HLN January 2013 by Healthy Living News

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Your Monthly Guide to Healthy Lifestyles

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e lthy l January 2013 • FREE

Also available at hlntoledo.com

Local healthcare CEOs talk 2013 Also in this issue: • • • • •

New Year facial rejuvenation Long-awaited Parkinson's center launched 15 minutes to a shapelier nose Needed: foster homes for babies RSV is nothing to sneeze at

• • • • •

Walk in the Park Feeling SAD? Eating Well Academy Corner And much more...

What’s your weight loss wish?

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Facial Rejuvenation Look your best in the new year!

ery few individuals realize that 80% of their facial appearance with aging is due to sun exposure and subsequent damage. All the brown spots (“age spots”), broken blood vessels on the face, fine lines, and sagging skin are caused almost entirely by sun! What about the “worry lines” between the eyes, deep smile lines, upper lip lines (lipstick runs uphill), and the sagging jowls and neck? These unfortunate processes caused from prior sun exposure can be improved dramatically with innovated and virtually pain-free cosmetic procedures performed by Dr. Handler. The Thermage NXT procedure painlessly heats Don’t let wrinkles and damaged collagen under age spots make you appear older than your years. your skin to lift sagging skin on the neck and jowls. The Thermage NXT utilizes radiofrequency energy (not laser) to uniformly heat the dermis while the epidermis is cooled and protected. This heating of the dermis causes immediate collagen contraction followed by new collagen production over a period of time. The procedure also encourages a natural repair process that results in further tightening and younger-looking skin. It is also an excellent non-invasive and pain-free procedure for tightening “crepe” skin on the abdomen of men or women and sagging skin on the upper arms. With only one treatment, results work over a 6-month time period to slowly lift and tighten the involved areas with results lasting 3-4 years. There is NO downtime and NO pain! For lines between the eyes, crows’ feet, and the “sleepy look with droopy eyelids,” the use of Botox or Dysport works well to improve these areas with resultant diminished lines and a more “wide-awake” The best prevention for look. This is also perearly aging and skin formed with minimal cancer is to protect your pain with results lasting skin from the sun. 5-7 months and longer.

2 January 2013 / Healthy Living News

The use of fillers, such as Restylane, Perlane, Juvederm, Radiesse, and others, to “fill” deep smile lines and the marionette (sad) lines from the corners of the mouth produces immediate results lasting 12-15 months! Since these products are combined with a numbing agent, the pain is minimal. For fine lines, large pores, and brown (age) spots, the Clear + Brilliant laser produces awesome results after 3-5 treatments. This is a painless procedure where a laser produces thousands of small columns in the dermis. Your body then produces collagen to fill these areas. There is NO downtime with this procedure. Dr. Handler is the only dermatologist performing this procedure in Northwest Ohio. Dr. Handler has performed these procedures for years with very gratifying results and very satisfied patients. All of these cosmetic enhancements are performed entirely by Dr. Handler. Dr. Handler’s office now has available a new

Before

After

camouflage make-up that is excellent to cover red or blue veins on the face or anywhere else on the body; blue, red, or yellow bruises from prior cosmetic procedures; and, especially, facial, neck, and chest redness secondary to rosacea. For more information about the above-mentioned procedures or products, please call Dr. Handler’s office at 419-885-3400. His staff will be able to address your questions or concerns about these procedures. Please visit Dr. Handler’s website at drharveyhandler.com to view many before-and-after photographs of patients who have had these procedures performed. Also, check with the office staff to inquire about specials on many cosmetic procedures. ❦

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To read this issue online, visit www.hlntoledo.com

Mission Statement Healthy Living News offers the residents of northwest Ohio and southeast Michigan a monthly guide to news and information about healthy life styles, health care, sports and fitness, and other issues related to physical, mental and emotional quality of life. The publication promises to be an attractive, interesting and entertaining source of valuable information for all ages, especially those 35 to 50. Healthy Living News is locally owned, committed to quality, and dedicated to serving our great community. Healthy Living News is published the first of each month. The opinions expressed by contributing writers do not necessarily reflect the opinions of the publisher. Distribution of this publication does not constitute an endorsement of any kind. While HLN makes every attempt to present accurate, timely information, the publication and its publisher and/or advertisers will not be held responsible for misinformation, typographical errors, omissions, etc.

Contacts Business office:

To advertise: Healthy Living News, 375 Rose Glenn Drive, Toledo, OH 43615. Phone: (419) 841-8202 or email Kevin O’Connell sfstennis76@bex.net. Ad reservation deadline is the 15th of the month preceding publication. HLN reserves the right to refuse advertising for any reason and does not accept advertising promoting the use of tobacco.

Editorial office:

To submit an article or announce an event: Editor, Healthy Living News, 1619 Circular Dr., Toledo, OH 43614. Phone: 419-754-1339, fax 888-506-5790; email: editorhln@bex.net. Deadline for editorial submissions is the 10th of the month preceding publication.

Publisher Kevin O’Connell Editor Jeff Kurtz Travel Editor LeMoyne Mercer Sales Robin Buckey Layout and Design Jan Sharkey Distribution Jim Welsh • Alison Foster Dominion Distribution Distributech - Toledo Copyright © 2012 Healthy Living News Reproduction in whole or part without written permission is prohibited. Healthy Living News is published for the purpose of disseminating health-related information for the well being of the general public and its subscribers. The information published in Healthy Living News is not intended to diagnose or prescribe. Please consult your physician or health care professional before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines.

H OWK\ O QJ HZV

January 2013 • Vol. 18, Issue 1

Your Monthly Guide to Healthy Living

Health & Beauty

Taking Care of Your Life

2 Look your best in the new year 11 Lung cancer largely preventable through smoking avoidance 14 Tinnitus can affect people with or without hearing loss, by Dianna Randolph, AuD, CCC-A 19 15-minute procedure creates shapelier nose without surgery 29 Sound Advice from Northwest Ohio Hearing Clinic 30 Heartland Rehab’s tips for maintaining your 2013 fitness resolutions 31 Feeling SAD? Let there be light! 34 The Laurels’ innovative occupational therapy program puts independence in reach 42 Migraine headaches and the eye by Bennett Romanoff, MD 44 RSV: much worse than common cold for at-risk people 45 Oh dear, the Mayans were wrong! by Douglas Schwan, DC, Dipl Ac 47 The Academy Corner Angina: risk factors and symptoms, by Angela K. Johnson, UTCOM MS4 48 Patient Advocacy Just say no to uninformed consent by Norene Massey Nungester

13 Spiritually Speaking Going to the dogs by Sister Mary Thill 22 Crossword, by Myles Mellor 23 Disciplined investing helps keep emotions in check 24 A Walk in the Park Toledoan left his mark on the Southwest, by LeMoyne Mercer 32 Wealth and taxes: planning for uncertain times by Scott D. Brown 35 Maintaining those New Year's Resolutions by Amanda Manthey 36 Nobody's Perfect Moving right along by Sister Karen Zielinski, OSF 43 Caregiving 101 for men by Jessica Derkis 49 Providing sustenance for winter-weary birds

Food & Nutrition 39 Eating Well “Can you work me up a diet?” by Laurie Syring, RD/LD

Children & Parenting 27 LCCS implores loving families to foster infants 46 St. Ursula students solve real-life problem by Christine A. Holliday Dear Readers, Happy New Year and thank you for picking up the January issue of Healthy Living News. At the start of a new year, it’s only natural to re-examine our lives and lifestyles with a critical eye. Most of us then resolve to make positive changes—to adopt habits that lead us down a healthier path and abandon those that take us in the opposite direction. We’re confident you’ll find plenty of information and encouragement to get you started down the right path here in this jam-packed, 52-page issue. Speaking of starting out on a healthier path, in this month’s cover story (p. 5), Mercy CEO and President Andrea Price, ProMedica President and CEO Randy Oostra, and University of Toledo President Lloyd Jacobs share their insights on the changing healthcare landscape and the exciting innovations taking place in their respective health

Our Community 5 Healthcare CEOs share insights on changes and challenges in 2013 10 News from Otterbein Watch out for winter! 15 UTMC launching long-anticipated Parkinson’s center 17 Trilogy Health Services brings new senior living alternatives to Maumee 20 Toledo/Lucas County CareNet—celebrating a decade of caring 26 CC4PM announces newest facility 28 Frame Chiropractic and Acupuncture welcomes new practitioner, expands services 38 Lourdes University nursing programs answer need for advanced nursing education 40 Meaningful Use, by Emma Opblinger, RN 47 Harbor expands Medicaid Health Home services

systems in 2013. In the article on page 19, Dr. Christopher Perry of The Toledo Clinic ENT Sinus Center of Excellence discusses the Non-Surgical Rhinoplasty procedure, an innovative technique for correcting mild to moderate imperfections of the nose using dermal filler injections rather than invasive surgery. We’re also thrilled to welcome the folks at Wells Fargo to our family of contributors. Throughout 2013, they’ll be providing a regular financial advice column. Their first installment, “Disciplined Investing Helps Keep Emotions in Check,” appears on page 23 and is chock full of timely strategies that will keep your investments healthy in our constantly changing financial markets. On a personal note, I would like to

congratulate Dr. Lawrence Elmer, Medical Director of the Center for Neurological Health, and Director of the Parkinson’s Disease and Movement Disorders Program at the University of Toledo Medical Center, on the opening of UTMC’s new dedicated Parkinson’s Center (p. 15). This center has been in the discussion and planning stages for over a decade and finally seeing it come to fruition is a dream come true for Dr. Elmer. Both my father and father-in-law are patients of Dr. Elmer, and we are forever indebted to him and his wonderful staff for the great care they’ve provided over the years. It’s a blessing to us and the community to have such a world-class physician and facility right here in Toledo. Until next month, stay safe, active, and healthy!

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Healthcare CEOs share insights on changes and challenges in 2013

hange is the only constant in the field of health care. Innovative treatments and state-of-the-art technologies are continuously emerging. Philosophies and strategies of care are ever evolving. And new challenges are always arising for providers and patients alike. Of course, the year 2013, with many provisions of the Affordable Care Act slated to go into effect, is sure to usher in its share of changes and challenges. To get a sense of what Andrea R. Price,

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a 10% decline in inpatient care and

a 7% increase in outpatient care. About 76 million Americans struggle with high blood pressure, also known as hypertension. It President and CEO of Mercy may be difficult to control, but without adequateAs treatment high blood pressure can becannot deadly. healthcare providers, we Physicians in our area are conducting a clinical sit research evaluate an investigational backstudy and to wait; rather, With the Affordable Care Actoral becomcombination of FDA approved medicines intended to treat hypertension. we have to address the

ing reality, the healthcare changes starting today. You may bewhat eligiblewill if you: landscape like theoldfuture? As such, at Mercy, • arelook at least 18 in years What mean for our with commu• does haveit been diagnosed hypertensionwe (highare blood pressure) more becoming nity,• andarehow is Mercyorworking to to become not pregnant, not planning pregnant nimble, proactively plan• the do not have Type 1 Diabetes address new realities? ning and innovating as • can attend 15 clinic visits for approximately 16as weeks. well aligning resources ealth care is undergoing unprecQualified participants will receive at no cost: for growth in outpatient • change all study-related evaluations, including physician edented right medical now, moving care. evaluations In order bytoa move all study-relatedhospital-based exams, monitoring and toward study drug.that future, we from • a fragmented, system to abecoordinated, have to ensure there are You may compensated for evidenceyour time and travel. based continuum-of-care model. What enough physicians to care Health insurance is not necessary. this means is simple: the healthcare for patients all along their see if you qualify, contact needs and the way careTo is delivered continuum of care. Exare changing forClinical both patients and panding those partnerResearch Source, Inc. our communities. ships with physicians is a Think about this: over the next key component for Mercy 10 years, Northwest Ohio will see

lies ahead for our community, Healthy Living News recently asked Mercy President and CEO Andea Price, FACHE; ProMedica President and CEO Randy Oostra, DM, FACHE; and University of Toledo President Lloyd Jacobs, MD, for their perspectives on what 2013 will bring. Here are their insights based on questions we posed: as physicians are at the center of any care-coordination model. While we are working to significantly grow the number of physicians we employ, we do not have a mindset of driving physicians solely into an employment structure. Rather, our goal is to partner with our physicians by providing them options to continue to care for their patients. Simultaneously, we are working to grow our ambulatory footprint to

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meet the needs for growing services and patient needs in the region (for example, the Mercy Emergency and Diagnostic Center in Perrysburg). Additionally, we are focused on clinical integration itself—from preventing disease, to treating patients in the office, and coordinating their care during and after a hospital admission. Key to clinical integration are Patient Centered Medical Homes, which foster a team-based approach to an ongoing, accessible, and comprehensive relationship between a primary-care physician and patient. Our goal by early 2013 is to have every Mercy primary-care practice be certified as a PCMH. Let me give you an example of the benefits of PCMH: A 68-year-old woman became a patient of one of

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our family-medicine physicians about a year ago. She had seen another physician for years prior but wasn’t engaged in her health care; rather, she simply was given additional medication to treat her conditions. We all understand and can appreciate the medication available; however, her previous physician was simply treating her conditions, not working with her to try to improve the conditions. When she came to see a Mercy family-medicine physician, he and his care team talked with her about her conditions, what her goals were for her health, etc. Then, they developed a care plan to make her goals a reality. Fast forward a year, and she is completely off her diabetic medication, weaning off her high-blood-pressure medication, and on a lower dose of her cholesterol medication. And she says she has more energy now than in many years. That’s the value we bring. Healthcare systems, employers, insurance providers, and employees all must learn to adapt to a future that balances access with financial stewardship, coverage with payment reform, episodic treatment with improving the health of entire populations. A key part of all of this is the technology infrastructure itself—electronic health records. In 2004, we were pioneers in EHR and developed the first hospital-based system in the region. Our leadership in EHR continues today as we are investing heavily in implementing an integrated electronic health record that allows for a single chart per patient irrespective of where care is delivered—be it in a physician office, a hospital, or an emergency department. This type of information sharing, we hope, will help break down the silos that can exist among the various sites of care as well as reduce duplication, improve quality of care, improve patient safety, and lower costs for our patients and the healthcare system overall. What exciting changes/innovations does your system have in store for 2013? Just like we’ve done for the past 157 years, Mercy is proactively addressing new paradigms in health care with strategic initiatives to strengthen our innovative position in the market and in the industry. Recently, Mercy broke ground on the area’s first free-standing ER in Perrysburg. This new, 15,000-square-foot facility will be backed by our highly regarded physicians, staff, services, and technology. It will serve patients

of all ages with comprehensive emergency care and diagnostic services, 24 hours a day, seven days a week, and it will be staffed by experienced emergency-medicine physicians and staff that are synonymous with the Mercy name and our leadership in emergency-level care. Additionally, we continue to work passionately to improve the safety of our patients. We are proud of the “culture of safety” we have created within our organization and how that culture is weaved into every action and every moment of every day. Recently, Mercy received recognition that we are on the right track—The Joint Commission, an independent, non-profit organization responsible for accrediting hospitals nationally, named Mercy as a “Top Performer,” nationally, in using evidence-based care to positively impact the medical outcomes of our patients. I’m also proud to mention that four Mercy hospitals recently received an “A” rating in the annual Hospital Safety Assessment conducted by The Leapfrog Group, a voluntary program aimed at recognizing healthcare safety, quality, and customer value. Mercy St. Vincent, Mercy St. Anne, Mercy St. Charles, and Mercy Defiance Hospital were among the hospitals to receive that “A” ranking identifying them among the “safest” hospitals in the nation. While honored to receive these recognitions, we understand we are on a journey in which we are seeking continuous improvement—because it is the right thing for the patients we serve and serves our mission of improving the health of the community. Randy Oostra, dm, fache President and CEO of ProMedica Looking at the healthcare landscape in 2013, what is your greatest source of optimism?

We are optimistic about the ongo-

ing cooperation and collaboration that is taking place in the communities we serve that will make our region stronger and more vibrant. ProMedica has skilled, professional, compassionate caregivers who strive to live our Mission every day, and we are confident that together with our community partners we can help our area thrive. What is the biggest healthcare challenge facing our community in 2013, and how is your system working to overcome it?

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One of our biggest challenges is the social complexity of our patients. The demands placed on our physicians, staff, and health systems require that, together, we negotiate this complexity amidst significant changes in access, information technology, increases in Medicare and Medicaid enrollment, and how we are paid for our services. Many factors affect the health of individuals and communities; whether people are healthy or not is determined by their circumstances and environment to a large extent. Factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health. Healthcare has traditionally been concerned with diagnosis and treatment rather than these social determinants, and increasingly health care needs to address both. ProMedica is involved in several projects to address these issues, including our work on hunger as a health issue. We have begun partnerships and programs with community organizations that help to better connect our patients and community residents to services they need. By strengthening the safety net, we can better ensure the health and well-being of those we serve.

How do you anticipate that the new healthcare law will impact your healthcare system and our community? Reform in health care would be happening with or without the new healthcare law because the current system is unsustainable. ProMedica has taken a proactive approach in anticipating changes in health care. With that in mind, to continue to deliver efficient,

effective, quality care; meet the health and wellness needs of the communities we serve; as well as properly prepare our organization for all the requirements of healthcare reform, ProMedica will continue to evolve at an accelerated rate. We will continue to build on our culture of safety and continuous improvement. By identifying and implementing best practices, we will continue to improve quality, safety, and satisfaction for those we care for while reducing costs. What exciting changes/innovations does your system have in store for 2013?

As always, the focus for ProMedica in 2013 is on our Mission to improve the health and well-being of those we serve, and on meeting the community need. Research has shown that health information technology, such as electronic medical records and bar coding for medica-

tion, can greatly improve the patient experience. ProMedica has embraced several important technological developments to enhance our quality of care, including implementing our new electronic medical record system. Providing health care is becoming more and more complex. The numerous medications and the need to understand and act on potential drug interactions, ongoing changes in medical practice occurring every day, frequent policy changes, Joint Commission and ODH requirements, and government reform incentivizing health systems to achieve meaningful use of an electronic health record are all factors that make providing quality

care at the bedside increasingly challenging. Further, innovation in the practice of medicine will continue to change at a dramatic pace. ProMedica recognizes the need for change and is taking steps to support our patients and the people that care for them. To that end, ProMedica is combining operational and process changes with patient-care technology to help drive quality and improvements in our delivery of care. ProMedica is committed to clinical and operational integration and excellence through technology. The ultimate goal is to improve quality and safety outcomes for ProMedica’s patients and the community we serve. Lloyd Jacobs, md University of Toledo President Looking at the healthcare landscape in 2013, what is your greatest source of optimism?

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tion that desires and values high-quality care. Americans are increasingly educating themselves about healthy options, and problems like obesity and diabetes are creating a large and growing group of Americans who are incredibly health conscious.

During the last decade, UTMC has been a leading innovator in rethinking the way we treat patients and—just as importantly—rethinking the way we educate the next generation of physicians, nurses, technicians and other caregivers. Using our Interprofessional Immersive Simulation Center, students have spent hours working

What is the biggest healthcare challenge facing our community in 2013, and how is your system working to overcome it? For the vast majority of our existence, health care was limited by our lack of knowledge. While we will always have more to learn about medicine and treatment, in the past few decades, logistics, costs, and resources have replaced knowledge as health care’s limiting factor. We cannot afford to do all we know how to do to treat the nation’s healthcare needs. AIDS in Africa is a one example of this challenge: We know education and prophylactics help to prevent HIV transmission, and we have developed effective drug cocktails to limit the growth of HIV once it is in the human body. But the scale of the problem outstrips our available resources and our ability to address it comprehensively. The University of Toledo Medical Center is taking advantage of the focus on sustainability in fields like energy and environmental sciences to work to scale up the technologies we use to treat patients and make health care sustainable. A key piece of that will be growing existing partnerships with other healthcare providers and establishing new ones that enable patients to benefit from the resources and knowledge of a broader base of healthcare expertise. How do you anticipate that the new healthcare law will impact your healthcare system and our community? The healthcare law will broaden access to care, and I think that is unquestionably a positive for patients and our community. But with that comes huge resource needs, and UTMC, like all hospitals and healthcare providers, will be challenged to find new ways to provide high-quality care faster, safer, and more cost effectively.

8 January 2013 / Healthy Living News

in teams that replicate real-world experiences long before they ever interact with a patient. We anticipate that we’ll soon hear positive news about UT’s application to the U.S. government to partner with the Toledo Clinic to create an Accountable Care Organization, a patient-focused collaboration that is designed to improve coordination between caregivers and Medicare patients. One of the best things that will result from the implementation of the healthcare law is that I think it will force UTMC, Toledo, and hospitals and communities across the nation to grapple with this notion of healthcare sustainability. What exciting changes/innovations does your system have in store for 2013? We have a number of projects coming to completion in the coming year. In 2012 we invested in pushing University-quality care out into the Toledo community, and in 2013 we will open our next primary-care clinic at The Shops at Fallen Timbers. UTMC’s new Dana Cancer Center will be treating patients by early February and will centralize all aspects of cancer care in a single location. We’ve installed some of the most advanced, precise radiation treatment devices available, which will reduce the length of treatments for many patients. UTMC’s new Gardner/McMaster Parkinson’s Center will open in the coming months, and we’re excited to see continued expansion of one of the most experienced and advanced stroke-treatment teams in the country. Academic Medical Centers set the bar for health care in the regions they serve, and that’s a responsibility UTMC embraces. ❦

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News From

Otterbein Watch out for winter

inter is a time when we should be particularly aware of healthy habits, especially the elderly. Not only is there the danger of the cold, but the long nights often mean we tend to stay indoors and become more isolated. Add the danger of slippery steps and roads due to inclement weather, and the winter months turn out to be a season of potential hazards! Americans are known for being good neighbors, so take this opportunity to get in touch with an elderly neighbor or friend on a regular basis and see what you can do to make their lives just a little bit easier. Here are some tips for random acts of kindness that will go a long way to ensure the safety and wellbeing of someone you care for. Help with the grocery shopping. Whether you have to go and get some of the groceries yourself or accompany

your neighbor to the supermarket, make sure that they have some help especially when the weather is particularly miserable. Ensure that their refrigerator and pantry are stocked with the basic essentials that lead to a healthy life. Check their home for drafts. Draft prevention is an important factor in preventing colds and muscular pains, but it also helps to keep the electricity and gas bills down. Do a quick inspection of any cold air coming in through the windows and doors. These problems can easily be fixed by buying an insulation kit and some draft stoppers. Encourage them to go outdoors in natural daylight when the weather is fine, especially at midday on bright days. Research has shown that a daily walk in the middle of the day is important in combating winter blues.

Being cold makes people more depressed. It has been shown that staying warm can reduce the winter blues by half. It is important that people keep warm with hot drinks and food, have warm clothes and shoes, and keep their home between 66° and 72°F. A healthy diet is a great mood booster, giving more energy and keeping weight gain in check. Balance cravings for carbohydrates, such as pasta and potatoes, with plenty of fresh fruit and vegetables. Encourage them to take up extra activities. But most importantly, spend some time just talking and taking an interest. Everyone is affected by the weather. As you are helping your neighbor through the winter season, use a discerning eye. Everyone wants to live independently at home for as long as possible, but for some, that home may become a burden or even an accident waiting to happen. Look out for these signs that may indicate it’s time to think about a move to a senior living community: • Food left out on the counter

and spoiled • Stove burners left on • Medications left open on the counter • Fall hazards: open dishwasher doors, too many throw rugs, small pets • Flammable items near the stove • Electrical appliances near the sink • Cleaning supplies near food in the kitchen • Groceries not put away Otterbein Portage Valley is a senior retirement community that has it all! You’ll find a country living lifestyle just minutes from downtown Perrysburg and Bowling Green. Villa homes, independent apartments, assisted living, and skilled nursing situated on a beautiful wooded campus provide the independence and the care in just the right balance. Improve your balance during these slippery winter months by considering a move to a carefree, maintenance-free retirement community. The winter’s looking better already! ❦

ALWAYS SO MUCH TO DO...

In January: Smart Phone and Tablet Classes, Day Trips, Concerts! Call Geri today for a tour and a complimentary lunch! Soup’s On! Friday’s in January, Call us to ﬁnd out more!

Euch re Card

Pa Tues rty! Janu day, a All ar ry 15th. e inv ited! Complimentary Lunch and Learn, “Beat the Winter Blues”

10 January 2013 / Healthy Living News

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Lung cancer largely preventable through smoking avoidance

f you’re a tobacco user and haven’t the cancer is in close proximity to one yet committed to a New Year ’s of the mainstem bronchi, the tumor resolution, smoking cessation should will tend to compress the bronchus be right at the top of your list—paras it grows. To visualize this effect, ticularly if you want to avoid lung think of holding a drinking straw cancer. between your thumb and forefinger and then squeezing the straw. The correlation between tobacco use and lung cancer risk is strong Dr. Phinney notes that there are and irrefutable. According to Richard two main classes of lung cancer, Phinney, MD, of The small-cell and nonToledo Clinic Cansmall-cell, and there cer Centers, while are various subtypes not everyone who within these broader smokes ends up categories. “Regardgetting lung cancer, less of histology or smoking is the numstaging, all forms of ber-one risk factor lung cancer are treatfor developing the able. Not all stages disease and between are curable, but they 85 and 90 percent are all treatable with of lung cancer cases varying degrees of efare associated with fectiveness,” he adds. Staging of lung smoking. Even secondhand, or passive, cancer is based on exposure to tobacco the size of the tumor, smoke is enough to whether there is inincrease risk. volvement of nearby Dr. Richard Phinney In addition to lymph nodes, and smoking, other hazardous expowhether the cancer has advanced sures, e.g., radon or asbestos, increase outside the lung or metastasized to lung cancer risk, as well. Particular distant sites in the body. Dr. Phinney points out that lung cancer preferenoccupations, such as ship building, tially spreads to the lung (multiple the insulation industry, and certain areas in the same lung or to the other forms of mining, may be associated lung), brain, bones, and abdomen. with these exposures. Also, external Small-cell, which tends to be more radiation exposure, for instance raaggressive, moves to the brain more diation therapy administered to the chest to treat breast cancer, increases commonly than non-small-cell does. the risk of developing lung cancer For early-stage lung cancer, which down the road. tends to be localized, surgical resection The symptoms of lung cancer is the primary treatment. Depending vary, depending on the location of on the pathology of the cancer, chethe tumor and other factors. “Among motherapy may be considered after the main symptoms is a cough, which surgery. More locally advanced cancan be either productive or not,” cers, which can be difficult to resect, explains Dr. Phinney. “If it is profor example if they’re located close ductive, the sputum may be clear, to an artery or other vital structure, but it’s much more concerning if are typically treated with a combinait contains blood. In that case, you tion of chemotherapy and radiation. should see your physician immediMetastatic lung cancers—those that ately. Another worrisome result of have traveled to another site in the lung cancer is pneumonia. When body, demand a more systemic aptreating patients with pneumonia, proach, so chemotherapy is usually primary-care physicians will usually the treatment of choice. “With surcheck chest X-rays for evidence of gical resection of lung cancers, the a mass. Other common symptoms goal is cure and the rate of success include fatigue, loss of appetite, and depends on the type of cancer you’re unintentional weight loss, which is dealing with. Metastatic cancers are treatable but not curable, so the goal definitely cause for concern.” Lung cancer can be “silent”—causof treatment is control of symptoms ing no obvious symptoms for an exand maximizing survival benefit,” tended period—if the tumor is located Dr. Phinney states. in the periphery of the lung. When The 5-year survival rate for lung more centrally located toward larger cancer is also quite varied based on airways, however, symptoms will type, staging, and other factors. more likely be noted. For example, if For example, for a stage-1 non-

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small-cell lung cancer, the survival rate at 5 years is 55 to 75 percent. That rate goes down as the stage increases—40 to 50 percent for stage 2, 10 to 35 percent for stage 3, and less than 5 percent for stage 4. Small-cell lung cancer is staged as “limited disease” or “extensive disease,” not as 1, 2, 3, or 4. Patients with limited disease have a median survival of about 20 months with treatment and 3

months without treatment. The median survival for patients with extensive disease is about 12 months with treatment but just six weeks without treatment. The good news is, there have been some positive developments in the area of lung cancer screening. An August 2011 study published in the New England Journal of Medi-

cine showed that screening reduced mortality among a select population of high-risk individuals who were all between the ages of 55 and 74 with at least 30 pack years of smoking (1 pack year is the equivalent of having smoked 1 pack of cigarettes per day for a year) and who quit within the last 15 years. The study participants, who were screened with a low-dose CT once a year for three years, showed a reduction in mortality of about 20 percent specific to lung cancer and about 7 percent from all other causes. “This is the first study I’m aware of where a reduction in mortality

was noted from screening. Previous screenings using chest X-ray showed no benefit,” observes Dr. Phinney. Still, smoking cessation or avoidance remains the most effective preventive measure against lung cancer. “The best advice I can give with respect to lung cancer prevention is don’t smoke! If you’re not a smoker, don’t start! If you’re a smoker, quit! If your spouse or other loved one smokes, make them quit. And try to minimize your exposure to secondhand smoke,” Dr. Phinney advises. When facing a diagnosis of cancer, more and more patients are choosing

ProteCt YoUr CHILD’S SLeeP JUSt AS YoU Do tHeIr SAFetY Sleep problems don’t just effect a child’s nights, they disrupt their days too. Lack of sleep can cause your child to have learning delays and be: • hyperactive • less alert • easily distracted • physically impulsive • injured from increased falls • overweight

How much sleep time do they need?

Mercy Children’s Hospital and Kohl’s Cares believe that fostering positive behaviors in health and nutrition will help children be healthier and happier. We’ve teamed up to offer parents and other caregivers practical advice on raising healthy children. Kohl’s Kids in Action is focused on four valuable steps that are important to better health: good nutrition, increased physical activity, proper water intake and good sleep habits.

Infants

14-15 hours

Toddlers

12-14 hours

Preschoolers

11-13 hours

School-age

10-11 hours

Teenagers

9-10 hours

establish a bedtime routine • Turn the TV, cell phone and computer off an hour before bedtime, allowing for quiet play • A warm bath and comfy pajamas will help your child ease into sleep • Take care of all of the “have-to’s” like brushing teeth and going to the bathroom so your child won’t ask after they’re in bed • Read to your child or let them read to you for 10-15 minutes • Give your child a big hug, tell them that you love them, turn off the light, leaving just a night light on, say “goodnight” and leave the room • Children thrive on routine so be consistent even on the weekends

Kohl’s Kids in Action offers free obesity prevention programs to your elementary school or at health fairs. For more information, call Kohl’s Kids in Action at 419-251-1246 or visit us online at kohlskidsinaction.org.

DRINK WATER, EAT hEAlThy, slEEp moRE AND gET movINg! 12 January 2013 / Healthy Living News

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The Toledo Clinic Cancer Centers. With eight board-certified hematologists/oncologists and eight nurse practitioners on staff, The Toledo Clinic Cancer Centers can provide imaging and laboratory diagnostic services, chemotherapy services, and IV services. Also, there are several offices (including the main location at 4235 Secor Road and satellite centers in Maumee, Bowling Green, Oregon,

Adrian, and Monroe) for the convenience of the patient. Many Toledo Clinic Cancer Centers patients are enrolled in the latest cancer research and studies in our region through the Toledo Community Oncology Program (TCOP). ❦ For more information, please call the Toledo Clinic Cancer Centers at 419479-5605.

BySister Mary Thill

Spiritually Speaking Going to the dogs Love me, love my dog.

—St. Bernard, 1150 A.D.

Recollect that the Almighty who gave the dog to be companion of our pleasures and our toils, hath invested him with a nature noble and incapable of deceit.

—Sir Walter Scott

t is with some trepidation that I write this article because I often have a conversation with one of my housemates about the seemingly endless articles about dogs in our hometown newspaper. If nothing new happens to a dog, then just turn to Today’s Log and you see pictures of dogs to be adopted and Dogs Killed listed with the deaths of the humans in Lucas County. I’ve heard that some folks from out of town are flabbergasted when they see the attention given to dogs in the newspaper. Some letters to the editor also express concern for such coverage. Recently, on the front page in the Second News section (The Blade, 12-812), there was a continuing report on Cutie’s Fund, a fund set up for emergency care for animals at the dog pound and named for a terrier-mix found with a broken leg in the central city area of Toledo. As I turned to the next page, at the bottom of the page there was a report of a court date being set for the father and mother of a baby who had been found in the freezer of a home in east Toledo earlier this year. Allow me to make my own conclusion about what is news here. You can make yours. What I see happening here is evidence of a shift in our culture regarding the place of humans, especially children, and pets in the family. Of course, it is also a sign of

what is happening to the structure of the family, period. As I watched endless commercials on TV over the holidays about getting gifts for children, I was struck by how many commercials were about getting gifts for our pets. One of them went so far as to show a woman leaving her husband behind at the pet store because she had her SUV so loaded up with gifts for her pet she didn’t even miss him. Another example that blew me away was the comment of a local pet store employee who invited the audience to come and have their pet’s picture taken with Santa, “and if you don’t have a pet, you can bring your child.” Wow! Where did that come from? In defense of pets, especially dogs, I refer you to the quotes above by St. Bernard and Sir Walter Scott. I do like dogs. I never had one of my very own but enjoy other people’s dogs, and I get all mushy when I watch “Too Cute” on Animal Planet. I do, however, believe that we need to put things in perspective when it comes to the place of pets in our lives. I find it especially sad when I see children being neglected and pets being cared for as “children.” I’m not saying don’t have any pets; just keep them in perspective regarding their place in our culture, in our communities, and in our families. Sure it’s easier to be nice to the one creature in your home who greets you with such delight that it makes you feel warm all over. It is much harder to be nice to a wife or child who doesn’t even greet you and acts like you don’t even exist. I believe that this skewed attitude toward pets is evidence of a lack of spiritual awareness that needs to be addressed individually and

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collectively. We are all creatures of God, made by God, and receive our value from our Creator. We are also each given a place in creation that is special and unique to each of us, human and animal. We need to celebrate and appreciate just who we are and where we are in the order of things and never forget that we are all companions on this journey, on

this planet, in this solar system. Let’s enjoy all of life and be concerned for one another—humans and animal alike! ❦ Sister Mary Thill is a Sylvania Franciscan Sister. She is Patient Liaison for Mature Health Connections at Mercy St. Vincent Medical Center. She can be reached at 419-251-3600.

Tinnitus can affect people with or without hearing loss by Dianna Randolph, AuD, CCC-A

hat is tinnitus? You may get different definitions of what it is, but tinnitus is defined as the perception of sound within the human ear in the absence of corresponding external sound. According to the American Tinnitus Association (ATA), tinnitus affects about 50 million people in the United States. It is the number one service-connected disability of veterans from all periods of service, and since 2005, the number of veterans receiving service-connected disability for tinnitus has increased at least 15% each year. We have seen our share of patients with tinnitus as their number one complaint. As mentioned, tinnitus is different for everyone. For some, it is heard once in a while for a short period of time; for others it is constant 24 hours a day, seven days a week; and some

report hearing tinnitus when it is quiet, like right before bed. Tinnitus sounds are also different to each individual. Some have reported hearing a “tea kettle” sound, while others may hear “crickets” or a “locust.” We also have had patients tell us they hear organ music playing all the time. However the sound is perceived, tinnitus is not a disease; it is a symptom or sign that something else may be wrong, much like pain. Tinnitus can be in one or both ears, and it is nondiscriminatory, affecting men, women, and children. The most common cause of tinnitus we see is hearing loss, especially noise-induced hearing loss. Other causes may be Meniere’s disease, which is a disorder of the inner ear; hearing loss with balance problems;

trauma to the ear or head; ear infections; wax impactions; and, in rare cases, an acoustic tumor. For the majority of these patients, the tinnitus does not seem to be disturbing. They are able to go about their lives and forget they even have tinnitus. A small percentage of them, though, are highly disturbed by the tinnitus, which affects their daily life and interferes with their sleep. At Northwest Ohio Hearing Clinic, we have found one of the easiest and most common solutions to tinnitus with hearing loss is the use of hearing aids. With the amplification of sound, the tinnitus is masked and the patient is then unable to hear it or the tinnitus deceases in loudness. The use of hearing aids is like “killing two birds with one stone."Not only will the patient get relief from the tinnitus, but they will also hear well. Another option is a tinnitus-treatment program from Neuromonics, which, with prescribed use, will facilitate the desensitization of the tinnitus. We have also seen many patients who complain of tinnitus and have normal hearing. Further investigation is required to determine what is causing the tinnitus. First, a disturbance along the auditory pathway needs to be ruled out. Specialized testing can evaluate the auditory pathway and determine

WE HELP CONTROL PAIN. WE CALM FEARS. WE BRING RELIEF AN COMFORT. WE HELP CONTROL PAIN. WE CALM FEARS. WE BRING

if there is a disruption, such as an acoustic tumor, which may cause the tinnitus. Once this is ruled out, we search for other reasons why the tinnitus may be present. In these cases, some detective work needs to be done because tinnitus can be caused by other things not directly related to the ear, such as certain medications, aspirin, jaw problems, stress, depression, or anxiety. The patient’s lifestyle is also discussed. For example, has there been a recent stressful situation or a recent major change in the patient’s life? We also review the medications prescribed to the patient. Too much caffeine, sodium, nicotine use, and high blood pressure have also been known to cause tinnitus, so these triggers need to be evaluated. Whatever the cause, the goal is to try to decrease the disturbance so it becomes more manageable. The disturbance may be decreased in several ways. As mentioned earlier, desensitization using the treatment program from Neuromonics has helped many of our patients with disturbing tinnitus. Neuromonics works by using individually designed music and a masking tone for several hours a day. The music promotes relaxation and concentration while the masking tone provides tinnitus coverage and relief. Over time and continuous use, the patient will notice a decrease in their tinnitus disturbance. Other therapies include sound therapy to mask the tinnitus, medications prescribed by a physician, and relaxation techniques like yoga or exercise. When the tinnitus treatment and hearing aids are not enough, counseling is recommended. Whatever the cause of your tinnitus, you don’t have to “live with it.” We have had great success in helping people get relief, but first we must get to the bottom of the real cause. It may not be a quick fix, but with our help and guidance, relief is not far away. If you have questions or know a family member or friend who suffers from tinnitus, let them know they are not alone and give us a call. ❦

e help control pain. calm we bring RELIEFfears. AND COMFORT. WE HELP CONTROL PAIN. WE CALM FEARS. ef and comfort. how “You’re not in this alone.” n we WE help you? we WE HELP CONTROL PAIN. WE BRING RELIEF AND COMFORT. lp control pain. wepain. WE HELP control m fears. we bring reCALM FEARS. WE BRING RELIEF AND COMFORT. WE HELP CONTROL f and comfort. how n we helpWE you? we calm PAIN. WE CALM FEARS. WE BRINGFEARS. RELIEF AND COMFORT. WE HELP lp control pain. we m fears. we bring reWe are the area’s largest and most experienced provider of CONTROL PAIN. WE CALM FEARS. WE BRING RELIEF AND COMFORT. f andWEcomfort. how BRING relief AND comfort. hospice care, a nonprofit organization solely dedicated to n we help you? we WE HELP CONTROL PAIN. WE CALM FEARS. WE BRING RELIEFproviding AND the best possible end-of-life experience for our lp control pain. we patients and their families. m fears.HOW we CANbring WE helpreyou? Ask for us by name. The sooner you do, the more we can help. f and comfort. COMFORT. WE HELP CONTROLhow PAIN. WE CALM FEARS. WE BRING Dianna Randolph, AuD, CCC-A, is a n we help you? we Doctor of Audiology with Northwest lp control pain. we RELIEF AND COMFORT.WE HELP CONTROL PAIN. WE CALM FEARS. Ohio Hearing Clinic, located at 3000 m fears. we bring reArlington Ave. in Toledo (419-383-4012) f and comfort. how and 1601 Brigham Dr., Suite 160 in WE BRING RELIEF AND COMFORT. WE HELP CONTROL PAIN. WE Perrysburg (419-873-4327). n we help you? we lp control pain. we CALM FEARS. WE BRING RELIEF AND COMFORT. WE HELP CONTROL m fears. we bring ref and comfort. how 14 WE January 2013 / Healthy To read this issue online, visit www.hlntoledo.com PAIN. CALM FEARS. WE Living BRINGNews can we help you?RELIEF AND COMFORT. WE HELP “We are experts in managing symptoms and pain as patients

get closer to the end of life. It’s very important to call as soon as possible so we can help you with the disease process you are facing. We will support you at every turn so you know

you’re not alone.“ – Dr. Vicki Bertka, Hospice of Northwest Ohio physician

Answers for Living the Last Months of Life

Visit hospicenwo.org

419-661-4001 (Ohio)• 734-568-6801 (Michigan)

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8/10/12 9:52 AM

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UTMC launching long-anticipated Parkinson’s center

eople whose lives are touched by Parkinson’s disease understand that this incurable, progressive neurological disorder cannot be compartmentalized. It’s a disease that affects the whole person and every aspect of life. Effective treatment demands a comprehensive, interdisciplinary approach. “From the time they wake up until the time they go to bed at night, people with Parkinson’s are affected by their disease,” explains Lawrence Elmer, MD, PhD, Professor of Neurology, Medical Director of the Center for Neurological Health, and Director of the Parkinson’s Disease and Movement Disorders Program at the University of Toledo Medical Center (UTMC). “It impacts their mobility; how they feel and think; their communication skills; their ability to exercise; their

eating, digestion, bathing, and other activities of daily living; their ability to sleep well; and much more.” For many people with Parkinson’s, traveling all over town to see the slew of specialists who manage their symptoms can seem like an insurmountable challenge. Owing to their various impairments, it’s often necessary for Parkinson’s patients to turn to family and friends—who have their own busy schedules to keep—for help getting to and from appointments. However, with the pending launch of UTMC’s new dedicated Parkinson’s Center, area Parkinson’s patients and their families will soon have the ability to come to the UTMC campus to see all the specialists they need in one convenient location. “The opening of a dedicated center is like a dream come true,” enthuses

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Health Care is complicated But that’s where you come in. Patient advocates, or professionals who act as liaisons between patients and the health-care provider, are needed now more than ever. You can supplement your undergraduate degree with training in this field through The University of Toledo’s Graduate Certificate in Patient Advocacy Program. This is a 100 percent online graduate certificate that can be completed in just two semesters.

HHS 148 510

For more information call or e-mail Debra O’Connell – 419.530.5421 or Debra.Oconnell@utoledo.edu.

No Needles! Make allergy shots a thing of the past. Toledo Clinic ENT is now prescribing the at-home allergy treatment NO-SHOTZ oral allergy drops. BOARD CERTIFIED

Oliver H. Jenkins, M.D. Christopher B. Perry, D.O. Specializing in Allergy, Nasal, and Sinus Disorders

Toledo Clinic ENT Sinus Center of Excellence

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Convenient, Same-day Allergy Testing and In-office Sinus CT Scans 16 January 2013 / Healthy Living News

Dr. Elmer. “We started discussing this concept over ten years ago, and now, thanks to funds raised through a strong partnership of UTMC with the Parkinson’s Foundation of Northwest Ohio and very generous private donations from the Gardner and McMaster families, it’s finally coming to fruition. The whole idea behind the 1.5-million-dollar center is to offer our community a dedicated facility that provides for the informational, educational, and therapeutic needs of patients and their families from the moment they walk in the door. We’ll have physical, occupational, and speech therapists; neuropsychologists; pharmacists; nurses; social workers; and audiologists, all helping people navigate the early and advanced symptoms of Parkinson’s disease. We’ll also have access to the latest options in surgical management, such as deep brain stimulation, as well as a big push in education and research and anything else that will help patients and their families deal with Parkinson’s more successfully. Our goal in a nutshell is to make Parkinson’s disease as insignificant as possible in the lives of those affected.” Technology plays a major role in the new center, as well. UTMC’s Information Technology department is working hard to create a tablet-based educational program that patients and their families can access. Also, there will be touch screens throughout the clinic, allowing clinicians to call up educational videos with a simple touch. “The IT group at UTMC has been tremendously supportive in providing tools that help patients understand their disease and how to get better. These resources free up patients and clinicians to spend more time working together as a team to defeat Parkinson’s,” says Dr. Elmer. Interdisciplinary care for Parkinson’s is not a new concept at UTMC. In fact, the Parkinson’s Disease and Movement Disorders Program has for several years offered a Parkinson’s Disease Interdisciplinary Clinic, codirected by Michelle Masterson, PhD and Chair of the PT department, and Molly Scott, RN, MSN, FNP-BC. Every Tuesday, three patients and their families come to the clinic and are evaluated sequentially by a team of specialists. The team members meet to present their findings and develop a care plan, which is then discussed with the patient and their family. The new dedicated Parkinson’s center simply takes this comprehensive care approach to the next level. Dr. Elmer notes that, in addition

to the new center, several recent advances in the area of Parkinson’s treatment are generating enthusiasm in his field. For instance, more and more research supports the benefit of Parkinson’s-specific therapies— dedicated exercises that are based in general physical therapy but work an order of magnitude better, particularly when combined with Parkinson’s medication. Examples include “BIG Therapy,” a specialized physical and occupational therapy program that involves the use of exaggerated movements to address motor impairments, and “Delay the Disease,” which is designed to maximize physical function while delaying the progression of symptoms. In the realm of medications, a new form of the drug Sinemet® (carbidopa/ levodopa), which treats the symptoms of Parkinson’s by increasing the level of dopamine in the brain, has proven to be a major breakthrough. Whereas the old form of carbidopa/levodopa would cause a spike in dopamine that would then dissipate, resulting in a “peak and trough effect” (periods of symptom control followed by periods of decreased mobility), the new agent is two to three times as long-lasting and maintains a more uniform level of dopamine, yielding greater benefit and fewer long-term complications. Parkinson’s clinicians are also discovering the importance of neuroplasticity, a concept that has dramatically impacted the field of stroke care. Neuroplasticity is the brain’s ability to form new neural pathways, making it possible for different areas of the brain to compensate for damaged areas. Just as with treating stroke patients, implementing prompt, aggressive therapy with Parkinson’s patients can help their brains learn to bypass damaged areas and tap into other, “silent” areas to assist, for example, with motor control. “It’s also noteworthy that this type of therapy doesn’t involve any medications. It’s an entirely natural process. The brain has always been able to learn something new; we just had to learn how to teach it,” Dr. Elmer states. Exciting breakthroughs are also occurring in clinicians’ understanding of how Parkinson’s develops. For instance, several markers that indicate someone is at risk for developing the disease have been identified. Among these “pre-motor symptoms” are loss of the sense of smell, changes in blood pressure, acting out dreams, and slowing of gastrointestinal activity. “We’re still at an early phase of

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this research, but these pre-motor symptoms will one day allow us to identify people who are en route to developing Parkinson’s,” says Dr. Elmer. “If we start treating early enough, we could possibly prevent the disease from occurring. I think the day will come in our lifetime when we can do simple, inexpensive tests to identify Parkinson’s risk and then initiate treatment to prevent it. If successful, this type of research could potentially make Parkinson’s disease extinct, similar to what happened with polio in the last century. That will be a wonderful day indeed!” UTMC’s dedicated Parkinson’s Center is slated to open in early spring of 2013. Dr. Elmer is especially grateful to the Toledo community for making the center a reality. “This would not have been possible in a city of this size anywhere else in the country. The fact that, in the midst of a major recession, this community came together to raise 1.5 million dollars to build this center says everything about the people of Toledo. The people here and throughout Northwest Ohio are generous beyond words, family and community oriented, and strongly committed to helping others, making this an amazing and wonderful place to live and work ,” he says. ❦

Trilogy Health Services brings new senior living alternatives to Maumee

rilogy Health Services announced recently the opening of their 74th health campus in Maumee, Ohio. The Lakes of Monclova features a full continuum of senior-living and related healthcare services, including short-term rehabilitation, assisted living, specialized memory care, longterm care, adult day care and respite services, all offered in a homelike setting that features an abundance of private suites, chef-prepared meals, and services specially tailored to meet residents’ individual preferences. The Lakes is located at 6935 Monclova Road in Maumee, and is owned and

operated by Louisville, Kentuckybased Trilogy Health Services. Trilogy’s approach of offering senior health and living services in a home-like setting is apparent the moment you enter The Lakes. Light streams in from windows in the cupola, hitting the clock tower and benches in the center of the Town Square. Around the Square, living rooms, a bistro, and a sunroom offer places to sit and visit, bake a batch of cookies, or enjoy a moment’s relaxation. Watercolor painting, gardening, foreign language classes, and discussion of current events are just a few choices

on the day’s agenda. Also located at The Lakes of Monclova is The Legacy at The Lakes, a neighborhood designed specifically to care for people living with Alzheimer’s and other forms of dementia. The Legacy is expected to open in January. “We are thrilled to be serving residents of Maumee, Lucas County, and the surrounding communities,” said Julie McKitrick, Executive Director of The Lakes of Monclova and The Legacy at The Lakes. “We look forward to bringing our exceptional approach to resident care and services to area seniors. Everything about our

Memory loss requires specialized care. Fortunately, that’s our specialty. Recognizing the symptoms of Alzheimer’s, dementia or other forms of memory challenges can be difficult. Knowing how to provide the proper care can be even harder. If you are caring for a loved one living with Alzheimer’s disease or a related dementia, we know your days may sometimes seem 36 hours long. The Lakes of Monclova would like to help. Stop by to learn more about our Legacy memory care neighborhood, and we will give you a free Caregiver Survival Kit. To learn more about our memory care services, please stop by or call us today.

COMPLIMENTARY CAREGIVER SURVIVAL KIT Visit our campus to learn more about our Legacy memory care neighborhood and receive your complimentary Caregiver Survival Kit, which provides excellent tips for coping with caregiver stress and includes a copy of The 36-Hour Day, by Dr. Peter Rabins. Quantities are limited.

(419) 866-3030 • 6935 Monclova Rd. • Maumee, OH 43537 • lakesofmonclova.com Now Accepting Reservations - Opening this Winter! Connect with our advertisers online. Click their web address in this issue’s interactive PDF at www.hlntoledo.com

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campus is tailored to meet our residents’ needs and personal choices. We invite members of the community to attend our Community Open House on Sunday, December 2 from 1:00 to 4:00 p.m. to take tours of our campus and meet our team of caregivers.” Donna Taylor and her husband are

two family members who are looking forward to the opening of The Lakes. “My husband and I are very excited about the Lakes of Monclova opening in our community,” commented Mrs. Taylor. “My husband’s mother is moving into the assisted-living residence, and she is looking forward to

Vision is a gift that keeps giving your whole life

Make Healthy Vision a New Year’s resolution for yourself & your family Have a safe and Happy New Year! Dr. Buz Romanoff and Staff

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socializing with people her own age and participating in the activities.” Members of the Monclova business community are also looking forward to the campus opening. Alicia Enright, Community Liaison for Beacon Associates, a member of The Lakes Community Advisory Board, commented, “We look forward to the partnership with Lakes of Monclova in caring for our seniors, wartime veterans, and their spouses. We wish all of you much success with your grand opening during this holiday season and throughout the upcoming New Year.” Mary Kay, director of the Monclova Community Center, added, “We want to welcome The Lakes of Monclova to our community! We are excited to have them involved with our seniors here at the Monclova Community Center and look forward to working together in the future.” According to Randall Bufford, President and CEO of Trilogy, “Our commitment to a servant leadership culture and our dedication to providing exceptional customer service that exceeds our customers’ expectations are the cornerstones of Trilogy’s operating philosophy. When you combine great services with a team of dedicated and compassionate caregivers in our residential model, the result is an outstanding senior-living experience. “We like to say you can feel the difference the minute you walk through the doors of one of our campuses, and you see it everywhere you look,” Bufford continued. “From staff engagement and our focus on customer satisfaction, to the local flavors on

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our menus, and even the names given to our different residential hallways—everything at a Trilogy campus is focused on our customers’ preferences and helping them have strong social connections, engagement, and purpose, while also providing options for all levels of healthcare.” The Lakes features private suites with private baths and numerous living rooms where residents can relax and visit with guests. The resident living areas are organized into neighborhoods, allowing caregivers and residents to truly get to know each other and establish long-term relationships. That same residentcentered focus is carried through to activity planning, menu selection, and other campus programs. The Legacy at The Lakes is designed to provide maximum independence and personalized care in the safest environment possible. The Legacy features “life stations” that encourage residents to engage in familiar tasks and décor that encourages reminiscing, in addition to a secured courtyard, family-style dining, and private bedrooms with private baths. The specially designed activity program, based on protocols embraced by advocacy groups such as the Alzheimer’s Association and the Alzheimer’s Foundation of America, are responsive to the energy patterns of those living with dementia. Staff working in The Legacy receive additional dementia-specific training that encompasses person-centered approaches to care, communication techniques, and behavioral interventions. “We are also offering special membership in our Founder’s Club for both The Lakes and the Legacy,” continued McKitrick. “Our Founder’s Club features first pick of floor plan and suite, no move-in fees, and priority admission, all for a small, refundable deposit.” To learn more about Founders Club benefits, please call 419-866-3030. ❦

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15-minute procedure creates shapelier nose without surgery

hey say it’s important to “put your best face forward” in life. However, if a visual defect or irregularity of the nose—the defining feature of your face—has you feeling self-conscious about your appearance, it can be difficult to face the world with any degree of confidence. Certainly, surgical rhinoplasty can correct most functional and cosmetic defects of the nose, but a costly, invasive procedure is not always the best or most practical solution for minor imperfections. Plus, some people are simply concerned that they won’t be satisfied with the permanent results of rhinoplasty or are emotionally or physically unprepared to undergo surgery. The good news is, an innovative technique known as Non-Surgical Rhinoplasty, offered locally by Dr. Christopher Perry of The Toledo Clinic ENT Sinus Center of Excellence, is now available to people who want to improve the shape of their nose without invasive surgery. “Non-Surgical Rhinoplasty involves the use of a dermal filler, typically Radiesse or Restylane, which is injected in precise locations following the application of a topical anesthetic cream and local anesthetic injection, to correct mild to moderate imperfections of the nose such as bumps, indentations, hollowness, or asymmetry,” explains Dr. Perry. “The procedure can be performed in approximately 15 minutes, produces immediate results, and requires no downtime or painful recovery.” Non-Surgical Rhinoplasty cannot change the size of a patient’s nose, but it can succeed in making a seemingly prominent nose appear smaller. Oftentimes, it’s not the size of the nose that makes it stand out, but the contour relative to the facial anatomy. For example, if someone has a small bump at the top of the nose or an indentation at the bridge, the nose may seem out of proportion to the face. The height of the nose bridge also affects the perceived width of the nose. By making the bridge taller, the nose will appear to be narrower. Using a soft tissue filler to smooth this imperfection will straighten the profile of the nose and, thereby, improve facial symmetry. Other examples of undesirable

nasal shapes that can be improved through the Non-Surgical Rhinoplasty procedure include drooping or downward turning of the tip of the nose, flat or scooped nasal bridge, sideward deviation of the nose, as well as various other contour irregularities. The procedure can also be helpful in improving displeasing results of prior surgical rhinoplasty procedures. “After the filler is injected under the skin, we can physically mold it to the precise shape desired. And, if a muscle is pulling the nose out of symmetry, we have the option of using a small amount of Botox to relax the muscle and help re-contour the nose,” says Dr. Perry. The results of a Non-Surgical Rhinoplasty are not permanent and may need to be touched up every year or two. That’s good news for patients who may be contemplating surgical rhinoplasty but aren’t sure whether a permanent solution is right for them. Also, patients who undergo Non-Surgical Rhinoplasty enjoy considerable dollar savings relative to conventional rhinoplasty. In fact, the cost of the non-invasive procedure is just one-fourth that of traditional surgery. Unlike traditional surgery, the Non-Surgical Rhinoplasty causes little if any post-operative pain, and patients can return to their normal lives immediately. Possible side effects include bruising and swelling that typically resolves within a week or less. “Though not everyone is a candidate for the procedure, Non-Surgical Rhinoplasty is an exciting alternative to surgery that can transform the appearance of your nose without broadcasting that you’ve had something done. All people will notice is that your nose is shapelier, your face is more symmetrical, and you’re exuding more confidence,” Dr. Perry states. ❦ The Toledo Clinic ENT Sinus Center of Excellence is located at 5800 Park Center Court, Suite C, in Toledo. For more information about Non-Surgical Rhinoplasty, please call 419-724-8368.

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Toledo/Lucas County CareNet

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any Toledoans are healthier today because in 2003 Mayor Jack Ford called upon Mercy and ProMedica to address the growing issue of the uninsured. Their leadership resulted in the creation of Toledo/ Lucas County CareNet—designed to increase access to coordinated healthcare services for low-income uninsured residents of Lucas County who fall through the cracks of public and private healthcare coverage. Through the efforts of local hospitals, physicians, federally qualified health centers, nonprofit organizations, and local government, existing community resources are coordinated into a state and national award-winning system of charity care comprised of 15 primary care sites, 8 hospitals, and 230 volunteer physicians. Celebrating its 10th anniversary in 2013, CareNet has resulted in almost 25,000 residents utilizing their CareNet card to access more than 400,000 services, including primary, emergency, outpatient, inpatient, and specialty care services, as well as TARTA bus transportation. Through coordinated and affordable care, CareNet members have benefited from regular medical care, valued at $130 million based on Medicaid rates. CareNet members have been diagnosed and treated for a variety of serious illnesses, from cancer to heart disease. If it wasn’t for CareNet, these individuals may not have even known how sick they were or, worse yet, may not even be alive today. Take Sheila, for example. Without CareNet, Sheila’s only option for accessing healthcare was the hospital emergency department. After enrolling in the program, she was able to receive primary healthcare services, which led to a diagnosis of hypertension. Additionally, a mammogram revealed breast cancer. Through CareNet, she received help enrolling in Medicaid and was successfully treated for both conditions. Sheila’s sister recently died from breast cancer at the young age of 60 years. Without the medical care she received as a CareNet member, Shelia

believes she, too, would have met the same unfortunate fate because she would not have had a mammogram or the early intervention she received as a result of CareNet. Indeed, CareNet membership has resulted in measurable health improvement for many members. A study conducted by the University of Toledo showed that 78 percent of female members aged 40 and older had a mammogram in the last two years, 60 percent of members with high blood pressure were successfully managing their condition, and 62 percent of members with diabetes have their blood sugar under control. These rates would be considered good for an insured population; however, for a population of uninsured and underinsured individuals, they are extraordinary. In addition to the health benefits of CareNet membership, the program also helps to contain healthcare costs. The focus on access to preventive care has led to a reduction in emergency department visits and in inpatient days. CareNet’s accomplishments are possible due to the commitment of its partners: Mercy, ProMedica, the University of Toledo Medical Center, United Way of Greater Toledo, Neighborhood Health Association, Toledo-Lucas County Health Department, The Academy of Medicine of Toledo and Lucas County, The Dental Center of Northwest Ohio, Lucas County Commissioners, The City of Toledo, Northwest Ohio Affiliate of Susan G. Komen for the Cure, Hospice of Northwest Ohio, The Pharmacy Counter, Prevent Blindness Ohio, TARTA, and over 230 private practice physicians. Each of CareNet’s partners individually meet important community needs every day. By working together through CareNet, their impact is magnified. What seemed impossible 10 years ago is now happening every day—people are connected to the health care they need but simply cannot afford. ❦ To learn more about CareNet, go to www. toledocarenet.org or contact CareNet at the Hospital Council at 419-842-0800.

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The Grass is always greener on the Land•Art side

by Myles Mellor

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Across 1 Entree, for example 3 Dietary measurement 6 Colorful flower, for short 8 Leaf vegetables 10 Rainbow ___ (fish) 11 Annoyance 12 Seed for flavoring 14 Fruits off the vine 17 Luau paste 18 Will Ferrell character 19 Ramen ___ 21 Place for a pea 22 Cheese, often grated in recipes 26 Tomato paste container 29 Show love for

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Answers on page 18 30 Laetrile can be extracted from these fruits 32 Fruit often eaten dried 33 Found on a billboard 36 They are used as vegetables in Asian cooking (2 words) Down 1 Salad topper 2 Additions to an entree 3 Buddhist sound 4 Prepared lettuce for a salad 5 Fulfilling nutrient needs 6 Only 7 Practice 9 Vitality 13 Recipe direction

1 Entree, for example 3 Dietary measurement

6 8

11 12

17 Luau paste 18 Will Ferrell character 19 Ramen ___ 21 Place for a pea 22 Cheese, often grated in recipes

17 19

12 Seed for flavoring 14 Fruits off the vine

28 30

31 33

32 34

Give your home or office curb appeal Paving 15 Gets ready for picking

29 Show love for

16 __ Prado,

30 Laetrile can be extracted from these fruits

Striping 17 Letter addition

32 Fruit often eaten dried

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33 Found on a billboard

23 Plot areas

36 They are used as vegetables in Asian cooking (2 words)

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10 Rainbow ___ (fish) 11 Annoyance

6 Colorful flower, for short 8 Leaf vegetables

14 Decision to move forward 15 Gets ready for picking 16 __ Prado, Spanish museum 17 Letter addition 20 Meadow muncher 23 Plot areas 24 Chocolate-flavored coffee 25 Fixed 26 It has cylindrical leaves and is used for seasoning 27 Summer month, for short 28 It provides coconuts 31 Decline 34 Medical advisor 35 Because

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26 It has cylindrical leaves and is used for

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Personal Disciplined investing helps keep emotions in check

nowing that financial markets are constantly changing, it’s often hard to gauge when the best time would be to jump in. Trying to time your investments in this way can cause you undue stress and cost you financially when you try to invest by guessing when the market has hit the “top” or the “bottom.” Fortunately, however, there are several timeless strategies that can help you eliminate the emotional component and get you on the right track to successful investing. Think long term. While past performance is never a guarantee of future results, the markets have historically performed well over the long run.

Investors who have developed the discipline and patience to stay the course over the long run, despite market fluctuations, have generally experienced more favorable results. Patiently accept volatility. Building on the last point, it’s important to realize that market highs and lows are a natural occurrence and should be considered a normal part of investing. Once you accept that fact, you can prepare yourself to resist the emotional urges to jump in and out of the market based solely on its current direction. Stay in the market. Some investors attempt to time the market. When it’s down, they sit on the sidelines waiting for it to rally before they get in on the action. Conversely, when the market is up, they wait for a correction so they can buy at what they see as bargain rates. Moving in and out of the market by timing its ups and downs is a skill not even the most seasoned investment professionals have mastered. Consistent investment—in both up and down markets—should produce more reliable results over time. Diversify. Possibly one

of the most important investment principles—and at the same time most overlooked—is the need for careful asset allocation. The popular adage that tells you not to keep all your eggs in one basket is especially true when it comes to your investments. A well-diversified portfolio should include complementary asset classes so they can cushion each other against the effects of market downturns and lower your portfolio’s overall risk. Watch your asset allocation. Even if you properly diversify your portfolio in the beginning, changing markets will affect the value of your investments and could alter your actual allocation. Consistent reviews will help you identify when your portfolio needs to be rebalanced, helping you maintain a proper asset mix. Bear in mind that asset allocation does not protect against fluctuating prices and uncertain returns. Pay yourself first. You may have heard this before, but it’s certainly worth repeating: Save first and then spend what you have left, rather than spend first and save what you have left. Inevitably, if you attempt to do the latter, you’ll often find there’s noth-

ing left to save. Reinvest dividends. Many quality companies have a history of paying dividends, regardless of overall stock market performance. Reinvesting these dividends offers you an excellent way to easily build your stock positions. Set goals. While this may seem like the most basic idea, it’s still one of the most important. When considering your investments, you need to have a clear idea of where you are, a goal in mind of where you want to go, and strategies in place to help you get there. By incorporating all of the abovementioned ideas, you will have a guide to help you in all your important investment decisions. ❦ This article was written by Wells Fargo Advisors and provided courtesy of Michael R. Foster, First Vice President— Investments, Quantitative Choice Portfolio Manager, Marcus W. Jones, First Vice President—Investments, Quantitative Choice Portfolio Manager, and Matthew Langham, Financial Advisor, in Perrysburg at 419-872-3840. Investments in securities and insurance products are: NOT FDIC-INSURED/NOT BANK-GUARANTEED/MAY LOSE VALUE. Wells Fargo Advisors, LLC, Member SIPC, is a registered broker-dealer and a separate non-bank affiliate of Wells Fargo & Company.

Fight back against tough economic times A sound defense against market fluctuations can start with an advisor who’s invested in your individual financial goals. Throughout changes in the markets and in your life, we’re on your side. Call today for a second opinion on any of your investments.

The Foster Jones Investment Group of Wells Fargo Advisors Marcus Jones First Vice President - Investments Quantitative Choice Portfolio Manager 28300 Kensington Lane Perrysburg, OH 43551 Tel: 419-872-3858 • 800-245-5782 Fax: 419-874-6315 marcus.w.jones@wfadvisors.com

Michael Foster First Vice President - Investments Quantitative Choice Portfolio Manager 28300 Kensington Lane Perrysburg, OH 43551 Tel: 419-872-3859 • 800-245-5782 Fax: 419-874-6315 michael.r.foster@wfadvisors.com Investment and Insurance Products:

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Lose Value

Wells Fargo Advisors, LLC, Member SIPC, is a registered broker-dealer and a separate non-bank affiliate of Wells Fargo & Company. ©2010 Wells Fargo Advisors, LLC. All rights reserved. The Foster Jones Investment Group of Wells Fargo Advisors 0312-2591 [74018-v3] A1287

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Toledoan left his mark on the Southwest

arly one morning, Shirley and I left San Antonio headed for Big Bend National Park, out in West Texas. As the sun rose, we could see a beautiful band of fog at the base of the mountains on the horizon to our left. When the highway turned towards the mountains, that fog soon became much less attractive. I slowed down and considered pulling over to the side of the road to wait for the fog to burn off. Rather foolishly, I reasoned that there could be no telling how long that might take. Besides, there was not much traffic out in Nowhere, Texas and the shoulder of the road did not even look wide enough to accommodate us. The trick, I told myself, was to drive slowly enough to avoid rear-ending another veThe "historic" Gage Hotel in Marathon, TX was designed by Toledo native Henry C. Trost.

hicle yet fast enough to escape being rear-ended myself. Rationally, there was no way to calculate precisely what that optimum speed might be. Eventually, we arrived in Marathon, TX. Still in the fog, but at least it was safe to park. We decided to take advantage of our fog delay by having breakfast at Johnny B’s, a small diner on what we assumed was the main street. (When you can’t see the other side of the street, it can sometimes be difficult to judge.) After breakfast, and still in a fog, we concluded that the morning would be better spent in town than on the road. Just up the street, we came across “The historic Gage Hotel.” Now, not being born yesterday, I knew that every small town in the country has something they think of as “historic.” Many of them even have buildings that pre-date the Johnson administration. (LBJ, not Andrew.) We went in to have a look. What a treat! This really did look like an authentic “historic” Texas hotel. (Ok. So, at the time, I didn’t really know what an authentic Texas hotel was supposed to look like, but I was soon to learn.) To begin with, this was clearly not a generic chain hotel. (The Ramada Inn that used to be a Holiday Inn that used to be a...I can’t remember what it was before that.) The Gage looks pretty much as it has always looked and, evidently, it attracts sufficient clientele to keep it viable—even in Marathon, TX. Have you been to Marathon? How about Marfa? Alpine? These towns are not typically seen as tourist destinations. Relevance? I’ll get to that shortly. In the lobby, Shirley

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Dried chilies hanging in the ramada help establish the local flavor of the Gage Hotel. Trost drew on elements from Spanish culture, Native American, and pioneer-era Texas ranches for his design concepts.

The reclining puma (stuffed) and saddles in the lobby of the Gage are touches of the "wild west" that guests would have appreciated in the 1930s—and still do.

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Albuquerque, Tucson, and northern Mexico. In 1927, Alfred Gage commissioned Trost to create a hotel and headquarters for his 500,000-acre ranch. The rail line from San Antonio passes just across from the hotel, so Gage was probably counting on tourist business. The elegantly rustic design that Trost presented is certainly more appropriate for the tourist trade than for business travelers seeking basic accommodations. It clearly would appeal to Easterners who might have developed their notions about life in the Wild West from the movies starring Tom Mix, Ken Maynard, and Hoot Gibson. And it continues to attract clientele to Marathon, TX, which is probably not on your list of top-ten destination cities. In the lobby of the Gage are dis-

Trost, once a designer of decorative ironwork, utilized design elements that conveyed his "Arid America" style.

picked up a large (octavo) volume from a coffee table. “Look at this,” she said, handing me a copy of Henry C. Trost: Architect of the Southwest. She pointed to the passage that identified Trost as a native of Toledo, OH who was born in 1860 and grew up on Bush Street. After attending art school in Toledo, Trost worked as an architectural draftsman. In 1881, he moved to Chicago where he joined the Architectural Sketch Club (later the Chicago Architectural Club) and designed ornamental metal. There he was influenced by the work of Louis Sullivan (“father of modern architecture”) and Frank Lloyd Wright. In 1899, Trost moved to Tucson and, in 1903, to El Paso where he achieved immediate success with landmarks that included El Paso’s first skyscrapers and other large downtown buildings. In addition, he designed more than 200 private homes, including the mansion of W. W. Turney that later housed the Museum of Art. Trost was also responsible for the The facade of the Paisano is Spanish baroque. first four buildings of what became Trost's architectural designs made extensive the University of Texas at El Paso. use of the regional history including, as well, Native American and pioneer Texan By the end of his life, he had created 10.25x4_ES_moveAd_co#6693B0.pdf 10/16/12 8:58:19 AM influences. more than 650 buildings in El Paso,

played three saddles, two authentic that somehow seems authentic rather looking (but cleaned up) work saddles than collected like the “antiques” at and one “silver” studded Mexican Cracker Barrel. show saddle. A stuffed puma reclines When the fog lifted at last, we on a table. On the opposite wall is a continued on to Big Bend National Park for several days and then headed deer head trophy. In the adjoining sitting room, over the Arizona. Along the way, there are Spanish-mission-style furwe paused in Marfa, TX specifically niture, Indian pottery, and a huge to visit the Paisano Hotel, another trophy elk head over the fireplace. Trost creation. The original pine flooring is still in The Paisano opened in 1930 and place, though there is also extensive for the first 40 years, functioned as use of Mexican tiles. a cattleman’s hotel. That is, ranchers Ceilings feature exposed beams routinely gathered in the lobby to with decoratively carved wooden buy and sell their herds. The hotel capitals on the pillars. A large, round was also the prime social location wrought-iron chandelier and other metal work are reminders that Trost started his career designing ornamental metal pieces. Outside, a patio is enclosed by adobe walls and strings of chilies hang in a ramada. On one wall, 30 cattle skulls are arranged so that, collectively, they in turn form the shape of a larger skull. A covered wagon sits near the parking lot. The Trophies flanking the entrance to the Paisano are Gage features lots of local color common features in the hotels Trost designed.

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within a 100-mile radius of Marfa. Weddings, anniversaries, conventions, and other events were held there. (If you have been to far west Texas, you understand why. With due respect to the Paisano, there really weren‘t any suitable alternatives.) In the lobby of the Paisano, Shirley and I met a woman wearing a green Ohio University sweatshirt. Her connection is a nephew from Sylvania who played on the Bobcat baseball team. You never can tell who is going to show up in a cosmopolitan place like Marfa. Probably the biggest event (Wait for it. Pun alert.) ever associated with Marfa and the Paisano was the 1955 filming of Giant starring Elizabeth Taylor, Rock Hudson, and James Dean. To this day, Dean’s room is still the most requested by guests. The gift shop offers memorabilia associated with the film. Flanking the main entry doors are trophy heads—a bison on one side and a longhorn steer on the other. (OK. Let’s not quibble. A steer is not really a trophy, but there it is.) The ceiling features exposed beams, and the floor and walls are colorfully tiled. In specific detail, the Paisano does not resemble the Gage, but in the abstract, the two

hotels are clearly related. By the time we reached the El Capitan in Alpine, TX, the basic attributes of the Trost style had become more than just coincidence. His hotels really don’t look alike. Except that they do. The Gage has a brick façade. The Paisano has the decorative plasterwork of a baroque Spanish Mission. The El Capitan looks like a typical adobe structure with extended roof beams or vigas. Still, they all have the look appropriate to the environment Trost called “Arid America.” Today, they are what we would consider generic Southwestern in style, but it is a style Trophies at the El Capitan fit the usual Trost pattern—except that they are not directly connected with the region. Caribou and moose may not be native to "Arid America," but they do say, "Hey, dude, this ain't the Waldorf!"

The El Capitan has the look of Native American adobe construction with exposed roof beams called vigas. Inside, though, it looks like pure Henry Trost.

assimilated and, in part, created by Henry Trost. The decorative elements he uses tend to be the same the way the rhyme scheme of Shakespearean sonnets is the same. The specific form taken by those elements is the source of the originality and variation from one location to the next. The trophy heads flanking the entrance at El Capitan, for example, are a moose and a caribou. And the tile is not the same color. And the carved wood capitals on the pillars are not quite the same. The exposed beams of the Gage Hotel are smoothed and finished, whereas those of the Paisano and El Capitan are rustic. The decorative metalwork and tiles that adorn the walls are not the same, yet, like the other elements, there they are. Architecturally, they represent what in musical terms would be called theme and variation. In a sense, a Trost design is like the desert itself. On the one hand, desert is defined by the absence of water and the dominant color is brown. But the Chihuahuan desert is not the Sonoran desert and neither of them is Death Valley. There is more to desert than sand, rocks, and cacti. And there is more to a Trost design than trophy heads and brightly glazed Mexican tiles. Like a hike in the desert, a stroll through a hotel designed by Henry Trost can be just a walk in the park. LeMoyne Mercer is the travel editor for Healthy Living News and the regular contributor of A Walk in the Park.

CC4PM announces newest facility The Comprehensive Centers for Pain Management (CC4PM) is pleased to announce the grand opening of our newest facility at 3400 Meijer Drive. An open house is scheduled for the medical and general community on Wednesday, January 30, 2013 from 5:30-7:30 p.m. as our Wellness Team will introduce “FLO–Enhanced Therapy and Wellness," an innovative approach to reducing pain and improving your everyday function. “The addition of FLO will offer an extension of our comprehensive approach to optimizing the quality of life for our patients,” said Dr. William G. James, Medical Director. Services will include licensed therapies, acupuncture, nutritional support, sleep hygiene, and exercise programs including Yoga and Pilates. With all services conveniently offered in one central location, participants can enjoy the experience of improving their overall wellness and functionality even further.

About CC4PM CC4PM is the premier multidisciplinary pain-management practice in Northwestern Ohio and Southeastern Michigan, and is focused on providing individualized care using the latest technology and ancillary services to help chronic pain patients greatly relieve their symptoms and increase

a new year, a new place. Franciscan Care Center, well-known for quality care, is enhancing its campus with a 25,000 square foot addition! Opening early summer 2013, the community will feature:

• New private suites • Quiet peaceful setting • Enhanced state- of-the-art rehabilitation and therapy center • Full-time chef

• Full entertainment schedule • Beautifully appointed chapel with religious services • and much more!

26 January 2013 / Healthy Living News

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their everyday function. Chronic pain conditions may be related to work or personal injury, post-operative issues, effects of acute or long-term illness, or even an unknown source. Whether utilizing the center’s services before, during, or after clinical painmanagement treatment, CC4PM’s patients and others in our community

can enjoy the effects of a well-rounded health-optimization program in their daily lives. For more information about CC4PM, visit the company’s website at www.cc4pm.com. For more information and to RSVP to our January 30 Open House, please call Lisa Francis at 419-843-1369, ext. 121. ❦

LCCS implores loving families to foster infants

he child-welfare advocates at Lucas County Children Services (LCCS) are currently facing an unusual dilemma—the declining availability of foster homes for babies. In fact, between 2008 and 2012, the number of homes in our community willing to foster an infant has dropped from 352 to 240, a reduction of 32 percent. LCCS foster care supervisors Amy Galvan and Pam Gaffney are uncertain why this decline has occurred. They suspect the economic downturn may be discouraging some people from adding another member to the family. Attrition may also play a role. Because 75 percent of foster families ultimately adopt their foster children, it’s possible that many have simply reached their goal of building a family and moved on. “For many years, we’ve told the community that we need foster homes for every age group except infants,” Galvan says. “We currently need homes for sibling groups of two or more, and we always need homes for teenagers, but now we’re also in the position of needing homes for babies.” Gaffney adds that the agency’s goal of reuniting infants with their birth families whenever possible may dissuade some who are expressly interested in adopting a baby. “They may be reluctant to make the emotional commitment to a child if the placement isn’t permanent,” she explains. “We have foster-to-adopt homes, and many babies do find their forever home through foster parents, but that’s not always the case. We have a tremendous need for people who can find the joy in caring for a baby and then taking an active part in a successful reunification process.” To help create an environment in the birth family that is conducive to reunification, LCCS offers parent care-plan services, such as a parenting curriculum, a substance-abuse program, or a domestic-violence

who can’t be placed through LCCS often must be placed in network homes, which are supervised by other agencies and cost taxpayers approximately three times as much. Furthermore, if the home is located outside Lucas County, it becomes much more difficult for the birth parents to visit the child. Prospective foster parents must be at least 21 years old and can be single, married, or a same-sex couple. They also need to complete mandatory training sessions, provide references, pass a home study, and undergo a background check. Some form of income is necessary, but they do not need to be wealthy. The house or apartment can be either owned or rented and should have at least two bedrooms. “Kids over a certain age need to have a bedroom separate from the parents’ room, so this last requirement is in the interest of keeping kids in one placement,” Galvan explains. Gaffney emphasizes that LCCS provides a wide range of support

VED O R P AP

program. The mother and/or father will be required to complete programs that address areas in which there is an identified deficit. The parents and child are separated only if it is proven to the court that the parents are not following through with the required care-plan services. Julie Malkin, public information officer for LCCS, notes that fostering a baby with the ultimate goal of bringing the birth family back together is a special calling that takes a special kind of person. She states, “These are parents who really know how to care for kids and are willing to be part of the life of a young mom who probably wasn’t properly parented herself.” Malkin also remarks that fostering offers the perfect opportunity for people who just enjoy having a baby in the house. Among the agency’s foster families is a retired couple who always foster two infants at a time. That way, there’s always one for each of them to hold. They love these babies, nurture them, help them through those critical milestones, and then help reunite them with their birth parent. “We believe there are many empty nesters out there who still have a lot of love to give, for example grandparents whose grandkids are getting older, retirees who still want to make a difference, or retired professionals, such as nurses or other healthcare workers, who might have the skills to care for a special-needs baby,” she adds. Making the loving commitment to foster a baby will also help relieve the county’s financial burden. Infants

and services to foster families. For example, a stipend is provided to help care for kids. The exact amount varies based on the child’s needs, but is typically in the range of $15 to $20 per day. “Plus, you’ll be surrounded by people who will provide all kinds of support such as medical, clothing, daycare, and linkage to other helpful community resources,” she says. For more information on fostering a child through Lucas County Children Services, please call 419-213-3336 or visit lucaskids.net. The next session of mandatory training classes begins on January 8 and will be held on Tuesdays and Thursdays from 6:00 to 9:00 p.m. All-day Saturday sessions begin on February 9. Attending these free classes does not obligate the participant to foster a child. ❦

You could be our foster PAreNt? We’re so excited! Lucas County Children Services has a critical need for foster families to care for babies, toddlers and groups of brothers and sisters. Help us meet the need. Attend our FREE training classes: • •

Tuesdays & Thursdays, 6–9 p.m., January 8 – February 14, 2013 Saturdays, 9 a.m. – 4 p.m., February 9 – March 16, 2013

Becoming a foster parent is easier than you think!

• • • • •

Must be at least 21 to become a foster parent. Can be married or single. Can own or rent a home or apartment with at least two bedrooms. Can work outside the home. Receive free training.

• • • •

Have a safety inspection for your home. Show proof of sufficient income to support yourself. Agree to a background check. Receive financial support, based on your foster child(ren)’s needs.

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Frame Chiropractic and Acupuncture welcomes new practitioner, expands services

rame Chiropractic and Acupuncture, the practice of Dr. Mickey E. Frame, official chiropractor for the Toledo Walleye and the Jamie Farr Owens Corning Classic, recently welcomed a new practitioner, Dr. Kassandra Schultz. A native Toledoan, Dr. Schultz is a 2005 graduate of Notre Dame Academy and a 2009 graduate of the University of Toledo. She earned her Doctor of Chiropractic degree in October of 2012 through Palmer College of Chiropractic in Davenport, Iowa. Dr. Schultz’s focus on wellness and prevention complements the practice’s emphasis on helping patients achieve the highest possible level of overall health, and she is the only practitioner in our area certified in the Activator Methods Chiropractic Technique (AMCT). AMCT involves the use of a small handheld, spring-loaded instrument, which delivers a low-force, focused impulse to correct skeletal misalignment and restore balance. AMCT may be used for any patient but is particularly useful in treating patients who may not be able to tolerate manual adjustments, such as children, or

28 January 2013 / Healthy Living News

for whom manual adjustment may be contraindicated, such as elderly patients with osteoporosis. Dr. Schultz’s interest in chiropractic was sparked at an early age after experiencing its benefits firsthand. She explains, “When I was in high school, I was very active in martial arts. Gradually, I started to develop headaches and back pain and had a hard time doing it anymore. The medical doctor I was seeing told me I could either quit martial arts or take all these pain killers. I didn’t like either option. My grandfather, who was a firefighter, suggested that I try chiropractic, so I did. Initially, I was sore and uncomfortable, but then I woke up one day and realized I was no longer in pain. Instead of having a couple headaches a week, I was having them only once every month to two months. So I decided then, at age 16, to become a chiropractor. Ten years later, here I sit!” One of Dr. Schultz’s more memorable educational experiences was having the opportunity last February through Palmer College to travel to Brazil with 25 other practitioners to provide chiropractic care. Over the

course of just five days, the team treated over 3,000 patients. One case that really stands out in her mind was a patient she saw on the first day at an orphanage for the mentally and physically disabled. She adjusted a female patient who was unable to talk and communicated only through noises. This patient appeared to be very young, perhaps six or seven years old. As Dr. Schultz later discovered, this “little girl” was actually 35. She also found it noteworthy to meet

"There’s only so much they can teach you in school. What they can’t teach is the finesse with which Dr. Frame adjusts patients and his unique manner of communicating with them.”

Brazilians with infectious diseases seldom if ever seen in the United States, such as leprosy and malaria. Since joining Frame Chiropractic and Acupuncture, Dr. Schultz has been amazed at how much she’s learned and experienced in just a few short months. She notes that she’s already seen disorders that her teachers said she’d be unlikely to encounter in practice, including a peripheral neurological disease called Charcot-Marie-Tooth. “It’s somewhat like an apprenticeship for me right now. There’s only so much they can teach you in school. What they can’t teach is the finesse with which Dr. Frame adjusts patients and his unique manner of communicating with them,” she comments. Dr. Schultz is also impressed with the wide range of therapies offered at Frame Chiropractic and Acupuncture. In addition to manual and instrument adjusting techniques, the practice offers services such as Acupuncture, Spinal Decompression, Manipulation Under Anesthesia, and a new state-

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of-the-art treatment called Radial Pulse Wave Therapy. Radial Pulse Wave Therapy is a non-invasive technique that involves the transmission of high-energy acoustic pulses through the tissues of an injured area to stimulate the body’s natural healing process and reduce pain and discomfort. The pulse waves, which are delivered via a handheld applicator at a rate of approximately 2,000 per four- to five-minute treatment session, are physical/mechanical in nature, not electrical. Plantar fasciitis, Achilles tendonitis, tennis elbow, golfer’s elbow, and frozen shoulder are just a sampling of the conditions that can be treated effectively with this technology. Typically, six to eight treatment sessions are necessary to achieve maximum benefit. Patients ordinarily seek chiropractic care for the first time because they’re in acute pain. But as Dr. Schultz em-

phasizes, chiropractic is not merely for symptom relief, but also for correction and prevention of the imbalances that lead to symptoms. As such, she encourages people to make chiropractic a regular part of their overall wellness strategy. “Just because you’re not currently in pain doesn’t mean a problem isn’t developing,” she says. “Chiropractic should be part of prevention just like going to the dentist or getting routine Pap tests. And keep in mind that if you have a condition, one adjustment is not going to fix it. Once you’re out of pain, you don’t necessarily have to keep coming back, but many people find that scheduling visits at regular intervals, such as once every four to six weeks, once every six months, or even once a year, helps them maintain proper function and optimal health. Remember, the spine is what houses your nervous system. Why wouldn’t you want to take care of that?” ❦

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: My daughter recently mentioned to me that because of my diabetes, I have a higher chance of suffering from hearing loss. Is this true? If so, what can I do about it?

: Your daughter is correct actually. Those with diabetes are two times more likely to experience hearing loss than those who do not have diabetes. A recent study proves this to be true. Even adults with prediabetes, whose blood glucose is higher than normal, had an increased risk of hearing loss. The American Diabetes Association has indicated that diabetes and hearing loss are two of America’s greatest health concerns. It may seem surprising, but let me lay out the relationship between diabetes and hearing loss so that you can fully understand the reasons. The presence of high blood glucose levels can eventually damage vessels and nerves in the cochlear duct, which can lead to reduced hearing ability. The research indicated that autopsies of the patients studied showed evidence of this damage. Moreover, those with diabetes often

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have less keratin, a protein that lines the ear canal. Less keratin relates to a higher probability of hearing loss. Additional evidence indicates that the cranial nerve responsible for transmitting sound from the cochlea to the brainstem suffers a loss of protection that can absolutely deteriorate hearing. When you combine the effect of diabetes and other factors that may affect our hearing, you become at greater risk for a sensorineural hearing loss. Be aware the next time you have a physical and discuss it with your primary-care physician. As a result of this significant finding, we suggest that diabetic patients be routinely screened for hearing impairment throughout their lives as well as monitor their blood sugar. If you don’t pass the initial screening, I would suggest a comprehensive audiological evaluation by an audiologist and annual rechecks afterwards. It’s important to point out, however, that hearing loss happens over time. It’s not a sudden loss, so symptoms may be difficult to notice. In addition, general patients may not always screen for hearing loss during routine

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Randa Mansour-Shousher, AuD, CCC-A, is a Doctor of Audiology with Northwest Ohio Hearing Clinic, located at 3000 Arlington Ave. in Toledo (419-383-4012) and 1601 Brigham Dr., Suite 160 in Perrysburg (419-873-4327).

Heartland Rehab’s tips for maintaining your 2013 fitness resolutions

appy 2013”! The New Year is a time for new resolutions. But many of us never really completed our 2012 resolutions. We had good intentions and started out strong, but as the year went by, we drifted away. So now it is 2013, and we are going to make good on these resolutions and stick to them the whole year. For many people, the top resolutions are to lose weight and exercise more. These two resolutions go together so well and are the key to overall health and wellness. So how can we be sure to keep these resolutions on track this time around instead of drifting off target by April? To be successful with any longterm goal, we need to do a few things: • One, make it measurable and

realistic. “I want to lose five pounds over the next three months” is much more realistic for most of us than “I want to lose 20 lbs in the next month.” Share your goal with someone else, and ask if they think it’s realistic. • Two, write it down. We all make more of a commitment when a goal is in writing. • Three, track the progress you are making. • Four, involve someone else. We all seem to commit more when we have someone else doing it with us. We can rely on someone else for support, encouragement, and motivation.

• Five, if you start to drift off, don’t just stop! Recommit and start from that point.

shortening or butter for baking, use applesauce for half of the butter amount. You may need to decrease baking time by 25 percent. Reduce sugar by 1/4 to 1/3 in baked goods. Cinnamon, vanilla, or almond extract can be used to increase sweetness. To increase fiber intake, replace regular grains with whole grains or whole-wheat flour. Eat the darker green or leafier lettuces, as opposed to iceberg lettuce, for more fiber. Drink plenty of water.

Now, some simple tips to start on this resolution to lose weight and • exercise. They say that, “you are what you eat,” but how often do you think about the foods that you are eating and their effect on your body? The • food you eat has a significant impact on overall health and wellness. The goal should not be to change every• thing but to begin eating healthier, making a commitment to having protein, carbohydrate (good carbs, • fibrous carbs), and fats in our meals. Exercise is the next step, but most Cut back on foods higher in proof us go at it wrong. We start out cessed sugars. going to the gym to walk, jog, or In addition, here are a few simple use the elliptical for at least an hour. changes or healthier substitutions This is great, but this is where we fail that will make your diet more hearton our resolution to exercise more. friendly. We may do well with the 60 • Limit intake of minutes at the gym initially, hydrogenated but as time goes on, we start oils, which can be finding other things to do in found in fast food, that hour. Either we get bored margarine, and with doing the same thing fried foods. for weeks on end or we just • Use extra-virgin olive oil and garlic “I want to lose have other time commitments that come up. We then feel when cooking. • Instead of in the next month” guilty when we aren’t able

2013

goals

physicals. Failure to manage hearing can result in depression and dementia. This is why it’s so important to monitor hearing, just as we do our vision. So mark your calendars and let’s make this an annual event. ❦

  20 lbs





   



Injury Prevention, Injury Management,



Strengthening, Conditioning.

Injury Prevention, Injury Management,  Strengthening, Conditioning.

Gym Memberships, Pilates, Personal Training, 

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30 January 2013 / Healthy Living News

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to make it to the gym, claim that we will make it up, and then we don’t follow through. Besides doing too much of one activity or exercise, we also may initially do too much weight or too many reps, which could cause an injury. Plan to establish a regular exercise program that you can do at least three times per week for at least 30 minutes. Depending on your age and your condition, it can be a straight 30 minutes or it can be spread throughout the day. In that 30 minutes, include some resistance exercise (weights, body weights, bands, balls, machines) and some cardio. Mixing it up will keep it refreshing and decrease the boredom factor. At times, the thought of going to the gym and performing a long, strenuous exercise routine is overwhelming and causes many people to not exercise at all. Here are some simple guidelines for beneficial exercise: • Try to exercise three to four times a week for at least 30 minutes. • Remain consistent, start out slow, and progress the exercise as tolerated. • Remember to stretch before and after exercise. • Keep hydrated and rest between sets. • Consult a physician prior to beginning any exercise program. • Consult a physical therapist for an individualized exercise program or to treat any injuries you may have. Here is a list of activities and calories burned based on a 150-pound individual performing the listed activity for 10 minutes: Activity

Calories burned

Playing a light basketball game

Moderate cycling

Light dancing (social, square, tap)

Moderate racquetball

113

Run 1 mile in 10 minutes

116

Light skating (ice or roller)

Light cross-country skiing

Light stair climbing

Moderate swimming

Moderate walking

A final tip for improving your health and wellness is to reduce stress, have a positive attitude, and get adequate sleep. Take a few minutes each morning and think of two things that you are grateful for. This will go a long way in taking your focus off your

problems and stresses and help you appreciate the blessings in your life. If you have questions and are not sure what to do, you can contact Heartland Rehabilitation Services and talk with the physical therapist so that you can begin on the positive road, injury free, to successfully achieving your 2013 resolutions. Heartland Rehabilitation also offers a Therapeutic Weight Management Program, which combines therapy,

nutrition, and exercise to reduce the limitations and pain in your joints that may be limiting you from losing weight and exercising. Heartland Rehabilitation Services has five locations in the Toledo and Bedford, Michigan areas with knowledgeable staff to assist with your physical and occupational therapy needs. Each location also offers a monthly membership for a small fee, with no contract, and the expertise of

licensed clinicians to help you with your exercise routine. If you have any questions about Heartland Rehabilitation Services or how physical and occupational therapy can benefit you, please feel free to contact Jim Berger at 419-787-6741 or visit us at www.heartlandrehab.com. ❦ Resources: http://ohioline.osu.edu/hyg-Fact/5000/5543. html, www.healthy-heart-guide.com, http://www.changing shape.com/resources/calculators/caloriesburnedcalculator. asp.

Feeling SAD? Let there be light!

t’s not unusual to experience a little postholiday letdown. After all, you’ve spent the last few months in a celebratory frame of mind surrounded by family and friends. Now that the celebration is over and a long, cold winter lies ahead, it’s natural to feel a bit melancholy. But for people who suffer from the condition known as Seasonal Affective Disorder, or SAD, the winter months can be a real emotional rollercoaster. As the days get shorter and the sun remains hidden behind heavy, gray skies much of the time, SAD sufferers can experience a host of unpleasant symptoms, including depression, lethargy, loss of concentration, carbohydrate cravings, difficulty waking, sleep disturbance, social withdrawal, reduced productivity at work, and overall irritability. SAD can strike at different stages of life, but onset usually occurs during adulthood. Women are four times more likely to experience SAD than men, and one out of every five people living in northern latitudes is affected. SAD also seems to run in families, which suggests the disorder may have a genetic link. Symptoms of SAD typically begin with the arrival of fall and gradually worsen until spring. Some people with the condition may also experience “winter worsening”—when a pre-existing condition such as depression or PMS gets worse during fall and winter. Studies have revealed that SAD actually stems from the lack of light— or, more accurately, an inadequate amount of light of the correct spectrum and intensity. What SAD sufferers need is increased exposure to sunlight, which, unfortunately, is sorely lacking in the northern latitudes at this time of year. So how does light, or the lack

thereof, cause a mood disorder? During the winter months, there is less sunlight passing through our eyes. This decrease in natural sunlight exposure can have a significant impact on two neurotransmitters strongly associated with mood—serotonin and melatonin. As the light level decreases in winter, the level of mood-regulating serotonin in the brain tends to decrease, which can lead to feelings of depression and other emotional

problems, and the melatonin level tends to increase. One of melatonin’s major roles is regulating the body’s internal clock so we feel relaxed and sleepy when night comes. About 90% of melatonin is produced in the pineal gland, which is located in the brain. Cells in the retina of the eye produce the rest. During daylight hours, the production of melatonin normally decreases. However, on short, cloudy winter days, more melatonin tends to be present, which explains why SAD sufferers often feel tired and lethargic. While some individuals who suffer from SAD may find relief through antidepressant medication, light therapy

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can be a very effective alternative. The theory behind light therapy is that when bright light passes through the eyes, chemical and electrical reactions begin to reverse abnormalities in brain chemistry related to serotonin and melatonin. Those able to afford a winter-long trip to Florida each year can get all the light therapy they need by basking in the sun at the beach, but those who are obliged to stay in northern climes may have to get their light through artificial means. Lighting manufacturers have responded to the demand for therapeutic lighting by producing various styles of SAD light boxes for use in the home. Light therapy involves sitting in front of a light box for a specified amount of time each day. The recommended duration for treatment sessions will vary depending on the severity of symptoms and may change as the winter season progresses. The best time to begin a light therapy session is upon first waking in the morning. A second treatment later in the day may also be helpful. Bedtime treatments are usually discouraged as they can cause insomnia, but some SAD sufferers find them beneficial. However, it’s important to note that when it comes to treating SAD, not all light boxes are created equal.

Many of the light boxes on the market are designed primarily to be compact and convenient but may be of dubious therapeutic value because they don’t necessarily provide lighting of the appropriate spectrum and lumen output. Consult with a reputable lighting specialist before making the investment in a light box.

If you experience symptoms of SAD, it’s important to discuss the problem and the best course of treatment with your doctor. Don’t assume it’s just a bad case of the winter blues or postholiday blahs. Once diagnosed, SAD is one of the most treatable mood disorders—and feeling better might just be a matter of seeing the light. ❦

Wealth and taxes: planning for uncertain times by Scott D. Brown

nless Congress and the president can agree on a compromise before the year ends, the Bush-era tax cuts will expire on January 1, 2013—potentially exposing millions of individuals and families to higher tax rates. This is not the first time in recent memory that Americans have faced heightened tax uncertainty. In 2010, policymakers ultimately decided to extend the Bush tax cuts by two years. Now that we are well into 2012, this topic is once again in the spotlight. It is important to grasp both the potential implications for and the options available to investors in the event that the tax code changes.

Facing the Fiscal Cliff: What happens if the tax cuts expire? If the Bush tax cuts expire at the end of 2012 as scheduled, most taxpayers will face some combination of higher tax rates on their incomes, dividends, and capital gains in 2013. In addition, high earners will pay an additional 3.8% tax on their investment income and a 0.9% higher Medicare tax as legislated by the Patient Protection and Affordable Care Act (better known as “ObamaCare”). The top tax rate on dividends, 39.6% before Bush and 15% for qualified dividends now, could become 43.4% (39.6% plus 3.8%) in 2013 if nothing is changed. The long-term capital gains rate, 20% before Bush and 15% now, could increase to 23.8%. The estate tax, 55% before Bush, 0% in 2010, and now 35%, could return to 55%. Finally, the estate and gift tax exemption, which before Bush was $675,000 for married individuals and is now $5.12 million, is scheduled to go back to $1 million.

Ten strategies for navigating an uncertain landscape While smart tax planning is practical in any environment, it’s even more prudent when there is the potential for significant tax increases. Listed below are 10 tax-smart strategies you

32 January 2013 / Healthy Living News

may want to consider that can help better position your portfolio against potential tax changes before year-end:

Max out retirement plans. Whether or not taxes increase, it may make sense to fully fund your company retirement accounts and/or IRAs. One of the primary advantages of participating in a Traditional IRA or an employer-sponsored retirement plan such as a 401(k) is that the money you contribute in a given year may be tax deductible. And because these are tax-deferred accounts, you do not pay income taxes on any earnings on your investments until you withdraw funds.

Consider a Roth IRA conversion. While income limits may preclude some investors from contributing to a Roth IRA, anyone can do a Roth Conversion by converting eligible funds from a Traditional IRA or employer-sponsored retirement plan to a Roth IRA. (Roth IRA contributions are made with after-tax dollars, and qualified withdrawals in retirement are tax free.1 When you convert, you must pay taxes on the amount converted as ordinary income for that year.) Converting to a Roth IRA can provide tax-free income in retirement, and now could be an ideal time to convert some of your assets—before a potential increase in income tax rates, which may come next year.

Review highly appreciated assets. If the capital gains tax rate increases from 15% to 20%, investors will pay a third more in taxes on both liquid and illiquid assets in 2013. Evaluate stocks, mutual funds, and even privately held businesses—with an eye to future performance—and consider capturing current gains before any potential rate hikes go into effect. 1. Restrictions,

penalties and taxes may apply. Unless certain criteria are met, Roth IRA owners must be 59 ½ or older and have held the Roth IRA for five years before completely tax/penaltyfree withdrawals are permitted.

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Give increased attention to buyand-hold strategies.If the tax rate on capital gains increases, the tax benefits of buy-and-hold strategies can become more valuable. Similarly, it becomes more important to harvest tax losses in order to shelter gains that otherwise would be taxed at the higher rate.

Augment your tax-advantaged investments with municipal bonds. Since municipal bonds are federally tax-free and generally free from state and local taxes, they are one of the most efficient investments available for defending against current and potentially higher tax rates. If income tax rates do rise, interest income earned on municipal bonds will feel little if any impact.

Focus on your goals first. As critical as it may be to understand the potential effects of possible tax increases, it is even more important not to make tax planning the sum total of your planning. First and foremost, you should focus on what you want most for yourself and your family now and in the future. Keeping those primary objectives always in the forefront, turn to your financial professional to see how you can best achieve them

Consider professionally managed and tax-advantaged investment strategies. Now is a good time to evaluate the overall tax efficiency of investments in your accounts. Beyond municipal bonds, consider tax-efficient mutual funds or separately managed accounts (“SMAs”) that are managed to limit the number of taxable events within your portfolio. These may include tax-managed funds and tax-exempt or low-turnover index funds with minimal capital gains distributions.

Article by Morgan Stanley Smith Barney LLC. Courtesy of Morgan Stanley Financial Advisor. Articles are published for general information purposes and are not an offer or solicitation to sell or buy any securities or commodities. This material does not provide individually tailored investment advice. Any particular investment should be analyzed based on its terms and risks as they relate to your specific circumstances and objectives. Morgan Stanley Financial Advisor(s) engaged Healthy Living News to feature this article. Scott D. Brown may only transact business in states where he is registered or excluded or exempted from registration http://www.morganstanleyfa. com/thefadel-browngroup/. Transacting business, follow-up and individualized responses involving either effecting or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Scott D. Brown is not registered or excluded or exempt from registration. © 2012 Morgan Stanley Smith Barney LLC. Member SIPC.

So do we. When it comes to your investments, you need solid guidance. But how can you be sure your financial advisor isn’t thinking about a commission instead of your future? The key is to find a professional who collaborates with you to set your objectives, and who has the

tools and motivation to consider possible options.

Review dividend distributions of your current portfolio. Dividend income will potentially receive the most dramatic impact if higher tax rates go into effect. If the top qualified dividend tax rate rises from 15% to 43.4% as suggested—a 189% increase—you will want to look closely at your dividend income and consider realizing gains now to take advantage of lower tax rates.

If you’d like to learn more, please contact Scott D. Brown, First Vice President, Financial Advisor, Morgan

Stanley Smith Barney, Toledo, OH, at 419-842-5312. Web address: http:// fa.morganstanleyindividual.com/the fadel-browngroup/.

You know the difference between a financial advisor and a salesman.

Consider redeploying assets to a variable annuity. In a rising tax environment, the tax-deferral feature of annuities becomes increasingly valuable. Diversifying your retirement portfolio with a variable annuity can provide taxdeferred growth potential, guaranteed lifetime income, increased retirement savings, equity upside potential, and a death benefit for named beneficiaries. Remember, withdrawals from variable annuities will be taxed as ordinary income.

Engage in gifting and legacy planning. After 2013, unless there is legislation to the contrary, estate and gift taxes are scheduled to return to rates that are higher than they have been for many years. If you plan to leave an estate to your heirs, you may want to consider strategically transferring assets this year as part of your overall plan. With the gift tax rate at an all-time low and the exemption at an all-time high, 2012 may be a good year to consider larger gifts, even taxable ones.

in the most tax-efficient manner. With changing markets and political pressures affecting the economy— specifically tax legislation and income tax rates—now is the time to be especially vigilant in reviewing and adjusting your overall financial strategy to keep investments aligned with your financial goals. ❦

As a Morgan Stanley Financial Advisor, I don’t represent products, I represent my clients. With access to in-depth research and analysis, I can help you create sophisticated investment strategies based on your specific situation. In today’s uncertain world, that’s a very valuable quality. Scott D. Brown CERTIFIED FINANCIAL PLANNER ™ First Vice President Financial Advisor 7124 W. Central Ave Toledo, OH 43617 419-842-5312 scott.d.brown@morganstanley. com http://www.morganstanleyfa. com/thefadel-browngroup/ The appropriateness of a particular investment or strategy will depend on an investor’s individual circumstances and objectives. © 2012 Morgan Stanley Smith Barney LLC. Member SIPC.

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The Laurels’ innovative occupational therapy program puts independence in reach

n the wake of an injury, surgery, or disabling illness, the road back to independent function can be long and difficult. Simple activities of daily living once taken for granted can suddenly seem like insurmountable obstacles. Strengthening the body and improving its flexibility and range of motion through physical therapy is certainly a vital step toward reclaiming that independence, but physical therapy is only half of the rehab equation. In addition, recovering patients often need some creative, individualized occupational therapy to help them learn to compensate for physical limitations or restrictions as they meet life’s challenges head on. To understand the role occupational therapy plays in making patients’ lives safer and easier, it’s necessary to first understand what occupational therapy actually is. In this context, the term “occupation” is not to be confused with “vocation,”

34 January 2013 / Healthy Living News

or what one does to earn a living. Rather, it refers to any everyday activity. That could mean something one does every day on the job—but also any other activity of daily living such as cooking, cleaning, bathing, using the toilet, climbing stairs, tying shoes, walking the dog, etc. At The Laurels of Toledo, a skilled nursing and rehabilitation center located at 1011 Byrne Road, innovative, personalized occupational therapy is woven into the fabric of the services they provide. “Our primary goal is to help our guests achieve the highest possible degree of function and independence,” explains licensed certified occupational therapy assistant Cristina Nickle. “Depending on their particular impairment or deficit, we develop an individualized treatment plan and assess what adaptive equipment or compensatory techniques might help

them overcome those obstacles and stay safe.” Laurels patients’ adaptive needs are assessed not only at the Byrne Road facility, but also right in their own home. During home evaluations, occupational therapists visit the patient’s house and observe them as they go through normal daily activities to assess what steps would make the home environment safer and life easier. Simple home modifications to reduce fall risk might be recommended, such as removing throw rugs or other tripping hazards. “Also, a lot of our recommendations are focused on making the bathroom safer, such as installing grab bars in the tub and around the toilet, applying a non-skid surface to the floor of the tub, installing a raised toilet seat, and using a tub bench to make transferring in and out of the tub safer and easier,” says Nickle. Many compensatory techniques are so simple that people might not even think of them. For example, wrapping rubber bands around jar lids or door handles makes them easier to grip and turn. Lifting a gallon jug of milk becomes much simpler when you use one arm to lift and the other to support the lifting arm

at the elbow or forearm. Or, simply switch to buying milk by the half gallon. For cardiac patients who are cautioned to avoid lifting their arms over their heads, storing frequently used kitchen items on the counter, table, or a bottom shelf makes meal preparation and kitchen cleaning much easier and safer. Nickle also points out that there’s an adaptive device on the market for virtually every challenge people might encounter during recovery from injury or surgery or as a result of a disabling condition. For example, a long-handled mechanical reacher can be used in all kinds of applications—from retrieving dropped items to grabbing laundry at the bottom of the hamper to pulling on pants and undergarments. A sock aid is another wonderful tool for those who can’t safely bend over to put on socks, such as people with back pain or who have undergone a cardiac procedure. This device consists of a cylindrical sleeve with two strings or straps attached. Essentially, you pull the sock over the sleeve, set it on the floor, slide your foot into the sleeve, and then use the strings or straps to pull the sock on. Other examples include long-

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handled shoehorns, long-handled ergonomic combs for reaching the hair on the back of your head, longhandled sponges for bathing hardto-each areas, button aids for people with fine-motor limitations, and elastic shoe laces, which never come untied and essentially convert tied shoes into slip-ons. The list goes on and on. Speaking of occupational therapy being “woven into the fabric,” Nickle and her mother, Lucia Rooks, an avid quilter (and former member of Quilting for Compassion), have joined forces to find a safer, more user-friendly alternative to the bulky wire baskets people have traditionally used to carry items while using a walker. The result of their collaboration is a line of fabric Carry All Walker Bags, each unique and handcrafted, which promote safety when carrying and retrieving items. “We present guests with five or six designs and let them choose the one that best suits their style and aesthetic

sensibilities,” Rooks comments. So far, the reaction from Laurels guests to the Carry All Walker Bags has been resoundingly positive. Deloris Hunt, who chose a pink and green bag because it matched the colors of her sorority, Alpha Kappa Alpha, loves not only the style of her bag, but the versatility that all the pockets provide. Patricia Huffer has discovered that the bag is perfect for carrying and organizing her crafting supplies. What’s more, Laurels guests who use wheelchairs instead of walkers have begun clamoring for bags of their own—and Nickle and Rooks are poised to launch a new line of wheelchair bags to meet this growing demand. ❦ The Laurels of Toledo accepts Medicare, Medicaid, and all private commercial insurances. A physician’s order is required to obtain outpatient services. For more information, call 419-536-7600 or visit www.laurelsoftoledo.com.

Maintaining those New Year's Resolutions by Amanda Manthey

ne month almost down and eleven more to go. Is keeping that New Year ’s resolution harder than you thought? If your resolution entailed improving your general health by exercising and you already feel you are on the downhill stretch, follow these easy uplifting tips. Most of us lose interest in a daily workout because it is too boring, too long, or we are short on time. We all battle the workout blues at one time or another. First, reevaluate your New Year’s resolution so it is attainable and fits your personal fitness expectation. Develop three levels of workout routines to maximize your goals, and create an organizational hierarchy based on your abilities. The three levels will be labeled minimal workout, moderate workout, and exceptional workout. The key ingredient is to listen to your body and do only what you are capable of doing. On the days when your body feels energized and more

Don’t miss Dave’s 10 Miler! Runners, get ready to “take your mark” in Dave’s 10 Miler, to be held Sunday, January 13, 2013 at 2:00 p.m. at Delta High School, Delta, Ohio. Online registration is available at www.imathlete.com.

time is available, your workout can be more intense and longer. On the days when your body is sore and time is limited, your workout can be less intense and shorter. Rather than saying, “I’ll do it tomorrow,” reduce the workout and use your three-level workout routines as a quick guide. Remember, you do not want to start over. Reducing your workout instead of skipping a workout maintains consistency and continues to build stamina. Here are a few ideas when time is limited and some form of exercise is better than no exercise: • Reduce your cardio minutes if time is limited, or reduce your resistance or speed if lacking motivation, whether it is on a machine at the gym or running outside. • When strength training, choose machines or strengthening exercises that will target two or more muscle groups. This may entail combining two or more exercises into one exercise. This can be more efficient and less time-consuming if done correctly. Consistency is the key to a successful New Year’s resolution. If the workout blues are approaching,

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reevaluate your situation and make adjustments to your workout routine. You might need to alter your longor short-term goals so that they are attainable fitness goals. Remember, don’t give up and keep a consistent workout lifestyle even if it is minimal. It will leave you feeling great each

and every day and one step closer towards accomplishing your New Year’s resolution. ❦ Amanda Manthey is a former collegiate runner for Eastern Michigan University. She writes about running and fitness for Dave’s Running Shop.

nobody’s perfect Sister Karen Zielinski, OSF

Moving right along

alph Braun can certainly appreciate why his company held a contest to raise awareness about respecting handicap parking spaces. The corporation he founded 40 years ago in Indiana tries to keep people moving by building vans that accommodate wheelchairs and electric scooters. When a person drives a van with their wheelchair or scooter in it, and cannot find a blue handicapped parking spot, it can be frustrating. More than that, it can stop them from

moving about to a store, church, or neighbor’s house. A person with a disability can use a motorized scooter, wheelchair, or accessible van—but not having a handicapped parking space can stop them in their tracks. These blue parking spaces are critical for their mobility. So when the Braun Corporation held a “Respect Blue Spaces” bumper sticker contest to raise awareness of proper use of blue handicapped

parking spaces, it fit right in with what founder Braun was all about: Keeping people moving despite a mobility disability. New Jersey resident Janet Onufer, the mother of Kate, a nine-year-old with Spina Bifida, relies on a positive attitude and sense of humor to get through the daily challenges of living with a physical disability. One of Janet’s pet peeves is when some people misuse handicap parking spaces. When she heard about BraunAbility’s Respect Blue Spaces campaign, she decided to get creative and come up with a slogan that would make someone think twice before parking in the spot reserved for people who need it, like Kate. From almost 500 entries and thousands of Facebook votes, Janet’s slogan ended up as one of BraunAbility’s top three entries. Over a two-week period, BraunAbility Facebook fans voted on the slogan they’d most like to see as a bumper sticker on their wheelchair van, and Janet’s was the overwhelming winner: “Blue Stripes For Really Cool Zebras & Wheelchair Vans Only!” “The idea just came to me when I thought about the blue stripes,” said Janet. “The stripes made me

think of zebras, and I thought who else should be able to park in those spots…no one! Unless of course, a really cool zebra just happened to be walking by.” Her first-place prize came with a $1,000 donation to the disabilityrelated cause of her choice, as well as a $1,000 prize for herself. Janet chose Camp Attitude, a home-away-fromhome that allows kids with disabilities to experience summer camp with a “buddy” who’s there to take care of all the campers’ extra needs. The camp has been a huge blessing for young Kate and her family. “I originally didn’t even realize

there was a prize involved for me,” said Janet. “I just thought it would be nice to win a donation for the camp.” The Braun Corporation and Janet hope that more awareness and compliance about blue parking spaces comes from the bumper sticker contest. Code blue: keep it moving!

Ralph Braun’s story At an early age, Ralph Braun was

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diagnosed with spinal muscular atrophy. The degenerative nature of the disease left him unable to walk at age 15. Despite the limitations on his mobility and society’s unfavorable attitudes toward the disabled, Ralph was able to complete his education and gain employment as a clerk at the local hospital. Necessity truly is the mother of invention. When the standard “iron monster” wheelchair left Ralph completely exhausted at day’s end, he began to think there had to be a better way. He started to tinker in his cousin’s farm shop, and soon the world’s first electric scooter was born. Ralph dubbed his invention the Tri-Wheeler, and word quickly spread among the disabled community. It seemed there were many others who weren’t content to sit still, and Ralph began to take orders and build Tri-Wheelers in his parent’s garage under the name Save-A-Step Manufacturing. In the early years, Ralph rode his Tri-Wheeler the short distance to and from work in all kinds of weather. But when his employer relocated further away from his home, the snowy Indiana winters presented a new transportation challenge. Once again, he took to the shop and soon the first wheelchair lift was created for a retired post office Jeep. A few years later, the arrival of the full-size van sparked the creation of the Lift-A-Way wheelchair lift. Again, the disabled community took note. Ralph began to get insistent phone calls, and he worked nights and weekends to meet the demand. Ralph found it increasingly difficult to manage his growing family, a full-time job, and the Save-A-Step business. It was clear that something had to give, and he made the difficult decision to quit his job and focus his efforts on his fledgling company. Save-A-Step was soon incorporated under the name The Braun Corporation, and the organization enjoyed phenomenal growth through the 70’s and 80’s. Many of Ralph’s first customers became dealers across the country, laying the foundation of a strong distribution network that endures to this day. With the passage of the Americans With Disabilities Act of 1990, the disabled community was awarded unprecedented access to public places. Soon after, a revolutionary product was introduced: the Entervan. This lowered-floor minivan offered unparalleled ease of access for wheelchair users, and it quickly became the flagship of the Braun product line as thousands discovered a newfound

independence. What started in a garage had grown into a worldwide corporation in just 20 short years, and Ralph remained at the helm of the company—and the industry—he had created. With the help of Braun mobility products, people with disabilities have become an integral part of society over the past decades. The public’s attention has shifted from a focus on an individual’s limitations to a celebration of their abilities. This gave birth to the name BraunAbility, and their

I am very

but one thing never will: they remain committed to helping individuals lead full and active lives, one customer at a time. Because—as Ralph Braun has known all along—Life is a Moving Experience. ❦ pledge to redefine the Ability Industry in the years to come. Their name may have changed,

Sister Karen Zielinski is the Director of Canticle Studio. Canticle Studio is a part of the Sisters of St. Francis of Sylvania, OH’s overall

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advancement effort and has a mission of being a creative center where artists generate works, products, and services

in harmony with the Mission of the Sisters St. Francis. She can be reached at kzielins@sistersosf.org or 419-824-3543.

Lourdes University nursing programs answer need for advanced nursing education

reliminary results of a survey conducted by the American Association of Colleges of Nursing show that enrollment in all types of professional nursing programs has increased in the past year. Bachelor of Science in Nursing programs show a 3.5% increase, the 10th year of enrollment increases in those programs, a signal that nurses and their employers are showing more interest in baccalaureate-prepared nurses. AACN officials note in a statement about the survey results that, “…groups inside and outside the nursing profession are calling for higher levels of academic progression in nursing…,” a move that is encouraging colleges to work with schools offering associate degrees and community colleges to encourage academic progression in nursing. The survey results are not news to officials at Lourdes University.

The College of Nursing at Lourdes has both an RN to BSN program for nurses who want a baccalaureate degree, and an RN to MSN option for those who want to work toward advanced roles in nursing education or leadership. The University works with area community colleges to offer a smooth transition from one level to the next, in a program that is unique in Northwest Ohio. The program offers registered nurses with associate degrees or diplomas in nursing the opportunity to continue their education in a university setting with small classes and a highly credentialed nursing faculty. The RN to MSN option gives students a chance to bypass the bachelor’s degree and earn the MSN with 25 fewer credit hours than the traditional method. The RN pursuing the MSN selects one of two tracks—the Nurse

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Leader Concentration or the Nurse Educator Concentration. The Leader Concentration choice emphasizes nursing theory, research and practice, and promotes the development of nursing leadership, knowledge, and concepts and skills. Graduates are prepared to serve in advanced leadership roles, coming to their positions with coursework in trends in nursing, research, healthcare policy, ethics, and diversity, among others. Those who choose the Nurse Educator Concentration are prepared (with courses including Teaching & Learning and Curriculum & Design) to teach in a variety of roles in nursing practice. They might find careers in patient education programs, undergraduate nursing education programs, and staff development. In the fall of 2011, Lourdes College of Nursing began offering the Nurse Anesthesia advanced practice role. The nurse anesthesia students are precepted by experienced certified registered nurse anesthetists (CRNA) and anesthesiologists in a variety of settings.

For those individuals who are not yet registered nurses, the program begins at the pre-licensure baccalaureate level, a four-year program for those who want to pursue nursing as a profession. Students starting “from scratch” begin with courses in the liberal arts and sciences, then begin their nursing courses in the second semester of their sophomore year. LPNs who are interested in a four-year degree program take classes that enhance their knowledge, and they are recognized for their previous education. After successful completion of the plan of study, they are eligible to sit for the National Council Licensure Examination for Registered Nurses (NCLEX). All nursing students benefit from small classes with individualized attention. The AACN survey noted that, “Interest in nursing careers remains strong, but those seeking to enter the profession cannot be accommodated…because of a shortage of clinical placement sites, faculty and funding.” Lourdes University College of Nursing has strong partnerships with over 45

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Master of Science in Nursing (MSN) degree programs  Nurse Anesthesia  Nurse Educator  Nurse Leader  Registered Nurse (RN) to MSN – For RNs with an Associate’s Degree or a diploma seeking a graduate degree in nursing leadership or education.

Contact Linette Will at 419-824-3995 or lwill@lourdes.edu 38 January 2013 / Healthy Living News

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acute-care and community agencies in Northwest Ohio and Southeastern Michigan to provide both graduate and undergraduate nursing students with excellent clinical experiences. Undergraduate students actually begin their clinical experiences in the community (senior centers, assisted living, health departments, schools, and homeless centers), which is unique for schools of nursing. As they attain critical thinking skills with advanced knowledge, they move into acute-care settings. Lourdes faculty use creative teaching strategies (simulation, lab work, and technology) to challenge the students and prepare them for a nursing career. ❦

Associate Professor Deborah Vargo, Director of the MSN Program, invites inquiries about the program at 419-8243792 or dvargo@lourdes.edu. This project is/was supported by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under Advanced Nursing Education grant number D09HP22602 for $955,687. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any official endorsement be inferred by, the DN, BHPr, HRSA, DHHS, or the US Government.

Eating Well

My rehab. My choices. My results. “Otterbein’s small house is NOT a typical rehab center! It is a welcoming home in a beautiful neighborhood. The personalized therapy and home-cooked meals allowed me to recover in record time. My doctor was amazed!” - Jim, Otterbein Small House

by Laurie Syring, RD/LD

"Can you work me up a diet?"

t’s the New Year—a time when we all like to reassess our goals and habits and make healthy resolutions. As a dietitian, I’m sure to be asked repeatedly, “Can you work me up a diet?” Now, I’m all about helping people get on the right nutritional track and make healthy choices, but I don’t really care for the word “diet.” I believe people achieve much better nutrition and fitness results if instead of launching yet another diet, they opt to focus on making good choices on most days. That way, proper eating becomes an ingrained behavior rather than a temporary lifestyle adjustment with a built-in end date (or end weight) that is followed by the inevitable relapse. Over the holidays, our healthy eating habits tend to be sabotaged, and many people tell me they have forgotten how to eat well. Plus, with all the diet information and misinformation floating around out there, it’s hard to know whether what’s deemed good to eat today will be considered bad for you the next. To help cut through all the confusion, here’s a simple “blueprint” for healthy eating that you can follow:

Start smart To begin eating healthy, start your day the right way with a good, healthy breakfast. And no, a buttered scone and grande mocha latte do not constitute a good

breakfast! Start thinking “1-2-3” each morning. That means three food groups should be represented in your morning meal. Here’s how to do it:

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1. Pick a protein: 1 egg, 1 cup of milk, 6 to 8 ounces of plain yogurt, ¼ cup cottage cheese, or 1 ounce of lean ham or turkey sausage. 2. Pick a fruit: 4 to 6 ounces of orange juice, ½ grapefruit, 1 orange, 1 small banana, or 1 cup of strawberries or blueberries. 3. Pick a complex carb: ½ cup oatmeal, 1 slice of whole-grain toast, or 1 cup of All Bran.

Lunch At lunchtime, 3 to 4 hours after breakfast, you get to pick 4—food groups, that is. 1. Pick a protein: 3 ounces of chicken, ½ cup cottage cheese, ½ cup tuna, or 3 ounces of low-fat lunchmeat. 2. Pick a complex carb: whole-grain bread or crackers, brown rice, or whole-wheat pasta. 3. Pick a fruit/vegetable: 6 baby carrots, 2 cups of salad, 1 apple, 1 orange, or 1 cup of melon cubes. 4. Pick a dairy (especially kids and women): 1 cup of skim milk or 6 ounces of yogurt.

Mid-afternoon snack Two hours after lunch, it’s time for your midafternoon snack! But please put down that Snickers and Coke! In-

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stead, pick one of the following: ¼ cup of nuts, granola bar, string cheese, hard-boiled egg, fruit, tortilla chips and salsa, or dry whole-grain cereal.

Dinner Two hours later, it’s time for dinner and you get to pick 4 again.

1. Pick a protein: 3 ounces of lean chicken, turkey, beef, or salmon (eat fish 2 to 3 times a week). 2. Pick a vegetable and a fruit: ½ your plate should be vegetables. Choose fruit as your dessert. 3. Pick a complex carb: brown rice, whole-wheat pasta, new potatoes,

or beans. 4. Pick a low-fat dairy: 1 cup of skim milk or 6 ounces of yogurt.

Beverages It’s easy to overlook just how many calories our beverages contain. Avoid drinking regular pop, sports drinks, and fruit drinks, and limit diet drinks to no more than 2 per day. Choose tea, coffee, and water, water, water!

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Remember, this is a way of eating, not a diet. If you use this simple plan—pick 3 at breakfast and pick 4 at lunch and dinner—as your blueprint for eating right, you really can’t go wrong. And you’ll be amazed at how much better you feel and how those cravings for sweets and fatty fast foods disappear! Following this plan doesn’t have

to get repetitive or boring. Nor do I encourage you to deprive yourself or to eat bizarre foods (unless you really like them and they’re healthy). What I do encourage is practicing mindful eating while mixing things up a bit. Learn to appreciate the taste of eating right—the flavors of roasted almonds, dark chocolate, berries, and avocados. Every day, we have to make numerous choices between good and bad foods. By planning ahead, we can simplify those decisions and take some of those temptations away. Only you can make healthful choices and changes. Don’t you owe that to yourself this year? Healthy Regards! ❦ Laurie Syring, RD/LD, is chief clinical dietitian at ProMedica Flower Hospital.

by Emma Opblinger, RN

made in

Hollywood Photographs from the John Kobal Foundation

October 7, 2012 N January 20, 2013

Meaningful Use

regon Clinic physicians have successfully completed all requirements to achieve status for meaningful use of electronic health records for 2012.

What is meaningful use?

Electronic health records can provide many benefits for providers and their George Hurrell, Clark Gable and Joan Crawford for “Dancing Lady” (detail), patients, but the benefits depend on MGM, 1933 gelatin silver print. how they’re used. Meaningful use is the set of standards defined by the Centers for Medicare & Medicns! olutio aid Services s e ’s R r a (CMS) Incene Y New tive Programs g that governs kin Smo the use of elecStop tronic health 3177 Bellevue Rd Toledo OH 43606 ight e w records and alLose www.acupuncturetoledo.com lows eligible ! y h providers and lt Hea Get E hospitals to E R for F n a earn incentive w ch Dr. S ll a payments by C n! io t meeting spea ult cons cific criteria. 419.472.7055 ays Holid y p The goal p Ha 055 7 . 2 m of meaningFro 47 419 . an! w ful use is to h c Dr. S promote the spread of electronic health records to imSupported in part by

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prove health care in the United States. The benefits of the meaningful use of EHRs include: • Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room. • Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors’ offices and hospitals and across health systems, leading to better coordination of care. • Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families. Beginning in 2015, Medicare-eligible

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professionals who do not patient safety, efficient use so when the patient leaves, he or and tobacco-cessation interventions. successfully demonstrate of healthcare resources, she can pick it up right away. They Eventually all of a patient’s impormeaningful use will be care coordination, patient don’t have to worry about losing tant health information will be shared subject to a payment adengagements, population any papers, being able to read the electronically with other healthcare justment. and public health, and cliniprescription. providers, for example emergency The Medicare and Medcal guidelines. room, consultants, specialists, etc. Along with some of the clinical icaid EHR Incentive ProThe Stage 1 meaningful qualities being measured, the clinic Patients will have medication lists, grams are staged in three use objectives are grouped is tracking and monitoring diabetic problem list, allergies, test, consultasteps with increasing reinto five patient-driven dopatients for adequate blood sugar tions, and visit summaries available quirements for participamains that relate to health control. Diabetes is recognized as from electronic health records. tion. All providers begin outcomes policy priorities. a leading cause of death and disThe meaningful use objectives and participating by meeting As depicted below, each ability in the U.S., and a large pormeasures in the table will evolve in the Stage 1 requirements core and menu objective three stages over the next five years. tion of our patient clientele have a Emma Opblinger for a 90-day period in their is aligned to one of the Achieving meaningful use durdiagnosis of Diabetes Mellitus. We first year of meaningful use and a full following domains: ing Stage 1 requires meeting both are also providing preventive care year in their second year of meancore and menu objectives. All of the and screenings for cancer, such as 1. Improve quality, safety, efficiency ingful use. After meeting the Stage breast and colon cancer screening core objectives are required. EPs and 2. Engage patients and families hospitals may choose which 1 requirements, providers will then 3. Improve care coordiobjectives to meet from the have to meet Stage 2 requirements Stage 1: 2011-2012 Stage 2: 2014 Stage 3: 2016 nation menu set. for two full years. Meaningful use criteria Meaningful use criteria Meaningful use criteria 4. Improve public and focus on: focus on: focus on: Clinical quality measures, or CQMs, Continuously measuring population health are tools that help us measure and and reporting these CQMs Improving quality, safety, and 5. Ensure privacy and Electronically capturing health More rigorous health track the quality of healthcare serhelps to ensure that the proinformation in a standardized efficiency, leading to improved information exchange (HvIE) security for personal format health outcomes vices provided by eligible profesviders at the Oregon Clinic health information sionals (EPs), eligible hospitals (EHs) can deliver effective, safe, Increased requirements for Using that information to track Decision support for national e-prescribing and incorporating and critical access hospitals (CAHs) First, the provider must key clinical conditions efficient, patient-centered, high-priority conditions lab results within our healthcare system. These use electronic health records equitable, and timely care. ❦ that Electronic transmission of Patient access to self-management measures use a wide variety of data in a meaningful way, such Communicating information for care patient care summaries across tools that are associated with a provider’s as e-prescribing. This is coordination processes Emma Opblinger, RN, has multiple settings ability to deliver high-quality care or where a provider can enter Initiating the reporting of clinical worked one year at Oregon Access to comprehensive patient data through patientrelate to long-term goals for healtha prescription right into the quality measures and public health More patient-controlled data Clinic as Manager of Wellness centered HIE EHR and it will be imme- information care quality. CQMs measure many Care & Quality Improvement. Using information to engage aspects of patient care, including diately transferred to the She is also involved in some and their families in Improving population health health outcomes, clinical processes, patient’s local pharmacy, patients research projects at the Clinic. their care

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Migraine headaches and the eye by Bennett Romanoff, MD

eadaches are the most common condition that people suffer from. The most frequent form is called a tension headache. Everyone sooner or later, some more often than others, experiences a tension headache. Fortunately, migraine headaches are much less common. Approximately 16% of women and 6% of men experience migraines. Migraines can be genetic or familial in nature. I have seen many patients who have a parent, a grandparent, a sibling, or a child with migraines. A typical migraine headache is on one side of the head and throbbing in nature. It can range from mild to incapacitating. It is often accompanied by nausea, loss of appetite, and anxiety. Other symptoms accompanying the migraine are sensitivity to light, smells, and sound. Blurred vision, a runny nose, sweating, abdominal

cramps, loss of concentration, and memory impairment also may occur. Most migraines last from a few hours to a few days. Migraines often start during the teenage years; however, they have been known to start at almost any age. Birth-control pills are known to increase risk. In many patients, the symptoms may be triggered by bright lights, loud noises, menstruation, as well as many other life circumstances. The first symptoms, called the prodromal phase, which indicates that a migraine is going to occur, are mental confusion, restlessness, irritability, increased urination, stiff neck, drowsiness and fatigue, diarrhea, or just generalized premonitions of the impending migraine. This prodromal phase occurs in about 60% of all migraine episodes. The prodrome may begin a few hours to a few days prior

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to the headache. Often after the prodrome and before the headache, an aura may occur in about 20% of migraines. An aura is a localized neurological event often characterized by shimmering lights and a blind spot in the middle of one’s vision. This is called a scintillating scotoma. It starts gradually and is on one side of the field of vision. It often looks like zigzag lines, heat wave lines, or herringbone lines that are either black and white or rainbow colored. They start small and can engulf the entire half of the field of vision to the right or the left. Usually the blind spot in the middle of the vision starts out small and enlarges enough to block all the central vision. After it reaches its peak, in 5 to 20 minutes, it slowly diminishes and goes away as does the blind spot. Auras vary greatly in symptomatology. Slurred speech, numbness on one side of the body, vomiting, inability to talk, and weakness of a limb on one side are all symptoms that may also occur during the aura phase. These other symptoms often occur along with the scintillating scotoma; however, they may occur without visual symptoms and within 20 to 60 minutes the onesided pounding headache begins. Many people who are prone to migraines can get a scintillating scotoma or other aura-related symptoms and never get a headache! I see this very often in my practice. The first time it occurs, it is terrifying to patients who are often sure that they are experiencing a stroke or a brain tumor. At worst, it can occur when driving or during other important visual activities. It is so important to pull off the road or stop the visual activity immediately before the blind spot engulfs the vision. In very rare cases, with certain brain vascular malformations, the first symptoms of what ultimately may be a stroke are quite similar to a migraine. The main difference is that the symptoms do not go away and the symptoms are much more severe. If the headache does not occur after the aura, at the worst it is usually nothing more than a very annoying and inconveniencing episode. The vision virtually always returns to normal, and one can resume whatever activity they were doing. After a migraine headache is over, many people feel totally listless and worn out. When migraines occur too often, depression and generalized

malaise are common aftereffects. There are many classes of drugs that are quite effective in treating migraines, and there are two general classes of treatments. First are drugs that treat the migraine headache once it has started, and second are drugs that are prophylactic, aimed at preventing recurrent episodes. Many people who get frequent attacks require both types of medication. Every patient is different as are the symptoms associated with migraine headaches. It is usually best to consult with one’s primary care doctor or a neurologist to determine which therapeutic regimen is best. When migraines occur too often and interfere with a patient’s lifestyle, Botox is quite effective in giving a long-term remission of the migraines. I have seen many of my patients that I have treated with Botox get four to nine months of relief. I have one patient who has not had a migraine in three years after one Botox treatment, which is a pleasant atypical result. Botox does not work on all migraines. In my experience, about 60% of patients get significant relief from the treatment. One patient of mine had almost daily or up to three times a day visual auras, without headaches, that were incapacitating. Botox more or less gave him his life back and has allowed him to function again. Botox treatments are easily repeatable and are usually not associated with significant discomfort. The medical management of migraines is usually challenging but can be very helpful in most patients. In those patients that have a known trigger that sets off the migraine attack, avoiding the triggering event is helpful. I always advise patients with migraines to consult their primary-care doctor first and if relief is elusive, to request a neurologic consultation. A consult with a medical eye doctor, an ophthalmologist, is also a very important part of the migraine workup.❦ Dr. Bennett Romanoff is Chief of Ophthalmology at Flower Hospital, a Clinical Assistant Professor of Ophthalmology at the University of Toledo College of Medicine, and an instructor of Ophthalmology in the Family Practice residencies with Flower and Toledo Hospitals. Since setting up his practice in 1978, Dr. Romanoff has helped thousands of patients in Northwest Ohio achieve better quality of vision with upto-date treatments and solutions.

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Caregiving 101 for men, by Jessica Derkis For God is not unjust so as to forget your work and the love which you have shown toward His name, in having ministered and in still ministering to the saints. —Hebrews 6:10

id you know that nearly 45% of senior family caregivers are men? I know; I expected that number to be much lower too. More and more husbands, sons, nephews, and friends are taking up the mantle of caregiver. Sometimes a husband helps his wife who cannot remember to take medications, dress herself warmly on cold days, or eat regularly due to the ravages of Alzheimer’s. Or a son or, as I witnessed recently, a few sons coordinate help for Mom and Dad by bringing in meals, mowing lawns, chauffeuring to appointments, shopping for groceries, and even personal care. “Most men have grown up in a household—and certainly a culture—in which females have been perceived as the primary family nurturers. Yet, often by necessity, more men than ever are rolling up their sleeves and helping an ill loved one with day-today tasks, such as dressing, toileting, bathing, eating, changing dressings, and managing medications,” according to a recent report at AgingCare.com.

Often sons and sons-in-law will spend thousands of dollars to adapt their home or their parents’ home to help with mobility, memory, or convenience. Even after that, the average caregiver continues to spend between $2,000 and $5,000 per year to help their loved one. Startling, isn’t it? In a recent interview for Seniors forLiving.com, Bob Bua, the President of CareScout, a Genworth partner with AARP®, noted that male family caregivers are the highest frequency callers to their caregiver hotline (1877-333-5885, Monday-Friday, 9:00 a.m.– 5:00 p.m.). Though still underserved, there are more resources for caregivers today than ever and many of those are realizing the need for a more inclusive approach. When considering care options, much of the information is written with women in mind. Verbiage is oriented to women, often citing choices, features, and amenities that will appeal to wives, daughters, and nieces. For example, ladies often watch for smiling faces and comfortable

environs while men typically look for structural and financial stability. Certainly there can be both. Any caregiver can get caught up in all of the responsibility and neglect their own bodies, minds, and spiritual

needs. But men are especially susceptible because they either do not realize the toll it is taking on them or perhaps they feel the need to push through. Sometimes they need a break. They need to ask for help. Navigating the various systems, like health care, community resources, assistance agencies, the Veterans Administration, or Job and Family Services, can be formidable. This is

especially true if you are not used to asking for help or advice. AgingCare. com notes that lack of information and “not asking” is a primary roadblock to getting needed services for men and those under their care. There are numerous local agencies that support caregivers in our area no matter their sex. The Alzheimer’s Association offers a multitude of support all over Northwest Ohio for families who are contending with more than a hundred types of dementia (1-800272-3900 or www.alz.org/nwohio). The Area Office on Aging offers a full range of services, including training and help finding resources for seniors and their caregivers (419-382-0624, ext. 1169). When you call, ask for your free copy of CaregivingSMARTS: The Resource Guide for Families & Persons Caring for Older Adults or find the whole book online at www.areaofficeonaging. com. In an effort to also be an advocate for seniors and their caregivers, St. Clare Commons has partnered with Blessed John XXIII and St. Rose Parish to bring some of these same resources to the community. The last couple of months, we focused on dementia education

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and care as well as safety in the home. In the coming months, we will look at caregiver resources, healthcare options, planning ahead, “knowing when to say when,” and many other senior concerns. Plus, the new St. Clare Commons has specifically designed communityeducation space coming next summer. We’re looking forward to hosting seminars, continuing education, and working with local educators to improve senior care in Northwest Ohio. This month, though, join us at St. Rose Parish in Perrysburg on Thursday, January 17 to learn more about Senior Nutrition. At 11:30 a.m., there will be a luncheon and a “Dine Well” discussion, and at 6:30 p.m., we invite caregivers and family members to learn how to make healthier foods—and make them more appealing. Call St. Rose Parish at 419-874-4995 to RSVP for either talk. Remember to focus on what keeps you going. Caregivers often say that the companionship and renewed relationship with their parent or spouse is the most positive benefit of caregiving. Thank you, men—and ladies—for caring for your relatives. Your service is calculated to be worth billions to the US economy but, more than that, you will not regret it. Your ministry to

the saints will not be forgotten. And when you need a little help, don’t forget to ask. Until next month, I hope your New Year is richly blessed. ❦ Jessica Derkis is the Director of Marketing

RSV

Much worse than common cold for at-risk people

t’s the most common virus you’ve probably never heard of—respiratory syncytial virus, or RSV. By age two, all infants have been exposed to RSV, and in most cases of infection, symptoms are relatively mild and mimic the common cold. However, in certain high-risk individuals, such as premature babies, people with heart or lung disease, and those who have a weakened immune system, RSV can lead to serious illness or even prove fatal. In fact, according to Ramalinga Reddy, MD, MBA, of Mercy Pediatric Pulmonary Specialists, each year in the US, approximately two million young children infected with RSV require treatment. Of those individuals, approximately three percent require hospitalization, just under

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for St. Clare Commons, a Franciscan Living Community located at 12469 Five Point Rd, in Perrysburg, Ohio. She can be reached at 419-931-0050 (office), 419-250-5227 (cell), or jderkis@ stclarecommons.org.

25 percent end up in the emergency room, and nearly 75 percent will be treated by their primary-care physician. In the first year of life after being born premature, RSV is the most common cause of hospitalization—even more common than pneumonia and influenza. “The burden of this illness is quite high, not just financially, but also emotionally for parents who may have no idea what RSV is and are terrified when their child is hospitalized,” Dr. Reddy states. Clinical Nurse Specialist Dawn Bolyard, RN, MSN, AE-C, also of Mercy Pediatric Pulmonary Specialists, explains, “Most patients with RSV experience little more than an upper-respiratory infection. However, some go on to develop bronchiolitis and some children with heart, lung, or neurological problems are at high risk of developing more serious disorders. Dr. Reddy adds that people who have a family history of allergy and were exposed to RSV at an early age are predisposed to asthma attacks later in life. Also, it’s noteworthy that apnea (pauses in breathing) can be an early symptom of RSV in infants. Premature babies are particularly vulnerable to more severe cases of RSV because they did not receive passive immunity to the virus from their mothers. Most pregnant women have been exposed to RSV, but immunity is passed on to the baby during the last trimester of pregnancy, so babies born early miss that window. That coupled with the fact that their lungs tend to be underdeveloped significantly increases their risk of morbidity (getting sick with the virus) or mortality. As Dr. Reddy points out, there’s both good news and bad news with respect to RSV in the US. “The good news is, mortality in this country from RSV is down considerably. Fifteen years ago, the rate was about 4,000 infants per year. Today, it’s down to

between 400 and 500. The bad news is, the morbidity rate has significantly increased,” he says. Both Bolyard and Dr. Reddy can speak about RSV from personal experience. Bolyard’s adopted son was born premature and had RSV as an infant. He went on to develop significant disease and spent a year in the hospital, requiring a tracheostomy and the use of a ventilator. He’s also still working to overcome developmental delays resulting from his illness. Dr. Reddy’s son was born on Christmas eve and ended up getting RSV (probably brought home by Dr. Reddy who was working in a hospital at the time), with vomiting, coughing, and wheezing, in early January. So both practitioners understand the potential severity of RSV and the anxiety parents feel when their children are sick with it. RSV is spread through contact with infected surfaces, not through airborne droplets like the common cold, and the virus can survive on a surface for six to eight hours. Infected individuals are contagious for approximately two weeks, and siblings under age five are a common source of transmission. There is no known treatment for the virus, and no immunization is currently available. “That’s why we urge people to practice prevention, including hand washing, keeping your hands away from your face, and avoiding overcrowded places such as the shopping mall during the holidays. Also, exposure to tobacco smoke during pregnancy and after birth appears to be an environmental contributing factor to increased risk, so if you’re pregnant, you must not smoke,” Dr. Reddy emphasizes. RSV follows a predictable seasonal pattern with some variability. In the Midwestern states, it’s most prevalent during the winter months, but in some parts of the country, such as Alabama and Florida, it’s a problem year round. Locally, the RSV season typically begins around the end of November to mid-December and ends in mid- to late April. However, Bolyard comments that she has seen cases as early as August and as late as May. What’s more, the current season is shaping up to be a significant one. “We monitor how much RSV is going on in the community, and for the last few weeks, it’s been almost like we’re

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in the middle of an epidemic. Plus, the season began about three weeks earlier than usual,” Bolyard says. It’s important for people to be aware that RSV isn’t strictly a pediatric disease. There are many strains of the virus, and infections can occur right into adulthood. This can be concerning for adults with COPD (Chronic Obstructive Pulmonary Disease), whose condition can worsen as a result of RSV, or other chronic ailments. Also, adults who, for any reason, have a compromised immune system are more vulnerable to serious illness stemming from RSV infection. Dr. Reddy reiterates, “Anyone at high risk of complications from RSV infection must be especially diligent when it comes to preventive measures, including hand washing, avoiding crowded places, and avoiding smoking if you’re pregnant.” ❦

Oh dear, the Mayans were wrong! by Douglas Schwan, DC, Dipl Ac

f you are reading this, then the world is still here and the Mayans blew it big time. So together we have to face another year, and with it comes a new batch of resolutions. Every year we resolve to make ourselves into a new image. By far the most popular New Year’s resolutions are to lose weight, quit smoking, and get pain relief by living a healthier life. Everyone needs a little help now and then, and those wishing to hold true to their New Year’s resolutions are no different. Fortunately, acupuncture is a safe, economical, and effective method to bolster your chances of leading a better life in 2013! Weight loss: With weight

loss, acupuncture works to help you in several ways. It reduces your overall appetite so you feel full faster. It boosts your metabolic rate so that you burn more calories and feel more energetic throughout your day, and it helps head off cravings that lead to consumption of empty calories. Combined with good nutritional advice, you can start the year ridding your body of dangerous toxins, increasing your energy level, and just feeling so much better. Stop smoking: Addictions of any kind are hard to kick. Whether you smoke, drink, or have any other addiction, acupuncture can help by stifling the urge and helping the body to cleanse toxins. It can control the emotional swings and irrationality that often accompany withdrawal. Acupuncture-assisted quitting is many times more effective than trying to quit on your own. Stopsmoking treatments pay for themselves in a very short time when one considers the cost of a pack of cigarettes today! Acupuncture is proven effective in smoking, alcohol, cocaine, heroin, and

other highly addictive substances. We all can be helped by giving our “will power” a little extra edge. Fertility: We are seeing more and more women experiencing difficulty conceiving today. Environmental toxins, extended use of birth control, and delaying the start of families are just a few of the contributing factors. A successful pregnancy is like an orchestra; you may be able to walk around and hear the individual instruments okay, but the group won’t make music until they all play in sync. Acupuncture is particularly adept at getting all the instruments to play together in harmony. Studies have even shown that just adding acupuncture to the IVF procedure increases the likelihood of a successful outcome by 15 to 17 percent! Pain relief: Pain makes the holidays less than joyful. For thousands of years, acupuncture and herbal medicine have been utilized to treat all types of pain, from chronic fibromyalgia to acute sports injuries. Taking pain medications for extended periods often results in addiction and an overall decrease in health as the strong chemicals take their toll on

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the body. Pain is often just masked. Acupuncture for pain is effective, safe, and long lasting, especially when combined with a healthy herbal and nutritional program. Depression & anxiety: Not a day goes by that I don’t see the “zombies” come through my office: people that are on three or four psychoactive drugs “just” to get through their day. Lack of focus, chronic pain, lack of energy, loss of sex drive, weight gain, uncontrolled anger are all symptoms of long-term depression and the drugs used to treat them. There is an overreliance on pharmaceuticals that usually help for a period but eventually have to be changed or added to due to decreased effectiveness. Studies have demonstrated that acupuncture with herbal therapy is capable of boosting neurotransmitters in the brain. It is thought that low concentrations of the neurotransmitter serotonin result in symptoms such as anxiety, poor sleep, fatigue, and, eventually, depression. In severe cases, acupuncture can be used as an adjunct with medications to lower dosages and increase effectiveness. General health: Traditional Chinese Medicine (TCM) has long had its origins in the treatment of the entire body. We have an innate healing ability within us that is pretty awe-

some! What manmade machine can self-repair just about any injury for almost a hundred years? This innate healing ability we posses draws on Qi (pronounced “chi”) energy, which is distributed around our limbs and organs in channels called meridians. And, like a car battery, this energy has to be the right type, connected correctly, and have the proper amount of energy carefully balanced throughout the body. For over four thousand years, TCM practitioners have developed treatments to restore and balance this energy so the body can function at its optimum level. Nutritional nugget: It is well known that low vitamin D levels and certain artificial sweeteners, like aspartame, can be associated with increased risk of breast cancers. Also excess fatty tissue and hormone replacement therapies (HRT) seem to accelerate growth of these cancers once they develop. With that in mind, some simple dietary advice is a cheap, safe, effective strategy for warding off such cancers. The breast cancer diet: • Supplement with 10,000 IUs of vitamin D3 every day. • Give up ALL forms of soda, both diet and regular. • Maintain a grain-free diet, and

Life at Swan Pointe...

~ Lois loves Swan Pointe Life at Swan Pointe for Lois Leninger was quite busy for a while. She received both physical and occupational therapy services and has now successfully completed her rehab services. Lois stated that “she loves living at Swan Pointe”. Both she and her daughter Carol are very pleased with the thoughful care Lois receives.

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give up refined sugars and flours. • Begin exercising. • Avoid HRT therapies. Switch to safer alternatives like bioequivalents. ❦ Dr. Schwan is a Doctor of Chiropractic and a Diplomate of the International Academy of Medical Acupuncture. He

is president of Schwan Chiropractic & Acupuncture Clinic with offices in Toledo and Perrysburg, OH. Doctor Schwan is available to speak at your group on a variety of health topics. He may be contacted at Dr_Schwan@ acupuncturetoledo.com. For more information on Alternative Medicine, please visit our website at www. acupuncturetoledo.com.

St. Ursula students solve real-life problem by Christine A. Holliday

cience, Technology, Engineering, Mathematics. Sound like heavyduty work areas populated by people in lab coats or hard hats solving problems like cancer or building bridges? Not always.t In fact, those subjects are popular in the halls at St.Ursula Academy, where members of the STEM Club are finding a solution to a problem that could potentially touch all of us. The seven girls are using money from a grant from the Lemelson-MIT InvenTeam Program to develop a pill dispenser that is programmed to deliver an appropriate dose of medicine at a prescribed time from any size prescription bottle. The girls decided to tackle the project during the summer of 2012, then entered the competition for award money. They were chosen to build a prototype of their idea, which they will present at Eureka Day, a several-day celebration of the inventive spirit, to be held at MIT in June, 2013.

of the STEM Club, notes that she has seen an awakening of student interest and desire to go into science-related careers that aren’t limited to medicine. She explains, “Many of them had no idea that engineering, for example, is a career out there. This program is a great way to encourage that interest.” She continues, “St. Ursula is one of three all-girls schools (out of 16 winning schools) that won 20122013 awards. The sponsoring group is pleased to see girls participating. They reminded us that a recent U.S. Department of Commerce report showed that women continue to be a minority in STEM fields, holding only 25% of jobs in those areas, and that women hold a disproportionately low share of STEM undergraduate degrees, especially in engineering. It is great to see the girls give serious thought to those careers.” Sophomore Neera Martin is a member of the Club. She plans a career in engineering and has enjoyed working with her teammates on a useful project. “We did interviews at Sunset House,” she reports, “and found that our idea might make it easier for patients who have to take medicines on a schedule. They won’t Left to right: Beth Ann Less, Madison Scott, Danielle Hunt, have to take the pills out Jessica Cetnar, Neera Martin, Gabrielle Mancy, Caroline of the bottle, and there will Lewandowski. be a button to program dispensing times. There The Lemelson-MIT InvenTeams will be a bit of technology involved, Program is designed to give teams of maybe like programming a VCR, but high school students the opportunity it will be easy to do.” to invent technological solutions Team member Danielle Hunt is to real-world problems. Each team excited about the opportunity to use chooses its own problem to solve, her knowledge of math, science, and and the team members rely on their problem solving to build an actual classroom lessons in the STEM course project. “I want to go into industrial areas and collaboration with others to engineering, and this competition develop prototypes. The SUA team experience has been like my own members are working with professors nerdy fairy tale,” she said. “It is simply at UT and designers at Omnicare to an amazing feeling to know that you came up with an idea, built the project perfect their product. Jackie Kane, the teacher/moderator with your own hands, and that the To read this issue online, visit www.hlntoledo.com

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project could actually transform lives.” Officials at MIT hope that the opportunity to solve real-life problems inspires young men and women to be future inventors. Leight Estabrook, the Program’s invention education officer, says, “This year’s projects… show that young Americans are not just motivated to invent, but are committed to improving the lives of others through invention. Our hands-on learning programs, like

the InvenTeam initiative, ensure that students gain the skills necessary to be competitive and successful in their education and their careers.” Team members are Jessica Cetnar, Danielle Hunt, Beth Ann Less, Caroline Lewandowski, Gabby Mancy, Neera Martin, and Madison Scott. ❦ Chris Holliday is a freelance writer and regular contributor to Healthy Living News.

The Academy Corner Presented on behalf of

The Academy of Medicine of Toledo & Lucas County

Angina: risk factors and symptoms by Angela K. Johnson, UTCOM MS4

emma is a 67-year-old woman who came to the emergency room because of pain in her chest. She says that the pain started while looking after her grandson a few weeks ago—specifically when she was chasing him around the house. When she sat down to rest, the pain went away. Over the last few weeks, she has noticed the pain more frequently— while climbing stairs, putting away

dishes, and walking to her car. She is nervous because her father died of a heart attack when he was in his 70s. In the emergency room, Gemma is resting and not feeling pain, but the doctor is still concerned that she may have had a heart attack and keeps this in mind as the most severe possible diagnosis. Symptoms of a heart attack may include chest pressure that extends into the

arm or jaw, shortness of breath, and sometimes nausea. The doctor also reviews her history to determine if her pain may signify “angina.” Angina (pronounced ANN-GINUH) is the pain that a person feels when their heart is not receiving enough blood. This could be because one of the main blood vessels supplying the heart is partially or completely blocked due to a blood clot or a collection of cholesterol on the vessel wall. If the heart doesn’t receive enough blood, it sends a signal to the body. This is the body warning the person that there is something going on and may signify that a heart attack is coming. Gemma tells the doctor that she has had both high blood pressure and high cholesterol for the past 20 years and has smoked for 40 years. She explains that she did not have any chest pain until a few weeks ago, and it has been on and off since then. She does not remember injuring her chest in a fall or while picking up her grandson; she feels the pain came on randomly. All of these factors are risks that increase the doctor’s suspicion that Gemma is having angina. The

doctor decides to administer some medications that will decrease the pain in her chest and prevent any further loss of blood flow to the heart. When a person has chest pain, the doctor will often perform an electrocardiogram (ECG) to determine if the electrical rhythms of the heart are normal. This test can usually identify if a patient is having a heart attack. Gemma’s doctor determined that she was having “stable” angina, chest pain occurring only with activity. After administering medications and ruling out a heart attack based on laboratory test and ECG results, he helped her set up a follow-up appointment with her family doctor to run some additional tests on her heart. It is a good thing Gemma went to the emergency room when she had chest pain, because daily medications and regular follow-up will help to protect her from a heart attack! ❦ Angela K. Johnson, UTCOM MS4, The University of Toledo College of Medicine Class of 2012, on behalf of The Academy of Medicine of Toledo and Lucas County.

Medicaid Health Home On October 1, 2012, Harbor expanded services to include Medicaid Health Home services to Medicaid beneficiaries. This new service model is possible because of provisions in the Affordable Care Act enacted March 23, 2010. The Affordable Care Act gives States the option to provide Health Homes for enrollees with chronic conditions and allows States to elect this option under the Medicaid State Plan. The State of Ohio’s decision to elect this option of service delivery is good for Ohio citizens with Medicaid. The Health Home service model focuses on person centered care integration that achieves improved services Gwen jones and outcomes for beneficiaries. Phase 1 of the State’s Vice President, Quality Improvement Health Home roll-out plan includes Lucas, Butler, Adams, Scioto and Lawrence Counties. Harbor is pleased and Harbor very excited to be part of Phase 1 and to offer Medicaid beneficiaries this expanded service. What does it all mean for Medicaid beneficiaries: Medicaid beneficiaries who are receiving behavioral health services or who may need behavioral health services in the future will have the option to participate in Harbor’s Medicaid Health Home. If they choose to participate, they will be assigned to a Health Home Team. The Health Home Team consists of a team leader, embedded primary care clinician, care manager and a qualified health home specialist. The Health Home team will provide client centered services to the client based on assessed care needs. The team will ensure care integration using a holistic approach that includes physical health care, behavioral health care, as well as social service needs like housing, transportation, employment readiness, etc. Statistics show that 68% of people with a mental health disorder have co-existing medical problems. Using this model, if a client has high blood pressure, high cholesterol, cardiovascular disease, asthma, dental care needs, housing needs, transportation needs, etc., the team will focus on all these areas to provide the best service to the “whole” person. The HH team will coordinate care by involving family members and other supports identified by the client, communicating with other health care providers and service organizations and transporting the client or arranging transportation as needed. The Medicaid Health Home service model is very beneficial to Ohio Medicaid beneficiaries. To learn more about Medicaid Health Home Services please contact: Lori Laidlaw at 419-475-4449 ext. 1224.

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done to them, to say no until we are better informed. This does not just apply to surgical procedures, where consent forms are often being shoved in your face with no expectation that you’ll actually read or understand it all, and with the hope that you don’t know that the physician alone is legally bound to fulfill his duty to fully inform you, including about all Just say no to “medically acceptable” alternatives. We must be just as firmly in control uninformed consent during a regular healthcare provider’s appointment, where nobody is askby Norene Massey ing you to sign a consent form, but Nungester where they still give you prescriptions (for new drugs the pharmacy rep left magine your neck is unstable from samples of without full information) an old injury. You have headaches or give you injections (often of corand neck pain and have to visit the tisone with all its known problems) chiropractor constantly. After years of with little or no explanation, even suffering and seeking answers, you though the risks of either may far end up in a neurological surgeon’s outweigh the benefit. office, where they are “informing” Thankfully, in addition to patient you that you need to have screws and advocates and patients themselves pins inserted into your cervical spine becoming more vocal about the legal because that is the only “alternative” doctrine of informed consent, docand they want you to “consent” to tors are jumping on the bandwagon, the surgery. even as it exposes the dark underbelly You flash back to overhearing your of financial gain which vet tech say she had her often drives “uniformed neck fused and could feel consent.” One such docthe screws poke into her tor is Jerome Groopman, throat for years, but “it author of How Doctor’s wasn’t so bad, I finally got Think. He specifically used to it”; and to your cites spinal surgeons neighbor, who thought who stick their fingers they had told her she in their ears when asked would be able to feel to consider less-invasive her fingers again after surgeries because “fusurgery, but she can’t sion surgery is a main and “they never did.” source of their income What do you do? Use Norene Massey Nungester and they are convinced what is left of your backof its value.” Groopman bone to tell your doctor holds out as a good example Dr. James that you will respond at a later date Weinstein, who prefers the term once you have exhausted all avenues “informed choice—a comprehensive to become truly informed, not only understanding of all the options and about the drawbacks of the surgery, their possible risks and benefits.” but possibly more important, the So, what happened to the neck alternatives (which are out there, patient? She did incredible amounts of though your surgeon may honestly research and said “yes” to prolotherapy not be aware of them). and “no” to surgery. Prolotherapy is a Informed consent is defined by treatment of injections given into loose Psychology.about.com as “a legal or damaged ligaments and tendons procedure to ensure that a patient, that heals them permanently (for at client, and research participants are least 80% of patients). Ever hear of aware of all the potential risks and costs prolotherapy? Neither did any of the involved in a treatment or procedure. neurosurgeons. How can they offer it The elements of informed consent as an alternative if they’ve never heard include informing the client of the of it? They can’t! It is up to you to quesnature of the treatment, possible altertion everything and inform yourself, native treatments, and the potential alone or with the help of an advocate, risks and benefits of the treatment. if the doctor is unable or unwilling to In order for informed consent to be inform you. It is an absolute legal right considered valid, the client must be that will save you from unwanted, competent and the consent should unnecessary, dangerous surgeries, be given voluntarily.” drugs, and treatments. ❦ We, as patients, must know and

exert our rights to be autonomous, to control our own bodies and what is 48 January 2013 / Healthy Living News

Norene Massey Nungester is a medical

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layperson and researcher and a student in the University of Toledo patient advocacy certificate program. She is the daughter of a skilled diagnostician MD father and nutritionist RN mother. She has worked in hospital ER’s and ICU’s as a unit secretary. She had a serious diving injury at the age of 16 and has spent her entire life working towards healing. She spent the past four years in and out of many different doctors’ offices, including

two different neurosurgeons who wished to fuse her neck. She did exhaustive research and discovered prolotherapy, a very “medically acceptable alternative” to surgery, and has successfully overcome her neck injury without surgery. She is a member of OSHCA, the Ohio Society for Healthcare Consumer Advocacy (OSHCA), Alliance of Professional Health Advocates (APHA), and Disruptive Women in Healthcare.

Providing sustenance for winter-weary birds

ld Man Winter’s arrival is good news for skiers, sledders, snowmobilers, and children hoping for s n o w days to liberate them from school, but it’s not such good news for the local bird population. Birds must hunt harder and fly farther to fulfill their nutritional needs during the winter months. When the landscape is buried beneath a blanket of snow and ice, foraging becomes even more of a challenge. Why not ease their burden by creating a bird-feeding sanctuary in your own back yard? Given time and a predictable food source, strikingly colorful cardinals, blue jays, and goldfinches will hone in on your feeder and make it a regular stop on their foraging rounds. Granted, the goldfinches will be sporting their somber winter coloration at this time of year, but they’re real “show stoppers” in the summer months. Eventually, you’ll also be blessed by regular visits from such feathered songsters as the blackcapped chickadee, white-breasted nuthatch, and tufted titmouse.

Which seeds should you feed? The easiest way to feed a varied assortment of birds is to buy the inexpensive seed blends sold in large sacks at any feed store. However, most of the birds will pick through the mix to get to the tastier tidbits, casting aside the cracked corn and millet that usually make up a significant percentage of these mixes. Black oilers are small, easy to crack, and seem to satisfy the pallet of almost all seed-eating birds. The harderto-crack striper sunflower seeds are popular with larger birds like blue jays. Safflower is a favorite of our state bird, the cardinal. Finches are especially fond of thistle and will painstakingly pick it out from the rest of the seeds and grains in the mix.

Don’t spare the suet! Woodpeckers—e.g., the local downy, hairy, and red-bellied varieties—are among the more welcome visitors to bird feeding stations. But they generally can’t be plied with mere birdseed. Woodpeckers are primarily insectivores and require a source of oil and fat. This can be provided by setting out a suet feeder—commonly available in the form of a rectangular, plastic-coated wire basket designed to hold a block of preformed suet. You can buy the suet cakes, either plain or impregnated with food items, such as seeds, peanuts, or fruit, at any feed store. Suet has a very high caloric content, which helps maintain birds’ high metabolism and helps to keep them warm.

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Other necessities of life A successful bird-feeding sanctuary should provide more than just seed and suet. Fresh water and shelter are equally important. If these needs are ignored, birds might just pass your feeder by in search of more favorable accommodations. Providing water is easy enough. Put out a birdbath or any shallow vessel capable of withstanding the temperature extremes of our local winters, and place a thermostatically controlled birdbath heater in it to prevent the water from freezing.

Feed predictably Once you make the commitment to feed the birds, don’t fall into the habit of on-again-off-again feeding. It can be very stressful for birds to make the effort to reach your feeding station, which they’ve learned to associate with sustenance, only to discover that the feeder is empty and the birdbath is dry. If you fill the feeder whenever it starts to get low and make sure the water is clean, fresh, and unfrozen, your feathered friends will reward you with their beauty and song all year long. ❦

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