. Once you get the tooth, identify the crown which is the short part of thetooth and the root (the longer portion of the tooth). The tooth should be cleaned

quickly and placed back into the toothsocket. Have the child bite down to get thetooth into place. It is better to transport the tooth partially in the socket as longas the child is not at risk of swallowingthe tooth. I you are unable to reimplant the tooth; it can be stored in cold milk and transported. If you don’t have milk,contact solution or saline is an alternative.

The tooth should never be transported in water or in a dry paper towel. Thechild should still present immediately to the dentist or emergency room for

stabilization of the teeth. Your child willneed a splint for the teeth and will likely need a root canal in the future. - RosalynnCrawford-McKendall, DDS. LouisianaState University Health Sciences Center.



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Otoplasty for OutstandingEars

Big ears are not funny. In fact, the American Society of Plastic Surgeons reported that nearly 40,000 teens in 2001 had

Otoplasty surgery to reduce the prominence of their ears.

Children and teens withprominent ears are oftenteased and ridiculed by their peers. Boysgrow tired of having togrow long hair to cover

their ears while girls affected by theproblem are reluctant to even tuck their hair behind their ears or wear a

pony tail – in fear of being ridiculed.Otoplasty gave these children morebalance to their facial features, but there are many patients and parents

who are unaware that overly prominent ears can be corrected by means of a simple surgical procedure.

Otoplasty, or ear pinning, is a surgicalprocedure for individuals whose ears areabnormally large or overly prominent. The



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As I see them back in my office followingrecovery with improved confidence and bigsmiles on their faces, I’m happy to know that I’vecontributed to that happiness in some way.

condition ranges from very mild, to the completeabsence of an ear (microtia) in severe cases. Forthe majority of patients with cupped, malformed,or even injured ears, dramatic improvement can be achieved through otoplasty surgery.

The procedure takes between one and two hours,depending upon the specific condition being

addressed. It can be done under local anesthesiain the office setting, but for younger children oraccording to patient wishes, surgical anesthesiacan be used. In any case, hospitalization is not required, recovery is quick, and pain control iseasily achieved with mild analgesic medications.

Ear pinning can be performed at any age but isbest done when patients are at least six or sevenyears old and can be involved and invested inthe decision and surgical process. I’ve performed this operation on children as young as four,but I prefer them to be closer to six, when they

are more aware of their bodies and becomeexcited about the change to their ears.

Although I do see some adults seeking improvement to their ears, the majority of patients are children.Concerned parents, most often prompted by theirchildren, bring them in for evaluation during theirschool years. As with all elective surgery, to meit’s very important for the patient to be part of the decision making process. When the patient isexcited about the change to their ears, he or sheis motivated and able to smoothly navigate thesurgical process. As I see them back in my officefollowing recovery with improved confidence and big smiles on their faces, I’m happy to know that I’ve contributed to that happiness in some way.

As for numbers of people affected, studies can’t isolate any race or gender for the condition, but some data, as well as empirical evidence, suggeststhat genetic inheritance is often involved. Therealso seems to be no gender predilection. Availabledata suggests that 53 percent of teens undergoingotoplasty procedure are males. Approximately 33percent of all otoplasty procedures are performed onboys and girls in their teens. However, as mentioned above, I have had numerous adult cases. In fact,

one patient was in his 70s when he presented forsurgery. I knew the procedure had been successful

when he cut his hair short enough to expose hisears for the first time in years. Otoplasty bringsa lot of joy to both the patient and the doctor.

As a fellowship trained Facial Plastic Surgeonand Otolaryngologist, I see many patientsinterested in improving this aspect of their faces,and I find great satisfaction in assisting themin their desires -Scott K. Thompson, MD

Before

After

Before

After

Two of Dr. Thompson’sotoplastypatients.Photosused withpermission.



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C o u l d

H e a r i n g Lo s s C o nt r i b u t e t o D e m e n t i a ?

Older adults with hearing loss may be missing out on more than just

what’s being said. A study by JohnsHopkins and the National Instituteon Aging suggests that hearing losscould increase the risk of dementia.

Seniors with hearing loss are significantly more likely to develop dementia over time than those who retaintheir hearing, a study by Johns Hopkins and National

Institute on Aging researchers suggests.* The findings,the researchers say, could lead to new ways to combat dementia, a condition that affects millions of people

worldwide and carries heavy societal burdens.

Although the reason for the link between the twoconditions is unknown, the investigators suggest that a common pathology may underlie both or that the strain of decoding sounds over the years may overwhelm the brains of people with hearing loss,leaving them more vulnerable to dementia. They alsospeculate that hearing loss could lead to dementia by

making individuals more socially isolated, a knownrisk factor for dementia and other cognitive disorders.

Whatever the cause, the scientists report, their findingmay offer a starting point for interventions — evenas simple as hearing aids — that could delay orprevent dementia by improving patients’ hearing.

“Researchers have looked at what affects hearingloss, but few have looked at how hearing loss affects

cognitive brain function,” says study leader Frank Lin, M.D., Ph.D., assistant professor in the Divisionof Otology at Johns Hopkins University School of

Medicine. “There hasn’t been much crosstalk betweenotologists and geriatricians, so it’s been unclear

whether hearing loss and dementia are related.”

To make the connection, Lin and his colleagues used data from the Baltimore Longitudinal Study on Aging(BLSA). The BLSA, initiated by the National Instituteon Aging in 1958, has tracked various health factorsin thousands of men and women over decades.



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The new study, published in the February 2011 Archives of Neurology, focused on 639 people whose hearing and cognitive abilities were tested aspart of the BLSA between 1990 and 1994. Whileabout a quarter of the volunteers had some hearingloss at the start of the study, none had dementia.

These volunteers were then closely followed with repeat

examinations every one to two years, and by 2008,58 of them had developed dementia. The researchersfound that study participants with hearing loss at thebeginning of the study were significantly more likely todevelop dementia by the end. Compared with volunteers

with normal hearing, those with mild, moderate,and severe hearing loss had twofold, threefold, and fivefold, respectively, the risk of developingdementia over time. The more hearing lossthey had, the higher their likelihood of developing the memory-robbing disease.

Even after the researchers took into account

other factors that are associated with risk of dementia, including diabetes, high blood pressure, age, sex and race, Lin explains, hearingloss and dementia were still strongly connected.

“A lot of people ignore hearing loss because it’s sucha slow and insidious process as we age,” Lin says.

*This research was supported bythe intramural research programof the National Institute on Aging.

“Even if people feel as if they are not affected, we’reshowing that it may well be a more serious problem.”

Johns Hopkins is embarking on a long-termstudy to search for a definitive link and to learn

whether treating hearing loss might delay the onset of dementia. In the meantime, Lin encouragespeople to address signs of hearing loss.

“Hearing aids are essentially no-risk therapies,” heexplains, “and they clearly improve your quality of life.” -This information provided courtesy of Johns Hopkins Medicine.



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" The Answer Is In

All of Us" A cure for Parkinson’s disease is closer than ever. The Michael J. Fox Foundation needs your help to make it a reality.

I

t’s spring in New York City, and thedowntown offices of The Michael

J. Fox Foundation for Parkinson’sResearch are vibrating with activity.

April is Parkinson’s Awareness Month,and a palpable sense of purpose and intensity attend preparations in every cornerof the floor-through space. Development staffers stuff envelopes for mailings and prepare welcome packets for grassrootscommunity fundraisers soon to runmarathons or host pancake breakfasts. On-staff PhDs lead grant review meetings and teleconferences with academic and industry scientists from around the world. No oneseems to feel there is a moment to spare.

As it turns out, they don’t. Urgency —some would call it impatience — is acore aspect of the Foundation’s culture.

“For those of us in the patient community,Parkinson’s is not a time-neutralsituation,” explains Michael J. Fox. “It’sa ticking clock. If that’s what you’d callimpatience, then I guess we’re impatient.”

ENTREPRENEURSHIP,ACCOUNTABILITY, EFFICIENCY

Parkinson’s disease is a chronic,degenerative neurological disorder that

affects one in 100 people over age 60. While the average age at onset is 60, Fox was diagnosed at age 29 — at the height of his fame and success as an actor —and some are diagnosed as young as 18. Estimatesof the number of people living with the disease vary,but recent research indicates that at least one millionpeople in the United States, and more than five million

worldwide, have Parkinson’s. There is no knowncure for the disease. Available treatments mask somesymptoms, bringing serious side effects, while theunderlying disease continues to worsen over time.

With more than $285 million in Parkinson’sresearch funded to date, this month’s launchof Fox Trial Finder — a next-generation Web

tool to help the PD community get involved inresearch to speed treatment breakthroughs

— and a $50-million fundraising challenge ineffect, there’s never been a better time to join

The Michael J. Fox Foundation in its quest to puta cure for Parkinson’s disease within reach.

P h t h b M k S l i



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In just over 10 years since Fox launched it with co-founder Deborah W. Brooks, who had transitioned from a high-powered career in the world of business and finance, The Michael J. Fox Foundation (MJFF)has grown rapidly to become the largest private funder of Parkinson’sresearch in the world. Today the Foundation is helmed by CEO Todd Sherer, PhD, Fox and Brooks. It is the only U.S. Parkinson’s nonprofit

with an exclusive focus on research — a nimble, problem-solving and entrepreneurial player with a mission to take charge of streamlining

and orchestrating Parkinson’s drug development for patients’ benefit.

“I joined the Foundation with a desire to do something impactfulfor patients rather than for an individual lab and individualprojects,” says Sherer, a formally trained neuroscientist, who

joined the Foundation’s research staff in 2004, transitioningfrom a career as an academic bench scientist. “When you haveto be the world’s expert on that particular project, you can losesight of the context.” Sherer became CEO in May 2011.

The Foundation has inherited humility as a core value from Fox (“I try not to pat myself on the back, even though I sometimes doit by accident,” he jokes — a reference to the excessive, sometimes

twisting movements brought on by Parkinson’s medications).But it is widely credited with having pioneered a new model forspeeding drug development. “MJFF is recognized as the model forhow patient-driven research should be conducted and fostered,”according to Anders Björklund, MD, PhD, of Lund University in Sweden, one of the world’s foremost Parkinson’s experts and a member of the Foundation’s Scientific Advisory Board.

The Foundation has had a hand in developing more than 100 Parkinson’stherapeutic targets to date, pushing dozens of these closer to the clinicand practical relevance in patients’ lives. MJFF has built a staff of PhD-trained neuroscientists, each paired with business-trained project leaders.

Parkinson’s Disease: The Basics

Parkinson's disease was firstcharacterized extensively by anEnglish doctor, James Parkinson,in 1817. Today, we understandParkinson's to be a disorder of the central nervous system thatresults from the loss of cellsin various parts of the brain,including a region called thesubstantia nigra. The substantianigra cells produce dopamine, achemical messenger responsiblefor transmitting signals within thebrain that allow for coordinationof movement. Loss of dopaminecauses neurons to fire withoutnormal control, leaving patientsless able to direct or control theirmovement. Parkinson's is one of several diseases categorized byclinicians as movement disorders.


· Recent research supports the hypothesisthat genetics plays a greater role in PD thanwas previously believed. New understandingof genetic targets such as LRRK2, the mostcommon genetic contributor to PD, haveopened entirely new avenues for PD drug

development over the next decade.

· A biomarker is a measurable physical traitused to indicate the effects or progressof a disease. Currently, there is no knownbiomarker for PD. This poses real problemsin testing potential drugs that might slowor stop the course of the disease, a majorunmet need for those living with PD today.MJFF is tackling the critical search forbiomarker head on through a landmark clinical study, the Parkinson’s ProgressionMarkers Initiative (PPMI), currently enrollingpeople with and without Parkinson’s

disease in 24 cities around the world.

· Dyskinesias are the involuntary,uncontrollable, and disruptive movementsthat are a common side effect of manytreatments for PD. Researchers areworking to improve on existing drugs,and over the past few years, with MJFFsupport, several new therapeutic targetsto treat dyskinesia have advanced fromearly-stage testing into the clinic.

People are generally most familiarwith the motor symptoms of Parkinson's disease, as they are themost evident signs of the diseasefrom the outside. These symptoms,which are also called the "cardinal"symptoms of PD, are restingtremor, slowness of movement(bradykinesia), postural instability(balance problems) and rigidity.Some other physical symptoms suchas gait problems and reduced facialexpression are also of note. Theseare due to the same discoordinationof movement that causes the better-known tremor and slowness.

There is also increasing recognitionof the importance of othersymptoms of PD that are sometimescalled "non-motor" or "dopamine-

non-responsive" symptoms. Whileneither of these terms is ideal, thesesymptoms are common and canhave a major impact on peoplewith PD. For example, cognitiveimpairment, ranging from mildmemory difficulties to dementia, andmood disorders, such as depressionand anxiety, occur frequently. Alsocommon are sleep difficulties, lossof sense of smell, constipation,speech and swallowing problems,unexplained pains, drooling, andlow blood pressure when standing.

Parkinson's symptoms manifestdifferently in different patients.Many patients experience somesymptoms and not others, andeven the pace at which the diseaseworsens varies on an individual basis.



Sitting at the global hub of Parkinson’s research, thisteam comes to work every day with the single-minded purpose of prioritizing limited resources for maximumimpact on patients’ lives in the nearest possible term.

“We don’t outsource funding decisions to other‘experts,’ ” says Brooks. “We have a team of scientists— eight PhDs and one MD — and we understand the

business of drug development and not just neuroscience. We ask ourselves, How we can speed progress? Wepair the doctors with business people to help themunderstand the business of science. This is part of

what helps us keep things moving. We’re really tryingto figure out what it’s going to take to go from the“a-ha” moment in the lab to the drugstore shelf.”

Efficiency and accountability also are core values.Since inception, 87 cents of every dollar spent by theFoundation has gone straight to the research effort.

And MJFF deliberately holds no endowment. Every dollar raised is immediately deployed to push forward

research with the best chance of leading to new PDtherapies and, ultimately, a cure. “We believe that donor-raised capital has an obligation to advancethe state of the science today,” explains Sherer.

FOX TRIAL FINDER AND THE RESEARCHPARTICIPANT SHORTAGE

Working with the patient and researcher communities,

The Michael J. Fox Foundation has developed a strategicroadmap to speed Parkinson’s therapeutic development,providing both financial and intellectual leadership that has galvanized the scientific field and moved it tangibly closer to definitive clinical trials and breakthroughtreatments. The need for high-impact investment inresearch has never been more urgent. But while financialinvestment is critical, dollars alone will not take carry therapeutic breakthroughs across the finish line. Theactive involvement of Parkinson’s patients and theirloved ones in clinical research is vital to finding the cure.

Clinical trials and studies play a critical role inthe development of new and better medicines.Currently, 80 percent of clinical trials finish latedue to difficulties enrolling participants. Even morealarming, nearly one-third of trials fail to recruit asingle subject and cannot ever begin. Underenrollment in clinical research, by people with and without Parkinson’s, is slowing research progress — and patients pay the price in terms of higher costs and longer time horizons to treatment breakthroughs.

The Foundation has stepped up to answer thischallenge with the development of a next-generation

Web tool, Fox Trial Finder (foxtrialf inder.org), auser-friendly solution to connect willing volunteers

with the specif ic trials that need them.

Fox Trial Finder makes it easier than ever to find information about trials specifically matched toindividual volunteers’ characteristics. The tool comparesinformation entered by the user, such as geographicallocation and medical history, with trial needs and location to provide users with a short list of theirbest potential matches. Volunteers can review thesematches and use the in-site messaging functionality to anonymously connect with trial personnel. New trials launch all the time, and registered users receive

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notification of new matches in real time without having to return to the site and repeat their search.

The tool also enables research coordinators toreview volunteers’ de-identified profiles and reachout to eligible volunteers to further explore thequalifications and appropriateness of the volunteerfor their trial. Throughout this process, volunteers’

privacy is protected by the highest level of security protocols; personal information such as name and contact information remains private unless volunteerschoose to share this information with a trial team.

Launched in beta version last July, Fox Trial Findercurrently includes over 190 clinical trials in its system.

Nearly 4,000 volunteers have already registered, but moreare needed — the Foundation hopes to reach 10,000 by the end of 2012 in order to make serious inroads intothe volunteer shortage that stands in the way of progress.

“Fox Trial Finder sends the Parkinson’s community aninvaluable message: There’s something you can do,”says Fox. “Participating in research makes you an agent of change. Fox Trial Finder is a practical tool to helpyou get started. That’s a message we want everyoneaffected by Parkinson’s to receive loud and clear.”

TEAM FOX AND THE COMMUNITY FOR A CURE

The Foundation’s grassroots fundraising network, Team Fox, was launched in 2006 “as a responseto the incredible outpouring of support we saw from people all over the world and as a way to helpthem help us,” says Fox. It has grown dramatically since then, with $16 million raised to support the Foundation’s ambitious research agenda.

Today, Team Fox is the collective voice for theFoundation’s message of can-do optimism and actionacross the country and around the world — and its



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numbers continue to increase. Each year, morethan 1,500 Team Fox members worldwide turntheir passions and interests into unique fundraisingevents and athletic feats. From putting on fashionshows and parading vintage cars to summiting

mountains, Team Fox members have done it all.

In 2011, Sam Fox (no relation to Michael J. Fox) ranfrom Canada to Mexico in two months (averagingabout 40 miles a day), raising $150,000, in honorof his mother, Lucy, who has Parkinson’s disease.

“On the trail, I thought about my mother and what she goes through,” Sam says. “She lives with the symptoms of Parkinson’s every day witha smile and with strength — I tried to emulatethat.” He has since joined the Foundation’s staff as Outreach and Engagement Officer, helpinginspire others to get involved to speed a cure.

(What did Lucy think of Sam’s plan? “At first I thought he was nuts,” she says. “Now I’m tremendously proud.”)

“We know how passionate people feel about thiscause,” says Brooks, “and extreme events reflect adesire to translate that into a physical challenge. But Pancakes for Parkinson’s is also a signature Team Fox event. We’re grateful for every lemonade stand and bake sale, golf tournament and walkathon, birthday party and art gallery opening that becomes a TeamFox event. There’s room for everyone in Team Fox.”

GET CONNECTED

The Foundation has always been committed tobringing knowledge and expertise directly to patientsand families and engaging with them in their owncommunities through educational offerings such asResearch Roundtables, a Seminar “Hot Topics” CallSeries and support group presentations. With theaddition of a Digital Strategies team in 2011, theFoundation is working to leverage the growing senseof community among patients in the virtual realm.

“With our sole research focus we aren’t chapter-based and we don’t offer support groups or patient care programs. But advances in technology present an amazing opportunity for us to communicateour goals and engage with a greater portion of the Parkinson’s community,” says Sherer. “Digitalplatforms provide opportunities to spread the

word and offer tools like Fox Trial Finder to matchpatients with the clinical trials that need them.”

The Foundation’s Web traff ic grew by over 30percent in 2011, and it is in the process of redesigningits Web site (www.michaeljfox.org) for greaterinteractivity and to better reflect the patient and caregiver experience (the redesigned site is expected to launch next month). MJFF is also active on themajor social networks, with over 100,000 Facebook fans and over 10,000 Twitter followers. “OurFacebook community has truly come alive — we



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see patients asking questions and commenting onothers’ posts,” says Brooks. “It’s a real community.”

The Foundation has also launched a blog, which isupdated several times a day with Parkinson’s researchnews analysis, updates on Foundation leadership,information on Team Fox events, and general-interest news for the Parkinson’s community.

“THE ANSWER IS IN ALL OF US”

Darkness is settling over the city, but the lightsare still on at MJFF headquarters. Staffers work into the evening, refining plans and strategies forParkinson’s Awareness Month and beyond. For now,the group’s impact on the trajectory of Parkinson’sdrug development remains a work in progress. But

while everyone is sober about the work that remainsto be done, there’s a tangible feeling of optimism.

That probably has something to do with theorganization’s most significant supporters, who have

kept the Foundation’s revenues growing throughout recent economically challenging years. In fact, thanksto the support of MJFF’s largest donors, Sergey Brin(co-founder of Google) and Anne Wojcicki (co-founderof personal genetics company 23andMe), donors tothe Foundation can double their impact in the searchfor a cure. Thanks to the Brin Wojcicki Challenge,up to $50 million in gifts to the Foundation through

December 31, 2012, wil l be matched. Brin’s motherand aunt have Parkinson’s disease, and he carries agenetic mutation linked to increased risk for PD.

“[The Challenge] is truly a radical act of generosity,”says Fox. “We’re obviously thrilled and grateful toSergey and Anne, not only for their gift, but for thecare and thought they put into how they structured

it to bring more people onboard with our work.

“I don’t think we knew when we set out just how broken our medical research system was,” he continues.“We came to realize over time that there are all thesedifferent players on the field but no single entity orchestrating their efforts to speed the best resultsfor patients. There’s no ‘Department of Cures.’

“I had this vision of a new kind of organization that would be built for speed and impact. From the earliest days everything for us has come down to a streamlined focus on moving the needle, on purity of motive. It turns out that message speaks to a lot of people, and

we’re just trying to do our work and find as many of those people as we can to be part of it. Because whenthe cure for Parkinson’s is found — and it will be —it won’t be because of me, or our Foundation, or any one individual. It will be because of all of us, workingtogether. The answer is in all of us.” -This information provided courtesy of The Michael J. Fox Foundation.



Setting the Record Straight:

I

f there is only one thing you takeaway from reading this article,here it is: in the fight against breast cancer, mammograms are

the standard diagnostic tool –known to detect even the smallest

cancers more than five years beforethey can be felt. Women over 40 areencouraged to be tested yearly. Period.

A recent article in The Atlanticmagazine reported that, for women

with dense breasts, mammograms only detected cancer 40 to 50 percent of the time, and that breast ultrasound should be added as a diagnostic tool.

This recommendation is based on a

single, small study, and the findingsfocused on women with dense breastsand who were already considered “high-risk” for breast cancer.Ultrasound is more expensive and

University of California, San Diego’s Moores Cancer Center, support the American Cancer Society'srecommendation that women get regular mammograms beginningat age 40 as an important part of a breast cancer screening plan.

Such screenings are done in women with no symptoms of breast cancerin order to find the disease early,

when treatments are more likely to besuccessful. For now, it is my view that the role of ultrasound in breast cancerremains most useful in differentiatingcysts versus solids lesions or to guidespecialists in conducting breast biopsies. - Haydee Ojeda-Fournier, MD. UCSan Diego Moores Cancer Center.

time consuming than a mammogram,on average taking 40 minutesper case, compared to eight to 10minutes for a typical mammogram.

In addition, ultrasound screeninghas many false positives, which could result in unnecessary biopsies, and unnecessary anxiety for women.

Most importantly, eight large,randomized clinical trials looking at

women over a 30-year period haveshown mortality due to breast cancerdecreases as much as 30 percent as aresult of mammographic screening. Wealso know that digital mammograms,

which were not available until 2005,

are even more sensitive in detectingcancer in women with dense breasts.

Most studies, and my personalexperience with patients at the


MammogramsWhy Remain the Gold Standard in Breast Cancer Detection



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While heart disease continues to receivea lot of attention, certain mythssurrounding the disease persist.

A couple of the most commonmyths are that heart disease is morecommon in men than women, and

that the first signs of a heart attack are the same forboth men and women, says Dr. Mary Ann McLaughlin,

medical director of the cardiac health program at The Mount Sinai Medical Center in New York.

Heart disease remains the leading cause of death inmen and women in the United States, affecting bothsexes relatively equally. “Women are more afraid of dying from cancer,” says McLaughlin. “But in fact,they are much more likely to die from heart disease.”

Also, the f irst signs of a heart attack can manifest themselves in different ways between men and women.

While both men and women can experience the more

well-known symptoms like chest pain or tightness and a shooting pain in the left arm, there are differencesin symptoms by sex, according to McLaughlin.

The more obvious symptoms are more prevalent in men, which might be why research showsthat men go to the emergency room withsymptoms much earlier in than women.

More subtle symptoms are more likely in women. These include shortness of breath, sweating ordizziness, nausea, severe fatigue, sudden sleepdisturbances, pain radiating through the jaw, smallof the back or between the shoulder blades.

”Women with diabetes are about twice assusceptible to heart attacks as men with thecondition,” says McLaughlin. “Increased risk factors for women also include having anautoimmune disorder and a history of gestationaldiabetes or preeclampsia during pregnancies.”

F irs t s igns d i f feren t, bu t t

hrea t

s im i lar for men and wom

en



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Knowing the first signs of aheart attack is important, but reducing your risks for heart disease is the best way to avoid experiencing one. McLaughlinoffers the following tipsfor a healthy heart:

* Reduce salt intake. Limitingyour consumption of

processed foods canhelp with this, as they

are often high in salt.

* Ask your doctor whethera daily regimen of low-dose aspirin would beappropriate for you,as it could lower yourrisk of a heart attack.

* Know your numbers. Your doctor can help you getyour readings and give you advice on how to meetthe following goals for optimum heart health:

Total cholesterol: less than 200

LDL (bad cholesterol): less than 100

HDL (good cholesterol): greater than or equal to 40

Total cholesterol to HDL ratio: less or equal to 4.4

for women and less than or equal to 5 for menTriglycerides: less than 150

Blood pressure: less than 120 systolicand less than 80 diastolic

Non-fasting glucose: less than 120

Fasting glucose: less than 100

Hemoglobin A1c: less than 7

To learn more about heart disease and care, and to hearstories from patients who have experienced heart disease,

visit www.mountsinai.org/heart. -This information provided courtesy of Mount Sinai Medical Center.

* Maintain a daily intakeof 1,000 mg of vitaminD, which can be foundin some of the same

fatty fish that containhigh levels of omega-3fatty acids. Vitamin Dsupplements can also helpyou achieve this, as lowlevels are associated withheart disease and highblood pressure. Exposureto sunshine also helps yourbody produce vitamin D,

but don’t forget yoursunscreen.

* Choose your fats wisely. Use olive oilinstead of butter, snack on nuts instead of other sugary and high-fat snacks, and takesupplements like flax seed oil that can boostyour levels of omega-3 fatty acids, which canreduce artery inflammation. Consuming moreomega-3s can also help you reduceyour LDL (bad cholesterol) levels.

* Get regular exercise. A good ruleof thumb is when balanced with aproper diet, 30 minutes of exercise aday will help you maintain your currentweight, while 60 minutes willhelp you lose weight. If thatseems like a lot, try to work exercises in to your dailytasks by taking the stairs insteadof the elevator or walking orbiking to work. Maintaining ahealthy weight lowers yourrisk for cardiovascular disease.



Don't Let Your AllergiesBloom This Spring

T

he term allergic rhinitismeans allergic reactionsoccurring in the nose and surrounding tissues. Thesereactions are caused by airborne substances such

as seasonal pollen, mold spores, housedust mites, dust from animals, and dust from cockroaches. Everyone breathesthese materials, but some people makeIgE antibodies (allergic antibodies) and become allergic to these substances.

An estimated 60,000,000 people inthe United States have allergic rhinitis,approximately 19 percent of thepopulation. The symptoms of allergicrhinitis are nasal itching, sneezing, runny

nose, nasal congestion, obstruction of thenose at night resulting in poor quality sleep (allergic inf lammation becomesmuch more intense during the night),snoring, postnasal drainage, dry throat in the morning, popping and ringing

and pressure sensations in the ears, and sinus pressure headaches. Some people

with allergic rhinitis also have allergicconjunctivitis and experience intenseitching and burning of the eyes, excessivetearing, swelling around the eyes, and dark discoloration beneath the eyes(allergic shiners). Some allergy sufferersdevelop a crease across the bridge of the nose (where the cartilage joins thenasal bones) because of constant rubbingof the nose to relieve the itching.

Seasonal allergic rhinitis causes fatiguein approximately 80 percent of patients,and depression in 30 percent. Seasonalallergic rhinitis, caused by tree and grass pollen in the spring and weed and ragweed pollen in the fall causes several

other problems to flare. Active seasonalrhinitis nearly doubles patients’ needsfor doctor visits and new medicationsfor anxiety, depression, asthma, sinusinfections, middle ear infections, and tonsil infections (Crystal-Peters, et.al.

Annals of Allergy, Asthma & Immunol.2002;89:457-462). Migraine headachesare more frequent when allergies areactive. Embarrassing symptoms occurin at least 25 percent of patients.

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The economic impact of allergicrhinitis includes 3,500,000 workdayslost each year and approximately 2,000,000 days of school lost becauseof allergic rhinitis. When allergicrhinitis is active, productivity at work or school is impaired by fatigue,

distraction by allergic symptoms, and sometimes by the sedating propertiesof over-the-counter allergy remedies.

How to control of allergic rhinitis

We have gained a detailed understanding of the mechanismsof allergic rhinitis. This has led tothe development of a broad rangeof powerful interventions canprovide nearly complete controlof allergic rhinitis symptoms and methods to eliminate these allergic

reactions, with mild or no adversereactions from medications.

Reasonable expectationsof these interventions:· No symptoms. Symptoms of allergic

rhinitis usually can be suppressedto the point that they are of littleconsequence in most patients.

· No sleep disturbance. Aggressiveinterventions can eliminate nocturnalnasal obstruction which leads topoor quality sleep. This seems tobe the main reason for fatigue and

other allergic rhinitis complications.· No complications. Aggressivemanagement of allergic rhinitisshould minimize the chance of complications such as bacterialsinusitis or f lares of asthma.

Three levels of care for allergicrhinitis: Self-care, physician care,and specialist physician care

Self-care: Approximately 80 percent of people with allergic rhinitis eitherendure the problems or use over-

the-counter medications. Keepingthe windows in the home and carclosed helps. HEPA air filters in thebedroom may help. Oral antihistaminescan be helpful for itching, sneezing,runny nose, and itching and burningof the eyes, reducing symptoms25% better than a placebo. Oldersedating antihistamines such as

diphenhydramine can be helpful, but also have been shown to impair ourability to drive and learn. Newer, non-sedating antihistamines are availableover-the-counter that provide relief and are much safer. Antihistamineshave little effect on nasal or sinuscongestion. Oral decongestantscan provide some relief from thecongestion, but they also disrupt normal sleep architecture, and cancause heart rhythm problems,dizziness, anxiety and tremors.

Nasal spray decongestants canbe effective for congestion,but many people quickly become dependent upon thedecongestant sprays. Oncethe effect of the decongestant spray wears off, the noseswells shut and is very uncomfortable unless thespray is used again. Intranasalcromolyn and intranasalsaline also help some individuals.

Is self-care effective? For someindividuals, self-care providesacceptable relief from symptoms,protection against sleepdisturbance, and protection against complications such as sinusitis.

Physician care: Approximately 20 percent of patients with allergicrhinitis see a physician for morepowerful interventions. Prescriptionmedications proven to be effectivefor allergic rhinitis include intranasalsteroids, intranasal antihistamines,intranasal nerve blocking agents, oralmedications that block leukotrienes(allergy mediators that along withhistamine account for most of theallergic manifestations), and in extremecases, oral or injected steroids.

If the allergic rhinitis symptoms aresuppressed, sleep isn't disturbed, and there are no complications, the goalsreasonably expected have been achieved.

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Expert care: When symptoms are not well controlled, and sleep is disturbed by nocturnal nasal obstruction, or whencomplications of allergic rhinitis such asasthma or sinusitis are present despitethese interventions, an Allergy and Immunology specialist is able to provideeffective relief. Accurate diagnosis is

necessary to establish that the problemreally is allergic rhinitis, to guidespecific measures to avoid exposure tothe causes and aggravating factors, and to identify patients whose problemscan be minimized or eradicated by immunotherapy (allergy shots). Theevaluation also includes searching forcomplications or concurrent problemssuch as nasal polyps, nasal septaldeviation, other anatomical problemsin the nasal passages, bacterial sinusitis,medication effects on the nose, and

multiple other factors that modify ormimic allergic rhinitis. Concurrent problems such as asthma, sensitivity to non-steroidal anti-inflammatory drugs, Vitamin D deficiency,and antibody immunodeficiency should be identified and corrected.Interventions selected and adjusted for individualized care usually provideexcellent control of allergic rhinitis.

Symptoms of Seasonal AllergicRhinitis and Conjunctivitis

• Nasal itching

• Sneezing

• Clear nasal secretions (runny nose)

• Poor quality sleep

• Snoring

• Sinus pressure headaches

• Ear symptoms -popping, ringing,congestion, variable hearing changes

• Eye symptoms – itching, burning,tearing, swelling around the eyes

Complications of Seasonal Allergic Rhinitis

• Fatigue (80%)

• Depression (30%)

• Anxiety

• Sinus

• Sinus infection

• Middle ear infection

• Migraine headaches

• Public embarrassment becauseof obvious symptoms (25%)

The likelihood allergic rhinitis willspontaneously go away is approximately 1-2 percent per year. Seasonalallergies usually return and beingprepared is essential to the long-term management of this problem.Starting intranasal steroids before thepollen season can markedly reduce or

eliminate the flare in some patients.

Immunotherapy (allergy shots), especially rush immunotherapy, may be useful togreatly reduce the severity or completely eliminate seasonal allergic rhinitis.Patients with allergic rhinitis severeenough to require the help of an allergist are usually excellent candidates fortherapy aimed at cure, rather than relief.

Don’t accept disrupted quality of life because of allergic rhinitis.

We now have a large array of over-the-counter, prescription, and specialist interventions tosuppress, and even, eliminateseasonal allergic rhinitis. Youdo not have to put up withseasonal allergies anymore.Don’t let your allergies bloomthis spring. -Timothy J. Sullivan, MD and Vicki J. Lyons, M D



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If Luella Love believed in lucky numbers, she

would pick 11.

“I got my new lungson November

11, 2011, during

a surgery that started at 11 p.m.,” said Love, 48, of Concord, NC. “I don’t believe inlucky numbers, but I do believe in God.”

Love, a petite Indiana native who has lived in NorthCarolina seven years, was born with cystic fibrosis (CF),a life-shortening inherited disease that causes abnormally thick, sticky mucus to build up in the breathing passagesand in the pancreas, resulting in breathing difficultiesand related digestive system issues. At Luella’s birth,life expectancy for CF patients hovered in the teens.

“I was diagnosed at 18 months old and my mother was told I wouldn’t live to see kindergarten,” Lovesaid. “My mother died of lung cancer in 1996, and Icelebrated my 48th birthday days after my transplant.

My new chance at life feels like a miracle to me.”

Despite CF, Luella had never excused herself from life. She ran five miles– morning and evening – in her20s. When she could no longerrun, she walked. She worked incustomer relations for a bank until

chronic respiratory and digestive

issues requiring hospitalizationssignaled that CF was winning. By May of last year her body was showing signs of shutting down.

She prayed for new lungs. Reluctantly.

“I’m a long-time organ donor myself, and I had real mixed emotions when I prayed for new lungs,”Luella said. “Never will I forget that my getting asecond chance at life means someone lost theirs. Still,I wanted the call that there were lungs for me.”

The call came early on Nov. 11 and during a 14-hoursurgery, Benjamin E. Haithcock, MD, assistant

professor of surgery at the UNC School of Medicineand lead lung transplant surgeon at the UNC Centerfor Transplant Care, transplanted the new lungsinto Luella’s chest. Fifteen to 20 lung transplantsare performed at UNC Hospitals each year.

To learn about becoming an organdonor, contact CarolinaDonor Services, thefederally designated

organ procurement organization serving6.1 million peoplein 79 counties inNorth Carolina and Danville, Va. (www.carolinadonorservices.org, 919-489-8404)

Luella :

New Lungs for a NewLove Life



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“I will always remember Dr. Haithcock tellingme my new lungs were pristine and the perfect size for my small frame,” Luella said. “When thetime is right, I want to thank the family of thedonor for their loved one’s priceless gift.”

Dr. Haithcock credits Luella’s diligence with pre-transplant physical therapy withgetting her back in the game of life.

“Our lung transplant patients are required to be up and moving around as much as possible,” Dr. Haithcock said.“Luella followed those instructions to the letter, and it shows. Four to six hours after transplant, she was raringto go, the breathing tube came out and she was walking.”

Unexpected gallbladder and liver issues required additional surgery and extended her recovery, but Luella sees them as distant bumps in the road.

“Often the steroids and anti-inflammatory drugs that transplant patients must take make them less sensitiveto pain, and it’s sometimes hard to diagnose whenthere are post-transplant infections or issues,” Dr.Haithcock said. “Still, she’s really done great, and I fully expect to see her on a track or running a 5K soon.”

Luella expects that soon, too. Her diligencein all post-transplant therapies rivals her pre-transplant dedication because she sees time that she didn’t expect to have stretch before her.

“Before the transplant, my best day would be someone else’s bad day,” Luella said,remembering the difficulty breathing when

not even exerting herself, the digestive issues,some bladder- and bowel-control issues. “I’mfree of all that now. And I have time.

“I want to ramp up my advocacy for organdonation. I want to work with support groups forCF patients because I know what it’s like not tohave that. I want to be there to hold someone’shand when they need it most. I want to learn todance, to run – yes, a 5K, and to learn to crochet.”

Learning to crochet helped pass the time duringLuella’s required 90 to 100 days post-transplant stay at SECU Family House, the 40-bedroomhospital hospitality house minutes away from UNCHospitals that provides comfortable, convenient and affordable housing for seriously ill adult patients and their family member caregivers.

Transplant patients are monitored closely for signsof organ rejection and other complications and have multiple therapies weekly to help their mindsand bodies adjust to the new normal. A shuttletakes patients to and from the hospital regularly,and emergency transport is arranged as needed.

“As excited as I am about going home, I am sad

about leaving Family House,” Luella said, as sheheaded home to Concord on March 1. “I’m treated like family here, with love and respect. I know

without this place my recovery would have beenslower. The food provided by volunteers is alwaysexcellent, and the after-dinner entertainment isalways nice. There are places for solitude and places for coming together. I have to figure out a way to give back for all they’ve given me.”

Luella was joined at Family House by hersister, Crystal, from Indiana, who stayed by Luella’s side since the transplant.

“Crystal is a blessing to me,” Luella said. “She’s lifted me, bathed me, done my laundry, organized my very large pillbox, gone with me to every appointment and helped me think, and she’s taught me to crochet.

“She’s missed her sons’ birthdays, and Thanksgiving,Christmas and New Year’s with her husband and their family. She misses them greatly, and I can’t thank her enough for what she’s done for me.She’s been a little bit of everything to me, and at the end of the day, she’s stil l my sister.” -Written by Elizabeth Swaringen for UNC Health Care



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Q

What time of year is flu typicallyat its peak? And why?

A Influenza, or the “flu,” typically circulates in the late

fall and winter months in the northern hemisphere.

During most years, the flu season can last up to 3

months with peak activity lasting 1-2 weeks or more. There

is some variability in the start of the flu season—some

years it starts in November, while in others (like this one)

it can start in February or later. The seasonality of the flu

remains one of the great mysteries in infectious diseases.

Several potential explanations have been proposed (air

temperature, humidity, etc) but none have been proven.

FLU, COLD OR VIRUS

Questions & MythsCleared Up

It's been an unseasonably warm winter, and with January and February days in the 60's and 70's, flowers are

blooming early and grass hasn't completely gone dormant. The warm winter has also kept flu season from hitting most of the country, but the experts assure us the virus is stillsure to hit. It's not an issue of if the flu will hit, but when.

So, are you protected? The easiest, and safest way to keepyou and your family protected from the flu this season, eventhis late into the winter, is to get a flu shot. And it's not toolate, says our Infectious Diseases expert, Dr. Jeffrey Kahn.




QDoes wet hair actually make youmore likely to catch a cold/the flu?

A That’s what our mothers and grandmotherstell us and I am not going to argue with

them. So dry your hair and wear a hat!

QCan you get the flu by beingout in cold weather? And…

why is there a flu season?

A The flu is typically spread from person to person

(so temperature and weather may not have a

direct impact) and as we learned with the swine

(H1N1) flu, cold weather is not required. The peak of H1N1 activity in Dallas in 2009 was early September

when the daily temperatures were in the 80’s and 90’s!

QWhy do kids’ fevers tendto spike at night? Why do

their stuffy noses and coughsseem to get worse at night?

A While these are common observations,

there is no single answer to these

questions. Increase in cough and

congestion at night may be the result of

position effecting nasal drainage (upright

vs. lying down). As for fevers being worse

at night, I am not sure that there is solid

evidence for this but we know that body

temperature varies with the circadian rhythm.



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QHow can you tellthe difference

between a cold, theflu or some otherrespiratory virus?

A Typically, the flu has a

sudden onset with high

fevers and body aches.

However, it is difficult at times

to tell the difference between

infection with influenza and

infection with other respiratory

viruses. But, if it is in the middle

of flu season and you suddenly

get sick with high temperaturesand feel like you’ve been hit by

a bus, it’s most likely the flu.

QDoes Tamiflureally work?

AAbsolutely! Formaximum effect,

it should be taken

within 48 hours of the

onset of symptoms.

QDoes getting a flu

shot give you the fluvirus? Will you get sick fromthe flu shot or flu mist?

A The injectable flu vaccine is

inactivated (killed) virus so you

can’t get the flu from the shot.

Flumist is a weakened form of the virus

that can only replicate in the nose and

does not result in flu symptoms in the

VAST majority of recipients. Bottom line:

either flu vaccine is SAFE and EFFECTIVE.

Q Is it too late toget a flu shot?

ASince we are just beginning

to see flu activity, there is still

time to get vaccinated. So if

you have not already done so, GET THE

VACCINE! It’s the best way to protect

yourself and your loved ones from

getting the flu. - Jeffrey Kahn, MD,

PhD. UT Southwestern Medical Center.



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Acid Reflux The Burning Issue

Pharmacy shelves are full of medications for reflux "heartburn." Mostof us know the symptoms: a burning sensation in the chest with

belching, sour stomach fluid coming up into the mouth, or worse yet,awakening suddenly, choking on burning acid in the airway. Refluxaffects 40% of Americans monthly and 18% of Americans weekly.

Too many people blow off Acid Refluxor Heartburn as no big deal. Does thissound familiar? You go out to dinnerand eat a large meal consisting of fried and fatty foods, accompaniedby a glass of wine. You follow dinnerwith a beautiful chocolate dessertand a cup of coffee. Of course, yougrabs some mints on the way outand go to bed an hour or two later.

Do I pop an antacid or take some pink liquid so everything will be fine in themorning? In reality, acid reflux canaffect the esophagus, the stomach,or the digestive tract, and untreated,can eventually lead to cancer. So whatare the signs to ignore? What arethe signs to worry about? What canyou eat? What should you avoid?

These are – pardon the pun – burningquestions we have asked several leadingexperts to answer in detail in the nextsection. Before you start tasting thatmeal a second time around, read on:



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In addition to thesymptoms, untreated reflux can cause deathdue to esophageal cancer,

which is one of the most deadly cancers, affecting

about 14,000 Americans every year and growing rapidly.

Research shows the increasein reflux and cancer isdirectly related to the nation’sincrease in obesity. There is acorrelation between increased

weight and heartburn, and between weight loss and theimprovement of heartburnsymptoms. In 1991, 15% of

Americans were considered obese and 30% were considered overweight. Today, 30% are

obese with 60% overweight.

What is Heartburn or Reflux?

The stomach produces acid toaid in the digestive process. Theproblem is not the acid itself,but when the acid comes up, orrefluxes, into the esophagus. Tounderstand the nature of acid reflux it is helpful to understand a bit of human anatomy.

We are able to breathe becausethe rib cage and diaphragmfunction like a bellows.

The diaphragm is a sheet of muscle separating the chest cavity from the abdominalcavity. In the middle of thismuscle is a hole, or hiatus,allowing the esophagus to join with the stomach.

When you inhale, your diaphragm contracts,expanding the chest cavity, creating negative pressureallowing air to flow into your lungs. Downward contraction of the diaphragm increases abdominalpressure forcing liquid up the esophagus.

Of course, our bodies are designed to keep this fromhappening. Acid reflux occurs only when somethinggoes wrong. Factors that allow reflux include:· TLESR, or Transient Lower Esophageal Sphincter

Relaxation. The lower esophageal sphincter isa weak ring of muscle that closes off the bottomof the esophagus from the top of the stomach,preventing acid from rising. But sometimesthe sphincter relaxes when it shouldn’t.

· Acid Clearance. When sleeping, we stop producingsaliva and stop swallowing which helps clear acid

from the esophagus. Saliva also contains growth factorsthat heal the esophagus from the damage of acid.

· Reduced resistance to injury. Once youresophagus is injured, it loses its protective defensesand is much more susceptible to further injury.

· Delayed stomach emptying. Food and acid cansometimes sit in the stomach longer than usual. This iswhat happens when you go to bed with a full stomach.

· Sleep apnea. The partial blockage of your airwayby the soft palate and uvula can cause your chestto expand harder than normal to overcome theresistance. This pulls more acid into your esophagus.

· Hiatal hernia. A portion of your stomach protrudesinto your chest cavity through the hiatus. It forcesthe lower esophageal sphincter open and basicallyallows the food and acid up into your chest.



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· Cigarette smoke and alcohol. The esophagusis protected from toxins in cigarette smokeby a mucus lining, as well as the rinsing effectof saliva, which washes acid out. Alcoholdissolves the mucus layer and also dissolvesthe smoke toxins so they are adsorbed (notabsorbed) directly to the esophageal surface.

In the long term, acid reflux can lead toulceration or stricturing (narrowing) of theesophagus, which makes it difficult to swallow.It can also lead to Barrett's esophagus, amutation in the lower esophageal tissue that can eventually develop into esophageal cancer.

How is Reflux Diagnosed?

Your doctor may suspect reflux based onyour symptoms, and will typically confirmthe diagnosis with an upper endoscopy,especially if any red-flag symptoms arepresent. These red flags may include:· Difficult or uncomfortable swallowing

· Unintended weight loss

· Vomiting blood or material thatlooks like coffee grounds

· Black, tarry stools

· An onset of symptoms after age 50

· Disappearance of reflux symptoms without anychange in lifestyle, body weight or medicationmay suggest the development of Barrett'sesophagus, a mutation that will protect youagainst reflux symptoms, but can lead to cancer.

Medication Options There are many options, which promisedifferent results. It’s important to have abasic understanding of how they work and

what can be expected of each type.

* Acid neutralizers such as Tums, Rolaids, Alka-Seltzer, Maalox and milk of magnesia. Thesemedications work by neutralizing the acidalready produced in the stomach and arelargely available over the counter. They can beeffective for occasional symptomatic reflux. If you have other medical conditions--especially

kidney disease--use caution with over-the-counter preparations containing calcium,magnesium or phosphate. It’s also importantto know that Alka-Seltzer contains aspirin. Foracid reflux, use the Alka-Seltzer Heartburnpreparation, which does not contain aspirin.

* H2 blockers, or histamine blockers, suchas Pepcid, Zantac, Tagamet and Axid. Thesemedications work by blocking much of the acid produced in the stomach. Theyare available in both over-the-counter andprescription strength. H2 blockers are more

The following foods are fine to eat:

√ Mineral water (neutralizes the acid)

√ Most vegetables except friedpotatoes and raw onion

√ Lean, non-fried meat

√ Apples√ Bananas

√ Multi-grains

√ Low-fat dressings (vinegar and olive oil)

√ Low-fat desserts like sorbet



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effective for frequent heartburn treatmentand for healing injury to the esophagus

than the acid-neutralizing medications.

* Proton pump inhibitors (PPIs), such asprescription-strength Prilosec, Nexium,Aciphex, Protonix, Zegerid, Prevacid andKapidex. They block the final common

pathway of acid production in the stomachand are the most effective for the healing andmaintenance of symptoms. Prilosec has anover-the-counter option but it ’s not time-

released and therefore not as ef fective asthe prescription strength. Most of thesemedications should NOT be taken with Plavix,an antiplatelet agent for the prevention of heart attack or stroke. PPIs may interfere withthe effect of Plavix. If you take Plavix andare on a reflux medicine, check with yourdoctor or pharmacist to be sure it’s safe.Prilosec and Nexium are also contraindicated

with Celexa also known as Citalopram.

Non-Medication Treatments

If you want to avoid taking prescriptionmedication or if you’ve tried it and your reflux is still a problem, you might consider the following treatments:· Surgery can tighten the junction of the stomach

and the esophagus. (For more information onsurgical options, refer to Dr. LeGrand Belnap’sarticle on Acid Reflux Surgery in this issue)

· Lifestyle modification, primarily weightloss, can have dramatic results. But even

if you don’t have a lot of weight to lose,eating smaller meals and going to sleepwith an empty stomach can help.

· Elevating the head of the bed a fewinches with wooden blocks can makea difference. Let gravity help you.

If you have acid reflux, I recommend the following dietary cautions:

× Eating large volumes of food

× Eating less than three hours before bedtime

× Caffeine, including coffee and soft drinks

× Liquor, including wine and beer

× Citrus, tomato, and cranberry fruits and juices× Ice cream or milkshakes

× Chocolate (one of the worst offenders)

× Sour cream

× High-fat desserts

× Peppermint (one of the most potent esophageal sphincterrelaxers of all! Avoid those after-dinner mints)

It is not lost on me that foods to avoid are more appealing.

The following medications may alsocause or worsen acid reflux:

• Nonsteroidals such as aspirin or Motrin

• Calcium channel blockers

• Anticholinergics• Beta agonists

• Dopamine

• Bisphosphonates such asalendronate for osteoporosis

• Sedatives

• Progesterone

• Antibiotics

• Antihistamines simple

-Steve Porter, MD



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Aromantic evening intown, an excessively rich meal late inthe evening, wine,and a couple of peppermints from

the checkout counter sets thestage for a night of discomfort,indigestion, and choking onundigested food and sour acid

regurgitated into the mouth...Youhave just crossed over into the

Twilight Zone of gastroesophagealreflux disease (GERD).

GERD refers to the regurgitationof stomach contents intomouth and airways.

Food and acid are typically prevented from reflux by competent function of thelower esophageal sphincter,a ring of muscle in the loweresophagus, which is assisted in its job by the diaphragm,maintaining a mechanical barrier at the top of thestomach and lower esophagus to prevent backflow of acid and symptoms of ref lux. Heartburn, also called acid indigestion, is the most common symptomof GERD. However, if left untreated, GERD cancause esophageal ulcers, esophageal bleeding, and narrowing of the esophagus (peptic stricture).

What causes GERD?

GERD results due to a failure of themechanical barriers to reflux:1. Incompetent (overly relaxed) esophageal

sphincter which no longer controls backflow.2. A hiatal hernia (top of the stomach

bulges over the diaphragm)

3. Overly filled stomach with delayed emptying (becausethe stomach does not empty while we sleep.)

The interaction of all of these factors is a fairly complex mechanical and physiologic interchange.For more in depth information about physiologic,dietary, and weight loss options for GERD, please seethe article in this issue by Dr. Steve Porter on pages29-31 titled "Acid Reflux: The Burning Issue".

Once GERD is identified, a number of treatment options can be prescribed.

Surgical Options

Nissen fundoplication is an anti-reflux operation that helps patients who have persistent symptoms despite medical treatment.

The upper part of the stomach (gastric fundis) is wrapped around the lower esophagus and is sutured tothe stomach, which helps the lower esophageal sphincter(the valve between the esophagus and stomach) close

more effectively. This prevents the gastric acid backflow which causes GERD. The esophageal hiatus is alsonarrowed using sutures to treat hiatal hernia, preventingthe upper part of the stomach from sliding upthrough enlarged esophageal hiatus of the diaphragm.

This procedure is usually done laparoscopically,i.e., without actually opening the abdomen.

Studies have shown fundoplication to be a safe and effective procedure with nearly 90% of patientsbeing symptom-free after 10 years. Post-surgery complications can include trouble swallowing

When Surgery is Needed to

Correct Acid Reflux



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(dysphagia), irritable bowel (which may last 2 weeks),and the fundoplication can come undone over time in5-10% of cases, which may warrant a repeat surgery.

Laparoscopic (videoscopic) Procedure

A videoscopic surgical procedure is an alternative tothe traditional or what is known as "open" surgery, in

which a large incision is made. This technologically

advanced option allows the surgeon to use minimally invasive surgery to treat GERD. Videoscopic surgery eliminates the need for a long incision. Small incisionsonly millimeters in size are made to accommodatesmall tubes called "trocars." These create a passageway for special surgical instruments and a laparoscope.

A fiberoptic instrument called a laparoscope is inserted into the abdominal wall. This device transmits imagesfrom within the body to a video monitor, allowing thesurgeon to see the operative area on the screen. In alaparoscopic Nissen fundoplication procedure, smallsurgical tools and a laparoscope are used to repair the

muscle that separates the stomach and esophagus.

This procedure has many advantages over a traditionalsurgery including minimal scarring and reduced recovery time. Hospital stays are reduced and totalrecovery time is reduced to half. The risk of infectionis also minimal because of very small puncture sites.

Best yet, the laparoscopic surgery often requires ahospital stay of less than 24 hours instead of four

to five days as in the case of traditional surgery.In many cases, a patient’s total recovery time canbe as little as one to two weeks, compared to thefour to six weeks time for traditional surgery.

If you have failed to respond to conservative therapy,or suffer from complications of reflux diseasesuch as ulcers, strictures or Barrett’s esophagus,

it may be time to consider a surgical approach.

Who are good candidates for the procedure?

Surgical candidates are those whose heartburn is not well controlled with medicine, those who want to fix the problem without having to take medicine long term,and those who have complications from reflux suchas ulcers, strictures, hernias or Barrett's esophagus.

What can I expect before and after the surgery?

Patients are counseled before the operation about lifestyleand dietary adjustments that are needed for the first six

weeks following surgery. They are advised to eat smaller

amounts of food at each meal, chew their food well, and avoid chewing gum and drinking carbonated beveragesto make sure that they heal properly from the surgery.

The success rate for the minimally invasive surgery is 90to 95% for patients who have typical symptoms of GERDsuch as heartburn, regurgitation, and belching. For those

with less typical symptoms, including hoarseness and chronic cough, the surgery is about 70 to 80% effective inrelieving their symptoms. - LeGrand P. Belnap, MD, FACS



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Reflux in Redux

Whenever I try to simplify a subject forpatients, I find myself struggling tofind a balance between adequately

explaining, overly explaining,overly simplifying etc. If thisseems too simple I apologize.

If this is too complex, I apologize. Bear with me,it is important to understand digestion in order tounderstand the nature of reflux. There is a tendency to think of the digestive process as being magical.From a design perspective it is elegant and simple.

How We Convert Food into Nutrition

To illustrate this point, we will use a piece of your favorite pizza. The choice of the example

is not that relevant, so you have permission tosubstitute a sandwich or something else that combines carbohydrates, proteins and fats.

This piece of pizza contains what our bodiesconsider to be the three major food groups:

Carbohydrate is present primarily in the bread, but also in vegetables and some of the components of thecheese and most of the tomato sauce. Carbohydratesare basically long complex chains of sugars, somedigestible in our bodies, others not. Carbohydratesalso include plant fiber, which is of no nutritional

value. The value of fiber in the diet is to act as a scrubbrush in the lower intestine to help clean the lining



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of the colon. It is this fibrous matter in conjunction with dead cells from the intestinal lining that makeup the majority of our bowel movement volume.

The digestible carbohydrates are of relatively low potency for energy production with 1 gram of carbohydrate yielding between 3 and 4 kcal of energy.

Protein is present in some of the plant productssuch as vegetables, but also in the cheese and inpepperoni or sausage or ham. Proteins are longcomplex chains of amino acids folded in tight packagesand protected by connective tissue boundariesthat must be broken down further to derive theamino acids actually used by the cells of the body.1 gram of protein provides about 5 kcal of energy.

Fat is present in the cheese, meat and oil. Fats arecomplexes of cholesterol and various glycerides and fatty acids that must be broken down and made soluble(dissolvable in water) to be absorbed into the body.

This calls for bile, which functions as a detergent toemulsify fat or break it down into tiny fragments called micellar units that can be absorbed into the lymphaticsystem of the intestinal tract and brought to the liver

for further processing. 1 g of fat provides about 7 kcal of energy. (The highest kilocalorie per gram-yield comes from alcohol at about 9 kcal per gram.

We really don't recommend it as a basic food group).

If you are hungry, looking at the picture above triggersyour eyes, which are highly developed specialized skin connected through the nervous system to thebase of the brain, then the occipital lobe of the brain

with subsequent connections to the cerebral cortex. This fact is important because the first phase of digestion is triggered by either sight or smell, or just hearing about food. The thalamus in the base of the

brain, in conjunction with the medulla oblongatain the brainstem exert control over the vagus nerve,

which is a nerve that controls the movement of the entire digestive system. This is known as thecephalic phase of digestion and stimulates the initialproduction of acid and leads to salivation in themouth and movement of the GI tract, particularly agrowling, rumbling sensation in the stomach itself.

The Mouth

Now we have the pizza in our hand, we can feel it, and we can smell it, furthering the production of saliva and then we take the first bite. Our mouth is now awash

with saliva and we are chewing the food like there is notomorrow. This process of mixing of saliva and chewingis very important for digestion. Saliva is a mixture of glycoprotein mucus, with water, in conjunction with twoenzymes called Salivary Amylase and Salivary Lipase.

The function of salivary amylase is to start breakingdown complex carbohydrates into smaller fragments of sugars and starches. This happens at neutral pH and isinhibited once the food reaches the acid of the stomach.Salivary amylase allows us to taste the sweetness of sugars in the food immediately. Salivary lipase allowsus to taste the buttery or oily fats in the food. Sourand bitter are separate taste bud functions that we

will discuss later, in regard to bile and acid reflux.

The Purpose of Saliva:

· Moisturizing food

· Initiation of minor digestion

· Washing bacteria off teeth

· Washing acid out of the esophagus

Once we have chewed adequately, it’s time to swallow and this is one of the most underappreciated and dangerous tasks our bodies are required to perform.

The vagus nerve is part of what is called the autonomic




nervous system. Some people mispronounce it asautomatic and they are not really wrong. It takes careof the things we take for granted such as maintainingour blood pressure when we rise from a seated orlying position, as well as allowing us to breathe and carry on our basic functions of daily living without having to think about it. We never really think about the danger of moving food and liquid from

the mouth past the airway into the esophagus untilsomething goes wrong with the process and wefind ourselves choking. Here’s how you swallow:

· First the sides of the tongue curl up and thetip of the tongue flips backward tossing thebolus of food or liquid into the back of theoropharynx and top of the hypopharynx.

· With perfect synchronization the oropharynx andpalate and hypopharyngealwall relax to receive thefood bolus as the hyoidbone is lifted upward

closing the epiglottis acrossthe airway and formingan air and watertight sealto prevent food or liquidfrom going down thetrachea into the lungs.

· Next there is a smallswallow of saliva followedby rinse and repeat, rinseand repeat, rinse andrepeat. Those of us whoare overweight are rinsingand repeating too much.

The Esophagus Now the food is in theesophagus. The functionof the esophagus is topropel the chewed food and saliva mixture past thelower esophageal sphincter,

which opens then closesoff to prevent reflux upfrom the stomach. Thisis accomplished throughthe motor function of theesophagus with peristaltic

waves propelling downward. The esophageal musclesrelax ahead of the contractile

wave allowing easy passage.Even between meals theesophagus rinses itself withswallowed saliva, which

washes out any acid that might reflux up from thestomach. The saliva alsocontains epidermal growth

factor (EGF) promoting repair of theesophageal tissue damaged by acid reflux.

Now the Pizza Is in the Stomach, Hallelujah!

(If you’re like us, you’re probably getting hungry. Takeyour own pizza break, come back to finish reading.)

Our piece of pizza will spend quite a bit of time in the

stomach, which is not a passive adventure at all. It is a very dark, harsh chemical and mechanical environment.

· During the first 40 minutes, the middle and the lowerstomach are contracted while the food is stored inthe upper dome of the stomach (the fundus) underthe heart on the left side. Acid is working on thefood, breaking down connective tissue and cellularbarriers, and unfolding long chains of proteins, largeglobules of fat, and long chains of carbohydrates.



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· In the next 40 minutes, the body of the stomachrelaxes to allow the food to enter the middleportion where most of the folds are located. Thereis increased acid production as well as enzymeproduction. In this area, the food will be furtherground mechanically into smaller and smaller pieces.

· Finally, the antrum relaxes and the food entersthe lower portion of the stomach where thereis further exposure to acid and grinding.

Stomach Acid

This is a good opportunity to discuss stomach acid production, since it’s one of the most interestingthings our body does for us. That might seem tobe an unusual statement given acid is considered to be a villain these days, when in fact, it is not.

Gastric acid, also called HCL (hydrochloric acid) isproduced by parietal cells in the lining of the stomach.

This production of acid requires an energy driven system within the cell called a proton pump. The proton pumpactively moves hydrogen protons into the stomach that

will couple with chloride to become hydrochloric acid.In between meals the stomach does not contain acid.

Acid is created on demand by three primary stimulators.

1) Acetylcholine stimulates movement of thestomach wall. Movement of the stomach stimulatesacid production anticipating incoming food.

2) Histamine 2 is the pathway blockedby Zantac, Tagamet or Pepcid, and is amajor mediator of acid production.

3) Gastrin is a hormone produced byG cells in the stomach in response toperceived need for acid production.

All three of these pathways converge atthe proton pump and will be blocked by proton pump inhibitors, stopping the final

common pathway of acid production.

Stomach Enzymes

· Pepsin. The stomach lining produces a pre enzymecalled pepsinogen, produced by chief cells. This preenzyme is converted in the presence of stomach acidinto pepsin, which is a potent digestive enzyme.

· Gastric Lipase. Works on fat breakdown,similar to salivary lipase.

These enzymes, while produced in the stomach,activate in the more neutral pH in the smallintestine. They will combine with additional

digestive enzymes coming from the pancreas.

The Gastric Hormones

· Gastrin is produced in the G cells of the stomach,stimulating acid production from the parietalcells. Low levels of acid output stimulate gastrinproduction and can stimulate development of additional G cells to increase acid production.

· Somatostatin produced in the D cells of thestomach decreases gastric blood flow and stopsgastric activity and acid production. Basicallythis hormone shuts down the GI tract.



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Duodenum

We should first talk about the anatomy of the duodenum, which is controlled at the entry by thepylorus. From the pylorus we enter into the bulb of the duodenum and then we move around a very sharp turn to what is called the duodenal sweep. About 8 inches down, we run into a nipple or valveon the left wall, which is the entry of the common bile duct and pancreas duct. The probable reasonfor the placement of the valve at this position is that the “S-trap” of the duodenal sweep preventsenzymes and chemicals coming from the pancreas and gallbladder from backwashing into the stomach,

which would neutralize acid in the stomach and disrupt the mechanical phase of digestion.

After about an hour and a half in the stomach, our pizza and acid has been reduced to a sludge know as chyme. The pyloric sphincter winks open allowing about a half a teaspoon of chyme, three times a minute, into theduodenum. In between each small entry, the pylorus closes again. The presence of acid, fat, carbohydrateand protein within the duodenum triggers release of three hormones. Now the chemical digestion begins.

pancreatic amylase being the further breakdown of starches and complex sugars into more basic simplesugars that can be readily absorbed into the smallintestine lining as well. Pancreatic lipase performsa similar function on certain types of fat causinghydrolysis or breakdown to create more absorbableforms with some of the simple fatty acids being ableto be absorbed into the duodenal lining directly while

more complex fats will require further processing.· Cholecystokinin (CCK). Causes contraction of the

gallbladder and bile duct and possibly the pancreasduct as well as relaxing of the sphincter of Oddi muscle,to allow the flow of bile and pancreatic enzyme intothe duodenum. The purpose of bile in our digestionis to function as a detergent. Bile can break greasedown into tiny fragments surrounded with a shellof detergent through a process known as micellarformation. This allows the micellar units to be ingestedinto the lining of the small intestine. In the absence of bile, fats would not be properly broken down to the

Duodenal Hormones

The function of chemical digestion is controlled by three primary hormones produced in the duodenumin response to the drop in pH, as acid and chymepass through the pylorus. These hormones and theirresulting effect on digestion are outlined below:

· Secretin. This is a hormone produced in the first partof the duodenum triggering release of pancreatic

enzyme and bicarbonate into the lower portion aroundthe “S-trap” of the duodenum. There is significantflow of bicarbonate and digestive enzymes includingtrypsin and chymotrypsin, which are initially secretedin their inactive form and converted in the presenceof each other and of acid into their active form. Theseenzymes are necessary for the further breakdown of proteins into basic amino acids, which can be readilyabsorbed in the microvilli in the surface of the smallbowel, completing the digestion of proteins. At thesame time secretin will cause the release of pancreaticamylase and pancreatic lipase. The function of



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smallest units and would pass through to the largeintestine, presenting a rich diet to the bacteria of thecolon. This would result in the release of byproductsthat cause diarrhea, abdominal pain, bloating etc.

This was the case in the ill-fated attempt to use a non-absorbable oil called Olestra in preparation of potatochips several years ago that resulted in diarrhea aftereating the chips. The synthetic form of CCK is used to

study the function of the gallbladder in a test called aCCK HIDA scan. The test looks for abnormal gallbladderfunction and problems with the bile duct opening,also known as sphincter of Oddi dysfunction.

· Gastric Inhibitory Peptide also known as GIP. Thishormone is a member of the secretin family and has amotor effect to decrease stomach emptying, slowingthe digestive process, allowing chemical digestion toproceed at an acceptable rate in the small intestine.

This exertion of control is why it takes three or fourhours for most meals to empty the stomach. Thishormone is also involved in the stimulation of theproduction of insulin in response to food entering the

duodenum, particularly proteins and carbohydrates.Insulin allows the cells of the body to take in sugarabsorbed into the bloodstream through the lining of the small intestine. Insulin is absent in Type 1 diabetes.In Type 2 diabetes, the cells are resistant to insulin.

This basically completes the process of digestion. The nutrients from our pizza have now been brokendown mechanically and enzymatically and absorbed.

The Importance of Stomach Acid

Stomach acid occurs naturally and is responsible forsome very important functions. These include:

· The already mentioned assistance with uncoiling of

larger molecules for exposure to enzyme activity.

· The conversion of iron and calcium into a form thebody can absorb in the first portion of the duodenum.

This is a pH-dependent phenomenon meaning thatin the absence of acid, calcium and iron cannot berendered into the appropriate absorbable form,resulting in problems with anemia or osteoporosis.

· Stomach acid kills most bacteria, allowing fora sterile small intestine. A small intestine full of bacteria, competes with our body for nutrientabsorption producing harmful metabolites that canlead to problems with bloating, gas, and diarrhea-

-a condition known as bacterial overgrowth. This lack of acid can also lead to increasedsusceptibility to more pathogenic bacteria suchas Salmonella, Vibrio, and Clostridium Difficile.

· Activation of digestive enzymes.

I am frequently asked about all the problems of acid suppression in terms of taking long-term protonpump therapy such as Prilosec. These medicationsare grossly overused. If they are needed they should be taken and we will deal with the possible associated risk. If they are not needed they should not be used

on a regular basis. Unfortunately, people who actually need medication are concerned about taking it and the people who don't need it, eat it like M&Ms.

What Happens to the Stomach Acid

The secretin causes st imulation of sodium bicarbonateproduction in the pancreas, which flows into thethird portion of the duodenum and neutralizes the

stomach acid. After mixing of stomach acid withpancreatic juices, the resulting mixture is neutral pHand therefore does not cause injury to the rest of thesmall intestine. The neutralization of acid involvesthe following basic equation from chemistry.

HCL+ NaHCO3 yields NaCL + H2CO3Quickly reverting to salt and water and carbon dioxide.

So What Does This Have To Do with Acid Reflux

We have discussed acid ref lux, but we haven't talked about everything else that can reflux. All of theenzymes and bile are capable of refluxing from the

duodenum into the stomach and from the stomachinto the esophagus. This type of reflux is not covered by antacid medication and there is some data tosuggest that the proton pump inhibitors might actually facilitate reflux of bile and digestive enzymes. It is evenspeculated that bile may play a significant role in theproduction of the precancerous transformation of theesophagus known as Barrett's esophagus. It is important therefore to consider the entire digestive process inesophageal reflux disease. Bile will not respond toantacid medication, but can respond to alginic acid alsoknown as Gaviscon liquid over-the-counter, which is

worth a try in patients who are not responding to acid

suppression, or have taken acid suppression with good results and are now having breakthrough symptoms.

Differentiating Acid Reflux from Bile Reflux

· Acid is sour like lemon juice but bileis bitter like green herbs.

· Acid responds to proton pump inhibitor therapy.Failure to respond to acid therapy should lead toconsideration of the possibility of bile reflux. Treatmentwith proton pump inhibitor that is no longer responsive,should likewise trigger consideration of bile reflux.

· Food triggers acid production. When the stomach isempty there is no acid therefore if you are awakening

in the middle of the night or have not eaten for manyhours but are having reflux it may well be bile.

How Does the Stomach Protect Itself

We have discussed the harsh chemical environment in the digestive system, particularly in the stomach.It is not magic that the stomach does not digest itself. The stomach produces a 7 micron thick layer(about the thickness of a bacteria) of mucus and bicarbonate. This completely protects the stomachlining from acid and enzymes. We have problems



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when something happens to prevent or eliminatethis barrier, some examples of which are:

· Aspirin and nonsteroidals are famous for producingstomach ulcers. They do not directly ulcerate thestomach lining but they block inflammation in thebody by blocking a biochemical pathway calledthe cyclooxygenase pathway. Unfortunately, thereis a biochemical crossover, as one of the resulting

products is responsible for the production of thismucus and bicarbonate slime that covers and protectsthe stomach lining. Blocking this production of slime,allows the acid and digestive enzymes to comeinto contact with the stomach lining creating ulcersor significant inflammation known as gastritis.

· Helicobacter pylori infection.This bacteria gets a lotof press because of its role in ulcer development andits role in cancer development. It causes ulcers because

it produces an enzyme called urease that breaks downthe mucus and bicarbonate protective slime allowinginjury to occur. It is very important to know that thepresence of H. pylori in the stomach actually suppressesacid production. Eradication of the bacteria will resultin worsening of acid reflux rather than improving it.

· Bile Is a Detergent. It does not belong in the stomach. The anatomy and physiology of the human body triesits best to prevent that. As a detergent, it easily washesaway the protective slime allowing damage to occur andalso probably washes away a similar protective mucouslining in the esophagus allowing injury to the cells.

Where Do We Go from Here

The piece of pizza we started with is now chemicals and a small amount of waste. We will deal with the waste inlater issues. Until then, “Bon Appetit”. -Steve Porter, MD



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Grumbling Guts? Understanding Irritable Bowel Syndrome

Most of us feel some discomfort in our guts from time to time.It may be because we’re nervousabout something, or perhaps weate something that didn’t agree

with us. But if you regularly feel aches in your abdomen, it might be a sign of a disorder called irritable bowel syndrome.

Irritable bowel syndrome affects about 1 in 5 Americans.It occurs more often in women than men, and beginsbefore the age of 35 in about half the people who get it.

There’s no medical test to identify irritable bowelsyndrome. Instead, doctors make a diagnosis based onthe patient’s symptoms. The most common symptomsinclude bloating and pain in the abdomen, along withchanges in bowel habits. People with irritable bowelsyndrome may have constipation, diarrhea or both.

Irritable bowel syndrome doesn’t lead to cancer or otherhealth problems. But its discomfort can be difficult to live with. The severe or frequent abdominal painit can bring often leads people to visit a doctor.

Physicians and researchers don’t know for sure what causes irritable bowel syndrome. One possibility isthat it comes from changes in the way that the brainand the gut communicate. Dr. Emeran Mayer at theUniversity of California, Los Angeles, is an NIH-funded scientist who’s working to find treatmentsto correct altered brain-gut interactions.

“Most people would agree that stress plays animportant role in triggering symptom flaresin irritable bowel syndrome,” says Mayer.

Many patients first notice symptoms after a stressfulevent, like losing a loved one or changing jobs. People

with irritable bowel syndrome often report higher levels

of stress or anxiety. Stress reduction strategies and cognitive behavioral therapy, a type of talk therapy, canhelp relieve the symptoms of irritable bowel syndrome.

Some researchers suspect that irritable bowel syndromecan be caused by a change in gut bacteria. The gut isusually filled with helpful bacteria, which our bodies need to digest food. But sometimes the types of bacteria canchange, like after taking certain medications. For people

with this type of irritable bowel syndrome, a supplement of probiotics—a collection of live, healthful bacteria—might help. Probiotics are available as capsules, tablets

and powders, and they’re found in some dairy foods,such as yogurts with live active cultures. The potentialbenefits of probiotics, however, are still under study.

Many people with irritable bowel syndrome find that certain foods can make them feel worse. “Thereis no specific irritable bowel syndrome diet,” says

Mayer. “Irritable bowel syndrome patients aregenerally more sensitive to a variety of foods.”

If you have irritable bowel syndrome, try keeping a

diary of the foods you eat and how they make youfeel. Then, you and your doctor can decide togetherif you should try making changes to your diet.

Every case of irritable bowel syndrome is unique,so if you have symptoms that disrupt your life,don’t suffer in silence. Your doctor can work withyou to find the treatment that works best for you. -Source: NIH News in Health, February 2012, Published by the National Institutes of Health andthe Department of Health and Human Services. For more information go to www.newsinhealth.nih.gov

Signs of Irritable Bowel Syndrome

• Bloating

• Distension and discomfortof the abdomen

• Abdominal pain

• Constipation

• Diarrhea



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In Young Boys, EatingDisorders May Look

Like Picky Eating

BoysGet Eating

Disorders, Too



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When teen-age girls get eatingdisorders, they often declarethemselves to be "fat." But whenyoung boys develop eating disorders,they do not usually use words.

"They may become extremely picky eaters and the list of foods they will eat grows

smaller and smaller," says Ellen Rome, MD, a Cleveland Clinic expert in adolescent medicine. "They may avoid many foods and may even gag on some things."

Warning signs

One strong warning sign is when a child suddenly cutsentire food groups out of his diet, such as declaringhimself to be a vegetarian. When this starts tohappen, parents must be alert to additional symptomssuch as failure to gain weight or grow, she says.

"With girls, the cessation of menstrual periods is often a red flag. That is obviously missing in boys, but older boys may notice a decreased libido,” Dr. Rome says. She adds that this

is a detail they are not likely to share with family or friends.

Potential triggers

Many things can trigger eating disorders in youngboys. The most common is being teased about their

weight, especially at home. "This leads to low self-esteem, which puts them at even greater risk forobesity and eating disorders," Dr. Rome says.

Stresses such as parental divorce, sexualabuse or a general fear of growing up cancontribute to an eating disorder as well.

Ensuring good nutrition

If young boys want to become vegetarian,"take them to a registered dietitian so they can learn to be a healthy vegetarian," says Dr.Rome. "They need to know how much tofuor other non-meat protein it will take to makeup the protein they formerly got in meat."

She also suggests that children with a sudden diet change be checked for physical problems that may becausing pain when they eat, such as irritable boweldisease. "Also, remember that reducing food intakecan cause painful gastric slowdowns and constipation,further reducing a child’s desire to eat," she says.

Treatment usually requires a team approachinvolving a dietitian, a pediatrician or adolescent medicine expert and a therapist to coach parentson forging new eating patterns. "Look forprofessionals who are experienced in disordered eating in children," notes Dr. Rome.

Underlying problemsShe adds that "in kids under 12, eating disordersmay just be the tip of the iceberg. Younger boys and girls are more likely than older patients with eatingdisorders to have an underlying anxiety disorder,depression or obsessive-compulsive disorder."

Concerned parents should get help from apediatric psychologist or psychiatrist, becausethese disorders respond very well to treatment once they are recognized. -This information provided courtesy of Cleveland Clinic Heath.



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Infertility is a common, yet complex, problemaffecting approximately 15 percent of couples tryingto have a baby. Too often, blame for the inability to conceive is placed on the women when in reality,men and women share the burden equally. In upto 50 percent of infertile couples, the problem is

partly related to male reproductive issues. Fortunately, with today's high-tech procedures and powerfulmedications, a diagnosis of infertility means the road to parenthood will be challenging but not impossible.

Infertility clinics in the United States using AssistedReproductive Technology (ART) reported thesuccess of 61,426 infants in 2008. This is about

1% of all babies born each year nationally.

Many of those who suffer from infertility describe overcoming the disease is like ridingan emotional roller coaster. Cassee and Patrick

McCleary’s story exemplifies this well.

Cassee and Patrick decided to have a baby in 2002,but after a year of trying and no luck, they began theemotional trek of exploring infertility options. Thefirst stop was their family OB/GYN. Under his care,Patrick had surgery and Cassee had a few procedures.

TheEmotional

Road ToFamily Life After another non-productive year, their OB/GYNreferred the couple to an Infertility Specialist.

The McCleary’s OB/GYN is a very good physician,but recognized he didn’t have the proper trainingnor equipment necessary to help the couple. Heknew all about women’s health and deliveringbabies, but making babies was an entirely different discipline. He did the right thing in referring thecouple to someone he thought could help.

While their hopes were high, the results were not.Unfortunately, they then spent another 3 years visitingseveral other specialists who could not provide the

care they needed. Insurance hassles and continued unsuccessful treatments led to much disappointment.

“There were so many roadblocks at almost everyturn,” Cassee said. “But we weren’t going togive up. We weren’t going to back down.”

In Patrick’s mind the worst frustration was thesuboptimal quality of care they received. Patrick

works for a major pharmaceutical company and knows the practice of medicine well. They werelooking for a physician and clinic that would



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demonstrate the same care and passion that they have in their quest to become parents.

Patrick said, “We often talk about medical care,but the element of ‘care’ was noticeably absentin most practices. We want to feel good aboutour doctor. We even visited a major Universityand walked away. The lack of individualized

care and concern was a major turnoff.”

Cassee and Patrick felt they lost five valuable years. They were determined to experience the joy of bringing a new life into the world, but they also realized they had to bemore cautious and do a little more homework. They didn’t give up. After talking to friends, other doctors and anyone

who listen, they somehow found information about my clinics in Boise, Idaho and Pleasant Grove, Utah.

I met the McCleary’s in 2007 and it was obvious fromthe start that they were determined, yet cautious.

They were educated, patient and had gone through agreat deal in their quest for pregnancy. I learned they had been thorough in their research and had beento a number of treatment centers. Having suffered personally from infertility, I believe that infertility puts a couple in an emotional state that, quite frankly,requires an emotional connection with their doctor.

Patrick was obvious in his frustration when hesaid: “Dr. Foulk’s office was different. It seemed he and the staff were passionate about what they did and we felt like we were their only patients.”

I give a lot of credit to Patrick who recognized, throughtesting, that he was a major part of the problem.

Looking back on the issue, he explains the problem with a smile, “most sperm are activelittle swimmers looking for an egg toimpregnate, and my swimmers ended up being the lazy kind who simply laid at the bottom of the pool”.

Infertility is treatable--virtually every cause can be overcome to help every couple have a baby of their own. The most common cause of infertility problemsare ovulation defects and male factors.Couples must understand why they cannot get pregnant and have a plan toovercome it. They should begin withthe easiest step and understand exactly

why any treatment is not successful. It is crucial to identify the problem, thentreat it proactively each month. Many people become frustrated and quit if they don’t get the right kind of help.

We are meant to have children; there isalways a reason why we can not. The keyis to know the reason and overcome it.

Infertility treatment is affordable. Most couples canachieve pregnancy with minimal and affordabletreatments. Too often, unwary couples get pushed intotreatments that are not best for them or do ineffectivetreatments that waste their time and money.

Less than 10% of infertile couples need theexpensive high tech treatments like IVF.

Infertility is an emotional burden. The best way tocope is to understand the dysfunction, know all theoptions and then develop a plan that is realistic and based on the one’s history and needs. After five years of frustration, the McCleary’s took a pragmatic approachand the roller coaster eased into a smoother road.

For the McCleary’s, after we identified the problem,the solution was easy and effective. They wereundaunted in their quest and the results were beautiful.Cassee gave birth to the couple’s first baby in 2008.Recently, the couple came to me again and we wereable to produce a second pregnancy. This time, Casseegave birth to twins at the end of April this year.

Happily, Cassee and Patrick will tell you that marriage and kids go together. In spite of all thetrials and tribulations the couple went through, theend result has been three healthy children. They willtell you it was a fun, yet often trying, experience.

Evidently the journey with my staff was moreenjoyable than I had realized. Cassee referred her40-year-old sister and another cousin to me, both

who are now pregnant and happily expectingtheir first children. - Russell A. Foulk, MD




With the McCleary’s three children and the four children born to cousins and in-laws, Dr. Foulk iscredited with helping bring seven new McCleary family members into the world. There is hope.

Among those the McCleary’s have referred Dr. Foulk havebeen Cassee’s sister Andrea and brother in-law Brian. TheStaheli’s were blessed with twin boys this past January.

The McCleary’s also referred Patrick’s cousins,Kristin and Jeremy Colter to Dr. Foulk. This pastMarch, Kristin had twins as well – a boy and a girl.

Update: Patrick and Cassee McCleary have been spreadingthe word about Dr. Foulk’s ability to give hope to familieswho have been through the difficulty of infertility.



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When Eating Goes to Extremes

With summer just around the corner,

we see constant reminders about getting in shapefor swimsuit

season. Magazines offer annual tips forslimming down. Pencil-thin modelsshow us the bodies we can’t possibly achieve. We may feel inspired to shed afew pounds, but most of us don’t takethese media messages too seriously.

For the small minority of people witheating disorders, however, the relentlesspursuit of an ideal body can havedire or even deadly consequences.

Scientists had long believed that eatingdisorders were primarily triggered by cultural pressures or psychology. “But over the past decade, there’s been a realrevolution in thinking about the factorsthat lead to eating disorders,” says Dr.Cynthia Bulik, director of the EatingDisorders Program at the University of North Carolina at Chapel Hill. “We

now have evidence of the substantialrole that genes can play.” People whoare genetically vulnerable may be moresusceptible to cultural cues. “They may start extreme dieting or binge eating.

That could lead them down the pathto an eating disorder,” says Bulik.

The result is that, when faced witha full-length mirror, people witheating disorders take self-criticismto extremes. They excessively focuson body weight and shape. They

have an out-of-control urge to eat either far too much or far too little.

Accurate data on the number of people with eating disorders has been scarce.Earlier this year, however, Harvard scientists reported results of the first nationally representative study of eating disorders in the U.S. They found that, overall, 4.5% of adults, orover 9 million people, have struggled

with eating disorders at some point

in their lives. The study also found asurprisingly high number of men witheating disorders (see “Statistics” box).

Eating disorders are complex conditions. The three most widely recognized are anorexia nervosa, bulimia nervosaand binge-eating disorder.

Anorexia nervosa is the least common but most deadly of thethree. People with this disorderbecome dangerously thin, often by

severely limiting their food intake,exercising excessively or using self-induced vomiting, laxatives or other

“purging” techniques. Malnourishment may lead to osteoporosis and anemia.

Women lose their menstrual periods.

People with bulimia nervosa areoften normal weight. They feel anuncontrollable urge to eat largeamounts of food, or binge eat. Thenthey compensate by purging, fastingor exercising too much. Dr. Susan Z.Yanovski, director of NIH’s Obesity and Eating Disorders Program, says,“Bulimia nervosa can cause a lot

of medical problems, such as heart irregularities and difficulties with the

digestive system. Self-induced vomiting can

wear away tooth enamel.”

The third disorder,binge-eating disorder,also involves frequent episodes of bingeeating, but without thecompensatory behaviorsseen with bulimia

nervosa. “As you canimagine,” Yanovski says,“if you frequently eat large amounts of calories

without compensating inother ways, you’ll gain

weight. That’s why binge-eating disorder is oftenassociated with obesity.”

And with obesity comes an increased risk for diabetes,stroke, heart disease

and certain cancers.

Binge-eating disorder,unlike anorexia nervosaand bulimia nervosa, isnot officially recognized as a psychiatric disorder.But the Harvard study found that binge-eating disorder is by far the most commonof the three, affecting

The Excesses of Eating Disorders



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If you’re the parent of a child yoususpect may have anorexia nervosa,don’t hesitate to act. “Given that anorexia nervosa has the highest death rate of any psychiatric illness,it always should be taken seriously,”Bulik says. “Never assume it’s apassing phase.” -Source: NIH News in Health, May 2007, published bythe National Institutes of Health and the Department of Health and Human Services. For more information

go to www.newsinhealth.nih.gov

Know the Signs of Eating Disorders

Anorexia Nervosa• Refusing or unable to maintain at

least 85% of normal body weight.

• Repeatedly checking bodyweight, carefully portioningfoods and eating only very small

quantities of only certain foods.Bulimia Nervosa• Recurrent episodes of

binge eating at least twicea week for 3 months.

• Going to extremes tocompensate for eating—forexample, making yourself vomit or abusing laxatives.

Binge-Eating Disorder• Feeling out of control when

eating a large amount of food, atleast twice a week, for 6 months.

• Experiencing extremedistress about overeating.

In a study of nearly 3,000 U.S. men and women, Harvard scientists found:

• Men account for 25% of Americans with anorexia or bulimiaand 40% of those with binge-eating disorder.

• The median age of onset for eating disorders is 18-21 years.

• Eating disorders are often accompanied by other psychiatricconditions, like depression, drug abuse and anxiety disorders.

• Fewer than half of people with bulimia nervosa or binge-eatingdisorders have sought treatment for their condition.

nearly 3% of the population. Incontrast, anorexia nervosa affects0.6% and bulimia nervosa 1%.

Eating disorders are treatable, but better treatments are needed. Current therapies usually involve a combinationof medical and psychological approaches.

Doctors sometimes use antidepressantsor other medications. But the only oneapproved by the U.S. Food and Drug

Administration is fluoxetine (Prozac),for the treatment of bulimia nervosa.

Yanovski and her colleagues hope totake a preventive approach to bingeeating by spotting risky behaviorsbefore a full-blown disorder and obesity develop. Yanovski explains,“If we can identify kids who may not yet be obese but who have problems

with loss-of-control eating, they may be in a high-risk group. We’relooking at ways to intervene to prevent obesity as well as eating disorders.”

One path to improved therapiesis a better understanding of theunderlying genes and biology. Studiesof families and twins provide strongevidence that genes contribute toall three major eating disorders.

An international research team—led by Dr. Walter Kaye, now at the

University of California, San Diego—has found regions of DNA that may hold genes associated with anorexianervosa and bulimia nervosa. Theirfindings inspired a 5-year NIH-funded study to identify specific genes that influence anorexia nervosa risk inhundreds of U.S. families. The initialresults are expected later this year.

If you suspect someone you care about may have an eating disorder, Bulik says,“the most important thing is to talk

about it with them directly. In a firm

but compassionate way, let them know that you’re concerned about their well-being. Do whatever you can to get themin for an evaluation as soon as possible.”

Yanovski notes that most people with bulimia nervosa or binge-eatingdisorder will admit to their behaviorsif asked directly. In contrast, those

with anorexia nervosa often deny theirsymptoms. “If you ask why they’re not eating, they may say they’re not hungry

or they’ve already eaten,” Yanovski says.



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Thr ou gh

T h i c k & T h i n

Did you know... Nearly10 million females and

1 million males in theU.S. are battling eatingdisorders such asanorexia and bulimia,while millions moresuffer from bingeeating disorder. Thepeak onset of eatingdisorders occurs during

puberty and thelate teen/early adultyears, but symptomscan occur as youngas kindergarten.More than onein three normaldieters progresses topathological dieting.



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I recently received a book in the mail––it was thefirst copy of my new book, a memoir of anorexianervosa. I picked it up off the front door mat whereit lay swaddled in brown cardboard like baby Jesusin a basket. When my husband came home and

I unwrapped it and held it bare in my hands forthe first time, I said, "It feels a bit thin! I expected it to be… thicker." We both immediately recognized theirony in my statement, coming from the mouth of arecovered anorexic, and we laughed. Society acceptsthicker books, "fatter" books, we call them tomes and consider them to be intelligently written, of value,containing substance. My book of 264 pages, however"thin" it feels, contains the weight of the decade of my

Anorexia, which started at age fourteen and waned at age 24. I'm now 34 and ten years recovered.

I was born and raised in Johannesburg, South Africa

where I grew up in an all-female, diet-free, nutrition-filled eccentric, artistic household. I attended a private Jewishschool where I belonged, miserably and involuntarily, tothe "odd ones out" and not the "popularati." My parentshad divorced, when I was nine, on our return to South

Africa after a short, failed immigration to Israel and it was then that I suffered my first unofficial depression. Iremember the feeling of being in a place (physical and emotional) that I didn't want to be and having absolutely no power to change it. I can tell from photographs of that time by the look on my face, my demeanour, the way my clothes sag on my sad childish frame that I had lost thehappiness that I had suddenly discovered in Israel and there

was no way out. On top of that my father moved out and my already precarious world ripped in two. I felt it rip.Suddenly we were a family of three sisters: my mother––a young thirty-something woman, herself struggling

with depression, my sister and me. On the periphery wasmy distant and emotionally unavailable father whom I

wanted more than anything in the world to show melove. Over the years when the pain of being the pariah at school persisted, I wanted out. Out of the pain of feelinglike the odd one out, the awkward one, the sad one. Idecided at age fourteen after a humiliating incident at school to change schools and my life took a new turn.

I suddenly found myself popular at my new school––a multi-racial (which in those days was unheard of inapartheid South Africa) Catholic, co-ed convent asdifferent from my elite, all-white Jewish school as could be. I hooked up with a group of girls––many of whomcame from "dysfunctional" families, all of whom wereteens on the verge of daunting womanhood, strugglingto find their true identities, craving to fit in, to be loved and accepted by one another, wanted by the boys. Inthose days, however, there were no online sites dedicated to girl empowerment movements or self-esteem boost ingorganizations to which to belong as there are now. Thegirls in my clique only had each other to rely on, to

turn to in crisis and we were all stuck in the same boat of teenage naivety and the insatiable desire to belong.

It was at the convent that I first heard about dieting. And within months I latched onto this once utterly foreign concept and was unexpectedly on a suddenmission of weighing myself and on a downward spiral of

weight loss that caused amenorrhea, depression as wellas a high, an illusory sense of control, and focused my attention on something other than my daily stress and my inner turmoil. Nine months later, I should have beenhospitalized but the doctors in those days wouldn’t haveknown what for. I didn't know what Anorexia was, nor

did I know anyone who was anorexic. Growing up inSouth Africa, I wasn't inundated with Hollywood "thin"extravaganza and Anorexia was nowhere to be found in the media. That was 1991. An almost (unbelievable)twenty years ago and yet that so-called teenage "diet"set the stage for the rest of my life. Soon enough Ibecame a reclusive, defiant, angry, aggressive, unhappy teenager. I started to lie, steal, sleep around and drink in secret pursuit of some unattainable escape, all the

while conspiring with an invisible entity––Anorexia––that had overtaken my life, my being and wasbecoming me or me Her. Yet she remained nameless.



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For six years I lived in denial of my disorder. I refused to label it or define it although I knew there was aproblem. I knew my starving was all-consuming. But I didn't believe (like others thought) that my intention

was to starve to death. I know it wasn't. Instead,starving, for me, was an act of survival. In my mind,I honestly believed that Anorexia was the only thingprotecting me. Anorexia became my identity. Years

later, after moving to Israel after high school and beingrecruited to the Israeli army (a decision Anorexia agreed to on my behalf), I returned to South Africa and my mother, who had not seen me in months, took onelong at me and realized the severity of my situation.

After six years of watching me waste away and beingpowerless to stop it, she managed to track downsomeone in the field of eating disorders to speak to me.For some obscure reason, I agreed. That man, in oneconversation, broke my denial and a few months later

while actively pursuing a dead-end career in raving and doing drugs, I had an epiphany that woke me up tothe reality that my sense of self, "I" was being lost to

Anorexia. And from there, I knew that if I crossed theline, there would be no return. I realized that if I didn’t stop starving, I would experience something worsethan death. "I", my sense of self, would die forever.Yet I would be alive, for a little while, to realize it.

It took another three years of reckless behavior and debilitating confusion before I finally, after ten years,and some serendipitous happenings, made the consciousdecision to want to be well. However, I didn't think it meant letting Anorexia go, as though she meant nothing. I just knew that I could no longer hold on.

After ten years of f ighting the disorder alone, almost every day, believing I had the will power to stop it,

while paradoxically "feeding" it with my starvation, Ifinally gave in. I surrendered. That was the start of along, emotionally excruciating and exhausting recovery.It was the start of my journey back to my true self.

My story is not a misery memoir, it's not a to-hell-and-back story, it's strangely enough a wild ride that Iam lucky to have survived. I am lucky to have had theundying support of my amazing, loving family whobelieved in me every step of the way and incredibletherapists and nutritionists who supported my recovery.I could never have done it alone. Especially valuable wasthe support group I attended for years where girls and

women with eating disorders gathered to share theirstories. It was there that someone planted the seed for meto share mine. That was in 2002, the year that I started

writing being Ana, which is ultimately a story about one girl's search for her Self, through thick and thin.

I wrote being Ana to share what I learned about thiscomplex and controversial disorder––Anorexia. I hopethat it inspires readers to find compassion for theirloved ones and friends suffering from Anorexia, and maybe that it encourages sufferers to want to find a

way out. Because there is a way out––a clear-cut, albeit painful and messy, way out. But the journey out requires

tenacity, courage and endurance, which I believeevery Anorexic has. Rabbi Nachman, who lived in theeighteenth century, once said, "If you believe you canspoil, then believe that you can repair." He also believed that the purpose of sharing one's story, one's dark secrets

with others is to take a weight off the soul as part of thehealing process. On that note, it is also my hope that readers of this Story of Hope or of my book will walk away with the will to want to share their own stories sothey can lead lives in which they are true to themselves.

Shani Raviv worked as a freelance writer in South Africa. She currently lives in Seattle where sheis marketing her book, being Ana: a memoir of

anorexia nervosa, leading creative writing workshops,practicing yoga, hiking and camping in rainforestsand volunteering at NEDA where she is working onoutreach for NEDA Awareness Week 2011. Visit her

website: www.shaniraviv.com -This story is reprinted courtesy of the National Eating Disorders Association.

www.NationalEatingDisorders.org Toll-free Helpline: 800-931-2237

Shani Raviv



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Fertility AdvancesBringHelp and Hope

Sometimes it takes a little science to help

fulfill a dream. At least that’s what it oftenfeels like for people who turn to UAB’sDivision of Reproductive Endocrinology and Infertility for answers, help, and hope.

Now more of those dreams are coming true.In less than 10 years, UAB’s success rate for in vitrofertilization (IVF) has more than doubled. Divisiondirector G. Wright Bates, M.D., credits much of thesuccess to refinements in IVF techniques. “We havecome a long way in treatment cycles,” he says. “Back in 2002, less than one in four women with a good prognosis got pregnant within a month. Now we

often exceed 50 percent in a month with IVF.” Headds that increased awareness of infertility issues—and more widespread information on potentialsolutions—also has helped educate the public and encouraged more patients to learn about their options.

Increasing the Chances

Today, the division, which provides individualized careto both women and men, continues to investigate new advances in fertility treatment that will increase thechances of conceiving and carrying healthy babies. Oneavenue of research is the multicenter PCOS-II Trial,

sponsored by the National Institutes of Health (NIH),

which is testing two oral medications, clomiphene citrate(Clomid) and letrozole (Femara), to determine which isthe most effective in inducing ovulation and enhancingfertility in women who have irregular cycles, don’t ovulate regularly, or exhibit signs of hormone imbalance.

“We’re thrilled to be part of this group,” Batessays. “There is no other center in the Southeast participating, and we think it’s a great way



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for us to improve our treatment options, and better serve the women of Alabama.”

The trial covers basic fertility testing for both womenand men and provides four months of treatment.Patients interested in enrolling in the trial can callstudy coordinator Susan Mason at (205) 801-8207 for more information and a phone screening.

Another revolutionary development, Bates says, is pre-implantation genetic screening, which examines embryosfor disease and potential developmental problems.“This doesn’t mean designer babies, or choosing haircolor and eye color,” Bates explains. “We’re talkingabout ensuring a normal chromosomal number and avoiding major developmental issues to enhance thechances of producing a normal, healthy offspring.”

Bates is quick to underscore the division’s emphasis onhealthy pregnancies. UAB is committed to avoidinghigh-order multiples—triplets or more—that can posea threat to both the woman and the fetuses, he says.

Fertility After Cancer

Beyond assisting couples who are struggling toconceive, Bates and his colleague Janet McLaren,

M.D., are focusing on ways to help cancer patients who have concerns about their future reproductivecapabilities. UAB is participating in the

National Physician Cooperativeand Oncofertility Consortium,an NIH program workingto develop techniques toimprove the reproductiveprospects of people who

have undergone treatmentssuch as chemotherapy or radiation that can bedetrimental to fertility.

“As treatments for cancerhave improved, survivalhas become morecommonplace. Peopleare going on to livefull l ives, and formany of them,that includes

having children,”Bates says.

A very successfulsolution for thesepatients, he notes, isfertility restoration,in which donated eggs or spermallow couples who areinfertile from treatment to experience pregnancy and

parenthood. And both women and men can benefit from a variety of fertility preservation techniques,Bates says, including banking sperm, eggs, embryos,or an ovary before cancer treatment begins.

The newest and most experimental of these techniquesis ovarian tissue cryopreservation, in which a woman’sovary is harvested and frozen. Following successful

cancer treatment, the frozen tissue is transplanted back to the remaining ovary in the woman’s body.

While only about two dozen pregnancies worldwidehave resulted from this technique, Bates says that it is particularly promising for women and younggirls for whom reproduction may not be a priority now, but who may want children in the future.

Bates adds that the majority of patients who havesought information regarding fertility preservationprior to cancer treatment have chosen to not pursuefertility preservation or use traditional IVF withembryo freezing, with only a small number pursuing

egg or ovarian tissue banking. However, it is very important to note that simply having the optionsdiscussed and their questions addressed may allay some common fears about cancer treatment, heexplains. “We want to help people go from survivingcancer to surviving parenthood,” Bates says.



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Infertility—Common Causes

There are several complex processes that must occur inorder for you to become pregnant and carry a baby toterm. Disruption of any of these processes can lead toinfertility. The physicians in UAB’s infertility program arespecially-equipped to diagnose the cause of infertility and

begin treatment to help you and your partner get pregnant.

Some common causes of infertility include:

Male Infertility

Infertility in couples is not always confined to the woman. In fact, research data suggests that nearly half of all infertile couples have a male component.

When facing infertility, a male semen analysis is one of the most important tests that a couple can have, and

should be completed early in the infertility evaluation.Ovulatory Disorders

There are numerous conditions that can lead toirregular or absent ovulation. Treatments forovulatory disorders seek to correct the underlyingcause and/or stimulate ovulation. This is usually accomplished by correcting any behaviors associated

with the disorder and by prescription drugs.

Polycystic Ovarian Disease (PCOS)

PCOS, also known as polycystic ovarian disease(PCOD), is a common cause of infertility

in women. PCOS is characterized by a

cluster of symptoms that are seen in most women who have the syndrome.

Endometriosis

Endometriosis occurs whencells that line the uterus(endometrium) attach to organssuch as the ovaries and intestine.

Endometriosis is a common causeof infertility and is often accompanied

by severe menstrual cramps, painfulbowel movements or urination, pain during

intercourse, and pelvic pain. Endometriosis

may cause no pain yet still cause infertility.

Recurrent Miscarriage

Approximately 15 percent of pregnancies end between week fourand week 20 in miscarriage, alsoknown as spontaneous abortion.

Spontaneous abortion means thepregnancy ends due to natural causes,

versus surgical or medical. Recurrent miscarriage is defined as three or more

consecutive spontaneous abortions. Recurrent miscarriage in fertility patients is especially

tragic because they have often undergone monthsof fertility treatment to achieve pregnancy.

Cervical Factor Infertility

Cervical Factor Infertility can occur when the mucuslining the cervix is too thick, therefore impedingthe man’s sperm from progressing past the cervix. It can also occur when a woman produces antibodiesthat attack and kill the sperm before it can enter thecervix. Intrauterine insemination (IUI) is often thefirst line treatment for cervical factor infertility.



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Tubal Factor Infertility

Tubal disease occurs when conditions, such asendometriosis, cause damage to the tubes. Scarring fromendometriosis can constrict and damage the tubes. Pelvicinflammatory disease can create scarring of the tubesand other internal organs. In rare cases, some womenare born with only one, or no, fallopian tubes. Some

women also want to have previous tubal steri lizationreversed because of changes in their life situations.

Female Age and Infertility Advancing age, which is ultimately accompanied by reduced ovarian reserv e, is a common causeof infertility. As eggs age they lose their capacity to fertilize and develop, which results in low estrogen levels and irregular or no ovulation.

If you are in your thirties, are having regular intercourseand are not pregnant after 6-12 months, you arestrongly urged to seek care from a reproductiveendocrinologist. Our specialists conduct athorough diagnostic evaluation and rapidly implement the treatments most

likely to result in pregnancy.

Unexplained Infertility

First level treatment of unexplained infertility may involve stimulated IUI. If this is not successful, many patients become candidates for in

vitro fertilization. In many cases,intracytoplasmic sperm injection orassisted hatching will also be employed.

Uterine Factor Infertility

Several disorders of the uterus may cause infertility.Large polyps, fibroids, or scar tissue may obstruct the uterus. In most instances, times these conditionscan be corrected by hysteroscopic surgery. Some

women are born with congenital abnormalities of theuterus including conditions such as the unicornuateuterus (half uterus) and uterine septum (verticalbarrier inside uterus). Uterine abnormalities canbe diagnosed by hysterosalpingogram, ultrasound,sonohystogram, MRI, or hysteroscopy withlaparoscopy. -This information provided courtesy of the University of Alabama at Birmingham Medicine




Identifying Parkinson's DiseaseNew Imaging Test Give

Physicians a Better Tool to Diagnose

Parkinson's Disease

T hanks to a new diagnostic imaging technique, physiciansnow have an objective test to evaluate patients forparkinsonian syndromes, such as Parkinson’s disease.

Northwestern Memorial Hospital is among the first institutions in the country to offer DaTscan™, theonly FDA-approved imaging agent for assessment

of movement disorders. Until now, there were no definitivetests to identify the disease, forcing physicians to rely on clinicalexaminations to make a diagnosis. This technology allows doctorsto differentiate Parkinson’s from other movement disorders.

“The scan by itself does not make the diagnosis of Parkinson’s but it allows us to identify patients who have loss of dopamine, the majorchemical responsible for the symptoms, from those who have nodopamine deficiency,” said Tanya Simuni, MD, a neurologist at

Northwestern Memorial and director of Northwestern’s Parkinson’sDisease and Movement Disorders Center. “This is a very important step in being able to accurately identify and treat movement disordersand hopefully allow us to better understand these diseases over time.”

Parkinson’s disease is a neurodegenerative disorder that afflicts

nearly 1.5 million Americans, with an additional 50,000 to60,000 new cases identified each year. People with Parkinson’slack dopamine in the brain, which leads to tremor, slownessof movement, muscle stiffness and balance problems. Clinicalexaminations, particularly early in the disease when symptomsare slight, can be inconclusive or lead to misdiagnosis of anothermovement disorder, such as essential tremor, which share similarsymptoms to Parkinson’s, but require different treatment.

Developed by GE Healthcare, DaTscan is a substance used todetect the presence of dopamine transporters (DaT) in the brain.

A patient is injected with the contrast agent and then undergoes a

single-photon emission computed tomography (SPECT) scan. Thetest captures detailed pictures of the brain’s dopamine system and can provide visual evidence of thepresence of dopamine transporters.Scans of patients with Parkinson’sdisease or another parkinsoniansyndrome will show very low dopamine levels. A SPECT scanexamines brain function, ratherthan structure, and can show change in the brain’s chemistry.

“In Parkinson’s patients the brain’sanatomy remains largely normal,unlike other conditions such asstroke, where damage to the brain is

visible,” explained Simuni, who is alsoan associate professor of neurology at Northwestern University Feinberg

School of Medicine. “DaTscanattaches to dopamine neurons whichilluminate on the SPECT scan;the more light areas that exist, themore healthy dopamine brain cellsremain. If the areas of the brain that should show dopamine remain dark,it may indicate the patient has sometype of parkinsonian syndrome.”

An accurate clinical diagnosis forpatients with neurodegenerative



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movement disorders, such as Parkinson’s, can takeup to six years. While symptoms often mimicParkinson’s, other movement disorders, such asessential tremor, occur in different areas of thebrain and do not involve the dopamine system.

“Even though they may appear similar, other movement disorders require different management. DaTscan

allows us to confirm our diagnosis earlier and start the correct course of treatment sooner,” said Simuni.“We are hopeful that this will lead to improved quality of life for these patients with better long termoutcomes, as well as protection from unnecessary treatments initiated because of misdiagnosis.”

While Simuni does not believe it is necessary forevery patient to confirm their Parkinson’s diagnosis

with DaTscan, she does see it as a valuable tool forpatients with uncertain syndromes, or those whohave not responded to treatment. She also sees it as a means for improving Parkinson’s research by

ensuring those enrolled in studies actually have thedisease. DaTscan is already being used by the Michael J. Fox Foundation for its landmark biomarkersstudy, the Parkinson’s Progression Markers Initiative(PPMI), to validate that the subjects have Parkinson’sdisease. Northwestern is one of the 14 U.S. medicalcenters enrolling for the PPMI, which is amongthe first clinical trials using DaTscan in this way.

“Currently, we are not able to say with certainty that those enrolled in Parkinson’s studies have the disease,”said Simuni. “With the addition of DaTscan, we can bemuch more confident in the status of research subjectsin both the control and experimental groups. By havinga better understanding of these populations, we should be able to have clearer outcomes and hopefully that willtranslate sooner into treatments and eventually a cure.”

Researchers are also hopeful that DaTscan will proveto be useful in following the progression of Parkinson’sthroughout a patient’s lifetime. “The disease isclinically measured at certain points of time to helpphysicians understand its development,” said Simuni.“A lot of questions about how Parkinson’s diseaseprogresses can be answered if DaTscan is able to show us changes in the brain’s chemistry over time.”

Northwestern’s Parkinson’s Disease and Movement Disorders Center is the only National Parkinson FoundationCenter of Excellence in Illinois. The center provides

innovative, multidisciplinary care, while also conductingresearch to extend knowledge and treatment of movement disorders. There is an emphasis on education and support for patients, families, caregivers, healthcare providers and the community. For more information, visit Northwestern’sParkinson’s Disease and Movement Disorders Centers at

www.parkinsons.northwestern.edu -This information provided courtesy of Northwestern Memorial Hospital



Partial Hearing Loss andthe Hybrid Cochlear Implant

Hearing loss canaffect anyone at any time. But it can be especially frightening forsomeone who

suddenly starts to lose hearingduring adulthood. Tom Groves,77, first noticed his diminishinghearing when he was in hisearly 40s. He was unable to

hold conversations with largegroups of people, found it nearly impossible to socializein high-background noiseenvironments like restaurants.and couldn’t enjoy radio, TV and movies unless they werecaptioned. Now, Groves ishearing much better than hehas in 30 years, thanks to anexperimental hybrid cochlear implant.

Northwestern Memorial Hospital isone of nine centers in the U.S., and theonly in Illinois, that is participating ina study investigating the effectivenessof a new cochlear implant device that aims to restore hearing for individuals

with high-frequency hearing loss and functional low-frequency hearing.

This group of patients doesn’t meet the criteria for conventional cochlearimplants because they have nearperfect residual hearing in low pitchesthat allows them to perform well ontests used to determine candidacy for

traditional implants. However, theirhearing in high pitches is so poor that a hearing aid is not helpful, makingthem ideally suited for the hybrid implant, which addresses both issues.

“We are hopeful that the hybrid cochlear implant will provide a subset of people who were previously not candidates for an implantable devicethe opportunity to test the deviceto determine if they can experience

sound again,” said Northwestern Medicine neurotologist Andrew Fishman, MD, principal investigatorof the study, staff in the departments

of otolaryngology and neurosurgery at Northwestern University’s FeinbergSchool of Medicine, and Mr. Groves’cochlear implant surgeon. “Thepotential for patients with a significant amount of residual hearing, but a largeamount of high-frequency hearingloss, to have an alternative to hearingaids would be a great improvement over what is currently available.”

Cochlear implants were FDA approved in 1984 as a treatment option for

restoring hearing in people with severeand profound hearing loss. The surgicalimplant system is designed to stimulatethe auditory nerve by bypassingdamaged parts of the ear. A smallbattery-operated mini “computer” and microphone are worn on the outside of the ear and convert sounds into electricsignals. The signals are then transmitted to implant electrodes in the cochlea,

which stimulate the nerve endings sosound can be perceived by the brain.

The hybrid cochlear implant works in the same way astraditional cochlear implants,stimulating nerve endings in thecochlear so that high-pitched sounds can be heard. In addition,it also involves amplification forlow-pitched sounds, similar toa hearing aid. Like traditionalcochlear implants, the hybrid

version is worn outside the

ear and converts sounds intoacoustic and electric signals.

“The surgical implantation of cochlear devices is typically done on an outpatient basis,and usually with non-seriouscomplications, aside from mild discomfort following surgery,”said Northwestern Medicine

otolaryngologist Alan Micco, MD, co-investigator of the study and chief of otology/neurotology at the FeinbergSchool of Medicine. “A few weeksfollowing surgery, the activationprocess and fine-tuning take place todetermine what audio thresholds work best for the individual, and sounds canusually be perceived shortly thereafter.”

Post-activation evaluations take placeat three, six and 12 months followingthe initial activation process to assessprogress of the cochlear implant. Anaudiologist will also test the implant to determine if participants are ableto understand words, sentences in

noisy and quiet environments, as wellas experience music recognition.

A few months post-surgery, Grovesis happy to have some of his hearingrestored. “I’m very excited and encouraged by my experience withthe implant. I know I’m hearingbetter than I have for many, many years, and for that I’m very grateful.” -This information provided courtesy of Northwestern Memorial Hospital

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"Brain Pacemaker"-Bringing Hope to

Parkinson's Patients

S

tudies have shown that a "brain pacemaker"called deep brainstimulation (DBS) is aneffective treatment forParkinson's disease.

But there's been debate over what region of the brain to stimulate --the globus pallidus interna or thesubthalamic nucleus. Now, a majorstudy published in the June 3, 2010

New England Journal of Medicine isshowing that stimulating either regionresulted in similar improvements inmotor function. There were smalldifferences in non-motor effects suchas mood and cognitive function.

"Both targets in the brain are viable

for improving motor function. This isgreat news for patients," said Frances

Weaver, PhD, of Edward Hines Jr. VA Hospital and Loyola University HealthSystem. Weaver, one of the study's lead investigators, is a professor and directorof the Program in Health Researchat Loyola University Chicago StritchSchool of Medicine and director of theCenter for Management of Complex Chronic Care at Hines VA Hospital.

DBS is a treatment for Parkinson's

patients who no longer benefit fromdrugs, or who experience unacceptableside effects. DBS is not a cure, and it does not stop the disease fromprogressing. But in the right patients,DBS can significantly improvesymptoms, especially tremors. DBSalso can relieve muscle rigidity that causes decreased range of motion.

"DBS increases the percentage of time that a patient is functional," said



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Loyola neurosurgeon Dr. Douglas Anderson, who hasan active practice in DBS and movement disorders. "It also improves a patient's ability to move arms or legsin a more coordinated fashion. And there is a lesseningof bradykinesia [slowness of motion]." Anderson is aprofessor in the Department of Neurological Surgery.

In the DBS procedure, a neurosurgeon drills a dime-sizehole in the skull and inserts an electrode about 4 inchesinto the brain. A connecting wire from the electroderuns under the skin to a battery implanted nearthe collarbone. The electrode delivers mild electrical signals that effectively reorganize thebrain's electrical impulses. The procedure canbe done on one or both sides of the brain.

Weaver was first author of a pivotal 2009study, published in the Journal of the

American Medical Association, whichfound that DBS was more effectivethan medications in treating patients

with advanced Parkinson's disease.

The new study included 299 Parkinson'sdisease patients at 7 VA and 6 university hospitals. Patients were randomly assigned to receive DBS in either the globuspallidus interna or subthalamic nucleus.

While there were no signif icant differences in motor function,researchers did find differences inother areas. Patients who received

subthalamic stimulation required lower doses of L-dopa medications. But the subthalamic group alsohad slower visuomotor speed, which measures how quickly a patient thinks and acts on information.

Also, depression got worse in the subthalamicgroup, but lessoned in the pallidal group.

"Based on the findings of this study, we expect that doctors will consider factors other thanmotor function when deciding what region

of the brain to target," Weaver said.

In addition to Weaver,the study was led by first author Dr.Kenneth Follett of the University of

Nebraska MedicalCenter and Dr. Matthew Stern of the University of Pennsylvania and

Philadelphia VA MedicalCenter. It was funded by

the Department of Veterans Affairs, the NationalInstitute of NeurologicalDisorders and Stroke and

Medtronic Neurological, which makes DBSsystems. -This information

provided courtesy of LoyolaUniversity Health System.



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HealthWatchMD

with Dr. Randy Martin

Provided courtesy of Piedmont Healthcare

Dr. Randy Martin: Lately it seemslike almost everyone has or at leastknows someone who has arthritis.According to a recent report, wemay not be far off base – nearly 25percent of Americans suffer fromsome form of arthritis. To learn more,I met with Dr. William McClatchey, arheumatologist at Piedmont Hospital.

Arthritis One in four people sufferfrom this painful condition



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T he Centers for DiseaseControl and Prevention

reported in 2010 that two out of every nine

Americans have arthritis(approximately 50 million

people), making it one of the leadingcauses of disability in the country.But what exactly is arthritis?

William McClatchey, M.D., a board-certified internist and rheumatologist at Piedmont Hospital, says that arthritis refers to a symptom, not adiagnosis. He adds that it is important

to distinguish between osteoarthritisand rheumatoid arthritis.

“It makes a big difference in terms of treatment and prognosis,” he says.

Osteoarthritis is the most commontype of this condition.

“It is a term that describes thesame process as degenerativearthritis,” he says.

An Increasingly Common Condition

“It’s a huge problem,” Dr. McClatchey says. “Clearly, the obesity epidemicaffecting Americans today has atremendous impact [on the increasein cases of osteoarthritis].”

Proper care and treatment of yourbody is crucial, he says, comparing theaging process to car maintenance.

“If [you are] 65 years old, [it’s likehaving] 65,000 miles on your tires,”he explains. “If you’ve gone lickety-

split around a lot of curves, you’re

Dr. Randy Martin: If you experience joint pain, talk with your primary care doctor to determine if yousuffer from a form of arthritis. To prevent joint damagein the first place, maintain a healthy weight and stayactive to maintain range of motion in your joints.

going to have more trouble thanif you’ve gone at a low speed.”

Osteoarthritis typically occurs in the weight-bearing joints, such as the lowerback, hips and knees, as well as in thehands. Common symptoms includepain after engaging in moderatephysical activity and crepitus,

which is a creaking in the jointscaused by cartilage irregularity.

To treat osteoarthritis without surgery, “the first thing we do ismake the accurate diagnosis and

exclude other forms of arthritis(such as rheumatoid arthritis),”says Dr. McClatchey. “Beyond that, [we recommend] anti-inflammatory medication. Thesemedications are really good at helping people with comfort level, pain and functionality.”

There are also lifestyle changesyou can make to improve yourarthritis symptoms, such as

weight loss and – even though it sounds counterintuitive – exercise.

“It’s really not [counterintuitive],”he explains. “Exercise to maintainrange of motion in the affected

joints is really important, with onecaveat: avoid [high]-impact exercises.”

If you are concerned that you may have arthritis, Dr. McClatchey recommends talking with yourprimary care physician first.

“For people who have more difficulty and need help, rheumatologists arehere,” he says. “That’s what we do.”



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I’ve heard this from:• a mother who was eating abicycle wheel-sized pepperoni andsausage pizza in Rochester, NY

• a father who was eating cheese fries withRanch dressing outside of Green Bay, WI.

• two parents eating a bucket of friedcalamari with sun-warmed tarter sauceon the boardwalk in Santa Cruz, CA

All of them were eating with their kids. Actually,all of them were controlling what their

kid’s ate. But just not for the better.

The Nutritional Gatekeeper

and the Solution“I can’t controlwhat my kids eat!”

My Food and Brand Lab at Cornell

University did a study on NutritionalGatekeepers. These are the criticalpeople who purchase and preparemost of the food their family eats at home. I’d bet you’re that

person, or you wouldn’t be reading this magazine.

We studied over 400 Nutritional Gatekeepers in theUS and Canada. One discovery was that the average

Nutritional Gatekeeper – even if they claimed to be aterrible “I-can’t-boil-water” cook – controlled 72% of

what their family ate. This was for better or worse.

72%



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It was for better if they had a fruit bowl in thekitchen out instead of a cookie dish. It was for worseif they ate at a restaurant and ordered BBQ ribs and

white bread instead of going to a place that served something green. It was for the better if they packed their kid a “school snack pack” of some carrots,crackers, and a cheese stick instead of waving 2

bucks at them and saying “Buy what you want.”

What if they don’t take a plum from the fruit bowl,or they don’t order a salad, or they don’t eat theirsnack pack. Well, chalk that up to the 28% wedon’t control. At least you have them a healthy option they wouldn’t have otherwise considered.

Herein lies the power of the NutritionalGatekeeper. It’s not in being a perfect cook, it’s ingiving kids an option and modeling this.

If we want our little gooblets to eat better,the first place to start is with us. If we

don’t have cut-up fruit in baggies in thefridge, they probably won’t ask for it. If

we don’t order lean meat and vegetables,they won’t either. If we’re eating aduffle bag of chips while watching theBiggest Loser, why shouldn’t they?

Because I’m not a coffee drinker, one of my indulgences is Diet Coke and Diet Pepsi. I drink one before breakfast every day - “Gross,” is what you’re thinking.I don’t think it’s gross, but here’s what’s

making me reconsider this 30 year old habit.Every time I have a can in my hand, my two and four year old daughters grab for it saying, “Sipof pop, sip of pop.” I’m 100% sure they don’t ask for a Diet Coke or Pepsi if I’m not around.

“I can’t control what my kids eat.”

We control what our kids eat more than we think – its just going to be for thebetter or the worst. - Brian Wansink, PhD. Cornell Food and Brand Lab.




Newmelanoma

drugnearly doubles

survival in majorityof patients



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Investigators from Vanderbilt-Ingram CancerCenter (VICC) and 12 other centers in theUnited States and Australia have found that anew drug for patients with metastatic melanomanearly doubled median overall survival.

More than half of patients who were treated withthe novel drug vemurafenib, known commercially as

Zelboraf, responded to treatment and experienced an impressive median overall survival of nearly 16 months – far longer than the typical survivalof just six to 10 months for most patients whosemelanoma has spread beyond the initial tumor site.

Results from the Phase 2 trial, led by co-principalinvestigators Jeffrey Sosman, M.D., director of the

Melanoma Program and co-leader of the Signal Transduction Program at VICC, and AntoniRibas, M.D., professor of Hematology/Oncology at UCLA’s Jonsson Comprehensive Cancer Center,

were published in the Feb. 23 issue of the peer-

reviewed New England Journal of Medicine.“This study confirms what we have discovered in ourearlier trials. Many of our patients are exhibiting astrong, immediate response to this drug and someare living significantly longer, with manageableside effects,” said Sosman, professor of Medicineat Vanderbilt University Medical Center. “It wasinteresting to note that a few of the patients weretreated with the drug for up to six months beforeshowing convincing evidence of response.”

“This study shows that Zelboraf changes the naturalhistory of the disease,” said Ribas. “These results tell

us that this drug is having a very big impact, and thischanges the way we treat metastatic melanoma.”

Approximately half of all patients with metastaticmelanoma – the most deadly form of skin cancer – havea BRAF V600 mutation in their tumor. Vemurafenibis an FDA-approved oral drug which works as akinase inhibitor of the BRAF V600 mutation.

While vemurafenib induced clinical responsesin a significant number of BRAF-positivepatients when it was approved last year, theinitial clinical trials had not followed patientslong enough to determine overall survival.

A total of 132 patients with stage IV, BRAF-positivemelanoma were enrolled in the Phase II trial. Allof the patients had received at least one form of systemic treatment before enrollment in the trial.

Forty-seven percent of patients had a partial responseto the drug and six percent exhibited a completeresponse, for an overall response rate of 53 percent.

Debra Johnson’s melanoma had already spread to oneof her lungs and her lymphatic system when she was

referred to VICC for mutation testing. Her tumor wasBRAF-positive and after more than a year on the drug,the wife and mother from New Site, Miss., says herscans are clear and there is no visible evidence of disease.

“This treatment has been an answerto my prayer,” said Johnson.

The majority of patients had at least one adverse event related to the drug, but most of these were minor. The most common side effects were joint pain, rash,sun sensitivity, fatigue and hair loss. More than aquarter of the patients (26 percent) also developed cutaneous squamous-cell carcinomas – a less seriousform of skin cancer - which were surgically removed.

A Phase III trial of this same drug confirmed significant improvement in both progression-freesurvival and overall survival with vemurafenib overchemotherapy in an interim analysis. The Phase II study is the first to confirm the durability of the response.

While the clinical trials for vemurafenib have beenpositive to date, the great majority of patientseventually experience disease progression.

“We are trying to determine what is causing thisdrug resistance and are searching for new therapiesthat we can use, perhaps in combination with

vemurafenib,” said Sosman. -This information provided courtesy of Vanderbilt University Medical Center



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OsteoporosisGet The FactsQWhat is osteoporosis?

AOsteoporosis (OS-tee-oh-poh-ROH-sis) is adisease of the bones.

People with osteoporosis have bonesthat are weak and break easily.

A broken bone can really affect your life.It can cause severe pain and disability.It can make it harder to do daily taskson your own, such as walking.

QWhat bones doesosteoporosis affect?

AOsteoporosis affects all bonesin the body. However, breaksare most common in the hip,

wrist, and spine, also called vertebrae(VUR-tuh-bray). Vertebrae support

your body, helping you to stand and sit up. See the picture below.

Osteoporosis in the vertebrae cancause serious problems for women.

A fracture in this area occurs fromday-to-day activities like climbingstairs, lifting objects, or bendingforward. Signs of osteoporosis:· Sloping shoulders

· Curve in the back

· Height loss

· Back pain

· Hunched posture· Protruding abdomen

QWhat increasesmy chances of

getting osteoporosis?

A There are several risk factorsthat raise your chances of developing osteoporosis. Some

of these factors are things you cancontrol, while some you can’t control.

Factors that you can’t control:

· Being female

· Getting older

· Menopause

· Having a small, thin body(under 127 pounds)

· Having a family history of osteoporosis

· Being white or Asian, butAfrican American women andLatinas are also at risk

· Not getting your period (if you should be getting it)

· Having a disorder that increasesyour risk of getting osteoporosis,(such as rheumatoid arthritis,type 1 diabetes, prematuremenopause, anorexia nervosa)

· Not getting enough exercise

· Long-term use of certainmedicines, including:

o Glucocorticoids (GLOO-koh-KOR-ti-koids) — medicines used totreat many illnesses, including

arthritis, asthma, and lupuso Some antiseizure medicines

o Gonadotropin (GOH-nad-oo-TROO-pin) -releasing hormone— used to treat endometriosis(en-doh-mee-tree-O-sis)

o Antacids with aluminum— the aluminum blockscalcium absorption

o Some cancer treatments

o Too much replacementthyroid hormone

Factors you can control:

Smoking

Drinking too much alcohol.Experts recommend no morethan 1 drink a day for women.

A diet low in dairy products or othersources of calcium and vitamin D

Not getting enough exercise

You may also develop symptoms that

are warning signs for osteoporosis.If you develop the following, youshould talk to your doctor about any tests or treatment you many need:

Loss in height, developing a slumped or hunched posture, or onset of sudden unexplained back pain.

You are over age 45 or a post-menopausal and you break a bone.

Q

How can I find out if I have weak bones?

A There are tests you can get tofind out your bone density.

This is related to how strong orfragile your bones are. One test is called dual-energy X-ray absorptiometry (DXA or dexa). A DXA scan takes

X-rays of your bones. Screening toolsalso can be used to predict the risk of having low bone density or breaking abone. Talk with your doctor or nurseabout this test or tools to assess risk.



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QWhen should I get abone density test?

A

If you are age 65 or older, youshould get a bone density test to screen for osteoporosis. If

you are younger than 65 and haverisk factors for osteoporosis, ask yourdoctor or nurse if you need a bonedensity test before age 65. Bone density testing is recommended for older

women whose risk of breaking a boneis the same or greater than that of a65-year-old white woman with no risk factors other than age. To find out your fracture risk and whether youneed early bone density testing, your

doctor will consider factors such as:· Your age and whether you

have reached menopause

· Your height and weight

· Whether you smoke

· Your daily alcohol use

· Whether your mother orfather has broken a hip

· Medicines you use

· Whether you have a disorderthat increases your risk of getting osteoporosis

QHow can I preventweak bones?

A The best way to prevent weak bones is to work on buildingstrong ones. No matter how

old you are, it is never too late tostart. Building strong bones during

childhood and the teen years is oneof the best ways to keep from gettingosteoporosis later. As you get older,your bones don’t make new bonefast enough to keep up with thebone loss. And after menopause,bone loss happens more quickly.But there are steps you can taketo slow the natural bone loss withaging and to prevent your bonesfrom becoming weak and brittle.

1. Get enough calcium each day.

Bones contain a lot of calcium. It is important to get enough calciumin your diet. You can get calciumthrough foods and/or calcium pills,

which you can get at the grocery store or drug store. Getting calciumthrough food is definitely better sincethe food provides other nutrientsthat keep you healthy. Talk withyour doctor or nurse before takingcalcium pills to see which kind is best for you. Taking more calcium pillsthan recommended doesn't improveyour bone health. So, try to reachthese goals through a combinationof food and supplements.

Here’s how much calciumyou need each day.Daily calcium requirements

Ages Milligrams(mg) per day9-18 1,300

19-50 1,000

51 and older 1,200

Pregnant or nursing women needthe same amount of calcium asother women of the same age.

Here are some foods to help you get the calcium you need. Check thefood labels for more information.



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Foods containing calcium

Food Portion Milligrams

Plain, fat free yogurt 1 cup 452

Milk (fat-free) 1 cup 306

Milk (1 percent low-fat) 1 cup 290

Tofu with added calcium 1/2 cup 253

Spinach, frozen 1/2 cup 146

White beans, canned 1/2 cup 106The calcium amounts of these foods aretaken from the United States Department of Agriculture’s Dietary Guidelines for Americans.

2. Get enough vitamin D each day.

It is also important to get enough vitamin D, whichhelps your body absorb calcium from the food you eat.Vitamin D is produced in your skin when it is exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a

week to make enough vitamin D. The amount of timedepends on how sensitive your skin is to light. It also

depends on your use of sunscreen, your skin color, and the amount of pollution in the air. You can also get vitamin D by eating foods, such as milk, or by taking vitamin pills. Vitamin D taken in the diet by food orpills is measured in international units (IU). Look at the pill bottle or food label for the IU amount.

Here’s how much vitamin D you need each day:Daily vitamin D requirements

Ages IU per day

19-70 600

71+ 800

Although it ’s difficult to get enough vitamin D

through food, here are some foods that can help.Check the food labels for more information.

Foods containing vitamin D

Food Portion IU

Salmon, cooked 3 1/2 oz 360

Milk, vitamin D fortified 1 cup 98

Egg (vitamin D is in the yolk) 1 whole 20

These foods and IU counts are from the NationalInstitutes of Health Office on Dietary Supplements.

White milk is a good source of vitaminD, most yogurts are not.

3. Eat a healthy diet.

Other nutrients (like vitamin K, vitamin C, magnesium,and zinc, as well as protein) help build strong bonestoo. Milk has many of these nutrients. So do foods likelean meat, fish, green leafy vegetables, and oranges.

4. Get moving.

Being active helps your bones by:Slowing bone loss

Improving muscle strength

Helping your balance

Do weight-bearingphysical activity, whichis any activity in whichyour body works against gravity. There are many things you can do:Walk DanceRun Climb stairs

Garden JogHike Play tennisLift weightsYoga Tai chi

5. Don’t smoke.

Smoking raisesyour chances of getting osteoporosis.

It harms your bones and lowers the amount of estrogen in your body. Estrogen is a hormonemade by your body that can help slow bone loss.

6. Drink alcohol moderately.

If you drink, don’t drink more than one alcoholic drink per day. Alcohol can make it harder for your body to usethe calcium you take in. And, importantly, too muchat one time can affect your balance and lead to falls.

7. Make your home safe.

Reduce your chances of falling by making yourhome safer. Use a rubber bath mat in the showeror tub. Keep your floors free from clutter. Removethrow rugs that may cause you to trip. Make sureyou have grab bars in the bath or shower.

8. Think about taking medicines toprevent or treat bone loss.

Talk with your doctor or nurse about the risksand benefits of medicines for bone loss.

QHow can I help my daughterhave strong bones?

A Act now to help her build strong bones to last alifetime. Girls ages 9-18 are in their critical bone-building years. Best Bones Forever!® is a national

education effort to encourage girls ages 9-14 to eat more foods with calcium and vitamin D and get morephysical activity. There is also a website for the parents. This site gives parents the tools and information they need to help their daughters build strong bones duringthe critical window of bone growth — ages 9-18.

QWhat if dairy foods make mesick or I don't like to eat them?

How can I get enough calcium?

AIf you’re lactose intolerant, it can be hard to get enough calcium. Lactose is the sugarthat is found in dairy products like milk.

Lactose intolerance means your body has a hard



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time digesting foods that contain lactose. You may have symptoms like gas, bloating, stomach cramps,diarrhea, and nausea. Lactose intolerance can start at any age but often starts when you get older.

Lactose-reduced and lactose-free products are sold infood stores. There’s a great variety, including milk,cheese, and ice cream. You can also take pills or liquids

before eating dairy foods to help you digest them.You can buy these pills at the grocery store or drugstore. Please note: If you have symptoms of lactoseintolerance, see your doctor or nurse. These symptomscould also be from a different, more serious illness.

People who are lactose intolerant or who are vegans(eat only plant-based foods) can choose from otherfood sources of calcium, including canned salmon

with bones, sardines, Chinese cabbage, bok choy, kale,collard greens, turnip greens, mustard greens,broccoli, and calcium-fortified orange juice.Some cereals also have calcium added. You canalso take calcium pills. Talk to your doctor ornurse first to see which one is best for you.

QDo men getosteoporosis?

AYes. In the U.S., over twomillion men have osteoporosis.

Men over age50 are at greater risk.So, keep an eye onthe men in your life,especially if they areover 70 or have broken any bones.

QHow will pregnancyaffect my bones?

A To grow strong bones, a baby needsa lot of calcium. The baby gets hisor her calcium from what you eat

(or the supplements you take). In somecases, if a pregnant woman isn’t gettingenough calcium, she may lose a little fromher bones, making them less strong. So,pregnant women should make sure they are getting the recommended amounts of

calcium and vitamin D. Talk to your doctorabout how much you should be getting.

QWill I suffer bone lossduring breastfeeding?

A Although bone density can be lost during breastfeeding, this loss tendsto be temporary. Several studies have

shown that when women have bone lossduring breastfeeding, they recover full bonedensity within six months after weaning.

QHow is osteoporosis treated?

AIf you have osteoporosis, you may need to make some lifestyle changesand also take medicine to prevent

future fractures. A calcium-rich diet, daily exercise,and drug therapy are all treatment options.

These different types of drugs are approved forthe treatment or prevention of osteoporosis:

Bisphosphonates (bis-fos-fo-nates) —Bisphosphonates are approved for both preventionand treatment of postmenopausal osteoporosis.Drugs in this group also can treat bone loss, and in some cases, can help build bone mass.

SERMs — A class of drugs called estrogen agonists/ antagonists, commonly referred to as selective estrogen

receptor modulators (SERMs) are approved forthe prevention and treatment of postmenopausalosteoporosis. They help slow the rate of bone loss.

Calcitonin (kal-si-TOE-nin) — Calcitoninis a naturally occurring hormone that

can help slow the rate of bone loss.

Menopausal hormone therapy (MHT) — These drugs, which are

used to treat menopausal symptoms,also are used to prevent bone loss.

But recent studies suggest that this might not be a good

option for many women. The

Food and Drug Administration (FDA)

has made the followingrecommendations for taking MHT:

Take the lowest possible doseof MHT for the shortest timeto meet treatment goals.

Talk about using other osteoporosismedications instead.

Parathyroid hormone or teriparatide (terr-ih-PAR-a-tyd) — Teriparatideis an injectable form of humanparathyroid hormone. It helps thebody build up new bone faster thanthe old bone is broken down.

Your doctor can tell you what treatments might work best for you. -This information provided courtesy of the US Department of Health and Human Services, of fice on Women's Health www.womenshealth.gov



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As the school year drawsto a close, thousandsof children across thecountry will take on afamiliar chore: mowingthe lawn. June is National

Home Safety Month and five nationalmedical organizations are warning

Americans that the routine task of lawnmowing can be extremely dangerous tochildren, the operator, and those nearby if proper safety precautions aren't taken.

Sadly, 253,000 people were treated for lawn mower-related injuries in2010, nearly 17,000 of them childrenunder age 19, the U.S. ConsumerProduct Safety Commission reports.Lawn mower-related injuriesare up 3 percent since 2009.

"Lawn mower injuries to childrenare easily preventable," said ASRMPresident Keith Brandt, MD. "Children

SteerChildrenClear of Lawn Mower

InjuriesNational MedicalSocieties' SafetyTips Help KidsAvoid Becominga Statistic



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should remain inside the house orunder the direct supervision of anotheradult, whenever a lawn mower is beingused. If no other adult is available,create a danger zone of 20 feet around the mower. Shut down immediately if anyone enters the danger zone."

To help prevent injuries, the American Society for Reconstructive Microsurgery (ASRM), AmericanSociety of Plastic Surgeons (ASPS),

American Society of Maxil lofacial

Surgeons (ASMS), American Academy of Pediatrics (AAP), and American Academy of OrthopaedicSurgeons (AAOS) are educatingadults and children about theimportance of lawn mower safety.

"The ASMS is a proud partner inthe coalition for lawn mower injury prevention," said ASMS President Steven Buchman, MD. "The significant number of devastating injuries that occur to both children and adultscan be life changing events."

Many lawn mower-related injuriesrequire a team of physicians from

various specialties to properly repairthem. Often, patients must endurepainful reconstructive operationsfor months, sometimes years, torestore form and function.

"I've seen broken and dislocated bones,deep cuts, missing fingers and toes,limb amputations, burns, and eye

injuries from lawn mower accidents,"said ASPS President Phillip Haeck,

MD. "The best way to treat a lawnmower-related injury is to prevent it."

"I cannot stress the importance of operating a lawn mower properly.

The dangers are very real, but very preventable," said AAOS President Daniel J. Berry, MD. "Alwaysremember to wear sturdy shoes -never sandals - when mowing and make sure your children are at a

safe distance and that they don't operate a mower until they are old enough to control the machine."

Lawn mower injuryprevention tips include:

Children should be at least 12years old before they operateany lawn mower, and at least 16years old for a r ide-on mower.

Children should never bepassengers on ride-on mowers.

Always wear sturdy shoes whilemowing - not sandals.

Young children should be at a safedistance from the area you are mowing.

Pick up stones, toys and debrisfrom the lawn to preventinjuries from flying objects.

Use a mower with a control thatstops it from moving forwardif the handle is released.

Never pull backward or mow in reverseunless absolutely necessary - carefullylook for others behind you when you do.

Always wear eye and hearing protection.

Lawn mowers can be a cause of seriouseye injury. This year the AAP Sectionon Ophthalmology has added thefollowing to its safety tips: Childrenin the vicinity of running lawnmowers should wear polycarbonateprotective eye wear at all times.

"Every year at this time, it is commonto see children operating or playingaround lawn mowers in unsafe ways.

And every summer, thousands get hurt,"said AAP President O. Marion Burton,

MD, FAAP. "We want parents and kids to be more aware of precautions totake so that injuries can be prevented."

To help educate the public, the ASRM, ASPS, and ASMS offer a video, "When Lawn Mowers Attack," with tips on how to avoid injuries. -This information (originally released6/01/2011) provided courtesy of The American Society of Plastic Surgeons



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SUNSCREEN:

LOOKING BEYOND THE NUMBERS



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S

eems pretty obvious – if a sunscreen withan SPF of 30 is good, then an SPF of 100should be at least three times as good.

Unfortunately, that is not the case. Thereare other important details to consider

when you are purchasing a sunscreen.

“People have become much more educated about theimportance of using sunscreen, and manufacturershave responded with an abundance of products,”says Carl Washington, MD, associate professorof Dermatology at Emory University School of

Medicine. “Unfortunately, the labeling can beconfusing and many of the current sunscreens only

contain the ingredients necessary to offer protectionagainst sunburn, but not skin cancer or aging.”

Recently, the Food and Drug Administration created new regulations to establish standards for sunscreenmanufacturers to follow before they label their products.

Under the new regulations, which will go into effect in2012, sunscreen products that protect against all typesof sun-induced skin damage will be labeled “broad spectrum” and “SPF 15” or higher on the container.Only products that have been tested to ensure they protect against both UVA (ultraviolet radiation A) and UVB (ultraviolet radiation B) radiation will be allowed to use this labeling. Broad-spectrum sunscreens of SPF




15 and higher can also be labeled as protective against skincancer and premature aging. The maximum SPF value is set at 50-plus because the FDA says anything higher doesn’t provide a significant amount of additional protection.

Manufacturers will have to include warning labels on productsthat are not broad spectrum. Products that claim to be

water resistant must indicate how long the consumer should expect to be protected in the water, and using such languageas “waterproof” or “sweat proof” will not be allowed.

“Skin cancer is the most common form of cancer in theUnited States, and the number of people affected keepsrising. Simply getting into the habit of using a sunscreenevery day – with the appropriate levels of protection –can make a significant difference in preventing many skincancers, as well as premature aging,” says Washington.

“These new regulations will help consumers understand thedifference in degrees of sun protection, and choose carefully.”

Washington also suggests staying out of direct sunlight between 10 am and 2 pm, seeking shade when youare outdoors, remembering to reapply sunscreen every two hours and wearing protective clothing. -This information provided courtesy of Emory Healthcare.



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