- Heart CareGeneral Page Tier 3BlogNancy Dick, 78, was sitting at a table playing poker with several of her good friends. They’ve been getting together once a month for the past seven years. Their friendship predates their card games, taking them back to kindergarten. Fast-forward several decades and now, instead of playing on the schoolyard, they find joy in exchanging dimes and nickels. “We laugh a lot together,” says Nancy. Mary, whom Nancy has known the longest out of the group, always carries an oxygen tank with her. Out of curiosity that afternoon, Nancy asked Mary if she could try her pulse oximeter. “My oxygen was OK but my pulse was 43,” says Nancy. “Mary asked me to try it again and my pulse was 44, which is still very low.” Concerned about the pulse reading, Mary encouraged Nancy to call her doctor right away. Worried, Nancy took action. “I called my internist who was able to see me next morning,” she says. After doing an EKG to record the electrical activity of her heart, Nancy’s internist described her pulse as “irregularly irregular” and scheduled her to see Juan Cordero, MD, cardiologist at Anne Arundel Medical Group (AAMG) Cardiology Specialists. He immediately said she needed to see an electrophysiologist, or a heart doctor who specializes in hearth arrhythmias. A few days later she would meet with Baran Kilical, MD, cardiologist and electrophysiologist with AAMG. He told her that what she had would not kill her, but he could improve her quality of life. “I knew that I was dragging,” Nancy recalls. “I couldn’t walk further than 25 feet without being out of breath. I would fall asleep at the drop of a hat.” Dr. Kilical’s recommendation? A Micra pacemaker. What is a Micra pacemaker? The Micra Transcatheter Pacing System (or Micra) is the newest and the world’s smallest pacemaker, and FDA approved for use in the U.S. since April 2016. Currently, Anne Arundel Medical Center (AAMC) is one of only a few Maryland hospitals offering Micra pacemakers. Compared to traditional surgery with an incision, Micra can inserted through a catheter in the patient’s groin. The Micra pacemaker is about the size of a large vitamin capsule and 93 percent smaller than a traditional pacemaker. Dr. Kilical describes the several advantages of this small technology. “A traditional pacemaker requires an incision on the chest of about 3-5 cm in length,” says Dr. Kilical. “Micra has no incision and is cosmetically more appealing. There are lower complications because there are no leads, which most complications long-term with a pacemaker are due to the leads and them malfunctioning, breaking or fracturing over time.” The recovery time is also much quicker. Traditional pacemakers usually restrict patients from showering for a week and prevent heavy activity with the left arm. With Micra implants, patients can shower the next day and activity restriction decreases to roughly a week versus a full month. How does it work? It is less invasive and self-contained. Whereas a conventional pacemaker has leads that can fracture over time, increasing the likeliness of future complications, Micra is completely self-contained within the heart. Nancy, who had a mastectomy when she was 63, had a port on the right side of her chest and Dr. Kilical expressed his worry about scar tissue. “He gave me options,” says Nancy. “It didn’t take me any time to agree that the Micra pacemaker was the best choice.” Here’s how the implant works, from beginning to end: During a Micra implant, an anesthesiologist will first sedate a patient. A doctor, in this case Dr. Kilical, will then proceed to take a needle and make a small hole in the femoral vein (located in the patient’s groin). Through that, he puts a delivery sheath, or a straw-like catheter, that goes up into the heart. Through that sheath, the Micra pacemaker is brought up into the right atrium and then into the right ventricle of the heart. Once Dr. Kilical has verified that it is placed correctly, he tests the device to make sure it functions appropriately. Then, Dr. Kilical will release the tether and remove the delivery system. Is it for everyone? No. Micra is intended for patients who need a single chamber pacemaker, also known as a ventricular pacemaker or VVIR. For Nancy, this was the perfect option. “I knew I would be taken care of,” she says. She says her life has changed for the better. “I’ve felt good ever since,” she says. “Before, if I sat down for any length of time, I would frequently fall asleep. I’m not doing that at all. I feel a lot more energetic, I am happy camper for 78.” Now that’s a real royal flush! Originally published Aug. 10, 2018. Last updated March 11, 2019.0
- Behavioral Health, Community, PediatricsGeneral Page Tier 3BlogThe heroin epidemic is a national problem that hits close to home in Anne Arundel County. According to the Anne Arundel County Department of Health, heroin-related deaths in the county have increased by 128 percent between 2010 and 2013. The rate of heroin use here is 5.5 percent for youths ages 16 and 17 and 10.7 percent for adults age 18 and older. Both of these numbers are above the averages for the state of Maryland. The Danger of Opioids Fueling the epidemic are opioids. Opioids come in two main forms: prescription painkillers like OxyContin and Percocet and illegal drugs like heroin. The Centers for Disease Control and Prevention (CDC) is writing new guidelines for physicians to explore other options before prescribing opioids. Still, many people already have a prescription for opioids. In 2012, doctors wrote 259 million opioid prescriptions. That’s enough for every adult in the United States to have a bottle of pills, according to the CDC. Not everyone who takes opioids gets addicted. However, everyone develops tolerance and some may start to crave these drugs. Opioid use can lead to risk of falls, respiratory problems, sleep apnea, interaction with other medications and potentially fatal overdoses. Suboxone: A Safe Solution Quitting opioids “cold turkey” is painful and dangerous. Withdrawal symptoms start around 12 hours after someone stops using opioids. Symptoms can include stomach pain, anxiety, body pain, chills, diarrhea, nausea, sweating, insomnia, weakness and more. For people dependent on opioids, Suboxone can help. Suboxone is a medication that helps people safely stop opioid use by reducing withdrawal symptoms and opioid cravings. The medication also blocks the effects of other opioids. Suboxone treatment not only allows people to safely withdraw from opioids with little discomfort, it helps manage other health issues related to opioid use. Suboxone treatment also links people with professional counselors. Counselors can help people develop coping skills and behaviors to prevent setbacks. Only qualified, licensed doctors can prescribe Suboxone. Pathways, Anne Arundel Medical Center’s substance use and mental health treatment center, offers both inpatient and outpatient Suboxone treatment. Both programs begin with a phone call to understand the patient’s needs. Based on the phone call, we recommend either inpatient or outpatient care. The opioid epidemic is complex, and the solution is not simple. At Pathways, we believe we can begin to turn this public health crisis around by working together with other healthcare professionals, our community partners and our patients. For more information on Suboxone treatment and other options available through Pathways, visit PathwaysProgram.org.0
- Physical TherapyGeneral Page Tier 3BlogThe way we breathe can either induce stress or encourage healing and calmness. Inhaling and exhaling properly affects us mentally and physically. What’s in a breath? Breathing is not only taking in oxygen. It’s also about managing the levels of carbon dioxide, a gas released when exhaling, that contributes to our respiratory function. The longer you practice exhaling through your nose, the more relaxed your body will feel as it releases more carbon dioxide. Carbon dioxide is a potentially toxic gas when it builds up in the body. What impacts my breathing? Seasonal allergies, along with irritants such as smoke, dust, pollen and fragrances effect the efficiency of breathing. These pollutants cause internal swelling, excessive mucous, coughing and a host of other health issues. What can I do to breathe better? Deep breathing lowers blood pressure and promotes the body’s balance. Diaphragmatic breathing is a form of deep breathing. Also known as “abdominal breathing or belly breathing,” it encourages full oxygen exchange as you inhale air into the deepest parts of the lungs while engaging your abdominal muscles. Practice deep breathing by lying on your back with a pillow under your head with your knees bent. Place one hand on your stomach and one hand on your chest. Inhale or breathe through your nose, allow your belly and chest to rise and then exhale out of your mouth. This technique is most effective when the stomach rises higher than the chest. How will intentional breathing and wearing a mask improve my health? Walking and taking deep breathes on a regular basis helps keep you healthy. The American Heart Association recommends 30 to 50 minutes of exercise daily to promote respiratory strength. Wearing a mask reduces the risk of transmitting COVID-19, the flu and other contagious diseases. Some ways to minimize the discomfort and anxiety of wearing a mask include: Using essential oils (placing a drop of lavender oil in your mask), chewing gum or wearing lip balm. Ultimately, wearing a mask is a form of self-care and shows respect for others. Luminis Health Physical Therapy is opening a new location in Upper Marlboro on Nov. 12. Authors Rhonda Fowler PT, MS, CLT, CWS, is a physical therapist at Luminis Health Doctors Community Medical Center. Clarissa M. Ocampo, MM MA CCC-SLP, CLSVT LOUD, is a speech language pathologist at Luminis Health Anne Arundel Medical Center.0
- Cancer Care, Women's Health, Pediatrics, Uncategorized, Patient StoriesGeneral Page Tier 3BlogElma Courtenay was treated for Breast Cancer at the DeCesaris Cancer Institute. She says just knowing she was in the best hands possible helped her focus her energy on getting well. “You know you hear the word cancer, and the first word that pops into your head is death. When I was given the diagnosis, my mind was a complete blank. Then Dr. Tafra said something that made all the difference. When she first saw me, she said, “We’re going to get you down to a healthy weight.” Those were the words of life and hope. I thought, ‘that could take a long time,’ and, immediately, I knew I was going to live. And I held on to those words every single day. I was given chemo to treat the breast tumor so I could have the surgery. My nurse navigator was so amazing. I had never heard of a nurse navigator before, but it was such a godsend. They walk you through everything so you’re focusing on healing yourself and not worrying about who you have to make appointments with. Just knowing that she was always there at a moment’s notice to return my call immediately was amazing. It just made everything so literally stress-free because the one worry I did not have in my life at the time was my medical attention and care. I sensed and I knew that I was in the best of care possible and the rest was up to me. I really focused on keeping everything positive; not listening to news, and even being very selective of the music I was listening to. I changed my thought process, and I welcomed the medication. I saw it as the airstrike coming into my body to get rid of the bad army. I cut out all processed food, all sugar, all carbs. I ate very natural organic foods. I dropped 25 pounds. It sounds strange but I felt healthier. And the tumor shrank beyond my doctor’s expectations. When I was first diagnosed, a lumpectomy was not on the table. It was going to be a mastectomy. But the tumor shrank enough for a lumpectomy. Then, after the surgery, during my radiation treatment, my husband who is in the Marine Corps, was transferred to Texas. But with the care and compassion that I received there at the Breast Center, I could not just stop right in the middle. I realized I was surrounded by compassionate people that really wanted to see me go through it with the least worries and stress. So I told my husband, “Go ahead and go. I am in very good hands.” And I was. Now that all my tests have come back negative, I’m getting ready to join him. And I am so, so thankful for the wonderful, wonderful care I got at Anne Arundel Medical Center. Being in a place where I could get the quality of care, the attention that they give to their patients made a big difference in my recovery.”0
- Women's HealthGeneral Page Tier 3BlogIf you’re one of the estimated 25 million women dealing with pain “down there,” embarrassment may be keeping you from getting the help you need. You’re not alone. Only an estimated 15% of women dealing with pelvic pain bring it up with their doctor. Too many women assume pelvic pain – pain that mostly or only occurs in the area below a woman’s belly button – is something that “comes with the territory” and silently live with it. But there’s good news: You don’t have to. What is Pelvic Pain? Pain is the body’s way of letting you know something’s not right. While it’s common for many women to experience mild cramping or discomfort before or during their monthly menstrual cycle, pelvic pain can involve much more, including pain in your lower stomach or back, buttocks and genital area. Pelvic pain may: Be steady or come and go Cause pressure or discomfort around the vaginal area Feel sharp and stabbing in a specific spot, or dull and spread out Make inserting a tampon or getting a gynecological exam uncomfortable Pelvic pain is chronic if it lasts more than six months and affects your normal activities like work, exercise or having sex. What Causes Pelvic Pain? Pelvic pain can be hard to diagnose because the pelvic area in women includes different systems —digestive, reproductive and urinary — along with many muscles, ligaments and nerves. There may be one source of pain or multiple causes. Some common causes include: Aging Childbirth Endometriosis Adenomyosis Fibroids Genetics Hormonal changes Injured or irritated nerves Scar tissue Urinary tract infection Weak pelvic floor muscles Pelvic pain feels different for everyone and your pain level may not relate to how severe the problem is. For instance, a tiny area of endometriosis may cause intense pain for you, while someone else could have extensive endometriosis with little to no pain. Pelvic pain isn’t something to minimize or try to live with; ignoring it comes with risks. Left untreated, pelvic pain can lead to pelvic inflammatory disease, scarring and fertility problems. Emotional problems can flare too – depression, anxiety, insomnia and intimacy struggles are real. Your Doctor Wants to Help – Start Talking Finding relief starts with mustering the courage to talk openly with your doctor about what you’re experiencing. Be prepared to be as specific as possible. You’ll likely be asked questions like: Can you describe the pain you’re experiencing? Can you rate your pain on a scale from one to 10? Does it wake you at night? How frequently do you have pain? How long have you been experiencing pain? What kinds of activities trigger it? What makes it worse or better? Do you find yourself calling out of work or school due to pain? Pinpointing the cause of pelvic pain isn’t always clear-cut and can take time. You may even have more than one thing going on. After talking with you and doing a physical exam, your doctor may want tests to gather more information. Diagnostic tools such as ultrasound, laparoscopy and cystoscopy allow for a closer look. With these results, you and your doctor can talk about the treatment that’s right for you. Treating Pelvic Pain Thankfully, there are treatment solutions that don’t involve surgery, or if they do, have a minimally invasive approach. The most common treatment options include: Diet and lifestyle changes. Changes to your eating and exercise plans. Medication. Over the counter and prescription pain relievers and muscle relaxants. Physical therapy. Massage, stretching, strengthening and learning how to control pelvic floor muscles. Surgery. Minimally invasive procedures to remove adhesions, fibroids or endometriosis. Finding relief for pelvic pain may mean trying more than one approach or a combination of treatments. If you feel you are not being heard, don’t hesitate to seek a second opinion. It can take time, but opening up to your doctor and working together can lead to brighter days ahead. Author Jessica Ton, MD, is board-certified in obstetrics and gynecology. She specializes in minimally invasive gynecologic surgery. Make an appointment by calling 443-481-3493.0
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