Vertigo: The Real Thing

The psychological thriller “Vertigo” is considered an Alfred Hitchcock masterpiece, filled with suspense and intrigue. In that classic film, life starts to unravel for a police officer who develops vertigo, a feeling of debilitating dizziness, after a terrifying incident.

The movie is fiction, but the condition of vertigo is very real for about 70 million Americans. Although people at any age are at risk, vertigo is most often diagnosed in those who are 60 years old and older. By age 65, it is the most common reason that adults make appointments to see their doctors.

Vertigo is a specific type of dizziness caused by an inner-ear problem, which is triggered by when the head moves. People who experience it often say it feels as though they are spinning or as though the room around them is spinning when neither is moving.

Vertigo and imbalance can be caused by ear infections, drug toxicity, migraines or a general decrease in the functioning of the inner ear. When the symptoms are at their worst, a person may not be able to stand or walk without falling. Nausea and/or vomiting can also be other side effects.

The most common type of vertigo is benign paroxysmal positional vertigo (BPPV). This happens when crystals in the inner ear, which normally work with the brain to keep people properly balanced, move from their intended spot and migrate into one of the canals of the inner ear so that when the head moves, these crystals send incorrect communication to the brain. These wrong messages result in vertigo and rapid involuntary eye movements. That’s why the spinning feeling happens when individuals bend over, look up, get in and out of bed and roll over in bed, among other situations.

Vertigo is not life threatening, but it can be very disruptive because of the intense dizziness and imbalance that it causes. Sufferers are also at an increased risk for falls.

BPPV is very common in older adults. However with younger individuals, head injuries are the main cause. There is a 30 percent recurrence rate in the first year after treatment, and by five years, about half of all patients have experienced it again.

BPPV is commonly diagnosed with a maneuver called the Dix Hallpike. The person being evaluated should have both vertigo and rapid alternating eye movements for an official diagnosis.

Treatment for BPPV is pretty clean-cut. Physical therapists will use certain maneuvers to put the head and body into positions that direct the inner ear’s crystals back into their proper place.

However, in cases of dizziness and imbalance from other conditions, or from a poorly functioning inner ear, the treatment program is much more individualized.

Physical therapists will do eye/head exercises and will improve gaze stabilization. These can involve having a person focus on a stationary (or moving) target while moving his/her head. Other exercises use repetitive movements so that the brain can get used to certain positions until they no longer cause dizziness.

Treating vertigo is a partnership. A large part of a person’s success can be linked to doing the exercises that their physical therapists give them to complete at home.

While Hitchcock’s “Vertigo” may be scary, with the proper help, the medical condition should not cause any fear.

Susan Bloom is a physical therapist in the Outpatient Rehabilitation Services Department at Northwest Hospital.

Easier For Women

No woman really relishes the idea of having an annual gynecologic examination, but it’s one of the most important things that she can do. Many female organ diseases are undetectable without this vital yearly process. If a problem is discovered, early diagnosis and treatment are associated with a better outcome. If the gynecologic condition requires surgery, how that surgery is performed can also determine a patient’s outcome.

What gynecologic surgeons have learned over the past 20 years is that the size of the incision made to the abdomen — not the actual magnitude of the surgery — most often determines how easy a patient’s recovery is. Traditional surgery with a large abdominal or pelvic incision usually requires days of inpatient hospitalization and a prolonged recovery that’s more painful than what would have been experienced with minimally invasive surgery.

Minimally invasive, or laparoscopic, surgery requires a few tiny keyhole incisions and sometimes can even be done with a single surgical cut made inside a patient’s navel. Small instruments and a camera are inserted through these incisions, and the surgeon sees the surgical site on a television screen, as he or she maneuvers the instruments. Because the patient’s pelvis and abdomen remain closed, there is much less risk for infection or blood loss.

When gynecologic procedures are performed as minimally invasive laparoscopic surgeries, they can be done on an outpatient basis. Recovery with a return to normal life is significantly faster than with traditional open surgery. Rather than being out of commission for four to six weeks — as one often is with an open procedure — many patients who have had minimally invasive surgery report being able to return to work in about a week.

Not insignificantly, the cosmetic results with minimally invasive surgery are better as well. Instead of a prominent pelvic scar, patients who have had a minimally invasive procedure usually have smaller, almost unnoticeable scars that are often hidden in the navel or bikini line.

Almost all major gynecologic surgeries can now be performed using laparoscopy or robotically assisted laparoscopic methods. The list of conditions that require a traditional open surgery approach is growing shorter every day. In all cases, when performed by skilled and specifically trained GYN surgeons, women can enjoy the benefits of minimally invasive surgery.

If your doctor determines that you need gynecologic surgery, be sure to ask if he or she is trained to do it with a minimally invasive method. If not, you owe it to yourself to seek another opinion from a gynecologist with expertise in minimally invasive surgery.

The American Association of Gynecologic Laparoscopists published a position statement in 2010: “It is the position of the AAGL that most hysterectomies for benign disease should be performed either vaginally or laparoscopically and that continued efforts should be taken to facilitate these approaches. Surgeons without the requisite training and skills required for the safe performance of VHs [vaginal hysterectomies] or LHs [laparoscopic hysterectomies] should enlist the aid of colleagues who do, or [they] should refer patients requiring hysterectomies to such individuals for their surgical care.”

In this modern era, women should demand minimally invasive surgical care or be given a reason if their doctor won’t do so. Women deserve no less.

David L. Zisow, M.D., F.A.C.O.G., is a gynecologist and the associate chief of the Division of Minimally Invasive Surgery at Northwest Hospital, as well as its director of the Fellowship in Minimally Invasive Gynecologic Surgery.

Palpitations: What Your Heart Is Trying to Tell You

The human body is a remarkable and complex machine. This miraculous machine is composed of numerous canals, cavities and apparatus that we call organ systems.

Everyone receives this equipment free of charge, and it functions in a coordinated effort to move fluids, solids and electrical energy throughout our bodies for a very important purpose: to allow us to live our lives.

Most of the time, we prefer not to be too aware of all of these functions. We have a “don’t bother me, I won’t bother you” approach. However, every so often, we hear from our bodies. This message is what doctors call symptoms.

The heart is a perfect example. It fills and squeezes constantly, and hopefully we are never aware of it. Only when the beating is “irregular” or “hard” do we become aware, and this awareness of the heart beating is known as a palpitation.

Palpitations are the symptom of an abnormal rhythm — or misfires — of the heart’s electrical system. Although scary, often it is not a medical emergency.

Abnormal heart rhythms — arrhythmias — can be dangerous, but they are also commonly benign.

Palpitations can be acquired either at birth and/or with aging and the development of heart disease. Palpitations are not always associated with underlying heart disease; sometimes too much stress (emotional and/or physical) can cause them to occur in an otherwise healthy heart.

For a person with a skipped or rapid heartbeat, the urgency to assess this should be related to the circumstances and the accompanying symptoms. If those symptoms are associated with fainting, dizziness, chest pain or other worrisome feelings, you should seek immediate medical attention by calling 911.

If the palpitations come and go without other symptoms, the first step is a routine evaluation by a cardiologist. Rest assured that there are many simple and painless noninvasive methods used to make a proper diagnosis and therapy plan.

The best advice to keep your heart healthy and to avoid stressing it too much is:
> Exercise (all you really need to do is raise your pulse 10 to 15 beats for 20 minutes).
> Do not smoke.
> Eat a balanced diet and don’t over indulge.
> Avoid dehydration; electrolyte imbalances will cause misfires.
> Meditate or take part in a stress-relieving activity.

A patient who is diagnosed with an arrhythmia should see a heart-rhythm specialist, a cardiologist who specializes in the treatment of arrhythmias.

Heart-rhythm doctors diagnosis the condition and give it fancy names such as atrial fibrillation, ventricular tachycardia or supraventricular tachycardia.

Professionals in the field are dedicated to treating arrhythmias by offering simple, safe and effective curative catheter heart procedures known as
ablations and with implantable devices such as pacemakers.

Most importantly, the symptoms are removed, the equipment is silent again, and the machine can get back to its primary purpose: to serve you so you can live your life.

Dr. Jeffrey Banker is a heart-rhythm cardiologist at the Heart Center at Sinai Hospital.

The Eyes Have It For E-readers

There’s nothing like getting lost in a good book, whether you prefer “To Kill a Mockingbird,” “Steve Jobs” or “Goodnight, Goodnight, Construction Site.” We each have our own tastes when it comes to what we think is a good page-turner.

However, choosing books is now just one part of the process, because it’s a question not only of fiction or non-fiction and author or genre, but also of how we are going to enjoy our favorites.

There are dozens and dozens of electronic readers, such as the Amazon Kindle, Barnes and Noble’s Nook and the Apple iPad, and they have bec-ome popular alternatives for reading enthusiasts.

Many people think it’s a no-brainer to carry an e-reader rather than books, because books are bulkier and heavier. With more than two million e-books available to download at the click of a button, e-readers are also easy to update. In fact, one in 10 Americans says that he or she currently uses some kind of e-reader.

Of course, as with any change, there is uncertainty. One of the questions I get most often is, “Do e-readers cause eye strain?”

For the most part, they do not. Let’s put things into perspective. Even when you are reading the print edition of a book, your eyes may feel fatigued, so it’s nice to take a bit of a break: Get up, stretch, look around, refocus and then go back to your book.

The same thing holds true with an electronic reader. If you’re staring at an e-reader for a long time, you might feel that same sense of tired or strained eyes that you would with the printed word. Simply follow your instincts to stretch, look away and check out something in the distance to allow your focusing muscles to recalibrate; then start again.

Eye strain can cause your eyes to be sore and feel tired and make your vision blurry. However, the symptoms are not permanent, and once you rest your eyes, the symptoms will disappear. If they don’t, however, and are accompanied by headaches and double vision, you should check with your doctor; they could indicate something else is wrong.

As someone who uses e-readers, I think they’re terrific devices. If you are like me and are a bit nearsighted, they can be very helpful. I have to wear reading glasses for regular books, but I never have to wear them when I use my e-readers because I can enlarge the text as much as I want.

In addition, it’s not your imagination if you notice differences among e-readers. LCD screens can be more difficult to read in bright sunlight, and in those instances I use a Kindle, which uses electronic ink, as opposed to an LCD screen, to cut down on the glare.

For the vast majority of people, e-readers are a good thing because they make reading accessible, and I don’t think you need to worry about additional eye strain.

Whether you select paper or electronics, I hope that you enjoy this latest chapter in technology.

Dr. Donald Abrams is chief of the Department of Ophthalmology at the LifeBridge Health Krieger Eye Institute.

Back to School 101

Your children are enjoying every second of summer vacation but you need to get ready to send them back to school. Don’t think your list stops with pencils, backpacks and new clothes. You also need to prepare a back to school health checklist. Children need to be healthy and alert in order to do well in school. That means you need to prepare for everything from physicals to home schooling on germ warfare. Where should you start?

1. Call your child’s school and ask about required immunizations. Different schools have different requirements. Many school websites have a page of health-related requirements.

2. Your child’s doctor should perform a school physical. This physical can identify health problems, including hearing and vision issues. The Centers for Disease Control and Prevention reports that about one in four school-age children have a vision problem.

3. Talk with your children about germs and how they spread. Teach the kids when and how to wash their hands properly. Use warm, soapy water after using the bathroom, before eating and when they come home from school. It may sound simple, but it is the best way to battle germs that hitch a ride home on the school bus. Also, make sure your children know what to do when they need to cough or sneeze. They should carry tissues or, if necessary, sneeze into the inside of their elbow instead of in their hands. While it may be nice to share some things, it’s not good to share germs, so talk with your children about not sharing food, drinks, clothes, hats and hairbrushes with their friends. Head lice are another classroom pest that may be slowed by these good health habits.

4. Children fall out of their school day routine during vacation. Don’t wait until the night before school begins to get back into that routine. Ease your children back into their sleep schedule by gradually imposing an earlier bedtime a few weeks before school begins.

5. Have a plan for sick days. Pediatricians stress that you should not send your child to school with a fever. A fever means the immune system is trying to fight off something, and your child may be contagious to other children and adults. Have a plan in place for last minute sick child care. You will probably need it before the school year ends.

6. Do your children use their backpacks correctly? It is uncertain whether heavy backpacks cause permanent damage in children, but overloaded and improperly work backpacks can cause temporary back pain. Pediatricians urge parents to look for backpacks with individual compartments for sharp objects pike pencils. Heavier items should be placed closer to the body. Your child’s backpack should also have two should straps for even weight distribution.


Off To College

College freshmen are essentially high school seniors without their parents there to guide them.

Many families are now in the midst of preparing their college-bound students to go away to school, and for a lot of families this will be the first time their children are leaving home for more than a night or two.

Preparation is important not only for the typical tools and personal items that college students require for studying and living, but also for the health-related planning that should be done. It is vital to prepare your high school student for life away from home, for while it can be a very positive, it can also be stressful for both students and their parents.

Some topics for parents to focus on with their children are the basics of how to make appropriate choices after they leave the supervision and comforts of home. Lifestyle issues should be front and center. For instance, reminding young adults about the importance of getting enough sleep, the dangers of substance abuse and even that they may be scared or depressed until they become used to their new routines are just some of the subjects that parents should discuss before their teens leave.

Other matters to kick around are how they can make the best choices about new friends and how to go about setting boundaries in these new relationships. Believe it or not, the more these topics are discussed, the easier the conversation will become over time.

This may also be the first time that teens will be able to make their own food choices over a long stretch. Since there probably will be an overwhelming number of options, it is worthwhile for parents to recommend plans to help their students navigate. Along with the desserts and snacks in their college cafeteria, a simple reminder to include fruits, vegetables and other healthy selections is crucial.

With some thought about each of the topics mentioned here, freshmen will have an easier time making decisions at college.

Additionally, parents should also keep a running dialogue going throughout the school year and talk about what is right and what could be improved upon.

The same issues should be addressed by the young person’s primary-care physician, along with a complete pre-college physical.

By the time they are ready for college, most teens will be up to date on vaccines and booster shots, but talk with your children’s doctor about the late adolescent vaccines, including a tetanus booster, three human papilloma vaccine shots and two meningococcal (meningitis) vaccines.

Finally, technology can be a great way for parents and their college kids to stay in touch. It can enable an open line of communication while it is also gives students a chance to spread their wings.

One of the best ways for parents to respect the new independence of their college children is to prepare them for what lies ahead and to be open to their questions during their time away from home. After all, no matter how grown up they are, they are still your children.

Dr. Oscar Taube is medical director for pediatric outpatient services and coordinator for adolescent medicine at the Herman & Walter Samuelson Children’s Hospital at Sinai.

OMG … What’s a Webinar?

Who says doctors don’t make house calls anymore? While it’s definitely not the same as decades ago when physicians often treated patients at home, there are still a lot of opportunities to learn about diseases and treatments in the comfort and privacy of your own house, office or other location.

Here’s how. You may have heard of the word webinar, but you may not have a clue about what it means.

A webinar is a live online presentation that can be viewed by anyone anywhere as long as he or she has a computer and is registered. The length of each one varies, and the subjects are as numerous as the imagination allows. A webinar usually consists of one or more speakers who use visual aids, such as PowerPoint slides, along with their lectures. Only the presenter is seen, not those who sign up.

What is also unique about these web conferences is the capability for immediate interaction. Participants can ask questions or make comments during the webcast, and the host(s) can provide answers before it ends.

When it comes to learning about different health issues, the sky is the limit. For instance, among the many diverse themes that can be addressed are ankle arthritis, the causes of and treatments for epilepsy and help for children who break bones while they are playing sports.

Another example of a hot health-related webinar topic is diabetes. During an hour-long webinar, an
endocrinologist can talk about how the disease affects the body, who is at risk for developing it, how it can be treated and how it can be prevented.

To take part in any webinar, all you need is a desktop computer or laptop, Internet access and speakers and/or headphones.

Some things to consider if you are thinking about giving webinars a try:
• Make sure that the website offering the online conference is reputable.

• Find out if it is free and, if not, decide if you are willing to pay a fee.

• Check the presenter’s credentials.

• Expect to hear basic information but follow up with your own doctor for specifics about your own condition.

The benefits are many:
• You can hear information from an expert in the health-care field.

• You don’t have to be in the same state, or even in the same country, to be part of a webinar.

• You do not have to dress up to attend.

• You can learn additional facts by hearing the answers to other people’s questions.

• You can usually find a webinar to fit your schedule because starting times and days fluctuate.

If you miss a presentation, sometimes these web seminars are taped and posted on the presenter’s website so that they can be listened to at any time. As you do when you listen to any expert, remember that there are differing points of view on every issue so keep an open mind. Thanks to technology, webinars can be a great way for people to learn valuable information in a very accessible way.

Helene King is a communications coordinator at LifeBridge Health.

Be Your Best Self

071213_be_your_best_selfFor many, summertime conjures up images of long days basking in the sun, swimming in the pool and unwinding from the rigors of a hectic school year. It’s a time to recharge one’s batteries, to get in shape.

But, said Amy Schwartz, fitness and wellness director at the Jewish Community Center of Greater Baltimore, although it may seem as if summer is a more relaxed time of year, people actually seem more programmed and have less time.

First of all, for families with young children, schedules change during the summer months — camp starts later than school, and older children have more sporadic schedules, where they may be home some weeks while attending different camps with different schedules. At the same time, because summer offers so much to do, parents often run around to keep their children occupied.

That means, Schwartz says, that many parents, accustomed to attending exercise classes at specific times, are often thrown off their schedules.

“Some may miss their normal 9:30 a.m. class because of camp schedules,” said Schwartz. “I tell them it’s better to come late to a class than not at all. Forty-five minutes instead of 60 minutes is still great. You don’t have to do all your exercise in one sitting. If you can’t make it to a class, walk more.”

But exercise is critical year-round. Even in summer, it’s important to do a combination of strength training, cardiovascular training and flexibility training to keep bodies fit and healthy.

What’s New?
This summer, the JCC has added a few new exercise options to its programs. SMRT is a “smart rolling” foam roller called a grid that one rolls over muscles before a class. “We do it before and after classes like cycling or Zumba, and we roll over those muscles specific to the muscles we are using in the exercise. It’s like a massage. SMRT makes you stand taller and feel better,” said Schwartz.

In addition, the JCC has added small group personal training to address specific needs. For example, a personal trainer may work with a small group of individuals who have bad knees to strengthen their leg muscles.

Eating Healthy
There’s nothing like biting into a ripe, red tomato picked minutes before eating and summer is the ideal time to enjoy some of the freshest fruits and vegetables. Farmers’ markets and CSAs (Community Supported Agriculture) Center provide ways for individuals to get seasonal vegetables picked at the height of ripeness.

Families who participate in Pearlstone’s CSA pay a seasonal fee to receive a weekly share of fresh pesticide- and chemical-free produce. It provides participants a chance to learn about seasonal eating — in the heat of the summer months, members enjoy freshly picked tomatoes, cucumber, eggplants, peppers, onions and zucchini, for example.

“I am passionate about fresh vegetables. I come home every day from work and see what I can create with what I picked at the farm,” said Josh Rosenstein, farm director at Pearlstone Center. Rosenstein adds that Pearlstone, although not certified organic, engages in organic-farming methods. The farm doesn’t use herbicides or pesticides on crops, practices cover cropping and crop rotation for healthy soil development and grows mostly heirloom varieties.

To encourage seasonal eating, Pearlstone is blogging and offering recipes that feature vegetables the farm is currently harvesting. Here are some additional suggestions:

• Marinate veggies like eggplant, peppers, squash and zucchini in balsamic vinegar, olive oil, sea salt, cracked black pepper and fresh herbs. Grill!

• Slice zucchini or other summer squash very thin into spaghetti-shaped pieces. Steam, and use instead of pasta.

• Cut a banana in half; stick a popsicle stick in it. Dip it in dark chocolate and freeze.

Potato, Squash and Goat Cheese Gratin
serves six

2 medium yellow squash, about a half pound
4 small to medium red
potatoes, about 1 pound
3 tablespoons olive oil
4 ounces goat cheese
Salt and freshly ground
black pepper
1⁄4 cup milk
1⁄3 cup freshly grated Parmesan cheese
1 tablespoon thinly sliced basil or thyme leaves

Preheat oven to 400 degrees. Lightly grease a 11⁄2- to 2-quart casserole dish with a drizzle of olive oil.

Use a mandolin or chef’s knife to slice the squash and potatoes into very thin slices, an eighth of an inch or less. Toss vegetables with olive oil in large bowl. Place a third of the squash and potato slices in the bottom of the dish — no need to layer them squash-potato-squash; just spread evenly — then season with salt and pepper. Top with half of the goat cheese, scattered evenly in large chunks. Repeat with another a third of the vegetables, seasoning again with salt and pepper and topping with remaining goat cheese. Finish by layering on the final a third of the vegetables. Season with salt and pepper. Pour milk over the entire dish. Top with parmesan cheese. Bake covered for 30 minutes, then uncover and bake 15 more minutes, until top browns. Scatter on the fresh basil, if using.

Rochelle Eisenberg is PR manager at The Associated: Jewish Community Federation of Baltimore and an area freelance writer.