High Blood Pressure Has No Minimum

How tall is your child? How much does he or she weigh? Most parents can answer those questions easily. But here’s a tougher question: what is your child’s blood pressure?

High blood pressure, or hypertension, is often considered an adult health problem. But this serious condition is no longer adults-only.

“The number of children with high blood pressure is rising,” says Susan Mendley, MD, head of the Division of Pediatric Nephrology at the University of Maryland Children’s Hospital and an associate professor of pediatrics at the University of Maryland School of Medicine. “Left unchecked, high blood pressure can result in lifelong health complications including heart disease, stroke and kidney failure. Fortunately, small changes now can turn this trend around.”

What’s Normal?

For adults, 120/80 or lower is normal blood pressure and 140/90 or greater is high blood pressure. But for children, high blood pressure is determined differently.

“Children are not little adults,” says Dr. Mendley. “High blood pressure for children is defined as a blood pressure reading greater than the 95th percentile for their age, height and gender.”

It’s estimated that about 2 million kids in the U.S. have high blood pressure, and many of those children-and their parents- don’t know it.* That’s because high blood pressure, also known as the “silent killer,” has no symptoms. However, childhood high blood pressure often has a common clue: obesity.

Predicting hypertensions

A growing number of children are eating more, exercising less and weight in above their ideal weight range. As a result, obesity rates have been rising in the U.S. for the past two decades.**

“Obesity is one of the highest predictors of high blood pressure in children,” says Dr. Mendley. “It’s difficult for parents to tell on their own if their child has health risks related to weight.”

The American Academy for Pediatrics recommends screening children for high blood pressure annually starting at age 3. “It’s really important to keep up with your child’s annual checkup,” Dr. Mendley says. “Don’t wait until there is a problem. There are many small things that parents can do to prevent big problems later.”

To make an appointment with Dr. Mendley or the Nephrology team call 410-328-6749 or visit umm.edu/PediatricNephrology

*Source: The Journal of the American Medical Association

**Source: Centers for Disease control and Prevention

 

 

What Can Women Do to Prevent Early Menopause?

About Early Menopause

The average age a woman goes into menopause is 51. Menopause is considered abnormal when it begins before the age of 40 and is called “premature ovarian failure.” Common symptoms that come with menopause include hot flashes, night sweats, sleep problems, sexual issues, vaginal dryness, pain during sex, pelvic floor disorders (urine, bowel leakage, pelvic organ prolapse), losing bone mass, and mood swings.

Menopause is mostly genetically predetermined, which means you generally can’t do much to delay it from happening. What we can do is work to counter-balance or prevent the symptoms and effects that tend to develop during menopause.

What You Can Do

Women can do a lot of things to prepare themselves for changes that will come with menopause. These include modifying our lifestyles so we are eating a healthy diet and exercising regularly.

Diet and Exercise

Related to diet, women should look into their caloric intake and make adjustments like eating smaller meal portions, and eating a well-balanced diet that includes lots of fiber and protein and less carbohydrates. Avoid eating late at night or snacking, which means no eating two to three hours before bed time.

Take calcium and vitamin D supplements for bone health to prevent osteoporosis. Well-balanced food with decreased caffeine intake also helps to decrease night sweats.

Exercise is one of the most important and modifiable factors that all women must take advantage of. Cardio workouts including walking or jogging three times a week will boost your cardiovascular system and endurance, and also help you control your weight. It’s also important to do weight-bearing exercises regularly to build up bones and prevent osteoporosis.

Kegels

Kegel exercises can help prevent pelvic floor disorders (urine, bowel leakage, pelvic organ prolapse). Kegel exercises should ideally be done every day three times a day. Every woman needs to know how to do Kegel exercises properly. Unfortunately, many women think they do Kegel exercises when, in fact, they do not, because the muscles are hidden inside the body. Your physician should be able to help you with it. You can do long squeezes for 10 seconds, or fast squeezes. This helps to maintain strength and endurance of the pelvic muscles in order to prevent urinary or bowel leakages in the future.

Mental Health

If possible, I recommend having regular sex. It improves vaginal lubrication and helps to prevent vaginal dryness and pain with intercourse. It is also good for your overall mood.
Finally, every women should work on developing a positive attitude, and spending time in a healthy environment helps – for example, taking frequent walks in a park or whatever makes you feel good; finding a way to de-stress and/or control any stress in your life. This will improve your mental health.

Hormone Therapy

Hormonal treatment for early menopause and menopause has been out of favor because of concerns with breast cancer, cardiovascular disease, and stroke. With that said, it is still gold-standard treatment especially for hot flashes and night sweats. Hormonal therapies could offer significant benefits to women especially those going through early menopause. Talk to your doctor about what is right for you.

Fertility

A woman going through early menopause is still fertile. Unless you don’t have periods at all anymore, there is still a risk that you can get pregnant, so it’s important to use some form of contraception to avoid pregnancy.

Tatiana V. Sanses, MD, is Assistant Professor of Female Pelvic Medicine and Reconstructive Surgery at University of Maryland School of Medicine and Director of Outreach Program for Urogynecology at University of Maryland Medical System.

 

 

Child Life Month

How Play is Helping UMMC’s Youngest Patients

By: Colleen Schmidt, System Communications Intern

As many parents know, the hospital can be a scary and unfamiliar place for a child. To help relax these fears, UMMC’s team of child life specialists and assistants use a variety of techniques to help children adjust to the hospital setting. Child life specialists, or CLS, aim to provide a positive and non-traumatic hospital experience for all patients at the University of Maryland Children’s Hospital.  UMMC’s Child Life team consists of six CLS and two assistants. They work in the Pediatric Progressive Care Unit (PPCU), Pediatric Intensive Care Unit (PICU) and the Pediatric ER.

Members of the Child Life Team

 

Play is one technique often used by child life team to help normalize the child’s hospital experience.  Various types of play are thoughtfully used to help children meet developmental milestones, express emotions, and understand their medical situation.  For example, during a practice called medical play, a CLS will provide their patient with a “hospital buddy” or small doll that the child can decorate. Next, with the guidance of a CLS, the child is introduced to medical equipment that they can explore and use on their new hospital buddy.  According to Aubrey Donley, a CLS at the pediatric ER, medical play is helpful in addressing misconceptions the child has about medical equipment.

“It gives them a sense of control and mastery over their hospital experience and over what they’ve been through,” she explains. Medical play empowers patients and allows them to have an active role in their hospitalization. Helping the children understand their environment lessens the chances of confusing or traumatizing them.

In addition to medical play, the child life team uses therapeutic play to help children work through a variety of issues that may accompany hospitalization. Sometimes, children who are hospitalized have experienced severe trauma. Unlike adults, children may not be able to verbalize their feelings. Play is how they express themselves and work through their experiences. For example, one of Donley’s young patients survived a house fire and used play to understand what happened to him. “He was running around in a fireman costume pretending to put out a fire. For an onlooker, it might seem like he was just playing but we understand he is trying to make sense of the chaos and trauma that he had witnessed,” she explained. Therapeutic play can also help children who are at the hospital for long periods of time meet their physical and cognitive milestones.

With backgrounds in child development, the child life team is able to make individual plans for each child that matches their medical, physical, and emotional needs.  The team advocates for the children they support, and work with an interdisciplinary team of medical professionals to provide a comprehensive plan for that child. Child life specialists also provide educational and emotional support for families. All services provided by the child life team come at no charge to families.


For more information on our child life services please visit: http://umm.edu/programs/childrens/services/inpatient/child-life

Answering Your Colon Cancer Questions with Dr. Jiang

A new study released by the National Cancer Institute shows colon and rectal cancers have increased dramatically and steadily in young and middle-age adults in the United States over the past four decades. Dr. Yixing Jiang, a Medical Oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center, answers all the questions you’re now asking yourself about colon cancer.

Q. What are the risk factors for colon cancer?

A. The risks for developing colon cancer are: obesity; insulin resistance diabetes, red and processed meat; tobacco; alcohol; family history of colorectal cancer; certain hereditary syndromes (such as familial adenomatous polyposis (FAP)); certain genetic mutations (APC mutation); inflammatory bowel disease (ulcerative colitis or Crohn’s disease); being a patient long-term immune suppression (transplant patients) and a history of abdominal radiation.

Q. Who had always been traditionally has always been at risk for colon cancer?

A. Most colorectal cancer happens sporadically. But patients with familial syndromes (FAP or Lynch syndrome), inflammatory bowel disease, certain genetic mutations, a family history of colon cancer or a history of polyos are at higher risk of developing colon cancer.

Q. What’s the best way to protect myself against colon cancer?

A. To reduce the risk of colon cancer, exercise regularly; eat less red meat, eand eat a diet high in fresh vegetables, fruits, fibers, vitamin D, and omega 3 fatty acids.  Asprin and NSAIDs been shown a degree of protection against colon cancer. Of course, the best way of preventing colon cancer is screening with a colonoscopy.

Q. What’s the best screening tool for colon cancer?

A. The screening guidelines varies depending on the recommending agencies. For example, the Center for Disease Control recommends the following: For average general population, the recommendation is to start screening colonoscopy every 10 years at age of 50; fecal occult blood test annually and flex sigmoidoscopy every 3 years. The US Preventive Services Task Force recommends screening between the ages of 50 and 75.

The most used screening test for colon cancer is a colonoscopy.

Q. Is colon cancer treatable? What’s the best treatment options?

A. Colon cancer is a very treatable disease if discovered early. For stage I cancer, surgery cures more than 90% of patients. For patients with a more advanced stage cancer, surgery alone is usually not enough. Additional chemotherapy is generally required to increase the chance of a cure. Today, with more therapies available and better surgical techniques, we are able to cure close to 30% patients with stage IV disease.

For more information on diagnosing and treating colon cancer, please visit UMGCCC’s website, umgccc.org. 

Joint Replacement Q&A with Dr. Theodore Manson

Theodore Manson, MD is an Orthopaedic Surgeon at the University of Maryland Medical Center and an Associate Professor of Orthopaedics at the University of Maryland School of Medicine.

Dr. Manson specializes in hip and knee replacements and orthopaedic trauma. Below he answers the most common questions about joint replacement.

 

Q. What advances have there been in joint replacements including new technologies, changes in patient-management and rehabilitation?

A. One significant advancement in the last 10 years has been around pain management and early recovery protocols. The goal is to minimize the amount of narcotics patients require after surgery. Today, we manage pain through many different types of medicines in addition to narcotics. There’s been a lot of success recently with joint (intra-articular) injections of anesthetic around the hip or knee joint at the time of surgery. This injection limits the amount of pain patients have when they first wake up from surgery. We know that if you limit that first pain sensation, it helps with the whole pain management process going forward.

Another significant advancement is infection prevention. Patients’ skin is now pre-operatively prepped with the antiseptic and disinfectant chlorhexidine both at home prior to surgery and at the hospital as well. In addition, we optimize patients’ nutrition and health pre-operatively. These two things have drastically cut down on infection rates. We did not use to address patient nutrition. Now, we assess patients’ nutritional status before surgery. If a patient is at a higher risk for nutritional deficiencies – those with chronic illness, diabetes or poor appetite, we then work in conjunction with a nutritionist so their infection rates are lower.

Borrowing from the aviation industry, there have been substantial improvements to patient safety in the hospital postoperatively as well.  Standardized protocols, safety checklists and quality control monitoring have dramatically reduced untoward events in joint replacement patients.

Q. What new innovations in joint replacement surgery (hardware and techniques) are noteworthy and why?

A. There is a lot of marketing material on the internet regarding various joint replacement approaches, minimally invasive surgery, robotic surgery and use of custom hip and knee replacement parts.  It is important to realize that none of these things has been shown to be of any benefit. When considering joint replacement, choose a surgeon who performs a high volume of hip and knee replacement surgeries and who you get along with well on a personal level.

While there haven’t been any substantial innovations with implants in the last five years, we do have long-term data on our current implants and techniques that shows them to be functioning extremely well.

Q. Who should get a joint replacement? What factors should a person consider? How should a potential patient decide?

A. In general, joint replacement is an elective procedure. If the patient is falling due to their hip or knee arthritis, it can be a very dangerous situation, so falls are an indication they should go ahead with a joint replacement. If a person is no longer able to climb stairs, if the hip/knee pain keeps him/her up at night, or if s/he is constantly dependent on an assistive device like a cane, then I think they should strongly consider a joint replacement. For others with less severe symptoms, a joint replacement may still be of great benefit to them, but they should consider surgery when the time is right and shouldn’t feel pressured into a surgical option.

Q. What should a patient expect?

A. Once they have scheduled the surgery, most patients undergo pre-habilitation prior to the joint replacement. Many patients find it useful to go to a preoperative joint class at the hospital where they’re going to have the surgery. This helps to alleviate anxiety about the procedure and educate them on what is to come. For those who are substantially debilitated preoperatively, going to prehab (physical therapy) to strengthen the operative leg is helpful and helps us foresee any challenges that may arise postoperatively.

If you have a body mass index (BMI) of 40 or greater, you should delay joint replacement until you can get below 40. This is because infection rates increase substantially for people who have a BMI of 40 or greater.

Q. Does the type of implant used depend on patient activity and age? How?

A. In the past, different implants were used based on age, but for the vast majority of surgeons we use the same type of implants no matter the age. Occasionally patient with poor bone quality will require different implants, but usually we use the same regardless of age or activity level.

Q. What is the target recovery period and regimen for various categories of patients?

A. Patients see the majority of their improvement six to 12 weeks after surgery. They reach their maximum improvement six to 12 months after hip/knee surgery.

Q. What is the lifespan of replacement joints and do you expect the lifespan to grow longer soon?

A. The lifespan of replacement joints have a 1-percent-per-year failure rate, so with 20 years, you have a 20 percent risk of needing the joint replacement redone. I expect this will grow longer as we get better at preventing infection rates. If you are over 60 years old, the odds are you’ll probably never need to have the joint redone.

Q. Have risk factors (infections, failures, etc.) declined or increased (and for whom)?

A. Risk factors have declined because of more critical evaluation and optimization of risk factors for infection around the time of surgery.

Q. Are revision surgeries more or less common these days and why? Do you expect that to change? How and why?

A. Revision surgeries are more common these days simply because of the number of people who have gotten a joint replacement is increasing, and the number of baby boomers having joint replacement is increasing. I expect the number to continue to go up just because the number of people having a joint replacement is going up.

To make an appointment with Dr. Manson or one of our other orthopaedic specialists, please call 410-448-6400.  For more information on joint replacement or other orthopaedic issues, check out the University of Maryland Orthopaedics’ website.

What To Ask Your Doctor (and Why) When You’ve Been Diagnosed With Lung Cancer

Heather Mannuel, MD, MBA is an Assistant Professor of Medicine at the University of Maryland School of Medicine and a Medical Oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center.  Below are a few questions she says to ask your doctor when you’ve been diagnosed with lung cancer, and why they’re important to ask.

What kind of lung cancer is this? Lung cancers are divided into small cell and non-small cell types, and the treatment is very different for each of these.

What is my stage? The stage helps to give information on whether the cancer is only in the lung or whether it has spread outside the lung to the lymph nodes or to other parts of the body.  This is very important in guiding the next steps of treatment.

What kind of treatment is available for my kind of cancer?  Should I see a surgeon?  Should I see a radiation oncologist? Depending on what type of cancer you have and what stage your cancer is, you may benefit from surgery or radiation.  Some patients only receive one type of treatment, and others receive several types in sequence.  Your oncologist can discuss the options in detail with you.

What kind of chemotherapy treats this lung cancer?  Chemotherapy is sometimes given with radiation, or it may be given alone.  Often two or more different chemotherapy drugs are combined together to treat lung cancer most effectively.

What kind of side effects does the chemotherapy cause?  Although chemotherapy can cause many symptoms including nausea, diarrhea and appetite loss, there are excellent medications available today to help combat these side effects and help patients feel as well as possible during their treatment.

Is immunotherapy an option for my cancer?  Immunotherapy helps your own immune system target and fight the cancer; it is being used in a variety of different cancers today, including lung cancers, with good results.  Your oncologist can discuss whether you are eligible for this kind of therapy, when and how it fits in with standard chemotherapy, and the potential side effects.

I’m interested in adding alternative therapies to my chemotherapy; is this possible?  Many patients feel that therapies such as acupuncture and massage allow them to be more relaxed and comfortable during their treatment.  Some vitamins and herbal supplements are safe to combine with chemotherapy, but some may cause dangerous side-effects.  Before you start any type of alternative therapy, always talk with your oncologist to make sure it’s safe.

Are there any clinical trials that apply to my case?  Trials may provide an opportunity for you to be treated with drugs or other therapies that are not yet on the market but that may ultimately become standard cancer treatments in the future.  Most large cancer centers participate in clinical trials or have an association with other hospitals and centers that run trials.  You can also access https://clinicaltrials.gov/ which is run by the National Institutes of Health and which is a registry of available clinical trials across the United States for a variety of different diseases.

How will I feel during treatment?  Can I still work and take care of my children?  Although many side effects are able to be controlled today, some patients will have treatments that require them to be away from work for several weeks at a time, or that leave them fatigued and unable to maintain their normal work and child care schedule.  Your oncology team can work with a social worker or case manager to help you find solutions to these problems.

What kind of results do you expect from this treatment?  Is this curable?  This is a difficult and scary question, but it is very important to discuss this so you can plan ahead for you and your family.  Although not always the case, even incurable cancers can sometimes be treated and controlled successfully for several years.

Learn more about the Lung Cancer Service at UMGCCC by clicking here.

Winter Wives’ Tale

The University of Maryland Children’s Hospital sets the record straight…

Put on your hat since you lose most of your body heat through your head.”
This is not necessarily true! Your body heat escapes from any exposed area- so if you had on snow pants and a T-shirt and you forget your hat and jacket, the most amount of heat would escape through your arms- since that would be the largest exposed part of your body. Putting on winter accessories such as hats, mittens and scarves is still a very good idea to avoid the outside dangers of frostbite and hypothermia.

You will get sick if you go outside with wet hair.”
This is another winter wives’ tale. While your kids may be cold, they won’t actually catch a cold by venturing outdoors with a wet head. Germs are spread by people, and temperature simply doesn’t play a part.

 

Occupational Therapist Brings Holiday Cheer to NICU with Photo Shoot

img_9300-3Just before the holiday season, Lisa Glass, an occupational therapist in The Drs. Rouben and Violet Jiji Neonatal Intensive Care Unit (NICU) set up a Christmas photo shoot to show off the festive side of some of our tiniest patients.

Glass, who enjoys photography in her spare time, developed the idea for the photo-shoot as a “cute way to give some nice holiday photos to parents”. Since NICU babies are often among the sickest children in the hospital, and need round the clock medical care, it can be difficult for parents to appreciate the traditional joys of having a newborn. Especially during the first few critical months of life, this can include newborn pictures. Glass and her coworkers wanted to be able to “highlight how beautiful [these] babies are,” and give parents a view of their child in a more upbeat and positive light.

img_9142-3After work hours, Glass and two physical therapy coworkers in the University of Maryland Department of Rehabilitation Services, Laura Evans and Carly Funk, went from room to room, and for four and a half hours, photographed over 30 babies. Following the photography session, Glass edited her pictures, emailed them to parents, and even printed a few copies to surprise parents in their babies’ rooms. Following the photo shoot, she received many happy emails thanking her for what she had done. But for Glass, going above and beyond to show compassion and joy was an easy feat.

“For me, it was a pleasure to interact with the babies and the parents”, said Glass. “Parents are used to seeing their children as sick patients, not as beautiful babies. It’s important to see your patients not just as patients, but as people, too.”

Glass also emphasized the importance of teamwork in this endeavor.

“I wouldn’t have been able to do this without [Laura and Carly’s] help the whole way through.” This NICU trio showcases the importance of working together to bring some extra joy to UMMC.

Glass’ photography serves as a great reminder to see patients as the people they are, and not simply for the medical treatment they are receiving. Although these babies may have breathing tubes and cords surrounding them, they are also enveloped in a multitude of love and support.

trilpets-single-photos



Working Hard to Engage West Baltimore Communities

Members from UMMC’s Community and Workforce Development and Commitment to Excellence teams visited Mr. Barnett’s 5th grade class at James McHenry Elementary/Middle School.

The team dropped off 32 book bags (one for each student) filled with books and school supplies. Students also received holiday toys, donated by UMMC employees and staff. Additionally, through UMMC Commitment to Excellence holiday “Give Back Campaign”, UMMC employees and staff donated socks, undershirts, underwear, and other under garments to James McHenry Elementary/Middle School’s Uniform Closet.

UMMC has officially “adopted” this class, and will be closely working with them to provide mentoring, professional development and engagement opportunities. The UMMC community will continue to work with these students through middle school, high school, college and beyond!

This is just one example of how UMMC is continually working to improve the lives of those in its surrounding communities. UMMC aims to identify and address critical issues in West Baltimore by building permanent relationships with individuals and organizations in the area.

Some other UMMC initiatives include:

  • Launching the Stanford Living Well/Chronic Disease Management Program.
  • Implementing the BHEC Baltimore City-wide Community Health Work Training Certificate Program.
  • Sponsoring 50 youth in the 2017 Youth Works Internship program.
  • Initiating meetings with West Baltimore community organizations to introduce new CEO and re-establish collaborative relationships.

 

Learn more about UMMC’s community engagement efforts on our website: http://umm.edu/community

 

Setting the Table for Celiacs: Q&A with Celiac Disease Program’s Nutritionist

University of Maryland Medical Center nutritionist Pam Cureton answers questions about celiac disease and gluten-free diets.

pam-cureton-rdQ: What is gluten?

A: Gluten is a protein found in wheat, rye and barley. These grains in any form must be avoided. Foods labeled gluten free are safe to eat but if a food item is not labeled gluten free look for these six words in the ingredient list to see if it contains a gluten containing ingredient: Wheat, Rye, Barley, Malt, Brewer’s yeast and Oat (only use oats that are labeled gluten free).

Q: What exactly is wrong with gluten?

A: The problem with gluten is that it is not completely broken down into smaller amino acids that can be easily absorbed by the intestine. For the majority of people this presents no problem at all but in individuals with celiac disease, the body sees this protein as a toxin and this sets off a string of reactions leading to intestinal villous damage.

Q: What cross contamination problems should I look for in the kitchen?

A: Preventing gluten free foods from coming in contact with gluten containing foods make the difference in your guest enjoying a wonderful holiday meal or becoming ill and leaving early. Guest with celiac disease cannot simply take the croutons out of a salad or eat the meat from the wheat bread sandwich. Gluten free foods can be contaminated by using the same spoon to mix or serve foods, putting wheat products next to the gluten free dips, “double dipping” the knife into a condiment then gluten containing product then back into the condiments or using the same toaster.

Q: Can you taste the difference between gluten-free foods and their gluten counterparts?

A: Gluten free foods have come a long way in their taste and texture to be very close to their gluten containing counterpart. There are so many great tasting gluten free products on the market today that no one should be eating something they do not like.

Q: What are the symptoms of Celiac Disease:

A: Celiac disease can present itself in many different forms. Untreated, celiac disease causes multi-system complications such as diarrhea, constipation, gas, bloating, iron deficiency anemia, decreased bone density, failure to thrive, short stature, and behavior problems. If you have any concerns, please check with your primary care provider before you start a gluten free diet.

Q: I have severe reactions when I eat bread, such as stomach bloating and pain in my joints. Does this mean I could have celiac or gluten sensitivity?

A: We recommend that you see your primary care provider and ask to be tested for celiac disease. However, do not start a gluten free diet before this testing is done. The first step is a simple blood test for screening. If all the tests are complete and you do not have celiac disease, then try a gluten free diet to see if you improve as it may be non-celiac gluten sensitivity.

Q: How common is late-onset celiac disease and is there any way to know if other family members are at risk of developing it later in life?

A: It is possible to develop celiac disease at any age. You may have had celiac disease for many years before being diagnosed because symptoms may have been attributed to other conditions or you may not have had any symptoms with the active disease. We recommend that all first degree relatives be screened for celiac disease after the relative had been diagnosed and if negative at that time, repeat the screening labs every 2-3 years or if symptoms appear.

Q: Is there a cure for Celiac Disease?

A: Currently the only treatment for celiac disease is the gluten free diet. In most cases, this treatment works very well but it can be expensive, socially isolating and, at times, difficult to follow. Also, there are people that do not respond completely to the diet or take up to 2 years to heal after diagnosis. For these people, additional therapies are need to prevent additional complications of celiac disease.

 

Learn more about the Celiac Disease Program or call 410-328-6749 to make an appointment.

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