JohnsHopkins Bayview · Anisa Gire, O.D. Optometrist OptometristAnisa Gire,O.D.,has joined...

To schedule an appointment,call 410-550-0453.

Orthopaedicsurgeon RobertSterling, M.D.,has joined theDepartment ofOrthopaedics. Hespecializes in totaljoint replacementand reconstruction.


Robert Sterling, M.D.Orthopaedic surgeon

2 Winter 2014 Johns Hopkins Bayview Medical Center / hopkinsmedicine.org/jhbmc

Johns Hopkins BayviewNoteworthy News


Anthony Accurso, M.D.Internist

Internist AnthonyAccurso, M.D.,has joined theComprehensiveCare Practice.He specializes ingeneral internalmedicine.


Ana-Maria Orbai, M.D.Rheumatologist

RheumatologistAna-MariaOrbai, M.D.,has joined theDepartment ofRheumatology.She specializesin psoriatic arthritis,rheumatoid arthritisand inflammatoryarthritis.

Welcome New Physicians

Johns Hopkins BayviewDiversity Council NamedOne of Top 10 in Country

The Johns Hopkins Bayview Diversity Council hasbeen recognized by the Association of DiversityCouncils as one of the top 25 diversity councils in theUnited States for the third year in a row. Ranked tenththis year, the Council improved its standing from 2012.The award is given to organizations that show out-standing contributions through management commit-ment, measurement, accountability, communicationand education. Johns Hopkins Bayview was joined onthe top 25 list by Comcast, AmericanAirlines,GeneralMotors and FedEx Freight, to name a few.

The Council was started in 2007 with 42 mem-bers and is led by Johns Hopkins Bayview presidentRichard Bennett, M.D., and Anita Langford, vicepresident of care management services. In recentmonths, the Diversity Council has built a relationshipwith the Baltimore International Rescue Committeeto better prepare for refugees from foreign countrieswho come to the Baltimore area for medical care;begun work on a civility and respect awarenesscampaign on the Medical Center campus; held acommunity diversity session to address health needsof the local Bhutanese/Nepali community; andgraduated the second cohort of its employee leader-ship mentoring program.

New Center Focuses onLatino Health Needs

Building on a decade of providing healthservices to the Latino community,Johns Hopkins Medicine has createda Center of Excellence for LatinoHealth, located at Johns Hopkins

Bayview Medical Center. The Center, whichopened in summer 2013, emphasizes a family-centered, multidisciplinary approach to health,and brings together medicine, pediatrics, gyne-cology and obstetrics, and psychiatry.

“Addressing the health care needs of Latinofamilies in a comprehensive way will be ournumber one priority,” says Tina Cheng, M.D.,director of the Center and director of pediatricsat Johns Hopkins Bayview. In this venture, shepartners with Sarah Polk, M.D., a pediatricianin the Children’s Medical Practice at JohnsHopkins Bayview; and Kathleen Page, M.D.,and Adriana Andrade, M.D., infectious diseasesspecialists at The Johns Hopkins Hospital.

“We plan to enhance our efforts by learningfrom the Latino community about their healthneeds, then developing programs to addressthem—incorporating cultural awareness educa-tion, training of our health professionals andresearch on health disparities,” says Dr. Cheng.

The Center of Excellence for Latino Healthwas made possible by a gift from the Aaron andLillie Straus Foundation and matching fundsprovided by leaders of The Johns HopkinsUniversity School of Medicine, The JohnsHopkins Health System and Johns HopkinsBayview Medical Center.

Did You Know?Compared to the overall U.S.population, Latinos have:• reduced access to quality care• limited health literacy• low parental satisfaction with care• greater unmet medical needs• higher rates of injuries and preventable

complications of illness

Johns Hopkins Bayview currentlyhas several programs gearedtoward the Latino community:

• The Latino Family Advisory Board

• Crianza y Salud (parenting classes basedat the Children’s Medical Practice)

• Hispanic community mental health clinic

• HOLA (Hopkins Organization for LatinoAwareness)

Additional work by the Center’s faculty includes a bi-monthly health column publishedin a Latino periodical; a Spanish language radio program on El Zol, the largest Latino HIVoutreach program in Baltimore; and pro-bono provision of care at La Esperanza Center.

Jemima Albayda, M.D.Rheumatologist

RheumatologistJemima Albayda,M.D., has joinedthe Johns HopkinsMyositis Center.She specializes ininflammatorymuscle diseases.


continued on page 4

Ask the Expert:

Joint PainOrthopaedic surgeon Harpal “Paul” Khanuja, M.D.,has joined the Department of Orthopaedics. Hespecializes in hip and knee joint replacement andreconstructive surgery. Below, he answers commonquestions about joint pain and advises on when toschedule an appointment with an orthopaedic surgeon.

What causes knee and hip pain?Joint injuries and problems vary based on a person’s age. For example, younger, athleticpatients may experience sports injuries, while older patients may suffer from pain due toarthritis (the degeneration of cartilage around a joint). Knee and hip pain also can becaused by a number of other factors: pulled or strained muscles around the joints, stretchedor sprained ligaments, or tendon injuries.

What are common joint injuries and problems?A torn meniscus is one of the most common knee injuries and can cause severe knee pain.Any activity that causes you to forcefully twist or rotate your knee, especially when puttingthe pressure of your full weight on it, can lead to a torn meniscus.

Bone abnormalities around the hip socket can cause hip pain. The most common prob-lem I see is arthritis. While it used to be most prevalent in older patients, more and moreyounger patients are presenting with it.

When should I schedule an appointment with an orthopaedic doctor?Simple sprains and strains can be treated by your primary care doctor, and usually heal withrest and anti-inflammatory medicine. However, if you have pain that lasts for an extendedperiod of time or seems to get worse, it may be a good idea to see an orthopaedic provider.At Johns Hopkins Bayview, we have a great team of physicians, nurse practitioners andphysician assistants who treat orthopaedic problems both surgically and non-surgically.

At what point should I considerjoint replacement surgery?Joint replacement surgery is an excellentprocedure to treat advanced arthritis painthat prevents you from being active.However, as a joint replacement surgeon, Iwould suggest surgery only after you havetried everything else. Weight loss, exercise,anti-inflammatory medications and injec-tions are all non-surgical options that cantreat or decrease joint pain. Our goal is tokeep you as active as possible.

To schedule an appointment with aJohns Hopkins orthopaedic surgeon, call 410-997-2663.

Comments, requests,change of address?

E-mail us [email protected].

Johns Hopkins Bayview Medical Center / hopkinsmedicine.org/jhbmc Winter 2014 3

Contents2 Noteworthy News

5 Eating Healthy to LowerYour Blood Pressure

6 Taking Back ControlPatient achieves weight-loss successwith the help of bariatric surgery

8 Rebuilding After Breast CancerWhen healing takes shape

10 From Healer to HealedJohns Hopkins Bayview employeefinds herself on the other endof kidney cancer diagnosis

12 Harnessing COPDTreatment helps patients get back to life

14 What To Do When YourHeart Skips a Beat

Seminars & Screenings

15 Saving Tomorrow’s LivesResearch thrives on Johns HopkinsBayview campus

16 A Lung Cancer ScreeningCould SaveYour Life

Cover: Breast cancer patientNikki Jones says her diagnosis isjust a blip on the radar, and sheis going to keep living her life.See story on page 8.

Harpal “Paul” Khanuja, M.D.

A Joint EffortThe Causes and Cures of Joint Pain

For people who suffer from hip and knee joint paindue to arthritis or trauma-related conditions.

April 236 p.m.

Johns Hopkins BayviewMedical Center

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



Harry Randall, M.D.Ophthalmologist

OphthalmologistHarry Randall, M.D.,has joined the WilmerEye Institute. Heprovides comprehensiveophthalmology care.


Anisa Gire, O.D.Optometrist

Optometrist AnisaGire, O.D., hasjoined the WilmerEye Institute. Shespecializes in ocularsurface disease, dryeyes and Sjögren’sSyndrome.

Johns Hopkins BayviewNoteworthy News

Welcome New Physicians continued from page 2

Beyond Chemotherapyand Radiation

Cancer care for the heart and mind

For more information or to schedule an appointment, call 410-550-6337.**Phone will be answered as Memory & Alzheimer’s Treatment Center. Dr. Reese operates her clinic within this Center.

When you’re living with cancer,some aspects of everyday life canchange in unexpected ways—things that you used to take for

granted can become challenging.Emotional and sexual health are two important

parts of cancer care. Psychologist Jennifer BarskyReese, Ph.D., guides patients with cancer, andtheir family members, in strengthening theirrelationships and dealing with changes. “Keepingrelationships strong can help people cope andrecover,” says Dr. Reese.

Many factors influence emotional and sexualhealth during and after cancer treatment. Forsome, the stress and anxiety of a cancer diagnosiscan make intimacy less of a priority. For others,physical changes from surgery or side effectsfrom treatment get in the way. The fatigue thatis associated with cancer treatment can lead to lessinterest and energy to engage in sexual intimacy.Some surgeries or other treatments directly impactsexual function and can make it difficult, impossi-ble, or occasionally painful to be intimate.

Reconnecting After CancerDr. Reese works with patients and their partnersto address these challenges. “During the initialassessment, we talk about psychological factors,behavioral issues, and emotional and physicalhealth. Together, we look at how depression,anxiety and relationshipdistress also mightcontribute to thepatient’s concerns.Considering all ofthese elements helpsme know where tofocus to best help each person,” says Dr. Reese.

Some people are helped by learning copingskills or using simple sexual health aids that arelow cost with no side effects, such as vaginalmoisturizers and lubricants, to assist with vaginaldryness due to cancer therapies. Sexual therapycan teach couples to reconnect by helping themadjust to changes in their sexual relationship andallowing them to refocus on enjoying both physi-cal and emotional intimacy.

Communication Is Key“Communication about intimacy is one commonchallenge that many people with cancer face,”reveals Dr. Reese. Being able to express whatyou’re going through and what would help bringyou closer together is part of the solution. Dr.

Reese teaches patients skills andtechniques to be more comfort-able with their communicationand affection.

“Maintaining or enhancingintimate relationships can affirmyour vitality. It’s one way of feel-

ing “normal” during a time when so much in lifeis changing and uncertain,” adds Dr. Reese. Notall patients experience negative effects of cancer ontheir intimate relationships; in fact, a number ofcouples report feeling that the cancer experiencebrought them closer together.

—Karen Tong

Jennifer Barsky Reese, Ph.D.Psychologist

Julie Paik, M.D.Rheumatologist


RheumatologistJulie Paik, M.D.,has joined the JohnsHopkins MyositisCenter. She specializesin inflammatorymyopathies, suchas dermatomyositis,polymyositis andinclusion body myositis.

One in three Americans is diag-nosed with high blood pressure.It is a serious condition that canlead to coronary heart disease,heart and kidney failure, stroke

and other health problems.There are usually no signsor symptoms associated withhigh blood pressure, whichis why it is so important to“know your numbers” andhave your blood pressurechecked regularly (see box).

Fortunately, high blood pressure can betreated with lifestyle changes and medication.

One of the easiest ways to maintain normalblood pressure is to eat a healthy diet. DietitianCynthia Finley, RD, recommends a diet that isrich in fruits and vegetables, whole grains, low-fat dairy and lean proteins. “You also should

decrease or eliminate foodsthat are high in sodium, fatand sugar, which are knownto increase blood pressure,”she says.

The DASH diet(Dietary Approachesto Stop Hypertension)

is a flexible and balanced eating plan thatstudies have shown helps lower blood

pressure. It is low in saturated fat, cholesteroland total fat, focusing instead on fruits, vegeta-bles, fat-free or low-fat dairy products, wholegrains, fish, poultry, beans, seeds and nuts. TheDASH diet contains fewer sweets, sugars andsugary beverages, sodium and red meats thanthe typical American diet.

“Different diets work for different peopleand should be customized to ensure compliance,”says Finley. “If you want to lower your bloodpressure by changing your diet, you shouldschedule an appointment with a dietitian.He or she will be able to customize a planthat best suits your needs and will meet yourindividual goals.”

—Meghan Rossbach

KnowYour NumbersBlood pressure is the force of blood pushing against the walls of the arteries as the heart pumps. It ismeasured as systolic (blood pressure when the heart beats) and diastolic (blood pressure when the heartis at rest between beats).You most often will see blood pressure numbers written with the systolic num-ber before the diastolic number, such as 120/80.

Below is a table that illustrates normal blood pressure numbers and ranges that put you at greater riskfor health problems.What are your numbers?

Source: National Heart, Lung and Blood Institute


To schedule an appointment with a registered dietitian, call 410-550-7728.

Eating Healthyto Lower YourBlood Pressure

Johns Hopkins BayviewNutrition

Category Systolic (top number) Diastolic (bottom number)

Normal Less than 120 Less than 80

Pre-hypertension 120-139 80-89

High blood pressure, Stage 1 140-159 90-99

High blood pressure, Stage 2 160 or higher 100 or higher

Cynthia Finley, RDDietitian

ControllingYourBlood Pressure• Maintain a healthy weight.

• Be moderately physically activeon most days.

• Follow a healthy eating plan, whichincludes foods lower in sodium.

• If you drink alcoholic beverages,do so in moderation.

• If you are prescribed medicationfor high blood pressure, alwaystake it as directed.

TakingPatient achieves weight-loss s

Being overweight was a partof life for Stephanie Swordsfor as long as she couldremember. Even as a child,she was obese. Swords

occasionally had migraine headachesand suffered from obstructed sleepapnea. Despite that, she didn’t feelmany limitations in her life. “I sawmyself as the healthiest overweightperson,” remembers Swords, now a 30-something living in Essex, Maryland.

When she and her long-termboyfriend began thinking ahead aboutfamily planning, Swords wanted to loseweight to be healthier before pregnancy.Over the years she had tried differentweight-loss programs, but hadn’t foundanything to be effective in helping herlose a lot of weight. After doing someresearch, she found Michael Schweitzer,M.D., and the Johns Hopkins Centerfor Bariatric Surgery.

Uncovering the TruthSwords’ weight was negatively impact-ing her health more than she knew.

“Stephanie didn’t realize she had fattyliver disease or that her body massindex was over 50, meaning she wassuper morbid obese,” says Dr. Schweitzer,a bariatric surgeon and director of theCenter. Together they decided thatRoux-en-Y gastric bypass was the bestsurgical option for her. Swords hadsurgery in February 2010.

During this laparoscopic procedure,the stomach is divided into a little pouchthe size of an egg that can hold only asmall amount of food. The small intes-tine is then connected to the new pouch.


StephanieSwordsworked hardto lose weightand improveher health.

Johns Hopkins BayviewBariatric Surgery

Completingthe Journey

After significant weight loss,

some people can benefit from

body contouring to help remove

excess skin and help them feel

comfortable in their new clothes.

To learn more aboutbody contouring, see page 9.

BayviewWinter2014FINAL:Layout 1 1/6/14 1:27 PM Page 6

Back Controls success with the help of bariatric surgery

Food doesn’t enter the rest of the stomach orthe first part of the small intestine, so the bodyabsorbs less of it. The hormones produced bythe stomach and intestine help to decreaseappetite and make the patient feel full longer.This helps the patient lose weight in the short-term and keep the weight off over time.

Usually, patients spend two days in theMedical Center after surgery and return to worktwo weeks later. They’re encouraged to walk soonafter surgery, and to resume daily activities oncethey return home. For a month after surgery, aspecial diet of liquids and purees helps them toheal while ensuring they get proper nutrition.

A New Way of Life“For the long run, a healthy diet is a necessity,”says Dr. Schweitzer. “Surgery doesn’t replacehealthy eating and exercise.” Physical activity,such as walking, also helps patients lose weightand keep it off while building muscle mass.

Swords was successful in her weight-lossjourney because she eats small, healthy portionsand exercises. “The number one reason whypeople regain too muchweight after surgery is ifthey choose to eat badcarbohydrates, such ascandy and potato chips,”notes Dr. Schweitzer.

The surgery haschanged Swords’ life,and helped her losemore than 150 pounds.“It’s completely differentnow. I started runningand completed my firsthalf marathon!” she

explains. Sheis proud thather healthierlifestyle isspreading toother familymemberswho have lost weight and are cooking morenutritious meals.

Recently, Swords got married. She and herhusband are looking forward to many happy,healthy years together.

While bariatric surgery is an importantweight-loss tool, it’s not a magic wand. “Aftersurgery, you have to be committed to takingvitamins for the rest of your life,” says Dr.Schweitzer. “Eating out less and avoiding fastfood can help. You need to be vigilant withyour health and lifestyle.”

Helping HandsAs part of the program at the Johns HopkinsCenter for Bariatric Surgery, specially traineddietitians work with each patient before and

after surgery to teach themnew ways to look at food andchoose healthy meals andsnacks that will provide thenutrition they need. “Thedietitians put the numbersin perspective for me, whichwas helpful. I used theirservices a lot,” says Swords.

The Center also offersfree support group meetingstwice a month. “Data supportsthat regularly attending thesupport group helps people

maintain and continue their weight loss,”says Dr. Schweitzer. Swords has consistentlygone to support group meetings for morethan two years. “Being a part of the supportgroup keeps me accountable,” she says.“It’s a great resource for informationand encouragement.”

Swords advises anyone considering weight-loss surgery to do a lot of research and askquestions. “You have to be honest aboutyour habits and ready to make changes,” sherecommends. “It’s a decision only you canmake, and you need to commit to the lifestylechanges. That was the key to my success.”

—Karen Tong


Michael Schweitzer, M.D.Bariatric surgeon

For more information or to make an appointment at theJohns Hopkins Center for Bariatric Surgery, call 410-550-0409.

To watch a video of another patient describingher successful weight-loss journey, visithopkinsmedicine.org/jhbmc/bariatrics.

Video�

AreYou a Candidatefor BariatricWeight-Loss Surgery?You may quality for bariatric surgery if you:

• Have a body mass index (BMI)of 40 kg/m2 or higher

• Have a BMI of 35 kg/m2 orhigher with other obesity-related disease (such as diabetes)

• Are healthy enough for surgeryand have tried other weight-loss options

• Are 100 pounds or more overweight

Weight-LossSurgery SeminarFor individuals 100 pounds or

more overweight who areconsidering weight-loss surgery.

Note: This seminar is required toreceive a consult for bariatric surgery.

Johns Hopkins BayviewMedical Center

(see page 14 “Seminars & Screenings”for a complete list of dates and times)

BayviewWinter2014FINAL:Layout 1 1/6/14 1:27 PM Page 7


Johns Hopkins BayviewBody Contouring

When Nikki Jones, a 38-year-old lawyer in Washington,D.C., first heard her diag-nosis—breast cancer—sheonly had one thought: get

it out. But then she started to worry about thebreasts she would be left with. What wouldthey look like? How would they feel?

These are common concerns for womentrying to wrap their heads around an alreadydifficult diagnosis, says Troy Pittman, M.D.,a surgeon in the Department of Plastic andReconstructive Surgery at Johns HopkinsBayview Medical Center. “Many women areafraid that they will feel less than whole, orthat they will only be comfortable being inti-mate with their partners in the dark,” he says.

Luckily, these women have options. Plasticsurgery is so much more than cosmetic surgery,says Dr. Pittman. In fact, the majority of plasticsurgery procedures at Johns Hopkins Bayview arereconstructive, including breast reconstructionafter cancer surgery, body-contouring proceduresafter bariatric surgery or other major weight loss,reconstruction after skin cancer, or post-traumaticreconstruction. “We are able to close the loop ondisease and give patients back what was takenaway,” says Dr. Pittman.

What many women don’t realize is that federaland state laws require insurance companies thatoffer coverage for mastectomy services to also coverthe cost of breast reconstruction after removal of apatient’s breast tissue. This includes any surgeryrequired on the opposite breast for symmetry,whether it be breast augmentation or reduction.

A Unique ApproachAfter her cancer diagnosis, Jones did plentyof research. She decided to come to the JohnsHopkins Breast Center based on what she found.“It’s the best treatment center for breast cancer inthe region,” she says. Still, for years Jones had beenusing another major health system for all of herhealth care needs, andshe was nervous aboutmaking the switch.

Her appointment inAugust helped alleviateall of those fears. First,Jones met with MehranHabibi, M.D., directorof the Johns Hopkins Breast Center, who walkedher through her treatment options. They deter-mined that a lumpectomy (a procedure to removethe tumor), followed by chemotherapy and radia-tion treatment, would be the best approach for

her. Then Dr. Habibi picked up the phone andcalled Dr. Pittman, who was able to meet withJones just a couple of hours later to discuss herbreast reconstruction options.

That’s one of the things that makes the JohnsHopkins Breast Center unique: a multispecialtyteam of providers—surgeons, radiologists, medicaland radiation oncologists, plastic surgeons andpatient navigators—works collaboratively underone roof to analyze patient cases and create treat-ment plans. “We are literally in the operatingroom together,” says Dr. Pittman. “It’s a veryunique approach.”

The team behind Jones’s care brought herpeace of mind. “It was comforting to know

that Dr. Habibi and Dr. Pittmanwere in constant contact,” she says.

Restoring FemininityJones talked to Dr. Pittman abouther biggest concerns surroundingher lumpectomy: scarring and lossof sensation to her nipples. The

tumor was large, and removing it would leave anoticeable indentation in her breast. “He explainedall of my options, but left the decision up to me,”says Jones.

Mehran Habibi, M.D.Director, Johns Hopkins

Breast Center

RebuildingAfter BreastCancerWhen healing takes shape

Reconstructivesurgery helpedNikki Jones regainher confidenceafter breast cancer

After careful consideration, Jones opted to haveher lumpectomy and her reconstruction about aweek apart in September. Although they can behandled as a single procedure, Jones wanted towait for the biopsy of her lumpectomy to comeback clear—indicating that Dr. Habibi had beenable to remove all cancerous cells from herbreast—before undergoing her reconstruction.Dr. Pittman remained an important part of herinitial lumpectomy, though. The day beforesurgery, he mapped out incision lines so thatDr. Habibi could remove the tumor in themost minimally invasive way possible, withthe ultimate reconstructive plan in mind. Dr.Pittman also was in the operating room duringthe lumpectomy to offer guidance.

Because Jones had large breasts, she and Dr.Pittman decided to perform a breast reduction onthe opposite breast along with the reconstruction,and were able to use her own tissue to fill theindentation left by the lumpectomy, in a proce-dure known as oncoplastic surgery.

Understanding Your Choices“Reconstruction of a breast that has been removeddue to cancer or other disease is one of the mostrewarding surgical procedures I perform,” saysDr. Pittman. “New surgical techniques anddevices have made it possible for plastic surgeonsto create a breast close in form and appearanceto a natural breast.”

Women who undergo a mastectomy (completeremoval of the breast) or a lumpectomy (removalof the tumor) have a number of reconstructiveoptions. They may choose to use a silicone orsaline implant to restore their feminine form.These devices, which have been deemed com-pletely safe by numerous studies, are able to offera much more natural look and feel than they didin years past. Women also may choose autologousreconstruction, meaning that the patient’s own

tissue, not an implant, is used to rebuild thebreast. Both options have advantages and disad-vantages, which plastic surgeons like Dr. Pittmancarefully review with each patient. In an autolo-gous reconstruction, tissue can be used from theback, abdomen, thighs or buttocks. Many womenopt to use tissue from the abdomen because theylike the added “tummy tuck” benefit it provides.Others choose to couple a breast reduction withthe reconstruction, as Jones did.

Living with ConfidenceSince her reconstruction, Jones has been ableto return to all the things she loves, and more.The cancer diagnosis has inspired her to live ahealthier lifestyle; she met with a nutritionist andis exercising more. “Exercising is so much easiernow than it was before my reconstruction,” shesays. “It’s been wonderful.”

And Jones doesn’t even have visible scars toserve as a daily reminder of her cancer battle.“Dr. Pittman was able to keep all of the incisionmarks under my breasts. Even now, they arealmost gone,” she says.

Jones isn’t finished her journey—she is nowundergoing chemotherapy—but it hasn’t stoppedher from enjoying life each and every day. Shereturned to practicing law in October. On week-ends, she and her spouse enjoy going to localmusic shows, watching college football, spendingtime with friends, or going for a motorcycle ride.“My breast cancer diagnosis was just a blip on theradar for me,” says Jones. “I’m going to keep livingmy life.”

—Sara Baker

To schedule an appointment with the Department of Plastic and Reconstructive Surgery, call 443-997-9466.To schedule an appointment with the Johns Hopkins Breast Center, call 410-550-8282.


Learn MoreBody Contouring After Weight Loss

For people who have lost a significant amount ofweight and are considering surgical proceduressuch as tummy tucks, thigh lifts, breast lifts, arm

lifts and facial rejuvenation. Participants will meetpatients who have undergone the procedures.

March 266:30 p.m.

Johns Hopkins Bayview Medical CenterTo register, call 410-550-KNOW (5669).

Troy Pittman, M.D.Plastic surgeon

Body ContouringAfter Weight-Loss Surgery

Patients who have successfully lost a sub-

stantial amount of weight, especially after

bariatric surgery, are often frustrated to find

that their new, smaller clothes don’t fit the

way they’d like due to excess skin. Body

contouring surgery can be the final step in

helping them to achieve their goal.

“An ideal candidate for body contouring

is someone who is motivated, has good

nutrition, doesn’t smoke, and has reached a

plateau in their weight loss,” says Dr.

Pittman. Body contouring improves the

shape and tone of tissue that supports fat

and skin, and removes excess sagging from

areas of fat loss.

Body contouring has a very high patient

satisfaction rate, says Dr. Pittman. Patients

find that after surgery they are able to exer-

cise more freely and buy flattering clothes

right off the rack. “It’s often the final push

they need to become even healthier,” he

says. In fact, Dr. Pittman is interested in

researching the long-term effects that body

contouring has on control of weight and

management of chronic illness.

For 10 years, medical secretaryWanda Walker worked withurologic cancer patients at JohnsHopkins Bayview Medical Center.She scheduled their appointments,ensured they had correct medical

forms and calmly listened to their stories ofbladder, kidney and prostate cancer with openears and caring ways.

But in August 2012, Walker unexpectedlycame face to face with the same diagnosis asmany of the patients she helped: kidney can-cer. “I was shocked,” she says. “I’m usually onthe other end of those calls.”

Doctors discovered the cancer, a 4-centime-ter mass on her right kidney, during a CT scanto monitor diverticulitis, a digestive diseaseWalker has had for years. “I don’t think I everhad any (cancer) symptoms,” Walker says. “Ihad no bleeding, no pain in my back.”

Immediately, Walker shared the news withher boss, Christian Pavlovich, M.D., directorof urologic oncology at Johns HopkinsBayview. The diseased kidney needed to comeout, Dr. Pavlovich says.

“Sometimes, tumors are so deep-seated orso large it’s just better to remove the wholething,” he says. But instead of removingWalker’s kidney through a conventional open

procedure, Dr. Pavlovich performed a mini-mally invasive laparoscopic nephrectomy. AtJohns Hopkins Bayview, more and moreurologic cancer patients are benefiting fromthese less invasive laparoscopic and robot-assisted procedures, which typically resultin less post-operative pain, a shorter hospitalstay and a faster return to daily activities.

Leaders in the FieldFor decades, surgeons relied on open proce-dures when it came to surgical treatment ofcancer. Yet in the 1990s, a team of experiencedurologists and nurses decided to make JohnsHopkins Bayview the “cradle” of minimallyinvasive urologic surgery, Dr. Pavlovich says.That meant researching and implementinglaparoscopic surgery.

Using three small incisions instead of onelarge one, urologists insert a telescope and smallinstruments through a patient’s abdomen andthen remove the kidney. Urologists also canremove part or all of the bladder or prostateusing laparoscopic surgery.

“Patients have a shorter recovery time andless blood loss than with open surgery,” Dr.Pavlovich says.

In recent years, Johns Hopkins Bayviewurologists have incorporated robotic-assistedsurgery into the minimally invasive program.Urologists still use small incisions and a tele-scope, just like manual laparoscopic proce-dures do. But with the help of the robot, theycan control tiny instruments with superiorprecision. That means more healthy organsand tissue can be spared. When operating with

the robot, urologists also have a 360-degreerange of motion, which cannot be achievedwith the human wrist.

“The robot allows for more precise surgery,more reproducibly, more often,” Dr. Pavlovichsays. Urologists may soon use the robot forpercutaneous treatments, where they useneedles to freeze or heat and then destroykidney cancer.

A FamiliarVoiceWithin a few weeks of her surgery—and aftera well-deserved vacation—Walker went backto work. She credits Dr. Pavlovich with savingher life. “I was diagnosed and had surgeryand became a cancer survivor before I evenknew it,” she says with a laugh. “He’s a greathuman being.”

In the office, Walker is still schedulingpatients’ appointments, ensuring they havecorrect medical forms and listening to theirstories. But now, as a kidney cancer survivor,her calming voice bears true empathy. “Peopleneed you to be down to earth,” she says.“They’re scared. I can comfort them frompersonal experience.”

—Allison Eatough

Johns Hopkins BayviewUrology

Christian Pavlovich, M.D.Urologic oncologist

To learn more about kidney cancer or treatment options, callthe James Buchanan Brady Urological Institute at Johns Hopkins Bayview Medical Center at 410-550-7008.

FromHealer to HJohns Hopkins Bayview employee finds herself on the other e



Wanda Walker,cancer survivor

Kidney CancerKidney cancer, also called renal cell

cancer, originates in the kidneys—

the bean-shaped organs that sit

behind your abdominal organs.

Almost half of all kidney cancer

cases are discovered incidentally,

when patients are scanned for

other ailments and illnesses.

Kidney cancer rarely causessymptoms in its early stages.Advanced kidney cancersigns include:

• Blood in the urine

• Upper abdomen or backpain just below the ribs

• Palpable abdominal mass

• Weight loss

• Intermittent fever

• Fatigue

Healedr end of kidney cancer diagnosis


Jane Cloud remembers the daya decade ago when she real-ized something wasn’t right.“I had been visiting Harper’sFerry with friends,” recalls the

69-year-old. “My friends wereahead of me at the top of a set ofsteps. I ran up the steps to catchup, and I just collapsed. I couldn’tcatch my breath and Ihad no idea what was going on.I considered myself a healthyperson and in good shape.”

A few days later, Cloud’s pri-mary care physician referred her toa pulmonologist (lung doctor) forlung capacity testing called spirom-etry. Her lungs were functioning atonly 50 percent. She was diagnosedwith chronic obstructive pulmonarydisease (COPD).

Understanding COPDCOPD is a progressive lung condition that affectsthe airways and air sacs in the bronchial tubes, aswell as the thousands of smaller, thinner tubesthat branch off of those, called bronchioles. Thedisease inflames and narrows small airways anddestroys delicate air sac walls, making it harderand harder to breathe.

“Normally, it isn’t until about 50 percent of aperson’s lung capacity is gone that they feel some-thing isn’t right and go to the doctor,” explainsRobert Wise, M.D., a pulmonary specialist atJohns Hopkins Bayview Medical Center. “This

has always been a concern, because COPD isvery easy to diagnose early on with a simplespirometry test.”

Nearly 13 million adults in the U.S. haveCOPD. Even though she was among millions,Cloud’s diagnosis left her feeling isolated, over-whelmed and scared of a condition she’d have todeal with for the rest of her life. “I went into totaldenial,” she remembers. “You think to yourself,‘I'm different. This isn’t me. I'm going to heal.’But, I can tell you from experience, the sooneryou can acknowledge it, the better off you are.”

Taking ControlFive years later, after two longbouts of pneumonia, Cloudadmitted she had to take controlof her disease. She gave up smok-ing and worked with her primarycare physician and specialists inpulmonology, including Dr. Wise,to learn as much as she couldabout COPD and how she couldbest manage it. “We perform bestwhen we work in partnership witha primary care doctor,” explainsDr. Wise. “We can then providea coordinated approach.”

The pulmonary clinic at JohnsHopkins Bayview brings togethera specialized staff to streamlineeach aspect of care. In addition tophysicians with expertise in COPDand a variety of other respiratory

conditions, a respiratory therapist educatespatients on their respiratory status, as well asbreathing techniques and equipment (i.e. nebuliz-ers, oxygen therapy devices) that can improvetheir breathing and lifestyle. A senior nurse coor-dinator focuses on further educating patients ontheir disease and health, as well as preventive care.

Harnessing

COPDTreatment helps patients get back to life

Johns Hopkins BayviewPulmonology

Robert Wise, M.D.Pulmonologist

Jane Cloud enjoys a beautiful fall fishing trip—her first in over a decade—with her son-in-law, daughter, life-long friend and husband.

Pulmonary rehabilitation, an outpatient exer-cise and education program designed for patientswith breathing disorders, also plays a vital role intaking control of COPD. This is where patientscan put the techniques they’ve learned to use.

“Pulmonary rehab combines exercise, educa-tion and support,” explains Marlene Dougherty,a RRT, pulmonary rehabilitation coordinator atJohns Hopkins Bayview. “Patients learn and prac-tice techniques to help manage their symptoms,stay active and use their respiratory medicationsproperly. They also meet with a dietitian to assesstheir nutritional needs. These are tools that canreally improve the patient’s overall quality of life.”

Dr. Wise adds that the real key to controllingCOPD, or any chronic disease, is gaining asmuch knowledge about your condition as possi-ble and learning about all the resources available.This will enable you to self-manage and be anactive partner in your care.

Adapting toYour New Life“Find a doctor you’re comfortable with,” Cloudencourages. “I found Dr. Wise later in my life.He’s wonderful to talk to and keeps me in theloop on new treatments and options. If youdon’t have someone you can talk to, you’llremain isolated and on your own, and notmake much progress.”

“I encourage people to live the life they’recapable of,” she adds. “There are things I canno longer do, but it’s like anything else in life—you have to adapt and continue living.”

Cloud recently found a portable oxygen devicethat allows her to more easily travel and take partin activities she hasn’t been able to enjoy in over adecade. “I scheduled a fishing trip with my fami-ly. I absolutely love fishing, and haven’t been sincebefore my diagnosis. But I have the knowledgeand skills I need to control my symptoms and,most importantly, amazing family support.”

—Jessica McQuay

For more information on pulmonary medicine or to schedule an appointment,call 410-550-LUNG (5864) or visit hopkinsmedicine.org/pulmonary.


Stay Ahead of COPDCOPD is almost always caused bysmoking. Other risk factors includefamily history and living or workingin areas with poor air quality.Themost important things you can doto prevent COPD include:

• Not smoking.

• Avoiding secondhand smoke, as wellas any area with poor air quality.

• Talking to your doctor aboutspirometry testing, especially if youhave these other risk factors.You’llbe able to learn about your lungfunction and catch any lung capacityissues early.

Johns Hopkins Awarded $2.1 Millionto Improve Post-Hospital Care for COPD

The Johns Hopkins Armstrong Institute for Patient Safety and Quality has been awarded $2.1 million todevelop, implement and study a program that better supports people with COPD following hospitalization.

Many with COPD are hospitalized or treated in the emergency department due to sudden, seriousworsening of symptoms, known as exacerbations, which cause difficulty breathing.Too often, they are neverasked whether they need help at home before they’re discharged, and never told what symptoms to monitorin order to prevent subsequent hospitalizations.Therefore, they wind up back in the hospital shortly after.

The research program will focus on those hospitalized at Johns Hopkins Bayview Medical Center forCOPD exacerbations.These patients and their families/caregivers will receive education on COPD, symp-toms to look for and self-management skills during their time in the hospital, and will get repeat calls orhome visits from a nurse case manager in the three months following their hospitalization.They also willbe connected with community-based resources, such as transportation services enabling them to attendfollow-up medical appointments.

Hanan Aboumatar, M.D., MPH, principal investigator for the research program, explains,“The goal is todevelop ways to advance the patient’s and their loved ones’ capacity to handle their illness and provide thetools and support they need.”

Cloud showsoff her “catchof the day.”

Marlene Dougherty, RRTPulmonary rehabilitation

coordinator

SCREENINGSVaricose Vein ScreeningFor individuals with varicoseveins who are considering

treatment or surgery.For a complete list of

upcoming screenings, visithopkinsmedicine.org/veincenters

or call 410-550-VEIN (8346).

SEMINARSOh, My Aching Back!

For people who havebeen diagnosed with

degenerative disc conditionsand want to learn about

the treatment of back andrelated leg pain.

March 20May 146 p.m.

Johns Hopkins BayviewMedical CenterTo register, call

410-550-KNOW (5669).

Weight-LossSurgery Seminar

For individuals 100 pounds ormore overweight who are

considering weight-loss surgery.Note: This seminar is required to

receive a consult for bariatric surgery.

March 4April 1 & 15May 6 &20June 3 & 17

4:30 to 6 p.m.Johns Hopkins Bayview

Medical CenterMarch 18April 22May 13June 10

5 to 6:30 p.m.Medical Pavilion at HowardCounty General Hospital

To register, visithopkinsmedicine.org/

jhbmc/bariatrics.If you do not have computer access,

call 410-550-0409.

DoYou Have anIrregular Heartbeat?

Learn about the symptoms,risks and new treatment

options for atrial fibrillation.March 18

6 p.m.Johns Hopkins Bayview

Medical CenterTo register, call

410-550-KNOW (5669).

Body ContouringAfter Weight Loss

For people who have lost asignificant amount of weight and areconsidering surgical procedures such

as tummy tucks, thigh lifts, breastlifts, arm lifts and facial rejuvenation.Participants will meet patients whohave undergone the procedures.

March 266:30 p.m.


410-550-KNOW (5669).

A Joint Effort:The Causes and Cures

of Joint PainFor people who suffer from hip

and knee joint pain due to arthritisor trauma-related conditions.

April 236 p.m.


410-550-KNOW (5669).

PATIENTINFORMATION

SESSIONSChildbirth Preparation

This session provides expectantmothers and their labor coaches

in-depth instruction on labor, delivery,pain control and other topics relatedto the birth experience. Classes areled by a certified childbirth educator.

One Saturday andSunday per month

March 1 & 2

April 5 & 6May 3 & 4June 7 & 8

August 2 & 3September 6 & 7

9 a.m. – 3 p.m. both daysCost: $65


410-550-BABY (2229).

BreastfeedingLearn the benefits of breastfeeding,behaviors of a normal newborn, how to pump and store breast milk, and how medications and

contraceptives affect breastfeeding.March 3April 7May 5June 2

1 – 3 p.m.Cost: $30


410-550-BABY (2229).

&

Johns Hopkins BayviewCardiology

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

SeminarsScreenings

Johns Hopkins Bayview Medical Center offers a variety of educational programs and screenings.

The programs listed on this page are provided at no charge, unless otherwise noted.

14 Winter 2014 Johns Hopkins Bayview Medical Center / hopkinsmedicine.org/jhbmc Johns Hopkins Bayview Medical Center / hopkinsmedicine.org/jhbmc Winter 2014 15

Despite what romantic comedies andlove ballads may lead you to believe,having your heart skip a beat can bequite unpleasant. Luckily, in mostcases a fast or fluttering heartbeat is

harmless, and common—millions of Americansexperience some form of a heart arrhythmiaevery year.

Arrhythmias are caused by malfunctioningelectrical impulses that signal the heart’s chambersto contract. This causes the heart to beat out ofsync and usually leads to a skipping, fluttering orracing sensation due to irregular compression inone or more chambers of the heart. Arrhythmias

cannot be prevented, but a healthy lifestylereduces the risk of heart disease, which helpsprevent more dangerousarrhythmias later in life.

Still, arrhythmias can beassociated with lightheaded-ness or fainting, headaches,shortness of breath or painin your chest, back, neck,shoulders or arms. Forpatients suffering from thesemore significant symptoms,there are many forms oftreatment available, includ-

ing medication, implantable cardiac devices suchas pacemakers and defibrillators, and surgery.

Cardiologists at Johns HopkinsBayview Medical Center have avariety of state-of-the-art heartmonitoring tests to diagnose anddetermine the best course of treat-ment for heart arrhythmias, such aselectrocardiograms (ECG), Holtormonitors, stress tests and electro-physiology testing and mapping.

—Martin Fisher

What To Do WhenYour Heart SkipsaBeat

Do You Have anIrregular Heartbeat?Learn about the symptoms, risks and new

treatment options for atrial fibrillation.

March 186 – 7:30 p.m.

Johns Hopkins Bayview Medical CenterTo register, call 410-550-KNOW (5669).

If you have experienced significant cardiac arrhythmias, contact your primary care physician orcall 410-550-4642 to schedule an appointment with a cardiologist at Johns Hopkins Bayview.

��

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


Dedicated physician scientistsdevote enormous amounts oftime and energy to medicalresearch on the Johns HopkinsBayview campus. In fact, evenas federal research funding is

shrinking and less than ten percent of grantsare funded, three scientists conducting extra-ordinary research on campus were awardedfive-year research grants by the NationalInstitutes of Health.

Finding New Treatment forAllergic ReactionsOne of the projects awarded an NIH grant, ledby Bruce Bochner, M.D., is the continuation ofa decade-long project to understand a specifictype of white blood cell, known as eosinophils.These cells, although important safeguardsagainst parasites in places like Latin Americaand Africa, have little to guard against in theUnited States. They are often involved in allergicreactions where allergens are mistaken for para-sites, injuring surrounding tissues and exacerbat-ing existing problems like asthma. Dr. Bochner’steam is hopeful that targeting a specific proteinwill enable them to kill overactive eosinophilswithout the side effects caused by current treat-ments. Dr. Bochner’s 12-year-old nephew, whohas an eosinophil-related gastrointestinal disorder,provides additional motivation to find a therapy.

Stablizing Sjögren’s SyndromeAnother project, headed by Antony Rosen, M.D.,aims to understand the tissue damage caused bySjögren’s syndrome, an autoimmune disorder thatdestroys patients’ salivary glands. Noting the“striking stability of the disease over long periodsof time,” Dr. Rosen believes that the disease may“represent a new stable state,” as the immune sys-tem and tissue repair system counteract the dis-ease’s effects. He and his team will examine theseinteractions, hoping to find new, more effectivetreatments for Sjögren’s.

Improving Life for Older AdultsThe third grant-funded project, headed by JeremyWalston, M.D., is attempting to determinewhether mitochondria, which are essentially acell’s power plants, could be one cause of frailty, acondition often seen in older adults. Dr. Walston’steam believes that mitochondria are impeded bylow levels of inflammation as people age. As aresult, despite needing even more energy to coun-teract the inflammation, cells produce less energy.Much more research will need to be done, butDr. Walston is hopeful that their research willultimately yield treatments to “help improvemuscle strength and thinking ability, and lowerthe risk for development of chronic diseases.”

The dedication and intellect of physicianscientists at Hopkins Bayview is what allowsfor such a thriving research community. DavidHellmann, M.D., vice dean of the Johns HopkinsBayview campus, is understandably proud of ourphysician scientists, whom he says are “recognizedamong the best in the world.”

—Martin Fisher

Johns Hopkins BayviewResearch

For more information about research at Johns Hopkins Bayview Medical Center,visit hopkinsmedicine.org/jhbmc/research.

Research in ActionAs a hub for medical scientists fromJohns Hopkins Medicine and the NationalInstitutes of Health, the Johns HopkinsBayview campus has a long history ofresearch leadership. Here are a few of theways this research has ultimately helped saveand improve hundreds of thousands of lives:

• Treatment of burns traditionally has relied ontissue grafts. However, for patients who rejectdonor tissue, Johns Hopkins Burn Centerdirector Stephen Milner, M.D., and his teamhave developed a new technique known as a“cultured epithelial allograft.” The techniqueallows doctors to grow tissue in a lab beforegrafting it to the patient’s skin, avoiding therisk of rejection and reducing the need fortissue donors.

• Heart disease is the leading cause of death in theUnited States, and during cardiac arrest, everysecond counts. Nisha Chandra-Strobos, M.D., director of the Division of Cardiology, and otherresearchers are developing methods to evaluatecardiac patients much more quickly, which willprovide faster, more effective treatments andmore accurately predict survival.

• After childbirth, many mothers suffer pelvicfloor problems. In order to better understandthese issues, professor of gynecology andobstetrics Victoria Handa, M.D., and her teamlaunched the Mothers’ Outcomes After Deliverystudy in 2008. The initiative has produced awealth of usable data, including the effect ofchildbirth on pelvic muscle strength.

• Dehydration from cholera and otherdiarrhea-causing organisms can be life-threat-ening. Research to combat dehydration hascontinued at Johns Hopkins Bayview for morethan 40 years, and was pivotal in developingoral rehydration therapy. Professor of medi-cine William Greenough, M.D., notes that oralrehydration therapy is credited with reducingglobal death rates in children from more than8 million per year to less than 2 million peryear today, and that world-renowned medicaljournal The Lancet considers oral rehydrationtherapy the most important medical advanceof the 20th century.

Saving Tomorrow’s LivesResearch thrives on the Johns Hopkins Bayview campus

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Lung cancer killsmore Americansthan breast cancer,prostate cancerand colon cancer

combined—it will claim anestimated 200,000 lives thisyear. “Lung cancer is deadlyfor two reasons. It’s resistantto most therapies, and it’stypically diagnosed at a latestage,” says Phillip Dennis,M.D., director of thoraciconcology at Johns HopkinsBayview’s Sidney KimmelComprehensive CancerCenter. “Screening peopleat high risk will increase thenumbers who are diagnosed at a curablestage of the disease.”

The Johns Hopkins Lung Cancer Screening and Pulmonary Nodule Clinics provide screeningsand a multidisciplinary approach to treatment.Screenings include a meeting with a nurse

practitioner to determine thelevel of risk, and low-doseCT scans once a year forthree years, which a 2011clinical study shows canreduce the number of lungcancer deaths by 20 percent.

Patients are consideredhigh risk for lungcancer if they:

• Are over the age of 50.

• Have a significant smokinghabit (consisting of one packper day for at least 20 years,or two packs per day for atleast 10 years), or have quitwithin the last 15 years.

• Have one additional risk factor (i.e. radon oroccupational exposure, history of smoking-related cancer, family history of lung cancer,or history of COPD or pulmonary fibrosis).

It is important to understand that everyone’s riskis individualized and can increase if you have afamily member with lung or tobacco-related cancer.

—Heidi Fosnaughtt

To find out about your individualized risk or schedule an appointment,call 410-955-LUNG (5864).

Phillip Dennis, M.D.Director of

thoracic oncology

A Lung Cancer ScreeningCould SaveYour Life

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