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Sjogren's Syndrome YOUR VITAL LINKS ICD-10 IS HERE Johns Hopkins Medicine offers the Johns Hopkins Medicine following resources for you and International When referring patients to Explore Our Online your patients. Patients from outside the United States Johns Hopkins Medicine, and for non-English-speaking residents please be sure to include Resource for Physicians: Hopkins Access Line (HAL) +1-410-502-7683 ICD-10 codes. Your 24/7 connection with Johns hopkinsmedicine.org/international Clinical Connection Hopkins faculty physicians in any For more information, visit Clinical Trials specialty. www.cms.gov/ Connect with Johns trials.johnshopkins.edu Hopkins health care ☎ 1-800-765-5447 Medicare/Coding/ (Continental United States) CME Progams ICD10/. professionals sharing ☎ +1-410-955-9444 hopkinscme.edu insights on the latest PhysicianUpdate (Baltimore area/International calls) 410-502-9634 clinical innovations and [email protected] advances in patient NEWS FOR PHYSICIANS FROM JOHNS HOPKINS MEDICINE FALL 2015 Online Referral Directory care. Johns Hopkins CareLink Find a Johns Hopkins physician A Web-based portal for real-time Scan the QR code or visit by name, specialty and more www.hopkinsmedicine.org/ hopkinsmedicine.org/doctors access to your patients’ medical records; notification of your clinicalconnection. Johns Hopkins USA patients’ visits, admissions and Residents from outside of Maryland discharges; and secure messaging Some of the research reported in this newsletter While you’re there, sign up for the New Thinking on may have corporate sponsorship. For more 1-855-695-4872 with Johns Hopkins specialists. information, please contact the Office of Policy Clinical Connection e-newsletter. hopkinsmedicine.org/usa hopkinsmedicine.org/carelink Coordination at 410-516-5560. Myositis Rehab hen it comes to managing patients An online search led Tae Chung Non-Profit Org with myositis, says , fear Darnell to studies on U.S. Postage of causing harm can be overstated. myositis, many of which he PhysicianUpdate PAID WThe physiatrist and director of found were authored by Johns Permit No. 5415 the neuromuscular rehab team at Johns Hopkins Hopkins researchers. So he Johns Hopkins Medicine Baltimore, MD explains that physicians often discourage exercise scheduled an appointment Marketing and Communications for patients with the rare inflammatory muscular with Chung and flew to 901 S. Bond St./ Suite 550 disorder out of concern that it could raise creatine Baltimore. Chung suspected Baltimore, Maryland 21231-3339 kinase (CPK) levels and further damage weakened and confirmed that Darnell This newsletter is published for the Johns Hopkins muscles. That fear is understandable, says Chung, has immune-mediated Clinical Practice Association by Johns Hopkins Medicine Marketing and Communications considering how little research has been conducted necrotizing myopathy on these patients to demonstrate their threshold for with HMGCR antibody, Clinical Practice Association William Baumgartner, M.D., physical therapy and which exercises might prove a disease entity discovered Johns Hopkins Medicine Vice Dean for Clinical Affairs; helpful. in neurologist Andrew President, Clinical Practice Association But, says Chung, he and his colleagues have Mammen’s lab, where Marketing and Communications found a way to customize rehab for patients with Chung worked some years Dalal Haldeman, Ph.D., M.B.A., Senior Vice President myositis while prescribing medications to fight ago. It’s a rare complication of Sue De Pasquale, Managing Editor Tae Chung tests Matt Darnell’s reflexes on a Christen Brownlee, Judy F. Minkove, their autoimmunity. “These patients want to do statins. Darnell, however, had follow-up visit for myositis care. Darnell says he Ekaterina Pesheva, Lisa Rademakers, Writers something to strengthen their muscles,” says Chung, never taken these types of wishes more patients with his condition were Max Boam, Kristen Caudill, Designers cholesterol-lowering drugs. aware of the benefits of early physical activity. Keith Weller, Photographer “and we’ve developed rehab protocols at various stages of the disease.” Despite the long day spent meeting with Chung, Questions or comments about this issue? Call 410-614-5044 or email [email protected]. The exercises—mostly focused on high-intensity other specialists, and physical and occupational resistance and core muscle strengthening—are based therapists at Johns Hopkins’ Myositis Center, © 2015 The Johns Hopkins University and The Johns Hopkins Health System Corporation on studies using objective measures, notes Chung. Darnell says he values the thorough team approach Protocols are modeled after numerous studies because “it puts different eyes on the same problem.” performed in Sweden, which the Swedish team has Chung was the first of Darnell’s physicians to Neuromuscular Rehab Clinic shared with him. Since the neuromuscular clinic prescribe immunosuppresants. “We need to control at a Glance opened last fall, Chung has been documenting each the immune system,” Chung told Darnell, “so patient’s baseline strength and tracking blood values the muscle is no longer inappropriately attacked.” The Johns Hopkins Neuromuscular Rehab Clinic to build on this research. Darnell says he’s tolerated the drugs well, and that is among the first to focus on the diagnosis Among those who appear to be benefiting is Matt they have lowered his CPK. and rehabilitative management of neuromus- Darnell. The 33-year-old engineer from Chicago In between the monthly visits that have followed, cular disorders, including all known forms of knew something was amiss last summer when he Darnell has stayed in close touch with Chung and myositis: dermatoyositis, inclusion body myositis, PhysicianUpdate had trouble doing his morning pushups, a habit physical therapists Albert “Fin” Mears and juvenile myositis and polymyositis. Directed by Ruben Pagkatipunan Tae Chung, the center combines the expertise he’s sustained since his years in the Navy. “I felt an and occupational therapist of physical therapists, occupational therapists Sarah Hess overall weakness,” he says, “and was worried when it . and speech-language pathology therapists. didn’t improve.” Roughly 70 percent of the patients with When needed, referrals are made to neurology, 1 2 3 Blood work showed elevated CPK, and an myositis now under the team’s care are from out rheumatology and pulmonology. Treatments are electromyography was consistent with irritable of state or from overseas. And, because patients’ New Thinking An individualized based on diagnosis and severity of The Planning myopathy. This was followed by a biopsy. But, as local therapists are often uncomfortable about disease, which are scientifically assessed. Each on Myositis Electrifying Stage of is the case for many patients with myositis, which prescribing PT, says Mears, “we spend a lot of time patient’s baseline strength and blood values are Inside Rehab Approach to Complex tracked to build on neuromuscular research Epilepsy resembles many other neuromuscular diseases, educating patients, practicing exercise programs and Fracture Repair his neurologist couldn’t pinpoint a diagnosis. conferring with their therapists.” n studies. Meanwhile, Darnell was advised not to exercise. To make an appointment at the clinic, call 410-502-2272. ROUGHLY 70 PERCENT OF THE PATIENTS WITH MYOSITIS NOW UNDER International inquiries: +1-410-502-7683 THE TEAM’S CARE ARE FROM OUT OF STATE OR FROM OVERSEAS. NEUROSURGERY ORTHOPAEDICS An Electrifying The Planning Stage Approach to Epilepsy of Complex Fracture Repair bout one-half of patients with epilepsy can control their hen Erik Hasenboehler sees a patient with seizures with medication, but when that doesn’t prove a complex fracture involving 10 to 20 fracture successful, surgery to remove the seizure focus—the segments in an area, his first thought is not about Abrain region triggering the episodes—can often render the exact approach he will use to repair the injury. patients seizure-free. For some, however, surgery isn’t a viable W He initially thinks about the optimum time he should wait before option. Those who have more than one seizure focus or more repairing the injury. than one in locations where removal would lead to neurological As the primary orthopaedic traumatologist at Johns Hopkins deficits, for example, aren’t candidates for the procedure. Bayview Medical Center, Hasenboehler specializes in complex In the past, these patients had few other options. fracture repair in the upper and lower extremities. Planning the Gregory Bergey Now, neurologist and neurosurgeon proper surgical approach for such extensive injuries, he says, William Anderson Gregory Bergey, left, and William Anderson now Timing is crucial when it comes to planning are offering a new treatment, responsive offer responsive neurostimulation therapy to control involves studying the fracture pattern, and that can take some time. the proper surgical approach for extensive neurostimulation therapy, which recently gained U.S. Food and epileptic seizures—a treatment that was in clinical But the main reason for waiting is to allow the body to relax. fractures, notes orthopaedic traumatologist Erik Drug Administration approval. trials at Johns Hopkins and other sites, and was Hasenboehler. recently approved by the FDA. “The amount of soft-tissue swelling goes down, which decreases the This therapy is delivered via a device consisting of a small morbidity and the infection risk after surgery,” says Hasenboehler. computer and stimulator,
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