MedStar Health Blog

The holiday season will soon be upon us, which means get-togethers with family and friends. Unfortunately, for many it’s also a time for overeating and weight gain.

“On average, Americans gain approximately one to two pounds during the holidays. While this weight gain isn’t dramatic, research shows it tends to stick and accumulate over the years,” says Jessica DeCostole, MS, RD, a dietitian educator in the Good Health Center at MedStar Good Samaritan Hospital.

“Mindless eating is a big part of the problem,” DeCostole notes. “Luckily, you can avoid putting on extra pounds by planning ahead.” Here are a few simple strategies:

• Do not skip meals before a big holiday party as this may result in overeating. Instead, eat a smaller meal or a light snack like raw vegetables or a piece of fruit to curb your appetite. You will be less tempted to overindulge.
• Try to maintain a balanced diet. Be sure to pick a food from each food group— protein, carbohydrates and vegetables— and include more of the latter. Vegetables are fiber-rich foods that fill you up and are lower in calories. But remember, while it’s important to include healthy foods in your diet, all food should be eaten in moderation.
• Use a smaller plate. This keeps you from putting too much food on your plate and encourages proper portion sizes. Also, start by filling your plate with vegetables and salad before going to the entrees and desserts.
• Be aware of the beverages you consume. Alcohol, in particular, is high in calories. For example, a standard 12-ounce beer has 150 calories while a shot of vodka alone has about 100 calories. Mix that with fruit juice or soda, both of which are full of sugar, and the calories really add up. Alcohol can also lessen inhibitions and induce overeating. Stick to one drink if you can. If you decide to have more than one, drink a glass of water in between.

“Focus on the social aspect of the occasion. Spend time talking to your family and friends. Think about what you are celebrating, not just how good the food is. And after eating, get in some physical activity,” DeCostole suggests. “It’s a great time to go for a walk or play a game of catch with the kids.”

For more information, call 410-248-8322 for a free Healthy Recipes guide.

Multidisciplinary Approach Benefits Aging Bodies and Minds

Americans are living longer and healthier lives. Even so, many older adults will eventually develop one or more of a group of related medical problems called geriatric syndromes. These syndromes can limit older adults’ abilities to carry out basic daily activities, threaten their independence and lower their quality of life.

“Geriatric syndromes usually have more than one cause, and don’t necessarily involve just one organ system,” explains George Hennawi, MD, chief of Geriatrics at MedStar Good Samaritan Hospital and director of the Center Hughes and his wife, Sharon, are grateful for the comprehensive care available at the Center for Successful Aging. “For these reasons, providing care to older people with geriatric syndromes can be complicated. Geriatricians and other geriatric healthcare providers can play an important role in diagnosing and managing these syndromes.”

The Center for Successful Aging is dedicated to addressing the unique needs of people experiencing complex medical and social age-related conditions, providing patient-centered care— care that is comprehensive and coordinated among doctors, nurses, therapists, and other caregivers—all in one convenient location.

Robert Hughes, a patient of the Center for Successful Aging, epitomizes the type of individual who benefits most from the multidisciplinary care offered. The 81-year-old has chronic obstructive pulmonary disease, high blood pressure and suffers from anxiety and depression. Two years ago, he was diagnosed with dementia, one of the most common and complex geriatric syndromes, according to Dr. Hennawi.

“Cognitive disorders, such as Alzheimer’s disease and other types of dementia, cause the loss of cognitive function, which affects one’s memory, judgment, processing, attention span, mood and ability to complete basic daily functions,” Dr. Hennawi says. “In the case of vascular dementia—the type of dementia Robert has—the sense of balance is also affected, making walking difficult.”

For patients with complex forms of dementia and neuropsychiatric complications such as agitation, aggressive behavior or wandering, the center collaborates with the Cognitive Wellness Program to provide them with the specialized care they need.

“The goal of the Cognitive Wellness Program is to further enhance the coordination of care in the elderly,” says Elias Shaya, MD, DFAPA, regional medical director, Behavioral Health Services, MedStar Health. “Older folks who struggle with cognitive challenges almost always end up with neuropsychiatric problems making it difficult to navigate daily life.”

Patients at the Center for Successful Aging receive regular health assessments to identify both medical and cognitive function issues and determine if they are at risk for other conditions or in need of more specialized treatments. Cynthia Fields, MD, a geriatric neuropsychiatrist at MedStar Good Samaritan, is part of the assessment team.

“Evaluating them while they are in familiar surroundings at the Center for Successful Aging is much easier for both the patient and the family,” says Dr. Fields. “If the patient clearly needs specialized care, the individual is referred to our Cognitive Wellness Program.”

While at the Center for Successful Aging, the needs of caregivers, who are often overwhelmed—physically and mentally—by the responsibilities of caring for their loved ones, are an important consideration, too. “We offer a wide range of resources and educational support to help families and caregivers better understand and cope with the situation,” Dr. Fields adds. Sharon Hughes, Hughes’ wife and caregiver, is grateful for the coordinated and comprehensive care available at the Center for Successful Aging. “Now that Robert needs to use a wheelchair because of his dementia, just getting ready for a doctor’s appointment is a challenge,” she says. “Going to the Center for Successful Aging is much more convenient for us … everything we need is there.”

“Many people who are developing or have dementia are not diagnosed. Early signs of serious problems are easy to miss. Unfortunately, the failure to evaluate memory or cognitive complaints often hinders the treatment of other underlying diseases and conditions,” Dr. Hennawi notes. “That’s why integrating medical and behavioral care is so essential to this population.”

For more information about the Center for Successful Aging and the Cognitive Wellness Program, call 410-248-8322.

Muscle And Memory Class Offers Exercise For The Brain

Studies have shown the benefits of regular exercise on cognition, dementia risk and even dementia progression. Muscle and Memory is a class developed by the Cognitive Wellness Program in partnership with the Good Health Center at MedStar Good Samaritan Hospital, specifically for seniors with memory and cognitive challenges.

A free, 30-minute seated exercise class for patients 65 and older, it includes a combination of simple upper and lower body movements as well as mental stimulation activities. For more information and class times call 410-248-8322.

Related Services

• Geriatrics/Center for Successful Aging
• Care for People with Dementia and Cognitive Impairment

The bustling environment of Emergency Medicine may seem worlds away from the relatively benign atmosphere of the corner pharmacy. But even after Maryann Amirshahi, MD, PharmD, MPH, had begun her career as a pharmacist, she sought opportunities to bring her knowledge of medications and drug therapies to other aspects of medicine.

After several years of working in commercial and hospital pharmacies, Dr. Amirshahi earned her medical degree at Temple University, followed by an emergency residency at the Hospital of the University of Pennsylvania.

Why Medical Toxicology

“I was always interested in toxicology, overdoses and similar cases,” explains the New Jersey native. “During my ER rotations, I saw numerous opportunities where my pharmacy background could help ensure patients received proper medications and dosages, for both their immediate and pre-existing conditions.”

A medical toxicology fellowship at The George Washington University brought Dr. Amirshahi to the nation’s capital, which she followed that fellowship with a clinical pharmacology fellowship at Children’s National Health System. Ever the learner, Dr. Amirshahi also received a Masters of Public Health degree, focused on environmental and occupational health from GWU. She is board certified in emergency medicine, medical toxicology, addiction medicine and clinical pharmacology.

As an attending emergency medicine physician for both MedStar Washington Hospital Center and Children’s, Dr. Amirshahi often consults with other physicians on cases involving dosages and related issues. A frequent challenge, she says, is a lack of available information on what other prescription medications patients may be taking.

“Even the patients don’t always know exactly what they’ve been prescribed,” she says. And given the growing awareness of opioid addiction across the country, Dr. Amirishi says it’s critical that emergency medicine prescriptions don’t inadvertently start a patient on the path to addiction.

“If there’s a shortage of certain drugs, a physician may have to use a less-familiar medication that may interact differently,” she adds.

Involvement in the Medical Community

In addition to serving as an assistant professor of emergency medicine at the Georgetown University School of Medicine, Dr. Amirshahi is a toxicology consultant for the Mid-Atlantic Center for Children’s Health and the Environment, and for the National Capital Poison Center. She’s involved in local and national research focusing on medication safety, medical toxicology and prescription drug abuse.

“It’s rewarding to be making a difference on a large scale,” she says. “Along with developing protocols for safe opioid use, we’re also helping physicians implement new and alternative therapies.”

Life Outside the Hospital

With a family that includes a husband who is also a physician, two young children and five pets, one might assume that quiet time is a rare commodity in Dr. Amirshahi’s life. Though yoga and pilates do help her decompress, she rarely hesitates to indulge her longtime love of heavy metal music.

That includes attending a performance by Slayer, her favorite metal band, even though she was eight months pregnant at the time.

Otherwise, Dr. Amirshahi says with a laugh, “my time in the mosh pits is over.”

Millions of people get a flu vaccine in the fall as recommended by the Centers for Disease Control and Prevention (CDC), the American Medical Association and other professional medical groups. But many people don’t, believing it doesn’t work or will make them sick.

If you’re thinking about skipping a flu shot this season, David Weisman, DO, medical director of the Good Health Center at MedStar Good Samaritan Hospital, encourages you to reconsider. Here are five reasons why:

1. Not only can the flu vaccine keep you from getting the flu, it may make your illness milder if you do get sick.
2. Getting vaccinated benefits everyone around you. “The flu virus spreads easily— you can contract it when an infected person coughs, talks or sneezes. You can also get the flu by touching something that has the virus germs on it, then touching your eyes, nose or mouth,” notes Dr. Weisman.
3. Some people are at greater risk of getting seriously ill from the flu, like pregnant women, older adults and people with chronic health conditions. If you fall into one of these categories, the vaccine can help protect you. “Flu symptoms can lead to dehydration, the worsening of chronic illnesses, bacterial pneumonia, ear or sinus infections, and in severe cases, death,” says Dr. Weisman. “Every year, about 200,000 people are hospitalized because of the flu.” The CDC estimates that flu-associated deaths in the United States ranged from about 3,000 to 49,000 annually between 1976 and 2006.
4. The flu shot is safe and it can’t give you the flu. The flu vaccine is formulated from dead or inactive viruses, so it can’t make you sick. If you do get sick, chances are you were exposed to the virus before getting the shot David Weisman, DO or you picked up a virus not included in the vaccine.
5. Last year’s vaccination won’t protect you this year. “The flu is a virus that changes from year to year,” Dr. Weisman explains. “The vaccine is reformulated annually to protect against strains of the virus predicted by the CDC to be most widespread.”

Children ages 6 months or older and most adults should get vaccinated against the flu annually. Flu season usually starts in October and can last until May, so it is important to get vaccinated early. “Getting the shot is the single best way for nearly everyone to prevent the flu,” says Dr. Weisman.

The Good Health Center at MedStar Good Samaritan Hospital offers flu and pneumonia vaccines. Seasonal flu vaccines are $20 and pneumonia vaccines are $25 and are free for those with valid Medicare Part B cards. For details call 410-248-8322.

Nearly 200,000 people get bariatric surgery each year in the United States, and about 1,000 of them are teenagers. The obesity rate among adolescents age 12 to 19 more than doubled between 1988 and 2014.

Even more unsettling is the increase of extreme obesity among these young adults, which is defined as a body mass index (BMI) at or above 120 percent of the sex-specific 95th percentile on the Centers for Disease Control and Prevention’s BMI-for-age growth charts. Extreme obesity rates in those age 12 to 19 rose from 2.6 percent in 1988-1994 to 9.1 percent in 2013-2014.

Obesity is linked to a variety of chronic health conditions that used to strike adults only: diabetes, high cholesterol, high blood pressure, sleep apnea, and bone and joint problems, among others. More and more young people are developing these ailments, and if they don’t already have them, they certainly are at increased risk for developing them in the future.

It’s in the best interest of our younger generations to gain control of their weight, and sooner rather than later. For some of them, making changes in their diet and physical activity is enough. But for many, it isn’t. As a result, more young people are considering bariatric surgery.

Bariatric surgery considerations for teens

Bariatric surgery isn’t for everyone, and there are some additional factors to take into account for a young person. But for some, it may be a good option to help them lose weight and improve their current and future health. One of these young adults—and a patient of mine—is 18-year-old Jewel Francis-Aburime, who shared her story about having weight loss surgery in spring 2017. She has some sage advice for people her age who are in a similar situation.

Jewel isn’t the first teen we’ve worked with, and she won’t be the last. But that doesn’t mean every obese teen should have bariatric surgery. It’s not a magic bullet, and it’s not an “easy way out.” If you’re not motivated and fully committed to making permanent lifestyle changes, you won’t get the results you want, no matter your age.

When working with teens and young adults, we must take into consideration whether they have finished growing. The nutritional impact of weight loss surgery can be substantial, and we don’t want to hinder growth.

There are certain surgical approaches we can take, such as the sleeve gastrectomy that doesn’t cause malabsorption, a condition that prevents absorption of nutrients. Talk to your doctor about the best options for you or your loved one.

Bariatric surgery is not for the slightly overweight, and it’s not done purely for cosmetic reasons. We follow National Institutes for Health guidelines to determine who is eligible for bariatric surgery. Potential candidates must:

• Be 100 pounds higher than ideal weight, or have a BMI of more than 40
• Have a BMI between 35 and 40 with conditions, such as high blood pressure, sleep apnea, heart disease or diabetes
• Have tried to lose weight through medically supervised diet plans, exercise and behavioral modification programs without success

Read and watch: Learn more about Jewel’s bariatric surgery journey in the Vox story.

Evaluating maturity, not age

When it comes to teens and bariatric surgery, age is just a number. The important thing is that they are mature enough to understand what they’re signing up for, the potential benefits and the lifetime commitment they’ll need to make for the surgery to be successful. I’ve met 40-year-olds who aren’t ready for this!

We spend months getting to know our patients before surgery to make sure they are truly prepared for surgery and life following it. Insurance companies require all patients to have a psychological or psychiatric evaluation before having bariatric surgery. These specialists can assess a whether they have an eating disorder or another behavioral or mental health issue we need to address before going ahead with surgery.

Everyone who has bariatric surgery needs the support of family, friends and healthcare team. Our psychology and psychiatry team also assess a person’s family support structures. Jewel was lucky enough to go through the process with her mother, who had surgery a month before her. This actually isn’t that uncommon. We often see husbands and wives or siblings who decide to have surgery around the same time.

While it can be helpful to have someone who knows exactly what you are going through, it’s not absolutely necessary. Having a loved one who will attend appointments with you or a roommate who will encourage healthy diet choices and join you for a walk can be just as vital to your success.

Committing to lifestyle changes during adolescence

As we transition from childhood to adulthood, we begin to learn who we are and how the world perceives us. We gain new freedoms, but also new responsibilities.

When you have bariatric surgery, you must accommodate a whole new set of lifestyle changes. Breaking old habits and building a healthy relationship with food and exercise is a difficult task at any age. Even more so when you are learning to make your own meals; selecting food in a college cafeteria; and trying to fit physical activity into a hectic school, work and social schedule. It can feel overwhelming at times, but you’re not alone.

I mentioned we spend months getting to know our patients and preparing them for surgery, and that relationship continues long after surgery. Follow-up care is a critical component to success. Psychological support is available along with continuing to meet with your surgeon and dietitian. We also offer monthly support groups where you can meet other people who have had bariatric surgery, discuss challenges and successes you’ve had and learn from others’ experiences.

While there are limited data on the long-term impacts of bariatric surgery in young adults, we do know the long-term risks of obesity. I would rather treat a young person now than wait 10 years or more when they’ve gained another 100 pounds and are diabetic or sick with heart disease.

Locations

MedStar Washington Hospital Center (Washington, D.C.,)
MedStar Montgomery Medical Center (Olney, MD)
MedStar St. Mary's Hospital (Leonardtown, MD)
MedStar Health at Brandywine (Brandywine, MD)

It started out as a normal day for Deborah Neal Wall. “The date was Sept. 15, 2016. I got up and took my walk, and came home and did some sewing,” she says. “Then my neighbor called and said she was stopping by. We had lunch in the living room and I went into the kitchen to get a towel. When I came back my neighbor asked me what was wrong and I said I don’t know. That’s all I remember.”

Wall was rushed to the Emergency department at MedStar Union Memorial Hospital where tests revealed a stroke had occurred in the thalamus on the right side of the brain, which causes the left side of the body to be affected. “Deborah had a significant stroke resulting in deficits in her functional mobility,” explains Scott Lepre, MD, chair of Physical Medicine and Rehabilitation at MedStar Good Samaritan Hospital and associate medical director of Regional Physiatry for the Baltimore region of MedStar Health.

She was admitted to the Comprehensive Integrated Inpatient Rehabilitation Program at MedStar Good Samaritan where patients who have experienced a life-changing illness or event, like a stroke, can receive the expert, specialized attention they need in a nurturing environment. There she was cared for by Dr. Lepre and a dedicated team of specialists including rehabilitation physicians, nurses, physical and occupational therapists, speech-language pathologists, case managers, and other clinical providers.

“Most hospitals offer a wide range of care to stabilize patients by treating apparent conditions and addressing primary needs on a short-term basis. But not every patient recovers in five days or even two weeks.” Dr. Lepre says. “Through our inpatient rehabilitation program, a partnership between MedStar Good Samaritan and the MedStar National Rehabilitation Network, we are able to provide patients with acute care and rehabilitation services all under one roof—right within our hospital building,” he points out. “Our many services are focused on improving the lives and medical conditions of patients who need acute care for a longer period of time in order to fully recover.”

As a result of her stroke, Wall was unable to move the left side of her body. “When I first got to MedStar Good Samaritan, I was sad. I am very independent and I couldn’t bathe myself, I couldn’t lift my left side. I felt very restricted,” she says. “But then I realized that they were going to teach me how to be me again.” MedStar Good Samaritan’s inpatient rehabilitation program has provided compassionate, evidence-based, multidisciplinary rehabilitation for an estimated 40,000 patients whose lives have been altered by stroke, amputations, spinal cord injuries, and more. The program, established in 1971, is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and has earned a specialty designation from CARF for the care it provides to stroke patients.

“We use a team approach in caring for patients. Our treatment team focuses on a patient’s capabilities rather than disabilities to develop individualized plans of care. This positive approach allows our rehabilitation professionals to help patients return to their highest levels of independence,” Dr. Lepre notes. “But the participation of the patient is crucial to a successful recovery.” For the next two months, Wall worked hard. “The first time I took a step, I cried,” she says. “That’s when I knew it was going to work. Day-by-day, I saw me coming back … every day was getting better.”

Today, at age 67, Wall is still making progress. “There is some slight paralysis and I still use a cane, but I have had no other health issues. I want to be 100 percent me and I’m almost at 75 percent,” she notes. Now back at home, where she lives with her son, she is sewing again, taking care of her plants and cooking. She even took a trip by train to New York—by herself—to visit her daughter, four grandchildren and two great grandchildren. Her goal is to be able to stand without her cane so she can go dancing to celebrate her birthday in December.

While she is currently continuing her rehabilitation at home, she still gets to MedStar Good Samaritan regularly to see her primary care physician, Mohammed Khan, MD, and to visit Dr. Lepre. MedStar Visiting Nurse Association also checks up on her weekly. “I have a lot of caring people that I would like to thank,” Wall says.

This article appeared in the fall 2017 issue of Destination: Good Health. Read more articles from this issue.