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Hopkins News for You
This is a service for our friends around the world from Johns Hopkins International. To receive reports, please send e-mail to patientnewsletter@jhmi.edu with the name of this e-newsletter.
September 2003
1. Are Continuous Wear Contact Lenses Safe?
2. Thoracic Outlet Surgery: Who Should Have It?
Mechanical Ventricles: Alternative to Transplant?
1. Infectious Impostor
2. Another Reason to Stop Smoking
Zeynep Kocabal, Europe Division
1. Are Continuous Wear Contact Lenses Safe?
On the surface, the new silicone-based soft lenses designed to be worn for up to a month appear to be a contact wearer's dream. But some eye care professionals are urging caution. Overnight contact wearers are especially prone to infection and potential corneal ulcers for several reasons. These include oxygen deprivation to the eye, a lens that fits too tightly, and dirt that builds-up between the lens and the eye.
Johns Hopkins Director of Contact Lens Services Lee Raykovicz says the new lenses are supposed to allow six times more oxygen to reach the eye, but wearers should still be alert to potential problems. "Any kind of persistent irritation, redness, discharge, light sensitivity is not normal, and that is something that should be checked immediately." Raykovicz suggests buyers of these long-term lenses get checked a day or two after the initial fitting, and again in the middle and end of the thirty day cycle.
2. Thoracic Outlet Surgery: Who Should Have It?
Patients describe pain and swelling so severe in their arm that all they can do is sit there and hold it. Others say they feel tingling and numbness, like their arm is a dead weight. Often, doctors can't make sense of it. "Some people believe that everyone with a sore arm has it; others believe it doesn't exist at all," says anesthesiologist Peter Staats, M.D.
One of the most difficult to diagnose conditions, thoracic outlet syndrome, or TOS, can be caused by accidents and repetitive motions like brushing one's hair, or simply being born with an extra rib, the "cervical rib." The syndrome occurs when the artery, vein and nerves that run down the arm from the thoracic outlet behind the collarbone are compressed. But if you can't determine whether painful symptoms are biological or psychological, how do you treat them?
That's the critical question when it comes to thoracic outlet syndrome, says Hopkins' new chief of surgery, Julie Freischlag. Dr. Freischlag not only developed an improved, safer surgery for TOS but before coming to Hopkins was part of a team that evaluated 800 cases a year and learned that selecting the right patients for surgery was more important than the surgery itself.
"If you pick patients improperly, they won't get better," she says. "They'll continue to have pain and emotional symptoms that become even more devastating, because they were looking forward to the operation and to getting better." The good news is that Dr. Freischlag brings a 90 percent success rate in treating patients because of what she has learned about preoperative assessment of TOS. She works with pain specialists like Dr. Staats to identify surgical candidates through innovative techniques in numbing nerves in the neck and brachial plexus, or armpit.
Mechanical Ventricles: An Alternative to Transplant?
An LVAD, or left ventricular assist device, is used to keep the heart working until transplantation and is designed to work for an average of 100 days. Now, newer, smaller models of these machines are being designed to work much longer-and with less risk of complications. Surgeons say these devices might soon be used as an alternative rather than as a bridge to transplant. "The thinking is, we can sustain a patient as well as a heart transplant can with potentially fewer complications, such as organ-tissue rejection" says cardiac surgeon John Conte.
Conte explains that 90 percent of heart transplant patients need a new heart because of left-ventricle failure. So why replace the entire heart if the right ventricle is doing an adequate job of pumping blood into the lungs? These are among the reasons why Hopkins is participating in a study of a new LVAD named after heart surgeon Michael DeBakey. Like most LVADs, the DeBakey is externally powered, but is just one-tenth the size of a typical device. That means it can fit into more patients, and could be less prone to infections and clots, the two major problems with LVADs. Initially, the device will be offered to patients ineligible for transplant. If they do well, it may one day be an option for transplant patients.
1. An Infectious Impostor
Urinary tract infections are usually associated with adults, but they are also among the most common missed diagnoses in children. Johns Hopkins researchers estimate that 1% of boys and as many as 5% of girls suffer such infections. Often the only outward symptom is fever. This can cause redness in the ears that pediatricians may mistake for an ear infection. Pediatric Urologist Ranjeev Matthews, says urinary infections often affect infants and newly toilet-trained children who become too busy with activities to urinate.
"Your bladder requires frequent filling and frequent emptying; if you don't empty your bladder on a routine basis, you become susceptible to urinary tract infections." Dr. Matthews says that to limit these infections, toilet-trained children should urinate every two to three hours during the day.
2. Another Reason to Stop Smoking
There is no cure for emphysema, but a study suggests that early stage patients who quit smoking might affect emphysema's long-term course. Researchers studied over 6,000 patients with early chronic obstructive pulmonary disease, which often leads to the development of emphysema. Patients were either given typical smoking cessation education or put into an aggressive smoking cessation program. Hopkins pulmonologist Robert Wise, says those in the smoking cessation program were four times more likely to quit.
"We found that those patients who quit smoking, and then even if they reverted back to smoking but quit again, did better than those patients who continued to smoke. There was a benefit in terms of lung function over five years even in patients who were not able to sustain quitting smoking for a full five year period." After 14 years, those who had been in the smoking cessation program had their mortality rate from all causes including emphysema cut by 20%.
Zeynep Kocabal, Europe Division
A native of Turkey, Zeynep Kocabal, a Patient Coordinator in the Europe Division, was selected Employee of the Year at Johns Hopkins International in recognition of the outstanding service she provides to patients.
Question: How did you start working for Hopkins?
Zeynep: Actually, I started at Hopkins as an international patient myself. I moved to Baltimore in 1994 because of my husband's studies. At the time, I was working for an airline company based in New York. I left the company in 1996 and started working as a Turkish instructor, but I had to come to Hopkins for a surgery. During my recovery, I met a lot of people from Johns Hopkins International. I was impressed by the quality of their service and the support they gave me during my stay. In 1998, they asked me if I wanted to be part of their team as a Turkish interpreter, and I took the opportunity.
Question: What are your main responsibilities today?
Zeynep: I began as a part-time Turkish interpreter but soon I became a full-time patient coordinator. My job today is to make sure all patients who come to Johns Hopkins Hospital have everything they need, from appointments with the right doctors to accommodations for their families. This is a job that is not always easy, but time and experience have taught me how to handle difficulties. I am not aware of many places that offer this kind of service to international patients. Within the United States there are a couple of other hospitals with similar services, but not in foreign countries. In Turkey, for example, I don't know of a hospital with special programs for international patients. So what I do here is pretty special, and I try to do my best.
Question: How do you feel being selected Employee of the Year?
Zeynep: Being named Employee of the Year was a huge honor. In fact, when I heard the news I was shocked! I was in Turkey at the time, sleeping, when our CEO, Mr. Steve Thompson, called me at 4 a.m. I just remember hearing a voice: "This is Steve Thompson from Johns Hopkins International…" I thought I was dreaming! I jumped from my bed. My husband was laughing at me because he already knew I had been chosen, but I couldn't believe it. I was so happy. I do not feel pressured because I love my job and I always do my best. To be recognized for my work like that is nothing but a great honor!
Question: Is there anything special about the way you deal with your patients that makes a difference in your job?
Zeynep: First of all, I really like what I do. This is essential. I take my responsibilities very seriously. From the first inquiry I receive until the moment the patient leaves the hospital, I feel I owe this patient the best service I can possibly give. I always put myself in their place. I know their culture because it is mine too, and I know their expectations because I was there once and I received world-class service. This is what I want to give my patients as well. I try to understand their situation and I always try to give them a smile. My patients say that by smiling I make their days happier. When they get a smile on a difficult day, they feel more comfortable. My patients believe I bring luck to them because I am by their side when they need something. Sometimes they speak English as well as I do, but they like a human being by their side to ease their pain.
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