johnshopkinsbayview - hopkins medicine

2 Fall 2012 Johns Hopkins Bayview Medical Center / hopkinsbayview.org

Johns Hopkins BayviewNoteworthy News Ask theVascular Surgeon

Vascular surgeon, Jennifer Heller, M.D.,answers some frequently asked questions:

What are varicose veins?Varicose veins are enlarged veins that are swollenand raised above the surface of the skin. They aremost commonly found on the back of the calves or the inside of the leg.Varicose veins develop when valves in the veins that pump blood toward the heart

stop working. Blood pools in the veins, and causes them to dilate and appear larger.

What are the risk factors?Risk factors include age, gender, family historyand trauma. Women are more likely than mento develop varicose veins.

What are the symptoms?Blood pooling in the lower legs can cause feelingsof heaviness, fatigue, aching, and sometimes eventhrobbing in the legs. Over time, symptoms canworsen and develop into superficial throm-bophlebitis and deep vein thrombosis (DVT).

When should someone seek treatment?It’s important to know that just because you havevaricose veins, doesn’t mean that you need surgicalintervention. Varicose veins can be treated with compression stockings or lifestyle changes,such as exercising regularly and not sitting or standing for long periods of time.You should seek medical advice when varicose veins cause pain, blood clots, skin ulcers

or other problems.At the Johns Hopkins Vein Center, our vascular surgeons provide a unique perspective

on the diagnosis and treatment of varicose veins.We are specially trained to recognize thecomplexities of vascular disease, and are equipped to treat you appropriately and safely.

Jennifer Heller, M.D.,Director, Johns HopkinsVein Center

FreeVaricoseVein Screening

For individuals with varicose veins whoare considering treatment or surgery

November 135 – 8 p.m.

Johns HopkinsBayivew Medical Center

To register, call410-550-VEIN (8346).

WelcomeNewPhysicians

To schedule an appointment,call 410-550-0790.


Pankaj Jay Pasricha, M.D.,Gastroenterologist

Bradley Strunk, M.D.Internist

Bradley Strunk,M.D.,has joined the InternalMedicine Practice.His clinical interestsinclude preventive careand managing chronicmedical diseases, such ashypertension, diabetesand COPD.

Gastroenterologist Pankaj JayPasricha, M.D. has joined theDivision of Gastroenterology asdirector of the Johns HopkinsCenter for Neurogastroenterologyand Motility Disorders. His clinicalinterests include GI motilitydisorders and chronic abdominalpain syndromes, as well as thedevelopment of novel endoscopicprocedures and devices.

For more information about the Johns Hopkins Vein Center, call 410-550-VEIN (8346).To hear Dr. Heller discuss varicose vein treatment, visit hopkinsbayview.org/vein.

What to Expect:Having a Baby atJohns Hopkins BayviewAre you or is someone you know having a baby?Visit hopkinsbayview.org/obtour to learnabout the laborand delivery, andmother baby unitsat the MedicalCenter. Hearfrom nursesabout whatto expect,what tobring andotherimportantinformation.

For more information about maternity care orto make an appointment, call 443-997-0400.


Vanessa Walker Harris, M.D.Endocrinologist

Endocrinologist VanessaWalker Harris,M.D.,has joined the Departmentof Endocrinology. Shespecializes in metabolicbone disorders and generalendocrinology, includingdiabetes, thyroid, pituitaryand adrenal disorders.

Maggie Arnold, M.D.Vascular surgeon

With the peak of flu season rapidlyapproaching, it is more importantthan ever to get your flu vaccine.“Not only can people transmit thedisease easily to family members

and other people they come in contact with, the flualso causes complications that can result in death,” saysJonathan Zenilman, M.D., chief of infectious diseases.Each year in the United States, more than 200,000

people are hospitalized and approximately 36,000people die because of the flu. During this flu season,Johns Hopkins Bayview is taking extra steps to preventthe spread of influenza by requiring all employees toreceive a flu vaccine. Those who work in health careare at a greater risk of exposure to the flu, and also aremore likely to come in contact with patients who areprone to flu-related complications. By making the fluvaccine mandatory, Johns Hopkins Bayview ensuressafer patient care and less chance of hospital-relatedillnesses or infections.

Comments, requests,change of address?E-mail us at

[email protected].

Johns Hopkins Bayview Medical Center / hopkinsbayview.org Fall 2012 3

HaveYou HadYour FluVaccine?We Have!

ProtectYourself.ProtectYourFamily.You, too, can prevent the spread of flu by gettingvaccinated.The flu shot or mist is provided bymost primary care physicians.

You should especially get an annual fluvaccination if you:

•Work in health care• Are 50 or older• Are pregnant• Have chronic medical conditions, such asdiabetes, asthma, renal disease or emphysema• Live in a nursing home or long-term care facility• Live with anyone at high risk for flu• Have contact with children less than 6 months old

You should NOT get a flu vaccination if you:• Have an allergy to chicken or eggs• Had a reaction to a flu vaccine• Developed Guillain-Barré syndrome (GBS) within6 weeks of receiving the flu vaccine• Have a fever• Are less than 6 months old

The General Internal Medicine practice at Johns Hopkins Bayview is accepting new patients.To schedule an appointment with one of our physicians and to receive a flu vaccine, call 410-550-3350.


Teresa Chen, M.D.Nephrologist

Nephrologists TeresaChen,M.D., andValeriu Cebotaru,M.D., have joined theDepartment ofNephrology.Theyspecialize in generalnephrology, acutekidney injury andkidney stones.

Valeriu Cebotaru, M.D.Nephrologist

continued on page 4


Vascular surgeon MaggieArnold,M.D., has joinedthe Department of Surgery.Her clinical interests includeendovascular and opentreatment of critical limbischemia, endovascularaneurysm repair, visceraland renal artery stenting,carotid artery disease andvenous disease.

Contents2 Noteworthy News

Special Edition:Breast Care

6 Making the Journey TogetherMother and daughter find strength ineach other as they battle breast cancer

7 Johns Hopkins Breast CenterCentralizes Services forWomenEarly diagnosis and coordinatedcare benefit patients

8 Breast Cancer: Finding ItEarly Is Key

9 Eating Best for Breast Health

10 A Gut ReactionJohns Hopkins center provides relief forpeople suffering from gastrointestinal disorders

12 Taking It to HeartCardiology patient takes active rolein his own health

14 Patients Benefit from an InnovativeApproach to a Common Diagnosis

15 Seminars & Screenings

Why I Give

16 New Clinic Helps Clear theWayHelp for people with chronic sinusitis,allergies & asthma


Sandy Fang, M.D.Colorectal surgeon

Colorectal surgeonSandy Fang,M.D., hasjoined the Departmentof Surgery. Her special-ties include colorectalcancer, minimally invasivesurgery, sphincter-pre-serving surgery, inflam-matory bowel disease,anorectal disorders anddiverticulitis.

Five million Americans are living withmemory disorders, Alzheimer's diseaseor another form of dementia.While wecannot cure these conditions, there is alot that can be done to help patients andcaregivers alike live better and fuller lives.

Join faculty and staff of the Johns HopkinsMemory and Alzheimer's TreatmentCenter for a free conference about thediagnosis and treatment of memory loss,and tips for managing Alzheimer’s disease.Presenters include Johns Hopkins physi-cians and Sylvia Mackey, widow of NFLlegend John Mackey and advocate fordementia patients and caregivers.

To register, call 800-442-9160.



Christopher Oakley, M.D.Neurologist

Edward Tanner, M.D.Gynecologic oncologist

Gynecologic oncologistEdwardTanner,M.D.,has joined the Departmentof Gynecology andObstetrics. He specializesin gynecologic oncology,including cervical cancer,ovarian cancer, uterinecancer, vulvar cancer anduterine fibroids.


Sarak Nakib, M.D.Dermatologist

Dermatologist SarakNakib,M.D., hasjoined the Departmentof Dermatology. Shespecializes in generaldermatology andmedical dermatology,including the treat-ment of non-healingwounds.

NeurologistChristopherOakley, M.D., hasjoined the JohnsHopkins HeadacheCenter. He specializesin the treatment ofheadaches in pediatricpatients, ages 0-18years old.

To schedule an appointment,call 410-550-ACHE (2243).

For more information or to make an appointment,call 410-955-LUNG (5864).

Johns Hopkins BayviewNoteworthy News

AJourneyto Hope

Pulmonary Nodule ClinicNow Seeing Patients

Have you had an abnormal finding on a chest X-ray or CT scan?

A lthough most pulmonary nodulesare not lung cancer, it is essentialthat they be monitored over time,

especially for those who have an increasedrisk of developing lung cancer (see below).

A diagnostic CT scan, with a higher dose ofradiation, or a PET scan often is necessary tohelp determine if further testing is needed.“Patients who have nodules need a lung

cancer risk assessment and a long-term careplan,” says Peggy Lang, CRNP, thoraciconcology coordinator. “This helps catch thesmall percentage of nodules that are lungcancer at an early stage when the chance ofcure is the highest.”

The clinic’smultidiscipli-nary treatmentteam includesspecialists inradiology,medical oncol-ogy, thoracicsurgery andpulmonarymedicine who are skilled and experienced inthoracic surgery and lung cancer care.

You may be at risk if you:• Are over the age of 50

• Have a family history of lung cancer ortobacco-related cancers

• Are a current smoker or former smokerwho quit less than 15 years ago

• Have had occupational exposures, suchas asbestos

The PulmonaryNodule Clinic provides:

• Treatment plans forpatients with nodules

• Personalized lung cancerrisk assessment

• Long-term nodulesurveillance

Help for patients and caregiversdealing with Alzheimer’s disease

Saturday, November 10, 20129 a.m.

To make an appointment or for more informationabout the Spine Program, call 410-550-0939

or visit hopkinsbayview.org/spine.

Spine Program NamedUnitedHealth Specialty Center

The Johns Hopkins BayviewSpine Program is proud to bedesignated a UnitedHealthPremium Surgical Spine

Specialty Center. This designationrecognizes the program’s commitmentto providing safe and superior surgicalspine care, and the best possibleoutcomes to its patients. Only ninecenters in Maryland havereceived this designation.The Johns Hopkins

Bayview Spine Programprovides medical and surgi-cal treatment for individualswith spinal stenosis; cervicaland lumbar disc herniation;degenerative disc disease;and scoliosis. More than400 back procedures wereperformed in 2011.


Primary Stroke Center Designation

If you or a loved one suffered from a stroke, would youknow where to go? Being cared for at an accreditedstroke center could impact your recovery.Johns Hopkins Bayview is designated by the Maryland Institute forEmergency Services Systems (MIEMMS) and The Joint Commissionas a Primary Stroke Center.This means that the MedicalCenter has the appropriateresources and procedures inplace to best take care ofstroke patients and minimizethe damage of stroke.“Johns Hopkins Bayview

has a spectacular multidiscipli-nary approach to the care ofstroke patients,” says RafaelLlinas, M.D., director, JohnsHopkins Bayview StrokeCenter. “Our outcomes showgreat consistency in treatmentand attention to detail. Wenot only do an expert job inthe acute setting, but also offerrehabilitation services and allother components of care.”

Lawrence Named StrokeProgram CoordinatorErin Lawrence, RN, has been namedstroke program coordinator for theStroke Center. In this role, she willprovide community education sessionsand outreach toraise awarenessabout stroke.Lawrence also isinvolved with themonthly strokesupport group, Inchby Inch, which isheld on the thirdThursday of everymonth, at 7 p.m.

Oh,MyAching Back!For people who have been diagnosedwith degenerative disc conditions andwant to learn about the treatment

of back and related leg pain

November 7 & January 176 p.m.

Johns Hopkins BayviewMedical Center

To register, call 410-550-KNOW (5669).

For more information about the Stroke Center’s communityoutreach or support group, call 410-550-7793.

American HeartAssociation BronzeAward

Erin Lawrence, RN

AsaCardiac Interventional Receiving Center,Johns Hopkins Bayview is able to immedi-ately intervene when a patient arrives at theMedical Center with signs of a heart attack.Often, this means performing a cardiac

catheterization to determine what part of the heart isaffected, and providing necessary tests and treatment.Johns Hopkins Bayview was recently recognized for its

efforts in treating heart attack patients by the AmericanHeart Association.The Medical Center is the recipient

of the 2012 Bronze Award for complying with qualitymeasures related to improving the care of cardiac patients.The criteria includes treatment time, treatment optionsand patient education.“We are honored to be recognized with this

award and are proud to offer nationally recognized,comprehensive, state-of-the-art cardiac care toour patients,” says Nisha Chandra-Strobos, M.D.,chief of the Division of Cardiology.

“We are willing totravel for the best,”says Hagerstown, Maryland, resident JoanneKnapp. “The people who take care of us bendover backwards to help us. We are so happy tohave the team at Hopkins. They are keeping usalive and together.”In December 2008, Knapp was diagnosed with

breast cancer during a routine mammogram. Whatmakes this story even more heartbreaking is thatjust one month earlier, her daughter, Anna Rollins,also had been diagnosed with breast cancer.Side-by-side and with guidance and support

from the Breast Center team, mother and daugh-ter began to literally fight together for their lives.In the spring of 2009, while Rollins underwentfive months of chemotherapy treatment, Knapp,diagnosed with DCIS (ductal carcinoma in situ)had two surgeries, including a lumpectomy.When the summer months rolled around,Rollins had a modified radical mastectomywith simultaneous breast reconstruction, andKnappbeganradiationtreatment.And in themidst of itall, oncesurgeries were completed and treatments ended,both women, along with their husbands, soldtheir homes and moved to a new neighborhood.“Cancer gives you a chance to reevaluate your

life,” says Rollins, whose original diagnosis was

Stage II triple negative breast cancer, along withfollicular lymphoma. “We realized how importantit was for us to spend more time together as afamily, enjoy one another and support each other.Living so close makes it easy for us to have thoselittle moments that make a life.”So, they became next door neighbors.

Recovery Journey ContinuesSince then, the family’s breast cancer recoveryjourney has continued, with many highs and lowsalong the way. They have enjoyed the convenienceof living side-by-side and being able to do thesimple, everyday kinds of things in life together,such as gardening and shopping. Today, Knapp’scancer is in remission, with her past threeannual mammograms confirming that sheremains cancer free. Two years ago, Rollinslearned that her breast cancer had metasta-sized. But she remains positive, hopefuland in-tune with the approach of herphysician, Mehran Habibi, M.D.,surgical oncologist anddirector of the JohnsHopkins Breast Center.“Dr. Habibi told

me that he wouldtreat my cancer as achronic disease that

can be lived with, rather than a terminal condi-tion,” Rollins says. “Of course, I have had tomodify my lifestyle, and there are challengesto face, but I feel inspired to live because of thesupport I get at Johns Hopkins.”Perhaps it’s this level of compassionate care that

makes the drive to Baltimore from Rollins’s andKnapp’s Hagerstown homes all worth it.


Mehran Habibi, M.D.Director of theBreast Center

Making theJourneyTogether

For more information or to make an appointment, call 410-550-8282.

Joanne Knapp andher daughter

Anna Rollins areeach other’s

greatest support.

Johns Hopkins BayviewBreast Cancer

Mother and daughterfind strength in eachother as they battlebreast cancer

There is a place in Baltimorethat women seek out forbreast cancer care; womenlike Joanne Knapp and AnnaRollins (see story on page 6),who found an entire team of

care providers who supported and cared forthem in the early detection, diagnosis andtreatment of their breast cancer. Thoughbreast cancer care has been an integral serviceon the Johns Hopkins Bayview campus formany years, we now offer a more compre-hensive approach at the Johns HopkinsBreast Center, a brand-new facility designedto provide women with the right people,tools and technologies to stay healthy.

Expert and personalized careThe recently opened center is managed by amultispecialty team of care providers, whocome together to analyze patient cases andwork collaboratively in the creation of treat-ment plans that aim for the best possible out-comes. There also is significant emphasis onthe importance of treating each patient as anindividual, with needs that go beyond whatcan be physically detected.“There are a lot of hospitals for patients

to choose from in Maryland, but there aretremendous benefits of coming to JohnsHopkins,” says Mehran Habibi, M.D., direc-tor of the Johns Hopkins Breast Center.“Expertise matters. When you want the best, youget it here.”In addition to providing patients with access

to some of the world’s most commended physi-cians, all fellowship trained, the opening of thenew Breast Center means that women now haveone centralized resource to turn to when itcomes to managing their breast health. Here,surgeons, radiologists, medical and radiationoncologists, plastic surgeons and patient naviga-tors put their thoughts together with the latesttechnology to create a comprehensive system forpatient support. As breast cancer becomes more

prevalent, and patients take a more active rolein their health care delivery process, the teamalso is seeing an influx of people in search of asecond opinion.“It’s important to take the time to get a

second opinion and make sure you are workingwith the right team of people, who will puttogether a plan that is best for you,” Dr. Habibisays. “Individuality is the key. And that isamong the things we do best.”

Putting patients at easeThere are many ways that the Breast Center teamoffers that individualized approach. A certifiedoncology nurse is available to answer questions

and walk women through every step in theprocess. The availability of Johns Hopkinsclinical trials further increases the opportuni-ty for each patient to follow a customizedtreatment plan, based on her unique healthneeds. And knowing that breast care canbe a sensitive and emotional topic for manywomen and their families, the team at theBreast Center is committed to makingcustomer service, including quick answers,a top priority.“We expedite the screening or treatment

process for our patients, making same ornext-day results available when we can,” saysSemra Engin, M.D., radiologist. “It helpstremendously that we have all of the rightpeople and technology in one place withthe opening of the Breast Center. It makesit easier for us to collaborate and get backto our patients with answers quickly.”

Early detection is keyBoth Drs. Habibi and Engin promotethe importance of early detection, encourag-ing women in the community to come intothe new Breast Center for annual mammo-grams, while also performing breast self-exams on a monthly basis (see article, BreastCancer: Finding It Early Is Key on page 8 andbreast self-exams sidebar on page 9 ). Whenfound in earlier stages, many breast cancers

can be cured completely.“A woman knows her body better than

anyone else,” says Dr. Habibi. “Regular physicalexaminations and annual mammograms can goa long way in preventing the spread of disease.And when a cancer is detected, it’s important fora woman to know we are here and ready to takecare of her.”

—Tracey Fitzgerald


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Johns Hopkins Breast CenterCentralizes Services for Women

Johns Hopkins Breast Center medical team, left to right, DanijelaJelovac, M.D., medical oncologist; Marshalee George, Ph.D.,AOCNP,oncology nurse practitioner; Mehran Habibi, M.D., surgical oncolo-gist; Semra Engin, M.D., radiologist

To make an appointment,call 410-550-8282.


Johns Hopkins BayviewBreast Center

arly detection of breast cancer savesthousands of lives each year. If morewomen took advantage of breast can-cer screenings, many more lives couldbe saved. The goal of screening examsfor early breast cancer detection is to

find cancers before they start to cause symptoms.Screening refers to tests, such as digital mammog-raphy, to find a disease, such as cancer, in peoplewho do not have any symptoms.If breast cancer is found because it’s already

causing symptoms, it’s more likely to havealready spread beyond the breast. In compari-son, breast cancers found during screeningexams are more likely to be smaller and stillconfined to the breast, which improves thechances that breast cancer can be diagnosedat an early stage and treated successfully.

Digital mammography takesthe “wait” awayToday, technology makes it even easier andfaster to detect the presence of lesions, tumorsor other signs of breast cancer. Similar to how adigital camera is capable of storing and showingan image immediately after a picture is taken,digital mammograms are stored and analyzedelectronically. This gives physicians an opportuni-ty, on the spot, to focus in on areas of questionor concern and adjust the contrast of imagesas needed, to create clearer, easier-to-interpretviews of a woman’s breast.In addition to the obvious benefit of immedi-

ately available results, many patients tend toprefer digital mammography over traditionalfilm mammograms because they require muchless radiation.“The Breast Center offers the most advanced

digital mammography technology available onthe market,” says Semra Engin, M.D., radiologist.“We have always promoted the importanceof early detection and screenings, and digitalmammography means that the patient doesn’thave to wait at all to get results. It helps preventanxiety and keeps the process moving along.”

Breast Biopsy:What to ExpectIf a lump is found in a patient’s breast during aroutine examination, mammography, ultrasoundor MRI, the physician may order a breast biopsy.A biopsy involves the removal of a sample ofbreast tissue, cells or fluid, which is then viewedunder a microscope to determine if the lesion ormass detected is malignant (cancerous) or benign(non-cancerous).The type of breast biopsy a physician orders

depends on the type of material that he or sherequires to make an accurate diagnosis. Fine-needle aspiration biopsies extract a sample of cellsor fluid from the breast. Core needle and vacuum-assisted biopsies are performed to collect a smallsample of breast tissue. In cases when part or allof a lump must be removed in order to conducta thorough assessment, an open, or surgicalbiopsy may be required. At the Johns HopkinsBreast Center, ultrasound and stereotactic needlebiopsies are often performed, using the latesttechnology to assure that samples are extractedfrom the precise location in question.

“A breast biopsy is almost always performedwhen an abnormality is detected in a woman’sbreast,” says Mehran Habibi, M.D., surgicaloncologist and director of the Johns HopkinsBreast Center. “It allows us to fully understandthe composure of a breast mass and what ournext steps should be, in the event that cancerouscells are present.”In many cases, there is nothing a patient must

do ahead of time to prepare for a breast biopsy.Following the procedure, it is common to experi-ence breast tenderness as well as light bruising,swelling or bleeding, which can be controlledwith ice packs or over-the-counter pain remedies.Heavy lifting, as well as any activities that wouldinvolve use of the chest muscles, should be avoid-ed for one to two days.

—Tracey Fitzgerald

Who should geta mammogram?

Annual mammograms are recommended forwomen age 40 and over, or younger in caseswhere a family history of breast or ovariancancer exists.The American Cancer Society(ACS) has established guidelines for earlydetection of breast cancer in women withoutsymptoms.While it’s recommended thatwomen over the age of 40 have an annualmammogram, those between the ages of20 and 40 are encouraged to have a clinicalbreast exam every three years. In many cases,a woman’s physician will conduct this examina-tion in conjunction with an annual gynecologiccheck-up.Additionally, the ACS encourageswomen to begin conducting breast self-examsas early as their 20s.

Quick Facts AboutEarly Detection• Every woman is at risk for developingbreast cancer.

• The average woman has a 12 to 13percent chance of being diagnosed withbreast cancer in her lifetime.

• 220,000 new cases of breast cancer willbe diagnosed in 2012.

• Breast cancer will claim more than 40,000lives in 2012.

• Breast cancer risks increase with age.

• The survival rate for those whose canceris diagnosed in Stage I is 98 percent.Those who are diagnosed in Stage IVhave a survival rate of just 16 percent.

Breast Cancer:Finding It Early Is Key

To schedule a screeningmammogram, call 410-550-8282.

It is estimated that excess weight and obe-sity contribute to as many as one in fivecancer deaths. Extra weight is consideredto be a risk factor for breast cancer, expe-cially for postmenopausal women.

According to Johns Hopkins Bayviewclinical dietitian Katie Flickinger, RN, LDN,eating a healthy, balanced diet is one of thethings a woman can do to decrease her riskof breast cancer and breast cancer recurrence.“Though diet alone is not solely responsiblefor whether an individual will get cancer, itdoes play a major role in maintaining ahealthy weight,” explains Flickinger.

Women who maintain a healthy weightare less likely to be diagnosed with breastcancer than women who are consideredoverweight or obese. Eating a healthy, well-

balanced diet that is rich in a wide varietyof fruits and vegetables, whole grains, fish,poultry and low-fat dairy boosts the immunesystem and helps regulate weight, which mayreduce the risk of developing breast cancer.

—Nicole McFarland


If you are interested in adopting a healthier lifestyle, our dietitians can help.To make an appointment, call 410-550-0311.

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Breast Self-Exam:Your Most ImportantMonthly Appointment

Just about every woman knows that breastself-exams are important. A commonchallenge, however, is that many womendon’t know how to do them. Use thissimple guide to make your breast health apriority by conducting a quick 10-minuteself-exam every month.

Take a look. Remove your shirt andbra and stand in front of a mirror so that youcan see both breasts. Place your hands on yourhips and focus on the shape, size, texture andcoloration of your breasts, nipples and areolas.Make note of any visible changes in the timesince your last self-exam.Then, raise your armsover your head. Do your breasts shift in a simi-lar fashion as you move? Does there appear tobe any swelling near your armpits? Documentany changes that are apparent month-to-month,and call your doctor right away if anything looksor feels abnormal.

Check each breast, top to bottomand side to side. First, raise your left arm aboveyour head and use your right hand to assessyour left breast. Move your fingers from the topof your breast to the bottom, and then left toright, using small circular motions and applyinglight pressure. Repeat this process on the otherside, using the same patterns and motions tocheck for any lumps, areas of sensitivity orchanges in the overall feel of your breasts.

Check your nipples. Place bothhands by your sides.With your right hand, useyour index and middle fingers to gently squeezeyour left nipple, pulling it forward slightly andthen releasing it. Does it pull back into thebreast, as it should? Repeat this process on theother side, making note of any inconsistencies,pain or fluid discharge.

It’s important to conduct your breast self-exam on the same day of each month. Pick aday and mark your calendar.

Keep a log of your findings and in the eventthat you detect a concern, it’s best to contactyour doctor right away.

Eating Best for Breast Health

Katie Flickinger, RN, LDNRegistered dietitian

Eating Healthy Means:• Reducing alcohol consumptionto no more than one drink per day. Recent studieshave shown that alcohol consumption is linked toa higher risk of breast cancer in both pre- andpostmenopausal women.

• Including antioxidant-rich foods,such as berries, prunes, grapes, mangos, onions,beans, squash and spinach in your diet.Theantioxidants present in these foods are believedto contribute to cancer prevention.

• Reducing intake of refined grain products(i.e. white bread) and consuming fewer sugar-sweet-ened beverages. Consuming high-sugar foods maylead to excess calorie consumption without providingany of the nutrients that help reduce cancer risk. Inaddition, excess calorie intake leads to obesity.


When Drew Ginsbergtraveled to China inDecember 2010, heexpected to enjoy thefood, experience theculture and spend

time with his brother, who was living in Shanghaiat the time. He did not expect to vomit continu-ously for three days straight.“I thought it was food poisoning,” says

Ginsberg, 28. “But within 36 hours, I felt fine.”Thinking he had rebounded to his normal,

healthy self, Ginsberg continued his trip. “I ateeverything, drank everything, with no problems atall,” he says.But within two days of returning to his Takoma

Park, Maryland, home, Ginsberg began vomitingagain. And this time, he had extreme stomachpain and discomfort around his ribs.“It felt like I was being stabbed over and over

again,” he says. “Nothing was able to go down,or once it went down, it was forced back up.”Visits to the local emergency room, two hospi-

talizations and prescribed medications failed to

alleviate his symptoms, and within a few weeks,the fit, 6-foot-tall kinesiology instructor droppedfrom 196 pounds to just under 150 pounds.“My body was starting to shut down,” he says.That’s when he turned to the Johns Hopkins

Center for Neurogastroenterology and Gastroin-testinal Motility Disorders for help. John Clarke,M.D., clinical director of gastrointestinal motility,found Ginsberg was suffering from post-infectiousdysmotility, a severe disorder that can follow aninfection of the stomach and intestines.

A GutReactionJohns Hopkins center providesrelief for people suffering fromgastrointestinal disorders

Johns Hopkins BayviewMotility Disorders

Drew Ginsbergis feeling back tonormal again andstaying active.

What’sYourGut Feeling?If it’s reflux, gastroparesis,

constipation or fecal incontinence,join our panel discussion to learn

about the diagnosis and latest treatmentoptions for these conditions

December 126 – 7:30 p.m.

Johns Hopkins BayviewMedical Center

To register, call 410-550-KNOW (5669).


“Drew needed medical help, and he neededit fast,” Dr. Clarke says.Fortunately for Ginsberg, post-infectious

dysmotility is one of the many motility andneurogastroenterology disorders the centerdiagnoses and treats, Clarke says.

Motility disorders describedMotility disorders are disorders involvingthe movement of food through the digestivesystem. Some of the morewell-known examplesinclude gastroesophagealreflux disease (GERD),also known as acid reflux,irritable bowel syndrome,severe constipation andesophageal spasms. Peopleof any age can be affected, and a majority willsuffer at least one time in their lives from amotility disorder. Many of these conditions arefirst presented to the primary care physician,who may then refer the patient to a gastroen-terologist for further diagnosis and testing.While not uncommon, these disorders arenotoriously difficult to assess, says PankajPasricha, M.D., director of the Division ofGastroenterology at Johns Hopkins Bayview.Fortunately, the Center for Motility

Disorders is home to highly-trained gastroen-terologists who specialize in the disorders andstate-of-the art testing techniques. “We takecare of complex conditions that have been hardto diagnose and treat,” Dr. Pasricha says. “Andwe are a resource to both patients and doctors.”

The brain-gut connectionWithin the world of motility disorders, there isneurogastroenterology–a field that examineshow a patient’s central nervous system and gutare involved. “The gut has its own brain,” Dr.Pasricha says.The gut’s brain is known as the Enteric

Nervous System. It’s a collection of nerve cellsthat are within the wall of the gut, runningbetween the esophagus and rectum. Just like the

larger brain in human heads, the system sendsand receives impulses throughout the stomachand intestines. It also responds to emotions.Research shows this system can affect moodsranging from happiness to depression.More importantly for motility disorder

patients, this system can impact how the gas-trointestinal tract works. It regulates absorption,digestion and moving material from one endof the gut to the other. For example, many

patients with irritable bowel syndromeexperience diarrhea, constipation andpassing mucus. Often, problems withthe brain-gut signals can be the cause,Dr. Pasricha explains.The gut has more nerve cells than

the entire spinal cord. Ninety percentor more of the body’s serotonin and

half of the body’s dopamine, bothchemicals that relay signals fromone area of the brain to another,lie in the gut. Because of this, Dr.Pasricha and fellow Hopkinsexperts are performing research toexamine how the brain in the gutrelates to the brain in the head. The teamis discovering new drug targets as it tries tounderstand the molecular basis for commonsymptoms such as abdominal pain and nausea,Dr. Pasricha says. Research into the EntericNervous System’s stem cells also holds promisefor regenerating areas where function has beenpermanently lost.“There’s a big picture here beyond just

disorders,” he says. “The nerves in the gut havelots of clinical and physiological implications.”

Testing and treatmentsWhile motility disorders are often difficult todiagnose, there are tests available to determinethe type of disorder and its severity.The Johns Hopkins Center for Neurogas-

troenterology and Gastrointestinal MotilityDisorders is one of only a few locations onthe East Coast to offer many of these tests,including high-resolution esophageal manome-

try to measure the strength and function ofthe esophagus muscles, 24-hour esophagealpH monitoring to evaluate acid reflux disease,and anorectal manometry to evaluate constipa-tion or fecal incontinence.The center also takes a multidisciplinary

approach when it comes to treatment. Depend-ing on the disorder, treatment can includemedication, dietary changes, psychologicaltherapy and alternative medicine, says Dr.Pasricha. To ensure patients have the besttreatment plan possible, center physicianswork with internists, allergists, psychiatrists,psychologists and complementary specialistslike acupuncturists.For Ginsberg, a combination of anti-nausea,

pain and acid-blocking medication, probioticsand acupuncture did the trick. Two weeks after

visiting Clarke, Ginsbergcould finally keep waterand sports drinks down.Then rice cakes, and thensmoothies. Now, more than18 months after his initialillness, Ginsberg is starting

to feel normal again. He’s even eating vegetablesand meat again. “I don’t have as much energyas I used to,” he says. “But for the most part,I feel healthy.”The discomfort is gone, and his weight is

back up to 165 pounds.“I’m hoping to gain another 10 pounds

back, but I’m happy being in this range,”Ginsberg says.He’s also happy he found Dr. Clarke.“All along, I knew I should have gone to

Hopkins,” Ginsberg says. “If it wasn’t for Dr.Clarke, I could have been in a lot of trouble.I would recommend him 100 percent.”

—Allison Eatough

To make an appointment with a Johns Hopkins gastroentrologist, call 410-550-0790.

Pankaj Pasricha, M.D.Director, Division of

Gastroenterology

John Clarke, M.D.Clinical director,gastroenterologist


Taking It toHeartCardiology patient takes active role in his own health

Johns Hopkins BayviewCardiology

To help prevent heart disease or catch symptoms early, studiesshow that adults ages 50 and older should have an annual cardio-vascular assessment—even younger if you have a family history ofheart disease. Is it time for your heart check-up? Take the quiz!Go to hopkinsbayview.org/heartquiz.

Colonel Gerald Altman reads toa fellow resident of his assisted-living home.Altman aims to staybusy and keep his mind andbody as active as possible.


“He doesn’t just sit back and leta team of people care for him,”says Gerry Altman’s cardiologist,Sheldon H. Gottlieb, M.D. “Hedoes everything possible to seethat he is as much a part of theteam as anyone else. That kind ofinvolvement is key in managing,or even preventing heart disease.”

Owings Mills, Maryland, resident, ColonelGerald Altman, 88, has had coronary heartdisease (CHD) for as long as he can remember.Despite having fought in active duty duringWorld War II, Altman would agree that pro-tecting his heart has truly been the fight of hislife. First, in 1979, he had triple bypass surgeryin Wisconsin. Since then, he has received carefrom cardiologists at Johns Hopkins Bayview.He has had several angioplasties (a procedureused to clear plaque from narrow or blockedcoronary arteries) and a defibrillator surgicallyimplanted (a device that shocks the heart whenit detects a rhythm disturbance). More recently,Altman was diagnosed with a thoracic aorticaneurysm, a weakened area in the upper aorta,which requires close monitoring by a cardiolo-gist. Surprisingly, none ofthis has slowed him down.Altman is anything but

inactive. He is an avidwalker and he spendsmuch of his free timeupdating fellow residentsof his assisted-living facility on local and worldnews, even reading to them from newspapers tokeep their minds active.

His lifestyle is remarkable for a man whoseheart has been assaulted by CHD, the mostcommon type of heart disease and the numberone cause of death for both men and women.CHD is marked by the buildup of plaqueinside the coronary arteries, which preventsoxygen-rich blood from reaching the heartmuscle. Preventing and/or managing the condi-tion can be tricky, but Altman’s dedication tohis health has led to a robust zest for life, andconstant involvement in his own medical care.

Becoming your ownhealth advocateDr. Gottlieb stresses that awareness and involve-ment in your medical care are crucial when itcomes to heart health. He encourages all ofhis patients to pay special attention to what hecalls the three best physicians, “Dr. Diet, Dr.Exercise and Dr. Happiness.” Balancing thosethree elements can work wonders for currentheart disease patients, as well as patients whoare focused on preventing heart disease. Altmanknows these “doctors” well. He makes a con-scious effort to eat a balanced diet, he walksalmost everywhere he goes, and he maintainsa positive outlook on life.“Gerry puts these principles to work in his

own life,” says Dr. Gottlieb.Altman’s Johns Hopkins doctors are very

pleased with his efforts, andAltman is just as appreciativeof their extraordinary care.“I’m a lawyer by profession,

and I’m extremely cynical.But I think even the mostskeptical people in the worldwould lose their cynicism if

they had physicians like these to work with,”Altman shares.

The relationship between Altman and hisdoctors epitomizes the art of caring. “We carefor him and he cares for us,” concludes Dr.Gottlieb. “We wouldn’t have it any other way.”

—Nicole McFarland

For more information or to make an appointment with a Johns Hopkins Bayview cardiologist, call 443-997-0274.

Key Questions toAskYour DoctorNext time you visit your primarycare doctor or cardiologist, be sureto ask these important questions.

•What is my overall risk of heart disease?•What are my risk factors (i.e. family history,obesity, poor diet, past or present smoking,lack of physical activity)?•What type of plan should I follow to protectmy heart?•What does my blood pressure mean for me?• Do you have a suggested diet plan?•What else should I do to lower my bloodpressure?•What do my cholesterol numbers mean forme? Are they a problem?•What foods should I avoid to lower mycholesterol?•What else can I do to lower my cholesterol?• Do I need to lose weight?

Sheldon H. Gottlieb, M.D.Cardiologist

Colonel Altman servedfour years in the Armyand Air Force duringWorldWar II andseveral tours of activeduty after the war.

One in 12 young women has one.

Most people will develop one bythe time they’re 50 years old.

This diagnosis of one of themost common endocrineproblems in the United States.What is it? A thyroid nodule. And it’s morecommon than you think.Johns Hopkins surgeons are taking a new,

cosmetic approach when it comes to removingthe thyroid. The procedure, known as roboticfacelift thyroidectomy, uses robotic technologyand leaves no visible scars on a patient’s neck.“If anyone were looking from the front or

the side, you would notsee a visible incision,”says Jeremy Richmon,M.D., director of headand neck robotic surgeryat Johns HopkinsBayview Medical Center.Johns Hopkins is one of only a few hospitals

in the country to offer the procedure.The thyroid gland is located at the base of

the neck. It produces hormones that regulategrowth and control metabolism. But sometimes,

the thyroid–or just part of it–needs to be removed.Reasons include thyroid cancer, suspicious orenlarged nodules or an overactive thyroid.In a traditional thyroidectomy, surgeons make

a visible incision on the lower partof the neck (see diagram A).But some patients prefer not

to have such a prominent scar,Dr. Richmon says. For thesepatients, robotic facelift thyroid-ectomy could be an alternative.

During the robotic procedure, an incision ismade behind the ear, just as plastic surgeonswould for a facelift (see diagram B). The incisioncontinues around the back of the neck andbehind the patient’s hairline. Usually a smallportion of hair is shaved before the procedure,but once it grows back, most of the scar ishidden, Dr. Richmon says.Since the incision is so far away from the

thyroid, robotic technology allows surgeons toaccess the gland, while at the same time avoidinga visible neck scar. The procedure takes about

two hours and typically involves one nightin the hospital. There is minimal pain, Dr.Richmon says.“Patients are usually up eating, walking

and talking the day of the surgery,” he says.

—Allison Eatough

Johns Hopkins BayviewHead and Neck

Surgery


For more information about robotic facelift thyroidectomy, call 410-955-6420.

Jeremy Richmon, M.D.Director, head and neck

robotic surgery Women are more likely tosuffer from thyroid problemsthan men.Watch for thefollowing signs and symptomsof thyroid disorders:

• Unexplained change in weight• Swelling or enlargement in the neck• Neck mass• Hair loss• Changes in heart rate• Changes in energy level or mood• Feeling too hot or too cold• Muscle weakness or trembling hand

Patients Benefit from an InnovativeApproach to a Common Diagnosis

(A) Traditionalthyroidectomy

B) Robotic faceliftthyroidectomy

Ultrasound testis used to imagethe thyroid.

Johns Hopkins BayviewDevelopment

SCREENINGSVaricoseVein Screening

For individuals withvaricose veins whoare considering

treatment or surgeryNovember 135 – 8 p.m.

Johns HopkinsBayview Medical Center

To register, call410-550-VEIN (8346).

SEMINARSOh,MyAching Back!For people who havebeen diagnosed with

degenerative disc conditionsand want to learn aboutthe treatment of backand related leg pain

November 7 & January 176 p.m.

Johns HopkinsBayview Medical Center

To register, call410-550-KNOW (5669).

What’sYourGut Feeling?

If it’s reflux, gastroparesis,constipation or fecalincontinence, join ourpanel discussion to learnabout the diagnosis andlatest treatment optionsfor these conditionsDecember 126 – 7:30 p.m.Johns Hopkins

Bayview Medical CenterTo register, call

410-550-KNOW (5669).

Battle of the BulgeLearn about currenttreatment options fordifferent types of hernias,including minimallyinvasive proceduresNovember 146 – 7:30 p.m.Johns Hopkins


410-550-KNOW (5669).

Allergies andStubborn Sinusitis

For people who suffer fromchronic sinusitis and want tolearn how allergies andasthma contribute to it,

as well as current treatmentoptions to relieve suffering

November 86 – 7:30 p.m.Johns Hopkins


410-550-KNOW (5669).

Weight LossSurgery Seminar

For individuals 100 pounds ormore overweight who are

considering weight loss surgeryNote: This seminar is required to

receive a consult for bariatric surgery

November 13 & 28December 10 & 194:30 – 6 p.m.Johns Hopkins

Bayview Medical CenterTo register, visit

hopkinsbayview.org/weightloss/infosession.

If you do not have computer access,call 410-550-KNOW (5669).

To see a full list of seminars and screenings, and toregister online, visit hopkinsbayview.org/seminars.


Seminars &Screenings

Johns Hopkins Bayview Medical Center offers a variety of educationalprograms and screenings. The programs listed on this page are providedat no charge, unless otherwise noted.

The Pitt Family

For Jim and Kathleen Pitt,like any parents, their sonwas the light of their lives.A junior at Marshall University

in Huntington, West Virginia, Jimmywas pursuing a degree in theater,with hopes of becoming a director.Tragically, his life changed in an instantwhen he was in a serious car accidentthat caused damage to his spinal cord.Jimmy’s injuries were so traumatic thathe was hospitalized for two years. He spent his final year at Johns Hopkins Bayviewon the progressive care unit (PCU).

“Of all the hospitals and facilities Jimmy went to after his accident, I felt like hereceived the best care in the PCU,” says Mr. Pitt. “The nurses were exceptional. Igive them credit for my son living as long as he did.”

Not long after Jimmy’s death, the Pitts made a significant donation to the PCUin honor of the nurses who cared for their son. The initial contribution was given tothe Nursing Education Fund, which provides continuing education to PCU nursesto enhance their skills as health care providers.

“I have never met a more dedicated group of people,” says Mr. Pitt. “When wepresented our first donation, every nurse on the unit was there—even those whoweren’t scheduled to work that day. That’s how much they care.”

The Pitts continue to make a donation to the PCU every year to honor their sonand recognize the exceptional work of his nurses. They also remain in touch with thestaff that they formed a relationship with during Jimmy’s hospitalization.

“My wife and I will continue to give to the PCU so they can impact otherpatients and families like they impacted us,” says Mr. Pitt.

—Meghan Rossbach

To learn more about giving to Johns Hopkins Bayview, call410-550-1663 or visit hopkinsbayview.org/development.

Jim and Kathleen Pitt stand in frontof a portrait of their son, Jimmy.

4940 Eastern AvenueBaltimore, MD 21224-2780

Non-Profit Org.U.S. PostagePAID

Permit #470Baltimore, MD

Johns Hopkins BayviewHealth and Wellness News

Johns Hopkins Bayview Medical Center410-550-0100,TTY 410-550-0316hopkinsbayview.org

Director of Communications and Public Affairs:

Sandy Reckert-Reusing

Director of Community Relations:

Gayle Johnson Adams

Editor:

Sandy Reckert-Reusing

Design:

Cindy Herrick

Photography:

Bill Klosicki & KeithWeller

Johns Hopkins Bayview Health and Wellness News

is published by the Johns Hopkins Bayview MedicalCenter Office of Communications and Public Affairsand the Community Relations Department forfriends and neighbors of the Medical Center.

Now on facebookwww.facebook.com/johnshopkinsbayview

This issue is availableonline at

hopkinsbayview.org

NewClinic HelpsClear theWayHelp for people with chronicsinusitis, allergies &asthma

Winter is approaching, and withits arrival comes sniffles andsneezes. Yet, contrary to popularbelief, these symptoms aren’talways the result of colds andflu. People with pollen allergies

may find relief when the temperatures dip; however,for those with allergies triggered by things like moldand dust mites, winter can bring on sinus discomfortthat is both irritating and painful, and can worsen thesymptoms of asthma.

If you’ve been suffering with chronic sinus problems,accompanied by allergies and/or asthma, there’s helpno matter the season. The Allergy-OtolaryngologySinusitis Clinic is now open at Johns Hopkins Bayview.Led by Jean Kim, M.D., Ph.D., and Nikki Erekosima,M.D., MPH, the clinic provides comprehensive careto patients who have a history of sinus disease andallergies and/or asthma.

What’s unique about this clinic is that, in mostcases, patients are seen by a specialist, sent for testingand diagnosed all in the same day. The clinic offers afull range of services, from nasal endoscopy to allergyskin testing.

“Many times, our patients suffer for years withoutrelief. We want to identify the problem as soon as we

can in order to start the most appropriate treatment,”says Dr. Kim.

Because chronic sinus problems often occur withother immune and respiratory disorders, Drs. Kimand Erekosima also can refer patients to an appropriatespecialist, if needed.

—Jessica McQuay

For more information or to schedule an appointment, call 410-550-2368.

Jean Kim, M.D., Ph.D.Otolaryngology

Allergies andStubborn SinusitisFor people who suffer from chronic

sinusitis and want to learn how allergies andasthma contribute to it, as well as currenttreatment options to relieve suffering

November 86 – 7:30 p.m.Johns Hopkins

Bayview Medical Center

To register, call410-550-KNOW (5669).

johnshopkinsbayview - hopkins medicine

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