Transform Your Life a New Study Shows Four Behavioral Changes Can Dramatically Increase Your Chances of Being Healthier, Longer

Compliments of Johns Hopkins Medicine International

WINTER 2014 Insight and news from Johns Hopkins Medicine

Transform Your Life A new study shows four behavioral changes can dramatically increase your chances of being healthier, longer

Surprising symptoms for one type of hernia

On the lookout for eating disorders in boys

Olympic snowboarder back on the slopes after facial fracture

FdJHWI1402_01_Cover.indd 1 12/12/13 8:54 AM Contents Straightening WINTER 2014 Out a Common QUICK CONSULT Stomach Ache 4 Severe chest pain and chronic Hand Concern acid re ux could be signs of one kind of hernia. Appetites Gone 5 Wrong Teenage boys can get eating disorders. Parents, nd out what to watch for.

FIRST PERSON Eye on the Prize 10 An Olympic snowboarder is back on the slopes after a traumatic facial injury.

SECOND OPINION A Dif cult Diagnosis or some people, the simple act of brous tissue. e day after the procedure, 11 Experience counts when it laying a hand at on a table can prove the person returns and a physician physically comes to recognizing these painful or impossible. manipulates the hand to break up the tissue. tumor-like formations. Marked by abnormalities in the Because Dupuytren’s contracture is a Fsoft tissues around the palm and ngers that progressive disease, Shores says it can recur prevent them from straightening, Dupuytren’s regardless of the treatment—as early as ON THE COVER contracture is a fairly common disorder that, months later for some, but years later for 6 Transform Your Life left untreated, can be debilitating. ough most others—and additional treatment may in Four Simple Steps it occurs most commonly in people 60 be needed. “If it becomes problematic again,” (Seriously!) and older, some develop it as early as their he says, “improvement may still be achieved Backed by research led by late 30s. using the same treatment or an entirely Johns Hopkins, we show you No one knows exactly what causes di erent treatment, depending on the char- how you can live longer. Dupuytren’s, though genetics are thought acteristics of the disease at that point.”

Cover Image: Ronnie Kaufman/Larry Hirshowitz/Gallery Stock to play a role, says Jaimie Shores, M.D., a plastic and reconstructive surgeon at Johns Hopkins. “It occurs at a di erent speed and time in each person,” he explains. “People might develop lumps or indentations in their FREE SIGN UP ONLINE SEMINAR for Health Information palms, and their ngers may start to ex downward. Eventually, they can no longer TREATMENT FOR COMMON from Johns Hopkins straighten their ngers.” HAND CONDITIONS Thursday, March 6, midnight–1 a.m. GMT Get the latest news on health Fortunately, Shores says, there are Don’t ignore symptoms of the common causes of hand and wellness topics important several treatment options. For severe numbness and pain. During this interactive webinar, Johns Hopkins plastic and reconstructive surgeons to you and your family, cases, surgery might be performed to Scott Lifchez, M.D., and Jaimie Shores, M.D., all from the experts at remove the troublesome tissue. ere will discuss the diagnosis and treatment of carpal tunnel Johns Hopkins Medicine. are less invasive procedures as well, syndrome, trigger nger, Dupuytren’s contracture and The Hopkins News for You e-newsletter including using a needle to break up other hand conditions. Minimally invasive approaches is delivered straight to your inbox. Visit the hardened tissue. to surgery will also be covered. To register, visit hopkinsmedicine.org/intlnews for Recently, an even less invasive proce- hopkinsmedicine.org/intlseminars. your free email subscription. dure has become available, Shores says: an injectable medicine that is inserted into the 20 | 2 | johns hopkins health winter 2014 +1-410-614-4561 | hopkinsmedicine.org/international

FdJHWI1402_02-3_Insights.indd 2 12/12/13 9:31 AM Straightening healthinsights Out a Common Does Curing

Excessive Sweating MAMMOGRAPHY Hand Concern RECOMMENDATIONS Stop the Related FROM JOHNS HOPKINS Screening mammography Anxiety? has long been the best Imagine a life captivated by fear of your own tool for discovering breast cancer before it sweat, when a simple handshake is accompanied has a chance to spread. For by crippling anxiety. Johns Hopkins Medicine’s That’s reality for people who have hyperhi- recommendations and drosis, in which overactive sweat glands cause heavy, even dripping, perspiration. Although advice on when and the coinciding psychological conditions are usually managed with anti-anxiety medications, how often to have a mammogram, watch the physical cause of the emotional distress often goes unrecognized and untreated. Yet, says this Q&A: Malcolm Brock, M.D., a thoracic surgeon at Johns Hopkins, some evidence suggests that bit.ly/Mammogram treating hyperhidrosis can reduce the person’s anxiety. Recommendations. Treating hyperhidrosis usually involves a minimally invasive technique that decreases perspiration, Brock explains. “We’ve had several patients who came to us on anxiety medications and were diagnosed with a primary psychiatric problem, but whose actual anxiety was second- ary to hyperhidrosis,” Brock says. “When we treated their sweating, many were able to stop the medications.” For more information, or to watch an educational video on excessive sweating, visit hopkinsmedicine.org/sweat_disorders. New Research May Improve Outlook for Ovarian Cancer

PHYSICIANS HAVE LONG ASSUMED Compelling evidence from a recent study that ovarian cancer—one of the deadliest can- by Kurman and his colleagues suggests that cers among women—originates in the ovaries. ovarian cancer might begin in the fallopian But new research indicates that the disease tube but that the cancerous cells shed into might begin elsewhere, a breakthrough that an ovary, where they grow. If additional could improve mortality and preserve fertility. studies prove this, he says, physicians could “There have always been inconsistencies remove the fallopian tubes of women at high because ovarian cancer cells don’t resemble risk for ovarian cancer before the cancer FREE ONLINE SEMINAR the cells normally found in the ovary,” says implants in the ovary. Robert Kurman, M.D., a gynecologic “By preserving the ovaries, you pre- TREATMENT FOR COMMON pathologist at Johns Hopkins. “Usually, can- serve the potential for in vitro fertilization,” HAND CONDITIONS cerous cells resemble the cells in that organ. Kurman explains. “And if you can identify Thursday, March 6, midnight–1 a.m. GMT But for years, we’ve recognized that these tumors early or prevent them altogether, Don’t ignore symptoms of the common causes of hand tumors more strongly resembled cells in the there’s a greater likelihood of success- numbness and pain. During this interactive webinar, Johns Hopkins plastic and reconstructive surgeons fallopian tubes.” ful treatment.” Scott Lifchez, M.D., and Jaimie Shores, M.D., will discuss the diagnosis and treatment of carpal tunnel syndrome, trigger nger, Dupuytren’s contracture and other hand conditions. Minimally invasive approaches of ovarian cancers are to surgery will also be covered. To register, visit hopkinsmedicine.org/intlseminars. found early, in the most treatable stage. 20 % Source: American Cancer Society hopkinsmedicine.org/international | +1-410-614-4561 winter 2014 johns hopkins health | 3 |

FdJHWI1402_02-3_Insights.indd 3 12/12/13 9:02 AM quickconsult Appetites Gone Wrong Stomach Ache

Hernias can be painful. Fortunately, the treatment for one type no longer is

Severe chest pain and chronic acid reflux are widely known symptoms that something is wrong, but you might be surprised about the cause for some people. Anne Lidor, M.D., M.P.H., a minimally invasive gastrointestinal surgeon at Johns Hopkins, explains paraesophageal hernias.

How would I know if I have this kind of hernia? Should I see a doctor?

The most frequent symptom of a paraesophageal hernia is acid Most people are referred to a specialist by their cardiologist or reflux that doesn’t respond to antacids. Some people get such bad internist, who has already diagnosed the paraesophageal hernia. If chest pain that they think they’re having a heart attack. Other your symptoms aren’t affecting your quality of life, the specialist people might have trouble eating and vomit frequently, and some usually won’t do anything. Doctors used to perform surgery right may vomit blood because the hernia has caused bleeding inside away to prevent the risk of the stomach twisting on itself and the stomach lining. causing gangrene. But now we know the risk of that is exceed- ingly low, especially as you get older.

Why is it happening? What if my symptoms become severe? A paraesophageal hernia develops in your diaphragm, the muscle that helps you breathe by drawing air into the lungs and also divides your chest cavity (heart and lungs) from your abdominal Then it’s time to talk about surgery. Although some hospitals cavity (stomach and intestines). The diaphragm can develop a still perform the repair by making a large incision in the chest, hole that allows the stomach to move up from the abdomen and others like Johns Hopkins take a minimally invasive approach. into the chest. We make five or six small incisions in the abdomen, pull the stomach down and free it from any scar tissue. Then we close the hole in the diaphragm, usually with a biologic mesh; perform an anti-reflux procedure; and attach the stomach to the abdominal Watch a Q&A on treatment options for paraesophageal wall to keep it from moving again. This approach is far less pain- hernias. Visit hopkinsmedicine.org/upperGIsurgery. For more information, appointments or consultations, ful than open surgery, and it has a much shorter recovery time. call +1-410-614-4561. There may be minor dietary restrictions, but most people are so happy to be free of symptoms that they don’t mind. n

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FdJHWI1402_04-5_Consult-Eating.indd 4 12/13/13 9:30 AM Appetites Gone Wrong Boys will be boys, but when it comes to eating disorders, they’re not that different from girls

f you have teenage boys, you probably anorexia nervosa,” which is a severe and WHAT TO expect them to eat everything they can potentially life-threatening fear of gaining as their food cravings keep pace with weight, Guarda says. “Or loss of appetite WATCH FOR their growing frames. What you might could be the result of major depression, A signi cant change in weight not expect, however, is an appetite anxiety or obsessive-compulsive disorder.” isn’t the only clue your teen Ithat goes wrong. Fortunately, treatment is available. To might have an eating disorder. Experts want you to know: Teenage understand the need for help, it’s impor- Shauna P. Reinblatt, M.D., a child and adolescent boys can get eating disorders. tant for parents to recognize the signs psychiatrist and medical direc- Overeating and undereating can both of overeating and undereating, which tor of the Child Psychiatry be problems in teenage boys, says Angela might not be as obvious as you think. Overeating Clinic at Johns Guarda, M.D. , a psychiatrist and the (See “What to Watch For.”) Hopkins, urges parents to be director of the Johns Hopkins Eating “I think parents recognize eating on the lookout for changes Disorders Program. disorders in boys later, because they just in emotional responses and “In a way, overeating is kind of part don’t expect it,” Guarda says. “But once eating habits. of being a teenage boy,” Guarda says, they do, boys often tell us they feel a “Sneaking and hiding food “but obesity is becoming a much bigger sense of reassurance, because they felt like or eating multiple meals are problem everywhere.” a ‘freak’ with a ‘girls disorder’ until they some warning signs of over- Healthy appetites aside, there are found out it happens to boys, too.” I eating,” she says. limits, says Shauna P. Reinblatt, M.D., People who have anorexia a child and adolescent psychiatrist and nervosa may try to hide that medical director of the Child Psychiatry they’re eating less by push- Overeating Clinic at Johns Hopkins. “If ing food around on the plate. your teenage son gains a lot of weight Excessive vomiting and laxa- from one checkup to the next,” she says, tive use are warning signs, too. “it’s something you should talk to his Eating disorders are doctor about.” treated based on individual Reinblatt’s research has shown a needs and may include nutri- connection between attention de cit tional evaluation, behavioral hyperactivity disorder and bingeing and therapy and medication. being overweight. Other research has demonstrated that depression can con- tribute to overeating, too. On the other hand, depression and anxiety can also lead to undereating. In the case of both extremes, it’s not always clear whether eating disorders are the cause or consequence of other mental disorders. For example, “depression could be a symptom of

For more information, appointments or consultations, call +1-410-614-4561.

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FdJHWI1402_04-5_Consult-Eating.indd 5 12/12/13 8:54 AM Transform Your Life in Four Simple Steps (Seriously!)

New research led by Johns Hopkins proves that four behavioral changes can dramatically increase your chances of a longer, healthier life. The study’s authors explain why and how

Maintain Make Don’t normal Get up healthy smoke body and food weight move choices

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FdJHWI1402_06-9_Lifestyle.indd 6 12/12/13 8:54 AM ou want to lead a healthier lifestyle, but where do you start? Do you eat a bowl of granola? YTake a yoga class? Give up coffee? Maybe you feel as though you’re too old to make Transform Your Life in a difference. Or that you’ve been dealt a bad genetic hand. Well, maybe you shouldn’t even bother. Because most of what involves good health is beyond your control, right? Wrong. Important new research from Johns Hopkins shows just how wrong. Four Simple Steps In an eight-year study of 6,200 men and women (Seriously!) across the United States, a team of researchers— eight of them, including the lead authors, from Johns Hopkins—found that those who adopted four common-sense lifestyle behaviors protected themselves against coronary heart disease and the early buildup of calcium deposits in heart arteries. The jaw-dropping finding of this study is this: People who engaged in these healthy behaviors reduced the chance of death from all causes by an astounding 80 percent. “Even knowing how important a healthy lifestyle is, we were surprised at how large a risk reduction there was for mortality,” says Haitham Ahmed, M.D., M.P.H., a cardiologist at Johns Hopkins and the lead author of the study, which was published in June in the American Journal of Epidemiology. The researchers found that those who achieved the greatest benefit had these factors in common: They didn’t smoke, they maintained an optimal weight, they were physically active, and they followed a Mediterranean-style diet. “There are a lot of things that determine your health,” Ahmed says. “Some you can’t control, but we found four things that you can control, and they pro- duce tremendous benefits.” The investigators were also able to show how and why. “We looked at the causes and effects,” says cardiologist Michael Blaha, M.D., M.P.H., a co-author. “We linked these factors to less early plaque in the arteries, less progression of plaque and thus fewer heart attacks, and consequently fewer deaths.” These factors provide a template for creating the healthy lifestyle we want—and, thanks to this research, we now know we can achieve it. >

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FdJHWI1402_06-9_Lifestyle.indd 7 12/12/13 8:54 AM JOHNS HOPKINS LIFESTYLE CHANGE NO. 1 “Healthy weight is gener- to push themselves to chest- RECOMMENDS DON’T SMOKE ally a re ection of the total heaving, gasping-for-air levels e ort in adherence to diet of intensity. Healthy people don’t smoke, and exercise,” Blaha says. “It’s e standards that plain and simple. e impor- important because it integrates researchers used are the widely tance of this can’t be under- these e ects over time, and we followed U.S. Department of stated: Although the ideal know that these healthy life- Health and Human Services’ formula for health is to adopt style traits have an impact over guidelines for physical activ- all four lifestyle factors, if a lifetime.” So while it’s impor- ity, which are 150 minutes of Information on how to quit smoking: you had to choose one, the tant to hit your target weight moderate-intensity activity per betobaccofree.hhs. researchers say, this is it. or BMI in any given week, the week or 75 minutes of more gov/quit-now “A smoker who eats well, real goal is to maintain that vigorous exercise per week. exercises and maintains an weight over the years. e recommendation ideal body weight will still To nd out your BMI, breaks down to about 30 min- be at greater risk than a non- Blumenthal recommends utes a day most days of the smoker who does none of the using a free online calculator. week. And those 30 minutes other three,” says senior author Any number between 18.5 can be accumulated: You could Roger Blumenthal, M.D., and 24.9 is considered healthy. break it into three 10-minute director of the Johns Hopkins instances of activity per day— Ciccarone Center for the LIFESTYLE CHANGE NO. 3 a 10-minute walk in the morn- GET UP AND MOVE Calculate your BMI: Prevention of Heart Disease. ing, another at lunch and a cdc.gov/healthyweight/ at’s not an argument stroll after dinner, if that suits assessing/bmi against doing the other You don’t need to run a your schedule. things—in fact, the more of marathon—or even around How you measure these behaviors you adopt, the the block—to meet the mini- your activity is up to you. data suggest, the healthier you mum requirements for healthy Blumenthal recommends a will be. It’s just a reminder as to exercise. In fact, many public pedometer to track how many how important smoking ces- health experts prefer to call it steps you take. A good rule sation is. “Smoking not only “physical activity” as a way to of thumb is at least 5,000 a ects coronary arteries and remind people that while they steps per day with a target of lungs,” Ahmed says. “Smokers do need to move briskly for a more than 10,000 steps per World Health also have increased rates of sustained time, they day, most days of Organization’s physical cancer and risk of stroke. It just don’t need the week. activity guidelines: a ects so many organ systems.” who.int/diet physicalactivity/pa LIFESTYLE CHANGE NO. 2 MAINTAIN NORMAL VIDEO BODY WEIGHT LIFESTYLE CHOICES THAT ARE GOOD FOR YOUR HEART e healthiest people in the Learn more about protecting your heart with study maintained a body healthy lifestyle choices from Roger Blumenthal, M.D., mass index (BMI)—a ratio director of the Johns Hopkins Ciccarone Center of height to weight that mea- for the Prevention of Heart Disease, and Dominque Ashen, Ph.D., certi ed registered sures body fat—of less than nurse practitioner, in the video “ABCs of Yahoo Health blog 25. e best way to achieve Prevention of Cardiovascular Disease: Lifestyle by Michael Blaha, that, of course, is to get busy Choices That Minimize Risk Factors.” Visit M.D.: health. bit.ly/CardiovascularABCs. yahoo.net/experts/ on lifestyle changes 3 and 4. heartsmartliving Ronnie Kaufman/Larry Hirshowitz/Gallery Stock (2)

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FdJHWI1402_06-9_Lifestyle.indd 8 12/12/13 9:11 AM T ips to Get You Started to push themselves to chest- Lifestyle change No. 4 heaving, gasping-for-air levels Make healthy food choices A new Johns Hopkins-led study Once you can achieve this easily, then of intensity. shows that making four lifestyle changes increase your goal little by little.” The standards that can lead to significant health improvements researchers used are the widely The study found that the and a longer life. Of course, simple doesn’t Measure your momentum. “Have followed U.S. Department of healthiest people followed necessarily mean easy when you’re talk- some way of monitoring your progress Health and Human Services’ a Mediterranean-style diet. ing about stopping smoking, losing weight, that’s easy and works for you,” Smith says. guidelines for physical activ- Blaha thinks he knows why. improving eating habits and starting an This could be using a pedometer to track exercise program. your steps, a logbook for your workouts or ity, which are 150 minutes of “The Mediterranean diet “It might be overwhelming for someone a food diary for what you eat. moderate-intensity activity per revolves around food choices,” to go out and do all of those four things week or 75 minutes of more he says. “It is a low-carb, right away,” says Michael T. Smith, Ph.D., Share it with everyone. Tell your vigorous exercise per week. healthy-fat, lean-protein diet, director of the Johns Hopkins Center for friends and family members that you’re The recommendation but that’s not how we describe Behavior and Health. setting out to make these changes in your breaks down to about 30 min- it to patients. I tell them, ‘Eat Change is definitely achievable, Smith life. The support you get is one reason for utes a day most days of the like a Mediterranean.’ ” says, if you start with these tips. doing it. But more important, “you want to act in ways that are consistent with week. And those 30 minutes That means a diet rich in Make it matter. “You can’t make how you see yourself and project yourself can be accumulated: You fresh fruits and vegetables, changes for other people’s reasons,” Smith to the world,” Smith says. “So if you tell could break it into three tree nuts with healthy oils, says. “It has to be important for you.” Do people, you’ll have a much better chance 10-minute instances of activ- fish (and less red meats), you want to live to see your grandchildren of success.” ity per day—a 10-minute whole-grain carbs and olive graduate high school? Do you want to look walk in the morning, another oil for cooking. and feel better? Anticipate problems—and solu- at lunch and a stroll after din- “It’s the most palatable diet tions. Think about possible barriers to Start small. “If you don’t believe that making this change and develop a plan to ner, if that suits your schedule. and most tasty, and patients you can do it, you’re not likely to do it,” get around them. For example: When Smith How you measure tend to stick with it the most,” Smith says. So start where you think you first came to Johns Hopkins, he was over- your activity is up to you. Blaha says. might have the most success. Instead of weight and decided it was finally time that Blumenthal recommends “When I tell my patients exercising 30 minutes, five days a week, he slimmed down. By keeping track of his a pedometer to track how that a typical Mediterranean maybe it’s 10 minutes a day for three days. eating, he realized he was consuming a lot of many steps you take. A good dinner might be salmon, Maybe it’s just one day. “You always want calories at night. His answer: “I started exer- rule of thumb is at least couscous and some fresh veg- to establish a realistic, specific, short-term cising later in the evening,” he says. “It was 5,000 steps per day with a gies,” Blaha adds, “they say, goal at which you’re likely to succeed. time I wasn’t in front of the TV eating.” target of more than 10,000 ‘I’d pay twenty dollars for steps per day, most days that meal!’ ” n of the week.

What’s Your Healthy Lifestyle Score? Give yourself 1 point for each of the four lifestyle habits that you have now: don’t smoke, maintain normal body weight, get up and move, make healthy food choices. Add them up and see how you’ve already affected your chances of living a longer life. tock (2) S Score Change in death risk* 0 +10% irshowitz/Gallery

H 1 -21% arry

L 2 -39% 3 -51% 4 -81% * over 7.6 years onnie Kaufman/ R

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FdJHWI1402_06-9_Lifestyle.indd 9 12/12/13 8:54 AM firstperson Visionary Surgical Technique Repairing an eye socket is no easy task. “You’ve got to work around the eye- ball. Space is very limited, and seeing the fractured bones and important nerves, blood vessels and muscles is challenging,” Eye on the Prize says Michael P. Grant, M.D., Ph.D., chief of oculoplastic surgery at the Johns Hopkins Wilmer Eye Institute. “You After U.S. Olympic snowboarder Gretchen Bleiler can do more harm than good if you’re suffered a career-threatening facial injury, not careful.” Johns Hopkins performs eye socket Johns Hopkins surgeons got her back on the slopes reconstruction using computer-assisted surgery: Computed tomography (CT) scans are taken of the injured area before- hand. The injury is analyzed, the repair is performed virtually on a computer and the virtual surgery is sent to the operating I’ve been snowboarding competitively room. The surgeon then plans the pro- for more than 10 years, and you don’t win four X Games gold medals or cedure, follows the plan during the actual surgery and verifies the results with a an Olympic silver medal without getting injured more than a few times. postoperative CT scan. But what happened to me during training in 2012 was by far the most “This makes the operation safer and traumatic accident I’ve experienced. I was working on double back flips more predictable for our patients,” Grant when I came down on the trampoline the wrong way. My knee went right says, “because we can precisely plan and into my face, shattering my eye socket and my nose. perform the procedure.” After doing some research, I decided Johns Hopkins was the best option. Because the damage was so significant, my surgeon, Michael P. Grant, M.D., Ph.D., said there was a chance I might have double vision for the rest of my life. But he promised he’d do the best he could to get me back to all the things I wanted to do. He repaired my eye socket and my broken nose in a single procedure. Just four months later, he cleared me to start snowboarding again. I still had the double vision, though, which made it really tough to navigate the half-pipe, which is where I compete. When you’re doing spins and flips up and down a 6.7-meter wall of snow, good vision is essential. Working with my trainer, I started doing some serious rehabili- tation with my recovering eye to strengthen the muscles so they moved at the same pace as the uninjured eye. Not long after, I dropped into a half-pipe again and realized my vision was back. Aesthetically, you’d never know I’d been injured, thanks to the work Dr. Grant did. I’m still on the U.S. team and com- peting again—with my sights set on a spot in the 2014 Winter Olympics. n H arry arry H ow/2013 To watch videos of people telling their stories of care G at Johns Hopkins, visit hopkinsmedicine.org/mystory. etty I For more information, appointments or consultations, mages call +1-410-614-4561.

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FREE ONLINE SEMINAR VASCULAR MALFORMATIONS: A RARE BUT TREATABLE CONDITION Wednesday, February 5, midnight–1 a.m. GMT The dif culty with vascular malformations is that they’re masters of disguise. Often mistaken for tumors or cysts, vascular anomalies can occur almost anywhere in the body. The good news: They are often treatable and are very responsive to nonsurgical treatment. During this interactive webinar, Johns Hopkins physicians Sally Mitchell, M.D., and Clifford Weiss, M.D., will discuss the different types of vascular malformations and available treatment options. To register, visit hopkinsmedicine.org/ intlseminars. A Dif cult Diagnosis Specially Suited Experience matters “We had a young woman from China who for Diagnosing had a massive tongue malformation,” Mitchell Malformations when treating this says. “She could hardly speak or eat. But once Although vascular malfor- we were able to shrink it down, she was able to mations require expert common vascular return to a normal life again.” care, rst comes a diagno- Treatment options vary depending on the sis, which is no easy feat. condition type and severity of the malformation. Arterial “Some patients spend malformations may require a physician to go years trying to gure out into the artery and plug the connections to what they have,” says interventional radiologist lthough vascular malformations are a the vein, possibly with medical-grade glue. Sally Mitchell, M.D., prevalent condition, they can be dif- Lymphatic and venous malformations, how- “and then several more cult to diagnose and tricky to treat. ever, are generally treated with percutaneous years looking for someone “ is condition shows up in so (through-the-skin) therapy, perhaps a high- who can treat it.” Amany di erent forms in so many di erent parts dose antibiotic that causes the mass to break Mitchell launched of the body. It can take a while to gure out down. “ ere is no skin cutting or scalpel,” the multidisciplinary how to treat them,” says Sally Mitchell, M.D., says Cli ord Weiss, M.D., an interventional Johns Hopkins Vascular Anomalies Center of an interventional radiologist at Johns Hopkins. radiologist at Johns Hopkins. “It’s the best Excellence to provide Which is why, she explains, Johns Hopkins example of minimally invasive therapy and is care for the many suffer- is among only a few facilities in the U.S. extraordinarily e ective. ers of vascular malfor- equipped to manage the condition. “It’s very satisfying to treat these patients,” mation. “Even the most Often mistaken for tumors, vascular mal- Weiss continues. “Vascular malformations well-trained interventional formations are actually masses that form in the are understudied, underfunded and under- radiologists may see only one or two vascular Harry How/2013 Getty Images Harry lymph nodes, veins or arteries, usually com- recognized. Typically, our patients have gone anomalies per year,” says posed of excess blood vessels. e masses can undiagnosed or misdiagnosed for years and Clifford Weiss, M.D., be severely painful and cause skin breakdown, arrive at our clinic feeling scared and hopeless. who shares cases at the dis gurement and loss of function. ey We provide them with an accurate diagno- center with Mitchell. “At occur before birth but may show symptoms sis, an understanding of their disease and a Johns Hopkins, we see 15 at any age. directed treatment plan.” I to 16 patients a week.”

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