BRIGHTER FU­TURES

PHILADEL­PHIA’S FINEST DOC­TORS ARE ON THE FRONT LINES OF SOME OF THE WORLD’S MOST AD­VANCED AND EX­CIT­ING TREAT­MENTS—ES­PE­CIALLY IN WOMEN’S HEALTH. BY DR. NINA RAD­CLIFF WITH AD­DI­TIONAL RE­PORT­ING BY KRISTIN DET­TER­LINE

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Few fields of­fer so much prom­ise to lever­age new knowl­edge and tech­nol­ogy than in the world of women’s health. There are tremen­dous break­throughs oc­cur­ring in this area of medicine, and Philadel­phia is rec­og­nized as a na­tional and in­ter­na­tional leader in life-chang­ing care and med­i­cal ad­vance­ments with a spe­cial fo­cus on the unique needs and chal­lenges fe­males face. Here, six pro­grams tack­ling some of women’s most press­ing health con­cerns us­ing the lat­est tech­nol­ogy, im­proved treat­ments, and no short­age of TLC.

HEALTH BREAKTHROUGH #1: HEAL HEADACHES AT THE DEN­TIST

Are you one of the 45 mil­lion Amer­i­cans who suf­fer from chronic headaches? Did you know women are af­fected three times more of­ten than men? It’s been said that our mouth serves as a win­dow into what is go­ing on in­side our body: Oral health can re­flect se­ri­ous health con­di­tions such as heart at­tacks, stroke, and di­a­betes, but it can also aid in the di­ag­no­sis for headaches.

“Even a per­son’s bite can af­fect their health and qual­ity of life,” ex­plains Dr. Lind­sey Marshall, a grad­u­ate of the

“EVEN A PER­SON’S BITE CAN AF­FECT THEIR HEALTH AND QUAL­ITY OF LIFE.” — DR. LIND­SEY MARSHALL

Har­vard School of Den­tal Medicine and Fel­low of The Las Ve­gas In­sti­tute. “When your bite is not bal­anced with the mus­cles of the head and neck, it can re­sult in headaches, neck pain, ring­ing in the ears, or fa­cial pain, a con­di­tion known as tem­poro­mandibu­lar joint dis­or­der (TMD).”

TMD af­fects 15 per­cent of the Amer­i­can pop­u­la­tion—with women be­ing twice as likely as men to be af­fected. This mis­align­ment of the jaw can re­sult from break­down of your teeth (from clench­ing and grind­ing or re­flux) or from miss­ing teeth or even poorly aligned teeth.

Neu­ro­mus­cu­lar den­tists spe­cial­ize in di­ag­nos­ing and treat­ing this con­di­tion. “We see a lot of pa­tients come in with chronic headaches, some­times for decades. They have con­sulted with ENTS, neu­rol­o­gists, and pain spe­cial­ists and have taken med­i­ca­tions for years with­out re­lief,” Dr. Marshall ex­plains.

The first step of treat­ing TMD is non­in­va­sive. “Through the use of a TENS unit to re­lax the mus­cles and a com­puter for EMG readings of the mus­cles of the head and neck, we can find the most ideal po­si­tion and cre­ate a cus­tom­ized ap­pli­ance to hold the jaw in this re­laxed po­si­tion,” Dr. Marshall says. If the ap­pli­ance is ef­fec­tive in re­liev­ing symp­toms, the next step is to fix the un­der­ly­ing prob­lem, which may mean ad­just­ing the po­si­tion of the teeth with or­thodon­tics or restora­tive care. “Most peo­ple, in­clud­ing med­i­cal pro­fes­sion­als, do not think of headaches as hav­ing a den­tal cause,” Dr. Marshall says. 602 The Times Build­ing, Ard­more, 610-649-0696; lind­sey­mar­shall.com

HEALTH BREAKTHROUGH #2: MOMMY MAKEOVERS GIVE MA­JOR RE­SULTS

Ac­c­grd­ing to the most re­cent an­nual re­port by the Amer­i­can So­ci­ety of Plas­tic Sur­geons, women un­dergo 92 per­cent of the 15.9 mil­lion cos­metic pro­ce­dures per­formed ev­ery year in the United States. Part of the rea­son is that sur­gi­cal tech­niques and tech­no­log­i­cal ad­vance­ments have evolved, along with their safety pro­files, says

“MOST PEO­PLE, IN­CLUD­ING MANY MED­I­CAL PRO­FES­SION­ALS, DO NOT THINK OF HEADACHES AS HAV­ING A DEN­TAL CAUSE.”— dr. lind­sey marshall

Ivona Percec, MD, PHD, as­so­ciate di­rec­tor of Cos­metic Surgery at Penn Medicine Plas­tic Surgery. “Pa­tients can un­dergo pro­ce­dures with less risk and down­time,” she says.

And the use of in­jectable fillers, a min­i­mally in­va­sive op­tion to de­crease the ap­pear­ance of fine lines and wrin­kles, has sky­rock­eted. “When a pa­tient comes in for a con­sul­ta­tion, we tie in their anatomy and bud­get to de­ter­mine what will max­i­mally im­prove them aes­thet­i­cally,” says Dr. Percec. “Our re­search teams have spent many years ap­ply­ing in­no­va­tive 3-D imag­ing to study fa­cial dy­nam­ics and mo­tion, which we ap­ply to our pa­tients. The goal is to have a face that moves nor­mally—to avoid the over­done look or a face that doesn’t move.”

The num­ber of “mommy makeovers,” which de­scribes a com­bi­na­tion of breast and ab­dom­i­nal re­ju­ve­na­tion, has also in­creased re­cently. Dr. Percec says, “Women of­ten come to us un­happy with the way their breasts changed, that they can­not lose weight, or their clothes aren’t fit­ting prop­erly. Ev­ery case is dif­fer­ent. With re­spect to the breast, we may uti­lize an im­plant in ad­di­tion to a breast lift to re­store vol­ume and give a full look and in some cases make them even bet­ter. And in re­gards to the tummy, there are mul­ti­ple vari­a­tions—li­po­suc­tion, tight­en­ing of deeper lay­ers that have sep­a­rated.” Stom­ach mus­cles can sep­a­rate dur­ing preg­nancy or from a Ce­sarean sec­tion, so when a wo­man eats, she may not feel as full and, as a re­sult, eat more.

For those who are con­sid­er­ing cos­metic plas­tic surgery but are some­what hes­i­tant, Dr. Percec sug­gests sim­ply sched­ul­ing an ap­point­ment. “A per­sonal con­sul­ta­tion is a good place to be­gin with get­ting an­swers to ques­tions,” she says. 23 Morris Ave., Ste. 219, Bryn Mawr, 215-662-7300; pen­n­medicine.org/plas­tic­surgery

HEALTH BREAKTHROUGH #3: MAN­AGE MENOPAUSE WITH IN­DI­VID­UAL TREAT­MENT In­te­gra­tive medicine at Jef­fer­son

WOMEN UN­DERGO 92 PER­CENT OF THE 15.9 MIL­LION COS­METIC PRO­CE­DURES PER­FORMED EV­ERY YEAR IN THE UNITED STATES.

Health com­bines the best of tra­di­tional, mod­ern medicine with life­style mod­i­fi­ca­tions and novel ther­a­pies to max­i­mize health per­for­mance. “We have a rich his­tory of de­liv­er­ing ev­i­dence-based ther­a­pies that com­ple­ment a pa­tient’s treat­ment plan and of­ten give a ther­a­peu­tic edge. Ear­lier this year, nearly two decades of re­search and pro­gram de­vel­op­ment cul­mi­nated in the for­ma­tion of the Mar­cus In­sti­tute of In­te­gra­tive Health, a ded­i­cated re­search and clin­i­cal en­tity of Jef­fer­son Health,” says An­thony J. Baz­zan, MD, as­so­ciate di­rec­tor of the In­sti­tute. The com­pre­hen­sive range of pro­grams for men and women of all ages in­cludes spe­cial­ized care for can­cer, weight prob­lems, choles­terol, ge­nomics, nat­u­ral hor­mone re­place­ment, brain and heart health, and a pre­mier ex­ec­u­tive health pro­gram, among oth­ers.

Rec­og­niz­ing that many women ex­pe­ri­ence dis­tress­ing side ef­fects at menopause and dur­ing peri-menopause, the Mar­cus In­sti­tute of­fers cus­tom­ized treat­ment plans for each pa­tient. Of­ten, women ex­pe­ri­ence de­creases in es­tro­gen, pro­ges­terone, and testos­terone lev­els, caus­ing a va­ri­ety of symp­toms such as hot flashes, night sweats, in­som­nia, di­min­ished bone min­eral den­sity, mood swings, and de­creased li­bido.

“Our ap­proach is to cre­ate a cus­tom­ized strat­egy that may in­volve some com­bi­na­tion of nat­u­ral hor­mone re­place­ment ther­apy, stress re­duc­tion, nu­tri­tional coun­sel­ing, ex­er­cise, and where needed, med­i­ca­tions,” Dr. Baz­zan says. Re­cent stud­ies have shown that nat­u­ral or bio-iden­ti­cal hor­mones given in the right doses and mode may not carry the same health risks as an­i­mal or chem­i­cally man­u­fac­tured hor­mones.

“We sup­port each wo­man’s bi­o­log­i­cal jour­ney and help them un­der­stand it, show­ing them what hap­pens,” adds Dr. Baz­zan. Menopause is a de­vel­op­men­tal mile­stone in women’s health and it is dif­fer­ent for each wo­man, so tai­lored op­tions on an in­di­vid­u­al­ized ba­sis rather than a “one treat­ment fits all” reg­i­men is the key to suc­cess. “We are care­ful to make it clear that they have choices in their health: We are the tech sup­port, they are the pi­lots, and the fly­ing can be won­der­ful.” 789 E. Lan­caster Ave., Vil­lanova, 800-JEFF-NOW; jef­fer­son.edu/in­te­gra­tive­health

HEALTH BREAKTHROUGH #4: SLEEP BET­TER TO LIVE BET­TER Oto­laryn­gol­o­gists are

“WE SUP­PORT EACH WO­MAN’S BI­O­LOG­I­CAL JOUR­NEY AND HELP THEM UN­DER­STAND IT, SHOW­ING THEM WHAT HAP­PENS.” — dr. an­thony j. baz­zan

physi­cians who di­ag­nose and man­age dis­or­ders of the neck and face, in­clud­ing the ears, nose, si­nuses, voice box, and throat. Jef­fer­son Hos­pi­tal’s Oto­laryn­gol­ogy—head and Neck Surgery Depart­ment has been con­sis­tently ranked as one of the na­tion’s top spe­cialty pro­grams byu. S. News & World Re­port. Ed­mund Pribitkin, MD, a pro­fes­sor at Thomas Jef­fer­son Univer­sity and codi­rec­tor of the Jef­fer­son Thy­roid and Parathy­roid Cen­ter, the first ded­i­cated, mul­ti­dis­ci­plinary cen­ter of its kind in the Delaware Val­ley, says, “Our physi­cians are lead­ing ex­perts in the field.

“Our depart­ment is ex­cep­tion­ally unique in how we have merged tech­no­log­i­cal ad­vance­ments and col­lab­o­ra­tion with other spe­cial­ties and de­part­ments within Jef­fer­son to give pa­tients lead­ing-edge, mul­ti­dis­ci­plinary per­sonal care.”

One ex­am­ple, ob­struc­tive sleep ap­nea (OSA), is a con­di­tion where breath­ing re­peat­edly stops and starts while sleep­ing due to com­plete or par­tial ob­struc­tion of the up­per air­way. OSA not only af­fects sleep but also over­all health and qual­ity of life. While in the past it has been con­sid­ered a man’s dis­ease, find­ings show that it poses se­ri­ous and even life-threat­en­ing health risks for women as well—par­tic­u­larly those who live with the con­di­tion un­di­ag­nosed.

“We have har­nessed the ben­e­fits of tech­nol­ogy in the treat­ment of OSA,” Dr. Pribitkin notes. “Of­ten­times pa­tients strug­gle with the stan­dard op­tion of us­ing a mask and ma­chine that blows air into the throat, and it is chal­leng­ing to cure peo­ple with surgery. We have found good suc­cess with a novel ap­proach called In­spire Ther­apy.” The de­vice is an im­plantable “pacemaker” that is in­serted in the chest. It mon­i­tors breath­ing and, based on the pat­tern, de­liv­ers mild stim­u­la­tion to a nerve that con­trols move­ment of the tongue and other key air­way mus­cles. 925 Ch­est­nut St., 215-955-6760; hos­pi­tals. jef­fer­son.edu

HEALTH BREAKTHROUGH # 5: A NEW ERA IN WEIGHT LOSS

Ad­vances in tech­nol­ogy have ush­ered in an era of min­i­mally in­va­sive al­ter­na­tives to surgery and, when pos­si­ble, non-sur­gi­cal tech­niques. “We fre­quently see

WHILE IN THE PAST OB­STRUC­TIVE SLEEP AP­NEA HAS BEEN CON­SID­ERED A MAN’S DIS­EASE, IT POSES SE­RI­OUS HEALTH RISKS FOR WOMEN AS WELL.

pa­tients who are mildly or mod­er­ately obese who have been un­suc­cess­ful at shed­ding their un­de­sired weight with diet and ex­er­cise, but they are not quite ready to go un­der the knife. Our of­fice is the sec­ond in the na­tion to of­fer pa­tients the Obalon Bal­loon Sys­tem, a newly FDAap­proved, non-sur­gi­cal de­vice that can help them achieve their goal weight,” says Louis Bucky, MD, chief of Plas­tic Surgery at Pennsylvania Hos­pi­tal. “The bal­loons serve to oc­cupy space in the stom­ach. By cre­at­ing a feel­ing of full­ness, or what we call sati­ety, pa­tients eat less and con­sume fewer calo­ries.”

Bal­loon in­ser­tion is done in an out­pa­tient set­ting, typ­i­cally takes less than 10 min­utes, and does not re­quire anes­the­sia, se­da­tion, or down­time. Dr. Bucky ex­plains that it “is con­tained within a cap­sule that is swal­lowed and then re­motely in­flated with gas via a mi­cro-catheter, which is then re­moved. This process is re­peated twice within the fol­low­ing three months, leav­ing three light­weight bal­loons in the stom­ach.”

In clin­i­cal tri­als, when the Obalon Bal­loon Sys­tem was used along­side a diet and ex­er­cise pro­gram, pa­tients lost twice as much weight com­pared to diet and ex­er­cise alone. “Our of­fice also pro­vides nu­tri­tional coun­sel­ing be­cause the suc­cess of long-term weight loss de­pends on the pa­tient’s abil­ity to mod­ify their eat­ing habits,” Dr. Bucky un­der­scores. “The good news is that when they do, re­search shows that, on av­er­age, 89 per­cent of the pounds that were shed stayed off six months af­ter the bal­loons are re­moved.” Re­moval of all three bal­loons is per­formed af­ter six months in an out­pa­tient set­ting with an en­do­scopic pro­ce­dure un­der anes­the­sia.

“The public is learn­ing that plas­tic surgery goes

HEALTH BREAKTHROUGH # 6: COM­BAT HEART DIS­EASE WITH LIFE­STYLE CHANGES

Car­dio­vas­cu­lar dis­ease is the num­ber-one killer of Amer­i­can women—caus­ing one in three deaths each year. De­spite these stag­ger­ing sta­tis­tics, many still con­sider it a man’s dis­ease. The more a wo­man knows about heart dis­ease, the bet­ter chance she has of beat­ing it.

“Many risk fac­tors are sim­i­lar to men’s—like blood pres­sure, choles­terol, and weight—while oth­ers are unique to women, like en­dometrio­sis and a his­tory of a com­pli­cated preg­nancy,” says Dr. Mar­jorie Stanek, car­di­ol­o­gist at Ein­stein Health­care Net­work and this year’s 2017 Go Red for Women Wo­man of Heart. Go Red for Women was de­vel­oped in 2004 by the Amer­i­can Heart As­so­ci­a­tion as a na­tional move­ment to raise aware­ness about heart dis­ease and risk fac­tors in women.

She adds, “Es­tro­gen pro­vides a pro­tec­tive ef­fect on our hearts and, as a re­sult, women gen­er­ally have a 10-year de­lay when it comes to de­vel­op­ing car­dio­vas­cu­lar dis­ease. Once menopause sets in, that shield goes away.”

While some risk fac­tors are out­side your con­trol— like race, age, and gen­der— there are many that you do be­yond want­ing to look good—it can also im­prove your qual­ity of life, even with­out surgery,” says Dr. Bucky. Mul­ti­ple lo­ca­tions, 215-323-5000; dr­bucky.com have the power to con­trol, such as diet, to­bacco and al­co­hol use, choles­terol, and blood pres­sure. Dr. San­dra Abram­son, di­rec­tor of the Car­dio­vas­cu­lar Imag­ing Cen­ter at Lanke­nau Med­i­cal Cen­ter, and 2017’s Go Red for Women Cham­pion, em­pha­sizes, “Even with risk fac­tors and a strong fam­ily his­tory of heart dis­ease, you’re not des­tined for heart dis­ease. If it’s proac­tively man­aged and treated, you can sig­nif­i­cantly de­crease your risk and level the play­ing field, but that re­quires com­mit­ting to an over­all healthy life­style.”

Be­ing phys­i­cally ac­tive is a very pow­er­ful tool to de­crease your risk. Says Dr. Abram­son, “The goal should be 150 min­utes a week. If you are in­ac­tive, start slowly—even if it means tak­ing a walk around the block once a day.”

And when it comes to smok­ing, just don’t do it. If you do smoke, look for re­sources in your com­mu­nity to help you quit. “There is no healthy amount of smok­ing,” Dr. Abram­son ex­plains. “We have one body, and our en­tire lives, to treat it well.” Both doc­tors will be hon­ored by the Amer­i­can Heart As­so­ci­a­tion at the Go Red for Women Lun­cheon on May 12 at the Crys­tal Tea Room. Dr. Mar­jorie Stanek, 60 Town­ship Line Road, Elkins Park, 215-6636700; ein­stein.edu; Dr. San­dra Abram­son, 100 E. Lan­caster Ave., Wyn­newood, 484-476-1000; main­line health.org

“Mommy makeovers,” a com­bi­na­tion of breast and ab­dom­i­nal re­ju­ve­na­tion, are a ris­ing trend in cos­metic surgery pro­ce­dures among women.

Health con­cerns spe­cific to women, like en­dometrio­sis and a his­tory of com­pli­cated preg­nan­cies, can in­crease the risk of car­dio­vas­cu­lar dis­ease.

Menopause is man­aged on an in­di­vid­u­al­ized ba­sis at Jef­fer­son’s Mar­cus In­sti­tute of In­te­gra­tive Health.

Jef­fer­son Hos­pi­tal’s Oto­laryn­gol­o­gyHead and Neck Surgery Depart­ment treats dis­or­ders of the neck and face.

Thanks to In­spire Ther­apy, pa­tients suf­fer­ing from ob­struc­tive sleep ap­nea can sleep bet­ter know­ing they are breath­ing eas­ier.

Pa­tients who un­der­went the new Obalon Bal­loon Sys­tem weight- loss pro­ce­dure had bet­ter re­sults when they adopted a diet and ex­er­cise pro­gram.

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