January is National

Blood Donor Month.

Every two seconds someone in the
United States needs blood. We salute
the generous blood donors who help
save lives every day thank you!
If you are interested in donating blood,
please visit us online at redcrossblood.org
or call 1-800-RED CROSS (1-800-733-2767)
to schedule an appointment or for
more information.
whatdoctorsknow.com
On Call with Dr. Porter
Steve Porter, MD
Publisher and Chairman
Oh how time fliesJanuary is here once again.
Traditionally, this is the time to make our
resolutions as we wonder where last year went
and why the same resolutions keep showing up
on our lists year after year. Of course, February
shows up (all too quickly)and we realize we
have already given up on those resolutions and
moved on to humdrum routine of years past.
Its too bad we start off with great intentions
that fizzle so quickly. Did you ever wonder
why its so hard to keep the resolutions to live
smarter and healthier which could mean
living longer with a better quality of life?
I think the first mistake is making resolutions without any foundation. For example,
so many make a resolution to live smarter and healthier. What does that mean?
How well do you know your body? How do you live smarter and healthier? Your
doctor is the one person who should help you answer those questions. But when
was the last time you had a serious talk with your doctor about your health?
Putting together a magazine like we do here at What Doctors Know has helped the staff
realize how important communication between doctor and patient is. And, as a doctor
myself, I always strive to make sure that line of communication is open and honest. Making
sure my patients understand their health conditions is a priority to my staff and I.
Dr. Lisa Masterson is an Emmy nominated talk show host on The Doctors, an
extremely popular daytime program featuring doctors proactively communicating
with the audience. Dr. Lisa and her co-hosts are among a growing group of
physicians who are encouraging patients to have better communication with their
doctor. Knowledge is power. Getting that knowledge from your doctor will help
you take control of your healthcare so you can be successful in your resolutions.
In this issue, Dr. Lisa gives some great advice on communicating with your doctor. I encourage
you to read her story and open up those lines of communication between you and your doctor.
As you start a New Year, we hope you find the great variety of topics in this issue
help you take control of your healthcare so you can have a long and happy life. We
hope you enjoy the magazine. Speaking of communicating, we enjoy hearing from
our readers. So dont be shy, if you have a question or suggestion, let us know.
Heres to a Happy New Year.
whatdoctorsknow.com
WHAT DOCTORS KNOW
And you should, too!
Taking Control
10 Too Young for a Hip Replacement?
12 A HIRO in Radiology
16 Healthy Help-A Phone Call Away
18 The Time is Now Together,
We Will End Cancer
24 Getting Back In the Gameof Life
P34
Health Hints
26 Uncovering Eating Disorder Facts
30 10 Things You Need to Know
About Birth Defects
32 Save Your Heart, Spare Your Brain
34 Important Flu Recommendations
for High-Risk Populations
38 10 Tips to Alleviate Stress
P18
whatdoctorsknow.com
Vol. 2 Issue 1
01 On Call With Dr. Porter
04 Meet Our Doctors
06 Medicine in the News
22 HealthWatchMD: Know Your
Blood Type, It May Save Your Life
41 CDC Vital Signs: More People
Walk to Better Health
46 Know Your Specialist:
Gastroenterologist
In Every Issue
Contents
08 We Need to Talk!
36 Get Off the Couch
Live Longer
48 Can COPD Be
Hereditary
On The Cover
Inquiring Minds
50 Infection During Pregnancy
52 Exercise, Meditation Can fight Cold, Flu Symptoms
54 Folic Acid
58 Lower Risk of Cardiovascular & Cancer Mortality
60 Using the Immune System to Fight Cancer
P50
whatdoctorsknow.com
Meet Our Doctors
Copyright 2012 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,
in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The
Advertising space provided in What Doctors Know is purchased and paid for by the advertisers.
Products and services are not necessarily endorsed by What Doctors Know,LLC.
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
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.
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.
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.
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.
whatdoctorsknow.com
WHAT DOCTORS KNOW
And you should, too!
Published by
What Doctors Know, LLC
Publisher and Chairman
Steve Porter, MD
Editorial Advisory Board
Vicki J. Lyons, MD, Chairman
Editorial and Design Director
Bonnie Jean Thomas
Senior Designer
Suki Xiao
Design Associate
Raulin Huang
Executive Director, 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@
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For information on subscriptions, please
visit www.whatdoctorsknow.com
Corporate Office
What Doctors Know
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whatdoctorsknow.com
Most women who have double
mastectomy don't need it
ANN ARBOR, Mich - About 70 percent of women who have both
breasts removed following a breast cancer diagnosis do so despite a
very low risk of facing cancer in the healthy breast, new research from
the University of Michigan Comprehensive Cancer Center finds.
Recent studies have shown an increase in women with breast cancer choosing
this more aggressive surgery, called contralateral prophylactic mastectomy,
which raises the question
of potential overtreatment
among these patients.
The study found that 90
percent of women who had
surgery to remove both breasts
reported being very worried
about the cancer recurring.
But, a diagnosis of breast
cancer in one breast does not
increase the likelihood of
breast cancer recurring in the
other breast for most women.
Women appear to be using
worry over cancer recurrence
to choose contralateral
prophylactic mastectomy. This
does not make sense, because
having a non-affected breast
removed will not reduce
the risk of recurrence in the
affected breast, says Sarah
Hawley, Ph.D., associate
professor of internal medicine
at the U-M Medical School.
whatdoctorsknow.com
New York, NY - A team of researchers
led by an epidemiologist at Mount Sinai
School of Medicine has found that being
one of the younger kids in class can
affect a student's academic performance.
The authors of the study believe that
these findings should be taken into
account when evaluating children for
attention-deficit/hyperactivity disorder
(ADHD). As a result of the study, the
team recommends that educators and
health care providers take children's
relative age in class into account when
evaluating academic performance and
other criteria for ADHD diagnosis.
Helga Zoega, PhD, Post-Doctoral
Fellow of Epidemiology at Mount
Sinai's Institute for Translational
Epidemiology, along with researchers
from Harvard School of Public Health
and the University of Iceland worked
on the study, titled "Age, Academic
Performance and Stimulant Prescribing
for ADHD: A Nationwide Cohort
Study." The study appears online
in Pediatrics on November 19.
These findings should be taken into account
before prescribing stimulants for ADHD.
The researchers studied more than
11,000 students over a several year
period of nationwide data from Iceland.
They looked at the likelihood of the
children ages 9 and 12 scoring low on
tests and how this related to their ages
compared to others in their class. They
also noted the relative likelihood
of younger versus older children
being prescribed stimulants
between ages 7 and 14.
"Our results showed that
children in the youngest third of
their class attained scores more
than 10 percentile points lower
than students in the oldest
third of the class for both
math and language arts," said the
studys lead author Dr. Zoega.
"Children in the youngest
third were 50 percent more
likely than those in
the oldest third
to be prescribed
stimulants for
ADHD."
The researchers found that the effect of
relative age on academic achievement
might lessen over time, but it is a
significant factor up until puberty.
Parents can use these findings to help
inform their decisions about school
readiness for children born close to
cutoff dates for school entry.
Latest Technology:
Laser Device for
Cataract Surgeries
Aurora, Colo - Eye surgeons at
University of Colorado Hospital
(UCH) are using their scalpels
less and embracing the latest
technology for removing cataracts:
bladeless cataract surgery.
The LenSx machine uses an
incredibly precise laser to make
incisions in the cornea, resulting in
better patient outcomes and fewer
complications compared to traditional
cataract removal surgeries.
A cataract is a cloudiness of the
lens inside the eye, which gradually
worsens as we age. Cataract patients
might need more light to read or see
glare or haloes around lights. Most
people with a cataract will experience
a gradual decrease in eyesight.
In addition to the precise, computer-
guided incisions, the LenSx laser
will also help break the cataract
into small pieces so it can then
be more easily removed.
Using precise measurements of the
eye obtained prior to surgery, the
surgeon will then place an artificial
lens inside the eye. This lens will
correct the patients vision, and it
can even correct their astigmatism.
The LenSx laser helps make this
entire procedure incredibly quick and
accurate. Patients are home the very
same day and oftentimes state that
their vision has never been better.
The LenSx

femtosecond laser is
the first laser in the United States
to be FDA approved to perform
laser-based, blade-free, cataract
surgeries. Femtosecond lasers emit
pulses with durations of about
one quadrillionth of a second.
whatdoctorsknow.com
We Need to
D
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.
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:
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.
Dont let an expert voice or an authoritative tone
from your doctor discourage you from inquiring
further into your current health situation.
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.
Talk!
whatdoctorsknow.com
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
whatdoctorsknow.com 0
Too Young for
a Hip Replacement?
Younger patients are becoming
candidates for hip replacements
R
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
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.
whatdoctorsknow.com
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.
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.
whatdoctorsknow.com
whatdoctorsknow.com
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
whatdoctorsknow.com
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
You may n
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but your b
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reparing for
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years.
So your bodys ready when you are.
be ready to have a baby,
You have lots to do before motherhood. But make sure to take folic acid today and every
day. Whether you get it in a pill by itself, in a multivitamin, or in foods like breakfast cereals,
breads and pastas, this essential B vitamin helps prevent some serious birth defects in babies.
1-800-232-4636 (CDC-INFO)
01/2009 CS124503 099-6230
whatdoctorsknow.com
Te
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Talks
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W
eekly telephone contact with a nurse
substantially reduced hospital re-
admissions 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 one-
third 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.
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whatdoctorsknow.com
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
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.
whatdoctorsknow.com
whatdoctorsknow.com
T
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 cross-
functional professional teams working in a goal-
oriented, 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.
whatdoctorsknow.com 0
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: Community-
based 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 evidence-
based 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
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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."
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.
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
whatdoctorsknow.com
HealthWatchMD
with Dr. Randy Martin
Provided courtesy of Piedmont Healthcare
Dr. Randy Martin:
We have told you about
many factors that can
increase your risk of
stroke, but what if I told
you something as simple
as your blood type may
increase the risk? I met
with Dr. Robert Allen, a
hematologist at Piedmont
Hospital, to learn more.
Know Your Blood Type,
It May Save Your Life
whatdoctorsknow.com

There are a few major

blood types the
most common type
is type O, explains
Robert Allen, M.D.,
a hematologist at
Piedmont Hospital. The
others include type A, B and
AB, where you inherit the gene
for type A from [one parent]
and type B [from another].
Everyone has a specific protein
on the surface of their blood
cells. For example, if you have
blood type B, you have a different
protein than type A. If you are
type AB, you have both types
of proteins. A person with type
O has neither type of protein.
Know Your Blood Type
Most people learn which
blood type they have the first
time they donate blood.
It is always important to do a
type and a cross-match in any
situation when you do a blood
transfusion, he explains.
Blood Type as a
Predictor of Stroke
According to a recent study
at Brigham and Womens
Hospital, researchers believe
blood type can be tied to an
increased risk of stroke.
In this study, they looked at
90,000 people over a 20-year
period and looked at about
3,000 instances of stroke,
says Dr. Allen. Researchers found that men and
women who had type AB blood had about a 25
percent increased chance of getting a stroke. Women
who had type B blood had a 15 percent increased
risk. There appears to be some correlation between
blood type and your risk for having a stroke.
So how exactly does your blood type
influence your risk of stroke?
These proteins, which may be present in other areas
of the body in addition to the surface of red blood
cells, are probably somehow related to damage to
the blood vessels and risk for stroke, he says.
Dr. Allen believes that ultimately physicians will identify
a patients blood type to determine his or her stroke risk.
However, were not there yet. We dont have
enough information to support this, he explains.
Maybe five or 10 years from now, when we have
more information, we can say, If you have type AB
blood, we want to control your cholesterol a little
more carefully than if you have type O blood.
Given this information, just how important
is it to know your blood type?
It cant hurt [to find out], says Dr. Allen. The
quickest and simplest way to find out your blood
type is to [donate] a pint of blood at the Red Cross.
Theyll give you a card with your blood type while
youre sitting there. This way youll know your type
and will be doing the country some good, too.
Dr. Randy Martin: As you can see, donating blood
can have many benefits, from helping someone
who is undergoing surgery or cancer treatment
to learning your own blood type as a potential
predictor of stroke. I encourage you to get involved
in a blood drive this month and throughout the
year there is no better time to start than now.
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whatdoctorsknow.com
Getting Back in
the Game...of Life
E
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 non-
athletes, 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
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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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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:
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
Uncovering Eating
Disorder Facts
W
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).
whatdoctorsknow.com
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 binge-
and-purge cycles of
bulimia can affect
the entire digestive
system and can lead
to electrolyte and
chemical imbalances
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:
Illness Prevalence Research Funds
Eating disorders: 10 million $7,000,000*
Alzheimers disease: 4.5 million $412,000,000
Schizophrenia: 2.2 million $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.
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:
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.
whatdoctorsknow.com
References
Collins, M.E. (1991). Body figure perceptions and preferences among pre-
adolescent 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.
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 diet-
related 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
But at this moment, shes fighting cancer.
Thats why St. Jude Childrens Research Hospital spends every moment changing
the way the world treats children with pioneering research and exceptional care.
And no family ever pays St. Jude for anything. Dont wait. Join St. Jude in finding
cures and saving children like Angiel. Because at this moment, she shouldnt just be
dreaming of trips to the beach and the park. She should be there.
Help them live. Visit stjude.org.

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stuff to do.
St. Jude patient Angiel:
Big Dreamer
whatdoctorsknow.com
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.
Save Your Heart,
Spare Your Brain
whatdoctorsknow.com
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.
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?
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
whatdoctorsknow.com
Important Flu
Recommendations
for
High-Risk
Populations
W
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.
whatdoctorsknow.com
"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
whatdoctorsknow.com
Get Of the
Couch...
Live Longer
U
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:
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.
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
whatdoctorsknow.com
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.
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.
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
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, post- menopausal breast,
endometrial, kidney, and cancer of the esophagus.
Cancer Screening
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.
The Presidents Cancer Panel
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
3
Make "Me" Time: Carve out
time to wind down for a
few minutes before sleep
4
No Work Allowed! Use
the bedroom for sleeping
and sex, not work
M
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:
10
Tips to
Alleviate Stress
1
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
2
Sex Alleviates Stress:
Sexual problems can
contribute to stress, but
healthy sex can alleviate stress
7
Turn Off TVs and
Smartphones! Before
bedtime and during
sleep, avoid light exposure,
even from electronic devices
8
Be Cozy: Create a cozy
bedroom environment
with a room temperature
between 65-70 Fahrenheit
5
The Secret to Sleep: The key elements
of an adequate night's sleep include
timing, duration and quality
6
Seven Hours or Bust! Only a fraction
of people can function optimally
with six or less hours of sleep
-This information provided courtesy
of Weill Cornell Medical College
9
Keep a Routine: Establish a
night time routine and get up
at the same time every day
10
Manage your Stress:
To better manage
your stresses consider
relaxation training, better time
management and problem solving
whatdoctorsknow.com
Equal Parts Comfort & Style:
Therat by Dr. Lisa Masterson
The comfort shoe trend has a strong new contender
Therat by Dr. Lisa. Co-developed by Dr. Lisa Masterson
of the Emmy Award-winning television series, The
Doctors, these shoes are designed specically 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 insuerable
aches, pains and stress. Therat 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 dicult 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 Therat 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, Therat
By Dr. Lisa oers extra comfort for the active woman with
their patented, innovative technology. The Therat 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 shock-
absorbing 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.
Therat 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 Theratshoe.com.
More styles will launch in the near future as well!
The Therat 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
www http://www.cdc.gov/vitalsigns
More People Walk
to Better Health
More than 145 million adults now include
walking as part of a physically active
lifestyle. More than 6 in 10 people walk for
transportation or for fun, relaxation, or
exercise, or for activities such as walking the
dog. The percentage of people who report
walking at least once for 10 minutes or more
in the previous week rose from 56% (2005) to
62% (2010).
Physical activity helps control weight, but it has
other benefits. Physical activity such as walking
can help improve health even without weight
loss. People who are physically active live
longer and have a lower risk for heart disease,
stroke, type 2 diabetes, depression, and some
cancers. Improving spaces and having safe
places to walk can help more people become
physically active.
Want to learn more? Visit
Walking is the most
popular aerobic physical
activity. About 6 in 10
adults reported walking
for at least 10 minutes in
the previous week.
Adults who walk for
transportation, fun, or exercise
went up 6 percent in 5 years.
48%
About half of all adults get
enough aerobic physical activity*
to improve their health.
6 in 10
6%
*Aerobic activities like brisk walking, running, swimming and
bicycling make you breathe harder and make your heart and
blood vessels healthier.
National Center for Chronic Disease Prevention and Health Promotion
Division of Nutrition, Physical Activity, and Obesity
Problem
Americans need more
physical activity
1. Less than half of all adults get the
recommended amount of physical
activity.
Adults need at least 2 and 1/2 hours (150
minutes) a week of aerobic physical activity.
This should be at a moderate level, such as a
fast-paced walk for no less than 10 minutes
at a time.
Women and older adults are not as likely
to get the recommended level of weekly
physical activity.
Inactive adults have higher risk for early
death, heart disease, stroke, type 2 diabetes,
depression, and some cancers.
Regular physical activity helps people get
and keep a healthy weight.
Walkable communities result in more
physical activity.
2. More people are walking, but just how
many depends on where they live, their
health, and their age.
The West and Northeast regions have the
highest percentage of adults who walk in the
country, but the South showed the largest
percent increase of adults who walk compared
to the other regions.
More adults with arthritis or high blood
pressure are now walking, but not those with
type 2 diabetes.
Walking increased among adults 65 or older,
but less than in other age groups.
3. People need safe, convenient places to
walk.
People are more likely to walk and move about
PRUHZKHQWKH\IHHOSURWHFWHGIURPWUDIFDQG
safe from crime and hazards.
Maintaining surfaces can keep people who
walk from falling and getting hurt. This also
helps wheelchairs and strollers and is safer
for people with poor vision.
People need to know where places to walk
in their communities exist that are safe and
convenient.
Walking routes in and near neighborhoods
encourage people to walk to stops for buses,
trains, and trolleys.
The Guide to Community Preventive Services recommends:
Creating more places for physical activity with information and outreach that
lets people know where these are.
Considering walkability in community design .
Using community-wide campaigns to provide health education and social
support for physical activity.To see the full recommendations:
http://www.thecommunityguide.org/pa/index.html
3
Within
1 mile
Within
1 mile
Within
3-4 miles
Within
3-4 miles
Within
1 mile
Within
1 mile
Within
3-4 miles
Within
3-4 miles
1%
46%
1%
40%
1%
35%
5%
60%
% of Trips to Work
by Walking
Within 1 miles - 35%
Within 3-4 miles - 1%
% of Trips to School or
Church by Walking
Within 1 mile - 46%
Within 3-4 miles - 1%
% of Trips to Shops
by Walking
Within 1 mile - 40%
Within 3-4 miles - 1%
% of Trips for Social or
Recreational Fun
by Walking
Within 1 mile - 60%
Within 3-4 miles - 5%
Percentage of adults
who walk for physical activity
to get to places they want to go
when places are nearby.
People walk
SOURCE: USDOT, Federal Highway Administration,
2009 National Household Travel Survey.
0 20 40 60 80 100 0 20 40 60 80 100
18-24 years White, non-Hispanic
Black, non-Hispanic
Hispanic
Other race
Needs help to walk
Does not need
help to walk
25-34 years
35-44 years
45-64 years
65+ years
2005
2010
2005
2010
SOURCE: CDC National Health Interview Survey, 2005, 2010.
www http://www.cdc.gov/mmwr
www http://www.cdc.gov/vitalsigns
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: 08/08/2012
What Can Be Done
US government is
Working with partners to carry out the
National Prevention Strategy to make physical
activity easier where people live, work,
and play www.healthcare.gov/prevention/
nphpphc/strategy/index.html.
Helping people get active through programs
like Community Transformation Grants and
Nutrition, Physical Activity, and Obesity
state programs www.cdc.gov/obesity/
stateprograms/cdc.html, and by working with
partners like Safe Routes to Schools
www.saferoutespartnership.org/.
Studying ways that communities can make it
easy and convenient for people to be
more active.
State and local government can
Considering walking when creating long-range
community plans.
Consider designing local streets and roadways
that are safe for people who walk and other
road users.
Consider opportunities to let community
residents use local school tracks or gyms after
FODVVHVKDYHQLVKHG
Make sure existing sidewalks and walking
paths are kept in good condition, well lit and
free of problems such as snow, rocks, trash,
and fallen tree limbs.
Promote walking paths with signs that are easy
to read, and route maps that the public can
HDVLO\QGDQGXVH
Employers can
Create and support walking programs
for employees.
Identify walking paths around or near the
work place and promote them with signs
and route maps.
Provide places at work to shower or change
clothes, when possible.
Individuals can
Start a walking group with friends
and neighbors.
Help others walk more safely by driving the
speed limit and yielding to people who walk.
Use crosswalks and crossing signals when
crossing streets and not jaywalk.
Participate in local planning efforts that
identify best sites for walking
paths andsidewalks.
Work with parents and schools to encourage
children to walk to school where safe.
CS233690-B
CS235410-B
Every 4 minutes, a baby
is born with a birth defect.
National Center on Birth Defects and Developmental Disabilities
Division of Birth Defects and Developmental Disabilities
We want to help you reduce that risk.
January is Birth Defects Prevention Month.
Learn more about prevention, detection, treatment and living with
birth defects at www.cdc.gov/birthdefects and www.nbdpn.org.
This fyer was developed in partnership with the National Birth Defects
Prevention Network (NBDPN). The NBDPN is a national network of
birth defects programs and individuals working at local, state, and
national levels in birth defects surveillance, research, and prevention.
whatdoctorsknow.com
KNOW YOUR SPECIALIST
WHAT IS A GASTROENTEROLIGIST?
Most of us know all about colon cancer and colon cancer
screenings, which are done by a gastroenterologist.
But a GI doctor has expertise in a number of other
areas. Gastroenterology is the study of the normal
function and diseases of the esophagus, stomach, small
intestine, colon and
rectum, pancreas,
gallbladder, bile
ducts and liver. It
involves a detailed
understanding of
the normal action
(physiology) of the
gastrointestinal
organs including
the movement of
material through
the stomach
and intestine
(motility), the
T
he medical community has become
a vast variety of specialties and sub-
specialties. Gone are the days of seeing
one doctor for all that ails you.
Now, your Primary Care Physician
(or Generalist) is referring patients
to specialists who concentrate their practice on
particular illnesses that involve specific tissues or
organ systems within the body. From Anesthesia to
Nephrology to Urology, these doctors have added a
number of years on to their education and training
to give their patients an added level of care. Wading
through this sea of specialties can be intimidating
and overwhelming. We would like to help take
the fear and confusion out of this necessary level of
medical care. In this latest addition to our regular
line up, we will be discussing different specialties
the doctors training, their expertise, what are some
of the symptoms you may experience, and the
types of testing or screening you may see in this
specialty. This issue we look at gastroenterology.
Gastroenterologist
whatdoctorsknow.com
digestion and absorption of nutrients into the body,
removal of waste from the system, and the function
of the liver as a digestive organ. It includes common
and important conditions such as colon polyps and
cancer, hepatitis, gastroesophageal reflux (heartburn),
peptic ulcer disease, colitis, gallbladder and biliary
tract disease, nutritional problems, Irritable Bowel
Syndrome (IBS), and pancreatitis. In essence, all
normal activity and disease of the digestive organs
are part of the study of Gastroenterology.
Training
A gastroenterologist must first complete a 4-year college
degree followed by 4 years of medical school at which
time they receive a medical degree. The next step is a
3-year residency in internal medicine. At that time a
physician is eligible to continue additional specialized
training in gastroenterology. A gastroenterology
fellowship is 2 to 3 years during which a physician learns
to evaluate and manage gastrointestinal diseases. This
training encompasses conditions that may be seen in an
office or in a hospital setting and dedicated training in
diagnostic endoscopy procedures, such as a colonoscopy.
In all, a gastroenterologist has undergone a minimum
of 13 years of formal classroom education and practical
training before becoming a certified gastroenterologist.
Expertise
A gastroenterologist must have proficiency in diagnosing
and treating a number of intestinal conditions including:
Anorectal conditions
Hemorrhoids
Colonic neoplasms
Cancer
Polyps
Diverticulosis
Esophageal reflux
Gastritis
Gastroesophageal Reflux Disease (GERD)
Hepatitis
Hiatal Hernia
Inflammatory bowel disease
Ulcerative colitis
Crohn's disease
Irritable bowel syndrome
Ulcers
Signs and Symptoms
A gastroenterologist must also be proficient in
treating and managing and symptoms including:
Abdominal pain
Abnormal x-ray findings
Constipation
Diarrhea
Difficulty swallowing
Heartburn
Indigestion
Jaundice
Liver Disease
Malabsorption
Nausea
Post-operative colon tests
Rectal bleeding
Unexplained weight loss
Vomiting
Diagnostic testing/screening
Some of the screening tests a
gastroenterologist performs include:
Colon screening exams
Esophageal and intestinal dilation
Hemostasis
Polypectomy
whatdoctorsknow.com
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,
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
Can COPD Be Hereditary?
Alpha 1-Antitrypsin Deficiency: A Hereditary Form
of Chronic Obstructive Pulmonary Disease
whatdoctorsknow.com
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:
PiMM: 100% (Normal)
PiMS: ~80% of normal serum level of A1AT
PiSS ~60% of normal serum level of A1AT
PiMZ ~60% of normal serum level of A1AT
PiSZ ~40% of normal serum level of A1AT
PiZZ ~10-15% of normal serum level of A1AT
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
airflow obstruction, and patients with unexplained
liver disease. This can be done by measuring the blood
level of A1AT and determining the A1AT genotype.
Treatment of A1AT deficiency includes:
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.
whatdoctorsknow.com 0
Quick Guide to What
You Need to Know
I
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
Infection During
Pregnancy
whatdoctorsknow.com
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.
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.
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.
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
Exercise,
Meditation
Can Fight Cold,
Flu Symptoms
S
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 high-
quality 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
whatdoctorsknow.com
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 fnd
lower sodium varieties.
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.
Breads & rolls
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
fnd lower-sodium varieties.
1
Cold Cuts &
Cured Meats
Sodium levels in poultry can vary
based on preparation methods.
You will fnd a wide range of
sodium in poultry products, so it
is important to choose wisely.
these si x popular foods can add
hi gh levels of sodi um to your di et
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 lower-
sodium varieties of your favorite
lunch meats.
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.
2 3
4 5 6
sandwiChes
Poultry
souP
Pizza
When you see the Heart-Check mark on a product, you know the food has been
certifed to meet nutritional criteria for heart-healthy foods, including sodium.
DI D YOU KNOW?
DI D YOU KNOW?
The American Heart Association recommends that you
aim to eat less than 1,500 mg of sodium per day.
1
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.
whatdoctorsknow.com
page 1
Fre que ntl y As ke d que s ti ons
U.S. Department of Health and Human Services, Office on Womens Health
http://www.womenshealth.gov
1-800-994-9662
TDD: 1-888-220-5446
Folic Acid
Q: What is folic acid?
A: Folic (FOH-lik) acid is a B vitamin. It
helps the body make healthy new cells.
Folic acid and folate mean the
same thing. Folic acid is a manmade
form of folate. Folate is found naturally
in some foods. Most women do not
get all the folic acid they need through
food alone.
Q: Who needs folic acid?
A: All people need folic acid. But folic acid
is very important for women who are
able to get pregnant. When a woman
has enough folic acid in her body before
and during pregnancy, it can prevent
major birth defects, including:
Spina bifida (SPEYE-nuh BIF-
ih-duh), which occurs when an
unborn babys spinal column does
not close to protect the spinal cord.
As a result, the nerves that control
leg movements and other functions
do not work. Children with spina
bifida often have lifelong disabilities.
They may also need many surgeries.
Anencephaly (an-en-SEF-uh-lee),
which is when most or all of the
brain does not develop. Babies with
this problem die before or shortly
after birth.
The results of some studies suggest that
folic acid might also help to prevent
other types of birth defects.
Folic acid also helps keep your blood
healthy. Not getting enough can cause
anemia (uh-NEE-mee-uh).
U.S. Department of Health and Human Services, Office on Womens Health
Experts think that folic acid might also
play a role in:
Hearr healrh
Irevenring cell changes rhar nay
lead to cancer
More research is needed to know this
for certain.
Q: How much folic acid do women
need?
A: Women able to get pregnant need 400
to 800 mcg or micrograms of folic acid
every day, even if they are not planning
to get pregnant. (This is the same as 0.4
to 0.8 mg or milligrams.) That way, if
they do become pregnant, their babies
will be less likely to have birth defects.
Talk with your doctor about how much
folic acid you need if:
You are pregnanr or are planning ro
become pregnant. Pregnant women
need 400 to 800 mcg of folic acid
in the very early stages of pregnancy
often before they know that they are
pregnant. A pregnant woman should
keep taking folic acid throughout
pregnancy. Women should discuss
their folic acid needs with their doc-
tors. Some doctors prescribe pre-
natal vitamins that contain higher
amounts of folic acid.
You are breasrfeeding. Lreasrfeeding
women need 500 mcg. Some doc-
tors suggest that breastfeeding
women keep taking their prenatal
vitamins to be sure they are get-
ting plenty of folic acid while they
are breastfeeding and should they
become pregnant again.
You had a baby virh a birrh defecr
of the brain or spine and want to get
pregnant again. Your doctor may
whatdoctorsknow.com
page 2
Fre que ntl y As ke d que s ti ons
U.S. Department of Health and Human Services, Office on Womens Health
http://www.womenshealth.gov
1-800-994-9662
TDD: 1-888-220-5446
give you a prescription for 4,000
mcg of folic acid. That is 10 times
the normal dose. Taking this high
dose of folic acid can lower the risk
of having another baby with these
birth defects.
You have a fanily nenber virh
spina bifida. Your doctor may give
you a prescription for 4,000 mcg
folic acid.
You have spina bifida and vanr ro
get pregnant.
Some people also need more folic acid.
Talk to your doctor about how much
folic acid you need if you:
Are raking nedicines used ro rrear:
Epilepsy
1ype 2 diaberes
Iheunaroid arrhriris, lupus, pso-
riasis, asthma, and inf lammatory
bowel disease
Have kidney disease and are on dial-
ysis.
Have liver disease.
Have sickle cell disease.
Have celiac disease.
Cfren consune nore rhan one alco-
holic drink a day.
Q: I dont plan on getting pregnant
right now, and I am using birth
control. Do I still need folic acid?
A: Yes! Birth defects of the brain and
spine happen in the very early stages
of pregnancy, often before a woman
knows she is pregnant. By the time she
finds out she is pregnant, it might be
too late to prevent those birth defects.
Also, half of all pregnancies in the
United States are not planned. For
these reasons, all women who are able
to get pregnant need 400 to 800 mcg
of folic acid every day.
Q: How can I be sure I get enough
folic acid each day?
A: Women can get enough folic acid by
taking a vitamin pill every day. If you
have a hard time swallowing pills, you
might try a chewable or liquid product
that has folic acid. Most U.S. multi-
vitamins have at least 400 micrograms
(mcg) of folic acid. Check the label on
the bottle to be sure. Or you can take a
pill that only contains folic acid. When
choosing a brand of vitamins, look for
USP or NSF on the label. These
seals of approval mean that the pills
have been made properly and contain
the amounts of vitamins stated on the
label. Also, make sure the pills have not
expired. If the bottle does not have an
expiration date, do not buy it. Ask your
pharmacist for help selecting a product.
Please note, if you already are taking
a daily prenatal vitamin, you probably
are getting all the folic acid you need.
Check the label to be sure.
Multi
vitamin
Folic
Acid
400mcg
whatdoctorsknow.com
page 3
Fre que ntl y As ke d que s ti ons
U.S. Department of Health and Human Services, Office on Womens Health
http://www.womenshealth.gov
1-800-994-9662
TDD: 1-888-220-5446
Vitamin Label
Check the Supplement Facts label to
be sure you are getting 400 to 800 mcg
folic acid.
Find folic acid. Choose a vitamin that says
400 mcg or 100% next to folic acid.
Q: What foods contain folic acid?
A: Folic acid is found naturally in some
foods, including leafy vegetables, cit-
rus fruits, beans (legumes), and whole
grains. Folic acid is added to foods that
are labeled enriched, such as:
Lreakfasr cereals (Sone have 100
percent of the Daily Value of folic
acid in each serving)
Lreads
Ilours
Iasras
Cornneal
Vhire rice
Food Label
Check the label on the package to see
if the food has folic acid. The label will
tell you how much folic acid is in each
serving. Sometimes, the label will say
folate instead of folic acid.
Find folate. Read across to see how
much folic acid is in your food.
whatdoctorsknow.com
page 4
Fre que ntl y As ke d que s ti ons
U.S. Department of Health and Human Services, Office on Womens Health
http://www.womenshealth.gov
1-800-994-9662
TDD: 1-888-220-5446
Q: Can I get enough folic acid
through food alone?
A: The body does not use the natural form
of folic acid (folate) as easily as the man-
made form. We cannot be sure that eat-
ing foods that contain folate would have
the same benefits as consuming folic
acid. Also, even if you eat a healthy,
well-balanced diet, you might not get
all the nutrients you need every day
from food alone. In the United States,
most women who eat foods enriched
with folic acid are still not getting all
that they need. Thats why its impor-
tant to take a vitamin with folic acid
every day.
Q: How can I remember to take
folic acid every day?
A: Take your folic acid at the same time
every day, such as when you brush your
teeth, eat breakfast, or give your chil-
dren their daily vitamins. This way, tak-
ing folic acid becomes a routine. If you
can, set up your cell phone or computer
to give you a daily reminder.
Q: Can women get too much folic
acid?
A: You can't get too much folic acid from
foods that naturally contain it. But
unless your doctor tells you otherwise,
do not consume more than 1,000 mcg
of folic acid a day. Consuming too
much folic acid can hide signs that a
person is lacking viranin L12, vhich
can cause nerve damage. Lacking
viranin L12 is rare anong vonen
of childbearing age. Plus, most prena-
ral viranins also conrain L12 ro help
women get all that they need. People at
risk of nor having enough viranin L12
are mainly people 50 years and older
and people who eat no animal products.
Q: I am no longer of childbearing
age. How much folic acid do I
need?
A: Older adults need 400 mcg of folic acid
every day for good health. But older
adults need to be sure they also are get-
ring enough viranin L12. 1oo nuch
folic acid can hide signs that a person is
lacking viranin L12. Ieople older rhan
50 are at increased risk of not having
enough viranin L12. If you are 50 or
older, ask your doctor what vitamins
and supplements you might need. N
-This information provided courtesy of
U.S. Department of Health and Human
Services, Office on Women's Health
whatdoctorsknow.com
Lower Risk of
Cardiovascular
& Cancer
Mortality...
Watch Red Meat
Consumption
whatdoctorsknow.com
Lower Risk of
Cardiovascular
& Cancer
Mortality...
Watch Red Meat
Consumption
A

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,
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
whatdoctorsknow.com
whatdoctorsknow.com 0
Using the Immune System
to Fight Cancer
A
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 long-
lasting, 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
Every time you see our pinwheel,
take a breath. And then help us
spread the word about COPD, or chronic
obstructive pulmonary disease. Because
its a leading cause of death in the US,
and it took my grandmother. COPD is
slowly robbing as many as 24 million
Americans of their ability to breatheand
an estimated half of them dont even
know they have it. Its a race against time
to spread awareness.
Find out at
and talk to your healthcare professional.
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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 all without treatment,
many wont survive. But to read about those who have, go to myneda.org
National
Eating
Disorders
Association
By the time you notice asthma symptoms, you might already be losing control.
Be in the knowmonitor airway inammation with NIOX MINO

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Rewrite your asthma storyask your healthcare provider about NIOX MINO today!
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