IT’S HOW MEDICINE SHOULD BE ® | FALL 2010 QUESTIONS & ANSWERS ISSUE • The question mark began life as punctus interrogativus in the second half of the eighth century. It was introduced by the English scholar Alcuin of York. • Spanish uses a question mark at both the beginning and end of a question, with the ﬁrst one upside down. Example: ¿Que hora es? (What time is it?) • For kids who need to be hospitalized at Rush, the Child Life Program offers special preparation through a role-playing exercise in which children reveal their questions and concerns about going to the hospital. • Every science project begins with a simple research question: What if? • In algebraic chess notation (a way to record moves in a game for learning purposes), “?” means a bad move while “??” is a blunder. • A question mark in medical notes suggests a possible diagnosis. If a patient has blood in his or her stool, a doctor might note “?colon cancer” to indicate the patient should be checked for colon cancer. • Applicants to the Doctor of Nursing Practice (DNP) program at Rush Uni- versity College of Nursing must identify and respond to a question or problem that requires a change in health care as part of their applications. INSIDE 2 Hot health topics: 4 Keeping current: Experts at Rush discuss answers Understanding the medical field to common wellness questions is key to understanding your care WWW.RUSH.EDU QA & ANSWERS FROM EXPERTS HOT TOPICS IN HEALTH When it comes to your health, you want the best information you can get. But it can sometimes be tough to tell fact from fiction — unless you have a source you can rely on. Here, four experts 1 from Rush University Medical Center discuss hot topics in health. How close are we to finding a cure for cancer? Howard Kaufman, MD, director For example, with melanoma, “The tumor doesn’t necessar- of the Rush University Cancer an immunotherapy agent called ily go away completely, but it Center, says another concept in ipilimumab activates the immune doesn’t grow either,” Kaufman cancer care may be more appro- system, prompting it to attack says. Similar drugs are in the priate than “cure”: control. cancer cells. Patients live much works for lung cancer, liver can- “Many cancers can now be longer as a result of this therapy. cer and others. controlled like chronic condi- Control can also mean stabiliz- “We don’t cure these can- tions,” he says. “The idea of ing a tumor. That’s what hap- cers, but we can help patients Howard Kaufman, MD, has living with cancer while prevent- pens with a targeted medicine have a good quality of life for conducted numerous clinical trials ing it from growing is gaining for renal cell carcinoma, a form a very long time,” Kaufman on cancer vaccines and immuno- therapy for cancer patients. He is momentum.” of kidney cancer. says. F the author of The Melanoma Book and many other publications. 2 Vitamin D: Why is it important? Vitamin D has recently taken center stage studies show that vitamin D may protect against multiple in health news as it has become clear that sclerosis. many people don’t get enough of this vita- Getting enough vitamin D from food can be difficult, min. That’s a problem because vitamin D is since food sources are limited. Milk and some cereals essential for bone health, helping the body are fortified with vitamin D, and it’s also in fatty fish absorb and use calcium in bones and teeth. such as salmon and tuna. Sunlight converts vitamin D to It also helps build your immune system and its activated form in the skin, but during the short days Kathryn Keim, PhD, regulate cell growth. of winter, it’s hard to get enough sun — especially in is a registered dietitian According to Kathryn Keim, PhD, a registered dietitian northern-latitude locations such as Chicago. at Rush. Her research focuses on developing at Rush, that’s just the beginning. According to Keim, the solution is to take a vitamin D assessment tools for “Vitamin D is involved in a lot more body processes supplement. Infants and children need at least 200 inter- nutrition education, than was originally thought,” Keim says. national units (IUs) per day. (Ask your pediatrician about especially among For example, most people know that vitamin D defi- how to give vitamin D to your baby.) Adults up to age 50 minorities and ciency can cause weakened bones. But research now sug- need at least 200 IUs each day. As we age, we become people with low gests that low levels of this vitamin also may be linked to less efficient at converting sunlight to vitamin D, so income who have diabetes. diabetes and heart disease. In fact, in one study, people people age 51 to 70 need 400 IUs, and people age 71 with low levels of vitamin D and high blood pressure and older should get 600 IUs each day. had nearly twice the rate of heart attack as those with Extremely high doses of vitamin D are toxic. But tak- adequate levels, although the reason was not clear. ing up to several thousand IUs a day is safe. In fact, the Vitamin D also may be important to thinking and mem- daily recommendation may soon be raised in light of ory. And although more research needs to be done, some vitamin D’s recently uncovered roles in health. F MORE Talk to a doctor about how these questions and answers may affect your health. Call (888) 352-RUSH (7874) to find the doctor who’s right for you. 2 WWW.RUSH.EDU 3 Alcohol: Good for the heart, bad for cancer. What do you do? News headlines pull you one way today levels,” Forys says. Specifically, it raises and another tomorrow. A certain diet or your high-density lipoprotein, or HDL, the food is great, and then it isn’t. A medica- good cholesterol that protects your heart. tion or therapy works, but maybe not Studies suggest other benefits such as for you. How do you decide what to do reduced risk for gallstones and diabetes. when a medical question seems to have But drinking alcohol also has a down- Olivia Forys, MD, more than one answer? side. Excessive drinking is associated with is an internist who Your first move should be to talk with liver disease and cancers of the mouth, practices at Rush University Family your doctor. He or she can help you esophagus and breast. Physicians at Lincoln evaluate the risks and benefits of tests, Forys emphasizes that nondrinkers Park. She is espe- treatments or lifestyle choices. A good shouldn’t start drinking for the health cially interested in example is drinking alcohol. According benefits. And if you already drink, mod- preventive medicine, to Olivia Forys, MD, an internist at Rush, eration is key. “That’s one drink per day women’s health and moderate consumption of alcohol — the for women and two for men,” she says. health issues related to hypertension. type doesn’t matter — can confer health Because older people may be more vul- benefits. nerable to alcohol-related health prob- “Alcohol can lower your heart dis- lems, men over age 65 should also limit ease risks by improving your cholesterol their intake to one drink per day. F 4 Why are women’s heart attack symptoms different from men’s? Pain, pressure, squeezing, kind of coronary artery dis- “Women have real discomfort — these are ease, which can lead to heart symptoms, but doctors may some of the sensations in attacks. not recognize what’s hap- the chest that can signal a “The blockages in women pening,” Volgman says. heart attack in both men can be in the smaller blood The best time to talk and women. vessels,” Volgman says. “The with your doctor about Other symptoms are less end result is the same — the heart attack symptoms is obvious signals of a heart heart doesn’t get enough before you have them. Ask attack, and that’s where blood. But it’s harder to about your risk for heart an important distinction diagnose.” disease and about advanced Annabelle Volgman, shows up. Women experi- This condition is known tests that can diagnose MD, is a cardiologist at ence symptoms such as as endothelial dysfunction difficult heart attack cases Rush specializing in the electrophysiology of the nausea, fatigue or jaw pain or microvascular disease, in women. heart. She has written more often than men do. and even if it causes a heart “Women can also have extensively about heart According to Annabelle attack, women may not real- heart disease that is easily disease in women and Volgman, MD, medical direc- ize their symptoms are seri- diagnosed. But it’s important was selected as a top tor of the Rush Heart Center ous. In fact, initial tests at an to have a doctor who under- doctor for women in for Women, that’s because emergency department can stands that that’s not always the ﬁeld of cardiology by Women’s Health women can have a different miss it. the case,” Volgman says. F magazine. MORE How can you relieve low back pain? How does a pain reliever find the right location? For more questions and answers, visit www.rush.edu/discover. 3 WANT TO GET The experts at Rush University A HANDLE ON HEALTH CARE? Medical Center answer questions to help you stay in the loop about health care. A FEW INQUIRIES INTO ITS EVER-CHANGING WORLD The field of medicine changes rapidly — even daily. From newly developed technologies and research discoveries to innova- tive initiatives to improve quality of care, changes in medicine can significantly affect your health care. To help you keep up, we’ve asked experts at Rush University Medical Center about one of the latest technologies, how some discoveries are made and how asking questions can help you get better care. Easy as 1, 2, 3 ... Can your stools Tar-black stools. These Red, bloody Gray-colored reveal health 1 aren’t your normal dark 2 stools. If blood 3 stools. Stools the stools, Patil says, but comes out of your color of gray clay problems? jet-black stools with the bottom, and you see it either are rare, Patil says. Normally, Adults tend to shy away from the subject of consistency of mushy tar (such as on toilet paper or in the toilet food mixes with bile and bowel movements. However, in the interest of you might see when a parking lot is bowl, pay attention — even bacteria in the colon, giving your health, it’s a good idea to take a look at being paved). The color may come if it’s sporadic and just a few stools their brown color. If Abhitabh Patil, MD, them once in a while. from digested blood — blood turns drops of blood. It may not be there’s no bile in the colon, is board certiﬁed in If you know what your stools normally look black when it comes in contact with blood but something you ate, then the stool comes out gastroenterology like, it’s easier to spot changes. In most cases, stomach acid. Black, tarry stools might such as beets, tomatoes or gray or light colored. Pancre- and internal medi- changes aren’t serious and clear up quickly — indicate bleeding in the upper intestine red food coloring in gelatin, atic cancer causes bile block- cine. His research interests include but you should still discuss them with your or stomach. However, don’t panic, Patil Popsicles or other foods. age. This is not something pancreatitis and doctor. says. This color can also appear if you Many people also blame you will notice just once — gallstone disease. “Three changes may be cause for concern — ingest iron pills, bismuth (the active hemorrhoids. However, it it will be a persistent prob- in particular, there are three colors you don’t ingredient in Pepto-Bismol), blueber- could be a sign of colon can- lem. No food or medicine want to see show up in your stools,” says ries or black licorice. If your stools are cer, Patil says, so it’s important can cause this, so if you do Abhitabh Patil, MD, an interventional gastroen- black, give your doctor a call so the to get checked out by your notice it, see your doctor terologist at Rush University Medical Center. two of you can ﬁgure out the cause. doctor. right away. 4 WWW.RUSH.EDU Why is everyone How do clinical trials moving toward electronic lead to new treatments? Clinical trials play an important part in Rush’s mission of medical records? providing the best care possible to patients. But what exactly “Coordination of care and immediate access to patient data are they? are two key beneﬁts that electronic medical records provide to “A clinical trial is simply a way to ask and answer a question the patient health care team,” says Julio Silva, MD, MPH, chief about how we can improve some aspect of health care,” says medical information ofﬁcer at Rush. Using a secure login, every James Mulshine, MD, associate provost for research at Rush doctor at Rush who treats a particular patient can quickly ac- University. James Mulshine, cess that patient’s complete medical history to make the most For example, when scientists and doctors at Rush were MD, is an interna- informed and timely choices for the patient’s care. When any researching treatments for breast cancer, they asked the tionally recognized expert on lung doctor adds information to a patient’s ﬁle, those updates are question, Could antibodies play an important role in the cancer and is Julio Silva, MD, immediately available to all of the patient’s physicians. treatment of breast cancer? To ﬁnd the answer, Rush teamed responsible for MPH, is chief Electronic medical records (EMRs) can increase patient safety with researchers from the company that produces the antibody managing research medical informa- in additional ways. The system features clinical decision sup- Herceptin to lead a multicenter clinical trial in which doctors did activities at Rush. tion ofﬁcer at Rush port, which provides pop-up alerts, reminders and checks for the following: University Medical Center. Prior to health care providers, such as a patient’s drug allergies and • Gave Herceptin to a large group of breast cancer patients this appointment, potentially harmful medication interactions when a doctor is • Documented the impact of the antibody administration on patients’ conditions he concentrated prescribing new medications. • Analyzed the results and reported that data, along with other sponsor data, to the his practice and These are some of the reasons EMRs were on the radar U.S. Food and Drug Administration research on emer- at Rush before they appeared in the American Recovery and • Published the research ﬁndings gency medicine. Reinvestment Act of 2009. Planning for Rush’s EMR began in This trial was one of the key trials that led to the approval of Herceptin, now one of 2006, and the system came online in April 2007 as part of the Rush Transformation, a the mainstays of breast cancer treatment. While Mulshine credits trial sponsors, doctors 10-year project to build new facilities, renovate existing buildings and adopt state-of- and scientists with this discovery, he also believes another group deserves recognition. the-art technologies that will create new models of patient care. “We would never make progress in improving outcomes in medicine without the To read more about the beneﬁts of EMRs or the Rush Transformation, incredible contributions of patients in volunteering to participate in the clinical trials MORE visit www.rush.edu/discover. process,” Mulshine says. If you’re interested in learning more about how you could beneﬁt from MORE participating in a clinical trial, go to www.rush.edu/discover. How can asking questions improve the quality of your care? Patients who ask questions get better quality health care and are J What are my treatment options? happier with their results, according to the Agency for Healthcare If you are given a new prescription: Research and Quality (AHRQ), part of the U.S. Department of J How will this help my condition? Health and Human Services. Knowing what questions to ask and J What are the possible side effects? when to ask them can help you make sure you’re getting the right J Would a generic drug work just as well? care at the right time. If you’re told you need a test: A good place to begin is asking your doctor to explain things J How will this test be used to diagnose or monitor my more plainly, says Laco Lane Mace II, MD, an internist at Rush. condition? Laco Lane Mace II, “Physicians can get caught up in scientiﬁc terminology and may J What are the beneﬁts and risks of having this test? MD, practices at forget to explain things in a way that is easy for the patient to J When will I get the results, and how will they be communi- West Loop Univer- understand,” Mace says. cated to me? sity Medicine. His In addition, he recommends asking your doctor the following For more information about questions to ask your special interests MORE include diabetes, questions: doctor and ways to receive the highest quality hypertension and If you have just received a diagnosis: health care, visit the AHRQ at www.ahrq.gov or the Rush Web hyperlipidemia. J How will my condition progress in the future? site for information on quality at www.rush.edu/quality. 5 RUSH IN THE NEWS For current clinical trials, visit www.rush.edu/clinicaltrials. Flat, flexible footwear is easier on knees MANY PEOPLE WEAR flip-flops because they’re effects on the rest of the leg,” says rheumatologist on the knee joints during walking is a key factor in comfortable. But according to a study by researchers and lead study author Najia Shakoor, MD. the development of osteoarthritis, affecting both at Rush University Medical Center, there may be an The study, which was published online in the jour- the severity and progression of the disease. even better reason to favor flat, flexible footwear: nal Arthritis Care & Research, found that flip-flops In the study, flat, flexible and lightweight flip- It can help protect your knees against osteoarthritis. and sneakers with flexible soles actually cause less flops and walking shoes seemed to mimic the “Traditionally, footwear has been engineered stress on the knees than rigid clogs or even special mechanics of walking barefoot. In fact, the force to provide maximum support and comfort for the walking shoes. And that’s important, because a on the knee was roughly the same whether the foot, with little attention paid to the biomechanical higher-than-normal load — or amount of force — subject wore flip-flops or went barefoot. With clogs and stability shoes (athletic shoes specifi- cally designed to control and neutralize the stride of a person with an unstable gait), conventionally CLINICAL TRIALS AT RUSH believed to provide appropriate cushioning and support, the force on the knees was up to 15 per- cent higher than with flat walking shoes, flip-flops INTRAOPERATIVE IMAGE-GUIDED INFLAMMATORY BOWEL or bare feet. F NAVIGATION KYPHOPLASTY STUDY DISEASE FLARE-UP STUDY The Department of Neurosurgery is conducting a study The Section of Gastroenterology and Nutrition is Rush earns top marks to see whether the use of intraoperative image-guided navigation during vertebral kyphoplasty (a procedure to conducting a study to determine whether using one of two eight-week, mind-body medicine courses can from Thomson Reuters repair painful vertebral fractures using a cementlike com- help reduce stress and, as a result, prevent ﬂare-ups RUSH UNIVERSITY MEDICAL CENTER was selected pound) may reduce radiation exposure for the patient. in patients with ulcerative colitis. Prior research indi- as one of the 100 Top Hospitals in the United Patients will be randomly assigned to receive treat- cates that stress is an important trigger for ulcerative States by Thomson Reuters, a for-profit information ment using either traditional intraoperative ﬂuoroscopic colitis ﬂare-ups. source for businesses and professionals. The annual visualization techniques or intraoperative image-guided Participants must meet the following criteria: Thomson Reuters 100 Top Hospitals National navigation. • Have a clinical diagnosis of moderately severe Benchmarks study identifies the 100 best U.S. Participants must meet the following criteria: ulcerative colitis hospitals based on their overall organizational per- • Have one to three vertebral compression fractures, • Be 18 to 70 years of age formance. Rush was one of only 15 major teaching caused by either disease or reduced bone density, • Be in remission at the time of recruitment, with at hospitals in the country to be named. The 17th requiring kyphoplasty least one documented disease ﬂare-up within the annual study evaluated hospitals’ performances • Not have symptomatic spinal cord compression past two years in several key areas, including mortality, medical This is a partial list of inclusion and exclu- This is a partial list of inclusion and ex- complications, patient safety, average length of MORE MORE sion criteria. For more information, please clusion criteria. For more information, stay, patient satisfaction and adherence to clinical contact Sarah Tieche, MS, at (312) 563-3776. please contact Delia Daian, MD, at (312) 942-3644. standards of care. F DISCOVER RUSH is published as a service President and Chief Executive Ofﬁcer Information in DISCOVER RUSH comes for the Rush community. Larry J. Goodman, MD from a wide range of medical experts. Models may be used in photos and RUSH UNIVERSITY MEDICAL CENTER For information about DISCOVER RUSH, illustrations. If you have any questions Rush is a not-for-proﬁt 1700 W. Van Buren St., Suite 456 contact Erin Thorne at erin_thorne@rush. about your health, please contact your health care education Chicago, IL 60612-3244 edu or (312) 942-3215. For general informa- health care provider. and research enterprise www.rush.edu tion about Rush or to make an appointment ©Rush University Medical Center comprising Rush University with a physician, call (888) 352-RUSH (7874). CUM25106c Medical Center, Rush University, Rush Oak Park PLEASE NOTE: All physicians featured in this publication are on the medical faculty of Rush University Medical Center. Some of the physicians Hospital and Rush Health. 6 featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center. | S AT U R D AY WWW.RUSH.EDU RUSH UPCOMING EVENTS FREE CLASSES FOR YOUR HEALTH | FALL 2010 F R I D AY Rush Generations presents … Older adult and caregiver programs All Rush Generations programs are held at Rush University Medical Center, Searle Conference Center, 5th floor (Elevator II, Professional Building), 1725 W. Harrison St. | Staying Safe and On Making Sense of T H U R S D AY Your Feet: Balance and Stress and the Blues Fall Prevention Wednesday, Sept. 22 CLICK For a complete and Prevention and Wednesday, Sept. 1 1:30 to 3:30 p.m. up-to-date list of Treatment of Stroke 10:30 a.m. to noon Depression and anxiety are normal community wellness events at Rush, Tuesday, Oct. 5 Falls are not just the result of getting emotions, yet when left unad- visit www.rush.edu/events, where Risk assessments: 5 to 6 p.m., older and can often be prevented. dressed, they can become serious you can also find handouts from Room 994 Join us to learn about medical and health concerns. Join experts at Rush previous talks. Talks: 6 to 8 p.m., Room 976 physical factors that contribute to for a discussion of depression and | Armour Academic Center balance problems and simple inter- anxiety in older adults, and explore Advances in Prostate 600 S. Paulina St. ventions you can use to improve bal- ways of coping with these emotions. W E D N E S D AY Cancer Treatments Stroke is the third leading cause of ance and prevent falls. Tuesday, Sept. 21 death in the United States, but you 6 to 8 p.m. can lower your risk of disability or Armour Academic Center death from stroke by knowing the Rush Generations en español Room 994, 600 S. Paulina St. warning signs and understanding Todos los programas Rush Generations tienen lugar en el Searle Comprehensive care that is per- your risk factors. Stroke neurologists Conference Center de Rush University Medical Center, situado en la sonalized for each patient is espe- at Rush will educate you on the pre- quinta planta (Ascensor II, Professional Building), 1725 W. Harrison St. cially important in the treatment of vention, symptoms and treatment Si quiere registrarse para cualquiera de estos programas o actividades, cancer. The Coleman Foundation of stroke. Personal risk assessments llame a (888) 352-RUSH (7874). | Comprehensive Prostate Cancer will be offered on a first-come, first- Clinic at Rush offers men the ability served basis. Cómo superar el estrés y la depresión T U E S D AY to meet with a urologist, medical Miércoles 25 de agosto oncologist and radiation oncologist Heart Attack Prevention 1:30 a 3 p.m. in a single visit. Join this group of and Treatment La depresión y la ansiedad son emociones nor- physicians to learn about exciting Wednesday, Oct. 13 males; sin embargo, si no se atienden, pueden new treatments for prostate cancer, 6 to 8 p.m. convertirse en serios problemas de salud. such as TomoTherapy and the Armour Academic Center Venga a Rush para hablar con expertos en la da Vinci robotic surgery system. Room 976, 600 S. Paulina St. materia sobre la depresión y la ansiedad en | Heart disease is the nation’s lead- adultos mayores, y explorar formas de enfren- ing killer of both men and women. tarse a estas emociones. | M O N D AY Cardiologists from Rush will discuss how you can control certain risk fac- tors to prevent heart disease. They will also discuss the symptoms of CLICK You can get helpful health information in your e-mail inbox and latest treatment options for a each month with our e-newsletter, DISCOVER RUSH ONLINE. heart attack. Sign up today at www.rush.edu/discover. S U N D AY Because space is limited, please call to reserve your seat. For more details and to register, call (888) 352-RUSH (7874). Free parking in the Rush garage is available with validation.7 Nonproﬁt Org. 1700 W. Van Buren St., Suite 456 U.S. Postage E-NEWSLETTER: DISCOVER RUSH ONLINE Chicago, IL 60612-3244 PAID Rush University Medical Center LISTEN UP If you’re having a hard time hearing, check out the August issue of Discover Rush Online for advice about when to seek help and tips about ways to be- come a better listener. Sign up for the newsletter at www.rush.edu/discover. WWW.RUSH.EDU HEALTH CARE: THE HOT JOB MARKET? AT A TIME when job prospects are Besides these two fields, we’re seeing a lot of generally bleak, careers in health growth in jobs for occupational therapists, who care are growing. In fact, the U.S. treat people of all ages with physical and mental Department of Labor estimates 3.2 mil- disabilities. And with the need to plan responses lion new jobs will be created in health to terrorist attacks and other disasters, there are care between 2008 and 2018, largely increasing opportunities for people to go into due to the health care needs of the administrative careers in emergency management. aging baby boomer population. Lois Kazmier What jobs will be available? Discover Q. What education does a person need Halstead, PhD, Rush recently spoke with Lois Kazmier to work in health care? RN, vice provost, Halstead, PhD, RN, vice provost at Rush A. The education needed for a career in health is responsible for University, about opportunities in health care ranges from associate to doctoral degrees, the day-to-day operations of Rush care and how to pursue a career in this though the trend is toward more education. For University. She was expanding field. instance, a few years ago, Rush University rede- knowledge you need to practice in the health care previously associate signed its program in audiology from a master’s to field. The illnesses we treat are becoming more dean at the Rush Q. What are the biggest a doctoral level because Rush could foresee one complex, and the science and technology to treat University College growth areas in health care? would soon need a doctorate to practice in the them are expanding practically by the day. of Nursing and A. Nursing jobs are expected to field. Similarly, nurse practitioners currently must has been actively involved in health increase by a healthy 23 percent over have at least a master’s degree, but by 2015, a Q. How would you describe the ideal professions educa- the next eight years, and physician Doctor of Nursing Practice (DNP) degree will be rec- candidate for a career in health care? tion for many years. assistant jobs will grow by a whopping ommended for nurse practitioners. Rush University A. Health care practitioners need to be able to bal- 41 percent. Part of this increase is due has had a DNP program since 2005. Rush also ance caring for increasingly sick patients with con- to the national shortage of primary care physicians, recently began offering bachelor’s and master’s cern for the bottom line, all the while keeping up which has created a demand for physician assis- degree programs in respiratory care because of the with the latest technologies. We need smart people tants and for nurses with advanced training, such growing need for therapists in this area, and most who care. F as nurse practitioners. job opportunities are for those with at least bach- Because of this demand, the Rush University elor’s degrees in their fields. Rush University is a health sciences nurse practitioner program is bursting at the seams, and we began a physician assistant program in Q. Why does it take more education to university offering programs in June. The new Master of Science program prepares be in the health professions? physician assistants to work in primary care or spe- A. The changes in education and in practice are medicine, nursing and more than cialties such as orthopedics. a response to the increasing depth and breadth of a dozen allied health care fields. F MORE ONLINE AT WWW.RUSH.EDU DO YOU HAVE ALL THE ANSWERS? Test your knowledge with health quizzes at www.rush.edu/discover. Just select the “Interactive Health Tools” link to ﬁnd out how much you really know about asthma, breast cancer, cholesterol, stroke and even your child’s ﬁrst year.
Pages to are hidden for
"Discover Rush Fall 2010"Please download to view full document