SUNDAY, OCTOBER 28, 2012
HEALTH MATTERS 2012
THE ITEM
F1
Surgical Care Illness & Injury
Pain Management
Diagnostic Imaging
matters Physical Therapy & Rehabilitation
Urgent Care
Special Section to
Nutrition for a Healthy Heart
A healthy diet, along with physical activity, plays a very important role toward reducing the risk of heart disease. Any healthy diet should be low in fat and include a variety of fresh fruits, vegetables and whole grains. For those at risk for a heart condition or for those recovering from a heart attack, stroke or heart surgery, the cardiac diet is recommended. The cardiac diet is low in sodium, fat and cholesterol. Sodium is a mineral that is needed in the body. However, when consumed in excess it can cause fluid to build up in the body, causing the blood pressure to rise. The best way to avoid consuming too much sodium is to avoid table salt and to eat as fresh as possible. Use herbs, spices, lemon juice and other sodium-free seasonings when cooking and avoid processed foods with added sodium such as canned soup and frozen meals. A tip for low sodium shopping is to shop the perimeter of the grocery store. This is where the fresh foods are located. Most processed, prepackaged foods are found in the aisles.
It also is important to know the difference between bad fats and good fats when starting a heart healthy diet. Saturated fats and trans fats are known as bad fats because they have a negative effect on cholesterol levels. Saturated fats are solid at room temperature and are most often found in animal products. Most foods that are high in cholesterol, such as fatty meats, whole milk and butter, are also high in saturated fats. Therefore, cholesterol can be reduced in the diet simply by reducing the fat. Trans fats can be found in foods such as store-bought baked goods and many deep fried foods. If a food contains partially hydrogenated oils, which can be found in the ingredient list of the food label, it contains trans fat. To optimize heart health, these bad fats should be replaced in the diet by good fats. These good fats that can help lower cholesterol are called monounsaturated and polyunsaturated fats. They are liquid at room temperature and can be found in most plant oils, such as olive and
BY CAROLINE D. THOMPSON, RD, LD
canola oil, nuts, seeds, avocado and oily fish, such as salmon, herring and trout. Attempting to follow the recommendations of the cardiac diet can often be a challenge. It is important to start off slow and make small changes to avoid burnout. Every change is a step in the right direction! Remember
Clinical Dietitian, Clarendon Health System that making the diet more heart healthy not only improves health, but is a reminder of how food is meant to taste in its natural state. Also, remember to eat a variety of foods and try a variety of cooking methods to prevent boredom. It is possible to eat healthy and delicious food!
Clarendon Health System’s Cardiac Rehabilitation program includes a nutrition class on the cardiac diet. For further information on the cardiac diet visit the American Heart Association at www. heart.org or contact Caroline Thompson, clinical dietitian at Clarendon Health System at 803-435-3176.
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F2
HEALTH MATTERS 2012
THE ITEM
SUNDAY, OCTOBER 28, 2012
BY MISSY CORRIGAN Director of Healthy Living
Why ‘Weight’ to Exercise?
As I am driving my kids to their respective schools in the mornings, I pass by many walkers and runners in admiration of their dedication to improving their health and fitness day after day. However, I then wonder if this is all they do or if they are incorporating strength training into their daily or weekly routine in order to maximize their health benefits and to reach their fitness goals. All too often individuals focus on cardio to burn calories and fat. While cardio exercise increases muscular endurance and provides endless health benefits as well as burns calories, it does not promote muscle building and strength. There is no extended calorie burn after a cardio session. As soon as you are finished with your session, your metabolism returns to normal. Compare that to resistance training (weight lifting) where your metabolism stays elevated for more than six hours allowing your body to continue burning fat and calories. Getting fit goes way beyond burning calories; it’s about losing body fat and building muscle. A consistent strength training program increases muscle strength, muscle size and tone while strengthening tendons, bones and ligaments. This can be achieved with the use of free weights, cables, fixed machines and even your own body weight. All of this positively impacts physical performance, metabolic efficiency and physical appearance, while reducing risk of injury. Research indicates that we lose approximately half a pound of muscle each year after age 25 which corresponds to a loss of strength. This results in a reduction of your resting metabolic rate (the number of calories your body burns every day at rest) every year, causing your metabolism to slow which results in fewer calories burned, therefore increasing body fat. So, does increasing muscle mass increase resting metabolic rate? Yes! The more muscle you have the faster your metabolism will be
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and the more fat and calories your body will burn at rest. Women have a fear of bulking up when starting a strength training program, but rest assured because women have low levels of testosterone, they are not capable of building big muscles. We all have muscles. The goal to get “toned” or “ripped” is just a matter of decreasing body fat to reveal the muscle that has been developed underneath. Strength training isn’t just for vanity; it has been shown to improve psychological health by increasing self-esteem, confidence and self-worth. Furthermore, strength training can help fight obesity, osteoporosis, diabetes and arthritis. Here are some tips to remember when beginning a strength training program: •Seek professional guidance to learn proper form and safety of each exercise. •Strength train a minimum of two days a week with at least 48 hours of rest for specific muscle groups in between each training session. •Strength train each muscle group every week, focusing on a minimum of two exercises per muscle group, and two sets of 8-15 repetitions of each exercise. •Start with light weights to build good mechanics before moving to heavier weights •Always lift with a controlled movement and breath and complete each repetition with full range of motion. So dust off those weights sitting in your garage and start lifting your way to a stronger, firmer, more fit you. It’s never too late to start! Beginning a strength training program can seem a bit overwhelming. While there are all kinds of information and programs to help you get started online, you may need a more personal hands-on approach. That’s where the Sumter YMCA Fitness Center staff can provide assistance. Our wellness coaches and staff are certified fitness instructors and personal trainers who can provide you with tips and guidance in your weighttraining program. With your membership, you have access to our MobileFit system which is a computerized personal training program that creates a resistance training program for you based on your goals, current health and injuries, as well as your current activity level. We also offer a free fitness center orientation to assist you with the machines and MobileFit program. If you are looking for more individualized attention we have highly qualified certified personal trainers on staff who can create a program for you and assist you along the way. For more information about healthy living, visit www.ymcasumter.org or call 803-773-1404.
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HEALTH MATTERS 2012
SUNDAY, OCTOBER 28, 2012
THE ITEM
F3
BY KELLI MCGREGOR
Employee of Colonial Healthcare
What is patient centered medical home? If you have ever heard the term “Patient Centered Medical Home” you may have wondered exactly what that term means. If you haven’t heard that term, then be prepared, because over the next few years it’s a term that more and more family health care practices will start using to describe the type of care that will be provided to you as a patient. So what is a Patient Centered Medical Home (PCMH) exactly? Well, first of all, a PCMH is considered by the American Academy of Family Physicians, among other healthcare organizations and insurers, as a better approach to health care. It is not, however, an actual home, or building, but rather something bigger. A PCMH is when a family practice creates a trusting relationship with you the patient. It offers same-day and after-hour care, it implements a personalized team approach to coordinate care among your different health specialists, and it provides you with advanced technologies in healthcare. A PCMH is a patient-centered approach that has been proven to improve long-term health. To better explain, let’s elaborate on some of these points. In a PCMH you should feel like you have a personal and trusting relationship with your physician. This requires that your family doctor have improved work flow and efficiencies that allow her to spend more time with you focusing on prevention, and on you as a whole person. Improved efficiencies also allow your physician’s office to offer same-day, and after-hour patient care. A PCMH also requires a team approach to care coordination between different medical specialties. Health care in general can be very overwhelming and confusing; and as a patient, the lack of proper communication and coordination between specialties can negatively affect your health. With care coordination, your family physician leads your personalized team made up of nurses, pharmacists, specialists, or anyone else involved with your health, to make sure appointments are made, kept, and that results are shared with everyone on your team. This ensures everyone sees the same big picture instead of bits and pieces. For chronic disease management, such as diabetes or heart disease, a specialized care coordination team is created for those patients. Finally, a PCMH offers advanced innovations in healthcare such as, electronic patient satisfaction surveys, online registering, reporting and scheduling, and electronic medical records. Technologies such as these, give a PCMH the ability to work and communicate efficiently and effectively so doctors can focus on improving your overall health. The whole world is utilizing new technologies and innovations to improve your life, and health care should be no exception. We must note that these are just a few main points to explain what a Patient Centered Medical Home is. Trust us; there are many more details and requirements in becoming a PCMH than could ever be listed here. But, the reality is that this is the new direction that family health care is headed. Even major insurers such as Medicare and BlueCross BlueShield are pushing for more Patient Centered Medical Homes because of the evidence of improved clinical outcomes and reduced healthcare costs. The good news is that many family practices are on their way to meeting PCMH standards, and patients everywhere will benefit!
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F4
HEALTH MATTERS 2012
THE ITEM
SUNDAY, OCTOBER 28, 2012
BY KEVIN HUDSON, D.V.M, M.S. Hudson Veterinary Hospital
Maintaining a Healthy, Happy Aging Pet
As dogs get older, their needs change with regards to diet, preventive care, and exercise to maintain a good quality of life. Dogs age 5-7 years for every year of our life, thus the importance of regular visits to your veterinarian will help identify important health changes and address specific needs your pet may have. This article will discuss the importance of preventive care and the different health problems and concerns you may have as your pet ages. Routine preventive care starts while kittens and puppies. Vaccinations to prevent infectious diseases should be part of an annual program to maintain good health. Heartworms lead to congestive heart failure and a much shorter life span, many times as short as 7 years of age. Monthly heartworm prevention for the life of your pet will add years to their life. Similarly, routine dental care, including annual dental prophylaxis, will increase longevity and keep your pet healthy and happy. Although it was common years ago for a pet to only live 10-12 years, we are seeing pets commonly live 15+ years when a good preventive care program is in place. Seeing your veterinarian every six months is equivalent to seeing your doctor only every three years. Thus, it is important for your pet to have a good physical examination and blood work every 6 months. Blood results give us insight into internal organ function, including the kidneys and liver. Good physical examinations will help identify any changes in weight and detect significant changes that
can point to a number of diseases or potential problems. Always provide a good history of your observations to help identify specific problems. Is your pet drinking or urinating more than usual? Is he having accidents in the house? Is he having a hard time getting up? Are there any changes to his appetite or weight? Is he more tired than usual? These are all questions that will help lead to an early and accurate diagnosis to treat an underlying disease and improve the quality of life of your pet. 1. Is your pet drinking or urinating more than usual? Is he having accidents in the house? These signs may seem trivial, but can actually point to specific problems with the kidneys, or even diabetes. Although urinary tract infections can also cause these signs, simple blood tests should be performed to identify these more serious diseases so they can be treated early. 2. Is he having a hard time getting up? Is he more tired than usual? Arthritis is a big cause of a pet slowing down. Joint pain leads to reluctance to exercise which then leads to loss of muscle (atrophy). The lack of activity can then lead to obesity which creates a downward spiral for your pet’s quality of life. There have been many advances in promoting joint health. Ask your veterinarian about chondroprotectants (i.e. glucosamine, chondroitin, and Adequan injections) and the use of medications to alleviate arthritis pain (anti-inflammatories). 3. Are there any changes to his appetite or weight? Pets may gain or lose weight as they age. A sedentary lifestyle often leads to obesity if we do not feed the right food or the right amount of food. We should be feeding senior diets to all pets over the age of 7 years, and there are prescription diets to aid in the treatment of many diseases, including arthritis. Also tell your veterinarian about weight loss, as this finding may also point to disease (i.e. diabetes, hyperthyroidism) which needs to be treated. Talk to your veterinarian at your pet’s regular check-ups to identify any conditions that may be affecting your older dog or cat. It is our goal to make sure your pet stays happy, healthy, and live a long Physician and fruitful life. Through preventive care, good nutriSumter, SC 29150 tion and exercise, we can achieve these goals.
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HEALTH MATTERS 2012
SUNDAY, OCTOBER 28, 2012
THE ITEM
F5
J. MARSHALL DENT, M.D.
Board Certified in Bariatric Medicine, Obstetric and Gynecology and Family Medicine
Diabesity: What you don’t know may kill you A recent survey shows that the obesity rate in South Carolina is 31 percent and will exceed 63 percent by the year 2030. And, South Carolina will be ranked in the top 5 for the highest obesity rate in the United States. Is this a ranking we should be proud of? With about two-thirds of Americans obese now, is there anything we can do as a state and as a country to alter this course? There are children having diabetes and heart disease earlier than previous generations. As a nation, we are on course for this to be the first generation of children in history that will live sicker and die younger than their parents. It is down right frightening if we don’t change the course of this trend. We must all work together to take back our health. What is the problem that is leading to this epidemic? It is called many things: insulin resistance, metabolic syndrome, syndrome X, pre-diabetes, adult onset diabetes and type 2 diabetes. These are all essentially one problem: some vary by severity but all can have deadly consequences. The term has been coined diabesity, the continuum from normal blood sugar balance to insulin resistance and full-blown diabetes caused by obesity. Diabesity is one of the leading causes of heart disease, dementia, cancer, and premature death in the world. It is caused almost entirely by environmental and lifestyle factors. This means that it is almost 100 percent preventable and curable. Scientists conservatively estimate diabesity will affect 1 in 2 Americans by 2020. Gaining just
tes.
11-16 pounds doubles your risk and 17-24 pounds triples your risk of type 2 diabe-
Diabesity starts early in childhood. Here are some of the startling statistics: • One in three children are overweight in America. • Childhood obesity has tripled from 1980 to 2010. • There are 2 million morbidly obese children above the 99 percentile in weight. • One in three children will have diabetes in their lifetime. • Childhood obesity will have more impact on life expectancy than all cancers combined. How do we correct this trend toward diabesity and get our health back as a nation? First, we have to make the proper diagnosis. The test would include a fasting insulin level and a fasting glucose level. Many times the glucose level is normal but the physician does not probe deeper, and the patient is left untreated. The insulin level is the real measure of the condition. Insulin is the first value that will rise long before the blood glucose level does. Many times these labs are not checked even on a diet program and the person is left wondering why am I having a hard time losing weight even with diet and exercise? The answer is the lack of metabolic correction. The additional weight one puts on contributes to the increased production of insulin that further compounds the problem. Once the insulin level has shown to be elevated, the use of insulin lower-
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ing medicines can assist in the weight loss process and prolonging pancreatic function. The labs should be checked on six-week intervals until a normal insulin level is obtained. As the weight is reduced the dose of medicines then can be reduced. The dietary key is the lack of carbohydrates, refined sugar, and natural sugar that contribute to the insulin levels being elevated. A high protein and low carbohydrate diet is essential for weight loss and maintaining muscle mass. The elevated insulin level also can lead to high blood pressure, abnormal cholesterol and inflammation inside of the contrary arteries. All of these factors contribute to heart disease and stroke, the leading cause of death in this country. An elevated insulin level predisposes one to weight gain and this increase in adipose tissue enhances the production of estrogen. Estrogen is a very weight positive and weight- depositing hormone. It deposits fat in the breast, hips, and lower abdomen. Can you see the implication of increase insulin on hormone balance and weight gain? We must take control of our future for our selves and future generations. It all gets back to education about diabesity and what are the signs and symptoms of the condition. With proper education we can empower families to make positive changes that will impact their life expectancy, as well as quality of life.
Clarendon Health System and Providence Heart Institute Partner to Better Serve You. Clarendon Health System is proud to announce a partnership with Providence Hospital—South Carolina’s Heart Hospital. Together, our combined experience and compassionate care results in better outcomes for you and your loved ones. Dr. John Hicks and Dr. Lee Butterfield with Clarendon Cardiovascular Associates are Board certified cardiologists dedicated to providing the best heart care possible to people in South Carolina. Now, you will have access to their expertise close to home as well as exceptional care at Providence Heart Institute’s nationally ranked heart program for interventional procedures.
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F6
HEALTH MATTERS 2012
THE ITEM
BY LINDA PEKURI Executive Director, SCAL
You probably have heard or read that walking is good exercise and good for your health, but maybe you are still not convinced that walking for exercise is something you can and should do to improve your own health. But, what will it take to convince you? Perhaps reading the following personal stories of Sumter County residents or workers who are walking for their health and enjoyment as part of the Sumter County On The Move! (SCOTM!) walking program will work. Being invited to participate in this free and convenient program might, too. Keep reading. “I’ve tried other programs geared toward health improvements—but nothing that would ever stick. It is working this time because of the group support I receive,” says Angela Levy, a member of one of the first SCOTM! walking groups formed earlier this year. During her first
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seven months in SCOTM! , Angela lost 23 pounds and lots of inches. She adds, “It has been the best thing for me! My story, my journey, I pray it will be a force to motivate others.” Ron Gailliard joined his worksite’s SCOTM! group in February because he wanted to lose weight and gain more energy. He had been looking for a workout facility that was easily accessible to him but, instead, discovered that walking was easier because it can be done anywhere. He began taking walks with his wife again, and after awhile, he realized that he had much more energy throughout the day. Ron states, “My wife and I started bicycling in our neighborhood about six weeks ago because of the SCOTM! program. It has motivated us to be more active.” “When I heard about SCOTM!, I immediately wanted to sign up. Even though my time is limited, I love to walk; so I checked out the program and decided it could benefit me. It has been a true blessing!” exclaims Pam Wilfong, who recently formed her walking group and enrolled into the program. “After receiving a pedometer from SCOTM!, I set a goal of walking 10,000 steps daily. I constantly search for more ways to walk! As a result, I feel more energetic, and I have even moved some clothes from the ‘too little’ side of the closet to the ‘fits’ side. That has been a great reward. I certainly move more than I did before joining SCOTM!.” SCOTM! group leader Mamie Smith gives this explanation for joining the walking program: “When I looked at myself, I realized that I was becoming the person that we laugh at and joke about. Then I decided it was time for a change. So (one) morning I got up and took a long walk. I walked three miles straight for the first time in my life! I am so proud of myself! I still can’t believe it, but I did it with the help of God!” Mamie is thankful that the SCOTM! program helps her to become more health conscious and take control of her life. These are just a few of the many testimonies about how Sumter County On The Move! positively impacts people’s lives. This free, groupbased walking program is for all adults who live, work, worship or spend time in Sumter County. It is also a research study funded by the Centers for Disease Control and Prevention that is being conducted by the University of South Carolina (Columbia) Prevention Research Center, in partnership with Sumter County Active Lifestyles (SCAL). Its goal is to get more adults in the county active and healthier by walking for exercise. SCOTM! includes support for formation of walking groups, training for group leaders and members, informational materials on walking resources and tips for increasing physical activity, follow-up communication to support the walking groups and recognition of participant accomplishments. If you think that walking for exercise is something you can and should do to improve your own health, will you get involved in the Sumter County On The Move! walking program? Consider yourself invited! To find out how to get involved, visit www. SumterCountyMoves.org or call Linda Pekuri, SCAL executive director, at (803) 774-3861.
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HEALTH MATTERS 2012
SUNDAY, OCTOBER 28, 2012
Compounded Drugs Fill in Medication Gaps The iconic portrait by Norman Rockwell of the pharmacist pouring a dark liquid into a vial with a sick child looking on reflects a time gone by in pharmacy practice. Through the 1950s, most downtowns had corner drugstores in which the pharmacist would make – or “compound” – your prescription medication from raw materials produced by chemical companies. In fact, many patients remember the unique smells of these pharmacies due to the aromatic nature of ingredients stored in rows of wooden drawers. Eventually, chemical companies produced tablet forms of the most commonly compounded medications, and this changed the landscape of pharmacy practice dramatically. Within a decade, a majority of prescriptions were manufactured by pharmaceutical companies. Pharmacists need only to count the tablets and place them in a bottle. Food and Drug Administration (FDA) guidelines mandated that each drug be proven safe and effective for patient use with defined dosing guidelines. Good manufacturing practices and other regulations were enacted to ensure that manufactured medications were produced in sanitary environments. The question then arises of whom or what governs the compounding process? And how does that differ from manufacturing? This question is certainly being debated extensively these days. One of the primary standard bearers is the United States Pharmacopeia (USP. see www.usp.org). Section 795 of USP provides the standard of practice for non-sterile compounding (capsules, oral suspensions, etc) and section 797 of USP covers sterile compounding (injectables, ophthalmic preparations, etc). Board of Pharmacy regulations cover the practice of compounding (see www.llr.state.sc.us) and these regulations mandate that each prescription is to be compounded pursuant to a prescription for a particular patient. This regulation is one of the central issues swirling around the recently reported steroid injection tragedies in which several patients have died from fungal meningitis across the U.S. Were these injections prepared pursuant to a prescription for an individual patient or were these injections prepared and mailed across the U.S. without patient prescriptions? This sad tragedy has brought compounded medications and compounding pharmacies into the crosshairs of the FDA, pressured by public outcry to rectify this situation and prevent further tragedies. Sumter Cut Rate Drugs, located in downtown Sumter, is a compounding pharmacy. Following USP 795 guidelines, Sumter Cut Rate Drugs has a separate laboratory in which to compound any non-sterile prescription needed. Cut Rate has a window in which anyone can view the lab and see their prescription compounded. All compounding personnel at Sumter Cut Rate Drugs have completed an advanced compounding training course in Houston from the Professional Compounding Centers of America (see www.pccarx.com). When the need arises in Sumter for sterile compounding, most patients drive no farther than Columbia where several sterile compounding pharmacies provide those services. Prescribers from many areas of practice write for compounded medications in the Sumter area. The prescriptions are generated when the prescriber determines that a compounded medication is more appropriate for the patient than a commercially available product. In many instances, the prescriber will contact a compounding pharmacist to discuss options in the treatment regimen of patients whose condition is not adequately treated with traditional medication. Examples of popularly prescribed medications in the Sumter area encompass all age groups. Suspensions made from adult capsules of potent stomach
THE ITEM
BY JOHN HOLLADAY
Sumter Cut Rate
acid reducers for infants and toddlers are commonly prescribed by pediatricians. Infants treated for heart ailments receive prescriptions for adult medications to regulate heart rate and blood pressure and these adult forms are compounded into liquid forms help these patients. The demand for bio-identical hormone replacement continues to rise in our area. Topical creams and capsules of these unique remedies are commonly prescribed and compounded in Sumter. Area pain management physicians often prescribe medications in transdermal gels that are applied directly to the site of pain for relief. Hospice patients also benefit from compounded medications for nausea and restlessness. Pets throughout Sumter are prescribed compounded medications to help treat seizures, nervousness, blood pressure and numerous other maladies. All of these should be compounded pursuant to a prescription. If not, this practice is deemed as pharmaceutical manufacturing and thus under the authority of a multitude of manufacturing regulations. The current national news on compounding medications is centered on this issue: Is it compounding for a patient or is it manufacturing that subverts regulations? Sumter Cut Rate Drugs operates under the philosophy that the patient-physician-pharmacist relationship is vital to competent healthcare, and all compounded medications are ordered by the prescriber for a particular patient. Compounded medications improve the quality of life for many patients each day. Patients must know where and how their medications are compounded, and if the staff is qualified to compound.
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THE ITEM
HEALTH MATTERS 2012
SUNDAY, OCTOBER 28, 2012
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