HEAD

FIRST
Center offers hope
for patients with
brain Tumors

Exercising with Asthma

Baylor’s New Cancer Center
Hypothermia Treatment:
A Degree Above

fall 2008 volume 2 no.4 a publication of baylor university medical center at dallas
 Our Mission
b a y l o r
innovations
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 CONTENTS fall 2008 volume 2 no. 4

COVER STORY
27 Head first
Physicians on the medical staff at the Skull Base Center at Baylor Neuroscience
Center employ a number of minimally invasive techniques to remove tumors
from the hard-to-reach skull base.

SPOTLIGHT ON
15 EXERCISING WITH ASTHMA

15
Don’t let exercise-induced asthma bench you for good. With proper diagnosis
and preventive medications it is possible to work out and breathe easy.

18 A DEGREE ABOVE
Physicians on the medical staff at Baylor are investigating whether putting
existing technology to new use may prevent hypothermia in trauma patients.

53 Baylor’s NEW CANCER CENTER

Plans to expand the Baylor Sammons Cancer Center mean expanded
patient care with up-to-date cancer therapies and a modern, patient-centric
environment.

WOMEN’S HEALTH
27 16 DEFINING POWER
Testosterone may rev up the male psyche, but women have a power hormone
of their own: estrogen.

Living Well
36 THE TRUTH ABOUT ANTIOXIDANTS
Antioxidants have known healing potential that you can unlock largely
through a healthy, colorful diet, but not all scientists are convinced of their
cure-all powers.

36
6 Baylo r I n n o v a t i o n s : : fall 2 0 0 8
 HOT TOPICS
20 THE GAME OF LIFE
Video games may one day (in the not-so-distant future) save lives.
Cardiac surgeons are using gaming technology to challenge traditional
open-heart surgery.

24 SOURCING THE PAIN

Research linking fibromyalgia to the central nervous system may finally get
to the root of the elusive, painful disease.

11
11
Mental Health
CALM CONNECTIONS
Brain scans reveal why older adults are more likely to go with the flow than
their younger counterparts.

47 THE SELF-HEALING BRAIN

Intense mental exercise and memory training can boost IQ and may provide a
drug-free method to treating severe brain injury and developmental disorders.

50 PSYCHOLOGY OF A PACK RAT

Why do you cling to that dusty pile of magazines or blouses that were
stylish a decade ago? Researchers blame hoarding tendencies on the

24 human brain and hard-wired endowment effect.

Self Care
13 FLIP-FLOP FLOUNDER
Flip-flops may be the go-to for casual footwear, but recent studies suggest
the flimsy sandals may also contribute to leg and foot pain.

8 IN BRIEF

56
50
GET THE PICTURE

58 CALENDAR

fall 2008 : : Bay l or I n n o v a t i o n s 7

news
In Brief From the BI Staff
QUALITY OF LIFE IMPROVES FOR AMERICAN TEENAGERS, BUT
WORK REMAINS TO IMPROVE LIFE FOR YOUNGER CHILDREN
The well-being of teenagers in the United States has
improved on a number of fronts, according to the 2008 Kids
Count project from the Annie E. Casey Foundation.The report
documented improvements in the child death rate, teen
death rate, teen birth rate, high school dropout rate and the
number of teens not in school and not working. However, key
measurements for the well-being of infants stayed the same
or declined. There was no change in the infant mortality rate,
while four areas worsened: low-birth weight babies, children
living with jobless or underemployed parents, children in
poverty and children in single-parent families. Researchers
noted that the percentage of underweight babies born in
America has reached the highest point in nearly 40 years.
STRONG FLAVORS CAN HELP DIETERS LOSE MORE WEIGHT
FASTER BY MAKING THE BODY FEEL SATISFIED
Dieters may be able to lose weight faster by using calorie-
free seasonings and sweeteners to feel full and reduce the
amount they eat. In a study presented at the 2008 annual
meeting of the Endocrine Society, researchers used “tastants”
to stimulate the sense of smell and taste in overweight and
obese subjects. Researchers put salt-free savory flavors, such
as cheddar cheese and onion, on salty foods and put sugar-
free sweet crystal flavors, such as cocoa, spearmint, banana,
strawberry and malt, on sweet or neutral-tasting foods. A
control group did not add tastants to foods. Researchers
found that the average weight loss over a six-month period
8 Baylo r I n n o v a t i o n s : : fall 2 0 0 8
was more than 30 pounds, or 15 percent of the subject’s
body weight, versus 2 pounds in the control group. Although
the specialized tastants are not available to the public,
dieters can use similar tactics to add flavor to low-calorie
foods. Strong smells and tastes can trick the body into feeling
satisfied, reducing the amount a person eats.
FITNESS LEVEL, NOT WEIGHT LOSS, HELPS MEN WITH
DIABETES ENJOY A LONGER LIFE
Regardless of their weight, men with type 2 diabetes
who are physically fit have a greater chance of living longer
than their less-fit counterparts. Researchers at two Veterans
Administration hospitals studied male veterans with diabetes
and rated their fitness as low, medium or high. The subjects
also were classified as normal, overweight or obese by body
mass index, a measurement of body fat determined using
height and weight. Those subjects with the highest fitness
level and normal body weight reduced their risk of death
by 60 percent, and those who were overweight or obese
reduced their risk of death by 65 percent. Those classified as
obese but in reasonably good shape cut their risk of death
by 52 percent, compared with those who had a lower level
of fitness. Researchers said moderate exercise, the equivalent
of walking 30 minutes a day, five days a week, would offer
similar health benefits for people with diabetes.
MEN WITH LOW TESTOSTERONE LEVELS LIK ELY TO BE
UNTREATED DESPITE ACCESS TO HEALTH CARE
Men with low testosterone levels may not receive
adequate treatment, according to a study of more than
1,000 men published in the Archives of Internal Medicine.
Researchers suspect this is because the condition may go
unrecognized or because of an unwillingness by doctors to
prescribe therapy. Among the 97 men in the study with low
male hormone levels, also known as androgen deficiency,
only 11 had been prescribed treatment. However, all the
men with untreated deficiency had access to adequate
health care. Men with androgen deficiency (both treated
and untreated) were found to be more likely than men
without the condition to receive regular care and visit
their doctor more often: 15.1 visits per year for those
with untreated androgen deficiency, 12 visits for those
with treated androgen deficiency, and 6.7 visits for those
without the condition. Symptoms of androgen deficiency
include low libido, erectile dysfunction, osteoporosis, sleep
disturbance and fatigue.
USING THE BODY’S OWN CELLULAR SYSTEM TO CREATE
ANESTHETIC WITHOUT NUMBNESS
By combining the chemical that makes chili peppers
hot and a specialized local anesthetic, doctors have
learned to block pain without causing numbness. Doctors
at Massachusetts General Hospital used a derivative of
lidocaine, a local anesthetic, and capsaicin, the pain-
producing substance in chili peppers. The chili pepper
chemical caused channels in nerve fibers to open, and the
special anesthetic flowed into the pain receptor cells to
block their function. This particular anesthetic, which does
not affect the sense of touch or motor skills, is not effective
alone in injections. But capsaicin opens pathways into the
cells, allowing the pain killer to do its work. Researchers are
looking for other chemicals that will carry the pain killer
into the cells, because the chili pepper extract causes the
sensation of heat. They note that this is the first example of
using the body’s own cellular channels as a drug delivery
system, targeting treatment only at pain fibers.
NEW BIOMARK ERS COULD LEAD TO EARLY DETECTION
OF PANCREATIC CANCER
Researchers have moved a step closer to developing a
blood test to identify pancreatic cancer in its early stages,
when treatments are more successful. Researchers at the
Fred Hutchinson Cancer Research Center in Seattle and
other centers found five proteins or biomarkers that are
linked to pancreatic cancer, the fourth leading cause of
cancer death in the United States. By studying genetically
engineered mouse models of human cancer, researchers
found proteins associated with the disease in humans at an
early stage. Researchers said the tests for the biomarkers
would be most effective when combined with an existing
screening that looks for another pancreatic cancer
biomarker. The combined tests could improve detection of
pancreatic cancer before symptoms are evident. The test
could also help distinguish between cancer and pancreatitis,
a noncancerous inflammatory condition. Additional studies
are necessary before biomarkers can be used routinely to
identify pancreatic cancer in its early stages.
fall 2008 : : Bay l or I n n o v a t i o n s 9
 NATIONALLY RANKED FOR:

s%NDOCRINOLOGY s/RTHOPAEDICS
s'YNECOLOGY s2ESPIRATORY$ISORDERS
s+IDNEY$ISEASE

Baylor. Recognized for 16 consecutive years.

Ranked in 5 specialties.
Once again, U.S. News & World Report has ranked Baylor University Medical Center
at Dallas among “America’s Best Hospitals”. In the recent 2008 issue, they rated
Baylor one of the top 50 hospitals in five different specialties – more recognitions
than any other North Texas hospital. This means you can always count on us for
quality health care. At Baylor, we are committed to developing new treatments
through leading research, and are dedicated to serving you, our patients.

For a physician referral, call 1.800.4BAYLOR BaylorHealth.com

Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community, or affiliated medical centers and are neither
employees nor agents of those medical centers, Baylor University Medical Center at Dallas, or Baylor Health Care System. CE BUMC BI 7.08

Calm Connections
Brain scans show emotional control gets better with age.
By Joann Milivojevic
Why, when you’re 25 years old, does a
negative situation make you feel like your world
is falling apart, yet, when you reach 65, a similar
situation musters nothing more than a mere shrug
of the shoulders? The answer could be that some
neurological connections in your brain get wiser
with age. At least that seems to be the case when
it comes to controlling emotions, according to a
new study.
Many older adults have something researchers
call the “positivity” bias. It essentially means that
they are less bothered by negative situations, so
they stay calmer when younger people can get
rattled. Peggy St. Jacques, a researcher at Duke
University, says this bias allows older adults to
maximize their emotional well-being. Accepting
that life is limited motivates older adults to think
of things in a more positive light, according to
St. Jacques.
Researchers have long known this to be
true behaviorally. But a new study sheds light
on what happens neurologically. Florin Dolcos,
Ph.D., assistant professor of psychiatry and
neuroscience at the University of Alberta,
conducted a study in collaboration with Roberto
Cabeza, Ph.D., and St. Jacques. The researchers
peered inside the brain to see how different
regions react to emotional stimuli and how
those reactions change as we age.
The study, published in Neurobiology of
Aging, included 30 participants; half were
around 70 years old and the other half were
about 25 years old. Both groups were shown
positive, neutral and negative images. While
looking at the images, their brain activity was
measured by functional magnetic resonance
imaging (fMRI), in which a giant magnet records
brain activity. The fMRI revealed functional
differences in how the two groups processed
the visual information.
“We found that there was increased interaction
between two brain regions in the older adults,”
explains St. Jacques, “one being the amygdala,
which we know is involved in emotions. The
other was the ventral anterior cingulate cortex,
which is involved in emotional regulations. One
of the reasons older adults may show better
ability to regulate their emotions is because of
Mental health
Brain images of older adults reveal
increased interaction between two
brain regions responsible for emotions.
this increased interaction between these two
brain regions.”
Older study participants naturally interpreted
images less negatively. This could have
implications for treating people who have
difficulty with negative emotions. Understanding
more about how the positivity bias works can help
researchers better understand and treat clinical
disorders that involve negativity bias, such as
depression and anxiety, says St. Jacques.
POINT OF CONTACT:
To learn to manage your emotions and stress without
the mellowed benefits of age, visit www.webmd.com
and search for “stress management.”
fall 2008 : : Bay l or I n n o v a t i o n s 11
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Flip-Flop Flounder
Could walking in flip-flops be the reason some of us experience foot and leg pain?
By CYNTHIA KINCAID
A study conducted by researchers at
Auburn University in Alabama found that people
who wear flimsy shoes have an altered gait. And
this change may account for the lower leg and foot
problems people experience after wearing flip-
flops for long periods of time, says study author
Justin Shroyer, a graduate student in Auburn’s
department of kinesiology.
However, not everyone agrees with the study’s
conclusion. While someone walking in flip-flops
will have a different gait than they would if they
were walking in shoes or going barefoot, “flip-
flops cause us to use muscles that we don’t
normally use and, therefore, they cause achy
pain just the way a good workout does,” says
Glenn B. Pfeffer, M.D., director of the Foot and
Ankle Center at Cedars-Sinai Orthopaedic Center
in Los Angeles.
“I thought [the Auburn University study] made
some excellent points,” Dr. Pfeffer says. “But
looking at any type of shoe wear and its effect
on gait and pain is difficult because there are so
many variables.”
self care
Dr. Pfeffer concedes that one of the main
reasons for the pain that people experience when
wearing flip-flops is the lack of foot protection.
“They are thin, don’t support the arch, and the
force of the heel strike is directed right into the foot
as opposed to being cushioned by a thick sole,”
he says. “So it’s not surprising that wearing flip-
flops for a whole day is uncomfortable. They were
Wearing flip-flops gives your toe muscles a
never designed to be worn for a whole day.”
workout that other footwear doesn’t require.
Dr. Pfeffer feels that the leg and calf discomfort
reported by wearers may be due to the extra
muscle work involved in walking in the shoes.
“When you walk in flip-flops for a long time, you’re
actually working your foot muscles in a way that flops every few months and limiting wear time is
you never do in [regular shoes],” he says. “When a good idea. “Flip-flops can break down and get
you walk in flip-flops, you use your toes more loose, just like any other shoe,” Dr. Pfeffer says.
to hold on and keep the flip-flops in place. That “Just when they get that worn-in look is when we
increased action is actually an exercise that few should get worried that they don’t fit properly.”
of us do and is the same discomfort you get from
exercising a lot.”
Whether flip-flop wearers experience pain from POINT OF CONTACT:
an altered gait or flexing unused muscles, both the To learn more about the Auburn University
study, visit www.auburn.edu and search for
study and Dr. Pfeffer agree that replacing your flip-
“flip-flop research.”
fall 2008 : : Bay l or I n n o v a t i o n s 13
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Working out with Asthma
People who experience shortness of breath after exercise
may be experiencing exercise-induced asthma.
By ESTHER M. bauer
Exercise-Induced Asthma (EIA) is one
of the most visible manifestations of uncontrolled
chronic asthma, and the longer and more intense
an exercise session, the more likely it will trigger
an attack. It is believed that EIA is triggered
when the airways dry out from inhaling air that
doesn’t contain much humidity. EIA is different
from allergy-triggered asthma that may cause an
asthma attack while exercising outdoors on days
with a high pollen count.
“Many things can cause shortness of breath,
so it’s very important to have an objective
diagnosis of asthma, particularly if you are
going to have to take medicine for it,” says Mark
Millard, M.D., a physician on the medical staff at
Baylor University Medical Center at Dallas and
medical director of the Baylor Martha Foster
Lung Care Center.
Confirming the diagnosis of exercise-
induced asthma can involve measurements
of airflow and sometimes challenge tests to
reproduce symptoms.
One of the best tests to confirm EIA, endorsed
by the International Olympic Committee, is the
eucapnic voluntary hyperventilation (EVH) dry-
Eucapnic voluntary hyperventilation (EVH) is an
EIA diagnostic tool endorsed by the International
Olympic Committee.
air challenge, in which a dry carbon dioxide-
oxygen blend is inhaled rapidly to simulate
the effect of exercise without the sweat.
Cardiopulmonary exercise testing (CPET)
is another option that evaluates whether
breathing, heart or muscle problems are
limiting exercise.
Breathing Easier
Comprehensive diagnostic testing, including CPET
and EVH, allows for a smarter approach to exercise
training and its usage in pulmonary rehabilitation
sets the Baylor Martha Foster Lung Care Center
apart in North Texas, says Dr. Millard.
“You might have asthma, but asthma
shouldn’t have you,” he says. “The goal of
asthma therapy is for people to be able to
exercise in a meaningful and intensive fashion
without limitation from their asthma.”
While pre-exercise inhaled albuterol, a quick
relief medication, is often used to avoid EIA,
daily therapy with an inhaled steroid spray may
eliminate the need for pre-treatment therapy and
control non-exercise related asthma symptoms
as well. Inhaled steroids, paired with long-acting
bronchodilators, further increase asthma control
SPOTLIGHT
and likewise reduce asthma attacks.
Heather Moncrief Rivera-Torres, 33, has had
asthma for 15 years and traces her condition to
environmental factors. But when she has trouble
with asthma, exercise exacerbates it.
Until last September, when she moved to
Texas from Chicago, her asthma had been
under control. But in Dallas, worsening asthma
symptoms with exercise sent her to Baylor where
physicians designed a new program based on
the results of her testing.
Today, Rivera-Torres uses a daily maintenance
drug and exercises five days a week.
“I would encourage people to seek treatment
and get their asthma under control because it
makes a huge difference in your quality of life,”
she says.
POINTs OF CONTACT:
For more information on Baylor’s asthma
services, visit www.BaylorHealth.com and
search for “asthma pulmonary center.”
Visit the National Heart, Lung, and Blood
Institute’s Web site at www.nhlbi.nih.gov and
view the asthma education section by searching
for “NAEPP.”
fall 2008 : : Bay l or I n n o v a t i o n s 15
Women’s Health

Defining Power
Estrogen influences power motivation in women.
By Joann Milivojevic

What do you imagine when you hear the words The team’s findings suggest that estrogen may be for women
“testosterone and men”? You might think of muscle-bound what testosterone is for men: the fuel of power.
body builders or high-powered CEOs gracing the covers of
THE DRIViNG FORCE
business magazines. Hear “women and estrogen,” and in all
likelihood you see less aggressive images. The role of testosterone as a motivator in men’s drive for

Exploring the sources of power in women is the subject of dominance has been well documented. Testosterone has

a recent study from the University of Michigan.
The study by Oliver Schultheiss, a psychology professor at
the University of Michigan who directs the Human Motivation
& Affective Neuroscience Lab, and researcher Steven Stanton
was recently detailed in the journal Hormones and Behavior.
also been studied as a potential power-base for women,
but the results have been inconsistent. Estrogen, however,
is known to play a very strong biological role in women.
According to Renee Scola, M.D., an internist at Northwestern
Memorial Hospital in Chicago, hormones such as estrogen

16 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
 The level of estrogen found in the study depended on whether a woman won
or lost and her non-conscious desire for power. Contest winners with the
greatest desire for power had higher estrogen levels after they won. Losers
with a high desire for power showed a decrease in estrogen.

and testosterone are like chemical messengers. They are
produced in one area of the body and generally travel through
the bloodstream to affect different organs.
“One of the main roles of estrogen is regulating menstrual
and reproductive cycles,” explains Dr. Scola. “It also has
cardiovascular, bone and central nervous system implications
– and it does seem to play a role in emotions.”
Given estrogen’s strong influence in women, Schultheiss
and Stanton set up their study to test saliva levels of the
hormone against women’s non-conscious desire for power.
The researchers defined power as a preference for having
impact and dominance over others.
THE WINNING HORMONE
The study included 49 graduate and undergraduate women
who competed in pairs in one-on-one computerized
dominance contests. Estrogen and testosterone levels were
determined before and after the contests, as well as the
women’s non-conscious preference for power.
In men, winners of dominance contests show an increase
in testosterone levels. Losers, on the other hand, have a
decrease in testosterone. The level of estrogen found in the
study, however, depended on whether a woman won or lost
and her non-conscious desire for power. Contest winners
with the greatest desire for power had higher estrogen
levels after they won. Losers with a high desire for power
showed a decrease in estrogen. Women with a low desire
for power did not experience this fluctuation in estrogen
levels. Levels measured a day after the contest found that the
rise in estrogen remained high in power-motivated winners.
These findings parallel results in testosterone studies in men
– leading researchers to suggest that estrogen is women’s
power fuel.
The sampling of women in the study included women who
were single, some in close relationships and a mix of those
groups taking oral contraceptives. The study noted that the
rise in estrogen was stronger in single women compared
to women in close relationships. Researchers theorize this
may have to do with estrogen’s role in a finding a partner:
Those in pursuit have higher levels to spur on their desire
for finding a mate. And unlike women on birth control, those
with natural menstrual cycles showed a higher positive link
between power motivation and estrogen.
“It was quite interesting that if you’re artificially
supplementing estrogen, it didn’t really have quite the
same effect as sufficient levels of natural estrogen,” says Dr.
Scola. “That’s something we don’t quite know. We just can’t
artificially give someone estrogen and have it increase their
power motivation.”
While the clinical applications of this research are not yet
clear, it does suggest that estrogen and not testosterone is the
power driver for women. And that adds a fresh dimension to
this much-studied hormone.
POINTs OF CONTACT:
For more information on the ways estrogen affects the female body and
emotions, visit www.webmd.com and search for “estrogen.”
For Forbes magazine’s 2008 list of the world’s most powerful 100 women,
visit www.forbes.com and search for “100 powerful women.”

fall 2008 : : Bay l or I n n o v a t i o n s 17

SPOTLIGHT
A Degree Above
Baylor team investigates repurposing equipment
to save trauma patients.
By Amy M. Avery
Cold can kill. Even in the hot climate of Texas, clinicians have
long been challenged to warm patients experiencing life-threatening
hypothermia caused by trauma.
But staff at Baylor University Medical Center at Dallas have recently taken
on this challenge with their investigation of an innovative approach that has
caught the attention of hospitals and trauma centers worldwide.
Oxygen deprivation
“When patients lose a large amount of blood – after falls, motor vehicle
collisions, assaults and gunshot wounds, for example – they go into
hemorrhagic shock and acidosis,” says Michael L. Foreman, M.D., medical
director of the trauma/surgical intensive care unit and physician on the
medical staff at Baylor University Medical Center at Dallas. “As a result of this
and other factors their bodies cannot rewarm themselves.”
The result is a life-threatening chain reaction: slowing of organ function
and further reduction in the body’s ability to respond to the crisis.
“Hypothermia is something everyone in the medical community struggles
with,” says Dr. Foreman. “This new approach may give us the ability to add
direct thermal energy to the core of the patient. This is exciting.”
Warmed to the core
The new approach being investigated stems from repurposing medical
equipment designed, ironically, to induce hypothermia in patients after
cardiac arrest.
“But it also rewarms them afterward,” explains Cyndi J. Mastropieri, R.N.,
manager for trauma services. “It’s working well in patients participating in the
investigation, and we’re having great results.”
The device warms the body using specialized catheters with heat-
18 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
A machine originally used to
induce hypothermia may prove a
vital tool in reversing hypothermia in
patients experiencing trauma.
exchange balloons that are inserted into a major vein. Warmed saline in the
balloons transfers heat to the blood as it passes over them, warming the core
of the body rather than just the exterior as most methods do. This ultimately
may lead to more lives saved, shorter stays in intensive care and fewer days
on ventilators, Baylor clinicians report. As part of the research project, this
equipment was used for purposes not approved by the FDA at this time.
International interest
The procedure was working so well during the investigation, “we knew we
needed to get the word out into the medical community,” Dr. Foreman says.
So a team of clinicians led by Edward E. Taylor, M.D., a physician on the
medical staff at Baylor University Medical Center at Dallas, outlined their
success in a paper published this spring in Baylor’s Proceedings publication.
The team has already been invited to present findings at national medical
meetings with thousands in attendance. They have also fielded calls from
colleagues across the world.
“We hope that publishing this article will lead to additional research, and
give others one more tool to help desperately ill trauma patients recover,” says
Dr. Foreman.
POINT OF CONTACT:
To read the full article, “Active intravascular rewarming for hypothermia
associated with traumatic injury,” visit www.baylorhealth.edu/proceedings,
click on Past Issues and then Volume 21, No. 2.
 We are dedicated to providing advanced
treatment options for complex skull base tumors,
whether they be benign or malignant.

MENINGIOMA VASCULAR CEREBRAL ANEURYSM OCCIPITAL AND CERVICAL TUMORS ORBITAL LESIONS HEAD AND NECK TUMORS

Introducing The New Skull Base Center at Baylor. Now patients have a valuable resource
to treat complex skull base disease. Our multidisciplinary team of health care professionals
work together to provide each patient with a customized treatment plan that might involve
radiosurgery, interventional neuroradiology or advanced surgical procedures all designed to
be as minimally invasive as possible. Our team of physicians on our medical staff consists of:

.EUROLOGICAL3URGEONSs(EADAND.ECK/NCOLOGIC3URGEONSs.EURORADIOLOGISTS
.EURO OTOLOGISTSs/RBITAL3URGEONSs(EADAND.ECK3URGEONSs2ADIOSURGEONS
)NTERVENTIONAL2ADIOLOGISTSs.EURO ONCOLOGISTS

For a physician referral, please call 1-800-4BAYLOR.

1-800-4BAYLOR BaylorHealth.com
Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees
nor agents of those medical centers, Baylor University Medical Center, Baylor All Saints Medical Centers or Baylor Health Care System. CE BUMC BI 7.08
HOT TOPICS
The Game of Life
A pioneering technology from the world of video
gaming may revolutionize cardiac surgery.
By Mark Cantrell
Although many people think video games are a waste
of time, researchers in the cardiac surgery department
at Children’s Hospital in Boston would disagree. Using
technology borrowed from the world of computer gaming,
they’ve made it possible for surgeons to peer inside the body
without opening the chest cavity, using 3-D technology to
operate within a living, beating human heart.
“You feel like you’re really inside the cardiac chamber,
working on these moving structures,” says Nikolay Vasilyev,
M.D., a surgeon in the hospital’s department of cardiac
surgery. “When you approach them with instruments, you
can actually see the length and depth of the instrument
much like open-heart surgery.”
Stereoscopic glasses resemble 3-D glasses used for IMAX movies, and
work to provide an intimate view into the heart.
20 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
The technique uses ultrasound, or echocardiography, to
look inside the heart and depict its movements in real time.
The use of ultrasound in surgery isn’t new; it has been used
for diagnostic purposes since shortly after the end of World
War II. Even 3-D ultrasound imaging has been around for a
while. The difference, explains Pedro del Nido, M.D., chief
of cardiac surgery at Children’s, is that the older method
produces only a static image.
“That’s great for diagnostic work,” says Dr. del Nido. “You
have plenty of time. You can examine any plane and image
you want and spend hours going through the data to decide
which is the proper way to view and display it.
“But a surgeon operating on a heart doesn’t have hours.”
Techno-tracking Sound Waves
That’s where video-game technology intersects with health
care – in the form of stereoscopic glasses and blazing fast,
commercially available video cards. But instead of zapping
aliens and monsters with various exotic weapons, the
technology allows surgeons to navigate the maelstrom that
is the interior of a human heart. When married to a high-end
ultrasound machine and attached to a computer, the glasses
give surgeons a moving image showing them exactly where
their instruments are located within the heart’s chambers,
displaying the depth needed to precisely target a problem area.
Those 3-D glasses aren’t the type you may remember from
old movies, with their headache-inducing red and green
lenses. Today’s stereoscopic glasses employ LCD shutters
to display alternating images for each eye, offset by a few
 Gaming technology allows surgeons to see the precise
location of instruments during open-heart surgery.
degrees to mimic the eye’s own binocular vision. If you’ve
ever watched a 3-D movie at a major theme park or IMAX
theater, you’d recognize them.
When used in cardiac surgery, the glasses give the surgeon
the extra dimension that’s so critical in the placement of
instruments. “Depth perception is important because you
need to know if something is closer to you or farther away,”
explains Dr. del Nido. “When you advance an instrument – a
knife or a needle – toward a structure in the heart, you need
to know if you’re in front of it or behind it, so that you don’t
accidentally collide into it.”
Three-dimensional Wizardry
In Hollywood, 3-D movies are created using two cameras,
or a camera with two lenses to create a separate image for
each eye. But in modern ultrasonic imaging, information is
streamed out of the machine in the form of data. Working
with the Children’s Hospital researchers, Robert Howe,
Ph.D., came up with a way to essentially split the data in two.
First, the ultrasound signal from the machine is captured as
a dataset then divided in two – one for each eye. A software
program called a volume renderer creates two separate images
from the data, offset by a certain number of degrees that
fall 2008 : : Bay l or I n n o v a t i o n s 21
HOT TOPICS

“There’s no heart-lung machine and no stopping the heart. So all of that

trauma would be eliminated. Recovery is much quicker as well – more akin to
recovering from angioplasty than open-heart surgery.” – Pedro del Nido, M.D.

correspond to the distance between each eye. Those images
are then displayed to the surgeon using the LCD glasses. All
of this takes place at a rate of 70 frames per second, faster
than most of today’s video games.
As reported in the June 2008 issue of the Journal of
Thoracic and Cardiovascular Surgery, the team’s early
testing on pigs with atrial septal defects, or holes in their
much more comfortable to visualize the structures and
gain depth perception. And they’re still comfortable after
two or three hours.”
One Giant Leap for Heart Patients
Although the 3-D method may be a bit challenging for doctors,
it promises to be a revolutionary boon for cardiac patients.

hearts, was very promising. Dr. Vasilyev managed to place Consider a typical operation to repair a hole in a patient’s

patches over the holes 44 percent faster than with flat
imaging techniques. Placement was also more accurate.
Although the technique is a quantum leap over the open-
heart method, there will be an inevitable learning curve for
surgeons new to the procedure. “It’s difficult, because you
don’t have a direct view of the structures,” says Dr. Vasilyev.
“You’re looking at the heart using 3-D ultrasound data, and
that’s not how surgeons are trained to operate. You have to
get used to the imaging and understand what structures you
have on the screen in front of you.”
That’s where the stereoscopic glasses really shine, notes
Dr. Vasilyev: “When you put the glasses on, it’s actually
heart: Under general anesthesia, the chest is cut open at the
breastbone, and the ribs are spread so the surgeon has access
to the chest cavity.The patient is put on a heart-lung machine
and the heart is stopped while the operation is completed.
After the procedure, the heart is restarted and the patient is
taken off the heart-lung machine.
Although this traditional method of cardiac surgery is
considered relatively safe and effective, it is still an invasive
shock to the body that carries the risk of several side effects
and complications, such as infection, serious bleeding,
kidney failure and stroke. After the operation, the patient
is generally observed in an ICU for a day or more, and full

22 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
 Nikolay Vasilyev, M.D., a cardiac
surgeon at Children’s Hospital in
Boston, tests cardiac computer
gaming technology.

Image courtesy of Children’s Hospital Boston

recovery may take three months or longer. During that time,
pain and swelling are also factors.
“Three-D cardiac surgery eliminates all that,” says Dr. del
Nido. “We envision making a small incision on the chest
(eventually it may be catheter-based, although we haven’t
developed those tools yet) and introducing the instruments is attempting to take the technology even further. “He’s

directly into the heart. There’s no heart-lung machine and no working on a way to robotically move the instruments to

stopping the heart. So all of that trauma would be eliminated. match the heart’s rhythm,” says Dr. del Nido.“To the surgeon

Recovery is much quicker as well – more akin to recovering looking through the 3-D glasses, it will look as though the
heart is not moving at all.”
from angioplasty than open-heart surgery.”
So the next time you see a friend or relative ensconced in a
The benefits of the procedure become even more apparent
comfy chair immersed in a video game, take heart: He or she
when operating on a heart valve, says Dr. del Nido, because
may be field-testing the next big medical breakthrough.
the surgeon can see the valve in operation, something that’s
not possible with traditional open-heart techniques. “If you
have an area of the valve that’s prolapsing, for instance, you
can move the leaflet patch to where you think it should go,”
POINTs OF CONTACT:
he explains. “If it stops the leak, you’ve solved the problem.” For more information on video game technology and heart surgery, visit
the Children’s Hospital of Boston Web site, www.childrenshospital.org,
Dr. del Nido and his team are currently planning
and search for “video game heart surgery.”
clinical trials, and hope to begin using the technique on To learn more about the ways video games intersect with medicine, visit
a limited basis within the next year. In addition, Dr. Howe www.msnbc.msn.com and search for “video game surgery.”

fall 2008 : : Bay l or I n n o v a t i o n s 23

HOT TOPICS

Sourcing the Pain

Research links fibromyalgia to the central nervous system.
By Linda Melone

Until recently, physicians relied solely on a patient’s

symptoms of muscle and joint pain to diagnose fibromyalgia.
“No biomarker of the disease existed,” says Richard E. Harris,
Ph.D., research investigator in the division of rheumatology
at the University of Michigan Medical School and a researcher
at the university’s chronic pain and fatigue research center.
“We based everything on a patient’s self-report to tell us how
much pain they were in.”
However, new research that connects the central nervous
system to fibromyalgia may not only provide a biomarker
for the disease, but also offer new, effective ways to treat
the condition.
Fibromyalgia is characterized by widespread muscular
pain, fatigue and tenderness. It affects 2 to 4 percent of
the population, predominantly women, according to the
American College of Rheumatology. Although the condition
is considered its own process, people with fibromyalgia
often experience additional maladies, including migraine
headaches, irritable bowel syndrome, temporomandibular
joint disorder (TMJ), restless leg syndrome, sensitivity to
noise and temperature, as well as anxiety and depression.
Symptoms vary from person to person and in intensity over
time, often making diagnosis a process of elimination.
Fibromyalgia affects more women than men, and its hallmarks are
chronic pain and fatigue.
Chemical clues
Researchers at the University of Michigan Health System
recently discovered a link between a brain molecule
and pain in fibromyalgia patients, shedding light on this
often-misunderstood condition and its connection to
related disorders.
The study found that levels of glutamate, an excitatory
brain neurotransmitter (a nerve stimulant), decreased
when patients were given a treatment designed to reduce
their pain. “The pain reduction directly correlated with the
reduction in glutamate,” Dr. Harris says.“Our findings suggest
that fibromyalgia may be a central nerve biological condition

24 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8

that enhances activity in processing pain signals, making
people with fibromyalgia physically more sensitive.”
Previous studies with fibromyalgia patients showed
excitement in a part of the brain called the insula. Based on
their functional magnetic resonance imaging (fMRI) studies,
researchers hypothesized that the increased activity was related
to increased levels of glutamate. To test their theory, researchers
used a non-invasive brain imaging technique called proton
magnetic resonance spectroscopy to measure pain symptoms
over a period of four weeks. Results showed decreased
glutamate levels that coincided with pain reduction.
“Consequently, treatments targeting glutamate pathways
may be fruitful,” says Dr. Harris.“The insula is a region known
for its involvement in somatic stimuli [sensations from
muscles and skin] in addition to internal sensations like the
bowel.” This connection may explain an association between
fibromyalgia and some of its associated conditions, such as
irritable bowel syndrome. “Because fibromyalgia patients
have a heightened level of sensory processing, it follows that
glutamate may play a role in that,” says Dr. Harris.
First medicines approved
As a result of similar research, the Food and Drug
Administration (FDA) has approved the first two drugs for the
treatment of fibromyalgia: pregabalin and duloxetine. “Both
Pain associated with fibromyalgia may stem from high levels of the
nerve stimulant glutamate.
drugs work centrally, but through different mechanisms,” says
Andrew Holman, M.D., rheumatologist and clinical assistant
professor of medicine at the University of Washington.
Pregabalin targets neuropathic pain by reducing the number
of pain signals produced by damaged nerves. Duloxetine
affects production of serotonin and norepinephrine, two
naturally occurring brain substances, and was used as an
antidepressant before the FDA approved the drug to treat
fibromyalgia symptoms.
“The most intriguing science is in looking at dopamine
deficiencies in the hippocampus, an area of the brain that
modulates pain and also controls autonomic responses
like fight or flight,” says Dr. Holman. “Associated conditions
like irritable bowel syndrome and anxiety seem to also be
managed by the autonomic nervous system and may be
linked.” Excessive arousal in the brain stem from a dopamine
deficiency may also be responsible for the inadequate sleep
in fibromyalgia patients, researchers believe.
Managed approach
“Fibromyalgia is not a condition where you can do one thing
and then you’re done,” says Dr. Harris. “Patients need to be
aware of their symptoms and manage them appropriately
through medications, cognitive behavioral therapy and
exercise.” But this new research gives patients hope and real
options for relieving chronic pain.
POINT OF CONTACT:
For a physician referral to a rheumatologist, visit www.BaylorHealth.com
or call 1-800-4BAYLOR.
fall 2008 : : Bay l or I n n o v a t i o n s 25
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HeadFirst
By Debra Wood, R.N.

Center offers hope for patients with brain lesions

fall 2008 : : Bay l or I n n o v a t i o n s 27

feature
Angela Harris of Cedar Hill, Texas, felt tingling in her
arm, and then the left side of her body became numb and
weak. She couldn’t walk. At first she thought it might have
been a stroke or a heart attack. But her neurologist sent her
for magnetic resonance imaging (MRI), which picked up a
benign tumor at the base of her skull.
The bones of the skull base enclose the brain and separate
it from the eyes and oral cavity. Blood vessels supplying
the brain and nerves that control sight, smell, hearing and
facial function pass through the skull base. Tumors in the
skull base are difficult to reach by traditional methods, but
physicians on the medical staff at the Skull Base Center at
Baylor Neuroscience Center employ minimally invasive
techniques to reach and remove such lesions.
Harris consulted with several physicians before turning to
28 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
Benign tumors in the skull base often do not present symptoms until
they are quite advanced.
physicians on the medical staff at the Skull Base Center at the
Baylor Neuroscience Center.
“I was scared,” Harris says. “Each doctor told me how
difficult it was to get to. But when I found Baylor, the
physicians were confident they could remove the tumor and
get all of it out.”
The tumor was located at the back of Harris’s brain, near
her pineal gland.The physicians on the medical staff at Baylor
successfully removed the tumor and more than a year later,
she remains disease free.
Skull base surgery
Skull base conditions are rare and include meningiomas,
acoustic neurinomas and pituitary tumors that develop
deep inside the head. They often can progress until quite
advanced without the patient being aware, due to their
relatively hidden location. However, as the masses grow,
they can compress nerves in the brain.
“Benign tumors can cause a loss of function and death
if left unattended,” says otolaryngologist and facial plastic
 The bones of the skull base enclose the brain and separate it from the eyes
and oral cavity. Blood vessels supplying the brain and nerves that control
sight, smell, hearing and facial function pass through the skull base.
surgeon Yadranko Ducic, M.D., a physician on the medical
staff at Baylor University Medical Center at Dallas and Baylor
All Saints Medical Center at Fort Worth, and co-medical
director of the Skull Base Center.
Besides tumors, skull base specialists perform
procedures to remove vascular lesions, such as cerebral
aneurysms, and repair malformations of the occipital-
cervical junction or shifting of the vertebrae as a result
of rheumatoid arthritis. But as with skull base tumors,
removing lesions and correcting malformations in this
area presents challenges.
“The difficulty is because of the complex anatomy of the
skull base,” says Caetano Coimbra, M.D., a physician on the
medical staff at Baylor Dallas and Baylor All Saints and co-
medical director of the Skull Base Center. “Our approach is
minimally invasive treatment. It may include surgery and
radiation therapy in the form of the Gamma Knife ®.”*
A team approach to care
This March, the Skull Base Center opened in two locations
*Gamma Knife and Leksell Gamma Knife are U.S. federally registered
trademarks of Elekta Instruments, S.A., Geneva, Switzerland.
at Baylor Fort Worth and Baylor Dallas. It brings together a
team of sub-specialists on the hospital medical staffs who
focus on a comprehensive range of procedures – including
neurosurgery, head and neck surgery, otolaryngology,
neuro-otology, orbital surgery, neuro-oncology, radiation
oncology, radiosurgery, neuropathology and interventional
neuroradiology – that contribute to an optimal plan of care
to preserve a patient’s function and quality of life.
“Base-of-skull tumors are difficult to access, and it usually
takes a combination of neurosurgery and head and neck
surgery to get them out,” Dr. Ducic says.
Surgeons frequently enter through the skull or nose, but
sometimes may open the face to reach structures behind it.
Several types of surgeons often stand by on cases, ready to
assist as needed.
Physicians from throughout Texas and the United States
refer patients with skull base tumors and malformations to
the Skull Base Center at Baylor. Other people find the center
on their own.
fall 2008 : : Bay l or I n n o v a t i o n s 29
feature

More than a year after physicians removed a benign tumor from

Angela Harris’ skull base, she remains disease free.

“A lot of the patients we have seen have been told there

is nothing that can be done, that the tumors are unable to
be removed with surgery,” Dr. Ducic says. “But the tumors
are resectable. There is plenty we can do, and there can be
problems if they do not have something done.”
The physicians on the medical staff at the center
block blood flow to a tumor with a high blood supply before
evaluate lab tests and existing imaging studies. Then, based
surgery. Such procedures make the operation safer with less
on the location and type of tumor, they develop a plan
blood loss. A cancer patient also may need chemotherapy,
of treatment. Traditional surgery sometimes is not the best
possibly in conjunction with surgery.
option. Some patients may need radiosurgery. The Gamma
Surgical patients receive a complete workup before the
Knife ® and CyberKnife ® target beams of radiation at the
procedure, which may take a couple of weeks. Specific testing
tumor to destroy it, without significantly damaging healthy
depends on the lesion but may include imaging studies to
surrounding tissue. Patients may receive radiosurgery as
precisely identify locations of blood vessels and nerves.
the sole treatment or in combination with surgery.
For an aneurysm, a patient may need interventional Approaching the lesion
neuroradiology to place a coil to prevent rupture. “The skull has different access points from above and below,”
Interventional neuroradiology also may be employed to Dr. Ducic says.“Above has traditionally required a craniotomy,

Continued on page 33

30 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
Baylor’s Comprehensive
Neuroscience Center
Baylor Neuroscience Center located at Baylor University Medical
Center at Dallas specializes in conditions affecting the brain, spine and
central nervous system. The center is a comprehensive facility with
specialists using advanced technologies to diagnose and treat over 600
neurological diseases.
“All the services are covered in one center,” says neurosurgeon David
Barnett, M.D., chief of neurological surgery at Baylor University Medical
Center at Dallas and physician on the medical staff. “Collaboration is a big
part of the neuroscience center.”
The center offers patients one-stop access to neurologists, neurosurgeons,
neuroradiologists and specialists with expertise in diagnosing and managing
aneurysms, spine disorders, epilepsy, Parkinson’s disease, Alzheimer’s
disease, brain tumors, sleep disorders and many other conditions. A nurse
navigator simplifies access to the Baylor Neuroscience Center’s services
and physicians on the medical staff at Baylor University Medical Center at
Dallas for patients and referring physicians.
“It is a patient-friendly system,” Dr. Barnett says. “Our new nurse
navigator, Keesha Paul, guides patients and referring physicians through
our system, creating a smooth transition between providers, diagnostic
testing and treatment.”
Many patients are referred by their doctor for treatment of a complex
medical condition. Other times, they may have received care at a local
facility, but the cause of their problem remains a mystery, Dr. Barnett says.
A full array of diagnostic capabilities, including advanced neuroimaging,
epilepsy monitoring and other neurodiagnostic testing helps physicians
on the medical staff at Baylor Dallas nail down the cause and devise a
treatment plan.
Physicians on the medical staff at Baylor Dallas have been trained to
perform advanced procedures. For instance, neurointerventional radiologists
regularly treat aneurysms and vascular disorders using minimally invasive
endovascular procedures. Spine
surgeons may offer patients with
disc disease an artificial disc designed
to preserve motion while decreasing
pain. Neurosurgeons may treat patients with
Parkinson’s disease with deep brain stimulation targeted to
regions in the brain to minimize tremor.
Baylor Dallas is constructing a neuroscience inpatient unit to provide
specialized care to the neuroscience patient population. The neuroscience
unit will offer an area where patients can receive care throughout their stay
in the hospital without having to move to different nursing units within the
hospital. A single unit will be able to meet patients’ needs, including critical
care services, epilepsy monitoring, acute care and postoperative spine care.
Four new image-guided operating rooms, also under construction as part
of Baylor Neuroscience Center, will house the world’s second BrainLAB/GE
intraoperative MRI unit.
The Baylor Radiosurgery Center offers both the CyberKnife® and
Gamma Knife® stereotactic radiosurgery systems, delivering precisely
targeted radiation to tumors previously considered untreatable with
conventional therapy.
Clinical trials conducted through the center give patients the opportunity
to participate in research that may develop new techniques and approaches
to care. Current investigations involve chemotherapy, a vaccine to treat
brain cancer and the use of stereotactic radiosurgery. U.S. News & World
Report has recognized the Baylor Neuroscience Center several times as one
of the country’s top neurology/neurosurgery programs.
POINT OF CONTACT:
For more information about the Baylor Neuroscience Center,
visit www.BaylorHealth.com or call 1-800-4BAYLOR.
fall 2008 : : Bay l or I n n o v a t i o n s 31
feature
Baylor’s Neuro-Oncology Program
Patients from throughout the Southwest turn to the neuro-oncology
program at Baylor University Medical Center at Dallas through the Baylor
Neuroscience Center for innovative and potentially life-prolonging treatment
of brain tumors. Physicians on the medical staff at Baylor Dallas care for
patients with brain tumors ranging from low-grade (less aggressive) tumors
to high-grade, rapidly growing and malignant lesions.
Patients are usually referred to the neuro-oncology program after brain
surgery has been done to diagnose the type of tumor and
to remove as much of a tumor as possible. “Surgery
can often remove the worst part of the tumor.
But there are almost always residual
tumor cells that require treatment with
radiation therapy, chemotherapy or
both,” says neuro-oncologist Karen
Fink, M.D., Ph.D., a physician on the
medical staff at Baylor Dallas. “Some
low-grade patients do well for years, and
don’t require any therapy, but need close
monitoring to catch any deterioration of their
tumor early. Outcomes for patients with higher
grade tumors are better than they have been in years
past, because we have better surgical techniques and better treatments.”
An oral chemotherapy agent also has increased survival for patients
with the most malignant brain tumor, glioblastoma. The agent interferes
with the proliferation of rapidly dividing cancer cells and is now used in
combination with radiation therapy to improve the survival rate for patients
with malignant brain tumors. It has become a standard treatment.
In addition to traditional treatments, physicians on the medical staff at
Baylor may offer patients the opportunity to participate in a clinical trial.
Baylor’s neuro-oncology program is enrolling patients with recurrent brain
tumor in a trial that uses an oral chemotherapy agent and an investigational
growth-factor inhibitor. Baylor is also participating in a trial that creates
an “anti-tumor vaccine” by using tumor tissue removed at the time of
32 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
the patient’s initial surgery at Baylor Dallas to stimulate their immune
(dendritic) cells to fight the brain tumor. These dendritic cells are given
back to the patient periodically during radiation and chemotherapy in hopes
of improving survival further.
Dr. Fink is also researching the effectiveness of an approved drug for
patients who have recurrent brain tumor. This drug blocks the signal
the brain tumor sends out to generate a new blood supply to feed
itself. Dr. Fink uses the drug in combination with the chemotherapy
agent carboplatin. More than 60 percent of patients participating in this
clinical research trial have shown an improvement in their MRI scans
after receiving this experimental regimen.This is in contrast with most
treatments for recurrent brain tumors that produce a tumor response only
about 15 to 20 percent of the time. “We are improving quality of life and
survival for patients, especially for those unfortunate enough to have their
brain tumor recur,” Dr. Fink says.
The neuro-oncology program takes a multidisciplinary and collaborative
approach to treating patients with primary brain tumors. Patients have
access to neurosurgeons, radiation oncologists, medical oncologists, neuro-
oncologists and radiosurgery specialists to treat their tumor. Rehabilitation
physicians and therapists help patients overcome neurologic deficits
caused by the tumor or its treatment, and social workers are available to
assist with disability claims and financial concerns. Baylor also provides
access to hospice or palliative care when the end of life nears.
Baylor supports the patient and family in every possible way, from
innovative treatments that offer hope for improved function and improved
survival, and support for the whole person and the whole family throughout
the treatment process.
POINT OF CONTACT:
For a physician referral visit www.BaylorHealth.com
or call 1-800-4BAYLOR.
 A skilled skull base surgeon avoids cutting into brain tissue, using focused
skull base approaches to reach under the brain. Depending on the location
of the tumor, these approaches include an eyebrow incision, small incisions
around the ear or entering through the frontal sinus cavity.

an incision in the skull. From below, it’s minimally invasive.”
When the surgeon approaches from above the goal is to
remove as little bone as possible – just enough to allow
direct access to the lesion. A skilled skull base surgeon avoids
cutting into brain tissue, using focused skull base approaches
to reach under the brain. Depending on the location of the
tumor, these approaches include an eyebrow incision, small
incisions around the ear or entering through the frontal sinus
cavity. Use of special instruments with miniature cameras
allows the surgeon to see tissue inside the skull without
opening it.
Alternately, the surgeons may use endoscopes through the
nasal passage to remove a pituitary tumor or other lesions,
avoiding any retraction or manipulation of the brain.
“It decreases discomfort and trauma to the bone and
muscle,” Dr. Coimbra says. “Yet it still allows us to navigate
externally, outside the brain, for direct access to the tumor.
The nasal approach avoids any brain retraction and soft
tissue trauma.”
In other cases, a surgeon may find it necessary to
temporarily remove parts of the face to access the area.
Once the lesion is out, the surgeon restores the face,
focusing on function and aesthetics. The procedure may
take several hours.
“Sometimes, we have to do fairly drastic things, where
we open the face like a book to get to tumors behind
the face or at the base of the brain,” Dr. Ducic says. “Even
those [cases] we do with no incisions on the face. They
are all hidden inside the nose or the lip. Patients generally
look and feel pretty good after their surgery.”
Dr. Ducic explains that human anatomy places almost
all of the vital parts of the body off center, on the side,
including the eyes, arteries and nerves, which facilitates a
central approach.

fall 2008 : : Bay l or I n n o v a t i o n s 33

feature

Vital organs and body parts, including eyes, nerves and arteries, are
located off center in the human anatomy. This allows physicians to
perform a portion of skull base surgeries through central parts of the face,
such as the nose.

“We mobilize the eye sockets, the upper jaw and the lower
jaw,” Dr. Ducic says. “We can protect those structures and
access the brain with really nothing much vital in our way.
Then we put it all back together, rebuilding the nose, the eye
sockets and the midface.”
Patients are typically discharged within a week. They will
eat soft foods for six to eight weeks.

An operative success
“I was really blessed,” Harris says. “I knew everybody. My
family was there, and I was able to talk. I could remember
things. About three days after the surgery, the doctor
brought in a newspaper, and I could read. I could walk.”
Harris did not even require rehabilitative services.
Three months after her surgery, she returned to work
performing accounting functions for the U.S. Department
of Homeland Security.
“It was my first time at Baylor, and I had a good experience,”
Harris concludes.

POINT OF CONTACT:
For more information about the Skull Base Center at Baylor Neuroscience
Center, visit www.BaylorHealth.com or call 1-800-4BAYLOR.

34 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
Living Well

The Truth About

Antiox
Only research can expose real benefits,
false claims, future promise. BY AMY M. AVERY

36 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
idants
Claims concerning the purported powers of
antioxidants receive a barrage of challenges from both
published research and the popular press. Motivated by
scientific curiosity and by concern about unsubstantiated
claims, scientists and physicians expend great amounts of
energy to unlock the secrets of antioxidants.
With all the data for and against antioxidant claims,
understanding what the medical community knows and
does not know about antioxidants is not a simple matter.
Identifying actionable information – research that is
meaningful on an individual level – is more difficult still.
But researchers and clinicians are intrigued and excited
about how antioxidants, oxidative stress and free radicals
impact health, and they want the public to benefit from
the knowledge.
“Because of all the published reports and claims,
some people are desensitized to antioxidants and their
benefits,” says Peter Campochiaro, M.D., Eccles professor of
ophthalmology, researcher and practicing ophthalmologist
at Johns Hopkins University Medical Center.
“Researchers have identified very clear fingerprints of
oxidative damage, and they’ve demonstrated that certain
antioxidant treatments can reduce the progression of
specific eye disease, for example,” he says. “Research into a
wide variety of antioxidant treatments is exciting.”
Free radicals, oxidation
O
Antioxidants work by offering protection from oxidative
stress, a condition that occurs when cells are damaged at
the molecular level when the body metabolizes, or breaks O
down, oxygen. Damage occurs during natural processes such
as digesting food and metabolizing medications, and from
exposure to environmental toxins such as cigarette smoke,
pollution, pesticides and even sunlight.
These damaged cells, called free radicals or oxygen-free
radicals, are missing an electron, which they attempt to
replace from healthy cells.When healthy cells lose an electron,
they can become open to disease processes by causing
extensive damage to proteins, membranes and DNA. Research
focuses on when, where and how antioxidants either stabilize
the free radicals or prevent them from causing harm at all.
Research, treatments, cures
Even a quick review of clinical research reveals dozens
of peer-reviewed studies debunking the broad cancer-
prevention claims of antioxidants such as vitamins C
and E and coenzyme Q10, for example. Research has also
revealed surprising evidence that supplements with beta-
carotene, another antioxidant, can actually cause harm to
people who smoke. And though the antioxidant lycopene
has been touted for prevention of prostate cancer, research
has not corroborated the claim.
fall 2008 : : Bay l or I n n o v a t i o n s 37
 VA L E T PA R K I N G .

P R I VAT E , LUXURIOUS SUITES.

IMPECCABLE SERVICE.

Think Of It As A Five-Star Physical Exam.

A Program of the Baylor Health Care System

Comprehensive health and fitness assessment

From the minute you arrive for your Personal Edge Assessment at Baylor,
you’ll find the treatment first class all the way.
It begins with your own well-appointed examination suite where you can conduct
business or just relax throughout the day, enjoying the ultimate in privacy and comfort.
Of course, you’ll receive a thorough medical physical and fitness assessment. And should
the results indicate a need for further care, you’ll have prompt access to an appropriate
specialty physician.
To make an appointment, please call 214.363.2745

A program of the Baylor Health Care System

411 North Washington, Suite 3000, Dallas, TX 75246
www.personaledgehealth.com

Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are
neither employees nor agents of those medical centers nor Baylor Health Care System. ©2008 Baylor Health Care System CE-PE BI 2.08

A diet rich in beta-carotene may
help prevent macular degeneration, but
other research suggests the antioxidant
could be dangerous to smokers.
Reports such as these are common, but other clinical
research demonstrates positive outcomes for people with
certain diseases who use specific antioxidants or who
combine antioxidants with certain minerals.
Broad implications
Concerning his published research on retinitis pigmentosa,
an eye condition that can lead to blindness, Dr. Campochiaro
notes the “link between oxygen and photoreceptor damage,
as well as the potential of antioxidant treatment ... that may
help to protect patients with retinitis pigmentosa.”
This link offers widespread promise, he says. Despite the
hundreds of mutations that are responsible for the death of
rod photoreceptors in the eyes, oxidation is a common factor
leading to cone cell death in retinitis pigmentosa.
“Stopping oxidative damage – and so preventing cone
cell death – would prevent the most debilitating aspects
of the disease,” Dr. Campochiaro says. “Antioxidants can
provide a treatment.”
Vitamins and minerals
In a study of age-related macular degeneration, another eye
disease that can lead to severe vision loss, a trial concluded
that the antioxidant lutein, a carotenoid, or lutein with other
LIVING WELL
Beta-Carotene
C40H56
nutrients, plays a role in improving visual function. The large
and important Age-Related Eye Disease Study (AREDS) by the
National Institutes of Health also found that highly regulated,
clinical doses of vitamin C, vitamin E, beta-carotene, zinc and
copper together reduced progression of the disease by 25
percent and vision loss by 19 percent.
Research continues in a range of other medical specialties,
targeting conditions such as prostate cancer and heart
disease. Like AREDS, many studies are examining the
synergies between multiple factors, versus the power of a
single antioxidant.
Studies of synergies
“It is possible that antioxidants, as found in fruits and vegetables,
act synergistically, rather than individually,” says Aditya Bardia,
M.D., M.P.H., a physician and researcher at the Mayo Clinic.
Several studies support this idea.
• One study suggests a protective effect of the antioxidant
gamma-tocopherol, part of the vitamin E family, in reducing
risk of prostate cancer.
• A single trial in which vitamin E was combined with
omega-3 fatty acids showed increased survival of patients
with various malignancies.
fall 2008 : : Bay l or I n n o v a t i o n s 39
Living Well
Damage occurs during natural
processes such as digesting food
and metabolizing medications,
and from exposure to
environmental toxins such as
cigarette smoke, pollution,
pesticides and even sunlight.
• Another trial showed a reduction in occurrence of new
tumors in patients with bladder cancer who took a specific
tuberculosis vaccine combined with vitamin C.
• Two studies suggest benefits in combining certain
antioxidant vitamins, including E and C. One showed
delays in the progression of Alzheimer’s disease, and
the other showed reductions in the risk of coronary
heart disease.
In contrast to these results, however, other researchers
concluded from a randomized controlled trial of women that
vitamin E supplements alone provide no overall benefit for
either cardiovascular disease or cancer.
100,000 patients
In the interest of clarifying the facts behind antioxidants
and cancer, Dr. Bardia led a research team to perform a
systematic review of all randomized clinical trials that had
assessed the efficacy of antioxidants for cancer prevention.
After reviewing a dozen trials that involved a total of more
than 100,000 patients, Dr. Bardia and his colleagues found
surprising results.
40 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
“From our research, we concluded that antioxidants
overall are probably not helpful in supplement form,”
he says. “Beta-carotene was actually found to be harmful
for smokers.
“On the positive side, selenium might be helpful for males,
particularly for prevention of prostate cancer. However, more
evidence is needed before selenium can be recommended
for general use, but a large trial assessing this is currently
under way.”
Clear direction
Today, antioxidant research provides more direction to
scientists and perhaps the family physician than it does
to people interested in embracing antioxidants for their
own preventive or curative powers. Even when studies
show strong evidence of antioxidant benefits, few lead to
specific recommendations about when and how much of
an antioxidant to take and in what form.
“It’s hard work to determine which is the most effective
dosage and from which source,” says Dr. Campochiaro. “But
translational research, research that provides actionable
 Attention, Class Understanding the classes of antioxidants and the foods
associated with them is the best way to pack a power lunch.

Antioxidants fall into various groups, called classes. A quick review of the and research continues on how specific foods and/or specific antioxidants
chart below shows the variety of foods that have antioxidant benefits. It also interact in beneficial – or harmful – ways.
reveals the complexity of information required for you to bring the best mix
Understanding the research
of antioxidant-rich foods to your dinner plate or lunchbox.
Until scientists agree on a common nomenclature and as they publish
Researchers and physicians realize that these unfamiliar names can
new information, becoming familiar with the classes and subclasses of
make it difficult to absorb this level of detail, and they have proposed simpler
antioxidants can help you to evaluate and apply the research.
classifications – sometimes based on food color – to help the public apply
Today, experts agree that the best way to gain the greatest variety of
this information to their grocery shopping lists and restaurant menu choices.
antioxidants, each of which offers different benefits, is to eat a variety of
Further complicating the issue, antioxidant classes are still being discovered,
foods from these groups:

Select antioxidants, antioxidant classes and where to find them*

Class/Components
Carotenoids, such as beta-
carotene, lutein, lycopene
Food Sources Potential Benefit
Beta-carotene: carrots, some fruits
Lutein: kale, collards, corn, eggs, citrus
Lycopene: tomatoes (cooked and raw)
Beta-carotene neutralizes free radicals and bolsters
cellular antioxidant defenses; lutein may contribute
to healthy vision; lycopene shows promise to reduce
prostate cancer risk

Flavonoids, such as Anthocyanidins: berries, Flavonoids neutralize free radicals and bolster cellular
anthocyanidins, flavanols, red grapes, cherries antioxidant defenses; anthocyanidins may contribute
flavanones, flavonols, and Flavanols: tea, cocoa, onions, broccoli, to brain health; flavonols to heart health; flavanones
proanthocyanidins apples, tea bolster cellular antioxidant defenses; proanthocyanidins
Flavanones: citrus to urinary health
Proanthocyanidins: wine, peanuts,
cinnamon, berries

Isothiocyanates, such as Cauliflower, broccoli, broccoli sprouts, May enhance detoxification of undesirable compounds and
sulforaphane cabbage, kale, horseradish bolster cellular antioxidant defenses

Phenols, such as caffeic acid and Apples, pears, citrus fruits, some May bolster cellular antioxidant defenses
ferulic acid vegetables

Sulfides/Thiols, such as diallyl Garlic, onions, leeks, scallions, and May enhance detoxification of undesirable compounds and
sulfide and allyl methyl trisulfide cruciferous vegetables such as broccoli, contribute to heart health and a stronger immune system
and dithiolthiones cabbage, bok choy, collards

Whole Grains Cereal grains, whole-wheat bread, bulgur May reduce risk of coronary heart disease and cancer; may
wheat, oats contribute to reduced risk of diabetes
Samples of antioxidant vitamins and minerals
Vitamin A Liver and other organ meats, Protects cells from free radicals
eggs, sweet potato, spinach,
dairy products, fish

Vitamin C Bell peppers, citrus fruits, guava, Protects cells from free radicals
kiwi, strawberries

Vitamin E Oils, fortified cereals, sunflower seeds, Protects cells from free radicals; helps with immune function
mixed nuts, turnip greens and DNA repair

Selenium Brazil nuts, red meats, tuna, plant foods, Helps prevent cellular damage from free radicals and can
grains, garlic, liver, eggs increase the body’s natural production of antioxidants

*Chart adapted from International Food Information Council, Functional Foods Fact Sheet:
http://www.ific.org/publications/factsheets/antioxidants.cfm and other sources. fall 2008 : : Bay l or I n n o v a t i o n s 41
Living Well
O
OH
Caffeic acid in foods such as pears, basil and tarragon may
bolster cellular defenses.
information for patients, is critical to determine what is
most effective for patients.”
A further problem in creating translational research is
that the public today does not have access to regulated
supplements. Those used in clinical trials are tested for
purity; those in the general marketplace usually are not. This
creates great variances in content from brand to brand, with
sometimes 100-fold differences in active ingredients.
Definitive advice
While the use of supplements is open to much debate,
studies have determined that certain foods do prevent
cancer, Dr. Bardia says.
“I encourage people to eat lots of fruits and vegetables,” he
says. “They have many beneficial effects, not just for cancer,
but for heart disease, diabetes and other diseases.”
Many federal and private organizations concur and
offer definitive advice. The American Heart Association,
American Cancer Society, National Cancer Institute and
the Food and Drug Administration all recommend diets
high in fruits and vegetables.
42 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
Caffeic Acid
C 9H 8O 4
OH
OH
Color codes
In part because of their antioxidant content, the Mayo Clinic
places several foods on its top 10 list: apples, almonds,
broccoli, blueberries, red beans, salmon, spinach, sweet
potatoes, vegetable juice and wheat germ.
Nutritionists note that some types of antioxidants are
found in foods with distinct colors. Perhaps most well known
today are antioxidants found in bluish-purple fruits like
blueberries, blackberries and purple grapes, plus eggplants.
Other hints for antioxidant-rich foods are the reds of cherries
and tomatoes, the orange of carrots and the yellows of corn,
mangos and saffron.
Focus on the future
Top researchers call for more study to understand how dietary
antioxidants are absorbed and metabolized and how these
processes change as people age. Today, multidisciplinary
teams bring in the expertise of researchers in the fields
of nutrition, biochemistry, physiology, epidemiology
and molecular biology to better define the relationships
between nutrition and health.  Through such teams, an
impressive body of translational research is under way.
 Children’s
Kid Biz

The Cure for the Common Fashion & Clothing

Betty Reiter

Shopping Experience. Café Coton

Calypso
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Jos. A. Bank Clothiers
lucy
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Pickles & Ice Cream
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Jewelry & Accessories

Bachendorf’s
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Rebecca Collins
Naomi Fine Jewelry Lounge
Marnie Rocks

Food & Restaurants

Baskin Robbins
Café R+D
Corner Bakery
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Health & Beauty

Montana Salon
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Specialty Shops
Apples to Zinnias
The Cultured Cup
Lili Pad
lucky dog barkery
Occhiali Modern Optics
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Swoozie’s
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Services
American Express Travel
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PR E S T O N R O A D AT N O RT H W E S T H I G H WAY Fidelity Investments
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HERE, EVERY STORE HAS A S T O R Y . TM The UPS Store
Living Well
The Spice of Life
Variety in diet offers the broadest benefits of antioxidants.
When it comes to antioxidants, researchers agree with Mom:
Eat a variety of fruits and vegetables. Though the body produces its own
antioxidants to some degree, it relies on food intake to provide the levels
needed to prevent or limit the oxidative stress that leads to disease.
Clinical trials do not support dietary supplements as a beneficial source
of antioxidants, except in people with a confirmed deficiency. Instead,
researchers, physicians and nutritionists all recommend daily intake of
foods that are high in antioxidants.
A natural bonus
Not only do fruits and vegetables deliver more antioxidants than any
supplements can, they also provide beneficial fiber, protein, vitamins and
minerals – usually in a low-fat, low-cholesterol form.
More research is needed to determine whether the body benefits
more from antioxidants in one food over another or in combination
with other foods. Therefore, experts in a variety of fields – from cancer
research and nutrition to cardiovascular health – are also united in their
recommendations to eat a variety of foods to get the most effective daily
dose of antioxidants.
As a matter of fact, the U.S. Department of
Agriculture recommends eating the right
foods with every meal, since antioxidants
can neutralize free radicals generated
during the very act of digestion.
44 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
Antioxidant-rich food choices
• Snack on a bowl of berries of any color. Good antioxidant sources are
blueberries, blackberries, strawberries, raspberries and cranberries.
• Make a fruit salad of apples, avocados, cherries, pears, plums,
pineapple, oranges and kiwi.
• Eat a savory soup or side dish of legumes, including pintos, along with
black, small red and kidney beans.
• Pile on vegetables of all colors: artichokes, spinach, red cabbage, red or
white potatoes (with the peels), sweet potatoes and broccoli.
• Give recipes an antioxidant boost by adding ground allspice, cloves,
cinnamon, garlic, ginger, rosemary, oregano, saffron, sage, thyme and
turmeric powder. These have some of the highest levels of antioxidants
of all foods.
• Wash the antioxidants down with green tea, coffee, fruit juice or a
moderate amount of red wine.
• For breads and cereals, concentrate on oat-based products.
• Add a few nuts to the mix, including almonds, hazelnuts, pecans,
pistachios and walnuts.
• Top off a good meal with a small piece of dark chocolate.
Admittedly, researchers call for more study to determine the effective
dosages of antioxidants, but “regular use [of a variety of foods] offers a
wide array of bioactive substances that have nutritional value,” according
to a recent Mayo Clinic report.
 Nutritionists note that some types
of antioxidants are found in foods
with distinct colors. Perhaps most
well known today are antioxidants
found in bluish-purple fruits like
blueberries, blackberries and purple
grapes, plus eggplants.

Bioavailability is one area of current research that explores has excited this area of exploration. Though promising, the
how easily the body can use vitamins, minerals, antioxidants field is in its infancy.
and more, and under what conditions. The U.S. Department Gerontologists, health care professionals who work with
of Agriculture (USDA) supports research in this area through older adults, are also exploring the relationship between
studies in six different human nutrition research centers oxygen free radicals, antioxidants and aging, including the
across the United States. role of DNA mutations.
The sheer number of antioxidant classes, foods
Cornucopia of research
and potential benefits offer a wide range of potential
Tufts University, for example, is undertaking several
research topics, and, hopefully, of greater and more
studies. Researchers there are exploring the bioavailability,
specific information everyone can use to improve their
pharmacokinetics and antioxidant capacity of plant extracts;
health. (See the sidebar on page 41 to learn more about
vitamin A status related to plant carotenes and dietary fat;
specific antioxidants.)
antioxidant therapies and stroke; and the relationships
“I look forward to the day when I am able to tell all of my
between diabetes, exercise and oxidative stress.
patients that we’re engaged in clinical trials to determine
Other USDA studies are exploring bioavailability as it
the optimal antioxidant regime for their diseases,” says Dr.
relates to a person’s age; the relationship between coronary
Campochiaro. For his field of ophthalmology, he offers hope
artery disease and cranberry juice; DNA damage in smokers
that such research will begin as early as next year.
who ingest almonds; consumption of oats and herbal teas;
and reduction in blood pressure and insulin resistance
with cocoa.

Free radicals, genomes POINTs OF CONTACT:

A new area of research explores the interrelationship
between human genetics, diet and chronic diseases. Since
free radicals in the absence of effective antioxidants create
mutated cells and mutated DNA, the Human Genome Project
For more information on antioxidants, visit www.nutrition.gov and search
for “antioxidants.”
Or visit the U.S. National Library of Medicine Web site, www.nlm.nih.gov,
and search for “antioxidants.”

fall 2008 : : Bay l or I n n o v a t i o n s 45

“Pain Free”
“I came in unable to walk,” Mike Holley says. “They fixed me.” Mike was experiencing debilitating
pain from a degenerative disc. At Baylor, he had spinal discectomy and fusion, complex
procedures for treating conditions of the spine. Specialists on the medical staff at Baylor
University Medical Center at Dallas are skilled in advanced spine care solutions. Now Mike
is free of pain and free to enjoy life. “I’m here because of what Baylor did for me and I’ll
personally never forget that.”

3 5 0 0 G a s t o n Ave. D a ll a s , T X 7 5 24 6
1.8 0 0.4BAY LOR w w w.BaylorHealth.com
Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary,
community or affiliated medical centers and are neither employees nor agents of those medical
centers, Baylor University Medical Center or Baylor Health Care System. CE BSC BI 7.08
 mental health

The Self-Healing Brain

Increasing fluid memory through mental exercise
may heal the brain and boost intelligence.
By linda melone

Rebuilding memory in those with cognitive impairment,

improving IQ, and relieving psychotic symptoms in
individuals with chronic schizophrenia – all without drugs
– summarizes some of the promising new research on brain
plasticity. “We now understand that the brain is continuously
making adjustments,” says Michael Merzenich, Ph.D., professor
emeritus at the University of California San Francisco. “Every
time you acquire a new ability, it’s accounted for by physical
and functional changes in the brain. It’s a different brain than
before you had this ability – you’ve changed the local [neural]
connectivity. Conversely, a functional loss is also expressed
by changes in the brain.” When you acquire new skills, you form new neural connections in your brain.
Through various stimuli or lack of stimuli, these changes
may also be reversed or improved over time. “At any point wiring, indicating a possible degradation or even severing of
in time, the brain can drive itself in a corrective direction,” a pathway connected to memory.
Dr. Merzenich says. Based on this platform, he and other We associate learning and exploring with youth and
researchers prove verifiable – and often astounding – young adulthood, a time to discover and learn new things.
results from what was once considered soft science. “We On the other hand, older adulthood is linked with memory
now know we can get the brain to correct itself if that’s loss and other symptoms signaling a slowing down of
possible in a particular case, which it is in many situations,” cognitive abilities. “Normal aging may bring about substantial
says Dr. Merzenich. operational degradation of the brain,” says Dr. Merzenich.
“You’re less precise and your memory slows as your brain
Defining Plasticity
becomes less efficient. You don’t process what you hear, see
Plasticity, as it refers to the brain, describes its ability to
and feel as well as you once did.” But the new research shows
respond to new circumstances and to new learning. Gray
that, given the right stimulus and conditions, even the aging
matter can shrink or thicken and neural connections may
brain can grow.
be created, weakened or destroyed. Learning how to play
a new musical instrument or studying a new dance step, Plasticity-Based Treatment
for example, forges new “wiring,” or neural pathways in Based on knowledge of the brain’s plasticity, scientists
the brain, reflecting a change in the physical brain itself. are finding great success with drug-free techniques
Forgetting a person’s name reflects a different change in that help the brain to heal itself. These techniques

fall 2008 : : Bay l or I n n o v a t i o n s 47

MENTAL HEALTH
Crystallized intelligence, also known as long-term memory, draws on
existing skills, knowledge and experiences to solve problems or access
information. Fluid intelligence, on the other hand, relies on short-term
memory and constitutes working memory.
rely on the retraining of the brain through repetitious,
challenging activity. In an era where drug side effects and
adverse reactions coincide with our increasing reliance
on medications, it’s exciting to think the next great
breakthrough may come from a less-invasive source, notes
Dr. Merzenich.
Fluid Intelligence
Research led by Swiss post-doctoral fellows Susanne M.
Jaeggi and Martin Buschkuehl, working at the University of
Michigan Ann Arbor, demonstrates the plasticity or fluidity of
the brain when it comes to IQ testing. Studying a person’s IQ,
or intelligence quotient, involves measuring a combination of
crystallized and fluid intelligence. Crystallized intelligence,
also known as long-term memory, draws on existing skills,
knowledge and experiences to solve problems or access
information. Fluid intelligence, on the other hand, relies on
short-term memory and constitutes working memory. We rely
on fluid intelligence to recall phone numbers or memorize a
piece of information for a short time.
Jaeggi and Buschkuehl studied four groups of volunteers
using a complex training task, offering both auditory and
visual cues used to train their working memory. Half-hour
sessions were held once a day for eight, 12, 17 or 19 days.
The trained groups not only improved significantly from the
control group, but gains in intelligence increased according
to the length of time trained.
The findings showed that memory task training led to
48 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
an increase in fluid intelligence and an improvement in
general intelligence as measured by IQ tests. Although they
say further studies are needed, the researchers surmise that
this type of memory training may also help children with
developmental problems and adults facing memory decline.
Role of Nutrition
Part of brain health and the prevention of cognitive and
memory decline includes a diet rich in nutrients such as
omega-3 fatty acids, vitamin E, antioxidants and folic acid.
For example, “DHA [docosahexaenoic acid], found in fish, is
also the primary fatty acid found in the brain,” says Andrea N.
Giancoli, R.D., M.S., spokesperson for the American Dietetic
Association. A study published in the journal Archives of
Neurology showed a 10 percent slower decline in cognitive
abilities in people who consumed one fish meal a week;
those who consumed two or more fish meals a week
experienced a 13 percent slower decline. “If you eat fish
for heart health, you’re likely helping your brain health as
well,” Giancoli says.“It’s best to eat a variety of fish, although
salmon and sardines have the highest levels of omega-3s;
strive to eat five ounces of omega-3-rich fish a week.” In
lieu of salmon, flaxseed and walnuts also contain healthy
amounts of omega-3s.
Moreover, antioxidants, such as those found in fruits and
vegetables, may also help slow down the breakdown of
brain cells; berries contain particularly high amounts of
antioxidants. Flavanols, found in cocoa, are also reputed to
have brain-healthy properties, as does folate (folic acid),
present in dark green leafy vegetables like kale, spinach and
collard greens. (Learn more about antioxidants on page 36.)
A low-fat diet with the addition of these healthy foods may
help prevent or slow down rates of cognitive decline due to
normal aging.
Help for Abnormal Brains
In severe cases of age-related cognitive decline, plasticity-
based approaches work well, as noted previously. Yet
research in patients with schizophrenia and other genetic
and trauma-induced brain abnormalities has shown that the
plasticity approach also yields dramatic improvements in
these populations.
Scientists at Yale University and the University of California
San Francisco recently conducted large trials among patients
with chronic schizophrenia. The technique uses a complicated
form of training, addressing problems in the frontal lobe
that relate to how the brain records working memory
(fluid intelligence). “Basically, with schizophrenia, the brain is
poisoned by an overexpression of two chemicals: dopamine
and noradrenaline,” Dr. Merzenich explains. “This causes the
person to lose track of associations across time – they don’t
know if they did something or someone else did. We try to
rebuild that working memory by doing things that strengthen
these associations.”
In its current form, the training takes around 100 hours, with
patients sitting in front of a computer in one-hour sessions.
The results: “Every imaging, every blood chemistry test done
A person’s IQ is based on crystallized and fluid intelligence. And
brain training to boost the brain’s plasticity also increases a person’s IQ.
so far is substantial and all directed towards renormalization,”
says Dr. Merzenich. “Although it’s still a work in progress,
the training is better and more effective in its impact than
anything else done thus far.”
In addition, the results appear well sustained and enduring.
“We may still need to assess behavior over time, and some
patients may need additional training later on to maintain
their abilities,” notes Dr. Merzenich. “But you could never do
this with a drug.” He cites similar results with those suffering
cognitive loss from chemotherapy, AIDS, Lyme disease, West
Nile virus and brain infections. “We’re developing strategies
customized to each one of these conditions and have had
significant results we can see by imagery or elemental
psychophysical measures,” he says. “We want people to see
this as medicine. We’re teaching the brain to fix itself.”
Points of Contact:
For memory-building techniques you can practice on your own, visit:
www.mayoclinic.com and search for “memory exercise” or
www.mindtools.com and search for “memory tools.”
fall 2008 : : Bay l or I n n o v a t i o n s 49
MENTAL HEALTH

Psychology of a Pack Rat

What’s mine is better than yours.
By Cynthia Kincaid

Do you ever wonder why you might not
be able to throw anything away? Are your
garage and closets bursting from all the things
you have collected over the years: old college
T-shirts, out-of-date clothing, sports equipment
and rarely used furniture gathering dust? A new
study just might have the answer.
New research highlights the neuropsychological
connection people have to their possessions,
especially when they anticipate the possible
loss of those belongings. The study, published
in Neuron, found that people tend to prefer
things that they own. They believe their
possessions have more positive features
than items that do not belong to them, even if
they have owned the objects for only a short
time. “When you get something, you just
can’t stand the thought of losing it. People
don’t like the thought that they might be
deprived of that thing,” says Brian Knutson,
Ph.D., study author and associate professor

50 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
 “This isn’t some parlor trick that psychologists play on people, this is a real
effect that influences how efficient people are with their market transactions,
and it can cost them a lot of money.” – Brian Knutson, Ph.D.
of psychology and neuroscience at
Stanford University.
This phenomenon is known as the
“endowment effect” and can sometimes
result in self-sabotaging behavior. “People
ask for twice as much to sell something as
they would pay to buy that same thing,” says
Dr. Knutson. “This effect exists regardless of
market conditions.”
Study Design
To conduct the study, Dr. Knutson gathered a
group of people and gave half of them mugs
and half of them pens of equal value. He then
asked how many would like to trade. “In a class
of 100 to 200 people, only a handful of people
wanted to do the trade,” he says.
During the study, Dr. Knutson’s subjects
also bought and sold items such as noise-
canceling headphones, iPod® Shuffle music
players, iPod ® alarm clocks, flash drives and
other items ranging in price from $60 to $80.
Participants were randomly given two items
to keep before the experiment began. When
it came to buying and selling, the subjects
wanted twice as much to sell the items than
they were willing to pay for them. “There was
no difference in how long they had owned
these things; they had just gotten them,” Dr.
Knutson says.
While the buying and selling went on, Dr.
Knutson had his subjects’ brains scanned
to determine activity in different parts of
the brain. “Our hypothesis was that people
wouldn’t want to lose what they had, and that’s
why they jacked up the asking price,” says Dr.
Knutson. “The other theory was that they would
like what they had better and that would jack
up the price.” Dr. Knutson found evidence for
the first hypothesis. “When people looked at
objects that they might sell, especially if they
liked those things to begin with, we saw more
activation in areas of the brain associated with
anticipating loss. But we didn’t see any more
activation in the area of the brain associated
with anticipating gain.”
What does all of this mean?
According to Dr. Knutson, people lose money
(sometimes lots of it) because of their attachment
to things and the resulting endowment effect.
“This isn’t some parlor trick that psychologists
play on people,” he says. “This is a real effect
that influences how efficient people are with
their market transactions, and it can cost them
a lot of money.”
Dr. Knutson points to examples such as the
costs that people incur when selling houses or
cars or when moving ratty, out-of-date furniture
across the country because they simply can’t
part with it and paying storage fees every
month for items they are unwilling to sell or
give away.
Because of the endowment effect, Dr. Knutson
advises hiring a real estate agent to sell your
next home. “They don’t feel the pain of selling
your house that you feel,” he says. “It’s their job
to get you halfway in meeting the buyer, who is
probably going to undervalue your home.”
He offers the same advice for other types of
transactions as well. “If you have something
valuable, and you want or need to sell it, it might
be wise to have someone else sell it for you. They
may do a better job of getting it sold.”
Point of Contact:
For ideas on paring down your possessions, visit
www.guynameddave.com and look for the “100
Thing Challenge.”
fall 2008 : : Bay l or I n n o v a t i o n s 51
 Every day matters in the fight against
pancreatic cancer.
-Dr. Randy Pausch

Dr. Randy Pausch, testifying to Congress on behalf of the Pancreatic Cancer Action Network,
about the need to increase federal funding for pancreatic cancer research. March 13, 2008. Photo by Max Taylor.

After Dr. Randy Pausch was diagnosed with pancreatic cancer, he gave his famous last lecture
at Carnegie Mellon University. His message was simple. Every day matters, even in the face
of adversity. Randy lived and died by these words as he fought pancreatic cancer, the fourth
leading cause of cancer death. He made a difference by joining with the Pancreatic Cancer
Action Network to raise awareness, advance research, support patients and advocate for a cure.
You can, too. Join us. Together, we can create real hope for those with pancreatic cancer.

Get involved and make every day matter in the fight against pancreatic cancer.

www.pancan.org

Baylor’s New Cancer Center
Expanding our cancer care vision to enhance patient care.
By cynthia kincaid
Baylor University Medical Center at Dallas HAS announceD
the expansion of the Baylor Charles A. Sammons Cancer
Center at Dallas.
Construction on a new 450,000 square-foot outpatient
cancer center expansion began earlier this year and is
expected to be completed by 2010. When the outpatient
cancer center is complete, a dedicated 120-bed cancer
hospital will be developed in the Collins Building at Baylor
Dallas with an expected completion in 2012.
“We decided on the expansion because there is a huge
community need for cancer services,” says Donna Bowers,
J.D., vice president of Baylor Health Care System. “The
incidence of cancer continues to grow as the population
ages; the projected increase for cancer diagnosis is 19 to 21
percent over the next five to 10 years.”
To support a decision to expand the now 32-year-old
Baylor Sammons Cancer Center, Baylor conducted a thorough
analysis, looking at national cancer rates as well as regional
and local needs. The analysis found that the United States
has been successful in reducing cancer mortality, so death
rates are going down, but the incidence rates of cancer are
going up. “We have increasing rates of cancer incidence, but
we are treating it more effectively,” says John McWhorter III,
president of Baylor University Medical Center at Dallas.
spotlight
“We want to reduce cancer to a chronic disease. The net
result of successful treatment is that a lot of cancer survivors
are going to need continual care for the rest of their lives.”
According to Marvin Stone, M.D., a physician on the medical
staff and chief of oncology at Baylor Dallas, and medical
director of the Baylor Sammons Cancer Center, the strategic
planning process identified the necessity of enlarging the
program as well as facilities. “Advances in cancer care have
accelerated rapidly, and Baylor is accepting this challenge to
provide our patients with advanced treatment,” he says.
Treatments and Programs
In addition to offering the current traditional cancer
treatments, the expanded cancer center will feature more
choices in complementary medicine and clinical trials for
patients. “One of our goals is to increase the number of clinical
trials provided to our patients,” says Bowers. “Our patients want
to go to facilities where clinical trials are being conducted.”
Baylor Sammons Cancer Center already offers patients
access to more than 150 clinical trials (including national
fall 2008 : : Bay l or I n n o v a t i o n s 53
spotlight

trials) and innovative cancer treatments for all cancer types

including leukemia, lymphoma, myeloma, lung cancer, breast
cancer and colon cancer. “We want that number to climb
significantly,” says Bowers.
The new cancer center expansion will also allow for a
more comprehensive molecular medicine program, more
commonly known as personalized medicine, including
promising areas of research such as targeted therapy. “With
targeted therapy, we’re going to be able to look at a patient’s
DNA and determine what type of treatment is going to
work best with their particular genes,” says Bowers. “We
can tailor medicine more toward the individual and end up
with better outcomes. It’s going to revolutionize medicine
over the next 10 years.”
Dr. Stone says that the expansion of our cancer care vision
will help Baylor in developing and expanding its current
targeted therapeutic approaches. “I think these approaches
are going to advance the entire field, and we’re already
applying them in certain kinds of leukemia, breast, lung and
colon cancer,” he says. “There’s going to be a tremendous Espenola Pinckney experienced patient-centric care at the Baylor
Sammons Cancer Center first hand. In 1999, she was treated for colon
increase in our ability to make more accurate diagnoses
cancer and is currently in remission.
and target therapy in individual patients. These will be more
effective and produce fewer side effects.”
talked to patients and their families to find out what they
The new cancer center will also develop a physical
wanted in the new center,” says Bowers.“We are building our
medicine program designed specifically for oncology
new cancer center based on their feedback.”
patients and a new pain management department will be
Dr. Stone agrees. “At Baylor Dallas, we have always felt
created to focus only on cancer patients. The cancer center’s
that compassionate patient care was the central part of
boutique, Ernie’s Appearance Center, also focuses on cancer
our mission,” he says. “Here, individualized patient care
patients by providing special clothing, prostheses and wigs.
is what we have always felt was most important, and that
“Ernie’s has been a huge success, and it’s something that’s
continues to be the case.” Baylor will also continue to
tremendously needed,” says Bowers. “Baylor has done a
emphasize strong educational and research programs to
superb job in this area.”
stay abreast of current medical advances, according to
Patient-Centered Treatment Dr. Stone.
Ultimately, the new cancer center will continue to support Baylor has emphasized a multidisciplinary interaction among
Baylor’s overall mission of patient-centered treatment. “We various specialists from the beginning; that interaction, Dr.

54 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
 “At Baylor we work to address the mental and spiritual aspects of living
with cancer not only for the patient but also for the family.”
_ Donna Bowers, J.D., vice president of Baylor Health Care System

Stone says, has become the linchpin of the modern practice of
oncology. The expansion of the Baylor Sammons Cancer Center
will underscore and enhance this emphasis. “As evidence to
our devotion to that concept, we have more than 200 different
site tumor conferences per year, all of which are participated
in by medical oncologists, surgical oncologists, radiation
oncologists, pathologists and various other specialists,
depending on which cancer type is being discussed,” says Dr.
Stone. “We have more than 6,000 physicians, trainees, nurses
and paramedical people attend those per year. They all grant
CME credit for physicians, and they are a very important part
of the activities at Baylor Sammons Cancer Center.”
The focus on patient care, according to Bowers, rests on
the cornerstone philosophy of treating all aspects of the
person – not just their physical health. “When someone is
told they have cancer, their needs go beyond traditional
medical treatment. At Baylor we work to address the mental
and spiritual aspects of living with cancer not only for the
patient but also for the family. Therapies offered include
massage, acupuncture, music and art, journaling educational
programs and support groups,” she says.
In 1999, Espenola Pinckney experienced Baylor’s patient-
centered attention first-hand when she was diagnosed and
treated for colon cancer. Now in remission, Pinckney can’t
say enough about her experience at Baylor Dallas. “The
doctors were wonderful,” she says. “They ran a lot of tests; I
make sure it is available for the patients they treat.”
Baylor’s patient-centered treatment philosophy will be
deeply reflected in the new expansion by providing patients
with access to resources for online information, books and
magazines. The building will also house a restaurant, coffee
bar and docking stations for wireless computer access.“There
is a lot of personal space in this new building,” says Bowers.
“When patients and their families come, they will have places
where they can work while waiting for their own or a family
member’s treatment.”
The Overall Goal
Ultimately, the Baylor Sammons Cancer Center’s goal is to
treat cancer patients with up-to-date therapies in a modern
and patient-centric environment.“We are a leader in oncology
care and we want patients to feel comfortable that they are
going to get quality care with advanced technologies and
treatments when they are here,” Bowers says.
McWhorter couldn’t agree more. “Baylor has historically
been the leader in cancer care in the north Texas area, and
we feel a great responsibility to offer the best cancer care
in the country,” he says. “We want people to be cared for
quickly, confidently and in a compassionate manner. And we
want to continue to be the destination center for cancer care
for citizens of north Texas.”

Point of Contact:
had chemotherapy and radiation over a three-month period,
and it worked.
“Everyone at Baylor was just so caring, and I was so For more information on the Baylor’s Charles A. Sammons Cancer Center,
impressed,” she adds. “The treatment I received was top- visit www.BaylorHealth.com and click on “Dallas” and then “Cancer” or
notch. Whatever advanced technology, Baylor is going to call 1-800-4BAYLOR.

fall 2008 : : Bay l or I n n o v a t i o n s 55

 Improve
Heart Health
with HDL By Joann Milivojevic

56 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
 get the picture

When it comes to keeping your cholesterol in check, the good

can definitely outweigh the bad. LDL (low-density lipoprotein) is often
referred to as “bad” cholesterol because it sticks to the walls of your
arteries. The increased buildup puts you at greater risk of heart attack
and stroke. HDL (high-density lipoprotein) is called “good” cholesterol
because it actually helps reduce risk.
“LDL promotes hardening of the arteries,” explains Mary Ann Bauman,
M.D., of Integris Health in Oklahoma City, and a spokesperson for the
American Heart Association. “But HDL pulls off LDL and takes it back to the
liver to be metabolized.”
According to the American Heart Association, HDL cholesterol levels of
60 mg/dL or higher provide some protection against heart disease. Here
are five ways to increase HDL:

1. Get some aerobic exercise. Aim for at least 30

minutes four to five times per week.
2. Lose weight. Just seven pounds down can
increase your HDL by 1 mg/dL.
3. Eat heart smart. Replace saturated fats with
monounsaturated fats (for example, use olive
oil instead of butter).
4. Quit smoking. It can help you can raise your
HDL by as much as 15 to 20 percent.
5. Consider niacin. Available over the counter,
niacin is an effective pharmaceutical option for
raising HDL cholesterol. Consult your doctor
before starting niacin therapy.

Point of Contact:
Learn more about what you can do about cholesterol and raising healthy
HDL at www.americanheart.org.

fall 2008 : : Bay l or I n n o v a t i o n s 57

calendar

Baylor University Medical Center at Dallas

Community Calendar October – January

Celebrating Women ONGOING PROGRAMS

Join us for the Celebrating Women Luncheon benefiting breast Diabetes Support Group
cancer research, community outreach and expanded technology October 21, December 16
at Baylor Health Care System. 11:30 a.m. - 1 p.m.
The keynote speaker will be Geralyn Lucas, author of “Why I Wore Lipstick Baylor University Medical Center - Ruth Collins Diabetes Center
to My Mastectomy.” Call (214) 828-2350 for more information.
Thursday, October 16, 2008
11:45 a.m. - 1:15 p.m. (Doors open at 11:30) Weight Loss Surgery Seminars
Hilton Anatole Hotel, Dallas October 23, November 13 & 27, December 11
2201 Stemmons Freeway 5:30 p.m.
Dallas, Texas 75207 Seating limited. Registration requested.
Call 1-800-4BAYLOR to register. Call 1-800-4BAYLOR.

Heartwell Forum
October 15, November 19, December 17
11:15 a.m. until 1 p.m.
Call 1-800-4BAYLOR.

Newborn and Parenting Classes

Women’s and Children’s Services
Classes held all year on a variety of topics.
Seating limited. Must register.
Call 1-800-4BAYLOR.

Cancer Support Groups’ Meeting

Baylor Charles A. Sammons Cancer Center
Cvetko Education Center, Collins Bldg., Suite 615
Call (214) 820-2608 for topics, dates and registration.

For more information about classes or other events, call 1-800-4BAYLOR

or visit BaylorHealth.com and click on Classes and Events.

58 B ay l o r I n n o v a t i o n s : : fall 2 0 0 8
 Solutions for the changing
healthcare environment

Architecture Interiors Planning

Perkins+Will is proud to be a part of Baylor University Medical Center’s exciting

future. Congratulations on your innovative evolution of Cancer Care.

Dallas 214.283.8700
www.perkinswill.com
 THE 45TH: REMEMBERING PRESIDENT JOHN F. KENNEDY

Please join us for a

series of daytime and evening events November 17-22, 2008, to
reflect and learn about the assassination and legacy of President John F. Kennedy.
Presenters include
Gene Boone z The Reverend William Holmes z Bob Huffaker z John Kelin z Jim Leavelle z Bill Mercer
Bill and Gayle Newman z George Phenix z Dan Rather z Kenneth Salyer, M.D. z Wes Wise

411 Elm at Houston z West End Historic District z Downtown Dallas, TX

214-747-6660 z www.jfk.org z Open 10-6 Tuesday-Sunday, 12-6 Monday

Speakers are subject to change.

Photo: William Allen, Dallas Times Herald Collection/The Sixth Floor Museum at Dealey Plaza

Nonprofit Org.
U.S. Postage
PAID
2001 Bryan Street, Suite 750
Clarksville, TN 37040
Dallas, TX 75201 Permit #191

25005BAY-BUMC-0508