Take a Little Time for You!

GBMC has a long history of caring for women. After all, The Hospital for the Women of Maryland, of Baltimore City, was one of the two hospitals that consolidated to form the health system patients know today. Not only does GBMC care for women as patients, but it recognizes the critical role women play in ensuring the health of the ones they love.

With such a strong focus on caring for others and also managing the hustle and bustle of everyday life, it can be easy for a woman to lose sight of a very important person – herself! Knowing this, GBMC aspired to create a program to give women time to take a break and focus on their own wellbeing. This was the inspiration for Time for Me!, a free women’s health lecture series held each spring and fall. During the month-long series, one lecture is given per week. Each week’s topic is different and presented by GBMC’s own physicians to offer practical information and advice on the prevention, treatment and management of the most common health issues affecting women. 

Join us for one or more of our Spring 2014 lectures!

Tuesday, April 1, 2014
SOS. Could I have IBS? What is Irritable Bowel Syndrome and how to know if you have it. 
Kirsten “Kisha” Weiser, MD

Tuesday, April 8, 2014
The Heat is On! The hot facts about managing menopause.
Beth Aronson, MD

Tuesday, April 15, 2014
Bye, Bye Dry Eye! Learn the signs, symptoms and treatment for dry eye.
Sudeep Pramanik, MD

Tuesday, April 22, 2014
Hold it! Taking control of Urinary Incontinence.
Nicole Korbly, MD

All events are held in the Civiletti Conference Center in Physicians Pavilion East. Check-in will begin at 6:00 p.m., with the lecture beginning promptly at 6:30 p.m. and ending at approximately 8:00 p.m. There is no cost to participate, and all attendees will receive a special gift and a complimentary parking pass. We also encourage attendees to invite family and friends to attend!

To register, visit www.gbmc.org/timeforme or call 443-849-GBMC (4262).

Into the Wilderness: Beyond Primary Care

Primary Care Physician and Wilderness
Medicine specialist Jillian Verby, MD,
on an excursion outside of Wanaka,
New Zealand.

For Jillian Verby, MD, the practice of medicine is not confined to the walls of a clinical exam room. The GBMC primary care physician’s study of Wilderness Medicine has provided her the opportunity to work in exotic locations like a clinic in Montana’s Yellowstone National Park, a medical practice in rural New Zealand and in Cusco, Peru, where she conducted high altitude illness research. Wilderness Medicine is the practice of medicine in limited-resource environments. It encompasses topics such as altitude sickness, cold- and heat-related illness, trauma, expedition and disaster medicine, dive medicine, search and rescue efforts and wild animal attacks. “From activities like exploring deserts, climbing mountains and skiing to scuba diving, white-water rafting and windsurfing, people find themselves in situations where medical issues can and do occur,” Dr. Verby explains. A doctor trained in Wilderness Medicine may be the difference between life and death for a patient.

“My interest in this field has been lifelong; I grew up hiking and camping, and I always knew I also wanted to become a physician,” says Dr. Verby, who is a member of the Family Care Associates practice at GBMC. During her residency, Dr. Verby learned of the Wilderness Medical Society and knew she had found her niche. She decided to specialize in the subject and now works closely with the Society to hone her skills and educate other doctors. Throughout the course of her training, Dr. Verby has lectured on topics such as heat illness, wilderness ophthalmology, sun exposure, water procurement and purification, knot tying and land navigation.

While Wilderness Medicine certainly involves extreme situations, medical professionals in the field are not solely focused on injuries or illnesses occurring in remote locations. These specialists also assist with the issuance of protocols for first response and secondary care, provide insight about prevention of medical emergencies, conduct epidemiological studies and contribute to public policy advisement and issuance of guidelines to disaster planning agencies. 

Dr. Verby on an ice field in Big Sky,
Montana.

So what’s the benefit of having a primary care physician who has climbed 18,000 feet in Bolivia and surfed in Hawaii? “I think one of the advantages of this training is creative problem solving. I may not be discussing Wilderness Medicine with each patient, but the thought processes and skills learned are parallel,” says Dr. Verby. Her patients can consult with her when planning for or returning from locations with limited medical resources and benefit from her extensive regional knowledge. “An ounce of prevention is worth a pound of cure,” she notes, while adding that if patients return from vacations or expeditions with a medical issue — such as a fever or gastrointestinal upset — her experience with Wilderness Medicine is a great help as she works to find the best course of treatment.

For additional information or to schedule an appointment, call 443-849-GBMC (4262) or visit www.gbmc.org/familycare. To view a full list of primary care physicians, visit www.gbmc.org/mydoctor.

It Takes a Team to Keep Patients Safe

Did you know that Patient Safety Awareness Week is celebrated nationally every year from March 2 to 8? When it comes to patient safety, every member of GBMC’s family has a role to play. This was highlighted by a recent “good catch” that was made by a member of the Environmental Services (EVS) team. One day, as she completed her regular work, the EVS associate responsible for cleaning the Surgical Intensive Care Unit (SICU) glanced into one of the rooms and noticed a patient attempting to get out of a chair.

Utilizing GBMC’s safe behaviors, the EVS staff member first paid attention to detail – noticing that a patient who was at a high risk for falling was trying to get out of a chair without assistance. She then communicated the situation clearly and directly by notifying the nursing staff immediately so they could assist. Working together as a team, the employee and the nursing staff intervened to prevent this patient from potentially being harmed by a fall.

“We’re proud and appreciative of this team member’s willingness to go above and beyond her daily responsibilities to ensure our patients are safe and that we are able to provide the care we would want for our own loved ones,” says Carolyn Candiello, Vice President of Quality and Patient Safety. “She and the SICU nurses are perfect examples of our GBMC family working together, regardless of their organizational roles – clinical or nonclinical – and getting in action to keep patient safety at the top of mind.”

GBMC believes that patients have a right to know about the hospital’s efforts to provide safe and reliable care. Members of the community are welcome to visit the patient safety and quality webpage, www.gbmc.org/quality. The site tracks GBMC’s progress in various safety measures, from hand hygiene to surgical site infections, and is updated regularly.

Turning a Corner in Breast Cancer Detection

New Technology Offers Enhanced Imaging of Dense Breast Tissue

Having dense breast tissue can pose challenges when it comes to the imaging capabilities of a mammogram. Some early cancers may go undetected because they could be hidden behind dense tissue. Women with dense breast tissue are often called in for additional testing due to unclear results. However, a new Food and Drug Administration (FDA)-approved technology is enhancing mammography for women in this category. This groundbreaking tool is called tomosynthesis mammography, or 3-D mammography, and it is now offered on GBMC’s campus through its imaging partner, Advanced Radiology. 

“Tomosynthesis mammography is the next logical step in screening women with dense breast tissue,” says Lauren Schnaper, MD, Director of the Sandra & Malcolm Berman Comprehensive Breast Care Center at GBMC. “By imaging ‘slices’ through the breast, overlapping shadows are eliminated and each area of tissue can be seen more clearly.” She explains that subtle tumors become more obvious because they can be separated from background tissue. Fewer women will be called back for additional imaging because of positional changes in the breast from year to year. “Hopefully, it will allow us to advance in two areas: to perform fewer unnecessary biopsies and to find tumors that are hiding behind normal dense tissue.”

Some studies show that, when combined with digital 2-D technology, 3-D mammography can provide improved breast cancer detection. All women undergoing a standard mammogram may elect to have this added to their exam at an additional cost of $100, as insurances do not currently pay for the test. 

Recognizing Breast Cancer Risk 
Besides skin cancer, breast cancer is the most common cancer affecting American women. According to the American Cancer Society (ACS), about 12 percent of women in the United States will develop invasive breast cancer at some point during their lives. Fortunately, thanks to improved technologies, like tomosynthesis mammography, and better education, breast cancers are being diagnosed earlier and more people are surviving it. All women are encouraged to become acquainted with screening recommendations that could help detect breast cancer in its earliest stages. 

The ACS recommends the following guidelines with regard to breast cancer screenings:

Women age 20 and over: Individuals should become familiar with what their breasts usually look and feel like. If any changes are noticed, they should call their doctor. Self breast exams are also an option.

Women in 20s and 30s: Receive a clinical breast exam approximately every three years. 

Women 40 and over: Receive yearly clinical breast exams and mammograms. 

Consult with your physician to determine if 3-D mammography might be a good option for you. Or, call Advanced Radiology at GBMC at 410-580-2300 to learn more about the technology. 

Charred Asparagus with Shaved Parmesan

Ingredients:

• 1 ½ lbs asparagus, tough ends snapped off
• 2 tbsp olive oil
• ½ tsp coarse smoked salt (available in specialty food stores)
• 1/8 tsp freshly ground black pepper
• 1 tbsp fresh lemon juice
• 1 oz Parmesan, shaved into thin strips

Instructions:

• Preheat oven to 425 degrees F. Put a baking sheet on the middle rack and heat for 5 minutes. 
• If the asparagus spears are especially thin, slice lengthwise into two equal pieces. If they’re larger (about ½ in thick), quarter them into four long segments. 
• Place asparagus in a large bowl, drizzle with olive oil and toss to coat. 
• Arrange asparagus onto a hot baking sheet in a single layer. Return to oven and cook for 15 to 20 minutes, tossing with a spatula halfway through, until tender and tips have started to blacken. 
• Transfer to a serving platter, season with salt and pepper and drizzle with lemon juice. Sprinkle shaved Parmesan over top and serve immediately. 

Nutrition:
Servings: 6
Calories: 83
Fat: 6g
Protein: 4g
Carbohydrate: 5g
Fiber: 2g

Which Healthcare Setting is Right for You?

Knowing where to turn for healthcare can be confusing because there are many options available, all offering what seem to be similar services. People might wonder if it is necessary to have a primary care physician (PCP) versus going to an urgent care or convenience care clinic. They may also struggle with deciding when an issue warrants a visit to a hospital’s emergency department. Listed below are descriptions for different types of care to help minimize the confusion.

A primary care physician’s office, which usually includes physician assistants, nurses, nurse practitioners, technicians and clerical staff, builds relationships with patients, truly getting to know their healthcare goals and needs. The most valuable benefit of having a primary care doctor is that he or she concentrates on health maintenance and managing chronic illnesses like diabetes. GBMC PCP offices offer extended weekday hours and morning office hours on Saturdays. All of GBMC’s PCP offices function as patient-centered medical homes, emphasizing prevention and wellness rather than treating patients when they’re already sick. Although PCPs are very focused on wellness, they also build time into their schedules to accommodate patients when they are sick as well as to treat minor urgencies, such as sprains. Additionally, nurse practitioners act as extensions of the physicians to offer convenient, timely healthcare access.

Urgent care clinics are staffed by a team similar to that of a PCP office, but they typically treat conditions such as sprained ankles, cuts and fevers. They are more focused on episodic care (when a person is already sick or has a minor injury) rather than prevention or overall wellness. Urgent care clinics have late hours, are open on weekends, accept walk-ins and often have other service capabilities such as X-rays, lab work and prescriptions available onsite for patient convenience.

Convenience care clinics are located in pharmacies or grocery stores. They are not always staffed by a physician, but instead by nurses or assistants who treat conditions like earaches, sore throats and flu-like symptoms. These clinics typically also offer common vaccinations, like the flu shot, on a walk-in basis. 

Hospital emergency departments are meant to treat more critical health problems, which may include heart attack, stroke, allergic reaction, major injury, etc. If someone is experiencing symptoms consistent with the above conditions, or has suffered a severe injury, it’s important to call 911 and get to the closest ED. 

“Finding a PCP is often a good place to start. This will ensure patients have a go-to person who is aware of their overall health status and maintains all of this information on their electronic health record,” explains Mark Lamos, MD, President and Medical Director of Greater Baltimore Medical Associates and Internal Medicine physician at GBMC. “Fortunately for patients, there is always a healthcare option available to handle their individual situation.” 

Interested in finding a primary care physician who is right for you? Visit www.gbmc.org/mydoctor or call 443-849-GBMC (4262) for a listing of GBMC’s PCP office locations. Videos of many physicians are available for viewing on the website and appointments can also be requested online.

Commonly Used Cooking Oils

If you are health-conscious and like to cook or bake, you have likely stood in the aisle of the supermarket, glancing at the many types of oils, trying to select the best one. There are more than 20 types of cooking oils and since they are derived from plants, such as nuts, olives and seeds, they all have different characteristics.

Things to Consider When Choosing Oils

Smoke Point

Each type of oil has its own unique “smoke point,” and it’s best to select an oil with the right smoke point for the dish you are preparing. Once oil exceeds its smoke point, the temperature at which it begins to chemically break down and produce smoke, it emits cancer-causing carcinogens into the air and a strong foul smell. 

Fat Content

Oil is a form of fat, carrying 14 grams in a single tablespoon, so it should be consumed in moderation. Not all fat is created equally, however. There are two types of fat: saturated and unsaturated. Unsaturated fat, whether monounsaturated or polyunsaturated, is considered to be heart-healthy, or “good” fat. Saturated fat, found in fatty meats and vegetable oil, can increase cholesterol and increase the risk of heart disease, heart attack and stroke. While vegetable oil is commonly used, its high fat content from partially hydrogenated oils is bad for the heart.

Flavor

Some types of oils are flavorless, some have mild flavor and certain types have rich, distinct flavoring. The flavor factor is worth considering when using the oil in baking or when you want to pack some punch to a recipe.

Pros and Cons of Commonly Used Cooking Oils

Olive Oil

Depending on the type you choose, olive oil has many uses. Light olive oil has a high smoke point, making it preferable for cooking foods at a high temperature, such as pan-frying. Extra virgin olive oil has a strong, grassy flavor and a lower smoke point, so choose that when whipping up a marinade, dip or dressing. It also is considered one of the healthiest oils, with 75 percent monounsaturated fat.

Canola Oil

With a high smoke point, no distinct flavoring and only seven percent saturated fat, canola is one of the most versatile, healthy oils. Canola can be used instead of vegetable oil when baking and when cooking foods at a high heat. 

Sesame Oil

With a strong, intense flavor, sesame oil is a key ingredient in many Asian dishes, and its 350 degree Fahrenheit smoke point makes it perfect for stir-frying. The dense flavor of sesame oil allows you to use a minimal amount - usually less than a tablespoon - which helps to reduce calories. Additionally, it has high unsaturated fat content and low saturated fat. 

Sunflower Oil

Sunflower oil is high in monounsaturated fat. This heart-healthy oil is similar to light olive oil and canola oil; it carries a light, almost unnoticeable flavor and can be used up to 440 degrees Fahrenheit. 

Coconut Oil

Coconut oil has gained popularity lately for its rich flavor and versatility. Natasia Tomlinson, RD, LDN, a clinical dietitian at GBMC, does not recommend the use of coconut oil for its high saturated fat content. Its health benefits are limited and largely unproven, so it’s better to opt for a more heart-healthy choice. 

Vegetable Oil

Containing hydrogenated oils and saturated fat, vegetable oil can raise cholesterol and increase risk of blood clots. If you have to use vegetable oil, use sparingly when possible. Canola oil is a great substitute for vegetable oil.