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A Primer On Celiac Disease

Almost 3 million people in the United States have celiac disease (gluten intolerance) and only 3 percent know they have it. Those who have this inherited, autoimmune disease suffer damage in the lining of the small intestine, caused by eating gluten and other proteins found in wheat, barley, rye and possibly oats. The disorder is most common in Caucasians and those of European ancestry; women are affected more often than men.

Signs of celiac disease vary, which is part of the reason diagnosis is frequently delayed. Wide-ranging gastrointestinal symptoms include abdominal pain and bloating, diarrhea and constipation, and nausea and vomiting. Treatment is direct and effective: a lifelong gluten-free diet, which allows the intestinal lining to heal.

FYI: Some research suggests an association between untreated celiac disease and reproductive problems, including unexplained infertility and menstrual disorders, but other studies find little or no connection. More research is needed, experts say, before any underlying mechanism is completely understood.

Sources: nlm.nih.gov/medlineplus, womenshealth.gov, celiac.nih.gov

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Our New State-of-the-Art MRI

John Muir Health patients and physicians now have access to the most powerful MRI (magnetic resonance imaging) scanner available for routine clinical use. The new ultrahigh field 3.0 Tesla magnetic resonance imaging (MRI) scanner, which debuted in September 2008 at John Muir Medical Center – Walnut Creek, has twice the magnetic field strength of a conventional 1.5 Tesla MRI. Its high-power magnet increases the resolution of acquired images and decreases the time required to perform a scan.

“The higher field strength allows us to capture more signal from scanning the tissue and that signal is translated by the computer into higher resolution images,” explains Kirk So, M.D., chief of Neuroradiology at John Muir Health. Dr. So likens the new MRI’s boost in imaging capability to that of high-definition TV vs. analog TV. “It gives us much greater detail in imaging, which allows us to detect smaller lesions, earlier—such as brain tumors or plaques from multiple sclerosis—and to see smaller musculoskeletal structures than can be seen with a conventional 1.5 scanner. Improvements in diagnostic imaging of arterial structures of the brain or the extremities will also be greatly enhanced, benefiting patients with peripheral vascular disease and intracranial stenoses or aneurysms.”

The new scanner’s increased capability can also substantially reduce scan times for lengthy exams, such as for breast MRI, adds Dr. So. “A typical breast MRI takes almost an hour,” he says. “John Muir Health’s new scanner can cut down on time that a patient is in the scanner and can make it a more comfortable experience.”

Another exciting advantage of the new MRI is that it will bring techniques that once had been relegated to clinical research into the realm of today’s clinical practice, according to Ira Finch, M.D., John Muir Health’s co-medical director of Angiography and Interventional Radiology. For instance, John Muir physicians will be able to perform tests traditionally offered only at university medical centers, including magnetic resonance spectroscopy and functional MRI.

“The benefits of this state-of-the-art machine make it an incredible asset. Having both this unit and the 1.5T MRI allows us a choice of using the best-suited equipment for different applications. This really sets us apart in terms of what we can offer,” say Dr. Finch.

“The 3T MRI gives us a platform for even newer technology—3T utilization will grow over the years, with the development of new software and hardware,” he adds.

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Prostate Cancer Surgery: Using Robotics

Prostate cancer is often a family affair—affecting not only the diagnosed patient but also the loved ones who care for and about him. That’s why it’s important for women, as well as men, to be informed about the most advanced treatments for the disease that will strike an estimated one in six U.S. men over the course of their lifetime.

Treatment options that offer long-term disease-free survival for men with early stage prostate cancer are prostatectomy (removal of the prostate using open-surgical or laparoscopic procedures) and radiation therapy. Other treatment such as hormone therapy may also be offered to advance overall benefit.

For this article, we are focusing on robotic-assisted laparoscopic prostatectomy because of its potential advantages over open-surgical and standard laparoscopic procedures: more precision, less pain and blood loss, shorter hospitalization and quicker recovery.

At John Muir Health, robotic-assisted prostatectomies are performed with the da Vinci Surgical System. The surgeon sits at a console and directs three robotic hands holding surgical instruments. On the monitor, the surgeon sees enlarged, 3-D images prostate cancer surgery: of the surgical area, transmitted by a tiny camera attached to a robotic arm.

“The main advantage of the robot in these procedures is that with it we can do very delicate reconstructive surgery,” says Stephen Taylor, M.D., a urologist on staff at John Muir Health who specializes in prostate cancer and robotic surgery. “With the tenfold magnification and dexterity of the instruments, we can save the nerves needed for erection—which most men with prostate cancer are worried about—much better than in standard surgery aided by the naked eye. And we do such a precise reconnection of the bladder to the urethra, that there’s much quicker return of normal bladder control. With standard open surgery, it takes men two months to return to strenuous exercise. With robotic-assisted surgery, men are playing tennis and back to normal activity in two weeks.”

Brian D. Hopkins, M.D., a urologist with John Muir Health who specializes in urologic oncology and advanced laparoscopic surgery, is a proponent of the robot’s use in prostate cancer surgery. “The robot allows me to be a better surgeon,” he says. “In appropriate cases, this surgery is the best mechanism we have for getting rid of cancer and preserving quality of life.”

Still, not every patient with prostate cancer is a good candidate for surgery, in general, or a robotic-assisted procedure, specifically. Physicians consider the patient’s age; type and stage of cancer; and levels of PSA (prostate-specific antigen), the telltale protein released by the prostate that’s detectable by a blood test. (Low PSA levels are a sign of a healthy prostate.) Says Dr. Hopkins, “We’re looking for patients whose cancer is localized to the prostate and will derive a benefit from surgery and who have no problems with undergoing anesthesia.” The robotic technique makes it difficult to operate on very obese patients and those who’ve had extensive surgery in the pelvis.

“I try to educate patients as much as possible about the advantages and disadvantages, risks, benefits and outcomes, and also convalescence of any of the options for treatment,” emphasizes Dr. Hopkins. ”Most patients talk it over with their partner, and it’s often a mutual decision.”

For those who have opted for robotics-assisted prostatectomy, Dr. Taylor offers this advice: Choose a surgeon and medical facility with proven expertise in the field. Drs. Taylor and Hopkins and their colleagues have performed more than 500 robotic-assisted prostatectomies at John Muir Medical Center since its da Vinci system was obtained in 2002. “We’re lucky to be one of the first hospital Bay Area to get a robot,” says Dr. Taylor. “It gave us a head start and allowed us to develop our expertise. We have people who come from all over the United States and from other countries just to have robotic surgery here because they’ve heard about our program and our successes.”

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Copyright © 2008 by John Muir Health. WH is published three times a year by John Muir Health as a community service and is not intended for the purpose of diagnosing or prescribing. WH Editorial Advisory Board: American Heart Association and the Office on Women's Health, U.S. Public Health Service. Produced by DCP.