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2 Gazette Health | Spring 2013 A GAZETTE PUBLICATION

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The Gazette is a division of Post-Newsweek Media, Inc.Prince George’s Office: 13501 Virginia Manor Road, Laurel, MD 20707

Gazette Health is produced by The Gazette’s Special Sections, Advertising andCreative Services departments. It does not involve The Gazette’s newsrooms.

Send comments to [email protected] is for informational purposes only and should not be

construed as medical advice, or as a substitute for seeing your own doctor.COVER PHOTO: ISTOCKPHOTO/THEBOONE

GAZETTE.NET Spring 2013 | Gazette Health 3

A publication of The Gazette | Spring 2013

Associate PublisherCreative Director

Doug S. HayesAnna Joyce

Editors

Designer

Contributing Writers

Prepress Manager

Kimberly BamberAnna Joyce

Anna Joyce

Karen Finucan ClarksonScott HarrisArchana Pyati

John Schmitz

CorrectionIn the article on bacterial vaginosis in the winter 2012 issue of Gazette Health,

the definition of the pH scale was reversed. The article should havestated that the lower the pH, the higher the acid level.

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study published last September of more than 1,000 people who began using mari-juana at 13 and continued regular use into adulthood found that, by 38, their IQshad dropped an average of 8 points. “For context, a loss of 8 IQ points could drop

a person of average intelligence into the lowest third of the intelligence range,” according to theNational Institute on Drug Abuse. The study, conducted in NewZealand, also found that thosewho began using the drug regularly after 18 showed minor drops in IQ, and that those whohad never used it showed no decline.According to the institute, 1 in 15 high school seniors uses marijuana regularly.Newer research, however, suggested that other factors, such as socioeconomic status, may have

been the cause of the IQ decline seen in the regular marijuana users in the New Zealand study.Regardless, the institute said these studies and others show that “regular marijuana use in

adolescence is known to be part of a cluster of behaviors that can produce enduring detrimen-tal effects and alter the trajectory of a young person’s life—thwarting his or her potential.Beyond potentially lowering IQ, teen marijuana use is linked to school dropout, other drug use,mental health problems, etc.”

Drinking too much, including binge drinking, results in about 23,000 deaths in women and girls each year.About 1 in 8 women age 18 and older and 1 in 5 high school girls binge drink. –CDC

A liquid therapy placed underneath thetongues of people with peanut allergy canreduce their sensitivity topeanuts, a new study found.With further development, theexperimental techniquecould make life easier forpeople whose only currentoption is to avoid every-thing that contains peanuts.In the study, the results of whichwere reported in January, a group receivedescalating doses of peanut powder. After 44weeks of daily therapy, 70 percent were ableto consume at least 10 times more peanutpowder than they could at the beginning of thestudy. After 68 weeks, they could consumesignificantly more peanut powder withouthaving an allergic reaction than those givena placebo in the study. The therapy causedonly minor side effects, such as itching in themouth. –National Institutes of Health

Vitamin D supplements do not appear tohelp those with osteoarthritis intheir knees, accordingto a study from TuftsMedical Center inBoston. “We found noeffect either on theamount of knee pain thatpeople experienced or on theamount of cartilage that they lost.”–U.S. Department of Health & Human Services

Cancer Deaths DroppingDeath from cancer declined from 2000through 2009 in the United States,maintaining a trend seen since theearly 1990s, according to a Januaryreport from the National CancerInstitute. Mortality fell for most can-cer types, including the four most

common in the U.S.—lung, colorectal,breast and prostate—although the trendvaried by cancer type and across racial andethnic groups. The declines in cancer deathaveraged 1.8 percent per year for men, 1.4percent for women and 1.8 percent forchildren up to 14 during that same time period.

ISTOCKPHOTO:BRAIN

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ore than 600 medications, both pre-scription and over-the-counter (OTC),contain the active ingredient aceta-

minophen to help relieve pain and reduce fever.Taken carefully and correctly, these can be safeand effective, but taking too much acetamino-phen can lead to severe liver damage.Acetaminophen is a common medication for

relievingmild tomoderate pain from headaches,muscle aches, menstrual periods, colds and sorethroats, toothaches, backaches and for reducingfever. It’s also used in combination medicines,those with more than one active ingredient totreat more than one symptom.The National Institutes of Health reported

that Americans catch 1 billion colds per yearand as many as 20 percent of Americans get theflu. Seven in 10 of us use OTC drugs to treatsymptoms of illnesses.

Consumers might not know that acetamino-phen comes in combination with many othermedications used to treat those symptoms. “Soif you’re taking more than one medicine at atime, you may be putting yourself at risk forliver damage,” said Fathia Gibril, M.D., withthe U.S. Food and Drug Administration (FDA).Symptoms of acetaminophen overdose may

take many days to appear, and even when theybecome apparent, they may mimic flu or coldsymptoms.The current maximum recommended adult

dose of acetaminophen is 4,000 milligrams perday. To avoid exceeding that dose: don’t takemore than one OTC product containing aceta-minophen; don’t take a prescription and anOTC product containing acetaminophen; anddon’t exceed the recommended dose on anyproduct containing acetaminophen.

Check the Drug Facts label of OTC cold,cough and flu products before using two ormore in the same time frame, Gibril said. Ifyou’re still not sure which to buy, ask a phar-macist for advice.Acetaminophen is also used in many com-

monly prescribed medications in combinationwith pain relievers such as codeine, oxycodoneand hydrocodone. The FDA reported that as ofJanuary 2011, overdoses from prescriptionmedicines containing acetaminophen accountedfor nearly half of all cases of acetaminophen-related liver injury in the U.S. –FDA

A healthy heart beats about 100,000 times a day. –American College of Cardiology

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BY SCOTT HARRIS

Macular degeneration causes vision loss inthe center of your field of vision, according tothe Mayo Clinic, and occurs when the macu-la, the center area of the retina on the insideback wall of the eyeball, deteriorates. Thereare two types of macular degeneration—dryand wet. Dry is the more common type and,if left untreated, can lead to the rarer, moresevere wet type. Dry macular degenerationcan cause blurred vision and difficulty seeingin low light, among other symptoms. The wettype of the disease produces similar symp-toms and can also involve the growth ofvision-damaging irregular blood vesselsbehind the retina.The Alliance for Aging Research estimates

that 1.75 million Americans 40 and olderhave advanced age-related macular degenera-tion, with another 7.3 million at substantialrisk of losing vision as a result of the disease.

SENIOR ADULTS ARE THE MOST VULNERABLE,according to Deborah Reid,M.D., an ophthal-mologist with Retina Associates, a practicewith multiple locations, including Bowie,Rockville and Silver Spring, that specializes intreating retina and macular diseases. Given thewell-documented graying of the Americanpopulation, Reid said, macular degenerationcases will only become more frequent.“Aging of the eye and the population is

aging, so you put one and one together andsee we have a growing issue,” Reid said.The good news for those with the dry type,

according to Reid, is that the condition istreatable with certain vitamins and antioxi-dants, though that should be undertaken incollaboration with a doctor.“The dry type of macular degeneration can

affect your ability to drive or live alone,” Reidsaid. “It’s treated with high-dose antioxidants.You can’t just go out and buy a vitamin ... itmust be under a doctor’s supervision.”Fritz Allen, M.D., an ophthalmologist and

retina specialist with Visionary Ophthalmol-ogy in Rockville, said along with aging, riskfactors for the disease include smoking, highblood pressure and prolonged exposure tostrong sunlight—fishermen and ski instructors,

Seniors’ Health

here is no cure for macular degeneration.But, like many incurable diseases, modern medicine has

made it a manageable chronic condition for those with

access to the necessary care. New treatments are aimed at

making it even more manageable—increasing time inter-

vals between office visits and decreasing discomfort or side

effects. But the search for a cure continues, and current

research is exploring whether stem-cell therapy—a contro-

versial but promising option for a host of diseases and condi-

tions—may hold the key.

T

Macular Degeneration

ISTOCKPHOTO/CLARKANDCOMPANY;OPPOSITEPAGE,PEEPO

Treatments for


for example, can have a higher riskfor the condition.A study published in January by

The Journal of the American MedicalAssociation found that people whoregularly took aspirin might have ahigher risk of developing wet maculardegeneration. “There’s no treatment,but the caution you take in stoppingsmoking and controlling blood pres-sure and eating vegetables can pro-vide some protection,” Allen said.Mark Farbman, an optometrist

with Longmeadow Optical in Fred-erick, said he refers a couple ofpatients a month with a possiblediagnosis of macular degeneration tophysicians. A basic test and a fewsimple pieces of information canprovide big clues as to whether onehas it, he said.“Red flags go up when someone

has a family history of the disease andtheir vision is not correctable to 20/20with glasses,” Farbman said. “Pat-ients volunteer that their vision is dis-torted. A telephone pole might appearbent or bowed. If we want to take a

closer look, we dilate the pupil andlook at the macula.”

THOUGH THERE IS STILL NO CURE,treatments have come a long way inthe past three decades. According toReid, in the 1980s physicians usedlasers to halt its progression. The lasertreatments became less damagingover the years, but the next big break-through happened in 2006, whendrugs were developed that could pre-vent the disease from advancing.According to Allen, that class of

drugs, generally known as angiogene-sis inhibitors (or drugs that slowblood vessel growth), were originallydeveloped for use in cancer patients.In macular degeneration patients,they must be administered regularlyfor the rest of a patient’s life and canbe quite expensive.“Right now, it’s about $2,000 per

shot,” Allen said. “It’s very successful,but we have to inject it constantly tokeep vessels from growing.”Much of the current macular

degeneration research explores ways

of increasing intervals between injec-tions. However, some facilities,including the Bascom Palmer EyeInstitute of the University of MiamiHealth System, are investigating stemcells as a possible cure.“You would inject stem cells

directly under the macula and hopethey regenerate themselves,” Reidsaid. “It is only in clinical trials nowfor tissue loss as the result of aging.”Because of the controversy associ-

ated with embryonic stem cells, saidReid, working with stem cells engi-neered from the cells of living adultsmay also be an option.For now, the drug injections

remain the most effective treatment ifregularly administered.“It’s a repetitive treatment,” Reid

said. “It’s a chronic disease and wecan’t cure it. The injections don’thurt, but it’s time and effort. It’s timein the doctor’s office for the rest oftheir lives. The best we can do isextend the time between visits, whichwe can do as many as once every twoor three months.”

“RED FLAGS GO UP

WHEN SOMEONE HAS

A FAMILY HISTORY OF

THE DISEASE AND

THEIR VISION IS NOT

CORRECTABLE TO 20/20

WITH GLASSES.”

– MARK FARBMAN, OPTOMETRIST

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BY ARCHANA PYATI

argaret Newman knew her son Matthewwould be a sensitive child from the day hewas born. There was a history of anxiety onher side of the family, and, from her hus-

band, Matthew inherited shyness. He was so attached toNewman that he couldn’t tolerate separating from her for amoment, even if his father was close by.“I would need to go the bathroom, and Matt would just

cry,” said Newman, a 52-year-old Silver Spring resident. Shewould have to allow Matthew into the bathroom with her tocalm him down. “I knew he needed a lot more sense of securi-ty than other children.”Newman, who left a robust real estate career before having

Matthew in 1999, sized up her son’s fragile temperament andrealized he would need her undivided attention. She became afull-time mother and worked diligently to create an emotionallysupportive environment for Matthew, enrolling him in specialspeech-therapy programs for late-talkers, accompanying him toa parent-child class at a local Waldorf school and keeping datenights with her husband to a minimum. She even gave himPulsatilla, a homeopathic remedy, to calm his nerves.Thirteen years later, her sacrifices have paid off. Matthew is a

chatty and exuberant tween who loves sports, goes on skiingtrips with his dad, and—like any teenager—occasionally mouthsoff to his mom.The separation anxiety Matthew experienced to an

extreme is a normal phase of early childhood development,local child psychologists and pediatricians said. Indeed, somechildren like Matthew may have a genetic predisposition tofeeling higher levels of anxiety, but what makes all the differ-ence among even the most fragile is how parents react to achild’s anxiety and the specific strategies employed to makeseparations emotionally manageable.

Children’s Health

ISTOCKPHOTO/KICKSTAND

SEPARATIONANXIETYLearn how to recognizewhat’s normal and what’snot—and how to manage it

[continued on 16]

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Women’s HealthPHOTOSCOURTESYOFTHEIR

SUBJECTS

There’s no denyingthat the payoff is big in terms ofhealth, appearance and self-esteem.But the effort required to loseweight can be off-putting, whichhelps account for the fact thatnearly 58 percent of Marylandwomen are overweight or obese,according to The Henry J. KaiserFamily Foundation. Maryland,more than a full point above thenational average, ranks 19thamong states in the percentageof women with weight issues.

Despite the fact that Americansspend upward of $60 billionannually on products and servicesdesigned to help them dropexcess pounds, according toMarketResearch.com, mostwomen cannot achieve a normalweight. There are, however,success stories—women who havesurveyed the weight-loss landscapeand found a strategy, either asingle technique or combinationof approaches, that allows themto incorporate weight reductioninto their lives.

5 localwomenlost weight

BY KAREN FINUCAN CLARKSON

AGE: 38

POUNDS LOST: 39

POUNDS LEFT TO LOSE: 15

HOME: Upper Marlboro

SUPPORT: Zumba classes

ADVICE: “Take little steps. Instead of sittingon the couch or at a desk all day, get up andmove around. Once you see a little [weight]come off, it’ll motivate you.”

I t was the combination of a new job andthe return of her brother and sister-in-law to the area that jump-started NatashaVandross’ weight loss. “I started movingagain,” she said. No longer working fromhome, Vandross would regularly walkaround the office and would use the stairs.Meanwhile, her health-conscious sister-in-law met her for Zumba classes three timesa week. “I’m not big on working out, butZumba is a lot of fun.”

As her activity level improved, Vandrossbegan eating healthier—“salads and soupsand smart lunches. I cut out processedfoods and stopped eating a lot of starch.Dinner is fish and a veggie or chicken anda veggie.”Key to Vandross’ success is that she

doesn’t let herself get hungry. “I’m goodabout eating six meals a day.”Her biggest obstacle is that “I’m lazy by

nature and don’t like exercising much.” Arecent increase in work-related travel hasforced her to cut back on Zumba classes,something she hopes to change shortly.Now within 15 pounds of her goal,

Vandross uses imagery to stay focused.“For the past few years I’ve told myself

that by the time I’m 40 I’ll have that HalleBerry-Catwoman body. I still have somework to do to get there, but I’m closer nowthan I’ve been before.”

before after

Natasha Vandross

HOW


before after

Tina Parker

AGE: 36

POUNDS LOST: 130

POUNDS LEFT TO LOSE: “Happy to be where I am”

HOME: Hagerstown

SUPPORT: FMH Wellness Center in Frederick

ADVICE: “Be sure you have lots of support, people who will be therefor you. And communicate with them. If you don’t let them knowyou’ve had a bad day or are struggling, they can’t help you.”

“When my mom got pancreatic cancer, she made a wish list ofthings she wanted and one of the wishes was for me to get

healthy,” said Tina Parker. “I grieved for a good year after she diedand gained an additional 40 pounds before I finally got serious.”Obese, Parker thought about gastric bypass surgery, “but it

scared me.” Instead, in March 2010, she opted for a medicallymonitored, very low-calorie diet. New Direction beverage mealreplacements, offered through the FMH Wellness Center inFrederick, allowed Parker to experience immediate weight loss,which kept her motivated.“The first week seemed hard. Emotionally, I wondered if I could

actually do it. When I saw I’d lost 10 pounds that first week, I thought‘Ohmy gosh, I really can do this.’”While not everyweekwas as uplift-ing as the first, there was never a week that Parker didn’t lose.One of her biggest challenges was dealing with co-workers and

friends who had trouble accepting her decision to “go on a liquid fast.I don’t understand why others would try to sabotage my success.”With support from the staff at FMHWellness, Parker began exer-

cising and learned to take control of her eating. By October 2010,she had dropped 130 pounds. She continues on a maintenance pro-gram at the center, checking in monthly.

AGE: 25

POUNDS LOST: 45

POUNDS LEFT TO LOSE: 20-30

HOME: Annapolis

SUPPORT: Kait Fortunato, dietitian with Rebecca Bitzer &Associatesin GreenbeltADVICE: “There’s always tomorrow. If I splurge, I remind myself that Ican make a fresh start the next day.” She also suggested surroundingyourself “with friends who are supportive and want you to succeed.”

At the beach with her family in the summer of 2011, Sarah Beckwas despondent. Carrying an extra 70 pounds made her “very

uncomfortable and I hated that I was losing an opportunity toenjoy myself.”Beck also was frustrated that her diet wasn’t working. “I went

vegetarian in the beginning of 2010 and ate lots of healthy foods. Icouldn’t understand why I was still such a large size.”In fall 2011, she turned to Kait Fortunato, a Greenbelt dietitian.

“She put things into perspective for me, especially in terms of por-tioning and ratios … Turns out my carbs were out of whack. So, I nolonger follow calories. I follow carbs.”Today, Beck eats three meals a day, with no more than 30 grams

of carbohydrates per meal, and two snacks with up to 15 grams ofcarbs each. “It’s a lifestyle change, one that I’m always going tohave to stay cognizant of.”A challenge for Beck is incorporating the occasional alcoholic

drink. “One drink can be almost a full meal’s worth of carbs.”Another is her boyfriend, who has a “high metabolism … He’s hadto learn about my new eating habits. He doesn’t have to followthem, but has to know that I will.”Beck’s work leaves her limited time for exercise, so she tries to

work in push-ups and sit-ups whenever possible. “I do squats whilebrushing my teeth.”

before after

Sarah Beck

MOREONPAGE 12


“Between my feet botheringme and my doctor saying,

‘Carol, it’s really time to do some-thing,’ I decided to make somechanges,” said Carol Freedman.After losing 12 pounds on herown in 2011, she joined forceswith a nutritionist and a newpersonal trainer in early 2012to lose another 26.Realizing that her craving for

sugar was undermining her attempt

to lose weight, Freedman soughtout Janet Zalman, a nutritionist“who specializes in diets that elimi-nate sugar and reduce starch.”Today, Freedman avoids “any

product with over 4 grams of sugarand double starches at any meal.”She’s also ramped up her exercise

regimen. After working with per-sonal trainer Nora Mann for amonth, Freedman saw “such animpact—I was reducing inches and

gaining muscle—that I increased totwice a week.” Her other five to sixhours of exercise during the weekinclude ice-skating and cardio—mostly spinning.For years, Freedman allowed her

fitness needs to take a backseat tothe needs of others.“It wasn’t until my youngest son

went off to college that I felt I couldfinally make myself a priority.”Unlike previous attempts to lose

weight, which she kept to herself,Freedman is sharing.“By [my] being open, my friends

and family can support me. WhenI was secretive, my friends didn’trealize that they were underminingmy diet.”She admitted that it is “hard to

socialize and stay on a diet. So, Ichoose my social situations carefully—what restaurants to go to andhow often.”

With her daughter entering herlast year of preschool and a

return to the workforce looming oncekindergarten rolled around, MelissaLadd knew the time was right. “I’dbeen overweight since college, butnever had the determination. I simplywoke up one day and realized I hadthis one year,” she said.

Ladd started slowly in September2011. “I began exercising five daysa week—a mix of cardio, yoga andstrength training.” Her workoutsserved as motivation to change herdiet. “I didn’t want to undo every-thing by eating badly.” So, Laddmade healthier food choices andtracked everything she ate. “I also

watched my portions and drank alot of water.”Then she began running. “I had

difficulty running for even oneminute. But, within a year, I was ableto train myself to run a halfmarathon.” In September, she com-pleted the Parks Half-Marathon,running from Rockville to Bethesda

in 2:16:35. Her trainer was theCouch to 5k website c25k.com.Her greatest challenge came when

she sprained her ankle. “I worriedthat because I couldn’t run I wouldgain the weight back. To keep thingsin check, I reminded myself thatwhile I might not lose weight thisweek, there was no reason to gain.”

before after

before after

Melissa Ladd

Carol Freedman

AGE: 33

POUNDS LOST: 75

POUNDS LEFT TO LOSE: At goal

HOME: Rockville

SUPPORT: Couch to 5k,www.c25k.com

ADVICE: “Every day brings thechance for a new start. Justbecause you don’t eat well one mealdoesn’t mean you should give up.The next meal is a new chance toeat healthy.”

AGE: 57

POUNDS LOST: 38

POUNDS LEFT TO LOSE: “No settarget, but will continue to forge on.”

HOME: Bethesda

SUPPORT: Nora Mann, personaltrainer with Mann-Up Fitness inBethesda, and Janet Zalman,nutritionist with Zalman NutritionGroup in Washington, D.C.

ADVICE: Find friends “who havesuccessfully lost weight andmaintained it. Make dates withthese people for coffee, lunch, walksor phone conversations to discussyour successes and hardships.”Freedman also suggested creatingexercise opportunities that can serveas social events.

Women’s Health

PHOTOSCOURTESYOFTHEIR

SUBJECTS


Could Just One Glass Be Too Much?BY ARCHANA PYATI

s scientific understandingof fetal development hasdeepened over the past 30

years, many doctors are now taking azero tolerance approach towarddrinking alcohol during pregnancy.“The safest course is abstinence,”

said Michelle Spector, M.D., an OB-GYN at Capital Women’s Care ofRockville and vice chair of the OB-GYN department at Shady GroveAdventist Hospital. While some doc-tors may believe the very occasionaldrink is OK for a pregnant patient, “Idon’t know of any studies that demon-strate there is a safe level of alcoholconsumption,” said Spector. “I recom-mend to patients to have no alcohol.”In an August 2011 opinion, The

American College of Obstetriciansand Gynecologists (ACOG) recom-mended that OB-GYNs screen allwomen for alcohol use once a yearand during the first trimester for preg-

nant patients. For pregnant womenor those who may become pregnant,the opinion urges physicians to “givecompelling and clear advice to avoidalcohol use” and “provide assistancefor achieving abstinence.” It also sug-gests specific screening tools andquestions to ask when assessing awoman’s alcohol use.According to Imelda Udo, M.D.,

an OB-GYN with Carroll HospitalCenter in Westminster, the opinion ispart of ACOG’s effort to identifywomen who are drinking at a timewhen they may not realize they’repregnant. “They’re urging us to askopen-ended questions,” said Udo.“The point is to ask everyone, andnot just people perceived to be atrisk” for higher alcohol consumption,like women from a lower socioeco-nomic background, she said.Fetal alcohol syndrome was identi-

fied in the 1970s as a set of physicaland developmental abnormalities evi-dent in babies whose mothers had

consumed alcohol during pregnancy.Now, doctors speak more about fetalalcohol spectrum disorders—orFASD—to describe a whole range,from mild to severe, of abnormalitiesthat can be attributed to a mother’salcohol use, some of which don’tpresent until later in a child’s life,according to Udo.Lower birth weight and head size,

the absence of a ridge in the spacebetween the nose and upper lip, andsmall eyes are signs of FASD at birth,according to the Centers for DiseaseControl and Prevention (CDC).Problems with attention and hyperac-tivity, low IQ and speech and lan-guage delays fall within the range ofFASDs, according to the CDC, andmight not be noticeable until a childreaches school age.Recent research has fine-tuned

our understanding of when alcoholis particularly harmful to a develop-ing fetus. Published in Alcoholism:Clinical and Experimental Research,

a January 2012 study of 992 womenfrom 1978 to 2005 found that prena-tal alcohol exposure during the firsttrimester’s second half was the periodassociated with specific physicaldefects like smaller head circumfer-ence, lower body weight, and a thinborder outlining the lips from sur-rounding skin.Tobie Beckerman, M.D., of

Beckerman Women’s Health inRockville, always discusses alcoholuse during preconception counseling.She believes there is no safe thresholdfor alcohol consumption during preg-nancy, but is careful not to inducepanic in those who discover they’repregnant at a time when alcohol is anormal part of their lives.“I don’t condone it, but I also try to

diffuse the fear,” she said. While therisk of birth defects may be minimalin the first few weeks of pregnancy,“not calling something dangerousisn’t calling something safe.”

A

Women’s Health

ISTOCKPHOTO/LAFLOR


TRACEYBROWNPHOTOGRAPHY,COURTESYOFWASHINGTONADVENTISTHOSPITAL

Racing Heart

ranges from “a little jittery” to “abouncing” that is impossible to ignore.These episodes of atrial fibrillation(Afib) are, according to GuillaumeMarçais, unpredictable in their fre-quency, duration and intensity.Generally, “it feels as though my heartis beating too fast and too hard. I canactually feel it pumping in my chest,and, if I walk around or am active, Ican actually see my chest beating,” saidthe 37-year-old Boyds resident.Atrial fibrillation is caused by a dis-

ruption in the heart’s electrical system,which is responsible for coordinatingthe cardiac contractions that pumpblood throughout the body. The elec-trical disruption prompts the twoupper parts of the heart, the atria, toquiver or fibrillate. The result is a rac-ing or uneven heartbeat.Afib affects some 2.5 million

Americans. Although the condition inand of itself is not always life threaten-ing, left untreated, it can lead to com-plications such as blood clots and heartfailure. Stroke is five times more likelyto afflict those with Afib than thosewithout the condition, according to theAmerican College of Cardiology.

“People around me think it’s prettyscary,” said Marçais, acknowledgingthat “there can be dire consequences….My father-in-law had a similar con-dition and he died from it.”Because Marçais is young and fit—

he enjoys running, biking and rockclimbing—Afib has beenmore of a nui-sance to him than a life-threatening ail-ment. “When young athletes go intoatrial fibrillation, their hearts just don’tperform as well and, as a result, theyjust can’t do the things they want to do,such as long-distance running or, inGuillaume’s instance, climbing,” saidSean Beinart, M.D., an electrophysiol-ogist and co-director of the Center forCardiac & Vascular Research atWashington Adventist Hospital inTakoma Park. It “is a true burden to hisquality of life.”

ATRIAL FIBRILLATION IS FOUND MOSToften in people with high blood pres-sure, coronary or rheumatic heart dis-ease, heart failure, or structural or con-genital heart defects, none of whichapply to Marçais, who recalled firstbeing diagnosed with Afib in late 2003or early 2004. He may have hadepisodes as early as his teens. “Iremember a few times where I could

see my heart beat through my chest, asearly as 13 or 14 years old. But I nevertold anybody about it, as it was rareand just a curiosity for me.”While physicians have yet to identify

what is responsible for Marçais’ Afibepisodes, the working theory is “stress,like a sudden change in pace, is the trig-ger for me. It can happen when I’m sit-ting and jump up,” he said.

IT WAS A MIDDLE-OF-THE-NIGHT CRYfrom his son that set Marçais’ heartracing in early 2012. “I jumped out ofbed and ran to see him. When I gotback to bed, I knew that my heart wasnot doing well.” While his heart wouldeventually calm down—“There’s not awhole lot they can do in the emergencyroom other than monitor,” he said—that Afib episode led Marçais to seekhelp from Beinart.The physician recommended a pro-

cedure known as cardiac ablation.Marçais had undergone ablation sur-gery in 2004, “but I knew it could taketwice,” he said. “So I was prepared todo it again.”The idea was to perform the second

ablation while Marçais was still youngand healthy, “when any consequencesare minimal,” he said.

Cardiac Ablation Keeps 37-Year-Old Climbing

The feeling

BY KAREN FINUCANCLARKSON

“I can actuallyfeel [my heart]pumping in mychest, and, if Iwalk around oram active,I canactuallysee mychestbeating.”

HISSTORY

Stabilizing a

[continued on 18]


“We see a lot of children in ourday-to-day practice dealing with sep-aration anxiety,” said Paul Feinberg,M.D., a pediatrician with ThePediatric Center of Frederick. “It’simportant that parents remain calmand reassuring. The other thing isplanning ahead. If you know yourchild is going to have a difficult time[separating from you], make thattransition as easy as possible.”

ROOT CAUSESThe origin of separation anxiety is

rooted in an early awareness of our-selves as separate beings fromour care-givers. Toddlers develop a sense of“object permanence”—knowledgethat people and objects exist in theirabsence—leading them to questionwhether people they’re attached to willreturn or abandon them, said ReenaBernards, a licensed clinical marriageand family therapist with Jonah Greenand Associates in Kensington.“It’s a normal reaction, and part of

that is a feeling of ‘will they comeback? Will I be OK if they’re nothere?’ That question stays with achild for awhile,” she said.For certain youngsters, that inse-

curity gets amplified when adjustingto new environments away fromhome, like day care or a babysitter’shouse. Excessive crying, tempertantrums, physically clinging to par-ents, aggressive behavior towardpeers, refusing food or sleep, and aninability to be consoled either byother adults or their peers are signs achild needs support making thesetransitions, according to JessicaFloyd, a clinical psychologist with aprivate practice in Bethesda whoworks with families at the ReginaldS. Lourie Center for Infants andYoung Children in Rockville.“When the separation occurs, a

child will exhibit these behaviors as away to express their feelings whenthey don’t have the words,” saidFloyd. “They don’t have the means toexpress themselves in verbal ways,but can express themselves throughtheir bodies.”Separation anxiety also manifests

itself through physical symptoms,such as abdominal pain, headaches,sweating, vomiting or nausea, saidFeinberg. “The pain is real and the

distress is real,” he said. “Oftenthere’s a pattern where the physicalcomplaints are worse in the morningbefore a child has to go to school orpreschool. They tend to be muchbetter on the weekends or when thereis no school.”While most children experience

separation anxiety to a certain extent,if the distressed behavior lasts longerthan four weeks and persists in differ-ent settings, a child may have separa-tion anxiety disorder, said Floyd. Inthese cases, a family should considerseeking professional counseling. Playtherapy—in the form of puppetshows or role-playing with dolls oraction figures—can help a childexpress underlying fears without hav-ing to articulate the problem, accord-ing to Floyd. Among older children,who have the ability to verbalizefears, cognitive behavioral therapy,which targets patterns of thinking,can also be effective, she said.Psychologists and therapists might

also meet with parents separately todiscuss family dynamics and poten-tially triggering events. “Assessing thefamily situation to see if there’s any-thing that has happened to make thechild feel insecure—a divorce, a deathin the family, a new child—givessome sense of logic to what’s goingon,” said Bernards.Denying or minimizing their feel-

ings will only cause children “to dig intheir heels and become more resistantto changing the behavior,” saidBernards. Instead, parents shouldencourage kids to articulate their fears.When a child has some success withseparation, praise the results. Celebratesuccessful transitions and separationswith incentives, such as stickers or aspecial reward, said Floyd.

SEPARATION, continued from 8

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Children regularly mimic their par-ents, often unintentionally. If a parenthas anxiety about being apart fromtheir children and trusting otheradults to care for them, children canpick up on this.“The other thing that plays a big

role is parenting, and how they’redealing with these emotions,” saidKim Burgess, a child and adolescentpsychologist, founder and director ofRockville’s Pediatric PsychologyCenter, and an adjunct associate pro-fessor of behavioral sciences and pedi-atrics at The George WashingtonUniversity School of Medicine andHealth Sciences. “Some parents makeit unintentionally worse. What’s nothelpful is a child sensing a parent’sanxiety about letting a child go to anew place.Maybe it’s hard for them tolet their child go, and maybe the childis worried about the parent.”Psychologist Renee Neely-Walters

has worked with students whose fre-quent absences from school aren’tdue to separation anxiety, but toattend to a parent’s emotional needs.“I’ve actually had cases where par-ents are depressed, maybe they’reexiting a relationship themselves, andthey make the child feel like they needto take care of them,” said Neely-Walters, who counsels young childrenat the Metropolitan Psychological

Group in Lanham and elementarystudents at aWashington public char-ter school. One solution was to find avolunteer opportunity for the motherat her child’s school, fulfilling herneed to be close without compromis-ing the child’s personal and intellectu-al development.

SUCCESSFUL TRANSITIONSParents can minimize their child’s

stress during transitional times by stay-ing upbeat, being up front about whyyou need to be apart and reassuringthemof your return, said Bernards andFeinberg. In other words, sneaking outof your toddler’s classroom when sheisn’t looking isn’t the best approach.Day care teachers and even class-

mates can be a parent’s allies in sooth-ing a distressed child. Pairing themwith a buddy or giving them a leader-ship role in the classroom—like ask-ing them to help distribute juice andcookies during snack time—deflectsattention from the distress and buildsinner confidence and trust in the care-giver, according to Neely-Walters.“Try to do things in small chunks

that are manageable for the child,”said Bernards. At day care, for exam-ple, a parent could say, “‘you’re goingto go in there, and I’m going to goshopping, but then I’ll come back.’They get to practice

“GIVE THEM SOME TIME TO DEVELOP THEABILITY TO SOOTHE THEMSELVES.”

– JESSICA FLOYD, CLINICAL PSYCHOLOGIST

[continued on 18] 1869226


“And, it means I don’t have to takemedicine.”“Drugs in a lot of patients are a

very attractive and appropriate alter-native,” said Beinart. “In youngerpatients, they tend to have significantside effects and can promote thedecline in the quality of life that we’retrying to prevent in the first place.”

CARDIAC ABLATION DESTROYS SMALLareas within the heart where rhythmproblems start. Because the areas oftissue are very tiny, damaging themdoes not affect the heart’s ability todo its job.Physicians “use a spaghetti-sized

wire, called a catheter, that deliversheat energy to specific, targeted areasof the heart,” said Beinart. The resultis an elimination of “electrical signalsin that area in a safe, very precision-driven fashion.”The ablation procedure at

Washington Adventist Hospital inMay of last year took about fourhours, according to Marçais. “Goingthrough the procedure is somewhattaxing. Because they put the catheter

in through the groin area and up intothe heart, the groin area is sore. Thenight after the procedure is painfuland you must lie on your back for 24hours. You cannot lift or run for afew days,” he said.It wasn’t long, however, before

Marçais, a bioinformatics researcherat the University of Maryland inCollege Park, was back to work andenjoying athletic pursuits. And whilethere are no guarantees as to whatthe future holds—“I may need noother remediation … or maybe somesmall amount of blood thinners,”—he is optimistic that the racing in hisheart has been permanently calmedand the potential “for other healthcrises” averted.

HIS STORY, continued from 15

BECAUSE THE AREASOF TISSUE ARE VERY

TINY, DAMAGING THEMDOES NOT AFFECT THEHEART’S ABILITY TO DO

ITS JOB.

and have their feelings about it andtheir success.”Another skill parents can help chil-

dren develop early on is self-soothing,beginning at infancy, said Floyd. Toooften, parents are unwilling to leave achild unattended during the first fewminutes of a cry. “The child thenlearns that if they do this behavior,my parent will come,” said Floyd.“That’s not to say leave them cryingall day, but give them some time todevelop the ability to soothe them-selves. It’s important for children todevelop internal resources.”Jessica McCausland’s toddler

Claire has always felt a strong attach-ment to her mother because Clairewas not bottle-fed. The bond they’veshared over nursing makes longerseparations harder on Claire, saidMcCausland, who recently relocatedfrom Silver Spring to Florida.An attorney, McCausland, 39,

returned to work when her daughterwas 9 months old; caregivers cared forClaire at home. It went smoothly, shesaid, because the nanny was “on herdaughter’s turf,” and each morning,

the nanny, Claire and McCauslandwould have a warm-up period wherethey played together.When it was time for McCausland

to leave for work, she sang a song—“heigh-ho, heigh-ho, it’s off to work Igo”—which made her departure acheerful, rather than distressing,event. She always made eye contactwith her daughter, and the nanny,meanwhile, would have a bookpicked out for her and Claire to read.McCausland would take frequentbreaks from work, which was only ablock away from home, to breast-feed Claire, who understood hermom was never far away.

SEPARATION, continued from 17

SEPARATION ANXIETYALSO MANIFESTS ITSELFTHROUGH PHYSICALSYMPTOMS, SUCH ASABDOMINAL PAIN,

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W e often think of the skin as a barrier—it keeps the insides ofour bodies in, and it keeps the outside world out. But skin isalso filled with immune system cells that protect against

viruses, bacteria and other threats. Whenever these cells detect a suspi-cious substance, they begin a chain reaction in the skin that leads toinflammation. The medical name for this reaction is dermatitis—a rash.There are many different types of dermatitis, and each has distinct

treatments. Sometimes the skin’s immune cells react to something thatdirectly touches it. Other times, the immune systemflares in the skin because of a whole-body infectionor illness.Symptoms of these different types of rashes often

overlap. “Itching is a common symptom for all theseproblems,” said Dr. Stephen I. Katz, director of theNational Institutes of Health’s National Institute ofArthritis and Musculoskeletal and Skin Diseases.Many rashes are red, painful and irritated. Sometypes may lead to blisters or patches of raw skin.While most rashes clear up fairly quickly, others arelong lasting and need to be cared for over longperiods of time.Eczema, or atopic dermatitis, is a dry, red, itchy

rash that affects up to 1 in 5 infants and young chil-dren. It often improves over time, although it canlast into adulthood or start later in life. In this con-dition, the watertight barrier between skin cells getsweak, which lets moisture out and other things in.That’s why people with atopic dermatitis have tomoisturize their skin, and why they’re more suscep-tible to skin infections.

RESEARCHERS HAVE RECENTLY IDENTIFIED SPECIFICgenes that are involved in maintaining the skin bar-rier. People with certain versions of these genes aremore likely to get atopic dermatitis.“The skin is the outermost sentinel for fighting off

bacteria and noxious agents,” said Katz. “If the barrier is broken some-how, you can become more allergic to things.”A skin allergy, or allergic contact dermatitis, produces a red, itchy rash

that sometimes comes with small blisters or bumps. The rash arises whenthe skin comes in contact with an allergen, a usually harmless substancethat the immune system attacks. Allergens can come from certain soaps,creams and even pets.Your immune system might not react the first time you encounter an

allergen. But over time, it can become sensitive to the substance. As aresult, your next contact may lead to inflammation and an allergic rash.

“The most common form of dermatitis that is seen anywhere is anallergic contact dermatitis to nickel,” said Katz. “Why? Because of earpiercing.” Many inexpensive earrings are made of nickel, and over time,wearing nickel earrings can cause an allergic reaction to the metal. Othercommon causes of allergic dermatitis are poison oak and poison ivy.Mild cases of allergic contact dermatitis usually disappear after a few

days or weeks, but if the rash persists, is extremely uncomfortable oroccurs on the face, it’s important to see a physician. A doctor can pre-

scribe medications that will tone down the immunereaction in the skin. This eases swelling and itchingand will protect your eyes and face.The immune cells of the skin can also produce

rashes when they react to invading germs—like bac-teria, fungi and viruses. Bacterial and viral infectionswithin your body can cause your skin to break outin spots, as well. The chicken pox virus, for example,can cause itchy spots in children. Years later, in olderadults, the same virus may reappear as shingles,resulting in a painful rash and high fever. Vaccinescan prevent several rash-causing diseases, includingchicken pox, shingles and measles.

CERTAIN DRUGS, INCLUDING ANTIBIOTICS LIKEamoxicillin, may also cause itchy rashes. If you’reallergic to a drug, a rash can be the first sign of a seri-ous reaction. As with other allergies, a drug reactionmay not occur the first time you take it. Not all drugrashes are due to an allergy, however. If you breakout in itchy spots after starting a new drug prescrip-tion, contact your doctor right away.While most rashes get better with time, some can

last a lifetime. Psoriasis, a condition where skincells build up into thick red patches, tends to run infamilies. “It’s a complex genetic disease, in thatthere’s not one gene that causes psoriasis, butmany,” said Katz. Other long-term diseases that

can produce rashes include autoimmune diseases, such as lupus, andsome forms of cancer.If you notice an itchy or painful rash on your skin and don’t know the

cause, think twice before going to the drugstore and getting some cream.“The creams that you buy can produce problems that make your originalproblem even worse,” Katz said. Because rashes can be caused by manydifferent things—bacteria, viruses, drugs, allergies, genetic disorders andeven light—it’s important to figure out what kind of dermatitis you have.“If you have any significant rash, you should see a dermatologist.”

– NIH News in Health

experts’ adviceNational Institutes of Health

What’s That Rash?

Psoriasis, a conditionwhere skin cells build

up into thick redpatches, tends torun in families.

ISTOCKPHOTO/QUAYSIDE


1869150

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