Winning the Battle Within

Transcription

1 Complimets of Johs Hopkis Medicie Iteratioal fall 2013 Wiig the Battle Withi Isight ad ews from Johs Hopkis Medicie Iovatios are chagig what we kow about autoimmue diseases ad, ultimately, how to stop them The troublig tred of strokes i youger adults A paret s guide to maagig ADHD log term Are you (ad your family) ready for geetic testig?

2 Cotets Fall 2013 Quick Cosult 4 try This at Home With most physical therapy, success is i what you re doig betwee appoitmets. 5 A Ouce of Prevetio Does Agelia Jolie have you thikig about geetic testig? Read this first. First Perso 10 Youg ad at Risk Discover the subtle symptoms of a 47-year-old s stroke. Secod Opiio 11 Maagig ADHD Kids are t likely to outgrow this attetio deficit disorder. Fid out what parets ca do. 6 ON THE COVER Wiig the Battle Withi Iovatios are chagig what we kow about autoimmue diseases ad, ultimately, how to stop them. Sig Up for Health Iformatio from Johs Hopkis Get the latest ews o health ad welless topics importat to you ad your family, all from the experts at Johs Hopkis Medicie. The Hopkis News for You e-ewsletter is delivered straight to your ibox. Visit hopkismedicie.org/itlews for your free subscriptio. Mammography i 3-D Advaced techology idetifies breast cacer earlier ad more accurately A ew, 3-D mammogram has bee show to improve the chaces of detectig small, early stage breast cacers i wome, especially those who have dese breasts a commo characteristic i which a high proportio of the breast is gladular rather tha fatty. Dese breast tissue decreases the sesitivity of stadard digital mammography. This meas our ability to idetify a breast cacer is limited. Additioally, dese tissue ca look like abormalities, leadig to more false alarms or false-positive fidigs, says Susa Harvey, M.D., director of breast imagig at Johs Hopkis. We also kow that breast desity itself is a risk factor for breast cacer. To address the issue, some breast imagig ceters ow use 3-D imagig, or tomosythesis, to examie 1-millimeter slices of tissue, Harvey says, allowig them to see the breast i much greater detail. The overlap of tissues is resolved ad cacers are see more readily. 2-D 3-D Whereas stadard 2-D mammography (left) appears ormal, a 3-D rederig of the breast (right) produces slices resultig i far greater tissue details icludig this suspicious mass. Several studies show the false-positives decrease by 40 percet. Ad the cacer detectio rate icreases, she says. I a large screeig study i Europe, cacer detectio icreased by 40 percet, ad i the Uited States, oe study showed over a 50 percet icrease i detectio of ivasive cacers. A Johs Hopkis Expert Explais Watch as Susa Harvey, M.D., director of breast imagig at Johs Hopkis, explais 3-D mammography ad discusses the beefits of this ew breast cacer screeig tool. Visit bit.ly/3dmammography. 2 johs hopkis health fall hopkismedicie.org/iteratioal

3 healthisights RA Diet Details Carryig extra weight is hard o your joits, ad the issue is more complex for people who have rheumatoid arthritis (RA). But eve people with RA who are at a healthy weight eed to be careful about their utritio, as some medicatios deplete the body s valuable utriets. The medicatio that is the greatest culprit is predisoe, says Rebecca Mao, M.D., a rheumatologist at Johs Hopkis. It causes patiets to lose lea mass ad gai fat mass. People who have RA should cocetrate o buildig lea muscle, Mao says. They ca do this by followig a healthy diet icludig plety of fruits ad vegetables ad lea protei (such as black beas, salmo ad white meat chicke). We re also keepig a eye o boe health ad vitami D deficiecy, she says. We ca treat that with supplemets, if ecessary. Always discuss the use of supplemets with your doctor. Johs Hopkis curretly has a exercise study uderway. Visit bit.ly/arthritistrial for details, icludig eligibility ad how to sig up. Predictig Postpartum Depressio It s a commo worry amog ew mothers: What happes if I experiece postpartum depressio (moderate to severe depressio for more tha two weeks after givig birth)? Could I hurt my child, or myself? It s a real cocer. Nearly a millio wome a year have symptoms up to 18 percet of all births ad results iclude mothers harmig or killig their babies or themselves ad developmetal problems for childre. Now researchers believe they ca predict which mothers might develop the coditio, so they ca get the help they eed. Studyig epigeetic patters marks o DNA that affect how gees act i the blood of pregat wome, researchers idetified at-risk wome with 85 percet accuracy, says Zachary Kamisky, Ph.D., a assistat professor at Johs Hopkis who led a study of 52 wome. The ext step is to collect blood samples from a larger group of wome over a loger time. If there is similar success i further trials, Kamisky says, these blood tests oe day could become part of a ormal blood screeig pael. I the meatime, if you thik you have postpartum depressio, you should go see a doctor, your iterist, Ob/Gy or a psychiatrist, says Jeifer Paye, M.D., director of the Wome s Mood Disorders Ceter at Johs Hopkis. A care provider ca work with you ad provide appropriate treatmet. For more iformatio, appoitmets or cosultatios, call Katie Couric, keyote speaker Save the Date Wome s Health Coferece Seize this rare opportuity to lear about a wide variety of wome s health issues from reowed Johs Hopkis physicias ad faculty i oe day. Atted A Woma s Jourey, Johs Hopkis Medicie s aual wome s health coferece ad treat yourself to a educatioal ad excitig evet devoted to wome s health. Katie Couric, acclaimed jouralist ad cacer advocate, will be the keyote speaker i Baltimore o Nov. 16. For more iformatio about a coferece ear you, call or visit hopkis medicie.org/ awomasjourey. Got Health Questios? Get Aswers Search our olie video library or sig up for a semiar Johs Hopkis Medicie offers a variety of olie health educatio semiars featurig Johs Hopkis experts discussig various health coditios, risk factors, symptoms ad latest treatmets. If your schedule does ot allow time to atted oe of our evets, ot to worry! All of our olie semiars are recorded ad archived i our video gallery that you ca view by visitig bit.ly/healthsemiarvideos. All evets are free uless a cost is oted. For a full list of upcomig evets, or to register, visit hopkismedicie.org/itlsemiars. hopkismedicie.org/iteratioal fall 2013 johs hopkis health 3

4 quickcosult Try This at Home With physical therapy, you ofte get out what you put i at your scheduled sessios ad at home, too. Aaro Keil, P.T., DPT, OCS, outpatiet rehabilitatio maager at Johs Hopkis, explais why For more iformatio, appoitmets or cosultatios, call I m goig to physical therapy three times a week. Is there more I have to do? Most likely, yes. We tell our patiets that there s a pretty good chace we ca help you get out of pai, but we do t wat to see you agai i six moths for the same thig. Addressig the origis of the problem typically ivolves makig some chages outside of the cliic, such as how you lift thigs or how you maage stress. So, I eed to do exercises at home? The vast majority of patiets, regardless of why they come to us for physical therapy, will get some form of daily homework, usually i the form of stretchig or exercisig. We work with our patiets o tryig to move them toward the activities they used to ejoy. Sometimes my therapy stretches are paiful. Is that OK? Therapists sped a lot of time educatig people o the reasos behid what they are beig asked to do. This icludes what kid of pai is cosidered ormal durig physical therapy alog with ecouragemet that the pai s worth edurig to achieve their recovery goals. Therapists also teach people what kid of pai is cause for cocer. It s all part of helpig patiets speed their recovery ad prevet future ijuries. Why is learig what ot to do importat? If you have low-back pai, for example, we wat to figure out the causes of that pai to help prevet it from recurrig. That s why we suggest that people who have pai or ogoig discomfort, but have t bee prescribed physical therapy, come for at least a oetime cosultatio. A physical therapist speds a hour with the perso to provide isights ot oly ito what s wrog, but, more importat, how he or she got that way ad what should be doe to fix it. The ext steps deped o what kid of therapy the perso eeds either at home or workig here with us ad how motivated the perso is to get better. 4 johs hopkis health fall hopkismedicie.org/iteratioal

5 A Great Time for Guidace A Ouce of Prevetio Agelia Jolie s double mastectomy has people thikig about geetic testig Whe Agelia Jolie told the world that she d had a prevetive double mastectomy after learig she was at high risk for developig breast cacer, the public reacted with surprise, compassio ad, for may wome, woder. Accordig to Lillie Shockey, R.N., admiistrative director of the Johs Hopkis Breast Ceter ad Cacer Survivorship Programs, oly about 5 percet of breast cacers are thought to be caused by the BRCA1 or BRCA2 gee, though wome like Jolie who carry BRCA1 have a 60 to 80 percet chace of developig breast cacer, as well as a 40 percet risk of ovaria cacer. Before wome rush out to get tested, however, Shockey strogly advises they first speak to a geetic couselor, who ca help them determie what the results might mea for them ad their families. If a woma tests positive for the gee, is she psychologically ready to take proactive measures? she says. There are other issues, too, because it impacts the etire family. Will her childre ad sibligs, who also might carry the gee, be ready for her ews? O the other had, a egative test does t mea a woma will ever develop breast or ovaria cacer. If your BRCA gee test is egative, but your family history highly suggests you might develop cacer, extesive testig of other gees may be required, says David Euhus, M.D., chief of breast surgery ad director of the Breast Ceter. Me who have similar family histories should cosider geetic testig, too. Their risk of developig breast cacer is low (6 percet for those carryig a gee), but they could pass the gee o to their daughters. Some wome who carry the BRCA1 gee choose to be proactive ad have a double mastectomy. Others opt istead to scree for breast cacer more diligetly ad the take surgical measures if ecessary. The latter is acceptable for breast cacer, but ot for ovaria cacer, Shockey says. We really have o good way of testig for ovaria cacer. She is a advocate for wome with the BRCA1 gee havig their ovaries ad fallopia tubes removed as a precautio. Most importat, Shockey urges wome to have a thoughtful, serious discussio with a geetics expert before testig ad after, if they test positive. Wome eed to determie how aggressive they wat to be about prevetio, she says, ad uderstad every optio available to them. Who Should Get Geetic Testig? Watch a video of Lillie Shockey, R.N., discussig geetic testig at bit.ly/hopkisgeetictestig. For more iformatio, appoitmets or cosultatios, call Geetic testig for breast cacer opes up opportuities ad emotios, says Lillie Shockey, R.N., admiistrative director of the Johs Hopkis Breast Ceter ad Cacer Survivorship Programs ad a two-time breast cacer survivor. Havig geetic couselig first is essetial to prepare for whatever the outcome of testig might be. Havig someoe to support you as you make decisios ca be just as importat. The geetic cosultatio ad testig program at Johs Hopkis icludes voluteers who have tested positive for the breast cacer gee. Wome who are cosiderig geetic testig ofte like to talk to someoe else who s traveled that road, Shockey says. We have the ability to coect them with someoe who would be a mirror image of themselves. That provides a lot of comfort. You do t feel like you re doig this o your ow. hopkismedicie.org/iteratioal fall 2013 johs hopkis health 5

6 wiig The BATTLE withi The field of autoimmuity is complicated ad fast-movig, but iovatios are chagig the way we thik about these diseases ad, ultimately, how to stop them he Noel Rose, M.D., was i medical school i the 1950s, o oe talked about autoimmue disease. The cocept simply did t exist. We were taught that the immue system oly respoded to viruses, germs or other foreig ivaders, Rose recalls. It seemed logical eough at the time. Why would the body eed to respod to itself? The youg studet, however, was curious about just how the immue system egieered these resposes, ad he ad his colleagues soo made a startlig discovery: I some cases, the immue system would tur o itself, attackig healthy cells ad orgas. The cocept of autoimmuity a immue respose directed at the host body was firmly established i humas. Ad with it, the cocept of autoimmue disease, a disorder caused by that same respose. Now, decades later, Rose is the director of the Ceter for Autoimmue Disease Research at Johs Hopkis, ad he believes more groudbreakig 6 johs hopkis health fall hopkismedicie.org/iteratioal

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8 discoveries are o the horizo. Except for the first years whe we got the field started, this is the most excitig time for me, he says. We re begiig to see that real treatmets ad real cures are possible. What We Kow More tha 80 diseases ca be classified as autoimmue, icludig type 1 diabetes, multiple sclerosis (MS), lupus, rheumatoid arthritis ad, the most commo, Hashimoto s thyroiditis. I the Uited States, approximately 50 millio people, or oe i five, suffer from these ad other autoimmue diseases, accordig to the America Autoimmue Related Diseases Associatio. For reasos ot fully uderstood, 75 percet of those affected are wome. We also have more kowledge of how these disorders are liked; how they ca be treated; ad how a awareess of the body s resposes to autoimmue diseases might lead us to ew ways of fightig other coditios, icludig cacer. We ow realize the immue system is adaptive, Rose says. It lears to recogize pathoges that come alog, ad ew oes are comig alog all the time. A pathoge is aythig that causes disease, for example, this year s flu or a ewly emerged coroavirus. To help with this recogitio process, the body develops receptors o the surface of lymphocytes the cells that fuctio as the guards of the immue system. Discoverig What Are ad Are t Cotributig Factors As we develop a greater variety of receptor cells, scaig for a greater variety of ew pathoges, some of these will ievitably react to somethig i our ow bodies, Rose explais. For may of us, this happes at a low level, ad it s perfectly harmless. But for about 80 or so types of diseases, it is ot harmless. For oe reaso or aother, this atural respose gets out of cotrol. improvig diagosis Ivestigators at Johs Hopkis have made some surprisig discoveries, ofte through a itegrative approach. For example, researchers studyig MS might share ad collaborate with their Johs Hopkis colleagues doig work i rheumatoid arthritis or lupus, as well as those doig basic autoimmue research. That multidiscipliary approach to autoimmue disease helps i aother, ofte frustratig aspect: diagosis. This, Rose cocedes, is a extremely great challege. The reaso is that may autoimmue diseases start with vague symptoms that do t become clear util weeks or moths later. Fatigue a state of total exhaustio, where the patiet is uable to coduct daily activities is a typical early warig sig, Rose says. But that could be a symptom i ay autoimmue disease, or it could be a sig of other types of disease, icludig cacer ad chroic ifectio. So, ofte, you have to wait. That, he ackowledges, is frustratig to the physicia as well as the patiet. That said, the ability to diagose faster ad more precisely is improvig. This is especially true at Johs Hopkis, where idividuals workig i differet areas ad departmets share their kowledge to advace the health of their patiets, as well as their e of the big questios autoimmuity researchers are askig is why certai people get autoimmue diseases ad others do t. What are the triggers? Who is most susceptible? For what reasos? Peter Calabresi, M.D., director of the Johs Hopkis Multiple Sclerosis Ceter, cites research o twis suggestig that while gees are a cotributig factor, they do t ecessarily predict autoimmuity. These twis have the same gees, he says, yet i oly 30 percet of the cases does the secod twi also get MS. (I oidetical twis, the icidece of a secod twi gettig the disease is 3 percet.) Calabresi is also seeig evidece of the precise way i which autoimmuity fuctios. I MS, he says, researchers have thought for the last three decades that the attack is agaist myeli the fatty sheath that wraps aroud erves ad helps coduct impulses. But recet research at the Multiple Sclerosis Ceter coducted o the eyes of people who have MS suggests somethig differet. Some of the autoimmue respose seems to be directed agaist the erve itself, he says. That would be a big chage i our thikig about how MS works. The aalogy, he says, is that if the body is a tree, MS has bee thought of as a ifectio of the bark. We re ow thikig, he says, that maybe the immue system is poisoig the truk. 8 johs hopkis health fall hopkismedicie.org/iteratioal

9 Fox Sports Supports Johs Hopkis Research Johs Hopkis Medicie has bee selected as oe of three charities for this year s Fox Sports Supports program ad moey raised will go directly to Johs Hopkis cuttig-edge research o autoimmue disease. Established i 2007, Fox Sports Supports is devoted to raisig awareess, providig fiacial assistace ad spurrig voluteerism for select health-related charities. Lear more at hopkismedicie.org/fox. are t quite that broad. Very few molecules are attacked, ad they are very specific, he says. What s more, the levels of fuel i these cells are high. I other words, the immue system appears to deliberately target the cells that ca make the coditio worse. uderstadig of autoimmue disease. Rose says he kows of may people who have some form of autoimmue disease who received a faster diagosis ad more effective treatmet because of Johs Hopkis closely etworked commuity of physicias ad scietists. We compare otes o research, Rose says, ad that carries ito our cliical practice as well. diggig deeper Oe of the most strikig recet isights is that whe the immue system does begi to attack the body, it s ot firig at radom. It seeks specific targets. The old idea is that it starts idiscrimiately targetig thigs i the body, says Atoy Rose, M.D., director of the Divisio of Rheumatology. What we re comig to uderstad, however, is that it s actually targetig thigs with icredible specificity. Ad i some cases, it seems, the targeted cells are ripe for attack. Rose cites the coditio kow as myositis, a geeral class of autoimmue diseases such as dermatomyositis, polymyositis ad juveile myositis i which the immue system damages muscle. Patiets preset with symptoms of muscle weakess, Rose says. They re uable to lift their arms over their heads, ad large muscle groups become weak. O the surface, it looks as if much of their musculature has bee affected. But Rose ad his Johs Hopkis colleagues have leared that the effects coectios to cacer The targetig of specific cells may help to explai why a strikig 20 percet of people who have autoimmue diseases go o to develop cacer. That worrisome statistic, however, may also provide us ways to fight back. The study of cacer autoimmuity is the other side of the autoimmue coi. The cocept here is that the immue system, which ca attack ad destroy cells, also has properties to attack ad destroy tumors, Rose says. I a healthy immue system, T cells help regulate the immue respose ad coordiate the attack o foreig ivaders. I autoimmuity, however, the T cells are activated agaist the self. Elizabeth Jaffee, M.D., who co-directs ceters for pacreatic ad gastroitestial cacers at Johs Hopkis, is lookig at what stops or starts T cells; her work might lead to better treatmets for cacer, ad for autoimmue disease. We would like to be able to cotrol these mechaisms to figure out how to activate aticacer immue cells, as well as subdue autoimmue cells, she explais. Johs Hopkis is a world leader i this area, oe of the most promisig of autoimmue research. People did t thik we could use the immue system to fight cacer, Jaffee says. But they re ow believers. We re eterig a differet age. Do You Wat to Participate i a Cliical Trial? Johs Hopkis is helpig trasfer health care advaces from the laboratory to patiet care. To fid out about the latest research, icludig curret trials ope for erollmet, visit trials.johshopkis.edu. hopkismedicie.org/iteratioal fall 2013 johs hopkis health 9

10 firstperso Youg ad at Risk At age 47, Amy McDougall had o reaso to thik she was havig a stroke. But that s exactly what happeed I ve always had migraie headaches, but i April 2012 I had this itese pai i the back of my head, alog with a bad earache ad toothache. Ad I d shrugged off some fleetig umbess I d had a few moths earlier. It was allergy seaso, so I thought maybe it was just sius pressure, ad whe I saw a doctor he put me o atibiotics. A couple of days later, I started hearig this extremely loud whoosh soud i my head. I was hot ad flushed ad sat dow because I could t figure out what I was supposed to be doig with a piece of paper I had i my had. My husbad ad daughter took me to the emergecy room. They ra some tests, recommeded I see a eurologist i the ext two weeks ad set me home. Later that ight, i bed, the whoosh soud came back, ad I told my husbad. That s the last thig I remember util I woke up i the same hospital. This time the doctor idetified a blood clot withi my brai ad jugular vei, but without a eurologist available he suggested we go to Johs Hopkis. There, they cofirmed a blood clot i a vei o the left side of my brai ad dow the back of my head. I did t have ay risk factors for stroke, other tha a family history of clottig. The team at Johs Hopkis put me o blood thiers, which I ll probably be o for the rest of my life. But I m doig great ow; the pressure i my head is goe, ad I m so grateful I was able to walk out without ay lastig problems. To watch a video of Amy McDougall tellig her story, visit hopkismedicie.org/ mystory. For more iformatio, appoitmets or cosultatios, call Lookig for Sigs Amy McDougall was fortuate to get a quick stroke diagosis from Rafael Lliás, M.D., a eurologist at Johs Hopkis. Some of the most commo sigs of stroke are umbess or weakess, especially o oe side of the body; visio chages; a severe headache with o kow cause; sudde cofusio; ad speech problems. McDougall s oly symptoms were a whoosh soud i her head a form of tiitus caused by a chage i blood flow ad a speech abormality, which might be why her coditio wet udiagosed as log as it did. Aother factor i the delayed diagosis could have bee McDougall s age. At 47, she was a example of a troublig tred: Oe i five strokes ow occurs i people ages 20 to 55. The icreased rate of strokes i youger adults is attributable to risk factors such as high blood pressure, smokig ad hormoal birth cotrol, but also greater awareess ad better diagostics. Lliás is quick to poit out that listeig to a patiet is just as importat as lookig at symptoms. To him, McDougall s family history of blood clots was a red flag. Clots ca form i the brai as easily as aywhere else, Lliás says. The imagig is great, but it s all about what the patiet tells you about what s goig o. Nothig beats that. It s importat to tell your doctor about a persoal or family history of coditios, icludig high blood pressure levels, high cholesterol levels or blood clottig disorders. 10 johs hopkis health fall hopkismedicie.org/iteratioal

11 secodopiio Maagig ADHD With ew research poitig to a log-term illess, parets have resources ready Childre grow up far too quickly. Ofte, parets are told kids will leave behid coditios such as allergies or asthma as they age. Nevertheless, research from Johs Hopkis shows that childre who have moderate to severe cases of attetio deficit hyperactivity disorder (ADHD) wo t grow out of it much, eve with medicatio. The fidigs ope a broader discussio of how parets ca best maage what i most cases will be a chroic, ot passig, illess. Over a six-year period, researchers followed 207 patiets, mostly boys, ages 3 to 5. Although problems decreased by year three, symptoms remaied moderate to severe through the etire period. Nearly ie out of 10 met ADHD impairmet criteria at the ed of the study. What ca parets do? Use the tools right i frot of them, says Mark Riddle, M.D., a child psychiatrist at Johs Hopkis ad oe of the study s authors. First ad foremost is early idetificatio, Riddle explais. We ca t cure ADHD, but there are a lot of thigs we ca do to reduce symptom severity, ad that will impact the child s developmet ad family life. Next, whe ADHD is diagosed, cosider medicatio for the child, if appropriate. Ad it s critical that parets moitor the effects of the medicatio over time. No less importat, however, is behavior maagemet traiig for the parets, Riddle says. It really requires super-cosistet paretig, he says. Fially, make use of appropriate school itervetio. Usually, whe those three thigs are i place, Riddle says, life ca be a whole lot better for the child ad for the family. Free Olie Semiar ADHD Treatmet Optios: Fidig the Right Balace Tuesday, December 3, 11 p.m. midight GMT Is your child oe of the millios aroud the world affected by attetio deficit hyperactivity disorder? This coditio is ofte overlooked as a simple focus problem but is a debilitatig iability to cocetrate. Durig this iteractive webiar, Johs Hopkis child psychologist Carisa Perry-Parrish, Ph.D., ad child psychiatrist Marco Grados, M.D., will discuss the paretig challeges of ADHD ad treatmet optios to maage the coditio with both medicie ad evidece-based behavioral therapy. To register, visit hopkismedicie.org/itlsemiars. For more iformatio, appoitmets or cosultatios, call helpig Your adhd tee cope Puberty ca be difficult for parets raisig tees with attetio deficit hyperactivity disorder (ADHD). What should parets do? First, if medicatios are ivolved, keep a eye o dosage, says Mark Riddle, M.D., a child psychiatrist at Johs Hopkis. Use the lowest dose that sufficietly reduces symptom severity ad does t cause problematic side effects, Riddle says. Parets should also approach their child as the adult he or she is soo to become, Riddle says. Teeagers wat to feel ormal. Parets ca reiforce ormality by emphasizig their child s stregths ad accomplishmets ad the importace of the teeager s job i takig prescribed medicatio ad attedig prescribed therapy sessios, he says. Parets well-beig is equally importat. Take it easy o yourself, Riddle says. Parets who are experiecig stress while maagig their child s symptoms or behavior eed to appreciate that this is commo ad is ot a reflectio of bad paretig, he says. Eve the best of parets ca get etagled i a cycle of good ad bad behavior with their adolescet. hopkismedicie.org/iteratioal fall 2013 johs hopkis health 11

12 Johs Hopkis Medicie Iteratioal 1300 Thames St. Baltimore, MD USA We re here for you J o h s H o pk i s M ed i c i e I t er at i o a l coordiates the highest-quality care for thousads of patiets from more tha 100 coutries, so we uderstad ad aticipate your cultural expectatios. Our carig, kowledgeable staff will be there to assist you durig all phases of your medical visit, tailorig each step to your idividual eeds. Before Your Visit Appoitmet Fiacial schedulig couselig Accommodatio arragemets Groud trasportatio ST. PETERSBURG, FLORIDA Durig Your Treatmet Persoal escort 24/7 to medical appoitmets laguage iterpretatio Care maagemet urse durig ipatiet stay Equipmet ad/or home care arragemets (if eeded) Private duty urse arragemets (if eeded) Follow-up appoitmet(s) schedulig Cocierge services for diig ad etertaimet Iteratioal ewspapers ad Iteret access Relaxig, hospitable executive louge NEW YORK PHILADELPHIA After Your Departure Assistace with medical records with prescriptios Follow-up with cliical ad admiistrative staff Future appoitmet schedulig Cosolidated fial bills Assistace BALTIMORE WASHINGTON, D.C. Coectios ad Commuities Olie Cliical trials Facebook News Semiars Twitter YouTube Trials.johshopkis.edu Search Johs Hopkis Medicie Hopkismedicie.org/ ews Hopkismedicie.org/ YouTube.com/ johshopkismedicie For commets, requests or chages of address hopkishealth@jhmi.edu call write Johs Hopkis Health c/o Johs Hopkis Medicie Iteratioal 1300 Thames St. Baltimore, MD USA Johs Hopkis Health is published quarterly by the Marketig ad Commuicatios office of Johs Hopkis Medicie. Iformatio is iteded to educate our readers ad is ot a substitute for cosultig with a physicia. Kathy Smith, Seior Director, Strategic Marketig & Outreach; Steve J. Kravet, M.D., Physicia Adviser. Desiged by McMurry/TMG, LLC. To fid this issue olie or it to a fried, visit hopkismedicie.org/iteratioal.