Thursday, February 23, 2017

5 Embarrassing Questions You Don't Want to Ask Your Doctor (But Should!)

In the age of Google, it can be tempting to try to solve your own medical conundrums, especially if you find them a bit embarrassing. However, if you have a new symptom, it's important to talk to your primary care physician, who can evaluate you and provide a much more reliable diagnosis than the internet. It's natural to feel a bit of shyness when sharing certain details about your body, but keep in mind that your primary care physician is a trained professional. It's his or her job to listen to your symptoms, make you feel comfortable, and offer their best possible advice. “Remember, your doctor is used to hearing all sorts of intimate information about patients' bodies, so while it might feel awkward for you, it's actually quite routine for him or her,” says Dr. Robin Motter-Mast, GBMC’s Chair of Family Medicine and a physician with Hunt Manor at GBMC.

If you're worried about how to begin the conversation, try making a list of the things you want to discuss at your next visit. Preparation might make you feel more comfortable. Bring the list with you so you won't forget anything, and if you get tongue-tied, you can always hand the paper to your doctor.

So, how do you know if your query is worth bringing up and could be indicative of a serious problem or if it's a nonissue you should ignore? It's always better to be safe than sorry, as there will never be any penalty for asking a seemingly silly question. Here are five common issues people worry about discussing with a doctor, and why they are worth raising.

1. Sometimes I urinate a little when I laugh and/or sneeze.
This type of urinary incontinence, called stress incontinence, is most common in women. It happens when the pelvic floor muscles can no longer properly support the bladder. When you're experiencing a sudden leak during a cough, sneeze, laugh, or exercise, the bladder is dropping down and pushing against the vagina, but the muscles that close off the urethra aren’t tightening quickly enough. Though this is common if you've recently given birth or gained weight, it is definitely a topic to bring up with your physician. He or she will want to make sure you don't have a urinary tract infection and may be able to recommend treatment or strategies to help with the leaking. This could include pelvic floor muscle exercises, called Kegels, which can strengthen your urinary sphincter, or examining your lifestyle to identify a medication or vitamin that may be exacerbating the condition. It is unlikely that you'll require surgery, but there are surgical options. Be prepared for your doctor to ask questions about your typical fluid and caffeine intake, frequency of urination, and your bowels.

2. I frequently have very bad breath.
If you practice good dental hygiene, including brushing, flossing, and using an antibacterial mouth wash, and still have persistent bad breath, this is definitely a topic to raise with your physician. Bad breath, called halitosis, doesn't just carry a social stigma; it can indicate a variety of other medical conditions including gum disease, yeast infection of the mouth, diabetes, liver or kidney problems, and more. You could also be experiencing halitosis because of dry mouth, which can be a side effect of various medications. When you're going to an appointment to have your breath evaluated by your doctor, avoid wearing perfume, scented lotions, or lipstick, as the type of smell you're emitting can actually help the physician identify what could be causing it. Expect to answer questions about your dental routine, diet, allergies, and your sleeping/snoring habits.

3. My medication/treatment/test is too expensive for me.
No one likes to admit when they can't afford something, but with the rising costs of healthcare, this is an increasingly common problem. If you question whether a test is necessary, you may also be worried that your physician may perceive you as not valuing his or her opinion. Be honest with your doctor about your financial limitations. It's possible there may be an alternative to an expensive medical test, as research is always providing new evidence and less invasive alternatives. You may even be able to enroll in a clinical trial. If a medication has gone up in price, ask your doctor if there is an available generic – or even an over-the-counter – product available that might work for you. Together, you can decide over time if this is an effective enough alternative. Lastly, depending on the drug you’re taking, your physician may have a patient assistance program application from a pharmaceutical company that could help you. It never hurts to ask.

4. I think I noticed blood in my stool.
Though you most likely aren't excited to talk to your doctor about your bowel movements, avoiding discussing this issue could be dangerous. If you think you see blood in the bowl or on the toilet paper, head straight your primary care physician, as this is never considered normal. One of the worst case scenarios could be colorectal cancer, though there are a variety of other less serious causes including hemorrhoids, anal fissures, peptic ulcers, and more. Your doctor will very likely ask you about the color of the blood you saw, as different shades of red can indicate varying conditions. He or she may also want you to have a test such as an endoscopy, colonoscopy, or fecal occult test, which checks for blood (even hidden blood) in stool. Be sure to share any other symptoms you may be having, even if you don’t think they seem relevant. Rest assured that there are many available treatments, ranging from small things you can do at home to medications and surgeries that can address the problems associated with blood in stool.

5. I sweat excessively.
Excessive sweating, called hyperhidrosis, does not refer to the exhilarating and satisfying dampness you feel after an intense workout, but rather to bodily wetness when you aren't physically exerting yourself at all. If you're sweating profusely and you're just sitting around, or if you feel the need to wipe your hands before every handshake, this is not normal. Hyperhidrosis is potentially a warning sign of thyroid problems, diabetes, infection, or drug interaction, though not necessarily. While it isn't medically risky, it can certainly interfere with the quality of your life and is a legitimate medical condition you should raise with you doctor. Be prepared to be asked about which body parts are sweating, medications you're taking, and whether or not members of your family experience the same issue. There are drugs that can stop your sweat glands from activating and treatments that stop your nerves from triggering too much sweat, so don't be afraid to raise this issue.

A good way to overcome your nerves or anxiety about a doctor's visit is to remind yourself that you can't afford to take chances with your health. It's unlikely you will shock your doctor with your symptom(s), and you will feel much better once your problem is in professional hands, even if it is nothing. “Your doctor will not laugh at you or mock your symptoms. Instead, he or she will address your concerns and help determine the best plan of action,” says Dr. Motter-Mast.

By being proactive about attending routine physicals and mentioning all new symptoms (even if you find them embarrassing!) you may even help your doctor catch a health condition before it becomes serious. Click here to find a primary care physician who is right for you.

Taking on Stress, Depression, Anxiety and Addiction

In case you missed it, GBMC and WMAR ABC2News recently hosted an interactive Facebook Live event on the topics of stress, depression, anxiety and addiction featuring primary care physician Kevin Ferentz, MD. Watch it on YouTube now. An estimated 11 to 36 percent of current primary care patients have some type of behavioral health disorder. With that in mind, GBMC HealthCare and Sheppard Pratt Health System are partnering to proactively address the behavioral health needs of the community.

“Our organizations are integrating behavioral health services in GBMC primary care offices and working to better manage all aspects of a person’s health in one setting,” says Robin Motter-Mast, DO, Chair of Family Medicine at GBMC. “For example, we are adding new team members to each of our primary care practices: behavioral health consultant, consulting psychiatrist and substance use consultant. Our work focuses on strong collaboration among the patient, primary care physician and these three new resources, depending on the patients’ needs.”

A Sheppard Pratt Health System behavioral health consultant will be located in each practice, operating as an internal expert for patients’ behavioral health needs. He or she is able to support minor to moderate mental health conditions through counseling techniques such as motivational interviewing, behavioral activation and problem solving therapy. The consulting psychiatrist, also employed by Sheppard Pratt Health System, can recommend medications or programs and may see patients face-to-face, serving as an additional resource to the primary care physician and behavioral health consultant. For patients who would benefit from treatment for addiction, the substance use consultant engages them in counseling (motivational interviewing) and offers resource navigation. Other services may be provided as needed by Kolmac Outpatient Recovery Centers and Mosaic Community Services, part of the Sheppard Pratt Health System.

“We have effective treatments for anxiety, depression, addiction, and other behavioral health problems, but it’s often hard for people to get access to expert care quickly when they need it,” notes Robert P. Roca, MD, MPH, MBA, Vice President and Medical Director, Sheppard Pratt Health System. “Our behavioral health consultants and psychiatrists are part of the GBMC primary care team and are on the spot to help when the primary care physician calls us in. It’s designed to be a seamless experience.” To utilize behavioral health services, simply contact your GBMC primary care provider and ask for more information. Please note: behavioral health consultants are not available in all practices yet, so your physician may put you in contact with a team member from another location.

Nurse Creates SAFE Haven for Patients of Sexual Violence

Growing up in a family of nurses, Ashley McAree, RN, FNE-A/P, CFN, knew from a young age that she was interested in a nursing career. But it wasn’t until she was working as a psychiatric nurse on GBMC’s Medical Psychiatric Unit that she made an eye-opening connection: many of her patients had a history of being sexually assaulted or abused in childhood. The issues seemed so pervasive that Ashley wondered if working with patients during their healing process, right after an attack, might prevent future victims from ending up in a psychiatric unit down the road. “My supervisor at the time was a Sexual Assault Forensic Examination (SAFE) nurse and she encouraged me to go through SAFE training myself,” Ashley said. “That’s when I knew it was my calling and it truly became my passion.”

Ashley is one of seven forensic nurses in GBMC’s SAFE program who specializes in pediatrics, a field she was initially anxious about, as she worried working with children would be too emotionally demanding. Program Manager Laura Clary, RN, FNE-A/P, SANE-A, CFN, CPEN, who suggested she be certified in pediatrics, helped her feel more comfortable. “Laura is very supportive. She goes at your pace – she doesn’t push,” Ashley said. “I started attending different trainings with her and seeing the great work we can do for kids and the important evidence we collect. It took a little while, but seeing the rewards and the impact on the kids and parents was significant.”

That doesn’t mean working with children who have been sexually abused gets any easier. Ashley cries with her patients and often thinks of them when she’s not at work, but she doesn’t view this as a flaw. “I’ve begun to think that being such an emotional person, which I initially thought would be a drawback, actually helps,” she says. “I am able to get on a patient’s level, show how much I care, and most importantly, that I believe them. They may not have been believed by others in the past; showing that I accept and believe them really helps them begin to heal.”

Despite the emotional difficulty, certain moments make it all worthwhile. Ashley recalls a particular young patient whose story sticks with her: “She was terrified, understandably so – of the hospital, the police, and really scared of me,” Ashley says. “She wouldn’t speak or even look at me. I gave her a lot of time and tried to make her as comfortable as possible. During the exam, I let her put on her favorite music, and we chatted – about friends, about school, and I asked her what she wanted to be when she grew up. She wasn’t sure. Later, as she was leaving, she stopped me and said, ‘I know what I want to be now – a forensic nurse.’ She gave me a huge hug. I will remember her forever.”

Join Ashley and the rest of the SAFE team as they march against rape, sexual assault, domestic abuse, and gender violence on April 22, 2017 at GBMC’s second annual Walk a Mile in Her Shoes®. Click here to register and fundraise.

Glaucoma: The "Sneak Thief" of Sight

Eat right. Stay fit. Don't smoke or drink. For many of today's most common diseases, there are simple prevention tips we've heard again and again. However, when it comes to glaucoma, which is the second leading cause of blindness worldwide and the leading cause of irreversible blindness in African Americans, there are no precautionary habits to practice. "It's important for patients to know that this is not on them," says Tanvi Shah, MD, a board-certified GBMC ophthalmologist. "Unlike diabetes or high blood pressure, there is no diet, exercise, or anything you can do to change whether or not you'll develop glaucoma."

Glaucoma has no signs or symptoms; you cannot see or feel it. In fact, it's possible to have very advanced glaucoma, including partial peripheral blindness, and not even notice it. It's often referred to as the "sneak thief" of sight because vision loss occurs slowly and painlessly – it could go unnoticed for years, even decades. There is only one way to find out if you have it: routine eye exams with an ophthalmologist.

Glaucoma is a condition of increased pressure within the eyeball (that you can't feel), which causes gradual loss of sight. More than 3 million Americans have been diagnosed with vision loss due to glaucoma, though its causes are still unknown. It is more common in African Americans and Hispanics than it is in Caucasian people, and it can run in families.

Though there are treatments available for glaucoma, including eye drops, laser, and surgery, these can only prevent further loss of vision; it is not possible to restore lost vision. This is why it's imperative to have yearly eye exams when you're over 40 (or sooner if you have a family history of glaucoma). A glaucoma test is non-invasive, involving checking the eye pressure, dilating eye drops (called mydriatrics) and the ophthalmologist examining your eyes with a light.

If you are diagnosed with glaucoma, you can still live a very normal life. "It is very treatable with monitoring and compliance and only leads to complete blindness in rare cases," says Dr. Shah. "Committing to regular eye exams is the key."

Visit gbmc.org/ophthalmology for more information or call 443-849-2106 to request an appointment with an ophthalmologist.

Turkey Bolognese with Pasta

Ingredients

1½ cup dry red wine (optional)
½ oz dried porcini mushrooms (optional)
1 cup onion, chopped
½ cup celery, rinsed and chopped
1 cup carrots, rinsed and thinly sliced or shredded
1 tbsp garlic, pressed or finely chopped (about 2–3 cloves)
1 tbsp olive oil
12 oz 99 percent lean ground turkey
1 tsp anise seed
¼ tsp salt
8 oz medium shell pasta
4 tbsp no-salt-added tomato paste
½ cup shredded parmesan cheese

Recipe

1. (Optional step:) Bring the wine to a boil in a medium saucepan. Break up the mushrooms, then stir them into the wine. Cover, reduce heat, and simmer for 20 minutes.

2. Finely chop the onion, celery, carrots, and garlic. Or you can coarsely chop them, place them in a food processor, and pulse until all vegetables are finely chopped.

3. In a 4-quart saucepan, bring 3 quarts of water to a boil over high heat.

4. While the water is heating up, warm the olive oil in a large nonstick pan over medium-high heat. Crumble in the ground turkey. Sprinkle with anise seed and salt. Cook for 5–10 minutes to brown, stirring occasionally.

5. Meanwhile, when the water comes to a boil, add pasta to boiling water. Cook according to package directions for the shortest recommended time, about 10–12 minutes.

6. Add vegetables to cooking turkey. Reduce heat to medium. Cook and stir 10 minutes until all vegetables are soft, but not browned. Add tomato paste, and simmer for an additional 5–10 minutes. (Continue to optional step 7 if including the optional ingredients; otherwise, skip to step 8.)

7. Optional step: While the pasta and turkey mixture cooks, strain mushrooms, draining unabsorbed wine directly into the turkey mixture. Place mushrooms on a cutting board and chop finely, or place in food processor and pulse once or twice to more finely chop mushrooms. Stir mushrooms into turkey mixture. Simmer for 10–15 minutes to blend flavors

8. Drain pasta. Add pasta to turkey mixture (the minimum internal temperature of cooked turkey should be 165 °F). Stir to blend well.

9. Divide pasta mixture evenly (about 2 cups each) among four dinner plates. Top each with 2 tablespoons of shredded parmesan cheese.

Nutrition Information

Serving Size: 4 Servings, about 2 cups of pasta
Calories: 463
Total Fat: 9 g
Saturated Fat: 3 g
Cholesterol: 63 mg
Sodium: 465 mg
Protein: 35 g
Carbohydrates: 47 g

Be Our Guest!

We're giving away 50 pairs of tickets to a special pre-opening night screening of Disney's new live-action film, Beauty and the Beast, on March 16...the night before it opens in theaters! All you have to do is register for one of these exciting events before March 9. Sign up for both events and be entered in our ticket raffle twice!

Register for GBMC's 29th Annual Father's Day 5K and 1 Mile Fun Walk! on Sunday, June 18. All proceeds support GBMC's Neonatal Intensive Care Unit (NICU), which provides round-the-clock care for sick and premature infants.

Want another entry?! Register for GBMC's second annual Walk a Mile in Her Shoes® on Saturday, April 22. All men and women (whether wearing heels or not!) are encouraged to support this important event, which benefits GBMC's Sexual Assault Forensic Examination (SAFE) and Domestic Violence programs.

Thursday, January 19, 2017

Avoid Medication Mishaps

According to the Centers for Disease Control and Prevention, there are more than 700,000 adverse drug events — injuries resulting from the use of medication — that result in hospital emergency room visits each year. Many of these events could have been prevented if information about adverse drug reactions and general medication safety had been more well known.


If you're using multiple medications, including powders, ointments, supplements, capsules/tablets, drops, implants, and injectables, it's time to get organized. Making a list is a great way to start. That way, when you visit any health care provider, you won't have to rack your brain about the exact names of your medications and their dosages. Create a table that will help you remember every medication's name, strength, the time(s) of day you take it, and its purpose for you. Share this list with all of your doctors, even if you don't think all of the information is necessarily relevant to them.

It's also a good idea to gather all of your medications, including anything over-the-counter you may be taking, in a Ziploc bag and bring them to your appointments. Even if an item seems benign, such as a vitamin, herb, or supplement, you never know what kind of medical interaction could occur without consulting your physician. It's also wise to try to use the same pharmacy to fill your prescriptions, so that they can help you keep track of everything you're taking. You may form a relationship with the pharmacist, who can alert you of any potential issues to raise with your doctor.

Sometimes, the medications you are taking together may not necessarily be dangerous, but can cancel each other out. For example, if you are taking an iron supplement, the calcium in your daily multivitamin may inhibit your body from fully absorbing the iron supplement. If your doctor knew you were taking both of these, he or she would likely recommend taking them at different times of the day. This way, you know you aren't wasting your money and effort and are getting the full benefit of both medications.

If you think it may be time to update your doctor about your medications and learn about any possible adverse reactions, talk to your primary care provider. If you don’t have a primary care physician, visit www.mygbmcdoctor.com to find one who is right for you.