GBMC to Open Human Milk Bank to Care for Premature Infants

Premature babies face a number of challenges. In fact, 10 to 15 percent of those born at a weight of fewer than 1500 grams will develop a potentially fatal complication called necrotizing enterocolitis, a condition that causes damage to the lining of the intestines. Fortunately, studies have shown that this condition can often be avoided by using breast milk. For this reason, GBMC will soon add a Human Milk Bank to its Neonatal Intensive Care Unit (NICU).

According to Howard Birenbaum, MD, Director of Neonatology at GBMC, “Some new mothers experience insufficient milk production, are unable to breastfeed due to a medical condition or choose not to breastfeed. But, we want the most vulnerable babies to have the advantage of breast milk, as it contains live cells, antibodies and many more components that help decrease the likelihood of infection and gastrointestinal problems. Breast milk won’t prevent all cases of necrotizing enterocolitis, but it reduces the incidence by half and is a big step in the right direction.”

Dr. Howard Birenbaum

GBMC’s goal is to provide all babies younger than 30 weeks gestation or weighing less than 1,250 grams with an exclusive human milk diet if the parents approve, even if the milk does not come from the biological mother. As the infant grows, the breast milk will require fortification to ensure they are getting additional nutrients and more calories to continue to grow at the appropriate rate. GBMC will utilize human milk derived fortifiers, as well. Once babies reach about 1,800 grams, they can transition to premature formula if the mother does not intend to continue providing breast milk. .

The milk will be supplied by licensed milk banking organizations in San Jose, California and Wake, North Carolina, which follow strict regulations put in place by the Human Milk Banking Association of America. All milk will be processed and tested to ensure product safety before it will be sent frozen to GBMC. “Maryland has stringent requirements regarding donating human tissue, and breast milk is considered a tissue. Parents can rest assured that the milk their babies receive is safe and healthy,” explains Dr. Birenbaum.

Dr. Victor Khouzami

According to Victor Khouzami, MD, Chairman of Obstetrics and Director of Women’s Services at GBMC, costs associated with having a Human Milk Bank are high, but the benefit to babies is worth it. “In the long term, very premature babies who have had the advantage of human milk are less likely to deal with future gastrointestinal issues and expensive, complex surgeries,” he says. Dr. Khouzami adds that milk bank services are not yet covered by insurance in Maryland, but thanks to generous support from the Women’s Hospital Foundation, donations will cover the cost of breast milk for babies in need at GBMC. “We express our sincerest gratitude to the Women’s Board for making our Human Milk Bank possible. Having this service available here is the right thing to do for our most fragile babies,” says Dr. Khouzami.

Additional funding is needed in order to support the Human Milk Bank. To make a donation, visit http://foundation.gbmc.org or call 443-849-2773. Please note: GBMC is not able to accept donations of breast milk itself.

A Life Saved Twice - Gastric Bypass Patient Wins Colon Cancer Battle

Me today, in training for my next
half- and full-Ironman races.

Fifty-five-year-old Brian Lewis was just learning his “new normal” after undergoing a successful gastric bypass. He was embracing his healthy lifestyle when, two weeks after completing a grueling physical competition, he received a shocking colon cancer diagnosis. This is his story, in his own words.

When my first granddaughter was born in 2007, I remember holding her and realizing that I had a lot to live for. She was, in a way, an inspiration for me to get back in control of my life. I was very overweight and, basically, my family physician told me that I needed to lose weight or I would die. I had a heart attack at age 45 and suffered with several other medical issues, from sleep apnea to asthma. It was time to make a change.

The Marine Corps Marathon in
2009 was the first marathon I ran
after having gastric bypass
surgery at GBMC.

I found out about GBMC’s Comprehensive Obesity Management Program (COMP) through my insurance company and decided to check out the program. Living hours away on the Eastern Shore, I knew I wouldn’t be able to utilize all of the program’s helpful resources (such as the support groups), but the entire team impressed me, from the surgeons and dietitians to the patient services assistants. They seemed to have thought of everything to help their patients succeed. I chose to go through with gastric bypass surgery — a decision that changed my life. My surgeon, Babak Moeinolmolki, MD, performed successful laparoscopic surgery on July 2, 2008, and by the following March, I had trained for and completed a half-marathon! My asthma and sleep apnea were gone. I no longer needed many of the medications I used to depend on. Best of all, I was confident that I was going to be around for my grandchildren. GBMC’s COMP team saved my life, and they continue to support me and troubleshoot any weight or diet challenges I face.

Nation's Triathlon in 2010. This was
the first triathlon I completed. The
money I raised was donated to finding
a cure for cancer.

A few years later, in July 2011, a new diagnosis changed my world. Two weeks after competing in a half-Ironman race, which consisted of 70.3 miles of swimming, biking and running, I was diagnosed with colon cancer. Having had no obvious symptoms, I was caught off-guard. Polyps had been found during a routine colonoscopy screening and tested positive for cancer. Unsure of what to do, I talked to Dr. Moeinolmolki, who suggested I make an appointment with his colleague George Apostolides, MD, FACS, FASCRS, GBMC’s Chief of Colorectal Surgery. Dr. Apostolides saw me right away, and we soon realized that my cancer was aggressive. During the initial diagnosis and CT scan, it appeared that the cancer was stage 1, with no apparent lymph node involvement. After a sonogram about 10 days later, Dr. Apostolides recognized that the cancer actually had reached my lymph nodes and was stage 3. I underwent surgery on August 2 and began a six-month course of chemotherapy on September 15. I’m happy to say that I’ve been cancer-free ever since.

Although I have nerve damage from my chemotherapy that causes discomfort in my feet and still feel a little tired sometimes, I’m working hard to get back into the good physical condition I was in before cancer. Determined to keep pushing toward that “new normal” I enjoyed after my weight loss surgery, I’m training to do a full-Ironman in November. I continue to live the healthy lifestyle that I began after my bariatric surgery, focusing on nutrition and fitness. My GBMC physicians remain a powerful resource for me in my endeavors, and everyone who cared for me did a wonderful job explaining what to expect each step of the way. When I had my bariatric surgery, I was thankful to know I’d be here for my grandkids. Now, thanks to both Dr. Moeinolmolki and Dr. Apostolides, I’m hopeful that I’ll be here for my great-grandkids, too.

Visit www.gbmc.org/weightloss, www.gbmc.org/colorectaloncology or call 443-849 GBMC (4262) to get additional information about the services offered by GBMC’s Comprehensive Obesity Management Program and Colorectal Oncology Department.

Should You Say Goodbye to Gluten?

Gluten: it’s a protein found in grains like wheat, rye, barley and oats that’s getting a lot of attention these days. In fact, one of the latest trends in nutrition is the “gluten-free diet.” For some people, especially those with celiac disease, adopting a gluten-free diet is critical to their health. However, for others who digest gluten well and have no medical reason to avoid it, the diet might not offer any benefit at all.

In individuals with celiac disease, gluten inflames the lining of the intestines, leading to issues with absorption and digestion. Because celiac brings with it potentially dangerous complications, it’s necessary for those suffering from it to completely eliminate gluten from their diet. It’s also possible for individuals to have gluten sensitivity, meaning they don’t have celiac disease, but gluten seems to cause digestive upset for an unknown reason. Even those with gluten sensitivity may be able to tolerate a certain amount of gluten, depending on their threshold.

If you suspect you may have an issue with gluten, it is important that you consult your doctor before testing out a gluten-free diet. A simple blood test should first be performed to rule out the possibility of celiac disease.

If you choose to eliminate gluten from your diet with no medical reason, be careful of the foods you consume. It’s not unheard of for so-called “healthier” food options to have some less-than-desirable qualities. Like foods that are labeled “fat free,” gluten-free products may be high in carbohydrates, sodium and sugar. They may also have a high fat content.

Finally, as is always the case, take care to maintain a well balanced diet, even if you’ve said goodbye to gluten. This will help you avoid any nutritional deficiencies that could possibly be brought on by cutting foods with gluten from your repertoire.

Grilled Vegetable Gazpacho

Ingredients:

• 3 ripe beefsteak tomatoes, cored and cut in half crosswise (about 3 pounds)
• 1 onion, sliced crosswise into ¼-inch-thick slices
• ¼ cup extra-virgin olive oil, divided
• 1 (1-ounce) piece French bread baguette, cut into 2 slices
• Cooking spray
• 1 red bell pepper
• 1 jalapeño pepper
• ½ cup water
• 2 ½ tablespoons fresh lemon juice, divided
• ¾ teaspoon kosher salt, divided (optional)
• ¼ teaspoon freshly ground black pepper
• 2 garlic cloves, crushed
• 2 cups thinly sliced, quartered English cucumber
• ¼ cup minced green onions
• 3 tablespoons fresh cilantro leaves

Instructions:

1. Preheat grill to medium-high heat.
2. Lightly coat bread with cooking spray. Place bread on grill rack, and grill 1 ½ minutes on each side or until toasted. Remove from grill. Place peppers on grill rack coated with cooking spray. Grill 8 minutes or until blistered, turning after 4 minutes. Remove peppers from grill and place in a small paper bag, folded tightly to seal. Let stand for 20 minutes. Then remove skin and seeds from peppers. (Note: wear gloves when working with jalapeño peppers and wash hands thoroughly afterwards.)
3. Brush cut sides of tomatoes and onion slices with 1 tablespoon oil. Arrange onion on grill rack and cook for 10 minutes. Turn onion over. Arrange tomatoes, cut sides down, on grill rack; cook onion and tomatoes for 10 minutes. 
4. Combine 2 tablespoons oil, bread, grilled vegetables, ½ cup water, 2 tablespoons lemon juice, ½ teaspoon salt (optional), black pepper and garlic in a blender. Process until smooth. 
5. Combine the remaining 1 tablespoon olive oil, remaining 1 ½ teaspoons lemon juice, remaining ¼ teaspoon salt (optional), cucumber and remaining ingredients; toss. 
6. Ladle about ⅔ cup soup in each of 6 bowls, and top each serving with about ⅓ cup cucumber mixture.

*To lower the sodium content, omit the ¾ teaspoon of kosher salt listed. When the soup is complete, add a small pinch to taste if necessary.

Nutrition:

Servings: 6
Calories: 134
Fat: 9.4g
Protein: 2.2g
Carbohydrate: 11.5g
Fiber: 2.5g
Calcium: 29mg
Sodium:  280mg (if ¾ teaspoon kosher salt is used)

Recipe by: Cooking Light

Photo by John Autry; Styling by Leigh Ann Ross

Oh, My Aching Head!

For many, headaches are more than just a nuisance. Whether the pain is a moderate ache or a severe throbbing, all over or localized to one area, headaches and the other symptoms they may cause (sensitivity to light, dizziness, nausea, fatigue, to name a few) can severely impair a person’s quality of life.

There are several techniques that headache sufferers can use to help manage their symptoms:

• Reduce emotional stress by learning relaxation skills like deep breathing and progressive muscle relaxation. 
• Reduce physical stress by stretching periodically, especially after sitting for a long period of time. Also make sure you get enough sleep – 7 or 8 hours per night is best for most adults. 
• Exercise regularly. It’s important to get at least 20 minutes of exercise three times a week.
• Keep a routine. Try to eat meals and snacks at approximately the same times every day.
• Quit smoking. Not only can smoking trigger a headache, but it can also make one worse. Need help quitting? GBMC offers American Lung Association Freedom from Smoking Classes.
• Learn what triggers your headaches by keeping a diary. When you know what causes your headaches, you can take avoidance measures in the future.

If you have persistent headache pain that isn’t relieved by over-the-counter medications, or if it prevents you from taking part in normal daily activities, consider talking to a doctor. The physicians at the new GBMC Center for Neurology may be able to help! Dr. Michael Sellman, Dr. James Bernheimer and Dr. Arash Taavoni opened the 4,000-square-foot center on July 1, 2013 and are currently accepting new patients. The center is well equipped to care for patients with neurologic conditions such as headaches, stroke, epilepsy, carpal tunnel syndrome and pinched nerves in the neck or back. Many tests and some treatments can be performed within the office.

Please call 443-849-4145 for more information or to schedule an appointment.

Understanding "Swimmer's Ear"

Known to medical professionals as otitis externa, swimmer's ear is an inflammation of the ear canal. Its common name comes from the fact that it often occurs in children and young adults who swim frequently. However, any cause of dampness in the canal can lead to the irritation and chafing of swimmer’s ear – it’s actually very similar to diaper rash in babies.

The moisture can cause the skin inside the ear canal to become chafed, dry and cracked. A break in the skin may allow bacteria or (more rarely) a fungus to invade the tissue of the ear canal and cause an infection. Swimming in dirty or polluted water, therefore, is a common cause of swimmer's ear; the bacteria in the water find a hospitable home in the moist environment of an inflamed ear canal.

Skin conditions, such as seborrheic dermatitis and psoriasis, and excessive or improper cleaning of wax from the ears can also lead to swimmer's ear. Not only does wax protect the ear canal from excess moisture, but it also harbors friendly bacteria. Removing this protective barrier -- particularly with hairpins, fingernails, or other objects that can scratch the skin -- makes it easier for an infection to take hold. Hair spray or hair coloring, which can irritate the ear canal, may also lead to an outer ear infection.

Symptoms are isolated to the ear and include:

• Itching
• Watery discharge
• Severe pain and tenderness
• A foul-smelling, yellowish discharge
• Muffled hearing

Fortunately for those suffering from it, swimmer’s ear typically clears up quickly once treatment begins. The key is going to the doctor before the condition has the chance to get more complicated and painful. Basic treatment usually includes gentle cleansing of the ear and use of antibiotic drops. Oral antibiotics may also be prescribed by your physician. 

Are you in need of a primary care physician for your family? Visit www.gbmc.org/mydoctor for physicians in your area who are accepting new patients.

Total Knee Replacement Gets Patient Back in Motion

After two total knee replacements,
patient Kathleen Speca is on her feet again.

When Kathleen Speca, in her fifties, was diagnosed with early osteoarthritis in her late twenties, she recognized that her knee pain would increase over the years. However, after being diagnosed and treated successfully for breast cancer through radiation treatments and long-term medication, her discomfort worsened more quickly than expected. 

In the hopes of alleviating her pain, Mrs. Speca turned to Lee M. Schmidt, MD, Director of GBMC’s Joint Center. “We first tried a conservative approach of cortisone shots and physical therapy to strengthen the muscles surrounding my knee,” Mrs. Speca explains. When the pain persisted despite the treatment, she and Dr. Schmidt discussed and agreed upon the surgical option of a total knee replacement. 

“I had the first total knee replacement surgery on my right knee on March 6, 2012, and then on my left knee on October 23, 2012. Although I was prepared for a tough recovery, I bounced back like a teenager!” she says. “There was certainly pain and discomfort, but nothing I couldn’t handle. Plus, with Dr. Schmidt’s excellent surgical technique and by strictly following my physical therapy guidelines, I was off to a speedy recovery.”

According to Dr. Schmidt, “Every component of the joint replacement process is done at the Joint Center. Patients are evaluated by a surgeon and are given a guidebook that explains what happens each day in the hospital, how to prepare for surgery and plan for their recovery.” He adds that patients are invited to attend a class to meet the Joint Care Coordinator and become better educated about the process.

Post-operative care is provided on Unit 58, which is tailored specifically for joint replacement patients. The team includes orthopedic nurses, nurse practitioners, physician assistants, physical and occupational therapists and discharge planning specialists, all supervised by the Joint Care Coordinator. Each patient also has a designated coach to help them prepare for surgery and assist in recovery. In addition to total joint replacement, the Center offers a full array of surgical services, including  minimally invasive options and partial joint replacement surgery, in which only the arthritic portions of the joints are replaced, resulting in faster recovery.

“The nurses and techs on the unit were all fabulous. The care I received from the beginning to my discharge was superb,” says Mrs. Speca. “Dr. Schmidt and the entire staff treated me like family every step of the way.” 

Whether dancing, cooking or relaxing
at home, Mrs. Speca is thankful to be
pain-free.

Mrs. Speca enjoys dancing and cooking, which always played havoc on her knees. Even going up and down steps was extremely painful. “Now, I am better able to be on my feet for hours preparing meals for guests, and no matter what, I’ll never stop dancing,” she says. “It’s so nice not to have your knees hurt as you climb the stairs. I can keep enjoying my life as a productive person in society, continuing my career in the non-profit sector, volunteering and helping others.”

For more information on GBMC’s Joint Center, call 443-849-GBMC (4262) or visit www.gbmc.org/jointandspine.