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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 topatientnewsletter@jhmi.edu .
October 2002
Medical Management: A New Support for International Patients
1. New Technique Preserves Fertility After Cervical Cancer
2. A Closer Solution for Farsightedness
3. Male Menopause?
1. Coffee and Blood Pressure
2. More on Alzheimer's Disease
Medical Management: A New Support for International Patients
Johns Hopkins International is committed to helping patients receive the best medical care possible, at the right time, in the right setting, by the right doctor. To accomplish this, the International department has adopted the concept of Medical Management in which a healthcare professional coordinates an interned patient's program of care to ensure continuity and efficiency. Beatriz Kohler, R.N., MPH, a nurse, serves this role as Johns Hopkins International's medical management specialist.
A native of Brazil, Beatriz has worked at Johns Hopkins International for the past 10 years and is therefore intimately familiar with the cultures and needs of our international patients. She is a member of the team that facilitates care while the patient is at Johns Hopkins, following each patient's case to ensure that care is proceeding on schedule and in the most cost-effective manner for the patient. She stays in touch with the patient's insurance company or doctor at home, participates in daily rounds in the various clinical units where our patients are staying, visits patients in their hospital rooms, and discusses any issues or questions with the patient and family members.
The medical management specialist also helps patients make the transition between the hospital and their home environment. Beatriz is responsible for arranging emergency or air ambulance transport of patients to and from Johns Hopkins. Following discharge, she coordinates any additional services the patient may require as an outpatient, such as physical therapy, pharmacy needs or nurse visits to the patient's hotel. Finally, she educates and counsels the patient and family on what they need to know about their medical care and serves as an important resource for patients if they have concerns or questions once they return home.
1. New Technique Preserves Fertility After Cervical Cancer
One of the most compelling individuals featured in the acclaimed "Hopkins 24/7" television documentary that aired across the United States two years ago was Dr. Frederick Montz. A gynecologist specializing in cervical and ovarian cancers, he has become the hope of many patients with cervical cancer who want to preserve their ability to have children. "Removing the ovaries and the entire uterus does not play any role in the treatment of cervical cancer," says Dr. Montz. "You don't need to do it."
In treating cervical cancer, the first step is to surgically remove the cancer. Because the uterus is made up of two parts--the corpus containing vital blood supply and the uterine neck or cervix--most surgeons, concerned that cancer cells may have spread from the cervix to the corpus, automatically remove both. But Dr. Montz uses a new technique that is different. He removes the cervix, the immediate surrounding tissue and the lymph nodes to prevent any spread, but he saves the corpus. Called a radical vaginal trachelectomy, the surgery preserves a woman's fertility (although her ability to become pregnant drops from 80% before surgery to 50% afterwards).
"Every study comparing this approach to hysterectomy shows that there is no difference in cure rate," he says. Still, this procedure is not for everyone, explains Dr. Montz. The cancer must be in an early stage and confined to the cervix. Also, the patient should feel strongly that she wants to have a child and be willing to deliver by Cesarean section.
2. A Closer Solution for Farsightedness
Surgeons at Johns Hopkins' Wilmer Eye Institute are now offering conductive keratoplasty, or CK, to correct low-level farsightedness in selected patients over age 40. The procedure, approved in April by the U.S. Food and Drug Administration, is the first non-laser treatment for hyperopia, a condition in which people can see objects far away but have trouble focusing on those nearby. It is an outpatient surgery performed under local anesthesia in just minutes.
Unlike laser treatments, which use light waves as an energy source, CK employs a pen-shaped instrument with a tip as thin as a human hair that releases the radiofrequency energy. The tip is applied in a circular pattern on the outer layer of the front of the eyeball to shrink small areas of tissue. The result is a constrictive band of tissue, similar to a tightened belt, that increases the overall curvature of the cornea.
"Nearly 95 percent of patients with low to moderate farsightedness achieve normal or near-normal vision after the procedure," says ophthalmologist Terrence O'Brien, M.D. Symptoms of hyperopia include eyestrain, blurred vision or headache, especially when reading or at the end of the day.
3. Male Menopause?
Most of us have heard of menopause in women but what about men? Just as levels of estrogen drop as women enter middle age, about 25% of men experience a dip in the male sex hormone testosterone as they age. While younger men with low testosterone are often given replacement therapy, the benefits versus risks of such therapy in older men aren't clear. Some doctors believe the therapy can enhance libido and improve muscle tone in older patients. But Hopkins endocrinologist Adrian Dobs warns that testosterone therapy's side effects can include a drop in HDL, or good cholesterol, and may also promote prostate cancer.
"Most people agree that testosterone does not create the cancer but if it is already there it can cause it to grow. So any man thinking of undergoing testosterone therapy should have a PSA test done to rule out prostate cancer, and should have a digital rectal exam to make sure there aren't any nodules," says Dr. Dobs.
1. Coffee and Blood Pressure
Americans joke about needing their morning jolt of java, but Hopkins researchers are seriously studying the long-term effects of caffeine consumption. In a study of 1100 coffee-drinking doctors who were followed for nearly 50 years, researchers were surprised to find that coffee consumption, even 5 cups a day, doesn't notably increase the risk for high blood pressure, or hypertension. However, if you already have high blood pressure, Hopkins internist Mike Klag suggests you break the coffee habit.
"I ask my patients to stop drinking caffeinated coffee for two weeks and see what happens to their blood pressure. In some people with high blood pressure, it can have a profound effect of lowering their blood pressure by up to 10 points." Consult your doctor for help on how to stop the caffeine habit.
2. More on Alzheimer's Disease
Long-term use of aspirin and other non-steroidal anti-inflammatory drugs could prevent Alzheimer's disease if taken before symptoms of dementia occur, concludes a study by Hopkins researchers published last month in the journal Neurology.
The researchers followed 3,000 adults over age 65 for three years and monitored their use of aspirin and other anti-inflammatory drugs such as ibuprofen, naproxen, and other drugs. The findings? People who took aspirin or other anti-inflammatory drugs for more than two years before the study began were 55 percent less likely to develop Alzheimer's than those who did not. They also found that longer use of non-steroidal pain relievers was associated with greater protection from the disease.
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