St. John Thrive by Bernadette Sheridan

stjohn.org Fall 2009

thrive

S t . J o h n a n d P r o v i d e n c e h o sp i t a l s ’ G u i d e t o L i v i n g W e l l

Tips for cool-weather workouts

4 essential breast tests

Help your heart keep the beat

Got diabetes? Get moving!

St. John Hospital and medical center • St. John Macomb-Oakland Hospital • St. John River District Hospital • st. john north shores hospital Providence Hospital • Providence Park Hospital • Brighton Hospital

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Autumn is in the air By the time you receive this issue of Thrive!, you’ll probably be in the throes of the fall season—and that means cold and flu season isn’t far behind. As a health care administrator and especially as a parent, I understand your concerns about the H1N1 influenza virus, otherwise known as “swine flu.” To protect yourself and your family from this health threat, keep these flu facts in mind: Ñ H1N1 flu can be spread by coughing, sneezing or even touching a door handle, elevator button, computer keyboard or other object that has the virus on it and then touching your mouth, eyes or nose. Ñ Symptoms of the H1N1 virus are similar to those of regular flu—fever, cough, sore throat, body aches, headache, chills and fatigue. Some people also experience diarrhea and vomiting. Ñ If you do get sick, prescription antiviral medications can make your illness milder and help you feel better faster. Talk to your doctor to see if they’re appropriate for you. Ñ You can protect yourself and your family against the flu, including the H1N1 virus, by avoiding people who are sick. Ward off germs that can lead to illness by washing your hands for at least 15 to 20 seconds (or using alcohol-based hand sanitizer); encourage your entire family to do the same. I hope this information—as well as the information in the rest of this issue of Thrive!—helps you live your healthiest this autumn.

Sincerely,

Patricia Maryland, DrPH President and CEO St. John Health System

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Scared sick? Ease medical test anxieties

ou’re in a cold exam room, wearing a flimsy paper gown, staring at the strange-looking medical equipment. No wonder you get butterflies in your stomach when it comes to medical tests. Some people fear these exams because they’re not sure what to expect. Some may be a little embarrassed about the procedure because it involves a particularly sensitive or private part of the body, while others fear any pain that may be associated with the test. These are all legitimate worries. If you’re feeling nervous, tell your health care provider so he or she can address your concerns. Other helpful strategies:

Take other people’s experiences with a grain of salt. There’s always that friend of a friend who had a bad experience with the procedure. “Remember, everyone responds differently,” says Howard Schubiner, MD, an internal medicine physician at Providence and Providence Park Hospitals. “And with technology constantly changing, your test could very well involve less-invasive techniques, require a less-harrowing preparation and offer more gentle anesthesia than the same procedure did just a few years ago.” Understand why you’re having the test. Did a prior screening reveal something unusual? Is this a routine screening for someone your age? What might the results show? Knowing exactly why you’re having a test can help you feel well prepared, more relaxed and in control of the situation. Know what to expect. Surprises aren’t a good thing when you’re talking about testing. “Don’t be afraid to ask your health care provider about how he or she performs the procedure, how it might feel and how long it will take,” advises Tom Wayne, MD, a family medicine physician at St. John River District Hospital. “Knowing

If you get butterflies in your stomach before a procedure, these strategies can help calm your nerves. what to expect can go a long way toward easing your apprehension.”

Follow orders. Some tests have specific preparation instructions. For example, you need to fast for several hours and take a laxative preparation to clean out your bowels before a colonoscopy. Not following your health care provider’s instructions precisely can mean the procedure has to be rescheduled, causing you more stress. Just relax. Take your mind off your worries in the waiting room by reading or listening to your favorite music on your iPod or portable CD player. Some people find relaxation techniques to be helpful. You can pretend to be somewhere else—picture yourself on a desert island. Or try breathing techniques: Take slow breaths, concentrating on the sound of your breathing. Ask about comfort measures. If a procedure is becoming unbearable, let the health care professional performing it know. Ask whether the procedure can be modified or whether another technique may be less painful for you. For example, if you just can’t stand the compression of a mammogram, the technician may be able to ease up a little or use a special pad that cushions the breast. Are you a woman who’s uncomfortable having a man perform the procedure? Inquire about having a female health care professional perform or observe your test.

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A better way to beat prostate cancer

Cancer care and more

o man wants to be diagnosed with prostate cancer, but the good news is that more options are available to treat the cancer than ever before. As these techniques become more advanced, the chances of beating cancer increase. Among the many prostate cancer treatment options at the Providence Cancer Institute at Providence Hospital is an advanced technique called radioactive seed implants. Radioactive seed implants are a form of internal radiation therapy. This innovative treatment targets tumors with pinpoint precision, delivering a high dose of radiation to the prostate while helping men avoid common radiation side effects.

How do seed implants work? In radioactive seed implants, dozens of seeds—each one the size of a grain of rice—are placed inside the prostate through needles guided by ultrasound imaging. The seeds give off radiation

In addition to the latest cancer treatments and diagnostic tools, the Providence Cancer Institute offers a wide range of support services for cancer patients, including pain control, nutrition counseling, social work, pastoral care, support groups and an information library. For more information, visit the Institute at its two locations: Ñ Southfield Cancer Center

22301 Foster Winter, Southfield 248-849-3321 Ñ Assarian Cancer Center

47601 Grand River Ave., Novi 248-465-4300 for months; removal of the seeds isn’t necessary. The benefits? Radiation is delivered directly to the tumor with little effect on the surrounding areas, so healthy tissue is spared. “This procedure also has a major convenience factor,” says Patrick McLaughlin, MD, medical director of the radiation oncology department at Providence and Providence Park Hospitals. “It takes about 90 minutes, no incisions are needed, and most patients go home the same day.” Men who have a non-aggressive cancer that’s contained in the prostate; those who have a PSA level of less than 10; and men who have normal rectal exams are considered good candidates for seed implants.

A better quality of life “Once you start treating the cancer, the focus moves to qualityof-life issues,” Dr. McLaughlin says. “Naturally for men who have prostate cancer, that includes concerns about radiation side effects like erectile dysfunction.” In a recent study published in the Journal of Clinical Oncology, researchers found that seed implants were associated with the lowest rates of erectile dysfunction of all therapies available. “The fact that so many contemporary studies on prostate cancer deal with quality of life is a major shift and tells you that with early diagnosis, the vast majority of men diagnosed with prostate cancer have highly curable disease,” says Dr. McLaughlin. “The new definition of successful prostate cancer treatment is cure and quality of life.”

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3 steps to a healthier you! These lifestyle changes offer big benefits

ant to boost your immune system? Reduce your risk of illness? Feel more energetic? It’s simple— and it doesn’t require taking a pill. Read on to learn how three key lifestyle behaviors—nutrition, exercise and stress reduction—can put you on the path to a healthier life.

Nutrition “Many people make an effort to eat healthy, but a lack of knowledge about what’s healthy—what’s good for you, and in what way—can prevent them from meeting their goals,” says Nisha Chellam, MD, an internal medicine physician at Providence and Providence Park Hospitals. She recommends focusing on portion control; reading nutritional labels and ingredient lists; avoiding canned or processed foods; including lots of fresh fruits and vegetables in your meals; and sticking to whole grains, low-fat dairy products and fresh or frozen products.

Exercise Experts recommend getting 30 to 60 minutes of exercise on most days of the week. Sound too difficult? Try breaking up that time into smaller sessions throughout the day. (Remember, though, to check with your health care provider before starting a new exercise regimen.)

the potential to bring about illness and emotional problems. “It’s important to interact with others and have a good support system,” Dr. Chellam says. Talk with your doctor about ways to reduce stress.

Reap the benefits “Our lifestyle choices can really have an impact on many diseases,” says Dr. Chellam. In some conditions, they can even help reduce or eliminate the need for medications. Exercise, a healthy diet and stress reduction can improve or reduce the risk of these conditions: Ñ Alzheimer’s disease Ñ osteoarthritis Ñ diabetes Ñ macular degeneration Ñ high blood pressure Ñ certain cancers Ñ coronary artery disease Ñ osteoporosis Ñ diverticulitis

Your call to action Making healthy lifestyle changes has clear benefits for your health and quality of life. But it’s up to you to take these steps. “You and your physician have to work as a team and decide what’s best for you,” Dr. Chellam says. “You won’t lose if you work together.” G ET H e a l t h y !

Stress reduction

Better health starts here!

“Reducing stress is key to a healthy life,” says Dr. Chellam. Some stress can be good for you, but unhealthy stress levels have

To make an appointment with Dr. Chellam, visit stjohn.org or call 1-866-501-DOCS.

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Say yes to breastfeeding! Moms benefit from nursing, too

ou’ve heard it over and over: Breastfeeding is the best way to feed your baby. And it’s true—a mother’s milk offers crucial benefits babies can’t get elsewhere. In addition to getting just the right amount of nutrients, breastfed babies also have fewer illnesses, a better response to immunizations and a lower risk of obesity. But nursing offers advantages for moms, too. “Some people are quite surprised that breastfeeding can be good for the mother as well as the baby,” says Paula Schreck, MD, a pediatrician and medical director of the Outpatient Breastfeeding Clinic at St. John Hospital and Medical Center.

Breastfeeding can … Ñ help you recover from childbirth. “Breastfeeding releases hormones that aid in postdelivery contraction of the uterus—it gets smaller faster,” Dr. Schreck explains. This decreases uterine bleeding, which also decreases the risk of anemia. Ñ spur weight loss. “Because nursing moms burn an additional 700 to 1,000 calories a day, they return to prepregnancy weight faster than bottle-feeding women,” notes Dr. Schreck. Ñ reduce ovarian and breast cancer risks. Women who breastfeed benefit from a lower risk of premenopausal breast cancer and a lower lifetime risk of ovarian cancer. Ñ protect you from osteoporosis. “Studies have shown that postmenopausal women who breastfed their children have higher bone density,” says Dr. Schreck.

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Need breastfeeding help? If you’re having problems nursing your baby, don’t give up. “With proper support, most mothers can breastfeed successfully,” Dr. Schreck says. The Outpatient Breastfeeding Clinic at St. John Hospital— the only physician-led breastfeeding clinic in Michigan— helps mothers overcome barriers to breastfeeding. With the assistance of specially trained lactation consultants and pediatricians, moms find solutions to insufficient milk supply, latching, painful nursing and more. The clinic can also address breastfeeding problems in babies whose medical conditions, such as prematurity, cleft palate or poor weight gain, may affect feeding. “Most mothers are able to solve their nursing problems in one to three visits,” says Dr. Schreck. In addition, the clinic’s Nurturing Nook retail boutique offers a variety of breastfeeding supplies, pumps and clothing for breastfeeding moms. The Outpatient Breastfeeding Clinic is open to mothers who have given birth at any hospital, not just St. John Hospital. To schedule an appointment, call 313-343-3146. “True, breastfeeding is a little harder during the first few weeks,” Dr. Schreck acknowledges, “but if you can work through the initial increased effort, the benefits do continue for a lifetime for you and your child.”

Get moving to manage diabetes

nyone who’s tried to lose weight knows how challenging it can be. And for people with diabetes, it’s an even tougher task, since balancing food and blood sugar go hand in hand. But if you’re overweight and have diabetes, losing a few pounds with exercise can lower your blood sugar and improve your health.

Losing weight lowers insulin

The importance of education Diabetes education provides people with the knowledge, skills and tools they need to successfully manage their diabetes. St. John Health System’s diabetes outpatient education programs are taught by educators who are certified by the American Diabetes Association. Topics offered through the programs include: Ñ coping with diabetes Ñ blood glucose monitoring Ñ medications Ñ preventing complications Ñ food label reading Ñ insulin pump training Ñ activity and exercise

Classes range from one session to weekly ongoing events, depending on the topic(s). Group and individual classes are offered. A physician’s prescription and insurance referral (if applicable) are required for classes.

“Muscles that are in use during exercise use four times more glucose than resting muscles do,” says Regina Kurian, MD, an endocrinologist at St. John Hospital and Medical Center. “Once glucose is lowered, there is less secretion of insulin which, in turn, promotes weight loss.” Losing just 10 or 15 pounds has enormous health benefits. “When someone loses 5 percent to 10 percent of their weight, they can significantly reduce their blood sugar levels,” says Dr. Kurian. What’s more, this effect may also reduce or possibly eliminate the need for diabetes medication. Before you start any weight-loss plan, however, it’s important to work with your health care providers because your blood sugar, insulin and medications need special attention.

Goal-reaching plans The diabetes educators and nutritionists at St. John Health System work with patients to develop a well-balanced weight-loss plan, and patients often have great success. “We develop an individualized plan for each person. Our team of experts work together to provide the education patients need to manage their diabetes while losing weight,” says Dr. Kurian. “We see it all the time. Diet and weight loss are the best ways to sensitize the body to insulin,” Dr. Kurian adds. “It shows you how interwoven body weight and diabetes are.” G ET H e a l t h y !

Be in the know! For more information about diabetes education programs within St. John Health System, call 1-866-501-DOCS.

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In the Kitchen

Souper soups! Make it a meal! Need a little more to eat? Pair these healthy soups with any of the following to fill you up: Ñ a whole-wheat dinner roll or a slice of whole-wheat bread Ñ a green salad, topped with light salad dressing Ñ one ounce of light cheese and a few whole-grain crackers Ñ an apple, a pear or another fruit

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Ladle up some healthy fare

othing warms you up on a brisk autumn day like a steaming bowl of soup. Unfortunately, though, soup can be a real salt trap if you choose a canned or prepared version. “In fact, even with a so-called ‘healthy’ version, you can slurp your entire sodium limit for the day with just one bowl,” says Kathleen Fulgenzi, MD, a family medicine physician at St. John Hospital and Medical Center. With more than 75 percent of the average American’s sodium intake coming from processed or prepared foods, it makes perfect heart sense to make your own soup. It’s easy and gives you complete creative control over the final product. “Plus, you’ll be doing your blood pressure a big favor,” Dr. Fulgenzi adds. Try the two tasty recipes on the next page.

Firehouse lentil soup 1½ cups uncooked lentils 6 cups water ½ teaspoon black pepper ½ teaspoon cumin ½ teaspoon oregano 2 bay leaves

Broccoli soup 4 oz. can diced green chilies, undrained 1 medium red bell pepper, chopped 1 medium carrot, diced ¼ cup lime juice 1 tablespoon olive oil

3 cups chopped broccoli (or 2 10 oz. packages frozen broccoli) ½ cup diced celery ½ cup chopped onion 1 cup low-sodium chicken broth

2 cups nonfat milk 2 tablespoons cornstarch ¼ teaspoon salt dash pepper dash ground thyme ¼ cup grated Swiss cheese

Ñ Place first 6 ingredients in a large pot. Bring to a boil and

Ñ Place vegetables and broth in a saucepan. Bring to a boil,

simmer until lentils are tender, about 20 minutes. Remove 1 cup of lentils and puree with green chilies in blender. Add back to the soup. Add bell pepper and carrot and cook until the vegetables are tender. Discard bay leaves; serve with lime juice and olive oil. Serves six.

reduce heat, cover and cook until vegetables are tender (about 8 minutes). Mix milk, cornstarch, salt, pepper and thyme; add to cooked vegetables. Cook, stirring constantly, until soup is lightly thickened and mixture just begins to boil. Remove from heat. Add cheese and stir until melted. Serves four.

Per serving: 200 calories, 3 g fat (1 g saturated), 0 mg cholesterol, 80 mg sodium, 32 g carbohydrates, 12 g fiber, 13 g protein

Per serving: 140 calories, 3 g fat (2 g saturated), 10 mg cholesterol, 270 mg sodium, 20 g carbohydrates, 5 g fiber, 11 g protein

Broccoli soup photo © istockphoto/Branislav Senic; Can illustration © istockphoto/Oscar Scotellaro Butterfly images on pages 2-3 © istockphoto/proxyminder

Recipes reprinted from the Centers for Disease Control and Prevention’s FruitsandVeggiesMatter.gov.

Canned soup: Read before you buy “When you do buy soup, check the label so you don’t accidentally choose a can that’s loaded with sodium, fat or calories,” says Olga Mondrusova, MD, a family medicine physician at Providence and Providence Park Hospitals. What to look for: Ñ Say “so long” to sodium. Look for “low-

sodium” on the front of the can and avoid the following terms in the ingredient list: Ñ sodium chloride (salt) Ñ monosodium glutamate (MSG) Ñ sodium bicarbonate (baking soda) Ñ baking powder

Ñ Fight fat. If it has the words “creamy,” “cream of,”

“cheesy” or “cheese” in the name, it’s likely loaded with fat and calories. Ñ Skip the milk. Choose broth- or tomato-based

soups over the creamy, milk-based or flourthickened varieties (think New England clam chowder) to save major calories. For example, a cup of mushroom bisque can contain as many as 400 calories versus a cup of minestrone, which has just 112 calories. Ñ Fill up. “Look for soups chock-full of

vegetables and legumes to get your daily fill of fiber,” Dr. Mondrusova says.

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Orthopedics

Don’t shrug off shoulder pain

ou may not give your shoulders much thought until a stiff, aching joint makes activities like carrying groceries or buckling a child into a car seat nearly impossible. The shoulder is capable of a wider and more varied range of motion than any other joint in your body—yet its flexibility is what makes it vulnerable to instability and injury.

Shouldering the pain Shoulder problems can creep up over time, or they can occur after a burst of activity like raking leaves in early fall. “Tendons and bursal tissue may become irritated or inflamed, causing tendonitis or bursitis,” says Jeffrey Placzek, MD, an orthopedic surgeon at Providence and Providence Park Hospitals. “Very inflamed tendons can thicken and become pinched by surrounding structures, causing a condition called impingement syndrome.” Repetitive motion, aging and arthritis can also contribute to shoulder pain as surrounding tissues begin to wear down. Signs of these conditions include ongoing shoulder pain, stiffness or discomfort; mild to severe pain when you raise your arm; and difficulty lying on your shoulder or sleeping. Have these conditions treated early to head off more serious problems later. “A torn rotator cuff—a group of tendons in your shoulder—is also a common cause of pain and restricted motion,” says Nicholas Schoch, DO, an orthopedic surgeon at St. John Hospital and Medical Center. “It can slowly develop over time or result from an injury.” Treatment may include rest, anti-inflammatories, ultrasound and physical therapy. Severe cases may require surgery.

Protect your shoulders The key is to guard against shoulder pain and injury in the first place. Try these measures: Ñ Exercise and stretch regularly to keep your shoulder muscles and joints strong. Ñ Don’t carry heavy shoulder bags. If you must lug heavy contents, use a backpack. Ñ Stand up straight. This promotes good posture, preventing future problems. Ñ Take regular breaks and stretch your back and shoulders at work if your job involves repetitive motions or sitting at a computer all day. Ñ If activity causes soreness or stiffness, rest your shoulder before engaging in the activity again. Ñ Ease into a sport you’ve been away from for a time. Tennis players, swimmers and ballplayers have the highest risk of shoulder injuries.

G E T H e a l th y !

Feel better today! To find a St. John Health System physician who can help you function your best, call 1-866-501-DOCS.

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Kids and substance abuse A guide for parents of middle- and high-school students

ore than ever, children and adolescents face pressure to do well in school, excel in sports and be in the ‘in’ crowd. “But perhaps the biggest pressure they’ll face is the one to use drugs, alcohol or prescription medications,” says Mark Menestrina, MD, medical director of the Detoxification Program at Brighton Hospital. “Parents can help children say no to these dangers.” Answer “yes” or “no” to the following questions. If you answer “yes” to two or more (especially questions 1 or 2), you may want to schedule a private consultation with a Brighton counselor.

Question

Yes No

1. Do your child’s friends seem like drug or alcohol abusers or have a bad reputation?

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2. Do you feel in your gut that your child is using drugs?

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3. Do other family members (parents, grandparents, siblings, etc.) have a history of drug or alcohol abuse?

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4. Is your child bringing home bad grades on papers or exams?

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5. Have you had calls about incomplete or missing assignments from teachers?

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6. Have coaches or athletic instructors expressed a fall-off of motivation or teamwork?

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7. Is your child moping or depressed?

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8. Have any of your child’s friends had run-ins with the authorities as a result of DUIs, possession of drugs or alcohol or car crashes?

G E T H e a l th y !

We can help Brighton Hospital offers intervention programs, treatment services and free addiction prevention classes for children and adolescents. Call 1-877-976-2371 or visit brightonhospital.org for more information.

9. Do you suspect that your child may have had an early onset of sexual activity?

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10. Has your child complained of cold or flu symptoms until you, a physician or someone else has given them medicine?

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11. Has anyone in your household complained of missing medicines or other valuables?

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12. Do you feel your child may have low selfesteem, even if you don’t know how to measure that?

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13. Has your child managed to avoid participating in school or church groups?

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14. Have you found pills, alcohol, cigarettes or other strange items in your child’s bedroom?

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Your Heart

Beating to a different rhythm?

ost everyone has experienced an odd heartbeat— feeling your heart race, pound, flutter, pause or skip a beat. These episodes of unusual heart rhythm, or arrhythmia, caused by abnormal electrical impulses in the heart, are often minor and harmless. Sustained or more serious irregular rhythms, however, can pose a danger. Some people don’t notice any symptoms (see “Follow the signs”), but if you experience symptoms suddenly or frequently, seek urgent care.

Follow the signs People who have arrhythmias may experience: Ñ palpitations Ñ a slow heartbeat or pauses between heartbeats Ñ tiredness or light-headedness Ñ loss of consciousness or feeling faint

What’s going on?

Ñ shortness of breath

A normal heart rate is between 60 and 100 beats a minute and fluctuates during the day and in response to anxiety, excitement or some medications. “Physicians classify the many types of arrhythmias by where they originate and the type of heart rate they cause,” says Luis Pires, MD, a cardiac electrophysiologist and director of the Heart Rhythm Center at St. John Hospital and Medical Center. A rate faster than 100 beats a minute is called tachycardia, and a rate slower than 60 beats a minute is called bradycardia. For example, in ventricular tachycardia, abnormal impulses in one of the heart’s ventricular, or lower, chambers cause it to beat too fast. Atrial fibrillation, the most common arrhythmia, refers to very fast and chaotic contracting of the heart’s atrial, or upper, chambers. Sinus node dysfunction occurs in the area of the heart that serves as a natural pacemaker. When the heart’s normal electrical pathways shut down or allow only intermittent signals, heart block occurs, which can slow heart rate at varying degrees of severity.

Ñ chest pain

Treating your arrhythmia “Not all arrhythmias require treatment, but patients need to manage arrhythmias that cause significant symptoms, increase risk for a more serious condition or impair the heart’s efficiency and circulation,” says Christian Machado, MD, a cardiologist and cardiac electrophysiologist at Providence and Providence Park Hospitals. Treatment depends on the type and degree of the arrhythmia and may include: Ñ Lifestyle measures. Exercise, an improved diet, better stress G E T H e a l th y !

At the heart of your health To find a St. John Health System cardiologist who can help you stay healthy, call 1-866-501-DOCS.

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Ñ excessive sweating Ñ anxiety

management, not smoking and limiting caffeine and alcohol may help reduce episodes. Ñ Vagal maneuvers. Some types of tachycardia can be treated by stimulating your vagal nerves—the part of the nervous system that regulates your heart rate—which respond by slowing your heart rate. These “maneuvers” include holding your breath and straining; coughing; and dunking your face in ice water. Ñ Drugs. Sodium channel blockers, beta-blockers, potassium channel blockers, calcium channel blockers and digitalis may slow or suppress tachycardia. However, these drugs may produce unwanted side effects, cause an arrhythmia to occur more frequently or produce a new arrhythmia. Ñ Implantable devices. Surgery to implant an artificial pacemaker is a common treatment for bradycardia. “This device, implanted under the skin and attached to the heart, sends an electrical impulse whenever the heart rhythm becomes too slow,” explains Dr. Pires. Another device, the implantable cardioverter defibrillator, can be placed in the chest to correct an abnormally fast heartbeat, the usual cause of cardiac arrest and sudden death. Ñ Cardioversion. This treatment uses drugs or an electrical shock to reset the heart to its regular rhythm. Ñ Catheter ablation. Catheters are threaded through blood vessels to the heart and deliver radiofrequency energy to carefully destroy (ablate) the abnormal portions of the heart causing the arrhythmia. This method is highly successful in treating tachycardia.

Who’s at risk? Factors that contribute to arrhythmias include: Ñ age Ñ an abnormality in the heart’s structure

What you need to know about arrhythmias

Ñ coronary artery disease or a previous heart attack Ñ thyroid problems Ñ certain drugs and supplements, such as cold

medications that contain pseudoephedrine and diet aids that contain ephedra, guarana or ginseng

Ñ Open-heart surgery. Cardiologists use open-heart surgery usually only after patients haven’t responded to other treatments. “Patients suffering severe coronary artery disease in addition to ventricular tachycardia may require coronary bypass to improve blood supply to the heart,” Dr. Machado says.

Ñ high blood pressure

The bottom line

Ñ an imbalance of potassium, sodium, calcium and

It’s important to tell your doctor about any symptoms of arrhythmia you experience. Even if symptoms pass quickly, your heart’s ability to work may be compromised. Over time, a seemingly harmless arrhythmia could lead to a more serious condition.

Ñ diabetes Ñ obstructive sleep apnea

magnesium Ñ heavy alcohol consumption Ñ use of stimulants such as caffeine, nicotine,

amphetamines and cocaine

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Cancer Connection

Breast exams and mammograms

Lifesaving strategies you can’t ignore

reast cancer often makes itself known in its early stages, when there’s a good chance for a cure. But here’s the catch: You must have the right screenings to detect breast cancer. That includes monthly breast self-exams, regular clinical breast exams and regular mammograms. Read on to learn about four essential breast tests:

Annual screening mammogram, starting at age 40. “A technician will compress each breast between two plates to flatten and spread the tissue,” explains Laura Freedman, MD, a radiation oncologist at Providence and Providence Park Hospitals. The equipment uses low-dose radiation to take an X-ray that is read by a radiologist.

Clinical breast exam (CBE), starting at age 20. Have this examination of your breasts and underarm area performed every three years during your 20’s and 30’s and annually after age 40. A health care professional will gently knead your skin to search for any lumps. Schedule the CBE close to and preferably before a mammogram.

Monthly breast self-exam (BSE), starting at age 20. “If you regularly examine your breasts,

Annual screening MRI, starting at age 30. This painless test that uses no radiation is recommended for women who have the BRCA1 or BRCA2 gene (or have a close relative with the gene if they haven’t been tested themselves), were treated with radiation therapy to the chest before age 30 or have other reasons to be at very high risk for breast cancer. The MRI scan doesn’t replace your annual mammogram. G E T H e a l th y !

Need a mammogram? To schedule your appointment, call 1-866-501-DOCS.

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The best breast care In June, the St. John Health System Breast Care Program received a three-year, full accreditation designation by the National Accreditation Program for Breast Centers. This ensures that patients who have breast disease receive the full spectrum of interdisciplinary care (evaluation, treatment and follow-up). Services are available at St. John Hospital and Medical Center, St. John Macomb-Oakland Hospital, Providence Hospital and Providence Park Hospital. Visit stjohn.org/breastcare or call 1-888-440-0644 for more information.

you’re more likely to notice any changes from month to month,” says Jennifer Nowasielski, DO, an Ob/Gyn at St. John Macomb-Oakland Hospital. The best time to perform a BSE is about a week after your period ends.

Hard Wired

When Alzheimer’s strikes early

hen you think of Alzheimer’s disease, what images come to mind? Do you picture the disease affecting someone your parents’ or grandparents’ age? “Most Alzheimer’s patients are older, but up to 10 percent of cases are under age 65,” says Jagannadha Divvela, MD, an internal medicine physician at St. John Macomb-Oakland Hospital. The symptoms are the same: repeating statements, misplacing items, difficulties performing daily tasks and, in advanced stages, language difficulties, forgetting who you are and not recognizing family members. “In most cases, the reason people develop Alzheimer’s at an early age isn’t known,” says Mark Silverman, DO, a neurologist at Providence and Providence Park Hospitals. “In rare instances, the early-onset form may be linked to genetics.” Early-onset Alzheimer’s poses several challenges, including: Ñ Misdiagnosis. Because you’re younger, you may be mistakenly diagnosed with stress, depression or another psychiatric illness. “Avoid misdiagnosis by requesting a thorough diagnostic workup,” Dr. Divvela advises. Ñ Family issues. You may still have children to raise, or maybe you’re caring for an aging parent. You can manage these and other issues by asking family and friends to pitch in or by checking out local respite care services. Ñ Job troubles. Alzheimer’s symptoms may be mistaken for lack of motivation or diligence and could lead to you being fired— and losing your health care insurance. Discuss your options with your company’s human resources representative.

If you’ve been diagnosed These suggestions may help you cope with an Alzheimer’s diagnosis: Ñ Join an Alzheimer’s Association support group.

Encourage family and friends to attend meetings with you to educate them about the disease. Ñ Continue to take part in your favorite activities for as

long as you can. Ñ Discuss with your spouse how he or she can help you. Ñ Talk about the disease openly with your children. Ñ Meet with a financial consultant to discuss investments,

insurance and retirement options. Look into assistance programs such as Social Security, Medicare and Medicaid. Ñ See your health care provider regularly to monitor the

disease’s progression and recommend any appropriate treatments. Ñ Lack of services. Many community services like free home meal deliveries, adult day care and transportation may be unavailable to you if you don’t meet the age requirement. Ask about alternative programs.

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Healthy Moves

Fall fitness

Don’t let cool weather keep you from staying active

hen wind and cool weather replace warm, sunny days, many people become “fair-weather” exercisers, trading their outdoor workout routines for extra time in front of the TV. But a year-round exercise program is key to maintaining your current fitness level until the weather warms up again. And if you don’t currently exercise regularly, there’s no better time to start than during the crisp autumn months. “In addition to increasing stamina and flexibility, exercise can elevate your mood and keep you energized as the days grow shorter and cooler,” says Michelle A. Khurana, MD, a family medicine physician at Providence and Providence Park Hospitals. Just because warm summer days are gone doesn’t mean you have to give up your outdoor exercise routine—it just requires more preparation. Be sure to dress appropriately and take a few extra precautions.

Dress the part. What you wear when you work out is important. 14

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“Exercise generates body heat, which, when held in by external clothing, may cause fatigue and discomfort,” says Daniel Ryan, MD, a physical medicine and rehabilitation specialist at St. John MacombOakland Hospital. “Layer lightweight garments that don’t restrict movement and are made of fabrics that take moisture away from your body.” Head and neckwear are also essential, because your body loses as much as 65 percent of its heat through the head and neck. As the temperatures continue to drop, have a hat and scarf handy for colder days.

Warm up. Do some warm-up exercises before you head outdoors. This will help increase blood flow to your arms and legs and keep you warm. “Warming up also helps prevent injury to your muscles and joints,” adds Dr. Khurana. Work with the wind. The wind causes your body to lose additional heat. Start your workout against the wind and return with the wind toward your back.

If it’s too cold outside … Ñ Consider joining an indoor gym. Ñ Sign up for a local mall-walkers group. Ñ Rent or buy exercise videos to use

at home.

Play smarter, not harder Whatever the season, it’s important to make sure you’re working out safely. Get the most out of your workouts by taking these safety measures: Ñ Wear proper shoes designed for your activity.

Jogging photo © istockphoto/Hans Meier

Ñ Warm up with jogging, calisthenics and light

Use your best judgment. If temperatures outside are very low, exercise indoors. And remember that the wind chill can make a cold day feel even colder. If you begin to feel uncomfortable at any time, go inside to exercise. Cool-weather exercise demands greater motivation and planning. Be flexible with your fitness routine and always check with your physician before beginning any exercise program.

stretching. Cool down and stretch after your activity. Ñ Avoid bending your knees past 90 degrees. Ñ Cross train by exploring other activities and

include cardiovascular, strength training and flexibility exercises. Ñ Increase exercise amount or intensity by no more

than 10 percent a week. Ñ Avoid asphalt, concrete and other hard surfaces. Ñ Vary intensity with a hard-day, easy-day pattern

and occasional rest days. u Address minor aches before they become full-

blown injuries. s tjohn.org

Face facts Before you Botox, do your homework

otox, collagen, microdermabrasion, chemical peels … today, there are more options than ever for younger, smoother, fresher-looking skin. Dermatologists and other health care professionals can reverse some of the effects of normal aging—like lines, sun damage and wrinkles—with nonsurgical procedures performed right in their offices. As with any medical procedure, however, it’s important to get the facts about your cosmetic procedure to ensure you’re making the right decision.

Educate yourself Once you’ve found a health care provider you trust (see “Choosing the right provider”), ask him or her these questions to learn more about your procedure and how it will affect you: Ñ Is this the right procedure? Make sure the technique you’ve selected matches your desired result. “For example, chemical peels treat skin texture; other products, like filling agents such as Juvederm, work for skin contouring,” says David Altman, MD, chief of dermatology at St. John Macomb-Oakland Hospital.

Choosing the right provider

First things first: “Look for a board-certified physician,” advises Dr. Altman. “Anybody can inject a needle into the skin, but it’s a matter of what looks right on you, what structures to avoid and what to do if a problem occurs. A trained professional will know the answers to these questions.” Ask friends or other health care professionals for referrals, or search the American Society of Plastic Surgeons’ Web site (plasticsurgery.org). Once you’ve found a professional you feel comfortable with, ask him or her the questions on this page, as well as how many procedures they’ve performed. This information will tell you more about the provider’s expertise in the treatment you’ve chosen.

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Ñ What’s the procedure like? Find out how the technique is performed, how long your recovery will be and any special instructions you’ll need to follow. Ñ Are there risks? Though rare, mishaps occur that may cause unwanted results. Ask your provider if any risks apply to you. Ñ What’s the cost? “Compared to face-lifts, minimally invasive facial procedures are less expensive, which is one reason why they’re so popular,” Dr. Altman says. “But none are covered by insurance.” Ask about the cost of your selected procedure before you decide. Ñ Will I need follow-up or repeat procedures? The amount of maintenance you’ll need—plus the additional costs—should be factored into your decision. The results of Botox, for example, only last for three to four months.

From spas to salons, it seems everyone is offering nonsurgical cosmetic procedures these days. But who’s the best provider to perform these services for you?

When chest pain strikes

t may be tempting to write off chest pain as the result of something you ate or just a fluke. But the discomfort could be more than that: It could be a heart attack. Preparing for a cardiac crisis is one of the most important steps you can take toward a positive outcome. Following these guidelines may help.

Follow the signs These symptoms should prompt an immediate reaction: Ñ chest discomfort that feels heavy, tight or crushing Ñ discomfort in the shoulders, arms, neck or jaw that may radiate from the chest Other symptoms that may or may not accompany chest discomfort include shortness of breath, weakness, light-headedness, dizziness, nausea, vomiting or a cold sweat.

Then, respond Immediately dial 911. Tell the operator the phone number from which you’re dialing; your address and nearest cross street; and your symptoms. While you wait for help to arrive, chew an uncoated aspirin tablet. This will make the medication enter your bloodstream faster, helping to dissolve any clots blocking blood flow to your heart. “Most of our local paramedic units are equipped with EKG [electrocardiogram] capabilities on the scene,” says Margarita Pena, MD, an emergency medicine physician and medical director of the Clinical Decision Unit at St. John Hospital and

Expert heart care, close to home St. John Hospital’s Chest Pain Center is accredited by the Society of Chest Pain Centers. This distinction illustrates the hospital’s commitment to providing the best care and treatment of chest pain. St. John Macomb-Oakland Hospital has also applied for this accreditation. “Saving heart muscle in a cardiac emergency depends on experts working together and communicating effectively to give you the best possible care,” says Dr. Pena. “This accreditation means that in a cardiac emergency, patients benefit from the verified clinical excellence of—and collaboration between—local Emergency Medical Services and our ED, Cardiac Catheterization Lab and Clinical Decision Unit.”

Medical Center. An EKG measures the heart’s electrical activity. “[Paramedics] can transmit the EKG to us, and we can interpret it while the patient is on his or her way to the hospital.”

At the hospital If the EKG results indicate a heart attack, emergency staff are prepared to act fast. “We notify cardiac personnel and the cath lab so they’re ready when the patient comes in,” Dr. Pena says. St. John Hospital’s Emergency Department (ED) and accredited Chest Pain Center ensure prompt, expert treatment. In fact, the hospital’s door-to-balloon time—the time between the patient’s arrival at the ED and a procedure in which a balloon widens the patient’s narrowed arteries to help blood flow again—is less than an hour. (St. John Macomb-Oakland Hospital also shares this distinction.) “We’re proud to be able to provide the best cardiac care in the area for our patients,” says Dr. Pena. G ET H e a l t h y !

What’s your risk? Take our free Heart Check risk assessment online at stjohn.org/heartcheck.

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Detecting diabetes Spot the signs and take control

iabetes is a chronic, progressive condition that can go undetected for years, since many of its symptoms don’t seem out of the ordinary. But ignoring the signs can have dire consequences. Left untreated, diabetes can lead to heart attack, stroke, blindness, kidney failure and even death. That’s why early detection is key.

Know the symptoms

The importance of early detection “Early detection allows you to start management sooner and prevent complications associated with diabetes,” says Suchitra Zambare, MD, an endocrinologist at Providence Hospital’s Joslin Diabetes Center. “Seeking medical help sooner and making improvements in your diet and physical activity levels is key to taking control of your diabetes. These changes will help you manage the condition in its early stage, normalize your blood sugar faster and prevent uncontrolled diabetes. “Diagnosing diabetes in its early stages and determining care plans for each patient leads to great success stories,” Dr. Zambare adds. “People can fit diabetes into their lives, rather than having their lives be controlled by diabetes.”

A team approach Joslin Diabetes Center offers the latest treatment options, patient education and support services for patients who have diabetes. Physicians, nurses, nutritionists, educators and others help patients learn how to care for their condition. “We offer patients the tools they need to help them understand the condition and to confidently manage it over the long term,” says Dr. Zambare.

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Who’s at risk? You’re at a higher risk for diabetes if you: Ñ are age 45 or older Ñ had diabetes during a previous pregnancy Ñ are overweight (especially around the waist) Ñ have a family history of diabetes Ñ gave birth to a baby weighing more than 9 pounds Ñ have HDL cholesterol under 35 mg/dL Ñ have high triglyceride levels Ñ have high blood pressure Ñ have low activity levels Ñ don’t eat a nutritious diet Ñ are African-American, Hispanic-American or Native-

American (these ethnic groups have high rates of diabetes) G ET H e a l t h y !

Don’t let diabetes get you down! For more information about Joslin Diabetes Center or to make an appointment, call 248-465-4010.

Let your physician know if you experience any of these diabetes warning signs: Ñ frequent urination Ñ excessive thirst Ñ extreme hunger Ñ unusual weight loss Ñ increased fatigue Ñ blurry vision

Sleep easy

Good sleep hygiene is key

or some people, getting to sleep is the biggest challenge of the day. What’s worse, night after night of tossing and turning takes its toll, impairing judgment and memory, sapping mental skills and affecting one’s mood. The good news, however, is that making some changes in your daily and evening routines can promote sound sleep. “This is referred to as sleep hygiene,” says Bradley Rowens, MD, a sleep medicine specialist at the Michigan Institute for Sleep Medicine, located at the Providence Park outpatient center in Novi. Here, Dr. Rowens offers his top tips for good sleep hygiene. Try adopting them for a better night’s sleep tonight.

1. Develop a pre-sleep ritual. “A warm bath, light snack or a few minutes of reading or listening to music can help initiate good sleep,” Dr. Rowens says. 2. Get out of bed … if you aren’t asleep in 20 minutes, that is. “Leave your bedroom and find something else that will relax you enough to make you sleepy,” Dr. Rowens recommends.

3. Keep a sleep schedule. Wake up at the same time each day, even on weekends and holidays. This is a good way to program your body for regular sleep. 4. Work it out. Regular physical activity is linked to restful sleep. “However, avoid strenuous activity within six hours of bedtime,” warns Dr. Rowens. 5. Reserve the bed for sleeping. The more wide-awake time you spend in bed—eating, watching television, talking on the phone, playing cards or using your laptop—the more difficult it will be to fall asleep. 6. Avoid caffeine and alcohol. Caffeine makes it harder to get to sleep; alcohol makes it harder to stay asleep. 7. Nix naps. Never take a nap after 3 p.m. “If you must nap, try to limit it to less than one hour,” Dr. Rowens says. 8. Keep a regular daily schedule. “Maintaining a regular schedule for meals, medications, chores and other activities helps keep your body’s clock running smoothly,” says Dr. Rowens.

Still counting sheep? If sleep problems are affecting your health and quality of life, the Michigan Institute for Sleep Medicine can help. The institute’s boardcertified sleep specialists provide overnight sleep studies and a wide range of treatment options, including medications and continuous positive airway pressure (CPAP) equipment, for conditions like sleep apnea, insomnia, narcolepsy and more. For more information or to make an appointment, call the Michigan Institute for Sleep Medicine at 248-465-4290.

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There’s no place like home

The workings of a medical home Patients who choose SJHS as their medical home have a primary care physician (PCP) who participates in a new program called Partner Health, which allows physicians to collaborate with other health care providers in the medical home model. “We have a onestop system among multiple, participating providers who exchange

“We offer patient-centered, quality care that’s comprehensive and coordinated. It’s the medical home model.” —Gina Buccalo, MD health information through a shared database,” explains Scott Eathorne, MD, medical director of Providence Medical Group and Partner Health. Here’s an example of how it works: “Depending on the condition, the PCP may refer a patient to an urgent care facility or a specialist in Partner Health who has access to the patient’s medical record,” Dr. Buccalo says. “Having this information can help reduce errors, such as medication interactions or allergies. The urgent care staff or specialist then shares this information with the PCP using an electronic medical record. This keeps everyone on the same page.”

The patient advantage The medical home offers tremendous health benefits for patients, who develop strong relationships with their providers. “Patients who have a united team of providers are more likely to have their care needs met, have fewer hospitalizations, have lower costs of care, keep doctor appointments and receive preventive care services,” says Dr. Eathorne. Another plus: The medical home offers modern conveniences such as e-mail communication and secure online tools. Many SJHS physicians connect with their patients electronically about: Ñ preventive services Ñ management programs for chronic conditions Ñ links to community services Ñ consultations Ñ electronic pharmacy prescriptions Ñ specialist referrals Ñ automated reminders for screenings, annual physicals or immunizations Ñ test result summaries Ñ the patient’s viewable health profile (patients can always access their information) G E T H e a l th y !

Welcome home! If you’re interested in making St. John Health System your medical home, contact St. John Health Partners Provider Relations at 586-753-0926.

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f you and your family see several different health care providers, you know how challenging it can be to keep track of them and the information they provide you. Plus, making sure that information is shared among your different providers and specialists can be especially frustrating. Now, however, there’s a better option—the medical home. “At St. John Health System [SJHS], we offer patient-centered, quality care that’s comprehensive and coordinated. It’s the medical home model,” says Gina Buccalo, MD, medical director of the St. John Physician Practice Network.

Balance

Short on time? You may have more than you think

f only you had more time in the day, you could get around to all those things you promised you’d do … exercise, make nutritious meals, floss—and just get a taste of pressure-free

living. The truth is, you probably have more time than you think. To find out, write down everything you do in a typical day. Make note of how you feel, too: irritated, energetic, happy. Then analyze your notes, looking for patterns. Are you devoting highenergy time to low-energy activities? Is the phone a distraction? Now that you have a better idea about where your time goes, what might you do differently? Here are some tips.

Make the most of your time by … Ñ prioritizing. Jot down the week’s tasks in order of importance. Can any of them be dropped or handled by a family member or colleague? Ñ using your peak-performance hours to work on a demanding task. Ñ anticipating times when you’ll be kept waiting. Take a book along. Write a letter. Knit. Turn a potentially frustrating situation into a constructive one. Ñ eating balanced meals and getting adequate rest. “This will give you the energy you need to operate at your peak,”

says Cherolee Trembath, MD, a family medicine physician at Providence and Providence Park Hospitals.

Build more time by … Ñ delegating effectively. Choose a willing, qualified person, give instructions and then let go. Ñ turning off the TV. Are you watching three hours of TV a night? That’s 21 hours a week! Enough said. Ñ getting up early. “Try setting the alarm an hour early for a few days, and use the time as you wish,” says Christy Petroff, MD, a pediatrician at St. John Hospital and Medical Center and a busy mother of two young boys. “Read, exercise, straighten up, get a head start on work or spend a little extra time with your kids.” If you make it a permanent habit, go to bed a bit earlier.

Get rid of distractions by … Ñ letting others know that you do not want to be disturbed. “Close your door, retreat to a private space or leave, if need be,” Dr. Trembath says. Ñ limiting your phone conversations. Just tell the other party that you’re on deadline and ask when it might be a good time for you to call back. Some people find it helpful to set a timer when they get a call.

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Mark your calendar Events are free unless otherwise noted. For a complete listing of events, classes and support groups, visit stjohn.org/HealthInfoLib. Sushi Demystified Join us for this fun, interactive “Lunch and Learn” session. When: Tuesday, October 13, noon– 1 p.m. Where: Valade Healing Arts Center, Van Elslander Cancer Center (third floor), 19229 Mack Ave., Grosse Point Woods Call: 313-647-3320 to register (class size is limited) Dessert with a Doc: Help for Headaches and Migraines Why do women have more headaches than men? And what can you do to get relief? Join Richard Klein, DDS, of the Michigan Head and Neck Institute, and Malaz Almsaddi, MD, of the St. John Chronic Headache and Migraine Institute, to find out. When: Monday, October 19, 6–8 p.m. Where: St. John Macomb-Oakland Hospital, Oakland Center Call: 1-866-501-DOCS to register Ongoing Diabetes Support Groups Talk about your concerns and meet others who have “been there” to help understand and learn how to manage your diabetes.

Where: St. John Macomb-Oakland Hospital, Macomb Center, and St. John River District Hospital Cost: Free Call: 1-866-501-DOCS for dates and times St. John Health Heart Check Assessment Heart disease is the No. 1 killer of adults. What’s your risk for this condition? Find out by taking this online risk assessment. It only takes a few minutes, but it could save your life. Visit: stjohn.org/heartcheck Weight-Loss Seminars St. John Health System’s bariatric surgeons can help you achieve the life-changing results you desire. Attend a free seminar to find out how! Where: Locations throughout metro Detroit Call: 1-866-823-4458 for more information or visit stjohnweightloss.com Yoga

punch cards; other packages available Call: 248-465-5478 or visit stjohn.org/ ProvidenceHealingArts for dates and times Food For Life Join us for weekly cooking and nutrition classes that focus on cancer prevention and healthy eating. When: Tuesdays, 6:30–8 p.m. Where: Second-floor conference room, Assarian Cancer Center, 47601 Grand River Ave., Novi Cost: $10 per class Call: 248-465-5455 to register “Dinner with a Doctor” Series Join us for a free casual dinner, health presentation and question-and-answer session. When: Monthly; call for dates and topics Where: Providence Hospital and Providence Park Hospital Call: 1-866-501-DOCS for dates, times and to register

For all skill levels. Where: Reflection Space, Assarian Cancer Center, 47601 Grand River Ave., Novi Cost: $10 for walk-ins; $80 for 10-class

If you no longer wish to receive these mailings, or if you receive multiple copies, let us know by calling 1-866-501-DOCS or visiting stjohn.org/optout.