HealthWatch - Spring 2012 Issue

*ANUARY

"AXTER MOM LOSES POUNDS

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Table of Contents 16 18 21 22 24 27 28 30

Joint Wellness Program gives knee replacement patients a renewed sense of youth

Your home’s age important for child lead exposure

ESSENTIA HEALTH-ST. JOSEPH’S MEDICAL CENTER

FDA steps up testing for fungicide in orange juice

ASSOCIATED PRESS

ASSOCIATED PRESS

Stronger and healthier than ever

New Year’s baby born at Lakewood Health System Exercise-related hormone may help obesity

ASSOCIATED PRESS

Ohio parents admit denying ailing son medical care

ASSOCIATED PRESS

More N.D. anti-tobacco spending means less smoking

Study finds no better odds using 3 embryos in IVF ASSOCIATED PRESS

Physician, heal my medical bills

LAKEWOOD HEALTH SYSTEMS,STAPLES

Tiniest babies are growing healthy despite odds

JODIE TWEED

Websites makes weight loss wagering easy

ASSOCIATED PRESS

Low risk of heart incidents found for marathoners

ASSOCIATED PRESS

Outsmarting the snack attack

ASSOCIATED PRESS

Medical Home: The Quiet Revolution

ASSOCIATED PRESS

Gluten-free living: A Baxter mom loses 75 pounds by changing her diet

JENNY HOLMES

ASSOCIATED PRESS

‘Jack’s Pledge’ aims to lower hockey risks ASSOCIATED PRESS

SHEILA HELMBERGER

Firm previews painkiller, abuse experts worried ASSOCIATED PRESS

On the cover Who we are Publisher- Tim Bogenschutz Advertising- Sam Swanson Editor- Sarah Nelson Katzenberger

*ANUARY

"AXTER MOM LOSES POUNDS

Genesis Sparks (right) and her daughter, Vayda, demonstrated their gluten free lifestyle in the kitchen of their Baxter home.

HealthWatch is a quarterly publication of the Brainerd Dispatch.

Read HealthWatch online at www.brainerddispatch.com

For advertising opportunities call Sam Swanson at (218) 855-5841.

Email your comments to sarah. nelsonkatzenberger@brainerddispatch.com or write to: Sarah Nelson Katzenberger Brainerd Dispatch P.O. Box 974 Brainerd, MN 56401

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Essentia HealthSt. Joseph’s Medical Center’s Joint Wellness Program gives knee replacement patients a renewed sense of youth

Linda and Corky Crimmins of Pequot Lakes enjoy the sun in Spain during a cruise they took just three months after Corky had his second knee replacement surgery at Essentia Health-St. Joseph’s Medical Center in Brainerd. Corky used treadmills on the cruise ship to continue the rehabilitation he began in the hospital’s Joint Wellness Camp. He had no problem traversing Europe’s cobblestone streets or climbing the Acropolis in Athens.

Corky Crimmins isn’t shy about sharing his age.

“I’m 59,” said the Pequot Lakes resident.

“Well, I’m mostly 59 but some parts of me are younger.”

That’s how Crimmins described two successful knee replacements at Essentia Health-St. Joseph’s Medical Center by Dr. Christopher Metz of Northern Orthopedics.

“Dr. Metz fixed me so my wife, Linda, wouldn’t kill me,’’ Crimmins joked, explaining that knee pain had severely limited his activities. He struggled to get through the day as postmaster in Hackensack, Minn. At night, he’d wake in pain. He’d gone through a long line of over-the-counter and prescription medications as well as a knee brace before choosing surgery.

Crimmins’ right knee was replaced in March 2008 and his left in January 2009. Three months after the second surgery, the couple went on a cruise and traversed cobblestone streets across Europe. In January 2010, they cruised around the world and visited 40 cities.

“These knees have been around the world, and they’re real good knees,” said Crimmins, who credits the surgeries and the hospital’s Joint

Wellness Program with returning him to an active lifestyle. The program recently received the Gold Seal of Approval from the Joint Commission, a national health care accreditation organization.

The Joint Wellness Program offers a three-day post-surgery care “camp” for people who have knees and hips replaced at St. Joseph’s Medical Center. Patients share meals and attend therapy and classes together. Spouses and family members are trained as recovery coaches.

An interdisciplinary team of doctors, nurses and therapists staff the camp. “You’re anxious, but they get you through,” Crimmins recalled.

“They inspire you and they’re there with you every step of the way.”

Linda Crimmins said the program helped her understand not only the surgery but how to best support her husband. Her biggest concern was how she’d care for him at home. “I didn’t know what I’d do with him once he got out of the hospital but this program showed me and gave me confidence,” she recalled.

Dr. Christopher Metz, an orthopedic surgeon with Northern Orthomedics, said camaraderie develops among patients at camp: “They know they’re not alone. They know their pain is the

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same. They encourage one another.”

One of the best parts of camp happens a month after surgery, when patients and their caregivers return for a reunion luncheon. “They bonded with their campmates and staff and enjoy being able to see each other again and celebrate their recovery,” Metz explained.

Three years after surgery, Crimmins has retired but he isn’t sitting in his recliner holding a remote control. Joint Wellness Camp taught him the importance of exercise for his recovery and his overall health. Now he walks five miles a day, enjoys outdoor activities and travels regularly.

“It would be such a shame for me to sit at home and waste all the work they’ve done,” he said.

“Corky has gained his life back due to Dr. Metz and the care given to him by the staff at the Joint Wellness Camp,’’ Linda Crimmins said. “We owe them our happiness.”

In 2011, the Joint Camp at Essentia HealthSt. Joseph’s Medical Center in cooperation with Northern Orthopedics changed the lives of more than 500 Brainerd Lakes Area residents with elective hip and knee replacement surgeries; enabling them to live the quality of life that the Brainerd Lakes Area offers and beyond.

Jack’s pledge aims to make prep hockey safer in Minnesota MINNEAPOLIS (AP) — Youth hockey leaders in Minnesota are asking players and coaches to take a safety pledge to prevent the kind of life-changing injuries that have left two prep players in the state paralyzed in as many weeks.

The Minneapolis Storm youth hockey association launched a website Wednesday night encouraging players of all ages across the state and country — even college and NHL players — to sign “Jack’s Pledge.” It’s a commitment to playing safe in tribute to 16-year-old Jack Jablonski, who was checked from behind into the boards Dec. 30.

“I play to win by following the rules. I do not play to win by any other means. I take the body to take the puck. I do not hit to hurt. I do not board.

I do not cross-check. I do not check from behind. Ever,” the pledge reads in part.

Coaches are encouraged to take a similar pledge to teach safe play, including keeping players who have committed violent infractions off the ice longer than they’re required to sit in the penalty box.

While Jack’s Pledge is a grass-roots effort without enforcement measures, the Star Tribune reported Thursday (http://bit.ly/AdWbwf ) that organizers hope to spark a change in hockey culture, especially among the more than 60,000 youth, high school and adult league players in Minnesota. The Minneapolis Storm will provide helmet stickers reading “Jack Jablonski — In Our Hearts,” for players whose coaches or association leaders register on the site.

The Jablonski family is “driving a mission to change the way that hockey is played by eliminating the violence, especially in the youth game,” association President Paul Larson said.

In addition to the pledges, the association proposes that coaches observe a new informal “Rule 13” by keeping players called for dangerous penalties — including checking from behind, boarding, cross-checking into boards and head contact — out of the game for twice the time required by the penalty.

The proposal also says checking-from-behind penalties should be reported and tracked by associations, and that consequences imposed by the associations should increase dramatically for repeat offenders.

Larson said injuries are rising at the youth level as coaches desiring to win put more emphasis on a physical style of play instead of teaching other hockey skills.

Jablonski, who played for Benilde-St. Margaret’s, remains at Hennepin County Medical Center, where doctors have said he dislocated his spine and suffered several fractures and significant ligament disruptions, making it very unlikely that he would regain the use of his hands or walk again. However, he has since moved both arms more than initially thought possible.

In the same hospital, Jenna Privette, 18, of St. Croix Lutheran High School, lost feeling in her legs when she was checked into the boards from behind Jan. 6 but can move her tingling arms. Her mother, Penny Privette, said her daughter suffered a similar spine injury in 2008 and it took several months to recover, with feeling coming back in stages. She said doctors have likened the injury to a concussion of the spine.

Mike Jablonski, Jack’s father, said his family supports the pledge.

“We want the finesse back in the game,” he said.

Joint replacement program earns Gold Seal certification The hip and knee replacement program at Essentia Health-St. Joseph’s Medical Center in Brainerd has earned a prestigious national certification.

The Joint Wellness Program, which partners with physicians at Northern Orthopedics, received the Gold Seal of Approval from the Joint Commission. It is the second program in Minnesota to achieve the designation for its quality and patient outcomes.

The unique program begins working with patients and their caregivers even before surgery through a class that explains the procedure and what to expect in recovery. The hospital’s three-day post-surgery camp offers group and one-on-one sessions for patients while training caregivers as recovery coaches.

To earn the Joint Commission’s Gold Seal of Approval, St. Joseph’s Medical Center underwent a rigorous on-site survey in October. The surveyor evaluated the hip and knee replacement program’s compliance with standards of care for patients and families, including infection prevention, medication management and leadership. The certification program also evaluates compliance with national standards of care, effective use of evidence-based guidelines and an organized approach to measuring performance and improvement.

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FDA steps up testing for fungicide in orange juice WASHINGTON (AP) — The Food and Drug Administration says it will step up testing for a fungicide that has been found in low levels in orange juice.

FDA officials said they aren’t concerned about the safety of the juice but will increase testing to make sure the contamination isn’t a problem. In a letter to the juice industry Monday, the agency said that an unnamed juice company contacted FDA in late December and said it had detected low levels of the fungicide carbendazim in the company’s own orange juice and also in its competitors’ juice.

Fungicides are used to control fungi or fungal spores in agriculture.

Orange juice futures surged nearly 11 percent on Tuesday, gaining 20 cents to close at about $2.08 cents a pound. Investors are concerned that increased testing could pinch juice supplies.

TransWorld Futures analyst Robert Rutger said the supply questions were enough to send prices higher, even though current inventories are relatively healthy.

Carbendazim is not currently approved for use on citrus in the U.S., but is used in Brazil, which exports orange juice to the United States. Brazil is the biggest producer of oranges in the world, according to the Agriculture Department.

Top orange juice brands in the U.S. include PepsiCo’s Tropicana and Minute Maid, marketed by The Coca-Cola Co. An FDA spokeswoman said the company’s testing found levels up to 35 parts per billion of the fungicide, far below the European Union’s maximum residue level of 200 parts per billion.

The U.S. has not established a maximum residue level for carbendazim in oranges.

In the letter to the Juice Products Association, FDA official Nega Beru said the agency will begin testing shipments of orange juice at the border and will detain any that contain traces of the chemical.

Because it is not approved for use in this country, any amount found in food is illegal.

Beru said that because the FDA doesn’t believe the levels of residue are harmful, and the agency won’t remove any juice currently on store shelves.

But he asked the industry to ensure that suppliers in Brazil and elsewhere stop using the fungicide.

“If the agency identifies orange juice with carbendazim at levels that present a public health risk, it will alert the public and take the necessary action to ensure that the product is removed from the market,” he said.

The discovery comes after the agency said it would also step up testing for arsenic in apple juice. FDA officials said last year that the agency is considering tightening restrictions for the levels of arsenic allowed in the juice after consumer groups pushed the agency to crack down on the contaminant.

Studies show that apple juice has generally low levels of arsenic, and the government says it is safe to drink. But consumer advocates say the FDA is allowing too much of the chemical — which is sometimes natural, sometimes man made — into apple juices favored by thirsty kids.

Patty Lovera of the consumer group Food and Water Watch said the federal government needs to rely on its own testing, not that of the companies.

“The federal government needs to set consistent, meaningful, enforceable standards for all toxins,” she said.

New Year’s baby born at Lakewood Health System Twenty-twelve brings the celebration of birth for Todd and Amanda Hillukka of Pelican Rapids, who welcomed their new baby boy, Traven Isaiah into the world on January 1.

The first baby of the New Year at Lakewood Health System, Traven was born at 12:28 p.m. and weighed in at 7 pounds, 4 ounces and measured 20 and a half inches.

Delivering physician, Dr. Julie Benson was assisted by Registered Nurse Kendall Roline.

To celebrate Traven Isaiah’s birth, the Lakewood Health System Auxiliary and Piece

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Makers Quilting Club presented gifts to the family in honor of the New Year. The Auxiliary gave a gift of $50, presented

by Marilyn Wilson of Staples.

Representing the Piece Makers Quilting Club, Missie Daniels gave a beautiful handmade baby quilt, prepared months in advance just for the 2012 New Year’s baby. The Auxiliary and Piece Makers Quilting Club annually present gifts to the family of the New Year’s baby at Lakewood Health System.

Traven joins big sister Alexis and brother Levi, who were also delivered by Dr. Benson.

All patients who give birth at Lakewood Health System are showered with free gifts, including a candlelight dinner, a relaxing massage, an infant car seat, a CD of baby photos, a diaper bag with supplies, a tote bag, a complimentary home visit by the expectations team and a choice between a case of diapers, a Boppy breastfeeding pillow, and a spa basket.

Along with the gifts, Lakewood strives to give our customers and patients exceptional service, by giving them their experience surrounding the birth of their child.

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Exercise-related hormone may help obesity, Harvard study says NEW YORK (Bloomberg News) — A hormone naturally found in muscle cells that triggers the calorie-burning benefits of exercise, may have potential as an obesity drug, according to Harvard University scientists.

The researchers found that the hormone, called irisin, rises during exercise, converting white fat into brown fat, a substance whose primary function is to generate body heat, according to a study published Wednesday in the journal Nature. When they injected irisin into obese, pre-diabetic mice, the animals lost weight and their blood sugar levels improved.

The research may lead to treatments for obesity and diabetes, as well as other disorders where exercise may benefit patients who are too weak to engage in it, said study author Bruce Spiegelman, a cell biologist at the Dana Farber Cancer Institute and a professor at Harvard Medical School. The compound has been licensed by Boston-based Ember Therapeutics Inc., a closely held company co-founded by Spiegelman.

“We’re not trying to replace diet and exercise,” Spiegelman said in a telephone interview. “That’s still important.” Irisin may amplify the effects of eating well and working out, he said. Also, irisin won’t build muscles, because it doesn’t appear to make them stronger, Spiegelman said.

Ember Therapeutics is meeting with potential pharmaceutical partners at the J.P. Morgan Healthcare

Conference in San Francisco, said Chief Executive Officer Louis Tartaglia. A version of irisin may be tested in humans as soon as two years from now, he said in a telephone interview.

While it’s still too soon to consider a sale or a public offering, the company is interested in developing partnerships with companies that are also doing work on brown fat, Tartaglia said. He declined to say which.

“We are in fact seeing quite a lot of major pharma companies and have been approached by quite a number, and have been in discussions to see what deal structure makes sense for us,” he said. “Perhaps there will be a partner in the future to develop a broad relationship in brown fat.”

Researchers began their study with a notion that something must increase energy expenditure in addition to exercise in tissues besides muscles. They found the hormone in mice and in human muscles from people who’d been engaging in endurance exercise.

Irisin appears to make white fat, which stores energy, behave more like brown fat, which burns energy and was thought to be found only in babies until 2009, said C. Ronald Kahn, an endocrinologist at the Joslin Diabetes Center in Boston. Kahn, who was involved in one of three research groups that showed brown fat is found in adults, wasn’t involved in Wednesday’s study.

As part of the study, the researchers dosed obese

mice on a high-fat diet with irisin. Within 10 days, the mice had better blood sugar levels and lost a small amount of weight. There were no signs of toxicity or side-effects, the study found.

“There’s considerable interest in trying to find different ways to stimulate brown fat itself or the browning of white fat,” said Kahn, who is also a professor at Harvard Medical School and a co-founder of Ember, in a telephone interview. “We really have very few and limited tools to address the epidemic of obesity, which is driving the epidemic of type 2 diabetes, and almost no tools to help increase energy expenditure.”

Though the study looks interesting, cold exposure is a better way to increase brown fat and can be achieved with less effort than exercising, said Leslie Kozak, a researcher at the Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences in Olszyn, who has worked with brown fat in mice.

“It will be interesting to see if a drug can emerge from this,” he wrote in an emailed statement.

Ember Therapeutics is also looking at ways of making the hormone more effective and allowing it to stay in the blood longer, Tartaglia said. The company didn’t sponsor Wednesday’s study. Ember Therapeutics, formed by Third Rock Ventures, was launched last December with startup funds of $34 million.

Ohio parents admit denying ailing son medical care CLEVELAND (AP) — The parents of an 8-year-old boy who died from Hodgkin lymphoma after suffering for months from undiagnosed swollen glands have pleaded guilty to denying him medical treatment.

Monica Hussing, 37, and William Robinson Sr., 40, both of Cleveland, face up to eight years in prison at sentencing.

They pleaded guilty Monday to attempted involuntary manslaughter in a last-minute plea deal before their trial was about to begin.

Willie Robinson collapsed at his home on March 22, 2008. Prosecutors say he had begged his parents to take him to see a doctor but was rejected. Hodgkin lymphoma is a highly treatable cancer.

Hussing’s attorney, John Luskin, said his client took responsibility in the case but, given her education and background, didn’t realize the boy was seriously ill and was treating him with cold medication.

“She is a mother that just did not have the capability to recognize” cancer, Luskin said Wednesday.

Robinson’s lawyer, Thomas Rein, called it a “sad, horrific case” that drew him inquiries from the White House as

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changes to federal health care law were being considered in 2009.

“Had he had regular health coverage, it possibly could have prevented this,” Rein said of the boy’s death.

Luskin and Rein said the parents had financial problems and tried to get checkups for their children but couldn’t afford it.

Hussing’s daughter, Lillian Hussing, said the family didn’t have money for medical care when they lived in Warren, tried repeatedly to get help from social services and visited a free clinic but left when told they would have to pay $180.

“We did not know it was cancer,” she said. “We tried and tried to get help and were denied every time,” said the daughter, who’s 18.

The family soon moved to Cleveland and the boy died within weeks.

Prosecutors say that while the boy was suffering, the parents claimed financial hardship but paid $87 to have a pit bull treated for fleas. Luskin said the dog belonged to Hussing’s parents and her parents paid for the treatment.

Trumbull County Children Services says it had worked with the family to pro-

vide Willie health care, getting involved after receiving a phone call in July 2007.

Agency officials said a case worker visited the family at least monthly and pushed the parents to have a medical follow-up on his swollen neck but they didn’t.

However, Rein said a social worker who visited the family in January 2008 “indicated the kids were healthy and happy.” He said no one knew the boy had cancer until he died and an autopsy was performed.

And Lillian Hussing said a case worker had told the family the boy’s lump looked like a swollen gland and to hold off until they could secure financial assistance before getting it checked.

About two weeks after they moved to Cleveland, she said, her brother came down with something. Her mother treated him with cold medicine and he died within three days.

She said the boy never complained about his neck.

“He played, he went outside, he wrestled, he played video games,” the boy’s sister said. “He was the happiest kid you could imagine. It never seemed like he was suffering.”

The emotional aftermath from their son’s death led the couple to split, according to Luskin.

The couple’s four other children under 18 were placed in the custody of a family member. Luskin said the daughter, upon turning 18, decided to return to live with her mother.

Rein said Robinson agreed to plead guilty so his children could be spared any further grief and wouldn’t have to suffer by testifying. Lillian Hussing said her mother took a plea bargain because of the uncertainty of a trial and fear she could be sent to prison for a long time.

As part of the deal, the prosecution agreed to drop four counts each against each parent, including child endangering. Prosecutors didn’t agree to a sentence recommendation. Both Luskin and Rein said they hope the judge will consider probation.

“There’s not a day my client ... starts without shedding a tear for his son,” Rein said.

The coroner ruled that the boy was a victim of medical neglect and died from pneumonia due to Hodgkin lymphoma.

More N.D. antitobacco spending means less smoking BISMARCK, N.D. (AP) — The director of North Dakota’s tobacco control agency says increased spending on anti-tobacco efforts has resulted in less smoking among adults and young people.

North Dakota lawmakers say the rate of decline has been slow, and Jeanne Prom says the adult smoking rate is “not very impressive.”

Prom briefed legislators Tuesday on the agency’s anti-tobacco spending.

In the last two years, 42 public and private schools and five colleges have adopted tobacco-free policies. Five cities have approved comprehensive smoking bans in buildings.

Prom says the youth smoking rate has dropped from 21.1 percent to 19.4 percent among young people since 2007. For adults it has declined from 18.1 percent to 17.4 percent in three years.

Prom says she wants to see those figures in the low single digits.

AP Photo

Jeanne Prom, director of the North Dakota Center for Tobacco Prevention and Control Policy, spoke, to a meeting of the North Dakota Legislature’s interim Health Services Committee at the North Dakota state Capitol in Bismarck, N.D. Prom said increased spending on tobacco control in North Dakota has resulted in declines in smoking rates, but they are still higher than health officials would like.

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Glutenfree living A Baxter mom loses 75 pounds by changing her diet

By JODIE TWEED | STAFF WRITER

B

AXTER — A year ago Genesis Sparks made a decision that has changed her life.

Sparks, a 32-year-old Baxter mother of two, felt terrible after her son, Cavan, was born in April 2010. She had constant stomachaches, fatigue and headaches and started researching her symptoms online. She had gained 100 pounds during her pregnancy, just as she had when she had her daughter, Vayda, now 5. It was a strange thing, since she didn’t eat any differently during her pregnancy. It took her two years to lose the weight she gained during her pregnancy with Vayda.

She read about how some people are sensitive to gluten, the protein in grains that create dough, and she thought that might be what was happening to her. So Sparks decided to try a traditional gluten-free diet in November 2010, eating products like breads and Brainerd Dispatch/Steve Kohls

Vayda and her mom, Genesis Sparks, baked gluten-free in their Baxter home. Sparks said eating gluten-free means making more homemade meals but the benefits are worth it for those who have a gluten intolerance.

Brainerd Dispatch/Steve Kohls

Genesis Sparks, Baxter, discussed her journey toward gluten-free living.

The experience not only made her lose 75 pounds, but made her feel better and more energetic.

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pastas that are labeled gluten-free and was starting to feel better.

She was given a blood test and a biopsy of the intestine to test for celiac disease, an autoimmune disorder caused by a reaction in the small intestines to gluten proteins, but the tests came back negative.

Sparks went off her gluten-free diet in December 2010 and felt even worse and lethargic.

“I immediately felt like I was going to die,” she said. “I could barely get off the couch.”

Another biopsy for celiac disease came back negative. She was diagnosed with fibromyalgia and arthritis and ended up with psoriasis and eczema after she had her son. She began breaking out with blisters on her hands and losing her fingernails because of the blisters underneath her nails. She even started having memory problems.

One of her doctors told her that she without a doubt had symp-

“My goal wasn’t to lose weight but the pounds were falling off” ...“It’s not as hard as you think. I just wanted to feel good. I was 30 and felt like I was 80.”

-Genesis Sparks toms of celiac disease but the tests were negative. Sparks said she has read online that the tests aren’t always accurate and that there is gluten in some products that are labeled gluten-free. So in January 2011, Sparks decided it was time to take back her life.

She quit eating corn, wheat, barley, oats, rye and rice. She decided to eat more of a Paleo-type diet, which includes mostly meats, fruits and vegetables. Her daughter also was showing signs of a gluten intolerance so she also went gluten-free.

“It was really hard,” Sparks said of last January’s gluten-free New Year’s Resolution. “I almost went through a carb withdrawal. But I immediately started feeling better and better.”

That first month she lost 20 pounds just by cutting out gluten.

By the end of December 2011, she had lost 75 pounds. She hasn’t done any exercising, other than playing with and chasing her children. Her New Year’s Resolution this year is to start to working out.

“My goal wasn’t to lose weight but the pounds were falling off,” said Sparks. “It’s not as hard as you think. I just wanted to feel

CONTINUED ON PAGE 12

Brainerd Dispatch/Steve Kohls

Genesis Sparks uses a lot of organic coconut oil in her cooking, as well as coconut flour and cocoa powder.

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Brainerd Dispatch/Steve Kohls

Genesis Sparks and her daughter, Vayda, sat at their Baxter home and talked about what it’s like to be gluten-free.

good. I was 30 and felt like I was 80.”

Sparks said her daughter had sinus problems for a year. When she was taken off gluten, those sinus problems disappeared, as well as some behavioral issues Sparks believes is related to a gluten sensitivity.

“Grains are really inflammatory,” said Sparks.

The Sparks family, including her husband Tim, eat and use a lot of coconut oil, which is supposed to help raise your metabolism.

Their children get a teaspoon of it daily. She also started cooking with coconut flour and made a delicious chicken and dumpling soup using coconut flour recently, she said. She also makes her own homemade gluten-free dressings.

“It was really good,” said Sparks. “We’re just always kind of researching and trying new things.”

Vayda said she doesn’t mind eating glutenfree. It makes her feel better.

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“I get sores in my mouth,” Vayda said when she eats gluten.

Sparks always went dairy-free and the family likes to drink smoothies made with coconut milk, fresh berries and bananas. The family buys grassfed beef.

Sparks said she has accidentally consumed gluten and now, especially since she’s glutenfree, it really affects her health.

“You can pretty much bet you’re not going to feel good for a week,” said Sparks.

Sparks suggests to those who aren’t feeling well and suspect they may have a gluten intolerance try going gluten-free for a month and see how you feel. Then go back on gluten.

“If you feel sick right away, that’s your answer,” said Sparks. “Trust your body.”

Sparks said she isn’t an expert on the topic but she has done a lot of research. If anyone would like to email her with questions, she’d Brainerd Dispatch/Steve Kohls be happy to help if she can. Her email is gen- Vayda Olander-Sparks, the 5-year-old daughter of esisjoy@live.com.

Genesis Sparks in Baxter, enjoys cooking gluten-free with her mom.

Websites make weight-loss wagering easy NEW YORK (AP) — Neil Ylanan eats for a living and travels constantly as a food expert for a company that supplies in-flight meals to airlines. Toss in those sleepless, sluggish early years of fatherhood — he’s got three young kids — and he was dealing with significant weight gain.

Looking around his office in Irving, Texas, the 37-year-old Ylanan realized he wasn’t alone, so he rallied four of his fellow foodies at LSG Sky Chefs for a weight-loss competition online.

They named their team “All About the Benjamins,” in homage to the $10,000 top prize offered by Healthywage.com, one of at least a dozen diet betting sites to emerge after “The Biggest Loser” went on the air and the nation’s obesity epidemic grew worse.

Each of the Benjamins anted up $60 to lose more — up to a safe weekly maximum — than 30 or so teams from the same company and around the map. They had three months. Victory was theirs in October.

“At first we really were all about the Benjamins, but the impetus kind of changed. You didn’t want to let your teammates down,” said Ylanan, who at 5-foot-7 began the competition at 245 pounds and ended it at 196.

“I joined a gym. We’ve all picked up racquetball,” he said. “I haven’t played racquetball in 15 years.”

Research on whether financial incentives lead to weight loss is inconclusive, but that hasn’t kept thousands of people off diet betting sites since they began sprouting in 2004. Many of the sites experience dramatic hikes in traffic during the danger stretch between Thanksgiving and January.

“We think of New Year’s as our Black Friday,” said Victoria Fener, director of operations for Stickk.com.

Each site has its own rules and tools, like line graphs to track progress, regular emails with tips and support, and rankings to keep an eye on the competition. Stickk allows users to set their own stakes, including an “anticharity” donation to a hated cause. The George W. Bush Presidential Library and Americans United for Life are top recipients.

Most of the sites are free or require a small fee. Many make money betting optional to tackle weight loss and other health goals.

Regular weigh-ins are usually required, either through the honor system or a third-party source like a doctor or a health club. Privacy settings keep sensitive details hidden if desired but Facebook-esque walls provide that soughtafter share factor popular with players.

Seth Brown, 28, in Morgan Hill, Calif., got a jump in August on his New Year’s resolution to lose 62 pounds.

He had fallen into a routine of burritos, fast food and video games when he lost his job and moved back in with his parents. He put up $30 to compete against 14 strangers in a public individual challenge at Weightlosswars.com, where Dell, Google and Groupon have sponsored employees.

“I first set out to find a website that acted as sort of a social network for fat people,” Brown said. “I thrive in competitive situations and I loved the idea of competing with a group of people who are in the same boat I am.”

He was in the lead with six pounds to go heading into the final stretch. The top three contenders will win about $260 each when the challenge concludes Jan. 16.

Other people like their wagers the old-fashioned way, organized on their own among people they know for token sums, prizes or simple encouragement.

Around this time last year, Marietta, Ga., attorney Debbie Haughton was

facing down her 40th birthday. She joined a 12-week, 40-person pool organized by a friend. She put in $20, weighed in weekly on the honor system and lost about 10 pounds.

Small prizes, including workout DVDs and pedometers, were awarded along the way. Haughton won a few and went back for another 12-week round after the organizer decided to save up the money to dole out as cash at the end.

Haughton dropped about 18 pounds and walked away with $200. She’s at the tail end of a third challenge, this one running 16 weeks, and was about seven pounds from her goal weight heading into the holidays.

“I knew that a competition would stoke that fire for me, since I tend to be fairly driven,” she said. “I’m very toned and looking and feeling great. I’ve also become a runner for the first time in my life.”

Not all sites that provide tracking and social tools to achieve health goals use money as a motivator.

Alex Rainert is head of product for the location-based check-in service Foursquare. He tried to organize a get-healthier office contest himself using a

CONTINUED ON PAGE 15

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Outsmarting the Snack Attack Think twice about what you — and your kids — ­ are eating between meals

By SHEILA HELMBERGER | HEALTHWATCH CORRESPONDENT I’m not an expert on coercing kids to eat healthy. In fact, the truth is, I shudder to think of how much frozen pizza is eaten in my kitchen in a year. It’s not because I personally love it that much (although it is a weakness), but because my kids and their friends would much rather eat a piece of a $3 frozen pizza then a slab of choice beef from the local meat counter. My pocket book should probably thank them, but my conscience doesn’t.

The fact is our kids don’t only get their nutrition at mealtimes. Snacks are almost as important in their days as real meals are and finicky eaters will get most of their day’s nutrients from them. For that reason, even if it means being a little sneaky, the healthier the snacks we make available the better. There’s no real point in explaining all of the important reasons for eating well – like the fact that they’re still growing, what they eat contributes to their energy level and concentration and that they’re forming lifelong eating habits. It’s better to just make healthy food available and hope they’ll ‘bite’ on it.

Most parents know that our kids will choose foods that don’t take a lot of work. Simplicity is the name of the game. They’ll choose the quickest, easiest thing to nibble on, even if there are healthy choices available. If an apple needs coring or if an orange needs peeling it will probably just sit on the counter in favor of something that just needs unwrapping.

Choosing nutritional items sometimes means paying closer attention at the grocery store. Even though an item is labeled as being natural that

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doesn’t mean it’s nutritious. Sending the gang off with a handful of granola bars, something I actually do quite often, doesn’t mean it’s a good option. Some granola bars are a good source of nutrients but a closer look can be surprising.

Many are also filled with trans-fat and loads of sugar which mean high calories. Comparing labels can be an eye-opener.

Simple items like tortilla shells and yogurt are the basics to all kinds of wonderful concoctions. Adding any fruit to some frozen vanilla yogurt means an instant fruit smoothie or parfait.

Low-fat cheese, chicken, or even lettuce salad can become an easy, tasty and nutritious wrap.

Instead of microwave popcorn a bowl of popcorn popped by hand, old-fashioned style over the stove or with an electric popper, means total control of how much butter and salt are added.

Experimenting with different toppings like parmesan, garlic or cinnamon, offer an opportunity for variety.

A bowl of pre-cut vegetables and dip can be placed handily in the front of the refrigerator where it just might catch the eye. The most popular raw vegetables for kids are carrots, snap peas, celery and broccoli. They might not be a fan of all of them but chances are they’ll find one or two things they like.

Trail mix is another great snack that can be tailored to individual taste. Just start with a couple of different whole grain breakfast cereals and add a couple of different types of nuts, a variety of dried fruit, and if necessary, sweetening the deal with just a little a handful of choco-

late chips will add some appeal. A container of frozen grapes becomes a cool, refreshing treat.

Beverages can be tricky, too. We usually have a couple of different kinds of juice on hand, some water, and I know by the frequency of my trips to the grocer’s cooler that milk goes out of my home at about a gallon every two days. Other popular choices that are better than sugary sodas are low calorie natural juices, lemonades and teas.

Some of the popular foods that our kids like when they eat out can be even better if they’re made at home. There’s nothing wrong with sub sandwiches for a snack or for a family meal. If there are a variety of fresh ingredients offered kids are often happy to create their own masterpieces. Do they relish a trip to the local ice cream parlor? Banana splits can be made with sliced bananas, yogurt, low fat ice cream and some chopped peanut sprinkles.

One good thing about teaching our kids to eat healthy at home means their choices might be better when they’re away from us. Teenagers, especially, eat a lot of their food when we’re not around. That pizza that they all love so dearly?

It doesn’t have to be a terrible option. A variety of crusts are available at the grocery store – from homemade, to frozen or refrigerated. Loose some of the fat content by using a thin or wheat crust and pile on some fresh, healthy vegetables.

Top your creation with a reasonable amount of cheese and it’s just like the frozen option – only fresh and so much better.

simple spreadsheet and small money antes. He found he couldn’t keep up with record keeping and the money didn’t seem to work to rally his colleagues.

So he turned to Healthmonth.com, which doesn’t use money bets. Winners receive virtual fruit to give in solidarity to others over a month’s time. At the beginning, participants fill out detailed questionnaires that are later used by the site to craft daily emails offering help with self-selected goals like limiting alcohol or soda and eating more greens or whole grains.

About 40 of Foursquare’s 100 employees participated and met their personal challenges earlier this year. Rainert, 35, wanted to drop some of the pudge he picked up when he became a dad nearly two years ago.

“I’ve used countless food and fitness trackers to try to change,” he said. “I think this worked for us because of the social pressure. When you’re doing something with someone, you don’t want it to look like you’re underperforming.”

Rainert plans to organize another round after the new year. Healthmonth, with about 50,000 users, sees two or three times more traffic in January than any other month.

At Weightlosswars, where the motto is “Lose together or gain alone,” marketing director Pete Maughan expects 10,000 to 15,000 people to register from mid-December through January. The site already has nearly 130,000 users in private team weight loss competitions among friends, families and co-workers, along with individuals competing in public challenges like Seth Brown.

“We’re kind of like an annual flower,” Maughan said. “I don’t view it as a solution to America’s weight loss problem but it’s an important spark and a fun and extremely motivational way to get started on a weight loss journey.”

Klark Overmyer in Snellville, Ga., lost 58 pounds as part of a five-person team backed by his company, Rooms to Go. They lost a collective 252 pounds in three months and — like Ylanin’s Benjamins — evenly split one of the $10,000 Healthywage jackpots.

“I would like to say that I’m above the money being a big motivator but who am I kidding,” said Overmyer. “Without the money my vacation to Disney wouldn’t be a possibility. Instead of seeing Mickey my son would be seeing his fat dad on the sofa.”

Instead of cash, Healthmonth.com deals in virtual prizes to help motivate users with the weight loss goals.

David Roddenberry, co-founder of Healthywage, offers several other types of weight-loss competitions and had 20,000 users by the end of last year. The site will close out 2011 with about 100,000 users, he said.

Ylanan and the other Benjamins shed 266 pounds collectively, or 49 to 56 pounds each. So what’d they buy with their winnings, amounting to about $2,000 each?

“We ended up buying new clothes,” Ylanan said. “Nothing fit.”

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Your home’s age important for child lead exposure WASHINGTON (AP) — If you’ve been putting off repairing a peeling windowsill, or you’re thinking of knocking out a wall, listen up: Check how old your house is. You may need to take steps to protect your kids from dangerous lead.

The risk of lead-based paint from older homes is back in the news, as the government considers tightening the definition of lead poisoning in babies, toddlers and preschoolers. Lower levels than previously thought may harm their developing brains.

That’s a scary-sounding message. But from a practical standpoint, it’s not clear how much would change if the government follows that advice. Already there’s been a big drop in childhood lead poisoning in the U.S. over the past few decades.

Public health programs have targeted the youngsters most at risk — poor children living in crumbling housing, mostly in cities — to try to get them tested and their homes cleaned up.

But specialists say it can be a risk in more affluent areas, too, as do-it-yourselfers embark on fix-ups without knowing anything about an environmental hazard that long ago faded from the headlines.

The main value of the proposed change may be in increasing awareness of how to avoid lead in everyday life.

“What we need to do is prevent the exposure in the first place,” said Dr. Nicholas Newman, who directs the environmental health and lead clinic at Cincinnati Children’s Hospital.

There are lots of ways people can be exposed to lead: Soil polluted from the leaded gasoline of yesteryear. Old plumbing with lead solder. Improperly using lead-glazed pottery or leaded crystal with food. Certain jobs that expose workers to the metal. Hobbies like refinishing old painted furniture.

Sometimes even imported toys or children’s jewelry can have illegal lead levels, prompting recalls if they’re caught on the U.S. market.

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But the main way that U.S. children are exposed is from layers of old paint in buildings built before 1978, when lead was banned from residential paint.

Sure, the walls might have been painted over recently, and there may be no obvious paint chips to attract a tot crawling around on the floor. But friction from opening and closing windows and doors allows tiny leaded particles to make their way into household dust — and youngsters then get it on their hands that go into their mouths, explained Dr. John Rosen, a lead poisoning specialist at the Children’s Hospital at Montefiore in New York City.

Very high lead levels can cause coma, convulsions, even death, fortunately a rarity today. But lower levels, especially in children under 6, can harm a child’s brain, can reduce IQ and cause other learning, attention and behavioral problems — without any obvious symptoms to alert the parent.

How much is too much? Until now, the definition of lead poisoning in young children was 10 micrograms of lead per deciliter of blood. But in a draft report last fall, the National Toxicology Program analyzed recent scientific research to conclude there’s good evidence that levels lower than 10 are a risk. Now advisers to the Centers for Disease Control and Prevention are urging that agency to lower the definition to 5 micrograms for now, periodically reassessing.

If the CDC agrees, its advisers estimated that could classify about 450,000 children with lead poisoning, up from roughly 250,000 today.

At these levels, there’s no treatment for the child other than to end the ongoing exposure — clean up the house, Newman stressed. That’s why prevention is so important. And while the youngest children are the most vulnerable, lead’s not good for anyone’s brain, so he advises taking commonsense precautions before potential exposures like renovating an old home.

What should families do? Here’s advice from

AP Photo

Contractors clean up lead paint at a contaminated building in Providence, R.I. The risk of lead-based paint from older homes is back in the news, as the U.S. government considers tightening the definition of lead poisoning in babies, toddlers and preschoolers. Lower levels than previously thought may harm their developing brains.

the Environmental Protection Agency and public health agencies: • Check the age of your house. At checkups for babies through age 5, pediatricians are supposed to ask if you live in a home built before 1960, or one built before 1978 that’s recently undergone renovation. The answers help guide who may need a blood test to check lead levels. Some states require testing of toddlers on Medicaid.

• Wash kids’ hands before they eat, good advice no matter where you live or how old your house.

• Clean up paint chips immediately, and regularly wash toys that tots put in their mouths.

• Regularly wash windowsills and floors where paint dust can collect.

• If you’re planning repairs or renovation in an old building, use lead-certified contractors who must follow EPA rules to minimize exposure from the work and can perform quality tests to see if your old paint really contains lead.

• If you rent and have peeling paint, notify your landlord. Many cities and states have lead-abatement rules, and programs to contact for help.

• Aside from paint, take off shoes at the door, to minimize tracking in lead-tainted soil.

• Use only cold water for drinking, cooking and making baby formula, and run it for 15 to 30 seconds. Hot tap water can pick up more lead from older plumbing than cold water.

EPA lead information: http://www.epa.gov/lead/pubs/leadinfo.htm#hazard

Homicide drops off U.S. list of top causes of death ATLANTA (AP) — For the first time in almost half a century, homicide has fallen off the list of the nation’s top 15 causes of death, bumped by a lung illness that often develops in elderly people who have choked on their food.

The 2010 list, released by the government Wednesday, reflects at least two major trends: Murders are down, and deaths from certain diseases are on the rise as the population ages, health authorities said.

Homicide was overtaken at No. 15 by pneumonitis, seen mainly in people 75 and older. It happens when food or vomit goes down the windpipe and causes deadly damage to the lungs.

This is the first time since 1965 that homicide failed to make the list, according to the Centers for Disease Control and Prevention.

The CDC’s latest annual report on deaths contained several nuggets of good news: —The infant mortality rate dropped to an all-time low of 6.14 deaths per 1,000 births in 2010. It was 6.39 the year before.

—U.S. life expectancy for a child born in 2010 was about 78 years and 8 months, up about a little more than one month from life expectancy for 2009.

—Heart disease and cancer remain the top killers, accounting for nearly half the nation’s more than 2.4 million deaths in 2010. But the death rates from them continued to decline.

— Death rates for five other leading causes of death also dropped in 2010, including stroke, chronic lower respiratory diseases, accidents, flu/pneumonia and blood infections.

But death rates increased for Alzheimer’s disease, which is the nation’s sixth-leading killer, kidney disease (No. 8), chronic liver disease and cirrhosis (No. 12), Parkinson’s disease (No. 14) and pneumonitis.

The report is drawn from a review of at least 98 percent of the death certificates filed in the U.S. in 2010.

The government has been keeping a list of the top causes of death since 1949. Homicide has historically ranked fairly low. It was as high as 10th in 1989 and in 1991 through 1993, when the nation saw a surge in youth homicides related to the crack epidemic.

In the past decade, homicide’s highest ranking was 13th. That was in 2001 and was due in part to the 9/11 attacks.

Murders have been declining nationally since 2006, according to FBI statistics. Falling homicide rates have been celebrated in several major cities, including New York City, Detroit and Washington.

Criminologists have debated the reasons but believe several factors may be at work. Among them: Abusive relationships don’t end in murder as often as they once did, thanks to increased incarcerations and better, earlier support for victims.

“We’ve taken the home out of homicide,” said James Alan Fox, a Northeastern University criminologist who studies murder data.

Some also credit better police work and public health programs aimed at reducing violence.

Demographics are an important factor, too, as the largest segment of the population is now 50 and older. Younger people — who are most likely to commit or fall victim to murder — are making up a smaller share of the population.

That ties in to the changes in the CDC’s list of causes of death.

“The risk of homicide declines with age, and the risk of death by disease increases,” Fox said.

However, some causes of death associated with old age are giving way to others, noted Robert Anderson, the CDC official who oversaw the report.

Doctors have been getting better at preventing and treating heart disease and cancer, which allows something else to become the cause of death.

“In previous years, someone with both heart disease and Parkinson’s would have been more likely to have died from heart disease. Now with better treatment, they die from Parkinson’s instead,” Anderson said in an email.

Pneumonitis is another example. Despite its name, pneumonitis is not related to pneumonia. It occurs in people who have lost the ability to swallow or protect their airway.

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Brainerd Dispatch/Steve Kohls

Client Laurie Barrett watched her movements in the mirror at Anytime Fitness in Nisswa while working with personal trainer Sherry Johnson.

NISSWA — One look at her and you’d never guess this energetic and athleticlooking woman was anything but physically fit throughout her life.

Now at the age of 47, Sherry Johnson says she looks, feels and performs better than ever before. But it didn’t happen overnight. In fact, Johnson said it wasn’t until her mid-thirties did she decide to kick a 20 year smoking habit and get serious about her health. Not only did she succeed, but she also took a major detour off her career path and went back to school to become a personal trainer.

“I’ve been an off and on runner since I was about 19,” Johnson said. “But after having kids, you’re focused on them and not focused so much on yourself and your own

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Stronger and healthier than ever

By JENNY HOLMES | HealthWatch correspondent

needs. I decided to quit smoking. Running actually helped me quit. I traded in one addiction for another.”

Leaving a lengthy nicotine habit in the dust, Johnson said she felt she needed to keep going, afraid if she quit running she’d start smoking. So she reassessed her goals and began training for her first triathlon.

Feeling stronger and healthier than ever before, at the age of 36, Johnson competed in the prestigious Ironman Triathlon series in Racine, Wisconsin.

“After that, I felt like if I could do it, anybody could do it. And I wanted to share that with other people.”

Shortly after, Johnson left behind a career in marketing when she and husband, Charlie, moved from the Twin Cities to the

Lakes Area in the mid-1990s. She began working as a volunteer coordinator with the Crisis Line Referral Service in Brainerd and was also certified as an Emergency Medical Technician. At the mid-point in her professional career, Johnson’s resolve to help others took her down a new, and unknown, path.

She enrolled in the Cooper Institute in Dallas, Texas where she earned her Fitness Specialist Certification; later became a Certified Personal Trainer through the American Council on Exercise, then became an independent contracted personal trainer under the name It’s Fit for You. Renting space from Anytime Fitness in Nisswa and Crosslake, as well as the In Motion Physical Therapy center in Baxter, Johnson works one-on-one

After having kids, you’re focused on them and not focused so much on yourself and your own needs. I decided to quit smoking.

Running actually helped me quit. I traded in one addiction for another.”

-Sherry Johnson with clients, ranging from ages 17 to 82, who want to get serious about fitness and making a permanent change in their lifestyle.

With a current clientele list of about 130 men and women, Johnson said a majority of her clients are women in their 40s and 50s looking to lose “that little pooch,” as well as many who want to get, and stay, active in their golden years.

“What I’m finding out from older people is they want to be able to play golf, or want to be able to finish every day chores and be active in their older age. I think it’s different for everybody. People just one day commit to doing something about their health. I think, in general, it takes people anywhere from six months to a year to make that commitment. When people come in to me for a consult, they’re already raring to go for Brainerd Dispatch/Steve Kohls whatever reason it is in their life.”

Client Laurie Barrett passed the ball at Anytime Fitness in Nisswa while working with personal trainer Sherry Johnson recently.

So, what exactly does ‘fit’ mean and how do you get from here to there?

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cont’d. FITNESS, PAGE 19 “I would define fit as being able to get through your day with tons of energy left over. By eating well - nutrition is big when it comes to that. And you have to exercise. Weight bearing exercises and resistance training is really key. As people get over 40, they lose a lot of their muscle because they’re not playing anymore.

But you just need to move and eat well.

You’ve got to get up off your butt, turn the TV off manually, take the stairs. That’s what you’ve got to do to get fit. Thinking about it consciously, everyday.”

Johnson blames a society obsessed with convenience as the reason so many have become sedentary in their lifestyles.

“Let them walk!” she laughed.

Fad diets also give false hopes to those looking for a quick fix. Johnson said people often lose muscle instead of fat, which actually inhibits weight loss since muscle is key in the battle of the bulge.

Working each and every day in the gym helping others reach their personal goals, it could be easy for Johnson to lose sight of her own.

“It does get hard to work out when I get home in the afternoon. That’s really been an issue for me, and I’ve got to dig deep to work out. It’s easy to talk yourself out of it. But the bottom line is nobody wants to hire a fat trainer. If I can’t adapt that into my lifestyle, how do I expect others to adapt it into theirs? I’m no busier than anyone else.”

Johnson said she gets much motivation to get out and run from her energetic chocolate Lab, Emo, as well as from her clients who are reaching milestones they never thought possible.

“I get a lot from them. Actually, I think I get more from my clients than they get from me. I get to see that high they get when they figure out they can do something; having people saying to me ‘I can’t believe I did that!’ When I’m here at work, it’s the time when I’m truly living in the moment with people. I’m not thinking about what I’m going to make for dinner.

I’m in the moment with these people, and it’s pretty cool.”

Johnson plans to go back to school in

the fall to pursue certification as a medical exercise specialist, allowing her the expertise to work with individuals postsurgery in gaining strength and mobility.

Promoting fitness, proper nutrition and lifestyle changes to her clients, the ironic part of the story comes in that Johnson’s husband, Charlie, owns Jimmy’s Pizza in Brainerd.

“I get heat from that a lot,” she laughed. “But really, it’s about balance.

You can eat pizza. As long as you have a salad and a glass of water with it and only have one or two slices instead of the whole pizza. And you also need to get out and move the next day.

I think in order to stick with something think of it as a lifestyle change. It’s not always about losing weight. You need to think about eating whole foods – whole grains, lean meats – and moving throughout your day. That’s really all it takes. Losing weight is what happens when you’re living a healthy lifestyle. It’s really a side effect.”

Brainerd Dispatch/Steve Kohls

Client Laurie Barrett worked with personal trainer Sherry Johnson at Anytime Fitness in Nisswa recently.

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Study finds no better odds using 3 embryos in IVF LONDON (AP) — A new study of fertility treatment found that women who get three or more embryos have no better odds of having a baby than those who get just two embryos.

They also have a greater chance of risky multiple births.

“Women who have gone through infertility treatment want the best chance of having a baby, but we need to explain that the data shows transferring more embryos doesn’t actually do that,” said Dr. Scott Nelson, head of reproductive and maternal medicine at the University of Glasgow, who co-authored the study published in Thursday’s issue of Lancet.

In Western Europe, where some countries pay for in-vitro fertilization, or IVF, many authorities recommend a single embryo transfer for women under 37 and a maximum of two embryos for women 37 to 40. For women over 40, three is often the limit by law.

In the United States, there are relatively lax guidelines and a lack of regulation. That country has seen a rise in multiple births, including the highly publicized case of Nadya Suleman, labeled the “octomom.” She had octuplets in 2009 after her doctor transferred 12 embryos. She already had six children through IVF. Most fertility treatment in the U.S. is paid for privately and can cost at least $10,000 per cycle, which experts believe encourages the use of more embryos in the belief it will improve odds.

The American Society for Reproductive Medicine recommends single embryo transfers for women under 35, but there is no enforcement of that. For women 35 to 37, they advise two to three embryos, and three to four embryos for women ages 38 to 40.

In their study, Nelson and Debbie Lawlor, of the University of Bristol, analyzed data for all 124,000 IVF cycles in the U.K. between 2003 and 2007, resulting in more than 33,500 live births. The women were 18 to 50 and had varying histories of infertility. During IVF, eggs are fertilized with sperm in a lab dish and then put in the womb.

For women under 40 who had two embryos transferred, the live birth rate was 33 percent overall. With three embryos, that dropped to 25 percent, though researchers weren’t sure why. Nelson said it might be due to the higher risk of miscarriage in a multiple pregnancy and that miscarrying one fetus would jeopardize the entire pregnancy.

For women over 40, the live birth rate was 13 percent whether they had two or three embryos transferred.

Nelson said patients going through IVF may pressure doctors to transfer more embryos, believing it may boost their chances of having a baby and avoiding more treatment.

“Doctors may feel if they don’t do what their patients want, they’ll just go down the street to another clinic,” he said. “They need legislation to help control the situation.”

The U.K. has tougher policies. Transferring three embryos in women under 40 is banned. And if doctors transfer more than three embryos, they must explain their actions to the fertility regulator. In 2010, about 65 percent of embryo transfers involved two embryos and 4 percent used three. The rest were single embryos.

In the U.S., data from 2009 showed about 52 percent of embryo transfers involved two while 23 percent used three embryos. Nearly 12 percent involved four to seven or more embryos. Only about 14 percent used one.

Multiple births have a higher risk of problems, including an increased chance of miscarriage and pregnancy complications like high blood pressure and diabetes. Twins and triplets are more likely to be premature and have an increased risk of developmental problems such as cerebral palsy.

Dr. James Grifo, director of the New York University Fertility Center, agreed doctors should avoid using more than three embryos. But he said it was warranted for some, such as older women with a history of failed treatment.

Grifo said the fact many Americans pay for their treatment out of pocket makes a big difference. “I spend a lot of time trying to talk patients out of the three-embryo transfer and you can’t always do it,” he said.

“My last set of triplets was a patient who demanded I put back three embryos,” he said.

Grifo said she wasn’t swayed by the data. “She delivered the triplets and they’re fine, but I wasn’t happy about it.”

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Physician, heal my doctor bills NEW YORK (AP) — Few things make me feel as clueless as a bill from my doctor’s office.

I don’t recognize the abbreviations or understand the jargon. I can’t tell when I’m being charged too much. And there’s no screen on the wall, at least not at my doctor’s office, tallying the cost of each extra test I agree to or question I ask.

But, even if you have health insurance as I do, medical bills can spiral quickly, eating up savings or in extreme cases leading to bankruptcy. Here are ways to protect yourself throughout the process.

Choosing Doctors And Hospitals: Even people who studiously comparison-shop for their digital camera or winter coat don’t always realize they should do the same for medical services. Prices can vary significantly.

“You can get an MRI on one side of the

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street that will cost you $2,000, and the exact same MRI on the other side of the street will cost $4,000,” says Dr. Neel Shah, executive director of Costs of Care, a nonprofit that aims to help patients deflate their medical bills.

He isn’t speaking metaphorically. Dr. Jeffrey Rice, CEO of the Healthcare Blue Book, estimates that there’s an average difference of 300 percent to 600 percent between the lowest price and the highest price for any single medical procedure in any U.S. city.

If you’re thinking you needn’t comparison shop because you have insurance, think again. Many insurance plans will still hold you responsible for a portion of the bill in addition to the deductible. And don’t assume that choosing a doctor who’s in your insurance company’s network will solve the problem: Their prices can vary too.

“The biggest problem we see is patients

don’t ask about costs before they get their care,” Rice said. “It’s like going to buy a car and deciding afterward that the price was too high.”

You need to call each doctor’s office or hospital you might visit to learn what they charge. The Healthcare Blue Book website, which is free to consumers, can help you figure out what prices might be reasonable.

It collects information about the fees doctors accept from insurance companies.

If you’re uninsured, ask about a “selfpay” discount. Doctors often charge less to patients who have to pay out of pocket, but they generally don’t advertise this.

At your visit: Tell your doctor you need to watch what you spend. She might not know the exact cost of each procedure or whether your insurance covers it, but she’ll know the relative value of each test she orders. Maybe she can hold off on a few for a couple of

“You don’t want to assume that everything somebody is charging you for is correct.” months, until she’s certain you need them. Or, if you need surgery, maybe your doctor can do it at an outpatient facility instead of a hospital.

It’s also important to make sure you’ve followed your insurance company’s paperwork procedures, no matter how ridiculous you think they are. For example, if your doctor sends you to a specialist, ask your insurance company whether you’ll need pre-authorization for the visit. The pre-authorization is just another layer of paperwork — maybe your doctor’s office has to fill out an extra form or make an extra phone call — but you want to be sure it gets done.

“There are times when a test is ordered and performed and no one really realized it (needed pre-authorization), and the patient gets stuck with a bill for a test that would have been covered,” said Dr. Stephen Meyers, a physician in Oak Ridge, N.C., who runs SmartMedSavings.com.

Or say you have two health insurance plans — a primary and a secondary — and you need a procedure that your primary plan won’t cover but your secondary will. It’s likely that you’ll still need to file a valid claim with the primary insurer, just to get it denied, to guarantee that the secondary insurer will pay up.

The bill: In most cases, you won’t see any tally of prices until your insurance company sends you a document listing what the doctor or hospital charged, how much the insurance company paid and what’s left for you to cover.

It’s a good idea to ask for a line-item bill from your doctor’s office or the hospital so you know exactly what you’re being charged for.

Check for glaring errors: Are the medicines listed on the bill the ones you actually received? Is there lab work listed on a day when you didn’t have blood drawn? It’s easy for a billing office to accidentally key in “11” instead of “1’’ and charge you for 10 extra pills or to transpose a few digits in a code and charge you for an injection when you really just got counseling.

“You don’t want to assume that everything somebody is charging you for is correct,” said Louis Saccoccio, CEO of the National Health Care Anti-Fraud Association.

The appeal: If you believe you’ve been charged for something your insurance company should cover, contact the company first. If it still denies your claim, you have the right — under the new health care reform laws — to ask for an independent organization to review your claim. If your health insurer tries to deny you this external review, contact your state insurance commissioner’s office.

Other state agencies also can help you. Check the “Consumer Assistance Program Locator” on the nonprofit Families USA’s home page or HealthCare.gov, a website managed by the U.S. Department of Health and Human Services.

Some for-profit companies also will scour your medical bills for errors and try to get the charges lowered. But these companies will keep a portion of any savings they recover for you, sometimes as much as 35 percent.

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Medical Home: The Quiet Revolution While talk of healthcare reform lingers on, some healthcare systems have already embraced a new model of care.

F

or Jody Kuyava of Bertha, her once rewarding life as a wife, mother and business owner had been reduced to what seemed liked nothing but a series of medical visits, phone calls to doctors, and constant attention to managing her twenty medications.

Diagnosed with Multiple Sclerosis, Jody was struggling to keep her symptoms manageable and was experiencing additional symptoms that her MS treatments didn’t seem to address.

“It took twelve years for my MS to be diagnosed so by the time I started going to Lakewood [Health System, Staples], I had a thick file of medical records,” said Jody.

Once at Lakewood, Jody’s doctor suggested she become a participant in Lakewood’s Medical Home program. “I had no idea what that meant exactly,” said Jody. “When my doctor explained what it was about, I was excited – but afraid to be too hopeful – because I’d been through so much just trying to find someone who could help me feel better.”

What Jody’s doctor told her was that Medical Home was designed specifically for people like her who had chronic or complex

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Dr. Halfen, Medical Director at Lakewood Health System, attributes Lakewood’s leadership role in implementing the Medical Home model to its staff: “Our physicians recognized that it was time to explore a new way to deliver care.”

medical conditions, were struggling to manage their symptoms, or were taking multiple medications.

To start, Jody was given the name and number of Niki Worden, a Registered Nurse (RN) at Lakewood, who would become Jody’s Care Coordinator and her first point of contact whenever she had questions or was experiencing symptoms that were of concern.

For Jody, that one act alone was transformative. “With MS you can suddenly start having new symptoms or problems that you’re not sure are because of your MS, or something else,” said Jody. “People with MS also have weakened immune systems, so I get sick a lot more than most people.”

Because of this, Jody used to make frequent phones calls to her doctor. Each time, she would find herself having to repeat her medical history and give more detail about all her medications and the issues she was experiencing. “I often needed to be seen fairly quickly, so having to tell my story over and over again was really frustrating.”

That ended when Niki entered the picture.

Whenever Jody was experiencing a flare-up

with her MS or had a question about her medication, she picked up the phone and called Niki who, as her Care Coordinator, was familiar with Jody’s medical history and had direct access to Jody’s medical records.

If Niki couldn’t answer Jody’s question, she would consult with someone who could, whether it was Jody’s physician, a pharmacist, or specialist. If it was determined that Jody needed to be seen right away, Niki would arrange a same-day appointment with Jody’s personal physician.

This kind of immediate access is a key feature of the Medical Home model. Care Coordinators are available twenty-four hours a day, seven days a week and Lakewood physicians reserve time in their schedules every day to accommodate Medical Home patients. This, and the advent of electronic medical records that enable real-time, shared access to patients’ records, is at the heart of the Medical Home promise of improved care and better health outcomes for patients.

As a result of becoming a Medical Home participant, Jody was able to reduce her medications by more than half, and her overall symptoms were eventually so well improved

Jody Kuyava says participating in Lakewood’s Medical Home program changed her life. “I used to take 20 different medications, now I take less than half that amount.”

that she received a call from Niki wondering if everything was ok. “I hadn’t called or been in for a while so Niki wanted to check in on me,” said Jody. “I had to laugh because I told her I was doing really well, that’s why she hadn’t heard from me.”

According to Dr. Halfen, Lakewood Health System Medical Director, stories like Jody’s are not uncommon among Lakewood’s Medical Home participants. “Since implementing Medical Home at our facility, we’ve seen significant reductions in emergency department visits and hospital admissions for these patients,” said Dr. Halfen.

Lakewood Health System is considered a pioneer in the Medical Home movement, and was one of the first healthcare systems to receive Medical Home/Health Care Home Certification by the Minnesota Department of Health. In order to receive certification, healthcare providers must meet a set of rigorous standards and demonstrate that they can deliver coordinated care that works toward improving the quality of care while managing the cost of care.

Dr. Halfen said the choice to become a Medical Home facility was driven by several factors, and was made possible by the advent of computerized medical record-keeping. “Prior to becoming a Medical Home we had a computerized medical records system in place,” said Dr. Halfen, “but we were using only a small part of its potential. At the same time, our primary care physicians were welltrained, excellent physicians, but each was frustrated with a national system of healthcare that they recognized had many inefficiencies, errors, and waste.”

See MEDICAL, Page 26A

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MEDICAL, From Page 25A But how do you improve patients’ health outcomes while controlling, or even reducing, healthcare costs at the same time?

“Most healthcare dollars are spent on a small percentage of the population,” said Dr. Halfen, “typically for those with chronic conditions that are poorly controlled, or for those whose health has been poorly monitored until they are in crisis and show up in the emergency room. Medical Home is designed to try to get in front of these events so that people use and need less care because they’re not falling through the cracks.”

While Lakewood physicians and staff embraced the Medical Home model, convincing insurance companies and other healthcare payers to reimburse the cost for such care was another matter. “As with most innovations, it takes time to create new systems based on new models,” said Dr. Halfen. “But things are changing. Insurance companies are responding. We continue to believe that this is the right philosophy of care, not simply because it focuses on cost savings, but because it’s designed to improve the quality of care at the same time.”

As for Jody, she can’t imagine going back to the old way of receiving care. In September of 2010, she experienced some unexpected issues that resulted in an emergency room visit, something that hadn’t happened in some time. “Because all my care is coordinated, Niki knew about my ER visit,” said Jody. “She immediately got involved to make sure I understood my follow-up instructions and that my doctor was aware of the visit.

Knowing I have someone I can call who knows me and my medical history has taken so much of the anxiety out of having a chronic illness. As for Niki and the other Medical Home staff, well, I call them my angels.”

Lakewood’s Medical Home Care Coordinators serve as patient advocates, though some patients, including Jody Kuyava, refer to them as “my angels”. L to R: Niki Worden, RN and Sara Erickson, RN (not pictured: Connie Hermes, RN).

What is a Medical Home?

Medical Home is a newer model of medical care for patients with several chronic or complex health conditions. It takes an integrated, wholeperson approach to health management, and involves a team of health professionals who work together to provide a more comprehensive type of care.

How is it different from the type of healthcare people receive now?

Medical Home focuses on providing patients with direct access to a “care coordinator” and easy and more immediate access to their physician and to other healthcare providers as needed. Care is delivered in a team approach so that everyone on a patient’s “team” is kept informed and upto-date on the health status of that patient.

Who is typically part of a Medical Home “team”?

The team will typically include a patient’s primary doctor, Medical Home care coordinators, a pharmacist, social worker, physical therapist, family members, caregivers, and other specialists that might be involved in a person’s care. The patient is also considered a critical part of the team and is encouraged to play an active role in their ongoing care.

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Can anyone request to participate in a Medical Home program?

Healthcare providers who offer Medical Home programs typically have a set of criteria they use to determine if someone’s healthcare is best delivered by a team approach. That criteria will usually include things like multiple diagnoses (typically three or more requiring treatment), or taking multiple medications (usually four or more prescriptions) or having a severe or chronic illness like diabetes or heart disease, or an illness that requires frequent visits (every two months or less).

How much does it cost?

Lakewood Health System in Staples (currently the only certified Medical Home facility in this area) does not charge patients an additional fee for participating in Medical Home. The State of Minnesota and most insurers have agreed to pay a monthly fee to Lakewood for the patients they are insuring. Medicare in Minnesota has also agreed to pay for accredited patients being seen under the State of Minnesota criteria. Other healthcare providers may vary as to how they handle reimbursement for Medical Home care.

Tiniest babies are growing up healthy — despite odds LINDSEY TANNER/AP Medical Writer

CHICAGO (AP) — One is a healthy first-grader, the other an honors college student majoring in psychology. Once the tiniest babies ever born, both girls are thriving, despite long odds when they entered the world weighing less than a pound.

A medical report from the doctor who resuscitated the infants at a suburban Chicago hospital is both a success story and a cautionary tale. These two are the exceptions and their remarkable health years later should not raise false hope: Most babies this small do poorly and many do not survive even with advanced medical care.

“These are such extreme cases,” said Dr. Jonathan Muraskas of Loyola University Medical Center in Maywood, Ill. They should not be considered “a benchmark” to mean that doctors should try to save all babies so small, he said.

The report involves Madeline Mann, born in 1989 weighing 9.9 ounces, then the world record; and 7-year-old Rumaisa Rahman, whose 9.2-ounce birth weight remains the world’s tiniest. Rumaisa’s birth weight was initially reported as several ounces less, but that figure was based on a different conversion scale.

Two other babies born since 1989 weighed less than Madeline, and a German girl was born last year at her same birth weight.

The report was released online Monday in Pediatrics.

It addresses a question that was hotly debated when Madeline was born 22 years ago, remains hot now — and still has no answer: “What is the real age of viability? No one knows,” said Dr. Stephen Welty, neonatology chief at Baylor College of Medicine and Texas Children’s Hospital in Houston.

Muraskas and the report’s co-authors say most newborn specialists consider babies born after 25 weeks of pregnancy to be viable — likely to survive — and so they should receive medical intervention if necessary to breathe.

Younger babies are generally in a “gray zone,” where intervention isn’t always so clear cut, the report suggests.

In Japan, doctors have lowered that threshold — the gestational age — to 22 weeks. Normal pregnancies last about 40 weeks.

Some U.S. doctors will attempt to save babies at 22 weeks, but that is not done routinely, said Dr. Edward Bell, a University of Iowa pediatrics professor.

Bell runs an online registry of the world’s tiniest babies, born weighing less than about 14 ounces, or slightly less than 1 pound. Since 1936, 124 have been listed. The registry is compiled from doctors’ voluntary reports and so does not represent all survivors.

Bell estimates that about 7,500 U.S. babies are born each year weighing less than 1 pound, and that about 10 percent survive.

Sometimes tiny babies with zero chance of surviving show signs of life at birth, and may be able to breathe for a short time if put in an incubator and hooked up to a breathing machine and intravenous treatments. “But even so, if it’s a baby that doesn’t have a chance, we don’t want to put the baby and the family through the discomfort,” Bell said.

Muraskas says his report highlights a sometimes overlooked fact: gestational age is even more critical for survival than size.

Rumaisa and Madeline were both palm-sized, weighing less than a can of soda pop — the average size of an 18-week-old fetus but they were several weeks older than that. Their gestational ages — almost 26 weeks for Rumaisa and almost 27 weeks for Madeline — meant their lungs and other organs were mature enough to make survival possible.

But both required intensive medical intervention. They were delivered by cesarean section more than a month early because their mothers had developed severe pre-eclampsia, dangerously high blood pressure linked with pregnancy. Both babies were hooked up immediately to breathing machines

with tubes as slender as a spaghetti strand slipped down their tiny airways.

Rumaisa has a twin who was more than twice as big at birth. Few details about her are included in the report.

Before the births, both mothers were given steroid drugs to speed up growth of the babies’ immature lungs. Even so, Rumaisa and Madeline were on breathing machines for about two months, and hospitalized for about four months.

Madeline had mild brain bleeding, common in tiny preemies, but with no lasting effects. Severe cases can cause serious mental disabilities. She and Rumaisa got treatment for an eye condition common in preemies called retinopathy, which in severe cases can cause blindness.

Madeline has asthma and remains petite — 4 foot 8 and about 65 pounds at age 20; Rumaisa at age 5 weighed 33 pounds and was 3 1/2 feet tall, smaller than about 90 percent of kids her age. Current information on the girls’ size was not in the report; Madeline is now 22 and a senior at Augustana College in Rock Island, Ill.; Rumaisa is 7 and attends first grade in suburban Chicago.

Jim Mann, Madeline’s father, said having a baby born so small was “terrifying” at first. But other than asthma, the only lasting effect his daughter has mentioned is having trouble finding age-appropriate clothes because she remains so small, he said.

That she has done so well is a source of pride, and wonder, her dad said.

“I don’t know why, we were just extraordinarily lucky,” Mann said.

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Low risk of heart incidents found for marathoners

MALCOLM RITTER | AP Science Writer NEW YORK (AP) — It’s dramatic news when a marathon runner collapses with no pulse. Now a big study finds such calamities are rare and usually due to a pre-existing heart problem.

The study also found such incidents are increasing as more runners try to go the distance.

“You hear about this more and more,” said Dr. Aaron Baggish, senior author of the study Baggish, who runs a program for athletes with heart issues at Massachusetts General Hospital, and co-authors present their analysis in Thursday’s issue of the New England Journal of Medicine.

The study covers 10.9 million runners who participated in marathons or half-marathons in the United States from 2000 to 2010.

By scouring media reports and checking with medical staff of races, the researchers identified 59 cases of cardiac arrest, where a runner became unconscious with no pulse during the race or within an hour of finish-

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ing. Cardiac arrest is when the heart stops because of a heart attack, a rhythm problem or other disorder.

Forty-two of the runners died.

The overall figures translate to 1 cardiac arrest per 184,000 participants and 1 death per 259,000 participants, the researchers said. Those numbers are low compared to other athletic activities, as shown by prior studies of deaths in college athletes, triathlon participants and previously healthy middleaged joggers, researchers said.

Most of the cardiac arrests involved marathons rather than half-marathons, and 51 of the 59 cases happened in men.

More cases showed up during 2005-2010 than in the preceding five-year span, but that’s just because more people are participating in the races, Baggish said. More worrisome was the finding that among male marathoners, the rate of cardiac arrest per 100,000 runners was higher during the latter half of the decade than in the first half.

Baggish thinks that’s because of a shift in attitudes about who can run long distances.

Even a decade ago, 26.2-mile marathons were considered appropriate only for very athletic people, he said. But more recently people have come to think of it as “something anyone can do,” and even as a healthy activity for lowering the risk of heart disease, he said. So it has attracted people with a family history of early heart disease or early deaths, and “these are just the people who are likely to get into trouble.”

In the 31 cardiac arrests for which researchers could find a cause, most were due to clogged, hardened arteries or hypertrophic cardiomyopathy, a sometimes inherited condition in which an unusually thick heart muscle can interfere with the pumping rhythm. Most of the victims were unaware of their pre-existing conditions, Baggish said.

Baggish said he would encourage aspiring and experienced runners to talk to their doctors about their heart risks for distance

“We don’t want to alarm people about marathon running.

The benefits of exercise are well established” running.

Dr. Gordon Tomaselli, president of the American Heart Association, called the study “reassuring” for finding so few cardiac arrests.

For most people, “running a marathon, if you are so inclined, is a reasonably safe proposition,” he said.

Tomaselli, a heart specialist at Johns Hopkins University, also said runners should pay attention if they feel chest pain, dizziness, lightheadedness or unusually short breath or rapid heartbeat while running. “You should listen to your body,” he said.

In the same issue of the journal, other doctors wrote a brief report about treating three runners who suffered heart attacks after finishing last year’s Boston Marathon. None had cardiac arrest and all survived.

“We don’t want to alarm people about marathon running. The benefits of exercise are well established” said one of that report’s authors, Dr. Navin Kapur of Tufts Medical Center in Boston. The report shows even seasoned marathon runners can have heart attacks, something paramedics should keep in mind if a runner shows suggestive signs, he said.

AP Photo

Fredison Costa, 34, from Brazil, crossed the finish line to win the annual Walt Disney World Marathon.

Indiana nose doctor sues Alabama insurance company HAMMOND, Ind. (AP) — A former nose surgeon from northwestern Indiana accused of billing insurers and patients for procedures he didn’t perform is suing his malpractice insurance company, claiming it failed to properly defend him in hundreds of civil cases.

The Post-Tribune reports Mark Weinberger is seeking unspecified damages from Medical Assurance Co. The lawsuit filed Monday alleges Medical Assurance used information garnered from Weinberger’s malpractice cases in its own lawsuit against Weinberger.

That lawsuit, filed in 2006, seeks to determine what role if any Medical Assurance owes in Weinberger’s cases.

A telephone message seeking comment from Medical Assurance was left Wednesday by The Associated Press.

Weinberger was captured in Italy two years ago after more than five years on the run. He still faces lawsuits from hundreds of former patients.

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Health Watch Service Directory • January 2012

Accounting

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To have your business listed in future editions of Health Watch, please contact Dave Wentzel at 218-855-5821

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