Where to go During an Emergency

Asthma attacks. Broken bones. Dehydration. Ear infections. Irregular heartbeat. Infectious diseases. Uncontrollable vomiting. This is a short list of the medical problems that are handled each year in the Pediatric Emergency Department at the University of Maryland Children’s Hospital.

Children and adults have different needs. This is why the University of Maryland Children’s Hospital has an exclusively pediatric emergency department staffed by highly experienced nurses and health care professionals trained to put children at ease. What makes this pediatric emergency department unique is the access to a large network of pediatric specialists who make up the Children’s Hospital. We are a resource for other physicians. When a case is very complicated, we are often called to help diagnose or treat complex problems. We pride ourselves on delivering care and compassion that can only come from an institution with a primary focus on providing the highest quality of care to children and their families.

Because we have access to specialists in more than 20 areas of pediatric medicine, we provide the most advanced care. The Pediatric Asthma Program is one example of how patients benefit from the close collaboration of physicians in the emergency department and other specialties. This asthma program, which is the first of its kind in the region to be awarded the Joint Commission’s Disease-Specific Certification, assures that children admitted to the emergency department not only leave breathing easier – they are also given the tools, knowledge and medication to improve their long-term asthma control.

During a medical emergency, there is little time to consider where to take your sick child. Remember the University of Maryland Children’s Hospital is here for you and your family.

Learn more about the University of Maryland Children’s Hospital by visiting www.umm.edu/pediatrics.

Free Holiday Concerts at UMMC

Three different groups will be performing holiday music at the University of Maryland Medical Center the week of December 17, most members of which are University of Maryland doctors or medical students.

The concerts, which are from noon to 1 p.m. through Dec. 21, are on UMMC’s first floor, feature the following groups:

The Not2 Cool Jazz Trio kicked off the week on Dec. 17. The Trio is led by trumpet player Michael Grasso, MD, PhD, professor of medicine and emergency medicine, who plays the trumpet.

On Dec. 18-20, The UMMC Chamber Players return for the 25th year in a row. Founded and directed by cardiologist Elijah Saunders, MD, clinical professor of medicine, the Players feature musicians and vocalists who play and sing a variety of holiday favorites. The group’s music director is Candy Carson, an accomplished musician and wife of Benjamin Carson, MD, a Johns Hopkins neurosurgeon.

Wrapping things up is Otitis Musica, a group of medical students who have performed with the UMMC Chamber Players in the past.


The UM Chamber Players perform various Christmas songs in the hospital lobby near Au Bon Pain on Dec. 18-20th 2012 as an annual tradition.

 

Mandatory Pulse Oximetry Screening for Newborns Takes Effect in Maryland

By Carissa M. Baker-Smith, MD, MPH

Assistant Professor, University of Maryland School of Medicine

Pediatric Cardiologist, University of Maryland Children’s Heart Program

A quick, painless and non-invasive test to determine the amount of oxygen in a newborn baby’s blood is a first step in screening infants for congenital heart defects. Beginning September 1, 2012, hospitals in Maryland must administer the test to all newborns.

Congenital heart disease (CHD) occurs in approximately 8 of every 1,000 children.  Infants born with congenital heart disease have structural defects of the heart. Approximately 25% of all CHD cases are critical and require intervention during the infant’s first month of life. Interventions can include the administration of special medications or even surgery. Pulse oximetry may be helpful in improving the detection of critical CHD (CCHD).

On September 1, 2012, hospitals across Maryland begin mandatory pulse oximetry screening for all newborns. The screening must be done by a health professional before the infant is discharged and within 24 to 48 hours after birth. All hospitals in Maryland will be responsible for creating and implementing pulse oximetry screening protocols.

Children who “fail” pulse oximetry screening will undergo further evaluation, and their primary care providers will work closely with pediatric cardiologists to make the correct diagnosis. Failing the pulse oximetry test means oxygen saturation is lower than normal without another explanation, such as infection or lung disease.

What is pulse oximetry?

Pulse oximetry relies on the use of a non-invasive, painless method for detecting the amount of oxygen in the blood.  Probes are applied to the palm of the hand and the sole of the foot. The protocol selected by the State of Maryland for screening  is published in the Journal of Pediatrics (Pediatrics 2011; 128; e1259). Children with oxygen saturation less than 90% automatically test positive and fail screening.  Children with oxygen saturation greater than 95% test negative and pass screening. Children with oxygen saturation between 90% and 95% will undergo repeat testing and evaluation.

What is the potential impact of pulse oximetry screening?

We anticipate that pulse oximetry screening will enhance detection of CCHD. Data indicate that for every 1,000 children born in Maryland, 2.3 have CCHD.  Currently, between 60% and 70% of these infants are diagnosed through prenatal screening, leaving approximately 30% who are not yet diagnosed by the time they are born. Combined with physical examination, pulse oximetry is reported to improve sensitivity for detecting CHD by 20%.

What is the role of the Children’s Heart Program?

The University of Maryland Children’s Heart Program offers a comprehensive panel of services designed to accurately diagnose and effectively manage and treat children with CHD and CCHD.  Pediatric cardiologists are available 24 hours a day, 7 days a week, to assist with the diagnosis of CHD.  Through consultation and telemedicine services, the Children’s Heart Program is ready to assist surrounding providers and families with the evaluation of infants with suspected CCHD.

For more information on pulse oximetry, please contact the Children’s Heart Program at 410-328-4FIT (4348).

Dr. Baker-Smith is a member of the Maryland State Advisory Council’s Committee for CCHD and the Newborn Screening for Critical Congenital Heart Disease multi-institutional group.

A Mission to Ecuador for Pediatric Heart Surgeon

By Meghan Scalea

UMMC Communications Account Leader

Sunjay Kaushal, M.D., Ph.D., associate professor at UM School of Medicine and director of pediatric cardiac surgery at UMMC, recently returned from a medical mission to Ecuador, where he performed life-saving heart surgeries on nearly 20 children who would have died without surgery.

 

Dr. Kaushal, a father of two, is a huge advocate for kids. This medical mission to Guayaquil, Ecuador, was his fifth trip with the International Children’s Heart Foundation (ICHF), a group dedicated to providing supplies, training and surgical resources to care for underprivileged children with heart disease in dozens of countries around the world.

According to the ICHF, 1% of the world’s population is born with heart disease, only about one-third is diagnosed, and even fewer receive life-saving heart surgery. Congenital heart disease is the most common birth defect in the world.

“There is a huge surplus of kids with congenital heart disease,” says Kaushal. “Traveling with this group allows me to provide free health care for children who wouldn’t otherwise be treated.”

Joining him in Ecuadorwas UMMC certified surgical technologist, Nicolette Dupuis, who supports Dr. Kaushal in his pediatric heart surgeries in the OR in Baltimore. This marked Dr. Kaushal and Ms. Dupuis’s third medical mission trip together. During their week inEcuador, they worked with cardiologists and intensivists from hospitals around theU.S. in the sparse operating rooms.

 “Part of our job while we were inEcuadorwas to teach the local medical professionals to do congenital heart surgeries like we do, but on a smaller level,” says Dr. Kaushal. “Our day began at 7:30 am, and we’d operate until 9:00 pm. We staffed the ICU 24/7 during the time we were there to make sure those children had the post-operative care they needed.”

Dr. Kaushal is the only board-certified congenital heart surgeon inMaryland, giving him a unique expertise in performing surgical procedures on babies just a few days old who were born with heart disease, children with congenital and acquired heart disease, and adults living with heart conditions they developed as babies, known as adult congenital heart disease.

Dr. Kaushal performs the most complex pediatric heart surgeries available today, including surgeries for babies with hypoplastic left heart syndrome, Tetralogy of Fallot and ventricular septal defect, and those in need of pulmonary valve replacement. He is also preparing to open a clinical trial that will use a baby’s own stem cells to regenerate the underdeveloped portion of their heart caused by hypoplastic left heart syndrome.

We invite you to learn more about what Dr. Kaushal and the Children’s Heart Program at UMMC are doing for children within the Mid-Atlantic region.

Arthritis and Joint Problems Sideline NFL Pros and Weekend Warriors Alike

Robert Sterling, MD

Robert Sterling, MD

By Robert D. Sterling, MD
Associate Professor of Orthopaedics

Ouch! As you can imagine when you see a player get sacked, years on the football field can take their toll! A 2008 University of Michigan study of retired NFL players found that, compared to the general public, these former football greats have a very high rate of diagnosed arthritis. Their joints are, plain and simple, just worn out. So of the older retirees in this study, almost 25 percent have had at least one joint replacement. The vast majority have had knees replaced. Hips replacements are less common.

So as some great athletes take to the field this Super Bowl XLVI weekend, some of us former “great” athletes may be wondering if that creaky knee or aching hip needs a possible replacement. When is the right time to see a doctor about it? Listen to your body, and it will tell you: If you are experiencing pain, swelling or stiffness in one of your joints, now is a good time to get checked out.

During your evaluation, we will get a full history of your complaints and examine your joints to figure out why you are having pain. This history and physical exam is often followed by an x-ray to look at your bones. The first steps we try for treatment of arthritis usually involve exercise, weight reduction, knee braces, and medications to help your pain.

Whether you want to get back on a field or just back to playing with grandkids, diagnosis and appropriate treatment of any joint pain should be the next step in your training program.

For more information or to make an appointment, contact the University of Maryland Department of Orthopaedics at 877-771-4567.

Mitral Valve Repair Lets Marathon Runner Boogie at Son’s Wedding

By Nick Papas

I had just completed the 2011 Pittsburgh Marathon. It was not my best time. There was no personal record that day. It was a day marked by a continued struggle with a chronic heel injury.  But there was something more serious brewing in my body that day. It was a particularly strong flare-up of my mitral valve pain. I was so familiar with the pain. It had been diagnosed and studied throughout my life. I had mitral valve prolapse. 

 So, I brushed off the chest pain as I slogged through the marathon and finished.

Then a couple hours later, as the marathon and half-marathon runners of our family celebrated with extended family and supportive friends, I shared my personal marathon experience with my soon-to-be daughter-in-law, Beth Ann. My tale included the throw-away detail about my old familiar chest pains. No big deal. Or so I thought.

 Beth Ann, a medical student, was not as flippant as I was about the little detail of chest pain.  She pulled out her stethoscope and diagnosed me on the spot as having mitral valve regurgitation. She strongly suggested that I see my PCP. I was stubborn and a bit incredulous. I didn’t rush.

 Eventually my heart acted up in such new and painful ways that I was compelled to go to my doctor. This set into motion the chain of events that lead me to Dr. James Gammie at UMMC.

An initial link in this chain was me doing my homework. I read the scientific papers. I consulted with knowledgeable, trusted people and friends.

 I had to make my decision: Was I, a man who loves to be active by running and biking, going to be happy taking drugs? Would I be satisfied watching my body get weaker and weaker while my heart became more and more sick?

 Ultimately, the decision was a no-brainer.

 I took action right away, partially because I concluded that it was the right thing to do and partially because my son’s wedding was just around the corner. I wanted to be healed enough to dance at my son’s wedding.

My surgery was performed at UMMC on September 6, 2011. Noah and Beth Ann were married October 8, 2011! I am happy to say I danced! I danced quite a bit! My wife, Patty (in the photo with me), and I had a great time.

 I am grateful not only to be alive but to be living. I am optimistic that with my newly repaired, healthy heart I will be able to enjoy the coming years with my family and to live these years actively. 

In the future, look for me in the 2012 Baltimore Half or Full Marathon. I’m the self-proclaimed, 52-year old, poster “child” of UMMC Mitral Valve Repairs!

 

 

September is PAD Awareness Month – So What?

By Robert Crawford, M.D.
Assistant Professor of Surgery

Everyone asks, “what is PAD?” September is as good a time as any to explain.

PAD stands for Peripheral Arterial Disease — sort of a mouthful, so we stick with PAD. It is a condition that affects the arteries that bring blood to your lower extremities. These arteries become blocked with plaque (cholesterol) and become hardened, and this reduces blood flow to the legs. PAD produces pain in the legs caused by poor circulation, and in more severe cases it can lead to gangrene and loss of the limb. Depending on the stage of the disease at presentation, the most devastating consequence, if left untreated, is amputation.

It’s worth knowing about because PAD is quite common and can cause you to lose your legs, but yet it’s often preventable through lifestyle changes. Close to 10 million Americans are affected, including one-third of the population over age 70.

Consider this: the five year risk of death of patients with PAD is greater than that of a patient with breast cancer. Additionally, having PAD places patients at increased risk of having other serious problems, such as heart attacks.

Significant risk factors include smoking, hypertension, high cholesterol and diabetes. In fact, the prevalence of PAD is in some cases double that of non-diabetics. PAD is more common in aging populations and African Americans.

Sounds very dramatic –- loss of limbs? –- and it is. But there’s hope. PAD is a chronic progressive disease, which means it gets worse over time. But depending on the  stage at presentation, PAD can be treated to reduce your chances of losing a limb to amputation. Here are the most common treatments we deploy to treat PAD:

  1. Stopping smoking
  2. Better diet and nutrition
  3. Effective management of diabetes, hypertension and high cholesterol
  4. Working with your doctor to establish a prescription intervention plan with aspirin or
    anti-cholesterol medications
  5. A regimented exercise program
  6. Minimally invasive surgical intervention
  7. Open surgical intervention

And that’s where I come in. Surgery should be a last stop for the treatment of PAD, but if it has to happen, it’s important to come to the experts who are skilled in treating the most severe cases of this disease every day.

The Division of Vascular Surgery at the University of Maryland Medical Center is made up of a team of physicians who specialize in the treatment of PAD. Because of our role as a premier academic institution, our patients get the benefit of having an entire top-notch team, not just an individual doctor, caring for you. The vascular doctors at UMMC received quality training in open and endovascular
surgical techniques. Our involvement in clinical trials grants us access to the latest technology used for PAD therapy. Most importantly, we take great pride in providing the best care for you from the moment you walk through our doors.

As a final note, understand that at least half of the patients with PAD don’t have any obvious symptoms. If you have any of the risk factors listed above, call our Vascular team or your physician and ask for a PAD screening

If you’re like the other half of patients with PAD, you will likely experience some of the following symptoms:

    1. Claudication: This refers to pain in the calves when walking. It is commonly described as a cramping pain that starts after a variable distance (“Doc…my legs hurt after I walk for about one block”). This pain will get better when patients stop walking. Some patients can have a more atypical type of pain, such as pain in the hips or thighs (“Doc…when I walk my legs just so get very tired…I have to stop”). This too will get better when walking stops.
    2. Rest pain: This symptom typically represents a more severe form of the disease. Patients will get pain in the legs, typically the top part of the foot at night. This pain can be so bad that it can wake patients up from sleep and gets better with movement or dangling the leg from the side of the bed.
    3.  Ulceration: Patients can develop sores in their feet. Sometimes this happens after minor trauma, such as a simple scrape or clipping of toe nails. These ulcers tend to not heal, a clear sign that blood flow is impaired.
    4. Gangrene: This is a consequence of severe PAD. Essentially the tissues die because of a lack of blood flow and oxygen. This can lead to surgical amputation if left untreated..

If we can be of any help, call 410-328-5840 for our Vascular team or e-mail us at MarylandVascularCenter@smail.umaryland.edu.

 

Art Teacher Happy to be Back in the Classroom Following Successful Tinnitus Treatment

Artist George Goebel first noticed a strange ringing sensation in his ears in December 2007. His ENT referred him to Dr. David Eisenman at the University of Maryland Medical Center, a specialist in treating disorders of the inner ear. After successfully treating George for endolymphatic hydrops, Dr. Eisenman recommended George meet with Dr. LaGuinn Sherlock to begin treatment for tinnitus, the condition causing the ringing in his ears.

Click here to read George’s story as posted on the University of Maryland Medical Center’s Web site.

Cancer Center Doctor Runs Half Marathon for His Patients — Past, Present and Future

By Dr. Aaron Rapoport
Associate Director, Bone Marrow/Stem Cell Transplant Program

Editor’s Note: The 3rd Annual Maryland Half Marathon takes place this year on Sunday, May 15 at Maple Lawn in Howard County.  All proceeds will go to support the work of the University of Maryland Marlene and Stewart Greenebaum Cancer Center.  Many cancer center staff are participating — as runners, volunteers and fund raisers.  Here is an example of what motivates one runner.

April 2011

Dear Friends:

As you all know, The University of Maryland Marlene and Stewart Greenebaum Cancer Center (UMGCC) is my home away from home.  It is where I treat those fighting cancers, conduct my research and learn a great deal from my patients and their families.

The marathon is scheduled for Sunday, May 15, 2011 and this year marks my third consecutive year running the Maryland Half Marathon.  I will be running on behalf of, and with some of my patients who are also training for the race.  Your support last year was phenomenal and I hope you will once again consider making a contribution to my effort.  Any size donation would be greatly appreciated!

This is a very gratifying experience for me, and as I run the 13.1 (hilly!) miles, I will be doing it for all of my patients; past, present and future.

To make a donation, just click on the link below:

http://www.ummsfoundation.org/Rapoportrun2011

Thank you for your generosity!

Aaron P. Rapoport, M.D.

See Dr. Rapoport’s runner’s Web page

For more information, to register for the race, or to sponsor a runner, visit to Md Half Marathon Web site

Have Voice Problems? Get to Know Dr. VyVy Young

As the new Director of Laryngology at the University of Maryland Medical Center, Dr. VyVy N. Young has been instrumental in expanding the number of services UMMC offers to patients who are experiencing a wide array of voice-related problems and disorders.

Dr. Young offers a variety of treatment options for our patients who have been diagnosed with benign vocal lesions, chronic hoarseness, paradoxical vocal fold disorder, spasmodic dysphonia and vocal fold paralysis. She also offers an extensive variety of professional voice care options for patients who rely heavily on their voices in their daily lives.

Dr. Young specializes in office-based laryngeal surgery, allowing our patients to have many of their procedures performed in the comfort of an office setting at a time most convenient for their busy schedules.

If you or someone you know is concerned about voice-related condition or problem, we encourage you to visit the Division of Laryngology Web site to find out more about Dr. Young and the services she and her team can offer.