Ask the Expert

September is prostate cancer awareness month and as the second-most common cancer among American men, prostate cancer has increasingly become a topic on the minds of adult men everywhere. But, prostate cancer is most sucessfully treated when found early and more than 2.5 million men in the US currently are prostate cancer survivors. The five-year survival rate for men diagnosed with prostate tumors discovered at these stages is nearly 100 percent.

H. Ballentine Carter, M.D.

Johns Hopkins prostate cancer expert H. Ballentine Carter, M.D. provides some answers to a few questions about this disease in this week's Ask The Expert.Q: How can I tell that I, or someone that I know, has prostate cancer?

A: Early prostate cancer may be present without any symptoms. It can often be detected with screening tests.

Q: Should I get my PSA levels checked?

A: PSA testing has become a polarizing topic, with experts insisting the risks outweigh the potential benefits. If you’re between the ages of 55 and 69, are African-American or if you have a family history, speak to your doctor about prostate cancer screening. Only you and your doctor can determine the appropriate course of action based on your health and background.

Q: Can a baldness drug prevent or reduce the incidence of prostate cancer?

A: Finasteride, a baldness drug, has generated buzz after two studies suggested the drug was capable of reducing the incidence of minor prostate cancers. and after reviewing the methodology, I believe the results are overpromising and that finasteride does not appear to be an effective method of prostate cancer prevention.

Q: Where can I find more information?

A: Visit hopkinsmedicine.org/news/stories/september_prostate_cancer_awareness_month.html for more information or visit the Johns Hopkins Health Library for more information about prostate cancer.

Regardless of an employee’s level of performance, it is essential that leaders/coaches meet one-on-one with each employee to "touch base", one or two times per month, depending on the number of your direct reports. This meeting is to ensure that you and your staff communicate about performance, goals and any issues facing the department. Learn how to have an effective one-on-one meeting, whether you are a supervisor or an  employee, in this week’s Hopkins Happenings’ Ask the Expert with Ruth Mitchell and Jennifer Clarke, organization and development training consultants.

For the Employee

Be prepared.

• Go into the meeting with your agenda and questions/ challenges / barriers you need addressed.

Be proactive.

• Think about solutions to your challenges and barriers.

Be thoughtful.

• Recognize others who have been helpful to you.

Be open.

• Go in ready to learn something you might not want to hear.

Consider using these open-ended questions in one-on-one meetings:

What is going well?

What isn’t going so well?

What do I need to do differently?

For the Manager

For a thirty minute meeting, follow the 10-10-10 rule.  Ten minutes for them, ten minutes for you and ten minutes for their development.

What should you do:

1. Acknowledge the contributions this employee makes, and to demonstrate that what he/she does is important to the organization.
2. Ask for input on what is working, what’s not working in departmental processes, operations and direction.
3. Discuss barriers to successful performance and formulate a plan to remove the barriers.
4. Establish and review goals.
5. Give and seek feedback.
6. Take interest in the employee's professional and career development.

Consider using these open-ended questions in one-on-one meetings:

How can I support you?

What progress have you made on your goals?

What barriers prevent you from accomplishing your goals?

What has been a recent success? How did that work? How do you feel about it?

If we had to do "x" project all over again, what would we do differently?

If you could change the way you do your job, what improvements would you recommend?

What frustrations are you experiencing? What steps can we take to minimize the frustrations?

What skills, experiences and/or knowledge would you like to obtain to position yourself for the future?

A National Sleep Foundation poll reported that of the women who responded: 31 percent complained of sleep problems; 63 percent of women experienced symptoms of insomnia at least a few nights a week; and 31 percent had taken drugs to stay awake. Charlene Gamaldo, director of the Johns Hopkins Center for Sleep at Howard County General Hospital, shares tips to promote better sleep for women.

Before considering pharmacological solutions for sleep disorders, there are a number of things women can do:

• Cool the ambient temperature of the bedroom to help regulate core body temperature
• Dress in layers so you can peel down when you get too hot
• Drink something cool at bedtime but try to avoid tobacco, caffeine, alcohol and spicy food
• Lose weight: body fat holds onto estrogen and can release it at sporadic times, which can cause hot flashes
• Try relaxation techniques like yoga or meditation
• Get more exercise, but early in the day is better than in the evening
• Try to establish regular sleep and wake times.

Read more at Well and Wise.

As manager of Johns Hopkins Medicine Mail Distribution and Transport Services, Roderick Toney oversees the mail system for hospital, health system, schools of medicine, and Asthma and Allergy Center on the Johns Hopkins Bayview Medical Center campus. Read more about Toney in Dome and Inside Hopkins.

Once you receive mail or shipment of items to be distributed to employees across the campus, how long should it take for your staff to deliver it?

Our goal is to deliver mail within a two-day window once received in our mail center. Some areas may experience receiving same day delivery. In other areas, depending upon delivery location and/or how the item was addressed, it could take longer. Our FY 2014 mail tests results revealed that our overall turn-around time average was three days.

What are some of the obstacles in achieving timely delivery?

The most common obstacle is improperly addressed mail and receiving inaccurate personnel data information that we add to our internal database.

What can we do to expedite delivery and receipt of mail, e.g. is there a certain way to address mail?

We process the majority of mail via automation. It is vital that Mail Services is alerted whenever there are personnel changes within Hopkins (new hires, terminations, new students, campus moves, multiple office locations, etc.). That way we will have a record of each employee’s mail delivery location in our database. You can send a change of address to insidehopkinsmedicine.org/mailservices/coa.cfm or contact me at rtoney1@jhmi.edu or Lakeysha Richardson at lricha21@jhmi.edu or 410-614-2572.

In addition, proper addressing for both interdepartmental and USPS outbound mail greatly influences mail delivery times. Internal mail must have the recipient's full name, department, building and room number. Make sure that all previous addresses have been crossed off the envelope.

Can you provide an example?

Domestic U.S. mail that is outgoing should include the following:

 
Return Address:
Sender's Name
Sender's Address
(Dept., Bldg. Room)
Sender's City, State, and Zip

Destination Address

 
 
Recipient's Name
Recipient's Address
Recipient's City, State, and ZIP

To obtain the best possible mail service from the United State Postal Service:

• Capitalize everything in the address
• Use common abbreviations (see below)
• Eliminate all punctuation in the last two lines of address
• Use the USPS' two letter state abbreviations (see below)
• Use ZIP+4 Codes, if applicable

Make sure the destination address appears on the line immediately above the city, state, and zip code line (i.e. 123 W Main St, Suite 400 or PO Box 125, but not both!)

What are the biggest misconceptions about mail service at Johns Hopkins?

I believe that many feel that Mail Services is a mom and pop operation, just a small room in the basement where mail is received. They are unaware that along with the great Hopkins tradition, we too are on the cutting edge of implementing new innovations and technology from a service perspective.

What’s ahead?

We’d like to see an updated mail services website where employees can submit address corrections and inquiries to improve service.

Which departments receive the most mail?

Radiology, pathology, medical records, cardiology and pediatrics receive about 60 to 70 pieces per day.

Every year during the first week of August, more than 170 countries celebrate World Breastfeeding Week to encourage breast-feeding and to improve the health of babies around the globe. The Johns Hopkins Breastfeeding Support Program (BSP) provides resources to mothers who want to continue breastfeeding after returning to work and their supervisors. The resources include:

• Mother’s Rooms on several campuses
• Hospital grade breast pumps available for purchase at discounted prices
• A vending machine with supplies for breastfeeding employees available inside the Mother's Room in Nelson 2-104
• Consultations with breastfeeding employees and supervisors
• Website with educational materials and online resources

Personal Story

I am currently an employee at JHH. I just wanted to send you a quick email to thank you for all the support I have received through the Breastfeeding Support Program. I am winding down on one year of breastfeeding my son, and definitely believe I could not have completed it without the amazing support of the BSP. I feel very lucky to have access to wonderful pump rooms with hospital grade pumps, and attribute my success to completing one year of breastfeeding to this. Thank you for all you do for new moms!

Are there laws or policies that support my choice to breastfeed after returning to work?

The Patient Protection and Affordable Care Act (ACA) requires insurance companies to cover certain women’s preventive services such as breastfeeding support, supplies, and counseling. The ACA amends the Fair Labor Standards Act of 1938 by requiring employers to provide reasonable break time and place, other than a restroom, that is private and clean for mother to express breast milk.

Johns Hopkins University & Health System have policies that are compliant with federal law.

How can I find out if there is a Mother’s Room near where I work? What should I do if there isn’t?

There are more than 15 Mother’s Rooms at various Johns Hopkins campuses. For the most up-to-date information, visit http://hopkinsworklife.org/mothers-rooms. The comprehensive list also provides information about the contact people for each room. If your campus does not have a Mother’s Room, look at the list of Mother’s Room for locations of individuals tasked with finding space on an as needed basis.

New rooms are being added regularly. If you are interested in hosting a room, please email worklife@jhu.edu or call 443-997-7000.

One of my co-workers just returned from maternity leave and needs to pump a couple of times per day which means I need to cover for her. I feel like her choice is making more work for me. I’m feeling resentful. Any suggestions?

Changes in workload can be frustrating. It is important that your supervisor knows about your concerns and any questions that you might have. Your supervisor has the responsibility of managing employees’ schedules and making sure that performance standards are met. Also remember that employers have a legal responsibility to provide nursing mothers with time and space to pump.

According to the Business Case for Breastfeeding, employees whose companies provide breastfeeding support consistently report improved morale, better satisfaction with their jobs, and higher productivity. It is likely your co-worker is very appreciative of your efforts and will look for opportunities in the future to support you.

What kinds of discounts do you offer on breastfeeding pumps and supplies?

The Pumps for Purchase program offers discounted personal breast pumps and Mother’s Room accessory kits for hospital-grade pumps. A vending machine located in Nelson’s Mother’s Room – 2-104 offers breastfeeding supplies for employees at discounted prices. The vending machine accepts debit or credit cards for the purchase of accessory kits, milk storage bags, breast pads, and other supplies.

One of my employees told me she would like to continue breastfeeding after returning to work. How can I best support her?

Supporting breastfeeding after an employee returns to work can be a win-win situation for everyone. You and your employee can plan for the possibility that she will breastfeed after returning to work. When your employee returns, you can review her schedule and work plans. Encourage revisiting the plans periodically to see if any changes need to be made. Email worklife@jhu.edu for a digital copy of the brochure Breastfeeding Support Guide for Managers & Supervisors. Print copies will be available by the end of August.

Did you know your eyes can sunburn? What is the difference between UVA and UVB ultraviolet radiation? Ophthalmologist Maria Soledad Romero of the Wilmer Eye Institute’s Bel Air office, shares preventive measures to protect your eyes during the summer. Read her advice and submit a comment to ask her a question.

What are the best preventive measures to protect your eyes during the summer?

Do not look directly at the sun for a prolonged period of time even during an eclipse, because of the extreme eye damage it may cause. Always wear sunglasses or a visor cap when outside in the sun to protect your eyes.

Who is at risk for UV (ultraviolet) eye damage?

Everybody is at risk (including children and seniors), when spending time outdoors. People specifically at risk include: water skiers or surfers; sunlamp or tanning bed users; fishers; gardeners and people who take any medication that can increase the sensitivity to UV radiation. If you are unsure about your risk level, ask your doctor to estimate your risk. Also at risk are patients with a history of prior cataract surgery. During cataract surgery, the natural lens is removed and replaced by an intraocular lens. Old models of intraocular lens are not UV-absorbent. If you are unsure what model of intraocular lens you have, wear sunglasses and a hat for protection.

What are some of the eye diseases that may be caused by exposure to UV radiation?

Some of the common diseases caused by exposure to UV radiation include: Pinguecula /pterygium (growths on the eye); cataracts of the lens (representing a clouding of the lens); photokeratitis or “sunburn of the eye” which causes redness, tearing and temporary blurred vision; certain types of malignancies of the eye; macular degeneration and solar retinopathy, which is an irritation of the retina due to high exposure to sunlight.

What is the difference between UVA and UVB ultraviolet radiation?

UVA is more dangerous to the skin and eyes than UVB and both are at higher levels during the summer than during the winter. UVA radiation represents a spectral ultraviolet band at lower frequencies (lower energies) than UVB; however, both may be harmful to the eye.

How do I choose the right sunglasses?

The best sunglasses screen out 99 to 100 percent of the ultraviolet radiation of the sun and have good optical quality so the images through the lenses are not distorted. Don’t be fooled by color or price: the ability to block UV radiation is not dependent on the darkness or the lens price. Impact resistant lens will also protect your eyes from most of the eye injuries related to breaking of the glasses while you are wearing them. Plastic and polycarbonate materials are the best option.

Are there particular sun safety tips to protect the eyes of children?

Children also should wear sunglasses that will protect their eyes from UV radiation. Choose a wrap-around style that will protect their eyes from all angles. If they are too young to wear sunglasses, look for sunshades or umbrellas and avoid sun exposure from 11:00 am to 2:00 pm. Don’t be fooled by clouds, the sun rays can pass through the haze and still damage eyes.

For appointments, call 410-893-0480. For more information about Wilmer, visit hopkinsmedicine.org/wilmer.

What is the dependent child tuition program?

This benefit provides tuition assistance for unmarried naturally born, legally adopted children or qualified stepchildren under the age of 26 who are primarily dependent upon the eligible parent for financial support.  The dependents must be enrolled full time in an accredited degree-granting college or university. 

Which employees are eligible for this benefit?

All full time JHHSC/JHH employees, which includes: Johns Hopkins Community Physicians, Johns Hopkins Health Care, The Johns Hopkins Hospital and Johns Hopkins Health System Corporation with a minimum of two years of consistent employment that are in good standing and have not been on corrective action within the past 12 months.

What is covered?

Employees are eligible to receive up to 50 percent, less taxes of the dependent child’s full time undergraduate tuition and mandatory academic fees not to exceed 50 percent of Johns Hopkins University’s freshman undergraduate tuition.  You are not eligible to receive tuition support on room, board, books, materials, part-time or graduate studies.

How do employees apply for this benefit?

Apply for this benefit via the online portal no later than 30 days after the start of the semester.  To access the tuition portal, simply log in to https://myjh.edu with your JHED ID and password.  Click on “Staff” and then click “Enrollment”.  At the bottom of the message, click the “I understand and agree button”.   Select tuition from the tabs at the top of the page.  Click on Dependent Child Tuition.  First time applicants must provide a copy of the birth certificate.  The remaining submissions must include a grade report from the prior semester printed from your dependent’s student portal.  This must contain your dependent’s name and the URL (www.mychild’sschool.edu...) of the site from which it was printed.  The following information also must come from the school’s portal and contain the URL: an itemized bill separating the cost of tuition and fees and your dependent’s enrollment schedule detailing the courses and number of credits.   You will also need a system generated tuition confirmation approval form signed by yourself.

What if the URL did not print with the other information when I printed the forms?

Try using a different internet browser (Internet Explorer, Chrome, FireFox, etc.) as the setting in your current browser may be blocking the URL from printing. 

How long does it take to process my application?

It typically takes four to six weeks to process a tuition request.

How can I check to see if my request has been approved?

Log back into the tuition portal to view the status of your application.  If the status is “released to payroll”, your request has been processed.

How do employees receive the benefit reimbursement?

The benefit reimbursement will be itemized on your paycheck. JHHS/JHH does not pay the school directly. It is helpful to remember that this is a taxable benefit, so JHHSC/JHH may report the benefit amount as taxable income and withhold at a higher tax rate from such benefit amount from the employee’s other salary income. 

For more information, or to view the entire policy, please visit www.hopkinsmedicine.org/human_resources/  and click on Benefits, Tuition assistance, view the Dependent Child Tuition Assistance Policy-HR 335, or call 443-997-5400 and select option 4 to speak to a Tuition Benefits Coordinator. 

Eating to avoid gas, bloating, and flatulence

These uncomfortable and sometimes embarrassing symptoms can be caused by swallowing too much air, eating foods that produce a lot of gas, or having a reaction to a food that your system has trouble digesting. It’s normal to pass gas 18 to 20 times a day. If flatulence or bloating becomes more of a problem, try these tips:

• To avoid swallowing too much air, avoid carbonated beverages. Don’t drink through a straw, and, in general, eat and drink more slowly. Rather than gulping, savor each mouthful.
• Go easy on gas-producing foods such as broccoli, beans, cabbage, and cauliflower.
• Avoid chewing gum, especially gum that contains sorbitol. The air you swallow while gum chewing may cause gas, and sorbitol causes flatulence in some people.
• The protein in milk is hard for many people to digest, a condition called lactose intolerance. If milk products give you gas, try cutting back on how much of them you eat or drink to see if the symptoms go away. The protein in grains such as wheat and rye are also hard for some people to digest. Talk with your doctor if you think you might have problems with these foods.

Eating to avoid heartburn

Everybody gets occasional heartburn. If you have heartburn frequently, especially if it wakes you up at night, you could have gastroesophageal reflux disease, or GERD. Talk with your doctor about frequent heartburn. Try these tips to help avoid it:

• Stop smoking and only drink alcohol in moderation. That means no more than one drink a day for women and two for men.
• Stop eating at least three hours before you go to bed.
• Eat smaller, more frequent meals.
• Avoid foods that are known to cause heartburn, especially fatty foods and foods and beverages with caffeine, chocolate, and peppermint.

Eating to avoid constipation

Just about everybody gets constipated every now and then. It's not usually considered a problem unless you're having bowel movements fewer than three times a week. Before reaching for a laxative, you should know that the most common cause of constipation is your diet. Other culprits include dehydration, too little physical activity, and overuse of laxatives. Try these tips to get more “regular”:

• High-fiber foods such as fruits, vegetables, and whole grains prevent constipation. Too many low-fiber foods such as cheese, eggs, and meat can cause it. Aim to get 25 to 35 grams of fiber in your diet each day. Some high-fiber cereals offer more than half that amount in just one serving.
• Not getting enough fluids is another cause of constipation, but some fluids are better than others. Your best bet is to drink water. Caffeine, colas, and alcoholic beverages can actually dehydrate you and make constipation worse.
• Get some exercise every day. Walking 30 to 45 minutes a day won’t just help with your constipation, it will also improve your mood and your fitness level.
• Ask your doctor if any of the medications you’re taking might be causing constipation and if there are any alternatives.

More eating tips for better digestion

No matter what your digestive health issues are, you’ll probably benefit from choosing whole foods over processed foods. Processed foods are foods that have been changed by food companies before you eat them. Whole foods are foods that are eaten in their natural state, like that shiny apple or juicy tomato.

Processed foods often have a lot of added (and unwanted) fat, sugar, and salt. A lot of their original nutrients may be lost as well. For instance, whole grains have their outer shells removed to become processed grains such as white flour. As a rule, whole foods are better for your digestive health and your overall health. Here are simple swaps to make:

• Choose brown grains such as brown rice and steel-cut oatmeal over white grains like packaged pasta and white rice.
• Choose whole fresh fruits and vegetables over canned fruits and vegetables.
• Avoid processed junk foods, desserts, sodas, juices with added sugar, canned soups, and snack foods.
• Shop around the outside perimeter of your grocery store to find the whole foods.

 Most digestive complaints are short-lived and harmless. But if you notice any unusual symptoms that don’t go away, call your doctor.

Does it feel like every season is allergy season? Does just the thought of pollen make you sneeze? Sandra Lin, associate professor of otolaryngology-head and neck surgery, gives her expert advice on ways to treat seasonal allergies and her thoughts on what’s next in terms of treating asthma and allergies alike. 

1. What is the worst season for seasonal allergy sufferers?

The worst seasons for a person depends on what that individual is allergic to. However, in my practice, most patients say their worst symptoms are in the spring and fall. These seasons are the worst because of tree pollen and weed allergies, which are common in this part of the country and provoke severe symptoms in many patients.

2. Is it true that the allergy season is lasting longer thanks to the warming trend in our environment?

Some studies link climate change to increasing pollen levels. In addition, some studies suggest greenhouse gases, like carbon dioxide and ozone, can increase allergic response.

3. What are the most effective ways to treat seasonal allergies?

Allergies are treated with avoidance of the allergen and medications. For those that have symptoms despite these treatments, sublingual immunotherapy is an option.

4. Can you talk a little bit more about sublingual immunotherapy?

Immunotherapy treats the cause of allergies by giving small doses of what a person is allergic to, which increases “immunity” or tolerance to the allergen and reduces the allergic symptoms. Unlike injection immunotherapy, which is given as shots in a doctor’s office, sublingual immunotherapy is given at home as drops or tablets under the tongue.

5. Do you have any natural remedies that you suggest?

Saline washes of the nose are helpful in washing out allergens, and many of my patients find them to be helpful.

6. What are your thoughts about the new study that suggests that exposing newborns to more dirt and germs lowers allergy and asthma risk?

This is referred to as the hygiene hypothesis. That is the scientific name for the theory that not enough early exposure to allergens and germs increases chances of allergies and asthma. It’s an interesting idea, but this idea needs more study before we can say that it has been proven.

7. Can you allergy-proof your home?

Allergy-proofing should be directed toward the allergens you are sensitive to.  Allergy testing can be helpful in this regard. If you are allergic to outdoor allergens such as pollen, keeping the windows closed and running the air conditioning can be helpful.  For pet allergies, keeping the pet out of the bedroom and washing the pet frequently can help.  For those with dust mite allergies, HEPA filters, mattress covers and washing bedding can help.

8. What do you think the next important research around allergies and asthma will be?

The next important studies, in my opinion, will focus on how we can prevent allergies and asthma. Some studies have shown the immunotherapy can prevent the development of allergic asthma; if we can identify those children at high risk at a young age, we may be able to really impact their lives by preventing the development of asthma and new allergies.

9. Is there anything else you’d like to add that you think our employees should know?

If you have nasal symptoms that aren’t well controlled with simple treatments, seeing a specialist such as an otolaryngologist (ear, nose, throat) is very important.  It could be allergies sinusitis, or another condition that can be helped by a professional.