MedStar Health Blog

For decades, women with uterine fibroids, or benign growths inside the uterus, commonly have been offered two options to manage the symptoms—get a hysterectomy, or just deal with the pain.

Uterine fibroid embolization, a minimally invasive procedure, can relieve painful symptoms without removing a woman’s uterus. But a 2017 survey found that almost half of women diagnosed with uterine fibroids had never heard of uterine fibroid embolization, which has been available for a couple of decades. This statistic shocked my Fibroid Center colleagues and me. Women need to know about this life-changing procedure, which involves pinhole incisions only and has been shown to improve symptoms in 90 percent of the women who get it.

More than a third of all hysterectomies are performed due to uterine fibroids. Doctors must do a better job of getting the word out about this procedure because fibroids affect millions of women. Uterine fibroid embolization is highly effective, and women who undergo the procedure can get back to their daily routines in about half the time as women who have hysterectomies.

Preventive medicine is the wave of the future as doctors and patients focus more on maintaining good health. In conjunction with the trend, medical professionals should initiate discussions with patients and their loved ones regarding preferences for end-of-life care.

Part of my job as a palliative care social worker involves having such discussions. Unfortunately, some of these happen when patients and families are facing medical crises and have little time to consider their options.

Fewer than 10 percent of the patients I meet have an advance directive, a document that outlines how they’d want to be cared for if they were seriously ill. I believe we can do better. For example, more than 90 percent of people living in La Crosse, WI, have advance directives. The medical professionals in that community launched an extensive marketing campaign to educate residents on the role and value of advance directives, as well as how and where to obtain them.

Completing an advance directive is part of a process referred to as advance care planning. The process involves reflecting on what makes life meaningful to you, how you define quality of life, how and where you want to die, and who in your life can help carry out your wishes for end-of-life care. Having advance care planning discussions before sickness or serious injury occurs can help ensure you receive care on your terms. After my mother died in 2006, my partner and I talked about what we would want if one of us became sick or suffered a life-threatening injury. In doing so, we both discovered personal preferences that were important to us, and in some instances even surprising.

Advance care planning conversations can help relieve your family from the burden of wondering what you would have wanted. My palliative care colleagues and I work every day with families and loved ones who struggle to make end-of-life care decisions for patients, and understandably so. The emotional weight of having to make these decisions can be eased by sharing what you prefer and need in advance.

Let’s walk through when and how to have end-of-life discussions with your loved ones, and how these discussions can shape your future care.

3 steps to start an advance care planning discussion

There is no way to anticipate every scenario that might occur at the end of life. However, there are three steps we recommend to start the process of advance care planning: designate a health care power of attorney, fill out an advance directive, and have conversations with loved ones.

1. Designate a health care power of attorney

A health care power of attorney is someone with whom you feel comfortable discussing what is important to you regarding your end-of-life care. This individual doesn’t have to be a family member. It can be a friend or other trusted individual. The most important quality in a power of attorney is that they will carry out your wishes, even if they don’t agree with them or would make different decisions for themselves.

2. Fill out an advance directive

This document should include specific medical interventions and healthcare details that are important to you. Since there is no way to cover every possible circumstance in one document, you should approach the advance directive as a general guideline to your preferences for end-of-life care. That’s why conversations with your health care power of attorney are crucial.

There’s no need to contact a lawyer to get this form. You can get it from your local medical center, or even print one from the internet. My team often recommends Five Wishes Online, which is a great planning tool, but comes with a charge. Free advance directives available for download can be found at Caringinfo.org. Once completed, you should provide your doctors with a copy of your advance directive so it can be added to your medical record.

It’s possible that your doctor has never raised the topic of advance care planning with you. If this is the case, please let your doctor know that this is something you would like to discuss.

3. Have face-to-face conversations about your wishes.

If you are healthy, now is the time to start a conversation about what you may want should you experience a life-threatening illness or injury. You could reference a friend’s situation or a news story about someone who died as a framework. “I wonder how their family made decisions about their care. This is what I would want if I were in that position.”

If you or a loved one is already facing a serious medical issue, consider speaking with your medical team about specific treatments they may be recommending, as well as any side effects and risks. Speak with your health care power of attorney about your thoughts, concerns and questions regarding treatment risks, and what should happen if your condition becomes critical.

Tools to help you start an end-of-life discussion

If you find yourself unsure of how to begin sorting out your own wishes or broaching the topic with a loved one, there are tools available to help jumpstart those conversations.

Coda Alliance sells GoWish cards, which help guide you in considering aspects of care to consider at the end of life. For example: Would you want a specific medical procedure? Would you want a provider to talk to or touch you if you were unable to communicate? Who would you want at your bedside? The cards also prompt may wish to do if you are sick but can still communicate, including funeral arrangements, meeting with clergy, keeping someone with you at all times and so forth.

Having discussions about advance care planning helps loved ones know what’s important to you. Though it doesn’t make the dying process less painful for families, it can help alleviate concerns that loved ones may have regarding what you would decide for yourself. Advance care planning not only helps assure fidelity to your preferences, but can also provide your loved ones with some peace of mind that their decisions are consistent with your wishes.

The goal of any glaucoma treatment is to prevent vision loss by lowering pressure in the eye caused by excess fluid. This doesn’t necessarily mean surgery. In fact, the majority of people with glaucoma can manage the condition with medication—usually in the form of eye drops.

When we say “excess fluid” in glaucoma patients’ eyes, we’re not talking about extra tear production. Instead, we are referring to the fluid that is produced in the eye and normally drains back into the venous system. When your eye produces too much fluid or the drainage system doesn’t work correctly, fluid builds up and creates pressure in the eye.

There are many types of glaucoma medications. Some cause the eye to make less fluid, while others help fluid drain from the eye. Let’s look at the types of glaucoma medication available, their side effects and how we help patients follow their medication regimen.

Types of glaucoma drugs and their side effects

Most glaucoma medications come in the form of eye drops. There are some glaucoma drugs that you take by mouth, but they’re used far less often. Some more common types of eye drop medications include:

Prostaglandin Analogs

These drugs increase the outflow of fluid in your eye. You might know them by the names Lumigan, Travatan Z and Xalatan.

Prostaglandin analogs are often the first line of treatment that your doctor will recommend. This is because you only need to take these drops once a day and there are few side effects. The main problems patients have with these drugs are red or stinging eyes.

The drugs also can cause the eyelashes to grow and cause light-colored eyes, such as blue or hazel, to get a bit darker. These side effects are far less common and don’t cause most patients to stop taking the drugs. In fact, many women enjoy the longer lashes!

Beta blockers

These are the second most common type of medication prescribed for glaucoma, and they work by reducing the amount of fluid produced in the eye. Examples include timolol and betaxolol.

Side effects of beta blockers include difficulty breathing, a slowed heart rate and lowered blood pressure. For this reason, they can cause problems for people with heart and lung conditions, such as heart rhythm disorders (arrhythmia), asthma and emphysema. Beta blockers are related to blood pressure medications, so we’re also careful about prescribing them to patients on these medications so we don’t lower their blood pressure too much.

Alpha-adrenergic agonists

These drugs both reduce fluid production and increase drainage in the eye. A common type is Alphagan. The most common side effects of alpha-adrenergic agonists are red, itchy eyes. They also can cause an irregular heartbeat, high blood pressure and fatigue.

Carbonic anhydrase inhibitors

These drugs, which are used less often for glaucoma and also come in a pill form, reduce the production of fluid in the eye. Examples of carbonic anhydrase inhibitors include dorzolamide and brinzolamide. Carbonic anhydrase inhibitors can cause a metallic taste in your mouth; tingling in the hands or feet; and burning, red eyes. They also have been associated with kidney stones.

Improving medication compliance for glaucoma patients

As with any medication, glaucoma drugs only work if you take them—and take them correctly. Not doing so risks vision loss. Unfortunately, one of the biggest hurdles we face when it comes to glaucoma medication is compliance, which refers to patients taking their medication as prescribed.

In fact, according to the Glaucoma Research Foundation, up to 25 percent of glaucoma patients don’t take their medication at all. And another big group of them don’t take it properly, which could mean they forget to take some doses, take it at the wrong time, or take too much or too little.

There can be many reasons for this. One is that patients often are motivated to take medications because they see results. Glaucoma often has no symptoms, so it can be tempting to stop taking your medication or become lax in taking it exactly as prescribed.

Related reading: 5 tips to improve medication compliance

We try to help patients with compliance by finding the simplest, yet effective, medication regimen possible. For example, if you take two eye drops a day, we may be able to find a combination medication that combines two drops in one bottle, so you only have to take one drop a day.

Your doctor should spend time teaching you how to use your medications correctly. This includes making sure you know what time of day to take them, how much to take and how to put drops into your eye.

Reducing side effects of glaucoma drugs also is important to improve compliance. No one wants to take a medication that causes pain or discomfort. Most eye drops will cause an uncomfortable burning or stinging, but this should only last a few seconds. If you experience side effects due to your glaucoma medication, contact your doctor. They may be able to change the medication or dosage over the phone, or they might advise you to stop taking the medication until you can come in for an appointment.

We don’t currently have a cure for glaucoma. While medication usually is the first line of defense against glaucoma, there may come a point at which you’ll need more than drugs to prevent vision-threatening damage. This could include laser procedures such as selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgeries (MIGS) , more traditional surgery, or a combination of medication and surgery. But medication often can delay or in some cases prevent the need for advanced treatment.

MedStar Harbor Hospital's New President and Chief Medical Officer

As a toddler, his favorite toy was a "Let's Play Doctor" medical kit. As he got older, the television show he looked forward to watching the most was "Emergency." Something about ambulances, sirens, and hospitals always appealed to Stuart Levine, MD, FACP.

So it should shock no one that his career has evolved the way it has. Academic, clinical, and leadership experience all paved the way, leading Dr. Levine directly to the president and chief medical officer's seat at MedStar Harbor Hospital. It's a role for which he says he is extremely honored to have been selected. And, according to his colleagues, it's a role in which he already excels.

Dr. Levine took some time to share his personal and professional experiences, his goals, and how he makes it a priority to ensure every single employee at his hospital feels valued and appreciated, while also ensuring that MedStar Harbor patients receive the highest quality care in a safe environment that meets their service expectations.

What inspired your career path?
I wanted to be a doctor at a very young age, which surprised a lot of people because I come from a family of accountants. I knew that if I went into medicine, I would have the opportunity to do good things, help people feel better, and make a positive difference. I have held a lot of different roles over the years, including the one I am in now. But I always have been, and always will be, a doctor first.

Why did you join MedStar Health and has the organization been a good fit for you?
I was working for an academic medical institution, but wanted to focus more on clinical care. I thought that I could achieve a good balance in a role that was centered on patient care, but also offered leadership opportunities and a chance to be involved in medical education programs.

I found that balance at MedStar Health. I was here for just a short time when I was presented the chance to get involved in truly innovative work that could and would impact the entire MedStar system of care. The leadership team was receptive to my observations and encouraged me to bring new ideas and approaches to the table. They were confident in me, and that gave me confidence in myself.

How did your career experiences prepare you for your new role?
Every job I've had has helped me grow and prepare to lead MedStar Harbor. While each role has been different, all have carried a strong link to the things I am most passionate about: providing excellent patient care and taking every possible step to maximize patient experiences and outcomes; building relationships among the team, because everything is possible with strong collaboration and respect; and problem solving.

Hospitals face numerous challenges every day. Many of the initiatives I have worked on over the years have requires strong scientific and systematic thinking. As a doctor who has also working in various leadership roles, I've been able to offer a unique perspective and solutions for consideration.

You have a lot of responsibilities. How do you remain focused on what matters most?
In health care, it's essential to always be thinking about the future, and the steps our organization must take to reach our goals. But it's equally important to keep a good focus on where we are now. I'm a believer in the value of being present.

Obviously, I can only be in one place at one time, yet it's key that my influence as president and chief medical officer is felt throughout the hospital, even at times when I am not physically here. I can do this by inspiring people and instilling confidence in them when they do see me. I'm an active player in resolving conflicts, and helping everyone on the team identify the best resources to get our jobs done productively and efficiently.

I make it a priority to be out in the hospital meeting with people in various roles. I want them to know that I am on their team too. And along the way, I want to make sure everyone is having some fun. That's important!

Why do you believe MedStar Harbor is a great place to receive care? 
This is a very friendly place. Many employees here consider their colleagues family. Our people take personal responsibility for ensuring every encounter with a patient or family member is a positive one. That approach goes a long way in our ability to deliver an outstanding patient experience and achieve the best possible outcomes for every person who chooses to come here for care.

Additionally, during the past 18 months, MedStar implemented an "interdisciplinary model of care," or IMOC, as we call it, that aims to improve our internal collaboration and communications, as well as the way we share information with patients and their families. IMOC has had a positive impact at all the MedStar hospitals. MedStar Harbor was one of the earliest adopters of the new model. Our team played an instrumental role in building it, and that speaks volumes about our commitment to providing great care.

What are the biggest challenges you face, especially in light of the constantly changing and evolving healthcare landscape?
Health care is complicated. Period. Our daily work, and one of our biggest challenges, is to try to set the complicated stuff aside and think about the core principals that guided why we went into healthcare careers in the first place. We need to understand the regulatory, political, and financial factors that impact our industry, but we can't allow these things to distract us from what we are here to do. And that is to provide outstanding patient-centered care in alignment with the needs of our community.

We need to constantly evaluate the services we offer and are known for, such as women's care and behavioral health, and keep growing in those areas. We need to develop new expertise, and invest in skilled providers, new technology, and expanded facilities to deliver that expertise in the form of excellent patient care. As we successfully expand our service offerings, we become better equipped to provide a true continuum of care.

What are the three most important things for people to know about MedStar Harbor?
First, this is a hospital you can come to for world-class care, in a warm, friendly, and family-focused environment. Along with that, MedStar Harbor is a great place to turn for a wide range of healthcare services. If your medical needs are more complex, and require a level of care beyond our capabilities, we are still able to help manage your care through our specialty service line partnerships with the MedStar Health system, which offers regionally and nationally recognized clinical programs at MedStar hospitals across the Baltimore/Washington, D.C., corridor. And lastly, in Baltimore City we are a "marquee" healthcare provider. We are a safe place to turn. You have our commitment that we will do everything in our power to take good care of you.

What do you like to do when you are not working?
I love spending time with my family, especially my three daughters, who are ages 16, 13, and 9. I am passionate about music and enjoy playing the guitar. I also like getting outdoors as much as I can, whether it's to go for a run with the dog, or take a day or weekend trip with my family. We love to go skiing, and some of us are adventure enthusiasts. My oldest daughter and I love roller coasters and our personal favorite is the Griffon at Busch Gardens in Williamsburg, Virginia.

Can you share a fact about yourself that isn't well known?
I'm a naturalized U.S. citizen. I was born and raised in Montreal, Quebec, Canada.

Anything else you'd like to share?
I am incredibly humbled and proud to lead this hospital. I'm grateful for the people who choose to come here for care, and for the people who choose to work here, and make this hospital as great as it is. MedStar Harbor Hospital is truly a special place, and I want everyone around us to know it.

Winter 2018

A Behavioral Health Specialist Can Make all the Difference

Stress and worry are part of everyday life. But what happens when you become consumed by it; when it becomes difficult to simply get through the day?

MedStar Harbor Hospital’s expanded behavioral health program gives people who live in Baltimore and beyond a place to turn for care and treatment of this problem—best known as general anxiety disorder. It’s a condition that can significantly impact a person’s quality of life, affecting relationships, work performance, and overall health and wellness.

“In addition to feeling consumed with worry, people with generalized anxiety disorder will often experience a number of physical symptoms as well, including nausea, excessive fatigue, muscle tension, and headaches,” says Reena Ardeshna, MD, a psychiatrist and part of MedStar Harbor’s team of behavioral health experts.

“Some will find it difficult to sleep, eat, or concentrate, or they may feel overwhelmed and exhausted by tasks that others consider to be simple, such as paying bills or going to the grocery store,” she notes.

Dr. Ardeshna says people with the disorder tend to worry excessively about health, safety, relationships, finances, and work. “We all worry about these things to some degree but people with generalized anxiety disorder worry about them so much, it makes it hard to function.”

Those with a family history of generalized anxiety disorder may be more prone to being diagnosed with the condition, however, life experiences and stress levels can increase the risk of developing the disorder. Research shows that in the United States, between five and 12 out of every 100 people will experience generalized anxiety disorder at some point in their lives.

“A lot of patients turn to their primary care physicians for the physical symptoms they are generalized anxiety disorder remains undiagnosed and untreated for an extended period.

Dr. Ardeshna stresses the importance of seeking care from a behavioral health specialist, sooner rather than later, if feelings of worry and anxiety seem to be taking over your life. “There are many treatment options available that can offer relief, once you are in the right hands.” Treatment typically involves medication, therapy, or a combination of both.

MedStar Harbor’s team of psychiatrists, nurses, and therapists determine the best plan of care for each patient, with adult inpatient treatment, partial hospitalization, an intensive outpatient program, and an outpatient clinic, all available to support those who are suffering from anxiety.

“We account for the severity of the symptoms our patients are experiencing, along with their functional abilities, to provide the clinical care they need and deserve,” Dr. Ardeshna says.

Dr. Bitar, medical director of MedStar Harbor Women's Care with patient Christy Ryan, RN, after the delivery of her baby girl.

MedStar Harbor Women's Care Goes Above and Beyond

Christy Ryan, RN, was more than halfway through her pregnancy with her third child when she was offered the opportunity to join the team in the Emergency department at MedStar Union Memorial Hospital as a staff nurse. She was excited about her new job, but with it came a change in her health insurance. She needed to find a new obstetrician as soon as possible.

“I was at a critical point in my pregnancy and was experiencing some medical challenges, so it really wasn’t an ideal time to find a new doctor,” Ryan says. “But I had to.”

She began researching her options, focusing on practices located near her home. MedStar Harbor Women’s Care seemed to meet her needs, offering a comprehensive scope of services and an experienced team of physicians and care providers. She made an appointment with Wael Bitar, MD, medical director of the practice, and hoped for the best.

“I knew within a few minutes of meeting Dr. Bitar that I had made the right choice,” says Ryan. “He gave me his full attention. He answered my questions, eased my fears, and promised me that despite my complicated health issues, we would have a healthy mom and a healthy baby girl. And I believed him.”

Ryan’s pregnancy was considered high risk because she has just one kidney, increasing her risk for urological infections and kidney stones, in general, and even more so during pregnancy. Making her situation even more complicated was the fact that at 28 weeks into her pregnancy, she was diagnosed with gestational diabetes.

From that point forward, in addition to taking new medications and meeting regularly with a dietitian, she had weekly screenings in the Fetal Assessment Center at MedStar Harbor Hospital. And every three weeks, her baby girl was measured to ensure her growth was on track.

“Being diagnosed with gestational diabetes was a first for me, and it was life changing,” notes Ryan, already mom to two boys, Nathan, 8, and Jacob, 3. “I had to change everything about the way I was eating. I had to cut carbohydrates and all junk food.”

It was also an emotional time, Ryan recalls. “I was pretty upset and worried,” she adds. “But every time I had a doctor’s appointment, I got the reassurance I needed. Dr. Bitar calmed me down and kept me centered.”

On November 6, 2017, Ryan and her husband Shawn finally got to meet their daughter, Hailey. Seeing and holding her baby girl for the first time, Ryan was filled with a different kind of emotion.

“I kept looking at Hailey and thinking that everything I had gone through during my pregnancy was worth it,” she says. “And I am so thankful that I had such a caring and supportive doctor and team by my side, working with me week in and week out to get me to that day.”

Caring for Women of all Ages
MedStar Harbor Women’s Care offers comprehensive obstetrical and gynecological services for women of all ages. The practice prides itself on its ability to offer care that addresses health issues that impact women at every stage of their lives. Dr. Bitar is one of three board-certified physicians who serve the practice, working alongside two nurse practitioners and a group of medical assistants.

“Our team is very diverse, which allows us to truly accommodate patients with various medical needs and personal preferences,” explains Christina Barett, CRNP, a certified registered nurse practitioner. “We all have different backgrounds and key areas of interest or a specialty. Some of our providers speak multiple languages.”

And, as part of the MedStar Health network, the team can easily streamline care for patients who present with more complex medical issues, and need a referral to another specialist.

“We have relationships with physicians who focus on different kinds of medicine, and we can quickly refer a patient who has a problem or condition we can’t address,” Barett adds. “For example, we collaborate often with the gynecologic oncologists at MedStar Harbor when our patients have a need for those services.”

One thing that also sets MedStar Harbor Women’s Care apart from other local practices is its focus on holistic health. While women come in primarily for obstetrical and gynecological care, they find that they’re able to talk about and get guidance on a wide range of health issues.

For example, a woman who comes in for her annual checkup might end up engaging her physician in a conversation about diabetes, thyroid issues, or depression. It’s also common for questions to come up about nutrition, sleep habits, and strategies for coping with stress.

“Our job is to see the patient as a whole person and be a liaison for her good health,” says Fawn Manning, MD. “Sometimes we are talking with a patient about very sensitive issues; in fact, it might be the first time she is having a conversation out loud about an extremely personal topic. But we want her to open up and feel comfortable confiding in us because when she does, we can point her in the right direction.”

Dr. Manning notes that many of those conversations include laughs, hugs, and sometimes even tears and tissues. “I get to connect with my patients during the most special and personal moments in their lives, whether it’s about marriages, babies, getting through challenging medical issues, or the loss of a spouse,” she says. “I hear about it and I get to be part of it. And I get to help that woman through it. This isn’t a job for me; it’s a life.”

MedStar Harbor Women’s Care offers its services in three locations: on the MedStar Harbor campus, in Federal Hill in Baltimore City, and in Pasadena. The same scope of medical care is available at each location, and providers rotate between the three offices, giving patients flexibility and options when it comes to scheduling and managing health care.

“Many patients utilize two locations because they live close to one and work close to another,” says Barett. “They appreciate that convenience and the fact that it makes it easier to get an appointment quickly.”

The practice is currently accepting new patients. Appointments are available at any of the locations by calling 410-354-0800.