My mother has a brain tumor. She is terrified that she will need brain surgery. What are the options?
There are many ways to treat brain tumors, depending upon the location and origin of the tumor. For treatment of a brain tumor, you want care that combines a dedicated team of specialists with state-of-the-art technology. At Jefferson, the most experienced and well-known neurosurgeons in the country work continually to improve and increase treatment options for brain tumors. Since 1994, when it began, Jefferson's Stereotactic Radiosurgery Program – a collaboration between Jefferson Hospital for Neuroscience, where it is based, and Jefferson's Department of Radiation Oncology – has established a new standard of care for patients with brain tumors.
Radiation therapy is a safe, effective alternative to major brain surgery for treating brain tumors. It has become a very exact science, often involving sophisticated techniques to help maximize its effect on those tumors and minimize its effect on normal brain cells. There are a number of different methods for delivering radiation therapy.
One particularly effective method is stereotactic radiosurgery, which is not actually "surgery" – the surgeon does not open up any part of the body. Stereotactic radiosurgery uses computer technology to deliver precisely focused radiation therapy to brain tumors and lesions that are otherwise untreatable, or that are treatable only by means that may cause substantial side effects.
Jefferson Hospital for Neuroscience is the only medical center in the Delaware Valley equipped with all of the leading units, or tools, for stereotactic radiosurgery, enabling us to provide a unique and versatile assortment of treatment options for patients with brain tumors. One of these tools, the Gamma Knife, is used to apply a single beam of radiation at a lesion or tumor with computer-programmed precision while sparing surrounding, healthy tissue from unnecessary exposure. The tumor or lesion then decreases slowly over time until it dissolves. Gamma Knife treatment is typically completed in just one session.
For more information about the Gamma Knife and other treatment options available from Jefferson's Stereotactic Radiosurgery Program, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/neuroscience.
My father recently learned that he has cancer and will need to undergo radiation therapy. I am worried about the effects of radiation. Is there any way to reduce the side effects?
Radiation therapy is the use of high-energy x-rays to treat cancer. Approximately 50 percent of cancer patients will receive radiation at some point in their treatment. It's not uncommon for cancer patients to worry about treatment side effects such as nausea and hair loss, but these responses are not commonly the results of radiation therapy. Radiation works locally and its side effects are limited to the area that is being treated. For example, radiation therapy for a malignant brain tumor may result in hair loss but only in the area that is specifically targeted for treatment.
In many cases, fatigue is the only significant side effect of radiation, and the smaller the area that is subjected to radiation, the less the fatigue. However, one side effect of radiation is toxicity to the normal tissues surrounding the tumor being treated. It is in this area that great strides have been and continue to be made.
What Keeps Treatments On Target?
Treatment strategies offered by Jefferson's Department of Radiation Oncology are made more precise through the input and research of our staff of radiation biologists and medical physicists, utilizing our modern, computerized facilities.
Over the years, pioneering physicians from Jefferson's Department of Radiation Oncology, on staff at the Bodine Center for Cancer Treatment, have developed several new cancer treatments. We are using novel approaches to reduce normal tissue effects from radiation. Precision targeting treatments such as intensity modulated radiation therapy (IMRT) and stereotactic radiation enable a decrease in the dose of radiation to the surrounding normal tissues and also allow a higher dose to the tumor to improve the outcome. A technique we use at Thomas Jefferson University Hospital is called respiratory gating, which modifies the radiation beam to take into account respiration and lock in the tumor. This allows the radiation oncologist to treat less normal tissue around the tumor and reduce side effects.
To schedule an appointment or for more information, call 1-800-JEFF-NOW or fill out our online appointment request form
My mother and her mother each had a stroke in their late sixties. In a few years, I'll be sixty. I'm in reasonably good health yet I worry constantly that I'll have a stroke. Is my fate inevitable?
Certain stroke risk factors, like age, sex, and family history, can't be changed. Fortunately, there are measures that you can take to reduce your risk of stroke and there are procedures that can prevent reoccurrence of stroke in patients with certain conditions. Factors that can be changed, treated or controlled include: high blood pressure, cigarette smoking, diabetes mellitus, carotid or other artery disease, atrial fibrillation, other heart disease, high blood cholesterol, poor diet, physical inactivity and obesity, and drug and alcohol abuse. Your doctor can help you take steps to prevent stroke, which is why it's important to have regular check-ups. Lifestyle changes like improving your diet, exercising regularly, controlling your weight, and giving up smoking can shift the risk factors in your favor. Be sure to take your medications and follow recommended regimens to keep heart disease or diabetes under control.
Know the warning signs of stroke:
If you have any of these symptoms, it's important to call 911 immediately. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.
Stroke is the third leading cause of death in the United States. A stroke occurs when blood flow to part of the brain is interrupted. When nerve cells in the affected area of the brain don't get oxygen, they can't function and die within minutes. The part of the body controlled by the nerve cells can't function either. A severe stroke can result in permanent damage because brain cells can't be replaced. The sad truth is that many strokes are a predictable outcome of an unhealthy lifestyle. Making changes now can substantially reduce your risk.
To schedule an appointment or for more information, call 1-800-JEFF-NOW or fill out our online appointment request form
I have inoperable liver cancer, and chemo-therapy failed. I understand that there is a new treatment that can shrink the tumors. What is it and how is it helpful?
In most cases, liver cancer is diagnosed at a later stage because its symptoms are so vague, and by then, the disease is difficult to manage. For most patients with primary liver cancer, also known as hepatocellular carcinoma (HCC), treatment like liver resection or liver transplantation is not an option either because there are multiple tumors or the underlying damage to the liver is too severe. Primary liver cancer is not the same disease as cancer that spreads to the liver from another part of the body. Non-surgical treatments for primary liver cancer, several of which are new and hold great promise, are being offered at Thomas Jefferson University Hospital.
Symptoms of Liver Cancer
Liver cancer is difficult to detect in an early stage because the symptoms can be vague. Symptoms may include:
At Jefferson, we are in the midst of a study that uses radioembolization, a revolutionary treatment that delivers radiation directly to liver tumors, via microscopic beads embedded with a radioactive element called 90Yttrium, while sparing healthy tissue. This treatment doesn't cure the cancer, but it often shrinks the tumors and helps patients live longer. It can be used for patients for whom chemotherapy did not work, with fewer toxic effects than the standard treatment.
At least 20 percent of our liver cancer patients are what I would call incidental diagnoses — they have an annual checkup, and routine blood work shows elevated liver enzymes, which leads to a CAT scan that detects the liver cancer. That's why it's so important to have an annual physical and blood tests for hepatitis or cirrhosis from any cause.
To make an appointment for an evaluation with the Liver Tumor Program team at Jefferson's Kimmel Cancer Center, or for more information about liver transplantation or other treatments for liver disease, call 1-800-JEFF-NOW or fill out our online appointment request form.
Most of my friends are Type A personalities, working crazy hours all week and then playing tennis for hours on the weekends. But nearly all of them have had some kind of sports injury. What can I do to avoid the same fate?
You're smart to be concerned. Sure, exercise is healthy but with an erratic exercise program, you are setting yourself up for a sports injury. Poor training practice is in fact, one of the causes of chronic sports injuries. Chronic injuries happen after playing a sport or exercising for a long time, and can be the result of inadequate warm up or improper gear. About 95 percent of sports injuries are due to minor trauma involving soft-tissue injuries – injuries that affect the muscles, ligaments, and/or tendons, including contusions (bruises), sprains, or strains. Acute sports injuries, on the other hand, occur suddenly, usually from an accident or a fall. Knees, shoulders and elbows are the most commonly injured areas that require sports medicine intervention.
There are several things you can do to minimize the possibility of a chronic sports injury. As the sport season approaches, begin to exercise the muscles you'll be using. But don't overdo it. The body needs a rest period following exercise to recover. So, athletes should undergo preseason conditioning only two or three days a week. Choose your equipment wisely and use a qualified person to help you get the proper grip on that tennis racquet, for instance. Respect the elements. For instance, very hot, humid weather is not ideal for three hours of aggressive tennis. And if you're an older adult, consider any medical problems that might put you at risk.
Above all, stop exercising if you get hurt. Contin-uing to play or exercise can cause more harm. Treat your injury with RICE – rest, ice, compression, and elevation – until you get to the doctor. There are many new ways to treat sports injuries – most can be treated non-surgically. For surgical treatment, arthroscopy, much less invasive than open surgery, is common.
For the past couple of years, I can't seem to fall asleep, and when I finally do, I wake up after a few hours. I'm always tired and cranky. It's affecting my work and my marriage. Will I ever get a good night's sleep again?
Sleep is essential to physical and emotional health. As you're discovering, lack of sleep can take a toll on one's personal life. You're not alone – 74 percent of Americans suffer sleep disorders; the majority of them are undiagnosed.
You may be suffering from chronic insomnia, which is common in the United States. Insomnia is defined as the perception or complaint of inadequate or poorquality sleep due to any of the following: difficulty falling asleep, waking frequently during the night with difficulty returning to sleep, waking up too early or nonrefreshing sleep. Insomnia may be caused by many factors, including stress, depression, anxiety, physical illness, excessive caffeine intake, irregular bedtime schedules or drugs (including alcohol and nicotine).
If you find that the insomnia lasts for more than a few days or weeks, and especially if it begins to affect your daytime functioning, consult a physician to identify the underlying cause. Loud, irregular snoring, pauses in breathing, daytime sleepiness and other symptoms of insomnia may be related to sleep apnea syndrome, a condition that requires medical attention. Once the underlying cause of insomnia has been identified, the sleep problem can be treated or managed by a sleep specialist.
Suggestions toward improving your sleep:
At the Jefferson Sleep Disorders Center, we diagnose sleep disorders using a variety of methods. Many treatment options are also available, depending upon a patient's diagnosis and particular needs and circumstances.
If you suspect you have a sleep disorder, or if you have symptoms that interfere with sleeping or daytime alertness, call for an evaluation at the Jefferson Sleep Disorders Center. You may schedule an initial appointment by calling 215-955-6175 or 1-800-JEFF-NOW or fill out our online appointment request form.
Last week, I celebrated my 75th birthday. Isn't it rather futile to think about preventing heart disease at my age?
Not at all. In many cases, coronary heart disease is preventable, and because risk attention at any age can make a difference, it's never too late. While you can't change certain risk factors like your age, gender, or family history, there are many risk factors that are treatable. These include high cholesterol, tobacco use, obesity or being overweight, previous stroke and high blood pressure. These place you at a higher risk for heart disease and also stroke. Fortunately, you can do something to change these.
Heart disease is the leading cause of death in the US, accounting for over one quarter of all deaths, and a major cause of disability. What most people do not realize is that coronary heart disease is an equal opportunity killer. Both men and women die from heart disease, with more women dying from heart disease than from cancer, including breast cancer. Symptoms in women tend to be more atypical and can run the gamut from back pain to a twinge in the face or jaw. Generally, men experience more typical symptoms like chest discomfort.
Obviously, the earlier you recognize your risk factors and begin to treat them, the better your chance of increasing longevity. What can you do to reduce your risk factors? Begin annual checkups by age 20, which is when hypertension can begin. Some heart disease is silent, as are certain risk factors. Your doctor will identify any risk factors and develop a treatment plan tailored to your individual needs.
Switch to a balanced, heart-healthy diet. Watch your cholesterol (so critical is this risk factor that pediatricians now check cholesterol). Lose weight. Get your diabetes and blood pressure under control. Give up tobacco. And start exercising regularly – at least 30 minutes for four or five times a week helps maintain health. You can break up the time into smaller increments as long as you are doing moderate-intensity physical activity. Even a 75-year-old will benefit from risk prevention management, so make your health a priority throughout life.
My doctor says I have atrial fibrillation. Does that mean I must stay on a blood thinner?
Atrial fibrillation (AF) is a type of irregular heartbeat affecting more than one million Americans, most over the age of 65. With AF, electrical signals in the atria (upper chambers) of the heart fire in a very fast, uncontrolled manner. Normally, as the electrical impulse moves through the heart, the heart contracts about 60 to 100 times a minute. In someone with AF, the atria may beat as many as 400 times a minute. Some people experience this as a pounding or racing heartbeat, while others feel "flutters."
In some people, the only symptom of AF may be dizziness or lightheadedness. Others complain of feeling tired, while there are those who experience chest pain. And some people have no symptoms at all. I ask my patients to tap their fingers to demonstrate what kind of heartbeat they are experiencing. When I see an irregular tapping, I get suspicious.
When the atria do not contract effectively, the blood may pool, resulting in the formation of blood clots. These clots can break loose and travel through the bloodstream. If a blood clot becomes lodged in an artery in the brain, it may cause a stroke. About 25 percent of strokes occur in persons with atrial fibrillation.
In treating a patient with AF, the most important thing I can do is to assess his or her need for a blood thinner or anticoagulant, which prevents the blood from clotting and greatly reduces the risk of stroke. Warfarin (brand name Coumadin) is the drug of choice for long-term anticoagulation in AF patients. Some patients are reluctant to take a blood thinner because it can cause bleeding, but in this case, the benefits usually far outweigh the risk.
The only way to know for sure if you have AF is to have your doctor perform a painless test called an electrocardiogram (ECG). There are several options for treating AF. To make an appointment for an evaluation with the highly trained specialists at the Jefferson Heart Institute, call 1-800-JEFF NOW.
I've been playing golf with the same group of men for 30 years. In the past two years, three of us have been diagnosed with prostate cancer. Doesn't this seem unusual?
It's hard to say, without knowing the age of your friends and their family history. But we do know that one in six or seven men will be diagnosed with prostate cancer in their lifetime. In fact, prostate cancer is the number-two cause of death in men, and, unfortunately, there is no known cause. In the disease's earliest stages, most men experience no symptoms. That's why early detection is so critical – prostate cancer is very treatable and survival rates are very high when detected early.
The prostate gland is one of the male sex glands, and produces semen. It is located right beneath the bladder and in front of the rectum. The most effective way of fighting prostate cancer is by screening, which includes both a rectal exam and PSA blood test.
The American Cancer Society recommends a prostate screening for:
There have been dramatic improvements in prostate cancer treatment, and side effects have been greatly diminished over the last 10 years. Many men who are diagnosed with prostate cancer are candidates for "active surveillance." They don't need treatment: instead, they can be closely monitored.
The Multidisciplinary Genitourinary Center at the Kimmel Cancer Center at Jefferson pioneered its multidisciplinary approach to prostate cancer back in 1996, making it the first program of its kind in the Delaware Valley. It is one of only a handful of such progressive programs available in the US. In one visit, patients can receive input from multiple cancer specialists and get nutritional, alternative medicine and social support. Clinicians are dedicated to providing the best professional care, delivered with compassion, for all patients. Our team of fellow-ship-trained oncologists and robotic surgeons are nationally and internationally recognized for their contributions to the field of prostate cancer.
To schedule an appointment for a prostate screening and evaluation, call 1-800 JEFF NOW.
My husband, a civil engineer, is 40 years old and was recently diagnosed with Parkinson's disease. He's very depressed, convinced that his life is over. Although he has few symptoms now, how long will he be able to continue working?
About 60,000 Americans are diagnosed with Parkinson's disease (PD) each year, with more than 1.5 million Americans affected at any one time. PD is an age-related condition — the longer we live, the more likely we are to develop PD. Although the majority of PD patients develop symptoms in their 60s, about 10 percent of patients, such as Michael J. Fox, develop their illness in their 40s or younger. Your husband has what we call "young-adult onset Parkinson's disease."
PD is a slowly progressive, degenerative disease associated with symptoms that result from the loss of dopamine-producing brain cells. Dopamine affects mood, mobility and movements. PD symptoms include tremor, stiffness of the limbs and trunk, slow movement (bradykinesia), and impaired balance and coordination. Possible non-motor symptoms include depression, bowel and bladder symptoms, or memory loss.
Symptoms of PD vary from patient to patient, but they generally start on one side of the body and spread to the other side. Early symptoms may be subtle and often progress over many years before reaching a point where they interfere with normal daily activities.
People suffering from PD have to cope with the fact that the disease will progress. There may be a loss of independence and mobility; however, PD is not always a disabling condition. With the right care, most patients will lead functional lives for many years.
While we have yet to find a cure, with proper medical therapy, we can control the symptoms for many years. At Jefferson's Movement Disorders Center, our treatment integrates the latest pharmacologic therapies, and patients also have the opportunity to participate in investigational clinical trials and research. Jefferson also performs Deep Brain Stimulation (DBS) surgery, a minimally invasive, highly effective neurosurgical procedure which may be an option for patients with medically refractory PD.
Tsao-Wei Liang, MD, is a graduate of Johns Hopkins University and New York University School of Medicine
Daniel Erik Kremens, MD, is a graduate of Columbia College of Columbia University, Columbia University School of Law, and Jefferson Medical College of Thomas Jefferson University.
Both doctors completed residencies in Neurology and fellowship training in Movement Disorders at the Hospital of the University of Pennsylvania.
Since I've reached my mid-sixties, it seems that every week I hear about someone I know having heart failure. Why is heart failure so prevalent?
Heart failure, also called congestive heart failure, can affect all of us eventually because we are living longer. It's actually the only cardiovascular disease that is increasing in prevalence, even as the overall incidence of heart disease is slowly dropping. In fact, eighty percent of people over 65 have some form of heart failure. With our aging population, including the baby boomers beginning to reach retirement age, it is estimated that roughly 550,000 people in this country will develop symptomatic heart failure this year.
Heart failure occurs when the lower chambers of the heart are not able to pump blood effectively and cannot meet the needs of the body's other organs. If heart muscle has been damaged by conditions such as long-term high blood pressure, coronary artery disease, heart valve or heart muscle problems, it is more difficult for the heart to pump effectively. Many causes of heart failure are conditions that can be treated or controlled.
That's why it's so important to make a commitment to your health early in life by exercising, watching your diet and seeing your doctor regularly.
Heart failure can develop slowly and people often dismiss symptoms as normal signs of aging. Common symptoms of heart failure include shortness of breath during rest, exercise or lying flat; weight gain; visible swelling of the legs and ankles, and, occasionally, the abdomen; fatigue and weakness; loss of appetite and nausea; persistent cough; and reduced urination. A good rule of thumb is that if you begin to feel physically different, you should consult your physician.
When diagnosed early, heart failure can be treated effectively with medications and lifestyle accommodations. However, heart failure that has progressed to an advanced stage is a multi-organ disease process also affecting the kidneys and lungs, for example, and requires aggressive treatment. At Jefferson's Advanced Heart Failure and Cardiac Transplant Center, physicians offer a comprehensive approach to the disease process with state-of-the-art care. They provide individually tailored, aggressive therapy to treat each patient using a wide range of medical and surgical options that include investigational treatment devices and heart transplants.
I am a 25-year-old female competitive runner plagued by debilitating groin pain, the cause of which has been diagnosed as hip impingement. Is this the end of my running career?
Femoral or hip impingement is caused by insufficient space between the neck of the femur (thigh bone) and the rim of the acetabulum (concave socket in the pelvis). When the hip is flexed, as in sitting or running, the neck and rim jam together, resulting in pain in the hip or groin region with the potential for early degenerative arthritis of the hip. Now, we have two innovative orthopedic procedures that preserve a patient's native hip joint, giving hope to younger individuals who have had to rely on medications like non-steroidal anti-inflammatory drugs to relieve chronic pain or a hip replacement or resurfacing.
Why Hip Preservation?
Hip preservation is an optimal choice for younger, qualified patients because it reduces pain, restores mobility, leaves the anatomy intact, and allows for options should arthritis progress. No implants or devices to replace the natural joint are required.
Of the two types of hip-preserving procedures, periacetabular, or the Ganz procedure, as it's called (after the doctor who developed it), is the more complicated, usually involving several cuts in the pelvis. The procedure treats hip dysplasia, a condition in which the head of the femur only loosely or partially fits into the acetabulum, and the femoral head or acetabulum is misshapen. The Ganz procedure deepens the socket to eliminate the wear and tear of dysplasia. The patient is hospitalized for several days. Recovery can take three months, with the use of crutches. The benefit is symptom-free hips for many years before the need for a hip replacement.
Femoroacetabular osteoplasty done through a small incision, a procedure I helped develop, is far less complicated than the Ganz procedure. We make the incision and smooth the surface in the space between the neck and the head of the femur. It's a quick surgery with just an overnight hospital stay. Recovery takes about six weeks. The 75 to 80 percent success rate is much higher than arthroscopy and as successful as or more so than the more complicated Ganz procedure.
Young patients with groin pain and underlying hip dysplasia and minimal osteoarthritis are candidates for the procedure. Patients must be no older than 50. You'll be pleased to know that after this procedure, you can look forward to resuming your running pain free and maybe even speedier than before.
For information or to make an appointment with a physician at the Rothman Institute at Jefferson call, 1-800-JEFF NOW or fill out our online appointment request form.
I'm 25 years old and my mother and her sister had breast cancer. What can I do to prevent it from happening to me?
Although routine care is the best way to keep you and your breasts healthy, there are certain risk factors you can't control, such as your age and genetic makeup. Detecting breast cancer at its earliest stages, when it's most treatable, is the main goal of routine breast care. Every woman's routine care plan should include regular breast self-examination, clinical examination, and typically, a mammogram beginning at age 40.
In your case, however, there is a significant risk factor of hereditary breast cancer so early screening is essential. An estimated 20 percent of all women diagnosed with breast cancer have a close relative with this diagnosis. In general, the greater the number of relatives diagnosed with breast cancer, the greater the risk for you and other family members. But it's important to remember that having a significant family history of cancer does not mean that you will develop cancer.
Women who are identified to be at high risk for breast cancer can especially benefit from screening and prevention services. Remember, while screening is for every woman, prevention is for people who have been diagnosed at risk. Genetic testing is an option you should consider. In the detailed process of genetic counseling, your medical and family history is carefully evaluated and the risk for carrying a hereditary breast cancer trait is assessed. Once your risk is evaluated, you and your physician can decide on breast cancer prevention options such as beginning mammography at an earlier age, and possibly getting additional imaging testing.
Even among women diagnosed with "benign" breast lumps (meaning no cancer is present), there are still certain types of benign breast diseases with an increased risk for cancer. The most worrisome group of women is those whose breast cells are proliferative (growing) or who have atypical hyperplasia (cells that are both abnormal and increased in number). If the cells are proliferative, the risk goes up, depending on family history. An alarming percentage of the women in these groups will develop breast cancer within 15 years. Prevention, as we know it at the moment, requires prophylactic surgery or medication like tamoxifen for as long as five years.
I've heard that a ruptured brain aneu-rysm feels like the worst headache you'll ever have, even worse than a severe migraine. What exactly is an aneu-rysm and can you prevent one?
A cerebral, or brain aneurysm is a bulging, weakened area in the wall of an artery in the brain, resulting in an abnormal widening or ballooning. The terrible headache, which usually strikes without warning, is the number one sign of a ruptured brain aneurysm and requires immediate medical attention.
Although aneurysms are not hereditary, certain risk factors for aneurysm formation are. You may not be able to control the hereditary risk factor, but you can control acquired risk factors such as smoking, binge drinking, illicit drug use or hypertension.
The symptoms of a cerebral aneurysm may resemble those of other problems or medical conditions. Some-times diagnostic tests for other conditions reveal the presence of a cerebral aneurysm, but generally the aneurysm goes undiagnosed until it ruptures. Occasionally symptoms occur prior to an actual rupture, due to a small amount of blood leaking into the brain. Signs of an unruptured brain aneurysm include headaches, dizziness, eye pain, and vision problems.
The most common type of brain aneurysm causes hemorrhaging. About 70% of the aneurysms we treat present with hemorrhage and about 22% are detected before rupture. Signs of a rupture include: rapid onset of the "worst headache in my life"; stiff neck, nausea and vomiting, changes in mental status such as drowsiness, pain in specific areas such as the eyes, dilat-ed pupils, loss of consciousness, hypertension (high blood pressure), loss of balance or coordination, sensitivity to light, back or leg pain, or difficulty swallowing. Notify your physician immediately if you experience symptoms or warning signs of a brain aneurysm.
The physician will consider many factors when planning treatment for a cerebral aneurysm. In some cases, the aneurysm will not be treated, but the patient will be closely monitored. In other cases, surgical or endovascular treatment may be indicated.
My father has had Parkinson's disease for ten years. In the past year, his symptoms seem worse and his medication doesn't seem to be working. I read about a surgical procedure for Parkinson's patients that controls symptoms. What happens if he has the procedure and a better treatment comes along later?
Deep Brain Stimulation (DBS) is a surgical procedure for patients with Parkinson's disease who have stopped responding to drug treatment. Its purpose is to deliver controlled electrical signals to precisely targeted areas of the brain through a tiny, implanted wire with electrodes attached. The electrical stimulation helps control the tremors that are characteristic of Parkinson's disease by shutting off the hyperactivity in the portion of the brain which controls this movement.
DBS surgery is performed in two stages. The patient is awake during the first stage, and asleep, under general anesthesia, during the second. One month later, the patient returns to have the pacemaker turned on. Although the initial surgery takes from six to eight hours, the pacemaker battery lasts nearly five years for Parkinson's and can be replaced in a simple thirty-minute procedure.
DBS is ideal for a progressive, neurodegenerative disorder like Parkinson's, a disease which affects some 1.5 million people in this country, because it involves a single area of the brain. The treatment may have several advantages over other treatments because its effects are very precise and controlled. Doctors can easily increase the current or frequency of pulse and further modify a patient's electrical dosing.
On average, about 50 percent of individuals having DBS reduce their medication by half, and 10 to 20 percent are able to stop taking their medications. If the treatment becomes ineffective, it's probably because the disease is progressing.
There's no need to worry about DBS interfering with treatment advances in the future because DBS, unlike older treatments for Parkinson's, is reversible, and the patient will still be a candidate for developing therapies.
For more information about deep brain stimulation, please call, 1-800-JEFF-NOW or fill out our online appointment request form.
My lower back has been bothering me for months, and now I feel pain when I bend to tie my shoes. My wife wants me to see a specialist, but I'm terrified of what the doctor will say. What are the chances I'll need surgery?
More than 80 percent of adults will experience significant back or neck pain at sometime during their life. It's no wonder, considering the complexity of the spinal structure. The spine, which protects the spinal cord, provides both mobility and strength, and proper functioning of the neck and back allowing for fluid, effortless movement. But when there's a spinal problem, commonplace activities such as bending, stretching or turning become painfully challenging, and your quality of life can be greatly diminished.
Many things affect the spine—arthritis, degenerative wear and tear on the joints and disks, and a variety of other abnormalities that cause pain, numbness and weakness in other parts of the body as well. Problems in the low back or lumbar spine can affect the leg and foot, while problems in the cervical spine of the neck can affect the arms and hands.
Steps to improve back and neck health:
If you're suffering from back pain, don't put off seeing a doctor. Fortunately, the vast majority of back pain is treated non-operatively. Generally, a course of physical therapy, anti-inflammatory medication or an epidural injection is sufficient for most back problems. Unless there's a progressing deformity of the spine or the person is developing leg pain or leg weakness, most patients do not require surgery.
To make an appointment with the highly trained specialists of the Rothman Institute at Jefferson, call 1-800-JEFF-NOW or fill out our online appointment request form.
I belong to a tennis club and lately, it seems that everyone complains about a rotator cuff injury. Is it that commonplace?
The rotator cuff consists of tendons and muscles that work together to hold the shoulder in place. It allows you to lift your arms and reach up. The rotator cuff may be damaged from a fall or other injury to the shoulder or damage may occur slowly over time from repetitive movement or overuse of the shoulder. Rotator cuff tears are also due to aging. A rotator cuff tear is manifested by shoulder pain that is worse with overhead activity. Symptoms include recurrent pain, limited ability to move the arm, and muscle weakness.
When a tennis buddy says 'I had a rotator cuff injury,' it can mean a million different things. Many problems pass for a rotator cuff injury, making accurate diagnosis important for proper treatment. A partial tear of the rotator cuff is a totally different condition than a tear that goes all way through tendon or when the whole thing pulls off the bone. Those injuries take much longer to recover from.
A rotator cuff injury is one of the most common injuries that the shoulder specialists see at the Rothman Institute at Jefferson. A rotator cuff injury doesn't necessarily mean surgery although arthroscopy is often used to repair certain tears. Instead, your doctor may prescribe rest, nonsteroidal anti-inflammatory medications, strengthening exercises, ultrasound therapy, or steroid injections. The goal of rotator cuff repair is to help restore the function and flexibility of the shoulder and with surgery, to relieve the pain that cannot be controlled by other treatments.
While nobody disputes the value of remaining physically active, especially as we age, keeping physically fit with a balanced program of aerobics, stretching and strengthening all your body parts helps to prevent injuries. If you think you have injured your rotator cuff, consult a physician or physical therapist before starting an exercise program.
For care and treatment of a shoulder injury, schedule an appointment at the Rothman Institute at Jefferson or at the Methodist Hospital Division, which houses a specialized center for shoulder and elbow surgery.
Call 1-800-JEFF-NOW or fill out our online appointment request form.
When my father was 87 and had pancreatic cancer, the doctors said he was too old for surgery. Yet now I hear that doctors are performing surgery on pancreatic cancer patients who are in their 90s? Is this true and why the change?
Age used to be a deciding factor for certain cancer surgery but that's not true anymore. In fact, pancreatic cancer used to be a "death sentence" but now we have many innovative treatments that, in some cases, can cure this cancer. The Whipple, a surgical procedure that treats pancreas tumors and tumors that have formed in the bile duct, can be successfully performed on patients in their 80s and even in their 90s and older. This is true partly because of advances in medicine, for example, in anesthesia and ICU care, but there's another reason. While it's not a huge paradigm shift chance per se, we've got a population of healthy, old people. They exercise, eat right, and take care of themselves. So while longevity increases the risk for pancreatic cancer, a healthier population makes for better surgical risk.
At Jefferson, whenever possible, we treat pancreatic tumors with a procedure called a "mini-Whipple", which preserves the entire stomach and pylorus. If there is a mass that is resectable in the pancreas, chances are that we can take it out safely and the patient will do well. The advantages of this mini-Whipple procedure over the classic Whipple, in which part of the stomach is removed, include a shorter hospital stay and fewer complications.
We've learned that the five-year survival rate for individuals at least 80 years old is comparable to that of the younger population and complication rates with resected pancreas cancer for these individuals are what would be expected, involving conditions that afflict many that age, such as heart disease, diabetes and high blood pressure.
What's the lesson here? If an experienced group of surgeons safely perform the right operation, the patient likely will do fine. The good news is that as the population ages, more individuals may be eligible for such surgery, and as a result, will enjoy a better quality of life in their golden years.
I’m a 61-year-old healthy, active male. Recently, I experienced chest pains and a catheterization revealed blockage in an artery. My doctor recommends a stent instead of bypass surgery. I’ve heard conflicting things about stents. How safe are they?
Coronary artery disease (CAD) is a serious condition that occurs when plaque buildup clogs the arteries, reducing blood fl ow to the heart. The blockage can lead to chest pain, shortness of breath or even a heart attack.
Angioplasty with a stent has become more common than bypass surgery in treating CAD because it is far less invasive. During the procedure, a stent, which is a tiny wire coil, is inserted into a clogged artery to keep the artery from narrowing or closing again.
The original bare-metal stents represented a significant advancement, but a sizeable percentage of patients had a recurring blockage, necessitating another angioplasty or even bypass surgery. Hence, the development of medicated stents, referred to as “drug-eluting” stents because they use a time-released drug to prevent the formation of the scar-like tissue that causes blockage. Jefferson was the fi rst hospital in the Philadelphia area to off er the new XIENCE™ V medicated stent aft er approval by the U.S. Food and Drug Administration.
Despite the dramatic improvement these stents offer, there are limitations. For example, patients who receive stents may develop life-threatening cardiac complications if they undergo subsequent non-cardiac surgery. Jefferson has developed strategies to take these patients through surgery safely.
Jefferson cardiologists have been at the forefront in developing less-invasive therapies, such as stents, for treating CAD. Off ering innovative techniques and expertise in complex high-risk patients, Jeffersson physicians strive to fi nd the best treatment option for each individual patient.
For more information about stents for heart patients and other treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/heart.
I keep hearing about breast MRIs and ultrasounds. Should I have a breast MRI or an ultrasound rather than a mammogram for my annual breast cancer screening?
Every woman’s routine breast care should include regular breast self-examination, clinical examination, and, typically, a mammogram (an x-ray of the breast) beginning at age 40. For the average woman, there is no test better than mammography for early detection of breast cancer, before it is big enough to feel or cause symptoms and when it is easier to treat.
A routine breast screening ultrasound will detect fewer breast cancers than a routine screening mammogram; therefore, a routine ultrasound is always performed in addition to a mammogram.
Concerned About Your Risk for Developing Breast Cancer?
Meet with a genetics specialist in the risk assessment program at the Jefferson-Honickman Breast Imaging Center. Once your risk is evaluated, you and your physician can decide on breast cancer prevention options such as beginning mammography at an earlier age and possibly getting additional imaging testing.
Breast MRI is more complicated, involving an intravenous injection of contrast. It can detect some cancers not seen by mammography and ultrasound. But breast MRI may detect many other uncertain areas that turn out to be benign. Routine breast MRI is being studied for women with a very high risk for breast cancer. For the average woman, however, there is no evidence that a screening MRI is more eff ective then mammography.
For more information about breast imaging and MRIs and other treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/breast.
I’m only 52 but I’ve had to give up tennis and skiing because of joint pain. My doctor says I’m a candidate for total hip replacement surgery. Should I wait a few more years until the technology is better?
The decision to undergo total hip replacement is a personal one that depends upon a number of criteria. One critical element is your pain tolerance. If you suffer from severe pain that affects your daily life, and you find yourself reducing your activity level, it’s time to consider a hip replacement.
There’s no reason to wait until your muscles atrophy and you become deconditioned. With today’s longer life expectancies and increasing activity levels, joint replacement is being performed in increasing numbers on younger patients like yourself. Thanks to new advances in artificial joint technology, many of which were pioneered at the Rothman Institute at Jefferson, patients who have hip replacement surgery can expect to resume normal activities.
At the Rothman Institute at Jefferson, the focus is on resolving pain and restoring function with a rapid recovery. The newer anesthetic agents that we use in the operating room can block pain for three days aft er surgery. Once you reduce pain, a lot ofgood things happen. Patients can get up and walk right away, and there’s a more rapid recovery. A patient who undergoes hip replacement surgery in the morning will be up and walking by afternoon. At afternoon rounds, I’ll inquire, “Are you having much pain?” And most often, the response is, “What pain?” When asked to describe the level of pain on a scale of 1 to 10, the patient says “zero.”
Finally, when you are ready for joint replacement surgery, be sure to use a surgeon who performs a large volume of your particular surgery. Research studies have proven that outcomes are better with less complication.
For more information about joint pain and other treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/ortho.
I’m a 56-year-old male with prostate cancer. My doctor recommends surgery to remove the prostate. I’ve been hearing about this robotic surgery. What exactly is it and would I be a candidate?
Jefferson urologists were the first in the Delaware Valley to offer minimally invasive laparoscopic prostatectomy to remove the cancerous prostate – a far less-invasive procedure than the traditional open surgery, off ering the possibility of fewer side eff ects, smaller incisions, less pain, and quicker recovery. And now, robotic technology empowers the surgeon to perform a more-efficient, very precise, nerve-sparing laparoscopic operation.
The good news is that nearly every prostate cancer patient who is a candidate for surgery is a candidate for robotic prostatectomy. Th e patients who may not qualify are those with medical problems such as obesity, lung disease, extensive prior surgery or previous radiation therapy.
Surgical treatment for prostate cancer has three main goals: (1) to cure cancer, (2) to minimize side effects, and (3) to make recovery easier. Robotic prostatectomy hits the mark on all three. The cancer cure rate seems to be as good as with open surgery. Side effects, such as leakage of urine and the risk of postoperative impotence, and recovery are signifi cantly improved. Patients go home with a urinary catheter that, typically, is removed after nine or 10 days.
The Multidisciplinary Genitourinary Center at the Kimmel Cancer Center of Jefferson pioneered our multidisciplinary approach to prostate cancer back in 1996, making this the first program of its kind in the Delaware Valley and one of the fi rst in the US. Our team of fellowship-trained oncologists and robotic surgeons are nationally and internationally recognized for their contributions to the entire field of prostate cancer. In fact, we have the most fellowship-trained surgeons for laparoscopic and robotic-assisted surgery in the region.
For more information about robotic surgery and other treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/urology.
There are many more patients waiting for a kidney than there are available kidneys. The waiting time for a kidney from a deceased donor can often be three to five years.
The majority of transplanted kidneys come from deceased organ donors. When a kidney comes from a living donor, the procedure is called a living-donor transplant. Although one-year success rates for living-donor and deceased-donor kidneys are both excellent, those from living donors have a better long-term success rate. Deceased-donor kidneys last eight years on average, while living-donor kidneys often last 15 to 20 years.
A living donor need not be a blood relative of the recipient. Spouse, friends and even total strangers (so called “altruistic” donors) can donate a kidney. Potential kidney donors are evaluated very carefully to ensure that they can safely donate and still live a normal life. As a matter of fact, probably as a result of this thorough workup, kidney donors on average live longer than the general public! Their remaining kidney grows after donation so that they maintain excellent kidney function.
While not a cure, kidney transplantation enables a patient to resume a healthier, independent lifestyle without the need for dialysis. At Jefferson, our multidisciplinary team approach guides the donor and recipient through the entire process, from evaluation to postoperative care.
For more information about kidney transplant and other treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/transplant/kidney/index.html.
It’s been four years since I was diagnosed with epilepsy. My medication is no longer working. What are my options?
Between 35 to 40 percent of people with epilepsy or a seizure disorder have seizures not completely controlled by medication. Uncontrolled seizures limit independence, restrict employment and educational opportunities, and can cause accidents and injuries, brain damage or dysfunction, or even death.
Most people with epilepsy know within the first two years of taking a medication whether or not it is working. As a rule, if you continue to have seizures after trying two drugs, it’s time to have an evaluation by an epilepsy specialist to verify the diagnosis and determine which treatments might be most effective.
Proper Diagnosis is Key
To learn about your treatment options, see an epilepsy specialist, who will make sure that your seizures have been properly diagnosed. At the Jefferson Comprehensive Epilepsy Center, patients have access to renowned neurologists, neuropsychologists and neurosurgeons working together to provide complete and thorough diagnostic services.
Once the type of epilepsy is diagnosed, we consider whether new types of medicines should be used and whether other options, such as brain surgery, ketogenic diet, or vagus nerve stimulation might help. If conventional therapy is not effective, then we can offer other alternatives – investigational drugs or surgical procedures such as brain stimulation. Jefferson has a large clinical trials program to develop new treatments for people with uncontrolled seizures.
For more information about epilepsy and other treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/neuroscience.
I’m a 57-year-old male whose passion is golf. For the past year, my arthritic shoulder is so painful that I haven’t been able to play much. My doctor suggests a shoulder replacement, but I feel I should wait until retirement. What do you think?
We used to put off the surgery as long as possible, but now, we view it as a quality-of-life issue. I ask my patients, “Are you willing to live with pain for the rest of your life, or do you think you’ll consider surgery at some point?” If you know you will opt for surgery eventually, sooner is better. Have the surgery while you are in good health and will enjoy the benefi t of more quality years.
Osteoarthritis, a common cause of shoulder pain and mobility loss, aff ects more than 16 million Americans. Arthroplasty (total shoulder replacement surgery) helps restore function to shoulders damaged by degenerative joint disease, osteoarthritis or rheumatoid arthritis. Replacing the worn out ball and socket in the shoulder with a prosthetic device relieves pain and increases shoulder mobility.
Patients usually describe immediate post-surgical pain as less than the arthritis pain they had been living with, often for years. At Jefferson, a patient usually remains in the hospital for two nights. Exercise, which is vital to recovery, begins on day one and continues at home. Initially, stretching is required to minimize stiffness. Later, light strengthening exercises are added to the regimen with peak improvement reached between four to six months
For more information about shoulder replacement options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/ortho.
I’ve had heartburn for years and just learned that I have Barrett’s esophagus. My doctor recommends treatment to eliminate the risk of esophageal cancer. How eff ective are these new treatments?
Barrett’s esophagus is a precancerous condition aff ecting the lining of the esophagus – the tube that carries food from the mouth to the stomach. Barrett’s esophagus results from chronic acid refl ux, which can cause changes in the cells of the esophageal lining that may eventually become cancerous. Patients with Barrett’s esophagus have increased risk of developing esophageal cancer.
Before the introduction of photodynamic therapy (PDT), surgery was the only way to treat Barrett’s esophagus in those who already had precancerous changes. PDT is a method by which a light-sensitive chemical is injected into the body and then activated with a laser fi ber passed through a scope to target precancerous cells in the esophageal lining. Patients who undergo PDT must avoid direct sunlight or bright indoor light for 30 to 60 days.
At Jefferson, we also employ novel techniques like radiofrequency ablation (RFA) and cryoablation to treat Barrett’s esophagus and decrease side eff ects such as chest pain, nausea and photosensitivity. With RFA, a wire-wrapped balloon is slipped down the esophagus. Bursts of radiofrequency energy are sent along the wire to destroy the precancerous cells. In just three to four sessions, we can put the esophagus back to normal greater than 90 percent of the time, provided the patient remains on medication for acid suppression. We are also studying new cryoablation technology to remove the aff ected esophageal lining by freezing it with liquid nitrogen spray.
For more information about esophageal cancer treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/gastro.
I’ve had heartburn for years and just learned that I have Barrett’s esophagus. My doctor recommends treatment to eliminate the risk of esophageal cancer. How eff ective are these new treatments?
Barrett’s esophagus is a precancerous condition aff ecting the lining of the esophagus – the tube that carries food from the mouth to the stomach. Barrett’s esophagus results from chronic acid refl ux, which can cause changes in the cells of the esophageal lining that may eventually become cancerous. Patients with Barrett’s esophagus have increased risk of developing esophageal cancer.
Before the introduction of photodynamic therapy (PDT), surgery was the only way to treat Barrett’s esophagus in those who already had precancerous changes. PDT is a method by which a light-sensitive chemical is injected into the body and then activated with a laser fi ber passed through a scope to target precancerous cells in the esophageal lining. Patients who undergo PDT must avoid direct sunlight or bright indoor light for 30 to 60 days.
At Jefferson, we also employ novel techniques like radiofrequency ablation (RFA) and cryoablation to treat Barrett’s esophagus and decrease side eff ects such as chest pain, nausea and photosensitivity. With RFA, a wire-wrapped balloon is slipped down the esophagus. Bursts of radiofrequency energy are sent along the wire to destroy the precancerous cells. In just three to four sessions, we can put the esophagus back to normal greater than 90 percent of the time, provided the patient remains on medication for acid suppression. We are also studying new cryoablation technology to remove the aff ected esophageal lining by freezing it with liquid nitrogen spray.
For more information about esophageal cancer treatment options available from Jefferson, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/gastro.
I’m a healthy 40-year-old woman whose parents had heart attacks in their fifties. Should I get an annual stress test?
A stress test, sometimes called a treadmill test or exercise test, helps your doctor determine how well your heart handles its workload. The test monitors your heart, breathing and blood pressure during exercise, and can reveal limitations of blood flow to an area of the heart. A stress test can be a good diagnostic tool for detecting advanced heart disease or determining a prudent level of exercise following a heart attack or heart surgery, but it does not guarantee the absence of heart disease.
Most important to your heart health is the ongoing dialogue between you and your cardiologist. Your physician must know your family medical history and be familiar with your lifestyle. It’s essential that you develop an understanding of coronary artery disease and what you can do to prevent it, especially when there’s a family history of stroke or heart attack. You should also know the signs and symptoms of a heart attack. If you experience symptoms call 911 immediately. Remember, prompt treatment is essential.
The specialists at the Jefferson Heart Institute are dedicated to the diagnosis, treatment and prevention of heart disease through superb clinical services, research and educational programs.
A few years ago, I had surgery to remove a pituitary tumor. The tumor has reappeared and my surgeon is suggesting a newer, less-traumatic procedure. What is this new kind of surgery?
Advanced technology and innovative techniques have dramatically changed the outcome for patients with cranial base (skull) and brain tumors. Previously, tumors were oft en inaccessible or required extensive and lengthy surgeries. Now, minimally invasive cranial base surgery gives surgeons better tumor access, enabling more-complete removal.
The Jefferson Center for Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery is one of the most comprehensive in the Delaware Valley. Instead of reaching tumors with quite-invasive surgery that oft en requires facial reconstruction, we access them through the nose and mouth with endoscopes (basically, tiny telescopes) guided by computer navigation systems. We can remove tumors safely, with fewer complications and less risk.
With minimally invasive surgery, patients experience less postoperative discomfort, shorter hospital stays and faster recoveries. Patients requiring other treatments, such as radiation and chemotherapy, can begin them sooner. The results are better outcomes and greater patient satisfaction.
I’m a 30-year-old woman with a family history of heart attacks and strokes. Is there anything I can do to reduce my risk of following in the footsteps of my aunts, uncles and cousins?
Heart disease used to be considered a disease of men. But in reality, more women than men die every year of cardiovascular disease (CVD) in many countries, including the United States. Globally, CVD, which encompasses heart attack and stroke, which share similar risk factors, is the leading single cause of death among women, responsible for over one-third of all deaths – far more than breast cancer.
Fortunately, healthy lifestyle choices can reduce your risk for heart disease and stroke. February – American Heart Month – is the perfect time to start making changes.
The groundwork for developing CVD is laid down when one is young, although the disease may take decades to surface. To avoid CVD, prevention should begin in your teens or young adulthood. But that’s not to say it’s ever too late to start. Smoking, for example, is a major risk factor, yet in the fi rst two years aft er a smoker quits, the risk for heart disease drops in half.
The Jefferson Heart Institute provides out-standing, comprehensive medical and surgical care to patients with cardiovascular concerns. Through the combined impact of high-quality clinical services, educational and research programs it sponsors, JHI contributes significantly to the diagnosis, treatment and prevention of heart disease.
I’m a healthy female approaching my 50th birthday. I have no symptoms and no family history of colon cancer. Why is my doctor recommending colon cancer screening?
Colorectal cancer is the third most common cancer diagnosed among both men and women in the US, and the second leading cause of cancer death. It is also one of the most easily prevented cancers. Screening can help prevent colorectal cancer by finding and removing polyps, or it can detect cancer early, when the cure rate is highest.
Colon polyps and early-stage colon cancer often don’t cause any symptoms, so it’s important that everyone – even individuals with no family history of colon cancer – be screened beginning at age 50. If someone in your family has had polyps or colon cancer, you should have your fi rst colonoscopy at age 40 or 10 years before that relative was diagnosed – whichever occurs first.
The Jefferson Digestive Disease Institute’s new, state-of-the-art endoscopy suite offers the latest technology, including a swallowed camera pill to identify problems in patients’ digestive tracts.
I’ve been diagnosed with a brain tumor. My doctor suggests that I participate in a clinical trial. Should I agree?
A clinical trial is performed in order to translate a promising discovery into an accepted treatment for cancer.
Entering a clinical trial is a very personal decision. In considering it, patients and their families should understand that participation is purely voluntary and that the law protects their rights. Th ey should be aware of what the standard treatment is and how the trial treatment diff ers, how long the trial is going to continue, and how oft en they will have to visit the hospital. They should ask about side effects and who to contact if problems arise.
Taking part in clinical research can be daunting, but please be assured that they are designed to maximize patients’ safety. Patients are encouraged to learn about the treatment being tested; being more knowledgeable will help you make the decision that is right for you.
Pros of Clinical Trial Participation
- Access to innovative treatments that may prove better than current therapies
- Satisfaction from contributing toward development of new treatments that help others
Cons
- Risk of side effects
- No guarantee that the treatment received will work better than the standard
Distinguished radiation and medical oncologists at the Kimmel Cancer Center at Jefferson and neurosurgeons and neuro-oncologists at Jeff erson Hospital for Neuroscience work closely together to provide comprehensive treatment for patients with brain tumors. Strong support from residents, nurses, social workers, radiation technicians and research coordinators ensures that leading-edge treatment is delivered with compassionate care. At Jefferson, we are proud to have a wide range of clinical trials open so that our patients can receive tomorrow’s therapies today.
For more information about clinical trials and other treatment options available from the Department of Radiation Oncology, call 1-800-JEFF-NOW, or please visit us at www.JeffersonHospital.org/radonc.
Richard J. Lawrence, MD, graduated from Cambridge University in the United Kingdom and then from University College London Medical School. He has been a member of the Royal College of Physicians of London since 2002. Dr. Lawrence utilizes stereotactic radiosurgery, incorporating linear accelerator (LINAC) and gamma knife technologies, for the treatment of brain tumors. He recently published a pioneering paper on the use of radiation therapy in the treatment of brain tumors. In 2009, Dr. Lawrence received the American Society for Clinical Oncology’s Young Investigator Award.
I’m a woman in my 40s. I feel fine but my father developed heart failure in his 50s. Is heart failure any more or less common among women than men? How can I reduce my risk?
Heart failure is equally common in women and men. Unfortunately, women are often so busy taking care of children, spouses and elderly parents that they don’t get suffi cient care for themselves. You must make time to see your family doctor for periodic physicals and, if necessary, referrals to a cardiologist (and other specialists).
Hypertension (high blood pressure) and coronary artery disease can increase your risk of developing heart failure. Th erefore, the diagnosis and treatment of these problems are important. Your physician can help you identify and control cardiovascular risk factors that may be playing a role, such as smoking, high cholesterol, diabetes, poor diet and lack of exercise, excessive alcohol consumption and sleep apnea.
Your physician needs a specific and detailed family history because heart failure may be genetic and affect members within a family. Your family history may lead to screening tests such as an echocardiogram to evaluate the heart’s function.
Different Causes of Heart Failure
In order for the heart to efficiently pump out blood, it has to be able to contract, or squeeze, normally, and relax, to fi ll with blood normally. Inability to contract normally is a cause of heart failure in both
men and women. As women get older, heart failure can often be due to the heart’s inability to relax, causing fluid retention.
The staff of the Jefferson Heart Institute (JHI) works in close partnership with Thomas Jefferson University Hospital to provide clinical services that span the entire spectrum of heart disease, including heart failure diagnosis and treatment. JHI is conveniently located at 925 Chestnut Street, Philadelphia (entrance: 10th and Ludlow Streets).
For more information about treatment options available from the Jefferson Heart Institute, call 1-800-JEFF-NOW, or please visit our web site.
Sharon Rubin, MD, earned her medical degree at Temple University School of Medicine, Philadelphia. She completed her internship, residency in internal medicine and a cardiology fellowship at Temple University Hospital. Dr. Rubin has a wealth of experience in end-stage heart failure and cardiac transplantation. She also has a special interest in adult congenital heart disease and obstetric care in the cardiac patient.
My flat feet have become progressively more painful despite my use of orthotic inserts. What are my treatment options?
The flat foot is a common condition among adults and can oft en be controlled with the use of an in-shoe orthotic insert. Orthotics, however, may not be enough to relieve persistent pain.
One treatment option is wearing a custom-molded brace that goes above the level of the ankle onto the leg. Although it provides support and pain relief, this brace does not fix the problem, and patients must wear it indefinitely.
The only permanent correction for flat feet is surgery. If done before arthritis sets in, one of the many tendons that move the little toes can be transferred to replace the damaged posterior tibial tendon, and the arch can be realigned. If arthritis has already set in, a more complex procedure to fuse the arch bones together is required so that the tendon no longer has to function to support the arch. Both options can result in significant improvement in pain and function and eliminate the need for bracing.
Why Feet Flatten
Flat foot is a condition in which the arch of the foot has collapsed, with the entire sole of the foot coming into direct contact with the ground. Causes include genetics, tendon failure, and abnormal tendon function and bone structure.
Flat feet may lead to misalignment to other structures of the feet. Pain may develop in the arch, calf, and perhaps the lower back. In severely flat feet, patients may have pain that makes moving and/or standing difficult.
The goal of the Rothman Institute at Jefferson’s Foot and Ankle Services is to relieve patients of chronic pain and to return function and enjoyment to everyday activities. To accomplish this, our specialists utilize a broad range of surgical and nonsurgical treatments.
For more information about treatment options available from the Jefferson's Foot and Ankle Services, call 1-800-JEFF-NOW, or please visit our web site.
Steven M. Raikin, MD, earned his medical degree from the University of Witwatersrand Medical School, South Africa. He completed a residency in orthopedic surgery at Mt. Sinai Medical Center, Cleveland, Ohio, and fellowships in foot and ankle surgery at Union Memorial Hospital, Baltimore, Maryland. Dr. Raikin specializes in treating elective and traumatic disorders of the foot and ankle.
I’m a 65-year-old male recently diagnosed with early prostate cancer. I’m considering various types of radiation therapy – internal or external, involving either photons or protons. Which is best for me?
The field of radiation oncology has had significant technological advances over the past decade. Today, photons (x-rays) can be targeted at cancerous tissues in the prostate either externally or internally. Your urologist and radiation oncologist can advise you about which approach is right for you and potential side effects.
A newer form of radiation therapy involves protons (subatomic particles) rather than photons. There is no evidence that proton therapy is more effective than photon therapy. Currently, proton therapy treatment delivery technology is not as advanced as that for photon therapy (IMRT). Whether protons will result in fewer side effects remains to be seen.
Some Radiation Treatment Options
Two leading radiation therapy options for prostate cancer available at Jefferson are:
Jefferson’s radiation therapy takes place through our Department of Radiation Oncology at Jefferson’s Kimmel Cancer Center and Jefferson Hospital for Neuroscience in Center City, the Radiation Oncology Pavilion at Jefferson’s Methodist Hospital in South Philadelphia, Jefferson-Aria Health Radiation Oncology, and Jefferson Radiation Oncology Center at Riddle Memorial Hospital. The department has a state-of-the-art system of image-based planning and treatment delivery, and offers clinical research trial participation to many patients.
For more information about treatment options available from the Department of Radiation Oncology, call 1-800-JEFF-NOW, or please visit the Radiation Oncology Web Site.
Adam P. Dicker, MD, earned his undergraduate degree from Columbia College, New York, his PhD in molecular pharmacology from Weill Graduate School of Medical Sciences of Cornell University and his MD from Weill Medical College of Cornell University. He completed his residency in radiation oncology at Memorial Sloan-Kettering Cancer Center. Dr. Dicker has conducted extensive research on prostate cancer therapies, is the author of Basic and Advanced Techniques in Prostate Brachytherapy, and is the only radiation oncologist on the Investigational Drug Steering Committee of the National Cancer Institute’s Cancer Therapy Evaluation Program.
My brother needs a liver transplant. I am hepatitis C-positive, but he is not. Can I donate a portion of my liver to him?
No. A liver procured from a hepatitis C-positive patient can only go to a hepatitis C-positive recipient.
With a living donor liver transplantation, a portion of the donor’s liver is transplanted in the recipient. Within a few weeks, the donor’s liver regenerates to its full size and regains full function. The transplanted liver portion also regenerates.
More than 17,000 people in the United States are waiting for liver transplants. Available organs are in short supply, so donating one is truly giving a gift of life.
The expanded cadaver donor option may enable a patient to receive a transplant sooner. With this option, the recipient agrees to accept a liver from a donor who has had contact with the hepatitis B or hepatitis C virus. Any patient who is willing to sign a consent form before transplantation and to take certain medication after the surgery can receive a liver from a hepatitis B donor.A hepatitis C-positive donor doesn’t necessarily have a damaged liver. If we determine that a hepatitis C-positive donor’s liver is not damaged and is suitable, we can transplant it in a consenting recipient who is also hepatitis C-positive.
Cataldo Doria, MD, PhD, FACS, received his medical degree and completed his internship and residency in general surgery at Italy’s University of Perugia School of Medicine. He fulfilled a research fellowship in small bowel transplantation through a partnership with and completed a clinical fellowship in multi-organ transplantation surgery at the University of Pittsburgh School of Medicine. Dr. Doria has extensive expertise in liver, kidney, pancreas and small-bowel transplantation as well as hepatobiliary-pancreatic surgery.