If you have Parkinson’s Disease, Consider Your Risks

Parkinson's Risk ChartWe can define risk as the probability of damage or injury caused by some event which could be reduced by avoiding the situation or taking some pre-emptive action. These are often sudden events that may lead to sudden loss of functional capacity. The most common are falls that result in traumatic injuries.

Avoid high-risk activities

It is obvious that most of us should not be tight-rope walking over a body of water containing sharks, but some things are not as obvious. If you are planning an activity, think about the likelihood of some unintended consequence. If there are severe consequences and the risk is significant, you should probably avoid the activity.

Falls can be game changers

Many people with advancing Parkinson’s disease (PD) develop balance problems, which can lead to falls and traumatic injuries. Changes in your medications are not likely to improve your balance, but physical therapy can help, and physical therapists can train you to properly use assistive devices, such as canes and walkers. If you have a balance problem and your physician and physical therapist recommend that you use a walker, that is a good pre-emptive action you can take to reduce your risk of falling.

Unfortunately, falls are fairly common in PD as the disease advances, although they are rarely a problem early in the disease. When a patient falls, they can fracture anything from their hip to their arm. In my experience, people who suffer traumatic injuries never walk as well again. Falls are game-changers and should be prevented, if possible. Physical therapy and training in the use of assistive devices, such as canes and walkers, can reduce your risk of traumatic injuries.

How you can reduce your risk of falling

  • Be cooperative if physical therapy is recommended.
  • Use a walker or cane if your “team” recommends it.
  • Consider when/if to stop driving (most of us do at some point).
  • Install grab bars in the shower.
  • Hold onto railings when walking on stairs.

The following is an example of how a hip fracture can result in severe consequences. The graph shows that the patient was able to walk back and forth down our short hallway in about 12 seconds for many years. However, following a hip fracture, they struggled to walk the same distance in 30 seconds.

Parkinson's Hip Fracture Chart


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For Parkinson’s Patients, Exercise is Part of the Treatment

Woman walking ThinkstockPhotos-147919046Having treated people with Parkinson’s Disease for over 20 years, I have come to realize that the key to being healthy is to . . . well . . . be healthy. This includes exercising your mind and body, eating healthily, and maintaining an ideal body weight.

Meaningful exercise involves sustained and ongoing physical activity sufficient to increase the heart rate and the need for oxygen for at least 20-30 minutes. You can do this with formal exercise, such as walking, jogging, treadmill walking or swimming, participating in sports such as tennis, soccer, golf or fencing or even doing chores, such as raking leaves or shoveling snow. Try to do some kind of exercise at least three to four times a week.

In addition to the general health benefits of exercise (cardiovascular, reduction in osteoporosis/fracture risk, and the burning of calories) there is evidence from recent research studies that indicates that exercise may be helpful in the following ways:

  • Walking on a treadmill improves your walking.
  • There is slower disease progression and better quality of life.
  • There is a reduction in the risk of dementia and mild cognitive impairment.
  • There is improvement in depression and anxiety.
  • Sleep is improved.

So, develop a regular exercise program and stick to it. It should be considered a primary treatment strategy in Parkinson’s disease. The choice of exercise is up to you and should be tailored to your interests and limitations. You might ask your physical therapist to help design the program and, if you have heart disease, you should consult with your cardiologist about a suggested protocol.

The most important thing about exercise is that you do it!


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Choosing Your Care Team for Parkinson’s Disease

If you have recently been diagnosed with Parkinson’s disease (PD), choosing your physician is an important decision. Unfortunately, in the current health care environment, you may be limited to doctors who are in your insurance network. You may also want to know if the physician is affiliated with your hospital. But the most important thing to consider when making your choice is finding a physician with whom you can develop a good relationship—hopefully one that will be enduring.

Scientific data suggests that you will get the best care if you choose someone specializing in your condition. Movement disorders specialists (neurologists specializing in PD) are best at diagnosing and managing Parkinson’s disease but, depending on where you live, that may not be feasible or easy.

Integrative care: the team approach

Scientific literature demonstrates that “integrative care” is beneficial (Van der Marck 2014). While the best approach would be to get all of your physicians in a room together with you to plan treatment, this is probably not going to happen except in special circumstances or as part of a clinical trial. The next best thing, however, is to ensure that all of your physicians and therapists communicate. They are your “team” and your internist is the “captain of the ship,” primarily responsible for ensuring that all specialists involved in your care work together. Be certain that each physician involved in your care is sharing your information with the other physicians. You should insist that we work together to give you the best care possible.

Be actively involved in your care in these ways:

  • Bring a medication list to each visit with all of your physicians.
  • Bring a contact list (with fax numbers) to all of your physicians.
  • Remind physicians and therapists to send notes to each other.
  • When hospitalized, arrange to have hospital records sent to all of your physicians.
  • Bring a list of discussion topics when you visit your physicians, but try to limit topics to no more than two or three per visit.

The choice of your physician and your involvement in your medical care and treatment are very important elements in your successful medical outcome. I encourage my patients to be involved and informed in their care.

Van der Marck MA, Bloem BR (2014) How to Organize Multispecialty Care for Patients with Parkinson’s Disease. Parkinsonism and Related Disorders, S167-173


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The flu and you: advice for fighting flu this season

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© Madartists | Dreamstime.com

With all the news about infectious diseases, people may get the idea that the flu isn’t all that serious; but we need to remember that it can be a very dangerous—even fatal—illness, especially to the very young, the very old and the immune-compromised. It descends upon our local communities every year, causing a great deal of sickness and sometimes death. The Centers for Disease Control and Prevention (CDC) notes, “Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During a regular flu season, about 90 percent of deaths occur in people 65 years and older.” But even healthy people can get very sick from the flu and spread it to others.

How should I prepare for the flu?
As with most illness, prevention is the best defense and the best form of prevention is the annual flu vaccine. The CDC recommends a yearly flu vaccine for everyone 6 months of age and older.

Influenza can be spread even before you have symptoms. Therefore, practicing good flu etiquette is always encouraged:

  • wash your hands often
  • try to stay away from people who are sick
  • stay home if you are sick
  • cover your cough with tissue or the inside of your elbow.

Is there any treatment for the flu?
If you get the flu, there are antiviral drugs that can make your symptoms milder and make you feel better sooner. They can also prevent serious flu-related complications, like pneumonia. However, sometimes a flu virus has changed in a way that makes antiviral drugs less effective, and the CDC conducts studies to determine which strains are becoming resistant. (Click for more information about antiviral drugs.)

What should I do if I get the flu?
If your illness is mild, stay home and avoid contact with other people. 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. See People at High Risk of Developing Flu–Related Complications. Your doctor may prescribe an antiviral drug.

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 tell if a person has the flu.

When should I get the flu vaccine?
The flu season peak activity most commonly hits in the U.S. between December and February, however it can begin as early as October and continue until May. Since it takes about two weeks to develop antibodies after vaccination, it is a good idea to get vaccinated soon after the vaccine becomes available, usually in October, to ensure you are protected before the flu season starts.

Where can I get the flu vaccine?
Flu vaccines are offered at locations throughout the community: doctors’ offices, clinics, health departments, pharmacies, college health centers, employers and even some schools. Even if you don’t have a regular doctor or nurse, you can find a vaccination location by visiting the HealthMap Vaccine Finder.

How long does the flu vaccine protect from the flu?
Studies over several years show that the body’s immunity to influenza viruses (acquired through natural infection or by vaccination) declines over time. Older people and those with weakened immune systems might not generate the same amount of antibodies after vaccination, so it’s important to get a vaccine every season.

Can the vaccine provide protection even if the vaccine is not a “good” match?
Even if the virus and vaccine are not a “good match,” getting the vaccine can lessen the severity of your illness. Antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related viruses, although sometimes with reduced effectiveness.

Myths about the flu and flu vaccine:

  • You can get the flu from the flu vaccine.
    No, you cannot contract the flu from either the flu shot or the nasal spray, although you might have a mild fever, runny nose or sore arm that lasts only for a day or two.
  • The flu vaccine is more dangerous than the flu.
    No. Any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Getting vaccinated is a much safer choice than risking illness.
  • Getting vaccinated twice provides more immunity.
    No. Studies have not shown any benefits for adults receiving more than one dose during an influenza season. Except for some children, only one dose is recommended.

Are there special concerns for vaccinating children?
Children between 6 months and 8 years may need two doses of flu vaccine to be fully protected. Your child’s health care professional can tell you whether your child needs two doses. Visit Children, the Flu, and the Flu Vaccine for more information.

Starting with this season, the CDC recommends use of the nasal spray vaccine (LAIV) for healthy children 2 through 8 years, because recent studies suggest that nasal spray is more effective than the flu shot for younger children. However, if the nasal spray vaccine is not immediately available and the flu shot is, your child should get the flu shot. Don’t delay vaccination to find the nasal spray flu vaccine. Visit Nasal Spray Flu Vaccine in Children 2 through 8 Years Old or the 2014-2015 MMWR Influenza Vaccine Recommendations. Children younger than 6 months are at higher risk of serious flu complications, but are too young to get a flu vaccine. If you live with or care for an infant younger than 6 months of age, you should get a flu vaccine to help protect them from flu. See Advice for Caregivers of Young Children for more information.

Emergency Warning Signs
Go to the Emergency Department if a child experiences the following symptoms:

  • Fast or difficult breathing
  • Bluish skin color
  • Not taking fluids
  • Not waking up
  • Fever with rash
  • Symptoms that improve but return with fever and worse cough.

For adults emergency signs include:

  • Difficult breathing and shortness of breath
  • Pain or pressure in chest or abdomen
  • Sudden dizziness or confusion
  • Persistent vomiting
  • Symptoms that lessen but return with fever and worse cough.

The bottom line is the flu vaccine is your best defense. More information about influenza vaccines is available at Preventing Seasonal Flu with Vaccination.


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A Primer on Respiratory Virus Enterovirus D68

sick teddy bear

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The rare respiratory virus that has sickened hundreds of kids across the Midwest has made its way to the East Coast, its arrival in Maryland was confirmed this past Wednesday (Sept. 24). Reports of severe illness have fueled anxiety among parents and caregivers, but infectious disease specialists at the Johns Hopkins Children’s Center expect that most children who get the bug should recover swiftly without lingering after-effects.

What is Enterovirus D68?
Enterovirus D68 belongs to a family of nearly 100 viruses that cause a wide range of symptoms, infecting millions of people around the world each year. First identified in the 1960s, Enterovirus D68 is not a new virus. It affects predominantly children and teens and causes mild to moderate upper respiratory infections. Some people may also develop more serious infections of the lungs. The virus is contained in airway and mouth secretions, such as saliva, spit and nasal mucus, and is spread in much the same way as the common cold and the flu viruses — by touching contaminated surfaces, coughing and sneezing.

How dangerous is it?
In most healthy children, the virus will cause brief and self-limiting illness that resembles a bad case of the common cold, but it could lead to more severe disease and respiratory distress, particularly in those with underlying chronic conditions such as asthma, cystic fibrosis, sickle cell disease, heart disease or compromised immune function.

How is it treated?
There is no specific treatment for this virus. Children should drink plenty of fluids to avoid dehydration and rest until fully recovered. Antibiotics used to treat bacterial infections will NOT work against this or any other virus. Over-the-counter anti-inflammatory medications, such as ibuprofen, can help reduce fever, pains and aches. Aspirin should not be given to children.

What can I do to reduce the risk of infection?
Follow common sense hygiene etiquette. The single most effective way to reduce the risk of infection is to wash hands frequently and avoid touching your face. Sneeze and cough into your sleeve rather than in the palm of your hand. Keep home children with cough and fever to avoid spreading the virus to others. Make sure that infected family members use separate hand and facial towels and do not share cups, glasses or utensils.

When should I take my child to the ER?
Most children who get the virus will do fine and do not require emergency care or hospitalization. A small number of children may go on to develop more serious disease and require urgent medical attention or emergency treatment.

One or more of the following warrants a trip to your pediatrician’s office or to the ER:
• Struggling to breathe, apparent respiratory distress
• Severe, prolonged vomiting
• Fever over 103 degrees that does not break in 48 hours
• Lethargy

Dr. Julia McMillan is a pediatric infectious disease specialist at The Johns Hopkins Children’s Center. The center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. Johns Hopkins Children Center is consistently ranked among the top children’s hospitals in the nation by U.S. News & World Report.

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When good drugs go bad, take them back!

Properly dispose of unwanted or unneeded medications at Drug Take Back Day on Sept. 27 in Howard County

Have you ever opened your medicine cabinet and wondered, “What are all of these medications?” Some you may not have used for years and can’t remember why you had them in the first place, but you keep them because you just don’t know what to do with them.

What is the best way to handle unneeded and expired drugs? Your Howard County General Hospital pharmacists recommend participating in the Drug Take Back Day on Sept. 27, 2014 in nine locations throughout Howard County.

Our pharmacists give tips on why it is vital to safely dispose of unneeded medications and other ways you can delete them from your cabinet in the below slideshow.

 

 

Drug Take Back Day is sponsored by the Howard County Police and HC Drug-Free. The program offers a way for everyone to properly dispose of expired or unwanted medications.
 
Masoomeh Khamesian, Pharm. D., is the director of pharmacy for Howard County General Hospital.
Susan Shermock is the medication safety manager of the Pharmacy at Howard County General Hospital.
  
 

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Stone House Cakery cooks up a healthy recipe: natural ingredients from local farms

baked goods

Stone House Cakery & Cafe

Because everyone loves dessert!

My husband, Dean, and I have a long line of bakers on both sides of the family, so starting Stone House Cakery & Café was a natural. We actually started the bakery in 2009, out of necessity, after he had an accident and I lost my job. I had to find something to do to keep my sanity.

Everyone seems to be health conscious these days, but sometimes they still want to treat themselves to a delicious dessert. When they do, they want it made with the best and most natural ingredients. That’s what we try to offer at Stone House Cakery & Café with our cakes, pies, sweet breads, cupcakes, jams, jellies, rolls, bars, donuts and brownies. We use unbleached flour with no processing chemicals and pure vanilla in our baked goods. We bake everything fresh every day. If you have a special party, birthday or wedding, we can also make and decorate the cake.

Our business has grown, and we now participate in four farmers markets each week and operate a store-front bakery in Taneytown. We’ve recently hired several employees – one to help with baking, one to make sandwiches and one to decorate cakes for weddings and parties. The sandwiches are something new and we make them out of our own bread and with high quality meat.

I love unusual old recipes and some of ours date back to the 1800s. Our ‘creeping crust’ cobbler came from Dean’s great-grandmother. We changed the name because people didn’t seem to like it, but it came from the way the cobbler is made with the batter on the bottom and fruit on top and the crust creeping up over the sides. Dean’s mom used a family recipe for real minced pie, which isn’t at all like the stuff you buy in a jar. Hers was made from real meat, suet, spices, fruit and lots of liquor. Most people use bourbon but she liked to use port wine. I also have my mom’s recipes for peanut butter fudge and pound cake that came from her great-grandmother. When Dean’s mom passed, she left two huge boxes of recipes that I’m still trying to go through. Sometimes customers tell us about an old family favorite recipe and we’ll try to recreate it.

I hope our business is about more than just selling a product. We feel a commitment to our community and try to support other sustainable farmers, buying our fruit, milk, buttermilk and cream (from grass-fed cows using no hormones) and cage-free eggs from local farms. And we supported the Carroll County Economic Development mentoring program this summer, bringing in three students who wanted to learn about baking. We want to keep the tradition going into the future.

If you need to satisfy a sweet tooth, stop by to see Lois at the HCGH Farmers Market on Fridays from 2 to 6 p.m.

Lois Trout is co-owner of the Stone House Cakery & Café.


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creative salad mix

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“Food is a powerful arsenal against disease,” says Lynda McIntyre, R.D., L.D., an oncology nutrition specialist with Johns Hopkins Medicine. “Consuming plant-based foods, which are rich in antioxidants, helps to protect the body’s cells from damage and decrease your risk of cancer.”

HCGH Oncologist Nicholas Koutrelakos, M.D., agrees, also noting that “eating fruits, vegetables and grains that contain beta carotene and vitamin C can help prevent cancer-causing carcinogens from forming and help to reduce obesity and heart disease.”

“I encourage patients to ‘eat the rainbow;’ in other words, eat brightly colored fruits and vegetables that are high in antioxidants,” says McIntyre. “Try to consume seven to eight servings of fruits and vegetables each day (three servings of fruit/four servings of vegetables). A serving size is a half cup, and you should try to eat at least one cup at every meal.”

 

Add Color and Spice To Your Diet
  • Foods that are orange and dark green (high in beta carotene): spinach, mangoes, carrots.
  • Oranges! One orange contains every anti-cancer phytochemical that has been discovered. Part of the power of the orange is in the zest – adding it to salads increases the nutrition density of that food.
  • Cruciferous vegetables: broccoli and kale (four to five times per week).
  • Vitamin C-rich foods daily: strawberries, citrus, mango, bell peppers, kiwi.
  • A variety of fruits and vegetables – not just one color – but three to four colors.
  • Plenty of fiber: 30 grams per day from whole grains, whole wheat, beans (kidney, red, lentils, garbanzo, legumes) and peas.
  • A combination of foods. Certain foods can maximize nutritional impact when combined. Foods containing beta-carotene, combined with certain fats, bolster nutrition. For example, carrots dipped in hummus and sautéing spinach in olive oil increases the absorption of the beta-carotene. When we combine foods that contain iron with those containing vitamin C, the absorption of iron is increased. For example, a spinach and strawberry salad.
  • Foods containing Omega 3 fatty acids. “Our bodies do not make these,” says Dr. Koutrelakos. “They have great nutritional benefit and are only found in foods that we eat, such as fish and beans.
  • Herbs and spices (dried is acceptable and has more concentrated antioxidant benefit):
    • Turmeric and curry are healthy additions.
    • Cinnamon: Just a half teaspoon has as much antioxidant properties as a half cup of raspberries. Add cinnamon to everything you can think of – cereal, apples, coffee – and it will increase the nutrition density of your food.
    • Thyme and oregano are powerful antioxidants – just a half teaspoon provides a lot of health benefits.

     

    Beyond Fruits and Vegetables
    • Eat lean protein: turkey breast and chicken breast. You can include lean red meat once a week.
    • Your cooking method is important. Keep it “slow and low” temperature whenever possible. Be careful when grilling not to char.
    • Marinades with lemon and rosemary or wine and beer help to decrease cancer-causing agents in grilling.
    • Limit alcohol intake to three to four times per week.
    • Exercise/activity is as important as diet. Studies have shown that people who are sedentary and obese are at a higher risk of getting colorectal cancer. Obesity also can increase your risk of developing breast cancer.
    • “Maintain a normal body weight. Seventy percent of my patients are overweight,” says Dr. Koutrelakos. “That is directly related to cancer. I am seeing cancer in younger patients, too, who are eating the wrong foods and foods that are too high in fructose (sugar) resulting in an increased body mass index (BMI).”
    • Keep fat intake low. High fat intake can increase your risk of developing some types of cancers.

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breast self-check

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Johns Hopkins OB/GYN Francisco Rojas, M.D., discusses various types of breast lumps and what you can do about them.

Q: How common are lumps in the breast?
Breast lumps are common, particularly in young women in their late teens and early 20s. Women also may feel a breast lump during pregnancy or breastfeeding. Lumps in older women tend to be less common but more dangerous.

Q: What causes breast lumps?
Most breast lumps are benign or “normal;” however, breast lumps also can be caused by cancer. We cannot always explain what causes benign breast lumps.

Q: What are the different types of breast lumps?
Fibroadenomas are benign masses in the breast. They are not cancer and will not become cancer. They occur most often in younger women but also can happen in later years. Cysts are fluid-filled lumps that may cause pain and are usually benign. Other tumors are less common, can be benign or malignant and should be removed. The important thing to remember is that breast cancer also can present as a lump.

Q: What should you do if you detect a lump?
Any change in the breast should be evaluated by your physician or provider. Your provider will need to know when you noticed the lump and if it has changed in any way; also tell your provider about any changes in the skin or nipple discharge and if you notice any other lumps or changes in the breast or armpit. Tests such as an ultrasound, mammogram or MRI may be ordered.

Q: How are breast lumps treated?
Treatment is determined by the type of breast lump. Most often, a biopsy of the lump will be needed to determine the type. Fibroadenomas can be watched over time for changes. Cysts can be drained with a needle to remove fluid. Other tumors and breast cancer must be removed by a surgeon.

Q: Is there anything you can do to prevent breast lumps?
You may not be able to prevent breast lumps, but for your breast and overall health it is important to eat a healthy diet with fruits and vegetables. Do not smoke, and consume alcohol only in moderation. Exercise and maintain a healthy weight. Perform self-breast exams once a month and have breasts examined annually by a medical provider. Report any changes in your breasts to your provider as soon as you notice them.

Q: Who is at the greatest risk for developing breast lumps?
Anyone can develop a lump, but people who have a prior personal history of breast cancer or family history of breast cancer are at a higher risk of developing a malignant tumor.

Dr. Francisco Rojas is a Johns Hopkins OB/GYN.

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New to Medicare? Attend a free seminar that breaks it down

Medicare 101 and 102 Seminars

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© Kurhan | Dreamstime.com

They say getting older isn’t for sissies. But there’s one birthday that makes many people happy: reaching the milestone Medicare-eligible age of 65! No one wants to spend the money they’ve saved for travel, hobbies and other long-anticipated pleasures of their golden years on devastating medical expenses.

Medicare will generally be the main component of your health insurance coverage in retirement, or if you are eligible for Medicare due to a disability, even if you have other insurance to supplement it. Perhaps you are approaching Medicare age and are still covered by your (or your spouse’s) employer group health plan. Regardless of your situation, Medicare is complicated! Being informed about the rules, benefits and choices of Medicare is essential. You want to make the best coverage decisions for your needs and at the right times.

If you will be enrolling within the next three to six months, have recently enrolled or are assisting your aging parents with their health care and insurance, you probably have a lot of questions about what to expect. Come to the Medicare 101 and Medicare 102 presentations at Howard County General Hospital’s Wellness Center in September to learn about these and other topics:

  • What are Medicare Parts A (Hospital), B (Medical), C (Medicare Advantage/Health Plans) and D (Prescription Drug Plans)?
  • Which parts of Medicare do I need and what are the best times to enroll?
  • How do Medicare prescription drug plans differ and how do I find the right one for me?
  • What is the important information to review when considering a Medicare Advantage/Health Plan, such as network doctors and hospitals, cost sharing and additional benefits?
  • What is a Medigap/Medicare Supplement policy?  Do I need one? How do the different types of plans cover out-of-pocket expenses (gaps) in Original Medicare and how do I find one that I can afford?
  • What are my costs with Medicare and are there resources to help me pay for premiums, deductibles and/or copays?

These free presentations (given monthly in various locations) are offered by the Howard County Office on Aging’s State Health Insurance Assistance Program, better known as SHIP.  If you have specific questions afterwards or if you are already on Medicare and need some detailed assistance, SHIP offers free, confidential and unbiased counseling at several locations around the county.  Call at 410-313-7392 to set up an appointment or for SHIP offices in other counties.


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Classes & Events to Make You Well & Wise

calendar_2014sm

Tuesday, Sept. 2, 7:00 p.m. Guided Meditation at Miller Branch.Enjoy a guided mindfulness meditation designed to impart a feeling of peacefulness and connection. Please bring a cushion or meditation pillow. Presented by Star Ferguson, M.Ac., L.Ac. Register online or by calling 410.313.1950.

Wednesday, Sept. 3, 7:00 p.m. Stress Busters for Teens! at Glenwood Branch.Discover coping strategies for stress as you learn about triggers and their physical effects. Practice fun techniques for relieving stress. Ages 11-17.Registration is required. Register online or by calling 410.313.5577.

Monday, Sept. 8, 10:00 a.m. – 12:00 p.m. Blood Pressure Screening at Savage Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. No registration required.

Monday, Sept. 8, 10:30 a.m. & 11:15 a.m. Tae Kwon Do: Mommy & Me at Miller Branch. Mommy and child participate in a fun-filled activity, led by instructors from Sykesville Tae Kwon Do, while developing movement awareness, motor skills, balance, coordination, flexibility, and agility. Wear athletic shoes, and loose fitting pants or shorts. Ages 2-3 with adult; 30 min. Registration and a signed release form is required.
Sept. 8 10:30 a.m. Registration Release  Sept. 8 11:15 a.m. Registration|Release

Tuesday, Sept. 9, 1:00 p.m. – 3:00 p.m. Blood Pressure Screening at Elkridge Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. No registration required.

Tuesday, Sept. 9, 6:30 p.m. I’m Going to Be a Big Brother or Sister at Miller Branch. Prepare for the arrival of a baby in this class for new siblings. Enjoy stories, activities, and bring a favorite doll or stuffed animal to practice holding a baby. Resources for parents, too. Families; 30 – 45 min. Ticket required. Well & Wise event – In partnership with Howard County General Hospital: A Member of Johns Hopkins Medicine.*Limited space; tickets available at Children’s Desk 15 minutes before class.

Saturday, Sept. 13, 2:00 p.m. Declutter Your Life at Glenwood Branch. Ellen Newman, owner of ClutterRx, shows how to make your life easier by clearing the clutter. Register online or by calling 410.313.5577.

Monday, Sept. 15, 3:30 p.m. – 5:30 p.m. Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. No registration required.

Tuesday, Sept. 16, 7:00 p.m. Hands Only CPR & AED at Elkridge Branch. Learn how to start CPR right away and continue doing chest compressions until help arrives. Learn about cardiac arrest, how to recognize it’s happening, and the three simple steps of Hands-only CPR for victims over 8 years old. Receive a basic overview of an automated external defibrillator (AED). Training in Hands-Only CPR gives you the ability to help save a life without using mouth-to-mouth ventilation or obtaining a certification card. Ages 11-17. Register online or by calling 410.313.5088.

Tuesdays and Thursdays, September 16-November 6, 6:30-8 p.m. Healthy Weight Connection. Kick-start individual lifestyle changes, including diet and exercise, to help you reach a healthier weight. Receive personalized guidance from a certified dietitian. Various nutrition topics and gentle yoga. Cost is $195. To register, call 410-740-7601 or visit hcgh.org. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Wednesdays, September 17-November 5, 6:30-7:30 p.m. Prenatal Exercise. Taught by a certified instructor. Physician permission required. Eight-week session, cost is $88/eight sessions. To register, call 410-740-7601 or visit hcgh.org. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

 

 


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What’s Brewing at the Farmers Market?

Did you know coffee is available at the Howard County General Hospital Farmers Market? Every Friday, the Cosmic Bean Coffee Company provides a variety of flavors and blends. Owner Rob Haroth gives us a brief tutorial on coffee.

A great-tasting cup of coffee goes through many steps before it reaches your cup. Growing high-quality coffee requires patience, since it can take up to five years for a coffee tree to mature and produce its first beans. “Beans,” by the way, aren’t really beans. They are seeds of the coffee cherries and each tree produces only enough cherries for about one pound of roasted coffee per year. The cherries have to be processed to remove the surrounding fruit and protective layers to get to the beans, which must then be cleaned and classified by criteria that include size and color.

The next step is roasting, which is part art and part science and can have a profound effect on the way coffee tastes. It involves timing and monitoring at two critical points. The “first crack,” a loud popcorn sound, happens at 375° F and the “second crack,” a much faster and more frantic sound, is when you have to decide whether you will pull the beans out to let them cool or continue roasting to get a darker bean. Coffee can go through six phases during roasting: green (before roasting begins), yellow, cinnamon, city, full city, Vienna, French and Italian. In my opinion “full city” is the optimum roast for most coffees. That’s when it has reached its full flavor potential. I think Italian has too much roast flavor that can overpower the taste.

We usually bring 15-20 varietals from around the world to the markets, including coffee from Brazil, Columbia, Costa Rica, Ethiopia, India, Papua New Guinea, Indonesia, Rwanda and more. We also sell a few of our own blends. One of my favorites is called Buddha’s Blend, because the inspiration came while I was at a Buddhist retreat and the coffees I use are from Buddhist countries like Indonesia and Viet Nam. I think Africa is probably my favorite region for coffees. Coffee from Ethiopia is very aromatic with blueberry, apricot and mango notes, and Tanzanian Peaberry has delicate citrus notes and a distinct cocoa flavor with floral hints. It is best when roasted to “city” or “full city.”

It’s good to note that some studies promote the health benefits of coffee as a heart saver, liver protector, diabetes foe and Parkinson’s fighter – so go ahead and enjoy your favorite morning beverage.

With Cosmic Bean Coffee, I really hope to enhance the enjoyment people get from the experience of drinking coffees from around the world by educating them about specialty coffees and the roasting process. I have a lot of interests and I’ve always been an entrepreneur, so some of my hobbies have turned into businesses. About ten years ago I started roasting my own coffee in a small roaster at home. I’d give it away to neighbors and friends and got a lot encouragement to try selling it at farmers markets. Coffee was something I could do part time while still working as a curriculum designer, but now I can indulge my passion for roasting coffee full time.

Rob Haroth is the owner of the Cosmic Bean Coffee Company. When Rob isn’t roasting coffee or bringing it to a local farmers market, you might find him tending his bees or teaching holistic practices like meditation and qigong.

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Prostate-specific antigen or “PSA” is a blood test that screens for the level of a protein in the blood that can indicate prostate cancer. For many years, it has been the only screening tool for prostate cancer. According to the Centers for Disease Control, approximately 30 million PSA screenings are done every year, and about 1.5 million of the screenings are found to be abnormal. Of the one million men who undergo a biopsy due to an abnormal PSA test, 250,000 are diagnosed with prostate cancer. This means that three out of four men with an increased PSA are found to be negative for cancer after having a biopsy.

The American Urology Association (AUA) released its new clinical guidelines on prostate cancer screening in 2013, creating a stir of questions by patients. The panel decided that, from a public health perspective, the current strategy of PSA-based screening that measures the level of enzyme in the prostate provided high rates of over-diagnosis, needless biopsies and over-treatment.

“We still believe the PSA test is the standard,” said Dr. Alan Partin, M.D., Ph.D., chairman, professor and urologist-in-chief of the Department of Urology and the James Buchanan Brady Urological Institute at The Johns Hopkins Hospital. “However, in the past, when an elevated PSA was found and the biopsy was negative, we would routinely biopsy again. Today, due in part to research Johns Hopkins participated in, we can offer two new tests: the Prostate Health Index (PHI) blood test and PCA3 urine test. As these tests become more widely available, urologists will be able to follow those 750,000 men each year and avoid performing some additional biopsies.”

Marc Applestein, M.D., a urologist on staff at HCGH, notes, “These new tests will offer men new options. PHI testing will be more widely available soon and, at present, neither the PHI nor the PCA3 tests are covered by insurance. There is still debate and a lack of consensus about recommendations for men about screening. Men should discuss their family history and when to start PSA testing as well as what new testing options are available with their urologist.”


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Don’t Dabble at Kids’ Dosages

Use the correct medicine device for children, never a kitchen spoon

boy receiving medicine on spoon

© Wanchai Yoosumran | Dreamstime.com

A “spoonful of medicine” has long been the prescription for making sick children well. But “spoonful” is a highly inaccurate description and can lead to dangerous dosing errors when parents administer medicine to their children.

According to a study published in the Journal of Pediatrics, more than 40 percent of parents have made dosing errors and they are more than twice as likely to make mistakes when using teaspoon or tablespoon measures than when using millimeter measurements. The rate of potentially dangerous outpatient medication errors for children is three times that of adults due to the complexity of weight-based dosing, inaccurate measuring devices, incomplete instructions and inadequate education for care givers about the medication.

It’s difficult for parents when pharmacies put a teaspoon measurement on the package, but then supply an oral dosing syringe that’s marked in milliliters. Parents have to do a complicated math conversion that must also take their child’s weight into consideration. Because pharmaceutical companies base their dosing on weight (mg/kg), the dosage for each child will be different. The physician or pharmacist needs to calculate the correct dose and then educate parents or other care givers on how many milliliters to give to the patient.

It is also very important for parents to use the correct dosing device: an oral syringe, dropper or dosing spoon. Kitchen spoons come in many sizes and shapes and are not accurate for dosing medications. Their use should be discouraged by doctors and pharmacies.

In addition to correct dosing, there are a number of other things parents need to consider in order to safely administer their children’s medicines at home:

  • What time should the medicine be given? How often and for how long?
  • How should the medicine be administered: by mouth; inhaled; inserted into ears, eyes or rectum; or applied to the skin?
  • Should the medicine be taken with or without food?
  • How and at what temperature should the medicine be stored?
  • What are common side effects or allergic reactions?
  • Are there interactions with other medications your child may be taking?
  • What happens if your child misses a dose?
  • Do your doctor and pharmacist have your child’s correct current weight?

Remember that kids are not just miniature adults and are often more sensitive than adults to certain drugs. Getting the dose even slightly wrong can lead to serious problems. If unsure of dosing instructions, parents should always check with their pharmacist or their pediatrician!

Masoomeh Khamesian, Pharm. D. is the director of pharmacy for Howard County General Hospital. She is also a mother of two children and three step children.

 


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Men and Women are Different, Even in Sleep

How can he fall asleep so easily? She is staring at the ceiling, making “to do” lists, and worrying about her kids, her parents and a host of other things she can’t get out of her mind. One minute she’s hot and the next she’s cold, while he is sleeping like a baby. Of course, getting a good night’s sleep can be a problem for both men and women of all ages, but women, across the board, do report more sleep problems than men.

 A National Sleep Foundation poll reported that of the women who responded:

  • 31 percent complained of sleep problems
  • 75 percent often got two hours less than the recommended eight hours of sleep per night
  • 63 percent of women experienced symptoms of insomnia at least a few nights a week, compared to 54 percent for men
  • Women are more likely to have daytime sleepiness
  • Women are more likely to suffer from nighttime pain
  • 31 percent had taken drugs to stay awake and 13 percent had taken drugs to go to sleep.

Why do so many women have trouble getting a good night’s sleep?  Various biological, psychological and socio-cultural factors come into play to affect the way women sleep.

Hormones, hormones, hormones
Women’s hormones get the blame for a lot of things, but when it comes to sleep they really can cause trouble. Conversely, lack of sleep can affect our hormone levels, so there can be a vicious cycle of sleeplessness. When hormone levels spike and drop during and after pregnancy, during the menstrual cycle and at the time of menopause, women may experience higher rates of sleep problems.

The female hormone estrogen is related to REM (rapid eye movement) sleep, and it helps to increase sleepiness and need for more sleep. Progesterone, another female hormone, increases non-REM sleep and too much progesterone can cause fragmented, interrupted sleep. Progesterone also causes a woman’s body temperature to rise during ovulation, which can disturb sleep.

Before, during and even after menopause, the loss of hormones, particularly estrogen, can cause hot flashes and irritability, making sleep difficult. Hormonal fluctuations associated with PMS (premenstrual syndrome) can also affect a woman’s mood, cause bloating and increase stress – all three bad for sleep. While we observe these things anecdotally all the time, the science isn’t really there to prove there are differences in sleep between women who are “PMSing” and the controls who are not. And, while  American women report the highest rates of sleep problems during menopause, among Mayan women menopausal problems are unheard of. More research is needed.

Socio-cultural factors
I have joked that a big difference between men and women is that men have one “on/off” button, while women have lots of buttons and switches. They are complicated and prone to multi-tasking and taking on more than they should.

The pressures of working and child rearing while sometimes also caring for aging parents can put undue stress on women that affects their mood and their sleep. Working moms may find it difficult to meet all of their family and work responsibilities and still have time to relax and enjoy themselves.

Tips to promote better sleep for women
Before considering pharmacological solutions for sleep disorders, there are a number of things women can do:

  • Cool the ambient temperature of the bedroom to help regulate core body temperature
  • Dress in layers so you can peel down when you get too hot
  • Drink something cool at bedtime but try to avoid tobacco, caffeine, alcohol and spicy food
  • Lose weight: body fat holds onto estrogen and can release it at sporadic times, which can cause hot flashes
  • Try relaxation techniques like yoga or meditation
  • Get more exercise, but early in the day is better than in the evening
  • Try to establish regular sleep and wake times.

If you still need help, talk to your doctor to see if an underlying cause such as depression, anxiety, reflux, bladder problems or pain may be aggravating your sleeplessness. He or she may prescribe estrogen replacement therapy or other medications or botanicals. And you may want to talk to a sleep specialist to get help with sleeping as well as he does.

Charlene Gamaldo, M.D., is the director of the Johns Hopkins Center for Sleep at Howard County General Hospital.

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Classes & Events to Make You Well & Wise

calendar_2014smWednesday, July 30 and Thursday, July 31, 6-9 p.m. Living with Diabetes: Executive Summary. A condensed version of Living with Diabetes offered in the evening. Most insurance plans cover all or part of this program. To register, call 443-718-3000. Bolduc Family Outpatient Center at HCGH, 5755 Cedar Lane, Columbia.

Friday, Aug. 1 and Tuesday, Aug. 5, 8:30 a.m.–2:30 p.m. Living with Diabetes. Learn from an endocrinologist, podiatrist, psychologist, diabetes nurse educator and dietitian. Most insurance plans cover all or part of this program. To register, call 443-718-3000. Bolduc Family Outpatient Center at HCGH, 5755 Cedar Lane, Columbia.


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Secondary drowning doesn’t happen under water

Six clues to observe in your child if he takes in too much water

secondary drowning photo

It’s every parent’s worst nightmare. One second your toddler is happily swimming in the backyard or neighborhood swimming pool. You look away for a few seconds and, when you turn back to the pool, he is struggling under water and then gasping at the surface for air. You get him out of the water immediately and, after a few minutes, hours or even up to two days, he seems no worse for his frightening experience. But suddenly he starts to have strange symptoms that require an emergency hospital visit.

A swimmer may inhale a lot of water or take in a rush of water after jumping off a high surface or coming off a water slide. A toddler can slip into water that is over his head. It only takes a few seconds in the water – just enough time for the water to get past the vocal chords before the body can react.

The majority of children, or anyone for that matter, who suffer the effects of secondary drowning, will survive. But a small percentage could have permanent brain damage and others may even die.

It is a rare condition – the syndrome occurs in less than one to two percent of near-drowning victims–but its onset is usually rapid and is characterized by a period of one to 24 hours of respiratory well-being. The swimmer seems fine at first, but water left in the lungs begins to cause swelling and diminished oxygen exchange to and from the blood. As the blood oxygen level drops, oxygen flow to the brain and other vital organs is reduced. Inhaling pool water can cause an additional condition called chemical pneumonitis, inflammation of the lungs due to harmful chemicals. An interesting observation is that children who develop secondary drowning syndrome after immersion in fresh water have a higher rate of survival than those who take salt water into their lungs.

Common symptoms of secondary drowning are persistent cough, shortness of breath, chest pain, lethargy, fever and unusual mood change. These signs can be difficult to spot in young children who are normally tired and fussy after a day a long day in the water. If symptoms are diagnosed early on, a physician can administer oxygen and remove fluid from the lungs. If not treated, the syndrome can progress to pulmonary edema (swelling) with a frothy pink discharge from the nose and mouth; partial or complete lack of oxygen supply to the brain, which can cause serious cognitive, physical and psychological impairment; respiratory and cardiac arrest; and death.

It sounds very scary, but none of this means parents should needlessly worry or forego the joys of family summer vacations at the beach or long days at the swimming pool. Just remember that vigilant monitoring of children when near the water is extremely important and water safety is the best prevention. If your child does have a near drowning experience, you should observe him or her in the following days and know what to look for. If you see any signs of secondary drowning, immediately take your child to an emergency department. Time is a critical factor in treatment – it could save your child’s life.

Dr. David J. Monroe is the director of the Children’s Care Center at Howard County General Hospital.

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Classes & Events to Make You Well & Wise

calendar_2014smMondays, July 21, 3:30 p.m. – 5:30 p.m. Blood Pressure Screening at Glenwood Branch – a Well & Wise Event. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine.

Saturday, July 26, 9-11 a.m. Home Sweet Home. Children ages 8–12 and their parents learn ways for children to stay at home alone. Register at hcgh.org or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Monday, July 28, 5:30-9 p.m. Adult/Child/Infant CPR and AED. Learn skills to clear an airway obstruction, perform CPR and how to use an automated external defibrillator (AED). Earn two-year American Heart Association completion card (not a health care provider course). Cost is $55. Register at hcgh.org or call 410-740-7601.Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.


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© Innovatedcaptures | Dreamstime.com

© Innovatedcaptures | Dreamstime.com

If your sleep partner thrashes around and frequently kicks you during the night, don’t assume he or she is angry at you. And the friend who can never sit still for more than a few minutes may not just have “ants in her pants.” They may have a neurological disorder called restless legs syndrome (RLS), also referred to as Willis-Ekbom Disease named after the doctor who first described this condition more than 300 years ago. While anyone, even children, can develop RLS, it is more common among women. According to The Johns Hopkins Center for Restless Legs Syndrome, five percent of the general population and as many as 10 percent of those over 65 years old suffer with this condition.

RLS Symptoms The hallmark of this condition is an abnormal creeping sensation in the legs that causes an uncontrollable urge to move them. People with RLS can barely sit through a movie or quietly read a book without having to get up and move, and it makes sleeping almost impossible. Rest brings on symptoms, which usually peak at night, and activity relieves them. These sensations may be felt anywhere from the thigh to the ankle in one or both legs and sometimes in the arms, but rarely in the feet. Some people’s legs jump on their own, and there may be semi-involuntary movements of the legs. Many with RLS will have rhythmic or semi-rhythmic movements of their legs while they are asleep.

RLS Causes?

  • Iron deficiency – There is a strong relationship between iron deficiency and RLS and even people with normal blood iron levels may have iron deficiency in the tissues that can cause symptoms.
  • It’s in the genes – There is considerable evidence that there is a genetic component to RLS and, while genetic variations do not always cause RLS, they can increase your risk of developing it. We also know that there is a connection between several genes and iron regulation, which supports the idea that iron levels and genes may trigger the onset of RLS.
  • RLS is also associated with pregnancy, kidney dialysis and increased age.

Treatments We like to start with treatments that don’t require medication, such as hot baths, massaging the legs, applying hot or cold packs, moderate physical activity, and restricting caffeine and alcohol. These remedies may bring some level of relief, but for most, they will not bring a good night’s sleep. Certain medications, such as antihistamines, can actually make the condition worse, but others have proven to be very helpful in reducing symptoms. So if you or your sleep mate can’t lie still at night and it’s keeping one or both of you awake, it may be time to seek professional help for diagnosis and treatment. For information or to schedule an appointment, call 800-WESLEEP (800-937-5337) or visit hcgh.org/sleep.

Rachel Salas, M.D., is a neurologist and assistant medical director of The Johns Hopkins Center for Sleep at HCGH and director of its home sleep testing services.


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Classes & Events to Make You Well & Wise

calendar_2014sm

Mondays, July 14-Aug. 18, 11 a.m.-12 p.m. Qigong: Meditation in Motion. There is a state of the heart known by ancient traditions and cultures to vaporize illness from the body. Whether we profoundly heal illness, or learn to live in a state of holy joy, irrespective of our circumstances, living in this state of heart changes the way we think, feel and heal. Learn self-healing practices to powerfully unlock often unrecognized or neglected Mind-Body resources. Access your inner Molecules of Medicine! $72 for six-week class or $15 per class. Room 100 of The Medical Pavilion at Howard County. Taught by Bridget Hughes, M.Ac., L.Ac. Registration is required, call 410-964-9100 x 2 or email bridget@healingpoint.biz.

Tuesday, July 15, 5-6:30 p.m. Weight Loss Through Bariatric Surgery. Learn about weight-loss surgery from Johns Hopkins Center for Bariatric Surgery. 410-550-5669 or hopkinsmedicine.org/jhbmc/bariatrics.

Wednesday, July 16, 7-9 p.m. Happiest Baby on the Block. Parents and parents-to-be learn techniques to quickly soothe baby. $50 per couple (includes parent kits). Call 410-740-7601 or visit hcgh.org. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.


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Night music – when snoring is more than just noise

© Ileanaolaru | Dreamstime.com

You or your sleep partner anticipates when it will begin every night. That dreaded sound of a buzz saw with intermittent gasping and choking sounds that can wake you up and keep you awake for too much of the night. Snoring is the subject of cartoons and sitcoms, but in real life, it isn’t very funny.

What is obstructive sleep apnea (OSA)? Just about everyone has, at some time, experienced snoring, but chronic loud snoring accompanied by the actual cessation of breath that lasts for ten seconds or more is the most common symptom of a sleep disorder known as obstructive sleep apnea (OSA) or sleep disordered breathing. The back of the airway is obstructed by the tongue and the back of the throat collapses so that air can’t come through to the lungs. People with OSA may even have trouble breathing during daytime napping. This causes retention of carbon dioxide and a drop in blood oxygen levels that can lead to headaches, daytime drowsiness, difficulty concentrating, insomnia, depression and nighttime urination. Anyone can develop OSA, but men are more prone, perhaps because they have bigger and more muscular necks; and women sometimes go undiagnosed because they display different symptoms, including depression. In children, sleep apnea is usually associated with enlarged tonsils and/or adenoids. A large tongue, excess tissue in the upper airway, blocked nasal passages or the structure of the jaw and airway are other risk factors, as is being overweight. As the waistline of the American public has expanded over the years, so has the number of people with sleep apnea.

What are the consequences?
Without treatment, sleep apnea can have many unfortunate consequences, including stroke, diabetes and cardiac problems. OSA can also aggravate other medical conditions, such as high blood pressure, acid reflux and insomnia. If you have existing high risk for any of these conditions, OSA can move you faster toward developing the disease; and because oxygen levels sometimes go down very low during sleep, people can die from sleep apnea.

What is a sleep study?
We always want to get the patient’s history, but with symptoms of OSA, an overnight sleep study is required to make a conclusive diagnosis. This study, also called a polysomnogram, can be done either at the hospital in a sleep lab or using portable monitoring equipment at home. The purpose is to evaluate how a patient breathes during sleep. A trained technician will connect wires to the patient’s head, chest and legs in order to monitor the oxygen level, breathing pattern and sleep pattern throughout the night.

How do we treat OSA?
Adequate treatment of sleep apnea can improve both symptoms of OSA and its associated medical conditions. For mild apnea, sometimes a pillow or sleeping on one’s side can help alleviate the symptoms and there are dental appliances that reposition the lower jaw and keep the tongue forward to open the airway. But for more severe cases of OSA, CPAP (continual positive airway pressure) machine therapy is the gold standard. A machine is worn during sleep to push air through the throat and keep it open during the night. For overweight patients, weight loss and sometimes surgery, such as removal of tonsils and adenoids is recommended. Tobacco, sleeping pills and alcohol can exacerbate apnea, so avoiding these substances may help. Remember – snoring is not just annoying. It can be a warning sign that you have a sleep disorder that may have serious health consequences and a “wake up” call that you need to improve your sleep!

Francis Chuidian, M.D., is a pulmonary, critical care physician with the Johns Hopkins Center for Sleep at HCGH. For more information about the center, visit hcgh.org/sleep.

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Easy Fixes for Better Sleep

sleeping african princessAre you tired of counting sheep, getting up three or four times during the night and always feeling tired and unrested in the morning? If you have had difficulty falling asleep and staying asleep for more than 90 days, you may need to get professional help, but there are a lot easy things we can all do – or not do – on our own in order to get a better night’s sleep.

The first thing to consider is how to make your bedroom a sleep-friendly environment.

  • Your bedroom should be your “bat cave” – dark and quiet.
  •  It should be comfortably cool. Use a fan and a cooling blanket if you get too warm during the night.
  • A cluttered room can increase anxiety at bedtime, so try to keep your sleeping room tidy.
  • Cotton, cotton, cotton! It breathes better than other fabrics, so cotton PJs and sheets are best.
  • Allergies can interrupt sleep, so keep things as clean as possible. Use an air purifier, change sheets and clean carpets often. Your pillow is like a petri dish for germs and allergens. Change it out once a year and replace mattresses every five years.

There are also some simple behavioral changes that can help you get better sleep.

  • Unplug! Using laptops, tablets and phones right before bed or even having them in the room at night can alter your circadian rhythm, and the blue light they emit is very bad for sleep. Late night TV can also disturb sleep.
  • Avoid doing work and answering emails at bedtime. This can increase anxiety or be too stimulating.
  • Try to have a regular bedtime – within 30 minutes – every night. This helps to set your internal clock and get you ready for sleep.
  • Avoid late meals – especially spicy, fatty or acidic foods.
  • Avoid caffeine and alcohol at bedtime.
  • A warm shower or bath at night is good, but not right before bedtime, because it can raise your core body temperature.
  • Try to avoid negative thoughts that increase stress late at night.
  • Relaxation techniques like meditation, prayer, yoga breathing, and even blowing bubbles can help.
  • Get more exercise during the day.
  • Remember that there are only three things that should happen in bed: sleep, sickness and sex.
  • This may not be negotiable for some pet owners, but having Fido in bed can increase allergies and disturb sleep.
  • Make your bed every day. It’s been shown that routine bed makers are better sleepers. Mom was right!
  • Have less light at night but more in the daytime. Get sun exposure during the day or try a light therapy box in winter.
  • Quit smoking! It’s terrible for your health in general, and smoking at night can cause restlessness.

I’d like to leave you with one final tip for a good night’s sleep. Embrace the idea that sleep is vital for good health and make it a priority in your life. The benefits you’ll reap are well worth the effort.

Seema Gulyani, NP, Ph.D, is with the Johns Hopkins Center for Sleep at Howard County General Hospital. For information or to schedule an appointment, call 1-800-WESLEEP (1-800-937-5337) or visit hcgh.org/sleep.

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Here comes the sun…Protect your eyes!

bright sun thinkstock 83404658After a long cold winter, we’re all happy to see and feel the warmth of the sun.  It makes us look and feel healthy, and we actually need some sun exposure to produce vitamin D, which helps in the absorption of calcium for healthy bones. Most of us are aware that the sun’s ultraviolet (UV) rays can cause serious damage to the skin that can lead to melanoma and other skin cancers. But we need to remember that the sun can be equally damaging to our eyes, causing cataracts and other eye diseases. So when you think about protection from the sun, remember that you also need to safeguard your eyes.

There are three kinds of UV rays: UVA, UVB and UVC. Only the first two reach the earth’s surface and the UVB rays cause greater risk than UVA, but both can cause serious injury.

Too much sun exposure can cause the growth of cataracts and pterygia, fleshy growths on the whites of the eyes that are also known as “surfers eye.” Excessive UV can also increase the risk of cancerous tumors on the surface and inside the eyes, and can result in sunburn to the eye itself. It can also increase the risk of developing macular degeneration.

The best way to protect yourself from the sun’s harmful rays is to limit sun exposure, but there are a number of other ways you can minimize the sun’s dangerous rays:

  • Purchase protective eye wear for you and your children. You don’t have to spend a fortune, but be sure they have labels saying they block 99-100 percent of UV rays or they say “UV400.” Gray-tinted lenses affect color the least; amber increases contrast. Polarized lenses reduce glare and are good for use on the water, but may dim the images from certain liquid crystal displays. Larger, wraparound frames are best for preventing sun damage to the sides and whites of the eyes.
  • Remember that snow, water and sand are great reflectors of UV rays, so you need to wear your sunglasses even under the beach umbrella. A wide-brimmed hat provides additional protection.
  • Wear your sunglasses whenever you go outside – even on overcast days.
  • Your everyday eye glasses should also have a coating that absorbs UV rays.
  • Do not use tanning beds. They use ultraviolet lights and can cause eye damage. If you want to get a tan, use a self-tanning product, but use it with sunscreen.
  • Use a water-proof, broad-spectrum (this means it protects against UVA and UBA rays) with SPF of at least 20-30 and apply very carefully around the eyes.
  • Never look at the sun – especially during an eclipse!

Finally, you should remember that your eyes need protection all year round – not just during the lazy, hazy, sunny days of summer!

David B. Glasser, M.D., is an ophthalmologist in private practice with Patapsco Eye MDs and is a member of the Howard County General Hospital Department of Surgery.


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Classes & Events to Make You Well & Wise

calendar_2014smSaturday, June 21, 10-11:30 a.m. Mind-Body Connection and Health. Presented by Sharon Burns, RN, BSN, MA. Registration is requested at 410-740-5858. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Columbia, Md.

Saturday, June 21, 9 a.m.-1 p.m. Essentials in Babysitting. Learn to manage children, create a safe environment and apply basic emergency techniques. Cost is $50. To register, call 410-740-7601 or visit hcgh.org.  Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Monday, June 23, 7:00 p.m. Improving Your Mood Through Meditative Art at the Miller Branch – a Well & Wise Event. Research shows that creative activities can boost serotonin levels. Join us in the Enchanted Garden as we use artistic expression to improve our moods. All levels of artistic ability welcome. A Well & Wise event. Register online or by calling 410.313.1950.

Tuesday, June 24, 5:30-9 p.m. Adult/Child/Infant CPR and AED. Learn skills to clear an airway obstruction, perform CPR and how to use an automated external defibrillator (AED). Earn two-year American Heart Association completion card (not a health care provider course). Cost is $55. Register at hcgh.org or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.


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Sleepless in Columbia…what it means for your health

Man sleepingAs director of the Johns Hopkins Center for Sleep at HCGH, I am thrilled to know that so many people in Howard County care about their sleep and want to do something about it. I always tell my patients that sleep is not a luxury item – it is a minimum requirement. Sleep deprivation experiments with mice have shown that even if they get everything else they need, without sleep they will die! So sleep is an absolute must for life, and healthy sleep is essential for a healthy life.

Anyone who has suffered from insomnia or other sleep disorders knows that getting a good night’s sleep is not always easy. And when we don’t sleep well for long periods of time, the results can be devastating: high blood pressure, stroke, diabetes, cardiac problems, weight gain, daytime drowsiness that can lead to accidents, depression and even sudden death.

So…what keeps us from getting good sleep and what can we do to help us sleep like babies again? To get on the path to healthy sleep, there are some basic things we need to understand.

How sleep works

The drive for sleep is extremely powerful – even greater than the need to eat and drink. You have to consciously act to eat and drink, but deprived of sleep for long enough, you WILL sleep, whether you want to or not. The average needed amount of sleep is 7 ½ to 8 hours per day, and that average usually remains the same throughout your life. If you don’t get enough, eventually you’ll have to repay your sleep debt.

There are two kinds of sleep – REM (rapid eye movement or dreaming sleep) and non-REM, and during a sleep session we should cycle four to five times between these two types of sleep.

How you fall asleep

As the day goes on, our need for sleep builds up naturally. Our circadian rhythm, however, keeps us awake and dips at certain times of the day. Our circadian rhythm is influenced by light and darkness. Light in the morning helps us stay awake and darkness at night helps us sleep. So maybe it’s a better idea to put on those sunglasses in the afternoon rather than on the way to work in the morning.  Keep your environment bright and well lit early in the day, and lower the lights as the evening progresses. A dim night light in the bathroom is better than turning the light on full blast during the night, because that light can affect your sleep.

Unplug at night!

We’re addicted to our devices and they can adversely affect our sleep. Laptops, iPads and cell phones that are pinging and blinking and lighting up in the bedroom during the night are bad, and the blue light they emit is especially deleterious to sleep. Watching TV in the bedroom can also be too stimulating and make it hard to fall asleep. So unplug and read a good book instead. Remember! Only three things should happen in bed: sleep, sickness and sex.

What about naps?

We have a normal physiological desire for sleep between 1 and 4 p.m. Is it ok to take a nap? If it doesn’t affect your sleep at night, go for it. But giving into a nap after dinner can affect your circadian rhythm and make it hard for you to sleep through the night. Studies show that when we break the normal sleep pattern we won’t have good sleep at night.

Sleep is a safety issue

Many disasters and accidents occur during these dips in our circadian rhythm and these rhythms may differ through age. For example, among the young, car crashes are more frequent at night; for middle age, in the afternoon and night; for age 60-65, in the morning; and over 65, in the late afternoon. The highest-risk populations for sleep-related accidents are shift workers, medical residents, truck drivers and people who work hard and play hard without getting enough sleep.

Because sleep is extremely important for not only our own health and safety but also for the wellbeing of our families and community, we shouldn’t take sleep problems lightly. Remember that the first step in resolving a sleep disorder is admitting that it exists and taking positive action to get the good sleep we need.

For information or to schedule an appointment, call 1-800-WESLEEP (1-800-937-5337) or visit hcgh.org/sleep.

Charlene Gamaldo, M.D., is the director of the Johns Hopkins Center for Sleep at Howard County General Hospital.

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Classes & Events to Make You Well & Wise

calendar_2014smMonday, June 16, 10-11:30 a.m. Medicare 102. Learn about Medicare Health Plans (Part C) and Medicare Supplement Policies. Presented by the State Health Insurance Assistance Program, Howard County Office on Aging. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Monday, June 16, 3:30 p.m. Blood Pressure Screening at Glenwood Branch– a Well & Wise Event. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. No registration required.

Monday, June 16, 6:30 p.m. Look Good…Feel Better. This American Cancer Society program provides a free workshop by a licensed cosmetologist. Women undergoing cancer treatment learn to manage the appearance-related side effects of cancer treatment and receive a complimentary bag of cosmetics. Registration: American Cancer Society at 1-888-535-4555. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Columbia, Md.

Wednesday, June 18 and Thursday, June 19, 6-9 p.m. Living with Diabetes: Executive Summary. A condensed version of Living with Diabetes offered in the evening. Most insurance plans cover all or part of this program. To register, call 443-718-3000. Bolduc Family Outpatient Center at HCGH, 5755 Cedar Lane, Columbia, Md.

Thursday, June 19, 7-8:30 p.m. Understanding Fibroids. Gynecologist Phyllis Campbell, M.D., will discuss the symptoms, when treatment is appropriate and what treatments are available. Call 410-740-7601 or click here. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Friday, June 20 and Tuesday, June 24, 8:30 a.m-2:30 p.m. Living with Diabetes. Learn from an endocrinologist, podiatrist, psychologist, diabetes nurse educator and dietitian. Most insurance plans cover all or part of this program. To register, call 443-718-3000. Bolduc Family Outpatient Center at HCGH, 5755 Cedar Lane, Columbia, Md.

Saturday, June 21, 9 a.m.-1 p.m. Essentials in Babysitting. Learn to manage children, create a safe environment and apply basic emergency techniques. Cost is $50. To register, call 410-740-7601 or click here.Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Saturday, June 21, 10-11:30 a.m. Mind-Body Connection and Health. Presented by Sharon Burns, RN, BSN, MA. Registration is requested at 410-740-5858. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Columbia, Md.

Monday, June 23, 7:00 p.m. Improving Your Mood Through Meditative Art at the Miller Branch – a Well & Wise Event. Research shows that creative activities can boost serotonin levels. Join us in the Enchanted Garden as we use artistic expression to improve our moods. All levels of artistic ability welcome. Register online or by calling 410.313.1950.

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What are Uterine Fibroids? How are they treated?

According to Michelle Seavey, M.D., an OB/GYN on staff at HCGH, the most common symptoms of uterine fibroids are:

  • Seven or more days of menstrual bleeding
  • Heavy menstrual bleeding or clots
  • More frequent menstrual cycles
  • Frequent urination
  • Trouble emptying your bladder
  • Pelvic pressure/pain
  • Constipation

What are Uterine Fibroids?

Uterine fibroids are typically noncancerous growths of the uterus that usually appear during your childbearing years. “They can vary greatly in size—from undetectable to the human eye to masses that enlarge your uterus. You can have just one or many, and they can grow quickly, slowly or stay the same size,” explains Melinda Afzal, D.O., an OB/GYN on staff at HCGH. “They also can enlarge during pregnancy and then shrink after pregnancy as your uterus returns to its normal size.”

What are the Symptoms?

“At least 60 to 70 percent of women will get fibroids at some point, however most women are unaware they have fibroids because they have no symptoms,” states Dr. Afzal. “Typically, fibroids are found incidentally during a routine pelvic exam. If your doctor feels irregularities in your uterus’ shape, he or she may suggest a pelvic ultrasound—the gold standard for diagnosis.”

How are They Treated?

“When most women find out they have fibroids, they are concerned and think the fibroids need to be removed. If you have a small fibroid and are not experiencing any symptoms, we will follow it at your annual visits. If you have a larger fibroid, we may monitor you every six months to see size change,” states Dr. Seavey. “Fibroids are not associated with an increased risk of uterine cancer. However, there are many options for treating uterine fibroids, and treatment recommendations depend on the severity of symptoms and the size and number of fibroids. If you have symptoms, talk with your doctor to determine which option is best for you.”

Medications. An injection that blocks the production of estrogen and progesterone, creating a temporary postmenopausal state that lasts three to six months, can shrink the fibroid’s size. “Hormone therapy, in the form of oral contraceptives, can help control menstrual bleeding but will not reduce fibroid size,” notes Dr. Seavey.

Minimally Invasive Procedures. “Uterine artery embolization uses a small device that is placed in the major blood vessel that supplies the uterus with blood to reduce the blood supply to the fibroid, causing it to shrink,” says Dr. Seavey. “This technique can be used depending on the size and location of the fibroid.”

Hysterectomy (the surgical removal of the uterus). “Depending on fibroid size, a hysterectomy can be performed laparoscopically with three to four small abdominal incisions and typically a one-day recovery in the hospital,” explains Dr. Afzal. “Patients who require an open hysterectomy typically have a three-day hospital stay and another four to six weeks for recovery after the procedure.” While a hysterectomy is not an option for those still wanting to bear children, it remains the only proven permanent solution for fibroids.

 

Howard County General Hospital is hosting a discussion called, “Understanding Fibroids” on Thursday, June 19, 7-8:30 p.m. at the HCGH Wellness Center. Presented by Phyllis Campbell, M.D., the presentation will include the symptoms, when treatment is appropriate and what treatments are available. For information, click here.

 


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Classes & Events to Make You Well & Wise

calendar_2014sm

Monday, June 9, 7:00 p.m. Notable Author: Dr. Pam Peeke at Miller Branch. Dr. Pam Peeke, New York Times bestselling author of The Hunger Fix, Fit to Live, Body-for-Life, and Fight Fat After Forty. A “Meet the Author” event. Register online or by calling 410.313.1950.

Tuesday, June 10, noon-1 p.m. Learn and experience different practices, such as breath meditation and guided imagery. Facilitated by Mary Dowling, LCSW-C. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Columbia, Md. Call 410-740-5858.

Tuesday, June 10, 5-6:30 p.m. Weight Loss Through Bariatric Surgery. Learn about weight-loss surgery from Johns Hopkins Center for Bariatric Surgery. For information, call 410-550-5669 or click hopkinsmedicine.org/jhbmc/bariatrics.

Tuesday, June 10, 7-9 p.m. Smoke-Free Lungs. Education and support for those wanting to quit or who have quit. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md. For information, click here or call 410-740-7601.

Tuesday, June 24, 5:30-9 p.m. Adult/Child/Infant CPR and AED. 
Learn skills to clear an airway obstruction, perform CPR and how to use an automated external defibrillator (AED). Earn two-year American Heart Association completion card (not a health care provider course). Cost is $55. Register here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.


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Farmers Market Feature: Pong’s Orchard

Farmers market season is in full swing! Howard County General Hospital’s Farmers Market is open every Friday afternoon, 2-6 p.m., in the rear of Lot C, and features a number of local farms and products, including Pong’s Orchard. May Pong gives us a view into the farm’s history.

A taste of the exotic for good health at the HCGH Farmers MarketAsian Pear

My husband, Al, and I used to operate an Asian restaurant, but we were having a hard time finding good bean sprouts, so we decided to grow our own in the basement. One thing led to another and, before long, we bought a farm with an apple and peach orchard in Montgomery County.

Everyone was selling apples and we couldn’t sell enough to survive, but when we discovered we could grow Asian pears – something a little different – we cut down some of the apple trees and planted Asian pears and some unusual “gourmet” fruits. That was over 30 years ago and we believe that, along with Dr. Chris Walsh of the University of Maryland, we were the first in Maryland to grow Asian pears commercially.

In 2001, we bought a farm in Fulton, Md., where we now live and grow more varieties of exotic fruits: aronia berries (black choke berries), calamondin sour oranges, navel oranges, red navel oranges, satsuma tangerines, Chinese grapefruits, red grapefruits, clementines, Kishu tangerines (much sweeter than clementines), pomegranates, goji berries, Meyer lemons, sweet lemons, pink lemons, Persian limes, sweet limes, Thai limes, Key limes, kumquats, figs, guavas, a citrus fruit called Buddha’s hand and Dekopon tangerines, which sell for $10 each in Japan. One of our new products is the Japanese persimmon. We also have fragrant flowering trees, such as michelia figo, Japanese flowering apricot, sweet olive, and Chinese tree peonies that will perfume your backyard and your house.

People are surprised to hear we’re growing these things right here in Howard County – and without a heated green house. We sell lots of plants that you can take home and grow in your own house or backyard. All you really need is about six to eight hours of sunlight every day and a place to bring the plants inside during the winter. Most of them can withstand very cold weather – even the winter we just went through – but they can’t survive cold wind. Before you know it, you, too, can be picking organically-grown tropical or citrus fruit from your own tree in Maryland.

We call many of these fruits “super fruits” because of they are said to have many health benefits, including being anti-oxidants and having properties that fight cancer, obesity and protect against heart disease. We added three medicinal plants this year, including one called “cholesterol spinach” because it is said to help lower blood sugar, cholesterol and triglycerides. Citrus fruits are also wonderful for cooking, and they make delicious beverages.

We sell at the farm as well as at farmers markets because we love meeting and sharing our produce with the people in local communities.

~May Pong

May and Al Pong have been married for 51 years and farming together for more than 30 of them. You’ll find them selling the products of Pong’s Orchard every Friday from 2-6 p.m. at the Howard County General Hospital Farmers Market.

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Classes & Events to Make You Well & Wise

calendar_2014smJune 2 & 16, 3:30 p.m. Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. A Well & Wise event. No registration required.

Wednesday, June 4, 6 p.m. Advance Directives. Leslie Rogers, MSW, LCSW-C, OSW-C, clinical oncology social worker at HCGH and the Claudia Mayer/Tina Broccolino Cancer Resource Center, will review what advance directives are, who needs them and how you get them. You will have the opportunity to leave this class with a completed advance directive document. Also, learn what it means to appoint, or to be appointed, a health care agent. Registration is required for this free event. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Wednesday, June 4, 6:30 p.m. Managing Incontinence with Confidence. Learn about the kinds of incontinence that caused women in your mother’s generation to give up activities due to fear of “leaking.” Urologist Jennifer Bepple, M.D. will discuss stress incontinence (when you cough, sneeze, or jump) and urge incontinence (when you just can’t wait) and what diagnostic tests and treatments are available to women today. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Thursday, June 5, 9-11:30 a.m. Stroke Assessment with BMI and Diabetes Screening. Meet with a registered nurse to receive a diabetes/stroke screening that includes a glucose blood test, BMI (body mass index) and weight management information. Immediate results. Fasting eight hours prior to test is recommended. Registration is required for this free event. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

June 9, 10:30 a.m. & 11:15 a.m. Tae Kwon Do: Tiny Tigers at the Miller Branch. Sykesville Tae Kwon Do instructors focus on motor skills, listening, and taking turns. Wear athletic shoes and loose fitting pants or shorts. Ages 3-5 with adult; 30 min. Well & Wise event. Registration and a signed release form required or register by calling 410.313.1950.
June 9 10:30 a.m. Registration & Release Form
June 9 11:15 a.m.
Registration & Release Form

Monday, June 9, 5:30-9 p.m. Adult/Child/Infant CPR and AED. Learn skills to clear an airway obstruction, perform CPR and how to use an automated external defibrillator (AED). Earn two-year American Heart Association completion card (not a health care provider course). Cost is $55. Register here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

June 9, 7:00 p.m. Notable Author: Dr. Pam Peeke at Miller Branch. Dr. Pam Peeke, New York Times bestselling author of The Hunger Fix, Fit to Live, Body-for-Life, and Fight Fat After Forty. A “Meet the Author” event. Register online or by calling 410.313.1950.


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Keeping Our Kids Cavity Free

Daniel Biederman, D.D.S., and his daughter, Darcy, often visit area schools to educate children about good dental health.

Daniel Biederman, D.D.S., a.k.a. “Dr. Dan,” and his daughter, Darcy, often visit area schools to educate children about good dental health.

Dental hygiene and a good diet are the keys to healthy teeth. As a pediatric dentist, I want my patients to have a positive experience and a good dental checkup when they come to my office. The best advice I can offer parents on how to make this happen is to make sure their children keep their teeth clean and eat a healthy diet.

Dental hygiene

As soon as baby’s first tooth erupts, parents should start thinking about keeping those choppers clean and healthy. The sooner they start, the more likely their child will develop and continue to have good dental hygiene habits throughout life.

Parents will need to offer their very young children hands-on assistance with tooth brushing – every night before bed and again in the morning. Until a child can spit out toothpaste consistently and thoroughly after brushing, it’s best to use toothpaste without fluoride. In fact, just water and a toothbrush are probably sufficient for most kids. Many children don’t like the taste of toothpaste, and using it may decrease their tolerance for tooth brushing. Additionally, toothpaste creates a lot of bubbles, which makes it more difficult for parents to see how well they have cleaned their child’s teeth.

Fluoride

Fluoride is, without a doubt, beneficial to the development of strong, healthy teeth – but only in very small amounts. It’s easy for a small person to ingest excessive fluoride from swallowing toothpaste that contains fluoride, so parents should check with their child’s dentist if they have questions on when to use toothpaste containing fluoride.

While there are toothpastes on the market that claim to be “safe to swallow” because they do not contain fluoride, there is really no additional therapeutic benefit to using this type of toothpaste. When a child is still learning to spit out effectively – usually around 3-4 years of age – “safe-to-swallow” toothpaste might be helpful.

Diet

While we always encourage a healthy diet to reduce cavity risk, I like to focus on the liquid sugars kids are exposed to when they drink milk and juice. While milk and juice are healthy for children’s bodies, the sugars in these liquids act as a food source for cavity-causing bacteria. Your pediatrician can tell you how much milk or juice your child should drink, but dentists recommend limiting the amount of time they spend consuming non-water beverages to 15-20 minutes. Between meals, they can drink as much water as they want.

Lots of brushing, the right amount of fluoride and a healthy diet can help keep your kids’ teeth strong and cavity-free.

Daniel Biederman, D.D.S., a.k.a. “Dr. Dan” as he is known to his patients, is a pediatric dentist in private practice and is a member of the Howard County General Hospital Department of Surgery. Visit his website at kidsdentalcenter.

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Classes & Events to Make You Well & Wise

calendar_2014smTuesday, May 27, 1-3 p.m. Quilting Support Group: Second and fourth Tuesdays of each month. Designed for cancer patients and survivors. Join us as we come together in the spirit of the old-fashioned quilting bee to share fellowship and fun. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Suite G050, Columbia, Md. 410-740-5858.

May 27, 6:30 p.m. Invitation to the Ballet at Central Branch. Students of Misako Ballet perform classical ballet and contemporary dances. Children from the audience may learn a quick piece and perform it. Register online or by calling 410.313.7880.

May 28, 10 a.m.-Noon. Knitting and Crochet Fellowship Group: Wednesdays from 10:00 a.m.to noon. This group is designed for cancer patients and survivors. Join us for fellowship and fun. No experience necessary, instructions and directions will be provided. Claudia Mayer/Tina Broccolino Cancer Resource Center, 10710 Charter Drive, Suite G050, Columbia, Md. 410-740-5858.

May 29, 7:00 p.m. Trivia Night at Miller Branch. Exercise your brain and enjoy a fun-filled night of trivia, featuring five rounds of ten questions. Form a team or join a team at the event with other trivia night participants. Register online or by calling 410.313.1950.

May 30, 3:00 p.m. Move with Games at Glenwood Branch. Exercise while competing with your friends on the Wii or XBox Kinect. Healthy snack provided. Ages 11-17. No registration required.

June 2 & 16, 3:30 p.m. Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. A Well & Wise event. No registration required.

Wednesday, June 4, 6 p.m. Advance Directives. Leslie Rogers, MSW, LCSW-C, OSW-C, clinical oncology social worker at HCGH and the Claudia Mayer/Tina Broccolino Cancer Resource Center, will review what advance directives are, who needs them and how you get them. You will have the opportunity to leave this class with a completed advance directive document. Also, learn what it means to appoint, or to be appointed, a health care agent. Registration is required for this free event. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.

Wednesday, June 4, 6:30 p.m. Managing Incontinence with Confidence. Learn about the kinds of incontinence that caused women in your mother’s generation to give up activities due to fear of “leaking.” Urologist Jennifer Bepple, M.D. will discuss stress incontinence (when you cough, sneeze, or jump) and urge incontinence (when you just can’t wait) and what diagnostic tests and treatments are available to women today. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, Md.


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A Dog Blog: How My Dog Made Me Healthier

Dana PoolsideThis is Dana. She is a 12-year-old yellow Labrador Retriever and I would do anything for her. Anything.

You could argue that I am crazy when it comes to this dog. My former boss used to say she’d like to come back in her next life as my dog….because she has such a good life.

A few years ago, when she was eight, she began showing signs of arthritis – stiffness, limping and obvious pain. She was officially diagnosed and we put her on pills, tried to keep her out of pain, keep the weight off her joints, the usual routine. She was never grossly overweight, but she wasn’t at what veterinarians consider an ideal weight (which is pretty thin if you’ve ever looked at the photos in a vet’s office). And if you’ve ever met a Lab, they love their food, so losing weight is not an easy task!

As I continued to watch her suffer, I consulted my sister-in-law, who is a vet. She said she needed to lose 20 pounds! She told me about her own experiences with her dog who had cancer. He lived much longer than she expected after she began changing his diet to real food (in her case a raw diet). When she told me to start cooking for my dog to help with weight loss and inflammation, I told her there was no way; I already cook for my whole family and work full time.

Dana continued to struggle so I broke down and gave it a try. The weight came off steadily and our dependence on pain pills was reduced. The pain wasn’t completely relieved, but she was showing real improvement. She began swimming laps in the pool and taking daily walks. Now, four years later, I regularly cook for her. I supplement with a brand of natural, whole food but she eats everything from green beans to sardines. I realize that some vets may be concerned about this approach because dogs need certain nutritional elements. I think I am covering her needs.

I work in healthcare and we talk about how important good nutrition is for people – but I never really stopped to think about how a dog should be eating. They should eat the right mix of vegetables, meat and a small amount of grain. And maybe some of the processed food isn’t good for them either!

So because of the fact that my 70+ pound friend eats a lot of volume, I joined a community supported agriculture farm share (when a local farm lets you share a portion of their crops for a fee). The two of us look forward to Thursdays when we pick up a load of vegetables and make a fresh batch of “dog stew.”

Although I was always a fairly healthy eater and maintained an active lifestyle, seeing the difference good nutrition made in my dog’s overall health has made me committed to eating even more vegetables and fruit. I find I don’t get sick as often, I feel better, and I do pretty well at keeping weight off myself (despite an aging metabolism and a few arthritis symptoms of my own).

So you could argue that what I’ve given her in TLC and cooking time has come back to me tenfold, to say nothing of the way her smile reduces my stress. I know she won’t live forever but I am grateful for how much better she is today. So give your dog some (healthy) table scraps. And then give yourself some.

Susan Case is the director of Marketing and Communications at Howard County General Hospital.


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Classes & Events to Make You Well & Wise

calendar_2014smJune 2 & 16, 3:30 p.m. Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. A Well & Wise event. No registration required.

Wednesday, June 4, 6 p.m. Advance DirectivesLeslie Rogers, MSW, LCSW-C, OSW-C, clinical oncology social worker at HCGH and the Claudia Mayer/Tina Broccolino Cancer Resource Center, will review what advance directives are, who needs them and how you get them. You will have the opportunity to leave this class with a completed advance directive document. Also, learn what it means to appoint, or to be appointed, a health care agent. Registration is required for this free event. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.

Wednesday, June 4, 6:30 p.m. Managing Incontinence with Confidence. Learn about the kinds of incontinence that caused women in your mother’s generation to give up activities due to fear of “leaking.” Urologist Jennifer Bepple, M.D. will discuss stress incontinence (when you cough, sneeze, or jump) and urge incontinence (when you just can’t wait) and what diagnostic tests and treatments are available to women today. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.

Thursday, June 5, 9-11:30 a.m. Stroke Assessment with BMI and Diabetes Screening. Meet with a registered nurse to receive a diabetes/stroke screening that includes a glucose blood test, BMI (body mass index) and weight management information. Immediate results. Fasting eight hours prior to test is recommended. Registration is required for this free event. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.

June 9, 10:30 a.m. & 11:15 a.m. Tae Kwon Do: Tiny Tigers at the Miller Branch. Sykesville Tae Kwon Do instructors focus on motor skills, listening, and taking turns. Wear athletic shoes and loose fitting pants or shorts. Ages 3-5 with adult; 30 min. Well & Wise event. Registration and a signed release form required or register by calling 410.313.1950.
June 9 10:30 a.m. Registration & Release Form 
June 9 111:15 a.m. Registration & Release Form

June 9, 7:00 p.m. Notable Author: Dr. Pam Peeke at Miller Branch. Dr. Pam Peeke, New York Times bestselling author of The Hunger Fix, Fit to Live, Body-for-Life, and Fight Fat After Forty. A “Meet the Author” event. Register online or by calling 410.313.1950.

Thursday, June 19, 7-8:30 p.m. Understanding Fibroids. Gynecologist Phyllis Campbell, M.D., will discuss the symptoms, when treatment is appropriate and what treatments are available. Click here or call 410-740-7601. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.


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Weighing the Benefits of Breast Reduction

From the Summer 2014 edition of Wellness Matters.Teresa-Hamilton_March2014_web

It was the pressure in her back, neck and shoulders that caused Teresa Spikes-Hamilton so much discomfort. The cause? The size of her breasts – DDD. “I had to wear several layers of clothes and sometimes a girdle to help support myself,” says Teresa.

In April 2013, Teresa underwent breast reduction surgery at HCGH to decrease the size of her breasts to a D cup. Today, she is pain free.

What is Breast Reduction Surgery?

Breast reduction is the surgical removal of excess breast fat, glandular tissue and skin to achieve a proportional breast size for your body as well as to alleviate discomfort due to overly large breasts.

“The weight of excess breast tissue can impact your ability to live an active lifestyle,” explains Teresa’s doctor, Eric Chang, M.D., a board-certified plastic surgeon on staff at HCGH. “These women often battle with self-consciousness and physical discomfort and pain.”

How is it Performed?

The exact technique to reduce your breast size will depend on a variety of factors including breast composition, the desired amount of reduction and your personal preferences. “Everyone is different, but, for most patients, this is an outpatient procedure done under general anesthesia in about three hours,” says Dr. Chang.

“While you can see the results immediately, you will have post-surgical swelling that goes away. The surgery does leave scars around the nipple and/or under the breast. However, these usually will be hidden by a swimsuit or bra and often fade and improve over time.”

Recovery

According to Dr. Chang, patients typically have a two- to three-week recovery and can return to the gym after six weeks. “As the surgery involves repositioning the areola, some patients may lose sensation in the nipple,” notes Dr. Chang. “As with any surgical procedure, you should review all risks and benefits with your physician.”

Is it Right for Me?

“The decision to undergo breast reduction surgery is highly personal,” stresses Dr. Chang. “Do it for yourself and not as a means to fulfill someone else’s desires or fit any sort of ideal body image. Talk with your doctor to determine if the procedure will achieve your goals.”

According to Dr. Chang, breast reduction may be advisable if:

  • You don’t smoke.
  • Your breasts are too large or limit your physical activity.
  • You have back/neck/shoulder pain.
  • You have shoulder grooves from bra straps and/or skin rashes beneath your breast crease.
  • You have low-hanging breasts and stretched skin including enlarged areolas.

“Patients often ask if they should lose weight before having surgery,” says Dr. Chang. “In a perfect world, you want to get as close as you can to your ideal weight. However, overly large breasts present a catch-22 for many women; they can’t exercise because of their breast size.”

“After recovering from the surgery, I went jogging – something I could not do before,” adds Spikes-Hamilton. I could actually fit into a regular sports bra and work out without pain.”

“Following surgery, patients often are able to do things they couldn’t do before. They feel better about how they look, and surgery kick-starts a total body improvement,” says Dr. Chang. “There are a lot of women who for some reason aren’t doing this, but the first thing a woman in her 60s often tells me after surgery is: ‘I don’t know why this took me so long!’”

“Besides feeling so much better, I’m saving money because I don’t have to purchase special-size expensive bras!” says Teresa. “I feel as if a weight has truly been lifted off me in so many ways.”

To learn more, click here to watch a video explaining breast reduction surgery, featuring Dr. Chang and Sarah Mess, M.D.


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Breakfast, lunch & dinner at HCGH Farmers Market

Farmers MarketWhen the cow bell rings at 2 p.m. this afternoon in Parking Lot C, the 2014 Howard County General Hospital Farmers Market officially opens and customers can browse and enjoy the offerings of a number of vendors selling produce and other local products from Howard County Farms.

You can buy food to take you through the day, starting with fresh, locally roasted coffee beans at Cosmic Bean Coffee Company. If coffee isn’t your cup of tea, they also offer a variety of herbal and traditional teas. Serve fresh free-range eggs and local bacon from TVA Farms and TVA honey to go on a delicious assortment of breads from The Breadery or scones from Stone House Bakery.

TVA Farms can provide the main course for dinner with their farm fresh beef and pork, and a number of vendors will be selling in-season vegetables and herbs. Take home a bunch of early spring asparagus and kick it up a notch with a spicy sauce from Thai Spices or enjoy some of their curry puffs on the side. If you love tomatoes for salads and cooking, you can grow your own with tomato plants from Love Dove Farms and buy salad mix and micro greens from Wheeler Farm.

Everyone loves dessert, and Stone House Bakery will tempt you with scrumptious pies, cakes, cookies and more.

End your day by taking a nice relaxing bath with handmade soap and incense from The Cosmic Bean Coffee Company. And what better way to fall asleep than with a good new or used book from Books with a Past?

Stop by from 2-6 p.m., meet local Howard County farmers and go home with a bag full of healthy, fresh, local produce, meat and other farm products while supporting our local agricultural economy!

The 2014 Farmers Market line up

(Many items are seasonal, so check the local harvest calendar at to see what’s in season throughout the summer. Vendor numbers increase as the season goes on and crop varieties grow larger.)

The Breadery: wholegrain and artisan breads, baked goods, assorted focaccia and rolls. www.breaderyonline.com

The Cosmic Bean Coffee Company: fresh roasted coffees, herbal, black, green and medicinal teas, handmade soaps and incense. www.thecosmicbean.com

MacBride & Gill Falcon Ridge Farm: fresh fruits including cherries, raspberries, blueberries, peaches, apples and Asian Pears; jams and fruit butters. www.facebook.com/falconridgefruit

Love Dove Farms: Heirloom tomatoes and plants, squash, green beans, potatoes, garlic, kale and other greens. www.lovedovefarms.com

Pong’s Orchard: Citrus plants, including meyer lemon, calamondin, kumquat, limes, and grapefruit. Other fruits, vegetables and plants include peaches, plums, Asian pears, figs, persimmons, tomatillos, aronia berries, tomatoes, sweet and spicy peppers, eggplants, cucumbers and a variety of herbs. www.pongsorchardmd.com

Stone House Bakery: Cakes, pies, cookies, jams, bar cookies, cupcakes, sweet breads, rolls, muffins, and scones. www.stonehousebakes.com

Thai Spices: spicy sauces, Thai custards, curry puffs, curry sauce, mango & sweet rice, spring rolls and Thai iced tea.

TVL Tree Farm: seasonal vegetables and fruits, bedding plants, cut flowers, honey, pumpkins, fresh meats, eggs and more. www.tlvtreefarm.com

The Wheeler Farm: farm to table vegetables including peppers, tomatillos, heirloom tomatoes, beans, sugar snap peas, greens, carrots, asparagus, broccoli, cauliflower, radishes, beets and potatoes. www.thewheelerfarm.com

Bowling Green Farm: 10th generation farm that produces fresh, local creamy cheese, cheese spreads, and butter. www.Bowlinggreenjones.com

Books with a Past: Used new, new books and literary sidelines. www.bookswithapast.com


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Happy Mother’s Day … from the heart

As we approach Mother’s Day, our gift to you is a primer on heart disease and women. According to the National Heart, Lung and Blood Institute (NHLBI), one in four U.S. women dies from heart disease.

Coronary heart disease, or atherosclerotic cardiovascular disease, occurs when plaque builds up in artery walls, narrowing them and making it harder for blood to flow through. If a blood clot forms, the blood flow can stop and cause a heart attack.

Signs and Symptoms

“Women tend to think of themselves as caregivers, but they also need to be care getters,” stresses Lili Barouch, M.D., a Johns Hopkins cardiologist on staff at HCGH. “Women should not ignore their symptoms, even if they don’t seem typical, because women with heart disease get a wider variety of symptoms than men. Although ‘classic’ heart disease symptoms include chest pain radiating down the left arm at rest or with exercise, women may only experience more atypical types of chest discomfort such as squeezing, burning or tightness, or even have no chest discomfort at all. Their ‘chest pain’ may feel like indigestion or acid reflux, nausea, cold sweats or they may only have shortness of breath. Women and men with diabetes often do not experience chest pain due to diabetic nerve damage; rather, they may just feel short of breath, nauseous and sweaty. If you aren’t sure, or if you sense something is wrong, see your doctor.”

Risk Factors

“In general, women have the same risk factors as men, but they may affect women differently from men,” says Dr. Barouch. “There are several risk factors for heart disease—including those you can’t control and those you can.”

  • Age and menopause. Estrogen provides women with some protection before menopause, so women who are 55 and younger have a lower risk compared to men. However, the risk for heart disease increases in both men and women after 55.
  • Women who undergo early menopause (before age 46) are at an increased risk.
  • Family history. Your risk for heart disease increases if your father or a brother was diagnosed with heart disease before 55 or if your mother or a sister was diagnosed with heart disease before 65. A family history of stroke—especially a mother’s stroke history—also can help predict the heart attack risk in women.
  • Preeclampsia during pregnancy, which occurs when women have a rise in blood pressure and excess protein in the urine.
  • Smoking
  • High cholesterol and triglyceride levels
  • High blood pressure
  • Diabetes/pre-diabetes
  • Overweight/obesity
  • Birth control pills
  • Physical inactivity
  • Unhealthy diet
  • Stress/depression
  • Sleep apnea

Weighing In on What Matters Most

“It is more important to be fit than thin. Even if you don’t lose weight, exercise improves cardiac efficiency and lowers blood pressure, blood sugar and cholesterol,” says Dr. Barouch. “Start by exercising at least three days a week and see what you can do comfortably. Don’t push yourself to exhaustion, or you will not sustain it. Pick a moderate exercise that you enjoy; once it becomes a habit, increase your time until you get to the goal of 30 minutes or more of exercise each day.”

According to NBLHI, inactive people are nearly twice as likely to develop heart disease compared to those who are physically active. In addition, a lack of physical activity can worsen other heart disease risk factors.

Via Howard County General Hospital’s Wellness Matters.


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Classes & Events to Make You Well & Wise

calendar_2014smNotable Author: Dr. Pam Peeke at Miller Branch, June 9 at 7:00 p.m. Registration begins May 2. Dr. Pam Peeke, New York Times bestselling author of The Hunger Fix, Fit to Live, Body-for-Life, and Fight Fat After Forty. A “Meet the Author” event. Register online or by calling 410.313.1950.

May 2, 3:00 p.m. 
Move with Games at Glenwood Branch. Exercise while competing with your friends on the Wii or XBox Kinect. Healthy snack provided. Ages 11-17. No registration required.

May 3, 2:00 p.m. I’m Going to Be a Big Brother or Sister at Elkridge Branch. Prepare for the arrival of a baby in this class for new siblings. Enjoy stories, activities, and bring a favorite doll or stuffed animal to practice holding your baby. Resources for parents, too. Families; 30 – 45 min. In partnership with Howard County General Hospital: A Member of Johns Hopkins Medicine. Limited space; tickets available at Children’s Desk 15 minutes before class.

May 5, 3:30 p.m. – 5:30 p.m. 
Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital. Well & Wise event. No registration required.

May 5, 6:30 p.m. Move with Games at Elkridge Branch. Exercise while competing with your friends on the Wii or XBox Kinect. Healthy snack provided. Ages 11-17. No registration required.

May 5, 7:00 p.m. Guided Meditation at Miller Branch. Enjoy a guided mindfulness meditation designed to impart a feeling of peacefulness and connection. Please bring a cushion or meditation pillow. Presented by Star Ferguson, M.Ac., L.Ac. Well & Wise event. Register online or by calling 410.313.1950.

May 7, 6:30 p.m. Map and Ship at Central Branch. Peggy Hoffman, division manager of Howard County Office on Aging’s Aging and Disability Resource Center, elucidates Maryland Access Point (MAP) and the State Health Insurance Assistance Program (SHIP), which assist older adults or individuals with disabilities. Well & Wise event. Register online or by calling 410.313.7800.

Tuesday, May 6, 7-8:30 p.m.
Drug Abuse: It’s a Family Matter. Learn why drug abuse is a family disease in this two-part class. Part 1: Understand why people abuse drugs and the signs of abuse. Part 2: Learn the various classes of drugs of abuse, levels of treatment, and how treatment can be the right family solution. Recommended for parents of children of all ages. This program is not appropriate for children and teens. Presented by Joseph Gagliardi, M.D. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.

May 9, 2-6 p.m. Howard County General Hospital’s Farmers Market opens for the season. Located in the rear of HCGH visitor Lot C, the market features farm-fresh produce and items from local farmers. For details and information about other Howard County Farmers Markets, click here.

May 13, 1:00 p.m. – 3:00 p.m. Blood Pressure Screening at Elkridge Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital. Well & Wise event. No registration required.

May 13 and May 15, 5-7 p.m. Skin Cancer Screening. Register for a free skin cancer screening on one of these nights. A dermatologist will examine one or two areas of concern. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.

May 15, 4:30 p.m. Let’s Plant a Rainbow at Miller Branch. Blue potatoes, purple carrots? We can make it happen in a rainbow garden. Discover the vegetables that make a rainbow and keep you healthy. Then, join in planting a rainbow in the Enchanted Garden. Ages 6-8; 45 min. Registration and signed release form required. Register online or by calling 410.313.1950.

May 17, 9 a.m.-1 p.m. Essentials in Babysitting. Are you ready to be a babysitter? Learn the skills and knowledge necessary to become a responsible babysitter, including how to effectively manage children, create a safe environment and apply basic emergency techniques. Marketing tips and age-appropriate activities for children will also be discussed. For children ages 11-13. The cost is $50 and includes lunch. Howard County General Hospital Wellness Center, 10710 Charter Drive, Columbia, MD.

May 19, 3:30 p.m. – 5:30 p.m. Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital. Well & Wise event. No registration required.

May 20, 7:00 p.m. Save Your Knees: You’ll (K)Need Them for a Long Time! at Miller Branch. Learn how to reduce your risk of knee injury and what you can do now if you are experiencing knee pain. Presented by Christy Edwards, ACE Personal Trainer and owner of Aurora Fitness, and Leigh A. Roberts, DPT, OCS, and owner of L A R Physical Therapy. Christy Edwards has been an American Council on Exercise (ACE) certified personal trainer since 1994. Leigh A. Roberts is a Doctor of Physical Therapy (DPT) and Board Certified Orthopedic Clinical Specialist (OCS). Well & Wise event. Register online or by calling 410.313.1950.

May 23, 4:00 p.m. Calling All Volunteers at East Columbia Branch. Make reading fun for kids and earn service learning hours. Volunteers assist HCLS instructors with the summer reading club and other tasks. To register for this orientation session, submit a volunteer application to the teen instructor at the branch where you would like to volunteer. Accepted applicants will be contacted to confirm registration. Ages 13-17.    Register by calling 410.313.7700. Calling All Volunteers at Glenwood Branch 5/28 at 4:30 p.m. & 7:00 p.m. Register by calling 410.313.5577.

May 25, Howard County Library System Closed in Observance of Memorial Day.

May 27, 6:30 p.m. Invitation to the Ballet at Central Branch. Students of Misako Ballet perform classical ballet and contemporary dances. Children from the audience may learn a quick piece and perform it. Register online or by calling 410.313.7880.

May 29, 7:00 p.m. Trivia Night at Miller Branch. Exercise your brain and enjoy a fun-filled night of trivia, featuring five rounds of ten questions. Form a team or join a team at the event with other trivia night participants. Register online or by calling 410.313.1950.

May 30, 3:00 p.m. Move with Games at Glenwood Branch. Exercise while competing with your friends on the Wii or XBox Kinect. Healthy snack provided. Ages 11-17. No registration required.

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Hold it! What you need to know about urinary incontinence.

Millions of women are affected by urinary incontinence. Often a nuisance, it can become so problematic that it affects a woman’s lifestyle, keeping her from activities such as exercising. In this blog, Urologist Jennifer Bepple, M.D. explains what you need to know about incontinence as well as treatment options.

Q: What are the types of urinary incontinence?

There are several different types of incontinence. It is important to distinguish what type of leakage you have as treatments vary greatly.

  • Stress—loss of urine during laughing, coughing, sneezing or exercise
  • Urge—inability to delay urination that results in leakage
  • Overflow—when the bladder does not empty

Q: What are the risk factors for incontinence?

Risk factors include: age; menopausal status; weight; the number of children you have had; and if you have had larger babies, pelvic radiation or pelvic surgery. A family history of incontinence also may be a risk factor.

Q: When should I see a doctor for urinary incontinence/leaking?

You do not have to “live” with incontinence. If it is affecting your quality of life, talk to your doctor so you can weigh the various treatment options. Depending on the cause, your leakage can be treated with diet, exercise and behavioral changes. Your physician also can review if a medication may help.

Q: What can I do to reduce my symptoms?

For stress incontinence, do pelvic floor exercises in addition to your regular exercise routine. For urge incontinence, avoid foods and drinks that irritate the bladder: coffee, tea, juice, soda (even decaf), acidic fruits, spicy foods and artificial sweeteners.

Q: What treatment options are available?

Options for stress incontinence include pelvic floor physical therapy, conservative measures or surgery using a device or sling. If behavioral and dietary changes do not improve urge incontinence, your physician may suggest injectable medications; or utilizing a “bladder pacemaker” approved to treat certain incontinence conditions.

 Q: Are injectable medications an option for me?

The FDA has approved injectable medications for use on some patients with incontinence issues. Performed with sedation or local anesthesia, it needs to be repeated every 6–10 months. Side effects may include urinary tract infections or the inability to urinate.

Q: What is a bladder pacemaker?

This is an implanted device that is done as a staged procedure; during the testing phase, the nerves that supply the bladder are stimulated and monitored for response, prior to placing the battery. It is an excellent long-term option for many patients who cannot tolerate or respond to overactive bladder medications.

Q: Is a sling safe?

In 2013, the FDA stated that, “the safety and effectiveness of multi-incision slings is well-established in clinical trials.” While the sling has a success rate of 80 percent, you should always review the risks and benefits of any procedure with your surgeon. Also, be aware that it is not an advisable treatment for every woman.

Jennifer Bepple, M.D., is a urologist in private practice with privileges at Howard County General Hospital. She will discuss Managing Incontinence with Confidence on June 4, 6:30-8 p.m. at the HCGH Wellness Center. For information, click here.

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As We Close National Donate Life Month

mom-and-son-pink-flowers-i-stock_webCurrently, there are more than 120,000 people in the nation waiting for a life-saving organ transplant, including nearly 3,000 in Maryland. The demand for organ donors is at an all-time high – sadly, about 18 people on the national waiting list die every day due to lack of available organs. Johns Hopkins Medicine, together with The Living Legacy Foundation of Maryland (LLF), uses Donate Life Month to raise awareness of the need for organ, eye and tissue donors.

In order to raise awareness for organ and tissue donation, the State of Maryland, along with the LFF and Donate Life Maryland, currently have implemented several initiatives to educate and increase donor registration. Presently there are over two million Marylanders already making the decision to designate themselves as organ, eye and tissue donors, either through the Maryland Motor Vehicle Administration or the Maryland Donor Registry at www.donatelifemaryland.org. While this is great start, it only represents roughly 50 percent of the state’s population who have the potential to be an organ and tissue donor.

In the state of Maryland, 70 percent of potential organ and tissue donors go on to be actual deceased organ and tissue donors. One donor has the potential to save nine lives through organ donation, give sight to two people and help 50 or more people though tissue donation.

Over the past three years the Johns Hopkins Health System has had 77 deceased organ donors who gave the gift of life. During that same time period, we had 130 donors who gave the life-changing gift of tissue donation.

At Johns Hopkins, we also celebrate those brave individuals who make the altruistic decision to be a living donor. The Johns Hopkins Hospital in east Baltimore performed 98 living kidney and liver donations in 2013 and a total of 367 adult and pediatric transplants.

On Thursday, April 24 from 1 to 2 p.m. join us for a live chat about organ and tissue donation on the Johns Hopkins Medicine Facebook page. Experts from the Living Legacy Foundation and The Johns Hopkins Hospital will be able to answer any questions you may have regarding this topic.

Benjamin Philosophe, M.D., Ph.D., is the clinical chief of the Division of Transplantation for Johns Hopkins Medicine and a Professor of Surgery at The Johns Hopkins School of Medicine.

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Do You Have an Advance Directive?

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

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

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

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

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

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

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

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

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


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Childhood Obesity – Advice from Dr. Mom

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

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

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

The risks for overweight kids

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

Body Mass Index

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

Eat less – do more

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

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

They are what they eat

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

The role of psychology

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

Rx for healthy living

It doesn’t involve pills. Here it is:

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

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

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

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

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


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Healthy ways to discuss weight issues with kids (or how to approach the “F” word)

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

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

Some ways to approach a touchy subject

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

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

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

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

Avoid isolation

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

Depression and anxiety – when should you worry?

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

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

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


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Get a Move on this Spring with Tips to get your child exercising

While driving down Cedar Lane on the first warm day during our long winter, I saw kids outside playing and biking. It warmed my heart! It was great to see folks getting some fresh air and exercise.

Dreamstime

Dreamstime

As an exercise physiologist with the HCGH Cardiac Rehabilitation Program, I see the long-term effects of heart disease, diabetes and other conditions that are made worse by excess weight. It’s especially worrisome to see so many kids struggling with their weight, because childhood obesity is a precursor to many health problems that will follow them into adulthood.

Here’s some advice to help get kids started with regular exercise:

Start with what they know.

A good way to start is to have the child perform exercises that they’ve done in gym class and see how many pushups or crunches they can do in a minute, how long they can hold a plank or how many times they can run around the track. Record the results and use this as a baseline to track progress. If your child is not an athlete, pushing sports – especially team sports – may be a turn off.

Set achievable goals.

For teens, find out what they want to get out of an exercise program. Do they want to lose weight? Build muscle? Have more energy? Or, just want to become more fit? Help them to set goals they can meet. Set a timeframe to re-evaluate progress; e.g., every two weeks or once a month, and then set new goals.

For children through “tweens,” build in rewards. Suggest that you’ll walk or bike around the lake or neighborhood and then stop at the playground for free time. Invite their friends to come along.

Once a regular routine has been established for two to three months, mix it up. Inspire them to try new activities – dance class, rock-wall climbing, kayaking. Find out what motivates them and use it – friends, competition or keeping logs to see progress. Keep them motivated.

Start out simple and slow.

Kids are still growing, so you need to be careful to prevent injury and build strength and endurance over time.

  • Watch the impact on joints. Cycling, swimming, biking, martial arts and tennis are good exercises.
  • Use low weights, building with higher repetition and resistance bands to help increase strength.
  • Stability balls are great and inexpensive tools.
  • Set your kids up for success. If they are completely new to exercise, just starting to move is a great beginning. Running is a tough way to start if the child isn’t fit.
  • Start with exercise that is challenging, but not too difficult. A little discomfort is okay; a lot of pain is not.
  • Gradually increase the intensity and duration of exercise. For most kids, the ultimate goal should be 60 minutes of exercise a day.
  • Do a combination of cardio, strength and flexibility exercises.
  • Don’t encourage crash diets or extreme exercise. These can be discouraging and impossible to stick with.

As fitness increases, consider new activities.

  • Get Active/Stay Active Howard County has a variety of programs that allow kids to try out new activities without committing to long-term, expensive programs. Visit stayactivehowardcounty.org.Howard County Striders is a great opportunity to run and walk with other kids at a variety of fitness levels. Visit striders.net.
  • Girls on the Run is an after-school running program. Visit gotrcentralmd.org.
  • Visit the Howard County Recreation and Parks site for a full list of affordable and accessible facilities at bit.ly/outdoorshc.
  • Team sports through community leagues or school.

Get educated about exercise.

Teach good form for all exercises to avoid injury and maximize benefit. If you are not familiar with an exercise, get help from a professional. Online tools and apps track activity, calories and goals. Exercise should be a life-long goal, not a temporary hobby.

Support them.

You can’t exercise for them, but you can be a great source of inspiration, motivation and encouragement. Let your child or teenager know you are in this together and that exercise is as important for you as it is for them. By exercising with them, you can set a great example and get your child on the road to a healthier lifestyle.

Make sure your child knows exercise is not about the way they look. They need to feel loved and accepted, not criticized. Exercise should be a way of life, not something that has to be forced. Build the healthy habit!

For more information about encouraging a healthy lifestyle for your children, see this presentation called “Weighing in on Your Child’s Weight.”

Suzie Jeffreys is an exercise physiologist with the Howard County General Hospital Cardiac Rehabilitation Program. Click here for a presentation called “Weighing in on Your Child’s Weight,” featuring Suzie Jeffreys.

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Veggielicious! Learn to Love What’s Good for You!

“I hate broccoli. I hate asparagus. I hate vegetables! Yuck!”veggies

A common enough refrain from kids who just don’t know any better, but there are a lot of adults out there who also haven’t discovered just how delicious vegetables can be. Not just great for your health, but for your taste buds as well. Check out some simple and tasty ways to incorporate more vegetables into your diet.

Try roasting asparagus in a hot oven until tender and then serving with a little butter and gremolata (minced lemon peel, parsley and garlic.)

Keep your veggies green by dropping them into boiling, lightly salted water and cooking for about four minutes. Rinse with cold water until they are very cool, refrigerate and then, right before serving, heat them up to finish cooking in a sauté pan with a little butter (or olive oil), salt, pepper, your favorite herbs and a few drops of lemon juice. (Lemon juice is a great way to get a nice bright flavor without adding a lot of salt.)

Get kids to eat veggies by cutting them into sticks and serving them raw with dips. They’ll be more likely to accept them as an after-school snack when they’re good and hungry, but there’s no reason not to include them this way at the dinner table.

Check out Healthy Recipes at Johns Hopkins Medicine for healthy and delicious ways to prepare vegetables.

For more information about encouraging a healthy lifestyle for your children, see this presentation called “Weighing in on Your Child’s Weight.”

Get more vegetables into your kitchen and your diet

Fill your grocery cart from the outside in.

Start shopping at the perimeter of the supermarket. Fruits, vegetables, fresh meats and poultry, and dairy items are usually located on the edges of the store, while high-carb, sugary, pre-packaged foods are in the center aisles. Fill your cart with colorful vegetables and you’ll be less tempted to buy snack foods.

Become a gardener.

If you like to garden, consider growing fruit, vegetables and herbs along with your flowers. Ornamental tomatoes and peppers and Asian eggplants not only taste great, they add beautiful color to your garden. If you have limited space, try a container garden with pretty ceramic and terra cotta pots. Get your kids involved to help them understand where their food comes from, and have them pick and prepare the vegetables at mealtime.

Be creative.

You can use vegetables in creative ways, like using pureed veggies instead of cream or flour to thicken soups or sauces. Diced carrots in tomato sauce taste sweet and help to neutralize the acidity, and the added nutrition and fiber will fill them up.

Buy and eat local.

Eating healthy can seem more expensive, but it is possible to buy local produce without paying a premium price for imported produce at the grocery store. Community supported agriculture (CSA) programs are a popular new way to buy local produce. Residents sign up to purchase a weekly “share” in a local farm and then get to share the produce, and many CSAs offer half shares for small families. The following organizations have listing for CSAs in and around Howard County:

Farmers markets are another option. There are five such markets in Howard County, including the one in Howard County General Hospital’s parking lot that operates on Friday afternoons from early May through late October. You’ll be surprised at the excellent produce, fruit, cheeses, breads, honey and other great foods that come from our local farmers, and you can get to know them and ask questions about their farms and their food. Click here for a listing of Howard County farmers markets.


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