fault in our starsI don’t want to say “You have to have been living under a rock not to have read/seen/heard of The Fault in Our Stars” because heaven knows I am frequently unaware of popular things, current fads, or even world-changing news at times (plus it is a little unkind to say that to someone anyway). But The Fault in Our Stars is colossally popular. It was even first mentioned on this blog two years ago by our wonderful JP. And, though I have yet to see the movie (sorry, Nerdfighteria, I promise as soon as it makes it to DVD, I’m there), I have read the book and laughed and cried through the amazing story of Hazel Grace and Augustus.

But what is the appeal? Why has a love story about two teenage cancer patients struck a chord in so many people? (It really is much more than a love story between two teenage cancer patients, but I can’t go into it without giving too much away.) I think (aside from the fact that the writing and the characters are humorous, honest, heartbreaking, smart, and realistic), the book’s popularity has a lot to do with how much cancer still looms in people’s lives. I’ve rarely met a person whose life hasn’t been touched by cancer in some way or another. Additionally, according to the CDC, cancer is still the second leading cause of death in the U.S., and, according to the WHO, lung cancers are the #4 killer in the world.

But why is this ancient beast (The American Cancer Society cites the first recorded description of cancer from Egypt at about 3000 BC) still plaguing us after so many years and so much research? Cancer certainly gets a lot of attention. For example, in FY2013, The National Cancer Institute’s budget was $4.8 billion. And there are numerous cancer research programs throughout the world. Even HCLS carries four periodicals devoted to cancer alone, and there are over 1,200 books in our collection dealing with this topic. But cancer continues. Is it really the result of a fault in our stars?

this star won't go outWell, maybe it’s a fault in our cellsThe National Cancer Institute states: “Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues.” Or maybe it’s a fault in our blood or lymph systems since it “can spread to other parts of the body through the blood and lymph systems.” Or maybe cancer is a fault in our genes as the American Cancer Foundation points out how certain risk factors that run in families and abnormal gene function can also play a role in cancer.

Maybe, however, we should stick with blaming our stars after all; The National Cancer Institute points out that cancer “is not just one disease but many diseases,” and with many possible causes. These causes and risk factors can include: chemical and environmental elements (including food content and radiation exposure), genetics, hormonal changes, infectious agents, exposure to the sun(!), tobacco use, weight, and physical activity levels, just to name a few without getting too in depth. We might as well blame the stars (not just the sun, but all of them) since some factors we can control, some we can’t, and Fortuna’s mood seems to come into play more than we’d like. No wonder cancer remains a provocative topic; it truly can come out of no where and change everything.

Alas, cancer is still very much a reality in the world, and I think we all hope for a day when it’s not. The Fault in Our Stars treats a frightening topic with care but without a sugar coating. Sometimes just a sense of mutual understanding can provide great comfort. And I feel this book has touched many hearts; it certainly did mine. If it touched your heart too, you may want to check out This Star Won’t Go Out: The Life and Words of Esther Grace Earl, a collection of works from the brave, young lady who was one of the inspirations for The Fault in Our Stars.

Joanne Sobieck-Lingg is glad to blog about her many, disparate interests (though expert in none, except maybe parenthetical asides). In past lives, she was a writer, proofreader, editor, project manager, teacher, and even co-coordinator of a certain health blog. She has been happily ensconced among the fiction and teen books at the Central Branch of HCLS since 2003.

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self healingMusic gives a soul to the universe, wings to the mind, flight to the imagination and life to everything. ~ Plato, ~400 BCE

Every sound in our environment affects our minds and bodies.

Consider a warm evening with crickets chirping outside your open windows and distant passersby murmur quietly. You’re well on your way to sleep, when a car’s brakes screech, followed by a discordant crash and angry shouts. The tranquility you were experiencing is gone, affected by sounds in the environment.

Music has a profoundly positive effect on the mind and body. Music helps us to concentrate, wakes us up or helps us to sleep, excites or calms us. And people used it for social bonding—in religion or love, or for mind-altering experiences such as war dances, since before time began. Anyone who has rocked out at a concert or flipped on the radio to your favorite music station knows that we are still using and enjoying music today.

Scientists have recently identified the ways that music changes the state of the body. The levels of the brain chemicals dopamine and the endorphins rise; the pupils dilate, antibodies increase (with their protective role in the immune system). In the brain, music activates the amygdala (involved in processing emotion) and prefrontal cortex (involved in decision-making).

These chemical changes explain why music is so appealing. With an increase in the brain chemical dopamine, anxiety decreases and depression lifts. Research has found that music is as effective as medication in decreasing presurgical anxiety. Even sick premature babies respond well to the playing of music. People listening to music at the gym showed improvements of 15% in their endurance and workouts, and coronary disease patients boosted cognitive and verbal skills while exercising.

So, the pleasure of listening to music is an important part of a balanced wellness program. What kind of music is best? Whatever you like! Pick your favorite music, make a playlist, and “medicate yourself with music.”

Jean has been working at Howard County Library System’s Central Branch for nearly nine years. She walks in the Benjamin Banneker Park whenever she gets a chance.

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How can he fall asleep so easily? She is staring at the ceiling, making “to do” lists, and worrying about her kids, her parents and a host of other things she can’t get out of her mind. One minute she’s hot and the next she’s cold, while he is sleeping like a baby. Of course, getting a good night’s sleep can be a problem for both men and women of all ages, but women, across the board, do report more sleep problems than men.

 A National Sleep Foundation poll reported that of the women who responded:

  • 31 percent complained of sleep problems
  • 75 percent often got two hours less than the recommended eight hours of sleep per night
  • 63 percent of women experienced symptoms of insomnia at least a few nights a week, compared to 54 percent for men
  • Women are more likely to have daytime sleepiness
  • Women are more likely to suffer from nighttime pain
  • 31 percent had taken drugs to stay awake and 13 percent had taken drugs to go to sleep.

Why do so many women have trouble getting a good night’s sleep?  Various biological, psychological and socio-cultural factors come into play to affect the way women sleep.

Hormones, hormones, hormones
Women’s hormones get the blame for a lot of things, but when it comes to sleep they really can cause trouble. Conversely, lack of sleep can affect our hormone levels, so there can be a vicious cycle of sleeplessness. When hormone levels spike and drop during and after pregnancy, during the menstrual cycle and at the time of menopause, women may experience higher rates of sleep problems.

The female hormone estrogen is related to REM (rapid eye movement) sleep, and it helps to increase sleepiness and need for more sleep. Progesterone, another female hormone, increases non-REM sleep and too much progesterone can cause fragmented, interrupted sleep. Progesterone also causes a woman’s body temperature to rise during ovulation, which can disturb sleep.

Before, during and even after menopause, the loss of hormones, particularly estrogen, can cause hot flashes and irritability, making sleep difficult. Hormonal fluctuations associated with PMS (premenstrual syndrome) can also affect a woman’s mood, cause bloating and increase stress – all three bad for sleep. While we observe these things anecdotally all the time, the science isn’t really there to prove there are differences in sleep between women who are “PMSing” and the controls who are not. And, while  American women report the highest rates of sleep problems during menopause, among Mayan women menopausal problems are unheard of. More research is needed.

Socio-cultural factors
I have joked that a big difference between men and women is that men have one “on/off” button, while women have lots of buttons and switches. They are complicated and prone to multi-tasking and taking on more than they should.

The pressures of working and child rearing while sometimes also caring for aging parents can put undue stress on women that affects their mood and their sleep. Working moms may find it difficult to meet all of their family and work responsibilities and still have time to relax and enjoy themselves.

Tips to promote better sleep for women
Before considering pharmacological solutions for sleep disorders, there are a number of things women can do:

  • Cool the ambient temperature of the bedroom to help regulate core body temperature
  • Dress in layers so you can peel down when you get too hot
  • Drink something cool at bedtime but try to avoid tobacco, caffeine, alcohol and spicy food
  • Lose weight: body fat holds onto estrogen and can release it at sporadic times, which can cause hot flashes
  • Try relaxation techniques like yoga or meditation
  • Get more exercise, but early in the day is better than in the evening
  • Try to establish regular sleep and wake times.

If you still need help, talk to your doctor to see if an underlying cause such as depression, anxiety, reflux, bladder problems or pain may be aggravating your sleeplessness. He or she may prescribe estrogen replacement therapy or other medications or botanicals. And you may want to talk to a sleep specialist to get help with sleeping as well as he does.

Charlene Gamaldo, M.D., is the director of the Johns Hopkins Center for Sleep at Howard County General Hospital.

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calendar_2014smWednesday, July 30 and Thursday, July 31, 6-9 p.m. Living with Diabetes: Executive Summary. A condensed version of Living with Diabetes offered in the evening. Most insurance plans cover all or part of this program. To register, call 443-718-3000. Bolduc Family Outpatient Center at HCGH, 5755 Cedar Lane, Columbia.

Friday, Aug. 1 and Tuesday, Aug. 5, 8:30 a.m.–2:30 p.m. Living with Diabetes. Learn from an endocrinologist, podiatrist, psychologist, diabetes nurse educator and dietitian. Most insurance plans cover all or part of this program. To register, call 443-718-3000. Bolduc Family Outpatient Center at HCGH, 5755 Cedar Lane, Columbia.


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Six clues to observe in your child if he takes in too much water

secondary drowning photo

It’s every parent’s worst nightmare. One second your toddler is happily swimming in the backyard or neighborhood swimming pool. You look away for a few seconds and, when you turn back to the pool, he is struggling under water and then gasping at the surface for air. You get him out of the water immediately and, after a few minutes, hours or even up to two days, he seems no worse for his frightening experience. But suddenly he starts to have strange symptoms that require an emergency hospital visit.

A swimmer may inhale a lot of water or take in a rush of water after jumping off a high surface or coming off a water slide. A toddler can slip into water that is over his head. It only takes a few seconds in the water – just enough time for the water to get past the vocal chords before the body can react.

The majority of children, or anyone for that matter, who suffer the effects of secondary drowning, will survive. But a small percentage could have permanent brain damage and others may even die.

It is a rare condition – the syndrome occurs in less than one to two percent of near-drowning victims–but its onset is usually rapid and is characterized by a period of one to 24 hours of respiratory well-being. The swimmer seems fine at first, but water left in the lungs begins to cause swelling and diminished oxygen exchange to and from the blood. As the blood oxygen level drops, oxygen flow to the brain and other vital organs is reduced. Inhaling pool water can cause an additional condition called chemical pneumonitis, inflammation of the lungs due to harmful chemicals. An interesting observation is that children who develop secondary drowning syndrome after immersion in fresh water have a higher rate of survival than those who take salt water into their lungs.

Common symptoms of secondary drowning are persistent cough, shortness of breath, chest pain, lethargy, fever and unusual mood change. These signs can be difficult to spot in young children who are normally tired and fussy after a day a long day in the water. If symptoms are diagnosed early on, a physician can administer oxygen and remove fluid from the lungs. If not treated, the syndrome can progress to pulmonary edema (swelling) with a frothy pink discharge from the nose and mouth; partial or complete lack of oxygen supply to the brain, which can cause serious cognitive, physical and psychological impairment; respiratory and cardiac arrest; and death.

It sounds very scary, but none of this means parents should needlessly worry or forego the joys of family summer vacations at the beach or long days at the swimming pool. Just remember that vigilant monitoring of children when near the water is extremely important and water safety is the best prevention. If your child does have a near drowning experience, you should observe him or her in the following days and know what to look for. If you see any signs of secondary drowning, immediately take your child to an emergency department. Time is a critical factor in treatment – it could save your child’s life.

Dr. David J. Monroe is the director of the Children’s Care Center at Howard County General Hospital.

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© Innovatedcaptures | Dreamstime.com

© Innovatedcaptures | Dreamstime.com

If your sleep partner thrashes around and frequently kicks you during the night, don’t assume he or she is angry at you. And the friend who can never sit still for more than a few minutes may not just have “ants in her pants.” They may have a neurological disorder called restless legs syndrome (RLS), also referred to as Willis-Ekbom Disease named after the doctor who first described this condition more than 300 years ago. While anyone, even children, can develop RLS, it is more common among women. According to The Johns Hopkins Center for Restless Legs Syndrome, five percent of the general population and as many as 10 percent of those over 65 years old suffer with this condition.

RLS Symptoms The hallmark of this condition is an abnormal creeping sensation in the legs that causes an uncontrollable urge to move them. People with RLS can barely sit through a movie or quietly read a book without having to get up and move, and it makes sleeping almost impossible. Rest brings on symptoms, which usually peak at night, and activity relieves them. These sensations may be felt anywhere from the thigh to the ankle in one or both legs and sometimes in the arms, but rarely in the feet. Some people’s legs jump on their own, and there may be semi-involuntary movements of the legs. Many with RLS will have rhythmic or semi-rhythmic movements of their legs while they are asleep.

RLS Causes?

  • Iron deficiency – There is a strong relationship between iron deficiency and RLS and even people with normal blood iron levels may have iron deficiency in the tissues that can cause symptoms.
  • It’s in the genes – There is considerable evidence that there is a genetic component to RLS and, while genetic variations do not always cause RLS, they can increase your risk of developing it. We also know that there is a connection between several genes and iron regulation, which supports the idea that iron levels and genes may trigger the onset of RLS.
  • RLS is also associated with pregnancy, kidney dialysis and increased age.

Treatments We like to start with treatments that don’t require medication, such as hot baths, massaging the legs, applying hot or cold packs, moderate physical activity, and restricting caffeine and alcohol. These remedies may bring some level of relief, but for most, they will not bring a good night’s sleep. Certain medications, such as antihistamines, can actually make the condition worse, but others have proven to be very helpful in reducing symptoms. So if you or your sleep mate can’t lie still at night and it’s keeping one or both of you awake, it may be time to seek professional help for diagnosis and treatment. For information or to schedule an appointment, call 800-WESLEEP (800-937-5337) or visit hcgh.org/sleep.

Rachel Salas, M.D., is a neurologist and assistant medical director of The Johns Hopkins Center for Sleep at HCGH and director of its home sleep testing services.


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