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Compliments of Johns Hopkins USA summer 2011 Insight and news from Johns Hopkins Medicine Putting cataract surgery in focus Guiding your tween daughter Faster recovery from joint replacement Inside Obesity Johns Hopkins experts seek new ways for people to lose weight Contents S U M M E R 2 011 4| Clear Solution Qu ic k Con s u lt Focus in on the cause of cataracts and learn about specialized eye surgery. Find out what’s normal, and what’s not, as your daughter enters puberty. 1 0|A Heartbeat First Pe rson Gone Haywire James Cromwell conquered sudden cardiac death, thanks to fast-acting family and emergency teams. 11|Is Your Life Out S econ d Opi n ion of Joint? Discover the secret for quicker recovery after joint replacement surgery. ON THE COVER War 6| Waging on Weight Johns Hopkins seeks long-term solutions to the complex problem of obesity. Join Our Online Communities @HopkinsMedNews YouTube.com/johnshopkinsmedicine Search Johns Hopkins Medicine Learn more News and publications Hopkinsmedicine.org/news Clinical trials Trials.johnshopkins.edu ealth seminars H Hopkinsmedicine.org/healthseminars 2 | johns hopkins health Summer Eczema Management F 5|Girl Talk | Shedding Light on summer 2011 or most people with eczema (atopic dermatitis), summer brings a respite from skin sensitivity. For others, the season of sunshine and perspiration means flare-ups. “Sunlight actually serves as a trigger to make their disease worse,” says Ron Sweren, M.D., a dermatologist and director of the photomedicine unit at Johns Hopkins. On top of that, some sunscreens aggravate the condition, he says. Look for skin-sensitive sunblock. “Good skin care is good skin care … whether it’s winter or summer,” Sweren says. Because people perspire more in summer, they may bathe more, and frequent washing, with or without harsh soap, can worsen eczema, adds Sewon Kang, M.D., director of the Department of Dermatology. Adequate moisturizer is essential, he says. During any season, phototherapy—the use of light to treat skin disorders—may be an option for people who have eczema with severe itching. Johns Hopkins is one of a few U.S. institutions to offer stand-up UVA1 treatment. UVA1 rays offer the skin-soothing benefits of sunlight, yet are less likely to cause sunburn. Because the patient is standing up, the entire body can be treated at one time. “This light source seems to control itching quite well,” Kang says, “and can also help dissipate the rash of eczema.” For more information, appointments or consultations, visit hopkins medicine.org/dermatology. Common-Sense Wound Care Is Key to Healing As usual, your mother was right. Prompt, careful cleaning of children’s skin wounds may be more important than the use of antibiotics. A new Johns Hopkins Children’s Center study looked at two anti biotics used to treat staph skin infections. According to the researchers, 95 percent of the children in the study recovered in a week, regardless of the antibiotic they were prescribed. “It seems that good, low-tech wound care, cleaning, draining and keeping the infected area clean, is what truly makes the difference,” says study lead investigator Aaron Chen, M.D., an emergency physician at Johns Hopkins. For more information, appointments or consultations, call 877-546-1872 or visit hopkinschildrens.org. 877-546-1872 | hopkinsmedicine.org/usa healthinsights Could Hearing Loss Contribute to Dementia? Older adults with hearing loss may be missing out on more than just what’s being said. A study by Johns Hopkins and the National Institute on Aging suggests that hearing loss could increase the risk of dementia. Researchers are trying to determine the reason. “That’s really the billion-dollar question,” says study leader Frank R. Lin, M.D., Ph.D., a Johns Hopkins otologist who specializes in hearing loss among older adults. Johns Hopkins is embarking on a long-term study to search for a definitive link and to learn whether treating hearing loss might delay the onset of dementia. In the meantime, Lin encourages people to address signs of hearing loss. “Hearing aids are essentially no-risk therapies,” he explains, “and they clearly improve your quality of life.” For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/hearing. Watch and listen to Johns Hopkins hearing experts explain hearing loss and treatment options. View “Can You Hear Me?” and “Hearing: Lost and Found” at hopkinsmedicine.org/healthseminars. Welcome, All Children’s Hospital! Johns Hopkins Medicine recently welcomed All Children’s Hospital as a new member of the Johns Hopkins Health System. Located in St. Petersburg, Fla., All Children’s Hospital is a leader in pediatric treatment, education, research and advocacy. It is a 259-bed free-standing pediatric hospital with outreach facilities in eight west-central Florida counties. Drawing patients from throughout Florida, the U.S. and around the world, All Children’s provides expert care in heart transplantation, blood and marrow transplantation, and pediatric trauma services, and is home to one of the largest neonatal intensive care programs in the Southeastern U.S. As a regional referral center for children with some of the most challenging medical problems, All Children’s, with its highly specialized staff, services and facilities, can benefit even the most fragile pediatric patients. Learn more about All Children’s Hospital at allkids.org. hopkinsmedicine.org/usa | 877-546-1872 Sodium-Restricted Diet Can Help in Treating Hypertension Sodium intake is one of the leading drivers of high blood pressure (hypertension). The main source of sodium in Americans’ diets is processed foods, especially baked goods and cereals, such as bread, breakfast cereals, muffins and cakes. In fact, the average American gets one-third of his or her daily requirement by consuming those types of foods. Generally, reducing sodium in the diet is a healthy choice for most people. Ideally, you should try to keep your intake under 1,500 milligrams per day. That is quite low for the average person, but it tells you just what an important role sodium plays in cardiovascular health. Always check your food’s nutrition labels for sodium content and keep track throughout the day of how much you are consuming. A good rule of thumb is that individual food products should contain no more than 200 mg per serving, while meals should contain less than 600 mg total. Find more questions answered by Johns Hopkins Medicine experts and others at sharecare.com, a new Web site designed to simplify your search for quality information on topics of health and wellness. summer 2011 johns hopkins health | 3 | quickconsult Clear Solution Get a good look at how to rid yourself of cataracts—and the need to wear glasses—from Wilmer Eye Institute experts Walter J. Stark, M.D., and Oliver Schein, M.D., M.P.H. What are cataracts? Your eyes contain a lens that focuses incoming light rays. A cataract is nothing more than your natural lens losing its clarity as you get older. Symptoms include increasingly blurred or double vision, halos or blurriness around lights, increased sensitivity to light and glare, the need for frequent changes in eyeglass or contact lens prescriptions, and difficulty driving at night or in bright light. How do I decide whether I should have cataract surgery? Choosing to have cataract surgery is a personal decision based on your visual needs. At the Wilmer Eye Institute, we ask patients: “Does your reduced vision interfere with your activities of daily living?” The good news is, the success rate here for cataract surgery is 99 percent. How has technology improved? When the eye lens is removed during cataract surgery it can be replaced with a premium lens—called a multifocal intraocular lens or an accommodating intraocular lens—that allows a patient to focus near and far with a reduced need for corrective glasses. Eighty to 90 percent of patients with the new premium intraocular lenses can get through the day without wearing glasses. Even patients with astigmatism can enjoy the benefits of clearer vision, thanks to another kind of intraocular lens. Are premium lenses right for me? It depends. Premium lenses are not for people with other eye diseases, such as macular degeneration, severe glaucoma or diabetic retinopathy. Also, the cost of premium lenses, which is not covered by Medicare or major insurances, may not fit everyone’s budget. But, according to one estimate, you could recoup that cost in 15 years by pocketing the money you would have spent on glasses. n Watch and listen to Johns Hopkins ophthalmologist Michael Boland, M.D., explain glaucoma and cataracts. View “The Aging Eye” at hopkinsmedicine.org/healthseminars. For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/wilmer. | 4 | johns hopkins health summer 2011 877-546-1872 | hopkinsmedicine.org/usa Girl Talk Making puberty’s bumpy ride go smoother for your tween daughter H oly hormones! You’ve seen the signs—wispy hair peeks out from under her freckled arms, her slim, tomboyish hips form new curves, and breasts begin to bud. Day by day, your little girl’s body is transforming into a young woman’s—and you just don’t know how to handle it. Relax. Johns Hopkins pediatric and adolescent gynecologist Delese LaCour, M.D., reveals the truth about tweens—their body angst, daunting social pressures, monthly cycles and menstrual pain. Here’s your guide on what to expect, including what’s normal and what isn’t. What to expect: Struggles with body image. What’s normal: “It’s normal for tweens to gain weight as they develop a more adult woman’s shape,” LaCour says. “It’s concerning to them as they develop hips and especially breasts. I hear lots of concerns about breast development, especially about asymmetry or size.” What’s not: Your daughter uses negative language to describe herself based on physical development and attractiveness. What to expect: Social pressures. What’s normal: “It’s a time when a girl looks for more acceptance outward, outside the family,” LaCour says. “She’s trying to navigate FREE Online Seminar Menstrual Problems in Adolescents self-acceptance and the idea that she may be different from others in her peer group.” What’s not: Your daughter has chest pains, trouble sleeping, tiredness or lack of energy. These are symptoms of too much stress. Thursday, October 6, 7–8 p.m. Physical changes during puberty can be difficult for teenage girls, particularly when it comes to menstruation. Join pediatric gynecologist Delese LaCour, M.D., as she discusses the most common menstrual problems adolescents encounter and the best approaches for managing them. To register, visit hopkinsmedicine.org/ healthseminars. What to expect: Menstrual cycles. What’s normal: LaCour says it’s normal for menstrual cycles to begin within two years of breast development. What’s not: Your daughter’s menstrual cycles last longer than seven days, are spaced more than 90 days or fewer than 21 days apart, or are especially heavy (soaking one feminine hygiene product every one to two hours). What to expect: Menstrual cramps. What’s normal: Mild cramping pain that can be relieved with a heating pad or hot shower. What’s not: Your daughter’s cramps stop her from doing her daily activities or if she is absent from school one or more days each month because of pain. For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/jhcp. n When It’s Time to See a Gynecologist Your daughter’s first visit to a gynecologist should take place between ages 13 and 15, according to recommendations by the American College of Obstetricians and Gynecologists. But don’t worry that she’ll need a pelvic exam. Johns Hopkins pediatric and adolescent gynecologist Delese LaCour, M.D., says most girls don’t need one at that point. Take an active role in your adolescent’s health. Johns Hopkins can help. Visit hopkinschildrens.org. hopkinsmedicine.org/usa | 877-546-1872 summer 2011 johns hopkins health | 5 | Johns Hopkins exper ts explore surgical and nonsurgical solutions to the obesity upsurge Johns Hopkins offers a variety of weight-loss and management services. To learn more, visit hopkins medicine.org/usa. T he Centers for Disease Control and Prevention reports that about one in three adult Americans is obese, a situation that’s exacting a huge toll on society. Some 160,000 people die prematurely every year because of obesity-related ills, according to studies, and a person who is 70 pounds or more overweight racks up as much as $30,000 in additional lifetime medical costs. A number of Johns Hopkins researchers have been playing a crucial role in the effort to unravel and tame this daunting, complex problem, and on several fronts. This multipronged approach to tackling obesity has been paying off in key insights, as well as in new treatments whose benefits and promise are being proved in several groundbreaking studies. For Tom Magnuson, M.D., the focus has been on finding ways to make bariatric surgery an ever more useful tool for combating obesity. Magnuson, who heads the Johns Hopkins Center for Bariatric Surgery, notes that bariatric surgery has far and away been the most effective weight-loss tool for those with a very high body mass index, or BMI— a numerical scale based on height and weight in which a number over 30 signifies obesity, and over 35 severe obesity. “Most dietary and pharmacological interventions don’t seem to result in the sort of dramatic, longterm weight loss that people who are 100 pounds or more overweight need,” Magnuson says. “Surgery is the only treatment method that results in durable weight loss in that segment. It has potential risks, but, for most people who carry that much extra weight, the benefits are greater than the risks.” Magnuson emphasizes that the primary goal of the surgery isn’t weight loss, but rather improvement of the medical disorders that usually accompany extreme excess weight. He ticks off a grim list: cardiovascular disease, type 2 diabetes, kidney disease, sleep apnea, arthritis, increased risk of cancer, and more. But these problems are dramatically improved and in many cases reversed after surgery. “Eighty percent of people on diabetes medications are off them within a month or two after surgery,” Magnuson says. “Patients often come in here on 12 different medications, and six months after the operation they’re already off 10 or 11 of them. That’s gratifying.” He adds that it’s also an enormous boon to a health care system that is staggering under growing costs, noting that one large study showed the resulting health care savings for bariatric surgery patients exceeded the costs of the surgery within two to three years after the operation. > Weigh Waging War On | 6 | johns hopkins health summer 2011 877-546-1872 | hopkinsmedicine.org/usa ht hopkinsmedicine.org/usa | 877-546-1872 summer 2011 johns hopkins health | 7 | Long-Term Success Requires Behavior Change Is bariatric surgery right for you? Visit hopkinsbayview. org for information about online and in-person educational sessions. As effective as bariatric surgery usually is, about one in four patients who get the surgery never loses the amount of weight expected, and most patients will regain at least some weight. That vexing problem is the one tackled by psychologist Janelle Coughlin, Ph.D., who directs the Obesity Behavioral Medicine Program at Johns Hopkins. The essence of the problem isn’t related to a defect in the surgery, Coughlin says. Rather, it’s that while the surgical procedure prevents a patient from taking in too many calories, that restriction can be defeated if the patient doesn’t adapt his or her eating habits. “People often have the surgery without having fully engaged in lifestyle behavioral changes,” Coughlin says. “And those changes are necessary for success.” The basic lifestyle changes that bariatric surgery patients have to embrace, Coughlin explains, are thought to be pretty much the same ones that patients who want to lose weight the old-fashioned way have to enlist: eating fewer calories (whether from foods or beverages) and moving more. To reduce the risk of postsurgical weight regain, Coughlin meets with patients who are candidates for the surgery to try to get a sense of whether they’re likely to have particular trouble in adjusting eating and exercise habits. In fact, insurance companies won’t cover the procedure unless the patient has made some effort to lose weight nonsurgically, but Coughlin tries to further zoom in on what sort of approach the patient has taken. “I’d rather see that they’ve learned to chew their food more slowly and they’ve stopped skipping breakfast than that they’ve lost several pounds,” she says. “If they’re not making those sorts of changes, then I worry that they’re waiting for surgery to fix all their problems, but it won’t.” That’s why Coughlin favors working with patients on lifestyle changes before surgery, instead of waiting until weight regain becomes a problem months after surgery. Tangible Benefits of Support Groups Is it possible to lose significant amounts of weight— and keep it off—without surgery? The conventional wisdom says no, at least for the great majority of heavily overweight people. But Fred Brancati, M.D., is well on the way to helping overturn the conventional wisdom. Brancati, who heads the Division of General Internal Medicine at Johns Hopkins, is helping to run the largest, most ambitious clinical trial of a nondrug, nonsurgery weight-loss intervention in history. The trial focuses on helping patients change their eating and exercise behaviors, with an eye to rigorously proving that doing so provides the sorts of impressive health benefits doctors have long been saying would follow. “We know we’re supposed to get improvements in heart disease, diabetes and cancer risks when people lose weight with diet and exercise,” Brancati says, “but no one has ever been able to test that claim. This study will have a huge influence on the way we think about and provide care for obesity.” Started in 2001, the ongoing study involves 5,000 overweight patients with type 2 diabetes. (Recruitment is closed for this study.) Patients were randomly assigned to get either the usual care that people with diabetes receive, or participate in an intensive support program aimed at changing the way they eat and exercise. This latter group regularly meets individually with counselors, and attends frequent support group meetings This isn’t a single battle. It’s a long-term war, and we have to keep the patients engaged in fighting it. | 8 | johns hopkins health summer 2011 877-546-1872 | hopkinsmedicine.org/usa and larger, themed events involving hundreds of fellow patients—NASCAR, golfing and “beat Pittsburgh” have been popular themes for the Baltimore-area patients in the Johns Hopkins patient group. “We’ve been looking to create strong bonds between the patients themselves and between patients and counselors,” says Jeanne Clark, M.D., an obesity expert at Johns Hopkins and co-principal investigator on the trial. “This isn’t a single battle. It’s a long-term war, and we have to keep the patients engaged in fighting it.” Although the study continues through 2014, the results have already been encouraging: After nearly a decade, patients in the behavior-change group have kept their weight 4 to 8 percent below the regular-diabetescare group. “It may not sound like a lot, but that amount of weight loss can have a big effect on disease risk,” Brancati says. Interpersonal vs. Internet It’s not necessarily losing weight that’s so hard, notes Larry Appel, M.D., a colleague of Brancati’s and director of Johns Hopkins’ Welch Center for Prevention, Epidemiology and Clinical Research. Rather, it’s keeping the weight off. And through a parallel study to Brancati’s, Appel is pinpointing what sort of behavior-change techniques work best. In this second study, Appel has taken patients who have lost at least 10 pounds and randomly assigned them to one of three groups: a group that gets no special support for weight-loss maintenance; a group that receives support over the Internet; or a group that gets support from a personal counselor, mostly by phone. The Internet group had early but transient benefit while the group that received regular personal contacts had sustained weight loss. “There hasn’t been a huge amount of research into weight maintenance in the period after weight loss,” Appel says. “Person-to-person counseling works. However, my instincts are that the combination of a person-to-person program supplemented by the Web would be even more effective.” And not just any counseling. “A counselor who just provides information won’t help that much,” Appel adds. “We’ve really needed to train our counselors to understand human behavior and motivate people to develop the skills required to deal with a dangerous food environment out there.” Another challenge: The costs of providing every overweight person with frequent personal counseling would be overwhelming. That’s why Appel is hopkinsmedicine.org/usa | 877-546-1872 hopeful that the availability of Internet support, while it can’t replace counseling, can help reduce its frequency and duration and thus lower costs significantly. In spite of the progress made by these researchers on different aspects of the problem, no one claims that the obesity fix is right around the corner. But, thanks to this research, the toolbox is getting fuller. That means more overweight patients can look forward to reducing their exposure to a host of disorders and significantly raising their quality of life. That’s an improvement that will have a profound effect on not just the third of the population that suffers from obesity, but for all of society. n Will There Be a Weight-Loss Pill? Hope remains high that medical science will be able to provide a drug that safely makes weight loss easier. To that end, Tim Moran, Ph.D., who directs the Behavioral Neuroscience Lab at Johns Hopkins, has been studying “brain-gut communication”—that is, the way the body releases chemicals in the gut that help signal the brain that it’s time to stop eating. Versions of these so-called satiety peptides work at different sites in the body and in different ways, providing Moran and his colleagues with a number of avenues for a potential intervention that would crank up the stop-eating signals in obese patients. One big clue that leads Moran to think he may be on the right track: The release of many of these peptides increases in patients who have bariatric surgery, an increase that appears critical to these patients feeling full after eating only small amounts of food. “If we can make those sorts of signals more potent in patients who don’t have surgery, we might see the same sort of results,” Moran says. Not that coming up with a viable drug to strengthen the satiety signal will be easy. A big part of the problem is that the body typically uses the chemicals it produces for many tasks, and that’s probably true of satiety peptides as well. That means increasing their strength may indeed lead to less appetite, but it could also have undesirable side effects, especially in the brain. One strategy for trying to get the satiety effect without risking much harm is to come up with molecules that are very similar to the satiety peptides and work well in the gut, but that are too big to make it into the brain, which filters out many chemicals. In fact, Moran notes, researchers have discovered drugs that operate this way and can lead to weight loss of as much as 20 percent within six months. But so far they’ve only worked as injections, not as pills, making them unlikely to catch on with doctors and patients. Moran is also looking into how different types of bariatric surgery affect peptide levels. “We’re hoping we can identify less drastic forms of surgery that will still provide comparable feeding suppression and weight loss,” he says. summer 2011 johns hopkins health | 9 | firstperson A Heartbeat Gone Haywire Catheter After an irregular heart rhythm struck out of the blue, James Cromwell made a dramatic comeback Understanding Ablation w w w cardiac electro A physiologist, using MRI images and electrical signals, pinpoints where the irregular rhythm is originating in the heart and destroys (ablates) a tiny bit of tissue to prevent recurrence. I never expected my he procedure has an T 85 to 95 percent success rate for idiopathic ventric ular tachycardia (without structural heart disease). F or patients with ischemic ventricular tachycardia (with structural heart disease), the success rate is 70 to 80 percent. FREE Online Seminar Treatment Options for Ventricular Tachycardia Tuesday, September 20, 7–8 p.m. If you have ventricular tachycardia (VT), you may be a candidate for VT ablation. Join Johns Hopkins electrophysiologist Saman Nazarian, M.D., as he discusses the treatment options beyond an implantable defibrillator. To register, visit hopkinsmedicine.org/ healthseminars. heart’s steady beat to suddenly go haywire. But an arrhythmia, or irregular heart rhythm, can strike out of the blue, as it did one night in July 2009, just after my wife, stepdaughter and I finished dinner at home in Frederick, Md. As I got up from the table, I collapsed, unconscious. My fast-thinking stepdaughter performed CPR while my wife dialed 911. Once the emergency medical ser vices arrived, they discovered my heart quivered in a rapid chaotic rhythm called ventricular fibrillation. My heart could no longer deliver blood to my brain and muscles, a condition called “sudden death.” The paramedics used an external defibrillator to deliver an electric shock through my chest, restoring my heart beat’s normal rhythm—for a while. I was rushed to the ER, where my heart erupted into the same chaotic rhythm 10 times in 45 minutes, requiring more shocks. I was even given my last rites. After I was stabilized, I was transferred to Johns Hopkins, where they used a cooling technique to save my brain function. Then surgeons placed an implantable cardioverter defibrillator (ICD) in my chest. The ICD delivers electri cal shocks to the heart, restoring its rhythms, whenever it detects ventricular tachycardia or fibrillation. I also began taking an anti arrhythmic drug called amiodarone, but the ICD still had to send electrical shocks to restore my heart’s rhythm 46 times in four months after I left the hospital. When the device goes off, it’s like a horse’s kick to the chest; I started having panic attacks over when it might go off next. Then, Dr. Saman Nazarian, a Johns Hopkins cardiologist, told me about a minimally invasive procedure called catheter ablation that’s used to treat arrhythmias, and I agreed to try it. Using an advanced technique, Nazarian pinpointed the origin of my heart’s arrhythmias before he cauterized the area to stop the irregular electri cal activity. The procedure was a huge success, and I no longer live in fear of my ICD. My heart’s steady, rhythmic beats are a gift from Johns Hopkins’ talented doctors and medical staff who saved my life. n To watch a video of James Cromwell telling his story, visit hopkinsmedicine.org/mystory. For more information, appointments or consultations, call 877-546-1872. | 10 | johns hopkins health summer 2011 877-546-1872 | hopkinsmedicine.org/usa secondopinion Is Your Life Out of Joint? Rapid recovery program enhances life after joint replacement surgery T he decision to have joint replacement surgery can seem nearly as agonizing as those painful and aching joints. But the good news for bad hips and knees: Recovery from joint replacement surgery is probably much quicker than you think. Johns Hopkins’ rapid recovery program for hip replacement puts healing on a fast track, says orthopedic surgeon Simon Mears, M.D., Ph.D. Whereas a typical hospital stay after hip replacement can range from three to 10 days, with this program, “you’re in the hospital for a day or two,” Mears says, “and we’ll get you up right away and moving so you can go home and, ideally, start outpatient therapy the next week.” Afterward, you can return to work in as early as two weeks, resume your daily 30-minute walks in four to six weeks and get back on the golf course or play other sports in two to three months, Mears says. The secret for this success? The first step is for patients to meet with a physical therapist before surgery so they know what to expect and to begin “prehabili tation.” Mears says building strength in the muscles surrounding the damaged joint will not only help patients regain function more quickly but also will help relieve pain and give them a good idea of some of the exercises they will perform after surgery. Procedures are usually scheduled early in the day so patients can stand up and walk the day of the surgery, with nerve blocks providing pain relief. “On the day after that,” Mears says, “patients will do more therapy, climb some stairs and hopefully go home.” n Moving Statistics w w w Musculoskeletal symptoms— such as pain, aches, weakness and limited movement—were the No. 1 reason for physician visits in 2008, according to the latest data from the American Academy of Orthopaedic Surgeons. With Americans living longer than ever, the American Association of Hip and Knee Surgeons estimates there may be a need for 500,000 hip replacements and 3 million knee replacements in the U.S. each year by 2030. About 90 to 95 percent of hip and knee replacement patients have good to excellent results, even 10 years after surgery. For more information, appointments or consultations, call 877-546-1872 or visit hopkinsbayview.org/jointeffort. hopkinsmedicine.org/usa | 877-546-1872 summer 2011 johns hopkins health | 11 | Non Profit Org. U.S. Postage PAID Johns Hopkins Health Marketing and Communications 901 S. Bond St., Suite 550 Baltimore, MD 21231 In 2010, The Johns Hopkins Hospital was ranked for the 20th consecutive time as the No. 1 hospital in America by U.S.News & World Report. hopkinsmedicine.org/usnews We’re here for you To find this issue online or email it to a friend, visit hopkinsmedicine.org/health/usa For comments, requests or changes of address: NEW YORK PHILADELPHIA BALTIMORE Email [email protected] Write Johns Hopkins Health c/o Marketing and Communications 901 S. Bond St., Suite 550 Baltimore, MD 21231 WASHINGTON, D.C. Call 877-546-1872 W e are pleased to offer you Johns Hopkins USA, a convenient link to Johns Hopkins’ expertise—no matter where you live. With one call, a caring, knowledgeable coordinator will guide you through the best medical care in a way that is tailored to your needs. And to ensure your trip to Baltimore is smooth and comfortable, we’ll help you: n S chedule medical appointments with the right specialists Make travel, lodging and transportation arrangements n Know what to bring and what to expect n UNITED STATES CANADA To learn more or to request assistance, call 877-546-1872 or visit hopkinsmedicine.org/usa. Kathy Smith Director, Market Development Steven J. Kravet, M.D. Physician Adviser Johns Hopkins Health is published quarterly by the Marketing and Communications office of Johns Hopkins Medicine. Information is intended to educate our readers and is not a substitute for consulting with a physician. Designed by McMurry.