What is Well & Wise? Well & Wise is a health education partnership led by Howard County General Hospital: A Member of Johns Hopkins Medicine and the Howard County Library System, both in Columbia, Maryland. What is the vision of the partnership? The vision is to enhance, advance, and elevate health education in Howard County, improving the health of our entire community. What is the... read more
Howard County General Hospital
Howard County General Hospital: A Member of Johns Hopkins Medicine is a private, not-for-profit, community health care provider, governed by a community-based board of trustees. Opened in 1973, the original 59-bed, short-stay hospital has grown into a 249-bed comprehensive, acute-care medical center specializing in women’s and children’s services, surgery, cardiology, oncology,... read more
Howard County Library
A major component of Howard County’s strong education system, Howard County Library System is a nationally recognized leader among the great public library systems that delivers high-quality public education for all... read more
What is Well & Wise? Well & Wise is a health education partnership led...
Howard County General Hospital
Howard County General Hospital: A Member of Johns Hopkins Medicine is a...
Howard County Library
A major component of Howard County’s strong education system, Howard...
[Credit: Nastco]/[iStock]/Thinkstock] Common CHF may be due to a weak heart muscle, leaking or narrowed valves, untreated high blood pressure, cardiac arrhythmias and, less often, diseases of the sac around the heart. Our Dr. George Groman offers advice for managing CHF.
The human body is a sponge, and for those with congestive heart failure (CHF), keeping their heart from being overwhelmed by too much fluid accumulating in their body can be an ongoing challenge.
According to George Groman, M.D., a cardiologist on staff at Howard County General Hospital, common causes of CHF can include a weak heart muscle damaged by a heart attack; leaking or narrowed valves; untreated high blood pressure; some cardiac arrhythmias; and, less often, diseases of the sac around the heart. These conditions can make the heart too weak to pump blood adequately. Another cause of CHF is diastolic dysfunction—when the heart is stiff and can’t sufficiently relax to fill with blood. This dysfunction becomes increasingly common with age and uncontrolled blood pressure as well as other causes.
Preventing Fluid Complications If you have CHF, to reduce fluid buildup, Dr. Groman recommends you should:
Limit salt intake. Use pepper or herbs and spices instead. Check with your doctor before using a salt substitute, which could cause a dangerous elevation of potassium.
Be evaluated for sleep apnea if you snore.
Use alcohol prudently—it can weaken the heart in some cases.
Not use illicit drugs.
Eat heart healthy—minimize saturated fat, trans fat and sugar.
Maintain a healthy weight, and monitor your weight daily. If you see a progressive increase of three or more pounds in a week, call your cardiologist, who may adjust your diuretic dose.
Take medications prescribed by your cardiologist.
Treating Fluid Buildup: New Hospital Service
“There can come a time when your small intestine becomes so waterlogged that your medications cannot be adequately absorbed,” says Dr. Groman. “This can result in further fluid buildup and may put you at risk for needing hospitalization and other types of intensive care.” To help patients avoid having to stay in the hospital, HCGH has begun an outpatient IV diuresis service to which your cardiologist can refer you. Appointments are offered weekdays in the hospital’s Infusion Center and last several hours to allow your nurse to record urinary output in response to the diuretic.
During treatment, nurses will speak with you about your diet and medications. All patients will receive a referral for a home care evaluation and remote, nursing-based patient monitoring. Lab work will be done (primarily to evaluate kidney function) and reviewed prior to you returning home.
“This collaborative effort between the patient’s physician, clinic nurses and home health has the potential to keep patients out of the hospital—and that is a very good thing,” notes Dr. Groman.
Sitting for many hours a day is a common practice. Without realizing it, many people are falling victim to sitting disease. The American College of Cardiology defines sitting disease as being sedentary for many hours with little movement and calls it a lifestyle risk factor for cardiovascular disease, blood clots, heart attack, stroke, diabetes and a variety of other conditions.
Even those who incorporate exercise into their routine can have sitting disease. “Going to the gym three days a week to get your heart rate up is not sufficient. You actually need to incorporate movement throughout your daily routine as well,” says Kabir Yousuf, M.D., a cardiologist on staff at Howard County General Hospital. “Often people try to plan out their physical activity too much and get wrapped up with a trainer or a gym class exercise regimen instead of getting out and just moving. My philosophy is to just get up and move—the more the better. This is especially important if you have a sedentary job. Moving doesn’t have to be scheduled—every step and minute you spend doing physical activity counts and can reduce your risk of cardiovascular disease.”
Desk Jockeys: 8 Ways to Stay Fit
Take the stairs
For every hour you sit, move for five minutes. If you can’t do this every hour, do it every two hours and increase your movement to 10 minutes.
Instead of sitting while on the phone, stand.
Park further away in the parking lot to take advantage of walking.
Have walking meetings instead of sitting in meetings throughout the day. If you even take a quarter of your meetings outside of the conference room and walk somewhere, it is beneficial.
When you are at a store—instead of shopping right away—take a lap or two around the store before buying anything.
Get a partner or a friend to motivate you—you will be more apt to be active when you have a partner.
Incorporate technology—using activity trackers, websites and apps, you can track your activity and be reminded to move throughout the day.
Have you ever experienced an emotion that you could not explain or describe? If you have, you can attest to this unexplained emotion leading to even more indescribable emotions. Before you know it, you are left feeling like you don’t understand yourself.
I have had experiences where loved ones have told me to “be happier” or “calm down” after I try to explain what I’m feeling. These dismissive responses have caused me to repress my emotions at times; as if they didn’t exist. You can’t just “be happy” because someone told you that you should be. In fact, you shouldn’t tell someone how and when to feel a certain way. Instead, be respectful of their feelings and find ways to help them.
Many people living with depression and/or anxiety can’t always put their feelings into words. Much less, explain why it’s happening, just that it is. The society we live in is very good at prescribing solutions to fix, assist, or aid in one’s physical health. If we tell a friend we’ve broken our arm, the solution is a cast. If we have any kind of physical illness or disease we have everything from physical therapy to surgery to address these ailments. Unfortunately, when it comes to emotional health (and intelligence) our friends and family aren’t always able to come up with tangible solutions. In fact, mental wellness is often seen as a more abstract concept and, sadly, isn’t always taken seriously.
Working to recognize your emotions (and the emotions of others) and the ability to distinguish between different feelings is key. Once you’re able to identify your emotions and the feelings that come with them, you can use that information to guide your thinking and behavior. Having a plan and taking action to healthfully address your state of mind is an essential step in managing your wellness. A few examples include: examining your diet and exercise regimen, trying meditation, exploring a new hobby, exploring the outdoors, making time for yourself, talking with a close friend or therapist, and coloring. These are just a few ways you can find positive behaviors that can make you both happier and healthier.
Each person experiences life, and the world around them, in a different way. So, the answers to their emotional needs will be just as diverse. Let’s find more ways to be more understanding and practice compassion when the people around us are comfortable sharing their feelings. Besides, we’re on this planet to help each other.
Laci Radford is a Children’s Instructor & Research Specialist at Miller Branch. She is a music lover, writer, and an avid reader. She enjoys attending concerts, plays, and other forms of live entertainment. Her favorite activities include scoping out unique items at thrift stores, bonfires with friends, and having tie-dye parties. She is studying Psychology and plans to become a music and art therapist sooner rather than later.
I was an overweight and inactive kid and never an athlete during my school years. About 15 years ago, my weight was increasing and my cholesterol was high, so I began going to the gym. I found I liked spin classes, but I wanted to get out of the hot spin studio. My cardiology practice partner at the time, Dr. Jack McWatters, was an avid cyclist and lent me a bike so I could try cycling outdoors. That was the start of my addiction to cycling, which eventually led me to participate in many long-distance bike rides both locally and in such far-flung destinations as California and the French Alps.
Around the same time, a neighbor of mine, who was a ‘couch potato’ and a cigar smoker, announced he was going to do a triathlon and I thought, “Why can’t I do that?”
So, in 2005, I found a triathlon training group. I started competing in local events, like the Columbia Triathlon held in Howard County every May. Triathletes are so exuberant, excited and inclusive—they suck you into their world and you want to be part of the next challenge.
In 2011, a cycling buddy encouraged me to compete in my first IRONMAN in Florida, and it went exceptionally well. In 2014, I completed IRONMAN Lake Placid, which was scenic and beautiful. Afterward, my coach encouraged me to race in another IRONMAN in Lake Tahoe to keep momentum and training. As it happened, an arsonist set a forest fire in the area around Lake Tahoe that week and, just as we were warming up for the swim, the organizers cancelled the event. In every IRONMAN competition, spots are given to winners for the world championship. Because no winners came from that event, those spots were chosen from a lottery, and I was selected for one of those coveted spots as IRONMAN World Championship.
An international race, the IRONMAN World Championship in Kona, Hawaii, features the best professional triathletes and best athletes from every age group. For this event, 2,300 athletes started the race and 2,144 finished on a 97-degree day with 100 percent humidity and 20 mph headwinds during much of the bicycle portion. During the race, I burned 10,500 calories!
I train between eight and 17 hours a week, depending on the season. I swim, bike and run, but adding strength training has kept me injury-free for the past three years. I limit processed carbohydrates. I don’t eat out of a box, I eat foods in their least processed form. I eat a variety of fruits and vegetables, lean protein, grains, nuts, dark chocolate and I drink almond milk.
Why do I do this? I like a challenge, I like how it feels and I want to set an example for my patients. I know the profound effect that exercise and diet have on your heart. My lipids were terrible before I started exercising regularly, and now they are off the charts good! My HDL/good cholesterol was under 30, now it’s 86; my LDL/bad cholesterol was 150-160, now it’s 79; my triglycerides were 250, now they are 38.
High, intense and regular levels of exercise cause a release of endorphins—cycling is my legal addiction. If I can’t exercise because it’s snowing or I am too busy, you can tell by my lousy mood.
I tell my patients who don’t exercise that anything is possible—if I can do this, you can do this. You’ve got to start somewhere and build exercise into your routine. You don’t have to be like me, because I’m nuts! But you must build muscle mass and participate in aerobic exercise.
After running, biking and swimming the IRONMAN, I feel an overwhelming elation that I can’t even describe. Coming across the finish line makes me feel like there’s nothing I can’t do.
You don’t have to be like me and do extreme exercise, but you should exercise regularly. The American Heart Association recommends at least 150 minutes of moderate exercise (or 75 minutes of vigorous exercise) every week for adults. This translates into 30 minutes a day, five times a week—but ANY amount of exercise is better than none!
In September 2014, Michael Silverman, M.D., started a year of intense training in preparation for the IRONMAN World Championship. The training included biking 3,915 miles, swimming 414,240 yards, running 898 miles and completing 98 hours of strength training. A cardiologist with Cardiovascular Associates of Central Maryland, Dr. Silverman could be seen on the roads of Howard County starting his day running or biking at 5:30 a.m.
“When it comes to eating right, I find it’s so important for food to be tasty, so that you’ll want to keep eating well for a lifetime,” so goes the opening to the super neat and scrumptious The All-Natural Diabetes Cookbook, which covers everything from classic comfort foods to more exotic fare.
Essential to Jackie Newgent’s philosophy is simplicity, both with time in the kitchen and in choosing the freshest, least-processed foods. One of my favorite recipes in her book is “Buckwheat Banana Pancakes with Walnuts” (page 26). I was surprised to discover that buckwheat is not wheat at all but an herb of Russian descent. Central to Newgent’s cookbook is the idea that non-starchy vegetables promote an essential (and delicious) plant-based approach and that some vegetables can become the entrée, such as yummy cauliflower “steak” (see pages 256-257) “A good rule of thumb,” the registered dietitian nurse says, is “to fill half of your plate with non-starchy vegetables, whether grilled, steamed, roasted, microwave-baked or raw.”
Jessie Shafer, Food and Nutrition Editor for Diabetic Living, supports the half plate non-starchy veggies “ideal” as well. In the intro to the fabulously colorful and very user friendly cookbook Diabetes Meals by The Plate she explains that the trick to healthful eating is in how you arrange your plate. “Visually divide your plate in half and fill one of those halves with nonstarchy vegetables,” she begins, then “divide the remaining half of the plate in two and fill one quarter with a protein. Fill the last quarter with a serving of grains or other starchy food.” Diabetes Meals by The Plate features dozens of pretty, but more importantly, very tasty and healthy recipes. There are lots of offerings for people who like their meat, but also (and in a very neat and unique way) there are offerings for the vegetarian and “Caribbean Tofu and Beans” (see pages 182 and 183) just jumps off the page with vibrancy and the promise of a terrific meal, even for those normally wary of tofu.
Perhaps the most “foodie” of the cookbooks mentioned here, in terms of looks and taste, though (thankfully) not complexity, is the gorgeous (and mouthwatering) The New Diabetes Cookbook. One of my favorite recipes in the book is for “smoked gouda and broccoli lasagnettes.” (see pages 94 and 95) If you love lasagna as much as the author does then you might understand what she means when she says that one of the things she does not like about it is how easy it is to overeat it. That’s where “lasagnettes,” not lasagna, come in. Lasagnettes are mini lasagnas made in a muffin tin, where wontons are used instead of pasta, which saves on both both carbs and calories. Lasagnettes also travel very well and make for easy on-to-go snacks AND they freeze well.
Kate Gardner wrote The New Diabetes Cookbook knowing that cooking and eating well with diabetes is not always easy. There are the worries about carbohydrate content, blood sugar and making the “right” choices. All three cookbooks mentioned here focus on the belief that eating well with diabetes means eating whole, unprocessed foods in moderate portions. Jackie Newgent calls it “eating real” and makes cooking with vegetables a real joy, even to those who are not veggie lovers. Each color group provides distinctive health benefits and makes for terrific presentation in your meals as well as a tasty treat for your palate. It is the position of the American Diabetes Association that there is not “a one size fits all” pattern to eating and that is delightfully evident in all the wonderful and varied choices delivered in these three cookbooks.
Angie Engles has been with the Howard County Library System for 17 years, 14 of which were at the Savage Branch. She currently works at the Central Branch primarily in the Fiction and Audio-visual departments. Her interests include music, books, and old movies.
Jimmy Brothers, Battalion Chief in EMS Operations for the Howard County Department of Fire and Rescue Services
I don’t smoke. I am not overweight. I exercise regularly and eat pretty healthy. But on April 26, 2015 at the age of 46, my heart stopped.
It was a Sunday, and I woke up feeling like I was getting a cold. Not sure I can describe it exactly—I just didn’t feel well. I took some cold medicine and headed out with my family to coach my daughter’s lacrosse game.
On the way home from the game, the elephant arrived and was sitting on my chest. The pain was crushing and shooting down my arm. I was sweating and nauseated. As the Battalion Chief in EMS Operations for the Howard County Department of Fire and Rescue Services (HCDFRS), I knew the symptoms. I was having a heart attack.
My wife was driving, and I realized we were so close to the Elkridge Fire Station. I told her to call to see if the ambulance was there, which, thank goodness, it was. The ambulance crew was waiting outside when we pulled up to the station. I took two steps out of the car and collapsed onto the gurney as they attached a 12-lead EKG to get a reading of my heart. As they hit ‘send’ on the unit to transmit my EKG to Howard County General Hospital, my heart stopped.
I don’t remember going unconscious. The paramedics, one who I had trained, did high performance CPR and shocked my heart back into rhythm.
When my wife Becky arrived at the HCGH Emergency Department, I was already headed to the cardiac catheterization lab where they were waiting for me. The cardiac catheterization showed a 100 percent blockage in the left anterior descending (LAD) artery—a condition sometimes referred to as ‘the widow maker.’ I was given a clot-dissolving medication and a stent was inserted to hold the artery open.
The irony of my story is that, in my role with HCDFRS, I had worked with HCGH to bring much of the cardiac technology and protocols to the county—a system that nearly 10 years later saved my life.
As a part of this unique partnership, paramedics are provided with advanced cardiac training at the HCDFRS Education & Training Section by HCGH cardiologists. In addition, HCDFRS ambulances are equipped with technology that can wirelessly transmit EKG data to HCGH cardiologists and emergency physicians in real time. In the event of a diagnosed heart attack, like I had, the hospital can assemble the cardiac catheterization team before the patient arrives—saving valuable time and, in turn, heart muscle. The gold standard of time to open an artery (often referred to as door-to-balloon time) is no more than 90 minutes from the time the patient enters the hospital’s door. My time was only 38 minutes because I recognized the signs and got help quickly.
The earlier that lifesaving care can be started, the less time the heart muscle is deprived of blood and oxygen which causes the heart to work harder, possibly leading to dangerous cardiac rhythms as was the case with me. This is often followed by cardiac arrest.
Once the heart stops beating, there is only a matter of minutes to get it started again.
Fortunately, my heart attack didn’t leave Becky a widow, but I do have some heart damage. I attended HCGH cardiac rehabilitation for several months and am feeling good.
I encourage everyone to learn CPR so that, if a loved one has a heart attack, you know what to do. If you know CPR, download this free app and follow HCDFRS so you can be notified if someone near your location in Howard County is having a cardiac emergency. The app also will alert you of Automated External Defibrillators (AEDs) close by.
Most important, call 911 if you think you or a loved one is having a heart attack so you can receive emergency cardiac care quickly. Do not wait, and do not drive to the hospital.
James Brothers is the Battalion Chief in EMS Operations for Howard County Department of Fire and Rescue Services (HCDFRS).
February is American Heart Month. President Obama stated in his proclamation, “Every person can take steps to reduce the risk factors associated with heart disease in themselves and in those they care about –whether as parents, caretakers, or friends—by encouraging healthy eating, physical activity, and by discouraging the use of tobacco.”
One of the ways to keep your heart healthy is to eat well. Howard County Library System has an extensive collection of cookbooks to help you get started. Go Fresh: A Heart-Healthy Cookbook with Shopping and Storage Tips is one of the cookbooks in a series by the American Heart Association. What I liked best about this cookbook is that most of the ingredients cited I have on hand in my kitchen or I know I can find easily in the grocery store. This cookbook includes in an appendix a list of the approximate equivalents in weight and volume for the most common vegetables and fruits. Also included in the appendices, are vegetable cooking times and a food storage guide. I learned it is best to store fresh herbs, such as parsley, dill, and cilantro, in the refrigerator in a juice glass half-filled with water and, covered loosely with plastic. Now let’s get to the recipes, which by the way, include desserts! My boys liked the Peppered Sirloin with Steakhouse Onions (p.167) and I liked the Ancho Chicken and Black Bean Salad with Cilantro-Lime Dressing (p.96). We are going to try the Buffalo Chicken with Slaw (p.147) next. I think I can even convince them to try one of the vegetarian entrées, especially if we can have Soft-Serve Blueberry-Cinnamon Ice Cream (p. 297) for dessert! Visit the library to find more cookbooks from the American Heart Association, including titles on slow cooking, reducing sodium, and reducing bad fats.
I also recommend Barbara Seelig-Brown’s Secrets of Healthy Cooking: A Guide to Simplifying the Art of Heart Healthy and Diabetic Cookingpublished by the American Diabetes Association. This cookbook is great for the new cook because it includes sections on building a pantry for healthy cooking, an essential equipment list, a kitchen glossary, how to read a recipe, and the must-know basic wine pairing. I found the fish know-how section very helpful. I am not a fan of seafood, so I liked the tip “…if you don’t like fish, then disguising it with strong flavors is for you.” There are colorful pictures throughout the book that illustrate step-by-step how to, for example, cook in parchment, steam shrimp, peal and chop garlic, cut a mango, cook with wine, make pizza/calzone dough, or a phyllo pie crust. My favorite recipes were the salad pizza (p. 28) and the crunchy quinoa stuffed zucchini (p. 99). The next time my kids are all home I might just feel brave enough to try the lemon garlic shrimp on a cucumber flower (p. 82). What I liked about this cookbook is that it is perfect for both the beginner cook and the experienced cook.
Healthy eating and cooking can make a difference in improving your cardiovascular health. Some of the foods that are heart-healthy include fish high in omega-3s, such as salmon and tuna, healthy nuts such as almonds or walnuts, berries, such as blueberries and strawberries, dark beans, such as kidney or black beans, and red, yellow, and orange veggies. You can find more information on heart healthy foods at Johns Hopkins Medicine. This month when you’re shopping for your valentine, remember that your loved ones need you to take care of the most important heart of all, your own. After looking at these cookbooks in your local library, you might just be inspired to cook a healthy-heart meal instead of making that reservation.
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.