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• WH - A Guide to Women's Health
• Winter 2008
• Healthy You
• Being a Mom
• At the Doctor's

WH - A Guide to Women's Health

Are Clinical Trials for You?

Clinical trials are a means to develop safe and effective new treatments for diseases and conditions. There are strict rules for such research, which is monitored by the National Institutes of Health (NIH) and the U.S. Food and Drug Administration. Before you decide to volunteer to participate in clinical research, the NIH advises you to get answers to the following questions:

• What is the studyÕs purpose?
• What will be required of you? What is your role in the studyÑwill you be volunteering as a patient or as a healthy volunteer?
• Will you benefit directly from the study? Will the study benefit others?
• Are there any risks? If so, what are they, and what are the chances that they will occur? What pain or discomfort might be involved?
• How much total time is involved? Are there other inconveniences?
• Have you discussed your participation in the study with your friends and family?

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Recognizing the Signs of Depression

Did you know that women experience depression about twice as often as men? Hormones are a key factor in this increased rate of depression, experts say, especially those at play in menstrual cycle changes, pregnancy, miscarriage, the postpartum period, perimenopause and menopause.

According to the National Institute of Mental Health, signs of depression include:

• Persistent sad, anxious or ÒemptyÓ mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy and fatigue
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain

If you or a loved one exhibit such symptoms, consult a physician without delay. The good news: With todayÕs treatmentsÑincluding medications and psychosocial therapiesÑthe great majority of people with depression can be helped.

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Q&A: Minimally Invasive Cardiac Surgery

Minimally invasive surgical procedures are among the many leadin gedge treatments available at John Muir Health. Learn more about two of such proceduresÑtreatments for malfunctioning heart valves and problems with the heartÕs rhythmÑin the following Q&A with Jatinder Dhillon, M.D., John Muir HealthÕs medical director of cardiac surgery, and Andreas Kamlot, M.D., a cardiothoracic surgeon on staff at John Muir Medical CenterÕs Walnut Creek and Concord campuses.

Q: Generally speaking, what are the benefits of minimally invasive cardiac surgery procedures, and when should they be considered?

Dr. Dhillon: Minimally invasive procedures in cardiac surgery use smaller incisions, and as a result, patients typically experience less pain on recovery and usually are able to return to normal activities and work more quickly. Of course, not every heart patient is a good candidate. Whether the problem is a malfunctioning valve, heart rhythm disorders, such as atrial fibrillation, or some other heart condition, I recommend that the patient first see a cardiologist, and that the cardiologist, together with a cardiac surgeon, then identify appropriate treatment.

Q: What is atrial fibrillation? What health risks does it pose?

Dr. Kamlot: Atrial fibrillation is the uncoordinated contraction of the upper chambers of the heart, called the atria. ItÕs a very serious problem that may have life-threatening health risks, including increased risk for heart failure and stroke.

Q: Q: How is atrial fibrillation treated? When are minimally invasive surgical procedures an option?

Dr. Kamlot: In the past, most patients with atrial fibrillation were treated with one or both of two kinds of medicationsÑ those that restore the heartÕs normal rhythm and blood thinners that aim to prevent formation of blood clots, the origin of strokes. In many cases, though, these patients had to take lifetime medication, which can have significant risks in itself. Good candidates for minimally invasive procedures include patients who donÕt want to take lifetime medications, and particularly those for whom medications have failed.

Q: What is the Maze procedure, and how is it used?

Dr. Kamlot: Maze is an FDA-approved procedure that can help identify the origin of atrial fibrillation and treat it surgically. The Maze procedure eliminates abnormal conduction pathways on the heart, using ultrasound or cryoablation to freeze tissue, or electrocautery to treat abnormal tissue with heat. In the new, closed-chest procedure, long catheters are inserted between the ribs to access the beating heart via keyhole incisions. Maze can also be used in tandem with open-heart procedures such as coronary bypass surgery.

Q: How are minimally invasive procedures used to repair or replace heart valves?

Dr. Dhillon: Depending on the degree of malfunction, defective valves in the heart can be life-threatening and may require surgical repair or replacement. The most common are two types of valve surgery Ñone for the mitral valve, which controls blood flow between the upper and lower chambers of the heart, and the other for the aortic valve, which regulates blood flow from the ventricle or lower chamber of the heart and the aorta. Often, we can repair the mitral valve. In other cases, we put in a prosthetic valve (mechanical, made of metal or of pig, cow or human pericardium tissue). When indicated, we typically replace the aortic valve with a prosthetic valve.

At John Muir Health, we are developing techniques to access the heart and valves using smaller incisionsÑabout two inches long vs. the six-inch incisions used in conventional surgery. According to reports in medical literature, these less invasive procedures can be done safely and effectively. WhatÕs more, the results are better cosmetically and the patientÕs recovery is faster.

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Relieve Neck Pain

Everyday actions like blow-drying your hair, backing out of the driveway and using a computer are routine for many of us. But for those suffering from chronic neck pain, these seemingly simple tasks can be daunting and at times impossible to perform. But now a breakthrough procedure is offering hope for some people.

Neck Pain

Neck pain can be caused by an acute injury or by chronic overuse of the neck. Pain can result from indirect trauma like whiplash from an auto accident or by rotation and compression of the disc, such as when the force of impact lands on the top of the head. Other people are prone to neck-strain injuries as a result of abnormal posture or normal Òwear and tear.Ó Picture someone sitting at a computer keyboard, straining to see a monitor that is incorrectly adjusted. Whatever the cause, the chief symptom is pain. Additional symptoms may include neck stiffness that can radiate into the lower back, the inability to perform daily work or activities and occasional difficulty with chewing, swallowing and breathing. While the rest of the spine is well protected, the cervical spine is encased in a small number of muscles and ligaments, and therefore, is more vulnerable to injury. Also, the neckÕs normal function requires greater range of motion than does the rest of the spine.

A Common Problem

Degenerative disc disease (DDD) of the cervical spine or neck is a painful condition that strikes more than half of Americans by age 50 and is a more serious cause of neck pain and instability that breaks down the disc that acts as a cushion. When the disc loses flexibility, the compression causes pain with the movement of the head. Many patients find relief with medication or physical therapy. However, instability may indicate a need for surgery.

Surgery always should be considered as a last resort, according to Terence Chen, M.D., medical director of Neurosurgery at John Muir Medical Center - Walnut Creek Campus. ÒWe generally try this surgery only after someone has failed to get results from more conservative treatments like physical therapy, medications and cortisone injections,Ó he says. ÒMost cervical spine problems can actually be treated without surgery.Ó

Until this year, the Ògold standardÓ in surgical treatment has been to fuse the degenerating discs together. While cervical disc fusion surgery has relieved pain in many patients, there is a trade-off of loss of motion and flexibility in the treated vertebral segment, and it can result in more pressure on adjacent segments, causing breakdown over time.

New Implant

Now, select patients with DDD have an alternative to fusion. In July, the FDA approved the first artificial metal disc designed especially for the cervical spine, called the Prestige¨ Cervical Disc.

ÒWe are pleased to offer this exciting new disc-replacement surgery as an option for pain relief and improved motion,Ó says Abid Qureshi, M.D., chair of the Department of Orthopedic Surgery at John Muir Medical Center - Walnut Creek Campus. The technique involves replacing the patientÕs own damaged or herniated spinal disc with an artificial metal disc. The artificial disc potentially can prevent and protect the adjacent discs above and below against degeneration.

The surgery is performed through a tiny, four-centimeter incision in the front of the neck. Patients usually spend just one night in the hospital after this treatment, and recovery is much faster than from traditional fusion surgeryÑa few weeks at most, as opposed to two to three months for fusion. Doctors are optimistic about the promise of this new procedure for the right patients, and even more enthusiastic about what lies ahead. ÒI think weÕre going to see many new changes over the next two to three years,Ó says Dr. Qureshi. ÒSeveral more disc designs will be going for FDA approval in the near future. This is a fast-moving area of medical technology, and we at John Muir Health are proud to be part of these pioneering surgical solutions that carry a huge benefit for our patients.Ó

Selective Surgery

While the new disc-replacement surgery is promising, surgeons say it isnÕt for everyone. ÒThe ideal patient is someone who has isolated, single-level disease and who is still fairly young and has a fairly mobile cervical spine,Ó says Dr. Chen. The treatment isnÕt recommended for people who have multiple levels of disease or who have arthritis, osteoporosis, myopathy (muscle weakness) and other conditions that can cause neck instability. While the new disc replacement surgery has its benefits, long term studies arenÕt yet available. But for those that are good surgical candidates, maintaining full motion and being able to perform simple tasks without pain makes the procedure a worthwhile consideration.

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