FOCUS ON NUTRITION - Maryland Academy of Family Physicians

FOCUS ON NUTRITION 

Nutrition Counseling in Pregnancy 

Preventive Strategies for Childhood Obesity 

Managing Diabetes Through Good Nutrition 

Rediscover Dairy: Helping Your Patients 

Manage Lactose Intolerance 

This edition is supported by the Mid-Atlantic Dairy Association 

winter 2013 

Also… 

• Editor-In-Chief: “My 

Prediction” 

• Adjust Your Sails! 

• My Year as a White 

House Fellow 

• February MAFP CME: 

“Considerations in Patient 

and Physician Safety” 

This Edition Approved 

for 2 CME Credits. 

Complete and Return 

Journal CME Quiz at 

www.mdafp.org. 

The Maryland familydoctor / winTer 2013 • 1

225 International Circle | Hunt Valley, Maryland 21030 

410-785-0050 | 800-492-0193 

2 • The Maryland familydoctor / winTer 2013 

Maryland’s largest medical professional 

liability insurer is always on call for you. 

In today’s heated legal environment, even 

the best Doctors feel the constant threat 

of litigation. That’s why there’s Medical 

Mutual, the company created and directed 

by Doctors to safeguard your practice and 

professional reputation. Day in and day out, 

we’re here for you, providing high quality 

professional liability insurance, the most 

proactive claims defense, and the most 

dependable financial strength and stability 

in Maryland. With just one call, we’ll rush in— 

and put your worries out. It’s no wonder why 

more Maryland Doctors are protected by 

Medical Mutual than any other insurer.

tHe MArYLAnD familydoctor 

winter 2013 

Volume 49, number 3 

contents 

FeaTUreS 

10 

12 

13 

15 

17 

18 

23 

26 

Nutrition Counseling in Pregnancy 

by Kathryn Boling, M.D. 


by Jill Cotter, D.O. 

Managing Diabetes Through Good Nutrition 

by Claire Bilski, RN, BSN 

Rediscover Dairy: Helping Your Patients 

Manage Lactose Intolerance 

by Dawn Clausing, RD, LDN 

My Prediction 

by Richard Colgan, M.D. 

Adjust Your Sails! 

by Patricia A. Czapp, M.D. 

My Year as a White House Fellow 

by Kisha N. Davis, M.D., MPH 

February MAFP CME: “Considerations in 

Patient and Physician Safety” 

d e p a r T M e n T S 

4 Board of Directors, Commissions and Committees 

5 President 

The Affordable Care Act: How It Affects Marylanders 

by Yvette Oquendo-Berruz, M.D. 

7 Editor 

Good Nutrition – Back to Basics! 

by Jessica M. Stinnette, M.D. 

11 Calendar 

19 Letter to the Editor 

28 Membership 

Mission Statement 

To support and promote Maryland family 

physicians in order to improve the health of 

our State’s patients, families and communities. 

8 Executive Director 

Thoughts from the Managing Editor 

by Esther Rae Barr, CAE 

20 CME Quiz 


officers & directors 2012-2013/2014 

commissons & commmittees 

PRESIDENT 

Yvette Oquendo-Berruz, M.D.* dr.yvetteoquendo@gmail.com 

PRESIDENT-ELECT 

Kisha Davis, M.D.* kishagreen@hotmail.com 

TREASuRER 

Christine L. Commerford, M.D.* ccommerford8@gmail.com 

SECRETARY 

Eva S. Hersh, M.D.* evastephanie@ymail.com 

VICE PRESIDENTS 

Central 

Jocelyn M. Hines, M.D. jhines001@live.com 

Eastern 

Eugene J. Newmier, D.O. docnewmier@rosehillfp.com 

Southern 

Ramona G. Seidel, M.D. rgms01@verizon.net 

Western 

Matthew A. Hahn, M.D. mhahn@oxbowemr.com 

DIRECTORS 

Central 

Nancy B. Barr, M.D. nancy.b.barr@medstar.net 

Mozella Williams, M.D. mowilliams@som.umaryland.edu 

COMMISSIONS AND COMMITTEES 

Executive Committee of Board of Directors 

Yvette Oquendo-Berruz, M.D. (President) dr.yvetteoquendo@gmail.com 

Kisha N. Davis, M.D. (Pres-Elect as of 9/1/12) kishagreen@hotmail.com 

Christine L. Commerford, M.D. (Treasurer) ccommerford8@gmail.com 

Eva S. Hersh, M.D. evastephanie@ymail.com 

Eugene J. Newmier, D.O. (Immediate Past Pres) 

Commission on Membership and Member Services 

Vice President Central District 

docnewmier@rosehillfp.com 

Jocelyn M. Hines, M.D. 

Bylaws Committee 

jhines001@live.com 

Yvette Oquendo-Berruz, M.D.** dr.yvetteoquendo@gmail.com 

Adebowale G. Prest, M.D. 

Finance Committee 

aprest@surfree.com 

Christine L. Commerford, M.D.** ccommerford8@gmail.com 

Kisha N. Davis, M.D. kishagreen@hotmail.com 

Kevin S. Ferentz, M.D. kev107@aol.com 


Yvette Oquendo-Berruz, M.D. dr.yvetteoquendo@gmail.com 

Joseph W. Zebley, III, M.D. 

Nominating Committee 

josephzebley@mac.com 

Eugene J. Newmier, D.O.** docnewmier@rosehillfp.com 



Katherine J. Jacobson, M.D. (PGY II, FSHC) jacobsonkj@gmail.com 


Trang M. Pham, M.D. 

Member Support Committee 

trangmpham@gmail.com 



Eugene J. Newmier, D.O. 

RH = Rural Health 

docnewmier@rosehillfp.com 

Donald Richter, M.D.** don@mtnlaurel.org 

Matthew A. Hahn, M.D. mhahn@oxbowemr.com 

Andrea L. Mathias, M.D. amathias@dhmh.state.md.us 


Adebowale G. Prest, M.D. 

SC = Special Constituency 

aprest@surfree.com 

Kisha N. Davis, M.D.** (New Phys) kishagreen@hotmail.com 

Jocelyn M. Hines, M.D. (Minority) jhines001@live.com 

Julio Menocal, M.D. (IMG) jmenocal@fmh.org 

Shana O. Ntiri, M.D. (Women) sntiri@som.umaryland.edu 

Eva S. Hersh, M.D. (GLBT) 

Technology Committee 

evastephanie@ymail.com 

Kristen Clark, M.D. kc@wellbeingmedicalcare.com 

Matthew Hahn, M.D. mhahn@oxbowemr.com 


Neil M. Siegel, M.D. 

Commission on Health Care Services and Public Health 

Vice President Western District 

nsiegel@umm.edu 

Matthew A. Hahn, M.D. 

Public Health Committee 

mhahn@oxbowemr.com 

Niharika Khanna, M.D.** nkhanna@som.umaryland.edu 

Kari Alperovitz-Bichell, M.D. kbichell@chasebrexton.org 


Judy B. Davidoff, M.D. (HIV, onc, w hlth) jdavidoff@chasebrexton.org 

Lauren Gordon, M.D. (women’s hlth) lauren.gordon@medstar.net 

Amanda P. Guzman, M.D. (domestic violence) amanda.p.guzman@medstar.net 

Jocelyn M. Hines, M.D. (underserved) jhines001@live.com 

Kenny Lin, M.D. (screeng tsts, lifestyle couns) kwl4@georgetown.edu 

Christine A. Marino, M.D. (oncology) cmarino3@jhmi.edu 

Donald Richter, M.D. (PCMH) don@mtnlaurel.org 

Richard Safeer, M.D. (COPD,cardiovascular) richardsafeer@gmail.com 

Elizabeth Salisbury-Afshar, M.D., MPH esalisbu@jhsph.edu 

Bernita C. Taylor, M.D. bctaylor14@hotmail.com 

Sara A. Vazer, M.D. (immunizations) saravazer@gmail.com 


Eastern 

Andrew S. Ferguson, M.D. akcferg@msn.com 

Rosaire M. Verna, M.D. vernar@georgetown.edu 

Southern 

Patricia A. Czapp, M.D. pczapp@aahs.org 

Trang M. Pham, M.D. trangmpham@gmail.com 

Western 

Kevin P. Carter, M.D. kcart006@gmail.com 

Kristen M. Clark, M.D. kc@wellbeingmedicalcare.com 

AAFP DELEGATES 

William P. Jones, M.D. wpj@georgetown.edu 

Howard E. Wilson, M.D. hwilny@aol.com 

AAFP ALT. DELEGATES 

Adebowale G. Prest, M.D. aprest@surfree.com 

Yvette L. Rooks, M.D. yrooksmd@yahoo.com 

IMMEDIATE PAST PRESIDENT 

Eugene J. Newmier, D.O.* docnewmier@rosehillfp.com 

RESIDENT DIRECTOR 

Katherine Jacobson, M.D. (FSMC) jacobsonkj@gmail.com 

STuDENT DIRECTOR 

Andrea Schulze (UM) andrea.schulze@som.umaryland.edu 

*Member of Executive Committee 

Commission on Legislation & Economic Affairs 

Vice President Southern District 

Ramona G. Seidel, M.D. 

Governmental Advocacy Committee 

rgms01@verizon.net 

William P. Jones, M.D.** wpj@georgetown.edu 

Kari Alperovitz-Bichell, M.D. kbichell@chasebrexton.org 


Patricia Czapp, M.D. pczapp@aahs.org 


Robert S. Goodwin, M.D. drrgoodwin@verizon.net 

Kim R. Herman, M.D. kimherman2@gmail.com 

Katherine J. Jacobson, M.D. (PGY II, FSHC) jacobsonkj@gmail.com 

Kenneth B. Kochmann, M.D. kbkochmann@comcast.net 

F. George Leon, M.D. fgleon56@gmail.com 


Ben E. Oteyza, M.D. boteyza@msn.com 


Neil M. Siegel, M.D. nsiegel@umm.edu 

Rosaire M. Verna, M.D. vernar@georgetown.edu 


Commission on Education 

Vice President Central District 

Vacant 

Education Committee 


Shana O. Ntiri, M.D.** sntiri@som.umaryland.edu 

Nancy Beth Barr, M.D. nancy.b.barr@medstar.net 

Kristen M. Clark, M.D. (SAM) kc@wellbeingmedicalcare.com 

Lauren Gordon, M.D. lauren.gordon@medstar.net 

Eva S. Hersh, M.D. evastephanie@ymail.com 

Niharika Khanna, M.D. nkhanna@som.umaryland.edu 



Adebowale G. Prest, M.D. aprest@surfree.com 

Ramona G. Seidel, M.D. rgms01@verizon.net 

Netra Thakur, M.D. netra.thakur@medstar.net 

Howard E. Wilson, M.D. (SAM) hwilny@aol.com 

Marc Wilson, M.D. emnluv@aol.com 


Publications Committees 

MFD = MFD Editorial Board 


Richard Colgan, M.D.** rcolgan@som.umaryland.edu 

Patricia A. Czapp, M.D. pczapp@aahs.org 

Joyce Evans, M.D. joycespeaks@yahoo.com 

Trang M. Pham, M.D. trangmpham@gmail.com 

Ryane A. Edmonds, M.D. raedmonds2@hotmail.com 

Jessica M. Stinnette, M.D. jessica.m.stinnette@medstar.net 

Tracy A. Wolff, M.D., MPH tracy.wolff@gmail.com 


EB = E-Bulletin 


Joseph W. Zebley, III, M.D. ** josephzebley@mac.com 



Jocelyn M. Hines, M.D. jhines001@live.com 


Kevin S. Ferentz, M.D. ** 

PRA = Public Relations & Awards 

kev107@aol.com 



**Chair 

josephzebley@mac.com

president 

The Affordable Care Act: 

How It Affects Marylanders 

Yvette Oquendo-Berruz, M.D. 

WITh The 2012 re-election of President 

Obama (like it or not), along with the prior 

vote of the Supreme Court upholding its 

constitutionality, the Patient Protection 

and Affordable Care Act (ACA) is here to 

stay! Personally, I am grateful that this 

new health care law will force insurance 

companies to provide needed coverage 

without delays or denials for pre-existing 

conditions or dropping coverage when a 

sickness occurs. The law also bans health 

plans from imposing lifetime dollar benefits 

on health benefits which will provide 

peace of mind to cancer patients or individuals 

with chronic health conditions 

that consume higher health care dollars. 

Is estimated that 46,000 young adults 

in Maryland gained insurance coverage 

with the provision that they could stay on 

the health plan of their parents until age 

26. The health care law has also already 

provided much needed help to senior 

citizens under the Medicare prescription 

drug coverage provision of the ACA which 

helps them to afford the cost of brand 

name prescriptions when they hit the 

Medicare Part D coverage gap also called 

the “donut hole.” The ACA also stipulates 

that the donut hole will close by 2020. 

Since 2011 preventive services such 

as mammograms and colonoscopies 

have been provided without the need 

for co-pay or deductibles for both private 

and Medicare insurance. This will 

most certainly allow us to encourage 

patients to get these much needed preventive 

services. 

Under this new law, health plans will 

need to spend 80% of premium dollars 

on health care and quality improvement 

services instead of overhead and salaries. 

If they do not they will need to provide 

health consumers with a rebate or 

reduce premiums. 

Here are some significant aspects of 

how the ACA is and will continue to benefit 

Marylanders: 

• As of August 2012, a new Pre-existing 

Condition Insurance Plan (PCIP) 

was created under the health care 

law which has already insured 1113 

Maryland residents who, due to preexisting 

conditions, had not been able 

to secure insurance. 

• Maryland has already received 

$157,512,122 in grants for research, 

planning, information technology 

development and implementation 

of Affordable Insurance Exchanges 

to assist newly insured individuals to 

access the best plans for them. 

• Maryland has already been provided 

$16,000,000 in grants from the Prevention 

and Public Health Funds. 

• Maryland based Community Health 

Centers, invaluable resources for the 

under and uninsured Maryland residents, 

will receive increased funding. 

• ACA is providing much needed funds 

to support the health care workforce, 

by assisting with the re-payment of 

educational loans to those health 

continued on page 6 

tHe MArYLAnD 

familydoctor 

Winter 2013 

Volume 49, Number 3 

Editor-in-Chief 

Richard Colgan, M.D. 

Edition Editor 

Jessica M. Stinnette, M.D. 

Managing Editor 

Esther Rae Barr, CAE 

Editorial Board 

Zowie S. Barnes, M.D. 

Patricia A. Czapp, M.D. 

Ryane A. Edmonds, M.D. 

Joyce Evans, M.D. 

Trang Mai Pham, M.D. 


Tracy A. Wolff, M.D., MPH 


pcipublishing.com 

Created by Publishing Concepts, Inc. 

David Brown, President • dbrown@pcipublishing.com 

For Advertising info contact 

Tom Kennedy • 1-800-561-4686 

tkennedy@pcipublishing.com 

EDition 11 

Publisher 

Maryland Academy of Family Physicians 

5710 Executive Dr., Suite 104 

Baltimore, MD 21228-1771 

410-747-1980; 410-744-6059 Fax; 

info@mdafp.org 

The Maryland Family Doctor is published four 

times annually and is the official publication of 

the Maryland Academy of Family Physicians. 

The opinions expressed herein are those of the 

writers and not an official expression of Academy 

policy. Likewise, publication of advertisements 

should not be viewed as endorsements of 

those products and services by the publisher. 

Readership: over 10,000. Copyright: All contents 

2003 MAFP. All rights reserved. 

Contributions and Deadlines 

Those interested in submitting articles for 

publication can view the Author’s Protocol Sheet 

by clicking on News and Publications at www. 

mdafp.org or contacting the headquarters 

office. Deadline schedule for submitting articles: 

May 15, August 15, November 15, February 15. 


Johns hopkins 

Community 

physiCians 

continues to grow, and is 

looking for board certified/ 

board eligible physicians to 

join well-established practices 

in suburban/rural Maryland 

communities located near 

Baltimore, Maryland. 


president (continued) 

professionals who chose to 

practice in health professional 

shortage areas in our State. 

• ACA is also providing funds to 

support other public health 

outreach efforts such as: 

School based Health Centers, 

Aging and Disabilities Resource 

Center, Centers to support families 

with children with special 

health care needs and Maternal, 

Infant and Early Childhood 

Visiting Programs. 

In spite of the fact that there are 

provisions in this comprehensive 

health care law that many of us do 

not like… and I agree that the law 

is not perfect. However, I celebrate 

the fact that we are moving in the 

right direction. ■ 

Current opportunities in Westminster and Annapolis practices offer a choice of 

urban, suburban or rural practice styles with a variety of recreational and cultural 

opportunities. These are outpatient primary care settings, all within 10 to 60 

miles of Baltimore. Night call is less than once per month with no inpatient or 

OB obligation. Enjoy an opportunity to practice high-quality medicine with a 

competitive salary and benefits as part of the Johns Hopkins health system. 

You can visit these practices at www.hopkinsmedicine.org/jhep. 

If you are interested in any of these positions, or would like more information, 

please contact Steven Blash, MD at: sblash1@jhmi.edu. 

Johns hopkins Community physician 

3100 Wyman Park Dr., Baltimore, MD 21211 

240.291.1812 • www.hopkinsmedicine.org/jhep

editor 

Good Nutrition - Back to Basics! 


GeNeRAl NUTRITION has always been 

an interest of mine, but peaked during a 

patient encounter very early in my intern 

year. I was warned by the CMA that the 

12 year old was heavy, but with a high BMI 

and borderline hypertension, I was amazed 

at his mom’s response to my concerns, “I 

didn’t know that letting him drink a 

2 liter bottle of orange soda a day 

was a problem.” I have watched 

American waistlines grow, as has 

the rest of the world. In the news, 

rarely does a day go by, when nutrition 

isn’t addressed: soda taxes in 

New York, antioxidants found in 

some corner of the rain forest. Lifestyles 

have changed so drastically, 

and with it, our diets. 

The common belief is that busy 

lives mean less time to shop and 

prepare meals, and that “quick 

fixes,” like take-out, are needed. I 

try to debunk this with each patient 

encounter, as I hear “Doc, I don’t 

know why I’m gaining weight. I 

promise I’m eating okay. I read that 

this could be my thyroid.” This is my 

open door to educate on how simple 

it is to really eat healthy while 

having a busy life, and I always 

give my patients my two secrets: 

my crock pot and my vegetable 

steamer. I have found myself going 

back to the basics to teach patients to be 

smart consumers: from reading food labels, 

to spending the majority of their grocery 

shopping in the produce section. 

I’m very excited about this edition with 

its several great articles centering on nutrition. 

Dr. Kathryn Boling, a former OB NP, 

writes on how to properly counsel obstetrical 

patients on their diets, debunking the 

“you’re eating for two” myth. Dr. Jill Cotter, 

a former dietician, focused on childhood 

obesity. Claire Bilski writes from a RN’s 

perspective on how to counsel diabetic 

patients and Dawn Clausing, RD from the 

Mid-Atlantic Dairy Association brings focus 

to lactose intolerance. 

There are many barriers to making healthy 

food choices: lack of local resources, finances, 

Mobile PaPer Shredding & recycling 

• Security-cleared personnel 

• Offices coast to coast 

• Locked containers supplied 

• Shredded in our truck at your location 

• Call for a free estimate 

I have watched 

American waistlines 

grow, as has the 

rest of the world. 

allergies. The key is to identify those barriers 

and help patients and their families start 

moving towards healthier lifestyles. ■ 

Dr, Stinnette, a PGY-III at the Medstar Frank- 

lin Square Medical Center Family Medicine 

Residency, joined the MAFP Editorial Board 

last year and has been a regular contributor 

to the Residency Corner segment of this 

publication. She edits this, her first edition. 

The top law enforcement 

agencies and corporations 

in the world use Shred-it! 

Est. 

1988 410-796-1500 

1-800-697-4733 (1-800-69-SHRED) 

www.shredit.com 

ON-SITE PAPER 

SHREDDING 


executive director 

Thoughts from the Managing editor 

esther Rae Barr, CAe 

WITH THIS eDITIOn of The Maryland 

Family Doctor Editor-In-Chief Dr. Richard 

Colgan’s service in that important position 

comes to an end. He gives his reasons for 

stepping down in “My Prediction” on p. 

17. His has been an extremely productive 

tenure since his succession to the position 

following the untimely passing in 2001 of 

then EIC Dr. Marion Friedman. 

Dr. Friedman was MAFP President-Elect 

in 1983… instrumental in my being hired 

that year as MAFP Executive Director. To 

me, and I know to a host of others, he was 

a mentor, role model, teacher, leader. He 

was the consummate family physician setting 

an example (and a high bar) for his colleagues 

and young physicians in training. 

His career-long involvement in the affairs 

of MAFP, his devotion and skills as a motivator, 

helped grow the organization from 

its formative years to its continued position 

of strength and viability among AAFP 

chapters and among medical specialty societies 

in Maryland. The mere mention of 

his name evokes so many memories and 

experiences that I could go on… but getting 

back on track…. 

The evolution of this publication has 

been progressive and interesting. When 

I started with MAFP, we had a quarterly 

newsletter. Prior to that, there were intermittent 

modest newsletters prepared and 

published by whomever may have taken 


The evolution of this publication has been 

progressive and interesting. When I started 

with MAFP, we had a quarterly newsletter. 

Prior to that, there were intermittent modest 

newsletters prepared and published by 

whomever may have taken an interest or was 

assigned as ex officio from the MAFP Board. 

an interest or was assigned as ex officio 

from the MAFP Board. The person who 

“took the reins” in the late 1970s to the mid 

1980s was Dr. Alva Baker of Westminster. 

Dr. Baker realized that the “MAFP Newsbulletin” 

should be an important benefit 

of membership, a tangible tool for members 

to use in receiving information about 

the MAFP and about the still relatively new 

specialty of Family Medicine. 

In 1986 when he was Immediate Past 

President, Dr. Friedman became EIC. He 

envisioned the publication to be a more viable 

and valuable MAFP program. With his 

foresight and leadership the MAFP Editorial 

Board was created, CME accreditation was 

achieved and advertising was accepted to 

help offset production and mailing costs. 

When Dr. Colgan took over as EIC in 

2001, he saw the need for regular bi-annual 

meetings of the Editorial Board where 

the next 8-10 edition themes were developed 

and editors assigned. This would 

insure continuity and content, especially 

as we sought to produce a CME-accredited 

publication of high quality. He created the 

position of Resident Editor to keep readers 

apprized of news from Maryland’s two residencies 

(thru the Residency Corner segment) 

but also to increase and strengthen 

the Editorial Board pipeline. 

Dr. Colgan has overseen the production 

of 48 successful editions! He has been 

a steady, behind the scenes force. Not 

wanting to overshadow or micromanage 

the edition editor or the managing editor 

(me), he has always been there for us, 

responsive to often needed assistance 

and guidance. His tasks have ranged 

from honest critique of submitted and 

prospective articles to approval of ads to 

transition in production companies. He 

has overseen the publication’s evolution 

into the computer age. With technology, 

in addition to the transference of files to 

be completely automated in the production 

phase, MAFP now provides online 

digital versions at www.mdafp.org (each 

with a 2-year shelf life) where readers 

can also take and submit CME quizzes for 

credits averaging 24 per year! 

Happily, Dr. Colgan has agreed to remain 

on the Editorial Board and will edit 

the next Spring, 2013 edition. His successor 

as EIC will be Dr. Joyce Evans, a MAFP 

Past President (2003-04) and member of 

the Editorial Board since its beginning. 

I wish her success and enjoyment as 

MAFP’s EIC. 

My work as managing editor for The 

Maryland Family Doctor is fun. I like my 

role in coordinating all aspects and players 

and occasionally writing. The Editorial 

Board is made up of a dedicated and 

talented group of volunteers. Working 

with them continues to be a privilege.

Consultative 

insuranCe 

review 

Med Chi Insurance Agency was 

established in 1975 “by physicians 

for physicians” to satisfy the needs 

of doctors and medical practices. 

Contact Keith Mathis at 800.543.1262, 

ext. 4422 or KMathis@medchiagency.com 

today to schedule your “no obligation” 

review at no cost! 

Insurance and Financial Services 

Owned by MedChi, The Maryland State Medical Society 

1204 Maryland Avenue, Baltimore, Maryland 21201 

410.539.6642 or 800.543.1262 

410.649.4154 fax 

www.medchiagency.com 

Your “no obligation” 

review inCludes 

the following: 

employee benefits: 

• Group Medical, Dental, and Vision 

Coverage 

• Group Life & Disability 

• Voluntary Benefits 

Property & liability: 

• Medical Malpractice 

• Workers Compensation 

• Medical Office Insurance 

• Employment Practices Liability 

• Directors & Officers Liability 

• Privacy/Data Breach Coverage 

• Bonds (Fiduciary/Fidelity/ERISA) 

Personal: 

• Life Insurance 

• Disability (Individual/Pension/Business 

Overhead) 

• Annuities 

• Long Term Care 

• Estate Planning/Retirement Planning 

• Auto/Homeowners/Umbrella Coverage 

The Maryland familydoctor / winTer 2013 • 9 

■

nutrition Counseling in Pregnancy 

Kathryn A. Boling, M.D. 

In 1962 while my mother was pregnant 

with my sister, her doctor prescribed diet 

pills in order to keep her total pregnancy 

weight gain below 25 lbs. By 1979, when I 

had a baby of my own, the practice of prescribing 

diet pills was long over, but due 

to very little nutritional guidance, I gained 

70 lbs over the course of my pregnancy. 

Things have not changed much since the 

1970s: most women have no idea how to 

manage weight gain during pregnancy and 

many physicians remain at a loss on how to 

counsel their prenatal patients about this 

issue. Effective counseling for pregnant 

women is a powerful weapon against this 

ignorance, but will only occur if the physician 

understands the importance of nutritional 

education in prenatal visits. 

As part of an initial prenatal visit, all 

women should be counseled to eat a wellbalanced 

and varied diet that includes 

meats, dairy products, fruits, vegetables 

and grains. It is important that women and 

their physicians understand that baseline 

caloric requirements do not increase until 

the second and third trimesters of pregnancy 

– and then only by 340-450 calories 

a day. Whether or not pregnant, a person’s 

baseline caloric needs depend on body size 

and exercise activity. In general, sedentary 

persons will remain at a stable weight 

if they consume 13 calories per pound of 

body weight each day. Exercise (depend- 


ing upon the intensity) raises that maintenance 

requirement to 16-18 calories per 

pound of body weight daily. 1 

This means a moderately active 125 lb 

women will need approximately 2,000 calories 

a day to maintain her weight if she is not 

pregnant. During pregnancy, she will need 

the same 2,000 calories a day until her second 

trimester of pregnancy when she will 

require between 2300-2500 calories a day. 

Most guidelines recommend that women 

with a normal BMI gain between 25-35 lbs 

during pregnancy. Higher or lower weight 

gain has been associated with increased 

risks to mothers and babies. Understanding 

these basic guidelines surrounding the 

daily caloric requirements of both pregnant 

and non-pregnant patients is the cornerstone 

to helping all patients maintain a 

healthy weight throughout the course and 

changing circumstances of their lifetimes. 

Besides routine counseling about alcohol, 

cigarette smoking, and drug use, pregnant 

women should also be counseled 

regarding the use of nutritional supplements 

in pregnancy. Many patients are 

already taking nutritional supplements, 

and certain ones may even be harmful during 

pregnancy. For instance, Vitamin A 

intake should be limited to less than 5,000 

units a day as higher levels have been implicated 

in fetal defects. This is in contrast to 

other supplements that are recommended 

both before and during pregnancy like 

folic acid supplementation (0.4-0.8mg) 

which should be started at least 1 month 

pre-conception and taken at least until 

the 12th week of gestation in order to prevent 

neural tube defects. Other supplements 

may be required depending upon 

the patient’s usual dietary habits. Patients 

who have been screened and found to be 

anemic may require iron supplementation. 

Patients whose diets are deficient in cal- 

cium may require supplementation to meet 

the calcium requirement during pregnancy 

of 1000mg-1300mg each day. Women who 

live in areas with decreased sunlight may 

require Vitamin D supplementation – but 

no more than of 200IU per day as higher 

levels may be toxic to the fetus. 2 

Part of the initial pregnancy visit should 

include a diet history from the patient. This 

can help the physician tailor his or her recommendations 

regarding diet. There are 

many common dietary practices that might 

require education and/or modification. 

For instance, women who consume artificially 

sweetened foods and drink should be 

counseled regarding the unknown effects 

of these sweeteners, especially saccharin 

– which is known to cross the placenta and 

may remain in fetal tissue. Caffeine can 

probably be consumed in moderation, but 

should be limited to 150-300mg/day (about 

1 ½ cups of coffee). 

Women should avoid unpasteurized 

milk and milk products as pregnant women 

have increased susceptibility to Listeria and 

Toxoplasmosis, bacteria sometimes found 

in unpasteurized milk products. Soft 

cheeses, lunch meats and meat spreads 

may also carry Listeria, and pregnant 

women should be counseled regarding 

this risk. Everyone should avoid raw eggs, 

but pregnant women should be counseled 

specifically about the risk of Salmonella 

leading to intrauterine sepsis. Finally, pregnant 

women should wash all fruits and 

vegetables before eating them and should 

use caution regarding foods cut on a cutting 

board that may have not been properly 

washed between uses. 

Herbal preparations should be used 

with caution as many have never been 

tested for safety. Teas containing ginger, 

citrus peel, lemon balm, and rose hips are 

probably safe. However, pregnant women

should avoid teas containing chamomile, licorice, 

peppermint or raspberry leaf as there is some 

controversy regarding their safety in pregnancy – 

particularly the first trimester. 3 

To avoid Listeria, leftover foods should be 

thoroughly heated and processed meats like hot 

dogs should be heated to steaming hot. Raw or 

undercooked meats should be avoided to prevent 

Toxoplasmosis. Utensils and cutting boards 

used to cut these foods should be washed with 

soap and water before further use. 

Pregnant women should limit their intake of 

fish and seafood products to 12 ounces per week 

(about two fish meals/week). Pregnant women 

may eat farm-raised salmon in moderation, however 

they should avoid raw seafood of any type 

due to possible contamination with parasites and 

Norwalk-like viruses. Due to high levels of mercury, 

seafood like shark, swordfish, king mackerel, tilefish, 

tuna steaks and other long-lived fish high on 

the food chain should be avoided completely. 3 

In essence, the nutritional component of 

prenatal counseling is extremely important. It 

begins with a clear and concise explanation of 

the basics – calorie requirements before, during 

and after pregnancy. It continues as the physician 

obtains a good dietary history and tailors counseling 

to address relevant dietary issues. And 

most importantly, it is not a one-time counseling 

session: nutritional counseling and guidance 

should continue throughout the pregnancy as 

caloric requirements change and issues arise. It 

is through this education that patients will obtain 

the most benefit – both to their own health and 

that of their newborn baby. 

■ 

Dr. Boling is a PGY-2 at the Medstar Franklin Square 

Medical Center Family Medicine Residency in Baltimore. 

Prior to entering medial school, she practiced 

for many years as a Nurse Practitioner specializing 

in Women’s Health Care. 

Note: references for this article are posted at www. 

mdafp.org; publications tab. CME questions for this 

article appear on the Journal CME Quiz at www.mdafp. 

org; CME Quiz tab, Winter, 2013. 

calendar 

2013 

February 23 MAFP Winter Regional Conference 

Sheraton Baltimore North 

Towson 

April 24-26 AAFP Annual Leadership Forum and National 

Conference for Special Constituencies 

Kansas City, MO 

June 27-29 MAFP Annual CME Assembly & Trade Show 

Clarion Fontainebleau Hotel 

Ocean City 

August 1-3 Southeastern Family Medicine Forum 

Lexington, KY 

August 1-3 AAFP National Conference for Family Medicine 

Residents and Medical Students 


September 23-25 AAFP Congress of Delegates 

San Diego, CA 

2014 

February MAFP Winter Regional Conference 

TBD 

May 1-3 AAFP Annual Leadership Forum and National 

Conference for Special Constituencies 


August 7-9 AAFP National Conference for Family Medicine 

Residents and Medical Students 


October 20-22 AAFP Congress of Delegates 

Washington, DC 

AAFP Scientific Assembly Schedule 

2013 Sept. 24-28 San Diego 

2014 Oct. 21–25 Washington D.C. 

2015 Sept. 29 - Oct. 3 Denver 

2016 Sept. 20-24 Orlando 

2017 Oct. 17-21 Phoenix 

CMe Author Disclosure Statements 

The authors of CME articles in this publication, except for any listed below, 

disclose that neither they nor any member of their immediate families 

have a significant financial interest in or affiliation with any commercial 

supporter of this educational activity and/or with the manufacturers 

of commercial products and/or providers of any commercial services 

discussed in this educational material. 

Dawn Clausing discloses that she is employed full time by the Mid-Atlantic 

Dairy Association. 

Next edition 

□ Focus on Disparities in Health Care 

2018 Sept. 25-29 Boston 

2019 Oct. 22-26 Las Vegas 

2020 Oct. 13-17 Chicago 

2021 Sept. 28 - Oct. 2 San Francisco 



Jill Cotter, D.O. 

Obesity in the pediatric population has 

been rapidly reaching epidemic propor- 

tions in the United States. In 2008, more 

than one third of US children and adolescents 

were considered overweight or 

obese. 1 In Maryland, 28.8% of children met 

criteria for one of these two categories, 2 

representing a threefold increase in the 

past 30 years. 1 

In children older than 2 years, overweight 

and obesity are defined by the body 

mass index (BMI) percentile as determined 

by the CDC growth charts for age and 

gender. A healthy BMI is one that is below 

the 84th percentile. Children whose BMI 

falls between the 85th and 94th percentile 

are considered overweight, and anything 

greater than 95th percentile is obese. 

Behavior-based weight loss and maintenance 

in any population can be challenging, 

expensive and often ineffective. As is 

true of any chronic disease, the best way to 

manage this problem is prevention. In all 

children, education around healthy habits 

should begin in early childhood. 

Complications of Pediatric 

Overweight and Obesity 

There are both medical and emotional 

ramifications of having excess body 

weight as a child. Overweight children are 

more likely to become overweight adults, 

placing them at higher risk of develop- 


ing cardiovascular and cerebrovascular 

disease, hypertension, dyslipidemia, diabetes, 

osteoarthritis and cancer. However, 

medical complications can manifest 

in the childhood years. Type 2 diabetes 

now represents almost 45% of all newly 

diagnosed cases of diabetes in children. 

Other obesity associated complications 

commonly seen in the childhood years 

include asthma, sleep apnea, nonalcoholic 

fatty liver disease, PCOS, hypertension 

and lipid abnormalities. 

Overweight children are also more likely 

to have depression and low self esteem. 

They are less likely to participate in organized 

sports and physical activity, further 

increasing their risk for continued obesity. 

Strategies for Prevention 

Family physicians should be involved 

in the prevention and treatment of pediatric 

weight issues. Healthy eating and 

exercise habits begin in childhood, and 

are largely influenced by family dynamics. 

Children with overweight parents 

are more likely to be overweight in the 

future, even if their current weight is normal. 

3 For this reason, all family members 

should be involved in the education process 

and should be counseled to attain 

and maintain a healthy weight. 

Prenatal and Newborn Counseling 

Preventive strategies should start pre- 

natally by discouraging excessive preg- 

nancy weight gain. Children born large 

for gestational age, to mothers who are 

obese or had gestational diabetes are more 

likely to become overweight children. New 

mothers should be encouraged to breast 

feed exclusively for the first four months of 

life but preferably for the first six months as 

breastfeeding has shown an inverse association 

with the development of obesity. 3,4 

Limit Screen Time 

There is strong evidence to support a 

correlation between time spent watching 

television and childhood obesity. 4 More 

television means less physical activity and 

fewer calories burned. One study reported 

that by age 17, the average child will spend 

more than 3 years of life watching TV. 4 

Current guidelines recommend no television 

before age 2 and limiting recreational 

screen time, including computer and video 

games, to a maximum of 2 hours per day. 5 

Children should not have televisions in 

their bedrooms. 

Physical Activity 

Physical activity is required to increase 

energy expenditure. Not only does move- 

ment support a healthy weight, it aids in the 

development of motor skills and may promote 

cognitive and social development. 3 

Children should engage in at least 1 hour of 

physical activity each day. 5 Neighborhood 

safety and weather may hinder outdoor activity 

in some populations. Clinicians should be 

aware of barriers to outdoor play in the populations 

they serve and have a list of resources 

such as local afterschool programs or YMCAs. 

Healthy Eating 

Diet is one of the most important life- 

style factors to address. Healthy eating 

strategies should encourage moderation. 

Good nutrition starts with eating breakfast 

every day. Children who consistently eat 

breakfast perform better in school and are 

less likely to be overweight. 5 

Research shows that weight increases 

with the number of meals eaten away from 

the home. 5 Fast food and restaurant meals 

are typically high in fat and calories. Families 

should be encouraged to fix the majority 

of meals at home. If financially possible, 

packing school lunches instead of purchas-

ing them will help ensure a healthy meal. 

Clinicians should encourage that meals be 

eaten together as a family5 and ask parents 

to involve kids in meal planning and grocery 

shopping. Allowing children to choose 

new nutritious foods will make them more 

invested in the meal. 

A balanced diet that is low in fat and high 

in fiber from fruits, vegetables and whole 

grains will provide adequate nutrients and 

promote a healthy weight. Current dietary 

guidelines recommend five to nine servings 

of fruits and vegetables every day. If finances 

limit buying fresh fruits and vegetables, 

canned or frozen options can be just as nutritious. 

No-salt- added canned vegetables are 

inexpensive and limit the amount of added 

sodium. Canned fruit that is packed in water, 

not juice or syrup, can provide a healthy, less 

expensive alternative to fresh fruit. 

Children should not consume sugar 

sweetened beverages, 4,5 as they are empty 

calories. Even 100% fruit juice is high in 

sugar without much added nutrition. Eating 

a whole fruit would provide the same 

essential nutrients with fiber that pro- 

Diabetes prevention and management is 

one of the top three conditions we treat at 

motes satiety. Children should have two 

to three servings of low fat or no fat milk 

each day and water as the foundation of 

their fluid intake. 

Oversized portions have become the 

norm and play a significant role in the 

development of obesity. The Plate Method 

is a great tool to teach patients about portion 

sizes. It is important to note that appropriate 

portion sizes are often different than 

the serving size listed on food labels. Teaching 

families how to identify and read nutrition 

labels can give them a powerful tool to 

support their own nutritional health. 

Conclusion 

Family physicians are in a unique position 

to address the prevention of pediatric 

obesity. Providers not only know the medical 

and social history, but also have insight 

into family dynamics. Therefore, they are 

in an excellent position to educate families 

on diet and exercise and promote lifestyle 

modification. Successful prevention of 

overweight and obesity requires identification 

of less healthy behaviors and effective 

the Family Health Center (FHC) at MedStar 

Franklin Square Medical Center (MSFSMC). 

My role as Care Coordinator is to provide 

team based care to patients who are identified 

as high risk patients. The FHC recently 

achieved Patient Centered Medical Home 

(PCMH) status, the model of practice which 

provides continuous, comprehensive and 

coordinated care through a partnership 

between patients and their health team. As 

such care at the FHC is provided through 

“evidenced-based medicine, open access 

and communication, care coordination, 

behavior modification that is relevant to the 

cultural, social and unique family needs. A 

balance between energy intake and expenditure 

is the basis of successful prevention 

of childhood obesity. 

Tools for Primary Care Providers 

• www.choosemyplate.gov 

Interactive nutrition education tool 

• www.letsgo.org 

The 5-2-1-0 Let’s Go campaign to prevent 

childhood obesity 

• www.eatright.org 

The American Dietetic Association provides 

current nutrition information ■ 

Dr. Cotter is a PGY-1 at the Medstar Franklin 

Square Medical Center Family Medicine 

Residency in Baltimore. She is a graduate of 

the University of New England College Of 

Osteopathic Medicine. 


mdafp.org; publications tab. CME questions for 

this article appear on the Journal CME Quiz at 

www.mdafp.org; CME Quiz tab, Winter, 2013. 

Managing Diabetes Through Good nutrition – A Perspective 

Claire Bilski, Rn, BSn 

wellness and prevention with special attention 

to culturally and linguistically sensitive 

care.” My role as Care Coordinator is a 

requirement within the PCMH model. 

In the process of transforming our practice 

to PCMH, we identified our top three health 

conditions to be diabetes, hypertension, 

and hypercholesterolemia. Part of my Care 

Coordinator role is patient population management. 

We have identified our high risk 

diabetic patients (HGA1c > 9%) by running 

reports from our electronic medical records 



Managing Diabetes (continued) 

(EMR) system. I contacted these patients, 

some of which had not been seen for more 

than a year, discussing with them how they 

were managing their diabetes, what were 

their barriers to care, and then arranged 

appointments for these patients to begin to 

re-establish care. I myself learned how to better 

manage our high risk diabetic population. 

Nutrition is one of the hardest obstacles 

for a diabetic patient. Realizing this, I 

reached out to the MSFSMC Diabetes and 

Nutrition Center (DNC) where I was provided 

diabetic and nutritional educational 

tools to use with our patients. I attended 

patient teaching sessions on diabetes and 

nutrition where I learned of various useful 

materials and teaching techniques. Materials 

included Planning Consistent Carbohydrate 

Meals; Meal Planning Tips for Diabetes; 

Diabetes Meal Planning: The Basics, as well as 

websites where patients can find more information. 

The nutritionist at DNC provided 

me with basic teaching tools, including the 

Plate Method, how to read food labels and 

prepare sample menus, the importance of 

portion control and serving size, and carbohydrate 

tracking. 

Below is a general meal plan that I provide 

to diabetic patients at the FHC: 

I emphasize to physicians at the FHC, 

the importance of their guidance in a 

patient’s diabetes management, with special 

attention given to nutrition education. 

This contributes to the process where 

patients are provided with individualized 

nutritional treatment plans where height, 

weight, insulin dependency, and activity 

level are factored in. The patient is encouraged 

to count the amount of carbohydrate 

servings. If patients have difficulty reading 

nutrition labels or carbohydrate count- 


ing, I educate the patient about the Plate 

Method and simple measures on how to 

monitor portion sizes. Meal plans can 

also include low fat, low cholesterol and 

low sodium foods based on the patient’s 

health history and current needs. When 

patients come in for follow up visits, their 

self-management can be easily reassessed 

with a shared EMR system between the 

FHC and the DNC. 

Merck’s Diabetes Education Program, 

“Journey For Control” has also been helpful. 

This program includes educational 

resources such as: “Basic Carbohydrate 

Counting” worksheets; “Living Well with 

Diabetes, A Self-Care Workbook” in collaboration 

with the American Diabetes 

Association. I am certified as a facilitator for 

the company’s “Conversation Mapping for 

Diabetic Care” program. A future goal of 

the FHC is to have a diabetic support group 

for our patients with the focus on diabetic 

care and nutrition. 

In addition to the DNC, an additional 

community resource is the “Journey 

for Control Program,” which provides 

monthly diabetes support classes. FHC 

diabetic patients are urged to avail themselves 

of suggested resources with special 

SNACk PORTIONS CARbOhyDRATeS PeR MeAl 

WOMeN 15gms or one carbohydrate serving 45 gm (3 carbohydrate servings) 

MeN 15gms or one carbohydrate serving 60 gm (4 carbohydrate servings 

attention given to the nutritional classes 

provided by a certified nutritionist. I have 

also attended these classes with the intent 

to invite as many diabetic patients to the 

group classes as possible. 

When we assess a patient, it is important 

to determine the status of a patient’s diabetes 

management, with special consideration 

given to diet. In our EMR system, we 

have encounter forms which I use to evaluate 

the patient’s nutritional status, including 

their diet regimen, their food budget, 

the primary grocery shoppers, whether 

they have been to a nutritionist, and the 

identification of barriers to healthier eating. 

I encourage patients to keep a food diary 

for at least three days, after which I review 

it with the patient and make recommendations. 

Patients are advised about making 

healthier food choices and portion control, 

not just for them, but for the entire family, 

as everyone needs to make better food 

choices in their lives. 

Stress as a factor in successfully controlling 

diabetes is also addressed. Also, having 

diabetes should not make someone feel isolated 

and alone, especially in their journey to 

better management. The journey to diabetes 

control needs to be a partnership among 

the patient, their health care team, family, 

friends and community. 

In summary, I encourage patients to take 

ownership of their diabetes which includes 

taking the necessary time and having 

patience throughout the process. I let them 

know that, as Case Manager, I am available to 

address their concerns and to answer their 

questions. With a team-based collaboration, 

we encourage patients to engage in their 

own care and to use the educational tools 

and resources available to them, specifically 

those which address proper nutrition. I 

always tell my patients,” Do not let diabetes 

control you. You take control of the diabetes.” 

With time, education, and the building 

of trust, I have seen many positive outcomes 

for our diabetic patients. 

■ 

Ms. Bilski is a RN at the Family Health Center 

at MedStar Franklin Square Family Medical 

Center in Baltimore. Her career spans more 

than 30 years including adult medical-surgical 

and ambulatory nursing. 




www.mdafp.org; CME Quiz tab, Winter, 2013.

Rediscover Dairy: 

helping your Patients Manage lactose Intolerance 

Dawn Clausing, RD, LDn 

There is no disputing the important role 

that dairy plays in a healthy diet. Physicians 

and dietitians agree that dairy and its essential 

nutrients are associated with improved 

nutrient intake and diet quality, better bone 

health, and reduced risk of certain chronic 

diseases like hypertension, cardiovascular 

disease and diabetes. 

The significance of dairy’s contribution 

to the diet has repeatedly been acknowledged 

by the Dietary Guidelines for Americans 

(DGA). In the most recent edition (2010), 

milk was identified as the #1 food source for 

three of the four nutrients of concern in the 

American diet: potassium, calcium and vitamin 

D—all nutrients that most people are 

lacking. 1 Per the advice of the DGA, increasing 

the intake of low-fat and fat-free dairy 

products can help bridge that nutrient gap 

between actual intake and recommendations. 

This is great news for the majority of 

the population, but what about patients 

with lactose intolerance? 

People dealing with lactose intolerance 

have the same nutrient needs as everyone 

else, but unfortunately, all too often, the 

easy “fix” for this population is self-directed 

dairy avoidance. Even some healthcare providers 

have often seen lactose intolerance 

as a barrier to recommending dairy to their 

patients who suffer with this condition. Now, 

emerging science in this area is shedding 

light on new information about lactose intolerance 

and how dairy can—and should, 

still be an important part of the diet for many 

in this group. 

What lactose Intolerance is 

and What it is Not 

Lactose intolerance is often misunderstood. 

While health professionals know the 

difference between lactose intolerance and 

a true cow’s milk allergy, many patients confuse 

the two conditions. To clarify, lactose intolerance 

is a sensitivity to the carbohydrate 

(lactose) found in milk and milk products, 

while a milk allergy is an allergic reaction to 

milk protein. Lactose intolerance is related 

to the incomplete digestion of lactose in the 

gastrointestinal (GI) system; milk allergy is 

triggered by the immune system. It is possible 

for people with lactose intolerance to 

enjoy dairy products using simple management 

strategies, but those with a true milk 

allergy should avoid all dairy products. 

The incomplete digestion of lactose, 

due to low activity of the lactase enzyme, is 

called lactose maldigestion; people with this 

condition may be entirely asymptomatic. 

Lactose intolerance occurs when GI disturbances 

follow consumption of more lactose 

than the body is able to digest. So, while 

everyone who has lactose intolerance also, 

by definition, has lactose maldigestion, not 

everyone who has lactose maldigestion has 

lactose intolerance—they may be asymptomatic. 

As a practitioner, it’s important to 

remember that there are varying degrees 

of lactose intolerance. Some people experience 

GI disturbances every time they eat 

foods with lactose, while others may only 

have symptoms if they consume a large 

amount on an empty stomach. 

Lactose intolerance is a very individualized 

condition, so if a patient complains of 

symptoms, a formal clinical diagnosis, via 

testing such as a hydrogen breath test, lactose 

tolerance test, or stool audit test, should 

be encouraged to verify its presence. Once 

confirmed, then management strategies can 

be discussed. However, if lactose intolerance 

is ruled out, then further testing would 

be indicated to investigate other more serious 

conditions that also produce GI disturbances, 

such as irritable bowel syndrome, 

celiac disease, Crohn’s disease, etc. 

What Does the Science Say? 

In February 2010, the National Institutes 

of Health (NIH) Consensus Development 

Conference on Lactose Intolerance and 

Health was convened to examine the latest 

research on lactose intolerance, strategies to 

manage the condition and the health outcomes 

of diets that exclude dairy foods. The 

panel of experts assembled by the NIH concluded 

that eliminating nutrient-rich milk 

and milk products due to lactose intolerance 

may not only be unnecessary to manage the 

condition—it could impact diet and health 

as well2 (see sidebar on the Unintended Consequences 

of Dairy Avoidance). 

Some key findings from the panel suggest 

that while lactose intolerance, both real 

and perceived, does exist, the actual prevalence 

of the condition is unclear. In fact, a 

recent study from researchers at the Baylor 

College of Medicine found that prevalence 

rates may be significantly lower than previously 

believed. 3 

The NIH panel also concluded that 

more research-based strategies are needed 

to ensure appropriate consumption 

of calcium and other nutrients in lactose 

intolerant individuals, and that more educational 

resources and practice guidelines 

are needed as well. 2 



ediscover Dairy (continued) 

What Do health Professionals 

Need to know? 

To help patients best manage the con- 

dition of lactose intolerance, health professionals 

should do three things: 2 

• Encourage formal diagnosis – help prevent 

nutrient shortfalls associated with 

dairy avoidance 

• Recognize there are individual 

variations in the amount of lactose 

that can be comfortably consumed 

– evidence shows that people with 

lactose malabsorption can consume 

at least 12 grams of lactose at a time 

(equivalent to the amount in one cup 

of milk), with little or no symptoms; 

larger amounts can be tolerated if 

ingested with meals and distributed 

throughout the day 

• Talk about the health benefits of dairy 

foods – bone health and beyond; when 

people eliminate dairy, they miss out on 

many health benefits 

Strategies for Solutions 

It’s important to remember that many 

people with lactose intolerance may be 

open to dairy solutions, if they can avoid 

the discomfort associated with dairy con- 

sumption. 4 

The DGA recommends increased consumption 

of nutrient-rich foods—including 

low-fat or fat-free milk and milk products. 

Current recommendations are three cups 

per day for all people 9 years and older. Here 

are some easy-to-remember strategies to offer 

lactose intolerant patients for incorporating 

dairy into their diets: 

• Try It. Try lactose-free milk and milk 

products. They are real milk products, 

just without the lactose, and provide 

the same great nutrients as regular dairy 

products. 

• Sip It. Start with a small amount of milk 

daily and increase slowly over several 

days or weeks to increase tolerance. 


UNINTeNDeD CONSeqUeNCeS 

OF DAIRy AvOIDANCe 5 

People who avoid milk and milk products due to lactose 

intolerance miss out on many health benefits associated with dairy 

consumption. Dairy has a unique nutrient package comprised of 

nine essential nutrients including calcium, potassium, vitamin D 

and high quality protein. Without milk, cheese and yogurt in the 

diet, its very difficult for people to meet the recommended intake 

level of several key nutrients. 

Current evidence indicates that dairy and its essential nutrients 

are associated with: 1 

• Improved nutrient intake and diet quality 

• Better bone health 

• Weight management 

• Reduced risk of certain chronic diseases (i.e., cardiovascular 

disease, hypertension and type 2 diabetes) 

Stir It. Mix milk with other foods, such 

as smoothies, soups or sauces – or pair 

it with meals. This helps give the body 

more time to digest it. 

• Slice It. Top sandwiches or crackers with 

natural cheeses such as Cheddar, Colby, 

Monterey Jack, mozzarella and Swiss. 

These cheeses are low in lactose. 

• Shred It. Shred a favorite natural cheese 

onto soups, pastas and salads. It’s an 

easy way to incorporate a serving of 

dairy that is low in lactose. 

• Spoon It. Enjoy easy-to-digest yogurt. 

The live and active cultures in yogurt 

help to digest lactose. 

Accurate diagnosis, knowledge of the 

variation in symptoms, and individualized 

strategies for management, are tools all 

healthcare providers can use to help their 

lactose intolerant patients successfully manage 

their condition. Successful manage- 

ment is the key for these patients to enjoy 

dairy again—and reap the many health benefits 

at the same time. 

■ 

Ms. Clausing is a nutrition communica- 

tions manager and media spokesperson 

for Mid-Atlantic Dairy Association. She has 

significant experience in developing and 

marketing nutrition education materials for 

educators and health professionals to use 

with their students, clients and patients. 

As a registered dietitian with more than 

15 years of experience in the field, Dawn 

is committed to communicating nutrition 

messages that promote wellness, health 

promotion and disease prevention. 




www.mdafp.org; CME Quiz tab, Winter, 2013.

editor-in-chief 

My Prediction 


“The best way to predict the future 

is to create it.” - Abraham Lincoln 

I’ve been involved in the MAFP since 

being urged to do so by Dr. C. Earl Hill in 

1982. I am thankful to my former UMSOM 

residency director for many things, including 

this nudge. The truth is: I’ve gotten a 

great return on my investment from volunteering 

for the MAFP. I’ve gotten more 

then I put in. I love The Maryland Family 

Doctor and the MAFP which is why, with 

the publication of this edition, I am stepping 

down as Editor-in-Chief. The Maryland 

Family Doctor is perhaps the most 

tangible link we have with other family 

doctors in the state and nationally. Over 

the years I’ve looked to The Maryland Family 

Doctor for good articles, tips, and local 

news involving my colleagues. 

Dr. Alva Baker was the first Editor-in- 

Chief, from 1981 to 1986 followed by Dr. 

Marion Friedman whose tenure lasted 

from 1987 until his unexpected passing 

in 2001. I initially accepted this position 

to help stabilize things for a year following 

Dr. Friedman’s passing. That didn’t 

happen. The truth is: serving in this role 

involves a lot of e-mails and bi-annual inperson 

meetings but most all of the work 

is done by the Editorial Board, the managing 

editor Esther Rae Barr, and with the 

sage wisdom of lifelong volunteer Dr. Jos 

So why am I stepping back now from The 

Maryland Family Doctor? I am stepping aside 

in order to give others a chance to serve. 

Zebley. In addition to Dr. Zebley and Ms. 

Barr I would like to thank the other members 

of the Editorial Board, namely: Drs. 

Zowie Barnes, Patricia Czapp, Ryane Edmonds, 

Joyce Evans, Trang Mai Pham, Jessica 

Stinnette, and Tracy Wolff, as well as 

past Board members, for the outstanding 

jobs they have done in bringing to you our 

award winning publication each quarter. 

This year marks my 30th year in medicine. 

I’ve been fortunate to enjoy a great 

residency followed by a wonderful private 

practice in Annapolis, Maryland with Drs. 

Mike LaPenta, Bill Dabbs and Scott Eden, 

whom I also consider my mentors. I didn’t 

dream that things could get better… but 

they did. Returning to the University of 

Maryland and working for the past 14 years 

with medical students and residents has 

been a blessing and taught me a lot. I am 

grateful to my many mentors who have 

helped me over the years. 

So why am I stepping back now from 

The Maryland Family Doctor? I am stepping 

aside in order to give others a chance 

to serve. As Dr. Hill did for me I suspect, 

lately I’ve been focusing on “paying it forward” 

and helping others take on leadership 

roles. I suppose I am trying to create 

the future by serving as a mentor to not 

only the editorial board but rising leaders 

within the University of Maryland’s Department 

of Family and Community Medicine. 

Drs. Mozella Williams, Katye Coniff, Sharon 

Feinstein, James Baronas and Stephanie 

Davis are already setting the world on fire 

in their new roles as Directors of different 

enterprises within our faculty practices and 

educational efforts. Their energy, zeal and 

expertise are inspirational. 

My successor as Editor-in-Chief will 

be Dr. Joyce Evans whom I fully expect to 

do the same with the next editions of The 

Maryland Family Doctor. Dr. Evans has been 

a steadfast, hardworking Editorial Board 

member who will bring a new vision and 

viewpoint to our publication. I am happy 

to stand aside so that she and others can 

bring us fresh new ideas. With future leaders 

like these I am confident that Family 

Medicine in our state, the MAFP and The 

Maryland Family Doctor are in great hands. 

I predict things will only get better. I can’t 

wait to read future issues. 

■ 

Dr. Colgan, a MAFP Past President (1998) 

is an Associate Professor in the Department 

of Family and Community Medicine 

at the University of Maryland School of 

Medicine where he serves as Vice Chair 

for Medical Student Education and Clinical 

Operations. He is the author of Advice to 

the Physician on the Art of Medicine and the 

recently released Advice to the Healer: On 

the Art of Caring (see p. 28). 

Note: To acknowledge his successful run as 

MAFP’s Editor-in-Chief, the Academy will pay 

tribute with a Special Award of Recognition 

at its upcoming 2013 Winter Conference on 

February 23rd. 

Dr. Colgan is stepping aside but not out! 

He will edit the next edition (Spring, 2013) 

focusing on Disparities in Healthcare. 


Adjust Your Sails! 

Patricia A. Czapp, M.D. 

“The pessimist complains about 

the wind; the optimist expects it to 

change; the realist adjusts the sails.” 

- William Arthur Ward 

Memphis, Tennessee hosted the 

2012 AAFP State Legislative Conference 

the weekend immediately before the 

general election on November 6th. Of 

course, speculation about the election’s 

outcome was a pet subject of this annual 

gathering of family docs/political junkies 

from around the nation – we just 

couldn’t help ourselves. 

However, we quickly turned our focus 

to items we knew no election will change, 

for any state: 1) the primary care workforce 

shortage and with it the attendant 

scope of practice issues, 2) Medicaid 

Expansion, Health Insurance Exchanges, 

the Medicaid Bump, and 3) the very real 

threat of shrinking budgets. More than 

ever, state governments are challenged 

to “do more with less” and are seeking 

health care delivery strategies that bring 

more value per dollar spent. Maryland is 

no exception, and in fact is ahead of many 

states in developing - and implementing 

- health care delivery strategy. 

What follows is a synopsis of selected 

items, as discussed at the conference, with 

added emphasis on where we are in Maryland 

at the time this article is written. 


Medicaid expansion: 

The Supreme Court upheld the Affordable 

Care Act’s (ACA) Individual Mandate, 

but ruled that Medicaid Expansion (another 

part of the ACA) must be voluntary for states. 

Maryland is already poised to expand Medicaid 

in 2014 to individuals and families with 

income below 139% of the Federal Poverty 

Level (FPL), translating to $15,000 annual 

income for individuals, $32,000 for a family 

of four. Additionally and importantly, individuals 

already enrolled in Maryland’s Primary 

Adult Care (PAC) will AUTOMATICALLY 

convert to Medicaid coverage as of January 

1, 2014, significantly broadening their available 

scope of health care benefits. 

Medicaid bump: 

Per the ACA, beginning January 1, 2013, 

physician payment for a broad range of primary 

care services provided to Medicaid 

beneficiaries will be reimbursed at a rate 

equal to Medicare. There are also significant 

increases to physician reimbursement for 

administration of vaccines under the VFC 

(Vaccines for Children) program. Maryland 

will implement these important changes 

that make Medicaid a more attractive payer. 

health benefit exchange: 

The ACA requires each state to build and 

operate a Health Insurance Exchange by 

2014, or enroll in a federal exchange, or enroll 

in a hybrid. Maryland will provide its own 

exchange. This is an on-line market place that 

provides apples-to-apples comparisons of a 

broad range of plans offered by commercial 

payers. An individual or family will log in, enter 

limited data, and then, behind the scenes, an 

interface with the IRS and SSA automatically 

calculates their eligibility for either Medicaid 

(if eligible, they are enrolled immediately) or 

for a subsidy on the exchange (if their income 

is above 138% or below 400% of the FPL). 

Now is the best time 

for family physicians 

to come to the 

bargaining table 

with government, 

payers, and even 

employers. 

Navigational capabilities will help all individuals 

and families make the best choice for the 

coverage they purchase. 

Workforce Implications: 

With provisions of the ACA moving ahead 

in Maryland, more citizens will have insurance 

coverage. Who will take care of the newly 

entitled, estimated to be about 300,000 in 

Maryland alone? Scope of practice issues will 

again become prominent as less expensive, 

non-physician providers of care are turned 

to in order to improve access to care. Key to 

improving access to care safely and efficiently 

will be a focus on building multi-disciplinary, 

collaborative teams led by physicians. This 

has been a successful approach in our sister 

states, most notably and recently in Virginia. 

Expanding primary care graduate medical 

education programs, and even re-designing 

the educational model of our own specialty, 

are two current topics of discussion at our 

national leadership level. 

Shrinking budgets: 

You’ve heard the buzzwords, “fiscal 

cliff,” “Medicaid Reform,” “doc fix,” “budget 

deficit” and so on. How should we position 

ourselves to best weather fiscal cuts, if 

those occur? Legislators, government, and 

payers “get” that primary care done well 

can save money. But continued incentives 

are needed to grow and sustain projects like

PCMH. Some states and payers are bargain- 

ing now with PCMH practices to provide per 

member per month incentives that are independent 

of at-risk funding, so that they can 

reward and promote this fundamental and 

enduring value in improving quality of care 

while controlling costs. 

Now is the best time for family physicians 

to come to the bargaining table with 

government, payers, and even employers. 

As the nation and all states seek to fulfill the 

letters 

There is hope 

I have to admit that this racial tension 

can be overwhelming at times. White on 

black, white on latino, latino on black, 

black on latino, latino on latino… and 

I haven’t even started mentioning the 

Myanmar folks. There are plenty of offenses 

to go around. 

It is draining of energy. It seems there 

are never a shortage of hard feelings. If I 

am late to see a patient it can only be because 

they are of a different racial group. 

If we had another matter and couldn’t call 

somebody back with a result in a splitsecond, 

it is because we are obviously discriminating 

or, in some instances, because 

we are who we are. 

As Stephen Stills so famously said “Nobody’s 

right if everybody’s wrong.“ Can’t 

we all see that if you come to my practice 

everybody is on the same boat? You have 

the wrong kind of insurance and now you 

are relegated to my humble services. It 

is not about black, white or brown. It is 

about not having enough green. 

Maybe there is some hope. A faint 

glimmer if you will, but heart-warming 

nonetheless. Just last week a middle aged 

Caucasian male came in to the office for 

Triple Aim (better care experience for individuals, 

improved population health, and 

controlled costs), primary care voices must 

be heard. We have the skill set to help make 

the Triple Aim happen and improve the 

care provided to the communities we serve. 

Those skills, coupled with technology and 

reporting capabilities to demonstrate value 

in both quality and cost, are what lend our 

specialty a unique opportunity at this time 

of enormous change in health care. Let’s 

a physical. Covered with tattoos he explained, 

in an embarrassed fashion, that 

he had obtained them while he was in 

prison. As I examined his abdomen, he 

tried in vain to cover a tattoo that covered 

most of his belly. That, he explained, was 

how he got protection “inside.” It was the 

motto of the AB. What is that? I asked naively. 

The Aryan Brotherhood he stated. 

Man, I thought, this dude is in the 

wrong part of town for my waiting room 

was packed with just about every foreign 

nationality and skin color! And here was 

this ex-con, rippling in muscles and every 

inadequate tattoo boasting of his Aryan 

blood line. But hey, that is part of the deal 

for a doctor. You have promised you will 

take care of everyone…. Even the unpopular 

ones. 

Yet, as I gave him his parting instructions 

he grabbed my hand and he said quietly 

“Doc, let me tuck my clothes in for I do not 

wish to offend anyone in your waiting room.” 

He thanked me sincerely. His eyes misted 

over for, you see, since he had state insurance 

(PAC) he had been turned down 

by his old practice and 3 others. And yet, it 

took a practice that caters to the outcasts of 

the system to take care of his needs. He rec- 

adjust our sails, examine how we can promote 

better care, and help create the success 

we hope to achieve. 

Dr. Czapp of Annapolis is a MAFP Board 

member and member of MAFP’s Legislative 

Committee. She is Chair, Clinical Integration 

at Anne Arundel Health Systems. She writes 

this, her 3rd consecutive report as the Maryland 

Chapter’s representative to the Annual 

AAFP State Legislative Conference. 

ognized a break and I could see in his eyes 

that for him we were all the same color. 

Julio Menocal, M.D. 

Frederick 

Fortunately-Foot exam 

I used to be oblivious to mnemonics. 

That changed when I started teaching 3rd 

and 4th year students. The centerpiece 

disease, in my estimation continues to be 

diabetics. Just recently one of the 3rd year 

students, Danielle Glick put a mnemonic 

together that makes sense!! It describes 

the right interventions every diabetic 

should have at each visit for their illness. 

These are all Class A recommendations by 

the American Diabetes Association. 

Kudos to Danielle Glick, MS III, University 

of Maryland School of Medicine (submitted 

November, 2012). 

Fortunately Foot Exam 

A A 1 C 

Scared Systolic 

Diabetic Diastolic 

Makes Microalbumin 

life Lipids 

very Vaccines 

easy Eye Exam 



letters (continued) 

Additonal Two-Cents… 

Foot exam should be carried out once 

a year by the clinician. It should include 

a monofilament test of the bottom of 

the toes and forefoot. If you wish to purchase 

your own materials (and save some 

money)… you can obtain # 10 Fly fishing 

Monofilament line. In lieu of that, 30 lbs. 

test monofilament regular fishing line will 

do perfectly. You cut a 2 inch length and 

tape it to a tongue depressor. Leave one 

inch of line exposed. Put enough pressure 

on the instrument until the line begins to 

bend. Do not apply any further pressure. 

Map the areas that are not sensitive. 

hemoglobin A1C should be checked 

twice a year. Hopefully the patient returns 

every 3 months. It is controversial to treat 

Hemoglobin A1C under 6.5. In insulin de- 

journal CMe quiz 

Articles 

1. Nutrition Counseling in Pregnancy p. 12 

2. Preventive Strategies for Childhood 

Obesity p. 14 

3. Rediscover Dairy: Helping Your 

Patients Manage Lactose Intolerance p. 17 

The Maryland Family Doctor has been reviewed 

and is acceptable for Prescribed credits by 

the American Academy of Family Physicians 

■ 

(AAFP). This Winter, 2013 edition (vol. 49, 

No. 3) is approved for 2 Prescribed credits. 

Credit may be claimed for two years from 

the date of this edition (expiring October 31, 

2014). AAFP Prescribed credit is accepted by 

the American Medical Association (AMA) as 

equivalent to AMA PRA Category 1 credit toward 

the AMA Physicians Recognition Award. 


pendent diabetics, it could be dangerous. 

Systolic blood pressure in diabetics 

should be treated to under 135 mm/ 

Hg. A diabetic who is hypertensive is 

assumed to be a “Step II” hypertensive. 

Systolic BP primarily affects large vessels 

over small vessels. 

Diastolic blood pressure should be 

treated to under 80, and is an independent 

risk factor for kidney and retinal disease. 

Studies in Type I diabetics have shown that 

use of ace inhibitors decreases progression 

of diabetic retinopathy. 

Microalbumin needs to be checked 

twice a year Even though a lot of “disease 

management” advocate the nephro protective 

benefits of ACE’s and ARBs, most of 

the evidence of these drugs is centered on 

regression of microalbuminuria and not 

Obtain CMe Credit via The Maryland Family Doctor 

on prevention. Once a patient has microalbuminuria, 

it is safe to assume that there 

is retinal and cardiac involvement. Testing 

should be performed by the appropriate 

specialists if needed. 

lipids, especially LDL with the target 

under 70. Since all type 2 diabetics have 

similar cardiac mortality to cohorts who 

have had one MI, 81 mg of ASA daily are 

also recommended. Remember that for 

every 10 points that the triglycerides are 

elevated over 150, you should adjust the 

LDL value upwards by at least 1 mgrs/dl. 

vaccines. Flu, pneumovax (or prevnar 

13), TDAP, zoster. 

eye exam. Dilated retinal pictures once 

a year. 

Julio Menocal, M.D. 

Frederick 

ONLINE COMPLETION AND SUBMISSION OF MAFP JOURNAL 

CME QUIZZES AT WWW.MDAFP.ORG 

The process for completion and submission of MAFP Journal CME quizzes is fully automated. 

Read the CME articles in this edition (listed above) either from your mailed version or 

the online version at www.mdafp.org. Each “live” version is posted online at the Publications 

tab. Access the quiz by clicking on the CME Quiz tab at www.mdafp.org. 

Once on the CME Quiz page (where quizzes for each “live” edition are posted), follow 

the directions. Upon sending, you will receive an immediate confirmation that your quiz 

has been received by MAFP. The confirmation will list the edition and the amount of 

credits earned. 

Those unable to complete/send the quiz using the automated system can get a hard 

copy of the quiz by contacting the MAFP office. Once completed and returned to MAFP, 

the sender will be sent a confirmation by MAFP staff. 

Quiz answers for each edition are posted at www.mdafp.org; Publications tab. 

Readers are responsible for reporting, to AAFP or other entities, credits obtained through 

MAFP’s CME Journal Quizzes. Confirmation of quiz submission will suffice for verification. 

Questions? Contact the MAFP office via email to info@mdafp.org or call 410-747-1980.

The days of 

going without the right 

medical professional 

liability coverage are 

Coverys protection lets you 

move forward with confidence 

The right medical professional liability 

coverage gives you the peace of mind 

necessary to perform at your best. 

That’s why over 20,000 physicians, dentists 

and allied healthcare professionals and 

hundreds of hospitals, health centers and 

clinics don’t leave things to chance. 

They choose Coverys. Financial strength, 

innovative products and services, and 

commitment to your protection make us 

the company you can depend on. 

Go with confidence. Go with Coverys. 

www.coverys.com 

Medical Professional Mutual Insurance Company 

ProSelect Insurance Company • MHA Insurance Company 

Washington Casualty Company

Discover the Concentra difference. 

Concentra is a national health care company focused on improving America’s health, one patient at 

a time. Through its affiliated clinicians, the company provides occupational medicine, urgent care, 

physical therapy, and wellness services from more than 330 medical centers in 40 states. In addition 

to these locations, Concentra serves employers by providing a broad range of health services and 

operating more than 270 worksite medical facilities. Through this complement of services, Concentra 

intends to raise the standard of health by putting individuals first, treating them with clinical 

excellence, and focusing on their ongoing well-being according to our Orange Book values: 

• A healing focus 

• A selfless heart 

• A tireless resolve 

If you are interested in learning more about Concentra, please contact Kim Mote at 877-401-8973 

or MoteK@workatConcentra.com. We’d love to hear from you. 

MDAFP.workatConcentra.com 

Concentra is an equal opportunity employer. 

22 • The Maryland familydoctor / winTer 2013

My Year as a White House Fellow 

Kisha n. Davis, MD, MPH 

Editor’s Note: MAFP is proud of its President- 

Elect Dr. Davis who, after a strict and competitive 

application, was chosen to participate in 

the 2011-2012 class of 15 White House Fellows. 

As her year of service is now complete, she has 

kindly agreed to write of her experience. 

My journey to the White House Fellowship 

began about this time two years ago. 

I had a new baby, a new house, and was 

soon to get a new Masters in Public Health. 

I had spent my time since residency at a 

community health center, living my dream 

doctor job: seeing patients from birth to 

death with a broad range of ethnic and socioeconomic 

backgrounds. A place where 

I could help the poor, but still felt comfortable 

referring my friends to be patients 

there. I often tell the story of the day I saw 

a diabetic homeless man who lived in a 

tent in the park and a woman who had just 

returned from spending the summer on a 

sail boat with her family in back-to-back 

visits. I was happy to be using my skills 

and felt like I was being true to the doctor 

I wrote about in my medical school essays. 

At the same time I felt like something was 

missing. I felt like I wasn’t doing enough to 

help my patients. 

The Affordable Care Act debate energized 

and reminded me that much of what 

affects my patients’ health actually occurs 

outside of the exam room. Can they afford 

their co-pays and medications; is there a 

Dr. Davis with Surgeon General Regina Benjamin and Everett Davis (husband) at the White House spring picnic. 

2011-2012 White House Fellows set to board the George HW Bush Aircraft Carrier 

specialist that will take their insurance; is 

their neighborhood safe enough to get 

the walking I am recommending; are they 

educated on a healthy diet and, if so, can 

they find fresh fruits and vegetables in 

their neighborhood? At the same time it 

became more and more clear that family 

physicians were becoming a dying breed. 

Working as an employed physician at a 

Federally Qualified Health Center protected 

me from some of the payment difficulties 

my colleagues were facing. However, 

as I became more active with MAFP and 

AAFP I realized how burdensome private 

practice was becoming. With these tencontinued 

on page 24 


white House Fellow (continued) 

In return for the Fellowship year, 

President Johnson expected the Fellows 

to “repay that privilege” when they 

left by “continuing to work as private 

citizens on their public agendas.” He 

hoped that the Fellows would contribute 

to the nation as future leaders. The 

central tenets of the program are 

education, leadership, and service. 

sions in mind I pursued the White House 

Fellowship as a way to better understand 

the federal government so that I could be 

a better advocate for my patients and the 

profession of Family Medicine. 

The President’s Commission on White 

House Fellowships was created in 1964 under 

President Lyndon B. Johnson. The intent 

is to draw individuals of exceptionally 

high promise to Washington for one year 

of personal involvement in the process of 

government. In return for the Fellowship 

year, President Johnson expected the Fellows 

to “repay that privilege” when they 

left by “continuing to work as private citizens 

on their public agendas.” He hoped 

that the Fellows would contribute to the 

nation as future leaders. The central tenets 

of the program are education, leadership, 

and service. 

My colleagues and I experienced leadership 

through our placements, having 

the opportunity to interact with leaders at 

the highest level. During my time at the 

US Department of Agriculture (USDA), I 

attended regular senior policy meetings 

with the Secretary and Undersecretaries 

and gained a better understanding of the 

personal dynamic that comes into play 

in government. My experiences at USDA 

ranged from touring a slaughterhouse to 


discussing the childhood obesity epidemic 

with the Prince of Sweden to attending 

Senate budget hearings with Secretary 

Tom Vilsack. 

One of the highlights of the year was representing 

USDA with the US delegation to 

the United Nations for the Commission on 

the Status of Women. I am also proud of being 

able to make some lasting changes to 

support breastfeeding for USDA employees. 

The education program consists of 

roundtable discussions with renowned 

leaders from the private and public sectors, 

and trips to study U.S. policy in action 

both domestically and internationally. 

Our sessions usually took place over 

lunch where our group of fifteen had the 

opportunity to discuss with leaders such 

as President Obama, General Colin Powel, 

Surgeon General Regina Benjamin, and Dr. 

Paul Farmer. We met with over 100 individuals 

who shared their views on a variety 

of topics from leadership lessons to their 

childhood to the challenge of balancing 

work and family. We traveled to Chicago, 

Detroit, New York City, and Brazil, meeting 

with a variety of government, business, 

and philanthropic leaders to learn about 

the impact of US Federal policy on their 

government or organization. 

The education and service programs 

also provided the opportunity for us 

to bond as a class. We met two to three 

times a week for various speakers, service 

projects, or other events. It is the bond of 

friendship amongst the fellows that makes 

this program so unique and special. Our 

group was diverse with physicians, a psychologist, 

military personnel, lawyers, an 

educator, social entrepreneurs and business 

leaders. This fellowship afforded us 

the rare opportunity to share in depth 

views with persons outside of our chosen 

profession. We supported each other 

through births and deaths and will have a 

life long bond. 

There is not enough space here to recount 

all of the fantastic details of the 

experience. Sometimes it felt mundane 

(are we really meeting about having a 

meeting?), sometimes unfathomable (am 

I really walking with the President to the 

Oval office?). All in all, it was a learning experience. 

I learned that to make change 

in Washington, sometimes you have to be 

on the inside, and sometimes you have to 

push from the outside, but the real key 

is knowing when and how to do both. I 

learned that my voice is just as important 

as those who may be dominating the conversation. 

I learned that Family Medicine 

needs to have more of a place at the table 

in Washington. I learned that great leaders 

are just regular people like you and 

me with the commitment and the drive to 

make their vision a reality. 

■ 

Dr. Davis is the Director of Community 

Health and Outreach at Casey Health Institute 

a holistic center for primary care in 

Gaithersburg. 

To learn more about the White House 

Fellows program visit the website: www. 

whitehouse.gov/about/fellows. Applications 

for the class of 2013-2014 are available 

now and due in mid-January.

NEW 

ICD-10 DEADLINE: 

OCT 1, 2014 

2014 COMPLIANCE 

DEADLINE FOR ICD-10 

The ICD-10 transition is coming October 1, 2014. The ICD-10 transition will change 

every part of how you provide care, from software upgrades, to patient registration 

and referrals, to clinical documentation, and billing. Work with your software vendor, 

clearinghouse, and billing service now to ensure you are ready when the time comes. 

ICD-10 is closer than it seems. 

CMS can help. Visit the CMS website at www.cms.gov/ICD10 for resources to get 

your practice ready. 

Official CMS Industry Resources for the ICD-10 Transition 

www.cms.gov/ICD10 


Shana O. Ntiri, M.D. 

From the Program Chair 

On behalf of the MAFP Education Committee 

I am happy to present the February 

2013 Winter Regional CME Conference 

of the Maryland Academy of Family 

Physicians which will afford family physicians 

and other primary care professionals 

opportunities to increase their 

knowledge on a variety of compelling and challenging therapeutic 

and socially pertinent topics. Presentations will relate 

to patient safety in a variety of scenarios, as well as address 

issues in physician safety reflecting environmental factors as 

we practice in today’s world. Of particular interest will be a 

90-minute interactive panel discussion featuring two renown 

trauma surgeons, a psychiatrist and a law enforcement officer. 

During the conference luncheon we will learn about the 

status of health reform in Maryland and congratulate “retiring” 

MAFP Editor-in-Chief (see p. 28) with a special Award 

of Recognition. We will also offer a pre-conference Self Assessment 

Module Study Hall on Preventive Care to satisfy 

requirements of the ABFM. 

Also, following a “green” approach, participants will be 

able to access presentations and other conference materials 

on their electronic devices…. but we will provide a printstation 

for the convenience of others. 

We look forward to having you join us in February! 

Pre-Conference SAM Study Hall 

Friday, February 22, 2013 

American Board of Family Medicine (ABFM) 

Maintenance of Certification (MC-FP) 

Self Assessment Module Session (SAM) – Preventive Care 

Howard E. Wilson, M.D. and Kristin M. Clark, M.D., Facilitators 

Pre-Registration is Mandatory at www.mdafp.org or call 

410-747-1980 

• meet part II requirement for ABFM MC-FP 

• go through the 60 core competency questions 

• 12 CME credits upon completion of the Clinical 

Simulation 

• dinner included 

CONFERENCE AND SAM DETAILS, REGISTRATION 

MATERIALS, HOTEL INFORMATION AND ONLINE 

REGISTRATION AT WWW.MDAFP.ORG OR 

CONTACT 410-747-1980 


MAFP WInTeR ReGIOnAL CMe COnFeRenCe 

CONSIDERATIONS IN PATIENT AND PHYSICIAN SAFETY 

Saturday, February 23, 2013 

Sheraton Baltimore north Hotel, Towson, MD 

APPROVED FOR 7.75 CME CREDITS! 

COnFeRenCe TOPICS AnD FACuLTY 

Child and Adolescent 

Immunizations 

Karen B. Mitchell, M.D. Andrea R. Gauld, PharmD 

Recognizing and Preventing 

Child Maltreatment and Reducing 

Infant Mortality 

Scott Krugman, M.D. Dr. Rebecca Middleton 

Other… 

• Avoiding Pitfalls 

of Prescribing 

Controlled 

Substances 

• Status of Health 

Reform in Maryland 

• SAM Study Hall: 

Preventive Care 

• MAFP Special Award 

of Recognition: 


Safe use and Monitoring of 

Atypical Antipsychotics 

Information Technology and 

Patient Safety 

Panel Discussion: Violence, Gun Safety, Issues in Physician Safety 

Edward E. 

Cornwell, M.D. 

elder Abuse 

George Taler, M.D. 

Thomas M. 

Scalea, M.D. 

Christopher J. 

Welsh, M.D. 

Detective 

Chris Hodnicki, 

BCoPolice 

Richard 

Colgan, M.D.

a new conversation about lactose intolerance 

Most people with lactose 

intolerance say they are 

open to dairy solutions 

as long as they can avoid 

the discomfort associated 

with consuming them. 7 

And research shows that 

people like lactose-free 

milk more than non-dairy 

alternatives. 8 

Help Your Patients 

Enjoy Dairy Again 

* The 2010 Dietary Guidelines for Americans recommends 3 daily servings of low-fat or fat-free milk and milk products 

for those ages 9 and older, 2.5 cups for children ages 4 to 8 years, and 2 cups for children ages 2 to 3 years. 

Many health authorities agree that low-fat and fat-free milk 

and milk products are an important and practical source of 

key nutrients for all people – including those who are lactose 

intolerant. 1,2,3,4,5,6 

In fact, the 2010 Dietary Guidelines for Americans (DGA) 

recognizes dairy foods as an important source of nutrients for 

those with lactose intolerance. 7 Milk is the #1 food source of 

three of the four nutrients the DGA identified as lacking in the 

diets of Americans – vitamin D, calcium and potassium – and 

the DGA recommends increasing intakes of low-fat or fat-free 

milk and milk products to help fill these nutrient gaps. 

A Solutions-Focused Approach 

People who are lactose intolerant should know that when it 

comes to dairy foods, practical solutions can help them enjoy 

the recommended three servings of low-fat and fat-free 

dairy foods every day*, without experiencing discomfort or 

embarrassment: 

• Gradually reintroduce milk back into the diet by drinking 

smaller amounts of milk at a time, trying small amounts of 

milk with food, or cooking with milk. 

• Drink low-lactose or lactose-free milk products, which are real 

milk just with lower amounts or zero lactose, taste great and 

have all the nutrients you’d expect from milk. 

• Eat natural cheeses, which are generally low in lactose, 

and yogurt with live and active cultures, which can help the 

body digest lactose. 

Visit nationaldairycouncil.org for more 

information, management strategies 

and patient education materials. 

These health and nutrition organizations support 3-Every-Day of Dairy, a science-based education program encouraging 

Americans to consume the recommended three daily servings of nutrient-rich low-fat or fat-free milk and milk products, 

to help improve overall health. 

1 U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for 

Americans, 2010. 7th Edition, Washington, DC: U.S Government Printing Office, January 2011 

2 National Institutes of Health Consensus Development Conference Statement. NIH Consensus Development 

Conference: Lactose Intolerance and Health. Draft statement, issued at 7:47 p.m. ET on February 24, 2010. 

http://consensus.nih.gov/2010/images/lactose/lactose_draftstatement.pdf 

3 American Academy of Pediatrics, Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006; 118 

(3):1279-1286. 

4 USDA, FNS. Special Supplemental Nutrition Program for Women, Infants and Children: Revisions in the WIC 

Food Package, Interim Rule; 7 CFR, Part 246. 

5 National Medical Association. Lactose Intolerance and African Americans: Implications for the Consumption 

of Appropriate Intake Levels of Key Nutrients. Journal of the National Medical Association. Supplement to 

October 2009; Volume 101, No. 10. 

6 Wooten, WJ and Price, W. Consensus Report of the Nationals Medical Association: The Role of Dairy and Dairy 

Nutrients in the Diet of African Americans. Journal of the National Medical Association 2004; 96:1S-31S. 

7 J N Keith et al. The prevalence of self-reported lactose intolerance and the consumption of dairy foods among 

African American adults are less than expected. J Natl Med Assoc. 2011;103:36-45 

8 Palacios OM, et al. Consumer Acceptance of Cow’s Milk Versus Soy Beverages: Impact of Ethnicity, Lactose 

Tolerance And Sensory Preference Segmentation. Journal of Sensory Studies, 2009; 24:5. 

©2011 National Dairy Council® 


members 

News For and About MAFP Members 

Advice to the healer: On the Art of Caring 

Note: MAFP Past President (1998) and retir- 

calling can provide. 

ing Editor-in-Chief (see p. 17) has published 

The healing profes- 

his 2nd book described below. His first book 

sions have an ancient 

Advice to the Physician on the Art of Medicine 

and venerable tradi- 

was published in 2009. Dr. Colgan is an Assotion 

of service, honor, 

ciate Professor at the University of Maryland 

and humanism that 

School of Medicine and Vice Chair for Medical 

is often communi- 

Student Education and Clinical Operations in 

cated from teacher 

the Department of Family and Community to student in anecdotes and bits of wisdom 

Medicine in Baltimore. 

told quickly in passing. Gathering together 

Clinicians-physicians, nurses, dentists, this type of valuable information in one place, 

pharmacists, social workers, psychologists, Advice to the Healer: On the Art of Caring, Sec- 

physician assistants, nurse practitioners, and ond Edition, includes biographies of historical 

others--share the unique responsibility of luminaries in medicine, tales from everyday 

patient care and the limitless fulfillment this practice, inspirational quotes and artwork, 

Residency Corner 

Medstar Franklin Square 

Medical Center 

by Jessica M. Stinnette, M.D., PGY-3 

The recent holiday season 

was an exciting time 

of year, also marking the 

half-way point through 

the academic year with 

the interns well-settled 

in and the third years job searching. Happily, 

the 2012 holiday season also brought 

many bundles of joy, from fellow residents 

to office staff. 

We are pleased to have opened the door 

for international electives. Dr. Joseph Nichols, 

PGY-2, worked with a faculty member 

in a Shoulder-to-Shoulder sponsored trip 

to Honduras. Dr. Matthew Loftus, PGY-2, 

published some reflections in a recent edition 

of Maryland Medicine on the privilege 

of practicing medicine and dealing with 

chronic illness. His piece, titled “Life Can Unexpectedly 

Change in a Moment!” illustrates 

his thoughts as a brand new intern who was 

unable to see patients for several weeks, due 

to his immune-suppressed state. 


Special congratulations also go to 

Dr. Mindy Guzman, PGY-1, who is serving 

as the representative of the MAFP 

to the DHMH Domestic Violence Task 

Force. With representatives from other 

primary care provider groups, the task 

force is working on a protocol for statewide 

screening of domestic violence. Dr. 

Guzman has also been appointed to the 

MAFP Public Health Committee as the 

Domestic Violence “go to” person. 

Our residents continue to strive to be 

community leaders, and we are proud to 

give our kudos to them! 

University of Maryland FM Residency 

by Ryane A. Edmonds, M.D., PGY-3 

This is dedicated to my 

residency class, the 3rd 

year residents at the University 

of Maryland Family 

Medicine Residency. 

It is my pleasure to announce 

that our class will be graduating on 

June 23, 2013. As a group, we have jobs or 

are on our way to signing contracts. 

and advice for new and veteran healers alike. 

“Today, when medical education shortchanges 

basic clinical skills in favor of technology, 

when many young clinicians seem to 

view medicine as a trade instead of a calling, 

and when we see practicing physicians hawking 

their services on roadside billboards, it is 

refreshing to read a book that extols medicine’s 

rich history and traditional values.” 

Robert B. Taylor, MD 

Professor Emeritus of Family Medicine 

Oregon Health & Science University 

For more information go to www.advicetotheyoungphysician.com 

• Dr. Maria Aktar plans to practice Family 

Medicine in Northern Virginia. 

• Dr. Georgia Bromfield plans to go back to 

her home in the New York area and has 

had several interviews to become a newly 

minted attending Family Physician. 

• Dr. Tracy Givens is applying and 

interviewing for Emergency Medicine 

fellowships. 

• Dr. Jessica Lue, a native Marylander, 

plans to practice here in the State, planning 

to focus on Community Medicine 

and Women’s Medicine. 

• Dr. Michael Pitzer plans to become a 

Sports Medicine Fellow next year. 

• Dr. Casey Rice is looking forward to 

practicing on the Eastern Shore with 

her special interests in Adolescent 

Medicine and Sports Medicine. 

• Dr. Castel Santana deserves congratulations, 

as he is the very first resident in 

our class to sign a contract. He will be 

providing inpatient and outpatient care 

at a major hospital in beautiful Oregon. 

• As for me, Dr. Ryane Edmonds, I’m a 

native of the Maryland/DC area as well.

I have a passion for dermatology and 

I plan to make clinical and procedural 

dermatology a great part of my practice. 

So, as you can see we are a diverse 

bunch! We are so eager to complete the 

next 6 months of residency, as we will be 

looking out into a bright future. I’m sure 

that we will all feel some level of nervousness 

and excitement as we step out into 

the world as independent family physicians. 

Thanks to all of our wonderful attendings 

at the University of Maryland, 

who have trained us. We appreciate all 

of the time and attention they’ve given 

us over the last 2 1/2 years. We hope to 

make them proud. We live by our motto, 

because The University of Maryland Family 

Medicine residents truly do it all! 

Congratulations to MAFP Members for Special Appointments, honors, Features, Achievements! 

William D. hakkarinen, M.D., MAFP age serum albumin level in a group of Robin Motter-Mast, M.D. of Cock- 

President 2000-01, of Cockeysville, re- individuals who were found to be diseysville was featured in “Take a Shot at Better 

ceived a Regional Commissioner’s Citation abled compared to an equal group found Health,” an article about flu shots in the Oc- 

from the Social Security Administration in not disabled. Results of the study were tober 18, 2012 edition of The Baltimore Sun. 

an Awards Program at Maryland Disabil- presented at meetings of the National Student member Sarah e. britz (UMD) 

ity Determination Services, Lutherville, Association of Disability Examiners and of Baltimore was featured in “MD med stu- 

on Wednesday, November 7. The Regional the American Association of Social Secudents give the needy holiday fare, care” in 

Commissioner’s Citation is the second rity Disability Medical Consultants. 

the November 23, 1012 edition of The Bal- 

highest award that Social Security gives This is Dr. Hakkarinen’s second Regiontimore Sun. 

to employees who demonstrate the highal Commissioner’s Citation. The first was The following members were honest 

standards of professionalism as estab- awarded in 2004. 

ored in the annual “Top Doctors” edition 

lished by the agency. 

katherine J. Jacobson, M.D. of Catons- of Baltimore Magazine, November 2012: 

Dr. Hakkarinen was noted for his proville, PGY-3, Medstar Franklin Square Family Family Medicine: 

ductivity, participation as a trainer for Medicine Residency and MAFP Resident Di- Richard Colgan, M.D. 

new examiners and medical consultants, rector presented “Forming Holistic Prac- Sarah F. Whiteford, M.D. 

and for his presentation of a study anatitioners: A Case Study in Foreign Medical yvette l. Rooks, M.D. 

lyzing the relationship between serum Mission as a Training Ground for Family Phy- Geriatrics: 

albumin levels and disability. That study, sicians” at the 2012 Family Medicine Educa- Jason black, M.D. 

performed in 2009 with then-examiner tional Consortium Conference in Cleveland, Mel, P. Daly, M.D. 

Debra Masket, MSW, found a lower aver- OH on September 29. 

James P. Richardson, M.D. 

Welcome New Members 

May 1, 2012 - October 31, 2012 

ACTIve 

Nana Y. Adu-Sarkodi, M.D. 

Mariama J. Bah-Sow, M.D. 

Kathleen A. Byrne, M.D. 

Lelin Chao, M.D. 

Eva DiCocco, M.D. 

Thomas E. Dooley, M.D. 

William M. Duggan, M.D. 

Terry L. Everhart, M.D. 

Sharon E. Feinstein, M.D. 

Michael A. Gee, M.D. 

Matthew H. Gibson, M.D. 

Bianca F. Gray, D.O. 

Beth M. Greenwood, M.D. 

William E. Gunn, M.D. 

Mikel A. Hofmann, M.D. 

Alisa D. Ingram, M.D. 

Ruth E. James, M.D. 

Heather M. Kearney, M.D. 

Dhirendra Kumar, M.D. 

Kerry A. Lecky, M.D. 

Heather M. Mancebo, M.D. 

Brian D. Mancke, M.D. 

Rashida E. McCain-Hall, M.D. 

Chalak N. Muhammad, M.D. 

Amarachi E. Nwankpah, M.D. 

Olubayo Oluadara-Fadare, M.D. 

Todd Phillips, M.D. 

Jedlyn Pierrilus, M.D. 

Leone M. Prao, M.D. 

John C. Reed, M.D. 

Sophia L. Robinson, M.D. 

Natalie E. Ruff, M.D. 

Rohit Seem, M.D. 

Priya Shashidharan, M.D. 

Sokpheary Srorn, M.D. 

Melinda L. Sutton, M.D. 

Bhavani Vaddey, M.D. 

Camille Woodson, M.D. 

Chihong Yang, M.D. 

ReSIDeNT 

Sade Adeyi, M.D. 

Megan J. Barber, M.D. 

Janna J. Becker, M.D. 

Mohini K. Bedi, M.D. 

Peter M. Burkill, M.D. 

Corey M. Carson, M.D. 

Maria N. Churaman, M.D. 

Jill Cotter, D.O. 

Erkeda L. DeRouen, M.D. 

Merritt L. Echols, M.D. 

Daniel C. Gold, M.D. 

Amanda P. Guzman, M.D. 

Christine Jalluri, M.D. 

Angela L. Kunzia, M.D., MPH 

Fatmatta Kuyateh, M.D. 

Ho N. Leung, M.D. 

Avinash Narine, M.D. 

Phillip L. Nguyen, M.D. 

Ansu M. Punnoose, D.O. 

Nirmal Ravi, M.D. 

Emily K. Riggs, M.D. 

Margaret T. Sass, M.D. 

Jason Singh, M.D. 

Katherine D. Stolarz, D.O. 

Eric R. Swearengen, M.D. 

Felicia A. Washington, M.D. 

Marian R. Zuses, M.D. 

STUDeNT 

Sheriff O. Abudu 

Ameer Abutaleb 

Sowmya Arja 

Aleksandra Babiarz 

Constance N. Bezankeng 

Andrew E. Bluher 

Laura Bomze 

Sara E. Britz 

Marthe M. Bryant-Genevier 

Steven J. Cassady 

Stephanie Chan 

Haoxing Chen 

Kevin Chun 

Kristen Coletti 

Erin N. Compton 

Rachel Davis 

Andrew Delopenha 

Nizar U. Dowla 

Maria Rosario T. Driscoll 

Lillian Dubiel 

Kevin C. Gauvey-Kern 

Dylan Goldberg 

Miranda Gordon-Zigel 

Kelly Grob 



2013 MAFP ANNUAL 

CME ASSEMBLY 

COMPREHENSIVE 

ERENCE 

Including “Dermatology Day 

at the Beach” on Saturday 

Presented by the Faculty, 

Department of Dermatology 

University of Maryland 

School of Medicine 

CLARION FONTAINEBLEAU 

RESORT HOTEL 

Ocean City, Maryland 

Thursday-Saturday, June 27-29 

MARK YOUR CALENDARS 

DETAILS AS THEY BECOME 

AVAILABLE AT WWW.MDAFP.ORG 

OR CONTACT 410-747-1980 


Members (continued) 

Danielle L. Guiffre 

Ally Ha 

Erin M. Hansen 

Tiffany F. Ho 

Shelly Hwang 

Laura Jenkins 

Syed A. Karim 

Antony G. Kironji 

Gowry Kulandaivel 

Sabrina E. Kunciw 

Hongloan T. La 

James a. Ladd 

Jay Leheri 

Juliana A. Llano 

Juliana Macri 

list of advertisers 

Are you looking for a satisfying career and a life outside of work? 

Enjoy both to the fullest at Patient First. 

Founded and led by a physician, Patient First has been a regional healthcare leader in Maryland 

and Virginia since 1981. Patient First has 42 full-service neighborhood medical centers where our 

physicians provide primary and urgent care 365 days each year. In fact, over 240 physicians have 

chosen a career with Patient First. We are currently looking for more Full and Part-Time Internal 

and Family Medicine Physicians in Virginia, Maryland and Pennsylvania. At Patient First, each 

physician enjoys: 

• Unique Compensation 

• Flexible Schedules 

• Personalized Benefits Packages 

• Generous Vacation & CME Allowances 

• Malpractice Insurance Coverage 

• Team-Oriented Workplace 

• Career Advancement Opportunities 

Nicky Mehtani 

Patrick S. Moon 

Christina Morris-Berry 

Maxine A. Norcross 

Zeke Oliver 

Kevin O’Malley 

Jui Pandya 

Alex L. Pappas 

Edgar Petras 

Kerry E. Phillips 

Meaghan M. Phipps 

Emily Purcell 

Sheila Razden 

Remigio Roque 

Emily Schulman 

Medical Mutual Insurance .................. 2 

Kolmac Clinic.......................................... 6 

Johns Hopkins Community 

Physicians ............................................... 6 

Shred-it ................................................... 7 

Med Chi Insurance Agency Inc. ......... 9 

Coverys .................................................. 21 

Laura Segors 

Brian Stephens 

Sharlene Su 

Ali Syed 

Dina Sztein 

Akina Tamaki 

Milly Turakhia 

Kevin Turek 

Jessica Ullman 

Amanda Wong 

Jessica Yung 

Matthew R. Zeitler 

Samantha Zullow 

Concentra .............................................22 

Centers for Medicare & 

Medicaid Services ...............................25 

Patient First .........................................30 

Concentra ............................................. 31 

American Spine ...................................32 

To discuss available positions please contact Eleanor Dowdy, 

eleanor.dowdy@patientfirst.com or (804) 822-4478. We will arrange 

the opportunity for you to spend time with one of our physicians to 

experience firsthand how Patient First offers each physician an 

exceptional career. 

■

Discover the Concentra difference. 

At Concentra, we’re redefining the patient experience, reshaping it, and making it what it 

should be--for both our patients and our providers. As one of the largest and most rapidly 

growing providers of health care services in the nation, we’re creating exceptional 

opportunities for providers who truly want to practice patient care. We believe that our 

patients should expect more, and that our providers deserve the same: a welcoming and 

respectful team environment in which their individual talents, skills, and leadership are 

recognized and rewarded. 

We offer: 

• CME reimbursement 

• Malpractice coverage 

• Medical license fees 

• Health insurance 

MDAFP.workatConcentra.com 

Concentra is an equal opportunity employer. 

• Performance/productivity incentives 

• Regular hours/minimal on-call 

• Holiday pay 

• 401k 

If you are interested, please contact physician recruiter Kim Mote at 877-401-8973 or 

MoteK@workatConcentra.com. We’d love to hear from you. 

©2012 Concentra Operating Corporation. All rights reserved. 12/12 MDAFP 


MARYLAnD ACADEMY 

of fAMiLY PhYsiCiAns 

5710 Executive Dr., Suite 104 

Baltimore, MD 21228-1771 

freedom from pain 


begins here 

Presorted Standard 

U.S. PoSTAge PAId 

LITTLe Rock, AR 

PeRMIT No. 2437 

with our accomplished team of multi-specialty doctors 

AS Main # 240.629.3939 www.americanspinemd.com 

Sandeep Sherlekar, MD • Atif Malik, MD • Charles Winters, MD • David Rodriguez, DO • PK Grewal, MD • Rickey Kim, DO • Said Osman, MD 

Malini Narayanan, MD • Nilay Shah, MD • Ritu Varma, MD • Mike Yuan, MD • Lindsay Gonzalez, PA-C • Denise Hines, PA-C • Xavier Lennon, PA-C 

Ginger Stewart, PA-C • Cheree Jamison, PA-C • Shirley Coffie, CRNP 

1050 Key Parkway, Suite 102 & 103 

Frederick, MD 21702 

f 240.629.3932 

10700 Charter Dr, Ste 335 

Columbia, MD 21044 

f 240.629.3937 

12070 Old Line Center Dr, Ste 210 

Waldorf, MD 20602 

f 240.629.3934 

1110 Opal Court, Suite 3 

Hagerstown, MD 21742 

f 240.629.3936 

141 Thomas Johnson Dr, Ste 190 

Frederick, MD 21702 

f 240.206.3205 

18111 Prince Phillip Dr, Ste 124 

Olney, MD 20832 

f 240.629.3937 

6196 Oxon Hill Rd, Ste 220 

Oxon Hill, MD 20745 

f 240.629.3974 

15245 Shady Grove, Ste 145 

Rockville, MD 20850 

f 301.637.9093 

19506 Doctors Dr 

Germantown, MD 20874 

f 301.528.7175 

40900 Merchants Lane, Ste 204 

Leonardtown, MD 20650 

f 240.629.3943

FOCUS ON NUTRITION - Maryland Academy of Family Physicians

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?