HealthWatch Sept 2004

You were just told you

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need surgery.

But how about something for the butterflies in your stomach?

At St. Joseph’s Medical Center, you’ll find more board-certified surgical specialists than anywhere else in the Brainerd Lakes region.

We have the area’s most highly trained surgeons on staff, and we’re continually upgrading

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LIFETIME MOBILITY BEGINS AT PURCHASE You are in need of a power chair or scooter and you see an advertisment on television selling them. You figure it is a good deal so you call and they take your order. All is fine until one day your granddaughter is over and when she asks you to play “Chutes and Ladders” your power chair or scooter is not running correctly. You end up spending the afternoon on the phone trying to figure out how to get someone to come and fix it. After your granddaughter leaves disappointed, someone finally tells you that you have to call your local medical supplier - so much for the 800 customer service line. You thought when you purchased your equipment that they would be there after the sale too!

This scenario is very disheartening because little did you know what buying a power chair or scooter entailed.

And the consequences are enough to break your granddaughter’s heart! You must remember there are 3 important things to where you purchase a scooter and they are as follows: Education, Evaluation and Service. The organization from which you purchase a scooter should be educated. They should also be capable and willing to perform an evaluation of you and your scooter to ensure a correct fit. Finally they should extend a service policy you will be happy with during and after the purchase of your power chair or scooter.

When talking about an educated facility, there are terms you must know. An Assistive Technology Practitioner (ATP) is one who has completed the certification process of advancing to a higher level in the technology specialization:

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“The ATP certification process is a healthy developmental milestone for the relatively young field

of assistive technology. The basic role of assistive technology credentialing is to ensure consumer safety and increase consumer satisfaction. The ATP certification is not a license to practice and does not allow people to practice in an area in which they are not prepared. However, it is the only formal process that attests to advanced knowledge and practice skills in the assistive technology specialization area.

Although the ATP is not currently required for one to practice in the field, it is very likely that this certification will be a criterion for employment in the not-too-distant future. Fortunately for occupational therapy practitioners, we are well positioned to attain the ATP designation and continue our role as valued members of the assistive technology service.” (Source: Certification in Assistive Technology

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There is also an organization called the National Registry of Rehabilitation Technology Suppliers that certifies suppliers on a nationwide basis. This title can help assure you as a consumer that you are purchasing equipment that will be of utmost satisfaction. “NRRTS is dedicated to ensuring the provision of high-quality Rehabilitation Technology and related services to people with disabilities.

All NRRTS registrants meet specific professional membership requirements and agree to adhere to the Code of Ethics, Standards of Practice and Blind Bidding policies of our organization. The cornerstones of these codes are quality, professionalism and integrity.” (Source: http:// www.nrrts.org/)

You know you will be satisfied with your scooter or wheelchair if the technicians do a proper evaluation prior to the purchase. One evaluation that should be done is called “Pressure Mapping.” Pressure mapping involves using a pressure sheet that is attached to a computer. The pressure sheet will show any pressure areas that cause skin breakdown. Once the supplier has this information, they can then choose the most appropriate cushion for the user. This process ensures a comfortable fit.

There are other points of evaluation that the process entails, including a proper fit regarding your lifestyle and needs from the power chair or scooter. This is a process that only an ATP or NRRTS certified technician can perform.

Finally, when choosing where to purchase your scooter, you should keep service after the sale in mind. It is important to remember that your power chair or scooter is a machine, just like a car or computer that may need to have repairs. A credited store will pick up and deliver your scooter for most or all repairs. They will also have the proper technicians on hand to help you over the phone or in person if you are having difficulties with your power chair or scooter. You should never be left in the dark after buying a power chair or scooter!

Actually, you should never be left in the dark at any part of the purchasing process. A technician should be educated enough to walk you through the evaluation and purchase process as well as the follow-up evaluation after the sale, if and when it is needed. After all, if your power chair or scooter breaks down when your granddaughter is over, wouldn’t you rather make one call to your local medical supplier than spend the afternoon calling an 800 customer care number?

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Maura Hall has spent more than $25,000 on a kidney transplant for her cat, Lily. People are willing to spend serius money on their pets, a sea change that began in the late 1980s, driven by technological innovation and the rising social status of the American house pet.

Lakes Area Rehabilitation Services provides the opportunity for clients to continue to recover and gain strength after a stay in the hospital and prepares them for functional independence to return home.

counterweight to the agribusiness interests that have traditionally underwritten much veterinary research at universities.

All this has put new pressure on the ordinary clinic. Vets, who 30 years ago needed little more than a stethoscope and an Army surplus field X-ray machine to set up a practice, now equip their clinics with an array of expensive diagnostic equipment, from blood-analysis machines to ultrasound scanners. Setting up a small practice costs upward of $500,000.

The average veterinary bill, which has tripled in the past 10 years, reflects this. It’s the direct result of a half-million-dollar study commissioned by the leading veterinary professional organizations in 1998 to figure out why veterinarians’ salaries were lagging. The study cited federal statistics showing that veterinary practice incomes had declined during the 1990s, when many other professional incomes rose, and the profession set up a national commission to encourage vets to concentrate harder on the bottom line.

These days, veterinary school graduates enter a profession more focused on management economics than ever before, and one in which ethical questions are beginning to surface. Veterinary malpractice cases, once rare, are on the rise. State courts have begun awarding aggrieved pet owners sums as high as $30,000 for pain and emotional suffering.

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From the editor Thinking back to my junior high days, three things come to mind: poofy hair, huge glasses and a mouthful of braces.

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The hair and glasses may have been a fad, but to this day I still see people with a mouth full of tin. Who knew there was a teeth-straightening alternative to braces? Check out the story on Invisalign, and find out if you can straighten your teeth without having a “metal mouth.”

This fall issue of HealthWatch covers a variety of topics, including local families struggling with tick diseases, a professional’s ideas on teenage behavior and a disease profile on polio and postpolio syndrome.

As always, your story ideas are welcome. Is there a disease or procedure out there you are curious about? Let me know by e-mailing heidi.lake@brainerddispatch.com.

Heidi Lake, Editor

Table of contents 5 26 28 10 14 30 19 32 36 22 24 COVER STORY: Invisalign

INNOVATION: Improved bandages

TICKS: And the diseases they carry

MUSCLE MATTERS: Baby yoga

RUN FOR A REASON: Sudden Unexplained Death in Childhood

PAST AND PRESENT: Polio and postpolio

HEART HEALTH: Fish can be good for you

DISEASE: Angelman syndrome

TOOTHBRUSHES: Electric vs. manual

PET HEALTH: Health care for animals

$1,400 brain scan. And if there was a brain tumor? How I would know how much medical treatment was right and how much was too much? How much could I afford? Already we were flying on credit cards.

Until the 1940s, veterinary medicine was devoted to helping agriculture manage its food animals, with a creed of helping society by helping animals (as opposed to helping animals themselves). Until the 1960s, most vet students were men with a background in farming or animal science.

During the suburbanization of the 1950s, practices began to proliferate, but cats and dogs still spent much of their time outside. As recently as the late 1980s, most owners treated their pets as second-class citizens.

Veterinary practices reflected this lowly status. Even now most veterinarians carry little or no malpractice insurance, because until very recently it was impossible for a pet owner suing over loss of a pet to recover anything more than its replacement value. The bigger part of the vet’s week was spent administering vaccines and fixing the broken bones that were common before leash laws. When the

problems became difficult or expensive to fix, the animal was euthanized.

“One of the most discouraging parts of my practice in the early days was having a dog come in with a simple broken leg and having the owner say, ’Well, it costs money and it’s just a dog, so put him to sleep,’ ” says Walther.

In the late ’80s, however, pets began to fill the emotional and physical void created by rising divorce rates and growing numbers of single-person and childless households. And from 1987 to 2000, the life spans of the average dog and cat increased by more than one-third, thanks to better commercial pet foods and widespread vaccination, according to the AVMA. But that longevity meant a jump in the incidence of the diseases of old age: cancers, organ failure, crippling arthritis. With the family pet now ensconced on the bed instead of the yard, medical problems were easier to spot and harder to ignore.

Today, many people think of their pets as family members, and they want them to have access to the same medical technology they do, vets say. And this is possible, thanks to the same biomedical revolution

that transformed human medicine in the 1950s and ’60s. According to the FDA, which regulates drugs for the veterinary market, the pharmaceutical industry has begun shifting its energies away from the agricultural market and toward companion animals. The number of new drugs approved for veterinary use has increased dramatically in the past decade, with special interest in drugs for behavior modification and pain relief.

The focus on pain medication is particularly significant. Until very recently, desensitizing veterinary students to animal pain was an important part of their education. “When I went to vet school back in the Stone Age, we didn’t really talk about pain,” says Stephen Sundlof, director of the FDA’s Center for Veterinary Medicine. “It was, ’Do the surgery, and the animals will get along fine.’ ” This gradual and ongoing “evolution in consciousness,” says Elliott Katz, a veterinarian and founder of the advocacy group In Defense of Animals, has been spurred by the entrance of large numbers of women to the profession in the past 15 years, and by the demands of pet owners, whose economic clout is becoming a

PSYCHOLOGY: Teenage behavior

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Aligners replace braces in quest for metal-free mouth

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Story/Mary Battiata Photos/Carol Guzy Washington Post

Amy Newhall, of Owings Mills, Md., with her pug, Stanley, 10, who recently lost an eye. People are now willing to invest in a pet having health problems.

Owners do what it takes to keep pets healthy WASHINGTON — The blood-pressure reading was fine, and now the veterinary anesthesiologist picked up an electric hair clipper to clear a patch of fur from my dog’s foreleg. This was too much. Stoic through patient intake and the tightening of the blood-pressure cuff, he now turned his head toward the whirr and chick of the blades and began to quaver in a way I’d never seen.

“He’s probably just picking up on your anxiety,” the vet tech said. I nodded and tried harder to act like a $1,400 veterinary brain scan was no big deal.

But the dog knew better, and so did I. Looking down at my boon companion for more than half of my adult life, I thought, “I hope this is the right thing to be doing.”

My most recent experience with major veterinary care had been way back in the ’70s, when 10 was old for many dog breeds, and visits to the vet with the family dog never involved anything more complicated than a rabies shot or a worming pill.

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Now, we were uneasy pilgrims in a strange new world, where we never seemed to get out of the clinic for less than $250 and our first real sick visit cost $900, more than I’d ever spent on one doctor visit for myself.

Bear was a 14-year-old mutt who looked a lot like a black Labrador, until you stood him next to one. His symptoms were mysterious; the diagnosis was elusive. He was sluggish; he had fevers and loss of sensation in his paws. The regular vet diagnosed a thyroid condition, but beyond that, he was stumped. He sent us to a veterinary neurologist, who, suspecting a brain tumor, had sent us here to the Washington area’s only commercial veterinary MRI facility — the Iams Pet Imaging Center in suburban Vienna, Va. It was hard to get appointments here — specialists like veterinary neurologists were in such demand that veterinary schools were having trouble keeping enough on hand to teach.

“Believe me,” the center’s senior veteri-

narian, Pat Gavin, had told me, “if George W. Bush were getting an MRI, he wouldn’t be any better monitored than the animals at this facility.”

I’d had trouble wrapping my brain around the idea. Others concurred.

“An MRI for a dog?” said an acquaintance. “You’re kidding, right?” She shook her head. “The old-fashioned kind of vet,” she said firmly. “That’s what you want.”

What did that mean, anyway? True, I’d always been a fan of the old-fashioned approach, enshrined in books like James Herriot’s “All Creatures Great and Small,” where the vet is kindly and competent and does things the old-fashioned way. In principle, at least, I was as irritated as anyone by the unceasing, often pointless-seeming innovation of modern American consumer life, the incessant alarms about the dangers of this toxin or that. Part of the appeal of having a dog had always been the connection it seemed to offer to a simpler way of life.

And now we were in the middle of a

Invisalign uses clear plastic aligners to gradually straighten teeth, without the shiny silver look of braces. Aligners should be taken out to eat and drink, and are replaced every two weeks.

Story/Heidi Lake Photos/Nels Norquist

The days of being taunted with The age of invisible orthodontics is names such as “brace face” and “metal here. People who want to straighten mouth” could be over for some teeth- their teeth, but aren’t a fan of the metal straightening candidates. mouth look, there’s hope.

5

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covered by insurance.

Here’s out it works.

Impressions, or molds, are taken of the teeth using a soft putty-type substance. Those impressions are sent to Invisalign and plaster models of the teeth are made. The models are then used to create a 3-D digital image and a computerized movie called ClinCheck depicts the movement of the teeth from the beginning to the final teeth-straightening stage. After the dentist or orthodontist approves the ClinCheck via the Internet, a series of plastic aligners is made. Each aligner differs slightly, moving the teeth slowly until they are straight. Each aligner is worn for about two weeks.

Invisalign was started in 1997 and Bailey said it is becoming more popular among dentists and orthodontists, thanks to better technology and constant improvements. More than 70 percent of orthodontists in the United States are certified to use Invisalign.

“I work really hard to be on the cutting edge of technology,” Bailey said.

Each doctor has their own guidelines regarding which patients could use Invisalign rather than braces. Bailey said she can treat almost any case with Invisalign, even if that means using braces for a short time and primarily Invisalign to straighten teeth.

Dr. Steve Colby, orthodontist at Brainerd Dental Specialists, has treated about 170 patients with Invisalign and said the primary criteria for using it is that patients must have all of their adult teeth fully erupted, except wisdom teeth. Colby said cases are individually evaluated to determine what is the most appropriate and efficient way to straighten their teeth.

“It won’t take the place of braces,” Colby said. “But Invisalign can be a wonderful option.”

Colby expects his patients to wear their aligners 22 hours a day, except when eating, drinking or brushing their teeth. For teenagers especially Colby said he takes things on a case-by-case basis.

“I emphasize the importance of compliance and recommend braces for cases where I believe cooperation will be an issue,” Colby said.

Bailey agrees. She doesn’t recommend smokers use Invisalign because the aligner can become discolored.

“Smoking will stain retainers,” she said. “And there goes your whole invisible braces (concept).”

Because there are no bands or wires and the alignDr. Jill Bailey, general dentist at Smile Design Orthodontics in Staples, checked the ers can be removed to brush and floss teeth, Colby progress of patient Becca Nordell’s teeth after using Invisalign. Following 10 months said Invisalign makes oral hygiene easier. Not to menof use, Invisalign straightened Nordell’s crowded teeth. tion it is more comfortable for patients to wear.

“The amount of force and sensation of moving Invisalign creates a way to straighten teeth using clear plastic teeth is a lot less,” Bailey said, explaining with braces patients aligners, making the treatment almost invisible for people to feel instant tightness after getting them adjusted while see.

Invisalign’s aligners gradually put pressure on teeth to move.

“I didn’t want to have metal on my face for senior pictures and For dentists and orthodontists to become certified Invisalign thought this would be easier,” said Becca Nordell, 17, of Staples. providers they must attend a training class where they learn to Invisalign provides the same result as braces in the same use the Invisalign software. amount of time, but costs a little more. Dr. Jill Bailey, general “Patients absolutely love it,” Bailey said. “They’re proud to tell dentist at Smile Design Orthodontics in Staples, said on average people they’re using Invisalign.”

Invisalign costs $800 to $1,000 more than braces, and is usually

6

Studying abnormalities on chromosome 15 also has led scientists to the genetic origin of one form of autism, long sought by researchers. While genetic causes of most forms of autism remain elusive, Angelman gave scientists a view about how such links might work.

As many as 3 percent of people with autism also have an Angelman deletion, but with this twist: They carry an extra chromosome 15, according to Dr. N. Carolyn Schanen, a geneticist at the University of Delaware.

Like most children with autism, but unlike Angelman kids, these particular autistic children often form unusual attachments to objects and can be socially aloof. However, compared with others with autism, these children “are more puppy-like in their behavior, and they sometimes lick you,” Schanen said.

“This research might be broadened to help understand the molecular underpinnings of autism,” she said.

The study of Angelman syndrome also has produced valuable leads into the study of epilepsy, a much more common disorder.

In a significant subset of Angelman cases, a key neurotransmitter system in

Better get a

the brain known as GABA is abnormal, said Dr. Edward Novotny, a pediatric neurologist at Yale University School of Medicine. People with this form of Angelman are especially prone to seizures — 1,500 a day in one of Novotny’s patients.

Novotny is using imaging studies to try to figure out just what is happening in the

enclosed bed to protect her.

The genetic defect set off a chain reaction of events during Nicole’s early childhood development that would be difficult if not impossible to undo.

“That would be a realistic assessment,” said Dr. Robert Greenstein, professor of pediatrics in the division of human genetics at the University of Connecticut Health Center and Connecticut Children’s “If we can contribute in Medical Center. any way to the advanceBut that hasn’t stopped the Clavettes enrolling Nicole in at least three diffrom ment of science when it ferent scientific studies involving comes to this, we’ll do it. If Angelman.

The studies help them understand the it can help somebody else, strange world she inhabits, her parents it’s worth it.” say.

“If we can contribute in any way to the - Mark Clavette advancement of science when it comes to brains of these patients. The knowledge this, we’ll do it,” Mark Clavette said. “If it may one day help doctors find the best can help somebody else, it’s worth it.”

And scientists investigating rare disway to treat different forms of epilepsy, eases believe the research one day will including the one found in Angelman.

Donna and Mark Clavette know that help, Greenstein said.

“Even though it may be an esoteric disresearch is unlikely to significantly improve their daughter’s life. Nicole, now ease,” he said, “when we learn the genetic 15, isn’t able to speak, although she smiles keys to an illness, it will lead to better and engages with her family members. diagnosis and treatment down the line.”

She also needs to sleep in a special

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TRUST THE DOCTORS THE

on one chromosome is damaged or missing, then the other copy can be activated.

But in Angelman and about a dozen similar diseases, that does not happen.

At the University of Connecticut Health Center, geneticist Marc Lalande wants to understand why.

“Why go through millions of years of evolution to get a second copy (of a gene) and shut one down?”Lalande said. “That is the million-dollar question.”

Studying Angelman syndrome offers a window into understanding genetic imprinting — the process that determines which of the parental genes will be activated early in development, he said.

“If you muck with the imprinting process, you perturb development, and that is crucial in a lot of human disease states,” Lalande said.

For instance, a nearly identical deletion of chromosome 15 — but from the paternal gene — leads to a totally different disease, Prader-Willi Syndrome. Like Angelman kids, children with Prader-Willi are mentally retarded, but they tend to be short in stature and lack muscle tone.

While some Angelman children have little appetite, Prader-Willi children often cannot stop eating.

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children — about 250 new cases each year.

The syndrome was first recognized in 1965, when English physician Harry Angelman described peculiar behavioral abnormalities in three patients and hypothesized that the cases were linked to a single but as-yet unnamed disease. The children with their flapping arms and laughter reminded Angelman of an oil painting by Gian Francesco Caroto, “Boy With a Puppet.”

It wasn’t until the early 1980s that Angelman was identified as a specific disease. Angelman patients have a normal lifespan but require 24-hour care.

In about 70 percent of cases, there is a missing genetic sequence on chromosome 15. Humans have 23 pairs of chromosomes on which all genes are located.

The deletion linked to Angelman is only found on the maternal chromosome. This mystified scientists, because sexually reproducing organisms come with maternal and paternal copies of each chromosome.

Genes on the chromosomes from both parents are activated seemingly at random in the developing child. This genetic redundancy is nature’s way of protecting against developmental disorders. If a gene

S 6th St

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However, as with investigations of many rare disorders, understanding Angelman won’t necessarily improve the lives of people who have it.

By the time Nicole Clavette of Tolland, Conn., was 1, her mother, Donna Clavette, knew something was wrong. Nicole almost never slept, her motor control was poor and she sometimes burst out laughing in the middle of the night.

Doctors told first-time parents Donna and Mark to relax, that Nicole just might be developmentally delayed. But by the time she was 2, her doctors were concerned, too. Her movements were jerky, and she had seizures, which led one doctor to suggest Nicole had cerebral palsy.

But her puppet-like mannerisms and peculiar laughter led Donna Clavette to suspect something else.

It took more than a year of consultations with medical experts before tests confirmed that within Nicole’s DNA, a segment of chromosome 15 was missing — the telltale genetic sign of most Angelman syndrome cases.

The mystery of Nicole’s illness was solved, but scientists are still baffled by some aspects of the syndrome, which is estimated to afflict about one in 15,000

N

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REVISE FOR BRAINERD !& # PDF !-

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Donna Clavette and her daughter, 15year-old Nicole Clavette embraced in the driveway of their home. Nicole has Angelman Syndrome, which produces children who laugh easily, flap their arms but do not talk and have a mental age of about 2 years old.

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Scientists unlock genetic secrets of Angelman syndrome

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Story/William Hathaway Photo/Rick Hartford Hartford Courant

Children with Angelman syndrome used to be called “happy puppets� because they tend to laugh with ease, flap their arms like marionettes and never talk.

Nearly 40 years after the syndrome was first described to skeptical doctors, scientists know what causes the rare and devastating developmental disorder. And by studying it, researchers have stumbled on new insights into a number of similar genetic diseases, as well as autism and epilepsy.

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Dr. Jackie McCall

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Diseased ticks invade area counties, leaving residents feeling sick Story/Jodie Tweed Graphic/Connie Jenson

fatigued, he went inside and took a nap.

“I thought I was just worn out,” said Fitzer, who works in software development at BISYS. “I didn’t know.”

After a few days of suffering through what he thought was the flu, Fitzer’s wife, Carolyn, checked the brochure she had saved about Lyme disease. Her husband had all the classic MINNESOTA COUNTIES WITH THE symptoms, including a HIGHEST NUMBER OF CASES OF “bulls-eye”-type rash on LYME DISEASE AND EHRLICHIOSIS his thigh. She urged him to go to the doctor. Fitzer LYME DISEASE COUNTY

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It was a warm and sunny Sunday afternoon in early August and Rick Fitzer of Pequot Lakes could barely stand up.

Fitzer had just finished mowing the lawn on his riding mower and didn’t feel well. He felt chilled but he was sweating. His head was throbbing with pain. Fitzer felt as if he had no energy. Feeling unusually

said he “just did the guy thing,” and postponed a trip to the doctor for several days after the symptoms first appeared, waiting instead to see if he would feel better. He didn’t.

“When you get it, you think it’s the flu,” said Fitzer. “That’s what I thought. But you don’t get the flu for four days.”

Fitzer’s doctor diagnosed him with Lyme disease, a tick-borne disease surprisingly common in Crow Wing County and the surrounding counties. Fitzer recalled finding a deer tick on him weeks earlier but it hadn’t attached itself to his skin.

Name: Bob Loucks Age: 72 Age diagnosed with Polio: 17

nerve cells and muscle strength after age 50. People who have had polio have already lost some motor nerve cells, increasing their chance of suffering a decline in muscle strength earlier in life.

“The muscle weakness and the inability to do a certain activity is caused by nerve damage (from polio),” Beachy said.

(Reported cases, 1993-2003)

Crow Wing Pine Aitkin Cass Chisago Mille Lacs Kanabec Isanti St. Louis Carlton COUNTY Crow Wing Cass Aitkin Pine Morrison Chisago Anoka Mille Lacs Carlton Isanti

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Loucks, Jensen and Keithly all suffer from postpolio syndrome. They all agree the best treatment for postpolio is to take things easy.

“If you overdo it, you’ll be down for three days,” Jensen said. “It changes your whole life. You learn to accommodate for yourself.”

Name: Bob Jensen Age: 59 Age diagnosed with Polio: 7

In 1992 Loucks started a support group for people with postpolio syndrome.

About 10 people gather at 10 a.m. the first Monday of each month at the Brainerd Public Library to discuss postpolio symptoms and what can be done to relieve the pain. The group does not meet January through March.

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Rick and Carolyn Fitzer sat with their 5-year-old twin sons, Tony (left) and Marty, outside their Pequot Lakes home. The couple are worried that their sons will get a tickborne illness since Carolyn was diagnosed with ehrlichiosis in June and Rick contracted Lyme disease in August. Photo/Nels Norquist

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For some, polio is a disease they haven’t thought about in years. For others, they are reminded every day by muscle soreness and fatigue stemming from a disease they contracted more than 50 years ago.

A polio epidemic swept across the United States in the 1940s and 50s, leaving thousands of people with the sometimes fatal disease. In 1952 alone, 21,000 cases of polio were reported in the United States.

Mary Kay Keithly of Pillager became stricken with paralytic polio in 1946 when she was 6. She remembers her father got fired from his job and her family was quarantined to their house for fear of spreading the disease.

“You were completely isolated from society if you had it,” Keithly said.

Keithly was in a Kansas City, Mo., hospital for four months after she contracted paralytic polio. At her worst point, she was paralyzed from the chest down, but after three months of physical therapy, she was able to walk again with the help of leg braces.

Paralytic polio is a viral disease that enters the body through the nose or throat and causes inflammation and damage to nerve cells and tissue in the lower brain and spinal cord. It is usually spread through contact with the feces of an infected person.

For some, symptoms feel like the flu,

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with head, neck and overall muscle pain.

For those with paralytic polio, people can lose the use of their muscles, become easily fatigued, and have unexplained pain and breathing difficulties.

Bob Jensen, 59, contracted paralytic polio when he was 7 and living in Staples.

“I was in bed for three months and never got out,” he said.

In 1952, when Jensen was stricken with the disease, there weren’t many treatment options. He remembers being wrapped in a wool Army blanket that had been soaked in boiling water to loosen his muscles.

Before a polio vaccine became available in 1955, the Centers for Disease Control and Prevention reported 13,000 to 20,000 cases of polio each year in the United States. These annual epidemics of polio left thousands of victims, mostly children, in leg braces, crutches and wheelchairs — lasting reminders of the disease.

Today, the CDC recommends children be vaccinated four times with Inactivated Polio Vaccine, which is given in the form of a shot in the leg or arm. IPV should be administered four times to children 2 months, 4 months, 6-18 months and 4-6 years old.

“Children are required to get vaccinated (for polio) before they start kinder-

garten,” said Dr. Arden Beachy of Lakewood Health System.

The CDC reports the development of polio vaccines have eliminated paralytic polio in the United States and the entire Western hemisphere.

For those who have contracted polio at some point in their life, however, they are not out of the woods yet.

Between 25 and 80 percent of people who survived polio will experience the symptoms of postpolio syndrome.

Governor Tim Pawlenty even designated 2004 as “the year of polio awareness”in an attempt to create awareness of postpolio syndrome.

Although postpolio is not infectious, the symptoms are similar to polio with muscle fatigue and pain.

Jensen’s muscles get extremely fatigued when he’s doing minor activities, such as brushing his teeth or mowing the lawn.

In 1985, 33 years after he was cured from polio, Jensen started feeling the effects of postpolio syndrome. In 1997 Jensen was forced to retire and “give everything up.” Today the 59-year-old father and husband cannot walk more than 200 feet without resting.

“When it hits you, it hits you bad,” said Bob Loucks, a 72-year-old sufferer of postpolio syndrome.

Healthy adults tend to gradually lose

“It messes with your brain,” said Fitzer, of Lyme disease. “It’s hard to focus. You don’t have ambition. You don’t care about anything. You’re just ready to lay down and that’s it.”

Carolyn knew to check if her husband had Lyme disease because she, too, had recently suffered with a tickborne illness. She was diagnosed with ehrlichiosis in June. That weekend she suffered from a mindnumbing headache that wouldn’t go away, a 103-degree fever, chills and head-to-toe body aches. A stay-athome mom with twin 5-year-old boys, Carolyn said she had no energy. She went to the doctor right away on Monday to get antibiotics and started feeling better about three days later.

The Fitzers have always been careful to make sure their sons, Tony and Marty, were protected from ticks and check them over often after they’ve been outside. Now they’re concerned that if they easily got these diseases, their young sons could as well.

There is reason to be concerned

about tick-borne diseases, particularly in Crow Wing County. The county leads the state in the number of reported cases of Lyme disease, ehrlichiosis (which is now often referred to by medical professionals as human anaplasmosis) and potentially the lesser-known babesiosis, a rare illness caused by a parasite that lives on diseased ticks. Babesiosis is rare but there have been several cases reported in Crow Wing County. This tick-born disease can be fatal in individuals with no spleen or those who have a compromised immune system. There can be only mild symptoms in otherwise healthy individuals who have babesiosis.

They may not even know they have it.

“We are probably the ehrlichiosis capital of the world,” said Dr. Nicholas Bernier, director of medical affairs at St. Joseph’s Medical Center in Brainerd.

Bernier said all tick-borne diseases are treatable, but they need to be identified. The Brainerd hospital has seen a decline in the number of

What is ehrlichiosis? ➤ Ehrlichiosis (pronounced er-lick-ee-o-sis) is a bac-

terial disease transmitted to humans from the same ticks that transmit Lyme disease. ➤ Unlike Lyme disease, the majority (79 percent) of patients diagnosed with ehrlichiosis between 19982002 lived in greater Minnesota. In 2002 Crow Wing and Cass counties had the greatest numbers of exposures to infected deer ticks or black-legged ticks. ➤ Symptoms usually start 5-10 days after a person has been bitten by a tick but can take up to a month to appear. ➤ Symptoms include a sudden onset of a fever of 102 degrees or more, chills, shaking, fatigue, severe headache, muscle and joint pain, nausea and vomiting, cough, stomach pain and sore throat. It is rare to have a stuffy nose or sinus trouble with ehrlichiosis. This can distinguish ehrlichiosis from the flu, a bad cold or a sinus infection. ➤ There were 78 cases of ehrlichiosis reported in Minnesota in 2003, but Brainerd health care officials believe the number of actual cases is much higher than reported. ➤ Ehrlichiosis can be easily treated with an antibiotic.

Information provided by the Minnesota Department of Health and DNR.

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“We are probably the ehrlichiosis capital of the world.”

—Dr. Nicholas Bernier, director of medical affairs at St. Joseph’s Medical Center in Brainerd

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On the left is an adult male deer tick. In the middle is an adult female deer tick. On the right is a wood tick. Wood ticks do not spread Lyme disease. Photo/Minnesota Department of Health

In its second year, primarily from May through August, a nymph becomes active and takes its second feeding from a mammal. If the tick received the bacteria from its first feeding in the larva stage, it can transmit the bacteria during its second feeding. A nymph stage tick often looks like a speck of dirt or a freckle on a perPhoto/Minnesota skin. son’s Department of Health

... Infants and toddlers cannot verbalize if the stretch is uncomfortable as older children and adults can.”

But Garabedian said babies can and do let others know when a pose hurts or pleases. She said instructors’ training covers cues that babies like or dislike an activity, and instructors then teach parents to recognize these signs. If caregivers or instructors notice babies showing signs of discomfort, they’re supposed to stop the activity, she said.

Signs of engagement, or happiness with an activity, Garabedian said, include cooing, giggling and making eye contact. Cues signaling disengagement, or frustration or pain with a pose, she said, include crying, turning their heads away and arching their backs.

In the training she provides, she said, “I also teach the facilitators a lot about the baby’s anatomy.”

Garabedian took a 200-plus hour course to earn certification as an “infant development movement educator” from the School for Body-Mind Centering in Massachusetts; among the school’s other offerings is a 500-hour somatic movement education program, which requires students to explore the relationship between

the body, mind, movement and touch.

Garabedian, who started practicing yoga when she was 10, also says she is certified in Hatha yoga, yoga pregnancy teaching and in infant massage.

She said she started her exercise program to combine her love for yoga with an activity she could use to bond with her children. (Her first child, Andrew, was born last month.) Garabedian said she’s never taught the kind of mother-and-baby class in which both exercise together. “I believe that a mom’s yoga practice should be separate from the baby’s because yoga is almost like an inner experience.”

She says she has trained some 60 instructors, including Clarkin. She requires five days of instruction for those planning to teach her trademarked Itsy Bitsy Yoga to children up to age 2 and two days for those working with kids aged 2 to 4. Garabedian said she addresses how to safely work with infants’ and toddlers’ growing bodies.

“I think that training is very, very important ... to make (instructors) understand how slow they need to go” with infants and toddlers, said Garabedian. “Their spine is totally different. ... There is really a lot that we have to do to ... work with

infants and babies successfully.”

What Comes Naturally In Itsy Bitsy Yoga, caregivers help kids learn poses by gently positioning them and moving their arms and legs. But instructors said some kids spontaneously put themselves into facsimiles of adult yoga poses such as “Downward Facing Dog,”where they bend over with their feet and hands planted on the ground — creating an upside-down V — even before taking classes.

“When I had my son, I was just so struck by how naturally yoga came to him,” said Clarkin, whose son, Benjamin Evans, is 11 months old. “I could see that he was doing poses, and I could see some of the benefits.”

One of those benefits is a calming effect on young yogis, say parents and instructors. That proved useful a few weeks ago, said Wilcox, when her son got cranky during a flight with her from Minneapolis.

“I laid him down on the seat and did yoga and he got very happy,” Wilcox said.

“There’s a bouncing one where you bounce them on your knee, called ‘Hop Along Yogi.’ He loves that.... He smiles and starts kicking his feet.”a little bit older.”

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Story/January W. Payne Photo/Cathy Kapulka Washington Post

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You’re never too young to benefit from yoga Nine-month-old Bryce Saunders giggled, legs dangling, as his mom held him in what was meant to be a soothing yoga pose. Then, with one hand clutching Bryce’s bottom and the other wrapped around his stomach, she bent her knees and dropped down quickly into a squat.

“Am I holding him right?” Christine Saunders asked, as she stood back up.

Bryce squinted his eyes and began to fuss.

“Yes ... and he doesn’t want you to stop,” said instructor Moira Clarkin.

Saunders and son’s lesson in Divine Drops, as the move is called, took place in an Itsy Bitsy Yoga class, open to children from 3 weeks to 2 years of age, at Boundless Yoga Studio in Washington.

There, babies and toddlers — with a sometimes-considerable adult assist — practice yoga poses along with their caregivers.

The poses, including “Kicky Cobra” and “Down Dog,” are based on a program developed by Massachusetts yoga instructor Helen Garabedian. The author of “Itsy Bitsy Yoga: Poses to Help Your Baby Sleep Longer, Digest Better and Grow Stronger” (Fireside/Simon & Schuster, 2004), Garabedian claims yoga reduces babies’ stress and anxiety.

Wendy MacLeodChappell helps daughter Halla, 8 weeks, through a class in Washington of yoga moves designed for infants. The Itsy Bitsy Yoga class is open to children from 3 weeks to 2 years of age.

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In a switch from traditional “mom and baby” postpartum yoga classes, which emphasize the mother’s yoga practice and incorporate the baby only passively, the new concept involves more than 75 poses focused strictly on the baby’s movement, soothing and enjoyment. Caregivers act as helpers, guiding the babies’ arms and legs into poses and, at times, holding and bouncing the children, as Saunders did.

Some fitness-conscious parents are flocking to these classes, hoping an unusually early introduction to formalized movement will help keep their tots from becoming obesity statistics. About 15 percent of children ages 6 to 11 were overweight in 1999-2000, compared with 11.3 percent in 1988-94, according to the Centers for Disease Control and Prevention. Children 12 to 19 showed a similar trend, with 15.5 percent overweight in 1999-2000, compared with 10.5 percent in the earlier period.

“My mantra is: Fit baby equals fit toddler equals fit child equals fit teen equals fit adult,” said Garabedian, who started her program five years ago. “Children who are exposed to age-appropriate exercise at an early age are more apt to continue that.”

Mary Wilcox is a believer. “I definitely

want my kids to be active,” said the Falls Church, Va., resident who took her 9month-old son, Liam Timar-Wilcox, to Clarkin’s class in March and April. “I wanted to do something with him, and have him do the exercises and get the benefits from it.”

But pediatricians are generally skeptical of the benefits some parents ascribe to baby and toddler yoga classes, saying that no studies have examined their effects.

Eric Small, chairman of the American Academy of Pediatrics’ Committee on Sports Medicine and author of “Kids & Sports” (Newmarket Press, 2002) advised that parents shouldn’t expect that enrolling their tykes in baby yoga classes will better their health.

“It’s just an activity for them to do,” Small said in an interview. “But having quality interaction with a babysitter or a parent is probably equally as beneficial as attending a yoga class.”

In a later e-mail, he addressed the obesity question: “There are genetic, nutritional (and) exercise factors that contribute (to excess weight). Doing baby yoga in and of itself will not prevent childhood obesity. The baby has ... (to) eat healthy and play and be active on a daily basis.”

And then there’s the safety question.

cases of Lyme disease but the frequency of reported cases remains higher than in other counties. Bernier said the hospital is seeing an increase in ehrlichiosis cases and has seen a few patients with babesiosis.

“A handful of people in Crow Wing County with this disease is huge because it’s so rare,” said Bernier, of babesiosis.

Bernier said he believes that area doctors have become acutely aware of these diseases and are quick to detect them. St. Joseph’s laboratory employees are used to seeing these diseases and have become experts at uncovering them, he said.

Kirk Smith, epidemiologist supervisor for the Minnesota Department of Health for Foodborne, Vectorborne and Zoonotic Diseases, said Brainerd area physicians are likely better at diagnosing tick-borne diseases than Twin Cities physicians. One problem with detecting these diseases is that blood tests can be inaccurate. Lyme disease tests are sensitive and can turn out many false positives.

Blood tests for ehrlichiosis can come back negative if the patient is tested with-

in the first seven days after experiencing symptoms. The antibodies aren’t yet present in their blood, said Smith, adding that one study found that only 23 percent of ehrlichiosis cases come back positive through blood testing.

“While most doctors have heard of Lyme disease, they’ve heard of anaplasmosis but don’t know what to look for,” said Smith. “In the Twin Cities, I don’t think doctors look for this in their patients.”

The Twin Cities area doesn’t have a lot of deer ticks, but Smith said many of the Twin Cities residents infected with tickborne diseases are bitten by deer ticks while vacationing in Crow Wing and its neighboring counties.

“They’re getting them from recreating up north,” said Smith. “In Brainerd it’s obvious. Crow Wing County and the surrounding counties are a hot bed for tickborne diseases.”

Smith said he believes the number of reported cases are only the tip of the iceberg. Many patients go to the doctor because they are ill and they’re given antibiotics, which relieves their symp-

What is babesiosis? ➤ Babesiosis (pronounced bab-e-see-oh-

sis) is a tick-borne illness caused by a parasite that lives on some types of ticks. ➤ Although considered to be rare, there have been several cases of babesiosis diagnosed in Crow Wing County. ➤ Most cases are mild, but can develop into a severe infection and can be fatal, particularly for people who have had their spleen removed or have a suppressed immune system. ➤ Patients diagnosed with babesiosis can contract the other two tick-borne illnesses, Lyme disease and erhlichiosis. A blood test is needed to diagnose this illness. ➤ Symptoms are similar to erhlichiosis and include a sudden high fever, chills, sweating, fatigue, poor appetite and a severe headache. Some people with this illness may not have symptoms. ➤ Antibiotics are administered to treat babesiosis.

Information provided by the Minnesota Department of Health and the DNR.

Continued on Page 18

Safety Matters Small said he worries that some baby yoga instructors lack training in infant development and knowledge of health problems that could make exercise risky.

One such problem, he said, is hypotonia, a condition involving muscle weakness and poor head and leg control that is often not diagnosed until 6 months of age. Hypotonia affects one to five percent of children, Small said.

“Infants and toddlers are generally very flexible in joints and muscles,” Small wrote.“They have soft bones at their growth plates. With overstretching, there is a potential to cause a growth plate fracture.

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CMYK

Max Best, 13-month-old son of Mitchell and Jen Best, died of Sudden Unexplained Death in Childhood, a rare and mysterious disease that strikes children over the age of 12 months.

Son of former Brainerd man dies of SUDC As is often the case, tragedy inspires.

The sudden, unexpected loss of 13month-old Max Best motivated his parents to raise more than $70,000 in Max’s Run for a Reason last fall in Minneapolis.

Today, his death and the efforts of Jen and Mitchell Best to understand what happened to their son have sparked a national fundraising effort. As a result, other families are planning their own Run for a Reason and the Mayo Clinic’s Long QT Clinic and Sudden Death Genomics Laboratory purchased research equipment designated to explore the causes of Sudden Unexplained Death in Childhood.

The second annual Max’s Run for a Reason will be Nov. 13 in Minneapolis.

Additionally, to help raise awareness nationally for SUDC, funds from Max’s Run led to the creation of an advertising campaign. The campaign was revealed at the SIDS International Convention in early

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July. It will appear in national medical journals and magazines starting this fall. The campaign features two families that both tragically lost young children for unknown reasons. The Bests will be one of the featured families.

Mitchell Best, Max’s father, is a Brainerd High School graduate. He is the son of Mary Best, Minneapolis, and Roger Best, Brainerd. Becky Best, Brainerd, is Mitchell’s sister.

“It’s been heartbreaking, yet an utterly important journey for us,” said Jen Best.

“Planning this run in Max’s memory is how we cope with the loss. We’re so proud and amazed that our son inspired such an outpouring of love and generosity. Unfortunately, however, as awareness for SUDC builds, so do the case numbers.

Since Max’s death 19 months ago, more unexplained deaths of children have been classified as SUDC. We have to help doc-

tors understand how to save these children.”

The research equipment the Mayo Clinic was able to purchase is just one major step toward understanding.

“What the Best’s are doing to help raise awareness for SUDC on a national level is astounding,” said Dr. Michael Ackerman, pediatric cardiologist and director of Mayo Clinic’s Long QT Syndrome Clinic and Sudden Death Genomics Laboratory.

“Parents who lose young children deserve answers. Unfortunately, we continue to struggle with concrete reasons for why these young children die suddenly. It’s only recently that we’ve uncovered a possible connection. The research equipment we’ve been fortunate enough to purchase will help us explore this theory.”

In addition to the research equipment acquired by the Mayo Clinic, funds from the first Max’s Run for a Reason also sup-

Fred Tewell, product director for Johnson & Johnson’s BandAid Brand Adhesive Bandages, says industry research shows that mothers continue to be the primary purchasers of bandages for the whole family. He says older consumers, a growing group, are buying bandages that are gentle to the skin, such as the liquid type or Band-Aid’s Hurt-Free line.

We’ve come a long way from the birth of the first Band-Aids, which company lore says were invented in 1920 by Earle Dickson, a cotton buyer for Johnson & Johnson, whose new bride, Josephine, was prone to acquiring cuts and burns while cooking. He fashioned bandages for her from cotton gauze and adhesive strips, which soon were marketed by the company.

At first made by hand and 3 inches wide by 18 inches long, they were not an immediate success, but smaller strips soon caught on. And Dickson became a vice president. By now, more than 100 billion Band-Aids have been made, and the company’s trademarked name has become the shorthand term for any adhesive bandage.

According to a report posted on MarketResearch.com, 60 percent to 70 percent of adhesive bandages in the United States are used on children, and those with licensed images account for 15 percent to 20 percent of the entire market.

Among other popular innovations: Hydrocolloid or hydrogel bandages, such as Johnson & Johnson’s Advanced Care and Curad’s Hydro-Heal brands.

They have particles that absorb fluids from the wound and form a gel that provides a moist environment.

That is most helpful, says Corbett, because it helps tissues heal faster with less scarring. Some of these bandages are semipermeable and form a seal around the wound that helps trap healing cells. ”We tell our clients to think rain forest, not desert,“ Corbett

says of the emphasis on covering wounds and keeping the environment moist.

Letting a wound dry out and form a scab lengthens the time it takes to heal and increases the possibility of scars or infection, says Marcia Taraschi of Johnson & Johnson.

Liquid and spray-on bandages offer aesthetic appeal, flexibility, good waterproofing and the ability to cling to the wound.

They are useful for hard-tocover areas and slough off when the wound heals.

Scar-reducing bandages can minimize the appearance of raised or red scars over a period of weeks and can be used on fresh or old scars.

Bandages containing ionized silver, tiny bits that leach out over time, offer a natural antibacterial effect. Their use has shaken up hospital care of chronic wounds, says Corbett. ”Silver is a very potent antimicrobial,“ she says, but adds that for minor cuts likely to heal within a few days, less-expensive traditional bandages will do the job well.

Anti-blister bandages use hydrocolloid technology to generate a gel cushion that stays in place for several days, seals out water and germs, and is flexible.

Anti-itch bandages contain a topical ointment that dulls pain and throbbing, lessening the urge to scratch an insect bite or minor wound, which can lead to infection.

Anti-bleeding bandages use fibers or gels to stop bleeding quickly. They may be of use to people who take anti-coagulant drugs.

But a little bleeding can be a good thing, says Corbett. ”We like it when wounds bleed. It’s the first phase in the cascade of healing,“ when blood platelets migrate to the wound and attract growth factors for new tissue, she says.

Just as a mild fever is a natural part of fighting infection, bleeding plays an important role in healing.

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It used to be so simple.

You were a kid. You fell down and skinned your knee.

You cried.

Mom came to the rescue, washed off your wound -- let’s use the technical term, which is “boo-boo” or “owie” -- and applied hydrogen peroxide or mercurochrome. You cried again.

She opened the little can that holds the adhesive bandages, and depending on the extent of your boo-boo, selected the wide kind, or the skinny little one or the dot, and stuck it on. When it was time to peel off the bandage, it hurt. You cried some more.

But today if mom needs to reach for a bandage, her choices go far beyond just size or shape. The consumer market for adhesive bandages has exploded in the past decade or so, driven, say industry spokesmen and medical professionals, by technological advances in hospitals.

Lisa Corbett, an advancedpractice registered nurse with the Center for Wound Healing and Hyperbaric Medicine at Hartford Hospital in Connecticut, says the improved treatment of chronic nonhealing wounds, those that persist longer than 30 days, has spun off products now available to the public.

So mom now is faced with store shelves jam-packed with products: liquid and spray-on bandages, ionized-silver bandages or waterproof or moistenvironment-promoting or easy-to-remove bandages. Or anti-itch, anti-bleeding or antibacterial bandages. Not to mention bandages shaped to fit fingers or knuckles, or medicated to minimize scars or

cushioned to heal blisters.

There are eye-catching bandages for kids, decorated with licensed cartoon characters or tattoo designs, and clear ones that appeal to adults because they don’t catch the eye. ”At first, it seems like a challenge to navigate“ among all these choices, says Todd Andrews, a spokesman for CVS Corp. ”But it’s a real benefit to consumers.“ Just as there have been advances in treating heart disease, Andrews says, there have been ”leaps forward in technology in wound care and management products.“ The diversity ”seems daunting, but is useful,“ he says, noting that as hospital stays grow shorter, postoperative wound care is increasingly being managed at home. ”Our customers have told us, through studies, that they want these products,“ he says.

Michael Sweeney, a spokesman for 3M’s Nexcare line, says that while different products offer different benefits, the most important is their performance, such as whether they are easier to use, longerlasting or more waterproof.

Liquid-bandage products are among the newest to catch the interest of consumers, he says, and while they may be more expensive per application, they last longer, which helps bring their cost closer to that of strip bandages. Further refinements will make such innovations more convenient and affordable, Sweeney says.

The choices can seem overwhelming, he says, and that is why Nexcare has recently redesigned its packaging as ”a simplification to help consumers find what they need.“

ported the following: • Minneapolis Children’s Hospital’s and Clinics grief program for bereaved parents.

• Minnesota’s Sudden Infant Death chapter.

• Attendance at the 2004 SIDS International Convention.

• The creation of an advertising campaign to raise awareness of SUDC. The success of Max’s Run for a Reason has energized bereaved parents across the country. Tami and Jake Gove of Denver lost their son, Josh, for unexplained reasons when he was just 15 months old.

Now the Gove’s are pairing with a n o t h e r Denver family to host a second Run for a Reason.

Lunden and Pat MacDonald, lost their son, Gus, at 18 months. Denver’s first Josh and Gus Run for a Reason will be Nov. 6.

“Max’s story inspired us,” said Tami Gove. “After hearing how successful Max’s run was, we just had to do the same. The effort will not only raise important funds for research, but it honors our son’s memory.

The second Max’s Run for a Reason is once again on Max’s birthday. The 5K run and 2K family fitness walk will take place at 10 a.m. at Lake Harriet in Minneapolis. Additional details and registration are at www.maxwellbest.com. All proceeds benefit the SUDC program as well as local children’s hospitals and clinic’s programs for bereaved parents such as the Healing Quilt and Minnesota Sudden Infant Death Center.

SUDC is the sudden and unexplained death of a child over the age of 12 months. An estimated 4,708 U.S. children ages 1 to 4 have died from unknown or unspecified causes in the past two decades. While the medical

Max Best died suddenly of Sudden Unexplained Death in Childhood when he was 13 months old.

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community has focused research efforts on SIDS, SUDC has not received the same attention. The National SUDC Program was created in September 2001 to provide a centralized resource for families searching for information and support as well as to coordinate research efforts and increase awareness.

More information may be found at www.sudc.org or by calling 800-620SUDC.

CMYK

Scholarship fund honors Max Best

The Maxwell Douglas Adamek Best Memorial Scholarship Fund was started at Central Lakes College to increase awareness and educate the public about in Death Unexplained Sudden Childhood.

The scholarship fund was started with a $1,000 donation from Becky Best, associate vice president of academic affairs at CLC. The late Maxwell Best, who died in December 2002 from SUDC, was Best’s nephew.

Two $500 scholarships will be awarded each year to single parents with schoolage children. The student recipient must be majoring in child development or pursuing a degree in the health care field.

Max Best’s parents, Mitchell and Jen Best, raised more than $70,000 in Max’s Run for a Reason last fall in Minneapolis. In an attempt to raise awareness of Sudden Unexplained Death in Childhood, the fund-raiser will take place again Nov. 13 in Minneapolis.

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The teenage brain and sex While many parents would like to deny it, their children are having sex. Walsh said twothirds of youths have had sex before their high school graduation. The average age to become sexually active is 15 for boys and 16 for girls.

In his book, Walsh says the idea of romance begins before puberty. Around age 10 hormones increase, leading children to their first taste of romance — a crush. Walsh describes a child’s first crush as “a preview of coming attractions.”

Once puberty hits, sexual interest and sex drive kick in.

“There are days for some teenage boys where all they think about is sex. This is normal,” Walsh said.

Adolescent girls also have erotic thoughts, but Walsh states, “They don’t seem to be as all-consuming as boys’.”

Walsh reported four out of every five teenagers say they have had zero or little communication with their parents about sex.

“Where are they getting their information?

The media,”Walsh said, explaining television, movies and magazines are increasingly promoting sexual activity.

The transition from childhood to adolescence is a major step in a person’s life. With all of the physical and mental changes going on, Walsh said this is prime time to discuss puberty and sex.

Sexually transmitted diseases Three million teenagers in the United States contract an STD each year. STD rates, more specifically, chlamydia and gonorrhea rates, are on the rise in Minnesota. Between 2002 and 2003, chlamydia rates increased by 6 percent and gonorrhea rates by 5 percent.

STD rates are highest in the Twin Cities area and, according to the Minnesota Department of Health in 2003, Crow Wing County reported 67 cases of chlamydia and four cases of gonorrhea. Cass County reported 37 cases of chlamydia and five cases of gonorrhea.

Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. According to the Centers for Disease Control and Prevention, teenage girls have the highest risk of infection because their cervix is not fully matured.

Chlamydia can be transmitted during vaginal, oral or anal sex.

Chlamydia is known as the “silent” disease because it usually does not present any symptoms. If untreated, chlamydia can progress to serious reproductive and other health problems with both short- and longterm consequences.

Gonorrhea is another common infectious disease. The CDC Web site says gonorrhea is a bacteria that can grow and multiply easily in warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra in women and men.

Gonorrhea is spread through genital, oral or anal contact. Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and AfricanAmericans.

The CDC states females with gonorrhea rarely have symptoms, while infected males can experience a burning sensation when urinating, painful or swollen testicles, or a white, yellow, or green discharge from the penis.

The disease can be treated with antibiotics.

To reduce the risk of getting STDs, including chlamydia and gonorrhea, the CDC recommends abstinence, a long-term, monogamous relationship or consistently and correctly using latex male condoms.

Alcohol and drugs With all the recent attention on methamphetamine use locally, it may come as a surprise that alcohol is the substance that does the most damage to the most young people, Walsh reported.

During his workshop, Walsh said drugs and alcohol affect the adolescent brain differently than the adult brain. When consuming alcohol, an adult’s brain sends off signs, like sleepiness and slurring language, telling the body it has had enough. A teenager’s brain reacts differently in that those signals don’t go off until much later, when the person may already be dangerously drunk.

“In the absence of warning signals that tell them to stop, adolescent drinkers tend to drink more and do more damage to themselves,” Walsh wrote.

Alcohol impacts the learning and memory capabilities of a teenager, more than it does for an adult. Adolescents also have a higher risk of having alcohol problems as an adult if they start drinking at a young age.

“For teens, alcohol is more dangerous than for adults,” Walsh said.

Nicotine also affects adolescents’ brains differently than adults’. Young people are more likely to get addicted to nicotine, and they get addicted much faster.

In his book, Walsh calls tobacco a “gateway drug,” stating adolescents who smoke are at higher risk of using alcohol and other substances.

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Life as a teenager can be difficult. Life as the parent of a teenager can be even more challenging.

In the book, “Why Do They Act That Way?,” Dr. David Walsh addresses the problems that are too familiar to many parents of teens, including moodiness, anger, sex and drug and alcohol use.

Walsh, a psychologist from Minneapolis, has written eight books and frequently appears on national TV news shows. Walsh has served as a children’s behavioral expert on “The Early Show,” “Today,” “20/20” and “Dateline NBC,” among others.

He recently conducted a workshop for the St. Joseph’s Foundation’s annual community health symposium, where he discussed teenage behavior. Nearly 300 parents, pastors, teachers and other professionals attended the event.

Janelle DeSmith, a volunteer coordinator for the Crisis Line, said she attended the workshop because she often speaks to teens and parents who call the Crisis Line with questions.

“I will relate this information to all the volunteers (who answer the phones),” she said.

For 10 years, Walsh, a father of three, worked as a high school

24

teacher and counselor, until new brain research caught his attention.

“I’ve always been interested in adolescence,” Walsh said. “An adolescent’s brain is different from an adult brain.”

Through his book and workshop, Walsh said he tried to “translate science so people can understand” what is going on in a teenager’s brain during the emotional and hormonal highs and lows of adolescence. Walsh also coached parents and people who work with youths on the hard-totalk-about subjects of sex, drugs and alcohol.

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Continued from Page 13

toms, but the cases of tick-borne diseases aren’t reported to the state because they’re not confirmed cases. He said while many people have heard of Lyme disease, they haven’t heard of ehrlichiosis and babesiosis.

“I’m sure the vast majority of the population hasn’t heard of the other tick-born diseases,” said Smith. “I’m sure of it.”

Smith said in 2003 there were 60 reported cases of Lyme disease in patients exposed to the disease in Crow Wing

County. There were 18 cases of Lyme disease in which patients were exposed in Cass County. But Smith believes those numbers are only a portion of the actual number of cases.

The key to combating tick-borne diseases is identifying if you’ve been exposed to a deer tick and being aware of potential symptoms.

In August, 4-year-old Sophie Palmer was watching cartoons in her Breezy Point home when she pulled a deer tick from

her ear and gave it to her dad, Chris Palmer. Palmer recognized that it was a deer tick so he saved the tick in a plastic bag. A month later when Sophie came down with a fever and multiple rashes and blotches on her legs and face, her parents brought Sophie and the dead tick to the doctor. The little girl was diagnosed with Lyme disease. With antibiotics, Sophie was feeling better within a couple of days.

“They’re so small,” said Chris Palmer, of deer ticks. “They’re really hard to see.”

What is Lyme disease?

“bulls-eye” rash that may have a reddened area with a clear area in the middle at the original site of the tick bite. It also may appear in several other places on the body. ➤ Other symptoms include a fever, headache, chills and muscle and joint pain. It is not unheard of that a patient may contract Lyme disease and the other two tick-borne illnesses, ehrlichiosis and babesiosis, at the same time.

➤ If left untreated, Lyme disease can

CMYK

➤ Lyme disease is the most common tick-

borne illness in Minnesota and other areas of the country. ➤ The infection is caused by a spirochete bacteria spread by deer ticks and blacklegged ticks. The disease can be spread to humans and animals. ➤ In 2003, 473 Minnesotans were diagnosed with Lyme disease. ➤ One characteristic of Lyme disease is a

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develop into arthritis and problems with the nervous system. In rare cases this can cause memory loss, trouble with concentration, muscle weakness and numbness in arms and legs. ➤ Lyme disease tests can be unreliable, but antibiotics are available to treat the infection.

Information provided by the Minnesota Department of Health and DNR.

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Khin Phillips, a Baltimore dentist, has been recommending that her patients use electric toothbrushes for about three years. She uses a Braun Oral-B power toothbrush herself.

Phillips said electric toothbrushes are better at plaque removal and help patients get in the habit of brushing one tooth at a time. Consumers also are more willing to spend between $70 and $140 on the technology if their dentist recommends it, marketing experts and dentists said.

The advent of battery-powered toothbrushes, which cost between $6 and $20, also has fueled the growth in sales, letting consumers in on the power toothbrush trend at a fraction of the price of high-end models.

Electric toothbrushes have been around since the 1940s, starting with a device called the Toothmaster, said Dr. Scott Swank, curator for the National Museum of Dentistry in Baltimore. The first successfully marketed electric toothbrushes were unveiled in 1961. The Squibb Broxodent was a brush that needed to be plugged in, while General Electric produced a cordless rechargeable model.

By 1995, up to a quarter of all toothbrush sales were electric, Swank said. Sonic and

ultrasonic technology emerged during the early 1990s and between 2000 and 2001, battery-operated toothbrushes emerged.

Toothbrush companies have worked to promote the new technology during the past several years through advertising campaigns. Marketing efforts also target young children with themed battery-operated brushes, sporting characters such as Spider-Man and Hello Kitty.

Area dentists said two of the most popular power toothbrushes are the Philips Sonicare line and the Braun Oral-B series.

The Sonicare brush ($119 to $139) uses sonic technology and side-to-side motion to move its bristles at high speeds. The Oral-B Professional Care 8000 ($120) uses a rotating oscillating head with high-speed pulsation to clean teeth.

The makers say that their cutting-edge brushes reduce gingivitis more than any manual brush. But results of a January 2003 study by the American Dental Association casts some doubt on such claims.

The ADA study, conducted to learn whether power toothbrushes clean more effectively than their manual counterparts, tested various brushing techniques as well as products. The study found that only the brush with the rotating oscillating head —

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the Braun Oral-B — showed significant benefits over manual brushes in reducing plaque and gingivitis. But the study found that those benefits were modest.

But Clifford Whall, director of the ADA’s Seal of Acceptance Program, said that parts of the study were not ”robust“ enough. He added that a more definitive study is needed because it is not clear how much better one brush is than another.

Some dentists say they recommend electric toothbrushes because their motion is gentler than manual brushing and lessens irritation of gums. Some also said those with timers help people who don’t brush for the full two minutes the ADA recommends.

Whall said that people may like power brushes better because they are easier to use. Manual brushes should be held at a 45-degree angle to clean teeth properly, he said, but a power brush does not have similar requirements.

And it’s good oral care that’s the bottom line, no matter what kind of brush it is, said Leslee Williams, ADA manager of media services. ”The key is that the user has to use the brush properly,“ Williams said.

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Electric toothbrushes bristle with sales activity Story/ Michelle Betton Baltimore Sun

CMYK

More Americans are buying electric toothbrushes than ever before thanks to less-expensive technology, increased marketing and growing approval from dentists.

Sales grew 23 percent between 2002 and last year, according to Information Resources Inc., a Chicago-based retailtracking group. ”If you buy the nice quality ones, it’s great,“ said Savvy Palmer of Baltimore, an electric toothbrush user who believes the technology cleans better.

Consumers also bought fewer manual toothbrushes, with sales falling 6 percent between 2002 and last year, Information Resources reported.

Even so, about 180 million manual toothbrushes were sold last year — nearly six times as many as their electric cousins.

Marketing experts consider cost a major reason. ”(Manual) toothbrushes are fine,“ said Ruth Louie of Baltimore, who said electric brushes are too expensive for her taste. ”I replace them every few months and move on.“ The total value of both markets is almost $800 million a year, but the growth in sales clearly is on the technological end of the spectrum, according to Information Resources.

A study last year showed little difference between results achieved with the two brushing methods. But as costs for electric toothbrushes have become more affordable, consumers seem more willing to embrace them. And dentists increasingly are recommending them to patients.

Baked, broiled or deep-fried — how you take your fish might affect how well your heart performs.

Seniors who ate tuna or other broiled or baked fish from one to four times a week had a 28 percent lower risk of developing an irregular heartbeat than those who ate fish less than once a month, according to a recent study.

“We do need to eat fish regularly because we can get a lot of benefits in terms of cardiovascular disease prevention,” said Dr. Ka He, an assistant professor at Northwestern University’s Feinberg School of Medicine, who was not involved in the study. “But also we should pay attention to the cooking process or types of fish.”

Atrial fibrillation is a heart problem in which the two upper chambers twitch instead of beating properly. This can cause blood to collect in the heart, sometimes leading to blood clots and strokes. The condition affects about 2.2 million Americans.

People who ate healthfully prepared fish five or more times a week lowered their risk of developing atrial fibrillation by about one-third. Eating fried fish or fish sandwiches did not reduce the risk of atrial fibrillation, the study found.

Researchers said the benefit to the heart might come from omega-3 fatty acids found in fish, such as salmon and tuna, that are commonly broiled or baked.

Beginning in 1989, researchers from Brigham and Women’s Hospital, Harvard University, the University of Washington and Wake Forest University studied the eating habits of 4,815 people older than 65.

Over 12 years, 980 of the participants were diagnosed with atrial fibrillation.

Researchers did not know whether the participants’ eating habits changed over time or how many years they had been eating fish, both of which could affect the outcome of the study.

The study was published July 19 in the online version of the journal Circulation.

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Surgery Is An Art. Meet Our Picassos.

CMYK

These are the surgeons who practice their art at the Minnesota Institute for Minimally Invasive Surgery (MIMIS) at Cuyuna Regional Medical Center on the medical campus at Crosby. Each brings a rare and unique set of skills to the job.

Together, they’re helping to shape the future of surgery in this region – and across the state. Equipped with new

procedures and new technologies, they’re working wonders. In many procedures, the incisions they make are less than three millimeters long - and closed with a band-aid, not with staples or stitches.

Their training has taken them around the world. Their resumes include some of the most prestigious schools, internships and residency programs in

America. They ’re teachers, too. No less than four of our MIMIS surgeons are actively involved in training other surgeons around the region in minimally invasive surgery. Four are on the faculties of regional medical colleges.

They ’re experts in joint repair and joint replacement. In cataract and laser vision correction. In a multitude of

procedures that can improve the quality of your life. If you (or someone you know) is in need of surgery (or considering some form of elective surgery), ask your doctor about the surgeons of MIMIS at the Cuyuna Regional Medical Center on the medical campus in Crosby.

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Surgery Is An Art. Meet Our Picassos.

CMYK

These are the surgeons who practice their art at the Minnesota Institute for Minimally Invasive Surgery (MIMIS) at Cuyuna Regional Medical Center on the medical campus at Crosby. Each brings a rare and unique set of skills to the job.

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Electric toothbrushes bristle with sales activity Story/ Michelle Betton Baltimore Sun

CMYK

More Americans are buying electric toothbrushes than ever before thanks to less-expensive technology, increased marketing and growing approval from dentists.

Sales grew 23 percent between 2002 and last year, according to Information Resources Inc., a Chicago-based retailtracking group. ”If you buy the nice quality ones, it’s great,“ said Savvy Palmer of Baltimore, an electric toothbrush user who believes the technology cleans better.

Consumers also bought fewer manual toothbrushes, with sales falling 6 percent between 2002 and last year, Information Resources reported.

Even so, about 180 million manual toothbrushes were sold last year — nearly six times as many as their electric cousins.

Marketing experts consider cost a major reason. ”(Manual) toothbrushes are fine,“ said Ruth Louie of Baltimore, who said electric brushes are too expensive for her taste. ”I replace them every few months and move on.“ The total value of both markets is almost $800 million a year, but the growth in sales clearly is on the technological end of the spectrum, according to Information Resources.

A study last year showed little difference between results achieved with the two brushing methods. But as costs for electric toothbrushes have become more affordable, consumers seem more willing to embrace them. And dentists increasingly are recommending them to patients.

Baked, broiled or deep-fried — how you take your fish might affect how well your heart performs.

Seniors who ate tuna or other broiled or baked fish from one to four times a week had a 28 percent lower risk of developing an irregular heartbeat than those who ate fish less than once a month, according to a recent study.

“We do need to eat fish regularly because we can get a lot of benefits in terms of cardiovascular disease prevention,” said Dr. Ka He, an assistant professor at Northwestern University’s Feinberg School of Medicine, who was not involved in the study. “But also we should pay attention to the cooking process or types of fish.”

Atrial fibrillation is a heart problem in which the two upper chambers twitch instead of beating properly. This can cause blood to collect in the heart, sometimes leading to blood clots and strokes. The condition affects about 2.2 million Americans.

People who ate healthfully prepared fish five or more times a week lowered their risk of developing atrial fibrillation by about one-third. Eating fried fish or fish sandwiches did not reduce the risk of atrial fibrillation, the study found.

Researchers said the benefit to the heart might come from omega-3 fatty acids found in fish, such as salmon and tuna, that are commonly broiled or baked.

Beginning in 1989, researchers from Brigham and Women’s Hospital, Harvard University, the University of Washington and Wake Forest University studied the eating habits of 4,815 people older than 65.

Over 12 years, 980 of the participants were diagnosed with atrial fibrillation.

Researchers did not know whether the participants’ eating habits changed over time or how many years they had been eating fish, both of which could affect the outcome of the study.

The study was published July 19 in the online version of the journal Circulation.

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Continued from Page 13

toms, but the cases of tick-borne diseases aren’t reported to the state because they’re not confirmed cases. He said while many people have heard of Lyme disease, they haven’t heard of ehrlichiosis and babesiosis.

“I’m sure the vast majority of the population hasn’t heard of the other tick-born diseases,” said Smith. “I’m sure of it.”

Smith said in 2003 there were 60 reported cases of Lyme disease in patients exposed to the disease in Crow Wing

County. There were 18 cases of Lyme disease in which patients were exposed in Cass County. But Smith believes those numbers are only a portion of the actual number of cases.

The key to combating tick-borne diseases is identifying if you’ve been exposed to a deer tick and being aware of potential symptoms.

In August, 4-year-old Sophie Palmer was watching cartoons in her Breezy Point home when she pulled a deer tick from

her ear and gave it to her dad, Chris Palmer. Palmer recognized that it was a deer tick so he saved the tick in a plastic bag. A month later when Sophie came down with a fever and multiple rashes and blotches on her legs and face, her parents brought Sophie and the dead tick to the doctor. The little girl was diagnosed with Lyme disease. With antibiotics, Sophie was feeling better within a couple of days.

“They’re so small,” said Chris Palmer, of deer ticks. “They’re really hard to see.”

What is Lyme disease?

“bulls-eye” rash that may have a reddened area with a clear area in the middle at the original site of the tick bite. It also may appear in several other places on the body. ➤ Other symptoms include a fever, headache, chills and muscle and joint pain. It is not unheard of that a patient may contract Lyme disease and the other two tick-borne illnesses, ehrlichiosis and babesiosis, at the same time.

➤ If left untreated, Lyme disease can

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➤ Lyme disease is the most common tick-

borne illness in Minnesota and other areas of the country. ➤ The infection is caused by a spirochete bacteria spread by deer ticks and blacklegged ticks. The disease can be spread to humans and animals. ➤ In 2003, 473 Minnesotans were diagnosed with Lyme disease. ➤ One characteristic of Lyme disease is a

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develop into arthritis and problems with the nervous system. In rare cases this can cause memory loss, trouble with concentration, muscle weakness and numbness in arms and legs. ➤ Lyme disease tests can be unreliable, but antibiotics are available to treat the infection.

Information provided by the Minnesota Department of Health and DNR.

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Khin Phillips, a Baltimore dentist, has been recommending that her patients use electric toothbrushes for about three years. She uses a Braun Oral-B power toothbrush herself.

Phillips said electric toothbrushes are better at plaque removal and help patients get in the habit of brushing one tooth at a time. Consumers also are more willing to spend between $70 and $140 on the technology if their dentist recommends it, marketing experts and dentists said.

The advent of battery-powered toothbrushes, which cost between $6 and $20, also has fueled the growth in sales, letting consumers in on the power toothbrush trend at a fraction of the price of high-end models.

Electric toothbrushes have been around since the 1940s, starting with a device called the Toothmaster, said Dr. Scott Swank, curator for the National Museum of Dentistry in Baltimore. The first successfully marketed electric toothbrushes were unveiled in 1961. The Squibb Broxodent was a brush that needed to be plugged in, while General Electric produced a cordless rechargeable model.

By 1995, up to a quarter of all toothbrush sales were electric, Swank said. Sonic and

ultrasonic technology emerged during the early 1990s and between 2000 and 2001, battery-operated toothbrushes emerged.

Toothbrush companies have worked to promote the new technology during the past several years through advertising campaigns. Marketing efforts also target young children with themed battery-operated brushes, sporting characters such as Spider-Man and Hello Kitty.

Area dentists said two of the most popular power toothbrushes are the Philips Sonicare line and the Braun Oral-B series.

The Sonicare brush ($119 to $139) uses sonic technology and side-to-side motion to move its bristles at high speeds. The Oral-B Professional Care 8000 ($120) uses a rotating oscillating head with high-speed pulsation to clean teeth.

The makers say that their cutting-edge brushes reduce gingivitis more than any manual brush. But results of a January 2003 study by the American Dental Association casts some doubt on such claims.

The ADA study, conducted to learn whether power toothbrushes clean more effectively than their manual counterparts, tested various brushing techniques as well as products. The study found that only the brush with the rotating oscillating head —

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the Braun Oral-B — showed significant benefits over manual brushes in reducing plaque and gingivitis. But the study found that those benefits were modest.

But Clifford Whall, director of the ADA’s Seal of Acceptance Program, said that parts of the study were not ”robust“ enough. He added that a more definitive study is needed because it is not clear how much better one brush is than another.

Some dentists say they recommend electric toothbrushes because their motion is gentler than manual brushing and lessens irritation of gums. Some also said those with timers help people who don’t brush for the full two minutes the ADA recommends.

Whall said that people may like power brushes better because they are easier to use. Manual brushes should be held at a 45-degree angle to clean teeth properly, he said, but a power brush does not have similar requirements.

And it’s good oral care that’s the bottom line, no matter what kind of brush it is, said Leslee Williams, ADA manager of media services. ”The key is that the user has to use the brush properly,“ Williams said.

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A Lifetime of Quality at the Lowest Everyday Prices* Story/Heidi Lake

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Life as a teenager can be difficult. Life as the parent of a teenager can be even more challenging.

In the book, “Why Do They Act That Way?,” Dr. David Walsh addresses the problems that are too familiar to many parents of teens, including moodiness, anger, sex and drug and alcohol use.

Walsh, a psychologist from Minneapolis, has written eight books and frequently appears on national TV news shows. Walsh has served as a children’s behavioral expert on “The Early Show,” “Today,” “20/20” and “Dateline NBC,” among others.

He recently conducted a workshop for the St. Joseph’s Foundation’s annual community health symposium, where he discussed teenage behavior. Nearly 300 parents, pastors, teachers and other professionals attended the event.

Janelle DeSmith, a volunteer coordinator for the Crisis Line, said she attended the workshop because she often speaks to teens and parents who call the Crisis Line with questions.

“I will relate this information to all the volunteers (who answer the phones),” she said.

For 10 years, Walsh, a father of three, worked as a high school

24

teacher and counselor, until new brain research caught his attention.

“I’ve always been interested in adolescence,” Walsh said. “An adolescent’s brain is different from an adult brain.”

Through his book and workshop, Walsh said he tried to “translate science so people can understand” what is going on in a teenager’s brain during the emotional and hormonal highs and lows of adolescence. Walsh also coached parents and people who work with youths on the hard-totalk-about subjects of sex, drugs and alcohol.

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community has focused research efforts on SIDS, SUDC has not received the same attention. The National SUDC Program was created in September 2001 to provide a centralized resource for families searching for information and support as well as to coordinate research efforts and increase awareness.

More information may be found at www.sudc.org or by calling 800-620SUDC.

CMYK

Scholarship fund honors Max Best

The Maxwell Douglas Adamek Best Memorial Scholarship Fund was started at Central Lakes College to increase awareness and educate the public about in Death Unexplained Sudden Childhood.

The scholarship fund was started with a $1,000 donation from Becky Best, associate vice president of academic affairs at CLC. The late Maxwell Best, who died in December 2002 from SUDC, was Best’s nephew.

Two $500 scholarships will be awarded each year to single parents with schoolage children. The student recipient must be majoring in child development or pursuing a degree in the health care field.

Max Best’s parents, Mitchell and Jen Best, raised more than $70,000 in Max’s Run for a Reason last fall in Minneapolis. In an attempt to raise awareness of Sudden Unexplained Death in Childhood, the fund-raiser will take place again Nov. 13 in Minneapolis.

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The teenage brain and sex While many parents would like to deny it, their children are having sex. Walsh said twothirds of youths have had sex before their high school graduation. The average age to become sexually active is 15 for boys and 16 for girls.

In his book, Walsh says the idea of romance begins before puberty. Around age 10 hormones increase, leading children to their first taste of romance — a crush. Walsh describes a child’s first crush as “a preview of coming attractions.”

Once puberty hits, sexual interest and sex drive kick in.

“There are days for some teenage boys where all they think about is sex. This is normal,” Walsh said.

Adolescent girls also have erotic thoughts, but Walsh states, “They don’t seem to be as all-consuming as boys’.”

Walsh reported four out of every five teenagers say they have had zero or little communication with their parents about sex.

“Where are they getting their information?

The media,”Walsh said, explaining television, movies and magazines are increasingly promoting sexual activity.

The transition from childhood to adolescence is a major step in a person’s life. With all of the physical and mental changes going on, Walsh said this is prime time to discuss puberty and sex.

Sexually transmitted diseases Three million teenagers in the United States contract an STD each year. STD rates, more specifically, chlamydia and gonorrhea rates, are on the rise in Minnesota. Between 2002 and 2003, chlamydia rates increased by 6 percent and gonorrhea rates by 5 percent.

STD rates are highest in the Twin Cities area and, according to the Minnesota Department of Health in 2003, Crow Wing County reported 67 cases of chlamydia and four cases of gonorrhea. Cass County reported 37 cases of chlamydia and five cases of gonorrhea.

Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. According to the Centers for Disease Control and Prevention, teenage girls have the highest risk of infection because their cervix is not fully matured.

Chlamydia can be transmitted during vaginal, oral or anal sex.

Chlamydia is known as the “silent” disease because it usually does not present any symptoms. If untreated, chlamydia can progress to serious reproductive and other health problems with both short- and longterm consequences.

Gonorrhea is another common infectious disease. The CDC Web site says gonorrhea is a bacteria that can grow and multiply easily in warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra in women and men.

Gonorrhea is spread through genital, oral or anal contact. Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and AfricanAmericans.

The CDC states females with gonorrhea rarely have symptoms, while infected males can experience a burning sensation when urinating, painful or swollen testicles, or a white, yellow, or green discharge from the penis.

The disease can be treated with antibiotics.

To reduce the risk of getting STDs, including chlamydia and gonorrhea, the CDC recommends abstinence, a long-term, monogamous relationship or consistently and correctly using latex male condoms.

Alcohol and drugs With all the recent attention on methamphetamine use locally, it may come as a surprise that alcohol is the substance that does the most damage to the most young people, Walsh reported.

During his workshop, Walsh said drugs and alcohol affect the adolescent brain differently than the adult brain. When consuming alcohol, an adult’s brain sends off signs, like sleepiness and slurring language, telling the body it has had enough. A teenager’s brain reacts differently in that those signals don’t go off until much later, when the person may already be dangerously drunk.

“In the absence of warning signals that tell them to stop, adolescent drinkers tend to drink more and do more damage to themselves,” Walsh wrote.

Alcohol impacts the learning and memory capabilities of a teenager, more than it does for an adult. Adolescents also have a higher risk of having alcohol problems as an adult if they start drinking at a young age.

“For teens, alcohol is more dangerous than for adults,” Walsh said.

Nicotine also affects adolescents’ brains differently than adults’. Young people are more likely to get addicted to nicotine, and they get addicted much faster.

In his book, Walsh calls tobacco a “gateway drug,” stating adolescents who smoke are at higher risk of using alcohol and other substances.

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Story/Carole Goldberg, Hartford Courant

It used to be so simple.

You were a kid. You fell down and skinned your knee.

You cried.

Mom came to the rescue, washed off your wound -- let’s use the technical term, which is “boo-boo” or “owie” -- and applied hydrogen peroxide or mercurochrome. You cried again.

She opened the little can that holds the adhesive bandages, and depending on the extent of your boo-boo, selected the wide kind, or the skinny little one or the dot, and stuck it on. When it was time to peel off the bandage, it hurt. You cried some more.

But today if mom needs to reach for a bandage, her choices go far beyond just size or shape. The consumer market for adhesive bandages has exploded in the past decade or so, driven, say industry spokesmen and medical professionals, by technological advances in hospitals.

Lisa Corbett, an advancedpractice registered nurse with the Center for Wound Healing and Hyperbaric Medicine at Hartford Hospital in Connecticut, says the improved treatment of chronic nonhealing wounds, those that persist longer than 30 days, has spun off products now available to the public.

So mom now is faced with store shelves jam-packed with products: liquid and spray-on bandages, ionized-silver bandages or waterproof or moistenvironment-promoting or easy-to-remove bandages. Or anti-itch, anti-bleeding or antibacterial bandages. Not to mention bandages shaped to fit fingers or knuckles, or medicated to minimize scars or

cushioned to heal blisters.

There are eye-catching bandages for kids, decorated with licensed cartoon characters or tattoo designs, and clear ones that appeal to adults because they don’t catch the eye. ”At first, it seems like a challenge to navigate“ among all these choices, says Todd Andrews, a spokesman for CVS Corp. ”But it’s a real benefit to consumers.“ Just as there have been advances in treating heart disease, Andrews says, there have been ”leaps forward in technology in wound care and management products.“ The diversity ”seems daunting, but is useful,“ he says, noting that as hospital stays grow shorter, postoperative wound care is increasingly being managed at home. ”Our customers have told us, through studies, that they want these products,“ he says.

Michael Sweeney, a spokesman for 3M’s Nexcare line, says that while different products offer different benefits, the most important is their performance, such as whether they are easier to use, longerlasting or more waterproof.

Liquid-bandage products are among the newest to catch the interest of consumers, he says, and while they may be more expensive per application, they last longer, which helps bring their cost closer to that of strip bandages. Further refinements will make such innovations more convenient and affordable, Sweeney says.

The choices can seem overwhelming, he says, and that is why Nexcare has recently redesigned its packaging as ”a simplification to help consumers find what they need.“

ported the following: • Minneapolis Children’s Hospital’s and Clinics grief program for bereaved parents.

• Minnesota’s Sudden Infant Death chapter.

• Attendance at the 2004 SIDS International Convention.

• The creation of an advertising campaign to raise awareness of SUDC. The success of Max’s Run for a Reason has energized bereaved parents across the country. Tami and Jake Gove of Denver lost their son, Josh, for unexplained reasons when he was just 15 months old.

Now the Gove’s are pairing with a n o t h e r Denver family to host a second Run for a Reason.

Lunden and Pat MacDonald, lost their son, Gus, at 18 months. Denver’s first Josh and Gus Run for a Reason will be Nov. 6.

“Max’s story inspired us,” said Tami Gove. “After hearing how successful Max’s run was, we just had to do the same. The effort will not only raise important funds for research, but it honors our son’s memory.

The second Max’s Run for a Reason is once again on Max’s birthday. The 5K run and 2K family fitness walk will take place at 10 a.m. at Lake Harriet in Minneapolis. Additional details and registration are at www.maxwellbest.com. All proceeds benefit the SUDC program as well as local children’s hospitals and clinic’s programs for bereaved parents such as the Healing Quilt and Minnesota Sudden Infant Death Center.

SUDC is the sudden and unexplained death of a child over the age of 12 months. An estimated 4,708 U.S. children ages 1 to 4 have died from unknown or unspecified causes in the past two decades. While the medical

Max Best died suddenly of Sudden Unexplained Death in Childhood when he was 13 months old.

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Max Best, 13-month-old son of Mitchell and Jen Best, died of Sudden Unexplained Death in Childhood, a rare and mysterious disease that strikes children over the age of 12 months.

Son of former Brainerd man dies of SUDC As is often the case, tragedy inspires.

The sudden, unexpected loss of 13month-old Max Best motivated his parents to raise more than $70,000 in Max’s Run for a Reason last fall in Minneapolis.

Today, his death and the efforts of Jen and Mitchell Best to understand what happened to their son have sparked a national fundraising effort. As a result, other families are planning their own Run for a Reason and the Mayo Clinic’s Long QT Clinic and Sudden Death Genomics Laboratory purchased research equipment designated to explore the causes of Sudden Unexplained Death in Childhood.

The second annual Max’s Run for a Reason will be Nov. 13 in Minneapolis.

Additionally, to help raise awareness nationally for SUDC, funds from Max’s Run led to the creation of an advertising campaign. The campaign was revealed at the SIDS International Convention in early

14

July. It will appear in national medical journals and magazines starting this fall. The campaign features two families that both tragically lost young children for unknown reasons. The Bests will be one of the featured families.

Mitchell Best, Max’s father, is a Brainerd High School graduate. He is the son of Mary Best, Minneapolis, and Roger Best, Brainerd. Becky Best, Brainerd, is Mitchell’s sister.

“It’s been heartbreaking, yet an utterly important journey for us,” said Jen Best.

“Planning this run in Max’s memory is how we cope with the loss. We’re so proud and amazed that our son inspired such an outpouring of love and generosity. Unfortunately, however, as awareness for SUDC builds, so do the case numbers.

Since Max’s death 19 months ago, more unexplained deaths of children have been classified as SUDC. We have to help doc-

tors understand how to save these children.”

The research equipment the Mayo Clinic was able to purchase is just one major step toward understanding.

“What the Best’s are doing to help raise awareness for SUDC on a national level is astounding,” said Dr. Michael Ackerman, pediatric cardiologist and director of Mayo Clinic’s Long QT Syndrome Clinic and Sudden Death Genomics Laboratory.

“Parents who lose young children deserve answers. Unfortunately, we continue to struggle with concrete reasons for why these young children die suddenly. It’s only recently that we’ve uncovered a possible connection. The research equipment we’ve been fortunate enough to purchase will help us explore this theory.”

In addition to the research equipment acquired by the Mayo Clinic, funds from the first Max’s Run for a Reason also sup-

Fred Tewell, product director for Johnson & Johnson’s BandAid Brand Adhesive Bandages, says industry research shows that mothers continue to be the primary purchasers of bandages for the whole family. He says older consumers, a growing group, are buying bandages that are gentle to the skin, such as the liquid type or Band-Aid’s Hurt-Free line.

We’ve come a long way from the birth of the first Band-Aids, which company lore says were invented in 1920 by Earle Dickson, a cotton buyer for Johnson & Johnson, whose new bride, Josephine, was prone to acquiring cuts and burns while cooking. He fashioned bandages for her from cotton gauze and adhesive strips, which soon were marketed by the company.

At first made by hand and 3 inches wide by 18 inches long, they were not an immediate success, but smaller strips soon caught on. And Dickson became a vice president. By now, more than 100 billion Band-Aids have been made, and the company’s trademarked name has become the shorthand term for any adhesive bandage.

According to a report posted on MarketResearch.com, 60 percent to 70 percent of adhesive bandages in the United States are used on children, and those with licensed images account for 15 percent to 20 percent of the entire market.

Among other popular innovations: Hydrocolloid or hydrogel bandages, such as Johnson & Johnson’s Advanced Care and Curad’s Hydro-Heal brands.

They have particles that absorb fluids from the wound and form a gel that provides a moist environment.

That is most helpful, says Corbett, because it helps tissues heal faster with less scarring. Some of these bandages are semipermeable and form a seal around the wound that helps trap healing cells. ”We tell our clients to think rain forest, not desert,“ Corbett

says of the emphasis on covering wounds and keeping the environment moist.

Letting a wound dry out and form a scab lengthens the time it takes to heal and increases the possibility of scars or infection, says Marcia Taraschi of Johnson & Johnson.

Liquid and spray-on bandages offer aesthetic appeal, flexibility, good waterproofing and the ability to cling to the wound.

They are useful for hard-tocover areas and slough off when the wound heals.

Scar-reducing bandages can minimize the appearance of raised or red scars over a period of weeks and can be used on fresh or old scars.

Bandages containing ionized silver, tiny bits that leach out over time, offer a natural antibacterial effect. Their use has shaken up hospital care of chronic wounds, says Corbett. ”Silver is a very potent antimicrobial,“ she says, but adds that for minor cuts likely to heal within a few days, less-expensive traditional bandages will do the job well.

Anti-blister bandages use hydrocolloid technology to generate a gel cushion that stays in place for several days, seals out water and germs, and is flexible.

Anti-itch bandages contain a topical ointment that dulls pain and throbbing, lessening the urge to scratch an insect bite or minor wound, which can lead to infection.

Anti-bleeding bandages use fibers or gels to stop bleeding quickly. They may be of use to people who take anti-coagulant drugs.

But a little bleeding can be a good thing, says Corbett. ”We like it when wounds bleed. It’s the first phase in the cascade of healing,“ when blood platelets migrate to the wound and attract growth factors for new tissue, she says.

Just as a mild fever is a natural part of fighting infection, bleeding plays an important role in healing.

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Story/January W. Payne Photo/Cathy Kapulka Washington Post

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You’re never too young to benefit from yoga Nine-month-old Bryce Saunders giggled, legs dangling, as his mom held him in what was meant to be a soothing yoga pose. Then, with one hand clutching Bryce’s bottom and the other wrapped around his stomach, she bent her knees and dropped down quickly into a squat.

“Am I holding him right?” Christine Saunders asked, as she stood back up.

Bryce squinted his eyes and began to fuss.

“Yes ... and he doesn’t want you to stop,” said instructor Moira Clarkin.

Saunders and son’s lesson in Divine Drops, as the move is called, took place in an Itsy Bitsy Yoga class, open to children from 3 weeks to 2 years of age, at Boundless Yoga Studio in Washington.

There, babies and toddlers — with a sometimes-considerable adult assist — practice yoga poses along with their caregivers.

The poses, including “Kicky Cobra” and “Down Dog,” are based on a program developed by Massachusetts yoga instructor Helen Garabedian. The author of “Itsy Bitsy Yoga: Poses to Help Your Baby Sleep Longer, Digest Better and Grow Stronger” (Fireside/Simon & Schuster, 2004), Garabedian claims yoga reduces babies’ stress and anxiety.

Wendy MacLeodChappell helps daughter Halla, 8 weeks, through a class in Washington of yoga moves designed for infants. The Itsy Bitsy Yoga class is open to children from 3 weeks to 2 years of age.

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In a switch from traditional “mom and baby” postpartum yoga classes, which emphasize the mother’s yoga practice and incorporate the baby only passively, the new concept involves more than 75 poses focused strictly on the baby’s movement, soothing and enjoyment. Caregivers act as helpers, guiding the babies’ arms and legs into poses and, at times, holding and bouncing the children, as Saunders did.

Some fitness-conscious parents are flocking to these classes, hoping an unusually early introduction to formalized movement will help keep their tots from becoming obesity statistics. About 15 percent of children ages 6 to 11 were overweight in 1999-2000, compared with 11.3 percent in 1988-94, according to the Centers for Disease Control and Prevention. Children 12 to 19 showed a similar trend, with 15.5 percent overweight in 1999-2000, compared with 10.5 percent in the earlier period.

“My mantra is: Fit baby equals fit toddler equals fit child equals fit teen equals fit adult,” said Garabedian, who started her program five years ago. “Children who are exposed to age-appropriate exercise at an early age are more apt to continue that.”

Mary Wilcox is a believer. “I definitely

want my kids to be active,” said the Falls Church, Va., resident who took her 9month-old son, Liam Timar-Wilcox, to Clarkin’s class in March and April. “I wanted to do something with him, and have him do the exercises and get the benefits from it.”

But pediatricians are generally skeptical of the benefits some parents ascribe to baby and toddler yoga classes, saying that no studies have examined their effects.

Eric Small, chairman of the American Academy of Pediatrics’ Committee on Sports Medicine and author of “Kids & Sports” (Newmarket Press, 2002) advised that parents shouldn’t expect that enrolling their tykes in baby yoga classes will better their health.

“It’s just an activity for them to do,” Small said in an interview. “But having quality interaction with a babysitter or a parent is probably equally as beneficial as attending a yoga class.”

In a later e-mail, he addressed the obesity question: “There are genetic, nutritional (and) exercise factors that contribute (to excess weight). Doing baby yoga in and of itself will not prevent childhood obesity. The baby has ... (to) eat healthy and play and be active on a daily basis.”

And then there’s the safety question.

cases of Lyme disease but the frequency of reported cases remains higher than in other counties. Bernier said the hospital is seeing an increase in ehrlichiosis cases and has seen a few patients with babesiosis.

“A handful of people in Crow Wing County with this disease is huge because it’s so rare,” said Bernier, of babesiosis.

Bernier said he believes that area doctors have become acutely aware of these diseases and are quick to detect them. St. Joseph’s laboratory employees are used to seeing these diseases and have become experts at uncovering them, he said.

Kirk Smith, epidemiologist supervisor for the Minnesota Department of Health for Foodborne, Vectorborne and Zoonotic Diseases, said Brainerd area physicians are likely better at diagnosing tick-borne diseases than Twin Cities physicians. One problem with detecting these diseases is that blood tests can be inaccurate. Lyme disease tests are sensitive and can turn out many false positives.

Blood tests for ehrlichiosis can come back negative if the patient is tested with-

in the first seven days after experiencing symptoms. The antibodies aren’t yet present in their blood, said Smith, adding that one study found that only 23 percent of ehrlichiosis cases come back positive through blood testing.

“While most doctors have heard of Lyme disease, they’ve heard of anaplasmosis but don’t know what to look for,” said Smith. “In the Twin Cities, I don’t think doctors look for this in their patients.”

The Twin Cities area doesn’t have a lot of deer ticks, but Smith said many of the Twin Cities residents infected with tickborne diseases are bitten by deer ticks while vacationing in Crow Wing and its neighboring counties.

“They’re getting them from recreating up north,” said Smith. “In Brainerd it’s obvious. Crow Wing County and the surrounding counties are a hot bed for tickborne diseases.”

Smith said he believes the number of reported cases are only the tip of the iceberg. Many patients go to the doctor because they are ill and they’re given antibiotics, which relieves their symp-

What is babesiosis? ➤ Babesiosis (pronounced bab-e-see-oh-

sis) is a tick-borne illness caused by a parasite that lives on some types of ticks. ➤ Although considered to be rare, there have been several cases of babesiosis diagnosed in Crow Wing County. ➤ Most cases are mild, but can develop into a severe infection and can be fatal, particularly for people who have had their spleen removed or have a suppressed immune system. ➤ Patients diagnosed with babesiosis can contract the other two tick-borne illnesses, Lyme disease and erhlichiosis. A blood test is needed to diagnose this illness. ➤ Symptoms are similar to erhlichiosis and include a sudden high fever, chills, sweating, fatigue, poor appetite and a severe headache. Some people with this illness may not have symptoms. ➤ Antibiotics are administered to treat babesiosis.

Information provided by the Minnesota Department of Health and the DNR.

Continued on Page 18

Safety Matters Small said he worries that some baby yoga instructors lack training in infant development and knowledge of health problems that could make exercise risky.

One such problem, he said, is hypotonia, a condition involving muscle weakness and poor head and leg control that is often not diagnosed until 6 months of age. Hypotonia affects one to five percent of children, Small said.

“Infants and toddlers are generally very flexible in joints and muscles,” Small wrote.“They have soft bones at their growth plates. With overstretching, there is a potential to cause a growth plate fracture.

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“We are probably the ehrlichiosis capital of the world.”

—Dr. Nicholas Bernier, director of medical affairs at St. Joseph’s Medical Center in Brainerd

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On the left is an adult male deer tick. In the middle is an adult female deer tick. On the right is a wood tick. Wood ticks do not spread Lyme disease. Photo/Minnesota Department of Health

In its second year, primarily from May through August, a nymph becomes active and takes its second feeding from a mammal. If the tick received the bacteria from its first feeding in the larva stage, it can transmit the bacteria during its second feeding. A nymph stage tick often looks like a speck of dirt or a freckle on a perPhoto/Minnesota skin. son’s Department of Health

... Infants and toddlers cannot verbalize if the stretch is uncomfortable as older children and adults can.”

But Garabedian said babies can and do let others know when a pose hurts or pleases. She said instructors’ training covers cues that babies like or dislike an activity, and instructors then teach parents to recognize these signs. If caregivers or instructors notice babies showing signs of discomfort, they’re supposed to stop the activity, she said.

Signs of engagement, or happiness with an activity, Garabedian said, include cooing, giggling and making eye contact. Cues signaling disengagement, or frustration or pain with a pose, she said, include crying, turning their heads away and arching their backs.

In the training she provides, she said, “I also teach the facilitators a lot about the baby’s anatomy.”

Garabedian took a 200-plus hour course to earn certification as an “infant development movement educator” from the School for Body-Mind Centering in Massachusetts; among the school’s other offerings is a 500-hour somatic movement education program, which requires students to explore the relationship between

the body, mind, movement and touch.

Garabedian, who started practicing yoga when she was 10, also says she is certified in Hatha yoga, yoga pregnancy teaching and in infant massage.

She said she started her exercise program to combine her love for yoga with an activity she could use to bond with her children. (Her first child, Andrew, was born last month.) Garabedian said she’s never taught the kind of mother-and-baby class in which both exercise together. “I believe that a mom’s yoga practice should be separate from the baby’s because yoga is almost like an inner experience.”

She says she has trained some 60 instructors, including Clarkin. She requires five days of instruction for those planning to teach her trademarked Itsy Bitsy Yoga to children up to age 2 and two days for those working with kids aged 2 to 4. Garabedian said she addresses how to safely work with infants’ and toddlers’ growing bodies.

“I think that training is very, very important ... to make (instructors) understand how slow they need to go” with infants and toddlers, said Garabedian. “Their spine is totally different. ... There is really a lot that we have to do to ... work with

infants and babies successfully.”

What Comes Naturally In Itsy Bitsy Yoga, caregivers help kids learn poses by gently positioning them and moving their arms and legs. But instructors said some kids spontaneously put themselves into facsimiles of adult yoga poses such as “Downward Facing Dog,”where they bend over with their feet and hands planted on the ground — creating an upside-down V — even before taking classes.

“When I had my son, I was just so struck by how naturally yoga came to him,” said Clarkin, whose son, Benjamin Evans, is 11 months old. “I could see that he was doing poses, and I could see some of the benefits.”

One of those benefits is a calming effect on young yogis, say parents and instructors. That proved useful a few weeks ago, said Wilcox, when her son got cranky during a flight with her from Minneapolis.

“I laid him down on the seat and did yoga and he got very happy,” Wilcox said.

“There’s a bouncing one where you bounce them on your knee, called ‘Hop Along Yogi.’ He loves that.... He smiles and starts kicking his feet.”a little bit older.”

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Story/Heidi Lake Photos/Nels Norquist

For some, polio is a disease they haven’t thought about in years. For others, they are reminded every day by muscle soreness and fatigue stemming from a disease they contracted more than 50 years ago.

A polio epidemic swept across the United States in the 1940s and 50s, leaving thousands of people with the sometimes fatal disease. In 1952 alone, 21,000 cases of polio were reported in the United States.

Mary Kay Keithly of Pillager became stricken with paralytic polio in 1946 when she was 6. She remembers her father got fired from his job and her family was quarantined to their house for fear of spreading the disease.

“You were completely isolated from society if you had it,” Keithly said.

Keithly was in a Kansas City, Mo., hospital for four months after she contracted paralytic polio. At her worst point, she was paralyzed from the chest down, but after three months of physical therapy, she was able to walk again with the help of leg braces.

Paralytic polio is a viral disease that enters the body through the nose or throat and causes inflammation and damage to nerve cells and tissue in the lower brain and spinal cord. It is usually spread through contact with the feces of an infected person.

For some, symptoms feel like the flu,

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with head, neck and overall muscle pain.

For those with paralytic polio, people can lose the use of their muscles, become easily fatigued, and have unexplained pain and breathing difficulties.

Bob Jensen, 59, contracted paralytic polio when he was 7 and living in Staples.

“I was in bed for three months and never got out,” he said.

In 1952, when Jensen was stricken with the disease, there weren’t many treatment options. He remembers being wrapped in a wool Army blanket that had been soaked in boiling water to loosen his muscles.

Before a polio vaccine became available in 1955, the Centers for Disease Control and Prevention reported 13,000 to 20,000 cases of polio each year in the United States. These annual epidemics of polio left thousands of victims, mostly children, in leg braces, crutches and wheelchairs — lasting reminders of the disease.

Today, the CDC recommends children be vaccinated four times with Inactivated Polio Vaccine, which is given in the form of a shot in the leg or arm. IPV should be administered four times to children 2 months, 4 months, 6-18 months and 4-6 years old.

“Children are required to get vaccinated (for polio) before they start kinder-

garten,” said Dr. Arden Beachy of Lakewood Health System.

The CDC reports the development of polio vaccines have eliminated paralytic polio in the United States and the entire Western hemisphere.

For those who have contracted polio at some point in their life, however, they are not out of the woods yet.

Between 25 and 80 percent of people who survived polio will experience the symptoms of postpolio syndrome.

Governor Tim Pawlenty even designated 2004 as “the year of polio awareness”in an attempt to create awareness of postpolio syndrome.

Although postpolio is not infectious, the symptoms are similar to polio with muscle fatigue and pain.

Jensen’s muscles get extremely fatigued when he’s doing minor activities, such as brushing his teeth or mowing the lawn.

In 1985, 33 years after he was cured from polio, Jensen started feeling the effects of postpolio syndrome. In 1997 Jensen was forced to retire and “give everything up.” Today the 59-year-old father and husband cannot walk more than 200 feet without resting.

“When it hits you, it hits you bad,” said Bob Loucks, a 72-year-old sufferer of postpolio syndrome.

Healthy adults tend to gradually lose

“It messes with your brain,” said Fitzer, of Lyme disease. “It’s hard to focus. You don’t have ambition. You don’t care about anything. You’re just ready to lay down and that’s it.”

Carolyn knew to check if her husband had Lyme disease because she, too, had recently suffered with a tickborne illness. She was diagnosed with ehrlichiosis in June. That weekend she suffered from a mindnumbing headache that wouldn’t go away, a 103-degree fever, chills and head-to-toe body aches. A stay-athome mom with twin 5-year-old boys, Carolyn said she had no energy. She went to the doctor right away on Monday to get antibiotics and started feeling better about three days later.

The Fitzers have always been careful to make sure their sons, Tony and Marty, were protected from ticks and check them over often after they’ve been outside. Now they’re concerned that if they easily got these diseases, their young sons could as well.

There is reason to be concerned

about tick-borne diseases, particularly in Crow Wing County. The county leads the state in the number of reported cases of Lyme disease, ehrlichiosis (which is now often referred to by medical professionals as human anaplasmosis) and potentially the lesser-known babesiosis, a rare illness caused by a parasite that lives on diseased ticks. Babesiosis is rare but there have been several cases reported in Crow Wing County. This tick-born disease can be fatal in individuals with no spleen or those who have a compromised immune system. There can be only mild symptoms in otherwise healthy individuals who have babesiosis.

They may not even know they have it.

“We are probably the ehrlichiosis capital of the world,” said Dr. Nicholas Bernier, director of medical affairs at St. Joseph’s Medical Center in Brainerd.

Bernier said all tick-borne diseases are treatable, but they need to be identified. The Brainerd hospital has seen a decline in the number of

What is ehrlichiosis? ➤ Ehrlichiosis (pronounced er-lick-ee-o-sis) is a bac-

terial disease transmitted to humans from the same ticks that transmit Lyme disease. ➤ Unlike Lyme disease, the majority (79 percent) of patients diagnosed with ehrlichiosis between 19982002 lived in greater Minnesota. In 2002 Crow Wing and Cass counties had the greatest numbers of exposures to infected deer ticks or black-legged ticks. ➤ Symptoms usually start 5-10 days after a person has been bitten by a tick but can take up to a month to appear. ➤ Symptoms include a sudden onset of a fever of 102 degrees or more, chills, shaking, fatigue, severe headache, muscle and joint pain, nausea and vomiting, cough, stomach pain and sore throat. It is rare to have a stuffy nose or sinus trouble with ehrlichiosis. This can distinguish ehrlichiosis from the flu, a bad cold or a sinus infection. ➤ There were 78 cases of ehrlichiosis reported in Minnesota in 2003, but Brainerd health care officials believe the number of actual cases is much higher than reported. ➤ Ehrlichiosis can be easily treated with an antibiotic.

Information provided by the Minnesota Department of Health and DNR.

11

Diseased ticks invade area counties, leaving residents feeling sick Story/Jodie Tweed Graphic/Connie Jenson

fatigued, he went inside and took a nap.

“I thought I was just worn out,” said Fitzer, who works in software development at BISYS. “I didn’t know.”

After a few days of suffering through what he thought was the flu, Fitzer’s wife, Carolyn, checked the brochure she had saved about Lyme disease. Her husband had all the classic MINNESOTA COUNTIES WITH THE symptoms, including a HIGHEST NUMBER OF CASES OF “bulls-eye”-type rash on LYME DISEASE AND EHRLICHIOSIS his thigh. She urged him to go to the doctor. Fitzer LYME DISEASE COUNTY

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It was a warm and sunny Sunday afternoon in early August and Rick Fitzer of Pequot Lakes could barely stand up.

Fitzer had just finished mowing the lawn on his riding mower and didn’t feel well. He felt chilled but he was sweating. His head was throbbing with pain. Fitzer felt as if he had no energy. Feeling unusually

said he “just did the guy thing,” and postponed a trip to the doctor for several days after the symptoms first appeared, waiting instead to see if he would feel better. He didn’t.

“When you get it, you think it’s the flu,” said Fitzer. “That’s what I thought. But you don’t get the flu for four days.”

Fitzer’s doctor diagnosed him with Lyme disease, a tick-borne disease surprisingly common in Crow Wing County and the surrounding counties. Fitzer recalled finding a deer tick on him weeks earlier but it hadn’t attached itself to his skin.

Name: Bob Loucks Age: 72 Age diagnosed with Polio: 17

nerve cells and muscle strength after age 50. People who have had polio have already lost some motor nerve cells, increasing their chance of suffering a decline in muscle strength earlier in life.

“The muscle weakness and the inability to do a certain activity is caused by nerve damage (from polio),” Beachy said.

(Reported cases, 1993-2003)

Crow Wing Pine Aitkin Cass Chisago Mille Lacs Kanabec Isanti St. Louis Carlton COUNTY Crow Wing Cass Aitkin Pine Morrison Chisago Anoka Mille Lacs Carlton Isanti

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Loucks, Jensen and Keithly all suffer from postpolio syndrome. They all agree the best treatment for postpolio is to take things easy.

“If you overdo it, you’ll be down for three days,” Jensen said. “It changes your whole life. You learn to accommodate for yourself.”

Name: Bob Jensen Age: 59 Age diagnosed with Polio: 7

In 1992 Loucks started a support group for people with postpolio syndrome.

About 10 people gather at 10 a.m. the first Monday of each month at the Brainerd Public Library to discuss postpolio symptoms and what can be done to relieve the pain. The group does not meet January through March.

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Rick and Carolyn Fitzer sat with their 5-year-old twin sons, Tony (left) and Marty, outside their Pequot Lakes home. The couple are worried that their sons will get a tickborne illness since Carolyn was diagnosed with ehrlichiosis in June and Rick contracted Lyme disease in August. Photo/Nels Norquist

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Story/William Hathaway Photo/Rick Hartford Hartford Courant

Children with Angelman syndrome used to be called “happy puppets� because they tend to laugh with ease, flap their arms like marionettes and never talk.

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Donna Clavette and her daughter, 15year-old Nicole Clavette embraced in the driveway of their home. Nicole has Angelman Syndrome, which produces children who laugh easily, flap their arms but do not talk and have a mental age of about 2 years old.

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on one chromosome is damaged or missing, then the other copy can be activated.

But in Angelman and about a dozen similar diseases, that does not happen.

At the University of Connecticut Health Center, geneticist Marc Lalande wants to understand why.

“Why go through millions of years of evolution to get a second copy (of a gene) and shut one down?”Lalande said. “That is the million-dollar question.”

Studying Angelman syndrome offers a window into understanding genetic imprinting — the process that determines which of the parental genes will be activated early in development, he said.

“If you muck with the imprinting process, you perturb development, and that is crucial in a lot of human disease states,” Lalande said.

For instance, a nearly identical deletion of chromosome 15 — but from the paternal gene — leads to a totally different disease, Prader-Willi Syndrome. Like Angelman kids, children with Prader-Willi are mentally retarded, but they tend to be short in stature and lack muscle tone.

While some Angelman children have little appetite, Prader-Willi children often cannot stop eating.

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children — about 250 new cases each year.

The syndrome was first recognized in 1965, when English physician Harry Angelman described peculiar behavioral abnormalities in three patients and hypothesized that the cases were linked to a single but as-yet unnamed disease. The children with their flapping arms and laughter reminded Angelman of an oil painting by Gian Francesco Caroto, “Boy With a Puppet.”

It wasn’t until the early 1980s that Angelman was identified as a specific disease. Angelman patients have a normal lifespan but require 24-hour care.

In about 70 percent of cases, there is a missing genetic sequence on chromosome 15. Humans have 23 pairs of chromosomes on which all genes are located.

The deletion linked to Angelman is only found on the maternal chromosome. This mystified scientists, because sexually reproducing organisms come with maternal and paternal copies of each chromosome.

Genes on the chromosomes from both parents are activated seemingly at random in the developing child. This genetic redundancy is nature’s way of protecting against developmental disorders. If a gene

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However, as with investigations of many rare disorders, understanding Angelman won’t necessarily improve the lives of people who have it.

By the time Nicole Clavette of Tolland, Conn., was 1, her mother, Donna Clavette, knew something was wrong. Nicole almost never slept, her motor control was poor and she sometimes burst out laughing in the middle of the night.

Doctors told first-time parents Donna and Mark to relax, that Nicole just might be developmentally delayed. But by the time she was 2, her doctors were concerned, too. Her movements were jerky, and she had seizures, which led one doctor to suggest Nicole had cerebral palsy.

But her puppet-like mannerisms and peculiar laughter led Donna Clavette to suspect something else.

It took more than a year of consultations with medical experts before tests confirmed that within Nicole’s DNA, a segment of chromosome 15 was missing — the telltale genetic sign of most Angelman syndrome cases.

The mystery of Nicole’s illness was solved, but scientists are still baffled by some aspects of the syndrome, which is estimated to afflict about one in 15,000

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Impressions, or molds, are taken of the teeth using a soft putty-type substance. Those impressions are sent to Invisalign and plaster models of the teeth are made. The models are then used to create a 3-D digital image and a computerized movie called ClinCheck depicts the movement of the teeth from the beginning to the final teeth-straightening stage. After the dentist or orthodontist approves the ClinCheck via the Internet, a series of plastic aligners is made. Each aligner differs slightly, moving the teeth slowly until they are straight. Each aligner is worn for about two weeks.

Invisalign was started in 1997 and Bailey said it is becoming more popular among dentists and orthodontists, thanks to better technology and constant improvements. More than 70 percent of orthodontists in the United States are certified to use Invisalign.

“I work really hard to be on the cutting edge of technology,” Bailey said.

Each doctor has their own guidelines regarding which patients could use Invisalign rather than braces. Bailey said she can treat almost any case with Invisalign, even if that means using braces for a short time and primarily Invisalign to straighten teeth.

Dr. Steve Colby, orthodontist at Brainerd Dental Specialists, has treated about 170 patients with Invisalign and said the primary criteria for using it is that patients must have all of their adult teeth fully erupted, except wisdom teeth. Colby said cases are individually evaluated to determine what is the most appropriate and efficient way to straighten their teeth.

“It won’t take the place of braces,” Colby said. “But Invisalign can be a wonderful option.”

Colby expects his patients to wear their aligners 22 hours a day, except when eating, drinking or brushing their teeth. For teenagers especially Colby said he takes things on a case-by-case basis.

“I emphasize the importance of compliance and recommend braces for cases where I believe cooperation will be an issue,” Colby said.

Bailey agrees. She doesn’t recommend smokers use Invisalign because the aligner can become discolored.

“Smoking will stain retainers,” she said. “And there goes your whole invisible braces (concept).”

Because there are no bands or wires and the alignDr. Jill Bailey, general dentist at Smile Design Orthodontics in Staples, checked the ers can be removed to brush and floss teeth, Colby progress of patient Becca Nordell’s teeth after using Invisalign. Following 10 months said Invisalign makes oral hygiene easier. Not to menof use, Invisalign straightened Nordell’s crowded teeth. tion it is more comfortable for patients to wear.

“The amount of force and sensation of moving Invisalign creates a way to straighten teeth using clear plastic teeth is a lot less,” Bailey said, explaining with braces patients aligners, making the treatment almost invisible for people to feel instant tightness after getting them adjusted while see.

Invisalign’s aligners gradually put pressure on teeth to move.

“I didn’t want to have metal on my face for senior pictures and For dentists and orthodontists to become certified Invisalign thought this would be easier,” said Becca Nordell, 17, of Staples. providers they must attend a training class where they learn to Invisalign provides the same result as braces in the same use the Invisalign software. amount of time, but costs a little more. Dr. Jill Bailey, general “Patients absolutely love it,” Bailey said. “They’re proud to tell dentist at Smile Design Orthodontics in Staples, said on average people they’re using Invisalign.”

Invisalign costs $800 to $1,000 more than braces, and is usually

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Studying abnormalities on chromosome 15 also has led scientists to the genetic origin of one form of autism, long sought by researchers. While genetic causes of most forms of autism remain elusive, Angelman gave scientists a view about how such links might work.

As many as 3 percent of people with autism also have an Angelman deletion, but with this twist: They carry an extra chromosome 15, according to Dr. N. Carolyn Schanen, a geneticist at the University of Delaware.

Like most children with autism, but unlike Angelman kids, these particular autistic children often form unusual attachments to objects and can be socially aloof. However, compared with others with autism, these children “are more puppy-like in their behavior, and they sometimes lick you,” Schanen said.

“This research might be broadened to help understand the molecular underpinnings of autism,” she said.

The study of Angelman syndrome also has produced valuable leads into the study of epilepsy, a much more common disorder.

In a significant subset of Angelman cases, a key neurotransmitter system in

Better get a

the brain known as GABA is abnormal, said Dr. Edward Novotny, a pediatric neurologist at Yale University School of Medicine. People with this form of Angelman are especially prone to seizures — 1,500 a day in one of Novotny’s patients.

Novotny is using imaging studies to try to figure out just what is happening in the

enclosed bed to protect her.

The genetic defect set off a chain reaction of events during Nicole’s early childhood development that would be difficult if not impossible to undo.

“That would be a realistic assessment,” said Dr. Robert Greenstein, professor of pediatrics in the division of human genetics at the University of Connecticut Health Center and Connecticut Children’s “If we can contribute in Medical Center. any way to the advanceBut that hasn’t stopped the Clavettes enrolling Nicole in at least three diffrom ment of science when it ferent scientific studies involving comes to this, we’ll do it. If Angelman.

The studies help them understand the it can help somebody else, strange world she inhabits, her parents it’s worth it.” say.

“If we can contribute in any way to the - Mark Clavette advancement of science when it comes to brains of these patients. The knowledge this, we’ll do it,” Mark Clavette said. “If it may one day help doctors find the best can help somebody else, it’s worth it.”

And scientists investigating rare disway to treat different forms of epilepsy, eases believe the research one day will including the one found in Angelman.

Donna and Mark Clavette know that help, Greenstein said.

“Even though it may be an esoteric disresearch is unlikely to significantly improve their daughter’s life. Nicole, now ease,” he said, “when we learn the genetic 15, isn’t able to speak, although she smiles keys to an illness, it will lead to better and engages with her family members. diagnosis and treatment down the line.”

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Aligners replace braces in quest for metal-free mouth

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Story/Mary Battiata Photos/Carol Guzy Washington Post

Amy Newhall, of Owings Mills, Md., with her pug, Stanley, 10, who recently lost an eye. People are now willing to invest in a pet having health problems.

Owners do what it takes to keep pets healthy WASHINGTON — The blood-pressure reading was fine, and now the veterinary anesthesiologist picked up an electric hair clipper to clear a patch of fur from my dog’s foreleg. This was too much. Stoic through patient intake and the tightening of the blood-pressure cuff, he now turned his head toward the whirr and chick of the blades and began to quaver in a way I’d never seen.

“He’s probably just picking up on your anxiety,” the vet tech said. I nodded and tried harder to act like a $1,400 veterinary brain scan was no big deal.

But the dog knew better, and so did I. Looking down at my boon companion for more than half of my adult life, I thought, “I hope this is the right thing to be doing.”

My most recent experience with major veterinary care had been way back in the ’70s, when 10 was old for many dog breeds, and visits to the vet with the family dog never involved anything more complicated than a rabies shot or a worming pill.

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Now, we were uneasy pilgrims in a strange new world, where we never seemed to get out of the clinic for less than $250 and our first real sick visit cost $900, more than I’d ever spent on one doctor visit for myself.

Bear was a 14-year-old mutt who looked a lot like a black Labrador, until you stood him next to one. His symptoms were mysterious; the diagnosis was elusive. He was sluggish; he had fevers and loss of sensation in his paws. The regular vet diagnosed a thyroid condition, but beyond that, he was stumped. He sent us to a veterinary neurologist, who, suspecting a brain tumor, had sent us here to the Washington area’s only commercial veterinary MRI facility — the Iams Pet Imaging Center in suburban Vienna, Va. It was hard to get appointments here — specialists like veterinary neurologists were in such demand that veterinary schools were having trouble keeping enough on hand to teach.

“Believe me,” the center’s senior veteri-

narian, Pat Gavin, had told me, “if George W. Bush were getting an MRI, he wouldn’t be any better monitored than the animals at this facility.”

I’d had trouble wrapping my brain around the idea. Others concurred.

“An MRI for a dog?” said an acquaintance. “You’re kidding, right?” She shook her head. “The old-fashioned kind of vet,” she said firmly. “That’s what you want.”

What did that mean, anyway? True, I’d always been a fan of the old-fashioned approach, enshrined in books like James Herriot’s “All Creatures Great and Small,” where the vet is kindly and competent and does things the old-fashioned way. In principle, at least, I was as irritated as anyone by the unceasing, often pointless-seeming innovation of modern American consumer life, the incessant alarms about the dangers of this toxin or that. Part of the appeal of having a dog had always been the connection it seemed to offer to a simpler way of life.

And now we were in the middle of a

Invisalign uses clear plastic aligners to gradually straighten teeth, without the shiny silver look of braces. Aligners should be taken out to eat and drink, and are replaced every two weeks.

Story/Heidi Lake Photos/Nels Norquist

The days of being taunted with The age of invisible orthodontics is names such as “brace face” and “metal here. People who want to straighten mouth” could be over for some teeth- their teeth, but aren’t a fan of the metal straightening candidates. mouth look, there’s hope.

5

From the editor Thinking back to my junior high days, three things come to mind: poofy hair, huge glasses and a mouthful of braces.

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The hair and glasses may have been a fad, but to this day I still see people with a mouth full of tin. Who knew there was a teeth-straightening alternative to braces? Check out the story on Invisalign, and find out if you can straighten your teeth without having a “metal mouth.”

This fall issue of HealthWatch covers a variety of topics, including local families struggling with tick diseases, a professional’s ideas on teenage behavior and a disease profile on polio and postpolio syndrome.

As always, your story ideas are welcome. Is there a disease or procedure out there you are curious about? Let me know by e-mailing heidi.lake@brainerddispatch.com.

Heidi Lake, Editor

Table of contents 5 26 28 10 14 30 19 32 36 22 24 COVER STORY: Invisalign

INNOVATION: Improved bandages

TICKS: And the diseases they carry

MUSCLE MATTERS: Baby yoga

RUN FOR A REASON: Sudden Unexplained Death in Childhood

PAST AND PRESENT: Polio and postpolio

HEART HEALTH: Fish can be good for you

DISEASE: Angelman syndrome

TOOTHBRUSHES: Electric vs. manual

PET HEALTH: Health care for animals

$1,400 brain scan. And if there was a brain tumor? How I would know how much medical treatment was right and how much was too much? How much could I afford? Already we were flying on credit cards.

Until the 1940s, veterinary medicine was devoted to helping agriculture manage its food animals, with a creed of helping society by helping animals (as opposed to helping animals themselves). Until the 1960s, most vet students were men with a background in farming or animal science.

During the suburbanization of the 1950s, practices began to proliferate, but cats and dogs still spent much of their time outside. As recently as the late 1980s, most owners treated their pets as second-class citizens.

Veterinary practices reflected this lowly status. Even now most veterinarians carry little or no malpractice insurance, because until very recently it was impossible for a pet owner suing over loss of a pet to recover anything more than its replacement value. The bigger part of the vet’s week was spent administering vaccines and fixing the broken bones that were common before leash laws. When the

problems became difficult or expensive to fix, the animal was euthanized.

“One of the most discouraging parts of my practice in the early days was having a dog come in with a simple broken leg and having the owner say, ’Well, it costs money and it’s just a dog, so put him to sleep,’ ” says Walther.

In the late ’80s, however, pets began to fill the emotional and physical void created by rising divorce rates and growing numbers of single-person and childless households. And from 1987 to 2000, the life spans of the average dog and cat increased by more than one-third, thanks to better commercial pet foods and widespread vaccination, according to the AVMA. But that longevity meant a jump in the incidence of the diseases of old age: cancers, organ failure, crippling arthritis. With the family pet now ensconced on the bed instead of the yard, medical problems were easier to spot and harder to ignore.

Today, many people think of their pets as family members, and they want them to have access to the same medical technology they do, vets say. And this is possible, thanks to the same biomedical revolution

that transformed human medicine in the 1950s and ’60s. According to the FDA, which regulates drugs for the veterinary market, the pharmaceutical industry has begun shifting its energies away from the agricultural market and toward companion animals. The number of new drugs approved for veterinary use has increased dramatically in the past decade, with special interest in drugs for behavior modification and pain relief.

The focus on pain medication is particularly significant. Until very recently, desensitizing veterinary students to animal pain was an important part of their education. “When I went to vet school back in the Stone Age, we didn’t really talk about pain,” says Stephen Sundlof, director of the FDA’s Center for Veterinary Medicine. “It was, ’Do the surgery, and the animals will get along fine.’ ” This gradual and ongoing “evolution in consciousness,” says Elliott Katz, a veterinarian and founder of the advocacy group In Defense of Animals, has been spurred by the entrance of large numbers of women to the profession in the past 15 years, and by the demands of pet owners, whose economic clout is becoming a

PSYCHOLOGY: Teenage behavior

Who we are Publisher — Terry McCollough Advertising Director — Mary Panzer Editor — Heidi Lake Graphic Designer — Cindy Spilman

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counterweight to the agribusiness interests that have traditionally underwritten much veterinary research at universities.

All this has put new pressure on the ordinary clinic. Vets, who 30 years ago needed little more than a stethoscope and an Army surplus field X-ray machine to set up a practice, now equip their clinics with an array of expensive diagnostic equipment, from blood-analysis machines to ultrasound scanners. Setting up a small practice costs upward of $500,000.

The average veterinary bill, which has tripled in the past 10 years, reflects this. It’s the direct result of a half-million-dollar study commissioned by the leading veterinary professional organizations in 1998 to figure out why veterinarians’ salaries were lagging. The study cited federal statistics showing that veterinary practice incomes had declined during the 1990s, when many other professional incomes rose, and the profession set up a national commission to encourage vets to concentrate harder on the bottom line.

These days, veterinary school graduates enter a profession more focused on management economics than ever before, and one in which ethical questions are beginning to surface. Veterinary malpractice cases, once rare, are on the rise. State courts have begun awarding aggrieved pet owners sums as high as $30,000 for pain and emotional suffering.

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Ear, nose and throat, to maxillofacial procedures, to orthopedics. It’s all right here.

Invisible braces

Goodbye to metal mouths Page 5 Where patients come first.

Brainerd, MN • www.sjmcmn.org

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County health

Thick with diseased ticks Page 10

September/October 2004 2004 September/October