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

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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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whooping cough vaccine

Whooping cough vaccination starts in infancy, but because immunity wanes after about 10 years, doses should be given to preteens and then again in adulthood. [© Skripko Ievgen |]

What is whooping cough?
Whooping cough, also known as pertussis, is a highly contagious bacterial infection that starts with the cold symptoms of a runny nose, congestion, fever and cough. The hallmark of this infection, however, is a persistent dry cough which arises from toxins that the bacteria secrete in the lung. Pertussis is known as the “100-day cough” and coughing spasms, even to the point of a cracked rib or vomiting, can occur. In fact, the sound of the first breath of air taken after a coughing fit, which sounds like a “whoop,” gives rise to the name of the syndrome.

Who gets whooping cough?
Though the infection is seen as a childhood illness, adults and adolescents are common carriers. According to Mark Landrum, M.D., an infectious disease specialist on staff at Howard County General Hospital, children and especially infants are at greatest risk for severe illness. “In 2012, more than 48,000 cases of pertussis were reported to the Centers for Disease Control and Prevention (CDC), including 20 deaths. Most deaths were in infants less than 3 months of age,” explains Dr. Landrum. “The CDC estimates that half of all infected infants less than 1 year of age require hospitalization.”

How can I avoid whooping cough?
In the past few years, pertussis cases have been rising across the nation. “Immunity from the vaccine weakens over time, placing us at risk for infection from Bordatella pertussis. Infants start vaccination at 2 months of age, while most preteens get a vaccination at 11 to 12 years of age, and all adults from 19 to 65 need a booster dose,” says Dr. Landrum.

“Pregnant women should receive a dose of Tdap at the end of the second trimester or during the third trimester with each pregnancy. This antibody protection is shared with the infant and provides some protection for new babies. Grandparents shouldn’t be surprised if the new mom insists on vaccination for visitors. All adults over 65 should receive a dose if in contact with infants to prevent infection in those who can’t protect themselves.”

Test Your Whooping Wit with Dr. Landrum
True or False:
My childhood booster vaccination gives me immunity forever.
False: The protective effect wears off after about 10 years. Recommendations are for additional vaccination at ages 11 to 12, and again after ages 19 and 65.

There are risks to getting the booster as an adult.
False: The older form of the vaccine was known to cause high fevers, but the newer vaccine, Tdap, has few serious reactions. Most complain of tenderness at the injection site the next day.

I only get the vaccine once as an adult/adolescent.
False: Current recommendations are for adult vaccination between ages 19 to 64 and once after age 65. You should still get the tetanus/diphtheria Td booster every 10 years.

I have gotten the whooping cough once, so I will never get it again.
False: Immunity seems to wane after about 10 years.

Mark Landrum, M.D., is the section chief of Infectious Diseases at Howard County General Hospital and the Chair of Epidemiology and Infection Prevention Committee. He is with Infectious Disease Associates in Ellicott City.

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tinnitus relief

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Our Johns Hopkins specialist explains the condition and offers tips for tinnitus relief.

An old Irving Berlin song begins with the lyrics, “I hear music and there’s no one there.” When the speaker wonders why, he’s told, “You’re not sick. You’re just in love.” A lovely and romantic notion. But for the millions of people that suffer from tinnitus, the sounds that occur only inside their own head can cause great stress and anxiety, even interfering with their sleep and daily activities.

An estimated 50 million American adults have experienced tinnitus at some time, and one in five of those with tinnitus seek medical attention. It is most common among the elderly and is listed as the most common service-related disability among military veterans—tinnitus is believed to be linked to long-term noise exposure, such as that caused by firearms or loud music.

What is tinnitus?
Tinnitus is the clinical name for ringing in the ears, but it can also include other phantom sounds like buzzing, clicking, hissing, whooshing and pulsating, for which there are no apparent external sources. There are two types: primary tinnitus has no obvious cause and is often associated with hearing loss, while secondary tinnitus is associated with an underlying disease or condition and may also be accompanied by hearing loss. The American Tinnitus Association lists a variety of causes for this condition that include:

  • damage to nerve endings and stiffening of bones in the inner ear
  • advancing age
  • exposure to loud noises
  • allergies
  • high or low blood pressure
  • diabetes
  • thyroid problems
  • wax buildup
  • certain medications
  • head and neck tumors.

Johns Hopkins pediatric otolaryngologist David Tunkel, M.D., led a panel to develop guidelines to help primary care physicians and specialists treat and manage tinnitus (October 2014 issue of Otolaryngology—Head and Neck Surgery). The following information and suggestions come from the guidelines published by Dr. Tunkel’s committee and from the American Tinnitus Association.

What should I do if I think I have tinnitus?
Have your doctor diagnose your condition by reviewing your medical history and giving you a physical exam to rule out other possible conditions. He or she will look inside your ear canal and may find a treatable cause, such as earwax or fluid behind the eardrum. You should also have a hearing test to see if hearing loss is accompanying the tinnitus.

What treatments are available?
Tinnitus may go away on its own, but when it lasts for more than six months, and when tinnitus is bothersome, one or more of the following may be helpful:

  • Hearing aids can make the tinnitus less noticeable.
  • Cochlear implants may help mask tinnitus with ambient sounds or suppress tinnitus with the electrical stimulation they send through the auditory nerve.
  • Counseling and cognitive behavioral therapy can teach people how to cope to reduce the impact of the tinnitus.
  • A variety of sound therapy devices and methods may help. Such therapies range from devices that supply background noise such as a smart phone, CD or MP3 player or radio, to specialized devices made just for the treatment of tinnitus.
  • Treatment by a dentist to correct your bite can bring relief if you suffer from a dysfunction of the jaw known as TMJ (temporomandibular joint).
  • There is no convincing clinical evidence to prove that products such as Ginkgo Biloba, melatonin or zinc help patients with tinnitus. Similarly, there is no proof that medications injected through the eardrum, magnetic stimulation or acupuncture can improve tinnitus.


Where can I find help if I have tinnitus? Your doctor can provide information and suggest self-help books. Support associations and resources are also available. For more information, visit the American Tinnitus Association, the American Academy of Otolaryngology-Head and Neck Surgery and National Institutes of Health.


Johns Hopkins pediatric otolaryngologist David Tunkel, M.D.


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