First Bilateral Hand Transplant in Region Performed at Penn Medicine

The first bilateral hand transplant in the Greater Philadelphia region was recently performed at the Hospital of the University of Pennsylvania. Under the leadership of the Penn Transplant Institute, the extensive 11 1/2-hour procedure was performed by Penn’s Hand Transplant Program in close partnership with the Gift of Life Donor Program.

Penn’s Hand Transplant Program is a joint venture of the Penn Transplant Institute, Penn Orthopaedics and Penn Plastic Surgery. The multidisciplinary team is dedicated to working together to restore independence to amputees who have lost their arms and legs

• Read more about the region's first bilateral hand transplant
• Learn more about Penn’s Hand Transplant Program
• Learn about the Gift of Life Donor Program

Summertime Injuries – Penn is Here to Help

Summer is finally here and with it comes trips to the pool, going to the beach, outdoor runs, tending to our gardens, and firing up the grill. Kids are out of school and begging you to play basketball, soccer or other outdoor activities.

For some, these extra activities are a kind of seasonal re-commitment to fitness, weight loss and relaxation. But for a few, some of these activities can lead to unexpected injuries and accidents, some even needing serious medical attention. And, as the motto goes, an ounce of prevention is worth a pound of cure. Which means, knowing where to go if anything does happen is a good idea to have in mind.

In case of injury, whether a sprained ankle, broken foot or any other musculoskeletal injury, the orthopaedic team at Penn Medicine is ready to help. In most cases, you can even see a physician on the same day.
Highly skilled and highly specialized, Penn Orthopaedic physicians treat each joint condition, spinal disorder or sports injury with a personalized approach. With ten orthopaedic subspecialties, physicians at Penn Orthopaedics not only treat more complex conditions — they are uniquely qualified to treat each condition individually.

Penn Orthopaedics offer same-day appointments for:

• Foot and ankle
• General orthopaedics
• Hand and wrist
• Joint replacement
• Neuro orthopaedics
• Orthopaedic oncology
• Shoulder and elbow
• Spine
• Sports medicine
• Trauma and fracture care

“You call with any musculoskeletal need and we’ll see you that day,” says L. Scott Levin, MD, chair of Orthopaedic Surgery.

Please be safe and enjoy this summer. If you need us, we’re a call or a click away.

Atrial Fibrillation: Causes, Symptoms and Prevention Methods

Does your heart ever feel like it’s racing or doing somersaults in your chest?

Approximately 2.5 million Americans experience atrial fibrillation (AFib) each year. This common heart disorder occurs when electrical signals in the heart become irregular, causing the heart to beat out of rhythm. The normal range for a heart rate is 60 to 100 beats a minute while the heart rate in atrial fibrillation may range from 100 to 175 beats a minute.

Causes and Symptoms
Causes of atrial fibrillation vary and range from existing heart problems to infections to chronic conditions like obesity and sleep apnea.  Common risk factors and conditions that may cause AFib are:

• Congenital heart defects (defects you are born with)
• Heart attack, or a damaged heart muscle from a past heart attack
• Heart valve diseases
• Heart failure or coronary artery disease
• High blood pressure
• Hyperthyroidism 
• Substances or drugs, including alcohol, caffeine, or stimulants 

Symptoms of atrial fibrillation vary and many people are unaware they have AFib until it’s diagnosed during a regular physical exam. While the most common symptom is a fast or irregular heartbeat, others who have AFib may also experience lightheadedness, shortness of breath, lack of energy and chest pain. The biggest danger of atrial fibrillation is to leave it untreated.  If you experience symptoms, call your physician immediately.

How You Can Defend Against AFib
Since atrial fibrillation is often caused by conditions that cause damage or place extra strain on the heart, making simple lifestyle changes to improve your heart health may help protect against AFib.

• Don't smoke. Avoid alcohol and stimulants.
• Eat a heart-healthy diet that includes fish, fruits, vegetables, whole grains and olive oil. 
• Stay active. Get regular exercise on most days of the week. Your physician can suggest a safe level of exercise for you. 
• Control your cholesterol and blood pressure. 
• If you have diabetes, keep your blood sugar in your target range.
• Find ways to cope with stress.

For additional information on atrial fibrillation and treatment options, download Penn’s Guide to AFib.

Why Choose Penn Medicine for AFib Care
Penn Medicine’s Cardiac Arrhythmia Program is one of the largest in the country and performs more than six times the national standard of AFib ablations procedures. So patients like Dominic, a retired Philadelphia police officer, receive the most advanced care from an experienced team of physicians, nurses and support staff.

Contact with Families after a Patient's Death

On April 28 I wrote a post to report that the New York Times Ethicist column had taken a quote about doctor-patient sex from this site. The next day I received a phone message from Langley Danowitz, daughter of Emily Lublin, a long time patient of mine, who had died in 2000 at age 84. Emily had a great sense of humor. We had a warm, friendly relationship and very much enjoyed working together on various vicissitudes of her 70s and 80s. At one point Emily said - "you have to promise not to retire before I die." I was sad when she died, but happy to have been able to keep my promise.

Emily and her daughter Langley were close. Over the years I heard a lot about Emily's visits with Langley, who lives in New York. Langley and her husband Jeff conducted a memorial for Emily in Boston, which I attended, and met them there. When Langley saw my name in the New York Times column she called me, to thank me for caring for her mother and to give some news about herself.

When I returned Langley's call we reminisced about her mother, and I heard about how Langley has reinvented herself as an actor when a job she'd been in for 30 years ended. Langley told me she is a "young looking 70 year old," and explained how the advertising industry has used her when they want an athletic, youthful-looking, older person. Since aging is one of the topics I write about on this blog (as well as on Over65, which I co-edit) I invited Langley to write about how she adapted to the end of her long time job. She wrote the delightful piece that follows. I'm publishing it and have spoken in this post about her mother Emily with her permission:

           Part I - Adjusting

Five years ago, when I was (requested to) retire from being the corporate controller (MBA) for a manufacturing company, I was relieved but mostly terrified. After 30 years of non-stop work, I had no idea what I would do to keep myself sane, out of trouble and out of the refrigerator. And although I had always enjoyed the domestic scene, was an avid gym-goer, and had loving family, my life had revolved around the office for as long as I could remember. My 2 thoughts when I got the word were: “you mean I don’t have to come here anymore?” and “omg, now what do I do?” My wonderful husband, Jeff, who had served as Homefront Captain for years, graciously re-introduced me to Laundry and I stampeded into the fray. For weeks, I used my considerable energy cooking and cleaning, organizing and discarding, baking and searing, writing and phoning. Mind you, I was still getting up at 5:30 AM to get to the gym by 6:30 – sleeping in had not occurred to me. Change my Type A style? Never in my mind! Occasionally, I must admit when I raced around my Upper East Side NYC hood, I noticed other gals of an age lunching together and shopping or just strolling…where did they find each other and why did they look so…was it “relaxed”? I wished I had some friends too but – it seemed everyone I knew was still working. Where would I find people to like who would like me too?

Part II – I find a friend

I decided to take up the piano – I’m musical and love a challenge. I hung a sign in our Laundry Room – “Adult student, plays by ear, needs patient piano teacher” and someone penciled on it: “Apt 1222 teaches”. I adopted Friend #1 – my 1982 Kawai console piano, which, as the movers remarked, matches our living room furniture. I found not one, but two teachers, who proceeded to complement and battle each other for my soul. I played in my first recital after 4 lessons – a day which shall live in my annals of terror forever. I basked in the applause and drank lots of wine afterwards.

Part III – I hit the boards

As you can tell, I was learning how resilient I am. So – I finally tackled something I had always wanted to do – become an actor! You should know, I probably came out of the womb taking a bow. After all, I studied Speech at Northwestern and played Little Buttercup in junior high. Now, I had the time to do it professionally – could I? Only one way to find out - headshots, acting resume (somewhat bogus at first), agents – ta dah! As you can tell – modesty is not moi. And, with my physical fitness + energy, I figured that if I said I could do it, I would do it. And now I have the hula hooping (Wellcare Insurance), push upping (Advil) and headstanding (Geisinger) TV credits to prove it.

More to come????

Having the opportunity to know people in depth and work with them on their health and well-being over time is one of the core privileges in being a physician, nurse or other health professional. Thirteen years after Emily Lublin's death I had fond memories of her, and I was moved that her daughter Langley, who I'd only met once, had memories of me from what she'd heard from her mother. Having an opportunity to be once again in the role of Emily Lublin's clinician talking about her with her daughter 13 years after her death is an experience I cherish and feel lucky to have had.

(I couldn't find YouTube videos showing Langley standing on her head in a Geisinger commericial, doing push ups for Advil, or hula hooping for Wellcare, but I did find this tamer video of her in an advertisement for iYogi.

Vegetable Potato Curry

Using some of the traditional spices used for curry I created a delicious vegetable potato version.  I think you are going to love this one.  Curry dishes are richly satisfying with their intense spices, easy to make, healthy and very inexpensive. I have created several curry dishes that are available on my website:  Red Potato Curry Over Lemon-Basil Zucchini, Corn and Cashew Nut Curry with Perfect Brown Rice, and Tofu and Green Bean Red Curry.  I also have a raw version called Raw Curry in a Hurry, created by Tanya Alexseeva (Better Raw).  Try to include a lot of raw, organic foods in your diet.  Then supplement with a smaller percentage of healthy cooked foods.  You will find good health and enjoyment from this way of eating.

I recently tried Koshihikari brown rice. This new state-of-the-art technology allows milling of rice grains just 10%.  This lets Hokkura Brown Rice absorb water quicker and cook up fluffier, like white rice, without sacrificing the natural minerals and nutrients of brown rice. The best way to prepare Hukkura brown rice is exactly like you would white rice, only let the brown rice soak for 30 minutes in your rice cooker before turning it on to start the cooking process.  So normally if you put two cups of rice in your rice cooker, you would  then add water to the two mark.  In addition to this, let the rice soak for 30 minutes and then turn the cooker on. I found the flavor of Hukkura brown rice to be extra tasty, fresh and of the highest quality. You can order Hukkura brown rice on Amazon to give it a try, or possibly find it at your Asian supermarket. This particular premium rice doesn't state that is organic, so I now have a quest to find a similar one that is. Click on the picture below to find on Amazon. hope you will give this curry recipe a try and let me know what you think.  My family loved it! Also, check out my Perfect Organic Brown Rice made with regular organic brown rice.

Hukkura Brown Rice

Vegetable Potato Curry

Printable Recipe

Serves 4-6

5 medium russet potatoes, cut into 1/2 - 3/4" squares
4 stalks celery, finely chopped
3 carrots, finely chopped
2 heaping tablespoons parsley, finely chopped
1 onion, diced
2 cloves garlic, minced
6 1/2 cups vegetable broth with sea salt
1 lemon, juiced

SPICES:
1 teaspoon ground turmeric
1 teaspoon ground cumin
1/2 teaspoon red chili powder
1 teaspoon ground ginger
1 teaspoon curry powder
2 teaspoons sweetener of choice

1.  Prepare potatoes, celery, carrots, parsley and set aside.
2.  Add diced onion, 1 1/2 cups vegetable broth, all seasonings, sweetener and add to larger soup type pan.  Simmer for 5 minutes.
3.  Add remaining vegetables and half of the remaining broth.  Bring to a boil and then simmer, stirring frequently until potatoes and carrots are soft.  Continue to add vegetable broth as needed until all broth is used.  Curry should be thick with some liquid present.  If it is too dry, add some additional water.
4.  Serve over brown rice and enjoy!

Spaghetti and "Meatballs" from Forks Over Knives

Everyone loves pasta, so I wanted to share a recipe from the book Forks Over Knives.  A lot of you have probably seen the video, but if you haven't you can buy it on Amazon along with the companion cookbook. 

THE CLASSIC ITALIAN-AMERICAN dish gets a healthy makeover with millet standing in for the meat.  Loved this yummy and inexpensive dish.  You can simplify this recipe by adding your own favorite pasta sauce. I also used brown rice noodles in this recipe.

What I love about this book is that the recipes are very simple with ingredients you are use to seeing and using already.  You will find you have a lot of the ingredients in your home right now and can easily make a lot of the recipes by picking up just a few things from the store or getting them from your garden.  This is a great book for home food storage as well.  If you stock up on the cooking basics (page 12, 13, 14 & 15), and keep items on your shelves that you rotate, like vegetable stock, brown rice, quinoa, millet, whole grain pasta, various packaged & canned beans & lentils, various kinds of canned tomatoes, frozen berries & fruits, raisins, etc., you can create a 3 month or more supply of food that you rotate for your family.  You will also need to store some water. The recommendation is to have 1 gallon of water per person to last 2 weeks and 3 months of food.  I highly recommend this book to help you set up an excellent working kitchen and food storage plan. 

Some hints that have helped me with preparing my meals is to freeze a few items to make meal preparation easier.  I keep a bag of garlic in my freezer and pull them out as needed.  They work well frozen with my mincer.  I also freeze leftover parsley, cilantro, herbs and spinach. I can easily add these frozen veggies during my meal preparation.

Spaghetti and "Meatballs"
Printable Recipe
Serves 4

2 cups Vegetable Stock (page 23), or low-sodium vegetable broth
1 cup millet  (see below how to soak and prepare your millet before cooking)
1/2 teaspoon salt, or to taste
1 large yellow onion, peeled and diced small
6 cloves garlic, peeled and minced
1/2 cup minced basil
1/2 teaspoon freshly ground black pepper, or to taste
1/4 cup tomato puree
2 tablespoons arrowroot powder or cornstarch
1 pound whole-grain spaghetti, cooked according to package directions, drained, and kept warm
2 cups Tomato Sauce (page 25), heated  (I used my own favorite spaghetti sauce here)

1.) Preheat the oven to 350 degrees F.
2.) Bring the vegetable stock to a boil in a medium saucepan.  Add the millet and salt and bring the mixture back to a boil over high heat.  Reduce the heat to medium and cook, covered, for 20 minutes, or until the millet is tender.  Drain any excess water and keep warm.
3.)  Place the onion in a large saucepan and saute over medium heat for 7 to 8 minutes.  Add water 1 to 2 tablespoons at a time to keep the onion from sticking to the pan.  Add the garlic, basil, and pepper and cook for another minute.  Add the tomato puree and 1/4 cup of water and cook until the liquid is almost evaporated, about 3 minutes.
4.) Line a baking sheet with parchment paper.
5.) Add the cooked millet and the arrowroot powder to the onion mixture and mix well.
Using an ice-cream scoop, shape the millet mixture into 2-inch balls and place on the prepared baking sheet.  Bake for 10-12 minutes.
6.) To serve, divide the spaghetti among 4 individual plates.  Top with some of the "meatballs" and pour some of the tomato sauce over the prepared plates.

SOAKING MILLET
You must soak your millet the night before you plan on using it in your recipe. One cup of dried millet generally yields about 3 cups cooked. Measure out millet, place in a ceramic or glass bowl (never use plastic) and soak with purified water for 12-18 hours. For optimal soaking, add 1 tsp. apple cider vinegar.
Much like quinoa, millet is gluten-free and easy on the belly. It is also more alkalizing than other non-gluten grains. It is rich in B vitamins, iron, magnesium, phosphorous and potassium. Millet has an impressive amino acid profile, including the essential amino acid methionine, making it an excellent source of protein.  
Preparing Basic Millet 101 - Yogitrition

 

Women & Heart Disease: Know Your Risk, Protect Your Heart

Heart disease is often thought of as a health problem for men, but more women die of heart disease each year, killing approximately one woman every three minutes. An estimated 42 million American women live with heart disease, but many are unaware of the danger they face.

Heart or cardiovascular disease is any disorder that affects the heart's ability to function normally. Types of heart disease are coronary artery disease, congestive heart failure, cardiac arrhythmia, stroke, peripheral vascular disease and valvular disease.

It is important for women to know the warning signs of heart disease because these symptoms are likely to be different from those experienced by men. Women may experience common symptoms of chest pain and shortness of breath, but also have less obvious symptoms including:

• Discomfort in the back, shoulders, arms, stomach, jaw, neck or throat 
• Generalized pressure in the chest 
• Indigestion 
• Lightheaded
• Nausea and vomiting 
• Palpitations 
• Unexplained fatigue 

Once heart disease develops, it’s a lifelong condition that will gradually worsen unless lifestyle changes are made. Fortunately, women may be able to lower heart disease risk by more than 80 percent by making healthy lifestyle choices. These include:

• Exercising and maintaining a healthy weight.
• Following a healthy diet that is low in saturated fat and cholesterol, and includes a variety of fruits, vegetables and whole grains. 
• Finding ways to cope with stress.
• Managing high blood pressure.
• Knowing your family history and getting tested for diabetes.
• Lowering total cholesterol to less than 200 mg/dL.
• Not smoking and limiting alcohol.

Penn's Preventive Cardiovascular Program was designed specifically prevent the onset, recurrence and progression of heart and vascular disease. To learn more or schedule an appointment, please call 800.789.PENN (7366).