Baylor Innovations | Fall 2008

HEAD FIRST Center offers hope for patients with brain Tumors

Exercising with Asthma Baylor’s New Cancer Center Hypothermia Treatment: A Degree Above fall 2008 volume 2 no.4

a publication of baylor university medical center at dallas

Our Mission

Founded as a Christian ministry of healing, Baylor Health Care System exists to serve all people through exemplary health care, education, research and community service.

Our Values

Integrity, Servanthood, Quality, Innovation and Stewardship.

Our Vision

To be trusted as the best place to give and receive safe, quality, compassionate health care.

b a y l o r innovations Baylor University Medical Center at Dallas John B. McWhorter III President

Jana Pope Director of Marketing and Public Relations

Kim Stephens Consulting Editor

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Editorial Office 100 North Biscayne Blvd., Suite 1300, Miami, Florida 33132, (305) 350-5700 Physicians with medical staff privileges at Baylor University Medical Center at Dallas: Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center or Baylor Health Care System. Photography may include models or actors and may not represent actual patients. Web site disclaimer: The Web sites referenced within Baylor Innovations are provided solely for the convenience of the reader. Neither Baylor Health Care System, Baylor University Medical Center at Dallas, nor their subsidiaries, affiliates or community medical centers own these Web sites or control their content or privacy, and the reference to these Web sites should not be construed as an endorsement of the entities that own the Web sites or the information, products or services offered by them. Disclaimer: Information in Baylor Innovations is not intended as a substitute for the personalized advice given by your health care provider. The opinions expressed on the pages of Baylor Innovations are those of the authors and do not necessarily reflect the views of sponsors, editorial board or publisher. Although Baylor Innovations strives to present only current and accurate information, readers should not consider it as professional advice, which can only be given by a health care provider. Although great care has been taken in compiling and checking the information given in this publication to ensure accuracy, the authors, Wax Custom Communications, LP, and Baylor Health Care System, including its subsidiaries and affiliates, and their servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions or inaccuracies in this magazine, whether arising from negligence or otherwise or for any consequences arising therefrom. Legal description: Baylor Innovations is published by Wax Custom Communications. To contact Baylor Innovations, write to 100 North Biscayne Blvd., Suite 1300, Miami, Florida 33132 USA or e-mail [email protected]. Editorial correspondence: For editorial information, contact Fiorella Juarez at [email protected]. Advertising inquiries: For advertising information, contact Mark Collins at [email protected]. If you are receiving multiple copies, need to change your mailing address or do not wish to receive this publication, please e-mail Pamela Acy-Roberson at [email protected] or contact her at Baylor University Medical Center at Dallas, Marketing and Public Relations Department, 2001 Bryan Street, Suite 750, Dallas, Texas 75201, (214) 820-2116. ©2008 Baylor Health Care System, All rights reserved.

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CONTENTS fall 2008

volume 2 no. 4



27

COVER STORY

Head first

Physicians on the medical staff at the Skull Base Center at Baylor Neuroscience Center employ a number of minimally invasive techniques to remove tumors

15



from the hard-to-reach skull base.



SPOTLIGHT ON

15

EXERCISING WITH ASTHMA

Don’t let exercise-induced asthma bench you for good. With proper diagnosis



and preventive medications it is possible to work out and breathe easy.

18

A DEGREE ABOVE

Physicians on the medical staff at Baylor are investigating whether putting

existing technology to new use may prevent hypothermia in trauma patients.

53

Baylor’s NEW CANCER CENTER

Plans to expand the Baylor Sammons Cancer Center mean expanded

27



patient care with up-to-date cancer therapies and a modern, patient-centric



environment.



WOMEN’S HEALTH

16

DEFINING POWER

Testosterone may rev up the male psyche, but women have a power hormone

of their own: estrogen.



Living Well

36

THE TRUTH ABOUT ANTIOXIDANTS

Antioxidants have known healing potential that you can unlock largely

36 6

Baylo r I n n o v a t i o n s : : fall 2 0 0 8



through a healthy, colorful diet, but not all scientists are convinced of their



cure-all powers.



HOT TOPICS

20 THE GAME OF LIFE

Video games may one day (in the not-so-distant future) save lives. Cardiac surgeons are using gaming technology to challenge traditional

open-heart surgery.

24 SOURCING THE PAIN Research linking fibromyalgia to the central nervous system may finally get

11



to the root of the elusive, painful disease.



Mental Health

11

CALM CONNECTIONS

Brain scans reveal why older adults are more likely to go with the flow than

their younger counterparts.

47

THE SELF-HEALING BRAIN

Intense mental exercise and memory training can boost IQ and may provide a

24



drug-free method to treating severe brain injury and developmental disorders.

50

PSYCHOLOGY OF A PACK RAT



Why do you cling to that dusty pile of magazines or blouses that were



stylish a decade ago? Researchers blame hoarding tendencies on the



human brain and hard-wired endowment effect.



Self Care

13

FLIP-FLOP FLOUNDER

Flip-flops may be the go-to for casual footwear, but recent studies suggest

50

8 56 58

the flimsy sandals may also contribute to leg and foot pain.

IN BRIEF GET THE PICTURE CALENDAR

fall 2008 : : Bay l or I n n o v a t i o n s

7

news

In Brief

From the BI Staff

QUALITY OF LIFE IMPROVES FOR AMERICAN TEENAGERS, BUT

was more than 30 pounds, or 15 percent of the subject’s

WORK REMAINS TO IMPROVE LIFE FOR YOUNGER CHILDREN

body weight, versus 2 pounds in the control group. Although

The well-being of teenagers in the United States has

the specialized tastants are not available to the public,

improved on a number of fronts, according to the 2008 Kids

dieters can use similar tactics to add flavor to low-calorie

Count project from the Annie E. Casey Foundation.The report

foods. Strong smells and tastes can trick the body into feeling

documented improvements in the child death rate, teen

satisfied, reducing the amount a person eats.

death rate, teen birth rate, high school dropout rate and the number of teens not in school and not working. However, key measurements for the well-being of infants stayed the same or declined. There was no change in the infant mortality rate, while four areas worsened: low-birth weight babies, children living with jobless or underemployed parents, children in poverty and children in single-parent families. Researchers noted that the percentage of underweight babies born in America has reached the highest point in nearly 40 years.

FITNESS LEVEL, NOT WEIGHT LOSS, HELPS MEN WITH DIABETES ENJOY A LONGER LIFE

Regardless of their weight, men with type 2 diabetes who are physically fit have a greater chance of living longer than their less-fit counterparts. Researchers at two Veterans Administration hospitals studied male veterans with diabetes and rated their fitness as low, medium or high. The subjects also were classified as normal, overweight or obese by body mass index, a measurement of body fat determined using height and weight. Those subjects with the highest fitness

STRONG FLAVORS CAN HELP DIETERS LOSE MORE WEIGHT

level and normal body weight reduced their risk of death

FASTER BY MAKING THE BODY FEEL SATISFIED

by 60 percent, and those who were overweight or obese

Dieters may be able to lose weight faster by using calorie-

reduced their risk of death by 65 percent. Those classified as

free seasonings and sweeteners to feel full and reduce the

obese but in reasonably good shape cut their risk of death

amount they eat. In a study presented at the 2008 annual

by 52 percent, compared with those who had a lower level

meeting of the Endocrine Society, researchers used “tastants”

of fitness. Researchers said moderate exercise, the equivalent

to stimulate the sense of smell and taste in overweight and

of walking 30 minutes a day, five days a week, would offer

obese subjects. Researchers put salt-free savory flavors, such

similar health benefits for people with diabetes.

as cheddar cheese and onion, on salty foods and put sugar-

8

free sweet crystal flavors, such as cocoa, spearmint, banana,

MEN WITH LOW TESTOSTERONE LEVELS LIK ELY TO BE

strawberry and malt, on sweet or neutral-tasting foods. A

UNTREATED DESPITE ACCESS TO HEALTH CARE

control group did not add tastants to foods. Researchers

Men with low testosterone levels may not receive

found that the average weight loss over a six-month period

adequate treatment, according to a study of more than

Baylo r I n n o v a t i o n s : : fall 2 0 0 8

1,000 men published in the Archives of Internal Medicine.

alone in injections. But capsaicin opens pathways into the

Researchers suspect this is because the condition may go

cells, allowing the pain killer to do its work. Researchers are

unrecognized or because of an unwillingness by doctors to

looking for other chemicals that will carry the pain killer

prescribe therapy. Among the 97 men in the study with low

into the cells, because the chili pepper extract causes the

male hormone levels, also known as androgen deficiency,

sensation of heat. They note that this is the first example of

only 11 had been prescribed treatment. However, all the

using the body’s own cellular channels as a drug delivery

men with untreated deficiency had access to adequate

system, targeting treatment only at pain fibers.

health care. Men with androgen deficiency (both treated and untreated) were found to be more likely than men without the condition to receive regular care and visit their doctor more often: 15.1 visits per year for those with untreated androgen deficiency, 12 visits for those with treated androgen deficiency, and 6.7 visits for those without the condition. Symptoms of androgen deficiency include low libido, erectile dysfunction, osteoporosis, sleep disturbance and fatigue.

NEW BIOMARK ERS COULD LEAD TO EARLY DETECTION OF PANCREATIC CANCER

Researchers have moved a step closer to developing a blood test to identify pancreatic cancer in its early stages, when treatments are more successful. Researchers at the Fred Hutchinson Cancer Research Center in Seattle and other centers found five proteins or biomarkers that are linked to pancreatic cancer, the fourth leading cause of

USING THE BODY’S OWN CELLULAR SYSTEM TO CREATE ANESTHETIC WITHOUT NUMBNESS

By combining the chemical that makes chili peppers

cancer death in the United States. By studying genetically engineered mouse models of human cancer, researchers found proteins associated with the disease in humans at an

hot and a specialized local anesthetic, doctors have

early stage. Researchers said the tests for the biomarkers

learned to block pain without causing numbness. Doctors

would be most effective when combined with an existing

at Massachusetts General Hospital used a derivative of

screening

lidocaine, a local anesthetic, and capsaicin, the pain-

biomarker. The combined tests could improve detection of

producing substance in chili peppers. The chili pepper

pancreatic cancer before symptoms are evident. The test

chemical caused channels in nerve fibers to open, and the

could also help distinguish between cancer and pancreatitis,

special anesthetic flowed into the pain receptor cells to

a noncancerous inflammatory condition. Additional studies

block their function. This particular anesthetic, which does

are necessary before biomarkers can be used routinely to

not affect the sense of touch or motor skills, is not effective

identify pancreatic cancer in its early stages.

that

looks

for

another

pancreatic

cancer

fall 2008 : : Bay l or I n n o v a t i o n s

9

NATIONALLY RANKED FOR:

s%NDOCRINOLOGY

s/RTHOPAEDICS



s'YNECOLOGY

s2ESPIRATORY$ISORDERS



s+IDNEY$ISEASE

Baylor. Recognized for 16 consecutive years. Ranked in 5 specialties. Once again, U.S. News & World Report has ranked Baylor University Medical Center at Dallas among “America’s Best Hospitals”. In the recent 2008 issue, they rated Baylor one of the top 50 hospitals in five different specialties – more recognitions than any other North Texas hospital. This means you can always count on us for quality health care. At Baylor, we are committed to developing new treatments through leading research, and are dedicated to serving you, our patients.

For a physician referral, call 1.800.4BAYLOR

BaylorHealth.com

Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community, or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center at Dallas, or Baylor Health Care System. CE BUMC BI 7.08



Mental health

Calm Connections Brain scans show emotional control gets better with age. By Joann Milivojevic

Why, when you’re 25 years old, does a negative situation make you feel like your world is falling apart, yet, when you reach 65, a similar situation musters nothing more than a mere shrug of the shoulders? The answer could be that some neurological connections in your brain get wiser with age. At least that seems to be the case when it comes to controlling emotions, according to a new study. Many older adults have something researchers call the “positivity” bias. It essentially means that they are less bothered by negative situations, so

peered inside the brain to see how different

Brain images of older adults reveal

regions react to emotional stimuli and how

increased interaction between two

those reactions change as we age.

brain regions responsible for emotions.

The study, published in Neurobiology of Aging, included 30 participants; half were around 70 years old and the other half were about 25 years old. Both groups were shown positive, neutral and negative images. While

they stay calmer when younger people can get

this increased interaction between these two

looking at the images, their brain activity was

rattled. Peggy St. Jacques, a researcher at Duke

brain regions.”

measured by functional magnetic resonance

University, says this bias allows older adults to

imaging (fMRI), in which a giant magnet records

images

maximize their emotional well-being. Accepting

brain activity. The fMRI revealed functional

implications for treating people who have

that life is limited motivates older adults to think

differences in how the two groups processed

difficulty with negative emotions. Understanding

of things in a more positive light, according to

the visual information.

more about how the positivity bias works can help

St. Jacques.

Older study participants naturally interpreted less

negatively. This

could

have

“We found that there was increased interaction

researchers better understand and treat clinical

Researchers have long known this to be

between two brain regions in the older adults,”

disorders that involve negativity bias, such as

true behaviorally. But a new study sheds light

explains St. Jacques, “one being the amygdala,

depression and anxiety, says St. Jacques.

on what happens neurologically. Florin Dolcos,

which we know is involved in emotions. The

Ph.D., assistant professor of psychiatry and

other was the ventral anterior cingulate cortex,

neuroscience at the University of Alberta,

which is involved in emotional regulations. One

conducted a study in collaboration with Roberto

of the reasons older adults may show better

Cabeza, Ph.D., and St. Jacques. The researchers

ability to regulate their emotions is because of

POINT OF CONTACT: To learn to manage your emotions and stress without the mellowed benefits of age, visit www.webmd.com and search for “stress management.”

fall 2008 : : Bay l or I n n o v a t i o n s

11

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self care

Flip-Flop Flounder

Could walking in flip-flops be the reason some of us experience foot and leg pain? By CYNTHIA KINCAID

A study conducted by researchers at

Dr. Pfeffer concedes that one of the main

Auburn University in Alabama found that people

reasons for the pain that people experience when

who wear flimsy shoes have an altered gait. And

wearing flip-flops is the lack of foot protection.

this change may account for the lower leg and foot

“They are thin, don’t support the arch, and the

problems people experience after wearing flip-

force of the heel strike is directed right into the foot

flops for long periods of time, says study author

as opposed to being cushioned by a thick sole,”

Justin Shroyer, a graduate student in Auburn’s

he says. “So it’s not surprising that wearing flip-

department of kinesiology.

flops for a whole day is uncomfortable. They were

However, not everyone agrees with the study’s

never designed to be worn for a whole day.”

Wearing flip-flops gives your toe muscles a workout that other footwear doesn’t require.

conclusion. While someone walking in flip-flops

Dr. Pfeffer feels that the leg and calf discomfort

will have a different gait than they would if they

reported by wearers may be due to the extra

were walking in shoes or going barefoot, “flip-

muscle work involved in walking in the shoes.

flops cause us to use muscles that we don’t

“When you walk in flip-flops for a long time, you’re

normally use and, therefore, they cause achy

actually working your foot muscles in a way that

flops every few months and limiting wear time is

pain just the way a good workout does,” says

you never do in [regular shoes],” he says. “When

a good idea. “Flip-flops can break down and get

Glenn B. Pfeffer, M.D., director of the Foot and

you walk in flip-flops, you use your toes more

loose, just like any other shoe,” Dr. Pfeffer says.

Ankle Center at Cedars-Sinai Orthopaedic Center

to hold on and keep the flip-flops in place. That

“Just when they get that worn-in look is when we

in Los Angeles.

increased action is actually an exercise that few

should get worried that they don’t fit properly.”

“I thought [the Auburn University study] made some excellent points,” Dr. Pfeffer says. “But

of us do and is the same discomfort you get from exercising a lot.”

looking at any type of shoe wear and its effect

Whether flip-flop wearers experience pain from

on gait and pain is difficult because there are so

an altered gait or flexing unused muscles, both the

many variables.”

study and Dr. Pfeffer agree that replacing your flip-

POINT OF CONTACT: To learn more about the Auburn University study, visit www.auburn.edu and search for “flip-flop research.”

fall 2008 : : Bay l or I n n o v a t i o n s

13

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SPOTLIGHT

Working out with Asthma People who experience shortness of breath after exercise may be experiencing exercise-induced asthma. By ESTHER M. bauer

Eucapnic voluntary hyperventilation (EVH) is an EIA diagnostic tool endorsed by the International Olympic Committee.

Exercise-Induced Asthma (EIA) is one

air challenge, in which a dry carbon dioxide-

of the most visible manifestations of uncontrolled

oxygen blend is inhaled rapidly to simulate

Heather Moncrief Rivera-Torres, 33, has had

chronic asthma, and the longer and more intense

the effect of exercise without the sweat.

asthma for 15 years and traces her condition to

an exercise session, the more likely it will trigger

Cardiopulmonary

environmental factors. But when she has trouble

an attack. It is believed that EIA is triggered

is another option that evaluates whether

when the airways dry out from inhaling air that

breathing, heart or muscle problems are

doesn’t contain much humidity. EIA is different

limiting exercise.

from allergy-triggered asthma that may cause an asthma attack while exercising outdoors on days with a high pollen count. “Many things can cause shortness of breath, so it’s very important to have an objective diagnosis of asthma, particularly if you are

exercise

testing

(CPET)

Breathing Easier

and likewise reduce asthma attacks.

with asthma, exercise exacerbates it. Until last September, when she moved to Texas from Chicago, her asthma had been under control. But in Dallas, worsening asthma symptoms with exercise sent her to Baylor where

Comprehensive diagnostic testing, including CPET

physicians designed a new program based on

and EVH, allows for a smarter approach to exercise

the results of her testing.

training and its usage in pulmonary rehabilitation sets the Baylor Martha Foster Lung Care Center apart in North Texas, says Dr. Millard.

Today, Rivera-Torres uses a daily maintenance drug and exercises five days a week. “I would encourage people to seek treatment

going to have to take medicine for it,” says Mark

“You might have asthma, but asthma

Millard, M.D., a physician on the medical staff at

and get their asthma under control because it

shouldn’t have you,” he says. “The goal of

Baylor University Medical Center at Dallas and

makes a huge difference in your quality of life,”

asthma therapy is for people to be able to

medical director of the Baylor Martha Foster

she says.

exercise in a meaningful and intensive fashion

Lung Care Center.

without limitation from their asthma.”

Confirming the diagnosis of exercise-

While pre-exercise inhaled albuterol, a quick

induced asthma can involve measurements

relief medication, is often used to avoid EIA,

of airflow and sometimes challenge tests to

daily therapy with an inhaled steroid spray may

reproduce symptoms.

eliminate the need for pre-treatment therapy and

One of the best tests to confirm EIA, endorsed

control non-exercise related asthma symptoms

by the International Olympic Committee, is the

as well. Inhaled steroids, paired with long-acting

eucapnic voluntary hyperventilation (EVH) dry-

bronchodilators, further increase asthma control

POINTs OF CONTACT: For more information on Baylor’s asthma services, visit www.BaylorHealth.com and search for “asthma pulmonary center.” Visit the National Heart, Lung, and Blood Institute’s Web site at www.nhlbi.nih.gov and view the asthma education section by searching for “NAEPP.”

fall 2008 : : Bay l or I n n o v a t i o n s

15

Women’s Health

Defining Power

Estrogen influences power motivation in women. By Joann Milivojevic

What

do you

imagine when you

hear the

words

“testosterone and men”? You might think of muscle-bound body builders or high-powered CEOs gracing the covers of business magazines. Hear “women and estrogen,” and in all likelihood you see less aggressive images. Exploring the sources of power in women is the subject of a recent study from the University of Michigan.

16

The team’s findings suggest that estrogen may be for women what testosterone is for men: the fuel of power.

THE DRIViNG FORCE The role of testosterone as a motivator in men’s drive for dominance has been well documented. Testosterone has also been studied as a potential power-base for women,

The study by Oliver Schultheiss, a psychology professor at

but the results have been inconsistent. Estrogen, however,

the University of Michigan who directs the Human Motivation

is known to play a very strong biological role in women.

& Affective Neuroscience Lab, and researcher Steven Stanton

According to Renee Scola, M.D., an internist at Northwestern

was recently detailed in the journal Hormones and Behavior.

Memorial Hospital in Chicago, hormones such as estrogen

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

The level of estrogen found in the study depended on whether a woman won or lost and her non-conscious desire for power. Contest winners with the greatest desire for power had higher estrogen levels after they won. Losers with a high desire for power showed a decrease in estrogen. and testosterone are like chemical messengers. They are

These findings parallel results in testosterone studies in men

produced in one area of the body and generally travel through

– leading researchers to suggest that estrogen is women’s

the bloodstream to affect different organs.

power fuel.

“One of the main roles of estrogen is regulating menstrual

The sampling of women in the study included women who

and reproductive cycles,” explains Dr. Scola. “It also has

were single, some in close relationships and a mix of those

cardiovascular, bone and central nervous system implications

groups taking oral contraceptives. The study noted that the

– and it does seem to play a role in emotions.”

rise in estrogen was stronger in single women compared

Given estrogen’s strong influence in women, Schultheiss

to women in close relationships. Researchers theorize this

and Stanton set up their study to test saliva levels of the

may have to do with estrogen’s role in a finding a partner:

hormone against women’s non-conscious desire for power.

Those in pursuit have higher levels to spur on their desire

The researchers defined power as a preference for having impact and dominance over others.

THE WINNING HORMONE The study included 49 graduate and undergraduate women who competed in pairs in one-on-one computerized dominance contests. Estrogen and testosterone levels were determined before and after the contests, as well as the women’s non-conscious preference for power. In men, winners of dominance contests show an increase in testosterone levels. Losers, on the other hand, have a decrease in testosterone. The level of estrogen found in the study, however, depended on whether a woman won or lost and her non-conscious desire for power. Contest winners with the greatest desire for power had higher estrogen levels after they won. Losers with a high desire for power showed a decrease in estrogen. Women with a low desire for power did not experience this fluctuation in estrogen levels. Levels measured a day after the contest found that the rise in estrogen remained high in power-motivated winners.

for finding a mate. And unlike women on birth control, those with natural menstrual cycles showed a higher positive link between power motivation and estrogen. “It was quite interesting that if you’re artificially supplementing estrogen, it didn’t really have quite the same effect as sufficient levels of natural estrogen,” says Dr. Scola. “That’s something we don’t quite know. We just can’t artificially give someone estrogen and have it increase their power motivation.” While the clinical applications of this research are not yet clear, it does suggest that estrogen and not testosterone is the power driver for women. And that adds a fresh dimension to this much-studied hormone.

POINTs OF CONTACT: For more information on the ways estrogen affects the female body and emotions, visit www.webmd.com and search for “estrogen.” For Forbes magazine’s 2008 list of the world’s most powerful 100 women, visit www.forbes.com and search for “100 powerful women.”

fall 2008 : : Bay l or I n n o v a t i o n s

17

SPOTLIGHT

A Degree Above

Baylor team investigates repurposing equipment to save trauma patients. By Amy M. Avery

A machine originally used to

Cold can kill. Even in the hot climate of Texas, clinicians have long been challenged to warm patients experiencing life-threatening

induce hypothermia may prove a vital tool in reversing hypothermia in patients experiencing trauma.

hypothermia caused by trauma. But staff at Baylor University Medical Center at Dallas have recently taken

exchange balloons that are inserted into a major vein. Warmed saline in the

on this challenge with their investigation of an innovative approach that has

balloons transfers heat to the blood as it passes over them, warming the core

caught the attention of hospitals and trauma centers worldwide.

of the body rather than just the exterior as most methods do. This ultimately

Oxygen deprivation “When patients lose a large amount of blood – after falls, motor vehicle collisions, assaults and gunshot wounds, for example – they go into

may lead to more lives saved, shorter stays in intensive care and fewer days on ventilators, Baylor clinicians report. As part of the research project, this equipment was used for purposes not approved by the FDA at this time.

hemorrhagic shock and acidosis,” says Michael L. Foreman, M.D., medical

International interest

director of the trauma/surgical intensive care unit and physician on the

The procedure was working so well during the investigation, “we knew we

medical staff at Baylor University Medical Center at Dallas. “As a result of this

needed to get the word out into the medical community,” Dr. Foreman says.

and other factors their bodies cannot rewarm themselves.” The result is a life-threatening chain reaction: slowing of organ function and further reduction in the body’s ability to respond to the crisis.

So a team of clinicians led by Edward E. Taylor, M.D., a physician on the medical staff at Baylor University Medical Center at Dallas, outlined their success in a paper published this spring in Baylor’s Proceedings publication.

“Hypothermia is something everyone in the medical community struggles

The team has already been invited to present findings at national medical

with,” says Dr. Foreman. “This new approach may give us the ability to add

meetings with thousands in attendance. They have also fielded calls from

direct thermal energy to the core of the patient. This is exciting.”

colleagues across the world. “We hope that publishing this article will lead to additional research, and

Warmed to the core

give others one more tool to help desperately ill trauma patients recover,” says

The new approach being investigated stems from repurposing medical

Dr. Foreman.

equipment designed, ironically, to induce hypothermia in patients after cardiac arrest. “But it also rewarms them afterward,” explains Cyndi J. Mastropieri, R.N., manager for trauma services. “It’s working well in patients participating in the investigation, and we’re having great results.” The device warms the body using specialized catheters with heat-

18

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

POINT OF CONTACT: To read the full article, “Active intravascular rewarming for hypothermia associated with traumatic injury,” visit www.baylorhealth.edu/proceedings, click on Past Issues and then Volume 21, No. 2.

We are dedicated to providing advanced treatment options for complex skull base tumors, whether they be benign or malignant. MENINGIOMA

VASCULAR CEREBRAL ANEURYSM

OCCIPITAL AND CERVICAL TUMORS

ORBITAL LESIONS

HEAD AND NECK TUMORS

Introducing The New Skull Base Center at Baylor. Now patients have a valuable resource to treat complex skull base disease. Our multidisciplinary team of health care professionals work together to provide each patient with a customized treatment plan that might involve radiosurgery, interventional neuroradiology or advanced surgical procedures all designed to be as minimally invasive as possible. Our team of physicians on our medical staff consists of: .EUROLOGICAL3URGEONSs(EADAND.ECK/NCOLOGIC3URGEONSs.EURORADIOLOGISTS .EURO OTOLOGISTSs/RBITAL3URGEONSs(EADAND.ECK3URGEONSs2ADIOSURGEONS )NTERVENTIONAL2ADIOLOGISTSs.EURO ONCOLOGISTS

For a physician referral, please call 1-800-4BAYLOR.

1-800-4BAYLOR

BaylorHealth.com

Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center, Baylor All Saints Medical Centers or Baylor Health Care System. CE BUMC BI 7.08

HOT TOPICS

The Game of Life

A pioneering technology from the world of video gaming may revolutionize cardiac surgery. By Mark Cantrell

Although many people think video games are a waste

The technique uses ultrasound, or echocardiography, to

of time, researchers in the cardiac surgery department

look inside the heart and depict its movements in real time.

at Children’s Hospital in Boston would disagree. Using

The use of ultrasound in surgery isn’t new; it has been used

technology borrowed from the world of computer gaming,

for diagnostic purposes since shortly after the end of World

they’ve made it possible for surgeons to peer inside the body

War II. Even 3-D ultrasound imaging has been around for a

without opening the chest cavity, using 3-D technology to

while. The difference, explains Pedro del Nido, M.D., chief

operate within a living, beating human heart.

of cardiac surgery at Children’s, is that the older method

“You feel like you’re really inside the cardiac chamber,

produces only a static image.

working on these moving structures,” says Nikolay Vasilyev,

“That’s great for diagnostic work,” says Dr. del Nido. “You

M.D., a surgeon in the hospital’s department of cardiac

have plenty of time. You can examine any plane and image

surgery. “When you approach them with instruments, you

you want and spend hours going through the data to decide

can actually see the length and depth of the instrument

which is the proper way to view and display it.

much like open-heart surgery.”

“But a surgeon operating on a heart doesn’t have hours.”

Techno-tracking Sound Waves That’s where video-game technology intersects with health care – in the form of stereoscopic glasses and blazing fast, commercially available video cards. But instead of zapping aliens and monsters with various exotic weapons, the technology allows surgeons to navigate the maelstrom that is the interior of a human heart. When married to a high-end ultrasound machine and attached to a computer, the glasses give surgeons a moving image showing them exactly where their instruments are located within the heart’s chambers, displaying the depth needed to precisely target a problem area. Those 3-D glasses aren’t the type you may remember from Stereoscopic glasses resemble 3-D glasses used for IMAX movies, and work to provide an intimate view into the heart.

20

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

old movies, with their headache-inducing red and green lenses. Today’s stereoscopic glasses employ LCD shutters to display alternating images for each eye, offset by a few

Gaming technology allows surgeons to see the precise location of instruments during open-heart surgery.

degrees to mimic the eye’s own binocular vision. If you’ve

Three-dimensional Wizardry

ever watched a 3-D movie at a major theme park or IMAX

In Hollywood, 3-D movies are created using two cameras,

theater, you’d recognize them.

or a camera with two lenses to create a separate image for

When used in cardiac surgery, the glasses give the surgeon

each eye. But in modern ultrasonic imaging, information is

the extra dimension that’s so critical in the placement of

streamed out of the machine in the form of data. Working

instruments. “Depth perception is important because you

with the Children’s Hospital researchers, Robert Howe,

need to know if something is closer to you or farther away,”

Ph.D., came up with a way to essentially split the data in two.

explains Dr. del Nido. “When you advance an instrument – a

First, the ultrasound signal from the machine is captured as

knife or a needle – toward a structure in the heart, you need

a dataset then divided in two – one for each eye. A software

to know if you’re in front of it or behind it, so that you don’t

program called a volume renderer creates two separate images

accidentally collide into it.”

from the data, offset by a certain number of degrees that

fall 2008 : : Bay l or I n n o v a t i o n s

21

HOT TOPICS

“There’s no heart-lung machine and no stopping the heart. So all of that trauma would be eliminated. Recovery is much quicker as well – more akin to recovering from angioplasty than open-heart surgery.” – Pedro del Nido, M.D.

correspond to the distance between each eye. Those images

much more comfortable to visualize the structures and

are then displayed to the surgeon using the LCD glasses. All

gain depth perception. And they’re still comfortable after

of this takes place at a rate of 70 frames per second, faster

two or three hours.”

than most of today’s video games. As reported in the June 2008 issue of the Journal of Thoracic and Cardiovascular Surgery, the team’s early

22

One Giant Leap for Heart Patients Although the 3-D method may be a bit challenging for doctors,

testing on pigs with atrial septal defects, or holes in their

it promises to be a revolutionary boon for cardiac patients.

hearts, was very promising. Dr. Vasilyev managed to place

Consider a typical operation to repair a hole in a patient’s

patches over the holes 44 percent faster than with flat

heart: Under general anesthesia, the chest is cut open at the

imaging techniques. Placement was also more accurate.

breastbone, and the ribs are spread so the surgeon has access

Although the technique is a quantum leap over the open-

to the chest cavity.The patient is put on a heart-lung machine

heart method, there will be an inevitable learning curve for

and the heart is stopped while the operation is completed.

surgeons new to the procedure. “It’s difficult, because you

After the procedure, the heart is restarted and the patient is

don’t have a direct view of the structures,” says Dr. Vasilyev.

taken off the heart-lung machine.

“You’re looking at the heart using 3-D ultrasound data, and

Although this traditional method of cardiac surgery is

that’s not how surgeons are trained to operate. You have to

considered relatively safe and effective, it is still an invasive

get used to the imaging and understand what structures you

shock to the body that carries the risk of several side effects

have on the screen in front of you.”

and complications, such as infection, serious bleeding,

That’s where the stereoscopic glasses really shine, notes

kidney failure and stroke. After the operation, the patient

Dr. Vasilyev: “When you put the glasses on, it’s actually

is generally observed in an ICU for a day or more, and full

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

Nikolay Vasilyev, M.D., a cardiac surgeon at Children’s Hospital in Boston, tests cardiac computer

Image courtesy of Children’s Hospital Boston

gaming technology.

recovery may take three months or longer. During that time, pain and swelling are also factors. “Three-D cardiac surgery eliminates all that,” says Dr. del Nido. “We envision making a small incision on the chest (eventually it may be catheter-based, although we haven’t developed those tools yet) and introducing the instruments

is attempting to take the technology even further. “He’s

directly into the heart. There’s no heart-lung machine and no

working on a way to robotically move the instruments to

stopping the heart. So all of that trauma would be eliminated.

match the heart’s rhythm,” says Dr. del Nido.“To the surgeon

Recovery is much quicker as well – more akin to recovering

looking through the 3-D glasses, it will look as though the

from angioplasty than open-heart surgery.” The benefits of the procedure become even more apparent when operating on a heart valve, says Dr. del Nido, because the surgeon can see the valve in operation, something that’s

heart is not moving at all.” So the next time you see a friend or relative ensconced in a comfy chair immersed in a video game, take heart: He or she may be field-testing the next big medical breakthrough.

not possible with traditional open-heart techniques. “If you have an area of the valve that’s prolapsing, for instance, you can move the leaflet patch to where you think it should go,” he explains. “If it stops the leak, you’ve solved the problem.” Dr. del Nido and his team are currently planning clinical trials, and hope to begin using the technique on a limited basis within the next year. In addition, Dr. Howe

POINTs OF CONTACT: For more information on video game technology and heart surgery, visit the Children’s Hospital of Boston Web site, www.childrenshospital.org, and search for “video game heart surgery.” To learn more about the ways video games intersect with medicine, visit www.msnbc.msn.com and search for “video game surgery.”

fall 2008 : : Bay l or I n n o v a t i o n s

23

HOT TOPICS

Sourcing the Pain

Research links fibromyalgia to the central nervous system.

By Linda Melone

Until recently, physicians relied solely on a patient’s symptoms of muscle and joint pain to diagnose fibromyalgia. “No biomarker of the disease existed,” says Richard E. Harris, Ph.D., research investigator in the division of rheumatology at the University of Michigan Medical School and a researcher at the university’s chronic pain and fatigue research center. “We based everything on a patient’s self-report to tell us how much pain they were in.” However, new research that connects the central nervous system to fibromyalgia may not only provide a biomarker

Fibromyalgia affects more women than men, and its hallmarks are chronic pain and fatigue.

for the disease, but also offer new, effective ways to treat the condition.

24

Chemical clues

Fibromyalgia is characterized by widespread muscular

Researchers at the University of Michigan Health System

pain, fatigue and tenderness. It affects 2 to 4 percent of

recently discovered a link between a brain molecule

the population, predominantly women, according to the

and pain in fibromyalgia patients, shedding light on this

American College of Rheumatology. Although the condition

often-misunderstood condition and its connection to

is considered its own process, people with fibromyalgia

related disorders.

often experience additional maladies, including migraine

The study found that levels of glutamate, an excitatory

headaches, irritable bowel syndrome, temporomandibular

brain neurotransmitter (a nerve stimulant), decreased

joint disorder (TMJ), restless leg syndrome, sensitivity to

when patients were given a treatment designed to reduce

noise and temperature, as well as anxiety and depression.

their pain. “The pain reduction directly correlated with the

Symptoms vary from person to person and in intensity over

reduction in glutamate,” Dr. Harris says.“Our findings suggest

time, often making diagnosis a process of elimination.

that fibromyalgia may be a central nerve biological condition

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

Pain associated with fibromyalgia may stem from high levels of the nerve stimulant glutamate.

drugs work centrally, but through different mechanisms,” says Andrew Holman, M.D., rheumatologist and clinical assistant professor of medicine at the University of Washington. Pregabalin targets neuropathic pain by reducing the number of pain signals produced by damaged nerves. Duloxetine affects production of serotonin and norepinephrine, two that enhances activity in processing pain signals, making

naturally occurring brain substances, and was used as an

people with fibromyalgia physically more sensitive.”

antidepressant before the FDA approved the drug to treat

Previous

studies

with

fibromyalgia

patients

showed

fibromyalgia symptoms.

excitement in a part of the brain called the insula. Based on

“The most intriguing science is in looking at dopamine

their functional magnetic resonance imaging (fMRI) studies,

deficiencies in the hippocampus, an area of the brain that

researchers hypothesized that the increased activity was related

modulates pain and also controls autonomic responses

to increased levels of glutamate. To test their theory, researchers

like fight or flight,” says Dr. Holman. “Associated conditions

used a non-invasive brain imaging technique called proton

like irritable bowel syndrome and anxiety seem to also be

magnetic resonance spectroscopy to measure pain symptoms

managed by the autonomic nervous system and may be

over a period of four weeks. Results showed decreased

linked.” Excessive arousal in the brain stem from a dopamine

glutamate levels that coincided with pain reduction.

deficiency may also be responsible for the inadequate sleep

“Consequently, treatments targeting glutamate pathways may be fruitful,” says Dr. Harris.“The insula is a region known for its involvement in somatic stimuli [sensations from muscles and skin] in addition to internal sensations like the bowel.” This connection may explain an association between fibromyalgia and some of its associated conditions, such as irritable bowel syndrome. “Because fibromyalgia patients have a heightened level of sensory processing, it follows that glutamate may play a role in that,” says Dr. Harris.

First medicines approved As a result of similar research, the Food and Drug Administration (FDA) has approved the first two drugs for the treatment of fibromyalgia: pregabalin and duloxetine. “Both

in fibromyalgia patients, researchers believe.

Managed approach “Fibromyalgia is not a condition where you can do one thing and then you’re done,” says Dr. Harris. “Patients need to be aware of their symptoms and manage them appropriately through medications, cognitive behavioral therapy and exercise.” But this new research gives patients hope and real options for relieving chronic pain.

POINT OF CONTACT: For a physician referral to a rheumatologist, visit www.BaylorHealth.com or call 1-800-4BAYLOR.

fall 2008 : : Bay l or I n n o v a t i o n s

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HeadFirst By Debra Wood, R.N.

Center offers hope for patients with brain lesions

fall 2008 : : Bay l or I n n o v a t i o n s

27

feature

Benign tumors in the skull base often do not present symptoms until they are quite advanced.

physicians on the medical staff at the Skull Base Center at the Baylor Neuroscience Center. “I was scared,” Harris says. “Each doctor told me how difficult it was to get to. But when I found Baylor, the Angela Harris of Cedar Hill, Texas, felt tingling in her arm, and then the left side of her body became numb and weak. She couldn’t walk. At first she thought it might have been a stroke or a heart attack. But her neurologist sent her for magnetic resonance imaging (MRI), which picked up a benign tumor at the base of her skull. The bones of the skull base enclose the brain and separate

get all of it out.” The tumor was located at the back of Harris’s brain, near her pineal gland.The physicians on the medical staff at Baylor successfully removed the tumor and more than a year later, she remains disease free.

Skull base surgery

it from the eyes and oral cavity. Blood vessels supplying

Skull base conditions are rare and include meningiomas,

the brain and nerves that control sight, smell, hearing and

acoustic neurinomas and pituitary tumors that develop

facial function pass through the skull base. Tumors in the

deep inside the head. They often can progress until quite

skull base are difficult to reach by traditional methods, but

advanced without the patient being aware, due to their

physicians on the medical staff at the Skull Base Center at

relatively hidden location. However, as the masses grow,

Baylor Neuroscience Center employ minimally invasive

they can compress nerves in the brain.

techniques to reach and remove such lesions. Harris consulted with several physicians before turning to

28

physicians were confident they could remove the tumor and

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

“Benign tumors can cause a loss of function and death if left unattended,” says otolaryngologist and facial plastic

The bones of the skull base enclose the brain and separate it from the eyes and oral cavity. Blood vessels supplying the brain and nerves that control sight, smell, hearing and facial function pass through the skull base.

surgeon Yadranko Ducic, M.D., a physician on the medical

at Baylor Fort Worth and Baylor Dallas. It brings together a

staff at Baylor University Medical Center at Dallas and Baylor

team of sub-specialists on the hospital medical staffs who

All Saints Medical Center at Fort Worth, and co-medical

focus on a comprehensive range of procedures – including

director of the Skull Base Center.

neurosurgery, head and neck surgery, otolaryngology,

Besides

tumors,

skull

base

specialists

perform

neuro-otology, orbital surgery, neuro-oncology, radiation

procedures to remove vascular lesions, such as cerebral

oncology, radiosurgery, neuropathology and interventional

aneurysms, and repair malformations of the occipital-

neuroradiology – that contribute to an optimal plan of care

cervical junction or shifting of the vertebrae as a result

to preserve a patient’s function and quality of life.

of rheumatoid arthritis. But as with skull base tumors,

“Base-of-skull tumors are difficult to access, and it usually

removing lesions and correcting malformations in this

takes a combination of neurosurgery and head and neck

area presents challenges. “The difficulty is because of the complex anatomy of the skull base,” says Caetano Coimbra, M.D., a physician on the medical staff at Baylor Dallas and Baylor All Saints and comedical director of the Skull Base Center. “Our approach is minimally invasive treatment. It may include surgery and radiation therapy in the form of the Gamma Knife ®.”*

surgery to get them out,” Dr. Ducic says. Surgeons frequently enter through the skull or nose, but sometimes may open the face to reach structures behind it. Several types of surgeons often stand by on cases, ready to assist as needed. Physicians from throughout Texas and the United States refer patients with skull base tumors and malformations to

A team approach to care

the Skull Base Center at Baylor. Other people find the center

This March, the Skull Base Center opened in two locations

on their own.

*Gamma Knife and Leksell Gamma Knife are U.S. federally registered trademarks of Elekta Instruments, S.A., Geneva, Switzerland. fall 2008 : : Bay l or I n n o v a t i o n s

29

feature

More than a year after physicians removed a benign tumor from Angela Harris’ skull base, she remains disease free.

“A lot of the patients we have seen have been told there is nothing that can be done, that the tumors are unable to be removed with surgery,” Dr. Ducic says. “But the tumors are resectable. There is plenty we can do, and there can be problems if they do not have something done.” The physicians on the medical staff at the center evaluate lab tests and existing imaging studies. Then, based on the location and type of tumor, they develop a plan of treatment. Traditional surgery sometimes is not the best option. Some patients may need radiosurgery. The Gamma Knife ® and CyberKnife ® target beams of radiation at the tumor to destroy it, without significantly damaging healthy surrounding tissue. Patients may receive radiosurgery as the sole treatment or in combination with surgery. For an aneurysm, a patient may need interventional

block blood flow to a tumor with a high blood supply before surgery. Such procedures make the operation safer with less blood loss. A cancer patient also may need chemotherapy, possibly in conjunction with surgery. Surgical patients receive a complete workup before the procedure, which may take a couple of weeks. Specific testing depends on the lesion but may include imaging studies to precisely identify locations of blood vessels and nerves.

Approaching the lesion

neuroradiology to place a coil to prevent rupture.

“The skull has different access points from above and below,”

Interventional neuroradiology also may be employed to

Dr. Ducic says.“Above has traditionally required a craniotomy, Continued on page 33

30

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

Baylor’s Comprehensive Neuroscience Center Baylor Neuroscience Center located at Baylor University Medical

endovascular

procedures.

Spine

Center at Dallas specializes in conditions affecting the brain, spine and

surgeons may offer patients with

central nervous system. The center is a comprehensive facility with

disc disease an artificial disc designed

specialists using advanced technologies to diagnose and treat over 600

to preserve motion while decreasing

neurological diseases.

pain. Neurosurgeons may treat patients with

“All the services are covered in one center,” says neurosurgeon David Barnett, M.D., chief of neurological surgery at Baylor University Medical Center at Dallas and physician on the medical staff. “Collaboration is a big part of the neuroscience center.”

Parkinson’s disease with deep brain stimulation targeted to regions in the brain to minimize tremor. Baylor Dallas is constructing a neuroscience inpatient unit to provide specialized care to the neuroscience patient population. The neuroscience

The center offers patients one-stop access to neurologists, neurosurgeons,

unit will offer an area where patients can receive care throughout their stay

neuroradiologists and specialists with expertise in diagnosing and managing

in the hospital without having to move to different nursing units within the

aneurysms, spine disorders, epilepsy, Parkinson’s disease, Alzheimer’s

hospital. A single unit will be able to meet patients’ needs, including critical

disease, brain tumors, sleep disorders and many other conditions. A nurse

care services, epilepsy monitoring, acute care and postoperative spine care.

navigator simplifies access to the Baylor Neuroscience Center’s services

Four new image-guided operating rooms, also under construction as part

and physicians on the medical staff at Baylor University Medical Center at

of Baylor Neuroscience Center, will house the world’s second BrainLAB/GE

Dallas for patients and referring physicians.

intraoperative MRI unit.

“It is a patient-friendly system,” Dr. Barnett says. “Our new nurse

The Baylor Radiosurgery Center offers both the CyberKnife® and

navigator, Keesha Paul, guides patients and referring physicians through

Gamma Knife® stereotactic radiosurgery systems, delivering precisely

our system, creating a smooth transition between providers, diagnostic

targeted radiation to tumors previously considered untreatable with

testing and treatment.”

conventional therapy.

Many patients are referred by their doctor for treatment of a complex

Clinical trials conducted through the center give patients the opportunity

medical condition. Other times, they may have received care at a local

to participate in research that may develop new techniques and approaches

facility, but the cause of their problem remains a mystery, Dr. Barnett says.

to care. Current investigations involve chemotherapy, a vaccine to treat

A full array of diagnostic capabilities, including advanced neuroimaging,

brain cancer and the use of stereotactic radiosurgery. U.S. News & World

epilepsy monitoring and other neurodiagnostic testing helps physicians

Report has recognized the Baylor Neuroscience Center several times as one

on the medical staff at Baylor Dallas nail down the cause and devise a

of the country’s top neurology/neurosurgery programs.

treatment plan. Physicians on the medical staff at Baylor Dallas have been trained to perform advanced procedures. For instance, neurointerventional radiologists regularly treat aneurysms and vascular disorders using minimally invasive

POINT OF CONTACT: For more information about the Baylor Neuroscience Center, visit www.BaylorHealth.com or call 1-800-4BAYLOR.

fall 2008 : : Bay l or I n n o v a t i o n s

31

feature

Baylor’s Neuro-Oncology Program Patients from throughout the Southwest turn to the neuro-oncology

the patient’s initial surgery at Baylor Dallas to stimulate their immune

program at Baylor University Medical Center at Dallas through the Baylor

(dendritic) cells to fight the brain tumor. These dendritic cells are given

Neuroscience Center for innovative and potentially life-prolonging treatment

back to the patient periodically during radiation and chemotherapy in hopes

of brain tumors. Physicians on the medical staff at Baylor Dallas care for

of improving survival further.

patients with brain tumors ranging from low-grade (less aggressive) tumors to high-grade, rapidly growing and malignant lesions.

Dr. Fink is also researching the effectiveness of an approved drug for patients who have recurrent brain tumor. This drug blocks the signal

Patients are usually referred to the neuro-oncology program after brain

the brain tumor sends out to generate a new blood supply to feed

surgery has been done to diagnose the type of tumor and

itself. Dr. Fink uses the drug in combination with the chemotherapy

to remove as much of a tumor as possible. “Surgery

agent carboplatin. More than 60 percent of patients participating in this

can often remove the worst part of the tumor.

clinical research trial have shown an improvement in their MRI scans

But there are almost always residual

after receiving this experimental regimen.This is in contrast with most

tumor cells that require treatment with

treatments for recurrent brain tumors that produce a tumor response only

radiation therapy, chemotherapy or

about 15 to 20 percent of the time. “We are improving quality of life and

both,” says neuro-oncologist Karen

survival for patients, especially for those unfortunate enough to have their

Fink, M.D., Ph.D., a physician on the

brain tumor recur,” Dr. Fink says.

medical staff at Baylor Dallas. “Some

The neuro-oncology program takes a multidisciplinary and collaborative

low-grade patients do well for years, and

approach to treating patients with primary brain tumors. Patients have

don’t require any therapy, but need close

access to neurosurgeons, radiation oncologists, medical oncologists, neuro-

monitoring to catch any deterioration of their

oncologists and radiosurgery specialists to treat their tumor. Rehabilitation

tumor early. Outcomes for patients with higher

physicians and therapists help patients overcome neurologic deficits

grade tumors are better than they have been in years

caused by the tumor or its treatment, and social workers are available to

past, because we have better surgical techniques and better treatments.” An oral chemotherapy agent also has increased survival for patients

assist with disability claims and financial concerns. Baylor also provides access to hospice or palliative care when the end of life nears.

with the most malignant brain tumor, glioblastoma. The agent interferes

Baylor supports the patient and family in every possible way, from

with the proliferation of rapidly dividing cancer cells and is now used in

innovative treatments that offer hope for improved function and improved

combination with radiation therapy to improve the survival rate for patients

survival, and support for the whole person and the whole family throughout

with malignant brain tumors. It has become a standard treatment.

the treatment process.

In addition to traditional treatments, physicians on the medical staff at Baylor may offer patients the opportunity to participate in a clinical trial. Baylor’s neuro-oncology program is enrolling patients with recurrent brain tumor in a trial that uses an oral chemotherapy agent and an investigational growth-factor inhibitor. Baylor is also participating in a trial that creates an “anti-tumor vaccine” by using tumor tissue removed at the time of

32

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

POINT OF CONTACT: For a physician referral visit www.BaylorHealth.com or call 1-800-4BAYLOR.

A skilled skull base surgeon avoids cutting into brain tissue, using focused skull base approaches to reach under the brain. Depending on the location of the tumor, these approaches include an eyebrow incision, small incisions around the ear or entering through the frontal sinus cavity.

an incision in the skull. From below, it’s minimally invasive.” When the surgeon approaches from above the goal is to

The nasal approach avoids any brain retraction and soft tissue trauma.”

remove as little bone as possible – just enough to allow

In other cases, a surgeon may find it necessary to

direct access to the lesion. A skilled skull base surgeon avoids

temporarily remove parts of the face to access the area.

cutting into brain tissue, using focused skull base approaches

Once the lesion is out, the surgeon restores the face,

to reach under the brain. Depending on the location of the

focusing on function and aesthetics. The procedure may

tumor, these approaches include an eyebrow incision, small

take several hours.

incisions around the ear or entering through the frontal sinus

“Sometimes, we have to do fairly drastic things, where

cavity. Use of special instruments with miniature cameras

we open the face like a book to get to tumors behind

allows the surgeon to see tissue inside the skull without

the face or at the base of the brain,” Dr. Ducic says. “Even

opening it.

those [cases] we do with no incisions on the face. They

Alternately, the surgeons may use endoscopes through the nasal passage to remove a pituitary tumor or other lesions, avoiding any retraction or manipulation of the brain.

are all hidden inside the nose or the lip. Patients generally look and feel pretty good after their surgery.” Dr. Ducic explains that human anatomy places almost

“It decreases discomfort and trauma to the bone and

all of the vital parts of the body off center, on the side,

muscle,” Dr. Coimbra says. “Yet it still allows us to navigate

including the eyes, arteries and nerves, which facilitates a

externally, outside the brain, for direct access to the tumor.

central approach.

fall 2008 : : Bay l or I n n o v a t i o n s

33

feature

Vital organs and body parts, including eyes, nerves and arteries, are located off center in the human anatomy. This allows physicians to perform a portion of skull base surgeries through central parts of the face, such as the nose.

“We mobilize the eye sockets, the upper jaw and the lower jaw,” Dr. Ducic says. “We can protect those structures and access the brain with really nothing much vital in our way. Then we put it all back together, rebuilding the nose, the eye sockets and the midface.” Patients are typically discharged within a week. They will eat soft foods for six to eight weeks.

An operative success “I was really blessed,” Harris says. “I knew everybody. My family was there, and I was able to talk. I could remember things. About three days after the surgery, the doctor brought in a newspaper, and I could read. I could walk.” Harris did not even require rehabilitative services. Three months after her surgery, she returned to work performing accounting functions for the U.S. Department of Homeland Security. “It was my first time at Baylor, and I had a good experience,” Harris concludes.

POINT OF CONTACT: For more information about the Skull Base Center at Baylor Neuroscience Center, visit www.BaylorHealth.com or call 1-800-4BAYLOR.

34

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

Living Well

The Truth About

Antiox

Only research can expose real benefits, false claims, future promise. BY AMY M. AVERY

36

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

idants Claims

concerning

the

purported

powers

of

Free radicals, oxidation

antioxidants receive a barrage of challenges from both

Antioxidants work by offering protection from oxidative

published research and the popular press. Motivated by

stress, a condition that occurs when cells are damaged at

scientific curiosity and by concern about unsubstantiated

the molecular level when the body metabolizes, or breaks

claims, scientists and physicians expend great amounts of

down, oxygen. Damage occurs during natural processes such

energy to unlock the secrets of antioxidants.

as digesting food and metabolizing medications, and from

With all the data for and against antioxidant claims, understanding what the medical community knows and

pollution, pesticides and even sunlight. These damaged cells, called free radicals or oxygen-free

Identifying actionable information – research that is

radicals, are missing an electron, which they attempt to

meaningful on an individual level – is more difficult still.

replace from healthy cells.When healthy cells lose an electron,

But researchers and clinicians are intrigued and excited

they can become open to disease processes by causing

about how antioxidants, oxidative stress and free radicals

extensive damage to proteins, membranes and DNA. Research

the knowledge. “Because of all the published reports and claims,

O

exposure to environmental toxins such as cigarette smoke,

does not know about antioxidants is not a simple matter.

impact health, and they want the public to benefit from

O

focuses on when, where and how antioxidants either stabilize the free radicals or prevent them from causing harm at all.

Research, treatments, cures

some people are desensitized to antioxidants and their

Even a quick review of clinical research reveals dozens

benefits,” says Peter Campochiaro, M.D., Eccles professor of

of peer-reviewed studies debunking the broad cancer-

ophthalmology, researcher and practicing ophthalmologist

prevention claims of antioxidants such as vitamins C

at Johns Hopkins University Medical Center.

and E and coenzyme Q10, for example. Research has also

“Researchers have identified very clear fingerprints of

revealed surprising evidence that supplements with beta-

oxidative damage, and they’ve demonstrated that certain

carotene, another antioxidant, can actually cause harm to

antioxidant treatments can reduce the progression of

people who smoke. And though the antioxidant lycopene

specific eye disease, for example,” he says. “Research into a

has been touted for prevention of prostate cancer, research

wide variety of antioxidant treatments is exciting.”

has not corroborated the claim.

fall 2008 : : Bay l or I n n o v a t i o n s

37

VA L E T

P R I VAT E ,

PA R K I N G .

LUXURIOUS

IMPECCABLE

SUITES.

SERVICE.

Think Of It As A Five-Star Physical Exam.

A Program of the Baylor Health Care System

Comprehensive health and fitness assessment

From the minute you arrive for your Personal Edge Assessment at Baylor, you’ll find the treatment first class all the way. It begins with your own well-appointed examination suite where you can conduct business or just relax throughout the day, enjoying the ultimate in privacy and comfort. Of course, you’ll receive a thorough medical physical and fitness assessment. And should the results indicate a need for further care, you’ll have prompt access to an appropriate specialty physician. To make an appointment, please call 214.363.2745 A program of the Baylor Health Care System 411 North Washington, Suite 3000, Dallas, TX 75246 www.personaledgehealth.com

Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers nor Baylor Health Care System. ©2008 Baylor Health Care System CE-PE BI 2.08

LIVING WELL

Beta-Carotene C40H56

A diet rich in beta-carotene may help prevent macular degeneration, but other research suggests the antioxidant could be dangerous to smokers.

Reports such as these are common, but other clinical

nutrients, plays a role in improving visual function. The large

research demonstrates positive outcomes for people with

and important Age-Related Eye Disease Study (AREDS) by the

certain diseases who use specific antioxidants or who

National Institutes of Health also found that highly regulated,

combine antioxidants with certain minerals.

clinical doses of vitamin C, vitamin E, beta-carotene, zinc and

Broad implications Concerning his published research on retinitis pigmentosa, an eye condition that can lead to blindness, Dr. Campochiaro notes the “link between oxygen and photoreceptor damage, as well as the potential of antioxidant treatment ... that may help to protect patients with retinitis pigmentosa.” This link offers widespread promise, he says. Despite the hundreds of mutations that are responsible for the death of rod photoreceptors in the eyes, oxidation is a common factor leading to cone cell death in retinitis pigmentosa. “Stopping oxidative damage – and so preventing cone cell death – would prevent the most debilitating aspects of the disease,” Dr. Campochiaro says. “Antioxidants can provide a treatment.”

Vitamins and minerals

copper together reduced progression of the disease by 25 percent and vision loss by 19 percent. Research continues in a range of other medical specialties, targeting conditions such as prostate cancer and heart disease. Like AREDS, many studies are examining the synergies between multiple factors, versus the power of a single antioxidant.

Studies of synergies “It is possible that antioxidants, as found in fruits and vegetables, act synergistically, rather than individually,” says Aditya Bardia, M.D., M.P.H., a physician and researcher at the Mayo Clinic. Several studies support this idea. • One study suggests a protective effect of the antioxidant gamma-tocopherol, part of the vitamin E family, in reducing risk of prostate cancer.

In a study of age-related macular degeneration, another eye

• A single trial in which vitamin E was combined with

disease that can lead to severe vision loss, a trial concluded

omega-3 fatty acids showed increased survival of patients

that the antioxidant lutein, a carotenoid, or lutein with other

with various malignancies.

fall 2008 : : Bay l or I n n o v a t i o n s

39

Living Well

Damage occurs during natural processes such as digesting food and metabolizing medications, and from exposure to environmental toxins such as cigarette smoke, pollution, pesticides and even sunlight.

• Another trial showed a reduction in occurrence of new

“From our research, we concluded that antioxidants

tumors in patients with bladder cancer who took a specific

overall are probably not helpful in supplement form,”

tuberculosis vaccine combined with vitamin C.

he says. “Beta-carotene was actually found to be harmful

• Two studies suggest benefits in combining certain antioxidant vitamins, including E and C. One showed

“On the positive side, selenium might be helpful for males,

delays in the progression of Alzheimer’s disease, and

particularly for prevention of prostate cancer. However, more

the other showed reductions in the risk of coronary

evidence is needed before selenium can be recommended

heart disease.

for general use, but a large trial assessing this is currently

In contrast to these results, however, other researchers

under way.”

concluded from a randomized controlled trial of women that vitamin E supplements alone provide no overall benefit for either cardiovascular disease or cancer.

40

for smokers.

Clear direction Today, antioxidant research provides more direction to scientists and perhaps the family physician than it does

100,000 patients

to people interested in embracing antioxidants for their

In the interest of clarifying the facts behind antioxidants

own preventive or curative powers. Even when studies

and cancer, Dr. Bardia led a research team to perform a

show strong evidence of antioxidant benefits, few lead to

systematic review of all randomized clinical trials that had

specific recommendations about when and how much of

assessed the efficacy of antioxidants for cancer prevention.

an antioxidant to take and in what form.

After reviewing a dozen trials that involved a total of more

“It’s hard work to determine which is the most effective

than 100,000 patients, Dr. Bardia and his colleagues found

dosage and from which source,” says Dr. Campochiaro. “But

surprising results.

translational research, research that provides actionable

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

Attention, Class

Understanding the classes of antioxidants and the foods associated with them is the best way to pack a power lunch.

Antioxidants fall into various groups, called classes. A quick review of the chart below shows the variety of foods that have antioxidant benefits. It also reveals the complexity of information required for you to bring the best mix of antioxidant-rich foods to your dinner plate or lunchbox. Researchers and physicians realize that these unfamiliar names can make it difficult to absorb this level of detail, and they have proposed simpler classifications – sometimes based on food color – to help the public apply this information to their grocery shopping lists and restaurant menu choices. Further complicating the issue, antioxidant classes are still being discovered,

and research continues on how specific foods and/or specific antioxidants interact in beneficial – or harmful – ways.

Understanding the research Until scientists agree on a common nomenclature and as they publish new information, becoming familiar with the classes and subclasses of antioxidants can help you to evaluate and apply the research. Today, experts agree that the best way to gain the greatest variety of antioxidants, each of which offers different benefits, is to eat a variety of foods from these groups:

Select antioxidants, antioxidant classes and where to find them* Class/Components Food Sources Potential Benefit Carotenoids, such as betacarotene, lutein, lycopene

Beta-carotene: carrots, some fruits Lutein: kale, collards, corn, eggs, citrus Lycopene: tomatoes (cooked and raw)

Beta-carotene neutralizes free radicals and bolsters cellular antioxidant defenses; lutein may contribute to healthy vision; lycopene shows promise to reduce prostate cancer risk

Flavonoids, such as anthocyanidins, flavanols, flavanones, flavonols, and proanthocyanidins

Anthocyanidins: berries, red grapes, cherries Flavanols: tea, cocoa, onions, broccoli, apples, tea Flavanones: citrus Proanthocyanidins: wine, peanuts, cinnamon, berries

Flavonoids neutralize free radicals and bolster cellular antioxidant defenses; anthocyanidins may contribute to brain health; flavonols to heart health; flavanones bolster cellular antioxidant defenses; proanthocyanidins to urinary health

Isothiocyanates, such as sulforaphane

Cauliflower, broccoli, broccoli sprouts, cabbage, kale, horseradish

May enhance detoxification of undesirable compounds and bolster cellular antioxidant defenses

Phenols, such as caffeic acid and ferulic acid

Apples, pears, citrus fruits, some vegetables

May bolster cellular antioxidant defenses

Sulfides/Thiols, such as diallyl sulfide and allyl methyl trisulfide and dithiolthiones

Garlic, onions, leeks, scallions, and cruciferous vegetables such as broccoli, cabbage, bok choy, collards

May enhance detoxification of undesirable compounds and contribute to heart health and a stronger immune system

Whole Grains

Cereal grains, whole-wheat bread, bulgur wheat, oats

May reduce risk of coronary heart disease and cancer; may contribute to reduced risk of diabetes

Samples of antioxidant vitamins and minerals Vitamin A

Liver and other organ meats, eggs, sweet potato, spinach, dairy products, fish

Protects cells from free radicals

Vitamin C

Bell peppers, citrus fruits, guava, kiwi, strawberries

Protects cells from free radicals

Vitamin E

Oils, fortified cereals, sunflower seeds, mixed nuts, turnip greens

Protects cells from free radicals; helps with immune function and DNA repair

Selenium

Brazil nuts, red meats, tuna, plant foods, grains, garlic, liver, eggs

Helps prevent cellular damage from free radicals and can increase the body’s natural production of antioxidants

*Chart adapted from International Food Information Council, Functional Foods Fact Sheet: http://www.ific.org/publications/factsheets/antioxidants.cfm and other sources.

fall 2008 : : Bay l or I n n o v a t i o n s

41

Living Well

Caffeic Acid C 9H 8O 4 OH

O OH

OH Caffeic acid in foods such as pears, basil and tarragon may bolster cellular defenses.

information for patients, is critical to determine what is

Color codes

most effective for patients.”

In part because of their antioxidant content, the Mayo Clinic

A further problem in creating translational research is

places several foods on its top 10 list: apples, almonds,

that the public today does not have access to regulated

broccoli, blueberries, red beans, salmon, spinach, sweet

supplements. Those used in clinical trials are tested for

potatoes, vegetable juice and wheat germ.

purity; those in the general marketplace usually are not. This

Nutritionists note that some types of antioxidants are

creates great variances in content from brand to brand, with

found in foods with distinct colors. Perhaps most well known

sometimes 100-fold differences in active ingredients.

blueberries, blackberries and purple grapes, plus eggplants.

Definitive advice

Other hints for antioxidant-rich foods are the reds of cherries

While the use of supplements is open to much debate,

and tomatoes, the orange of carrots and the yellows of corn,

studies have determined that certain foods do prevent

mangos and saffron.

cancer, Dr. Bardia says. “I encourage people to eat lots of fruits and vegetables,” he says. “They have many beneficial effects, not just for cancer, but for heart disease, diabetes and other diseases.” Many federal and private organizations concur and

42

today are antioxidants found in bluish-purple fruits like

Focus on the future Top researchers call for more study to understand how dietary antioxidants are absorbed and metabolized and how these processes change as people age. Today, multidisciplinary teams bring in the expertise of researchers in the fields

offer definitive advice. The American Heart Association,

of

American Cancer Society, National Cancer Institute and

and molecular biology to better define the relationships

the Food and Drug Administration all recommend diets

between nutrition and health.  Through such teams, an

high in fruits and vegetables.

impressive body of translational research is under way.

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

nutrition, biochemistry, physiology, epidemiology

The Cure for the Common Shopping Experience.

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Living Well

The Spice of Life

Variety in diet offers the broadest benefits of antioxidants. When it comes to antioxidants, researchers agree with Mom:

Antioxidant-rich food choices

Eat a variety of fruits and vegetables. Though the body produces its own

• Snack on a bowl of berries of any color. Good antioxidant sources are

antioxidants to some degree, it relies on food intake to provide the levels

blueberries, blackberries, strawberries, raspberries and cranberries.

needed to prevent or limit the oxidative stress that leads to disease. Clinical trials do not support dietary supplements as a beneficial source of antioxidants, except in people with a confirmed deficiency. Instead, researchers, physicians and nutritionists all recommend daily intake of foods that are high in antioxidants.

pineapple, oranges and kiwi. • Eat a savory soup or side dish of legumes, including pintos, along with black, small red and kidney beans. • Pile on vegetables of all colors: artichokes, spinach, red cabbage, red or white potatoes (with the peels), sweet potatoes and broccoli.

A natural bonus Not only do fruits and vegetables deliver more antioxidants than any supplements can, they also provide beneficial fiber, protein, vitamins and minerals – usually in a low-fat, low-cholesterol form. More research is needed to determine whether the body benefits more from antioxidants in one food over another or in combination with other foods. Therefore, experts in a variety of fields – from cancer research and nutrition to cardiovascular health – are also united in their recommendations to eat a variety of foods to get the most effective daily dose of antioxidants. As a matter of fact, the U.S. Department of

44

• Make a fruit salad of apples, avocados, cherries, pears, plums,

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

• Give recipes an antioxidant boost by adding ground allspice, cloves, cinnamon, garlic, ginger, rosemary, oregano, saffron, sage, thyme and turmeric powder. These have some of the highest levels of antioxidants of all foods. • Wash the antioxidants down with green tea, coffee, fruit juice or a moderate amount of red wine. • For breads and cereals, concentrate on oat-based products. • Add a few nuts to the mix, including almonds, hazelnuts, pecans, pistachios and walnuts. • Top off a good meal with a small piece of dark chocolate.

Agriculture recommends eating the right

Admittedly, researchers call for more study to determine the effective

foods with every meal, since antioxidants

dosages of antioxidants, but “regular use [of a variety of foods] offers a

can neutralize free radicals generated

wide array of bioactive substances that have nutritional value,” according

during the very act of digestion.

to a recent Mayo Clinic report.

Nutritionists note that some types of antioxidants are found in foods with distinct colors. Perhaps most well known today are antioxidants found in bluish-purple fruits like blueberries, blackberries and purple grapes, plus eggplants. Bioavailability is one area of current research that explores how easily the body can use vitamins, minerals, antioxidants

has excited this area of exploration. Though promising, the field is in its infancy.

and more, and under what conditions. The U.S. Department

Gerontologists, health care professionals who work with

of Agriculture (USDA) supports research in this area through

older adults, are also exploring the relationship between

studies in six different human nutrition research centers

oxygen free radicals, antioxidants and aging, including the

across the United States.

role of DNA mutations.

Cornucopia of research Tufts University, for example, is undertaking several studies. Researchers there are exploring the bioavailability, pharmacokinetics and antioxidant capacity of plant extracts; vitamin A status related to plant carotenes and dietary fat; antioxidant therapies and stroke; and the relationships between diabetes, exercise and oxidative stress. Other USDA studies are exploring bioavailability as it relates to a person’s age; the relationship between coronary artery disease and cranberry juice; DNA damage in smokers who ingest almonds; consumption of oats and herbal teas;

The sheer number of antioxidant classes, foods and potential benefits offer a wide range of potential research topics, and, hopefully, of greater and more specific information everyone can use to improve their health. (See the sidebar on page 41 to learn more about specific antioxidants.) “I look forward to the day when I am able to tell all of my patients that we’re engaged in clinical trials to determine the optimal antioxidant regime for their diseases,” says Dr. Campochiaro. For his field of ophthalmology, he offers hope that such research will begin as early as next year.

and reduction in blood pressure and insulin resistance with cocoa.

Free radicals, genomes A new area of research explores the interrelationship

POINTs OF CONTACT: For more information on antioxidants, visit www.nutrition.gov and search

between human genetics, diet and chronic diseases. Since

for “antioxidants.”

free radicals in the absence of effective antioxidants create

Or visit the U.S. National Library of Medicine Web site, www.nlm.nih.gov,

mutated cells and mutated DNA, the Human Genome Project

and search for “antioxidants.”

fall 2008 : : Bay l or I n n o v a t i o n s

45

“Pain Free” “I came in unable to walk,” Mike Holley says. “They fixed me.” Mike was experiencing debilitating pain from a degenerative disc. At Baylor, he had spinal discectomy and fusion, complex procedures for treating conditions of the spine. Specialists on the medical staff at Baylor University Medical Center at Dallas are skilled in advanced spine care solutions. Now Mike is free of pain and free to enjoy life. “I’m here because of what Baylor did for me and I’ll personally never forget that.” 3 5 0 0 G a s t o n Ave. D a ll a s , T X 7 5 24 6 1.8 0 0.4BAY LOR w w w.BaylorHealth.com Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center or Baylor Health Care System. CE BSC BI 7.08

mental health

The Self-Healing Brain Increasing fluid memory through mental exercise

may heal the brain and boost intelligence. By linda melone

Rebuilding memory in those with cognitive impairment, improving IQ, and relieving psychotic symptoms in individuals with chronic schizophrenia – all without drugs – summarizes some of the promising new research on brain plasticity. “We now understand that the brain is continuously making adjustments,” says Michael Merzenich, Ph.D., professor emeritus at the University of California San Francisco. “Every time you acquire a new ability, it’s accounted for by physical and functional changes in the brain. It’s a different brain than before you had this ability – you’ve changed the local [neural] connectivity. Conversely, a functional loss is also expressed by changes in the brain.”

When you acquire new skills, you form new neural connections in your brain.

Through various stimuli or lack of stimuli, these changes may also be reversed or improved over time. “At any point

wiring, indicating a possible degradation or even severing of

in time, the brain can drive itself in a corrective direction,”

a pathway connected to memory.

Dr. Merzenich says. Based on this platform, he and other

We associate learning and exploring with youth and

researchers prove verifiable – and often astounding –

young adulthood, a time to discover and learn new things.

results from what was once considered soft science. “We

On the other hand, older adulthood is linked with memory

now know we can get the brain to correct itself if that’s

loss and other symptoms signaling a slowing down of

possible in a particular case, which it is in many situations,”

cognitive abilities. “Normal aging may bring about substantial

says Dr. Merzenich.

operational degradation of the brain,” says Dr. Merzenich.

Defining Plasticity Plasticity, as it refers to the brain, describes its ability to respond to new circumstances and to new learning. Gray matter can shrink or thicken and neural connections may be created, weakened or destroyed. Learning how to play

“You’re less precise and your memory slows as your brain becomes less efficient. You don’t process what you hear, see and feel as well as you once did.” But the new research shows that, given the right stimulus and conditions, even the aging brain can grow.

a new musical instrument or studying a new dance step,

Plasticity-Based Treatment

for example, forges new “wiring,” or neural pathways in

Based on knowledge of the brain’s plasticity, scientists

the brain, reflecting a change in the physical brain itself.

are finding great success with drug-free techniques

Forgetting a person’s name reflects a different change in

that help the brain to heal itself. These techniques

fall 2008 : : Bay l or I n n o v a t i o n s

47

MENTAL HEALTH

Crystallized intelligence, also known as long-term memory, draws on existing skills, knowledge and experiences to solve problems or access information. Fluid intelligence, on the other hand, relies on short-term memory and constitutes working memory.

rely on the retraining of the brain through repetitious,

an increase in fluid intelligence and an improvement in

challenging activity. In an era where drug side effects and

general intelligence as measured by IQ tests. Although they

adverse reactions coincide with our increasing reliance

say further studies are needed, the researchers surmise that

on medications, it’s exciting to think the next great

this type of memory training may also help children with

breakthrough may come from a less-invasive source, notes

developmental problems and adults facing memory decline.

Dr. Merzenich.

Part of brain health and the prevention of cognitive and

Research led by Swiss post-doctoral fellows Susanne M.

memory decline includes a diet rich in nutrients such as

Jaeggi and Martin Buschkuehl, working at the University of

omega-3 fatty acids, vitamin E, antioxidants and folic acid.

Michigan Ann Arbor, demonstrates the plasticity or fluidity of

For example, “DHA [docosahexaenoic acid], found in fish, is

the brain when it comes to IQ testing. Studying a person’s IQ,

also the primary fatty acid found in the brain,” says Andrea N.

or intelligence quotient, involves measuring a combination of

Giancoli, R.D., M.S., spokesperson for the American Dietetic

crystallized and fluid intelligence. Crystallized intelligence,

Association. A study published in the journal Archives of

also known as long-term memory, draws on existing skills,

Neurology showed a 10 percent slower decline in cognitive

knowledge and experiences to solve problems or access

abilities in people who consumed one fish meal a week;

information. Fluid intelligence, on the other hand, relies on

those who consumed two or more fish meals a week

short-term memory and constitutes working memory. We rely

experienced a 13 percent slower decline. “If you eat fish

on fluid intelligence to recall phone numbers or memorize a

for heart health, you’re likely helping your brain health as

piece of information for a short time.

well,” Giancoli says.“It’s best to eat a variety of fish, although

Jaeggi and Buschkuehl studied four groups of volunteers

salmon and sardines have the highest levels of omega-3s;

using a complex training task, offering both auditory and

strive to eat five ounces of omega-3-rich fish a week.” In

visual cues used to train their working memory. Half-hour

lieu of salmon, flaxseed and walnuts also contain healthy

sessions were held once a day for eight, 12, 17 or 19 days.

amounts of omega-3s.

The trained groups not only improved significantly from the

Moreover, antioxidants, such as those found in fruits and

control group, but gains in intelligence increased according

vegetables, may also help slow down the breakdown of

to the length of time trained.

brain cells; berries contain particularly high amounts of

The findings showed that memory task training led to

48

Role of Nutrition

Fluid Intelligence

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

antioxidants. Flavanols, found in cocoa, are also reputed to

have brain-healthy properties, as does folate (folic acid), present in dark green leafy vegetables like kale, spinach and collard greens. (Learn more about antioxidants on page 36.) A low-fat diet with the addition of these healthy foods may help prevent or slow down rates of cognitive decline due to

A person’s IQ is based on crystallized and fluid intelligence. And brain training to boost the brain’s plasticity also increases a person’s IQ.

normal aging.

Help for Abnormal Brains

so far is substantial and all directed towards renormalization,”

In severe cases of age-related cognitive decline, plasticity-

says Dr. Merzenich. “Although it’s still a work in progress,

based approaches work well, as noted previously. Yet

the training is better and more effective in its impact than

research in patients with schizophrenia and other genetic

anything else done thus far.”

and trauma-induced brain abnormalities has shown that the

In addition, the results appear well sustained and enduring.

plasticity approach also yields dramatic improvements in

“We may still need to assess behavior over time, and some

these populations.

patients may need additional training later on to maintain

Scientists at Yale University and the University of California

their abilities,” notes Dr. Merzenich. “But you could never do

San Francisco recently conducted large trials among patients

this with a drug.” He cites similar results with those suffering

with chronic schizophrenia. The technique uses a complicated

cognitive loss from chemotherapy, AIDS, Lyme disease, West

form of training, addressing problems in the frontal lobe

Nile virus and brain infections. “We’re developing strategies

that relate to how the brain records working memory

customized to each one of these conditions and have had

(fluid intelligence). “Basically, with schizophrenia, the brain is

significant results we can see by imagery or elemental

poisoned by an overexpression of two chemicals: dopamine

psychophysical measures,” he says. “We want people to see

and noradrenaline,” Dr. Merzenich explains. “This causes the

this as medicine. We’re teaching the brain to fix itself.”

person to lose track of associations across time – they don’t know if they did something or someone else did. We try to rebuild that working memory by doing things that strengthen these associations.” In its current form, the training takes around 100 hours, with

Points of Contact: For memory-building techniques you can practice on your own, visit:

patients sitting in front of a computer in one-hour sessions.

www.mayoclinic.com and search for “memory exercise” or

The results: “Every imaging, every blood chemistry test done

www.mindtools.com and search for “memory tools.”

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49

MENTAL HEALTH

Psychology of a Pack Rat What’s mine is better than yours. By Cynthia Kincaid

50

Do you ever wonder why you might not

New research highlights the neuropsychological

than items that do not belong to them, even if

be able to throw anything away? Are your

connection people have to their possessions,

they have owned the objects for only a short

garage and closets bursting from all the things

especially when they anticipate the possible

time. “When you get something, you just

you have collected over the years: old college

loss of those belongings. The study, published

can’t stand the thought of losing it. People

T-shirts, out-of-date clothing, sports equipment

in Neuron, found that people tend to prefer

don’t like the thought that they might be

and rarely used furniture gathering dust? A new

things that they own. They believe their

deprived of that thing,” says Brian Knutson,

study just might have the answer.

possessions have more positive features

Ph.D., study author and associate professor

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

“This isn’t some parlor trick that psychologists play on people, this is a real effect that influences how efficient people are with their market transactions, and it can cost them a lot of money.” – Brian Knutson, Ph.D.

of

psychology

and

neuroscience

at

Stanford University. This phenomenon is known as the

no difference in how long they had owned

their market transactions, and it can cost them

these things; they had just gotten them,” Dr.

a lot of money.”

Knutson says.

Dr. Knutson points to examples such as the

“endowment effect” and can sometimes

While the buying and selling went on, Dr.

costs that people incur when selling houses or

result in self-sabotaging behavior. “People

Knutson had his subjects’ brains scanned

cars or when moving ratty, out-of-date furniture

ask for twice as much to sell something as

to determine activity in different parts of

across the country because they simply can’t

they would pay to buy that same thing,” says

the brain. “Our hypothesis was that people

part with it and paying storage fees every

Dr. Knutson. “This effect exists regardless of

wouldn’t want to lose what they had, and that’s

month for items they are unwilling to sell or

market conditions.”

why they jacked up the asking price,” says Dr.

give away.

Study Design To conduct the study, Dr. Knutson gathered a group of people and gave half of them mugs and half of them pens of equal value. He then asked how many would like to trade. “In a class of 100 to 200 people, only a handful of people wanted to do the trade,” he says. During the study, Dr. Knutson’s subjects also bought and sold items such as noisecanceling headphones, iPod® Shuffle music

Knutson. “The other theory was that they would

Because of the endowment effect, Dr. Knutson

like what they had better and that would jack

advises hiring a real estate agent to sell your

up the price.” Dr. Knutson found evidence for

next home. “They don’t feel the pain of selling

the first hypothesis. “When people looked at

your house that you feel,” he says. “It’s their job

objects that they might sell, especially if they

to get you halfway in meeting the buyer, who is

liked those things to begin with, we saw more

probably going to undervalue your home.”

activation in areas of the brain associated with

He offers the same advice for other types of

anticipating loss. But we didn’t see any more

transactions as well. “If you have something

activation in the area of the brain associated

valuable, and you want or need to sell it, it might

with anticipating gain.”

be wise to have someone else sell it for you. They may do a better job of getting it sold.”

players, iPod ® alarm clocks, flash drives and

What does all of this mean?

other items ranging in price from $60 to $80.

According to Dr. Knutson, people lose money

Participants were randomly given two items

(sometimes lots of it) because of their attachment

to keep before the experiment began. When

to things and the resulting endowment effect.

it came to buying and selling, the subjects

“This isn’t some parlor trick that psychologists

wanted twice as much to sell the items than

play on people,” he says. “This is a real effect

www.guynameddave.com and look for the “100

they were willing to pay for them. “There was

that influences how efficient people are with

Thing Challenge.”

Point of Contact: For ideas on paring down your possessions, visit

fall 2008 : : Bay l or I n n o v a t i o n s

51

Every day matters in the fight against pancreatic cancer. -Dr. Randy Pausch

Dr. Randy Pausch, testifying to Congress on behalf of the Pancreatic Cancer Action Network, about the need to increase federal funding for pancreatic cancer research. March 13, 2008.

Photo by Max Taylor.

After Dr. Randy Pausch was diagnosed with pancreatic cancer, he gave his famous last lecture at Carnegie Mellon University. His message was simple. Every day matters, even in the face of adversity. Randy lived and died by these words as he fought pancreatic cancer, the fourth leading cause of cancer death. He made a difference by joining with the Pancreatic Cancer Action Network to raise awareness, advance research, support patients and advocate for a cure. You can, too. Join us. Together, we can create real hope for those with pancreatic cancer.

Get involved and make every day matter in the fight against pancreatic cancer.

www.pancan.org

spotlight

Baylor’s New Cancer Center Expanding our cancer care vision to enhance patient care. By cynthia kincaid

Baylor University Medical Center at Dallas HAS announceD the expansion of the Baylor Charles A. Sammons Cancer Center at Dallas. Construction on a new 450,000 square-foot outpatient cancer center expansion began earlier this year and is

“We want to reduce cancer to a chronic disease. The net

expected to be completed by 2010. When the outpatient

result of successful treatment is that a lot of cancer survivors

cancer center is complete, a dedicated 120-bed cancer

are going to need continual care for the rest of their lives.”

hospital will be developed in the Collins Building at Baylor Dallas with an expected completion in 2012.

According to Marvin Stone, M.D., a physician on the medical staff and chief of oncology at Baylor Dallas, and medical

“We decided on the expansion because there is a huge

director of the Baylor Sammons Cancer Center, the strategic

community need for cancer services,” says Donna Bowers,

planning process identified the necessity of enlarging the

J.D., vice president of Baylor Health Care System. “The

program as well as facilities. “Advances in cancer care have

incidence of cancer continues to grow as the population

accelerated rapidly, and Baylor is accepting this challenge to

ages; the projected increase for cancer diagnosis is 19 to 21

provide our patients with advanced treatment,” he says.

percent over the next five to 10 years.” To support a decision to expand the now 32-year-old

Treatments and Programs

Baylor Sammons Cancer Center, Baylor conducted a thorough

In addition to offering the current traditional cancer

analysis, looking at national cancer rates as well as regional

treatments, the expanded cancer center will feature more

and local needs. The analysis found that the United States

choices in complementary medicine and clinical trials for

has been successful in reducing cancer mortality, so death

patients. “One of our goals is to increase the number of clinical

rates are going down, but the incidence rates of cancer are

trials provided to our patients,” says Bowers. “Our patients want

going up. “We have increasing rates of cancer incidence, but

to go to facilities where clinical trials are being conducted.”

we are treating it more effectively,” says John McWhorter III, president of Baylor University Medical Center at Dallas.

Baylor Sammons Cancer Center already offers patients access to more than 150 clinical trials (including national

fall 2008 : : Bay l or I n n o v a t i o n s

53

spotlight

trials) and innovative cancer treatments for all cancer types including leukemia, lymphoma, myeloma, lung cancer, breast cancer and colon cancer. “We want that number to climb significantly,” says Bowers. The new cancer center expansion will also allow for a more comprehensive molecular medicine program, more commonly known as personalized medicine, including promising areas of research such as targeted therapy. “With targeted therapy, we’re going to be able to look at a patient’s DNA and determine what type of treatment is going to work best with their particular genes,” says Bowers. “We can tailor medicine more toward the individual and end up with better outcomes. It’s going to revolutionize medicine over the next 10 years.” Dr. Stone says that the expansion of our cancer care vision will help Baylor in developing and expanding its current targeted therapeutic approaches. “I think these approaches are going to advance the entire field, and we’re already applying them in certain kinds of leukemia, breast, lung and colon cancer,” he says. “There’s going to be a tremendous increase in our ability to make more accurate diagnoses and target therapy in individual patients. These will be more effective and produce fewer side effects.” The new cancer center will also develop a physical medicine program designed specifically for oncology patients and a new pain management department will be created to focus only on cancer patients. The cancer center’s boutique, Ernie’s Appearance Center, also focuses on cancer patients by providing special clothing, prostheses and wigs. “Ernie’s has been a huge success, and it’s something that’s tremendously needed,” says Bowers. “Baylor has done a superb job in this area.”

Patient-Centered Treatment

54

Espenola Pinckney experienced patient-centric care at the Baylor Sammons Cancer Center first hand. In 1999, she was treated for colon cancer and is currently in remission.

talked to patients and their families to find out what they wanted in the new center,” says Bowers.“We are building our new cancer center based on their feedback.” Dr. Stone agrees. “At Baylor Dallas, we have always felt that compassionate patient care was the central part of our mission,” he says. “Here, individualized patient care is what we have always felt was most important, and that continues to be the case.” Baylor will also continue to emphasize strong educational and research programs to stay abreast of current medical advances, according to Dr. Stone.

Ultimately, the new cancer center will continue to support

Baylor has emphasized a multidisciplinary interaction among

Baylor’s overall mission of patient-centered treatment. “We

various specialists from the beginning; that interaction, Dr.

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

“At Baylor we work to address the mental and spiritual aspects of living with cancer not only for the patient but also for the family.” _ Donna Bowers, J.D., vice president of Baylor Health Care System Stone says, has become the linchpin of the modern practice of

make sure it is available for the patients they treat.”

oncology. The expansion of the Baylor Sammons Cancer Center

Baylor’s patient-centered treatment philosophy will be

will underscore and enhance this emphasis. “As evidence to

deeply reflected in the new expansion by providing patients

our devotion to that concept, we have more than 200 different

with access to resources for online information, books and

site tumor conferences per year, all of which are participated

magazines. The building will also house a restaurant, coffee

in by medical oncologists, surgical oncologists, radiation

bar and docking stations for wireless computer access.“There

oncologists, pathologists and various other specialists,

is a lot of personal space in this new building,” says Bowers.

depending on which cancer type is being discussed,” says Dr.

“When patients and their families come, they will have places

Stone. “We have more than 6,000 physicians, trainees, nurses

where they can work while waiting for their own or a family

and paramedical people attend those per year. They all grant

member’s treatment.”

CME credit for physicians, and they are a very important part of the activities at Baylor Sammons Cancer Center.” The focus on patient care, according to Bowers, rests on the cornerstone philosophy of treating all aspects of the person – not just their physical health. “When someone is told they have cancer, their needs go beyond traditional medical treatment. At Baylor we work to address the mental and spiritual aspects of living with cancer not only for the patient but also for the family. Therapies offered include massage, acupuncture, music and art, journaling educational programs and support groups,” she says. In 1999, Espenola Pinckney experienced Baylor’s patientcentered attention first-hand when she was diagnosed and treated for colon cancer. Now in remission, Pinckney can’t say enough about her experience at Baylor Dallas. “The

The Overall Goal Ultimately, the Baylor Sammons Cancer Center’s goal is to treat cancer patients with up-to-date therapies in a modern and patient-centric environment.“We are a leader in oncology care and we want patients to feel comfortable that they are going to get quality care with advanced technologies and treatments when they are here,” Bowers says. McWhorter couldn’t agree more. “Baylor has historically been the leader in cancer care in the north Texas area, and we feel a great responsibility to offer the best cancer care in the country,” he says. “We want people to be cared for quickly, confidently and in a compassionate manner. And we want to continue to be the destination center for cancer care for citizens of north Texas.”

doctors were wonderful,” she says. “They ran a lot of tests; I had chemotherapy and radiation over a three-month period, and it worked. “Everyone at Baylor was just so caring, and I was so

Point of Contact: For more information on the Baylor’s Charles A. Sammons Cancer Center,

impressed,” she adds. “The treatment I received was top-

visit www.BaylorHealth.com and click on “Dallas” and then “Cancer” or

notch. Whatever advanced technology, Baylor is going to

call 1-800-4BAYLOR.

fall 2008 : : Bay l or I n n o v a t i o n s

55

Improve

Heart Health with HDL

56

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

By Joann Milivojevic

get the picture

When it comes to keeping your cholesterol in check, the good can definitely outweigh the bad. LDL (low-density lipoprotein) is often referred to as “bad” cholesterol because it sticks to the walls of your arteries. The increased buildup puts you at greater risk of heart attack and stroke. HDL (high-density lipoprotein) is called “good” cholesterol because it actually helps reduce risk. “LDL promotes hardening of the arteries,” explains Mary Ann Bauman, M.D., of Integris Health in Oklahoma City, and a spokesperson for the American Heart Association. “But HDL pulls off LDL and takes it back to the liver to be metabolized.” According to the American Heart Association, HDL cholesterol levels of 60 mg/dL or higher provide some protection against heart disease. Here are five ways to increase HDL:

1. Get some aerobic exercise. Aim for at least 30 minutes four to five times per week. 2. Lose weight. Just seven pounds down can increase your HDL by 1 mg/dL. 3. Eat heart smart. Replace saturated fats with monounsaturated fats (for example, use olive oil instead of butter). 4. Quit smoking. It can help you can raise your HDL by as much as 15 to 20 percent. 5. Consider niacin. Available over the counter, niacin is an effective pharmaceutical option for raising HDL cholesterol. Consult your doctor before starting niacin therapy.

Point of Contact: Learn more about what you can do about cholesterol and raising healthy HDL at www.americanheart.org.

fall 2008 : : Bay l or I n n o v a t i o n s

57

calendar

Baylor University Medical Center at Dallas Community Calendar October – January

Celebrating Women Join us for the Celebrating Women Luncheon benefiting breast cancer research, community outreach and expanded technology at Baylor Health Care System.

ONGOING PROGRAMS Diabetes Support Group October 21, December 16 11:30 a.m. - 1 p.m.

The keynote speaker will be Geralyn Lucas, author of “Why I Wore Lipstick

Baylor University Medical Center - Ruth Collins Diabetes Center

to My Mastectomy.”

Call (214) 828-2350 for more information.

Thursday, October 16, 2008 11:45 a.m. - 1:15 p.m. (Doors open at 11:30)

Weight Loss Surgery Seminars

Hilton Anatole Hotel, Dallas 2201 Stemmons Freeway

October 23, November 13 & 27, December 11 5:30 p.m.

Dallas, Texas 75207

Seating limited. Registration requested.

Call 1-800-4BAYLOR to register.

Call 1-800-4BAYLOR.

Heartwell Forum October 15, November 19, December 17 11:15 a.m. until 1 p.m. Call 1-800-4BAYLOR.

Newborn and Parenting Classes Women’s and Children’s Services Classes held all year on a variety of topics. Seating limited. Must register. Call 1-800-4BAYLOR.

Cancer Support Groups’ Meeting Baylor Charles A. Sammons Cancer Center Cvetko Education Center, Collins Bldg., Suite 615 Call (214) 820-2608 for topics, dates and registration.

For more information about classes or other events, call 1-800-4BAYLOR or visit BaylorHealth.com and click on Classes and Events.

58

B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

Solutions for the changing healthcare environment Architecture

Interiors

Planning

Perkins+Will is proud to be a part of Baylor University Medical Center’s exciting future. Congratulations on your innovative evolution of Cancer Care.

Dallas 214.283.8700 www.perkinswill.com

THE 45TH: REMEMBERING PRESIDENT JOHN F. KENNEDY

Please join us for a series of daytime and evening events November 17-22, 2008, to reflect and learn about the assassination and legacy of President John F. Kennedy. Presenters include Gene Boone z The Reverend William Holmes z Bob Huffaker z John Kelin z Jim Leavelle z Bill Mercer Bill and Gayle Newman z George Phenix z Dan Rather z Kenneth Salyer, M.D. z Wes Wise

411 Elm at Houston z West End Historic District z Downtown Dallas, TX 214-747-6660 z www.jfk.org z Open 10-6 Tuesday-Sunday, 12-6 Monday Speakers are subject to change. Photo: William Allen, Dallas Times Herald Collection/The Sixth Floor Museum at Dealey Plaza

2001 Bryan Street, Suite 750 Dallas, TX 75201

25005BAY-BUMC-0508

Nonprofit Org. U.S. Postage PAID Clarksville, TN 37040 Permit #191