1) The document is a newsletter from The George Washington University Hospital that provides information on various health topics and procedures available at the hospital, including dermal fillers, weight loss surgery, treatment for uterine fibroids, knee replacement surgery, and heart health for women. 2) It describes several minimally invasive cosmetic and weight loss procedures available at the hospital and provides before and after photos. It also promotes an upcoming seminar on innovative treatments for uterine fibroids. 3) The newsletter highlights new procedures like a gender-specific knee replacement device and advanced laparoscopic techniques for removing uterine fibroids. It provides details on conditions like fibroids and their symptoms as well as various treatment options.

1. The George Washington University Hospital
health
www.gwhospital.com
newsWinter 2007
Women’s
Guide to
a Healthy
New Year
Nicole Lost
140 Pounds in
One Year!
Learn More
on Page 2.
• New Knee Replacement
Especially For Women
• Fibroids: You Don’t Have
To Live With Them
• Heart Smarts Just for Her

2. new year
new you
Face the
New Year
With Confidence!
If pollution, stress and years have
left your face looking less than
flawless, take a step to recapture
your youthful glow. A dermal fill
procedure can smooth out fine
lines, augment lips and enhance
cheekbones. In-office procedures
take just minutes and the results
are long-lasting: Most dermal fills
last for six months — many for a
year or more. Thanks to a numbing
solution, most patients experience
minimal discomfort and are back
to normal routines quickly. Weigh This Option for a Healthier You!
Losing weight is never easy, but with the right procedure
and support, you can change your life. GW Hospital and
The Center for Obesity Surgery, along with Joseph Afram, MD,
have been named a “Bariatric Surgery Center of Excellence” by the
American Society for Bariatric Surgery — a distinction awarded to
those who offer patients optimal care and surgical excellence.
Today, nearly 85 percent of bariatric surgery patients in the
United States are women. In addition to a slimmer appearance, weight loss
may reduce your risk for several diseases, help you control your cholesterol
and blood pressure, and improve your self-esteem.
When the holiday season is over, give yourself a gift — a body boost that will leave you feeling confident and
healthier! Unwrap a new you with GW Hospital’s help. Procedures include dermal fill, laser removal of varicose
veins and weight-loss surgery.
To learn more, please call
202-741-3241 or visit
www.dccosmeticsurgerycenter.com.
Before the dermal fill procedure,
deep “puppet” lines were evident.
After the dermal fill procedure,
lines almost disappear.
For a free, confidential information kit, please call 202-715-4445.
s
The George Washington University Hospital Winter 2007
Legs You’ll Want to Show
Off — in Just 45 Minutes!
Spring is just around the corner, but breezy
skirts, shorts and bathing suits don’t have to
send you running for cover anymore! After laser
removal of unsightly varicose veins, you’ll have a leg up
on the competition and impress your toughest critic — you!
Unlike “vein stripping” procedures, laser removal is performed
in the doctor’s office under local anesthetic with ultrasound guidance.
The laser emits enough heat to cause the vein to shrivel away,
preventing a recurrence. It usually takes just under an hour, and
you will be back to your activities the next day.
To learn more, please call 202-741-3210.
Nicole Karl,
one month and
18 months after
gastric bypass
surgery with
Dr. Afram.

3. About Uterine Fibroids
Uterine fibroids, benign tumors found in
the uterus, occur in as many as 80 percent
of women annually, and they are more
common in African-American women. Most
fibroids are asymptomatic, but one in four
women complain of aggravating symptoms,
such as:
Heavy bleeding
Pain
Abdominal distension
Frequent urination
Constipation



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
A
rlene Vollin, a 46-year-old deputy sheriff in
Alexandria, Va., underwent laparoscopic
surgery this past fall to have uterine
fibroids removed. Her fibroids were so large that
she appeared 35 weeks pregnant. For 11 years,
fibroids affected how much Arlene could eat at
one sitting, caused sleep loss because she couldn’t
sleep on her stomach or side, and she was
urinating four to five times each night.
“Before I visited GW Hospital, a doctor told
me my fibroids were so large it was impossible
to have them removed laparoscopically,” Vollin
says. “So I was extremely surprised and pleased
to find Dr. Paul MacKoul and learn that he
could perform such an advanced laparoscopic
procedure. He was able to remove the fibroids
through three very small incisions. As a result
of the procedure, I have regained my normal
eating and sleeping patterns, and I am free of
the constant discomfort. I have my life back!”
The GW Hospital Advantage
“Our approach is unique to the DC region,”
says Damian Alagia, MD, Program Director
for Minimally Invasive Gynecological Surgery
and Clinical Associate Professor of Obstetrics
and Gynecology. “We have combined resources
so that each patient has a team of surgeons
committed to offering a spectrum of procedures
that best meet that patient’s needs.”
Until recently, treatment for heavy uterine
bleeding and uterine fibroids often involved a
continued on page 6
It’s Nice To Have Options
New Treatments Mean Fibroids Don’t Have To Weigh You Down
hysterectomy, an operation to remove
a woman’s uterus. Today, this is just one
of many options to solve these problems.
“We now can offer women a wide range
of treatments to help improve their quality
of life,” says James K. Robinson, MD,
Assistant Professor of Obstetrics and Gynecology
who is fellowship-trained in laparoscopic surgery.
“When performed by an experienced practitioner,
the advanced surgical techniques offered at GW
Hospital can be very beneficial.”
Treatment Advances Mean More Options
In the past, laparoscopic removal of larger
fibroids was difficult: doctors would start the
procedure intending to use a small incision, but
often find it necessary to make a much larger
incision. Paul J. MacKoul, MD, FACOG, Director
of Gynecological Oncology and Clinical Associate
Professor of Obstetrics and Gynecology, has
pioneered a procedure to remove even the largest
of fibroids through three quarter-inch incisions.
Winter 2007 www.gwhospital.com
Join us for a free
seminar, “Innovative
Treatment for
Uterine Fibroids”
March 21.
See page 8 for more details.
Damian Alagia, MD,
Program Director for
Minimally Invasive
Gynecological Surgery;
Clinical Associate
Professor of Obstetrics
and Gynecology
James K. Robinson, MD,
Assistant Professor of
Obstetrics and Gynecology
Paul J. MacKoul, MD, FACOG,
Director of Gynecological
Oncology; Clinical Associate
Professor of Obstetrics and
Gynecology

4. D
ebilitating knee pain and
disability affect hundreds of
thousands of women each year.
Women undergo nearly two-thirds of
knee replacement procedures performed
annually. But until this year, the
prosthetic joint used for this surgery was
not fitted specifically to women; rather,
it was created using the average size of
male knees and female knees.
This “not-so-perfect” fit sometimes
left patients with continued knee pain
after joint replacement surgery.
But the Zimmer®
Gender Solutions™
Knee, a promising new joint scientifically
designed to fit women’s anatomy, is said
to offer women a better fitting and better
functioning knee.
“Knee replacement surgery is hugely
successful today for 95 to 97 percent
of patients,” says James Graeter,
MD, Director of the GW Total Joint
Replacement Center; Clinical Professor
of Orthopaedic Surgery. “With an
advancement like the Gender Knee
it can only get better — patients will
experience improved mobility.”
Although prosthetic knees have
always come in different sizes, the
design did not reflect the
anatomical differences
between men and women.
In the past, when the
The Gender Knee has three qualities designed to fit women’s
bodies — and their active lifestyles:
Thinner Profile — The Zimmer Gender Knee has a thinner
profile to accommodate this anatomical difference between
men and women.
More Natural Movement — The angle between the hip and
the knee affects how the kneecap moves over the end of a
thighbone. Women have a distinct shape that often results
in a different angle between the hip and the knee when
compared with men. The Zimmer Gender Knee accounts for
this difference, allowing for more natural movement.
Contoured Shape — The Zimmer Gender Knee has a
contoured shape to more closely match the narrower
anatomy of a woman’s knee. This more precise fit may
prevent the implant from overhanging the bone and
potentially pressing on or damaging surrounding ligaments
or tendons.

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
IllustrationscourtesyofZimmer,Inc.
The George Washington University Hospital Winter 2007
Why the Gender Knee Might Be a Better Fit for You
Traditional Knee
Traditional Knee
Traditional Knee
Zimmer Gender Solutions Knee
Zimmer Gender Solutions Knee
Zimmer Gender Solutions Knee
New “Gender Knee” for Women Shows …
Front View

5. www.gwhospital.com Winter 2007
… One Size Does Not Fit All
fit was less than perfect, the only solution was to
remove part of the patient’s bone or reposition
the implant during surgery — a limiting option.
“The Gender Knee provides a better-fitting
knee for women,” says Anthony Unger, MD,
Director of the GW Minimally Invasive Joint
Replacement Surgery Program; Associate Clinical
Professor of Orthopaedic Surgery. “It was
developed based on a scientific and sophisticated
map of the female knee.
Katherine Davies, a 63-year-old attorney and
Gender Knee recipient living in Bethesda, Md.,
agrees. “I’m the kind of person who likes
advances,” says Davies. “So when I learned about
the Gender Knee, it made sense that I would
need a knee that is different from what a man
would need.” Davies’ knee replacement surgery in
October of 2006 has provided her with much-
needed relief from recurrent, debilitating knee
pain caused by an injury during a family touch-
football game.
Knee replacement surgery with Gender Knee
can be done through both open and minimally
invasive surgical procedures. “As a matter of
course, surgeons at the GW Hospital Total
Joint Replacement Center strive to use the least
invasive procedure possible based on the patient’s
condition and need,” says Craig Faulks, MD,
an orthopaedic surgeon and Assistant Clinical
Professor of Orthopaedic Surgery at
GW Hospital. “Using Gender Knee and a
minimally invasive procedure can result in shorter
hospital stays and recovery times,” he adds.
“Living with knee pain and disability is a
thing of the past,” says Andrew Holmes, MD,
Andrew Holmes, MD,
Orthopaedic Surgeon;
Assistant Professor of
Orthopaedic Surgery
an orthopaedic surgeon and Assistant Professor
of Orthopaedic Surgery at GW Hospital.
“Advancements like the Gender Knee and
minimally invasive surgical procedures offer
women a far improved quality of life. In my
opinion, there’s never been a better time to
undergo knee replacement surgery.”
To learn more about the Gender Solutions Knee
and knee replacement surgery at GW Hospital visit
www.gwhospital.com or call 1-888-4GW-DOCS.
Katherine Davies enjoys many activities thanks to a
new knee-replacement device designed specifically
for women.
Craig Faulks, MD,
Orthopaedic Surgeon;
Assistant Clinical Professor
of Orthopaedic Surgery
Join us for a free
seminar, “New Hip
and Knee Surgeries”
February 28.
See page 8 for more details.
James Graeter, MD,
Director, GW Total Joint
Replacement Center;
Clinical Professor of
Orthopaedic Surgery
Anthony Unger, MD,
Director, GW Minimally
Invasive Joint Replacement
Surgery Program; Associate
Clinical Professor of
Orthopaedic Surgery

6. The George Washington University Hospital Winter 2007
“New techniques developed at GW
Hospital now allow us to remove fibroids of
any size,” says Dr. MacKoul. “These techniques
allow for excellent control of blood flow to
the fibroids. The fibroids then are removed in
pieces through the smallest incisions possible.
Minimal blood loss with tiny incisions results
in a very fast recovery with minimal pain. As
a result, most of our patients are able to leave
the hospital the same day of the surgery and
are back to work within two weeks.”
The spectrum of treatment options
for fibroids includes:
• Minimally invasive removal of fibroids or
the uterus as well as ablative techniques for
management of heavy periods or abnormal
uterine bleeding.
• Medicines that block the production
of estrogen, causing the fibroids to
shrink temporarily.
• Uterine artery embolization, a procedure
that blocks blood flow to the fibroid,
causing it to die.
To learn more about fibroid treatment options
available at GW Hospital, please call 1-888-
4GW-DOCS or visit www.gwhospital.com.
During the one- to
two-hour procedure,
an interventional
radiologist inserts a
catheter into the groin
area through a small
incision and threads it
to the arteries on both
sides of the uterus. The
physician then injects
tiny particles that will
block blood flow to the
fibroid, causing it to
shrink or even disappear.
A one-night hospital stay is routine. Most women
experience relief from symptoms and are back to
normal activities soon.
“Most patients find that UAE reduces or
completely relieves their symptoms,”says Anthony
Venbrux, MD, Director of Interventional Radiology;
Professor of Radiology and Surgery at GW Hospital.
“In fact, studies have shown it to be at least
85 percent effective in providing symptom relief.”
UAE is an option for most fibroid patients; however,
it typically is reserved for women who no longer wish
to have children since there are no long-term studies
on its effects on fertility. It may not be ideal for massive
fibroids as patients may not have desired shrinkage of
benign tumors.Talk with your doctor to determine if
you are a candidate for UAE.
To register, please visit our Web site at www.gwhospital.com or call 1-888-4GW-DOCS.
It’s Nice to Have Options
continued from page 3
Winter 2007 Seminars for Seniors
Anthony Venbrux, MD,
Director of
Interventional
Radiology; Professor of
Radiology and Surgery
About Uterine Artery Embolization (UAE)
Catheter
Femoral
Artery
Fibroids
Uterine
Artery
New Developments in Spinal Surgery
Thursday, March 1, 2–4 PM, Free
Presenter: Warren D. Yu, MD, Assistant
Professor of Orthopaedic Surgery.
Have you been told you need back
surgery? Know your options. This
seminar will discuss new, state-of-the-art
developments in spinal surgery.
Location: Hospital Auditorium.
Diabetes:What You Need to Know
andWhat You Can Do
Thursday, March 8, 2–4 PM, Free
Presenter: Joshua Cohen, MD, FACP,
Associate Professor of Medicine,
Director of the Diabetes Center.
Learn what you can do to decrease
your chances of developing diabetes,
including blood sugar and weight
management, and dietary and lifestyle
changes. For those who have diabetes,
the program will cover self-care,
including diet, exercise and preventive
medicine.
Location: Hospital Auditorium.
Street Smart Seniors
Thursday, March 15, 2–4 PM, Free
Presenter: Paul F. Bendesky,
Administrative Director of Security
Seniors will learn from GW
Hospital Security and DC Police how
to keep themselves out of harm’s way
by following simple, common sense
tips. Keep yourself safe on the Metro
or while you’re walking or banking.
Know how to be more aware of your
surroundings to protect yourself and
your community.
Location: Hospital Auditorium.

7. 1
2
3
www.gwhospital.com Winter 2007
American women have “taken to heart” the message that cardiovascular
disease is their leading cause of death. Yet the journal Circulation recently
reported that in a survey of 300 primary care physicians, 100 obstetricians/
gynecologists and 100 cardiologists, fewer than one in five physicians knew
that more women than men die from the disease.
So what’s a gal to do?
Be your own heart health advocate: Make your physician aware of your
family history and other risk factors and symptoms. If you are not satisfied
with your doctor’s response, or if you need a cardiologist, take advantage of
GW Hospital’s Women’s Heart Program, which specializes in caring for the
unique female heart. The program offers comprehensive heart screening to
determine and reduce your risk for cardiovascular disease.
Please call 202-715-5400 to schedule a screening with the GWWomen’s Heart
Program.To learn more, please visit us online at www.gwhospital.com.
“Test Drive”a
New Incontinence
Treatment
Do you find yourself mapping out
bathrooms or constantly excusing
yourself at the worst times? For some
women, loss of bladder control is an
inconvenience, for others it makes once
enjoyable activities a source of stress.
If you’re one of the millions of women
in the United States who suffer from
incontinence, consider a new treatment
option: InterStim®
.
This implantable device sends mild
electrical pulses to stimulate the nerve in
the lower back that influences the bladder,
as well as the muscles that manage
urinary function. Bladder control can be
significantly improved as a result of the
electrical stimulation.
To determine if InterStim will be
effective, a patient can “test drive” the
system by wearing a stimulator placed
just under the skin for two weeks.
During that time, the patient
or physician can
modify settings to
provide varying
levels of stimulation.
If the therapy is
successful, the system
can be permanently
inserted under
the patient’s skin
through a minimally
invasive procedure.
Recovery for both procedures usually
occurs within days.
InterStim is most effective in people
age 55 and younger, and its success rate
is as high as 79 percent.
If urinary incontinence is hampering
your lifestyle, please call 1-888-4GW-
DOCS to make an appointment with
a urologist, or visit our Web site at
www.gwhospital.com.
GW Offers Heart Program
Just for Women
MRI Now a Useful Tool for Women
at High Risk for Breast Cancer
Fear of breast cancer is something many women experience. But facing that fear
may save your life. Early detection and treatment increase survival rates. With
monthly self-breast examinations and routine mammography, you can increase
your chances for survival. Additionally, creating a baseline mammogram will, over
time, help you and your physician detect changes in your breasts that may mean
further evaluation or treatment is necessary. If a mammogram detects a suspicious
finding or if you’ve been told you have dense breasts, you may be referred for
additional diagnostic testing.
Today, a new screening option, magnetic resonance imaging (MRI), is being
used for breast cancer detection. MRIs already have been used successfully as a
diagnostic tool for heart disease and other cancers and are quickly becoming a
valuable tool for diagnosing breast cancer in high-risk individuals — those with
a strong family history, a previous diagnosis or the breast cancer gene. At the
GW Breast Care Center, MRI also is used to guide minimally invasive biopsy,
a technique available in only a few healthcare facilities.
Because the MRI is so sensitive, it may identify benign tumors. As a result,
its use should, for now, be limited to those at high risk. To determine if
MRI is appropriate for you, talk with the radiologist at your next breast
imaging examination.
To schedule your mammogram at GW’s Breast Imaging Center,
please call 202-741-3036.
Take Charge of Your Health in 2007
Read These Three to See How!

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Communications Manager
Information in Health News comes from a wide range of
medical experts. If you have any concerns or questions about
specific content that may affect your health, please contact
your healthcare provider. Models may be used in photos or
illustrations. Any opinions expressed by an author whose
article appears in this publication are solely the opinions of
the author and do not necessarily reflect the views of The
George Washington University Hospital or Universal Health
Services, Inc. Physicians mentioned in this publication are
on the medical staff of The George Washington University
Hospital but, with limited exceptions, are independent
contractors who are not employees or agents of The George
Washington University Hospital. ©2007. All rights reserved.
Printed in the U.S.A.
health news
Postmaster: Please deliver between January 22 and 27.
To register, please visit our Web site at
www.gwhospital.com or call 1-888-4GW-DOCS.
A Better Option for Prostate Cancer
Wednesday, February 7, 7–8:30 PM, Free
Presenters: Jason D. Engel, MD, FACS,
Vice Chairman and Director of Urologic
Robotic Surgery and Assistant Clinical
Professor; Harold A. Frazier II, MD, FACS,
Clinical Director of Urologic Oncology,
Associate Clinical Professor.
There’s now a better surgical solution
for prostate cancer — the daVinci®
Robotic
prostatectomy. This option decreases the
risk for incontinence, avoids large incisions,
minimizes blood loss, shortens recovery
time and has the precise ability to spare
the nerves that control erection.
Location: Hospital Auditorium.
Long-TermWeight-Loss Surgery
Wednesday, February 21, 7–8:30 PM, Free
Presenters: Juliet Lee, MD, Assistant
Professor of Surgery.
If you’re severely overweight and have
tried dieting and weight-loss programs
without success, surgery may help you
achieve long-term, successful weight loss.
Learn more about traditional gastric bypass
surgery and the newer minimally invasive
procedures, including the Roux-en-Y and
Laparoscopic Adjustable
Gastric Banding
(Lap-Band®
). Find out
who qualifies and the
benefits, risks, recovery
and anticipated results.
Location: Roosevelt
Room.
New Hip and Knee Surgeries: Less Pain,
Smaller Scars, Fast Recovery
Wednesday, February 28, 7–8:30 PM, Free
Presenter: Anthony Unger, MD, Director
of Minimally Invasive Joint Replacement
Surgery, Associate Clinical Professor of
Orthopaedic Surgery.
You’ve been living with arthritis long
enough. With the help of new minimally
invasive technology and accelerated
rehabilitation, the outcome of joint
replacement surgery has improved
significantly. Find out how minimally
invasive hip and knee replacement surgeries
speed recovery time and reduce pain. Learn
more about the new Zimmer®
Gender
SolutionsTM
Knee replacement for women.
Its slender profile, more natural movement
and contoured shape may result in a better
fit. Location: Hospital Auditorium.
Incontinence: ImproveYour
Quality of Life
Wednesday, March 7, 7–8:30 PM, Free
Presenter: Michael H. Phillips, MD, FACS,
Clinical Professor of Urology.
Incontinence is not part of aging and
not a disease. Male and female incontinence
may be a symptom or side effect of a
medical condition. Learn about what
form of incontinence you have, and the
evaluation and treatment options, including
male slings and the artificial sphincter, and
new procedures for female prolapse.
Location: Hospital Auditorium.
Chronic Heartburn and GERD
Wednesday, March 14, 7–8:30 PM, Free
Presenter: Mohammed M.H. Kalan,
MD, FACS, FRCS, Associate Director of
Minimally Invasive Surgery.
When heartburn medications don’t
work, surgery may be the best option. If
left untreated, GERD can lead to bleeding
ulcers, difficulty swallowing, Barrett’s
esophagus and an increased risk for
esophageal cancer. Learn about options,
including medications, minimally invasive
procedures and surgery.
Location: Hospital Auditorium.
InnovativeTreatment Options
for Uterine Fibroids
Wednesday, March 21, 7–8:30 PM, Free
Presenters: Paul J. MacKoul, MD,
FACOG, Director for Minimally Invasive
Gynecologic Oncology and Clinical
Associate Professor; James A. Robinson,
MD, Assistant Professor.
Have you been told that you are not a
candidate for laparoscopic procedures, or
that your uterine fibroids are too large for
this technique? Surgeons at GW Hospital
have developed new minimally invasive
techniques for the removal of fibroids
through tiny incisions for women who are
heavy, have had multiple prior surgeries or
have large fibroids. Patients go home the
day of surgery or the following morning
with far less pain and a much faster
recovery.
Location: Hospital Auditorium.
Winter 2007 Seminars
Look for
Senior
Seminars
on page 6.