3

The “man’s disease”

that kills more

women than men

4

For men with prostate

cancer, male bonding

at its best

8

A new and

improved

triage system

Fall 2007 • Volume 9 • Number 1

A New Beginning

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DR. ROBERT I. GROSSMAN, NEW DEAN & CEO,

ACTS TO UNIFY SCHOOL OF MEDICINE AND

HOSPITALS CENTER

In 1975 Robert I. Grossman, M.D., was midway through a residen-cy in neurosurgery when he saw some of the earliest CT imagesever produced. Awed by the promise they held for advances inmedicine, he switched fields, deciding to become a radiologist.

Three decades later, on July 1 of this year, Dr. Grossman shifted hisfocus again, this time moving from Chairman of Radiology to 15thDean & CEO of NYU Medical Center.

In a sense, his recent move had as much to do with his vision of the future as had the first one. One of Dr. Grossman’s first steps,announced even before taking office, was to introduce a streamlinednew leadership team chosen to help him achieve a primary goal: aunified, fully integrated Medical Center.

“Bringing together the superb clinical expertise of the NYU hospitals and the world-class research and educational capabilities ofthe School of Medicine will enhance our already cutting-edge, high-quality medical education, scientific research, and patient care,” saidDr. Grossman, the Louis Marx Professor of Radiology. “This integra-tion will also promote a more collaborative culture — one moreresponsive to patients, physicians, scientists, nurses, and staff — and cre-ate a more productive working environment. I am confident that thistransformation will help NYU Medical Center build on its legacy ofgreatness, setting the standard for academic medicine for decades to

Shortly before taking office, Dean & CEORobert I. Grossman, M.D., toured theMedical Center to get better acquainted withits employees and facilities. On 16 East atTisch Hospital (far left), Barbara Zimmer,R.N., introduced him to Rosemary Ramos,R.N. He also met with Karen L. Brewer,Ph.D., Chairwoman of the EhrmanMedical Library (left); Katina GriffithPollard (bottom left); and Jane Lu, R.N.,Melissa Martinez, R.N, and MarilynJohnston, R.N. (bottom right).

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The transition from elementary to middle school can be adifficult time for any child, but for Julie Smith (not her realname), starting seventh grade in a New Jersey suburb wastraumatic. Unable to make friends, handle changing classes,or adjust to the different expectations of each teacher, shejust shut down. Her mother, Elaine, recalls watching herdaughter curl up in a ball on her bed and refuse to go toschool. Julie spent the entire eighth grade year at home,refusing to talk to the tutors the school sent.

Julie, now 14, has Asperger syndrome. Her world today is aless isolated and confusing place, thanks to the AspergerInstitute’s Advanced Learning Laboratory at the NYU ChildStudy Center, where she now receives her schooling.

Asperger syndrome is a neurologically based developmen-tal disorder related to autism, in which children are unable tointeract socially. Recent data suggest that at least one in 150children have an autism spectrum disorder, such as Aspergersyndrome; the incidence of Asperger syndrome may be as highas one in 300. Boys are eight times likelier than girls to haveit. A diagnosis is usually made between the ages of eight and11 when social difficulties at school become most noticeable.As awareness of Asperger Syndrome increases, however, diag-nosis at younger ages is becoming more common.

Asperger kids are often bright, with intensely focusedinterests in a single subject (with Julie, it’s the popular science

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Educating Julie NYU Child Study Center Receives Landmark$30 Million Gift to Create Asperger Institute

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Carolyn Yohannes might haveknown better. Some would sayher doctors certainly should have.Overweight and age 60, Carolynhad been treated for type 2 dia-betes and high blood pressure fora decade, all of which she knewput her at high risk for a heartattack. Yet when she was struck bysudden fatigue one Friday after-noon in July of 2005, she thoughtlittle of it. When she developed apain in her shoulder and couldn’tsleep, she still didn’t think it wasserious enough to call her doctor.The next morning she went to awalk-in clinic, where she wasdiagnosed as having pneumoniaand given antibiotics.

Carolyn’s symptoms persisted,so she went to see her internistthe following Monday. During

the exam, her heartbeat becamewildly irregular. She was rushedto the emergency room, wherean angiogram revealed blockagesin her coronary arteries andCarolyn was told she had suf-fered a heart attack. “I didn’t haveany of the classic symptoms of aheart attack, like chest pain,” sherecalls. “I had not been feelingsick. So it took me completely by surprise.”

Unfortunately, Carolyn’s expe-rience is all too common, says car-diologist Nieca Goldberg, M.D.,Associate Professor of Medicineand Medical Director of NYU’snew Women’s Heart Program. Dr. Goldberg launched the pro-gram to overcome barriers toeffective cardiac care that womenlike Carolyn too often encounter.

Most studies on cardiovasculardisease (CVD) have been conduct-ed among men, fostering the perception that heart disease is a“man’s disease,” says Dr. Goldberg.A 2005 study by the AmericanHeart Association (AHA) foundthat even among cardiologists, only56 percent correctly identifiedwomen as being at high risk whenthe women had the same risk profile as men. Similar percentagesof primary care physicians andgynecologists also failed to recog-nize such high risks. Physicianswere also less likely to recommendpreventive treatment for women.Other studies show that cardiolo-gists are twice as likely to refermen for angioplasty or bypass surgery than they are to referwomen with the same risk profile.

In fact, more women thanmen die of CVD— 462,000women annually, 410,000 men.Yet only 17 percent of cardiolo-gists knew this, according to theAHA 2005 study.

“There has been progress inunderstanding the differences incardiovascular disease betweenmen and women, but not in treat-ing women,” says Dr. Goldberg.“We need to do better.”

“Many women who come tosee me have had previous evalua-tions, often from multiple spe-cialists, but were told nothing iswrong. They feel their doctorsdismiss their symptoms. Well, if‘nothing is wrong’ why do theystill have symptoms?”

Even when a woman doeshave classic chest pain, it may beattributed to other causes, such asanxiety (see box). What’s more, says

Dr. Goldberg, some routine diag-nostic tools such as stress tests andangiograms, may not detect signsof coronary disease because ofrecently recognized anatomical dif-ferences. For example, women tendto have more evenly distributedplaques in coronary arteries, whichcan make them appear clear on anangiogram, and more blockages insmaller blood vessels that cannot beseen on angiography.

Drawing on cutting-edgeresearch, clinicians at the NYUWomen’s Heart Program willinvestigate — and treat— women’s

symptoms more aggressively. Forexample, the complete medicalrecords of women in the programwill be accessible by computer, sothat a woman with heart-relatedsymptoms and risk factors wouldimmediately be flagged and eval-uated appropriately.

The program will also createa network of physicians fromother specialties within NYU todeliver more-effective care to thetotal woman. Says Dr. Goldberg:“A shared medical records data-base will make it easier to studythe links between CVD andother diseases, such as lupus, thatprimarily affect women, develop-ing new clinical practice modelsto improve the entire spectrumof women’s healthcare.”

“Our goal in creating theWomen’s Heart Program is toestablish a comprehensive,

patient-friendly center for thediagnosis and treatment ofwomen at risk of cardiovasculardisease,” says Glenn I. Fishman,M.D., Chief of the Division of Cardiology. “Moreover, wehope to integrate the HeartProgram into a complete multi-disciplinary Women’s Health Care Network, including patient-care, educational, andresearch components. This willrepresent nothing less than a paradigm shift in our approach to women’s healthcare issues atNYU Medical Center.” ▫

Don’t think for a minute that doctors areimmune to urban legends and old wives’tales,” says William L. Goldberg, M.D.,Assistant Director of the Department of

Emergency Medicine. “Back in medical school I was taught never to shave off an eyebrow whensuturing a laceration because it won’t grow back.Wrong. Now tweezing — that’s a different story.”

This is just one of the many myths Dr.Goldberg debunks in his surprise runaway best-seller Why do men have nipples? The book is subtitled “Hundreds of Questions You’d Only Aska Doctor after Your Third Martini,” suggesting thesource of its inspiration. “These are the wacky ques-tions people keep asking me at cocktail parties,”says Dr. Goldberg, who originally considered thesubtitle: “Things They Don’t Teach You in MedicalSchool.” “I was tentative about the title because I didn’t want to be known around the hospital as ‘Dr. Nipples,’ ” he quips, arching one of hisown eyebrows.

Over the course of a decade, Dr. Goldbergscribbled such curiosities on napkins and scraps of paper. Eventually he had enough for a book—two books, in fact. The sequel is entitled Why do men fall asleep after sex? Together, they’ve soldnearly 1,400,000 copies, with each title rising tonumber one on The New York Times bestseller list.“I did an interview with Reuters and the booktook off,” says Dr. Goldberg. “Next thing I knew,a CNN crew was at my apartment and I wasbooked on The Today Show.”

Dr. Goldberg’s co-author is Mark Leyner, a novelist and screenwriter he met while servingas medical consultant to a TV program calledWonderland. Despite the fact that his collaboratorwas the professional writer on the team, Dr.Goldberg wrote about 95 percent of the prose. “It just crystallized in my mind as I was doing the research,” he explains. Dr. Goldberg’s quest forauthoritative answers to quirky questions led himto some obscure sources, such as the Bulgarian

journal Akusherstvo i Ginekologia (Obstetrics and Gynecology).

More than one reviewer hasdescribed the books’ wisecrackingtone as “snarky.” But Dr. Goldbergoffers no apologies. “In emergencymedicine,” he says, “you have to be a little irreverent to survive.”Recently, he and Leyner have foundtwo new forums for their wit: amonthly Q&A column, “The BodyEccentric,” in Best Life magazine and a biweekly podcast, “The Body Odd,” on MSNBC.

So what did Dr. Goldberg learnfrom all that research? “In many areas of science there’s a big black hole,” he sighs. “There are some questionswe just don’t have the answers to.People get very frustrated aboutthat, but I think it’s beautiful.” ▫

Funny You Should Ask...

“

“Women are not small men,” says cardiologist Dr. Nieca Goldberg, shown here reviewing the results of an EKG with patient CarolynYohannes. “Our physiology is very different, especially when it comes to heart disease. Our hearts are proportionally smaller, and whenwe develop the first signs and symptoms of heart disease, we are usually 10 years older than men.”

Not Your “Hollywood Heart Attack”

Women are twice as likely as men to die when they suffer a heart attack. Why? For

one thing, they typically wait longer (20 minutes to 2 hours) to call 911. When a

woman finally gets to the emergency room, she may be misdiagnosed or wait

longer for treatment.

“Doctors—and many women too—are under the impression that heart disease is

a ‘man’s disease,’” explains Dr. Glenn I. Fishman. “Even if a woman had chest pain,

it was likely seen as gastrointestinal or anxiety-related. So some women would

either get improper treatment or no treatment at all. As a result, they would die.”

In contrast to the image of a “Hollywood heart attack,” showing a man clutching

his chest in agony, recent studies suggest that—in addition to those symptoms

common to men, such as shortness of breath and sudden fatigue or weakness—

women often have atypical symptoms, including dizziness, faintness or lighthead-

edness, chest discomfort, and a cold sweat or chills.

Putting More HEARTinto Women’s Cardiac Care

news & views • fall 2007

Dr. William Goldberg, the man with the answers

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Henry, a man inhis 60s who was suffering arecurrence of prostate can-cer, thought he was accom -

panying his daughter, Karen, on a tripto buy speakers for her iPod. Butinstead they arrived at the NYUClinical Cancer Center. Karen hadtaken him there to confront his ill-ness—the reason so many other menhad gathered that night at the Man-to-Man Prostate Cancer Education andSupport Program at the Cancer Center.

“This is the first time Dad actuallyspoke about his disease,” said Karen. “Ifeel as if we’ve been guided to the rightgroup.” Said Henry: “I’m glad I came.”

Until just a decade ago, few supportgroups for prostate cancer were avail-able in New York City. One of the firstwas formed by Anna Ferrari, M.D.,Associate Professor of Medicine, whenshe served at another hospital. For itspeer leader, she recruited her patientMel Katz, who has since followed herto NYU. The Man-to-Man Program isjointly sponsored by the multidiscipli-nary team of the NYU CancerInstitute and the American CancerSociety.

Such groups have been scarce,explains Dr. Ferrari, because our under-standing of prostate cancer has laggedbehind that of other types, such asbreast cancer. Given the lack of con -sensus about screening methods, earlydetection guidelines, treatment options,and side effects, patients often feelbewildered, frustrated, and scared. “I seethe Man-to-Man Program as part of a

comprehensive approach to treatingprostate cancer,” says Dr. Ferrari.

Through presentations by experts inthe departments of Urology, MedicalOncology, and Radiation Oncology, and

discussions with peers, Man-to-Manprovides an informal forum to helpmen make informed decisions and

develop effective coping strategies. “Thefirst thing I tell newcomers,” says MelKatz, “is that I’m a 14-year survivor.When I was diagnosed at age 49 I had aPSA [prostate specific antigen] of 91. Thenormal range is 2 to 4. That makes themperk up.”

Held on the last Thursday evening ofthe month, the free sessions are some-times standing room only. Like Henry,many attendees are cajoled into comingby their partners, relatives, or friends,who sit by their side during delicate dis-cussions about sexual dysfunction, incon-tinence, and other potentially devastatingconsequences of treatment. “Once thesemen realize that their life has beensaved,” explains Dr. Ferrari, “they need tosave their self-image. For a man withprostate cancer, the organ comes to sym-bolize his sexuality and identity.”

According to the American CancerSociety, prostate cancer is the mostcommon form of non-skin canceramong American men and the secondmost deadly, after lung cancer. Dr.Ferrari, a leading researcher in the field,notes that the chances of survivingprostate cancer for more than 15 yearsafter diagnosis are over 90 percent forthe vast majority of men. “This longerlife expectancy has changed the way welook at this kind of cancer,” she says.

“It’s refreshing to see men sharingtheir feelings in a group,” notes SaraKlein, LMSW, the social worker whoparticipates in each session. “Whatmakes this group so special is that thesemen really care about one another.They’re not just in it for themselves.”

For more information, contact Sara Klein at 212-731-6049 or

Two years ago, 33-year-old Frankie Aponte had lost 268pounds, though at 300 pounds he still had a ways to go. But he also stood to lose something else: his right leg.

Like many people with diabetes — a chronic disease char-acterized by the body’s inability to produce enough insulin or properly break down sugar in the blood —Aponte sufferedfrom numbness in his feet, making him vulnerable to silentinjuries. Plagued by an ulcer on his big toe that wouldn’t heal,he had developed osteomyelitis, a chronic bone infection that,left unchecked, could claim his leg.

Aponte was referred to the Diabetes Foot and AnkleCenter at NYU Hospital for Joint Diseases, New York City’sclinic of last resort for those at risk for amputation. “Patientsare frequently referred to us for a second opinion, and we’reoften able to save their limbs,” says Robert M. Lind, M.D.,Assistant Professor of Medicine, an endocrinologist who is thecenter’s Medical Director. In Frankie’s case, he did lose a bigtoe and parts of the other four, but he still has his right foot.

Aponte’s operation was performed by Kenneth J. Mroczek,M.D., Assistant Professor of Orthopaedic Surgery, the center’s

Director. Dr. Mroczek and his colleague Steven Sheskier, M.D., Clinical Assistant Professor of Orthopaedic Surgery, perform about 100 limb-saving surgeries per year, but mostpatients require only non-operative treatments, such as bracingand casting. “One of the biggest fears of any patient with diabetes is losing a leg,” says Dr. Mroczek. “Our goal is tomake sure that doesn’t happen.”

“Many diabetes-related amputations are preventable,”explains Dr. Mroczek. Accordingly, the center’s emphasis is on educating patients about proper self-care, providing earlymedical intervention, and employing state-of-the-art surgicaltechniques to save limbs. He attributes a large share of the center’s success to its multidisciplinary approach and expertise.

The Diabetes Foot and Ankle Center offers the mostcomprehensive program of its kind in New York City. Its specialists comprise a team of podiatrists, led by Dr. LeilaKermani, who provide front-line treatment, a nurse practitionerwho coordinates care, and a social worker who offers support-ive counseling and assistance. The team also includes plasticand vascular surgeons, as well as a rehabilitation specialist.“They’re like a second family to me,” says Aponte.

With some 7,000 patient visits annually, the center reflectsthe growing epidemic of diabetes, particularly among thelargely low-income population it serves. According to Dr.Lind, diabetes afflicts more than 20 million Americans, butonly one in three people with the disease is diagnosed.

For Frankie Aponte, now down to 240 pounds, diabetes is still a fact of life, but one that’s under control. His next goalis to reach his target weight: 190 pounds.

For more information, call 212-598-2378 or visitmed.nyu.edu/hjd/diabetes. ▫

4 news & views • fall 2007

RESEARCH & CLINICAL SERVICES SPOTLIGHT

Last November, former NFL defensiveback Andre Waters, 44, committed suicideafter suffering years of depression. Anautopsy revealed that his brain resembledthat of an 85-year-old man withAlzheimer’s disease. Both his depressionand his brain damage were tied to repeat-ed sport-related concussions, some ofwhich apparently were not properly evaluated or treated.

A new handheld device calledBrainScope, which has been developed by researchers in the Brain ResearchLaboratories (BRL) at NYU School ofMedicine, may help reduce the toll ofconcussions by enabling first respondersto detect subtle brain injuries immediatelyafter they occur. According to the Centersfor Disease Control and Prevention, morethan 1 million sport-related concussionsoccur annually in the U.S., and manymore go unnoticed and untreated.

“Mild-to-moderate concussions often appear as normal findings on sophis-ticated imaging scanners, including CTsand MRIs,” explains the lead researcher, E.Roy John, Ph.D., Professor of Psychiatryand Director of the BRL. Moreover, suchscans must be carried out in a hospi-tal, where they are typicallyperformed hours ordays after the initialinjury, thus delaying treat-ment.

BrainScope, based on Dr.John’s pioneering studies of EEGtracings (recordings of the brain’selectrical activity on an electroen-cephalograph), consists of an adhesivestrip, containing nine electrodes, which areconnected to a mini-computer that resem-bles an oversized iPod. After a suspectedhead injury, a first responder affixes theelectrode strip to the patient’s forehead.The device then collects and analyzes thepatient’s EEGs, which are compared to adata bank of normal scores.

Within minutes, BrainScope’s colordisplay indicates whether any of thepatient’s brain functions deviate from nor-mal and, if so, by how much. This providestimely guidance for medical intervention,says Leslie S. Prichep, Ph.D., Professor ofPsychiatry, Dr. John’s longtime colleague.The device is intended for use as a triage

instrument in a variety of settings: onambulances, in emergency depart-

ments, in clinics, and on thebattlefield.

BrainScope is cur-rently undergoing

preclinical testing atthree hospitals, including

Bellevue Hospital Center,where emergency medicine

physicians are determining whetherthe device is useful in distinguishingbetween strokes caused by clots or bybleeding. Clinical trials for evaluatingpatients with concussion are planned forthis fall. The device, based on patents heldby NYU, is manufactured by BrainScope,Inc., a privately held company located inChesterfield, Mo. ▫

A concussion? Or just a bad headache?

SavingLife and Limbat Joint Diseases

All forOne

Prostate Cancer Awareness Ribbon

Through a regimen of diet and daily exercise, Frankie Apontehas dropped 328 pounds, holding his diabetes in check.

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