“There are many cardiac differences between men and women,” says Andrea M. Russo, M.D., Director of the Cooper Electrophysiology and Arrhythmia Program. “Women usually have a faster resting heart rate than men, they have smaller heart vessels, and there are even differences in the electrical activity in the heart,” says Dr.  Russo.

Unfortunately, these differences were unknown and unexplored for many years, as traditionally clinical trials for new medications and implantable devices were conducted predominantly on men.

To address this disparity, Dr. Russo has researched and published extensively on gender differences in cardiac arrhythmias. In addition to variances in response to treatments, Dr. Russo noted a discrepancy in the proportion of symptomatic males and females who are referred by physicians for cardiac evaluation and treatment.

“Females are less likely to have implantable cardioverter defibrillators (ICDs) implanted than men and are also underrepresented in referrals for other arrhythmia treatment, specifically catheter ablation for the treatment of atrial fibrillation. While women represent over half of all individuals who have atrial fibrillation in the United States, only 23 percent of atrial fibrillation ablation procedures are performed in women,” says Dr. Russo.

While many arrhythmias can exist without signs or symptoms, the most common symptoms in women are palpitations (feeling that your heart is skipping a beat, fluttering, or beating too hard or fast), an irregular heartbeat or feeling pauses between heartbeats.

Of more concern are arrhythmias that occur in conjunction with other symptoms such as : weakness, dizziness, lightheadedness, fainting or nearly fainting, sweating, shortness of breath, or chest pain.

“Women and men may present with similar symptoms,” Dr. Russo said, “but in women, some symptoms, such as palpitations, may be taken less seriously. Women are more likely to be diagnosed with anxiety than men.”

Regardless of gender, Dr. Russo advises anyone with recurring heart rhythm issues to:

• Talk with your primary care physician.
• See a heart specialist (a cardiologist or electrophysiologist) for diagnostic testing.
• Develop a plan for evaluation and treatment with your doctor, and follow the recommendations.

“Proper evaluation and treatment can often control or eliminate irregular heartbeats and extend your life,” Dr. Russo said.

For an evaluation of a cardiac arrhythmia at the Cooper Heart Institute, call: 856.342.2034.

Through the new High Risk Lung Cancer Screening Program, Cooper’s lung cancer team of experts are now offering eligible men and women a low dose spiral CT screening at our state-of-the-art Imaging Centers in Camden and Voorhees, N.J. Based on the findings of the screening, our experts guide patients through a comprehensive diagnostic evaluation, access to smoking cessation programs, long-term follow-up and, if needed, treatment.

Eligibility

• Individuals between the ages of 55 and 74 who are current or former smokers.

Men and women with a history of at least “30 pack years” of smoking.  A “pack year” is the number of packs smoked per day multiplied by the number of years smoked. For instance:

1 pack per day x 30 years = 30 pack years

2 packs per day x 15 years = 30 pack years

½ pack per day x 20 years = 10 pack years

• Patients should not have a history of any cancer within the past five years.
• Former smokers must have quit within the past 15 years.

 The out-of-pocket expense for the High Risk Lung Cancer Screening at Cooper is $300 payable at the time of the study.

 To determine your eligibility for the High Risk Lung Cancer Screening Program at Cooper and to schedule your appointment for screening call 856.342.2141.

Pediatric Emergency Medicine, Cooper University Hospital

Over the past several weeks, we have been overwhelmed by the news reports detailing abuse committed on children. To wit: the Penn State scandal, the Syracuse Basketball headlines, the reports of abuse by clergy and, most recently, the child molestation allegations against Philadelphia sports writer Bill Conlin, purported to have happened 40 years ago.

The headlines are sensational. How can one believe these things could happen in such hallowed institutions? Yet, the allegations have become all too familiar.

Each day when I go to work, I listen to children’s stories, stories that detail experiences that no child should have to endure: sexual abuse, physical abuse, emotional abuse and neglect. Sadly, these experiences are shared by thousands of other vulnerable people in our communities, but without the national headlines. Most stories are told by children who are much like our own. They attend local schools and have parents who are ‘regular, every-day’ people. The perpetrators of the abuse most often are people who are trusted by the children and their families—a relative, a close friend, a neighbor. These violations against children occur in secrecy and often have been perpetrated for weeks, months or years. Most children tell of their experiences long after the onset of abuse.

All too often, once allegations are made, people in the community and even members of the family question the truth of what the children relate. The accusations often seem to be beyond belief. We ask ourselves, “How could this happen?”  “How did I not know?” The accusations seem too fantastic, too surreal,  too difficult to accept.

How do we stop this? How do we stop child abuse? I don’t have the answers. Even though I have spoken to hundreds of children, I cannot understand the prevalence, frequency, or inhumanity of humans against those most in need of care and protection.

What I do know is that each and every one of us must be willing to call attention to the plight of the children in our lives—our own children; our neighbors’ children; our children’s school mates and team mates; the children we see on the street, at the store or mall, or on the playground. If we suspect that a child is in harm’s way or is in any way unsafe, we must report our concern to the N.J. Division of Youth and Family Services by calling the Child Abuse/Neglect hotline, at 1-877-NJ ABUSE.  Callers do not need proof to report an allegation of child abuse, and they can make the report anonymously. (Every state has a similar statewide hotline.)

If we witness aggression against a child, we must, morally and ethically, intervene on that child’s behalf. We must listen and believe children, no matter how difficult it may be. The worst thing we can do is ignore a child’s plea for help as we do when we ignore or dismiss a child’s disclosure.

Furthermore, we must provide them with the opportunity to tell their story to professionals who have the skills to support them. And, finally, we must provide the resources to treat children if they have experienced abuse so that they may begin to heal.

Remember, if you are in New Jersey and concerned for a child’s safety or well-being, MAKE THE CALL: 1-877-NJ ABUSE.  If the child is in immediate danger, call 9-1-1 as well.

To learn more about how and when to report child abuse/neglect, visit: www.nj.gov/dcf/abuse/how/

Who is the “cosmetic surgery” patient? In our office the most common reason that a patient seeks advice is that the image they see in the mirror does not reflect the youth and vitality they feel. The old image of the cosmetic patient as the privileged wealthy or Hollywood star is outmoded. Even the term “cosmetic surgery” doesn’t truly reflect the wide range of non-surgical procedures that are available for rejuvenation. And while the “extreme makeovers” we see on reality TV are compelling, they do not accurately depict the day-to-day services provided in cosmetic practices throughout the country. Here are some of the biggest myths about cosmetic procedures:

Myth #1: People who have cosmetic surgery look fake. Only poorly done and/or excessive cosmetic procedures look artificial. Well-planned and carefully chosen procedures restore your natural appearance and make you look fresher, rested and yes, a little younger. Make sure your doctor listens to what you are trying to achieve. Everyone has a different bone and soft tissue structure. Everyone ages differently. Trying to restore a more youthful appearance or making modest changes is usually achievable. Trying to completely change your features or look like a model in a magazine can lead to an artificial appearance.

Myth #2: Botox makes your face look frozen. Only poorly done or excessive injections of botulinum toxin look unnatural. When done correctly, facial movement is fluid and natural and only the undesirable movement (such as frowning) is softened.

Myth #3: Injectible fillers are not worth doing as the results are too short-lived. Many of the fillers such as hyauluronic acids (best known – Restylane and Juvederm) and others stimulate the body to lay down collagen and over time can give a natural filling that requires fewer products, less often.

Myth #4: Liposuction is for people who want an alternative to diet and exercise. Liposuction is a reshaping procedure that works best in people that have a figure problem that is resistant to diet and exercise. An example would be the outer thigh or “saddle bag” area in women which corrects nicely with liposuction.

If you do decide to go to your dermatologist for a cosmetic evaluation, make sure that you get a full face analysis taking into account your face shape, bone structure and fat distribution. You should be given clear pricing for everything discussed. Finally, no cosmetic procedure is emergent. Don’t feel pressured if you are not comfortable.

Head of the Division of Emergency Medical Services and Disaster Medicine at Cooper

It can be very stressful when an emergency medical event occurs that requires activation of the 9-1-1 system. It is even more stressful when you don’t know what to expect once that phone call is made. Understanding how 9-1-1 works, and what you need to do during and after that phone call, can go a long way in lessening the tension of an already stressful situation.

How 9-1-1 Works

All 9-1-1 calls are answered by trained emergency medical dispatchers who will ask a series of questions based on the reason for the call. The dispatchers will have access to state-approved guidecards that will guide the dispatcher through the call to obtain specific information and to provide basic instructions to the caller. While on the call, the dispatcher will deploy emergency medical personnel to the scene.

The New Jersey Emergency Medical Services system, called EMS, provides two levels of response depending on the call. The first level:  Basic Life Support (BLS) services, which are performed by certified Emergency Medical Technicians, or EMTs, who generally are responsible for ground transport via ambulances. The second level: Advanced Life Support (ALS) services, whose providers are certified paramedics or licensed Mobile Intensive Care Registered Nurses who are dispatched to potentially life-threatening incidents to offer the highest level of pre-hospital care.

What to Do When You Call 9-1-1

Please follow these recommendations:

1.  Provide accurate information to the 9-1-1 dispatcher.

The dispatcher will send an ambulance with EMTs to provide BLS services and to transport the patient to the hospital. Based on the information received, the dispatcher will determine whether ALS services are needed. ALS services can later be requested or recalled by the EMTs after their assessment of the situation, but immediate accurate information can assist the dispatcher in getting the appropriate resources to the patient as soon as possible.

2.  Be involved in the pre-hospital care.

Although sometimes difficult in emergency situations, patients should always understand the care that is being provided. EMS providers are patient advocates, and patients should work collaboratively with them for optimal care. Patients need to ask questions and to express any concerns to the EMS providers. Patients also should have available pertinent information that may affect their care (e.g., names of treating physicians and hospital affiliations, medications/medication list, advance directives, medical records, lab results, radiology reports). EMS providers will take the patient to the closest, most appropriate facility unless patients request transport to a particular hospital. Reasons to transport to a particular hospital include previous hospitalizations there, physician affiliations, and specialty care. However, EMS providers may not transport based on patient preference if the decision may negatively affect the patient’s health.

3.  Trust in the EMS providers’ ability to provide care.

Both ALS and BLS providers are specifically trained to provide emergency care outside of the hospital setting. They must go through an initial certification and routine recertification processes approved by the New Jersey Office of Emergency Medical Services to function as EMS providers. These processes involve required and elective classes in various topics that are encountered in the pre-hospital setting.

For more information, contact your local EMS agency or access the New Jersey Office of Emergency Medical Services website at www.state.nj.us/health/ems.

Flu season is here and the best way to protect against flu is to get a flu vaccine. Annual flu vaccination is recommended for everyone 6 months of age or older.

What is flu?

Flu, also known as influenza, is a contagious illness caused by the influenza virus which infects the nose, throat, and lungs. Symptoms include fever, chills, cough, sore throat, runny or stuffy nose, headache, muscle aches, and fatigue. Flu also can cause pneumonia.  Other illnesses can have similar symptoms and be mistaken for flu. If flu is suspected, your doctor may be able to order a test that can detect the flu virus in the nose or throat.

Can flu cause serious illness?

Yes!  Flu can lead to very serious complications, including pneumonia, and even death. For example, from 2009 to 2010 in the United States, 275,000 hospitalizations and 12,500 deaths were estimated to have occurred due to flu. While serious complications from flu are more common among certain people–children younger than 5 years of age, adults age 50 or older, pregnant women, and people with certain chronic medical conditions, complications also can occur in otherwise healthy individuals of any age.

How do I protect myself and my family from flu?

The most important step in protecting against flu is to get a flu vaccine every year. Getting a flu vaccine may also protect your family and others around you. How? If you don’t get vaccinated and become infected with flu, you can spread the virus to others who may be at high risk for serious illness or death from flu, such as a baby, a child, a pregnant woman, grandparents, or a friend. Also helpful in preventing the spread of flu is washing your hands frequently, or using an alcohol-based hand rub, as well as covering your nose and mouth with a tissue when you cough or sneeze.

Is the flu vaccine safe?

Yes! The most commonly administered flu vaccine is the “flu shot.” It is made of killed virus, so you cannot get the flu from it. The most common side effect from the flu shot is soreness where the shot was given, which typically lasts only one or two days. The risk of serious problems from the flu shot, such as a severe allergic reaction, is extremely small. Of course, even if you get the flu shot, you still can catch a non-flu virus or bacteria that may cause symptoms that mimic flu.

Where can I get the flu vaccine and how long does it take to develop immunity?

See your doctor or go to other locations where the flu vaccine is being offered. It typically takes about two weeks for your body to develop an immune response after getting the flu vaccine, so get vaccinated now to protect yourself and your family. Remember, flu activity in the United States usually peaks in January or February and can continue to occur as late as May.

Embarrassing? Maybe…But Your Health Depends on It

Visiting the gynecologist can cause anxiety for many women.  Much of the stress stems from feelings of modesty or the fear that something may be wrong. It is important, however, that women muster the strength and visit their gynecologist for their annual gynecology exam.

This annual exam is often referred to as the “Well Woman Exam.” It is meant to reassure women that there are no potential problems that may cause symptoms in the near future. If a problem is identified prior to it causing any symptoms, it is likely more amenable to treatment.

This visit should include questions by the gynecologist that can lead to the diagnosis of medical issues before the onset of symptoms. Some of the questions are probing and may even seem embarrassing. These questions are meant to give each woman the opportunity to discuss problems they might otherwise fail to mention. They are also meant to identify problems that women may think are a normal part of aging and nothing can be done to correct them. Although this  is false, the most common of these problems are urinary issues and pain with intercourse.

The annual exam is also a time to get information about your health, what tests are currently recommended for your age and what healthy lifestyle regimens are useful to maintain your good health.

In order to make the most of this Well Woman Exam, come prepared with your medical, surgical and family histories as well as your list of medications so that the doctor has accurate information to work with. Also, it is a good idea to bring a list of questions with you to discuss with the gynecologist during your visit.

The most important thing to remember is that your physician is there to help you manage your health. If you haven’t visited your gynecologist in the past year (or longer), I urge you to make an appointment right away. If you don’t have a gynecologist, ask your primary care doctor, your friends, or family members as soon as possible for recommendations. The right gynecologist is out there for you, and it is important that you go. Your health depends on it.

Program Manager, Cooper Diabetes Center

As you prepare for family dinners and get-togethers this holiday season, think about how many people in your family have diabetes. If your mother, father, sister or brother has diabetes, it is more likely you will also get diabetes.

But diabetes can be prevented. There is a window of opportunity right before the diagnosis of diabetes called pre-diabetes. One of the most important studies in the field of diabetes, The Diabetes Prevention Program, has shown us beyond a shadow of a doubt that during this period of time, diabetes can be stopped for many people with pre-diabetes.

How do you know if you have pre-diabetes and what do you have to do to stop diabetes in its tracks?

It is now very easy to check if you are heading toward diabetes.  Ask your doctor for a blood test called a Hemoglobin A1c, which measures the amount of glucose that has “sugar-coated” the hemoglobin in your blood. If you have normal blood glucose, the Hemoglobin A1c is about 5 percent “sugar coated.” If your Hemoglobin A1c is 6.5 percent or higher, you have diabetes. But there is a period of time, called pre-diabetes, when you can turn back the hand of the ticking clock of diabetes, and that is when your Hemoglobin A1c is “sugar-coated” between 5.7 percent and 6.4 percent.

Stopping diabetes is easy. The Diabetes Prevention Program has shown that losing 7 percent of your weight (for a 250 pound person, 7 percent translates into 17 pounds) and exercising 30 minutes a day, five days a week, can stop diabetes in its tracks.  It is a good idea to start with being more active, because being active can help with weight loss. Start with an activity you enjoy and something you know you can do, such as bowling, dancing to your favorite oldies or maybe a walk around the block with a friend.

Then make a family commitment, because if you take care of yourself and are active, there is a good chance your children and grandchildren will follow in your footsteps.

So, this year, as you celebrate the holidays with your family, tell them the steps you will take to lose weight and ward off diabetes – for instance, you’re going to take a walk around your neighborhood, three times a week – so that you will be around to celebrate with them next holiday season, and for many holiday seasons to come.

Remember, you can prevent diabetes by reducing your weight and increasing your activity. Cooper’s comprehensive education and nutrition programs – The Healthy Weigh and The Diabetes Weigh – can help you achieve your goals and ensure your health.

In addition to being Program Manager of the Cooper Diabetes Center, a program of Cooper University Hospital’s Department of Endocrinology and the Center for Health and Wellness, Francine Grabowski is co-author of The Best Diet on Earth, based on The DASH Diet, and Lead Diabetes Educator for the Camden Citywide Diabetes Collaborative.

Cardiovascular disease, despite improved efforts at prevention, remains the No. 1 killer of women in the United States, accounting for approximately one-third of all deaths.

Cardiovascular disease far surpasses breast cancer. This statement is true regardless of ethnicity. In fact, the average lifetime risk for cardiovascular disease in women is approximately 50 percent. It wasn’t until recently that these statistics began to affect doctors’ approaches to the diagnoses and treatment of cardiovascular disease in women.

In the past, women were often under-diagnosed or treated less aggressively for heart disease. Perhaps this occurred because women tend to have more atypical cardiovascular symptoms, such as shortness of breath, fatigue, and jaw or neck pain.

Although women are different from men in many ways, their risk for heart disease is approximately that of their male counterparts as they age and particularly after menopause. Although women are more likely to have symptoms of heart disease later in life than men, by the time they are diagnosed, they tend to be a lot sicker and are more likely to die from it than men.

Recognize Your Risks

Cardiovascular disease is a broad term that describes a spectrum of diseases that affect your heart, including myocardial infarction (heart attack), heart failure, and heart rhythm problems. It also includes peripheral arterial disease (PAD), which refers to the build-up of plaque in the arteries that lie outside the heart, such as the aorta, carotid arteries, or arteries in the legs. However, a significant amount of cardiovascular morbidity and mortality in women is preventable if detected and treated early.

Traditional risk factors such as high blood pressure, diabetes, a family history of heart disease, obesity, excessive alcohol intake, smoking and high cholesterol all should be discussed with your primary care doctor at each visit.

If you have any of these risk factors, you should discuss them with your doctor. Most importantly, do not ignore symptoms. If you start to notice that you run out of steam a lot easier or that you can no longer walk around the block without getting winded, let your doctor know. He or she might ask for a stress test or an echocardiogram to determine if your symptoms are related to heart disease.

Reduce Your Risks

Decreasing your risk for heart disease can start with simple lifestyle changes. If you smoke, stop now. One study has shown that even one cigarette a day significantly elevates a woman’s risk for heart attacks. After approximately two-to-three years of being tobacco-free, a woman’s risk for heart attack is equal to that of a non-smoker.

A sedentary lifestyle also contributes to heart disease. Approximately 30 minutes of moderate exercise, such as brisk walking, five days a week will help reduce risk. If you have trouble walking, then resistance training with lightweights is a good alternative.

A few simple things can reduce a woman’s chances of dying from heart disease. Recognizing your risks and speaking with your doctor are the first steps.

To learn more visit the Cooper University Hospital Heart Institute. 

After decades of work by breastfeeding advocates, it’s now generally accepted that breastfeeding is the best source of nutrition and immunologic protection for infants, and that both babies and mothers receive excellent health benefits from it. In fact, babies who are breastfed are less likely to become overweight and obese, have fewer ear infections, stomach viruses, respiratory infections, and other pediatric conditions and diseases.

Despite the gradual change in public opinion, however, many new mothers still do not choose breastfeeding as their babies’ main source of nutrition. Now, New Jersey has taken a lead in prioritizing breastfeeding as a public health topic, particularly for the role of breastfeeding in the prevention of obesity–an epidemic problem for New Jersey residents. Multiple strategies are being developed to target communities, schools, workplaces, and healthcare settings.

Some of us who work in healthcare have also been working hard to increase breastfeeding rates. Our group, The Baby-Friendly Hospital Coalition, is collaborating with the American Academy of Pediatrics and maternal/child health experts at 10 New Jersey hospitals to implement new policies and practices at those facilities that make the education, support and encouragement of  mothers and babies in breastfeeding a priority. Recently, we received a major boost in our efforts to promote breastfeeding by being awarded a grant from the Centers for Disease Control and Prevention entitled, Communities Putting Prevention to Work.

Cooper University Hospital is taking the lead in this initiative. Last year, we became one of the first facilities to stop the practice of giving out formula–company-sponsored sample packs, a practice shown to undermine breastfeeding. Now, through the collaborative, more than a dozen N.J. hospitals have stopped distributing sample formula packs.

Additional changes that Cooper and other facilities are working on include: having comprehensive infant feeding policies; training all of their staff, including physicians, on the benefits and management of breastfeeding; providing prenatal and post-partum information about breastfeeding, delivery by skin-to-skin, rooming-in, avoidance of unnecessary supplementation, and showing mothers how to maintain lactation should they be separated from their newborns. These policies and practices are described in the World Health Organization’s “Ten Steps to Successful Breastfeeding” and serve as the basis for the Baby-Friendly hospital initiative.

While N.J. currently has no Baby-Friendly certified hospitals, we expect that with this collaborative not only will more hospitals receive certification, more mothers in N.J. will breastfeed exclusively for the first six months, continue breastfeeding for at least one year, and fewer children in N.J. will be victims of the obesity epidemic.

To learn more visit the Cooper University Children’s Regional Hospital.