Johns Hopkins Bayview Noteworthy News 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 Hematologist/oncologist appointment, call 410-575-6611 To make an appointment, call 410-550-1711. (press option 5). 2 Spring 2010 Johns Hopkins Bayview Medical Center / hopkinsbayview.org Contents 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 P 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, email@example.com. call the Johns Hopkins Vein Center at 410-550-VEIN. Johns Hopkins Bayview Medical Center / hopkinsbayview.org Spring 2010 3 Cover Johns Hopkins Bayview Orthopedic Surgery Breaking a Hip alking her 15-pound Shouldn’t Break W 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 toward refine our surgical relieving 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- Lessis 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 More 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 I 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 Gastrectomy • 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 hopkinsbayview.org/weightloss/infosession. 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 A 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 Cardiology 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 Treatment: 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 O 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 osteoporosis 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 SCREENINGS 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/ infosession. 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 PAID 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 hopkinsbayview.org 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 Editor: 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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