Many thanks to Greatist for the use of their work on Well & Wise.
The holiday season is upon us and with that comes Thanksgiving dinner, holiday gatherings, and an abundance of sweets and extra helpings. It can be challenging to practice portion control during this festive time of year (understatement).
Our first contributor to those extra holiday pounds is Thanksgiving dinner. You stuff yourself until your stomach surrenders, waddling away from the dinner table only to go back for a second round later in the evening. And for some, the preparation for Thanksgiving tips-off the seasonal non-stop grazing of all the goodies that seem to be around. Following this indulgence is Christmas and many interspersed holiday gatherings brimming with assorted meats, cheeses, cakes, pies, cookies, eggnog, and other calorie-laden beverages. Then, there’s the self-dialogue. That conversation you have in your head justifying the extra piece of pie or the third helping of mashed potatoes and gravy, “It’s the holidays! They only come once a year! Enjoy yourself!” We’re all guilty of some holiday indulgence and those extra calories add up and can negatively impact your body.
According to a report published in The New England Journal of Medicine, a study from Tufts University wanted to see if the commonly touted assertion that “adults typically gain 5 or more pounds during the 6-week period from Thanksgiving to New Year’s” was true. What the study found was that those who were already overweight were likely to gain more weight over the holiday season versus those who were considered average weight. This may not seem like much, but this increase in weight is a significant find for adults who are already overweight and a reminder that we’re all susceptible to holiday weight gain.
Dr. Steven A. Schnur’s book, The Reality Diet, affirms our susceptibility further: “ the holidays can be stressful for people and one of the most common ways to deal with stress is to eat. And with all the holiday food lying around, it’s all too easy to indulge in this method of escape.” Dr. Schnur recommends finding other outlets for your seasonal stress in order to curb overeating at holiday parties or while cooking holiday meals. He suggests some simple exercises like sipping water, chewing gum, or deep breathing.
Another factor that may contribute to weight gain around the holidays is seasonal affective disorder (or SAD), which is a form of clinical depression brought on by winter’s shorter days. The founder and director of the Johns Hopkins Weight Management Center, Dr. Lawrence J. Cheskin, said in a previously published interview, that “there is a small percentage of the population who is predisposed to this condition [SAD] specifically during the winter months…people who show symptoms associated with seasonal affective disorder may have trouble with overeating due to changes in mood and lower serotonin levels in the brain.” So how do you come up with a strategy during the holidays to manage your portions and minimize weight gain?
Here are some tips that may help prevent holiday weight gain:
Exercise daily. Exercise releases those “feel good” chemicals, endorphins, and boosts serotonin levels. Also, exercise after a meal can help better regulate your blood-sugar levels, especially after a large meal. Take time for a walk or some running around with your friends or the kids an hour after your feast. You’ll feel better.
Manage your holiday stress.The Blood Sugar Solution suggests “Anything stressful can trigger hormones that activate cravings. Adopt a daily relaxation routine and stick to this routine during the holidays.”
Eat before a meet & greet. Get ahead of your cravings by eating something healthy and filling before you go to that holiday gathering. When you don’t eat before a party, you’re pretty much sabotaging yourself.
Plan your meal(s) in your head before you arrive at dinner and swap out the junk for the good stuff once you see what’s available. If you don’t have enough options, portion-control will be your best friend. It’s also a good opportunity for you to bring a delicious healthy dish to the party too. When you finish your meal put your napkin on your plate to signal to yourself, “I’m done.”
The greatest bit of advice I can give you is this: have a plan. Sometimes you can’t avoid holiday stress, you don’t want to eat at home before the party or the big dinner, and you don’t have any time to exercise. These are all excuses. If you have a plan you can make time to walk with your loved ones, practice healthy coping activities to avoid stress-eating, and be prepared for what’s going to be on the dinner table. Make a plan and stick to it!
This is the season of food. Lots of it. Try to focus on the togetherness aspect of the holidays this year. Remember that food is fuel for your body. You wouldn’t put sugar in your gas tank, so don’t put junk in your body. Make the conscious decision to be well and stay healthy in your food choices this holiday season. The healthier choices you make today, the less weight you’ll gain and the more likely you’ll be around next year to celebrate with your friends and family.
Alex Hill is a Customer Service Specialist at the East Columbia Branch. She has worked for Howard County Library System in the Customer Service department for more than 5 years. Alex enjoys giving movie recommendations, talking to East Columbia’s teens and in her spare time, taking pictures. (Co-Authored by Jessica Protasio)
New AHA Guidelines for Statins- What Does It Mean For You?
For the last 20 years, physicians have focused on specific target levels for cholesterol to determine which patients should use cholesterol-lowering “statin” drugs. Statins like Lipitor (atorvastatin), Crestor (rosuvastatin) and Pravachol (pravastatin) inhibit an enzyme linked to cholesterol production in the liver and have been a proven tool in the reduction of heart disease. Under the former guidelines, 15.5 percent of adults in the United States were eligible for statins.
Last week, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for lowering cholesterol. Doctors are now advised to consider patients’ overall cardiovascular risk factors, not just their cholesterol numbers. The new guidelines identify four specific high-risk groups who could benefit from statins:
People with extremely high cholesterol (LDL of 190 milligrams per deciliter or higher)
People who already have atherosclerotic heart or vascular disease, including stroke
People age 40-75 who have diabetes
People age 40-75 who have a 7.5 percent or higher risk of developing cardiovascular disease as measured by a new revised formula.
The new guidelines, which use an online risk assessment calculator, could increase the number of patients eligible for statins from 15.5 percent to 31 percent of adults in the U.S. This translates to millions of additional adults eligible for cholesterol-lowering statin drugs.
Two independent reviewers have questioned the accuracy of the risk calculator in a commentary in the November 19 issue of The Lancet. The physicians believe that the calculator overestimates the risk anywhere from 75 to 150 percent, potentially leading to an over-prescription of statins. The AHA and ACC issued a press release standing firmly behind the new risk calculator and guidelines.
It can be challenging to wade through all of this new information, so we asked Howard County cardiologist and Johns Hopkins Associate Professor of Medicine, Lili A. Barouch, M.D., to give us some insight into the new guidelines.
Question: Why are these new guidelines important and why can’t we just use cholesterol numbers anymore?
Answer: The biggest difference in the new guidelines is that there is no longer a specific cholesterol level that determines the need for therapy, nor is there a target cholesterol number that we are shooting for as a goal of treatment. We know from numerous research studies that people who already have cardiovascular disease and those who are at high risk will benefit from lowering their cholesterol, no matter what their number was when they started. While we still need to help patients reduce cholesterol, we also want to evaluate the whole patient by considering all other risk factors. For example, adults with diabetes have just as much risk of having a cardiovascular event as someone who has already had a heart attack. The new guidelines help us look beyond a number on a lab test and focus instead on improving outcomes, especially for those at the highest risk of having a heart attack or stroke.
Question: What about the controversy concerning the risk calculator in the new guidelines?
Answer: All of the risk calculators out there have to be used in “real life” for a while before we decide whether they are effective for clinical practice. They are not used in isolation, but rather are only one of the tools we use to determine the best treatment for each patient. Using this calculator and the new guidelines, there likely will be people for whom we will prescribe statins for the first time. The goal is to identify high risk people who are currently undertreated and help prevent them from having a heart attack or stroke. Conversely, there may be some people currently on statins who could now reduce their statin dose based on the new guidelines, so it could work both ways. The key is to evaluate each patient’s risk in context and make a clinical assessment for that individual.
Question: How does a patient wade through this information to determine whether or not they should be taking statins?
Answer: Patients need to talk to their doctors before changing any of their medications. Please work with your doctor to decide whether you need a statin or not; there is no need to try to figure it out for yourself. It is important to note that there are other classes of drugs that lower cholesterol, but have not been proven to lower the risk of heart attack. With the new guidelines, your doctor will stick with the drugs that improve patient outcomes, not just make numbers look good on a blood test. The new guidelines can sound confusing. Although it is easier to grasp a target number than a set of risk factors, the new recommendations focus on preventing cardiovascular events in those who need it most. Lastly, the guidelines are ultimately just that – guidelines, and not an absolute decision on whether or not someone needs to be medicated. Each person needs to be evaluated and treated individually by his or her physician.
Cardiologist Lili A. Barouch, M.D. is an Associate Professor of Medicine at Johns Hopkins. She completed her training, residency and fellowship at the Johns Hopkins University School of Medicine and holds certifications in Cardiovascular Disease and Advanced Heart Failure and Transplant Cardiology from the American Board of Internal Medicine. She is affiliated with the following Johns Hopkins Centers: Heart and Vascular Institute, Women’s Cardiovascular Health Center, Comprehensive Transplant Center, and the Heart Failure and Cardiomyopathy Service.
Reverse total shoulder replacement surgery – a new option for shoulder degeneration.
Like other joints in the body, the shoulder is susceptible to degeneration, or wear and tear, over time. Wear and tear of the shoulder is quite common as we age and typically takes the form of rotator cuff disease or arthritis. While there are many treatment options for these conditions, surgical reconstruction may be required if the symptoms (pain and limited function) are not relieved by conservative measures (rest, ice, pain medications, physical therapy, cortisone injections).
In some cases, the rotator cuff tear can be so significant that it is not surgically repairable or would be unlikely to heal even if surgically repaired. When the rotator cuff is not functioning effectively, accelerated degeneration of the joint can occur. This can leave an individual with both an arthritic joint and rotator cuff tears. This can be a very debilitating condition, causing significant pain and inability to lift the arm.
A new technology called “reverse total shoulder replacement” has been developed to address this unique and challenging problem. This new type of shoulder replacement has been in use in Europe since the 1980s. The “reverse” prosthesis was FDA approved for use in the United States since 2004. This type of shoulder replacement is called a reverse because it “reverses” the normal orientation of the ball and socket joint (Figure 2).
In a typical shoulder replacement, the arthritic humeral head (ball) is replaced by a metal ball and stem on the arm side, while the socket (shoulder blade side) is replaced with a plastic component (Figure 1). This shoulder replacement requires a functioning rotator cuff to work effectively. Because some patients have both rotator cuff tears and arthritis the “reverse” shoulder allows the replacement to function without the rotator cuff by “reversing” the ball and the socket (Figure 2). The ball is now placed on the socket (shoulder blade) side and the socket or cup is placed on the arm (humeral) side.
The reverse total shoulder replacement has provided significant pain relief and improved function to many patients with debilitating shoulder dysfunction. The procedure has allowed patients to return to basic activities of daily living, such as combing your hair or reaching into a cupboard, as well as returning to recreational activities such as golf.
Uma Srikumaran currently serves as an Assistant professor of Orthopaedic Surgery at Johns Hopkins University. Specializing in shoulder surgery, Dr. Srikumaran treats patients with shoulder pain, rotator cuff disease, traumatic injuries, instability or dislocations, fractures, osteoarthritis, or other sports related injuries. His surgical expertise includes fracture fixation, rotator cuff repair, shoulder stability procedures, revision shoulder surgery, as well as total shoulder replacements and reverse shoulder replacements. His practice is based in Columbia on the Howard County General Hospital campus, but he also sees patients in Odenton. Dr. Srikumaran trained as a medical student and resident at Johns Hopkins School of Medicine and completed a fellowship in shoulder surgery at Harvard. He also presently serves as a team physician to the Baltimore Orioles.
I am not exaggerating when I say I haven’t seen or eaten a brussels sprout in more than twenty years. Unlike arugula, which I had never heard of before it became a trendy salad green in the ’90s, brussels sprouts exist in a dim memory from my childhood. A bitter, green, round, chewy vegetable, the brussels sprouts of my youth were soft in consistency and unappetizing in taste and appearance. Times have changed, and now it seems all the best food establishments have a tasty version of this mini cabbage.
In Howard County, the salad bar at the largest supermarket offers both chilled brussels sprout slaw and warm, roasted brussels sprouts. A local ale house offers grilled brussels sprouts with bacon, shallots and caramelized onions. Even in Greenville, South Carolina, where I visited this past summer, one of the most highly recommended gourmet restaurants offered “Crispy Brussels Sprouts” prepared with Serrano ham and shaved Manchego cheese in a sherry reduction. The lovely green orbs were served on a long, thin plate, lined up like the rarest of delicacies.
Certainly you protest that it’s not the vegetable itself but the creative cooking that makes the contemporary brussels sprout so appetizing. I have to disagree; when not overcooked and given the most minimal culinary respect, the brussels sprout is delicious. And healthy too. Who knew? A member of the cabbage family, the brussels sprout is a cruciferous vegetable. Other cruciferous vegetables include broccoli, cauliflower, bok choy, collard greens, arugula and kale. These vegetables are abundant in carotenoids, vitamin E, vitamin C, vitamin K, folate and glucosinolates. Carotenoids and vitamin E are antioxidants, the substances that protect our cells from the damaging effects of free radicals. Free radicals have been found to contribute to the development of heart disease and cancer. Vitamin C is used by the body to build the components of cartilage, bone, muscle and blood vessels. Vitamin K is essential in the blood clotting process. Folate helps prevent neural tube defects in the developing fetus and may help reduce the risk of cardiovascular disease.
Extensive information is available on glucosinolates, including their interaction with cancer cells and the impact of an individual’s genetic makeup, and further research is ongoing. Many studies have linked ingestion of cruciferous vegetables to a decreased risk of cancer. When foods containing glucosinolates are cooked and digested, they break down into indole-3-carbinol (I3C), a substance that has been shown to destroy the Cdc25A molecule found in elevated levels in Alzheimer disease and breast, prostate, liver, colon and stomach cancer. Of note, the sulfur component of glucosinolates accounts for these vegetables’ slightly bitter flavor and distinctive smell.
As vegetables go, brussels sprouts are also a good source of fiber and are relatively high in protein (4 grams per 1-cup serving respectively). Fiber is important to gastrointestinal health. Protein provides the building blocks for essential elements of the human body including, muscle, bone, skin, blood, hormones and enzymes. Foods high in protein and fiber also help us to feel full and not overeat.
For ideas on creating tempting treats featuring the brussels sprout, check out the wonderful cookbook collection at your favorite Howard County Library System branch. Barefoot Contessa Foolproof has a recipe for balsamic-roasted brussels sprouts. Meatless includes a recipe for brussels sprouts with grapes and walnuts. ChopChop provides kid-friendly instructions for oven roasted or pan-roasted brussels sprouts. Power Foods contains information about buying, storing and steaming brussels sprouts as well as recipes for salad and for roasting with pears and shallots.
I predict that Dame Edna, the stage performer who is such an astute observer of cultural mores, will soon be trilling “brrrruuussel sprowwt” instead of shrieking “ahrooguhla!”
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.
Yoga is a great, low-impact activity anyone can try despite joint-inflammation conditions.
As a child, I routinely had physical therapy sessions for stretching and exercising my joints. I remember these experiences as mostly painful. My joints were stubbornly resistant to moving and the therapists would push ineffectively on my unmovable parts. Then, I would be given a list of exercises to repeat at home.
Let’s just say I wasn’t always compliant on my exercise regimen when I was a child coping with juvenile rheumatoid arthritis. I did, however, enjoy walking, running, playing, and swimming before I had too much joint damage. Because my family lived in the country, I had plenty of opportunity to do these activities.
As an adult, I’ve experimented with various forms of exercise. Recently, I had several months of physical therapy and found it quite helpful. This time the exercises focused on what I could do while also expanding my abilities by challenging me to work additional muscles, increasing my range of motion. I also took home-exercises and integrated them into different routines for me to complete throughout the week.
The best way to get me to exercise involves a few components:
Have a few routines with a variety of exercises. Variety gives me the chance to mix things up and not get bored by doing the same exact exercises every time.
Make exercise a habit. I’m more successful at carrying through my exercises knowing that it’s part of my daily routine. I expect to do a round in the morning, some during my breaks in work, and more in the evening.
Change it up. While I have a series of exercises I work through, I also really enjoy yoga and swimming. I’ll substitute in a swim or yoga session to challenge muscles that I may not regularly be reaching.
Incorporate practical activities. One of the greatest things my latest physical therapist said to me was that exercises to practice my ability at daily living activities were great for me because not only do I get stronger, I get better at doing things I want to do. For example, standing and walking. With my therapist’s support, these (and similar activities) are a part of my exercise routine and have increased my physical independence in daily life.
For me, exercise is about gaining (or maintaining) strength, keeping my joints active, and overall wellness. I’m not looking to become a marathon runner. I’m realistic about the severity of my rheumatoid arthritis and the level of activity my joints can handle. I choose exercises that fit my needs—not too stressful on the joints, yet challenging to the muscles, and entertaining enough for me to want to repeat. In a lot of ways, this is true for anyone.
One other important point to note is that everyone—and I mean absolutely everyone—can exercise. I spend most of my day in a wheelchair and have significant physical limitations. But even I have found exercises that help keep me as active as possible. Not only that, but I’ve seen people with more disabilities dance in their wheelchairs, wave their arms, or wriggle their fingers. Just start exercising where and when you can, and go from there.
Kelly Mack lives in Washington, DC, and works for a marketing communications firm.
“None of us are prepared for a family member or friend to have a stroke. We end up relying on the skills and experience of a whole team of people. It is phenomenal that HCGH has a designated stroke center just 10 minutes from our home. We got the best therapy from wonderful people who are a part of our community.” – Claire Cohen, Clarksville, Md.
The HCGH Stroke Program has demonstrated higher standards for care, thus increasing recovery for many stroke patients. The Maryland Institute for Emergency Medical Services Systems (MIEMSS) has designated HCGH as a primary stroke center for the State of Maryland, which means that our treatment of stroke patients is monitored and measured.
HCGH is ready to treat stroke, any time of night or day. A special protocol is initiated the moment Howard County Emergency Medical Services (EMS) calls the hospital with a potential stroke victim. While EMS transports the patient, the hospital team prepares. Within minutes of arrival at the hospital, a physician assesses the patient, blood is drawn for lab work and a CT scan of the brain is conducted.
Sobering National Stroke Statistics from the American Heart Association
Someone has a stroke every 45 seconds in the United States.
Only 20 to 25 percent of patients admitted to the hospital with a stroke arrive within three hours of the onset of symptoms, the “critical window” for treatment of certain strokes.
Less than five percent of patients in the United States receive thrombolytics, a critical treatment for some strokes.
Eric Aldrich, M.D., Ph.D., vice president of Medical Affairs and a neurologist who was instrumental in refining HCGH’s stroke program, believes that we must treat stroke according to the latest guidelines. A patient’s family can help ensure their loved one gets the best care. Dr. Aldrich explains, “I can’t emphasize enough the importance of calling 9-1-1 to get a head start on treatment. First responders begin treatment in the field and gather critical information about when the symptoms began.
“Our physicians can then diagnose and determine whether to administer thrombolytics, also known as tPA or clot-busting drugs. (Theses drugs are used in ischemic strokes, those caused by a blood clot, but not in hemorrhagic strokes, those caused by a bleed.) According to the National Stroke Association, carefully selected patients who receive these drugs within three hours from the onset of symptoms are 33 percent more likely to recover from their stroke with little or no disability after three months.” Dr. Aldrich adds, “Our focus is getting lifesaving, brain-saving care to patients within the critical three-hour window.”
(l. to r.) Susan Groman, RN, stroke program coordinator, laughs with Claire Cohen, Jose Maldanado and Jerry Cohen at a recent stroke support group.
Treatment at HCGH continues beyond diagnosis and acute care. According to Susan Groman, R.N. Stroke Program coordinator, HCGH encourages stroke patients to receive individualized rehabilitation services, including physical, occupational and speech therapy, for at least 24 months following a stroke. Stroke survivor, Jerry Cohen, began the program in 2010 and continues to benefit from what was learned from his therapists. “The team is excellent, they really know their business,” Jerry’s wife, Claire Cohen, says. “Best of all, physical, occupational and speech therapies are in one location, which makes scheduling back-to-back appointments easy. Transportation can be a huge issue, so convenience is key.” Today, Jerry is much improved. “The old myth was that after 18 months, there is little progress, but for everyone in this stroke group the progress continues,” says Claire. “We were told my husband would never be able to walk. He is walking. He came out of the hospital on a ventilator and a feeding tube. Now he can walk into a restaurant and enjoy normal food with family and friends.”
A monthly stroke support group is described by many patients and caregivers as an essential part of recovery. “The group is extremely helpful and is part of our routine,” Claire says. Group members are all ages and Claire notes that, like her, a number of caregivers are still working. Susan says; “Everyone is welcome, patients and caregivers alike.” Claire believes a diverse group is important. She says, “All strokes are different, they affect patients and families uniquely, but when you gather together in a supportive setting, there is much similarity. We discuss clinical trials, legal issues, home modification, transportation resources and how to find respite care. We share concerns and work together to find solutions.”
Education is also a part of the Stroke Program. Susan says, “We know that by teaching people the symptoms of stroke and the importance of calling 9-1-1 we can make a difference. Most of my patients wish they had called 9-1-1 sooner.”
Susan and her husband, cardiologist George Groman, M.D., have a commitment to stroke and emergency care in Howard County. Susan explains, “I’ve been an emergency nurse and a caregiver to aging parents and in-laws – so I know firsthand how valuable timely emergency treatment and rehabilitation are to a patient’s recovery and quality of life. Knowing this care exists can also give peace of mind to caregivers.”
Signs of Stroke Every minute counts, so act FAST when you see these signs:
Face – Droopy face on one side? Ask the person to smile.
Arms – Weak or numb arm? Ask them to raise their arms. Does one drift down?
Speech – Slurred speech? Ask them to repeat a simple sentence to see if they can.
Time – If the person shows any of these symptoms, call 9-1-1 immediately.
The HCGH Stroke Program recently received the American Heart Association (AHA) “Get With the Guidelines Stroke” Gold Quality Achievement Award. To learn more about our stroke support groups, call 410-740-7601 or visit www.hcgh.org/stroke.
Dr. Groman explains more about symptoms and treatment for stroke in these videos: