Jeniah Simpson wearing a red hat from the American Heart Association's Little Hats, Big Hearts for heat disease awareness.

Jeniah Simpson wearing a red hat from the American Heart Association’s Little Hats, Big Hearts. Supporters knit and crochet red hats to give to thousands of babies at participating hospitals during American Heart Month.

Congenital heart defects are the most common type of birth defect. But despite great advances in screening and diagnosis, congenital heart disease can go unnoticed for a long period of time until heart damage has progressed enough to cause detectable symptoms.

While we celebrate Valentine’s Day this week, it also marks Congenital Heart Disease Awareness Week. The pediatric cardiologists at Johns Hopkins Children’s Center and elsewhere remind both parents and their pediatricians to watch for any subtle signs that could signal the presence of congenital heart disease.

What Is a Congenital Heart Defect?

When the heart or blood vessels around it do not develop properly or develop abnormally before birth, a condition called congenital heart defect occurs (congenital means “existing at birth”). Congenital heart defects occur in close to one percent of all babies born, affecting some 40 thousand infants annually in the U.S. That’s about eight babies for every one thousand children born in the U.S. Most young people with congenital heart defects live into adulthood now, but may require more than one intervention or surgery to treat their condition.

Types of Congenital Heart Defects

  • A hole between two chambers of the heart (common defect)
  •  The right or left side of the heart is not formed completely (hypoplastic)
  • Only one ventricle is present
  • Both the pulmonary artery and the aorta arise from the same ventricle
  • The pulmonary artery and the aorta arise from the “wrong” ventricles

Signs and Diagnosis of Congenital Heart Disease

In infants, the classic signs include the following:

  • Fatigue
  • Sweating around the baby’s head during feeding
  • Slow growth
  • Breathing fast while at rest and/or asleep
  • Irritability
  • Bluish or pale skin, a sign of abnormally low oxygen levels

In older children, typical signs of congenital heart defects include:

  • Complaints of heart palpitations
  • Feelings of dizziness
  • Getting tired very easily with physical exertion
  • Inability to keep up with other kids

Cause of Congenital Heart Defects

In most cases, the cause is unknown. Sometimes a viral infection in the mother causes the condition. The condition can be genetic (hereditary). Most heart defects either cause an abnormal blood flow through the heart, or obstruct blood flow in the heart or vessels.

Treatment for Congenital Heart Problems

As children grow, some minor heart defects such as small holes may repair themselves. But when a defect requires correction, there are both non-surgical and surgical treatments available today which are less invasive and involve cardiac catheterization, medical device insertion, and minimally invasive heart surgery. In rare cases, a heart transplant may be needed.

Learn more about congenital heart defects from Johns Hopkins Medicine’s Pediatric Cardiology.


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Primary care physicians (PCPs) hold the key to better health for you and your family. These physicians are on the front lines of health care and they get to know you, your family and medical history. It’s important to have a PCP that you like and have a good relationship with to get the best care possible.

Your PCP is like the quarterback on a football team calling the plays, or in this case, making the plans to address your health concerns and guiding your plan of care. Primary care can handle 85 percent of the problems that patients have, and can coordinate care needed for other problems as well.

It’s so important to get good primary care that many health care systems, including Johns Hopkins Medicine, are creating a new approach to primary care called “medical homes.”

Vice President of Population Health and Advancement at Howard County General Hospital, Elizabeth Edsall Kromm, Ph.D., offers some important insights on the benefits of primary care.

Broad Knowledge and Skills
While PCPs are not specialists, they have a special skill set, which allows them to be adept at spotting a broad, underlying condition responsible for a range of symptoms. Depression or a chronic inflammatory disorder, for example, can manifest in any number of ways: stomach discomfort, joint pain or problems with multiple organs.

There is a growing emphasis today on preventive medicine and maintaining overall wellness to ward off problems before they occur, if possible. Helping preserve and protect your health helps you save money on health care costs and also reduces costs for the health system overall.

For example, cardiovascular disease, diabetes and other chronic conditions are preventable. The effect of healthy habits on a person’s life can be enormous. Recent preliminary evidence shows a 5 percent reduction in weight in an overweight person can reduce their risk of diabetes by 65 percent.

Your Primary Care Team
To help ensure care is delivered most effectively and efficiently, health care systems are creating the “patient-centered medical home.” In short, the medical home transforms a primary care clinic or other facility into a home base, where most of what a person needs for better health is located and available.

Though the primary care physician remains at the center of providing care, emphasis on a team is paramount. These teams typically include nurse practitioners, physician assistants, health coaches, community health workers and more.

Technology Makes It More Personal
Electronic medical records are another component of the medical home that seamlessly weave together detailed notes from every care provider who sees the person, lab and imaging results, and the like. This way the primary care team can get reports on which patients are facing gaps in their care.

For more information about the benefits of primary care and selecting the best physician for you and your family, read Four Reasons Why You Should Have a Primary Care Physician.


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Measure your health scale.

Measure your health scale. [Credit: Iqoncept] / [Dreamstime]

A healthy weight is an important contributing factor in your overall health. It can help you prevent and control many diseases and conditions, including heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems and certain cancers.

Determining a Healthy Weight
How much you should weigh is not as simple as looking at a height-weight chart. You need to consider the amount of bone, muscle and fat in your body’s composition.

The amount of fat your body carries is a critical measurement, and can be measured using the Body Mass Index (BMI). Our Adult BMI Calculator helps you determine if you are at a healthy weight, overweight or obese.

If your results indicate you are overweight, having extra body weight from muscle, bone, fat and/or water; or obese, having a high amount of extra body fat; you should consider speaking to your health care provider. While BMI provides a fairly accurate assessment, it’s not a perfect measure.

You may also find it helpful to attend our Wellness Screening for Your Health, which provides a free weight risk assessment.

Achieving a Healthy Weight
Many factors can contribute to your weight, and while you may not be able to control factors like family history, the environment, genetics and metabolism, you can change your behaviors and habits.

The service providers of our Journey to Better Health program, a program that provides health monitoring and support services to Howard County residents and faith community members, recommend the following when trying to lose weight to achieve a healthy weight:

  • Set a goal
    Your weight loss goal should be a realistic goal that you can accomplish. You should start slow and change only one habit at a time.
  • Conduct a needs assessment
    Identify what you need to accomplish your goal. Make a checklist of supplies/tools and resources you need to support your goal. For example, identify the amount of healthy food options in your pantry. If you have little to none, you will need to stock up on your healthy food supply.
  • Start immediately
    In the words of Benjamin Franklin, “do not put off until tomorrow what you can do today.” Empower yourself to make small efforts that can be repeated to make your goal come to fruition. For example, take the stairs instead of the elevator or include a fruit or salad with your meal.
  • Track your progress
    Whether it be on paper or a mobile app, recording your activity informs you of how you are progressing towards completing your goal. You may find you are on target or need to make improvements. It may seem mundane, but tracking your progress is critical towards achieving success.
  • Celebrate your success
    Find healthy ways to reward your accomplishments. For example, schedule a massage or go line dancing with friends.

For more information on losing weight, read our Five Step Weight Loss Guide for the New Year.

Maintaining a Healthy Weight
Continuing the healthy lifestyle changes you adopt, including eating a healthy diet and engaging in 60 to 90 minutes of physical activity most days of the week, are key to maintaining a healthy weight.

Successful weight maintenance is considered to be regaining less than six to seven pounds in two years and sustaining a reduced waist circumference of at least two inches.

For long-term motivation, ask your friends, family and health care provider(s) for encouragement, consider joining a support group and attend health screenings that assess your weight. Our Journey to Better Health program offers such screenings in the community for free. For a schedule of dates and locations, call 410-720-8788 or send an email to hcgh-j2bh@jhmi.edu.

The longer you can maintain a healthy weight, the more likely you will achieve long-term success.

For more healthy weight information, view Aim for a Healthy Weight from the National Institutes of Health (NIH).


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Family caregiver serving food to loved one. [Credit: Katarzyna Bialasiewicz] / [Dreamstime]

Dementia touches most everyone, whether they have it or know someone who does.

Dementia is the gradual loss of cognitive functioning (thinking, remembering and reasoning), which eventually interferes with a person’s daily life. Dementia is a set of symptoms, not a disease. Memory loss is a common dementia symptom and Alzheimer’s disease is the most common form of dementia.

As dementia progresses, people cannot manage their lives on their own and depend more on others for help. Their caregivers are often family.

When caring for a loved one with dementia, caregivers should:

  1. Make decisions in advance. Have conversations about finances, health care, transportation and living arrangements, while it is still possible for the loved one to participate in the decision making process.
  2. Research resources. The Alzheimer’s Association is a great place to start—offering a 24-hour hotline and local support groups.
  3. Stay active. Encourage the loved one to remain socially active and continue to pursue activities he/she enjoys.
  4. Play music. Dementia patients often respond to music from an era when they were active, and music is a great way to involve a younger generation in caregiving and connecting with the loved one.
  5. Make safety a priority. Keeping the loved one safe becomes a big issue as dementia progresses. It may be necessary to schedule additional in-home help or move the loved one into a care facility.
  6. Manage medications. Keep a current medication list and seek medical assistance in eliminating drugs that might cause or add to your loved one’s confusion. Use pill boxes to manage medications and seek pharmacies that can prepackage medications in daily doses.
  7. Stay calm. Personality and behavior changes, especially agitation and depression, are all common symptoms of dementia. Try to be agreeable in your conversations and do not argue, unless there is imminent danger.
  8. Keep to a routine. Maintain regular routines in a calm, familiar environment to help reduce the stress and anxiety that often occurs in people with dementia.
  9. Take care of yourself. Caregiving can be extremely stressful and comes at great cost, often including a loss of the relationship with the loved one.

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Woman on scale happy about weight loss. [Credit: Edward J. Bock III] / [Dreamstime]

Woman on scale happy about her weight loss. [Credit: Edward J. Bock III] / [Dreamstime]

Weight loss is one of the top items that appear on New Year’s resolution lists. Unfortunately, only a small percentage of people succeed, while most see it as a reoccurring item for the next new year.

What most people do not realize is that is takes more than just desire to lose weight. It takes commitment and planning, beginning with our step-by-step guide.

Step 1: Make a Commitment
Rather than just committing to losing weight, commit to specifics. Commit yourself to the amount of weight you want to lose, the date by which you want to lose it, diet changes you will make to establish healthy eating habits and your plan for exercising regularly.

The best way to lose weight is to set a reasonable goal and lose it slowly and gradually. An initial weight loss goal of 5 to 7 percent of body weight is realistic for most individuals.

Step 2: Know Your Current State
Speak with your health care provider about the state of your health, specifically asking about weight-related risks. Healthy weight is especially important if you have or have had heart disease; type 2 diabetes; stroke; high blood pressure; high total cholesterol level; cancer of the uterus, gallbladder, kidney, stomach, breast or colon; and arthritis, especially osteoarthritis of the back, knees and hips.

Keep a food diary for a few days to realize what and when you are eating so you become aware of the types of food you eat most often and your mindless eating tendencies. If you find you eat a lot of processed foods, know that those foods tend to be high in trans fats, sugar and sodium or salt, which make it difficult to lose weight.

Also analyze your lifestyle. Identify obstacles that could be a challenge for your weight loss, and think of solutions to overcome those challenges. Recognize opportunities that can support your weight loss (e.g. living near a fitness center) and how to take advantage of those opportunities.

Step 3: Set Milestones
Establish short-term goals for yourself that will act as milestones to getting you to your long-term goal weight. These goals should be specific and realistic. For example, lose 1/2 to 1 pound a week. Achieving your milestones will motivate you to continue making progress.

Your milestones should also be forgiving when you experience occasional setbacks. Rather than criticize yourself and give up, forgive and get back on track as soon as possible. It’s realistic for you to sporadically have setbacks.

Step 4: Take Advantage of Resources and Support
Reach out to family, friends and co-workers who will support you. Perhaps they are trying to lose weight as well, in which case you can support and motivate each other. You are more likely to eat better and exercise more if your friends and family are doing the same.

Also look to local organizations for information and guidance. For example, Howard County General Hospital offers a free Looking to Lose Weight class where a certified nutritionist and registered dietitian discusses the physiology and health challenges that affect weight, and teaches meal plans that taste great, provide a balanced diet and promote health.

Learn to read food labels to make better food choices. Foods like gravy, mayonnaise, sauces and salad dressings often contain hidden fat and lots of calories, and some yogurts may be low in fat, but are high in carbohydrates and sugars. Or, eat foods in their natural state, and you will not have to read labels at all!

Step 5: Monitor Your Progress
Evaluate your progress of the milestones you set in Step 3. Identify areas of your plan that are working well and areas that need adjusting. It may be necessary to rewrite your short-term goals and plan accordingly.

As you are monitoring your progress, you may find you need to focus more on the fit of your clothes and less on reading the scale, especially if you have increased your exercise level. As you increase muscle mass and lose fat, the reading on your bathroom scale may not change much, but the fit of your clothes may be looser. Measure your waistline and compare the results.

Do not forget to reward yourself for your successes, but not with food. If achieving your milestones are coming too easily, consider adding a new, more challenging milestone that will get you to your long-term goal.

Using this step-by-step guide will get you on your way to achieving your New Year’s weight-loss resolution and having a healthier new year.


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Adult children caring for aging parents.

Adult children caring for aging parents. [Credit: Goldenkb] / [Dreamstime.com]

Caregiving for an aging parent can be challenging. Follow these tips to make the process easier.

Prepare for Doctor’s Visits

Older patients often have more health issues to discuss. Create an agenda and questions for the appointment. Attend appointments with your loved one, if you can, or send someone you trust, who can take notes and help remember and understand everything that was said.

Also bring all of their prescription bottles to their appointment. Elderly patients are more susceptible to side effects and interactions between medications and they often see many physicians—so bringing bottles is extremely helpful to the physician.

Organize Daily Medications

Use a pill dispenser with compartments for each day of the week or another reminder system to let your loved one know when to take medications. You can also keep a medication schedule and post it somewhere visible—the refrigerator or medicine cabinet.

Set an alarm on your loved one’s phone, watch or clock to help make taking medications a part of the daily routine.

Make a List of Medications

Maintain a list of medications—with the name of the drug, the dose, how often it is taken and why. Keep a copy somewhere immediately accessible, like your purse or car, in case there is an emergency. Schedule annual medication reviews with your loved one’s primary health care provider. Keep in mind, many common drugs can have interactions with food.

Fill Prescriptions at One Pharmacy

Using one pharmacy makes refilling prescriptions simpler and it helps your pharmacist protect against drug interactions and avoid potential problems. Some pharmacies even deliver.

Take Advantage of Technology

Many health care providers, pharmacies and insurance plans offer apps or websites to manage records. These online tools can help you retrieve and share health care information quickly. If you rely on electronic files, be sure to keep a back-up of logins and passwords. Johns Hopkins MyChart is one example—for more information, visit MyChart.

Discuss Advance Directives

Start the difficult but important conversations about end-of-life care early, when you are not in a crisis, and there is more time to think and make better decisions.

Advance directives identify who will make decisions regarding treatments, such as life support measures, when your loved one is too sick to do so themselves. The designee should have a full understanding of the patient’s wishes.

Know that you are not alone. There are many great resources for caregivers. To start, download a free copy of the Johns Hopkins guide “Take Care: A Guide for Family Caregivers.”

Anirudh Sridharan, M.D., is a board-certified geriatrician on staff at Howard County General Hospital.

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