connect - Duke Health

04 Detox delusion 06 Name that headache
10 Build your bones 12 Pick the right shoe
14 What is “whole-person care”? 16 Chronic
pelvic pain 18 Of scabs and school lunches
connect
Medicine’s
future brought
home to you
fall 2009
Up close and digital:
How technology
helps personalize the
patient experience
page 14
connect
Medicine’s future
brought home to you
fall 2009
12
8
in this issue
04 The detox delusion 06 Understand your
headache 08 How to be serene 10 Build your
bones at every age 12 Pick the right shoe
14 Computers get personal 16 An end to
endometriosis? 18 Kids’ health Q&A 20 Your
guide to Duke Medicine 22 Calendar
14
Editor: Kathleen Yount
Designers: Cara Ragusa, Mike Joosse
Duke Medicine Connect is published biannually
by Duke University Health System and is
produced by Marketing and Creative Services.
Duke Medicine Connect strives to offer
current news about health topics of interest
to our readers. It is not intended to provide
personal medical advice, nor to substitute
for consultation with a professional health
care provider.
© Copyright Duke University Health System,
2009. MCOC-6546
special announcement
Duke Medicine’s plan to expand
this fall Duke Medicine is embarking
on a series of major construction projects
designed to dramatically enhance the
experience of patients, families, students,
and staff at Duke for decades to come,
including the new Duke Medicine Cancer
Center and Duke Medicine Pavilion,
a major addition to Duke University
Hospital. Together, the long-planned-for
buildings (and related renovations) will
add more than 800,000 square feet of
space to the medical center.
While the additional space will help
Duke meet a growing demand for care,
the most innovative aspect of the new
buildings is their patient-centered design.
The layout of the cancer center building
will be streamlined so that patients will
be able to get to all the services they need,
including access to new experimental
therapies and innovative treatment
approaches through clinical trials, without
ever leaving the building—there’s even
a special terrace where chemotherapy
patients can receive their treatment in
the fresh air. The patient and waiting
rooms in Duke Medicine Pavilion will
be large enough to accommodate visitors
and family members, and the operating
suites will be outfitted to allow efficient
use of the latest innovations in surgical
and imaging technology. Both buildings
are designed to bring in lots of natural
light and provide soothing views of
green spaces. 0
Duke Medicine Quadrangle, a
new “central park” at the heart
of the medical center campus,
will welcome visitors to the
Pavilion and the Cancer Center.
A patient-centered campus:
Duke Medicine Pavilion, a 580,000+-square-foot,
eight-story addition to Duke University Hospital
focused on surgical and intensive-care services,
will include a patient library, a café, a quiet space
for reflection, and plenty of natural lighting and
rooms with views of green spaces. OPENING late 2013
Duke University
Hospital
Going green: Both buildings are
designed to meet high standards
for environmental friendliness.
Want to know more?
Get all the facts online at:
dukemedicine.org/construction
A two-story, climatecontrolled concourse will
allow easy movement
between buildings.
Duke Medicine Cancer Center, a
267,000-square-foot, seven-story,
freestanding cancer center devoted to
outpatient care and clinical research,
will include a host of features to
enhance the patient experience—such
as a terrace where patients can receive
chemotherapy in an outdoor setting.
OPENING 2012
03 Duke Medicine Connect
Duke
Clinic
the real deal
Detox
diets
like your lemonade with a dash of hot pepper and
maple syrup? Enough to consume it exclusively for days
or even weeks on end? That’s the sum-total menu of the
“Master Cleanse,” current king of the so-called “detox
diets,” which purport to rid the body of harmful toxins
while helping it shed unwanted pounds.
Detox diets typically involve fasting or food restriction
and may include some combination of nutritional
supplements—products that could also contain laxatives,
diuretics, or stimulants. Some regimens recommend
frequent colonics or enemas as part of the cleansing process.
Duke nutritionist Beth Reardon
says the best detox is your
body’s natural process—that is,
when you don’t get in its way.
The evidence supporting detox diets is slim to none,
but they’re often touted as holistic and popularized by
celebrities small and smaller. Scores of slender starlets
can’t be wrong—can they?
Interested in integrative medicine
approaches to nutrition and weight loss?
Duke Integrative Medicine is offering
a three-day weight loss program,
designed to help participants develop
skills for successful weight loss and
maintenance. January 15 to 17, 2010;
visit dukeintegrativemedicine.org.
health news from Duke Medicine
0
H1N1: get the flu facts
Duke was one of the 12 national testing sites for the H1N1
(a.k.a. “swine”) flu virus vaccine, which was approved for
use in September. Duke Medicine has launched a Web
site to help spread the facts about this type of flu, which
is expected to persist throughout the flu season: visit
dukehealth.org/flu to find up-to-date information
about vaccines and tips on staying well.
0
Check up on heavy bleeding
Women who have heavy blood loss during their menstrual
cycles should talk with their doctors, particularly if they have
other signs of excessive bleeding—such as notable bruising
without injury and excessive or unexpected bleeding after
dental extractions, minor wounds, surgeries, or giving birth.
Duke researchers helped develop a new set of guidelines
that is helping doctors better identify bleeding disorders in
patients—many of whom go undiagnosed.
“We naturally detox most substances
that could be harmful.” —Beth Reardon
Flushing out the truth
It’s not merely the lure of plummeting
pounds that draws people to detox diets.
There’s powerful appeal in the promise
that these diets will cleanse our body of
toxins, observes Reardon. “We are so
bombarded by our food supply, what’s in
it, what’s not. We hear about additives,
preservatives, dioxins, carcinogens; we see
some horrific pictures from the Internet of
something that supposedly came out of a
colon; and we’re just overwhelmed. The
fear factor is pretty convincing. People
are grasping to do what makes sense, and
the notion of detoxifying the body sounds
right. But there just isn’t good science
behind detox diets.”
Claims don’t hold water
Most detox diets are awash in fluids; the
Master Cleanse’s liquid-only regimen
includes, in addition to six to 12 eightounce daily servings of lemon drink, a
quart of water with added sea salt—the
“saltwater flush”—as well as herbal
laxative teas to combat the constipation
that can result from the lack of food
intake. Reardon warns that overuse of
these electrolyte mixes or laxatives can
“disturb our natural balance, causing
0
dehydration, nausea, cramps, dizziness.
And excessive fluid intake can lead to
hyponatremia: low sodium in the blood.”
She says that people who are taking
medication for their heart or to regulate
blood sugar are at great risk for this
serious complication.
Not so fast
Reardon respects limited fasting as part of
one’s religious or cultural practice, but as
a dietary strategy, she stresses that fasting
or extreme food restriction is ineffective—
and it can be dangerous. “Cutting calories
ultimately slows down your metabolism,
which prevents weight loss.” And what
about that “natural high” some people
ascribe to fasting? “Reaching some altered
state, feeling euphoric—it’s ketones, a
metabolic disturbance. Soon you’ll start
feeling low energy and fatigue. Without
food, in a matter of days glycogen stores
are depleted and the body starts breaking
down muscle tissue, harming the heart
and other organs. It’s not healthy for
extended periods.”
effective approach to weight loss, and
what our bodies really need, says Reardon,
is a “plant-based, whole foods diet. That
means aspiring to eat nine to 12 servings
of fruits and vegetables a day and opting
for most of your protein in the form of
legumes and seafood, with occasional
poultry or grass-fed beef. You will
naturally ‘detox’ and feel better when you
stop eating all the processed and packaged
foods that cause jags in blood sugar.”
Finally, says Reardon, you just don’t
need to go to extremes to cleanse your
body of toxins. “Give your body more
credit. We have evolved over two-and-ahalf million years with highly effective
detoxification systems—such as the liver
and kidneys. We naturally detox most
substances that could be harmful. Our
bodies are designed to do this—if we give
them proper food and hydration and don’t
stress our systems by eating a diet that
includes a disproportionate amount of
processed foods.” 0
Don’t be a yo-yo
The rapid and dramatic weight loss
reported by some—singer Beyoncé’s
20-pound dip in two weeks was the big
buzz this year—is largely due to fluid
loss. And once you resume normal eating,
the weight rebounds quickly. A more
The mindful way to 40 winks
Stressed-out people sleep better and take sleep
medication less often when they learn to let go of
intrusive thoughts, according to a new study from Duke
Integrative Medicine. The researchers’ data show that
participants who took an eight-week mindfulness-based
stress reduction course reported less trouble sleeping
through the night, and also less sleepiness during the
day. Learn more at dukeintegrativemedicine.org.
Want to hear more from Beth Reardon?
Attend her free talk on diet and
inflammation—and other talks about
nutrition and weight management—
at Duke Medicine’s Teer House.
Details on page 23.
Attend a free talk on using meditation to
improve sleep. See page 23 for details.
The DukeHealth.org Poll:
How much sleep do you get at night?
Take the poll and read about sleep health at
05 Duke Medicine Connect
Beth Reardon, MS, RD, nutritionist for
Duke Integrative Medicine, gives us the
skinny on a recurring diet craze:
practically speaking
our
y
s
s
e
s
as
just
. Bad. Is it
s
t
r
u
h
d
a
uld it
Your he
ache? Co
d
a
e
h
n
io
g in
a tens
somethin
r
O
?
e
in
a
ent?
be a migr
ncy treatm
e
g
r
e
m
e
need of
For someone with a history
of migraine headaches, the signs
are familiar and unmistakable. Scott Huler
of Raleigh, age 50, who has had migraines since
adolescence, describes “a neon flashing in my eyes, a
small blot that eventually spreads to about 90 percent of
my vision; I can still see but am unable to drive or read.
Soon after, there’s a piercing, almost electrical pain that
to me is completely different from a regular headache.”
But for others the distinction is not always so clear.
There’s a wide range of possible migraine symptoms,
due to the complex activities occurring in the brain,
says neurologist Heather Adkins, MD, who specializes
in headache and face pain at the Duke Pain Clinic.
Attend a free talk
on December 8
to learn more
about managing
headaches and
migraines. See
page 22.
“A migraine is an event in the brain that actually starts
well before the pain begins. A neuron in the brain’s
cerebral cortex becomes activated, and that activation
spreads to other neurons—it’s almost like what
happens in a seizure.” But while a seizure is a spreading
wave of increased brain activity, a migraine is a wave
of decreased brain activity—that’s why early symptoms
can include vision problems, difficulty concentrating,
or numbness or tingling in the extremities. The pain
of a migraine occurs when the trigeminal nerve is
stimulated and releases substances that inflame and
dilate the blood vessels around the meninges, which are
pain-sensitive membranes encasing the brain.
So how do you know if you have a migraine? Migraine
sufferers often report throbbing or pounding
sensations, whereas tension headaches are more
commonly described as a tightening or steady ache,
often a band-like sensation around the head. Tension
headaches at their strongest may be hard to distinguish
from migraines, but they don’t tend to have the
additional symptoms associated with migraines, such
as migraine aura that involves visual disturbances
and tingling. Nausea and increased light and sound
sensitivity, frequently reported by migraine sufferers,
are uncommon for tension headaches—which, by
definition, cannot have more than one of these
symptoms. Also, physical activity does not typically
increase tension headache pain as it does migraine pain.
Another strong indicator of migraine is having a
family history of it. “Since so often there are multiple
family members with migraines, we think the cause
is primarily genetic,” says Adkins. There may be a
hormonal component to migraines in women, she adds.
“Men and women have the same rate of migraines until
puberty; after that, women are at greater risk. Many
women report migraines flaring up or worsening
around the menstrual cycle or after pregnancy.”
Whether it’s a tension headache or a migraine,
treatment is available. “Treatment of migraine has
advanced significantly in the last several years,” notes
Adkins, “so if you couldn’t find adequate relief before,
it’s worth seeking help again; we have a lot of new
options available, and more are on the horizon.”
It’s vital to seek immediate help for sudden, severe
headache, which can be an early sign of stroke. Other
warning signs include: numbness or weakness in the
face, arm, or leg; confusion such as difficulty speaking
or understanding; vision problems in one or both
eyes; or trouble walking, dizziness, or loss of balance.
“For a thunderclap type of headache, go to the ER
immediately,” stresses Adkins. “And any time you have
a headache that’s different from usual—if it’s changed in
pattern, in frequency, in intensity—call your doctor.” 0
Name that
1. Linked to prolonged exertion. Usually harmless,
though there could be a secondary cause of concern—
you should see your doctor for any headache caused
by exertion.
Match the name to its
description—but don’t give
yourself a headache! Take a
peek at the answer key below
if the pressure starts getting
to you. And regardless of the
suspected type or origin, seek
medical care for any headache
that concerns you or that
bothers you for more than 15 days per month.
2. There are many possible culprits for headaches that
interrupt sleep, some quite serious. Check with your
doctor if you wake up because of a severe headache.
3. Any headache could fall under this category if it occurs
15 or more days per month, but chiefly they are
migraine, tension, and rebound. Recent research shows
that most children who suffer these outgrow them.
— a. Stress headaches
— b. Cluster headaches
— c. Ice cream headaches
— d. Sinus headaches
1-g 2-h 3-i 4-b 5-c 6-d 7-e 8-f 9-a
4. Sudden and painful, often focused in or around the
eye; attacking in bouts of frequency, hence the name.
5. It seems like a cruel life lesson that the joy of biting
into a frozen treat is often tempered by one of
these. We’re not quite certain of the cause. They’re
usually fleeting and harmless, but if you’re prone to
migraines, be warned: they may trigger one.
6. Marked by pressure and throbbing. But even if you’re
congested, don’t rule out migraine. Lots of people
mistake their migraines for these.
7. Not the age-old excuse for avoiding intimacy. These
are triggered by orgasm and more common in men
and migraine sufferers.
— e. Sex headaches
— f. Rebound headaches
— g. Exercise headaches
— h. Nighttime headaches
8. The result of headache medication overuse, these
headaches will fade after the overuse is corrected.
9. Also known as tension headaches; usually a mild to
moderate ache or tightening. A good remedy: address
the cause of the stress.
— i. Chronic daily headaches
Neurologist Heather Adkins
says that understanding the
type of headache you have can
help you beat it.
It’s easy to jump to the most frightening
conclusion when frequent, recurring
headaches are involved. “I commonly
hear from patients worried they might
have a brain tumor,” says Adkins. She
offers this reassurance: “In general,
headaches are not the way brain tumors
present. The cerebral cortex does not
sense pain. There has to be pressure on
the meninges before there’s pain—and
by that point, the tumor would have
grown large enough that you’d probably
be having other neurological symptoms
to alert us.”
07 Duke Medicine Connect
It’s not a tumor
the Duke how-to
Get serenity now
Depression, anxiety, and anger do more
than complicate relationships and make
life difficult—they take a decided toll on
physical health, especially the heart.
The link between emotional and
physical health is not a theory—it’s a
fact. “We know there’s a relationship
between mental health and heart
health,” says cardiologist Christopher
O’Connor, MD, director of the Duke
Heart Center and co-director of the new
Duke Heart-Mind Center. “For example,
people with depression are shown to
have blood platelets that are stickier
and therefore more likely to form a clot;
it’s also associated with an increase
in inflammation and heart rhythm
disturbances.” And there’s a behavioral
component, as well: a person under stress
tends to isolate herself more, which
means less social support, a key factor
in healthy living. Stressed people are
also less likely to take their medication
responsibly or to actively participate in
their health care, he says. It all adds up
to a higher likelihood of health crises,
complications, and perhaps a shorter life.
As study after study offers yet another
compelling reason not to let stressful
emotions wreak havoc on your body,
perhaps it’s finally time to take the advice
of teenagers everywhere to heart—and
just chill. Here’s how:
Just sit there
People who practice meditation and
mindfulness have better health outcomes
than those who don’t, according to
Jeff Brantley, MD, director of the
Mindfulness-Based Stress Reduction
Program at Duke Integrative Medicine
and the author of several how-to books
on the subject, including Calming Your
Anxious Mind. “Research has shown
that the ability to concentrate attention
can promote deep relaxation in the body,
and that the ability to be more mindful
in each situation can help break the
destructive habitual reactions to stress.”
One simple exercise for deep relaxation,
described in Brantley’s book Five Good
Minutes, involves focusing on the
sensations of the breath. Imagine that
you are taking in feelings of calm and
peacefulness with each inhalation, and
expelling tension with each exhalation.
Simmer down
Anger management techniques have
proven remarkably successful in reducing
blood pressure and alleviating depression,
says Redford Williams, MD, director of
Duke’s Behavioral Medicine Research
Center and co-founder with his wife,
Virginia Williams, PhD, of LifeSkills, a psychosocial skills training program.
Williams suggests writing down specific
episodes of anger to help identify your
unique patterns, triggers, and responses.
And when faced with enraging situations,
stop to assess before taking action.
Look at the facts objectively, then
ask yourself his four “I Am Worth It”
questions:
I:
Is this matter important to me?
A: Are my thoughts and feelings
appropriate to the situation?
M: Is the situation modifiable in a
positive way?
Worth It: When I balance the needs of
others and myself, is taking action
worth it?
Positive takes practice
Negative emotions may be bad for you,
but Williams says research also shows
the converse to be equally true. A recent
Women’s Health Initiative study associates
optimism with a reduced incidence of
heart disease and total rates of death.
But can a dedicated cynic be reformed?
Williams says optimism may come more
naturally to some people than others,
but anyone can cultivate the trait with
practice. “Simply learning to cope better
increases optimism. As people improve
their anger and stress management skills,
they realize they are not at the mercy
of the situation.” In fact, they have the
power to improve it.
Improving personal relationships is
another path to a positive outlook.
“Listening is key,” Williams advises.
“Keep your mouth shut until the other
person is finished speaking, and try
to be open to the possibility of being
changed by what you hear.” One of the
exercises he gives to people in LifeSkills
is to “think of someone you encounter
every day, list five positives you can
inject into that relationship, then do
them.” The psychologic and physiologic
benefits of such practices are measurable:
participants’ satisfaction with life and
social support go up, overall blood
pressure goes down, and blood pressure
surges during stressful times are less acute.
Don’t blow off the blues
“People who are depressed die at a
greater rate than those who aren’t, and
those deaths are largely related to heart
problems,” says O’Connor. Because the
links are so strong and the stakes so high,
he believes depression screening should
be part of a routine cardiac workup.
O’Connor notes that your primary
health care provider already has tools
to screen for major depression—if a
patient answers “yes” to either of these
questions: During the past month, have
you often been bothered by feeling down,
depressed, or hopeless? How about by
little interest or pleasure in doing things?
“The questions can help doctors identify
more than 90 percent of patients with
major depression,” O’Connor says—and
can make a lifesaving difference. “We
think it’s as important to check as blood
pressure, glucose, or cholesterol.” 0
09 Duke Medicine Connect
Cardiologist Christopher O’Connor, integrative medicine specialist Jeff Brantley, and
psychiatrist Redford Williams all agree that emotional health can play a significant role
in the development—or prevention—of chronic illnesses such as heart disease.
Emotional
health may be
as important
to monitor as
blood pressure
or cholesterol.
living well at every age
build your
bon e s
Oddly enough, the bone-weakening
disease osteoporosis isn’t something you
can feel in your bones. All too often,
people remain unaware until it makes its
presence known via a disabling fracture
in the hip or spine. Nearly half of women
and one in four men over age 50 will
break a bone as a result of osteoporosis,
according to the National Osteoporosis
Foundation. But prevention, detection,
and treatment of osteoporosis have made
great strides in recent years. You may not
be able to alter certain risk factors such as
gender (80 percent of those affected are
female) or genetic predisposition (present
in 66 percent of people with osteoporosis),
Big builders
but being aware and proactive can help
you maximize your bone density.
Duke physical therapists Peggy Anglin
and Courtney Frankel, who train and
educate people with osteoporosis every
day, share their thoughts on optimizing
bone health at every age and stage of life.
Prime time
It’s crucial to build strong bones in childhood and adolescence,
when 85 to 90 percent of bone mass is acquired. Anglin notes
that the decline of physical education and recess in schools means
parents need to step up efforts at home. “Do everything you can
to get your kids involved in physical activity.” Adds Frankel, “Kids
should be running, jumping, and playing, really putting that
maximum impact on the bones. Sports are a fine venue
to get children and teens moving.” Both caution parents
to look out for emerging eating disorders in
adolescents. Extreme dieting and over-exercising
can seriously affect bone density.
KIDS
Physical therapists share
skeletal tips for every stage
of life
&
TEENS
Bone mass usually peaks at skeletal maturity in the early
20s and is normally maintained until around the mid-30s.
“These are your prime years,” notes Anglin. “Athletes are
usually at their top performance levels during this time.”
Still, it’s easy to get derailed by accidents or injuries. Start
taking care of your back; learn proper lifting postures to
avoid bending over at the spine, which could set you up for
compression fractures. Frankel advises developing a fitness
routine if you haven’t already. “Young adults should aim
to do weight-bearing exercise three to five days a week
and weight-training two to three days per week.”
THE
ROARING
Things you can do at any age to reduce the risk or impact of osteoporosis include
getting good nutrition, maintaining a healthy weight, quitting smoking, and reducing or
eliminating alcohol. Exercise is especially vital for building or maintaining bone mass.
“These healthy behaviors are not something you do for a few weeks to accomplish a
goal,” stresses Duke physical therapist Courtney Frankel, “but as part of daily life.”
2
Research news:
Osteoporosis drug does double duty
In 2007, Duke researchers
reported a 28 percent
reduction in death among
patients who received the
osteoporosis drug zoledronic
acid (Reclast) within 90
days of surgery for a hip
fracture. Many assumed the
drop in mortality was due
to a reduction in secondary
fractures. But a new Duke
study reports that the
reduction in additional
broken bones accounts
for only 8 percent of the
mortality benefit. People in
the zoledronic acid group
who had certain cardiac
problems such as arrhythmia
and pneumonia were
much less likely to die from
those conditions than their
counterparts in the control
group. Zoledronic acid is
known to affect the immune
system and inflammation,
and both of those are
important in fighting
infection and cardiovascular
disease. Further studies will
investigate whether the drug
is changing the body’s ability
to fight off and recover from
those illnesses.
Physical ther
apists Pegg
y Anglin an
it ’s never to
d Courtney
o late — or to
Frankel say
o early—to
improve bo
ne health.
Bone-boosting supplements
Along with eating a balanced diet, taking supplements of
calcium and vitamin D can help maintain bone mass. Most
physicians favor calcium citrate over calcium carbonate for
better absorption. The National Osteoporosis Foundation
recommends these daily doses:
For ages 9 to 18: 1,300 mg calcium; 400-800 units D
For ages 20 to 50: 1,000 mg calcium, 400-800 units D
After age 50: at least 1,200 mg calcium; 800-1,000 units D
Finding balance
Bone mass starts to level off around age 35,
when age-related bone loss begins. That’s all
the more reason to stay fit. “Especially if you’re
a parent,” says Anglin, “this can be a really busy
stage with plenty of lifting; old injuries may tell on
you, and stiffness may develop. It is a good time to
focus on healthy habits and posture.” Strengthening
your abdominal area will help straighten posture
and protect the lower back, and stretching helps
avoid stiffness after exercise. Particularly for woman
approaching menopause, Frankel recommends a fitness
routine that includes four to five days of weight-bearing
exercise per week and two to three days of weightlifting or weight-resisting exercise per week. Anglin
advises that women request a bone density scan around
age 50 if they’ve never had one.
mid-
30s
to
50
FIFTY
20s
Reclaim, maintain
Avoiding falls is of paramount concern for people as
they get older. “People start to lose their balance
as they age,” notes Frankel, “but they can regain it
through practice. It can be as simple as standing on one
foot while brushing your teeth. Also, tai chi improves
balance and is a safe activity for almost anyone. Asian
studies on tai chi show great outcomes in terms of
reduced falls and fractures.” Anglin recommends that
folks with bad knees or bad backs learn safe techniques
for activities such as raking, vacuuming, or reaching for
items. “It’s about avoiding twists and maintaining the
normal spinal curve while doing any activity.” Both
stress that it’s much worse to become inactive. “You will
lose bone mass from inactivity,” warns Anglin. “Never
stop doing what you enjoy,” says Frankel. “Just modify
it; reduce the intensity a bit.” 0
AFTER
50
11 Duke Medicine Connect
Duk
H ou e M e d
i ci n
se se is
e
you minar of ferin ’s Teer
r sh
s on
g
o
ke free
u
h ea
l t hy l d e r s a e p i n g
n
i nju
a
r y. nd av d knee
See
oid
p a g in g s
e 22
.
from dukehealth.org
Pounding the
How to choose the right walking or running shoe
Having a shoe that supports your foot is the
key to keeping you moving. To pick the right shoe,
you need to know your foot type. You also need to
know the type of shoe that best supports your arch
and running style. Duke Sports Medicine physical
therapist Randall Lazicki offers these tips:
Normal
pronater
What’s your foot type?
When you walk or run, you naturally land on
the outside of your foot and roll inward. This
inward rolling is called pronation. There are
three different foot types: neutral arch, low arch,
and high arch. The height of the arch affects the
direction and severity of the way your foot rolls,
or pronates.
To determine your foot type, just take a look at
the bottom of your running shoe. The wear on
your shoe (as shown at right) will likely reveal
your foot type.
neutral arch
overpronater
If this tactic doesn’t tell you what type of foot you
have, a simple “wet test” may do the trick. You’ll
need water, a shallow pan, a brown paper grocery
bag, and your foot. Follow these steps:
flat arch
1. Place the pan on the ground.
2. Put the bag in front of the pan so you can
comfortably step from the pan to the bag.
3. Pour water into the pan—enough to cover
the bottom completely.
4. Take your shoes off.
5. Stand a foot’s length behind the pan.
6. Step into the pan so your foot gets wet.
7. Step onto the grocery bag.
Lifting your foot reveals your foot type. Your
footprint should resemble one of the arch images
at right.
underpronater
high arch
No matter how expensive your
shoes are or how much technology
they contain, they will not do their
job unless they fit correctly.
Matchmaking
At the store
Now that you know your foot type,
it’s time to find the right shoe for you.
Shoes are generally categorized as
stability shoes, motion control shoes,
or cushioning shoes.
If you shop at a quality running store,
the employees often have extensive
knowledge about the shoes and can help
you select a pair that supports your foot
type. When you try on shoes, remember
these key points:
Motion control shoes are great for flatfooted and heavy runners who tend to
overpronate. The arch area on motion
control shoes is filled in for increased
stability. The extra rigidity in these shoes
prevents the ankle from turning out and
the foot from overpronating.
Cushioning shoes help support people
with high arches and rigid feet who tend
to underpronate. This highly flexible shoe
is built on a curve and made of lightweight
materials that provide minimal rigidity
with optimal cushioning.
•
Try on running shoes toward the end
of the day—your feet swell after many
hours of supporting you.
•
Wear the socks, orthotics, and braces
that you would wear when running.
•
Stand up to check the length and width
of the shoe.
•
Perform a heel raise, a walk, and a jog
while trying on the shoe to make sure
it offers the support that you need.
How the shoe feels in the store is how
it will feel when you are running, so
choose wisely.
How’s your form?
Watch and learn with
videos from Duke.
Visit dukehealth.org to
find videos featuring Duke
Sports Medicine experts that
teach you proper exercise
techniques, such as safe and
effective ways to stretch
your hamstrings, strengthen
your core, and achieve good
running form.
You should replace running shoes every
400 to 600 miles because the shock
absorption depletes with every passing
mile. And remember, no matter how
expensive your shoes are or how much
technology they contain, they will not
do their job unless they fit correctly. 0
This story is condensed from the original version that appeared on DukeHealth.org. You can find
more health tips like this online—where you can also sign up for DukeHealth.org Digest, a biweekly
e-mail newsletter that delivers stories like this and other health news directly to your inbox.
13
Duke Medicine
Medicine Connect
Connect
13 Duke
Stability shoes are best for runners with
normal arches and only mild control
problems. Stability shoes are typically
built with a gentle arch from front to
back that provides heel stability and
forefoot flexibility.
feature
Computers
make it personal
The digital road
to “whole person”
cancer care
Ah, the waiting room. No matter what
kind of appointment you’re waiting for, it’s
almost always the same: vintage Family Circle
magazines to browse, easy listening or talk radio
droning in the background, and those clipboards
with forms to be filled out in triplicate. You may
while away the time pondering such questions as:
Is your personal information disappearing into a
file somewhere? Do they really need your address
and insurance ID numbers again?
Not a
problem
0
Mild
problem
1
2
3
Moderate
problem
4
5
6
Severe
problem
7
8
As bad as
possible
10
9
The cancer clinics at Duke are changing this
waiting game with a digitized experiment. When
patients arrive for an appointment, instead of the
clipboard they’re given a wireless, tablet-style
computer. It guides them through a series of
questions about their symptoms and quality of life.
Their clinician gets a report of the answers, and
he or she can use the information to make the visit
more productive—whether that’s by adjusting
medical treatment of a particular symptom,
providing an educational video for the patient
to view while waiting for an exam or during
chemotherapy, or some other service.
Amy Abernethy, MD, who directs the Duke
Cancer Care Research Program, says that
patients find the new system easy and even
pleasant. They’re presented with a symptom such
as headache and asked to rate the severity from
0 (“not a problem”) to 10 (“as bad as possible”—
as shown at left). They touch the appropriate
number with a stylus, it vanishes from the screen,
and the next symptom or question appears.
The format makes it easier to provide frank
answers to sensitive questions. “Our studies are
showing that the computer allows people to say
things they wouldn’t have otherwise said. We
really saw the difference in reporting difficulties
with sexual function and social support. It can
be hard to be honest when your spouse is right
next to you looking over your shoulder at the
Oncologist Amy Abernethy directs the Duke
Cancer Care Research Program, which aims to turn
the philosophy of “whole-person care” into real
clinical practice.
clipboard, but electronically, you provide the
answer and it disappears.”
The clinician can immediately compare the
patient’s answers with those from previous
visits and get a strong sense of whether or not
symptoms are truly improving. “Research shows
these reports to be very reliable,” notes Abernethy.
And in the aggregate, the information patients
provide here helps create a bigger picture of what’s
happening to a group of cancer patients over time.
Researchers and clinicians are assessing this longterm data and using it to improve patient care.
“For example, among the breast cancer patients we
noticed that sexual distress was an underserved
concern,” says Abernethy. “I don’t think anyone
Find free support groups and classes
to help patients and families that are
living with cancer. See page 23 or go
online to dukehealth.org.
Advances on every front
Abernethy describes the system as providing
“a kind of triage. Through this technology
we can better understand patients’ needs,
whether they require more education about
their condition or help with transportation or
payment. There’s so much support on hand at
Duke; we just need to appropriately match our
patients with what is available.”
Rather than having a distancing or
depersonalizing effect, handing patients a
computer has become a means to provide
comprehensive, whole-person care. “I’m
interested in improving the cancer patient’s
experience,” says Abernethy. “You can’t do that
if you don’t know what the problems are, how to
measure them, or how good of a job you’re doing.
We’re taking care of the whole person here, not
just their cancer.” 0
Rather than having
a distancing effect,
handing patients a
computer actually
makes their experience
more personal.
Duke cancer research gets real on all aspects of cancer care,
including:
Chemo’s side effects: As cancer patients live longer, side effects
of their therapies take on new meaning. Up to a third of all
patients who take a class of successful chemotherapies called
anti-angiogenesis drugs develop high blood pressure. Scientists at
Duke have found out why—the drugs, in addition to disrupting
a tumor’s growth, also disrupt an important biological system
that regulates blood vessel health. The finding paves the way for
strategies to counteract this effect.
Prevention and control: Previous studies have shown that men
taking cholesterol-lowering drugs called statins seem to have
a lower incidence of advanced prostate cancer, and a new
Duke study may help explain: it showed that men in the study
who were on statins had a 72 percent reduction in risk for
tumor inflammation. Other Duke Prostate Center research has
found that inflammation in tumors is associated with recurrent
prostate cancer.
Whole-person care: A Duke pilot study of the Pathfinders
program—which provides patient navigation, counseling, copingskills training, mind and body techniques, and lifestyle advice—
has shown that it helps improve quality of life for women with
terminal cancer. The program helped improve distress and
despair during the initial three months and up to six months after
diagnosis among women with metastatic breast cancer and a
six-month life expectancy.
Monitoring treatment effectiveness: Typically, patients undergo
chemotherapy and then return several weeks later for a scan to
measure changes in their tumor size. Duke cancer researchers
and engineers have developed a new technique to track chemo
effectiveness by examining the patterns in which light bounces
off cell surfaces. The technique might be used as a tool for
measuring patients’ response to chemotherapy more quickly and
non-invasively than current methods.
Other research news includes new findings on treatment
strategies for ovarian, brain, prostate, and other cancers.
Read more in the Health News section of DukeHealth.org.
15
Duke Medicine
Medicine Connect
Connect
15 Duke
had any idea just how much of an issue it was,
but one in three people were scoring over 5 in
that area. [A score of 4 to 6 denotes a moderate
problem, while 7 to 9 denotes a severe problem.]
So this was remarkable. It very quickly put
us onto two pathways: offering patients more
education through the tablets and working with
psychologists to develop coping methods for
patients who report that problem.”
research gets real
An end to
endometriosis?
A new treatment may give some women
the cure they’ve been waiting for
Lauren Willis had hoped her chronic
pelvic pain would end with the removal of a
grapefruit-sized cyst from her ovary. But just
a month after the surgery, she was hurting so
much she could barely walk. Her doctor said
it was due to endometriosis, a condition where
endometrium—tissue that normally lines the
inside of the uterus and is shed during the
menstrual period—exists elsewhere in the body.
The errant tissue can cause pelvic pain, as well
as affect fertility.
Duke surgeon Patrick Yeung Jr.
says that women suffering
with chronic pelvic pain
may have more options for
treatment than they realize.
through scar tissue to detach it.” Even then, her
pain would not abate. “I’d be in bed for days. It
felt like something was ripping my insides out.”
Further ablations brought only temporary relief,
and continued hormonal therapy came with
unwelcome side effects: “I gained 35 pounds in
three weeks.” Ultimately, her doctors advised
Willis, then age 22, to “have a child by 25, if
you’re going to. Or get a hysterectomy now.”
Willis was treated with ablation, a minimally
invasive procedure that aims to destroy
endometrial tissue by burning or coagulation,
but in two months, the pain was back. The
next approach was hormonal suppression.
“Depo-Provera made me bleed too much,” she
says, “so they tried ‘medical menopause’ and
I didn’t have a period for seven months. They
put me on 12 different kinds of birth control
pills. Nothing worked. I felt really sick.”
Then she was referred to Patrick Yeung Jr., MD,
director of The Duke Center for Endometriosis
Research and Treatment. “Women with pelvic
pain are all too often written off at first—given
medications, and told that what they’re
experiencing is normal,” says Yeung. “That
does them a real disservice. A woman who
is doubling over with pain, missing work or
school—that is not normal. These women know
something’s wrong, and they want something
done.” And for most women, a hysterectomy is not the ideal solution.
Another surgery was done to repair adhesions
in her intestines, bladder, ovary, and uterus
caused by the endometriosis, which had
continued to advance. “My uterus was stuck
to my spine,” Willis says. “They had to cut
Yeung specializes in the surgical removal of
endometriosis using a carbon dioxide (CO2) laser.
The procedure is minimally invasive, requiring
only a keyhole incision through the navel
and two small incisions below the bikini line.
Patients generally go home the same day and can
expect to return to work in a week or two.
Yeung favors the CO2 laser for excision surgery.
“I would never want to ablate around a vital
organ, but I have used the laser to remove lesions
over ureters and bowels. The laser is a very
discriminating tool.” Also, all the removed tissue
is then sent to pathology, so that the patient can
get a definitive diagnosis. Yeung says the average
length of time between onset of symptoms
and definitive diagnosis of endometriosis is an
astounding 12 years. “This disease is vastly
underdiagnosed and undertreated,” he says.
For many women, knowing that they have
an abnormal condition—and that it can be
removed—can be very therapeutic.
Duke Medicine’s Teer House
offers a variety of free
seminars on women’s health
issues, including polycystic
ovary syndrome (PCOS) and
incontinence. See page 22.
Duke Medicine has clinics
for women’s health in Durham,
Raleigh, and Cary. To learn more
about excision surgery and other
services for chronic pelvic pain,
call 1-888-ASK-DUKE or visit
dukehealth.org.
Yeung and his colleagues at the Center for
Endometriosis believe excision to be superior
to ablation in the treatment of endometriosis.
His unpublished data show a very low rate of
recurrence with excision—less than 10 percent,
compared to more than 50 percent recurrence
with ablation after five years. “With ablation,
you may just be burning the tip of the iceberg.
There may be a whole lesion underneath that
you haven’t gotten to; some are very thick.”
Willis had the laser excision procedure in
mid-March 2009, and when the two-month
mark passed without pain, she began to have
confidence. “I’m feeling great,” she says today.
“Before, I’d have had another surgery by now.”
Almost worse than the pain had been the loss of
hope that things could get any better. “My first
doctor told me, ‘You’re just a baby; it’s not that
bad.’ It’s really sad because you feel horrible,
but you have to keep pressing to get to what’s
wrong.” Changing the fates of women who are
suffering with endometriosis keeps Yeung fired
up about his work, he says. “It’s my passion.” 0
“Women with pelvic pain
are all too often written
off at first. That does
them a great disservice.”
—Patrick Yeung Jr., MD
17
Duke Medicine
Medicine Connect
Connect
17 Duke
While hormonal suppression is more successful
in some women than it was for Willis, Yeung
views it as “Band-Aid therapy. It may keep the
disease at bay for some women, but it doesn’t
remove the lesions.”
Duke docs on q
Make it
better!
Duke pediatric
ians William La
wrence,
Martha Gaglia
no, and Micha
e
l Land
talk turkey on
school lunches,
nasty
noses, seasona
l sneezes, and
scabs
School is starting again, and I’m afraid
that when left to their own devices, my
kids will subsist on cafeteria corn dogs
and Tater Tots. How can I make sure
they’ll eat healthy meals?
Want more articles on kids’ health?
Go to DukeHealth.org’s Health Library
and click on Your Child’s Health.
Find free seminars on keeping
kids and families healthy at
Duke Medicine’s Teer House.
See page 23.
William Lawrence, MD: Whenever feasible,
we encourage packing a breakfast or lunch to
send to school. It really gives you control over
content. Most children don’t get enough fruits
and vegetables in their day, so send things that
are packable and won’t quickly spoil: apples,
bananas, carrot sticks. And for breakfast, try
thinking beyond traditional foods like pancakes.
A little bit of protein and a good carbohydrate
source, like a stick of mozzarella and a piece of fruit, can make a healthy breakfast.
While packing meals is not always practical,
simply knowing what’s on the school menu
[check your school’s Web site] can help you steer
your child toward healthier options. Depending
on your child’s specific dietary needs, good
everyday choices may include 1 percent milk
instead of whole or chocolate milk, or opting
for water instead of juice—there are a lot of
concentrated calories in juice, so cutting it out
can really have a good impact.
My day-care provider says my child
should probably stay home if he’s got
“green snot.” Does that mean he has
an infection? When should I take him
to the doctor, and when can he just
ride it out at home?
The younger a child is, the harder it is to know
how serious an illness is. Both viral and bacterial
infections can make very young children quite ill, so
with infants it’s best to be proactive and to follow your
instincts: If your baby is listless, eating poorly, or just
doesn’t look “right” to you, call your doctor. Any fever
in a baby less than one month old is worrisome, and
you should call your doctor immediately.
For older children, things are a little easier. In general,
viruses cause lower fevers (less than 102.5º), are
accompanied by symptoms such as a runny nose,
hoarseness, vomiting, or diarrhea, and improve over
three or four days. The illness is more likely to be
bacterial if the fever is high, if it lasts longer than
four days, of if there is specific pain (like a sore
throat or an earache). Note that antibiotics don’t
work on viruses, only on bacterial infections. We
have a huge problem with drug resistance because
of the overuse of antibiotics, so you don’t want to
use them unless they will really do some good. For a
virus, keep your child comfortable and hydrated and
wait it out. Most viruses are at their worst for three
to four days, so if it lasts longer, or if the fever is
103 o or higher, go to the doctor.
Is it really better to “air out” a
scab and keep it dry, or should
you keep it covered and moist—
or does it make a difference?
Gagliano: Airing out scabs has fallen out of
favor among dermatologists. Scabs itch and
kids pick at them. We’d rather keep it covered
and not let it form that thick, itchy scab.
Coat the scab in an antibiotic ointment like
Polysporin, then bandage it to keep it moist
and not let it get crusty.
Gagliano: That’s controversial—maybe the
fever’s doing some good, but maybe not. If your
child is uncomfortable, treat the fever. Most kids
look terrible with a fever, so they’re very difficult
to assess. Controlling the fever allows both the
doctor and parent to assess how that child is doing.
Also, kids get dehydrated easily; when they have a
fever, they’re losing water and need more, but they
often won’t drink as much, so they’re at higher
risk of dehydration. My opinion is to go ahead and
treat those fevers.
At our house, we know it’s autumn
before the leaves change color
because our child’s sneezing and
runny nose really ramp up. Can you
recommend any natural remedies
for seasonal allergies?
Michael Land, MD: There is not enough strong evidence to
recommend the use of herbal supplementation, acupuncture,
or “special diets” for the treatment of allergic rhinitis.
Some patients benefit symptomatically from nasal saline
rinse, which washes out debris and pollens. Allergy shots
are considered by some to be a natural way of dealing with
allergies, although they are still a medical treatment given
by a doctor. These injections actually expose your body to
small amounts of what you’re allergic to. By starting with
tiny amounts and gradually increasing regularly, these
injections slowly change your immune system to be able
to tolerate larger amounts of the allergens.
The best way to get rid of the symptoms of allergic rhinitis
would be to avoid the allergen that is triggering them.
Reducing exposure to outdoor allergens is important when
the pollen count is high. To avoid outdoor pollens, keep
the windows closed in your home and car. Also, pollens
are often emitted in the early morning hours (between
5 a.m. to 10 a.m.), so avoiding early morning outdoor
activity can help extremely sensitive people. 0
19 Duke Medicine Connect
Martha Gagliano, MD: That’s a myth—the color of
mucus is completely irrelevant. Kids don’t blow their
noses very well, so the mucous turns green.
While we’re on the subject of fevers, is
it better to let a mild fever go? If I bring
down my child’s temperature with Tylenol
or Motrin, for example, am I hampering
the body’s ability to fight infection?
for your reference
Map legend
Hospital
.
Medical Plaza
Primary Care
.
Urgent Care/ER
Specialty Care
Ambulatory Surgery
Obstetrics
Location, location, location
Duke Medicine is based in North Carolina’s Triangle region, with three hospitals and more than
150 clinics throughout Durham, Raleigh, Cary, and Chapel Hill. Other Triangle communities where
you can find Duke Medicine clinics include:
n
Clayton
n
Knightdale
n
Morrisville
n
Pittsboro
n
Smithfield
n
Hillsborough
n
Mebane
n
Oxford
n
Roxboro
n
Wake Forest
Duke’s health services in the Triangle include:
n
Cancer
n
Gastrointestinal
n
n
Ear, nose, and throat
n
Health and wellness
n
n
Eye care
n
Heart
n
Fertility
n
Lung
n
Neurology
n
Pediatrics and
pediatric specialties
Obstetrics and
gynecology
n
Primary care
Orthopaedics
n
Urgent care
National rankings
Patient care quality scores
How to find Duke Medicine
In 2009, 14 of Duke’s specialty programs
were ranked by U.S.News & World Report as
among the best in the nation, including eight
programs that were in the top 10 of their field.
All Duke services have teams that focus
on clinical quality and patient safety. See how
Duke measures up compared to the national
averages at dukehealth.org/quality.
To learn more about Duke Medicine’s
health services and locations, go online
to dukehealth.org or give us a call at
1-888-ASK-DUKE (1-888-275-3853).
New openings
Live outside the Triangle? Find Duke Medicine in your neighborhood:
Cary
Capital Orthopaedics and Sports
Medicine
401 Keisler Drive
Suite 100
Cary, NC 27518
919-851-5880
Burlington, NC
Duke Electrophysiology at
Kernodle Clinic
Raleigh
Capital Orthopaedics and Sports
Medicine
1108 Dresser Court
Raleigh, NC 27609
919-876-8300
Duke Pediatric Cardiology Clinic
at Laurinburg
Duke Perinatal Consultants
of Burlington
n
Maternal and fetal medicine, pediatric allergy
Concord, NC
NorthEast Cardiovascular
Duke Cardiovascular Surgery
of Lumberton
Creedmoor, NC
Butner-Creedmoor Family Medicine
Danville, VA
Duke Cardiovascular Surgery of Danville
Duke Ophthalmology Consultative Clinic
Duke Medical Plaza Brier Creek
10211 Alm Street
Raleigh, NC 27617
919-484-8345
Henderson, NC
Duke Hematology/Oncology
Fertility
n Physical and occupational therapy
n Primary care
n Urgent care
n Women’s health
Henderson Family Medicine Clinic
Duke Radiology of Raleigh
formerly Capital Radiology
3480 Wake Forest Road
Raleigh, NC 27609
North Hills Internal Medicine
3320 Wake Forest Road
Raleigh, NC 27609
919-855-8911
Henderson
Duke Orthopaedics of Vance County
511 Ruin Creek Road
Suite 106
Henderson, NC 27536
252-436-1655
Lumberton Children’s Consultative Clinic
Duke Hematology/Oncology
Duke Cardiology
Greensboro, NC
Duke Perinatal Consultants
of Greensboro
Duke Physical Therapy at Dresser Court
1108 Dresser Court
Suite 201B
Raleigh NC 27609
919-876-8300
Duke Neurosurgical Associates
of Lumberton
Sanford, NC
Duke Health Center of Sanford
Fayetteville, NC
Duke Children’s Cardiology
of Fayetteville
Duke Children’s Consultative Services
of Raleigh
3480 Wake Forest Road
Suite 310
Raleigh, NC 27609
919-668-4000
n
Lumberton, NC
Duke Cardiology of Lumberton
South Hill, VA
Duke Hematology/Oncology
Whiteville, NC
Duke Cardiology of Whiteville
Maternal and fetal medicine
Pediatric cardiology
n Reproductive endocrinology
Duke Hematology/Oncology
n
n
Wilmington, NC
Coastal Carolina Eye Clinic
Duke Orthopaedics of Vance County
Duke Radiation Oncology
Call 1-888-ASK-DUKE
Wilson, NC
Medical Eye Associates
Winston-Salem, NC
Duke Eye Center of Winston-Salem
available 7:30 am to 6 pm
The expert staff at Duke’s Consultation and Referral Center can answer your
questions and help you find a physician, schedule an appointment, or just get
more information about a topic or a service that interests you.
Sign up for The Digest:
Get DukeHealth.org delivered to you
DukeHealth.org Digest is an e-newsletter that helps you keep up with what’s
new in health news. The Digest is delivered to your inbox every two weeks.
Each issue includes highlights from DukeHealth.org, such as:
Health articles from and about Duke experts
Videos and podcasts featuring Duke physicians
n News, including the latest research findings
n Events taking place in the Triangle
n Clinical trial opportunities
n
n
It’s free and easy to sign up for—just provide your name and e-mail address.
Sign up at dukehealth.org.
21 Duke Medicine Connect
Duke Physical Therapy at Keisler Drive
401 Keisler Drive
Suite 101B
Cary, NC 27518
919-851-5880
Laurinburg, NC
Duke Hematology/Oncology
mark your calendar
Healthy Happenings
Unless noted, all events take place at
Teer House, a gracious historic home
located at 4019 N. Roxboro Road in
Durham providing community, patient,
and family education as part of Duke
Medicine’s Department of Clinical
Education & Professional Development.
Events are free unless noted, but registration is required.
Sign up at dukehealth.org, or call 1-888-ASK-DUKE.
Heart health
Understanding medications for
heart disease
Tuesday, November 10, 6:30–7:45 pm
Get an overview of certain
prescriptive heart medications and
their side effects.
Stress management for heart health
Tuesday, December 1, 7–8:30 pm
Learn to protect your heart from the
real effects of stress.
Keeping the pressure down
Thursday, December 3 and Thursday,
March 4, 7–8:30 pm
Learn lifestyle changes and
medications to help control high
blood pressure.
Your heart, your health:
A red dress tea $25
Saturday, February 20, 9 Am –2:30 pm
Brier Creek Country Club
10404 Lumley Road, Raleigh
Join Duke Heart Center for a health
fair, cooking demonstration, hearthealthy lunch, and presentations
from Duke experts. Free education,
counseling, and risk-factor screenings,
plus much more. Find details at
DukeHealth.org. To register, call
1-888-ASK-DUKE.
Keeping your heart healthy
February 16, 8–8:45 Am
Cary Town Center Mall Food Court
Duke Cardiologist Mark Winchester
will speak; includes free breakfast,
exercise warm-up, and blood
pressure, weight, and BMI screenings.
Call 1-888-ASK-DUKE to register.
Special topics
Free to breathe 5K run/walk
Saturday, November 7, 9:30 Am
NC State University Centennial Campus,
Raleigh
Duke Raleigh Cancer Center is the
presenting sponsor of this North
Carolina Lung Cancer Partnership
event. To register or learn more, visit
freetobreathe.org.
How sweet it is
Tuesday, November 10, 9:00 Am
Duke Raleigh Hospital
Cardinal and Dogwood Rooms (cafe)
3400 Wake Forest Road, Raleigh
Join the Diabetes Center at Duke Raleigh
Hospital for this introductory seminar
about the causes and implications of
diabetes and pre-diabetes. Please call
919-954-3616 to register.
Fibromyalgia
Tuesday, November 17, 7–8:30 pm
Understand the diagnosis, treatment,
and controversies.
Urinary incontinence:
Non-surgical approaches
Celiac disease: New diet options
Tuesday, January 19, 6:30–8 pm
Learn what’s new with the diet and how
to tailor it to your needs.
Polycystic ovary syndrome (PCOS)
in young women
Monday, January 25, 7–8:30 pm
Learn about symptoms, diagnosis,
associated problems, and current
therapies.
Coping with hearing loss
Tuesday, February 9, 6:30–8 pm
Discuss types of hearing loss, common
symptoms, and treatments.
Living with diabetes:
What could I—should I—eat?
Wednesday, December 2, 6:30–8 pm
Learn about exercise and behavioral
management approaches.
Tuesday, February 9, 6:30–8 pm
Learn how healthy eating and
individualization can help achieve
blood glucose control.
My head is killing me!
Managing headaches and migraines
The complexity of chronic pain
Tuesday, December 8, 7–8:30 pm
Explore helpful medications, herbal
supplements, and behavior changes.
Knee pain: Injury prevention
and treatment
Monday, January 11, 7–8:30 pm
Learn to avoid and treat the most
common injuries.
Wednesday, March 10, 7–8:30 pm
Hear how specialized pain programs
address chronic pain.
Keeping shoulders healthy
Tuesday, March 16, 7–8:30 pm
Learn preventive exercises to reduce
your risk of common shoulder problems.
Healthy families
ADHD Series
Mondays, 6:30–8 pm: November 16,
January 25, February 22, March 22
See event calendar on dukehealth.org
for description of each talk.
Keeping kids healthy at a fast-food pace
Thursday, January 14, Thursday, February
11, and Tuesday, March 9, 7–8:30 pm
Discover the “5–3–2–1 Almost None”
plan for healthy eating and activities.
Parenting toddlers: Fun and frustrating
Tuesday, February 2, 7-8:30 pm
Learn effective strategies including
appropriate discipline, coparenting, and
consistency.
Back pain in new moms
Tuesday, March 2, 6:30–8 pm
Get tips on easing postpartum back
pain with movement, posture, and
exercise. Babies welcome.
Nutrition and
weight management
Living well
Breaking through the diet mentality
Wednesday, November 11, 3–5 pm
Get noticed with a repackaged resume and
cover letter. Polish your interview skills.
Thursday, November 19, 7–8:30 pm
Refocus your self-defeating “diet
mentality” to proactive, realistic weight
management strategies.
Keeping it off: Tips on
weight management
Tuesday, January 12, 6:30–8 pm
Learn strategies for maintaining weight
loss long term.
Navigating the job market
Finding online health information
you can trust
Thursday, November 19, 2–3:30 pm and
Thursday, March 18, 6:30–8 pm
Learn internet search tips for diseases,
drugs, and clinical trials.
Cooking with herbs $10
Thursday, March 18, 6–7:30 pm
Discover how to incorporate flavorful
herbs into your healthy cuisine.
Chronic illness: The role of the
anti-inflammation diet
Monday, March 22, 6:30–8 pm
Discover what foods help to curb
inflammation and how that relates to
chronic illness.
Coping with loss and change
Family discussions: Understanding
emergency treatments
Tuesday, November 10, 7–8:30 pm
Before an emergency occurs, discuss
your wishes for resuscitation and lifeprolonging measures (DNR and MOST).
Holiday hurts
Thursday, December 3, 6:30–8:30 pm
Prepare for the holidays after a death.
Preventing Medicare scams
Thursday, January 21, 7–8:30 pm
Protect your benefits from identity theft,
billing errors, and fraud
Effective communication:
Is anybody listening?
Thursday, February 4, 6:30–8 pm
Get your point across while enhancing
your relationships.
Improving sleep with meditation
Senior depression:
Symptoms and solutions
Thursday, January 28, 7–8:30 pm
Explore symptoms and treatments.
Easing menopausal symptoms
Tuesday, February 16, 7–8:30 pm
Discover options to relieve hot flashes,
night sweats, and other symptoms
through natural remedies, medications,
exercise, and behavioral changes.
AARP driver safety program
$12 AARP members, $14 nonmembers
Monday, March 15, 9:30 Am –3 pm
Learn ways to compensate for agerelated cognitive and physical changes.
Welcome to Medicare
Tuesday, March 23, 6:30–8 pm
Know the options available and decisions
faced by new Medicare beneficiaries.
Find more Teer House classes,
including pre- and postnatal
classes and support groups,
on dukehealth.org—where
you can learn more, register,
and get directions.
23 Duke Medicine Connect
Aging well
Thursday, February 25, 6:30–8 pm
Discover how meditation can improve
your quality of sleep, minimize sleep
disturbances, and improve your overall
energy.
Duke Medicine Connect DUMC Box 3687, Durham, NC 27710
201090017
NON-PROFIT
ORG
U.S. POSTAGE
PAID
DURHAM, NC
PERMIT NO. 60
Under construction:
A new home for cancer care
Cancer is going to be a disease we see more of in
our area: by 2011, the number of North Carolinians
with cancer is expected to be 14 percent higher than
its 2006 levels—and in the Triangle, the increase is
expected to be 21 percent. The new Duke Medicine
Cancer Center, now under construction, is being built
to accommodate this growing need, and to foster
improved, patient-centered cancer care and innovative
clinical research. See page 3 for details on this building
as well as the new Duke Medicine Pavilion, two
landmark construction projects that will reshape the future of patient care at Duke.
This report is printed on Utopia Two, 100-lb. text stock.
Environmental savings realized by using this paper are summarized below:
Lbs of Paper used 50,000 | Trees Saved 49 | Waste Water Reduction in Gallons 17,949 | Solid Waste Reduction in Lbs 2,970
Greenhouse Gas Reduction in Lbs 42,915 | Kilo-watt Hours Saved 19,500