<p class="article-body"> Navigating the healthcare system can be daunting. Patients, especially those with chronic diseases, such as diabetes, hypertension and obesity, are tasked with keeping track of a multitude of overwhelming details about their own care. These details include understanding and properly managing their medications, knowing who to contact with questions, remembering to schedule follow-up appointments with their primary care doctors and specialists and locating social and financial resources to help them meet their goals. <br> <br> </p> <blockquote> Our goal is to keep members of the community healthy and out of the hospital. </blockquote> Recognizing that the complexity of the healthcare process is often an obstacle preventing patients from getting the care they need, GBMC’s primary care practices offer services to help keep patients on the right track. The services, led by a team of nurse care managers and care coordinators, ensure that patients know how to safely navigate the healthcare system and get timely care, answers to questions and referrals to resources. The care managers and coordinators work closely together and with all providers on the medical team to meet the gamut of patient needs — medical, social and financial. “Our primary care patients can expect to receive a call from a care manager and/or coordinator if they’ve recently visited the emergency room or hospital and need any type of follow-up care, education or assistance,” explains Diana Mantell, Administrator for Population Health. “Patients can rest assured that it is not a solicitation call and their medical information remains private and secure. The care manager or coordinator is simply another member of their healthcare team offering assistance.” <br> <br> According to Ms. Mantell, the service is essentially an added benefit to the high-quality care patients already receive at GBMC — one that is meant to be informative and non-intrusive as well as to provide them with individualized care plans and resources that support their healthcare goals. This year alone, nurse care managers have worked with more than 500 patients and the care coordinators have connected patients with resources more than 1,000 times. <br> <br> “One great feature of our care manager and coordinator services is that they are available to any and all of our primary care patients, regardless of what insurance they hold,” says Ms. Mantell. They are in the offices, ready to answer questions, teach patients how to administer medications or use health monitoring devices such as glucometers, and assist in finding financial resources and other support groups to help patients push through any barriers they are facing in maintaining their health and wellness. “Our goal is to keep members of the community healthy and out of the hospital,” she says. “Care manager and coordinator services are designed to help achieve that goal.” <br> <br> Patients interested in being connected to a nursing care manager or care coordinator are encouraged to contact their GBMC primary care physicians directly via their main office number. To find a primary care provider who is right for you, visit <a href="http://mygbmcdoctor.com/" target="_blank" alt="www.mygbmcdoctor.com" title="My GBMC Doctor">www.gbmc.org/mydoctor</a> or call 443-849-GBMC (4262). <div class="end-of-story"> </div>
<p class="article-body"> A diagnosis of breast cancer is a terrifying reality to face. Unfortunately, the disease seems to know few boundaries, affecting women and men of all ages and ethnicities. According to the American Cancer Society, about one in eight women in the United States will develop invasive breast cancer during her lifetime. <br> <br> Sara Fogarty, DO, breast surgeon at the Sandra & Malcolm Berman Comprehensive Breast Care Center at GBMC, does not want that statistic to frighten women. “People should keep in mind that modern medicine has many tools available to estimate a patient’s risk, detect abnormalities early and treat the disease successfully,” she says. “In addition to self-exams and regular visits to an OB-GYN, a lifetime risk assessment is one of the most valuable weapons women have against breast cancer. <br> <br> <strong>Why is a Risk Assessment Important?</strong> <br> Ignorance is often described as bliss, but when it comes to breast cancer, knowledge is power. After an appointment with a physician, patients are presented with a complete picture of their odds for developing breast cancer at some point during their lives. The results of the assessment allow the physician to determine when it’s appropriate to begin mammograms for screening and whether the patient is eligible for more extensive MRI screening or genetic testing. In certain cases, the risk assessment result may signal the physician that a discussion about preventive breast removal surgery (prophylactic mastectomy) is worthwhile. <br> <br> <strong>What to Expect</strong> <br> During a lifetime risk assessment, the physician inquires about a number of standard personal health details like age, menopausal status, use of hormone replacement therapy (HRT) and parity, which refers to the number of children a woman has borne. He or she will also measure the patient’s body mass index (BMI) and take a family history of first- and second-degree relatives with breast or ovarian cancer, including their ages at the time of diagnosis. The physician uses a tool to assess the data and can discuss results with the patient during the same visit. <br> <br> <strong>The Bottom Line</strong> <br> Although patients cannot control some risk factors like family history or age, they can take action on others. Measures that have the most impact on reducing risk include maintaining a healthy weight through diet and exercise, breastfeeding if possible, minimizing alcohol use to no more than one drink per day and avoiding or limiting HRT. “Breast cancer risk assessments are often the beginning of a conversation between the patient and physician about what the patient can control in order to decrease her risk,” notes Dr. Fogarty. “This is an important first step toward prevention.” <br> <br> For more information on the services provided at the Sandra & Malcolm Berman Comprehensive Breast Care Center, visit <a href="/node/2336" alt="www.gbmc.org/breastcare" target="_blank">www.gbmc.org/breastcare</a> or call 443-849-GBMC (4262). </p> <div class="end-of-story"> </div>
<p class="article-body"> Breast cancer is a diagnosis that one in eight women will receive during her lifetime. It can be a scary and overwhelming experience, filled with doctors’ appointments, treatment plan discussions and important decisions to be made. For women whose cancer requires radiation in addition to surgery, treatment itself becomes a time commitment, as they visit the hospital daily over a period of weeks for therapy. GBMC is pleased to offer a new approach to radiation for certain patients. Through intra-operative radiation therapy (IORT), eligible breast cancer patients can receive their entire course of radiation in one session during the lumpectomy surgery. After the breast surgeon removes the lump, a radiation oncologist uses a special device to radiate the area where the tumor used to be. Then the surgeon completes the procedure by closing the site. <br> <br> In addition to the convenience of consolidating weeks of radiation treatment into one session, initial findings show that the recovery time is comparable to that of undergoing lumpectomy alone. The risk of cancer recurrence is also similar between IORT and external radiation therapy. <br> <br> “In a select group of women, IORT offers the chance to have a single radiation dose at the time of surgery,” explains Lauren Schnaper, MD, Director of the Sandra & Malcolm Berman Comprehensive Breast Care Center at GBMC. “It is an attractive alternative to repeated whole breast radiation treatments over an extended period of time. Not everyone is eligible for this type of procedure. The tumor must be a certain size and have favorable behavioral characteristics. IORT is not recommended for young women or those with ductal carcinoma in situ.” Albert Blumberg, MD, radiation oncologist at GBMC, elaborates: “The tumor itself should be deep enough in the breast to allow one centimeter between skin surface and the balloon surface of the radiation device. Ideal candidates are 60 or older, although those in their 50s could be considered if other criteria are met.” <br> <br> There appear to be fewer side effects with IORT as well. Since the treatment occurs under the skin and within the breast tissue itself, skin damage and irritation is reduced. With the highly concentrated dose of radiation being precisely directed to the lumpectomy cavity, other surrounding healthy tissues and organs, including the lungs, heart and ribs, receive reduced radiation exposure. <br> <br> “This technology is helping women to receive treatment quickly so they can get on with their lives,” says Dr. Blumberg. “We’re proud to be able to offer it as an option in their cancer care.” <br> <br> </p> <div class="end-of-story"> </div>
<h3> What Type of Healthcare Setting is Right for You? </h3> Knowing where to turn for healthcare can be confusing because there are many options available, all offering what seem to be similar services. People might wonder if it is necessary to have a primary care physician (PCP) versus going to an urgent care or convenience care clinic. They may also struggle with deciding when an issue warrants a visit to a hospital’s emergency department. Listed below are descriptions for different types of care to help minimize the confusion. <br> <br> A primary care physician’s office, which usually includes physician assistants, nurses, nurse practitioners, technicians and clerical staff, builds relationships with patients, truly getting to know their healthcare goals and needs. The most valuable benefit of having a primary care doctor is that he or she concentrates on health maintenance and managing chronic illnesses like diabetes. GBMC PCP offices offer extended weekday hours and morning office hours on Saturdays. Most of GBMC’s PCP offices function as patient-centered medical homes, emphasizing prevention and wellness rather than treating patients when they’re already sick. Although PCPs are very focused on wellness, they also build time into their schedules to accommodate patients when they are sick as well as to treat minor urgencies, such as sprains. Additionally, nurse practitioners act as extensions of the physicians to offer convenient, timely healthcare access. <br> <br> Urgent care clinics are staffed by a team similar to that of a PCP office, but they typically treat conditions such as sprained ankles, cuts and fevers. They are more focused on episodic care (when a person is already sick or has a minor injury) rather than prevention or overall wellness. Urgent care clinics have late hours, are open on weekends, accept walk-ins and often have other service capabilities such as X-rays, lab work and prescriptions available onsite for patient convenience. <br> <br> Convenience care clinics are located in pharmacies or grocery stores. They are not always staffed by a physician, but instead by nurses or assistants who treat conditions like earaches, sore throats and flu-like symptoms. These clinics typically also offer common vaccinations, like the flu shot, on a walk-in basis. <br> <br> Hospital emergency departments are meant to treat more critical health problems, which may include heart attack, stroke, allergic reaction, major injury, etc. If someone is experiencing symptoms consistent with the above conditions, or has suffered a severe injury, it’s important to call 911 and get to the closest ED. <br> <br> “Finding a PCP is often a good place to start. This will ensure patients have a go-to person who is aware of their overall health status and maintains all of this information on their electronic health record,” explains Mark Lamos, MD, President and Medical Director of Greater Baltimore Medical Associates and Internal Medicine physician at GBMC. “Fortunately for patients, there is always a healthcare option available to handle their individual situation.” <br> <br> <div class="end-of-story"> </div>
<blockquote> “Approximately one out of four women over the age of 18 has likely experienced an involuntary leakage of urine" </blockquote> Embarrassed by the social stigma surrounding urinary incontinence, women experiencing bladder control issues often remain silent or wait years before seeking help. However, according to Joan Blomquist, MD, Division Head of Urogynecology at GBMC, it’s a very common problem to have. “In fact, 11 percent of women will have surgery sometime during their life for incontinence or pelvic organ prolapse. That figure doesn’t even capture the women who can be treated with more conservative approaches or those who are suffering in silence,” says Dr. Blomquist. <br> <br> <figure class="image-left"> <img src="/sites/default/files/hg_features/hg_post/e6b1dbac12720fe8e402daac87900873.jpg"> <figcaption> Joan Blomquist, MD </figcaption> </figure> Urinary incontinence is broken into two main categories: urge and stress. Urge incontinence typically impacts women as they age and makes them feel the need to “go” frequently, often not making it in time. Contractions of the bladder either cause a sudden urge to urinate or, if the contractions are strong enough, bladder leakage. Since urge incontinence can be triggered by acidic or spicy foods, caffeine and alcohol, dietary changes may alleviate some of the symptoms. Other treatments include behavioral management, bladder retraining, pelvic floor exercise/physical therapy and medications to manage the spasms. For some patients, urge incontinence is related to an abnormality of the nerve supplying the bladder. As a result, nerve stimulation, via an office procedure called posterior tibia nerve stimulation, can also be beneficial. “With this procedure, an acupuncture-sized needle is inserted near the ankle to stimulate the tibia nerve once a week for 12 weeks,” explains Dr. Blomquist. “This treatment has proven 60 to 70 percent effective.” <br> <br> Conversely, stress incontinence is less likely to be age related, and is more of an anatomical issue involving improper support of the urethra. “Stress incontinence can be associated with having had a vaginal birth, being overweight or lifting heavy objects — anything that puts excess pressure on the pelvic floor,” she says. Women who are affected by this form of incontinence may experience leakage when laughing or coughing. Treatments include pelvic floor exercises, in-office injections into the urethra, insertion of a medical device in the vagina to hold the urethra stable or an outpatient procedure. <br> <br> “GBMC offers both conservative and surgical treatment options to cater to each individual’s preference and lifestyle,” says Dr. Blomquist, who adds that two physical therapists specializing in pelvic floor issues are available right on campus. “If urinary control issues are impacting your quality of life by preventing you from doing daily activities you enjoy, you might benefit from a consultation with your doctor. With all of the options available, you will likely find a treatment that works very well for you.” <br> <br> <div class="end-of-story"> </div>
<figure class="image-left"> <img src="/sites/default/files/hg_features/hg_post/0ad6925516c1c0127d5f1b908ddeccb7.jpg"> <figcaption> The physicians of GBMC’s Center for Neurology: James Bernheimer, MD; Michael Sellman, MD; Arash Taavoni, DO </figcaption> </figure> Christine Kolodziejski, 77, has an admittedly high pain tolerance. A sufferer of arthritis, she expects a certain amount of pain from day to day. But when pain in her neck started causing progressively worse, excruciating headaches, Mrs. Kolodziejski decided to reach out for help. “It eventually became unbearable — the headaches were so bad that I had trouble seeing,” she says. “I tried calling several neurologists, but the waits were far too long.” She looked to her primary care doctor for advice and learned about GBMC’s Center for Neurology, led by Michael Sellman, MD. “Dr. Sellman had just relocated his practice to GBMC, but made time to see me. He immediately acknowledged how bad my pain was, gave me an injection for instant, but temporary, relief and I was able to carry on with my appointment pain-free.” <br> <br> According to Dr. Sellman, “when people suffer from headaches, like those Mrs. Kolodziejski was experiencing, we start by doing some detective work to find the root of the problem. In her case, the pain was a result of a pinched nerve in the neck.” He emphasizes the importance of taking a holistic approach when caring for headaches, looking at the whole body, both physiologically and psychologically. “Taking care of headaches requires comprehensive examination to rule out issues such as uncontrolled blood pressure, sleep apnea, kidney disease and lung diseases that may be related,” he states. In some cases, the headaches are migraines, which are very common in women and can be triggered by a variety of factors. Treatment options include prescription medication and lifestyle changes, including altering diet, reducing stress and increasing exercise. Botox injections can also help, and are available through the Center. “It’s easy to jump to a worst-case scenario such as assuming headaches are caused by a brain tumor, but that is generally rare. Evaluation can help get to the root of the problem and open a door to many treatment options.” <br> <br> Although the injection Dr. Sellman offered Mrs. Kolodziejski was a temporary fix to her problem, he referred her to Greater Baltimore Neurosurgical Associates (GBNA) to consider surgery as a more permanent solution. His kind demeanor made an impact on her. “I was so impressed with the consideration and compassion of Dr. Sellman and the politeness of his office staff in general,” says Mrs. Kolodziejski. “Thanks to him, I’m now on the path to enjoying my typical lifestyle.” <br> <br> <div class="end-of-story"> </div>
<p class="article-body"> If you’re like most people, you keep a variety of over-the-counter and prescription medications in your home for everything from headaches to heartburn. But did you know that these medications lose their effectiveness past their given expiration date and can also lose potency if they are improperly stored? Here are some important facts to keep in mind to ensure that your medication remains as safe and effective as possible. <br> <br> Expiration dates represent the date at which the manufacturer’s guarantee of a drug’s safety expires. If you take a drug past its expiration date, there is no way to be certain that the medicine will work as intended. The Food and Drug Administration (FDA) requires all medication to have clear labeling of the expiration date. For prescription drugs, look for the term “EXP” followed by the date printed on the label. Over-the-counter medications have the date stamped on the lid or packaging. Once a medication is expired, the FDA recommends specific instructions for disposing of it properly. For more information about properly discarding unwanted drugs, visit the FDA website <a href="http://redirect.viglink.com/?format=go&jsonp=vglnk_150912881942314&key=034153a8f6f990b64f375d12e1cc4572&libId=j9a6ucjn01000nv1000DA1r4cyp5yu0081&loc=http%3A%2F%2Flivinghealthylivingwell.blogspot.com%2F2013%2F12%2Fprescription-for-safety.html&v=1&out=http%3A%2F%2Fwww.fda.gov%2FDrugs%2FResourcesForYou%2FConsumers%2FBuyingUsingMedicineSafely%2FEnsuringSafeUseofMedicine%2FSafeDisposalofMedicines%2Fucm186187.htm&title=Prescription%20for%20Safety%20%7C%20Living%20Healthy%2C%20Living%20Well&txt=%3Cspan%20style%3D%22color%3A%20blue%3B%22%3Ehere%3C%2Fspan%3E" target="_blank">here</a>. <br> <br> Prior to the expiration date, there are several factors to consider for storing your medication. A popular place to store medications is in a bathroom medicine cabinet, but experts at the National Institute of Health (NIH) indicate that it is not an ideal location. The humidity, heat and moisture in a bathroom can decrease a drug’s effectiveness by causing changes in chemical compositions, especially for tablets and capsules (as opposed to liquids). The NIH used aspirin as an example of what can happen as a result of improperly storing aspirin. When kept in a humid environment, aspirin tablets break down into acetic and salicylic acid, which can irritate the stomach. <br> <br> The NIH recommends storing medication in climate-controlled areas. Optimal locations include a hall linen closet shelf, a bedroom drawer or a kitchen cabinet, away from the stove. If you have children, always keep medications in secure containers and out of reach. When traveling, keep your medication with you in a carry-on bag if you are flying to ensure it is in a climate-controlled environment. Never leave medication of any sort in a car, as heat can reduce effectiveness. <br> <br> </p> <div class="end-of-story"> </div>
<p class="article-body"> Having dense breast tissue can pose challenges when it comes to the imaging capabilities of a mammogram. Some early cancers may go undetected because they could be hidden behind dense tissue. Women with dense breast tissue are often called in for additional testing due to unclear results. However, a new Food and Drug Administration (FDA)-approved technology is enhancing mammography for women in this category. This groundbreaking tool is called tomosynthesis mammography, or 3-D mammography, and it is now offered on GBMC’s campus through its imaging partner, Advanced Radiology. “Tomosynthesis mammography is the next logical step in screening women with dense breast tissue,” says Lauren Schnaper, MD, Director of the Sandra & Malcolm Berman Comprehensive Breast Care Center at GBMC. “By imaging ‘slices’ through the breast, overlapping shadows are eliminated and each area of tissue can be seen more clearly.” She explains that subtle tumors become more obvious because they can be separated from background tissue. Fewer women will be called back for additional imaging because of positional changes in the breast from year to year. “Hopefully, it will allow us to advance in two areas: to perform fewer unnecessary biopsies and to find tumors that are hiding behind normal dense tissue.” <br> <br> Some studies show that, when combined with digital 2-D technology, 3-D mammography can provide improved breast cancer detection. All women undergoing a standard mammogram may elect to have this added to their exam at an additional cost of $100, as insurances do not currently pay for the test. <br> <br> <strong>Recognizing Breast Cancer Risk</strong> <br> <br> Besides skin cancer, breast cancer is the most common cancer affecting American women. According to the American Cancer Society (ACS), about 12 percent of women in the United States will develop invasive breast cancer at some point during their lives. Fortunately, thanks to improved technologies, like tomosynthesis mammography, and better education, breast cancers are being diagnosed earlier and more people are surviving it. All women are encouraged to become acquainted with screening recommendations that could help detect breast cancer in its earliest stages. <br> <br> Consult with your physician to determine if 3-D mammography might be a good option for you. Or, call Advanced Radiology at GBMC at 410-580-2300 to learn more about the technology. </p> <div class="end-of-story"> </div>
<p class="article-body"> A large percentage of Americans have taken antibiotics at some point during their lives. They are powerful medicines that physicians may prescribe to treat an infection caused by bacteria. Although some think of them as cure-alls, antibiotics do not work against illnesses that are caused by a virus, like common colds or the flu. Those who take antibiotics to treat a viral infection should think again—they may do more harm than good if not used properly. <br> <br> <strong>Know the Risks</strong> <br> <br> “Antibiotic use certainly has potential risks such as allergic reactions or side effects including nausea or diarrhea,” says Gregory Small, MD, Primary Care Physician for GBMC at Texas Station. “There are also numerous types of antibiotics that treat many different kinds of bacteria. ”Those variables, paired with a person’s individual chemistry, make it nearly impossible to predict whether someone will experience side effects or how severely. <br> <br> Antibiotics don’t distinguish between “bad,” illness-causing bacteria and the normal bacteria that live within the intestines. “Because they upset the balance between bad bacteria and the good types that our bodies need, they may allow some harmful types to grow out of control,” Dr. Small explains. “One increasingly common condition that may occur after antibiotic use is an inflammation of the large intestine or colon called Clostridium difficile colitis, or C. Diff. Symptoms include profuse watery diarrhea, abdominal pain and fever. If left untreated, it can become life-threatening.” <br> <br> Taking antibiotics unnecessarily can also cause what’s known as breeding resistance. With repeated antibiotic exposure, bacteria become resistant to the drugs and continue to grow, ultimately making them more difficult to treat. Stronger medications are required, which often have more serious side effects and a higher cost. <br> <br> <strong>What You Can Do</strong> <br> <br> Dr. Small says the best thing people can do to stay healthy is maintain open communication with their primary care physicians. “Keeping your doctor informed of your symptoms enables him or her to provide better care,” he says. <br> <br> Avoid the temptation to self-diagnose or self-medicate. Differentiating between a bacterial and a viral infection is something that only a physician is qualified to do. Plus, doctors take a number of factors into consideration before selecting an antibiotic for a specific patient. “Take antibiotics exactly as prescribed for you. Never take antibiotics that were prescribed for someone else, or those left over from a previous illness,” he cautions. <br> <br> In the event that an illness is viral rather than bacterial, follow a physician’s instructions and be patient as doctors can recommend or prescribe products to give some relief from cold or flu symptoms, but time is the only cure. Take prevention seriously by getting an annual flu shot and practicing good hand hygiene to stop the spread of germs. <br> <br> </p> <div class="end-of-story"> </div>
<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/WKAgqcs2EfI?list=PL94F16D9D1E83BA12" allowfullscreen="allowfullscreen"></iframe> <p class="article-body"> Dr. Niraj Jani answers common questions about digestive health and gastrointestinal disorders. </p>
<p class="article-body"> REFLUX CRAMPING YOUR STYLE? Talk to Your Physician about GERD <br> <br> For about 20 percent of the United States, gastroesophageal reflux disease (GERD) is a nagging problem. GERD is a digestive disorder that causes the contents of the stomach, mostly acid and bile, to flow back up into the esophagus (the tube that carries food from the mouth to the stomach). The most common symptoms of GERD are heartburn, usually after meals, as well as vomiting and nausea. Other symptoms of GERD can include sore throat or hoarseness, dry cough, bad breath, laryngitis and chest/abdominal pain. <br> <br> “Generally, GERD can be treated through lifestyle modifications, such as diet changes, avoidance of large meals, weight loss and elevating the head of the bed,” says Niraj Jani, MD, Division Head of Gastroenterology and Division Head of GI Oncology at GBMC. “Certain medications may also provide relief, including over-the-counter heartburn remedies.” In extreme cases, surgical procedures to prevent reflux may be considered. <br> <br> </p> <blockquote> “The difficult thing about BE is that there are really no warning signs other than GERD” </blockquote> <strong>When GERD is More than Just a Nuisance</strong> <br> Ten to fifteen percent of patients experiencing chronic GERD will develop a more serious disease called Barrett’s Esophagus (BE). BE causes damage to the lining of the esophagus and can increase a person’s risk of developing esophageal cancer. “The difficult thing about BE is that there are really no warning signs other than GERD,” says Dr. Jani. “However, some factors can help us identify a patient’s risk for BE.” The longer an individual has symptoms of GERD, the more at risk he or she is to get BE. The risk of BE goes up as a person ages, and it is more common in white men. Those with a family history of reflux disease are more likely to suffer from GERD, and in turn, BE. <br> <br> GBMC patients who are identified to be at a higher risk for BE are evaluated by a simple procedure using a long, thin tube with a light and camera at the end, to examine the lining of the esophagus for abnormalities. If any are found, multiple techniques are available for ablating abnormal areas. “One highly effective procedure offered at GBMC’s Kroh Center for Digestive Disorders is called radiofrequency ablation (RFA), which uses heat energy generated by current to burn abnormal cells,” explains Dr. Jani. <br> <br> He encourages patients to see a doctor at the onset of symptoms to prevent serious damage to the esophagus. “Even with our advanced capabilities for treating GERD and BE, there is still no substitute for early detection.” <br> <br> <div class="end-of-story"> </div>
