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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Prácticas de Piscina By Asdrubal Velasquez (Visionado on FLICKR)


I rejoice when the weather is warm enough to swim! Swimming is one of the most healthful ways to exercise, and is broadly enjoyed by people of all ages, from babies to the aged. People can get into the pool and enjoy themselves so much that they don’t even know how much beneficial aerobic (heart-pumping) exercise they’re getting.

Aerobic exercise itself has important health benefits: it reduces harmful inflammation linked to many diseases; lowers stress; lowers blood pressure; strengthens muscles (including the heart), and can even help smokers to quit. In fact, swimming is one of the most highly-recommended types of aerobic exercises, according to Johns Hopkins exercise physiologist Kerry J. Stewart, Ed. D. In addition, it’s one of the best exercises for older adults, as it’s easy on the joints.

Most swimmers in Howard County don’t have access to natural bodies of water, such as lakes or the ocean, so we swim in the neighborhood pool, kindly supplied by Columbia Association, one of the neighborhoods in other towns, or by a private owner. The water in these pools needs to be carefully maintained for cleanliness, because the people splashing around bring bacteria into the standing water of the pool. The operators of these pools add chemicals to the water. Without chlorination, health risks would prevent our swimming in a pool.

Most pool operators maintain water cleanliness with chlorine-based chemicals, then test the water for the correct balance of pH (acid-alkaline balance) and chemicals several times throughout the day. Although several alternatives to chlorine exist, each has a disadvantage, including a substantial differential in price. So additions of chlorine seem to be the default choice for water cleanliness.

But chlorine use has its side affects: it’s drying to skin and hair, and may make swimmers’ eyes redden and burn. Some some people are undeniably allergic to chlorine; some people suspect chlorine of causing serious diseases of the respiratory tract or even cancer; but research on these serious side effects is not conclusive.

But (sniff) what’s that sharp smell? Smells like too much chlorine!

Actually, that smell is the result of inadequate amounts of chlorine. Here’s the science: molecules of chlorine combines with molecules of nitrogen or ammonia being thrown off our bodies (organic matter). This is what smells bad. Whenthere is more chlorine in the water, the chlorine can do its job and the odor should be minimal. It’s inadequately-chlorinated water that is most irritating to the skin and eyes, and may be implicated in swimmer’s ear, a common ear infection due to constantly-wet ear canals and bacteria in the water.

And why is the water so cloudy? It’s due to any combination of these events: particles forced out of the water by imbalanced water, poor filtration or sanitation, or heat. Hot days can contribute to cloudy water.

Unless there are other health-related risks, the health benefits, fun, and social value of swimming far outweighs the disadvantages posed by chlorine. One of the rites of summer is swimming, especially out of doors on a hot Maryland day.

The Center for Disease Control’s Triple A’s of Healthy Swimming go into depth on ways to keep everyone healthy when in the water. The most important and easiest of these include:

  • Staying out of the water if you are ill, especially illness of your digestive tract. Also stay out of the water if you have a cut or other break in your skin. Being aware of potential water-borne problems.
  • Showering before you swim to rinse off the organic materials on your skin. This way, you won’t be contributing to what the chlorine as to break down.
  • Regular bathroom breaks for children and adults are crucial. Urine, after all, in another organic material.
  • Protecting yourself with eye goggles, an after-swim shower, shampoo, and body moisturizer.
  • Questions to ask the pool operator: “Are chemical levels checked at least twice per day, or more often when the pool is heavily used?”, “What is the latest pool inspection score?”, and “Has the pool operator completed specialized training in pool operation?”Have a great swim!
Jean has recently retired from Howard County Library System. She also swims at four different Columbia Association pools each summer.

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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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method express 617397With the pressure of the beach and pool season upon us, many people start looking for stomach exercises to look better in their bathing suits. Visions of 6 pack abs, or any pack abs for that matter, from magazine photos and TV ads often drive these requests. It takes months and months to build muscle tissue and developing visible abs requires a great amount of work with both nutrition and exercise as well as the right genetics. Additionally, any sort of 1, 2, or 6 pack does not necessarily equate to great posture and daily function just as the absence of a “pack” does not indicate weak muscles.

So, where’s the motivation to exercise if the visible benefit comes with so much work and little promise of actually seeing those abdominals? Ever experience back pain or stiffness? Or neck/shoulder “stress”? Going beyond what we look like in our swimsuit and on to exercises that impact our posture takes a generic workout and extends it into specific and appropriate movements for each individual person to help minimize some of these annoying, painful issues.

Posture! Such an exciting word, right? At some point, we’ve all had to address our posture either because of a constant nagging to “stand up straight” or our bodies screaming at us in pain. Let’s take a deeper look and investigate what this means. Throughout this article, you will learn how posture influences breathing, muscular tightness and balance and some tips to help make improvements and feel better overall.

fixing you back pain 317138A normal spine consists of a curvature in the neck or cervical area, the mid back or thoracic area and the lower back or lumbar area. Over time, abnormal curvatures develop in one or more of these areas contributing to various aches and pains. The terms kyphosis, lordosis and scoliosis define these curvatures. Kyphosis means a curve in the upper part of the back1, often appearing with slouched, rounded shoulders and a forward head. Lordosis appears as a strong curve in the lower part of the back, like a sway back. With scoliosis2, the spine curves in a C or S shape and the shoulders and/or hips appear higher on one side.

In the average person, these postural issues signal how our bodies develop over time and can come from sitting for hours, carrying a purse or backpack, and in most cases can be positively impacted through the right exercises. Finding the balance of appropriate strength training, range of motion exercises, and cardiovascular exercise can help improve these muscular imbalances.
For example, for someone with rounded shoulders doing exercises to open up the chest, strengthen the upper back and mid-section will bring the head and chest back up into better alignment. Doing lengthening exercises on the hamstrings may help as well. This will also help open up the lungs for better breathing. The person with a sway back will benefit from exercises loosening up the lower back, strengthening the muscles that extend the hip and opening up the hip flexors. Look at how you stand in the mirror. While it may not seem extreme, pay attention to how your shoulders, hips, and head sit in relation to each other.

Spend time working on incorporating exercises that strengthen the entire body and develop a well-rounded program with all components. With exercise, take time to be intentional with your movements. Make sure to use appropriate progressions with the right intensity for your fitness level, at that point in time. Learn proper form and the benefit of movement for a lifetime, not a moment in time.

[Editors note: As always, please speak with your family physician before starting a new exercise program.] 

Lisa Martin founded the Girls on the Run program in Howard County in 2009. Lisa is AFAA & NSCA certified, has more than 15 years of personal training experience, and practices a multidimensional wellness approach at her studio, Salvere Health & Fitness. Lisa says that one of the best things about being in the health and fitness industry is watching people accomplish things they never thought possible.

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choose a pediatrician

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“Parenthood is a long and wonderful journey and having a medical professional who is caring and understanding from the beginning is an important part of this experience,” says Edisa Padder, M.D., a pediatrician on staff at HCGH. “Every parent should feel their pediatrician cares about their child as if they are their own. Your pediatrician’s office should be your medical home, where all your child’s medical needs are met.”

One way to get started finding a pediatrician is to ask for referrals from family and friends. Your next step should be visiting the pediatrician’s office and meeting with the doctor, even before your baby is born. “A few issues to consider when choosing a pediatrician are the willingness of the pediatrician to listen and hear your concerns about your child, whether a simple question or complex medical issue,” explains Dr. Padder. “If you have a trusting relationship with your pediatrician, even a difficult situation becomes more manageable.”

Understand whether your pediatrician works full- or part-time and who you talk to or see after hours. “You want to talk to a physician who knows your family so he/she can give you proper guidance and advice,” explains Dr. Padder. “When your child gets sick after office hours, you should call your pediatrician’s answering service for guidance — if you know it is truly an emergency, go to the emergency room. If you are not sure whether your concern requires an urgent evaluation, please contact your pediatrician on call immediately. Additionally, you want to know how easy it is to get an appointment if your child is sick or for a well-child visit.”

Choose a doctor who shares your parenting philosophy and style and sees eye-to-eye with you on issues such as feeding, antibiotics, colic and sleep problems. Decide whether you want a solo practitioner or group practice and check the pediatrician’s training and credentials. “Know your initials,” says Dr. Padder. An M.D. attended medical school, did three years of residency and passed American Board of Pediatrics examinations. FAAP after a doctor’s name signifies a fellow of the American Academy of Pediatrics. Also trained to work with children are medical doctors who are family practitioners, nurse practitioners (NPs) and physician’s assistants (PAs).

In addition to family and friends, other sources for finding a pediatrician include the Howard County General Hospital Find A Doctor, your insurance’s website and the American Academy of Pediatrics .

Visiting the Office
When visiting potential pediatrician offices, ask questions:

  1. Is the doctor in a group practice?
  2. Does another physician cover for the doctor at times?
  3. Is there a nurse in the office who can answer routine questions?
  4. Who handles phone calls when the office is closed?
  5. Is your insurance accepted?
  6. What is the office policy on taking and returning phone calls?
  7. A question to ask yourself: Are the physician and office staff courteous? Do they show compassion and patience or did you feel rushed?
Edisa Padder, M.D., is a pediatrician with Padder Health Services in Columbia. Call for an appointment, 301-560-4747

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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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