Epilepsy Monitoring Key to Proper Diagnosis

Epilepsy is a chronic neurological condition in which seizures recur. Seizures happen when nerve cells in the brain fire electrical impulses in an abnormal way. Since nerve cells in the various parts of the brain have different functions, the outward appearance of a seizure can include anything from jerking, numbness, tingling, changes in vision or other senses, confusion, “zoning out” or falling.

Other neurological or non-neurological conditions can mimic seizures. Making the correct diagnosis is crucial for doctors to provide the appropriate treatment.

At the Epilepsy Monitoring Unit at Sinai Hospital, a program of the LifeBridge Health Brain & Spine Institute, a team of medical experts uses the latest diagnostic equipment to evaluate and treat seizures and epilepsy.

Saurabh R. Sinha, M.D., Ph.D., and P. Jay Foreman, M.D., Ph.D., coordinate the care of patients with seizures and epilepsy. The Epilepsy Monitoring Unit allows doctors to observe and record the brain waves of patients experiencing seizures or seizure-like behaviors in a comfortable, relaxed setting. Patients stay in a private room and are free to move about while attached to a minimal amount of medical monitoring equipment.

Patients generally stay for three to seven days in the Epilepsy Monitoring Unit.

“We encourage people to come in if their physician thinks they are experiencing seizures, but is not sure,” Sinha says. “Also, if people with seizures are not responding well to medication, we try to answer two questions by testing: Is the diagnosis correct and what kind of seizures are they having?”

If the diagnosis is epilepsy, the patient is not alone. There are 2.7 million people who live with epilepsy in the United States. At Sinai, doctors benefit from knowing the exact type of seizures and where the seizures originate in the brain. This lets them find better ways to treat patients who may not be responding to medical therapies.

When doctors can determine the precise spot in the brain where seizures begin, and when medications fail to stop seizure activity, there is still hope. Removal of the malfunctioning area of the brain can often control the seizures. Often, an approved surgical device called the Vagus Nerve Stimulator (VNS) can effectively reduce the number of seizures.

The information obtained during a stay in the Epilepsy Monitoring Unit is essential in determining if a patient is a candidate for one of these procedures.

“For the majority of patients with epilepsy, seizures can be controlled through medical devices, drugs or surgery,” Sinha says. “More importantly, for many people there are nonmedical therapies. We do testing to figure out what is appropriate for a particular person.”

For more information about the Epilepsy Monitoring Unit at Sinai Hospital, call 410-601-WELL (9355).

LifeBridge Health Gets Wired

In the past, doctors made house calls to evaluate swollen ankles or persistent fevers. Now, when concerned parents need advice on treating injuries and colds, their first stop is often the Internet.

Some 80 percent of U.S. Internet users search for health information online, and about a third of them use it to find a hospital or physician, according to the Pew Internet & American Life Project.

Bearing out the survey’s findings, LifeBridge Health has experienced a tremendous increase over the last year in Web traffic on its site, lifebridgehealth.org. In August 2007, the site had 89,479 total visits. One year later the number had jumped 40 percent, to 125,788 total visits.

To attract more visitors – and keep them from surfing to other sites –the LifeBridge Web team has launched several unique initiatives.

First, the LifeBridge Health site got a complete makeover. Improved navigation means visitors can find what they’re looking for more quickly; and search capabilities were enhanced. Sinai Hospital, Northwest Hospital, Levindale and Jewish Convalescent each were given a unique color scheme.

The LifeBridge Web team also maintains several micro Web sites that broaden our presence on the Web. Performance Edge at LifeBridge Health & Fitness (LBH&F), braVo!, LifeJobs and knowyournumbersbaltimore.com all launched or were given a facelift last year. LBH&F’s redesigned Web site features new videos highlighting many of the center’s programs and services.

New features were added to draw visitors deeper into the sites from the homepage. In-person video messages catch the eye and ear immediately and direct visitors to pages they may not visit otherwise. Detailed 3-D Human Atlas animations describe common medical conditions and procedures, from allergies to heart bypass.

To make our open positions easier to find, the Web team invested in software that makes LifeBridge Health jobs appear at the top of search engine results pages. Last month, LifeBridge recruiters hosted a virtual job fair where they chatted online with potential candidates.

Social networking has quickly become a popular recruitment tool and a way for companies to reach consumers. Again, LifeBridge Health is ahead of the curve, having become one of the first health care companies in Maryland to launch a Facebook® page and create a LinkedIn account. LifeBridge Health, Sinai Hospital, Northwest Hospital, Levindale, Jewish Convalescent and braVo! all have unique pages on Facebook.

As the Web continues to grow as a mechanism for consumers to find health care–related information, the Web team at LifeBridge Health is poised to be a regional leader in online consumer marketing.

Taking the Hysteria Out of Hysterectomies

At Northwest Hospital in Randallstown, new advances in surgery now allow our doctors to perform what’s called “minimally invasive,” or laparoscopic, surgery. That means hysterectomies with fewer complications for common gynecological conditions such as uterine fibroids, abnormal bleeding, endometriosis and urinary incontinence.

Minimally invasive surgery most often involves the use of laparoscopes, telescope-like instruments inserted through small incisions that allow the insertion of ultra-thin fiberoptic tubes connected to television monitors. By using laparoscopes, doctors can perform many surgical procedures without the need for large incisions. Smaller incisions also mean less bleeding, fewer complications and less need for prescribed drugs.

“It makes good sense to keep the incisions as small as possible,” says David Zisow, M.D., a gynecologist and associate head of the Division of Minimally Invasive Surgery at Northwest Hospital in Randallstown. “The obvious problem with a large incision is that you are creating a large injury that takes a long time to heal. If you make a big incision, you’re going to have a patient who recovers more slowly and with more pain than someone with a small incision.”

In most cases, patients undergoing gynecological minimally invasive surgery can return home the same day as their procedure. Patients who’ve undergone minimally invasive surgery often return to work and daily activities within a week or two of their procedure, and generally with far less pain than with conventional surgery.

With hysterectomies being the most commonly performed gynecological operation – over 600,000 hysterectomies are performed annually – medical experts say it makes sense to consider minimally invasive surgery when it is appropriate. In addition to hysterectomies, procedures such as endometrial ablations (removal of the lining of the uterus to control menstrual bleeding), repair of pelvic floor hernias and removal of ovarian cysts can all be done using minimally invasive surgery techniques. Procedures such as paravaginal repair also can be remedied through laparoscopic surgeries.

Minimally invasive surgeries include the transobturator sling procedure (TOT). That involves placing a synthetic mesh tape under the neck of the bladder as a “hammock” to support the urethra in times of stress such as coughing or laughing. It can be done in a scant 15 minutes using three very small incisions, says Zisow. “The relief is immediate,” says Zisow, “and women can enjoy a return to normal bladder control after a simple outpatient surgery.”

Although minimally invasive surgery may be easier on patients, doctors say, for their part, this type of surgery is demanding, yet rewarding.

“Minimally invasive surgery is technically challenging to perform,” says Zisow. “It requires not only a surgeon skilled in the methods, but also an operating team that is specifically trained to assist not only in the methods, but also in these types of procedures. Northwest Hospital has established a team of operating room personnel who have this expertise, thereby making it possible for me to operate efficiently and effectively.”

For more information about minimally invasive surgery, call 410-601-WELL (9355).

Adult Hydrocephalus Center at Sinai Hospital

The Adult Hydrocephalus Center at Sinai Hospital specializes in the diagnosis, treatment and management of normal pressure hydrocephalus (NPH) and hydrocephalus diagnosed in young and middle-aged adults. Additionally, the trained medical staff in the center assists pediatric hydrocephalus patients as they transition into adulthood in their late teens.

“The Adult Hydrocephalus Center provides internationally recognized expertise in the diagnosis, treatment, long-term care and management of adults with hydrocephalus,” says Michael A. Williams, M.D., the center’s founder and director.

Howard Weiss, M.D., and Robin K. Wilson, M.D., Ph.D., join Williams in the center, located in the new Michel Mirowski, M.D., Medical Office Building on the Sinai Hospital campus. The center is a program of the LifeBridge Health Brain & Spine Institute.

Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid within cavities called ventricles inside the brain. Hydrocephalus occurs when there is an imbalance between the amount of cerebrospinal fluid that is produced and the rate at which it is absorbed back into the bloodstream.

As the fluid builds up, it causes the ventricles to enlarge and the pressure inside the head to increase, resulting in hydrocephalus.

The condition can result from a variety of causes and can occur at any age, though the most well-known forms of hydrocephalus are those that occur at the extremes of life – in infancy or the elderly.

In adults, symptoms of hydrocephalus can include difficulty with walking and balance thinking and memory, and bladder control, as well as headaches, lethargy and difficulty staying awake.

The Adult Hydrocephalus Center at Sinai Hospital brings together physicians at the forefront of hydrocephalus diagnosis, treatment and research.

“The team of experts in the center is actively involved in research, and patient and family education, as well as patient advocacy efforts,” says Wilson, associate director of the Adult Hydrocephalus Center.

Adult-Onset Normal Pressure Hydrocephalus
Normal pressure hydrocephalus occurs when accumulated cerebrospinal fluid causes the ventricles in the brain to become enlarged. The name of this condition, which has been known for over 40 years, is misleading, however, because fluid pressure can fluctuate from high to low levels.

In most cases of normal pressure hydrocephalus, the cause cannot be determined. However, it can develop as the result of a head injury, cranial surgery, meningitis, tumor or cysts, or bleeding within the brain. Unlike other forms of hydrocephalus, normal pressure hydrocephalus develops slowly over time and is most commonly seen in adults age 50 and older.

Patients who experience difficulty walking, mild dementia and impaired bladder control should be tested for normal pressure hydrocephalus, as it is one of the few treatable causes for these symptoms. Because the symptoms closely mirror Alzheimer’s and Parkinson’s disease, initially many cases are misdiagnosed.

However, with appropriate treatment, the symptoms of hydrocephalus can be reversed. Physicians at the Adult Hydrocephalus Center at Sinai perform a thorough clinical examination, followed by advanced computer testing to confirm the diagnosis. Surgical placement of a shunt in the brain is the most common and usually the only available treatment for normal pressure hydrocephalus. The surgery, performed by a skilled neurosurgeon, is a relatively short and uncomplicated procedure.

“One of the goals of the Adult Hydrocephalus Center is to provide family centered care because this condition not only affects the patient, but the entire family as well,” says Weiss.

For more information about the Adult Hydrocephalus Center at Sinai Hospital or the
LifeBridge Health Brain & Spine Institute, call 410-601-WELL (9355).

BLOOD…

The medical evidence is clear: We cannot live without blood. It sustains life by supplying body tissue with oxygen from the lungs and returning harmful carbon dioxide to the lungs to be exhaled. Blood helps us grow by transporting nourishment from digestion and hormones from glands throughout the body. And it keeps us healthy by transporting disease-fighting substances to the tissue and waste to the kidneys.

But how exactly does blood do these things?

According to the American Red Cross, the average adult has about 10 pints of blood coursing through a miles-long network of vessels called arteries and veins. Arteries transport oxygenated blood from the heart to the rest of the body. Veins return the blood back to the heart and lungs, where it receives more oxygen.

Blood is made up of three types of cells: red blood cells (erythrocytes), white blood cells (leukocytes) and platelets. Resembling flattened discs, red blood cells have an indented center. They are responsible for carrying oxygen from the lungs to all the cells in the body and taking carbon dioxide back to the lungs to be exhaled. The body contains more red blood cells than any other type of cell, and each has a life span of about four months. Each day, the body produces new red blood cells. White blood cells move in and out of the bloodstream, helping the body to fight off diseases and infections. There are fewer white blood cells than red cells, but the body increases production of white blood cells to fight infection. There are three main types of white blood cells, and their life spans vary from a few days to months.

Approximately 55 percent of blood is plasma, a yellowish-colored liquid that carries the solid cells and the platelets, which help blood clot. Without blood platelets, you would bleed to death from a cut. The reason you never run out of blood when you bleed or donate blood is the body is constantly producing new blood cells inside the marrow of your bones. In adults, the spine, ribs and pelvis are the largest producers of blood. As the blood cells develop, they seep into the blood that passes through the bones and on into the bloodstream.

Blood also helps the body regulate its temperature and deliver nutrients to all parts of the body. It takes waste products to the lungs, kidneys and liver for disposal. Most people never experience a problem with their blood. But some blood disorders or diseases can cause illnesses that impair the ability of blood to function properly.

A common condition affecting red blood cells is anemia, where the blood’s capacity for carrying oxygen is reduced. Anemia is most commonly caused by an iron deficiency or lead poisoning, though it can be a complication of cancer or human immunodeficiency virus infection, especially in children. Hemophilia, sickle cell anemia and leukemia also commonly affect kids.

Though it all looks the same to the human eye, a microscopic view of blood reveals several differences. The main red blood cell groups are A, B, AB and O. The letters stand for two antigens (chemical substances that can be targeted by one's immune system) labeled A and B. Group O blood has neither antigen. Your blood type – there are eight – is passed down to you by your parents.

Knowing your blood type is important because every two seconds someone in the United States will need a blood transfusion, according to the Red Cross. Blood transfusions are used for trauma victims – due to accidents and burns – heart surgery, organ transplants, women with complications during childbirth, newborns and premature babies, and patients receiving treatment for diseases of the blood. The problem is, not all blood types are compatible. People with O- blood are particularly in demand because people of all blood types can receive O- blood.

U.S. institutions collected more than 15 million units of whole blood and red cells in 2001, the most recent year for which data are available, according to the National Blood Data Resource Center. Hospitals collected 7 percent of the total.

To give blood, you must:
Be in generally good health
Be at least 17 years of age
Weigh no less than 110 pounds
Have not received a tattoo within the past year
Have not donated whole blood within the past 56 days
For more information on donor restrictions, visit my-redcross.org.

Thrombosis Research at Sinai Hospital

Researchers at Sinai Hospital of Baltimore are studying a very small part of the human body with a very big impact.

The Center for Thrombosis Research, part of the Heart Center at Sinai, is conducting groundbreaking research in the area of platelet aggregation, or stickiness. The clumping together of platelets, also referred to as aggregation, is the main reason blood clots develop, causing heart attacks, strokes and the blocking of new coronary artery stents.

Currently, aspirin and PLAVIX are the two major, approved conventional
medications to prevent blood clot formation in people who have coronary artery disease. The Sinai Center for Thrombosis Research, led by Paul A. Gurbel, M.D., questions why some patients continue to form deadly blood clots despite being on these conventional medications. Gurbel, also a member of Hagerstown Heart with a practice at the Heart Center at Sinai, is the hospital’s busiest interventional cardiologist.

In the most recent study performed at the Center for Thrombosis Research, Gurbel and his team found that current aspirin therapy successfully blocks its target at all dosage levels, including 81 mg, 162 mg and 325 mg, in patients with a history of heart disease. The research also showed that aspirin might be just as effective at a lower dose as it is at the maximum dosage in some patients.

As well as studying the effects of aspirin, Gurbel has been leading research on PLAVIX, a commonly prescribed anti-clotting medication. After significant research, Gurbel uncovered that PLAVIX does not work the same in all patients. In fact, up to 30 percent were non-responsive to the standard dose of the drug.

In recent investigations, Gurbel established that patients who did not respond to PLAVIX optimally, frequently had an adverse outcome. In this landmark study, Gurbel and his team clearly demonstrated that high platelet aggregation and less response to PLAVIX after coronary stenting are associated with poor outcomes.

“We are now conducting further research to better understand additional reasons why these deadly blood clots form in some patients, in an effort to continue to improve patient outcomes,”
says Gurbel.

The groundbreaking research being conducted at the Sinai Center for Thrombosis Research may change the current dosing strategy for aspirin and PLAVIX and has had far-reaching effects for patients being treated with coronary stents worldwide. The American Heart Association and the American College of Cardiology have altered some of their practice guidelines as a result of the center’s research findings.

Currently, investigators at the Center for Thrombosis Research are recruiting patients with stable coronary artery disease to measure their platelet reactivity and response to conventional medications, such as aspirin and PLAVIX. Patients who have a poor response to these medications may be asked to participate in studies investigating new anti-clotting medications.

The Center’s research will strongly influence the way doctors treat cardiovascular disease in the future and will likely mandate the universal measurement of the degree of platelet stickiness to ensure that the drugs given are actually doing their job.

For more information about the Center for Thrombosis Research and the Heart Center at Sinai, please call 410-601-WELL (9355).

LifeBridge Health’s Top Doctors Featured in Baltimore Magazine

Congratulations to the 40 LifeBridge Health doctors featured in Baltimore magazine’s annual Top Docs report, available now on a magazine rack near you. Of course, it’s also online here. Two LifeBridge Health doctors were profiled for this year’s edition: Pediatric Anesthesiologist Aaron Zuckerberg, MD, and Cardiologist Stacy Fisher, MD. Sinai Hospital’s Chief of Orthopedics, Jerome P. Reichmister, MD, was one of five judges.

The Top Docs issue features the following LifeBridge Health Physicians:
Aaron Zuckerberg, MD (Pediatric Critical Care medicine)
Joseph Wiley, MD (Pediatric Hematology/Oncology)
Edward Gratz, MD (Pediatric Neurology)
Scott Brown, MD (Physical Medicine and Rehabilitation)
Michael Shear, MD (Physicial Medicine and Rehabilitation)
Samuel Adler, MD (Psychiatry)
Mark Brenner, MD (Radiation Oncology)
Robert Brookland, MD (Radiation Oncology
Eva Zeinrich, MD (Radiation Oncology)
Hyo Ahn, MD (Radiology)
Ira Fine, MD (Rheumatology)
Stacy Fisher, MD (Cardiology)
Irving Wolfe, MD (Dermatology)
Murray Perlman, MD (OB/GYN)
Fouad Abbas, MD (Gynecologic Oncology)
Brian Boher, MD (Sleep)
Jason Marx, MD (Sleep)
Flavio Kruter, MD (Hematology/Oncology)
Richard Berg, MD (Infectious Diseases)
Mark Deitch, MD (Orthopedics, hand)
Stephen Friedman, MD (Orthopedics, hand)
Neal Naff, MD (Neurosurgery)
Mukund Didolkar, MD (Surgical Oncology)
Peter Golueke, MD (Vascular Surgery)
Wayne Reichman, MD (Vascular Surgery)
Jonthan Matz, MD, (Allergy and Immunology)
Kenneth Schuberth, MD (Allergy and Immunology)
Miriam Cohen, MD (Cardiology)
Jeffrey Posner, MD (Nephrology)
Howard Moses, MD (Neurology)
Frank Morris, MD (Cardiology)
Judith Rossiter, MD (Maternal Fetal Medicine)
Deborah Bittar, MD (Pediatrics)
Lauren Bogue, MD (Pediatrics)
Ralph Brown, MD (Pediatrics)
Alan Lake, MD (Pediatrics)
James Buck, MD (Pediatric General Sugery)
Stephen George, MD (Pediatric Rheumatology)
Joel Brenner, MD (Pediatraic Cardiology)
Redmond C. Stewart Finney Jr., MD (Cardiac Surgery)

Straight to the Heart - Sinai’s Heart Center Offers Comprehensive Care

It pays to know your numbers. To take a free online heart risk assessment and enter a drawing to receive one of 500 free Omron pedometers*, visit KnowYourNumbersBaltimore.com.

*While supplies last.



The Heart Center at Sinai Hospital is one of the most comprehensive cardiac care centers in the region. Using advanced heart care methods and an Emergency Chest Pain Evaluation Unit located in Sinai ER-7, physicians diagnose and begin treatment at the earliest possible moment.

The Cardiac Catheterization Laboratory at Sinai is a fully digital system that provides the utmost on heart visualization. The full-service facility offers patients the advantage of diagnostic testing, coronary stent placement and recovery in one convenient setting. An ultra modern and expanded cardiac catheterization laboratory with 24 preparatory and recovery beds opened last year.

The Schapiro Cardiac Diagnostic Center merges the latest in medical technology and patient comfort. Sinai is the first hospital in the greater Baltimore area to offer a flat-panel, biplane X-ray machine. This revolutionary technology takes simultaneous images of the heart at two different angles, providing physicians and technicians with crisper, cleaner and fully digital images of a patient’s arteries and veins.

The Heart Center at Sinai excels in the field of cardiac surgery. The most skilled heart surgeons perform bypass procedures and valve surgery in state-of-the-art operating rooms. A recovery area with 10 coronary care beds, a 35-bed progressive care unit, and 14 post-cardiac surgery step-down beds further enhances patient care.

The Heart Center at Sinai treats patients and patients’ family’s needs with compassion and understanding. Through its Tender Touch program, all Heart Center patients receive special services to make their hospital stay as comfortable and stress free as possible.

Patients at the Heart Center at Sinai also may be referred to the new LifeBridge Health Cardiac Rehabilitation Program, which is designed to help improve cardiovascular well-being. Cardiologists, cardiac rehabilitation specialists, nutritionists, exercise physiologists and behavioral psychologists help patients maintain a healthy heart.

Advancing heart surgery
Recent technological advances have made it possible for heart surgeons at Sinai to perform heart valve procedures without fully dividing the breastbone (“sternotomy”). Mitral valve procedures are especially well suited for less invasive techniques, in which the operation is performed without stopping the heart from beating.

Minimally invasive surgery is shorter, leaves smaller scars and reduces the trauma and pain associated with conventional open-chest surgery. A patient’s recovery time is greatly reduced, as are the amount of blood loss, the likely need for blood transfusions and the risk of developing infections. Patients who undergo minimally invasive surgery often heal faster and are able to resume normal activities sooner.

Cardiovascular research
Cardiovascular research conducted at Sinai Hospital has benefited the lives of countless patients. Physician pioneers at Sinai developed the first implantable cardioverter-defibrillator, a life-saving device now used to treat patients around the world.

Sinai’s commitment to cardiovascular research is ongoing in the Center for Thrombosis Research. Under the direction of Paul A. Gurbel, M.D., a team investigating blood clot formation – the major cause of heart attack and stroke – is changing the way doctors treat patients with heart disease.

For more information about the Heart Center at Sinai, call 410-601-WELL (9355).

Northwest Hospital Breaks Ground on New Medical Office Building

Northwest Hospital in Randallstown and Blue & Obrecht of Lutherville broke ground on the new Northwest Medical Office Building at Carlson Lane. The $10 million project is expected to provide over 51,500 square feet of new office space and will be home to about 10 medical practices and more than 20 physicians. The three-story building will be located adjacent to the hospital on the other side of Carlson Lane, and a pedestrian bridge will connect it to the hospital.

Practice space in the medical office building is 55 percent pre-leased, and tenants so far include primary care physicians, surgeons and a podiatrist. The building will also house Northwest Hospital’s executive offices and several administrative departments.

“We are excited to move forward with our efforts to provide needed new medical practice space in an area that is centralized and convenient to the Randallstown, Glyndon, Pikesville, Owings Mills, Baltimore and southern Carroll County communities,” says Erik Wexler, president and COO of Northwest Hospital. “This is part of the Northwest Hospital Renaissance, and I’m happy that the building momentum continues to make our campus reflect even more our high level of care.”

The new medical office building is expected to open in November 2009. Physicians interested in leasing space at the new Northwest Medical Office Building at Carlson Lane should contact Lynn Abeshouse at 410-581-2515.

Pharmacy Robots debut at Sinai

They’re polite, efficient and do not need to take breaks.

The four new TUG robots – Rigby, Jake, Elwood and Herbie – started working as new members of the Sinai Hospital Pharmacy department in September. The TUGs have been well-received by nurses and are good news for patients in need of their medications. Since their debut, the self-propelled robots have trimmed delivery wait times to 45 minutes, and it is hoped they can be cut down to about a half-hour, says John R. DiBona, Pharm.D., R.Ph., director of pharmacy for LifeBridge Health and Sinai.

“By getting the medicine to the patient more quickly, it allows us to achieve the best patient care,” John says.

Once a pharmacist verifies an order, the McKesson robot is responsible for pulling the medication for a patient. The McKesson robot reads a bar code to make sure it is the correct medication before putting it into an envelope marked with the patient’s name. A Pharmacy tech loads the medications into the TUGs, and sends them off to their assigned area. Rigby goes to Mt. Pleasant 1 and 2, 3 North, and 3 East and West; Herbie covers the second floor and 3 South; Jake makes rounds on the fourth floor; and Elwood has the fifth and sixth floors.

“Each TUG is doing 18 trips a day,” says Lisa M. Polinsky, R.Ph, the pharmacy operations manager at Sinai.

The TUGs have sophisticated whiskers than can sense movement, so they will stop if there is an object in their way. They can also call the elevators.

“At first, people were very curious and they touched them, but as the weeks have gone on they have let them go and do their jobs,” Lisa says.

When a TUG arrives, it announces itself, and nurses must use a code to unlock the tray carrying the medications. None of the TUGs carry narcotics.

The nursing staff has been supportive and done a great job interacting with the robots, John says.

Orthopedic Neuro-Trauma clinical leader Linda Covert, M.S., R.N., says the TUGs have encouraged nurses to keep the hallways clear.

“The TUG, bless its heart, is being asked to do a lot of maneuvering,” she says. “Pharmacy has been very responsive when the TUG gets confused, which rarely happens and is not the fault of the TUG.”

If you see a TUG in distress, call Pharmacy at ext. 2-4274.

Since the machines get the medications to the units faster, her nurses are pleased, Linda says.
“It allows us to give a higher level of service to our patients,” she says.

Both John and Lisa see other future applications with the TUGs, and think it is possible a fifth robot will join the team when the vertical expansion at Sinai opens. Northwest Hospital leaders are also looking at using TUGs there.

“Robots are very useful for these applications,” John says.

Bariatric Surgery at Sinai Hospital

Dr. Alex Gandsas, head of the
Division of Bariatric and Minimally
Invasive Surgery at Sinai Hospital

To an outsider, gastric bypass surgery may seem to be a way of treating obesity. But Alejandro Gandsas, M.D., head of the Division of Bariatric and Minimally Invasive Surgery at Sinai Hospital, says the increasingly popular surgery is really much more than that.

“It may appear that you’re just treating obesity, but what you’re really treating is health problems,” Gandsas said. “And it’s amazing to see how those problems – from hypertension to high cholesterol to sleep apnea – disappear or are cured within a one-year period of the surgery.”

Gastric bypass, or bariatric, surgery has come a long way in the past decade. Procedures have improved, making the surgery more effective and less invasive than ever. As a result, medical professionals and patients alike are increasingly recognizing gastric bypass as a real option for people who have tried, but failed, to lose weight by other methods.

The Journal of the American Medical Association recently reported that an estimated 180,000 gastric bypass surgeries were performed in 2006.

Under the direction of Gandsas and Christina Li, M.D., Sinai’s Bariatric Surgery program has blossomed into one of the nation’s best. The American Society of Bariatric Surgery named it a “Center of Excellence” in 2006.

Patients have a variety of options when choosing weight loss surgery including gastric bypass surgery, the Lap Band and a new procedure: the gastric sleeve.

In gastric bypass surgery, the surgeon makes small incisions between the breastbone and navel and then sections off a small section of stomach about the size of an egg. Then, the surgeon attaches a section of the patient’s intestine to this “new” stomach. Another limb of intestine is then attached to the original stomach to allow digestive juices produced there to be emptied into the intestines.

The gastric sleeve is a relatively new approach in bariatric surgery. It involves a vertical resection of up to 85 percent of the stomach resulting in a small “tube” or “sleeve” to accommodate food, hence, creating a feeling of satiety with a small meal.

Unlike the gastric bypass, the gastric sleeve operation does not involve any “re-routing” of the small bowel and no implantation of a plastic device (as seen with the Lap-Band technique) is necessary.

All three procedures create a new, smaller stomach, allowing patients to satisfy their hunger with smaller portions. As a result, they will likely consume fewer calories, allowing them more easily to lose weight.

Still, Gandsas is quick to point out that the surgery alone will not lead to success. Even after the surgery, patients need to work to change their habits and adjust to their new stomach – and their new life. “It requires extreme accountability from the patients,” Gandsas says. “They need to be compliant with their diet. The operation is just a tool. It’s not a 100 percent fix. You have to go and work with the tool.”

For more information about Sinai Hospital’s Division of Bariatric and Minimally Invasive Surgery, come to one of the free seminars held p.m., or call 410-601-WELL (9355) for more information.

Know your Numbers to Watch Heart Health

It pays to know your numbers. To take a free online heart risk assessment and enter a drawing to receive one of 500 free Omron pedometers*, visit KnowYourNumbersBaltimore.com. *While supplies last.




Last year, Nadine Williams-Holmes began having chest pains, and the thought of having a heart attack sent her into a tailspin.

She had been an insulin-dependent diabetic for 13 years and taking blood pressure medication since her second pregnancy. Both diabetes and hypertension are major risk factors for cardiovascular disease, and she feared the worst.

“I wasn’t prepared,” says the 46-year-old nurse from Woodlawn. “I didn’t know if I was going to see my children grow up.”

Like many Americans, Williams-Holmes knew she could be in danger but didn’t necessarily keep track of the details. Today, she carefully tracks her weight, her blood pressure, her blood sugar and her cholesterol levels.

Knowing the numbers that dictate your heart health will allow you to make smart choices today and as you age, particularly because age itself is a risk factor for coronary artery disease. Even if you think you’re heart healthy, it’s best to check with a doctor to be sure.

“It kind of boils down to this basic principle: The more risk factors you have, the more you need to know,” says William R. Herzog, M.D., head of the Division of Cardiology at Sinai Hospital.

So what numbers do you need to know? For most people, the essential numbers include total cholesterol, blood pressure, and weight or body mass index measurement. Others, particularly those with a family history of diabetes or symptoms like high blood pressure, should also have a glucose screening to test for insulin resistance.

Knowing her numbers helped Williams-Holmes lose 60 pounds. She has daily blood sugar readings just above the normal range and an outstanding blood pressure rate of 120/70.
To take care of your heart, you should know these key numbers and how they impact your overall health.

Cholesterol For patients with good health and a low risk of heart disease, a total cholesterol reading of 200 or lower is normal. If your results are good, Herzog suggests patients only be tested every three years.

Blood Pressure High blood pressure is the largest risk factor for stroke, the third leading cause of death in America. Numbers to know, according to the National Heart, Lung and Blood Institute, include high blood pressure – 140/90 and over; high blood pressure for diabetics – 130/80; and normal blood pressure – 120/80 and under.

Body Mass Index The body mass index (BMI) formula measures weight relative to height. According to the National Center for Health Statistics, you should shoot for a score between 18.5 and 24.9. Individuals with a BMI of 30 or higher are considered obese, are generally 30 pounds or more overweight, and are at an even higher risk of cardiovascular disease.

Bringing the Numbers in Line
If lifestyle changes alone don’t work for you, most doctors will recommend medication as the next step. Taking a pill, however, doesn’t free you from exercising and eating a healthy diet. Doctors warn that patients who abandon lifestyle changes once beginning medication will undermine the prescription’s benefits.

When even medication doesn’t work – or in cases where a patient has chest pain, blocked arteries or a full-blown heart attack – surgical interventions may be considered.

The Heart Center at Sinai offers a highly equipped cardiac catheterization laboratory -where doctors can look into your heart and check for blockages – and an Emergency Chest Pain Evaluation Unit that allows physicians to diagnose and begin treatment at the earliest possible moment.

To schedule an appointment with a LifeBridge Health cardiologist or for information on a free upcoming heart screening, call 410-601-WELL (9355).

Sinai Hospital uses Advanced Radiosurgery to Treat Tumors and Lesions

CyberKnife® Center at Sinai Hospital

Since opening the CyberKnife® Center of the Alvin & Lois Lapidus Cancer Institute in 2003, Sinai Hospital has becomerecognized as a national leader in the treatment of pancreas, lung, spine, liver, brain and prostate tumors. More than 1,200 CyberKnife procedures have been performed at Sinai, where physicians from all over the country are trained in how to use the cancer treatment technology.

Sinai Hospital’s CyberKnife Center ranks in the top 10 worldwide in total volume of patients treated for pancreas, lung and other soft tissue tumors. To support the center’s continued growth and to pioneer new therapies, Sinai Hospital has acquired a second CyberKnife. Only four other centers in the world have this capacity.

CyberKnife stereotactic radiosurgery is a frameless, linear accelerator-based system mounted on a robotic arm. Because there are no surgical incisions, anesthesia is not required.

The CyberKnife’s computer-guided tracking system is so precise doctors use it to treat inoperable tumors and cancers that have failed to respond to other types of radiation, including radiotherapy. This is especially advantageous near the spinal cord or other vital organs. Additionally, new tracking systems for the CyberKnife allow it to recognize the shape of a patient’s spine and thus increase the degree of precision. Alan M. Levine, M.D., director of the Alvin & Lois Lapidus Cancer Institute, notes that “Sinai has the largest reported experience with malignant tumors of the spine. Patients from across the country with complex spinal tumors are referred here for treatment.”

Over the last five years, physicians have demonstrated CyberKnife’s ability to perform revolutionary, noninvasive procedures to eradicate soft tissue tumors in pancreas, liver and lungs. Mukund S. Didolkar, M.D., has achieved survival results with patients with inoperable pancreatic cancers not previously possible. Sinai was also one of the first centers to acquire a new program for lung tumors that tracks the patient’s breathing motion, ensuring individual lung tumors are treated. Lynne A. Skaryak, M.D., head of Sinai’s Division of Thoracic Surgery, uses the CyberKnife to treat lung cancers in patients not able to undergo surgery.

Prostate cancer also is now treatable without surgery with the CyberKnife. Research has shown patients undergoing CyberKnife treatment for certain prostate cancers have a lower rate of side effects.