Thomas Jefferson University Hospital - July 2005

The How To's of Choosing Athletic Shoes
(Published 7-27-05, WebMD) Running and walking are among the purest, most natural forms of exercise around. With newfangled innovations like Freon-filled midsoles and pump-it-up tongues, it's knowing which shoes to buy that seems to require an advanced degree.

Choose the wrong athletic shoes and you could end up lying on the couch nursing shin splints or aching heels instead of enjoying a brisk walk or run.

While most specialty sport-shoe stores have knowledgeable staff to guide you, you'll be a few steps ahead of the game armed with some basic knowledge about your feet and their specific needs. Here is some expert advice to heed before buying new footwear:

It's a myth that foot size doesn't change in adults," says Steven Raikin, M.D. "It does change as we get older, so have your feet measured twice a year. Sizes also vary between brands, so go by what fits, not by what size the shoe is." Dr. Raikin is director of the foot and ankle service at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia.
Department of Orthopaedic Surgery
Rothman Institute

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A profit-thinner
(Published 7-25-05, www.modernhealthcare.com) No drug probably is cheaper and more effective in preventing strokes in a large and growing patient population than the anticoagulant warfarin, more commonly known by its brand name Coumadin, and probably no drug is more of a money-loser and thankless chore for hospitals. Patients would probably be thrilled to get out from under the incessant monitoring and dosage readjustment associated with the drug, too.
Geno Merli, M.D., director of the division of internal medicine at Thomas Jefferson University Hospital and Jefferson Medical College in Philadelphia, says that although the hospital's anticoagulation service charges $20 for blood testing, insurance reimburses only $8. The test costs $6, and does not include the physician's time.

Anticoagulant drugs are widely used for a broad array of cardiovascular problems, and most commonly for cardiac rhythm disorders.

To remedy the burden for patients, drug companies for years have been working to develop an alternative drug that doesn't require constant dosage monitoring, that doesn't adversely interact with a multitude of foods and drugs and that does not come with deadly side effects of bleeding and stroke. But conquering the business proposition may prove even more daunting than conquering the clinical proposition.

"An alternative drug that requires no monitoring and causes no drug interactions would be 'a positive step' for the 1,000 patients who are monitored by the hospital's anticoagulation service," says Dr. Merli.

It is going to take more work on the part of pharmaceutical companies to come up with an alternative "that makes us all comfortable," says Dr. Merli and he is "cautiously optimistic" that a new agent will be found.
Department of Medicine
Division of Internal Medicine

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Myths and Facts About Cooling Down
(Published 7-25-05, NBC10) It's tough to stay cool when the temperature outside is scorching, and it is only expected to get worse in the next couple of days.

One of the urban legends of staying cool that Bank came across involves ice cubes. Some people say that if you put them behind your knee or just hold them in your hands, that will cool you down.

Doctors say it could actually work.

"Certainly that will cool you off a little bit," said Dr. Alexander Limkakeng, of Jefferson University Hospital's Department of Emergency Medicine.

Dr. Limkakeng also confirmed another myth as fact -- you can get cool by running cold water over your wrists.
Department of Emergency Medicine

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Scientists Shed New Light on Alzheimer's
(Published 7-25-05, ABC News) Proteins called amyloid-B peptides that accumulate in plaques around brain cells are known to contribute to Alzheimer's disease, which affects an estimated 4.5 million Americans. Now, new research suggests that similar peptides accumulating in the blood vessels of the brain contribute to the disease, too. In fact, researchers suspect this blood vessel accumulation may actually lead to plaque formation around neurons brain cells later on. 'What these new studies show is that the accumulation of amyloid-B in blood vessels is also an important contributing factor to the problems that occur in an Alzheimer's brain,' said William E.

Van Nostrand, professor of research medicine at Stony Brook University, New York, and the senior author of one of the two studies, both of which are published in the August issue of the American Journal of Pathology. For years, he said, the general thinking was that amyloid-B accumulates in plaque deposits around the neurons in the brain, leading to problems with memory and other signs of Alzheimer's. Experts have also long known that amyloid-B is found in the brain's blood vessels, but that area had not been a prime focus of research.

Both studies provide new information that is different from each other, said Dr. Samuel Gandy, director of the Farber Institute for Neurosciences at Thomas Jefferson University, in Philadelphia. 'Researchers have been trying to understand how the relationship between amyloid in plaque and amyloid in blood vessels are related how you can get one and not the other, sometimes both.

It was a real conundrum,' he said. As far as practical applications, 'I don't see anything you could do right now for a patient [based on the new studies],' said Dr. Gandy. 'It's a very complicated issue because there is no direct access to the compartment where this material is clumping. It's clumping in between nerve cells and we can't quite get there to wash it out.'
Farber Institute for Neurosciences

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Selective Surgery
In the pursuit of beauty, it seems that everyone wants to go under James W. Fox IV's knife. But this doctor won't operate on just anyone.
(Published 7-24-05, Philadelphia Inquirer) Dr. James W. Fox IV has a jowl, "a turkey wattle" he calls it, pulling affectionately at the flesh.

His midsection will never be mistaken for washboard abs. He admits, "I have a very large nose, though I would never have rhinoplasty." His eyes? "They're starting to look a little tired."

At a time of perpetual self-improvement, when people with desire and means are bent on becoming better versions of themselves, Fox freely allows how he might benefit, but hasn't.

"I haven't had any plastic surgery at all, but I need it," says Fox, which is important to know given that he's one of the area's leading aesthetic plastic surgeons. That he isn't one of those narcissistic over-dermabrased docs hooked on such handiwork has a calming effect on prospective patients.

Fox's success is reflected in his work quarters, a vast third-floor aerie in The Rittenhouse where Nan Duskin once dwelled. The waiting room is stocked with a phalanx of wing-back chairs, and his vast burgundy office with laurel-wreath wallpaper resembles an exclusive private club, one with a jaw-dropping view of Rittenhouse Square.

It is here that Fox, age 60, a genial man in Italian glasses and burnished loafers, sees 40 consults a day, two days a week, the rest of his time spent in surgery at Thomas Jefferson Hospital, where he chairs the department of plastic surgery and has operated for 32 years.
Department of Surgery

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Open wide meets Smile, Say Cheese
(Published 7-23-05, Philadelphia Inquirer) "Patients can come in over their lunch break," said Anthony Infantolino, a digestive disease specialist at Thomas Jefferson University Hospital, when describing the ease of using the Pillcam ESO to diagnose abnormalities in the esophagus.

With just a few swigs of water, the camera, which looks like a pill, is swallowed then slides down the esophageal tract, lights flashing from both ends, and takes about 2,600 images for a quick diagnosis while minimizing patients' discomfort and hospital time. It passes naturally out of the body in eight to 72 hours.

The Pillcam ESO is used primarily to screen people with chronic acid-reflux disease, a condition in which the acidic liquid of the stomach backs up into the esophagus. At Jefferson most patients are being screened for Barrett's esophagus, a precancerous condition, as well as for swollen veins and bleeding in the esophagus.
Department of Medicine
Division of Gastroenterology and Hepatology

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Scientists Issue Warning for Women With Benign Breast Tumors
(Published 7-21-05, KYW Newsradio(1060AM)) A new study published in the New England Journal of Medicine finds that women with benign breast lumps have different risks of developing breast cancer in the future, depending on the kind of lump.The new study indicates the analysis of tissue in benign breast lumps, when considered along with other factors, can determine the future risk of developing cancer.

Dr. Anne Rosenberg is a breast surgeon at Thomas Jefferson University Hospital:
"We hope that this will encourage women to better understand their pathology report, because the specific diagnosis that you see in your report is how you can determine what your risk is."
Department of Surgery
CancerCare at JeffersonHospital

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Caution urged on benign biopsies
(Published 7-21-05, Philadelphia Inquirer) A breast biopsy that comes back benign is reassuring to most women, but about a third are still at a significantly higher risk of breast cancer and need to discuss their options, a new study concludes.

Those options include taking tamoxifen, undergoing genetic testing, and supplementing regular mammography with breast MRIs.

The study found that 6 out of 100 women diagnosed with nonproliferative breast changes would be expected to develop breast cancer within 15 years - not substantially different from the 5 out of 100 women in the general population. But the rate jumps to 10 out of 100 for women with fast-dividing breast cells, and to 19 out of 100 for women with atypia.

Breast surgeon Anne Rosenberg, M.D., at Thomas Jefferson University Hospital, says "although benign is benign- you don't have cancer- there are still certain types of benign breast diseases" with an increased risk.
Department of Surgery
CancerCare at JeffersonHospital

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A breast cancer finding
(Published 7-20-05, CBS3) Most women with breast lumps or other abnormalities that turn out to be non-cancerous do not face a substantially greater risk of developing breast cancer later, especially if they have little family history of the disease, a reassuring study found.

However, certain "benign" growths are not so harmless and may be precursors to cancer, it also found. Women with these may want to consider surgery or tamoxifen to lower their risk, doctors say.

Breast surgeon Anne Rosenberg, M.D., at Thomas Jefferson University Hospital, says "although benign is benign- you don't have cancer- there are still certain types of benign breast diseases" with an inreased risk.
Department of Surgery
CancerCare at JeffersonHospital

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Benign Breast Lumps Could Mean Trouble Ahead Some Women May Be 400 Times More Likely To Get Breast Cancer
(Published 7-20-05, NBC10) A new study shows that woman who have benign breast lumps may actually have a higher risk for breast cancer. According to the study, published by the New England Journal of Medicine, there are different types of benign lumps. If you have a lump removed, Thomas Jefferson University Hospital breast surgeon Anne Rosenberg, M.D., says that you need to find out what kind of benign lump it is, because that will tell you your future risk for developing breast cancer. If you have one particular kind of benign lump, you could be 400 times more likely to get breast cancer.

If you have proliferative fibrocystic changes without atypical cells your report will say papilloma, ductal hyperplasia, sclorsing adenosis or radial scar. Then you have an 88-percent increased risk of breast cancer.

"The absolute numbers would be that the standard woman has a 10 to 11 percent lifetime risk. A person in this category would have an 18 to 19 percent risk (of developing breast cancer over her lifetime)," Rosenberg said.

Rosenberg said that these women should be more diligent about getting their mammograms on time and getting physical exams from their doctors.
Department of Surgery
CancerCare at JeffersonHospital

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A Business Prescription
Why more and more businesses are turning to incentive programs to rein in soaring costs for employee healthcare
(Published 7-19-05, U.S.News &World Report) Physician A. O'tayo Lalude is an apostle of rigorous diabetes management. When patients come to his Louisville, Ky., office, they get the works--a battery of preventive measures ranging from blood sugar, cholesterol, and urine tests to counseling on diet, exercise, and how to quit smoking.

While better versed than many of his primary-care peers in the finer points of managing the chronic disease, even Lalude admits his attention to detail has improved since joining Bridges to Excellence, a voluntary "pay for performance" initiative that singles out and rewards physicians who achieve quality- of-care goals.

Today, it is the trend du jour in healthcare. More than 100 performance-based programs are in place across the United States, nearly triple the number up and running in 2003, according to Med-Vantage, a healthcare software firm in San Francisco. Today, most large health insurers have some sort of provider incentive program. Medicare alone has demonstrations in the works at 10 sites.

Foisting onerous managed-care constraints upon resistant doctors and patients, a common practice of the mid-1990s, did not solve the nation's healthcare problems. So employers are taking a different tack. By demanding higher quality, they hope to rid the healthcare system of costly errors and inefficiencies.

To the average consumer, paying doctors and hospitals to do what they ought to be doing anyway might seem a bit cockeyed. "I think that Joe and Jane on the street are very wary of this whole thing and appropriately so, because one could ask the question, 'Haven't we always done this?'" observes Dr. David Nash,professor and chair of Health Policy at Jefferson Medical College in Philadelphia.
Department of Health Policy

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Health: Soda Warning Labels
(Published 7-13-05, CBS3) The Center for Science in the Public Interest has called for warning labels on regular soft drinks which are packed with sugar and empty calories. These sodas have been linked to America's growing obesity epidemic and many serious health problems.

"Every additional soda you drink increases your risk of becoming obese by 60 percent," said Dr. Christopher Haines, Family Medicine doctor at Thomas Jefferson University Hospital. Further, Dr. Haines says that obesity caused by soda also increases the risk for developing diabetes and other life threatening problems.
Department of Family Medicine

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Health: Soy Supplements
(Published 7-12-05, KYW-TV) According to new research, tens of thousands of women are getting a second bout of menopause after they stopped taking hormones because of safety concerns.

For some women, soy can help to reduce menopausal symptoms. Birgit Rakel, M.D., a physician at the Jefferson-Myrna Brind Center for Integrative Medicine at Thomas Jefferson University Hospital, says that "adding soy into a menopausal woman's diet is extremely important. There can be up to a 56 percent reduction in hot flashes." Natural forms like tofu and soy milk are most helpful.
Jefferson-Myrna Brind Center for Integrative Medicine

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Statins fail to hold off Alzheimer's in study
(Published 7-11-05, USA Today) Popular cholesterol-lowering drugs called statins did not protect elderly people from Alzheimer's or other kinds of dementia, a study reports today.

Statins are a group of drugs widely prescribed to reduce the risk of heart disease. Recent scientific evidence suggested these drugs also might protect the brain from Alzheimer's.

The new findings don't support that hope as yet, but Sam Gandy, M.D., director of the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia, says they represent just one piece of evidence in a line of studies that suggested a role for statins in the prevention or treatment of Alzheimer's.

"Statins might work as a shield only if given early in life, before the disease has a chance to take hold in the brain," says Dr. Gandy, who is also a spokesman for the Chicago-based Alzheimer's Association.

"Ongoing studies could help clear up some of the confusion about whether statins can help protect the brain," Dr. Gandy says. "We may have some answers later this year."
Farber Institute for Neurosciences

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iPods can damage your ears
(Published 7-11-05, Philadelphia Inquirer) Jeff Hurst, 24, and Gianni Lee, 19, love their music so much they listen to it on their iPods for hours - maybe too many hours.

Hearing experts wonder whether the frequent use of these devices, particularly with the inserts that sit within the ear, are contributing to noise-induced hearing loss.

"The incidence of hearing loss is underappreciated," said Dr. Thomas Willcox, associate professor in otolaryngology, Jefferson Medical College of Thomas Jefferson University, and director of the Hearing Center at Thomas Jefferson University Hospital. "We're going to have a boom of this population because of the increased exposures that previous generations haven't had."
Department of Otolaryngology
Jefferson Hearing Center

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Phila. Hospitals Get High Marks in Doctor's Survey
(Published 7-8-05, KYW Newsradio) US News and World Report is out with its "best hospitals" rankings, and Philadelphia institutions are making the grade. Only a handful of medical centers across the country earned honor roll status, a mark of particular distinction. Thomas Jefferson University Hospital also had several categories listed, including the only hospital in Philadelphia ranked among the best for orthopedics.
Department of Orthopaedic Surgery

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Paying for Alzheimer's
(Published 7-7-05, The Washington Times) Dr. Sam Gandy, director of the Farber Institute for Neurosciences at Thomas Jefferson University, addressed research breakthroughs highlighted at a recent Alzheimer's conference.

"The promise of this scientific research cannot be realized, however, unless the federal government provides more funding for the clinical trials and technology needed to confirm all the initial research results and actually get the science into the national health-care system," Dr. Gandy said.

"Spending a little money now saves a lot of money later. Delaying the onset of Alzheimer's could, within five years, save Medicaid $10 billion annually, the same amount that Congress is currently trying to wrench out of Medicaid programs over five years. It could save the Medicare program $51 billion a year.

"Alzheimer's is unique. It costs taxpayers three times as much to treat an Alzheimer's patient as any other patient under Medicare. Preventing Alzheimer's is simply good health-care economics. An investment of millions will save the government billions.

"The aging of the boomer generation will add tens of millions of people who will be living longer and joining the ranks of Alzheimer's patients. Our health-care system, in its current state, will not be able to care for them."
Farber Institute for Neurosciences
Geriatric Psychiatry

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Philadelphia Firefighters now wearing radiation detectors
(Published 7-05-05, CBS 3) Thomas Jefferson University Hospital's Radiation Safety Director John Keklak says a new pager-size radiation detector, that Philadelphia's fire and rescue EMTs will now be using to avoid radiation exposure, should be of help when responding to emergencies.

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Playing the patient to help train new doctors
(Published 7-4-05, Philadelphia Inquirer) There I was, a fake patient with a fake sprained ankle and a fake crack cocaine habit.

But my situation seemed real enough to seven third-year physician assistant students. For half an hour each, they poked and prodded, leaving my arms bruised from blood pressure cuffs and feet sensitive from ticklish exams. The staged patient visit is being used at medical schools nationwide to prepare students for the "CS 2," a clinical skills test implemented last June by the National Board of Medical Examiners. Schools have spent millions on "bedside manner" training, hiring full-time faculty to teach physical exam skills, building waiting rooms, and employing standardized patients by the score.

The test requires would-be doctors to see 10 patients with various problems, all in 15 minutes. The goal is to make sure they can gather a history, perform a physical exam, diagnose the problem, and recommend treatment. To pass, students must perform the clinical skills, communicate well, and speak English.

At Jefferson Medical College, "patients" train for several days to fake a pulmonary embolism or congestive heart failure. The program also brings in patients who have real problems, like a heart murmur, for students to detect and diagnose. "Seeing patients is the fun part, being able to really listen and evaluate,"said Dr. Katherine Worzala, who oversees the clinical skills lab with her husband, Dr. Dale Berg. "And without seeing it as fun, there's a high rate of burnout."
Jefferson Medical College
AISR Simulation Center

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Staying Safe At Live 8
(Published 7-1-05, CBS3) It is going to be crowded and warm for the Live 8 concert Saturday. Center city hospitals have extra staff in case there are serious injuries and there will also be medical tents and personal along the parkway. So if you are planning on going to the big concert, there are a few things to keep in mind. One of the biggest Live 8 health worries is drug and alcohol use.

"We anticipate a lot of people will be drinking alcohol," said Dr. Ted Christopher,chair of Emergency Medicine at Thomas Jefferson University Hospital, adding "Hopefully they won't, because that makes you more dehydrated."
Department of Emergency Medicine

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Live 8 Health Preparations
(Published 7-1-05, CBS3) With so many people expected out on the parkway for Live 8, there are bound to be some medical problems. The city and Philadelphia hospitals are ready to handle everything from big trauma cases to cuts and dehydration. Center City emergency rooms are gearing up for Live 8. At Jefferson Hospital the staff will be increased ten-percent on Saturday. "You really can't tell what's going to happen," said Dr. Ted Christopher, chair of Jefferson's Emergency Medicine department. "It might be a slow day, it might be a very busy day, so you have to really staff up to prepare for that."
Department of Emergency Medicine

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