Hulick, MD, MMsc, Medical Geneticist at NorthShore, discusses the increased risk for breast and ovarian cancer in women who carry the BRCA1 and BRCA2 gene mutation. He responds to the recent study from the
Journal of Clinical Oncology on the impacts these mutations have on women as well as identifies ways women can minimize their risk.
What are your general impressions of the new study?
The study, particularly given its size, helps further parse out the details of risk differences between BRCA1 and BRCA2. There have been retrospective studies that have suggested this, but here we have a prospective study that adds further evidence.
In addition, it looks at overall reduction in mortality which shows the gains go beyond the ovarian cancer risk reduction.
Who is most at risk for having the BRCA1 and BRCA2 mutation?
There are many potential ways someone can be at risk, but certain characteristics stand out:
Ultimately, if you have been diagnosed with breast and or ovarian cancer, or multiple family members have, you should discuss the family history with a cancer risk specialist.
What is the difference between the two genes?
Both genes are involved in how the body repairs DNA damage that accumulates and maintaining the “checks and balances” that control cell growth. As this study reinforces, there are differences in cancer risks associated with each. While the risk for ovarian
and breast cancer might be somewhat lower for BRCA2 than BRCA1 (though still considered high compared to average risk), BRCA2 mutation carriers tend to have higher risk for other BRCA-related cancers (e.g. pancreatic, prostate).
What preventative measures can women engage in to minimize their risk of breast and ovarian cancer?
The first step is to get an accurate assessment of one’s risk. Women may still be at elevated risk even if BRCA testing is negative. Other genes and non-genetic factors contribute to ovarian and breast cancer risk. Depending on the risk level, certain
options exist for increased screening, preventative medications or preventative risk-reducing surgery. This is a complex and very personal decision and accurate information about risk is key.
What screening options are available for women to learn more about their risk?
The first thing women can do is to get an accurate family history from BOTH sides of the family, then discuss with one’s physician.
What next steps would you recommend for women with the BRCA1 / BRCA2 mutation?
I would recommend women talk to their doctors about speaking to someone familiar with cancer genetics such as a geneticist, a genetics counselor, or a gynecologist/oncologist/breast surgeon knowledgeable about the management of BRCA carriers. There
are online resources from Be Bright Pink and FORCE that can be helpful in understanding the implications of having BRCA mutation and putting in a plan to reduce risk. As this study and others have shown, we have the ability to greatly reduce one’s risk if
we know one faces these risks.
Foot and ankle pain might be common in active, athletic individuals but that doesn’t mean it can or should be ignored.
If left unexamined, mild foot and ankle discomfort could lead to pain that disrupts day-to-day activities, or even lead to a more severe injury. Pain and noticeable discomfort are signs that there could be something wrong. Identifying the site and source of
the pain could be the first step to getting back on your feet, pain-free.
Lan Chen, MD, Orthopaedic Surgery at NorthShore, discusses foot and ankle injuries common in the sporty set:
Plantar fasciitis. A common cause of heel pain, plantar fasciitis occurs when the plantar fascia, a band of tissue that connects the heel bone to the toes, becomes swollen or irritated. The pain is most severe after long periods of rest—first
thing in the morning or when climbing stairs—and it typically subsides the more active you are throughout the day. In older individuals, plantar fasciitis is caused by the natural wear and tear of aging. Plantar fasciitis is also a common injury in young athletes
and those who spend long periods of time on their feet.
Treatment: There is no cure-all for plantar fasciitis. Giving your feet a break, cutting back on exercise or simply changing your shoes could relieve some or all of the pain. Stretching of the ankle and plantar fascia are also very important.
If you think you might be suffering from plantar fasciitis, discuss your treatment options with your physician.
Achilles tendonitis. Often an overuse injury, Achilles tendonitis is a swelling of the Achilles tendon, which extends from the heel to the calf muscle. Not stretching before and after physical activity, wearing high heels, or simply having
flat feet or fallen arches are all common causes of Achilles tendonitis. Tendonitis pain may be mild to moderate but the pain following an Achilles tendon tear will be sudden and severe.
Treatment: If you give it the time and rest it needs, Achilles tendonitis will heal on its own, but make sure to see your physician to determine the extent of the injury. Your doctor will then help you determine the best way to proceed, which
could include rest or the use of crutches to keep your weight off the injury.
Stress fracture. Stress fractures are small cracks that develop in the bones of the feet, ankle and legs. For active individuals, they are most often caused by overuse in high-impact sports like distance running (e.g. feet repeatedly hitting
the ground). Worn out, unsupportive shoes as well as a sudden increase in physical activity might also be to blame. The most common locations of stress fractures are the second and third metatarsals in the foot, and the bone at the top of the foot called the
navicular. Pain from stress fractures will most likely develop gradually, increasing the more you are on your feet and decreasing when at rest. Also look for swelling and bruising at the site of the pain.
Treatment: Rest is essential! Ignoring the pain could cause more serious injury, including a complete break of the stress-fractured bone. See your doctor to determine the exact location of the stress fracture; treatment varies depending on
the severity and location of a stress fracture.
Turf toe. Common in football players, turf toe is a sprain of the ligaments surrounding the big toe. It’s caused by a hyperextension of the toe, or bending back of the toe beyond the point of normal movement. Injury can occur from a sudden,
forceful movement or repeated hyperextensions over a period of time. Pain, swelling and limited movement of the big toe are all indicators of turf toe.
Treatment: As with many overuse injuries, rest is best. Depending on the severity of the injury, your doctor might recommend immobilization, either by taping the injured toe to another to relieve the stress on the joint or the use of a cast
Ankle sprain. With the ice and snow on the ground, ankle sprains are most common in the winter months. Mechanical twisting of the lower leg and ankle can cause simple ankle sprains, which will heal on their own, or high ankle sprains, which
can be more serious and require additional stabilization in a cast or boot. Other injuries such as ligament tears, tendon strain and cartilage injuries can all occur in an ankle sprain.
Treatment: Most ankle sprains will heal on their own. Resting a short period to allow the initial pain and swelling to subside is common and you may need a brace or boot initially. Chronic pain after an ankle sprain is a clue that there is
something else going on. And that’s when it is important to see your doctor right away. Additional imaging and exam might be needed to clarify the situation and physical therapy might come into play.
Have you injured yourself while playing your favorite sport?
“First and foremost, we’re looking for the best possible outcome,” says
Lalit Puri, MD, Orthopaedic Surgeon and Division Chair of Adult Reconstruction at NorthShore. And, according to Dr. Puri, the philosophy of the Total Joint Replacement Center at NorthShore is that the best possible outcomes are created from strong partnerships
between patients and healthcare professionals.
Dr. Puri shares more information on the partnerships formed between patients and their orthopaedic care teams at the NorthShore Total Joint Replacement Center:
Why is the partnership between patient and healthcare provider so important?
If we enter into a partnership with our patients, we’re asking the patient to give his or her best before and after surgery, just as we’ll give our best throughout as well.
We know that surgery can certainly be anxiety-provoking, but we don’t want patients to come into NorthShore feeling like that. So our partnerships are about trying to demystify the process. Our partnerships start with an open and honest dialogue.
Part of that demystification process is patient education. Why is educating the patient before surgery so important?
It’s critical that the patient has an understanding of what to expect before surgery. Most importantly because it reduces anxiety in the patient’s mind so that he or she is more comfortable with what’s ahead. I also think that the more educated a patient is
about surgery, the more he or she can participate in his or her care. A more informed patient has a better understanding of what is happening, and therefore may be a more active participant.
What does patient education at the Total Joint Replacement Center involve?
A key element of our partnership with the patient is our comprehensive Patient Education Program. This program guides patients through the entire process of a total joint replacement before surgery even happens, from pre-surgery preparation recommendations
to full rehabilitation.
Patients are encouraged to attend a class prior to surgery that is run by a team of specially trained orthopaedic nurses. In this class, they learn what they can do to be active participants in their own care, and have an opportunity to interact with many
of the clinicians who will be a part of their care teams.
The Patient Education Program is not just about educating patients though. Our multidisciplinary team uses this time to learn about the individual needs of each patient by asking and answering questions, getting to know each individual patient, to discover
the best way to help patients maximize their health before the surgical procedure.
Find out more about the Patient Education Program and Total Joint Replacement Center here:
Developing a regular exercise routine is one of the most important elements of a healthy lifestyle, and roughly 53% of Americans show their agreement by exercising three or more days a week. However, participation in any physical activity, whether it's hitting
the gym or the slopes, increases your risk for an exercise-related injury. Still, the health benefits of exercise far outweigh the risks, as long as you approach each new physical activity and sport armed with the right information.
Get fit but also stay safe with the help of our sports injury prevention infographic. Learn how to recognize common sports injuries that affect both athletes and energetic amateurs and use our simple, easy-to-follow sports injury prevention tips to keep
you pain free and active. Click on the link to view our full NorthShore University HealthSystem
The update to a report first published 25 years ago in the British Medical Journal continues to raise important questions about the value of mammography; however, it must be considered in the context of other randomized trials that
confirm a significant reduction of breast cancer mortality in women who regularly undergo screening mammograms. This report shows, as it did previously, an improvement in survival rates for women who had their breast cancer detected via mammogram before clinical
signs of cancer had become apparent.
As screening technology continues to evolve, screening guidelines may be modified. At present, there is convincing data that women should have annual screening mammograms beginning at 40, as suggested by the American Cancer Society’s guidelines. Those with
a strong family history or a genetic predisposition may begin screening earlier after consultation with their physician.
For more information on mammography services and locations at NorthShore, please visit
Have medications and physical therapy done little to relieve your joint pain? Are you hoping to find a way to get
back to the things you love without having to worry about pain? Total joint replacement might be the next step, but it’s a step you shouldn’t take without asking some important questions first.
Ravi Bashyal, MD, Orthopaedic Surgeon, specializing in minimally invasive hip and knee replacement surgery at NorthShore, answers questions on total joint
replacement surgery, from what makes someone a good candidate to recovery, rehabilitation and beyond:
Who is a good candidate for joint replacement surgery?
Total joint replacement surgery is an excellent option for patients who have "worn out" their hip or knee joint, found little relief from conservative management options such as injections or medications, and who feel that their worn-out joint is significantly
impacting their ability to enjoy their daily activities and life.
Are there minimally invasive options for total joint replacement?
Yes. There are many new techniques and implants that allow total joint replacements to be done now in a much less-invasive fashion than in the past. These innovations can allow for shorter surgical times, lower complication rates and faster recovery. Talk
to your surgeon about his/her personal approach, and how you might fit into this as an individual patient.
What should a total joint replacement patient do prior to surgery?
There are numerous steps one should complete prior to a joint replacement surgery:
First and foremost, meet with an orthopaedic surgeon to make sure you are a good candidate for this type of surgery. He or she can talk to you about possible risks, recovery times and patient outcomes. Also make an appointment with your medical doctor and
any other specialists (i.e. cardiologist) to make sure you are medically cleared to safely proceed with surgery.
Attend a class regarding joint replacement at the NorthShore Total Joint Replacement Center. This is an excellent opportunity to participate in a program focused on hip and knee replacement. You'll have a chance to meet with nurses, physical therapists,
social workers, and other team members that will explain the ins and outs of what to expect before, during and after your surgery and during your hospital stay.
Make a pre-operative appointment with your surgeon and his/her team. This will give you a chance to review what you have learned during the pre-operative process, discuss any questions/concerns that may have come up, and to feel comfortable and confident
going into your surgery.
What can a patient do to help to ensure the best possible outcome?
Become a partner in your care. The Total Joint Replacement Center at NorthShore is there to guide patients from beginning to end, from pre-op to rehabilitation. Patients are encouraged to communicate with their surgeon but also with our highly trained orthopaedic
nurses and staff throughout the process. We feel that it’s important for our patients to have a thorough understanding of what to expect before, during and after surgery.
How long should you expect to be in the hospital after a total joint replacement?
Most of our hip-replacement and knee-replacement patients are ready to be discharged 2-3 days after their operation. Some patients are even ready to go home the day after. Many of our patients go directly home after surgery with in-home nursing and therapy
arranged by our social work team, while others elect to go to an inpatient rehab center prior to going home. Ask your surgeon what to expect, and discuss with him/her what would work best for your individual situation and preference.
While recovery time varies case by case, what timeframe for recovery should a patient of total joint replacement expect?
Recovery is different for everyone. With our use of minimally invasive techniques and advanced post-operative care, many patients are recovering at a much quicker pace than 10 or 15 years ago. We have many patients back to work and activities within a few weeks.
Of course, this is subject to individual recovery times, and the specific activities that each patient will return to after surgery. A discussion with your surgeon about your recovery is an important part of the pre-operative process.
What about long-term? How long should someone expect an implant to last?
Innovations in joint replacement technology have dramatically increased the longevity of many types of implants. Many currently available implants can survive for 20 or more years, and even if these devices "wear out," currently technology allows us to replace
only the worn-out part without having to re-do the entire operation or replace all the parts.
Dunlap, MD, Orthopaedic Surgeon and Sports Medicine specialist at NorthShore, has been treating elite-level hockey players since 2009. He has worked with USA Hockey as a team physician during tournaments in the United States and Europe. As a former college
hockey player, his own personal athletic experience provides insight into the way athletes think, both in injury and health.
Here, he tells us what inspired his pursuit of sports medicine and why getting an athlete back in the game is the biggest reward of all:
Were you a hockey player yourself?
I grew up playing hockey starting at the age of five and played through college at Yale University. I still play occasionally in adult hockey leagues and am on the ice several times a week helping coach my nine-year-old son’s team. My daughters, ages four and
five, are also on the ice, learning to skate.
What made you choose sports medicine/orthopaedics as a specialty?
I sustained a knee injury that required surgery while playing hockey my freshman year in college. My surgeon was a former Yale football player and he did a great job taking care of me. He got me back on the ice without missing a beat. That’s what sparked
my interest in orthopaedics and, in particular, sports medicine. I love working with motivated athletes, helping them to get back to the best of their abilities. I feel that as a former athlete, I have some insight into how athletes think and take great joy
in seeing them get back into the game.
What is the day-to-day like for a team physician, particularly as a physician of hockey players?
There is actually a lot of down time covering these tournaments. I love being around hockey, talking hockey with the players, coaches and training staff so I get to be around that during these tournaments. Typically, I consult with the training staff
and evaluate players before and after practice and am obviously ready should there be any injuries that occur during game play. While there are the more significant injuries to tend to (lacerations, dislocations, concussions), many times it’s just as important
to make sure that things such as pink eye don’t spread throughout the team or that a player with the flu has a separate water bottle from the rest of the team. Hockey players in general are great to deal with. The perception is that hockey players are rough
and tough, but they actually tend to be good-natured, down to earth, and appreciative of the help we can provide.
What challenges have you encountered as a hockey team physician?
As with any elite athletes, the players we work with are incredible competitors. They love hockey and they love to be on the ice. However, it can be difficult at times as they can minimize the significance of injuries, especially those that require
subjective complaints and feedback such as concussions. It is my job to make sure we look out for the athlete’s best interest and health, both short-term and long-term. It can be unpopular to pull a player off the ice, but if it’s the right thing to do then
that is ultimately my job and that is why I’m there with the team.
What are the rewards of working with elite athletes?
The biggest reward is seeing the players succeed. The team physician is just one cog in the wheel to maximize and optimize the players’ abilities. There is also personal satisfaction for me in being able to combine two of my passions: hockey and medicine.
How does your work with USA Hockey inform your treatment of other patients?
I think working with athletes of any level is fundamentally the same. Is there a difference between working with the elite young athletes at USA Hockey who will someday make hockey their profession and a weekend warrior who just needs to be able to be on the
ice or court Saturday afternoon? Absolutely. But my goal is the same: to keep them in the action and maximize their ability to compete and be at their best.
For an athlete there is nothing worse than suffering a sports injury that takes him/her out of competition. While some
injuries require more rest and rehabilitation than others, those who undergo surgery for an anterior cruciate ligament (ACL) injury need to take it slow before heading back into play.
In most cases, ACL surgery is done through small incisions, or arthroscopic surgery, rather than open surgery. Not only does this help reduce scarring and decrease recovery time but it can also help reduce complications and risks. Often the surgery is performed
on an outpatient basis, meaning the patient won’t have to spend even a night in the hospital. Outpatient surgery doesn’t make recovery any less serious, however.
Patrick Birmingham, MD, Orthopaedic Surgery and Sports Medicine at NorthShore, shares his tips for ensuring a safe and
speedy recovery from ACL surgery:
Have you had ACL surgery or know someone who has?