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A Service for the Well-Informed Health Consumer

THE JOHNS HOPKINS WHITE PAPERS 2009

• Arthritis • Memory and Osteoporosis in • Back Pa on Drugs ti • Prescrip ion and Stroke ns • Hyperte isorders D te • Prosta ntion ack Preve Control tt A t r a e H t • and Weigh se n io it tr u N • isea y Heart D r a n o r o C • • Vision ancer • Colon C • Diabetes rders o • Lung Dis n and Anxiety io s s e • Depr s e Disorder • Digestiv

BALTIMORE, MARYLAND

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“When you are faced with

a serious medical condition, you need to base your decisions on the best information, the latest research, and a clear understanding of your treatment options. We created the Johns Hopkins White Papers to meet this vital need.

Simeon Margolis, M.D., Ph.D., Medical Editor and Professor of Medicine and Biological Chemistry

Contents of this Special Bulletin

Prescription Drugs

Arthritis

Boost your health benefits, cut your risks and costs . . . . . . . Page 6 New ways to live a fuller, more comfortable life . . . . . . . . . . Page 8

Memory

Heart Attack Prevention

Protecting your memory as you age . . . . . . . . . . . . . . . . . . . Page 10 Proven strategies to reduce your risk . . . . . . . . . . . . . . . . . . Page 12

Diabetes

Vision

Digestive Disorders

Best ways to prevent future complications . . . . . . . . . . . . . . Page 15 Halting and reversing vision loss . . . . . . . . . . . . . . . . . . . . . . Page 16 Recent advances in treatment . . . . . . . . . . . . . . . . . . . . . . . . Page 18

Nutrition and Weight Control

Back Pain and Osteoporosis

Maximizing the healing benefits of foods . . . . . . . . . . . . . . . Page 20 Relief for “Oh, my aching back!”. . . . . . . . . . . . . . . . . . . . . . Page 22

Hypertension and Stroke

Prostate Disorders

Colon Cancer

Manage high blood pressure to prevent stroke . . . . . . . . . . . Page 26 Better outcomes, fewer side effects . . . . . . . . . . . . . . . . . . . . Page 28 Prevent it, treat it, get on with your life . . . . . . . . . . . . . . . . Page 30

Depression and Anxiety

Lung Disorders

Coping with mood disorders and more . . . . . . . . . . . . . . . . . Page 32 Help when breathing is a challenge . . . . . . . . . . . . . . . . . . . . Page 34

Coronary Heart Disease Improving the quality and duration of lives . . . . . . . . . . . . . . Page 36

FREE 30-Day Preview . . . . . . . . . . . . . . . . . Page 39

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The 2009 Johns Hopkins White Papers

Dear Reader, It’s the first thing so many of my patients do when diagnosed with a serious or life-altering medical condition: Learn everything you can about the disorder to become the best-informed health consumer you can be. But where do you start? The library? The Internet? How can you tell what’s current…what’s accurate…what’s safe? Your own physician? If only doctors had the kind of time required to give their patients the in-depth education they want and need. Introducing…

The 2009 Johns Hopkins White Papers The expertise you require in the layperson’s language you can understand and apply. The White Papers redefine “informed consumer.” These specialized reports explore a single health condition in significant depth. Since this landmark program’s inception, hundreds of thousands of Americans have relied on Johns Hopkins’ expertise to help them manage a serious condition. The new 2009 White Papers are designed to help you ensure the best outcome. Use what you learn to help you: (Over, please…) 3 90214 University Health White 09-03-09 09:25:35

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• Recognize and respond to symptoms and changes as they occur. • Communicate effectively with your doctor, ask informed questions, and understand the answers. • Make the right decisions, based on an understanding of the newest drugs, the latest surgical techniques, the most promising research. • Take control over your condition and act from knowledge, rather than fear.

Direct to you from America’s #1 Medical Center It’s no surprise that the annual U.S. News & World Report “Best of the Best” ratings have held Johns Hopkins Hospital in the #1 spot for eighteen consecutive years. Johns Hopkins stands at the forefront of modern medicine, leading the nation in diagnosis, treatment, and prevention of the diseases that undermine healthy living and longevity. Each new 2009 White Paper has been prepared for your use by some of the most respected medical specialists in the field. Look to the White Papers for: A thorough overview of the condition, its causes, and symptoms… Treatment options, with a Johns Hopkins recommendation on each… Groundbreaking new research and a review of the latest studies… Drugs used to treat the condition, with precautions on avoiding harmful side effects… A glossary of medical terms you need to understand… Leading hospitals that specialize in the disorder; health information organizations; support groups…and more.

FREE 30-DAY EXAMINATION Each White Paper gives you up to 96 pages of timely 4 90214 University Health White 09-03-09 09:25:35

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information, backed by Johns Hopkins resources and expertise. As part of our ongoing commitment to health education, we make the White Papers available at an affordable price, with generous 30-day free preview privileges. You pay just $19.95 plus shipping and handling for each White Paper you keep. Then, as a service, you will be offered the next year’s White Paper update at the same low price, no matter how much new research and information is added. A card will be sent to you in advance and if you wish to examine the next year’s White Paper, do nothing and it will arrive automatically with an invoice. If you don’t wish to see the new White Paper, simply return the card within 30 days. You may notify us at any time if you don’t want to continue in the program. Fighting disease with the facts is what we do every day at Johns Hopkins and what the White Papers empower you to do in your own life. To your healthy future,

Simeon Margolis, M.D., Ph.D. Professor of Medicine and Biological Chemistry Johns Hopkins Medicine Medical Editor, The Johns Hopkins White Papers

P.S. You are invited to examine any White Paper, including our newest titles -- Prescription Drugs and Colon Cancer -- without obligation. You must be completely satisfied or simply return it with the invoice marked “No, thanks.” You risk nothing to take a look.

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Spend less and get more from your prescription drugs Safe, effective use of prescription drugs means learning as much as you can about how new drugs are tested and approved. You need to know what drugs are available for your condition, and the risks and benefits associated with each. You must know NEWEST which over-the-counter TITLE drugs, foods, and dietary Preview it supplements can interfere with your prescription medications.

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Getting maximum benefit from your prescription drugs with minimal side effects requires that you ask the right questions of your doctor and pharmacist, understand the answers more fully, and control your out-of-pocket expenses as healthcare costs soar. This new publication helps you become an informed, confident consumer with highlights that include: ■ Generic equivalents of expensive biologic drugs:

Will they be an option any time soon? ■ How to reduce your risk of getting addicted to prescription drugs, and what to do if you get hooked. ■ Should you join a clinical trial? Crucial information to help you decide.

Another Johns Hopkins “FIRST”

■ Sweeping changes at

Johns Hopkins scientists invented the first microcomputer-controlled, implantable medication delivery system in 1975.

the U.S. Food & Drug Administration that lower your risk in taking a newly-approved drug. 6

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■ Are all osteoporosis drugs alike? What you should know about Fosamax, Evista, Actonel, and others. ■ The latest on chronotherapy: When you take medications can matter as much as what you take. ■ Drugs that raise your risk of falling, and how to stay safe. ■ Side effects of antidepressants: Deciding if the benefits outweigh the risks. ■ Could a compounding pharmacy prove useful to you? ■ Why doctors may soon be less likely to prescribe beta-blockers before surgery for patients with coronary heart disease. ■ Viagra for women: A surprising off-label use

that’s on the horizon. ■ Warnings that you’ll see on a class of antibiotics that includes Cipro, Levaquin, and other fluoroquinolones. How Oral Drugs Are Metabolized in Your Body

Step 2: The pill travels to the stomach through the esophagus.

Step 1: A pill is swallowed.

Step 6:

Step 3:

Drug carried to the heart and circulated.

The pill breaks down in the stomach and small intestine.

Step 5: The drug travels from the gut to the liver by the portal system.

Step 4: The drug is absorbed by the stomach and the small intestine.

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Newer, better way to prevent and treat arthritis You are not alone. By age 50, almost every man and woman has occasionally experienced joint pain and stiffness. Arthritis in some form (there are more than 100 diseases included in the term) is one of our most widespread chronic health problems affecting an estimated 70 million FREE Americans. This special 30-DAY report focuses on the most common forms — PREVIEW! osteoarthritis, rheumatoid Page 39 arthritis, gout, bursitis, fibromyalgia, and more. The more you know about managing arthritis, the better able you will be to anticipate and deal with the fluctuations in its course. Learning as much as possible about the causes and treatments is the first step toward living a full life with minimal discomfort and physical limitations. Important new highlights this year: How Osteoarthritis and Rheumatoid Arthritis Affect Your Joints worn cartilage exposing bone

pannus eroding cartilage and bone collapsed, misaligned joint space

white blood cell

bone spur

fragment floating in synovial fluid

swollen synovial membrane

deformed joint capsule

Joint with Rheumatoid Arthritis

Joint with Osteoarthritis

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inflamed, overgrown synovial membrane

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■ 7 key indicators of whether your symptoms are from rheumatoid arthritis or osteoarthritis. ■ Safe ways to start, and stick with, the best exercise program for relief of pain and stiffness. ■ Gender bias and knee replacement: Why women

may want a second or even third opinion. ■ Pros and cons of new alternatives like minimally invasive surgery, metal-on-metal implants, and replacement knees designed for women. ■ The year’s best gizmos and gadgets for living and functioning independently despite arthritis. ■ Unintended consequences in the search for safe,

effective gene therapy for rheumatoid arthritis. ■ Rheumatoid arthritis and cancer risk: New evidence that RA may put you at increased risk for certain cancers, with ways to protect yourself.

Another Johns Hopkins “FIRST” Johns Hopkins doctors performed the first total knee replacement in 1971.

■ Surprising research links a popular beverage to the dramatic rise of gout in the United States.

■ Recent research brings scientists closer to answering the most troubling questions about fibromyalgia – keys to diagnosis and effective relief. ■ Encouraging results from the first large-scale

evaluation of the People with Arthritis Can Exercise (PACE) program. ■ New research on the effects of pregabalin (Lyrica) on reducing fibromyalgia pain and improving related sleep problems. ■ The cardiovascular benefits of a gluten-free vegan diet for people with rheumatoid arthritis. 9 90214 University Health White 09-03-09 09:25:35

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Breakthroughs in the battle against memory loss A dramatic increase in the number of people affected by Alzheimer’s disease has heightened the urgency of research into Alzheimer’s and other causes of dementia. According to the American Academy of Neurology, 10% of people over age 65 and 50% of those 85 years and older suffer from dementia. This new special report brings you state-of-the-art knowledge on the best ways to keep your memory sharp as you get older. You will learn about important new research in identifying, treating, and preventing memory disorders, as well as new drugs that can slow the decline. You will welcome the practical advice on dealing with the day-to-day challenges of caring for someone with dementia. Important highlights:

See page 39 to examine it FREE

■ When is it time to stop driving with dementia? Practical help for a serious problem. ■ New research links melatonin to improved sleep

for older dementia sufferers. ■ Scientists link reduced alcohol intake and less smoking to delays in lateonset Alzheimer’s disease: What made the difference? ■ Predicting the course of Alzheimer’s: What you can expect after a diagnosis.

Another Johns Hopkins “FIRST”

In 2000, Johns Hopkins researchers identified a key enzyme in the brain linked to Alzheimer’s disease.

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The Steps of Memory parietal lobe frontal lobe occipital lobe basal ganglia

hippocampus temporal lobe cerebellum

■ Do the brain benefits of ginkgo biloba outweigh the increased risk of TIAs (ministrokes)? ■ Scientists discover a type of depression that

may signal Alzheimer’s disease in your future. ■ Wine or hard liquor? One may lower a woman’s risk of dementia while the other may raise it. ■ New study shows that vitamin E may lengthen the lifespan of people with Alzheimer’s. ■ Obesity isn’t the only danger! New research links being underweight to a 40% boost in dementia risk. ■ The value of a nap: Research supports that even a very brief nap significantly boosts memory processing. ■ Men vs. women and dementia: Surprising and

important gender differences. ■ How cardiovascular fitness can keep you mentally sharp in addition to helping your heart. 11 90214 University Health White 09-03-09 09:25:35

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How NOT to have a heart attack Each year, some 600,000 Americans suffer a first heart attack, and another 320,000 have a recurrent attack. About a fifth are fatal. And it’s not just a “man’s disease.” Women are six times more likely to die of a heart attack than of breast cancer. PREVIEW IT

While heart attack remains the leading cause of death in America, Johns See page 39. Hopkins specialists have identified a number of steps that can dramatically lower your risk. This timely new report contains potentially lifesaving strategies for the millions of people with high cholesterol, hypertension, obesity, a sedentary lifestyle, and other known risk factors. Use it to work with your doctor to develop your own customized program for heart attack prevention.

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■ Calcium and Vitamin D: How to protect

both your heart and your bones based on the latest research. ■ Heart attack symptoms (including some less familiar ones) and an action plan when minutes count. ■ You exercise, don’t smoke, eat a healthy diet, but are overweight: How much heart attack risk do the extra pounds pack?

Did you know? A 2003 Hopkins study found that

a woman’s fitness level, and how long it takes her heart to return to normal after exercise, are better indicators of her risk of heart disease than the electrical recordings of the heart that are used to diagnose hidden heart disease in men.

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■ Sleep and your heart: New link recognized between sleep apnea and restless legs syndrome and an increased risk of coronary heart disease. Angina and Heart Attacks

■ Important news about a common drug for type 2 diabetes that’s been linked to an increase in heart attacks. ■ Extra steps that can protect you when someone else in the family develops early heart disease. ■ Protecting your arteries:

New research connects high blood pressure to the hazard of LDL cholesterol. atherosclerotic plaque reducing blood flow

■ Reach for your tape measure to assess your heart attack risk: Step by step instructions.

■ Understanding your lipid profile: Know your goal and what the numbers say about your heart attack risk.

Narrowed Coronary Artery

■ Women and Coronary

Microvascular Disease: The heart problem that doesn’t show up on angiograms. ■ The whole grain secret: Foods that help control cholesterol, reduce abdominal fat, and lower heart disease risk. ■ Is it time to stop prescribing Vytorin and Zetia? Hopkins experts interpret the latest research.

damaged heart muscle

blood clot forming, blocking blood flow

Heart Attack

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Top 10 Reasons to try the 2009 White Papers ohns Hopkins created the White Papers in response to the growing need for better information. Each White Paper is a substantial report written for the layperson by some of the most respected medical experts. You will find the facts you need to make informed decisions, the first step toward taking control over the care you receive.

J

5. New research findings of special interest and importance. (Highlights of selected medical journal articles included.) 6. Simple illustrations to help you better understand the disease. 7. Lifestyle adjustments that can bring relief and help you live a fuller life. 8. Valuable resources, including leading hospitals that specialize in treating the disorder, national support groups, and health information organizations (many with useful websites).

Each White Paper gives you: 1. A clear explanation of the condition, including its causes and symptoms. This is the first step toward managing your condition and communicating effectively with your own doctor.

9. Helpful sidebars that summarize recent drug tests, important surgical techniques, and research breakthroughs so new that many doctors won’t yet be fully aware of their promise.

2. A thorough, up-to-date exploration of treatment options, including drugs, surgery, lifestyle changes, and alternative therapies, where appropriate.

10. Reassurance that comes with reliable information from a responsible source you can trust.

3. The newest and most effective medications, both prescription and over-thecounter.

Use the Free Preview Request on page 39 to examine any White Papers for 30 days.

4. A glossary of medical terms you will hear from your doctor and encounter in your reading about the condition.

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Blocking the complications of diabetes The lessons of the last ten years are clear: Effective management of diabetes in its early stages is the best way to prevent or minimize future complications. People with diabetes have new ways to monitor the condition and control PREVIEW IT their blood glucose. In this groundbreaking new report, Johns Hopkins specialists for 30 days explore the impact of recent research on lifestyle measures and the newest advances in treating the disease. Important highlights:

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■ Promising research on bariatric surgery as an effective way to send type 2 diabetes into remission. ■ Plan-ahead tips for safe travel with your diabetes under control. ■ Is there science behind cinnamon, a popular natural therapy for treating diabetes? ■ Expert advice on which healthcare professionals and routine tests can help you prevent complications of diabetes. ■ The best way to lose weight despite the claims about “new” diets. ■ What the headlines don’t tell you about Avandia and Actos and the risk to your bones and heart. ■ How to prevent hypoor hyperglycemia when you’re exercising. ■ The kidney threat you may never see coming and the simple test to detect it.

Another Johns Hopkins “FIRST”

In 1999, Johns Hopkins researchers identified a drug that stops the growth of abnormal blood vessels in the eye, an advance that could save the sight of people with complications from diabetes.

■ New research on statins and aspirin to prevent the #1 health threat to people with diabetes. ■ Should you take chromium or ginseng to help regulate blood glucose? ■ Tests that must be part of your regular eye exam for early detection and treatment of diabetes-related eye diseases. ■ Biggest mistakes diabetics make when buying shoes.

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How to halt or reverse vision loss Most of us take our vision for granted until we develop a disorder like cataracts, glaucoma, age-related macular degeneration, or diabetic retinopathy. While people may fear losing their vision See page 39 for entirely, it’s important to FREE 30-DAY realize that visual loss can PREVIEW often be halted, or even reversed, with early treatment. This year’s White Paper brings you the current state of knowledge in prevention, diagnosis, and treatment of these four eye diseases, as well as expert guidance on coping with low vision. Important highlights: ■ Medications that can cause or aggravate dry eye, and where to find relief. ■ Is there an “anti-eye disease diet”? Foods with

the most promise to protect your vision. ■ The right way to use eyedrops for maximum protection against worsening eyesight.

Another Johns Hopkins “FIRST” Johns Hopkins researchers developed photodynamic therapy and translocation surgery in 1999 to reduce vision loss in people with macular degeneration.

■ What to expect after cataract surgery: Tips for successful recovery. ■ Promising new

treatments for age-related macular degeneration, and how to participate in a clinical trial.

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■ Telescreening for diabetic retinopathy: A hi-tech alternative to your annual exam at the ophthalmologist’s? ■ How to preserve your sight by controlling both diabetes and hypertension. ■ Fish and age-related macular degeneration: Will eating more seafood save your sight? ■ Trab versus Tube: New findings on the complication

rates of two kinds of glaucoma surgery. Common Diseases That Affect the Eye Diabetic Retinopathy with retinal vessels leaking into vitreous humor

blood vessels in the retina retina

vitreous humor

macula

lens optic nerve

cornea pupil

Glaucoma with fluid pressure injuring optic nerve

iris

Cataract with cloudy area obstructing central vision

Neovascular Macular Degeneration with new blood vessels and scarring behind the retina

■ New research shows multivitamins decrease risk of one kind of cataract but increase it for another. So what should you do? ■ Does estrogen protect against macular degeneration or cause it? Important research sheds light. ■ New finding: A more effective therapy than corticosteroids for diabetic macular edema (DME), with fewer side effects. 17 90214 University Health White 09-03-09 09:25:36

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Good news for your gut Remember when standard advice for many digestive disorders was a bland diet? Recent advances have led to radically improved treatments for people who suffer from conditions affecting the gastrointestinal tract, from the mouth to the rectum. The encouraging news is that the symptoms of digestive disorders can be alleviated, and often completely eliminated, with the right combination of medication, dietary changes, exercise, weight loss, stress reduction, and surgery. Johns Hopkins specialists look at gastroesophageal reflux disease (GERD), peptic ulcers, dysphagia, achalasia, Barrett’s esophagus, esophageal spasm and stricture, gastritis, FREE 30-DAY gallstones, diarrhea, constipation, celiac PREVIEW See page 39 disease, Crohn’s disease, ulcerative colitis, and colon cancer. Important highlights: ■ GERD and longevity: New research looks at whether acid reflux can shorten your life. ■ A first treatment for Crohn’s disease that may

offer better results without the side effects of corticosteroids. ■ Life without a gallbladder: How your body adjusts once it’s removed.

Another Johns Hopkins “FIRST” over the

rs helped disc In 2001, Johns Hopkins researche Crohn’s disease. first gene directly involved in causing 18 90214 University Health White 09-03-09 09:25:36

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■ An effective new alternative for bleeding ulcers that spares you the cost and discomfort of endoscopic and I.V. treatments. ■ Which hospitals offer the best outcome for inflammatory bowel disease-related surgery? ■ Tantalizing new research links the rise in esophageal cancer with increased carbohydrate and corn syrup consumption. ■ Foodborne illness: Surprising truths about rinsing

poultry, buying organic, and other preventive steps. ■ A new option: What you should know about Amitiza, the first drug approved to treat constipationpredominant IBS in women.

One Meal’s Digestive Journey

pharynx

■ Dairy, gluten, or fructose intolerant? Restaurant tips for eating out without upsetting your digestive tract. ■ 12 things you can have when the doctor tells you to avoid all solid foods.

esophagus

lower esophageal sphincter gallbladder stomach duodenum

■ Do probiotic products like Dannon’s Activia yogurt work as advertised to regulate digestion?

pancreas jejunum

colon ileum

■ A dietary approach to relieving the constipation that can accompany a woman’s pelvic floor disorder.

rectum

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Eat your way to better health and longer life! The evidence is overwhelming: A diet abundant in nutrient-rich foods can be a powerful tool in preventing disease. Maintaining a healthy weight through a combination of diet and exercise is known to help lower the risk of high cholesterol, high blood Preview it pressure, diabetes, osteoporosis, arthritis, and many kinds of cancer. In this much-requested report, Johns Hopkins nutrition and weight control specialists show you how to shop for, cook, and enjoy a health-promoting, balanced diet, and to lose unwanted pounds. Important highlights:

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■ Why obese men may lose more weight on a high-protein, low-carbohydrate diet, new research shows. ■ Best way to keep the weight off after you

lose it: Experts compare in-person and online counseling, versus going it alone. ■ On the horizon: A new way to make yourself feel full faster so you eat less. Plus your food will taste better! ■ Serious but hidden risk to your kidneys if you are overweight, particularly for women. ■ Move over, olive oil. Researchers identify a different oil that may be better at promoting weight loss. ■ Dietary and lifestyle changes that give you

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■ The high blood pressure diet that offers a bonus to women: lower risk of coronary heart disease. ■ Are you getting enough vitamin D to protect against coronary heart disease? ■ What’s the real difference between eating antioxidant-rich foods and taking antioxidant supplements? ■ Delicious diet that may

lower your risk of diabetes by as much as 83%.

Another Johns Hopkins “FIRST” In 1993, Johns Hopkins researchers identified the chemical in broccoli and other cruciferous vegetables that appears to inhibit the development of cancer.

■ Are oats still the darlings of a heart-protective diet? What we know from a decade’s worth of research. ■ Rethinking the link between vitamin E and cataract protection: Update from the Women’s Health Study. Making Smart Portion Choices with MyPyramid Find out how much to eat from each food group

How Much To Eat?

Recommended calorie intake

Food group

1,600

1,800

2,000

2,200

2,400

2,600

2,800

3,000

Fruits

1.5 cups

1.5 cups

2 cups

2 cups

2 cups

2 cups

2.5 cups

2.5 cups

Vegetables

2 cups

2.5 cups

2.5 cups

3 cups

3 cups

3.5 cups

3.5 cups

4 cups

Grains

5 oz-eq

6 oz-eq

6 oz-eq

7 oz-eq

8 oz-eq

9 oz-eq

10 oz-eq

10 oz-eq

Meats and beans

5 oz-eq

5 oz-eq

5.5 oz-eq

6 oz-eq

6.5 oz-eq

6.5 oz-eq

7 oz-eq

7 oz-eq

Milk

3 cups

3 cups

3 cups

3 cups

3 cups

3 cups

3 cups

3 cups

Oils and fats

5 tsp

5 tsp

6 tsp

6 tsp

7 tsp

8 tsp

8 tsp

10 tsp

Discretionary calories

132

195

267

290

362

410

426

512

oz-eq = ounce-equivalent.

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Information and relief for, “Oh, my aching back!” It’s the price we pay for evolution: A lifetime of walking, standing, lifting, and twisting causes significant low back pain in 80% of all adults. In fact, this pain sends more people to the doctor than any other complaint except upper respiratory Turn to symptoms. And, as our page 39 to population continues to try it FREE age, osteoporosis becomes an increasingly widespread for 30 Days problem. In this special report, the Johns Hopkins experts tackle sprains, strains, spasms, disk herniation, degenerative changes in the disks and spine, spinal stenosis, and osteoporosis, a common cause of hip and spine fractures. You will explore the causes and diagnostic techniques, read about preventive steps that can spare you significant pain, and examine treatments that include the very latest drug and surgical options. Important highlights: ■ Back pain and depression: Best ways to fight the psychological consequences of chronic back pain. ■ The limitations of imaging for low back pain: Why your doctor may not order an x-ray or MRI. ■ Newly-approved way to take far less risedronate

(Actonel) without reducing its osteoporosis protection. ■ Expert advice on reducing your back pain while minimizing side effects from over-the-counter medications. ■ Prompt treatment options for neck pain, with

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■ Men and osteoporosis: New research on malespecific risk factors that raise a man’s risk.

I certainly have an interest in taking care of my health in every way.

■ Rethinking drug therapy for osteopenia based on a newer way to assess the risks of thinning bones.

John P. Sisson, Tallahassee, FL

■ Effective ways to consume the calcium your bones need when you can’t or won’t eat dairy. ■ Smart and sometimes surprising ways to prevent falls that fracture hip bones. ■ Which works better on acute low back pain:

Active therapy (exercise, stretching) or passive measures (such as heat or ice, ultrasound)? ■ The bottom line on improving bone mineral density naturally by eating isoflavone-enhanced foods. ■ Antidepressants are often prescribed for chronic back pain, but do they really help at all?

cervical vertebrae

The Many Important Functions of the Spine

body of vertebra

thoracic vertebrae

spinal cord in spinal canal

intervertebral disk lumbar vertebrae

sacrum

tranverse process

facet joint

facet joint on articular process

coccyx Vertebral Spine (side view)

Two Lumbar Vertebrae (from behind)

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spinal nerve branching off cord

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spinous processes


The expertise of Johns Hopkins on every page n U.S. News & World Report’s annual ratings of the “Best of the Best” American hospitals, Johns Hopkins Hospital has topped the list eighteen years in a row. Hopkins continues to lead the nation in the medical specialties that affect so many adults. The School of Medicine is the largest recipient of biomedical research funds from the National Institutes of Health, and received $625 million in research grants and contracts in 2005. In 2003, Hopkins professor Peter Agre, M.D., won the Nobel Prize in chemistry. Since 1889, researchers at Johns Hopkins have advanced the development of science and medicine, quickly transferring new knowledge from the research laboratory to the patient’s bedside. With the introduction of the White Papers, Johns Hopkins has found an effective, affordable way to transfer that new knowledge to the widest possible audience, benefiting countless men and women with serious health concerns.

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More than 100 years of Johns Hopkins “Firsts” 1897 The first American use of x-rays in surgery 1913 First model of renal dialysis 1944 First “blue baby” operation ushers in the era of heart surgery 1960 Pioneering work in bone marrow transplantation 1969 First use of laser to prevent blindness 1982 Nerve-sparing surgery for prostate cancer 1984 First use of genetically engineered t-PA to stop a heart attack 1995 Helped develop the first effective treatment for sickle cell anemia 2000 Used stem cell grafts to restore movement to limbs of paralyzed animals, a major advance in efforts to overcome paralysis in humans

2002 Discovered the first screening test for the earliest and most curable stage of colon cancer

2004 Created new surgical technique even less invasive than standard laparoscopy.

2006 Figured out how to safely perform MRI scans in people with implanted defibrillators and pacemakers.

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Rated #1 among America’s best hospitals

18 years running! Once again, The Johns Hopkins Hospital topped the Honor Roll in U.S. News & World Report’s ranking of America’s Best Hospitals. For 18 consecutive years, Hopkins has been singled out for its reputation and expertise, as well as quality of nursing care, advanced technology, and other relevant factors. In addition to its overall rank of #1, Hopkins ranked #1 nationwide in Ear, Nose and Throat, Rheumatology, and Urology; #2 in Geriatrics, Gynecology, Psychiatry, Ophthalmology, and Neurology and Neurosurgery; #3 in Cancer, Digestive Disorders, Endocrinology, Heart and Heart Surgery, and Respiratory Disorders. The White Papers bring you the latest and best information in many of these, and other areas, along with significant new developments that could affect your health.

Informed healthcare consumers “ are ultimately the final arbiters of a hospital’s reputation and quality,

says Ronald R. Peterson, president of The Johns Hopkins Hospital and Health System and executive vice president of Johns Hopkins Medicine. 25 90214 University Health White 09-03-09 09:25:36

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HYPERTENSION: Stop the “silent killer” before a stroke High blood pressure, or hypertension, gives few or no warning signs before it erupts with major complications such as a stroke. Fortunately, in most cases, the condition can be easily detected and is usually controlled with a combination of diet, exercise, and medication. Drawing on the latest research findings, the experts at Johns Hopkins explain what you can do to manage Stay informed about hypertension to prevent your condition! stroke. You will also FREE 30-DAY learn how stroke patients are best treated, and PREVIEW where caregivers can get the support and assistance they need. Important highlights: ■ Don’t leave your doctor’s office without getting answers to these questions about your high blood pressure. ■ The latest treatment option? Using the Web to control your blood pressure. ■ Success tips for sticking with the DASH diet. It can lower blood pressure as much as an antihypertensive drug! ■ Proven strategies for

controlling resistant hypertension when three drugs aren’t enough.

Another Johns Hopkins “FIRST” Found that a family of antibiotics that includes penicillin may help prevent nerve damage and death in a variety of neurological diseases including dementia, stroke, and epilepsy.

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■ Will eating fish save your brain? It depends on how it’s cooked. ■ The migraine-stroke link: Which type of migraine

increases your risk, and what to do about it. ■ Depression and stroke: Recognizing and treating a common complication that can slow recovery. ■ The blood pressure drug that might also protect against Parkinson’s disease. ■ Key steps to minimizing your high risk of a stroke after a TIA. Blood Circulation in the Brain cerebrum

right anterior cerebral artery

cerebrum

circle of Willis

basilar artery right middle cerebral artery

left internal carotid artery

right internal carotid artery

right posterior cerebral artery

right vertebral artery

cerebellum brainstem

right common carotid artery

View From the Right Side

left vertebral artery left common carotid artery

Frontal View in Cross Section

■ Why falling poses a serious threat to 40% of people in the year following a stroke. ■ Botox: Not just for your face. New findings on

Botox for limb spasticity. ■ How to recognize a transient ischemic attack (TIA) or stroke and get appropriate treatment fast. 27 90214 University Health White 09-03-09 09:25:36

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What every man must know about prostate health With so many treatment options, men with benign prostatic hyperplasia (BPH) or prostate cancer need accurate, reliable advice from the most trusted medical specialists. The experts at Johns Hopkins bring you Read it now! up to speed on the latest See page 39 refinements to current for a free therapies that result in a preview. better outcome with fewer side effects. The 2009 White Paper reviews the newest information on prostate disorders – including prostatitis, a common condition that affects even young men. This clear, up-to-date information is provided to help guide your treatment decisions. Important highlights: ■ What’s your prostate symptom score? Self-test

helps you determine what kind of help to seek. ■ Will the latest laser procedure for BPH replace TURP as the gold standard for treating an enlarged prostate? ■ Who stands to benefit from genetic testing for the prostate cancer gene. ■ Vitamin that may reduce your risk of prostate cancer and suppress the spread of the disease in men who already have it.

Another Johns Hopkins “FIRST”cific

d the first spe Johns Hopkins researchers mappe me 1, in 1996. prostate cancer gene to chromoso 28 90214 University Health White 09-03-09 09:25:36

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■ New studies, conflicting views: Why some

doctors say “NO!” to Proscar for prostate cancer prevention. ■ Weighing the pros and cons of radical prostatectomy vs. radiation therapy. ■ Why most men in their mid-70s or beyond should not accept AndrogenDeprivation Therapy alone for treatment of prostate cancer.

How BPH and Prostate Cancer Affect the Urinary System

urethra

■ Breakthrough: PSA levels at midlife could indicate which men need more intensive prostate cancer screening later on.

Normal Prostate

enlarged tissue compressing urethra

■ A new study questions the value of testosterone supplements for treating the symptoms of aging.

Prostate with BPH

■ Promising results on a new prostate cancer screening test that’s performed on a urine sample. tumor distorting outer region

■ Could a physically active job cut your risk of prostate cancer by nearly half? Tantalizing new research.

Prostate with Cancer

■ Which men are candidates for erection

rehabilitation, a new way to speed recovery of sexual potency after radical prostatectomy. 29 90214 University Health White 09-03-09 09:25:36

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Best ways to beat a highly curable cancer. Although the American Cancer Society ranks colorectal cancer as the third most common cause of cancer overall in the United States, it is one of the most curable of all cancers when diagnosed and treated in the early stages. The five-year survival rate for people whose colon (or rectal) cancer is discovered and treated in the early stages is over 90%. In addition, early screening may reveal precancerous growths that can be removed, preventing cancer from developing in the first place. In this White Paper, Johns Hopkins doctors show you how colon cancer develops, how it can be detected early, and how you can reduce your risks. You will learn about new developments in screening, diagnosis, research, and treatment options, as well as how people who already have been treated for colon cancer can lower their risk of a recurrence. Highlights include:

Examine it

FREE!

■ Two options for minimally-invasive surgery offer

alternatives for more people with rectal cancer. ■ What to ask the doctor doing your next colonoscopy about his or her completion rate and polyp detection rate. ■ New research: Would we prevent more cancer and save more lives if the first colonoscopy were at age 40? ■ A safer alternative to the common bowel

cleansing prep that can cause severe kidney damage in older users. 30 90214 University Health White 09-03-09 09:25:36

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■ Better therapies to try if rehab is of little help after rectal cancer surgery.

Another Johns Hopkins “FIRST”

■ Update on exercise and cancer prevention: What you do right now can make a difference. ■ Expert help in fighting the isolation that is common among cancer survivors with permanent stomas.

Johns Hopkins researchers discovered the generic alteration with the potential to let us predict up to 40% of new colon cancers before they begin. (1998)

■ Is chemotherapy a reasonable option for colon cancer if you’re over 70? What the research now shows. ■ Update: What the studies show about virtual colonoscopy as an alternative to the more invasive procedure. ■ Newer, more accurate alternative to the widely-used test for fecal occult blood. ■ Breakthrough research on vitamin D to boost

the survival rate of colon cancer patients. ■ Promising research that paves the way for an annual blood test for colon cancer screening. Colon Cancer Surgery Removing a threat while preserving a vital function

transverse colon splenic flexure transverse colon

descending colon

anastomosis

sigmoid colon rectum

Left colon removed

sigmoid colon

Colon reattached

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Moving past depression and anxiety When sadness or anxiety impairs your daily life, you may have a mood or anxiety disorder. Recent advances in research give us new tools – both medical and nonmedical – for managing these conditions. The 2009 White Paper helps you understand and cope more effectively with major depression, dysthymia, 30-DAY atypical depression, bipolar disorder, seasonal affective disorder, panic PREVIEW disorder, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and phobic disorders. Important highlights:

FREE

■ Therapeutic approach that can help prevent post-traumatic stress disorder, despite many doctors’ reluctance to use it. ■ Red flags that are warning signs of suicide in the elderly. ■ How to get “back in the mood” when antidepressants cause, or worsen, sexual problems. ■ What’s the scientific evidence for St. John’s wort, SAM-e, and other “natural” treatments for depression? ■ Is generic Prozac (fluoxetine) as effective as brand name? ■ Protecting yourself with a psychiatric advance directive (PAD). ■ Conquering phobias with exposure therapy (either direct or virtual), an approach with a 90% success rate. ■ Are antidepressants forever? How do you know when you’re “done” and what’s a safe, gradual way to withdraw? ■ The testosterone-depression connection: Would older men benefit from supplementation as testosterone levels decline? ■ A shorter, better use of electroconvulsive therapy for depression that results in less memory impairment. ■ New research on the breast cancer drug tamoxifen to ease mania in people with bipolar disorder.

Another Johns Hopkins “FIRST”

Johns Hopkins researchers provided the first reliable evidence of genetic susceptibility to schizophrenia in 1998.

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Advisory Board to the Johns Hopkins White Papers • Arthritis Specialist John A. Flynn, M.D. Professor of General Internal Medicine and Rheumatology and Clinical Director of the Division of General Internal Medicine

• Memory Specialist Peter V. Rabins, M.D., M.P.H. Professor of Psychiatry and Director of the Division of Geriatric Psychiatry and Neuropsychiatry

• Back Pain Specialist Lee H. Riley, III, M.D. Associate Professor of Orthopedic Surgery and Neurosurgery and Chief of the Orthopedic Spine Division at Johns Hopkins Medicine

• Nutrition Specialist Lora Brown Wilder, Sc.D., M.S., R.D. Assistant Professor, Department of Medicine • Osteoporosis Specialist Suzanne M. Jan de Beur, M.D. Associate Professor of Medicine and Director of Endocrinology, Johns Hopkins Bayview Medical Center

• Colorectal Cancer Specialist Ross C. Donehower, M.D. Professor of Medicine and Oncology and Director of the Division of Medical Oncology

• Prescription Drug Specialist Brent G. Petty, M.D. Associate Professor of Pharmacology and Molecular Sciences

• Coronary Heart Disease Specialist Gary Gerstenblith, M.D. Professor of Medicine • Depression and Anxiety Specialist Karen L. Swartz, M.D. Assistant Professor of Psychiatry, Director of Clinical Programs at the Johns Hopkins Mood Disorders Center, and Co-Director of the Women’s Mood Disorders Center • Diabetes Specialist Christopher D. Saudek, M.D. Professor of Endocrinology and Metabolism, Director of the Johns Hopkins Diabetes Center, and Deputy Director of the Institute for Clinical and Translational Research • Digestive Disorders Specialist H. Franklin Herlong, M.D. Associate Professor of Medicine and Director of Clinical Hepatology

• Pulmonary Specialist Peter B. Terry, M.D. Professor of Medicine in the Division of Pulmonary and Critical Care Medicine • Prostate Specialist H. Ballentine Carter, M.D. Professor of Urology and Oncology and Director of Adult Urology at the Johns Hopkins University School of Medicine • Stroke Specialist Rafael H. Llinas, M.D. Associate Professor of Neurology and Director of Clinical Services for Neurology at the Johns Hopkins Bayview Medical Center • Vision Specialist Susan B. Bressler, M.D. Julia G. Levy Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins

• Heart Attack Prevention Specialist Roger S. Blumenthal, M.D. Professor of Medicine and Director of the Ciccarone Preventive Cardiology Center

• Weight Control Specialist Lawrence J. Cheskin, M.D. Associate Professor of Medicine and Director of the Johns Hopkins Weight Management Center

• Hypertension Specialist Lawrence Appel, M.D. Professor of Medicine, Epidemiology and International Health

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Timely information to help you breathe easier When drawing a breath is a challenge, the pulmonary specialists at Johns Hopkins offer timely information, new research findings, and the best medical advice available to help you cope with your condition. You will gain valuable insight on managing lung disorders that include emphysema, chronic bronchitis, asthma, pneumonia, interstitial lung disease, lung cancer, and sleep apnea. Important highlights:

Preview it on Page 39

■ Is salmeterol (Serevent) safe? How to interpret the conflicting studies on this long-acting beta agonist. ■ For men with sleep apnea, the best treatment may involve their wives staying in the same room instead of sleeping elsewhere, according to a new study. ■ What a recent study reveals about smoking and your risk of interstitial lung disease (ILD) – a concern for people with rheumatoid arthritis. ■ Encouraging research on a new treatment for deep vein thrombosis that may prevent blood clots from traveling to the lungs.

Another Johns Hopkins “FIRST” CPR was developed in 1958 by Johns Hopkins researchers.

■ New research shows how to spend less on

antibiotics the next time your COPD flares up. 34 90214 University Health White 09-03-09 09:25:36

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How Obstructive Lung Diseases Disrupt Breathing enlarged air spaces alveoli epiglottis

left mainstem bronchus

pharynx

airsac smooth muscle

larynx

bronchiole (1 mm or less in diameter)

trachea

Emphysema

Healthy small airway right lung

left lung enlarged, constricted muscle

cartilage smooth muscle

swollen lining

bronchial lining

Healthy bronchus

overproduced mucus Bronchitis

Asthma

■ Can’t stop smoking? This non-prescription “secret weapon” significantly boosts your chance to succeed. ■ Vitamins that don’t protect against lung cancer

despite the hoopla, plus one that could actually raise your risk. ■ Should women take low-dose daily aspirin to prevent asthma? Surprising answers from the Women’s Health Study. ■ Flu shots and asthma: What you don’t know could make next winter harder on your health. ■ Is there an asthma diet? What the research shows

about a low-sodium diet, fiber, and your breathing. ■ Dust mite busters: Unexpected findings challenge the standard advice about mattress covers and air filtration devices. ■ The best drug combination to reduce COPD death risk, according to a new study. 35 90214 University Health White 09-03-09 09:25:36

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Coronary Heart Disease: Extending and improving lives Coronary heart disease (CHD) is the single biggest killer in the United States, but recent advances are improving the quality and duration of life of those affected. This detailed report looks at the best ways Preview the New Edition for to manage the problems that 30 days FREE! result, including angina, heart attacks, heart failure, and arrhythmias. Important highlights: ■ Best way to detect symptom-free abdominal aortic aneurysms before they rupture. ■ The test that measures blood pressure in

your ankle and paints a clearer picture of your heart attack risk. ■ Is body fat really that bad for your heart, or is it possible to be fat and fit? ■ Important advisory on

safety of CT scans if you have a pacemaker or implanted defibrillator. ■ Just-revised guidelines that may spare you the pre-operative testing and treatment before noncardiac surgery.

Another Johns Hopkins “FIRST” Developed the first biologic pacemaker for the heart (2002), paving the way for a genetically engineered alternative to implanted electronic pacemakers.

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■ New studies show the risks of low HDL even if your LDL levels are well controlled. ■ Can exercises like yoga and tai chi actually benefit your heart? What the studies show. ■ Resistant hypertension: Where to turn when

simultaneous triple-drug therapy can’t control blood pressure. ■ Latest scientific research on dietary supplements and your heart: Update on hawthorn, CoQ10, vitamin D and calcium. The Process of Atherosclerosis Narrowed Coronary Artery plaque aorta

coronary arteries

Blood Flow Blocked

damaged heart muscle blood clot developing from ruptured plaque

■ How to benefit most from cardiac rehabilitation, which can cut death risk by 15% to 28%. ■ Another benefit to statins: They may play a role in preventing the heart-rhythm abnormality atrial fibrillation. ■ Do the life-saving benefits outweigh the technical malfunctions of implantable defibrillators (ICDs)? 37 90214 University Health White 09-03-09 09:25:36

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▼ Remove page, fold and mail in envelope provided. ▼

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