Guilt-free Holiday Gifts

This year, consider giving gifts that will help your friends and family achieve, not defeat, their New Year’s Resolutions! 

1. Water bottle – Encourage hydration with a quality, durable water bottle. Check online to find specialty water bottles, such as those with built-in water purifiers or fruit infusers. Be sure to choose a BPA-free model!
2. Sunglasses – Most people don’t think about sunglasses in the middle of winter, but proper UV protection is needed year-round. (Especially when bright white snow is reflecting off the ground on a sunny day!) 
3. Moisturizer – A good moisturizer can help skin stay smooth and hydrated while fighting cracking, peeling and dryness. Consider a scented body butter or a light facial moisturizer. Bonus: Find one with SPF of at least 15.
4. Cookbook/Tablet holder – If your loved one is working hard to prepare healthy recipes, why not make it a little easier? Cookbook holders can hold cookbooks on your kitchen counter for easy recipe reading while you cook, and there are also stands designed to hold a tablet (such as an iPad) upright so you can read recipes straight from the web. 
5. Red wine – Wine is a traditional gift that many people already enjoy; red wine provides the bonus benefit of vitamins and antioxidants. Tip: Make sure the recipient doesn’t have any health issue precluding him or her from imbibing responsibly.
6. Journal – Mental health experts state that journaling can help with managing stress and relieving negative emotions. Health benefits of journaling include reduction of anxiety and physical symptoms brought on by stress.
7. Cutting board – Some people don’t think to buy these for themselves, but you can never have too many cutting boards to slice, dice and prepare fresh fruits and vegetables. Bonus: Include seasonal fruits or vegetables with the gift!
8. Gift card to a natural grocery store – Sometimes visiting a new store can be intimidating. A gift card can encourage someone to try new, healthy things they might not normally buy.
9. Countertop grill – Indoor grills provide a way to enjoy meats without all the fat, and they provide a great amount of protein, too! They are also great in the winter months when venturing outside to the grill is not a favorable option.
10. Yoga mat – Giving a friend or family member a yoga mat may be just what they need to try a new class. If they are shy, consider pairing it with a yoga DVD or CD.

Prescription for Safety

If you’re like most people, you keep a variety of over-the-counter and prescription medications in your home for everything from headaches to heartburn. But did you know that these medications lose their effectiveness past their given expiration date and can also lose potency if they are improperly stored? Here are some important facts to keep in mind to ensure that your medication remains as safe and effective as possible. 

Expiration dates represent the date at which the manufacturer’s guarantee of a drug’s safety expires. If you take a drug past its expiration date, there is no way to be certain that the medicine will work as intended. The Food and Drug Administration (FDA) requires all medication to have clear labeling of the expiration date. For prescription drugs, look for the term “EXP” followed by the date printed on the label. Over-the-counter medications have the date stamped on the lid or packaging. Once a medication is expired, the FDA recommends specific instructions for disposing of it properly. For more information about properly discarding unwanted drugs, visit the FDA website here. 

Prior to the expiration date, there are several factors to consider for storing your medication. A popular place to store medications is in a bathroom medicine cabinet, but experts at the National Institute of Health (NIH) indicate that it is not an ideal location. The humidity, heat and moisture in a bathroom can decrease a drug’s effectiveness by causing changes in chemical compositions, especially for tablets and capsules (as opposed to liquids). The NIH used aspirin as an example of what can happen as a result of improperly storing aspirin. When kept in a humid environment, aspirin tablets break down into acetic and salicylic acid, which can irritate the stomach.

The NIH recommends storing medication in climate-controlled areas. Optimal locations include a hall linen closet shelf, a bedroom drawer or a kitchen cabinet, away from the stove. If you have children, always keep medications in secure containers and out of reach. When traveling, keep your medication with you in a carry-on bag if you are flying to ensure it is in a climate-controlled environment. Never leave medication of any sort in a car, as heat can reduce effectiveness.

Healthier Hot Chocolate

Ingredients:

• 1/4 cup cocoa, no sugar added
• 1/2 cup coconut palm sugar or 1/4 cup honey (to taste)
• 1/4 cup dark chocolate chips, (gluten, soy and dairy free chips available)
• 4 1/2 cups low-fat milk
• 1 teaspoon vanilla extract 

Instructions:

1. In a medium saucepan, heat milk over medium-low heat until steaming. Add cocoa, sweetener, and chocolate chips, stir until cocoa is combined.
2. Warm over medium-low heat until all ingredients are combined and hot chocolate is to desired temperature. Add vanilla and stir to combine.
3. Serve in mugs with a ladle and sprinkle a little cocoa or shredded dark chocolate.

Nutrition:

Servings: 4 (1 cup per serving)
Calories: 192 per serving
Fat: 6g 
Carbohydrate: 26g 
Fiber: 2g
Sugar: 23g
Protein: 6g

Recipe and photo courtesy of www.skinnyms.com

Local Nurse Survives Cancer, Faces Non-healing Wound Decades Later

Patricia Tuck in the hyperbaric oxygen
therapy (HBOT) unit at GBMC.

A radical course of radiation treatment in 1985 saved 29-year-old nurse Patricia Tuck’s life, and her right leg. However, nearly 30 years later, she found herself once again fearing amputation — this time due to the radiation that had previously spared her limb. This is her story, in her own words.

When I was diagnosed with a rare form of osteosarcoma in my right leg 28 years ago, not much was known about the disease. The standard treatment at the time was amputation, which I didn’t want to accept. My oncologist decided to try something new — extensive radiation to my entire leg. Fortunately for me, it worked! I was cancer free, but not out of the woods. I knew that radiation could have implications for me later in life. It could cause tissue damage and even other forms of cancer.

Sure enough, many years later, I started seeing the negative effects in my right foot. As a nurse, I’m on my feet all day long and was experiencing pain due to the tissue damage. In May of 2013, I underwent surgery to straighten the toes in my foot to make walking a little more comfortable. Unfortunately, the surgery caused a new problem — a wound that wouldn’t heal. After four weeks of no improvement, my primary care physician told me it was time to see a wound care specialist. Knowing that GBMC has a renowned Wound Care Center as well as a hyperbaric oxygen therapy (HBOT) unit, I opted to go there to see Ziad Mirza, MD.  I really didn’t know if my condition indicated HBOT, but I wanted to go to a center that had that capability just in case.

Within five minutes of meeting me, Dr. Mirza recognized my history of heavy radiation treatment and knew HBOT would be the most effective therapy for my wound. The staff immediately called my insurance company, took care of all the background work, and had me in the HBOT chamber the very same day.

A technician prepares Ms. Tuck
for her treatment within the chamber.

Even though I have a clinical background, they fully explained everything to me in easy-to-understand terms. Dr. Mirza explained to me that I’d be placed inside the enclosed chamber and would breathe 100 percent oxygen at two to three times atmospheric pressure. It works by dissolving oxygen into the blood plasma, causing an increase in tissue oxygenation, stimulating healing of tissues, forming new blood vessels, controlling infections and regenerating new, healthy tissues. It is a best practice for the treatment of non-healing radiation-induced wounds, in addition to many other types.

I may be part of the medical world, but I was still a little nervous about the treatment. The thought of being enclosed inside a chamber was scary to me, and the staff recognized that. They helped to reassure me and ease my fears. I would never be left unattended while in the chamber — the technicians would be closely monitoring me the entire time. The chamber tops are also clear, so I was able to see outside the whole time and even watch TV or a DVD —although, sometimes I chose to simply take a nap!

The improvement in my wound was astounding, and very quick. Within a week, I saw a huge difference in the healing process and was in much less pain. After just 30 daily treatments, I was completely healed and discharged from the program even earlier than expected. I can now complete my entire shifts at work. I’m so fortunate that Dr. Mirza is so knowledgeable and experienced in his field. Had I not known that HBOT was an option, my wound may have never healed, and I may have lost part of my foot. I am forever grateful to Dr. Mirza and the entire staff of GBMC’s Wound Care Center and HBOT for their continuous compassion, bedside manner and incredible expertise. Thanks to them, I can say that I have been cancer-free for 28 years and still have both of my legs to show for it!

To learn more about Hyperbaric Medicine and Wound Care at GBMC, call 443-849-GBMC (4262), visit www.gbmc.org/hyperbaricmedicine or www.gbmc.org/woundcare.

Break the Silence: Discuss Urinary Incontinence with Your Doctor

Members of GBMC's Urogynecology
team (l to r): Nicole Korbly, MD; Joan
Blomquist, MD; and Janis Logan, MS,
CRNP, CNM.

Embarrassed by the social stigma surrounding urinary incontinence, women experiencing bladder control issues often remain silent or wait years before seeking help. However, according to Joan Blomquist, MD, Division Head of Urogynecology at GBMC, it’s a very common problem to have. “Approximately one out of four women over the age of 18 has likely experienced an involuntary leakage of urine,” says Dr. Blomquist. “In fact, 11 percent of women will have surgery sometime during their life for incontinence or pelvic organ prolapse. That figure doesn’t even capture the women who can be treated with more conservative approaches or those who are suffering in silence.”

Urinary incontinence is broken into two main categories: urge and stress. Urge incontinence typically impacts women as they age and makes them feel the need to “go” frequently, often not making it in time. Contractions of the bladder either cause a sudden urge to urinate or, if the contractions are strong enough, bladder leakage. Since urge incontinence can be triggered by acidic or spicy foods, caffeine and alcohol, dietary changes may alleviate some of the symptoms. Other treatments include behavioral management, bladder retraining, pelvic floor exercise/physical therapy and medications to manage the spasms. For some patients, urge incontinence is related to an abnormality of the nerve supplying the bladder. As a result, nerve stimulation, via an office procedure called posterior tibia nerve stimulation, can also be beneficial. “With this procedure, an acupuncture-sized needle is inserted near the ankle to stimulate the tibia nerve once a week for 12 weeks,” explains Dr. Blomquist. “This treatment has proven 60 to 70 percent effective.” 

Conversely, stress incontinence is less likely to be age related, and is more of an anatomical issue involving improper support of the urethra. “Stress incontinence can be associated with having had a vaginal birth, being overweight or lifting heavy objects — anything that puts excess pressure on the pelvic floor,” she says. Women who are affected by this form of incontinence may experience leakage when laughing or coughing. Treatments include pelvic floor exercises, in-office injections into the urethra, insertion of a medical device in the vagina to hold the urethra stable or an outpatient procedure.

“GBMC offers both conservative and surgical treatment options to cater to each individual’s preference and lifestyle,” says Dr. Blomquist, who adds that two physical therapists specializing in pelvic floor issues are available right on campus. “If urinary control issues are impacting your quality of life by preventing you from doing daily activities you enjoy, you might benefit from a consultation with your doctor. With all of the options available, you will likely find a treatment that works very well for you.”

For additional information about GBMC’s Division of Urogynecology, call 443-849-GBMC (4262) or visit www.gbmc.org/urogyn. 

Please note! Urinary incontinence will be a topic at one of GBMC's Time for Me! women's health lectures in April 2014. Check www.gbmc.org/timeforme for additional information on all of the topics in late winter.

Skinny Green Bean Casserole

Ingredients:

• 1 (14 oz) bag of frozen whole green beans (or about 4 cups fresh)
• 1 cup mushrooms, thinly sliced 
• 1 medium onion, finely chopped
• 1 tsp garlic, chopped

For the Sauce:

• 1 cup plain low-fat Greek yogurt (or low-fat sour cream)
• 1 tsp corn starch
• 1 tsp salt
• 1/2 tsp pepper
• 1 pkt Stevia (or 1/2 tsp sweetener of choice)

For the Topping:

• 1 tbsp minced dried onion
• 1/2 cup grated parmesan cheese
• 1/2 cup panko bread crumbs 

Instructions:

1. Preheat oven to 350 degrees. Spray a large baking dish with cooking spray and set aside. Meanwhile, spray a large skillet with cooking spray. Sautee the onions, garlic and mushrooms in 1/2 cup water, stirring occasionally until the water is completely evaporated. Remove onions and mushrooms from pan and place in a medium bowl.
2. If using frozen green beans, thaw the green beans in the microwave for 5-10 minutes or until thawed. (If using fresh, steam green beans, snip off the ends and place beans in a large pot of boiling water for about five minutes or until tender and drain). Add green beans to the bowl with the mushrooms and onions. Let cool to room temperature before adding sauce mixture.
3. In a small bowl, mix ingredients together to make the sauce. Add sauce to the green beans and toss until everything is well coated. Add everything to prepared baking dish.
4. Mix topping in a small bowl and sprinkle evenly over the top. Bake (uncovered) 35-40 min or until topping is golden brown. Serve warm.  

Nutrition:

Servings: 6
Serving size: about 1 cup
Calories: 110
Fat: 3 g
Carbohydrates: 13 g
Fiber: 2 g
Sugar: 4 g
Protein: 9 g

Recipe and photo courtesy of www.dashingdish.com

The Growing Importance of Advance Care Planning

W. Anthony Riley, MD, pictured
with a patient.

Discussing end-of-life wishes can be an uncomfortable topic, but it is an extremely important one. In fact, it’s a good idea for patients with any serious chronic illness to begin this advance care planning soon after receiving a diagnosis. “Taking the opportunity to initiate this planning early with your healthcare provider will enable you and your family to make educated decisions about treatments you may need to consider in the future,” says W. Anthony Riley, MD, Medical Director of Gilchrist Hospice Care, Medical Director of Gilchrist Greater Living, and Physician Board Chairman of Greater Baltimore Health Alliance. “For patients with advanced chronic illnesses, many of the available treatments have substantial burdens along with their benefits. Engaging proactively on advance care planning gives you, your family and your provider the time needed to consider which treatment approaches will best meet your needs further down the road.” 

This dialogue should result in the completion of Medical Orders for Life-Sustaining Treatment (MOLST) forms. The MOLST order, a medical order made by a physician or nurse practitioner, complements the Advance Directive, a legal document, which provides general guidance on patients’ wishes and allows them to name a healthcare agent.  MOLST forms cover, in detail, wishes regarding everything from CPR and artificial ventilation to blood transfusion, antibiotic use and artificially administered fluids and nutrition. Patients and their physicians should review and update the document periodically. If a MOLST form is on record, it will be treated as a medical order and will be followed accordingly, even if a patient is unable to speak for him or herself. 

Conversations about advance care planning are encouraged and, in fact, expected, in the current healthcare environment. Says Dr. Riley, “We want our patients and physicians/nurse practitioners to engage in open, honest communication and shared decision making so patients will have the right mix of treatments and support available to them at each stage of their illness.”  

Advance care planning has been found to be very beneficial for patients, families and providers alike.  “Many of my patients report feeling a profound sense of relief after engaging in advance care planning,” says Dr. Riley. “They have a better understanding of what their disease course might look like; they feel confident that their provider and their family members understand their wishes; and they feel that they have freed their loved ones from the burden of making difficult decisions in a crisis. I encourage everyone in the GBMC community with a chronic illness to take the opportunity to initiate this important dialogue with their healthcare provider.”

Gilchrist Hospice Care now offers an Advance Care Planning Series, led by W. Anthony Riley, MD, for individuals interested in learning more. The discussions are held the second Tuesday of every month, and include topics such as general, cardiac, pulmonary, and neurodegenerative conditions and dementia advance care planning. For more information about the Advance Care Planning Series or to register for a discussion, please visit gilchristhospice.org/advancecareseries or contact Nicole Conradi, GHC Program Management Specialist, at 443-849-8205 or nconradi@gilchristhospice.org.