Health

The fourth of 5 operations you don't want to get—and what to do instead.

A whopping 60 million Americans experience heartburn at least once a month; some 16 million deal with it daily. So its no wonder that after suffering nasty symptoms (intense stomach-acid backup or near-instant burning in the throat and chest after just a few bites), patients badly want to believe surgery can provide a quick fix. And, for some, it does.

A procedure called nissen fundoplication can help control acid reflux and its painful symptoms by restoring the open-and-close valve function of the esophagus. But Jose Remes-Troche, MD, of the Institute of Science, Medicine, and Nutrition in Mexico, reported in The American Journal of Surgery that symptoms dont always go away after the popular procedure, which involves wrapping a part of the stomach around the weak part of the esophagus.

“That may be because surgery doesnt directly affect healing capacity or dietary or lifestyle choices, which in turn can lead to recurrence in a hurry,” he says.

The surgery can come undone, and side effects may include bloating and trouble swallowing. Remes-Troche believes its best for very serious cases of long-standing gastroesophageal reflux disease (GERD) or for those at risk of Barretts esophagus, a disease of the upper gastrointestinal tract that follows years of heartburn affliction and can be a precursor to esophageal cancer.

What to do instead
Make lifestyle changes. A combination of diet, exercise, and acid-reducing medication may help sufferers beat the burn without going under the knife. But its a treatment that requires perseverance.

“It took me four years of appointments, diets, drugs, sleeping on slant beds—and even yoga—to keep my heartburn manageable,” says Debbie Bunten, 44, a Silicon Valley business-development manager for a software firm, who was eager to avoid surgery. “But I did it, and am glad I did.”

Pose for a picture. Another technological development can make a heartburn diagnosis easier to swallow—a tiny camera pill that beams pictures of your esophagus (14 shots per second) through your neck to a receiver or computer in the doctors office; it passes harmlessly out of your system four to six hours later. The $450 Pillcam (a similar camera capsule from Olympus is awaiting Food and Drug Administration approval) can be used instead of standard endoscopy to screen chronic-heartburn sufferers for various esophageal complaints, including GERD, which can develop into the potentially precancerous Barretts esophagus. Unlike an endoscopy, in which youre sedated and a lighted tube is snaked down your throat, a capsule camera leaves you wide awake and is finished within 20 minutes, says Pillcam guru David Fleischer, MD, a staff physician in gastroenterology and hepatology, and professor of medicine at Mayo Clinic College of Medicine. If anesthesia makes you sick, the capsule camera may be for you.

The Craigslist ad was short and to the point: “Please Help Us, My Dad Needs a Kidney!” Jennifer Flood, 30, and her sisters (her twin Cynthia and older sibling Heather, 32) posted the message on Craigslist in a desperate attempt to find a someone willing to make the ultimate sacrifice: donate a kidney to a complete stranger without asking anything in return.

That ad launched a chain of events that eventually led the Pleasantville, N.Y.-based family to find such a person—a 48-year-old California woman named Dawn Verdick—who was willing to donate a kidney to their father, Daniel Flood, 68. The kidney transplant took place December 12, and the family is beyond grateful.

The journey was incredible, but it was also difficult, Flood says, and Craigslist isnt the easiest way to find an unrelated organ donor. But there are plenty of people trying to do the same on the free online network, including patients in New Jersey, Colorado, Pennsylvania, Delaware, and other areas.

“Were not recommending people to post ads on Craigslist, just because theres a lot of loopholes, a lot of scammers. If youre not skilled at sifting through tons of information, its not going to work for you,” says Flood. She called the experience an “emotionally draining, physically draining journey.”
Next Page: When Flood found out… [ pagebreak ]When Flood found out in 2007 that her dads kidneys were failing, she was shocked. Like many parents, her father had tried to protect his children from the bad news for as long as possible.

Although Flood, her two sisters, and their brother, Christopher, knew their father had hypertension and was taking blood pressure–lowering drugs, they didnt know his kidney damage was so bad that he needed dialysis—or a kidney transplant—soon.

“He kind of kept it a secret; he was trying to protect us from his illness,” says Flood. Immediately, the family members had themselves tested to see if they could donate a kidney, but no dice. (Although kidney transplants do require tissue matching, having a matching blood type is even more important.)

Flood, a psychiatric nurse, knew that the statistics werent encouraging. Roughly 17 people in the U.S. die each day while on waiting lists (which are managed by the United Network for Organ Sharing (UNOS)), and about 80,000 people are currently on the waiting list. Patients can wait anywhere from two to six years for an organ. Flood also knew that sometimes these organs, which come from cadavers, dont function as well as those from a living donor.

Their desperate solution? Put an ad on Craigslist. The family was already using the site for just about everything—to find jobs, childcare, and to buy and sell items. "We all just came together and said, 'Why not use Craigslist to find a living donor for dad?'" she says. "Even though its a shot in the dark, why not try?"

They posted an ad in August 2007 and not much happened. But then a local journalist saw their post and mentioned it on a radio show; the responses started streaming in. Overall, there were more than 100 replies to the ad within a few months.
Next Page: Posting the ad… [ pagebreak ]Posting the ad turned out to be the easy part. “It was tons of work,” says Flood. She and her sisters had to wade through the responses to find an appropriate donor.

They interviewed all the candidates and sent likely candidates a kit for a blood donation. They ended up with five possible donors, and after tissue matching were left with three. Two were ruled out due to other medical conditions, leaving Verdick, a childrens book publisher, who ended up donating a kidney to their father.

But part of the screening process including steering clear of people who wanted to sell a kidney, which is illegal.

“You can tell right away,” says Flood. “The conversations are, 'You know, I cant pay my bills this month; Im going to need that much for this.' Thats when you pretty much know where its going.”

In fact, finding a kidney donor on the Internet is a controversial practice because of the potential for abuse, says Flood.

Typically, the organ recipients health insurance covers the donors surgery to have the organ removed. By law, the recipient can also pay for the donors lost wages, travel expenses, accommodations, and other transplant-related expenses, but thats it. (Which is what the Flood family covered for Verdick.)

Looking for a donor was so tricky that the Flood sisters launched a foundation in March, the Flood Sisters Kidney Foundation of America, to provide a matching service for patients and altruistic donors willing to take the leap and donate a kidney to a stranger. They have postings from potential donors and recipients, including one potential donor who originally responded to the Craigslist ad but wasnt a match for Daniel Flood. (They charge fees for posting on the site.)

However, there are other resources for people looking for an unrelated kidney donor.
Next Page: Ruthanne Hanto, RN, MPH… [ pagebreak ]Ruthanne Hanto, RN, MPH, clinical program manager of the New England Program for Kidney Exchange (NEPKE), has never heard of someone finding a donor organ on Craigslist.

“Whats unique about this family is that they are very strong advocates for their father and they have the resources to investigate other options,” she says. “Not everybody has the knowledge or tools available to do that.”

Had Craigslist not worked out, the Flood family could have pursued paired kidney donation, she says, which helps people who have a friend or a family member willing to donate but unable due to a blood-type mismatch. Donor A and recipient B are paired to donor C and recipient D; donor A gives a kidney to recipient D, and donor C gives one to recipient B.

“Exchange programs are a way that these people who dont match to their family and friends can actually donate a kidney and get more people transplanted in the bargain,” says Hanto.

The first paired donation in the U.S. took place in 2000, and the practice started to pick up speed in 2004, when computer optimization programs were developed. There are now several networks in the country doing paired donations: Johns Hopkins University; the Alliance for Paired Donation, in Toledo, Ohio; and NEPKE are the largest, says Hanto. Many of these networks are regional. For example, NEPKE largely works with donors and recipients in six New England states and several centers in New Jersey.

However, they are willing to work with any transplant center in the country to help facilitate a swap, she says.

NEPKE averages 9 to 10 paired donations per year, and nearly 500 have been done in the U.S. so far, according to Hanto. One big advantage of paired exchanges is that people who want to volunteer to donate a kidney to anyone in the network can help two or more people get a kidney—the person they match and a person who is a good match for that individuals family or friend who is willing to donate (and so on).

Paired donation programs have been such a success that UNOS is launching a pilot program in the spring of 2010 to have a more national system, she says.

“Im very much looking forward to paired exchange moving to a national level,” says Hanto. “People are limited right now because they dont have a paired exchange program near them.”

There are also other donor-recipient matching services, notably a site called MatchingDonors.com. For a one-time cost of $595, the site allows people seeking an unrelated kidney donor to post information about themselves. The nonprofit service allows a free posting if an individual is unable to pay.

“We developed this website back in 2003, and our first successful match that went on to surgery was October of 2004,” says Jeremiah Lowney, DO, the sites cofounder and medical director, who said hes never heard of a family using Craigslist to find a donor organ. The site has had 91 successful matches that have gone on to surgery, he says. However, the site doesnt screen potential donors in any way. It currently boasts 380 recipient profiles and 5,500 potential donors.

Once the potential donor contacts the patient, the patient has a transplant center send the donor a test kit; the donor then goes to a doctor or a local lab to draw a blood sample. The transplant center, in turn, determines if the two have matching blood types.

Alternative-donation options arent well known and may be missed by families grappling with a health crisis. This was true for the Flood family, although it worked out in the end.

“We didnt know at the time about MatchingDonors.com or any other paired donation procedures,” says Flood. However, she notes that “when we received over 100 responses in October 2007, we knew there was hope in Craigslist.”

“We put it out the universe, and people are good out there; I dont think a lot of people realize that theres good people in the world.”

Q: Between my job and family, Im so crazed its making me cranky. I lash out at my family all the time. How can I get some Me Time so I stop snapping at everyone?

A: You can start by treating the driveway as your transition space. When you pull up, sit there a minute and ask yourself: How do I want to show up for my family? Do you want to be patient, loving, and attentive, or reactive and angry?

Make the decision to behave in a way that makes you proud of yourself. Also, change out of your work clothes when you get home to consciously and physically separate your office self from your home self. If work stress starts seeping in, cut it off by reminding yourself that the place to tackle it is at your office, tomorrow. Here, a few tips for managing stress:

Control your anger.
When you feel anger coming on, its best to take a time out. Head to a different room or go outside, and remember your intention of being loving and calm. To excuse yourself without hurting others, tell them that “you deserve to have my full attention, but I cant give it to you right now, so I just need a few minutes by myself.”

Work in Me Time.
Time alone is essential to your well-being. So put it on your to-do list (at the top!). Whether its 20 minutes in bed with a book, a soak in the tub, or a walk, taking this breather will make you feel more relaxed. And dont be afraid to ask for help so you can steal that solo time. Once you reconnect with yourself, youll be a calmer mom, partner, and friend.

The fifth of 5 operations you don't want to get—and what to do instead.

Since the 1980s, operations for lower-back pain and sciatica have increased roughly 50 percent, from approximately 200,000 to more than 300,000 surgeries annually in the United States. That rise is largely due to minimally invasive advances that include endoscopic keyhole tools used in tandem with magnified video output.

To its credit, surgery (endoscopic or the traditional lumbar-disc repair) does relieve lower-back pain in 85 to 90 percent of cases, docs say. “Yet the relief is sometimes temporary,” says Christopher Centeno, MD, director of the brand new Centeno-Schultz Pain Clinic near Denver. And that adds up to tens of thousands of frustrated patients who find the promise of surgery was overwrought or short-lived.

What to do instead
Try painkillers and exercise. Despite the relentless nature of lower-back pain, the most common cause is a relatively minor problem—muscle strain—not disc irritation, disc rupture, or even a bone problem, experts say. Despite its severity, this type of spine pain most often subsides within a month or two. Thats why surgery, or any other invasive test or treatment beyond light exercise or painkillers, is rarely justified within the first month of a complaint. Even pain caused by a bulging or herniated disc “resolves on its own within a year in some 60 percent of cases,” orthopedists claim.

“Seventy to eighty percent of the time we can get to a concrete diagnosis, find a way to manage pain, and get patients off the drugs without surgery,” Centeno says. “Or, more appropriately, never start the drugs.”

“We used to prescribe 30 days bed rest for patients with herniated discs, but that was 15 to 20 years ago,” says Venu Akuthota, MD, medical director of the Spine Center at University of Colorado Hospital and associate professor of medicine at the University of Colorado School of Medicine. “Actually, movement is very helpful for treating back conditions. Nowadays, we prescribe moderate, low-impact exercise, like walking, or working out on an elliptical trainer or treadmill.”

Learn about stem cells. Ive seen the future of back surgery firsthand. And it looked to me, from behind my surgical mask, as if a womans bare behind was doing much of the work. Up close, huddled inside the Centeno-Schultz Pain Center, I joined a team of MDs, a PhD, and two nurses to witness orthopedic history in vivo: an adult stem cell (ASC) transplant to help bones and joints grow anew.

In the midst of the huddle, Centeno, the back- and neck-pain specialist, is plunging a needle that looks big enough to use on a horse deep into the hip bone of a 54-year-old weekend athlete and skier whos been forced to the sidelines by injury and long-term lower-back pain. The patient is tired of pain pills but wary of major surgery. Instead shes undergoing one of the first ASC orthopedic transplants in the nation.

The harvested stem cells will be used to grow millions of new ones that will be implanted in her back to spur and regenerate more youthful, healthy joint tissue—if all goes as planned in this part of an ongoing study approved by a medical research institutional review board, that is. So far, at least, it has. Early MRI pictures of related procedures have shown impressive growth of regenerative tissue. And theres even better news: By using the patients own stem cells, the surgical team avoids the ethical debate over using embryonic tissue for research purposes.

Age: 29
Home: Carbondale, Colorado
Profession: Program director for an adolescent drug-abuse-prevention program
Passions: Playing Scrabble (and winning!); hanging out at home with friends; a good, sweaty trail run

“If you dont take care of your body, where will you live?”

Just about any woman whos ever struggled with a body-image issue is celebrating the recent backlash against superthin supermodels—and no one more so than Health reader Karyn Simmons. Karyn has made it her mission to help young women embrace the idea that being healthy is as much about your mind, your emotions, and your relationships as it is about how much you weigh or how often you exercise.

For Karyn, the issue is personal. Eight years ago, after seeing a close friend die from anorexia, Karyn struggled with guilt. “I felt pretty worthless at the end of Carries life,” she says. “Every time we talked, I told her I loved her. But after she died, I realized she needed to know I loved her not because she was tall, thin, and beautiful—but for the way she listened, for her silly jokes, for her humility. And she needed to hear that when she was a teenager, not when anorexia had completely taken over.”

This realization prompted Karyn, a middle school English teacher, to jump at the chance to teach her schools health and wellness class, where she spent three years sharing Carries story. “Many teens believe they need to be perfect—the smartest, the most popular, always happy. I want them to know its not about being the best; its about balance.”

Now working with a substance-abuse-prevention program, Karyn continues to inspire change in kids when theyre most vulnerable. “I talk about Carrie in the present tense because I believe she served an incredible purpose in this world,” she says. “I feel like I have found my lifes work.”

We met Karyn during Healths Real Beauty Road Tour 2006 with photographer Nigel Barker of Americas Next Top Model.