When an expectant mother arrives at MedStar St. Mary’s Hospital, she will undergo a variety of tests prior to delivering, including a screening for drugs and alcohol. If a mother’s results are positive, her newborn child will also be tested.

“We are seeing episodes of babies testing positive for opioids much more frequently than several years ago,” said Jeanne Hill, MSN, RNC, director of MedStar St. Mary’s Hospital’s Women’s Health & Family Birthing Center. Babies born to drug-addicted mothers are the youngest victims of what continues to be a nationwide crisis and they are not difficult to identify, said Jeanne. “They have a high-pitched cry, they can’t calm themselves down, they have tremors, they often have diarrhea and tensed muscles,” she said. “It is just heartbreaking.”

MedStar St. Mary’s Hospital is among 30 birthing centers in Maryland joining forces with the Maryland Patient Safety Care Center to standardize care for babies suffering neonatal abstinence syndrome. As part of the hospital’s efforts, mothers are presented with information about how and where to get help with substance abuse. Although Jeanne feels their work is making a difference, there is still plenty to be done.

Fighting the Addiction 

“We need every single person in the community to recognize addiction is an illness, it is a brain disease and it requires an evidenced-based approach to treatment,” said Meenakshi G. Brewster, MD, MPH, St. Mary’s County Health Officer. The Health Department, MedStar St. Mary’s Hospital and Sheriff’s Department are among the many community organizations coming together to offer a comprehensive response to this epidemic. “It is a challenge like we have never seen before in the treatment community,” said Kathleen O’Brien, PhD, chief executive officer of Walden, which provides crisis, behavioral health, trauma, and recovery services to Southern Maryland. “Certainly, here, historically most of our treatment was related to alcohol and a mixture of some other drugs, but prior to about six years ago, we weren’t seeing opioids or heroin as a presenting problem. Now, that is about 70 percent of the primary substance abuse cases coming through our doors.”

Harry Gill, MD, PhD, medical director of Behavioral Health for MedStar St. Mary’s Hospital and president of Axis Healthcare Group, says he believes the opioid epidemic has gotten worse due to the prevalence of more lethal synthetic opioids. “Most patients have co-occurring disorders − they have a psychiatric disorder and addiction,” said Dr. Gill. “Going through substance abuse treatment provides temporary relief, but if the psychiatric condition is not treated, relapse is highly likely.”

Dr. Gill said many people who turn to opioids also have anxiety, depression, and post-traumatic stress disorders, all of which are treatable. In his work with the hospital, Dr. Gill is called in for psychiatric consultations with patients suspected of intentionally overdosing on opioids. These patients are typically discharged to outpatient substance abuse programs such as those provided by Walden, but often need treatment for co-occurring disorders. Support from their family and their community also plays a large role in the recovery process. “Family support is critical because it is such an isolating illness, such an isolating disorder that re-engaging with the world and, in particular, the people who love you unconditionally is a critical component of recovery,” said Dr. Gill.

Changing the Conversation

Winning the battle against opioid addiction means making sure those fighting their addictions know that assistance is available and they can receive help to access it. In addition, the community as a whole needs to accept that addiction is a disease, not a choice or a moral weakness, said Dr. O’Brien, and that treatment works and recovery is possible. “This disease doesn’t affect others, it affects all of us, and we all could possibly be afflicted by this disease,” said Dr. O’Brien. “In all my years in doing this, people think it’s the other who gets impacted, but we are all vulnerable.”

WHERE TO FIND HELP

Call the Maryland Crisis Hotline
at 1-800-422-0009 or visit
MedStarStMarys.org/Opioids
for information and links.

Note: This article concludes a four-part series on the opioid epidemic in our community. 

Locals Regaining Health, Embracing New Lifestyle after Newly-Offered Bariatric Surgery in Leonardtown 

The tipping point came in the form of a toddler. 

Paul Horner’s two-year-old grandson  David, affectionately called “Junior,”  and big sister Jamie wanted to play with their grandpa. Paul wanted that, too — but his weight made participating in everyday activities difficult. 

The 56-year-old aircraft mechanic says he has been heavy his whole life.  A U.S. Navy veteran, Paul had to lose weight in order to join the military at age 17. He served eight years in the Navy before being honorably discharged for failure to meet body composition standards. 

Decades later, the father of two and grandfather of seven reached his heaviest point: 467 pounds. 

Interacting with Junior only reinforced how restricted Paul was.  Knee pain made walking difficult and painful. He stopped shopping in stores, choosing to stay in his truck while longtime girlfriend Rose ran the errands. Sleep apnea prevented  Paul from getting adequate rest  — especially challenging given his schedule; he’s worked the night shift for 25 years. 

And there was the mental pain, too:  stares and comments from strangers.  “Kids would say, ‘Oh, he’s fat.’ It hurt,”  Paul said. “Of course it did.” 

Previous attempts at weight loss had been unsuccessful. And traveling to medical centers in Washington,  D.C., to explore surgical options and find support was inconvenient for the California, Maryland-based mechanic. 

Through Health Connections at  MedStar St. Mary’s Hospital in  Leonardtown, Paul met nutritionist  Catherine Dowling, RDN, LDN. In  May 2017, he committed to following a bariatric menu: smaller portions that are high in protein, low in carbohydrates. 

Catherine shared information on a bariatric support group that meets monthly at MedStar St.  Mary’s. There Paul found a wealth of resources and support: through medical professionals, yes, but also from attendees standing in the same shoes. Paul’s goal was to get prepared — physically and mentally  — for the sleeve gastrectomy that would be performed by Nicholas  Tapazoglou, MD, a board-certified bariatric and general surgeon at  MedStar St. Mary’s. 

Also known as a gastric sleeve procedure, this technique involves removing the outer margin of the stomach so only a “sleeve”— roughly the size and shape of a banana —  remains. 

Paul was determined to get into “the right mindset” before his surgery.  With the camaraderie and resources offered by his nutritionist, support group, Dr. Tapazoglou, and his staff, he lost 112 pounds in five months simply by following the bariatric menu.  The extensive pre-planning made him feel “ready and prepared” by October  2017, he said, when Paul became the first patient to undergo a sleeve gastrectomy at MedStar  St. Mary’s. After one night in the hospital,  he was sent home with a smaller stomach  — and a new lease on life. 

Now a self-professed “label reader,”  Paul pays close attention to the protein and carbohydrate content of everything he consumes. He still eats three meals a day, but they’re 4 ounces of lean,  healthy foods, with protein shakes in between. 

The Navy veteran reports to Naval  Air Station Patuxent River when most people are going to bed. His “lunch,”  then, comes at 2 a.m. Paul brings small,  healthy selections like Greek yogurt,  salad, and light soup for his breaks. 

Gone are the medications he was taking to combat high blood pressure and depression. His knee pain has disappeared. Most notably, weight loss has lessened the pressure on  Paul’s airways; he has not used a BiPAP machine for sleep apnea since last fall. 

The financial savings have been considerable, too. He estimates he was spending $20 to $25 on fast food daily.  Rose, Paul’s girlfriend, now prepares most of the couple’s meals with an emphasis on vegetables. He loves  Fairlife milk (“the best milk,” Paul enthused), and bread and pasta have been eliminated from his diet completely.  With his increased mobility and energy, Paul pursues a passion shared with his best friend, Gene: working on antique cars.  Navigating the workshop is much easier these days.  The two are restoring a ’23  Ford T-Bucket, Gene’s dream car, while Paul is fixing up a ’67  Chevrolet Nova. 

By late December, Paul had dropped an additional 48 pounds — 160 and counting. He plans to reach 220 before shifting to maintaining his weight.  Paul attributes his success, in part, to the support of nutritionist Catherine,  MedStar St. Mary’s patient services coordinator Jennifer McDermott,  and nurse Rita Michelle McDonald,  CMA. He also speaks highly of Dr.  Tapazoglou, who impressed Paul and his family greatly by always making the time to answer questions and follow up on Paul’s care. 

The bariatric support group attendees have been a tremendous resource,  too. The group has a private Facebook page to stay in touch between meetings. “When I’m feeling down,  maybe stalling in my weight loss, I  go there and find encouragement,”  said Paul, recently scrolling through inspirational words from friends — some with surgeries behind them, others with surgeries to come. 

Considering the advice he would give others thinking about this “life-changing”  procedure, Paul said, “Make sure your mind is straight. You have to be ready to do this mentally. The  surgery is just a tool; if you don’t use  the tool right, you’re not going to get  the job done.” 

Junior and Jamie see the difference in their grandfather, who moves more and smiles easily. “Now I’m doing the chasing,” Paul said. “Junior doesn’t  chase me; I chase him.” 

The Happy Struggle 

For Rashida Blake, the weight came on gradually. 

A mother of three and new grandmother, Rashida has lupus; a  decade’s worth of weight fluctuations were a source of frustration. When she reached 384 pounds, the Lexington  Park woman knew she needed to seek a solution to be there for her family. 

“I started noticing I wasn’t doing things like I used to. I had small kids, and I  wanted to be able to do physical activities with them — being so tired,  dealing with back pain . . . it was time for a change,” she said. 

With the help of Dr. Tapazoglou and dietitians at MedStar St. Mary’s,  Rashida began a journey that started with reframing her thoughts about eating. 

“The nutrition counseling was really inspiring,” she said. “I didn’t think you could look at food in that sense: measuring it, considering protein  . . . it was very educational.” 

Eight months of preparation set Rashida up for success, she said,  when she started 2018 by undergoing a sleeve gastrectomy on Jan. 2. 

“Nutrition counseling literally broke everything down day by day and gave me confidence going into that procedure,” she said. 

After just two days at MedStar St. Mary’s, Rashida was released to continue her progress at home. “Recovery has been really good.  The pain was not as severe as I thought it would be,” she said.  “Dr. Tapazoglou is very in tune with his patients; he’s very thoughtful,  and wanted to make sure I felt OK to go home. Dr. T wanted me  to walk [in the hospital], and I started walking around literally that  evening [post-surgery].” 

And Rashida just keeps going. “When my Fitbit says to move, I move,”  she said, noting that a three-story townhouse and young children at home help keep her hopping. “Going up and down the stairs is a constant. I just started walking on a treadmill, and that has  been great.” 

A few weeks after her procedure, Rashida was down 29 pounds toward her personal goal weight of 220. She’d already noticed her  feet were no longer swollen and her legs felt “looser.” 

“This is more mental than anything else,” said Rashida. “You have to prepare and be ready to make the lifestyle change. But to anyone dealing with obesity, tell yourself: this is needed. This is a healthy decision. It will be a struggle, but it turns out to be a happy struggle. 

“Go for it!” she said. “It’s your life. Life is too short to waste it. Just go  for it.” 

Visit MedStarStMarys.org/Bariatrics for more information or to schedule a consultation. 

Schedule a Consultation 

To schedule an appointment with Nicholas Tapazoglou, MD, General & Bariatric Surgeon, call 240-434-4088.

Dr. Nicholas Tapazoglou is available from 8 a.m. to 4:30 p.m. daily. He is board-certified in general surgery and is able to coordinate patient care through a wide range of specialty physicians available through the MedStar Health system. He offers care and treatment for various conditions, including abdominal wall/hernia, gallbladder, morbid obesity, skin and soft tissue, small intestine, spleen, stomach, surgical treatments of gastroesophageal reflux disorder (GERD) and thyroid.

Learn More:

• Bariatric Surgery Candidacy
• Pre- and Post-Surgical Surgery Support
• Types of Bariatric Surgery

Eating Right After Surgery 

Complete dietary changes are at the heart of the bariatric journey. Depending on insurance requirements, patients will meet with a nutritionist for two to seven months prior to surgery. "Four ounces of food — half a cup, about the size of your fist — is roughly what the stomach will hold after a sleeve gastrectomy,” explained Wendy Chatham,  RDN, LD, a dietitian at MedStar St. Mary’s  Hospital.  

After the initial liquid and soft food diet stages post-surgery, patients can expect a few things:

• Consume a protein-rich diet that is low in carbohydrates and fat. Proteins are the priority: meat, fish,  poultry, eggs, low-fat dairy, soy,  nuts, and legumes. 
• Drink all fluids separately from meals. Fluids must be calorie-free,  non-carbonated, and caffeine-free. 
• Avoid sweets, alcohol, and high-fat foods. 
• Take a daily vitamin/ mineral supplement. 

For appointments With Wendy Chatham, RDN, LD, dietitian, call  301-475-6019.