i on NIH Vodcast
April 15, 2011
“i on NIH” Vodcast Episode #0025
Welcome to “i on NIH”!
In this month’s episode: details on a spina bifida study, the Heart Truth keeps beating, and details on Dry Eye
From the national institutes of health in Bethesda, Maryland – America’s premiere medical research agency – this is “i on NIH”!
Covering health-research topics important to you and the nation, this public service vodcast is your information source from inside all 27 institutes and centers at NIH.
Half an hour, once a month, we’ll show you the excitement of advances and the important information that comes from medical research. And now, here’s your host, Joe Balintfy.
Host: Welcome to the 25th edition of I on NIH thanks for joining us. We have three stories for you this episode. This first is about a spina bifida study. In this interview we’ll learn what spina bifida is, and we’ll hear about the result of a trial undertaken to evaluate whether or not prenatal surgery for spina bifida was beneficial compared to the standard postnatal repair. We’re talking with Dr. Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human development. The first question: Why was the study undertaken?
Dr. Spong: The National Institutes of Health held a workshop looking at fetal surgery, at the state of fetal surgery as well as fetal surgery for conditions where the condition that was being treated with the surgery was not lethal. Meaning, the baby would survive the pregnancy, such as is the case with spina bifida. At that time, there were a number of sites that were doing this surgery and offering this surgery to pregnant women, but there wasn’t clear data that it was beneficial to the baby. And there was certainly risk—risk of preterm birth, risk of uterine rupture to the mother. So, the culmination of this NIH-sponsored workshop was that a trial needed to be undertaken to evaluate whether or not prenatal surgery for spina bifida was beneficial compared to the standard postnatal repair.
Balintfy: What is spina bifida?
Dr. Spong: Spina bifida is simply an open spinal cord, and myelomeningocele is the most severe form of spina bifida. In myelomeningocele, the spinal defect causes the nerves to come out of the spinal cord, and often you’ll have something called “hindbrain herniation,” where the base part of the brain is actually pulled into the spinal column. This can cause an increase in pressure in the baby’s head.
Balintfy: MOMS began in 2003 and recruitment ended in 2010 (follow-up is ongoing), enrolling pregnant women carrying a child with myelomeningocele at three different locations nationwide. Participants were enrolled on a rolling basis, however, enrollment was stopped early.
Dr. Spong: The study was stopped early after the 183 of the typically planned 200 patients were randomized. And this was because of a dramatic improvement of outcome for both primary outcomes at 12 months and at 30 months in the babies who had the surgery during pregnancy.
Balintfy: What did the study find?
Dr. Spong: What the study found for the 12 month outcome was that there was a significant decline in death or the need for a shunt. Where that only occurred in about 68% of the babies who had the prenatal surgery, compared to 98% of the babies who had the postnatal repair. So about one-third reduction.
At 30 months, there was a significant improvement in the score of both the mental and motor development. In addition, there was significant improvement in the baby’s ability to walk independently, where 42% of the babies who had the prenatal surgery could walk [stammers] independently or without devices, compared to only 21% in the babies with the standard postnatal repair.
At 30 months of age, when looking at hindbrain herniation, about one-third of the babies who had the prenatal repair no longer had evidence of hindbrain herniation compared to only 4% in the postnatal repair group. So the hindbrain herniation was essentially gone for about a third of those patients.
Balintfy: What makes MOMS unique?
Dr. Spong: This is the first time a fetal surgery has been undertaken for a condition that was not life-threatening. Meaning the baby typically survives the pregnancy, and the repair is done afterwards.
Balintfy: Are there risks to fetal surgery for spina bifida?
Dr. Spong: I think it’s important to remember that this is a major surgical procedure that’s being carried out on the mother, and there certainly are risks and the study does show that. I believe that it’s...although the results are very promising for the fetal outcomes, there were significant risks.
Balintfy: What should pregnant women carrying a child with myelomeningocele consider?
Dr. Spong: Fetal surgery requires close monitoring of both the mom and the baby, both during the procedure itself, as well as after the procedure and throughout the duration of the pregnancy. It should be only undertaken by experienced centers that have the multi-disciplinary teams necessary to really care best for both the mom and the baby - and [by] the experienced surgeons who know how to undertake these very delicate procedures.
Host: Thank you Dr. Catherin Spong. For more information on spina bifida and MOMS, visit the website, www.nichd.nih.gov.
In this next feature, we’re reminded that heart disease is the number one killer of women. To take action against it, the National Heart, Lung, and Blood Institute created the “Heart Truth” – a national awareness campaign. While the February Red Dress fashion show is over, the message is important year round.
The Heart Truth
Maria: I really didn’t expect myself to survive.
Christina: It really is a silent killer.
Beatriz: It is a conscious choice that you don’t want to become sick
Erin: You can truly take charge of it. But don’t wait for the bomb to drop, which is what happened to me.
Female Narrator: Heart Disease is the number one killer of women. But the good news is that heart disease is largely preventable…just by living a healthy lifestyle. Our heart health is in our hands.
To warn us about our number one killer and inspire us to take action against it, the National Heart, Lung, and Blood Institute (NHLBI) created The Heart Truth a national awareness campaign for women about heart disease.
At community events and through local programming throughout the country, the campaign encourages us to know our risk factors for heart disease and make changes to achieve heart health for ourselves and our families.
The centerpiece of The Heart Truth is the Red Dress, which was introduced by NHLBI as the national symbol for women and heart disease. The red dress is a red alert for women to take action and take care of their hearts at all ages.
Each February during American Heart Month, The Heart Truth has celebrated the power of the Red Dress through National Wear Red Day® and a partnership with the fashion industry, where the Red Dress symbol comes to life on the runway at the Red Dress Collection fashion show.
Dr. Nakela Cook: We know that if women take care of their hearts and are aware of their risk, they can reduce their chances of developing coronary artery disease.
Some of the risk factors that you can control are smoking, high blood pressure, high cholesterol, and high triglyceride levels, diabetes and pre-diabetes, being overweight or obese, being physically inactive, or having metabolic syndrome.
The risk factors you can't control include having a family history of early heart disease, being over the age of 55, or having had a history of preeclampsia.
It's also important that you know your numbers. We want women to discuss with their physician exactly what their cholesterol numbers are, their blood pressure reading, your body weight and your body mass index as well as your glucose numbers and whether or not you're at risk or may have diabetes.
So it's identifying your risk factors, having a personal conversation with your doctor about your personal risk for heart disease, and targeting where you want those numbers to move in order to reduce your risk for heart disease.
Erin O’Connell Peiffer: When I was 39 years old, I was exercising in a water aerobics class and began to cough and it turns out I ended up at the hospital. They determined that I needed a cardiac catheterization which revealed a 99% blockage.
And the cardiologist, said: “Erin, if you don’t have surgery, you have less than a one percent chance of being here in four months.”
And I very quickly went under the bypass surgery and had a double bypass.
I had a heart attack. I was in and out of the hospital at least a dozen times after my surgery. My life has changed dramatically: physically, emotionally, spiritually, financially. It was a huge struggle for me and my family.
Prior to the event I would have told you that my health was relatively good. In the mid 80s, when I came out of college, I was diagnosed with high cholesterol.
About six months prior to the event I had a couple episodes where my heart just felt like it was quivering, When I think back, I also realize how incredibly fatigued I was.
Women as a whole, we tend to blow it off. And we also tend to make excuses. So part of it is just by educating ourselves we’re empowering ourselves. There’s lots of Web sites out there. Hearttruth.gov has some phenomenal information to help women.
Since the surgery, to stay healthy, every single day I exercise, I take my medicine, I eat right and if need be, I go to see my doctor. My children don’t eat red meat. We only have skim milk. Butter is a thing of the past and I try to reduce stress as much as possible.
I’m very adamant that I exercise and now I walk two miles every day, just because I know I need to keep my heart healthy; my family’s gotten more involved with that. So, I’m hoping ultimately it’s a huge life lesson for them.
Dr. Cook: Commonly when people refer to heart disease, they're speaking of coronary artery disease or coronary heart disease which is a process in which plaque builds up in the arteries of the heart, and particularly the arteries that supply the muscle of the heart.
In a heart attack, an artery that supplies the blood to the heart has a buildup of plaque in the artery that ultimately can rupture and cause a blood clot to form in an area of the artery that could block the flow of the blood down to the heart muscle. And that would cause the heart muscle to die.
If a woman's experiencing signs or symptoms of a heart attack call 911. 911 is really what saves lives because a woman can receive treatment in route to the hospital.
Maria Maiquez Johnson: My heart trouble began when I was pregnant with my youngest child and I had the symptoms of a heart attack.
So they thought I was in labor pain and they, and I had to deliver by C-section and […] five days after that I had another, the same symptoms but this time it was a massive heart attack.
It felt like I was having indigestion. I was sweating. I was throwing up and then there was a little pain on my chest, but not really much. And then when I had the second heart attack which was the massive heart attack, I had exactly the same symptoms. This time the chest pain was like 10 elephants sitting on chest and it radiated on my left arm.
I had jaw pain, I had back pain; the after effects of, of the heart attack are much worse than having a heart attack itself. You know I was in, in deep depression. I was suicidal. I was in denial for a long time. I didn’t know that being healthy would help me be back on track until I found The Heart Truth Campaign.
It's not easy to, to change your life dramatically or to live a healthy life. Where I was raised… the diet is high in fat and cholesterol. Most of the foods are fried and the meat we eat are beef and pork. It, it takes a lot of willpower, determination and support it took me about a year to get to that system of... having to exercise daily and eating healthy and doing away with…sweet or processed foods. I really felt so proud of myself that, you know, I was able to achieve, achieve it.
Christine Gaba: Well after what had happened to my mom, I became more aware of my risk factors because that's the number one thing that she had told me.
I wanted to help people out, so I went into nursing to... to spread that message to other people, too.
I know I have a major risk factor which is family history. But just because I have that risk factor, it doesn’t mean that I have to have heart disease as well. I am working on other things like my diet and my health. I used to not go to the doctor every year, but after that had happened, I would always go to the doctor and make sure my blood work was okay.
We cook together too. We’re partners in crime in trying to get some more vegetables in our family's diet. So we, we try.
Maria: Yeah we're, we're partners in crime. There's so many things that I can change being only 24.
Beatriz Garcha: One of the risk factors is age. In being 65 I’m ten over, ten years over the limit. That’s why I try to make sure that I go to the doctor. I have a family history of heart disease. I like to be active as I am older so I do walk every morning, two, three miles. And in the evening with my husband. So that’s very important to us. I do a lot of gardening as part of my exercise. My husband had some health issues also. Cardiovascular issues. And then he got well and then we decided that we were going to travel and do the best we could while we were young and while we were mobile.
Change comes from within. So I would say that you can do it. If I can do it, anybody can do it. It’s a little bit of discipline.
Natalie Barnes and Christina Morris: I was 18 when I found out that I had high blood pressure. That was during my first pregnancy. I never really took it seriously until I almost died. So that was the start of things for us.
Natalie: It’s very important to know your family medical history. Our father had a heart attack, our mom…
Both Together: she does have high blood pressure and diabetes.
Natalie: I’ve heard it before that Hispanics and African American women have a higher rate of heart disease. I was always in great shape, so –you know- you tend to think just because you look a certain way on the outside that it’s the same on the inside and it’s not necessarily the case. So- you know- it was a wakeup call.
Christina: But we are more conscious of the things we eat now so we tend to eat a lot more salads and more fish and fruits.
She is the motivator. So having her right across the hall from me makes it easier for me to get up and play, just dance on the Wii or pull out my Tai-bo tapes and go outside and maybe run around the park.
Natalie: I think it’s very important to establish a healthy lifestyle earlier – and it’s very important for you to voice whatever health conditions you may have.
Narrator: Heart health is important at all ages. Having just one risk factor can double your chance of developing heart disease. Two risk factors can quadruple your risk, while having three or more risk factors increases your risk for heart disease more than tenfold.
Prevention is Key. Here are some steps you can take to improve your heart health: Don’t smoke, and if you do, quit! Aim for a healthy weight. Overweight and obesity cause many preventable deaths. Get moving! Try for 30 minutes of moderate intensity activity a day. Eat for heart health – Choose a diet low in saturated fat, trans fat, and cholesterol. Eat plenty of fruits, vegetables, whole grains and fat-free or low-fat milk products. Know your numbers – Ask your doctor to check your blood pressure, cholesterol, and blood glucose. Work with your doctor to improve any numbers that are not normal. Know your family’s medical history. Because the The Heart Truth starts with you.
Dr. Cook: It's very possible to make a difference. Heart disease, in and of itself is something that we know is preventable and can be treated and we can reduce the recurrence of heart disease as well as the progression of risk factors.
Christine: It’s never too early to change those risk factors. It’s never too early to…control of your life.
Natalie: We have to be more conscious of the things that we do and the things that we eat and take care of ourselves.
Maria: The red dress, it clearly symbolizes women and heart disease. I mean dress: for women; the red: for heart, love, so it’s really very inspiring.
Erin: The red dress symbol means to me hope. Hope for myself and all women so that they’re aware of the disease and we can take steps to take charge of our heart health.
Host: Again that Heart Truth website is www.hearttruth.gov. And in this third and final feature for this episode, we take a quick look at dry eye.
Narrator: A doctor explains dry eye and how to treat the condition.
Dr. Rachel Bishop: Dry eye disease is very common. In fact, among women over the age of 50, a significant portion suffer from some form of dry eye disease. And what this is is a feeling of irritation, burning, a sandy sensation as if there is something in the eye. Dry eye occurs because the eye is no longer making as many tears or the same quality of tears as it used to. So the way we treat dry eye is by having a patient use artificial eye tears, eye drops, which they purchase over-the-counter. And these can be used as often as they like, but typically four times a day would be an effective treatment regimen for dry eye. In more severe cases, there are some prescription eye drops which can be helpful. In some cases, dry eye is treated also with management of their eyelids with hot compresses and scrubs to help the glands work better around their eyelids. For more information about eye health, about finding an eye care professional, or about locating an organization that can provide financial assistance for eye care, please refer to our Website. That’s www.nei.nih.gov.
Host: That website again is www.nei.nih.gov. And that’s it for this episode on I on NIH. If you’d like to see or forward individual segments from this program, they’re available on YouTube. Check out the NIHOD channel.
Thanks for tuning in and please watch again next time. For I on NIH, I’m Joe Balintfy.
Narrator: “I on NIH” is a public service vodcast from the Department of Health and Human Servives. Produced by NIH News Media Branch, of the Office of the Director, Office of Communications and Public Liaison. Thanks for tuning in. We’ll be back again next month with another episode of “I on NIH.”
Social Media Links