Piecing Together the Puzzle of Sickness and Health by Mark Williams

THE HOW-TO GUIDE FOR HEALTHY LIVING IN KANSAS CITY H E A LT H a n d W E L L N E S S

Piecing together the puzzle of sickness and health

J U LY / A U G U S T 2010 J u ly / A u g u st 2010 W W W . E N H A N C E 4 L I F E . CO M w w w . e n h a n c e 4 l i f e . co m

Your

best choice.

H e a r t l a n d s u r g i ca l s p e c i a lt y H o s p i ta l When you or a member of your family need hospital care, you want the very best experience possible. This means top professional care and the service you deserve. At Heartland, we provide superior healthcare. Plus, our doctors, nurses and staff work very hard to earn the approval and loyalty of everyone we serve. We support the work of outstanding doctors in many different fields including: spine and orthopedic surgery; neurosurgery; general surgery; weight-loss surgery; plastic surgery; hand surgery; vascular surgery; urologic surgery; ear, nose and throat surgery; radiology; pain management; gastroenterology; and primary care medicine. Weâ&#x20AC;&#x2122;ve been proudly known as Heartland Spine and Specialty Hospital for the last seven years. Today, Heartland remains a leader in orthopedic surgery and in multi-specialty care. Heartland Surgical Specialty Hospital 10720 Nall Avenue, Overland Park, Kansas 66211 913-754-5000 or 1-800-975-4774 www.hssh.org

Whether you’re picking out names or helping them pick out colleges, choose the

Lee’s summit Physicians GrouP for your children’s prenatal and pediatric health care. New parents have lots of questions, and the doctors at the Lee’s Summit Physicians Group are available and accessible seven days a week to help.

Lee’s summit Physicians GrouP 1425 NW Blue Parkway • Lee’s Summit, MO

Pediatrics • 816-524-5600 • www.lsphysicians.com

Walk-in urgent care available 7 days a week.

• Open 7 days a week, with evening and weekend urgent care • Open Monday-Thurs., 8 a.m.-7p.m. and Fridays, 8 a.m.-5 p.m. (closed noon to 1 p.m.) • Weekend urgent care for pediatrics: Saturday 9-11 a.m. and Sunday 1-4 p.m.

No appointment necessary!

Internal medIcIne • 816-554-1918 • www.lsphysicians.com

Free PrenataL consuLts Monday – Friday 10-12 a.m. and 1-4 p.m. Call 816-524-3223, ext. 150

• Open Monday-Friday, 9 a.m.-noon and 1-4:45 p.m.

raintree Pediatrics 821 SW Lemans Lane • Lee’s Summit, MO

816-525-4700 • www.raintree-Pediatrics.com Urgent care available Monday-Friday, 8-11 a.m. Scheduled appointments: Monday-Friday, 8 a.m.-noon and 1-4 p.m.

We offer after hours on-call physicians, online scheduling, in-house x-rays, labs, EKG and bone scans and we accept most insurance plans.

Call for an appointment or stop by to see us.

from the publisher

time to check the engine After a long day of buzzing back and forth on the Kansas city freeway system, my 4-year-old vehicle sent out a dashboard alarm that every car owner fears: the

enhance magazine

“check engine light.”

I told myself that I could make the final few miles home if I drove really slow. How I wish I could take that one back! Within a couple of minutes the temperature gage spiked and the engine gave out. I had the vehicle towed to a repair shop for a diagnostic work-up. A week later, after praying that the fuel pump that was replaced would fix the problem, the mechanic called me with bad news. “We hooked your car up to diagnostic monitors, and you have low compression in your No. 8 cylinder, most likely the result of engine overheating caused by a faulty fuel pump and prolonged use of the car after the fuel pump had given out,” he said. He then admitted that his mechanics didn’t have the tools or the time to accurately diagnose and fix what looked to be a fatal problem with my truck. How ironic that my fiasco happened while we were putting together this issue of Enhance. While prevention is ideal (I should have checked the fluid levels to avoid the problem), at some point we all face warning lights that signal problems or illness. If we are lucky, the problems are easy to identify and fix. Sometimes though, things don’t go as planned. This issue of Enhance focuses on advances and challenges that exist in disease diagnosis and measurement. The topic of diagnostics doesn’t get as much press as the sizzling miracle cures out there, but if you’ve ever had a child with a fever, had a sore knee after a brisk walk, or had a cough that lingered for several days, you’ll understand the importance of diagnostic tools and the value of experts that guide the process of solving medical mysteries.

Our feature stories span the diagnostic spectrum from innovations in cancer detection (p. 36), fact and fiction of cholesterol testing (p. 44), to current dilemmas in measuring pain. (p. 30). This issue has something for every Kansas Citian that is searching for ways to live a balanced, healthy lifestyle. You may have noticed our new mantra on the front cover, “The how-to guide for healthy living in Kansas City.” Enhance magazine’s mission is to educate, inspire and connect our community by focusing on these core areas: Health Education, Healthy Body, Healthy Relationships, Healthy Eating, Healthy Community and a Healthy Peace of Mind. We’ve even added a “Health Resources and Expertise” guide to the magazine (pg. 75) that will better connect readers to the great healthcare providers, businesses and expertise that are right here in our back yard. Enjoy the issue and don’t hesitate to send story ideas my way. If anyone has a “gently” used Dodge Dakota engine you can send that my way too – my truck is still in the shop!

Publisher and Executive Editor mwilliams@enhancepublications.com www.enhance4life.com.

A>:EMAR LDBG

DONʼT LET THE SUN TAKE ITS TOLL ON YOUR SKIN From skin rejuvenation therapies to cancer treatments, there are many ways our board-certified dermatologists can help you maintain beautiful and healthy skin. Call us today to schedule your skin consultation.

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There are no extra pieces in the universe. Everyone is here because he or she has a place to fill, and every piece must fit itself into the big jigsaw puzzle.

Clockwise from top left: © Denise Williams; © Istockphoto.com / Dem10; winforkc; BlackRED; gary milner; web photographeer; ugurhan betin; jim kolaczko

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– Deepak Chopra

e n h a n c e M aG a Z I n e w w w . e n h a n c e 4 l I f e . co M

in this issue

THE HOW-TO GUIDE fOr HEalTHy lIvInG In Kansas CITy

Piecing together the puzzle of sickness and health

health education 36 52

diagnosis detectives Advanced technology doesn’t always provide the tools doctors need to pinpoint the causes of suffering.

Cancer’s diagnostic puzzle New and improved technologies help uncover clues on fighting cancer.

Foot fungus Don’t let a common infection creep into your life.

eye safety Protect your eyes from both the sun and seasonal injuries.

concussions What you need to know about a misunderstood problem.

Navigating cholesterol testing Common medical tests might not be revealing the true cause of a disease that is devastating our community.

healthy eating 72

A matter of taste Wine judges aren’t the final arbiter of what makes a great wine – nor should they be.

how my family started eating better A Brookside family takes advantage of locally grown foods.

Healthy recipes for busy families Local chefs show you how to make quick dishes from healthy, whole foods.

snowcones Fresher Than Fresh Snow Cones combines all natural ingredients in a fun summer treat.

healthy body 56

Strength conditioning starter kit You don’t need expensive equipment to get your body in shape.

healthy relationships Heat stroke and seniors Extreme heat and humidity can lead to serious health issues for seniors.

healthy community 14

Win for kc The Women’s Intersports Network wants to help girls get into the game.

local health events Learn about upcoming events and activities that can improve your health.

Health resource guide Connecting Kansas Citians to health professionals and expertise.

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6/21/10 12:56 PM

Volume 2, Issue 5 July/August 2010 Executive Editor Mark Williams Creative director Dennis Esser Art Director and copy editor Colleen Cooke Contributing photographers Jonathan Braswell, Sara Farrar, James Meierotto, Denise Williams Cover Photo © istockphoto.com / kroach; blackred Contributing Writers Ryan Brown, Colleen Cooke, Adam Dossen, Doug Frost, Heather Winslow Gibbons, Gina B. Kellogg, Michael Rutherford, Diane Samson ADVERTISING To advertise, please call Mark Williams, mwilliams@ enhancepublications.com 913-269-9227 Publisher Mark Williams Enhance Magazine is published by Enhance Publications. Any information contained within this publication should not be considered a substitute for consultation with a licensed physician. Enhance Publications, its affiliates, employees, contributors, writers, designers, and its Editorial Board of Advisors (“Publisher”) accept no responsibility for inaccuracies, errors or omissions with information for the claims made by Advertisers. Publisher expressly assumes no liability for any damages whatsoever that may be suffered by any patient, purchaser or user for any products or services advertised or mentioned editorially herein. You expressly agree that your use of the information in Enhance is at your sole risk. Photographs of any model in Enhance in no way suggest or imply that the subject has undergone any procedure or used the products showcased. Every effort is made to ensure accuracy in the information provided. Enhance Publications assumes no responsibility or liability for errors, changes, or omissions. Photography and material in the publication as well as design may not be copied or reproduced in any form without the written permission of: Enhance Magazine, 7111 W. 151st St., Overland Park, KS 66223. Phone: 913-269-9227, Fax: 913-322-1099 mwilliams@enhancepublications.com All rights reserved. ©2010 Enhance Publications.

www.enhance4life.com

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Student growers get down to business Students at Border Star Montessori run a booth at a farmers market with food they’ve grown.

J u ly / a u G u s t 2010

healthy community • calendar

local health events and activities Dave Rogers’ Big Bugs

Baby Sing and Sign Class

Farmstead Stampede OP5K

May 26-Oct. 3 Powell Gardens, 1609 NW Hwy. 50, Kingsville, Mo. Cost: $9.50 adults, $8.50 seniors and $4 children 5-12 We’ve got ants in our plants and swarms of family fun as Dave Rogers’ Big Bugs returns to Powell Gardens, Kansas City’s botanical garden. See the new 10-foot-tall daddy longlegs and 10 of his oversized friends, all made from natural materials.

Wednesday, July 7, 10 a.m. Shawnee Mission Medical Center Cost: $65 – to register: 913-676-2300; press 1 for classes Enjoy engaging and playful experiences with your little one through music, sign language and play. Recommended for babies and toddlers 6-18 months of age. Participants receive a Baby Sing & Sign book and music CD.

Saturday, Aug. 14, 7:30 a.m. Deanna Rose Children’s Farmstead 13800 Switzer Rd., Overland Park, Kan. Register: www.sportkc.org Register by Aug. 2 for $20 Register after Aug. 2 for $25 Includes a competitive race followed by a non-competitive 5K run/walk for all ages. Strollers are welcome. Proceeds benefit Friends of the Farmstead and Gift of Life. Online registration closes Aug. 13.

Zona Yoga

July 15 and Oct. 14, 5:30-8:30 p.m. Olathe Medical Center Cost: $25; contact: 913-791-4312 www.olathehealthsystems.org This non-certified CPR class teaches basic adult/child/infant CPR skills and how to aid a choking victim. Targeted for ages 9 to 15. No test is required. Parents should accompany their child to and from class.

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Hearing Your Best for Life

Tuesday, July 6, 9-10 a.m. Cushing Memorial Hospital 711 Marshall St., room 2N Leavenworth, Kan. www.saintlukeshealthsystem.org In this free presentation, Erica Stenberg, Au.D., discusses what is an audiologist, understanding your hearing, impacts of hearing loss, advances in hearing aid technology and what you can do to hear your best.

Tips for Maintaining Health Tuesday, Aug. 17, 10-11 a.m. Saint Luke’s South 12300 Metcalf, Overland Park, Kan. www.saintlukeshealthsystem.org Why wait for a health crisis to begin taking care of yourself? Learn keys to disease prevention from Kimberly Russell, M.D. in this free presentation.

Starry Night Hike

The Rivalry Run

Friday, July 23, 9:30-10:30 p.m. George Owens Nature Park, 1601 S. Speck Rd., Independence, Mo. To register: 816-325-7115 Explore the park that features four miles of walking trails. The hike will cover animal adaptations, human senses, games and Native American stories.

Saturday, Aug. 28, 8 a.m. Kansas City Power and Light District www.therivalryrun.org Contact: John Folber, 816-645-7526, toledonum1@sbcglobal.net The first annual Rivalry Run raises funds to help prevent domestic violence. Run for your state – the state where you live; where you were born; your favorite school or just your favorite side of the border. Online registration closes Aug. 26.

Do you have a health event you’d like to promote in Enhance magazine? Send your information to events@enhance4life.com

Saturdays starting July 3, noon-1 p.m. Information: 816-876-5516 7111 NW 86th St., Kansas City, Mo. www.zonayoga.com This yoga class is free to the community and is intended for ages 12 and up. We do ask that you leave a donation for Habitat for Humanity.

CPR class for kids

HEAVEN EXPOSED.

THE 2011 E-CLASS CABRIOLET. Experience all the natural elements of the 2011 E-Class Cabriolet. With its distinctive, aerodynamic design, its breathtaking performance, and four-passenger luxury that borders on divine, you may never want to go back inside again.

913.677. 3300 | I-35 & Shawnee Mission Pkwy. | aristocratmotors.com A MEM B ER O F TH E SOAV E AU TO M OTIV E G RO U P

health education • uv safety

July: UV Safety month

protect your peepers July is UV Safety Month, which raises awareness about sun safety for the eyes. Protecting your skin has become second nature, but your eyes are just as susceptible to UV damage. Everyone is equally at risk for eye damage from UV rays – skin pigmentation has no correlation. Children are at higher risk than adults. The risk is highest in the summer when the level of UV radiation is at least three times higher than during winter, according to the American Academy of Ophthalmology. UV damage to eyes has been shown to lead to cataracts and growths on the eye, such as cancer. Protect Yourself n Sunglasses that block at least 99 percent of UV and UV-B rays are the ones to look for. n Polarized lenses reduce glare but do not have any connection to UV protection. n Research has not shown a close connection between eye disease and infrared rays. Some sunglass manufacturers tout this kind of protection, but it is different from UV protection. n The color or darkness of the lenses do not indicate level of protection, nor does price tag. Protection from UV rays is found in a variety of sunglass styles and costs. n A wide-brimmed hat can also protect eyes.

August: Children’s eye health and Safety month

In the pool, in the sun, in the yard. In the summer, kids are all over the place and their eyes see it all. The Fourth of July is a time to celebrate our country with friends and family, not sitting in the emergency room. In the same one-month period in 2006, fireworks caused an estimated 1,500 eye-related injuries.

n Don’t

rub the eye. This could increase bleeding and make the injury worse. n Don’t rinse the eye out. n Don’t apply pressure to the eye. Instead, tape a foam cup over the eye to protect from any more contact with any item. n Don’t use over-the-counter pain relievers. Going straight to the emergency room will be most beneficial. n Don’t apply ointment; it only makes the area slippery and difficult to examine.

FROM LEFT: © istockphoto.com / JOSHUA HODGE, JASON LUGO

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you’ll poke your eye out!

“I strive to educate my patients and get them to take control of their oral health. Instead of being focused on treating disease, we want to focus on getting patients healthy for life!” – SCOTT CRAVEN, DDS

Take care of your smile.

(913) 451.4999 | www.scottcraven.com | 4860 College Boulevard, Suite 118 | Overland Park, Kansas 66211

health bits • tidbits

quick tips

Tidbits, fun facts and helpful hints to enhance your life

Have FRESH ORGANIC food DELIVERED TO YOUR DOOR You don’t have to hit all the farmers markets to add organic food to your diet. Have a variety of fruit, veggie or mixed fruit/veggie boxes delivered straight to your door every week from Door to Door Organics. The contents change every week based on the freshest arrivals from local organic farms. http://kc.doortodoororganics.com

Eat blueberries to stay young. They’re packed with antioxidants to delay the aging process.

Knockout

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Safer Grilling with Rosemary

Grilling meat and cooking meat at high temperatures can create to chemical compounds that may increase your cancer risk. To cut this risk, add rosemary extract to your meat before grilling it. Plus, it adds a great boost of flavor to your meat.

Can a knocked out tooth be saved and put back in place? Knocked out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket within one hour of being knocked out. Even if your tooth can’t be saved, you haven’t necessarily lost your smile. Thanks to dentistry advances, an implant can be anchored directly into your jawbone.

CLOCKWISE FROM TOP LEFT: © istockphoto.com / Kyoungil Jeon, Olivier Blondeau, Talaj, Blue Moon Studio Inc., Ewa Brozek

Walk it off

Walking is the easiest way kick-start a workout routine. Step 1: get a pedometer; step 2: start walking, preferably with a walking buddy. Walking reduces your risk of many life-threatening conditions, including cancer, heart disease and stroke.

mouth-Body CoNNeCtioNs

Gum disease aNd diaBetes Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications. People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don't have their diabetes under control are especially at risk. A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

Other mouth-Body Connections that we will cover in upcoming issues include: • Pregnancy Problems • Inflammation • Respiratory Diseases • Osteoporosis • Heart Disease & Stroke

A visit to Periodontal Specialists can improve your overall health – and give you peace of mind. • Dr. Amy L. Gillihan* • Dr. Daniel J. Thomas* • Dr. Melissa A. Combs* • Dr. Jonathan S. Thomas * Diplomates, American Board of Periodontolgoy

Periodontal SPecialiStS, P.a.

Leawood 913.663.4867

NorthLaNd 816.436.6767

topeka

785.272.0770

Lee’s summit 816.525.4867 (GUMS)

healthy community • local spotlight

WIN for KC | Kansas City

getting in the game Sports have long been the playground and proving ground for boys, but that hasn’t always been the case for their sisters and mothers, even in today’s post-Title IX world. The Women’s Intersports Network (WIN for KC) wants to show girls that the door is open to them as well. n Its mission is to empower girls and women through sports and fitness, while providing opportunities for participation in leadership development. But the benefits of physical activity go deeper than muscles and sweat. According to the Women’s Sports Foundation, studies show that girls who play sports have a better body image and better psychological well-being than those who don’t. So WIN for KC provides opportunities for females to get in the game.

GETTING THE BALL ROLLING

Game on

WIN for KC began as an all-volunteer organization in 1994 and expanded four years later thanks to the interest generated by the NCAA Women’s Final Four basketball tournament that came to Kansas City. A group of people – led by Kevin Gray, the president of the Kansas City Sports Commission and Foundation – wanted to start an organization similar to the Women’s Sports Foundation based in New York. Eventually, WIN for KC was born and now operates under the umbrella of the Kansas City Sports Commission and Foundation.

The organization focuses on a few yearly events, and each is an opportunity for girls and women to become more physically active.

“Our mission is to improve the health, confidence and leadership skills of girls and women in our community,” says Ashley Broockerd, WIN for KC’s assistant director. “We focus on the benefits that sports offer – not only the physical benefits, but the intangibles as well: increased self-esteem, positive attitude and confidence. We believe there is an athlete inside everyone.”

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WIN for KC is led by a 25-member advisory board and an executive director. And each year hundreds of volunteers help make events possible.

By Colleen Cooke

“Being an athlete is not a measure of fitness; it starts with a mindset, a confidence and a willingness to try new things,” Broockerd says. “The result is a healthier, happier and more empowered life. Participation opportunities have always been more readily available for boys than girls. By providing these opportunities for women and girls, women serve as role models to these girls so they can learn to make healthy choices and develop an active lifestyle as well.”

Camp WIN Each June 350 girls are introduced to 14 sports and fitness activities at WIN for KC’s flagship youth event, Camp WIN. With the help of instructors from local universities, high schools and other organizations, the campers not only learn the rules of the games, but they also reap the ancillary benefits that team sports have to offer like cooperation and self-respect. WOW – Women on Wheels After the Tour of Missouri cycling race came through Kansas City in 2008, interest in cycling took off among women. So, with the help of several cycling enthusiasts in the community, WIN for KC led the formation of WOW (Women on Wheels) to provide a one-stop shop for female bicyclists, providing resources and information to encourage women to start riding. It is especially geared toward first-time cyclists who are interested in getting involved in the sport. WOW hosts an annual bike festival and all-women’s charity ride, as well as monthly rides around the city.

healthy community • local spotlight

“I am so grateful that I had this race as my first experience. The support, the training opportunities and all the helpful tips from other racers was so great. I loved being able to be a part of something so inspiring and to see all those females working together.” – comment from a 2009 triathlon participant

Throughout Turning Point, participants see images of folded cranes, which have become a universal symbol of hope.

A warm and fuzzy triathlon

Recognizing role models

Contact

A triathlon – a 500-meter swim, 10-mile bike and 5K run – is an inherently intimidating event for many women. But the WIN for KC Women’s Triathlon, the largest all-women’s multisport race in the Midwest, is designed to help even first-time triathletes cross the finish line.

The WIN for KC’s annual banquet is held in conjunction with National Girls & Women in Sports Day and is the largest luncheon of its kind in the country. The event recognizes outstanding female members of the Kansas City community who inspire others through their commitment to sports and fitness.

You can help WIN for KC create more opportunities for girls and women by becoming a volunteer, an advocate or a financial supporter.

n Lockton Courage Award

www.winforkc.org abroockerd@sportkc.org

“It boasts a safe and supportive environment that allows women to challenge and explore their athletic and emotional boundaries,” Broockerd says. “It gives women a chance to step out of their comfort zone and gain that sense of empowerment you feel when you accomplish a goal.” Last year, of the 750 participants, 430 were firsttime triathletes, and WIN for KC offers a Women’s Fitness Series that includes clinics, workshops and organized training rides for all levels of triathletes. And the event has grown in popularity as the word has gotten out; this year’s July 31 race was sold out by March with 850 participants.

The triathlon has also been officially certified as a green race by the Council for Responsible Sport, and it’s one of only 12 races in the country to achieve the designation.

McGuff Sports Center 1308 Pennsylvania Ave. Kansas City, MO 64015 816-474-4652

WOM WOMEN’

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“This event is definitely geared toward a firsttime athlete,” Broockerd says. “The Women’s Fitness Series offers a starting point and motivation to become fit and active. It includes step-by-step guidance to prepare them for their first triathlon.”

– for a local female athlete who has overcome tremendous obstacles to make a comeback in life and sports. n Sprint Spirit Award – personify the “true spirit” of sport as a supporter, promoter or advocate of girls’ and women’s sports and fitness. This award recognizes the girl or woman who gives her all to sports through an outlet other than participation. n Hallmark Cards Outstanding Mentor Award – for a local female mentor who best exemplifies the characteristics of a mentor of female athletes of all ages. This award recognizes women who are volunteers at the grassroots level. n DST Adversity Award – demonstrate the ability to redefine barriers despite physical or mental challenges through her participation in sports. n UMB Senior Sportswoman Award – for a local woman, age 60 or older, who demonstrates significant athletic achievement, outstanding leadership qualities, and who encourages participation of girls and women in sports and fitness.

hear a F

symphony

rom the wind rustling through the tallgrass prairies of Kansas, to the meadowlark’s cheerful song, to the familiar strains of your favorite orchestra, the sense of hearing enriches your life with a symphony of sounds each and every day. If you have experienced difficulty hearing, you may think these sounds are long lost. But thanks to stateof-the-art diagnosis and treatment, today it’s possible to hear your best in a wide variety of listening situations.

The Area’s Premier Audiology and Hearing Aid Practice

www.hearingyourbest.com

A comprehensive diagnostic hearing evaluation is the first step in determining the type, degree, configuration and symmetry of your hearing loss. Ninety-five percent of individuals with hearing loss can benefit significantly from the advanced digital hearing aid technology available today. Consult the specialists at Associated Audiologists for a diagnostic hearing evaluation and personal consultation. Find out how you can enjoy life's full symphony of sounds once again.

A DV E R TO R I A L

AU D

IOLO G

ICE •

ER V

CEL

25 years

• ASSO TE

G 25 YEARS

IN AT

of sounds ST

25 years of hearing your best Today, Dr. Wise is president of Associated Audiologists, Inc.’s staff of 11 universitytrained audiologists. The practice has five offices located in Overland Park, Prairie Village, Shawnee Mission, Lenexa and Leavenworth. Each office uses advanced diagnostic and verification equipment and offers products from the world’s most respected hearing aid manufacturers.

Overland Park Saint Luke’s South Medical Bldg. 913-498-2827 Prairie Village Prairie Village Office Center 913-262-5855 Shawnee Mission Shawnee Mission Medical Bldg. 913-403-0018 Lenexa Shawnee Mission Outpatient Pavilion 913-634-5583 Leavenworth Cushing Medical Plaza 913-682-1870

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When James A. Wise founded the first office of Associated Audiologists, Inc. 25 years ago, the field of audiology was different than it is today, but his focus was the same. “From the beginning, my goal has been to provide the highest level of quality and service to patients,” Dr. Wise says. “We are committed to individualized care, to building relationships with our patients.”

Serving you in five convenient locations:

Don’t Be a Statistic While experts can’t predict a set temperature at which heat stroke sets in (it’s a combination of heat, humidity and personal factors relating to each person), if you hear a forecast for a heat advisory, plan ahead to ensure you stay cool. Do not stay in your home if you don’t have air-conditioning. And don’t think that just because you handled the heat in the past without problems that you’ll be OK the next time. Your body changes all the time. What you could tolerate previously could turn out to be too much next time around.

Extreme heat and humidity can lead to serious health issues for seniors

Summer

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By Gina B. Kellogg

healthy relationships • seniors and heat

The temperature reached a muggy 95° on Aug. 11, 2007 – hot enough for city officials to issue a heat warning. exhaustion and then heat stroke. July and August are notorious for hot weather in Kansas City. While the average high for July is 88.8° and 87.1° for August, weather extremes of the upper 90s and 100s are not unusual. Dr. Ryan Jacobsen, an emergency room doctor at Truman Medical Center, says that once a person’s core body temperature gets above 105°, mortality rates skyrocket. “Some studies show it’s as high as 60 percent in elderly patients with heat stroke,” he says. Those who don’t die aren’t in the clear. According to a study by the National Center for Atmospheric Research, nonfatal heat stroke often leads to long-term illness. The study reported, “About one-third of the patients admitted with heat stroke during a Chicago heat wave exhibited severe impairment, and those who survived showed no improvement after one year.” What makes these figures most heartbreaking? Heat stroke is 100 percent preventable.

“Your brain is like a thermostat; it tells your body how to regulate your temp. Your brain sends signals to the rest of your body whether to warm it or cool it. However, as you get older, sweat glands are not as active, and you don’t sweat as much to cool your body down.” – Jackie Halbin, living well manager at Lakeview Village, a retirement community in Lenexa, Kan.

spoiler

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Shoppers at the Olathe Wal-Mart waded through waves of heat radiating from the parking lot’s blacktop to reach the air-conditioned relief inside the store. As they did, they passed an 89-yearold man sitting in his car dressed in a heavy, long-sleeved shirt and a set of long underwear. His attire became more than simply unusual when he was found slumped over his steering wheel, the windows rolled up, the engine off. His clothing, combined with the oppressive heat, had caused his body temperature to soar to 107°. Johnson County Med-Act spokesman Jeff Johnson told a Kansas City Star reporter, “It’s not uncommon for an older person to feel cooler than what their body temperature actually is.” That disconnect – the temperature a senior feels vs. the actual temperature – can have devastating consequences. By the time an older person recognizes he or she is starting to overheat, it might be too late to help. Within minutes, heat illness can evolve into heat

healthy relationships • seniors and heat

“Because their mechanisms to cool themselves aren’t as intact as younger people, they more easily overheat. They will overlook symptoms that could be a sign of heatrelated illness because they’ve experienced more pain and stress in their lives as a whole. They often simply are not as aware of the insidious signs of heat stroke.”

The Risk to Seniors Age isn’t the only reason that seniors are more at risk for heat stroke. Other factors include greater incidences of illness, disability and medication use.

– Dr. Wesley Nash, College Park Family Care Center, Olathe, Kan.

Early symptoms (heat illness)

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If you or a loved one experiences any of these symptoms, immediately take a break somewhere cool and get a drink of water. n Profuse sweating n Fatigue n Thirst n Muscle cramps

More-serious symptoms (heat exhaustion)

Most-serious symptoms (heat stroke)

Don’t wait to act if you see these symptoms. You want to ensure heat stroke doesn’t set in. Lie down and put feet up. Apply cool wet cloths to skin and place cold compresses on neck, groin and armpits. Point a fan over the body to help wick away heat. Sip a half-cup of a beverage every 15 minutes. Water is good but a salted drink, like Gatorade, is even better. (Make one by adding 1 teaspoon salt to a quart of water.) n Headache n Dizziness and lightheadedness n Weakness n Nausea and vomiting n Cool, moist skin n Dark urine

CALL 9-1-1 if a person shows any of these signs: n Fever (temperature above 104°) n Irrational behavior n Extreme confusion n Dry, hot, red skin n Rapid, shallow breathing n Rapid, weak pulse n Seizures n Unconsciousness

recognizing danger signs of heat stroke

healthy relationships • seniors and heat

seniors’ top risk factors age

Because of the aging process, older adults’ bodies gradually lose the ability to control internal temperatures. As a result, even when it is hot outside, they might feel cold.

medications

Chronic dehydration is common among seniors because of medications, chronic illness or simply a lack of thirst. Therefore, they often drink less fluids than their bodies require, putting them at greater risk for heat-related illnesses.

difficulty acclimating

Kansas City’s variable summer temperatures can make it difficult for seniors’ bodies to adjust to the extremes. Even if you grew up without air conditioning, don’t think you can handle the heat today. Your body is different now, and it can’t acclimate like it used to.

urban living

Seniors in cities often have higher rates of cardio-respiratory diseases, which

puts them at greater risk of heat illness. Plus urban areas don’t cool down after the sun sets like the suburbs do.

socio-economic status

Researchers aren’t sure why this factor is so impactful, but many attribute the increased risk to differences in housing, neighborhood, access to air conditioning and the prevalence of chronic disease.

living alone

This risk factor might be the most critical. Studies from the 1995 and 1999 heat waves in Chicago showed a high correlation between death and seniors who lived alone and didn’t leave their homes daily. The obvious conclusion is that without someone to check on them regularly, many seniors succumb to the dangers of heat stroke.

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Some drugs interfere with the body’s ability to cope with high temperatures. Seniors on these drugs – which include some psychotropic medicines (such as Haldol and Thorazine), anticholinergics (such as Cystospaz), beta blockers (such as Betapace or Inderal) or diuretics (such as Dyazide or Levsin) – might not notice when high temperatures are making them ill.

dehydration

healthy relationships • seniors and heat

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The Greater Kansas City Chapter of the American Red Cross offers tips on what to do if a heat wave is imminent.

Stay indoors in air conditioning If your home has air conditioning, turn it on. Even if you feel cold, don’t listen to your body’s misleading signals. Instead, take the weather forecasters’ advice and remain inside where it is cool. If you don’t have air conditioning, go to a public building for several hours each day. Doing so will allow your body to recover from any heat you’ve experienced. Don’t rely on fans to keep you cool. They are no match for Kansas City’s dangerous high-heatand-humidity combo. In fact, fans can actually make you hotter when the humidity is too high for them to help your perspiration evaporate.

Slow down Avoid tiring activities or perform them only during the coolest part of the day (usually 4-7 a.m.). Wear lightweight, light-colored clothing When outdoors, the light colors reflect the sun’s energy. Drink lots of water Your body needs water to work properly and stay cool. Make sure you drink a glass every hour to replenish any fluid you’ve lost from sweating. Drink even if you aren’t thirsty. Waiting until you actually experience thirst means you already are dehydrated.

Avoid alcohol and caffeine A beer, iced coffee, tea or soda may initially make you feel cooler, but the negative effects from their ingredients will eventually increase the heat’s negative effects on your body. Eat small meals often Fruits and vegetables that contain a lot of water, such as watermelon, are especially good for you. Avoid foods high in protein, however, as they increase metabolic heat. Don’t take salt tablets unless your doctor tells you to.

Watch the Forecast Bill Snook, a program manager who has worked in heat mitigation and response for the Kansas City, Mo., Health Department, says the city has a task force that has developed a strong partnership with the National Weather Service and other local organizations, including United Way 2-1-1, to alert the public when a heat advisory is imminent. His top tips for eliminating the dangers of overheating? Get to a cool place and appoint a buddy who can check on the senior daily. “The best thing is to have a buddy because (a senior) may not be aware of what’s going on,” he says. With heat-related illnesses, awareness issues can be a crucial signal that a person is becoming dangerously overheated. “They can become dizzy and disoriented and float in and out of consciousness. So we need to catch them before they ever get to that point.”

when a heat is on the horizon

Not Feeling

Like yourself

Anymore?

Midlife (30’s-60’s) for women can be the perfect storm – hot flashes, low energy, sleep loss, weight gain, loss of sex drive and memory loss. But you can feel vibrant and healthy again. You can find health care that gives you personalized time and attention.

At The Midlife Wellness Center, Dr. Brenda Smith can help you feel like yourself again. Dr. Smith’s approach includes looking at all aspects of your health: • hormonal health • nutritional and metabolic health • preventative health And above all, you will meet with a true partner in your health. Dr. Smith has worked with women for 24 years and is dedicated to helping women feel vibrantly healthy. Breast thermography is also available. DR. BRENDA SMITH, MD

Visit www.midlifewellnesscenter.com for testimonials from patients and to learn more about our services.

Dr. Brenda Smith, MD www.midlifewellnesscenter.com

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health education • foot fungus

The fungus Summer is the season of

Beyond dry skin

bare feet and flip flops, of swimming pools and ballgames and lots of sweat. And that makes it a breeding ground for fungus to creep into your life and onto your feet.

How can you tell if you simply have dry skin or if it’s turned into a fungal infection? Athlete’s foot – or tinea pedis – can form in three ways: n Fluid-filled

blisters called vesicles, usually on the bottom of the feet. These become itchy and eventually they pop and drain, leaving dry skin. Be careful about scratching these blisters too much; if you cause open sores, you run the risk of contracting a bacterial infection on top of a fungal infection.

By Colleen Cooke

moccasin-shaped infection. It starts with some soreness on the foot, and then the skin on the bottom or heel becomes thick and cracks.

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n Interspace

infection. The spaces between your toes look like you’ve been in the bathtub too long. The skin becomes scaly, then it peels and cracks. Again, this break in the skin can cause bacterial infection as well.

n A

among us It’s not just athletes, despite the name. Children and teenagers are prone to contracting the infection, sometimes because of poor hygiene or because they’re more exposed to locker rooms and really sweaty feet. Dr. Eriksen says older people tend to get the infection in the nails.

“Dry skin and psoriasis can also look like athlete’s foot, and it may be hard to distinguish one from the other,” says Dr. Michael Fine of Fine Foot Care Center in North Kansas City. “You want to make sure you’re treating the right condition.” The same fungus that causes the bottom of your foot to itch is also responsible for infections in your nails. “The nail is the harboring ground for this fungus,” says Dr. Erich Eriksen of Fine Foot Care Center. “Once you have it in the nail, you’re probably going to have it in the skin.” The fungus can be spread by skin particles left on shower floors, around swimming pools, on towels and shoes. “Once it’s on the skin and in the environment, it’s easy to re-contaminate itself because it’s a fungus, it’s contagious and it’s found everywhere in the environment – showers, beds, shoes, socks,” Dr. Eriksen says.

Did you know? You can get athlete’s foot on your hands. The fungus is equal opportunity, so if your hands are often in that moist, warm environment that the fungus favors, or if your hands come into contact with the fungus and you have a break in the skin on your hands or fingernails, it will make the leap there. enhance magazine

Who gets athlete’s foot?

Contagious and ubiquitous

health education • foot fungus

What to look for

Prevention To keep fungal infections at bay, take some common sense steps: your socks regularly – that might include more than once a day if you sweat a lot. Cotton-blend socks are better than 100 percent cotton socks for keeping the feet dry. n Keep your environment clean – especially in wet areas like the bathroom. Clean your shower or tub with bleach or Lysol at least once a week, especially if you share the room with others. n Check your feet in between the toes and your nails for breakage. n Spray your shoes with Lysol once or twice a week. n Change your shoes after every 500 miles (three to six months depending on how active you are). n Be careful in public areas because you can cross contaminate that way. Always wear flip-flops in public showers like locker rooms or dorms. And it doesn’t hurt to wear them at home if the kids are at the pool or locker room a lot.

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n Change

“If someone is continually getting athlete’s foot, I have them use anti-fungal powder every morning and change their socks and apply more powder in the middle of the day,” Dr. Fine says. “I tell them to get in the habit of just using an anti-fungal powder forever.”

n itching,

burning or stinging between the toes or on your soles n scales, cracks, cuts, peeling skin or blisters between the toes or on your soles n dry skin on the sides or bottoms of your feet n bumps on your feet n cracked, blistered or peeling areas between your toes n redness and scaling on your soles It’s easy to hope that the itchiness or dry skin will go away on its own or with some simple moisturizer, but you need to pay attention to the condition of your feet to make sure it doesn’t develop into something more serious.

Athlete’s foot on the sole of the foot

Athlete’s foot with a secondary bacterial infection

Another way

“One mistake people athlete’s foot can make is that they don’t appear treat it in a timely manner; they think it will go away,” Dr. Fine says. “In my opinion, the hardest thing is not getting rid of foot fungus, but keeping it from coming back. Moisture has a lot to do with that, especially with teenagers – they get athlete’s foot all the time. The fungus loves that warm, moist environment that the feet are in.” The fungus is an opportunistic infection, which means it can strike harder on those who already have compromised immune systems, such as diabetics.

Treatment If you catch it early, over-thecounter products such as antifungal powder or creams and ointments can do the trick. And if the infection has reached your toenails, a pill like Lamisil will attack the infection through the bloodstream. But make sure to monitor your feet and don’t assume the infection will go away by itself. “A lot of people try over-thecounter medication first, which, if it’s a minor case, is OK,” Dr. Fine says. “But if you’re not getting anywhere after a couple of weeks or you see that it’s getting worse, then it’s worth getting it checked out. There’s a fine line between jumping the gun and sitting on it too long and letting it get worse.” An important part of the treatment is not only to deal with your feet, but also your environment. “When you treat a fungus, you have to not only treat the feet, but you have to look at the shower and the shoes,” Dr. Fine says. “Fungus is everywhere – you’re exposed to it all the time.” So, clean the shower with Lysol and bleach. Wear flip flops in the shower even at home once there’s been an infection. If one person in the house has the infection, it’s all too easy to pass it along. “When athlete’s foot gets bad, it’s usually not because the over-thecounter stuff isn’t working,” Dr. Eriksen says. “It’s usually because people haven’t been treating it at all and it’s allowed to get worse.”

There is a better way to treat and prevent seasonal allergies. No more relying on partially effective medications. No more time-consuming trips and painful allergy shots. Now, patients of all ages can find lasting relief with under-the-tongue allergy drops that can be taken at home. AllergyEasyâ&#x20AC;&#x2122;s oral drops work faster than allergy shots, and theyâ&#x20AC;&#x2122;re safer. And unlike over-the-counter or prescription medications, they treat more than just the symptoms. AllergyEasy gets to the root of your allergy problems for lasting relief.

SAfE: In more than 60 years of use in Europe and 25+ years in the U.S.; endorsed by the World Health Organization CONvENiENT: Because the allergy drops are so safe, it is self-administered at home. Simply place drops under the tongue, hold them for two minutes, then swallow. EffECTivE: Because the drops are so easy to use, patients are more likely to stick with the program compared to shots.

Ask your family doctor, pediatrician or ENT about the AllergyEasy Prescription. Or call 866-809-8519 to find a primary care doctor near you.

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A complete allergy and asthma immunotherapy program for primary care providers to offer convenient relief and healing – newly available in the Kansas City area.

How do allergy drops work?

How long until i feel better?

While medications may put a temporary stop to allergy symptoms, they are a short-term fix. The lasting solution is to treat the source of the problem through a process known as desensitization.

The vast majority of AllergyEasy patients experience marked symptom relief within the first couple months of starting treatment, and some feel better in just a few weeks. (Allergy shots, on the other hand, can take up to two years to produce results.)

AllergyEasy uses oral drops (rather than shots) to desensitize your body to allergies. The drops contain extracts of the dusts, molds, pollens and pet dander that give you the most trouble. We use a universal mix of a large number of antigens, which gives you much more thorough protection against the allergic world. When placed under your tongue, they absorb into the bloodstream. As you take the drops in gradually increasing concentrations, your immune system learns to make peace with “enemy allergens” over time, bringing an end to troubling allergy symptoms.

Are there any risks or side effects? Oral allergy drops are extremely safe and have never been associated with any serious health risks. In fact, they are safer than allergy shots, which carry a risk of life-threatening anaphylactic reaction.

big improvement over allergy shot programs, most of which require children to wait until age 7 for treatment.

When were oral allergy drops developed? Oral drops therapy (also known as sublingual immunotherapy) was developed over 60 years ago. It is widely used throughout the world and is especially popular in Europe where more than 50 percent of patients receiving allergy immunotherapy use drops rather than shots. The oral therapy drops are endorsed by the World Health Organization.

How do i get started? Does the program work well for children? First, get a brief allergy test and Yes. Nearly painless testing and shot-free therapy allows AllergyEasy to safely and successfully treat children as young as infants. That’s a

prescription from your primary care doctor. Then, begin taking your allergy drops at home. Easy as that!

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Valery Webb, CNM

The Women’s Healthcare Group is proud to provide the very best in Midwifery Services. We are pleased to announce the addition of two experienced, certified nurse midwives to our team of healthcare providers. Valery Webb and Deann Martin are currently scheduling appointments in our Overland Park and Lawrence offices.

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Kathleen Stone, M.D.

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D.O. (Overland

Jennifer Riggs, Kristi Torline,

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health education • diagnosis

Advanced technology doesn’t always provide the tools doctors need to pinpoint the causes of patients’ suffering By Heather Winslow Gibbons and Gina B. Kellogg

From a simple physical exam to blood tests, imaging and biopsies, diagnostic tests can help doctors quickly and accurately name the cause of a patient’s suffering and determine the best way to relieve it. But when it comes to a small percentage of patients – those with chronic pain for instance – test after test fails. They and their doctors are left without answers, without direction. The

trial-and-error process that ensues can be ineffective over the long term, not to mention costly and frustrating for both the doctor and the patient. The problem? Doctors don’t yet have the tools to help them diagnose symptoms that can’t be seen under a microscope or with an MRI. Pain is one of these imprecise variances. And, so far, the medical world hasn’t been able to invent a diagnostic tool to help measure it.

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Diagnosis Detectives 31

health education • diagnosis

Dr. Rebecca Burfeind of Pain Management Associates, a clinic with 10 sites in the Kansas City metro area, deals with the dilemma of diagnosing pain on a daily basis. The majority of her patients have chronic pain conditions related to the spine, joints, cancer, arthritis, headaches or complex regional pain syndrome, which usually affects the spine, arms or legs and can occur after an injury or surgery. For Burfeind, diagnosing the source of pain is rarely simple. She gives the example of a patient who has suffered chronic pain for 20 years, yet numerous MRIs, X-rays and nerve-conduction studies could not reveal from where the pain was coming. “Pain can be nebulous. It’s frustrating for the patient and for their physician when we can’t find a definitive cause,”

Burfeind says. When she can’t identify and treat the cause of pain, Burfeind resorts to treating the symptom of pain. But even that technique presents challenges because Burfeind can’t definitively measure a patient’s suffering on a comparative scale. Without a diagnostic tool, her only option is to ask questions to help her determine a person’s level of pain. Unfortunately, that technique can lead to other medical issues. “A patient doesn’t want to be perceived as someone who just wants to take pain pills, so he or she will sometimes downplay the pain,” Burfeind says, adding that for many patients, being “good” means not needing pain medicine. They might underreport how much medication they are taking, what treatments they have tried or how the

pain has affected their activity level, work and personal relationships. This underreporting can lead doctors to assume the problem is less serious than it is and can create a “pseudo addiction,” where a patient takes too much pain medicine because the pain is undertreated. The subtle yet severe side effects of chronic pain – depression, anxiety and insomnia, for example – are also underreported. And these side effects can cause as many problems as the pain that initiates them. Dr. Jim Lemons, director and medical psychologist with the Lemons Center for Behavioral Pain Management, Lenexa, Kan., notes that “thoughts and behaviors really do have an effect on how we feel and behave,” he says.

From left: © istockphoto.com / Alexander Yurkinskiy, Jason Woodcock

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the side effects of absent technology

BEHAVIORIAL PAIN MANAGEMENT

Don’t let chronic pain hold you back. We can help.

We recognize pain is a multi-faceted mind-body experience affecting the whole person, not just a particular body part. The goal of behavioral pain management is to reduce pain to the lowest possible degree and allow you to live your life to the fullest. Our multi-disciplined approach integrates psychology, physical therapy, medication management and pain management education — all in one convenient location. Using these services, we develop personalized treatment plans that consistently produce: reduced medical appointments, enhanced healing, less use of medications, reduced costs, improved quality of life and reduced pain levels. And we work cooperatively with your physician.

American Academy of Pain Management

PAIN PROGRAM ACCREDITATION

The Lemons Center has provided behavioral pain management to chronic pain patients for over 12 years. It is the only behavioral pain management accredited program in Kansas and Missouri. The center was founded by Dr. Jim Lemons, a licensed psychologist, who was formerly with the Mayo Clinic.

Call to learn more about how we can help free you from the burden of chronic pain. There is hope. We’re here to help.

www.lemonscenter.com 913-383-8977

health education • diagnosis

options for now

Ou Ask r S Ab pe ou cia t ls!

Until researchers develop techniques to measure and define pain, medical professionals will have to be creative with solutions in treating it. Lemons handles the problem by teaching his patients behavioral pain-management techniques, an approach that uses stress-management training, behavior modification, cognitive-behavior therapy and physical therapy to teach people how to adjust their thinking and behavior to help cope with pain. These therapies only work, however, if the patient and doctor have built a strong relationship based on trust. Patients need to leave their doubts at the door and have an open mind. “It’s not voodoo,” Lemons says. “Everything we do is based on science,

physiology and biochemistry.” Burfiend also focuses on developing trust with patients so they will be as honest as possible in defining their pain. “Patients need to know that I believe they have pain and that, even though I don’t know the cause of it, I’m going to develop a treatment plan so they don’t have to suffer an ongoing issue,” Burfeind says. Undoubtedly, researchers will rely on some of the same concepts Lemons emphasizes – science, physiology and biochemistry – to develop tools to measure pain. Until then, doctors will be dependent on some low-tech methods for diagnosing and treating pain and its debilitating side effects.

“A patient doesn’t want to be perceived as someone who just wants to take pain pills, so he or she will sometimes downplay the pain.” – Dr. Rebecca Burfeind, Pain Management Associates

Kansas City may not have palm trees and ocean views, but we do have a hidden treasure in Armour Oaks Senior Living Community. Come explore this tranquil, centrally located campus where the locals are friendly, and the livin’ is easy.

• New rental apartments without a buy-in fee • Garden villas • Assisted living and skilled nursing care

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• Locally owned and operated not-for-profit organization

816-363-5141• www.armouroaks.org 81st and Wornall, Kansas City, MO • info@armouroaks.org

There is no guessing when it comes to success.

We encourage you to learn as much as possible, so you can be confident about the decisions you make. We are the region’s most experienced in helping infertile couples become parents. We’re also the region’s leading innovator with a full range of treatment options ranging from minimal therapies to high-tech procedures. So learn the facts, check the stats. Visit rrc.com or call (913) 894-2323.

Celeste Brabec, M.D. • Ryan Riggs, M.D.

health education • cancer diagnostics

Cancer detectives solving diagnostic

PUzzles

New and improved technol0gies help uncover clues on fighting cancer

Jill Robke didn’t have cancer. She was in excellent health for a 40-year-old. Plus, she had taken all of the steps doctors recommended to reduce her risks of two fatal cancers for women: breast cancer and ovarian cancer. For example, she was of normal weight, had given birth to her first child before age 30, took oral contraceptives and performed monthly breast self-exams. Her doctor performed a variety of tests and was fairly certain no cancer existed in her body. Nevertheless, this past February, Robke had an ovariohysterectomy. A surgeon removed her uterus, cervix, upper vagina, parametrium, lymph nodes, fallopian tubes and ovaries. Robke is still recuperating, though five months have passed. The surgery also introduced new health issues Robke didn’t previously face. For example, her estrogen levels are now sharply reduced. This has led to “surgical menopause,” where the sudden hormonal shock to her body caused the rapid onset of menopausal symptoms. So Robke is now on hormone replacement therapy. In addition, because she no longer has ovaries, she now faces a seven times greater risk of cardiovascular disease, along with an increased risk for osteoporosis. Plus, due to the oophorectomy (the removal of her ovaries) before age 45, she has a fivefold mortality risk from neurologic and mental disorders. But to Robke, those risks were worth it. That’s because, by having the surgery, she reduced her probability of

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By Gina B. Kellogg

developing ovarian cancer by almost 100 percent. And that disease almost certainly would have killed her. Robke’s decision to have the surgery came after the discovery that her father carried a gene mutation called BRCA1 (breast cancer susceptibility gene 1). Subsequent tests showed that she had inherited it, too. According to the National Cancer Institute, BRCA1 is a human gene that belongs to a class of genes known as tumor suppressors. Mutation of this gene has been linked to the development of hereditary breast and ovarian cancer. “Individuals that have BRCA1 have a 40 percent chance of developing ovarian cancer and an 80 percent chance of developing breast cancer,” she says. Robke’s decision to remove seemingly healthy tissue was based on the simple fact that ovarian cancer is difficult to detect in the early stage of growth and once it is discovered, the survival rate is very low. Before 1990, when researchers discovered BRCA1, Robke would not have known about her risks for these cancers because they weren’t obvious in her family history. But knowing she had inherited this gene let her fight it even before a diagnosis. Her first step was surgery; the second is regular mammograms and breast MRIs every six months, as well as biannual clinical breast exams. Catching breast cancer at its earliest stage will help improve her odds of beating that disease. “I feel very lucky to have this information,” she says. “I don’t want to be the one person that knew of her high risk for breast cancer and failed to detect it early.” Robke’s journey is an example of how the extraordinary advances in risk identification and diagnostic testing are helping doctors detect and better treat cancer today. From genetic testing to precise imaging technologies and diagnostics in pathology, doctors now have tools our grandparents could never have imagined.

“I feel very lucky to have this information. I don’t want to be the one person that knew of her high risk for breast cancer and failed to detect it early.” – Jill RObke, Kansas City pharmacist enhance magazine

FROM LEFT © istockphoto.com / blackred, Georgo

health education • cancer diagnostics

health and •wellness health education cancer diagnostics

“If we can determine the people who are at risk, then we can prevent those cancers from recurring or detect and treat them early. This leads to a higher cure rate.”

Genetics: The First Tactic of the Cancer Detective Dr. Thomas Jeffery Wieman, medical director of the Cancer Institute at Saint Luke’s, Kansas City, Mo., is sympathetic to Robke’s relief at knowing her genetic family history, especially because she lacked the familial medical trail of those who develop ovarian and breast cancer. Usually, that’s how most women discover their risk for the disease. “The single most common way in which cancer is diagnosed,” Wieman explains, “is by taking of a good history and physical. The suspicion of cancer is developed using those two methods.” Wieman says breast cancer is the perfect example of how important genetics can be in cancer detection. The identification of BRCA1 is probably the most well-recognized genetic test and now a common one. “This defective gene is thought to be responsible for 5 to 7 percent of all breast cancers,” he says. Here’s how the test typically works: A medical specialist draws blood from a woman on the basis of her family history. If DNA analysis shows that a genetic alteration is present, the doctor knows that patient is at a substantially greater risk for developing breast cancer.

Breast cancer isn’t the only cancer where genetics play a role, however. “Today we have tests that detect people who are at risk for colon cancer and cancer of the female genitalia, ovaries and endometrium,” Wieman says. “There are also tests that detect families that are susceptible to different types of cancer. One of those would be HNTCC, which stands for hereditary nonpolyposis colon cancer. The single largest cause of colon cancer is of a hereditary nature.” Genetic tests are so important because genetic cancers affect younger people.

“If we determine the people who are at risk,” he says, “then we can prevent those cancers from recurring or detect and treat them early. This leads to a higher cure rate.” Diagnostic Devices Offer New Clues Diagnostic tools that help doctors determine if a person has cancer have become increasingly sophisticated. “The diagnostic tools available today, compared to 10 years ago, have significantly advanced, and that has aided oncologists and specialists in determining if a patient has a problem or a possible cancer, which aids in that earlier treatment,” says John Myers, director of clinical services and product line development at Kansas City Cancer Center. “I think they have more tools at their fingertips to make that best decision.” Depending on the part of the body and the type of cancer a doctor suspects, the physician can use one or several diagnostic tools. For example, Myers says, consider a patient who goes to his primary care physician complaining of a cough. The patient is a long-time smoker, and the doctor sends him to a pulmonologist, who specializes in lungs. The pulmonologist orders a CT scan, along with multiple other tests, and sees the patient has a nodule. “He’s not sure if it’s benign or malignant, but he sees the patient has a something in his lung,” Myers says. “We

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– Dr. Thomas JEffery Wieman, medical director at the Cancer Institute at St. Luke’s Hospital

You are told you have cancer.

Your first reaction will be to get moving… begin the battle, now.

It is this impulse you must fight first.

Consider the possibilities only The University of Kansas Cancer Center can offer. Getting a cancer diagnosis can be very emotional. Even more difficult, one of your earliest decisions…about where you ultimately receive your care, will likely determine how well you do. You want to move quickly. Before you do, please consider having your case reviewed by a specialist at The University of Kansas Cancer Center. Your care team will be aggressive in evaluating treatment methods newly proven in the research and consider possible enrollment in active clinical trials going on now. In fact, University of Kansas researchers played lead roles in formulating many of the cancer drugs used today. This is academic medicine. You won’t find treatment more in tune with what’s possible. To discuss your options or inquire about clinical trials call (913) 588-1227. Or, for more information, go to kucancercenter.org.

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call those solitary pulmonary nodules.” Myers says PET-CT is good at helping the pulmonologist determine what the next step should be. For example, if the nodule is very small, the doctor might decide to do nothing for the moment and have the patient return regularly for additional scans to watch whether the nodule grows or disappears. If it is larger, he might decide to do a biopsy. The size of the tumor can also help the doctor determine what stage the cancer is. Myers says a variety of tests are necessary because various cancers affect each person differently. There are some diseases that won’t show up using PET, for example, so those patients

A PET-CT scan

might need a CT or an MRI for accurate diagnosis. “Doctors have a pretty good sense of and understand the current science where PET/CT plays a crucial role and where the other modalities play an important role,” Myers says. Sometimes other factors determine which method of testing is necessary. For female patients with dense breast tissue, for example, doctors typically request a breast MRI (a machine dedicated to imaging breasts), rather than a mammogram. “You can get much more detailed information from an MRI than you can get from a mammogram,” Wieman says. “It is complementary to a mammogram but does not replace a mammogram, particularly when it comes to a genetically linked breast cancer.” To get a definitive diagnosis for breast or lung cancer, doctors need even more sophisticated methods. “By doing biopsies we can remove a sample of tissue and test to see if it is actually a cancer,” Wieman says. Biopsies are where new and advanced pathology procedures come into play.

The Ploy of Pathology: Outwitting the Nemesis Talking to Dr. Phillip Munoz, you wouldn’t think pathology is at the end of the continuum of cancer diagnostics. “Pathology is really the starting point,” he says. “An individual may come in with symptoms or signs that are very highly indicative of cancer,” says Munoz, a pathologist for Kansas City Cancer Center. “But, still, the type of cancer and the specifics as to how it is going to be treated becomes very much an issue of tissue. We’re the people who make that diagnosis.” Before he can make that diagnosis, however, Munoz must deal with that “issue of tissue,” and it starts with the biopsy that Wieman described. Reviewing biopsy samples at Munoz’s lab is time-intensive and critical to ensuring the pathologist can accurately examine and test the sample. Once he has determined whether the tissue is benign or malignant, Munoz adds stains to get specifics about the tumor. If those don’t reveal answers, he may turn to an immunohistochemical stain (IHC). Munoz anticipates a lot of growth in IHC research in the next few years. “The biggest advance I’ve seen in my career has been the advent of immunohistology,” he says. The IHC stain uses antibodies to identify specific antigens on the surface of cancer cells. (Antigens are any substance that causes the body to make a specific immune response.) IHC stains give Munoz clues to determine where in the body the cancer started, help him distinguish among different cancer types and help him diagnose and classify leukemias and lymphomas.

health education • cancer diagnostics

With suspected breast cancer, for example, Munoz says the cancer cells are likely to be responsive to anti-estrogen therapy. To test that theory, he applies antibodies to the sample tissue and determines whether the tumor cell has estrogen receptors on it. “That’s just the beginning of where this field has taken us,” he says. Immunohistology is not the only area in which Munoz has seen advances. He’s also been awed by the technological achievements of flow cytometry. This measurement technique identifies the number of cells, the percentage of live cells, cell size and shape, and the presence of tumor markers on the cell surface. Tumor markers can be a critical part of identifying specifics about a cancer. They are substances produced by tumor cells in response to cancer. Like stains, researchers use tumor markers today in ways they didn’t originally anticipate. “Ten years ago, we were using these markers for these very broad categories,” Munoz adds. “Now we’re using them to very specifically address whether patients are going to be treatable with certain types of medications.” In a patient with breast cancer, for example, Munoz says the pathologist would look at whether the cells in the tumor have a marker called HER-2/ NEU. “That is a marker which, in one respect, identifies an aggressive tumor with a poor prognosis. But it also highlights a potential therapy for that patient that is remarkably effective,” he says. As quickly as the area of immunohistology is advancing, however, Munoz sees the field making even greater progress in the areas of molecular diagnostics. A CT scan machine

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health education • cancer diagnostics

“We’ll be looking at how individuals metabolize drugs of all different sorts, whether it’s for cancer or for cholesterol or for anything. In cancer in particular,” he adds, “we’re going to be looking at pathways of cells that are turned on and hoping to find ways to turn them off so that we can bring a cancer back under normal control.” Munoz admits that research will always have a goal to hit a home run and find a way to cure cancer. But he suggests that an acceptable alternative might be to find a way to down-regulate the growth of cancerous cells and turn a malignant and fatal disorder into a chronic disease that is easy to manage. “Certainly, some cancers are more of a nuisance diagnosis than a true disease,” he says. “If we can make some of the bad ones more of a nuisance diagnosis, well, I think we can all live with that.”

“The future is becoming more and more molecular,” he says. Molecular diagnostic studies investigate the presence or absence of malignant cells and genetic or molecular abnormalities in specimens. The advances are coming at a pace that can be difficult to keep up with. “I always have the vision that if I don’t keep up with this, I’m going to be standing on a corner with a tin cup asking for handouts,” Munoz says with a laugh, “because of much of the way things are being presented in medical literature today is very molecular, genetic-related.” In the future, Munoz anticipates the introduction of immunopharmacology (the science of drugs that affect the immune system) or molecular pharmacology (the study of how drugs work on a molecular basis) to his medical techniques.

Discovery

As one of the few hospitals in the nation to install a 128 slice CT scanner, and the first in Missouri and Kansas, Truman Medical Centers provides the latest technology to see you more effectively, inside and out. And having a better view of you, means we can provide a faster, more accurate diagnosis. More importantly, our person-first approach puts the health needs of our patients before profits and allows our doctors to never have to compromise on care. Discover Truman Medical Centers.

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For more information, call 816.404.0760.

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without compromise.

health education • cancer diagnostics

the top 6 diagnostic tools for cancer John Myers, director of clinical services and product line development at Kansas City Cancer Center (with locations around the Kansas City area), identifies the top six diagnostic tools for cancer and how they have advanced.

1. X-rays

Myers says the most significant advances in X-rays have been the move from analog to digital (CT or CAT scan, for computed tomography or computerized axial tomography), which lets radiologists view multiple x-rays taken at different levels on a computer rather than on film. They can see a three-dimensional image of the object from a series of 2-D images taken from a center axis of rotation. For example, digital-measurement tools allow radiologists to compare past x-rays or scans with recent ones to see whether subtle changes have occurred over time.

2. Ultrasound

This is the use of sound waves to view internal structures of the body. Most of the advances with ultrasound have been in the functionality of the machines. “They’re getting smaller,” Myers says. “They’ve advanced to the point where they come in laptopsize units, so they are very mobile and versatile for ultrasound techs and physicians.”

3. MRI

“MRI (magnetic resonance imaging) uses a powerful magnetic field and radio-frequency pulses to produce detailed pictures of the internal body structures,” Myers says. “Throughout the last decade or so, there’ve been advances in the strength of that magnet. And using that, we’re able to get better images of specific body parts. And we’re able to do more with MRI.” A specialized form of MRI is magnetic resonance spectroscopy (MRS), which doctors use to measure the levels of different metabolites in body tissues. This can help them diagnose some metabolic disorders to provide information on tumor metabolism. “Spectroscopy using MRI to do breast imaging has been a huge advance,” Myers says.

A PET-CT (positron emission tomography-computed tomography) combines the anatomic detail of the CT with the metabolic information of PET. “A small amount of radioactive material – actually radioactive glucose – is injected into a patient,” he says. “That radioactive glucose is taken up by all cells but is taken up at a more rapid pace by cancer cells. Because of that, we’re able to pinpoint where they are.” Immediately after the PET scan, the patient is scanned using CT technology. “Then, those images are fused together,”

4. Nuclear medicine

“This form of diagnostic imaging uses small amounts of radioactive material to diagnose or treat many types of diseases,” Myers says. It combines radionuclides (atoms with an unstable nucleus) with other chemical compounds or pharmaceuticals to form radiopharmaceuticals. When this is injected into the patient, the particles gather in specific organs or cellular receptors. This lets researchers see the extent to which a disease has spread in the body. In some diseases, nuclear medicine studies can identify problems at an earlier stage than other tests. PEM (positron emission mammography) is making a huge impact in the cancer diagnostics world. Myers says this tool looks similar to a traditional mammography system but, instead of shooting X-rays to provide an image of the breast, the doctor injects radioactive sugar water into the patient. “With a PET mammogram, you can potentially see that what looks to be a normal-size structure on a traditional mammogram but says it’s ‘lighting up’ on the PEM. That means there’s something going on – there’s some active process that is causing these cells to take more of this radioactive sugar water up,” Myers says.

6. Optical imaging

This imaging technique, which allows medical professionals to view inside the body, is “probably where a lot of the future advances are going to come,” Myers says. “That’s because, at its base, it’s a relatively simple technique. In the case of breast cancer, for example, a nanoparticle loaded with a fluorescent dye can be injected into the body and taken up by specific cancer cells. Optical imaging can detect the fluorescent dye and identify the precise location of those cancer cells. While research is still in early phases, this modality appears to be very promising for detecting and treating cancers.”

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5. PET-CT

Myers says. “So you’re able to see the details from the PET scan precisely overlaid on the CT to see the tissue structure that is abnormal. It’s as precise as you can get.” Many hospitals and cancer centers have been replacing conventional PET devices with PET-CTs.

Navigating the

Todayâ&#x20AC;&#x2122;s medical tests might not be revealing the true cause of a disease that is devastating

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By Gina Kellogg and Diane E. Samson

ÂŠ istockphoto.com / Image Depot Pro, Rocco Montoya

our community

health education • cholesterol

“Cholesterol is carried inside the lipoprotein particle much like a passenger inside a vehicle. It’s not the number of passengers that causes a traffic jam on the highway; it’s the number of vehicles on the road. Similarly, it’s not the amount of cholesterol that causes heart disease. It’s an overabundance of bad lipoprotein particles that create the sticky plaque inside the artery wall.” – Dr. Mike Catausan, exclusive MD in Leawood, Kan.

Health Highway already begun to build up in her arteries? Testing for a Risk Many doctors rely on a traditional battery of tests to understand a patient’s medical issues. But some of these tests were never intended to be tools for diagnosis. That is, the tests are helpful to doctors in pointing out risk factors that could lead to health issues. But the tests themselves can’t diagnose that the problems definitively exist. In Jane’s case, her doctor interpreted her high cholesterol tests to mean that she was going to develop heart disease unless she reduced her cholesterol numbers. Over the years, they began breaking out her cholesterol into LDL (low-density lipoproteins) and HDL (high-density lipoproteins), which led to different interpretations of her cholesterol and its affect on her body. But even these interpretations didn’t give her doctors an accurate picture of her heart and artery health. That’s because doctors had been looking at a test that was never intended to diagnose heart disease. Cholesterol testing was only supposed to help show who might be at risk. As it turns out, the test might not be very effective at measuring any aspect of heart or artery health.

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Jane didn’t feel ill. When she was in her mid 20s and only a few pounds overweight, she exercised regularly and felt energetic. After a series of tests at a health fair at her office, she was surprised when the clinician told her she should follow up with her doctor because her cholesterol was pretty high. Jane’s doctor reviewed the results of another blood test. “We need to get you on some medicine and in front of a nutritionist as soon as possible,” he told her. “You’re at serious risk for heart disease.” Before she even realized what was happening, she heard a nurse on the phone asking if an appointment was available in the next hour. Jane was stunned. Was her health so bad that they thought she needed to take steps to amend it that very day? But she felt fine! In the 20 years since, Jane has taken cholesterol-lowering medications every day – more than 7,000 pills in all. She regularly has her blood tested to determine her cholesterol levels and has even had several heart tests, such as a treadmill test, sonogram and EKG. Each time, they showed her heart was strong and fit. She credited the cholesterol-lowering drugs. Still, Jane worried that she wasn’t doing enough to protect her heart. Surely, techniques exist to determine whether plaque has

health education • cholesterol

N av i g at i n g t h e h e a lt h h i g h way

The cholesterol conundrum When you understand how the problems with cholesterol tests evolved, you’ll know how critical it is for you to work closely with your doctor to identify what tests you need, especially if you have multiple risk factors for heart disease. We need to dissect what cholesterol is, how it relates to artery disease and how it became trusted as a marker for heart health and disease.

There is no bad or good cholesterol. It is actually the particles that carry the cholesterol that are good or bad, not the cholesterol itself.

The purpose of cholesterol Despite its bad reputation, cholesterol is actually essential to our health. It constructs the outer coating of cells, creates acids to digest food and helps make vitamin D and hormones. The liver produces 90 percent of the cholesterol in the body; 10 percent comes from diet. (Trying to eliminate that 10 percent by eating a fat-free diet doesn’t help lower your cholesterol levels. In fact, a fat-free diet actually signals your body to shift into warp speed to produce more cholesterol, which is a necessity for optimal health.)

The bad rap Researchers originally thought that too much cholesterol causes plaque to build up in the arteries, leading to a heart attack or stroke. Cholesterol is a fat, and just as water and oil do not mix, neither does cholesterol and your blood. Therefore, to safely transport the muchneeded cholesterol through your circulating blood stream, your body creates a vehicle – called a lipoprotein particle. These particles are a key component in understanding your heart-health risk – and they are where the distinction between bad LDL and good HDL cholesterol occurs. In reality, there is no bad or good cholesterol. It is actually the particles that carry the cholesterol that are good or bad, not the cholesterol itself. Science has known for a long time that a causal relationship existed between lipoprotein particles and heart disease. When researchers discovered this in the 1960s, they didn’t have the technology to measure the tiny carriers; scientists could only measure the cholesterol inside them. As a result, medical professionals assumed that by measuring the cholesterol within the particles they could determine the number of particles in the blood.

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The real suspect: Lipoproteins

In the years since, technology advanced and scientists began to see direct connections between the particles and heart disease. When researchers finally had the equipment to see and measure the particles, they looked at the levels of lipoprotein particles and the incidences of heart disease. Their discovery was a significant breakthrough in monitoring heart health. First, they learned that the amount of cholesterol within each particle varies widely from patient to patient. More importantly, they determined that the concentration of LDL particles in a person’s blood is a radically better predictor of atherosclerosis and other diseases than the cholesterol contained within the particles. Scientists now know that the high concentrations of LDL particles migrating through the artery wall create the plaque that causes heart disease, not the cholesterol. Lower the number of LDL particles, and you eliminate the cause of the disease.

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health education â&#x20AC;˘ cholesterol

health education • cholesterol

N av i g at i n g t h e h e a lt h h i g h way

A traffic jam in your arteries Studies support the lack of connection between high cholesterol and heart attacks. The results of the Framingham Heart Study reported in a peer-reviewed study in the American Journal of Cardiology that 50 percent of people who suffered from a heart attack had normal LDL-cholesterol levels.

Plaque progression

Dr. Mike Catausan

“I explain to my patients that cholesterol is carried inside the lipoprotein particle much More LDL particles like a passenger inside a vehicle. It’s not the number of passengers that causes a traffic mean more plaque Plaque Progression: More LDL particles = more plaque jam on the highway; it’s the number of vehicles on the road. Similarly, it’s not the amount of cholesterol that causes heart disease. It’s an overabundance of bad lipoprotein particles that create the sticky plaque inside the artery wall.” – Dr. Mike Catausan, a family practitioner at exclusiveMD in Leawood, Kan.

Dr. Tara Dall

“Multiple clinical trials have shown LDL particles better predict who dies from a heart Low Borderline High LOW attackplaque as compared to LDL cholesterol. In fact, it doesn’t matter if your LDL cholesterol ue Progression: More LDL particles = more is high or low; it is the LDL particle number that determines survival. There are people with high cholesterol who really aren’t at risk and don’t go on to develop heart disease. We really don’t want to just give them all medication to bring their cholesterol down.” – Dr. Tara Dall, a Delafield, Wis., lipidologist who specializes in early detection of heart disease and diabetes

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Borderline

High HIGH

Dr. Daniel Stock High “Before I switched to NMR analysis, I would have two to three patients a year who would have heart attacks or strokes despite having low levels of LDL-C, many with the rest of their lipid panels normal as well. After I learned about NMR I began to see why. They would come back after their attack and I’d test them with NMR and find they had high levels of LDL particles that just happened to contain little cholesterol. When I started treating their LDL-P, my patients quit having attacks. I’ve only had five heart attacks or strokes in 10 years since then, and each of those cases had another reason for their attacks besides LDL-P.” – Dr. Daniel Stock, a board-certified lipidologist from Indianapolis, Ind.

Low Borderline Borderline ore LDL particles = more plaque

health education • cholesterol

What Is the NMR Lipoprofile Test?

Identifying lipoproteins In this cross-section of your artery, the center of the circle represents circulating blood, plasma, lipoproteins, and platelets. The round spheres represent low density lipoprotein particles (LDL-P). Variable levels of cholesterol can be found within the particles but do not cause disease. At high concentrations, the LDL particles will transfer through gaps in the inner lining of the artery wall. The space between the outer and inner artery walls is called the intima. Over time, the LDL particles found within the intima of the artery are oxidized and converted to a sticky substance called plaque. If LDL-P levels in circulating blood are elevated over time (10 to 15 years) plaque will build up and may push against the inner lining of the artery. In some cases the plaque build-up may significantly restrict blood flow in the artery. Stints are often placed in the artery to control the restriction caused by plaque. Occasionally, the plaque will rupture through the inner wall of the artery and flood the blood stream which could cause a stroke.

It’s a way to determine a person’s risk for cardiovascular disease by measuring the number of LDL particles. The amount of cholesterol carried in LDL particles varies from person to person. As a general rule, doctors use a multiplier of 10 when comparing test measurements of LDL particles (LDL-P) and LDL cholesterol (LDL-C). Patients with heart-disease risk factors should target an LDL-C goal below 100; LDL-P should be below 1,000. Healthy individuals with no family history are considered at low risk as long as their LDL-P is below 1,300. Therapy can range from diet and exercise to medication – the same medication, in fact, that lowers LDL-C (or raises the good HDL-C). Specifically, physicians may place patients on low doses of statin drugs along with prescription-grade fish oil or niacin vs. prescribing high doses of a single medication. Medicare, Medicaid and most major insurance companies cover the test. It can be ordered through LabCorp and most local hospital labs that have access to Mayo Reference Lab. Be sure to specify NMR Lipoprofile; there are other advanced lab tests that are available but lack the robust accuracy of NMR technology. The cost is about $85 if you send it directly to the lab that engineered the technology: www.Liposcience.com.

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health education • cholesterol

N av i g at i n g t h e h e a lt h h i g h way

Health Education Disconnect If experts agree that measuring cholesterol levels isn’t the best way to determine heart disease risk, why hasn’t the medical community switched to measuring particle levels?

Old Habits Cholesterol testing is in the top-five most-ordered clinical lab tests year after year. Plus, it’s hard to change the test-ordering paradigm when pundits continue to refer to cholesterol as “good” and “bad” and use the word “cholesterol” when they actually mean “LDL.” (Remember: LDL particles – in high concentrations – cause disease; LDL cholesterol is simply along for the ride.)

Limited availAbility

The test for measuring lipoprotein particles, called the NMR Lipoprofile Test, is proprietary to the company that spent years developing and testing the technology, LipoScience, Inc. Its promotion is in the hands of one firm, and marketing is expensive and time-consuming.

An educational movement The American Association for Clinical Chemistry released a position paper two years ago on the topic. It said an educational movement was under way “to help physicians understand that the concentration of the total number of lipoprotein particles circulating in blood is more strongly and reliably correlated with cardiovascular risk than are measures of LDL-cholesterol concentration and ought to be used instead.” The authors recommended that physicians start to measure both LDL cholesterol and either the LDL particle concentration or the apolipoprotein B concentration, (each LDL particle contains one molecule of apoB that is measurable in a clinical lab).

Ice cream and crime What does this mean? It’s the same sort of “relationship” that exists between ice cream sales and crime. Statistics show that when ice cream sales increase, so does the crime rate. Does that mean that ice cream sales cause crime? Of course not. But this is how the cause vs. association relationship develops in people’s minds concerning medical tests and disease. When summer weather entices people outside, they often buy ice cream. When more people are out eating ice cream and enjoying the warm weather, crime rates increase. While the two may have a strong correlation or association, one does not cause the other. Similarly, when those with heart disease who have high levels of cholesterol while simultaneously having high levels of LDL particles, it doesn’t mean their high cholesterol caused their heart disease. Instead, the LDL particles created the environment causing artery disease; we simply have mistakenly associated cholesterol with the illness.

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When those with heart disease who have high levels of cholesterol while simultaneously having high levels of LDL particles, it doesn’t mean their high cholesterol caused their heart disease.

health education • cholesterol

N av i g at i n g t h e h e a lt h h i g h way

NMR Technology Treating Elevated LDL Lipoproteins

Here’s how NMR (nuclear Magnetic resonance) technology measures lipoproteins.

By Dan Stock, MD, Diplomat of the American Board of Clinical Lipidology

Radio waves and magnetic fields

1. Statin drugs offer a good starting point for therapeutic intervention if LDL particles (LDL-P) are elevated. They are much more effective at lowering LDL-P at low to medium doses. In my experience, high dose statins are ineffective. They may continue to lower LDL-C but stop lowering disease-causing LDL-P. Studies showed that high doses of statins didn’t save more lives than low doses and now we know why. 2. Not all statins lower LDL-P with the same effectiveness. If LDL-P levels are not at goal, don’t move the patient to a higher dose of the same statin – switch to a different statin and prescribe at low to medium doses. Monitor LDL-P levels to evaluate effectiveness.

4. Physicians should review HDLparticle numbers. We want HDL-P to be high. When they are high, it helps control excessive amounts of LDL-P. Niacin and Fibrates are very effective at raising HDL-P.

The Tolling of the bells An easy way to understand NMR technology is to compare it to the tolling or ringing of bells. When a group of bells is struck with equal-force blows, the frequency of the sound (tone) separates the ring of one bell from another while the amplitude (loudness) of the sound reflects the number of bells struck. By recording the “ringing” of all of the lipoproteins in a plasma sample, it is possible to identify the number and type of lipoprotein particles present. With this method, results don’t require chemical reactions, modification or pre-treatment of the sample. Each NMR scan of a specimen yields a complete record of sounds produced by molecules within the specimen under a specific set of instrument conditions.

Making better decisions Dr. Mike Catausan, a family practitioner at exclusiveMD in Leawood, Kan., says he has used the test to help identify people with normal cholesterol levels but abnormal particle levels. “Without this advanced test, they would never be identified or treated and, thus, would be at greater risk for developing plaque,” Catausan says. “It’s all about what we are measuring. This test provides me with more information and helps me make better, sounder decisions in the treatments of my patients.” He says when patients understand that an overabundance of these circulating particles are creating plaque traffic jams, they are sometimes more motivated to make small lifestyle changes that can make a difference in their overall health. Catching the disease (and the variables that create a bad environment inside the artery walls) 10 to 20 years up-river is essential.

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3. If statins are not helping the patient reach LDL-P goal, then look at NMR Lipoprofile results for LDL-P size: Niacin, Fibrates and fish oil are very effective at lowering small LDL-P. If the patient has predominantly large LDL particles, use a bile acid binding agent or ezetimibe. I often combine a statin with one or more of the above medications.

A patient’s serum or plasma sample is subjected to a short pulse of radio energy within a strong magnetic field. The resonant sound that is broadcast by the lipoproteins in the sample is recorded and analyzed to determine the number and size of lipoproteins present. Each type of lipoprotein broadcasts a signal that is characteristically distinct from the others. A computer algorithm separates the signals into groups and then quantifies the number of lipoprotein particles in that group.

health education • concussions

Diagnosis:

Concussion What you need to know about a misunderstood problem

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He remembered putting his shoes on that morning, and taking an Organic Chemistry test that afternoon. The next thing that Joshua Barnes remembered was a nurse taking his blood pressure. He had lost nearly 24 hours of memory – all the result of a vicious hit to his head during a football game. “The trainer said I literally didn’t have any idea who I was,” Barnes says. “I couldn’t say my name, what school I played for, my parents’ names – I just kept asking what time the dance was the next day. I still have no idea what happened.” The Liberty, Mo., native had suffered a grade three concussion, and it has permanently impacted the rest of his life. “I still have headaches, and I can’t play contact sports,” he says. “It sounds weird, but if I watch ‘Jeopardy’ on TV, I get a headache that wipes me out for the rest of the day. The doctor says I will probably have symptoms for as long as I live.”

By Ryan Brown

underdiagnosed and misunderstood The most damaging element of a concussion is that some patients might not know they are suffering from the ailment, and cause more damage to themselves. Dr. David Dyck, DO, Sports Medicine and a 12-year practitioner of medicine, says that concussions are often underdiagnosed. “It’s a flat-out epidemic,” he says. “People rarely equate a hit on the head with a potential brain injury. In fact, what usually happens is that the incident gets made light of, and someone will say, ‘you got your bell rung.’ The ramifications are not taken seriously.” Recently, the National Football League has taken steps to ensure that players who suffer a concussion are properly diagnosed and treated before being released to play again. Colleges and high schools have followed the trend, and this is a welcome change, according to Joe Oswald, assistant varsity football coach at Lee’s Summit West

High School. “In our profession, the welfare of the student athlete is the absolute top priority,” Oswald says. “The key is to identify the symptoms immediately and treat the athlete properly before we let them play again. It’s not like it was 20 years ago, when someone would get a concussion, sit one game and then go back out there.” Schools are now requiring students to be tested prior to the season to get a baseline reading of their brain function. If a player suffers a concussion or other trauma to the head, the athlete must complete a series of tests that measure memory, learning, the speed of processing information and reaction time. “We sit kids out for as many games due to concussions as we do for grades and misconduct at school,” Oswald says. “We’re under pressure as coaches to win, but we’re under more pressure to make sure the kids are protected.”

What causes a concussion? The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain does bang against the skull, the brain can get bruised, blood vessels can be torn, and the nerves inside the brain can be injured. This can lead to a concussion, which is the temporary loss of brain function.

Resource www.impacttest.com This site is dedicated to serving as a resource for baseline testing for athletes competing in contact sports.

“We sit kids out for as many games due to concussions as we do for grades and misconduct at school. We’re under pressure as coaches to win, but we’re under more pressure to make sure the kids are protected.”

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– Joe Oswald, assistant varsity football coach, Lee’s Summit West High School

health education • concussions

proactive vs. reactive Concussion management has evolved out of necessity. The annual incidence of sports-related concussion is about 300,000 per year, and about 19 percent of athletes participating in a contact sport will suffer a concussion. Though most patients who suffer a concussion will recover, some will show symptoms of post-concussion syndrome, which can cause cognitive and neurobehavioral difficulties, personality change (e.g. increased emotionality or irritability), sensitivity to light and noise, and shortterm memory loss. Rather than wait for these symptoms to appear and diagnose post-concussion syndrome, there are now measures in place to determine whether or not an athlete is still feeling the effect of their injury. Doctors can administer a test prior to start of each season to get the baseline reading, and then perform follow up tests once an injury has occurred. “It’s like preventative maintenance on your car,” Dr. Dyck says. “You don’t want the engine light to come on before you take steps to fix it. The same principle applies to a brain injury – you want to ensure you are taking care of it, rather than wait for something to go wrong.”

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Grade 1 The athlete may appear stunned or dazed. There is no loss of consciousness (LOC), and sensory difficulties clear in less than one minute. Grade 1 concussions are the typical “I got my bell rung” description from the athlete.

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n Word Discrimination

– having two words that appear to be similar but are slightly different on separate flashcards (like “spool” and “spoon”). The cards are shown to the patient quickly, to identify or differentiate them. n Design Memory – a series of patterns are shown, and the athlete must recite back the order of what they were shown, or answer which pattern would be next. n Color Match – colors are spelled out, but are printed in an alternate color (yellow is typed out in blue, for instance). The patient must then identify the color that the word is typed in. n Three Letters – the patient is shown a series of three-letter sequences, and must remember the order and content of each sequence.

Function tests n Attention

span memory n Sustained and selective attention n Response variability n Non-verbal problem solving n Reaction time n Working

severity of concussions

NorthLaNd

Lee’s summit

Baseline tests

Characterized by headache, cloudy senses lasting longer than one minute, and no LOC. The athlete may have other symptoms including, tinnitus, amnesia, irritability, confu-

sion or dizziness. One, all or none of these symptoms could be present.

Grade 3 Characterized by LOC of less than one minute, the athlete will not be comatose and exhibit the same symptoms as a grade 2 concussion.

Grade 4 Characterized by LOC of greater than one minute. The athlete will not be comatose, and will also exhibit the symptoms of the grade 2 and 3 concussions.

health education • concussions

Truman Medical Center has added a new tool to manage concussions and provide more accurate assessment of this injury. The ImPACT tool – Immediate Post-Concussion Assessment and Cognitive Testing – is a computerized, neurocognitive testing tool used by professional sports teams. ImPACT quickly and accurately measures symptoms, gives baseline data, measures attention, memory and processing speed and reaction time. It’s available at TMC’s Sports Medicine Center and the Lakewood Campus. Call 816404-9025.

Treatment of Concussions

defining a mystery While the term concussion conjures images of an unconscious athlete, they can happen with any head injury, often without any loss of consciousness. Patients who sustain concussions usually can recover within a week, without lasting health problems, by following certain precautions and taking a breather from sports. A person with an undiagnosed concussion can be at risk for brain damage and even

disability. If you do sustain a head injury, even without a loss of consciousness, watch for symptoms of a concussion, including: n a change in mental state n a bad headache n confusion n repeated vomiting Someone with these symptoms should be taken to the emergency room.

healing the brain There is no bandage or liniment someone can apply to heal their brain after a concussion. In fact, there is only one sure-fire cure. “Rest,” Dr. Dyck says. “You have to rest the body, and you have to rest the mind. If a student suffers a concussion, we’ll take them out of school for two or three days. Add in the social elements of school, the stress, and the temptation to resume a normal lifestyle and the student will actually prevent their brain from healing.” If you decide to “push through” and deal with the symptoms of a concussion,

you are prolonging the healing process, which is normally one to two weeks. “Every day someone doesn’t let the injury heal, they add another week to their recovery time,” Dr. Dyck says. “So if you suffer the concussion on Friday and conduct yourself in a normal fashion through the weekend and onto Monday, you’ve added three to four weeks onto your recovery time. We’ll see someone come in that is suffering from the same symptoms for months at a time – they are someone who hasn’t given their brain the opportunity to heal.”

Gently lower the patient to the ground, if this has not already been done. Protect the patient from further injury. Assess the airway, breathing, and circulation. Consider the possibility of simultaneous neck injury (cervical spine injury). Call 911 if needed. A physician generally will not permit the use of any pain reliever with sedative properties (such as a narcotic) in the first few days, since it may depress the level of consciousness and may make assessments more difficult.

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Having an ImPACT on concussions

healthy body • strength training

You don’t need expensive equipment to give your body the strength for a healthy life By Michael Rutherford, M.S.

Strength conditioning

A complete conditioning program includes a strength component. The problem for many is in how to begin and what all that might entail. All our strength and conditioning designs are built around the use of fundamental movement patterns. These are movements you incorporate into daily activities from cradle to grave. These movements include squat, lunge, push, pull, bend, twist, gait. Anything else is ancillary. As long as you remain competent in all these fundamental movements, you can live an independent life. If you lose strength and mobility in any of these primal movement patterns, you become dependant on someone else. This isn’t as sexy as cover model muscles but the reality is undeniable. Stay functionally strong and you live a life of abundance; anything else is a compromise. First, some starting guidelines. You should be free of any symptoms of illness and or orthopedic distress. If you have any questions please contact your primary care physician. Functional conditioning design mimics the requirements found in daily activities and thus our circuit design shadows these requirements. Machines mute this integration and confuse our nervous system. Rarely are machines useful in a training environment.

Michael Rutherford M.S. is president of Boot Camp Fitness Kansas City / CrossFit Kansas City

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Starter kit

healthy body â&#x20AC;˘ strength training

circuit training program Our circuit training movements are: n Dead lifting (stooping) 1 x 8-12 n Push-up 1 x 8-12 n Brace squats 1 x 8-12 n Body rows 1 x 8-12 n Anterior reach 1 x 8-12 n Step ups 1 x 8-12 n Ball chops 1 x 8-12 Note: 1 x 8-12 = 1 set of 8 reps; up to 12 reps Perform these exercise movements in a circuit style. While not cast in stone, I suggest that you sequence through in the order that

Dead lift

is presented. All these movements should be performed under control through a full range of motion. Perform each exercise for one set of prescribed repetitions before moving to the next movement. If you are successful with eight repetitions, add one additional repetition during the next session. Continue in this fashion each session until you reach the top of the range, which is 12 repetitions. While you will be moving with control and precision during the execution of the

1 x 8-12

movement, move without delay to the next exercise on the list. This equation is commonly written as 1 x 8-12. Once you have reached 12 reps you need to increase the amount of resistance you are using for that particular exercise. Begin by performing these exercises on non-consecutive days without more than 72 hours of rest between workout sessions. A common pattern is Monday, Wednesday and Friday or Tuesday, Thursday and Saturday.

Push-up

1 x 8-12

Start

Finish

Training tips Before you begin, warm up your muscles by spending 5â&#x20AC;&#x201C;10 minutes pedaling on a stationary bicycle or by taking a brisk walk around the gym. After finishing your workout, cool down by stretching all the major muscle groups to avoid injuries and keep your muscles flexible.

Fitness model: Heather Carroll

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Finish

healthy body • strength training

Strength training 101 Strength training is a vital part of a balanced exercise routine that includes aerobic activity and flexibility exercises. Regular aerobic exercise, such as running or using a stationary bike, makes your muscles use oxygen more efficiently and strengthens your heart and lungs. When you strength-train, you’re using your muscles to work against the extra pounds (this concept is called resistance). This strengthens and increases the amount of muscle mass in

Brace Squat

Start

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your body by making your muscles work harder than they’re used to. Before you start strength training, check with your doctor to make sure it’s safe for you to lift weights. Any time you begin a new sport or activity, go slowly so that your body gets used to the increase in activity. Even if you think you’re not exerting yourself very much, if you’ve never lifted weights before, your muscles may be sore when you wake up the next day. And, because of

1 x 8-12

Finish

Anterior reach

Start

something called delayed onset muscle soreness, the pain may be at its worst two or three days after you first exercise. Before you begin any type of strength training routine, get some guidance and expert advice from someone who is a certified fitness expert. They can give you advice on how many times a week you should lift and what kinds of warm-up and cool-down activities you should do before and after lifting to avoid soreness or injury.

Body Row

1 x 8-12

Start

1 x 8-12

Finish

Start

Finish

Step up

1 x 8-12

Finish

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grown by hand

healthy body • strength training

basic strength training rules n Start

with body weight exercises for a few weeks (such as sit-ups, pushups, and pull-ups) before using weights. n Warm up for 5–10 minutes before each session. n Ensure you’re using proper technique through supervision. Improper technique may result in injuries, particularly in the shoulder and back. n Cool down for 5–10 minutes after each session, stretching the muscles you worked out. n Don’t rely on strength training as your only form of exercise. You still need to get your heart and lungs working harder by doing some kind

made by hand

of additional aerobic exercise for a minimum of 20–30 minutes per session. Doctors recommend an hour a day of moderate to vigorous activity – so on days when you’re not lifting weights, you may want to get more aerobic activity. n Strength training is a great way to improve strength, endurance, and muscle tone. But remember to start slowly, use proper form, avoid heavy weights, and increase workouts gradually to prevent injury. Just a few short sessions a week will really pay off – besides better muscle tone and definition, you may find that you have more energy and focus.

Ball chop

Start

1 x 8-12

Finish

Training tips

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When you’re in the middle of a strength-training session and something doesn’t feel right to you, you feel pain, or if you hear or feel a “pop” when you’re in the middle of a workout, stop what you’re doing and have a doctor check it out before you resume training. It’s possible you may need to modify your training or even stop lifting weights for a while to allow the injury to heal.

It’s best to work only two or three muscle groups during each session. For example, you can work your leg muscles one day, your chest, shoulders, and triceps at the next session, and your back and biceps on the last.

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health and wellness

How my family started

Eating better

Cindy Craig of Brookside helped her family slow down and make better choices. Now fast food is a thing of the past and everyone works together to put healthy

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homemade food on the table.

As told to Heather Winslow Gibbons Photos by Denise Williams

healthy eating • one family’s story

Who Cindy Craig, 42

Hometown Kansas City, Missouri

What I Learned It’s easier to make a big change when everyone is on board. We don’t just have healthier bodies; we are closer as a family.

My husband Marc and I have three boys in three different schools. With work, sports, church and friends in the mix, we sometimes feel like we’re going in a hundred million directions. It’s no wonder that at mealtime, convenience is the main ingredient. For as long as I can remember, we were on a regular dinner rotation of premade processed foods like Hamburger Helper, frozen pizza, fish sticks and mac and cheese. Peas, potatoes and corn were about the only vegetables my boys would eat, and on soccer nights, dinner came through a fast-food drive-up window. I knew we could be eating better, but I didn’t think the kids would be open to trying new foods and I wasn’t even really sure where to start. Then in 2008, my oldest son’s school, Kansas City Academy, started a Farm to Cafeteria program. Now Coby Bryars, a chef from Bistro Kids, makes lunch from as many organic or locally grown foods as possible. Farmers visit for show-and-tell, and students grow food and take cooking classes. It’s a very cool way to help kids be

connected to where their food comes from. One day, Daniel came home raving about something new he’d tried at school. (He couldn’t remember the name of it, but we eventually figured out it was tabouleh.) I saw my opportunity to start making changes – when Daniel is interested in something, his younger brothers, Andrew and Matthew, usually want to be in on it too. I went to a local farmers expo and learned about Community Supported Agriculture. In a CSA program, members pay up front to provide income to farmers, then get locally grown food throughout the season. There were so many different kinds of programs offering meat, eggs, honey and fruits and vegetables, that I had trouble choosing one! I took fliers home to my family and we agreed on one that was affordable, provided the right amount of food and could be picked up while we were out doing the usual weekend errands and activities. When the season started, we were excited to see what our weekly CSA shares

Community Supported Agriculture is a great way to be more in touch with where your food comes from. You’re doing something good for your community, for local farmers and for your body. To find CSA programs in Kansas City, go to www.kc-csac.org.

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For the Craig family – Marc, Cindy, Daniel,15, Andrew,12, and Matthew, 7, – a surprise bonus of eating better was having more time to spend together.

About Community Supported Agriculture

healthy eating • one family’s story

held. Often, it was vegetables we’d never had in our house. To figure out what to do with all these new foods, I talked to friends, cracked open cookbooks and researched recipes. Some dishes were successful, some weren’t, but I specifically remember my disbelief when I served butternut squash with black olives and feta cheese and the boys wanted seconds! What I don’t remember is making a conscious decision not to eat fast food. We simply got out of the habit because the CSA food needed to be eaten. (If we ever eat fast food now, it doesn’t taste good, and even the boys can’t believe we used to eat it on a regular basis!) It was Daniel who started us on this

path, and he’s probably the one most changed by it. He goes to weekly cooking classes and has formed a friendship with Chef Coby. Daniel has learned to make bread, and often takes some to share with Chef Coby and his classmates. He also feels better because this new healthy diet makes him less susceptible to mood swings brought on by his ADD. I think he’s more even tempered and more focused when he eats good meals. The change also has been good for the whole family. We’ve managed to spend more time together and keep up with our other commitments (though we don’t watch as much television as we used to, which is probably a good thing!).

Each week the Craigs receive a bounty of vegetables from Fair Share Farm near Kearney, Mo.

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P H OTO G R A P H Y

denisewilliamsphotography.com

healthy eating • one family’s story

make time for healthy eating

grow something We tried gardening in the past, but now that the boys are involved, it’s a fun family activity. We all have a better appreciation for just how much work goes into getting food on the table. Also, the boys are more likely to try something when they’ve helped it grow from a seed into food they can eat. I think our family is closer, too, because working side by side creates a cooperative spirit and makes it easier to talk.

make your own fast food We are in the habit of freezing some of our CSA vegetables so we’ll have locally grown food even in the dead of winter. When the boys have friends over, we make our own pizzas – sometimes even the dough – from scratch. Tacos are another easy dinner each person can customize. Everyone helps chop our favorite ingredients: cooked chicken, lettuce, tomatoes, shredded cheese, black olives and salsa. When we have time to actually cook, we double the recipe and put half in the freezer. Inevitably, the frozen version tastes better!

involve the whole family

start slowly

redefine dinnertime

6 7

I knew it would be impossible to make over our food habits all at once. When you ban foods or force foods, no one wins. Our process was a series of small changes that eventually led to an entirely new way of eating.

Since I work late, the guys eat dinner together. When I get home and sit down to eat, everyone comes back to the table to talk about their day and make plans for tomorrow. Sometimes we play a question game some friends gave us a few years ago. It’s fun to find out what rule the boys would break if they could, or what is their favorite spot in the house.

keep trying I’ve read it can take 8-15 tries for a kid to like a new food, so I don’t take it personally if my boys reject something the first time. We’ll try it again a different way, and if dinner is ever a complete disaster, we don’t make it a fight, we make peanut butter and jelly instead.

be the change I have to admit there are times, especially when I’m stressed out or feeling particularly rushed, that I’m tempted to hit the drive through. In those “fast food moments,” I start to feel uneasy. That’s when I check myself and say, “This goes against what I’m trying to teach my family” or “This isn’t the example I want to set for my kids.” I know I can’t expect them to change their habits if I don’t change mine.

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This new approach to eating has become a normal part of how our family functions. Each boy gets to plan a dinner menu once a week. They make their own snacks to take in the car, and they have a say in what we’ll

grow in the garden or how we’ll use our CSA food. Not only are they learning to make good choices, they are learning valuable life skills, too.

healthy eating • local looks

| why i love | Gilbert, Whitney & Co. Specialty Groceries & Kitchenware “I was desperately seeking a garlic peeler and had all but given up when I walked into Gilbert, Whitney & Co. on the Independence Square. The original brick walls and high, molded ceilings made me feel at home the moment I entered, and I wanted one of each of the beautiful, useful and fun items in the kitchenware

| the face of a farmer |

room. A second room is full of

Every Wednesday afternoon at Border Star Montessori, a group of fidgeting students meets with the principal. But they’re not in trouble, they’re in business. These fourth- through sixthgraders are charged with running a booth at the Farmers Community Market at Brookside, which is located on their school grounds. “We wanted students to learn what it takes to start a business and maintain and grow it on a small scale,” says PTA President Paula Busser. The boys and girls have caught on quickly and are surprisingly astute. At meetings, they discuss business tactics most corporate executives are concerned with: marketing, employee motivation, competition, pricing and new product ideas. The produce they sell is organically grown by the entire student body in raised garden beds on what used to be a parking lot. The garden serves as an

world, including a feta cheese a Grecophile friend of mine can’t live without. I walked out with my garlic peeler and a new favorite place to get inspired.” - Kristina W. Pearson Visit Gilbert, Whitney & Co. at 104 North Liberty in Independence, Mo., or online at www.gilbertwhitney.net.

outdoor classroom where students can grow in many ways, connecting their academic work with real life, being physically active, experiencing nature and honing social skills. You can buy student-made salsa, vegetable seeds, birdseed and other handmade items at the Border Star Montessori booth at the Farmers Community Market at Brookside on Saturdays 8 a.m.-1 p.m. Profits from the Saturday sales help fund the sixthgraders’ annual trip to the Montessori Model United Nations in New York City.

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young growers get down to business at border star

edible treasures from around the

healthy eating • splurge

splurge

fresher than fresh snow cones

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Eat a Fresher than Fresh Snow Cone and you’ll feel like a kid again. Except you won’t miss that blue stuff running down your arm.

Lindsay Laricks, creater of Fresher than Fresh Snow Cones, makes syrup from all natural ingredients, many grown locally, instead of artificial colors or flavors. “I want to make something that’s really good but uses as few ingredients as possible, so Where to find you’re well aware of what’s in Fresher Than it,” she says. Fresh Snow Cones But knowing what’s in it n Hammerpress, 110 Southwest won’t necessarily prepare Boulevard, on you for the surprise delivered the first Friday by pure cane sugar and of every month, Larick’s inspired pairings of 6:30-10 p.m. or fruit and herbs. With her sellout knack for creating flavors like n The garden Blackberry Lavender, Lemon at 17th Street Prickly Pear and Espresso and Summit on Mexican Cane Sugar, she Sundays, puts a sophisticated twist on noon-7 p.m. this childhood classic. Eight inventive flavors make up the menu on any given day. A full-size snow cone costs $3 and is served in a compostable cup, a flight of any five flavors costs $4. The Daredevil Special is $2, discounted to reward those brave enough to try it. Inspired by the elusive food trucks of Austin, Texas, Laricks sells her snow cones out of a 1957 Shasta Compact travel trailer. Look for it at farmers markets, craft fairs and other events. Check in at www.ftfsnowcones.com for times and locations.

healthy eating • recipes

healthy fare for busy families Enjoy these quick-fix dishes made from healthy, whole foods. For peak flavor and optimum nutrition, shop for ingredients at one of Kansas City’s farmers markets.

chicken parmesan Ingredients n

8 oz. chicken tenders 1 cup quinoa flakes n ¼ cup Parmesan n 1 teaspoon greek seasoning n 2 tablespoons oil, ghee or butter n 1 cup prepared tomato sauce n 1 tomato, diced n

Instructions

Ingredients

Instructions

Heat oven to 350 degrees. Cut vegetables into 3-inch long “fries.” Toss with melted butter and maple syrup and place in a single layer on a baking sheet. Cook until the veggies are tender, not mushy, about 10-15 minutes. Let cool and serve. Leftovers, if any, can be kept in the refrigerator for up to three days.

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1 tablespoon unsalted butter, melted n 1 tablespoon maple syrup n 1 medium sweet potato, peeled n 1 carrot, peeled n 1 turnip, peeled

“Our boys love these yummy root veggie ‘fries.’ They make a great side dish and are easy to reheat for a snack. We eat them cold, too, if we’re in a hurry.” – Jackie Habiger, Bébé Appetit and Ted Habiger, Room 39

“My niece and nephew love these chicken tenders any time of the day! Quinoa flakes make them gluten-free, and they can easily be frozen after they are breaded and seared, but before they are cooked. Then, when you need a quick, healthy meal or snack, just pop the frozen chicken tenders in a 350° oven and they’ll be ready in about 20 minutes!” – Renée Kelly, Renée Kelly’s at Caenan Castle

roasted root vegetable fries

Heat oven to 350°F. Combine quinoa flakes, parmesan and seasoning and bread chicken tenders on both sides. Heat an oven safe sauté pan on medium heat and add oil. Sear each chicken tender about two minutes, or until golden brown on each side. Place in oven for five minutes or until fully cooked. Heat tomato sauce over low heat and add fresh diced tomato. Serve chicken parmesan with the sauce on top or in a little dish on the side. ___________________________________

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Where kids are Dino-mite!

healthy eating • recipes

quinoa vegetable salad with chickpeas and feta Ingredients

Instructions

Bring quinoa, salt and 1½ cups cold water to a boil, cover and simmer on a low heat for 20 minutes. Let quinoa cool to room temperature, then transfer to a serving bowl. Mix the garlic and chives thoroughly with the quinoa and add the remaining chopped herbs and vegetables. Stir in the lemon juice and extra virgin olive oil. Rinse beans, season with freshly ground pepper and salt, drizzle with olive oil and lemon juice, add feta and gently toss to coat. Set aside for at least 30 minutes before serving to allow the flavors to develop. Use mixed greens or fresh spinach as base for salad, add quinoa mixture on top.

1 cup quinoa, rinsed n ½ teaspoon salt n 2 cloves garlic, crushed n ¼ cup chives, chopped n ½ cup cherry tomatoes, halved n ½ cup cucumber, chopped n ¼ cup radish, chopped n 2 tablespoons fresh mint, chopped n 2 tablespoons fresh cilantro, chopped n ¼ cup fresh parsley, chopped n ¼ cup freshly squeezed lemon juice n ¼ cup extra virgin olive oil n ¼ cup black olives, pitted n ½ cup feta n 1 can chickpeas (aka, garbanzo beans), drained and rinsed n Kosher salt and freshly ground pepper, to taste n 3 cups mixed greens

“Quinoa, chickpeas, garlic and seasonal veggies make this salad super healthy. Kids love to make it in our cooking classes!” – Kiersten “Chef K” Firquan, Bistro Kids

Variation: Use any combination of your favorite fresh local vegetables and herbs.

“This recipe comes together in 30 minutes or less because you can cook and prep many of the ingredients while you’re waiting for the water to boil. Shrimp is expensive, but it’s high in protein and low in fat. Plus, it cooks quickly, which is great for busy families.” – Brian McAree, chef and kids’

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cooking instructor

Ingredients

Instructions

In a large pot, bring two gallons of water to a boil. While water is heating up, clean the arugula and chop the garlic. In a saute pan, heat olive oil and then add garlic. When it becomes slightly golden, season shrimp with a pinch of salt. Add shrimp to pan and saute until tail curls inward. Flip shrimp so each side cooks evenly. Remove shrimp from heat. When water comes to a full boil, add two tablespoons sea salt and pasta. Cook to desired doneness, which to me is al dente (a little bite left to it), and drain. Return pasta to stock pot and add arugula (the hot pasta will wilt it and bring out more of the spicy flavor). Then add the shrimp mixture and toss. Taste, then add crushed red pepper and sea salt, if needed. Add the extra virgin olive oil and place pasta into a serving dish or on individual plates. Zest lemon over pasta then squeeze lemon juice over it and serve.

1 pound penne pasta n 2 cups arugula, chopped n 1 pound shrimp, peeled, deveined and patted dry n 3 cloves garlic, chopped n 2 tablespoons olive oil n sea salt for pasta water and seasoning n 3 tablespoons crushed red pepper (use less if you like) n 1 lemon n 2 tablespoons extra virgin olive oil for dressing (note that this recipe calls for two kinds of olive oil)

arugula and garlic shrimp with penne pasta

There is hope. health education • foot fungus

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Kansas City:

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healthy eating • wine

a matter of taste Wine judges aren’t the final say on what makes a great wine – and nor should they be

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By Doug Frost

An April exposé in The Wall Street Journal unearthed the shocking news that wine competition judges did not agree. Can you imagine: Actual professional wine tasters not agreeing with each other? Judging scores were parsed and comparing a broad spectrum of wine competitions, it was revealed that certain wines won in certain competitions, but in other competitions they lost. The conclusion of the writer was that wine competitions are pointless and the wine competition judges are clueless. Perhaps you too believe that all wine competitions should strive to achieve uniform results, and that wine competition judges, despite that there are differing wine judges at each competition, should somehow ignore these differences and come to the same conclusions. But imagine that we were talking about barbecue. There are reviewers and food writers that purport to review and judge barbecue authoritatively. But one might say that the ribs at LC’s are the best in the city, while another might argue, no, they’re inconsistent; Oklahoma Joe’s is far better across the

board, while another might shout that they’re both wrong, it’s brisket that makes LC’s standout and as for ribs, what about Woodyard or Jack’s Stack or RJ’s Bob-be-que or Danny Edward’s or – well, you get the idea; they wouldn’t agree. Should this surprise us? No. People differ on such things, and we expect them to. But somehow wine has been perceived to be something more definitive than, say, food or music or art or film or restaurants or anything else you can imagine that somebody reviews. Taken in that context, you can see how ridiculous it is to hope that differing judges would always prefer the same wines, despite the fact that they might be in different places: one competition locale might be hot, like Dallas or southern California, while another might be cool and misty, like northern California, and that could affect people’s preferences for certain drinks. The judges are different at each competition, and wines change over time, sometimes abruptly. So, why would a publication like The Wall Street Journal be so misguided

“You could pour six glasses from the same bottle of wine for six different people, and they will all experience it differently. Depending on who they are, they might then start arguing about who is ‘right.’ We tend to treat out own experiences as objective when they are anything but. There are a lot more variables that a given taster brings to a glass of wine than a glass of wine brings to a variety of tasters.” – Jim Coley, Wine Buyer from Midtown Gomers

ÂŠ istockphoto.com / Brian Pamphilon

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“It is important to consider that there is no such animal as the perfect wine. While travel magazines routinely offer lists of the ‘Ten Best Beaches in the World,’ just as wine magazines offer opinions on the ‘Top 100 Wines of 2009’ as if these things could possibly exist outside the brain of the observer. What is ‘in’ today may seem cliche or passe in a generation or two.” – Robert Noecker, Garco Wine Company, Missouri

in this matter? I would argue that the wine industry, actually just a few cynical writers, has managed to con their readers into believing that wine reviewing is so precise that each wine can be given a score on a 100-point scale. The reviewer who first hatched this plot told me years ago in private conversation that the 100-point system helped him sell magazines, and that was enough for him. Perhaps it is. But scoring a wine on a 100-point scale is deeply flawed. There are myriad reasons but let’s focus on only one now: Everyone has a different palate. And everyone has a slightly different experience of any wine. Some folks like

bitterness; they’ll love big, powerful reds. Some folks prefer softness (and this group is far larger than any other such group); they’ll probably eschew big red wines for soft, even sweeter white wines, and more often, cocktails and beer. Each person has a set of experiences, and a set of aroma and taste receptors that create a different response to any wine, or food, or beer or anything you can name that you can put in your mouth. We are not supposed to like the same things. We never will. And anyone who tells you different is either a liar or an idiot or believes you to be one.

Doug Frost is a Kansas City writer who is one of only three people in the world to hold the dual distinctions of Master Sommelier and Master of Wine.

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healthy eating • wine

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conquering your pain Chronic pain is like an 800 pound gorilla. It can become the controlling force in your life that dictates how you interact with family, friends and even work. KC Pain CENTERS are here to help you get your life back. Your back hurts, your muscles ache, your joints are so stiff that you can’t move – pain is the most common reason that a person sees a doctor. Fortunately, pain is often easily treated with a visit to your primary physician. When your pain persists, however, it’s time to call in the experts and that’s where KC Pain Centers can help. “A statement I frequently hear from patients is that they’ve been told that they just have to live with their pain,” says Dr. George Edwards, who joined Anesthesia Associates in 1984 and is a founding member of KC Pain Centers. “Patients become discouraged and have a feeling of helplessness that nothing can be done. We are here to offer them hope.” KC Pain Centers offer a wide variety of treatments for chronic pain including interventional procedures and medication management. The newest advances in pain management come in the form of minimally invasive procedures that harness new technology. Selective neurostimulation and radio frequency nerve ablation are used to control painful nerves, while disc decompression can be used for relief of a bulging disc. These are just a few of the options available at KC Pain Centers.

Locations • KC Pain Centers South, Kansas City • KC Pain Centers East, Independence • Saint Luke’s East Hospital • Saint Luke’s South • Research Belton Hospital • Heartland Surgical Specialty Hospital • North Kansas City Hospital • Mid America Surgery Institute • Overland Park Surgery Center • Cass Regional Medical Center • Lee’s Summit Medical Center • Centerpoint Medical Center Pain Management Associates Central Scheduling, 816-763-1559 KC Pain Centers – South, 816-941-6700 KC Pain Centers – East, 816-795-6880

Web Site www.kcpain.com

a service of Pain Management Associates

Doctor’s chart

Mark Chaplick, DO

George Edwards, MD

Joel Ackerman, MD

Atef Israel, MD

Board Certifications

Amer. Board of Anesthesiology, Amer. Board of Pain Medicine, Amer. Academy of Pain Management

Amer. Board of Anesthesiology, ABA sub-specialty Certified in Pain Management

Amer. Board of Anesthesiology, Amer. Board of Pain Medicine

Medical Degree

University of Kansas

U. of Kansas School of Med.

Alexandria University, Alexandria, Egypt

University of Osteopathic Medicine and Health Services

James Scowcroft, MD

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Board Certifications

Amer. Board of Anesthesiology, ABA sub-specialty Certified in Pain Management Medical Degree

University of Texas Southwestern Medical School

Medical Degree

Curt Johnson, MD

Rebecca BurfEINd, MD

Howard Aks, MD

Board Certifications

Amer. Board of Anesthesiology, ABA sub-specialty Certified in Pain Management

Amer. Board of Anesthesiology, ABA sub-specialty Certified in Pain Management, Certified Amer. Board of Pain Management

Medical Degree

University of Nebraska College of Medicine

Medical Degree

University of Missouri-Kansas City School of Medicine

University of Kansas School of Medicine

kc pain centers

sponsored health resource

“You don’t have to live with chronic pain. There are options out there and we can help.” – Dr. George Edwards, KC Pain Centers

Front row, from left, Howard Aks, MD, Rebecca Burfeind, MD, Steven Charapata, MD, Thomas Laughlin, MD. Back row: Mark Chaplick, DO, James Scowcroft, MD, George Edwards, MD, Curt Johnson, MD, Joel Ackerman, MD, Atef Israel, MD.

Treating the mind and body

Services

Amer. Board of Anesthesiology, ABA sub-specialty Certified in Pain Management

In July, 2010 KC Pain Centers added a pain

n Epidural

Medical Degree

Shepard’s arrival.” Dr. Edwards says. “She will

Steven Charapata, MD Board Certifications

University of Wisconsin Medical School

Thomas Laughlin, MD

psychologist – Dr. Jenna Shepard, PhD – to its staff of doctors. “We’re very excited about Dr. give us additional options in helping patients deal with their chronic pain.”

Board Certifications

Lasting pain is more than a simple annoyance

Amer. Board of Anesthesiology, ABA sub-specialty Certified in Pain Management

for many patients - it can cause depression and strained

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Medical Degree

Creighton University School of Medicine

relationships. Don’t let it control your life.

steroid injections n Selective nerve blocks n Diagnostic procedures n Discography n Nucleoplasty n Disc decompression n Pain pumps n Neurostimulation n Radio frequency nerve ablation n Narcotic management n Vertebroplasty n Adjunctive analgesics (i.e., medications like Lyrica or Cymbalta)

pediatric professional association

sponsored health resource

focusing on children Parenting is a series of challenges, and one of the biggest is keeping a child healthy. Pediatric Professional Association ENCOURAGES parents TO partner in their children’s health care. For more than 50 years, the doctors of Pediatric Professional Association have been treating children in the Kansas City area, and by this point, they’re seeing the children (and sometimes grandchildren) of previous patients. The group treats children from birth to just before they enter college. These Board certified doctors put the children’s health first – and the group’s lineup offers a diverse array for parents to choose from. And they encourage new parents to get to know the doctors through a free initial visit to help them decide.

We see newborns at: • Overland Park Regional Medical Center • Shawnee Mission Medical Center • Saint Luke’s South

“It is important for parents to understand their children’s health needs. We help parents feel comfortable asking questions so they can make informed decisions,” says Dr. Liliane A. Baraban.

Main office 10600 Quivira Rd., Suite 210 Overland Park, KS 66215 913-541-3300

Pediatric Professional Association makes sure parents can reach a physician 24 hours a day through free phone support, and an in-house lab helps to reduce the time needed to see results on the most common lab tests. The goal is to promote quality care in an efficient, caring and timely manner.

Saturday clinics During the winter, we offer Saturday morning clinic hours

The doctors focus on working with families on preventative medicine and health education, making the parents partners in the process. “Rather than dictating their children’s care, we encourage parents to be actively involved in their health,” says Dr. Delsie Filardi.

Location

Web Site

www.ppadocs.com

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Doctor’s chart

Liliane A. Baraban, MD

Edward G. Belzer, MD

Board Certification

Barry M. Broeckelman, MD

Board Certification

American Board of Pediatrics Medical Degree

American Board of Pediatrics

Board Certification

American Board of Pediatrics

Medical Degree

American Board of Pediatrics eligible 2010

UFPE, Brazil; University of Kansas School of Medicine

University of Nebraska– Omaha Medical Center

Lynn H. Beck, MD

Specialty

Board Certification

American Board of Pediatrics

Developmental and Child Psychology

Board Certification

Medical Degree

Degree

American Board of Pediatrics

University of North Dakota

St. Louis University School of Medicine

University of Kansas

Christi Bostwick, PHD

Medical Degree

University of Kansas School of Medicine

Kathleen Farrell, MD

Medical Degree

University of Nebraska– Omaha Medical Center

Delsie Filardi, MD

Medical Degree

University of Kansas School of Medicine

Mary Jo Flint, MD Board Certification

American Board of Pediatrics

Thomas B. Heaphy, MD Board Certification

American Board of Pediatrics Medical Degree

University of New Mexico

pediatric professional association

sponsored health resource

“We’re excited that we get to provide our patients with up-to-date, evidence-based medical care in a great environment.” – Dr. Mary jo flint, Pediatric Professional Association

From left, Dr. Thomas B. Heaphy, Dr. Kathleen Farrell, Dr. Liliane A, Baraban, Dr. Edward G. Belzer, Dr. Mary Jo Flint, Dr. Lynn H. Beck, Dr. Barry M. Broeckelman, Dr. Delsie Filardi, Dr. Christi Bostwick.

Making health care accessible

Services

It shouldn’t be impossible to reach a doctor when your child needs one,

n Same-day

and Pediatric Professional Association makes sure their doctors are accessible. Not only are the Board certified physicians on call at all times, but the practice offers convenient walk-in hours Monday-Friday from 8 to 9 a.m. for established patients without appointment. Plus, when a parent needs to speak to a doctor, one is available just a phone call away, any time day or night. The answering service is available 24/7 free of charge. “As parents ourselves, we understand that problems arise at all times,” says Dr. Lynn H. Beck. “We want parents to know that we’re here for them

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whenever they have questions.”

sick appointments n Early morning walk-in clinic for established patients n In-office bloodwork and labs available n After-hours phone triage n Free prenatal visits n Physical exams for school, camp, sports and college n Vision and hearing tests n Strep throat, influenza and tuberculosis testing

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