2 Gazette Health | Spring 2013
A GAZETTE PUBLICATION
A publication of The Gazette | Spring 2013 Editors Designer Contributing Writers
Kimberly Bamber Anna Joyce Anna Joyce Karen Finucan Clarkson Scott Harris Archana Pyati
Associate Publisher Creative Director
Doug S. Hayes Anna Joyce
The Gazette is a division of Post-Newsweek Media, Inc. Prince George’s Office: 13501 Virginia Manor Road, Laurel, MD 20707
Gazette Health is produced by The Gazette’s Special Sections, Advertising and Creative Services departments. It does not involve The Gazette’s newsrooms. Send comments to email@example.com. Content is for informational purposes only and should not be construed as medical advice, or as a substitute for seeing your own doctor. COVER PHOTO: ISTOCKPHOTO/THEBOONE
Golf Rehab Improve Your Core
Strength and Flexibility Professional golfers make it look easy, but the golf swing is actually one of the most difficult and complicated movements in all of sports, requiring stability in some joints and flexibility in others. Having proper motion, strength, and function throughout the swing plays a large role in preventing injuries.
In the article on bacterial vaginosis in the winter 2012 issue of Gazette Health, the definition of the pH scale was reversed. The article should have stated that the lower the pH, the higher the acid level.
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Spring 2013 | Gazette Health 3
Drinking too much, including binge drinking, results in about 23,000 deaths in women and girls each year. About 1 in 8 women age 18 and older and 1 in 5 high school girls binge drink. –CDC
New Hope for Peanut Allergy Sufferers
Cancer Deaths Dropping
Will Weed Lower Your IQ? A
study published last September of more than 1,000 people who began using marijuana at 13 and continued regular use into adulthood found that, by 38, their IQs had dropped an average of 8 points. “For context, a loss of 8 IQ points could drop a person of average intelligence into the lowest third of the intelligence range,” according to the National Institute on Drug Abuse. The study, conducted in New Zealand, also found that those who began using the drug regularly after 18 showed minor drops in IQ, and that those who had never used it showed no decline. According to the institute, 1 in 15 high school seniors uses marijuana regularly. Newer research, however, suggested that other factors, such as socioeconomic status, may have been the cause of the IQ decline seen in the regular marijuana users in the New Zealand study. Regardless, the institute said these studies and others show that “regular marijuana use in adolescence is known to be part of a cluster of behaviors that can produce enduring detrimental effects and alter the trajectory of a young person’s life—thwarting his or her potential. Beyond potentially lowering IQ, teen marijuana use is linked to school dropout, other drug use, mental health problems, etc.”
4 Gazette Health | Spring 2013
A GAZETTE PUBLICATION
Death from cancer declined from 2000 through 2009 in the United States, maintaining a trend seen since the early 1990s, according to a January report from the National Cancer Institute. Mortality fell for most cancer types, including the four most common in the U.S.—lung, colorectal, breast and prostate—although the trend varied by cancer type and across racial and ethnic groups. The declines in cancer death averaged 1.8 percent per year for men, 1.4 percent for women and 1.8 percent for children up to 14 during that same time period.
Vitamin D Does Not Help the Knee
Vitamin D supplements do not appear to help those with osteoarthritis in their knees, according to a study from Tufts Medical Center in Boston. “We found no effect either on the amount of knee pain that people experienced or on the amount of cartilage that they lost.” –U.S. Department of Health & Human Services
I S T O C K P H O T O : B R A I N P U Z Z L E , M B O R T O L I N O ; M A R I J U A N A , P R I L L ; P E A N U T S , R E D H E L G A ; C A N C E R R I B B O N , B O O K A 1 ; V I TA M I N D , C A R L S S O N I N C
A liquid therapy placed underneath the tongues of people with peanut allergy can reduce their sensitivity to peanuts, a new study found. With further development, the experimental technique could make life easier for people whose only current option is to avoid everything that contains peanuts. In the study, the results of which were reported in January, a group received escalating doses of peanut powder. After 44 weeks of daily therapy, 70 percent were able to consume at least 10 times more peanut powder than they could at the beginning of the study. After 68 weeks, they could consume significantly more peanut powder without having an allergic reaction than those given a placebo in the study. The therapy caused only minor side effects, such as itching in the mouth. –National Institutes of Health
A healthy heart beats about 100,000 times a day. –American College of Cardiology
Overdose Alert M I S T O C K P H O T O : H E A R T B E AT, J U S U N ; P I L L S , S K H O W A R D
ore than 600 medications, both prescription and over-the-counter (OTC), contain the active ingredient acetaminophen to help relieve pain and reduce fever. Taken carefully and correctly, these can be safe and effective, but taking too much acetaminophen can lead to severe liver damage. Acetaminophen is a common medication for relieving mild to moderate pain from headaches, muscle aches, menstrual periods, colds and sore throats, toothaches, backaches and for reducing fever. It’s also used in combination medicines, those with more than one active ingredient to treat more than one symptom. The National Institutes of Health reported that Americans catch 1 billion colds per year and as many as 20 percent of Americans get the flu. Seven in 10 of us use OTC drugs to treat symptoms of illnesses.
Consumers might not know that acetaminophen comes in combination with many other medications used to treat those symptoms. “So if you’re taking more than one medicine at a time, you may be putting yourself at risk for liver damage,” said Fathia Gibril, M.D., with the U.S. Food and Drug Administration (FDA). Symptoms of acetaminophen overdose may take many days to appear, and even when they become apparent, they may mimic flu or cold symptoms. The current maximum recommended adult dose of acetaminophen is 4,000 milligrams per day. To avoid exceeding that dose: don’t take more than one OTC product containing acetaminophen; don’t take a prescription and an OTC product containing acetaminophen; and don’t exceed the recommended dose on any product containing acetaminophen.
Check the Drug Facts label of OTC cold, cough and flu products before using two or more in the same time frame, Gibril said. If you’re still not sure which to buy, ask a pharmacist for advice. Acetaminophen is also used in many commonly prescribed medications in combination with pain relievers such as codeine, oxycodone and hydrocodone. The FDA reported that as of January 2011, overdoses from prescription medicines containing acetaminophen accounted for nearly half of all cases of acetaminophenrelated liver injury in the U.S. –FDA
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Spring 2013 | Gazette Health 5
Macular Degeneration BY SCOTT HARRIS
Macular degeneration causes vision loss in the center of your field of vision, according to the Mayo Clinic, and occurs when the macula, the center area of the retina on the inside back wall of the eyeball, deteriorates. There are two types of macular degeneration—dry and wet. Dry is the more common type and, if left untreated, can lead to the rarer, more severe wet type. Dry macular degeneration can cause blurred vision and difficulty seeing in low light, among other symptoms. The wet type of the disease produces similar symptoms and can also involve the growth of vision-damaging irregular blood vessels behind the retina. The Alliance for Aging Research estimates that 1.75 million Americans 40 and older have advanced age-related macular degeneration, with another 7.3 million at substantial risk of losing vision as a result of the disease.
But, like many incurable diseases, modern medicine has made it a manageable chronic condition for those with access to the necessary care. New treatments are aimed at making it even more manageable—increasing time intervals between office visits and decreasing discomfort or side effects. But the search for a cure continues, and current research is exploring whether stem-cell therapy—a controversial but promising option for a host of diseases and conditions—may hold the key.
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I S T O C K P H O T O / C L A R K A N D C O M PA N Y; O P P O S I T E PA G E , P E E P O
here is no cure for macular degeneration.
SENIOR ADULTS ARE THE MOST VULNERABLE, according to Deborah Reid, M.D., an ophthalmologist with Retina Associates, a practice with multiple locations, including Bowie, Rockville and Silver Spring, that specializes in treating retina and macular diseases. Given the well-documented graying of the American population, Reid said, macular degeneration cases will only become more frequent. “Aging of the eye and the population is aging, so you put one and one together and see we have a growing issue,” Reid said. The good news for those with the dry type, according to Reid, is that the condition is treatable with certain vitamins and antioxidants, though that should be undertaken in collaboration with a doctor. “The dry type of macular degeneration can affect your ability to drive or live alone,” Reid said. “It’s treated with high-dose antioxidants. You can’t just go out and buy a vitamin ... it must be under a doctor’s supervision.” Fritz Allen, M.D., an ophthalmologist and retina specialist with Visionary Ophthalmology in Rockville, said along with aging, risk factors for the disease include smoking, high blood pressure and prolonged exposure to strong sunlight—fishermen and ski instructors,
for example, can have a higher risk for the condition. A study published in January by The Journal of the American Medical Association found that people who regularly took aspirin might have a higher risk of developing wet macular degeneration. “There’s no treatment, but the caution you take in stopping smoking and controlling blood pressure and eating vegetables can provide some protection,” Allen said. Mark Farbman, an optometrist with Longmeadow Optical in Frederick, said he refers a couple of patients a month with a possible diagnosis of macular degeneration to physicians. A basic test and a few simple pieces of information can provide big clues as to whether one has it, he said. “Red flags go up when someone has a family history of the disease and their vision is not correctable to 20/20 with glasses,” Farbman said. “Patients volunteer that their vision is distorted. A telephone pole might appear bent or bowed. If we want to take a
closer look, we dilate the pupil and look at the macula.” THOUGH THERE IS STILL NO CURE, treatments have come a long way in the past three decades. According to Reid, in the 1980s physicians used lasers to halt its progression. The laser treatments became less damaging over the years, but the next big breakthrough happened in 2006, when drugs were developed that could prevent the disease from advancing. According to Allen, that class of drugs, generally known as angiogenesis inhibitors (or drugs that slow blood vessel growth), were originally developed for use in cancer patients. In macular degeneration patients, they must be administered regularly for the rest of a patient’s life and can be quite expensive. “Right now, it’s about $2,000 per shot,” Allen said. “It’s very successful, but we have to inject it constantly to keep vessels from growing.” Much of the current macular degeneration research explores ways
of increasing intervals between injections. However, some facilities, including the Bascom Palmer Eye Institute of the University of Miami Health System, are investigating stem cells as a possible cure. “You would inject stem cells directly under the macula and hope they regenerate themselves,” Reid said. “It is only in clinical trials now for tissue loss as the result of aging.” Because of the controversy associated with embryonic stem cells, said Reid, working with stem cells engineered from the cells of living adults may also be an option. For now, the drug injections remain the most effective treatment if regularly administered. “It’s a repetitive treatment,” Reid said. “It’s a chronic disease and we can’t cure it. The injections don’t hurt, but it’s time and effort. It’s time in the doctor’s office for the rest of their lives. The best we can do is extend the time between visits, which we can do as many as once every two or three months.”
“RED FLAGS GO UP WHEN SOMEONE HAS A FAMILY HISTORY OF THE DISEASE AND THEIR VISION IS NOT CORRECTABLE TO 20/20 WITH GLASSES.” – MARK FARBMAN, OPTOMETRIST
Spring 2013 | Gazette Health 7
SEPARATION ANXIETY Learn how to recognize what’s normal and what’s not—and how to manage it
BY ARCHANA PYATI
8 Gazette Health | Spring 2013
A GAZETTE PUBLICATION
I S T O C K P H O T O / K I C K S TA N D
argaret Newman knew her son Matthew would be a sensitive child from the day he was born. There was a history of anxiety on her side of the family, and, from her husband, Matthew inherited shyness. He was so attached to Newman that he couldn’t tolerate separating from her for a moment, even if his father was close by. “I would need to go the bathroom, and Matt would just cry,” said Newman, a 52-year-old Silver Spring resident. She would have to allow Matthew into the bathroom with her to calm him down. “I knew he needed a lot more sense of security than other children.” Newman, who left a robust real estate career before having Matthew in 1999, sized up her son’s fragile temperament and realized he would need her undivided attention. She became a full-time mother and worked diligently to create an emotionally supportive environment for Matthew, enrolling him in special speech-therapy programs for late-talkers, accompanying him to a parent-child class at a local Waldorf school and keeping date nights with her husband to a minimum. She even gave him Pulsatilla, a homeopathic remedy, to calm his nerves. Thirteen years later, her sacrifices have paid off. Matthew is a chatty and exuberant tween who loves sports, goes on skiing trips with his dad, and—like any teenager—occasionally mouths off to his mom. The separation anxiety Matthew experienced to an extreme is a normal phase of early childhood development, local child psychologists and pediatricians said. Indeed, some children like Matthew may have a genetic predisposition to feeling higher levels of anxiety, but what makes all the difference among even the most fragile is how parents react to a child’s anxiety and the specific strategies employed to make separations emotionally manageable. [continued on 16]
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Spring 2013 | Gazette Health 9
local women lost weight
There’s no denying
that the payoff is big in terms of health, appearance and self-esteem. But the effort required to lose weight can be off-putting, which helps account for the fact that nearly 58 percent of Maryland women are overweight or obese, according to The Henry J. Kaiser Family Foundation. Maryland, more than a full point above the national average, ranks 19th among states in the percentage of women with weight issues.
BY KAREN FINUCAN CLARKSON
10 Gazette Health | Spring 2013
A GAZETTE PUBLICATION
before AGE: 38 POUNDS LOST: 39 POUNDS LEFT TO LOSE: 15 HOME: Upper Marlboro SUPPORT: Zumba classes ADVICE: “Take little steps. Instead of sitting on the couch or at a desk all day, get up and move around. Once you see a little [weight] come off, it’ll motivate you.”
t was the combination of a new job and the return of her brother and sister-inlaw to the area that jump-started Natasha Vandross’ weight loss. “I started moving again,” she said. No longer working from home, Vandross would regularly walk around the office and would use the stairs. Meanwhile, her health-conscious sister-inlaw met her for Zumba classes three times a week. “I’m not big on working out, but Zumba is a lot of fun.”
after As her activity level improved, Vandross began eating healthier—“salads and soups and smart lunches. I cut out processed foods and stopped eating a lot of starch. Dinner is fish and a veggie or chicken and a veggie.” Key to Vandross’ success is that she doesn’t let herself get hungry. “I’m good about eating six meals a day.” Her biggest obstacle is that “I’m lazy by nature and don’t like exercising much.” A recent increase in work-related travel has forced her to cut back on Zumba classes, something she hopes to change shortly. Now within 15 pounds of her goal, Vandross uses imagery to stay focused. “For the past few years I’ve told myself that by the time I’m 40 I’ll have that Halle Berry-Catwoman body. I still have some work to do to get there, but I’m closer now than I’ve been before.”
PHOTOS COURTESY OF THEIR SUBJECTS
Despite the fact that Americans spend upward of $60 billion annually on products and services designed to help them drop excess pounds, according to MarketResearch.com, most women cannot achieve a normal weight. There are, however, success stories—women who have surveyed the weight-loss landscape and found a strategy, either a single technique or combination of approaches, that allows them to incorporate weight reduction into their lives.
after AGE: 25 POUNDS LOST: 45
POUNDS LEFT TO LOSE: 20-30
POUNDS LOST: 130
POUNDS LEFT TO LOSE: “Happy to be where I am”
SUPPORT: Kait Fortunato, dietitian with Rebecca Bitzer &Associates in Greenbelt ADVICE: “There’s always tomorrow. If I splurge, I remind myself that I can make a fresh start the next day.” She also suggested surrounding yourself “with friends who are supportive and want you to succeed.”
HOME: Hagerstown SUPPORT: FMH Wellness Center in Frederick ADVICE: “Be sure you have lots of support, people who will be there for you. And communicate with them. If you don’t let them know you’ve had a bad day or are struggling, they can’t help you.”
hen my mom got pancreatic cancer, she made a wish list of things she wanted and one of the wishes was for me to get healthy,” said Tina Parker. “I grieved for a good year after she died and gained an additional 40 pounds before I finally got serious.” Obese, Parker thought about gastric bypass surgery, “but it scared me.” Instead, in March 2010, she opted for a medically monitored, very low-calorie diet. New Direction beverage meal replacements, offered through the FMH Wellness Center in Frederick, allowed Parker to experience immediate weight loss, which kept her motivated. “The first week seemed hard. Emotionally, I wondered if I could actually do it. When I saw I’d lost 10 pounds that first week, I thought ‘Oh my gosh, I really can do this.’” While not every week was as uplifting as the first, there was never a week that Parker didn’t lose. One of her biggest challenges was dealing with co-workers and friends who had trouble accepting her decision to “go on a liquid fast. I don’t understand why others would try to sabotage my success.” With support from the staff at FMH Wellness, Parker began exercising and learned to take control of her eating. By October 2010, she had dropped 130 pounds. She continues on a maintenance program at the center, checking in monthly.
t the beach with her family in the summer of 2011, Sarah Beck was despondent. Carrying an extra 70 pounds made her “very uncomfortable and I hated that I was losing an opportunity to enjoy myself.” Beck also was frustrated that her diet wasn’t working. “I went vegetarian in the beginning of 2010 and ate lots of healthy foods. I couldn’t understand why I was still such a large size.” In fall 2011, she turned to Kait Fortunato, a Greenbelt dietitian. “She put things into perspective for me, especially in terms of portioning and ratios … Turns out my carbs were out of whack. So, I no longer follow calories. I follow carbs.” Today, Beck eats three meals a day, with no more than 30 grams of carbohydrates per meal, and two snacks with up to 15 grams of carbs each. “It’s a lifestyle change, one that I’m always going to have to stay cognizant of.” A challenge for Beck is incorporating the occasional alcoholic drink. “One drink can be almost a full meal’s worth of carbs.” Another is her boyfriend, who has a “high metabolism … He’s had to learn about my new eating habits. He doesn’t have to follow them, but has to know that I will.” Beck’s work leaves her limited time for exercise, so she tries to work in push-ups and sit-ups whenever possible. “I do squats while brushing my teeth.” MORE ON PAGE 12 GAZETTE.NET
Spring 2013 | Gazette Health 11
Melissa Ladd AGE: 33 POUNDS LOST: 75 POUNDS LEFT TO LOSE: At goal HOME: Rockville SUPPORT: Couch to 5k, www.c25k.com ADVICE: “Every day brings the chance for a new start. Just because you don’t eat well one meal doesn’t mean you should give up. The next meal is a new chance to eat healthy.”
ith her daughter entering her last year of preschool and a return to the workforce looming once kindergarten rolled around, Melissa Ladd knew the time was right. “I’d been overweight since college, but never had the determination. I simply woke up one day and realized I had this one year,” she said.
Ladd started slowly in September 2011. “I began exercising five days a week—a mix of cardio, yoga and strength training.” Her workouts served as motivation to change her diet. “I didn’t want to undo everything by eating badly.” So, Ladd made healthier food choices and tracked everything she ate. “I also
watched my portions and drank a lot of water.” Then she began running. “I had difficulty running for even one minute. But, within a year, I was able to train myself to run a half marathon.” In September, she completed the Parks Half-Marathon, running from Rockville to Bethesda
in 2:16:35. Her trainer was the Couch to 5k website c25k.com. Her greatest challenge came when she sprained her ankle. “I worried that because I couldn’t run I would gain the weight back. To keep things in check, I reminded myself that while I might not lose weight this week, there was no reason to gain.”
ADVICE: Find friends “who have successfully lost weight and maintained it. Make dates with these people for coffee, lunch, walks or phone conversations to discuss your successes and hardships.” Freedman also suggested creating exercise opportunities that can serve as social events.
Carol Freedman POUNDS LOST: 38 POUNDS LEFT TO LOSE: “No set target, but will continue to forge on.” HOME: Bethesda SUPPORT: Nora Mann, personal trainer with Mann-Up Fitness in Bethesda, and Janet Zalman, nutritionist with Zalman Nutrition Group in Washington, D.C.
before etween my feet bothering me and my doctor saying, ‘Carol, it’s really time to do something,’ I decided to make some changes,” said Carol Freedman. After losing 12 pounds on her own in 2011, she joined forces with a nutritionist and a new personal trainer in early 2012 to lose another 26. Realizing that her craving for sugar was undermining her attempt
12 Gazette Health | Spring 2013
to lose weight, Freedman sought out Janet Zalman, a nutritionist “who specializes in diets that eliminate sugar and reduce starch.” Today, Freedman avoids “any product with over 4 grams of sugar and double starches at any meal.” She’s also ramped up her exercise regimen. After working with personal trainer Nora Mann for a month, Freedman saw “such an impact—I was reducing inches and
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gaining muscle—that I increased to twice a week.” Her other five to six hours of exercise during the week include ice-skating and cardio— mostly spinning. For years, Freedman allowed her fitness needs to take a backseat to the needs of others. “It wasn’t until my youngest son went off to college that I felt I could finally make myself a priority.” Unlike previous attempts to lose
weight, which she kept to herself, Freedman is sharing. “By [my] being open, my friends and family can support me. When I was secretive, my friends didn’t realize that they were undermining my diet.” She admitted that it is “hard to socialize and stay on a diet. So, I choose my social situations carefully —what restaurants to go to and how often.”
PHOTOS COURTESY OF THEIR SUBJECTS
Could Just One Glass Be Too Much? BY ARCHANA PYATI
s scientific understanding of fetal development has deepened over the past 30 years, many doctors are now taking a zero tolerance approach toward drinking alcohol during pregnancy. “The safest course is abstinence,” said Michelle Spector, M.D., an OBGYN at Capital Women’s Care of Rockville and vice chair of the OBGYN department at Shady Grove Adventist Hospital. While some doctors may believe the very occasional drink is OK for a pregnant patient, “I don’t know of any studies that demonstrate there is a safe level of alcohol consumption,” said Spector. “I recommend to patients to have no alcohol.” In an August 2011 opinion, The American College of Obstetricians and Gynecologists (ACOG) recommended that OB-GYNs screen all women for alcohol use once a year and during the first trimester for preg-
nant patients. For pregnant women or those who may become pregnant, the opinion urges physicians to “give compelling and clear advice to avoid alcohol use” and “provide assistance for achieving abstinence.” It also suggests specific screening tools and questions to ask when assessing a woman’s alcohol use. According to Imelda Udo, M.D., an OB-GYN with Carroll Hospital Center in Westminster, the opinion is part of ACOG’s effort to identify women who are drinking at a time when they may not realize they’re pregnant. “They’re urging us to ask open-ended questions,” said Udo. “The point is to ask everyone, and not just people perceived to be at risk” for higher alcohol consumption, like women from a lower socioeconomic background, she said. Fetal alcohol syndrome was identified in the 1970s as a set of physical and developmental abnormalities evident in babies whose mothers had
consumed alcohol during pregnancy. Now, doctors speak more about fetal alcohol spectrum disorders—or FASD—to describe a whole range, from mild to severe, of abnormalities that can be attributed to a mother’s alcohol use, some of which don’t present until later in a child’s life, according to Udo. Lower birth weight and head size, the absence of a ridge in the space between the nose and upper lip, and small eyes are signs of FASD at birth, according to the Centers for Disease Control and Prevention (CDC). Problems with attention and hyperactivity, low IQ and speech and language delays fall within the range of FASDs, according to the CDC, and might not be noticeable until a child reaches school age. Recent research has fine-tuned our understanding of when alcohol is particularly harmful to a developing fetus. Published in Alcoholism: Clinical and Experimental Research,
a January 2012 study of 992 women from 1978 to 2005 found that prenatal alcohol exposure during the first trimester’s second half was the period associated with specific physical defects like smaller head circumference, lower body weight, and a thin border outlining the lips from surrounding skin. Tobie Beckerman, M.D., of Beckerman Women’s Health in Rockville, always discusses alcohol use during preconception counseling. She believes there is no safe threshold for alcohol consumption during pregnancy, but is careful not to induce panic in those who discover they’re pregnant at a time when alcohol is a normal part of their lives. “I don’t condone it, but I also try to diffuse the fear,” she said. While the risk of birth defects may be minimal in the first few weeks of pregnancy, “not calling something dangerous isn’t calling something safe.”
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T R A C E Y B R O W N P H O T O G R A P H Y, C O U R T E S Y O F W A S H I N G T O N A D V E N T I S T H O S P I TA L
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14 Gazette Health | Spring 2013
Cardiac Ablation Keeps 37-Year-Old Climbing
The feeling ranges from “a little jittery” to “a bouncing” that is impossible to ignore. These episodes of atrial fibrillation (Afib) are, according to Guillaume Marçais, unpredictable in their frequency, duration and intensity. Generally, “it feels as though my heart is beating too fast and too hard. I can actually feel it pumping in my chest, and, if I walk around or am active, I can actually see my chest beating,” said the 37-year-old Boyds resident. Atrial fibrillation is caused by a disruption in the heart’s electrical system, which is responsible for coordinating the cardiac contractions that pump blood throughout the body. The electrical disruption prompts the two upper parts of the heart, the atria, to quiver or fibrillate. The result is a racing or uneven heartbeat. Afib affects some 2.5 million Americans. Although the condition in and of itself is not always life threatening, left untreated, it can lead to complications such as blood clots and heart failure. Stroke is five times more likely to afflict those with Afib than those without the condition, according to the American College of Cardiology.
“People around me think it’s pretty scary,” said Marçais, acknowledging that “there can be dire consequences …. My father-in-law had a similar condition and he died from it.” Because Marçais is young and fit— he enjoys running, biking and rock climbing—Afib has been more of a nuisance to him than a life-threatening ailment. “When young athletes go into atrial fibrillation, their hearts just don’t perform as well and, as a result, they just can’t do the things they want to do, such as long-distance running or, in Guillaume’s instance, climbing,” said Sean Beinart, M.D., an electrophysiologist and co-director of the Center for Cardiac & Vascular Research at Washington Adventist Hospital in Takoma Park. It “is a true burden to his quality of life.” ATRIAL FIBRILLATION IS FOUND MOST often in people with high blood pressure, coronary or rheumatic heart disease, heart failure, or structural or congenital heart defects, none of which apply to Marçais, who recalled first being diagnosed with Afib in late 2003 or early 2004. He may have had episodes as early as his teens. “I remember a few times where I could
see my heart beat through my chest, as early as 13 or 14 years old. But I never told anybody about it, as it was rare and just a curiosity for me.” While physicians have yet to identify what is responsible for Marçais’ Afib episodes, the working theory is “stress, like a sudden change in pace, is the trigger for me. It can happen when I’m sitting and jump up,” he said. IT WAS A MIDDLE-OF-THE-NIGHT CRY from his son that set Marçais’ heart racing in early 2012. “I jumped out of bed and ran to see him. When I got back to bed, I knew that my heart was not doing well.” While his heart would eventually calm down—“There’s not a whole lot they can do in the emergency room other than monitor,” he said— that Afib episode led Marçais to seek help from Beinart. The physician recommended a procedure known as cardiac ablation. Marçais had undergone ablation surgery in 2004, “but I knew it could take twice,” he said. “So I was prepared to do it again.” The idea was to perform the second ablation while Marçais was still young and healthy, “when any consequences are minimal,” he said. [continued on 18] GAZETTE.NET
“I can actually feel [my heart] pumping in my chest, and, if I walk around or am active,
I can actually see my chest beating.”
BY KAREN FINUCAN CLARKSON
Spring 2013 | Gazette Health 15
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ROOT CAUSES The origin of separation anxiety is rooted in an early awareness of ourselves as separate beings from our caregivers. Toddlers develop a sense of “object permanence”—knowledge that people and objects exist in their absence—leading them to question whether people they’re attached to will return or abandon them, said Reena Bernards, a licensed clinical marriage and family therapist with Jonah Green and Associates in Kensington. “It’s a normal reaction, and part of that is a feeling of ‘will they come back? Will I be OK if they’re not here?’ That question stays with a child for awhile,” she said. For certain youngsters, that insecurity gets amplified when adjusting to new environments away from home, like day care or a babysitter’s house. Excessive crying, temper tantrums, physically clinging to parents, aggressive behavior toward peers, refusing food or sleep, and an inability to be consoled either by other adults or their peers are signs a child needs support making these transitions, according to Jessica Floyd, a clinical psychologist with a private practice in Bethesda who works with families at the Reginald S. Lourie Center for Infants and Young Children in Rockville. “When the separation occurs, a child will exhibit these behaviors as a way to express their feelings when they don’t have the words,” said Floyd. “They don’t have the means to express themselves in verbal ways, but can express themselves through their bodies.” Separation anxiety also manifests itself through physical symptoms, such as abdominal pain, headaches, sweating, vomiting or nausea, said Feinberg. “The pain is real and the
DENYING OR MINIMIZING THEIR FEELINGS WILL ONLY CAUSE CHILDREN “TO DIG IN THEIR HEELS AND BECOME MORE RESISTANT TO CHANGING THE BEHAVIOR.” distress is real,” he said. “Often there’s a pattern where the physical complaints are worse in the morning before a child has to go to school or preschool. They tend to be much better on the weekends or when there is no school.” While most children experience separation anxiety to a certain extent, if the distressed behavior lasts longer than four weeks and persists in different settings, a child may have separation anxiety disorder, said Floyd. In these cases, a family should consider seeking professional counseling. Play therapy—in the form of puppet shows or role-playing with dolls or action figures—can help a child express underlying fears without having to articulate the problem, according to Floyd. Among older children, who have the ability to verbalize fears, cognitive behavioral therapy, which targets patterns of thinking, can also be effective, she said. Psychologists and therapists might also meet with parents separately to discuss family dynamics and potentially triggering events. “Assessing the family situation to see if there’s anything that has happened to make the child feel insecure—a divorce, a death in the family, a new child—gives some sense of logic to what’s going on,” said Bernards. Denying or minimizing their feelings will only cause children “to dig in their heels and become more resistant to changing the behavior,” said Bernards. Instead, parents should encourage kids to articulate their fears. When a child has some success with separation, praise the results. Celebrate successful transitions and separations with incentives, such as stickers or a special reward, said Floyd.
“GIVE THEM SOME TIME TO DEVELOP THE ABILITY TO SOOTHE THEMSELVES.” – JESSICA FLOYD, CLINICAL PSYCHOLOGIST
Children regularly mimic their parents, often unintentionally. If a parent has anxiety about being apart from their children and trusting other adults to care for them, children can pick up on this. “The other thing that plays a big role is parenting, and how they’re dealing with these emotions,” said Kim Burgess, a child and adolescent psychologist, founder and director of Rockville’s Pediatric Psychology Center, and an adjunct associate professor of behavioral sciences and pediatrics at The George Washington University School of Medicine and Health Sciences. “Some parents make it unintentionally worse. What’s not helpful is a child sensing a parent’s anxiety about letting a child go to a new place. Maybe it’s hard for them to let their child go, and maybe the child is worried about the parent.” Psychologist Renee Neely-Walters has worked with students whose frequent absences from school aren’t due to separation anxiety, but to attend to a parent’s emotional needs. “I’ve actually had cases where parents are depressed, maybe they’re exiting a relationship themselves, and they make the child feel like they need to take care of them,” said NeelyWalters, who counsels young children at the Metropolitan Psychological
Group in Lanham and elementary students at a Washington public charter school. One solution was to find a volunteer opportunity for the mother at her child’s school, fulfilling her need to be close without compromising the child’s personal and intellectual development. SUCCESSFUL TRANSITIONS Parents can minimize their child’s stress during transitional times by staying upbeat, being up front about why you need to be apart and reassuring them of your return, said Bernards and Feinberg. In other words, sneaking out of your toddler’s classroom when she isn’t looking isn’t the best approach. Day care teachers and even classmates can be a parent’s allies in soothing a distressed child. Pairing them with a buddy or giving them a leadership role in the classroom—like asking them to help distribute juice and cookies during snack time—deflects attention from the distress and builds inner confidence and trust in the caregiver, according to Neely-Walters. “Try to do things in small chunks that are manageable for the child,” said Bernards. At day care, for example, a parent could say, “‘you’re going to go in there, and I’m going to go shopping, but then I’ll come back.’ They get to practice [continued on 18]
Spring 2013 | Gazette Health 17
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SEPARATION, continued from 17
and have their feelings about it and their success.” Another skill parents can help children develop early on is self-soothing, beginning at infancy, said Floyd. Too often, parents are unwilling to leave a child unattended during the first few minutes of a cry. “The child then learns that if they do this behavior, my parent will come,” said Floyd. “That’s not to say leave them crying all day, but give them some time to develop the ability to soothe themselves. It’s important for children to develop internal resources.” Jessica McCausland’s toddler Claire has always felt a strong attachment to her mother because Claire was not bottle-fed. The bond they’ve shared over nursing makes longer separations harder on Claire, said McCausland, who recently relocated from Silver Spring to Florida. An attorney, McCausland, 39, returned to work when her daughter was 9 months old; caregivers cared for Claire at home. It went smoothly, she said, because the nanny was “on her daughter’s turf,” and each morning,
SEPARATION ANXIETY ALSO MANIFESTS ITSELF THROUGH PHYSICAL SYMPTOMS, SUCH AS ABDOMINAL PAIN, HEADACHES, SWEATING, VOMITING OR NAUSEA. the nanny, Claire and McCausland would have a warm-up period where they played together. When it was time for McCausland to leave for work, she sang a song— “heigh-ho, heigh-ho, it’s off to work I go”—which made her departure a cheerful, rather than distressing, event. She always made eye contact with her daughter, and the nanny, meanwhile, would have a book picked out for her and Claire to read. McCausland would take frequent breaks from work, which was only a block away from home, to breastfeed Claire, who understood her mom was never far away.
HIS STORY, continued from 15
“And, it means I don’t have to take medicine.” “Drugs in a lot of patients are a very attractive and appropriate alternative,” said Beinart. “In younger patients, they tend to have significant side effects and can promote the decline in the quality of life that we’re trying to prevent in the first place.”
BECAUSE THE AREAS OF TISSUE ARE VERY TINY, DAMAGING THEM DOES NOT AFFECT THE HEART’S ABILITY TO DO ITS JOB.
CARDIAC ABLATION DESTROYS SMALL areas within the heart where rhythm problems start. Because the areas of tissue are very tiny, damaging them does not affect the heart’s ability to do its job. Physicians “use a spaghetti-sized wire, called a catheter, that delivers heat energy to specific, targeted areas of the heart,” said Beinart. The result is an elimination of “electrical signals in that area in a safe, very precisiondriven fashion.” The ablation procedure at Washington Adventist Hospital in May of last year took about four hours, according to Marçais. “Going through the procedure is somewhat taxing. Because they put the catheter
in through the groin area and up into the heart, the groin area is sore. The night after the procedure is painful and you must lie on your back for 24 hours. You cannot lift or run for a few days,” he said. It wasn’t long, however, before Marçais, a bioinformatics researcher at the University of Maryland in College Park, was back to work and enjoying athletic pursuits. And while there are no guarantees as to what the future holds—“I may need no other remediation … or maybe some small amount of blood thinners,”— he is optimistic that the racing in his heart has been permanently calmed and the potential “for other health crises” averted.
experts’ advice National Institutes of Health
What’s That Rash?
I S T O C K P H O T O / Q U AY S I D E
“The most common form of dermatitis that is seen anywhere is an e often think of the skin as a barrier—it keeps the insides of our bodies in, and it keeps the outside world out. But skin is allergic contact dermatitis to nickel,” said Katz. “Why? Because of ear also filled with immune system cells that protect against piercing.” Many inexpensive earrings are made of nickel, and over time, viruses, bacteria and other threats. Whenever these cells detect a suspi- wearing nickel earrings can cause an allergic reaction to the metal. Other cious substance, they begin a chain reaction in the skin that leads to common causes of allergic dermatitis are poison oak and poison ivy. Mild cases of allergic contact dermatitis usually disappear after a few inflammation. The medical name for this reaction is dermatitis—a rash. There are many different types of dermatitis, and each has distinct days or weeks, but if the rash persists, is extremely uncomfortable or treatments. Sometimes the skin’s immune cells react to something that occurs on the face, it’s important to see a physician. A doctor can prescribe medications that will tone down the immune directly touches it. Other times, the immune system reaction in the skin. This eases swelling and itching flares in the skin because of a whole-body infection and will protect your eyes and face. or illness. The immune cells of the skin can also produce Symptoms of these different types of rashes often rashes when they react to invading germs—like bacoverlap. “Itching is a common symptom for all these teria, fungi and viruses. Bacterial and viral infections problems,” said Dr. Stephen I. Katz, director of the within your body can cause your skin to break out National Institutes of Health’s National Institute of in spots, as well. The chicken pox virus, for example, Arthritis and Musculoskeletal and Skin Diseases. can cause itchy spots in children. Years later, in older Many rashes are red, painful and irritated. Some adults, the same virus may reappear as shingles, types may lead to blisters or patches of raw skin. resulting in a painful rash and high fever. Vaccines While most rashes clear up fairly quickly, others are can prevent several rash-causing diseases, including long lasting and need to be cared for over long chicken pox, shingles and measles. periods of time. Eczema, or atopic dermatitis, is a dry, red, itchy rash that affects up to 1 in 5 infants and young chilCERTAIN DRUGS, INCLUDING ANTIBIOTICS LIKE dren. It often improves over time, although it can amoxicillin, may also cause itchy rashes. If you’re last into adulthood or start later in life. In this conallergic to a drug, a rash can be the first sign of a seridition, the watertight barrier between skin cells gets ous reaction. As with other allergies, a drug reaction weak, which lets moisture out and other things in. may not occur the first time you take it. Not all drug That’s why people with atopic dermatitis have to rashes are due to an allergy, however. If you break moisturize their skin, and why they’re more suscepout in itchy spots after starting a new drug prescripPsoriasis, a condition tible to skin infections. tion, contact your doctor right away. where skin cells build While most rashes get better with time, some can RESEARCHERS HAVE RECENTLY IDENTIFIED SPECIFIC last a lifetime. Psoriasis, a condition where skin up into thick red genes that are involved in maintaining the skin barcells build up into thick red patches, tends to run in patches, tends to rier. People with certain versions of these genes are families. “It’s a complex genetic disease, in that run in families. more likely to get atopic dermatitis. there’s not one gene that causes psoriasis, but “The skin is the outermost sentinel for fighting off many,” said Katz. Other long-term diseases that bacteria and noxious agents,” said Katz. “If the barrier is broken some- can produce rashes include autoimmune diseases, such as lupus, and how, you can become more allergic to things.” some forms of cancer. A skin allergy, or allergic contact dermatitis, produces a red, itchy rash If you notice an itchy or painful rash on your skin and don’t know the that sometimes comes with small blisters or bumps. The rash arises when cause, think twice before going to the drugstore and getting some cream. the skin comes in contact with an allergen, a usually harmless substance “The creams that you buy can produce problems that make your original that the immune system attacks. Allergens can come from certain soaps, problem even worse,” Katz said. Because rashes can be caused by many creams and even pets. different things—bacteria, viruses, drugs, allergies, genetic disorders and Your immune system might not react the first time you encounter an even light—it’s important to figure out what kind of dermatitis you have. allergen. But over time, it can become sensitive to the substance. As a “If you have any significant rash, you should see a dermatologist.” – NIH News in Health result, your next contact may lead to inflammation and an allergic rash.
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