Senior Connection - Diabetes & Chronic Ailments

Senior

Connection2012 March 25,

Managing Diabetes & Other Chronic Ailments

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Senior Connection | March 25, 2012

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Diabetes and You

Senior Connection | March 25, 2012

Bronson Diabetes Center

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Diabetes is a chronic disease characterized by the body’s inability to make or use its own insulin to control blood sugar.

The Center for Disease Control recently predicted that up to a third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise. In Michigan alone, over 800,000 people have diabetes and an additional 1.5 million have pre-diabetes. Additionally, 9.3 percent of adults in Calhoun County have diabetes.

Bronson Battle Creek is committed to stopping this disease in its tracks through an effective diabetes education program aimed at prevention, early detection and intervention.

Multiple studies have found that diabetes self-management education is associated with improved diabetes knowledge and improved self-care behavior, improved clinical outcomes such as lower hemoglobin A1C, lower self-reported weight, improved quality of life, healthy coping, and lower costs. Studies also demonstrate that people who received continuing diabetes education after the initial one-year period demonstrated fewer inpatient hospital admissions and higher compliance with diabetes medications.

Diabetes educators teach those with diabetes and pre-diabetes the tools required to control their diabetes. They ensure that they understand how to monitor blood glucose levels, eat healthy, engage in appropriate activity, and cope with the emotions and stress that can accompany the diagnosis of diabetes.

Outpatient Education Bronson Battle Creek Diabetes Center has received recognition by both the

Michigan Department of Community Health and The American Diabetes Association. The program meets the national standards for diabetes selfmanagement training.

The program provides a group education class on a weekly basis, which delivers a comprehensive overview to diabetes management. The group classes are held on three consecutive days for three hours each day, for a total of nine hours of education. The nine hours of education cover the following: • Diabetes overview • Acute complications • Chronic complications • Introduction to behavior change • Basics to nutrition: meal planning • Basics to exercise • Medications • Foot care • Blood glucose monitoring Morning, afternoon, and evening classes are offered to accommodate all schedules. Both a registered nurse and a registered dietitian who are certified diabetes educators teach the classes.

Each class begins with a health assessment prior to the first class. That assessment is done on an individual basis to ensure that we are meeting the needs of each patient in class. The participants are also invited back at 1, 3, 6 and 12 months after the initial class for follow up.

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The program offers one-on-one education opportunities for individuals with specific learning needs. In the individual session, the patient may receive education on topics such as medical nutrition therapy, glucose monitoring, injection therapy, medication therapy, and basic diabetes review. Gestational diabetes patients receive education on an individual basis for medical nutrition therapy and for insulin therapy.

Medical nutrition therapy is an integral component of diabetes prevention, management, and self-management education. In addition to its role in preventing and controlling diabetes, the American Diabetes Association recognizes the importance of nutrition as an essential component of an overall healthy lifestyle.

The cause Because of the complexity of nutrition issues, it of diabetes is recommended that a registered dietitian who continues to is knowledgeable and skilled in implementing be a mystery, nutrition therapy into diabetes management although both and education be the team member who genetics and provides medical nutrition therapy. environmental The program also offers continuous glucose factors such monitoring. The continuous glucose monitor as obesity and recorder is attached to a tiny glucose sensor lack of exercise inserted just under the skin for a course of three appear to play days. During the three days that the device is roles. worn, the recorder automatically measures and stores glucose values during daily activities like work, sleep, eating, and exercise. The data obtained by this device is particularly helpful for patients who experience inconsistent high and low glucose levels, who experience hypoglycemia unawareness and who are looking to achieve better control. It helps determine how everyday activities affect diabetes management. The patient returns to the diabetes center to have the sensor removed and the device downloaded, providing a comprehensive picture of the patient’s glycemic control.

The information that is obtained from the device is forwarded to the physician to help guide management decisions.

Individual sessions range from one hour to approximately two hours depending on the patient needs.

The Diabetes Center offers a Carry-On Support Group monthly. The support group meets on the third Thursday of every month at 9 a.m. in the Medical Office Building in Suite 309. This group provides ongoing education, networking and support for persons affected by diabetes, their family and friends. Topics include healthful living, dealing with diabetes, and exercise planning.

The Diabetes Center also offers a pre-

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H E A L T H

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suffering from diabetes? When feet are not cared for properly, they begin to show symptoms of illness. These symptoms may differ from person to person, but as a rule you will experience continuous pain, irritation, and discomfort.

Those are warning signs that your feet need special care and professional attention.

What are the symptoms? Cold feet, Type 2 diabetes, which most often corns, calluses, and fungus or cellulites, a occurs in people potentially fatal bacterial infection, may over age 40 and also indicate diabetes. People with diabetes in those who are often complain of burning feet or toes, overweight or similar to athlete’s foot, as well as fatigue obese, is now on or pain in the calf or buttocks after walking a the rise in eighthshort distance. grade age children and younger who Unless their feet hurt, people are inclined are obese and do to ignore them, figuring that the pain will go not exercise. This away. As a result, our feet are the body’s type of diabetes can most abused, neglected, and unexamined often be controlled part. But our feet mirror diseases, especially through healthy diabetes, and regular preventive foot care eating, exercise and about every two months can detect or oral medications. prevent serious complications.

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diabetes education session on a quarterly basis. The next class will be held Thursday, April 26, beginning at 6 p.m. in the Bronson Battle Creek Medical Office Building, Suite 309. This class focuses on how to delay or prevent the diagnosis of diabetes.

Physician referral is required for Type 1 diabetes, outpatient services but patients may selfformerly called refer and the staff will forward a referral juvenile diabetes, to the physician for signature. can develop at any age, but the greatest The Diabetes Center is located at Bronson incidence is in girls Battle Creek in the Medical Office Building ages 10-12 and boys in Suite 308. If you have questions about ages 12-14. In this the program or about your diabetes, you type of diabetes, may contact the Diabetes Center at (269) the pancreas loses 245-8190. the ability to make Since diabetes will not go away, it means insulin. People with Type 1 diabetes must that people diagnosed with it will go through various stages of adjustment until follow a healthy symptoms stabilize. The goal is to get meal plan and take through those times so the patient can injections of insulin accept and manage their diabetes. every day.

Foot Care Why is foot care so important to those

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Chronic illness impacts some seniors’ ability to live at homeÂ

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Common Chronic Conditions and Aging at Home

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Chronic diseases can have a profound impact on the health and quality of life of elder Americans, not to mention the financial burden that is often associated with long-term illness. But specialists in gerontology and the emerging field of anti-aging medicine are quick to point out that while the risk of disease and disability undoubtedly can increase with advancing years, poor health is not an inevitable consequence of aging.

According to the Centers for Disease Control (CDC) a lot of the sickness, disability, and even death associated with chronic disease can be avoided through preventive measures. The CDC suggests lessening the possibility of the onset of chronic disease in later years by: Practicing a healthy lifestyle that includes healthy eating, regular exercise and avoiding tobacco use Regular use of early detection and testing such as breast, prostate and cervical cancer screenings, diabetes and cholesterol screenings, bone density scans, etc.

Most common chronic conditions of the elderly All too often, because there are so many chronic conditions that seem to impact older persons, there is the mistaken perception that diabetes, arthritis and the like, are just “part of growing old� – and nothing can be done about them.

The truth is most of these diseases and conditions are treatable and should be addressed by a physician. According to the American Society of Consultant Pharmacists, the most common chronic diseases afflicting the elderly are:

• Adult onset diabetes • Arthritis • Kidney and bladder problems • Dementia • Parkinson’s disease • Glaucoma • Lung disease • Cataracts • Osteoporosis • Enlarged prostate • Alzheimer’s disease • Macular degeneration • Depression • Cardiovascular disease If your parents are diagnosed with any of these or other illnesses, the best thing you can do is to educate yourself about how you can best help them.

Usually when an older person is diagnosed with a chronic condition, there is an immediate feeling of facing a loss of freedom and autonomy, a sense that his or her days of living independently at home are numbered. This fear may actually make your aging parents refuse to seek help. Experts agree that one of the most practical ways an adult child can help parents facing a chronic illness is by providing information about available resources to enhance their independence

and quality of life. All the major chronic conditions listed in this article have an associated foundation or association with information that can help your parent to live with his or her condition. Providing these resources is one of the most important gifts you can give to your aging parent.

“A lot of the sickness, disability and even death associated with chronic disease can be avoided through preventive measures.” – Centers for Disease Control There are also many companies that are dedicated to manufacturing and distributing products specifically made to help people “age at home.” These often inexpensive aids for daily living include, but are not limited to, such things as: • Kitchen implements to make opening jars and bottles, peeling and cutting vegetables easier • Reachers – lobster claw-like devices for people with arthritis or other muscle or joint conditions that make bending or reaching difficult • Bathing benches and hand-held showers for bathing • Elevated toilet seats • Automatic lifts for stairwells, beds and chairs • Talking clocks, wristwatches, and calculators for people with poor vision Helping a parent with a chronic condition maintain his or her lifestyle can be a challenge, but by providing information about resources and other help available you can take comfort in the knowledge that you are doing what you can to support your parents’ needs and wishes.

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Physical Activity and Diabetes Being active is another part of living healthy and managing diabetes. Any type of physical activity you do will help lower your blood glucose.

Other benefits include: • Improving your A1C, blood pressure, and cholesterol • Having more energy • Relieving stress • Burning calories to help you lose or maintain your weight • Keeping your joints flexible • Increasing your strength • Improving your balance to prevent falls • Lowering your risk for heart disease and stroke Types of physical activity Any activity you do is helpful, so you may as well do things that you enjoy.

Exercise with friends and family for even more fun. There are four main categories of activity that all provide important benefits: Aerobic exercise helps to keep your heart strong. Aim to do 30 minutes at least 5 times a week. Start slowly!

• Walking • Aerobics (floor, water, or chair aerobics) • Bicycling • Tennis • Dancing • Gardening • Playing with grandchildren • Swimming • Raking leaves • Golfing (walk the course!)

Strength training helps to maintain and build muscle. Try to do strength exercises at least twice a week.

• Lifting free weights/using weight machines • Using resistance bands • Climbing stairs • Calisthenics (this includes push-ups, pull-ups, sit-ups) • Carrying groceries • Gardening (like digging or hoeing) • Doing yoga and tai chi exercises

Stretching helps you stay flexible and prevent stiffness. Stretch as often as you can.

• Basic stretches • Yoga • Pilates Balance exercises help you stay steady on your feet. They are especially important as you get older. Do balance exercises 3 or more days a week.

• Walking backwards or sideways • Walking heel to toe in a straight line • Standing on one foot • Standing from a sitting position Exercise and blood glucose The affects of exercise on your blood glucose will vary depending on multiple factors. If you take insulin or some diabetes pills, there are a few things you should do to prevent low blood glucose (hypoglycemia) when you exercise.

You can check your blood glucose before exercising.

If it is under 100 mg/dl, eat some fruit, crackers, or have a glass of milk or juice. Check it again after exercising to learn how your blood glucose reacts to exercise. Bring a snack if you’ll be out and moving for several hours.

Safe exercise You should warm up, stretch, and cool down to prevent injuries. If you are not active right now, you need to start slowly. You should be able to talk while you are exercising to make sure you aren’t working too hard. If you have other medical conditions or diabetes complications, talk to your doctor before increasing your activity. He or she will tell you what kind of activity is safe for you.

Once you can exercise for ten minutes at a low intensity, add a few minutes each day until you are at your goal. For most people, walking is a good way to start.

If you have trouble walking, try activities like swimming, chair exercise classes, or riding a stationary bike.

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Gastroesophageal reflux disease is one of the most common ailments to affect people. It is more often referred to as heartburn. Over 60 million people in the United States have problems with GERD (GastroEsophageal Reflux Disease).

One only has to watch TV for a short time before seeing advertisements for medications to treat the symptoms of GERD. Americans spend an estimated 10 billion dollars a year treating GERD. Most of this is spent on medications that only treat the symptoms, but do not eliminate the disease.

The esophagus is a long tube about an inch in diameter which carries the food from the mouth to the stomach. As the name implies, GERD occurs when acid from the stomach (“gastro”) back washes (“reflux”) into the esophagus (“esophageal”).

The stomach digests the food in many ways, but the two main actions are to mix the food with acid and churn it back and forth. The acid in the stomach is a very strong acid. The stomach lining is made to withstand the burning that this acid would produce to most tissues.

The esophagus, however, does not have a lining that will protect it from the acid. Therefore, if the valve between the esophagus and the stomach does not close tightly the acidic material will leak (reflux) back up into the esophagus and burn the lining of the esophagus. The person will feel this as heartburn or regurgitation (feeling food or liquid coming back up into the throat). Other symptoms that can go along with GERD include chest pain, coughing and/or choking, asthma, sore throat, difficulty swallowing, and hoarseness.

The standard treatment for GERD involves lifestyle changes and medications.

The strongest medications today are the PPI’s (Proton Pump Inhibitors – Prilosec, Nexium, Prevacid, Protonix, Aciphex). These drugs may stop the production of acid; however they do not address the problem of the leaking valve.

Therefore, the stomach contents are still washing up into the esophagus, but since they are not as acidic, the burning is reduced or eliminated. In many patients, even though the medications do control the symptoms, they will need to take them every day for the rest of their life. The long term effects of taking these medications are still being studied. There are also significant costs associated with long term use of these medications. Even the generic, over the counter ones can cost $1 per pill.

Surgical procedures to address GERD have been developed over the years.

The basic component of the repair is to re-establish the valve between the esophagus and the stomach. This allows the stomach to continue to produce acid (which is needed for digestion), but keep the acid from refluxing into the esophagus.

The most common of these operations is called a Nissen Fundoplication. It is commonly called a “wrap”, because the top portion of the stomach (the fundus) is wrapped (“plicated”) around the lower 2 inches of the esophagus to recreate the valve. If present, a hiatal hernia is repaired also. (A hiatal hernia occurs when the opening in the diaphragm that allows the esophagus to pass from the chest to the abdomen gets too large. Part of the stomach can then protrude (“herniate”) into the chest.)

For the last 18 years, the Nissen operation has been done laparoscopically. This involves making 4-6 small (less than an inch) incisions and inserting a small camera and doing the surgery while watching a video monitor.

Most patients are out of the hospital the same day or the next day after surgery.

The laparoscopic approach represented a huge advance in the healing and recovery time compared to the “open” procedure (which was done through an incision from the ribs to the belly button). 85-90% of patients report good control of their reflux and the ability to reduce or eliminate their need for medications. However, 5-30 percent of patients will complain of bloating, difficulty swallowing, or diarrhea after the operation.

The next advance in the correction of the faulty valve is the TIF procedure. This

stands for Transoral Incisionless Fundoplication. Though this a mouthful to say, the name says exactly what this procedure involves. It is a Fundoplication (recreating the valve) done via a Transoral (through the mouth, throat, and down the esophagus) thereby avoiding any incisions (Incisionless) on the abdomen.

The procedure takes about 45 minutes to perform and patients spend the night in the hospital for IV fluids.

Liquids can be started the next day. Since there are no incisions, there is very little pain after the procedure.

Over the next 4-6 weeks patients can start to lift more, and advance from liquids to soft to regular foods.

Dr John Koziarski, at Bronson Battle Creek, is the first in the Battle Creek/Kalamazoo area to do the TIF procedure. In the last 18 years he has performed hundreds of operations for patients with reflux as well as hiatal hernias. Adding the TIF procedure to his armamentarium of treating GERD represents Dr Koziarski’s commitment to staying on the leading edge of medical advancements.

If you would like more information about treating your GERD symptoms, or want to see if you could do something to eliminate having to take antacid medications the rest of your life, call Dr Koziarski at Family Surgical, PLC, 269-979-6200, www.famsurg.com.

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Diabetes and Travel: Tips for When You’re in the Sky or On the Road

Senior Connection | March 25, 2012

It’s difficult enough managing diabetes at home; however, travelling presents a new set of challenges.

Trips by plane or car provide plenty of hassles, but having diabetes can make traveling even more frustrating.

Regardless of how inconvenient diabetes may be, travelling should never be an excuse for not testing your blood glucose or taking medication. If you’re planning a vacation or business trip, keeping the following diabetes and travel tips in mind will help you stay healthy.

Before You Leave First, discuss diabetes and travel with your physician.

He/she may want to examine you before giving you the go ahead. Ask your doctor for a prescription as well as a letter describing your treatment plan and the medications you receive. Having this information may come in handy if you ever need medical assistance.

Ask around to see if any of your diabetic friends have once lived or visited the place you’re heading to. They can provide helpful suggestions regarding diabetesfriendly restaurants, and may also know of a nearby hospital or 24-hour pharmacy.

When planning your trip, also consider whether or not you’ll be passing into a new time zone. If so, try to arrive early or late the day before. This will allow you enough time to adjust and rest. While packing, make sure that

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you have more than enough medication. Although you probably won’t need all the medication you’ve packed, having extra may prove beneficial for your diabetes and travel destination.

Tips for the Airport Since the airport is an unpredictable place, packing your medication in a carry-on bag is a smart idea. Larger luggage is more likely to end up lost or stolen. Unlike large luggage, a carry-on bag is readily available, so you can easily test your blood sugar or administer a shot.

Before passing through clearance, inform an airport security officer about your condition. As a diabetic, you’re allowed to bring test strips, insulin pumps, and syringes onto the plane. Letting an official know about your condition beforehand will make the security process run more smoothly.

When you’re up in the air, you can still control your diabetes travel worries. If you’re hungry, you can ask a flight attendant for a meal that’s low in sugar, carbohydrates, and calories. You can also eat a snack from your carry-on bag. Walking up and down the aisle every hour or so may help control your blood sugar. This can be especially beneficial for those on a long flight.

Upon Arrival Once you’ve arrived at your destination, store excess diabetes medication in a secure place. Remember that cold and hot temperatures can reduce the effectiveness of insulin. For this reason, avoid places hit directly by the sun like a car trunk or backpack.

A diabetic travel journal can be a useful tool for keeping a record of grocery stores, pharmacies, and hospitals near your hotel. If you run out of food or medication or you need assistance, having a list of resources can prevent a diabetic emergency. If you’re traveling alone, it’s important to have a fully charged cell phone on you at all times.

In addition to carrying a cell phone, diabetics should carry a supply of snack items, a medical alert bracelet or necklace, a doctor’s prescription and letter, and extra diabetes medication with insulin clearly marked. Having these items will help you in case of a diabetic emergency.

Diabetes shouldn’t keep you grounded. Simultaneously managing your diabetes and travel plans may seem like a daunting task; however, preparation can reduce your stress. Talk with your doctor about the risks involved with diabetes and travel. Once you’re aware of the risks, you can take the necessary precautions to ensure that your trip is a success.

We’ve Got Your

Connection Senior Living

Natural Foods Wednesday Senior Discount Day

Bedford Manor Tel (269)

962-3561 Fax (269) 962-6735

Apartments

bedfordmanor@republicmgmt.com LJ-0100151695

Everyday Senior Discount on Supplements 10% OFF

100 South Bedford Road Battle Creek, MI 49037 Hours 8 a.m. to 5 p.m.

Equal Housing Opportunity

Sun: 11-5, Mon–Thur: 9-8, Fri: 9-4 (winter) Fri: 9-6 (summer) Sat. CLOSED

“We’re dedicated to your Healthful Living”

www.avnf.com • 269-979-2257 5275 BECKLEY RD

LJ-0100151141

Marshall Area Senior Fair Thursday, April 5th, 2012 10am - 2pm Marshall Middle School 100 East Green Street, Marshall This event showcases information & services of special interest to older adults and caregiving family members.

(Door Prizes and Light Lunch are Provided) This Free Event is brought to you by:

Call (269) 781-0846 For More Information.

LJ-0100153885

Senior Connection | March 25, 2012

Organizational Partners Family Health Center • Forks Senior Center • Fountain Clinic • J-AdGraphics Maplewood Of Marshall • Marshall Area Chamber Of Commerce Marshall Community Foundation 315 West Green Street, Marshall, MI 49068 Office: 269-781-0846, Toll Free: 877-645-5243, Fax: 269-781-0770 www.calhouncountymi.gov/seniorservices

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The

Private Guest Rooms Rehab Gym Spa Beauty Shop Courtyard Garden Cable / Satellite TV Telephones Daily Newspaper

Partners In Caring

Delivering a perfect blend of clinical excellence with high quality patient-centered rehabilitation, and skilled nursing-care.

Orthopedic Guest Rooms Neuro Rehabilitation Program Cardio Recovery Program Infection Resolution Program Wound Prevention & Healing Program Respiratory Program Digestive Disease Program

Senior Connection | March 25, 2012

Maximize your physical independence with a vital stop between a hospital stay and home at one of our convenient locations. We are a dedicated team of professionals committed to superior patient outcomes allowing our guests to return home.

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Sooner, Safer, and Stronger!

The O f

B e d f o r d

www.laurelsofbedford.com • 269.968.2296 LJ-0100154933

The

The O f

C o l d w a t e r

www.laurelsofcoldwater.com • 517.279.9808

O f

G a l e s b u r g

www.laurelsofgalesburg.com • 269.665.7043