Be Healthy Winter 2015

Winter 2015

Be knowledgeable. Be well. Be healthy.

PASS THE SALT, PLEASE AMERICANS CONSUME MORE THAN TWICE THE RECOMMENDED QUANTITY OF SODIUM

IT’S COMPLICATED KIDNEY AND HEART FAILURE ARE ONLY TWO OF THE POSSIBLE COMPLICATIONS OF HYPERTENSION

FITNESS TIPS AND HEALTHY RECIPES

High blood pressure

A SILENT AND DANGEROUS KILLER

Diabetes Health Guide

SPONSORED CONTENT

Managing Your Diabetes and High Blood Pressure According to the American Diabetes Association (ADA), around 2 in 3 people with diabetes report having high blood pressure or take medications to lower their blood pressure Keeping both blood sugar and blood pressure under control are central to staying healthy with diabetes. Managing these conditions during the colder winter months can be particularly challenging, but by focusing on a good diet, regular exercise and medication, if prescribed by your doctor, you can create a steady path to good health.

Diabetes occurs when your body does not make enough of a hormone called insulin or may not use insulin properly. Insulin helps your body use sugar from your food as energy or stores it for later use. When this does not happen, too much sugar stays in your blood. Over time, diabetes can lead to serious damage to your eyes, nerves, kidneys and blood vessels, as well

as heart disease and stroke. High blood pressure can contribute to this damage.

Research has shown that some people may be at a higher risk for diabetes and high blood pressure. Some risk factors include family history, being overweight and not getting regular exercise. Additionally, being of African, Asian, Hispanic, Native American, or Pacific Islander descent can increase your risk. Some symptoms of diabetes and high blood pressure include: frequent urination, increased thirst, extreme tiredness, and slow-healing wounds.

A healthy lifestyle can help lower your risk of developing diabetes and high blood pressure. Adjusting your diet to follow healthy eating guidelines is an important first step.

Keep these tips in mind when making decisions about your diet:

and to create a list before heading to the grocery store to stay on track.

• Eat a variety of foods • Limit fat, especially saturated and trans fat • Limit cholesterol • Eat enough starch and fiber • Limit sugar • Monitor sodium (salt) intake

It’s also important to be physically active – even just five minutes a day to start. In the colder winter months, take your exercise indoors by joining a gym, renting exercise DVDs from your local library, or taking a walk at your local mall. Check with your health care provider if you need advice on which type of exercise may be best for you.

At the grocery store, you can look for the red heart with a check mark — a symbol on food packaging that shows an item meets American Heart Association (AHA) criteria for saturated fat, sodium, and cholesterol. During the winter, there are still many fruits and veggies in season such as broccoli, carrots, leafy greens and winter squash that you can incorporate into your meals. The ADA suggests setting aside time to plan weekly meals

Your health care provider may recommend medication to help you reach your health goals. You can also check if your health plan offers any services to help manage and adjust your care. Even slight modifications to your daily or weekly routine can improve your overall health and wellness now and for the future.

To learn more, visit nhp.org/diabetes Reference: American Diabetes Association – Hypertension http://www.diabetes.org/living-with-diabetes/complications/high-bloodpressure-hypertension.html American Heart Association— www.heart.org

Small changes. Big results.

You can live well with diabetes and high blood pressure.

Diabetes and high blood pressure can cause serious complications, like kidney failure, heart attack, and stroke. The good news is that you can live well and feel better by making small changes, such as healthier meals, getting some exercise, and staying on your medication.

To learn more, visit nhp.org/diabetes

2 Be Healthy | Winter 2015

Publisher Melvin Miller Health Editor Karen Miller Senior Editor Yawu Miller Art Director Daniel Goodwin Production Caleb Olson Proofreader Rachel Reardon

High blood pressure

For advertising opportunities Please contact Karen Miller at (617) 936-7800 or kmiller@bannerpub.com

Be Healthy is published by Banner Publications, Inc. 23 Drydock Ave. Boston, MA 02210 Volume 3 • Number 3 Winter 2015 Be Healthy is printed by Cummings Printing 4 Peters Brook Drive P.O. Box 16495 Hooksett, NH 03106 603-625-6901 COVER PHOTO: THINKSTOCKPHOTOS.COM/ ANDS456 PAGE 3 PHOTO: THINKSTOCKPHOTOS.COM/ SIPHOTOGRAPHY

Editor’s note: The information presented in Be Healthy is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate for your age, sex, race and risk factors and make timely visits to your primary care physician.

Winter 2015

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Home monitoring: Keep tabs on your numbers

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Recipe: Edamame stew

The issue

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High blood pressure By the numbers

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Focus

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Medication OTC medication Pass the salt Kidney failure Heart failure Prevention Home monitoring

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Healthy steps

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Nutrition Recipes Fitness

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baystatebanner.com/news/be-healthy | Be Healthy 3

The issue: High blood pressure

High blood pressure A silent and dangerous killer IT’S EASY TO POP A PILL TO ALLEVIATE THAT NAGGING BACK PAIN OR THE HEADACHE THAT JUST WON’T QUIT. The allure of being pain-free is enticing. But when you feel fine and have no symptoms at all, that pill gets a little harder to swallow.

That’s the problem with high blood pressure.

For the most part, high blood pressure is a silent assailant — even when it’s dangerously high. That’s one of the reasons that adherence to a medication regimen for the disorder is low. Roughly half of Americans treated for HBP adhere to their long-term therapy, noted the Centers for Disease Control and Prevention.

That’s a mistake. The disorder wreaks havoc — under the cover of silence.

Lack of control of HBP can cause heart failure, heart attack, blindness, kidney failure, stroke and even dementia. That’s a hefty price to pay for a disease that for the most part can be easily controlled with medication and healthy lifestyles.

High blood pressure, also known as hypertension, is one of the most common medical conditions in this country. The American Heart Association estimates that 80 million, or one-third of the U.S. adult population is afflicted.

Blood pressure is the force exerted 4 Be Healthy | Winter 2015

against the walls of the arteries when the heart contracts or beats. Arteries are the blood vessels that carry oxygen and nutrients to muscles and organs. The upper number, or systole, measures the pressure when the heart beats. The bottom number, or diastole, measures the pressure when the heart relaxes between beats.

Both numbers are important. “Both are associated with heart disease, stroke and heart failure,” explained Dr. Myechia Minter-Jordan, the CEO and president of The Dimock Center in Roxbury. “We look at them equally and treat if even just one is high.”

Normal blood pressure is less than 120/80; high blood pressure is 140/90 or more. In between the two is pre-hypertension — 121/80 to 139/89 — which is typically not treated. Recent research, however, suggests that even pre-hypertension can cause complications down the line.

Treatment for HBP is not cookie-

Dr. Myechia Minter-Jordan, the CEO and president of The Dimock Center, warns her patients that you don’t feel high blood pressure until it’s too late.

PHOTO: THE DIMOCK CENTER

The issue: High blood pressure cutter. “It varies by the individual,” Minter-Jordan explained. Severity, age and even race are considered. For instance, according to the Mayo Clinic, older people and African Americans can often control their pressure more effectively with calcium channel blockers than with other medications. Additionally, regardless of the type of medication, black people can often more successfully control their pressure with two medications, one of which is a diuretic to help rid the body of excess fluid, Minter-Jordan explained.

There are two types of HBP. Primary or essential — the most common type of HBP — has no identifiable cause, and tends to develop gradually over many years. Secondary HBP, on the other hand, is due to an underlying, identifiable condition, such as tumors and thyroid conditions.

In some cases, HBP occurs beyond one’s control. Age, race and family history play significant roles. Certain chronic conditions, such as kidney disease, diabetes and sleep apnea can increase the risk of HBP, as do some medications, including birth control pills and some over-the-counter medications.

More often than not, however, we bring it on ourselves. We are our own worst enemies. Unhealthy lifestyles contribute to the disorder. Overweight and obesity, lack of physical activity, tobacco use, excessive alcohol use and diet are all controllable factors. Stress can also increase the pressure, but is typically temporary. Pressure can return to normal when the stress subsides.

African Americans For reasons not well understood, hypertension is prevalent in African Americans. As noted by the American Heart Association, more than 40 percent of blacks in this country are afflicted. Not only is HBP more common in blacks, it attacks earlier and is more severe than it is in whites.

Two risk factors in particular may be propelling the problem. Diabetes and obesity, both of which are common in blacks, are strongly linked to high blood pressure. In addition, researchers have found that there may be a gene that baystatebanner.com/news/be-healthy | Be Healthy 5

The issue: High blood pressure

The most threatening aspect of high blood pressure is that it is generally silent. You feel it when you suffer one of its complications. By that time it is often too late. High blood pressure is the culprit behind several life-threatening conditions. Its other complications significantly lower the quality of life.

LIFE-THREATENING

STROKE Stroke is the third leading cause of death in African Americans. About 77 percent of people who have a first stroke have blood pressure more than 140/90.

HEART FAILURE Seventy-four percent of cases of heart failure occur in people with blood pressure more than 140/90.

ATHEROSCLEROSIS Uncontrolled high blood pressure can cause hardening of the arteries, which increases the risk of heart attack, stroke and peripheral arterial disease.

DECREASED QUALITY OF LIFE » Loss of vision » Mental confusion and memory loss » Erectile dysfunction 6 Be Healthy | Winter 2015

ILLUSTRATION: CALEB OLSON

KIDNEY FAILURE More than 28 percent of cases of kidney failure are attributed to uncontrolled high blood pressure.

The issue: High blood pressure

WHAT DO THE NUMBERS MEAN? Blood pressure measurements fall into four general categories. Both numbers are important. Typically, a health provider will take two or three readings at three or more different times before diagnosing you with high blood pressure. However, if your pressure is very high, you might be started on medication right away. Often the pressure is measured in both arms to determine if there is a difference.

Category of blood pressure Normal blood pressure Prehypertension Stage 1 hypertension Stage 2 hypertension

makes blacks more sensitive to salt. In those with the gene, even one-half a teaspoon of salt could raise blood pressure as much as 5 mm Hg.

Prevention The good news is that many cases of HBP can be prevented or controlled with lifestyle changes. A healthy diet is key. In its landmark study the National Heart, Lung, and Blood Institute discovered that a diet low in sodium and rich in fruits, vegetables and whole grains significantly reduced both systolic and diastolic pressure, particularly in African Americans.

Maintaining a healthy weight is critical. Increased weight and fat cause the heart to beat with more strength in order to supply nourishment to a larger girth. Experts agree that losing just 5 pounds can lower pressure. The location of the additional weight is a factor.

Central obesity, or added fat around the middle, is closely linked to diabetes, a risk factor for high blood pressure.

Physical activity is essential. It not only lowers blood pressure it reduces stress and helps keep weight under control. Smoking is taboo. Tobacco injures the walls of blood vessels and causes hardening of the arteries. Alcohol is generally fine as long as men limit their drinks to two a day and women to one a day. Alcohol can raise the blood pressure in even healthy people.

Current status In spite of the availability of effective and inexpensive medicine, HBP is apparently not going away anytime soon

Systolic (upper number - in mm Hg.) Less than 120 120 to 139 140 to 159 160 or more

RISK FACTORS A risk factor is a characteristic that increases the likelihood of developing a particular disease. It is not a guarantee, however, that the condition will develop. High blood pressure has several risk factors, many of which can be controlled or modified.

RISK FACTORS THAT CANNOT BE CONTROLLED n Age – the incidence increases with age n Race – more common among blacks n Family history – tends to run in families RISK FACTORS THAT CAN BE MODIFIED n Overweight and obesity n Physical inactivity n Smoking and second-hand smoke n Diet n Too much salt n Too little potassium n Excessive alcohol use n Stress – can cause temporary increases in blood pressure

and is on the rise in younger people. A study sponsored by the National Institutes of Health in 2011 found that 19 percent of roughly 14,000 men and women between the ages of 24 and 32 had HBP. In comparison, a similar previous study reported that only 4 percent of that age range had the condition.

In its 2015 update on heart disease and stroke statistics, the American Heart Association noted that despite a drop in deaths from heart disease and stroke, deaths attributed to HBP were

Diastolic (lower number – in mm Hg.) Less than 80 80 to 89 90 to 99 100 or more

As the years pass everyone must be more vigilant. Your heart and blood vessels are aging right along with you and can lose a step or two. on the rise, largely because of its impact on heart failure and kidney failure. HBP contributes to 1,000 deaths a day, noted the CDC.

Screening Screening is most important. You can’t treat what you don’t know you have.

Minter-Jordan recommends checking at age 18 with yearly follow-ups. Those with HBP should be checked more frequently.

As the years pass everyone must be more vigilant. Your heart and blood vessels are aging right along with you and can lose a step or two. Healthy lifestyles and medication, if necessary, can keep you going strong. baystatebanner.com/news/be-healthy | Be Healthy 7

By the numbers: High blood pressure

4

You are four times more likely to die from stroke when you have high blood pressure

52% Only 52 percent of people with high blood pressure have it under control

80

MILLION The number of adults in the U.S. that have high blood pressure

1,000 The number of deaths per day linked to high blood pressure

28.4% The percent of cases of kidney failure attributed to high blood pressure

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$

BILLION

The yearly costs associated with high blood pressure

Recognized nationally as a model for the delivery of comprehensive health and human services in an urban community, The Dimock Center provides convenient access to high quality, low cost healthcare and human services that might not otherwise be available to the communities we serve.

Services: Health & Community Care Behavioral Health & Substance Abuse Services Child & Family Services 55 Dimock Street Roxbury, MA 02119 617-442-8800 8 Be Healthy | Winter 2015

Focus: High blood pressure Common, but often preventable » Medication 10 » OTC medication 11 » Pass the salt 12 » Kidney failure 14 » Heart failure 15 » Prevention 16 » Home monitoring 17

PHOTO: THINKSTOCKPHOTOS.COM/ Y-STUDIO

The bottom line is if you have high blood pressure — even if you are on treatment for it — it is advisable to ask your provider or a pharmacist if a particular OTC drug is safe.

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baystatebanner.com/news/be-healthy | Be Healthy 9

FOCUS: High blood pressure

PHARMD, BCACP, BC-ADM CLINICAL PHARMACIST WHITTIER STREET HEALTH CENTER

Prescription medications A variety of choices HYPERTENSION, ALSO KNOWN AS HIGH BLOOD PRESSURE, IS A COMMON MEDICAL CONDITION THAT AFFECTS APPROXIMATELY ONE OUT OF THREE ADULTS IN THE UNITED STATES. Most people who have high blood pressure might not have any symptoms. Having uncontrolled blood pressure can lead to many health problems that can affect your eyes and kidneys and other organs.

If you have been told that you have high blood pressure, it is important to reach your blood pressure goal and maintain it over time. Blood pressure goals can vary from person to person, so talk with your healthcare provider to learn your individual plan.

There are many things that you can do to improve your blood pressure. You can lose weight if you are overweight or obese, reduce the amount of salt in your diet, stop smoking, reduce your alcohol intake, increase your physical activity and eat a healthy diet. Medications can help too. The most commonly prescribed drugs and their side effects are discussed below. n Diuretics (Water pills): Do you take any drug called hydrochlorothiazide or furosemide? If so, then you are on a “water pill.” These drugs work by removing extra salt and water from the body. Common side effects include excessive urinating, always feeling thirsty, headaches and muscle pains.

Ask your healthcare provider to check your sodium (another word for salt) and potassium levels regularly. Take this drug in the morning to avoid waking up in the middle of the night to go to the 10 Be Healthy | Winter 2015

bathroom. Some people who take these drugs may need to take supplements or eat bananas regularly. n ACE inhibitors: Do you take any drug that ends in “pril” such as lisinopril, enalapril or quinapril? These drugs work to block a chemical in the body called angiotensin, which is responsible for narrowing your blood vessels. This allows the vessels to widen and relax, thereby reducing your blood pressure.

These drugs also protect your kidney, an advantage

if you have diabetes or kidney disease.

Some people who take these drugs can develop a dry, hacking cough. Other common side effects include rash, muscle pain and changes in kidney function. If you are pregnant or thinking of becoming pregnant, you must not take this medication. It’s been found that ACE inhibitors can cause injury and death to the developing fetus. n Calcium channel blockers: Do you take a drug called amlodipine, nifedipine, verapamil or diltiazem? If so, then you are on a calcium channel blocker. These drugs help the heart relax and work better. Common side effects include headache, constipation, nausea and lower ankle swelling. Calcium channel blockers are considered one of the “drugs of choice” in treating high blood pressure in the African American population. Studies show that hypertension in some blacks is better controlled with calcium channel blockers than ACE inhibitors or beta blockers. n Beta blockers: Do you take a drug that ends in “lol” — for example, metoprolol, atenolol or propranolol? If so, then you are on a beta blocker. They help lower blood pressure by decreasing how fast and how hard the heart works.

These drugs are also used for people who have had a previous heart attack.

They can sometimes cause headache, fatigue, exercise intolerance and/or sad mood. If you have asthma or other breathing problems, talk to your healthcare provider, since some of these drugs can worsen breathing disorders. Also, if you have diabetes, beta blockers can sometimes mask the signs and symptoms of low blood sugar.

It is very important not to suddenly stop taking this medication or any other medication without first talking with your doctor.

PHOTO: WIKIPEDIA

BY: STEFANIE C. NIGRO

FOCUS: High blood pressure

Over-the-counter medications and HBP Not always a good match PEOPLE ASSUME THAT BECAUSE OVER-THECOUNTER DRUGS ARE SO EASILY AVAILABLE, SURELY THEY MUST BE SAFE. For the most part, that is true.

PHOTO: WIKIPEDIA

That does not mean, however, that everyone can take them without suffering a negative reaction.

For instance, an excessive intake of acetaminophen (Tylenol) can cause liver failure; too much aspirin can cause internal bleeding.

People with high blood pressure have to be particularly vigilant in consuming OTC pills. Although they are taken to remedy a particular complaint, they may unknowingly worsen one’s pressure.

Antihistamines and decongestants are some of the biggest culprits. Decongestants relieve nasal stuffiness by narrowing blood vessels in the nose.

This narrowing, however, can affect other blood vessels, which can increase blood pressure.

Decongestants can also interfere with the effectiveness of some prescribed blood pressure medications.

Look for these ingredients on the label of cold and allergy medications: n Oxymetazoline n Phenylephrine n Pseudoephedrine

These medications are not the only ones to avoid. Some OTCs are high in sodium, which are known to elevate blood pressure numbers. Look for wording like “sodium” or “soda.” Sodium bicarbonate is a common medication used to relieve heartburn and indigestion. In one particular brand of bicarbonate, each tablet contains 178 milligrams of sodium. The maximum dose recommended is 12 pills a day. That equals 2,136 mg of sodium, which exceeds the

It is important to read labels to make sure over-the-counter drugs are safe.

daily recommended limit of 1,500 mg for people with high blood pressure.

NSAIDS — nonsteroidal anti-inflammatory drugs — such as ibuprofen, are used to relieve pain and inflammation for such conditions as headaches and arthritis. However, NSAIDS can cause the body to retain fluid, which in turn causes the pressure to rise.

Herbal supplements are not exempt. There is a misperception that herbal remedies are always safe.

Not so. Ginkgo biloba and St. John’s wort, both of which are used for depression, have been known to increase blood pressure as a side effect. Even licorice, a common ingredient in herbal medications and cough syrups, can have an effect.

The bottom line is if you have high blood pressure — even if you are on treatment for it — it is advisable to ask your provider or a pharmacist if a particular OTC drug is safe. baystatebanner.com/news/be-healthy | Be Healthy 11

FOCUS: High blood pressure

Pass the salt, please Americans consume more than twice the quantity recommended

Excess salt, especially when paired with reduced amounts of potassium, can increase the risk of high blood pressure.

This can start a chain reaction with unfortunate results.

High blood pressure increases the risk of stroke, heart attack, heart failure and kidney disease. Twenty-eight percent of the cases of kidney failure, which requires dialysis or kidney transplant, are attributed to high blood pressure.

It’s not that sodium is bad for you.

The body requires it to function properly. Sodium helps transmit nerve impulses and assists in muscle contraction. But you can have too much of a good thing.

The American Heart Association recommends limiting salt intake to 1,500 milligrams (mg) a day for older adults, particularly African Americans and those with high blood pressure.

That amounts to a scant 2/3 teaspoon a day. Yet, according to the Centers for Disease Control and Prevention, the typical American consumes 3,400 mg a day, or more than twice the recommended amount.

There is a misperception that easing off the salt shaker will do the trick. But, as noted in a report published in the Journal of the American College of Nutrition, only 6 percent of sodium comes from adding salt at the dinner table. Another 5 percent comes from salt added while cooking. The major culprits are packaged, processed foods and foods served in restaurants, which account 12 Be Healthy | Winter 2015

ILLUSTRATION: CALEB OLSON

SODIUM, MORE COMMONLY KNOWN AS SALT, CAN MAKE SOME FOODS TASTE SO MUCH BETTER, BUT IT DOESN’T DO MUCH FOR ONE’S HEALTH.

FOCUS: High blood pressure

for more than three-fourths of one’s sodium intake. For instance, it is possible to consume more than 1,200 mg of sodium with just one cheeseburger at a fast foods restaurant.

The problem is that, even when trying to limit the daily intake of salt, the odds are stacked against you. So many foods contain salt, but one has to carefully read labels to detect the ingredient. Some foods are obvious.

Salty snacks like potato chips and pretzels are easy to spot, but in many other foods it’s not so easy.

Most people do not realize that they are getting a good dose of salt in their morning cereal, but several cereals contain 250 mg of sodium in one half-cup serving. Cereals are but the tip of the iceberg. Top sources of sodium in the diet are breads and rolls, cold cuts, pizza and soups.

Even foods that don’t taste salty contain sodium. Much of the raw chicken or pork purchased at supermarkets has been injected with a sodium solution.

Some salts occur naturally. Cantaloupe, honeydew melon and grapes contain a small percentage of sodium as do broccoli, carrots and bell pepper. According to the U.S. Food and Drug Administration, two medium stalks of celery contain 115 mg of the mineral. All of these foods, however, account for a minimal percentage of the daily sodium intake.

The nutritional values of fruits and vegetables, such as potassium, fiber and vitamins, far outweigh the scant salt content.

Food labeling There’s a kind of sleight of hand in the description or labeling of foods. The focus may be more on fat content or the number of calories, thereby diverting attention away from sodium. Yet, foods labeled as “healthy” can be chock full of salt. For instance, a half cup of small curd cottage cheese can contain over 450 mg of sodium. One serving of

THE HIDDEN MEANING OF NUTRITION LABELS The Food and Drug Administration has developed a detailed food-labelling guide to define the content of various nutrients. The terms are not self-explanatory, however. If you are not familiar with their exact meanings, it’s anyone’s guess. n Sodium-free or salt-free: Each serving contains less than 5 mg of sodium n Very low sodium: Each serving contains 35 mg of sodium or less n Low sodium: Each serving contains 140 mg of sodium or less

JUST A SPOONFUL There is a misperception that you would have to consume great quantities of salt to surpass the daily recommended limit, but actually, a little goes a long way.

Below are the approximate amounts of sodium in milligrams in a given amount of table salt: n ¼ teaspoon salt = 575 mg sodium n ½ teaspoon salt = 1,150 mg sodium n ¾ teaspoon salt = 1,725 mg sodium n 1 teaspoon salt = 2,300 mg sodium Source: American Heart Association

“98 percent fat-free oven roast turkey breast” contains only 25 calories and one gram of fat, but 250 mg of sodium.

Doubling the serving, which is typical for a sandwich, does little to the fat and calorie content, but approaches onethird of the daily limit of salt.

Sodium in food is hard to avoid.

That makes it a challenge to limit its intake, but it is possible. Limit consumption of processed foods, such as processed turkey and bacon; eat a diet rich in fresh fruits, vegetables and whole grains. Use herbs and spices to flavor foods and eat sparingly frozen meals and vegetables with sauce. Read the Nutrition Facts labels. Products that are low sodium contain 140 mg or less per serving; very low sodium, 35 mg or less. Sodium-free products contain less than 5 mg per serving.

New research is emerging that large amounts of sodium each day may not

nR educed (or less) sodium: Each serving contains at least 25 percent less sodium than the regular version n L ight or lite in sodium: The sodium is reduced by at least 50 percent from the regular version

WHERE YOU’D LEAST EXPECT IT It’s clear that chips and snacks will contain salt, but many other foods — even those that are considered heathy — have greater content of salt than you would think. According to the Centers for Disease Control and Prevention, more than 40 percent of sodium comes from the following 10 types of food: n Breads and rolls n Cold cuts and processed meats n Pizza n Poultry n Soup n Sandwiches, especially from fast-food restaurants n Cheese n Pasta dishes n Meat-mixed dishes, such as meat loaf with tomato sauce n Chips and other salty snacks

be as harmful as previously thought, and that too little consumption may actually be damaging. It will be a while before consensus in reached on this debate. However, there is strong agreement that these findings do not pertain to people with high blood pressure. Limitation of salt consumption for this group of people remains strongly advised.

The taste for salt is acquired. Slowly decrease your use of salt and your taste buds will gradually adjust. baystatebanner.com/news/be-healthy | Be Healthy 13

FOCUS: High blood pressure

Kidney failure: A silent complication Dialysis and transplant the only treatments ANTOINE DAVIS ALWAYS THOUGHT HIGH BLOOD PRESSURE WAS A CONDITION OF OLDER ADULTS. Since his father was

14 Be Healthy | Winter 2015

Antoine Davis is an assistant coach with Pop Warner football.

pattern as millions of other people in this country with high blood pressure.

He had no symptoms. He went this long without a problem. Perhaps he had dodged a bullet, he reasoned.

Unfortunately, that was not the case.

His blood pressure silently began to cause damage. In 2012 the bottom fell out of his excuses. “I felt sluggish,” he explained.

Then fatigue set in. One day he was not sure he could make it from the subway station to work. “I thought I was going to pass out right there in the street,” he said.

He went to the emergency department and was told something he never saw coming. He was in kidney failure.

“This was the longest day of my life,” he admitted. Within a couple of days he was on dialysis and continues treatment three times a week for two hours at a time. He is on a list to receive a kidney transplant.

Davis is only 44 years old.

If he only knew then what he knows now. Davis chides himself. “This is all on

me,” he confessed. “I did not take this [high blood pressure] as seriously as I should have.” If he could turn back the clock things would be different. He said he would listen to his doctor and show up for appointments. Most of all he stressed the need for education. High blood pressure is often preventable. He knows that now.

It is too late for Davis. The damage is already done, but he is determined to prevent it from happening to others.

Young people are his main target. Davis is an assistant coach with Pop Warner football. He is trying to train his kids to win not only on the football field, but also in their health. He warns them about junk food, salt, sugar and tobacco use. He uses himself as an example.

“I’m only 44 years old,” he explains. “I should not have this [kidney failure]. I wouldn’t wish it on anyone.”

Davis keeps pushing. “If I can save just one or two lives, I will have succeeded,” he said.

PHOTO: ERNESTO ARROYO

afflicted, he knew that it probably was quietly lying in wait for him.

But when he was diagnosed in his late 20s he was taken aback. What shocked him even more were his actual numbers — 210/105. Normal blood pressure is less than 120/80. “You’re in stroke mode,” the nurse told him as she quickly ushered him to the emergency department. Davis said he was poked and prodded and eventually prescribed a number of pills to bring his pressure in line.

But the fear of a stroke slowly receded into the background, and the young, reckless male temperament took hold.

“I’d follow the regimen for a while,” he explained. “But I was young and foolish and thought that I was invincible.”

He said his pressure came down a little but it was a constant battle for him. “I gained a lot of weight,” he said. Excessive weight is linked to high blood pressure.

He ignored his doctor’s recommendations.

He missed his six-month interval appointments, and his adherence to his recommended drugs was spotty at best.

He ticked off the reasons for his behavior. He was feeling okay; he really didn’t need the meds; he forgot to take them; he was too busy. His job as a police officer in a major hospital and his responsibility for his daughter took preference.

Davis admitted he fell into the same

FOCUS: High blood pressure

Heart failure: A weakened and enlarged heart An inefficient pump SHE THOUGHT SHE HAD THE FLU. THAT ANNOYING COUGH WAS WORSE AT NIGHT. SHE HAD TROUBLE BREATHING WHEN LYING FLAT. SHE WAS FATIGUED — MORE THAN USUAL. Nicole Smith finally

PHOTO: NICOLE SMITH

went to the emergency room. No cold, the doctors told her, but “your heart is bigger than it should be.”

“I didn’t know what that meant,” Smith, 45, said. She knew it was serious because she was referred to a cardiologist first thing the next morning. She noticed the wording on the clipboard of one of the technicians who was testing her. “Her heart is huge!!!” The exclamation points got her attention.

“You’re in the midst of heart failure,” the cardiologist explained. “We cannot rule out a heart transplant.” The gravity of the situation still had not registered with Smith. “How long will that take?” she asked. “I have four kids and have to get back to work.”

Smith said the doctor came from behind the desk, sat in front of her and held her hands. “You’re not going to work any time soon,” he explained. “I was stunned,” she said. “I couldn’t believe I was that sick.”

Smith was admitted right away for additional tests, but her medical problems escalated while there. Two mild strokes set her back a bit.

Smith was only 33 years old.

The doctors came up with a plan, and apparently, good fortune favored her.

The medications are doing their job. She had a pacemaker defibrillator inserted to keep her heart pumping regularly. A

transplant is no longer in the picture.

Looking back, Smith understands now how she got into this predicament — and how it could have been avoided. She said she made sure her kids were up to date with their shots and took them to all the recommended doctor visits, but she put her health on hold. “I forgot myself,” she explained.

Since Smith did not visit a doctor regularly, she was unaware that she had high blood pressure. It’s unclear then how long it existed and how high it was. What is clear is that she had been hypertensive for quite some time, and untreated high blood pressure is one of the leading causes of heart failure and stroke.

Heart failure can occur when the pressure in the arteries is higher than it should be. The heart is then forced to beat more strongly to overcome the increased resistance. The heart, like any muscle, becomes larger with increased work. Here’s the problem. A larger quadriceps (knee muscle) may help you run with greater efficiency. An enlarged heart, on the other hand, becomes less efficient and pumps out less blood than it should. The body is then robbed of the oxygen and nourishment it needs to survive and do its job.

With every beat a normal size heart pumps out roughly 60 percent of the blood it holds. In Smith’s case, it could produce only 15 percent. That explains the fatigue and buildup of fluid in her body, which resulted in swollen ankles and persistent cough.

After several years on long-term

Nicole Smith suffered from heart failure as a result of unchecked high blood pressure.

COMMON SYMPTOMS OF HEART FAILURE n Shortness of breath n Persistent cough n Buildup of fluid in the body (swelling in feet and abdomen, for example) n Fatigue n Confusion

disability, Smith was finally able to return to work.

She has made lifestyle changes to prevent a setback. Smith watches her sodium intake. She walks. She is scheduled for weight loss surgery. She admitted the pounds have crept up following the death of her mother. Overweight and obesity are risk factors for high blood pressure.

And she keeps her blood pressure in check.

If she could turn back the clock, she would make two major changes. “I would take better care of myself,” Smith explained. “And I would read more health information instead of just fashion magazines.” baystatebanner.com/news/be-healthy | Be Healthy 15

FOCUS: High blood pressure

Keep high blood pressure at bay Many cases are preventable SOME CASES OF HIGH BLOOD PRESSURE ARE DIFFICULT TO AVOID. It may run in families or a medical condition precipitates it. For everyone the risk of hypertension increases with every tick of the clock.

But too many times our behavior brings it on. Here are risk factors that are in our court. Fortunately, we can have some control.

HEALTHY EATING The National Heart, Lung, and Blood Institute recommends limiting sodium (salt) and increasing consumption of potassium. Good sources of potassium are lima beans, sweet potatoes, avocados and spinach. Healthy eating also includes fruits and vegetables, whole grains, low-fat protein and fatty fish.

PHYSICAL ACTIVITY The 2008 Physical Activity Guidelines for Americans recommend that adults engage in 150 minutes a week of moderate-intensity activity. Examples are brisk walking and biking. Regular exercise helps keep arteries flexible, which reduces the risk of HBP.

HEALTHY WEIGHT Overweight and obesity significantly increase one’s risk of high blood pressure. The additional weight increases the workload of the heart, which puts more pressure on the walls of the arteries. A healthy weight is determined by the body mass index (BMI), which correlates height and weight.

BMI Reading Definition 18.5-24.9 Healthy 25-29.9 Overweight 30 or more Obese

WAIST SIZE Waist size is also an indicator of healthy weight. Central obesity — excess pounds around the middle —is a polite term for belly fat. Central obesity is associated with diabetes, which can increase blood pressure.

Gender Men Women

Desired measurement Less than 40 inches Less than 35 inches

ALCOHOL Drinking too much alcohol can increase your blood pressure.

A drink is a 12-ounce beer, a 5-ounce glass of wine and 1½ ounces of liquor, such as scotch or gin.

RECOMMENDATIONS Gender Daily limit Men 2 Women 1

TOBACCO The chemicals in tobacco smoke can damage the structure and function of blood vessels, which increases the risk of atherosclerosis, or buildup of fat. Second-hand smoke can also increase the risk of high blood pressure.

16 Be Healthy | Winter 2015

FOCUS: High blood pressure

Home monitoring Frequent checks help keep tabs on blood pressure DOCTORS OFTEN RECOMMEND HOME MONITORING OF BLOOD PRESSURE. Home monitoring

PHOTO: THINKSTOCKPHOTOS.COM/ GANGLIU10

is particularly helpful for not only those with diagnosed HBP, but also for those who experience “white coat syndrome” (elevated pressure at the doctor’s office) and those with several risk factors. Daily checks allow them to see your pressure over a period of time and also how well the medication is working. It is always recommended to document your findings and share them with your doctor at the next visit.

The trick is finding a reliable monitor. Not just any one will do.

The American Heart Association recommends an automatic, cuffstyle upper-arm monitor. Wrist and finger monitors are less reliable.

The quality can vary from one unit to another. Dabl Educational Trust (www.dableducational.org) tests several monitors and provides on its website a list of those that have been validated and approved.

Size may also be a factor. Special sized cuffs are available to accommodate larger or smaller people.

Home monitoring does not take the place of regular checks by your doctor. It merely shows your pressure on a continuum of several days in a row rather than a snapshot view. Contact your provider if your pressure remains consistently high after several readings.

CORRECTLY MEASURE YOUR BLOOD PRESSURE There is a proper method to use to measure one’s pressure:

1 2

Take your pressure the same time every day

Don't eat or use caffeine, alcohol or tobacco products 30 minutes before measuring your blood pressure

3 4 5

Empty your bladder Rest for three to five minutes before testing Do not talk

6 7 8 9

S it comfortably. Do not cross your legs or ankles. Make sure your back is supported Place the cuff on bare skin, not over clothes Rest your arm on a table or arm chair at about heart level rap the cuff snugly around the upper W arm. There should be enough room to place a finger under the cuff

10

T ake another reading one to three minutes later to check accuracy

Source: American Heart Association; Mayoclinic.com baystatebanner.com/news/be-healthy | Be Healthy 17

Healthy Steps Eat right, stay active, live well » Nutrition 19 » Recipes 20 » Fitness 22

Keeping it under control

Current research suggests that people who have pets — particularly dogs — often have lower blood pressure, partly due to decreased stress and increased physical activity.

18 Be Healthy | Winter 2015

22

Fitness:

Daily exercise can help keep your blood pressure low

PHOTO: THINKSTOCKPHOTOS.COM/ JUPITERIMAGES

High blood pressure is one of the most common chronic diseases. When not controlled, it can cause several life-threatening complications, including heart and kidney failure. With exercise and healthy eating, high blood pressure can often be prevented or reduced.

HEALTHY STEPS: Nutrition

BY: KATHY

THE PLAN

CUNNINGHAM, M.ED., R.D., L.D.

A sample DASH eating plan for a 2,000-calorie-a-day diet FOOD DAILY GROUP SERVINGS Grains 6–8 Meats, poultry and fish

6 or less

Vegetables 4–5

The DASH eating plan A natural way to lower blood pressure

Fruit 4–5 Low-fat or fat-free dairy products

2–3

Healthy fats and oils

2–3

Sodium

2,300 mg*

WEEKLY SERVINGS Nuts, seeds, dry beans 4–5 and peas

Sweets IT’S HARD TO IMAGINE THAT PLAIN OLD TABLE SALT CAN INCREASE BLOOD PRESSURE. BUT IT CAN. Sodium, also known as salt, causes the body to retain water, which in turn increases pressure in the arteries. The average American consumes more than 3,400 milligrams of sodium a day which is more than twice the 1,500 mg recommended by the American Heart Association for African Americans and older adults.

We consume most of our sodium from prepackaged processed meals, snacks, breads, pasta and canned soups.

Several years ago the National Heart, Lung, and Blood Institute sponsored a landmark study to examine the effect of healthy eating on blood pressure. The Dietary Approaches to Stop Hypertension, or DASH, is a diet rich in fruits, vegetables, whole grains and low-fat proteins and dairy products. The first DASH diet research showed that it could lower blood pressure in all study participants — those with and without hypertension — even with a daily intake of 3,000 mg of sodium.

The findings suggest that following a DASH plan might serve as an alternative to drug therapy in those with stage 1 HBP (140-159/90-99) and may delay or even prevent the need for medication in those with pre-hypertension (120-139/80-89). For participants with normal blood pressure, the results suggest that following a DASH plan may prevent HBP altogether.

Subsequent DASH studies examined the impact of varying levels of daily sodium consumption (3,300, 2,300 and 1,500 mg) and found that the lower the sodium, the lower the pressure. The results were particularly noted in African Americans.

The DASH diet is really a misnomer.

It is actually a lifestyle plan rather than a diet. It encourages increasing consumption of potassium and other essential vitamins and minerals, including fiber, protein and calcium. Fortunately, dairy products are not the only food source of calcium. For those who are lactose intolerant many fortified lactose or dairy-free products available. Other foods rich in calcium are dark green leafy vegetables, dried beans and canned fish with soft bones, such as sardines.

The original DASH diet research was not designed for weight loss. However, the Premier Trial — the third leg of the DASH trial studies — found that those who followed the DASH plan and received counseling on behavioral changes

5 or less

*1,500 mg sodium lowers blood pressure even further.

Source: National, Heart, Lung, and Blood Institute

for good health, lost weight as well as lowered their blood pressure.

The DASH plan has had an unintended outcome. Participants lowered their LDL, or bad cholesterol levels as well as their blood pressure, which indicates that the plan is effective in reducing the risk of many other diseases, such as stroke, heart disease, diabetes and some kinds of cancer.

Because of its many benefits, the DASH plan has been ranked as the number 1 diet in the country by U.S. News & World Report from 2011 through 2014.

When making a change in diet it’s best to take small steps. Giant leaps are hard to sustain. You can begin the DASH meal plan with a gradual decrease in sodium intake, and within three to four weeks you should see a change in the systolic pressure, or upper number of your blood pressure. Within the same time frame, your taste for salt and salty foods should also decrease. This gradual process can help you reach your goal of 1,500 mg (2/3 teaspoon of salt) without missing the flavor in foods and, more importantly, achieving the optimal effect on blood pressure reduction. baystatebanner.com/be-healthy | Be Healthy 19

HEALTHY STEPS: Recipes

Edamame stew THIS EASY-TO-MAKE STEW FROM THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE IS HIGH IN FIBER AND PROTEIN, WHICH WILL STICK TO YOUR RIBS AND KEEP YOU FEELING FULL LONGER. It is also low in sodium and very high in potassium, a winning combination to keep your blood pressure in check. Serve over brown rice for a complete meal. Prep and cook times are 20 minutes each.

INGREDIENTS n 1 bag (16 oz.) frozen shelled edamame (green soybeans)* n 1 can (35 oz.) no-salt-added Italian whole peeled tomatoes with basil, diced into small chunks n 2 cups zucchini, rinsed, quartered, and sliced n 1 cup yellow onion, diced n 1 tbsp. olive oil n 1 tbsp. ground cumin n ¼ tsp. ground cayenne pepper n ½ tsp. ground allspice (or substitute cinnamon or pumpkin pie spice) n 2 tbsp. garlic, minced or pressed (about 5 cloves) n 1 cup frozen yellow corn n ¼ tsp. salt n 2 tbsp. lemon juice (or 1 large lemon, freshly juiced) n ½ tsp. dried oregano * Frozen edamame is available in most grocery stores.

DIRECTIONS 1. P lace frozen edamame in a deep saucepan with just enough water to cover. Bring to a boil over high heat. Reduce heat to medium and cover. Cook for 5 minutes. Drain. Set aside.

2. While edamame cooks, chop tomatoes, zucchini and onion.

3. In a large nonstick sauté pan, cook onion in olive oil over medium heat until soft, about 5 minutes.

4. Stir in cumin, cayenne pepper and allspice (or cinnamon/pumpkin pie spice). Cook and stir for about 2 minutes.

5. Add garlic. Cook and stir for 1 minute.

6. Stir in the drained edamame, tomatoes, zucchini, corn and salt.

7. Cover. Simmer until zucchini is tender, about 15 minutes.

8. Stir in lemon juice and oregano. * Yield: 4 servings; serving size: 2 cups stew

NUTRITIONAL ANALYSIS PER SERVING n Calories: 285 n Total fat: 10 g n Saturated fat: 1 g n Cholesterol: 0 mg n Sodium: 303 mg

n Total fiber: 14 g n Protein: 16 g n Carbohydrates: 40 g n Potassium: 1,227 mg

Source: Keep the Beat™ Recipes: Deliciously Healthy Dinners, National Heart, Lung, and Blood Institute 20 Be Healthy | Winter 2015

HEALTHY STEPS: Recipes

Quinoa-stuffed tomatoes THIS SIMPLE SIDE DISH FROM THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE contains quinoa and avocado, both of which are high in fiber and potassium and low in sodium. This is a winning combination to help lower blood pressure.

INGREDIENTS n 4 medium (2½ inches) tomatoes, rinsed n 1 tbsp. olive oil n 2 tbsp. red onions, peeled and chopped n 1 cup cooked mixed vegetables, such as peppers, corn, carrots or peas n 1 cup quinoa, rinsed n 1 cup low-sodium chicken broth n ½ ripe avocado, peeled and diced n ¼ tsp. ground black pepper n 1 tbsp. fresh parsley, rinsed, dried and chopped (or 1 tsp. dried)

DIRECTIONS 1. Preheat oven to 350ºF. 2. Cut off the tops of the tomatoes and hollow out the insides. Set tomatoes aside.

3. Heat oil in a saucepan over medium-high heat. Add onions, and cook until they begin to soften, about one to two minutes.

4. Add cooked vegetables and heat through, about another one to two minutes.

5. Add quinoa, and cook gently about two minutes.

6. Add chicken broth and bring to a boil.

Reduce the heat and cover the pan. Cook until the quinoa has absorbed all of the liquid and is fully cooked, about seven to 10 minutes.

7. When the quinoa is cooked, remove the lid and gently fluff quinoa with a fork. Gently mix in the avocado, pepper, and parsley.

8. Carefully stuff about ¾ cup of quinoa into each tomato.

9. Place tomatoes on a baking sheet, and bake for about 15 to 20 minutes, or until tomatoes are hot throughout (tomatoes may be stuffed in advance and baked later). * Yield: 4 servings, Serving Size 1 tomato, ¾ cups stuffing

NUTRITIONAL ANALYSIS PER SERVING n Calories: 299 n Total Fat: 10 g n Saturated Fat: 1 g n Sodium: 64 mg

n Fiber: 8 g n Protein: 10 g n Carbohydrates: 46 g n Potassium: 906 mg

Source: Keep the Beat™ Recipes: Deliciously Healthy Dinners, National Heart, Lung, and Blood Institute baystatebanner.com/news/be-healthy | Be Healthy 21

HEALTHY STEPS: Fitness

Exercise and high blood pressure IT’S WELL ESTABLISHED THAT EXERCISE HELPS LOWER OR PREVENT HYPERTENSION. At first glance, however, that seems incongruous. Clearly, blood pressure rises during exercise and the pulse rate jumps up. The heart has to pump harder and faster to shunt more blood to muscles for energy. But that’s a short-term effect.

At rest the heart beats between 60 to 100 times a minute, but can more than double during strenuous activity.

Regular exercise fine tunes the heart to make it more efficient. Ultimately, the heart can pump the blood with fewer beats and less effort. Some well-toned athletes have resting heart rates of 40 beats a minute.

Regular exercise also helps keep arteries flexible. Arteries, the blood vessels that deliver oxygen to muscles and organs, are partly elastic and give somewhat to accommodate the burst of blood with each heartbeat. This accommodation allows the blood to flow with less resistance, which in turn prevents excessively high blood pressure.

Perseverance is key. To keep your pressure low it is necessary to keep exercising on a regular basis. According to Mayo Clinic, it takes about one to three months for regular exercise to have an impact on blood pressure. Additionally, the benefits last only as long as you continue to exercise.

Actually, exercise multitasks in relationship to blood pressure. It not only lowers one’s numbers, it helps maintain weight and reduce stress, both of which are closely linked to high blood pressure.

The good news is that your exercise 22 Be Healthy | Winter 2015

program does not need to be intensive, nor elaborate. A simple walk, household chores and even gardening will do the trick. The U.S. Department of Health and Human Services recommends that adults participate in 150 minutes of moderate-intensity activity every week.

That translates to about 30 minutes five times a week.

It’s not necessary to do a full halfhour at a time. Ten-minute intervals will do. Three such intervals a day will get you to the half-hour level, and offer the same benefit as a 30-minute workout.

But what constitutes moderate-intensity exercise? Here’s a tip. If you can sing and maintain your level of effort, you’re

not working hard enough. If you are breathing too hard and fast and can say only a few words without taking a breath, the activity is too strenuous. If you are able to talk and walk, but cannot sing, it is considered moderate-intensity. Examples are brisk walking and biking.

Researchers at the Healthy Lifestyles Research Center at Arizona State University recently published a study that suggests that just standing can improve blood pressure. In a small sample of overweight and obese people, they compared blood pressure in four different activities — sitting, walking, cycling and standing. They found that systolic blood pressure — the upper number that measures pressure when the heart is contracting — was lower in people who stood for 10 minutes every hour during the work day. Pressures were lower for those who followed the same schedule using treadmill desks or under-desk exercise bikes. For diastolic pressure — the low number that measures pressure when the heart relaxes — only cycling beat out sitting in lowering pressure.

Standing has become the new buzz word for exercise. Some offices are now equipped with standing desks to discourage workers from sitting most of the day.

The most positive aspect of regular exercise is that in many people it reduces the need for medication. Regular exercise can lower systolic rate 4 to 9 mm Hg, which equals some prescription medications. Healthy lifestyles, which include not smoking, weight control and healthy eating in addition to exercise, can obviate the need for high blood pressure medication.

PHOTO: THINKSTOCKPHOTOS.COM/ PURESTOCK

An alternative method to keep your pressure low

THE BOSTON ELDER PROTECTIVE SERVICES PROGRAM It’s a Confidential Matter.

Central Boston Elder Services assists persons 60 years and older who are at high risk and are suffering from either self-neglect, neglect, physical abuse, emotional abuse, sexual abuse or financial exploitation.

What does the program do?

The Boston Elder Protective Services Program intervenes in situations where abuse and/or neglect endangers an elder’s health and well-being in any way. The source of this abuse and/or neglect may be intentional or unintentional, and can take many forms, including: • Physical abuse (non-accidental acts where there is bruising, an injury, medical treatment required) • Sexual abuse (unwanted sexual acts, sexual misuse or exploitation, or threats of sexual abuse)

• •

•

•

Emotional abuse (deliberate act with negative impact to elder’s emotional well-being) Financial exploitation (non-accidental act or omission by another person which results in substantial monetary or property loss) Neglect (failure or refusal of the caretaker to provide one or more of the necessities for the elder’s well-being) Self-Neglect (failure or refusal by an elder to provide for one or more of his/her essential needs)

For more information, please visit our website at www.centralboston.org where you may download a copy of the brochure, or call 617. 442. 4200 FAX: 617. 991. 9772

CENTRAL BOSTON ELDER SERVICES

1. 800. 922. 2275 24 HOUR HOTLINE

Need health insurance? I’ll help you sign up!

Matilda Correia Brockton Neighborhood Health Center It’s Open Enrollment time at the Massachusetts Health Connector, where you can find high-quality health and dental plans from leading insurers. Most people who sign up qualify for help paying for their insurance each month.

Where to Get Help: Brockton

Dorchester

Brockton Neighborhood Health Center 63 Main Street 508-559-6699

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Harbor Health Services Inc. 250 Mount Vernon Street 617-533-2300

Boston Public Health Commission 1010 Massachusetts Avenue 617-534-5050

Health Connector Walk-in Center 146 Main Street 877-623-6765

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Family Health Center of Worcester 26 Queens Street 508-860-7700

Community Healthlink 72 Jacques Avenue 508-373-7818

UMass Memorial Medical Center Memorial Campus 119 Belmont Street 508-334-1000

Saint Vincent Hospital 123 Summer Street 508-363-5000

Community Healthlink Outpatient Clinic – Thayer Building 12 Queen Street 508-860-1260

Worcester

Spectrum Health Systems 10 Mechanic Street 508-752-2590 ext. 5341

Sign up for a plan online at MAhealthconnector.org.

Or get free in-person assistance signing up from one of our experts.

Edward M Kennedy Community Health Center 631 Lincoln Street 508-854-3260

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UMass Memorial Medical Center 55 Lake Avenue North 508-334-1000 UMass Memorial Medical Center Hahnemann Campus 281 Lincoln Street 508-334-1000 Rebecca Asare, Independent Broker 14 Merriweather Road 508-981-3318