Ocotber 2012 | North Georgia’s Health & Prevention Magazine
Meningitis IN THIS ISSUE
Meningococcal disease most often affects those age 15 to 24. The disease, which attacks key organs, can kill a healthy person in days.
Meninges layers What
Spinal cord
Diseased dura mater
Nerve root
Vertebr a (bone) Disc Hea
Brain
Head
happens Bacteria attack dura mater, one of the layers of the meninges membranes covering the brain and spinal cord
Potential carriers
carried in nasoMeningitis forms and Bacteria causes pharynx of about 5-10 percent of people; when a page carrier coughs, sneezes 2
Spinal cord
Nasopharynx Back of nasal passage
Prostate Diaries
or shares a drink or cigarette, bacteria can infect others
Symptoms
High fever, headache, stiff neck develop in several hours or over two days Nausea, vomiting, discomfort with bright lights, confusion, sleepiness Skin rashes occur in about half the cases
Deadly results
page 8
Cerebral spinal fluid surrounds brain, spinal cord
FEATURING
PAGES 12&13
Brain swelling Blood infection Respiratory failure Organ shutdown
Source: American Medical Association, U.S. Centers for Disease Control and Prevention, Dr. Gwendolyn Scott of the University of Miami School of Medicine and University of Miami/Jackson Memorial Medical Center Graphic: The Miami Herald Š 2004 KRT
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Meningitis has various forms and causes By Shannan Finke
may choose to give prophylactic medication to family members or close contacts of the ill person,” A recent meningitis outbreak has said Sandy Bozarth, RN and infecturned deadly, and it has raised tion prevention and control coormore questions than answers. What dinator with the Northeast Georgia is meningitis? Is it contagious? How Health System. Prophylactic medicine is did this outbreak happen? Understanding meningitis and designed to prevent a disease from its symptoms is key to protecting occurring; in this case, it contains yourself from becoming its vic- the spreading of meningitis to othtim, according to Dr. Andrew Dold, ers who may be susceptible. But those who have been infected who works with Northeast Georgia Health System and specializes in by the type of meningitis released internal medicine and infectious in this year’s outbreak are battling an entirely different illness. disease. A steroid drug contaminated “The signs and symptoms of meningitis make it very alarming. They with the fungus Aspergillus has been blamed for the fungal mencan be very subtle,” said Dold. Symptoms can range from fevers ingitis outbreak that has caused and headaches to light sensitivity multiple deaths and numerous and fatigue. A stiff neck is another other infections since its release. distinguishing symptom, yet none Unfortunately, this meningitis is of these signs are unique to menin- one of the most difficult types to treat, according to Dold. gitis alone. Bozarth explained that every “The problem is that a lot of people encounter symptoms like these outbreak-infected patient had on a day-to-day basis,” Dold said. received a tainted epidural steroid injection containing a medication “That’s what can make it scary.” While there are several kinds of that had been mixed in a pharmeningitis, each is caused by an maceutical compounding center infection that creates an inflamma- in Massachusetts, something that tion of the meninges, the coverings makes an outbreak like this a rare that surround the brain and spinal occurrence. “The Food and Drug cord. It’s seen most often in children, teenagers and young adults, Administration and state pharmacy but the elderly and those with a boards regulate pharmacies and compromised immune system are drug manufacturers,” said Bozarth. “This incidence will certainly also vulnerable. The most common types include increase the regulations of comviral and bacterial meningitis.While pounding pharmacies across the viral tends to be the most common United States.” Fortunately, fungal meningitis is and least severe, bacterial is very serious and can result in brain dam- not contagious. And while an outbreak like this is uncommon, it’s age and even death. In most forms, meningitis is con- uncertain how much worse the tagious. Regardless of the type, all current one will get. “It’s scary. Who knows if this is meningitis needs to be diagnosed and treated by a doctor for the sake the tip of the iceberg,” said Dold of the patient and those who could of future meningitis cases caused from the outbreak. “Fortunately, have been exposed. “Depending on the organism that this is not something that happens causes the illness, the physician often. sfinke@gainesvilletimes.com
Meningitis
Meningococcal disease most often affects those age 15 to 24. The disease, which attacks key organs, can kill a healthy person in days.
Meninges layers What
Spinal cord
Diseased dura mater
Nerve root
Vertebr a (bone) Disc Hea
Brain
Spinal cord
Head
Nasopharynx Back of nasal passage
happens Bacteria attack dura mater, one of the layers of the meninges membranes covering the brain and spinal cord
Potential carriers Bacteria carried in nasopharynx of about 5-10 percent of people; when a carrier coughs, sneezes or shares a drink or cigarette, bacteria can infect others
Symptoms
High fever, headache, stiff neck develop in several hours or over two days Nausea, vomiting, discomfort with bright lights, confusion, sleepiness Skin rashes occur in about half the cases
Deadly results Cerebral spinal fluid surrounds brain, spinal cord
Brain swelling Blood infection Respiratory failure Organ shutdown
Source: American Medical Association, U.S. Centers for Disease Control and Prevention, Dr. Gwendolyn Scott of the University of Miami School of Medicine and University of Miami/Jackson Memorial Medical Center Graphic: The Miami Herald © 2004 KRT
The Times, Gainesville, Georgia |
Meningitis outbreak: questions and answers By Amina Khan
Los Angeles Times
slurred speech.The symptoms can be slight, the CDC says.
Q: What is the source of the outbreak? A: Investigators have linked it to a steroid treatment that is injected into the spinal column to alleviate back pain. This is a very common procedure — millions of patients receive injections each year, said Dr. Shaheda Quraishi, a physiatrist at the Cushing Neuroscience Institute on Long Island in New York. The drug in question — preservative-free methylprednisolone acetate — came from the New England Compounding Center in Here’s a closer look at the state of Framingham, Mass.Three tainted batches of the steroid were sent to 75 medical facilithe outbreak. ties in 23 states. NECC has since shut down and recalled all of its products. Q: What is meningitis? Thus far, Tennessee has been hit hardest A: Meningitis is an infection that by the outbreak. causes inflammation of the meninges, the membranes covering the brain Q: Why was the steroid injection preserand spinal cord. The infection can be vative free? viral, bacterial or fungal. Those who A: Preservatives can cause arachnoiditis, have become sick as a result of the an inflammation of the arachnoid layer of recent outbreak are suffering from a the spinal cord and brain, Quraishi said. fungal variety. Some patients may also have allergies. So Fungal meningitis is extremely rare, it’s generally best to avoid putting them in though it can be caused by spores epidural injections. commonly found in the environment. The nationwide fungal meningitis outbreak has been linked to a tainted back pain treatment from a Massachusetts compounding facility. Health officials continue to investigate the cause, with the U.S. Centers for Disease Control and Prevention reporting earlier this month that some 14,000 patients in 23 states have been injected with the potentially tainted steroid, which was recalled.
Q: Is fungal meningitis contagious? A: No, the infection can’t travel from person to person. The fungus infects people once it’s injected into the central nervous system. Other types of meningitis are contagious. According to the CDC, the bacterial variety can be passed through nose and throat fluids (such as during kissing), and the viral variety is often spread by fecal contamination (when people don’t wash hands after using the toilet).
Q: Who is at risk? A: People who have had an injection and who are experiencing any symptoms should contact a doctor as soon as possible, the CDC said. The incubation period is usually between one and four weeks, but the CDC says infections have been known to surface outside that window, and the contaminated steroid could have been given as early as May 21.
Q: What is a compounding facility? A: These facilities are set up to create medicines that are tailored to a specific Q: What are the symptoms of fun- patient’s needs. They can take a manufacturer’s drug and raise or lower the dose or gal meningitis? A: They can include weakness, change it from solid to liquid form.They’ve worsened back pain, stiff necks, mild Please see Q&A page 11 headaches, light sensitivity, fever and
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Sunday, October 28, 2012
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Heart valves can leak or harden, especially with age By Charles Phelps
cphelps@gainesvilletimes.com You’re out with your friends, you feel a heaviness in your chest with some shortness of breath when walking briskly, then it goes away and you’re fine. But are you really? Those sensations may not be a fluke pain or mild heart attack, but actually a problem with a heart valve. “Most patients don’t know about (heart) valves,” Dr. Pradyumna Tummala, cardiologist at Northeast
Georgia Heart Center, said. “They know what blockages and heart attacks are. The symptoms can be similar.” Symptoms of leaky, or hardened, valves include shortness of breath, fatigue, chest pains, irregular heart beat and passing out. Some of these symptoms are also similar to what congestive heart failure entails. “There are many abnormalities of heart valves that can affect people of any age,” Tummala said. “Valve problems can start at birth.”
In adults, two valves cause the most problems, the mitral and the aortic valves. The mitral valve is located between the left atrium and left ventricle. The aortic valve is located between the left ventricle and the aorta. In most cases, your regular doctor may catch the problem by hearing a “heart murmur” while listening to your heart with a stethoscope. He or she may also order an echocardiogram (an ultrasound video of the heart), if the history or physical exam suggests heart problems. Heart valve problems are typically treated with medications till they become severe — then, the valves are repaired or replaced through surgery. One of the most common problems with valves occurs after age 60. The aortic valve become hardened and impairs blood flow out of the heart by not opening well.
Tummala said this may cause “chest discomfort, shortness of breath or passing out,” and leads to a valve replacement. Recently, a new minimally invasive procedure has been developed to replace the aortic valve without opening the chest. According to Tummala, the procedure is done through a small incision in the leg artery with the new valve delivered to the heart with a catheter (flexible tube). When it comes to medication for those that have had a valve replacement, or some work done to a valve, Tummala says, “People with a replacement need antibiotics.” Those who haven’t had a replacement valve but aren’t sure if they need to be taking medication, should talk with their cardiologist, at which point they will make a decision as to prescribe them to take a medication, or not, Tummala explained.
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The Heart Center gives you access to the state’s #1 rated cardiac program. Our heart care team is selected more than any other heart program in the region. Joon Ahn, MD Mitchell G. Davis, MD Allison G. Dupont, MD Abhishek Gaur, MD Brenda J. Hott, MD Jay H. Joseph, MD Christopher R. Leach, MD
Mark E. Leimbach, MD J. Jerey Marshall, MD Mark A. Matthews, MD Lalitha C. Medepalli, MD Gary M. Minkiewicz, MD Kashyap B. Patel, MD Salem N. Sayar, MD
Timothy A. Scully, MD Mehrdad S. Toosi, MD Prad E. Tummala, MD S. Steven Wang, MD Heather B. Westmoreland, MD Mark W. Wolozin, MD Andrew D. Yen, MD
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Editors: SUB corrects spelling of stomach Sunday, October 28, 2012
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Acid reflux not always a serious problem By Charles Phelps
cphelps@gainesvilletimes.com Have you ever had a chest pain that leaves after a couple seconds? What about a heartburn that may or may not persist? If so, you may be experiencing the first signs of acid reflux. However, not all acid reflux is uncommon or harmful in daily life. “All of us have some physiologic reflux that is usually short lived and not really bothersome,” Dr. Scott Clark, of Gastroenterology & Associates, said. “GERD (gastroesophageal reflux disease) is usually more than one symptom, and usually involves some chronicity and may or may not have heartburn associated with it. “(GERD) can have chest pain, dysphagia, water brash and regurgitation as part of the symptoms. However, not all those folks have symptoms.” Over-the-counter medicines can and will help control symptoms, but if you’re taking them more than a few times a week, daily therapy may be the best option, according to Clark, “It varies, some want relief right away, but it takes a few weeks before (the patients) can tell if the prescribed medication is going to work for them,” said Maria Perez, a medical assistant at Gastroenterology & Associates. Clark also suggested the lowest dose of medicine that works is the best treatment to fight against GERD. “Start with the H2 blockers such
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Sleeping position and acid reflux A new study found that sleeping on your left side can reduce the burning acid flow into the esophagus called gastroesophageal reflux disease.
LYING ON RIGHT SIDE Esophagus (food tube)
Stomach
LYING ON LEFT SIDE Acid less likely to leak into esophagus Any that leaks can flow back into stomach faster
as Zantac (heartburn relief medicine), then work up to the protonpump inhibitor like Nexium, if not improving,” Clark said. Acid can flow, “Then you have to worry about or “reflux,” downward a possible hiatal hernia. This can into esophagus occur due to age and obesity. The process of a hiatal hernia moves the lower esophageal sphincter up To prevent reflux: Avoid into the top of the stomach and the eating high-fat foods for diaphragm.” several hours before going to The diaphragm acts as a barrier to bed stop this occurrence from happening. If a hiatal hernia occurs, your SOURCES: American Journal of Gastroenterology, New England Journal of Medicine chances increase of having reflux HealthNews symptoms, and surgery becomes Graphic/LEE HULTENG/KRT 9/29/99 the only curable option, according to Clark. Age plays a major role in reflux. The older you are, the more prevalent reflux becomes. Clark says this occurs because of the loss of the muscle. This occurrence happens with the hiatal hernia; a major muscle that protects and holds back reflux symptoms breaks down and puts you at risk of symptoms occurring. More specifically, the diaphragm acts to give the lower esophageal sphincter added reinforcement so no acid is able to get into the esophagus. If these occurrences aren’t taken care of, cancer can be a consequence. “The real thing to worry about is esophageal cancer. Two types, but the adenocarcinoma type is almost FILE KEYWORD RELATED KRT PRODUCTS AND always due to damage from acid CATEGORY: HEALTH health, medicine, gastroenterology, reflux,” Clark FILEsaid. NAME: SUB Sleeping acid.fh8 stomach, acid, reflux, leak, flow, burn, ILLUSTRATOR: LeecomplicaHulteng Other, but less serious heartburn, gastric, liquid, contents, sleep, H. McComas position, side, right, left, drain, intestine, tions can RESEARCHER: include: strictures, dysORIGIN: mccomas, hulteng, skrt, 1999, risk, women phagia, cough andKRT aspiration. GRAPHIC SIZE: 2 col. x 3.5” POSTED: 9/29/99
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Medicare tries to steer seniors from low-ranked managed care plans By Diane C. Lade
performers. Medicare HMO participation was projected to increase by 11 percent next year. The stars are based on several For the first time this year, Medicare factors including patient satisfaction suris sending home bad report cards on its veys, the availability of screenings and vaccines, and the plan’s ability to manage under-performing private plans. Americans with Medicare managed chronic conditions. Insurers support the concept of care plans or stand-alone drug plans started receiving notices last month if their rewarding quality care, said Robert coverage had been rated 2.5 stars or less Zirkelbach, spokesman for America’s in the past three years in the government Health Insurance Plans, and rankings insurer’s five-star system. The govern- overall have been inching higher. But ment is so serious about steering people he said the industry remains concerned away from low-rated plans, it has disabled that the ratings truly reflect things that the electronic enrollment tool for those benefit consumers and don’t unfairly penalize certain plans operating in rural offerings on Medicare’s website. It’s all part of Medicare’s push to force or poor areas. About 9 percent of enrollees nationchronic under achievers to improve care quality.And there’s reward as well as pun- wide are in plans with fewer than three ishment: Plans with higher ratings can stars and another 7 percent are in plans get bonus payments of up to 5 percent not rated by the federal Centers for of their contracts, expected to total $3.1 Medicare and Medicaid services, according to the nonprofit Kaiser Family billion this year. Edith Gooden-Thompson, the Broward Foundation. Seniors have until midnight Dec. 7 to County, Fla., coordinator for the Serving Health Insurance Needs of Elders enroll in managed care or stand-alone Medicare counseling program, antici- drug plans. Those who later decide they pates getting calls from puzzled seniors are unhappy with their choice will be as the letters start hitting mailboxes able to drop that coverage and go back especial during the Medicare open to traditional Medicare, starting Jan. 1 enrollment period that started Oct. 15. through Feb. 14. Doug Goggin-Callahan, director of eduShe stresses that no one will be forced to leave the lower-starred plans or lose cation at the Medicare Rights Center, said there could be cases where a low-starred coverage. The notices just encourage beneficia- plan could be a senior’s right choice, ries with low-ranked coverage to care- depending that person’s finances, docfully review what they’re being offered tors and medical needs. So far, the cenand shop around — something everyone ter hasn’t determined any commonalties on Medicare should do anyway, Gooden- among low performers, he said. But ultimately, he thinks the star ratings Thompson said. Medicare officials, when announcing will be good for consumers. “If you are early 2013 plan details last month, said in a low-rated plan, you should check if they wanted to make it increasingly this is your best option,” Goggin-Callahan challenging for seniors to enroll in low said. Sun Sentinel
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Prostate expert finds social media audience By Shannan Finke
Being a prostate cancer survivor, McHugh has firsthand knowledge of the disease from There’s a doctor in Gainesville both a doctor and patient perwhose blog has more than spective. 200,000 hits from around the That’s why he has chosen to world. Out of approximately share his experiences with oth20,000 prostate cancer prod- ers through a book and social uct items on Amazon, his book media sites. appears right on top. His Twitter “I’m a regular doctor. I see lots account has more than 800 fol- of people every week and do lowers. surgeries, and that’s what makes Dr. John McHugh of Northeast this kind of interesting. I still Georgia Urological Associates make a living,” said McHugh of is a urologist, cancer survivor his career in light of his growing and registered user of some of popularity online and in print. the world’s most popular social Between running his practice media sites. His musings on and seeing patients, McHugh life and all things prostate can- maintains his Prostate Diaries cer can be found on Facebook, blog, which has anywhere from Twitter, iTunes, via an app and 400 to 500 visitors each day from an online blog that is fittingly any of the 130 countries his visinamed Prostate Diaries, and in Please see Blog page 9 the book he authored. sfinke@gainesvilletimes.com
Dr. John McHugh, whose book (above) is a top seller in the field of prostate cancer on Amazon, also has found success in social media. His blog, Prostate Diaries, has been named the No. 1 online influencer for prostate cancer by SharecareNow, a website that facilitates discussion about patient health and well-being.
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Blog
It’s unreal.” In addition to his blog, McHugh tweets using his profile prostatediaries, posts on Facebook and produces prostatediaries podcasts on iTunes, all of which he tors represent. Here, browsers links to his app, ProstateMD. Since using social media and can find tidbits of McHugh’s life, authoring his book, McHugh has interactive cartoons, videos and gained worldwide recognition. answers to common prostate He has been named the No. 1 cancer questions. online influencer for prostate “It’s information for the person cancer by SharecareNow, a webwhose been diagnosed. Once site that facilitates online discusyou get into my blog, you’re tied sion about patient health and to hundreds of things,” he said. It’s not uncommon for McHugh well-being. Closer to home, McHugh says to search online boards and websites to find what is being asked he has seen an increase in the most by those affected by pros- number of patients coming to tate cancer. His blog topics are his office for second opinions. geared toward these very ques- These, among other reasons, is tions, and it keeps his content why McHugh believes other doctors will begin to increase their relevant to readers. “If you Google something social media presence. “Doctors are going to start about prostate cancer, it comes to my blog,” McHugh said. “I hiring people as their media don’t know how it happened. specialists to focus just on devel-
Continued from page 8
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oping themselves online,” said McHugh. “People are using it to give out information but also promote themselves.” For example, McHugh believes there is an important distinction between recruiting a large number of Facebook fans versus building an email database. While both are used to reach a target audience, the power of Facebook is stronger. “Liking on Facebook now is better than an email database. With emails, your information goes straight to the person.When someone likes you on Facebook, it shows up a bunch of different places and other people see it. That can help build your patient base,“ McHugh said. But that’s not the only plus side to doctors utilizing social media. “It’s relatively easy to engage in,” said McHugh. “My blog is on Wordpress, and that’s a free
Sunday, October 28, 2012
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service, and setting up a Twitter account takes maybe 10 minutes.” Although McHugh is enjoying his ever-rising recognition, he also appreciates the number of people he has been able to help. At his practice, McHugh gives out 15 to 20 books a week to “the patients who come in and don’t know what to do.” And while he knows his expertise is helping patients and their loved ones better understand a prostate cancer diagnosis, McHugh said the interaction that comes from using social media has benefitted him as well. “It’s fun. People write in saying their husband’s been diagnosed and that all this has been helpful. It truly is a wonderful resource for a person who’s newly diagnosed and has no clue what to do. It’s like providing a service, and I think it’s made me a better doctor.”
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Men more frequently assuming role of caregiver By Jane Glenn Haas
The Orange County Register No one really has a tag on the numbers. AARP says more than 40 percent of all caregivers today are men. Dr. John Whyte, writing for the Huffington Post online, puts the number at “nearly 35 percent.” Marjorie Russ, 86, who lives in Cypress, Calif., doesn’t care about the numbers as long as her sons show up to give her a hand. Her youngest son, Patrick Russ, 58, arranges music for symphonies in movies and concerts and lives in Palos Verdes, Calif. He picks up the slack for his mom on Saturdays, among other visits. “She is more and more forgetful,” he said. “I do check-writing and so on. She got on some mailing lists. Now we have a joint account.
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“I do shopping, take her to the doctors, get prescriptions. My brothers do the same. We cover two or three visits a week, and we even take the caregiver for coffee.” The brothers are all happily married, he said, adding, “We would be delighted to have her live with us. But she doesn’t want to, and we try to honor her wishes.” The brothers have increased their caregiving duties over the past five years as Marjorie’s dementia has advanced. Two caregivers are employed to give her round-theclock attention. “We all wanted to help out, and we saw this coming so we basically got together and found our best course of action,” Patrick Russ said. “Our plan changes every six months as her condition worsens. We let the professionals guide us.” The professionals, in this case, are
headed by Leann Reynolds, president of Homewatch CareGivers in Garden Grove, Calif. More and more men — sons, husbands, fathers — are becoming caregivers because of vital changes in family structure, Reynolds said. And it is making a difference in who provides hands-on care. Women, in assuming the caregiving role, tend to wait longer to get professional help and often get “burned out,” she said. Men usually seek help sooner. “They do approach it differently. They are more task-oriented to do services like transportation, shopping, home repairs, finances. They have less to do with the more personal tasks like bathing and grooming.” To help men involved in this relatively new activity, she has helped launch a male caregiver community
forum on the Homewatch website, homewatchcaregivers.com. “It’s designed as a resource,” Reynolds said. “We provide information and assistance rather than resolve social situations.” Reynolds also acknowledges that many in her firm’s care have a form of dementia, which is why Homewatch also offers “Pathways to Memories,” a dementia program. “We look at the individual and try to incorporate their social history and cognitive ability to get them involved in daily life,” she said. “It is usually better for these folks to be in their own home than in a professional care home.” Jim Brindley of Whittier, Calif., agrees. He has back, ankle and foot problems and is recovering from multiple Please see Caregiver page 11
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Caregiver Continued from page 10 surgeries. He needs caregiving himself but also tried to help his wife, who died recently. “She had dementia,” he said.“And it got to the point where she needed someone 24/7 and, with my back condition, I couldn’t always help her.” He can’t make meals or beds, he said. And he felt stymied until he found a way to share those tasks with professional caregivers three hours every morning and evening. “Of course I was going to care for her,” he says. “We were married 57 years, and she took care of me all those years. “You do it because you love that person.” Brindley is one of many men realizing that today, age often brings on
role reversal. “Some men feel that their masculinity is threatened by taking on a role that requires intimacy and emotional support,” says Whyte in the Huffington Post. “They become wor-
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People joke that caring for the elderly is too much of a commitment for some men to make, he said. But as boomers age, more men will be called upon to provide elder care, Whyte predicts. He points to online
They say it takes a real man to do a woman’s job — but labeling it a woman’s job is part of the problem in the first place. ... I say it takes a real man to be a caregiver, ried about how their peers would perceive them if, say, they had to leave work early to care for an elderly parent. ... Some men feel unprepared for the responsibility of caring for another human being, and this unpreparedness deters them from embracing the caregiver role.”
resources, support groups and other places that can guide men in caring for the elderly. “They say it takes a real man to do a woman’s job — but labeling it a woman’s job is part of the problem in the first place. ... I say it takes a real man to be a caregiver,” Whyte said.
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Q&A Continued from page 3 grown popular with smaller clinics and private practices as a more affordable alternative to buying drugs in bulk straight from manufacturers, Quraishi said. Q: How did the fungus get into the steroid in the first place? A: It’s unclear — the CDC’s investigation is ongoing on that point. Experts from the U.S. Food and Drug Administration and the Massachusetts Department of Public Health are assisting. Q: Who oversees the safety of compounding facilities? A: Although the FDA regulates drug manufacturers, it does not have the same authority over drug compounders such as NECC. Lawmakers in Washington have called for a congressional investigation of the outbreak.
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Cardiology Cardiology CardiologyCardiology
Robert Ferguson, MD, FACC Robert Ferguson, MD,Matthey FACC Harris, Robert Ferguson, MD, Robert FACC Ferguson, MD, FACC MD, FACE
Matthey Harris, Jennifer Cacia SoaresEniki Mack, MD MD, FACE Matthey Harris, John-Kalarickal, MD Eniki Jennifer SoaresMatthey Harris, Jennifer Jennifer Cacia SoaresCacia Cacia SoaresWelch, MD, FACE Eniki Mack, MD Eniki Mack,Mack, MD MD John-Kalarickal, MD, MD, FACEFACE John-Kalarickal, MDJohn-Kalarickal, MD MD Welch, MD, FACE Welch,Welch, MD, FACE MD, FACE
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Andre Kallab, MD, FACP
Craig Brown, MD
Christina Saurel, MD Andre Kallab, Padma Nadella, MD Saloni Tanna, MD Christina Saurel, Christina Saurel, Christina Saurel, MDMDMDSaloniSaloni MD, FACP Kallab, MarkMD Kats, MD Padma Nadella, MD AndreAndre Kallab, Padma Nadella, MDPadma Nadella, MD MD Saloni Tanna, Tanna,Tanna, MD MD, FACP MD, FACP
Pulmonology Pulmonology Pulmonology Pulmonology
Kim Tran, MD Mark Kats, MD Laura Shepherd, MD Kim MD Tran, MD Kim Shepherd, Tran,MD MD MD Kim Tran, Kats, MDLauraLaura Mark Kats, MD LauraMark Shepherd, Shepherd,
Rheumatology Rheumatology Rheumatology Rheumatology
Joseph West, MD Craig Brown, MD Thomas Murray, MD Wesley Head , Joseph SylviaMD Dold, DO Joseph West, MDMDJoseph West, West, MD Craig Brown, Thomas Murray, CraigWesley Brown, MD , MD Thomas Murray, MD Murray, MD Wesley Head , Thomas Head Wesley Head , FCCP MD, MD, FCCP MD, FCCP MD, FCCP
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Department of Internal Medicine Department of Internal Medicine Department Department of Internalof Medicine Internal Medicine
Brent Archer, MD
Carol Hector, MD
Brent Archer, MD Richard Blatt, MD Shane Paul Chenard, MD Meghan Cook, MD Dennis Corn, MD Richard Gomez, Brent Archer, MDRichard Bussler, MDPaul MD, FACP Richard Blatt, Shane Paul Chenard, MD Meghan Cook, MDDennis Dennis Corn, Richard Gomez, Brent Archer, MDMD Richard Blatt, Blatt, Shane MD MD Paul Shane Chenard, MD Meghan Chenard, Cook, MD MD Meghan Dennis Cook, Corn, MDMD Richard Corn,Gomez, MD MD Richard Gomez, Bussler, MD, FACP Bussler, MD Bussler, MD MD MD, FACP MD, FACP
Roberto Villanueva, Hillary Morgan, MD Carol Hector, MD Taylor Henson, MD Bradley Pierce, MD Mini Sean Sumner, MD Jeff Terry, MD MD, FACP Roberto Villanueva, Hillary Morgan, MD Roberto Villanueva, Villanueva, Hillary Morgan, Hillary Morgan, MDMD Carol Hector, MDTaylor Shivprasad, DirectCare Taylor Henson, MD Bradley Pierce, Mini MD MD SeanTerry, Sumner, Jeff Terry, MD Roberto Carol Hector, MD MD Taylor Henson, Henson, MD MD Bradley Pierce, Bradley Pierce, MD MD Sean Mini Mini Sumner, Sean Sumner, Jeff MD MD MD Jeff Terry, MD MD, FACP MD, FACP MD, FACP Shivprasad, DirectCare Shivprasad, MD Shivprasad, MD MD DirectCare DirectCare
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DEPARTMENT SPOTLIGHT DEPARTMENT SPOTLIGHT DEPARTMENT DEPARTMENT SPOTLIGHT SPOTLIGHT
Department of Department Department Department of ofof Nephrology Nephrology Nephrology Nephrology Clinical care and consultation for Clinical care and consultation Clinical Clinical care and care consultation and consultation for forfor patients with kidney disease patients with kidney disease patientspatients with kidney with disease kidney disease
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Gainesville, GA | 770-536-9864 | www.ngdc.com si v G0 A- 5| 37| 677- 097-8056-35463-|69 -w 84w 6 4.| nw |g w w cw w..w .gnm om ilanl ieen,sevG A l li el l,| e G 7, 7A 896w d cno dgcd. cc .ocm
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The Times, Gainesville, Georgia |
Doctors can tailor breast cancer screening based on risk factors Women with no history of breast cancer have to muddle through conflicting recommendations from medical and advocacy groups on when, how and how often to screen for tumors, as the efficacy of routine mammograms continues to raise hot debate. The U.S. Preventive Services Task Force, an independent advisory panel appointed by the government, sticks by its 2009 decision to recommend mammograms every two years for women ages 50 to 74, though women who wish to start before then can talk to their doctor about it. The panel also advises doctors against teaching patients how to examine their own breasts. But several other organizations — including the American Cancer
Society, the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network — recommend that women at normal risk for breast cancer get a yearly mammogram and annual clinical breast exam starting at age 40. For women 20 through 39, these groups say, clinical breast exams should be performed every one to three years, and breast self-exams are optional for women starting at age 20, though everyone should be breast-aware and report changes to their doctor. The National Cancer Institute, part of the National Institutes of Health, recommends mammograms every one to two years for women older than 40. It has no recommendations for clinical
breast exams or self-exams. Meanwhile, the National Breast Cancer Coalition, a grass-roots advocacy group, believes there is “insufficient evidence to recommend for or against universal screening mammography in any age group of women,” and “the decision to undergo screening for asymptomatic women must be made on an individual level based on a woman’s personal preferences, family history and risk factors.” The debate about mammograms revolves around whether screenings do more harm than good among women younger than 50, who are more likely to have false positives and overtreatment of cancers that would never cause symptoms or threaten a woman’s life. Mammograms also are more
likely to miss cancer in younger women because their breast tissue is denser, making tumors harder to spot. In women with the densest breasts, mammography can miss half of cancers later found on ultrasound, according to a 2002 report in the journal Radiology that reviewed screening sessions performed on more than 11,000 women. The screening guidelines change for women considered at high risk for breast cancer, which means their lifetime risk of getting breast cancer is greater than 20 percent. Among the factors that can contribute to being high risk are having a BRCA1 or BRCA2 genetic Please see Screening page 15
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Screening Continued from page 14 mutation or having a first-degree relative with that genetic mutation; having had radiation therapy to your chest between ages 10 and 30; and strong family history of breast or ovarian cancer. Additional assessment tools help determine risk, and all screening decisions should be made in consultation with your doctor. According to the American Cancer Society’s guidelines, women at high risk should get an MRI in addition to a mammogram every year starting at age 30. Women at moderately increased risk, which includes having a lifetime risk of 15 to 20 percent, having a personal history of breast cancer or having “extremely dense� breasts, should talk to their doctor about adding an annual MRI screening.
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Going gluten-free gets easier By Joe Bonwich
St. Louis Post-Dispatch Rabia Rahman is as much a detective as a dietitian when she works with her patients to help them avoid gluten. “I had one patient who got really sick from licking an envelope,” says Rahman, who’s both a nutritional counselor and an instructor in the department of nutrition and dietetics at St. Louis University. Ironically, gluten is used in the binders or coatings of some medications that patients may be taking to feel better. And many of Rahman’s female patients are surprised to find out that gluten is sometimes an ingredient in makeup and lipstick. Helping patients eliminate gluten from their diets is easier than ferreting out some of these more obscure uses, but it still poses significant challenges. “We’ll always go over food habits and cover the broad items like wheat, barley and rye, which means they shouldn’t eat regular cakes, breads and pastas,” Rahman says. “But then I work with them to go over ingredient lists on labels closely and avoid specific items — hydrolized wheat starch, or anything that says malt, graham or spelt. “There’s often gluten where you really don’t expect it. Soy sauce is a big one; broth soups, potato chips and even French fries, which are sometimes dipped in a starch to preserve them.” The medical reasons for going gluten-free, says Rahman, range from mild gluten intolerance to wheat allergies and celiac disease, an autoimmune disease in which consumption of gluten damages the small intestine. Blood tests can diagnose allergies and celiac
disease, and Rahman calls a smallintestine biopsy the “gold standard” for diagnosis of celiac. But there aren’t any specific tests for gluten sensitivity. “That diagnosis often comes after a patient has gone from doctor to doctor to find out why they just don’t feel well,” Rahman says. “Sometimes it’s (gastrointestinal) symptoms, but many times the symptoms are less obvious — tiredness, headache, or even sometimes depression.” Rahman has her patients keep a log of both their food consumption and their symptoms and eventually may recommend that they eliminate gluten from their diets. Or, in some cases, she may work the other way by having the patients go gluten free to see if it makes their symptoms go away. In either case, she says, adopting a gluten-free diet gets easier every year. “Even in the past five years, there’s been a huge increase in cookbooks, in what’s available in stores and restaurants and in online support,” Rahman says. However, she adds, part of the demand has been generated by a certain trendiness in gluten-free lifestyles that’s been aided by their adoption by various celebrities. “They’re using it as a fashion statement, or in some cases they’re saying it might help with weight loss,” Rahman says. “But there’s no medical reason to follow it unless you have to.” But that said, she advises her patients and anyone else who’s been diagnosed as gluten-sensitive not to be shy about it. “Eating out or at someone’s house are things that many patients find very, very difficult,” Rahman says. “It’s not just the food itself — there are issues of
Gluten-free support on the web National Foundation for Celiac Awareness www.celiaccentral.org A nonprofit organization dedicated to finding a cure for celiac disease. Celiac Disease Foundation celiac.org A nonprofit, public-benefit corporation providing services and support through awareness, education, advocacy and research. Celiac Sprue Association csaceliacs.org Another nonprofit organization extensive online resources.
with
Gluten Intolerance Group www.gluten.net Tips for diet and finding medical professionals, as well as geographic lists of restaurants that offer gluten-free alternatives. cross-contamination, as simple as crumbs left when regular bread is made in the same toaster.” “But you have to be willing to advocate for yourself,” she
adds. “It’s also really important to involve family members and friends. You’ll often get a lot of support that really helps you stay on top of it.”
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Recipe Artisan gluten-free flour blend
Erik. M. Lunsford/St. Louis Post-Dispatch A gluten-free flour can be made with corn starch, sorghum flour, brown rice flour, xantham gum, potato flour and potato starch.
Yield: About 12 cups 5 cups (625 grams) brown rice flour 3 cups (350 grams) sorghum flour 2 2/3 cups (360 grams) cornstarch 1 cup (148 grams) potato starch 1/3 cup (57 grams) potato flour 4 teaspoons xanthan gum Combine all ingredients and store in an airtight container in the fridge. The authors recommend measuring by weight rather than by volume for a more accurate and consistent result. Notes: If you have a sensitivity
to a specific ingredient, use the following substitutions. For corn, replace the cornstarch with 1 ½ cups arrowroot flour. For potatoes, omit the potato starch and potato flour and replace with 1 1/3 cups tapioca starch. For sorghum, omit the sorghum flour and replace with an additional 3 cups of brown rice flour for a total of 8 cups of brown rice flour. The ingredients can frequently be found in the specialty-flour or health-foods aisle of the supermarket or in health food stores. Per cup: 468 calories; 2g fat; 0.5g saturated fat; no cholesterol; 6g protein; 105g carbohydrate; 1g sugar; 5g fiber; 11mg sodium; 11mg calcium. Adapted from “Artisanal GlutenFree Cooking,” by Kelli and Peter Bronski (second edition, The Experiment, 2012)
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Study chronicles lengthening of human lifespan By Melissa Healy
In evolution’s actuarial table, the researchers wrote, “72 is the new 30.” The bulk of that progress has Modern humans have gotten incomparably good at survival, been made since 1800, when doing more to extend our lives the average lifespan of a Swede over the past century than our at birth was 32. That is roughly forebears did in the previous 6.6 on a par with the 31 years that million years since we parted evo- the average hunter-gatherer can lutionary ways with chimpanzees, expect to live. By the year 1900, the average according to a new study. In fact, humans in societies with lifespan in Sweden had reached plentiful food and advanced medi- 52, and today it stands at 82 — an cine have surpassed other spe- increase of more than 150 percent cies used in life-extending medical in just over 200 years. That puts to shame efforts to research in stretching our longevity and reducing our odds of dying extend the lives of laboratory aniat every point along our ever- mals, the study authors noted. lengthening lifespans, the study By inducing genetic mutations in various species, scientists have finds. The research, published online boosted the longevity of nemaby Proceedings of the National tode worms by more than 100 Academy of Sciences, touches percent, of fruit flies by about 85 upon the hotly debated question percent and of mice by roughly 50 of whether an upper limit to lon- percent. Experiments in caloric gevity is inscribed in our genes. restriction have also extended the It makes clear that life extension lives of lab animals, but they also begins at birth, with a child born fall short of humans’ real-world in the last four generations stand- gains. No species dramatizes the ing a better chance of being alive during infancy, adolescence, the breathtaking rate of humans’ life reproductive years and after than extension more than chimpanin any of the 8,000 human genera- zees, mankind’s closest relative. At any age, the life expectancy tions that came before. The study authors, from of a human in a hunter-gatherer Germany’s Max Planck Institute society is closer to that of a chimp for Demographic Research, began in the wild than it is to a modernby comparing people who have day resident of Japan or Sweden, lived or now live in primitive according to the study. The authors wrote that the rapid hunter-gatherer societies around the globe in which lifespans have improvements in human survival been well documented to citi- could only be accounted for by zens of industrialized countries in environmental changes, including better nutrition and medical Europe and Asia. A typical Swede, for instance, is advances; changes in the genome more than 100 times more likely accumulate far too slowly to to survive to the age 15 than a typ- explain the progress. “We have much to learn” before ical hunter-gatherer. And a huntergatherer who has reached the ripe divining the limits of the human old age of 30 is about as likely to lifespan and understanding which die in the following year as the forces push hardest against those world’s champion of longevity — limits, the authors wrote. The report was overseen by James W. a 72-year-old woman in Japan. Los Angeles Times
Vaupel, a leading proponent of the idea that human longevity may have no upward limit. Jakob Bro-Jorgensen, an evolutionary biologist at Great Britain’s University of Liverpool who was not involved in the study, said it “revealed with remarkable clarity the spectacular drop in human mortality that has occurred in some industrialized societies over the past few generations.” Those rapid gains in human survival are clearly due to environmental, not genetic, influences. But by favoring some in human society over others, Bro-Jorgensen ventured, such advances may end up subtly changing the course of human evolution as well. “Are the people who leave the most descendants under today’s radically different living conditions characterized by different
genes than those who did so when we were hunter-gatherers?” he asked. Other experts criticized the study for failing to factor in the fact that obesity and other health problems have started to reduce life expectancy for some people in industrialized societies. S. Jay Olshansky, a public health professor at the University of Illinois in Chicago and a leading researcher in the emerging field of biodemographics, said the absence of such data — showing, for instance, that the lifespans of white Americans who haven’t completed high school have fallen significantly since the 1990s — suggests the authors “have a particular bias toward reporting only news that favors a preconceived notion that life expectancy can only rise.”
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New prostate cancer treatment available locally By Shannan Finke
sfinke@gainesvilletimes.com Sheila Still knew it was time for her husband to make an appointment with his physician when she saw the dark bags under his eyes. “She told me, ‘You need to go to the doctor. You haven’t been to get a physical in ... never,’” said Sheila’s husband, Randall Still. And at age 59, Still is continuing to fight the prostate cancer with which he was diagnosed nine years ago after that visit to the doctor upon which his wife insisted revealed higher than normal levels of the prostate-specific antigen, or PSA, in his body. Thankfully for Still, his oncologists have been able to keep the growth of his disease at bay
thanks to hormone therapy and one of the newest weapons in the fight against prostate cancer, an FDA-approved form of immunotherapy called Provenge. Provenge treatments are available through two local oncology practices, Northeast Georgia
approved by the FDA for prostate cancer. Immunotherapy allows the body’s immune system to fight cancer by either helping it work smarter and harder against the disease or providing it with components, or “helpers.” The Provenge
She told me, ‘You need to go to the doctor.You haven’t been to get a physical in ... never, Diagnostic Clinic and The Longstreet Clinic, both of which are affiliated with the Cancer Center at Northeast Georgia Medical Center. It is the first cancer treatment vaccine to be
treatment, also called sipuleucelT, incorporates aspects of both methods. Dr. Charles Nash, oncologist at The Longstreet Cancer Center in Gainesville, explains Provenge as
a kind of “foreign exchange program” for the body’s cells. “We take T cells from the blood of the patient and send them away to be exposed to the Provenge antigen,” described Nash. “When they’re both exposed to each other, the T cells incorporate this antigen into themselves and are put back into the body to fight the cancer cells.” Patients undergoing the treatment dedicate six appointments to the entire process. Blood is taken three times, two weeks apart, in a process called leukapheresis and shipped to an FDAapproved manufacturing facility. Once there, the Provenge dose is created from the sample and returned to be injected back into the patient’s body. Please see Treatment page 21
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Treatment Continued from page 20 “Provenge works by teaching the patient’s immune system to recognize the cancer as foreign,” said Dr. Andrew Kallab, an oncologist at Northeast Georgia Diagnostic Clinic. “Provenge is made from a patient’s own immune cells. Cells are removed from the patient and trained to target a protein found primarily in prostate tumor cells.” To qualify for Provenge treatments patients must have received hormone therapy but still have rising PSA levels. Nash believes in the power of Provenge to change not only the lives of prostate cancer patients, but also the future of cancer treatment. “It’s a relatively new treatment,
but it’s really cutting-edge,” he said. While Provenge does not cure prostate cancer, it has been shown to improve the quality of life and survivorship in cancer patients. In fact, patients who underwent Provenge have seen as much as a 22 to 38 percent increase in the improvement of survival since their treatment.
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progression. It has a survival benefit,” said Nash. Still is one of Nash’s patients and has received the Provenge treatments. According to the doctor, Still “just sailed through his treatments.” Because he had been undergoing hormone therapy and was not in an advanced stage of the disease, Still qualified as a candi-
While Provenge does not cure prostate cancer, it has been shown to improve the quality of life and survivorship in cancer patients. “It’s unlike radiation or chemotherapy in the sense that with this, we don’t nuke the cancer and watch it melt away. This is like immunizing the patient against
date for Provenge. Patients should check with their doctors to see if they would qualify for the treatment. Nash says side effects are simi-
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lar to what may be experienced with a flu shot, such as chills and a fever, but Still spent virtually no time succumbing to such symptoms. “It hasn’t been too bad,” said Still. “I felt a little bad after my last treatment, but with the other two, I didn’t feel bad at all.” Strides in eliminating prostate cancer have been made in recent years, according to Nash, particularly with an increase in the release of cancer drugs and treatments targeted specifically to prostate cancer, such as Provenge. “It’s just another bullet we have to fire,” said Nash. The hope is that Provenge is one of many treatments that will continue to be developed for prostate cancer patients, who, like Still, are ready to continue living their lives for many more years. “We’ve been married 30 years,” the Stills said together.“And hopefully, we’ll be married 30 more.”
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Grains, sugars can contribute to heart disease Red meats, hydrogenized oils — these are the foods we associate with heart disease and high cholesterol. But a few other things many people eat rather frequently could be contributing to future heart problems. White pasta and breads Researchers have found that eating a diet high in refined grains, including those in most store-bought pastas and white breads, can double the risk of heart disease. These foods are those that have a high glycemic index, or GI. Foods with a high GI quickly release sugar into the bloodstream. Doctors have found a correlation between high GI and heart disease, mainly in women, according to research at the University of Milan. The study questioned 32,578 women and 15,171 men. Those who consumed the largest concentration of high GI foods were 2.24 times more likely to develop heart disease than those with the lowest. Nutritionists advise that, when choosing grain products, it is important to select those made from whole grains. Not only do these products provide the nutritional benefits of whole grains, including fiber, they also help reduce cholesterol and the risk for heart disease.
for high cholesterol and heart disease. In its 2010 guidelines, the American Heart Association recommended limiting added sugar in the diet to no more than 100 calories a day for most women and 150 calories for most men. That’s 6 teaspoons for women and 9 for men. To put those guidelines in perspective, consider that a 12-ounce can of soda has between 8 Sugary items and 10 teaspoons. While many people associate sugIn addition, many processed foods ary snacks, beverages and sugar itself contain sugar even if sugar’s inclusion with dental decay or unnecessary seems foolish. Some restaurants and calories, these items also impact cho- food manufacturers have admitted to lesterol levels. adding sugar to foods — especially The average American eats the those geared to children — to make equivalent of 21 teaspoons of added them taste better and be more appealsugar a day, which is two to three ing.Therefore, sauces, ready-made dintimes the amount they should, accord- ners and other items may have sugar, ing to an article in the Journal of and the consumer may not know it the American Medical Association. without reading the nutrition label. Researchers found that individuals Also, it’s important to note that who consumed the most sugary prod- beverages are the leading supplier of ucts had the lowest HDL, or good cho- added sugar for many people. Simply lesterol, and the highest blood triglyc- reducing the amount of juices, sports eride levels. Eating large amounts of drinks and sodas in your diet can sugar can then be a major risk factor greatly reduce sugar consumption.
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Reason #2: Our Physicians We opened our state-of-the-art Ronnie Green Heart Center 10 years ago. As we look back at a decade of healing hearts at Northeast Georgia Medical Center (NGMC), there are many reasons to celebrate. Reasons, like the more than 80 cardiologists, surgeons, anesthesiologists and other physician specialists affiliated
RONNIE GREEN THE
HEART CENTER
with our Heart & Vascular Services who save lives every day. Many of our physicians have trained at the nation’s most prestigious cardiac programs including Harvard University, Columbia University and the Mayo Clinic. Their work is reflected in NGMC being named Georgia’s #1 heart hospital and top 5% in the nation for cardiac care for seven years in a row (2006 – 2012, HealthGrades®). See the list of reasons we’re celebrating, share your own reason and learn more about heart services at NGMC by visiting
nghs.com/10reasons
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