calendar_2014smMonday, Oct. 20, 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.

Monday, Oct. 20, 3:30 p.m. Superfoods at Miller. Some foods promote health and longevity better than others. Licensed nutritionist Karen Basinger names these powerhouses and how to best use them. Register online or by calling 410.313.1950.

Tuesday, Oct. 21, 9 to 11:30 a.m. Diabetes Screening & BMI. Free. Held in Howard County General Hospital’s Wellness Center. Meet with an RN for a glucose blood test, BMI measurement and weight management information. Immediate resu­lts. Fasting eight hours prior recommended.

Tuesday, Oct. 21, 7 to 8:30 p.m. Choose Your Pediatrician and Promote Your Newborn’s Health. Free. Held in Howard County General Hospital’s Wellness Center. Learn factors to consider and questions to ask when choosing your pediatrician and ways you can promote your newborn’s health. Presented by Dana Wollney, M.D.

Thursday, Oct. 23, 7 to 9 p.m. Get Moving Again: Total Joint Replacement. Held in Howard County General Hospital’s Wellness Center. Free. Learn about total hip and knee surgery from health care professionals, past patients of our Joint Academy and Richard Kinnard, M.D.

Monday, Oct. 27, 5:30 p.m. to 9 p.m. Adult, Child and Infant CPR/AED in Howard County General Hospital’s Wellness Center. Cost is $55. This course will teach the skills needed to clear an airway obstruction, perform cardio-pulmonary resuscitation (CPR), and how to use an automated external defibrillator (AED).


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Even though all women are at risk for gynecologic cancers, the risk can be lowered, and treatments work best when these cancers are found early.
Margot Watson, M.D.

Margot Watson, M.D., chair of the Department of Obstetrics and Gynecology at HCGH.

Uterine Cancer
Uterine cancer is the most common cancer of the female genital tract, and 2.6 percent of U.S. women will develop uterine cancer in their lifetime. “It often is caught early and usually has a high cure rate because most women have an early warning sign of abnormal bleeding or bleeding after menopause,” says Margot Watson, M.D., chair of the Department of Obstetrics and Gynecology at HCGH. “Women are encouraged to see their gynecologist promptly if they experience heavy or irregular bleeding or, most especially, any bleeding – even spotting – after one year of not having periods.” Long-term use of birth control pills and the levonorgestrel-releasing intrauterine system (IUD) can greatly lessen the risk of uterine cancer.

The strongest risk factors for uterine cancer include being over 50, obesity, never having had children, previous use of Tamoxifen or a long history of irregular menstrual cycles.

Cervical Cancer
Cervical cancer is the only gynecologic cancer for which there is an effective screening test: the Pap smear. It also is highly curable when found and treated early. The human papillomavirus (HPV), which is a sexually transmitted infection, causes cervical cancer. Eighty percent of sexually active adults will acquire HPV by age 50. HPV also causes cancer of the anus, vagina, vulva, penis and many oral cancers; however, there are two vaccines available (Gardasil and Cervarix) which lessen the risk of developing cervical cancer.

“All young people, both boys and girls, should be vaccinated against HPV at age 11 or 12, the ages at which they get the best immune response,” says Dr. Watson. “It is a great advance in medicine that we have a vaccine that lessens the risk of several types of cancer.”

Regardless of sexual activity, women should have their first gynecologist visit at age 15, and Pap smears should begin at age 21. From ages 21-30, women should have yearly gynecological exams and Pap smears every three years if normal. From ages 30-65, women should have yearly exams and Pap smears with HPV testing every five years if their Pap smears are normal.

Ovarian Cancer
About 90 percent of women who get ovarian cancer are older than 40, and the greatest incidence occurs in women over 60. Risk factors are obesity, never having had children and a strong family history of breast or ovarian cancer.

Unfortunately, there is no effective screening test for ovarian cancer, and it is difficult to detect in the early stages. Some women do present with symptoms such as abdominal swelling or bloating (due to a mass or a buildup of fluid), pelvic pressure or abdominal pain, difficulty eating or feeling full quickly and/or urinary symptoms (having to go urgently or often). Birth control pills and tubal ligation greatly lessen the risk of ovarian cancer.


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Patricia Silvia’s story

When I learned I had Stage III colon cancer in July of 2012, my first reaction was that I wanted no further treatment beyond surgery—no radiation and no chemotherapy. I had just gone through several hip surgeries and another one to remove a section of my colon, which resulted in a month-long hospital stay. I had been through it all with a dear friend some years ago and, after all my friend suffered, she didn’t survive her cancer. So I opted to go to my brother’s house to be cared for with the help of visiting nurses to change my dressings and help with physical therapy.

When I was well enough to go home and live on my own, I was ready to accept my fate and my family was ready to accept my choice to not have treatment, but my sister finally convinced me to see my oncologist, Dr. Edward Lee, one more time. I waited until November to make the appointment.

The very first appointment with Dr. Lee was great. He really got it and understood that the choices had to be mine. He offered me an alternative drug that had fewer side effects, and said that if at any time I didn’t like the way it was affecting me, I could stop taking it. A PET scan showed that my cancer had not spread and Dr. Lee had me take eight cycles of the drug and one week off. After seven weeks I had painful, burning feet and Dr. Lee stopped the pills for nine days and then reduced the dose. I finished my eight cycles in April 2013.

All through the whole thing, I had this attitude that whatever is, is, and whatever isn’t, isn’t. That’s my favorite saying, because we really don’t have control over it.

Surviving cancer on my own terms has changed my life and taught me how to cope with change. I am very thankful and now I’m working on changing some eating habits to improve my nutrition, gain some weight and fully get my health back.

I attended the first annual Surviving Survivorship: Living with Cancer conference last fall and was so excited to be there. It was a wonderful adventure and a gift. The speakers were great, the classes were exciting and even the food was excellent. The seminar I enjoyed the most was the one in which I made my first mandala and I have kept it on my desk ever since. (In various spiritual traditions, especially Buddhism, mandalas are circular drawings used to focus attention and as a spiritual guidance tool for creating a sacred space and as an aid to meditation.) I am very much looking forward to the second annual Surviving Survivorship: Living with Cancer seminar on Saturday Oct. 11, 2014.

I learned that I was in remission in May 2013 and I am so happy that I decided to take a chance on being a survivor and that I’m still here to tell my story. My advice to anyone going through something like this is to give it a try. And if the first thing doesn’t work, see if something else will. I believe in miracles and I believe I have received several. I also think that through my blessed visits to the Claudia Mayer/Tina Broccolino Cancer Resource Center, the miracles have kept on coming. I love all of my friends there! A good attitude helps, too, and of course all of the prayers from friends and family and from people I didn’t even know. I am truly blessed!!

 


Patricia Silvia is a cancer survivor and very happy to be one. She credits Dr. Edward Lee, the Claudia Mayer/Tina Broccolina Cancer Resource Center, her family and friends, and her belief in miracles for her survival.


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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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“Cancer treatment” is to “team” as “cancer recovery” is to “village” – an unexpected, but true analogy. With fall arrive new sports seasons, carpools for school athletics practices, and evenings and weekends of cheering at games. We make commitments to those who need us, and if a friend, family member, neighbor or coworker is sick, it might be time to join that person’s care team. A cancer support team also carpools, cheers, and rises to the challenges of each stage, each season, of the disease. Cancer patients often find themselves being cared for by a team. Various healthcare professionals join forces to provide chemotherapy, surgery, radiation therapy, nutrition, physical rehabilitation, and pharmacotherapy. The medical team is only a part of patient care, however. Many people outside the healthcare staff must join together as the village supporting the patient toward wellness. Just like a team requires many players in different positions playing their best to win the game, so too the patient needs all team members in place – physicians, nurses, pharmacists, dieticians, physical therapists, spiritual advisors, family, and friends. Even coworkers, bosses, and neighbors are needed to bridge the gaps in daily routines disrupted by time consuming, exhausting, and costly therapies.

Who can argue with the assertion that every patient needs an advocate? One of the most valued members of the village is that person sitting at the hospital bedside who can step in when the nurse is helping another patient, the IV pump is beeping or an extra blanket is needed. While hospitalized, a sedated or uncomfortable inpatient may not be able to ask for help. An advocate at the bedside can assure that questions are answered, needs are met, and treatments are administered properly. A bedside advocate can observe more details of the patient’s condition over time and give essential feedback to the healthcare team. Vital signs and lab work tell only part of a patient’s story and an advocate can assure that each team member knows the problems that need to be addressed. Once s/he is out of the hospital, a fatigued or anxious outpatient might forget a medication dose or miss an appointment. A team member helps keep everything on track.

jp care teamRecovery from a complicated disease such as cancer is a challenge from every perspective – scientific, medical, social, psychological, sexual, personal. Each member of the village brings his or her own special skills and gifts to this process. Compassion, empathy, physical strength, motivation, cooking, cleaning, and monitoring of dosages, symptoms, lab results and x-rays will all be required. Recognizing depression, withdrawal and repressed rage falls to the team members who see the patient every day. The medical professionals see the patient only intermittently and can miss important milestones in the patient’s progress during and after treatment.

Each person’s needs during an illness are different. One person might greatly appreciate if you bring over meals, while another might want you to bring your pug to visit. A coworker might appreciate if you bring by some magazines or movies. A neighbor might be grateful if you help vacuum or mow the lawn. The message is the same – battling cancer requires a team and recovery takes a village.

The American Cancer Society’s Cancer Caregiving A to Z: An At-Home Guide for Patients and Families helpfully guides the cancer patient’s support team through the many challenges of life during cancer treatment. The writing is clear and straightforward with advice on topics ranging from anxiety to fever to weight changes. Breakthroughs in medical research have resulted in more aggressive, sophisticated and successful oncology therapeutics. The winning playbook for cancer treatment is longer and more complicated, but with the right team in place, victory is achievable.

Cherise Tasker is an Instructor & Research Specialist at the Central Branch and has a background in health information. Most evenings, Cherise can be found reading a book, attending a book club meeting, or coordinating a book group.

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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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