fcgazhealth_092012

2 Gazette Health | Fall 2012 A GAZETTE PUBLICATION

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Dr. Sudhir Rao

DO YOU SUFFER FROM CHRONIC PAINTHAT LIMITS THE QUALITY OF YOUR LIFE?

2702 Back Acre Circle • Suite 290 B • Mt. Airy, MD. 27117 • 301.703.8767 • www.passmd.com

The VisionInspired by his experiences treating wounded U.S. soldiers suffering from debilitating injuries,coupled with a desire to create an innovative approach to personalized care, have truly beendepicted in his vision. Dr. Rao has created a medical facility that is one of a kind. Not only is thislocation a complete polar opposite of what most have come to expect from a pain managementpractice, but his ideals on “patient centric care” far exceed the standards in his field of medicine. Dr.Rao has provided the patient with an atmosphere unlike any other for treatment of chronic pain.

About the PracticeWhen you make that first call it will be obvious as to what this practice is trying to accomplish.Their friendly Personal Care Professional will make you feel welcome and assist you with anyquestions you may have. As you walk through the door for your initial consult you willimmediately notice the upscale and modern feel. A personal liaison will then assist you and yourfamily through your visit and any continued care. With several treatment options, this practice andits staff are definitely a top notch medical facility.Pain and Spine Specialists of Maryland is conveniently located just outside downtown Mt Airy andjust inside 20 minutes’, low traffic drive from Frederick and Damascus.

From Dr. Rao:“Due to economic conditions, the medical community has (by unfortunate necessity) lost touchwith true patient care. I feel the patient is starving for personalized attention and I intend to providethat environment. From the moment you speak to one of our Patient Care Professionals to schedulean appointment till you receive the follow up “Care Call”, it will be obvious that this is not yourtypical patient care facility” Sudhir R Rao MD.

Patient Testimonials:“This practice sets a high standard that all practices should follow” -Daniel B.“Exceptional experience from the first call and throughout every exchange!” -Jennifer V.

Mt. Airy Welcomes New Pain and Spine Specialist, Dr. Sudhir R. Rao.

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of Pain and Spine Specialists of Maryland

GAZETTE.NET Fall 2012 | Gazette Health 3

A publication of The Gazette | Fall 2012

PublisherCreative Director

Director of Creative Services

Dennis WilstonAnna JoyceLois Pruitt

The Gazette is a division of Post-Newsweek Media, Inc.Frederick Office: 2 N. Market St., 4th floor, Frederick, MD 20701

Gazette Health is produced by The Gazette’s Special Sections, Advertising andCreative Services departments. It does not involve The Gazette’s newsrooms nor

editorial departments. Send comments to [email protected].

Content is for informational purposes only and should not be construed as medicaladvice, nor as a substitute for seeing your own medical professional(s).

COVER PHOTO: CHRIS BARRITT, COURTESY OF CHRIS BARRITT ANDWASHINGTON ADVENTIST HOSPITAL

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Anna Joyce

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1304 South Main Street,Mount Airy,MD 21771(301) 829-1800

[email protected]

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Taking vitamin D supplements may lower children’s risk of respiratory infections. Because the body naturallyproduces the vitamin in response to sunlight, this may be especially true in winter when that light is limited.

Giving small daily doses ofegg powder to children with anegg allergy could pave the wayto letting them eat the foodsafely.After 10 months, more than

half of the allergic children in anew study who had been eatingegg powder daily showed noallergic reaction, or only minorsymptoms. A year later, 30 of

the 55 kids in the studypassed a challenge witheven higher doses of eggpowder. Those 30 then avoid-ed all egg products for four tosix weeks, after which theywere given egg powder, plus awhole cooked egg. Over a thirdof those children did not reactand were cleared to eat eggs aspart of their diet. A year later,

they were stillshowing no signsof allergic reaction.Researchers said the

therapy is still in theearly experimental stages. Andthey strongly cautioned thatthis type of oral immunothera-py should never be tried athome due to the risk of severeallergic reaction. -NIH

Beating egg allergy in kids

Brain abnormalitiesseen in hoardersUntil recently, hoarding disorder has

been considered a type of obsessive-compulsive disorder (OCD). Now, manyexperts consider it a unique diagnosis.People with hoarding disorder have

trouble making decisions about when tothrow things away. Possessions pile up,resulting in debilitating clutter.Results from a new study funded by the

National Institute of Mental Health suggestthat hoarders’ decisions about posses-sions are hampered by abnormal activityin brain regions used to identify theemotional significance of things.Scientists believe that these

abnormalities are specific to hoardingand separate the disorder from OCD. Inaddition to further exploring the uniquetraits of hoarders, the researchers arenow using this information to help assesspotential treatments.

Previous studies of brain function inhoarders implicated regions associatedwith decision-making, attachment, rewardprocessing, impulse control and emotionalregulation. But the patient populations andresearch methods varied among thestudies, making clear conclusions difficult.In the new study, researchers analyzed

brain images of 43 hoarders, 31 peoplewith OCD and 33 healthy controls.Participants were given six seconds tomake a decision about whether to keepor discard junk mail that either belongedto them or to someone else. They laterwatched as the items they chose todiscard were placed in a paper shredder.The hoarders chose to keep more mail

that belonged to them than those in theOCD or healthy control groups. Hoardersalso took longer to make decisions andreported greater anxiety, indecisivenessand sadness than the other groups. - NIH

L ittle teapots with long spouts havebecome a fixture in many homes forreasons that have nothing to do with tea.

Called neti pots, they are used to rinse the nasalpassages with a saline solution, and havebecome popular as a treatment for congestedsinuses, colds and allergies and for moisteningnasal passages exposed to dry indoor air.However, the U.S. Food and Drug Administra-

ion (FDA) warned about the risk of infection tiedto the improper use, issuing a statement inAugust about safe practices for using neti potsand other nasal rinsing devices.The source of water used with neti pots is the

largest concern, the FDA said. Unfiltered tapwater that is not treated in specific ways isunsafe for nasal rinsing. Tap water can containlow levels of organisms, like bacteria and proto-zoa, including amoebas that, while safe to swal-

low because stomach acid kills them, can live innasal passages and cause potentially seriousinfections, according to the Centers for DiseaseControl and Prevention.These devices are generally safe and helpful

when used and cleaned properly, said StevenOsborne, M.D., a medical officer with the FDA.Improper use of neti pots may have caused

two deaths in 2011 in Louisiana from a very rarebrain infection that the state health departmentlinked to tap water contaminated with an amoe-ba called Naegleria fowleri.Talk to your doctor to determine if nasal

rinsing will be safe and effective for your condi-tion. If symptoms are not relieved or worsen afternasal rinsing, then return to your health careprovider, especially if you have a fever, nosebleedor headaches while using the rinse.

-FDA

Is RinsingSinusesSafe?

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BY ARCHANA PYATI

Fear of the dentist is serious and has far-reaching consequences for aperson’s overall health. According to the Centers for Disease Controland Prevention, only 61 percent of U.S. adults in 2010 had visited thedentist within the previous year. However, 81.6 percent of adults in the“Bethesda, Gaithersburg and Frederick” region had seen a dentist atleast once that year.Many patients still avoid the dentist for a variety of reasons, including

a lack of insurance and basic paranoia. “If you have fear, go and have aconsult first,” said Michele Dozier, D.D.S., a pediatric dentist at nusmilesin Takoma Park. “A conversation, that’s where we start.”

1 Prevention of gum diseaseGum disease is the No. 1 cause of tooth loss in the United States,according to Tami Pantano, D.M.D., who recently openedAudubon Dental Center of Clinton. It begins with gingivitis, wherebacteria in the mouth cause plaque and tartar—a hardened form ofplaque—to build up along the bottoms of the teeth.If left untreated, gingivitis can progress to periodontal disease,when plaque seeps below the gumline, causing the gums to recedeand bone to deteriorate. “When that happens, that’s irreversible,”she said, adding that it takes six months for it to slip down beyonda toothbrush’s reach. Those scraping instruments a dentist uses,called scalers, are sharp and precise enough to remove plaquebuildup. “Even the healthiest mouths need cleaning every sixmonths,” said Pantano.

2 Spotting cavities before they lead to infection ortooth lossLike plaque, cavities are also caused by bacteria, whicheat away the tooth’s enamel, creating holes. If caughtwhen they’re small enough, they can be filled, saidDanny Dinh, D.D.S., a dentist with the Family SmileCenter in Frederick. If left to grow, cavities cause toothdecay, which may lead to an extraction or an infection ofthe nerves and tissues around the tooth.“By the time [the patient is] in pain, the cavity is huge.That’s when they need a root canal,” where damagednerves and tissue are removed and what remains of thetooth is sealed and protected with a crown, said Dinh.

3 Learning the proper way to brush“I didn’t know how to brush my teeth until I went todental school,” said Pantano. Proper brushing, she added,is not exactly an instinctual skill, but something that must belearned. She recommends brushing in a circular motion withthe brush held at a 30- to 35-degree angle.


DENTAL HEALTH

REASONS8to stop avoiding your dentist

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[continued on 17]

BY KAREN FINUCAN CLARKSON

f you think you’re immune towhooping cough, thinkagain. “Sometimes peoplethink, ‘I got vaccinated as akid so I’m protected,’” saidCynthia Roldan, M.D., apediatric hospitalist at

Carroll Hospital Center in Westmin-ster. With whooping cough—known aspertussis—staging a comeback nation-wide, Maryland public health officialsand physicians are encouraging vacci-nation of adults as well as children.Whooping cough can be fatal, espe-

cially in infants. “Pertussis can bringon seizures or make it difficult tobreathe properly, resulting in braindamage or death,” said Avni Jain,M.D., who is a primary care physicianwith Adventist Medical Group inGermantown and privileges at ShadyGrove Adventist Hospital in Rockville.“Two-thirds of children less than 1 yearof age with pertussis are hospitalized.”Of the 111 pertussis deaths in the U.S.from 2004 to 2008, 83 percent were ininfants under 3 months old, accordingto the Centers for Disease Control andPrevention (CDC).Whooping cough cases are on the

rise. The CDC reported 21,401 casesof pertussis this year, through Aug. 4.That is more than double what wasreported for each of the last three yearsat the end of the 31st week and is ontrack to become the highest numberrecorded in more than 50 years.Maryland has seen an increase in

pertussis, though it is not on par withWashington state, where 3,202 caseshave triggered an epidemic. There have been 141 cases of whooping coughin Maryland this year, compared with 56 in 2011 and 64 in 2010. InMontgomery County, Registered Nurse Cindy Edwards has noticed “a sig-nificant upswing of pertussis.” Last July there was one case, whereas thisJuly there were 14. In April through June of last year, two cases were report-

ed, compared with 36 in the samequarter this year. “That’s not an epi-demic, but still significant,” saidEdwards, the manager of the DiseaseControl Program with MontgomeryCounty’s Department of Health andHuman Services.

THERE ARE MULTIPLE REASONS FORthe increase, according to VivekSinha, M.D., a family medicine physi-cian with Southern MarylandHospital Center’s Fort WashingtonFamily Medical Center. “Some peo-ple, worried about side effects, are notvaccinating anymore. We’re testingmore, so we’re finding it more. And,after a while, the immunity of thosewho were vaccinated wanes,” he said.As a result, “we don’t have as high

of a herd immunity,” said Edwards.Couple that with the cyclical nature ofpertussis—“every three to four yearsthere’s a resurgence in cases,” shesaid—and there’s the potential for aperfect storm.The clouds of that storm began

forming in the 1990s when a newwhooping cough vaccine was devel-oped. In response to concerns aboutpotential side effects—fever, swellingat the injection site and, rarely,seizures—associated with the original1940 vaccine, which used smallamounts of inactivated whole bacte-ria, an acellular version, containingonly fragments of bacterial cells, wassubstituted. “There is concern that theacellular pertussis vaccine doesn’t pro-vide immunity as long as the olderpertussis vaccine,” Edwards said.Vaccination, which is about 85 per-

cent effective, remains the best way to prevent pertussis or minimize theseverity of the disease, most medical professionals agree. Two vaccines—DTaP and Tdap—help protect against diphtheria, tetanus and pertussis.DTaP is a pediatric formulation, while Tdap, considered a booster, is prima-rily for adolescents and adults.


CHILDREN’S HEALTHIS

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WHOOPING COUGHcases on the rise in Maryland

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Current “guidelines recommendthat DTaP be given five times—at2, 4 and 6 months, then at 15 to 18months and 4 to 6 years of age,”said Sinha. “In adolescence, aboutthe time they’re going into seventhgrade, they should get Tdap. Adultsbetween the ages of 19 and 64should get a single Tdap vaccine.”

IN FEBRUARY, THE CDC’S ADVISORYCommittee on Immunization Prac-tices recommended Tdap for alladults 65 years and older. Givenwhooping cough’s resurgence, thecommittee is reviewing the need foradditional doses of Tdap and thetiming of revaccination of thosewho have received Tdap.Because more than 30 percent of

whooping cough casesin infants can be tracedto the mother, it isimperative that preg-nant women be vacci-nated, said Roldan. Adose of Tdap may begiven to under-immu-nized women late in thesecond trimester or inthe third, or in the immediate post-partum period before dischargefrom hospital.Pertussis is highly contagious

and, once brought into a home,infects 80 percent of susceptiblemembers of the household. “Theonly way to protect your infant isto protect everyone around theinfant,” Roldan said.Jain concurred: “If you have a

small infant in the house, get every-one immunized who may come incontact—parents, grandparents,siblings, nanny.”Because pertussis initially mimics

a common cold, keeping those whocough or sneeze away from aninfant is sensible, although notalways practical. “If you’re a momor dad taking care of a baby, you’reprobably not going to let a coughor cold keep you from doing so,”said Sinha. Even more problematicis that someone in the early stagesof whooping cough may not know

he has it. “The incubation periodlasts up to three weeks and duringthat time there may not be anysymptoms, or just mild ones. Youmay not feel your best or have a bitof a runny nose.”Once symptoms appear, it takes

“about a week for the cough toturn more severe,” said Roldan.“It’s a rapid, deep cough followed,at the end of the episode, by a high-pitched whoop…Older kids maynot have the whoop, but maycough so forcefully that they vomit.Like other upper respiratory infec-tions, whooping cough may wors-en at night.”Pertussis often presents different-

ly in infants. “Instead of a cough,they may have trouble breathing or

periods of apnea, apause in their breath-ing,” said Roldan. “Ifyou’re seeing that in ayoung child or infant,call the doctor.”Whooping cough is

treated with an antibi-otic. “After five dayson an antibiotic, [a

person is] no longer consideredcontagious,” said Edwards. Still, itcan take weeks to fully convalesce.In the meantime, Edwards

works to identify anyone withwhom a whooping cough patientmay have had close contact duringthe incubation period and whensymptoms were present. “Ourinvestigation involves a fairly largegroup of contacts,” she said, “andwe recommend to every single onethat they receive a prophylacticantibiotic. We coordinate withphysicians and, if a minor isinvolved, the parents.”While natural infection may sub-

sequently boost immunity to per-tussis for a period—between fourand 20 years, according to CDCestimates—routine vaccinationsshould be continued. “We need tobe vigilant about vaccinations,”said Roldan. “No delays or with-holding. That’s how to protect theunprotected.”

More than 30percent ofwhooping

cough cases ininfants can betraced to the

mother.

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SENIORS’ HEALTH


e’re all destined to godeaf if we live longenough. If you make itto 100, you will be

hard of hearing, guaranteed. Everyone loseshearing to one degree or another as theyage,” said Bryan C. Ego-Osuala, M.D., anotolaryngologist with The Center for Ear,Nose & Throat at Doctors CommunityHospital in Lanham.The first signs of age-related hearing loss,

known as presbycusis, begin to appear inone’s late 50s or early 60s, according to Ego-Osuala. High-frequency sounds—such asthe chirping of a bird, the ringing of aphone, or consonants and blends such as“s” and “th”—generally are the first to go.“I was stunned when my husband and

children said I had a hearing problem. Ithought people weren’t speaking loudlyenough or were mumbling,” said LeanoreCalem, 79. “I kept turning the TV up loud-er and louder to the point when my kidswould visit they’d tell me to turn it down.”The Kensington resident is in good com-

pany. As many as half of all people 75 andolder have hearing loss, as do about a thirdof adults ages 65 to 75, according to theNational Institute on Deafness and OtherCommunication Disorders (NIDCD).Presbycusis is progressive. “We’re all

born with a finite number of hair cells inour ears—in the cochlea or inner ear—thathelp transmit sound to the hearing nerve,which then takes the sound to the brain,”said Ego-Osuala. “During our lives, as thehairs grow and are exposed to sound, theydie. They do not regenerate. So, most hear-ing loss is permanent.”“What we’re finding is that, for the vast

majority of people, hearing loss doesn’t hap-

Noise, not aging, maybe the No. 1 culpritof hearing loss


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pen in isolation,” said Kate Scully, aclinical audiologist with HearingCenter Silver Spring. There are anumber of physiological changes andage-related ailments that result inhearing loss.

“IT USED TO BE THAT AGING ALONEwas the No. 1 cause of hearing loss—and noise second. Now it’s [the]reverse,” said Scully. “Noise has acompound effect and, over time,takes a toll.”Many baby boomers who frequent-

ed rock concerts, cranked up thestereos and blasted personal CD play-ers are discovering that for themselves.Among Americans 46 to 64, about 15percent already have hearing prob-lems, according to a survey by theBetter Hearing Institute (BHI).While there are conflicting studies

as to whether the baby boomergeneration’s hearing loss is any moresignificant than that of previous gen-erations, the large number of agingboomers means that by 2030 theremay be 44 million Americans withsome degree of hearing loss, accord-ing to BHI. That would be an approx-imately 19 percent increase overtoday’s number.

CARDIOVASCULAR DISEASE CANbring about hearing loss. “The innerear is highly dependent on a richblood supply, so vessel health canaffect hearing,” said Scully. “Smokingalso can result in vascular issues andlimit blood flow to the cochlea.”More than 70 percent of those

between 60 and 79 live with cardio-vascular disease and, as a result, are atincreased risk for hearing loss.Cardiovascular disease, whichincludes high blood pressure, “isassociated more with low-frequencyhearing loss,” said Scully. That mightmean someone is less likely to hearthe rumbling of a truck or of thunder.Both heart and cancer patients may

suffer hearing loss as certain medica-tions can damage the ear, according tothe American Speech-Language-Hearing Association. More than 200drugs—some prescription, others overthe counter—are considered ototoxic.Diabetics are twice as likely as the

general population to suffer hearing

loss, according to Scully, and risk ofthe disease increases with age. “It’sone of the first questions I ask on theintake form, as there are about 20million diabetics in this country and54 million with prediabetes, and thenumber is rising,” she said.Kidney issues have a direct correla-

tion with hearing loss. “Over 50 per-cent of people with chronic kidneydisease have some degree of hearingloss,” said Scully.Age-related hearing loss tends to

run in families, according to Ego-Osuala. “If your mother became hardof hearing at age 38, there’s a highchance you will too. If hearing lossbegan at 65, we don’t consider thatunusual,” he said. Because age-relatedhearing loss is incremental, many peo-ple don’t notice it at first or don’t thinkthe problem is significant enough towarrant treatment, said Ego-Osuala.Such was the case with Calem, who

recently began wearing a hearing aid.“I must have had serious problems adecade before, which I either wasn’taware of or didn’t acknowledge. Ithink I was probably in denial.”

AFTER AN APPOINTMENT WITH ANotolaryngologist, Calem learned thather ears were structurally sound. Thenext stop was the audiologist’s office,where Scully “explained that I hadsome rather drastic losses in certainregisters. I knew she was right, but itwas an uncomfortable admission thatI didn’t like to make,” said Calem.Putting her vanity aside, Calem

opted to purchase hearing aids. “Mostpeople, if I didn’t say anything, would-n’t notice. The only thing not coveredbymy hair is a tinywire that goes fromwhat’s in my ear to the battery, whichis hooked behind my ear.”Her hearing improved dramatically.

“The first moment was a stunner. Italmost sounded artificial because foryears I hadn’t been hearing thesesounds—paper rustling, birds sing-ing,” she said.While nearly three-quarters of

those who use hearing aids reportmuch better or somewhat better hear-ing, according to a 2011 AARP study,only about a fifth of those who wouldbenefit from a hearing aid actuallyuse one, noted NIDCD.

Part of the reason has to do withcost. “Medicare does not pay for hear-ing aids,” said Ego-Osuala. Few insur-ance companies do. In 2010 BlueCross and Blue Shield’s FederalEmployee Plan began allowing$1,000 per ear. That may cover thecost for individuals with mild to mod-erate hearing loss, but those withmore significant hearing issues willstill have a large out-of-pocketexpense. “The cheapest hearing aidyou can get is about $900 and it goeson up from there to about $3,000—and that’s per ear. The worse yourhearing, the higher the price is, asthere’s more processing and program-ming involved.”Hearing aids are not 100 percent

effective and in some cases may notbe effective at all. It’s not unusual,according to Ego-Osuala, for peoplewho wear hearing aids to continue tohave trouble hearing in places, likerestaurants, where there is a lot ofbackground noise.

And, if hearing loss has more to dowith the way a person’s brain process-es the information, a hearing aid isn’tthe answer. “Making something loud-er won’t help if the sounds are jum-bled in the brain,” said Ego-Osuala.“Hearing aids have come a long

way since the first digital ones wereintroduced in 1996,” said Scully.“Today, there are devices other thanhearing aids that can help in morechallenging environments.” She pointsto mini microphones that the wearercan use to transmit sounds wirelesslyto a hearing aid and to hearing aidsthat use Bluetooth technology so thatphone calls and television shows canbe run through them.Getting medical help as soon as a

loss of hearing “is noticed by you orsomeone else is essential,” said Scully.“On average, people wait seven yearsto do something about it. Some waitdecades. By the time they come in, it’sharder to deal with because they maybe trying to cope with other issues.”


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SENIOR’S STORY


There were days when ChrisBarritt despaired of ever being ableto ride his motorcycle again, letalone take it on a much-anticipated5,000-mile international road trip.Unexpected open-heart surgery,while a lifesaver, left theMount Airyresident with 16 weeks to “heal andbuild enough strength back to beable to ride again,” he said.The events that led him to an

operating room at WashingtonAdventist Hospital in Takoma Parkwere traumatic, but they undoubt-edly saved his life. As he was dress-ing one morning in March 2011,Barritt, then 57, felt a familiarheaviness in his arm, a sensation hehad dismissed on previous occa-sions. This time, however, some-thing was different.

“I could thinkwords, but couldn’tget them out of my mouth, couldn’tspeak them,” he said. “Believe it ornot, I actually hemmed and hawedabout going to the hospital. Mywife called my primary care physi-cian who said to me, ‘Listen toyourself. You can’t speak properly.Go now.’”At Carroll Hospital Center in

Westminster, physicians diagnoseda transient ischemic attack (TIA), amini stroke, which occurs whenblood flow to a part of the braintemporarily stops.Because he was healthy and

active—Barritt worked as aMercedes-Benz mechanic and wasan avid walker—the diagnosiscame as a surprise. It would, how-ever, lead doctors to yet anotherdiagnosis that had even greatershock value.

PHOTOCOURTESYOFCHRIS

BARRITTFROMWASHINGTONADVENTISTHOSPITAL

1865943


As he sat in his cardiologist’soffice undergoing an echocardio-gram, he “could see something onthe screen flapping around like apiece of seaweed. I knew justenough to know that wasn’tright.” What had caught his eyewas a tumor.When Barritt asked the cardiolo-

gist how it could be fixed, “he toldme, ‘Open heart surgery. You’regoing to Washington Adventistnow. If it doesn’t come out, there’sa high possibility of a catastrophic,debilitating stroke or death. If apiece pops off, it’s a straight shot tothe brain.’”Barritt broke the news to his

wife and the couple drove fromMount Airy to Takoma Park. Hespent five days on blood thinnersbefore undergoing surgery. “It wasall kind of a blur and very surreal.”

Five days after the operation,Barritt was home. “God it hurt. Ithurt to sneeze, cough, laugh.There was a nine-inch incisionthat split my sternum.” Theplanned motorcycle trip throughNew England and Canada seemedlike pie in the sky.After a few days at home,

Barritt’s wife suggested he get outand walk. “Not far. Just to theneighbor’s mailbox and back...Iwasn’t allowed to walk the dogs forfear they’d pull and injure me.”Over time, he increased the dis-tance, but progress was slow.“My friend Glenn was doing

everything he could to keep up myinterest in the trip, keep me positiveabout it. But, after about six weeks,I thought, ‘There’s absolutely noway I can go.’ I was still one miser-able person.” [continued on 18]

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BY ARCHANA PYATI

magine eating a healthy diet and exercisingregularly, yet gaining weight and feeling a debil-itating fatigue for no explicable reason. Nowimagine going to your doctor, taking a bloodtest and being told you are absolutely fine.

This is precisely what happened to Abbey Black, 32, amedical assistant who lives on the outskirts ofHagerstown in Falling Waters, W. Va. Seeking a special-ist’s opinion can be important for women who sufferfrom hypothyroidism, a type of thyroid disease.

It took Black a year from the “everything’s fine” con-versation with her general practitioner to receiving adiagnosis from an endocrinologist that made sense toher: Hashimoto’s thyroiditis. The autoimmune diseaseoccurs when antibodies attack the thyroid gland, impair-ing its ability to secrete hormones that control everymajor bodily function—frommetabolism to heartbeat tohair growth to bowel movements.

“It’s a frustrating disease,” said Black, whose motherand sisters also have Hashimoto’s. “You have to work alot harder at things when you have thyroid disease.”

The American Thyroid Association (ATA) estimatesthat 20 million Americans have some form of thyroiddisease, and it disproportionately affects women.Women are five to eight times more likely to developthyroid problems, and up to 60 percent of those with athyroid disease are not aware they have a disorder.

“There’s a lot of misdiagnoses,” said Majd Hakim,M.D., the Frederick-based endocrinologist who treatedBlack. “Many patients have symptoms for many yearsbefore they get diagnosed.”

Hakim said the underdiagnoses stem, in part, from aless-than-precise blood test doctors administer to findout if a patient’s thyroid is working properly. The testmeasures the amount of thyroid-stimulating hormone, orTSH, in the blood. Secreted by the pituitary gland, TSHtriggers the thyroid to produce essential hormones T3(triiodothyronine) and T4 (thyroxine).

The test range for what’s normal is fairly broad, whichcauses many patients’ thyroid disorder to remain unde-tected. Symptoms, like fatigue, weight gain, insomniaand depression, persist and may even be attributed to amood disorder. “We need to look at patient family histo-ry, symptoms…a lot of times [patients]

WOMEN’S HEALTH

Sometimes a woman

can experience both

hyper- and

hypothyroidism, as was

the case with media

queen Oprah Winfrey,

who went public with her

struggles with thyroid

disease in 2009. After

putting back on the

pounds she had lost in

the mid-2000s, she

was diagnosed with

hyperthyroidism, which

then morphed into

hypothyroidism, a culprit

behind her weight gain.

“Who knew this tiny

butterfly gland at the

base of the throat had so

much power? When it’s

off, the whole body feels

the effects,” she wrote in

her essay “How Did I Let

This Happen Again?”

published in O,

The Oprah Magazine.

THYROID DISEASEwhy it may go undetected

ISTOCKPHOTO:OPRAH

WIN

FREY

BY

JASON

MERRITT/XX,EDSTOCK

CONTRIBUTOR;WOMAN

AND

DOCTOR,SKYNESHER

up to 60percent ofthose witha thyroiddiseaseare notawareof it

I

[continued on 18]


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ISTOCKPHOTO/FLUBYDUST

Misnomeralert: It’susually notcaused bybeer.

More than Unsightly,Abdominal Fat

IncreasesHealth Risks


f a keg now sits where yoursix-pack used to be, you couldend up paying a hefty price—your health or your life.“Excess weight in the midsec-tion can lead to problemswithcardiovascular disease, hyper-

tension, metabolic syndrome—whichcan lead to diabetes—and some can-cers, the most common for men being

prostate cancer,” said Patricia Guay-Berry, clinical nutrition manager atSuburban Hospital in Bethesda.

With nearly 75 percent of the menin Maryland considered overweightor obese, according to The Henry J.Kaiser Family Foundation, there aremore than 1.5 million men whosespare tires could use some deflating.And the sooner the better, as belly fatis potentially lethal, according to theMayo Clinic.

I

MEN’S HEALTH


What makes abdomi-nal fat so dangerous isthat it includes visceralfat, which lies deepinside the abdomen andsurrounds the internalorgans, said HeatherBoyd, lead dietitian atthe FMH WellnessCenter in Frederick.

“Visceral fat is morelikely to get brokendown and go into thebloodstream, increasinglipid and triglyceride lev-els,” she said. Unhealthyblood fat levels causeplaque to form onartery walls, eventuallyrestricting blood flowand leading to heartattack and stroke.

Despite the label, beer does notmake a belly. “The beer belly got itsname because people who drink alot of beer take in extra calories,”said Reed M. Shnider, a cardiolo-gist with Cardiology AssociatesLLC and privileges at MedStarMontgomery Medical Center inOlney, “and when you take inmore calories than you burn, youget fat.”

In men that fat ends up in thegut; in women, it most often plantsitself in the hips and thighs. “Menare apples and women are pears,”said Shnider. Gender plays a majorrole in how fat is distributed.

Hormones seem to influencewhere fat goes in the body, accord-ing to Boyd. Both estrogen andtestosterone hold in check anenzyme known as lipoproteinlipase (LPL), which promotes fatstorage. In a woman’s body, thehighest LPL levels are usuallyfound in the breasts, hips andthighs, and in a man’s body, LPLlevels are highest in the abdomen.As hormone levels decline with age,LPL in those areas becomes moreactive and fat deposits grow.

Awaist circumference of 40 inch-es or more for men and 35 inches ormore for women is cause for con-cern, according to Boyd. It indicates

an unhealthy concentra-tion of belly fat.

“The good news [formen] is that abdominalweight is easier to losethan weight from thehips and thighs,” saidGuay-Berry. Althoughvisceral fat is buried inthe abdomen, it tendsto respond well to dietand exercise.

The prevailing theo-ry is that visceral fat ismore metabolically ac-tive than subcutaneousfat, which is foundunder the skin, saidBoyd. In other words,bellies tend to shrinkfaster than hips orthighs. And, after just

a 10-pound reduction in visceralfat, “lipid levels start dropping.Ten pounds can make a differ-ence,” she said.

In addition to diet, exercise iscritical to reducing the size of one’spaunch. “But don’t think you canspot reduce. It doesn’t work,” saidBoyd. While sit-ups and crunchesmay strengthen abdominal mus-cles, those muscles will be hiddenunder a layer of fat. “It’s a combi-nation of aerobics and strengthtraining that will help reduce thatbeer belly.”

While it’s important “tobecome more mindful of whatyou are putting in your mouth,”said Guay-Berry, it’s not necessaryto deprive yourself of the libationthat gave your gut its name. “Beerand other beverages can be con-tinued, but make sure to havethem in moderation.

For men, that means two beersor two 1-ounce servings of liquoror spirits or two 6-ounce glasses ofwine maximum per day.”

“People with beer bellies canbenefit tremendously from lifestylemodification,” said Shnider. “Alter-ing the collection of fat in theabdomen is one of the most sensi-ble things you can do to improveyour overall health.”

“Don’t

think you

can spot

reduce. It

doesn’t

work. It’s a

combination

of aerobics

and strength

training that

will help.”

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“Many patients don’t know what the propertechnique is, and they never remove the plaqueeffectively,” said Rimple Singh-Crawford,D.D.S., of Fenton Family Dental’s Clintonoffice. Patients target the front teeth, she said,but aren’t always diligent about cleaning molarsin the back of the mouth.The insides of the bottom front teach are anoth-er tricky area where plaque can become a prob-lem, according to Pantano. The Philips Sonicare,she said, creates the circular motion needed forproper cleaning. Many electric toothbrushesalso have timers to make sure brushing lastslong enough.

4 Rule out oral cancer and other diseasesthat start in the mouthDentists check more than your gums and teeth.They consider overall oral health and performan oral cancer screening on new patients. “Weexamine the gums, the tooth structure…under-neath the tongue where they can’t see,” saidSingh-Crawford.“A lot of systemic diseases have oral dimen-sions,” said Pantano, citing HIV as an exampleof a disease that appears in its early stages in the

mouth. “Most of the time, it’s a fungal infection,and if we see a fungal infection, that shows thepatient is immunocompromised.”

5 Fix functional or cosmetic problemsEven if you diligently brush and floss every day,you can’t fix structural problems without thehelp of a dentist and, probably, an orthodontist.“Sometimes teeth need to be straightened outfor functional reasons,” said Dinh, such as theinability to clean in between the teeth due toovercrowding.Braces or retainers may be needed for adults ifstructural problems weren’t corrected when thepatient was younger. Under bites and overbitescould indicate a problemwith the jaw and othertemporomandibular disorders, said Pantano.

6 Control halitosis, known as bad breathOne telltale sign of periodontal disease, saidDozier, is a distinctive, foul odor. Halitosis iscaused by bacterial buildup in the mouth.Infrequent and ineffective brushing and flossingcan be the culprit, as can a failure to clean thetongue, said Dinh, who recommends a tonguescraper for this purpose. Getting timely clean-ings helps keep the buildup of plaque at bay,which will mean fresher breath.

DENTIST, continued from 5 7 Oral hygiene and health is critical whenmanaging diabetes.“Gum disease is more severe in diabeticpatients…and one of the biggest reasons is thatthe elevated blood sugar provides extra nutri-tion for the bacteria,” said Pantano. Due toweaker immunity, diabetic patients tend to beprone to infections in all areas of their body,including the mouth. Diabetes also manifestsitself with oral symptoms like dry mouth, saidPantano, which a dentist can help treat.

8 It’s better to take a preventative, ratherthan reactive, approach to oral health.In the old days, dentistry tended to be morereactive than proactive, said Pantano. Thethought “used to be if ‘it’s broken, fix it,’” saidPantano. “Now, we’ve figured out ways to pre-vent it from being broken in the first place.”

Not all of her patients, though, have changedtheir mindset about the importance of catchingproblems early. She still gets calls from emer-gency room doctors when one of her patientsshows up at the hospital in excruciating painwith an abscessed tooth. “I really push preven-tion,” she said. “I have happier patients and ahappier me when they don’t have problems.”

1865823

get misdiagnosed because their hor-mone level falls within the normalrange,” said Hakim.

In Black’s case, her conditionresulted in hypothyroidism, where thethyroid doesn’t secrete enough T3and T4; the sluggishness and weightgain without an increased appetite area result of the metabolism slowingdown. Hyperthyroidism, a conditioncaused by the thyroid producing toomuch T3 and T4, usually creates theopposite effect—loss of weight whilefeeling hungrier and eating more,anxiety and a rapid heartbeat.

Not only can the TSH test some-times fail to identify an overactive orunderactive thyroid, but in those whohave been diagnosed with hypothy-roidism, it may not be precise enoughto ensure a patient receives the correctamounts of hormone replacementtherapy, said Hakim. Getting the levelof the T4 hormone, known commer-cially as Synthroid, just right is espe-cially critical since T4 eventually con-verts into T3. “The bottom line is theproblems occur when they’re not tak-

ing the right amount of T4 to beginwith,” she said. “It’s a very, very com-mon scenario.”

Hyperthyroidism can be the resultof another underlying autoimmunedisorder—like Graves’ disease, inwhich antibodies are unleashed onthe thyroid, causing it to go into over-drive. Studies have shown that stress,

pregnancy or a viral infection canlead to an overactive thyroid, saidMadhuri Devdhar, M.D., an endocri-nologist with Adventist MedicalGroup in Montgomery Village.

While antithyroid medications areprescribed for Graves’, they’re notmeant for long-termuse due to damag-ing side effects, including the loss of

white blood cells, said Hakim. Aniodine pill that has been radiated isfrequently used as a one-time treat-ment for Graves’, and is generally con-sidered safe, while surgery is the lesscommon and riskier solution. Bothoften lead to hypothyroidism since thethyroid becomes disabled due to thepowerful radioactive iodine dosage orsurgical removal. Hormone replace-ment therapy, which is usually pre-scribed for the remainder of thepatient’s life, “is very benign,” andcauses “very little problem as far asside effects,” said Hakim.

Black, the medical assistant, whosesecond child was due this month, hassuccessfully navigated her thyroid dis-ease along with her pregnancy. Awoman’s thyroid requirementsincrease by 30 to 50 percent duringpregnancy since a fetus can’t produceits own thyroid hormone in the firsttrimester, according to Hakim. Blackhas had to increase her dosage ofSynthroid a few times. After her deliv-ery, she imagines life will go back tothe way it was, where weight man-agement is the perennial issue.


THYROID, continued from 12 Symptoms ofhyperthyroidismn Weight loss, even if you eat

the same or more foodn Eating more than usualn Rapid or irregular heartbeat

or pounding of your heartn Anxietyn Irritabilityn Trouble sleepingn Trembling in your hands

and fingersn Increased sweatingn Increased sensitivity to heatn Muscle weaknessn Frequent bowel movementsn Less frequent menstrual

periods with lighter thannormal menstrual flow

Barritt kept walking. His staminaincreased and his outlook changed.He’d heard from others about a point“where you suddenly walk through adoor and realize you’re no longer aheart patient. All of a sudden the cur-tain pulls back...On Memorial Dayweekend it was like the sky cleared orI walked out of this cloud. I realized,‘Hey, I am going to recover. It stillhurts, but I’ll be OK.’”

Recalling that, prior to the opera-tion, his heart surgeon said there wasno reason to cancel the trip, Barrittbecame determined to make the ride.He walked farther and picked up thepace. “Riding a motorcycle isn’t real-ly that physically demanding, but, atthe same time, it puts a fair amount ofstress on the chest. I still wasn’t sure Icould go.”

In mid-June, Barritt took a testride—to Vermont. “It was all pave-ment, no really hard riding, and I gotup there without any adverse effects.That’s when I finally thought I coulddo it.” And, four months after hissurgery, he did.

Recently, Barritt took an evenmore demanding trip to Silverton,Colo., “mostly on back and dirtroads. The mountains in Coloradoare especially challenging and therewere a couple of moments—likewhen my bike slipped off the roadand went down an embankment—that gave me pause. But after the sur-gery and all, this was an adventure Iwas glad I could enjoy.”

BIKER, continued from 11

“On Memorial Day

weekend it was like

the sky cleared or I

walked out of this

cloud. I realized,

‘Hey, I am going to

recover. It still hurts,

but I’ll be OK.’”

Symptoms ofhypothyroidismn Weight gain, even though

you are not eating more foodn Increased sensitivity to coldn Constipationn Muscle weaknessn Joint or muscle painn Depressionn Fatiguen Pale dry skinn A puffy facen A hoarse voicen Excessive menstrual bleedingn High levels of LDL cholesterol

SOURCE: womenshealth.gov

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VEGETARIANS MISS OUT ON A LOT OF FOODS, BUT THEY ALSO TEND TOmiss out on a lot of major health problems that plague many Americans.They generally live longer than the rest of us, and they’re more likely tobypass heart-related and other ailments.

Most people think of vegetarian diets as simply eating plant foods andnot eating meat, poultry and fish, but there are many variations.

Strict vegetarians, or vegans, eat plant foods and reject all animal prod-ucts—meat, poultry, fish, eggs, dairy and sometimes honey. Those whoalso eat dairy products are called lacto-vegetarians. Vegetarians who eatboth dairy and eggs are called lacto-ovo vegetarians. Some vegetarians eatfish but not meat or poultry. They’re called pescatarians (pesce is Italianfor fish).

“Then there are the so-called flexitari-ans, or semivegetarians. These are peoplewho eat a mostly vegetarian diet, but theyoccasionally eat meat,” said Jody Engel, anutritionist and registered dietitian at theNational Institutes of Health (NIH). “Theymight say ‘I’m a vegetarian, but I need toeat my burgers every Sunday.’ People tendto follow their own rules, which is one rea-son why it’s hard for researchers to studyvegetarians. There’s so much variance.”

Despite the different definitions, “there’stremendous agreement among nutritionexperts and health organizations that amore plant-based diet is beneficial, whetheryou’re a true vegetarian or not,” said NIHnutritionist Dr. Susan Krebs-Smith, whomonitors trends in cancer risk factors.

Vegetarian diets tend to ingest fewercalories, and have lower levels of saturatedfat and cholesterol, and more fiber, potassium and vitamin C than thosewith other eating patterns. They tend to weigh less than meat eaters, andto have lower cancer rates. “Evidence also suggests that a vegetarian dietis associated with a lower risk of death from certain heart diseases, andthat those who follow a vegetarian diet tend to have lower LDL [‘bad’]cholesterol levels,” said Engel.

IN SOME CASES, THOUGH, IT’S UNCLEAR IF CERTAIN HEALTH BENEFITScome from plant-based eating or from the healthy lifestyle of most vege-tarians. “Vegetarians are generally more physically active and havehealthier habits than non-vegetarians…,” said Krebs-Smith.

To tease out the effects of diet, scientists have to conduct large, careful-ly controlled studies that account for other factors. One of the world’slargest studies of plant-based diets is now under way at Loma LindaUniversity in California. Cardiologist Gary Fraser is leading an NIH-funded team of scientists to analyze data on 96,000 Seventh-day

Adventists in all 50 states and in Canada.Members of this religious grouphave unique dietary habits and a generally healthy lifestyle. Adventists areencouraged to follow a vegetarian diet, but about half the populationsometimes eats meat. These variable eating patterns allow scientists tocompare a wide range of dietary habits and look for links between dietand disease.

To date, the researchers have found that the closer people are tobeing vegetarian, the lower their risk of diabetes, high blood pressureand metabolic syndrome—a condition that raises the risk of heart dis-ease and stroke. “The trend is almost like a stepladder, with the lowestrisks for the strict vegetarians, then moving up for the lacto-vegetarians

and then the pescatarians and then thenonvegetarians,” Fraser explained.Earlier studies found that vegetarianAdventists also tend to live longer thanboth meat-eating Adventists and non-Adventists. The vegetarians also havefewer instances of coronary heart diseaseand lower rates of some cancers.

BECAUSE VEGETARIANS BY DEFINITIONdon’t eat meat, some people jump to theconclusion that simply cutting meat fromtheir diet will lead to health benefits.“But it’s actually more complicated thanthat,” said Fraser. “Differences in lifeexpectancy and other health mattersmight be related to the extra fruits, veg-etables, nuts and legumes—includingsoy—that vegetarians tend to eat. Youcan’t necessarily conclude it’s based onthe absence of meat.”

Experts generally agree that vegetarians who eat a wide variety offoods can readily meet all their body’s needs for nutrients. However, theyneed to be sure they take in enough iron, calcium and zinc. Studies showthat most vegetarians do get enough, in part because so many cereals,breads and other foods are fortified with these nutrients. “Vegans in par-ticular need to be certain to get enough vitamin B12 and omega-3 fattyacids,” said Rachel Fisher, a registered dietitian involved in nutritionresearch at NIH. Omega-3—found in fish, flaxseed, walnuts and canolaoil—is important for heart health and vision.

Some vegetarians take dietary supplements to ensure they’re gettingeverything they need. Talk to a registered dietitian or other health profes-sional if you’re a vegetarian or thinking of becoming one.

Whether you’re a vegetarian or not, Fisher said, you can benefit fromthe high fiber, low fat and rich nutrients of a vegetarian diet.

-Excerpted from NIH News in Health

experts’ opinionNational Institutes of Health

Is a Vegetarian Diet Healthy?

Vegetarians have fewer instancesof coronary heart disease andlower rates of some cancers.

ISTOCKPHOTO/M

ARIABOBROVA


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