Download Why Brain Rest Is Vital for Concussions

PatriotLife
JO H N S H O PK I N S U S FA M I LY H E A LTH PL AN
SPRING 2014
FORGED BY WAR
James Ficke brings unique
experience to his role as
director of orthopaedic surgery
Brain Rest
Handle with Care
Acid Reflux
TO YOUR HEALTH
Handle with CARE
D
o you frequently have numbness and tingling in your
hands and fingers or feel as if
your hand has fallen asleep?
Or do you notice your hands’ motor
skills aren’t what they used to be?
These symptoms might indicate carpal
tunnel syndrome, or CTS, which can
cause long-term damage if ignored.
An estimated 3 to 6 percent of
Americans suffer from this nerve disorder, which is caused by compression
of tendons and one of the wrist’s main
nerves in the carpal tunnel, the passageway for nerves from the forearm
to the palm of the hand. One of the
most common forms of surgery in the
United States is hand surgery to correct CTS.
People who have diabetes, are pregnant, have rheumatoid arthritis or are
more prone to swelling in general seem
more likely to develop the disorder.
“Really, anybody can get it, depending on how much room they have in
their carpal canal and how much all of
the tendons and nerves occupy at any
time,” says Jaime Shores, M.D., assistant
professor of plastic and reconstructive
surgery at Johns Hopkins.
If you think you may be suffering from CTS, see your primary care
physician, who can refer you to a neurologist for nerve testing or to a hand
surgeon. Often, hand pain is not CTS
but another nerve disorder, tendinitis
or arthritis. If you receive a diagnosis of
CTS, however, many treatment options
are available. Wrist splints or a steroid
injection may provide relief for people
with a mild form. More severe cases
may require surgery.
Why Brain Rest Is Vital for Concussions
T
he arrival of spring brings schoolaged children out to playing
fields to compete in such sports
as lacrosse, baseball, softball and
soccer. Amid the fun, it’s important for
coaches, parents and players to recognize
the risks associated with concussions—direct hits to the head—that can come from
contact with whizzing balls and sticks, or
hard hits to the ground. While helmets
can help prevent traumatic brain injuries,
they don’t prevent concussions.
To diagnose a concussion versus a runof-the-mill head bump, physicians rely on
symptoms and medical history, explains
Alicia Tucker, M.D., a family medicine
physician at JHCP at Bowie, who has
sports medicine training.
A concussion mainly has cognitive or
neurological symptoms—like headache,
dizziness, blurred vision or nausea. Some
patients have trouble sleeping or may experience a change in behavior, becoming
more aggressive. In severe cases, patients
may not remember what happened before
or after the hit.
“A concussion is like a bruise to the
brain,” Tucker says. Traditional brain im2 • PatriotLife • SPRING 2014
aging technologies won’t detect anything
abnormal. Still, if you get back in the
game or continue to tax your brain, the
condition can worsen.
Tucker strongly urges her patients
and their parents to observe strict “brain
rest” to recover. That means not only no
physical activity, but no homework and
no tests. Children who return to school
should be given frequent breaks to prevent
the brain from working hard for more
than 50 minutes at a time. Some patients
are disappointed to hear that brain rest
also means no video games and no text
messaging.
Watch your child closely. If the symptoms worsen or your child starts vomiting
uncontrollably, go directly to the nearest emergency room. Those who suffer
a concussion generally will be back to
normal within seven days, Tucker says,
but children who have attention-deficit/
hyperactivity disorder (ADHD), migraine
headaches or depression may take longer
to heal. Even after symptoms subside, you
should wait an additional week before resuming competitive sport activities.
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Reflux: Avoiding the Burn
S
ome people feel burning in their chest after eating. Others complain of a cough, hoarse voice
or trouble swallowing. And then there are those
who experience frequent belching or taste acid in
their mouth.
All of these are symptoms of gastroesophageal reflux,
a digestive disorder commonly known as heartburn,
which is often humorously depicted in TV commercials
touting over-the-counter remedies.
But for the estimated 60-million-plus Americans who
suffer regularly from gastroesophageal reflux, the condition is no laughing matter. And for a small percentage of
people, it can lead to a serious precancerous condition.
To learn more about heartburn and gastroesophageal
reflux, we turned to Jim Williams, M.D., a family practitioner with JHCP at Sibley Memorial Hospital.
Q: What causes reflux?
A:
Gastroesophageal reflux occurs when acid comes up out of the stomach and travels up the esophagus. This
happens because the esophageal sphincter, which opens to allow food into the stomach and closes to keep it in,
becomes relaxed for too often or too long. “Certain foods that you eat will make this relaxation of the esophageal
sphincter more likely to happen—anything with caffeine, nicotine, alcohol and peppermint,” says Williams. Medications, including those used to treat osteoporosis, can also cause heartburn. So can lying on the couch after dinner.
Q: Who is most at risk?
A:
People with large abdominal girth, smokers and pregnant women. Those who have a hiatal hernia—when
the upper part of your stomach pushes up through your diaphragm and into your chest—are also
more at risk. “With a hiatal hernia, stomach acid can slide up the esophagus more easily,”
Williams says. Hiatal hernias occur in about 3 to 10 percent of people, are more
prevalent with age and can be treated with surgery if necessary.
Q: What can I do to prevent reflux?
A:
“The most important thing you can do is to
identify the habit that’s the problem and change
it,” says Williams. “For example, people who
find heartburn and reflux intolerable at
bedtime need to avoid eating two hours
before they go to bed.” In addition,
losing weight, quitting smoking, cutting
down on alcohol and avoiding overeating
can all help prevent reflux.
Q: What are the most effective treatments?
A:
Over-the-counter antacids like Tums can be helpful in treating reflux,
Williams says. For more persistent reflux, Williams recommends taking H2 blockers (acid reducers), like Zantac and
Pepcid, which often have to be taken with every meal. “Far and away the best over-the-counter type of medication is
a proton pump inhibitor known as Prilosec OTC,” he says.
Q: When should I see my doctor?
A:
Any regular need for H2 blockers or Prilosec OTC should be reviewed with a physician. “You don’t just want
to put a bandage on a problem that needs something more,” Williams explains. Here’s why: Neglect your reflux for
too long and the condition can become chronic. “If the esophagus is exposed to hydrochloric acid of the stomach repeatedly over time, it gets burned and injured,” he says. One can even develop adhesions in the esophagus that make
swallowing difficult. Over years, the affected cells in the esophagus can become precancerous, a condition known
as Barrett’s esophagus. “Heartburn ignored for long enough, especially in combination with smoking and too much
drinking, puts you at increased risk for cancer of the esophagus,” says Williams.
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PatriotLife • SPRING 2014 • 3
COVE R STORY
An Exploratory
Approach to
Orthopedic Surgery
Orthopedic surgery—which millions of people
undergo annually in the form of hip and knee replacements, carpal tunnel release, meniscus and
rotator cuff repair and other procedures—may be a
common stop on the road to treating injured joints,
muscles and ligaments, but these surgeries should
not be treated lightly.
“There’s no such thing as minor surgery,” says
James Ficke, M.D., director of orthopaedic surgery
at Johns Hopkins. “To perform an incision, to
operate, means we create an injury. This is never
to be taken lightly and is an immense responsibility.
We, as surgeons, must never forget that personal
impact.We must maintain incredible respect for the
privilege to heal someone.”
With this in mind, here are four things to know
about orthopedic surgery:
Surgery should be the last stop, not the first.
Nonsurgical treatment for orthopedic problems
starts at the primary care level with lifestyle changes,
physical therapy and other interventions. “Many
treatments can be performed short of surgery that
will alleviate pain or cure a condition,” Ficke says.
(See sidebar.)
Not every condition can be improved by
surgery. Just because an issue can be addressed
surgically doesn’t mean that it will be improved by
surgery. For example, with back pain, only a select
group of people with certain nerve conditions or
arthritis can be helped by surgery, Ficke says.
Be realistic. “There is no surgery that makes us
normal,” says Ficke, a distance runner who had
shoulder reconstruction surgery a decade ago and
resumed running ultramarathons. “We can make
things better, but we can’t make them normal.”
Your voice matters. Diagnostic tests only tell part
of the story. A patient needs to tell the rest to an
attentive practitioner. “Often times we can look at an
X-ray and make a diagnosis, but we don’t always hear
what is happening,” Ficke says. “I think patients have a
lot to tell us. While it’s the doctor’s responsibility to
listen, it’s the patients’ responsibility to tell a focused
story to assist in understanding the person as well as
the condition.”
4 • PatriotLife • SPRING 2014
Meet
James Ficke
Forged by war, Johns Hopkins’ new
director of orthopaedic surgery brings
unique expertise to patient care.
J
ames Ficke, M.D., is a renowned expert in the
treatment of complex foot, ankle, and lower extremity injuries and amputation.
The retired U.S. Army colonel says he
wouldn’t be the surgeon, teacher and researcher
he is today without his decades of military service.
Central to his career are numerous leadership development opportunities he’s had, including a year
in Iraq. As deputy commander of clinical services at
the 228th Combat Support Hospital in Mosul, Iraq,
from 2004 to 2005, Ficke treated more than 600
U.S. soldiers and Iraqi patients for combat injuries.
While there, he supervised 15 physicians and managed 19 mass casualty incidents. “The experience
changed who I was,” he says.
It wasn’t just the volume of patients he saw or
the brutality of war that was transformative. “I
came back having recognized the sacrifice made by
men and women injured in combat—sacrifice that
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Keeping Joints
Healthy
Here are five ways you can help
keep joints healthy and protect them
from injury and disease:
Watch it. Maintaining a healthy weight is one of the best things you can do to reduce unnecessary strain on your joints.
Move it. Exercise of the right makes it imperative that
we learn improvements
in treatment. It is our responsibility to teach these
improvements to others,”
he says.
A 1983 West Point
graduate, Ficke earned his
M.D. from the Uniformed
Services University of the
Health Sciences’ F. Edward
Hebert School of Medicine
in 1987. Prior to coming to
Johns Hopkins last September, he was chair of
orthopedics and rehabilitation at the San Antonio
Military Medical Center
at Fort Sam Houston in
Texas. He also served as
the orthopedic surgery
consultant to the U.S.
Army surgeon general.
“I gain the most energy
when I see people return
to function after they have
undergone acute injuries.
I love to operate. I love
to teach and conduct research,” says Ficke.
“Learning how to do
all things well naturally
translates to a place like
Johns Hopkins, which has
a culture of excellence and
of serving something bigger than oneself.”
“I came back having
recognized the sacrifice
made by men and
women injured in
combat—sacrifice that
makes it imperative that
we learn improvements
in treatment. It is our
responsibility to teach
these improvements to
others,” says Ficke.
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kind can help strengthen muscles, maintain a healthy weight and reduce joint swelling.
Eat it. A balanced diet helps
to build strong bones.
Minimize caffeine, which has been shown to weaken
bones. Instead, opt for
foods rich in omega-3 fatty
acids, such as fish and nuts, which can help decrease joint inflammation.
Lift it. Weight training exercise can build muscle, strengthen ligaments and help support joints.
Straighten it. Good posture while standing, sitting, lifting and carrying can help protect joints.
PatriotLife • SPRING 2014 • 5
BRIE FING ROO M
When Questions Are the Answer
Your health depends on good communication. Asking questions and providing
information to your primary care provider can help improve your care.
Quality health care is a team effort, and you play an important role. One of
the best ways to communicate with your primary care provider is by asking
questions such as “What is this test for?” and ”When will I get the results?” Because time is limited during medical appointments, you will feel less rushed if you
think about possible questions before your appointment.
Your questions give your doctor and health care team important information
about you, such as your most important health care concerns.
Please visit www.hopkinsmedicine.org/usfhp/library.html to find
“Tips for Talking with Your Health Care Provider” to help you
prepare for appointments and meetings with your provider.
START SMART
Though breakfast is the most important meal
of the day, the morning rush can make it easy to
skip. But that’s not smart! Studies show that eating
breakfast is important to maintaining a healthy
body weight. (Those who miss this important
meal are apt to grab for late-morning snacks that
are high in fat and sugar.) Breakfast gives you the
energy you need to concentrate at work or school,
preventing a mid-morning slump, and it provides
important vitamins and minerals that your body
needs. Eating a healthy breakfast needn’t
be complicated or time-consuming.
Grab a piece of fruit, a cup of
skim milk or low-fat yogurt,
and a whole-grain granola
bar, and you’ll have the food
fuel you need to power
through until lunchtime.
DID YOU KNOW
Allergies affect 40 to 50 million people in
the United States, making them one of the
country’s leading chronic diseases.
SOURCE: Johns Hopkins Medicine Health Library
www.hopkinsmedicine.org/healthlibrary
6 • PatriotLife • SPRING 2014
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IN THE KNOW
2013 USFHP
MEMBER SATISFACTION
Exceeding
Expectations
T
90%
85.7%
87.8%
88.3%
86.2%
84.2%
84.0%
he results are
80%
in … and we’re
proud to report
77.4%
that USFHP
has once again
earned top
70%
marks in member satisfaction — well above the national average assessed by
the National Committee for
65.5%
Quality Assurance.
“We couldn’t be more
60%
pleased,” says Mary Cooke,
vice president of Johns
Hopkins US Family Health
Rating of
Rating of
Rating of
Rating of
Plan. “In our member surHealth Plan
Health Care
Personal Doctor
Specialist
vey conducted last spring,
respondents gave Johns
2013 USFHP
2013 National Commercial Plan Average**
Hopkins USFHP top scores
* Summary rate represents the percentage of respondents who gave a rating of 8, 9 or 10 on a scale
in four important areas: ratfrom 0 to 10, with 0 representing the “worst possible” and 10 representing the “best possible.”
ing of health care, rating of
** National average calculated by National Committee for Quality Assurance, a private, not-for-profit
personal doctor, rating of
organization dedicated to improving health care quality.
specialist, and rating of health
plan (see graph).
“What’s more, the survey showed that our
members continue to be highly satisfied with customer service and claims processing.”
IN YOUR OWN WORDS
Using criteria that included the survey results,
Consumer Reports rated Johns Hopkins US Family
Health Plan No. 2 in the State of Maryland for consumer satisfaction, prevention and treatment.
The 2013 survey feedback will be incorporated
The Johns Hopkins network was
into our continuous quality improvement process as
we continue to work on ways to be the best for our
definitely a calling card... and being able
members.
The Member Satisfaction Survey is being conto consistently have one provider that
ducted again this spring by mail and phone. USFHP
our whole family could see.
values your feedback. Please help us understand
your needs by answering your survey. Our mission
is to improve the lives of our plan members by pro— Robin C.
viding access to high-quality, patient-centered health
Wife of colonel, U.S. Air Force
care.
Member with her six children since 2010
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PatriotLife • SPRING 2014 • 7
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Sue De Pasquale, Editor
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