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GAM BIT’S HEALTH & WELLNESS > JULY 2012 > VOLUME 4 > NUM BER 7
G A M B I T ’ S H E A LT H + W E L L N E S S
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How Telemedicine Extends Doctors’ Reach
YOU’VE GOT
SOME GALL
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BONING UP
ON OSTEOPOROSIS
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A SUMMERY
SALMON RECIPE
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HealtH & Wellness > bestofneworleans.com > july 10 > 2012
REMOTE CONTROL
DoCtors anD healthCare systeMs statewiDe use teleConferenCing teChnologies to extenD their reaCh. By Carrie Marks
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find it an effective way to manage their patients through the primary care site. Cothren and Ali agree that telemedicine programs are beneficial on multiple levels. For one, they improve the quality of care for patients outside of urban areas by allowing them access to specialists and by reducing the costs associated with travel and the time spent away from work and family. “If you don’t live near a major hospital, you shouldn’t have fewer options,”
a shorter recovery time. It’s also being utilized by companies with oil rigs in the Gulf of Mexico so their employees have better access to potentially lifesaving resources, since offshore rigs are, at best, a helicopter flight and hours away from medical help. Cothren says there’s a space-age element to the process, but he has found that a remote diagnostic session can more closely mimic a face-to-face interaction than one might think. The live
Cothren says. Telemedicine also “allows clinic systems to focus on triaging their patients,” Ali says. “The referring site stays very actively engaged in the care of their patients, only now with the help of these outside consultants,” he says. For example, the use of telemedicine in monitoring high-risk pregnancy can mean a mother and child remain closer together during their neonatal stay. In time-sensitive situations, such as after a stroke, telemedicine can lead to immediate treatment, less long-term damage and
Telemedicine allows physicians and paTienTs To engage in diagnosTic conversaTions, even when They're miles aparT.
audio and video feed allows for an actual conversation between the specialist and the patient, during which the latter can describe symptoms in detail, ask questions and voice concerns. There is always a licensed health care professional with the patient, and Cothren uses the analogy of an air traffic controller to describe the process: “The present physician is
still technically ‘flying the plane,’” she says. “The specialist is just helping them stay between the lines.” Patients’ responses have been overwhelmingly positive. “They’re enthusiastic about the cutting-edge stuff if it works,” Cothren says. After witnessing a remote physician prove instrumental in an end-of-life decision for a patient, Cothren says she’s convinced the patient-practitioner relationship transcends the technology. Ali recommends patients uncomfortable with remote interaction consider this perspective: “It gives the option of improving timely access to health care in a system with challenges of capacity,” she says. To boot, telemed frees up practitioners’ time, so they can serve a wider patient base. As local telemedicine programs and the technologies behind them evolve, both Cothren and Ali envision health care becoming increasingly and immediately available to patients everywhere. In the not-so-distant future, patients may have scales and blood pressure cuffs in their homes and physicians may be able to access their results from a different location. Merging telemedicine with remote robotic surgery also is a possibility, Ali says. Cothren believes that as corporations become aware of the benefits of telemedicine, they will incorporate equipment into their locations, giving employees onsite access to better health care. Cothren hopes provisions in the Patient Protection and Affordable Care Act will pave for patients to have easier access to telemedicine. “We’ve always been concerned first and foremost with patients’ needs,” she says. “What we’re working toward is how we get it, so that with the push of a button, within seconds of getting on an Internet browser, you’re able to interact with a provider.”
HealtH & Wellness > bestofneworleans.com > july 10 > 2012
hen breaking news travels via text message in real time, when Facebook status updates are instrumental in solving crimes and when knowing celebrities’ whereabouts requires only that you follow them on Twitter, it’s clear the information age has altered the fabric of everyday life. Whether it’s improved it is debatable. Fortunately, medical practitioners across Louisiana now utilize these technologies to develop advanced telemedicine programs to provide specialized care remotely, benefiting both patients and physicians. Telemedicine outfits satellite practitioners with remote cameras that link back to a larger hospital. This way, physicians and patients can engage in a diagnostic conversation, even when they’re miles apart. Liz Cothren, director of telemedicine for Ochsner Health Systems, charts the beginning of telemedicine programs to within the past 15 years. “When we started this, we recognized that disease-specific physicians were becoming harder to find, and it was harder to make correct diagnoses,” she says. “We knew that we had to find a way to leverage the physicians that we had to help people at other hospitals.” Juzar Ali, medical director at LSU Health Sciences Center, likens it to a Skype session. “There’s an audio and video feed, and an exchange of images if needed,” he says. “Specific examinations, like using an electronic stethoscope, can also be done.” The medical fields utilizing the technology are vast and continue to grow: They include orthopedics, psychiatry, neurology, radiology, cardiology, endocrinology and Ochsner’s “Telestroke” network of more than 15 Louisiana hospitals, to name a few. Some practitioners use telemedicine as a screening process to determine if a face-to-face appointment is necessary, while others
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navel base
A new gAllblAdder surgery, performed through A single incision in the nAvel, hAstens recovery And eliminAtes visible scArring. by KAtie Kidder crosbie hen a gallbladder hurts from gallstones or other causes, the best option almost always is surgery. Gallbladder removal is one of the most common surgeries performed in the United States. Now, a new technique allows surgeons to remove a gallbladder through a single incision in the navel, making patients’ recovery times faster and leaving no visible scar. The gallbladder’s main purpose is to produce bile, which aids in digestion. When someone has gallstones or their gallbladder functions poorly, the digestive process is inhibited, which is why patients often associate food with pain from a gallbladder attack. Abdominal cramps, nausea and vomiting are the symptoms most people in need of gallbladder surgery experience. In severe cases, such as when a gallstone becomes lodged in a bile duct, people also may suffer from chills, fever and jaundice. Gallstones, hard masses made of cholesterol and bile salts, are usually the source of gallbladder concerns. Unfortunately, there are no definitive predictors for who will develop gallstones, nor is there a way to prevent them from forming. Dr. Chris Casten, a 50-year-old veterinarian from Mandeville, can attest to how painful a gallbladder attack can be. He’d been living with gallstones for some time before one became lodged in a bile duct. “I turned jaundiced (and had) very intense pain,” Casten says. He met with Dr. Joseph F. Uddo Jr., a surgeon at East Jefferson General Hospital and one of only 60 surgeons in the country trained to perform single-port gallbladder removal with the da Vinci Robotic Surgical System. This type of surgery is called robotic laparoscopic single-incision
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cholecystectomy. In laymen’s terms, that means a surgeon can remove a patient’s gallbladder making only one incision instead of four. “Traditional laparoscopic surgery for gallbladder removal involves four incisions — a 10mm incision at the belly button and three 5mm incisions across the top of the abdomen,” Uddo says. “The scars they leave are small, but you can see them. For single-port surgery, the upper incisions are gone. Cosmetically, it looks great because the incision essentially disappears, and when it heals there is almost nothing visible.” The da Vinci® is equipped with a 3-D camera that provides high-definition views of the surgery location. “You can zoom in on anatomy and get startlingly close views,” Uddo says. “That means we can be more precise during surgery, and I think, ultimately, it will provide more safety.” Because of the increased precision and the single incision, the instrumentation is less susceptible to movement, resulting in the absence of pain from the upper abdominal area and an easier recovery. Many patients return to work within a week. Casten had even better results. “The next day I actually was back to work,” he says. “I did a half a day. Had some minimal abdominal discomfort for a few days, but … it just felt like someone doing too many sit-ups.” Although gallbladder’s role is more substantial than, say, the appendix’s, the body adapts to the organ’s absence fairly easily. “The gallbladder stores bile and bile is made in the liver,” Uddo says. “In a healthy, functioning gallbladder, it pours bile into the intestines. When you no longer have a gallbladder, the main bile duct and the bile in the liver take over. People feel much better after surgery.”
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W ll spring h e a lt h n e Ws b r i e f s
B y M at t h e w h o s e
fertile ground
Vivere Health, a Tennessee-based network of fertility clinics, has partnered with Audubon Fertility and Reproductive Medicine to open a new fertility center in New Orleans. It will feature an in vitro fertilization laboratory, an andrology lab and a surgical center. The new clinic will be located at 2701 Napoleon Ave. and will open in early 2013.
nip it
Vinnie Myers, a tattoo artist renowned for his work tattooing realistic nipples on survivors of breast cancer, brings his talents to New Orleans. Once a month, Myers will provide his services for women at the Center for Restorative Breast Surgery (CRBS) on St. Charles Avenue. His tattoos, which create the illusion of a raised nipple without any surgery, offer an alternative to nipple/areola reconstruction. Dr. Scott Sullivan, cofounder of CRBS, says Myers’ work is an important step in making survivors of breast cancer feel whole again. For more information, visit www.breastcenter.com or call 899-2800.
neW program improving health technology
Public and private health care organizations across Louisiana have collaborated in the Crescent City Beacon Community (CCBC), one of 17 health programs nationwide seeking to speed development of the use of electronic services within the medical community. It is funded by the Beacon Community Program. In January, the CCBC designed “txt4health,” which offers personalized messages to assess members’ risk levels for Type 2 diabetes and helps them manage their overall health. New Orleans is the first city to implement a health program of this kind. For details, visit www.crescentcitybeacon.org.
neW Wellness and aquatic center at dryades ymca
The Dryades YMCA opens a two-story Wellness and Aquatic Center this month. The center will be open to all ages and features a 75-foot pool, cardio and strengthtraining equipment and several fitness classes. For more information and membership details, visit www.dryadesymca.com.
louisiana health centers receive nearly $2 million
Three Louisiana health centers will receive funding totaling $1.9 million to increase access to affordable health care, according to U.S. Sen. Mary Landrieu. The Hospital Service District No. 1-A in Delhi, the SWLA Center for Health Services in Lake Charles and the Marillac Community Health Centers in New Orleans will each receive around $600,000. Landrieu said these health centers will help reduce the need for unnecessary and expensive visits to the emergency room.
BONE J
THE LOUISIANA OSTEOPOROSIS STUDY AIMS TO SHED LIGHT ON A COMPLEX DISEASE.
VOYAGE
sis, a history of fractures, premature menopause, or a history of steroid use or anorexia, both of which damage bones. “If a women has estrogen around and is not fracturing, we don’t know if treatment (with medication) would be worthwhile,” Burshell says. “(Osteoporosis) is complex, and that complexity allows us to develop treatments for individual patients based on what is happening to them. This study is very important, because we have a lot of holes in our knowledge. They’re looking at some of these complex issues.” The study aims to recruit 20,000 male and female adults from all
ethnic groups. “We’ll measure the BMD of each subject, collect blood samples for DNA extraction, and … use their DNA for whole-genome genotyping,” Liu says. “We’re trying to find a sequence variance that may contribute to this disease. Once we find it, we may work with others, like pharmaceutical companies, to develop diagnostics which can be used to see who’s at a high risk for osteoporosis. I’ll probably design some medications to treat this disease.” Unlike muscular dystrophy or cystic fibrosis, diseases caused by a mutation in one gene, there are at least 100 genes that contribute to osteoporosis, Liu says. “There are so many small fish,” he says. “We have to recruit a lot of human samples to find those small fish.” Participants benefit by receiving a dual energy X-ray absorptiometry (DXA) bone scan and a report that includes information about bone density and body composition, as well as a $25 gift card. “The immediate benefit is you’ll know whether your BMD is good or not,” Liu says. Even if the news is not good, as in Jessica’s case, it allows participants to make more informed choices about their health. “Now that I have this information at my age, I want to be proactive about it,” says Jessica, who plans to take nutritional supplements and do weight-bearing exercises to improve her bone health. “More information is never going to hurt you. Everybody should have as much information about their own health as they possibly can. And when it’s on a research basis and you get it for free, that’s a win-win.” For more information about the Louisiana Osteoporosis Study, visit www.sph.tulane.edu/publichealth/ bio/clinical-recruitment.cfm, email bonestudyneworleans@tulane.edu or call 988-1056.
T H E R E A L 411
Five Tips for Healthy Bones Molly Kimball, a dietitian at Ochsner’s Elmwood Fitness Center, offers ways to keep bones strong. — Nicole Koster
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Get 1,200 milligrams of calcium a day. That equals about four cups of milk. It’s more difficult for the body to absorb the calcium in leafy greens, so try Greek yogurt and cottage cheese, which have 200-300 milligrams of calcium per serving.
2
To get vitamin D, which helps your body absorb calcium, spend 10 to 15 minutes in the sun without sunscreen between 10 a.m. and 2 p.m. Vitamin D creation is maximized when the sun is directly on you.
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People with darker skin or who are overweight have a harder time making vitamin D. Kimball recommends they take a 1,000 IU supplement of vitamin D.
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Know your osteoporosis risk factors. If you are thin, female, a smoker, post-menopausal or have a family history of osteoporosis, have a bone density test. Caucasians, Asians and Hispanics are at the highest risk for osteoporosis.
5
Long-term use of some medications (including some oral steroids, birth control and antidepressants) can thin bone tissue. Talk with your doctor about which medications have low risk factors.
HealtH & Wellness > bestofneworleans.com > july 10 > 2012
essica, a 29-year-old nurse, was interested in participating in the Louisiana Osteoporosis Study the moment she saw its flyer in a Metairie coffee shop. “I was pretty sure osteoporosis (low bone mass) ran in my family,” she says. “Being a nurse, having more information about my health is something I’m interested in.” Jessica (who asked that her last name not be used) signed up to participate in the research study, which is sponsored by Tulane University and will identify genetic and environmental factors of osteoporosis. She underwent a blood draw and a bone scan in a process that took about half an hour. As a slender Caucasian woman with a family history of osteoporosis, Jessica knew she had several risk factors, but her results still surprised her. “When (the women conducting the study) saw my results, they were both like, ‘Oh, this is surprising. This is bad,’” Jessica says. It turned out she has osteoporosis. “I was like, ‘What should I do? How bad is this?’” Jessica says. “And they said, ‘Well, you should see a doctor.’” Dr. Alan Burshell, an endocrinologist and section head at Ochsner Medical Center, says osteoporosis is a complex disease, especially when it is diagnosed in young people. “All the data and info (involved in a diagnosis of osteoporosis) is based on women who are post-menopausal,” he says. “The meaning of bone mineral density (BMD) in a person who is pre-menopausal is less well-defined.” BMD increases throughout childhood and peaks at age 20, says Dr. Yongjun Liu, a genetic epidemiologist who is facilitating the study. “BMD stays stable until age 50, then decreases gradually in men and sharply in women,” he says. “Without the protection of estrogen, (post-menopausal) women have a dramatically decreased BMD.” For this reason, Burshell recommends his patients wait until menopause to evaluate their BMD, except in cases where there’s a strong family history of severe osteoporo-
BY MISSY WILKINSON
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THE WORLD ALWAYS
LOOKS BETTER FROM BEHIND A
HealtH & Wellness > bestofneworleans.com > july 10 > 2012
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e at to li ve
Summer Salmon with Strawberry SalSa packS nutrientS and flavor into a light meal.
S
what &
how
whole foodS’ baked Salmon with Spinach and Strawberry SalSa Serves 4 4 (3-ounce) Salmon filletS, Skin removed 1 teaSpoon lemon zeSt 1 pound StrawberrieS, diced 2 kiwifruitS, peeled and diced 1 cucumber, diced 1 jalapeno, Seeded and minced 2 tableSpoonS chopped freSh mint leaveS 2 tableSpoonS freSh lemon juice 1 pound baby Spinach leaveS, rinSed but not dried
ganese. This powerful antioxidant fruit promotes healthy blood sugar levels and exhibits anti-inflammatory phytonutrients. With a high fiber content, the kiwi contains large amounts of vitamin C, as much potassium as bananas and a good amount of beta carotene. Cucumber is low in calories, has no fat, cholesterol or sodium, and is high in fiber. It promotes clear skin, helps reduce undereye swelling
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The dish combines a brighT mixTure of sTrawberries, kiwi and cucumber wiTh The rich flavor of salmon. Photo courtesy Whole Foods Market
and relieves sunburn. A jalapeno not only adds flavor to the dish, but also contains capsaicin, which helps relieve congestion, reduce inflammation, lower cholesterol and alleviate pain from migraines and sinus headaches.
Preheat oven to 350°F. Place salmon on a baking sheet and sprinkle with lemon zest. Bake 15 to 18 minutes or until cooked through. Meanwhile, place strawberries, kiwi, cucumber, jalapeno, mint and 1 tablespoon lemon juice in a medium bowl and toss until combined. Set aside. Heat a large, high-sided skillet over medium heat. Add spinach, with water still clinging to leaves, cover and cook 5 minutes or until wilted, stirring occasionally. Stir in remaining lemon juice. Divide spinach among plates. Top with salmon and salsa and serve.
Per serving: 240 calories (50 from fat), 6g total fat, 1g saturated fat, 45mg cholesterol, 220mg sodium, 29g total carbohydrate (9g dietary fiber, 10g sugar), 21g protein Recipe by Whole Foods Market Health Starts Here Program
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HealtH & Wellness > bestofneworleans.com > july 10 > 2012
ummer has diners seeking healthy but gratifying meals, and Whole Foods’ Health Starts Here program has a simple recipe that illustrates how filling a plate with colorful fresh ingredients is the easiest way to feed the body, mind and soul. The idea is simple. Fill a plate with nutritious ingredients that have a higher proportion of nutrients and fewer calories. Baked salmon with spinach and strawberry salsa is an approachable recipe perfect for summer that’s fun and simple yet unique enough to leave guests intrigued and satisfied. Salmon is packed with omega-3 fatty acids, which are important for brain development and heart and mental health. Any salmon variety will suffice for this dish. The recipe incorporates spinach, which is full of phytonutrients, minerals, vitamin A, which supports vision and the immune system, and vitamin K, which strengthens the cardiovascular system. As the topper and a source of additional beautiful color, strawberry salsa provides a lot of nutrients from simple ingredients. Strawberries are low in saturated fat, cholesterol and sodium. They are a good source of folate and potassium and an even better source of dietary fiber, vitamin C and man-
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