Arena, Echols co-authors
Book is 'A Common Sense Guide to Good Eating'
By David Williamson
A working mother of two, who calls
herself "a great believer in self-
education/' has written a book that she
hopes will help clarify many of the basic
principles of good nutrition.
Barbara Echols, who coordinates
special and regulatory programs at the
medical center, said inspiration for the
book came to her one afternoon in 1974
when she took her teenaged daughters
shopping for blue jeans.
"I noticed that many of the other
youngsters who came into the shop were
overweight," she explained. "That
surprised me, and I began to wonder how
much young people know about weight
control and nutrition."
Generally glossed over
Echols asked her daughters, their
friends and people who worked near her
office at Duke. She then circulated a
questionnaire among students at a local
high school.
"What 1 found was a conspicuous lack
of knowledge about the relationship
between diet and health," she said.
Nutrition, it turned out, was either not
taught in schools at all or generally was
glossed over in classes on home
economics and physical education. The
stores she canvassed were loaded with
books on the latest fad diets, but none of
those volumes seemed to present a
balanced picture of the subject.
Arena co-author
It was then that the former medical
technologist decided to write her own
book. After two years of research, the
result is "The Commonsense Guide to
Good Eating," a 174-page paperback just
published by Barron's Educational Series,
Inc., of Woodbury, N.J.
Dr. Jay M. Arena, professor of
pediatrics and a nationally-recognized
Duke University
Medical Center
Intercom
authority on accidental poisoning, served
as co-author.
The first chapter of "The
Commonsense Guide to Good Eating"
asks and answers seven questions
designed to let the reader test his or her
own knowledge about proper eating. The
second explains recommended dietary
allowances and discusses why the body
needs protein, fat, vitamins, minerals,
water and roughage.
Fat good in moderation
Fat, for example, is used for energy
reserves, internal organ padding and heat
(Continued on page 3)
VOL. 25, NO. 47
DEC. 1, 1978
DURHAM, N.C.
Study could help cut cost of finding cancer
By William Erwin
Physicians at the Comprehensive
Cancer Center have begun a series of
studies that could save money and time
for patients getting cancer examinations.
By showing how to save money for
these patients, the studies could also help
hold down the cost of health insurance
for perhaps millions of other Americans.
The studies will compare three ways of
diagnosing cancer — computerized
tomographic (CT) scanning, gamma
camera scanning and ultrasound. Duke
radiologists want to learn which method,
or combination of methods, proves most
useful for finding certain types of
cancerous tumors.
Dozens of pictures
A CT scanner works much like a
regular X-ray machine. Instead of taking
one picture, however, it takes dozens as
■ its X-ray tube rotates around the patient.
Sensitive detectors arranged in a circle
around the patient record how much X-
ray energy is absorbed by each part of the
body. A computer then puts this
information together and draws a cross-
sectional picture of the body's interior.
A gamma camera produces a different
kind of picture. It shows how much of a
substance tagged with a radioactive
tracer is taken up by parts of the body. As
the tracer is absorbed by an organ, it
forms an image of the organ when a
detector passes over the patient.
An ultrasound machine sends sound
waves into the body. These waves bounce
off structures inside the body just as
sonar waves bounce off objects
underwater. The returning echoes are
picked up by a sender-receiver probe and
are converted into a cross-sectional
picture.
Patients involved with the study will
already have had their tumors diagnosed.
Since doctors will know where the
tumors are, they can see which diagnostic
machine or machines give the most
helpful pictures at the lowest cost.
"We'll be defining the extent of disease,
showing changes, following the disease
after treatment and finding new areas of
spread," said Dr. Charles E. Putman,
director of radiological activities for the
Cancer Center.
"We're interested in early detection,
eventually. We're also interested in cost-
savings and cost-effectiveness. All of
these modalities are expensive.
Hopefully, we can save patients some
money."
Free exams in study
A CT scan normally costs about $250,
Putman said. A gamma camera scan costs
about $125 and an ultrasound exam costs
about $100, he said.
Patients admitted to the study groups,
however, will get their examinations
without charge. They will be referred by
their personal physicians.
Dr. Carl E. Ravin, Duke's clinical
director of imaging, said the current
"technological explosion" in diagnostic
methods makes it confusing for doctors
to try to choose the best method for
patients with suspected tumors.
The confusion results. Ravin said,
because "nobody has looked critically at
what these modalities will do individually
or in combinations to produce the
information we want."
May have four,
but need only one
A patient with possible liver cancer, for
instance, may have four or more different
diagnostic examinations, he said. "In fact,
he may need only one, but we don't know
(Continued on page 4)
Have cold hands? Just relax
"COLD" CHAMBERS—Dr. Richard Surwil, director of the Behavioral Physiology Laboratory, and
Angela Lanz, research technician, demonstrate the use of a chamber in the laboratory. The*
soundproof chamber will be used by some patients who participate in a study of Raynaud's
Disease, a painful cold hands ailment. Lanz has a band taped on her finger which is connected to
the digital temperature feedback unit Surwit is holding. The unit flashes in digital numbers the
temperature of the patient's finger. (Photo by Parker Herring)
By Parker Herring
A Duke psychologist is looking for 40
people with cold hands.
Dr. Richard Surwit, associate professor
of medical psychology and director of the
medical center's Behavioral Physiology
Laboratory, is seeking subjects to test a
technique which he says can help
sufferers of a painful cold hands disease.
The technique consists of relaxation
exercises which train victims of
Raynaud's Disease, symptomized by cold
hand attacks, to warm their hands.
Think warm
An article recently published in the
Journal of Behavioral Medicine reports
results of similar behavior modification
studies done by Surwit when he was at
Harvard. These results indicate that
Raynaud's Disease patients can raise the
temperature of their hands by relaxing
and thinking warm thoughts.
"Data from these studies show that
relaxation techniques increased blood
flow in the fingers of Raynaud's patients,
even during prolonged exposure to cold,"
Surwit noted.
The psychologist said he has
successfully used the techniques to treat
patients who had mild cases of Raynaud's
Disease and others who were more
severely afflicted, including one patient
for whom doctors were considering
amputating her fingers.
"Eighty percent of the Raynaud's
Disease patients I've treated show both
decrease symptom severity as well as
increased hand temperature," Surwit
said.
Cold, stress
The chronic cold hand attacks of
Raynaud's Disease are stimulated by cold
and/or emotional stress. During an
attack, the fingers change colors, turning
first white, then dark blue or deep purple
and finally a bright red.
Women are five times more likely to
have the disease than men, and Raynaud's
commonly begins when a person is in the
late teens or early 20s, Surwit said.
Victims of Raynaud's Disease have cold
hands because there is not enough blood
flowing to their fingers, and blood flow is
controlled by the sympathetic nervous
system (SNS), he explained.
"The same neuropathways that carry
signals from the brain to close blood
(Continued on page 2J