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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.
Both my kids played indoor soccer this past year, and what an eye-opener it was for me. Now, in the spirit of full disclosure, let me start by saying that I have one kid who will quite visibly cringe when the ball approaches and another who will very enthusiastically run up and kick the ball in absolutely the wrong direction. Needless to say, they get their great athleticism from me. But I do want them to be active and have the opportunity to learn about team work and good sportsmanship. And these were not teams or leagues being scouted by major-league recruiters or anything. So imagine my surprise when I encountered what I thought was only a thing of the past (and/or bad movie stereotypes)…poor-sport parents.
Let me clarify, no one was booing or name calling (mostly) or throwing things at the opposing team; it would seem that most sports associations have nipped that behavior in the bud, thank goodness. And my kids’ coaches were fair, encouraging, and focused on learning and fun. But parents who were attempting to “enhearten” members of their child’s team, or even their own child, were sometimes a bit aggressive in their “cheering.” There was a lot of “coaching” from the sidelines, a lot of outwardly expressed “frustration” when the “fan’s” team did not do as hoped, and even some not so subtle “rejoicing” when the other team missed. (That may be the greatest number sarcastic quotation marks I’ve ever used in a single sentence.)
Also, to clarify, I am very much opposed to giving out trophies for just showing up. I think competitive environments can be very good for children. All people need to learn to deal with disappointment and frustration in graceful ways (just as they should learn to deal with advantage and success in gracious ways). I am not at all questioning the kids, the parents, or the coaches in their competitive feelings, which I think are quite natural and can even be healthy. What I am questioning is the way that some people (adults in particular) express those feelings. Are we teaching our kids civil ways to communicate and providing the best examples of self control? And what is behind some parents’ lack of control?
In the book Pressure Parents, Stressed-Out Kids, Wendy S. Grolnick, Ph.D. and Kathy Seal discuss the psychological phenomenon known as “ego-involvement.” “Ego-involvement is a tendency to wrap our self esteem or ‘ego’ around successes or failures… [and] we occasionally wrap our egos around our children’s achievements.” This sometimes occurs “when our protective and loving hard-wiring collides with the competition in our children’s lives, prompting us to wrap our own self-esteem around our children’s performance…[giving] us our own stake in how well our child performs.” Gronlick and Seal go on to explain how this ego-involvement adds another layer of pressure on parents, making them subject to more ups and downs in their own self-esteem and weakening parenting skills because the parents are too distracted from their child’s needs.
The idea of ego-involvement is reinforced in Sport Psychology for Youth Coaches by Ronald E. Smith and Frank L. Smoll. The authors talk about the positive or “Mastery” approach to coaching that encourages athletes to continue desirable behaviors by reinforcing or rewarding them. But Smith and Smoll eschew the negative approach that attempts to eliminate mistakes through punishment and criticism. They state that the negative approach is “often present in an ego-based climate.” They also acknowledge that it is not just coaches who can create ego-based environments. Smith and Smoll suggest ways for coaches help curb parents’ ego-involvement and best deliver the message to parents who pressure their child too much that this can “decrease the potential that sports can have for enjoyment and personal growth.” They even quote Wayne “The Great One” Gretzky who said, “Parents should be observers and supporters of their athletically inclined children, never pushers.”
So, I don’t have any great solutions to poor-sport parents. Many sports organizations have come a long way at informing parents what is acceptable and unacceptable behavior. Sadly, however, this doesn’t always eliminate the behavior (and, rightfully, most coaches are paying more attention to the players rather than policing the parents). And there is no sure-fire method to eliminate any negative comments that may take place off the field. Maybe the best place to start is to look at oneself and ask, “Am I guilty of ego-involvement? Am I putting my kid’s needs first? Am I a ‘pusher’ or a model of civility and good sportsmanship?”
If you want to mix getting fresh air and light exercise with a dash of culture this fall, why not visit a local sculpture or topiary garden? There are quite a few within a driving day trip from the Baltimore/DC corridor. While many flowers are past blooming at this point, there’s still plenty to see.
Ladew Topiary Gardens
No matter when you come to Ladew, there is always something to look at no matter what’s in bloom. Full of color themed gardens and fun topiary works, Monkton’s gardens don’t disappoint. If you want something a little less touched by gardeners, they also have a 1.5 mile nature walk on the grounds as well punctuated by educational points discussing the different types of landscape and foliage.
Annmarie Sculpture Garden
If you happen to find yourself in Solomons, Maryland, this gem is an arts center as well as a sculpture garden. They house works from the Hirshhorn and the National Gallery of Art, as well as their own permanent collection. Throughout the year they also have a rotating temporary collection of works, currently including gnome and fairy houses and artistic birdhouses scattered throughout their ¼ mile path through the woods.
US National Arboretum
Located in the Nation’s Capital, the National Arboretum is 446 acres of gardens and trees. It’s great for bike riding or walking. It’s also free! They also house a nice collection of bonsai, some of which are at least 400 years old!
Chanticleer calls itself a “pleasure” garden, and it certainly is a feast for the senses. With a heavy emphasis on texture and the sculptural forms of plants, it is a unique visual treat.
Longwood is an impressive collection of indoor and outdoor gardens and one of the nation’s first public parks. It covers over 1000 acres of gardens, woodlands and fountains. If you prefer your summer nature experiences after dark when the temperature has dropped somewhat, Longwood also hosts evening fountain displays, live music and fireworks.
Posted by HCGH_SS on Aug 26, 2014 in Classes, Health | 0 comments
Medicare 101 and 102 Seminars
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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.
The title of this post is a quote attributed to Susan McHenry, from The Book of Awakening by Mark Nepo
“Cancer.” The first thought we may have when seeing someone without any hair or eyebrows.
Hair loss can be one of the greatest fears for a cancer patient. Many patients about to undergo chemotherapy shave their heads to avoid the experience of watching their hair thin and disappear. Why does this hair loss occur and why don’t all patients undergoing cancer treatment lose their hair? Medication administered to target and kill cancer cells is commonly referred to as “chemotherapy.” Many patients whose cancer treatment includes chemotherapy will lose their hair because of the mechanism of action of these medications. Some cancer patients undergo radiation treatment as well. Radiation may also result in hair loss.
Alopecia is the clinical term for loss of hair from the body. Alopecia can be in a specific area of the body, such as the scalp, or all over the body. Hair grows out of follicles and is characterized by a long growth phase, a transitional phase, and a brief resting phase, after which the hair falls out. One mechanism by which chemotherapy works is to kill off rapidly reproducing cells. Cancer cells and hair cells both divide constantly- and for this reason are targeted by many forms of chemotherapy. Chemotherapy speeds the progress of hair to the resting phase, resulting in a sudden onset of hair loss. Cancer patients receiving particular types of drugs, however, may not experience hair loss. Medications targeting specific cells or parts of cells or those that attack cancer by boosting a patient’s own immune pathways are unlikely to affect hair growth.
Since each medication has a slightly different onset of action and duration of effect, hair loss from chemotherapy may occur within a week or not until several weeks after treatment. Hair loss may be partial or total. Hair will usually return several weeks after treatment is completed. New hair growth may be a different color or texture from what it was prior to treatment, but the change is rarely permanent. Radiation therapy also destroys rapidly growing cells, so hair follicles in the area targeted by radiation may be destroyed. Hair loss in these areas can be permanent. If hair does return, any alteration in texture or color may be permanent because the goal of radiation is to alter and remove treated cells to prevent their regeneration. Radiation may target every cell in its path, while chemotherapy’s long-term effect is to permanently destroy only cancer cells.
Every cancer patient is different. Each person’s experience of hair loss is highly personal. One close friend might have a response you expect, another might surprise you. Be open and forthright and your friend or family member will appreciate your support. When one of my friends had hair loss during chemotherapy, she welcomed the hand-me-down hats from another friend whose sister had gone through chemo. A different person may not have wanted these hats. Sensitivity and empathy goes a long way. Years later, my friend and I still laugh about the wonderful experiences we had because she was bald and wearing a bold hat. It seemed we always got the best table in the restaurant and the most attentive service. Once, we got special attention from a rock star signing CDs after a concert. We’re convinced it was the crazy hat.
Websites for organizations such as the American Cancer Society, Johns Hopkins Medicine and the National Cancer Institute offer useful information about coping with chemotherapy-induced hair loss. The comedian Jay London has said, “I was going to buy a book on hair loss, but the pages kept falling out.” Nonetheless, there are many helpful text references including Cancer Caregiving A to Z: An At-Home Guide for Patients and Families and Learn to Live Through Cancer: What You Need to Know and Do.
Saturday, Aug. 16, 10 a.m. – 12 p.m. Ask A Master Gardener. Discuss gardening questions and concerns at the Glenwood Branch. University of Maryland Extension – Howard County Master Gardeners. Also offered at the Miller Branch Saturday, Aug. 16, 10 a.m. – 12 p.m. and Aug. 18 7 – 8:30 p.m. No registration required.
Saturday, Aug. 16, 10 a.m. Compost Demonstrations. Master Gardeners discuss and demonstrate composting on a drop-in basis at the Miller Branch. Free bins provided for Howard County residents. University of Maryland Extension – Howard County Master Gardeners. No registration required.
Saturday, Aug. 16, 11 a.m. Crop Swap. Do you have an abundance of vegetables from your garden? Let’s crop swap! Bring homegrown produce to trade for something new and delicious at the Miller Branch. Share growing tips and favorite varieties. Families welcome. Leftovers donated to the Howard County Food Bank. Set up from 11 – 11:30 a.m., swap from 11:30 a.m. – 12 p.m. Registration is required. Register online or by calling 410.313.1950.
Saturday, Aug. 16, 3 p.m. Kindergarten, Here We Come. The Central Branch will have stories and activities to help mark that all important first day, including boarding a real school bus. For children entering Kindergarten this fall; 45- 60 min. Cosponsored by Friends of Howard County Library and Howard County Public School System. Registration is required. Register online or by calling 410.313.7880. Another is offered on Aug. 19 at 10:15 a.m. at the Savage Branch and again at 7 p.m., and also at 2 p.m. at the East Columbia Branch. Offered again on Aug. 20 at 10:15 a.m. at the Savage Branch and at the East Columbia Branch at 7 p.m. And offered Aug. 21 at 10:15 a.m. at the Savage Branch.
Monday, Aug. 18, 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. Also offered, Tuesday, Aug. 12, 1 - 3 p.m.
Monday, Aug. 18, 2 p.m. Infectious Diseases. Learn about infectious diseases, how they are spread, and how disease detectives work to find and stop their spread using medical technology and nanotechnology at the Savage Branch. Participate in mock disease outbreaks around the globe to learn to identify and handle some of the most dangerous diseases, select the right medical or nanotechnology methods, and develop a communication pack to let others know. Being an Infectious Disease Detective has never been more fun! Ages 11-18. HiTech is funded in part by a National Leadership Grant for Libraries from The Institute of Museum and Library Services. Visit hclibrary.org/hitech_events. Registration is required. Register online or by calling 410.313.0760. Offered again on Aug. 19 at 2 p.m. , Aug. 20 at 2 p.m., Aug. 21 at 2 p.m., and Aug. 22 at 2 p.m.
Monday, Aug. 25, 7 p.m. I’m Going to be a Big Brother or Sister. In partnership with Howard County General Hospital: A Member of Johns Hopkins Medicine. A Well & Wise class. Come to the Central Branch to 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. Ticket required. Limited space; tickets available at Children’s Desk 15 minutes before class.
Tuesday, Aug. 26, 5 – 6:30 p.m. Weight Loss Through Bariatric Surgery in the Howard County General Wellness Center. Learn about weight loss surgery from Johns Hopkins Center for Bariatric Surgery. Register online or call 410-550-5669.
Tuesdays and Thursdays, Sept. 16 to Nov. 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. Class held in the Howard County General Wellness Center. Cost is $195. Register online or call 410-740-7601.