Primary Care. The comprehensive approach to overall health. The sleep and depression connection. One doctor s crusade against sudden cardiac death

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1 Complimets of Johs Hopkis Medicie Iteratioal Summer 2012 Isight ad ews from Johs Hopkis Medicie Primary Care The comprehesive approach to overall health The sleep ad depressio coectio Oe doctor s crusade agaist sudde cardiac death A secod opiio o chroic leg pai

2 Cotets Summer 2012 Quick Cosult 4 is Poor Sleep Makig You Sad? Drawig a coectio betwee sleep disorders ad depressio. 5 Youg at Heart Meet the cardiologist who is workig to reduce sudde cardiac death i youths. Maitaiig a Healthy Weight i Pregacy First Perso 10 the Mouths of Babes A Marylad couple foud help for their two childre who had oral birth defects. Secod Opiio 11 do t Take Leg Pai Lyig Dow Two solutios to cosider for peripheral arterial disease. 6 ON THE COVER Primary Care Good health begis with a great team cetered o the physicia who kows you best. 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. Two out of three wome of reproductive age are overweight or obese. Ad beig overweight durig pregacy ca cause a host of problems for mother ad baby. May primary Ob/Gys are t prepared to hadle some of the uique eeds of these wome. That s why Johs Hopkis established the Nutritio i Pregacy Cliic, to help wome who are obese their body mass idex, a ratio of weight relative to height, is 30 or greater achieve ad maitai a healthy weight durig pregacy. Obese expectat mothers are at risk for diabetes, heart disease ad difficulties with delivery, icludig icreased odds of eedig a cesarea sectio ad a greater chace of ifectio. There is also a higher chace of other complicatios, icludig miscarriage or malformatio. I additio, babies bor to overweight mothers are more likely to be overweight or proe to cardiac troubles later i life, says Free Olie Semiar Nutritio i Pregacy: A Weighty Issue Thursday, September 27, 7 8 p.m. EDT Obese expectat mothers are at a greater risk for health problems icludig diabetes ad heart disease. Joi Johs Hopkis Ob/Gy Jaice Hederso, M.D., as she discusses weight ad pregacy ad what you ca do to have a healthier pregacy. Lear what chages to make i your lifestyle ad diet that will carry you through your pregacy ad beyod. To register, visit hopkismedicie.org/ itlsemiars. Jaice Hederso, M.D., a materal-fetal medicie specialist at Johs Hopkis. The cliic provides resources that ca help wome make a ivestmet i their ow health ad the health of their babies, ow ad i the future, adds Hederso, who leads the cliic with fellow materalfetal medicie specialist Erika Werer, M.D. For more iformatio, appoitmets or cosultatios, call johs hopkis health summer hopkismedicie.org/iteratioal

3 healthisights The Truth About Me, Wome ad Heart Disease Whe it comes to matters of the heart that is, heart attacks cardiologists are serious about the distictios betwee the sexes. For example, did you kow me are more likely to develop coroary artery disease that ca lead to a heart attack i their 60s, about 10 years earlier tha wome? May experts believe this is partly related to the protective effects of estroge i wome before meopause; however, research at Johs Hopkis suggests that there may be other factors that explai this geder differece, says Pamela Ouyag, M.D., a cardiologist at the Johs Hopkis Wome s Cardiovascular Health Ceter. The cardiac experts at Johs Hopkis emphasize prevetig heart attacks for me ad wome before they happe by idetifyig ad reducig risk factors such as high blood pressure ad high cholesterol. Treatmet may iclude quittig smokig ad icreasig exercise ad, if ecessary, udergoig agioplasty, which is the procedure to ublock a blood vessel, especially a coroary artery, to restore blood flow to the heart. After a heart attack, particularly if it s treated with agioplasty, similar measures ca help prevet a recurrece ad retur people to ormal activity. Our cardiac rehabilitatio programs provide the exercise ad educatioal resources to reduce risk factors after a heart attack, Ouyag says. Guys: The Truth About Ager Maagemet Me who are proe to ager may be askig for a heart attack. That s the coclusio of a study coducted by Johs Hopkis. Ager is probably the emotio that s bee looked at the most, says Ila Wittstei, M.D., a cardiologist at Johs Hopkis. People, especially me, with agry or hostile persoalities are much more at risk for developig heart disease early i life. Negative emotios cause adverse physiological reactios, icludig high blood pressure ad arrowig of the arteries aroud the heart, which ca restrict blood flow ad result i a heart attack. Maagig stress ad ager is oe solutio, but Wittstei also recommeds reducig cotrollable risk factors such as high cholesterol. If you ve had a heart attack i the past four years, Johs Hopkis is seekig male ad female participats for a cliical trial to evaluate whether a medicie may prevet a heart attack from developig. Call for more details. It s OK to Ask for a Secod Opiio If you thik you wat a secod opiio, go with your isticts. Havig aother doctor review your case could be life-chagig. Neuroradiologists at Johs Hopkis published a article demostratig that a secod look at imagig studies resulted i a chage i treatmet or a differet diagosis early 8 percet of the time. Whe it comes to somethig like brai surgery or aother serious itervetio, gettig a secod opiio makes a lot of sese, especially if the first study was doe somewhere that hadles a low volume of cases, says Joatha Lewi, M.D., chairma of the Departmet of Radiology ad radiologist-i-chief at Johs Hopkis. A doctor who cares about your health should welcome your iterest i a secod opiio. Ofte, there may be o eed for additioal tests; just brig the origial imagig study to the secod expert. hopkismedicie.org/iteratioal summer 2012 johs hopkis health 3

4 quickcosult Is Poor Sleep Makig You Sad? Depressio ad sleep disorders such as sleep apea ca go had i had. Stacey Ishma, M.D., M.P.H., a otolarygologist (ear, ose ad throat doctor), sleep medicie specialist ad director of the Johs Hopkis Ceter for Sorig ad Sleep Surgery, has some aswers that ca help put your mid to rest. Is there a coectio betwee poor sleep habits ad depressio? There are studies that show associatios betwee obstructive sleep apea which causes iterruptios i breathig durig sleep ad depressio symptoms. It seems that depressio is more commo i people who have sleep apea. It might have to do with the fact that sleep apea leads to poor sleep quality, which ca make you feel dow or depressed. Ca treatig sleep apea relieve depressio? If you re diagosed with sleep apea ad depressio symptoms, treatig the sleep apea ca improve your mood ad reduce your depressio symptoms. For that reaso, it s a good idea for ayoe who has symptoms of depressio to be screeed for sleep apea ad other sleep disorders. I thik a lack of sleep is affectig my mood. What ca I do to fix this? Improvig your sleep habits ca help. Try to go to sleep ad wake up at the same time every day, ad make sure your bedroom is quiet, dark ad cool. Do somethig relaxig, such as readig, before you go to sleep. For more iformatio, appoitmets or cosultatios, call How do I kow if I have sleep apea, ad what ca I do about it? Sorig is the most commo sig of sleep apea. A sleep study ca give you a defiitive aswer. Treatmets iclude losig weight, chagig sleep positios, wearig detal appliaces ad usig a device called a CPAP (cotiuous positive airway pressure) machie, which helps maitai cotiuous airflow ad steady breathig. Surgery is also a optio for some people. Free Olie Semiar Puttig Sleep Apea ad Depressio to Rest Thursday, October 4, 7 8 p.m. EDT Joi otolarygologist ad certified sleep medicie expert Stacey Ishma, M.D., M.P.H., as she discusses the coectio betwee sleep apea ad depressio, ad treatmets that address sleep issues. To register, visit hopkismedicie.org/ itlsemiars. 4 johs hopkis health summer hopkismedicie.org/iteratioal

5 Youg Heart at Cardiologist Theodore Abraham is raisig awareess about a troublig cardiac coditio amog youths Johs Hopkis cardiologist Theodore Abraham, M.D., has a bold pla to reduce sudde cardiac death, which kills thousads of youg people a year, may of them athletes. Ofte, the cause is hypertrophic cardiomyopathy (HCM). I saw a lot of youg kids come i ad have this coditio with a high risk for sudde death, recalls Abraham, who i 2004 lauched the Johs Hopkis Hypertrophic Cardiomyopathy Cliic. What struck me durig these coversatios was that they were uaware, eve if their ow paret had died, that they were at risk. They were completely uaware. Abraham believed that a large academic medical ceter like Johs Hopkis could egage ad give back to the commuity by offerig a screeig oce a year, with a missio to offer youg people iformatio they would t otherwise have access to; use the screeig to raise awareess about heart disease i the youg; ad research HCM. The most importat thig about HCM, he says, is it s the umber-oe cause of heart-related sudde death i people youger tha 30. It s very ofte publicized whe athletes die suddely, ad very ofte the cause is hypertrophic cardiomyopathy. Three years after lauchig the cliic, Abraham became a ma with a ew missio to lead the ambitious aual Hopkis Heart Hype program that provides free heart screeigs for local youg athletes. To date, Abraham ad a bad of more tha 120 Johs Hopkis voluteers cardiologists, physicias, urses, allied health professioals ad laypeople have screeed more tha 1,000 youg athletes. Abraham has developed a ew screeig protocol that icludes a questioaire, a blood pressure check, a electrocardiogram, a echocardiogram ad a ultrasoud to detect five of the most commo causes of sudde cardiac death i youths. Abraham hopes to see the day whe every youg athlete has a thorough heart screeig i additio to a physical before participatig i sports, which is a cotroversial stace because of costs. We always tell people who are detractors or who challege us, talk to the paret of the 14-year-old who just died, ad fid out what price they d pay for that child, he says. The aswer lies there. Watch a video of cardiologist Theodore Abraham, M.D., right, explaiig why he established the Hopkis Heart Hype program ad what his goals are for hypertrophic cardiomyopathy screeig. Visit hopkishearthype.org. For more iformatio, appoitmets or cosultatios, call Takig Heart Sudde cardiac death is a short-circuit of the electrical system of the heart that ca happe without warig ad without symptoms of chest pai. It teds to show up betwee ages 12 ad 20. about 5 percet of the athletes whom cardiologist Theodore Abraham, M.D., screes have heart abormalities, icludig hypertrophic cardiomyopathy (HCM), that require treatmet. All athletes diagosed with HCM are advised to avoid streuous sports, such as football, basketball, ad track ad field, ad some who are at particularly high risk for sudde cardiac death udergo procedures to have implatable defibrillators placed i their chests to correct life-threateig heart rhythms. hopkismedicie.org/iteratioal summer 2012 johs hopkis health 5

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7 Norma Poulse, M.D., a physicia for 34 years, recalls a patiet he saw recetly. He described a set of symptoms to me, while I mostly just listeed, he says. The we talked about everythig goig o i his life, ad after that I told him we should watch his symptoms for a while before tryig a treatmet. A few days later he set me a ote sayig that our talk had made him feel much better. Just talkig with him had made a differece. Medicie is t always as simple as a good chat, of course. But Poulse, who leads family medicie ad is a regioal director at Johs Hopkis Commuity Physicias (JHCP), says this particular ecouter illustrates the importace to people of gaiig access to top-otch primary care, where a quality coversatio ca sometimes be as importat as ay other treatmet. Primary care ca hadle 85 percet of the problems that patiets have, he says. Ad it ca coordiate all the care eeded for the other problems. I fact, primary care providers medicie s frot lie i guardig our health are icreasigly beig see as the key to the best possible care, as well as to holdig dow health care costs. So importat is it for people to egage with good primary care that may health care systems, icludig Johs Hopkis Medicie, are creatig a ew approach to primary care called medical homes that may become the heart of how care is delivered. Broad Kowledge ad Skills If some people ted to uderestimate the importace of primary care, it may be i part because of the very phrase primary care, says Steve Kravet, presidet of JHCP, the largest primary care etwork i Marylad. The word primary makes people thik of basic or simple, as i primary color or primary school, he says. Kravet otes that the pivotal role of primary care i medicie has bee dramatically drive home i studies of how health care costs ad results vary aroud the world. Simply put, the stroger the emphasis a coutry places o its primary care system, the more likely it is to be highly raked. Primary care physicias are t techically cosidered specialists, Kravet says, but they do brig a special set of skills that ca make a big differece i our health. For oe thig, a primary care physicia ca be adept at spottig a broad, uderlyig coditio resposible for a rage of symptoms. Depressio or a chroic iflammatory disorder, for example, ca maifest i ay umber of ways: stomach discomfort, joit pai or problems with multiple orgas. Primary care physicias are very good at thikig holistically, Kravet says. They kow the patiet ad the patiet s family, ad ca put the illess ito Primary care The comprehesive approach to overall health hopkismedicie.org/iteratioal summer 2012 johs hopkis health 7

8 What to Look for i Primary Care Whe searchig for a primary care cliic or practice, cosider these capabilities: Team care. Icreasigly, primary care physicias are relyig o a team that might iclude a physicia assistat, a urse practitioer, a behavior coach ad others. A emphasis o prevetio. Most people stad to realize big health beefits, icludig lower risks of most major diseases, if they adopt healthier lifestyles. Your primary care team should play a strog role i helpig you achieve that goal. Quality time with the physicia. Although much of your care may come from others o your team, you should still have face time with a doctor you trust, who listes to you, ad who ca help you uderstad the big picture i your health. Electroic records. Care providers should have the ability to access all of your records aywhere i the office, ad eve remotely. Providig you with Web or smartphoe access is a big plus. cotext. What s more, he adds, the primary care physicia has a uderstadig of the medical system that allows him or her to refer the patiet to the right specialist whe eeded. But if primary care medicie has always bee importat, it is becomig icreasigly so i the face of big chages takig place i health care. Oe of the biggest is a growig emphasis o prevetive medicie. Cardiovascular disease, diabetes ad other chroic coditios are very prevetable, says Patty Brow, presidet of Johs Hopkis HealthCare, the arm of Johs Hopkis Medicie that admiisters govermet ad other medical coverage plas o behalf of about a quarter-millio people. Whe you look at the best way to make sure that someoe achieves those lifestyle chages, it s to esure that idividual has a good relatioship with primary care providers. The effect of healthy habits o a perso s life ca be eormous, she adds, otig a example that there is recet prelimiary evidece that a 5 percet reductio i weight i a overweight perso ca reduce the risk of diabetes by 65 percet. Your Primary Care Team To help esure care is delivered most effectively ad efficietly, health care systems are creatig the patiet-cetered medical home. I short, the medical home trasforms a primary care cliic or other facility ito a home base, where most of what a perso eeds for better health is available. Though the primary care physicia remais at the ceter of providig care, a emphasis o a team is importat. This typically icludes urse practitioers, physicia assistats, health coaches, commuity health workers ad more. There are may thigs that ca cotribute to a patiet s health that ca be doe, ad doe very well, by a team member other tha the physicia, Poulse says. I particular, Kravet otes, ophysicia team members ca do much of the coachig ivolved i prevetive medicie. Patiets eed to have time to discuss prevetio with a care provider to really uderstad what it takes to stay well, he says. Are they wearig seat belts? Are they wearig bike helmets? How much stress is there at work ad home? What are their relatioships like? What are their exercise habits? What about smokig ad drikig ad drug use? All the compoets of our lives affect our health, ad explorig them ca take log ad ivolved coversatios with a traied professioal. Kravet says this does t mea the physicia stays behid the scees. Rather, the physicia s time ca be used to zero i o the most challegig issues. People trust their doctors, ad wat to hear their doctors tell them what they eed to do to be healthy, he says. My role is to idetify the key issues ad discuss them with the patiet to come up with a pla. The team members ca help work with the patiet to carry out the pla. Techology Makes It More Persoal Aother compoet of the medical home is electroic medical records that seamlessly weave 8 johs hopkis health summer hopkismedicie.org/iteratioal

9 Dr. Oz o Maagig Your Health May people thik of health care as beig about diagosis ad treatmet at the doctor s office ad the hospital, says Mehmet Oz, M.D. But really, much of what eeds to happe for loger, healthier lives is about the lifestyle chages we ca all make i betwee visits to the doctor. Oz is the Emmy-wiig host of The Dr. Oz Show ad the co-creator of Sharecare, a Web-based, iteractive Q&A platform that eables cosumers to access quality health care iformatio from trusted sources, icludig Johs Hopkis Medicie. He is aware of all that specialized, high-tech medicie ca deliver to patiets who have serious health challeges. But he prefers to focus o what we ca do ourselves, backed by strog primary care medicie. Oz has several mai recommedatios for takig daily prevetive care ito our ow hads to reduce the risks of heart disease, cacer, diabetes, Alzheimer s ad other disorders, as well as to slow dow the ill effects of agig. Amog them: eatig a assortmet of fruits ad vegetables, exercisig, maagig stress ad sleepig better. Whe we egage i healthier habits, some of the positive effects start takig hold right away, Oz says. Ad whe we keep them up, they cotiue to pay off for a lifetime. Gettig good primary care is a importat part of the picture, he adds. It s ot oly that we eed to see someoe who s traied to catch early sigs of problems whe they re most easily treatable, he explais. It s also havig a caregiver who ca liste to you, address your cocers ad sped the time to help get you o the right path to takig care of yourself. These are keys, Oz says, to ejoyig a loger, healthier life. You ca fid aswers to thousads of medical questios, as well as tools ad tips for healthy livig, from Johs Hopkis experts ad others at sharecare.com, a website desiged to simplify your search for quality iformatio o health ad welless topics. together detailed otes from every care provider who sees the perso, lab ad imagig results, ad the like. We re seeig a real trasformatio i the amout of iformatio we ca have at our figertips ow, ad it s lettig us keep track of patiet care i a way we ve ever bee able to do before, Poulse says. Eve whe we re at home, we have full access to all the same iformatio that we d have at the office, ad that meas whe we get a call at ight we ca make decisios that keep patiets safer ad healthier. What s more, Poulse adds, the primary care team ca get reports o which patiets are facig gaps i their care. If patiets do t come ito the office as ofte as we d like, or are t gettig that test they were supposed to get, or are t fillig their prescriptios, Poulse says, we kow it ow, ad we kow what they eed. Armed with that sort of iformatio, the medical-home team ca reach out to get care to the perso, wherever he or she is. I ca have urses or pharmacists iteractig with the patiet by or phoe o a regular basis to reiforce the advice ad prescriptios they got at the office, Kravet says. It s ofte what happes betwee visits to the doctor s office that s most importat to health, he adds. Now we ca cotact them to see if there are ay problems or ay barriers to their improvig, whether it s depressio, cofusio about how to take their medicatio or difficulty i keepig up their exercise. People ca perform some of the betwee-visit moitorig themselves via a website or smartphoe. Not that ay tool will ever fully replace the face-to-face coversatio betwee patiet ad primary care physicia. Poulse recalls goig o a log sailig vacatio some years ago with his family, oly to fid himself thikig about those coversatios. I was really missig hearig patiets tell me their stories, he says. I thik the chace to liste to those stories is oe of the reasos may of us go ito this field. For more iformatio, appoitmets or cosultatios, call or visit hopkis medicie.org/jhcp. hopkismedicie.org/iteratioal summer 2012 johs hopkis health 9

10 secodopiio Do t Take Leg Pai Lyig Dow Treatmets are available for eve the most severe peripheral arterial disease Watch ad liste to Johs Hopkis vascular surgeos discuss the symptoms ad risks of peripheral arterial disease. Visit hopkismedicie.org/ itlsemiars. It so secret that clogged arteries ca edager your heart. But what you might call poor circulatio actually may be a potetially dagerous blockage of large arteries i the legs. This peripheral arterial disease (PAD) is caused by the same kid of fatty deposits or plaque that ca build up i the coroary arteries leadig to the heart. Although the disease is ofte liked to diabetes, the truth is we re all proe to PAD as we age, says Mark Lesse, M.D., a Johs Hopkis itervetioal radiologist, with oe i five people older tha 65 sufferig from the coditio. For people with moderate to severe PAD who may eed revascularizatio (reroutig of blood vessels) to restore blood flow to their legs, the good ews is Johs Hopkis features a expert multidiscipliary team with itervetioal radiologists, podiatrists ad surgeos all workig together to determie a perso s treatmet optios, icludig itervetioal radiology ad vascular surgery. Itervetioal radiology is miimally ivasive, requirig a eedle-sized icisio, Lesse says. Durig the procedure, the doctor passes a catheter ito the blocked artery, iflatig a tiy balloo to ope the blockage ad positioig a tiy metal stet to keep the artery ope. Most ofte, there s a shorter recovery time ad fewer complicatios, Lesse says, addig that there is a trade-off. Depedig o where the disease is, the effects of itervetioal radiology may ot last as log as vascular surgery. I some cases, vascular bypass surgery is a alterative. Thomas Reifsyder, M.D., chief of Johs Hopkis Bayview s Divisio of Vascular Surgery, is a expert i usig a segmet of a perso s vei to bypass the troublesome blockage. People who have the most advaced stage of PAD, kow as critical limb ischemia, face ohealig ulcers ad gagree, promptig some physicias to recommed amputatio. Reifsyder emphasizes the importace of gettig a secod opiio from Johs Hopkis. I frequetly get phoe calls from physicias ad family members of patiets tellig me their loved oes are goig to require a amputatio, he says. Whe I see those patiets as a secod opiio, frequetly the repair or surgery to save that limb is easily doe ad is somethig that ca absolutely chage a patiet s life. For more iformatio, appoitmets or cosultatios, call Whe Achy Legs Are a Warig The classic symptoms of peripheral arterial disease (PAD) are cramplike leg muscle fatigue or heaviess, ad discomfort or pai that occurs i the buttocks, thigh or calf muscles while walkig or climbig stairs. The pai typically ceases five to 10 miutes after you rest or stop the activity. Also be o the lookout for symptoms such as umbess, tiglig ad weakess. hopkismedicie.org/iteratioal summer 2012 johs hopkis health 11

11 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 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 After Your Departure with medical records Assistace with prescriptios Follow-up with cliical ad admiistrative staff Future appoitmet schedulig Cosolidated fial bills NEW YORK Assistace PHILADELPHIA 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, Director, Market Developmet; Steve J. Kravet, M.D., Physicia Adviser. Desiged by McMurry. To fid this issue olie or it to a fried, visit hopkismedicie.org/iteratioal.