StJohn_Summer2009 by Bernadette Sheridan

stjohn.org SUMMER 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

Get set for summer! Need a good night’s sleep? We can help Your birth plan: Have it your way!

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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Have a safe summer St. John Health System (SJHS) wants you to have a safe, healthy and enjoyable summer season, and this issue of Thrive! is packed with tips to help you do just that. Turn to page 9, for example, to learn about skin-protection tactics that can keep your skin sunburn-free while also lowering your risk of skin cancer. Summer is also a great time to get outdoors and get active. “Giving your heart a workout,” on page 10, explores the ways in which your heart health benefits from regular exercise. Remember, though, not to overdo it. If you experience pain or other problems in your knees, neck or back, seek your doctor’s care. Check out “Help for needy knees” (page 8) and “Targeting back pain” (page 12) for more information. Also in this issue of Thrive!, “Cook up a safe summer” (pages 6 and 7) offers valuable advice for safe outdoor cooking and protection from foodborne illness. And if you want to keep your kids—and yourself—safe from bee stings, mosquito bites and more, read “Enjoy the outdoors!” on page 18. The summer season is all about having fun, but should you or your family require emergency attention, you can trust SJHS hospitals to provide advanced, around-the-clock care. Visit stjohn.org for more information about our emergency and urgent care locations. It’s just one of the many ways we help you thrive all year long. Sincerely,

inding it harder to fit into your favorite jeans? Many women in their 40s and 50s notice an increase in weight that tends to settle at the waist. The good news: By understanding what’s happening to your body during menopause and making a few simple changes in diet and exercise, you can get back into those jeans. What’s more, you’ll steer away from many lifethreatening or debilitating illnesses associated with excess fat.

What causes menopausal muffin top?

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

Tame your

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“Some experts suggest that hormonal changes during menopause, such as a drop in estrogen and a rise in folliclestimulating hormone [the hormone that controls egg production], cause women to lose muscle mass and accumulate fat around the waist,” says Melissa Marback, MD, an Ob/Gyn at Providence and Providence Park Hospitals. “Add to that the natural age-related muscle-mass loss and the tendency to be less active, and your metabolism—the rate at which your body uses energy—can slow way down.” To make matters worse, the changes in body fat during meno-

tummy!

Diet and exercise can help reverse menopausal weight gain

With a healthy diet and regular, moderate exercise, you can keep the weight from creeping on. pause are linked to a rise in bad cholesterol (LDL) and insulin resistance, which in turn raise your risk for type 2 diabetes, high blood pressure, stroke and heart disease. “And studies show that excess pounds can increase your chances of developing breast and other cancers,” adds Richard Colman, DO, an Ob/Gyn at St. John Macomb-Oakland Hospital.

3 steps to take today With a healthy diet and regular, moderate-intensity exercise, you can keep the weight from creeping on. Take these three important steps to drop extra pounds:

1. Do the math. Portion control is vital. Mentally divide your plate into quarters: one quarter should have a portion of lean meat or fish about the size of your palm; another quarter should have a fist-sized portion of carbohydrates, preferably whole grains like brown rice or whole-grain pilaf; and the remaining two quarters should be filled with colorful vegetables. 2. Get active. “Regular physical activity strengthens your heart and bones, reduces your cancer risk and controls weight,” Dr. Colman says. “It also improves sleep, boosts energy, lessens hot flashes and helps elevate mood.” All it takes is 30 to 60 minutes a day of moderate aerobic activity, such as walking, swimming or cycling. 3. Build muscle. Because muscle burns more calories than fat, strength training will help raise your metabolism so you can burn fat more efficiently. Using a weight you can lift comfortably 12 to 15 times builds muscle and increases your strength.

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In the Kitchen

Cook up a safe summer

t’s finally summer, and after months of eating in the kitchen, most of us are eager for a change of scenery. But before you head for the beach or the back deck, here are a few things you should know about summer food safety. Food poisoning can be caused by various bacteria. “The most common is Salmonella, a type of bacteria found in foods of animal origin, such as meat, poultry, eggs and milk,” says Evan Stashefsky, MD, an internal medicine physician at St. John MacombOakland Hospital. “Symptoms of Salmonella infection—diarrhea, chills, fever and headache—usually last three to five days, but sometimes the infection is deadly.” Staphylococcus aureus is another type of bacteria that can cause food poisoning. “Usually, it’s spread when someone has an open wound that comes into contact with food he or she is preparing,” explains Janaki V. Annavarapu, MD, an internal medicine physician at Providence and Providence Park Hospitals. The bacteria can multiply quickly, especially in foods with mayonnaise or cream bases left at room temperature. “Symptoms include nausea, vomiting and diarrhea, which last about 12 hours,” Dr. Annavarapu says. An infection caused by Clostridium perfringens produces symptoms that include abdominal pain and diarrhea. This type of germ multiplies when cooked meat is left to cool slowly to room temperature over 12 to 14 hours. But with some careful preparation and common sense, you can make sure food poisoning doesn’t spoil your summer fun. Check out the helpful safety tips on these pages for more information.

Grill guidelines Ñ Wash your hands with soap and water for 20 seconds

before and after handling raw fish, meat or poultry— or any utensils used to handle those foods. Ñ Marinate raw fish, meat or poultry in the refrigerator,

not on the counter. Throw out any excess marinade that has come in contact with raw food—don’t save it for dipping or basting. Ñ Use a glass dish rather than a plastic one for

marinating. (Plastic is more likely to retain bacteria.)

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Brain matters

Critical treatment for a critical condition

f you’re one of the estimated 15 million Americans who will develop a brain aneurysm during his or her lifetime, no doubt you’ll want to be in the best hands possible. At St. John Hospital and Medical Center, you will be. That’s because St. John Hospital offers a new liquid treatment that’s helping patients survive this life-threatening diagnosis.

Treatment options Richard Fessler, MD, a board-certified neurological surgeon at St. John Hospital, has been treating brain aneurysms for nearly 20 years. “Most aneurysms are found by accident,” he says. “We’ll discover it when a patient comes in because he or she is being evaluated for a headache and gets a CT [computed tomography] scan or MRI.” Treatment options depend on the size and location of the aneurysm and include open brain surgery, which removes or repairs the aneurysm but involves a large scar and a prolonged hospital stay and recovery. A second, minimally invasive procedure called coil embolization is performed entirely through the blood vessels. The most recent treatment available is the minimally invasive Onyx treatment. This procedure doesn’t require open surgery and allows patients to return home within 24 hours of treatment. Dr. Fessler introduced the Onyx treatment at St. John Hospital last year and is the only physician in the state using this treatment for brain aneurysms.

How Onyx works During the procedure, a catheter is inserted in an artery in a patient’s leg and is threaded into the artery in the brain where the aneurysm is located. A tiny, soft balloon is inflated to bridge the neck of the aneurysm and stop the flow of blood into the aneurysm, while the thick Onyx liquid completely fills the aneurysm. Onyx takes the shape of the aneurysm and solidifies, blocking off the aneurysm space. This prevents the aneurysm from getting bigger or rupturing. “Treatments for brain aneurysms are getting better and better every day,” says Dr. Fessler.

Don’t wait! Nearly 40 percent of patients report head or neck pain, nausea, vomiting and visual disturbances before a brain aneurysm diagnosis. If you experience these symptoms, talk to your physician or find a physician at stjohn.org.

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About brain aneurysm A brain aneurysm is a bulge in an artery that provides blood to the brain. Its risks include reduced brain function, rupture (bleeding), stroke and death.

G ET H e a l t h y !

Your checkup checklist

etting an annual checkup is one of the most important things you can do to maintain your overall health. Studies show that patients who have good communication with their doctors are more satisfied with their care—and have better results. “It’s all about a partnership that depends on communication,” says Braswell Deen III, MD, a family medicine physician at Providence and Providence Park Hospitals. How can you benefit most from your next doctor’s visit? “Have a written agenda,” recommends Dr. Deen. “It’s very important to let the doctor know at the beginning of your visit if you have a problem or symptoms that are concerning you.” Before you head into the examination room, follow these five steps to ensure a successful visit.

® Be prepared. ¸

Bring an updated health history. List all drugs, vitamins and supplements you take, along with their dosages (the medication checklist on this page can help you track your medications). Include any allergies you have to food or medicines. Bring any X-ray films, test results and past records. Document the medical histories of immediate relatives.

Some questions your doctor may ask can be embarrassing or personal, such as possible alcohol or drug use, sexual history or other lifestyle matters. Remember, though, that the information you provide helps to determine your best care.

Clip out this form and take it to your doctor’s visit. Use it to keep track of your medications, supplements and vitamins.

® Do share. ¸

My medications

® Get informed. ¸

If you don’t understand something, ask the doctor to explain it another way. Your doctor may assume that everything is clear if you don’t ask for clarification. Ask if additional reading materials are recommended.

® Think ahead. ¸

Call if you have questions; your symptoms don’t improve; you have problems with your medicine; or if you had tests and haven’t heard back yet. Ask if your doctor has a designated time of day for returning calls. Perhaps you can send your questions by e-mail or someone else, such as a nurse or medical assistant, can assist you.

® Keep records. ¸

Get copies of your test results and share them with your other health care professionals.

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Medication, vitamin or supplement 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Dosage instructions

Sole smarts

Keep your feet healthy all summer long

ummer’s here, and so are sunny days that are perfect for outdoor activities. Whether you plan to walk in the park, play games outside or go swimming, don’t forget to focus on one of the most important parts of your body—your feet. People turn to flip-flops during the warm months, but they aren’t favored by the experts. The reason? “From a mechanical and structural perspective, there’s a complete lack of support,” explains Marc A. Borovoy, DPM, immediate past chief of podiatric surgery at Providence and Providence Park Hospitals. “However, minimal wear at the pool or beach is fine for a few hours.” Good, well-made sandals are a better option. “Look for sandals with a strap around the back heel and at least two straps on the forefoot. This keeps the foot implanted and offers appropriate support,” says Dr. Borovoy. Dr. Borovoy also warns against walking barefoot. “Your feet will have an increased risk of forming warts and encountering foreign bodies such as broken glass and splinters,” he says.

Tips for happy feet These additional pointers can keep your toes in tip-top shape this season: Ñ Apply sunblock to your feet. (They can get sunburned, too!) Ñ Wash and dry feet thoroughly after coming out of the water. A washcloth removes dead skin and bacteria. Ñ Trim toenails straight across. Cutting in corners or on the

If the shoe fits … Whether you’re shopping for a walking or running shoe, cushioning, stability and comfort are key. Ñ Visit the store late in the day, when your feet are

slightly swollen. Ñ Wear the same socks that you’ll wear while walking or

running. Ñ Get measured to get the right size, since feet spread and

lengthen as you age. Sizes and widths also vary based on the manufacturer. sides can lead to ingrown toenails. Ñ If you receive salon pedicures, make sure proper disinfecting practices are carried out. Licensed nail technicians are required to follow state board guidelines. For extra insurance, bring your own instruments. Ñ Purchase the right shoe for the specific activity to get maximum comfort and prevent injury (see “If the shoe fits ...”). Ñ Don’t share towels to avoid developing athlete’s foot and other diseases that can easily be spread. Ñ Keep sandals or water shoes on at the beach to prevent stings, cuts and other injuries.

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Expecting?

The childbirth services you need are right here

ongratulations on your baby-to-be! No doubt you’ve thought about your child’s birth and the experience you want when the big day arrives. If so, you’ll be happy to know that maternity services at St. John Hospital and Medical Center, St. John Macomb-Oakland Hospital and St. John River District Hospital are designed to offer you a secure and supportive birth experience.

Get ready Childbirth education classes offered at St. John Hospital, Macomb-Oakland and River District help expectant moms prepare for childbirth and understand why changes, if any, may be made the day of the birth. “Education is key in being sure you can have the birth experience you want and understand what to expect,” says Anne McCarren, MD, FACOG, a board-certified obstetrician and gynecologist. And hospital tours

Special care for you and baby St. John Hospital and Medical Center Ñ 31 all-private birthing

suites, 20 postpartum suites and 17 high-risk rooms Ñ 35-bed Level III NICU

(available at all three hospitals) allow new moms and dads to preview the hospitals’ comfortable surroundings and meet the friendly staff before baby comes.

Specialized care Should extra-special care be needed, parents-to-be can rest assured that maternal-fetal medicine specialists and perinatologists are on hand to provide care for high-risk pregnancies. St. John Hospital staffs four perinatologists in its perinatal center and six neonatologists in its Level III neonatal intensive care unit (NICU); patients from other St. John Health System hospitals may be referred there for care. This specialized care is essential to a healthy delivery. “The entire staff at the perinatal center specialize in obstetrics,” Dr. McCarren says. “When we’re dealing with high-risk pregnancies, this training is extremely important.”

A supportive staff No matter what kind of birth experience you envision, the caring medical and nursing staffs will ensure a welcoming atmosphere for baby’s birth. “I simply can’t say enough about the nursing staff,” Dr. McCarren says. “They’re so patient and kind while helping families on such a big day in their lives.”

Ñ 14-bed Special Care

Nursery

G ET H e a l t h y !

St. John Macomb-Oakland Hospital

Take a tour!

Ñ eight labor, delivery and

If you’re expecting, call us to learn more about birthing services.

recovery suites Ñ on-site neonatologist

St. John River District Hospital Ñ eight private labor, delivery,

recovery and postpartum suites Ñ on-site perinatologists

Ñ St. John Hospital and Medical

Center 313-343-8781 Ñ St. John Macomb-Oakland

Hospital 586-573-5211 Ñ St. John River District Hospital

810-329-5370

s t j o hn . o r g

Picnic pointers Ñ Make sandwiches and salads ahead of time so that

they can be well chilled in the refrigerator before you leave. Ñ Pack picnic foods in a cooler with plenty of ice or cold

packs—enough to keep food at 40° F. Put the cooler in the shade once you arrive. Ñ Don’t eat picnic leftovers unless they were kept cold

during the picnic and the ride home.

Is it done? Eating rare steak and burgers increases your risk of food poisoning. How well cooked does meat have to be to kill any bacteria that may be lurking? Check the guidelines below: Meat product

Safe temperature

Ñ Beef, pork and ground-meat patties

(roughly equivalent to “medium”)

160º F

Ñ Poultry

185º F

Ñ Ground-poultry patties

165º F

Ñ Veal

145º F

Ñ Lamb

145º F

If you don’t have a meat thermometer, check food by cutting into it. Juices should be clear and meat should not be pink.

Picnic basket photo © istockphoto.com/Jill Chen

Ñ If you’re precooking food so that it will take less time on

the grill, don’t do so far in advance. Food should be transferred immediately from the microwave or range to the grill. Another option: Cook the food completely ahead of time and use the grill to warm it up when you’re ready to eat. Ñ Use one spatula, tongs and sauce brush for raw foods and

different utensils for cooked foods. Ñ Don’t serve cooked food on a plate used to carry raw foods,

such as meat, poultry or fish, to the grill.

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Orthopedics

Help for needy knees When surgery is the answer

ith only two knees to work for you, it’s easy to understand how they can become worn out from a lifetime of repetitive bending, lifting and pushing. This stress causes the knee cartilage—the smooth cushioning tissue that serves as a shock absorber between your bones—to wear thin and become rough and bumpy. But there’s good news for bad knees: surgical advances can offer quick and comprehensive fixes to get you up and moving.

A common problem Many people begin to feel the effects of thinning cartilage when they’re in their 40s. If you suffer from this condition, you’ve most likely had to cope with stiff knees that ache when you walk, bend, sit or stand. Unfortunately, about 20 percent of sufferers require surgery to repair the problem. “Previous knee injuries such as fractures or ligament injuries may contribute to arthritis. If oral medications, injections, physical therapy and bracing don’t provide relief, joint replacement surgery can offer substantial improvements in pain relief and function,” says James Bolz, MD, an orthopedic surgeon at Providence and Providence Park Hospitals.

One-day surgery Arthroscopic surgery involves cutting, shaving or removing damaged bone and cartilage from the knee. The surgeon makes small slits in the knee and inserts a lighted optic tube called an arthroscope, which includes a tiny camera that sends pictures to a screen in the operating room. By watching the screen, the surgeon can operate on the knee with very thin instruments, eliminating the need for large incisions or a long recuperation. “Arthroscopic surgery is less invasive, requiring less than an hour to perform,” says Cory Zieger, MD, an orthopedic surgeon at St. John River District Hospital. “Patients normally can go home the same day.”

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Long-term relief Total knee replacement is a more complicated procedure designed to leave the surrounding muscles, tendons and ligaments intact while replacing damaged bones with an artificial knee joint made of plastic and metal. A hospital stay is required, along with physical therapy afterward to speed the healing process. Today’s knee replacements can last up to 20 years. They generally aren’t as effective as the real thing, but they are popular alternatives to chronic knee pain and disability. G E T H e a l th y !

Do you need surgery? If you suffer from knee pain, talk to your doctor about your options. To find a St. John Health System physician, call 1-866-501-DOCS or visit stjohn.org.

Cancer Connection

Skin check

A step-by-step guide to skin self-exam

ou may picture a skin-cancer candidate as blond, blueeyed and deeply tanned. But the truth is, everyone is at risk for the disease. “The most common form of cancer, skin cancer strikes 1 million Americans each year and makes up half of all newly diagnosed cancers,” says Louise Martin, MD, a dermatologist at Providence, Providence Park and St. John Macomb-Oakland Hospitals. However, by performing a monthly skin self-exam, you can catch potentially cancerous skin conditions when they’re still curable.

What to look for “If you notice any of the following skin changes, see your physician immediately,” advises Michael Fozo, MD, a facial plastic surgeon at St. John Hospital and Medical Center. “He or she can determine if the condition needs further medical attention.” Ñ any new growths, including sores, lesions, nodules and pearly, waxy, colored or suspicious bumps that may or may not cause pain Ñ a mole or birthmark that has undergone any of the following changes: increased size, irregular borders, color change, scaling or itchiness

The head-to-toe exam Use a bright light and check your entire body thoroughly. Ñ First, inspect your face, ears, head and the inside of your mouth using the hand mirror. A blow-dryer will help part your hair for a closer look at your scalp. Ñ Examine your hands (including your fingernails and palms), elbows, arms and underarms. Raise your arms and check your right and left sides. Ñ Examine your neck, chest and torso. If you’re a woman, check beneath your breasts. Ñ Use a hand mirror to carefully look at your back, shoulders and the back of your neck. Ñ In a full-length mirror, focus on your buttocks and the backs of your legs. Ñ Sit down and examine your genitals. Ñ Inspect your legs and feet, including your heels, soles, toenails and the area between your toes.

4 ways to prevent skin cancer These simple protective measures can prevent up to 80 percent of skin cancers. Ñ Avoid the sun between 10 a.m. and 3 p.m., when the

sun’s damaging rays are strongest. Ñ Rain or shine, always wear a broad-spectrum sunscreen

with an SPF (sun protection factor) of at least 15. Apply 20 minutes before going outside to allow your skin to absorb the cream. Ñ Wear a wide-brimmed hat and clothes that completely

cover you, including a long-sleeved shirt and a long skirt or pants. Ñ Sport sunglasses that offer UV protection.

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Your Heart

Giving your heart a workout

eating roughly 80 times each minute, the heart is constantly working to move oxygen- and nutrient-rich blood throughout your body. The heart’s tone, strength and function can be improved through regular exercise. And though it takes time to see exercise’s benefits in the mirror, your heart’s strength improves with each workout.

What happens when you exercise Say you’re raking leaves. Pulling the leaves across the grass requires your arm muscles to work. And the more raking you do, the stronger your arm muscles become. The same is true of your heart. “As you work out, your body’s muscles demand more oxygen, requiring your heart to work harder to pump blood throughout your body,” says Srinivas Koneru, MD, an interventional cardiologist at St. John Macomb-Oakland Hospital. The more often you make your heart work harder, the stronger and more efficient it becomes. “As your heart’s fitness improves, so does your blood circulation. And your resting heart rate—the number of times your heart beats when you’re not exercising—will likely decrease,” Dr. Koneru says. “Exercise also promotes other positive changes in your body that ultimately benefit your heart, such as reducing blood pressure, improving cholesterol, lowering stress, boosting mood and burning excess calories to avoid weight gain,” says Robert Maynard, MD, a cardiologist at Providence and Providence Park Hospitals.

Exercises that help your heart While resistance or weight-training activities challenge the heart to some degree, aerobic exercise—sustained rhythmic exercise such as walking, running, swimming or dancing—is the surest way to improve your heart’s fitness.

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If you’ve never exercised before, your doctor can help you design a program that’s right for you. Start slowly, with low-intensity exercises like walking, cycling or dancing. Work your way up to at least 30 minutes a day on most, if not all, days of the week. As you get stronger, strive for a moderate intensity level to increase the benefits to your heart. This means different things for different people: For some, walking may be moderate, but for others, a slow jog may feel moderate. “As you become more fit and your heart adapts to the demands you’re placing on it, it’s important to continue to challenge your heart in new ways,” says Dr. Maynard. “Try new or more vigorous activities, incorporate higher intensity intervals, lengthen your workouts or add more sessions to your week.” G E T H e a l th y !

Need heart help? St. John Health System hospitals offer the latest treatments and compassionate care for the full spectrum of heart conditions. To learn more, visit stjohn.org/sjhheartcare.

Medication alert Some medications, such as drugs to control blood pressure or diabetes, can lower your target heart rate. If you take medication or you have a heart rhythm abnormality, ask your doctor what exercise intensity and target heart rate you should aim for.

Finding your target heart rate How fast should your heart beat during exercise? First, you need to determine your maximum heart rate, which is how fast your heart should beat when you exercise as hard as you can. Researchers have been able to simplify this process by calculating a universal maximum heart rate of 220. Subtract your age from 220, and you’ll get your maximum heart rate. If you’re 50, for example, your maximum heart rate is 170 beats per minute (bpm). Ñ Your target heart rate is a percentage range of your

maximum rate. Moderate-intensity exercise should raise your heart rate to between 50 percent and 70 percent of your maximum. Working out in this range for about 30 minutes gives you an effective workout. For example, if you’re 50 years old:

Ñ 50 percent of 170 = 85 bpm

Ñ 70 percent of 170 = 119 bpm

Ñ To track your heart rate during exercise, use a heart rate

monitor or take your pulse for 10 seconds, then multiply that number by six. Too slow? Step up your pace or intensity. Too fast? Slow down a bit. As you become more fit, your target heart rate percentage needs to increase so you can continue to gain cardiovascular benefits and lose weight. Aim for 70 percent to 85 percent of your maximum heart rate.

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Hard Wired

Targeting back pain The right treatment can get you back on your feet in no time

hether you’re a weekend warrior, an active grandparent or an avid gardener, chances are you’ve experienced back pain at one time or another. But did you know there are different types of back pain—each with its own set of causes and treatments? Here, Daniel R. Pieper, MD, FACS, a board-certified neurological surgeon from the Van Elslander Neuroscience Institute at Providence and Providence Park Hospitals, and Devon A. Hoover, MD, a board-certified neurological surgeon at The Spine Center at St. John Hospital and Medical Center, explain three different types of back pain and their treatment options.

1. Disc-related pain

2. Nerve-related pain Characterized by pain radiating into the arms or legs, nerverelated back pain is often caused by pinched or compressed nerves. Depending on the nerve that’s affected, patients may feel less pain in the back but more pain or tingling in the legs, arms or neck. Ñ What causes it: herniated discs, bone spurs, arthritic changes, thickening of the joints and ligaments, spinal trauma, lumbar spinal stenosis (narrowing of the spinal column that compresses nerves) Ñ How to treat it: Drs. Hoover and Pieper recommend stopping

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the activity that brought on the pain and trying nonsteroidal antiinflammatory medication to treat the pain. “Any type of low-back pain will be treated conservatively initially,” says Dr. Pieper, “but if the pain persists, gets worse or is associated with weakness, it should be evaluated by a doctor.” Pain associated with loss of bladder control or numbness or tingling in the groin should be immediately treated by a doctor. Physical therapy, traction (gently separating vertebrae to relieve nerve pressure) and surgery are all options to treat persistent nerve pain.

3. Muscle-related pain Muscle-related back pain is typically associated with trauma such as car accidents, in which the spine may have sustained an injury and is depending on its muscles to stabilize itself. Muscles are tender to the touch and pain will remain isolated to the affected area— symptoms not shared with nerve- or disc-related back pain. Ñ What causes it: Major trauma, athletic injuries, falls, heavy lifting Ñ How to treat it: Patients should refrain from any activity that aggravates the pain and stay away from the activity that caused the pain. “Icing is recommended early on to reduce inflammation; if the pain persists, heat and massage can help stimulate blood flow and loosen the muscle,” says Dr. Hoover. “More extensive therapy can include ultrasound and range-of-motion exercises to help

Spongy discs separate and protect vertebrae from touching each other while absorbing the impact from everyday activities like walking. As we age, these discs become less spongy, lose height, become prone to tears and slip out of place (herniation). Herniated discs often compress spinal nerves and cause pain that radiates in the spine and through the limbs. Pain caused by disc-related conditions is greater when standing or sitting and less when lying down. Ñ What causes it: herniated, torn or brittle discs Ñ How to treat it: Physical therapy to strengthen the abdominal and back muscles, which support the spine and can help prevent injuries, is one of the best nonsurgical treatments for disc-related pain. Other therapies include injections, aquatic therapy, local anesthetics, acupuncture and chiropractic manipulation. Patients who experience prolonged or severe pain should have a magnetic resonance imaging (MRI) scan to identify the source of the pain. Patients may also undergo discography as a diagnostic test, during which fluid is injected into the disc while X-rays are taken. While surgery is a treatment option and artificial discs exist, both Drs. Hoover and Pieper believe nonsurgical methods to treat disc-related pain can be successful.

restrengthen damaged muscles.” Patients should see a doctor if the pain doesn’t improve, gets worse or becomes debilitating, or if they experience numbness or difficulty using the bathroom. These could be signs of a more serious injury.

When to consider surgery Patients who have serious injuries, loss of function or who have failed all other conservative treatments may be candidates for spine surgery. “We have to feel confident that we know where the pain is coming from and that we have a surgical procedure that will give them success,” says Dr. Hoover. Multiple factors also contribute to a patient’s candidacy, such as age, condition and lifestyle. “We can’t change hereditary conditions, but we can change conditions impacted by our lifestyles,” says Dr. Pieper. “Maintaining a healthy weight, not smoking and staying active all contribute to joint and spine health.” G E T H e a l th y !

Don’t take back pain lying down! To learn more about pain management options at St. John Health System hospitals, visit stjohn.org and click on “Find a Service,” then “Back and Neck Pain.”

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Healthy Moves

Burn, baby, burn!

hat fitness walk was good for starters, but your bathroom scale is telling you to step it up. Only problem is, you have a busy schedule. Instead of going longer (adding minutes to your session), you’ve got to go harder. That’s not a bad thing. Working out more vigorously is time-efficient—it burns more calories and boosts your fitness level. Check out the next page for approximate calorie counts, based on a 150-pound person, for a number of activities. “If you weigh 120 pounds or 180 pounds, you will burn fewer or more calories, respectively, than a 150-pound person who is working at the same intensity,” says Sam Awada, MD, a family medicine physician at St. John Macomb-Oakland Hospital. Other activities that burn more than seven calories a minute G E T H e a l th y !

Before you get started ... A yearly physical can help make sure you’re fit and able to perform a regular exercise program. Call 1-866-501-DOCS to schedule your physical today with a St. John Health System physician.

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Top calorie-burning exercises

Working out more vigorously is time-efficient—it burns more calories and boosts your fitness level. include race-walking, water-jogging, vigorous stationary bicycling, karate, tae kwon do, wheelchair basketball and tennis, and energetic square dancing and folk dancing.

Variety: The spice of exercise, too “Try different activities, since performing the same activity every day can lead to overuse injuries like tennis elbow, Achilles tendonitis or plantar fasciitis,” recommends Gregory Cibor, DO, a family medicine and sports medicine physician at Providence and Providence Park Hospitals. A good mix includes jogging (a weightbearing exercise that strengthens bones), swimming (a joint-friendly, no-impact exercise), skating (handy for getting the kids to exercise, too) and tennis or aerobic dance (a great way to socialize).

Approximate calories burned per hour Ö tennis:

476

àswimming:

408

stair climbing:

408

Ü jogging:

544

scrubbing floors:

440

bicycling:

544

á roller blading:

476

Ü hiking:

408

Jogging photo © istockphoto.com/Kris Hanke

racquetball:

476

Did you know? downhill skiing: á rope jumping: cross-country skiing:

408

680

544

A 150-pound person who walks for one hour at a moderate 3.5-miles-per-hour pace burns roughly 250 calories—the equivalent of a bowl of oatmeal with a cup of skim milk.

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Enjoy the outdoors! Know how to take the sting out of bug bites

ow many times has the perfect trip to the beach or a barbecue in the neighbor’s yard been interrupted by the cry of a child after he or she has been stung? Summer days go hand in hand with creepy-crawlers of all shapes, sizes and sting-ability. Knowing how to prevent and cope with insect bites will minimize discomfort and keep your outings safe and fun. Most bites and stings aren’t serious and require only home treatment. Here are some treatments for common bites:

Spider bites. Clean the area with soap and water, apply a cool compress and keep the affected limb elevated to about heart level. “If your child experiences any severe reactions, call your doctor or 911 immediately for further treatment,” says Gary Pilchak, DO, an emergency medicine physician at Providence and Providence Park Hospitals. Luckily, few spider bites are serious. Tick bites. “You can prevent Lyme disease if you detect ticks early, since infection is unlikely if a tick has been attached to skin for less than 48 hours,” says Antonio Bonfiglio, MD, medical co-director of the Emergency Department at St. John Macomb-Oakland Hospital. After your child spends time outdoors, thoroughly check his or her skin—both body and scalp—for ticks and rashes. If you find a tick, remove both the tick’s head and body. Use tweezers and pull the tick straight out. Wash your hands thoroughly after removal. Mosquito bites. Most mosquito bites do little more than cause itching, redness and general discomfort, but West Nile virus is a mosquito-borne illness. If you or your children experience difficulty breathing or tongue swelling, seek immediate medical attention. Thwart the breeding of mosquitoes by emptying standing water in your child’s swimming pool and pet dishes.

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The buzz on prevention To keep bites at bay: Ñ Apply insect repellent to all exposed skin before

heading to woods and grassy areas. Ñ Select clothing that covers the body. Ñ Refrain from using perfumed lotions or shampoos. Ñ Use insect repellents that contain 10 percent to

30 percent DEET, and only apply once a day. Ñ Once home, wash off repellent as soon as possible.

Bee stings. Try to remove the stinger by scraping or brushing it off with a firm edge, such as a credit card. Disinfect the area and apply hydrocortisone cream, calamine lotion or a baking soda paste to the sting several times a day until symptoms subside. To reduce pain and swelling, apply ice or a cold pack and take an antihistamine.

Giving cervical cancer prevention a shot

hile cervical cancer awareness has grown, more than 11,000 new cases are still expected this year in the United States. Fortunately, prevention is possible thanks to Gardasil®, the only vaccine available in the United States that prevents certain types of human papillomavirus (HPV) that cause cervical cancer and genital warts. If you’re considering vaccinating yourself or your daughter, it’s important to understand HPV and how Gardasil works.

What is HPV? HPV is a group of 100 viruses that have few or no symptoms and can be passed from one person to another through sexual contact. Almost all women will have HPV at one time or another, but not all will develop cervical cancer. While many types of HPV heal on their own without treatment, HPV types 6, 11, 16 and 18 may not. These types cause 70 percent of cervical cancer and high-grade precancerous cervical lesions and 90 percent of genital warts.

About Gardasil The Gardasil vaccine is approved for females ages 9 to 26 and is given in three injections over six months. “The vaccine is extremely effective,” says Leigh A. Solomon, MD, a board-certified gynecologic oncologist at St. John Hospital and Medical Center. “It’s

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Guard yourself! As with any vaccine, Gardasil may not be right for everyone. Consult your physician. To find a St. John Health System physician, visit stjohn.org.

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been shown to successfully prevent 90 percent to 100 percent of precancerous and cancerous lesions caused by these high-risk HPV types.” Minor side effects include injection-site pain, low-grade fever and headache. (In a small percentage of patients, more serious side effects have been reported.)

Education is key “Gardasil doesn’t protect against all HPV types or other sexually transmitted diseases, and it doesn’t treat current HPV infections or cervical cancer,” says Dr. Solomon. “And anyone who’s received the vaccine still needs to have regular Pap test screenings with her doctor.” The reason for vaccinating at a young age, says Dr. Solomon, is to reach girls before they’re ever at risk for exposure and while there’s still plenty of time for both parent and patient education. Talking with your family doctor about Gardasil, HPV and cervical cancer can help your daughter understand why she’s being vaccinated, what the vaccine is for and the importance of healthy behaviors. “Although cervical cancer is uncommon in the United States, it’s still expected to account for 4,070 deaths among American women this year,” says Dr. Solomon. “Young women and parents choosing to vaccinate their daughters with Gardasil can help lower that statistic.”

Vein, vein, go away!

aricose veins affect one out of two people, mostly women, ages 50 and older. Raised, dark blue or purple twisty veins appear on the backs of the calves or on the inside of the legs. They develop when valves in the veins that allow blood flow toward the heart stop working properly. Blood then pools in the veins, causing them to get larger. The good news? “We can treat varicose vein problems right in the office in an hour-and-a-half session,” says Kevin D. Nolan, MD, FACS, chief of vascular surgery and associate chair of the Department of Surgery at Providence and Providence Park Hospitals. “This is in stark contrast to the days when patients came into the hospital and the procedure consumed their whole day.”

Treatment options Patients who have varicose veins are usually symptom-free, although some experience aching, burning, itching, throbbing or swelling. Although varicose veins don’t pose a risk to your overall health, you just may not like the way they look. If so, your doctor can recommend the best treatment options for you. “We use a laser treatment for patients with the large ‘ropey’ veins and another treatment for smaller ‘spider’ veins,” says Dr. Nolan. “Treatment for spider veins is even less involved than the laser treatment we use for bigger veins, although extensive spider veins can take several sessions to completely address.”

Get a leg up on prevention Improving your circulation and muscle tone can help you reduce varicose vein discomfort and prevent new varicose veins. Try these approaches: Ñ Exercise. Get your legs moving to encourage blood

circulation. Ñ Watch your diet. Shedding pounds takes pressure off

your veins. A low-salt, high-fiber diet prevents swelling from water retention. Ñ Elevate. Take short breaks daily to elevate your legs

above the heart.

“We can treat varicose vein problems right in the office in an hour-and-a-half session.” — Kevin D. Nolan, MD, FACS 16

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position at least every 30 minutes to encourage blood flow. Ñ Watch what you wear. Avoid high heels. Low-heeled

shoes work calf muscles more, which is better for circulation. Tight clothes around your waist, legs or groin are too restricting.

Ñ Avoid long periods of sitting or standing. Change your

A leader in quality care Providence Hospital rated among nation’s top hospitals

ou may already know that Providence Hospital offers a full range of services to treat you with great expertise. But did you know that Providence is also one of the country’s top 100 hospitals? Providence has been recognized by the Thomson Reuters 100 Top Hospitals® program as one of the top 100 hospitals for overall performance. Providence was one of 15 hospitals nationally to be selected in the Major Teaching Hospital category of Thomson’s 100 Top Hospitals list. This is the third time Providence has been recognized by Thomson Healthcare, a benchmarking organization dedicated to improving the health care industry. “This honor recognizes us for our outstanding performance in patient care quality, patient safety and delivery of outstanding care,” says Michael Wiemann, MD, FACP, Executive Vice President of St. John Health System, West Region, and president of Providence. According to the Thomson study, top 100 hospitals attract more patients, have higher survival rates and keep more patients complication-free while keeping the facility financially stable. The study also determined that top 100 hospitals—such as Providence— treated sicker patients needing more advanced care, yet had better patient outcomes and lower costs.

The patient advantage What does this recognition mean for patients and the community? “When people come to Providence, they get the highest quality of care. There’s no need to search further, because the best care is right here,” Dr. Wiemann says. “To me, this award is a tribute to the entire Providence family,” adds Dr. Wiemann. “It’s reflective of the work we do as a team that provides the best outcomes for our patients and the community we serve.”

About the 100 Top Hospitals program Thomson Reuters’ annual 100 Top Hospitals study identifies the 100 top U.S. hospitals based on their overall organizational performance. The program recognizes hospitals that achieve or exceed national benchmark scores.

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See for yourself! To learn more about everything Providence has to offer, visit us at stjohn.org/Providence.

The 100 Top Hospitals study evaluates 3,000 shortterm, acute care, nonfederal hospitals across nine clinical areas, including mortality rates, patient safety, operational efficiency, financial stability and growth. The study has been conducted annually since 1993. Hospitals that are recognized as 100 Top Hospitals raise the bar every year by delivering a higher level of care and value for their communities.

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Pillow power

A sleep study can help you get zzzs with ease

hen Chakrapani Ranganathan, MD, a board certified psychiatrist, neurologist and vascular neurologist and medical director of The Sleep Center at St. John Macomb-Oakland Hospital, noticed an influx of high school students experiencing headaches, migraines and dizziness, he surveyed their sleep habits. They reported averaging six hours of sleep a night—far less than the nine hours recommended for teens. And teens aren’t the only ones getting less shut-eye. Busier lifestyles have adults getting less sleep, which leads to daytime sleepiness, irritability, headaches and other conditions. But sleep evaluations performed at The Sleep Center at Macomb-Oakland and St. John River District Hospital’s Sleep Studies Center may help you get the rest you need.

A health risk Lack of sleep increases the risk of heart disease and high blood pressure. For patients who suffer from sleep apnea (stopping breathing during sleep), the consequences can be even more serious, says Bassam Nasr, MD, chief of the medical staff at River District and a board-certified gastroenterologist and sleep medicine specialist. “Left untreated, patients are at increased risk for stroke, insulin resistance and other metabolic and systemic disorders,” he says.

About sleep evaluations During a sleep study, which takes place overnight in the sleep lab, sensors monitor oxygen levels and brain activity and a video camera records the patient while asleep. “We monitor body position, movement, breathing, how quickly the patient falls asleep and

Don’t ignore these poor-sleep signs: Ñ nighttime snoring Ñ not waking refreshed Ñ headaches Ñ excessive daytime sleepiness Ñ difficulty concentrating Ñ sudden rise in blood pressure sleep disruption,” says Dr. Ranganathan. “This information helps us determine if the patient has a sleep disorder and, if so, which one.” The study’s results are discussed with the patient. While many only need counseling on better sleep habits, some patients require medication. Others may need a continuous positive airway pressure mask to continue oxygen flow while sleeping. With these and other treatments, patients can look forward to a better night’s sleep. G ET H e a l t h y !

Sleep better tonight! Call us to learn more about sleep evaluations: Ñ The Sleep Center, St. John Macomb-Oakland Hospital,

Oakland Center 248-395-6697 Ñ Sleep Studies Center, St. John River District Hospital

810-329-5366

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Balance

Stuck in the middle and stressed? Here’s help for caregivers

ith folks living longer and couples having kids later in life, it’s not uncommon to have both children and aging parents in need of care. And with the 85-plus population the fastest growing in the nation, the trend shows no sign of slowing down. Are you caught in the middle these days? If so, these strategies may help you meet the challenge.

Caregivers may feel a mix of guilt, love, resentment and even anger. To keep things in perspective, share your feelings with your spouse or a friend.

1. Find alone time. A short break can have a surprisingly restorative

2. Make time for family. Plan one family activity a week. Catch a

effect. Use that time to escape to a quiet corner where you can read, listen to music or just close your eyes. “Remind yourself that you deserve this time and that you can’t help others if you feel frazzled,” says Michael Yacoub, MD, an internal medicine physician at St. John Hospital and Medical Center.

3. Say no. It’s okay … really! If you’re too tired to pay your parents’

movie, enjoy a special dinner together, visit a museum or take a hike.

bills or play Scrabble with your 10-year-old, say so. Pushing yourself past your limits will only create resentment.

4. Evaluate. Take a look at your situation. How many hours a week do you spend caring for Mom and Dad? Do they really require that much attention? Are your kids ready to branch out on their own? Remember, encouraging independence should be your primary goal as a caretaker and a nurturer.

5. Express your feelings. You may feel a mix of guilt, love, resentment and maybe even anger. To keep things in perspective, share your feelings with your spouse or a friend.

6. Be proud of yourself. Giving of yourself is a reason to feel good. 7. Share the care. Finding a friend or relative who can assist with caretaking, run errands or babysit can offer tremendous relief. When others offer to pitch in, take them up on it.

Take care of you “If depression and fatigue start setting in, talk to your health care provider,” says Mario De Meireles, MD, an internal medicine physician, board-certified geriatrician and medical director of geriatric services at Providence and Providence Park Hospitals. “He or she may recommend a support group or refer you to a counselor.” G E T H e a l th y !

Need help? St. John Health System hospitals offer a variety of mental, emotional and behavioral health services. Call 1-866-501-DOCS for more information. s tjohn.org

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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. Gentle Tai Chi An introductory class, open to all. When: Thursdays, 10:15–11 a.m. Where: Reflection Space, Assarian Cancer Center, 47601 Grand River Ave., Novi Cost: $5 per session Call: 248-465-5478 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 Healthy Habits for Healthy Kids Kids in grades 5 through 12 (and their parents) will learn to make smarter food choices at this interactive seminar. Healthy snacks provided. When: Wednesday, August 19, 11 a.m. Where: Macomb Mall, 32233 Gratiot, Roseville Call: 1-866-501-DOCS

Yoga For all skill levels. Where: Reflection Space, Assarian Cancer Center, 47601 Grand River Ave., Novi Cost: $10 for walk-ins; $45 for five-class punch cards; $80 for 10-class punch cards; $85 for one-month unlimited passes; $250 for three-month unlimited passes Call: 248-465-5478 for dates/times 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 or visit stjohnweightloss.com to learn more Reflexology Explore and learn about the health benefits, theory and basic techniques of reflexology. Cost: $85 Call: 1-866-501-DOCS for dates/times

Middle School and High School Sports Physicals St. John Physical Rehabilitation’s sports physicals assess general health and identify problems that can impact athletic performance. MHSAA physical forms provided. No appointment necessary. When and Where: Ñ Monday, August 3, 4:30–7 p.m. L’Anse Creuse North High School 23700 21 Mile Road Ñ Wednesday, August 5, 4:30–7 p.m. L’Anse Creuse High School 38495 L’Anse Creuse Road Ñ Thursday, August 6, 4:30–7 p.m. East Detroit High School 15501 Couzens Road Ñ Friday, August 7, 4:30–7 p.m. Clintondale High School 35200 Little Mack Ñ Saturday, August 8, 9:30 a.m.–noon Cousino High School 30333 Hoover Road Cost: $25 Call: 1-866-501-DOCS