2018 • Issue No. 11
Healthy Holidays It’s the perfect time to take stock of your family’s health
• Don’t fear the needle – it’s flu season • Genetic technology allows more precise diagnosis
inside
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2018 • ISSUE NO. 11
AROUND THE STATE NORTHEAST OHIO 14 PERSONALITIES
Medicinal Music
Physician syncs career and love of music 16 THE WRITE ADVICE
Caring for Kids
Treating the youngest patients
NORTHWEST OHIO 18 PERSONALITIES
6 Health for the Holidays The holidays are the perfect time to take stock of overall family health
New Development in Stroke Treatment
New procedure seeks to save lives
CENTRAL OHIO 22 THE WRITE ADVICE
Leading Cause of Death in the U.S. The basics of COPD 24 THE WRITE ADVICE
Bedtime Blues
How blue light from screens affects sleep
SOUTHERN OHIO 26 PERSONALITIES
10 Don’t Dilly Dally
Avoiding the flu means building out-of-season momentum
12 Future Medicine
Technology allows for patients to be studied on the genetic level
The Golden Rule
Physician treats patients the way he wants to be treated 28 THE WRITE ADVICE
Public Health Preparedness Preparing for the worst
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BOOKMARKS www.healthsceneohio.com
HealthScene Ohio
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HealthScene Ohio is published quarterly. For advertising information, call 614-572-1240. Individuals should consult with their own health care providers before making any health care decisions, or for guidance regarding any specific medical condition. No part of this publication may be reproduced without the written consent of the publishers. HealthScene Ohio is a registered trademark of CityScene Media Group. Printed in the U.S.A. Š2018
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There is no routine breast cancer. Breast cancer is never logical or straightforward or routine. That’s why fighting breast cancer with routine treatment just isn’t enough. At The James, you get the expertise of a multidisciplinary team that specializes not just in cancer but breast cancer. They apply their collective thinking toward discovering the most effective therapies, and delivering them at exactly the right time, for you — which means you can count on comprehensive breast cancer care that’s far beyond routine. To learn more, visit cancer.osu.edu/breast.
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HealthScene Ohio
Welcome Welcome to the new-look HealthScene Ohio! In every issue readers will find editorial that covers statewide medical issues affecting everyday Ohioans, success stories as told by patients and their medical professionals and regional profiles of doctors who are at the very least involved, if not leading, groundbreaking research or service organizations. These are stories that communicate what Ohio professionals are doing to advance the quality of healthcare and quality of life for all Ohioans. The magazine includes easy-to-read question and answer columns with doctors from all over the state, features spotlight massage therapists, genetics and allied medicine professionals and a Bookmarks section keeps you up-to-date on the latest health and fitness studies, books, apps and websites. HealthScene Ohio is mailed to more than 35,000 MDs, DOs and DPMs throughout Ohio, with BONUS distribution to waiting rooms, hospitals and health departments. The magazine is also available online and in digital format with pages that flip and clickable ads. Readers of our 2019 issues will see a shift to more healthcare consumer-driven content. Healthcare consumers, much like in the retail and consumer goods worlds, expect more from their healthcare experience these days, thanks in no small part to digital technology. These consumers want an easy, seamless and individualized experience. The things that make healthcare unique are the pressures from government and employers to tamp down costs in the midst of the digital revolution and rising consumer expectations. A shift toward consumer-centricity is today a necessity, rather than a luxury as in years past. According to a recent report, rising healthcare costs are expected to outpace population growth at least four times from 2017 to 2020. Concurrently, there’s been an 86 percent increase in worker contribution to health insurance premiums from 2005 to 2015, and a 67 percent increase in employee deductibles from 2010 to 2015. The takeaway is that consumers are becoming more focused shoppers of healthcare. The importance of identifying a physician, convenient scheduling, waiting room downtime and follow up are part in parcel with the increasing price tag for care. We hope you enjoy this issue and wish you all the best for the holidays and a healthy and prosperous 2019! Regards, Nathan C. Collins Managing Editor www.healthsceneohio.com
Better lives
ONE story at a time. “I was diagnosed with rheumatoid arthritis when I was 29. A few years into wrestling with the condition, I sustained severe damage to both knee joints. I couldn’t straighten my legs. I was lucky to have had Orthopedic ONE take me through my surgery. Now, I can hop out of bed in the morning and pick up my three-year-old and swing her around. I’m so grateful to everyone at Orthopedic ONE for changing my life.” PEER SELECTED 2017-2018
– Tammy Zimmerman, wife and working mom to two active kids
Visit orthopedicONE.com for all of Tammy’s story.
This is where you go to get better.
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A 2005 landmark study published in the Annals of Family Medicine by Ferrer et. al. revealed that up to 26.1 percent of the “variance” in health status comes directly from the family structure and development. In other studies, it has been shown that coronary health, in particular, can actually be related to the spouse of the individual as well. While fascinating in scope, the idea that family can influence health risk factors is also paramount to understand for concerned family – both genetic and by marriage – members and for families with extended health concerns. A great time to assess family members’ health is during the holidays. During the festivities, it can be tricky to evaluate individual family members’ health status, but even a little bit of work can go a long way. “The holidays are a wonderful time for families to get together for the social connection, importance of tradition and perpetuating those across generations,” says
Health for the Holidays The holidays are the perfect time to take stock of overall family health By David Allen & William Kosileski
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Dr. Tanya Gure, M.D., associate professor of clinical medicine, and section chief of geriatrics at The Ohio State University Wexner Medical Center. “Additionally, for the holidays it is important to determine if there are any restrictions or concerns about dietary preferences, as that should be something that is clarified before the festivities so that the appropriate foods can be available.” Family members also should remain mindful of the consistency and types of food available at holiday meals, including liquids. Salty and fatty foods can lead to exacerbation of a pre-existing heart condition, even one meal. Common medicines, such as blood pressure medications, are something of which to be particularly aware. Gure advises patients about the inherent dangers of alcohol, as overindulgence can interact adversely with prescribed medications. “Blood pressure medicines also do not work well with alcohol. Additionally, mixing pain medicines with alcohol can also become problematic,” says Gure. “Generally avoiding that or minimizing alcohol consumption or having alternatives available for meals is important to have.” However, even more than just the festivities themselves, it is important to assess the overall well-being of family members, specifically when it relates to elderly family members. It is important to ask them questions regarding their
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home life and general safety. Elder abuse is also much more common than recently understood. According to the World Health Organization, nearly one in every six people over age 60 experienced abuse at home. Age is the primary risk factor for elder abuse and any person who relies on dayto-day assistance is at risk for abuse, as it is widely underreported. “It is important to distinguish vulnerabilities that have come up in life that would cause them to have issues with independent living and independent function,” says Gure. “If there are any concerns about not being able to manage finances, or trouble with keeping track with investments and stuff like that, that puts patients at a high risk of abuse.” Another thing to watch out for is injuries, such as those arising from falls. “Falls can also be a good indicator of health. Falls are called sentinel events. I consider those to be an identifiable trigger and they require further evaluation, especially those with serious injuries,” says Gure. In regard to mental capacity, Gure says one indication that may suggest the presence of memory disorders are very subtle behavioral changes, such as slight attitude changes or crankiness, or having trouble with previously established rituals, like brushing teeth. These can occur at the onset of disorders and are important to keep in mind.
“If there is something that seems off with personality or difficulty with a hobby, that’s something to be concerned about,” Gure says. Apart from the assessment of elderly family members, it’s important to discuss, and potentially be a part of specific health situations regarding those in the family who have lifestyle restrictions including diabetes, Crohn’s disease, ulcerative colitis, Alzheimer’s disease, hypertension, chronic obstructive pulmonary disease and congestive heart failure. “Patient history is very private and we don’t give the go ahead unless we get the permission from the patient. However, if there is an opportunity to be a part of their healthcare experience, that would be great for the individual,” says Gure. Staying Healthy and Independent With Age Regardless of a person’s gender, profession or age, maintaining a healthy lifestyle is by no means a simple endeavor. This is especially prominent in elder adults, who often veer toward a less active, sedentary lifestyle as they age, which can potentially translate into health issues. Luckily, there are several programs, practices and trends implemented by geriatricians throughout the country that help adults 65 or older sustain an active lifestyle as they age, no matter their health status. Here in Ohio, Gure works with senior patients to help them live a healthy lifestyle through physical activity. “Exercise is incredibly important. I talk about that with just about every patient that I see. The programs I tend to emphasize in discussing with my older patients are mostly around trying to diversify their fitness portfolio,” Gure says. “I always kind of describe it that way so they understand that there’s more to it than just choosing one type of activity.” The fitness portfolio that Gure talks about includes four main components: aerobic exercise, strength training, flexibility and balance. According to Gure, a healthy mix of each of these types of physical activity can help to reduce injury, improve toning and manage weight, among other things. While each individual has different circumstances, preferences or limitations, Gure notes that elders
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can do these exercises on their own or, if necessary, with supervision of a caregiver. But more often than not, she recommends that her patients either do the exercises privately with a certified trainer or physical therapist, or in a group fitness class. “I try to take stock of what my patient has been doing over the course of their life to get an understanding of how new they are to these concepts, how much they’ve done in their day-to-day, because I want them to have a positive experience,” Gure says. “So I will often try to get a sense of what they’ve been doing and what they enjoy, and then provide them a recommendation around starting physical activity either through the support of using a trainer or through a physical fitness class.” Another trend that is being used in geriatrics is isometric exercise, which is a type of strength training that forces muscles to work against each other or a certain object. With older patients, this can be done with the use of resistance bands or straps. “It is strength training where you don’t have to load up a lot of weight in order to really be able to tone that muscle,” Gure says. “I think isometrics increases the appeal of fitness in (older adults), that may not be comfortable with lifting weights or using barbells.” In addition to working with a physical therapist or a trainer, Gure notes there are programs such as SilverSneakers, which is available through a lot of Medicare plans, and local recreational activities like chair volleyball or pickleball, that can help seniors maintain a healthy level of physical activity. “We’re fortunate in the city of Columbus, and also I’m sure in the metropolitan cities around the state of Ohio, that there are programs like this that exist that raise awareness of the importance of having places where seniors can go for physical activity,” Gure says. While physical fitness is a key component to overall health, mental health is another important factor. Mental health programs require very different and specific prescriptions, such as occupational or speech therapy. “There are some speech programs that do focus on cognitive training and behavioral training that can be prescribed when there’s a new change in cognitive function, either from a head injury, concussion or mild cognitive impairment,” Gure says.
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New State-of-the-Art Movement Specialty Program Comes to Westerville Amenities abound for active seniors in their golden years By Nathan Collins As part of its expansion project, Parkside Village has opened additional independent living, assisted living and memory care apartments along with a new state-ofthe-art Movement Specialty Program. The first of its kind in Ohio, this new program features highly trained staff and programming designed specifically to benefit residents with Parkinson’s Disease and other movement disorders. The Movement Specialty Program has been implemented to serve residents impacted by Parkinson’s disease and related Parkside Village movement disorders. Designed to improve A Danbury Senior Living Community balance and prevent falls, the exercise 730 N. Spring Rd., Westerville program is based on content developed by 614-794-9300 NeuKinetics, creators of online courses in the health and wellness fields. www.danburyseniorliving.com “The most critical aspect of Life Enrichment at Parkside Village is to give our seniors a sense of purpose,” says Katherine Benalcazar, director of life enrichment at Parkside Village. “We are here to help our residents maintain a quality of life and we want them to feel like they are not only able to contribute to our community, but the greater community as a whole. Everyone has a different idea of life enrichment at this stage of life, so we offer a wide variety of events and activities to try and meet their needs.” In addition to restaurant-style dining, all day, every day, noteworthy amenities include entertainment such as billiards and movies, card and book clubs, regular happy hours and a whole host of arts and crafts classes. “We recognize that aesthetics and amenities are important, but the most important thing is the love and care our residents receive each day,” says Kristel Smith, director of admissions and marketing at Parkside Village. “Without that, a building is just a building, but with it, a building becomes a home,” said Kristel Smith, director of admissions and marketing at Parkside Village.
In addition to being physically active and preserving strong mental health, Gure has myriad tips for individuals age 65 or older. These pointers include, but are not limited to: • Quit smoking cigarettes, or don’t start. • Keeping alcohol consumption within a very moderate range (one drink or fewer per day). • Maintaining a well-balanced diet that incorporates each of the major food groups. Eating leafy green vegetables and minimizing fats are a very important part of a healthy diet.
• Being compliant with a medication regimen for blood pressure control, if needed. “It’s important that older patients try to set reasonable goals,” Gure says. “Goals that are attainable, specific and that really allow them to have something within a range that they can work toward.”
William Kosileski and David Allen are contributing writers. Feedback welcome at feedback@cityscenemediagroup.com.
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Don’t Dilly Dally Avoiding the flu means building out-of-season momentum By Nathan Collins
It’s that time of year! Yes everyone, please form a line so flu shots can be administered. No? Afraid of needles? That’s ok, it’s more common than one might think. Trypanophobia – an extreme fear of medical procedures involving injections or hypodermic needles affects millions of people, especially during the flu season. So much so, that many avoid vaccination altogether, to the disappointment of doctors everywhere. According to the Ohio Department of Health, an estimated 200,000 people are hospitalized with the flu each year in the U.S. An average of 20,000 flu-related deaths are reported annually. Ohio reported 17,397 flu-related hospitalizations for the 2017-18 season. There were four pediatrics deaths that season related to the flu. All adults and children older than six months are encouraged to get a flu vaccine by the Centers for Disease Control and Prevention (CDC). The flu shot is not infallible and those who last year were vaccinated and still suffered the illness attest to that. However, the CDC conducts its due diligence and tweaks the vaccine to target the viruses that are expected to circulate. For the trypanophobes too distraught by the thought of vaccination, we’ve provided some alternative, but effective tips to avoid viruses. 10
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Sickly Stats • 31 flu-related deaths in Cuyahoga County • 1,750 flu-related hospitalizations in Cuyahoga County • 27 flu-related deaths in Summit County • 23 flu-related deaths in Medina County Tips for the Trypanophobic • Avoid sick people • Be considerate – stay home if you’re sick! • Cough/sneeze into your elbow to avoid spreading germs • Use antibacterial wipes liberally • Sanitize. Sanitize. Sanitize. • Get enough sleep. Your body achieves the most recovery during sleep. • Smokers have more respiratory infections. This is a fact – quit smoking!
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Future Medicine Technology allows for patients to be studied on the genetic level By Matthew Kent
What once was a common theme within science fiction writing, technological advancements in personalized medicine allow doctors the ability to deconstruct a patient at the genetic level to formulate a patient-specific therapy. Precision medicine allows oncologists to more precisely diagnose why a particular cancer grows, according to Dr. Sameek Roychowdhury, a physician scientist with The Ohio State University Comprehen12
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sive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. “We’re really trying to refine what is going on with that person’s cancer that makes it unique and defines why their cancer is growing and why it’s spreading,” Roychowdhury says. Roychowdhury indicates that if he were to evaluate 100 patients diagnosed with lung cancer, each one might be different based on their genetics. “You might find 25 percent of them have an abnormality and another 1
percent of those patients … might have something very different,” Roychowdhury says. “What that means is that everyone’s cancer is quite unique and rare … and you try to match patients with the right therapy so, from beginning to end, it’s understanding the disease more precisely.” In doing so, it can help develop diagnostic tests that can identify patients based on their biology and offer a specialized therapy, Roychowdhury says. “It turns out that if you can match patients with therapy based on their biology, you’re more likely to do well www.healthsceneohio.com
Photo courtesy of OSUCCC-James
and, in cancer for patients who have aged, you’re more likely to improve your survival, more likely to have response to the disease tweaking or improving, and avoiding therapies that may be less effective,” he says. Precision medicine started in the research lab around 2008, while doctors at OSU and elsewhere started using basic research technologies three years later for gene sequencing for patients through pilot studies. “More recently, in the past five years since 2013 and onward, the technologies are growing and growing in youth and many are not standard and routine, but many are being used in clinical trials at the James and other cancer centers. That sort of began the two-part movement for precision medicine, which is understanding the biology and making a diagnostic test,” he says. “The sequencing technologies can help us do both of those.” The typical way of identifying a person’s cancer through traditional methods has been determining where it came from, with the help of a microscope. However, technology known as next-generation sequencing is cheaper and faster and allows doctors to look at genetics. “We’re now able to use technology to study the genes of our patients on a more routine basis … and we’re now using DNA and RNA sequencing, the building blocks of the genetic code, and we’re characterizing one person’s cancer at a time,” he says. That involves identifying genetic changes in a person’s DNA, allowing doctors to determine what changes are driving one person’s cancer versus another person’s cancer. “That discovery (and) research turns into diagnostic tests … and diagnostic tests and results can be used by an oncologist to see what type of therapy might be matched,” says Roychowdhury. Patients are now being treated not solely based upon the type of cancer www.healthsceneohio.com
they have, but how it interacts with their genetics as well. “This is the cutting edge of development of clinical trials and oncology and I would say only a fraction of clinical trials are doing this and it’s still growing,” Roychowdhury says. “Ten years ago, there were no trials with this, but today, 5 to 10 percent of the trials being developed follow this paradigm of genomic-based medicine.” Roychowdhury, who has been at OSU since 2012, says that studies of precision medicine have also shown that if a doctor is treating a patient in which a marker has been identified, a medical professional is more likely to improve their outcome and survival and response rate. “They’re more likely to benefit and live longer than if you were to choose another therapy without a marker,” he says. “I think the benefit is there, but the challenge is there’s a shortage of therapy and we need more therapy developed.” Still, he says that more discovery and research also need to take place, noting that the biology and genetics of all cancers hasn’t been determined yet. Over the next 10 years, he hopes doctors will learn more about the biology of cancers while more drugs are approved. “These technologies are allowing us to do all of those things … and so, there are some areas where we know quite a bit, but there’s much we don’t know,” Roychowdhury says.
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We’re really trying to refine what is going on with that person’s cancer that makes it unique and defines why their cancer is growing and why it’s spreading.”
Matthew Kent is a contributing writer. Feedback welcome at feedback@ cityscenemediagroup.com.
Dr. Sameek Roychowdhury
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AROUND THE STATE
NORTHEAST OHIO
Personalities
Medicinal Music
Physician Connects Love for Sound to Clinical Practice By Cameron Carr
Publicly, Dr. Neil Cherian refers to himself as a closet musician. While it’s true that his daily work focuses less on music and more on clinical practice and some research collaboration, he’s managed to sync his career in neurology with his passion for sound and music.
Cherian, a staff physician at the Neurological Institute and member of the Center for Neuro-Restoration at the Cleveland Clinic, consults and participates in several audio and music organizations including The Rock & Roll Hall of Fame and Audio Engineering Society. He has had the opportunity to collaborate with and befriend musicians including bassist Bootsy Collins (Parliament Funkadelic, George Clinton) and drummer Jerry Marotta (Hall & Oates, Peter Gabriel, Indigo Girls). More specifically, he’s managed to incorporate this personal interest into his regular work focusing on tinnitus and other hearing-related disorders.
Thinking Like An Engineer The sides of Cherian’s family are split: his father’s side is full of engineers while his mother’s is full of physicians (his mother excluded). Excelling in science but not initially seeing himself as interested in interacting with patients regularly, Cherian chose to pursue electrical engineering at the University of Michigan. After a research opportunity involving brain data taken from EEG tests piqued his interest in medicine, Cherian used his additional college courses to fulfill the university’s pre-med requirements, in addition to his degree in electrical engineering. He continued to receive his medical degree from the State University of New York before completing his residency in neurology at Strong Memorial Hospital of The University of Rochester. “I feel more like an engineer than a doctor and I don’t feel like I could’ve done it any other way,” Cherian says. “I probably wouldn’t have liked medicine in the same way if I didn’t have that engineering (background).”
Cherian actively incorporates his engineering training and mindset into his work. He says that thinking like an engineer can be particularly beneficial when dealing with difficult cases where symptoms might be misleading. “Doctors are by no means unintelligent but we were never taught to think in a purely logical framework and, in general, we end up thinking in algorithms,” Cherian says. “Think about it like a roadmap: when I’m at the edge of the roadmap and conventional medicine fails me or fails the patient, it’s kind of using engineering logic and concepts and other things (to continue).” Making Music Out of Medicine After getting started in medicine, Cherian worked to connect his passion for sound and music to his work. This led him to look deeper into tinnitus, a brain disorder often leading to the perception of noise or ringing in one’s ears. In his practice, Cherian generally works with patients experiencing tinnitus or other
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A headache disorder can cause dizziness, a headache disorder can cause ringing of the ears and things, so part of it is data collection and part of it is data interpretation. So, my engineering brain is trying to kind of collect data, process it, and formulate it into a bigger picture.”
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issues involving hearing, dizziness, and balance. His engineering background has proven beneficial at tracing patients’ symptoms back to possible root causes. “A headache disorder can cause dizziness, a headache disorder can cause ringing of the ears and things, so part of it is data collection and part of it is data interpretation. So, my engineering brain is trying to kind of collect data, process it, and formulate it into a bigger picture,” Cherian says. While these issues are often associated with those who frequently experience loud music or work environments, Cherian points out that they can affect most anyone, even those without acoustic trauma where the condition may be influenced by a virus or other factor. www.healthsceneohio.com
Cherian continues to raise awareness of the importance of hearing protection and the prevalence of hearing loss and related disorders including tinnitus and hyperacusis. He served on the American Tinnitus Association’s board of directors for six years and is currently on the Audio Engineering Society’s hearing and hearing loss subcommittee. In addition to all of this, Cherian still finds time to play music and make use of his home recording studio, however casually. “I’m not a great musician but I think I have a good ear,” Cherian says. “I think I could become a better musician when I have some time to put more time into it.” Cameron Carr is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
Dr. Neil Cherian received his medical degree from the State University of New York Health Science Center in Brooklyn, New York. He completed his residency at the University of Rochester and underwent postdoctoral training at the Massachusetts Eye & Ear Infirmary at Harvard Medical School. He is currently a member of the Audio Engineering Society’s subcommittee on hearing and hearing loss and contributes to Neurology, the journal of the American Academy of Neurology. He was a member of the American Tinnitus Association’s board of director’s for six years. HealthScene Ohio
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The Write Advice With Maggie Ash
Caring for Kids
Akron Children’s Hospital professional speaks on what medical treatment is like for the youngest members of our families at their most difficult times Dr. John Pope is a pediatric intensivist, director of medical education and attending physician in the Pediatric Critical Care unit at Akron Children’s Hospital. A graduate of Case Western Reserve University School of Medicine, he is certified by the American Board of Pediatrics and Pediatric Critical Care Medicine. In addition to roles at Akron Children’s, Pope is a member of several medical associations and an assistant professor of pediatrics at Northeast Ohio Medical University. In 2014, he was awarded the Akron Children’s Distinguished Service Award, which is the hospital’s highest employee honor. HealthScene Ohio: Most people are familiar with pediatricians, either from going to one as a child or taking their children to see one. How does your subspecialty of pediatric intensivist differ from a more general pediatrician? Dr. John Pope: One way to answer this is to look at how we’re trained. Everybody 16
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thing about pediatric critical care is that who goes into pediatrics does three years we take care of children essentially from and when you’re done with the three years you’re qualified to be a general pedi- birth until they’re adults. Statistically, more of the children we take care of are atrician. If you want to do a subspecialty, it’s usually another three years. So, to be a younger, so our biggest age group is going pediatric critical care physician you go on to be under two. and train in critical care for another three years. We practice pretty much exclusively HSO: How has pediatric cardiac care changed since you’ve been in hospitals, usually in children’s hospipracticing? tals and more commonly in a pediatric JP: The growth in pediatric cardiac and intensive care unit. The patients we take congenital cardiac care has really just been care of are children who have sometimes incredible in my career and I’ve life-threatening illnesses, critical been doing this for 26 years now. medical illnesses such as pneuFor example, many babies used monia or meningitis, traumatic to not be able to survive, but injuries from car or bike accinow there are options to fix their dents, and children who have had surgery such as heart or hearts to some degree and allow neurosurgery to remove a brain them to have a relatively normal tumor. It’s a wide practice and life. The care continually keeps the common theme is children changing and the technology Dr. John Pope who are relatively ill or at least keeps getting better and better. have the potential to become sicker. HSO: Working with children rather HSO: What are some of the most than adults in any profession common critical conditions that you poses unique challenges. What treat in children? Are there certain difficulties arise specifically in groups or ages of children that pediatric critical care? you’re more likely to work with due JP: The biggest difficulty is that little to these conditions? children can’t understand what they’re JP: The most common conditions we going through. You can have an adult on see are respiratory illnesses and respiraa mechanical ventilator and that adult can actually be awake and interactive. A tory failure, especially starting (in winter) two-year-old is not going to be able to do with viruses. That’s our biggest group of that, so it’s a challenge to help them get patients. The challenging and interesting www.healthsceneohio.com
es actually walking them around. Keeping people moving when they’re sick is a way to get them better faster. HSO: Along with kids, you also interact with children’s parents and caregivers. How do you navigate difficult family relations when a child is in critical condition? JP: The biggest thing is to gain the parents’ trust, that they believe we’re all really trying to do the best thing for their child. I think listening to the parents and being empathetic to their situation is also very important, especially with parents who have children with chronic diseases. They know their children better than anybody and it’s really important that the health care team listen to them and work with them. HSO: Critical emergencies are rarely anticipated events. However, what are your tips for parents to avoid critical situations with their children? JP: Pediatrics is all about prevention. Immunize your children. There are diseases I used to see 30 years ago that don’t exist anymore in the ICU thanks to immunization. Put bicycle helmets on your children and put children in car seats and seatbelts. If you have guns at home, please lock them up. Eight children die or are injured every day from guns in the house. It’s really those preventative things that are important. through that experience. It requires that we sedate the children, which has its own risks. That’s the biggest challenge, trying to help the children deal with a situation that they have no idea what’s going on and that they certainly don’t want to be in. HSO: What treatment techniques and methods of care do you use for children that readers receiving adult medical care might not realize? JP: We tend to have to sedate the children a little bit more than you would an adult. We do have some wonderful people www.healthsceneohio.com
called child life workers who really help work with children. They help them get through procedures like blood drawing and putting in IVs and help parents work with their children to soothe them. We’re doing some new things where we’re trying to do nonpharmacologic therapies to help children on ventilators. In the old days we used to really heavily sedate the children, keep them in bed and not allow them to move. Now we’re going the complete opposite direction where we’re taking children that have a breathing tube in and sitting them up, and in some plac-
HSO: Professional resources in pediatric critical care are extensive, but what are some resources for readers to stay informed about pediatric health? JP: The website at Akron Children’s Hospital, www.akronchildrens.org, has a parents section (found under Health Information and Kidshealth Topics). There’s a lot of information contained on there. The other website I’d recommend is the American Academy of Pediatrics, www.aap.org.
Maggie Ash is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com. HealthScene Ohio
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Personalities
New Development in Stroke Treatment
Strokes account for roughly 20% of deaths in the U.S., but a progressive operation seeks to save lives By Kendall Lindstrom
As the leading cause of long-term disability in the United States, nearly 800,000 people suffer from stroke each year. As the number of stroke-related deaths grows, one development in the field is the endovascular thrombectomy, a breakthrough surgery that is predicted to minimize stroke deaths and resulting disabilities in survivors. Dr. Syed Zaidi, medical director of the Neurointerventional Lab at ProMedica Physicians Group in Toledo, is on the forefront of this advancement and answers some questions about the operation and its future. HealthScene Ohio: Could you describe the surgical procedure behind an endovascular thrombectomy? Dr. Syed Zaidi: An endovascular thrombectomy is a minimally invasive procedure for opening large blood vessels that are responsible for potentially devastating strokes. This is a catheter-based procedure during which a small incision 18
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is made in the groin, allowing us to access a large blood vessel in the leg known as the common femoral artery. Through this vessel, we are able to maneuver our catheters into the blood vessels supplying the brain. We first take pictures to ascertain the site of the blockage, then track our highly advanced catheters to the site of blockage in the brain. At this stage, we either suction out the blood clot or use a device called a stentriever to trap the clot before pulling it out. HSO: What type of medical complication would require this surgery? SZ: An endovascular thrombectomy is targeted to remove blood clots in certain vessels supplying the brain, but not all strokes are amenable to endovascular thrombectomy. There are other endovascular procedures we perform to help treat certain types of hemorrhagic or bleeding strokes. HSO: What makes endovascular thrombectomies more successful than other treatments for strokes? SZ: Prior to the advent of endovascular thrombectomy, only intravenous tissue plasminogen activator (tPA) was used to treat strokes in the early phase (within 4.5 hours). IV-tPA is very effective for smaller clots, but as the burden of clot
increases, as in the larger vessels, IV-tPA is not as effective. Large vessel occlusions result in a much higher rate of severe disability and death compared to other types of blockage or ischemic strokes. Studies have shown that IV-tPA results in recanalization of about 15 percent of large vessel occlusions, whereas endovascular thrombectomy has more than an 80 percent rate of recanalization. Furthermore, patients can undergo endovascular thrombectomy up to 24 hours after the onset of stroke symptoms, compared to IV-tPA, which can only be safely used within the first 4.5 hours. HSO: How effective are endovascular thrombectomies? SZ: The endovascular thrombectomy is one of the most effective treatments in modern medicine. Recent studies have shown that even up to 24 hours after the onset of stroke, the number needed to treat is two – this means that for every two people treated, one person will have a significantly improved outcome compared to patients who do not receive the same treatment. HSO: What risks or side effects are associated with this procedure? SZ: The surgery requires a small incision in the groin, which results in a risk of www.healthsceneohio.com
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bleeding and infection. At the incision site, we can have other vascular complications such as pseudoaneurysm formation or blockage of the leg vessels. Furthermore, kidney damage is possible from the dye injected to visualize the vessels. Complications from radiation overexposure are also possible but are relatively rare. The most serious complications can result from inadvertent injury to the blood vessels leading up to the brain or perforation of a blood vessel in the brain itself. The rate of complication varies from 5-8 percent. HSO: What is the recovery like for patients who have undergone an endovascular thrombectomy? SZ: Patients who have received mechanical thrombectomies oftentimes have dramatic improvements immediately after removal of the blood clot. These are some of the most rewarding moments for us. Other patients may take a longer time to recover depending on the extent of the stroke. This treatment is very time dependent, and the earlier the patients can reach the appropriate stroke center the higher the chance of recovery. HSO: Do you foresee the endovascular thrombectomy becoming the main treatment for all ischemic stroke victims, or is there a more specific candidate required to perform the procedure? SZ: Most strokes are not caused by large vessel occlusions and thus cannot be treated with endovascular thrombectomy. Endovascular thrombectomy is only effective for the most severe types of blockage or ischemic strokes. We are now able to treat smaller vessels of the brain than in the past, but since each procedure has risks and the effectiveness of IV-tPA is better for distal vessels, it is unlikely that endovascular thrombectomy will become the main treatment for all ischemic strokes. Whether you have a small or large stroke, the best outcomes are noted with earlier treatments, which is why early recognition of stroke by family members, friends and co-workers with activation of 9-1-1 is so crucial. HSO: How do post-surgery disability prospects differ in patients receiving the endovascular thrombectomy as opposed to other surgeries? SZ: Since mechanical thrombectomy is a minimally invasive procedure, there is 20
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usually no disability from the procedure itself. Besides the three to four hours of bed rest to minimize groin complications, patients post-procedure do not have any significant limitations of the activities they can perform if their recovery from the stroke allows it. That being said, recovery after stroke is slow, and stroke specialists understand this; that is why all stroke studies look at disability and functional outcomes at three months rather than a few days after a stroke. Patients who do not receive the endovascular thrombectomy are more likely to have severe disability, may not survive the stroke or may need neurosurgery to prevent death. HSO: How do you foresee endovascular thrombectomies impacting the progression of stroke treatment? SZ: Endovascular thrombectomies have revolutionized the treatment of stroke over the last decade. In the past, we had no good treatments for patients with such large and severe strokes. Now we are very effective at preventing severe disability and death in a large percentage of patients. The endovascular thrombectomy will continue to grow around the U.S. and worldwide, and hopefully we will continue to expand and provide this treatment to all patients, not only those who live in larger cities near thrombectomy centers. Technological advances will likely make the treatment even safer, cheaper and more effective over the next few years. HSO: At what stage of implementation is the surgery currently in Ohio? SZ: Ohio currently has 11 comprehensive stroke centers certified by the Joint Commission. This means that 11 hospitals meet the standards to treat the most complex stroke cases and have fulfilled the standards for the mechanical thrombectomy. Additionally, there are several primary stroke centers throughout the state that have the capability to perform the surgery. Our goal for Ohio should be to develop relationships so that every hospital has the capability to transfer eligible patients to thrombectomy-capable centers in a timely manner. In an important legislative advancement, Ohio House Bill 464 was recently referred to the senate committee that would mandate stroke center recognition and establish EMS protocols for severe stroke patients.
HSO: Where is this treatment being practiced? How soon do you expect it to spread to nationwide medical centers? SZ: The endovascular thrombectomy is currently performed at most large hospitals in the U.S., Canada, Europe, Australia and China and is gaining ground in the Middle East and South America. Within Lucas County, in collaboration with the local hospital systems and Lucas County EMS, we have created a pathway whereby patients exhibiting moderate to severe stroke symptoms are quickly identified and directly taken to a facility where advanced stroke treatments such as mechanical thrombectomy are available. We started this initiative in 2015, and this system of care – compared to our own previous model – has made us very time efficient. Nationwide, there is an ongoing attempt to adapt similar stroke care pathways. Within the United States, there has been a significant increase in the number of thrombectomy-capable centers over the last few years, and I expect this number to continue to grow. This treatment has gained a lot of momentum nationwide over the past five years. With our aging population, I hope to see this treatment available and accessible to everyone in the U.S. within the next few years. In the meantime, it is imperative that there is a system of care in place to 1) recognize stroke patients who are potential candidates for thrombectomy, and 2) direct transport/transfer to the most appropriate stroke center as early as possible. Kendall Lindstrom is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
Dr. Syed Zaidi is the medical director of the Neurointerventional Lab at ProMedica Physicians Group in Toledo. His specialties include stroke, brain aneurysm and interventional neurology. Zaidi received his medical degree from Dow Medical College in Karachi, Pakistan, in 2001 and completed his residency in 2007 at Cleveland Clinic Florida in Weston, Fla. He has also served as assistant professor of neurology at the University of Toledo since 2012. www.healthsceneohio.com
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AROUND THE STATE
CENTRAL OHIO
The Write Advice With Emily Chen
COPD: A Leading Cause of Death in the U.S. Breaking down the basics of Chronic Obstructive Pulmonary Disease By Emily Chen
Chronic Obstructive Pulmonary Disease (COPD) affects the lives of tens of thousands of Ohioans. The CDC reported 44.6 to 49.7 deaths per 100,000 people in Ohio during 2014. Rates of COPD are usually higher in the Midwest. COPD is an umbrella term for a large number of lung issues such as emphysema and chronic bronchitis. Smoking can lead to COPD, which means a lifetime of short breaths, wheezing and cough. Dr. Asegid Kebede, a pulmonologist at Licking Memorial Hospital, answers questions about this disease that affects so many. HealthScene Ohio: COPD is a reality for many Ohioans. What’s the best way to make the chronic condition easier to live with? Dr. Asegid Kebede: COPD is a challenging chronic disease. The patient must be committed to better health. The patients who follow recommendations from their physician will have improved 22
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quality of life. Treat COPD flares as soon as possible. Get vaccinated for seasonal influenza and pneumococcal pneumonia. Frequent hand washing and use of hand sanitizers are essential. Avoid stress, eat a healthful diet, exercise routinely and, most importantly, do not smoke. You should always keep your rescue inhaler with you. Use your regular inhaler as prescribed. HSO: How are emphysema and chronic bronchitis connected to COPD? AK: COPD is a term used during the diagnosis of patients who have chronic bronchitis and/or emphysema. Patients usually have both emphysema and chronic bronchitis, and we treat both conditions similarly. The symptoms of emphysema and chronic bronchitis are similar and both conditions are caused by smoking. Because of those reasons, we use an umbrella term – COPD. HSO: What are symptoms of the condition? AK: Common symptoms of COPD are chronic cough, sputum production and shortness of breath. Additional symptoms may include chest tightness, fatigue and weight loss.
HSO: Smoking is one cause of COPD, but are there others? AK: Smoking is the No. 1 cause of COPD. Exposure to dust and chemical fumes can also cause COPD, but that is rare. Patients who have asthma and smoke cigarettes will likely develop a severe form of COPD at an early age. Alpha-1 antitrypsin deficiency is a genetic abnormality that causes COPD. HSO: With the rise of vaping and e-cigarettes, do you think that there will be more COPD cases in future generations? AK: This determination is unknown. Although vaping and e-cigarettes are unsafe, the practices do not appear to possess toxins equal to cigarettes, so risks seem lower. However, vaping and e-cigarettes are new, and the long-term effects www.healthsceneohio.com
are unknown. In the future, both could prove to cause COPD as well. HSO: Who is the typical COPD patient? What do they look like? AK: The typical COPD patient is 5060 years of age. The individual usually has a significant history of cigarette smoking. HSO: How is the body affected by COPD? What happens to lungs? AK: COPD is primarily a lung disease; however, it has several other manifestations involving different parts of the body. A patient with COPD may experience osteoporosis, weight loss, anxiety and depression. COPD increases your risk of getting coronary artery disease.
HSO: Does COPD break along ethnic lines, and if so, why? AK: COPD affects all races and both genders. Minorities have a lower survival rate from COPD because of limited access to quality health care.
AK: This depends on the severity of the disease. Patients who are compliant with their care have better outcomes. Those who have additional health issues, including heart disease, have the lowest survival rate.
HSO: What do survival rates look like for COPD?
Emily Chen is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
HSO: What’s being done to reduce rates of COPD? AK: Tobacco cessation awareness and education in general, as well as focus on youth education. More and more public locations have been deemed non-smoking areas, which also reduces secondhand smoke issues. HSO: What are some resources for people with COPD? AK: Tobacco cessation and personal commitment to improving life is crucial. Family support is extremely helpful. Depending on the severity of diagnosis, lung volume reduction surgery or transplant may be a resource available to a patient. Dr. Asegid Kebede is a sleep expert and pulmonologist at Licking Memorial Hospital in Newark. Kebede earned his degree from Jimma University in Ethiopia. He is board certified in the fields of pulmonary disease, critical care medicine, sleep medicine and internal medicine. Kebede completed his residency at St. John’s Episcopal University N.Y. and his fellowship at the State University of New York. He has years of experience treating sleep disorders and pulmonary diseases like COPD. www.healthsceneohio.com
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AROUND THE STATE
CENTRAL OHIO
The Write Advice With Maggie Ash
Bedtime Blues
How does blue light from our screens affect sleep?
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It’s well-understood that checking one’s phone in bed can affect sleep. Not only does it train the body to think that bedtime does not equal the time to sleep; but the blue light emitted from the screen – whether that’s a smartphone screen, tablet or television – can actually disrupt the circadian clock. Lack of sleep might make one cranky, but more serious side-effects can include heart attack, diabetes, depression and more. HealthScene Ohio sat down with Dr. Matthew Kunar of OhioHealth to discuss blue light and its effects on sleep. HealthScene Ohio: According to the National Institutes of Health, between 10 and 30 percent of adults experience mild to chronic insomnia symptoms at some point in their life. What are some indicators that an individual may be suffering from insomnia? Dr. Matthew Kunar: Insomnia can be a big problem for people, their personal lives and professional lives, too. When we see someone that is having difficulty with good, impactful sleep, those individuals complain of fatigue, irritability and can struggle with an inability to concentrate. Over time, they might be able to deal with a few of these issues, but eventually these clusters of symptoms caused by an inability to sleep can lead to major health problems. HSO: How does blue light from cell phones, tablets and other electronic screens affect sleep? MK: To simplify it, blue light can mimic, at least for our brains and senses, the light we get from the sun. Too much blue light can actually trick sensors in our www.healthsceneohio.com
brains to want to stay awake or wake up. On the other side of that, a dark room set up with blackout shades or even a nice soft night light can lead to different feelings in the brain and help the body get into a more comfortable place. This leads to the start of restorative deep sleep. When there is that light triggering your body, there is a real chance that you won’t be able to ever get into that deeper sleep, which is restorative. If you stay in that lighter sleep state when you wake, you could still feel tired, meaning you haven’t been getting that quality sleep your body wants and needs. HSO: Are there any uncommon sources of blue light that individuals don’t anticipate? MK: People who fall asleep with the television on, and you have that light flickering in the room could impact your sleep. Computers if you have a home office that is in your bedroom and that light coming from your monitor that might be on all night or an iPad might cause the same issue as your phone. HSO: How do you typically treat insomnia in your own patients? MK: The first and really the easiest thing to do is to keep your devices in another room. Without them right by your side there won’t be the temptation to grab them before you sleep or right as you wake up. Check the settings on your devices as there are ways you could adjust the brightness or tone of the light. Developing a routine is critically important. Get to bed at a decent hour and give yourself time to allow your body to prepare for that sleep. Don’t eat or exercise after a certain hour, as both could trigger sleep issues. Also, find good temperature control in your room and have pillows and blankets that promote good sleep but don’t have a negative impact. Many people want to jump to a sleep aid, but I suggest to patients that they start with melatonin. In order for that to be used effectively, you have to
take it regularly. It doesn’t generally work if you take it on an as-needed basis. HSO: Beyond blue light, what are other common causes of insomnia that you treat? MK: One of the most common reasons for insomnia or non-restorative sleep is sleep apnea. There are machines that can help with that, or sleep studies that can look into what is happening, which allow specialists to present the patient with options. We do also see people with anxiety or depression or shift workers who struggle with having to sleep at nonregular hours. HSO: What are the dangers and side effects of not practicing healthy sleeping habits? MK: Overall, not getting enough sleep can lead to decreased concentration, irritability, weight gain, stress on the heart and not being yourself. If you feel you are not as productive or reaching your highest potential, or not connecting with family and friends because you are tired all the time, it might be time to talk with your doctor. There is good news, though; with proper bedtime techniques and good sleep hygiene, you can see quite an improvement in a relatively short amount of time. Maggie Ash is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com. Dr. Matthew Kunar is director of medical education at OhioHealth Dublin Methodist Hospital and a family medicine physician at OhioHealth Primary Care Physicians in Dublin. He completed his residency at Dewitt Army Community Hospital in family practice and received his medical degree from the Ohio University Heritage College of Osteopathic Medicine. HealthScene Ohio
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AROUND THE STATE
SOUTHERN OHIO
Personalities
The Golden Rule
Gallipolis doctor treats patients the way he would want to be treated By Cameron Carr
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Dr. Andrew Dittenhofer lives by an age-old principle: treat others the way you want to be treated. Specializing in general surgery and Robotic-Assisted da Vinci surgery at Holzer Health System, the golden rule takes on a new meaning.
Based in Gallipolis in a largely rural area of southeast Ohio, Dittenhofer strives to make himself understandable and approachable for patients. “I know a lot of medical terms, but I think about it as if I go to the mechanic shop and a mechanic spends his time trying to explain to me how a transmission works – because I have no idea how a transmission works – then I can take some extra time to explain how somebody’s cancer diagnosis may affect their life and the options around it,” Dittenhofer says. “The easiest part about relating to your patients is to know that they’re human beings just like you, they have problems, and they’re seeing you sometimes on the worst day of their life.” Practicing Reciprocity A career in medicine had long been a goal for Dittenhofer, dating back to his time as an Eagle Scout in the Boy Scouts of America. There he discovered a strong interest in the first aid procedures that paired with his enjoyment of subjects such as biology and engineering. He decided to pursue surgery specifically while studying medicine in college, but he sees his work as a continuation of the skilled trades practiced within his family. Likewise, he sees this as a connection to the community he serves. “A lot of my patients are active hardworking people,” Dittenhofer says. “So, it’s good to be able to relate when you use your hands.” Dittenhofer values his connection with patients, it’s part of his moral set, as evidenced in his practice, to meet them half
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way and make himself relatable. That’s part of the reason he chose to become involved with the Walk with a Doc program at Holzer. “When the patients hear that I had a salad for lunch and I grow my own vegetables and I’m going for a walk tonight even though Hurricane Flo’s coming in tonight … they really appreciate it when you’re honest with them and you don’t have an unhealthy physician trying to preach healthy habits to somebody who’s unhealthy because you lead by example,” Dittenhofer says. Walk with a Doc, founded by Dr. David Sabgir in Columbus and now an international organization, aims to encourage healthy physical activity while also breaking down barriers between patients and practitioners by arranging for doctors to lead open walks within their communities that patients can join for casual conversation. Dittenhofer says the program has been beneficial in making it easier for patients to seek advice. “It’s much easier to talk to a friend about a personal issue than it is to talk to a complete stranger,” Dittenhofer says. “You get down on the level of everybody and you realize that, ‘hey, if they realize that the doctor’s a normal guy like you then they won’t feel silly about asking (questions).’” Walk with a Doc is one way that Dittenhofer works to give back, but he also tries to remember the contributions of mentors during his education. He’s particularly conscious of the personal time others sacrificed in order to aid him. At Holzer he has opportunities to work with students from both the University of Cincinnati and Ohio University. “As a father I realize how important that time they spent with me is so I try to pass it along,” Dittenhofer says. “I always look at it that I’ve had so many people who invested in me, that I should pay it forward and invest in these people’s education.”
It’s always very rewarding to me to know that I helped this person with the skills that I developed over the years.”
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Moving Forward with Robotics In addition to his specialty in general surgery, Dittenhofer also practices with Robotic-Assisted da Vinci Surgery. Dittenhofer faces some misconceptions about robotic surgery assistance, mainly misconceptions that the automatons manage the procedure instead of the surgeon, but generally patients appreciate the benefits of the technology. “It’s another tool in the surgeon’s armament that allows their patients to get better faster, have less pain and, especially where I live in a more rural area, to have more advanced procedures that may not have been available previously,” Dittenhofer says. “If you can explain to people that you’re doing a big surgery through smaller incisions and that it should lower their hospital stay they typically hear the information they want.” The da Vinci technology allows Dittenhofer to do more complex procedures, some that would otherwise require patients to travel significantly longer distances for treatments at larger facilities. For him, the technology is just another method to achieve his end goal of helping patients. “Beyond being able to treat people with medicine it’s really important to me to be able to physically cure someone,” Dittenhofer says. “It’s always very rewarding to me to know that I helped this person with the skills that I developed over the years.” Cameron Carr is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com. Dr. Andrew Dittenhofer completed his undergraduate degree at Ohio University. He is a graduate of the Pikeville College School of Osteopathic Medicine in Pikeville, Ky. Dittenhofer interned with Bluefield Regional Medical Center in Bluefield, W. Va., before fulfilling his residency at East End Health Alliance in Long Island, N.Y. He currently practices at Holzer Health System’s Gallipolis and Jackson locations. HealthScene Ohio
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AROUND THE STATE
SOUTHERN OHIO
The Write Advice With Maggie Ash
Public Health Preparedness
Preparing for the worst while hoping for the best National health security is defined as the state of existence in which the nation and its people are prepared for, protected from, and resilient in the face of catastrophe and related health consequences. Local health departments play a key role in achieving national health security. Dr. Steven Englender, director of the Center for Public Health Preparedness in Cincinnati, provides insight on what it’s like to prepare for the worst, while at the same time hoping for the best. HealthScene Ohio: Can you list the different types of public health emergencies and provide a brief description of them? Dr. Steven Englender: Public health is involved in a variety of types of disaster response. It goes beyond our visual role of ensuring and providing immunizations, healthy moms/well baby, stuff like that, and beyond the usual recordable diseases. Outbreaks and even worse, epidemics and pandemics, are obviously public health emergencies currently. Ohio is one of the many states engaged in responding to hepatitis A, but when we’re talking about preparedness activity, we’re really talking 28
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about all hazards and disasters. Those can be both natural and man-made. Natural ones can include things like extreme weather, whether that’s drought and heat, ice storms and cold and hurricanes. Man-made disasters can come in a variety of forms too. Simply, the world that we live in poses dangers from all sorts of things that we create. In terms of disaster preparedness, you often hear the term CBRNE, which is Chemical Biological Radiation Nuclear and Explosives. These are categories of things that are, generally speaking, man-made. I think if you look at Hawaii with volcanic activity, that’s a natural catastrophe, at least if its localized. But one of the things that clearly defines disaster versus single event, public health gets engaged with mass causalities. That might be a disastrous event, but that’s not the type of thing that we plan for in ways to mitigate effects on population before these things occur. If there’s a chemical release from a rail car incident, public health’s role in that, as opposed to emergency management and hazardous materials, our role would be to monitor the population that may be exposed and provide the risk guidance, assist with the decision-making for the types of things that we can do to avoid ill effects – and that is either shelter-inplace or evacuating. Before nuclear, I think we can all remember Chernobyl, no such disaster ever occurred again. That was obviously not a terrorist attack, but concerns are high
from homeland security about both dirty bombs, radiation dispersal devices, as well as small scale nuclear. The likelihood of that is not public health’s role but being prepared, we’re there in the event where radiation monitoring of a population is needed. Explosives, obviously, this is something the world has been dealing with. It doesn’t fall to public health to prevent that, but to ensure with our partners, at least in most U.S. plans and terminology, our partners in health care as part of emergency support function at least. Which is public health’s meta-goal, that the systems work to get help to those based on the degree of injury and the potential injury. That’s much like any other mass casualty, where public health itself is more of a supporting role, but we do have a role to play. HSO: What are some recent public health emergencies that have occurred in Ohio? SE: Chemical exposures are not infrequent in Ohio. The reality is that our railroad infrastructure is aging, derailments do happen and sometimes that can involve chemicals. Here, public health has somewhat a peripheral role, HAZMAT is going to be the group making assessments, and fire departments work with HAZMAT. A while back, and this is more than a decade ago, there was a rail car filled with styrene (used as raw material in makwww.healthsceneohio.com
ing foam cups) that started leaking and produced an exothermic reaction. Given the right circumstances it’s supposed to expand and multiply the material. This was located near the municipal airport in Cincinnati and that airport is surrounded by residential homes. Because of this rail car that leaked for several days before it could be fully mitigated, we ended up indicating to people within a certain radius that they really ought to go elsewhere until fumes were under control. Public health’s role there was not only in helping determine who needed to be evacuated in Cincinnati but also, we have a chemical monitoring and detection piece that’s led by the health department. Our job with that is to monitor not the hot spot, but the edges of it for population exposure. The fire department is www.healthsceneohio.com
who goes in and deals with whatever the chemical event is. Our role was to monitor the neighborhoods with handheld devices that identify toxic fumes. HSO: What role does public health play in the event of natural disasters? SE: For the kinds of weather-related disasters, our role may be unseen. The Ohio River floods infrequently, but that’s not something we can control. Nature has its way of being far more powerful than our attempts to tame it. But our role typically is not one you think about. Here, restaurants are along the river. They may get flooded. Our folks have to ensure that not only are they cleaned up appropriately but any foods that may have been contaminated by river water have been
thrown out, which is not something that people think about necessarily, but is very important to protecting health. HSO: Has Ohio ever been the target of a bioterrorism attack, either foreign or domestic? SE: In terms of bioterrorism, we probably have to go back to the French and Indian War, where a general threw blankets from soldiers that had died of smallpox. Biologic terrorism has been a fairly rare event in the U.S. and not necessarily recognized at the time. For that, a good example is the cult group in Oregon who sprayed salmonella on salad bars to try and influence an election to have their leader be elected to the country court. That is a very interesting situation that we found out about sometime after, and HealthScene Ohio
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it’s not your usual form. Was that really terrorism? We didn’t call it that in the ’70s, but several cities in Ohio as well as across the nation continually monitor the air for select agents that could be used in a biologic incident – plague, tuberculosis and smallpox are monitored on a continuous basis, so we’re always looking for it. Fortunately, it has never been found. Vigilance is the price of freedom, and certainly in the context of biologic events, significant monitoring goes on across the country to be able to have early indicators where that could happen. A lot of states have syndromic surveillance, which is a method by which continual monitoring is analyzed for trends. If there’s an increase in unusual events that are consistent with a biological agent, we would receive an alarm to look into it. Obviously, this doesn’t mean the events are the result of anything that isn’t natural, such as going back to school and an increase in respiratory disease or increase in flu-like symptoms that occur every winter during flu season. The bottom line is that there have been no biologic terrorism events of which I’m aware. The potential for some has been created, in the work to better understand and prepare. For exam-
ple, sterilized anthrax spores were supplied by Dugway Proving Ground, one of the army installations and had been done so for years. What was recently discovered was that the radiation that Dugway used to provide these samples of sterile, nonreproductive anthrax spores to research institutions throughout the world were in fact not fully sterile. This just shows how the potential for biologic agents comes in many unexpected ways. HSO: What does it mean to shelter in place and what are some emergencies where this plan of action would be appropriate? SE: Shelter-in-place is used when either the exposure by being outside or the agent or problem at hand has more risk of remaining outside. Typically, this will be caused by airborne stuff, so actions such as turning off the air conditioning and closing all the windows are needed. If this is summertime, things will be a little bit stifled because avoiding bringing in outside air would be the better method as opposed to getting out of the area. Evacuations are very disruptive, difficult to manage and difficult to ensure that people are really gone. It’s much easier
to see that people are off the streets. So many of the chemical events that are expected to be short lived would require the shelter-in-place. But, shelter-in-place would be the appropriate risk mitigation should there be a radiation dispersal device. Typically, these things would be predicted to have short- term and long-term effects. After a nuclear explosion, the first 24 hours are most critical to avoid fallout, then the risk decreases over time. But when radioactive particulates are attached to dust or products of an explosion, that’s another shelter in place situation, but for the much longer term. HSO: How can citizens prepare themselves for impending health emergencies or other forms of crisis? SE: We have long partnered with a multitude of agencies, most prominently the Red Cross about the basic tenets of preparedness: have a plan and make sure that you can get information. If you think back to the derecho “a series of intense thunderstorms” from Hurricane Ike, where a million people lost power in Ohio, getting information was very difficult. You can’t watch television if you
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have no power. You need batteries and a radio, or a crank radio, to get information. In terms of having a plan, it’s what you need to stay self-sufficient. Three days supply of food and water is minimum, two weeks is what we talk about if we have disruptions caused by a severe epidemic. Part of a plan is how do you meet up with loved ones? What are your points of contact? What relative out of town do you talk to that others in the family will also talk to in case you’re separated in terms of some sort of disastrous event, whether it’s a tornado or a terrorist event? People don’t think about it often. In the coastal areas like Florida, people who have heard this message kind of know about evacuations for hurricanes. I’m not sure that in areas that don’t face these reoccurring disasters have taken the message to heart as well. HSO: What essentials constitute a robust emergency preparedness kit? SE: Redcross.org is a great place to see the list of things you need. You need appropriate supplies for the number of people in your family. For water that’s a gallon a day per person. If possible, you
put away and rotate several cases of water to ensure you have drinking water. You need to make sure you have food that is canned and ready to eat. You’re not going to have your microwave, unless you’re one of the lucky people with a generator to replace the power if it goes out. Having a can opener and other utensils is important. There are a variety of suggestions for the kinds of things needed in Red Cross materials and linked from local health department agencies. People often forget medication, and it’s not necessarily easy to ensure that you have an extra month’s supply for those with chronic illness. For example, people who are on insulin need to have enough to get them through if you can’t get them to a pharmacy. In the types of disasters that destroy homes, people really need to have copies of their important papers, physically and on a flash drive, so you have records of the various things that, if your home is destroyed, are very hard to rebuild. If you prepare for it, it’s a much easier time through the difficult process of rebuilding your life. Lighting devices, flashlights and candles, these things are important because around this time of year it is dark more than half the time.
HSO: Where can citizens be directed to learn about, and remain abreast of, potential public health emergencies? SE: Centers for Disease Control and Prevention, CDC.gov, has got an incredible compilation of information both for the general public as well as healthcare professionals. For emergency preparedness, there are vast resources including tips, reminders and infographics at many local health departments. Our webpages will link you to that information, it really doesn’t take a whole lot of searching. Maggie Ash is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
Dr. Steven Englender is a preventive medicine physician in Cincinnati. He received his medical degree from Case Western Reserve University School of Medicine and has been in practice for more than 20 years.
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Bookmarks In the News Cancer cells’ use of sugar holds the key to their destruction www.medicalnewstoday.com
Scientists have suggested a way to improve treatments that use viruses to attack cancer. Catharine Paddock, Ph.D., discusses how this treatment exploits the fact that cancer cells need a lot of glucose and must metabolize it rapidly to survive. Depression: Electrical stimulation can ‘significantly’ improve mood www.medicalnewstoday.com
New research shows that deep brain stimulation can tackle treatment-resistant depression. Ana Sandoiu looks at how stimulating a brain area called the orbitofrontal cortex and the significant improvements in mood for people with moderate to severe depression.
Phone Apps 7-Minute Workout Challenge App $2.99; iOS, Google Play An app designed with busy lifestyles in mind, the 7-Minute Workout Challenge App helps you transform your body in just seven minutes per day. Blogilates Free; iOS, Google Play Blogilates is the brain-child of Cassey Ho, a YouTube star known for fitness videos. Ho has become widely recognized for creating the #1 female fitness channel on YouTube. With this app you get access to daily recommended workouts featuring Cassey’s unique pop-infused Pilates.
FDA overhauls approval process as medical devices come under fire www.cnn.com
As the U.S. Food and Drug Administration publicizes its plans to overhaul the process for manufacturers that want to market medical devices in the U.S., Susan Scutti highlights an investigation by a nonprofit newsroom reporting more than 80,000 deaths potentially linked to medical implants since 2008. A New Year, new food resolution: Water www.cnn.com
According to the old rule of thumb, you’re supposed to drink eight glasses of water per day. That can seem like a daunting task on some days, but here’s the catch: You don’t have to drink all that water. Lisa Drayer writes about how best to remain hydrated. Is the CRISPR baby controversy the start of a terrifying new chapter in gene editing? www.vox.com
A Chinese scientist shocked the world when he reported that he’d created the world’s first babies genetically edited with CRISPR: a set of twin girls, with a third 32
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potential CRISPR baby on the way. Julia Belluz covers the story that has rocked the scientific world. Sperm Count Zero
www.gq.com
According to journalist Daniel Noah Halpern, a strange thing has happened to men over the past few decades: they’ve become increasingly infertile, so much so that within a generation we may lose the ability to reproduce entirely. FDA Approves ‘precision medicine’ drug for different cancers with same mutation www.washingtonpost.com
The Food and Drug Administration recently approved a drug for a wide range of cancers based on a shared mutation. Laurie McGinley discusses the advance for the sometimes controversial field of precision medicine.
Charity Miles Walk & Run Tracker Free; iOS, Google Play Need a little external motivation? Run or walk for the benefit of your favorite cause with Charity Miles. Earn money for charities with every mile and choose from 40 unique charities. Couch to 5k Free; iOS, Google Play The Couch to 5k app, or C25K as many call it, is designed to get you from couch potato to 5k runner, no matter what your starting fitness level. Daily Yoga Free; Google Play More than 400 yoga poses await you in the Daily Yoga app, with scheduled plans designed by the pros to help you reach your goals.
Women sleep better with dogs than with human partners, study says www.huffingtonpost.com
Brittany Wong explains why, according to research, women tend to sleep better next to dogs than they do next to members of their own species.. Why your health is the key to your success in business www.entreprenuer.com
Take care of yourself, and your business will take care of itself. Bedros Keulian offers some practical advice for entrepreneurs treating their bodies well. How might my oral and dental health change as I age? health.usnews.com
The body and mouth are intricately connected and maintaining good health across both parts require ongoing care. This article by Elaine K. Howley gives some details on how good oral and dental health is an important aspect of overall health. www.healthsceneohio.com
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