- Women's HealthGeneral Page Tier 3BlogWhen Roxanne Walsh’s son Van was born in October 2016, it could have been a difficult delivery. The Pasadena woman was more than a week overdue when she gave birth to the nearly 10-pound boy after 64 hours of labor. But there was someone by her side who helped make things much easier – her midwife Maria Mayzel, MSN, CNM, with Anne Arundel Medical Group (AAMG) Bay Area Midwifery. “I felt like she just had a gentle, guiding hand,” says Roxanne, 30, a hairstylist at Studio Salon in Annapolis. “I loved my experience. I wouldn’t change it for anything.” AAMG Bay Area Midwifery is a freestanding birth center located on Anne Arundel Medical Center’s (AAMC) Annapolis campus. Staffed by seven certified nurse-midwives, the midwifery team takes a holistic, individualized approach to pregnancy. “Just having a freestanding birth center in the state of Maryland is unique. We’re one of only two in the state,” says Maria, who has worked at AAMG Bay Area Midwifery for four years. While moms-to-be can opt for unmedicated births in the birthing center, AAMG Bay Area Midwifery is still an active part of the hospital. Clients, like those who want pain management such as an epidural, can choose between giving birth in the hospital or in the birth center. Clients who have high-risk pregnancies receive care from both the midwives and a team of specialists at AAMC. A seamless transfer system between the birth center and the hospital adds an extra layer of safety. “Safety is always our number one priority,” Maria says. READ MORE: The rising popularity of birth centers Roxanne learned about AAMG Bay Area Midwifery from her sister, who delivered three of her four children there. She liked the birth center’s attitude toward pregnancy, especially the close interactions all patients have with their midwives. Roxanne’s husband, Shane, also liked the idea of a natural birth for their first child. She remembers counting down the days until her first appointment, when she was eight weeks pregnant. But five weeks later, when she had her first sonogram, she learned some surprising news. Roxanne has a bicornuate, or heart-shaped, uterus, a condition that affects about 1 percent of women and frequently causes complications during childbirth. Risks can include a higher risk of miscarriage, improper attachment of the baby’s placenta, excessive bleeding and premature birth. Though Roxanne and Shane were concerned, the team at AAMG Bay Area Midwifery was reassuring. “Our plan was to just take it as it came,” Roxanne says. “I felt very confident.” As her pregnancy progressed, Roxanne held out hope that she would be able to have her baby in the birth center. But shortly after the 30-week mark, midwives told her she would be a better candidate for delivery in the hospital’s birth center, due to potential risks during labor. “At this point, we didn’t know how far my uterus could expand,” Roxanne says. Though she was disappointed, the partnership between the midwives and the hospital team comforted her. Plus, she would still be able to have one of the midwives by her side. Maria says the goal is always to honor the family’s wishes, which is why it is important to start talking about their birth plan early on. Those conversations include the entire family, Maria says. “The client’s family is the most important part of the birth team,” she says. Shane said his main concern was the safety of his wife and child, and was happy with the decision to deliver in the hospital. “It was just a change of scenery,” he says. The birth Roxanne went into labor at around 5 pm on a Saturday night, just as she and Shane were leaving a movie. At that point, she was more than 41 weeks pregnant. She called Maria, who told her to call back when the contractions were five minutes apart. A day later, the pain was intense and the contractions were holding steady. She made an appointment for Monday, when she had a stress test and learned her cervix was just four centimeters dilated. Maria says Roxanne was experiencing prodromal labor, which is when contractions happen for hours, even days, with no cervical change. After a day of therapeutic rest, Roxanne’s labor began to slowly progress. She returned to AAMC on Tuesday, and Maria — who happened to be on call that day — made a plan with Roxanne to proceed with labor induction. Roxanne was still in labor when Maria’s shift ended. “I was ready to lose it,” Roxanne says with a laugh. But Maria stayed an hour and a half past the end of her shift to help bring Van into the world — an example of the close relationship the midwives develop with their clients. “One of the biggest things we can offer our clients is more time,” Maria says. Roxanne says she had the experience she always envisioned, complete with essential oils, flameless candles and music — lots of Alice Coltrane in particular, she recalls. Shane, a musician who plays in several Annapolis-area bands, used special headphones to play Alice Coltrane for the baby when Roxanne was pregnant. Van came into the world happy and healthy, weighing nine pounds, 14 ounces. An ongoing relationship Today, Van is an active 18-month-old who loves to bang on his dad’s drums and play with blocks. And his parents couldn’t be happier with their family’s experience at AAMG Bay Area Midwifery. “She was a calm force of wonderful energy,” Roxanne says of Maria. “I feel like a lot of people would have talked me into doing other things, but I had a midwife who advocated for me.” Roxanne’s relationship with AAMG Bay Area Midwifery now continues through annual well woman visits. “At my six-week checkup, I was so sad I was leaving,” she said. “So I was thrilled to learn that I could still receive all my wellness care from the midwives.” AAMG Bay Area Midwifery midwives provide well woman and primary care for women throughout their life span, including family planning, Pap smears, screening and treatment for sexually transmitted infections, breast exams and referrals for mammograms, referrals for mental health services, and menopausal care. Roxanne says she will always remember the sense of community she felt throughout her pregnancy. She encourages any mom-to-be who wants a personalized birth experience to consider AAMG Bay Area Midwifery. “You couldn’t make a better choice,” she says.0
- Men's Health, Orthopedics, Women's Health, UncategorizedGeneral Page Tier 3BlogTotal hip replacement is one of the most successful surgeries for relieving pain and increasing function if you suffer from osteoarthritis in your hip. Traditionally, hip replacements were performed through two approaches – posterior or anterolateral. Now, the anterior method is gaining popularity as the “hip” hip replacement. When you have osteoarthritis in your hip, we always begin with conservative treatments, including: anti-inflammatory medications maintaining a healthy weight physical therapy a cane in the opposite hand to off load the pressure on the joint injections But if your pain persists, it’s imperative to have a surgeon skilled in modern replacement strategies to get you back on your feet and active again. Although originally described in 1881, the direct anterior approach to hip replacement was only sporadically used until recently. Technology advances, coupled with patients’ increased desire for minimally invasive surgery and faster recovery, has the anterior hip replacement gaining in popularity. Anterior hip replacement patients are routinely walking with physical therapy within hours following the surgery. The anterior approach is a muscle-sparing procedure that exposes the hip joint with one small incision over the front of the hip. The muscles and tendons are spread apart temporarily, rather than detaching them from the hip or thigh bones, as done during the traditional hip replacement approaches. Anterior hip replacement leads to less trauma to the soft tissues and more stability following surgery. During the surgery the patient is placed on a special table, called the Hana® table, that has independent leg spars allowing us to maneuver the patient’s legs to perform the surgery through the small anterior incision. This table also allows us to use intra-operative x-rays to “fine tune” the alignment of the hip replacement components. This offers better wear properties and increased stability of the hip. We use standing x-rays taken prior to surgery and reproduce this with our intraoperative x-rays to appropriately position the hip replacement components specifically for each patient, as well as make leg lengths equal. One of the biggest differences between the anterior approach and traditional hip replacement is the freedom from “hip precautions” following the procedure. Anterior patients can position the hip anywhere they feel comfortable immediately after surgery. Muscles are not cut and the risk of dislocation is low, which enables patients to have more freedom of movement after surgery. Anterior hip replacement patients are routinely walking with physical therapy within hours following the surgery. Following a traditional hip replacement, the surgeon must give specific instructions on hip precautions to prevent dislocating the new joint. These include avoiding bending the hip and turning the foot, sleeping with a pillow between the legs for six weeks, avoiding crossing the legs and not sitting in low chairs. But, for anterior hip replacement patients these precautions are unnecessary. Many patients go home in less than 24 hours and complete outpatient physical therapy within four to six weeks. The incision is closed with absorbable sutures and skin glue, which enables you to shower immediately and not have to have sutures or staples removed. The direct anterior approach can be utilized for nearly all total hip replacements. Whether patients have osteoarthritis, rheumatoid arthritis, femoral neck fracture or advanced avascular necrosis, the anterior approach is a reliable and reproducible surgical approach. Anterior hip replacement can help you get back to the life you want to be living. Author By Justin Hoover, MD, orthopedic surgeon at AAMC Orthopedics. To reach his practice, call 410-268-8862. Originally published March 31, 2015. Last updated May 31, 2018.0
- Cancer Care, Community, Patient & Family Advisors, UncategorizedGeneral Page Tier 3BlogPatricia Holle describes herself as a “mammogram success story.” When her breast screening showed an abnormality, Pat underwent 18 months of treatment for stage 2B breast cancer at Anne Arundel Medical Center. Once she was pronounced cancer-free, Pat was determined to help others who were facing cancer diagnoses. Luckily, she didn’t have to look far: She joined the volunteers who serve as AAMC’s patient and family advisors. Pat says she was hooked by the program’s theme, Nothing About Me Without Me. Pat had benefited from their services when she was a patient, so she felt it was a natural fit for her to return the favor. “There is something so special about AAMC,” says Pat. “They have such great care, even after treatment is done.” In her advisor role, Pat collaborated on the guide that breast cancer patients are given when they begin their cancer journey. “Empathy is wonderful,” says Pat, “but a unique perspective is given by someone who has been through breast cancer.” One annual event that holds particular meaning for Pat is AAMC’s National Cancer Survivors Day celebration. That’s where she learned about the Annapolis Dragon Boat Club, the local club of an international movement of cancer survivors who paddle and race stylized boats. “We like to say that it is a support group that’s not only about the disease,” says Pat. “Plus, being an athlete again is a great thing.” The dragon boat is featured in a painting that now hangs in The Rebecca Fortney Breast Center at the Geaton and JoAnn DeCesaris Cancer Institute, and is reproduced on note cards that are in a gift bag given to breast cancer patients on the day of their surgery. Pat remarks, “In the face of having a life-threatening diagnosis, it is reassuring to have a visit from a survivor with these special gifts.” Originally published Aug. 10, 2016. Last updated May 29, 2018.0
- News & Press Releases, Heart CareGeneral Page Tier 3BlogAnne Arundel Medical Center and community partners have brought life-saving technology to Anne Arundel County. Working together with the city, the Fire Department and Leadership Anne Arundel, the new PulsePoint app aims at improving bystander response to cardiac arrest victims and increasing the chance of survival. Here’s how it works: The app alerts CPR-trained citizens to someone nearby having a sudden cardiac arrest so they can help while professional responders are on the way. The app is activated by the local public safety communications center concurrent with the dispatch of local fire and EMS resources. Anne Arundel County residents can now easily download the app and register. PulsePoint looks to reduce the time between the victim’s collapse and CPR response through citizen awareness. It also increases awareness of public access defibrillator (AED) locations through real-time mapping of nearby devices. “Heart disease is still the number one killer in the United States,” said Jerry Segal, MD, medical director of cardiovascular services at AAMC. “ Timing is critical in these situations. Bystander CPR is important because it really does save lives. There have been studies done showing that it increases the survival rate in these patients by about threefold.” The app also shows fire and EMS activity in the community, strengthening community engagement. The app is only functional where adopted and implemented by the local fire/EMS agency because it requires a connection to the local public safety communications center. “In 2017 there were 534 people in Anne Arundel County who experienced a sudden cardiac arrest and 34 percent of the time bystanders performed CPR before first responders arrived,” said Allan C. Graves, Anne Arundel County fire chief, noting that the launch of the app was happening during the 44th Annual National EMS week. “The launch of PulsePoint is a demonstration of how we are stronger together.” An example of the potential of the app is Carl Smit, 47, of Annapolis. On Jan. 27, Carl was sailing in a local regatta when he had a sudden cardiac arrest. “I told the woman next to me that I was going to sit down and shut my eyes for a minute,” he said. “I wasn’t breathing or responding but luckily a good friend conducted CPR until they got me to shore. Not a lot of people there were trained on how to do CPR.” Carl Smit Having someone on site who was CPR-trained saved Carl’s life. And today, he was able to share his story during the launch because of this. “The team at AAMC is amazing. I have to thank Dr. Iliff, Dr. Reineck and Dr. Kilical,” Carl added. “I just graduated a couple of weeks ago from three months of cardiac rehab and it’s fabulous, the team here is outstanding.” Carl said he felt discouraged in the beginning since most people in rehab were much older than him. “I didn’t know how long recovery was going to be,” he said. “But I started walking on a treadmill and by the time I got out I was already rowing.” Carl understands the importance of quick response firsthand. He said the app might not only save lives, but also encourage more people to learn how to respond. “I think PulsePoint is going to make a huge difference in the Annapolis area by increasing awareness.” The PulsePoint app is now available in Anne Arundel County. If you’re a CPR certified or trained member of the community, learn more about PulsePoint here. Want to get CPR certified? We offer classes for the community. Sign up today!0
- Men's Health, Orthopedics, Women's Health, WellnessGeneral Page Tier 3BlogBarefoot and minimalist running became a popular trend over the last several years. The barefoot running technique, as its name implies, involves wearing little to no footwear while you run. The developers and advocates of this technique believe the human foot is evolutionarily designed to run barefoot, and shoes only hinder our performance and cause us injuries. David J. Keblish, MD, an orthopedic foot and ankle surgeon at AAMC, disagrees. “There is a romanticized notion that somehow the world would be a happier place if we didn’t wear shoes,” he says. “I think that’s nonsense. The human foot is not evolutionarily designed well for running, and I don’t think shoes are causing the problem.” Dr. Keblish believes it is our modern lifestyle that ruins our feet, not our choice of running shoes. “We’ve turned the earth flat, and most of us spend all day long in shoes without ever exercising the many muscles in our feet” he says. While early humans had a variety of terrains under their feet, we have mostly flat surfaces. Running on sidewalks, roads and gym floors is tough on our feet—the repetitive motion of feet hitting hard, flat pavement adds stress on our joints and prevents us from adapting to other surfaces.” “People who don’t have shoes don’t have better feet,” he says. “You don’t see marathon runners running barefoot or in minimalist shoes.” There is one aspect of barefoot running that Dr. Keblish does agree with—the forefoot strike technique. This running technique involves landing on the balls of your feet each time you take a step rather than heel striking, or landing on your heels first. Proponents of barefoot running suggest that forefoot striking is more intuitive when running barefoot, while shoes with thick soles and heels cause us to heel strike. “We shouldn’t be heel striking heavily, if at all, when we run,” Dr. Keblish agrees. Training ourselves to forefoot strike is hard to do, he adds, but is better for our feet in the long run. Dr. Keblish also advises that we take time to exercise our feet. “We wake up and immediately stuff our feet into slippers or shoes and most of us keep them there all day, which is not good,” he says. “Feet are like hands; we need to get those joints moving.” To do this, Dr. Keblish says, take the time to wiggle your toes, rotate your ankles and massage the soles of your feet before you get out of bed. He also advocates going barefoot or in minimalist shoes when doing balance drills and resistance training, such as squats and lunges to develop strong feet. Return to Finding the Right Running Shoes for Your Feet Contributor David J. Keblish, MD, is an orthopedic surgeon at AAMC Orthopedics with offices on the AAMC campus in Annapolis and in Pasadena. Prior to joining AAMC, Dr. Keblish deployed with Marines in Afghanistan where he led a military medical unit in caring for severely wounded US troops and coalition forces injured in battle. In addition to serving our nation, he has extensive experience covering NCAA division 1 intercollegiate sporting events and caring for athletes at every level. He can be reached at 410-268-8862. Originally published November 17, 2015. Last updated May 23, 2018.0
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