Spider Veins - Johns Hopkins Bayview Medical Center by pengxuebo


									     Johns Hopkins Bayview

Welcome New Physicians
Leigh Ann Price, M.D.
Leigh Ann Price, M.D., joins
the Johns Hopkins Burn Center.
Dr. Price is a plastic and
reconstructive surgeon who
specializes in acute and
reconstructive burn surgery,
and complex wounds.
   For more on complex                   Leigh Ann Price, M.D.
wounds, visit page 12.                   Plastic surgeon

     To make an appointment, call 410-550-6171.

Nancy Harthun, M.D.
Vascular surgeon Nancy Harthun,
M.D., joins Johns Hopkins Bayview.
She specializes in the treatment
of peripheral arterial disease,
carotid artery stenosis and
arterial aneurysms, with an
emphasis on endovascular and                                                 Johns Hopkins Cardiologists
minimally invasive interventions.        Nancy Harthun, M.D.
                                         Vascular surgeon                    Seeing Patients at Water’s Edge
    To schedule an appointment, call 410-550-4335.                           Johns Hopkins cardiologists are now seeing patients at
                                                                             Johns Hopkins Community Physicians at Water’s Edge
                                                                             in Harford County for:
Akil Merchant, M.D.                                                          • General cardiology
Hematologist/oncologist Akil                                                 • Women’s cardiovascular health
Merchant, M.D., joins the Medical
                                                                             • Pregnancy and heart disease
Center as the interim clinical
director for hematology.
                                                                             • Heart failure
Dr. Merchant specializes in                                                  • Arrhythmias
blood cancers, such as leukemia,                                             • Valvular heart disease
myelodysplastic syndrome,
multiple myeloma and lymphoma.           Akil Merchant, M.D.                    To schedule an
                                                                                appointment, call
     To make an appointment, call 410-550-1711.                                 (press option 5).

2    Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
                                                                                                                         2 Noteworthy News
                                                                                                                         4 Cover article:
                                                                                                                               Breaking a Hip Shouldn’t
                                                                                                                               Break Your Spirit
                                                                                                                         6     Less is More for Patients
                                                                                                                               Who Need Spine Surgery
                                                                                                                         8     Sleeve Gastrectomy

                                             Spider Veins                                                                      Bariatric surgery procedure
                                                                                                                               provides patients with excellent
                                                                                                                               weight loss results

                                          No Longer Have Legs                                                           10     Chilled to the Core
                                                                                                                               How Hypothermia Helps
                                                                                                                               After a Heart Attack

                                                                                                                        12     Surgical Wound Treatment:
                                                                                                                               Beyond the Physical

                    eople who suffer from                  they can be back to work that day—and
                    spider veins often                     best of all, they can see results immediately.                      Patient discovers that “healing” a chronic
                    dread wearing shorts                      “This is a wonderful new technique                               wound also meant “healing” his life
                    and skirts. But no more,               that allows patients to see a marked
                    thanks to a new mini-                  improvement previously not possible                          14     Osteoporosis and Men
                    mally invasive procedure.              with traditional methods,” says Dr. Heller.
   This new procedure, which uses radio-                                                                                       Eating for Strong
frequency waves, is less painful than tradi-                                                                                   Healthy Bones
tional ways to treat spider veins, such as                           Varicose Vein
sclerotherapy and laser treatments, and                               Screenings                                        15     Screenings and Seminars
can be performed at
any time during the                                          For patients with varicose veins who                       16     Closeness Counts
year (with other                                             are considering treatment or surgery                              Caregiver Support Impacts
treatments, patients                                                          May 19                                           Alzheimer’s Patients
need to avoid sun                                                           5 to 8 p.m.
exposure). It also                                             Johns Hopkins Community Physicians                              On the cover: Hip fracture patient
does not cause                                                   at Water’s Edge, Harford County                               Mary Saumure (story on page 4).
hyperpigmentation—                                                       September 22
when patches of                                                            5 to 7 p.m.
affected skin turn                                             Johns Hopkins Community Physicians
                           Jennifer Heller, M.D.
darker. And in most        Director of the Johns Hopkins                 at Glen Burnie
cases, patients have no Vein Center                             To register, call 410-550-VEIN.
                                                                                                                                Comments, requests,
recuperation time—                                                                                                               change of address?
                                                                                                                                    E-mail us at
                  To find out if this procedure is right for you or for more information,
                           call the Johns Hopkins Vein Center at 410-550-VEIN.

                                                                                                    Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010 3
    Johns Hopkins Bayview
Orthopedic Surgery

                                                              Breaking a Hip
                                   alking her 15-pound
                                                              Shouldn’t Break
    medical emergency.
                                   Norwich terrier,
                                   Corky, is something
                                   Mary Saumure
                                   did every day. But
                                   one cold night in
    January, this routine activity turned into a

       As they were heading home from the park,
    she and Corky paused for a moment. Saumure
                                                              Your Spirit
                                                                approach among orthopedic surgeons,
    began to walk in one direction, while Corky                 gerontologists and anesthesiologists.
    pulled in another. It was just enough to catch                 “Several factors contribute to the increased
    Saumure off balance, causing her to fall and                risk of hip fracture in the elderly,” explains
    fracture her hip. Fortunately, a neighbor                   geriatrician Perry Colvin, M.D. “Many have
    drove by and caught Saumure in her head-                    osteoporosis, which makes their bones brittle.
    lights. She pulled over and called 911. An                  Many also are sedentary, which leads to weaker
    ambulance soon arrived to take Saumure                      muscles. Some are on medications that make
    to Johns Hopkins Bayview.                                   them dizzy. Others have medical problems that
       Fractures of the hip are the most common                 impair balance. All of this comes together
    broken bone                                                            like a perfect storm for making falls
    that requires                                                          and injury more likely. Treating
    hospitalization,                                                       patients with this variety of medical
    with an esti-            Tariq Nayfeh, M.D.
                                                                           issues requires a collaborative,
    mated 340,000               Orthopedic surgeon                         comprehensive approach.”
    occurring each                                                            To make care for patients most effi-
    year. Most hip                                                         cient, all hip fracture cases that arrive
    fractures occur                                                        in the Johns Hopkins Bayview ED are
    in adults ages                                                         seen first by an orthopedic surgeon,
                                                                                                                       Mary Saumure
    65 and older, especially women, as a result of a            then followed by both a geriatrician and an            and Corky.
    simple fall from standing height. These injuries            orthopedic surgeon. These specialists, along with
    often lead to devastating consequences, such as             anesthesiologists, take care of patients to address
    persistent pain, limited physical mobility and              their individual medical and surgical needs.
    even death.                                                    “We are very experienced in managing
       Since 1998, doctors in the hip fracture service          this type of fracture and can do surgeries
    at Johns Hopkins Bayview have been taking a                 in less time with better results,” says
    unique look at the way these patients are treated,          orthopedic surgeon Tariq Nayfeh, M.D.,
    with a special eye toward the needs of the elderly          Ph.D. “Our dedicated team approach
    population. Their goal is to maintain the quality           and hip fracture clinic allow us to
    of life after hip fracture and quickly get patients         provide long-term follow up and
    back to a more normal level of functioning.                 track which interventions lead to
    They achieve this goal through a collaborative              the best improvement in the patient’s

                                                    For more information about orthopedic surgery,
                                                                  call 410-550-0453.

4   Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
                                                                                                                Lighter Sedation During
                                                        with smaller incisions and using a rod                  Surgery May Reduce
   To prevent the falls that
   may lead to hip fracture:
                                                        and screws to repair the hip,” adds                     Risk of Confusion,
                                                        Simon Mears, M.D., Ph.D., interim
   • Get adequate calcium and vitamin D                 chair of the department of orthopedic
                                                                                                                Agitation Afterward
     from diet, supplements and sunlight to             surgery. “After patients are discharged,                A common complication following surgery in
     prevent osteoporosis. To read more about           our Metabolic Bone Center can assist                    elderly patients is postoperative delirium.This
     osteoporosis and diet, see page 14.                in their recovery, creating a truly                     state of confusion, disorientation and agitation
   • Receive regular screenings for osteoporosis        comprehensive patient experience.”                      can lead to poor functional recovery, increased
     based on the recommendations of your                  To prevent fractures from happen-                    length of hospital stay, higher health care costs
     doctor. To schedule an appointment for a           ing in the first place, doctors and                     and a greater likelihood of placement in an
     DXA scan at Johns Hopkins Bayview’s Meta-
                                                        biomechanical experts at Johns                          assisted living facility after an operation.
     bolic Bone Center, call 410-550-BONE (2663).
                                                        Hopkins Bayview are investigating                           Surgeons and anesthesiologists for years
   • Evaluate your household and take easy fall-        ways to strengthen the bone with
     proofing precautions, such as securing loose                                                               have struggled with the question of whether
                                                        injections. Current studies aim to                      the postoperative delirium they see in their
     rugs, avoiding runners on the stairs, installing
     railings on both sides of steps, and installing    discover which substances and sites                     elderly patients is caused by the anesthesia
     handholds in the shower or bathtub.                may work best.                                          they are using during surgery. A new study
                                                           All of this adds up to what Mary
   • Use a nightlight to help you see when you                                                                  by Johns Hopkins researchers suggests that it
     get out of bed to use the bathroom.                Saumure calls “excellent care.” “I
                                                                                                                does have an effect and, by limiting the depth
                                                        couldn’t have asked for better,” she
   • Use a cane or walker if you are taking                                                                     of sedation during procedures, the risk of post-
     medications that make you dizzy.                   says. “Dr. Mears was very attentive
                                                                                                                operative delirium could be cut in half.
                                                        and instilled confidence. You look at
   • Avoid going outdoors in bad weather when                                                                       In a double-blind randomized study of 114
                                                        him and you know you’ve got the best.
     sidewalks and roads are icy or snow-covered.                                                               patients undergoing hip fracture repair at Johns
                                                        The nurses were at my beck and call,
                                                        the physical therapists gave me exercis-                Hopkins Bayview, patients first received spinal
                                                        es and instructions for what I should                   block anesthesia and were then either lightly
                                                        be doing at home, and I got very                        sedated with the drug propofol or more deeply
                                                        thorough discharge instructions that                    sedated with the same medication.The incidence
 quality of life.                                                        were a great resource                  of postoperative delirium was significantly lower
By doing so, we                                                          to help me plan my                     in the group that was lightly sedated.
 hope to not only             Simon Mears, M.D.                          follow-up care. They                       “Reducing the depth of sedation is a simple
  improve our                     Interim director of                    even coordinated an                    and cost-effective way to attack this problem,
  current patients’                    department of                     outstanding physical                   which is seen more often as the population con-
  outcomes, but to                 orthopedic surgery                    therapist to visit me at               tinues to age,” says Frederick E. Sieber, M.D.,
 look at ways to                                                         home. My recovery is                   director of anesthesiology at the Medical Center.
improve the care of                                                      going well, and my                     “Elderly patients, when they come to surgery,
 future patients and potentially look for               physical therapist tells me I’m ahead                   often are not afraid of dying.They want to know
    ways to prevent future hip fractures.”              of the curve.”                                          if they’ll return to the same functional level—
        Outcomes show that this approach                                                                        mental as well as physical—as before surgery.
    reduces the time it takes to get patients                                      —Kim Fabian
                                                                                                                That’s what
       into surgery, their length of stay and                                                                   their real
             their complications. “As a result                                                                  worries are,
              of working together, we also                                                                      and this is       Frederick Sieber, M.D.
             have developed ways to decrease                                                                    one step           Director of anesthesiology
                    delirium after surgery and
                        refine our surgical
                            techniques, such
                                                                                                                those fears.”
                              as doing repairs

                                                                                                    Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010   5
    Johns Hopkins Bayview
           Neurosurgery                                                                                                                    inimally invasive has been

                                                                                                                      M                    a buzzword in the medical
                                                                                                                                           community for years. But
                                                                                                                                           what does the term really
                                                                                                                                           mean, especially if you are
                                                                                                                                           looking into options for
                                                                                                                      surgery in an area as complex as the spine?
                                                                                                                         “Minimally invasive surgery isn’t just about
                                                                                                                      the size of the incision. That’s only the tip of
                                                                                                                      the iceberg,” explains Johns Hopkins neurosur-

                                                                                                                      geon Daniel Sciubba, M.D. “What we really
                                                                                                                      want to focus on is doing minimal damage to
                                                                                                                      the normal tissue surrounding the root of the
                                                                                                                      problem—whether it’s a tumor, arthritis, a
                                                                                                                      fracture or nerve compression.”
                                                                                                                         In classic procedures, surgeons cut a large

                                                                                                                      incision and open up a person’s tissues to get to
                                                                                                                      the affected area. This approach, while effective
                                                                                                                      at treating the problem, can cause scar formation,
                                                                                                                      expose the next area of the spine to further
                                                                                                                      damage and lead to wound-healing issues.
                                                                                                                         “In this day and age, we have the technology
                                                                                                                      to navigate the spine with precision. This allows
                                      for patients who                                                                us to do less collateral damage and improve the
                                                                                                                      outcomes of surgery,” Dr. Sciubba says. “If I

                                    need spine surgery                                                                can do something smaller and less invasive, I
                                                                                                                      want to offer it to my patients.”
                                                                                                                      A Variety of Options
                                                                                                                     This new technology has led to a greater variety
                                                                                                                     of minimally invasive options for the treatment
                                                                                                                     of spine problems. For example, Dr. Sciubba uses
                                                                                                                     tubular retractors to perform microdiscectomies
                                                                                                                     through one-inch incisions. He can fix fractures
                                                                                                                     by inserting screws with incisions of only one
                                                                                                                     centimeter. He also treats spinal compression with
                                                                                                                     a “transpsoas approach,” which means he can
                                                                                                                                               enter the body from the
                                                                                                                                               side to get to the affected
                                                                                                                                               area more efficiently. As a
                                                                                                                                               result of these and other
                                                                                              Daniel Sciubba, M.D.                             advances, patients like
                                                                                                        Neurosurgeon                           William Bechtold and
                                                                                                                                               Gerry Paradiso are
                                                                                                                                               reaping the benefits.
                                                                                                                                                  Bechtold, a 72-year-old
                                                                                                                                               retired physicist and engi-
                                                                                                                     neer, came to Dr. Sciubba with lumbar stenosis, a
                                                                                                                     degenerative condition in the lower spine that
                                                                                                                     causes nerve compression and, in turn, leg pain.
                                                                            Image of a patient's                     An avid golfer, Bechtold had to give up his
                                                                            spine after minimally                    favorite hobby when the pain became too severe.
                                                                            invasive surgery.                           “It was getting to the point where I was in con-
                                                                                                                     stant pain,” he recalls. “I even tried epidural shots,
                                                                                                                     but they didn’t work. It was like trying to paint a
                                                                                                                     used car—it wasn’t fixing the real problem.”
6   Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
   After his consult with Dr. Sciubba, Bechtold              groundbreaking, minimally invasive
was relieved that he could avoid a spinal fusion             approach. Using only two, two-inch
and instead be treated with a minimally invasive             incisions, he inserted tubular retractors
procedure called interspinous distraction. Using             to remove the tumor and decompress the
the latest instruments for surgery in the lumbar             spine. Then he performed a percutaneous
spine, Dr. Sciubba was able to decompress, as well           spinal fusion, using X-ray guidance to
as stabilize, Bechtold’s spine—a combination of              put screws through the skin in two,
outcomes that usually can                                                 one-centimeter incisions.
only be achieved with a much          Advantages                             This procedure resulted
larger conventional spinal            of Minimally                        in one-tenth of the blood loss
fusion operation. The inter-                                              of the traditional method.
spinous distraction takes only
                                      Invasive Surgery                    In addition, Paradiso was
about an hour and requires                                                moving his legs the next day                   Patient Nancy Baron
                                      • Smaller incisions
very small incisions. Most                                                and walking a few weeks later.                 with Dr. Olivi.
                                      • Lower infection rates
patients feel immediate relief                                            “Most important, he was able
                                      • Fewer wound complications
of their leg pain and stay in                                             to receive radiation treatment          Neurosurgery Advances Patient Care
the hospital only one or two          • Faster recovery time              for his cancer only a couple
days, as compared to five or                                              weeks after surgery, which

                                                                                                                      n our last issue, we reported on the new iCT
six days following the traditional fusion operation.         is unheard of with the open approach.                    scanner available to surgical patients at Johns
   Now, a month after his surgery, Bechtold is               Typically, patients must wait several                    Hopkins Bayview.The iCT is especially useful to
healing well and taking regular walks. He hopes              weeks longer before they are strong                  those who are having procedures of the brain and spine.
                                                                                                                  This past December, Nancy Baron was the first patient
to play golf again when he has fully recovered.              enough to receive radiation treatment,”
                                                                                                                  to benefit from the cutting-edge technology. She pre-
                                                             Dr. Sciubba says.                                    sented a complex case—a tumor at the base of her
Expertise for Complex Cases                                      “I think he saved my life and believe            skull, near her brain and an artery.
With training in neurosurgery, oncology and                  he was brought to heal me,” adds                         “When my neurologist said it was a tumor, I was
orthopedic surgery, Dr. Sciubba also offers                  Paradiso. “The surgery was life-altering.            devastated,” she confides. “Where the tumor was
expertise in the treatment of more complex cases.            I wasn’t supposed to get any movement                located, I wasn’t sure I was going to come out of
Gerry Paradiso, age 47, sought this expertise after          back in my legs. While I am still being              the surgery.”
collapsing in his home from intense back pain.               treated for my cancer, I am now able                     Baron’s doctor said he was going to find her the
                                                             to walk with a walker and control my                 best neurosurgeon for this type of work. He recom-
                                                                                                                  mended Alessandro Olivi, M.D., at Johns Hopkins
                                                             bodily functions. That really increases
                Back and                                     the quality of life. Let me tell you, he’s
                                                                                                                  Bayview. Looking for every possible advantage, Baron
                                                                                                                  was glad to hear that the hospital had just invested in
                Neck Pain                                    got magic hands.”                                    the iCT, which allowed her surgery to be performed
       For people who have been diagnosed with                                                                    in the most precise, accurate and safest fashion. “I
          degenerative disc conditions and are                                                                    knew God was blessing me when Dr. Olivi mentioned
       tired of suffering from back and neck pain               You may NOT be a                                  the new technology. I didn’t care if I was the first
                       May 20                                   good candidate for                                patient or the 999th patient to use it. I just wanted
                                                                                                                  anything that would increase my chances.”
                        6 p.m.                                  minimally invasive                                    During the surgery, doctors were able to remove
              Medicine Education Center
                                                                surgery if you:                                   all of her tumor. And only an hour after the proce-
      To register, call 410-550-KNOW.                           • have excessive scarring from
                                                                                                                  dure, Baron had 90 percent of her reflexes back. Now,
                                                                                                                  several months later, she continues to recover nicely.
                                                                  a previous surgery
                                                                                                                      “I was given the best possible scenario for
                                                                • have severe osteoporosis,                       a successful surgery,” she says. “This was a worst-
He was diagnosed with a tumor on his spine                        making the bones difficult                      case situation, and look how well it turned out. It’s
caused by the spread of prostate cancer.                          to see on an X-ray                              just amazing.”
    Traditionally, these are surgeries that require                                                                   To see a video about Baron’s experience and learn
at least a foot-long incision. In many cases,                                                                     more about the iCT, visit hopkinsbayview.org/neuro-
patients may not get their strength back. To                                            —Kim Fabian                surgery/iCT/benefits.html.
achieve better outcomes, Dr. Sciubba took a

                                        For more information about minimally invasive spine surgery,
                                                            call 410-550-0939.

                                                                                                           Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010   7
     Johns Hopkins Bayview
    Bariatric Surgery
                                                                            Modispaw looks
                                                                            forward to walking
                                                                            her daughter to
                                                                            school every day.

            Benefits of
        Laparoscopic Sleeve
     • Reduces the amount of food that can
       be consumed
     • Limits the risk of vitamin deficiency
       and malabsorption
     • Unlike the lap band, no adjustments
       are required
     • No medical devices or foreign objects
       are inserted

             Weight Loss
           Surgery Seminar
     For individuals 100 pounds or more overweight
        who are considering weight loss surgery
                           May 19
                       June 9 and 15
                        4:30 - 6 p.m.
                  Johns Hopkins Bayview
                           June 2
                           5 p.m.
                  Annapolis Area Library
                   To register, go to

8   Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
                       Sleeve Gastrectomy
    Bariatric surgery procedure provides patients with excellent weight loss results
                        t 140 pounds overweight,                  A Less Invasive Approach                                 The Proof is in the

                        Heather Modispaw was                      The sleeve gastrectomy is a minimally invasive           Positive Results
                        limited in the activities she             procedure where surgeons remove 85 percent of            Since her surgery in June 2009, Modispaw has
                        could do. Simple things like              the stomach, creating a smaller, “sleeve-shaped”         lost more than 50 pounds and has seen significant
                        walking her daughter to                   pouch. The surgeon makes several small incisions         improvements in her health. Prior to the sleeve
                        school or climbing the stairs             into the abdomen, and then inserts a laparoscope         gastrectomy, she had insulin dependent diabetes,
                        at a football game left her               into one of the openings. This long tube with a          high blood pressure, polycystic ovary syndrome
out of breath and taking breaks every few minutes.                camera and light attached allows the surgeon to          (PCOS) and arthritis in her back. Now, she is no
She tried dieting. She tried exercising. Nothing                  view the stomach on a video monitor. Then,               longer a diabetic, her blood pressure has decreased
worked. That’s when she decided to consult with                   specialized surgical instruments are placed into         considerably and the PCOS has shown great
physicians at the Johns Hopkins Center for                        the other incisions to dissect and remove part           improvement. While the arthritis in her back
Bariatric Surgery.                                                                            of the stomach.              will never go away, Modispaw says that her pain
    Modispaw first met with                                                                      The new, smaller          is a lot more bearable since she lost weight.
Michael Schweitzer, M.D.,                                                                     stomach limits the               Even though she is only able to eat about a
in 2006 to have laparoscopic           Michael Schweitzer, M.D.                               amount of food that          half of a cup of food at any given time, Modispaw
adjustable gastric banding,                       Bariatric surgeon                           can be ingested at one       admits that she chooses to eat healthier foods.
also known as the “lap band.”                                                                 time, so patients feel       She’s also joined a gym, which has not only
After losing 80 pounds, scar                                                                  full faster. The fundus—     helped her lose weight, but gets her in shape so
tissue caused complications                                                                   the upper part of the        she can enjoy the simpler things in life.
and the band had to be                                            stomach that produces the hunger hormone—                    “When you’re 320 pounds, you don’t have
removed. In early 2009, she met with Dr.                          also is removed during the procedure, significantly      the motivation to do anything. You don’t even
Schweitzer again to discuss other options for                     decreasing the patients’ appetite.                       want to get
weight loss surgery. Modispaw knew a lot                              According to Dr. Schweitzer, sleeve gastrectomy      off the               In addition to the
of people who had great outcomes with gastric                     is just beginning to emerge as a primary weight          couch,”               sleeve gastrectomy,
bypass surgery and sleeve gastrectomy. After                      loss procedure of choice. Of the 320 bariatric           Modispaw              the Johns Hopkins
reviewing the two procedures, she felt the sleeve                 surgeries performed at Johns Hopkins Bayview             says. “Now, I         Center for Bariatric
gastrectomy was best for her.                                     each year, more than 20 were sleeve gastrectomies        look forward          Surgery offers the
    “One of the benefits of the sleeve gastrectomy                in 2009. Dr. Schweitzer cautions, “Not all insur-        to walking            following surgical
is that the gastrointestinal tract is left in place,                                                                                             options for weight loss:
                                                                  ance companies cover this procedure, so we               my daughter
so food continues on it natural course,” says                     encourage our patients to check with their provider      to school            • Laparoscopic and Open
Dr. Schweitzer. “There is no malabsorption (the                                                                                                   Roux-en-Y Gastric Bypass
                                                                  prior to scheduling a consultation with us.”             every day. I
body’s inability to absorb nutrients), so patients                    A sleeve gastrectomy can help patients lose          feel like I’m        • Laparoscopic Adjustable
don’t experience the degree of vitamin deficiency                                                                                                 Gastric Banding System
                                                                  anywhere from 40 to 60 percent of their excess           starting a
like they do with gastric bypass.”                                body weight. Dr. Schweitzer says, “Any weight            whole new            • Laparoscopic Duodenal Switch
                                                                                                                                                  with Biliopancreatic Diversion
    Adds Modispaw, “After gastric bypass surgery,                 loss procedure should be viewed as an aid for            chapter in
you have to take vitamins and other supplements                                                                                                 • Revision of previous bariatric
                                                                  weight loss and not as a quick fix. No matter            my life!”              surgery
for the rest of your life. That was something that                what type of surgery you choose, it won’t force
I didn’t want to worry about.”                                    you to eat healthy and be more active. You have
                                                                                                                                                               —Meghan Rossbach
                                                                  to be committed to a total lifestyle change.”

                         For more information about the Johns Hopkins Center for Bariatric Surgery,
                         call 410-550-0409 or visit hopkinsbayview.org/bariatrics. Information seminars
                        are now available in Anne Arundel and Howard Counties, and Washington, D.C.

                                                                                                             Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010   9
     Johns Hopkins Bayview

                                                            Chilled to
                                                            the Core
                                       How Hypothermia Helps After a Heart Attack
                          etting the human heart                 doesn’t just survive, but their quality of life           Signs of a

     G                    restarted is not an impossible
                          task. Cardiopulmonary resusci-
                          tation, or CPR––a simple,
                          but critical manual procedure
                          developed at Johns Hopkins
     in 1960–can kick-start a heart back into rhythm,
     and the creation of portable, easy-to-use heart
     defibrillators (another device refined at Johns
     Hopkins) give an even better chance for survival.
                                                                 also is maintained,” says Dr. Geocadin.

                                                                 How does therapeutic
                                                                 hypothermia work?
                                                                 Once the patient is resuscitated and has a
                                                                 stable blood pressure, they are sedated and
                                                                 then cooled to a target temperature of 32-34°C
                                                                 as soon as possible (ideally within four hours).
                                                                 This cooling process is accomplished through cold
                                                                                                                           Heart Attack
                                                                                                                            Heart attacks usually
                                                                                                                            start with mild chest
                                                                                                                            pain but also include:
                                                                                                                          • Chest discomfort such as
                                                                                                                            pressure, squeezing, fullness
                                                                                                                            or pain
                                                                                                                          • Pain in the arms, shoulders,
                                                                                                                            back, neck, jaw or stomach
        However, sometimes the most challenging                  saline intravenous infusions and surface cooling         • Shortness of breath
     part isn’t actually getting the heart restarted,            measures, such as an ice water bath or sophisticat-      • Cold sweat, nausea or
     but managing the complications that can result              ed cooling vest. This hypothermia is maintained            lightheadedness
     from a heart attack, especially brain damage.               for 24 hours while the patient is in an intensive        When every moment counts, it is
     Brain cells die without oxygen and nutrients                care unit and closely monitored. Medicine is given       essential to get to the hospital quickly.
     that come as a result of blood flow from a                  to relax muscles and prevent shivering.                  Calling 911 is the fastest way to ask
                                                                                                                          for help so that lifesaving treatment
     functioning heart.                                              Unique cooling technology ensures that               can begin en route to the hospital.
        About seven years ago, Romergryko Geocadin,              the cooling is completed as quickly and safely
     M.D., director of the Division of Neurosciences             as possible, and that the body temperature
     Critical Care for the Johns Hopkins Medical                 does not fluctuate so that complications can             A team is ready at all times in
     Institutions, and Nitish Thakor, Ph.D., professor           be avoided. The hypothermia works to help             case a patient arrives needing to be
     of biomedical engineering at Johns Hopkins                  cardiac arrest patients by, “stopping further         resuscitated and given therapeutic
     University, began to change the focus of their              injuries at multiple levels, especially in the        hypothermia treatment. The faster
     treatment for cardiac arrest victims. Traditionally,        brain,” explains Dr. Geocadin.                        the treatment is started in the emer-
     the focus was to save the heart, and now, more                  While Dr. Geocadin focuses on protecting          gency department, the greater the
     emphasis is on saving the brain, too.                       the brain, Dr. Chandra-Strobos diagnoses and          benefit. “This is the only treatment
        Dr. Geocadin and Nisha Chandra-Strobos,                  treats the injured heart. “Our combined expertise     that is beneficial to brain function
     M.D., chair of the Division of Cardiology at                in neurological critical care and cardiology is a     after cardiac arrest,” says Dr. Chandra-Strobos.
     Johns Hopkins Bayview, introduced a treatment               great benefit to patients,” notes Dr. Chandra-        “With it, we save lives.”
     for cardiac arrest patients that included using             Strobos. “We’re aggressive with this hypothermia         For more information on cardiology services
     therapeutic hypothermia to cool the body and                treatment because we finally have a tool to           at Johns Hopkins Bayview, call 410-550-4642
     prevent further injuries to the brain and body’s            improve neurological outcomes in select cardiac       or visit hopkinsbayview.org/cardiology.
     systems. “With this intervention the patient                arrest cases.”                                                   —Karen Tong with excerpts from Geoff Brown

10   Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
     Dr. Geocadin and
Nitish Thakor, Ph.D.,
professor of biomedical
          engineering at
    The Johns Hopkins
        University, focus
 their treatment on the
       brain for cardiac
         arrest patients.

                                                       (Excerpts taken from “The Big Chill,” by Geoff Brown, in Hopkins Medicine Magazine, Spring/Summer 2009 issue. Photo by Mike Ciesielski.)

                            For more information on cardiology services at Johns Hopkins Bayview,
                                  call 410-550-4642 or visit hopkinsbayview.org/cardiology.

                                                                                                Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010                             11
     Johns Hopkins Bayview
      Surgical Wound

                                                               Surgical Wound
                                                       Beyond the Physical
                                                                             Patient discovers that “healing” a chronic
                                                                                  wound also meant “healing” his life

     “Ethan walks with a bounce                                  possible side effects, which made Ethan think
                                                                 twice. So, he continued to live with it. And live
                                                                                                                                   and bled freely, even on slight
                                                                                                                                   touching, which seriously
     like he did when he was a kid.                              with it was                                                              interfered with all of
                                                                 about all he                                                             Ethan’s activities,”
     I’m sure I don’t know most of                               could do.           Stephen Milner, M.D.                                 says Dr. Milner
     the day-to-day, moment-to-                                  This wound,
                                                                 which bled
                                                                                        Surgical director of the
                                                                                                Johns Hopkins
                                                                                                                                          (see picture below).
                                                                                                                                              What impressed
     moment improvements, but                                    constantly
                                                                                                Wound Center
                                                                                                                                          Ethan about
                                                                 and was ter-                                                             Dr. Milner
     I know he’s still amazed when                               ribly painful,                                                           and his staff
     he does something that he                                   curtailed many things that most take for grant-                   was the responsiveness
                                                                 ed—wearing shorts, swimming and ice skating.                      and support. In the past, Ethan
     hasn’t been able to do before.”                                “When I began law school, I realized enough                    explains, he would have to schedule procedures
                                                                 was enough,” says Ethan. “It was taking a toll                    six to eight months ahead of time. When asked
                          –Cris Zipf-Sigler (Ethan’s mother)
                                                                 on my social life and ruining my clothes                          when he could remove it, Dr. Milner answered,
                                                                 because it bled so much.” He and his family                       “tomorrow.” And Ethan knew immediately
     Ethan Zipf-Sigler was born with an angioker-
                                                                 made a conscious effort to look for other                         he was in the right place.
     atoma, which affected most of his left calf and
                                                                 options, even if it took them across the country.
     ankle. “It began as a gray mark on the back of
                                                                 This led to an appointment
     my leg,” says the 26-year-old Kansas City
                                                                 with plastic surgeon
     native. “And the older I got, the more it grew.”
                                                                 Stephen Milner, M.D.,
     At 4 years old, Ethan began with laser therapies
                                                                 director of the Johns
     to the back of his leg. These treatments contin-
                                                                 Hopkins Burn Center and
     ued through middle school. He visited several
                                                                 surgical director of the
     physicians and tried different treatments, but
                                                                 Johns Hopkins Wound
     none were successful.
                                                                 Center, who decided that
        In his late teens, some physicians suggested
                                                                 excision and grafting was                     Ethan Zipf-Sigler’s cobblestone-like wound
     excision and grafting—removing the infected                                                               before treatment in 2008.
                                                                 the best way to proceed.
     area and replacing it with healthy skin—but
                                                                    “This large cobblestone-
     the procedure had a long recovery time and
                                                                 like wound was ulcerated

12   Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
                                                                                             Ethan Zipf-Sigler with a
                                                                                             replica of a 427 Shelby
                                                                                             Cobra, that he and his
                                                                                             father built together
                                                                                             several years ago.

                                                                                   wound down to                    Healing All Wounds
                                                                                 the muscle, then                   It is estimated that almost six million people
                                                                                followed with a skin                in the United States are affected by chronic,
                                                                               graft harvested from                 non-healing wounds. Recent advancements
                                                                                                                    in technology and new treatments mean
                                                                              Ethan’s right thigh and               you do not have to suffer in silence.
                                                                             resurfaced the wound.
                                                                               When Ethan awoke                     You should seek treatment
                                                                          from surgery, he immediate-               for a wound if:
                                                                         ly began to cry, not because               • There is increasing pain, redness, drainage
                                                                                                                      or swelling at the site of the wound
                                                                       he was in pain or scared, but
                                                                                                                    • It has an odor
                                                                      because for the first time in
                                                                     years, he could feel his leg flat              • It is open and looks infected, and you
                                                                                                                      begin to run a fever
                                                                    against the mattress. “I was just so
                                                                                                                    • Red marks begin to show at the site of
                                                                  happy it was finally gone,” he says.                or near the wound—on your hand and
                                                                     Ethan spent several weeks in the                 arm, marks will show going up your arm;
                                                                hospital, working with the occupa-                    and on your foot or leg, marks will show
                                                                                                                      going up your leg
   Because Ethan’s MRI                                         tional and physical therapy team at
                                                              the Burn Center. Two years later,                     • It has not healed significantly within
showed that multiple blood vessels
                                                                                                                      three weeks
were feeding and entering the wound, Dr. Milner              Ethan still has a scar, but it does not
                                                                                                                    • It will not heal and continues to open,
consulted with chief of vascular surgery, Thomas            bother him. Because for the first time in                 bleed and scab over
Reifsnyder, M.D. Prior to surgery, Dr. Reifsnyder   a very long time, he can wear shorts and ice
                                                                                                                    • You have a chronic medical condition
performed a procedure to decrease blood flow to     skate with his friends—all the things he could                    such as diabetes, peripheral vascular
the wound, and thus ensure a safer surgery.         not do before.                                                    disease or are immunocompromised, and
                                                                                                                      you develop a wound below the knee
   During a complicated surgery affecting 50                                              —Katie Kuehn
percent of his lower leg, Dr. Milner removed the

                                 For more information, call the Johns Hopkins Wound Center at 410-550-0315.

                                                                                                  Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010   13
                                                    Osteoporosis and Men
                              steoporosis is often a silent                “A bone density test such as a DXA scan is a

     ile and likely to break.
                              disease, not detected until a
                              bone fractures. It is a disease
                              in which the
                              density and
                              quality of bone
     are reduced, so bones are more frag-

         Although osteoporosis affects
     fewer men than women, it remains
                                                         Some of the

                                                                       great tool to determine if men have osteoporosis
                                                                       or are at risk for fractures,” suggests Deborah

                                                         risk factors for

                                                         in men include:
                                                                                              Sellmeyer, M.D., medical
                                                                                              director of the Johns Hopkins
                                                                                              Metabolic Bone Center.
                                                                                              The Center’s experts prevent,
                                                                                              diagnose and treat bone dis-
                                                                                              eases such as osteoporosis in
                                                                                              men and women, fragility
                                                                                                                                   Deborah Sellmeyer, M.D.
                                                                                                                                              Medical director
                                                                                                                                         of the Johns Hopkins
                                                                                                                                        Metabolic Bone Center

     underdiagnosed and underreported                    • Older age                          and recurrent fractures and      enough fruits and vegetables also is important.
     in men. Generally, men have higher                  • Family or personal                 other skeletal disorders.        Plus, men should be sure they are getting the
     bone density than women but they                      history of fractures                  Men can take steps to         right amount of calcium and vitamin D.”
     are still at risk for osteoporosis and              • Losing too much calcium            prevent osteoporosis. “The          Those specific recommendations vary by
     fractures. Previous studies suggest                   in the urine                       cornerstone of prevention is     patient. The general recommendation is to get
     that men have worse outcomes after                  • Previous or current                nutrition and exercise,” notes   1000 IU (international units) of vitamin D and
     a fracture than do women, possibly                    steroid use                        Dr. Sellmeyer. “Men need         1200 mg of calcium each day. It also is important
     because they are typically older or                 • Low level of testosterone          more protein in their diet       to include weight bearing activity and strength
     have additional medical problems,                                                        than women do and may not        training in your daily activities.
     such as heart disease.                                                                   always get enough. Eating                                                 —Karen Tong

          To learn about your fracture risk and bone health, having a DXA scan is the first step. It is painless and non-invasive, with no patient preparation
                 needed. For more information, call the Johns Hopkins Metabolic Bone Center at 410-550-BONE or visit hopkinsbayview.org/bone.

                                                    Eating for Strong Healthy Bones
                  uilding and keeping strong bones                  adult years. Calcium stored in youth can be                     Good sources of

     B            is a lifelong process that includes
                  eating a diet high in calcium
                  (at least 3 servings a day) and
                  performing weight bearing exer-
                  cises for at least 30 minutes a day.
        Strong bones are built during teen and young
                                                                    beneficial for bone health in later stages of life.
                                                                    Although people can build bone density up
                                                                    to age 30, the rate that calcium is deposited
                                                                    in your bones is highest during adolescence.
                                                                    After menopause, loss of calcium from bones
                                                                    is greatest due to the lack of estrogen. The
                                                                    recommended daily requirement of calcium
                                                                    varies with age, however, an average daily
                                                                    intake of 800-1000 mg of calcium is
                                                                                                                                    calcium include:
                                                                                                                                    • Milk and milk products such as cheese,
                                                                                                                                      yogurt, milkshakes and eggnog (low fat)
                                                                                                                                    • Salmon, sardines and mackerel
                                                                                                                                    • Dried beans, such as kidney beans,
                                                                                                                                      baked beans and white beans
                                                                                                                                         • Vegetables, such as broccoli, Brussels
                                                                                                                                              sprouts, okra, green leafy vegetables,
                  Asha Gullapalli,                                  necessary to maintain strong bones.                                        peas and rhubarb
                     MS, RD, LD                                         In addition to the large number of                                    • Sesame seeds
                  Registered dietitian                              natural calcium-rich foods, several varieties
                                                                    of calcium-fortified foods are available,
                                                                    such as breakfast cereals, orange juice,                                          —Asha Gullapalli, MS, RD, LD
                                                                    soy milk, instant oatmeal and bread.

                                 If you would like to make an appointment with a registered dietitian at Johns Hopkins Bayview Medical Center,
                                   call 410-550-7728.These appointments often are covered by insurance. Check with your insurance provider.

14   Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org
Screenings & Seminars
Johns Hopkins Bayview Medical Center offers a variety of educational programs and
                                                                                                         Are You at Risk
                                                                                                          for Vascular
                                                                                                                                               Weight Loss
                                                                                                                                             Surgery Seminar
                                                                                                                                           For individuals 100 pounds or
                                                                                                                                              more overweight who are
                                                                                                            Disease?                      considering weight loss surgery
screenings.The programs listed on this page are held at the Medical Center and are                    For individuals 55 and               Note: This seminar is required to
                                                                                                    older with cardiovascular            receive a consult for bariatric surgery
provided at no charge, unless otherwise noted.                                                         risk factors, known                                May 19
                                                                                                      cardiovascular disease                         June 9 and 15
                                                                                                        or a family history                           4:30 - 6 p.m.
                                                                                                           of abdominal                         Johns Hopkins Bayview
                                                                                                         aortic aneurysm
                                                                                                                                                          June 2
                                                                                                     Monday through Friday                                5 p.m.
                                                                                                         8 a.m. to 4 p.m.                       Annapolis Area Library
                                                                                                     Cost: $40 per screening
                                                                                                                                                    1410 West Street
                                                                                                  To register, call 410-550-8522.                Annapolis, MD 21401
                                                                                                          Varicose Vein                            To register, go to
                                                                                                           Screening                       hopkinsbayview.org/weightloss/
                                                                                                           For individuals with
                                                                                                         varicose veins who are             If you do not have computer
                                                                                                          considering treatment             access, call 410-550-KNOW.
                                                                                                                or surgery
                                                                                                                                                   Back and
                                                                                                                  May 19
                                                                                                                5 - 8 p.m.                         Neck Pain
                                                                                                       Johns Hopkins Community               For people who have been
                                                                                                        Physicians at Water’s Edge          diagnosed with degenerative
                                                                                                                                          disc conditions and are tired of
                                                                                                  To register, call 410-550-VEIN.        suffering from back and neck pain
                                                                                                                                                       May 20
                                                                                                          SEMINARS                                      6 p.m.
                                                                                                                                             Medicine Education Center
                                                                                                         A Joint Effort:                 To register, call 410-550-KNOW.
                                                                                                       The Causes and Cures
                                                                                                           of Joint Pain                        Fixing the
                                                                                                          For people who                     Leaky Bladder in
                                                                                                        suffer from hip and                  Men and Women
                                                                                                      knee joint pain due to              For individuals who suffer from
                                                                                                       arthritis or trauma-              urinary incontinence and want to
                                                                                                         related conditions               learn about treatment options
                                                                                                   May 27, June 17 and July 29                         May 25
                                                                                                            4 - 5:30 p.m.                               6 p.m.
                                                                                                   Medicine Education Center                Medicine Education Center
                                                                                                 To register, call 410-550-KNOW.         To register, call 410-550-KNOW.

                     To see a full list of screenings and seminars, and to register online, visit hopkinsbayview.org/seminars.

                     Johns Hopkins Bayview                                                         Blood Pressure Screenings
                       in Your Community                                                               at Senior Centers
                  Stop by our table at the events below to receive                                      Screenings are free and open to the public.
                    educational materials and promotional items.                                                No appointment needed.

           Hamilton Street                      Perry Hall Town Fair                  Edgemere                       John Booth                      Victory Villa
         Festival & Car Show                               July 10                  Senior Center                   Senior Center                   Senior Center
                    July 25                           10 a.m. – 5 p.m.                Second Tuesday                    (Highlandtown)                   (Middle River)
               11 a.m. – 8 p.m.                   Honeygo Village Center               of the month                   Second Thursday                   Third Friday
         5400 and 5500 Harford Road             5009 Honeygo Center Drive                 10 a.m.                       of the month                    of the month
            Baltimore, MD 21214                    Perry Hall, MD 21128                                                    10 a.m.                         10 a.m.

                                                            For more information, call 410-550-0289.

                                                                                                Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010              15
                                                                                                                                                              Non-Profit Org.
                                                                                                                                                               U.S. Postage
                                                                                                                                                               Permit #470
                                                                                                                                                              Baltimore, MD

   4940 Eastern Avenue
   Baltimore, MD 21224-2780

                                                                                                                   Johns Hopkins Bayview

 Closeness Counts
                                                                                                                   Health and Wellness News

                                                                                                                   Johns Hopkins Bayview Medical Center
                                                                                                                   (410) 550-0100,TTY (410) 550-0316

   Caregiver Support Impacts Alzheimer’s Patients                                                                  Director of Communications and Public Affairs:
                           We all know the importance of caring for a loved one who is ill. But can                Sandy Reckert-Reusing
                              a close relationship with a caregiver prolong a person’s life?
                                  A recent Johns Hopkins study showed that Alzheimer’s patients who                Director of Community Relations:
                               had caregivers with close emotional relationships did very well with long-          Gayle Johnson Adams
                             term prognosis. That was
                             compared to patients with
                         caregivers who did not rate the                           Constantine Lyketsos, M.D.
                           same feelings of closeness.                             Director of the Johns Hopkins   Sandy Reckert-Reusing
                                   “It was intriguing that                         Memory & Alzheimer’s
                                                                                   Treatment Center                Design:
                                  simply a stronger emo-
                                    tional bond between                                                            Cindy Herrick
                                      caregiver and patient
                                        could have such a                                                          Photography:
                                          significant effect,” says Constantine Lyketsos, M.D., director of        Keith Weller, Bill Klosicki and
                                            the Johns Hopkins Memory & Alzheimer’s Treatment Center,               Mike Ciesielski
                                              and one of the study’s principle investigators. “In addition,
                                               the benefit was particularly strong when it related to
                                                 spousal caregivers,” explains Dr. Lyketsos.

                                                                                             —Katie Kuehn                    This issue is available
                                                                                                                                    online at
                                                         Ann Morrison, Ph.D., RN, director of caregiver                       hopkinsbayview.org
                                                         programs at the Memory Center, suggests
                                                         the following tips for strengthening the
                                                         bonds between patients and caregivers:
                                                         1. Make sure you have realistic expectations of           Johns Hopkins Bayview Health and Wellness News
                                                            each other.                                            is published by the Johns Hopkins Bayview Medical
                                                         2. Maintain social contacts, by making an effort to       Center Office of Communications and Public Affairs
                                                            meet with family and friends. Invite them over         and the Community Relations Department for friends
                                                            to play board games or to watch an old classic
                                                            movie. Also, it’s important to have others to talk     and neighbors of the Medical Center.
                                                            to when you have concerns.
                                                         3. Plan pleasant events, like walking in the park,
                                                            going out to get ice cream, cooking a favorite
                                                            meal or traveling, if possible.
                                                         4. Appreciate positive experiences by developing
                                                            gratitude of daily events, such as a beautiful
                                                            cardinal at your bird feeder. Express compli-
                                                            ments and thanks to each other.
 For more information, call the                          5. Know that humor is your best defense against
Memory Center at 410-550-6337.                              stress, feeling overwhelmed or depression.

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