SideBySide Spring 2016 complete issue

SPRING
A
S U T T E R
H E A L T H
2016
P U B L I C A T I O N
Partnering to
Benefit Children in
San Francisco
Heart Attack
Symptoms Disguised
for Women
A Family’s Legacy
for Cancer Care
When It’s More Than
“Just a Headache”
CPMCRI Leading
Future of Cancer Care
Integrated Care
April is a magical month, breeding lilacs out of renewed
Also in this issue, learn how a comprehensive, integrated
land. At Sutter Health’s CPMC, spring 2016 brings a
approach to cancer care is thriving at CPMC, where
special sense of anticipation. Our two new hospitals
generous community philanthropy is making it possible
are taking shape in San Francisco – one in the heart of
to expand care far beyond the needs of the body to
the city at Van Ness and Geary, and another on Cesar
encompass the whole person.
Chavez in the Mission district. These new green facilities
will allow us to provide San Franciscans with the kind
CPMC physicians, nurses and their teams are at the
of all-encompassing care they deserve. Both medical
forefront of addressing each patient’s quality of life with
campuses are on schedule to open in 2019. If you
support services that are as important to comprehensive
want more information or to follow the progress,
care as medicine itself.
visit cpmc2020.org.
As our new medical campuses grow closer to completion,
In this issue of Side by Side, you will find the compelling
we salute philanthropists who, in the words of Touraj
story of Patricia Hurd, whose choice of a caring
Touran, director of Cancer Services at CPMC, allow us to
primary care giver to care for her when she moved to
“help patients stay strong on the path to healing.”
San Francisco eight years ago paid off in a literally
lifesaving way. Read how the integrated CPMC team,
from primary care doctors to specialists, worked together
to provide the exact services that Patricia needed when
some vague symptoms turned out to be a heart attack.
Warren Browner, MD, MPH
Chief Executive Officer, CPMC
Patricia calls her case nothing less than “a miracle
of medicine.”
SIDE BY SIDE MAGAZINE
MARKETING DEPARTMENT
Jim Macksood, Vice President of Marketing
Christina Szeto, Editor
Lisa Oliver, Graphic Designer
CONTRIBUTORS
Jenna Cameron, Kermit Cantwell,
Kimberly Carlisle, Penny Cleary,
Bobbi J. Fagone, Sarah Goldberg,
Madeleine Kahn, Shaun Ralston, Morgen Wells
PHOTOGRAPHY
Ed Aiona, Alain McLaughlin, Nick Otto,
Bill Posner, CPMC Media Services
COPY EDITOR
John Maybury
Copyright © 2016 Sutter Health WBR. All rights reserved.
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Contents
SIDE BY SIDE MAGAZINE | S P R I N G 2 0 1 6 | C P M C
4 Partnering to Benefit
Children in San Francisco
14 When It’s More Than
“Just a Headache”
5 Heart Attack Symptoms
Disguised for Women
17 Community Classes
and Groups
8 Cancer Support:
Innovating Care for the
Whole Patient
19 CPMC Research
Institute Helping Lead the
Future of Cancer Care
11 Changing Lives –
For Life
Chanel and Sutter
Health’s CPMC
Partner to Benefit
Children
In a first-ever endeavor in San Francisco,
CPMC2020 Gala co-chairs and CPMC Foundation Trustees
iconic fashion brand Chanel hosted a gala
(l to r) Allison Speer, Sloan Barnett, Carolyn Chang, M.D., and Carol Bonnie
on February 24 at Pier 35 to celebrate the
(not pictured: Jacqueline Sacks)
building of CPMC’s two new smart hospitals.
The elegant evening was co-chaired by CPMC Foundation Trustees
Sloan Barnett, Carol Bonnie, Carolyn Chang, M.D., Jacqueline
Sacks and Allison Speer. Honored at the event were Sean Parker,
chairman of The Parker Foundation, and Kari Nadeau, M.D., a
global innovator in the field of food allergy and asthma at the
Sean N. Parker Center for Allergy & Asthma Research at Stanford.
Through CPMC’s partnership with Stanford Children’s Health,
children and their families in San Francisco and surrounding
communities will benefit from Dr. Nadeau’s innovative research
through a new clinic that has opened at CPMC.
Left: CPMC2020 Gala
honorees Kari Nadeau,
“This was and will be the most exciting event in all of California in
M.D., Ph.D. and Sean
2016,” says Sloan Barnett, co-chair of CPMC Foundation’s Board
Parker, Chairman of
of Trustees and one of the event’s creators. “Most important, we
The Parker Foundation
are raising money for a global leader in health care to bring her
transformative care to San Francisco and the many families like
mine whose children suffer from life-threatening food allergies.”
Proceeds will help fund CPMC programs and services,
including the new Pediatric Food Allergy Clinic, and continue
Dr. Nadeau’s vital research in pediatric food allergies.
For more information about food allergies or other
CPMC Pediatric Specialty Clinics, call 415-600-0779
or visit cpmc.org/pediatrics. ✤
Above: CPMC2020 Gala at Pier 35. Right: A special performance by singer Jonny P.
4
Cardiac Symptoms Often
Disguised for Women
For a San Francisco Woman, a Visit to Her
Primary Care Center Saves Her Life
By Meg Walker
When Patricia Hurd moved to San Francisco, one of the first
things she did was find a primary care physician she could
trust to help her maintain her health.
Eight years later, her relationship with her Sutter Health physician Michelle Malcolmson, M.D.,
and the team at the San Francisco care center, saved Patricia’s life.
Last fall, Patricia experienced on-and-off chest pain for several days. She kept up with her
daily activities, walking to her daughter’s house, and even taking a BART ride home from work.
She experienced some nausea, which she thought was related to indigestion.
“I just thought it was all due to aging,” Patricia says, “but when I
didn’t get any better, I called my primary care doctor because that
is who I trust.”
It turned out that at the age of 69, Patricia was having a heart
attack, though she did not have debilitating chest pain that might
have tipped her off to the seriousness of her situation.
A System of Coordinated Care
Patricia is thankful she receives care from Sutter Health’s
integrated medical system where teams of physicians – from
primary care doctors to specialists – work together and are
connected to the right hospitals and services that patients need.
That system triggered a series of lifesaving events for Patricia last
October 20.
Patricia called her doctor’s care center that morning. Her personal
physician, Dr. Malcolmson, was not available but she was able
to get an appointment an hour later that day with Hala Ali, M.D.,
another internal medicine doctor who works at the same Sutter
Health care center.
Because Patricia complained of recurring chest pain, Dr. Ali had
her take an electrocardiogram, which showed abnormalities
indicative of a possible heart attack. Dr. Ali and her team of
medical assistants jumped into action. The patient was given
nitroglycerin and aspirin, which help blood flow and prevent
clotting. An ambulance arrived and took Patricia to the emergency
room at Sutter Health’s CPMC.
“I examined her as quickly as I could,” says Dr. Ali, who was
concerned about Patricia’s symptoms plus the fact that she had
been a smoker and had a family history of heart disease. “In
women, the number-one cause of death is a heart attack, and
especially for women over 65, the symptoms can be atypical.
They may not have the severe chest pain.”
Efficient and Expert Care
At Sutter Health’s CPMC, the cardiologist on call,
Peter Hui, M.D., performed a coronary angiogram, a procedure
that uses x-ray imaging to see the heart’s blood vessels. The
angiogram confirmed that a main artery in Patricia’s heart was
severely narrow, closing and opening at different times, and
causing intermittent chest pain. When the artery closed, the result
was a heart attack.
Forty minutes after Patricia entered the hospital, Dr. Hui had
placed a stent in the artery, which opens the vessel so that blood
can flow freely through the heart.
6
Patricia was awake the whole time, as the procedures are
performed through a tube inserted into a blood vessel in the wrist.
“It was a miracle of medicine,” says Patricia of the care she
received. “I could tell when the artery was unblocked. I could
breathe easier.”
Patricia’s prognosis is good. She is on medication for her high
cholesterol, eats a low-fat, high-protein diet and exercises regularly
– walking through her hilly San Francisco neighborhood. She stays
away from cigarettes, french fries and sugary sodas.
Heart Attack Warning Signs for Women
Patricia’s experience is a wake-up call for women, say her doctors.
Women’s heart attack symptoms can be subtle and complex.
They do not always experience the crushing chest pain typical in
a male’s heart attack. They may experience shortness of breath,
nausea or vomiting or indigestion as well as chest discomfort.
To add to the confusion, some warning signs may be similar to
anxiety, stomach flu and acid reflux. They also need to be aware of
risk factors for heart disease, which include smoking, high blood
pressure, high cholesterol and diabetes.
“Many times patients fall into the trap of denial, thinking it’s not a
heart problem, that it is a stomach problem or another issue,” says
Dr. Hui. “They need to be aware of symptoms and risk factors.
Having a strong relationship with a primary care physician is
important – someone you can trust and rely on and [who] is astute
enough to do the right tests.”
Dr. Ali adds: “Women should seek attention when they are
uncomfortable, even with symptoms they think are not related to
the heart.”
Regular Exercise Is Key
“Daily walking and exercise are important to improve your
conditioning and help you assess any symptoms,” Dr. Hui
says. “If you are sedentary, you don’t know when something is
happening that is unusual or irregular, but if every day you feel less
comfortable when you exercise, then something may be awry.”
Sutter Health has primary care doctors – family medicine
and internal medicine – throughout the Bay Area. To find
a doctor near you and request an appointment online,
visit sutterhealth.org/findadoctor. ✤
“Many times patients
fall into the trap of
denial, thinking it’s
not a heart problem,
that it is a stomach
problem or another
Women
and Heart
Disease
issue,” says Dr. Hui.
Heart disease is the leading cause of death for
women in the United States, according to the federal
Centers for Disease Control and Prevention. Signs of a
heart attack in women can be subtle, and early warning
signs may often go unrecognized. Women may not
consider the possibility of a heart attack, and it may be
more natural for them to care for others first.
“Women have frequently been identified as taking care
of their own health after their caregiving responsibilities
for others – such as a spouse, parents or children,” says
Gregg Hopkins, M.D., a Sutter Health cardiologist in
Santa Rosa. “This can lead to a delay in diagnosis for
serious heart problems.”
Heart attack symptoms women
experience include:
Patricia Hurd has been increasing her physical fitness at CPMC’s
Cardiac Rehabilitation Program, a recovery and prevention program
for patients with heart disease. The program, which includes education
and counseling, helps heart patients improve health and lower the risk
of future heart problems.
• Chest discomfort often described as pressure or
tightness, which can also be felt in the back, jaws
or arms. (Dr. Hopkins says this is the most common
sensation, though a woman may experience other
symptoms listed below.)
• Shortness of breath
• Weakness
• Fainting
• Nausea or vomiting
• Extreme fatigue
Women also need to be aware of risk factors for
coronary heart disease. They can learn about these by
working with a primary care physician.
RISK FACTORS INCLUDE:
• Diabetes
• High blood pressure
• Being overweight or obese
• Poor diet
• Physical inactivity
• Excessive alcohol use
• Smoking
• Elevated cholesterol blood levels
• Family history of heart disease presenting early in
first-degree relatives
Exercise is a good way to maintain cardiac health. and
Dr. Hopkins recommends getting aerobic exercise for
30 minutes, three times a week. He also advises
getting blood pressure checks at regular office visits
with a physician and getting lipid panel blood work
every five years. For more information, visit
sutterhealth.org/cardiology
7
8
Cancer
Support:
Innovating Care for
the Whole Patient
By Madeleine Kahn
For many years, Sutter Health has provided
expert medical care for patients at every stage
of cancer, from diagnosis through surgery,
radiation or chemotherapy to clinical trials and
recovery, with a focus on medical treatments
for the body. But as more and more types
of cancer have moved from being terminal
diseases to chronic or even curable, more
consideration has been given to the patient’s
quality of life, fundamentally expanding the
model of care. Our comprehensive approach
to cancer now includes support services
that are as vital to leading-edge care as
the medicine itself. And this shift has been
catalyzed by philanthropy.
“Navigation services, massages, nutrition advice, and support
groups all help patients stay strong on the path to healing,” says
Touraj Touran, director of Cancer Services at Sutter Health’s
CPMC. “We owe thanks to the visionary philanthropists who have
helped us create these embracing programs.”
For example, Renee Menchhofer, manager of CPMC's Breast
Health Center, says the Notkin Family Breast Cancer Recovery
Program has "made us a very forward-thinking center because,
9
thanks to the Notkin funds, we offer
educational, personal navigation and recovery
services that other centers only dream of.”
(See sidebar.) The Bryan Hemming Cancer
Care Center provides private, spacious
rooms for chemotherapy infusions, and a
warm, supportive environment for genetic risk
assessments, nutritional and psychosocial
counseling, support groups and wellness
classes. “My own diagnosis inspired me to
create a safe haven for people with cancer,”
says Mr. Hemming.
“Philanthropic partners both
challenge us and enable us to
keep expanding our understanding
of what it means to care for the
whole patient.”
Similarly, at CPMC’s Women’s Health
Resource Center (WHRC), the Ovarian and
Reproductive Cancer Recovery Program
offers support of all kinds – free of charge
– to any woman who needs it. Barb Silver,
N.P., provides individual counseling and
help understanding medical information for
women undergoing treatment for uterine,
ovarian, vaginal, vulvar and peritoneal cancer.
WHRC also provides supportive services
that may improve women’s quality of life
by managing chemotherapy side effects,
including massage, acupuncture, yoga,
psychotherapy, nutrition counseling, wigs,
hats and scarves.
In recent years, some funds for these services
have come from a number of philanthropic
partners, including Jennifer Nathan, who left
a bequest to WHRC, and Lori Walker, who
before she died completed a 100-mile charity
bike ride and raised more than $10,000 for
the center. “You just can’t get support like
this anywhere else,” Lori would say to all who
were lucky enough to meet her.
At Sutter Santa Rosa, Cindi Cantril, R.N.,
OCN, MPH, has been a pioneer in the
One
Family’s
Legacy
10
fields of patient navigation and survivorship
programs, including an Equine Therapy
Program and the “WINGS” and “WINGMEN”
peer support groups for women and men
with cancer, as well as similar services for
caregivers. "We want patients to feel that the
care they have received is personalized and
fully supports their mind, their body, and their
spirit,” says Cindy. “Some patients may feel
their body has betrayed them with cancer.
For them, working with a 1,200-pound horse
can be incredibly physically empowering – it
helps them to re-enter their lives.”
The opportunity to participate in one of the
more than 70 cancer clinical trials available
through the Sutter Cancer Research
Consortium provides another kind of support
for the patient’s mind, body and spirit. For
those whose lives are extended by new,
effective, and less-toxic treatments through
clinical trials, the benefit is clear. But clinicaltrial participants for whom the treatments
are not as effective still gain a period of hope
and the knowledge that they have helped
advance medicine for future patients. Like
other cancer support services, some clinical
research is supported by recent philanthropic
efforts such as the William Greenbach Cancer
Research Fund, the Payden Foundation,
and donors to endowed chair positions
that support the translational research of
practicing clinicians.
"We want patients to feel that
the care they have received is
personalized and fully supports their
mind, their body, and their spirit.”
“Philanthropic partners both challenge
us and enable us to keep expanding our
understanding of what it means to care
for the whole patient,” says Mohammed
Kashani-Sabet, M.D., medical director of
CPMC’s Cancer Program, “and that
makes the experience of care better for
everyone involved.” ✤
The Notkin Family Breast Cancer Recovery Program services at CPMC’s Breast Health Center
are the result of a multigenerational family commitment to philanthropy. Shelby Notkin, whose
wife Melinda received care for breast cancer at CPMC, says, "I learned about how meaningful
philanthropy is for the giver from Melinda's father, and I thought for a long time about how best
to honor Melinda after she died. I think that now, 15 years after her death, she would be so
pleased that the Notkin Family Program services help over 4,000 women each year."
These services include education and individual support, case management and follow-up,
help understanding finances and insurance, group and individual psychological consultations,
and survivorship appointments for women who have completed their treatment. Shelby and
Melinda’s daughter Michelle Notkin, who volunteers at the Breast Health Center, says, "I have
been so fortunate to follow in Shelby's path by also serving on the CPMC Foundation Board.
Contributing to the business of philanthropy and experiencing the heart of philanthropy by
volunteering at the Breast Health Center both mean the world to me."
Changing Lives –
For Life
Mary Vallejos didn’t need to lose just
a few pounds.
At age 63, she was 5 feet, 4 inches tall,
and weighed more than 230 pounds. Her
body mass index (BMI) was 39.96 – on the
edge of morbid obesity. She suffered from
high cholesterol and high blood pressure.
Over an 18-month period she had
undergone two hip replacement surgeries
and another to replace her right knee.
After that third surgery, she says, “I
decided it was time to really make an
effort to get myself physically healthy.”
Mary Vallejos enjoys an active life in San Francisco. At the start
of 2016, Mary celebrates the loss of 65 pounds and has knocked
more than 10 points off her BMI with the help of Sutter Health's
CPMC MD Weight Management Program.
11
Of course, that’s easier said than done. Most overweight people
(and the Journal of American Medicine estimates more than 78
million American adults qualify as obese) have tried to lose weight
multiple times during their lives. Losing weight consistently ranks as
the most popular New Year’s resolution. And surveys show nearly
half of all such resolutions fail.
But as 2016 began for Mary Vallejos, she was celebrating the loss
of 65 pounds in the previous eight months. Her BMI was down
more than 10 points. She no longer was taking cholesterol or
blood pressure medications. She was exercising every day. And
she felt great.
“I’m extremely proud,” she says of her achievements.
“Everyone is so happy for me. They can see how
happy I am and how this has changed my life.”
“This” is the MD Weight Management Program offered by Sutter
Health’s CPMC in San Francisco. Originally developed in 1980 by
Joan Saxton, M.D., it is now directed by Anita Demas, M.D., and
Cathlin Milligan, M.D., two experienced internists who know that
extra pounds can lead to life-threatening medical problems.
Tackling a National Health Issue
“Obesity is a tremendous public health issue,” says Dr. Milligan.
To address it, the MD Weight Management Program has assembled
a staff of experts who help patients tackle their weight problems
with a comprehensive regimen that goes way beyond diet and
exercise routines. Participants in the program strive to change their
lives – for life.
“I just entered the maintenance phase” of the program, says
Eric Moore, shortly after reaching the milestone of losing 95
pounds in seven months. “Maintenance is the hardest part –
keeping the weight off. I joke that I’ll be on maintenance for the
next 1,000 weeks.”
12
But it’s no joke. Participants in the program are taught to look at
weight loss as a lifelong effort that doesn’t end when they reach
their targeted goals related to BMI or a specific number of pounds.
“We recommend that everyone stay in maintenance
for at least two years,” says Dr. Milligan. “They need to
establish new habits and they need the support of the
program, because the unfortunate thing about being
overweight is it causes metabolic changes, and your
body wants to put that weight back on even if you
want to keep it off.”
Team of Support Experts
Patients participating in the MD Weight Management Program join
group sessions each week that focus on the trials and triumphs
of losing weight and keeping it off. “The group model provides
affirmative support and also spurs people’s competitive nature,”
Dr. Milligan says. Dr. Demas says patients are urged to stick with
the group sessions for at least two years, but one group of patients
that began the program in the early 1980s still gets together almost
every week. “There’s a real strong bond there,” she says.
Besides peer support groups and the personal care of physicians
who monitor their overall health as they shed pounds, program
participants also receive the services of a staff that includes
William Hartman, Ph.D., a clinical psychologist who has been with
the program for more than 30 years, and Karen Ready, R.D., a
nutritionist and lifestyle counselor who specializes in weight and
stress management.
“Our staff has a tremendous depth of knowledge
based on decades of experience,” says Dr. Demas.
“We pass that knowledge on to our patients, so they
understand why things are happening to their bodies
and they understand their disease. The difficulties
they face are easier to deal with if they know what
they are up against.”
Some people can lose weight with
a simple New Year’s resolution.
Others need the help of a formal
weight-loss program that may
include the guidance of medical
professionals. And, in more difficult
cases, some patients need even
greater medical intervention.
Managing Weight and Making It Stick
Mary Vallejos, a retired San Francisco businesswoman, heard about the program from
a physical therapist when she was recovering from her knee replacement surgery.
She had lost weight before, but always gained it back. She said she knew the MD
program was different as soon as she walked in.
“It was a very thorough initial evaluation with blood work and an EKG. Two of my
doctors signed off and approved my participation. I see Dr. Milligan almost every
week. The nutrition classes are fun and informational. I’m there a couple of hours
every Tuesday. It’s a program that just seems meant for me,” she says.
Patients, who come from around the Bay Area, range in age from 20 to 80, and from
morbidly obese to moderately overweight. Insurance plans generally cover the cost
of the program for those with a BMI higher than 30, or even lower if the patient has
additional risk factors such as diabetes or hypertension. The program is customized
to each patient’s individual needs, Dr. Mulligan says.
Eric Moore, who is 63 and a finance manager for a San Francisco bank, found
the program on his own after a co-worker lost a lot of weight through bariatric
surgery (see accompanying story). He says he was impressed by the program’s
thoroughness, its physician-directed health monitoring, the support he has received
from fellow patients, and the food that has helped him go from a 44-inch waist to his
recent purchase of straight-legged Levi’s with a waist size of 34 inches.
“Even though it’s limited to 800 calories a day, I’ve never felt hungry,” Eric says of the
weight loss phase. Both he and Mary say they purchased their high-energy, lowcalorie foods through the program and never felt deprived. Typical meals in the weight
loss phase include powdered shakes and puddings, bouillon, fiber drinks and Jell-O.
Eric says he will add baked fish, chicken and more vegetables as he transitions to
the maintenance phase and moves up to 1,000-1,200 calories a day. Eventually, he
hopes to settle into a routine of about 1,500 calories a day.
Mary says she was greatly helped by the plans that nutritionist Karen Ready helped
put together prior to the food-centric holiday season.
“I had Christmas dinner with family at Spruce, which is an
outstanding restaurant,” she says. “I called ahead and told them
about my program, and they didn’t bat an eye. They made it so easy.
They were so kind.”
For information about CPMC's MD Weight Management program, call
415-674-5200 or go to http://www.cpmc.org/services/weight_mgmt.html. ✤
Sutter offers two types of bariatric (from
the Greek: related to weight) procedures
for patients whose struggles with extra
pounds put them at risk of other health
problems, such as hypertension or diabetes.
The first is a non-surgical gastric balloon
procedure recently approved for use in the
U.S., and the second is a group of bariatric
surgeries that actually reduce the size of a
patient’s stomach.
While both options can quickly help patients
lose weight, the physicians who perform
the procedures stress that none works on
its own. Whether a patient is undergoing
a gastric balloon procedure or a bariatric
surgery, he or she also should expect to
participate in extensive educational and
counseling programs both before and after
the procedure.
“We can make smaller stomachs,” said
Robert Woodbury, M.D., a bariatric surgeon
at Sutter Santa Rosa Regional Hospital. “But
the root of the problem – and of the cure –
is lifestyle.”
Once considered a last resort or even a
dangerous procedure, bariatric surgery
has become much more common and is
recognized as a viable tool for curing obesityrelated diabetes, said Gregg Jossart, M.D.,
of Novato. Most bariatric surgeries can be
performed laparoscopically, and patients are
on their feet within hours and home the next
day, he says.
The gastric balloon method is a non-surgical
procedure in which a silicone balloon is
inserted through the mouth into the stomach
and then filled with sterile saline. By taking up
space in the stomach, it helps control food
intake and “jump starts” the patient toward
permanent weight loss, says Yasser Bhat,
M.D., of San Francisco.
But "it's not just the balloon – that’s removed
after about six months,” says Dr. Bhat. “It’s
a complete program that involves education,
counseling, exercise and dietary habits that
lead to real lifestyle changes.”
13
When It's More Than
“Just a Headache”
By Bobbi J. Fagone
Unpredictable, fluctuating in frequency and
severity, migraines cannot be cured, but they
can be managed.
14
“I’ve always had headaches,” David
Jedeikin says, “but nothing that overthe-counter medicines couldn’t cure.
Then about three years ago, I started
experiencing sensitivity to noise
and light, plus nausea and intense
throbbing around specific areas of
my head. I realized that I was having
a migraine.”
A 45-year-old software engineer and San
Francisco resident, David describes his migraines
as a dull, aching, pulsating pressure behind his
eye sockets while the muscles on the back of
his neck grow tense and tender. Over time, his
episodes became increasingly frequent and
severe, often lasting eight hours or more.
“Migraines are not life-threatening,” he says, “but
they really knock you out of commission. Last
August I had one that took 16 hours to go away,
even using prescription medication. It’s kind of
like falling into icy water. You can’t concentrate on
anything but the pain and discomfort.”
Some 30-36 million people, about 10 percent of
the U.S. population, suffer from episodic migraine
headaches. Yet up to half of these patients are
never diagnosed.
Approximately 3-6 million Americans experience
15 or more headache days per month and are
considered chronic migraine sufferers. Between
doctor visits, medications, tests, imaging and lost
work time, it’s estimated that Americans spend
roughly $20 million each year trying to relieve their
headache pain.
The Anatomy of a Migraine
Although much about the cause of migraines is
not understood, researchers believe it may be
caused by a complex cascade of abnormal events
in the brain. This activity appears to begin in the
body’s largest cranial nerve—the ganglion of the
trigeminal nerve.
treating headache disorders. “If both your parents
get migraines, your risk is even higher, perhaps a
70 percent chance.”
The other key factor is environmental. “There is
something special about the migraine patient,”
says Donald Kitt, M.D., chief of Neurology and vice
chair of the CPMC Neurosciences Department.
“They are highly susceptible to stresses in their
surroundings. So they need a healthy, regimented
lifestyle.” This includes reducing anxiety,
maintaining a nutritious diet and a consistent meal
schedule, exercising regularly and getting sufficient
sleep with regular bedtime hours.
When this isn’t possible, pain often follows. “For
example, the patient is gunning for a deadline
which she has to finish before leaving on
vacation,” explains Dr. Kitt. “She’s working long
hours, skipping meals and winds up finishing
her project at midnight. The next day she’s finally
relaxing on the beach and, just about guaranteed,
she will get a migraine.” People who are prone
to migraines need to pace themselves, he says,
which is often hard to do in today’s fast-paced,
high-stress work environment.
Dr. Kitt says people often simply tolerate migraine
pain without seeking any help at all. “This is
because of the spectrum of severity,” he says.
“Some people experience infrequent disabling
migraines, but they live with frequent mild-tomoderate headache pain since it's ‘normal’
for their family members. This leads to delay in
treatment or the overuse of over-the-counter
medication before they finally see a doctor, which
can make the problem even more difficult to treat.”
Managing Migraines
While migraine headaches cannot be cured, they
can be controlled using prescription medications.
For best results, doctors recommend both a
preventive medication to reduce occurrences and
an abortive medication regimen to treat migraines
as they come.
As this nerve “fires,” chemicals are released,
inflammation rapidly spreads to a network of
nerves in the fragile outer lining of the brain, blood
vessels dilate and the normal blood flow pattern
is altered. Within minutes, molecular changes
occur in the pain-sensing nerves in this delicate
network of nerves, making them hypersensitive
and resulting in throbbing pain.
New therapies for migraine prevention include
antidepressants, anti-epileptic or anti-seizure
drugs, and medications called beta blockers,
which are used to treat high blood pressure.
Sometimes in chronic cases, tiny amounts of
diluted Botox are injected into the person’s head,
neck and shoulders to prevent migraine attacks.
Abortive therapies can include a category of
prescription drugs called triptans, anti-nausea
medications, and non-steroidal anti-inflammatory
drugs, such as ibuprofen.
Why Me?
Certain individuals are genetically prone to
migraines. “If you have one parent who has
migraines, you have a 50-60 percent risk of
developing migraines as well,” says Nelli Boykoff,
M.D., a CPMC neurologist who sub-specializes in
Some patients also find relief using alternative,
homeopathic methods, which are a good option
for people who are sensitive to medication. Scott
Larsen, D.C., is an integrative chiropractor at
the Institute for Health and Healing Clinic in San
Francisco (IHH).
15
Other alternative methods for treating migraines that Dr. Larsen
sometimes recommends include herbs and supplements such as
Feverfew, CoQ10, vitamin B2 and taking warm baths in Epsom
salt to replenish the body’s levels of magnesium.
The IHH integrative medicine primary care and specialty care
clinics offer a comprehensive team approach to care. Services
include board-certified physicians and nurses, as well as holistic
therapies such as osteopathy, chiropractic, traditional Chinese
medicine, nutrition counseling, integrative psychotherapy, and skin
and body care.
Relief at Last
After working with Dr. Boykoff for the past several months, David
Jedeikin has significantly reduced his incidence of migraines
by taking a migraine preventive that falls into an antidepressant
category. But the doses used for migraine are much lower than the
doses needed to achieve an antidepressant effect. “Where I used
to get up to 10 migraines per month, now I’m getting three to five,”
he says. “So I definitely consider that progress. We’re still working
on it and I’m hopeful we can get that number down to zero.”
“Tension headaches usually respond well to chiropractic therapy,”
Dr. Larsen says. “Often the vertebrae can get frozen in place due
to bad posture, a trauma, etc., causing spasms in the muscles
in the neck, resulting in headache pain. Spinal manipulation, soft
tissue therapy and physical therapy can restore the vertebrae to
have full range of motion and relieve the headaches.”
Dr. Larsen recalls one patient who was suffering from frequent,
disabling migraines that often lasted 48 hours. “She came to the
clinic and we found that her neck was really out of alignment,
which caused tension headaches, which then spiraled into
migraines,” he recalls. Through manipulation, Dr. Larsen fixed
her neck, then went to her workplace and helped her to replace
her office chair, desk and keyboard with ergonomic equipment.
The patient’s migraines immediately went from weekly to monthly
events. She followed up with treatment from a neurologist, as well,
and is now pain-free.
THE
3
“Severe headaches and migraines are incredibly debilitating,” says
Dr. Boykoff. “People can’t function at work, socialize or take care
of their families, so it’s very rewarding to turn that around.”
For more information about treatment options and to find a
headache specialist, visit http://www.cpmc.org/advanced/
neurosciences/headache-clinic.html or cpmc.org/ihh. ✤
Tension
BASIC TYPES OF HEADACHES:
Tension, CLUSTER
and
Migraine
Migraine
TIGHT BAND FEELING
“Tension headaches
are the most common form of headache. 60 to
80% of people have a tension type headache
at some point in their lives,” says Nelli Boykoff,
M.D., a CPMC headache specialist. Tension
headaches are often described as a dull pain
that feels as if someone has tied a too-tight
band around the person’s head.
“The second-most
common headache is a migraine,” she continues. The
pain is usually severe and can be accompanied by
nausea, vomiting, and light and noise sensitivity, lasting
from four hours to three days. Migraines are two to
three times more prevalent in women.
SEVERE PAIN
LIGHT SENSITIVITY
VOMITING
CLUSTER The least common type of
headache listed here is a cluster headache, described
as recurrent, sharp, severe pain that strikes behind or
around the eye on one side of the head. Onset is usually
rapid with the pain lasting from 15 minutes to three
hours. The majority of attacks occur at night, usually one
PAIN AROUND EYE
16
SHARP PAIN
RAPID ONSET
to two hours after the person has gone to bed. Cluster
headaches are three to four times more prevalent in men.
Community Classes and Groups
CPMC offers a wide variety of classes, events and support groups promoting a healthy lifestyle. See the reference key on the
next page for contact information and locations (unless otherwise noted). Visit cpmc.org/classes for a full listing.
Brain Health
The Basics: Memory Loss, Dementia,
& Alzheimer’s Disease (RDBHC)
Saturday, April 16, 10–12 p.m. FREE. Castro
& Duboce, Level B Auditorium. Contact
[email protected] or 415-863-8505 for more
information.
Dementia Conversations: Driving,
Doctors Visits, Legal and Financial
Planning (RDBHC)
Saturday, April 30, 10–12 p.m. FREE.
Castro & Duboce, Level B Auditorium.
Contact [email protected] or 415-863-8505
for more information.
Living with Alzheimer’s: For
Caregivers - Middle Stage (RDBHC)
Wednesdays, May 18, 25, & June 1, 2–4
p.m. FREE. Castro & Duboce, Level B
Cancer
Auditorium. Contact [email protected] or 415863-8505 to register for this 3-part series.
Healthy Living for Your Brain and Body:
Tips from the Latest Research (RDBHC)
Wednesday, June 15, 2–4 p.m. FREE.
Castro & Duboce, Level B Auditorium.
Contact [email protected] or 415-863-8505 for
more information.
Legal & Financial Planning for
Alzheimer’s Disease (RDBHC)
Wednesday, June 29, 2–4 p.m. FREE.
Castro & Duboce, Level B Auditorium.
Contact [email protected] or 415-863-8505 to
register for this 3-part series.
Breast Cancer Support Group (CAN)
Wednesdays, 5:30–7 p.m. Free.
Breast Health Center, 3698 California St.
Call 415-600-2717 for more information.
Cancer Caregiver Support Group (CAN)
4th Thursdays, 4–5 p.m. Free.
Call 415-600-3977 for more information.
Colorectal Cancer Support Group (CAN)
2nd Wednesdays, 2–3:30 p.m. Free.
Call 415-600-3977 for more information.
Liver Cancer Support Group (CAN)
2nd Tuesdays, 2–3:30 p.m. Free.
Call 415-600-1209 for more information.
General Health
Look Good…Feel Better: For Women
with Cancer (WHRC) Receive cosmetics
and wigs. March 17, May 19, 1-3 pm
1–3 p.m. Free.
General Health
Lymphedema Education, Exercise &
Prevention Group (CAN)
3rd Wednesdays, 6–7 p.m.Call 415-600-3383
for more information.
Arthritis and Inflammatory
Diseases (CHRC)
This two-part workshop will focus on
various aspects of arthritic disease.
Part 1, April 6, 5–6:30 p.m.: This session
will cover an overview of arthritis: what is
arthritis, causes and symptoms, common
types, screened and diagnoses.
Part 2, April 13, 5–6:30 p.m.: This session
will cover prevention strategies, research
and treatment of arthritic diseases.
2333 Buchanan St., 1st Floor,
Enright Room.
Common GI Disorders (CHRC)
Integrative approaches to managing
irritable bowel syndrome will be discussed,
and an overview of other gastrointestinal
disorders: physiology, symptoms, triggers,
and treatment options. Wednesday, April
20, 5–6:30 p.m. 2333 Buchanan St., 1st
Floor, Enright Room.
Health Consultations (WHRC)
Discuss menopause, osteoporosis,
preparing for hysterectomy, mental
health assessment and referral and/or
nutrition. $60/hour.
Massage Therapy for
Women & Men (WHRC)
30 min. $40; 60 min. $70; 90 min. $90.
Mindful Eating Class Series (CHRC)
Join the series with a registered dietitian;
discuss how mindful eating can change
the way you look at food and have an
enjoyable eating experience. Advance
payment/enrollment required. Call
415-923-3155 or email cpmcchrc@
sutterhealth.org for more information.
Dates: Wednesdays, June 1, June 8, June
15, June 22, 6-7:30 p.m. 2100 Webster
St., Suite 100
Probiotic Nutrition (CHRC)
An overview of which GI conditions
would be most appropriate for probiotic
use, research, bacteria strains present in
probiotic supplements and foods, and if
probiotics are right for you. Wednesday,
April 27, 5–6:30 p.m., 2333 Buchanan St.,
1st Floor, Enright Room.
Melanoma Support Group (CAN)
3rd Wednesdays, 4–5 p.m. 2–3:30 p.m.
Call 415-600-3977 for more information.
Ovarian & Reproductive Cancer
Recovery Program (WHRC)
Call 415-600-0502 for dates and times. Free.
Diabetes
CALIFORNIA CAMPUS (DIAB):
Adult Diabetes
Education
(physician
referral needed)
415-600-0506
•Type 1 and Type 2
- Individual and group
sessions
- Basic education
- Advanced education
• Carbohydrate
counting
• Insulin pumps
• Continuous
glucose monitors
• Prediabetesdiabetes/
preventing
diabetes
Adult Support
Groups
• Type 2—Living
with Diabetes:
11 a.m.—12:30
p.m., April 27, May
25, June 22.
• Type 1—Insulin
Pump Group:
6—7:30 p.m.,
April 13, May 25.
Diabetes and
Pregnancy Program
(Sweet Success)
Call 415-600-6388
for more information.
Pediatric Diabetes
Education Program
Call 415-600-0750
for more information.
17
Diabetes
Physical Fitness and Mobility
S T. L U K E ’ S C A M P U S ( D I A B * ) :
Diabetes Adult Education
- Individual appointments
- Continuous glucose
monitoring
- Pregnancy and Diabetes
(Sweet Success)
- Insulin Pump Initiation
and Support
By appointment, M.D. referral
required. Call 415-641-6826
for more information.
E
Move to Improve, Exercise
for People with or Who Are
at Risk for Diabetes
Tuesdays, 11 a.m.–12 p.m.,
Bayview YMCA,
1601 Lane St., SF
Thursdays, 11 a.m.–12 p.m.,
St. Luke’s Campus
3555 Cesar Chavez St.
415-641-6682
Mind & Body Wellness
Gentle Yoga (WHRC)
$60/six weeks. Call
415-600-0500 for start dates.
Healing Harp (IHH)
Preregistration required.
Location: 2040 Webster St., SF.
Email [email protected] or
call 415-600-1447 to register.
Free Intros: April 11, 10–11:15
a.m.; April 14, 5:30–6:45 p.m.
Beginner Classes:
Mondays, April 18-June 13,
10–11:15 a.m. (no class
May 30); Thursdays, April 21June 16, 5:30–6:45 p.m.
(no class May 26).
Mindfulness Based Stress
Reduction (IHH)
9 sessions + 1-day workshop.
Cost $400. This series may be
covered by your insurance. We
can verify your coverage for you;
please call for more information.
Tuesdays, March, 5:15–7:45 p.m.
(date to be confirmed)
Location: 2040 Webster St., SF.
Call 415-600-3503 to register or
for more information.
Pelvic Floor Yoga (WHRC)
$60/six weeks.
Call 415-600-0500 for
start dates.
Harp Ensemble Classes:
Mondays, June 27 to August 29,
10–11:15 a.m. (no class July 4
and July 11); Thursdays, June 30
to September 1, 5:30–6:45 p.m.
(no class July 7 and July 14).
Pregnancy and Parenting
Prenatal Classes (NBC)
• Big Brother/Big Sister –
Sibling Celebration
• Breastfeeding
• Childbirth Preparation
Intensive
• Childbirth Preparation
Express
• Expectant Fathers Only
• Maternity Tours – available in
English & Chinese
• Newborn Parenting
• Pain Relief Options: Ask the
Anesthesiologist
• Prenatal Yoga: 6-Part Series
• Transition to Parenthood
• Twins, Triplets and More!
18
Postnatal Classes (NBC)
• Latch Clinic
• Baby Steps to Motherhood
• Breastfeeding Support Group
• Starting Solid Foods
Childbirth Preparation (SLM)
English: Saturdays, March 12 &
May 14, 9 a.m.–2 p.m.
En Español: Saturdays, April 16
& June 11, 9 a.m.–2 p.m. 1580
Valencia St., Suite 508C
Prenatal Yoga (SLM)
Saturdays, 9:30–11 a.m. Free.
Pregnancy and Postpartum
Massage Therapy (WHRC)
30 min. $40; 60 min. $70;
90 min. $90.
Bone and Joint Health
Program for Women
(WHRC)
Tuesdays, 10–11 a.m.
$60/six weeks. Call
415-600-0500 for start dates.
Total Body Fitness (SWC)
Level I: Tuesdays, 10–11a.m.,
Thursdays, 3–4 p.m.
Levels I & II: Saturdays,
10–11 a.m.
Feldenkrais® (IHH)
10-week series : Thursdays,
April 14 to June 16, 7–8:15 p.m.;
Mondays, April 18 to June 27,
2–3:15 pm. (no class May 30).
Cost $150
Workshop - Relaxing the Neck
Through Movement: May 14, 10
a.m.–4:30 p.m. Cost $85
10-week series: Mondays, July
11 to September 26, 2–3:15
p.m. (no class August 1, 8 and
September 5); Thursdays, July
14 to September 29, 7–8:15 p.m.
(no class August 4 and August
11); Cost $150
Preregistration required.
Location: 2040 Webster St., SF.
Email [email protected]
to register.
Fit for Life (SWC)
A senior exercise class to help
increase strength and flexibility,
improving balance and reducing
risk of falls.
Mondays, 10:30–11:15 a.m.;
Tuesdays, 2:30–3:15 p.m.;
Thursdays, 10:45–11:30 a.m.
Reference Key
RDBHC = Ray Dolby Brain
Health Center in partnership
with the Alzheimer’s Association
provides education and support
for brain health, memory loss,
dementia and Alzheimer’s
disease. 408-372-9971 or rmain@
alz.org | cpmc.org/brainhealth
CAN = Bryan Hemming
Cancer Care Center offers
patients a variety of helpful and
compassionate care options in a
caring environment.
415-600-3081 | 2351 Clay St.,
1st Floor | cpmc.org/cancer
CHRC = Community Health
Resource Center, your resource
for accessible health information
and support. Classes offered on
a donation basis. 415-923-3155
2100 Webster St., Ste. 100
cpmc.org/chrc
DIAB = Center for Diabetes
Services offers adults individual
and group education sessions for
type 1 and type 2 diabetes selfmanagement. 415-600-0506
3801 Sacramento St., 7th Floor
cpmc.org/diabetes
DIAB* = Center for Diabetes
Services — St. Luke’s Diabetes
Center offers diabetes education
for pregnant women and adults in
English and Spanish.
415-641-6826
3555 Cesar Chavez St.
IHH = Institute for Health
& Healing classes support
wellness. 415-600-3426
2300 California St., Ste. 205
myhealthandhealing.org
NBC = Newborn Connections
offers education and resources
for pregnancy, breastfeeding, and
parenting, as well as a boutique.
More info, or RSVP at cpmc.org/
newbornconnections or
415-600-BABY. 3698 California
Street, 1st Floor
SLM = Maternity — St. Luke’s
offers a variety of pregnancy and
childbirth classes, as well as
activities to supplement the care
provided by your physician.
415-641-6911
3555 Cesar Chavez St.
SWC = Sports Wellness
Center, where certified physical
therapists are specially trained in
sports and wellness programs.
415-600-5860
2360 Clay St.
cpmc.org/sportswellness
WHRC = Women’s Health
Resource Center offers women’s
health classes and support,
and boutique for hair loss and
post-surgical breast needs.
415-600-0500
3698 California St., 1st Floor
cpmc.org/whrc
CPMC Research
Institute Leading
the Future of
Cancer Care
By Karin Fleming
In the past 15 years, cancer treatment
has significantly improved with the
advent of targeted therapies matched
to a patient’s specific tumor molecular
profile. But these molecular profiles test
only certain mutations and not the overall
tumor biology, which limits understanding
of why patients fail or become resistant to
targeted therapies.
Cancer Avatar Project Improves
Individualized Cancer Care
To overcome these limitations, scientists
at California Pacific Medical Center
Research Institute (CPMCRI) are
developing a new approach to move
beyond the current paradigm for
treating cancer.
1
Surgically
Removed
Tumor
2
“Through the Cancer Avatar Project,
our cancer scientists are working with
CPMC oncologists and surgeons to
create cell culture and mouse models, or
‘avatars’, of patients’ tumors, which will
give oncologists key information about
how well a patient’s tumor might respond
to a particular therapy,” says Michael
Rowbotham, M.D., CPMCRI Scientific
Director and Cancer Avatar Project lead.
Sabet, M.D., CPMCRI Senior Scientist
and Medical Director of CPMC’s
Cancer Program.“Sutter Health’s 3
million patients include a diverse cancer
population, allowing us to track outcomes
from initial diagnosis through long-term
follow-up. This is an exciting project
that will accelerate our innovation in
personalized medicine research in a way
that can ultimately improve patient care.”
Live Tumor Samples Provide More
Reliable Testing
“Instead of static testing—the traditional
cancer research approach—animal
and cell culture models of human
tumor growth provide a more dynamic,
accurate picture of how tumors grow,
metastasize, and respond to cancer
drugs,” says Liliana Soroceanu, Ph.D.,
M.D., a CPMCRI Senior Scientist who
leads the basic science component of
the project. “We are creating avatars
that replicate the cancerous process in
humans and provide a reliable model to
test new cancer drugs and treatment
combinations, response to therapy,
and to better understand how patients
become resistant to therapy.”
CPMC Foundation, the philanthropic
arm of CPMC, recently announced that
it will invest $8.95 million in the next
five years in this project and will raise
another $10 million for it during the same
period. “CPMC is one of only about 20
medical centers worldwide developing
cancer avatars for research,” says CPMC
Foundation President Doug Nelson. “We
thought this was a great investment and
would be a compelling opportunity for
other philanthropic partners as well.”
“Few medical centers offer something
like the Cancer Avatar Project, which
will allow us to lead a new paradigm of
precision medicine for fully individualized
cancer care,” says Mohammed Kashani-
Experimental Model
& Pharmacologic
Testing
3
Clinical Trials
& Feedback
to Patients
For more information and
updates on this research, visit
cpmcri-currents.org.
To give to this visionary cancer
research program, please visit
cpmc.org/giving. ✤
Samples are being obtained at
the time of surgery or biopsy from
the tumors of CPMC patients
with melanoma and high-grade
Consented
Patient
with Cancer
tumors of the breast, pancreas,
a.
colorectum, brain, lung, liver, and
ovary. Cells from the tumor are
b.
implanted into immunodeficient
mice. Once they grow in mice,
tumor cells are harvested to create
c.
a.
Patient-Derived Xenograft (PDX) models are mouse avatars. When transplanted from a
human patient with cancer into a mouse, tumors retain the characteristics of the original
specimen. PDX models allow researchers to test multiple drugs and drug combinations,
to find the one best suited to individual patients.
cell cultures for high-throughput
drug testing used to create more
avatars, or stored for later studies.
19
Nonprofit Organization
US Postage
PAID
Sacramento, CA
Permit No. 195
P.O. BOX 7999, SAN FRANCISCO, CA 94120-7999
CALIFORNIA PACIFIC MEDICAL CENTER
NOVATO COMMUNITY HOSPITAL
SUTTER LAKESIDE HOSPITAL
SUTTER PACIFIC MEDICAL FOUNDATION
SUTTER SANTA ROSA REGIONAL HOSPITAL
415-600-6000 | main CPMC phone
888-637-2762 | find a physician
cpmc.org
To be removed from the mailing list, please email
[email protected].
Join Us
for a Diabetes
Technology Fair
Presented by
Sutter Health’s CPMC
Center for Diabetes Services
Living with diabetes? Come join our team of experts and industry professionals
as they demonstrate the latest technology in diabetes care and management.
We invite adults and children living with Type 1 and Type 2 diabetes to learn
more about diabetes management and discover new developments in:
Insulin pumps • Continuous blood glucose sensors • The latest in diabetes
management apps • and more….
Location
CPMC California Campus
3801 Sacramento St., 7th Floor
San Francisco, CA 94118
Registration is not required,
drop-ins welcome.
Wednesday, April 13, 6:00 – 7:30 p.m.
This event is free of charge and
refreshments will be provided.