Doctor Talking To Senior Couple On WardEthel, a sweet, elderly grandmother of 13, was sitting in the admissions cubicle of a local hospital. The admissions coordinator asked Ethel routine questions about her insurance, her address, her doctor’s contact information, and whether she had an advance directive. Ethel sucked in her breath, turned to her husband and grabbed his arm. “She wants me to talk about my death? Harvey, I thought I was here for a routine procedure! What are you not telling me? Is it time? Am I dying?”

Religion, politics, and sex are generally considered unsuitable topics for dinner conversation. In most social circles, we can add “death” to that list. American culture harbors so many fears and taboos surrounding death that we often put our collective heads in the sand when it comes to discussing end-of-life issues – until we have to. “If we don’t talk about it, maybe it won’t happen.” On the other hand, there is a saying that the only things in life we can count on are paying taxes and dying.

What if we have specific ideas about how we want our medical team to treat us at the end of life? Do we know what they are? Have we told anyone? The dichotomy of knowing that death is inevitable but not wanting to talk about it can cause unnecessary anguish and pain for people dealing with a family member or loved one who is at the end of their life but has not clearly expressed their wishes about the kind of medical care they want to receive. When people wait until they are unable to speak for themselves, they put their families in the uncomfortable position of having to make end-of-life decisions for them.

As a clinical social worker at Howard County General Hospital and Director of the Claudia Mayer/Tina Broccolino Cancer Resource Center, I have had a lot of experience with difficult end-of-life conversations. We are a medical institution. If we can’t help people talk about what type of medical treatment they want or don’t want at the end of their life, who can? Filling out an advance directive can help people document their wishes in a legally valid way, giving their family members and medical team a guide to their care.

An advance directive document, which only covers medical decisions, is different from a power of attorney, which is financial. Completing an advance directive is free. There are many different forms available: the Maryland Attorney General form can be found at oag.state.md.us/Healthpol/adirective.pdf, and “5 Wishes” form at agingwithdignity.org, both available in a variety of languages. You do not need a notary, but the document does need to be witnessed. There are three parts to an advance directive:

  • Selection of a health care agent – someone you trust to voice your health care decisions for you in the event you cannot voice them yourself.
  • Creating a living will – states your preferences about artificial treatments that might be used to sustain your life.
  • Completing the witness page – two people who are not related to you need to witness your signature, but not your choices.

Putting medical treatment wishes into writing is very important. Completing an advance directive for your family is really a gift, giving them the comfort of knowing how to follow your wishes.

April is Advance Directive Month and Howard County General Hospital is holding a free seminar on this topic April 25 in the Wellness Center from 6 to 7 p.m. Participants will have the opportunity to complete an advance directive. To register, click here or call 410-740-7601.

Leslie Rogers, MSW, LCSW-C, OSW-C, is an oncology social worker and Director of the Claudia Mayer/Tina Broccolino Cancer Resource Center at Howard County General Hospital.
 


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In April 2001, the National Minority Health Month Foundation inaugurated National Minority Health Month. The goal is to raise awareness about the health disparities that affect racial and ethnic minorities and to strengthen the capacity of local, state, and federal organizations to reduce those disparities. Prevention, early detection, and control of disease complications are important keys to advancing health equity. This year the theme focuses on prevention: Prevention is Power: Taking Action for Health Equity. Chronic diseases like heart disease, stroke, and diabetes, to name a few, are among the most common and more importantly preventable of all health problems in the United States.

This April you can take action for a healthy heart. Heart disease and stroke are a leading cause of death for all racial and ethnic groups in the United States. Some of the things you can do to reduce your risk of heart disease are eat a healthy diet, maintain a healthy weight, exercise regularly, limit alcohol use, and do not smoke.  Take a moment to read the CDC fact sheet on heart disease, which includes information on signs and symptoms, risk factors and prevention. Howard County offers wellness activities, workshops, walks, nutrition education, health screenings, and more through Get Active Howard County. You can also find many books on heart disease at one of the Howard County Library System (HCLS) branches.

Some minority populations including African Americans, Hispanic Americans, and American Indians are at a higher risk of developing diabetes and related complications. This April is the perfect time to develop strategies including diet and lifestyle changes to prevent the onset of diabetes.  Visit the Johns Hopkins Diabetes Center for more information on the disease, diabetes education, including classes, and nutrition, including education and counseling.  If you or a loved one is living with diabetes, HCLS has an extensive collection of materials to help navigate your meal planning, exercise, and diabetes education.

A leading cause of preventable illness and death in the United States is tobacco use. Smoking cigarettes causes devastating disease and premature death across all races and ethnicities, but smoking is more prevalent in some racial and ethnic minority groups. The US Surgeon General said, “Smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.”

If you live or work in Howard County, there are free smoking cessation and tobacco treatment programs offered through the Health Department. Visit here or call 410-313-6265 for more information. Howard County General Hospital: A Member of Johns Hopkins Medicine will be offering Smoke-Free Lungs seminars this summer.

Immunizations are a powerful way to prevent disease. In April you can ensure that your immunizations and your family’s immunizations are up to date. Immunizations not only help the recipients, they also help persons who come in contact with them.  Protecting children from vaccine-preventable diseases is an effective tool for advancing health equity.  You can see the vaccine requirements for children attending school in the state of Maryland here. Also, take a moment now and mark your calendar to remind yourself and every member of your family to get the flu vaccine this fall.

If the fact that you are under-or uninsured is preventing you from taking the steps to help manage or reduce your risk for chronic disease, please visit the Howard County Health Department or call 410-988-3737 for more information on health care programs and services that may be available to you and your family. Also, HCLS will host a class to help older adults and individuals with disabilities navigate the MAP & SHIP programs, presented by the Howard County Office on Aging’s Aging and Disability Resource Center in May.

This April, do yourself and your loved ones a favor by taking action for a healthy you. Educate yourself and ask your doctor about disease risks more common to your racial or ethnic background, and learn what you can do to prevent those conditions. Knowing your risks gives you power. Reducing those risks can lead to a healthier you and longer life.

Nancy Targett is an Instructor & Research Specialist at the Miller Branch. She lives in Columbia and is the proud mom of three boys and a girl and a Siamese cat.

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Health FoodI’m a pediatrician and a mom. The issue of childhood obesity, for me, is both professional and personal. Even if we’re not worried about our kids being obese, we want them to live a healthy, active lifestyle. Discussing this issue with my patients and their families is as important as writing a prescription when they are sick.

The obesity epidemic is rooted in environmental, genetic and cultural factors. Our culture makes it difficult to have a healthy lifestyle. Fast food restaurants can take a 10-calorie vegetable – the onion – dip it in batter, fry it and turn it into a 1,000-calorie snack! And portion control is off the charts. A typical bagel is now two times the size and calories it was 20 years ago. We’ve come to think of “more” as “better,” but, when it comes to food, that is not the case.

Children and teens spend too much time in front of TVs, computers and electronic devices that require no physical activity. And parents often worry about their children playing unsupervised outdoors, so they end up spending more time at less active, indoor activities.

The risks for overweight kids

Being overweight is a serious health problem for children. It can lead to diabetes, high blood pressure, hip and knee problems, and liver disease. If a child is obese early in life, they have a higher risk of being obese as a pre-teen or adult. The emotional consequences include depression, low self-esteem and lower academic achievement. But parents can reverse this trend by reinforcing a healthy lifestyle.

Body Mass Index

We use a tool called Body Mass Index (BMI) to determine if a child is overweight. For children and teens, it is age- and sex-specific; for kids aged 2 to 18, a BMI in the 85th percentile is considered overweight; in the 95th percentile obese; and in the 99th percentile severely obese. Although the BMI is not ideal, it is helpful for diagnosing at-risk children. Once we acknowledge there is a problem, we can develop a plan of action.

Eat less – do more

The short answer is fairly simple. If you take in more than you spend, you will gain weight. If you take in less than you spend, you’ll lose weight. The trend today of eating more but doing less puts our kids on the wrong side of this balance.

Children should, ideally, get more than one hour of physical activity every day. It doesn’t have to be a formal “exercise” or an hour at the gym. A walk or jog in the park is great, or playing their favorite sport. Anything that gets them moving is good.

They are what they eat

The best source for vitamins and minerals is not vitamin tablets, but fresh fruits and vegetables. Juices and sugary drinks are fattening and those pretty green and red drinks are not strawberries and kiwi; they are red and green dye and sugar. Water and fresh fruit is a better option. Get creative in your kitchen and let your kids try new foods. Don’t give up! It can take up to twelve times for a child to get used to flavors and accept new foods.

The role of psychology

Obesity is a chronic disease and addressing it is not about a quick fix or a diet. It involves a commitment to adopting a healthy lifestyle. Setting weekly goals can be helpful. Rewards are important, but don’t use food. Most important for us, as parents, is that we teach by example. Maintaining a healthy weight, eating well and getting exercise should start with mom and dad.

Rx for healthy living

It doesn’t involve pills. Here it is:

  • Five servings of fruits and vegetables every day
  • Less than two hours of screen time
  • Get out and play hard for one hour every day
  • Cut down or eliminate soda and juice

For more information, visit: healthychildren.org, choosemyplate.gov, letsmove.gov and healthyeating.org

To learn more, watch the HCGH Wellness seminar, “Weighing in on Your Child’s Weight,” at bit.ly/hcgh_child_obesity, presented by:

Edisa Padder, M.D., Pediatrician
Robin Toler, M.D., Psychiatrist
Ashli Greenwald, Dietitian
Suzie Jeffreys, Exercise Specialist

Edisa T. Padder, M.D., FAAP, is a pediatrician in private practice in Columbia, MD. who works with her patients and their families on these issues.
 


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You can’t tell if someone has high cholesterol by what they look like – a fact I can personally attest to as a person with high cholesterol. I don’t look like someone with high cholesterol, as I keep getting told. The problem is I don’t really know what it means to have “high cholesterol,” so I decided to do some research and figure it out.

What is cholesterol?

Cholesterol is a fat-like, waxy substance that can be found in all parts of your body. It aids in the production of cell membranes, many hormones, and vitamin D. The cholesterol in your blood comes from two sources: the foods you eat and your liver. However, your liver makes all the cholesterol your body needs. Cholesterol and other fats are transported in your blood stream in the form of spherical particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).Johns Hopkins Health Library

I started with Controlling Cholesterol for Dummies (Rinzler & Graf, 2008), which says that a high level of LDL particles (low-density lipoproteins, also referred to as “bad” cholesterol) correlates to a higher risk of heart disease or attack (p. 17). Lipoproteins are fat and protein particles that carry cholesterol into your arteries (LDL) or out of your body (HDL). The more cholesterol in your bloodstream, the higher the risk for buildup and possible heart attack. This can also happen in cranial arteries, blocking the flow of blood to your brain and potentially causing a stroke (p. 30).

However, Cholesterol Clarity: What the HDL is wrong with my numbers? (Moore & Westman, 2013) posits the idea that cholesterol isn’t the problem we’ve been taught. In fact, the real issue may be chronic inflammation as caused by smoking, excessive alcohol consumption, high blood sugar, high blood pressure, consuming trans fats and processed carbs, and stress (p. 38). Cholesterol can’t accumulate in your arteries on it’s own, they need to be inflamed first.

A good indicator of this inflammation is the C-reactive protein, a level which can be checked by your doctor (p. 39). Additionally, LDL cholesterol varies in size from large, fluffy, and harmless (Pattern A) to small, dense, and potentially dangerous (Pattern B) (p. 98).

How can you get your cholesterol levels and what should they be?

Cholesterol levels are usually obtained through a blood test at your primary care physician’s office. It’s important to know your LDL and HDL numbers as well as your total cholesterol measurement since a high level of HDLs is good for your body. A high total cholesterol number can be less serious if your HDLs are high, just as a low total cholesterol number can be bad if your HDLs are low. What amounts to a dangerous level? A total measurement above 240, HDL’s below 40, and LDLs above 160 (Rinzler). The size of LDL particles can also be tested through a particle size test that can be ordered by your doctor or by individuals online (Moore & Westman, 2013, p. 99-102).

How can you manage your cholesterol?

A few simple steps should help lower your bad cholesterol level: exercise, reduce fatty food consumption, lose a little weight, and reduce damaging behaviors like smoking and drinking. Exercising and avoiding fatty foods are two categories where almost every person can find some health benefit, regardless of cholesterol level. Some resources for heart healthy cooking are the American Heart Association’s Low-Fat, Low-Cholesterol Cookbook, The DASH Diet Action Plan, Quick & Easy Cookbook, and The Mediterranean Diet for Every Day.

 

 

 

 

We’re still learning what cholesterol does for our bodies and how we can live long and healthy lives. The most important thing is to be your own health advocate. There’s nothing wrong with getting a second opinion when it comes to your health and well-being. The best thing to do with any health concern is read all the information and consult your doctor, who’ll be best suited to help you with your questions.

Jessica Seipel is an Instructor & Research Specialist at the Savage Branch. She has worked for the Howard County Library System, in various positions, for a decade.

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calendar_2014smApril 12, 10:00 a.m.- noon. Care Giver’s Support Group. Meets on the first Tuesday of each month at 3:30 p.m. or the second Saturday of each month at 10:00 a.m.- noon. Registration is required.  Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Columbia MD. Call 410-740-5858 for more information

April 16, 7:00-8:30 p.m. Breast Cancer Support Group. This group, facilitated by Mary Dowling, LCSW-C meets on the third Wednesday of each month. Free. Registration requested. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Columbia MD. Call 410-740-5858 for more information.

April 16 & 17, 6:00- 9:00 p.mLiving with Diabetes: Executive Summary. Have you recently been diagnosed with diabetes or have you been living with diabetes and would like to improve your health? Our diabetes specialists will teach you how to change your habits, give you practical, attainable solutions for staying healthy and design a diabetes management plan to fit your lifestyle. An interactive, group course taught by an endocrinologist, diabetes nurse educator, dietitian, psychologist, podiatrist, and exercise specialist, Living With Diabetes Executive Summary is a condensed evening program. Most insurance plans cover all or part of this program.  The Bolduc Family Outpatient Center at Howard County General Hospital. For more information or to register, please call 443-718-3000

April 17, 11:00 a.m. I’m Going to Be a Big Brother or Sister at Glenwood Branch. Prepare for the arrival of a baby in this class for new siblings. Enjoy stories, activities, and bring a favorite doll or stuffed animal to practice holding your baby. Resources for parents, too. Families; 30 – 45 min. Well & Wise event. In partnership with Howard County General Hospital: A Member of Johns Hopkins Medicine. Register online or by calling 410.313.5579.

April 18 & 22, 8:30 a.m.- 2:30 p.m. Living with Diabetes. If you’ve just been diagnosed with diabetes–or even if you have been living with diabetes for some time and would like to make a commitment to improve your health–this course will teach you how to change your habits and will give you practical, attainable solutions for staying healthy. Our diabetes specialists will empower you with information and design a diabetes management plan to fit your lifestyle. Living with Diabetes is a two-day, interactive, group course taught by an endocrinologist, diabetes nurse educator, dietitian, psychologist, podiatrist, and exercise specialist.  The class is held at The Bolduc Family Outpatient Center at Howard County General Hospital. Day classes will be held Friday and the following Tuesday from 8:30 a.m. – 2:30 p.m. Most insurance plans cover all or part of this program. For more information or to register, please call 443-718-3000.

 April 22, 5:00- 6:30 p.m. Weight Loss Through Bariatric Surgery. Learn about weight loss surgery from the Johns Hopkins Center for Bariatric Surgery. For individuals (and their friends and families) interested in learning more about the surgical weight loss options available at the Johns Hopkins Center for Bariatric Surgery. You’ll also learn about our program requirements and how to navigate the insurance approval process.  For more information and to register, call 410-550-KNOW (5669) or register online at Hopkinsmedicine.org/jhbmc/bariatric. Howard County General Hospital Wellness Center, 10710 Charter Drive Columbia, MD.

 

 


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For more years than I can remember certain seasons have been a struggle with congestion, sneezing, itchy eyes and the uncomfortable symptoms of allergies. Only recently did I brave a visit to an allergist and discover many reactions to a variety of common allergens: grass and tree pollen, molds, dust, and much more. Now I had an explanation for why I can be sniffly all year, but much worse in the spring and fall when certain allergens temporarily explode into activity.

I had been self-medicating with over the counter drugs, but the allergist has been very helpful in trying some stronger prescriptions and experimenting with a regiment to provide more relief. I’ve learned about medications, nasal sprays, and even eye drops (I don’t do eye drops – no, I really don’t, just ask my husband). Part of the process is just trying out medications to see what works for me.

Knowing what allergens spike reactions can be helpful, but they are nearly impossible for me to avoid. The doctor also shared information about cleaning and methods to minimize allergens indoors. Hopefully, managing my exposure at home will help me to feel better and get through the worst weeks of the year.

Another treatment I’m considering is supposed to have longer-term effects: allergy shots. They work to calm down the immune response to allergens that causes the uncomfortable symptoms like sneezing and congestion. The series starts more frequently and in time can be spaced out until the allergic reactions stop or are minimized.

One of the questions I’ve been pondering is if my allergies have a relationship to my rheumatoid arthritis (RA). Both are autoimmune-related diseases with RA attacking the joints and allergies attacking my sinuses (or so it seems). While my research hasn’t revealed a connection confirmed with research, I can’t help but wonder. It makes sense to me that my aggressive RA would be linked to strong allergies.

In the meantime, I visit my doctors and pursue treatment for each condition. Seeing the allergist has been very revealing for me to understand the discomfort of allergies and what I can do to feel better. I may never know why I have these allergies, or RA for that matter, but it’s good to be on a path to treat and hopefully better manage my health.

Kelly Mack lives in Washington, DC, and works for a marketing communications firm.

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Nutrition Label with circle CUYou love your child more than anything in the world. You want him or her to be happy and healthy. You have a pretty open relationship and can talk about almost anything. But when it comes to talking about weight with kids who are obese or on their way to being overweight, most parents are at a loss. They clam up and let the problem continue to get worse rather than confront the “Fat” issue, because it is such a loaded and complicated subject.

Most children are already self-conscious and sensitive about their weight and may be teased about it at school. Parents are often afraid they might compound the problem if they acknowledge a weight issue. Will my child develop anorexia if I mention her overeating? What if he thinks I don’t love him as much because he’s overweight? Is she overeating because of depression or some other problem?

Some ways to approach a touchy subject

So . . . how can parents bring up this difficult subject without hurting, alienating or making their child feel defensive? Here are some ideas:

Ask for help from your pediatrician. He or she has experience with this and can be neutral and bring up the topic of weight as a health factor, mentioning that the child has gone over the “healthy weight” line and that there are health risks involved. Talking about health, rather than social or cosmetic factors, can open the door to conversations about a healthy lifestyle and how important it is to overall well-being. You can continue the conversation by substituting healthy choices for fattening snacks and letting your child help with food shopping and preparation at home.

Put the focus on yourself. “Wow! Spring is just around the corner and I’ve really packed on some pounds this winter. Do you want to start an exercise program with me? Let’s try to lose some weight before summer.” Find an exercise you both enjoy and then be a partner rather than a superior. You can show, by your example, that regular exercise makes you feel better. You could even make it a family project.

Talk! Once the cat is out of the bag, it might be easier to address your child’s feelings about food. What is he feeling when he overeats? What is bothering her? Try to help them develop other ways to cope with their feelings and get them involved with activities they like rather than turning to food for comfort. Most of all, tell your child that you love them, no matter what.

Avoid isolation

Some kids with weight problems are treated differently by their peers. Encourage friendships; spend time together and let them know you have confidence in their ability to get healthy.

Depression and anxiety – when should you worry?

How do you know if depression is causing your child’s weight gain, or if weight gain is causing her depression? It can be a vicious cycle that’s hard to interpret. Emotional ups and downs are a normal part of growing up and all children will experience some degree of anxiety from time to time. But today’s social pressures are tough, and anxiety disorders and depression can lead to many devastating problems including suicidal thoughts and substance abuse. If you suspect serious depression or an eating disorder, consider consulting with a professional. Howard County Mental Health Authority (hcmha@hcmha.org) and National Alliance on Mental Health (NAMI) Howard County (info.namihch@gmail.com) are good resources for finding local mental health professionals.

To learn more, watch the HCGH Wellness seminar, “Weighing in on Your Child’s Weight,” at bit.ly/hcgh_child_obesity, presented by:

Edisa Padder, M.D., Pediatrician
Robin Toler, M.D., Psychiatrist
Ashli Greenwald, Dietitian
Suzie Jeffreys, Exercise Specialist


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