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The Promise of Medicine is Innovation.
The Promise of Medicine is Pushing Boundaries.
Inventing opportunity. Redrawing the lines of what is possible.
The Promise of Medicine is Collaboration.
The Promise of Medicine is making diseases treatable.
Preventable. Forgotten.
Insight and news from Johns Hopkins Medicine
SUMMER 2011
–Enjoy this issue of –
Johns Hopkins Health
Putting
Greetings,
cataract
Welcome to the Summer 2011 issue of Johns Hopkins Health. This
newsletter
is our way of keeping you posted on what Johns Hopkins is doing
surgery
in
to both push the boundaries of medical science and to apply these discoverfocus
ies to treating patients. It’s all part of our 120-year-old commitment to serving
people everywhere, and to fulfilling the promise of medicine.
In keeping with that legacy, we’re constantly looking for new ways to further
our position as a leader in medical science and patient care, so that we can do
more for the people who entrust their health to us.
To that end, we’re proud to announce that in April 2012 we’ll be opening
two new clinical buildings that will set a new standard for patient care everywhere. These state-of-the-art facilities are designed to improve every aspect
of the treatment experience, from providing access to more breakthrough
procedures, to ensuring the highest possible level of nursing care and patient
monitoring, to offering a supportive, comfortable environment for families. Even
the exceptional quality of the food we serve will be part of our leap forward.
We understand, however, that no matter how friendly our facilities and staff,
the task of navigating a major health care institution can seem intimidating,
especially for someone traveling from another country. To relieve you of that
burden, we’re pleased to offer special services—before, during and after your
Guiding
your tween
daughter
Faster
recovery
from joint
replacement
treatment—designed to help you and your family feel as close to home
as possible. With a single phone call, you’ll be paired with one of our
caring, experienced international care coordinators who will help you, in
your language of choice, to find the appropriate doctors and set up your
appointments, as well as help with any needed hotel and ground transportation arrangements. For more details, visit hopkinsmedicine.org/
international or call +1-443-287-6080 to discuss your needs with a
member of our team.
For more than a century, Johns Hopkins has been committed to finding
new ways to get patients to the best possible outcomes in the most supportive way. That’s the promise of medicine, and it’s our promise to you.
Sincerely,
Steven J. Thompson
CEO, Johns Hopkins Medicine International
The Promise of Medicine is profoundly compassionate.
The Promise of Medicine is seeing you beyond your condition to
provide a better answer. a better treatment. a better discovery.
The Promise of Medicine is serving humanity.
inSPIRING courage. creating hope.
The Promise of Medicine is being fulfilled right now,
in the place where modern medicine was born.
discover what’s possible.
Visit hopkinsmedicine.org/discover or Call +1.443.287.6080
Inside Obesity
Johns Hopkins experts seek new ways
for people to lose weight
The Promise of Medicine • Johns Hopkins Medicine
The Promise of Medicine • Johns Hopkins Medicine
Expanding Our Legacy
Take
a tour
and
learn
more at
explorehopkinshospital.org
Johns
Hopkins’
new hospital
buildings
improve
your patient
experience
A
ll of us at Johns Hopkins
are proud of the many medical
discoveries that come out of our
research. But our mission also
pushes us to continually find better ways to deliver these breakthroughs to the
patients who need them. That’s why several years
ago we started to rethink the very idea of what a
hospital should be.
We did not think small.
In fact, when our new buildings open in
April 2012 after five years of construction, it will
be one of the largest academic medical centers
ever built. Replacing half our existing hospital,
the facility consists of 1.6 million square feet in
two connected, 12-story towers—one for cardiovascular and critical care and the other for
our children’s hospital. No wonder it’s big: It is
designed not only to house an unprecedented
array of care advancements, but also to enhance
every aspect of the patient experience.
Visionary Care
We’ve made sure that each component of our
new buildings—the Sheikh Zayed Tower and
The Charlotte R. Bloomberg Children’s
Center—will serve as exemplars of the
leading-edge, patient-centered medicine
that Johns Hopkins has long pioneered. The
Children’s Center will include burn care as
well as Level 1 pediatric trauma care. Cardiac
and other operating rooms will be close to
dedicated recovery rooms and intensive care
units. An advanced air-circulation system will
help safeguard health and reduce respiratory
complications. Groundbreaking computer
systems will help the medical care team support patients and respond to problems. And
patients themselves will have dedicated Web
pages, where they can learn more about their
entire clinical care team, including photos
and biographies.
Being a patient is never easy, but every
patient deserves the best that medicine can
offer. We believe we’ve taken a major step
forward in creating an environment that truly
supports the visionary medical care Johns
Hopkins has been delivering for more than
a century. Next April, we’ll be able to fulfill
even more of that promise. n
Inside Facts
w
Every patient will have one of 560
accommodating private rooms.
w
he latest surgical technologies will equip
T
33 operating rooms, including 14 set up
for neurosurgery and 10 for pediatrics.
More than 120 years ago, Johns Hopkins
made a promise to serve humanity, in
the place where modern medicine was
Take
born. That promise continues to drive
Heart
the experts at Johns Hopkins Medicine
today. The Promise of Medicine is
our pledge to our patients to provide
the most innovative, collaborative
and compassionate care available.
By continually pushing boundaries,
we are redrawing the lines of treatment and possibility.
Learn more about innovaMedical Mysteries
tions happening right now and
how we can help you. Visit
WINTER 2011
Insight and news from
Johns Hopkins Medicine
Help for
hearing-impaired
children
Hard facts
on treating
kidney stones
Options for
women with
fibroids
Don’t fear
your family
tree. The
tragedy of
sudden cardiac
death may
be avoided
FdJHWI1101_01_Co
ver.indd 1
12/23/10 11:00 AM
FALL 2010
Insight and news from
Johns Hopkins Medicine
Protect your
voice for
a lifetime
Heavy
health concerns
surround metabolic
syndrome
Second
opinions give
second chances
w
w
orkstations between every two rooms
W
and throughout the floors will enable
nurses and the entire medical care team to
stay close to bedsides to better monitor
patients, access their records and meet all
their needs.
menities for patients, their families and
A
other visitors include large, windowed
lounges, an indoor play area, and a food
court and other shops offering selections
for different tastes and needs.
It’s not “all in your head.”
Beware
cause hard-to-diagnose of five conditions that
pain for women
hopkinsmedicine.org/
promise, where you’ll find
SUMMER 2010
FdJHFA1001_01_Co
ver.indd 1
Create
Your Sleep
Sanctuary
Insight and news from
Johns Hopkins Medicine
9/27/10 11:02:05
AM
Woman
Beats Terminal
Cancer
Beware
Burn Injuries
in Children
videos, articles and other links that
introduce you to our exper t physicians, connect you with patients who
Pushing Surgical
Boundaries
have been treated at Johns Hopkins,
and inform you about techniques and
procedures being performed at Johns
Hopkins. You can also sign up to continue to receive
this newsletter, Johns Hopkins Health, and other
Johns Hopkins news and information by visiting
hopkinsmedicine.org/international.
Instead of seeing obstacle
s, Johns Hopkins surgeon
see opportunities for
s
extending lives
FdHSU1001_01_Cov
er.indd 1
6/25/10 1:22:41
PM
Compliments
of Johns Hopkins
Medicine
International
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
Shedding Light on
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.
F
5|Girl Talk Find out what’s normal,
and what’s not, as your
daughter enters puberty.
1 0|A Heartbeat Out
First Pe rson
of Control 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/intlseminars
|
2 | johns hopkins health
summer 2011
Summer Eczema
Management
or most people with eczema (atopic dermatitis), summer brings a break 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 skinsensitive 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 hopkinsmedicine.
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 antibiotics 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 +1-443-287-6080 or visit hopkinschildrens.org.
+1-443-287-6080 | hopkinsmedicine.org/international
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 +1-443-287-6080 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/intlseminars.
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, Florida, 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/international | +1-443-287-6080
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 may not be
covered by insurance, may not fit everyone’s budget. But, according
to one estimate, you could recover 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/intlseminars. For more information,
appointments or consultations, call +1-443-287-6080 or visit hopkinsmedicine.org/wilmer.
|
4 | johns hopkins health
summer 2011
+1-443-287-6080 | hopkinsmedicine.org/international
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. (A tween is a child between middle childhood
and adolescence, usually between 8 and 12 years
old.) 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 self-acceptance
and the idea that she may be
different from others in her
peer group.”
What’s not: Your daughter
has frequent headaches, stomachaches, chest pains, trouble
sleeping, tiredness or lack of
energy. These are symptoms of
too much stress.
FREE
Online Seminar
Menstrual Problems
in Adolescents
Thursday, October 6, 7–8 p.m. EDT
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/
intlseminars.
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 +1-443-287-6080 or visit
hopkinsmedicine.org/international. n
Take an active role in your adolescent’s health. Johns Hopkins can help. Visit hopkinschildrens.org.
hopkinsmedicine.org/international | +1-443-287-6080
summer 2011
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.
johns hopkins health | 5
|
Johns Hopkins exper ts
explore surgical and nonsurgical
solutions to the increase in obesity
Johns Hopkins
offers a variety
of weight-loss
and management services.
To learn more,
visit hopkins
medicine.org/
international.
T
he World Health
Organiz ation reports that
in 2008, more than one in 10 of the
world’s adult population was obese.
Sixty-five percent of the world’s population live in countries where more deaths are attributed
to obesity or being overweight than to malnutrition.
Nearly 43 million children younger than 5 were
overweight in 2010. In the U.S., a person who is
70 pounds or more overweight can cost as much as
$30,000 in additional lifetime medical bills.
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 lasting
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. These form 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
relief 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
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ht
hopkinsmedicine.org/international | +1-443-287-6080
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 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 similar to those for any patient who
wants to lose weight: 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. Insurance companies
may not 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, non­
surgery weight-loss intervention in history.
The trial focuses on helping patients change
their eating and exercise behaviors, with a goal of
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
and larger, themed events involving hundreds of
This isn’t a single battle. It’s a
long-term war, and we have to keep
the patients engaged in fighting it.
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8 | johns hopkins health
summer 2011
+1-443-287-6080 | hopkinsmedicine.org/international
fellow patients—car racing and golfing have been
popular themes for those 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-diabetes-care 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 identifying
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 not long-lasting 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 hopeful that the availability of Internet
hopkinsmedicine.org/international | +1-443-287-6080
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 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 increase 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
Out of
Catheter
Control
Ablation
After an
irregular heart
rhythm struck
out of the blue,
James Cromwell
made a
dramatic
comeback
Understanding
w
w
w
cardiac electro­
A
physiologist, using MRI
images and electrical
signals, identifies where
the irregular rhythm is
originating in the heart
and destroys (ablates)
a tiny bit of tissue to
prevent recurrence.
I never
expected my heart’s
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. EDT
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/intlseminars.
steady beat to suddenly go
crazy. 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, Maryland. As I got up from the table,
I collapsed, unconscious. My fast-thinking step­
daughter performed CPR while my wife dialed
emergency medical services. Once they 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 medical technicians used an external
defibrillator to deliver an electric shock through
my chest, restoring my heartbeat’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
by a priest. 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 electrical shocks to the heart, restoring
its rhythms, whenever it detects ventricular
tachycardia or fibrillation. I also began taking
an antiarrhythmic 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 discovered
the origin of my heart’s arrhythmias before he
cauterized the area to stop the irregular electrical 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 +1-443-287-6080.
|
10 | johns hopkins health
summer 2011
+1-443-287-6080 | hopkinsmedicine.org/international
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, 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 “prehabilitation.” 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 leave the hospital.” n
For more information, appointments or consultations, call +1-443-287-6080
or visit hopkinsbayview.org/jointeffort.
hopkinsmedicine.org/international | +1-443-287-6080
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.
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.
alone 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.
summer 2011
johns hopkins health | 11
|
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Steven J. Kravet, M.D.
Physician Adviser
n
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.
The Promise of Medicine • Johns Hopkins Medicine
The Promise of Medicine • Johns Hopkins Medicine
Expanding Our Legacy
Take
a tour
and
learn
more at
explorehopkinshospital.org
Johns
Hopkins’
new hospital
buildings
improve
your patient
experience
A
ll of us at Johns Hopkins
are proud of the many medical
discoveries that come out of our
research. But our mission also
pushes us to continually find better ways to deliver these breakthroughs to the
patients who need them. That’s why several years
ago we started to rethink the very idea of what a
hospital should be.
We did not think small.
In fact, when our new buildings open in
April 2012 after five years of construction, it will
be one of the largest academic medical centers
ever built. Replacing half our existing hospital,
the facility consists of 1.6 million square feet in
two connected, 12-story towers—one for cardiovascular and critical care and the other for
our children’s hospital. No wonder it’s big: It is
designed not only to house an unprecedented
array of care advancements, but also to enhance
every aspect of the patient experience.
Visionary Care
We’ve made sure that each component of our
new buildings—the Sheikh Zayed Tower and
The Charlotte R. Bloomberg Children’s
Center—will serve as exemplars of the
leading-edge, patient-centered medicine
that Johns Hopkins has long pioneered. The
Children’s Center will include burn care as
well as Level 1 pediatric trauma care. Cardiac
and other operating rooms will be close to
dedicated recovery rooms and intensive care
units. An advanced air-circulation system will
help safeguard health and reduce respiratory
complications. Groundbreaking computer
systems will help the medical care team support patients and respond to problems. And
patients themselves will have dedicated Web
pages, where they can learn more about their
entire clinical care team, including photos
and biographies.
Being a patient is never easy, but every
patient deserves the best that medicine can
offer. We believe we’ve taken a major step
forward in creating an environment that truly
supports the visionary medical care Johns
Hopkins has been delivering for more than
a century. Next April, we’ll be able to fulfill
even more of that promise. n
Inside Facts
w
Every patient will have one of 560
accommodating private rooms.
w
he latest surgical technologies will equip
T
33 operating rooms, including 14 set up
for neurosurgery and 10 for pediatrics.
More than 120 years ago, Johns Hopkins
made a promise to serve humanity, in
the place where modern medicine was
Take
born. That promise continues to drive
Heart
the experts at Johns Hopkins Medicine
today. The Promise of Medicine is
our pledge to our patients to provide
the most innovative, collaborative
and compassionate care available.
By continually pushing boundaries,
we are redrawing the lines of treatment and possibility.
Learn more about innovaMedical Mysteries
tions happening right now and
how we can help you. Visit
WINTER 2011
Insight and news from
Johns Hopkins Medicine
Help for
hearing-impaired
children
Hard facts
on treating
kidney stones
Options for
women with
fibroids
Don’t fear
your family
tree. The
tragedy of
sudden cardiac
death may
be avoided
FdJHWI1101_01_Co
ver.indd 1
12/23/10 11:00 AM
FALL 2010
Insight and news from
Johns Hopkins Medicine
Protect your
voice for
a lifetime
Heavy
health concerns
surround metabolic
syndrome
Second
opinions give
second chances
w
w
orkstations between every two rooms
W
and throughout the floors will enable
nurses and the entire medical care team to
stay close to bedsides to better monitor
patients, access their records and meet all
their needs.
menities for patients, their families and
A
other visitors include large, windowed
lounges, an indoor play area, and a food
court and other shops offering selections
for different tastes and needs.
It’s not “all in your head.”
Beware
cause hard-to-diagnose of five conditions that
pain for women
hopkinsmedicine.org/
promise, where you’ll find
SUMMER 2010
FdJHFA1001_01_Co
ver.indd 1
Create
Your Sleep
Sanctuary
Insight and news from
Johns Hopkins Medicine
9/27/10 11:02:05
AM
Woman
Beats Terminal
Cancer
Beware
Burn Injuries
in Children
videos, articles and other links that
introduce you to our exper t physicians, connect you with patients who
Pushing Surgical
Boundaries
have been treated at Johns Hopkins,
and inform you about techniques and
procedures being performed at Johns
Hopkins. You can also sign up to continue to receive
this newsletter, Johns Hopkins Health, and other
Johns Hopkins news and information by visiting
hopkinsmedicine.org/international.
Instead of seeing obstacle
s, Johns Hopkins surgeon
see opportunities for
s
extending lives
FdHSU1001_01_Cov
er.indd 1
6/25/10 1:22:41
PM
Compliments
of Johns Hopkins
Medicine
International
INTL SURFACE AIR LIFT
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Johns Hopkins Medicine International
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The Promise of Medicine is Innovation.
The Promise of Medicine is Pushing Boundaries.
Inventing opportunity. Redrawing the lines of what is possible.
The Promise of Medicine is Collaboration.
The Promise of Medicine is making diseases treatable.
Preventable. Forgotten.
Insight and news from Johns Hopkins Medicine
SUMMER 2011
–Enjoy this issue of –
Johns Hopkins Health
Putting
Greetings,
cataract
Welcome to the Summer 2011 issue of Johns Hopkins Health. This
newsletter
is our way of keeping you posted on what Johns Hopkins is doing
surgery
in
to both push the boundaries of medical science and to apply these discoverfocus
ies to treating patients. It’s all part of our 120-year-old commitment to serving
people everywhere, and to fulfilling the promise of medicine.
In keeping with that legacy, we’re constantly looking for new ways to further
our position as a leader in medical science and patient care, so that we can do
more for the people who entrust their health to us.
To that end, we’re proud to announce that in April 2012 we’ll be opening
two new clinical buildings that will set a new standard for patient care everywhere. These state-of-the-art facilities are designed to improve every aspect
of the treatment experience, from providing access to more breakthrough
procedures, to ensuring the highest possible level of nursing care and patient
monitoring, to offering a supportive, comfortable environment for families. Even
the exceptional quality of the food we serve will be part of our leap forward.
We understand, however, that no matter how friendly our facilities and staff,
the task of navigating a major health care institution can seem intimidating,
especially for someone traveling from another country. To relieve you of that
burden, we’re pleased to offer special services—before, during and after your
Guiding
your tween
daughter
Faster
recovery
from joint
replacement
treatment—designed to help you and your family feel as close to home
as possible. With a single phone call, you’ll be paired with one of our
caring, experienced international care coordinators who will help you, in
your language of choice, to find the appropriate doctors and set up your
appointments, as well as help with any needed hotel and ground transportation arrangements. For more details, visit hopkinsmedicine.org/
international or call +1-443-287-6080 to discuss your needs with a
member of our team.
For more than a century, Johns Hopkins has been committed to finding
new ways to get patients to the best possible outcomes in the most supportive way. That’s the promise of medicine, and it’s our promise to you.
Sincerely,
Steven J. Thompson
CEO, Johns Hopkins Medicine International
The Promise of Medicine is profoundly compassionate.
The Promise of Medicine is seeing you beyond your condition to
provide a better answer. a better treatment. a better discovery.
The Promise of Medicine is serving humanity.
inSPIRING courage. creating hope.
The Promise of Medicine is being fulfilled right now,
in the place where modern medicine was born.
discover what’s possible.
Visit hopkinsmedicine.org/discover or Call +1.443.287.6080
Inside Obesity
Johns Hopkins experts seek new ways
for people to lose weight