University of Maryland School of Medicine offers laymen a mini education

In his novel, God Bless You, Mr. Rosewater, the late Kurt Vonnegut observed,  “The most exquisite pleasure in the practice of medicine comes from nudging a layman in the direction of terror, then bringing him back to safety again.”

Learning about Lupus or Lyme Disease can in truth be somewhat daunting.  So for five Wednesday evenings this fall, the University of Maryland School of Medicine will be gently nudging a group of laymen and women through Mini-Med School.

What is Mini-Med School?  The University of Maryland website answers the question:

“Offered as a public service by the University of Maryland School of Medicine, Mini-Med School is a series of tuition-free classes designed to help Baltimore residents improve their health and well being.  Mini-Med School lectures are presented by faculty physicians in medical school classrooms, but you don’t need a background in science to attend.  Mini-Med School is open to everyone.  The five weekly sessions are designed to be casual, fun, and informative, while focusing on health care issues that are important to everyone.

In addition to providing the public with important health care information, the goal of the University of Maryland’s mini-med school is to raise the public’s awareness of biomedical research and the importance of enrolling in clinical trials.  Mini-med school helps us to give a lay audience a better understanding of the basic terms and concepts used in the biomedical sciences, the processes involved in science and the importance of research to modern society.”

Caelie M. Haines, the schools public relations manager, told the Baltimore Post-Examiner 325 students are registered for this year’s sessions.  Those who attend four of the five classes will receive a graduation certificate.  Haines noted that the participants are predominantly older and that many of this year’s group are returning students.

Heather Graham Phelps, director of  communications and marketing for Office of Communications and Public Affairs, said the program, which is in its twelfth year, is conducted every fall.  Along with education, one of the goals of the program is to reach out to the people who live in the  surrounding area.

Dr. E. Albert Reece, vice president for Medical Affairs, University of Maryland, says in his introductory letter, “We designed the curriculum to cover the health issues you told us were of interest to you, and the issues we believe are important to you and your loved ones.”

Some of those health issues include Lupus, lead poisoning, complementary medicine, childhood obesity, drug interactions, eating disorders and child abuse prevention.  The classes run from 6:00-8:00 p.m.  every Wednesday night through October 10.  A comprehensive workbook is provided to each student; a boxed dinner is provided for all who attend.

The first lectures in the series covered sleep disorders and Lyme disease.

Dr Steven Scharf, professor in the department of medicine, spoke on sleep disorders.  Scharf said that 40 million Americans suffer from chronic sleep disorders. He noted that the annual direct cost of  sleep related problems is $16 billion with an additional $50-$100 billion in indirect costs, such as
accidents, hospitalization, litigation and death.

To make his point about the cost of sleeplessness, Scharf asked the audience how many of us had driven while sleepy.  Most (including this reporter) sheepishly raised our hands.  Scharf then played a video which demonstrated how dangerous sleepy driving could be.

Many factors  contribute to sleeping disorders, including ageing, lifestyle, shift work, travel, worry, bad eating habits and a lack of routine.  Speaking of lifestyle, Scharf noted  that, “We go 24/7.”

He then offered a number of practical suggestions to address the problem of eating habits, which he characterized as part of inadequate sleep hygiene.  Scharf advised people avoid alcoholic beverages 2-3 hours before bed, abstain from caffeinated drinks for anywhere from 8-12 hours before turning in and desist from eating foods which may cause indigestion or spike glucose levels, both of which could lead to a restless night.

Other ways to address inadequate sleep hygiene are:

• Fix a bedtime and fix an awake time
• Avoid Napping during the day
• Regular exercise is good, but NOT before bed.
• Bedroom should be cool, dark and quiet with a comfortable bed
• Bedroom should be reserved for sleep and sex – NOT a work or TV room

Scharf’s lecture also covered insomnia and sleep apnea.  Scharf said that for transient, or occasional insomnia, sleeping pills are just fine but a better choice for chronic cases is cognitive behavioral therapy.  CBT is a form of psychotherapy which incorporates a wide rage of behavioral modifications.

The workbook notes that sleep apnea is characterized by repeated episodes of decreased airflow during sleep.  The prevalence of this disorder can run anywhere from 1-9% in young to middle-aged adults and children.  Among the elderly, the disorder appears in as many as 24 percent of the population.  For some reason, the percentages in post menopausal women match the elderly.

Several treatments for sleep apnea were discussed, including medical treatment (such as smoking cessation), mechanical devices which promote free passage of air (CPAP), orthotic devices, artificial nasal valves and lastly, upper airways surgery.

Perhaps the most eye opening part of Scharf’s talk was the correlation between sleep apnea and cardiovascular disease.  He said the association with hypertension is striking, as up to 50 percent of patients present both maladies, and that increased danger for a heart attack is 23 fold.  The risk for stroke and sudden death are also greatly increased.

Following Dr. Scharf, Dr. Raymond H. Flores, associate professor in the department of medicine’s division of rheumatology & clinical immunology, spoke about Lyme disease.

Lyme disease (so named for the heavy cluster of cases around Lyme, Connecticut in the early 1970’s) is a bacterium which enters the skin from the bite of a blacklegged, or deer tick.  The areas with the greatest danger of the disease are a wide track along the Minnesota/Wisconsin border and a sizable swath from southern New England to the eastern two-thirds of Maryland.  Flores said that risk factors for contracting the disease include occupations such as landscapers, foresters and surveyors and recreational activities like camping, hiking and hunting.  Wooded and high grass locations present the greatest danger.

While most people know that a “bull’s eye” rash is one of the early signs of an infection, other symptoms include fevers, headache, stiff neck and malaise.  Early stages of the disease may begin to show in 1-3 months.  Later stages may not appear for years.

Flores discussed the various serologic tests for Lyme disease, noting that some are better than others and he stressed the importance of proper treatment once the disease has been confirmed.  Flores said that compounding the discomforting symptoms of the early stages, those infected are also at risk of developing heart disease, inflammatory arthritis and neurological disorders such as meningitis and Bell’s palsy.

Treatment for the disease includes a 2-4 week regiment of oral antibiotics or 4 weeks of the  intravenous kind.   If there was any good news in Flores’ talk, it is that if you suspect you may have been bitten by a tick, you should see your doctor as soon as possible.  Current thinking is that if the disease is caught within the first 36 hours, a one-time dose of doxycycline may be all you would ever need.

The best treatment for Lyme disease?  Flores says it’s, “Prevention.”

Flores suggests wearing long pants and shirts and avoiding woodsy, grassy areas.  The use of insect repellents which contain DEET are also recommended.  It is also important to check your body and scalp when you’ve been in a danger area.  Have your spouse or a friend check areas which you cannot easily see.  Checking pets, especially dogs, is also encouraged.  Flores said if a tick has attached, it must be carefully removed using tweezers and getting as close to skin as possible.  He said after removal, to clean the area with alcohol or soap and water.  Old school methods of tick removal, like applying kerosine or using a hot match head to the tick’s abdomen are no longer advocated.

Mini-Med School is presented in cooperation with the National Institutes of Health and the Association of American Medical Colleges.  Though registration is now closed for this year’s classes, information about the program may be found here
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