<p class="article-body"> Bariatric surgeons at GBMC have a common purpose when describing why they chose to work in bariatrics: helping people achieve sustainable weight loss in the most effective way possible. Shauna Costinett, MD, says, “Obesity permeates every aspect of a patient’s life. When people don’t feel good in their bodies, they don’t feel good in their lives.” <br> <br> Emily Watters, MD, agrees, “Obesity affects how you’re able to move around, play with your kids, or walk from your car to the grocery store, and it’s associated with more than 40 different types of illnesses.” <br> <br> This desire to help improve patients’ quality of life led Drs. Costinett and Watters to the Comprehensive Obesity Management Program (COMP) at GBMC HealthCare, where they regularly perform sleeve gastrectomy and gastric bypass surgeries, two of the most common weight loss surgeries implemented nationwide. <br> <br> In a sleeve gastrectomy, part of the stomach is separated and removed from the body. The remaining section of the stomach is formed into a tubelike structure, which cannot hold as much food. Gastric bypass surgery shrinks the size of your stomach, so you can't eat as much as you could before the surgery. The surgeon will also re-route, or bypass, part of your digestive system so you don't absorb as much food. <br> <br> Dr. Costinett says these are some of the most rewarding surgeries she does. For Dr. Watters, the choice to pursue a career in bariatric surgery came from a love of solving a problem as well as the continued communication with each patient after the procedure. <br> <br> “Surgery is a very satisfying profession. A problem comes in, surgery is performed, a problem is gone,” Dr. Watters says. “With bariatric surgery, there’s also a long-term relationship with the patient because it’s so life-changing.” <br> <br> Both doctors emphasize surgery is not the solution to long-term weight loss; rather it’s a tool in the toolkit for sustainability. COMP is key to helping patients keep the weight off for good. <br> <br> “We have a Facebook group full of amazing, supportive patients and staff who are there to offer advice. We have a great nutritionist who meets with patients once a month, and we partner with a personal trainer who’s been through surgery herself,” Dr. Watters says. <br> <br> “The Facebook support group is like a family that patients can turn to when things are getting hard or stressful,” Dr. Costinett adds. “Our clinical team is really active in the group, making sure patients are able to get in touch with us and get continued support after the surgery.” <br> <br> They encourage anyone who’s considering weight loss surgery to reach out to the COMP team at GBMC. <br> <br> Dr. Watters explains, “We [the surgeons] hold regular seminars to go over all the general information regarding weight loss surgery before meeting with patients one on one.” <br> <br> Dr. Costinett says scheduling a consultation with a surgeon should be viewed as an open conversation focused on gathering information. <br> <br> “People can be nervous to reach out, but you’re not signing a contract. We’re having a conversation. We’re here to explain why surgery is the most effective treatment we can offer patients in the disease of obesity, and let the patients decide if it's right for them,” Dr. Costinett says. <br> <br> Both women agree that coming to work at GBMC was an easy decision because of the collaboration between team members and dedication to patient care. <br> <br> “We have a great reputation as being a place that people want to stay and receive treatment,” Dr. Costinett says. “It’s a very special place where people love their jobs and love taking care of patients.” </p> <div class="end-of-story"> </div>
<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/E3HIa-bazl0" allowfullscreen="allowfullscreen"></iframe> <p class="article-body"> Doctor Brian Kaplan the challenge of his patients who are hearing impaired and how wearing a mask has made communicating difficult. </p>
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COVID-19 has presented itself in many different ways due to the number of its variants and each individual’s unique response to infection. Many who have had COVID-19 are still experiencing lingering symptoms—known as long COVID—even after the infection itself has moved on. Theodore Bailey, MD, JD, MA, Chief of the Division of Infectious Diseases at GBMC, said this should not be a surprise when you understand how infections in general move through the body. “Long COVID is not a chronic infection; it’s a chronic, lasting injury as a result of having had COVID,” Dr. Bailey said. “And that effect is not unique to COVID. You could have Hepatitis B and get cirrhosis, a scarring of the liver. If you cure the Hepatitis B, the scarring of the liver is still there. We know many, many infections can cause lasting injuries; COVID is just one more infection on that list.” Ongoing research on long COVID seeks to answer questions such as:Why does it affect some people and not others?How can we differentiate between somebody who has lasting injuries because of COVID and someone who is experiencing them for another reason?What can we do to intervene and when?How can we prevent long COVID?Who is most at risk?Can we reverse the damage?But until those questions can be answered, it’s important to understand the facts. SymptomsJust as the COVID-19 infection acts differently in everyone, so does long COVID. Common symptoms are exercise intolerance, loss of stamina, fatigue, racing heartbeat, brain fog or a change in accuracy of efficiency in thinking as well as a lasting and disruptive loss of taste or smell. These symptoms can also be indicators of different problems. Experts and clinicians are now challenged to determine the root cause in order to effectively move forward with treatment options. In addition to the more mild symptoms listed above, Dr. Bailey identified two major injuries that could occur as a result of COVID-19: one to the automatic nervous system and one to the lungs. “We know COVID can target the nervous system and may affect the nerves we don’t control like our ability to respond to increased levels of activity, which can cause fatigue and a lack of energy. One of the more extreme versions is something called POTS.” Postural orthostatic tachycardia syndrome (POTS) affects blood flow and causes lightheadedness and an increased heart rate when standing. The condition preexisted COVID but has become more prominent since. “The other injury that can happen is when the virus alters the actual structure of the lung tissue. It can cause the cells of the lung to fuse with each other to form syncytia, which means the elasticity or just the mechanical function of the lung may be permanently impaired well beyond the infection itself. That’s another major change that seems to occur in some patients.” SolutionsIf you suspect you have long COVID, or are experiencing symptoms, the first place to start is to schedule an appointment with your primary care physician. They will be able to look at the symptoms in relation to your medical history and advise on potential next steps. Lung issues can be treated by a pulmonologist, and a POTS diagnosis would require a cardiologist. There are also a rising number of long COVID clinics, that will by nature accumulate the greatest level of expertise and experience in treating this set of symptoms. “In visiting a long COVID clinic, you will benefit from and contribute to the accumulation of experience of this issue,” Dr. Bailey said. “This is not homogenous. We talk about Eskimos having 30 different names for snow, and for long COVID you want an expert who is aware of all the different iterations so they can treat specific types on their own terms instead of resorting to one stereotype as if there is a one-size-fits-all treatment for it. That kind of expertise and discrimination is going to be most available in these clinics so seeking those out would be the most practical thing to do.” While long COVID symptoms can be concerning or stressful, there is help available as well as extensive research being done to work through the causes, types and treatments. GBMC does not have a long COVID clinic currently, but GBMC Health Partners primary care practices can be great starting places for those questioning the origin of their symptoms. Additionally, clinical experts across specialties at GBMC such as infectious disease, pulmonology, physical therapy and more are continuing to educate themselves as long COVID research unfolds in order to treat patients with the best and most up-to-date care possible.
<embedded-content data-plugin-config="{"video_content_config":{"video_image":[],"video_image_alt":"","video_upload":[],"video_embed":"https:\/\/www.youtube.com\/embed\/xOR0nrwSdME","video_url":""},"video_style_config":{"video_background_color":{"settings":{"color":""}},"video_play_background_color":{"settings":{"color":""}},"video_play_opacity":"","video_play_color":{"settings":{"color":""}}}}" data-plugin-id="embedded_video"> </embedded-content><p class="article-body">The Medical Director of The Hoover Low Vision Rehabilitation Center at GBMC, Dr. Janet Sunness discussed age-related macular degeneration, a condition that causes you to see blurry, distorted, or blank spots.</p>
<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/AExqI4Q-AGU" allowfullscreen="allowfullscreen"></iframe> <p class="article-body"> Fong Liu, MD, Gynecologic Oncologist at GBMC and Assistant Professor at JHSOM will explain cervical cancer prevention, diagnosis, and treatment. </p>
<embedded-content data-plugin-config="{"video_content_config":{"video_image":[],"video_image_alt":"","video_upload":[],"video_embed":"https:\/\/www.youtube.com\/embed\/aApIR9kH8xc","video_url":""},"video_style_config":{"video_background_color":{"settings":{"color":""}},"video_play_background_color":{"settings":{"color":""}},"video_play_opacity":"","video_play_color":{"settings":{"color":""}}}}" data-plugin-id="embedded_video"> </embedded-content><p class="article-body">Dr. Emily J. Watters, general surgeon for GBMC Health Partners Finney Trimble Surgical Associates and a bariatric surgeon for the GBMC Comprehensive Obesity Management Program, discusses weight loss surgery and the role it plays in a lifestyle change.</p>
<embedded-content data-plugin-config="{"video_content_config":{"video_image":[],"video_image_alt":"","video_upload":[],"video_embed":"https:\/\/www.youtube.com\/embed\/xV4uAFykI-E","video_url":""},"video_style_config":{"video_background_color":{"settings":{"color":""}},"video_play_background_color":{"settings":{"color":""}},"video_play_opacity":"","video_play_color":{"settings":{"color":""}}}}" data-plugin-id="embedded_video"> </embedded-content><p class="article-body">Nearly 50,000 new cases of thyroid cancer are projected to be diagnosed in the U.S. in 2022. The good news is that 85% of those cancers will fall into the category of differentiated thyroid cancers, which are very treatable. “With a skilled and experienced surgeon and treatment team, most patients with this type of thyroid cancer can expect to be cured,” said Farzad Masroor, MD, head and neck surgeon at GBMC’s Milton J. Dance, Jr. Head and Neck Center. </p><p class="article-body">The thyroid is a butterfly-shaped gland located in front of the windpipe or trachea. It’s an endocrine gland that makes hormones that affect a wide range of processes in your body, from how quickly you burn calories to your heart rate, breathing, body temperature, cholesterol levels, and women’s menstrual cycles. </p><p class="article-body">There are several types of thyroid disorders, including hypo- and hyperthyroidism, which cause the gland to be under or overactive, and thyroid cancer. Hypo- and hyperthyroidism are usually treated with medications and radioactive iodine, though in some cases surgery may be an option. Most cases of thyroid cancer are treated with surgery to remove part or all of the gland and any surrounding lymph nodes where cancer is found followed by treatment with radioactive iodine. </p><p class="article-body">Thyroid cancer falls into three groups—differentiated thyroid cancer, where the cancer arises from cells in the lining of thyroid; medullary thyroid cancer, which is not as common and is slightly more aggressive; and anaplastic thyroid cancer, which is very rare and very aggressive. </p><p class="article-body">“Common symptoms of thyroid cancer include changes in your voice or hoarseness, changes in breathing, where it becomes harder to breathe or your breathing becomes noisy, and difficulty swallowing,” explained Ray Blanco, MD, medical director of GBMC’s Milton J. Dance, Jr. Head and Neck Center. “Some people notice a lump in their neck, indicating an enlarged thyroid, or they have no symptoms and changes in the thyroid are discovered by their primary care physician during an annual physical or during a work-up for another health condition.” </p><p class="article-body">People who are at a greater risk for thyroid disease and thyroid cancer include those with autoimmune diseases like rheumatoid arthritis and type 1 diabetes, people who had past radiation treatment of the neck, and people who are overweight. Gender also plays a role—thyroid cancer is three times more likely in women between the ages of 40 and 60. For medullary thyroid cancer, genetics can increase risk. “After surgery for thyroid cancer, many patients are able to go home the same day,” added Dr. Masroor. “Recovery is not particularly painful and pain management requires only Tylenol or ibuprofen.”</p>
<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/RzZUBC6k9ZQ" allowfullscreen="allowfullscreen"></iframe> <p class="article-body"> <a href="https://www.gbmc.org/dr-alan-l-kimmel-md-internal-medicine">Dr. Alan Kimmel</a> is the chair of Rehab Medicine at GBMC and has received comprehensive training as a lymphologist from Harvard Medical School. He has been the driving force behind GBMC's Lymphedema Center, which has become one of the nation's leading referral centers for complex Lymphedema patients. <br> <br> On December 8, Dr. Kimmel spoke about the importance of rehabilitation in conjunction with cancer treatment in order for the patient to feel like themselves after treatment and answered questions on what his team can do for patients to ensure they return to full function, which often starts with a visit prior to surgery or chemotherapy treatment. Dr. Kimmel believes knowing a patient's full, comprehensive history and lifestyle is important to preemptively addressing any issues a patient may run into during or after treatment. </p> <h3> Three Takeaways </h3> <ol> <li> Rehabilitation for cancer patients should begin before treatment. While starting treatment is the No. 1 focus, Dr. Kimmel suggests coming in for an evaluation prior to starting treatment or having surgery if possible. While rehab will not determine cancer treatment, it is important the rehab team considers a patient's lifestyle, activities they'd like to return to, as well as note previous physical injuries that might play a role in therapies. The main goal of the rehab program is for the patient to return to wellness. </li> <li> Neuropathy is a common disorder that can be caused by chemotherapies, and can be treated with medication and therapy. However, it is a nerve disorder that affects both cancer patients and non-cancer patients. Neuropathy is when the nerves in your extremities (fingers, toes, hands, feet) are hypersensitive and can experience a great deal of pain. </li> <li> Lymphedema is another disorder that can affect both cancer patients and non-cancer patients. Lymphedema is caused when cancer treatments damage the lymphatic system, which is the body's way of "emptying the garbage." If the lymph nodes are not properly functioning, that can lead to a build-up of fluid. Dr. Kimmel mentioned that since many improvements have been made for treating patients, the number of patients that suffer from lymphedema has decreased. </li> </ol> <br> <a href="/node/2543">The GBMC Rehab Medicine Program</a> works with multidisciplinary teams to help patients with their mental health as well. Specifically, GBMC's Oncology Support Program, which staffs social workers and provides resources for patients and families. Dr. Kimmel said it is important to have linear goals and focus on the small wins. Oncology Support Services is just one area of the Sandra and Malcolm Berman Cancer Institute that is 100% funded by philanthropy. To support oncology patients, <a href="https://www.classy.org/give/288692/#!/donation/checkout">please consider making a contribution to the Sandra and Malcolm Berman Cancer Institute.</a>
<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/WAc5_71wdGw" allowfullscreen="allowfullscreen"></iframe> <p class="article-body"> Janet S. Sunness, MD, Medical Director of the Hoover Low Vision Rehabilitation Services and Department of Ophthalmology at GBMC - Greater Baltimore Medical Center discussed Macular Degeneration. </p>
<p class="article-body"> The COVID-19 pandemic began more than 18 months ago, and while a sense of normalcy is returning to daily life, lingering evidence shows the lockdowns have affected Americans’ health and routines in many ways. Gregory Small, M.D., Director of Primary Care Medicine at GBMC HealthCare, says he’s seen an increase in type 2 diabetes diagnoses in primary care patients because of the pandemic. <br> <br> “There were definitely patients who went from pre-diabetes to diabetes during COVID-19,” he explains. “There was a transition from having properly controlled habits to poorly controlled [ones]. We saw a rise in the use of alcohol and a lot more stress.” <br> <br> Dr. Small says primary care physicians and nurses at GBMC have a responsibility to continue re-engaging with the almost 6,000 patients in the system who are diabetic and partner with them to properly manage their disease. <br> <br> Optimal diabetes control comes down to a collaboration between the patient and their provider, Dr. Small says. <br> <br> “At GBMC, we take ownership of our patients’ health by engaging in short-term follow up and reinforcing points of education,” he says. “It’s important that physicians have a partnership with their patients, which is much more complex than just prescribing medications.” <br> <br> One of the ways GBMC goes above the standard of care is by having a Registered Nurse (RN) Care Manager on staff, who serves as an extension of the physician team outside of office visits. <br> <br> “As an integral part of the care team, the RN can consult with the prescribing clinician for medication adjustments outside of traditional office visits while also arranging for nutritional education and providing other tools for supporting patients,” Dr. Small says. <br> <br> Because the severity of type 2 diabetes can be influenced and affected by lifestyle changes, Dr. Small says patients need to be armed with the right education so they understand how the decisions they make regarding their disease can influence the way diabetes affects other parts of their lives. Dr. Small adds diabetes care goes beyond monitoring glucose levels. <br> <br> “Poorly controlled diabetes can bring a lot more kidney and heart problems,” he explains. “We track blood pressure control, [and] we screen for protein in urine.” <br> <br> Diabetic retinopathy is a diabetic complication that can affect the eyes, so regular eye exams are also a part of the comprehensive care provided by GBMC Health Partners. <br> <br> To help with the mental effects of diabetes, GBMC also has a behavioral health counselor on hand who works with the primary care clinicians. <br> <br> “Many patients with a chronic illness that’s been poorly controlled will also suffer from depression or anxiety,” Dr. Small says. “Our behavioral health support helps break down barriers patients may be facing to help improve their mental and physical health conditions.” <br> <br> Above all, Dr. Small emphasizes, the clinicians at GBMC are committed to holding themselves accountable in helping patients manage chronic illness. <br> <br> “It’s about creating a system to have the right levels of support and education for our patients,” he says. “We want to partner with patients to ultimately minimize the medicines they need and keep their diabetes under control.” </p> <div class="end-of-story"> </div>
Caregivers are key for people living with dementia If you or someone you care about is living with dementia, you know it’s a complex disease. Ellen Deibert, MD, FAHA, Director of Neurology and Medical Director, GBMC Stroke Center, talked with Mary Beth Marsden and shared information to help patients, family members, and caregivers learn about this group of common brain disorders that affect approximately 47.5 million people worldwide. “Dementia is the larger category of brain disorders that cause a progressive, worsening process of neurodegeneration that affects memory, cognitive function, and behavior,” Dr. Deibert explained. “Family members and caregivers play a key role in both our diagnosis of dementia and helping the patient live her or his best life with this disease. Since there are already signs of dementia the first time I meet a patient, I start by learning about the patient—what hobbies they enjoy, what job they had, what their education level is. Family and caregivers are able to provide me with perspective so I can make a diagnosis.” As we get older, all of us experience some changes in memory, like forgetting what we came into a room to get or having some trouble putting names to faces outside of the context we’re used to seeing that person in. These changes don’t signal dementia. But when people begin to get lost when driving familiar routes and repetitively ask the same questions or tell the same stories, it’s time to make an appointment with your primary care physician or a neurologist for an assessment. “At this point in time, unfortunately, there are not a lot of treatments for dementia,” said Dr. Deibert. “What we work on is adapting around the problem to make sure the patient is able to live the rest of their life with this disease feeling safe, not being anxious, and being cared for. We also work to make sure family and caregivers are connected with support to help them learn how others cope and to help them avoid burning out.” She added that while there are medications for dementia, they don’t reverse or stop the disease. They simply make it possible for the patient to remain at home longer. While more research is needed, Dr. Deibert recommends that people eat a healthy diet, get regular exercise, be socially connected and engaged, and remain mentally active to support their cognitive health. “My focus is on educating patients and families about dementia so they know what to expect and can plan ahead. Understanding this disease is half the battle,” she said.
<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/hdiuJcTdKbc" allowfullscreen="allowfullscreen"></iframe> <p class="article-body"> There are many aspects of our health we need to manage, from keeping our cholesterol and blood sugar in check to getting recommended screenings for cancer and heart disease. One important part of our health and wellbeing we may not always think about, though, is our hearing. Regina Presley, Au.D., FAAA, CCC/A, senior cochlear implant audiologist at the Presbyterian Board of Governors Cochlear Implant Center of Excellence at GBMC, shared information about hearing loss, how it can impact your wellbeing, and what you can do to lower your risk of hearing problems. <br> <br> “Most hearing loss is caused by consistent exposure to loud noise, which irreparably damages the hair cells in the ear,” explained Dr. Presley. “This is partially due to the popularity of in-ear headphones and other devices we use when we’re listening to music and videos or using platforms like Zoom.” <br> <br> In addition to loud noise, loss of hearing can also be caused by any health conditions that restrict blood flow, including cardiovascular disease, diabetes, and kidney issues. <br> <br> When you think about hearing loss, you probably think of it as a problem that older people face. But hearing loss can and does affect people of all ages. In fact, recently a much larger number of teenagers have been diagnosed with hearing loss. <br> <br> There’s another important reason to protect your hearing. Loss of hearing also impacts your cognitive health. Dr. Presley emphasized that patients often don’t realize how hard they must work when hearing loss is in play. Having to compensate for hearing loss can be exhausting work and, over time, it causes patients to become disconnected from the world around them. <br> <br> How do you know if you or someone you care about may have hearing loss? Some indicators include needing to ask people to repeat what they said more frequently, difficulty hearing during phone conversations, and family members expressing concerns about your hearing. <br> <br> Fortunately, there are many ways to prevent and treat gradual hearing loss and monitor your hearing health. If you are listening to music, Dr. Presley recommended keeping the volume level at 60% and giving yourself a break every 60 minutes. If you’re attending a concert, you should wear ear protection to help lower the volume. <br> <br> She also suggested downloading an app on your phone that allows you to perform a brief hearing test. You should test your hearing every year or if you have a concern. If your score is higher than 20, visit an audiologist for further testing and treatment. “Hearing health is so important,” Dr. Presley said. “It connects us to the world around us and it impacts our overall health. So, make protecting your hearing a priority. The earlier we detect a problem, the more we can do to help.” </p>
<p class="article-body"> Even though Breast Cancer Awareness Month has passed, any time is a good time to discuss the roughly 281,550 new cases of invasive breast cancer that will be diagnosed in the United States this year. <br> <br> The good news is advancements in treatment have led to an overall de-escalation of surgical therapy for women with breast cancer. Sara Fogarty, DO, FACS, Director of the Sandra & Malcolm Berman Comprehensive Breast Care Center at GBMC, says, “Women used to complete radical mastectomies where we would remove the breast, muscle and all lymph nodes. How we treat breast cancer has drastically changed over the last several decades, thanks to clinical trials.” <br> <br> Dr. Fogarty says the outcomes of these trials are leading to more personalized therapies for women. <br> <br> “Recently, the FDA approved neoadjuvant immunotherapy in certain triple negative breast cancer cases,” she says. “Patients with certain types of disease will undergo chemotherapy first, and we’re seeing complete pathologic responses, where there is no disease left in the surgical resection.” <br> <br> “We follow the guidelines of the National Comprehensive Cancer Network (NCCN) regarding treatment, which depends on a few things – the type of tumor, the size of the tumor, and lymph node involvement being some of them.” Dr. Fogarty says breast conservation is a top priority at GBMC. <br> <br> She emphasizes there is not a one-size-fits-all approach to breast cancer treatment. <br> <br> “For example, there are many different types of cancer that would never require chemotherapy. she says. “It depends on the makeup of your tumor, your medical history, and what the imaging shows us. <br> <br> “It’s a decision-making process that can be very complicated and varies from person to person,” she says. <br> <br> New treatments for breast cancer are always being tested and studied, and Dr. Fogarty is enthusiastic about the developments happening in cancer care. <br> <br> “We’re seeing more studies looking at minimally invasive treatments like cryotherapy (freezing small tumors). We are doing less sampling of lymph nodes in specific cases in women over 70 years old. These are all ways to potentially de-escalate the need for surgery.” <br> <br> Dr. Fogarty says the best course of action after a diagnosis is to follow the recommendations of a team of doctors you trust. </p> <div class="end-of-story"> </div>
