Documente Academic
Documente Profesional
Documente Cultură
T HE
2011
NUMBER
Sleep has always been a mysterious, somewhat magical state that keeps us wondering about its purpose. We spend an enormous amount of our lives in this unconscious condition, yet we know little about its nature and role. After 50 years of research, William Dement reportedly said, "As far as I know, the only reason we need to sleep that is really, really solid is because we get sleepy."
The Lown Foundation is grateful to the Rodgers Family Foundation for their steadfast support of our work for nearly a decade. Their contributions have enabled us to advance our patient-centered model of health care here in Brookline, across the country, and around the world.
INSIDE
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Sleeping your way to health Florida friends welcome Foundation Q & A: Harvard Medical students Patient prole: Trusting heart health Can statins aect my memory?
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Meet the nurse & medical assistant team ProCor: Global heart health successes
NewsBeat
Contact us Sunlight and your health
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Alcohol Some of the important healing benets of sleep are reduced by alcohol consumption. While it causes people to fall asleep faster, alcohol increases the amount of lighter REM sleep through a rebound eect when it wears o in the middle of the night. This shortens slowwave sleep earlier in the night and reduces overall sleep time. As a result, it can cause more sleepiness during the next day. Melatonin The body creates a chemical called melatonin, which may be a helpful sleeping aid in certain situations like jet lag, shift work, and general insomnia. I sometimes recommend melatonin for my patients particularly post surgical patients when they are recovering from a hospitalization as a way to restore a more normal cycle. Although there are some who take melatonin nightly, and some on the internet who tout it as an anti-aging cure-all, I generally advise my patients to use it sparingly in specic settings since we dont really know the long term eects of daily use. For jet lag the optimal dose appears to be 5 mg, but for insomnia, a dose of less than one tenth of that (0.3 mg) appears adequate.
Tips on sleep
If you can, aim for seven hours of sleep a night. Since you cant control when you wake up go to bed early enough to get seven hours. Exercise: While aerobic exercise is better for sleep than weight training, exhaustive, high-intensity exercise for long periods of time can disrupt sleep it decreases REM sleep and increases wakefulness. Jet Lag: Take melatonin close to the target bedtime at the destination (10pm to midnight). The optimal dose seems to be 5 mg above that doesnt seem to add much. Regular melatonin seems to work better than slow-release. Caeine: Before you discount that morning cup of coee as causing your insomnia, abstain for several days (on a weekend if you have a weekday job!) and see what happens. Alcohol: If you enjoy that glass of wine, I suggest having your drinks with lunch or in the afternoon to optimize your night time sleep cycle. Our common sense and folk traditions are good guides to understanding sleep. Now science is lling in many details. Paying attention to sleep is an important, though much-neglected part of achieving optimal health and function especially as we age. Like so many areas of life, the secret of getting proper sleep is to train ourselves into healthy, habitual routines. Sweet dreams!
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DEVELOPMENT
Boca Raton hosts, Judy and Ira Rosenberg, with Dr. Blatt
Boca Raton guests Dr. Norton Klotz, and Joan and Richard Carroll
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FO RUM the Lown Center, the doctors work with the patient to develop a treatment plan and trust that the patient will follow through on their own. AC: The philosophy is dierent. The focus is on noninterventional procedures. If I didnt do this training, I would have left medical school with a much more invasive model of care. When theres no clear clinical guideline to follow, the philosophy takes over. Also, people talk about patients more here. Andrew and Dr. Blatt JW: The atmosphere and attitude of patient care is fundamentally dierent from other clinical experiences. The patient/physician relationship is based on mutual respect patients are viewed as more than just a series of laboratory data or exam ndings. There is a thoughtful approach to management plans that incorporates many aspects of a patient's story and past, and as a result each plan is dierent and individually tailored. What have you learned here that you didnt learn in the classroom or at other oces? EA: A good relationship with a patient can dictate their course of care. We get to see how the doctor talks to their patient and how they respond to the patient to develop good rapport. This program stands out because of the doctors willingness to wait, and to give the patient a shot. JW: I learned just how important it is to get to know your patient. Jerey and Dr. Bilchik Building relationships is critical to the Lown Center philosophy, and something I hope to always take with me in a future career. Would you recommend this training course? EA: Yes, my experience here has proven to me this style of management works. You can see how individual physicians practice and how patients respond to that. You see how the decisions were made; you read notes in the hospital, but you get to make the notes here. AC: Yes, especially because of the way the Lown Center approaches the patient/physician relationship. Because the emphasis is on behavior change, the patients become more involved in their own care. What are your interests/future plans? JW: I plan to apply to a medicine residency followed by a cardiology fellowship. The Lown Center has helped secure my belief that cardiology oers a satisfying clinical career with rich patient relationships and the ability to add value to the health of our community.
AC: Im interested in medicine because its a eld where I can interact with people and help guide them through some dicult decisions and times in their lives. EA: What most appealed to me about practicing medicine is that at its core, I believe it to be a service profession. Physicians are asked to use their knowledge and experience to help patients physically and emotionally, a calling that I believe to still be noble in its ends. Why did you choose to come to the Lown Center? AC: During my inpatient rotation at a hospital I didnt get to see what happens to patients before or after their visits. So much care has shifted to the outpatient setting, but so much of our training is inpatient. I heard good reviews about the Lown course from my classmates during my hospital rotation. What is unique about working at the Lown Center? EA: There is an emphasis on trust when treating a patient. In hospital settings the doctors are very hands-on, but at
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PATIENT PROFILE
than youve ever been. I trusted him implicitly. Dr. Bilchik explained exactly what happened to Brians heart. He also told Brian he didnt need all those medications. He began to eliminate some and reduce the dosages of others.
Brians walking turned into a ve-mile jog. He started to bike, and then took up swimming. A friend suggested he try a triathlon. This was just a year after his heart attack and by then he had already lost 112 pounds. Initially Brian was afraid he might die during the triathlon, but Dr. Bilchik encouraged him on, Try it. I dont want to hold you back. Its been six years since Brian came to the Lown Center, and seven years since his heart attack. He now participates in the Iron Man Triathlon 146 miles of swimming, biking, and running a full marathon. And hes down to two pills a day a low dose statin and an aspirin. If it wasnt for Dr. Bilchik and how he approached me as an individual, I wouldnt be doing Iron Man events today. He gave me the condence to try anything.
confounder is that memory problems aict an estimated 10% of the population older than 65 years. Patients in this age group are also more likely to be taking other drugs that alone or in combination may aect memory. A literature review in 2003 found 60 cases of statinassociated patient reported memory loss. The changes usually occurred within the rst two months after the initiation of therapy, and about half the patients noted an improvement when the statin was discontinued. However, a recent large randomized trial of over 20,000 patients conducted over ve years showed a similar rate of cognitive impairment in patients taking simvastatin (23.7%) and a placebo (24.2%). The major criticisms of this study were that it did not set out to test the hypothesis of whether statins aect memory, and that the rigor of the memory tests was questionable.
No causal link between statins and memory loss has been conclusively demonstrated.
However, if you feel that your memory has changed after the initiation of a statin, please discuss the issue with your doctor. Statins that are water-soluble, such as pravastatin and to a lesser extent rosuvastatin, are less likely to cross the blood-brain barrier and may be an option worth trying. It is reasonable to discuss trying to lower the dose of your current medication, or consider other alternative approaches to lowering your LDL.
Unfortunately, we do not yet have a clear understanding of the interaction between statins and memory.
Over 25 million patients use statins worldwide. Major patient concerns include muscle inammation and memory loss. As of 2008, there were over 5000 reported cases of memory problems in the literature. The biggest
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FO RUM Sharon Cullinane is a Medical Assistant who has been with the Lown Center for ten years. She earned a BS in Environmental Sciences and a degree in Medical Assisting from Framingham State College. Originally from Brookline, she is now raising her two boys (ages 13 and 17) here as well. In her spare time, Sharon enjoys jogging, walking, riding her bike, and reading. Christina Fowler is a Medical Assistant who joined the Lown Center in 2008. Born in Massachusetts, Christina was raised in Jamaica until age ve and then moved to Malden, MA with her family. She received her associates degree from Laboure College, and is currently enrolled in their nursing program. Christina enjoys the familyoriented environment created by the Lown Center sta. Outside of work and school Christina enjoys Zumba classes and spending time with family and friends. Elena Popkova is a Medical Assistant who has been with the Lown Center for ve years. She enjoys the friendly and supportive work environment created by the sta and physicians. Originally from Siberia, she moved to the united States 14 years ago, but returns home every summer to visit her family. Elena enjoys spending time with friends and taking hot yoga classes. Her favorite winter activity includes a visit to the sauna immediately followed by a jump in the snow!
PROCOR
them how to grow vegetables for their daily meals; Be Alive with Your Heart, a grassroots eort in uganda that promotes heart health from childhood through old age; and Olavarra: Tobacco Free City, a city-run, communityfocused tobacco advocacy, education, and support program in Argentina. The 2008 award recipient, Dr. Toakase Fakakovikaetau, the sole pediatrician in the South Pacic island nation of Tonga, was recognized for initiating a program to screen primary school children for rheumatic heart disease (RHD) and provide early, eective treatment. As a result of the Award publicity, The Lancet, a leading international medical journal, published a feature article about her work. The article was discovered by the World Heart Federation, leading to new partnerships and placing RHD on the global health agenda. Every year we receive many applications from all over the world that deserve the global visibility and opportunities for development that the Award brings. The Lown Cardiovascular Foundation Board of Directors and ProCor leadership engage in a dynamic process of narrowing the eld of many deserving programs down to one Award winner. We are currently reviewing applications for the 2011 Louise Lown Heart Hero Award, which will be awarded in early summer. For more information, or to help support the Award, please visit the ProCor website at: www.procor.org.
The Award is given annually in recognition of the role that Louise Lown, Dr. Lowns wife, had on his career in health promotion.
The Louise Lown Heart Hero Award aims to identify innovators who have an impact, are able to mobilize people, and educate their communities to make a change. Previous winners include: the Childrens Program of the Heart and Stroke Foundation of South Africa, which helps young children develop heart healthy habits by teaching
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Meet the Sta (left to right): Helene, Sharon, Elena, and Christina
Educational opportunities
Interested in hosting a lecture on a heart health topic by one of our physicians at your worksite or community organization? Please contact Jessica Gottsegen at jgottsegen@partners.org or 617-7321318 (x3805).
NewsBeat
On March 1, 2011 Dr. Tom Graboys participated in Brigham and Womens Hospital Center for Faculty Development & Diversity Lets Prepare Forum for Caregivers of Older Adults. Dr. Graboys discussed his memoir Life in the Balance on April 6, 2011 at the Atrium at Drum Hill, an assisted living facility in North Chelmsford, MA. ProCor and Lown Foundation sta attended the conference: The long tail of global health equity: Tackling the endemic NCDs of the bottom billion at Harvard Medical School on March 2-3, 2011. The conference was hosted by the Harvard School of Public Health, Partners in Health, the NCD Alliance, and the Department of Global Health and Social Medicine at Harvard Medical School. Please visit www.procor.org to learn more. Dr. Fred Mamuya was a guest speaker at Linden Ponds Retirement Living in Hingham, MA on March 7, 2011. More than 50 people attended this lecture where he discussed the topic of Second Opinions. Dr. Brian Bilchik has been nominated to serve another two years on the Brigham and Womens Hospital Physician Council. Mychal Voorhees, a graduate communications consultant working with the Lown Foundation, gave a presentation on the outreach and marketing campaign she developed for ProCor at Emerson College on April 26, 2011. The campaign seeks to engage African medical school students and professors in ProCors global network.
Board of Directors
Nassib Chamoun Chairman of the Board Vikas Saini, MD President Bernard Lown, MD Chairman Emeritus Thomas B. Graboys, MD President Emeritus Patricia Aslanis Charles M. Blatt, MD Joseph Brain, SD Janet Johnson Bullard J. Breckenridge Eagle Carole Anne McLeod C. Bruce Metzler Barbara H. Roberts, MD Ronald Shaich Robert F. Weis
CONTACT US
Lown Cardiovascular Research Foundation
21 Longwood Avenue Brookline, MA 02446 uSA (617) 732-1318 info@lownfoundation.org www.lownfoundation.org www.lowncenter.org www.procor.org
Advisory Board
Martha Crowninshield Herbert Engelhardt Edward Finkelstein William E. Ford Renee Gelman, MD Barbara Greenberg Milton Lown John R. Monsky Jerey I. Sussman David L. Weltman
PAID
THE PRINT HOUSE
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vitamin D from foods such as fortied milk, grains, and ocean sh. However, experts disagree on what constitutes adequate vitamin D blood levels and whether vitamin D supplements should be prescribed routinely. Bright, full-spectrum light exposure is also shown to improve mood and alleviate symptoms of depression another benet of moderate exposure to sunlight. Prolonged sun exposure can result in sunburns, premature skin aging, and higher risk for skin cancers. Cumulative sun exposure can cause skin cancers such as basal cell and squamous cell cancer in areas of the body typically exposed to the sun. Intense, intermittent sun exposure can cause melanoma, the most serious skin cancer, in areas of the body less frequently exposed to the sun. Childhood exposure is particularly hazardous.