E2
Health
CONSUMER REPORTS INSIGHTS
Need surgery? Pick your doctor carefully.
ven relatively straightforward procedures such as gall- bladder removal or hernia repair can sometimes cause serious complications, so you always want to be in good surgical hands. But the surgeon and hospital staff can be espe- cially important for procedures that are new or unusually complex or that are being done to treat a potentially fatal dis- ease such as cancer. Here are some tips on finding the surgeon and hospital that are best for your situation.
E
MICHAEL SLOAN
Signs of excellence
One indicator is how often sur-
geons and hospitals perform a procedure. That can be vital for operations that are relatively new, such as gastric bypass sur- gery for treating obesity. While many surgeons have started per- forming the operation, not all are equally qualified. A September 2009 study found that the risk of serious complications from the most common form of gastric by- pass surgery fell by 10 percent for every additional 10 cases per year the surgeon had performed. Volume may also be especially
important for unusually compli- cated procedures. For example, a study by researchers at New Hampshire’s Dartmouth-Hitch- cock Medical Center of people undergoing surgery for pancreat- ic cancer found that annual death rates were nearly four times higher for those treated by surgeons who performed the fewest operations than for those who performed this demanding procedure most often. But quantity isn’t the only or
even most important measure of quality. A May 2009 study of
In partnership with
For further guidance, go to ConsumerReportsHealth.org. More-detailed information — including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products — is available to subscribers to that site.
PROSTATE PROBLEMS?
You are invited to an informational lecture on
minimally invasive
Enlarged Prostate
RELIEF WITHOUT MEDICATION
Treatments for Enlarged Prostate
PRESENTED BY GIULIO I. SCARZELLA M.D. Associate Clinical Professor ofUrology George Washington University
Saturday, May 1, 2010 11:00 AM • Education Center Holy Cross Hospital of Silver Spring 1500 Forest Glen Road Silver Spring, MD 20910
call for reservation
1-800-588-4170 301-754-8800
www.dr-giulio-scarzella.com
LETTERS
WHERE TO WRITE:
health-science@washpost.com
The Washington Post, Health and Science 1150 15th St. NW, Washington, D.C. 20071
The deadliest skin cancer
The otherwise informative ar-
ticle “What were we thinking?” [April 20] on the health risks of tanning beds erroneously stated that melanoma “is the deadliest form of skin cancer.” At least one other form, Merkel cell carcino- ma, is more lethal. Approximately 33 percent of
patients diagnosed with MCC die of the disease, compared with about 15 percent of those with melanoma. But it is rare: In the United States, fewer than 2,000 new cases are diagnosed each year.
MCC typically begins as a sin- gle bump that resembles a cyst or blemish. It can develop anywhere on the skin, but most commonly occurs on a sun-exposed area. The same advice on detecting other skin cancers applies to MCC: If you notice something suspicious, have it checked out.
FREE Senior Health Seminars
Frequent Urination? Simple and Effective Solutions for an Enlarged Prostate
Thursday, May 13,2–4 p.m.
If you’ve been changing your lifestyle to accommodate urinary problems, learn about the latest minimally invasive surgical treatments that can reduce the size of the prostate and relieve urinary obstruction without damaging surrounding tissue, resulting in a faster recovery. Presenter:
Ramez Andrawis, MD, FRCS, MSc
Those Aching Feet
Thursday, May 20,2–4 p.m.
900 23rd Street, NW Washington, DC 20037 202-715-4000
www.gwhospital.com
(Next to the Foggy Bottom Metro Station)
Are foot problems putting your independence and well-being at risk? Learn about the diagnosis, treatment and most common foot problems affecting seniors today. Presenter:
Michael S. Stempel, DPM, FACFAS
The Senior Advantage Program is a special membership program exclusively available to adults 65 years and older. For more information or to join, please call 202-715-4263.
Physicians are independent practitioners who are not employees or agents of The George Washington University Hospital. The hospital shall not be liable for actions or treatments provided by physicians.
All seminars are held in the GW Hospital Auditorium.
Seating is limited, so please register today.
1-888-4GW-DOCS
1-888-449-3627
Just remember, even your derma- tologist may have never seen a case of MCC, so be proactive. I learned of MCC from some- one who, thank goodness, got on top of this aggressive disease be- fore it was too late.
STACYHOFFHAUS
Washington
A grandson’s diagnosis
“Living with Tourette’s” [April 13] brought back many memo- ries. My late husband’s twitches were a mystery until our grand- son, Zachary, was diagnosed with Tourette’s and the neurologist took family histories. She in- ferred from our description that he had had the disease, which no doctor had recognized during his life. (One gave him a series of ar- senic doses — in vain.) The disease manifested itself with his excellent focus and through some obsessive-compul- sive behaviors. Actually, partici- pation in sports helped by reliev- ing stress. He played champi- onship tennis into his 60s. He earned a PhD in physics and had a career at the Office of Naval Research, where he achieved international acclaim by developing “over-the-horizon radar,” an early-warning system. He later was chairman of the physics department at George- town University. The neurologist was amazed at his achievement in spite of appar- ent Tourette’s.
BARBARA THALER
Centreville
A bout with Lyme disease
I, too, received a long antibiotic
treatment for probable Lyme dis- ease. The “crushing fatigue and dizziness” you mentioned in “Ticked off, ‘Lymies’ challenge ex- perts” [April 20] are beyond imagining. My illness showed up in the
late 1980s and continued into the early 1990s, initially as sinus in- fections. The extremely severe headaches I had were likely the result of Lyme disease encephali- tis. I also had worsening joint pain.
Ultimately, I went to an ear, nose and throat specialist, who worked with an allergist. He kept me on a series of different antibi- otics for 18 months. It was gru- eling, with continuing severe dry- ness in my mouth, a perpetually unsettled stomach and loose bowels.
But I stuck with it. The head- aches, fatigue and dizziness took a long time to recede. The illness affected my life in deep and lasting ways, and it also strained the people around me.
CAROLE JOHNSON PHILLIPS
Annandale
HEALTH SCAN
MENTAL ILLNESS
Not too young to need a trail guide
“WELCOME TO THE JUNGLE” (CONARI PRESS, $14.95)
Canadian writer Hilary Smith has come through big time with a book about bipolar disorder targeted to teens or 20-somethings experiencing mental ill- ness for the first time. Smith, 24, wrote “Welcome to the Jungle” because it’s the sort of book she said she needed after receiving a diagnosis of bipolar dis- order in her junior year of college. The chapter titles reflect her darkly humorous tone: “Hell Is Finding Good Insurance,” “Voices Not in Your Head: Dealing With Friends and Family” and “Here Be Downers: Drugs, Booze and Suicide.” While the book doesn’t
have much in the way of scientific content or statistics — in fact, she leaves them out on purpose “because the whole point of this book is to make you feel less like a human scorecard and more like a human” — it does have a section on what it’s like to call a crisis telephone line and how to deal with the temptation to go off medication. It even has tongue-in-cheek instructions for putting on your shoes and leav- ing the house.
FITNESS
Thirsting for exercise?
“THE AMAZING WATER BOTTLE WORKOUT” (BASIC HEALTH PUBLICATIONS, $12.95)
Personal trainer Jason S. Greenspan and writer
Lee Noonan teamed up to write this odd exercise manual that substitutes water bottles for dumb- bells. “Water is heavy and, like dumbbells, water bottles come in different shapes and sizes,” accord- ing to the introduction. “Best of all, they are avail-
able EVERYWHERE!” The book is full of clear instructions for stan- dard exercises such as crunches, biceps curls and upright rows; it even includes a section of common mistakes to avoid. But there’s no big dumbbell shortage in this country, nor are they very expensive. They don’t have the potential to leak, and many of them have cush- ioned handles. That said, you can’t drink them when you’re done working out. One point for the water bottle.
— Rachel Saslow
QUICK STUDY
HEART DISEASE
Not all carbs affect the heart equally.
THE QUESTION Might the type of carbohydrates that people con- sume make a difference in the likelihood that they will develop heart disease? THIS STUDY analyzed data on the diets and health of 44,132 middle- age adults who did not have cardiovascular disease. In about an eight-year span, 463 of them developed coronary heart disease. Women whose diets included the most carbohydrates — especially high-glycemic-index carbohydrates, which convert to sugar in the blood very quickly — were more than twice as likely to have a heart disease diagnosis as were those who took in the fewest carbo- hydrates. No link between carbohydrate intake and heart disease was found among men. WHO MAY BE AFFECTED? Women who consume carbohydrates with a high glycemic index, such as rice, white bread, baked potatoes and watermelon. In the United States, more women die each year of heart disease than die from breast cancer and lung cancer combined. CAVEATS Data on food consumption came from the participants’ re- sponses to questionnaires. The authors speculated that the differing results for men and women might indicate that male and female hormones affect the way the body converts carbohydrates to blood sugar.
FIND THIS STUDY April 12 issue of Archives of Internal Medicine. LEARN MORE ABOUT heart disease at www.cdc.gov and www.
mayoclinic.com.
—Linda Searing
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.
81,289 adults who had coronary- artery bypass surgery, for exam- ple, found that success depended more on how well surgeons and hospitals adhered to various markers of surgical excellence, such as using the appropriate technique during the operation and prescribing the right medica- tions before and afterward, than the number of procedures they performed.
And a study of more than
10,700 prostate-cancer opera- tions found that complication rates varied considerably even among those that were per- formed by high-volume sur- geons. The authors concluded that experienced surgeons and hospitals still need to monitor their success and complication rates better and work to improve their techniques and safety meas- ures.
Question your surgeon
Ask your prospective surgeon these questions before going un- der the knife:
Is surgery necessary? The
best way to avoid surgical errors is to avoid surgery entirely, so ask
about the effectiveness and safe- ty of alternatives. Compare those with the risks of surgery and the chance that it will help you.
Is your board certification
up-to-date? Look for a surgeon who has undergone the neces- sary training, even after being in clinical practice, to maintain board certification in his or her specialty. To check on a doctor’s certification status, contact the American Board of Medical Spe- cialties by calling 866-ASK- ABMS or going to www.abms.
org.
What’s your experience? Ask
how many operations the sur- geon has performed in the past year and how that compares with his or her peers. “It’s not that you have to find the busiest, most ex- perienced surgeon in North America,” says Andrew Auer- bach, an associate professor of medicine at the University of California at San Francisco and an expert in surgical outcomes. “It’s more about avoiding the guy who does very few of the pro- cedures, especially in a place that does very few.”
What are your success, fail-
ure and complication rates?
Not all will be able or willing to tell you, but the good ones should be.
What’s the hospital’s infec-
tion rate? Seventeen states now make that information public, and many hospitals report their rates voluntarily. For information on how to find those data, and more on hospital infections, go to
www.consumerreportshealth.org
and click on the “Doctors and Hospitals” tab. You can also find additional information there on how to compare hospitals.
Does the hospital follow best
practices? The federal Centers for Medicare and Medicaid Ser- vices tracks how frequently hos- pitals give antibiotics on sched- ule, control blood sugar in heart- surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications. For details, go to www.
hospitalcompare.hhs.gov
click on “Find and Compare Hos- pitals.”
Copyright 2010. Consumers Union of United States Inc.
KLMNO
V1 V2 V3 V4
TUESDAY, APRIL 27, 2010
What will the overhaul of health care mean for you?
Here’s your chance to find out. A panel of
Washington Post reporters will discuss the new law and its implications at 6 p.m. Monday, May 10, at the Kaiser Family Foundation, 1330 G Street NW. The panelists are the authors of the recently published book “Landmark: The Inside Story of America’s New Health-Care Law and What It Means for All of Us” (Publi- cAffairs). Space is limited. If you would like to attend, send an e-mail giving your phone num- ber and the names of all attendees to
healthRSVP@washpost.com.
The Checkup
6voices.washingtonpost.com/checkup
Sorry, ladies: Viagra for women still a fantasy
After a British study about female sexual response was released on April 13, many of the headlines noted that Viagra for women may be “coming soon.” Not so fast. The study made clear that our understanding of
women’s sexual arousal — and the condition known as female sexual arousal disorder, or FSAD — remains so limited that a Viagra-like discovery isn’t in the immediate offing. Researchers at Pfizer, the company that makes Viagra, used anesthetized rabbits and found that electrical stimulation of the pelvic nerve would lead to engorgement of the female genitals and that an experimental drug would enhance the effect. The drug alone did not cause arousal in the absence of nerve stimulation. The study notes that “the rabbit model we used has not been
validated and the translation of results obtained in the rabbit to humans is currently unknown, especially when one considers that the link between blood flow and subjective arousal remains controversial.”
— Jennifer LaRue Huget
Popular stem cell lines submitted for approval
and
Four human embryonic stem cell lines that are popular among scientists have finally been submitted to the National Institutes of Health for approval under President Obama’s new stem cell policy. The WiCell Research Institute of Madison, Wis., asked the NIH to approve the lines April 13, including one known as H9, which is the most widely used line. Federal funding for human embryonic stem cell research was
restricted during President George W. Bush’s administration. Bush sided with critics who did not want federal funding to encourage the destruction of more embryos to create new lines. Obama lifted those restrictions, but the NIH instituted tough
new ethical requirements on any new lines that might receive federal funding. Officials at WiCell had said it was taking some time to assemble the documentation needed to make it through the NIH’s new approval process.
— Rob Stein
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