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Hopkins News for You
This is a monthly service for our patients and friends around the world from Johns Hopkins International. To receive monthly reports via e-mail, please send e-mail to patientnewsletter@jhmi.edu.
March 2003
Avoiding the Dangers of Peanuts
Weight-Loss Surgery
New Hope for Women with Premature Menopause
James Wenz, M.D., on Help for Troubles Knees and Hips
Avoiding the Dangers of Peanuts
For people allergic to peanuts, eating as little as one one-thousandth of a peanut can set off a reaction that can be deadly. Johns Hopkins pediatric allergist Robert Wood, M.D., says that it may be possible to reduce peanut allergy risk in children, starting when a woman is pregnant. Since most children acquire their peanut allergy by exposure through breast milk, if you want to keep a child away from peanut, counsels Dr. Wood, the mother should also avoid peanuts while she is breast feeding.
Dr. Wood also clears up some myths, such as the belief that exposing a baby to peanut can somehow build immunity. "We recommend that no child be exposed to peanuts in their first two years of life. If there is a history of allergy in the family we would wait until they're at least three," says Dr. Wood. Also, parents with a history of allergies need to be especially vigilant because there is a hereditary component to peanut allergies.
Other tips: Avoid food that is out of your control, especially in bakeries, ice cream shops, and Chinese and Thai restaurants where peanut is almost always present. Allergic individuals should always carry with them medications, including an epinephrine injector. And to calm some fears, Dr. Wood notes that unlike ingestion, inhalation of peanut odors is not likely to cause trouble.
Weight-Loss Surgery
Obesity is becoming a serious health problem worldwide and many severely overweight individuals consider weight-loss surgery as a possible solution. Johns Hopkins gastric surgeon Thomas Magnuson, M.D., says the ideal candidate for such a procedure is someone who is roughly 100 pounds (89 Kg.) or more over their ideal weight, as opposed to individuals wanting a quick fix to fit into a bikini. "It's important to stress that we do the surgery not for cosmetic reasons but to help the patient have better health, better quality of life and to expand their life expectancy."
For years, people had a surgery called gastric banding, where a small portion of the stomach was stapled off and narrowed into a funnel, which filled quickly and rapidly satiated hunger. "The problem is the staple line breaks down over a period of time and then the food just goes into the stomach normally. Most patients regained the weight two to three years after the surgery."
A better, and permanent surgical solution for the severely obese is gastric bypass. The surgery creates a small egg-sized pouch using the top section of the stomach. The pouch is attached to a new loop of small intestine that bypasses the rest of the stomach. Downstream, some small intestine is also bypassed, so some calories and nutrients that would normally be absorbed are instead excreted. The results, says Magnuson, are excellent. Patients typically lose between 60 to 70% of their excess body weight over the course of the first year after surgery and do not regain their weight.
New Hope for Women with Premature Menopause
For most women, menopause occurs around age 51. But because of reasons like autoimmune problems or cancer treatments, some women go through this life change before age 40, when they are still very much thinking about having children. Hopkins gynecologist Jairo Garcia, M.D., director of in vitro fertilization, has developed a fertility protocol to help these pre-menopausal women, who often are hard to identify.
Using blood tests and ultrasound, Garcia checks the levels of estrogen and follicle stimulating hormones, or FSH, on day 2 of the woman's menstrual cycle. After age 35, eggs left in the ovaries each month in these pre-menopausal women tend to be damaged, which means the pool of eggs available varies tremendously month to month. When there are few eggs available, the body secretes more of the FSH hormone. And instead of taking two weeks to ovulate, the patient might ovulate in six days.
If the estrogen and FSH levels are fine, Garcia will begin ovary stimulation on day 3 of the patient's menstrual cycle. On day 7, he'll check estrogen levels again, and continue stimulation depending on those levels. The patient will continue to be closely followed until the follicles are larger than 18 mm, typically on day 9. The eggs are retrieved 36 hours later. "This approach is important because typically these women don't participate in fertility programs," Garcia says. "They don't believe they can get any help."
Orthopedic Surgeon James Wenz on Knees and Hips
Question: What treatment options are there for patients with damage to cartilage in their knees?
Dr. Wenz: Until recently the only choice was conventional surgery, which provided only temporary pain relief. In about 60 percent of those cases, patients needed additional surgery within five years. But now we're offering cartilage transplants, which provide pain relief to about 80 percent of patients without the need for additional operations.
Question: Cartilage transplants?
Dr. Wenz: Yes. When cartilage is damaged it cannot heal itself. So we take cartilage cells from the patient, harvest new cells from them and then re-implant them into the knee. It works. Patients are more active without the knee pain.
Question: How about arthritic hips? Anything new in that area?
Dr. Wenz: Well, unfortunately the only option for many patients with severe osteoarthritis is hip replacement surgery, which can mean a long and painful rehabilitation. But we have developed a new mini-incision technique, which means a faster, less-painful recovery.
Question: Tell us more about this mini-incision technique?
Dr. Wenz: The incision is about 3 inches (7 cm) rather than the 12-inch (30 cm) incision made in conventional hip replacement. And because we don't have to cut as much tissue and muscle, there is less healing required and a shorter recovery time. In the traditional approach, patients have to use walkers or crutches for 12 weeks or longer because of the pain. With this technique, most of my patients can put their full weight on their hip the next day.
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