Patient Meeting with Geriatrician.

For an older adult, an ache or pain can have far-reaching effects, bringing additional concerns that are specific to their age. For example, a new knee pain can bring worry about reduced mobility and loss of independence or worsening existing illnesses.

If an older man has knee pain, he’s thinking about a lot more than just the pain. He’s thinking this might be the end of things as he knows them. He fears he’ll have to move, go into a nursing home or never see his dog again. That’s when a geriatrician can help.

Geriatricians are medical doctors who specialize in meeting the unique health care needs of older adults, including:

• Developing health care plans that are specific to older adults.

• Treating complicated conditions that are common with older adults, including heart disease, arthritis, diabetes, urinary problems, erectile disorder, cancer, depression and memory loss.

• Empathizing with older adult concerns, often anticipating what they think and feel when discussing how medical conditions will affect their lives.

• Providing a streamlined approach for working with specialists, a common need as older adults develop more health conditions as they age.

• Reducing the risk of adverse drug effects and drug interactions. Older adults typically take multiple medications. Aging bodies process and store medicine differently than younger bodies. Lack of proper understanding and monitoring could bring on complications.

While geriatrician’s help patients age gracefully, there are steps older adults can take towards living a healthy lifestyle. Learn more from our previous post, The Practice of Geriatrics – Six Steps to a Healthy Lifestyle.

Scott Maurer, M.D., is a geriatrician practicing in Glenwood. For an appointment, call 410-489-9550.

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Howard County General Hospital Emergency DepartmentWith so many medical care options these days, it’s confusing to know when you should go to the Emergency Room (ER) and when you should seek care at your physician’s office or urgent care center. When in doubt, trust your instincts. If you think you’re having a true medical emergency, always call 9-1-1.

This easy reference guide takes some of the guess work out of deciding.

Fever
First: Try acetaminophen or ibuprofen to control your fever. If your fever doesn’t go down, call your primary care physician or visit an urgent care facility.
Go to the ER: If you have a fever higher than 102 degrees that does not come down with acetaminophen or ibuprofen.

Flu Symptoms
First: Most physicians suggest you stay home and treat symptoms with over-the-counter medications and fluids. Your physician may prescribe medicine. After hours, your physician may have an answering service. Urgent care facilities are also a good option when your physician’s office is closed or unable to accommodate you for a visit that day.
Go to the ER: If you’re having difficulty breathing, a prolonged high fever, severe dehydration or relapse after getting better.

Broken Bone, Strain or Sprain
First: Typically a strain or sprain can be evaluated in a physician’s office or urgent care center. You may be referred for tests, physical therapy or to a specialist.
Go to the ER: If you think you have broken a bone.

Non-urgent Imaging Tests
First: Imaging studies such as an MRI, CT scan, ultrasound or X-ray, can be performed at many area imaging centers.
Go to the ER: If your physician specifically requests that you go the ER for a certain test.

Head Injury
Always go to the ER: If you hit your head, lose consciousness, experience a seizure and/or are vomiting.

Heart Attack or Stroke Symptoms
It’s especially important to call 9-1-1 if you are experiencing chest and/or arm pain, trouble breathing, excessive sweating and fatigue. These can all be symptoms of a heart attack. Howard County Fire and Rescue Services are specially trained to evaluate and stabilize heart attack patients while our team mobilizes at the hospital to prepare for your arrival. Do not drive yourself to the hospital.

Real Time Advice
Many physician practices now offer after-hours urgent care or an answering service, so check with your physician about these types of services. Also know that your primary care physician knows you and your medical history best and can often guide you to the appropriate treatment facility during office hours. Also, your insurance company may have a nurse hotline that can provide treatment and care setting advice. Again, none of these options should delay you from calling 9-1-1 if you feel you are having a true medical emergency.

Robert Linton II, M.D., is the director of the HCGH Emergency Department.

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Primary Care Physician Consulting Patient

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If you’re healthy and feeling good you’re probably wondering why you would need a primary care physician. According to William Saway, M.D., an internal medicine physician on staff at HCGH, “Even if you’re totally healthy, a primary care physician plays a very important role in keeping you healthy.”

Several benefits for having a primary care physician include:

  1. Gaining a Medical Home
    “Your primary care physician’s office is your medical home—they know you and your medical history to treat you best when you are feeling sick,” says Dr. Saway. They also ask you about your family’s medical history and use that information for preventative care and to determine any screening or testing you may need. “Patients who are otherwise healthy may have a family history of a condition that they in turn are susceptible to and they need to be monitored,” notes Dr. Saway. An emergency room visit can often be avoided by establishing a relationship with a primary care physician. Some local primary care practices also have extended hours or operate urgent care centers.
  2. Early Detection
    While you may feel perfectly fine, Dr. Saway warns, “You can have high blood pressure, diabetes and/or high cholesterol, which are silent killers. Pain brings you to the doctor and bleeding brings you to an emergency room but these conditions don’t give you a clue that you need to see the doctor. An annual visit to your doctor for screenings can provide insight before a condition can become serious.”
  3. Access to an Educational Resource
    A physician’s job is also to educate. For example, it is important to understand the consequences of high blood pressure or cholesterol or untreated diabetes. Your physician is your resource. Use your wellness visit to ask questions and get answers. If the need arises for you to seek the care of specialists, your physician can recommend specialists specific to your needs. Furthermore, they can provide collaboration between specialists and guide you to the appropriate resources. Specialists and patients should keep the primary care physician informed so care can be effectively managed.
  4. Electronic Tracking of Your Health Care
    Most physicians offer an electronic medical record that tracks test and screening results and generates reminders when you are due for a follow-up appointment, exam or test. This tool can be extremely helpful for managing a chronic illness. Your physician’s online website portal can provide education and an option for you to communicate with your doctor.

Internal medicine and family practice physicians serve as primary care physicians. Internal medicine physicians provide health care to adults and are skilled in preventing, diagnosing, treating and managing adult diseases as well as encouraging disease prevention and screening and promoting well-being. Family practice physicians provide ongoing, comprehensive health care for patients of all ages and genders. They also emphasize disease prevention and screening.

If your access to care is limited because of cost or insurance, Chase Brexton Health Care offers solutions as a Federally Qualified Health Center that serves underserved populations in the community as well as insured patients. “Our health care team is focused on helping patients stay healthy and providing care for urgent and chronic diseases. I enjoy working with my patients and their families to provide them with a comprehensive, team-oriented approach,” says Sarah Connor, D.O., a family medicine physician on staff at HCGH.

To find a primary care physician, visit Howard County General Hospital’s Find a Doctor webpage.

William Saway, M.D., specializes in internal medicine with Columbia Medical Practice in Columbia. For an appointment, call 410-964-5300. 
Sarah Connor, M.D., specializes in family medicine with Chase Brexton in Columbia. For an appointment, call 410-884-7831.

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blood pressureMy son had his blood pressure checked at a recent doctor’s visit. He made a terrible face as the cuff squeezed his arm. I assured him he was going to live. After the nurse left the room he said to me, “what do the numbers mean?” I told him I was not sure, but your numbers must be good or the nurse would have said something. Not the best answer or the most reassuring, so I decided to educate myself. Blood pressure is commonly recorded as two numbers and written as a ratio. The top (or typically higher) number is your systolic pressure, and it measures the pressure in the arteries when the heart beats. The bottom (or typically lower) number is your diastolic blood pressure, and it measures the pressure in the arteries between beats.

What are normal numbers? If you are a person age 20 or older, a systolic blood pressure reading of 120 or lower and a diastolic blood pressure reading of 80 or lower puts you in the normal range.  Your blood pressure changes throughout the day. It is lowest when you are sleeping and may go up when you are excited, nervous, or physically active. Systolic pressure readings of 140 or higher or diastolic pressure readings of 90 or higher are in the range for hypertension or high blood pressure. The range for high blood pressure does not change with age, and one reading in the range for hypertension does not automatically mean you have high blood pressure.

Even if your blood pressure is within the normal range there are things that you can do to minimize your risk for developing hypertension, especially because hypertension can take years to develop, and you may not experience any noticeable symptoms. Some of the risk factors for hypertension are advancing age, diabetes, family history, obesity, stress, or a sedentary lifestyle. Other risk factors include smoking, high intake of sodium, saturated fats, or alcohol. High blood pressure may increase your risk for further health complications, such as kidney failure, stroke, or heart attack. You can read more about hypertension/high blood pressure and the risks here.

dash dietIt is vital (recommended that you) to get your blood pressure checked regularly, even if you are symptom free. The HCLS Savage Branch has free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: A Member of Johns Hopkins Medicine on the second Monday monthly during the summer from 10-12 pm. You can also measure your own blood pressure at home with a digital blood pressure device that can be purchased from your local pharmacy or store. It is a good idea to calibrate your reading with your reading at the doctor’s office. It is best to take the measurement when you are at rest and at the same time every day.

The good news is that if you have high blood pressure there are things that you can do to modify your lifestyle and lower your blood pressure and your risk for other cardiovascular diseases. The next time you visit the library check out one of the books on hypertension or DASH-type (Dietary Approaches to Stop Hypertension) diets.

I was just at the doctor’s last week, and I had my blood pressure checked. I immediately sent a text to my son with my readings—120/70. What are your numbers?

Nancy Targett is an Instructor & Research Specialist at the Miller Branch. She lives in Columbia and is the proud mom of three boys and a girl and a Siamese cat.

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fortify your lifeI don’t know whether you’ve had any lab work done recently, but if you have, there’s a good chance your healthcare provider took a look at your vitamin D level. Why all the growing interest in vitamin D? Won’t a couple of glasses of milk per week and some sunlight take care of it?

Sufficient vitamin D promotes bone growth and repair and is required for our bodies to absorb calcium. Adequate calcium levels help assure bone strength. Conditions associated with low vitamin D levels include rickets, osteomalacia, and osteoporosis. Symptoms of decreased vitamin D include bone pain, muscle weakness, and fatigue. Older adults may experience symptoms of depression and cognitive impairment.

The NIH Dietary Supplements site notes that vitamin D is naturally present in very few foods. Fatty fishes such as mackerel, tuna, and salmon contain vitamin D. Tiny amounts of vitamin D are found in beef liver, cheese, and egg yolks. Some mushroom varieties are grown under ultraviolet light to boost their vitamin D content. Much of our vitamin D, however, is ingested from artificially fortified products such as milk, breakfast cereal, and yogurt. Ingestion of supplements and cod liver oil will also boost vitamin D levels. Patients with an abnormally low level of vitamin D may be advised to take vitamin supplements as it is difficult to obtain significant amounts of dietary vitamin D.

the vitamin D cureSun exposure causes our skin to synthesize vitamin D. During cold winter days and in smoggy conditions, sun exposure is limited, thus decreasing the body’s vitamin D creation. People who have more pigment in their skin are able to block some UV radiation – helpful in preventing sunburn, but detrimental to generating vitamin D. As we age, our skin’s ability to synthesize vitamin D decreases. The use of sunscreen also blocks the initiation of vitamin D production. Patients with digestive disorders such as inflammatory bowel disease or celiac disease may have decreased ability to absorb ingested vitamin D. Obesity is also be associated with decreased vitamin D levels as fat cells absorb vitamin D from the blood.

Studies have shown that vitamin D deficiency can lead to an increased susceptibility to colds, especially for those who have asthma and lung conditions. Blood cells critical to immune function have vitamin D receptors. When enough vitamin D is not present, the risk of autoimmune disease and infection increases.

Researchers have also found an association between low vitamin D levels and stroke. When vitamin D levels are insufficient, patients are at higher risk for strokes. In patients who have had strokes, the stroke is likely to be more severe if the vitamin D level is decreased. Links have also been found between poor bone health, low vitamin D level and increased risk of cardiovascular disease. Much research is underway to improve our understanding of population studies indicating high rates of hypertension, obesity and glucose intolerance in patients with low vitamin D levels. Further studies are needed to increase our understanding of the significance of vitamin D levels.

[Editor’s Note: As always, please consult your physician before taking any kind of supplement. Your doctor(s) are your greatest resource for your health needs. The post above is for informational purposes only and should not be interpreted as medical advice.]

 

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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caffeine side effects

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Do you use caffeine to help wake up in the morning or perk up in the evening? If the answer is yes, you are not alone. Millions of people use caffeine on a daily basis. According to Johns Hopkins Medicine, “caffeine is the most mood-altering drug in the world.”

On average, Americans consume about 280 milligrams of caffeine daily—about 30 milligrams alters mood and behavior and 100 milligrams can result in physical dependence. So how many cups of coffee a day is too much? The Food and Drug Administration (FDA) warns that four to seven cups of coffee is too much, however, everyone can be affected differently.

If you consume too much caffeine on a daily basis, side effects can include insomnia, nervousness, irritability, upset stomach, rapid heartbeat, muscle tremors and restlessness. Those who do not consume caffeine on a regular basis may be more sensitive and experience negative effects faster. Also, factors such as age, gender (females are more prone), medications and body mass can play a role in sensitivity.

The recent buzz
In recent years, caffeine use has been on the rise, and the industry is responding to Americans’ obsession with caffeine. While caffeine was typically consumed through coffee, tea, cola beverages and chocolate, more recently, caffeine can be found in all shapes and sizes—from energy drinks and pills, to powder you can mix into food and caffeinated gum. This addiction has become increasingly easier to form.

The addition of these products to the market has dramatically impacted public health, with thousands of caffeine overdoses, addiction and, in rare instances, death. The FDA has stepped in to warn people about the risks involved with consuming too much caffeine and has also banned various new, dangerous caffeinated products.

It’s not all perks
Caffeine can also be especially dangerous to those with existing health conditions. According to the FDA, “People with heart problems shouldn’t use caffeine because it makes their hearts work too hard.” Additionally, “People with anxiety problems or panic attacks may find that caffeine makes them feel worse.”

If you are one of the many caffeinated people out there, it is important that you monitor how much caffeine is in the food and drinks you consume and listen to your body if you think you could be experiencing a reaction or withdrawal. Speak with your primary care doctor about your caffeine intake to see what is right for you.


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