Choosing your New Baby’s Doctor: 7 Questions to Ask

choose a pediatrician

[Credit: michaeljung]/[iStock]/Thinkstock

“Parenthood is a long and wonderful journey and having a medical professional who is caring and understanding from the beginning is an important part of this experience,” says Edisa Padder, M.D., a pediatrician on staff at HCGH. “Every parent should feel their pediatrician cares about their child as if they are their own. Your pediatrician’s office should be your medical home, where all your child’s medical needs are met.”

One way to get started finding a pediatrician is to ask for referrals from family and friends. Your next step should be visiting the pediatrician’s office and meeting with the doctor, even before your baby is born. “A few issues to consider when choosing a pediatrician are the willingness of the pediatrician to listen and hear your concerns about your child, whether a simple question or complex medical issue,” explains Dr. Padder. “If you have a trusting relationship with your pediatrician, even a difficult situation becomes more manageable.”

Understand whether your pediatrician works full- or part-time and who you talk to or see after hours. “You want to talk to a physician who knows your family so he/she can give you proper guidance and advice,” explains Dr. Padder. “When your child gets sick after office hours, you should call your pediatrician’s answering service for guidance — if you know it is truly an emergency, go to the emergency room. If you are not sure whether your concern requires an urgent evaluation, please contact your pediatrician on call immediately. Additionally, you want to know how easy it is to get an appointment if your child is sick or for a well-child visit.”

Choose a doctor who shares your parenting philosophy and style and sees eye-to-eye with you on issues such as feeding, antibiotics, colic and sleep problems. Decide whether you want a solo practitioner or group practice and check the pediatrician’s training and credentials. “Know your initials,” says Dr. Padder. An M.D. attended medical school, did three years of residency and passed American Board of Pediatrics examinations. FAAP after a doctor’s name signifies a fellow of the American Academy of Pediatrics. Also trained to work with children are medical doctors who are family practitioners, nurse practitioners (NPs) and physician’s assistants (PAs).

In addition to family and friends, other sources for finding a pediatrician include the Howard County General Hospital Find A Doctor, your insurance’s website and the American Academy of Pediatrics .

Visiting the Office
When visiting potential pediatrician offices, ask questions:

  1. Is the doctor in a group practice?
  2. Does another physician cover for the doctor at times?
  3. Is there a nurse in the office who can answer routine questions?
  4. Who handles phone calls when the office is closed?
  5. Is your insurance accepted?
  6. What is the office policy on taking and returning phone calls?
  7. A question to ask yourself: Are the physician and office staff courteous? Do they show compassion and patience or did you feel rushed?
Edisa Padder, M.D., is a pediatrician with Padder Health Services in Columbia. Call for an appointment, 301-560-4747

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A Look Back: Reflections from a Long-time Nurse

national nurses week 2016 howard county general hospital judy brown

Retiring nurse Judy Brown has spent 34 years in health care at Howard County General Hospital. Here, she poses in her first nursing uniform holding her nursing graduation photo. She shares her insights on nursing, health care and Howard County in this farewell blog.

In 1982, I found myself working at a hospital in the community I called “home.” I wanted the quality of care to be the best it could be, and for the past 34 years, I have committed to doing just that.

Medicine runs in my family. My son is an emergency department physician in Pittsburgh, and my husband is a professor and medical researcher at Johns Hopkins Bloomberg School of Public Health. My mother attended nursing school during World War II. She never finished school and that was her biggest regret. She was my inspiration and the reason I chose to become a nurse.

Data collected from an aptitude test Bryn Mawr Hospital School of Nursing gave me during the application process said that I had a strong data analysis trait—which is true, and that I should be an accountant—which I didn’t want to do. I knew I wanted to work with people. Instead of following the path the data directed, I pursued my diploma in nursing and followed my nursing degree with a bachelor’s in business administration. Management was for me–after all, I wanted my first boss’s job. For two years I was a full-time student by day and a full-time nurse at night.

My work at Howard County General Hospital (HCGH) started as a shift director. Over the years, I continued my education with a master’s degree in administrative science from Johns Hopkins University and worked my way up in nursing at HCGH. During my tenure as the chief nursing officer, I felt strongly that HCGH should be moving toward magnet status, and my degrees were in business. I didn’t want my education to keep the hospital from achieving magnet status, so I went back and got my master’s in nursing.

To nurses today – I encourage you to achieve your education—one course at a time if that is what it takes—to progress, even if you want to stay at the bedside. No one can ever take it away from you.

Over the course of my career in nursing operations, I spearheaded the implementation of numerous programs at the hospital including the Sexual Assault Forensic Examiner (SAFE) Program and, with my team, launched The Center for Wound Healing at HCGH.

Today, I am the senior vice president of Outcomes Management and I provide oversight of performance improvement and am responsible for risk management, patient safety, infection control and The Joint Commission and CMS regulatory compliance. It was not my choice to move to the quality and regulatory role. But I had the clinical background and excruciating attention to detail–so I guess the aptitude test was accurate after all.

When I think about life after retirement in July 2016, it’s the people that I will really miss.


Judy Brown, MSN, MAS, RN, NEA-BC, FACHE, a 34-year employee of Howard County General Hospital, is the senior vice president of outcomes management. She retires in July 2016.

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From 9/11 to 9-1-1: a Nurse’s Journey

national nurses week howard county general hospital

Howard County General Hospital Emergency Department nurse Emilia Alvarez-Negron, RN, (right) in 2010 with her mother, Vilma E. Grevi Rosario, at her nursing pinning ceremony.

Reflections for National Nurses Week 2016

You reach an age in life where you reminisce…where am I? What have I done with my life? Where am I going? Am I on track for what I set out to do? I was 31-years-old when I was reminded in an instant that I had not embarked on my lifelong dreams yet.

It was 9-11. The day the towers came down. I watched it happen. From 1993-2000 I worked in and around the World Trade Center. I knew the city that was underneath the towers and the intricacies of the offices above ground. I wanted to do something. I wanted to help but had no training. That day reminded me that I needed to find a way to end my career as an executive assistant and begin my journey to become a nurse. I wanted to take care of people—not corporate executives—anymore.

Ever since I was a little girl, my mom called me Joan of Arc. I was always taking up other people’s causes and helping people. I have always been empathetic and sympathetic, although coming from the Bronx, working in corporate America and running with the bulls, you wouldn’t believe so.

By the age of 27, I was married and had three children. My focus was on daily life and taking care of their needs and working hard to survive life in New York. I knew that sitting in a classroom was not an option for me, but the online education era was beginning to take hold.

At the age of 34, I began my nursing career journey. I took as many courses as I could online, in the evenings, on the weekends—all while working full-time and being a mom. I had ignited a fire and it just kept getting bigger and bigger with each class I tackled. I had discovered my passion. With my first patient encounter, I knew I had found my calling in life. It took me five years, but at the age of 39 I graduated nursing school at the top of my class with my husband, parents and children by my side and my first grandchild in my arms.

As a nurse, I knew it started with teaching. I discovered in nursing school the best way for me to learn was to teach others. My schoolmates helped me recognize the pure joy in helping others learn and watching them grow. I also knew I wanted to get my master’s in science of nursing and then continue to nurse practitioner. I wanted to go as far as I could. Along the way I discovered just how few Spanish- speaking health care providers there were and the needs that existed.

I moved to Maryland with my family six years ago and worked in the Emergency Departments of several Baltimore-area hospitals before I landed at Howard County General Hospital (HCGH). I chose to work at HCGH because, when I walked in the door, I was welcomed with open arms in such a way that I felt I was home. It was warm, it was welcoming, it was a Johns Hopkins-affiliated community hospital and it had a feel to it that said, “we are here for you.” If you knew me, you’d know I strive for excellence in everything that I do. I wanted to align myself with people who think the same way I do, and I have to say I made the right choice.

As I finish my master’s degree as a nurse practitioner this August with an emphasis on acute care for adolescents and gerontology and a post master’s in nursing education, I have an opportunity to not only teach the public about disease processes—as I have done as a nurse these six great years—but now I can also help to treat them by actually managing their disease processes and prescribing medications when they are acutely ill.

I believe things happen for a reason, and certainly everything that has occurred in my life has not been by accident. I believe God put me on this planet to become a nurse and everything that I have ever experienced has been so that I can be the bilingual Spanish nurse that I became.

When a patient comes into the Emergency Department, they may be experiencing their worst moment possible and you do something that changes their world. You have made an impact. They probably won’t remember you but when you go home at night, you know you made a difference. That is nursing.

I had a career as an executive assistant and, although I was good at what I did, I can’t say that I loved my job. I can say that I absolutely love what I do now as a nurse and I wouldn’t change it for the world.

Emilia Alvarez-Negron, RN
HCGH Emergency Department

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Caffeine: why it’s not all perks when you have too much

caffeine side effects

[© Kjetil Kolbjornsrud |]

Do you use caffeine to help wake up in the morning or perk up in the evening? If the answer is yes, you are not alone. Millions of people use caffeine on a daily basis. According to Johns Hopkins Medicine, “caffeine is the most mood-altering drug in the world.”

On average, Americans consume about 280 milligrams of caffeine daily—about 30 milligrams alters mood and behavior and 100 milligrams can result in physical dependence. So how many cups of coffee a day is too much? The Food and Drug Administration (FDA) warns that four to seven cups of coffee is too much, however, everyone can be affected differently.

If you consume too much caffeine on a daily basis, side effects can include insomnia, nervousness, irritability, upset stomach, rapid heartbeat, muscle tremors and restlessness. Those who do not consume caffeine on a regular basis may be more sensitive and experience negative effects faster. Also, factors such as age, gender (females are more prone), medications and body mass can play a role in sensitivity.

The recent buzz
In recent years, caffeine use has been on the rise, and the industry is responding to Americans’ obsession with caffeine. While caffeine was typically consumed through coffee, tea, cola beverages and chocolate, more recently, caffeine can be found in all shapes and sizes—from energy drinks and pills, to powder you can mix into food and caffeinated gum. This addiction has become increasingly easier to form.

The addition of these products to the market has dramatically impacted public health, with thousands of caffeine overdoses, addiction and, in rare instances, death. The FDA has stepped in to warn people about the risks involved with consuming too much caffeine and has also banned various new, dangerous caffeinated products.

It’s not all perks
Caffeine can also be especially dangerous to those with existing health conditions. According to the FDA, “People with heart problems shouldn’t use caffeine because it makes their hearts work too hard.” Additionally, “People with anxiety problems or panic attacks may find that caffeine makes them feel worse.”

If you are one of the many caffeinated people out there, it is important that you monitor how much caffeine is in the food and drinks you consume and listen to your body if you think you could be experiencing a reaction or withdrawal. Speak with your primary care doctor about your caffeine intake to see what is right for you.

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Anemia’s Effect on Your Heart Health

anemia and your heart

[© Skypixel |] Some common anemia symptoms include lack of color in the skin, increased heart rate, fatigue, headaches, and irregular or delayed menstruation. When anemia is left untreated or is severe, it can affect your whole body—especially your heart.

Many people suffer from anemia but do not realize how it can affect your heart’s function. Anemia can cause your heart to work harder to pump blood and result in a rapid or irregular heartbeat.

What is Anemia?
Anemia is a common blood disorder that occurs when there are fewer red blood cells than normal, or there is a low concentration of hemoglobin in the blood. “Anemia stems from a variety of conditions,” says Karl Kasamon, M.D., a hematologist on staff at Howard County General Hospital, “but the most common cause is iron deficiency.” Common symptoms include lack of color in the skin, eyes and lips, increased heart rate, fatigue, breathlessness, irritability, headaches, irregular or delayed menstruation and jaundice.

“Those at the highest risk for anemia are menstruating females and generally elderly patients who have gastrointestinal related blood loss or bleeding,” says Dr. Kasamon. When anemia is left untreated or is severe, it can affect your whole body—especially your heart.

“The connection between anemia and heart complications is clear,” says Dr. Kasamon. “Red blood cells carry oxygen from lungs to tissues. When your red blood cells are low (you are anemic), your heart has to pump and carry blood cells much faster to deliver the same amount of oxygen. This strains the heart to contract faster and more intensely than normal.”

If you already have a heart condition, the condition can worsen if you develop anemia. Other factors, such as demographics, can determine the risk of anemia linking to heart conditions. “For example, 20 year olds with severe anemia rarely have dangerous complications, whereas older adults are at a much higher risk even if they are just mildly anemic,” says Dr. Kasamon.

Getting Treatment
Anemia is a reversible disorder. To optimize heart health, seek treatment for anemia to correct the red-blood-cell level back to normal, which will take strain off and positively affect your heart. Treatment varies depending on the cause of anemia and can include iron supplements, changes in diet, vitamins, prescription medication, blood transfusions or bone marrow transplant.

Dr. Kasamon also encourages those with anemia symptoms to be screened by a physician. “Patients often assume their anemia is caused by iron deficiency and self-medicate with iron. In some cases, this can cause iron overload and ironically lead to a variety of complications, including heart failure.”

Karl Kasamon, M.D., is a hematologist with Chesapeake Oncology-Hematology Associates in Columbia.

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9 Ways to Manage Congestive Heart Failure

congestive heart failure (CHF)

[Credit: Nastco]/[iStock]/Thinkstock] Common CHF may be due to a weak heart muscle, leaking or narrowed valves, untreated high blood pressure, cardiac arrhythmias and, less often, diseases of the sac around the heart. Our Dr. George Groman offers advice for managing CHF.

The human body is a sponge, and for those with congestive heart failure (CHF), keeping their heart from being overwhelmed by too much fluid accumulating in their body can be an ongoing challenge.

According to George Groman, M.D., a cardiologist on staff at Howard County General Hospital, common causes of CHF can include a weak heart muscle damaged by a heart attack; leaking or narrowed valves; untreated high blood pressure; some cardiac arrhythmias; and, less often, diseases of the sac around the heart. These conditions can make the heart too weak to pump blood adequately. Another cause of CHF is diastolic dysfunction—when the heart is stiff and can’t sufficiently relax to fill with blood. This dysfunction becomes increasingly common with age and uncontrolled blood pressure as well as other causes.

Preventing Fluid Complications
If you have CHF, to reduce fluid buildup, Dr. Groman recommends you should:

  • Limit salt intake. Use pepper or herbs and spices instead. Check with your doctor before using a salt substitute, which could cause a dangerous elevation of potassium.
  • Be evaluated for sleep apnea if you snore.
  • Use alcohol prudently—it can weaken the heart in some cases.
  • Not use illicit drugs.
  • Not smoke.
  • Eat heart healthy—minimize saturated fat, trans fat and sugar.
  • Maintain a healthy weight, and monitor your weight daily. If you see a progressive increase of three or more pounds in a week, call your cardiologist, who may adjust your diuretic dose.
  • Exercise.
  • Take medications prescribed by your cardiologist.

Treating Fluid Buildup: New Hospital Service
“There can come a time when your small intestine becomes so waterlogged that your medications cannot be adequately absorbed,” says Dr. Groman. “This can result in further fluid buildup and may put you at risk for needing hospitalization and other types of intensive care.” To help patients avoid having to stay in the hospital, HCGH has begun an outpatient IV diuresis service to which your cardiologist can refer you. Appointments are offered weekdays in the hospital’s Infusion Center and last several hours to allow your nurse to record urinary output in response to the diuretic.

During treatment, nurses will speak with you about your diet and medications. All patients will receive a referral for a home care evaluation and remote, nursing-based patient monitoring. Lab work will be done (primarily to evaluate kidney function) and reviewed prior to you returning home.

“This collaborative effort between the patient’s physician, clinic nurses and home health has the potential to keep patients out of the hospital—and that is a very good thing,” notes Dr. Groman.

George Groman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.


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8 Ways to Avoid Sitting Disease

sitting disease

[© Nruboc |] One way to avoid sitting all day at a desk job is to take your calls while standing up.

You Can Start By Reading This Blog Standing Up

Sitting for many hours a day is a common practice. Without realizing it, many people are falling victim to sitting disease. The American College of Cardiology defines sitting disease as being sedentary for many hours with little movement and calls it a lifestyle risk factor for cardiovascular disease, blood clots, heart attack, stroke, diabetes and a variety of other conditions.

Even those who incorporate exercise into their routine can have sitting disease. “Going to the gym three days a week to get your heart rate up is not sufficient. You actually need to incorporate movement throughout your daily routine as well,” says Kabir Yousuf, M.D., a cardiologist on staff at Howard County General Hospital. “Often people try to plan out their physical activity too much and get wrapped up with a trainer or a gym class exercise regimen instead of getting out and just moving. My philosophy is to just get up and move—the more the better. This is especially important if you have a sedentary job. Moving doesn’t have to be scheduled—every step and minute you spend doing physical activity counts and can reduce your risk of cardiovascular disease.”

Desk Jockeys: 8 Ways to Stay Fit

  • Take the stairs
  • For every hour you sit, move for five minutes. If you can’t do this every hour, do it every two hours and increase your movement to 10 minutes.
  • Instead of sitting while on the phone, stand.
  • Park further away in the parking lot to take advantage of walking.
  • Have walking meetings instead of sitting in meetings throughout the day. If you even take a quarter of your meetings outside of the conference room and walk somewhere, it is beneficial.
  • When you are at a store—instead of shopping right away—take a lap or two around the store before buying anything.
  • Get a partner or a friend to motivate you—you will be more apt to be active when you have a partner.
  • Incorporate technology—using activity trackers, websites and apps, you can track your activity and be reminded to move throughout the day.
Kabir Yousuf, M.D., is a cardiologist with Maryland Cardiovascular Specialists. To schedule an appointment, call 410-740-0549


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How a Spin Class Turned this Cardiologist into a Triathlete

cardiovascular exerciseI was an overweight and inactive kid and never an athlete during my school years. About 15 years ago, my weight was increasing and my cholesterol was high, so I began going to the gym. I found I liked spin classes, but I wanted to get out of the hot spin studio. My cardiology practice partner at the time, Dr. Jack McWatters, was an avid cyclist and lent me a bike so I could try cycling outdoors. That was the start of my addiction to cycling, which eventually led me to participate in many long-distance bike rides both locally and in such far-flung destinations as California and the French Alps.

Around the same time, a neighbor of mine, who was a ‘couch potato’ and a cigar smoker, announced he was going to do a triathlon and I thought, “Why can’t I do that?”

So, in 2005, I found a triathlon training group. I started competing in local events, like the Columbia Triathlon held in Howard County every May. Triathletes are so exuberant, excited and inclusive—they suck you into their world and you want to be part of the next challenge.

In 2011, a cycling buddy encouraged me to compete in my first IRONMAN in Florida, and it went exceptionally well. In 2014, I completed IRONMAN Lake Placid, which was scenic and beautiful. Afterward, my coach encouraged me to race in another IRONMAN in Lake Tahoe to keep momentum and training. As it happened, an arsonist set a forest fire in the area around Lake Tahoe that week and, just as we were warming up for the swim, the organizers cancelled the event. In every IRONMAN competition, spots are given to winners for the world championship. Because no winners came from that event, those spots were chosen from a lottery, and I was selected for one of those coveted spots as IRONMAN World Championship.

An international race, the IRONMAN World Championship in Kona, Hawaii, features the best professional triathletes and best athletes from every age group. For this event, 2,300 athletes started the race and 2,144 finished on a 97-degree day with 100 percent humidity and 20 mph headwinds during much of the bicycle portion. During the race, I burned 10,500 calories!

I train between eight and 17 hours a week, depending on the season. I swim, bike and run, but adding strength training has kept me injury-free for the past three years. I limit processed carbohydrates. I don’t eat out of a box, I eat foods in their least processed form. I eat a variety of fruits and vegetables, lean protein, grains, nuts, dark chocolate and I drink almond milk.

Why do I do this? I like a challenge, I like how it feels and I want to set an example for my patients. I know the profound effect that exercise and diet have on your heart. My lipids were terrible before I started exercising regularly, and now they are off the charts good! My HDL/good cholesterol was under 30, now it’s 86; my LDL/bad cholesterol was 150-160, now it’s 79; my triglycerides were 250, now they are 38.

High, intense and regular levels of exercise cause a release of endorphins—cycling is my legal addiction.  If I can’t exercise because it’s snowing or I am too busy, you can tell by my lousy mood.

I tell my patients who don’t exercise that anything is possible—if I can do this, you can do this. You’ve got to start somewhere and build exercise into your routine. You don’t have to be like me, because I’m nuts! But you must build muscle mass and participate in aerobic exercise.

After running, biking and swimming the IRONMAN, I feel an overwhelming elation that I can’t even describe. Coming across the finish line makes me feel like there’s nothing I can’t do.

You don’t have to be like me and do extreme exercise, but you should exercise regularly. The American Heart Association recommends at least 150 minutes of moderate exercise (or 75 minutes of vigorous exercise) every week for adults. This translates into 30 minutes a day, five times a week—but ANY amount of exercise is better than none!

In September 2014, Michael Silverman, M.D., started a year of intense training in preparation for the IRONMAN World Championship. The training included biking 3,915 miles, swimming 414,240 yards, running 898 miles and completing 98 hours of strength training. A cardiologist with Cardiovascular Associates of Central Maryland, Dr. Silverman could be seen on the roads of Howard County starting his day running or biking at 5:30 a.m.

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Minutes Before His Heart Stopped, He Knew What To Do: Would You?

jimmy brothers heart attack story

Jimmy Brothers, Battalion Chief in EMS Operations for the Howard County Department of Fire and Rescue Services

I don’t smoke. I am not overweight. I exercise regularly and eat pretty healthy. But on April 26, 2015 at the age of 46, my heart stopped.

It was a Sunday, and I woke up feeling like I was getting a cold. Not sure I can describe it exactly—I just didn’t feel well. I took some cold medicine and headed out with my family to coach my daughter’s lacrosse game.

On the way home from the game, the elephant arrived and was sitting on my chest. The pain was crushing and shooting down my arm. I was sweating and nauseated. As the Battalion Chief in EMS Operations for the Howard County Department of Fire and Rescue Services (HCDFRS), I knew the symptoms. I was having a heart attack.

My wife was driving, and I realized we were so close to the Elkridge Fire Station. I told her to call to see if the ambulance was there, which, thank goodness, it was. The ambulance crew was waiting outside when we pulled up to the station. I took two steps out of the car and collapsed onto the gurney as they attached a 12-lead EKG to get a reading of my heart. As they hit ‘send’ on the unit to transmit my EKG to Howard County General Hospital, my heart stopped.

I don’t remember going unconscious. The paramedics, one who I had trained, did high performance CPR and shocked my heart back into rhythm.


See Jimmy Brothers’ Story

When my wife Becky arrived at the HCGH Emergency Department, I was already headed to the cardiac catheterization lab where they were waiting for me. The cardiac catheterization showed a 100 percent blockage in the left anterior descending (LAD) artery—a condition sometimes referred to as ‘the widow maker.’ I was given a clot-dissolving medication and a stent was inserted to hold the artery open.

The irony of my story is that, in my role with HCDFRS, I had worked with HCGH to bring much of the cardiac technology and protocols to the county—a system that nearly 10 years later saved my life.

As a part of this unique partnership, paramedics are provided with advanced cardiac training at the HCDFRS Education & Training Section by HCGH cardiologists. In addition, HCDFRS ambulances are equipped with technology that can wirelessly transmit EKG data to HCGH cardiologists and emergency physicians in real time. In the event of a diagnosed heart attack, like I had, the hospital can assemble the cardiac catheterization team before the patient arrives—saving valuable time and, in turn, heart muscle. The gold standard of time to open an artery (often referred to as door-to-balloon time) is no more than 90 minutes from the time the patient enters the hospital’s door. My time was only 38 minutes because I recognized the signs and got help quickly.

The earlier that lifesaving care can be started, the less time the heart muscle is deprived of blood and oxygen which causes the heart to work harder, possibly leading to dangerous cardiac rhythms as was the case with me. This is often followed by cardiac arrest.

Once the heart stops beating, there is only a matter of minutes to get it started again.

Fortunately, my heart attack didn’t leave Becky a widow, but I do have some heart damage. I attended HCGH cardiac rehabilitation for several months and am feeling good.

I encourage everyone to learn CPR so that, if a loved one has a heart attack, you know what to do. If you know CPR, download this free app and follow HCDFRS so you can be notified if someone near your location in Howard County is having a cardiac emergency. The app also will alert you of Automated External Defibrillators (AEDs) close by.

Most important, call 911 if you think you or a loved one is having a heart attack so you can receive emergency cardiac care quickly. Do not wait, and do not drive to the hospital.

James Brothers is the Battalion Chief in EMS Operations for Howard County Department of Fire and Rescue Services (HCDFRS).

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Injury-Proof Your Next Snow Shoveling Chore

Like ham and eggs or sunshine and summer, with winter comes snow and shoveling the white stuff. Snow shoveling can be a good source of aerobic exercise, but it doesn’t come without risks. Improper shoveling can cause injuries to your back and shoulders. And the American Heart Association says the risk of heart attack can increase while shoveling since cold temperatures and physical labor make the heart work harder. This may be partially due to the sudden demands that snow shoveling puts on the heart, especially for those who live a fairly sedentary lifestyle.

Take note: if you are at risk for heart attack, you need to take special precautions. The National Safety Council and the National Institutes of Health recommend the following tips for safe snow shoveling:


  • snow shoveling tips
    [Credit: pavelgr/Thinkstock] Protect your heart if at risk for a heart attack: you recently had one and/or coronary stents, heart disease history, high blood pressure or cholesterol, smoker, sedentary lifestyle. Get your doctor’s permission beforehand. Take frequent breaks and pace yourself.
  • snow shoveling tips
    [© Robeo |] Call 911 if you have: chest tightness or pain, pain in your jaw or pain radiating down your arm. Experts recommend calling an ambulance versus driving to the hospital. Specially-trained emergency teams can assess your condition, stabilize you and activate a treatment team.
  • snow shoveling tips
    [© Dolgachov |] Avoid injury while shoveling. Don’t lift too much snow, use a smaller shovel or partially fill a larger one. Bend from the knees with a straight back and sit into the motion; avoid twisting movements. Listen to your body and stop if you feel pain.
  • snow shoveling tips
    [© Eurobanks |] Shovel snow when it’s fresh. It’s easier to move than when it’s wet and packed. Push the snow rather than always lifting.
  • snow shoveling tips
    [© Maszas|] Ears, nose, hands and feet need extra protection and are at risk for frostbite after as little as 10 minutes in sub-freezing temperatures. Dress in layers that can be removed as needed. Protect your face, since cold air makes working and breathing harder and adds strain on your body.
  • snow shoveling tips
    [© Ocusfocus|] Drink plenty of water. Dehydration is as serious in the winter as in the summer. Also, avoid eating before you shovel.
  • snow shoveling tips
    [© Scukrov |] Avoid caffeine and nicotine as they are stimulants that can increase your heart rate and cause your blood vessels to constrict, putting extra stress on the heart. Too much caffeine, alcohol or sugary drinks can all cause dehydration.
  • snow shoveling tips
    [© Pojoslaw|] Warm up before you start by marching in place or walking for a few minutes. Stretch your arm and leg muscles after you’ve warmed up. Warm muscles are less likely to be injured.

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Heartburn Holding You Hostage? 7 Tips To Break Free

heartburn, GERD

[© Atholpady |] Acid reflux occurs when stomach acid or its contents flow back and irritate your esophagus lining. Over time, the inflammation can cause complications. Healthy lifestyle choices (like avoiding tight clothing and eating smaller meals) can make a big difference in your symptoms.

Gastroesophageal reflux disease (GERD) or acid reflux disease is a chronic digestive disease that occurs when stomach acid or other stomach contents flow back into the esophagus irritating the lining. Over time, the inflammation can wear away the esophageal lining, causing complications such as bleeding, esophageal narrowing or Barrett’s esophagus (a precancerous condition).

What are common causes?
Causes include an abnormal weakness or relaxation of the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus that allows food and liquid to flow into your stomach — or structural problems, e.g., hiatal hernia, which weaken the mechanism that prevents acid reflux into the esophagus.

What are signs and symptoms?
Symptoms vary and include:

  • Burning in the chest, throat or upper abdomen (heartburn)
  • Acid reflux into the throat causing voice hoarseness, cough, throat irritation; and/or angina or chest pain

How is it diagnosed?
Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms. Other tests include pH testing, endoscopy and X-rays of the upper digestive tract.

What sort of lifestyle changes can help?
Maintain a healthy weight.
Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If you are at a healthy weight, maintain it. If you are overweight or obese, work to slowly lose weight.

Avoid tight-fitting clothing. This puts pressure on your abdomen and the lower esophageal sphincter.

Avoid food and drink triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion and caffeine may make heartburn worse.

Eat smaller meals. Too much food in your stomach may put pressure on your esophageal sphincter and not allow it to close.

Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.

Elevate the head of your bed. If you regularly experience heartburn at night, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head with additional pillows is not effective.

Don’t smoke. Smoking decreases the lower esophageal sphincter’s ability to function properly.


Common GI Procedures, What you Should Know: March 23, 2016, 7-8:30 p.m. Register now for this free seminar presented by Rudy Rai, M.D. Held in the Howard County General Hospital Wellness Center.

How is it treated?
Most people can manage GERD with lifestyle changes and over-the-counter medications that neutralize stomach acid. Antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.

Medications to reduce acid production, called H-2-receptor blockers, don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions of these medications are available in prescription form.

Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal.

If you don’t experience relief within a few weeks, you may need stronger medications, or even surgery, to reduce symptoms. New surgical options are offering promising results.

Are there any new treatments available in the management of GERD?
In situations where medications aren’t helpful or you wish to avoid long-term medication use, your doctor may recommend surgical options to relieve your symptoms.

Rudy Rai, M.D., is a gastroenterologist in Columbia. To schedule an appointment, call 410-290-6677.



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Unraveling who really needs a gluten-free diet

gluten-free diet

Celiac disease is a genetically predisposed autoimmune disorder that affects the small intestine when gluten is consumed. Many people follow a gluten-free diet when they do not have celiac disease. For those with celiac disease, it is absolutely essential to eat a gluten-free diet. For everyone else who is avoiding gluten, you may be limiting your choices unnecessarily. [© Andresr |]

The Gluten-free Phenomenon

In the last few years, the phrase “gluten-free” has become a household term. Whether you are walking down a grocery store aisle or reading a menu at a restaurant, it is no longer uncommon to see these words. For those suffering from celiac disease, these new additions are a welcome sight.

What Is Gluten?
Gluten is the name used for the proteins found in wheat, rye and barley. It acts as glue in foods, helping them maintain their shape, and is found in many foods.

Celiac and Gluten Connection
Celiac disease is an autoimmune disorder that affects the small intestine when gluten is consumed. According to Johns Hopkins Medicine, “When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Tiny fingerlike protrusions, called villi, which line the small intestine and enable the absorption of nutrients from food into the bloodstream, are lost. Without these villi, malnutrition occurs, regardless of how much food a person consumes.”

Celiac disease can be confused with irritable bowel syndrome (IBS) or other bowel issues. Patients are diagnosed most often with a blood test, which is a noninvasive approach. However, the gold standard to diagnose celiac disease is through an endoscopy with biopsies of the small intestine. Before any testing for celiac disease, you should continue to include gluten in your diet to ensure accurate results. Many people follow a gluten-free diet when they do not have celiac disease. For those with celiac disease, it is absolutely essential to eat a gluten-free diet. For everyone else who is avoiding gluten, you may be limiting your choices unnecessarily.

Signs of celiac disease can include bloating, gas, indigestion and diarrhea. However, some patients could have constipation or no GI symptoms at all. If you are having digestion issues, you should see your primary care physician first. If there is no diagnosis and symptoms don’t resolve, then you should visit a gastroenterologist who specializes in conditions of the digestive tract.

Anyone can get celiac disease. In fact, about one percent of the population, or nearly three million people, likely have celiac disease and are unaware of it. Celiac disease is a genetically predisposed disorder. Once a family member is diagnosed, you should be aware that you are at a higher risk of having or developing the disease and may want to be tested. However, you can be a carrier of celiac disease and never show symptoms until later in life, if at all. Being a carrier of the gene means you may not have the disease, but may be prone to it. It does not mean you will definitely develop it. Additionally, people with autoimmune disorders such as rheumatoid arthritis, Type 1 diabetes, osteoporosis, abnormal liver function and/or disease, or anemia are at higher risk for celiac disease. If you have one of these autoimmune conditions, you should consider being tested for celiac disease if you have symptoms and are not improving.

Although there is no cure for the disease, there is a lot of research underway for treatment, including prescription drug studies. Currently, the only treatment that is known to ease the symptoms of celiac disease is to eliminate foods containing gluten from your diet.

So What Should I Eat?
The Celiac Foundation’s website or the National Foundation of Celiac Awareness website have a lot of good information on diet options. The most important consideration when choosing your food is to be mindful of reading labels as many unsuspecting foods, and even some medications, contain gluten.

When Am I Going to Feel Better?
If you have celiac disease and start reducing your gluten intake, you should feel better within a couple of weeks. In some cases it takes up to a month before you notice a difference and start feeling better. Often this occurs because you have unknowingly consumed gluten.

Mahmood Solaiman, M.D., is a gastroenterologist with Gastro Associates in Elkridge. Appointments: 410-590-8920.


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Simple Ways to Fight Flu (and other germs) this Holiday Season

flu fighting tips

The best defense from the flu is a flu vaccine, and December is not too late to get one. The best defense from a cold is to wash your hands and avoid contact with airborne germs from coughs or sneezes of others. [© Racorn |]

If you’ll be home for the holidays, you’ll likely socialize with family and friends, travel on an airplane or be one of the crowd at the mall… and someone there inevitably will be sick. All it takes is one projectile sneeze, a handshake, a kiss at a party, or a taste of the dip after someone else double dipped and wham! You’re down with a cold or the flu.

Some people may think the flu isn’t all that serious; but you need to remember that it can be a very dangerous—even fatal—illness, especially for the very young, the very old and the immune-compromised. It descends upon our local communities every year, often causing serious illness and sometimes death. And after the holiday season, we begin seeing more cases.

The best defense from the flu is a flu vaccine – and December is not too late to get one. According to the Centers for Disease Control (CDC), it takes about two weeks after receiving the shot to develop antibodies to fight flu. The best defense from a cold is to wash your hands and avoid contact with airborne germs from the coughs or sneezes of others. Eating and sleeping well can also help boost your immunity. Here are some tips for safe socializing this holiday season:

      • wash your hands often
      • don’t share drinks or food
      • let your faithful friends gather near but not too near – try to stay away from people who are sick
      • stay home if you are sick, and
      • cover your cough with a tissue or cough into the inside of your elbow so your hands don’t transmit germs.

What should I do if I get the flu?
If your illness is mild, stay home and avoid contact with other people. Call your doctor’s office to see if a prescription antiviral drug is right for you. You should stay home for at least 24 hours after your fever is gone. However, if you have symptoms and are in a high-risk group, contact your doctor for advice.

What is the difference between the common cold and the flu?
In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness and dry cough are more common and intense. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections or hospitalizations. Special tests done within the first few days of illness can determine if you have the flu.

If you practice good infection prevention, you may be able to avoid looking like Rudolph the Red-Nosed Reindeer this season. Healthy Holidays!

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Flu Myths Dispelled

Mark Landrum, M.D., an infectious disease specialist on staff at Howard County General Hospital, dispels the following myths. (Get more facts about the flu and vaccine, or  find a location offering the flu vaccine.)


  • "I shouldn’t bother with this year’s flu shot, since last year’s shot wasn’t very effective." Actually, an annual flu vaccine is the best protection against this serious disease. Each year, vaccines contain the three most common or likely flu viruses, and some vaccines contain protection against an additional virus. [© Subbotina |]
  • “There is no treatment if I have the flu.” On the contrary, staying hydrated and getting rest will help you recover from the flu. A prescription drug given in the first two days of the flu can shorten the duration and severity. See your doctor as soon as you think you have the flu. [© Comzeal |]
  • "I could get the flu from the shot." This is a myth. The flu shot is not a live virus, so you cannot get an infection from the vaccine; instead it will boost your immune system. The nasal vaccine protects with a very weak strain of influenza that doesn’t cause significant symptoms.[© Atholpady |]
  • “At night or on weekends, I have no options except to go to the Emergency Room.” No, if you have flu-like symptoms and are otherwise in good health, most physicians suggest you stay home and treat symptoms with over-the-counter medications and fluids, or they may prescribe Tamiflu. Some doctors have an on-call answering service for after hours. Urgent care facilities are also a good option when your doctor’s office is closed. If you have difficulty breathing, a prolonged high fever, severe dehydration or relapse after getting better, seek emergency medical care. [© Ronfromyork |]

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6 Health Tips for a Thinner Thanksgiving

thanksgiving diet tips

[© Dmitriy Shironosov |]

And Any Upcoming Holiday Meal!

Everyone loves the holidays – a time for family and friends gathering and sharing meals and memories. Between turkey and stuffing and pies, this is also a time that is easy to fall off the healthy eating wagon and gain unwanted pounds. However, Thanksgiving does not always have to sabotage your waistline.

Below are some tips to enjoy your Thanksgiving while staying healthy:

  • Don’t overeat: It is easy on Thanksgiving with so many options and food in front of us to overeat. Skip the seconds by waiting at least twenty minutes after your meal to let your body realize if it is full or not. Have the turkey be the only thing that is stuffed this year!
  • Exercise: Put in a little extra exercise around the holidays before treating yourself to your Thanksgiving feast. Increasing the length of your workout and exercising to burn off the calories before you consume them is a good trick. In addition to exercising before your Thanksgiving meal, take a walk after dinner and plan a workout date for the following day.
  • Stay hydrated: Drinking water throughout the day will keep you hydrated and keep hunger pains, that may actually be thirst, to a minimum. Also, go easy on alcohol where calories can sneak up on you.
  • Eat breakfast: Many follow the myth of skipping breakfast to save their appetite for the Thanksgiving feast – but this could actually be detrimental. Not eating until later in the day can easily lead to binging.
  • Eat fewer appetizers: By staying away from appetizers that you can have any day of the year, you save your appetite for the main course.
  • Try healthier recipes: If you are cooking or bringing a dish to Thanksgiving, lighten up your dishes by using less sugar and fat. Typically, no one will notice the difference if you scale back and use lower calorie ingredients.

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Manage your IBD symptoms with these tips

IBD symptoms treatment

[© Lensonfocus |] Although no cure exists for IBD, dietary changes and medication may help. If left untreated, IBD complications can arise, affecting your quality of life and contributing to an added risk of cancer.

IBS and IBD…do these gastrointestinal disorder acronyms have you confused? Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) share some similar symptoms, but treatment varies significantly between the conditions, making it important to get an accurate diagnosis.

According to Johns Hopkins Medicine,
: the overarching name of two chronic diseases which cause swelling of the intestines or the colon: Crohn’s disease and ulcerative colitis.
IBS: a digestive disorder that causes abdominal pain, diarrhea, constipation, bloating, gas or a combination of these.

Crohn’s disease is a chronic, inflammatory IBD affecting all or only a small part of the gastrointestinal (GI) tract. This autoimmune condition can progress deep into affected tissue. Ulcerative colitis is an IBD where the inner lining of the large intestine and rectum become inflamed and ulcers can form.

The symptoms of IBD vary and are similar to other bowel conditions and include diarrhea, abdominal pain and cramping, fatigue, fistulas, incontinence, rectal bleeding and weight loss.

“IBD symptoms are not only found in the GI tract. Symptoms can be extra-intestinal (outside the intestine) to include arthritis and joint pain, rashes and eye redness,” says Grishma Joy, M.D., a gastroenterologist on staff at HCGH. “You should see a doctor if you have symptoms lasting more than a few weeks and/or have recurrent symptoms, persistent pain, unintentional weight loss and/or rectal bleeding.”

Diagnosing IBD
Initially, testing for IBD begins with blood work and a lab test to check for inflammatory markers in your stool. A colonoscopy, often combined with an upper endoscopy, to collect tissue samples and visualize the GI tract are important tools in diagnosing IBD.

What Causes IBD?
According to Dr. Joy, the exact cause of IBD remains unclear, but we know that genetics and environmental factors can trigger IBD. Potential risk factors include if you:

  • have had your appendix removed
  • used Accutane (a form of vitamin A used to treat severe acne)
  • have a relative with IBD
  • are of Jewish ancestry (although IBD can occur in all ethnic and racial groups)
  • if you have IBS or celiac disease, you can also have IBD.

There is no specific IBD diet, but Dr. Joy suggests the following tips that may decrease your symptoms:

  • include fewer foreign substances in your diet, such as processed foods
  • reduce fresh fruits/raw vegetables: the antigens found in these uncooked foods can trigger a chemical reaction that causes IBD symptoms; instead, cook fruits and vegetables before eating them to eliminate the antigens
  • avoid red meat – it is hard to digest. Animal fat, along with fat in general, causes inflammation. If you are already overweight, you have a higher level of inflammation in your body already, and you should concentrate on avoiding too much fat that will only further increase your inflammation levels.

Treating IBD
Although there is no cure for IBD, several medications are available to help. “Many of the side effects of IBD prescription medications can be concerning. However, it is important for those diagnosed with IBD to understand their importance. If IBD is untreated, your risk of cancer can be increased. Additionally, untreated IBD can result in complications as the disease progresses, including: perforation or tearing of the intestines as a result of deep ulcers; abscess or infection; a fistula attaching to other organs; or malnutrition,” says Dr. Joy. “IBD can really affect quality of life and, as such, those with IBD may suffer from depression. Recognizing and addressing this is a very important aspect of effective management of the disease.”

There are many studies that show over-the-counter probiotics can provide relief from IBD symptoms. However, probiotics do not heal the intestinal lining, so you will need to continue taking your prescription medications.

“There are many new FDA-approved medications showing promise for those with IBD, and much research is in the pipeline,” notes Dr. Joy. “Nevertheless, if you are not responding to medication currently available, surgery can be an effective treatment option that often brings significant relief.”


Grishma Joy, M.D., is a gastroenterologist with Digestive Disease Associates in Columbia.




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Rheumatoid arthritis relief is possible

rheumatoid arthritis

[© Hriana |] RA is chronic autoimmune inflammatory arthritis that causes pain, stiffness, swelling, and limited mobility and function of many joints. If you or your primary care physician suspect RA, you should be evaluated by a rheumatologist to develop an appropriate management plan.

Understanding Rheumatoid Arthritis
Could you be one of the more than 1.5 million people in the United States who suffer from rheumatoid arthritis (RA)?  RA is chronic autoimmune inflammatory arthritis that causes pain, stiffness, swelling, and limited mobility and function of many joints. Typically, RA starts by affecting small joints in the hands and feet but can impact any joint. This systemic illness also can sometimes affect other organs, including the heart, lungs and eyes. Other symptoms may include low-grade fever, firm bumps, loss of energy and loss of appetite.

Approximately 75 percent of those with RA are women, and while the disease is most common between ages 40 to 60, you can be diagnosed at any age. Also, having a family member with RA can increase your likelihood of developing the disease, although you can still suffer from RA without having a family history of the disease.

No one knows what triggers rheumatoid arthritis, and since many diseases may behave like RA, if you or your primary care physician suspect RA, you should be evaluated by a rheumatologist to develop an appropriate management plan. This will help avoid unneeded tests for conditions that can mimic RA symptoms.

What can I do if I have RA?
Although there is not yet a cure for RA, there is a lot of research targeting a cure. Today, medication can dramatically improve or resolve symptoms of stiffness and swelling of joints, putting a patient in remission. In addition to medication, exercise, rest and joint protection are also forms of treatment.

The Arthritis Foundation suggests those with RA remember:
If left untreated, the inflammation caused by RA can result in permanent damage to joints or internal organ

  • The earlier you receive treatment, the better chance of preventing joint damage
  • Remission is possible
  • Your risk for heart disease is increased
  • Exercise helps: aim for at least 30 minutes of low- to no-impact aerobics five days a week and, if possible, include strengthening exercises
  • Stress management and rest are also helpful
  • Maintain open communication with your physician

The Howard County General Hospital Bolduc Family Outpatient Center offers physical therapy and exercise for those diagnosed with RA. For an appointment, call 443-718-3000.


Moe Zan, M.D., is a rheumatologist with Arthritis Care Specialists in Ellicott City. Make your appointment by calling 410-992-7440.

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It’s That Time of Year Again – Get Your Annual Flu Vaccine!

With another flu season approaching, now is the perfect time to get a flu shot! Flu vaccines are now being offered at doctor’s offices, pharmacies and health fairs in Howard County, and are often offered free of charge or covered by insurance. This Friday, they are available at the 50+ Expo at Wilde Lake High School in Columbia, courtesy of the Howard County Health Department.

The flu can be a serious illness. According to the Centers for Disease Control (CDC), during recent flu seasons, between 80 and 90 percent of flu-related deaths have occurred in people age 65 years and older. Children and those with other health conditions may also become more seriously ill with the flu.

To get more facts about the flu and get all of your questions answered about the vaccine, visit the CDC for Key Facts About Seasonal Flu Vaccine.

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What if I Have Lupus?

lupus symptoms

[© Nandyphotos |] Lupus is a chronic, autoimmune disease that often causes joint pain, facial rash and fatigue. It can occur in anyone, but typically strikes non-Caucasian women ages 15 to 44 years old. Family history also plays a factor.

Living with Lupus
Lupus is a chronic, autoimmune disease that can affect any part of the body, most often the joints, skin and/or organs. It is a disease of flares and remissions and the most common symptoms are joint pain, facial rash and fatigue.

How do I know if I have Lupus?
Lupus can often be difficult to diagnose because the symptoms mimic a variety of other diseases. Generally, a blood test is used to diagnose lupus when a patient has joint pain or a facial rash. The severity and types of symptoms you have determine if you need to see a specialist. Most often, a rheumatologist will treat lupus, but in some cases, it can impact other areas such as the kidneys and nerves, and you will see a different specialist.

Who Gets Lupus?
Anyone can get lupus, but it is much more likely in women than men, especially women ages 15 to 44. Additionally, though all races and ethnic groups can develop lupus, women who are not Caucasian are more prone to be diagnosed. The likelihood of getting lupus also increases with family history. If you have lupus, your children have a higher chance of having it.

Often mistaken for being contagious through sexual contact, this is not a disease that you can “catch” or “give” to someone.

Lupus Flares
Lupus is a disease of flares (when symptoms appear and the disease worsens) that come and go, lasting anywhere from a couple of weeks to many years. Flares can be caused or worsened by:

  • Being out in the sun
  • Stress
  • Sulpha drugs

Lupus is a disease that varies in severity. While some people may have very severe cases, others’ cases are so mild it barely affects them. Although there is not a cure for lupus, a variety of medications can treat the disease and control symptoms.

One very common misconception that people have is that if you have lupus you will die from it. The reality is that more people have milder cases of the disease and, while they need to be treated, they can live a pretty normal life.

As with any medical condition, patients should work to stay healthy with these tips:

  • Join a support group
  • Exercise and stay active
  • Maintain a healthy diet (high in omega-3 fatty acids) and weight – this is additionally important because those with lupus have a slightly increased risk of developing cardiovascular disease
  • Get involved in your health care and see your doctor regularly
  • Avoid significant sun exposure and use high SPF sunscreen
  • Get sufficient rest and avoid stress

Drug-induced Lupus
Drug-induced lupus presents with lupus-like symptoms that have been caused by certain drugs. Some prescription drugs associated with this phenomenon are used to treat infection, hypertension, irregular heart rhythms and tuberculosis. Patients typically experience a milder form of lupus with a rash or joint aches. Not everyone who takes these drugs will develop drug-induced lupus and, typically, when you stop taking the medication, the lupus-like symptoms disappear.

Steven Geller, M.D., is an internal medicine physician with Centennial Medical Group in Elkridge. Appointments: 410-730-3399. (Chaim Mond, M.D., is a rheumatologist in Columbia. Appointments: 410-580-1330.)

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What Everyone Ought to Know about Mono

mono symptoms

[© Jpcprod |] Most mono infections occur in teens and young adults, and most adults have had mono whether they remember it or not.

Q: How do I get mono?
Mono is caused by the Epstein-Barr virus and is transmitted through saliva. While you can get mono through kissing, you can also become infected by sharing utensils or from a cough or a sneeze.

Q: What are the symptoms?
Symptoms usually develop four-to-six weeks after exposure and may consist of mild to no symptoms in some younger patients to the more typical symptoms in adolescents and young adults. These symptoms may include fatigue, general discomfort, sore throat, fever, swollen lymph nodes in the neck or arm pit, swollen tonsils, a headache and possibly an enlarged spleen or liver.

Q: How do you test for mono?
The diagnosis is based on patient history, physical exam and blood work. The blood work may include a monospot test (that detects a type of antibody during certain infections) and can be negative in some cases. A more specific test can be ordered which measures antibodies to the Epstein-Barr virus.

Q: Can I get mono more than once?
In most cases, a person will get mono only once. Once someone is exposed, they develop antibodies and are unlikely to become infected again. However, in some rare cases, symptoms may reappear months or even years later. If you have had mono before and start to experience symptoms again, contact your physician as some mono symptoms can mimic other conditions.

Q: How is mono treated?
There is no specific treatment for the virus that causes mono. Treatment with medications may help symptoms and control fever and pain. Some people may develop a secondary bacterial infection and require antibiotics other than Amoxicillin which often causes a rash in people with mono. If tonsil and lymph node swelling is severe, steroids may be given to decrease inflammation.

Q: Is mono more common in children or adults?
Most adults have had mono whether they remember it or not. More than 90 percent of adults have antibodies to the Epstein-Barr virus and are immune. Most infections occur in teens and young adults.

Q: Does having mono predispose me for any other complications?
Mono can result in severe complications, although they are uncommon. These can include liver problems, such as hepatitis and jaundice; an enlarged spleen, which in rare cases may rupture; blood problems with low blood counts; or neurologic complications.

If you suspect you have mono, contact your primary care physician for an evaluation, blood tests, if indicated, and treatment based on your individual symptoms. While mono is very common, it is usually a self-limiting disease that resolves without significant complications.

Sharon Silverman, M.D., is an internal medicine physician in Columbia. Call for an appointment, 410-964-5311.

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How to tell if it’s meningitis

meningitis symptoms

[© Obencem |] Many cases of viral meningitis improve without treatment while bacterial cases can be life-threatening and require urgent antibiotic treatment. A sudden high fever is a common meningitis symptom.

With flu season approaching, it is important to know about meningitis, which shares many similar early symptoms with flu and can be mistaken for the flu. According to the Centers for Disease Control and Prevention (CDC), meningitis symptoms and signs of meningitis can begin to develop anywhere from several hours to several days from infection and may include:

  • sudden high fever
  • stiff neck
  • confusion
  • vomiting or nausea with headache
  • severe headache
  • seizures
  • light sensitivity

Symptoms for newborns are slightly different and include: constant crying, extreme sleeping, high fever, inactivity and lack of interest in eating.

Meningitis stems from a variety of causes, though most common are viral or bacterial. It is important to know the specific cause of the meningitis, as it determines the treatment and severity of each case, warns the CDC. Many cases of viral meningitis improve without treatment while bacterial cases can be life-threatening and require urgent antibiotic treatment.

Bacterial vs. Viral Meningitis
With bacterial meningitis, the earlier you get treatment, the better the chance of preventing serious complications. This form typically develops when bacteria enters the bloodstream and makes its way to the brain and spinal cord. Meningococcal bacterial meningitis is very contagious – particularly in crowded living conditions such as dormitories or close contact situations such as sports – escalates quickly and can be deadly. That is why we immunize children at age 11 when they tend to start being exposed to these types of environments. Children who are medically or genetically at a higher risk can be vaccinated as young as two months of age. This includes those with diabetes, sickle cell disease, immune deficiency or who are of Native American descent. A booster dose is typically given in the late teens before children head off to college. Infant vaccines (PCV13 and Hib) also protect against other forms of bacterial meningitis.

Viral meningitis is a more common form, occurring as a result of a virus such as measles, mumps, enterovirus, herpes and West Nile among others. This form of meningitis is milder than bacterial and evolves more slowly.

Viral meningitis doesn’t respond to antibiotics and should resolve on its own. However, as with any disease, trust your gut. If your child is lethargic and not responsive, and/or is refusing to eat or drink, take them to their pediatrician. If they have a terrible headache, fever and neck pain – especially down the middle of the neck – go to the emergency room.

Lindsay Fitch, M.D., is a pediatrician with Klebanow & Associates in Columbia. Call for an appointment, 410-997-6400.

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Hospital VP Rides to Conquer Cancer in Honor of ‘Grand’ Grandfather

I have decided to participate in the Ride to Conquer Cancer to honor my grandfather, Angelo Incorvia Jr. who fought lung cancer for several years.

My grandfather was part of the highly respected Greatest Generation. Similar to many of his generation, he honorably served his country in World War II. He was so compelled to enlist that he found a creative way to circumvent the minimum age requirement and hearing screening to gain acceptance in the Army and ultimately served for three years in Europe.

I consider myself extremely lucky to have had such a close relationship with my grandfather. He was an integral part of my childhood and as a young adult I considered him my best friend. My fondest memories were Sunday dinners at his home, which consisted of an over-the-top Italian meal cooked by my grandmother and sitting on his front porch listening to his war stories. My grandfather was extremely modest, generous, had a great sense of humor and always seemed to know when someone needed a little extra love and attention. He had a profound impact on my personal development and I always strive to lead my life in a way that would make him proud.

ride to conquer cancer

Ryan Brown, VP of Operations at Howard County General Hospital, is biking in the 150-mile Ride to Conquer Cancer next month in honor of his grandfather Angelo Incorvia, Jr. (above), a World War II veteran and integral part of Ryan’s childhood. Click here to support Ryan and Ride to Conquer Cancer, which benefits Johns Hopkins Kimmel Cancer Center and Howard County General Hospital.

Family was most important to my grandfather, which was evident by the fact that his home was always full with children, siblings, cousins and friends. It was a meeting place for all and so many joyous holidays were celebrated under his roof. Later in life my grandfather grew quite fond of gardening and, in particular, his coveted tomatoes. Every time I enjoy a tomato I smile and think of him.

It was extremely difficult to watch someone I idolized develop cancer. My grandfather fought cancer for several years and, unfortunately, it metastasized and he lost his battle on May 5, 2004. The entire time he battled cancer he always found opportunities to introduce a little humor into situations to lighten everyone’s spirits. Typical of my grandfather – placing everyone’s feelings above his.

A 150-mile bike ride is certainly an overwhelming endeavor. However, I jumped at the opportunity to participate to honor my grandfather and raise funds that may help reach a cure for this disease.

Ryan Brown is vice president of Operations at Howard County General Hospital (HCGH). He and hospital President Steve Snelgrove are leading HCGH’s team in the two-day, 150-mile Ride to Conquer Cancer, a bike ride benefiting the Johns Hopkins Kimmel Cancer Center and HCGH.

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These over-the-counter pain relievers could lead to heart attack or stroke

pain relievers

Acetaminophen or aspirin are safer alternatives to manage pain than relying on ones like ibuprofen and naproxen, which can increase the risk of heart attack or stroke. [© Monkey Business Images |]

The U.S. Food and Drug Administration (FDA) recently announced it is “strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)­—including ibuprofen, naproxen, diclofenac, and celecoxib as well as others—increase the chance of heart attack or stroke. The risk of heart attack and stroke with NSAIDs, both of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of prescription drug labels.”

We knew that long-term use of NSAIDs increased the risk of heart disease and stroke, but this new study discovered that short-term use could also pose a significant threat. This warning is especially important for high-risk groups that include males over age 50, females over age 60 and those who have high-risk factors of developing coronary artery disease such as diabetes, high blood pressure, high cholesterol, smoking or obesity.

For my patients with diagnosed coronary artery disease, a stent, history of a heart attack or bypass surgery who are suffering from a headache, arthritis or backache, I recommend that they take NSAIDs for no more than a few days. If you are a high-risk cardiac patient, but have not had a cardiac event, you can take NSAIDs for a few weeks but no longer.

If you want to avoid the risks associated with NSAIDs, Tylenol (acetaminophen) or aspirin are safer alternatives to manage pain. If you have concerns, you should call your doctor to discuss your risk of taking NSAIDs versus the benefit they may have in treating your pain.

If you are taking NSAIDs and experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of your body or slurred speech, call 911.


According to the FDA, new prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
  • The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.
Keith Freidman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

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How You Can Support Our Cancer Resource Center’s Director on Her Ride to Conquer Cancer

I Ride for My Family, My Patients, and Because I Can

ride to conquer cancer

Leslie Rogers, director of Howard County General Hospital’s Claudia Mayer/Tina Broccolino Cancer Resource Center, supported her mother during her mother’s cancer surgery and recovery. Here, Leslie poses with her mother as they both try on her mother’s wigs. Leslie is raising funds in the Ride to Conquer Cancer in honor of her family members and patients who have been diagnosed with the disease.

I was excited when I heard about the Ride to Conquer Cancer, so I went to an in-service here at Howard County General Hospital (HCGH) to learn more. I’m always up for a new adventure, but this one is somehow different. Raising money for cancer services has always been close to my heart, but this came with an incredible physical challenge as well. What’s two days on a bike compared to months—even years—of cancer treatment?

I have been a certified oncology social worker for years, and I am also currently the director of HCGH’s Claudia Mayer/Tina Broccolino Cancer Resource Center. I have had the privilege of working with many patients and families in cancer treatment. I do not proclaim to be an expert on life, but I do know that people are resilient. I have been blessed to have worked with hundreds of people in a very intimate and professional capacity, during a very difficult period in their lives. I have watched them get through things they never thought they could! Whether it was hair loss, leave from their job, talking with their children, or even experiencing the death of a loved one, I have watched people surprise themselves every day. People are amazing.

I have always said that cancer is an equal opportunity offender. It doesn’t care where you work, if you are male or female, young or old, black or white. I have been humbled by those who have died. I am inspired by those who live with their diagnosis every day without hope for a cure, and I am hopeful for those who have heard the words, “no evidence of disease,” after months of treatment. I have sat with people who question their own mortality, question what they might have done wrong, and with families who wonder how they will make it through. I have learned many life lessons along the way, which help me to hug my family a little closer, laugh a little louder and sweat a little less about the little things.

On a more personal note, I have learned that cancer doesn’t have to define people. I sat with my mom after her surgery. I changed her dressings. I watched her and my kids giggle and play with her wigs. I even watched her bury her father in her wig, when cancer had to take a backseat to life. Since then, my mom has learned to ride a bike, swim, get a personal trainer and still be my mom, asking me, “Are you getting enough sleep? Are you taking care of yourself?” Moms worry about their kids at all ages.

I watched my dad’s ear get reconstructed with grafted tissue harvested from his thigh. I watch him rub a special chemotherapy cream on his skin to contain the many cancer cells on his face. I listen to him grumble about having to go to his dermatologist on a monthly basis for skin examinations, claiming, “She is just making up excuses to see me naked.”  Other than that, he is still my Dad. He fixes things around my house when he comes to visit.

I ride for many reasons. I ride for those who would love to ride but can’t. I ride for those who have been through so much. I ride because I believe in the cancer services provided here at HCGH. I ride because I can.


Click here to support Leslie and the 2015 Ride to Conquer Cancer, a two-day, 150-mile ride benefiting the Johns Hopkins Kimmel Cancer Center and Howard County General Hospital. The hospital team, led by HCGH President Steve Snelgrove and Ryan Brown, vice president of Operations, includes physicians and staff who are taking this challenge to support cancer patients everywhere. Our goal is ambitious and we can’t do it without the support of our community members.
Leslie Rogers is the director of Howard County General Hospital’s Claudia Mayer/Tina Broccolino Cancer Resource Center.

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breastfeeding tips

Dr. Natalia Colón Guzmán is an OB/GYN on staff at Howard County General Hospital. Also a mother of two, she shares her struggles with breastfeeding and the reasons she persisted until breastfeeding became a success. (Dr. Colón Guzmán with husband Eduardo Guzmán and daughters Susana and Ana Lucía.)

Breastfeeding may require some hard work, but it’s worth the effort says this OB/GYN and breastfeeding mom

In addition to being a mom of two, I am an obstetrician. So, I know how beneficial breastfeeding is to both mother and baby. When I had my firstborn, I was determined to breastfeed. Although it was more difficult than I expected, with assistance, I was able to be successful. If I can do it, anyone can.

Breastfeeding has long proven to be quite beneficial for both mother and infant. There is good evidence that it can influence many aspects of an infant’s life, including overall health, risk of infections, risk of obesity in the future and many others. Breast milk helps strengthen infants’ immune systems, which is why infants who are exclusively breastfed have fewer visits to doctors and hospitals for illnesses. Some studies even suggest that the longer a baby is breastfeed, the higher the child’s IQ could be later in life.

There are also many benefits to the mother, including helping to achieve a quicker recovery from delivery and reducing her levels of stress. It can enhance weight loss for many mothers and can be a method of birth control, although not quite perfect. Breastfeeding can reduce the risks of maternal ovarian and breast cancer and it is also good for the household economy as it is free (it is estimated it can save $1,000 in one year).

While it has many benefits, breastfeeding can, unfortunately, be challenging for many mothers. Sometimes the infant has issues, such as a tongue tie or congenital deformities, and sometimes the mother can have problems, such as flat nipples and low milk supply. Some women have to work very hard to achieve their breastfeeding goals.

When I had my first child, my milk came in a bit later than expected and the baby was not gaining as much weight as the pediatrician wanted. It was very hard work for me; I had to pump and supplement feedings with my own milk, but perseverance is one of my personality traits and I sought support and was able to pull through. Now I am breastfeeding my second child, and it is so natural to me that it feels as if I have been doing it my whole life.

In order to be successful at breastfeeding, I think it is important to take care of yourself. Eat well, stay hydrated by drinking lots of fluids/water, take your vitamins, and rest as much as you can. It is important to be persistent, even if the breastfeeding is not going as planned. In my practice, I find many women give up easily. I know how they feel…I almost gave up myself. But, a good lactation consultant, pediatrician and/or a lactation support group, will help women pull through and allow them many months of successful breastfeeding.

Howard County General Hospital hosts a Breastfeeding Support Group every Wednesday, 12:30-2:30 p.m. in our Wellness Center. No appointment is needed.

Natalia Colón Guzmán, M.D., FACOG, is an OB/GYN on staff at Howard County General Hospital. She and her husband, Eduardo Guzmán, are the proud parents of two little girls, Susana and Ana Lucía.

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Before deep brain stimulation, Howard County resident Andrea Freeman suffered from Parkinson’s disease. “I could barely walk…trips to the mall with my daughters were filled with worry that I wouldn’t get back to the car. I was totally hopeless.” Now she’s back to hiking and biking again, completing a 20-mile ride this past spring.

Deep brain stimulation gives Howard County resident new life after Parkinson’s diagnosis

In 2005, at age 34, Andrea Freeman, a longtime Howard County resident, found herself off-balance –literally. An avid hiker, she began tripping and falling frequently. She went from feeling energetic and active with her family to a state of utter exhaustion. Her most strange symptom was a slight shake in her little finger.

“For four years I sought answers and was tested for fibromyalgia and Lyme disease among other conditions and diseases,” recalls Andrea. “But the doctors couldn’t determine what was causing these strange symptoms in someone so young.”

Throughout those four years, Andrea continued to deteriorate. Andrea remembers “shaking a lot and dragging my right leg. My right arm and hand were rigid and stuck, and I started having a blank look on my face. “

In 2009, she started seeing Howard County General Hospital neurologist Joseph Savitt, M.D. who finally gave Andrea the answer she was looking for—a diagnosis: Parkinson’s disease.

Dr. Savitt started Andrea on a regimen of medications. “Many of the medicines had side effects that you take different medicines to counteract,” says Andrea. “I would get dyskinesia (twisting of my limbs) but at least I wasn’t shaking. Holding a job was no longer possible.”

By 2014, Andrea found herself withdrawn and overwhelmed by her symptoms. “I couldn’t take any more medicine—it made me tired, and I was already chronically exhausted but I couldn’t sleep,” she remembers. “I could barely walk—my leg would twist—and I would fall a lot. I would go for a walk in the woods and panic I wouldn’t get out. Trips to the mall with my daughters were filled with worry that I wouldn’t get back to the car. I was totally hopeless. I had reached the point that nothing else could be done for me except deep brain stimulation.”

Andrea began the process of being evaluated and was approved as a candidate for the surgery.

According to The Johns Hopkins Deep Brain Stimulation (DBS) Center, DBS is an FDA-approved neurosurgical procedure where electrodes are implanted in the brain to send mild electrical signals to the area that controls movement. These electrodes are connected to a stimulator (implantable pulse generator) that is implanted under the collar bone, similar to a pace maker.

“In November of 2014, my brain was turned back on,” says Andrea. “I am so grateful that I have my life back. I can cook, rollover in bed and smile again. I can put my feet on the ground, get out of bed and dress myself. The rigidity released immediately in my arm. It was like a switch was turned on. I am still building back my muscle, but this winter I did a six-mile hike up a mountain in Western Maryland. In the spring, I completed a 20-mile bike ride—it was hard and I went slowly—but I did it.

“You just can’t imagine the things that I couldn’t do that were simple tasks and the ability to be able to do those again—I can’t put into words. Not being able to work was the worst feeling. I was literally wasting away mentally, emotionally and physically. Now I am back at work full-time and have a purpose again. I start every day with complete gratitude.”

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Healthy Cookout Survival Guide

It’s summertime which means cookout season is in full swing! Whether you are hosting or attending a cookout, it is always difficult to stick to your diet or a healthy eating plan with all the delicious temptations surrounding you. Just keep in mind there are a variety of alternatives to add a healthier menu to your cookout which go beyond the traditional hot dogs and hamburgers!

Healthy tips for your next cookout:


  • Ditch the Chips – Substitute potato chips and French onion dip for raw veggies accompanied by hummus, salsa or guacamole. These snacks are not only better for you, they taste great and keep you full! Still crave that crunch? Try kale chips or a pickle! [© Jenifoto406 |]
  • Grill Outside the Box – Trade your regular ground beef burger for a lean meat such as chicken, sirloin, fish, pork or skinless turkey breast. Other popular, tasty options are salmon (or any fish!), black bean, portobello or veggie burgers. Don’t limit yourself to meat. Pineapple, peaches and vegetables are great grillers, too! Or fill a skewer with mushrooms, peppers, tomatoes, zucchini, squash and tomatoes. [© stockcreations |]
  • Talking Turkey (Dogs) – Switch your regular frank for a turkey dog to get that great hot dog flavor at a fraction of the calories and fat. If you are on a reduced sodium diet, read the label. [© Trudywilkerson |]
  • Calorie Counting – Using 100 percent whole grain sandwich thins is an easy way to cut down the calories. Go even lighter by ditching the bun altogether or prepare meat that doesn't require a bun. You can also say no to mayo in your salads by using a lighter alternative such as Greek yogurt or vinegar. [© Cardiae |]
  • Be Fruitful – Dessert doesn’t have to be a sugary sweet. Replace cookies and cakes with a naturally sweet fruit or fruit salad. [© Photodeti |]
  • Sweet Drinks – Trade your sugary beverages for water and add flavor by infusing with lemons, fresh strawberries or other fruit, mint, ginger or cucumbers! Low sugar lemonade or teas are also great options. [© Evgenyb |]

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See How Easily You Can Teach Your Kids Pool Safety This Summer

pool safety tipsFor many, summer means pool time! Though splashing around with family and friends is a highlight of the summer, it is important to keep pool safety and caution in mind. With drownings and pool injuries a valid concern, make water safety your first priority.

Follow these simple guidelines to keep pool time safe and fun for everyone:

  1. Never allow children near or in the water unattended, even if lifeguards are present
  2. Make it a rule for your kids to never go in or near the water without an adult nearby
  3. Teach your child to swim or sign them up for swimming lessons
  4. Designate a water watcher. Choose a responsible person to keep an eye on the water every time children are in or near the water
  5. Make sure your child knows basic water safety skills
  6. Stay in arm’s reach of young children
  7. Have young children who are inexperienced in swimming wear a life jacket near the pool
  8. Learn CPR!
  9. Make your child wait at least 30 minutes after eating to swim
  10. Establish safe pool rules and enforce them such as: no running near the pool, always swim with a buddy and no diving
  11. Make sure children know that drains and suction fittings in the pool or hot tub are always off limits
  12. If you have a pool in your back yard, make sure there is proper fencing and/or barriers around it
  13. Always wear sunscreen with a minimum SPF of 30

By following these simple safety guidelines, you are sure to have a summer full of fun at the pool and create great memories!


Resources: and the American Red Cross

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ride to conquer cancer event

John Dunn, administrative director for Diagnostic Imaging at Howard County General Hospital, is riding to conquer cancer this fall in memory of his father. He’s pictured here with his dad in front of the St. Louis Arch in 1976 and more recently in 2012 at Ocean City, NJ where the two biked together on vacation.

Father’s Memory Inspires Hospital Leader to Take Epic Challenge

What makes a person willing to ride 150 miles in just two days throughout Maryland? Knowing that you’re doing it for a good cause, a precious memory of a loved one. I’m riding in this September’s Ride to Conquer Cancer in memory of my father, also John, who lost his life to cancer a few years ago. By doing so, maybe I’ll be helping rid our world of the disease, so cancer can no longer rob us of precious moments with our loved ones.

Some of my favorite memories of my dad involve bicycling. I vividly remember one ride in the late 1970s through the Missouri countryside, near the house where I grew up. We started at dawn on a humid summer morning, and rode all day on the gravel roads in the Boone County countryside, through cow pastures and cornfields. I also have fond memories of bicycling up and down the boardwalk in Ocean City, New Jersey, and roaming the island on bikes while on vacation.

My father grew up just outside of Philadelphia. He loved sports of all kinds. He played high school basketball and ran track. He was also president of his senior class. After graduating from Penn State in 1959, he served in the Army in Fort Lee, VA. Following his discharge, he worked in retail and switched careers in the 1960s and completed a Ph.D. in agriculture at Rutgers University. He then joined the faculty at the University of Missouri and initiated the turf grass research program for the College of Agriculture. He remained involved in sports–he was a longtime member of the Columbia (Missouri) Track Club and coached youth soccer.

In October 2011, a few years after he retired, my father was diagnosed with lung cancer. It was shocking news to us all, especially since he had never smoked. He weathered the next year with courage and dignity, never complaining. He passed away on Monday, Nov. 19, 2012 at home with me, my sister and my mother by his side.

During his last year, my dad talked to me about how dying is part of the circle of life. He said, “Don’t fear dying. I have a feeling there are surprises waiting for us that are beyond our imagination.”  I don’t think he necessarily meant that in a conventional religious way. I do think he meant that life, and the universe, is more wondrous than we can grasp during our time on Earth. When I’m biking, I think about his words.

It’s been fun training for the Ride to Conquer Cancer in September. I’ve been riding on the Capital Crescent Trail, which starts near my house in Silver Spring and skirts the western border of Washington D.C., ending in Georgetown. From there, it’s a straight shot back up through Rock Creek Park to Silver Spring. It’s about 22 miles and is wonderfully scenic. As I ride, I think of how much my dad would have enjoyed the views of the Potomac River and the D.C. landmarks. Riding is a chance to reflect on some of the good times I spent with Dad.

My dad had a great sense of humor – I think I miss him most when something funny happens. He dearly loved his five grandchildren, and I wish they could have had more years with him. I wish I could have had more years with him. I’m doing my part to help conquer cancer by riding in this upcoming event and I would greatly appreciate your support.


The 2015 Ride to Conquer Cancer is a two-day, 150-mile ride benefiting the Johns Hopkins Kimmel Cancer Center and Howard County General Hospital. The hospital team, led by Steve Snelgrove and Ryan Brown, includes physicians and staff who are taking this challenge to support cancer patients everywhere. Support John here. Our goal is ambitious and we can’t do it without the support of our community members.


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How to tell if an animal has rabies — and what you can do to prevent being bitten

raccoon, rabies symptoms

© William Rodrigues Dos Santos |

Rabies is one of those things you don’t think about until it affects you. You should be aware of things you can do to prevent rabies when in certain situations­–like finding a bat in your house or seeing a fox in your neighborhood who acts a little off.

Rabies is a viral disease that is most commonly transmitted through animal bites. It infects the nervous system and can lead to death. Early symptoms include headache, fever and fatigue, but as time passes, more severe symptoms may develop including confusion, anxiety, insomnia, slight paralysis and difficulty swallowing, among others. When these symptoms occur, death often happens within days. If you suffer from an animal bite, be it domestic or wild, immediately seek medical help.

Rabies is much more commonly found in wild animals including raccoons, skunks, bats, foxes and coyotes than in domestic animals like dogs. However, in the United States, rabies from bats to humans is extremely rare with only one to two cases annually. In Howard County, we still see a lot of wild animals and residents should be aware.

The species in this part of the United States that most commonly carry rabies are typically raccoons, skunks and foxes. Rabies symptoms include the wild animal biting or snapping at inanimate objects, appearing tame and fearless, appearing wobbly or “drunk,” or acting disoriented. If you see a nocturnal animal such as a skunk or a raccoon out and active during the day and exhibiting abnormal behavior, that is a likely sign of rabies, and you should contact Howard County animal control at 410-313-2780. Additionally, if you find a bat in your house, as a precaution in case of being bitten while asleep, you should receive a series of shots, the first dose at the hospital and subsequent doses at an urgent care center.

Your dog is at a high risk for rabies if they have not been vaccinated and are exposed to wild animals. That is why it is important to mind the Howard County Police Department’s animal control law by maintaining a rabies vaccination for dogs, cats and ferrets that are four months of age and older.

When a dog shows behavior changes such as restlessness, irritability or aggression – this could be a sign that he or she has been exposed, according to the Centers for Disease Control and Prevention (CDC). The dog may present a fever and bite or snap at you or even objects. As the rabies progress, your dog may hide in darker places, lose their appetite, have seizures or a sudden death. If you think your dog has been in contact with a rabid animal, contact your veterinarian immediately.

Rabies is preventable. The CDC says vaccinating your pet, spay or neutering your pet, maintaining control of your pets, avoiding exposure to wild animals and reporting any stray or sick animals are all ways you can participate in rabies prevention. Also, keeping your dog on a leash and supervising it when it is outside is a great method to prevent their exposure to rabid animals.

Never approach or handle a wild animal. If bitten by a wild animal, scrub and flush the wound and seek medical help immediately – timely treatment has proven to be successful.


Sources: Centers for Disease Control and Prevention & The Humane Society of the United States

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Road Trip Snack Tips


road trip snacks

[© Wavebreakmedia Ltd |]

9 Healthy Snack Tips for Your Summer Road Trip

Summertime means road trip time! Here are some great ideas to fight off those snack attacks, and keep your energy up, too!  Plan your snack pack before you hit the highway to avoid unhealthy fast food stops and remember that a small insulated cooler is a must have.

  1. It’s A Wrap! Sandwiches can add protein and hearty grains to your diet. Keep wraps made with meat and cheese or hummus or veggies in a cooler.  Other options, like peanut butter and jelly on whole grain, can be kept at room temperature.
  2. Keeping It Cool: Yogurt. Whether it’s in a tube, made into a low-fat smoothie or mixed with fruit or granola, keep these road trip snacks in the cooler. It’s great snack for kids and adults.
  3. Hot On The Trail. Make trail mix at home that keeps well in a storage container with a lid.  Combine granola, raw nuts, seeds and dried fruits. Add a few dark chocolate chips for sweetness or wasabi peas for spice!
  4. Healthy Can Be Gouda, Too: low fat cheese, string cheese, single serve cottage cheese or cheese cubes. There are many low-fat cheeses, or soy or nut-based cheeses for those who are lactose intolerant. Prep cheese slices at home before and toss in the cooler. Pair with your favorite crackers you portion ahead of time, making it “snack-friendly” for the car.
  5. Dip It! Veggie Style. Fresh veggies can be sliced and stored in an insulated cooler. Road trip choices include cherry tomatoes, baby carrots, broccoli florets, cucumbers, celery and snap peas.  Add peanut butter or hummus as a dip to add good fats and protein, too.
  6. Energy Bars….Sweet! Replace those candy bars with an energy or granola bar. Protein and fiber, now that’s a healthier choice.
  7. Fruits, For Sure. Trip-friendly fruits that have been washed and sliced at home are a quick go-to from the cooler. Grapes and berries are finger-sized already. Others can be cubed and stored in containers, or eaten whole.
  8. Thirst Quenchers. Healthy beverages kept on ice are really nice on the road. Water, seltzer, 100 percent vegetable and fruit juices are the way to go.
  9. Go nuts! Craving crunchy? Pistachios, almonds, walnuts, whatever your favorite nut may be. Or go for sunflower or pumpkin seeds, air popped popcorn or rice cakes.
Karen Sterner is special events coordinator at Howard County General Hospital. She is an experienced traveler, having taken many road trips with her family.

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The Latest on Lung Cancer, and a Test that Could Save Your Life

lung cancer symptoms, screening

[© Ilexx |]

According to the National Institutes of Health, “Lung cancer is the most common type of cancer in both men and women, and the majority of these cancers are directly linked to cigarette smoking.” Lung cancer is more prevalent in smokers; however, non-smokers can also get lung cancer. If you are suffering from a chronic cough, recurring pneumonia or bronchitis, shortness of breath, or have a cough that produces blood, you should see your physician.

Smokers often disregard their cough as “a smoker’s cough” and do not seek a diagnosis until the cancer is advanced. Also, some patients in their 30s and 40s falsely believe they are too young to have lung cancer and ignore their symptoms.

In addition to smoking, risk factors for lung cancer include:

  • exposure to radon
  • secondhand smoke
  • certain chemicals or asbestos
  • a family history
  • or previous radiation to the chest.

Many people think that lung cancer is a death sentence, but, when caught early, a combination of chemotherapy, radiation and surgery can significantly increase your chances of a cure. The key is to catch the cancer in its early stages through screening.

New Screening
If you are age 55 to 80, have smoked in the last 15 years, or are currently smoking and have a 30-pack-per-year smoking history, the U.S. Preventive Services Task Force recommends you receive an annual low-dose CT scan. This test allows us to see lung cancer in its earliest stages using much less radiation than a traditional CT scan. This screening has saved many lives and is available at local imaging facilities with a prescription from your doctor.

Here to Help You Quit
Cigarette smoking is the number one risk factor for lung cancer. In fact, nearly 90 percent of lung cancers in the United States are linked to cigarette smoking. Even if you have smoked for many years, quitting now can still significantly reduce your risk for developing lung cancer. If you are looking for help to quit smoking, join the Howard County Department of Health Tobacco Cessation Program or call 410-313-6265.

In recent years, many people have been turning to e-cigarettes as a substitute for tobacco cigarettes. E-cigarette users should keep in mind that the safety of electronic cigarettes has not been adequately studied (nor demonstrated). Formaldehyde, a known carcinogen, has been shown to be an inhaled vapor of e-cigarettes.

Francis Chuidian, M.D., is a pulmonologist with Johns Hopkins Community Physicians Pulmonary Medicine in Columbia.

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Lingering cough? It could be pneumonia


Pneumonia symptoms often include a cough and fever, feeling weak, shortness of breath and chest pain that worsens when coughing. [© Photographerlondon |]

Unlike the flu, you can get pneumonia year-round. Though pneumonia is more prevalent in the winter months when it is cold and everyone is indoors, regardless of the time of year, if you have a cough lasting for more than three days, you should be seen by your physician.

What is Pneumonia?
Pneumonia is an infection of one or both lungs that can be caused by a bacteria, virus or fungus. The infection causes the air sacs in your lungs to become inflamed and filled with fluid. Symptoms often include a cough and fever, feeling tired or weak, being short of breath and chest pain that worsens when coughing.

Who is at risk?
Children under the age of 2 and adults over the age of 65 are at a higher risk of getting pneumonia and, when they do, tend to have a more severe case and often require hospitalization.

Also, if you have a weak immune system due to HIV, diabetes, liver disease, alcoholism or chronic heart disease, or have COPD or lung diseases such as asthma or Cystic Fibrosis, you are at an increased risk of getting pneumonia. Pneumonia can be a very serious illness, and you should receive a vaccination to prevent it — especially if you are at risk.

A Vaccine to Prevent Bacterial Pneumonia
Eighty percent of all bacterial pneumonia is caused by the bacteria streptococcus pneumoniae. Two vaccines prevent this type of pneumonia: Pneumococcal Polysaccharide Vaccine 23 (PPV23) and Pneumococcal Conjugate Vaccine 13 (PCV13).

If you are otherwise healthy, and age 65 or older, it is recommended that you get the PCV13 initially and then, in six months, get a dose of the PPV23. In five years, in some cases, you will receive a booster.

Also, all babies should receive a series of the PCV13 shots during their first year of life.

If you are an adult with a higher risk of pneumonia due to a compromised immune system or other risk factors, but younger than 65, you too should receive the PPV23 vaccine and PCV13 vaccine regardless of your age.

Unfortunately, there is no vaccine to prevent viral pneumonia.

What is Walking Pneumonia?
Walking pneumonia is typically diagnosed in younger adults and is also caused by bacteria. Usually symptoms are milder, and you will feel achy and may have a cough.

Reducing the Risk
In addition to getting the pneumonia vaccines:

  • Get an annual flu vaccination — the influenza virus can often lead to pneumonia
  • If you have asthma, make sure you are regularly taking your medication to control your asthma and get both flu and pneumonia vaccines
  • If you have a young baby, do not expose your baby to large crowds
  • If you are a smoker, stop smoking
  •  If you are a diabetic, keep your diabetes in check so you don’t lower your resistance to infection
  • Wash your hands regularly
  •  If you have a child under the age of 2, be sure to have him or her receive the Hib vaccine (the Hib vaccine protects your child from a specific flu that can cause pneumonia)
Gerren Perry-Fabrizio, M.D., is a family medicine physician with Johns Hopkins Community Physicians in Fulton/Maple Lawn.

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4 Tips for Better Breathing with COPD

According to the American Lung Association, chronic obstructive pulmonary disease (COPD) is a lung disease that, over time, makes it hard to breathe. COPD is a disease that involves inflammation and thickening of the airways and the destruction of the tissue of the lung where oxygen is exchanged.

Family on swing

© Photographerlondon |

Fernando DeLeon, M.D., a pulmonologist on staff at Howard County General Hospital (HCGH), explains that this disease is diagnosed through pulmonary function testing, though it can sometimes be diagnosed through X-rays or CT scans of the chest.

Some symptoms of COPD:

  • shortness of breath
  • coughing
  • wheezing

“Contrary to popular belief, if you are diagnosed with COPD, that does not mean you will end up on oxygen,” explains Dr. DeLeon. “COPD is treated with inhalers. It is progressive but moves at a slow pace — if you do not smoke and are not exposed to excessive airborne pollution. COPD is not a terminal disease. Many people diagnosed with it can even routinely exercise.”

As the disease advances, it becomes more difficult to remain active due to shortness of breath. HCGH offers pulmonary rehabilitation, a program that incorporates an individualized regimen of exercise, education, breathing retraining and the development of coping and support skills. It will help to ease your symptoms, achieve an optimal level of independence and self-reliance, decrease anxiety and depression, reduce infections and hospitalizations, and improve quality of life by increasing mobility and stamina. “Pulmonary rehabilitation does not treat the disease, but it makes someone more physically fit, which helps,” says Dr. DeLeon.

Take the Path to Pulmonary Wellness
Dr. DeLeon recommends:
1. SAY YES TO EXERCISE: Though it may be more difficult to stay active with COPD, exercise is recommended. People who are short of breath and do not exercise become even more short of breath.

2. SAY NO TO SMOKING: More than 80 percent of COPD cases in the United States are caused by tobacco use. The main precaution if you are diagnosed with COPD is to stop smoking if you are still smoking and to try to avoid being exposed to secondhand smoke.

3. SAY YES TO A HEALTHY DIET: In addition to exercise, a healthy diet is important if you have COPD. A diet with a variety of the right nutrients will not cure COPD, but will help you breathe easier and feel better. Because COPD patients use more energy to breathe than the average person, they may require more calories in their diet compared to a person living without COPD.

4. SAY NO TO AIRBORNE POLLUTION: In addition to not smoking, it is also important to avoid inhaling secondhand smoke and to be aware of your air quality by avoiding dust and fumes.

Fernando DeLeon, M.D., is a pulmonologist with Howard County Center for Lung and Sleep Medicine.

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Whoop! There It Is: What you need to know about the cough that is on the rise


whooping cough vaccine

Whooping cough vaccination starts in infancy, but because immunity wanes after about 10 years, doses should be given to preteens and then again in adulthood. [© Skripko Ievgen |]

What is whooping cough?
Whooping cough, also known as pertussis, is a highly contagious bacterial infection that starts with the cold symptoms of a runny nose, congestion, fever and cough. The hallmark of this infection, however, is a persistent dry cough which arises from toxins that the bacteria secrete in the lung. Pertussis is known as the “100-day cough” and coughing spasms, even to the point of a cracked rib or vomiting, can occur. In fact, the sound of the first breath of air taken after a coughing fit, which sounds like a “whoop,” gives rise to the name of the syndrome.

Who gets whooping cough?
Though the infection is seen as a childhood illness, adults and adolescents are common carriers. According to Mark Landrum, M.D., an infectious disease specialist on staff at Howard County General Hospital, children and especially infants are at greatest risk for severe illness. “In 2012, more than 48,000 cases of pertussis were reported to the Centers for Disease Control and Prevention (CDC), including 20 deaths. Most deaths were in infants less than 3 months of age,” explains Dr. Landrum. “The CDC estimates that half of all infected infants less than 1 year of age require hospitalization.”

How can I avoid whooping cough?
In the past few years, pertussis cases have been rising across the nation. “Immunity from the vaccine weakens over time, placing us at risk for infection from Bordatella pertussis. Infants start vaccination at 2 months of age, while most preteens get a vaccination at 11 to 12 years of age, and all adults from 19 to 65 need a booster dose,” says Dr. Landrum.

“Pregnant women should receive a dose of Tdap at the end of the second trimester or during the third trimester with each pregnancy. This antibody protection is shared with the infant and provides some protection for new babies. Grandparents shouldn’t be surprised if the new mom insists on vaccination for visitors. All adults over 65 should receive a dose if in contact with infants to prevent infection in those who can’t protect themselves.”

Test Your Whooping Wit with Dr. Landrum
True or False:
My childhood booster vaccination gives me immunity forever.
False: The protective effect wears off after about 10 years. Recommendations are for additional vaccination at ages 11 to 12, and again after ages 19 and 65.

There are risks to getting the booster as an adult.
False: The older form of the vaccine was known to cause high fevers, but the newer vaccine, Tdap, has few serious reactions. Most complain of tenderness at the injection site the next day.

I only get the vaccine once as an adult/adolescent.
False: Current recommendations are for adult vaccination between ages 19 to 64 and once after age 65. You should still get the tetanus/diphtheria Td booster every 10 years.

I have gotten the whooping cough once, so I will never get it again.
False: Immunity seems to wane after about 10 years.

Mark Landrum, M.D., is the section chief of Infectious Diseases at Howard County General Hospital and the Chair of Epidemiology and Infection Prevention Committee. He is with Infectious Disease Associates in Ellicott City.

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Do you hear what I hear? Or could it be tinnitus?

tinnitus relief

[Credit: xrender]/[iStock]/Thinkstock

Our Johns Hopkins specialist explains the condition and offers tips for tinnitus relief.

An old Irving Berlin song begins with the lyrics, “I hear music and there’s no one there.” When the speaker wonders why, he’s told, “You’re not sick. You’re just in love.” A lovely and romantic notion. But for the millions of people that suffer from tinnitus, the sounds that occur only inside their own head can cause great stress and anxiety, even interfering with their sleep and daily activities.

An estimated 50 million American adults have experienced tinnitus at some time, and one in five of those with tinnitus seek medical attention. It is most common among the elderly and is listed as the most common service-related disability among military veterans—tinnitus is believed to be linked to long-term noise exposure, such as that caused by firearms or loud music.

What is tinnitus?
Tinnitus is the clinical name for ringing in the ears, but it can also include other phantom sounds like buzzing, clicking, hissing, whooshing and pulsating, for which there are no apparent external sources. There are two types: primary tinnitus has no obvious cause and is often associated with hearing loss, while secondary tinnitus is associated with an underlying disease or condition and may also be accompanied by hearing loss. The American Tinnitus Association lists a variety of causes for this condition that include:

  • damage to nerve endings and stiffening of bones in the inner ear
  • advancing age
  • exposure to loud noises
  • allergies
  • high or low blood pressure
  • diabetes
  • thyroid problems
  • wax buildup
  • certain medications
  • head and neck tumors.

Johns Hopkins pediatric otolaryngologist David Tunkel, M.D., led a panel to develop guidelines to help primary care physicians and specialists treat and manage tinnitus (October 2014 issue of Otolaryngology—Head and Neck Surgery). The following information and suggestions come from the guidelines published by Dr. Tunkel’s committee and from the American Tinnitus Association.

What should I do if I think I have tinnitus?
Have your doctor diagnose your condition by reviewing your medical history and giving you a physical exam to rule out other possible conditions. He or she will look inside your ear canal and may find a treatable cause, such as earwax or fluid behind the eardrum. You should also have a hearing test to see if hearing loss is accompanying the tinnitus.

What treatments are available?
Tinnitus may go away on its own, but when it lasts for more than six months, and when tinnitus is bothersome, one or more of the following may be helpful:

  • Hearing aids can make the tinnitus less noticeable.
  • Cochlear implants may help mask tinnitus with ambient sounds or suppress tinnitus with the electrical stimulation they send through the auditory nerve.
  • Counseling and cognitive behavioral therapy can teach people how to cope to reduce the impact of the tinnitus.
  • A variety of sound therapy devices and methods may help. Such therapies range from devices that supply background noise such as a smart phone, CD or MP3 player or radio, to specialized devices made just for the treatment of tinnitus.
  • Treatment by a dentist to correct your bite can bring relief if you suffer from a dysfunction of the jaw known as TMJ (temporomandibular joint).
  • There is no convincing clinical evidence to prove that products such as Ginkgo Biloba, melatonin or zinc help patients with tinnitus. Similarly, there is no proof that medications injected through the eardrum, magnetic stimulation or acupuncture can improve tinnitus.


Where can I find help if I have tinnitus? Your doctor can provide information and suggest self-help books. Support associations and resources are also available. For more information, visit the American Tinnitus Association, the American Academy of Otolaryngology-Head and Neck Surgery and National Institutes of Health.


Johns Hopkins pediatric otolaryngologist David Tunkel, M.D.


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Itchin’ for Allergy Answers? Get Your Remedy with our Local Allergist

girl in field with allergies

 [© Frolovaelena |]

To help you survive this allergy season, HCGH allergist and immunologist Dr. Michael Goldman answers your allergy questions:

Q: What are some tips to survive allergy season?
Most people should expect to be able to manage their allergies through environmental control and medications. Trees in this area typically begin pollinating in March and continue through early June while grasses pollinate in May and continue through early July. Weeds, such as ragweed, start in mid-August and continue through October. To control pollen allergies: keep the pollen out by closing your windows during allergy season. Keeping the windows closed is better than installing an air filter. Also, take a shower before going to bed to remove allergens that have accumulated during the day on your hair and body.

Q: What medicines can help my allergies?
Medications called antihistamines block histamine that is produced by the body in response to allergens or irritants, and relieve a runny nose, sneezing, itchy nose and/or eyes. There are several long-acting, over-the-counter antihistamines available. Decongestants can help with nasal congestion, but should not be used in young children or in adults with hypertension, enlarged prostate or narrow angle glaucoma. Antihistamine eye drops can soothe itchy eyes. Nasal steroids are very good at treating nasal symptoms of allergies, but must be used every day and can take more than a week to reach maximum effect. I recommend avoiding nasal and eye decongestants, which can become addictive.

Q: At what point should I see an allergist?
If controlling your environment and medications are not enough to help your allergies, it is probably time to see the allergist. A board-certified allergist can accurately diagnose what you are allergic to and interpret tests in the context of your symptoms. Based on the testing, other environmental measures to control allergen exposure might be suggested or different medications might be prescribed. If symptoms persist, allergen immunotherapy, or desensitization, may be recommended. Immunotherapy now comes in two forms: allergy injections (allergy shots) and sublingual immunotherapy (drops or tablets under the tongue).

Q: Can my allergies lead to sinus infections?
Allergies can increase the risk of upper respiratory tract infections including recurrent sinus and ear infections. You may wish to consider testing to see if allergies are contributing to these conditions in you or your child.

Q: What are the pros/cons of steroid nasal spray?
Nasal steroids are very effective at controlling nasal symptoms of allergies. There is a small risk of growth effects in children and this should be monitored. A small percentage of patients are intolerant of nasal steroids due to nosebleeds. If you experience bleeding, you should stop the nose spray.

Q: What is the effectiveness of a saline nose rinse?
The saline nose rinse has not been well studied. Some people find rinses helpful, and others find it not to be worth the trouble. If you do find it helpful, you want to be sure to use distilled water to prevent introducing infection into the nasal cavity.

Q: How can I calm my itchy eyes?
Resist the urge to itch. Itching will introduce pollen into your eye from your finger tips and the skin around your eyes and make it worse. There are over-the-counter and prescription antihistamine eye drops that can help, and cool compresses (wet, clean washcloths) may feel soothing.

Q: What are some common misconceptions about allergies?
The term “hay fever” is a misnomer. Allergies do not actually cause an increase in body temperature, but people can feel feverish, sick and uncomfortable due to their allergies. Allergies can affect quality of life as much as many other chronic diseases. Allergic secretions are clear when you have a runny nose or watery eyes. If secretions are thick, yellow or green, they could be a sign of an infection.

Michael Goldman, M.D., is an allergist and immunologist with Allergy & Asthma Center of Central Maryland in Columbia.

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Allergist Answers Your Top Asthma Questions


Allergies are one of several important triggers for asthma in the majority of asthmatics – especially those who developed asthma younger in life. Understanding your asthma triggers is important.
[© Photographerlondon |]

Asthma Answered: How You Can Live Life to the Fullest

HCGH allergist and immunologist Michael Goldman answers your asthma questions:

Q: What does an asthma attack feel like?
The classic symptoms are a cough, wheezing, chest tightness and shortness of breath. However, everyone can experience asthma differently. For some, the only symptom is a cough. Typically asthma symptoms worsen with triggers such as colds, respiratory infections, allergen exposures (e.g. pollens, dust, pets), cold air and exercise.

Q: How do you diagnose asthma?
For most people, asthma is diagnosed by reviewing symptoms and responses to asthma medications. A special breathing test, before and after an asthma inhaler, can help determine the severity.

Q: How are allergies involved in asthma?
Allergies are one of several important triggers for asthma in the majority of asthmatics – especially those who developed asthma younger in life. More than 80 percent of 10 year olds with asthma have allergies contributing to inflammation of the bronchial tubes. Common allergy triggers for asthma include year-round allergens such as dust mites, cats, dogs, and even cockroaches and mice. Seasonal triggers include spring or fall pollens such as trees, grass and ragweed. Molds can also contribute to allergic asthma. Food allergies can trigger an asthma attack in those patients with food allergies, but are not a cause of ongoing asthma. The best way to tell if allergies are contributing to your asthma is to have allergy testing.

Q:  How can I prevent asthma attacks?
Understanding asthma triggers is important. Avoiding pets, if you are allergic to them, may be necessary. For those with frequent asthma symptoms, daily medications are used to prevent symptoms. Inhaled steroids, in the lowest dose effective to control symptoms, are the gold standard to treat persistent asthma. All asthmatic patients should have a short-acting rescue inhaler to use if symptoms develop. If you need the rescue inhaler more than every four hours you should contact your physician.

Q:  What are some common misconceptions about asthma?
While asthma symptoms may come and go, asthma should be considered a chronic disease just like hypertension or high cholesterol. Treating asthma when you are well is important to prevent symptoms over time and help you when you get sick. This often entails taking daily medications or controlling allergens and other triggers even when you feel perfectly fine. This is important to know. It is not a good idea to stop daily asthma medications unless you are in contact with your physician. These medicines prevent ongoing symptoms and lessen the severity of flares.

Asthma can vary in severity from mild to severe. For some people the only symptoms are mild chest tightness and cough during and following an upper respiratory infection. It may worsen with exertion or cold air at that time, but not when otherwise healthy. For others, asthma can be a daily and nightly struggle, with symptoms interfering with daily quality of life. If you are having asthma symptoms more than two times per week, you should see your provider to see if a daily, preventative medicine is appropriate, such as an inhaled steroid.

All patients with asthma should have a short acting bronchodilator, a “rescue” inhaler. These medications should be used as needed, when symptoms develop, or for some people, prior to exercise. If you need to use them more frequently than every four hours, you should seek medical attention. Your asthma may not be in control.

Q: When is asthma an emergency?
If you are suffering from severe shortness of breath, making it difficult to talk, very rapid breathing, your lips turn blue, or you need to use chest or neck muscles to aid in breathing your should seek medical attention immediately. Oral steroids may be necessary with asthma episodes, but long-term use of oral steroids is restricted for only the most severe asthmatics.

With appropriate attention and medical care, asthma can be controlled and you or your asthmatic child should be able to lead a perfectly normal life, able to do almost everything non-asthmatics can do. Some of the world’s best athletes have asthma. It should not be a barrier to all you want to do.

Michael Goldman, M.D., is an allergist and immunologist with Allergy & Asthma Center of Central Maryland in Columbia.


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Physician Advice for Managing Well with Parkinson’s Disease

parkinsons.chartThe shaded area (figure, above) indicates a range of how you might progress with PD. By making the right decisions, you can modify your progression and increase the probability that you remain in the “impaired” region rather than progressing more quickly to either being handicapped or disabled.

Answers and Advice
from a Specialist
Diagnosis with a chronic progressive disease such as Parkinson’s disease (PD) can be very scary and may come as a shock. Those newly diagnosed wonder what the future holds for them. Questions like: Will I end up in a wheel chair? Answer: Very rarely. Should I make funeral arrangements or get my affairs in order? Answer: People with Parkinson’s usually live a normal life span.

Parkinson’s disease is a slowly progressive disease that requires medical treatment, physical therapies and some modification in lifestyle. If you have been diagnosed with PD, there are ways you can increase the likelihood of maintaining your highest level of functional capacity—your ability to perform daily activities physically, socially and psychologically.

An important thing to remember is that evidence shows that people with PD who exercise regularly, maintain a healthy lifestyle and do not take unnecessary risks increase the likelihood of living a full and active life. Your brain controls your body in order to carry out your daily activities. The brain does the math and the messages it sends to your muscles must take into account how tall you are, how much you weigh and how strong you are. It is much easier, mathematically, for the brain to control a body that is in good shape and strong, than one that is debilitated.

First Steps After Diagnosis

  • First and foremost, educate yourself about PD.
  • Be a compliant but savvy patient and choose the right physician.
  • Choose a healthy lifestyle and don’t take inappropriate risks.
  • Learn about new drugs and treatments.

Seeking information about your disease is better than simply wishing you didn’t have PD. Scientific literature demonstrates that people with PD have a higher quality of life when they are informed about their disease (Shimbo et al 2004). You should understand:

  • How your medications work and why you are on them.
  • The role of exercise and how it can help you maintain a high level of function.
  • Where to get information that is specific to your situation. Your neurologist is probably the best source because he or she understands the stage of your disease and the most effective treatment strategies.

Information Sources
Various foundations are a good source of information, including the Parkinson Foundation of the National Capital Area, The Michael J. Fox Foundation, the National Parkinson Foundation and the American Parkinson Disease Association.

Howard County Support Groups:

  • Early Onset/Newly Diagnosed Support Group: Meets first Saturday, monthly, 10:30 a.m.-1 p.m. Bain Center, 5470 Ruth Keeton Way, Columbia. Contact: Deb Bergstrom, 301-712-5381 or
  • Howard County/Columbia Group: Meets third Monday, monthly, 7-8:30 p.m. Parkinson’s and Movement Disorders Center of Maryland, 8180 Lark Brown Rd, #101, Elkridge. Contact Kathleen Dougherty,
  • Howard County Carepartner Group: Meets second Tuesday, monthly, 10 a.m. Vantage House, 5400 Vantage Point Rd, Columbia. Contact Lynada Johnson, 410-992-1120.

Local Education Opportunities
Symposia are held throughout the Baltimore-Washington Area by local academic centers (Johns Hopkins, University of Maryland, Georgetown University) and by the Parkinson Foundation of the National Capital Area.

Stephen Grill, MD, PhD., is a physician with the Parkinson’s & Movement Disorders Center of Maryland.






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The Sleep and Exercise Connection

exercise and sleep“There is a reciprocal relationship between sleep and exercise,” said Charlene Gamaldo, M.D., medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital. “Most of us recognize the fact that when we sleep well we feel better and have more energy during the day, which includes feeling more motivated and having more energy to exercise. Those who sleep well tend to lead a more active lifestyle.”

On the flip side, studies show that the average person who exercises regularly has a tendency to fall asleep more quickly and go into deeper sleep stages. “These individuals also appear to prime their body and brain to be better and more efficient sleepers, which results in waking up feeling more rested and restored,” noted Dr. Gamaldo.

Exercise and insomnia
People suffering from insomnia are unable to fall asleep or struggle with staying asleep. For those who don’t respond to treatment, recent data suggests that exercise may help.

In one study, participants suffering with long-standing insomnia exercised moderately (with an increase in heart rate) for 50 minutes, three times a week, for six months,” said Dr. Gamaldo. “The results showed a significant improvement in their insomnia. This was not just a subjective measurement on how they felt, but also based on their sleep quality as measured in a sleep lab. This is exciting news, and there is no downside of exercise, no bad side effects. Patients also reap the health benefits that come with increased physical activity along with better sleep.”

Exercise when you can!
Although this study showed that the time of day that people exercised didn’t negatively impact the participant’s sleep, Dr. Gamaldo warns that everyone is different.  “I encourage my patients to exercise and, if they can fit it in more practically in the evening without hampering their sleep, then they should do so. For a long time we felt you shouldn’t exercise in the evening before sleep, and for some people that may still be the case. Listen to your body and try to incorporate physical activity at some point in your day that works for you.”

Charlene Gamaldo, M.D., is the medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital and associate professor of neurology at Johns Hopkins Medicine. For an appointments, call 800-937-5337.

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Have a student athlete at home? You’ll want to attend this pediatrician-led seminar on sports injuries

sports injuriesJohns Hopkins pediatricians present the free seminar, “Caring for the Young Athlete,” Wednesday, April 8 from 6-8:30 p.m. (dinner included) in the Howard County General Hospital Wellness Center

Super Bowl Sunday has long since come and gone and, with it, the intense media frenzy on sports-related injuries and NFL players who have suffered brain injuries as a result of multiple concussions playing the game.

If you have children who play sports in school or in your community, you know that professional football players are not the only athletes affected by the growing number of sports-related injuries. According to the Centers for Disease Control and Prevention (CDC), concussions and related injuries increased by 60 percent in the past 10 years and hospital emergency departments across the U.S. treat approximately 173,285 children and adolescents every year for traumatic brain injuries (TBIs), including concussions. In school settings alone, nearly 715,000 sports and recreation injuries occur each year.

In recognition of National Youth Sports Safety Month in April, Johns Hopkins pediatricians will present a seminar on “Caring for the Young Athlete” on April 8 from 6:30-8:30 p.m. (a complementary dinner is at 6 p.m.) in the Howard County General Hospital Wellness Center, to provide education on the prevention, evaluation and rehabilitation of sports-related injuries. Physicians who specialize in orthopaedics, sports medicine, neurosurgery, surgery and physical therapy will discuss signs and symptoms of more serious conditions and when you should seek medical help.

Register for the “Caring for the Young Athlete” seminar. Visit the Stop Sports Injuries website for tips on how you can help prevent sports injuries in your children and in their schools.



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Discover Your Child’s Fitness Personality and Make Exercise Child’s Play Every Day


“Exercise affects your whole body and makes your bones and muscles stronger. It improves your heart, lungs and brain function. It also reduces weight, increases lean body mass and can improve a child’s immune system,” said Suzie Jeffreys, an exercise physiologist at Howard County General Hospital.

Not only does exercise help children physically, but mentally as well. “Kids need to get up and move every day. It is a natural part of living and gets our blood flowing and allows more oxygen to reach the brain, which can result in clearer thoughts, better grades, more energy and focus, and improved test scores,”  noted Jeffreys.

“If you get them moving while they are young, it becomes a way of life. They don’t have to get drenched with sweat. Anything they do is better than sitting on the couch or in front of a video game or on their phone,” said Jeffreys.

Know Your Child’s Fitness Personality
With all the latest technology distractions geared toward children, they may sometimes need a little encouragement from their parents to get moving. “There are different fitness personalities. Not everyone is a born athlete and not everyone wants to be—so get to know your child,” remarked Jeffreys. Fitness personalities include:

The “Non-Athlete” – These children need more encouragement and help to get and stay active. They are not inclined to physical activity due to either lack of interest, ability or both. For these children, it is important to introduce exercise gradually and make it fun. To pique their interest, schedule time for activity, invite friends and find something they enjoy.

The “Casual Athlete” – These children find enjoyment in being active, but may not be a star athlete and are most likely not comfortable in a competitive environment. If you get these children out and moving, they will lead you, and you can introduce them to new activities and inspire them with new equipment or attire.

The “Athlete – These children do not need to have you encourage them as much as support them. Continue to provide support by recognizing their talents and suggest trying a variety of activities.

Low Cost Exercise Options in the Howard County area:

  • Team sports through leagues or school
  • Get Active/Stay Active Howard County has a variety of programs and allows kids to try out different activities.
  • Howard County Striders is a great opportunity to run and walk with other kids at a variety of fitness levels.
  • Girls on the Run is an after-school program through the schools: 443-864-8593,
  • Howard County Recreation Centers (Glenwood, North Laurel, Roger Carter) are great resources for families to play basketball, walk/run on an indoor track, jump rope or swim for a reasonable fee.
Suzie Jeffreys is an exercise physiologist for Howard County General Hospital.



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What You Ought to Know about Exercising While Expecting

pregnancy and exercises


You’re expecting a baby and you want to stay fit and healthy. But you probably have some questions about what kind of exercise and how much is safe for you and your baby. Lahaina Hall, M.D., an obstetrician on staff at Howard County General Hospital, has some answers for you.

Q: Can I exercise when pregnant?
You can exercise while pregnant, as long as you do not have any medical or obstetrical issues that put your health at risk. Some conditions that would limit exercise are vaginal bleeding, premature rupture of membranes, incompetent cervix, low placenta or risk factors of preterm labor. You should always speak with your doctor first before starting any exercise regimen.

Q: What is a healthy amount to exercise?
If you don’t already exercise regularly and you are beginning an exercise regimen during pregnancy, start slowly and work up to a goal of at least 30 minutes a day. This can have significant health benefits and help with the process of labor.

Q: Is there a time when I should stop exercising?
There is no set time to stop exercising if your pregnancy remains uncomplicated. Certain exercises may be more challenging as the pregnancy progresses, and those exercises will need some modification. Avoid excessive exercise in hot, humid weather. Stay hydrated. Stop exercising if you experience pain, vaginal bleeding, contractions, leakage of fluid, chest pain, shortness of breath, headache, decreased fetal movement, muscle weakness or are feeling faint or dizzy.

Q: Why should I exercise while pregnant?
Exercise during pregnancy has many benefits. It helps build muscle, bone and stamina; improves energy, mood, sleep and posture; promotes strength and endurance; relieves stress; and may possibly help to prevent and treat gestational diabetes.

Q: Which exercises are best for pregnant women?
The best exercises for pregnant women include swimming, walking (if you don’t exercise, walking is a good way to start and build endurance over time), cycling, low impact aerobics and running, especially if you were a runner before pregnancy.

Q: Are there any exercises I should avoid?
You should avoid exercises with an increased risk of falling and contact sports.  Skiing, horseback riding, gymnastics, hockey, soccer, football, basketball, volleyball and boxing are not recommended. After the first trimester, you should avoid exercises requiring you to lie on your back.

Q: How can I avoid injury?
Always warm up before exercising. Stretching is particularly important. This can help avoid stiffness and injury. Hormones during pregnancy cause ligaments to become more relaxed, enabling joints to be more mobile and at risk of injury. Always cool down after exercising by slowly reducing activity and then stretch.

As pregnancy progresses, be aware that your center of gravity will shift with your growing abdomen; this can make you less stable and more likely to lose balance and fall.

STAY HYDRATED!!!!! Make sure to drink water before, during and after exercise.

Lahaina Hall, M.D., is an OB/GYN with Signature OB/GYN in Columbia. For an appointment, call 410-884-8000.





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Commit to be fit! 10 ways to sneak exercise into your routine

exercising couple, biking

[Credit: YanLev]/[iStock]/Thinkstock

Exercising is important at every age. Studies report that, typically, adults need at least 150 minutes of aerobic activity and two days of muscle strength training every week. If that sounds unrealistic, try for 90 or 120 minutes. Any amount of exercise is beneficial.

Suzie Jeffreys, an exercise physiologist with Howard County General Hospital, suggests the goal of exercising for 30 minutes, five to seven days a week for adults in general. “Research shows even if you break up your exercise, as long as you exercise at least 10 minutes at a time, you get the same benefits.”

According to Jeffreys, physical activity not only helps control weight, but adults who do not exercise are at a greater risk for other health problems such as diabetes, certain types of cancer, heart problems and high cholesterol.

If you are an adult who is not in an exercise routine, or even if you have never exercised before, it is never too late to start. “Adults who are not accustomed to exercising can start slowly and gradually,” Jeffreys suggests. “Something is better than nothing. Start with 10 minutes, or 10 minutes twice a day, and then build from there. Though you will be tired when you start to exercise, within two weeks of regular exercise, you will have more energy.”

Make Exercise Your Norm
1. Don’t set unrealistic goals
If you’re hoping exercise will help you lose weight, remember that it didn’t take just a few weeks to put the weight on—especially for adults age 40 and older—and you may not see the results of your increase in physical activity immediately.

2. Don’t get discouraged
Instead of basing your results on your weight, which can often be discouraging, try on a pair of pants that are tight every two weeks. You will begin to see and feel a difference.

3. You don’t need a gym membership
Many people often use the lack of a membership as an excuse not to exercise. Walking is one of the best exercises, and no equipment or cost is required.

4. Walk with a purpose
When you go for a walk, don’t just stroll. Pump your arms and get your heart rate up. Push yourself to get a little winded.

5. Track your time
Get a calendar and put it where you will see it often. Put a checkmark for each day you exercise.

6. Exercise with your children
If you have young kids, get out and exercise with them. Power walk while they run around or ride their bikes.

7. Stretch after you are warmed up or after you complete your workout
You should always be warmed up before stretching to prevent injuries. For example, walk for five minutes then stretch before you do more moderate exercise.

8. Don’t have time until late?
Studies show the time of day you typically exercise may not affect your sleep. Do what works best for you.

9. Achy joints?
Exercise can actually help reduce arthritis symptoms.

10. Too busy?
Breaking up exercise into 10-minute segments throughout your day is still beneficial.

Susie Jeffreys is an exercise physiologist at Howard County General Hospital.




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Anti-aging technique you can do in your own living room

anti-aging, exercise

According to a Johns Hopkins study, “Most experts recommend exercise as the single most important anti-aging measure anyone can follow, regardless of age, disability or general level of fitness. A sedentary lifestyle accelerates nearly every unwanted aspect of aging.” [JackF]/[iStock]/Thinkstock

Exercise has long-term physical and mental benefits, even reducing arthritis symptoms in older adults

Physical Benefits of Exercise
A lack of physical activity can put you at higher risk for health problems such as diabetes and osteoporosis. In fact, according to Dianne Braun, P.T., a clinical program manager and physical therapist with Howard County General Hospital, “It is not only healthy for seniors to exercise, it can also be dangerous to not exercise. Not being physically active can be risky, as seniors can lose up to 75 percent of their strength from inactivity, making them prone to falls. Current statistics show that one in three people over the age of 65 fall every year and that number increases to one in two by age 80.”

Mental Benefits of Exercise
Not only does exercise help seniors physically, it can also have a positive effect mentally. Physical activity can help manage stress and reduce feelings of depression. “Depression is a big issue for seniors, and just five minutes of exercise a day has been shown to reduce the incidence of depression,” said Braun. Some studies also suggest that regular physical activity can increase various aspects of cognitive function.

How Much Exercise is Enough?
“General exercise recommendations for seniors include 30 minutes of exercise with strength training two times per week,” said Braun. “If you have a fear of increasing pain, or have a heart or medical condition, check with your physician for exercise guidelines. The important thing is to start exercising and make it a part of your daily routine.”

Studies show that exercising regularly and staying active have long-term benefits and improve the health of older adults. According to a Johns Hopkins study, “Most experts recommend exercise as the single most important anti-aging measure anyone can follow, regardless of age, disability or general level of fitness. A sedentary lifestyle accelerates nearly every unwanted aspect of aging.”

The Arthritis Antidote 
Though exercise may seem like the last thing you want to do when suffering from arthritis, exercise is very important to increase strength and flexibility, reduce joint pain and help with fatigue. Physical activity does not have to be at a high-intensity level, but studies indicate that a moderate level of exercise can help with the pain as well as help maintain a healthy weight.

“Strength training and aerobic activity (walking or other) are good for the joints. Many studies have shown a reduction in pain with regular strength training and aerobic conditioning,” said Braun.

Exercise Examples: 

  • Aerobic conditioning activities such as walking, biking, swimming, raking leaves
  • Strengthening activities for lower body: squats, single-leg stance, step-ups and sit to stand from a chair (try not to use your arms and upper body)
  • Strengthening for upper body that incorporates some weight lifting, such as arm raises, overhead raises and biceps curls.
Dianne Braun is a clinical program manager and physical therapist with Howard County General Hospital.

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Exercising this muscle may prevent heart disease and stroke

HCGH cardiac (heart health) team

Dr. Alexander Chudnovsky, director of Cardiac Rehabilitation Services at Howard County General Hospital, with (from left): Prasobha George, RN; and exercise physiologists Suzanne Jeffreys and Brett Goldberger. Dr. Chudnovsky is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

February is American Heart Month: Exercise to Tone Your Heart!

American Heart Month is a good time to remember how important exercise is for heart health. No matter what age you are or stage of life you are in, some form of exercise is beneficial for most people.

Alexander Chudnovsky, M.D., a cardiologist on staff at Howard County General Hospital (HCGH) and medical director of the hospital’s Cardiac Rehabilitation Program, wants you to know that exercise is for everyone, regardless of age or cardiac health status. The heart is meant to be used!

No Cardiac History?
Exercising doesn’t just tone the muscles in your arms, legs and core, it strengthens the heart muscle. According to the American Heart Association, physical activity helps prevent the nation’s number one and number four killers: heart disease and stroke. “When you exercise regularly, the heart becomes conditioned and uses oxygen and energy more efficiently,” says Dr. Chudnovsky. “To condition the heart, you should exercise at least four times a week and raise your heart to your target heart rate for 20 to 30 minutes during exercise.”

What is your target heart rate?
220 – your chronological age x 0.8 = your target heart rate.

The Cardiac Patient
In general, most cardiac patients benefit from exercise. Those with coronary artery disease and congestive heart failure can benefit significantly from cardiac rehabilitation offered in a clinical, monitored setting. You should discuss a cardiac program with your physician. HCGH offers many cardiac rehabilitation options to help those who have recently experienced a heart attack, angioplasty, stable angina, coronary bypass surgery, irregular heart rhythms, heart failure or transplant or valve surgery. Call 443-718-3000 for more information.

“Exercise can induce the heart to grow new blood vessels to supply areas of the heart that may have been affected by prior cardiac events,” notes Dr. Chudnovsky. “In addition, regular exercise can help reduce blood pressure, increase good cholesterol (HDL) and reduce bad cholesterol (LDL), improve glucose metabolism for those with diabetes and support weight loss.”


Before You Start: According to Dr. Chudnovsky, if you are planning to start exercising and you are not conditioned and have cardiac risk factors that include diabetes, smoking, high cholesterol, high blood pressure and/or a family history of cardiac events, you should see your cardiologist or primary care doctor before you put your heart under the stress of physical activity.

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Do this one thing to relax your mind and reduce stress


© Martinmark |

Meditation . . . mind, body and soul

In today’s busy world, there is often too little time to step back and reflect—on our lives or on the moment in which we’re living. Devices that were designed to help us manage our lives too often end up controlling them, and busy schedules eat up time we should take for relaxation and quiet contemplation. All of this is taking its toll, as more and more people suffer today from stress- and anxiety-related disorders. Meditation is one way we can take back some quiet time, to center our lives and enhance our sense of well-being.

Meditation and Religion
Meditation has been practiced throughout the world for thousands of years, most often as a component of religious beliefs and traditions, and usually involves an effort to regulate the mind in some way.

In the Bahá’í faith, meditation is a tool for spiritual development and a way to reflect upon the words of God. For Buddhists, meditation is part of the path toward enlightenment and nirvana. Christian meditation is used to reflect upon God. Hindus have practiced mediation for tens of thousands of years and the Buddha is believed to have been a Hindu prince who attained wisdom through meditation. In Islamic mysticism, or Sufism, remembrance of God is interpreted through various meditative techniques.

Meditation and Health
More recently, the Western world has adopted many meditative practices, including New Age meditation, which has its roots in the social revolution of the 1960s and 1970s, when many young people rebelled against societal rules and traditional systems of belief. During this era, several secular meditation practices emerged, bringing the realization that meditation can improve health. The National Center for Complementary and Alternative Medicine (NCCAM), a U.S. government entity that is part of the National Institute of Health, notes, “Meditation may be practiced for many reasons, such as to increase calmness and physical relaxation, to improve psychological balance, to cope with illness, or to enhance overall health and well-being.”

Biofeedback is one form of meditation that involves becoming more aware of physiological functions such as brainwaves, muscle tone, skin conductance, heart rate and pain perception. Using instruments that provide feedback, the goal is for the individual to eventually be able to manipulate their bodily functions at will to improve their health and conditions such as high blood pressure, depression, anxiety, irritable bowel syndrome, insomnia, headaches and migraines.

“…in our study, meditation appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants.”
Madhav Goyal, M.D., M.P.H., assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine

Meditation Benefits
There are many types of meditation, but most have four elements in common:

  • A quiet location with minimal distractions
  • A specific, comfortable posture (sitting, lying or walking)
  • A focus of attention that sometimes includes a specially chosen word or set of words (a mantra), an object, or a focus on breathing
  • An open attitude that allows distractions to come and go without judgment.

Meditation and the Brain
Today, we can look into the brain with instruments such as MRI and EEG to see how an individual’s body and brain change after meditating regularly, and research suggests that meditation may physically change the brain and body to improve certain health problems. A 2012 study indicated that people who practiced meditation for many years have more folds in the outer layer of the brain, a process that may increase the brain’s ability to process information. Clinical studies have also suggested that meditation may slow, stall or even reverse changes that take place in the brain due to normal aging. Results from a 2012 NCCAM-funded study suggest that meditation can affect activity in the part of the brain that processes emotions, and that different types of meditation can have different effects. While studies about the ability of meditation to reduce pain have had mixed results, some have shown that meditation can activate certain areas of the brain in response to pain.

Madhav Goyal, M.D., M.P.H., assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, led a study that was published in the JAMA Internal Medicine online magazine. He noted, “A lot of people use meditation, but it’s not a practice considered part of mainstream medical therapy for anything. But in our study, meditation appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants.” Goyal stated that further studies are needed to clarify which results are the most influenced by meditation.

While meditation has been practiced throughout history for many purposes, studies seem to indicate that it holds considerable promise for the field of medicine.

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Childhood diseases like measles and mumps: they’re not just for kids anymore!

childhood diseases, measles, mumps

© smartview27 |

How you can avoid the outbreak of childhood diseases, and what to do if you develop one

As if the flu and Ebola weren’t enough to worry about, now we’re hearing increasing stories of outbreaks of childhood diseases among adults. Angelina Jolie misses the premier of her new film due to a case of chickenpox. NHL hockey players sit out games because they’re coming down with the mumps, along with approximately 1,100 other Americans in 2014. In California, there’s an outbreak of whooping cough, among kids and adults. There’s also a multi-state outbreak of measles, 102 cases in January alone, most linked to Disneyland. Most of the measles cases were among people who were not vaccinated. (Measles cases in 2014 were triple the number from the previous year.)

Even adults who were vaccinated against these diseases as kids are contracting them at record rates. So, what’s happening and why are adults becoming victim to diseases we thought only children could catch?

Waning immunity
People old enough to remember the days before vaccines for mumps, measles and chickenpox probably contracted these diseases when they were young, so they have natural immunity and will be unlikely to succumb to the maladies. But adults who were vaccinated as young children, and therefore didn’t contract the diseases, may become vulnerable again because immunity can fade over time.

If you are concerned that your immunity may be wearing off, ask your doctor about a blood test that checks for antibodies to see if you are still immune. This is especially important for people with chronic medical conditions or who do a lot of foreign travel. And be sure you are up to date on vaccinations the CDC recommends for adults: a booster shot every 10 years for tetanus, diphtheria and whooping cough, and an annual flu shot.

Lower vaccination rates for children
The best defense against childhood diseases is to have your children vaccinated. In some parts of the country, skepticism regarding the safety of vaccines has resulted in fewer children being vaccinated for chickenpox, measles, mumps and whooping cough. Among parents of kindergarten children in California, “personal belief exemptions” rose from 1.56 percent in 2007-08 up to 2.79 percent in 2012-13. With fewer children being vaccinated against these diseases, they are much more likely to spread from one person to another.

Childhood diseases that are affecting adults
Causes fatigue, irritability, itchy rash that progresses to raised red bumps and then blisters. Adults who get chicken pox are more likely to contract pneumonia, hepatitis or encephalitis. This virus can also resurface years later as shingles.

Treatment: Bed rest, lots of fluids, a fever-reducer and an antihistamine to relieve itching. Calamine lotion or an oatmeal bath may also relieve symptoms.

Whooping Cough
Causes violent coughing accompanied by a “whooping” sound, nasal discharge, fever, sore and watery eyes. Lips, tongue and nail beds may turn blue during coughing spells. It can last up to 10 weeks and can lead to pneumonia and other complications.

Treatment: Antibiotics, keeping warm, plenty of fluids and reducing stimuli that provoke coughing.

Causes a rash, fever, runny nose, conjunctivitis, cough, swollen lymph nodes and headache. It can have serious complications in adults and can be fatal for children and adults with compromised immune systems. Complications include ear infection, pneumonia, vomiting, diarrhea and encephalitis.

Treatment: Plenty of fluids, fever reducer and antibiotics if a secondary infection develops.

Causes discomfort and swelling of salivary glands in front of neck, difficulty chewing, fever, headache, muscle aches, tiredness and loss of appetite. In males it can cause pain and tenderness of testicles, and, on rare occasions, sterility.

Treatment: Bed rest and analgesics (acetaminophen, ibuprofen) for fever and pain and applying cold packs to the swollen and inflamed salivary gland region may reduce symptoms and pain.

Fifth Disease
Causes cold-like symptoms and bright red rash that spreads from the cheeks to trunk, arms and legs. There may also be fever, headache, sore throat, nausea or vomiting and diarrhea. It can be associated with persistent fevers and arthritis in adults.

Treatment: Plenty of fluids,­­­ fever reducer and antihistamine for itching.

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Reduce your cervical cancer risk

cervical cancer vaccine

Vaccination to protect females against the types of HPV that cause most cervical cancers is recommended for 11- and 12-year-old girls, and for females 13 through 26 years who did not get the shots when they were younger. [© Bvdc |]

January is Cervical Cancer Awareness Month

What is cervical cancer?
The cervix is the lowest part of the uterus, which opens at the top of the vagina during childbirth. Johns Hopkins Medicine notes that if the cells in the cervix begin to grow and change, they can become malignant and the cancer can spread to the uterus and surrounding organs.

What causes cervical cancer?
According to the Centers for Disease Control and Prevention (CDC), the highest risk factor for developing cervical cancer is carrying HPV, a common virus that can be passed from one person to another during sex. Worldwide studies have shown that HPV virus exists in more than 99 percent of cervical cancers and viral proteins play a role in the transformation of HPV-infected cells into tumor cells. HPV is very common and often causes no symptoms, so it can go undetected and often goes away on its own. While not all women carrying this virus will develop cervical cancer, it is important for women who know they carry the virus to have an annual Pap smear to check for changes in cervical cells.

Other things that can increase the risk of developing cervical cancer are smoking, being HIV positive, using birth control pills for more than five years, giving birth to three or more children and having multiple sexual partners.

What are the symptoms of cervical cancer?
According to Johns Hopkins Medicine, in its early stages, cervical cancer usually has no noticeable symptoms, which makes it critically important for women to have Pap smears, a test to collect cells from the cervix to check for abnormal cells or signs of malignancy. Some women do experience symptoms such as abnormal vaginal bleeding or unusual discharge, pelvic pain and pain during intercourse. These symptoms are not always signs of cancer, but it is always best to check with your gynecologist to be sure. Your doctor may recommend further screening, a pelvic exam or a biopsy.

How can you reduce your risk of getting cervical cancer?
CDC recommends the following ways to reduce your risk of getting cervical cancer:

  1. Have an annual Pap test (or Pap smear) starting at age 21.
  2. Have an (HPV) test to see if you have the virus that can cause cell changes.
  3. Get an HPV vaccination.
  4. Two HPV vaccines are available to protect females against the types of HPV that cause most cervical cancers. Both are recommended for 11- and 12-year-old girls, and for females 13 through 26 years of age who did not get any or all of the shots when they were younger. Females should get the same vaccine brand for all three doses if possible. Remember that women who are vaccinated against HPV still need to have regular Pap tests because these vaccines do not protect against HPV types found in approximately 30 percent of cervical cancers.
  5. Don’t smoke.
  6. Use condoms during sex and limit your number of sexual partners.

Cervical cancer is very curable when detected early through screening with a Pap smear. Because precancerous lesions found by Pap smears can be treated and cured before they develop into cancer, and because cervical cancer is often detected before it becomes advanced, the incidence and death rates for this disease are relatively low in developed countries like the U.S. In places where there is limited access to health care and health screenings, however, the death rates are much higher.




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What You Need to Know About the Flu

sneezing father and daughter

© Jedimaster |

The flu season started earlier than usual this year, and most states are reporting continued and widespread outbreaks. Here are some commonly asked questions answered by a Johns Hopkins infectious disease specialist.

Q. Is it true that the flu season is turning out to be more severe than expected this year?
A. The flu season started off earlier and stronger than in several previous years, and the Centers for Disease Control and Prevention (CDC) says state-by-state reports of flu cases, hospitalizations and deaths are elevated. But it is still too early to tell if there will be more flu cases than is typical in the United States this flu season, which runs from October until May. That said, influenza is widespread in most states, so everyone should take precautions to avoid getting the flu.

Q. If people become sick with flu symptoms, should they go to an emergency room?
A. The flu can make you feel pretty lousy, but the best thing to do is first consult your personal doctor or health care provider. If you don’t have one, visit a community health clinic. Your personal health care provider is best able to determine, based on your symptoms, age and medical history, whether you need specialized care in an emergency department or hospital setting. Emergency departments are primarily set up to address urgent and critical medical issues.

Q. The flu vaccine available this year isn’t very effective. Why?
Flu vaccines are developed in advance to protect against several strains of flu virus that epidemiologists who track worldwide flu virus outbreaks do their best to predict. Unfortunately, the strain infecting most people this season — known as H3N2 — mutated, something viruses often do. As a result, the vaccine available this season isn’t as effective as hoped in protecting against the H3N2 strain.

Q. Does that mean the vaccine is useless? Should people still get it?
A. The vaccine still has significant value. Definitely ask your doctor or health care provider for a flu shot, because even this late in the season, it may still offer some protection or moderate the flu if you get it. The CDC recommends that everyone 6 months or older get a flu shot every year because it is an effective way of boosting the immune system to fight circulating strains of flu virus. In addition, by protecting yourself, you may also help protect others who could be exposed if you don’t get a flu shot and come down with the flu.

Q. Other than a flu shot, what other steps can we take to keep from getting the flu?
A.Yes. Wash hands often or use alcohol-based hand gel, especially after shaking others’ hands or being around someone who has cold or flulike symptoms, such as high fever, cough and fatigue.

Q. Should people who have the flu take Tamiflu?
Antiviral drugs like Tamiflu are best and typically prescribed for those most at risk for serious flu complications, including the young, elderly, or those with other serious health conditions or compromised immune systems. Antivirals are only available by prescription and can’t be purchased over the counter. No one should take an antiviral unless a doctor specifically prescribes it. Most otherwise-healthy people can beat the flu by staying home and resting in bed, taking medicines to reduce fever and drinking plenty of water or other clear liquids to stay hydrated.

Q. What can health care workers do to keep themselves and patients healthy in flu season?
A. First and foremost, health care workers who have direct patient contact should get the flu vaccination. They also should practice good hand hygiene with frequent hand-washing or the application of sanitizing hand gel. Health care workers who feel sick with cold and flu symptoms should stay home and rest to avoid exposing patients to a flu or cold virus.

Lisa Maragakis, M.D., is an infectious disease expert and director of the Department of Hospital Epidemiology and Infection Control at The Johns Hopkins Hospital.

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5 Dangerous Food and Drug Interactions

grapefruit & pills


You are diligent about taking your medication each day. But did you ever think that the bologna sandwich, grapefruit or glass of milk you have with it could be making your medicine less effective, or even dangerous? Read on for five facts you need to know about food and drug interactions.

      1.  Beware of grapefruit. This popular breakfast fruit interacts with a variety of medications, including blood pressure meds, statins, and HIV and organ transplant medications, says Charlie Twilley, Pharm.D., a pharmacist at Johns Hopkins Bayview Medical Center. The culprits are furanocoumarins, compounds found in grapefruit that block the enzymes in the intestines responsible for breaking down these drugs. This can make the drugs more potent, and raise the level of drug in your bloodstream. If you are a big grapefruit fan, talk to your doctor or pharmacist to find out whether it is safe to eat with the medications you take.
      2. Dairy diminishes an antibiotic’s infection-fighting powers. Twilley warns that the calcium in milk, yogurt, cheese, ice cream and antacids can interact with tetracycline and the tetracycline group of antibiotics used to treat a number of bacterial infections. To make sure you are getting the full benefit of your antibiotic, take it one hour before, or two hours after, you eat anything containing calcium.
      3. Leafy greens cancel warfarin effects. The vitamin K in spinach, collards, kale and broccoli can lessen the effectiveness of warfarin, a blood thinner used to prevent blood clots and stroke. The darker green the vegetable is, the more vitamin K it has. “You don’t want to eliminate leafy greens from your diet, because they do have many health benefits,” says Twilley. The key is to be consistent with the amount you eat. If you plan to drastically change the amount of these veggies in your diet, talk to your doctor or pharmacist first.
      4. Beer, red wine and chocolate are dangerous to mix with some antidepressants. These popular indulgences may be a nice way to relax in the evening, but they contain tyramine, a naturally occurring amino acid that can cause an unsafe spike in blood pressure when mixed with MAO inhibitors. Tyramine also is found in processed meat, avocados and some cheeses. “This is a significant, dangerous interaction,” says Twilley. If you take MAO inhibitors for depression, talk to your doctor or pharmacist before eating anything with tyramine. Alternative therapy may be considered.
      5. Think before you crush medication in applesauce. Many people who have trouble swallowing pills like to crush them and mix them with applesauce or pudding. Always ask your doctor or pharmacist before you crush or take apart medication. “This method can dump too much of the drug into your system at once, or change the way the drug works,” says Twilley.

Also keep in mind that some medications are affected by whether or not you eat with them. Before you start any new drug, talk to your doctor or pharmacist about whether it is affected by food. “They can help you come up with a schedule that’s good for the drug and convenient for you,” says Twilley. Even over-the-counter medications and supplements can have food interactions.

For additional reliable information about common food and drug interactions, you can search for this topic in the Johns Hopkins online Health Library.

Sara Baker, Public Affairs and Marketing Coordinator, Johns Hopkins Bayview Medical Center

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Common nutrition pitfalls to avoid in your child’s diet

Childhood headaches or frequent constipation? They can sometimes be symptoms of poor nutrition choices. Here’s five tips to get your child’s diet on track.

Adults in children’s lives play a large role in a child’s nutrition and developing eating habits. “Kids are going to model what their parents do. If their parents are eating a lot of fast food and drinking a lot of soda, their kids are going to develop those habits,” said Michael Lasser, M.D., a pediatrician on staff at Howard County General Hospital. “It is really important families sit down and eat together. Not only to see how the child’s day was, but if parents are eating healthy food, that is what the kids are going to eat.” Check out the below slideshow for more tips to help your children make wise food and drink choices.


  • The Water Connection: Children need to drink more water. "Kids do not drink enough water throughout the day and will come home from school with headaches because they didn't have breakfast or drink enough water and are dehydrated," said Dr. Lasser. [© Yarkovoy |]
  • Don't Forget the Big 'D': "Another issue I see is low Vitamin D levels in kids," said Dr. Lasser. And it's not only from lack of milk. "Another way to get Vitamin D is being outside, and kids are not spending enough time outside," he said. [© Gbh007 |]
  • Meal Skipping: Dr. Lasser also explains that it's okay if kids, particularly younger ones, skip a meal now and then simply because they aren't hungry. Some parents are worried and give non-nutritious foods to their children just to get them to eat. [© Marcel De Grijs |]
  • dietary counseling
  • After School Snacks: Nutritious snacks are essential for children ages six to 12 and make a great after school treat. Children in this age group have a steady but slow rate of growth and typically eat four to five times a day (snacks included). Fortunately, they're often willing to eat a wider range of food than younger ones. Use this to their advantage! Plenty of healthy snacks can help prevent frequent constipation in children, another common issue Dr. Lasser sees at his office. [© Robyn Mackenzie |]
  • The percent of children ages six to 11 in the U.S. who were obese increased from seven percent in 1980 to nearly 18 percent in 2010. The percent of those 12 to 19 who were obese increased from five to 18 percent over the same period. Poor dietary choices are often to blame. "Kids are drinking too many sweet things such as sodas and juices with empty calories and eating too much fast food," Dr.Lasser said. Keep that in mind next time you serve up a snack and your children will benefit from your wise choices. [© Skypixel |]

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Ensure your health in 2015 with these 3 nutrition tips

fattening food; nutrition tips

© Sarah2 |

Did you know vitamin-enhanced water can have as much sugar as 7 chocolate sandwich cookies? Think about your drink and other nutrition guidelines for your 2015 diet.

Here we go again! New Year’s Eve is tomorrow night, and after an evening  (and a season) of overindulging in so many ways, most of us will end the night with a farewell toast to Auld Lang Syne and a pledge to give up at least some of our vices in the new year. Many will be food-related – losing weight, giving up sugar and eating a healthier diet.

But what exactly does that mean? With so many choices and so much information about food and nutrition, it can be difficult—even for adults—to make good decisions when it comes to eating the right foods. These choices are important, because a healthy diet and lifestyle are the best weapons to fight diseases such as heart disease, stroke, diabetes and certain types of cancer.

The American Heart Association recommends a diet including lean meats and skinless poultry; fish at least twice a week; selecting fat-free, one percent fat or low-fat dairy products and cutting back on added sugars.

Choosing a healthy lifestyle that includes eating the right foods and getting plenty of exercise goes a long way in keeping the body healthy. Make sure half of your plate is vegetables or salad, and eat your fruit or vegetable first to help fill you up so you will eat less of other things.

Think about your drink
Everything has gotten big. Serving sizes that were once 8 ounces are now 20 ounces and sometimes even larger. When you couple the increasing size with the amount of sugar in many beverages, you have a recipe for weight gain. This is especially true when it comes to energy drinks.

Many beverages that may appear to have health benefits have added sugar that is not healthy. Scientific evidence supports the association between consumption of sugar-sweetened beverages and an increased risk of obesity, which can contribute to the development of diabetes, heart disease and cancer. Drinks that are labeled vitamin-enhanced water can have the same amount of sugar as seven chocolate sandwich cookies! To burn off the calories in a fancy 16 ounce coffee drink, you will need to strength train for 30 minutes. Also, calories consumed in a liquid form don’t tell our body to turn off hunger. So we need to be careful about using beverages to satisfy cravings.

Eat the rainbow
It is important to include colorful fruits and vegetables in your meals. Brightly-colored fruits and vegetables indicate that they are high in antioxidants. The deeper and darker the color of the vegetable or fruit, the better it is for you. When thinking about your daily diet, choose at least four servings of colorful vegetables and three servings of colorful fruits. Though there are supplemental pills available you may think would be easier, they do not supply the same benefits derived from food.

Read the labels for these key words
I understand that most of us are not going to soak our own beans and make our own breads, but if you buy pre-packaged food, you really need to read the labels. If one of the first three ingredients is sugar, salt or partially hydrogenated oil, put it back on the shelf. Processed food contains added salt, sugar and fat, and you lose fiber. On a food ingredients label, there are many words that can indicate added sugar that doesn’t occur naturally, including: high fructose corn syrup, agave, fruit juice concentrate – often added in yogurt, dextrose, honey, molasses and brown rice syrup just to name a few. Excess sugar causes inflammation inside our blood vessels even more so than saturated fats. Research is leading us to really take a look at the role excess sugar has on our cardiovascular system.

Let’s start the new year with a resolution we can actually stick to. Think about what you eat and drink and try to make it healthier!

Howard County General Hospital’s Teresa Love, MS, RD, CDE, has been a registered dietitian for more than 30 years and a certified diabetes educator since 2009. She enjoys helping patients manage their diabetes. In her spare time she is an avid tennis player.

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Remember Your Local Hospital in End-of-Year Donations

end-of-year-donations nurse holding heart


‘Tis the season for giving

As vice president of development for the Howard Hospital Foundation (HHF), I am fortunate to get to witness firsthand the benefits of our community’s charitable donations to Howard County General Hospital.

From patients who have honored their caregiver with a donation; to the baker who hosted a cupcake event with Santa with proceeds benefiting the hospital; to a local neighbor who for the past two years has mailed a check for $25 every month to support his local hospital; to the child who donated new toys to the pediatric department; to the widow who memorialized the life of her husband with a gift; to the man who provided a $5 million donation to recognize the care his wife had received; and to the many this year who have included the hospital in their estate plans – we thank you all!.

It does not matter how big or small your donation may be, each gift is important to providing quality care and comfort to those served by HCGH. Whether you are donating as an individual, business or organization – you are helping us develop vital new programs and purchase state-of-the-art equipment that we need to continually improve patient care.

As you make your plans for your end-of-year donations, I ask that you please keep the hospital in mind. Howard County General Hospital relies on the philanthropic support of its community. Additionally, your end of the year generosity also may provide you with tax benefits.

On behalf of the Howard Hospital Foundation and Howard County General Hospital, I thank each of you for all of your generosity year round. Warm wishes to you and your family during this holiday season.

Sandy Harriman is the vice president of development of the Howard Hospital Foundation, the fundraising arm of Howard County General Hospital.

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Bread and pasta with type 2 diabetes?

woman with pretzel

© Arne9001 |

Good nutrition is essential to a healthy lifestyle. For people with diabetes, nutrition has even more critical implications, so keeping track of what you eat to make sure you get a variety of the right foods in the right amounts is an important element of maintaining a healthy lifestyle.

According to the National Diabetes Education Program, nearly 21 million Americans have diabetes, a serious disease in which blood sugar (glucose) levels are above normal. Most people with diabetes have Type 2, once known as adult-onset diabetes.

Type 1 diabetes is not caused by obesity, and many people with this disease are of normal weight. Type 2 diabetes, on the other hand, is strongly related to being overweight or obese, and losing even a moderate amount of weight can reduce the need for treating the diabetes with medication. In some cases, it can even eliminate the diabetes and lower your blood pressure and cholesterol. Anyone with diabetes needs to watch their carbohydrate consumption to avoid spikes in blood glucose levels.

“You are somewhat in the driver’s seat. Typically, diabetics require more medicine over the years to manage their disease. But, if you can lose weight and make dietary changes, you may be able to reduce the medicine you need.”
—Teresa Love, MS, RD, CDE

Myth: Diabetics can’t eat fruit, bread, potatoes, rice, carrots or anything white.
Truth: They can in moderation.
People with Type 2 diabetes need to be aware of the carbs in their diet, but reducing overall calories and exercising regularly are the biggest keys to weight loss success. It is important to eat three meals a day with a balance of complex carbohydrates (vegetables and whole grains), healthy fats (think nuts and olive oil) and lean proteins (fish, chicken and beans). It’s also a good idea to keep some healthy snacks on hand.

Strict limiting of one particular kind of food over a long period of time is difficult for many people to stick with, so eat a well-balanced diet and get more exercise! The goal is not to eliminate all carbohydrates and sugars, but to practice moderation.

Lifestyle changes that can help you lose weight
The Diabetes Prevention Program, an evidence-based program led by the Centers for Disease Control and Prevention, has shown that you can prevent or delay the onset of Type 2 diabetes by losing weight through a reduced-calorie diet and by increasing physical activity. “Individuals should aim for a seven percent weight loss over three months and 150 minutes of physical activity weekly,” said Teresa Love, MS, RD, CDE, a nutritionist at Howard County General Hospital.

Diabetic diet DOs
Our nutritionist recommends that you:

  • Keep a log of all your food and beverages using a notebook or websites and apps to track calorie intake.
  • Incorporate lima, kidney and black beans into your diet. They are a good source of iron and fiber and a carbohydrate that doesn’t raise blood sugar significantly.
  • Try not to drink calories in the form of sugary beverages or alcohol.
  • Eat breakfast within an hour or two of getting up.
  • Eat consistently – a meal or a snack – every three to five hours.
  • Don’t consume all of your food at the end of the day.
  • Eat more vegetables.
  • Try to have a protein-based food with each meal: lean meat, eggs, cottage cheese, or yogurt to control hunger and blood sugar.
  • Practice strategies that help control portions like using
  • Do not buy all sugar-free and no-sugar-added products. Instead, eat whole foods that are natural and less processed. The fewer ingredients, the better the food is for you.
  • Eat half of your meal when you eat out at a restaurant and take the rest home or share with someone. Restaurant portions are typically too large.
  • Remember that exercise not only helps you lose weight but can help lower blood glucose levels.










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6 Vitamin Must-Knows for Seniors

In general, the components of a healthy diet don’t change terribly much over your lifespan. However, as people age, their vitamin needs change, which is a natural part of aging. Following are six vitamin checks for seniors to stay their nutritionally best from Alicia I. Arbaje, M.D., M.P.H., Assistant Professor of Medicine, and director of Transitional Care in the Research Division of Geriatric Medicine and Gerontology at Johns Hopkins University School of Medicine.


  • man taking vitamins
    Multivitamin Check: Seniors should supplement for specific vitamin deficiencies rather than take a general overall supplement. Multivitamins are not “one size fits all.” Also, taking too much of some vitamins can be toxic. Multivitamins are synthetic and not as beneficial as eating the vitamin in its natural! (Photo © Steveheap |
  • vitamin health
    Vitamin Level Check: Certain absorptions of some vitamins change over time. Seniors should have their B12 levels checked as well as their Vitamin D. (Older people might be indoors more and their skin isn’t as efficient in absorbing sun and converting into active Vitamin D.) (Photo © Monika Wisniewska |
  • happy seniors in winter
    Ways to Add Vitamin D: Our bodies are devised to absorb Vitamin D from the sun. Getting 20 to 30 minutes of daily sun exposure may increase your levels. Supplementing Vitamin D with food is a balancing act. You can get Vitamin D through food such as egg yolks, salmon and milk but these foods can effect other chronic conditions. For some seniors, Vitamin D is a necessary pill supplement. (Photo © Signorina |
  • healthy heart
    Low Vitamin D Consequences: Low Vitamin D levels are linked to many diseases including osteoarthritis, depression, pre-dementia and heart disease. We also have seen studies that show those with low Vitamin D have less balance and reduced muscle strength. This can make you more likely to fall, which often results in hip fractures. Studies are underway to research Vitamin D deficiency and an increased cancer risk. (Photo © Vonschonertagen |
  • dietary counseling
  • vitamin stew
    Vitamin B12 Supplement: Check your B12 levels regularly. If you have been diagnosed as deficient, you probably will need supplementation. (Photo © Karenfoleyphotography |
  • senior walker
    Low Vitamin B12 Consequences: Your body needs Vitamin B12 to make new cells for your nervous system to work normally. Vitamin B12 deficiency can lead to anemia (having too few red blood cells), which can make you feel tired or weak. A Vitamin B12 deficiency can also cause other symptoms including trouble walking, tingling or numbness in the hands or feet and memory problems. (Photo © Chiayiwangworks |



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