The Promise of medicine • Johns hopkins Medicine The ......Johns Hopkins experts seek new ways for people to lose weight Putting cataract surgery in focus Guiding your tween daughter

Insight and news from Johns Hopkins MedicineSUMMER 2011

Inside ObesityJohns Hopkins experts seek new ways

for people to lose weight

Putting cataract

surgery in focus

Guiding your tween daughter

Faster recovery from joint

replacement

The Promise of medicine is innovaTion.

The Promise of medicine is Pushing Boundaries. invenTing oPPorTuniTy. redrawing The lines of whaT is PossiBle.

The Promise of medicine is collaBoraTion.

The Promise of medicine is making diseases TreaTaBle. PrevenTaBle. forgoTTen.

The Promise of medicine is Profoundly comPassionaTe.

The Promise of medicine is seeing you Beyond your condiTion To Provide a BeTTer answer. a BeTTer TreaTmenT. a BeTTer discovery.

The Promise of medicine is serving humaniTy. insPiring courage. creaTing hoPe.

The Promise of medicine is Being fulfilled righT now, in The Place where modern medicine was Born.

discover whaT’s PossiBle. visiT hoPkinsmedicine.org/discover or call +1.443.287.6080

Johns Hopkins Medicine International5801 Smith Ave., Suite 305Baltimore, MD 21209 USA

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–Enjoy this issue of – JOHNS HOPkINS HEALTH

Greetings, Welcome to the Summer 2011 issue of Johns Hopkins Health. This

newsletter is our way of keeping you posted on what Johns Hopkins is doing to both push the boundaries of medical science and to apply these discover-ies to treating patients. It’s all part of our 120-year-old commitment to serving people everywhere, and to fulfilling the promise of medicine.

In keeping with that legacy, we’re constantly looking for new ways to further our position as a leader in medical science and patient care, so that we can do more for the people who entrust their health to us.

To that end, we’re proud to announce that in April 2012 we’ll be opening two new clinical buildings that will set a new standard for patient care every-where. These state-of-the-art facilities are designed to improve every aspect of the treatment experience, from providing access to more breakthrough procedures, to ensuring the highest possible level of nursing care and patient monitoring, to offering a supportive, comfortable environment for families. Even the exceptional quality of the food we serve will be part of our leap forward.

We understand, however, that no matter how friendly our facilities and staff, the task of navigating a major health care institution can seem intimidating, especially for someone traveling from another country. To relieve you of that burden, we’re pleased to offer special services—before, during and after your

treatment—designed to help you and your family feel as close to home as possible. With a single phone call, you’ll be paired with one of our caring, experienced international care coordinators who will help you, in your language of choice, to find the appropriate doctors and set up your appointments, as well as help with any needed hotel and ground trans-portation arrangements. For more details, visit hopkinsmedicine.org/international or call +1-443-287-6080 to discuss your needs with a member of our team.

For more than a century, Johns Hopkins has been committed to finding new ways to get patients to the best possible outcomes in the most sup-portive way. That’s the promise of medicine, and it’s our promise to you.

Sincerely,

Steven J. ThompsonCEO, Johns Hopkins Medicine International

T h e P r o m i s e o f m e d i c i n e • J o h n s h o p k i n s M e d i c i n e T h e P r o m i s e o f m e d i c i n e • J o h n s h o p k i n s M e d i c i n e

w every patient will have one of 560 accommodating private rooms.

w The latest surgical technologies will equip 33 operating rooms, including 14 set up for neurosurgery and 10 for pediatrics.

w Workstations between every two rooms and throughout the floors will enable nurses and the entire medical care team to stay close to bedsides to better monitor patients, access their records and meet all their needs.

w Amenities for patients, their families and other visitors include large, windowed lounges, an indoor play area, and a food court and other shops offering selections for different tastes and needs.

ALL OF US AT JOHNS HOPkINS are proud of the many medical discoveries that come out of our research. But our mission also pushes us to continually find bet-

ter ways to deliver these breakthroughs to the patients who need them. That’s why several years ago we started to rethink the very idea of what a hospital should be.

We did not think small. In fact, when our new buildings open in

April 2012 after five years of construction, it will be one of the largest academic medical centers ever built. Replacing half our existing hospital, the facility consists of 1.6 million square feet in two connected, 12-story towers—one for car-diovascular and critical care and the other for our children’s hospital. No wonder it’s big: It is designed not only to house an unprecedented array of care advancements, but also to enhance every aspect of the patient experience.

Visionary careWe’ve made sure that each component of our new buildings—the Sheikh Zayed Tower and

Johns Hopkins’

new hospital buildings improve

your patient experience

Expanding Our Legacy

Insight and news from Johns Hopkins Medicine

WINTER 2011

Take HeartDon’t fear your family tree. The tragedy of sudden cardiac death may be avoided

Help for hearing-impaired

children

Hard facts on treating

kidney stones

Options for women with

fibroids

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12/23/10 11:00 AM


FALL 2010

Medical MysteriesIt’s not “all in your head.” Beware of five conditions that cause hard-to-diagnose pain for women

Protect your voice for a lifetime

Heavy health concerns surround metabolic syndrome

Second opinions give second chances

FdJHFA1001_01_Cover.indd 1

9/27/10 11:02:05 AM


SUMMER 2010

Pushing Surgical BoundariesInstead of seeing obstacles, Johns Hopkins surgeons see opportunities for extending lives

Create Your Sleep Sanctuary

Woman Beats Terminal

Cancer

Beware Burn Injuries in Children

FdHSU1001_01_Cover.indd 1

6/25/10 1:22:41 PM

The Charlotte R. Bloomberg Children’s Center—will serve as exemplars of the leading-edge, patient-centered medicine that Johns Hopkins has long pioneered. The Children’s Center will include burn care as well as Level 1 pediatric trauma care. Cardiac and other operating rooms will be close to dedicated recovery rooms and intensive care units. An advanced air-circulation system will help safeguard health and reduce respiratory complications. Groundbreaking computer systems will help the medical care team sup-port patients and respond to problems. And patients themselves will have dedicated Web pages, where they can learn more about their entire clinical care team, including photos and biographies.

Being a patient is never easy, but every patient deserves the best that medicine can offer. We believe we’ve taken a major step forward in creating an environment that truly supports the visionary medical care Johns Hopkins has been delivering for more than a century. Next April, we’ll be able to fulfill even more of that promise. n

TAkE A TOur

And LEArn

MOrE AT

explorehopkinshospital.org

More than 120 years ago, Johns Hopkins made a promise to serve humanity, in the place where modern medicine was born. That promise continues to drive the experts at Johns Hopkins Medicine today. The Promise of Medicine is our pledge to our patients to provide the most innovative, collaborative and compassionate care available. By continually pushing boundaries, we are redrawing the lines of treat-ment and possibility.

Learn more about innova- tions happening right now and how we can help you. Visit hopkinsmedicine.org/promise, where you’ll find videos, articles and other links that introduce you to our expert physi-cians, connect you with patients who have been treated at Johns Hopkins, and inform you about techniques and procedures being performed at Johns Hopkins. You can also sign up to continue to receive this newsletter, Johns Hopkins Health, and other Johns Hopkins news and information by visiting hopkinsmedicine.org/international.

InSIdE FACTS

Insight and news from Johns Hopkins Medicinesummer 2011



Putting cataract

surgery in focus



replacement



SUMMER 2011

Quick consult

4| clear solution Focus in on the cause of cataracts and learn about specialized eye surgery.

5| Girl talk Find out what’s normal, and what’s not, as your daughter enters puberty.

First Person

10| A Heartbeat out of control James Cromwell conquered sudden cardiac death, thanks to fast-acting family and emergency teams.

second oPinion

11| is Your life out of Joint? Discover the secret for quicker recovery after joint replacement surgery.

Contents

6|on tHe coVer Waging War on Weight Johns Hopkins seeks long-term solutions to the complex problem of obesity.

Youtube.com/johnshopkinsmedicine

@HopkinsMednews

search Johns Hopkins Medicine

Join our online Communities

news and publications Hopkinsmedicine.org/news

Clinical trials trials.johnshopkins.edu

Health seminars Hopkinsmedicine.org/intlseminars

learn more

As usual, your mother was right. Prompt, careful cleaning of children’s skin wounds may be more important than the use of antibiotics.

A new Johns Hopkins Children’s Center study looked at two anti-biotics used to treat staph skin infections. According to the researchers, 95 percent of the children in the study recovered in a week, regardless of the antibiotic they were prescribed.“It seems that good, low-tech wound care, cleaning, draining and

keeping the infected area clean, is what truly makes the difference,” says study lead investigator Aaron Chen, M.D., an emergency physician at Johns Hopkins.

Common-Sense Wound Care Is Key to Healing

For more information, appointments or consultations, call +1-443-287-6080 or visit hopkinschildrens.org.

SHEDDIng LIgHt on

Summer Eczema Management

For most people with eczema (atopic dermatitis), summer brings a break from skin sensitivity. For others, the season of sunshine and perspiration means flare-ups. “Sunlight actually serves as a trigger to make their disease worse,” says Ron Sweren, M.D., a dermatologist and director of the photomedicine unit at Johns Hopkins. On top of that, some sunscreens aggravate the condition, he says. Look for skin-

sensitive sunblock. “Good skin care is good skin care … whether it’s winter or summer,” Sweren says.

Because people perspire more in summer, they may bathe more, and frequent washing, with or without harsh soap, can worsen eczema, adds Sewon Kang, M.D., director of the Department of Dermatology. Adequate moisturizer is essential, he says. During any sea-

son, phototherapy—the use of light to treat skin disorders—may be an option for people who

have eczema with severe itching.Johns Hopkins is one of a few U.S. institutions to offer stand-up UVA1

treatment. UVA1 rays offer the skin-soothing benefits of sunlight, yet are less likely to cause sunburn. Because the patient is standing up, the entire body can be treated at one time.

“This light source seems to control itching quite well,” Kang

says, “and can also help dissipate the rash of eczema.”

For more information, appointments or consultations, visit hopkinsmedicine.

org/dermatology.

| 2 | johns hopkins health summer 2011 +1-443-287-6080 | hopkinsmedicine.org/international

healthinsights

Watch and listen to Johns Hopkins hearing experts explain hearing loss and treatment options. View “can You Hear Me?” and “Hearing: lost and Found” at hopkinsmedicine.org/intlseminars.

Find more questions answered by Johns Hopkins Medicine experts and others at sharecare.com, a new Web site designed to simplify your search for quality infor-mation on topics of health and wellness.

Johns Hopkins Medicine recently welcomed All Children’s Hospital as a new member of the Johns Hopkins Health System.

Located in St. Petersburg, Florida, All Children’s Hospital is a leader in pediatric treatment, education, research and advocacy. It is a 259-bed free-standing pediatric hospital with outreach facilities in eight west-central Florida counties.

Drawing patients from throughout Florida, the U.S. and around the world, All Children’s provides expert care in heart transplantation, blood and marrow transplan-tation, and pediatric trauma services, and is home to one of the largest neonatal intensive care programs in the Southeastern U.S. As a regional referral center for children with some of the most challenging medical problems, All Children’s, with its highly specialized staff, services and facilities, can benefit even the most fragile pediatric patients.

Learn more about All Children’s Hospital at allkids.org.

Welcome, ALL CHILDREn’S HoSpItAL!

Could Hearing Loss Contribute to Dementia?

Sodium-RestrictedDiet Can Help

in Treating Hypertension

Sodium intake is one of the lead-ing drivers of high blood pressure (hypertension). the main source of sodium in Americans’ diets is processed foods, especially baked goods and cereals, such as bread, breakfast cereals, muffins and cakes. In fact, the average American gets one-third of his or her daily requirement by consuming those types of foods.

generally, reducing sodium in the diet is a healthy choice for most people. Ideally, you should try to keep your intake under 1,500 milligrams per day. that is quite low for the average person, but it tells you just what an important role sodium plays in cardio-vascular health.

Always check your food’s nutrition labels for sodium content and keep track throughout the day of how much you are consuming. A good rule of thumb is that individual food products should con-tain no more than 200 mg per serving, while meals should contain less than 600 mg total.

OLDeR ADULtS wItH HeARInG LOSS may be missing out on more than just what’s being said. A study by Johns Hopkins and the national Institute on Aging suggests that hearing loss could increase the risk of dementia.

Researchers are trying to determine the reason. “That’s really the billion-dollar question,” says study leader Frank R. Lin, M.D., Ph.D., a Johns Hopkins otologist who specializes in hearing loss among older adults.

Johns Hopkins is embarking on a long-term study to search for a definitive link and to learn whether treating hearing loss might delay the onset of dementia. In the meantime, Lin encour-ages people to address signs of hearing loss.

“Hearing aids are essentially no-risk therapies,” he explains, “and they clearly improve your qual-ity of life.”

For more information, appointments or consultations, call +1-443-287-6080 or visit hopkinsmedicine.org/hearing.

hopkinsmedicine.org/international | +1-443-287-6080 summer 2011 johns hopkins health | 3 |

Clear Solution

quickconsult

Get a good look at how to rid yourself of cataracts—and the need to wear glasses—from Wilmer Eye Institute experts Walter J. Stark, M.D., and Oliver Schein, M.D., M.P.H.

It depends. Premium lenses are not for people with other eye dis-eases, such as macular degeneration, severe glaucoma or diabetic retinopathy. Also, the cost of premium lenses, which may not be covered by insurance, may not fit everyone’s budget. But, according to one estimate, you could recover that cost in 15 years by pocket-ing the money you would have spent on glasses. n

When the eye lens is removed during cataract surgery it can be replaced with a premium lens—called a multifocal intraocular lens or an accommodating intraocular lens—that allows a patient to focus near and far with a reduced need for corrective glasses. Eighty to 90 percent of patients with the new premium intraocular lenses can get through the day without wearing glasses. Even patients with astigmatism can enjoy the benefits of clearer vision, thanks to another kind of intraocular lens.

Your eyes contain a lens that focuses incoming light rays. A cataract is nothing more than your natural lens losing its clarity as you get older. Symptoms include increas-ingly blurred or double vision, halos or blurriness around lights, increased sensitivity to light and glare, the need for frequent changes in eyeglass or contact lens prescriptions, and difficulty driving at night or in bright light.

Choosing to have cataract surgery is a personal decision based on your visual needs. At the Wilmer Eye Institute, we ask patients: “Does your reduced vision interfere with your activities of daily living?” The good news is, the success rate here for cataract surgery is 99 percent.

Watch and listen to Johns Hopkins ophthalmologist Michael Boland, M.D., explain glaucoma and cataracts. View “The Aging Eye” at hopkinsmedicine.org/intlseminars. For more information, appointments or consultations, call +1-443-287-6080 or visit hopkinsmedicine.org/wilmer.

Are premium lenses right for me?

How has technology improved?What are cataracts?

How do I decide whether I should have cataract surgery?


Take an active role in your adolescent’s health. Johns Hopkins can help. Visit hopkinschildrens.org.

Making puberty’s bumpy ride go smoother for your tween daughter

Holy hormones! You’ve seen the signs—wispy hair peeks out from under her freckled arms, her slim, tomboyish hips form new curves, and

breasts begin to bud. Day by day, your little girl’s body is transforming into a young woman’s—and you just don’t know how to handle it.

Relax. Johns Hopkins pediatric and adolescent gynecologist Delese LaCour, M.D., reveals the truth about tweens—their body angst, daunting social pressures, monthly cycles and menstrual pain. (A tween is a child between middle childhood and adolescence, usually between 8 and 12 years old.) Here’s your guide on what to expect, including what’s normal and what isn’t.

What to expect: Struggles with body image.What’s normal: “It’s normal for tweens to

gain weight as they develop a more adult woman’s shape,” LaCour says. “It’s concerning to them as they develop hips and especially breasts. I hear lots of concerns about breast development, especially about asymmetry or size.”

What’s not: Your daughter uses negative language to describe herself based on physical development and attractiveness.

What to expect: Social pressures.What’s normal: “It’s a time when a girl looks

for more acceptance outward, outside the family,” LaCour says. “She’s trying to navigate self-acceptance

and the idea that she may be different from others in her peer group.”

What’s not: Your daughter has frequent headaches, stom-achaches, chest pains, trouble sleeping, tiredness or lack of energy. These are symptoms of too much stress.

What to expect: Menstrual cycles.

What’s normal: LaCour says it’s normal for menstrual cycles to begin within two years of breast development.

What’s not: Your daughter’s menstrual cycles last longer than seven days, are spaced more than 90 days or fewer than 21 days apart, or are especially heavy (soaking one feminine hygiene product every one to two hours).

What to expect: Menstrual cramps.What’s normal: Mild cramping pain that can

be relieved with a heating pad or hot shower.What’s not: Your daughter’s cramps stop her

from doing her daily activities or if she is absent from school one or more days each month because of pain.

For more information, appointments or consultations, call +1-443-287-6080 or visit hopkinsmedicine.org/international. n

When It’s Time to See a Gynecologist Your daughter’s first visit to a gynecolo-gist should take place between ages 13 and 15, according to recommendations by the American College of Obstetricians and Gynecologists. But don’t worry that she’ll need a pelvic exam. Johns Hopkins pedi-atric and adolescent gynecologist Delese LaCour, M.D., says most girls don’t need one at that point.

FREE OnlInE SEmInaR

MenstruAL PrOBLeMs in ADOLesCents

Thursday, October 6, 7–8 p.m. EDTPhysical changes during puberty can be

difficult for teenage girls, particularly when it comes to menstruation. Join pediatric gynecologist Delese LaCour, M.D., as she discusses the most common menstrual

problems adolescents encounter and the best approaches for managing them. to register, visit hopkinsmedicine.org/

intlseminars.

talkGirl


Weight

The World health organization reports that in 2008, more than one in 10 of the world’s adult population was obese. Sixty-five percent of the world’s popula-

tion live in countries where more deaths are attributed to obesity or being overweight than to malnutrition. nearly 43 million children younger than 5 were overweight in 2010. in the U.S., a person who is 70 pounds or more overweight can cost as much as $30,000 in additional lifetime medical bills.

a number of Johns hopkins researchers have been playing a crucial role in the effort to unravel and tame this daunting, complex problem, and on several fronts. This multipronged approach to tack-ling obesity has been paying off in key insights, as well as in new treatments whose benefits and promise are being proved in several groundbreaking studies.

For tom Magnuson, M.d., the focus has been on finding ways to make bariatric surgery an ever more useful tool for combating obesity. Magnuson, who heads the Johns hopkins Center for Bariatric Surgery, notes that bariatric surgery has far and away been the most effective weight-loss tool for those with a very high body mass index, or BMi—a numerical scale based on height and weight in which a number over 30 signifies obesity, and over 35 severe obesity.

“Most dietary and pharmacological interventions don’t seem to result in the sort of dramatic, long-term weight loss that people who are 100 pounds or more overweight need,” Magnuson says. “Surgery is the only treatment method that results in lasting weight loss in that segment. it has potential risks, but, for most people who carry that much extra weight, the benefits are greater than the risks.”

Magnuson emphasizes that the primary goal of the surgery isn’t weight loss, but rather improve-ment of the medical disorders that usually accom-pany extreme excess weight. These form a grim list: cardiovascular disease, type 2 diabetes, kidney disease, sleep apnea, arthritis, increased risk of can-cer, and more. But these problems are dramatically improved and in many cases reversed after surgery.

“eighty percent of people on diabetes medica-tions are off them within a month or two after sur-gery,” Magnuson says. “Patients often come in here on 12 different medications, and six months after the operation they’re already off 10 or 11 of them. That’s gratifying.” he adds that it’s also an enormous relief to a health care system that is staggering under growing costs, noting that one large study showed the resulting health care savings for bariatric surgery patients exceeded the costs of the surgery within two to three years after the operation. >

Johns Hopkins exper ts explore surgical and nonsurgical

solutions to the increase in obesity

Johns Hopkins offers a variety of weight-loss and management services. To learn more, visit hopkins medicine.org/international.

Waging War on


Weighthopkinsmedicine.org/international | +1-443-287-6080 summer 2011 johns hopkins health | 7 |

Is bariatric surgery right for you? Visit hopkinsbayview.org for information about online educa-tional sessions.

This isn’t a single battle. It’s a long-term war, and we have to keep the patients engaged in fighting it.

she says. “if they’re not making those sorts of changes, then i worry that they’re waiting for sur-gery to fix all their problems, but it won’t.” That’s why Coughlin favors working with patients on lifestyle changes before surgery, instead of waiting until weight regain becomes a problem months after surgery.

Tangible Benefits of Support Groupsis it possible to lose significant amounts of weight—and keep it off—without surgery? The conventional wisdom says no, at least for the great majority of heavily overweight people. But Fred Brancati, M.d., is well on the way to helping overturn the conventional wisdom. Brancati, who heads the division of general internal Medicine at Johns hopkins, is helping to run the largest, most ambitious clinical trial of a nondrug, non-surgery weight-loss intervention in history.

The trial focuses on helping patients change their eating and exercise behaviors, with a goal of rigorously proving that doing so provides the sorts of impressive health benefits doctors have long been saying would follow. “We know we’re supposed to get improvements in heart disease, diabetes and cancer risks when people lose weight with diet and exercise,” Brancati says, “but no one has ever been able to test that claim. This study will have a huge influence on the way we think about and provide care for obesity.”

Started in 2001, the ongoing study involves 5,000 overweight patients with type 2 diabetes. (recruitment is closed for this study.) Patients were randomly assigned to get either the usual care that people with diabetes receive, or partici-pate in an intensive support program aimed at changing the way they eat and exercise. This latter group regularly meets individually with counsel-ors, and attends frequent support group meetings and larger, themed events involving hundreds of

Long-Term Success Requires Behavior Changeas effective as bariatric surgery usually is, about one in four patients who get the surgery never loses the amount of weight expected, and most patients will regain at least some weight. That vexing problem is the one tackled by psychologist Janelle Coughlin, Ph.d., who directs the obesity Behavioral Medicine Program at Johns hopkins.

The essence of the problem isn’t related to a defect in the surgery, Coughlin says. rather, it’s that while the surgical procedure prevents a patient from taking in too many calories, that restriction can be defeated if the patient doesn’t adapt his or her eating habits. “People often have the surgery without having fully engaged in lifestyle behavioral changes,” Coughlin says. “and those changes are necessary for success.”

The basic lifestyle changes that bariatric surgery patients have to embrace, Coughlin explains, are thought to be similar to those for any patient who wants to lose weight: eating fewer calories (whether from foods or beverages) and moving more. to reduce the risk of postsurgical weight regain, Coughlin meets with patients who are candidates for the surgery to try to get a sense of whether they’re likely to have particular trouble in adjusting eating and exercise habits. insurance companies may not cover the procedure unless the patient has made some effort to lose weight nonsurgically, but Coughlin tries to further zoom in on what sort of approach the patient has taken.

“i’d rather see that they’ve learned to chew their food more slowly and they’ve stopped skipping breakfast than that they’ve lost several pounds,”


fellow patients—car racing and golfing have been popular themes for those in the Johns hopkins patient group.

“We’ve been looking to create strong bonds between the patients themselves and between patients and counselors,” says Jeanne Clark, M.d., an obesity expert at Johns hopkins and co-principal investigator on the trial. “This isn’t a single battle. it’s a long-term war, and we have to keep the patients engaged in fighting it.” although the study con-tinues through 2014, the results have already been encouraging: after nearly a decade, patients in the behavior-change group have kept their weight 4 to 8 percent below the regular-diabetes-care group. “it may not sound like a lot, but that amount of weight loss can have a big effect on disease risk,” Brancati says.

Interpersonal vs. Internetit’s not necessarily losing weight that’s so hard, notes larry appel, M.d., a colleague of Brancati’s and director of Johns hopkins’ Welch Center for Prevention, epidemiology and Clinical research. rather, it’s keeping the weight off. and through a parallel study to Brancati’s, appel is identifying what sort of behavior-change techniques work best.

in this second study, appel has taken patients who have lost at least 10 pounds and randomly assigned them to one of three groups: a group that gets no special support for weight-loss main-tenance; a group that receives support over the internet; or a group that gets support from a per-sonal counselor, mostly by phone. The internet group had early but not long-lasting benefit while the group that received regular personal contacts had sustained weight loss.

“There hasn’t been a huge amount of research into weight maintenance in the period after weight loss,” appel says. “Person-to-person counseling works. however, my instincts are that the combina-tion of a person-to-person program supplemented by the Web would be even more effective.”

and not just any counseling. “a counselor who just provides information won’t help that much,” appel adds. “We’ve really needed to train our coun-selors to understand human behavior and motivate people to develop the skills required to deal with a dangerous food environment out there.”

another challenge: The costs of providing every overweight person with frequent personal counseling would be overwhelming. That’s why appel is hopeful that the availability of internet

Hope remains high that medical science will be able to provide a drug that safely makes weight loss easier. To that end, Tim Moran, Ph.D., who directs the Behavioral Neuroscience Lab at Johns Hopkins, has been studying “brain-gut communication”—that is, the way the body releases chemicals in the gut that help signal the brain that it’s time to stop eating.

Versions of these so-called satiety peptides work at different sites in the body and in different ways, providing Moran and his colleagues with a number of avenues for a potential intervention that would increase the stop-eating signals in obese patients. One big clue that leads Moran to think he may be on the right track: The release of many of these peptides increases in patients who have bariatric surgery, an increase that appears critical to these patients feeling full after eating only small amounts of food.

“If we can make those sorts of signals more potent in patients who don’t have surgery, we might see the same sort of results,” Moran says.

Not that coming up with a viable drug to strengthen the satiety signal will be easy. A big part of the problem is that the body typically uses the chemicals it produces for many tasks, and that’s probably true of satiety peptides as well. That means increasing their strength may indeed lead to less appetite, but it could also have undesirable side effects, especially in the brain.

One strategy for trying to get the satiety effect without risking much harm is to come up with molecules that are very similar to the satiety pep-tides and work well in the gut, but that are too big to make it into the brain, which filters out many chemicals. In fact, Moran notes, researchers have dis-covered drugs that operate this way and can lead to weight loss of as much as 20 percent within six months. But so far they’ve only worked as injections, not as pills, making them unlikely to catch on with doctors and patients. Moran is also looking into how different types of bariatric surgery affect peptide levels.

“We’re hoping we can identify less drastic forms of surgery that will still provide comparable feeding suppression and weight loss,” he says.

Will There Be a Weight-Loss Pill?

support, while it can’t replace counseling, can help reduce its frequency and duration and thus lower costs significantly.

in spite of the progress made by these researchers on different aspects of the problem, no one claims that the obesity fix is right around the corner. But, thanks to this research, the toolbox is getting fuller. That means more overweight patients can look forward to reducing their exposure to a host of disorders and significantly raising their quality of life. That’s an improvement that will have a profound effect for all of society. n


firstperson

To watch a video of James Cromwell telling his story, visit hopkinsmedicine.org/mystory. For more information, appointments or consultations, call +1-443-287-6080.

A Heartbeat Out of Control

delivers electrical shocks to the heart, restoring its rhythms, whenever it detects ventricular tachycardia or fibrillation. I also began taking an antiarrhythmic drug called amiodarone, but the ICD still had to send electrical shocks to restore my heart’s rhythm 46 times in four months after I left the hospital. When the device goes off, it’s like a horse’s kick to the chest; I started having panic attacks over when it might go off next.

Then, Dr. Saman Nazarian, a Johns Hopkins cardiologist, told me about a minimally invasive procedure called catheter ablation that’s used to treat arrhythmias, and I agreed to try it. Using an advanced technique, Nazarian discovered the origin of my heart’s arrhythmias before he cauterized the area to stop the irregular electri-cal activity. The procedure was a huge success, and I no longer live in fear of my ICD. My heart’s steady, rhythmic beats are a gift from Johns Hopkins’ talented doctors and medical staff who saved my life. n

After an irregular heart rhythm struck out of the blue, James Cromwell made a dramatic comeback

Understanding CAtHeter AblAtiOn

w �A cardiac electrophysiologist, using Mri images and electrical signals, identifies where the irregular rhythm is originating in the heart and destroys (ablates) a tiny bit of tissue to prevent recurrence.

w �the procedure has an 85 to 95 percent success rate for idiopathic ventricular tachycardia (without structural heart disease).

w �For patients with ischemic ventricular tachycardia (with structural heart disease), the success rate is 70 to 80 percent.

FREE OnlinE SEminAR

treAtMent OptiOns FOr VentriCUlAr

tACHyCArdiATuesday, September 20, 7–8 p.m. EDT

if you have ventricular tachycardia (Vt), you may be a candidate for Vt ablation. Join

Johns Hopkins electrophysiologist saman nazarian, M.d., as he discusses the treatment

options beyond an implantable defibrillator. to register, visit

hopkinsmedicine.org/intlseminars.

I never expected my heart’s steady beat to suddenly go crazy. But an arrhythmia, or irregular heart rhythm, can strike out of the blue, as it did one night in July 2009, just after my wife, stepdaughter and I finished dinner at home in Frederick, Maryland. As I got up from the table, I collapsed, unconscious. My fast-thinking step-daughter performed CPR while my wife dialed emergency medical services. Once they arrived, they discovered my heart quivered in a rapid chaotic rhythm called ventricular fibrillation. My heart could no longer deliver blood to my brain and muscles, a condition called “sudden death.” The medical technicians used an external defibrillator to deliver an electric shock through my chest, restoring my heartbeat’s normal

rhythm—for a while.I was rushed to the ER, where my heart

erupted into the same chaotic rhythm 10 times in 45 minutes, requiring more shocks. I was even given my last rites by a priest. After I was stabilized, I was transferred to Johns Hopkins, where they used a cooling technique to save my brain function. Then surgeons placed an implantable cardioverter defi-

brillator (ICD) in my chest. The ICD


The decision to have joint replacement surgery can seem nearly as agonizing as those painful and aching joints. But the good news for

bad hips and knees: Recovery from joint replacement surgery is probably much quicker than you think.

Johns hopkins’ rapid recovery pro-gram for hip replacement puts healing on a fast track, says orthopedic surgeon simon Mears, M.d., Ph.d. Whereas a typical hospital stay after hip replace-ment can range from three to 10 days, with this program, “you’re in the hospital for a day or two,” Mears says, “and we’ll get you up right away and moving so you can, ideally, start outpatient therapy the next week.”

Afterward, you can return to work in as early as two weeks, resume your daily

30-minute walks in four to six weeks and get back on the golf course or play other sports in two to three months, Mears says.

The secret for this success? The first step is for patients to meet with a physi-cal therapist before surgery so they know what to expect and to begin “prehabilita-tion.” Mears says building strength in the muscles surrounding the damaged joint will not only help patients regain function more quickly but also will help relieve pain and give them a good idea of some of the exercises they will perform after surgery. Procedures are usually scheduled early in the day so patients can stand up and walk the day of the surgery, with nerve blocks providing pain relief. “on the day after that,” Mears says, “patients will do more therapy, climb some stairs and hopefully leave the hospital.” n

Moving STaTiSTicSw Musculoskeletal

symptoms—such as pain, aches, weakness and limited movement—were the no. 1 reason for physician visits in 2008, according to the lat-est data from the american academy of orthopaedic Surgeons.

w The american association of Hip and Knee Surgeons esti-mates there may be a need for 500,000 hip replace-ments and 3 million knee replacements in the U.S. alone each year by 2030.

w about 90 to 95 percent of hip and knee replacement patients have good to excel-lent results, even 10 years after surgery.For more information, appointments or consultations, call +1-443-287-6080

or visit hopkinsbayview.org/jointeffort.

secondopinion

Rapid recovery program enhances life after joint replacement surgery

Your Life

out of Joint?

is


Kathy Smith Director, Market Development Steven J. Kravet, M.D.Physician Adviser

Johns Hopkins Health is published quarterly by the Marketing and Communications office of Johns Hopkins Medicine. Information is intended to educate our readers and is not a substitute for consulting with a physician.

Designed by McMurry.

To find this issue onlineor email it to a friend, visit hopkinsmedicine.org/international For comments, requests or changes of address: Email [email protected] Write Johns Hopkins Health c/o Johns Hopkins Medicine International 5801 Smith Ave., Suite 305Baltimore, MD 21209 USA Call +1-443-287-6080




WASHINGTON, D.C.

PHILADELPHIA

NEW YORK

BALTIMORE

We’re here for you

Johns Hopkins Medicine International coordinates

the highest-quality care for thousands

of patients from more than 100 countries, so

we understand and anticipate your cultural

expectations. A caring, knowledgeable

international care coordinator will be there

to assist you during all phases of your medical

visit, tailoring each step to your individual needs.

Before Your Visitn Appointment schedulingn Financial counselingn Accommodation arrangementsn Ground transportation

During Your Treatmentn Personal escort to medical appointmentsn 24/7 language interpretationn Care management nurse during inpatient stayn Equipment and/or home care arrangements (if needed)n Private duty nurse arrangements (if needed)n Follow-up appointment(s) schedulingn Concierge services for dining and entertainmentn International newspapers and Internet accessn Relaxing, hospitable executive lounge

After Your Departuren Assistance with medical recordsn Assistance with prescriptionsn Follow-up with clinical and administrative staffn Future appointment schedulingn Consolidated final bills

T h e P r o m i s e o f m e d i c i n e • J o h n s h o p k i n s M e d i c i n e T h e P r o m i s e o f m e d i c i n e • J o h n s h o p k i n s M e d i c i n e

w every patient will have one of 560 accommodating private rooms.

w The latest surgical technologies will equip 33 operating rooms, including 14 set up for neurosurgery and 10 for pediatrics.

w Workstations between every two rooms and throughout the floors will enable nurses and the entire medical care team to stay close to bedsides to better monitor patients, access their records and meet all their needs.

w Amenities for patients, their families and other visitors include large, windowed lounges, an indoor play area, and a food court and other shops offering selections for different tastes and needs.

ALL OF US AT JOHNS HOPkINS are proud of the many medical discoveries that come out of our research. But our mission also pushes us to continually find bet-

ter ways to deliver these breakthroughs to the patients who need them. That’s why several years ago we started to rethink the very idea of what a hospital should be.

We did not think small. In fact, when our new buildings open in

April 2012 after five years of construction, it will be one of the largest academic medical centers ever built. Replacing half our existing hospital, the facility consists of 1.6 million square feet in two connected, 12-story towers—one for car-diovascular and critical care and the other for our children’s hospital. No wonder it’s big: It is designed not only to house an unprecedented array of care advancements, but also to enhance every aspect of the patient experience.

Visionary careWe’ve made sure that each component of our new buildings—the Sheikh Zayed Tower and

Johns Hopkins’

new hospital buildings improve

your patient experience

Expanding Our Legacy


WINTER 2011

Take HeartDon’t fear your family tree. The tragedy of sudden cardiac death may be avoided

Help for hearing-impaired

children

Hard facts on treating

kidney stones

Options for women with

fibroids

FdJHWI1101_01_Cover.indd 1

12/23/10 11:00 AM


FALL 2010

Medical MysteriesIt’s not “all in your head.” Beware of five conditions that cause hard-to-diagnose pain for women

Protect your voice for a lifetime

Heavy health concerns surround metabolic syndrome

Second opinions give second chances

FdJHFA1001_01_Cover.indd 1

9/27/10 11:02:05 AM


SUMMER 2010

Pushing Surgical BoundariesInstead of seeing obstacles, Johns Hopkins surgeons see opportunities for extending lives

Create Your Sleep Sanctuary

Woman Beats Terminal

Cancer

Beware Burn Injuries in Children

FdHSU1001_01_Cover.indd 1

6/25/10 1:22:41 PM

The Charlotte R. Bloomberg Children’s Center—will serve as exemplars of the leading-edge, patient-centered medicine that Johns Hopkins has long pioneered. The Children’s Center will include burn care as well as Level 1 pediatric trauma care. Cardiac and other operating rooms will be close to dedicated recovery rooms and intensive care units. An advanced air-circulation system will help safeguard health and reduce respiratory complications. Groundbreaking computer systems will help the medical care team sup-port patients and respond to problems. And patients themselves will have dedicated Web pages, where they can learn more about their entire clinical care team, including photos and biographies.

Being a patient is never easy, but every patient deserves the best that medicine can offer. We believe we’ve taken a major step forward in creating an environment that truly supports the visionary medical care Johns Hopkins has been delivering for more than a century. Next April, we’ll be able to fulfill even more of that promise. n

TAkE A TOur

And LEArn

MOrE AT

explorehopkinshospital.org

More than 120 years ago, Johns Hopkins made a promise to serve humanity, in the place where modern medicine was born. That promise continues to drive the experts at Johns Hopkins Medicine today. The Promise of Medicine is our pledge to our patients to provide the most innovative, collaborative and compassionate care available. By continually pushing boundaries, we are redrawing the lines of treat-ment and possibility.

Learn more about innova- tions happening right now and how we can help you. Visit hopkinsmedicine.org/promise, where you’ll find videos, articles and other links that introduce you to our expert physi-cians, connect you with patients who have been treated at Johns Hopkins, and inform you about techniques and procedures being performed at Johns Hopkins. You can also sign up to continue to receive this newsletter, Johns Hopkins Health, and other Johns Hopkins news and information by visiting hopkinsmedicine.org/international.

InSIdE FACTS

Insight and news from Johns Hopkins MedicineSUMMER 2011



Putting cataract

surgery in focus



replacement

The Promise of medicine is innovaTion.

The Promise of medicine is Pushing Boundaries. invenTing oPPorTuniTy. redrawing The lines of whaT is PossiBle.

The Promise of medicine is collaBoraTion.

The Promise of medicine is making diseases TreaTaBle. PrevenTaBle. forgoTTen.

The Promise of medicine is Profoundly comPassionaTe.

The Promise of medicine is seeing you Beyond your condiTion To Provide a BeTTer answer. a BeTTer TreaTmenT. a BeTTer discovery.

The Promise of medicine is serving humaniTy. insPiring courage. creaTing hoPe.

The Promise of medicine is Being fulfilled righT now, in The Place where modern medicine was Born.

discover whaT’s PossiBle. visiT hoPkinsmedicine.org/discover or call +1.443.287.6080






–Enjoy this issue of – JOHNS HOPkINS HEALTH

Greetings, Welcome to the Summer 2011 issue of Johns Hopkins Health. This

newsletter is our way of keeping you posted on what Johns Hopkins is doing to both push the boundaries of medical science and to apply these discover-ies to treating patients. It’s all part of our 120-year-old commitment to serving people everywhere, and to fulfilling the promise of medicine.

In keeping with that legacy, we’re constantly looking for new ways to further our position as a leader in medical science and patient care, so that we can do more for the people who entrust their health to us.

To that end, we’re proud to announce that in April 2012 we’ll be opening two new clinical buildings that will set a new standard for patient care every-where. These state-of-the-art facilities are designed to improve every aspect of the treatment experience, from providing access to more breakthrough procedures, to ensuring the highest possible level of nursing care and patient monitoring, to offering a supportive, comfortable environment for families. Even the exceptional quality of the food we serve will be part of our leap forward.

We understand, however, that no matter how friendly our facilities and staff, the task of navigating a major health care institution can seem intimidating, especially for someone traveling from another country. To relieve you of that burden, we’re pleased to offer special services—before, during and after your

treatment—designed to help you and your family feel as close to home as possible. With a single phone call, you’ll be paired with one of our caring, experienced international care coordinators who will help you, in your language of choice, to find the appropriate doctors and set up your appointments, as well as help with any needed hotel and ground trans-portation arrangements. For more details, visit hopkinsmedicine.org/international or call +1-443-287-6080 to discuss your needs with a member of our team.

For more than a century, Johns Hopkins has been committed to finding new ways to get patients to the best possible outcomes in the most sup-portive way. That’s the promise of medicine, and it’s our promise to you.

Sincerely,

Steven J. ThompsonCEO, Johns Hopkins Medicine International

Documents

The Promise of medicine • Johns hopkins Medicine The ......Johns Hopkins experts seek new ways for people to lose weight Putting cataract surgery in focus Guiding your tween daughter