What Doctors Know

Heart disease is still the No. 1 killer of women, taking the life of 1 in 3 women each year.
Give the women you care about the power to save their lives at GoRedForWomen.org.
2012, American Heart Association. Also known as the Heart Fund. TM Go Red trademark of AHA, Red Dress trademark of HHHS. 5/12DS5882
On Call with Dr. Porter

February is Heart Month a month we give flowers, candy and express our love for those special people in our lives. As a health information magazine we focus on matters of the heart, but the heart we focus on is the physical one. The heart that, when ignored, can be deadly. Theres nothing wrong with getting caught up in the lovers lane version of the heart. However, our message this month stresses the need to balance the physical heart with the emotional heart both are important to a happy and healthy life. Sadly, bad hearts kill too many Americans every year. Sad, because so many of these deaths could have been avoided by changes in everyday lifestyles. Thats why its appropriate for February to be the month for love and your heart. When you read the information in this months issue, youll see why its important to love and respect your heart. Another focus in this months issue is cancer. World Cancer Day is February 4 and while having an official day is important, one day out of the year to bring attention to cancer isnt enough. Just as taking care of your heart is a year round battle, cancer doesnt raise its ugly head one day a year. Its a yearlong fight. Unlike taking care of your heart however, with cancer, sometimes no matter how healthy we have lived, it can strike. The medical profession has made great strides in the battle against cancer, and while we cant tell when, who and how, it will strike. We do know early detection and diagnosis is key to survival. Become informed about cancer. It could save you or someone you love. At What Doctors Know, we realize taking control of our health isnt easy, but the rewards are more than worth the effort. Not only can you live longer, but the quality of your life will be so much better. As always, if you have any health questions, send them along to our staff and well get answers from our medical experts.
Steve Porter, MD Publisher and Chairman
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WHAT DOCTORS KNOW

And you should, too!
P34
Taking Control
08 We Need to Talk! 10 Too Young for a Hip Replacement? 20 HIRO in Radiology 24 Healthy Help-A Phone Call Away 26 The Time is Now Together,
We Will End Cancer
32 Getting Back In the Gameof Life 34 New Head Lice Treatment

Now Available
35 Ignoring the Flu Can Be Deadly
Health Hints
26 Uncovering Eating Disorder Facts 36 Love Your Heart 40 Myth 1: Cancer Is Just A Health Issue 42 Save Your Heart, Spare Your Brain 44 Important Flu Recommendations
for High-Risk Populations
46 Team Up. Pressure Down. 48 Get Off the CouchLive Longer 50 10 Tips to Alleviate Stress 57 Screening and Preventing Cancer 62 Change Your Salty Way in Only 21 Days
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Vol. 2 Issue 2
Contents
Inquiring Minds
64 10 Things You Need to
Know About Birth Defects
68 Can COPD Be Hereditary 70 Infection During

Pregnancy
74 Lower Risk of
Cardiovascular & Cancer Mortality Fight Cold, Flu Symptoms System to Fight Cancer
76 Exercise, Meditation Can 77 Using the Immune
P74
In Every Issue
01 04 06 30
On Call With Dr. Porter Meet Our Doctors Medicine in the News HealthWatchMD: Common Type of Heart Condition Often Overlooked Blood Pressure Under Control
On The Cover
12 Be True to Your
Heart-You Won't Like the Break Up Disorder Facts
58 Uncovering Eating 72 Your Childs Oral Health
53 CDC Vital Signs: Getting
66 Know Your Specialist: Cardiologist

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Meet Our Doctors

Steven Porter, MD
Founder and publisher of What Doctors Know, Dr. Porter is recognized as one of the top gastroenterologists in the country. He is the medical director of the endoscopy lab at a leading hospital in Ogden, Utah and has been practicing for more than 25 years. Contact Dr. Porter at (801)387-2550.
Timothy J. Sullivan, MD
Contributing editorial advisory board member of What Doctors Know, Dr. Sullivan spent 25 years in full-time academic medicine at Washington University, University of Texas Southwestern Medical School, and Emory University. He currently has a full-time allergy and immunology practice in Atlanta, Georgia and is a clinical professor at the Medical College of Georgia.
William Goodnight, III, MD

Assistant Professor at the University of North Carolina Health Care in the Division of Maternal Fetal Medicine. Board certified in Obstetrics and Gynecology since 2000, Dr. Goodnights current clinical activities include prenatal diagnosis and management of medical complications of pregnancy.
Francisco RamosGomez, DDS, MS, MPH

Professor in the Division of Pediatric Dentistry at the UCLA School of Dentistry, Dr. RamosGomez has been a pediatric dentist for more than twenty years with specific focus and research in the areas of early childhood caries prevention, oral disease risk assessment, and commnity health with an emphasis on underserved populations.
Vicki Lyons, MD
Founding member and chairman of the editorial advisory board of What Doctors Know, Dr. Lyons is a board certified and fellowship trained allergist and immunologist practicing in Ogden, Utah. She has been practicing for 20 years. Contact Dr. Lyons at (801)387-4850 or www.vicki-lyonsmd.com.
Patrick T. Ellinor, MD, PhD

Director, Arrhythmia/ Step Down Unit at Massachusetts General Hospital, Dr. Ellinor joined the faculty in the Cardiac Arrhythmia Service in 2003. He is currently an Associate Physician at MGH and an Associate Professor at Harvard Medical School.
Kenneth H. Kim, MD
Assistant Professor in the Division of Gynecologic Oncology at the University of North Carolina, Dr. Kim has special interest in advanced surgical technologies, novel therapeutics in treatment of ovarian cancer, as well as HPV & cervical cancer.
Calling All Doctors. Our readers want to hear from you. What healthcare issues do you want to address? What do you want to tell patients all over the country? Whats new in your practice, in your specialty? Drop us a line and let us know about any healthcare topic you want to address in What Doctors Know. Remember, we want to inform and educate our readers. We know, an informed reader has the opportunity to live longer and happier. You can be part of that healing process. Our readers look forward to hearing from you.
Send story ideas to: submit@whatdoctorsknow.com

Copyright 2013 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine, in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The Advertising space provided in What Doctors Know is purchased and paid for by the advertisers. Products and services are not necessarily endorsed by What Doctors Know,LLC.
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WHAT DOCTORS KNOW

And you should, too!
Special Thanks To:
Published by What Doctors Know, LLC Publisher and Chairman Steve Porter, MD Editorial Advisory Board Vicki J. Lyons, MD, Chairman Editorial and Design Director Bonnie Jean Thomas Senior Designer Suki Xiao Design Associate Raulin Huang Executive Director, Marketing Larry Myers Production Kai Xiao, Vice President IT Manager Eric Lu
For more information on ad placement or contributing an article, please email submit@ whatdoctorsknow.com, or call (801) 825-4600. For information on subscriptions, please visit www.whatdoctorsknow.com
Corporate Office What Doctors Know 1755 E Legend Hills Dr., Suite 100, Clearfield, UT 84015 (801) 825-4600
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Tdap Recommended For Pregnant Women

Atlanta, GA - The Advisory Committee for Immunization Practices voted 14 to 0, with one abstention, to recommend providers of prenatal care implement a Tdap immunization program for all pregnant women. Healthcare personnel should administer a dose of Tdap during each pregnancy irrespective of the patients prior history of receiving Tdap. This builds upon a previous recommendation made by ACIP in June 2011 to administer Tdap during pregnancy only to women who have not previously received Tdap. By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant. If not vaccinated during pregnancy, Tdap should be given immediately postpartum, before leaving the hospital or birthing center. The U.S. remains on track to have the most reported pertussis cases since 1959, with more than 32,000 cases already reported along with 16 deaths, the majority of which are in infants.
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at the UCLA Eating Disorders Program say these individual too, should see a trained professional for consultation and, when warranted, treatment. Rough estimates suggest that about one percent of U.S. females have symptoms of anorexia nervosa, such as preoccupation with dieting and a misperception of their actual size, but they do not experience the extreme weight loss characteristic of the disease, says Michael Strober, Ph. D., the Resnick Professor of Eating Disorders and director of the UCLA Eating Disorders Program. Eating disorders are not limited to adults. The likelihood of a child eventually showing symptoms of an eating disorder can be reduced by promoting a healthy self-esteem and strong sense of self. Parents and other significant adults in childrens lives should demonstrate that there are many qualities that contribute to the childs value beyond appearance and weight, Dr. Cynthia Pikus, Ph.D. associate director of the UCLA Eating Disorders Program. That can be conveyed both verbally and by modeling whats important.
Eating Disorders Are Serious Medical Issues

Los Angeles, CA - Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating are serious medical illnesses that can significantly disrupt lives, harm physical health and, in some cases, prove fatal. But, in addition to the several million Americans who have a diagnosable eating disorder, many more show symptoms that, while not meeting the criteria for a diagnosis, should be cause for concern. Experts
Moderate Smoking Associated With Sudden Death Risk In Women

Dallas,TX - Women who are lightto-moderate cigarette smokers may be significantly more likely than nonsmokers to suffer sudden cardiac death according to new research in Circulation: Arrhythmia & Electrophysiology, an American Heart Association journal. The findings indicate long-term smokers may be at even greater risk, but quitting smoking can reduce and eliminate the risk over time. Cigarette smoking is a known risk factor for sudden cardiac death, but until now, we didnt know how the quantity and duration of smoking effected the risk among apparently healthy women, nor did we have long-term follow-up, said Roopinder K. Sandhu, M.D., M.P.H., the studys lead author and a cardiac electrophysiologist at the University of Albertas Mazankowski Heart Institute in Edmonton, Alberta, Canada. Researchers examined the incidence of sudden cardiac death among more than 101,000 healthy women in the Nurses Health Study, which has collected biannual health questionnaires from female nurses nationwide since 1976. They included records dating back to 1980 with 30 years of followup. Most of the participants were white, and all were between 30 to 55 years old at the studys start. On average, those who smoked reported that they started in their late teens. During the study, 351 participants died of sudden cardiac death.
Other findings include: Light-to-moderate smokers, defined in this study as those who smoked one to14 cigarettes daily, had nearly two times the risk of sudden cardiac death as their nonsmoking counterparts. Women with no history of heart disease, cancer, or stroke who smoked had almost two and a half times the risk of sudden cardiac death compared with healthy women who never smoked. For every five years of continued smoking, the risk climbed by 8 percent.
Among women with heart disease, the risk of sudden cardiac death dropped to that of a nonsmoker within 15 to 20 years after smoking cessation. In the absence of heart disease, there was an immediate reduction in sudden cardiac death risk, occurring in fewer than five years.
Sudden cardiac death results from the abrupt loss of heart function, usually within minutes after the heart stops. Its a primary cause of heart-related deaths, accounting for between 300,000-400,000 deaths in the United States each year.
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We Need to
r. Lisa Masterson of the Emmy Award-winning talk show, The Doctors, stresses the importance of communication between patients and their doctors. The board-certified specialist of gynecology, adolescent gynecology, infertility, obstetrics and family planning explains the dangers of a lack of communication between patients and their physicians.
Talk!
Dont let an expert voice or an authoritative tone from your doctor discourage you from inquiring further into your current health situation.
There is no reason to be intimidated. Many doctors are so used to using medical jargon all day long and they sometimes use it with their patients not to confuse or condescend but because it is an automatic way of speech for them. Dont feel bad about asking your doctor to translate what he/she is saying into laymans terms. You may misunderstand something critical to your health.
The old clich what you dont know cant hurt you can be very dangerous when it comes to patients health. In fact, in the medical health world the phrase shifts to what you dont know can kill you. The first step to good health is to speak openly and honestly with your physician. We shouldnt be afraid to talk to our doctors and we must also be sure to ask as many questions as possible. Keep in mind that good doctors want their patients to ask questions because it assists them in getting to the bottom of your diagnoses, treatments, medical advice, and so forth. Its a mutual benefit and it really helps to ensure that all angles are covered. Patients are advised to be involved with the health process and that starts with a good level of communication. Communication issues typically stem from the following:
If your doctor appears to be too busy for answering questions, still continue to ask dont hesitate. If you dont want to ask your doctor to explain further, go ahead and feel free to ask the PA (physicians assistant), MA (medical assistant) or a nurse. Another option is to reschedule your appointment and let the staff
1) Patients are afraid to ask questions. 2) Patients dont know what questions to ask. 3) Patients find it disrespectful or unwise to question their physicians.
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know its because you would like additional time to discuss your health situation with your physician. This is not offensive to doctors; its simply proactive taking control of your health and your life. Often, patients simply dont know what to ask or they dont ask enough questions. Remember that no question is a dumb one, especially when it comes to your health. It cant hurt to ask. Also know that its okay to call your doctor a few days after your visit if some questions come up for you or to schedule a second appointment for more information if need be. In the cases of shocking diagnoses, for example, typically patients dont know what to ask and they may need some time to absorb the news and to come up with questions when they have clearer minds. The internet can be a great help but it must be used wisely. Whereas self- diagnosing is unsafe and irresponsible, the internet is a great tool for a starting point for a conversation with your physician. In this information-driven society, its acceptable to seek out general information online. However, this should just be used as a tool to start conversations with your physician about what you have read, and what it could possibly imply. It is all too easy to overlook serious symptoms as small issues or vice versa. Information and communication are paramount where health is concerned. Open up a healthy and frank dialogue with your physicians and ask the right questions. Your doctors can only assist you more accurately when you have addressed all concerns and when you know that you are all on the same page. They dont expect their patients to know what they do or to be familiar with complex jargon so simply start discussions and make it a habit to keep up a healthy rapport of explanation, clarification and detailed information. Your health depends on it! -Lisa M. Masterson, MD
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Too Young for a Hip Replacement?

Younger patients are becoming candidates for hip replacements
ob Ashurst has always been an active guy. Into sports and exercise all his life, the 40-year old recently started doing a rigorous cross-fit program at a local fitness club with some office mates. One evening, after a hard workout, he felt a tweak in his hip. That tweak was his first indication he had a degenerative condition known as avascular necrosis, a disruption in the blood supply to the hip joint, causing the head of femur to die. That led to osteoarthritis and pain that worsened by the month. Ashurst came to University of Alabama at Birmingham orthopedic surgeon Herrick Siegel, M.D., who told him that he was a candidate for hip replacement, largely because new advances in materials and techniques mean surgeons are now able to offer hip replacement to younger patients. There is growing need for joint replacement in general, especially in the baby boomers and the weekend warriors, said Siegel, as associate professor of surgery in the Division of Orthopedic Surgery. Weve improved the surgical process and increased the lifespan of the implants to a point where its now viable for a younger population and for older patients who previously were not candidates due to other medical issues. One factor is better materials for the hip implants. Aluminum ceramic and highly cross-linked polyethylene provide harder, smoother surfaces that cause less wear and last longer than more traditional
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plastic materials. Other new materials help bone grow into the implant, providing additional strength. Modern hip replacements are not the same hips that were put in in the 1980s and 1990s, said Siegel. These are hips that have the potential to last a lifetime in most patients. Rob Ashurst hopes so. Three months after his hip replacement he was back at the gym. He took the hard-core fitness introductory class again and, to his surprise, scored better with his new hip than with his old one. I really figured Id be one of the slowest in the class, said Ashurst, but I beat everyone in the class the first day. Siegel says that in some patients, the new hip implants could last 40 years. He also touts another advance, operating from the front of the leg rather than the back. The anterior approach, as its called, means a shorter recovery time We come in from the front so we are dividing muscles rather than cutting through them, Siegel said. It produces an earlier return to full function. The anterior approach is best performed on a special operating table. UAB has two and considering getting a third. First developed for hip and hip joint fracture cases, the table allows surgeons to manipulate the patients hip to provide the access needed to use the anterior approach.
The bottom line is faster recovery, fewer complications and a quicker return to the lifestyle that many younger patients - and the baby boomers are demanding. When I first saw Dr. Siegel, he said the point is to get you back to living the lifestyle that you want to live, said Ashurst. Its like getting up in front of the class when you have to give a presentation. You either go first or last but either way you are going to have to do it. Im glad I was able to do the hip transplant now, so I can live the rest of my life pain free. -This information provided courtesy of the University of Alabama at Birmingham
Modern hip replacements are not the same hips that were put in in the 1980s and 1990s. These are hips that have the potential to last a lifetime in most patients. -Herrick Siegel, M.D.
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Be True to Your Heart
- You Won't Like the Break Up
A
ccording to the American Heart Association, 2,150 people die every day from cardiovascular disease thats one person every 40 seconds. Between 1999 and 2009, the rate of deaths from cardiovascular disease (CVD) fell 32.7 percent, but still accounted for nearly one in three deaths in the nation. In 2010, the American Heart Association set a goal to improve cardiovascular health of all Americans by 20 percent and reduce heart disease and stroke deaths 20 percent by 2020.
However, according to projections in a 2013 American Heart Association report, heart health may only improve by six percent if current trends continue. The biggest barriers to success are projected increases in obesity and diabetes, and only modest improvements in diet and physical activity. On a positive note, smoking, high cholesterol and high blood pressure rates are projected to decline. Among heart disease and stroke risk factors, the most recent data shows:
More adults age 20 and over are obese (34.6 percent) than normal or underweight (31.8 percent); 68.2 percent are overweight or obese. Among children ages 2-19, 31.8 percent are overweight or obese. Thirty-two percent of adults report no aerobic activity; 17.7 percent of girls and 10 percent of boys, grades 9-12, report less than an hour of aerobic activity in the past week. 13.8 percent of adults have total cholesterol of 240 mg/dL or higher. Thirty-three percent of adults have high blood pressure; African-Americans have among the highest prevalence of high blood pressure (44 percent) worldwide. 8.3 percent of adults have diagnosed diabetes, and 8.2 percent have undiagnosed diabetes; 38.2 percent have prediabetes.
HEART HEALTH AND CARE

We all know we have to eat healthy and exercise to avoid heart problems, but we still need to know the symptoms of heart problems because seconds count. Mount Sinai Heart is one of the top ten cardiology treatment centers in the United States so we took our heart questions to the experts and we got answers.
attract fibrous tissue, blood components, and calcium, and harden into artery-clogging plaques. Atherosclerotic plaques often form blood clots that also can block the coronary arteries (coronary thrombosis). Congenital defects and muscle spasms can also block blood flow. Recent research indicates that infection from organisms such as chlamydia bacteria may be responsible for some cases of coronary artery disease. A number of major contributing factors increase the risk of developing coronary artery disease. Some of these can be changed and some cannot. People with more risk factors are more likely to develop coronary artery disease. Coronary artery disease begins quietly during childhood, starting as early as age 3. Although a number of factors contribute to the development of coronary artery disease, lifestyle choices top the list. "All human beings start with normal, pristine arteries, like pipes in a newly built house, explains Jonathan Halperin, MD PhD, Professor of Cardiology and Director of Clinical Cardiology Services at Mt. Sinai. But gradually, over time, we pollute them."
What Is Coronary Artery Disease?

Coronary artery disease (CAD) is the most common form of heart disease. In coronary artery disease, fatty deposits known as plaques collect on the inner wall of the blood vessels. Coronary artery disease occurs when the coronary arteries become partially blocked or clogged. This blockage limits the flow of blood from the coronary arteries, which are the major arteries supplying oxygen-rich blood to the heart. The coronary arteries expand when the heart is working harder and needs more oxygen. Arteries expand, for example, when a person is climbing stairs, exercising, or having sex. If the arteries are unable to expand, the heart is deprived of oxygen (myocardial ischemia). When the blockage is limited, chest pain or pressure, called angina may occur. When the blockage cuts off the flow of blood, the result is heart attack (myocardial infarction or heart muscle death). Healthy coronary arteries are clean, smooth, and slick. The artery walls are flexible and can expand to let more blood through when the heart needs to work harder. The disease process in arteries is thought to begin with an injury to the linings and walls of the arteries. This injury makes them susceptible to atherosclerosis and blood clots (thrombosis). Over time, the plaques thicken and arteries narrow (atherosclerosis), making it harder for the heart to pump blood throughout your body. Left untreated, atherosclerosis can lead to a heart attack. Diet, stress, activity level, and family history all play a role in developing coronary artery disease. Coronary artery disease is usually caused by atherosclerosis. Cholesterol and other fatty substances accumulate on the inner wall of the arteries. They
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Risk Factors for Coronary Artery Disease

Major risk factors significantly increase the chance of developing coronary artery disease. Some risk factors can be changed and controlled, while others cant. Those that cannot be changed are:
HeredityPeople whose parents have coronary artery disease are more likely to develop it. African Americans also are at increased risk because they experience a higher rate of severe hypertension than whites. SexMen are more likely to have heart attacks than women and to have them at a younger age. Over age 60, however, women have coronary artery disease at a rate equal to that of men. AgeMen who are 45 years of age and older and women who are 55 years of age and older are more likely to have coronary artery disease. Occasionally, coronary disease may strike a person in the 30s. Older people (those over 65) are more likely to die of a heart attack. Older women are twice as likely as older men to die within a few weeks of a heart attack. Ethnicity weighs heavily in your likelihood of developing coronary artery disease. African Americans are at higher risk for early death and have higher mortality rates from cardiovascular problems in general. AfricanAmerican women with coronary artery disease are more likely to have a heart attack than Caucasian women.
Major risk factors that can be changed are:
SmokingSmoking increases both the chance of developing coronary artery disease and the chance of dying from it. Smokers are two to four times more likely than are non-smokers to die of sudden heart attack. They are more than twice as likely as non-smokers to have a heart attack. They also are more likely to die within an hour of a heart attack. Second hand smoke also may increase risk. High cholesterolDietary sources of cholesterol are meat, eggs, and other animal products. The body also produces it. Age, sex, heredity, and diet affect one's blood cholesterol. Total blood cholesterol is considered high at levels above 240 mg/dL and borderline at 200-239 mg/dL. High-risk levels of low-density lipoprotein (LDL cholesterol) begin at 130-159 mg/dL, depending on other risk factors. Risk of developing coronary artery disease increases steadily as blood cholesterol levels increase above 160 mg/dL. When a person has other risk factors, the risk multiplies. High blood pressureHigh blood pressure makes the heart work harder and weakens it over time. It increases the risk of heart attack, stroke, kidney failure, and congestive heart failure. A blood pressure of 140 over 90 or above is considered high. As the numbers rise, high blood pressure goes from Stage 1 (mild) to Stage 4 (very severe). In combination with obesity, smoking, high cholesterol, or diabetes, high blood pressure raises the risk of heart attack or stroke several times. Lack of physical activityLack of exercise increases the risk of coronary artery disease. Even modest physical activity, like walking, is beneficial if done regularly. Diabetes mellitusThe risk of developing coronary artery disease is seriously increased for diabetics. More than 80% of diabetics die of some type of heart or blood vessel disease. Signs and Symptoms of Coronary Artery Disease
In popular media, a heart attack victim clutches his or her chest and falls to the ground. However, symptoms of coronary artery disease are often far less obvious, ranging from mild discomfort to extreme pressure or pain. If one or more of signs or symptoms is present, call a doctor or seek emergency care immediately. Signs and symptoms of a heart attack include:
Pressure, tightness, and a squeezing pain in your chest Shortness of breath Pain radiating down your arm, shoulders, jaw, neck, and back, particularly on the left side Dizziness, sweating, weakness Anxiety, feeling of impending doom Indigestion or nausea and vomiting
Heart attack symptoms can vary significantly. Seek emergency medical assistance if you suspect you may be having a heart attack.
Women's Heart Disease Symptoms

"It's important for women to understand that heart disease is also a woman's disease," says Mary Ann McLaughlin, MD, Associate Professor of Cardiology and Director of the Women's Cardiac Assessment and Risk Evaluation (CARE) Program at Mount Sinai Heart. "The warning signs of heart attack in women can differ from the classic ones, and Mount Sinai cardiologists are well versed and very knowledgeable about the specific risks for women." As part of her mission to help women take heart disease seriously, Dr. McLaughlin gives talks at middle schools and nursing homes, country clubs and churches. She participates in health fairs, where she and her colleagues check blood pressure, measure body mass index, and offer cooking demonstrations. Dr. McLaughlin has been a regular on television shows such as "Martha" and is widely quoted in newspapers and magazines. Preceding a heart attack, women will often experience the same symptoms of pressure or pain in the chest that men do. But they have a greater chance of experiencing less obvious signs:
Excessive fatigue Pressure in the chest or middle of the back Cold sweats Hormone replacement therapy Evidence from a large trial called the Women's Health Initiative released in 2002 and 2003 found that hormone replacement therapy is a risk factor for coronary artery disease in postmenopausal women. The therapy was once thought to help protect women against heart disease, but in the trial, it was discovered that it was harmful to women with existing coronary artery disease.
Detection and Diagnosis of Coronary Artery Disease

It's easy to recognize coronary artery disease after someone suffers a heart attack. It is more challenging to detect it in people who show no signs or symptoms of heart disease. "The whole paradigm is shifting away from targeting the person who is at the edge of the cliff, and toward identifying the patient well before he reaches that edge," says Jonathan L. Halperin, MD, Professor of Cardiology and Director of Clinical Cardiology Services at Mount Sinai Heart. "It's not only being able to identify the disease when it is there, but identifying it before it is threatening." Mount Sinai's cardiologists use hands-on methods to identify heart disease. Valentin Fuster, MD, PhD, Professor of Cardiology and Director of Mount Sinai Heart, sometimes asks patients in his office to do a series of sit-ups, then listens to their hearts. Dr. Fuster's diagnostic skills, honed by decades of experience, enable him to tell just by hearing the heart's sounds after exertion whether blocked arteries have caused the vessel walls to stiffen. "For every patient, there is an appropriate test." says Annapoorna Kini, MD, Associate Professor of Cardiology and Associate Director of the Mount Sinai Cardiac Catheterization Lab. "If one test is not giving us the answer we're looking for, we always have another, whether it's an angiogram, ultrasound, or checking the pressure gradient in the arteries. We have everything we need."
Assessing Your Heart Disease Risk

A thorough physical examination is the first step in any comprehensive heart health assessment. But at some point, physicians may need to peer inside your body. Diagnostic tests can:
Confirm a diagnosis Predict long-term outcomes Identify patterns of disease associated with an adverse prognosis Identify patients who might benefit from more aggressive interventions Judge the risk of cardiac events
Assessing a patient at risk of coronary artery disease depends on his or her health, age, and significantly, gender.
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Photo courtesy of Mount Sinai Medical Center
Treatment
Coronary artery disease can be treated many ways. The choice of treatment depends on the severity of the disease. Treatments include lifestyle changes and drug therapy, percutaneous transluminal coronary angioplasty and coronary artery bypass surgery. Coronary artery disease is a chronic disease requiring lifelong care. Angioplasty or bypass surgery is not a cure. To maintain heart health, the physician considers a series of factors as they determine the method of treatment. These factors may involve lifestyle changes, medications, and in more advanced cases, surgery and rehabilitation. People with less severe coronary artery disease may gain adequate control through lifestyle changes and drug therapy. Many of the lifestyle changes that prevent disease progressiona lowfat, low-cholesterol diet, weight loss if needed, exercise, and not smokingalso help prevent the disease from developing. Drugs such as nitrates, beta-blockers, and calcium-channel blockers relieve chest pain and complications of coronary artery disease, but they cannot clear blocked arteries. Nitrates (nitroglycerin) improve blood flow to the heart. Beta-blockers (acebutelol, propranolol) reduce the amount of oxygen required by the heart during stress. One type of calcium-channel blocker (verapamil, diltiazem hydrochloride) helps keep the arteries open and reduces blood pressure. Aspirin helps prevent blood clots from forming on plaques, reducing the likelihood of a heart attack. Cholesterol-lowering medications are also indicated in most cases.
Factors that determine the course of treatment for heart disease include:
Overall health Age Progression of the disease Risk factors Patient preferences Prognosis
Heart Bypass Surgery

Sometimes coronary artery bypass graft surgery (CABG) is the best option for people with coronary artery disease. In this procedure, surgeons replace diseased arteries with healthy ones. Blood vessels removed from the chest, legs, or arms find a new home in the heart, keeping it well nourished. In coronary artery bypass surgery, a healthy artery or vein from an arm, leg, or chest wall is used to build a detour around the coronary artery blockage. The healthy vessel then supplies oxygen-rich blood to the heart. Bypass surgery is major surgery. It is appropriate for those patients with blockages in two or three major coronary arteries, those with severely narrowed left main coronary arteries, and those who have not responded to other treatments. It is performed in a hospital under general anesthesia. A heart-lung machine is used to support the patient while the healthy vein or artery is attached past the blockage to the coronary artery. About 70% of patients who have bypass surgery experience full relief from angina; about 20% experience partial relief. Only about 3-4% of patients per year experience a return of symptoms. Survival rates after bypass surgery decrease over time. At five years after surgery, survival expectancy is 90%, at 10 years about 80%, at 15 years about 55%, and at 20 years about 40%. Mount Sinai Heart features the daVinci Surgical System, a robotic device surgeons use to perform minimally invasive bypass surgery. The technology makes use of fingertip-size incisions, allowing patients a shorter hospital stay and a speedier recovery. Another technique is the off-pump bypass, or "beating heart" surgery. Surgeons often perform bypass surgery using a heart-lung machine, which stops the heart from beating, allowing surgeons to operate on a motionless, blood-free surface. The machine draws blood out of the heart and sends it to an artificial lung outside the body, where it receives oxygen. The newly oxygenated blood is then sent back into the bloodstream through the aorta, where it circulates throughout the rest of the body.
"For the right patients, off-pump graft surgery is a better option than conventional surgery," says Ramachandra C. Reddy, MD, Assistant Professor of Cardiothoracic Surgery. For this type of surgery, the heart-lung machine is not used. Using stabilizing techniques, the surgeon grafts the bypass onto the heart while it continues to beat. Off-pump bypass surgery offers many benefits. These benefits include a reduced need for blood transfusions, less risk of bleeding, stroke, and kidney failure, and reduced chance of nerve damage. Hospital stays are shorter, and patients can make a quicker return to day-to-day activities. Percutaneous transluminal coronary angioplasty and bypass surgery are procedures that enter the body (invasive procedures) to improve blood flow in the coronary arteries. Percutaneous transluminal coronary angioplasty, usually called coronary angioplasty, is a non-surgical procedure. A catheter tipped with a balloon is threaded from a blood vessel in the thigh into the blocked artery. The balloon is inflated, compressing the plaque to enlarge the blood vessel and open the blocked artery. The balloon is deflated, and the catheter is removed. Coronary angioplasty is performed in a hospital and generally requires a stay of one or two days. Coronary angioplasty is successful about 90% of the time, but for one-third of patients, the artery narrows again within six months. The procedure can be repeated. It is less invasive and less expensive than coronary artery bypass surgery. Various semi-experimental surgical procedures for unblocking coronary arteries are currently being studied. Athererctomy is a procedure in which the surgeon shaves off and removes strips of plaque from the blocked artery. In laser angioplasty, a catheter with a laser tip is inserted into the affected artery to burn or break down the plaque. A metal coil called a stent can be implanted permanently to keep a blocked artery open. Stenting is becoming more common.
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Traditional imaging technologies include: Exercise stress testing: Patients exercise on a treadmill while clinicians monitor their hearts Nuclear stress testing: Combines exercise or medical stress testing with nuclear images of blood flow to the heart, improving the accuracy of coronary disease detection as compared with conventional stress testing Calcium scoring: Tests for hard plaque build-up in artery walls Echocardiography: Uses sound to form a moving picture of the heart can be combined with stress testing (stress echocardiography) for detection of coronary disease Medical Therapy for Coronary Artery Disease
Medical therapy for coronary artery disease consists of single or combined medications to reduce major contributing factors to diseased arteries. Medications include:
RESCUE YOUR HEART

Prevention
A healthy lifestyle can help prevent coronary artery disease and help keep it from progressing. A heart-healthy lifestyle includes eating right, regular exercise, maintaining a healthy weight, no smoking, moderate drinking, no recreational drugs, controlling hypertension, and managing stress. Cardiac rehabilitation programs are excellent to help prevent recurring coronary problems for people who are at risk and who have had coronary events and procedures.
Eating right
A healthy diet includes a variety of foods that are low in fat, especially saturated fat, low in cholesterol, and high in fiber. It includes plenty of fruits and vegetables, nuts and whole grains, and limited sodium. Some foods are low in fat but high in cholesterol and some are low in cholesterol but high in fat. Saturated fat raises cholesterol and, in excessive amounts, increases the amount of the clot-forming proteins in blood. Polyunsaturated and monounsaturated fats are good for the heart. Fat should comprise no more than 30% of total daily calories. Cholesterol, a waxy substance containing fats, is found in foods such as meat, eggs, and other animal products. It also is produced in the liver. Soluble fiber can help lower cholesterol. Dietary cholesterol should be limited to about 300 milligrams per day. Many popular lipid-lowering drugs can reduce LDL cholesterol by an average of 25-30% when used with a low-fat, low-cholesterol diet. Fruits and vegetables are rich in fiber, vitamins, and minerals. They are low calorie and nearly fat free. Vitamin C and betacarotene, found in many fruits and vegetables, keep LDL cholesterol from turning into a form that damages coronary arteries. Excess sodium can increase the risk of high blood pressure. Many processed foods contain large amounts of sodium. Daily intake should be limited to about 2,400 milligrams, about the amount in a teaspoon of salt. The "Food Guide" Pyramid developed by the U.S. Departments of Agriculture and Health and Human Services provides easy-tofollow guidelines for daily heart-healthy eating. It recommends 6 to 11 servings of bread, cereal, rice, and pasta; three to five servings of vegetables; two to four servings of fruit; two to three servings of milk, yogurt, and cheese; and two to three servings of meat, poultry, fish, dry beans, eggs, and nuts. Fats, oils, and sweets should be used sparingly. Canola and olive oil are better for the heart than other cooking oils. Coronary patients should be on a strict diet. In 2003, the American Heart Association advised a diet rich in fatty fish such as salmon, herring, trout, or sardines. If people cannot eat daily servings of these fish, the association recommends three fish oil capsules per day.
Aspirin, which thins blood to prevent clots Cholesterol medications, such as statins, which can reduce and even reverse the buildup of plaques Beta blockers, which improve blood flow by reducing the heart's need for oxygen Nitroglycerin, which opens the coronary arteries to increase blood flow to the heart ACE inhibitors, which lower blood pressure and allow more blood to get to the heart Calcium channel blockers, which relax and open the muscle around the coronary artery Emerging therapies such as the polypill, an exciting advancement from Mount Sinai Heart that is currently being tested worldwide
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Regular exercise
Aerobic exercise can lower blood pressure, help control weight, and increase HDL ("good") cholesterol. It may keep the blood vessels more flexible. The Centers for Disease Control and Prevention and the American College of Sports Medicine recommend moderate to intense aerobic exercise lasting about 30 minutes four or more times per week for maximum heart health. Three 10-minute exercise periods also are beneficial. Aerobic exerciseactivities such as walking, jogging, and cyclinguses the large muscle groups and forces the body to use oxygen more efficiently. It also can include everyday activities such as active gardening, climbing stairs, or brisk housework. People with coronary artery disease or risk factors should consult a doctor before beginning an exercise program.
who are 20% or more over their ideal body weight have an increased risk of developing coronary artery disease. Losing weight can help reduce total and LDL cholesterol, reduce triglycerides, and boost HDL cholesterol. It also may reduce blood pressure. Eating right and exercising are two key components of losing weight.
Avoiding recreational drugs

Smoking has many adverse effects on the heart. It increases the heart rate, constricts major arteries, and can create irregular heartbeats. It raises blood pressure, contributes to the development of plaque, increases the formation of blood clots, and causes blood platelets to cluster and impede blood flow. Quitting can repair heart damage caused by smoking. Even heavy smokers can return to heart health. Several studies have shown that ex-smokers face the same risk of heart disease as non-smokers within five to 10 years after quitting. Drink in moderation. Modest consumption of alcohol may actually protect against coronary artery disease because alcohol appears to raise levels of HDL cholesterol. The American Heart Association defines moderate consumption as one ounce of alcohol per day, roughly one cocktail, one 8-ounce glass of wine, or two 12-ounce glasses of beer. However, even moderate drinking can increase risk factors for heart disease for some people (by raising blood pressure, for example). Excessive drinking always is bad for the heart. It usually raises blood pressure and can poison the heart and cause abnormal heart rhythms or even heart failure. Do not use other recreational drugs. Commonly used recreational drugs, particularly cocaine and "crack," can seriously harm the heart and should never be used.
Maintaining a desirable body weight

About one-fourth of all Americans are overweight and nearly one-tenth are obese, according to the Surgeon General's Report on Nutrition on and Health. People
Seeking treatment for hypertension

High blood pressure, one of the most common and serious risk factors for coronary artery disease, can be controlled completely through lifestyle changes and medication. Moderate hypertension can be controlled by reducing dietary intake of sodium and fat, exercising regularly, managing stress, abstaining from smoking, and drinking alcohol in moderation. People for whom these changes do not work or people with severe hypertension may be helped by many categories of medication. " -This information provided courtesy of Mount Sinai Heart
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A HIRO in Radiology
M
edical imaging has become a crucial tool for diagnosis and clinical research. Imaging services in an academic medical institution like the University of Chicago Medicine are used by dozens of departments for everyday patient care and clinical trials, making them subject to a bewildering array of policies and procedures to protect patient privacy and preserve the integrity of data. Navigating this labyrinth of issues can be a logistical headache for researchers, so to solve this problem a group of imaging scientists and radiologists at the University of Chicago Medicine formed an office with a name that promises to save the day for investigators who need medical imaging for their clinical trials.
The Human Imaging Research Office, or HIRO, may very well seem heroic to clinical trial investigators who need CT scans, MRI scans and X-ray images to go along with the rest of their research data. The HIRO was established through the Imaging Research Institute (IRI) of the Biological Sciences Division to coordinate the acquisition, collection, analysis and maintenance of images used for clinical research involving human subjects. Since it was created in early 2009, the HIRO has assisted with 191 research protocols and has delivered more than 44,000,000 images and associated reports to researchers. Samuel Armato III, PhD, associate professor of radiology and faculty director of the HIRO, said that imaging has become a bigger component of clinical trials in recent years. Usually imaging isnt the focus of the study, but its quite often used as a measure of whether or not the drug is working, he said. The drug companies in particular prefer to have imaging standardized across all of the sites that are participating in the trial. These clinical trials have very specific requirements for images that may differ from the conventional way an image might be created in everyday clinical practice. Laying the groundwork can be a challenge for someone who isnt familiar with the intricacies of radiology. Armato said this is where the HIRO comes into play. Clinical trial groups often didnt fully appreciate the
complexities involved with imaging, and they would call around to try and find someone to answer their questions. It was just one phone call after another that led to a lot of frustration, he said. We came along to help bridge that gap between clinical research and the imaging component of that research. Nick Gruszauskas, PhD, technical director of the HIRO said, We know that ordering a CT scan of the chest isnt like ordering a lab test thats performed the same way every time. There are several dozen perfectly reasonable and useful ways that we could perform that CT of the chest. If the investigators requesting the scan dont specify what they want, then the radiologist and technologist are going to use their best judgment on how to do it. But that may not be what the drug company wants for the clinical trial. Besides making extra work for radiology staff, repeating a scan for a clinical trial because it was done incorrectly the first time poses risks for the subject. It could expose them to radiation a second time unnecessarily. In the worst case, the window of opportunity to capture an image at a specific time could pass and the subject could be removed from the trial. This is a double whammy: The researcher loses a valuable subject, and the subject misses out on the potential benefits of the trial. Gruszauskas said the confusion over technical requirements for research imaging also puts a burden
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on radiology staff. A patient might show up in their area with an order for a CT, and then stapled to that order would be a 2-3 page pamphlet from the clinical trial that describes how this scan is supposed to be done, he said. Having a patient just show up with this packet of information that the tech is supposed to implement on the spot is simply inefficient. The solution, he said, is to collaborate beforehand to iron out these technical details. Someone from the HIRO now performs a review on any research protocol that goes through the Clinical Trials Research Committee at the medical center. This lets them identify any potential snags in the imaging requirements, and line up the appropriate resources to make sure the investigators get exactly what they need for their trial. Researchers are not required to submit their trials to the HIRO, but Gruszauskas said that doing so ensures that things go smoothly. We have excellent relationships with various people in radiology, and were continuing to build up more infrastructure to have the process go as smoothly as possible, he said. The HIRO provides a site visit packet with details about the Department of Radiology infrastructure to pharmaceutical company representatives who are evaluating the medical center for a trial. They also have a website where they explain the technical requirements for every research protocol they have
reviewed. Radiology staff can then refer to this information when its time to perform the scan. The HIRO website also allows researchers to request copies of images to be used for research. Such images often have a patients personal health information embedded in the metadata or on the image itself, and the HIRO has staff who specialize in editing images to adhere to privacy standards. Armato said that the HIRO is a work in progress, and probably always will be. Its one of these ongoing projects that must adapt to the changing needs of researchers, he said. Just when we think everything is under control, some new twist on a theme comes up and we need to figure out how to enhance the process again. But both he and Gruszauskas said that the ultimate success of the HIRO lies in overcoming long-established habits that researchers developed from years of trying to figure out their imaging needs on their own. Once youve been doing it in an ad hoc manner for years, you might realize its not the best way to go about it, but you dont have time to figure out another way, Gruszauskas said. Getting people away from that is difficult. In the complex and technical world of radiology, in which juggling standard patient care with sophisticated clinical research is commonplace, it helps to have a HIRO take charge and save the day. -Matt Wood, courtesy of the University of Chicago Medicine
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CANCER - DID YOU KNOW?
There are many myths out there. On 4 February 2013 get the facts.
p l e H y h t l a e H ll Away
a C e n o -A Ph
s Telephone Talk n with Nurse Cait l Reduce Hosp a Re-admissions
W
eekly telephone contact with a nurse substantially reduced hospital readmissions for high-risk patients, according to results of a University of Wisconsin School of Medicine and Public Health study.
The findings, published in the December issue of Health Affairs, also determined that health care costs were decreased by approximately $1,225 for each patient enrolled in the program, when compared to similar patients who were not enrolled. The study measured the efficacy of Coordinated Transitional Care (C-TraC), a program used by 605 patients discharged over an 18-month period from the William S. Middleton Memorial Veterans Hospital.
High-risk patients were defined in one of three categories: having dementia or some other impairment in memory, over 65 years old and living alone, or over 65 years old with a previous hospitalization in the last year. Patients in the program were onethird less likely to be readmitted than similar patients who were not in the program. According to Dr. Amy Kind, lead investigator and assistant professor of medicine (geriatrics) at the UW School of Medicine and Public Health, patients in C-TraC were phoned by a nurse case manager 48 to 72 hours after discharge. The nurse met with each patient before discharge to make arrangements for the phone calls and with each patients hospital providers to help ensure that the patients transition home was as smooth as possible.
The nurse engages the patient in an open-ended discussion, she said. They spend a lot of time talking about medications, follow-up, and the appropriate response to any signs and symptoms that the patients medical condition could be worsening. Kind said most of these discussions involved the proper use of medications. Many patients, within two days of discharge, were not taking their medications properly, she said. They may not have understood what they should have been doing, or became confused about their medications when they arrived home. Our nurse can help them work through those issues and make sure they are doing things as they should. Kind said the patients got weekly phone calls for up to four weeks or until they were transitioned to a primary-care provider. That provider was updated at each step of the process and immediately informed if problems were detected. Our role is not to complicate the process, but to more seamlessly bridge the patients journey from the hospital to the home and to primary care, she said. The study was funded by a grant from the VA. Kind estimates the program saved the hospital $741,125 in health care costs over its first 18 months of operation. This means more money for the VA to provide medical care to veterans in need, she said. Kind said C-TraC was very popular and only five patients of more than 600 approached declined to participate. Patients dont mind a phone call, she said. Also, since most traditional transitional care programs use home visits and most of our patients live beyond the reach of a home visit, transitional care wasnt even an option for them until C-TraC. Kind said 75 percent of the patients lived outside the Dane County, Wisconsin area, and the nurse made phone calls to patients as far away as South Dakota and Florida. Because it is phone-based and our nurse doesnt spend a lot of time traveling, we can communicate with many more patients per month than in traditional home visit-based transitional care, she said. Kind believes C-TraC could eventually be used in other clinical settings, and become a useful tool in lowering the cost burden on the health care system while minimizing re-hospitalizations of patients with high-risk health conditions, but notes that the program does need additional testing.
This model requires a relatively small amount of resources to operate and may represent a viable alternative for hospitals seeking to offer improved transitional care as encouraged by the Affordable Care Act, she said. It provides an option to hospitals that previously could not effectively access transitional care services, especially those in rural areas or other areas challenged by a wide geographic distribution of patients, or those with constrained resources. -This information provided courtesy of the University of Wisconsin School of Medicine and Public Health
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The Time is Now

Together, We Will End Cancer
Inspired by Americas drive generations ago to put a man on the moon, The University of Texas MD Anderson Cancer Center has launched an ambitious and comprehensive action plan, called the Moon Shots Program, to make a giant leap for patients to dramatically accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths.
his past September, The University of Texas MD Anderson Cancer Center announced the launch of the Moon Shots Program, an unprecedented effort to dramatically accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths. Even as the number of cancer survivors in the US is expected to reach an estimated 11.3 million by 2015, according to the American Cancer Society, cancer remains one of the most destructive and vexing diseases. An estimated 100 million people worldwide are expected to lose their lives to cancer in this decade alone. The disease's devastation to humanity now exceeds that of cardiovascular disease, tuberculosis, HIV and malaria - combined. The Moon Shots Program is built upon a "disruptive paradigm" that brings together the best attributes of both academia and industry by creating crossfunctional professional teams working in a goaloriented, milestone-driven manner to convert knowledge into tests, devices, drugs and policies that can benefit patients as quickly as possible. The Moon Shots Program takes its inspiration from President John Kennedy's famous 1962 speech, made 50 years ago this month at Rice University, just a mile from the main MD Anderson campus. "We choose to go to the moon in this decade ... because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win," Kennedy said. "Generations later, the Moon Shots Program signals our confidence that the path to curing cancer is in clearer sight than at any other time in history," said Ronald A. DePinho, M.D., MD Anderson's president. "Humanity urgently needs bold action to defeat cancer. I believe that we have many of the tools we need to pick the fight of the 21st century. Let's focus our energies on approaching cancer comprehensively and systematically, with the precision of an engineer, always asking ... 'What can we do to directly impact patients?'"
The inaugural moon shots

The program, initially targeting eight cancers, will bring together sizable multidisciplinary groups of MD Anderson researchers and clinicians to mount comprehensive attacks on:
acute myeloid leukemia/ myelodysplastic syndrome; chronic lymphocytic leukemia; melanoma; lung cancer; prostate cancer, and triple-negative breast and ovarian cancers two cancers linked at the molecular level.
Six moon shot teams, representing these eight cancers, were selected based on rigorous criteria that assess not only the current state of scientific knowledge of the disease across the entire cancer care continuum from prevention to survivorship, but also the strength and breadth of the assembled teams and the potential for near-term measurable success in terms of cancer mortality. Each moon shot will receive an infusion of funds and other resources needed to work on ambitious and innovative projects prioritized for patient impact, ranging from basic and translational research to biomarker-driven novel clinical trials, to behavioral interventions and public policy initiatives.
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The platforms make the program unique

The institution-wide, high quality scientific and technical platforms will provide key infrastructure for the success of the Moon Shots Program. In the past, each investigator or group of investigators has developed their own infrastructure to support their research programs. Frequently they were under-funded and lacked the high level management and leadership required to ensure that they were of the highest caliber and in particular that they were able to adapt to the rapidly changing scientific and technological environment. The moon shot platforms will be designed and resourced to provide expertise that will support the efforts of all of moon shots teams. The platforms will provide a critical component to the success of each moon shot and of the overall Moon Shots Program. In particular, they will leverage the investment across the moon shots.
These platforms include: Adaptive Learning in Genomic Medicine: A work flow that enables clinicians and researchers to integrate real-time patient clinical information and research genomic data, allowing understanding of the cancer genome and ultimately improving outcome. Big Data: The capture, storage and processing of huge amounts of information, much of it coming from Next Generation Sequencing machines (genome sequencing). Cancer Control and Prevention: Communitybased efforts in cancer prevention, screening, and early detection and survivorship to educate and achieve a measureable reduction in the cancer burden. Interventions in the areas of public policy, public education, professional education and evidencebased service delivery can make a measurable and lasting difference in our community, especially among those most vulnerable - the underserved.
Center for Co-Clinical Trials: Uses mouse or cell models of human cancers to test new drugs or drug combinations and discover the subset of patients most likely to respond to the therapy. Clinical Genomics: An infrastructure designed to bank and process tumor specimens for clinical tests that can guide medical decisions. Diagnostics Development: The development of diagnostic tests for use in the clinic to guide targeted therapy. Early Detection: Using imaging and proteomic technologies to discover markers that can identify patients with early-staged cancers. Institute for Applied Cancer Science: Developing effective targeted cancer drugs. Institute for Personalized Cancer Therapy: An extensive infrastructure that analyzes genomic abnormalities in patient tumors to direct them to the best treatments and clinical trials. Massive Data Analytics: A computer infrastructure that develops or uses computational algorithms to analyze large-scale patient and public data. Patient Omics: Centralizing collection of patient biospecimens (tumor samples, blood, etc.) to profile genes and proteins (genomics, proteomics) and identify mutations that can guide personalized treatment decisions and predict therapy-related toxicity to improve overall patient outcomes. Translational Research Continuum: A framework to facilitate efficient transition of a candidate drug from preclinical studies to early stages of human clinical trial testing so effective drugs can be developed in a shorter time and clinical trials can be quicker and cheaper with higher success rates. MD Anderson's "Giant leap for mankind"
A year ago, when DePinho was named MD Anderson's fourth president, he proposed the notion of a moon shot moment. "How can we envision what's possible to reduce cancer mortality if we think boldly, adopt a more goal-oriented mentality, ignore the usual strictures on resources that encumber academic research and use the breakthrough technology available today?" he asked. Response from the faculty and staff took the form of initial moon shot proposals that targeted several major cancer types and involved large, integrated MD Anderson teams, sometimes numbering in the hundreds. Frank McCormick, Ph.D., director of the University of California, San Francisco Cancer Center and president of the American Association for Cancer Research, led
the review panel of 25 internal and external experts that narrowed the field to the inaugural six moon shots. "Nothing on the magnitude of the Moon Shots Program has been attempted by a single academic medical institution," McCormick said. "Moon shots take MD Anderson's deep bench of multidisciplinary research and patient care resources and offer a collective vision on moving cancer research forward." McCormick added, "The process of bringing this amount of horsepower together in such a focused manner is not normally seen in academic medicine and is valuable in and of itself."
In the first 10 years, the cost of the Moon Shots Program may reach an estimated $3 billion. Those funds will come from institutional earnings, philanthropy, competitive research grants and commercialization of new discoveries. They will not interrupt MD Anderson's vast research program in all cancers, with a budget of approximately $700 million annually. In fact, the program's efforts will help support all other cancer research at MD Anderson, particularly with improved resources and infrastructure, as the ultimate goal is to apply knowledge gained from this process to all cancers. Implementation of the program will begin in February 2013, and is expected to reach full stride by mid-2013. "The Moon Shots Program holds the potential for a new approach to research that eventually can be applied to all cancers and even to other chronic diseases," DePinho said. "History has taught us that if we put our minds to a task, the human spirit will prevail. We must do this - humanity is depending on all of us." For more information, including backgrounders on the inaugural moon shots, please visit www. cancermoonshots.org. -This information provided by the University of Texas MD Anderson Cancer Center
Most ambitious program MD Anderson has ever mounted

The Moon Shots Program is among the most formidable endeavors mounted to date by MD Anderson, an institution ranked the No. 1 hospital for cancer care byUS News & World Report's Best Hospitals survey for nine of the past 11 years, including 2012. As the program unfolds and grows, it will be woven into all areas of the institution. Researchers and clinicians concentrating on any cancer - not just the first set of moon shots - will link to new technological capabilities, data and clinical strategies afforded by the platforms.
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HealthWatchMD
with Dr. Randy Martin
Provided courtesy of Piedmont Healthcare
Common Type of Heart Condition Often Overlooked

Dr. Randy Martin: Heart failure is a major problem in this country, but there is a common type of heart failure that is often overlooked. I met with fellow cardiologist Dr. Winston Gandy to get his views on this condition.
Heart failure symptoms Shortness of breath Fatigue Swelling in the ankles Chest pain Difficulty Sleeping
Dizziness Fluid in the lungs Irregular heartbeats Nausea
efining heart failure
Treatment for diastolic dysfunction

We want to treat the cause of the diastolic dysfunction, but most of the medicines we have available to us are multifactorial in what they can do, says Dr. Gandy. He adds that doctors can choose to control hypertension, high blood pressure, renal failure or diabetes to treat diastolic dysfunction. There may be drugs that not only help lower blood pressure, but also better enable the heart muscle itself to relax. His key message: When you have moderate to severe diastolic dysfunction, it should prompt the clinician to look for other related issues so we can identify someone who may be at risk.
Heart failure occurs when the heart is unable to pump enough blood out of the heart, and either through leakage of the valves or the heart not squeezing normally, the condition raises the pressure in the lungs, says Winston Gandy, M.D., a cardiologist at Piedmont Hospital. This creates a sensation of shortness of breath. Dr. Gandy says that heart failure does not necessarily mean the heart is failing; it is rather a constellation of symptoms that cause the heart to not pump as well as it should.
Systolic vs. Diastolic Function of the Heart

The squeezing component [of heart function] is the systolic function and the relaxing component is the diastolic function, says Dr. Gandy. To determine a persons blood pressure, physicians look at both of these functions. When the heart squeezes, that will generate the top number, when the heart relaxes, that will result in the bottom number.
Diastolic Dysfunction
A study from the Cleveland Clinic looked at outpatients who had echocardiograms, or ultrasound imaging of the heart, for various reasons. Researchers looked at the flow patterns when the hearts pumping chamber was being filled, says Dr. Gandy. What they noticed was a certain pattern that they termed diastolic dysfunction. It turned out that a large group of individuals, the majority of patients, have some type of abnormality with that inflow. In this particular study, in those patients who had moderate and severe diastolic dysfunction, there was an increase in the incidence of heart failure events.
Who is at risk for diastolic dysfunction?

Those with longstanding high blood pressure are at risk, says Dr. Gandy. Patients who suffer from coronary heart disease are also at risk, as are some diabetics because they can experience diffused disease that causes scaring in the heart over time.
Dr. Randy Martin: As Dr. Gandy noted, diastolic heart failure can lead to serious consequences. Remember that high blood pressure especially if its not adequately treated is one of the major causes of diastolic heart failure. While medication is one of the ways to treat hypertension or high blood pressure, key things you can do include cutting way back on salt in your diet, exercising regularly and losing weight. You should also know the symptoms of heart failure and be sure to check with your doctor if you have any.
Getting Back in the Game...of Life
ating disorders are an epidemic in the United States today. One population increasingly at risk for developing anorexia or bulimia is athletes. Athletes are far more prone to eating disorders than nonathletes, especially for females. The risk increases significantly for those involved in sports that necessitate a certain body type or weight, when success tends to be more appearance-based than performance-based, and when the athlete is competing at an elite level. This includes sports such as ice skating, gymnastics, wrestling, diving, rowing, distance running, ballet, and other forms of dance. Those taking part in judged sports are particularly at risk. Research indicates that female athletes in judged sports have a 13 percent prevalence of eating disorders, compared to just 3 percent in the general population. Factors that contribute to risk for developing an eating disorder include: endurance sports, sports with weight categories, individual sports and lean sports. Sports with revealing clothing are rapidly moving to the top of this list, as sports
attire continues to shrink. With every passing year, players on the tennis circuit or professional volleyball teams are revealing far more skin than ever before. Athletes struggling with eating disorders are not unlike non-athletes dealing with similar issues. Highly competitive, they rarely admit to having a problem, for fear of losing playing time or displeasing coaches, teammates or family members. They may incur more injuries and have declining health, as they restrict food intake and engage in rigorous exercise schedules. Often times, these dangerous behaviors go unrecognized by coaches, parents and teammates. In fact, these very behaviors are frequently encouraged by coaches and/ or parents who believe that weight loss and extreme training will give their athlete a competitive edge. Tragically, the cost may be the young persons life, since anorexia and bulimia are potentially fatal illnesses. What is important for parents, trainers and coaches to remember is that an athlete who develops an eating disorder doesnt have to permanently relinquish his or her involvement in sport. Effective treatment is available
and recovery is possible, especially if the individual is young and the eating disorder is relatively new. However, though weight may be restored and health regained, serious thought must be given to when or if the athlete will return to training or competition. Attention must be paid to what is motivating the person to return. Is it internal or external? Does the athlete want to return to competition due to a genuine love of the sport, or is pressure to return being applied by a coach, teammates or even family? Just because an individual is highly skilled in a particular area in no way means he/she must continue to participate, especially when first entering recovery. If a comeback is decided upon, it is imperative for an outpatient team of professionals to be in place. At the very least, this team should include a primary care physician, a psychiatrist, an individual therapist, a family therapist and a dietitian. A representative from the team should also be included in the treatment plan. This support network will ensure the athlete is maintaining recovery as a top priority. Recovery behaviors need to be clearly identified: taking in sufficient nutrition according to a meal plan prescribed by a sports nutritionist; sustaining a healthy weight and not exercising to excess; participating in individual, group and family therapy sessions; and attending 12 step or other community support groups. Parameters around weight ranges and recovery behaviors necessary for healthy participation in sport need to be developed and explicitly communicated to the athlete, parents and coaches. All parties involved need to support the treatment plan in order for it to work. There are some instances where return to sport would be contraindicated. For instance, if an athlete has unstable vital signs, abnormal electrolyte levels, significant weight loss, or engages regularly in eating disorder behaviors, he/she should not return to sport. If an athlete has relapsed with eating disorder behaviors several times in the past upon returning to sport, that person may need to consider not returning until at least 1-2 years of recovery are achieved, if ever.
It can be a devastating loss for the athlete and family to let go of the sport as well as the identity, meaning, and accolades that go with it. Grief work for the athlete and family can be an important piece of facilitating life-long recovery for those who cannot safely return to their sport. As tough as grief work is, it is much easier to help a patient and family work through the loss of sport, rather than the loss of their childs life. The good news is many of the same characteristics that make an athlete great make for a successful recovery from an eating disorder. Athletes tend to have better treatment prognosis because they are used to being coached and taking direction. They also have a built-in support system to help monitor signs of improvement and slip-ups: coaches, trainers, teammates and family. Finally, because of their love of the sport, many athletes have a unique motivation for recovery. They know they need to get healthy to get back in the game, thus giving them the internal motivation needed to succeed in a healthy and long-lasting recovery. -Kim Dennis, MD, courtesy of National Eating Disorders Association
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New Head Lice Treatment Now Available
n the United States, infestation with head lice is most common among preschool children attending childcare, elementary school children, and the household members of infested children. Although reliable data on how many people in the United States get head lice each year are not available, an estimated 6 million to 12 million infestations occur each year in the United States among children 3 to 11 years of age.
About Head Lice Head lice are wingless parasites that feed on human blood and live close to the human scalp. They move by crawling and are mainly spread by head-to-head contact, most commonly among preschool children attending childcare, elementary schoolchildren and the household members of infested children. Infrequently, transmission may occur by contact with items recently used by an infested person, such as clothing, brushes, towels or pillows.
Sanofi Pasteur, the vaccines division of Sanofi has made its Sklice, head lice treatment shampoo available by prescription in U.S. pharmacies. The product is for the topical treatment of head lice infestations in patients 6 months of age and older, and to be used as part of an overall lice management program. Sklice Lotion was developed as an effective head lice treatment option well tolerated in children 6 months of age and older. In clinical trials, Sklice Lotion was proven to resolve most head lice infestations with one well-tolerated, 10-minute application. Two weeks after the initial treatment, 71-76 percent of patients treated with Sklice Lotion were lice-free. The most common side effects included eye redness or soreness, eye irritation, dandruff, dry skin and burning sensation of the skin, none of which occurred in more than one percent of treated patients. Sklice Lotion should be used as part of an overall lice management program, which includes washing (in hot water) or dry-cleaning all recently worn clothing, hats, used bedding and towels, as well as washing personal care items such as combs, brushes and hair clips in hot water. No nit combing is required; however, if desired, a fine-tooth comb may be used to remove dead lice and nits. Sklice Lotion contains a broad-spectrum antiparasitic agent, ivermectin, which was developed from a soil bacterium that produces a family of compounds (avermectins) shown to bind selectively and with high affinity to certain ion channels present in invertebrate nerve and muscle cells but not in mammals. The resulting increased permeability of the cell membrane causes paralysis and death in certain parasites. Developed by Topaz Pharmaceuticals, which was acquired by Sanofi Pasteur in October 2011, Sklice Lotion was approved by the U.S. Food and Drug Administration (FDA) in February 2012. Sklice Lotion is only available by prescription. Parents must contact their health care provider before going to the pharmacy. Sklice Lotion is a prescription medication for topical use on the hair and scalp only, used to treat head lice in people 6 months of age and older. The product should be used as part of an overall lice management program including: Washing (in hot water) or dry-cleaning all recently worn clothing, hats, used bedding and towels. Washing personal care items such as combs, brushes and hair clips in hot water. Using a fine-tooth comb or special nit comb to remove dead lice and nits. Sklice Lotion should only be used under the direct supervision of an adult. Avoid getting Sklice Lotion in the eyes.
For more information, please see Full Prescribing Information for whatdoctorsknow.com 34 Sklice Lotion located at www.Sklice.com or call 855-4-SKLICE.
Ignoring the Flu Can Be Deadly

People who develop flu may quickly develop influenza pneumonia. If you begin to have a rapid breathing rate, rapid heart rate, lightheadedness, or shortness of breath you should go to the emergency room or call your doctor. The virus also can damage the lungs and set up a pneumonia caused by bacteria. If you develop shaking chills, chest pain or pain when you breathe, or bring up sputum containing blood, you should go to the emergency room or call your doctor. Influenza can be spread to other people beginning one day before any symptoms develop and up to seven days after becoming sick. When people cough, sneeze, or talk, droplets spread the virus. Less often, touching a surface a flu virus can lead to infection. A flu vaccine definitely is the best protection against influenza. However, those with severe allergy to chicken egg, anyone who has had a severe allergic reaction to the influenza vaccine in the past, and children younger than six months should not be immunized. If you are sick and have a fever, you should wait until you have recovered before getting the flu shot. Theres a lot you can do to help prevent the spread of germs that cause respiratory illnesses like the flu.
n December 20, 2009, 32-year-old actress Brittany Murphy died of flu related complications in her Beverly Hills, California home. Five months later her husband, Simon Monjack, was found dead in the same home with the same cause of death flu related complications. Ignoring the flu can certainly be deadly. Far too often, confused with the common cold, the flu (influenza) is a contagious respiratory illness caused by influenza viruses. They are unique among respiratory viruses because theyre amazingly adaptable and have a history of drifting and shifting into other, sometimes more lethal combinations. Thats why a new influenza vaccine has to be prepared every year. Flu season is from late November through March. Each year 35 to 50 million people are infected with influenza. Annual deaths from influenza in the United States have ranged from as few as 3,000 to as high as 49,000.
Cover your nose and mouth with a tissue when you cough or sneeze. Discard the tissue in the trash. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. If you are sick with flulike illness, the CDC recommends that you stay home for at least 24 hours after your fever is gone. Be prepared in case you get sick and need to stay home for a week or so. Have a supply of over-thecounter medicines, hand sanitizer, tissues and other related items to avoid trips out in public while you are sick and contagious.
-Vicki Lyons, MD and Timothy J. Sullivan, MD
Love Your Heart F

Take Steps to Reduce Heart Risks
ebruary is American Heart Montha time to reflect on the sobering fact that heart disease remains the number one killer of both women and men in the United States. The good news is you have the power to protect and improve your heart health.
NIH and other government agencies have been working to advance our understanding of heart disease so that people can live longer, healthier lives. Research has found that you can lower your risk for heart disease simply by adopting sensible health habits. To protect your heart, the first step is to learn your own personal risk factors for heart disease. Risk factors are conditions or habits that make you more likely to develop a disease. Risk factors can also increase the chances that an existing disease will get worse. Certain risk factorslike getting older or having a family history of heart disease cant be changed. But you do have control over some important risk factors such as high blood cholesterol, high blood pressure, smoking, excess weight, diabetes and physical inactivity. Many people have more than one risk factor. To safeguard your heart, its best to lower or eliminate as many as you can because they tend to gang up and worsen each others effects. A large NIH-supported study published last month underscores the importance of managing your risk factors. Scientists found that middle-aged adults with one or more elevated risk factors, such as high blood pressure, were much more likely to have a heart attack or other major heart-related event during their remaining lifetime than people with optimal levels of risk factors. For example, women with at least 2 major risk factors were 3 times as likely to die from cardiovascular disease as women with none or 1 risk factor, says Dr. Susan B. Shurin, acting director of NIHs National Heart, Lung and Blood Institute. You can and should make a difference in your heart health by understanding and addressing your personal risk. To tackle your heart risk factors, it helps to know your numbers. Ask your health care provider to measure your blood cholesterol and blood pressure. Then determine if your weight is in the healthy range. The higher your cholesterol level, the greater your risk for heart disease or heart attack. High blood cholesterol itself doesnt cause symptoms, so you cant know if your cholesterol is too high unless you have it tested. Routine blood tests can show your overall cholesterol level and separate levels of LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. All of these blood measurements are linked to your heart health.
High blood pressure (hypertension) is another major risk factor for heart disease, as well as for stroke. High blood pressure is often called the silent killer because, like high cholesterol, it usually has no symptoms. Blood pressure is always reported as 2 numbers, and any numbers above 120/80 mmHg raise your risk of heart disease and stroke. Scientific evidence is strong that controlling high blood cholesterol and high blood pressure prevents cardiac events such as heart attacks, says Dr. Michael Lauer, a heart disease specialist at NIH. Your weight is another important number to know. To find out if you need to lose weight to reduce your risk of heart disease, youll need to calculate your body mass index (BMI, a ratio of weight to height). This NIH web page can help: www.nhlbisupport.com/bmi/bmicalc. htm. A BMI between 25 and 29.9 means that youre overweight, while a BMI of 30 or higher means obesity. Next, take out a tape measure. A waist measurement of more than 35 inches for women and 40 inches for men raises the risk of heart disease and other serious health conditions. Fortunately, even a small weight loss (between 5% and 10% of your current weight) can help lower your risk. NIH has many tools available to help you aim for a healthy weight, including physical activity tips and a menu planner. To learn more, visit http://healthyweight.nhlbi.nih.gov/.
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Protect Your Heart Dont smoke. Maintain healthy cholesterol levels and blood pressure. Maintain a healthy weight. Choose more heart-healthy foods. Get and stay active. Know your family history. Learn the signs that somethings wrong. Set a good example.
A heart-healthy diet includes a variety of fruits, vegetables and whole grains, as well as lean meats, poultry, fish, beans and fat-free or low-fat dairy products. Try to avoid saturated fat, trans fat, cholesterol, sodium (salt) and added sugar. NIH's Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) diets both promote healthy eating. U.S. News & World Report named TLC and DASH the top 2 overall diets for 2012. Regular physical activity is another powerful way to reduce your risk of heart-related problems and enjoy a host of other health benefits. To make physical activity a pleasure rather than a chore, choose activities you enjoy. Take a brisk walk, play ball, lift light weights, dance or garden. Even taking the stairs instead of an elevator can make a difference. At least 2 and a half hours a week of moderate-intensity physical activity can lower your risk of heart disease, stroke, hypertension and diabetes a winner on multiple counts, says Dr. Diane Bild, a cardiovascular epidemiologist at NIH.
If you have diabetes, its important to keep your blood sugar, or glucose, under control. About two-thirds of people with diabetes die of heart or blood vessel disease. If youre at risk for diabetes, modest changes in diet and level of physical activity can often prevent or delay its development. If you happen to be a smoker, the best thing you can do for your heart is stop. People who smoke are up to 6 times more likely to suffer a heart attack than nonsmokers. The risk of heart attack increases with the number of cigarettes smoked each day. The good news is that quitting smoking will immediately begin to reduce your risk, and the benefit in reduced risk will continue to increase over time. Just one year after you stop smoking, your risk will have dropped by more than half. Beyond controlling your risk factors, you should be alert to certain symptoms and get checked by a doctor. Common signals that somethings wrong with your heart include anginapain in the chest, shoulders, arms, neck, jaw or backas well as shortness of breath, irregular heartbeat or palpitations (arrhythmia) and fatigue. Be aware that the symptoms of a heart attack can vary from person to person. If youve already had a heart attack, your symptoms may not be the same if you have another one. Finally, dont forget that you can influence your loved ones heart health by setting an example. Do you have children, grandchildren or other
young people who look up to you? If you follow a heart-healthy lifestyle, its more likely that they will, too. Because heart disease begins in childhood, one of the best things you can do for those you love is to help children build strong bodies and healthy habits. The bottom line is, its never too late to take steps to protect your heart. Its also never too early. Start today to keep your heart strong. Talk to your doctor about your risk and to create an action plan. Love your heart. -Source: NIH News in Health, February 2012, published by the National Institutes of Health and the Department of Health and Human Services. For more information visit www.newsinhealth.nih.gov
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MYTH 1:
CANCER IS JUST A HEALTH
ISSUE
TRUTH:
CANCER IS NOT JUST A HEALTH ISSUE

It has wide-reaching social, economic, development, and human rights implications.
CANCER AND DEVELOPMENT

Cancer constitutes a major challenge to development, undermining social and economic advances throughout the world.
EVIDENCE
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GLOBAL ADVOCACY MESSAGE

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NBEFBQSPNJTFUPGSFFQFPQMFGSPNFYUSFNFQPWFSUZ BOENVMUJQMFEFQSJWBUJPOT5IJTQMFEHFUVSOFEJOUPUIFFJHIU.JMMFOOJVN%FWFMPQNFOU(PBMT XIJDISFMBUFUPFYUSFNF QPWFSUZBOEIVOHFS NBUFSOBMIFBMUI DIJMENPSUBMJUZ HFOEFSFRVBMJUZ FOWJSPONFOUBMTVTUBJOBCJMJUZ VOJWFSTBMQSJNBSZ FEVDBUJPO )*7"*%4 BOEBHMPCBMQBSUOFSTIJQGPSEFWFMPQNFOU Visit: http://www.undp.org/content/undp/en/home/mdgoverview.html for more information.
CANCER AND HEALTH POLICY

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INVESTING IN CANCER
Investing in prevention and early detection of cancer is cheaper than dealing with the consequences.
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EVIDENCE
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worldcancerday.org
UNION FOR INTERNATIONAL CANCER CONTROL UNION INTERNATIONALE CONTRE LE CANCER 62 route de Frontenex t 1207 Geneva t Switzerland Tel. +41 (0)22 809 1811 t Fax +41 (0)22 809 1810 t info@uicc.org tuicc.org
Save Your Heart, Spare Your Brain

What patients and doctors need to know about Atrial Fibrillation
A
quivering heart isnt so romantic after all. In fact, it can be devastating. Atrial fibrillation or AFib an irregular or quivering heartbeat is the culprit in about one out of five strokes. But even though it affects 2.7 million Americans, it often goes undiagnosed and untreated.
Many dismiss the flutter or thumping in the chest, the rapid and irregular heartbeat and other symptoms, including chest pain. But AFib is the most common serious heart rhythm abnormality in people over 65. So if you experience these symptoms, see your healthcare provider (and chest pain should never wait; always call 9-1-1). If you do have AFib, you must manage it to prevent a stroke and possibly save your life.
Control your risk

Stroke strikes when a blood vessel to the brain is blocked or bursts. AFib dramatically increases your stroke risk because the rapid heartbeat lets blood pool in your heart, leading to blood clots that can travel to the brain and cause a stroke. Although strokes related to AFib are often major events that could leave you disabled or even kill you, they can be prevented. Heres why we have to work together: A recent survey by the American Heart Association showed that while 30 percent of patients with AFib fear stroke the most, they face five times the risk of suffering a stroke. And AFib strokes are deadlier. AFib is also costing our nation a lot of money: $26 billion a year by one recent estimate. Although two-thirds of AFib patients have discussed their stroke risk with their doctor, only about one-third of them recall being told theyre at high risk for stroke.
The No. 1 thing I tell my AFib patients is that being on the right blood thinner can substantially reduce their stroke risk. And I remind my colleagues that stroke risk for patients with AFib is significant, and many patients who should be on anticoagulation arent. A careful discussion about the benefits and risks of blood thinners is a must. In most cases, the benefits outweigh the risks. You also need to know your stroke risk and how to control it. You face the biggest risk if you have a history of stroke. Being older than 75, a woman or having other risk factors such as a history of high blood pressure, diabetes, congestive heart failure, heart attack or peripheral vascular disease also adds to your risk. Preventing or controlling high blood pressure can greatly lower your chances of having a stroke, so be sure and monitor and maintain your blood pressure, and take any medications as prescribed. Dont smoke, get regular exercise and maintain a healthy weight. Get plenty of fruits, vegetables and low-fat dairy products. And try to limit salt, cholesterol and saturated and trans fats in your diet. In the blink of an eye, a quivering heart could damage your brain and change your life forever. Take control by starting the conversation to safeguard your health. For more information about AFib, www. heart.org/afib. -Patrick T. Ellinor, MD, PhD
Start the conversation

AFib patients, what should you ask your doctor? Physicians and healthcare providers, what can you do for your patients? Try tackling these questions together:
(1) Whats my stroke risk? (2) Do I need to be on a blood thinner? If so, which one? (3) Is my heart rate well controlled? (4) Should an attempt be made to restore a normal rhythm?
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Important Flu Recommendations for High-Risk
Populations
hile it is important to get vaccinated against the flu virus as early as possible, it is never too late to reap the benefits of this vaccine. According to The Centers for Disease Control and Prevention, the peak months for the spread of the flu virus are January and February and the season can last into mid-May. Those at highest risk of complications from the flu are young children; people 65 and older; pregnant women; and people with health conditions such as heart, lung or kidney disease, or a weakened immune system. "Adults age 65 and older face the greatest risk of serious complications and even death as a result of influenza. That is why it is so important that they get immunized. Even when older adults contract the flu after immunization, which can happen, those cases tend to be less severe and of shorter duration," says Dr. Mark Lachs, director of geriatrics at NewYork-Presbyterian Hospital.
"It is important that all children get immunized against this illness," says Dr. Gerald Loughlin, pediatrician-in-chief at the Phyllis and David Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Lachs and Dr. Loughlin offer the following guidelines to help protect these most vulnerable populations from catching the flu this winter:
Get vaccinated early. The flu vaccine is most effective when administered during the fall months, before the onset of flu season. It's never too late. The flu season begins in the fall and can last through the spring, so if you do not get vaccinated in October you can still be immunized in December or January. Know your options. A nasal vaccine is available for healthy children from age two and over, and for adults up to the age of 49. There are some restrictions so check with your doctor first. Get your family members vaccinated. The Centers for Disease Control and Prevention recommends that the following groups get immunized against the flu every year: Children beginning at six months of age Pregnant women People 50 years of age and older People of any age with certain chronic medical conditions such as asthma, diabetes, cardiovascular disease, and any form of immunosuppressive illness People who live in nursing homes and other long-term care facilities People who live with or care for those at high risk for complications from flu, including: Health care workers Household contacts of persons at high risk for complications from the flu Household contacts and out-of-home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
Physicians and nurses at the Komansky Center for Children's Health at NewYork-Presbyterian Hospital/ Weill Cornell strongly urge parents to have their children immunized early to make sure they have optimal protection during December and January when flu epidemics are at their peak. -This information provided courtesy of Weill Cornell Medical College
Team Up. Pressure Down.

Improving Americans' Blood Pressure Control
maginepharmacists and patients working together to prevent heart attacks and strokes, simply thorough conversation and education. Its happening now, thanks to a new educational program launched by Million Hearts. Team Up. Pressure Down. is bringing together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke. The goal of Million Hearts is to prevent 1 million heart attacks and strokes by 2017. This valuable Million Hearts initiative will prevent heart attacks and strokes by bringing pharmacists into the care team to help patients control their blood pressure. Pharmacists are able to talk to patients and families about using medication to manage, high blood pressure, and they can also help patients address barriers to taking their medication, said Surgeon General, Regina M. Benjamin, M.D. In collaboration with pharmacists, the U.S. Department of Health and Human Services, and other partners, Team Up. Pressure Down. offers free tools and resources to help you manage hypertension, track and take your medication(s) as directed, plus helpful tips on how to work with your pharmacist between visits to your doctor. Tools such as a blood pressure control journal, and wallet card to track medication use, as well as viewing informative videos are among the resources available in this program. But dont think that this program is just for patients. It was created to bring pharmacist and patient together. An independent task force, appointed by the Director of CDC, recommended team-based careuniting the efforts of physicians, pharmacists, nurses, and other health care professionalsto improve blood pressure control. Its recommendation followed a review of evidence from more than 70 scientific publications. More than 36 million Americans, or more than half of those with hypertension, dont have their blood pressure under control and every single day, more than one thousand Americans have a heart attack or stroke, said Janet Wright, M.D., a board-certified cardiologist
and executive director of Million Hearts. Through the Team Up. Pressure Down. educational program for pharmacists, we are taking the first step in helping many more Americans achieve blood pressure control. The blood pressure initiative, part of the Million Hearts health education program, was developed by the Centers for Disease Control and Prevention, with practicing pharmacists and national pharmacist groups. The initiatives tools will help pharmacists talk about current medications and ways in which patients can use the medications most effectively. An additional benefit for pharmacists is the ability to obtain continuing pharmacy education credit for participating in the program. Our organization trains the next wave of young pharmacists who are committed to making a difference in patients lives, said William Lang, M.P.H., vice president for policy and advocacy, American Association of Colleges of Pharmacy. Team Up. Pressure Down. recognizes and supports the critical role of pharmacists in improving blood pressure control through team-based care. Team Up. Pressure Down. will help pharmacists in any setting talk to their patients about the importance of staying on blood pressure medications and coach them on how to control hypertension, said Carolyn C. Ha, Pharm.D., director of professional affairs, National Community Pharmacists Association. For more information about the Million Hearts Team Up. Pressure Down. program, visit: http://millionhearts. hhs.gov/resources/teamuppressuredown.html
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Get Off the Couch... Live Longer
se it or loose it! Research by the American Cancer Society and others is offering strong evidence that an individuals risk of developing cancer can be substantially reduced by healthy behavior including:
not using tobacco, getting sufficient physical activity, eating healthy foods in moderation, and participating in cancer screening according to recommended guidelines.
The eye-opening message here is the need for physical activity as part of a total healthy lifestyle. Being active can add years to your life. The American Cancer Society estimates that of the 565,650 cancer deaths that were expected in 2008, about 170,000 cancer deaths would be caused by tobacco use, and another third would be attributed to poor eating habits, overweight and obesity, and physical inactivity. Sadly, effectively promoting healthy behaviors, much of the suffering and death from cancer can be prevented or reduced. A recent letter to the president from the Presidents Cancer Panel to the president noted:
Healthier behavior could also reduce death and suffering from other diseases, such as type 2 diabetes, hypertension, coronary heart disease, and strokes. In 1993, researchers documented that modifiable behavioral risk factors had contributed substantially to the number of deaths that occurred in this country in 1990. Tobacco use accounted for 19% of all deaths, poor diet and physical activity accounted for 14%, and alcohol consumption accounted for 5%. Risky sexual behaviors and illicit use of drugs also contributed significantly to mortality. The researchers concluded that roughly half of all deaths that occurred in 1990 could be attributed to a limited number of largely preventable behaviors and exposures. A decade later, another team of researchers found that tobacco use, poor diet, physical inactivity, and alcohol consumption were among the leading causes of death; combined, the first three accounted for more than one-third of all deaths in the United States. In addition to mortality, these unhealthy lifestyle behaviors impose significant burdens on society, such as disability, diminished quality of life, and increased health care costs.
Tobacco
Tobacco use is a known risk factor for 15 types of cancer. Decreased tobacco use has reduced cancer deaths among men by at least 40% from 1993 to 2003. Although much has been accomplished, a considerable amount of work remains to be done. In 1964, 42.4% of adults in the United States smoked. Now, the CDC reports that 21.5% of adults in the United States are smokers, and 17.5% of adults are daily smokers. About 4 out of 10 smokers (42.4%) attempted to quit smoking
Despite irrefutable evidence that modifiable behaviors are linked to numerous types of cancer and the implementation of a multitude of programs to combat risk-promoting behaviors, many millions of Americans continue to practice unhealthy lifestyles.
to grow dramatically if the present trend continues unabated. A 2005 study estimated that 112,000 deaths in the United States were associated with obesity, making it the second-leading contributor (after tobacco) to premature death. Obesity and physical inactivity may account for 25 to 30% of several major cancers, including colon, postmenopausal breast, endometrial, kidney, and cancer of the esophagus.
Cancer Screening
in 2005, but the majority were unsuccessful. Of the daily smokers, only 40.2% were successful. Recently, smoking rates among adults and high school students have leveled off, possibly because of increased tobacco industry spending on marketing and promotion. Breast cancer deaths have been decreasing since 1990, with breast cancer screening playing a significant role. Unfortunately, the percentage of women who report that they have had a mammogram in the past 2 years has leveled off, remaining at the same level since 2000. If we can increase the number of women who have mammograms, more women will be diagnosed with breast cancer at an earlier stage, which dramatically increases their chances of surviving cancer. Although colorectal cancer screening not only results in earlier detection, but also can actually prevent cancer from developing, less than half of Americans age 50 and older are current for colorectal cancer screening.
There are well-agreed-upon standards for basic nutrition and minimum levels of physical activity for sustaining good health. However, much less is known about how to effectively encourage people to make healthy choices.
The Presidents Cancer Panel Physical Activity and Food Intake

Increasing evidence has accumulated showing that physical activity helps prevent cancer, and yet 38% of adults in the United States do not engage in any physical activity in their leisure time. Only 1 in 8 adults engages in vigorous physical activity in their leisure time for the recommended 5 times a week. Lack of exercise and poor nutrition are major factors in the growing obesity problem in this country. Almost two-thirds of adults in this country are overweight or obese, and the numbers are expected
In the . . . immediate term, the principal causes of lung and numerous other cancers are amenable to change through behavioral and policy/environmental interventions, which offer the best chance of substantially reducing the cancer burden.
Promoting Healthy Lifestyles 2006-2007 Annual Report of the Presidents Cancer Panel
The Presidents Cancer Panel recently released a report that summarized the findings of four meetings convened between September 26, 2006, and February 27, 2007, to discuss behaviors that affect cancer risk.8 These meetings examined the evidence regarding the effects of diet, nutrition, physical activity, tobacco use, and tobacco smoke exposure on cancer risk. The meetings also discussed actions ongoing and potential that could reduce the burden of cancer by promoting healthier lifestyles. The panels report commented that most of the federally sponsored cancer prevention research emphasizes genetic and other biologic factors, but the work needs to be accompanied by research that addresses the importance of physical, social, and cultural contexts in which food choices, physical activity, and tobacco use occur. The overall message from the research is: Getting up off the couch or that chair can add years to your life. -This information provided courtesy of the American Cancer Society
Tips to 10 Alleviate Stress
M
1 2
aking the time to take care of your body and fulfill your needs becomes increasingly more difficult with the pressures and stresses of a demanding schedule, fast-paced job and the increasing number of distractions around us. Dr. Ana C. Krieger and Dr. Gail Saltz presented these key tips on how to sleep better, have more sex and stress less at the 30th Annual Women's Health Symposium hosted by NewYork-Presbyterian/Weill Cornell Medical Center:
Sex is Good! Sex is a great form of exercise that enhances bonding with your partner, fights aging, reduces your stress and allows you to sleep better Sex Alleviates Stress: Sexual problems can contribute to stress, but healthy sex can alleviate stress
3 4
Make "Me" Time: Carve out time to wind down for a few minutes before sleep No Work Allowed! Use the bedroom for sleeping and sex, not work
7 8
Turn Off TVs and Smartphones! Before bedtime and during sleep, avoid light exposure, even from electronic devices Be Cozy: Create a cozy bedroom environment with a room temperature between 65-70 Fahrenheit
5 6
The Secret to Sleep: The key elements of an adequate night's sleep include timing, duration and quality Seven Hours or Bust! Only a fraction of people can function optimally with six or less hours of sleep
9 10
Keep a Routine: Establish a night time routine and get up at the same time every day
Manage your Stress: To better manage your stresses consider relaxation training, better time management and problem solving
-This information provided courtesy of Weill Cornell Medical College

Equal Parts Comfort & Style:

Thera t by Dr. Lisa Masterson
The comfort shoe trend has a strong new contender Thera t by Dr. Lisa. Co-developed by Dr. Lisa Masterson of the Emmy Award-winning television series, The Doctors, these shoes are designed speci cally for women, and provide cushioning, comfort, style and support and are accredited by the National Posture Institute. The 12-hour shoe for the 12- hour day, as we like to call it, completely transforms lives lled with errands, household activities, long days at the job, workouts and more. The wrong shoes can plague the body with insu erable aches, pains and stress. Thera t By Dr. Lisa shoes feature multiple layers and densities that distribute the shock of each step downward and outward providing cushioning and support. Theres no need to worry about rough landings leading to di cult body aches in the mornings. Women are constantly moving. Were always on the go and we want comfortable shoes that move with us, but we want them stylish enough so we can wear them wherever were going, says Dr. Masterson. Thats why Thera t By Dr. Lisa shoes were designed to be extra comfortable and to relieve pain in the back, hips, legs and feet. Thanks to the cushioning and supportive layers, Thera t By Dr. Lisa o ers extra comfort for the active woman with their patented, innovative technology. The Thera t By Dr. Lisa Personal Comfort System (PCS) Technology allows the outsole of the shoe to be adjusted to increase or decrease levels of impact resistance. There are three special dual-density Adapters inside the shockabsorbing wedge that may be removed to adjust the resistance and the cushioning. I know what it is to be a working mom, says Dr. Masterson. Juggling it all and maintaining good health is a challenge. This shoe is a realistic solution for women to encourage exercise, and bring overall wellness into their lifestyle. Depending on each womans unique physical conditions on a particular day or even hour they may remove the Personal Comfort Adapters to comfort tired, aching feet. Thera t By Dr. Lisa shoes make women look good and feel good in their active lifestyles constantly on the go. The Deborah model is for athletic or walking purposes and comes in ve great colors: pink, black/pink, red, silver/blue and black/white. The work shoe and a great uniform-appropriate style is the Renee model available in black or white. Prices for both models start at $95 and they can be shopped online exclusively via Thera tshoe.com. More styles will launch in the near future as well! The Thera t By Dr. Lisa shoes are a smart choice for active women in various styles of living to maintain a balance of comfort, support and style.
1 in 3
Getting Blood Pressure Under Control

Many missed opportunities to prevent heart disease and stroke
High blood pressure is a major risk factor for heart disease and stroke, both of which are leading causes of death in the US. Nearly onethird of all American adults have high blood pressure and more than half of them dont have it under control.* Many with uncontrolled high blood pressure dont know they have it. Millions are taking blood pressure medicines, but their blood pressure is still not under control. There are many missed opportunities for people with high blood pressure to gain control. Doctors, nurses and others in health care systems should identify and treat high blood pressure at every visit.
*Blood pressure control means having a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, among people with high blood pressure.
Nearly 1 in 3 adults (about 67 million) have high blood pressure.
About 36 million adults with high blood pressure dont have it under control.
36M
1,000
High blood pressure contributes to nearly 1,000 deaths a day.
Learn what you can do to get control of high blood pressure. Want to learn more? Visit
www
http://www.cdc.gov/vitalsigns
National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention
Controlling blood pressure has to be a priority. Problem

Why is blood pressure control so important to health?
When your blood pressure is high:
4 times more likely to die from a stroke You are 3 times more likely to die from heart disease
You are Even blood pressure that is slightly high can put you at greater risk.
Most people with uncontrolled high blood pressure:

.QRZWKH\KDYHKLJKEORRGSUHVVXUH6HHWKHLUGRFWRU7DNHSUHVFULEHGPHGLFLQH Each of these is important, but there is much more to do. Whats needed now is for doctors, nurses and their patients to pay regular and frequent attention to controlling blood pressure.
Know your numbers and what they mean

Systolic Diastolic Under
and
Systolic
or
Systolic Diastolic
Greater than or equal to Greater than or equal to
or
Under
Diastolic
KEEP UP THE GOOD WORK
MAKE HEALTHY LIFESTYLE CHANGES
If you have diabetes, talk with your doctor about appropriate blood pressure levels.
CHECK WITH YOUR HEALTHCARE PROVIDER AND TAKE MEDICINES AS PRESCRIBED
100% 80%
Percentage
67M
67
Million Americans have High Blood Pressure
53M
47M 31M
60% 40% 20% 0%

Have High Blood Pressure Aware Treated
Controlled
Source: NHANES 2003-2010
Tracking Success in Blood Pressure Control

Patients
Blood pressure control improves when patients take action. Take medicines as prescribed Learn to measure blood pressure on your own
Health care systems

High blood pressure control throughout health care systems improves by using electronic health records (EHRs) and patient registries to: Include quality measures for performance Identify and follow-up with patients who have high blood pressure Notify doctors about patients with high blood pressure readings
Lower your risk by: Eating a healthy, low sodium diet. Exercising Maintaining a healthy weight. Limiting alcohol use. Not smoking.
Uncontrolled High Blood Pressure

Too many people have it. The risks are serious. A team-based care approach can help.
Doctors, nurses and others who treat patients

High blood pressure control improves when its a priority: Focus on blood pressure and track your performance Use a team-based care approach Checking and addressing blood pressure at every visit Simplify treatment: Once-a-day doses of medicine when possible Fewer pills
Source: Wofford MR, Minor DS. Hypertension: issues in control and resistance. Curr Hypertens Rep 2009;11:3238. 3
What Can Be Done

Federal government is
Joining with the private sector in leading the national Million Hearts initiative to prevent a million heart attacks and strokes by 2017 (http:// millionhearts.hhs.gov). Working with pharmacists on activities to provide education and counseling to patients with high blood pressure. Focusing on the importance of high blood pressure as a Leading Health Indicator. (http://www. healthypeople.gov/2020/LHI/clinicalPreventive. aspx). 0HDVXULQJSURJUHVVDJDLQVWWKHVSHFLFREMHFWLYHV in Healthy People 2020. (http://www. healthypeople.gov/2020/topicsobjectives2020/ objectiveslist.aspx?topicId=21).
Doctors, nurses and others who treat patients can

Flag and monitor patients with high blood pressure or who are at-risk. Report progress on patients using National Quality Forum (NQF) 0018. (http:// www.qualityforum.org/MeasureDetails.aspx?actid= 0&SubmissionId=1236#p=2&s=n&so=a). Counsel patients to take their medicines and make lifestyle changes. Follow their progress. Regularly evaluate the blood pressure medicines they take to determine whether these need to be changed. Address every blood pressure reading that is high by talking with the patient about taking prescribed medicines, adjusting current medicines and/or encouraging lifestyle changes. Consider once-a-day doses of medicines when possible.
Health care systems where patients are seen and treated can
Start having doctors, nurses, and others review patient records, looking for patients who need more attention to control their high blood pressure. Create system-wide targets using Healthy People 2020 objectives to achieve blood pressure control. Update staff monthly on progress and give feedback on success measures. Make it easier for patients to stay on medicines: &RQVLGHUGD\UHOOVIRUSUHVFULSWLRQV &RQVLGHUQRRUORZHUFRSD\PHQWVIRU medicines
www www
Everyone can
Take prescribed medicines each day and follow the directions on the bottle. If your blood pressure is still not under control or if you have side effects, talk with your doctor, nurse, or pharmacist about possibly changing your medicine. Work to maintain a healthy weight and meet the Physical Activity Guidelines for Americans. (http://www.cdc.gov/physicalactivity/everyone/ guidelines/) Follow a heart healthy eating plan with foods lower in sodium. Get help to stop smoking. If you dont smoke, dont start. Measure and write down your blood pressure readings between doctors visits. This can be done at home, at a grocery store or at the pharmacy. .HHS\RXUGRFWRUQXUVHSKDUPDFLVWRURWKHUKHDOWK care provider informed of your blood pressure readings that you take at home.
CS233981-B
http://www.cdc.gov/vitalsigns http://www.cdc.gov/mmwr
For more information, please contact
Telephone: 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov

Web: www.cdc.gov Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Publication date: 09/04/2012
Screening and Preventing Cancer

Pap Smears, HPV Vaccines, and Your Cervix
ou have cancer. Words you dont want to hear. Words I dont want to say. Inevitably, the first thought that enters your mind: When will I die?
awkwardness of people not really knowing how to help (sometimes without wanting to really get that involved with the muddy details) or what to even talk to you about. To say the least, cancer is rude and intrusive and unrelenting, and can really mess up your life. Unfortunately, of all the cancers in the world, only a handful of them have effective screening tests. Luckily, though, a handful of them do have effective screening tests. These would include cervical cancer (Pap smear), breast cancer (mammogram), and colon cancer (colonoscopy); personally, being a gynecologic oncologist and obsessing about womens health, I think the world of these tests. Take the Pap smear, for example. This is the oldest medical test we have and, while its been modified, it has essentially remained the same since Drs Papnicolaou and Traut devised it. I have to get my Pap smear. It has become the major reason why women go to a doctor. And with this test, we are able to identify abnormal precancerous cells that are years and years ahead of their actual development to cervical cancer cells. We can diagnose and treat these cells, and cure people of this precancer (or dysplasia) long before cancer can rear its ugly head. Moreover, unlike most other cancers, we have discovered that the majority of cervical cancer is caused by infection with the human papillomavirus (HPV). Using this knowledge, we have developed an HPV vaccine that can effectively prevent the majority of HPV infections that will lead to cervical cancer and it is postulated that this will even lead to a decrease in the number of precancerous cells we find now. Consider: a cancer that is caused by an infection with a virus that we can now vaccinate people against. A vaccine that can prevent cancer. Novel. Powerful. Having seen the alternative many times over, if you ask me, Pap smears and vaccines are way better than getting diagnosed with and treated for cervical cancer. -Kenneth H. Kim, MD, Assistant Professor, UNC Gynecologic Oncology
Ben Franklin once said, An ounce of prevention is worth a pound of cure. In the field of cancer research and treatment, the conversion rate is probably something more on the order of a microgram of prevention to a metric ton of cure whether you are familiar with the metric system or not, you get the point that its way more than ounce-to-pound. The issue with cancer, in general, is that we are not reliably great at finding it at early or pre-cancer stages, and we are definitely not as good as we want to be in treating it. Dont get me wrong we have made vast advances in the past 20 years with improved chemotherapy drugs, improved anti-nausea and other supportive drugs, and are now really getting to the personalized molecular and genetic basis of this disease. But regardless of how good we are at treating and/or curing things, you would just as well rather not be sick at all and not deal with all the stress and hassle, not to mention the repeatedly visits to the hospital, taking time off work, and especially the
Uncovering Eating Disorder Facts

Health consequences
In anorexia nervosas cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in:
hat are Eating Disorders?
Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase or lifestyle choice. Eating disorders are serious, potentially life-threatening conditions that affect a persons emotional and physical health. People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. In the United States, nearly 10 million females and 1 million males are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Millions more are struggling with binge eating disorder. For various reasons, many cases are likely not to be reported. In addition, many individuals struggle with body dissatisfaction and sub-clinical disordered eating attitudes and behaviors. More than 80% of women are reported to be dissatisfied with their appearance (Smolak, 1996).
Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower. Reduction of bone density (osteoporosis), which results in dry, brittle bones. Muscle loss and weakness. Severe dehydration, which can result in kidney failure. Fainting, fatigue, and overall weakness. Dry hair and skin; hair loss is common. Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.
For females between fifteen to twenty-four years old who suffer from anorexia nervosa, the mortality rate associated with the illness is twelve times higher than
the death rate of ALL other causes of death (Sullivan, 1995). (Please note that the heightened mortality rate applies only to those with anorexia and does not mean that anorexia is the leading cause of death among all females aged 15-24 in the general public. The recurrent bingeand-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Health consequences include:
Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium,sodium and chloride from the body as a result of purging behaviors. Potential for gastric rupture during periods of bingeing. Inflammation and possible rupture of the esophagus from frequent vomiting. Tooth decay and staining from stomach acids released during frequent vomiting. Chronic irregular bowel movements and constipation as a result of laxative abuse. Peptic ulcers and pancreatitis.
Binge eating disorder often results in many of the same health risks associated with clinical obesity, including:
The incidence of bulimia in women 10-39 TRIPLED between 1988 and 1993. Only 6% of people with bulimia receive mental health care. The peak onset of eating disorders occurs during puberty and the late teen/early adult years, but symptoms can occur as young as kindergarten. More than one in three normal dieters progresses to pathological dieting. Eating disorders affect people from all walks of life, including young children,middle-aged women and men and individuals of all races and ethnicities. Although eating disorders are potentially lethal, they are treatable. Despite its prevalence, there is inadequate research funding for eating disorders.Funding for eating disorders research is fraction of that for Alzheimers disease. In the year 2008, the National Institute of Health (NIH) funded the following disorders accordingly:
High blood pressure. High cholesterol levels. Heart disease as a result of elevated triglyceride levels. Type II diabetes mellitus. Gallbladder disease. Did you know 40% of newly identified cases of anorexia are in girls 15-19 years old. A rise in incidence of anorexia in young women 15-19 in each decade since 1930. Anorexia has the highest rate of mortality of any mental illness.
Illness Eating disorders: Alzheimers disease: Schizophrenia:
Prevalence 10 million 4.5 million 2.2 million
Research Funds $7,000,000* $412,000,000 $249,000,000
* The reported research funds are for anorexia nervosa only. No estimated funding is reported for bulimia nervosa or eating disorders not otherwise specified.
Research dollars spent on eating disorders averaged $.70 per affected individual, compared to$113.00 per affected individual for schizophrenia.
whatdoctorsknow.com
59
American Public Opinion on Eating Disorders

In March 2005, NEDA contracted with Global Market Insite, Inc. (GMI), a leader in global market research, to conduct a 1,500 nationwide sample of adults in the U.S. Their findings concluded from those surveyed that:
Three out of four Americans believe eating disorders should be covered by insurance companies just like any other illness. Americans believe that government should require insurance companies to cover the treatment of eating disorders. Four out of ten Americans either suffered or have known someone who has suffered from an eating disorder. Dieting and The Drive for Thinness Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting,and taking laxatives (Neumark-Sztainer, 2005). Girls who diet frequently are 12 times as likely to binge as girls who dont diet (Neumark-Sztainer, 2005). 42% of 1st-3rd grade girls want to be thinner (Collins, 1991). 81% of 10 year olds are afraid of being fat (Mellin et al., 1991). The average American woman is 54 tall and weighs 140 pounds. The average American model is 511 tall and weighs 117 pounds. Most fashion models are thinner than 98% of American women (Smolak, 1996). 46% of 9-11 year-olds are sometimes or very often on diets, and 82% of their families are sometimes or very often on diets (Gustafson-Larson & Terry, 1992). 91% of women recently surveyed on a college campus had attempted to control their weight through dieting, 22% dieted often or always (Kurth et al., 1995). 95% of all dieters will regain their lost weight in 1-5 years (Grodstein, et al., 1996). 35% of normal dieters progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders (Shisslak & Crago, 1995). 25% of American men and 45% of American women are on a diet on any given day (Smolak, 1996). Americans spend over $40 billion on dieting and dietrelated products each year (Smolak, 1996).
www.NationalEatingDisorders.org-Information and Referral Helpline: 1-800-931-2237 -This information provided courtesy of the National Eating Disorders Association
References
Collins, M.E. (1991). Body figure perceptions and preferences among preadolescent children.International Journal of Eating Disorders, 199-208. Crowther, J.H., Wolf, E.M., & Sherwood, N. (1992). Epidemiology of bulimia nervosa. In M. Crowther, D.L. Tennenbaum. S.E. Hobfoll, & M.A.P. Stephens (Eds.). The Etiology of Bulimia Nervosa: The Individual and Familial Context (pp. 1-26) Washington, D.C.: Taylor & Francis. Fairburn, C.G., Hay, P.J., & Welch, S.L. (1993). Binge eating and bulimia nervosa: Distribution and determinants. In C.G. Fairburn & G.T. Wilson, (Eds.), Binge Eating: Nature, Assessment,and Treatment (pp. 123-143). New York: Guilford. Gordon, R.A. (1990). Anorexia and Bulimia: Anatomy of a Social Epidemic. New York: Blackwell. Grodstein, F., Levine, R., Spencer, T., Colditz, G.A., Stampfer, M. J. (1996). Three-year followup of participants in a commercial weight loss program: can you keep it off? Archives of Internal Medicine. 156 (12), 1302. Gustafson-Larson, A.M., & Terry, R.D. (1992). Weight-related behaviors and concerns of fourth-grade children. Journal of American Dietetic Association, 818-822. Hoek, H.W. (1995). The distribution of eating disorders. In K.D. Brownell & C.G. Fairburn (Eds.) Eating Disorders and Obesity: A Comprehensive Handbook (pp. 207-211). New York: Guilford. Hoek, H.W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 383-396. Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 27-37. National Institutes of Health. (2005). Retrieved November 7, 2005, from http://www.nih.gov/news/fundingresearchareas.htm Neumark-Sztainer, D. (2005). Im, Like, SO Fat! New York: The Guilford Press. pp. 5. Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18 (3), 209-219. Smolak, L. (1996). National Eating Disorders Association/ Next Door Neighbors Puppet Guide Book. Sullivan, P. (1995). American Journal of Psychiatry, 152 (7), 1073-1074.
DID YOU KNOW?

these six popular foods can add 1 high levels of sodium to your diet
The American Heart Association recommends that you aim to eat less than 1,500 mg of sodium per day.
When you see the Heart-Check mark on a product, you know the food has been certified to meet nutritional criteria for heart-healthy foods, including sodium.
Some foods that you eat several times a day, such as bread, add up to a lot of sodium even though each serving may not seem high in sodium. Check the labels to find lower-sodium varieties.
Breads & rolls

1
One 2 oz. serving, or 6 thin slices, of deli meat can contain as much as half of your daily recommended dietary sodium. Look for lowersodium varieties of your favorite lunch meats.
Cold Cuts & Cured Meats

2
A slice of pizza with several toppings can contain more than half of your daily recommended dietary sodium. Limit the cheese and add more veggies to your next slice.
Pizza
3
Sodium levels in poultry can vary based on preparation methods. You will find a wide range of sodium in poultry products, so it is important to choose wisely.
Poultry
4
Sodium in one cup of canned soup can range from 100 to as much as 940 milligramsmore than half of your daily recommended intake. Check the labels to find lower sodium varieties.
souP
5
A sandwich or burger from a fast food restaurant can contain more than 100 percent of your daily suggested dietary sodium. Try half a sandwich with a side salad instead.
sandwiChes
6
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), Vital Signs: Food Categories Contributing the Most to Sodium ConsumptionUnited States, 20072008, February 10, 2012 / 61(05);92-98.
Change Your Salty Ways
in Only 21 Days
Take the Sodium Swap Challenge
Sodium
the everyday meal offender that might make your face feel puffy and your jeans look, and feel, tighter. Did you know reducing your sodium intake during a three week period can change your sodium palate and start enjoying foods with less sodium? The American Heart Association has challenged Americans to step up to the plate, re-charge their taste buds and give their heart-health a boost with a new program called Sodium Swap Challenge. The average American consumes about 3,400 milligrams of sodium a day more than twice the 1,500 milligrams recommended by the American Heart Association/American Stroke Association. Changing your salty ways may be difficult, especially since you have acquired a taste for salt, but dont worry making the swap or taking the challenge doesnt have to be hard. With the help of the Salty Six (common foods that may be loaded with excess sodium that can
increase your risk of heart disease), youll be able to identify, and keep track of, top food culprits. "To get started with the association's challenge, we ask that consumers get familiar with the food labels and nutrition facts for the foods they eat and track their sodium consumption over the first two days to get an idea of how much they are eating, which I'm sure will be surprising to many people." commented Rachel Johnson, Ph.D., RD, FADA, spokesperson for the American Heart Association/American Stroke Association, Robert L. Bickford, Jr. Green and Gold Professor of Nutrition and Professor of Medicine at the University of Vermont. "Then, over the course of the next three weeks, consumers will use the Salty Six as their guide to help lower their sodium intake."
Heres a great way to kick-off your own challenge!
Week 1
Start by tackling your consumption of breads and rolls as well as cold cuts and cured meats. For example, one piece of bread can have as much as 230 milligrams of sodium while a serving of turkey cold cuts could contain as much as 1,050 milligrams of sodium. When your recommended daily intake is kept to 1,500 milligrams or less, its amazing how fast it all adds up. Check your labels on these items, look for lower sodium items and track your sodium consumption each day and log how much youve shaved out of your diet. Portion control does make a difference. Foods eaten several times a day add up to a lot of sodium, even though each serving is not high.
Week 2
Keep that momentum going! This weeks foods include pizza and poultry. If youre going to eat pizza, try to aim for one with less cheese and meats or lower sodium versions of these items or try something different and add veggies instead. When cooking for your family this week use fresh, skinless poultry that is not enhanced with sodium solution rather than fried or processed. Keep your eyes on the 1,500 milligrams of sodium each day and, again, log your results.
Week 3
As you round out your challenge and embark on the last week of your challenge, your focus includes soups and sandwiches. The two together typically make a tasty lunch or dinner duo, but one cup of chicken noodle or tomato soup may have up to 940 milligrams it varies by brand --and, after you add all of your meats, cheeses and condiments to your sandwich, you can easily surpass 1,500 milligrams in one day. This week, when choosing a soup, check the label and try lower sodium varieties of your favorites and make your sandwiches with lower sodium meats and cheeses and try to eliminate piling on your condiments. Be sure to track your sodium and try to keep your daily consumption to less than 1,500 milligrams.
By the end of the challenge you should start to notice a change in the way your food tastes and how you feel after you eat. You might even start to lean towards lower sodium options and will be aware of how much sodium you are consuming in a day keeping that sight on the goal of only having no more than 1,500 milligrams in a day and controlling the portion sizes of your meals. As you start jotting down your grocery list, or planning your next meal out, be sure to keep the Salty Six in mind and look for the Heart-Check mark on products in your local grocery story and menu items in restaurants. Products that are certified by the HeartCheck Food Certification Program meet nutritional
criteria for heart-healthy foods and can help keep you on track during your challenge. (www.heartcheckmark.org ) Making an effort to reduce the sodium in your diet will help you feel better and will help you live a hearthealthier life. Take time to educate yourself and lean more from others. Explore links to tasty recipes, get shopping tips, access tools and resources and share your personal Sodium Swap successes on our Facebook page: www.facebook.com/americanheart and click the Sodium Swap tab. For further sodium tips, resources and encouragement during your own Sodium Swap Challenge visit www.heart.org/sodium. -This information provided courtesy of the American Heart Association/American Stroke Association
KNOW YOUR SPECIALIST

Cardiologist
W
hat is a Cardiologist?
How are Cardiologists Trained?

Cardiologists receive extensive education, including four years of medical school and three years of training in general internal medicine. After this, a cardiologist spends three or more years in specialized training. Thats ten or more years of training. In order to become certified, doctors who have completed a minimum of ten years of clinical and educational preparation must pass a rigorous twoday exam given by the American Board of Internal Medicine. This exam tests not only their knowledge and judgment, but also their ability to provide superior care.
A cardiologist is a doctor with special training and skill in finding, treating and preventing diseases of the heart and blood vessels. Based on their outstanding credentials, achievements, and community contribution to cardiovascular medicine, physicians who are elected to fellowship can use F.A.C.C., Fellow of the American College of Cardiology, as a professional designation. The strongest evidence of achievement for those who earn the F.A.C.C insignia comes from their peers. Letters of sponsorship from other F.A.C.C.s and medical school faculty attest to professional competence and commitment to excellence, and are necessary for election to Fellowship in the College. When accepting election to Fellowship in ACC, each physician pledges, "cooperation and loyalty to the attainment of the ideals" of the College, the most important of which is to promote excellence in cardiovascular care.
When Would I See a Cardiologist?

If your general medical doctor feels that you might have a significant heart or related condition, he or she will often call on a cardiologist for help. Symptoms like shortness of breath, chest pains, or dizzy spells often require special testing. Sometimes heart murmurs or ECG changes need the evaluation of a cardiologist. Cardiologists help victims of heart disease return to
a full and useful life and also counsel patients about the risks and prevention of heart disease. Most importantly, cardiologists are involved in the treatment of heart attacks, heart failure, and serious heart rhythm disturbances. Their skills and training are required whenever decisions are made about procedures such as cardiac catheterization, balloon angioplasty, or heart surgery.
What Does a Cardiologist Do?

Whether the cardiologist sees you in the office or in the hospital, he or she will review your medical history and perform a physical examination, which may include checking your blood pressure, weight, heart, lungs, and blood vessels. Some problems may be diagnosed by your symptoms and the doctors findings when you are examined. You may need additional tests such as an ECG, x-ray, or blood test. Other problems will require more specialized testing. Your cardiologist may recommend lifestyle changes or medicine. Each patients case is unique.
Patients who are diagnosed with heart and lung disorders need surgery when their diseases do not respond to other forms of treatment. A cardiothoracic surgeon is trained to perform operations on people with lung cancer, heart disease, atherosclerosis, congenital defects, and a number of other potentially life-threatening conditions. Some procedures are minimally invasive; a surgeon can insert a camera and manipulate tiny surgical tools through a small incision in the chest cavity. Many conditions, however, require the surgeon to fully expose the heart or lungs in order to correct problems. A cardiothoracic surgeon may choose to specialize in his or her field in order to provide the best possible care. Many professionals work solely with children or the elderly. A surgeon may also concentrate on specific procedures, such as cancer excision, bypass surgery, or heart transplantation. Experts rely on nurses and other surgeons to assist them during operations to ensure patients remain stable and that the tools they need are at hand at all times. A person who wants to become a cardiothoracic surgeon is required to earn a degree from an accredited fouryear medical school. After graduation, he or she enters a residency program in general surgery at a hospital. A residency usually lasts for at least five years, during which time a new surgeon has the opportunity to work alongside experts in the field to gain practical experience and learn about detailed procedures. An additional two to three years are then spent in a cardiothoracic surgery residency at a general hospital or specialty clinic. Before a surgeon can work independently, he or she must pass an extensive series of exams administered by regional and national governing boards.
What Kinds of Tests May the Cardiologist Recommend or Perform?

Examples include:
Echocardiogram a sound wave picture to look at the structure and function of the heart. Ambulatory ECG a recording during activity to look for abnormal heart rhythms. Exercise test a study to measure your hearts performance and limitations. Cardiac Catheterization a test in which a small tube is placed in or near the heart to take pictures, look at how the heart is working, check the electrical system, or help relieve blockage. Is My Cardiologist a Surgeon?
No however, when surgery is required, your cardiologist most likely will refer you to a cardiothoracic surgeon.
What is a Cardiothoracic Surgeon?

A cardiothoracic surgeon specializes in conducting delicate surgical procedures on the heart, lungs, esophagus, and chest arteries. He or she utilizes sophisticated tools and techniques to treat patients for a variety of conditions. Many surgeons specialize by working with a certain population of patients or performing a specific type of operation. Most procedures are conducted to prevent future complications, such as unclogging an artery or removing a suspicious tumor. At times, however, a cardiothoracic surgeon may be required to perform an emergency operation to restore functioning during heart or lung failure.
Can COPD Be Hereditary?

Alpha 1-Antitrypsin Deficiency: A Hereditary Form of Chronic Obstructive Pulmonary Disease
C
hronic obstructive pulmonary disease (COPD) is a form of lung disease that limits the flow of air into and out of the lungs, resulting in shortness of breath. Smoking cigarettes is the most common cause, but chronic inhalation of irritating dusts also can cause COPD. The common forms of COPD result from damaging inflammation that narrows and scars airways, increased mucous formation (together called chronic bronchitis), and emphysema. In emphysema, there is progressive destruction of the walls of the alveoli, the small air sacs where oxygen is absorbed, from inhaled air and carbon dioxide diffuses into exhaled air. Approximately two percent of people who appear to have COPD actually have a genetic disorder called Alpha
1-antitrypsin (A1AT) deficiency. Alpha 1-antitrypsin is a protein made in the liver that is then secreted into the blood. This protein protects normal body tissues from damage by trypsin and other potentially damaging molecules released from neutrophils and macrophages in areas of inflammation, particularly in the lungs. Normal blood levels of A1AT are approximately 1 to 3 g/L of serum. Values less than 0.8 g/L are associated with a significant risk of COPD. Abnormal A1AT genes result in decreased alpha-1 antitrypsin activity in the blood and accumulation of abnormal alpha-1 antitrypsin protein in liver cells. The defective A1AT is not secreted properly, can accumulate in the liver, and can lead to liver damage and scarring (cirrhosis). Alpha-1 antitrypsin deficiency can cause liver disease,
cirrhosis, and liver failure in up to 15 percent of patients. Alpha-1 antitrypsin deficiency is a leading reason for liver transplantation in young children. There are 5 major forms of alpha-1 antitrypsin deficiency: Pi represents protease inhibitor (A1AT is a protease inhibitor). The capital letters refer to the two genes each person inherits that produce alpha-1 antitrypsin. MM stands for two normal genes. The main abnormal genes are designated S and Z. Scientific studies have found that the serum levels of A1AT in different genetic forms of A1AT deficiency depend on which genes a person inherits:
airflow obstruction, and patients with unexplained liver disease. This can be done by measuring the blood level of A1AT and determining the A1AT genotype.
PiMM: PiMS: PiSS PiMZ PiSZ PiZZ
100% (Normal) ~80% of normal serum level of A1AT ~60% of normal serum level of A1AT ~60% of normal serum level of A1AT ~40% of normal serum level of A1AT ~10-15% of normal serum level of A1AT
Avoidance of cigarette smoke and damaging inhalants. Immunization to prevent influenza or pneumococcal infections Pulmonary rehabilitation. Supplemental oxygen Replacement therapy with A1AT purified from human plasma can be used when emphysema becomes symptomatic in patients over 18 years of age, with severe lung obstruction. In very severe cases, liver or lung transplantation may be needed.
Treatment of A1AT deficiency includes:
Overall approximately 1 in every 3,000 Americans has A1AT deficiency. Unfortunately, the PiZZ form is both the most common and the most severe. People of European, and Saudi Arabian ancestry are at highest risk for the PiZZ genotype. PiZZ patients are likely to develop emphysema at a young age and 50 percent develop cirrhosis of the liver. Three percent before age 20 years and 30-50 percent before age 50 years. Emphysema may appear during patient's 30s or 40s even without a history of smoking. The mean age of onset of fixed airflow obstruction is under 50 years in PiZZ patients. Cigarette smoking is especially harmful in A1AT deficiency. Cigarette smoke causes lung inflammation and markedly inhibits the activity of whatever A1AT is present. Symptoms of A1AT deficiency include shortness of breath, and wheezing. Initially the shortness of breath may occur only with exertion, but over time the shortness of breath gradually worsens. The disease may resemble recurrent respiratory tract infections, COPD, or asthma that does not respond well to asthma treatment. Diagnosis of A1AT deficiency relies on a complete medial history and physical examination, chest X-rays and possibly high-resolution chest CT scans, pulmonary function testing, and specific laboratory tests. Testing for A1AT deficiency should be considered for all patients with COPD, asthma with irreversible
Purified human alpha 1-antitrypsin is available and can be administered intravenously once a week to try to minimize the ongoing process in the lungs. This medication is not useful for patients with liver disease caused by A1AT deficiency because the damage arises from the accumulation of abnormal protein in the liver cells. Recognition of A1AT deficiency is essential for minimizing the process in the lungs and to lead to the diagnosis of other family members who also are at risk for the lung and liver problems inherent in having the disease. -Vicki Lyons, MD and Timothy J. Sullivan, MD
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Infection During Pregnancy
Quick Guide to What You Need to Know
nfections in the prenatal period, while fortunately rare, can have adverse consequences to either the mother or the baby. A few simple preventative practices such as good hand washing, safe food handling, screening during prenatal care, and vaccination can reduce the risk of these infections. Here we will highlight some of the more commonly known prenatal infections and strategies used to reduce these infections.
Listeria
Probably one of the most recently publicized infectious diseases that can adversely affect pregnancy is Listeriosis. Fortunately, this is a very rare infection, affecting only 200 of the more than 4 million pregnancies in the US annually. Listeria is a bacteria found in contaminated food that can cause a flu-like illness with fever, muscle aches, and diarrhea. Infection usually occurs in high-risk populations such as those with a weakened immune system, older adults, newborns, or pregnant women. In pregnancy, maternal infection can result in preterm labor or miscarriage. If suspected, an infection can be treated with antibiotics. Prevention of infection is key to reducing the risk in pregnancy and includes:
Avoiding eating hot dogs or deli meats unless heated to steaming and voiding contamination of other foods with the juices of these foods Wash vegetables and fruits thoroughly prior to eating Avoid consuming non-pasteurized diary products, pate, or soft cheeses (brie, queso fresco, queso blanco)
More information on Listeria and pregnancy can be found at www.cdc.gov/listeria.
Cytomegalovirus
Cytomegalovirus, although less well known, is the most common congenital infection. CMV is passed from person to person contact of infected saliva, urine, or bodily fluids. Infection in pregnancy usually has no symptoms, but can be associated with a mild flu-like illness. In one third of maternal infections, the virus then can spread to the fetus across the placenta, and even fewer cause injury to the baby. Fortunately, CMV infection occurs in only 1-2 % of all newborns in the US. In most cases of fetal infection (90%) there are no symptoms
Influenza
Influenza is another common virus that can have adverse pregnancy effects. While influenza does not appear to have harmful effects on the fetus, influenza infection in pregnancy is more likely to result in severe maternal infection with higher risks of pneumonia, hospitalization, and even death. Prevention of the flu is primarily obtained through vaccination. Because of the risk of more serious consequences from influenza, pregnant women at any time in their pregnancy or during breastfeeding are recommended to receive the influenza vaccine. The nasal vaccine is not recommended in pregnancy, but can be using during breastfeeding. The vaccine will not only protect the mother, but also the unborn baby, and the newborn after delivery. Good hand washing as above will also provide protection against influenza infection. Other perinatal infections that can be prevented by vaccination prior to, in pregnancy, or the newborn period include Rubella (measles), Pertussis (whooping cough), and Varicella (chickenpox). Obtaining these vaccinations prior to pregnancy is an important step in preconception planning for a pregnancy. Varicella and rubella vaccines should not be given during pregnancy.
at birth, while 10% may have severe disease with liver and bone marrow failure and brain infection. CMV is somewhat notorious in that it is the leading cause of congenital deafness, which may not be apparent until 2 years of age. Currently, there is no proven treatment in pregnancy, so screening for CMV infection in pregnancy is not recommended. In certain high-risk groups, such as health care or childcare workers, or mothers with a toddler in a childcare setting, screening for maternal infection in pregnancy can be offered. The best method to reduce the risk of maternal infection and thus fetal infection is good hand washing, including washing hands for 15-30 seconds with soap and water, and dry hands with a paper towel that can be discarded. Use of disinfectant hand gels can be an alternative to soap and water if these are not available. Finally, avoid sharing food or drink with other people, especially children.
Group B strep
Group B streptococcus (GBS) is a commonly found bacteria that is present in the gastrointestinal and genital tracts of 1/3 of women. Maternal infection during pregnancy is very rare, however, the neonate can acquire infection from GBS in the first few days of life by acquiring the bacteria from the vagina during delivery. This infection can result in sepsis, meningitis, and pneumonia in the newborn. Prevention of neonatal GBS is accomplished by screening all pregnant women in the last month of pregnancy by obtaining a culture from the vagina and rectum. In women who carry GBS, antibiotics are given during labor with an 80% reduction in the risk of early on-sent GBS infection in the newborn. Simple measures such as good hand washing and hand hygiene, remaining up to date with vaccinations, screening during prenatal care, and safe food handling techniques can reduce the risk of the most common prenatal infections. -William Goodnight, MD MSCR, University of North Carolina Chapel Hill School of Medicine
Parvovirus
Similar to CMV is parvovirus. Parvovirus, also called Fifths Disease is a common virus that can cause a flu-like illness in children with a characteristic red rash on the cheeks (slapped cheeks disease). Most infections in pregnancy do not cause an infection in the fetus, but fetal infection can occur. When fetal infection occurs, severe anemia can develop in the fetus that can require treatment with intrauterine transfusion. Prevention of parvovirus is similar to CMV with good hand hygiene techniques. If there is suspected exposure, the obstetrician will determine if there is a risk fetal infection by a blood test for the mother, and if so will test with fetus with serial ultrasound examinations for 8-10 weeks to determine if there is anemia. Most fetal infections do not cause problems to the baby during the pregnancy and do not appear to cause long-term developmental problems.
Your Child's Oral Health
aintaining good oral health is crucial to overall health and the mouth should not be viewed separately from the body. Parents need to understand the importance of caring for their childs teeth and that what they do now will have a direct impact on their childs adult teeth and long term health. Dental caries, the clinical term used to refer to cavities, are a major public health concern. According to the Centers for Disease Control and Prevention, more than 19 percent of children, ages 2 to 19, have untreated cavities and this number goes up as children get older. Furthermore, underserved, low income and minority populations are at a disproportionally greater risk for this disease. With a few good habits incorporated into a childs daily routine, optimal oral health can be achieved. First, parents need to understand that cavities are caused by bacteria that are easily transmitted from
their mouths to their childs through close contact. Therefore, parents should make sure to take care of their own oral health and refrain from sharing eating utensils and activities that can transfer their saliva to their child such as kissing on the mouth. Most importantly, cavities can be prevented. To better combat cavities and tooth decay, the enamel of childrens teeth must be strengthened. The Maternal and Child Health Bureau of the Health Resources and Services Administration recommends that parents brush their child's teeth daily using a smear of fluoridated toothpaste for children under age 2 and a pea size amount for those over age 2. Ideally, parents should supervise their child's tooth brushing until the age of 8. Children should also drink fluoridated water in place of sugary drinks and juices. Tap water in the United States contains very low concentrations of fluoride and is a substance that is proven to prevent tooth decay and dental caries.
by permanent teeth. The habits children form at an early age are critical for maintaining a lifetime of good oral health. Good habits lead to reduced bacteria levels and healthy tooth development. A healthy mouth is essential for school readiness, appropriate personal growth and development and proper speech. Good oral health is necessary to an individuals total health now and in the future. For more information on oral health tips and the importance of fluoride, please visit HealthyChildren.org. -Francisco Ramos-Gomez, DDS, MS, MPH, of the UCLA School of Dentistry
Help Tiny Mouths Healthy diet limiting junk food and sugar Drink tap water containing fluoride Use fluoridated toothpaste Properly clean pacifiers and bottles when dropped Set a good example...take care of your oral health
A simple way to prevent cavities and achieve good oral health is a healthy diet. Sweets and frequent snacking in a childs diet should be limited. Children should not be allowed to have a bottle or Sippy cup, which contains liquids other than water, for extended periods of time. Babies should be weaned from a bottle or breast by age 1. In addition to the daily use of fluoridated toothpaste and through drinking tap water, parents should routinely check their child's teeth by lifting the child's lip at least once a month to do a visual check for white chalky spots or any other obvious problems. Just as every child routinely sees their medical doctor before problems occur, children should also see a dentist no later than age 1. The Academy of Pediatric Dentistry recommends that children be seen by a pediatric or general dentist at the time the first tooth comes into the mouth and no later than the childs first birthday. Parents and doctors alike must understand that baby teeth are important and need to be cared for, regardless of babys primary teeth being replaced
Lower Risk of Cardiovascular & Cancer Mortality...

Watch Red Meat Consumption
74
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body mass index, physical activity, family history of heart disease, or major cancers. Red meat, especially processed meat, contains ingredients that have been linked to increased risk of chronic diseases, such as cardiovascular disease and cancer. These include heme iron, saturated fat, sodium, nitrites, and certain carcinogens that are formed during cooking. Replacing one serving of total red meat with one serving of a healthy protein source was associated with a lower mortality risk: 7% for fish, 14% for poultry, 19% for nuts, 10% for legumes, 10% for low-fat dairy products, and 14% for whole grains. The researchers estimated that 9.3% of deaths in men and 7.6% in women could have been prevented at the end of the follow-up if all the participants had consumed less than 0.5 servings per day of red meat. This study provides clear evidence that regular consumption of red meat, especially processed meat, contributes substantially to premature death, said Hu. On the other hand, choosing more healthful sources of protein in place of red meat can confer significant health benefits by reducing chronic disease morbidity and mortality. -This information provided courtesy of Harvard School of Public Health
new study from Harvard School of Public Health (HSPH) researchers, published online in Archives of Internal Medicine in March 2012, has found that red meat consumption is associated with an increased risk of total, cardiovascular, and cancer mortality. The results also showed that substituting other healthy protein sources, such as fish, poultry, nuts, and legumes, was associated with a lower risk of mortality. Our study adds more evidence to the health risks of eating high amounts of red meat, which has been associated with type 2 diabetes, coronary heart disease, stroke, and certain cancers in other studies, said lead author An Pan, research fellow in the Department of Nutrition at HSPH. The researchers, including senior author Frank Hu, professor of nutrition and epidemiology at HSPH, and colleagues, prospectively observed 37,698 men from the Health Professionals Follow-up Study for up to 22 years and 83,644 women in the Nurses Health Study for up to 28 years who were free of cardiovascular disease (CVD) and cancer at baseline. Diets were assessed through questionnaires every four years. A combined 23,926 deaths were documented in the two studies, of which 5,910 were from CVD and 9,464 from cancer. Regular consumption of red meat, particularly processed red meat, was associated with increased mortality risk. One daily serving of unprocessed red meat (about the size of a deck of cards) was associated with a 13% increased risk of mortality, and one daily serving of processed red meat (one hot dog or two slices of bacon) was associated with a 20% increased risk. Among specific causes, the corresponding increases in risk were 18% and 21% for cardiovascular mortality, and 10% and 16% for cancer mortality. These analyses took into account chronic disease risk factors such as age,
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ome walking shoes or a yoga mat for meditation could be your best weapons against colds and flu, according to a new study by the University of Wisconsin School of Medicine and Public Health.
A study, published in the July 2012 Annals of Family Medicine, shows that people older than 50 involved in mindfulness training can reduce the incidence, duration or severity of acute respiratory infections (ARI) by 40 to 50 percent and the use of exercise can reduce symptoms by 30 to 40 percent. Both study groups were compared with a third control group that did not meditate or exercise. According to lead author Dr. Bruce Barrett, a family medicine physician and associate professor at the School of Medicine and Public Health, 149 older adults completed the study with 51 in the mediation group, 47 in the exercise group, and 51 in the control group. "They were all well, then got eight weeks of training in mindfulness meditation, exercise or neither (control group) and then were followed throughout the cold and flu season," he said. "A lot of previous information suggested that meditation and exercise might have ARI- preventing benefits, but no highquality randomized trial had been done." The participants were observed for cold and flu symptoms such as a runny nose, stuffiness, sneezing, and sore throat. Nasal wash samples were collected and analyzed three days after the symptoms began. The results showed the meditation group had 27 ARI episodes totaling 257 days of illness and the exercise group had 26 ARI episodes with 241 total days of illness. However, the control group reported 40 ARI episodes and 453 illness days. The meditation and exercise groups also missed fewer days of work due to ARI illnesses than the control group. "Nothing has previously been shown to prevent ARI," said Barrett. "Flu shots are partially effective, but only work for three strains of flu each year. The apparent 40 to 50 percent benefit of mindfulness training is a very important finding, as is the apparent 30 to 40 percent benefit of exercise training. If this pans out in future research, the impact could be substantive indeed." -This information provided courtesy of the University of Wisconsin School of Medicine and Public Health
Can Fight Cold, Flu Symptoms
Exercise, Meditation
Using the Immune System to Fight Cancer
bout a quarter of patients with deadly cancers had significant reductions of tumor size after taking a new antibody drug, according to results of a large early-stage clinical trial conducted by scientists from Yale School of Medicine, Johns Hopkins University, Harvard University, Bristol-Myers Squibb, and other major institutions. The study appears in the New England Journal of Medicine. The findings are also being presented at the annual meeting of the American Society of Clinical Oncology. Nearly 300 patients with advanced melanoma, non-small cell lung cancer, or renal cell cancer whose cancer progressed after receiving standard treatments were given the drug, which boosts the immune systems capacity to fight cancer. This is the first agent that blocks the tumors ability to fend off the cancer-fighting cells of the immune system, said senior author Mario Sznol, M.D., professor of medicine at Yale School of Medicine and co-director of the melanoma program at Yale Cancer Center. The study drug BMS-936558 (MDX-1106, anti-PD-1), manufactured by Bristol-Myers Squibb is an antibody designed to block a protein known as programmed death-1 (PD-1), which is present on the surface of immune lymphocyte cells (types of white blood cells) and inhibits their function. Administration of BMS-936558 is thought to restore the function of cancer-fighting lymphocytes. Anti-PD-1 was administered to 296 patients whose cancer had grown despite
standard treatment. Tumor shrinkage of at least 30 percent was seen in 18 percent of the lung cancer patients, 28 percent of the melanoma patients, and 27 percent of the renal-cell patients. Overall, anti-PD1 was generally well tolerated by patients, although a few patients developed severe and sometimes life-threatening side effects. Researchers reported that patients response to the drug tended to be longlasting, in some cases more than a year. Researchers were particularly intrigued by the response of patients with lung cancer, a type of cancer that many researchers thought would not be responsive to immune therapies. I believe we can extend these treatments to other types of cancer, and have great hope to improve them further by combining with other kinds of anti-cancer drugs, Sznol said. Co-author Lieping Chen, M.D., professor of immunobiology, medicine, and dermatology at Yale School of Medicine and director of the cancer immunology program at Yale Cancer Center, has made major contributions to the discoveries of these immune molecules, including the suppressive mechanisms of PD-1 and its two ligands, PD-L1 and PD-L2. We are now all convinced that our own immune system is very powerful if it is switched on in the right way. It is also particularly exciting and rewarding to see the discoveries made
in the laboratory being translated into clinical trials, Chen said. Co-author Scott Gettinger, M.D., associate professor of medicine at Yale School of Medicine, who treated the most patients with lung cancer taking part in the multi-center trial, is working with Chen and other scientists at Yale to understand why some patients respond and others didnt respond to anti-PD1 treatment. We have seen promising results in this study, with some dramatic responses in patients that appear to be long lasting in most cases, Gettinger said. Furthermore, this therapy has been well tolerated, markedly better than other available salvage therapies that are associated with low response rates. -This information provided courtesy of Yale Cancer Center
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)08501305&$5:063#"#:45&&5)'30.$"7*5*&4
Did you know that cavities are caused by germs that are passed from adult to child?
Babies are born without the bacteria that causes caries- the disease that leads to cavities. They get it from spit that is passed from their caregivers mouth to their own. Caregivers pass on these germs by sharing saliva- by sharing spoons, by testing foods before feeding it to babies, by cleaning off a pacier in their mouth instead of with water, and through other activities where saliva is shared. These germs can start the process that causes cavities even before babies have teeth, so its important to avoid sharing saliva with your baby right from the start. See below for more tips on how to keep your baby- and your babys teethhealthy and happy.
'PSZPV
Eat healthy foods to reduce the cavity-causing germs in your mouth. Brush your teeth with a toothpaste that contains uoride. Do not put anything in your babys mouth that has been in your mouth including spoons or a toothbrush, do not blow on your babys food Do not use your spit to clean your babys pacier - use water instead. If you have bleeding gums or cavities, you should visit your dentist as soon as possible.
'PSZPVSCBCZ
Before your babys rst tooth becomes visible in the mouth, you should wipe the mouth every day with a soft, moist washcloth. As soon as teeth become visible in the mouth, brush the teeth with a small soft bristle toothbrush that contains a pea-sized smear of uoride-containing toothpaste. Encourage your baby to spit out the toothpaste. You should brush your childs teeth at least twice each day - once in the morning and once at night. Remember, the most important time to brush your babys teeth is right before bedtime. Talk to your babys pediatrician or pediatric dentist about the right amount of uoride for your baby. Ask if your child should be brushing with toothpaste that contains uoride. Avoid giving your baby sticky foods and unhealthy snacks like candy, soda or juice in between meals. Instead, give your baby healthy snacks like cheese, yogurt or fruit. Only give your baby treats or juice at meal times. Establish bedtime routines that do not involve using the bottle lled with milk or juice to soothe the baby to sleep. Also avoid having the baby sleep with a bottle lled with milk or juice as the natural sugars in these liquids will get changed to acid, which will rot or decay the teeth and lead to dental infection and pain. Avoid having your baby drink from a sippy cup lled with juice between meals. Do not give your baby juice until he is 6 months old. Do not give your baby more than 4-6 ounces of juice per day. If you see white spots developing on your babys teeth, then take your baby to a pediatric dentist right away. A white spot is often the rst sign of a dental cavity. Schedule your babys rst dental visit with a pediatric dentist when she is one year old. Pediatric dentists have additional training beyond dental school working with babies and young children. Remember - rst tooth, rst birthday, rst dental visit!
Supported in part by Grant # G97MC04455 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.
Track Your Heart Health with Heart360.org
Heart360 is the American Heart Associations new online heart-health wellness center, powered by Microsofts HealthVault. Send your patients to Heart360.org to manage their heart health by setting goals and tracking their progress.
Encourage your patients to visit www.Heart360.org today.

2008, American Heart Association. 10 /08LS1294 7083
THE MONSTER ISNT UNDER THE BED. ITS IN THE fRIDgE.
People with eating disorders often distort the size of their food, so theyll eat less. They distort the size of their body, so thin looks fat. Which yields a fact that isnt distorted at allwithout treatment, many wont survive. But to read about those who have, go to myneda.org
National Eating Disorders Association

What Doctors Know - October 2012

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What Doctors Know - October 2012

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Heart disease is still the No. 1 killer of women, taking the life of 1 in 3 women each year.

On Call with Dr. Porter

Steve Porter, MD Publisher and Chairman

32 Getting Back In the Gameof Life 34 New Head Lice Treatment

35 Ignoring the Flu Can Be Deadly

68 Can COPD Be Hereditary 70 Infection During

76 Exercise, Meditation Can 77 Using the Immune

58 Uncovering Eating 72 Your Childs Oral Health

53 CDC Vital Signs: Getting

66 Know Your Specialist: Cardiologist

Meet Our Doctors

William Goodnight, III, MD

Francisco RamosGomez, DDS, MS, MPH

Patrick T. Ellinor, MD, PhD

Send story ideas to: submit@whatdoctorsknow.com

WHAT DOCTORS KNOW

Special Thanks To:

Tdap Recommended For Pregnant Women

Eating Disorders Are Serious Medical Issues

Moderate Smoking Associated With Sudden Death Risk In Women

Too Young for a Hip Replacement?

Be True to Your Heart

- You Won't Like the Break Up

HEART HEALTH AND CARE

What Is Coronary Artery Disease?

Risk Factors for Coronary Artery Disease

Major risk factors that can be changed are:

Women's Heart Disease Symptoms

Detection and Diagnosis of Coronary Artery Disease

Assessing Your Heart Disease Risk

Photo courtesy of Mount Sinai Medical Center

Heart Bypass Surgery

RESCUE YOUR HEART

Avoiding recreational drugs

Maintaining a desirable body weight

Seeking treatment for hypertension

CANCER - DID YOU KNOW?

The Time is Now

The inaugural moon shots

The platforms make the program unique

Most ambitious program MD Anderson has ever mounted

Provided courtesy of Piedmont Healthcare

Common Type of Heart Condition Often Overlooked

Dizziness Fluid in the lungs Irregular heartbeats Nausea

efining heart failure

Treatment for diastolic dysfunction

Systolic vs. Diastolic Function of the Heart

Who is at risk for diastolic dysfunction?

Getting Back in the Game...of Life

New Head Lice Treatment Now Available

Ignoring the Flu Can Be Deadly

Love Your Heart F

CANCER IS JUST A HEALTH

CANCER IS NOT JUST A HEALTH ISSUE

CANCER AND DEVELOPMENT

GLOBAL ADVOCACY MESSAGE

MILLENNIUM DEVELOPMENT GOALS

CANCER AND HEALTH POLICY

Save Your Heart, Spare Your Brain

Control your risk

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Important Flu Recommendations for High-Risk

Team Up. Pressure Down.