As summer turns to fall, I feel the seasons changeover with achy twinges in my joints. Some people with rheumatoid arthritis (RA), like myself, feel changes in the weather with their bodies. I can feel big storms, pressure changes, and shifts in humidity.

Frequently, the most challenging transition I encounter is when summer shifts to fall. I often feel my best during summertime. I experience less joint pain, swelling, stiffness, and have more energy overall. Unfortunately, as those warm summer days darken into chilly ones, my joints grow achier and harder to move.

Through the years, I’ve developed coping mechanisms to handle these seasonal changes. I don’t think I have a perfect routine, but I better understand what helps me to feel better and manage the changes in my physical condition.

      • Get more rest. Instead of getting angry at my body and denying the problem, I have to be gentler on myself and take time to get more rest. I try to go to sleep earlier, if possible, on week nights. And on weekends I may sleep in or take naps during the day. On especially bad days, I may scale back my schedule and replace activity with more resting.
      • Stay warm. When my joints become cold I have two problems. I feel worse, with more pain and stiffness. Plus, it takes a ridiculously long time for me to warm up and feel better. The best plan is to stay warm in the first place. I often dress warmer than most people—taking out the sweaters as early as September. And at night I have a heating blanket turned up on high. Taking proactive measures can help prevent bigger problems with my RA.
      • Keep up with gentle exercise. When my RA feels worse, it can be very difficult to motivate myself for exercise. It’s natural for my body to complain about moving when my joints ache and feel stiffer than molasses. But even on bad days if I do some gentle stretches and slow motions, then my bones loosen up and some of the pain dissipates. A little exercise can go a long way, which will hopefully help me feel better tomorrow as well.

Living with rheumatoid arthritis has its limitations, but I can still take care of myself with some gentleness. While I can’t necessarily fight the effects of winter, I can ease my body into it with a little self-care. Taking the time to observe how I feel and experiment with some techniques for combating the worst symptoms has helped me navigate the changing seasons.

Kelly Mack lives in Washington, DC, and works for a marketing communications firm.

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rheumatoid arthritis

[© Hriana |] RA is chronic autoimmune inflammatory arthritis that causes pain, stiffness, swelling, and limited mobility and function of many joints. If you or your primary care physician suspect RA, you should be evaluated by a rheumatologist to develop an appropriate management plan.

Understanding Rheumatoid Arthritis
Could you be one of the more than 1.5 million people in the United States who suffer from rheumatoid arthritis (RA)?  RA is chronic autoimmune inflammatory arthritis that causes pain, stiffness, swelling, and limited mobility and function of many joints. Typically, RA starts by affecting small joints in the hands and feet but can impact any joint. This systemic illness also can sometimes affect other organs, including the heart, lungs and eyes. Other symptoms may include low-grade fever, firm bumps, loss of energy and loss of appetite.

Approximately 75 percent of those with RA are women, and while the disease is most common between ages 40 to 60, you can be diagnosed at any age. Also, having a family member with RA can increase your likelihood of developing the disease, although you can still suffer from RA without having a family history of the disease.

No one knows what triggers rheumatoid arthritis, and since many diseases may behave like RA, if you or your primary care physician suspect RA, you should be evaluated by a rheumatologist to develop an appropriate management plan. This will help avoid unneeded tests for conditions that can mimic RA symptoms.

What can I do if I have RA?
Although there is not yet a cure for RA, there is a lot of research targeting a cure. Today, medication can dramatically improve or resolve symptoms of stiffness and swelling of joints, putting a patient in remission. In addition to medication, exercise, rest and joint protection are also forms of treatment.

The Arthritis Foundation suggests those with RA remember:
If left untreated, the inflammation caused by RA can result in permanent damage to joints or internal organ

  • The earlier you receive treatment, the better chance of preventing joint damage
  • Remission is possible
  • Your risk for heart disease is increased
  • Exercise helps: aim for at least 30 minutes of low- to no-impact aerobics five days a week and, if possible, include strengthening exercises
  • Stress management and rest are also helpful
  • Maintain open communication with your physician

The Howard County General Hospital Bolduc Family Outpatient Center offers physical therapy and exercise for those diagnosed with RA. For an appointment, call 443-718-3000.


Moe Zan, M.D., is a rheumatologist with Arthritis Care Specialists in Ellicott City. Make your appointment by calling 410-992-7440.

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With another flu season approaching, now is the perfect time to get a flu shot! Flu vaccines are now being offered at doctor’s offices, pharmacies and health fairs in Howard County, and are often offered free of charge or covered by insurance. This Friday, they are available at the 50+ Expo at Wilde Lake High School in Columbia, courtesy of the Howard County Health Department.

The flu can be a serious illness. According to the Centers for Disease Control (CDC), during recent flu seasons, between 80 and 90 percent of flu-related deaths have occurred in people age 65 years and older. Children and those with other health conditions may also become more seriously ill with the flu.

To get more facts about the flu and get all of your questions answered about the vaccine, visit the CDC for Key Facts About Seasonal Flu Vaccine.

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What if I Have Lupus?

lupus symptoms

[© Nandyphotos |] Lupus is a chronic, autoimmune disease that often causes joint pain, facial rash and fatigue. It can occur in anyone, but typically strikes non-Caucasian women ages 15 to 44 years old. Family history also plays a factor.

Living with Lupus
Lupus is a chronic, autoimmune disease that can affect any part of the body, most often the joints, skin and/or organs. It is a disease of flares and remissions and the most common symptoms are joint pain, facial rash and fatigue.

How do I know if I have Lupus?
Lupus can often be difficult to diagnose because the symptoms mimic a variety of other diseases. Generally, a blood test is used to diagnose lupus when a patient has joint pain or a facial rash. The severity and types of symptoms you have determine if you need to see a specialist. Most often, a rheumatologist will treat lupus, but in some cases, it can impact other areas such as the kidneys and nerves, and you will see a different specialist.

Who Gets Lupus?
Anyone can get lupus, but it is much more likely in women than men, especially women ages 15 to 44. Additionally, though all races and ethnic groups can develop lupus, women who are not Caucasian are more prone to be diagnosed. The likelihood of getting lupus also increases with family history. If you have lupus, your children have a higher chance of having it.

Often mistaken for being contagious through sexual contact, this is not a disease that you can “catch” or “give” to someone.

Lupus Flares
Lupus is a disease of flares (when symptoms appear and the disease worsens) that come and go, lasting anywhere from a couple of weeks to many years. Flares can be caused or worsened by:

  • Being out in the sun
  • Stress
  • Sulpha drugs

Lupus is a disease that varies in severity. While some people may have very severe cases, others’ cases are so mild it barely affects them. Although there is not a cure for lupus, a variety of medications can treat the disease and control symptoms.

One very common misconception that people have is that if you have lupus you will die from it. The reality is that more people have milder cases of the disease and, while they need to be treated, they can live a pretty normal life.

As with any medical condition, patients should work to stay healthy with these tips:

  • Join a support group
  • Exercise and stay active
  • Maintain a healthy diet (high in omega-3 fatty acids) and weight – this is additionally important because those with lupus have a slightly increased risk of developing cardiovascular disease
  • Get involved in your health care and see your doctor regularly
  • Avoid significant sun exposure and use high SPF sunscreen
  • Get sufficient rest and avoid stress

Drug-induced Lupus
Drug-induced lupus presents with lupus-like symptoms that have been caused by certain drugs. Some prescription drugs associated with this phenomenon are used to treat infection, hypertension, irregular heart rhythms and tuberculosis. Patients typically experience a milder form of lupus with a rash or joint aches. Not everyone who takes these drugs will develop drug-induced lupus and, typically, when you stop taking the medication, the lupus-like symptoms disappear.

Steven Geller, M.D., is an internal medicine physician with Centennial Medical Group in Elkridge. Appointments: 410-730-3399. (Chaim Mond, M.D., is a rheumatologist in Columbia. Appointments: 410-580-1330.)

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mono symptoms

[© Jpcprod |] Most mono infections occur in teens and young adults, and most adults have had mono whether they remember it or not.

Q: How do I get mono?
Mono is caused by the Epstein-Barr virus and is transmitted through saliva. While you can get mono through kissing, you can also become infected by sharing utensils or from a cough or a sneeze.

Q: What are the symptoms?
Symptoms usually develop four-to-six weeks after exposure and may consist of mild to no symptoms in some younger patients to the more typical symptoms in adolescents and young adults. These symptoms may include fatigue, general discomfort, sore throat, fever, swollen lymph nodes in the neck or arm pit, swollen tonsils, a headache and possibly an enlarged spleen or liver.

Q: How do you test for mono?
The diagnosis is based on patient history, physical exam and blood work. The blood work may include a monospot test (that detects a type of antibody during certain infections) and can be negative in some cases. A more specific test can be ordered which measures antibodies to the Epstein-Barr virus.

Q: Can I get mono more than once?
In most cases, a person will get mono only once. Once someone is exposed, they develop antibodies and are unlikely to become infected again. However, in some rare cases, symptoms may reappear months or even years later. If you have had mono before and start to experience symptoms again, contact your physician as some mono symptoms can mimic other conditions.

Q: How is mono treated?
There is no specific treatment for the virus that causes mono. Treatment with medications may help symptoms and control fever and pain. Some people may develop a secondary bacterial infection and require antibiotics other than Amoxicillin which often causes a rash in people with mono. If tonsil and lymph node swelling is severe, steroids may be given to decrease inflammation.

Q: Is mono more common in children or adults?
Most adults have had mono whether they remember it or not. More than 90 percent of adults have antibodies to the Epstein-Barr virus and are immune. Most infections occur in teens and young adults.

Q: Does having mono predispose me for any other complications?
Mono can result in severe complications, although they are uncommon. These can include liver problems, such as hepatitis and jaundice; an enlarged spleen, which in rare cases may rupture; blood problems with low blood counts; or neurologic complications.

If you suspect you have mono, contact your primary care physician for an evaluation, blood tests, if indicated, and treatment based on your individual symptoms. While mono is very common, it is usually a self-limiting disease that resolves without significant complications.

Sharon Silverman, M.D., is an internal medicine physician in Columbia. Call for an appointment, 410-964-5311.

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meningitis symptoms

[© Obencem |] Many cases of viral meningitis improve without treatment while bacterial cases can be life-threatening and require urgent antibiotic treatment. A sudden high fever is a common meningitis symptom.

With flu season approaching, it is important to know about meningitis, which shares many similar early symptoms with flu and can be mistaken for the flu. According to the Centers for Disease Control and Prevention (CDC), meningitis symptoms and signs of meningitis can begin to develop anywhere from several hours to several days from infection and may include:

  • sudden high fever
  • stiff neck
  • confusion
  • vomiting or nausea with headache
  • severe headache
  • seizures
  • light sensitivity

Symptoms for newborns are slightly different and include: constant crying, extreme sleeping, high fever, inactivity and lack of interest in eating.

Meningitis stems from a variety of causes, though most common are viral or bacterial. It is important to know the specific cause of the meningitis, as it determines the treatment and severity of each case, warns the CDC. Many cases of viral meningitis improve without treatment while bacterial cases can be life-threatening and require urgent antibiotic treatment.

Bacterial vs. Viral Meningitis
With bacterial meningitis, the earlier you get treatment, the better the chance of preventing serious complications. This form typically develops when bacteria enters the bloodstream and makes its way to the brain and spinal cord. Meningococcal bacterial meningitis is very contagious – particularly in crowded living conditions such as dormitories or close contact situations such as sports – escalates quickly and can be deadly. That is why we immunize children at age 11 when they tend to start being exposed to these types of environments. Children who are medically or genetically at a higher risk can be vaccinated as young as two months of age. This includes those with diabetes, sickle cell disease, immune deficiency or who are of Native American descent. A booster dose is typically given in the late teens before children head off to college. Infant vaccines (PCV13 and Hib) also protect against other forms of bacterial meningitis.

Viral meningitis is a more common form, occurring as a result of a virus such as measles, mumps, enterovirus, herpes and West Nile among others. This form of meningitis is milder than bacterial and evolves more slowly.

Viral meningitis doesn’t respond to antibiotics and should resolve on its own. However, as with any disease, trust your gut. If your child is lethargic and not responsive, and/or is refusing to eat or drink, take them to their pediatrician. If they have a terrible headache, fever and neck pain – especially down the middle of the neck – go to the emergency room.

Lindsay Fitch, M.D., is a pediatrician with Klebanow & Associates in Columbia. Call for an appointment, 410-997-6400.

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