MORE THAN

SKIN DEEPFormer dermatology resident

develops real-life training tool

for surgeons

LIFESTYLESD The Villages Daily Sun

To report feature news:

Holly Lawler, 753-1119, ext. 9299

or lifestyles@ thevillagesmedia.com

TUESDAY, SEPTEMBER 28, 2010

Hormone replacementshould be

used carefully

For American womenreachingmenopause, the

discussion of hormonereplacement therapy likely is overwhelming.

Mixed messages on thebenefits and risks of thesetreatments have left mostwomen fearful and confused.

As recently as five yearsago, hormone replacementtherapy for post-menopausalwomen was thought by manyto be the fountain of youth,not only alleviating some ofthe features of aging but alsoreducing the risks of heartdisease, stroke, Alzheimer’sand osteoporosis.

But following a seminalpaper published in the NewEngland Journal of Medicine,new evidence indicated thathormone replacement thera-py actually increased the riskof the same diseases that itonce had been touted to prevent.

And over time, more andmore research has confirmedthese findings.

Published in the journalCancer Epidemiology,research showed that hor-mone replacement therapysignificantly increased therisk of breast cancer, particu-larly in women who were notoverweight.

In this study, the longerthe hormones were taken, thehigher the risk.

For women who had ahysterectomy and took estro-gen therapy alone for 15years, the increased risk ofbreast cancer was 19 percent.

Women taking estrogenand progesterone for 15 yearssaw an increased risk of 85 percent.

Studies clearly show thathormone replacement thera-py — and particularly estro-gen therapy — reduces therisk of osteoporosis, but newresearch now indicates that itdoes not help protectstrength and muscle mass.

Based on all this evidence,experts in the field now rec-ommend hormone replace-ment therapy only to allevi-ate the symptoms of themenopause, using the lowestdose available and for as littletime as possible.

For women who have hada hysterectomy, estrogenalone can be used; otherwise,progesterone must be added,as estrogen alone dramatical-ly increased the risk of uter-ine cancer.

Despite the mounting evi-dence and warnings ofadverse effects, many physi-cians still are not convincedthat the increased risk of various health problems issignificant.

Some believe that theactual risk to an individualpatient is small, even if therisk to the population as awhole is quite significant.

There is also a large groupof physicians who maintainthat hormone replacementtherapy does have significantanti-aging effects.

They say that adverseeffects of the therapy arerelated to the fact that thehormones given are not iden-tical to those naturally occur-ring in pre-menopausalwomen and that the doseadministered is inappropriate.

31. Theater Company Open House,

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3. Market Night, 5-9 p.m., Market Square

INSIDETODAY:

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onthe

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SPOTLIGHTFavorite movie: ‘Grand Canyon’Favorite pool: Mulberry GroveFavorite rec center: Mulberry GroveFavorite candy: ChocolateFavorite food: Peanut butter and jellyFavorite car: 1947 Nash Brougham

■ Johnny Lobo, 5-9 p.m.

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The entire EncyclopediaBritannica is banned in

Texas because itcontains a formula formaking beer at home.

DAVID

LIPSCHITZ

LIFELONG

HEALTH

See LIPSCHITZ, D12

HEALTH

By APRIL TOLER

DAILY SUN

THE VILLAGES —

Sitting in a back room of Dr. Thi Tran’soffice, the IL Duomo, with its human-likeskin and piercing eyes, looks like some-

thing out of a scary movie.But the three-dimensional head, neck and

shoulders, which is dotted with pseudo cancertumors, isn’t a movie prop but rather a tool togive surgeons in training one of the most realisticscenarios possible.

“This is probably as good as it gets in terms ofa teaching model for young surgeons,” Tran said.“On the face, there’s a lot of nerves and bloodvessels that are critical to understanding wherethey are located. Other than to look at a book,you can’t really appreciate the three-dimensionalaspect from the surgical perspective.”

Having worked for years as a board-certifiedMohs surgeon, Tran, of Village Dermatology andCosmetic, definitely does not need the practice.

The head was a gift from its inventor, Dr. Keoni Nguyen, a long-time friend who spenttime with Tran as a resident surgeon here in The Villages.

After attending a seminar earlier this yearwhere Nguyen and fellow surgeons, includingTran, demonstrated the IL Duomo, Nguyen senthis friend and former mentor his own model.

Made to feel like real human skin — Nguyencan’t reveal exactly how it is made because of apending patent — the IL Duomo feels and looksalmost frighteningly real.

“He tried to look at the way the skin behavesand look at it from a scientific point, and simulatea material that would simulate that skin,” Transaid. “With that, he compounded all the knowl-edge that he gained when he was here as a surgi-cal fellow, he put that together and came up withthis surgical model.”

While the outside of the model is strikinglyrealistic, the inside is even more so.

The model features simulated subcutaneous fat,nerves, blood vessels, muscles, fascia, cartilage andbony structure beneath the first layer.

Nguyen said the inspiration for the look of ILDuomo came from a marble sculpture of aRoman senator he observed while visiting theMetropolitan Museum of Art in New York City.

He also was inspired, he said, by the time hespent working underTran in The Villages.

“It’s the combinationof (a need) and Dr.Tran’s passion for sur-gery,” Nguyen said.“His passion for surgery

See SKIN, D12

Photos by Peter Travers / Daily Sun

Dr. Thi Tran, of Village Dermatology andCosmetic, demonstrates on an IL Duomomodel which was created by fellow residentsurgeon Dr. Keoni Nguyen. The model wasdeveloped as a practice tool to help surgeonsin training.

The IL Duomo, developed by Dr. KeoniNguyen, is a three-dimensional head,neck and shoulders which features more than 30 cancer tumors surgeons in training can practice removing.

Graphic by Anthony Casto / Daily Sun

From Pages D1, D4, D8, D10D12DAILY SUN

Tuesday, September 28, 2010

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These physicians measurehormone levels in the bloodand saliva and compound“natural or bioidentical hor-mones” to achieve physio-logical levels in the blood.

Constant monitoring isrequired. While thisapproach is very popular,there is currently no rigor-ous research to documenteither benefit or risk in thisform of therapy.

Today, the vast majorityof women continue to takehormone replacement thera-py because their menopausesymptoms remain so severethat they simply cannotmanage without it.

These symptoms includesevere hot flashes, insomnia,emotional changes such asanxiety and depression,headaches, loss of libido andvaginal dryness leading topain with intercourse.

Another common prob-lem is an overactive bladderthat is characterized by uri-nary frequency and a needto rush to the bathroom.

The North AmericanMenopause Society and theEndocrine Society agree thatuse of hormone replacementtherapy should be limited totreatment of menopausalsymptoms, that the lowestdose should be used andthat the therapy should bediscontinued as soon aspossible.

Alternate treatments such

as vaginal estrogen creamsshould be considered forwomen who have vaginaldryness or pain.

Loss of libido can betreated with the use of avery low-dose testosteronecream.

Finally, experts in thefield have shown that trans-dermal estrogen used in apatch carries a much lowerrisk of heart attacks andstrokes than oral estrogen.

In addition, the patchdoes not increase the risk ofblood clots or reduce libido.

Currently, the evidence isaccumulating that shouldyou need to combat thesymptoms of menopausewith estrogen replacement,the patch is preferable.

Clearly, hormone replace-ment therapy is not withoutits problems.

However, like allapproved medications, thereare circumstances where thebenefits outweigh the risks.

Unless you have or havehad a high risk of breast can-cer, do not let fear ofreplacement therapy causeyou to suffer with severemenopausal symptoms.

When seeking hormonereplacement therapy, talk toyour doctor to ensure youget the right dose, in theright way, for the rightamount of time.

Dr. David Lipschitz is theauthor of the books “Breakingthe Rules of Aging” and “Dr.David’s First Health Book ofMore Not Less.”

LIPSCHITZ, from D1

transferred over to me, andI just took it to anotherlevel.”

The idea, he said, simplycame from the need for amore realistic training toolfor dermatology residents,other than the pig’s feetcurrently being used.

“The problem is in der-matology training, we don’treally have anything towork with because 84 per-cent of residency programsare still using pig’s feet tolearn how to suture,”Nguyen said.

Tran agreed and said hebelieves the model could bebeneficial not only to sur-geons in training, but alsoto current surgeons whomay want to tweak theirtechniques.

“In dermatology, other

than practice on realpatients in a surgical setting,you don’t have hands-onexperimentation of the tis-sue and how it reacts,” Transaid. “So even something assimple as sutures, there’sreally no material or teaching model that isappropriate.”

Nguyen currently isworking on having ILDuomo mass produced, andis hoping his model eventu-ally changes the way futuredermatologists train for surgery.

“My goal is to have theprogram accepted as a sur-gical tool for training,”Nguyen said. “I want IL Duomo to be like a textbook.”

April Toler is a reporterwith the Daily Sun. She canbe reached at 753-1119, ext. 9013, or april.toler@thevillagesmedia.com.

SKIN, from D1

Burns and Novick hadhoped to interview moreplayers, but were advisedthey wouldn’t get much outof them.

“They have a certain wayof talking, it’s almost as if it’sa flatline kind of thing,”Novick said. “They say justwhat they’re going to say.They already know whatyou’re going to ask and theyhave their preprogrammedanswer. It’s careful and veryguarded.”

“The Tenth Inning” looksat the rise of Latino players,including a visit to theDominican Republic to seeyoung players trained inbaseball academies with thehope their talents would liftthem out of poverty.

Then there is the coin’sother side: a visit to a base-ball game played in a NewYork City sandlot by LatinAmerican immigrants, allgood players with minorflaws that prevented themfrom achieving big leaguedreams.

For Burns, whose earliestchildhood memory is that hehad a baseball mitt, “TheTenth Inning” was personal.

He recently promoted themovie by throwing out firstpitches at various MajorLeague ballparks, and herecounts with childlike gleethe strike he threw in Colorado.

His personal tour of hor-rors was the footage of pastRed Sox season-endingnightmares before their 2004breakthrough.

“I had to edit the ’46Series (for ‘Baseball’) wherethe Cardinals put the (Ted)

Williams shift on,” he said.“The ’67 Series where ‘TheImpossible Dream’ came upone game short. The CarltonFisk Series where they cameup one game short. The one-game playoff with the Yan-kees when Bucky Dent hitthe home run. The ball goingthrough Buckner’s legs andthen, in order to get to this,we had to go through Aaronbleeping Boone in 2003.”

Ask a Red Sox fan for the

translation.The passion helped create

one of the film’s most sub-lime touches.

The second the ball John-ny Damon hit for a grandslam drops into the YankeeStadium bleachers in Game 7of the American LeagueChampionship Series, essen-tially clinching the Sox win,the soundtrack strikes up theStandells’ “Dirty Water,” aBoston rock anthem.

With everything that hashappened in baseball overthe past 15 years, Burns andNovick feel their series isincomplete.

The story keeps going on.When umpire Jim Joyce’s

bad call cost ArmandoGalarraga of the DetroitTigers a perfect game inJune, Burns immediatelythought: “That’s the pro-logue of ‘The EleventhInning.’”

SEQUEL, from D10

only to those, skippingsweets you eat just becausethey are available.

Some people find thatusing sweets only for dessert,rather than snacks, makes iteasier to limit them anddecreases cravings.

One study found that aftertwo weeks of eating choco-late twice a day — 15 minutesto 30 minutes after a meal —chocolate cravers reducedtheir desire for chocolate.

But both cravers and non-cravers who ate chocolatedaily between meals endedup with increased desire forchocolate.

The researchers suggestedthat regularly using choco-late to satisfy hunger teaches

us to crave it. If true, thatcould apply to other sweets,too.

Normalizing sweets alsogradually can reduce crav-ings that are rebound effectsof overly restrictive dieting.

If your cravings are emo-tion-related, each time youuse sweets to cope withemotions the pattern maybecome stronger.

Try not to focus on whatyou don’t want to do (eatsweets) and focus instead onnon-food strategies you haveidentified to respond to emo-tions and stress.

— American Institute for Cancer Research

Recipe

I am always on the huntfor a better chili recipe — likespaghetti sauce, there isalways a way to improve

on it.From Cooking Light’s

September 2010 issue, thisrecipe for Turkey and BeanChili includes a bit ofcilantro to add flavor.

Turkey and Bean Chili

■ 1 cup prechopped red onion■ 1/3 cup chopped seededpoblano pepper (about 1)■ 1 teaspoon bottled minced garlic■ 1 1/4 pounds ground turkey■ 1 tablespoon chili powder■ 2 tablespoons tomato paste■ 2 teaspoons dried oregano■ 1 teaspoon ground cumin■ 1/4 teaspoon salt■ 1/4 teaspoon black pepper■ 1 (19-ounce) can cannellinibeans, rinsed and drained■ 1 (14.5-ounce) can diced toma-toes, undrained■ 1 (14-ounce) can lower-sodiumchicken broth

■ 1/2 cup chopped fresh cilantro■ 6 lime wedges

Heat a large saucepan overmedium heat. Add first four ingre-dients; cook for six minutes oruntil turkey is done, stirring fre-quently to crumble.

Stir in chili powder and nexteight ingredients (through broth);bring to a boil. Reduce heat andsimmer for 10 minutes.

Stir in cilantro. Serve with limewedges. Yield: six servings (servingsize: 1 cup chili and 1 limewedge).

Per serving: 211 calories, 22.5 gprotein, 16.4 g carbohydrate, 6.5 gfat, 54 mg cholesterol, 4.7 g fiber,474 mg sodium.

Charlyn Fargo is a regis-tered dietitian from Springfield,Ill. For comments or questions,contact her at charfarg@aol.com.

FARGO, from D8

education program. “In aresting state, blood is prima-rily distributed to theorgans: the heart, the brain.It’s secluded from the mus-cles unless you’re usingthem.”

Warming up with dynam-ic stretches starts the bloodmoving from organs to mus-cles, says physical therapistSpivey, whose practice is SportsCare and Rehabilitation.

“You’re getting the bloodflowing, which improves thepliability of the tendon andmuscle,” says Spivey, whodoes dynamic stretching for10 minutes before a workoutand static for 10 after.“You’re getting your heartrate elevated enough soblood is getting to the tis-sue, whether you’re skip-ping, doing a lateral shuffleor high knees.”

Many amateurs, whetherrunning, biking or swim-ming, just take off and startgoing, he continues.

“They think, ‘I’m healthynow!’ But if you just take off,you can create overuseissues such as tendonitis orbursitis. It takes longer tostrengthen muscles andjoints than it does tostrengthen your cardiovas-cular system.”

Incerta likens the

warming-up process tostarting a car in the middleof winter.

“It won’t run as efficientlyif it’s been sitting in 30-degree weather,” he says.“The gears aren’t going toshift right. But if you turn iton and warm it up for 10 to15 minutes, it will be fine.Fluids are going through thepipes. No problems. It’s sim-ilar to the central nervoussystem of the body. If you’renot primed, you’re not readyto actually do physicalwork. Warming up gets allthat fluid going.”

On the other side of theworkout is when Trow-bridge advocates thestretching we tend to thinkof when we hear the word.

You’re telling your bodythe workout’s over, she says.You’re allowing it to rest, tostart repairing itself from thisworkout and to start prepar-ing itself for the next one.

“You’ve been dramatical-ly active,” she says. “It’simportant to bring the bodyback down. You don’t put akid who just had cottoncandy to bed right away.You read a story. So afteryou exercise, you have toquiet down, to cool down.Your muscles are moderate-ly fatigued and moreresponsive to being elongat-ed or stretched becausethey’re so warm. It’s likeputting cold taffy in themicrowave.”

STRETCH, from D8

happened to be shopping inthe local Publix this pastweek and I was having a hardtime finding an item on theirwell-stocked shelves.

I was walking from oneend of an aisle to the other,peering intently at each item,while stooping over and/orsquatting down, which is noeasy feat for my creakybones.

Publix’s “eyes in the sky”that look down on every inchof the store must have putout the alert, “Male shopperin distress on aisle 5!” becausetwo female employeesappeared, one from each endof the aisle, asking, “Are youin need of assistance, sir?”

Normally I would havesaid no — after all, Columbusdidn’t ask for directions, sowhy should I?

But I was wanting to gethome early enough to watchan important ball game, so Isurrendered and told themwhat I was looking for.

They, in almost perfectunison, said, “That’s on aisle7 sir, second shelf from thetop, on the left side. Is thereanything else we can helpyou with today?”

I thanked them and said Iwas OK and made my way toaisle 7 to get what I came for.Sure enough, there it was,second shelf from the top, onthe left side.

So, don’t worry ladies, justbecause we say we could getby without you, all us guysout here know that is nottrue. Thanks for being sogentle in your discipline of us.

Have a great week.

Tom Holbrook is a Villagesresident and freelance columnist.He may be reached by e-mail attomholbrook@comcast.net.

HOLBROOK, from D4

CindyTrowbridgedemonstrates astatic stretch,which should be done after a workout.

MCT

The Associated Press

Filmmaker Ken Burns holds up a baseball before delivering a ceremonial first pitch prior tothe Boston Red Sox facing the Baltimore Orioles in their baseball game Sept. 21 at FenwayPark in Boston. Burns’ latest baseball documentary, ‘The Tenth Inning,’ will be showntonight and Wednesday on PBS.