Do No Harmdo no harm is a gift of a book bestowed upon us by Henry Marsh, an accomplished British neurosurgeon. These linked stories eloquently describe life as the person who holds others’ lives in his hands. With 35 years in practice, Mr. Marsh has insight into all aspects of providing medical care. (In the UK, surgeons are referred to as “Mr., ” so please allow me to refer to this renowned physician as Mr. Marsh.) He shares his accomplishments, fears, and failures. He boasts, gripes, mourns and vents.Mr. Marsh takes us inside the skull, behind the orbits, into the brain. We join him on a fascinating anatomic journey as he incises through to the meninges, the spine, and the pituitary gland. We are riveted by the urgency of his patients’ conditions such as brain tumors, aneurysms and trauma. We are pulled along hoping that all of his patients do well, but he leaves us with no illusions.  These are stories of life and death and the mistakes even the most experienced surgeons make.

Not only patient outcomes lie at the heart of Do No Harm. Mr. Marsh also describes the challenges he has faced as son, father, husband, medical colleague and customer of the UK’s National Health Service (NHS). There is much dark humor in the aggravation he describes dealing with NHS management and computerized health records. Will there be beds for his patients? Will he be able to coax the NHS computer system to show him the patients’ brain scans? He admits to an arrogance that has mellowed over time, but we see that he continues to be an opinionated force wherever he goes. One of my favorite chapters is “Infarct,” where he confronts how medical care and bureaucracy impossibly conflict.

In Mr. Marsh’s beautiful descriptions of his days, as he cycles to work, evaluates patients, instructs new surgeons, and waits to enter the “operating theatre,” we appreciate his dedication. His powerful introspection illuminates how medicine is a “craft.” Enmeshed in the combination of art and science exists a huge human element with alternately confident and nervous providers striving to develop their skills to provide the best treatment for their patients. As in a lecture he has delivered internationally, “All My Worst Mistakes,” Mr. Marsh is willing to share his experiences so that others can grow from what he still hopes to learn.

Mr. Marsh never loses perspective on his fallibility as a surgeon no matter the fame he has achieved. As an example, he has worked extensively in Ukraine providing care to its medically underserved population. Documentaries have been made about him and his service. Still, he writes “of surgical ambition and of my failure” and reminds us that diagnosis and treatment plans are filled with “uncertainty” and that “patients become objects of fear as well as of sympathy.” As a reader, I am grateful for his honesty and generosity as a neurosurgeon and author.

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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raccoon, rabies symptoms

© William Rodrigues Dos Santos |

Rabies is one of those things you don’t think about until it affects you. You should be aware of things you can do to prevent rabies when in certain situations­–like finding a bat in your house or seeing a fox in your neighborhood who acts a little off.

Rabies is a viral disease that is most commonly transmitted through animal bites. It infects the nervous system and can lead to death. Early symptoms include headache, fever and fatigue, but as time passes, more severe symptoms may develop including confusion, anxiety, insomnia, slight paralysis and difficulty swallowing, among others. When these symptoms occur, death often happens within days. If you suffer from an animal bite, be it domestic or wild, immediately seek medical help.

Rabies is much more commonly found in wild animals including raccoons, skunks, bats, foxes and coyotes than in domestic animals like dogs. However, in the United States, rabies from bats to humans is extremely rare with only one to two cases annually. In Howard County, we still see a lot of wild animals and residents should be aware.

The species in this part of the United States that most commonly carry rabies are typically raccoons, skunks and foxes. Rabies symptoms include the wild animal biting or snapping at inanimate objects, appearing tame and fearless, appearing wobbly or “drunk,” or acting disoriented. If you see a nocturnal animal such as a skunk or a raccoon out and active during the day and exhibiting abnormal behavior, that is a likely sign of rabies, and you should contact Howard County animal control at 410-313-2780. Additionally, if you find a bat in your house, as a precaution in case of being bitten while asleep, you should receive a series of shots, the first dose at the hospital and subsequent doses at an urgent care center.

Your dog is at a high risk for rabies if they have not been vaccinated and are exposed to wild animals. That is why it is important to mind the Howard County Police Department’s animal control law by maintaining a rabies vaccination for dogs, cats and ferrets that are four months of age and older.

When a dog shows behavior changes such as restlessness, irritability or aggression – this could be a sign that he or she has been exposed, according to the Centers for Disease Control and Prevention (CDC). The dog may present a fever and bite or snap at you or even objects. As the rabies progress, your dog may hide in darker places, lose their appetite, have seizures or a sudden death. If you think your dog has been in contact with a rabid animal, contact your veterinarian immediately.

Rabies is preventable. The CDC says vaccinating your pet, spay or neutering your pet, maintaining control of your pets, avoiding exposure to wild animals and reporting any stray or sick animals are all ways you can participate in rabies prevention. Also, keeping your dog on a leash and supervising it when it is outside is a great method to prevent their exposure to rabid animals.

Never approach or handle a wild animal. If bitten by a wild animal, scrub and flush the wound and seek medical help immediately – timely treatment has proven to be successful.


Sources: Centers for Disease Control and Prevention & The Humane Society of the United States

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road trip snacks

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9 Healthy Snack Tips for Your Summer Road Trip

Summertime means road trip time! Here are some great ideas to fight off those snack attacks, and keep your energy up, too!  Plan your snack pack before you hit the highway to avoid unhealthy fast food stops and remember that a small insulated cooler is a must have.

  1. It’s A Wrap! Sandwiches can add protein and hearty grains to your diet. Keep wraps made with meat and cheese or hummus or veggies in a cooler.  Other options, like peanut butter and jelly on whole grain, can be kept at room temperature.
  2. Keeping It Cool: Yogurt. Whether it’s in a tube, made into a low-fat smoothie or mixed with fruit or granola, keep these road trip snacks in the cooler. It’s great snack for kids and adults.
  3. Hot On The Trail. Make trail mix at home that keeps well in a storage container with a lid.  Combine granola, raw nuts, seeds and dried fruits. Add a few dark chocolate chips for sweetness or wasabi peas for spice!
  4. Healthy Can Be Gouda, Too: low fat cheese, string cheese, single serve cottage cheese or cheese cubes. There are many low-fat cheeses, or soy or nut-based cheeses for those who are lactose intolerant. Prep cheese slices at home before and toss in the cooler. Pair with your favorite crackers you portion ahead of time, making it “snack-friendly” for the car.
  5. Dip It! Veggie Style. Fresh veggies can be sliced and stored in an insulated cooler. Road trip choices include cherry tomatoes, baby carrots, broccoli florets, cucumbers, celery and snap peas.  Add peanut butter or hummus as a dip to add good fats and protein, too.
  6. Energy Bars….Sweet! Replace those candy bars with an energy or granola bar. Protein and fiber, now that’s a healthier choice.
  7. Fruits, For Sure. Trip-friendly fruits that have been washed and sliced at home are a quick go-to from the cooler. Grapes and berries are finger-sized already. Others can be cubed and stored in containers, or eaten whole.
  8. Thirst Quenchers. Healthy beverages kept on ice are really nice on the road. Water, seltzer, 100 percent vegetable and fruit juices are the way to go.
  9. Go nuts! Craving crunchy? Pistachios, almonds, walnuts, whatever your favorite nut may be. Or go for sunflower or pumpkin seeds, air popped popcorn or rice cakes.
Karen Sterner is special events coordinator at Howard County General Hospital. She is an experienced traveler, having taken many road trips with her family.

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lung cancer symptoms, screening

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According to the National Institutes of Health, “Lung cancer is the most common type of cancer in both men and women, and the majority of these cancers are directly linked to cigarette smoking.” Lung cancer is more prevalent in smokers; however, non-smokers can also get lung cancer. If you are suffering from a chronic cough, recurring pneumonia or bronchitis, shortness of breath, or have a cough that produces blood, you should see your physician.

Smokers often disregard their cough as “a smoker’s cough” and do not seek a diagnosis until the cancer is advanced. Also, some patients in their 30s and 40s falsely believe they are too young to have lung cancer and ignore their symptoms.

In addition to smoking, risk factors for lung cancer include:

  • exposure to radon
  • secondhand smoke
  • certain chemicals or asbestos
  • a family history
  • or previous radiation to the chest.

Many people think that lung cancer is a death sentence, but, when caught early, a combination of chemotherapy, radiation and surgery can significantly increase your chances of a cure. The key is to catch the cancer in its early stages through screening.

New Screening
If you are age 55 to 80, have smoked in the last 15 years, or are currently smoking and have a 30-pack-per-year smoking history, the U.S. Preventive Services Task Force recommends you receive an annual low-dose CT scan. This test allows us to see lung cancer in its earliest stages using much less radiation than a traditional CT scan. This screening has saved many lives and is available at local imaging facilities with a prescription from your doctor.

Here to Help You Quit
Cigarette smoking is the number one risk factor for lung cancer. In fact, nearly 90 percent of lung cancers in the United States are linked to cigarette smoking. Even if you have smoked for many years, quitting now can still significantly reduce your risk for developing lung cancer. If you are looking for help to quit smoking, join the Howard County Department of Health Tobacco Cessation Program or call 410-313-6265.

In recent years, many people have been turning to e-cigarettes as a substitute for tobacco cigarettes. E-cigarette users should keep in mind that the safety of electronic cigarettes has not been adequately studied (nor demonstrated). Formaldehyde, a known carcinogen, has been shown to be an inhaled vapor of e-cigarettes.

Francis Chuidian, M.D., is a pulmonologist with Johns Hopkins Community Physicians Pulmonary Medicine in Columbia.

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Pneumonia symptoms often include a cough and fever, feeling weak, shortness of breath and chest pain that worsens when coughing. [© Photographerlondon |]

Unlike the flu, you can get pneumonia year-round. Though pneumonia is more prevalent in the winter months when it is cold and everyone is indoors, regardless of the time of year, if you have a cough lasting for more than three days, you should be seen by your physician.

What is Pneumonia?
Pneumonia is an infection of one or both lungs that can be caused by a bacteria, virus or fungus. The infection causes the air sacs in your lungs to become inflamed and filled with fluid. Symptoms often include a cough and fever, feeling tired or weak, being short of breath and chest pain that worsens when coughing.

Who is at risk?
Children under the age of 2 and adults over the age of 65 are at a higher risk of getting pneumonia and, when they do, tend to have a more severe case and often require hospitalization.

Also, if you have a weak immune system due to HIV, diabetes, liver disease, alcoholism or chronic heart disease, or have COPD or lung diseases such as asthma or Cystic Fibrosis, you are at an increased risk of getting pneumonia. Pneumonia can be a very serious illness, and you should receive a vaccination to prevent it — especially if you are at risk.

A Vaccine to Prevent Bacterial Pneumonia
Eighty percent of all bacterial pneumonia is caused by the bacteria streptococcus pneumoniae. Two vaccines prevent this type of pneumonia: Pneumococcal Polysaccharide Vaccine 23 (PPV23) and Pneumococcal Conjugate Vaccine 13 (PCV13).

If you are otherwise healthy, and age 65 or older, it is recommended that you get the PCV13 initially and then, in six months, get a dose of the PPV23. In five years, in some cases, you will receive a booster.

Also, all babies should receive a series of the PCV13 shots during their first year of life.

If you are an adult with a higher risk of pneumonia due to a compromised immune system or other risk factors, but younger than 65, you too should receive the PPV23 vaccine and PCV13 vaccine regardless of your age.

Unfortunately, there is no vaccine to prevent viral pneumonia.

What is Walking Pneumonia?
Walking pneumonia is typically diagnosed in younger adults and is also caused by bacteria. Usually symptoms are milder, and you will feel achy and may have a cough.

Reducing the Risk
In addition to getting the pneumonia vaccines:

  • Get an annual flu vaccination — the influenza virus can often lead to pneumonia
  • If you have asthma, make sure you are regularly taking your medication to control your asthma and get both flu and pneumonia vaccines
  • If you have a young baby, do not expose your baby to large crowds
  • If you are a smoker, stop smoking
  •  If you are a diabetic, keep your diabetes in check so you don’t lower your resistance to infection
  • Wash your hands regularly
  •  If you have a child under the age of 2, be sure to have him or her receive the Hib vaccine (the Hib vaccine protects your child from a specific flu that can cause pneumonia)
Gerren Perry-Fabrizio, M.D., is a family medicine physician with Johns Hopkins Community Physicians in Fulton/Maple Lawn.

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According to the American Lung Association, chronic obstructive pulmonary disease (COPD) is a lung disease that, over time, makes it hard to breathe. COPD is a disease that involves inflammation and thickening of the airways and the destruction of the tissue of the lung where oxygen is exchanged.

Family on swing

© Photographerlondon |

Fernando DeLeon, M.D., a pulmonologist on staff at Howard County General Hospital (HCGH), explains that this disease is diagnosed through pulmonary function testing, though it can sometimes be diagnosed through X-rays or CT scans of the chest.

Some symptoms of COPD:

  • shortness of breath
  • coughing
  • wheezing

“Contrary to popular belief, if you are diagnosed with COPD, that does not mean you will end up on oxygen,” explains Dr. DeLeon. “COPD is treated with inhalers. It is progressive but moves at a slow pace — if you do not smoke and are not exposed to excessive airborne pollution. COPD is not a terminal disease. Many people diagnosed with it can even routinely exercise.”

As the disease advances, it becomes more difficult to remain active due to shortness of breath. HCGH offers pulmonary rehabilitation, a program that incorporates an individualized regimen of exercise, education, breathing retraining and the development of coping and support skills. It will help to ease your symptoms, achieve an optimal level of independence and self-reliance, decrease anxiety and depression, reduce infections and hospitalizations, and improve quality of life by increasing mobility and stamina. “Pulmonary rehabilitation does not treat the disease, but it makes someone more physically fit, which helps,” says Dr. DeLeon.

Take the Path to Pulmonary Wellness
Dr. DeLeon recommends:
1. SAY YES TO EXERCISE: Though it may be more difficult to stay active with COPD, exercise is recommended. People who are short of breath and do not exercise become even more short of breath.

2. SAY NO TO SMOKING: More than 80 percent of COPD cases in the United States are caused by tobacco use. The main precaution if you are diagnosed with COPD is to stop smoking if you are still smoking and to try to avoid being exposed to secondhand smoke.

3. SAY YES TO A HEALTHY DIET: In addition to exercise, a healthy diet is important if you have COPD. A diet with a variety of the right nutrients will not cure COPD, but will help you breathe easier and feel better. Because COPD patients use more energy to breathe than the average person, they may require more calories in their diet compared to a person living without COPD.

4. SAY NO TO AIRBORNE POLLUTION: In addition to not smoking, it is also important to avoid inhaling secondhand smoke and to be aware of your air quality by avoiding dust and fumes.

Fernando DeLeon, M.D., is a pulmonologist with Howard County Center for Lung and Sleep Medicine.

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