St. John Thrive, Winter 2010 by Bernadette Sheridan

stjohn.org Winter 2010

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

From resolution to reality: Get healthy!

Kids and surgery: Pre-op tips Make your health care wishes heard

Don’t skip these lifesaving tests

St. John Hospital and medical center • St. John Macomb-Oakland Hospital • St. John River District Hospital • st. john north shores hospital Providence Hospitals—southfield and providence park

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A healthy new year Happy New Year! The start of another year is filled with the promise of new beginnings, fresh outlooks and positive changes. Don’t forget to make good on your resolutions for 2010! Get started by reading “Ready, set, succeed!” on this page for strategies that can help you stick with your weight-loss goals. Want a healthier body this year? Turn to page 14 and learn how to fight your fitness fears. Along with common resolutions to lose weight, eat better and break bad habits, many people also resolve to better themselves spiritually. If this sounds like you, you’re not alone. As a Catholic health ministry, St. John Health System understands the importance of spiritually centered, holistic care to the overall well-being of our patients. What’s more, experts say that keeping the faith can benefit your body just as much as your soul. To find out how, turn to “The power of prayer” on page 19. And visit us online at stjohn.org/aboutsjh/ mission to learn more about our faith-based mission and values. Here’s to a happy—and healthy—2010!

Sincerely,

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

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Ready, set, Turn your slim-down resolution into a reality

very January, you vow to finally drop those extra pounds you’ve been lugging around, and every February, you give up, going back to your old ways. Don’t despair: It happens to millions of us. Make this the year you succeed with these stick-to-it tips:

1. Make sure you’re ready. Before you begin overhauling your lifestyle, resolve any issues that could be contributing to your weight gain, such as depression, work stress or money worries. If you’ve got too much on your plate, maybe now isn’t the best time to start a weight-loss program. Instead, seek professional help to deal with the stress and any emotional issues holding you back. Then you can concentrate on slimming down. 2. Set realistic—and specific—goals. Don’t just say, “I want to lose 20 pounds.” Instead, focus on how you’re going to slim down. A better goal? “I’m going to start jogging and work my way up to three miles a day, four days a week.”

succeed! 3. Have a support system. “Getting a little guidance, whether from a dietitian, personal trainer, workout partner or all three, makes dieting easier and can help you be more successful at dropping excess pounds,” says Suchitra Zambare, MD, an endocrinologist and internal medicine physician with St. John Weight Loss’ medical program. 4. Take the long road. Frustrating as it may be, slow and steady is the way to go when it comes to weight loss. “A long-term approach is key,” says Gerald Cohen, MD, a cardiologist at St. John Hospital and Medical Center and a bariatrician and medical director of the medical program at St. John Weight Loss. “You’re much more likely to be successful with a gradual approach that empowers you with education and support over a period of years.”

8. Get creative. Eating bland, boring food day after day can put you on the fast track to failure. Instead, experiment with herbs and spices to liven up that grilled chicken and vow to buy one new fruit or vegetable a week. 9. Reward yourself. For each milestone you reach, big (losing 30 pounds) or small (completing a twomile walk), treat yourself to a new outfit, massage or other nonfood reward. Such incentives can keep you moving forward. 10. Lengthen your meals. Change the way you approach meals. “For example, make an effort to eat more slowly,” Dr. Zambare says. “You’ll enjoy the food, and you may even find that you eat less, since it takes about 15 minutes for your brain to signal that you’ve had enough.”

5. Grab a pen. Write down when you ate, what you had, how you felt at the time and how you could eat more healthfully. You may begin to notice a pattern to your bad habits (do you gravitate toward salty foods when you’re bored?) that you can work on changing. Chart your progress when you exercise by jotting down what you did and for how long. 6. Plan to goof. Don’t beat yourself up for that weekend chocolate binge and don’t give up on your goal after one slip-up. Instead, vow to get back on track at your next meal. And take time to figure out what went wrong and how to prevent it from happening again. 7. Have fun. Yes, experts recommend you get at least an hour of activity a day to lose weight, but if you hate walking on a treadmill, don’t do it. You’ll likely quit if you feel obligated to stick to a workout you don’t enjoy. Instead, try finding activities you do like: Tennis, dancing, ice skating and biking are all excellent options.

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Advance

or many of us, being in control of our health care—being able to make decisions about treatment and be informed about our care—is of vital importance. But what would happen if a sudden illness took away that control? Serious illness or injury can happen at any time. That’s why preparing advance directives—documents that communicate your medical wishes if you become unable to communicate them—is an important step you should consider taking. Letting your doctors, family members and loved ones know now about your preferences will be an invaluable tool for everyone later on. “Advance directives allow you to make decisions about your medical care so you know you’ll receive the kind of care you requested,” says Lynn Bidigare, LBSW, JD, a palliative care social worker at St. John Hospital and Medical Center. “Although you can’t plan for illness, you can plan for the time when it happens,” says John Finn, MD, medical director of palliative care services at Providence and Providence Park Hospitals. “We encourage our patients to prepare these documents so doctors and family members don’t have to do guesswork when it comes to determining what’s best for patients.”

Think about your wishes … When deciding which treatments you would (or wouldn’t) want, think about your values, such as how important it is for you to remain self-sufficient. Would you want treatment to extend your life in any situation? Would you want to be treated only if a cure is possible? Would you want palliative care to ease pain and discomfort if you were terminally ill? Trying to predict these scenarios can be difficult, but your health care provider can help. Ask him or her about what you should expect and what the treatment options are regarding your condition. Then let him or her know that you’ll be preparing advance directives.

“Although you can’t plan for illness, you can plan for the time when it happens.” — John Finn, MD

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directives

Helping you stay in control of your health care For you and your family

“Advance directives allow you to make decisions about your medical care so you know you’ll receive the kind of care you requested.” — Lynn Bidigare, LBSW, JD

Then put them in writing You can avoid worrying about what kind of care you’ll receive, as well as find comfort in knowing your preferences can be documented, by preparing these advance directives:

Living will. This document spells out the types of medical treatments and lifesustaining measures you do and don’t want—such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation—and under what conditions, if you aren’t able to express your choices.

“Advance directives are used any time a patient is too ill, sedated for medical reasons or unable to communicate,” says Jeanne Lewandowski, MD, director of palliative medicine at St. John Hospital. “The circumstances are usually related to beginning, continuing, discontinuing or not starting medical and surgical therapies that may be indicated for a patient’s condition.” Therefore, preparing these documents ahead of time is critical. “If you wait and are too ill, your family may need to seek legal guardianship to make decisions on your behalf,” says Bidigare. “This is costly and time-consuming and places a needless burden on family members. Advance directives are the only way to secure that your wishes for care will be honored and carried out by an individual you have chosen.” Once your directives are written out, keep the original and make copies for your physicians, the hospital and your medical POA to use in the future. Keep a copy at home where you and your family members can easily find it in case of an emergency. “An advance directive is easy to complete, doesn’t require a notary and, best of all, is a cost-free gift for your family,” says Bidigare.

Medical power of attorney (POA). The medical POA is a legal document that designates an individual as your health care agent, or proxy, to make medical decisions for you in the event you aren’t able to. A medical POA is sometimes called a durable power of attorney for health care. (Keep in mind that a medical POA is different from a power of attorney that authorizes someone to make financial transactions for you.)

Do not resuscitate (DNR) order. This is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Advance directives don’t have to include a DNR order, and you don’t have to have an advance directive to have a DNR order. Your doctor can put a DNR order in your medical chart.

G ET H e a l t h y

Get started today! You can download a copy of St. John Health System’s advance directive at stjohn.org/palliativecare under “Advance Directive.” Or, call 1-866-501-DOCS to request a copy. For more information, visit the National Hospice and Palliative Care Organization at caringinfo.org/PlanningAhead.htm.

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In the Kitchen

Mangia!

Italian meals go light and healthy

f you want a heart-healthy diet, eat Italian! “Sicilian dishes in particular feature fish, legumes, fruits, vegetables, pasta and little meat—plus healthy fats like olive oil,” says Saima Khan, MD, an internal medicine physician in private practice who is affiliated with St. John Macomb-Oakland Hospital. Try these low-fat recipes from the National Institutes of Health.

Minestrone soup

Spice it up! Try these tips to make your favorite Italian dishes a bit healthier:

Ñ Replace some of the salt in your

recipes with basil, oregano, garlic, parsley and other flavorful seasonings. Ñ Think fresh. Choose fresh, not

canned or processed, chicken, fish and meat. Ñ “Make smart substitutions,”

Serves 16 ¼ cup olive oil 1 clove garlic, minced (or 1/8 tsp. powder) 1 1/3 cups onion, coarsely chopped 1 ½ cups celery with leaves, coarsely chopped 1 can (6 oz.) tomato paste 1 Tbsp. fresh parsley, chopped 1 cup carrots, sliced, fresh or frozen 4 ¾ cups cabbage, shredded 1 can (1 lb.) tomatoes, cut up 1 cup canned red kidney beans, drained, rinsed 1 ½ cups frozen peas 1 ½ cups fresh green beans dash hot sauce 11 cups water 2 cups spaghetti, uncooked, broken Ñ Heat oil in 4-quart saucepan. Add garlic, onion

and celery, and sauté for about 5 minutes. Ñ Add all remaining ingredients except spaghetti.

Stir until ingredients are well mixed. Ñ Bring to a boil and reduce heat, cover and sim-

mer for about 45 minutes or until vegetables are tender. Ñ Add uncooked spaghetti and simmer for

2–3 minutes. Per 1 cup serving: 112 calories, 4 g total fat (0 g saturated fat), 0 mg cholesterol, 202 mg sodium, 4 g fiber, 4 g protein, 17 g carbohydrates, 393 mg potassium

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says Bev Cameron, a registered dietitian at Providence and Providence Park Hospitals. “Instead of whole milk or cream, cook with low-fat milk, and use vegetable oil instead of butter.”

Vegetarian spaghetti sauce Serves 6 2 Tbsp. olive oil 2 small onions, chopped Ñ Rinse tuna and other canned

foods before cooking to get rid of some of the sodium. Ñ Remove the skin from chicken

and any visible fat from other meats before cooking. Ñ Skip the salt when boiling water

for pasta. Ñ Cook with leaner beef and pork

cuts that end in “loin,” such as tenderloin, sirloin or pork loin.

3 cloves garlic, chopped 1¼ cups zucchini, sliced 1 Tbsp. oregano, dried 1 can (8 oz.) tomato sauce 1 can (8 oz.) no-salt-added tomato paste 2 medium tomatoes, chopped 1 cup water Ñ In a medium skillet, heat oil. Saute onions, garlic and

zucchini in oil for 5 minutes on medium heat. Ñ Add remaining ingredients and simmer, covered, for

45 minutes. Per ¾ cup serving: 102 calories, 5 g total fat (1 g saturated fat), 0 mg cholesterol, 260 mg sodium, 5 g fiber, 3 g protein, 14 g carbohydrates, 623 mg potassium Recipes reprinted from Keep the Beat: Heart Healthy Recipes from the National Heart, Lung, and Blood Institute. July 2003. Available for free download at www.nhlbi.nih.gov/health/public/heart/other/ktb_recipebk/index.htm, or in print by sending $4, plus $3.10 for shipping, to NHLBI Information Center at P.O. Box 30105, Bethesda, MD 20824-0105; or by calling 301-592-8573.

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Orthopedics

Arthritis relief : From simple to surgery

f your joints are feeling creaky or achy, you’re not alone. Arthritis affects nearly one in five Americans and is the major cause of disability in adults. There’s no known cure, but these treatments may provide you with relief.

Simple strategies Before trying any therapy or supplement, talk with your health care provider. Here are a few treatments you may want to ask about: Ñ Activity can play a key role in managing arthritis. “By controlling your weight and keeping joint muscles strong, regular activity can reduce pain and stiffness and keep you flexible,” says Anthony Baron, MD, a rheumatologist at St. John Macomb-Oakland Hospital. Ñ Acupuncture uses fine needles that stimulate points in your body to release natural pain-killing endorphins and fight inflammation. Acupuncture may be especially helpful in relieving knee pain from osteoarthritis. Ñ Capsaicin in over-the-counter creams, ointments and patches is an ingredient found in hot peppers. It’s recommended by the American College of Rheumatology for soothing knee osteoarthritis pain. Use with caution, however, because these products may cause skin irritation. Ñ Drugs, such as nonsteroidal anti-inflammatory drugs or cortisone shots, can offer short-term pain relief. DMARDS (diseasemodifying antirheumatic drugs) may slow disease progression. Ñ Massage therapy can ease pain and stiffness by kneading or stroking the affected area. Regular massages can improve sleep and boost your body’s endorphin production. Ñ TENS, or transcutaneous electrical nerve stimulation, delivers safe, low-voltage electrical currents through electrodes taped on or near painful areas. TENS can provide short-term pain

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relief by blocking pain messages to the brain and modifying pain perception. Ñ Supplements like chondroitin sulfate and glucosamine may help lessen osteoarthritis pain. Omega-3 fatty acids, the fats found in fish oil, may reduce inflammation and pain. S-adenosylmethionine (SAM-e) may increase joint flexibility and decrease pain.

When surgery is a must “If these measures aren’t successful, it may be time to talk with your health care provider about surgery,” says Bruce K. Kaplan, MD, section chief of rheumatology at Providence and Providence Park Hospitals. Your choices may include: Ñ Arthrodesis, or bone fusion surgery, to relieve pain, usually in the ankles, wrists, fingers and thumbs. Ñ Osteotomy, a surgical correction of bone deformity. The surgeon actually reshapes the bone to reduce stress on the joint. It can take three to 12 months to recover. Ñ Synovectomy, the removal of the tissues lining the joints, or synovium. It can help reduce pain and swelling, but the synovium often grows back. Ñ Joint replacement surgery, or arthroplasty, rebuilds a joint by resurfacing or relining the ends of bones or removing damaged bone or joint tissue and replacing it with metal, ceramic and plastic parts. Recovery can take several weeks. G ET H e a l t h y

We can help! For a referral to a specialist who can help you manage arthritis pain, call 1-866-501-DOCS.

Helping your teen build a better body image

ara takes nearly an hour to get dressed each morning, trying on one outfit after another only to toss them all in a corner with disgust, claiming they make her look fat. She even frequently skips lunch in an effort to shed pounds. Sara may remind you of many people, perhaps even yourself. But Sara is only 13 years old, and her doctor says her weight is healthy. What’s not healthy is Sara’s body image—the way she sees herself—and how it affects her sense of worth. Many teens start to struggle with their body image as they begin puberty. “As girls develop fuller hips and breasts, they may feel self-conscious and fat,” says Debra Hollander, MD, chair of the behavioral medicine department at Providence and Providence Park Hospitals. “As boys become gangly from a height-first growth spurt, they may try steroids or hormones to help their muscles catch up.” Teens with poor body images are more likely to try risky supplements and fad diets, develop eating disorders and exercise compulsively. Or, they may turn to alcohol and drugs to soothe their unhappiness. The messages kids get from magazines, movies and television are part of the problem—getting a handle on reality is difficult in an era when photos of celebrities are doctored and professional athletes take hormones to bulk up. Your teenager’s ideal may be an impossible-to-achieve illusion of computer tricks and chemical enhancements.

What’s a parent to do? Try these strategies: Ñ Be media savvy. Explain how most media are created to sell, persuade or manipulate. Teach how to view and think about media critically. Talk about whether that waif model is really healthy. Ñ Focus on health. “Help your teen set goals of being strong, fit and vital,” says Melissa Mueller, DO, a pediatrician at St. John Hospital and Medical Center who also practices at the St. John Children’s Center. “Plan healthy, nutritious family meals and encourage more physical activity. Explain how diets don’t work because food deprivation causes the body to burn fuel more slowly. Discuss the hype and dangers surrounding many supplements.” Ñ Watch your words. If you lament your own image in the mirror each morning or gush about how slim a friend looks, it reinforces the idea that a person’s worth is defined by his or her body. Ñ Talk to your teen’s doctor. Seek help if your teen becomes obsessed with fixing a certain part of his or her body or if low selfesteem causes avoidance of social situations.

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Your Heart

Vascular screenings: tests that

ccording to the American Vascular Association, 20 million to 30 million Americans are at risk for various vascular diseases, conditions that affect the arteries and veins that bring blood to and from the heart. Vascular diseases like peripheral artery disease (PAD), carotid artery disease and aortic aneurysms are serious and require prompt attention—making screening and early detection all the more important.

Testing, testing … Several tests, all of which are noninvasive and painless, are available to help detect vascular problems. “These screenings are simple—they don’t pose any risks or discomfort, and they can be done in minutes,” says Kevin D. Nolan, MD, MPH, FACS, chief of vascular surgery at Providence Hospital. Why screen? “Finding out if you have vascular disease can lead to the prevention of other health problems,” says Thomas Davis, MD, director of the cardiac catheterization lab and director of peripheral intervention at St. John Hospital and Medical Center. “These exams and their findings can help you take action now for better health, before conditions become worse. That’s the real value of screenings— they can save your life.” Read on for a closer look at three key vascular screenings. Talk to your doctor to see if they’re right for you:

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1. Abdominal aortic aneurysm screening An aortic aneurysm is a weakness causing a bulge in the aorta, the major vessel that runs from your heart through the middle of your chest and abdomen. Aneurysms can develop along the aorta, but they occur mostly in the abdomen. If an aneurysm ruptures, it can cause life-threatening bleeding. Aneurysms can be detected during routine medical tests, a computerized tomography (CT) scan, magnetic resonance imaging (MRI) or an abdominal ultrasound. “If the tests show abnormal screening results, it doesn’t necessarily indicate an aneurysm is big enough to require repair, but it does warrant a visit to your physician for further evaluation or a referral to a vascular specialist,” says Dr. Nolan. The idea is to monitor the aneurysm’s size. “Generally, your treatment options are to watch and wait or to have surgery,” says Dr. Davis. “It all depends on the size of the aneurysm and how fast it’s growing.”

2. Carotid artery disease screening The carotid arteries are blood vessels located on both sides of the neck. When fatty deposits called plaque build up in the arteries, the blood supply becomes blocked, thereby increasing the risk of stroke. This condition is referred to as carotid artery disease. Tests to evaluate your carotid arteries include a physical exam in which your doctor listens to your carotid artery with a stethoscope for

can save your life signs of plaque buildup; an ultrasound to check blood flow and pressure; CT angiography; or MRI scans that take images of your neck and brain. “If you have more than a 50 percent blockage of the carotid artery on a screening examination, follow up with your primary care physician so a more thorough evaluation can be completed,” says Dr. Nolan.

Should you be screened? The more risk factors you have for developing vascular disease, the more you’ll benefit from screenings. Risk factors include: Ñ smoking Ñ a family history of vascular disease Ñ being overweight Ñ an unhealthy diet

3. Peripheral artery disease (PAD) screening

Ñ lack of exercise

PAD is a common circulation problem in which plaque builds up in the arteries, limiting blood flow and oxygen to your extremities, usually the legs. “In moderate cases, muscle tightness develops with walking,” explains Dr. Nolan. “In severe cases, painful ulcers can develop on the toes, which can lead to the loss of toes, feet or legs.” A PAD screening may include a physical exam in which your doctor listens for a weak pulse over your arteries; an ankle-brachial index that compares the pressure in your ankle to the pressure in your arm using a blood pressure cuff; an ultrasound to check blood flow and detect blocked or narrowed arteries; and a blood test to check your cholesterol, homocysteine and C-reactive protein (a general marker of inflammation) levels. “Most patients with mild blockage may continue to have this blockage without it getting worse, while others could develop progressive disease that will require treatment,” says Dr. Davis. “If tests show a blockage, a vascular specialist can evaluate further.”

Ñ diabetes Ñ being male Ñ high blood pressure Ñ high cholesterol levels Ña ge (men ages 45 and older, and women ages

55 and older) G ET H e a l t h y

Need a screening? Call us! Talk to your primary care doctor to see if vascular screenings are appropriate for you. To find providers in your area who perform vascular screenings, call 1-866-501-DOCS.

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Hard Wired

Survivor R Fast action stops stroke in its tracks

ob Johns uses the word “lucky” a lot when he describes the morning of March 31, 2009. It may seem a strange adjective to use when you’re talking about the day you had a stroke, but it fits. Johns was lucky that he didn’t suffer the stroke while driving his teenage daughter to school that morning. He was lucky that he went to his office, rather than working from home like he’d planned. And he was lucky that a co-worker knew what to do when he had the stroke.

“I couldn’t talk” At 46, the Auburn Hills resident was much younger than the average stroke patient—the risk increases for every decade after age 55. But Johns suffers from atrial fibrillation, a condition that increases a person’s stroke risk fivefold. Atrial fibrillation means the heart’s upper chambers don’t effectively pump. This defect causes blood to pool in the heart and may lead to blood clots, which can travel to the brain and cause a stroke. And that’s what happened to Johns. When he got to his job at Sun Microsystems that morning, he pulled out his laptop and prepared to work. “I went to put the mouse on the right side of the computer, and I couldn’t use my right arm,” he says. Johns’ co-worker Tim Judnt stopped by to say hello. “I just looked at him,” Johns says. “I couldn’t talk.” An office manager called 911.

Here when you need us Every second counts in stroke care. That’s why St. John Health System hospitals have strict stroke protocols in place to quickly assess patients and get them treated. From leading-edge imaging and clot-removal technology to dedicated stroke specialists who are always at the ready, the designated stroke centers at St. John Hospital and Medical Center, Providence Hospital and St. John Macomb-Oakland Hospital are here for you when you really need them. The stroke centers are certified by The Joint Commission, an independent, non-profit organization that certifies and accredits more than 17,000 health care organizations and programs in the United States.

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Saving the brain Stroke is a medical emergency. Every minute that your brain is deprived of oxygen, brain cells die and the risk that you’ll suffer permanent disabilities increases. Stroke warning signs include: Ñ sudden numbness or

weakness of face, arm or leg, especially on one side of the body Ñ s udden confusion or trouble speaking or understanding

speech Ñ sudden trouble seeing in one or both eyes Ñ sudden trouble walking, dizziness, or loss of balance

or coordination Ñ sudden severe headache with no known cause

Time is of the essence At Providence Hospital, doctors and nurses worked fast to minimize the damage. After assessing Johns’ condition, it became clear a blood clot on the left side of his brain was causing a large stroke. James Mick, MD, an interventional neuroradiologist on staff at Providence Hospital, Providence Park Hospital and St. John Hospital and Medical Center, worked on Johns. “There are so many things we can do to treat stroke if you get to the hospital quickly,” says Dr. Mick. But those treatment options start dwindling after three hours. Stroke isn’t painful like a heart attack, he says, so many people don’t seek treatment right away. And some people suffering a stroke aren’t able to think clearly enough to get help, so they have to rely on others to recognize the symptoms. Johns was given the clot-busting medication tissue plasminogen activator (tPA). There was no change in Johns’ condition, so Dr. Mick turned to the Penumbra Stroke System. The catheter device is inserted into the groin and threaded through blood vessels up to the brain. There, it breaks up the clot into manageable bites, which are vacuumed out. Within five minutes, blood was flowing again in the left side of Johns’ brain.

The road to recovery Johns credits the fast thinking of his co-worker and the care he received at Providence with saving his life. The next day, he was

walking and talking. Still, there have been some lingering effects. An athlete by nature, he has some trouble shooting hoops and golfing like he used to. He’s taking the blood-thinner Coumadin to prevent more blood clots from forming, doctors’ appointments are pretty frequent, and he’s considering surgery to treat his atrial fibrillation. “I don’t always feel great,” Johns says. “I get tired, so I take it easy. But I can still pretty much do it all, so I feel lucky.”

G ET H e a l t h y

Are you stroke smart? Take our online quiz to test your knowledge! Go to stjohn.org and click on “Find a Service,” then “Stroke” to get started. Our free bookmark can help you remember the symptoms and signs of stroke. Call 1-866-501-DOCS to request yours today!

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Healthy Moves

Afraid to get fit?

he trouble with exercising isn’t getting started—you’ve probably done that more than once—but sticking with it. Taking local fitness classes or joining a health club may give you the motivational push and variety you need. But perhaps you just can’t get up enough nerve to step into an unfamiliar world of intimidating exercise equipment and fancy aerobic footwork.

Conquer your fitness and health club fears It’s normal to feel apprehensive or embarrassed when you’re pushed out of your comfort zone, and it takes some courage to walk through those health club doors for the first time. But you can overcome apprehension if you arm yourself with certain strategies to tackle your fears and build the confidence you need to get moving. Read on to see how you can conquer your health club phobia.

The fear: “I’m a workout newbie—and I don’t want to look silly or uncoordinated.” Relax—it only seems as if everyone else knows what they’re doing. Gyms and classes are full of beginners, and unlike the ads you see on TV, most health clubs aren’t swarming with buff bodies.

The fix: Shop around. Not all gyms are the same. Different health clubs have different clientele and atmospheres: Some are large and busy with loud music, while others are smaller and quieter with more mature members. Visit the health club at the same time of day you plan to work out since its atmosphere can change with the clock. Look for a club that has a friendly, helpful and knowledgeable staff. Gyms normally allow a day pass or a one-to-two-week trial membership so you can try before you buy. Hire a trainer. “You’ll learn what to do and how to do it safely,” says M. David Jackson, MD, section chief of

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internal medicine and physical rehabilitation at Providence and Providence Park Hospitals. Take advantage of free training sessions offered at many gyms when you sign up.

Take a class for workout novices. Your comfort level will increase if you’re among others at your level of ability and conditioning. Let the instructor know you’re a newcomer and discuss any concerns you have. “This is a perfect opportunity for you to get some one-on-one pointers about equipment use, proper form and safety issues,” adds Claudia Pop, MD, a family medicine physician at St. John River District Hospital. Do your homework. Check out fitness magazines or library books to learn basic exercise form. Don’t just look at the pictures—read the instructions for tips on safe technique. Buddy up with a friend. You’ll be too busy having fun to worry about others watching you.

The fear: “I’d like to work with a trainer— but it scares me.” Good trainers don’t want you to look or feel stupid. If you land a trainer who makes you feel weak, clumsy or foolish, try talking to him or her. If that doesn’t work, find a new trainer.

The fix: Get a reference. Word-of-mouth is often helpful. Keep an eye on trainers in the gym you may like to work with. Do they seem supportive and at ease with clients? Do they give clients their full attention or seem distracted and bored?

Have a consultation first. Discuss your goals, any health limitations you have and your past difficulties with working out. Listen to the responses before writing out a check.

The fear: “I’m too unhealthy/ too heavy to work out.” Fitness magazines are full of before-and-after photos of people who were once “too heavy or too unhealthy” to exercise—proving the excuse wrong. You just need to take certain precautions.

The fix: Talk to your doctor. “Find out what activities are safest for you right now, and start slowly,” Dr. Pop advises. If you haven’t exercised in years, a 15-minute walk is a great start. Use a heart monitor if necessary. Get professional help. Doing too much too soon can lead to muscle soreness or fatigue that makes you quit. “A knowledgeable trainer considers your health status and level of conditioning when designing your workout program,” Dr. Jackson says. Consider your needs. Some classes are geared toward people with arthritis, older adults or exercisers who need a low-impact workout. Talk to your instructor. If you have a medical condition such as arthritis or asthma, don’t be shy. Your instructor can also provide modifications if you’re a new exerciser or you need lower impact or lower intensity moves. Go at your own pace. Forget about keeping up with the competitive cyclist or the gym rat next to you.

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Cancer Connection

A helping hand

Hospice offers compassionate care

aking care of a loved one who has a lifelimiting illness like cancer is never easy. You may feel unprepared to handle his or her end-of-life care, or perhaps you have questions about the treatments he or she can receive. How can you ensure your loved one is comfortable and cared for in this final stage of life? St. John Hospice can help. Hospice is a special kind of caring. It offers people with life-limiting illnesses the choice to live as fully and as comfortably as possible in a familiar environment surrounded by family and friends. “Hospice provides supportive medical, emotional and spiritual care for patients at the end of their lives,” says Robert Leonard, MD, medical director of St. John Hospice. “We focus on enhancing the quality of life and not giving up during this difficult time.”

“Our multi-disciplinary hospice team offers holistic care to children and adults with terminal illness,” says Dana Buick, MD, associate medical director of St. John Hospice. “This team involves the patient, family, doctors, nurses, registered dietitians, home health aides, social workers, spiritual care counselors and volunteers. We work with patients and their families, focusing on comfort, education, coordination of care and other services.” Patients can receive hospice services at home, at nursing homes, at assisted-living facilities or at the hospital, depending on the patient’s individual needs. Services are available 24 hours a day, seven days a week and include: Ñ medical services Ñ pediatric hospice and palliative care Ñ skilled nursing care

The hospice advantage Hospice provides care to patients who have life-limiting illnesses such as: Ñ cancer

Ñ advanced Alzheimer’s disease

Ñ heart failure

Ñ renal failure

Ñ COPD

Ñ advanced emphysema

Ñ stroke

Ñ ALS (Lou Gehrig’s disease)

When to choose hospice “If aggressive treatment is no longer effective, choosing hospice early on allows us to build a relationship with the patient and the family,” says Eva Sylvester, administrator of St. John Hospice. “This ultimately helps reduce fears, provide support and create a better understanding of what to expect while moving along in the journey—together.” G ET H e a l t h y

The support you need For more information about hospice services throughout St. John Health System, call 1-800-248-2298 or visit stjohn.org/hospice.

Ñ dementia

Ñ home health aides Ñ chaplain services Ñ dietary counseling Ñ medical equipment and supplies Ñ Walk with ME (a palliative care program available to children from newborn to early adulthood) Ñ ambulance services Ñ bereavement services

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Images on pages 2, 3, 7, 10, 12 and 14 © istockphoto.com/Alex Slobodkin, TommL, Dusan Zidar, Nicholas, sorbetto, Carey Hope

How hospice helps

Preparing your child for surgery Advance planning can help both of you feel better

f you’re nervous about having surgery, just imagine how your child feels. Big equipment, unfamiliar surroundings and strange faces can seem pretty scary for a small child. But good preparation can ease anxiety and make the procedure and the recovery period go more smoothly for both of you. Here are four ways you can prepare your child for the experience.

1. Talk it out. Provide information at a level your child can understand. “Honesty is the best policy,” says Marc Cullen, MD, chief of pediatric surgery at St. John Hospital and Medical Center. “No matter how old your child is, he or she will cope better and be less afraid when he or she understands what’s going to happen and why it’s necessary. Explain that anesthesia is safe and that special medicines can make the pain go away if they’re sore after the surgery. “It’s also important for parents to communicate with hospital staff,” Dr. Cullen adds. “Speak up. Ask questions. Get on a firstname basis with the staff and establish trust. You’ll be less anxious, and so will your child.”

2. Take a tour. Seeing the hospital in advance will help quell your child’s anxiety, as well as your own. “Our hospital tour involves meeting with the anesthesiologist and pre-op nurses,” says Michael Mendelow, MD, an orthopedic surgeon at Providence and Providence Park Hospitals. “Parents will have the chance to ask questions and meet with a discharge coordinator to discuss post-surgery care.”

3. Get support. “I encourage families to speak with other families who’ve gone through similar procedures,” says Dr. Mendelow. “Often, these families end up becoming good friends.”

4. Make the environment familiar. “On the day of surgery, bring your child’s favorite toys to play with,” says Dr. Mendelow. Prepare distractions for when your child is out of surgery, and arrange for you and your child to have plenty

of time to rest and recuperate. Dr. Cullen suggests bringing another adult family member with you to act on your behalf, if necessary. “As a parent, being comfortable with the procedure is important,” says Dr. Mendelow, “because children pick up on that comfort.” St. John Health System knows what it takes to achieve that level of comfort. Our doctors, nurses and administrators are there every step of the way to guide you and your child through a successful surgery and recovery. G ET H e a l t h y

Need a pediatrician? For a physician who can help keep your child healthy, call 1-866-501-DOCS. Same-day appointments are available.

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How sharp is your vision knowledge?

True or false?

True False

1. Surgery is the only way to get rid of a cataract.

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2. Using a computer can damage your eyes. 3. If you are farsighted, you have trouble seeing things close up.

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4. Dry eyes are a possible complication of LASIK surgery.

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5. Macular degeneration destroys your peripheral (side) vision.

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G ET H e a l t h y

Keep an eye on your health! For a referral to an eye care specialist, call 1-866-501-DOCS.

Ne e d a d o c t or ? C a l l 1- 8 6 6 - 5 01- d o c s

1. True. When you have a cataract, your eye’s lens is clouded, making it difficult for light to pass through and blurring your vision. While not every cataract requires surgery, if a cataract makes it difficult for you to perform daily activities, you may need surgery. During a cataract procedure, your eye doctor removes the damaged lens and replaces it with a clear, artificial lens. Cataract surgery is typically very successful and improves vision in most people. 2. False. Looking at a computer screen for long periods can cause you to blink less often, leading to a feeling of eyestrain or fatigue, but causing no harm to your eyes. When working at your computer, make sure to take breaks by shifting your focus every now and then to objects farther away. 3. True. Farsightedness occurs if your eye is too short or the cornea isn’t curved enough, which means light entering your eye isn’t focused correctly. If you’re nearsighted, you have trouble seeing things in the distance. 4. True. Healing eyes may feel unusually dry for the first six months or so. If you have severe dry eye, you may need a second procedure that helps keep your tears from draining from the eyes’ surface. 5. False. Macular degeneration damages your sharp, central vision. There are treatments that can slow vision loss, but nothing can restore it. The disease is a leading cause of vision loss in Americans ages 60 and older.

Answers

any of us take our eyesight for granted. But how much do you know about the gift of sight? Test your knowledge by answering true or false to the statements below. Then check the answers to see how you did.

Healthy Spirit

The power of prayer Can spirituality keep you well?

o people who pray enjoy healthier lives? Possibly. People have turned to prayer and spiritual practices to help improve their health and well-being for thousands of years, but only recently have scientists begun studying the effects religion, faith and spirituality may have on health. Researchers know that many people pray. In a national survey of 31,000 people supported by the National Center for Complementary and Alternative Medicine, 45 percent of respondents used prayer for health reasons, including praying for their own health, having others pray for them and taking part in a prayer group for their health. Spirituality may be linked to reduced depression, better blood pressure and a healthier immune system, say some researchers. “Spiritual persons are less likely to have self-destructive behaviors like smoking and drug and alcohol abuse, and they suffer less stress and enjoy greater fulfillment with life,” says Betty Granger, CSJ, Senior Vice President of Mission Integration at St. John Health System. Experts suspect religion, faith and prayer may aid in protecting your health and fighting off disease because it can help you to:

Relax. When your body is relaxed, your heart rate, blood pressure and breathing rate all go down, decreasing the body’s stress response and levels of the stress hormone cortisol. Focus on personal goals. “Exploring what’s most meaningful in your life can help you clarify your goals and redirect your energy from less important things,” Granger says. Find your place in the world. “Feeling a part of something greater than yourself helps give you a sense of purpose and allows you to feel less alone,” says Granger. “Seeing the big picture can also help you realize you aren’t responsible for everything that happens in your life. Sharing this burden can help you better cope with hard times and enjoy the good times more.” Expand your support network. Belonging to an organized religion can provide many chances for social support. Attend religious services, or join the choir or a study group.

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St. John Hospital and Medical Center

St. John Macomb-Oakland Hospital, Oakland Center

22101 Moross Detroit, MI 48236 313-343-4000

27351 Dequindre Madison Heights, MI 48071 248-967-7000

Providence Hospital

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26755 Ballard Road Harrison Township, MI 48045 586-465-5501

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47601 Grand River Ave. Novi, MI 48374 248-465-4100

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St. John North Shores Hospital

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St. John Health System 28000 Dequindre Warren, MI 48092

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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. Weight-Loss Seminars St. John Health’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 for more information St. John Health Heart Check Assessment

Yoga

Childbirth Preparation

For all skill levels.

St. John Health System hospitals offer a variety of classes to help women and their partners prepare for labor and delivery.

Where: Convenient locations throughout St. John Health System Call: 1-866-501-DOCS for information about locations, times and cost

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.

Diabetes Education Classes

Visit: stjohn.org/heartcheck

Where: Convenient locations throughout St. John Health System Call: 1-866-501-DOCS for information about locations, times and cost

Alternative Birth Care Education Call or visit us to learn about the Alternative Birth Care Unit at Providence Hospital. This unit offers a personalized childbirth experience in a unique and private setting, with a wide range of amenities and services. Call: 248-849-3919 for more information

Ongoing classes are taught by certified diabetes educators; individual sessions are also available. A physician’s referral is required.

Tai Chi Beginner and continuing levels available. Where: Convenient locations throughout St. John Health System Call: 1-866-501-DOCS for information about locations, times and cost

Where: Convenient locations throughout St. John Health System Call: 1-866-501-DOCS for information about locations, times and cost Is it Hot in Here? Women looking for a non-estrogen-based treatment for hot flashes may be eligible to participate in a research study at St. John Macomb-Oakland Hospital, Macomb Center and St. John Hospital and Medical Center. Call: 586-573-5127 (St. John MacombOakland Hospital) or 313-343-3166 (St. John Hospital and Medical Center) for more information