Updated 12:40 PM CST, Thu, Nov 20, 2008

A lesson in listening to your hormones.

Hormones shouldn’t control anyone’s life. But for those who what to look for, and when, hormones may give their brain an boost for whatever they do.

Harnessing your hormones to boost productivity.

Hormonal? It can help your brain

The latest research is tracking hormonal levels throughout the day, NBC5’s Nesita Kwan reported on Wednesday.

They can be different for every person, but in general, the hours between 7 and 9 a.m. are highest for Oxytocin, which some scientists call the love hormone.

“We probably are feeling very loving, very amorous toward the husband or the boy friend or whoever,” says Chicago neuroscientist Leonard Cerullo. It’s also a time you’ll want to give your kid an extra hug, and kiss the spouse off to work.

After 9 a.m. the stress hormone cortisol kicks in. People are alert, sensitive and at their most creative, which makes it a good time to brainstorm with colleagues. After 11 a.m. people are fully awake, because their sleep hormone, called melatonin, is slowly draining away, which is when it’s best to take on challenging conversations, or tackle that endless list of emails. By 3 p.m., energy levels may be at their peak as melatonin levels bottom out. It’s an ideal time to exercise.

To determine the best mix, health psychologists suggest people keep a diary of moods and energy for at least a couple of weeks, then use their notes to build their own hormonal schedule.

“The most important thing is to become aware of, and sensitive to how you feel, which is a reflection of the total number of hormones reacting in all the cells of the body,” Cerullo said.

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“Nursing is one of the best things you can do for yourself…it is always there for you.”

Jennifer Casella, an ICU Staff Nurse and Resource Nurse at the Neurologic & Orthopedic Hospital of Chicago (NOHC), credits NOHC founder and neurosurgeon Dr. Leonard Cerullo with jump-starting her career as a specialty nurse. She also credits him for her satisfying work-life balance today.

In 1988, when Jennifer was just finishing nursing school at Ravenswood Hospital, her mother was diagnosed with a brain tumor, specifically an acoustic neuroma (8th cranial nerve which involves hearing). Shocked and scared, she and her parents looked for solutions. They came upon an article in a recent issue of Readers Digest about brain tumors, written by celebrated Chicago neurosurgeon Dr. Len Cerullo. A neurosurgeon for more than 30 years, Dr. Cerullo is often referred to as the “godfather” of neurosurgery. He is the founder and medical director of the Chicago Institute of Neurosurgery and Neuroresearch (CINN), Chicago, and is widely recognized as one of the nation’s leaders in the field of neurosurgery.

Jennifer was impressed with what she read and wasted no time in taking her mom to see him. During her mom’s subsequent successful treatment, Jennifer was so impressed with his surgical skills and the field of neurosurgery in general, that she sought to launch her nursing career in the neurosurgery unit working alongside Dr. Cerullo.

Jennifer enjoys learning more about neurosurgery in her position at the Neurologic & Orthopedic Hospital, which was also founded by Dr. Cerullo and is home to CINN. She works as a resource nurse in charge of an entire unit and in this capacity she is responsible for responding to any patient’s need, from triage to treatment. In addition, she is stationed in the ICU/medical surgical unit to care for post- op patients who have had spine, brain or orthopedic surgery.

While working, Jennifer enjoys the camaraderie with both patients and co-workers. “Patients come back to see me all the time,” she explains. “They thank me for helping them and even saving their life. I have definitely seen my share of difficult cases, but it is so wonderful to see patients walk back in to thank me. There could never be a more rewarding job!”

In addition, she appreciates the way the NOHC nurses, doctors and staff depend and rely on one another. Many of the nurses and doctors Jennifer started working with 20 years ago are still part of the team at NOHC and the staff has come to feel just like a family. In fact, she and surgeons Dr. Mkrdichian and Dr. Cerullo know each other so well that they instinctively know what the other will say or do. “It is way more than a job,” Jennifer says. “It’s a fun, comfortable and completely fulfilling place to work. It’s another home away from home.”

Jennifer admits that one of the best part of her job is the flexibility that allows her be with her children while they are young. A work-life balance is extremely important to her, now that she is mom to 13-year-old Joey and 6-year-old Frankie. Over the years, NOHC management, has worked with her to develop a flexible schedule, which allows her to spend more time with her kids and still provide a valuable contribution to patients. In addition, she will be able to return to work full-time when the time is right.

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Complimentary Back Pain Brochure and Smoking Tips
Offered by CINN during Great American Smokeout Week

Chicago, November 5, 2008 – Smoking cigarettes not only contributes to lung cancer and emphysema; it also leads to back pain and spine problems according to recent studies and observations from leading neurosurgeons in Chicago.

Physicians at the Chicago Institute for Neurosurgery and Neuroresearch (CINN), are encouraging Americans to “kick the habit” during the Nov. 20 Great American Smokeout, a national nonsmoking day sponsored by the American Cancer Society. Throughout this month, CINN will offer a complimentary booklet for back pain sufferers with tips for “kicking the habit.”

Recent studies, show smokers and former smokers are more likely to have more back problems and suffer from chronic back pain than non smokers. In a study published in the July 2008 Deutsches Arzteblatt International, it was determined that smokers and former smokers experienced chronic back problems more frequently than nonsmokers. Physicians attribute it to the nicotine, which restricts the flow of blood to the discs that cushion the spine.

“I have seen a number of failed spinal fusion procedures that could have been avoided if the patient would have stopped smoking,” says Dean Karahalios, M.D., spine neurosurgeon at CINN. “Smoking can also compromise a patient’s ability to recover from spinal fusion surgery.”

Fifty-two year old Sheree Maddex of Chicago, one of Dr. Karahalios’ spine patients did get the message and quit smoking. She is genetically predisposed to degenerative disc disease. Her father and son both have severe back problems. She had her first cervical spine fusion in 2001. While her first surgery was successful, due to further degeneration in 2002, she had her L4 and L5 disc replaced by Dr. Karahalios. Then in 2004, she was surprised to learn she had lung cancer. After she had had her upper right lobe removed, she vowed to throw the cigarettes away forever. But she says, it may not have been soon enough.

“After 30 years, I finally quit,” Sheree admits. “I realized that I wasn’t getting any healthier and it was keeping me from healing after surgeries.”

Sheree says her lung cancer is gone, but she continues to struggle with disc degeneration. Her debilitating pain prevented her from going to work at Evanston Hospital, where she was a cancer researcher. She couldn’t stand or sit for any prolonged period of time. Dr. Karahalios recently fused four discs in her spine, replaced hardware and implanted a titanium cage around a section of her spine to prevent further compression and to help heal the bone fragments. Presently she spends an inordinate amount of time in physical therapy.

Sheree adds, “Dr. Karahalios said it would be a slower recuperation than after my initial surgery, but I listen carefully to everything he says. I look forward to the day that I’m completely pain-free.”
“Sheree has strength and determination,” says Dr. Karahalios. “She was smart to quit smoking because she wasn’t healing properly. My advice for everyone is: don’t smoke, and if you are smoking now, please quit.”

The booklet can be obtained by visiting www.cinn.org or by calling 773 250-1009.

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As highlighted, complications for the spine surgeries performed at the Neurologic & Orthopedic Hospital of Chicago are 91% lower than the national average for 2008.  This surpasses the already excellent outcomes achieved in the prior year which are indicated on the graph (76% lower than the national average).  Once again the Neurologic & Orthopedic Hospital of Chicago has been recognized as the #1 hospital in the state of Illinois for Spine Surgery by HealthGrades.

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In developing its 2009 healthcare quality ratings, released today, HealthGrades analyzed more than 41 million Medicare hospitalization records from 2005 to 2007 at the nation’s approximately 5,000 non-federal hospitals.

As part of the nation’s most comprehensive, independent analysis of hospital quality, HealthGrades found that patients treated at five-star rated hospitals for nine common procedures are 47 percent less likely to experience a major complication, such as post-operative infections or heart conditions, which can lengthen their hospital stay and increase costs. According to the study, if all Medicare patients had been treated at a top-performing hospitals, like the Neurologic & Orthopedic Hospital of Chicago, compared to the lowest-performing hospitals during 2005-07, more than 123,000 major complications potentially could have been avoided.

“The study confirmed what we already know, “says Dr. Leonard Cerullo, Medical Director of NOHC. “We have some of the finest spine surgeons and spinal care clinicians in the nation. In fact, only 52 hospitals in the country have been recognized as being in the top 5%, and we were one of them. To be the only hospital in Illinois is an even greater honor.”

THE NEUROLOGIC & ORTHOPEDIC HOSPITAL OF CHICAGO
The Neurologic & Orthopedic Hospital of Chicago is the country’s only freestanding acute care facility dedicated exclusively to neuroscience and orthopedic services. During 2007, more than 2,000 neurosurgical and orthopedic surgeries were performed at NOHC. The brain and spinal fusion surgeries at NOHC have been acknowledged by many of Chicago’s well-respected insurance companies as having the fewest complications. A similar level of excellence is seen on the orthopedics side of the hospital.
LOCATION AND FOR MORE INFORMATION:
NOHC is located at 4501 N. Winchester Street in Chicago. For more information on NOHC, log on to www.neuro-orth.org.

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Ninety degree temperatures created a medical emergency for many Chicago Marathon runners last year, paving the way for improved medical care for Sunday’s 31st annual race.
The event was halted last year after four hours because temperatures hovered at nearly 90 degrees. One runner died after collapsing in the marathon and numerous others required hospital care.

The added health care includes 20 “aid stations” spaced one to two miles apart this year compared to 15 last year, according to race organizers. Medical professionals will be available at the stations along with water, Gatorade, and restrooms.

Race organizers also announced the addition of an extra medical tent available at the 26-mile mark along with the main medical tent at the finish line. The tent offers varied medical services. Some other added safety measures include a color-coded weather alert system customized to monitor and report wind, temperature and humidity conditions along the course of the race.

“We learned a lot from the experience of the 2007 race,” said Carey Pinkowski, executive director of the Bank of America Chicago Marathon in a recently released statement. “The improvements and additions for 2008 will strengthen this race by providing a stronger runner support system and offering insight to our road racing peers.”

Still, runners can avoid problems by adhering to simple sports fundamentals.

“Regularly consume water during the marathon,” said Dr. Paul Lento of the Rehabilitation Institute of Chicago. Watch for neurological symptoms such as lightheadedness, dizziness or swelling of the limbs, he said. “Those types of things may indicate a heat illness and someone should seek out a medical station.”

People should listen to their bodies, according to Lento. After training for an extended period of time to run the race, people should understand their limits.

“People have to have a plan,” said Dr. Preston Wolin, the director of the Sports Medicine Program at the Neurologic and Orthopedic Hospital of Chicago. “We are talking about several months [of training],” he said. “I think we all learned last year about the importance of hydration, not only during the race, but beforehand and after. There is not really any substitute for that. People tend to forget that hydration is important even on days when it is not hot.”

First-time marathoners should hydrate every chance they get and remember that the race is a marathon, not a sprint, said Chris Hall, the University of Chicago’s men’s and women’s cross-country and track and field coach,. Approximately 40 percent of the 45,000 marathon participants are first-timers, according to race organizers. That means an estimated 18,000 first-time participants for this week’s race.

“You will feel like this is easy [at first],” Hall said. “It’s a challenge to keep yourself controlled and to think your way through the early stages of the race versus getting caught up in it. The best advice for the beginners is that they are very cautious during the early stages of the race.”

The weather forecast for Sunday calls for mostly cloudy skies and temperatures in the low 70s, according to weather.com,. “That is still pretty warm,” Hall advised. “But that is not nearly what it was a year ago. It was tough out there, even watching as a spectator.”

The 26.2-mile marathon course begins and ends at Columbus Drive in Grant Park.

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As a linebacker on the Hinsdale Central football team, senior Brendan Sullivan takes pride in delivering punishing hits to opponents.

On occasion, however, he’s been the one to get his bell rung.

Sullivan, who also is an avid boxer and former wrestler, has suffered two concussions that he’s aware of during his athletic career but has no plans on hanging up the cleats.

“It’s never crossed my mind,” Sullivan said. “You only have so long to play sports. If there comes a time when someone says you can’t play football anymore, I’ll worry about it then.”

While Sullivan tries not to think about the potential danger associated with multiple concussions when he’s playing, he does takes a sense of comfort in knowing that Hinsdale Central uses a software program called ImPACT that helps manage concussions.

ImPACT, which is put out by the University of Pittsburgh Medical Center, is a research-based software tool developed to help sports medicine clinicians evaluate recovery following concussions. The test evaluates and documents multiple aspects of neurocognitive functioning including memory, brain processing speed, reaction time, post-concussive symptoms and an injury documentation system.

Hinsdale Central has been using the program since April 2007 and has done baseline tests for athletes on all levels of football this fall. They also did testing on all levels of wrestling, girls soccer and boys soccer, which are perceived as the sports with the most head injury risk. Testing also will also be done on the basketball teams.

“The program is another way for us to get some information on the athlete that we couldn’t get just by talking to them,” said Hinsdale Central certified athletic trainer Ted Hirschfeld, who estimates that between five and 10 athletes suffer concussions during a school year at Hinsdale Central. “Many times, what this program will let us do, is return athletes sometimes quicker than we normally would. It lets us know that we’re returning the athlete back to playing when we really know it’s safe.”

The ImPACT test, which takes about 30 minutes to complete, is given to athletes that sustain a head injury during a game or practice.

Some common symptoms of a concussion are confusion, amnesia, headaches, dizziness, nausea and slurred speech.

If symptoms persist for more than 15 minutes after the injury, Hinsdale Central athletes are not allowed to go back into the game. The next morning, if the athlete is symptom-free, they are given a post-injury test. The results are compared to the baseline results to help make a decision about how soon the player can return to action.

“It’s important to recognize it and treat it properly,” said Dr. Dean Karahalios, a neurosurgeon at the Chicago Institute of Neurosurgery and Neuroresearch (CINN). “Our goal is not to prevent people from playing sports, it’s quite the contrary. We want to recognize it, treat it and prevent someone from having permanent brain damage. If treated properly, they can come back and play pretty quickly. A player can recover completely if treated properly.”

Karahalios knows first hand about athletes not wanting to miss any playing time.

He graduated from Hinsdale Central in 1982 and played football and lacrosse.

“During my days at Hinsdale Central when I was involved in sports, you would get your bell rung and didn’t think it was anything significant and just shake it off and get back in and play,” Karahalios said. “Now we know from experience that these injuries are happening much more frequently than we thought and are very serious. A misconception about concussions is that you couldn’t get one unless you lost consciousness, but only a fraction of players that have concussions, about 10 percent, ever lose consciousness.”

That is the reason Karahalios estimates that there are about 3 million sports-related concussions a year, which is far more than the 300,000 widely reported in recent years based on athletes that lost consciousness.

Sullivan suffered his first concussion when he was 10 during a wrestling match. He was knocked out after having his head slammed on the mat. His second concussion came during last season’s football game against York when he was hit in the head by a player.

Despite his history of concussions, Sullivan hasn’t changed his approach to the game.

“You can’t play the game tentatively because that’s when you will get hurt,” Sullivan said. “You just have to trust the trainers and coaches that they’ll take care of you and tell you what’s best.”

Hinsdale Central is among 48 high schools, including Lyons Township and Nazareth Academy, in Illinois that currently uses the ImPACT program.

“No pun intended, but this (program) is a no-brainer,” Karahalios said. “Stakes are high and we’re putting (athletes) at risk by not recognizing (concussions). Now we have a way to recognize them, treat them and it’s important to educate players, trainers and coaches. Hats off to Hinsdale Central for recognizing the need for this.”

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Ruth Rothstein, 85, has a picture in her home office of former Israeli Prime Minister Golda Meir. Underneath is the caption, “But can she type?”

It’s a good reminder of how far Ms. Rothstein has come. When she first applied for an administrative position at Mount Sinai Hospital, the CEO offered her a secretarial job, noting that she didn’t have a college degree. Ms. Rothstein declined, saying she couldn’t type, but she eventually took another administrative job there. She went on to become the hospital’s president and CEO from 1977 to 1991.

Now semi-retired, Ms. Rothstein is perhaps one of the most recognized names locally in her field. As chief of the Cook County Bureau of Health Services for 14 years, she led the push to build the $630-million John H. Stroger Jr. Cook County Hospital in 2002.

A mother herself, Ms. Rothstein explains the urgency of replacing the old Cook County Hospital by noting that the obstetrics department had a “labor line,” a row of beds that offered no privacy for women preparing to give birth.

“Can you imagine that?” she says.

Perhaps it is not a coincidence that as women have risen through the leadership ranks, hospitals have pumped millions of dollars into improving labor and delivery departments. Many female health executives say they are proud to advance women’s causes through their own example and their policy choices.

Pamela Meyer Davis, 59, CEO of Edward Hospital in Naperville for the past 20 years, recalls her own struggle to prove herself to supervisors while raising a family in an era when it was frowned upon to ask for time off to attend a child’s concert or sports event.

“I want to be more flexible than people were with me,” she says.

Ms. Davis points out that today half of upper-level managers at Edward are women. “I simply tell people to hire the best person for the job,” she says. “Lo and behold, a lot of the people I hired were women.”

In one hospital administration job early in her career, she wanted to work on a construction project, only to be told construction was a man’s realm. In the years since, Ms. Davis has been largely responsible for building up Edward from a small community hospital to a regional medical center.

And it was a construction project that brought her into the spotlight. She helped blow the whistle on the Illinois Health Facilities Planning Board when members allegedly tried to bully her into using their associate’s construction company to win approval for a new hospital in Plainfield. Although her whistle-blowing won her some local awards, it has not won her the new hospital. In August, the planning board rejected the proposal for a third time, saying as it had before that there was no need for a new hospital there (Crain’s, Aug. 12).

Health care has always welcomed women in areas such as nursing. But it has taken decades for them to win spots in boardrooms and executive suites. The Chicago-based American College of Healthcare Executives has seen its percentage of women members fluctuate as the field has grown beyond the realm of individual public hospitals and those run by religious orders, many of which are overseen by nuns, and into corporate health care.

In 1944, the ACHE had 1,000 members, 51% of whom were women, says Deborah Bowen, the organization’s chief operating officer. By 1956, however, women had dropped to 24% as overall membership grew to nearly 4,000. By 1973, there were almost 8,000 members, but the percentage of women had dwindled to 13%. In the 1980s and ’90s, the ranks of women started to turn around. Today, 40% of the ACHE’s 30,000 members are women.

Sister Sheila Lyne, 72, is one of the nuns whose career traces back to the time when religious orders dominated the private-hospital landscape. She was the first woman and first non-physician to serve as commissioner of the Chicago Department of Public Health, and her résumé includes a master’s degree in psychiatric nursing and an MBA from the University of Chicago.

STILL NO CURE?

Pay gap persists

In a 2006 report, the American College of Healthcare Executives found that female health care executives, on average, earned 18% less than men who had the same levels of education and experience. Women earned an average of $107,800 in 2005, while men earned an average of $131,000.
Women and men, however, appear to be moving up the ladder at nearly the same rate. Some 30% of men and 25% of women were promoted from vice-president to chief operating officer or chief executive positions, according to the report.

While 70% of male health care executives aspired to become CEOs, only 40% of women did, the survey found.

Chicago appears to be ahead of the curve, with 26.7% of its hospital CEOs female, compared with 23.6% nationally, in 2008, according to American Hospital Assn. data provided by ACHE.
In 2000, she returned to Mercy Hospital & Medical Center, where she had served as president from 1976 to 1991, to become president and CEO. Her task was to pull the hospital back from the brink of financial collapse.
Mercy posted a loss of almost $42 million in fiscal 2001, she says. After making some needed cuts and ditching a managed-care contract that was losing money by the day, she has focused on refinancing debt, replacing equipment and expanding services, which has led to patient volume increases.

Sister Lyne says health care lately has lost some of its focus on healing in its quest to keep up in a corporate world. “I believe health care is a public good,” she says. “We’re making it a marketable commodity, and the concern would be that you would lose some of that healing perspective.”

She believes women have been drawn to healing professions such as nursing because “women’s nature is better at that.”

Other women, however, feel comfortable inhabiting the industry’s traditionally male-dominated roles, such as lobbyist. Elena Butkus, 43, vice-president of finance for the Illinois Hospital Assn., is one of them. At the IHA, she helped craft a 2007 state initiative for universal health care coverage, and pushed for a major overhaul of state workers compensation laws that gained approval in 2005.

She also spent time as the chief industry lobbyist for the Illinois Assn. of Health Plans and, before that, at the Illinois State Medical Society. While lobbying for the insurers’ association, she pushed for standardized contracting laws and prompt payment requirements and to defeat physician collective bargaining legislation.

“Twenty years ago, we used to do this in smoky back rooms in Springfield,” she says. “Over the past eight to 10 years, it’s become much more of a public process with less done behind closed doors. . . . I think that has enabled women to advance generally in lobbying.”

Ms. Butkus contends women are often more comfortable than men arriving at goals through consensus-building, which can work to their advantage in the legislative process.

“Where men like to dig in their heels and say ‘no,’ with women placed in the room, the process is just a little bit more of a give and take,” she says.

Pamela Meyer Davis, CEO, Edward Hospital | Photo: Stephen J. Serio
Sister Sheila Lyne, president and CEO, Mercy Hospital & Medical Center | Photo: Erik Unger

Linda Kloss also sees women bringing collaboration to the table. The 62-year-old CEO of the Chicago-based American Health Information Management Assn. says collaboration is key to her 52,000-member group’s push for adoption of new information technology that can improve record-keeping and patient care.

“In most health care organizations, you’ve got so many specialists and so many challenges bringing stakeholder perspectives together,” she says. “That’s different from many other businesses.”

Women have made strides in the medical profession, as well. In 2006, 27.8% of all physicians were women, up from 9.1% in 1975, according to the American Medical Assn. In 2007, 49.1% of medical school graduates were women, up from 6.9% in 1966, according to the Assn. of American Medical Colleges.

One of the exceptions is neurosurgery. In 2006, there were 331 female neurosurgeons, according to AMA data, accounting for just 6.1% of the total. One who practices in Chicago, Gail Rosseau, is trying to change that.

Dr. Rosseau, 51, is chief of surgery at the Neurologic & Orthopedic Institute of Chicago and director of skull base surgery services at the Chicago Institute of Neurosurgery & Neuroresearch. The only woman in her neurosurgical residency program at George Washington University in Washington, D.C., she attended a national meeting of the American Assn. of Neurological Surgeons in 1989 and looked around.

“In a room with 2,000 to 3,000 neurosurgeons in it, there were eight of us who met at the back of the room and said, ‘Hmm, we seem to have something in common. Let’s go out and have a drink together.’ ” That was the beginning of the Women In Neurosurgery group she helped found and whose board she still sits on.

In a white paper published in the September 2008 Journal of Neurosurgery, the group outlined the problem: With women now making up half of medical school students, neurosurgery is missing out on some of the highest-achieving doctors by not attracting more women.

The authors suggest promoting women so there will be more female mentors.

“As a patient, as I get older, I want to be sure there are smart young people who take care of my stroke and my brain tumor,” Dr. Rosseau says. “I want to make sure my field attracts the best and the brightest.”

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